HOL 16 The Metropolitan Borough of Holborn. REPORT FOR THE YEAR 1920 OF The medical officer of health WILLIAM ARTHUR BOND, M.A., M.D., D.P.H., Camb., Bach. Surgery Camb., M.R.C.P.Lond. Fellow, Member of Council and late President of Metropolitan Branch, of the Society of Medical Officers of Health; Fellow, and Member of Council, late Hon. Sec. of the Royal Institute of Public Health; Member, late Lecturer and Demonstrator, of the Royal Sanitary Institute; late Medical Officer of Health of the St. Olave District, Southwark, and the Holborn District Board of Works; late Acting Medical Officer of Health of St. Margaret and St. John, Westminster; late Assistant and Deputy to the Medical Officer of Health of the City of London; late Examining Physician, Equitable Life Assurance Society, U.S.A.; late Surgeon Captain 2nd (now 6th) London Rifles, etc., etc. London: THE MORGAN REEVE CO., LTD., 20-22, goldsmith street, kingsway, w.c. 2. 1921. INDEX. Page Introduction and Brief Abstract of Report 1 Memorandum of Ministry of Health 1 Great Improvement in Sanitary and Health Conditions during the past 25 years 1 Self-Help to Health 2 Its Neglect and the attendant Unrest 3 Cordial Co-operation of all Classes required 3 Industrial Warfare, like International, disastrous to Health 3 More Sunshine for Ixsndon and other towns 3 Importance of increased Scientific Education and methods 3 Increased pre-war and health arrangements during 1920 4 Dental Clinics 4 Prevention of Venereal Diseases 4 ADDITIONAL DETAILS. Natural and Social Conditions of the District 6 Population and Houses., 6 Vital Statistics 6 Registered Births and Birth-rate 7 Corrected Births and Birth-rate 7 Mortality 8 Corrected Deaths and Death-rates 8 Deaths of Children under 15 years of Age 8 Infantile Mortality 8 Poor Law and Hospital Relief 9 8anitary Circumstances of the Borough 9 Scavenging 9 Removal of Manure 10 Sanitary Inspection of District 10 Premises and Occupations Controlled by By-laws or Regulations 10 By-laws as to houses let in lodgings 10 Common Lodging Houses 10 Smoke Abatement Offensive Fumes 11 National Rat Campaign 11 Food 12 Dairies, Cow-sheds and Milk-shops 12 Public Health (Milk and Cream) Regulation, 1912 12 Bakehouses 13 Places where Food is Prepared for Sale 13 Ice Cream 14 Sale of Food and Drugs Act 14 Milk (Mothers and Children) Order 14 Meat 14 Slaughter-House 14 Unsound Food 15 Prevalence of and Control over Infectious Diseases 15 Infectious Diseases Generally 15 Bacteriological Work 16 Disinfectious 17 Cleansing of Persons Act 17 Tuberculosis Notifications 17 Tuberculosis Dispensary 17 Report of Tuberculosis Officer 18 Venereal Diseases, Prevention of 20 Page Maternity and Child Welfare 22 Puerperal Fever 24 Ophthalmia Neonatorum 24 Measles 25 Whooping Cough 25 Epidemic Diarrhœa 25 Polio-myelitis 25 Dental Clinic 25 Nursing Arrangements 26 Sanitary Administration 26 Staff 26 Other Services 27 Housing 27 APPENDIX. Table I. Vital Statistics of Borough during 1920 and ten previous years 29 Table II. Causes of and Ages at Death—year 1920 30 Table III. Infantile Mortality during year 1920 31 Table IV. Cases of Infectious Disease Notified during year 1920 32 Table V. Notifications of Infectious Diseases 1920 and ten preceding years 33 Table VI. Proportion of Notifications of Infectious Diseases to Estimated Population in 1920 and preceding ten years 34 Table VII. Deaths from Epidemic Diseases 1920 and ten preceding years 35 Table VIII. Sanitary Inspectors' Work—Inspections, &c. 36 Table IX. Ditto Notices served 37 Table X. Summary as required by L.C.C. 39 Table XI. Factories, Workshops, &c. 40 (1) Inspections 40 (2) Defects found 40 (3) HomeWork 41 (4) Registered Workshops 42 (5) Other matters 42 Table XII. Legal Proceedings 43 Table XIII. Meteorology 45 Introduction to and brief Abstract of the REPORT OF THE Medical Officer of Health FOR THE YEAR 1920. PUBLIC HEALTH DEPARTMENT. 197, HIGH HOLBORN, W.C. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn. Ladies and Gentlemen, In accordance with the Memorandum of the Ministry of Health, this Annual Report for 1920, as the preceding one for 1919, gives fuller details than had been required during the War, and the various subjects are dealt with on the lines indicated, and the order specified therein. It is also again suggested that there should be much increased distribution of the same in order to engender a popular interest in the subject, and an enlightened public opinion which shall support the Local Authority in realising its high responsibilities for the health of its area. As this is my last Annual Report I have much satisfaction in referring to the great improvement in the sanitary and health conditions of the Borough since my appointment about 26 years ago. I was at first required to deal with the scandal of the Holborn "Outside" Meat Market (now in Finsbury), at which diseased meat could be sold with impunity. On my advice, a special Meat Inspector was appointed and for more than a year much of my time was taken up with inspections of diseased meat, and the very many legal proceedings connected therewith. The insanitary houses also required much attention and during my first year several areas were represented, in the largest the " Union Buildings Area " (between Gray's Inn Road and Leather Lane), the death rate was about 50 per thousand, the Phthisis death rate more than 12 per thousand. It was not till 1900, however, that the Official Inquiry was held and the area afterwards dealt with by the London County Council. This lead finally to the Houses for the Working Classes, called the Bourne Estate, and Coram, Dickens and Thackeray Buildings in Herbrand Street, Reid's Brewery Site and that in Herbrand Street being purchased to rehouse those displaced by the Scheme. The Italian Colony was first represented in 1901, and again in 1905, and after the "Inquiry" in the following year all the houses in all the Courts were demolished 2 and the sanitary condition of the remainder improved. The anticipated development for commercial purposes has been delayed by the War. The new Kingsway and the widening of part of Southampton Row led to the demolition of much insanitary property. The houses of nearly all the Mews of the Borough have now been demolished, either previously to 1909 or under the Housing Act of that year. Under the same Act a number of small areas, and a large number of insanitary houses and underground rooms have been dealt with. Since my appointment also a large majority of the tenement houses have been provided with additional sanitary accommodation and water supply, and the large fixed ashpits replaced by movable sanitary dustbins. Very great improvement has been effected in the removal of house refuse, for in 1895, there were 2,114 notices for the removal of refuse, mostly accumulations of several weeks, in the Eastern part of the Borough, the then Holborn District Board of Works, while in 1913, the year before the War, only seven genuine complaints of non-removal were received from the whole of the Borough. In March, 1896, a new Contract for the removal at least once a week was begun ; for many years there has been (except partially during the War) in addition to a large increasing amount of daily collection, at least a twice weekly collection. The improvements in the general sanitary conditions have been followed by improvements in the general health conditions and largely reduced death rates. The death rate, which in 1895 was 24 4 per thousand, was gradually with slight annual variations reduced to 14.4 in 1913, the year before the War, which unfortunately led to generally adverse health conditions and gradually increased civilian death rates, culminating in the epidemic of influenza of 1918 and a death rate of 22.3. Since the War these rates have been again diminishing to 16.4 in 1919 and 15.2 in 1920. The Phthisis death rates of the Borough have also been reduced from 3.24 per 1,000 in 1895 to 1.13 in 1920, with rises also during the War and falls since. The Infantile death rate has been reduced from the high rate of 185 per 1,000 births in 1895 to 66 last year. This is a most satisfactory indication of the great value of Maternity and Child Welfare Work, as the foundation of an A.l nation is the maintenance of the health of expectant mothers and their infants. In my Annual Report for 1919, I gave details respecting the great importance of Self Help to health. I pointed out the marvellous complexity of the human body; that it can in many ways be compared with a very complicated automatic machine; that Medical men study Nature's methods so that they can assist recovery from disease by acting as Nature's assistants. Therefore, when ill, at once call in a well trained doctor, as Nature can be assisted most efficaciously at the beginning of the disease before much damage has been caused. Much money is worse than wasted, because of the harm that is so frequently done by the indiscriminate use of drugs and specious quack medicines. Prevention is much better than cure, and everyone can act as Nature's assistant, especially in the prevention of disease by Self-Help. Man is a " bundle of habits " and I indicated the good habits necessary for the healthy 3 ment of life and work ; and that this Self-Help also promoted the welfare of his family and that of the community, and the formation of an enlightened public opinion. The neglect of this Self-Help and the attendant industrial unrest leading to ca'canny strikes and insensate sabotage and increasing unemployment are sapping the physical and moral stamina of the nation. For strikes in one trade generally lead to unemployment in other trades in an increasing vicious circle, thus, notwithstanding inadequate relief by demoralising doles and unemployment pay, leading to much suffering and physical deterioration of not only the original strikers and their innocent wives and children, but also of a rapidly increasing number of families. Much improvement can be effected by extension of co-operation between employers and employed, as by Whitley Councils, profit-sharing schemes, industrial medicine, industrial " Welfare " and " Service " Schemes. The results of industrial warfare, however, like those of international warfare, are so disastrous to the general health and welfare of the community, that it behoves all men of good will to make supreme efforts to secure willing and intelligent cooperation and rational methods of settling disputes. Good wages can only be deserved and permanently paid by honest work and endeavour. On account of the great importance of adequate steps being taken to reduce the impurity of the air we breathe, I may remind you that your Council in 1912 circulated more than 10,000 copies of a pamphlet, " More Sunshine for London." Although an average person consumes more than four times the weight of air that he does of food and water combined, it has required a disastrous coal strike to forcibly demonstrate the enormous reduction of the impurity of the air of our large cities than can be effected by less wasteful methods of using fuel. As Public Health and Welfare is simply applied Science, may I appeal for increased scientific education and methods, at least, in our Public Schools and Departments. Unless we become a more scientific nation, we shall not even continue to " muddle through." Mankind is still suffering severely from the manifold conflicting and warring superstitions and creeds (with their attendant untold hypocrisies and heresies, inquisitions and inhumanities,) all apparently founded upon and fostered by man's appalling ignorance of Nature. "Relativity" reigns in all regions and at all times, and Nature can only be more and more truly worshipped and obeyed, by Her more complete conquest, by Her many marvellous mysteries being made more and more manifest by individual and international research. 