LCC50 LONDON COUNTY COUNCIL Interim Report of the County Medical Officer of Health and School Medical Officer for the year 1944 Published by the LONDON COUNTY COUNCIL And may be purchased, either directly or through any bookseller, from P. S. KING AND STAPLES, Limited 14, Great Smith Street, Victoria Street, Westminster, S.W.I Agents for the sale of the publications of the London County Council 1945 No. 3556. Price 1/6. Post free 1/8. London County Council INTERIM REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1944 By Sir Allen Daley, M.D., F.R.C.P., County Medical Officer of Health, and School Medical Officer INTRODUCTION Nineteen-hundred and forty-four was a trying year for Londoners. The lull in air raids was broken in January and the attack was intensified in June by the flying bomb bombardment, followed in September by that of the rocket shell. Many lost their lives, or were injured, and there was great destruction of homes and property. As the attack developed, steps were taken to evacuate mothers and children and hospital patients to safer localities. On pages 14-19 are tables of air-raid casualties in the County for each year of the war, which clearly show the intensity of the 1944 attack. The total number of civilian war deaths for the period of the war was 17,811. In spite of the ordeal caused by V1 and V2, and the continued strain of war, the general health of Londoners, on the whole, remained satisfactory. Now the European war is ended, and the Registrar-General has released population statistics for publication, it is possible, for the first time since 1939, to quote birth and death rates. Tables showing the trend of vital statistics in the County of London in five-yearly periods since 1891, and for each of the war years are given on pages 9 and 10 of this report. As a result of the war, the population of the County of London has, according to the Registrar-General's estimates, decreased from 4,062,800 in 1938 to 2,462,500 in 1944, i.e., by about 40 per cent. Marriages commenced to increase after the outbreak of war, reaching a maximum in 1941 ; during 1938 the marriage rate was 21.9 per 1,000, while in 1941 it rose to 30.2 ; during the year 1944 it was 21.5, compared with 21.7 in 1943. Birth and death rates were higher in 1944 than in 1943, being per 1,000 population 18.1 and 16.7, respectively, compared with 18.0 and 15.7 in 1943. The birth-rate has generally increased during the war. Since 1942 there seems to have been an increase in fertility or decrease in the practice of birth control; for the births are at present increasing on a falling marriage rate. Illegitimate births continued to increase as in previous war years, the rate per cent. of total live births being 9.3 compared with 8.2 in the previous year. The increase in the deaths since the previous year can mainly be ascribed to air-raid casualties as a result of enemy action during 1944. The infant mortality rate was 51 per 1,000 live births, the same as in 1943. Deaths in the first four weeks of life gave a neo-natal mortality rate of 23.1 per 1,000 live births compared with 23.4 in 1943. The maternal mortality rate is still decreasing, having reached in 1944 the record figure of 1.70 per 1,000 five births, compared with 2.13 in 1943 and 2 .51 in 1942. The death-rate from cancer was 2.35, compared with 2.46 in 1943 and 1.79 in 1938. This is the first occasion that there has been a decline in cancer mortality since records have been published by the Registrar-General. The total incidence of infectious diseases has fallen during the past year, but dysentery still continues to increase, the cases and deaths being 1,558 and 20, respectively, compared with 1,103 and 14 in 1943. Whooping-cough has also increased, with 7,144 notifications 700 (m°c 81019) 3-12-45 2615 (1) 2 and 116 deaths, compared with 6,661 and 84, respectively, in 1943. There were two cases of smallpox. The cerebro-spinal fever case rate has declined from .27 in the peak year 1940 to .08 in 1944, the deaths being 151 and 43, respectively. Diphtheria has also declined since 1941, when the case-rate was .92, to .46 in 1944; in 1938 the case-rate was 1.88. The death-rate was .02 in 1944, compared with .04 in 1941 and .05 in 1938. Enteric fever has decreased still further during the past year. The diarrhoea and enteritis death-rate per 1,000 live births for children under two has dropped from 9.9 to 9.6. Mortality from this disease of infancy was gradually falling prior to the outbreak of war, reaching the low level of 6.1 in 1940, since when it had been increasing. Scarlet fever, which decreased in incidence from 2.00 in 1938 to .81 in 1940, when it began to increase, has now fallen from 3.80 in 1943 to 1.69 in 1944. The case-rate of measles has also decreased from 9.18 to 3.05. The case-rate in 1942 was 8.33. The incidence of tuberculosis shows a decline since the previous year, the pulmonary tuberculosis death-rate being .84, compared with .88 in 1943, the notifications (all forms) being 5,729 and 5,848, respectively. There has been no return of the threatened influenza outbreak of 1943, which gave some anxiety in the last two months of that year; the incidence of pneumonia and of other lung diseases, including bronchitis, is also lower, doubtless due to the mild and dry weather experienced at the beginning and end of the year. In view of the interest shown, both in this country and in America, in the comparison, included in last year's report, of the rates of infantile mortality in New York City and in London, a section has, this year, been devoted to the relative vital statistics at all ages. The number of new cases of venereal disease attending the clinics has declined, but it must not be assumed that the real incidence of these diseases is diminishing for they still are a serious menace to the public health. No fewer than 1,344 notifications under Defence Regulation 33B were received. The apparatus for mass miniature radiography took an X-ray picture of the chests of 46,671 persons, and as a result 111 were referred for sanatorium treatment. These are people with good prospects of recovery who, in the absence of this scheme, would probably not have come under treatment until the disease was much more advanced and the prospects of recovery more remote. The domiciliary midwifery service maintained, in spite of difficulty and danger, the high traditions which it already possesses. The scheme for the evacuation of mothers for their confinements worked smoothly, but very many preferred to stay in London. The chemical branch had many new problems to solve and undertook research and investigational work of a high order. It is now possible to disclose in some detail the epic story of what occurred in the L.C.C. hospitals during the war years. No L.C.C. hospital in London or its vicinity escaped damage and, in all, the "incidents," to use the technical word of understatement, numbered 660. Many hospitals became untenable and the patients had to be transferred elsewhere. Buildings containing 5,007 beds were destroyed and not infrequently the returns of bed states showed that in addition 6,000 to 7,000 beds were temporarily out of action. All worked with a will, despite continued bombing, to restore any hospital buildings which could be got back into use and at no time had urgent cases to be refused admission. No matter what happened, staff of all grades were undaunted and showed an example of unquenchable spirit, high morale and devotion to their task of tending the sick and injured, the memory of which will never leave those who were responsible for ensuring that the service did not fail. A word must also be said about the patients, whose fortitude, and even defiance of the terror from the air, was remarkable. Admissions to the Council's hospitals during the year numbered 215,791. At the end of the year there were 43,150 patients under treatment (7,999 in general, 30,372 in mental and 4,779 in other special hospitals). 3 In the middle of the year damage to hospitals was becoming increasingly serious and the threat of rocket bombs was looming ahead. The Government therefore decided to evacuate a large number of patients out of the danger zone. Within a fortnight after the decision was taken, 6,500 patients were sent from L.C.C. hospitals, in hospital trains provided by the Government, to other parts of the country. Scotland and Wales, the Midlands, the North and the West were the main receiving areas and a very warm tribute must be paid to the hospital authorities and their staffs and the people of the neighbourhood for the welcome which they gave to these unfortunate people, mostly chronic sick and the tuberculous, uprooted from their surroundings and parted from their relations and friends, tired after weeks, or even months of almost sleepless nights, and anxious about the fate of those whom they had left behind. The opening, at very short notice, and the administration by the Council of four hospitals situated between 200 and 400 miles from London was a difficult and anxious task, which was only possible by the close co-operation of many departments of the Council. Most, however, of the evacuated patients were in hospitals administered by the authorities of the areas concerned, sometimes as large units staffed mainly by the London County Council and the outer London authorities, but generally just in one or two wards. Despite the upheaval caused by the bombing and the evacuation, a highly successful medical society was formed by the L.C.C. staff during the year. The work of the department was increasingly handicapped by shortage of staff of all grades, both centrally and at the hospitals. The ambulance service was called upon to endure yet another arduous year and it did so without flinching. The School Medical Service carried out its normal functions and, in addition, was responsible for the pre-evacuation inspection of 118,044 children. There was no recurrence of the complaints about the condition of the children which were received in 1939. On the contrary, many letters referred to the surprisingly good health and cleanliness of the children, especially in view of the state of London and the shelter life which then prevailed. There were 96,229 routine inspections of children in London schools. Nutrition was better than in 1938, a great tribute to the work of the Ministry of Food. Possibly associated with the better nutrition, there was an improvement in the dental condition, though there is still much to be done before the children's teeth can be regarded as satisfactory. The report of the Mental Health Services shows a further decline, from 30,812 to 30,372 of mental patients under institutional care. Several of the hospitals were damaged by bombs, and by reason of this and the use of accommodation for Emergency Hospital Service purposes, overcrowding continues. The farming operations were increased and now extend over 6,559 acres. It is a great pleasure to be able to record that during 1944 the British Empire Medal was awarded for gallantry to Miss W. A. Redgwell, telephone operator at St. Mary Abbots Hospital, and to Miss M. E. McCrossam, student nurse, Mr. L. L. G. Townsend, general porter, Mr. H. C. Allchorne, dispensary porter, and Mr. V. G. Grout, porter, all at Lewisham Hospital. VITAL STATISTICS The Registrar-General estimates the civilian population of the county in the Population middle of 1944 to have been 2,462,500, compared with 2,500,600 a year earlier. The corresponding estimates for metropolitan boroughs are shown in the table on page 9, and the rates given in this annual report are calculated upon these figures. The marriages registered in London during 1944 numbered approximately Marriages 26,450 or 21.5 per thousand of the population, the provisional rate for the preceding year being 21.7. B 4 Births The live births allocated to London during 1944 numbered 44,554 compared with 45,030 in the preceding year. The live.birth rate was 18.1 per thousand, the rate for 1943 being 18.0. Deaths The deaths in the civil population of London during 1944 numbered 41,077, giving a death.rate of 16.7 per thousand, compared with 15.7 in 1943. Of the total deaths, 19,643, or 47.8 per cent., were among females. Street accidents There were 268 deaths from street accidents. A comparison of the age distribution of deaths from this cause in each of the last six years is given in the following table:— Year (a) Age group 0.5 5.15 15.4 5 45.65 65 + All ages 1939 14 49 128 134 194 519 1940 24 32 144 144 199 543 1941 11 28 77 116 141 373 1942 14 32 66 75 99 286 1943 9 28 47 66 79 229 1944 13 41 49 62 103 268 (a) 1939 = 52 weeks. 1940.1944 = calendar years. The death.rates from all causes and from certain specified causes in each metropolitan borough in 1944 and in London as a whole in 1944 and preceding years will be found in the tables on pages 9 and 10. Infant mortality The deaths under one year of age per thousand live births were 51, as in the preceding year. The movements of the death.rates from the principal diseases at ages below one year since 1910 are shown in the following table:— Cause of death 1911 to 1914 1915 to 1918 1919 to 1922 1923 to 1926 1927 to 1930 1931 to 1934 1935 to 1938 1939 to 1942 1942 1943 1944 Measles 3.40 3.84 1.64 2.02 2.07 1.44 0.95 0.21 0.20 0.51 0.09 Whooping.cough 3.63 4.45 2.50 2.60 3.14 2.27 2.01 1.33 1.48 115 2.13 Influenza 0.27 M0 0.81 0.38 0.48 0.40 0.24 0.36 0.30 0.44 0.27 Tuberculosis 3.40 3.20 1.52 1.26 0.89 0.77 0.56 0.59 0.52 0.53 0.22 Bronchitis 6.41 6.72 4.42 2.91 2.30 2.16 1.97 1.69 2.19 1.67 1.39 Pneumonia 12.28 14.96 12.60 11.51 12.10 11.45 10.39 7.13 7.43 8.04 7.45 Diarrhoea 24.28 16.10 12.16 9.36 8.87 10.86 12.10 6.49 7.67 9.44 9.02 Premature birth 1816 17.42 17.00 14.74 14.17 14.91 13.41 11.67 13.50 11.66 12.03 Congenitaldefects 14.69 14.66 11.26 8.39 7.38 7.22 6.35 9.41 11.54 11.44 10.10 Other causes 21.48 20.55 15.09 11.83 12.60 13.52 12.30 7.59 5.24 5.84 7.79 All causes 108 103 79 65 64 65 60 46 50 51 51 Infectious diseases The attack.rates and death.rates of the principal infectious diseases in London during 1944 and earlier years and for the constituent metropolitan boroughs in 1944 are shown in the table on page 9. Anthrax No case of anthrax was notified during the year. Measles During 1944, 7,499 cases of measles were notified, compared with 22,882 in 1943, the attack.rate being 3.05 per thousand against 9.18 in 1943. The deaths numbered 7, giving a death.rate of .00 per thousand and a case.mortality of .1 per cent. The rates for 1943 were .0.2 and .0 respectively. The death-rates in London and England and Wales in recent years are shown in the following table:— 5  Area 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 London England & Wales 0.02 0.20 0.00 0.14 0.01 0.06 0.00 0.01 0.02 0.01 0. 02 0.00 0.05 0.09 0.03 0.07 0.03 0.04 0.01 0.02 0.03 0.01 0.02 0.01 Whooping. cough During 1944, 7,144 cases of whooping.cough were notified, compared with 6,661 in 1943, the attack.rate being 2.91 per thousand against 2.67 in 1943. The deaths numbered 116, giving a death.rate of .05 per thousand and a case.mortality of 1 .6 per cent. The rates for 1943 were .03 and 1 .3 respectively. The death.rates in London and England and Wales in recent years are shown in the following table:— Area 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 ###] London England & Wales 0.07 0.07 0.04 0.07 0.06 0.03 0.04 0.00 0.05 0.04 0.03 0.05 0.06 0.05 0.04 0.05 0.04 0.03 0.03 0.02 0.06 0.02 0.03 0.03 Scarlet fever There were 4,153 notifications ot scarlet lever in 1944, the corresponding figure for 1943 being 9,477. The attack.rate was 1.7 per thousand, compared with 3.8 for 1943. The deaths numbered 7, giving a death.rate of 00 per thousand of the nonulation at all ages and a case.mortalitv of .2 ner cent. Oiphtheriu Notifications ol diphtheria numbered 1,126 in 1944, compared with 1,862 n 1943. This gives an attack.rate of .46 per thousand, compared with .75 for thi preceding year. There were 38 deaths, giving a death.rate of .02 per thousanc ivinff. The case.mortalitv was 3.4 tier cent., compared with 31 per cent. in 1943 The death.rates in London and England and Wales in recent years are shown in the following table:— Area 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 London England & Wales 0.08 0.11 0.06 0.05 0.05 0.05 0.03 0.02 0.04 0.02 0.02 0.02 0.07 0.10 0.09 0.08 0.07 0.07 0.05 0.06 0.07 0.05 0.04 002 Diarrhoea and enteritis Diarrhoea and enteritis caused 427 deaths among children under two years oi age, or 9.58 per thousand live births. The corresponding rate in 1943 was 9.86. The death.rates per thousand live births in London and England and Wales in recent years are shown in the following table:— Area 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 London England & Wales 11.74 12.80 11.31 14.47 12.29 13.23 8.36 6.13 6.30 7.97 9.86 9.58 6.98 5.36 5.56 5.75 5.54 5.30 4.67 4.76 5.08 5.22 5.15 4.97 Puerperal lever and pyrexia : maternal mortality The persistently heavy death.rate in London from this condition is disquieting and research is being undertaken as to the reasons therefor. There were 172 notifications of puerperal fever and 387 notifications of puerperal pyrexia in 1944, compared with 147 and 471 respectively in 1943. The deaths from puerperal fever numbered 34 and from other puerperal causes 42, the deaths per thousand live births being .76 and .94 respectively, giving a total maternal mortality rate of 1.70, compared with 2.13 in 1943. B l The deaths from puerperal fever and other puerperal causes per thousand live births in each metropolitan borough and in the county of London in the periods 1931 to 1940 and 1941 to 1944, together with the deaths in childbirth in 1944 are shown in the following table:— 6 interference deaths Hu° to abortion excePc those legally determined to have resulted from criminal  Metropolitan boroughs arranged m topographical order Childbirth deaths* per 1,000 live.births Number of deaths in childbirth 1944 1931.40 1941.44 Puerperal fever Other causes Total Puerperal fever Other causes Total Puerperal fever Other causes Total Western Paddington 1.9 2.2 4.1 1.2 1.1 2.3 1 1 2 Kensington 1.5 1.6 3.1 0.8 1.2 2.0 - 1 1 Hammersmith 1.0 1.2 2.2 0.8 0.9 1.7 1 1 2 Fulham 1.1 1.6 2.7 1.1 1.1 2.2 - 2 2 Chelsea 1.5 1.8 3.3 1.4 1.4 2.8 1 - 1 Westminster 2.0 1.4 3.4 2.9 1.1 4.0 1 — 1 Northern St. Marylebone 1.5 2.1 3.6 1.2 2.0 3.2 1 3 4 Hampstead 0.8 1.4 2.2 0.3 2.1 2.4 - 1 1 St. Pancras 1.4 1.7 3.1 1.2 1.6 2.8 2 4 6 Islington 1.2 1.5 2.7 1.0 1.5 2.5 3 5 8 Stoke Newington 0.6 2.9 3.5 1.3 1.7 3.0 - 2 2 Hackney 0.9 1.4 2.3 0.4 0.8 1.2 1 — 1 Central Holborn 2.1 1.4 3.5 3.7 3.7 - - Finsbury 0.8 0.7 1.6 1.2 1.8 3.0 1 1 City of London 3.3 3.3 — — — - - - Eastern Shorediteh 0.8 1.4 2.2 2.0 0.8 2.8 1 1 2 Bethnal Green 1.1 1.0 2.1 0.9 0.6 1.5 1 - 1 Stepney 0.9 1.7 2.6 0.6 1.7 2.3 - - - Poplar 1.4 1.1 2.5 1.8 1.5 3.3 1 3 4 Southern Southwark 0.9 1.7 2.6 1.1 0.9 2.0 1 - 1 Bermondsey 1.3 1.5 2.8 1.6 1.9 3.5 3 2 5 Lambeth 1.0 1.1 2.1 1.2 1.1 2.3 5 4 9 Battersea 1.2 1.5 2.7 0.9 0.2 1.1 2 - 2 Wandsworth 1.6 1.4 2.9 1.1 1.4 2.5 4 4 8 Camberwell 1.2 1.5 2.7 1.3 1.4 2.7 2 2 4 Deptford 1.1 1.3 2.4 1.3 0.8 2.1 1 - 1 Greenwich 1.2 1.5 2.7 0.2 0.5 0.7 . 