4 Like any animal, each one of us has been developed and evolved from a minute marvellously complex cell (the female ovum) after fertilization by one or more microscopic, actively motile, marvellously complex, tadpole-like cells (the male spermatozoa). . Science is also increasingly teaching us the wonderful defensive, recuperative and compensatory mechanisms that have been evolved in living organisms especially in the higher animals. In other spheres of Science I will allude to only a few of the more modern marvels such as aviation, X-rays, wireless telegraphy and telephony. Moreover the pursuit of Science adds enormously to the zest and rational enjoyment of life, provided Nature's beneficent laws of health have been fairly obeyed. Details are given respecting the further resumption of pre-war conditions, and the various improved sanitary changes. In January, 1920, Miss B. M. Kidd, M.B., was appointed Medical Officer of the Maternity Centres and has given much satisfaction. On account of the largely increased attendances of children at the Wednesday afternoon Clinics, an additional Clinic on Fridays was started in February, 1920. The Ante-natal Clinic which was begun in October, 1919, was continued during the year. The largely increased number of applications for free or assisted milk and other food, and the very detailed work connected therewith has occupied much of the time of the Public Health Department. The infantile death-rate of the Borough for last year was the lowest recorded, and was only 66 per 1,000 births in comparison with 75 for London. The Dental Clinic for mothers and young children was continued during the year, and as dental treatment for men and boys was also required, and especially for tuberculous cases of both sexes (and the prevention of the many serious illnesses due to dental defects), an evening Dental Clinic on Tuesdays was begun in October last, and the attendances have satisfactorily increased. The valuable services of the Dentist, Mr. Cecil Gray, are much appreciated by the patients. The essential biological functions of all living organisms are assimilation and reproduction, it is therefore requisite for good health both individually and racially that these functions should be maintained in good order. The whole history of mankind has, however, unfortunately shown that as the assimilative functions have been and are so frequently abused and impaired by excess and errors in eating and drinking, so also the reproductive by excess and lust and unnatural vices. In my preceding Annual Report for 1919, I endeavoured to give some simple teaching respecting the prevention of disease of the assimilative functions, and last year, 1920, the Council agreed to give simple concise teaching " What Every Man Should Know," respecting the prevention of Venereal Diseases. 5 Prudery, prejudice, ignorance, hypocrisy and cant have for too long kept these as " hidden " diseases. On account of the terrible ravages caused by them, not only on the guilty, but on multitudes of innocent women and children, I was glad that the Society for the Prevention of Venereal Diseases was formed the latter part of 191!) to propagate teaching respecting additional measures essential for their effective prevention. I congratulate the Holborn Council on having the moral courage to be the first of the London Cities and Boroughs to comply with the request of this Society. A Special Enquiry by a Committee of the National Birth Rate Commission, consisting of twenty eminent men and women with the Bishop of Birmingham as Chairman, took place last year, and in a recent Report recommended action similar to that already taken by the Holborn Council. I had the honour last December of giving evidence at this Enquiry. As correct teaching respecting continence is most important I also submitted a brief Thesis on this subject. Further details concerning these and other matters are given under their respective headings (see index). " Ring out old shapes of foul disease ; Ring out the narrowing lust of gold, Ring out the thousand wars of old, Ring in the thousand years of peace." " Ring in the love of truth and right, Ring in the common love of good." I desire to express my high appreciation of the willing assistance and hearty co-operation that I have received from the Mayors, the Chairmen, Vice-Chairmen and Members of my Committees and the Council generally, the principal officers and the staff during my tenure of Office. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, W. A. BOND, M.A., M.D., B.C., D.P.H.Camb., M.R.C.P.Lond., Medical Officer of Health. 30th April, 1921. 6 ADDITIONAL DETAILS. Natural and Social Conditions of the District. Population and Houses. The enumerated population at the Census taken on Sunday, April 2nd, 1911. was 49,357, a reduction of 10,048 on the previous census of 1901 or 10.9 per cent. During the previous decennium 1891-1901 there was a reduction of 7,376 or 11.0 per cent. The following estimate of population has been adopted for the calculation of the death-rate and birth-rate of the Borough for the year 1920—39,670. At the Census 1911 the number of inhabited buildings was 7,985, and uninhabited (i.e., used for business purposes only) 1,393, and 38 were in course of erection. 33T per cent. of the population lived in tenements of only one or two rooms and 59.5 per cent. in tenement, of 1—4 rooms. The density of the population was 122 persons per acre in comparison with 61 for London. Although the number of Hotels and Boarding Houses keeps increasing, the Borough is becoming less and less residential and more and more important as a business centre. The number of factories, workshops, workplaces and offices keeps increasing so that we have now a very large day population. The chief occupations of the Borough are : Professional (Law, Architecture, etc.) ; Public Societies' and Commercial Offices ; Hotels and Boarding Houses; Printing and Bookbinding; Metal Refining; Precious stones and general trades and businesses. Vital Statistics. The birth-rate of the Borough was 20.8 per 1,000 in comparison with 13.6 per 1,000 in 1919. The death-rate was 15.2 per 1,000 in comparison with 10.4 in 1919. The deathrates for 1918 and 1919 were very high especially on account of the very large number of deaths from influenza and respiratory diseases, many of which were really complications of influenza. The population last year in the 999 L.C.C. tenements in the Borough was estimated at 3,611. The number of deaths was 45 or a death-rate of 12.5 per 1,000. On the other hand the number of deaths of residents of Common Lodging Houses in the Borough, which contain 1,220 beds was 69, which estimated on the number of beds was a rate of 56.6 per 1,000. 7 The infantile mortality, i.e., the number of deaths of young children under one year of age per 1,000 corrected births was 66 for the year 1920 in comparison with 96 for the year 1919. Although the legititmate infantile mortality was only 60 per 1,000 the illegitimate mortality was 128 per 1,000, more than twice as much. Of the 603 deaths at all ages, 387 died in hospitals and public institutions either within or without the Borough. The principal causes of death for the year 1920 in comparison with 1919 were as follows:- 1920 1919 Influenza 11 46 Respiratory Diseases 123 112 Tuberculosis (all forms) 55 75 Cancer, Malignant Disease 57 60 Organic Heart Disease 69 58 Premature Birth, Congenital Malformation and Debility 17 18 Violent (including Suicide) 33 29 Seven Principal Epidemic Diseases, viz: Smallpox, Measles, Scarlet Fever, Diphtheria and Membranous Croup, Whooping Cough, Typhoid and Typhus Fevers and Diarrhoea (under two years) 27 14 Registered Births and Birth Rate. The total number of births registered in the Borough was 619, being 300 males and 319 females. Of the 619, 601 were legitimate and 18 illegitimate. The registered birth-rate per 1,000 of the population was 15.3. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 163 legitimate infants and 61 illegitimate infants whose mothers were residents of the Borough. Fifteen of the 601 registered legitimate births and 1 of the 18 illegitimate births were infants of mothers who were non-residents of the Borough. The corrected numbers therefore are as follows:— Year. Corrected number of Births of Residents. Corrected Birth-rate per 1000. Legitimate. Illegitimate. Total. 1920 749 78 827 20.8 1919 447 62 539 13.6 In London the corrected number of births was 120,529 or a rate of 26.5 per 1,000, in comparison with 18 3 for 1919. 8 Mortality. The total number of deaths registered in the Borough was 827, of which 472 were males and 355 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough:— INSTITUTION. Residents. Non-Residents. St. Giles and Bloomsbury. Holborn. St. Giles and Bloomsbury. Holborn. French Hospital 3 - 30 - Children's Hospital 2 15 — 357 National Hospital — 1 77 London Homoeopathic Hospital 3 11 — 66 Italian Hospital 3 10 16 Alexandra Hospital — — - 2 Private - - 15 4 Total ! 1 37 45 522 There were 339 deaths of Civil " Residents " in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 69 of whom were removed from Common Lodging Houses in the Borough. Corrected Deaths and Death-Rates, 1920, compared with 1919. Year. Total Deaths at all ages registered in District. Deaths in Public Institutions in District. Deaths of nonresidents of Borough registered in District. Deaths of Residents registered beyond the District. Nett Deaths at all ages. D«ath Rat* for Borough. Death Rate. Registration London. 1920 827 596 566 339 603 15.2 124 1919 920 639 618 322 624 164 134 For details of causes of and ages at death, see Appendix, Table II. Deaths of Children under 15 years of age. The total number of deaths of children under 15 years of age was 95, of which 55 were under one year of age, 12 from 1 to 2 years, 13 from 2 to 5 years, and 15 from 5 to 15 years. Infantile Mortality. The number of deaths of children under one year of age, and the number of deaths of children under one year of age per 1,000 corrected births, were the following :— 9 Year. Deaths under one year of age. Deaths under 1 year per 1000 corrected legitimate Births. Deaths under 1 year per 1000 corrected illegitimate Births. Deaths under 1 year per 1000 corrected Births. London. Deaths under 1 year. Deaths under 1 year per 1000 Births. 1920 55 60 128 66 9025 75 1919 52 75 258 96 — 85 Death-rate per 1,000 corrected births in 1920 and in ten preceding years during which details respecting births have been supplied. 1910.. 1911. 1912. 1913 1914. 1915. 1916. 1917. 1918. 1919. Av'ge 1910-19 1920. Holborn Borough 100 113 78 100 88 96 97 107 141 96 102 66 London l°3 129 91 105 IOI 112 89 i°3 j°7 85 I°3 75 See also Appendix, Table III. Poor Law and Hospital Relief. The Clerk to the Guardians of the Holborn Union has kindly supplied me with the following information relating to persons from the Holborn Division of the Union who received Poor Law Relief during the year 1920. Number of Persons Indoor Relief 1,219 Outdoor Relief 346 Outdoor Medical Relief 46 Total 1,611 Of the total number of deaths 3S7 died in hospitals and public institutions either within or without the Borough. Sanitary Circumstances of the Borough. Scavenging. The removal of house and trade refuse which was transferred to the Public Health Department in June, 1905, is carried out by Contract. The number of complaints received was gradually reduced until in 1913, the year before the war, only seven genuine complaints respecting the non-removal of house refuse were received from householders in the whole Borough. In the main thoroughfares and in a number of other principal streets, there is a daily collection. In the remainder of the streets before the war there used to be a collection at least twice in every week. During the War in a number of streets in which there was not a daily collection, it was found to be impracticable to continue the 10 at least twice weekly collection, but this removal twice each week was gradually resumed and completed last year, and the work was generally satisfactorily carried out. In a very large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins. The number of notices served for the absence of, or defective, ashbin was 101. Removal of Manure. The removal of manure from the various mews in the Borough was satisfactorily carried out during the year. Again no complaint was received. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-laws or Regulations. In addition to my many inspections, the Sanitary Inspectors made about 22,000 varied inspections, each inspection frequently covering a number of different sanitary matters. The total number of notices served for nuisances found in dwelling houses and factories, workshops and workplaces, and premises that are subject to various by-laws, was 2,098, viz. :— Public Health (London) Act, 1891— Intimation Notices 893 Statutory Notices 171 By-laws as to Houses let in Lodgings 932 London County Council (General Powers) Act, 1904— Vermin 89 Rats and Mice (Destruction) Act, 1919 13 2,098 These notices were generally complied with. For those in which legal proceedings were necessary, see Table XII Appendix. By-Laws as to Houses let in Lodgings. At the end of the year, 603 houses were registered under these By-laws, of these, 305 are in St. Giles and Bloomsbury, and 298 in the Holborn District; 10 such houses were removed from the Register principally on account of the closing or demolition of the houses, and in some cases because the houses are now occupied only by members of one family, and 3 were added to the Register. During the year, there were 841 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. One notice was served for an overcrowded room, and 322 notices for other breaches of the By-laws, exclusive of 609 notices that were served for annual cleansing as required by the By-laws. Common Lodging Houses Acts, 1851 and 1853. The following is a list of the Common Lodging Houses registered in this Borough at the end of the year 1919 :— Of these 14 are in St. Giles and Bloomsbury for 1,060 lodgers „ 3 „ Holborn District for 160 Total 17 in the Borough for 1,220 „ 11 St. Giles and Bloomsbury. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. 6, Bettertcn Street 83 M 1-7, Macklin Street 96 M 2, Kennedy Court 8 w 19, do. 40 W 3, do. 10 w 21, do. 20 W 4, do. 19 w Parker Street Municipal 345 M 5, do. 8 w 7, 9, and 11, Short's 6, do. 8 w Gardens, and 311 M 7, do. 9 w 3, Neal's Yard ) 8, do. 34 w 6 and 7, Wild Court 63 M Holbom District. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. 40, Eagle Street 50 M 12 and 13, Took's Court 110 M These are principally under the supervision of the London County Council. Smoke Abatement. The smoke shafts in the Borough were frequently kept under observation and in 54 cases the inspections were recorded. Eleven complaints were received and six notices served, including one Statutory notice. Offensive Fumes from Laboratory. A number of complaints were received about the same time of much nuisance caused by offensive fumes from a laboratory. On inspection these were found to be sulphuretted hydrogen from the work carried on. The Directors of the Company at once made arrangements for the transfer of this work to other premises outside the Borough. National Rat Campaign. With a view to inaugurating an effective campaign throughout the country, it was suggested by the Board of Agriculture and Fisheries, that " Rat Weeks " should be arranged in the district of every Local Authority, namely, October 20th to 27th, 1919, 29th December, 1919 to January 3rd, 1920 and February 23rd to March 1st, 1920, and again from the 1st to 7th November, 1920. As mentioned in my last Annual Report, the matter received my careful attention and " Rat Weeks " were accordingly arranged in this Borough for cach 12 of those weeks. The premises where the rats had not been completely exterminated, also received much attention during the intervals, and this attention is still being continued. Prior to the first rat week, a very large number of restaurant and other premises known to harbour rats were inspected and directions given for steps to be taken for the extermination of the rats. In the majority of cases the rats have been exterminated, or their numbers very much reduced. The work required a very large number of inspections and re-inspections and the work is still being continued. The Rats and Mice (Destruction) Act, 1919, came into operation on the 1st day of January, 1920, and the Council authorised the Medical Officer of Health and the sanitary inspectors to enforce the Act in the Borough. In the majority of cases the owners at once agreed to take the steps required. Only 13 notices were served and it was unnecessary to take legal proceedings. Dairies, Cowsheds and Milkshops. The number of registered dairies and milkshops in the Borough at the end of the year was 156. Six dairies and milkshops were newly registered, and nine were removed from the register. In addition to my inspections the Sanitary Inspectors made 181 inspections of these premises, and one notice was served for sanitary defects or breaches of regulations, and in some cases alterations were carried out without the service of notices. Public Health (Milk & Cream) Regulations, 1912 & 1917. The following particulars of proceedings taken in the year 1920, under the above Regulations made in pursuance of the Public Health (Regulations of Food) Act, 1907, are given in the form suggested by the Local Government Board in their circular letter dated 27th October, 1913, and a copy was sent to the Ministry of Health in January, 1921. Food. 1. Milk and Cream not sold as Preserved Cream. (a) .(b) Number of Samples examined Number in which a preservative was for the presence of preservatives reported to be present and percentage of preservatives found in each sample. Milk 274 0 Cream 6 1 containing Boric Acid 0.248% Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. Milk nil. Cream. Boric Acid 0.248 per cent. 13 Vendor interviewed by Public Health Committee. Explanation satisfactory. Vendor cautioned. 2. Cream sold as Preserved. Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives were correct:— (I). Correct statements made 2 (II). Statements incorrect 0 2 (III). Percentage of preservative Percentage stated on found in each sample. Statutory label. 0.295 per cent. not exceeding 0.5 per cent. 0.248 per cent. not exceeding 0.4 per cent. (b) Determination made of milk fat in cream sold as preserved cream :— (I). Above 35 per cent 2 (II). Below 35 per cent. 0 2 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed :— None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. None. 3. Thickening Substances. Any evidence of their addition to cream or to preserved cream. Action taken where found. None found. 4. Other Observations (if any) None. Bakehouses. At the end of the year 1920 there were 29 bakehouses in the Borough of which 10 were factory bakehouses. During the year in addition to my inspections, there were 106 inspections of bakehouses. One notice was served for Sanitary defects. Places where Food is prepared for Sale. Under this head are included kitchens of hotels, restaurants and eating-houses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food is prepared for sale, excluding bakehouses which are given above. 14 The number of these places on the Register at the end of 1920 was 413 ; 1,756 inspections were made, and 29 notices were served during the year for sanitary defects found. In addition to the above inspections of places where food is prepared for sale, there were also 870 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are also regularly inspected on Saturday evenings and Sunday mornings. Ice Cream. During the year there were 31 premises in the Borough where ice cream was manufactured or sold, and in addition to my inspections .73 inspections of these premises were made. As ice cream is often made in the early morning, inspections between 6 and 9 a.m. were also occasionally made in order to ascertain whether there were any infringements of the London County Council (General Powers) Act, 1902. Sale of Food and. Drugs Acts.