1 1 Lewisliam 1.1 1.6 2.7 1.0 1.5 2.5 1 2 3 Woolwich 0.8 1.1 1.9 0.3 1.4 1.7 1 2 3 London 1.2 1.6 2.7 1.0 1.2 2.2 34 42 76 The deaths in childbirth in 1944 are shown in the above table but not the death. rates, as, owing to the smallness of the figures, the rates for a single year in any metropolitan borough may be misleading. The maternal mortality rates for each metropolitan borough in 1944 and for London as a whole annually since 1938 are, however, set out in the table on page 9. The death.rates per 1,000 live births in London and England and Wales in recent years are shown in the following table:— 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944[/##] Puerperal fever— London 1.09 1.34 1.15 0.75 0.84 0.79 0.05 0.98 1.47 1.13 0.95 0.70 England and Wales 1.83 2 03 1.08 1.39 0.98 0.89 0.77 0.82 0.85 0.80 0.75 0.62 Utner causes— London 1.97 1.46 1.43 1.23 1.45 1.12 1 .32 1.00 1.58 1.38 1.18 0.94 England and Wales 2.68 2.57 2.42 2.41 2.28 2.19 2.16 1.88 2 01 1.70 1.00 1.38 7 It must be borne in mind that the puerperal fever death-rates include a substantial number of deaths from post-abortion sepsis. Smallpox Two cases of smallpox were notified in London during the year. They were contacts of a patient in Middlesex and, by arrangement with the Surrey County Council, were admitted to their Clandon Hospital as this Council's smallpox receiving stations had been destroyed by enemy action and it was not considered desirable to open the Long Reach Hospital for the small number of patients involved in this outbreak. Scabies Scabies first became notifiable on 1st August, 1943, and in the twenty-two weeks from that date, 9,689 cases were reported. During 1944, 16,450 cases were notified. Enteric fevers There were 38 notifications of fevers of the enteric group in London in 1944 compared with 47 in 1943. The deaths numbered 4 as against 10 in 1943. The mortality from enteric fever has thus been maintained at the low level to which it has been reduced during the present century. Influenza The deaths from influenza during 1944 numbered 206 compared with 726 in 1943. Rheumatic fever The deaths in London from rheumatic fever in 1944 numbered 46, of which 14 were among children under 15 years of age. The corresponding figures in 1943 were 36 and 16 respectively. Cancer There were 5,783 deaths from cancer in 1944 as against 6,155 in 1943. The death-rate per thousand was 2.35. There was a decrease of 168 in the deaths among males and of 204 among females compared with the previous year. Tuberculosis The deaths from pulmonary tuberculosis in London during 1944 numbered 2,073, giving a death-rate of .84 per thousand living, the corresponding figures for 1943 being 2,204 and .88 respectively, and 2,164 and .90 for 1942. There were 237 deaths from other forms of tuberculosis in 1944 as against 256 in 1943 and 283 in 1942, the death rates being .10, .10 and .12 respectively. In England and Wales as a whole the corresponding death-rates for pulmonary and non-pulmonary tuberculosis, respectively, were .52 and .10 for 1944, .56 and .11 for 1943 and .54 and .12 for 1942. The number of primary notifications in metropolitan boroughs during the year 1944, after correction of figures within each metropolitan borough by the exclusion of cases notified as primary, but subsequently found to have been previously notified, was R 799 t.Vip rnrrpsnnnrlinc fipnire for 1943 Vioinc 5.848. The following is an analysis of the notifications in London during the year 1944:— Form of tuberculosis notified Sex Number of formal primary notifications of new cases of tuberculosis Total all ages Total notifica tions 1- 5- 10- j 15- 20- i 25- 35- > 45- : 55- 65 + Pulmonary tuberculosis M. 8 65 78 59 322 365 551 505 415 420 181 2,969 3,555 F. 3 59 54 52 333 508 550 272 114 89 53 2,087 2,545 Other forms of tuberculosis M. 4 44 61 40 36 40 45 32 8 15 5 330 380 F. 2 39 42 37 48 42 54 36 17 17 9 343 403 All forms of tuberculosis M. 12 109 139 99 358 405 596 537 423 435 186 3,299 3,935 F. 5 98 96 89 381 550 604 308 131 106 62 2,430 2,948 In addition to the primary cases shown in the above table, a number of cases came to the knowledge of medical officers of health otherwise than by notification. These figures include cases not notified until after death:— The sources of information as to the unnotified cases shown in the above table were as follows:— Source of information Number of cases Pulmonary Non-pulmonary Death returns f from local registrars 85 19 I transferable deaths from Registrar-General 166 45 Posthumous notifications 60 19 " Transfers " from other areas 724 94 Other sources 41 5 The following statement shows the numbers on the registers, for the whole county, during 1939 and subsequent years Cases on the register at the end of the year— 1939 1940 1941 1942 1943 1944 Pulmonary— Males 13,221 12,908 12,677 12,894 13,608 14,340 Females 9,820 9,448 9,119 9,441 10,232 10,990 Other forms— Males 3,402 3,263 2,916 2,785 2,847 2,866 Females 3,335 3,263 3,044 2,963 3,074 3,185 Total 29,778 28,882 27,756 28,083 29,761 31,381 No. per 1,000 of population 7.9 9.4 11.9 11.7 11.9 12.7 8  Form of tuberculosis Sex New cases of tuberculosis coming to knowledge otherwise than by formal notification 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65 + Total Pulmonary tuberculosis M 91 8 8 3 30 75 151 102 81 73 75 608 F. 3 9 10 13 39 112 138 71 30 21 22 468 Other forms of tuberculosis M. — 13 10 6 9 7 12 14 6 7 4 88 F. 1 14 11 7 14 15 20 4 3 — 5 94 All forms of tuberculosis M. 2 21 18 9 39 82 163 116 87 80 79 696 F. 4 23 21 20 53 127 158 75 33 21 27 562 9 Vital statistics for the metropolitan boroughs and the County of London in the year 1944 (Rates per 1,000 of population) Metropolitan boroughs arranged in topographical order Estimated civilian population, 1944 Live births Deaths Infant mortality (per 1,000 live births) Measles Scarlet fever Diphtheria Whooping cough Ty* phoid . fever diarrhoea and enteriti s age 0.2 (per 1,000 (live births) Pulmonary tuberculosis Pneumonia Other resp. dis. Cancer Maternal mortality (per 1,000 live births) Notifications of infectious disease (52 weeks) Scarlet fever Diphtheria Typhoid fever Erysipelas Cerebro spinal fever Acute pneumonia Measles Whooping cough Western Paddington 93,030 17.6 14.9 61 - - .02 .03 - 14.6 .82 1.20 .81 2.26 1.22 1.46 .53 - .34 .08 .63 1.86 1.70 Kensington 107,610 16.5 16.1 52 - — — .06 — 9.6 .68 .87 1.07 2.44 .56 0.77 .38 .04 .14 .06 .86 .92 1.76 Hammersmith 89,190 20.0 15.9 53 - — .03 .06 .01 9.5 .94 .99 1.15 2.24 1.12 1.56 .35 — .34 .11 .29 .80 1.75 Fulham 95,090 18.5 16.6 43 - — — .05 — 7.9 .79 .83 1. 04 2.21 1.14 2.53 .30 .01 .53 .12 .79 2.33 2.24 Chelsea 30,990 13.4 18.5 50 - — — — — 14.4 .97 .97 1.10 2.29 2.40 1.16 .52 — .45 .16 .71 2.43 1.71 Westminster, City of Northern 64,170 12.4 17.2 66 - - .02 - - 13.9 .79 1.08 .98 2.74 1.26 0.52 .39 .05 .23 .06 .13 .58 .64 St. Marylebone 54,550 14.0 15.3 47 - — — .02 — 10.5 .59 .86 .75 2.57 5.24 1.14 .22 — .33 .07 .68 1.07 1.67 Hampstead 69,840 16.1 14.6 62 - — .01 — 6.2 .67 .60 .82 2. 42 .89 1.12 .30 .06 .22 .06 .90 2.63 1.19 St. Pancras 105,780 18.1 18.9 64 - — .02 .06 .01 11.5 1.09 1.30 1.64 2.78 3.13 1 .73 .55 .01 .54 .09 115 7.53 5.44 Islington 188,560 20.3 16.2 48 .02 .01 .01 .10 — 9.1 .86 .95 1.36 2.20 2 .09 1.67 .50 .02 .43 .08 .65 3.33 4.32 Stoke Newington 35,240 20.6 14.5 34 .11 .03 4.1 .54 .60 1.19 2.41 2.75 0.80 .11 — .20 .03 .46 3.30 316 Hackney 135,540 19.1 14.4 49 — .01 .01 .05 .01 10.8 .68 .69 1.28 2.17 .39 1.83 .66 .01 .33 .05 .56 2.23 4.00 Central Holborn 18,020 11.5 16.8 53 - - - - - 14.5 .67 1.17 1.11 2.77 — 1.17 .22 .06 .45 — .78 1.89 1.73 Finsbury 26,740 16.0 19.9 47 — — — .04 — 11.7 1.42 1.50 1.83 2.39 2.34 2.32 .67 — .56 — .94 6.07 5.66 City of Lndn. (a) 4,270 8.4 16.4 56 — — — — — — .70 .70 1.64 2.81 — — .23 — — — .23 .94 .70 Eastern Shoreditch 35,390 18.7 16.5 36 - - - .06 - 9.0 .76 .62 1.33 2.77 3.02 2.58 .85 .06 .31 .17 .71 2.86 5.87 Bethnal Green 48,280 17.8 18.0 72 .08 15.1 .77 .99 1.47 2.46 1.16 1.58 .71 .02 .39 .06 .75 3.59 3.84 Stepney 73,030 17.9 19.5 59 .01 .01 .08 6.1 1.18 1.04 1.71 2.53 1.36 .66 — .43 .10 .89 2.76 3.41 Poplar 54,030 20.7 16.5 41 — - — .06 — 5.4 1.24 .64 1.09 2.33 3.57 1.65 .32 — .46 .09 1.95 3.62 3.45 Southern South wark 67,220 19.4 21.7 51 .01 — .01 .07 — 8.4 1.65 11.2 1 .61 3.09 .77 2.79 .60 .01 .45 .12 1.12 2.52 3.57 Bermondsey 44,800 18.9 18.1 66 .02 — .04 — 17.7 1.00 .87 1.29 2.46 5.91 2.44 .67 — .38 .16 2.24 7.70 5.06 Lambeth 162,960 18.5 17.6 57 — — .02 .01 — 11.0 .76 .94 1.31 2.33 2.99 2.15 .31 .02 .34 .06 .61 2.71 2.16 Battersea 85,380 19.0 17.7 50 — — .02 .06 — 11.7 .91 .95 1.48 2.53 1 .23 1.90 .58 .02 .43 .09 1.67 2.43 4.83 Wandsworth 251,510 17.0 16.2 41 — .01 .00 .03 — 5.6 .72 .67 1.14 2.35 1.86 1.63 .27 .01 .38 .08 .85 1.71 2.93 Camberwell 129,880 18.9 18.7 52 — — .02 .07 — 13.8 .74 .86 1.42 2.38 1.62 1.52 .39 .02 .33 .11 .63 2.32 2.42 Deptford 55,310 18.8 19.6 57 .02 — .13 .05 — 11.5 .89 .96 1.16 2.02 .96 2.25 1.36 — .42 .02 1.92 5.95 2.27 Greenwich 61,800 18.9 15.9 53 - — .11 .02 — 7.7 .68 .89 .99 2.02 .85 2.08 .92 — .24 .11 1.93 5.31 2.48 Lewisham 163,320 18.7 14.8 40 .01 .01 — .06 — 6.6 .79 .67 .80 2.01 .99 1 .62 .22 .01 .42 .06 .68 3.81 1.42 Woolwich 110,970 18.4 14.5 41 — — .01 .01 — 8.3 .82 .58 .74 2.01 1.47 1.90 .42 .02 .45 .07 1.96 6.40 2.95 London,1944 2,462,500 18.1 16.7 51 .00 .00 .02 .05 .00 9.6 .84 .87 1.19 2.35 1.70 1.69 .46 .02 .38 .08 .92 3.05 2.91 London, 1943 2,500,600 18.0 15.7 51 .02 .00 .02 .03 .00 9.9 .88 1.04 1.36. 2.46 2.13 3.80 .75 .02 .42 .09 1.27 9.18 2.67 „ 1942 2,405,000 16.9 15.0 50 .01 .00 .02 .04 .00 8.0 .90 .86 1.20 2.40 2.51 1.84 .76 .03 .43 .14 .94 8.33 2.60 „ 1941 2,327,300 14.6 18.7 57 .02 .00 .04 .05 .01 6.3 1.10 1.08 1.54 2.38 3.05 1.00 .92 .09 .50 .30 106 4.67 3.36 „ 1940 3,084,100 15.0 18.6 48 .01 .00 .02 .00 .00 6.1 .87 1.01 1.83 2.14 1.98 .81 .60 .05 .35 .27 .88 1.78 .22 „ 1939 3,780,700 13.0 12.3 47 .00 .00 .03 .04 .00 8.4 .70 .70 .52 1.85 1.97 1.51 .97 .03 .37 .04 .99 .35 2.79 10 County of London—Principal vital statistics, 1891.1944 Period Annual rate per 1,000 living Annual mortality per 1,000 living Annual mortality per 1,000 live births Live births Marriages Deaths (all causes) Cerebrospinal fever Tuberculosis Diarrhoea and enteritis 0—2 Puerperal fever Other acc. of ch. birth Diphtheria Enteric fever Scarlet fever Smallpox Whooping. cough Measles Influenza Pulmonary Non.pulmonary Pneumonia (all forms) Bronchitis Other resp. diseases Heart disease Cancer Diabetes Infants 0—1 1891.95 30.8 17.3 19.8 (a) 0.53 0.13 0.24 0.02 0.52 0.59 0.41 1.83 0.80 1.45 2.45 0.48 (a) 0.80 0.07 156 23.8 2.15 2.22 1896.1900 29.7 18.4 18.5 (a) 0.45 0.14 0.14 0.00 0.47 0.57 0.27 1.75 0.69 1.32 1.80 0.35 (a) 0.92 0.07 162 41.3 1.70 1.74 1901.05 28.6 17.7 16.4 (a) 0.20 0.08 0.11 0.07 0.36 0.45 0.17 1.58 0.57 1.46 1.41 0.26 1.31 1.01 0.08 139 30.4 1.64 1.52 1906.10 26.5 17.4 14.9 (a) 0.14 0.04 0.10 0.00 0.29 0.42 0.22 1.39 0.48 1.49 1.22 0.22 1.26 1.11 0.10 114 23.8 1.46 1.47 1911.15 24.0 20.0 14.8 0.02 0.13 0.03 0.05 0.00 0.22 0.43 0.16 1.39 0.39 1.33 1.29 0.21 1.54 1.16 0.11 108 28.0 1.40 1.57 1916.20 20.0 20.1 15.1 0.04 0.17 0.02 0.03 0.00 0.20 0.28 1.01 1.43 0.34 1.38 1.30 0.19 1.71 1.28 0.09 92 15.4 1.64 1.72 1921.25 19.9 17.9 12.3 0.01 0.17 0.01 0.04 0.00 0.15 0.17 0.32 1.01 0.19 1.14 0.97 016 1.66 1.38 0.10 71 11.7 1.36 1.63 1926.30 16.2 18.6 12.3 0.02 0.10 0.01 0.02 0.00 0.11 0.16 0.30 0.90 0.14 1.00 0.72 0.16 2.29 1.52 0.12 64 10.2 1.66 1.69 1931.35 13.8 19.5 12.1 0.03 0.08 0.00 0.02 0.00 0.07 0.09 0.26 0.79 0.11 0.85 0.47 0.14 2.99 1.66 0.14 63 11.6 1.50 1.66 1936.40 13.7 25.4 13.4 0.02 0.04 0.00 0.01 — 0.04 0.04 0.19 0.72 0.09 0.83 0.67 0.13 3.67 1.87 0.16 56 10.9 0.80 1.22 1941 14.6 30.2 18.7 0.05 0.04 0.01 0.00 - 0.05 0.02 0.17 1.10 0.15 1.08 1 37 0.18 4.46 2.38 0.13 57 6.3 1.47 1.58 1942 16.9 (b) 27.6 15.0 0.02 0.02 0.00 0.00 — 0.04 0.01 0.08 0.90 0.12 0.86 1.03 0.16 3.86 2.40 0.11 50 8.0 1.13 1.38 1943 18.0 (b) 21.7 15.7 0.02 0.02 0.00 0.00 — 0.03 0.02 0.29 0.88 0.10 1.04 118 0.18 4.02 2.46 Oil 51 9.9 0.95 1.18 1944 18.1 (b) 21.5 (b) 16.7 0.02 0.02 0.00 0.00 — 0.05 0.00 0.08 0.84 0.10 0.87 1.03 0.16 4.05 2.35 0.10 51 9.6 0.76 0.94 11 Comparison of vital statistics of London and New York It is useful to compare the vital statistics of London and New York. This is done in the following table for the years 1942-43-44, and in this connection due regard should be given to the differences of climate. Although London is in a higher latitude, its climate is temperate, while that of New York is subject to extremes of cold in winter and heat in summer. This has a bearing on the differences in morbidity of certain diseases; in the case of infectious diseases differences in periodicity of epidemics between the two cities must also be allowed for. The chief points of interest are :— Population—The population of the City of New York at present is about three times that of the County of London. Birth-rate—The London rate seems at present to be increasing while that of New York has fallen since 1943, the rates for the two cities being 16-9 (London) and 17-4 (New York) in 1942, and 18-1 and 16-0, respectively, in 1944. Death-rate—The death-rate (all causes) for London is about 50 per cent, higher than that for New York, but allowances must be made for air-raid deaths in the former. Infant mortality—That for London is about 70 per cent, above the rate for New York. Maternal mortality—This appears to be about the same for both cities. Infectious diseases—The case mortality of cerebro-spinal fever is increasing at present in London, and decreasing in New York. Diphtheria is on the decrease in both cities; allowing for the difference in population, however, this disease is at present above fifteen times more prevalent in London with a slightly lower case mortality on the average for the three years in question. Poliomyelitis case mortality is greater in London, as is also that of whoopingcough. Accidents—The accident death rate, including street accidents, is about the same in both cities. Appendicitis—The mortality is nearly the same in both. Cancer—In London the cancer mortality is about 40 per cent, higher than that of New York; the rate, however, in London showed a decrease in 1944 on the previous year for the first time since records have been kept, while in New York the mortality was still on the up-grade. Diabetes—The mortality from this disease in London is only 25 per cent, of that in New York. Influenza—As will be seen from the table, the death-rate of this disease is much higher in London. Tuberculosis—The mortality from pulmonary tuberculosis in London is about twice, while that from other forms is between three and four times, that in New York. c 12 Vital Statistics for London and New York City, 1942.1944 London New York City 1942 1943 1944 1942 1943 1944* Estimated mid.year population 2,405,000 2,500,600 2,462,500 7,573,000 7,625,000 7,677,928 Live birth.rate per 1,000 total population. 16.9 † 18.0† 18.l† 17.4 17.6 16.0 All causes death rate per 1,000 total population. 150 15.7 16.7 10.0 10.9 10.3 Infant mortality (0.l)per 1,000 live births. 50 51 51 29 30 31 „ „ (under 1 mth.) „ 25 23 23 21 21 23 Maternal mortality „ 2.5 2.1 1.7 2.3 2.2 1.7 Cerebro spinal fever ... cases 341 231 195 411 1,406 1,136 ,, ,, deaths 46 42 43 84 246 198 „ „ casemort. % 13.5 18.2 22.1 20.4 17.5 17.4 Diphtheria cases 1,813 1,862 1,126 392 274 274 „ deaths 51 58 38 7 16 7 „ case mort. % 2.8 3.1 3.4 1.8 5.8 2.6 Measles cases 19,987 22,882 7,499 2,261 23,627 26,161 „ deaths 31 50 7 1 19 21 „ case mort. % 0.2 0.2 0.1 0.0 0.1 0.1 Poliomyelitis cases „ deaths 24 40 18 88 361 1,980 3 4 2 8 16 100 „ case mort. % 12.5 10.0 11.1 9.1 4.4 51 Scarlet fever cases 4,416 9,477 4,153 7,009 9,484 8,542 „ deaths 1 11 7 8 12 8 „ case mort. % 0.0 0.1 0.2 0.1 0.1 0.1 Typhoid &feparatyphoi cases 67 47 38 119 123 133 „ ,, deaths 5 10 4 5 5 17 „ „ case mort. % 7.5 21.3 10.5 4.2 4.1 12.8 Whooping.cough .. cases 6,234 6,661 7,144 9,240 3,678 2,812 „ ,, deaths 101 84 116 58 43 34 „ „ casemort. % 1.6 1.3 1.6 0.6 1.1 1.2 All accidents (a) . deaths 1,215 1,132 1,202 3,778 3,969 3,268 „ death.rate per 1,000 0.51 0.45 0.49 0.50 0.52 0.43 Motor vehicle accidents deaths 254 192 268 825 732 582 „ „ death.rate per 1,000 0.11 0 .08 0.11 0.11 0.10 0.08 Air.raid casualties deaths 89 517 4,567 — — — „ „ . death.rate 0.04 0.21 1.85 — — Appendicitis „ „ 0.05 0.05 0.05 0.06 0.06 0.05 Cancer,, „ 2.40 2.46 2.35 1.72 1.73 1.77 Diabetes „ „ 0.11 0.11 0.10 0.41 0.43 0.41 Influenza „ ,, 0.08 0.29 0.08 0.01 0.02 0.01 Pneumonia (all forms) „ „ 0.86 1.04 0.87 0.39 0.51 0.45 Suicide „ „ 0.12 0.10 0.11 0.13 0.11 0.09 Tuberculosis (pulmonary) cases 4,734 5,066 5,056 9,145 8,283 7,359 „ „ deaths 2,164 2,204 2,073 3,228 3,343 3,256 „ „ death.rate per 1,000 0.90 0.88 0.84 0.43 0.44 0.42 „ (other forms) cases 796 782 673 689 667 573 „ „ deaths 283 256 237 274 317 275 „ „ death.rate per 1,000 0.12 0.10 0.10 0.04 0.04 0.04 „ (all forms) cases 5,530 5,848 5,729 9,834 8,950 7,932 „ „ deaths 2,447 2,460 2,310 3,502 3,660 3,531 „ „ death.rate per 1,000 1.02 0.98 0.94 0.46 0.48 0.46 †Calculated on civil population. Provisional figures, (a) Including motor vehicle accidents but excluding air.raid casualties. 