—About 500 samples, of which 274 were milk and 62 butter, were purchased by the Inspectors or their Agents and submitted to the Public Analyst. Of these only 14 or 2.8 per cent. were reported to be not genuine. Of these samples there were :— 274 Milk 9 not genuine = 3.3% 63 Butter 1 „ „ = 1.6% 23 Drugs 2 „ „ = 8.7% 204 Various foods 3 „ ,, = 1.4% The two samples of drugs reported to be not genuine were two of three samples taken of 33 per cent. calomel ointment, one of which was reported to contain 10.5 per cent. of calomel instead of 33 per cent., and the other 20.0 per cent. instead of 33 per cent. Milk (Mothers and Children) Order, 1919.—See page 23 under Maternity and Child Welfare. Meat.—All the butchers shops and market streets were frequently inspected, and, in addition, all the market streets (in which fish, fruit and vegetables are also sold) are regularly inspected on Saturday afternoons and Sunday mornings. Slaughter House. There has been only one slaughter house in the Borough, viz., 29 Red Lion Street, since 1905, which, in addition to my inspections was inspected on five occasions during the year. Sheep only are slaughtered. 15 Unsound Food. Applications were received for removal and destruction as trade refuse of the following articles of food, all of which were unsound and unfit for the food of man :— 9 cwt. 2 qrs. 15 lbs. Hams. 1 lb. 14 ozs. Bacon. 1 Side (2 qrs. 2 lbs.) Bacon. 100 lbs. Beef. 2l¾lbs. Butter. 20 (198 lbs.) Dutch Cheeses. 1 Barrel Herrings. 1 Box Cat Fish. 2 Boxes Cod. 6 Stone John Dory. 9 lbs. Sugar. 1 crate Peaches. 14 Cases Australian Jams and Fruits. 40 Jars Marmalade. 1 Case Marmalade in Cartons. 387 2 lb. Tins Australian Cherries. Prevalence of and Control over Infectious Diseases. Excluding Measles and German Measles the notification of which ceased at the end of 1919, the total number of notifications received during the year was 489 in comparison with 314 in the year 1919. The principal notifications were : 1920 1919 Diphtheria 146 88 Scarlet Fever 125 54 Tuberculosis (all forms) 123 94 Scarlet Fever and Diphtheria were again increasingly prevalent during last year in the Borough and in London generally. For some reason which has not yet been satisfactorily explained, the prevalence of Scarlet Fever in London during 1916 to 1918 was the lowest recorded since 1891. To some extent the increase in the notification of tuberculosis is due to a number of cases of Ex-Service men. Diphtheria.—Of 146 cases of diphtheria 12 were returned as not diphtheria. Four were apparently only bacteriological diphtheria as the diphtheria bacilli were found in the swabs taken before the removal of the patients. Only seven of the notified cases remained at home ; in three of these cases the bacteriological examinations were negative ; one was only bacteriological diphtheria and the remaining cases could be satisfactorily isolated at home. One notification was cancelled before removal as the result of the bacteriological examination was found to bo negative. There was one probable "return" case as a second case was notified 13 days after the return home of the first patient. Twenty-one of the notifications, 11 and 10 respectively, were from two residential homes of a business house containing about 550 and 300 residents respectively. On account of the occurrence of a case at the Kingsway Creche, 22 of the children were swabbed—only one was found to be positive and this one was not a resident in the Borough. 16 rate of only 3-4 per cent., which indicates that the cases generally were of a very mild type. Diphtheria anti-toxin was supplied free of charge on application by medical practitioners. During the year it was supplied in 27 cases. Scarlet Fever.—All the cases of Scarlet Fever were removed to hospital with the exception of three which were satisfactorily isolated at home. In eight of the cases during the year there was a second case. Seven of these were notified either at the same time or within a few days of the primary case. The remaining one was probably a " return " case as it was notified 10 days after the return of the primary case from hospital. Enteric Fever (Typhoid or Paratyphoid). In all six cases were notified during the year, including two of paratyphoid. Of the four cases of typhoid, at least three were not contracted in the Borough. Of the two cases of paratyphoid one was a student at Bedford College where a number of other cases occurred about the same time. An inquiry was conducted by the Ministry of Health which showed that the infection was probably spread by the cook who had contracted the disease. Encephalitis Lethargica.—Three cases of Encephalitis Lethargica were notified during the year, all of whom died. Pneumonia.—Twenty-six cases of pneumonia were notified during the year. As a number of medical practitioners were away during the war when the Regulations of January, 1919, were introduced, in cases in which death had occurred and no notification had been received, letters were sent to the respective medical practitioners asking for the reason of non-notification. Influenza.—There were only 11 deaths from influenza in comparison with 46 in 1919 and 138 in 1918. Thirty-four bottles of Government Anti-influenza Vaccine were given out to medical practitioners and hospitals, but 12 of these were not used. The forms required by the Ministry of Health to be filled up were afterwards obtained and forwarded to the Ministry. In a number of cases a second application for these forms was required. Non-Notifiable Infectious Diseases, Nursing Arrangements, etc.— For non-notifiable infectious diseases and for puerperal fever and ophthalmia neonatorum, see Maternity and Child Welfare, pages 24-26. Anthrax.-—It was ascertained that a large number of Japanese Shaving Brushes infected with Anthrax had been sold by Holborn Wholesale Merchants to chemists, etc., in many parts of the United Kingdom and the matter required much careful attention. Bacteriological Work. Bacteriological work for the Council is carried out by the Virol Research Laboratory at 10 Bedford Square, W.C.I. 17 The following table gives details of the examinations made during the year :— Diphtheria Enteric Fever. Consumption. Other Diseases. Number Submitted Result of Examination. Number Submitted Result of Examination Number Submitted Result of Examination. Number Submitted Result of Examin ation 75 15 bacilli not found I 1 Negative 87 78 bacilli not found 2 1 Negtive. 6o bacilli found (0 Positive 9 bacilli found 1 Positive Disinfections.—During the year 396 rooms and 4,287 articles of bedding, clothing, etc., were disinfected after various infectious diseases. Cleansing of Persons Act.—During the year 194 persons (187 men and 7 women) infested with vermin had their bodies and 3,100 articles of clothing disinfected, free of charge, at our cleansing stations at the Public Mortuary, Goldsmith Street. Tuberculosis. Tnberculosis Notifications. By the Public Health (Tuberculosis) Regulations, 1912, the notification of all forms of Tuberculosis was made compulsory. Excluding duplicates and military and naval cases the total number of notifications received was 123, of which 26 were private cases, 73 hospital cases, and 24 poor-law cases. Of these 111 were pulmonary cases and 12 non-pulmonary. Of the total number of cases 14, or 11.3 per cent., were residents of common lodging houses, and were all at once or soon afterwards removed to workhouse infirmaries. With few exceptions the remaining 109 lived in tenement houses, and 38 of these were removed to infirmary or hospital, 71 remaining at home, but some of these had previously been in infirmaries, hospitals or sanatoria. Some practitioners do not notify cases until tubercle bacilli have been found in the sputum, and a number of cases are not notified until shortly before death. The number of deaths from phthisis during the year was 45, or a death-rate of 1.13 per 1,000, in comparison with 1.76 for 1919. During the past year of the 45 deaths, 8 had been removed to infirmaries from common lodging houses in the Borough, that is about 17.7 per cent. Tuberculosis Dispensary.—Since February, 1915, the Council has made arrangements with the University College Hospital, conjointly with South St. Pancras, for dealing with cases of tuberculosis, including contacts, both insured and uninsured. 18 These are examined by the Tuberculosis Officer on Tuesday and Friday afternoons and Thursday evenings and the reports sent me and arrangements made for their removal to hospital or sanatoria when required. They are visited at their homes by the Tuberculosis Nurse, who reports to and consults with me weekly, and at other times in emergency. The following is the report of the Tuberculosis Officer, David William Fenwick Jones, M.B., B.S., for the year 1920. General Analysis of Cases. INSURED NON INSURED Male Female Male Female under 16 Totals Cases on Register on Dec. 31st, 1919 129 56 16 42 101 344 Number traced later as having died 10 4 0 1 0 5 Corrected Totals.. 119 52 16 41 101 329 In 1920 Old cases returned 1 3 I 0 0 5 New cases 35 22 7 18 56 138 Total cases in 1920 155 77 24 59 157 472 Number of cases dispensed with in 1920 36 17 1 9 10 73 Totals on Register on December 31 st, 1920 119 60 23 50 147 399 Detailed Analysis of Cases. Analysis of 73 Cases dispensed with in 1920. INSURED NON INSURED Male Female Male 1 Female under 16 Totals Left the Borough 27 12 1 4 6 50 Definitely Nontubereulous 3 0 0 3 2 8 Died 6 5 0 2 2 15 Totals 36 17 I 9 10 73 Analysis of 138 New Cases in 1930. INSURED NON INSURED Diagnosis Male Female Male Female under 16 Totals Pulmonary Tuberculosis 25 8 5 5 6 49 Non-Pulmonary Tuberculosis 1 0 0 0 4 5 Non-Tuberculous 7 11 '2 11 44 75 Doubtful Cases 2 3 0 2 2 9 Totals 35 22 7 18 56 138 19 Analysis of Treatment etc., of Cases on Register on December 81, 1920. Dispensary Domiciliary In Sanatoria or Hospitals Contacts Failed to attend Total 156 64 43 64 72 399 Treatment recommended during 1920. Dispensary Domiciliary Hospitals Sanatoria Conval. Homes. 