13 Civilian war deaths, 1939-44 The following tables give particulars of London civilian war deaths in each of the war years 1939-44 by boroughs, according to age and sex. The total deaths caused by enemy air-raids were 17,811 during the period, of which 8,771 were males and 9,040 females, the age distribution being as follows : Under 15, 1,772 (9.95 per cent.); 15-45, 7,591 (42.62 per cent.); 45-65, 5,584 (31.35 per cent.); over 65, 2,864 (16-08 per cent.). As will be seen, the peak year was 1940, that of daylight as well as night bombing raids, with a total of 7,973 deaths; in the following year of night bombing the number dropped to 4,661. A lull of two years in raiding followed and then came the flying bombs and rockets of 1944, causing 4,567 deaths. Comparison as regards the distribution and relative density of the raids as disclosed by the air-raid casualty rate per 1,000 population gives the order of the first eight boroughs as follows in 1940: Bermondsey, 5.2 ; Shoreditch, 4.9; Chelsea, 4.8; Finsbury, 4.4; Southwark, 4.1 ; Holbom, 3.9 ; Lambeth, 3-2 ; Deptford, 3.1. On the other hand, the order in 1944 was: Deptford, 4.7; Chelsea, 3.2; Bermondsey, 2.9; Camberwell, 2.7; Fulham, 2.4; Greenwich, 2.4; South wark, 2.3 ; Bethnal Green, 2.3. It will be noticed that in the 1940 raids the casualty rates were highest mainly in boroughs immediately surrounding the City and also in the vicinity of the seat of Government, while in 1944 they were more distributed, particularly in the south and south-eastern boroughs, but again also in the neighbourhood of Westminster. The fatality rate for the County was 2.59 in 1940 and 1.85 in 1944. The total number injured by bombing and conveyed by the Ambulance Service to hospitals or first-aid posts was 48,709. Apart from loss of fife and from injuries due to bombing, the destruction of dwelling houses was a serious matter from the public health point of view. The number of dwellings destroyed was 69,438, those seriously damaged and not occupied 55,878, and those less seriously damaged, including minor damage, and still occupied 584,202. Some appear in the "damaged" list several times. The total number of dwellings in London in 1939 was approximately 814,500. The number of bombs which fell per 1,000 acres has been worked out for each borough, and in 1944, Deptford (27.5) heads the list, followed by the City of London (26.6), Stepney (25.5), Bermondsey (24.6), Greenwich (23.1), Poplar (19.7), Camberwell (18.8) and Southwark (18.6). C 1 14 The number of civilian war deaths for the years of the war are shown below:— Administrative County of London—Civilian war deaths, 1939-44 Year All ages 0- 1- 5- 15- 45- 65- 1939 4 2 2 — 1940 7,973 64 223 447 3,549 2,480 1,210 1941 4,661 41 106 225 2,153 1,460 676 1942 89 — 4 10 36 22 17 1943 517 6 21 102 221 124 43 1944 4,567 56 134 333 1,630 1,496 918 Total M. 8,771 85 269 554 3,673 2,895 1,295 „F 9,040 82 219 563 3,918 2,689 1,569 Grand total 17,811 167 488 1,117 7,591 5,584 2,864 The following tables show the details year by year:— Administrative County of London—Civilian war deaths, 1939 Area All ages 0- 1- 5- 15- 45- 65- Bermondsey M 1 1 F — — — — — — Fulham M 1 — 1 — F — — — — Islington M 1 — — — 1 — — V — — Lambeth M 1 — — — 1 — — F — — — — — — — Total M 4 2 2 — F 15 Administrative County of London—Civilian war deaths, 1940 Area All ages 0- 1- 5- 15- 45- 65- City of London M 10 3 4 3 F 15 — 1 — 7 5 2 Inner and Middle Temple M — — — — — — — F — — — — — — — Batter sea M 92 1 3 8 35 31 14 F 104 2 1 4 49 34 14 Bermondsey M 183 3 10 11 91 48 20 F 186 4 9 23 89 42 19 Bethnal Green . M 74 — 3 4 36 20 11 F 72 1 4 33 20 14 Camber-well M 219 — 5 13 98 70 33 F 211 — 8 12 90 70 31 Chelsea M 62 — 3 30 15 14 F 122 1 — 3 55 38 25 Deptford M 109 1 4 3 50 39 12 F 128 1 2 8 50 46 21 Finsbury M 83 — 4 8 27 32 12 F 92 2 2 5 37 26 20 Fulham M 141 3 7 7 67 44 13 F 144 1 3 13 74 37 16 Greenwich M 98 2 3 5 50 29 9 F 94 2 3 9 34 30 16 Hackney M 217 — 4 6 103 77 27 F 274 2 6 9 136 86 35 Hammersmith M 113 5 11 48 34 15 F 116 2 3 7 49 34 21 Hampstead M 45 — — 1 20 21 3 F 60 — 2 1 21 28 8 Holborn M 46 — 3 19 17 7 F 46 1 — 20 14 11 Islington M 223 3 11 20 91 60 38 F 202 2 6 8 91 67 28 Kensington M 107 — 3 4 50 40 10 F 132 1 — 2 63 44 22 Lambeth M 344 6 10 19 150 123 36 F 337 1 8 21 146 106 55 Lewisham M 201 2 7 15 79 69 29 F 236 1 7 24 102 59 43 Paddington M 63 1 — 1 31 22 8 F 74 — — 4 36 24 10 Poplar M 171 — 3 12 93 43 20 F 122 3 4 4 57 37 17 St. Marylebone M 90 — 4 8 32 30 16 F 87 — 1 2 45 27 12 St. Pancras M 201 4 6 12 103 60 16 F 198 1 8 12 98 46 33 Shoreditch M 159 — 9 7 48 48 47 F 119 — 5 4 36 24 50 South wark M 199 2 5 9 84 66 33 F 220 3 2 20 96 70 29 Stepney M 170 1 5 7 79 54 24 F 197 3 6 13 85 53 37 Stoke Newington M 48 1 — 3 16 21 7 F 59 — — 1 29 20 9 Wandsworth M 237 2 9 12 111 78 25 F 203 — 3 4 86 63 47 Westminster M 115 — 1 3 59 40 12 F 111 — — 4 49 41 17 Woolwich M 111 6 2 52 31 20 F 81 — 4 9 31 23 14 . Total M 3.931 32 127 217 1,755 1,266 534 F 4,042 32 96 230 1,794 1,214 676 16 Administrative County of London—Civilian war deaths, 1941 Area All ages 0- 1- 5- 15- 45- 65- City of London M 12 3 8 1 F 4 — — — 2 1 1 Inner and Middle Temp M — — — — — — — F — — — — — Battersea M 39 1 2 1 21 12 2 F 42 — 4 — 17 10 11 Bermondsey M 117 3 — 13 66 28 7 F 84 3 2 9 37 18 15 Bethnal Green M 70 — 2 5 31 25 7 F 57 — 1 8 25 12 11 Camberwell M 152 2 3 11 69 53 14 F 129 1 1 7 63 35 22 Chelsea M 39 — — — 8 12 19 F 38 1 — — 13 15 9 Deptford M 59 — 2 2 31 19 5 F 38 — 1 — 15 15 7 Finsbury M 49 1 2 4 21 10 11 F 46 1 — 2 17 10 16 Fulham M 14 — — — 5 7 2 F 9 — — — 5 2 2 Greenwich M 60 — 1 2 30 21 6 F 56 — 1 3 25 17 10 Hackney M 85 1 4 4 40 27 9 F 55 — 3 3 21 18 10 Hammersmith M 26 — — — 11 12 3 F 9 — — 1 4 4 — Hampstead M 18 — — — 8 6 4 F 31 — — — 15 10 6 Holborn M 41 — 1 1 20 11 8 F 61 — — 25 16 20 Islington M 136 2 2 5 66 44 17 F 97 — 3 3 40 35 16 Kensington M 43 — — — 24 11 8 F 20 — 1 — 8 8 3 Lambeth M 230 1 6 13 98 78 34 F 187 4 7 7 92 52 • 25 Lewisham M 110 1 5 6 56 29 13 F 104 — 8 7 49 27 13 Paddington M 41 — 2 — 22 12 5 F 57 — 1 4 31 11 10 Poplar M 143 1 2 8 61 48 23 F 108 — 4 11 47 36 10 St. Marylebone M 41 — 1 1 18 15 6 F 50 — — 2 24 19 5 St. Pancras M 122 2 4 4 59 40 13 F 128 2 2 5 62 39 18 Shoreditch M 88 2 1 5 46 28 6 F 94 3 2 7 47 18 17 Southwark M 210 1 5 10 89 79 26 F 182 — 8 11 74 61 28 Stepney M 172 — 1 8 83 58 22 F 98 1 2 5 47 27 16 Stoke Newington M 9 — — — 5 3 1 F 13 — — 1 5 4 3 Wandsworth M 134 — 2 8 61 47 16 F 131 3 3 5 71 31 18 Westminster, City of M 170 2 1 8 75 58 26 F 146 2 2 2 74 52 14 Woolwich M 85 — 1 2 41 29 12 F 72 — — 1 30 27 14 Total M 2,515 20 50 121 1,168 830 326 F 2,146 21 56 104 985 630 350 17 Administrative County of London—Civilian war deaths, 1942 Area All ages 0- 1- 5- 15- 45- 65- City of London M - - - - - - - F - - - - - - - Inner and Middle Temples M - - — — — — F - - - - - - - Batter sea M 1 - - — 1 — — F — - - — — — — Bermondsey M 3 - - — 2 — 1 F — - - — — — — Bethnal Green M — - - — — — — F 1 - - — 1 — — Camber well M 4 - - — 2 1 1 F — - - — — - — Chelsea M — - - — — — — F 2 - - — 1 — 1 Deptford M 1 - - — — 1 — F — - - — — — — Fins bury M 1 - - - - 1 - F - - - - - — — Fulham M 1 - - - — 1 — F - - - - - - - Greenwich M — - - - — — — F - - - - - - - Hackney M 1 - - - — 1 — F 5 - - - 2 2 1 Hammersmith M 2 - - - 1 — 1 F — - - - — - — Hampstead M — - - - — — — F — - - - — — — Holborn M 1 - - - 1 — — F - - - - — — — Islington M 3 - - 1 — — 2 F 2 - - 1 — 1 — Kensington M — - - — — — F — - - - — — — Lambeth M 8 - - - 3 2 3 F 1 - - - — — 1 Lewisham M 3 - - - 2 1 — F 2 - - - — 2 — Paddington M 2 - - - 2 — — F 1 - - 1 - — — Poplar M - - - - — — F - - - - - St. Marylebone M - - - - - — F 1 - - - 1 St. Pancras M 3 - - - 2 1 — F 1 - - - - - 1 Shoreditch M 3 - - - 2 1 — F 1 - - - 1 — — South wark M 14 - 3 3 3 2 3 F 7 - 1 2 2 1 1 Stepney M 3 - — — 3 — — F - — — Stoke Newington M 1 - — — 1 — — F — - — — — — — Wandsworth M 5 - — 2 2 1 — F - Westminster, City of M — - — — — — — F 2 - — — — 1 1 Woolwich M 2 - — — 1 1 — F 1 - — — — 1 — Total M 62 - 3 6 28 14 11 F 27 - 1 4 8 8 0 18 Administrative County of London—Civilian war deaths, 1943 Area All ages 0- 1- 5- 15- 45- 65- City of London M - - - F - - - - - - - Inner and Middle Temples M — — - — F — — - — — — — Battersea M 12 1 - 3 3 3 2 F 7 — - 1 4 2 Bermondsey M 2 — - — — — 2 F 3 — - 1 2 Bethnal Green M 46 — 4 16 11 11 4 F 104 1 4 26 42 28 3 Camberwell M 11 — — 1 4 4 2 F 20 — — 1 9 4 6 Chelsea M — — — — F — — — — Deptford M 17 — 4 1 1 6 5 F 26 1 3 4 10 6 2 Fins-bury M — — — — F — — — — Fulham M 4 — — 1 2 1 F 13 — — — 12 1 Greenwich M 3 — — — 1 2 F 4 — — — 2 2 Hackney M 4 — — 1 — 3 - F 2 — — — 2 Hammersmith M 2 — — — 2 - F 1 - — — 1 Hampstead M 1 — — — — 1 - F 1 — — — 1 - Holbom M — — — — F 2 — — — 1 1 Islington M 6 — — — 5 1 F 1 — 1 __ Kensington M 1 — — — 1 F 1 — — 1 Lambeth M 5 — — — 4 1 F 3 — — 3 - Lewisham M 32 1 2 16 4 8 1 F 58 — 1 20 22 11 4 Padding ton M 1 — — — 1 — F 2 — — 1 1 Poplar M 3 — — — 3 F 6 — — 2 3 1 St. Marylebone M 6 — — 2 1 3 — F 11 — 1 2 4 3 1 St. Pancras M 8 — 6 1 1 F 6 2 — 2 2 Shoreditch M 2 — — 1 1 F 1 1 - - Southwark M — — — — F — — — - Stepney M 6 — — 1 3 1 1 F 12 — 1 1 8 1 1 Stoke Newington M — — — — — - - F 1 — 1. - - - Wandsworth M 23 — — — 16 6 1 F 24 — — 18 4 2 Westminster, City of M — — - - F 2 — 1 1 - Woolwich M 4 — 2 2 F 7 — — 1 4 1 1 Total M 199 2 10 42 67 58 20 F 318 4 11 60 154 66 23 19 Administrative County of London—Civilian war deaths, 1944 Area All ages 0- 1- 5- 15- 45- 65- City of London M 1 — — 1 — F — — — — — — — Inner and Middle Temples M — — — — — — F — — Batter sea M 80 2 2 8 31 32 5 F 85 — 3 5 33 29 15 Bermondsey M 64 1 — 3 30 21 9 F 64 1 2 5 28 15 13 Bethnal Green M 55 1 2 6 12 23 11 F 55 1 1 8 17 16 12 Camber well M 156 4 7 17 41 56 31 F 200 1 9 13 85 57 35 Chelsea M 40 — — 7 13 16 4 F 58 — 1 4 24 21 8 Deptford M 118 2 9 8 24 47 28 F 139 — 3 8 68 36 24 Finsbury M 24 — — 2 10 9 3 F 36 1 1 11 12 11 Fulham M 95 3 5 8 36 29 14 F 129 2 6 11 47 41 22 Greenwich M 68 — — 3 26 27 12 F 77 1 2 6 28 31 9 Hackney M 75 1 4 2 21 28 19 F 98 3 3 7 34 30 21 Hammersmith M 78 3 8 26 24 17 F 95 2 1 9 39 32 12 Hampstead M 26 — — 3 8 11 4 F 41 2 — 2 14 15 8 Holborn M 7 — — 1 1 4 1 F 10 — — — 5 4 1 Islington M 122 2 6 9 36 36 33 F 136 2 3 8 57 30 36 Kensington M 51 1 5 1 18 14 12 F 85 — 1 — 34 23 27 Lambeth M 162 2 5 14 47 61 33 F 193 3 4 15 64 64 43 Lewisham M 150 — 7 8 44 58 33 F 212 — 4 11 88 62 47 Paddington M 21 — 1 1 9 5 5 F 35 — 2 3 10 9 11 Poplar M 49 — 1 6 17 14 11 F 36 2 1 3 19 7 4 St. Marylebone M 17 — — 2 4 8 3 F 28 — — — 10 13 5 St. Pancras M 69 1 2 10 32 16 8 F 65 — — 5 33 22 5 Shoreditch M 18 1 — 1 5 8 3 F 23 — 1 2 10 7 3 Southwark M 76 1 4 1 22 33 15 F 79 1 3 9 30 23 13 Stepney M 58 2 2 6 22 16 10 F 59 — — 6 19 22 12 Stoke Newington M 18 — 1 8 5 4 F 26 — — 2 4 8 12 Wandsworth M 223 7 10 24 71 62 49 F 273 1 4 12 108 83 65 Westminster, City of M 46 — — 2 11 23 10 F 64 —- — 4 20 21 19 Woolwich M 93 — 4 6 28 38 17 F 106 3 — 6 38 38 21 Total M 2,060 31 79 168 653 725 404 F 2,507 25 55 165 977 771 514 D 20 The following tables show the damage to dwellings in the County of London, and in the London Civil Defence Region, as from 3rd September, 1939 :— War damage to dwellings—County of London* (As from 3rd September, 1939) District No. of dwellings in August, 1939 Totally destroyed So seriously damaged had to be demolished Seriously damaged ; unoccupied • Seriously damaged ; still occupied Minor damage Total destroyed or damaged (1) (2) (3) (4) (5) (6) (7) (8) Paddington 22,570 632 (a) 1,194 747 15,006 17,579 Kensington. 40,064 1,030 (a) 865 1,490 13,652 17,037 Hammersmith 39,000 181 624 447 1,775 14,872 17,899 Fulham 26,756 1,114 (a) 1,685 1,341 17,357 21,497 Chelsea 14,500 392 252 1,345 1,507 6,358 9,854 Westminster, City of 26,500 525 1,165 2,982 (b) 18,056 22,728 St. Marvlebone 20,466 421 605 1,033 524 12,406 14,989 Hampstead 17,552 297 177 930 1,075 10,926 13,405 St. Pancras 28,638 1,686 (a) 1,634 1,696 13,825 18,841 Islington 45,000 3,097 (a) 1,253 3,224 33,653 41,227 Stoke Newington 13,648 86 382 789 1,504 9,234 11,995 Hackney 30,112 3,657 357 3,239 1,744 21,115 30,112 Holborn 8,700 624 (a) 531 315 6,000 7.470 Finsbury 9,899 983 23 585 233 7.015 8.839 City of London 2,154 (Classification not appropriate) Shoreditch 19,678 3,360 1,050 1,041 14,201 19,652 Bethnal Green 21,700 2,233 (a) 893 2,457 16,117 21,700 Stepney 34,000 4,324 2,716 3,795 3,178 15,278 29,291 Poplar 21,906 4,663 2,481 2,317 2,434 10,011 21,906 Southwark 25,552 2,071 624 3,006 3,638 13,513 22.852 Bermondsey 19,019 1,552 1,648 1,042 2,842 11,715 18,799 Lambeth 55,000 4,000 (a) 4,000 5,000 35,000 48,000 Battersea 28,500 2,266 (a) 1,973 4,747 19,053 28,039 Wandsworth 79,478 1,484 1,551 5,614 9,122 56,964 74,735 Camberwell 40,104 5,291 (a) 5,086 3,976 25,348 39,701 Deptford 18,200 2,124 (a) 1,500 4,500 17,500 25,624 Greenwich 19,370 2,418 (a) 1,312 375 15,265 19,370 Lewisham 48,532 1,261 2,219 4,018 5,132 35,850 48,480 Woolwich 37,900 495 1,297 1,769 2,084 32,252 37,897 County of London 814,498 52,267 17,171 55,878 66,660 517,542 709,518 • As in August. 1945. (a) .Included in column (3). (6) Included in column (7). 21 London Civil Defence Region—War damage to dwellings* (As from 3rd September, 1939) District No. of dwellings in August, 1939 Totally destroyed So seriously damaged, had to be demolished Seriously damaged, unoccupied • Total destroyed or seriously damaged and unoccupied Still occupied Seriously damaged Minor damage (1) (2) (3) (4) (5) (6) (7) (8) West % % % % % % 169,390 2.3 1.2 5.0 8.5 4.1 50.4 North 155,416 5.9 1.0 5.7 12.6 6.3 65.1 Central 20,753 7.7 0.1 5.4 13.2 2.6 62 .7 East 97,284 15.0 6.4 8.3 29.7 8.3 57.2 S.E. 263,677 7.3 2.2 8.2 17.7 10.4 70.7 S.W 107,978 3.5 1.4 7.0 11.9 12.8 70.4 Total for County of London 814,498 6.4 2.1 6.9 15.4 8.2 63.5 Outer Ring N 169,241 0.5 1.6 3.7 5.8 6.7 74.2 N.W 219,837 1.2 0.4 2.7 4.3 5.0 46.3 W 317,424 0.8 1.0 2.7 4.5 3.9 66.2 S.W 154,143 0.9 1.9 3.6 6.4 7.7 77.7 E 257,871 3.3 5.6 11.4 20.3 9.8 64.9 S.E 122,998 2.0 1.9 5.5 9.4 4.6 78.1 London County Council housing property (a) 95,000 2.6 (b) 8.2 10.8 18.2 64.4 Total London Civil Defence Region. 2,151,012 3-4 2 0 5.9 11.3 7.5 65.1 *As in August, 1945. (a) Whether within the county area or without. (b) Included in column (3). GENERAL PUBLIC HEALTH Housing Notifications under section 33 of the Housing Act, 1936, continued to be received during the year from several of the Metropolitan Borough Councils as a result of the circular letter No. 2778, dated 4th March, 1943, from the Ministry of Health. In this letter, local authorities were asked to formulate a year's programme, which could be put into operation immediately conditions permit, whether during or after the war. Certain preliminary work involving conferences and the searching of records was undertaken in connection with these proposals. Many applications for preferential consideration for rehousing on the Council's estates, on grounds of ill-health, were received, particularly towards the end of the year. Appropriate recommendations on the applications received were made to the Council's Valuer. Tuberculous milk Milk sampling for the presence of tubercle bacilli has continued throughout the year. Most of the milk received in London was transported in rail and road tanks and the remainder came in churns. Only the churn milk was sampled, and 31 (3.7 per cent.) of 830 completed examinations of milk showed the presence of tubercle bacilli, compared with 2.3 per cent. in 1943. The source of infection was D 1 22 traced in approximately two-thirds of the farms involved, and 13 cows were dealt with under the Tuberculosis Order, 1938. Two samples of tuberculin-tested milk (of which 75 completed samples were taken) yielded a positive result, i.e., 2.6 per cent. As a result of investigation of these two attested herds, a Guernsey cow was slaughtered under the T.B. Order, 1938, and the post-mortem revealed tuberculous lesions in the udder. Samples of milk taken for biological tests from the remainder of the herd proved negative. It has been found impossible to identify the source of infection of the other T.T. sample; tuberculin tests of the herd have not revealed reactors, group samples covering the herd were submitted to biological examination and subsequently reported to be non-tuberculous. The farmer has, however, consistently contravened the requirements of the Milk (Special Designations) Order, 1936, in respect of labelling and sealing containers and his licence has been suspended. It was concluded that some infection had been introduced, but no confirmation could be obtained that supplemental milk had been added either at the farm or en route. Accredited milk showed a ratio of 1.4 per cent., and ungraded milk 4.8 per cent, positive, compared with 1.7 and 3 per cent., respectively, in 1943. Venereal diseases The work of the clinics included in the London and Home Counties Scheme for the free diagnosis and treatment of venereal diseases has been carried on throughout the year. Full facilities have been provided, but, owing to enemy air activity and the consequent evacuation of part of the population, there has been a slight decrease, compared with 1943, in the amount of work done. Towards the end of the year, however, when enemy activity subsided, the attendances increased, and were maintained at the original level. Work carried out at the clinics The following is a summary of work done at the London clinics for all areas during the undermentioned years:— Year New cases Total venereal cases Total non-venereal cases Syphilis S. Chancre Gonorrhoea M. F. M. F. M. F. M. F. M. F. 1918 3,764 3,002 116 13 4,844 1,940 8,724 4,955 1,345 1,348 1928 3,433 1,837 229 6 8,249 2,647 11,911 4,490 6,369 3,226 1938 1,799 1,065 235 9 7,120 2,151 9,154 3,225 8,249 5,269 1939 1,573 904 164 5 5,982 1,652 7,719 2,561 7,468 5,008 1940 1,493 709 146 9 4,591 1,319 6,230 2,037 5,383 3,515 1941 1,381 773 205 12 3,862 1,425 5,448 2,210 4,675 3,709 1942 1,369 917 148 9 3,082 1,444 4,599 2,370 4,960 5,177 1943 1,362 1,107 104 15 2,839 1,442 4,305 2.564 7,627 8,867 1944 1,176 967 89 13 2,929 1,363 4,194 2,343 6,568 8,234 Year Total attendances In-patient days Pathological examinations for M. F. M. F. Clinic Practitioners 1918 169,485 66,095 25,973 6,380 1928 544,969 218,566 23,821 41,285 107,410 29,785 1938 588,815 263,908 20,608 32,303 263,710 48,763 1939 412,067 189,355 13,030 22,715 223,696 40,176 1940 305,693 131,375 9,907 11,236 153,695 35,554 1941 224,954 122,492 13,708 10,459 135,152 34,981 1942 222,864 155,559 16,991 13,787 164,459 61,897 1943 219,014 177,859 6,828 9,725 182,558 76,533 1944 188,450 155,332 6,605 7,861 170,861 73,784 23 A decline in the incidence of V.D. during the war years cannot be assumed from the above figures. The number of patients treated under the Scheme has diminished, owing to a large proportion of the population of the ages at which exposure to infection is most likely to occur being in the Forces, and to the further decline in the population by reason of evacuation. The considerable reduction in the number of attendances is largely attributable to newer methods of treatment of gonorrhoea by sulphonamides, the average number of attendances made by sufferers from this disease being only 16.1 in the year 1944, compared with 23.4 in 1939. The use of penicillin should effect an even greater reduction in the number of attendances for both gonorrhoea and syphilis in the future. The increase in the number of non-venereal patients now attending the clinics is no doubt the result of the publicity campaign. Service patients During the year, 971 Service patients attended the clinics in the Scheme ; 5,106 Service attendances were made at the centres and 8,019 Service pathological tests were carried out in the approved laboratories. These figures are included in the above tables. Most of these patients were referred by the Service medical authorities in special circumstances to the civilian clinics for continuation treatment, and they represent only a very small proportion of the total number treated at the centres, viz., 4.5 per cent. of new cases, 1.5 per cent. of attendances and 3.3 per cent. of pathological tests. Additional in-patient treatment In addition to the in-patient treatment provided in direct association with the clinics, the Council's Sheffield Street Hospital (78 beds) continued to admit pregnant women suffering from venereal diaease, and at Queen Mary's Hospital for Children, Carshalton, the unit (36 beds) for children suffering from congenital syphilis and vulvo-vaginitis continued its work until the evacuation of the hospital in July, 1944, when these units were transferred to the North-Eastern Hospital. Almoners In a circular letter (No. 2834, dated 23rd July, 1943) the Ministry of Health asked local authorities to consider the advisability of employing trained almoners on the staffs of V.D. clinics. Suitable part-time appointments have been made during the early part of the year 1944 at those clinics in the Scheme which did not already have an almoning service, and a similar service has been arranged for this work at the Council's Whitechapel and Endell Street clinics. These trained social workers have established a helpful relationship between the patients and the clinics, and have materially contributed to the continuance of treatment. Propaganda Propaganda by means of posters and advertisements in the daily press has been continued throughout the year, and full use has been made of the services offered by the Central Council for Health Education. Hostels Owing to difficulties in staffing and management and in view of the small number of patients sent to the hostel from the courts, the London Police Court Mission decided to close Winnington House at the end of March. This hostel was opened in June, 1939, for the reception of girls on remand or on probation suffering from venereal diseases. Defence Regulation 33B Accommodation provided at the other hostels in the scheme remained the same as in 1943. The year 1944 saw a large increase in the number of alleged contacts reported under Defence Regulation 33b—1,344, against 654 in 1943. Much useful wprk was done in persuading those named once only, and therefore outside the scope of the Regulation, to obtain treatment. Of such contacts, 328 were found and 199 were examined, the majority requiring treatment. In addition, valuable work was done by a team of U.S. Army nurses, specially trained in this task. These nurses assisted to trace contacts named by American service men, and their efforts resulted in a number of the contacts being persuaded to undergo examination and treatment. 24 During the year, 172 contacts were named by more than one informant, and all those who could be traced (123) were dealt with under the Regulation by notice to attend a special practitioner for examination and treatment. In 10 instances the alleged contact was prosecuted for failing to obey the notice, and six were sentenced to terms of imprisonment; three were placed on probation and one dismissed under the Probation of Offenders Act. In four the contact was prosecuted for failure to continue treatment. Of these, one was sentenced to 14 days' imprisonment (to continue treatment on release) and the others were placed on probation for twelve months. Much difficulty is encountered in endeavouring to trace those named in the notifications. Frequently the informant has only a vague idea of the name and address of the contact, and, even when correct names and addresses are furnished, it is often found impossible to trace them owing to the migratory habits of most of them. In this connection I have to acknowledge the valuable help given by the Metropolitan Police in tracing contacts named by more than one informant. The following statement summarises the work of the year, the figures for the year 1943 being given in brackets:— M. F. (1) Total number of contacts in respect of whom form 1 was received 11 (34) 1,333 (620) (2) Number of cases in (1) in which attempts were made outside the scope of the Regulation to persuade the contact to be examined before the latter had been named on a second form 1 7 (20) 528 (190) Contacts found 7 (10) 328 (94) Contacts examined 6 ( 9) 199 (70) (3) Number of those in (1) in respect of whom two or more forms 1 were received — 172 (60) 123 (37) (4) Number of those in (3) who were:— (a) found - (b) served with form 2 — 123 (32) (c) examined after service of form 2 — 103 (29) (d) prosecuted for failure— (i) to attend for, and submit to, medical examination — 10 (3) (ii) to submit to and continue treatment — 4 (-) Dispensary service Treatment of tuberculosis The number of names on the dispensary registers at the end of the year was 23,671, compared with 21,914 at the end of 1943, and 21,740 at the end of 1938. The work of the dispensary service has considerably increased during the year, and has functioned satisfactorily, despite the very adverse conditions in London due to enemy aerial activity. Evening sessions were held during the summer, and Saturday afternoon sessions or other special sessions were substituted in some cases diirincr the winter. Residential treatment The number of recommendations for residential treatment with the corresponding figures for 1943, 1942 and 1938 were :— Year Men W omen Children Total 1944 3,655 2,864 792 7,311 1943 3,657 2,926 800 7,383 1942 3,394 2,594 754 ' 6,742 1938 4,341 3,121 996 8,458 The numbers of beds occupied by patients under the tuberculosis scheme on 31st December, 1944 (with corresponding figures for 1943 and 1938) were as follows; the figures in brackets represent the number of ex-Service men and women (included in the figures) whose tuberculous condition has been accepted by the Ministry of Pensions as connected with war service:— 25  Adults Children 1944 1943 1938 1944 1943 1938 Council's special hospitals and sanatoria 1.419 (242) 1,249 (184) 1,299 (1) 416 519 658 Council's general hospitals 490 (30) 713 (33) 1,010 (0) 12 19 13 Voluntary institutions 1,399 (157) 1,323 (120) 1,134 (16) 55 43 60 Total 3,308 (429) 3,285 (337) 3,443 (23) *483 581 731 •From the commencement of the flying bomb attack to the end of the year there was a decrease in the number of applications for the treatment of children and this is reflected in the reduced number of children under treatment on 31st December, 1944. †These figures include 462 patients evacuated from the tuberculosis wards of general hospitals in London and from the special hospitals in the area exposed to flying bomb danger; this is reflected in the decrease in the numbers remaining in general hospitals. The number of children boarded out has shown a steady increase for some years The average number boarded out during the year was 152, while the highest number was 179. Board ingout of child contacts The corresponding figures for 1943 were 135 and 167. The Invalid Children's Aid Association, who arrange the boarding-out of cases for the Council, reported great difficulty in placing children, especially under 5 years of age. To overcome this difficulty, accommodation was provided in some of the evacuated nurseries, and arrangements were made for a number of contact children to be boarded out in the Council's nurseries, residential schools and homes. During 1944, there were six residential open-air schools (type 1) in operation outside the London area. The number of children in residence at the end of 1944 was 294. Open-air schools type T) During the year, financial responsibility was accepted for the supply, renewal and repair of surgical appliances and for X-ray examination of orthopaedic patients attending after-care departments of hospitals (whether maintained by the Council or otherwise) at which residential treatment had been provided under the tuberculosis scheme. Free treatment and appliances were also provided at the out-patient departments of the Council's general hospitals for those patients attending for after-care following residential treatment under the scheme at Grove Park Hospital or at voluntary hospitals not having after-care clinics. Surgical after-care The facilities for the mass miniature X-ray examination of sections of the general public were continued during the year. To overcome the lack of mobility of the apparatus through the non-delivery of a special motor-van equipped with a generator and dark-room which had been authorised, examinations were carried out at the following six static centres: Wandsworth Town Hall; Plumstead Baths, Woolwich; South-Eastern Hospital, New Cross; County Hall, Westminster Bridge, S.E.I ; Jewish Boys' Club, Hackney; and St. Margaret's Hospital, Kentish Town. Miniature mass radiography The borough medical officers, with the tuberculosis officers, are responsible for selecting the groups of persons for examination in the respective areas. They, or their representatives, visit employers, explain to the management the meaning of mass radiography, stress the voluntary nature of the proceedings and particularly emphasise that results are confidential and not divulged to anyone,whether employers or medical officers, without the prior consent of the individuals concerned. Such procedure is regarded as essential to the success of the scheme. It is also emphasised that the examination is for the benefit of the employee and not the employer. Borough medical officers of health forward to the County Hall details of the groups in their areas which they have ascertained are willing to attend for examination and all arrangements and booking of appointments are then made from the County Hall. 26 At each of the centres, factory, shop and office employees, Civil Defence personnel and secondary and technical scholars from the surrounding metropolitan boroughs were examined. The medical director is responsible for the reading of the miniature films. For the interpretation of the full-sized films a consultative panel has been formed, comprising a radiologist, a general physician, the senior medical officer on the central staff in charge of tuberculosis work and the medical director. Also tuberculosis officers and other experts are invited to participate in the discussions. The panel meets weeklv. The following is a summary of the work done during the year:— Number Per cent. of Miniatures Miniature films taken 46,671 — Large films taken 1,795 3-85 (1) Details of conditions revealed by large films (i) Persons requiring further investigation— (a) For lesions probably tuberculous 355 .76 (6) For lesions probably non-tubereulous 21 .05 (c) For cardio-vascular lesions 92 .20 (d) Previously known tuberculosis cases 54 .12 (e) Possibly after further X-ray examination in 3.6 months 27 .06 549 118 (ii) Radiologically inactive lesions 676 1.45 (iii) No abnormality 570 1.22 1,795 (2) Analysis of lesions probably tuberculous (355) Diagnosis confirmed by tuberculosis officer 298 .64 Doubtful cases 28 .06 Awaiting tuberculosis officer's report 5 .01 Refused investigation 24 .05 355 .76 (3) Summary of reports from tuberculosis officers of advice given (pulmonary lesions probably tuberculous—355) Requiring no further medical action 4 .008 Requiring a further examination later as a precaution 21 .045 Requiring continued dispensary observation 187 .40 Should cease work and remain under observation at home 3 .007 Requiring sanatorium treatment 111 .24 Information so far not available or refused investigation 29 .06 355 .76 Maintenance allowances (Memo. 266T; All persons in whom evidence of disease was shown were followed up. lhe patient's doctor was communicated with and the X-ray film and report forwarded to him. At the same time the patient was told to see his own doctor, who was asked to inform the medical director of the subsequent diagnosis and steps taken to obtain treatment. It was suggested that the patient should be referred to the local tuberculosis officer if necessary. Payment of maintenance allowances under the Government's scheme, set out in memorandum 266T of the Ministry of Health, to patients undergoing prescribed treatment either in a hospital or sanatorium or at home under the tuberculosis officer's direction, continued throughout the year. The machinery of the dispensary service was utilised in connection with enquiries for the purpose of determining the amounts payable, and, where practicable, for the actual payment of the allowances. The tuberculosis officers are responsible for determining eligibility on medical grounds for any allowances authorised, and during the year a total of over £120,000 was paid in allowances. 27 Blind persons Particulars of examinations by the Council's ophthalmologists under the provisions of the Blind Persons Acts during the year are set out below :— Classification Certified blind Not blind Grand total Male Female Total Male Female Total New cases 157 270 427 51 73 124 551 Prev. blind, still blind 36 39 75 — — — 75 Prev. not blind, now certified 11 16 27 — — 27 Prev. not blind, still not blind — — — 17 39 56 56 Prev. blind, now not blind — — — 1 5 6 6 Total 204 325 529 69 117 186 715 In addition 104 certificates (28 male and 76 female) submitted by voluntary hospitals, outside authorities or private ophthalmologists were accepted as evidence of blindness. Twenty-four blind persons were examined as to suitability for training and 22 (12 male and 10 female) were found to be suitable. The number of examinations made during the year was considerably below the number of appointments for examination, as, during the flying-bomb attacks, patients were not seen because either they did not attend County Hall, or, if a home visit appointment was made, the medical officer found on arrival that the house had been rendered uninhabitable or the tenants had left. Midwives Acts, 1902 to 1936, nursing homes registration and contributions to voluntary organisations for maternity and child welfare Compared with 1943 there was a decrease in the total number of confinements undertaken by the Council's domiciliary midwives. The following are the figures for 1938, which was the first year of the Council's domiciliary midwifery service and for the years 1943 and 1944 :— Domiciliary midwifery service— London County Council midwivee Maternity nursinq cases Midwifery cases Total 1938 449 2,924 3,373 1943 447 6,400 6,847 1944 406 5,518 5,924 The number of midwives employed at 31st December, 1944, was 114 compared with 113 at the end of 1943, and in addition 6 were still lent to reception area authorities. The average number of midwives employed in London throughout the year (permanent and temporary) was 113, compared with 112.3 in 1943. The average annual number of confinements undertaken by each midwife was approximately 53. The reduction in the number of confinements compared with 1943 was due to enemy attacks with VI and V2 bombs, which caused more women to go to the country for their confinements. Twenty-two domiciliary midwives were lent to emergency maternity homes in the country. The midwives remaining in London attended the mothers in the same fearless and exemplary way as they did during the air raids in 1940-41. Of 100 homes established by the midwives by May, 1944, no less than 12 were either totally destroyed or so severely damaged as to force the midwife to leave, and 35 were severely damaged. In addition, many homes were damaged 28 Domiciliary midwifery service— voluntary organisations to a lesser and varying extent, and some have been damaged more than once. Fortunately, only eight midwives had to go off duty owing to injury or shock, and none was absent for more than 39 days. The number of district confinements undertaken by the voluntary organisations included in the Council's domiciliary midwifery service also showed a reduction compared with the figures for 1943. These numbers, together with those for 1938, were as follows:- Maternity nursing cases Midwifery cases Total Grand Total 1938 Voluntary hospitals domiciliary service 251 5,484 5,735 District nursing associations 606 1,158 1,764 7,499 1943 Voluntary hospitals domiciliary service 95 3,583 3,678 District nursing associations 361 1,556 1,917 5,595 1944 Voluntary hospitals domiciliary service 83 2,948 3,031 District nursing associations 329 1,323 1,652 4,683 Payment of medical fees The reduction in confinements compared with 1943 was also due to the VI and V2 attacks on London. The branch home of one district nursing association was demolished by a V2 bomb, and I regret that one midwife was killed. Fees paid under the Midwives Act, 1918, to medical practitioners called in by midwives in emergency amounted to £5.793 12s. 6d. and claims for fees paid were 3.875. Registration of nursing homes There were 118 nursing homes on the register at the end of the year, compared with 116 at the end of 1943. These numbers include homes closed temporarily owing to the war. Of the nursing homes registered at the end of the year, 44 were temporarily closed. Maternity and child welfare work of voluntary associations Grants paid to voluntary maternity and child welfare associations during the year 1944 under Section 101 (6) of the Local Government Act, 1929, amounted to £20,806, compared with £21,098 in 1943. Thirty-five associations were grantaided during the year, of which 6 were maternity hospitals, 16 mother and baby homes, 6 baby homes and 7 district midwifery practices. Of these associations, 13 Government grant to district nursing associations were functioning in London, 18 in the country, and 4 in both London and the country. In circular 32/44, dated 13th March, 1944, the Ministry of Health asked the Council to make payments on account of the Government grant to district nursing associations towards the cost of applying the recommendations of the Nurses' Salaries Committees (Rushcliffe). This request was implemented, with the assistance of the Central Council for District Nursing in London, and payments on account of £4,666 and £8,556 for the financial years 1943-44 and 1944-45, respectively, were sanctioned on 31st May, 1944, and 3rd October, 1944. Medical examination of staff The number of references made to the department for medical examination or advice concerning the health of staff and of members of the civil defence services was 15,072, compared with 14,294 in 1943. The sick parade at the Council's hospitals was continued for the civil defence services, and the numbers involved are not included above, apart from 1,695 employees of doubtful fitness, who were referred to the Council's examining medical officer. Reciprocity has been maintained with provincial medical officers of health whereby London personnel staying in the provinces and provincial personnel temporarily resident in London are examined locally. The number of patients so examined is small (19) but the procedure serves a useful purpose and is much appreciated. 29 Chemical branch The work of the chemical branch was carried on during the year at the three laboratories, the total number of samples examined being 14,991. A large proportion of the work during the year was again of an investigational and advisory character, this being necessitated by requests from chief officers of other departments for assistance on various matters in regard to which the science of chemistrv could be of service. Examines are :— Central laboratory (1) The Chief Officer, Meals Services, asked that consideration be given to the possibility of improving the efficiency of the washing-up process in restaurants where this is done by hand. The theoretical basis of detergency was studied and many commercial detergents were examined, particular attention being paid to those of the hew synthetic type. Laboratory scale tests were made, and subsequently it was recommended that trials of three formulae should be conducted on a practical basis, the opinion being expressed that the suggested procedure would, with due regard to economy, improve the efficiency of the washing-up process. (2) In view of the general use of petrol containing lead, the Chief Engineer asked that the question of the lead content of the air of the vehicular tunnels should be investigated having regard to the possibility of toxic effects due to lead. The conclusion was that, while the amount of lead in the air in the tunnels was by no means negligible in relation to the standards generally accepted, no risk to health need be anticipated from this source. A standard of ventilation in which the limit for carbon monoxide is 25 parts per 100,000 will also ensure that the concentration of lead is kept within the usually accepted limit. (3) The Architect requested that the failure of the sheet lead flashing on a large roof should be investigated. The conclusion was that it was due to fatigue occasioned by thermal effects causing the repeated application of alternating tensile and compressive stresses. The suggested remedies were the use of expansion joints or alternatively a lead alloy which had a greater resistance to such stresses. (4) An explosive incendiary bomb having penetrated the roof and damaged the coil of a refrigerator at a hospital, the food therein had become contaminated with methyl chloride, and, as appeared from the observations made, the decomposition products of this by heat. The various foods were examined and appropriate action was recommended in each case. (5) At the request of the Chief Officer, Public Control Department, opinions were expressed in a number of cases as to whether various processes being carried out in certain premises could be deemed to be " dangerous businesses " under the terms of the London Building Act, 1930. The many factors involved in each individual case (e.g., materials or chemicals used, method of heating or processing, the type and arrangement of the premises) were reviewed and a considered opinion was given. (6) The Chemist-in-Chief being also the Official Agricultural Analyst for the County under the Fertilisers and Feeding Stuffs Act, 1926, several samples of "unrationed" poultry food were submitted for examination. The war-time shortage of good feeding stuffs has encouraged vendors to offer for sale materials which are of doubtful value. It was difficult in some instances to decide whether the potential small feeding value outweighed the disadvantages of the material, but a considered opinion was expressed in each case, some being definitely adverse. (7) Samples of hair and nails from a man suspected, on clinical grounds, possibly to be suffering from arsenical poisoning were found to contain relatively large amounts of arsenic, and spectrographic examination also revealed the presence (subsequently confirmed and estimated chemically) of lead. The opinion was expressed that the patient might have been employed in an industry using lead arsenate and this, on enquiry, proved to be the case. Subsequent periodical examination of specimens showed a steady decline of the content of both metals. 