16 8 27 16 2 Attendances, etc. Insured Non Insured Totals Attendances 537 406 943 Examinations 232 199 431 Referred to other Hospital Departments 6 8 14 (* = positive) Sputa examined 37 (4*) 14 (7*) 51 Supervision of Home Conditions, etc. Visits to Homes. Insured Non Insured Totals Nurses Visits 738 559 1297 Medical Officer's Visits 11 0 11 749 559 1308 64 Contacts. Adults Children Totals Found to be Tuberculous 0 2 2 Non-Tuberculous 22 38 60 Doubtful 1 1 2 23 41 64 Reports and Communications. Insured Non Insured Totals To Public Authorities 255 107 362 To Practitioners 16 2 18 Totals 271 109 380 The Interim Tuberculosis Care Committee met at the Dispensary monthly, the work of this Committee is most valuable. 20 Prevention of Venereal Diseases. Venereal Diseases cause untold misery, suffering, and early decay and death. Still worse they cause lifelong suffering to innocent wives who are frequently made either childless or have dead, diseased, blind, deaf, deformed or imbecile children. Although the methods of treatment of these diseases have been improved their permanent cure is still very frequently not effected, because of the difficulty of keeping patients under observation and treatment long enough to render them innocuous to other people. These treatment centres are also very costly. The most effective method of preventing infectious disease is to attack the chain of infection at its weakest link. The weakest link is when the germs are on the surface of the male organ before they have had time to penetrate into the tissues of the body. The germs of these diseases have been scientifically proved to be easily destroyed by disinfectants. Therefore the most effective way of preventing these diseases is by immediate self-disinfection. I was therefore very glad that the Society for the Prevention of Venereal Diseases was formed in the latter part of 1919, and on account of my known adherence to the above most effective method of prevention, I was invited to become a Member of the Grand Committee. The S.P.V.D. while advocating that no moral measures should be neglected, recognises the plain unsavoury fact that a large proportion of the adult population (notwithstanding all these measures) has practised irregular sexual intercourse, and it therefore recommends the teaching of simple but efficient methods of self-disinfection ; also that the prevention of disease by all practicable methods is the paramount duty of Sanitary Authorities. The older Society, the National Council for Combating Venereal Diseases, while advocating principally only moral measures which have obviously been ineffective, has, however, recommended the use of disinfectants at so-called early treatment centres which are really delayed disinfecting centres. In addition to the great cost of such centres there are also grave reasons rendering their provision by Sanitary Authorities impracticable. I am therefore glad that the Holborn Council has adopted not only the most efficient but the most inexpensive system, namely, education by means of posters and leaflets placed in men's underground conveniences. 50,000 of the leaflets are supplied at a cost of about £19, that is, less than Id. for 10. For aesthetic reasons also a man is much more likely to adopt self-disinfection than to go to a centre for disinfection by a skilled attendant. The Holborn leaflet gives concise information—" What Every Man Should Know " —respecting the terrible ravages caused by these diseases; that the only safe, right, and manly course is to exercise self-control; that prevention is infinitely better than cure ; and that it is therefore the bounden duty of any man who will indulge 21 in promiscuous sexual intercourse to adopt this disinfection in order to avoid disease, which he may pass on to innocent people. The poster has the same wording. On the back of the leaflet are simple directions respecting (i) immediate self-disinfection, (2) delayed self-disinfection, and the advice (3) if any symptoms of disease arise immediately to consult a doctor or attend one of the special clinics at a hospital. Posters respecting (3) are also exhibited. Although any fairly intelligent youth or man can very easily carry out the simple directions, human machinery like other machinery is not fool-proof. Much venereal disease is the sequel of foolish indulgence in alcoholic beverages, and if a man will so render himself temporarily idiotic or imbecile he probably then would be unable to carry out efficiently direction (1), therefore the directions (2) and (3) are also given. At a very largely attended meeting of the S.P.V.D. at the Mansion House, the Lord Mayor of London in the Chair, on February 5th, 11)20, resolutions recommending the above methods were carried unanimously. A Special Enquiry by a Committee of the National Birth Rate Commission consisting of 20 eminent men and women, with the Bishop of Birmingham as Chairman, took place last year, and in a recent Report recommended action similar to that already taken by the Holborn Council. I had the honour last December of giving evidence at this Enquiry. As correct teaching respecting continence is most important 1 prepared for that Special Enquiry a brief written Thesis, indicating from physiological, pathological and historical considerations, the following conclusions :— "Although Nature's law of reproduction renders early marriage at maturity Nature's ideal for securing a healthy virile race, it is probable that sexual continence, not only before such early marriages, but even in the celibate of both sexes, is consistent with healthy, mental and bodily activity." 22 Maternity and Child Welfare. The Maternity and Child Welfare Committee consists of 15 members, of whom 10 are members of the Council (including 3 women) and the remaining 5 are women, also qualified by training or experience in subjects relating to health and maternity. Much increased work has been carried out during the year in connection with maternity and child welfare and the attendances at the centres have increased. On account of the largely increased attendances of children at the Wednesday afternoon clinic, an additional clinic on Fridays was started in February last year. This clinic was held for some weeks on Friday mornings and later on Friday afternoons. The Ante Natal Clinic, on alternate Wednesday mornings, which was begun in October, 1919, was continued during the year. I regret that the Short's Gardens Centre at the London Medical Mission, Short's Gardens, had to be closed at the latter part of the year as the branch of the London Medical Mission was discontinued. Miss B. M. Kidd, M.B.Lond., was appointed Medical Officer of the two Municipal Centres at the beginning of the year in succession to Dr. Lucy Harry who had resigned. The Mary Ward Voluntary Centre, formerly called the Passmore Edwards Settlement School for Mothers and used jointly with South St. Pancras, was continued during the year. One of our Health Visitors continued to attend on Monday afternoons when most of the Holborn children attend. An increased grant was agreed to by the Council and approved by the Ministry of Health. Mothers attending the Centres at John Street and Short's Gardens took part in the National Mothercraft Competition in June, gaining a fourth and seventh place respectively. An exhibition of work done by the mothers attending both these Centres was held at John Street during Health Week in May. Prizes and certificates were kindly provided by the Mayor (Councillor William G. Coxen) and were distributed by the Mayoress. The number of Births, Infant Deaths, etc., in the year 1920 were as follows :— Births. Registered (1) Legitimate 749. (2) Illegitimate 78. (3) Total 827. Notified (1) Live Births 564 (2) Still Births 10. (3) Total 574. (1) By Midwives 315. (2) By Parents and Doctors 259. When it was ascertained that a birth had not been notified, the respective doctor, midwife or hospital was communicated with requesting the reason for non-notification. Infant Deaths. Number. (1) Legitimate 45. (2) Illegitimate 10. (3) Total 55. Rate per 1,000 births. (1) Do. 60. (2) Do. 128. (3) Do. 66. 23 Health Visitors.—Visits paid by Health Visitors during the year. To Expectant Mothers. (1) First Visits 44. (2) Total Visits 108. To Infants. (1) First Visits 687. (2) Total Visits to all children up to 5 years of age, 1534. One visit frequently includes a visit to several young children in the same family. Total number of Health Visitors attendances at the Centres during the year, 479. Attendance of mothers and children at Centres. John Street. Short's Gardens. Mary Ward. Total 5430 982 836 Weekly Average 108 19.5 16.5 Number of Individuals 553 112 83 The Council's Centres and Clinics were open during the year as follows :— Sessions. Day and Time of Meeting. Average Attendance Medical Supervision and Description of Session. 10 John Street Weekly Mon. 2 to 4 p.m. Mothers 17 Class for Mothers. Do. Do. Wed. 2 to 4 p.m. Children 43 Med. Off. attends for Infant Consultations. Do. Fortnightly Wed. 10 a.m. to 12 noon. Expectant Mothers 7 Med. Off. attends for Ante-natal Clinic. Do. Weekly Thurs. 2 to 4 p.m. Mothers 17 Class. Do. Do. Do. Mothers & Children 10 Dental Clinic. Do. Do. Fri. 2 to 4.30 p.m. Children 26 Med. Off. attends for Infant Consultations Med. Off. for Infant Consultations. 45 Short's Gardens Fortnightly Tues. 2 to 4 p.m. Do. 21 Do. Do. Mothers 10 Class. In addition to above several social functions were arranged for mothers attending the Centre during the year. Since the year 1906 arrangements have been made for the supply of prepared milk, for infants who cannot be breast fed, at a reduced rate per day on production of a Certificate from me. This milk was used by 120 infants during the year in comparison with 69 in 1919. The 120 included 17 who were still taking the milk at the beginning of 1920. The results, when prepared milk is properly used are most satisfactory. Of the 103 new certificates issued during the year, 44 were for full price payments and 59 necessitous mothers were assisted, including 18 free of cost. The Milk (Mothers and Children) Order, February, 1918, the principle of which had previously been carried out in this Borough by voluntary assistance, was at once adopted and was continued during the year 1919. This Order was revoked by the Milk (Mothers and Children) Order, 1919, dated 22nd December, 1919. The Council decided, instead of supplying milk under the New Order, to submit for the approval of the Ministry of Health a scheme under the Maternity and Child Welfare Act, 1918, for the supply of milk and food to necessitous expectant and nursing mothers, and young children under 5 years of age. This scheme was approved by the Ministry of Health and has been in operation throughout the year. 24 The scale of necessity that was provisionally adopted was the same as was being used in several large Boroughs. On account of the largely increased