30 The regular examination of the drinking water at Council hospitals, etc., served by private wells was continued ; in all cases chlorination is applied. Foodstuffs and milk were examined as to quality, and sets of samples of various tendered materials were reported upon as to which were the most suitable quotations for acceptance, having regard to quality and price. The condition of the water in the swimming baths and ponds was examined and the regular testing of the air in the vehicular tunnels at Blackwell and Rotherhithe as to its carbon monoxide and black suspended matter content, etc., was continued ; it showed that the ventilating plant had maintained the atmosphere in a satisfactory condition. Statutory work under the Petroleum (Consolidation) Act, 1928, the Petroleum (Mixtures) Order, 1929, the London County Council (Celluloid, etc.) Act, 1915, the Public Health (London) Act, 1936, and the London Building Act, 1930, etc., was done as required, and the air examinations in connection with the problem of atmospheric pollution were continued, the results being communicated to the Department of Scientific and Industrial Research. Among the many other matters dealt with during the year were the examination of drugs and medical stores, the analytical control of steam-raising plants, etc., at hospitals and institutions, the analysis of metals, paints, building materials, school meals, oils, the testing of safety lamps, decontamination of premises from phosphorus bombs, etc. The formulation or amendment of many specifications was considered both in regard to those of the Council and of the British Standards Institution. The development of new analytical methods was kept under review and, in particular, the use of the spectrograph and of an absorptiometer, designed in the laboratory, might be mentioned. Sewage disposal Analytical work in connection with the disposal of sewage proceeded as formerly. In addition to the primary sedimentation process by which the sewage was treated at both outfalls, part of the flow at the Northern Outfall Works was further subjected to secondary sedimentation. The sludge digestion plant produced a satisfactory yield of gas. In order to obtain information as to the condition of the water of the river Thames, into which the effluents are discharged, periodical samples of river water were examined, these being taken at various points from Teddington down to the sludge dumping area, the position of which is fixed, during wartime, by Admiralty orders. An investigation was made during the year as to whether there was any accumulation of sludge on the river bed in this area. The results showed that there was no evidence of accumulation of "fresh" sludge and in this connection it must be borne in mind that the purification of the sludge by oxidation begins as soon as it is disseminated throughout the large volume of water into which it is discharged. Work on the manurial use of sewage products was continued, the chief material made being a house refuse sewage-screenings compost. Comparative tests of the fertiliser value of this, compared with those of other substances, were made during the year at a mental hospital farm in liaison with the work being carried out under the auspices of the Agricultural Research Council. Enemy action HOSPITALS AND ANCILLARY SERVICES General and special (other than mental) hospitals Between August, 1940, when the first air-raids on London occurred, and the end of the war there were few months entirely free from enemy activity, but intensive raiding was mainly confined to three periods—from September, 1940 to May, 1941, from January to April, 1944, and from June, 1944, when the first V weapon attacks began, until March, 1945. In all, there were some 660 incidents in the Council's general, mental and other special hospitals, and at only three of the 100 hospitals concerned (viz., Pinewood, Northern Hospital and Brunswick House) was no incident recorded. 31 The heaviest attacks were experienced during the first phase, when in a period of eight months the hospitals sustained damage on no fewer than 450 occasions. Of these incidents, 156 affecting 70 of the Council's hospitals occurred during the month of September, 1940, alone. In some incidents the damage was of a minor nature, but in many it was severe and 10 hospitals (Fulham, St. Georges-in-the-East (three times), St. Matthew's, Mile End, St. Giles, St. Peter's (twice), St. Andrew's, St. Leonard's, St. Pancras, and St. Luke's) were evacuated, while others had to be partly closed. Evacuation was in some cases only a temporary measure pending the restoration of essential services such as gas, water, electricity and telephones, but in others the accommodation had been destroyed or so severely damaged as to make re-occupation of some parts of the hospital impracticable. Although minor incidents occurred during the remainder of 1941 and in 1942 and 1943, no further serious damage was done to the hospitals until 1944, when a series of sharp raids took place between January and April, and 51 hospitals were affected, some being extensively damaged. In the third and last phase of enemy action which began in June, 1944, with the use of flying bombs (V 1) followed by rocket bombs (V 2) and continued until March, 1945, hospitals were damaged on 138 occasions. In many cases the damage was severe and seven hospitals (St. Mary Abbots, Mile End, Lambeth, St. Olave's, St. Francis, St. Nicholas' and St. Clement's) had to be completely evacuated. Other hospitals were partially evacuated. The most serious incident among this group was at St. Bernard's Hospital where a bomb destroyed the boiler house and about 2,000 mental patients had to be transferred elsewhere forthwith. Bombing created many extremely difficult administrative problems, particularly when evacuation was necessary. The transfer of patients to other hospitals, the redistribution of staff, the salvaging of stores and the diversion of supplies, and the improvisation of emergency arrangements to maintain essential services, e.g., the use of mobile field kitchens when a hospital kitchen was put out of action, had to be carried out with the utmost speed. Even minor damage to ward windows and black-out had to be made good before nightfall if accommodation was to remain occupied. When water mains were disrupted the Fire Brigade helped by pumping water into the storage tanks. The elasticity of the Council's comprehensive hospital service facilitated the solution of these problems, but the greatest credit is due to the staff of all grades who responded cheerfully to all calls made upon them and by their energy, resource and disregard of danger ensured that the service should continue to function. Outstanding examples of the many acts of gallantry and devotion to duty were officially recognised by the award of decorations to members of the staff, including one George Cross posthumously awarded and four George Medals. It was inevitable that the enemy attacks on London should inflict casualties upon patients and staff, but, in view of the large number of patients in the hospitals the loss of life was comparatively light. In all, 257 patients and 62 staff were killed, and, at the end of 1944, 5,007 beds were permanently out of action. In July, 1944, the Council made representations to the Minister of Health regarding the evacuation of the Council's children's hospitals which were situated in south London, the area most subject to attacks by flying bombs. Evacuation of children's hospitals The Minister approved the evacuation of these hospitals, and arrangements were accordingly made for those children, who were fit, to be discharged home in order that the parents could arrange for their evacuation under the official evacuation scheme. The patients remaining in the children's hospitals were disposed of as follows :— Queen Mary's Hospital, Carshalton—180 rheumatic children transferred on 19th July, 1944, to Scotton Bank Emergency Hospital, Knaresborough, Yorkshire; 30 orthopaedic children transferred on 14th July, 1944, to the Royal National Orthopaedic Hospital, Stanmore ; 29 general medical patients transferred on 16th 32 July, 1944, to the North-Eastern Hospital (26 of these patients were subsequently transferred to a children's hospital in Liverpool) ; 208 orthopaedic children transferred on 25th July, 1944, to Dryburn Emergency Hospital, Dryburn, Durham ; 13 children suffering from cerebral palsy transferred on 26th July, 1944, to St. Faith's Hospital, Brentwood. The Downs Hospital, Sutton—15 rheumatic children transferred on 17th July, 1944, to Scotton Bank Emergency Hospital; 45 other children subsequently transferred to the North-Eastern and Joyce Green Hospitals. Goldie Leigh Hospital, Abbey Wood—120 children suffering from ringworm and skin diseases transferred on 19th July, 1944, to the Northern Hospital, Winchmore Hill. White Oak Hospital, Swanley—49 children suffering from ophthalmia and one mother and baby with ophthalmia neonatorum transferred on 14th July, 1944, to the North-Eastern Hospital. These 49 children were transferred on 16th August, 1944, to a children's hospital in Manchester. Evacuation of other hospitals On 31st July, 1944, the Minister of Health informed hospital authorities in the London Civil Defence Region that as many patients as possible in hospitals in that area were to be removed to other parts of the country in view of the anticipated dangel of rocket bombs. All the Council's hospitals were involved, with the exception of Heatherwood Hospital, Ascot, Pinewood Sanatorium, Wokingham, King George V Sanatorium, Godalming, St. Faith's Hospital, Brentwood, and for a different reason Sheffield Street Hospital and St. David's Hospital, Edmonton. Certain priority classes were designated for evacuation. First—patients in the acute general hospitals and base hospitals, not likely to be fit for discharge home within a short period ; second—children not already evacuated ; third—chronic sick and tuberculous patients. Patients who were not evacuated were mental patients, and those suffering with venereal diseases, infectious diseases, epilepsy, postencephalitis lethargica and ophthalmia neonatorum. Evacuation from the acute general hospitals began on 4th August, 1944, and from the chronic sick hospitals on 9th August, 1944. All arrangements for the evacuation of the acute sick patients were made by the Ministry of Health, acting through the London sector hospital officers. Chronic sick and tuberculous patients were dealt with by the Council, and, in addition, the Council arranged for the evacuation of the tuberculous patients from local authority hospitals in London and the home counties in the London Civil Defence region. The chronic sick patients were all housed in accommodation administered by other authorities, but the following entirely new hospitals were set up for tuberculosis, and were administered by the Council on behalf of the Ministry of Health :— Abergele Emergency Hospital, Kinmel Hall, Abergele, North Wales—188 beds for male patients and 12 beds for Service casualties. The hospital was opened on 22nd August, 1944. The bulk of the patients were from Colindale Hospital. Naburn Emergency Hospital, near York—360 beds for male patients. The hospital was opened on 22nd August, 1944. Patients were sent from Grove Park Hospital, from tuberculosis wards in the Council's general hospitals and from tuberculosis hospitals in London and the home counties. Stannington Emergency Hospital, near Morpeth -380 beds for children and young female adults suffering from pulmonary tuberculosis. The hospital was opened on 20th August, 1944, and contained the whole of the children from High Wood Hospital, Brentwood, together with a number of young women from the Northern Hospital and St. George's Home. On 10th September, 1944, a fourth hospital was opened, viz., Turnberry Emergency Hospital, near Girvan, Ayrshire, containing 200 beds for female chronic sick patients and was used mainly to accommodate small groups of patients scattered 33 in hospitals in Scotland who had been evacuated from hospitals in the London region. The total number of patients evacuated from the Council's hospitals was about 8,700. The total number of staff transferred was about 1,600. The emergency arrangements for maternity patients were to close the maternity units at New End Hospital and St. Olave's Hospital and to reduce (on the instructions of the Minister of Health) the accommodation in the remaining maternity units by about 50 per cent> of their normal capacity. The staff thus released were transferred to emergency maternity units in the " reception areas." In the middle of September, H.M. Government decided that any further general evacuation of hospital patients to the North should cease, but agreed that "trickle" evacuation to hospitals administered by the Council could continue. To assist in the matter of " devacuation" a "general reception unit" was.established at the Western Hospital, Seagrave Road, Fulham, where patients on discharge from the hospitals in the reception area were sent for collection by their parents and friends. Since this arrangement commenced in September, 1944, 200 patients were dealt with in the reception unit up to the end of the year. Throughout the year, seven hospitals remained closed, viz., Millfield Convalescent Home, Littlehampton ; Norwood Hospital for Children ; Princess Mary's Convalescent Hospital, Margate; St. Anne's Home, Heme Bay; St. Luke's Hospital, Lowestoft; St. Margaret's Hospital, Kentish Town ; and the South-Eastern Hospital, New Cross. Of the twenty-five acute general hospitals, five were closed for considerable periods during the year owing to serious bomb damage. Two remained closed at the end of the year. Acute general hospitals At the beginning of the year, 8,584 patients remained under treatment. The number rose to 9,003 on 19th January, 1944, and then fell steadily to 5,715 on 2nd August, 1944. After evacuation of the Council's hospitals in August, 1944, the number dropped to 3,405, the lowest figure for the year (on 23rd August, 1944). When evacuation ceased, early in September, the numbers again rose steadily ; and the number remaining at the end of the vear was 6.530. The maternity services were greatly disturbed by the short but intense period of enemy action in February, 1944, and from June to the end of the year by the flying bomb and rocket campaign. Strong pressure was put on all expectant mothers to evacuate to safer areas at the eighth month and to remain out of London as long as possible after confinement. The total number of births in the general hospitals during 1944 was 13,050 (live births, 12,612 ; stillbirths, 438), and there were 12,752 confinements. These figures are lower than those for 1943 (13,872 and 13,666 respectively), and the number of confinements is the lowest since 1934 (13,050). These two years (1944 and 1934) therefore form an interesting comparison, and it is noteworthy that the maternity death-rate has in the intervening period since 1934, fallen by more than half and the death-rate from sepsis alone, is less than onetenth of what it was in 1934. This is a remarkable tribute to the efficiency of the maternity service, because the disorganisation incidental to war and the uncertainty of the women's plans naturally interfered greatly with the continuity of ante-natal care. There are no records of the numbers of booked and emergency cases, respectively, but it is certain that the proportion of cases with no ante-natal care at all, or very intermittent care, has risen greatly. At one hospital where figures were available, the number of unbooked cases rose from 10 per cent, of the total women confined to over 40 per cent. It was found that insistence on evacuation (which was only accepted reluctantly even during the most dangerous period) deterred women from booking until they Maternity patients 34 were in labour, and the hospitals were obliged to accept them as emergencies. A number of other expectant mothers went into the country under the official evacuation scheme, but returned to London unannounced just before their confinement. The total number of maternal deaths was 25, 17 being directly due to pregnancy or confinement and 8 to causes associated with these conditions. This represents a maternal mortality of 1.91 per thousand total births, a decrease from the rate for 1943, which was 2.67. The number of maternity beds was decreased, and 523 beds (including 101 for ante-natal patients) were in occupation in ten units in the acute general hospitals. Chronic sick hospitals At the beginning of the year the number of beds provided in the chronic sick hospitals was 2,885. Until the evacuation of the Council's hospitals in August, 1944, referred to above, the whole of this accommodation, apart from a number of beds which could not be used owing to shortage of nursing and domestic staff, was fully occupied. After the evacuation, the only chronic sick hospitals remaining open were St. John's Hospital, Battersea, and St. Pancras Hospital. The number of chronic sick patients remaining in London hospitals at the end of the year was 555. Acute infectious hospitals The South-Eastern Hospital remained closed throughout the year. In the early part of the year there were a considerable number of scarlet fever cases requiring admission to hospital, and throughout the year the shortage of isolation accommodation and of nursing and domestic staff dominated the problem of fever hospital administration. Towards the end of 1944, it became obvious that London would once again be faced with a measles epidemic, although the scale of the epidemic could not be estimated owing to altered conditions occasioned by the evacuation of children from London. The highest number of fever patients under treatment during the year was 1,977 on 5th April, 1944. The lowest figure was 670 on 13th September, 1944. (mainly due to the considerable evacuation of the civilian population occasioned by the advent of flying bombs). . The total number of fever patients admitted was 15,782, compared with 24,085 in 1943. In addition to cases of infectious diseases, 3,727 non-fever patients were admitted to general wards in the acute infectious diseases hospitals. Smallpox Two cases of smallpox were admitted during the year to the Clandon Isolation Hospital, where, by agreement with the Surrey County Council, London cases are received. Tuberculosis hospitals Until the evacuation of hospitals in August, 1944, all available beds for tuberculosis were occupied with the exception of a number of beds at Grove Park Hospital which could not be opened owing to a shortage of nursing and domestic staff. Children's hospitals The scheme whereby children were transferred from Dulwich, St. Giles, Camberwell and St. James', Balham, Hospitals at an early stage of acute illness to Queen Mary's Hospital, Carshalton, continued until July, although the transfer of children under one year of age was stopped owing to extensive quarantine at Queen Mary's Hospital, Carshalton. During the period from January to July, 1944, 1,178 children were dealt with under this arrangement. Hospitals for epileptics war. The two hospitals for epileptics continued to provide treatment as before the The number of patients undergoing treatment remained fairly constant. Convalescent hospitals Princess Mary's Convalescent Hospital, Margate, remained closed throughout the year and a very limited number of convalescent adult patients were sent to Queen Mary's Hospital, Sidcup. A number of adult male and female convalescent patients were sent to voluntary establishments. Other hospitals The convalescent fever hospitals (Northern Hospital at Winchmore Hill and Southern and Joyce Green Hospitals at Dartford) continued to serve a useful function in receiving large numbers of patients suffering from non-infectious conditions from the inner hospitals. 35 Beds for patients suffering from venereal diseases were provided at Sheffield Street, Bethnal Green and St. Charles' Hospitals. Venereal diseases The numbers of patients admitted during 1944, compared with 1938 and are shown below:— 1938 1943 1944§ Acute general hospitals 173,796 142,772* 127,184* Chronic sick hospitals 10,014‡ 8,451 7,244 Convalescent hospitals (adults) 4,698 — — „ „ (children) 4,257 — — Convalescent fever hospitals 2,942 18,490† 17,076† Acute fever hospitals 33,159 27,204Ø 19,509Ø Tuberculosis hospitals 4,163 4,039Ø 2,496Ø Children's hospitals 5,489 5,763 3,929 Post-encephalitis lethargica unit 49 35 140** Venereal diseases hospitals 801 413 527 Nursery units — 180 31 Epileptic hospitals 237 174 297 Total 239,605 207,521 178,433 ¶ Admissions to public health hospitals * Includes Queen Mary's Hospital Sidcup. † Hospitals devoted wholly to non-fever patients. ‡ Includes 802 patients in social welfare establishments. ø Includes general medical patients § The figures for 1944 are provisional only. ** Includes 125 patients temporarily transferred during evacuation. ¶ In addition, 1,155 tuberculosis patients and 269 chronic sick patients were admitted to auxiliary hospitals administered by the Council in the north of England and Scotland On 15th and 17th December, 1944, the tuberculous patients at Naburn Emergency Hospital, York, were, at the instance of the Ministry of Health, returned to Grove Park and Colindale Hospitals. On 16th October, 1944, 70 patients suffering from pleural effusion who had been evacuated from Queen Mary's Hospital, Sidcup, to Hefferston Grange Sanatorium, Chester, were returned to Sidcup. Return of evacuated patients In February, 1944, approval was given to the establishment at Lambeth Hospital of an ophthalmic unit consisting of 64 beds for the admission of ophthalmic patients for whom the Royal Eye Hospital had no in-patient accommodation. The unit was opened on 20th June, 1944, but, owing to damage by enemy action, was closed on 30th June. It was partially reopened on 1st December, 1944. Lambeth Hospital ophthalmic unit The arrangements for the medical examination and treatment at the Council's hospitals of civil defence personnel, including ambulance, fire, rescue and debris clearance services staff, were continued throughout the year. Treatment of civil defence personnel During the past year, six legacies have been received for the benefit of certain of the Council's hospitals, viz., Bethnal Green Hospital (£55 and £155), Lewisham Hospital (£435), New End Hospital, Hampstead (£22 and £28), and St. Giles' Hospital, Camberwell (£25). In accordance with the Council's policy, the larger sums have been invested and the interest will be used for the benefit of the patients and staff of the hospitals concerned. Legacies to hospitals Samaritan Funds, from gifts received from ex-patients or their relatives, in gratitude for treatment received, have been opened at three more of the Council's hospitals during the past year. Samaritan Funds The arrangements made in 1935 between the Council and the Invalid Children's Aid Association, whereby the Council pays capitation grants to the Association in respect of children sent to convalescent homes, has been continued during the year. The number of children treated during 1944-45 was 650, compared with 1,570 during 1943-44 and 1,400 in 1942-3, but the reduced use of the facilities available will, it is anticipated, prove to be temporary. It was no doubt due largely to the flying bomb and rocket attacks. Invalid Children's Aid Association— convalescence of children In 1944 the amount ot work done by district medical officers showed a slight decrease compared with that in 1943, probably due to the evacuation of a number of District medical service 36 the old people, who form a large proportion of the patients, during the period of flying bomb and rocket attacks. The number of patients seen was 26,640 compared with 30,366 in 1943. These patients made 100,992 attendances at medical relief stations or doctors' private surgeries, and district medical officers paid 30,172 visits to patients in their homes. The comparable figures for 1943 were 122,694 attendances and 35,000 visits. District nursing service During the year the arrangements by which district nursing associations undertake district nursing work as necessary on the Council's behalf were continued. The nurses made 239,151 visits to patients of the district medical officers and to other persons for whose nursing care the Council is responsible. Of these visits, 97,453 were to administer insulin to diabetic patients ; the remainder were for general nursing. The comparable figure for 1943 was 247,255 visits (of which 104,548 were insulin visits). The amount of annual grant paid by the Council to the Central Council for District Nursing in London for distribution to the local associations was increased, an additional payment being made in view of increased expenditure by associations which resulted from the application of the Rushcliffe Committee's proposals regarding salaries of nurses. Voluntary medical assistance Advantage continued to be taken ot the services ot a number ot senior medical students and doctors of Allied nationalities who worked for short periods in the Council's hospitals in a voluntary capacity in order to gain experience. In most cases free residence in hospital was arranged in return for their services. Accommodation of nurses, etc. During the year accommodation in hospitals has been provided for short periods for nurses from provincial hospitals attending courses of instruction in London. Similar facilities have also been made available for a number of persons desirous of obtaining experience of various special types of hospital work, e.g., hospital cookery. Supply and repair of artificial limbs The arrangements with Queen Mary's, Roehampton, Hospital, for the supply and repair of artificial limbs following amputation (including the provision of meals, where necessary, for patients and their escorts) have been continued during the year. The scheme first came into operation in 1932 and since that date an average of about 200 applications have been referred annually to the hospital for this purpose. Each applicant is seen by the limb-fitting surgeon on the occasion of his first attendance, and, after fitting with a limb, arrangements are made, where necessary, for admission to the hospital for instruction in walking, etc. There can be no doubt that the scheme has proved a great success, and that the patients have derived great benefit from the skill and experience of the staff of the hospital. Great advances have been made in recent years in the application of scientific knowledge and mechanical improvements to artificial limbs, with the result that the modern limb may be worn without discomfort by any patient whose stump is in a reasonably good condition. The total number of applicants dealt with from all sources in 1944 was 177, compared with 186 in 1943. War work by patients It was found possible to secure tor some ot the patients at Queen Mary s Hospital, Sidcup, and St. David's Hospital, Edmonton, interesting work, carried out in the hospitals for firms of government contractors. From the total payments received and placed in the hospitals' canteen funds, awards of savings stamps were made tc individual working patients. Works The resumption during the year of air attacks by means of new weapons (flying bombs and rockets) inflicted, in the latter half of the year, further damage, in some cases extensive and serious, to hospital buildings. First-aid repairs and adaptations were carried out as far as possible to enable services to continue, but the devastation of residential property caused by these attacks was so widespread as to call for the utmost possible diversion of labour and material to the repair of dwelling-houses. The Council co-operated to that end by deciding in October that works to its own buddings should, until further order, be limited to maintenance work and work necessary to carry on essential services. 37 The top-floor wards of the general hospitals, at which the ward blocks are mostly multi-storied, had not been used during the war, in view of the greater risk of danger from air attack. With the improvement in the war situation in the latter part of the year it was decided to take these wards into use again, and the necessary reconditioning was authorised. Various works needed to meet the requirements of the Emergency Hospital Scheme of the Ministry of Health were carried out, including extended provision of facilities for " rehabilitation " of patients. The annexe to the nurses' home at King George V. Sanatorium, the erection of which was authorised in 1943, was completed. Alterations and adaptations required in connection with the establishment at Lambeth Hospital of an ophthalmological ward and of a hearing-aids clinic were carried out. Shortly before the war, it had been decided to discontinue the use of the "South Wharf," Rotherhithe, as a smallpox diagnosing and receiving station, and plans were under consideration for its replacement by a unit in Long Reach Smallpox Hospital by the adaptation and extension of the " Pier Buildings," but the outbreak of war prevented further progress. South Wharf was practically destroyed by enemy action in 1940, and, although alternative emergency arrangements had been made for the provision of accommodation for sporadic cases, it was felt, in view of outbreaks of smallpox which had occurred elsewhere in Great Britain and the wide responsibilities of the Council in regard to hospital accommodation (which include, by agreement, the areas of various other local authorities), that the replacement of the lost accommodation at South Wharf should not be further delayed. Accordingly, a revised scheme, designed to meet existing difficulties in regard to building work, was prepared and approved. Owing, however, to shortage of labour, it had not been possible to begin work before the end of the year. Preliminary steps were taken for the reopening of Princess Mary's Hospital, Margate, which has been closed since May, 1940, and expenditure was sanctioned on the replacement of the engineering equipment (including electro-medical apparatus), which had been removed and drawn on to meet current requirements of the service generally. Further accommodation was needed at the Hammersmith Disposal Depot, where equipment from closed hospitals and also, where necessary, from hospital buildings damaged in air raids is stored pending re-issue, and advantage was taken of the vacation of part of the ground floor of the premises by the London Auxiliary Ambulance Service in the latter part of the year to incorporate this portion into the depot, after adaptation for that purpose. The peace-time arrangements for medical education at the Council's general and special hospitals were continued with such modifications as were necessitated from time to time bv war-time conditions. Medical education Courses of instruction in infectious diseases at fever hospitals were attended by 512 students, of whom 76 were women. The scheme whereby, at two fever hospitals, students became resident while receiving instruction was continued. In the spring of 1944 a proposal was made that an L.C.C. clinical society should be formed. The aims were :— Medical Society of the L.C.C. service (а) To promote contact between the medical members of the medical service of the London County Council; (b) To encourage contact between the medical staffs of London County Council hospitals, and of neighbouring municipal and voluntary hospitals, and general medical practitioners ; (c) To provide opportunities for the study and discussion of clinical problems; 38 (d) To collaborate with the Clinical Research Committee of the public health department of the London County Council. The proposal has met with an enthusiastic reception and some 300 medical officers from the Council's staff have joined as foundation members. The honorary secretary is Dr. Eli Davis and the County Medical Officer of Health accepted the invitation of the Council of the Society to become its first president. Clinical Research Committee In June, 1939, the Clinical Research Committee, representative of medical officers in the Council's hospitals and laboratories, was established. Among its main objects are:— (1) To assist medical officers of the London County Council in research; (2) To advise medical officers in their researches and to assist in making available to them the resources of the Council hospitals and medical services; (3) To appoint sub-committees to make surveys of the results of treatment and to carry out special clinical investigations; (4) To report to the medical officer of health on the value of any particular line of research and the methods by which such could be assisted; (5) To consider and report to the medical officer of health, when requested, upon applications from outside workers for research facilities in the Council's hospitals; (6) To consider and report to the medical officer of health upon the use of new appliances and drugs; (7) To take any steps that may appear desirable for the furtherance of research in the Council's hospitals. The Committee has met regularly during the war and 27 meetings have been held up to December, 1944. Various sub-committees have been set up to carry out special investigations, and much work of an extremely useful nature has been carried out. Staff The Council adopted the recommendations contained in the second report of the Nurses Salaries (Rushcliffe) Committee relating to male nurses, public health nurses and nursing staff in residential nurseries. The recommendations of the Mental Nurses Sub-Committee of the Nurses Salaries Committee were also adopted, and applied so far as applicable to staff in the mental observation units. In connection with the provisions of the Nurses Act, 1943, requiring the undertaking of prescribed training by candidates for admission to the roll of assistant nurses to be kept by the General Nursing Council, a regional preliminary training school for assistant nurses was established at St. Francis Hospital. A new grade of nursing staff possessing prescribed Nursery Nurses' Certificates obtained after college training and designated nursery nurse, class I, was introduced for employment in nurseries. In view of the importance placed by Government departments on the rehabilitation and resettlement of disabled persons, the facilities available in the Council's general and special hospitals for this work were extended and developed. Doctors and physiotherapists were given facilities to attend special courses of instruction on rehabilitation at selected rehabilitation centres, and extended provision was made for the employment of occupational therapists and physical training instructresses. The considerable additional responsibility which necessarily devolved on most of the stewards and assistant stewards in the hospitals service from the outbreak of war was recognised by the grant of special allowances of varying amounts up to 39 £100 a year, with effect from 1st April, 1943. Some improvement was also made in the basic scales of pay of certain sections of the hospital clerical staff. As an experiment, clerks were authorised for work in certain out-patients' departments and receiving wards to ease the work of nursing staff and to effect a more rapid turnover and better organisation. A general increase in the basic remuneration of subordinate technical laboratory staff in the hospitals was effected, it having been felt that the importance and value of the work of the laboratory technicians justified an improvement in their pay. To increase the scope of the research work on gastro-enteritis which is being carried out at the North-Western Group Laboratory, the staff was increased by a position of junior bio-chemist (new grade). Improvements were made in the rates of pay of domestic assistants and laundry women in the hospitals service. These led to some minor adjustments in the pay of certain allied grades later in the year. At the same time a general improvement in the remuneration of resident domestic staff was made. In making these improvements, regard was had to the recommendations of the Hetherington Committee on the wages and conditions of employment of domestics. During the first half of the year the staffing position showed little change compared with 1943, and the shortage which had gradually been growing since the early days of the war became more acute. This shortage was slightly relieved when, owing to the flying-bomb attacks on London which commenced in June, a number of hospitals were evacuated and patients were transferred to hospitals in the provinces. A large proportion of nursing staff accompanied the patients, but most of the male and female domestic staff were immobilised because of their residence, and as far as possible they were reposted to other hospitals in London. This temporary gain was offset by the necessity for supplying domestic staff for the four hospitals which the Council opened outside London for the reception of evacuated patients. Local staff were available only to a limited extent, and difficulty in securing an adequate number of London volunteers resulted in a heavy burden being thrown upon the staff of these four hospitals. Only willing co-operation and hard work on the part of all concerned enabled the hospitals to be satisfactorily run. Special difficulties were encountered in maintaining the necessary minimum staffs of pharmacists, physiotherapists and radiographers and increased use had to be made of the services of unqualified dispensers and also, for locum tenens duties, of pharmaceutical students during their vacations. Dark-room technicians were employed to assist radiographers in three of the large X-ray departments. The second course of training for pupil radiographers was commenced at Hammersmith and Lambeth Hospitals-. Five pupils, who successfully completed their training in November, 1944, were appointed as radiographers in the hospitals service. Since the outbreak of war, 1,197 members of the hospitals permanent staff have been called up for service with H.M. Forces, including 49 medical officers, 79 female and 170 male nurses, 514 porters, 206 clerks and 179 miscellaneous grades; and in addition 24 male and 15 female members of the permanent staff have undertaken work in war industry or the Merchant Navy or the Women's Land Army or hospital nursing services. As regards temporary staff, 365 of all grades left to undertake war service. Forty-one members of the staff have been killed in action or have died on war service, while 95 members of the staff have been discharged from H.M. Forces and have returned to duty at the hospitals. 