number of applications for assisted milk and food it was thought that stricter methods of enquiry respecting the family income should be adopted and we began to make inquiries through the Mutual Registration of Assistance to ascertain whether assistance was being given from other sources. It was also felt that some alteration in the scale of necessity should also be made. About a month after this system of additional enquiry had been in operation the matter was fully considered by the Maternity and Child Welfare Committee, and definite procedure was laid down for dealing with all applications. A revised and graduated scale of income was adopted and arrangements made for the verification of incomes given by applicants, by inquiries of employers, etc., and for preventing overlapping. A Rota Committee was appointed to meet weekly and all applications come before this Committee for primary consideration or review. The numerous enquiries and detailed work connected with the administration of the above, including the examination of the many milk accounts received monthly, occupied much of the time of the Public Health Department. Exclusive of prepared milk 356 cases received free or assisted milk or food during the year. This number included 90 who were receiving such assistance at the beginning of the year on orders issued in 1019. The 266 new cases received assistance on orders issued in 1920 as follows :— 109 Nursing mothers received free milk. 39 Expectant mothers received free milk. 70 Children under 5 years of age received free milk. 35 Nursing mothers received assisted milk. 10 Expectant mothers received assisted milk. 39 Children under 5 years of age received assisted milk. 30 Nursing mothers received free food (dinner or eggs). 14 Expectant mothers received free food (dinner or eggs). 6 Children under 5 years of age received free food (eggs). 2 Nursing mothers received assisted food (dinner or eggs). 1 Expectant mother received assisted food (dinner or eggs). 1 Child under 5 years of age received assisted food (eggs). 356 It will be seen that 356 orders were issued for 266 cases. This was necessary owing to many variations required in the orders, e.g., from free to assisted milk or vice versa, variations in quantity, etc. Puerperal Fever.—Only one case of puerperal fever was notified. The patient was removed to hospital and soon afterwards died. Ophthalmia Neonatorum.—The number of notifications of ophthalmia neonatorum received last year were 16, compared with only 7 in 1919, and an average of 6 25 in the preceding 9 years during which it was notifiable. Of these cases, 7 were attended by their own doctors, 4 at ophthalmic hospitals and 5 at other hospitals or infirmaries. One of the children died, three left their former address, and the remainder were reported to have recovered. A number of cases of ophthalmia apparently contracted more than 21 days after birth were also attended by the Bloomsbury nurses, mostly on the recommendation of the Medical Officer of the Maternity Centres. I do not know what proportion of the 16 cases notified were true gonorrhoeal ophthalmia as no bacteriological examinations were reported. From evidence by Dr. Niven, the Medical Officer of Health of Manchester, before the National Birth Rate Commission Special V.D. Enquiry, of the 2086 cases of opthalmia neonatorum notified in the years- 1915 to 30th June, 1920, inclusive—as many as 637, i.e., 30.5 per cent. were found to be not true gonorrhoeal ophthalmia. Measles.—The notification of measles was discontinued at the end of 1919, but during last year I received information, principally from school teachers, of 178 cases. Practically all were visited except those that were at once removed to hospital. Information was received that 19 cases were removed to hospital. Twelve of the cases received 242 visits by the nurses as mentioned below. Whooping Cough.—Whooping cough was first made notifiable in the Borough in 1914 for a period of 5 years, which was extended for a further period of 5 years from the 1st July, 1919. Only 12 notifications of the disease were received last year, all of which were visited and 3 received 39 visits by the nurses as mentioned below. Epidemic Diarrhoea.—This disease which is only notifiable in a few districts is not notifiable in this Borough. A number of cases were ascertained by the Health Visitors during their home visits. The number of deaths of young children under 2 years of age was 11, including 8 under 1 year. The methods adopted to diminish the mortality and permanent injury to health caused by this disease include the regular removal of house refuse and manure ; the use of prepared milk for infants who are not breast fed ; leaflets respecting the care of milk in the home, and the leaflet respecting the prevention of this disease issued by the National League for Health, Maternity and Child Welfare. Leaflets respecting the danger from flies are also used. Poliomyelitis.—Three cases were notified. Two of these completely recovered, but one is still at a hospital under treatment for paralysis principally of the left leg. One case was first notified as cerebro-spinal meningitis. Dental Clinic.—The Dental Clinic for Expectant and Nursing Mothers and Young Children which was begun in October, 1919, was continued during the year. The number of new patients during the year was 84, viz., 68 women and 16 children, and the number of attendances 426, being 383 women and 43 children. As good teeth are very important for the maintenance of health and especially for the prevention of tuberculosis and dietetic diseases, an evening dental clinic, specially for men and boys not attending school was started on the 12th October, 1920. The clinic is held weekly, on Tuesdays, from 7 to 8 p.m., for the poorer inhabitants of the Borough and from 8 to 9 p.m. for tuberculous patients. The number of new patients and 26 the number of attendances was at first very small but gradually increased, and during last quarter (i.e., the first quarter in 1921) the number of new patients was 24 and the number of attendances was 106. The excellent services of the dentist, Mr. Cecil 0. Gray, were much appreciated by the patients. Nursing Arrangements. Nursing arrangements have been made with the Metropolitan Nursing Association, No. 23 Bloomsbury Square for the nursing, when required, of necessitous cases of measles, whooping cough, ophthalmia neonatorum, diarrhoea and pneumonia. Fortunately there was no epidemic of measles, german measles or whooping cough, so that the cases requiring nursing were comparatively few, and only 488 visits were made by the nurses of the Association, viz :— Measles 12 Cases 242 Visits Whooping Cough 3 „ 39 ,, Ophthalmia Neonatorum 9 „ 192 ,, Pneumonia 2 ,, 15 „ Total 26 Cases 488 Visits Sanitary Administration and Other Services. Staff.—The following was the Staff during 1920. Medical Officer of Health—WILLIAM A. BOND, M.A., M.D., D.P.H.Camb., M.R.C.P.I.c.n Medical Officer of Maternity Centres—BEATRICE MARY KIDD, M.B.Lond. Medical Officer Tuberculosis Dispensary—DAVID W. FENWICK JONES, M.B., B.S Public Analyst—JAMES KEAR COLWELL, F.I.C. Sanitary Inspectors—ALBERT BENNETT. GEORGE F. CLARK. SAMUEL LARARD, M.R.San.I. Sanitary Inspector and Health Visitor—ETHEL JANE CHARLESWORTH. Health Visitor—ELIZABETH LISTER SHINNIE. Chief Clerk and Committee Clerk—EDWIN KENT. Assistant Clerks—FRANK FITCH. ARTHUR LONG. PHYLLIS BULL. Mortuary Keeper and Superintendent of Cleansing Station—CHARLES H. DAY. Superintendent of Women's Cleansing Station—ADELINE DAY. Caretaker of Maternity Centre—ELIZABETH ALDERTON. Home Help—ELIZABETH MOORE. Details of the work of the Sanitary Inspectors are given in Tables VIII, IX, X and XI. Legal proceedings that were required are given in Table XII. 27 Other details, the various changes that have been introduced, details respecting work under the Cleansing of Persons Act, bacteriological examinations and reports under the Sale of Food and Drugs Acts, etc., are reported under their various headings. In addition to the Services rendered by the Ministry of Health, the Home Office in connection with Factories, etc., the London County Council, the Metropolitan Asylums Board, the Metropolitan Water Board, the Registrar General for Statistical Returns, other Services arc rendered by the Holborn Board of Guardians for Vaccinations, the returns of births and deaths and the relief and treatment of the poor. Public Baths and Washhouses, a Public Library, a Public Mortuary and Coroner's Court are also provided. The return to pre-war conditions was further resumed during the year. The War Pensions Committee, which occupied much of the time of this Department, and especially of the Chief Clerk, who was Clerk to the Committee, was transferred to 29, Russell Square, at the latter part of April. Food Control work was also gradually diminished as the various Food Orders were revoked. Various improved Sanitary conditions have already been reported. On the other hand the largely increased applications for free or assisted milk and other food and the very detailed work connected therewith has occupied much of the time of the Public Health Department. HOUSING. In my Annual Report for the year 1919, I gave details respecting the general housing conditions of the Borough and of the changes that had taken place leading to a general increase in the value of land in Holborn, and making it increasingly difficult to find suitable sites for the erection of working class houses without heavy charges on the rates. I also reported that in the latter part of 1919, with a view to the erection of additional houses for the working classes, the following four sites were inspected, plans and estimates of expenditure and receipts were prepared, and carefully considered by the Housing Committee : The Italian Colony which was represented by me in 1905, and, after a Local Government Board Inquiry, was very much improved by the closing and demolition of the houses in all the small courts, and other sanitary defects remedied. A vacant site at the corner of Coram Street and Herbrand Street. Another vacant site in Herbrand Street and a vacant site in Short's Gardens, which had been purchased by the Council for housing and plans and estimates prepared in 1914. These sites, however, were finally not approved by the Ministry of Health in the early part of the year 1920. All the less sanitary houses are carefully inspected annually, and are dealt with from time to time, in accordance with the requirements. As reported in my last Annual Report for 1919, a Closing Order was made that year for the dwelling house No. 36 New North Street, and the two adjoining houses were closed voluntarily by the owners. A demolition order was withheld as alterations were being carried out. The whole ot the work agreed on was satisfactorily 28 carricd out, a great improvement being effected and all three houses rendered suitable for human habitation. The Closing and Demolition Orders were therefore determined. ("losing and Demolition Orders were made for 14 Red Lion Passage, the operation of the latter being suspended 011 the owner giving an undertaking to carry out the work necessary to render the house suitable for human habitation. In several other cases of houses which were reported 011 in detail for representation, the work required was voluntarily carried out by the owners, or the houses closed. 