40 Group laboratories Pathological laboratory service The number of examinations (including post-mortem examinations) completed in the group laboratories during the year ended 31st December, 1944, compared with the year 1943, is given below:— Group laboratory 1944 1943 Archway, Highgate 38,115 36,918 Lambeth 35,471* 41,930* Lewisham 32,873 38,627 Joyce Green (subsidiary to Lewisham), Dartford 11,121 15,279 Mile End 29,802 36,500 North-Western, Hampstead 51,027 59,050 St. Mary Abbots, Kensington 27,007 44,226 Southern, Dartford 12,613 16,149 Total 238,029 288,679 * Exclusive of 35,867 examinations in 1944 and 38,097 in 1943 undertaken for St. Thomas's V.D. clinic by arrangement. The number of post-mortem examinations carried out by the Central Histological Laboratory staff during the year was 1,101 (1,215 in 1943) and the number of histological examinations carried out was 26,512 (29,923 in 1943). The year's work shows a total diminution of about 50,000 examinations, occasioned by the evacuation of hospitals in July, referred to above. Several of the group laboratories received fairly extensive damage during this period, particularly those at Lewisham, Mile End and St. Mary Abbots Hospitals. This greatly restricted activities. Hospital laboratories The total number 01 specimens exammed in the hospital laboratories, as distinct from the group laboratories, during the year was 230,935 (264,427 in 1943), and 2,430 post-mortem examinations (2,727 in 1943) were carried out in addition to those bv the pathologists. General The Council continued the supply throughout the year of consumable laboratory requisites and materials to Ministry of Health emergency laboratories in London and the provinces. The whole of the culture media required by the British, Canadian and United States Forces in Europe was also supplied from the Council's media establishment. During the year 19 students of the Royal Free Hospital School of Medicine attended for periods of one or two months each, at the group and histological laboratories, Archway Hospital, for instruction in laboratory methods and postmortem technique. The Royal Society of Medicine held a meeting at Archway Hospital in November at which interesting specimens were shown from some of the group laboratories. LONDON AMBULANCE SERVICE The year 1944 was marked by an intensification of the demands for auxiliary ambulances because of the renewal of air attacks, at first by piloted aircraft and later by flying bombs and rockets. The attack in the months of February and March made no heavy demands on the service, but was sufficiently severe to put the personnel on their toes and to make clear the value of the operational training which had been continuously maintained in the lull period. The Government's preparations for a renewal of air hostilities, which subsequently proved to be associated with the opening of the second front in Europe, also contributed to the maintenance of the morale of the service; prominent among these preparations was a scheme for reinforcing the civil defence services in London by resources from the provinces, or conversely according to the nature of the enemy's retaliatory measures. In the event, the London Ambulance Service proved adequate for all requirements. 41 The ambulance stations suffered considerable damage by enemy action during the year. On 23rd June, 1944, within a few days of the start of flying-bomb attack, Honeywell Road L.C.C. School, a part of which was occupied by auxiliary ambulance station 180, was heavily damaged, three members of the staff receiving injuries. The station remained in commission, however, working first from the air-raid shelter and then from premises which had been held in reserve to meet such a contingency. Subsequent major incidents included the total destruction of the premises occupied by auxiliary ambulance station 118 in Woolwich, when eight members of the staff were injured. The station was transferred to the premises of another station, where it remained in commission until other accommodation could be secured. The Brook ambulance station premises were totally destroyed by a rocket on 11th November, 1944, two members of the staff being killed and thirteen injured. This station was one of the five administrative centres of the ambulance service in the County of London, and one of the six peace-time general ambulance stations of the Council. Despite the inevitable dislocation, the station went into full commission with the willing co-operation of the staff on 13th November, 1944, at the premises of an auxiliary ambulance station in the area. A skeleton service was maintained between 11th and 13th November, and the station was out of commission for no more than a few hours. "G" (Poplar) accident ambulance station was heavily damaged—also by a rocket—on 7th March, 1945, but remained in commission. In addition to these incidents, nearly every ambulance station in the County was damaged to a lesser extent, often on more than one occasion; and, although repairs were always executed as quickly as practicable, the shortage of labour and materials inevitably resulted in some delay on occasion. Considerable credit is due to the members of the staff, who never allowed any resultant discomfort to interfere with their devotion to their duties. When the attacks by flying bombs eased in September, they were replaced by long-range rockets. These weapons were not so destructive of human life as some of the earlier weapons, at any rate within the County of London. A simple indication of the intensity of air attack is provided by the number of injured persons carried in ambulance vehicles to hospitals or first-aid posts. This standard is approximate only ; for a single unlucky hit from a lone plane may cause more casualties than many bombs dropped in a heavy raid if they chance to land on thinly populated territory. Again, if the enemy chooses to use incendiary bombs in profusion he may cause relatively few human casualties (as on 29th December, 1940) but a great deal of material destruction. The total number of air-raid casualties carried by the London Ambulance Service in 1940-1 was 27,991 ; the total number in June, July and August, 1944 (i.e., the period of flying bombs) was 13,088, and the total from September, 1944, to March, 1945, when rockets were the principal weapon used, was 4,742. The figures of the number of patients carried on the occasion of particularly heavy raids tell the same tale. On 7th/8th September, 1940. these numbered 1,202 ; on 16th/17th April, 1941, 2,475 and on 10th/llth May, 1941, 2,154. As against these records the highest number carried in any period of twenty-four hours as a result of VI attacks was 1,024 on 18th June, 1944 ; while the V2 maximum was on 8th March, 1945, when 260 patients were carried. The ambulance personnel responded with courage and enthusiasm to every demand made upon them. During the long period of quiet between the major attack and the flying bombs there had been many changes among the personnel. A large proportion of those with "blitz" experience had left the service, their places being taken by newcomers without first-hand experience of street work in air raids. A substantial proportion of these were directed to the service by the Ministry of Labour, and a higher proportion than in the past were unpaid part-timers, either voluntary or directees. The stress of air-raid conditions in the summer of 1944 welded all these elements into a unified body of brave and efficient auxiliaries. 42 From all parts of London favourable reports were received on the way in which the staff responded to calls, the quiet and expeditious manner in which they conveyed casualties to hospitals, and the tolerant manner in which they accepted the comfortless conditions of life which circumstances had forced upon them. One important result of the intensification of air attacks was that the auxiliary service ceased to be available to the same extent as before to provide assistance for the regular ambulance service. In May, 1944, the Director of the London Ambulance Service (also Deputy Medical Officer of Health), Colonel Andrew Topping, T.D., M.D., M.R.C.P., resigned his appointment in order to take up a position with U.N.R.R.A. Mr. A. G. Helhnan was appointed Director and Mr. L. Welsh Assistant Director. Before the flying-bomb attack it was possible to complete the competition for the auxiliary service Efficiency Cup, which was won for the second time in succession by station 180 (Honeywell Road School, Battersea); the Runners-up Cup was won by station 39 (St. Marylebone), also for the second time. The Director's Cup for the station showing the greatest improvement in the preceding twelve months went to station 103 (Stepney), and the First Aid Cup to station 191 (Garratt Lane School, Wandsworth). Two successive improvements in the pay of auxiliary staff were made by the Government in 1944, and the principle of increased remuneration according to length of service was established. The differences between the remuneration of men and women in the graded ranks of the service were not removed, in spite of strong representations by the Council to the Ministry of Home Security. During the year the Ministry decided to issue chevrons to members of the auxiliary service to indicate length of service and wound stripes for those who had been injured in the course of their duty. Throughout the year the reduction in the strength of the service had been almost continuous. The number of full-time personnel fell from 2,518 at the beginning of the year to 2,158 by September, when the Government decided on a further reduction of the order of 50 per cent. Although, in view of the rocket attacks, this figure was not attained, a large number of stations were closed and some of the personnel had to leave the service. The continuous process of closing stations and transferring vehicles, equipment and staff raised considerable difficulties in the operation of the service, but these were overcome. The regular service continued to work under conditions of no little difficulty owing to staff shortages and to the deterioration of the mechanical condition of the ambulances owing to lack of replacements. As one means of overcoming the latter difficulty some of the vehicles of the auxiliary fleet were converted by the provision of rear doors, windows, etc., to supplement the regular ambulance service until such time as it becomes practicable to purchase new vehicles. SCHOOL MEDICAL SERVICE Government evacuation scheme Certain classes of children were evacuated throughout the year to special parties, etc.. as follows :— To nursery, nursery school, and handicapped children 6,748 To national camp 3 To hostels (specially difficult children and children of mothers on essential war work) 70 To billets (secondary school children 493) (central school children 36) (technical school children 105) 634 Compulsory evacuations (Defence Regulation 31c) 5 Total 7,460 43 This compares with 4,362 during 1943. Soon after the opening, in June, of the flying bomb attacks, Plans V and VII were again brought into operation. The numbers evacuated from the County of London under these arrangements were:— Plan V (unaccompanied school children) 40,260 Plan VII (children accompanied by mothers)— Mothers 23,465 Under 5's 23,901 Over 5's 22,958 70,324 Total for flying-bomb evacuation 110,584 Total of all evacuated during 1944 118,044 Every evacuee from the County was medically examined on the day previous to leaving London and was cursorily inspected on the morning of evacuation. Some 200 doctors were employed in this connection. Details of the " special parties " in December were as follows:— Number of Number in Accompanies residence modation Residential nurseries (0-5 years) 25 705 897 „ nursery schools (2-5 years) 38 1,516 1,749 „ schools for physically defective and delicate children. 9 613 679 ,, „ for the mentally defective 7 664 735 „ „ blind, deaf, diabetic and those with tuberculous histories 11 502 577 Total 90 4,000 4,637 The arrangements made for the medical supervision of these parties are set out in the report for 1943. Medical inspection The number of elementary school children in London in December, 1943, was 247,204; by May, 1944, this had decreased to 239,902, and by the end of the year the number had further decreased to 175,445, with a school attendance rate of 84.7 per cent.; the number of schools open in December was 668 compared with 741 at the end of 1943. The usual four age group inspections were continued throughout the year. Particulars of detailed examinations at elementary schools during 1943 and 1944 are:— Age group 1944 1943 Entrants 23,614 29,949 Children aged 7 16,118 19,387 Children aged 11 17,857 22,940 Leavers aged 13 plus 21,809 24,626 79,398 96,902 Other ages 16,004 24,944 95,402 121,846 Children in special schools and classes 827 903 Total 96,229 122,749 "Other ages" refer to the children outside the usual age groups who returned and were examined because no recent medical records were available. The reduction on previous years is due to damage to schools, and to evacuation resulting from enemy attacks in March and in the latter half of the year. 44 Re-inspections of children previously noted with defects totalled 52,285. These inspections showed that, excluding dental cases, 89.3 per cent, were treated or discharged as no longer needing treatment; the remainder were still to be followed up. In addition, 30,360 inspections were made of children who were being given school meals on the advice of school doctors, head teachers or school care committees, and 28,582 of children about whom advice was required by teachers, care committees, etc. Including the evacuation examinations and the children seen in schools and at day centres for the treatment of rheumatism, vision, ear and nutritional defects, the total number of inspections made was 352,169, exclusive of 12,683 carried out at higher education institutions. These compare with 291,719 and 12,320 for 1943. The following comparisons relate to the children examined in the four age groups in the two most recent war-time years, and those examined in the same age groups in 1938, the last complete pre-war year of medical inspection:— Numbers examined 1944 79,398 1943 96,902 Percentages 1938 169,995 Nutrition unsatisfactory 5.65 6.00 6.6 Nits or pediculi—hair 1.75 2.15 2.3 Teeth—obvious decay 26.33 31.01 29.8 Vision—6/9 or worse (excluding entrants) 23.76 22.61 32.2 Adenoids and enlarged tonsils 6.5 7.6 9.2 Skin diseases 1.5 1.8 1.0 Enlarged glands 1.0 1.2 1.5 External eye disease 1.7 1.9 1.7 Otorrhœa 0.5 0.5 0.6 Defective hearing 0.3 0.3 0.2 Heart disease 0.7 0.8 1.4 Anæmia 0.3 0.3 0.4 Lung disease (not T.B.) 1.2 1.3 1.5 Tuberculosis (pulmonary) 0.06 0.07 0.04 ,, (other lesions) 0.05 0.1 0.02 Rickets (boys—entrants only) 1.2 1.4 1.0 (girls—entrants onlv 0.9 0.9 0.4 Nutrition The nutritional condition of the great majority of children still continues to be satisfactory. The percentage of children in each age group where nutritional condition was unsatisfactory (either slightly or grossly subnormal) is shown below Age group—boys and girls— 1944 1943 1938 Entrants ... 5-90 6-67 6-46 7 years old 7 -65 7-98 8-75 11 years old ... ... ... 5-83 5-75 8-75 Leavers (13 tH 3-75 3-86 4-47 Thus every age group shows an improvement over the 1938 assessments, although the 11 year olds in 1944 show a slight retrogression on the 1943 results. Satisfaction can be felt in regard to the improved physical condition of the entrants who in the previous war-time years had shown a deterioration on the 1938 estimations. Dental conditions Dental conditions noted at the routine age group medical inspections, which showed some retrogression in 1941, when the percentage of children with unsound teeth was recorded at 41 -4, are now showing an improvement on the pre-war standard. This is confirmed by the results of inspections by the dental surgeons, analyses of whose figures are :— Year Children inspected Percentage noted for treatment 1938 292.971 69 0 1941 62,631 79.4 1942 103.285 75.2 1943 136,239 700 1944 105,968 67.4 The percentage of children in each age group where nutritional condition was unsatisfactory (either slightly or grossly subnormal) is shown below:— Age group—boys and girls— 1944 1943 1938 Entrants 5.90 6.67 6.46 7 years old 7.65 7.98 8.75 11 years old 5.83 5.75 6.75 Leavers (13 †) 3.75 3.86 4.47 Thus every age group shows an improvement over the 1938 assessments, although the 11 year olds in 1944 show a slight retrogression on the 1943 results. Satisfaction can be felt in regard to the improved physical condition of the entrants who in the previous war-time years had shown a deterioration on the 1938 estimations. 45 The children inspected by the dental surgeons are spread over all ages and are not confined, as are the medical inspection returns, to the four routine age groups. Some improvement on 1943 is noted, as a result of medical inspections, in the condition of the hair, but, on the other hand, the school nurses' inspections showed a slight deterioration, since the percentage reported by the latter as verminous rose to 6.39, compared with 6.19 in 1943. Skin diseases show a declining incidence, compared with 1943, but the percentage (1.5) is still above that of 1938, which was 1.0 per cent. Cleanliness Two of the Borough Councils in west London continued to provide tree shower baths at the borough first-aid posts, 11,538 baths were thus given in 1944. One of the Council's school nurses attends these bathing centres. Verminous children are sent to be cleansed before using the baths. Bathing of schoolchildren The arrangements described in the report for 1942, generously made by a private concern for giving warm shower baths by means of a mobile bathing unit, continued until the middle of June when, owing to the flying bomb attacks, they were suspended until November, finally ceasing in December, when the unit was transferred for work in the liberated European countries. In one typical borough (Bermondsey), in 1944, 6,713 warm shower baths were given, bringing to 51,314 the total baths in that borough since the inception of the scheme. Medical treatment The following table gives for 1944, 1943, 1942, 1941 and 1938 the numbers of " new " cases treated (a) at the treatment centres and hospitals included in the Council's scheme ; and (b) in the rheumatism (hospital) units:— Medical treatment The following table gives for 1944, 1943, 1942, 1941 and 1938 the numbers of "new" cases treated (a) at the treatment centres and hospitals included in the Council's scheme ; and (b) in the rheumatism (hospital) units:— (a) 1944 1943 1942 1941 1938 Dental 46,703 66,410 56,890 33,074 138,639 Vision (refraction and squint) 16,497 18,868 15,073 8,672 37,359 Minor ailments 63,790 82,142 59,167 24,348 128,819 Ringworm 51 39 10 3 103 Ear, nose and throat 689 601 261 — 12,726 " Special ear " defects 493 812 431 194 1,830 Rheumatism (supervisory centres) 845 921 733 409 1,885 Nutritional defects 451 584 464 360 641 (b) 129,519 170,377 133,029 67,060 322,002 Rheumatism— Admitted to the Council's hospitals 418 555 358 248 2,026 Discharged 496 466 249 231 2,037 At the end of the year, 9 centres were open with accommodation for 180 children for the treatment of stammering and other speech defects. The number of children who attended these centres at some time during the twelve months was 439, of whom 32 were discharged as cured or very much improved. Speech defects The in-patient school centres for the treatment of defects of ear, nose and throat ceased to function at the outbreak of war, but the pre-war arrangements for the treatment of such defects were re-introduced at Belgrave Hospital in 1940 and the South-Eastern Hospital for Children in 1943. Of the 689 children treated at these hospitals, 457 were operated on for the removal of adenoids and/or enlarged tonsils. In 1938 the number of such operations carried out at 15 centres or hospitals included in the Council's school medical scheme was 8,894. Throughout the war, children in need of operative treatment for these conditions have been referred to the Council's general hospitals and dealt with there. No record is available of the number of school children so dealt with. Ear, nose and throat treatment Ihe unit from Queen Mary's Hospital, Carshalton, was transferred (with 156 patients) to Yorkshire in July owing to enemy attacks. While in Yorkshire, 129 children were admitted from London. The long journey thus found necessary was not to the advantage of the child patients, and, in many instances, children whose Rheumatism 46 case notes showed that the disease had entered on a period of quiescence, exhibited for four or five days after the journey, all the signs of an acute or sub-acute relapse. Nevertheless, the children on the whole did well and benefited greatly as a result of the escape from the strain and disturbance of air raids. Personal hygiene There were 1,196,951 examinations in schools for personal hygiene by the school nursing staff. Of these, 76,597, or 6.39 per cent, showed verminous infestation. Every infestation, however slight, is counted. The percentage is slightly more than that for 1943 (6.19) but is practically at the 1942 level (6.3), and compares with 7.3 per cent, in 1938. During the year, 48,727 (59,857 in 1943) children were dealt with at the children's bathing centres ; of these, 15,785 (23,805 in 1943) were suffering from scabies or impetigo. There appears to be a reduction in the incidence of scabies. This may be due to the operation of the Scabies Order, 1941. Under the provisions of the County of London (Scabies) Regulations, 1943, scabies was made a notifiable disease in London as from 1st August, 1943. By the end of the year 16,785 cases (all ages) were notified to the borough medical officers of health. Not all the children who attended the centres were sent as a result of the nurses' routine personal hygiene school inspections; a number came for treatment before being evacuated. Cleansing agents Lethane 384 special is now commonly used for dealing with verminous heads while benzyl benzoate is still the main treatment for scabies. Handicapped children In December, 1944, 44 special units for defective children were functioning in London. In all, 1,808 children were examined in London or in the reception areas as to their suitability for special education. Of these, 508 and 463, respectively, were certified as fit for instruction at day schools for the mentally or physically defective. Of the children attending and seen in special schools, and at the special parties for handicapped children, 57 were sufficiently improved to justify return to elementary school instruction, and 67 children over 14 years of age were released from special schools as being no longer certifiable. The number of London children accommodated in the Council's hospital schools at the end of December, 1944, was 801. Some of these hospital schools were in " evacuation " premises. Provision of meals The education officer has supplied the following information:— The numbers of children provided with school meals and milk in public elementary and secondary schools in London on a typical school day in June, 1944, were as follows:— Type of school No. in attendance on selected day Number who had meals Number who had milk Breakfast Dinner Tea 1/3 pint 2/3 pint Total Free Paying Free Paying Free Paying Free Paying Free Paying Free Paying Elementary 213,756 — 110 4,727 66,024 — 2,337 493 39,638 7,525 107,520 8,018 147,158 Secondary 110 70,751 2,337 40,131 115,045 155,176 17,394 — 10,767 — 9,125 3,228 12,353 Junior technical schools — — 2,435 — — — — Total — 110 83,953 2,337 49,256 118,273 167,529 In addition, 2,567 children attending day special schools had school dinner, making a total of 86,520 pupils having school dinner on the selected day. Of these, ' 47 only 2,575 were supplied by independent canteens, the remaining 83,945 being supplied by the Londoners' Meals and Rest Centre Services. The percentage of the number of children in attendance who had school meals and milk was :— Meals Milk Elementary 33.63 72.59 Secondary 65.27 61.96 The milk figures for elementary schools, which are as at 8th June, showed an unexpected fall as compared with those for February, 1944 (meals 33.62; milk 75.89). Similar figures for a typical day in October, 1944, were:— Type of school No. in attendance on selected day Number who had meals Number who had milk Breakfast Dinner Tea 1/3pint 2/3 pint Total Free Paying Free Paying Free Paying Free Paying Free Paying Free Paying Elementary 128,755 — 54 2,177 34,010 — 2,123 433 24,457 4,190 62,085 4,623 86,542 Secondary 54 36,187 2,123 24,890 66,275 91,165 15,897 10,039 — 8,351 1,460 9,811 Junior technical schools 3,406 — 2,011 — 1,690 217 1 ;907 Total — 54 48,237 2,123 34,931 67,952 102,883 In addition, 1,519 children attending day special schools had dinner, making a total of 49,756 pupils having school dinner on the selected day. The percentages of the number of children having milk and meals to the total number of children in attendance were as follows, the comparable figures in June, 1944, being given in brackets :— Meals Milk Elementary 28.10 (33. 63) 70.80 (72.59) Secondary 68.81 (65.27) 61.71 (61.96) It will be seen from the figures that in the elementary schools there was a slight fall in the percentage of children having milk, and a more pronounced fall in the percentage of children taking their mid-day meal at school. In the interval between the selected dates (8th June and 12th October) the numbers fell even lower. The October figures represent the recovery which had been achieved by the middle of that month. Since then the process of recovery continued, and on 24th November the percentage of children in elementary schools taking the mid-day meal had risen to 31.5. Infectious diseases in schools As in previous war-time years, the figures available on the incidence of infectious diseases are vitiated by reason of the movements of the school population, but the usual control arrangements were made. The co-operation with the Metropolitan Borough Councils in the arrangements for carrying out in schools and centres immunisation against diphtheria, was continued. In nineteen boroughs, the Council's school medical staff carried out the immunisation while in nine boroughs this work was done in the schools by the medical staff of the Borough Councils. In 1944 the number of children who received the full course from the Council's medical staff was 4,065, bringing up to 65,199 the total of children immunised in schools by the school medical staff since the issue in November, 1940, of a circular on this subject from the Ministry of Health and the Board of Education. A survey by the school nurses showed that in July, 1944, about 68 per cent, of the children on the rolls of the elementary schools had been immunised. Immunisation against diphtheria 48 Heavy work has again been thrown upon the teaching and attendance staff, etc., of the education officer's department, and the thanks of the service are due to them for the results achieved. Child guidance Reference was made in the last report to the decision of the Education Committee that, in order to ensure that "problem" children should at the earliest moment be given appropriate help, a conference of officers should be established as an experiment for one year in each of the nine educational divisions. The conferences began in June, and, although the procedure was disturbed by the flying bomb attack, some progress was made in the "sifting" of children nominated for consideration. All children recommended for child guidance treatment by these case conferences must receive the formal concurrence of the school medical officer before being officially referred to child guidance clinics. In respect of each child so referred to voluntary child guidance clinics, payments are made to the clinic at the rate of 15s. for the first visit, and 5s. for each subsequent visit. Between 1st April and 31st December, the Council accepted financial liability on this basis for 203 children. Teaching of mothercraft in schools It has been the practice, for many years, for instruction in mothercraft to be given in the Council's schools as part of the course in domestic science, stress being particularly laid upon the care of the toddler rather than the young baby. During the latter part of the year, following discussion with the Education Officer's department, it was decided to give more specific instruction to older girls in the care and routine of the babe. A comprehensive syllabus was drawn up, talks were arranged ranging from the objects of mothercraft through the routine care and feeding of, to the physical and mental development of, the child, with a final talk on the social services available for the mother and child. The course comprises twelve lectures, each of about 40 minutes, with added time for practical demonstration and discussion. The lecturers were school nursing sisters with special experience. Courses were given in five central schools and were an unqualified success. It is proposed to extend these courses to more schools when staff becomes available. War-time nurseries, play corners and play centres All play corners but one have now been converted into war-time nursery classes attached to nearby infants' schools. At the end of 1944, there were 16 war-time nursery classes, and one play corner providing for an average attendance of 350 children. All the children are supplied on the premises with mid-morning milk, cod-liver oil, orange juice, and dinners, and a number at war-time nursery classes also have breakfast and tea. All facilities for medical treatment and cleansing and infectious disease control are provided on the usual lines in the Council's school medical service ; and the children in the classes are medically inspected on lines adopted for the smaller pre-war nursery schools. At the end of the year, there were 98 evening play centres attended each evening by some 10,000 school children. Tea is provided at 67 of these centres and in addition 6 play centres open before morning school, providing breakfasts for 65 children a day. War-time nursery classes and play centres are provided primarily for children whose mothers are at work. 49 MENTAL HEALTH SERVICES The following table shows the number of mental patients of all classes undergoing treatment in mental hospitals and institutions for the mentally defective during 1944 :— Lunacy and Mental Treatment Acts Uncertified senile patients M.D. Acts Total Certified Volunary Temporary Sections 24 & 25 Patients at 1st Jan., 1944 17,940 1,479 14 2,971 1,005 7,403 30,812 Admission in 1944- 350 Direct 1,574 1,130 46 106 543 6,434 Indirect 2,473 64 - 148 — Exits in1944- Discharged recovered 501 371 14 - - 185 Discharged otherwise 2,865 778 25 29 71 4,839 Deaths 1,077 72 10 322 390 164 2,035 Total patients 31st Dec., 1944 17,544 1,452 11 2,874 1,087 7,404 30,372 Statistics In addition there were 3,807 mental defectives under statutory supervision in their own homes and 365 under statutory guardianship. The number of mental patients requiring treatment has continued to fall during 1944. The considerable increase in the number of indirect admissions was due to the necessity to transfer large blocks of patients because of damage to hospitals by bombing. This was also reflected in the increase in the number of patients discharged otherwise than recovered. The number of patients under treatment in the emergency hospitals attached to the mental health services during 1944 on the undermentioned dates were:— 1st January 2,989 1st April 3,478 1st July 1,809 1st September 1,344 31st December 2,343 In all, 29,500 patients passed through these hospitals during 1944. During the year Bexley, Cane Hill, St. Bernard's and St. Lawrence's Hospitals and Darenth Park were withdrawn from the Emergency Hospital Service, leaving Claybury, Friern, Horton, Mill Hill and Sutton Hospitals still in the scheme. Banstead Hospital continues to function as a military hospital. Additional facilities were provided at the psychiatric out-patient clinic tor children at the Maudsley Hospital to meet the needs of the education service following the setting up in each of the nine education administrative divisions of a conference to consider the cases of "problem" children, and the services of a psychiatrist from Mill Hill Emergency Hospital were made available to give advice to the case conferences. Child guidance It was decided that, after the war, when the centres re-open, the organisation and management of the Council's occupation centres for mentally defective children and young persons under supervision shall be transferred to the Education Committee. The labour shortage caused by the war has provided increasing opportunity for placing in employment higher grade patients from the Council's mental deficiency institutions, and at the end of 1944 there were 418 mental defectives on licence in outside paid employment found for them by the institutions. Occupation centres for the mentally defective Employment of defectives Arrangements were made, subject to certain conditions, for reports to be furnished by social workers employed in the mental health services to the Provisional National Council for Mental Health on persons coming within the scope of a scheme drawn After-care 50 up by the Board of Control in conjunction with Service and other Government departments for the provision of after-care for ex-members of H.M. Forces invalided from the services on account of psychiatric disabilities not requiring in-patient treatment. Research To enable the programme of approved research work undertaken in the mental health services under arrangements with the Rockefeller Foundation to be extended, additions and improvements were made to the central pathological laboratory at West Park Hospital, where the laboratory had been transferred from the Maudsley Hospital at the outbreak of the war. Medical adviser on mental health Dr. R. M. Stewart, medical superintendent of Leavesden Hospital, was appointed medical adviser on mental health, for which purpose he was seconded for part-time duty on the central staff to assist the medical officer of health on medical matters concerning the mental health services. Staff The year 1944, as was only to be expected in the fifth year of war, proved increasingly difficult in the matter of the staffing of the mental hospitals and ancillary services. Further call-up of male staff, coupled with the diminishing availability of young women for recruitment as nurses and domestics, made the administration of the mental hospitals an anxious task. None the less, the service was maintained at a creditable level of efficiency and, notwithstanding the staff limitations, the emergency hospital section was able to play an effective part in the care of civilian and Service sick, particularly, as regards the latter, following the invasion of Europe on D-Day, 6th June, 1944. The depleted staff deserve the highest praise for the devoted way in which they performed a duty which at no time was easy and which on occasions must have tried them to the limit. During the year the Mental Nurses Sub-Committee of the Committee on Salaries of Nurses which had been set up under the chairmanship of Lord Rushcliffe issued its report, a report hailed on all sides as the mental nurses charter. This report marked a great preliminary step forward towards the integration of mental nursing with the other branches of the nursing profession and the Council immediately adopted and applied the recommendations contained in the report. The basis of remuneraation of nurses, particularly for female nurses, was changed by the report and salaries for resident staff which hitherto had been based on a gross payment with charges for residential amenities now became payable on an emolument basis, i.e., a cash payment with free residential amenities. Such a change, particularly as it affected the basis of provision of meals for nurses, was not without its problems. Nevertheless, the change-over was effected with a minimum of difficulty, thanks largely to the cooperative spirit in which the recommendations of the Mental Nurses Sub-Committee were received by the staff. Arising out of the recommendations of that Sub-Committee certain new gradings were adopted by the Council, notably those relating to qualified tutors, a new departure for most mental hospitals in the country. The Council in deciding henceforth to employ qualified tutors for its student mental nurses decided also to award twelve scholarships a year to enable suitable candidates from its mental nurses to train to become qualified tutors. Farming operations During the year 1944, further areas of land amounting to 235 acreas were added to that already farmed by the mental health services, increasing the total acreage cultivated on 30th September, 1944, to 6,559 acres (3,793 arable and 2,766 grass). Figures for previous years were :— 30th September, 1943—6,324 acres (3,612 arable and 2,712 grass) 1942—5,983 „ (3,169 „ 2,814 „ ) 1941—5,144 „ (2,239 „ 2,905 „ ) At outbreak of war—2,789 „ (1,041 „ 1,748 „ ) In addition, approximately 250 acres of land attached to general and special hospitals and educational and social welfare establishments are under the general supervision of the Mental Hospitals (Farming Operations Sub-) Committee.