29 APPENDIX. TABLE I. Vital Statistics of Whole District during 1920 and Ten Previous Years. Name of District—The Metropolitan Borough of Holborn. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Nett Deaths bolonging to the District Under 1 Year of Age At all Ages Uncorrected Number Nett Number Rate of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate I 2 3 Number 4 Rate 5 6 7 8 9 10 II 12 13 i910 50.148 1.352 1,017 20.3 943 18.9 567 392 102 100 768 i5.4 1911 49,092 1.273 920 18.8 923 18.9 588 407 104 113 742 15.2 1912 48,026 1,250 901 18.8 907 18.9 549 357 70 78 715 14.9 i9i3† 46,949 868 797 16.7 910 19.9 583 358 80 100 685 14.4 1914 46,832 703 765 16.4 888 19.0 558 408 67 88 738 15.8 1915 40,405 594 670 14.4 876 21.8 559 385 64 96 702* 17.4 1916 38,161 564 649 15.7 768 20.2 498 395 63 96 665* 17.5 1917 35.303 474 571 14.5 865 24.5 567 390 62 109 688* 19.5 1918 36,769 340 497 12.1 862 23.4 532 490 70 141 820* 22.3 1919 38.156 397 539 13.6 920 24.1 618 322 52 96 624* 16.4 1920 39,676 619 827 20.6 827 20.6 568 339 55 66 603* 15.2 Area of District in acres (exclusive of area covered by water) 405.1 Total population at all ages 49,357 at Census of 1911. Number of inhabited houses 7,895 ,, „ Average number of persons per house 6.2 „ „ Total families or separate occupiers 11,030 ,, „ N.B.—In the above Table the populations, birth-rates and death rates for the years 1909-1914 Inclusive have been estimated from the Census Populations of 1901 and 1911. For the years 1915 to 1920 inclusive, the populations, births and birth-rates, death and death. rates, are as estimated by the Registrar-General, founded upon his estimates of the Civilian population. * Excluding Military and Naval cases. †53 weeks in Registration year. 30 TABLE II. CAUSES OF, AND AGES AT, DEATH, YEAR 1920. Causes of Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the District. Total Deaths whether of "Residents " or "NonResidents" in Institutions in the District. All Ages. Under 1 year. 1 and under ? years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards All causes Certified 603 55 12 13 15 15 82 182 229 596 Uncertified - - - - - - - - — 1. Enteric Fever - - - - - - - - - 1 2. Small Pox - - - - - - - 3. Measles 7 I 3 1 2 - - - - 1 4. Scarlet Fever 2 - 1 - 1 - - - 5. Whooping Cough 2 2 - - - - - - - 8 6. Diphtheria and Croup 5 1 3 1 - - - 6 7. Influenza 11 - - - - 4 3 4 7 8. Erysipelas 2 - - 1 1 - 1 9. Phthisis (Pulmonary Tuberculosis) 45 1 — 3 19 17 5 13 10. Tuberculous Meningitis 5 - 1 1 2 - 1 - - 35 11. Other Tuberculous Diseases 5 1 1 3 - - 31 12. Cancer, malignant disease 57 - — — , 1 2 31 23 37 13. Rheumatic Fever 3 2 1 - - - 12 14. Meningitis - - - - - - 22 x5- Organic Heart Disease 69 2 8 24 35 16 16. Bronchitis 59 3 1 4 10 41 5 17. Pneumonia (all forms) 60 14 3 3 1 1 11 18 9 56 18. Other diseases of respiratory organs 4 1 - - 2 1 13 19. Diarrhoea and Enteritis 19 8 3 - - 2 2 4 42 20. Appendicitis and Typhlitis 4 - 1 1 - 2 - - 21. Cirrhosis of Liver .. 10 - - - 1 6 3 1 21a. Alcoholism 1 - - - - - - - - - 22. Nephritis & Bright's Disease 14 - - - - - 1 8 5 12 23. Puerperal Fever 3 1 2 - - - 24. Other accidents and diseases of Pregnancy and Parturition - - - - - - - - - 2 25. Congenital Debility and Malformation, including Premature Birth 17 16 - - - 1 - - - 76 26. Violent Deaths, excluding Suicide 26 1 3 1 5 11 5 5 27. Suicide 7 - - - - - 3 1 - 28. Other Defined Diseases 166 8 — — 5 3 13 44 93 194 29. Diseases ill-defined or unknown - - - - - - - - - - 603 55 12 13 15 15 82 182 229 596 Sub- Entries, included in above figures 14 (a). Cerebo-spinal Meningitis - - - - - - - - - - 28 (a). Poliomyelitis * * * - - - - - - - - - - *Sub"Entries should here be made for other deaths which it is desirable to distinguish on account of their administrative importance or special interest {e g., any deaths from Anthrax, Typhus, or Glanders, which have been included under 28. Other Defined Diseases; or deaths from pneumonia other than broncho-pneumonia, which have been included under 17. Pneumonia all forms). 31 TABLE III. Infantile Mortality during the Year 1920. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12 Months Deaths under One Year. All Causes Certified 11 1 1 4 17 15 11 9 3 55 Uncertified — — — — — — — — — — Small Pox — — — — — — — — — — Chicken Pox — — — — — — — — — — Measles — — — — — — — 1 — 1 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 1 — 1 — 2 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — 1 — — 1 Meningitis (not Tuberculous) — — — — — — — 1 — 1 Convulsions — — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — — — 1 1 — 1 3 Pneumonia (all forms) 1 — — — 1 3 5 3 2 14 Diarrhœa — — — — — — — — — — Enteritis — — — 1 1 2 3 2 — 8 Gastritis — — — — — — — — — — Syphilis — — — — — — — 1 — 1 Rickets — — — — — — — — — — Suffocation, overlying 1 — — — 1 — — — — 1 Injury at birth 2 — — — 2 — — — — 2 Atelectasis — — — — — — — — — — Congenital Malformations — — — — — — — — — — Premature Birth 4 1 1 7 2 — — — 9 Atrophy, Debility, Marasmus 3 — — I 4 3 — — — 7 Other causes — — — 1 1 3 1 — — 5 11 1 1 4 17 15 11 9 3 55 Nett Births registered legitimate, - 749 Nett Deaths registered legitimate infants 45 during the calendar year illegitimate 78 during the calendar year of illegitimate „ 10 TABLE IV. Cases of Infectious Disease notified during the year 1920. Name of District—Holborn. Notifiable Disease Number of Cases Notified Total Cases notified in each Locality (e.g. Parish or Ward) of the District. Total Cases Removed to Hospitals At all Ages At Ages—Years. St. Giles and Bloomsbury. Holborn. Under 1. 1 to 5 5 to 15 15 to25 25 to 45 45to065 65 and upwards Small-pox — — — — — — — — — — — Cholera (C) Plague (P) — — — — — — — — — — — Diphtheria (including Membranous Croup) 146 1 28 59 35 21 2 52 94 137 Erysipelas 22 — — — 1 10 10 1 11 11 5 Scarlet Fever 125 2 22 82 15 4 — — 59 66 122 Typhus Fever — — — — — — — — — — — Enteric Fever 6 — — 1 2 3 — — 3 3 5 Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 1 — — — 1 — — — 1 — 1 Anthrax — — — — — — — — — — — Hydrophobia — — — — — — — — — — — Glanders — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — Acute Polio-myelitis 3 — 2 — 1 — — — 3 — 3 Ophthalmia Neonatorum 16 16 — — — — — — 4 12 8 Acute Polio Encephalitis — — — — — — — — — — — Encephalitis Lethargica 3 — — 1 — 1 1 — 3 — 2 Dysentery — — — — — — — — — — — Malaria 3 — — — 2 1 — — — 3 — Pneumonia—Primary 13 1 1 — — 4 6 1 10 3 7 do. Influenzal 13 — — 1 1 8 1 1 4 9 4 Trench Fever — — — — — — — — — — — Tuberculosis Pulmonary 111 — 1 3 21 50 34 2 63 48 47 do. Non-Pulmonary 12 — 3 3 3 2 — 1 7 5 5 Whooping Cough 15 2 10 3 — — — — 5 10 — 489 22 67 153 82 104 55 6 225 264 346 33 TABLE V. NOTIFICATIONS OF INFECTIOUS DISEASES IN THE BOROUGH DURING 1920 AND DURING THE PRECEDING TEN YEARS. (Excluding Naval and Military Cases) Disease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Annual Average 1920 Small-pox 0 0 0 0 0 0 0 0 1 0 0.1 0 Diphtheria and Membranous Croup 45 85 88 59 63 67 99 69 79 88 74 146 Erysipelas 42 37 48 29 22 28 22 15 10 25 28 22 Scarlet Fever 68 120 113 131 173 154 66 29 23 54 93 125 Typhus Fever 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever 25 10 12 7 15 6 9 2 2 2 9 6 Continued Fever 0 0 0 0 0 0 0 0 0 1 1 0 Puerperal Fever 0 2 0 1 4 2 2 0 0 0 1 1 Cerebro-spinal Fever 1 0 1 0 0 10 3 6 0 2 2 0 Acute Polio-myelitis — 0 0 2 0 0 3 0 1 0 0.7 3 Ophthalmia Neonatorum — 5 5 3 6 6 12 4 5 7 6 16 Tuberculosis Pulmonary 170 187 210 169 115 162 185 137 152 76 156 111 Do. Non-Pulmonary — — — 35 20 36 33 12 11 18 24 12 Total 35i 446 477 436 418 471 434 274 284 273 395 442 Chicken Pox was notifiable during the period in the above table as follows:— 1911 22nd March to 21st June - during which period 101 notifications were received 1915 17th March to 30th June - „ „ „ 27 1918 27th March to 30th June - „ „ „ 33 Measles and German Measles were notifiable from the 1st January, 1916, to the 31st December, 1919, during which period the following notifications of civil cases were received:— Measles German Measles 1916 163 90 1917 496 145 1918 148 39 1919 136 45 Whooping Cough was made notifiable in Holborn for 5 years from the 1st April, 1914, and was continued for a further 5 years from 1st October, 1919. Notifications have been received as follows:— 1914 77 1917 15 1915 92 1918 31 1916 21 1919 3 1920 15 34 TABLE VI. PROPORTION TO ESTIMATED POPULATION OF CASES OF INFECTIOUS DISEASES NOTIFIED DURING 1920 AND DURING THE PRECEDING TEN YEARS. Disease. Annual Rate per 1,000 Estimated Population to Middle of each Year. Annual Average. Rate per 1000 1920 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Small-pox 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 Diphtheria and Membranous Croup 0.90 1.74 1.83 1.23 1.35 1.66 2.60 1.95 2.15 2.31 1.77 3.68 Erysipelas 0.84 0.76 1.00 0.61 0.47 0.70 0.58 0.42 0.27 0.66 0.63 0.55 Scarlet Fever 1.36 2.45 2.36 2.75 3.71 3.82 1.73 0.82 0.63 1.41 2.10 3.15 Typhus Fever 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Enteric Fever 0.50 0.20 0.25 0.15 0.32 0.15 0.23 0.06 0.05 0.05 0.19 0.15 Continued Fever 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.00 0.00 Puerperal Fever 0.00 0.04 0.00 0.02 0.09 0.05 0.05 0.05 0.00 0.00 0.03 0.03 Cerebro-spinal Fever 0.02 0.00 0.02 0.00 0.00 0.24 0.07 0.17 0.00 0.05 0.06 0.00 Acute Polio-myelitis — 0.00 0.00 0.04 0.00 0.00 0.07 0.00 0.03 0.00 0.01 0.08 Ophthalmia Neonatorum 0.10 0.10 0.06 0.13 0.15 0.32 0.11 0.13 0.18 0.14 0.40 TuberculosisPulmonary 3.39 3.81 4.37 3.60 2.45 4.00 4.84 3.88 4.13 1.99 3.65 2.80 Do. Non-Pulmonary — — — 0.74 0.43 0.89 0.86 0.34 0.30 0.47 0.58 0.30 Total 7.01 9.10 9.93 9.20 8.95 11.66 0.35 7.80 7.72 7.14 9.16 11.14 35 TABLE VII. DEATHS FROM EPIDEMIC DISEASES OCCURRING IN THE BOROUGH DURING THE YEAR 1920 AND DURING THE PRECEDING TEN YEARS. Year. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Total. Diarrhœa Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 births 1910 — — 13 026 — — 4 0.08 16 0.32 4 0.08 37 0.73 6 59 1911 — __ 15 0.31 3 0.06 3 0.06 3 0.06 2 0.04 26 0.53 33 35.9 1912 — — 25 0.52 0 0.00 6 0.13 7 0.15 1 0.02 39 0.8l 8 8.8 1913 — — 7 0.15 0 0.00 4 0.08 6 0.13 0 0.02 17 0.36 12 15.1 1914 — — 11 0.24 2 0.04 3 0.06 9 0.19 6 0.13 31 0.66 11 14.4 1915 — — 19 0.47 1 0.02 11 0.27 12 0.30 1 0.02 44 1.09 11 16.4 1916 — — 3 0.08 2 0.05 10 0.26 4 0.11 — — 19 0.50 10 15.4 1917 — — 37 1.05 0 0.00 1 0.03 1 0.03 — — 39 1.10 9 15.7 1918 — — 6 0.16 0 0.00 5 0.14 13 0.35 3 0.08 27 0.73 9 18.1 1919 — — 1 0.03 — 6 0.16 — — 1 0.03 8 0.2I 6 11.l Average 10 years 19101919 — — 14 0.33 1 0.02 5 0.13 7 0.16 2 0.04 29 0.68 12 15.7 1920 — — 7 0.18 2 0.05 5 0.13 2 0.05 — — 16 0.40 11 13.3 London 1920 — 0.00 — 0.22 — 0.05 — 0.22 — 0.17 — 0.01 — 0.67 — 9.5 * The Registrar General since 1911 has taken the deaths from diarrhœa and enteritis under two years of age. TABLE VIII. SANITARY INSPECTORS WORK.-Inspections, etc. 1920. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Charlesworth Inspector Shinnie Whole Boro ++ Inspections Infectious Diseases 108 100 143 100 86 537 Dwelling Houses 99 280 59 1 — 439 Lodging Houses 343 206 137 151 4 841 Common Lodging Houses — 3 — — — 3 Dairies, Cowsheds and Milkshops 18 95 68 — — 181 Ice Cream—Manufacture or Storage 14 4 55 — — 73 Slaughter-house — 5 — — — 5 Market Streets 343 95 438 — 876 Butchers' Shops 478 8 268 — — 754 Bakehouses 14 53 39 — — 106 Fried Fish Shops 20 7 67 — — 94 Other Food Shops 284 74 300 — — 658 Laundries — — — — — Other Workshops 61 109 65 1 — 236 Out-Workers' Rooms and Registers 13 18 — 8 — 39 Other Workplaces 64 42 67 1 — 174 Factories (excluding Bakehouses and Laundries) 31 19 42 — — 92 Smoke shafts 45 7 2 — — 54 Urinals — 11 — — — 11 Miscellaneous 280 137 144 5 1 567 Periodical Inspections 1.591 2,171 3,527 — — 7,289 Dust 27 19 10 — — 56 Mews 76 24 — — — 100 Maternity — — — 318 349 667 Total Inspections 3,909 3,487 5.431 585 440 13,852 No. of Re-Inspections 1.407 1,712 997 216 — 4.332 Do. do. Maternity — — — 424 411 835 Visits other than Inspections and Re-Inspections 431 929 599 4 4 1,967 Do. do. Maternity — — — 98 169 267 Maternity Centres : Attendances — — — 223 246 469 Food Control—Visits and Inspections 50 156 81 — — 287 Total 5,797 6,284 7,108 1,550 1,270 22,009 *See also Periodical Inspections. †The majority of these are weekly inspections of Registered lodging houses. ‡A large number of inspections respecting the removal of Refuse is also made during General and Periodical Inspections of houses. TABLE IX. SANITARY INSPECTORS' WORK.—Notices served. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Charlesworth Total. Intimation Notices—Total served 195 426 216 56 893 Houses 166 363 158 55 742 The house or part of the house in a dirty condition 48 115 32 1 196 The house or part of the house in a damp condition 3 11 5 7 26 The house in a dilapidated condition 20 73 22 7 122 The watercloset so foul as to be a nuisance 14 24 5 43 Do. without a water supply 12 11 12 — 35 Do. with a deficient supply of water 7 26 1 13 47 Do. improperly constructed — — — — — Do. so defective as to be a nuisance 46 53 44 12 155 Do. stopped 19 32 21 9 81 Do. placed in an improper position — 1 1 Insufficient external ventilation to watercloset 6 6 Insufficient watercloset accommodation 2 1 1 4 Absence of watercloset accommodation 2 — — ___ 2 Absence of proper watercloset accommodation for persons of each sex See under Workshops &c. The soil pipe defective 2 2 — — 4 Do. unventilated 1 1 — — 2 Do. improperly ventilated 1 1 2 The yard paving defective 11 14 7 — 32 Do. dirty 1 17 4 2 24 Do. undrained — — — — — The area improperly paved — 1 — — 1 Do. dirty 2 27 1 — 30 Do. undrained — — — — — The inlet of surface drain improperly trapped — — A gully trap improperly placed within the house — — 1 1 The waste pipe of sink improperly connected with the drain — 2 2 Do. do. improperly trapped — 1 1 2 Do. do. untrapped 11 25 4 1 41 Do. of lavatory improperly connected with the drain — 1 — — 1 Do. do. improperly trapped — — — Do. do. untrapped — — — — — Do. of bath directly connected with the drain — — — — Do. do. improperly trapped — — Do. do. untrapped — — — — — The water cistern so foul as to be a nuisance 28 7 — 35 Do. being without a close fitting cover 4 1 1 6 Do. being placed in an improper position — — — — — Do. defective 1 29 — — 30 An accumulation or deposit of refuse 6 35 11 5 57 The absence of proper ashbin 27 15 2 — 44 The ashbin defective 21 19 7 1 48 The drain foul — — — — — Do. defective 1 13 5 — 19 Do. choked or stopped 8 36 5 4 53 Do. unventilated — — — — — TABLE IX.—continued, SANITARY INSPECTORS WORKS.—Notices served 1919.—continued. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Charlesworth Total. Houses—continued. The rainwater pipe in direct communication with the drain — — — — — Do. do. do. with the soil pipe — — — — — Do. do. defective 5 12 3 — 20 The water supply used for domestic purposes connected with the cistern which is used for flushing the watercloset — — — — — The absence of proper water supply 1 4 1 1 7 The roof defective 26 36 30 6 98 The guttering defective 4 8 2 1 15 The paving of wash-house defective.. — 7 — — 7 The want of proper manure receptacle — 1 — — 1 An animal kept in such place or manner as to be a nuisance 2 2 3 — 7 The house or part of the house overcrowded — 1 — — 1 An underground room occupied as a dwelling contrary to the provisions of the Act 1 2 1 — 4 The space below floor in the basement or ground floor being unventilated — 2 — — 2 Do. improperly or insufficiently ventilated — — — — — A chimney sending forth black smoke in such quantity as to be a nuisance See under Workshops A urinal improperly constructed, drained or offensive — — 1 — 1 Do. with no supply of water — — 1 — 1 Other nuisances 4 25 12 — 4' *Factories, Workshops and Work Places 29 63 58 1 151 Dirty 17 22 12 1 52 Waterclosets, defective or dirty 7 22 22 — 51 Do. insufficient 1 2 2 — 5 Do. absence of separate accommodation for sexes 2 2 3 7 Drains, soil pipes, &c., defective 4 26 9 — 37 Improperly ventilated — — — — — Overcrowded — — — — — Chimney sending forth black smoke 3 2 — — 5 Other nuisances 2 16 16 — 34 Ashbins 6 2 1 — 9 Breach of Bye-laws or Regulations— ‡ Lodging-houses 87 112 74 50 323 Dairies, cowsheds, milkshops and slaughterhouses — — — — — Keeping of animals — — — — — London County Council (General Powers) Acts Urinals — — — — — Verminous Rooms 16 37 18 18 89 Ashpits — — — — — Foodshops — — 3 — — Statutory Notices 36 70 57 8 171 *Many nuisances at workshops that are parts of dwelling houses, are included in the Intimation Notices served under "Houses." tMany breaches of bye laws are included in Intimation Notices served under "Houses." TABLE X. AS REQUIRED BY THE LONDON COUNTY COUNCIL. Premises. Number on register at end of 1919. Number of Inspections Number of prosecutions. Cowsheds 0 0 — Milkshops 156 l8l — Houses let in lodgings 603 841 37 Ice cream premises 31 73 — Slaughter houses 1 5 — Offensive Trades 0 0 — Smoke Nuisances— Number of observations 54 Number of notices 5 Number of nuisances and complaints 11 complaints Number of summonses 0 Housing of the Working Classes— Number of houses inspected 800 Number of houses dealt with under section 15 of the Housing, Town Planning, etc., Act, 1909 0 Number of representations by householders 0 Number of representations by Medical Officer 1 Number of houses included in such representations 1 Number of Closing Orders 1 Number of houses included in such Closing Orders 1 Number of Closing Orders determined 1 Number of houses remedied without Closing Orders — (A number of houses were remedied without the necessity for representation) Number of demolition orders 1 Number of houses demolished; (a) in pursuance of Orders 0 (b) voluntarily 0 Obstructive Buildings— Number of representations under Section 38 of the Housing Act, 1890 0 Number of buildings demolished 0 Number of representations still under consideration 0 Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 0 Number of houses repaired by local authorities 0 Number of houses closed on notice by owner that they could not be made fit 0 Total number of houses in the borough 9416 Number of houses occupied by the working classes 9021 tenements Number of houses for the working classes— (a) erected during year (b) in course of erection 0 Underground Rooms— Number illegally occupied 4 Number closed or illegal occupation discontinued 4 Overcrowding— Number of rooms overcrowded 2 Number remedied 2 Prosecutions 0 Cleansing— Number of adults cleansed 194 Number of children cleansed 0 Number of rooms or premises cleansed 89 (vermin) Prosecutions (vermin) 11 Water supply to tenement houses— Premises supplied 7 Prosecutions 0 Sale of Food— Number of premises used other than ice cream premises, milk shops and cowsheds.. 442 Number of Inspections 2493 Disinfection shelter— Persons accommodated 0 Ophthalmia neonatorum regulations— Number of notifications received during the year from certified mid wives 0 Sanitary officers— Number of Sanitary Inspectors (whole-time) - Male 3 Female 0 Number of Sanitary Inspectors (part-time) - Male 0 Female 1 Number of Health Visitors - whole time 1 part-time 1 40 TABLE XI. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. I—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number 0! Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories (including Factory Laundries) 92 21 1 — Workshops (including Workshop Laundries) 342 89 9 2 Workplaces 2,854 70 5 Total 3,288 180 15 2 2—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. *Nuisances under the Public Health Acts:— Want of cleanliness 52 52 — 2 Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 87 87 — — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 51 51 — — not separate for sexes 7 7 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) — — — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 202 202 — 2 * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. TABLE XI.—continued. 3.—HOME WORK. NATURE OF WORK.* Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances . Orders made (S. no) Prosecutions (Sections 109,110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists † Outworkers, f Lists. Outworkers. Contractors. Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (?) (8) (9) (10) (ii) (12) C3) (14) (15) (16) Wearing Apparel— (1) Making, &c. 88 223 280 5 10 13 — — — — — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household Linen — — — — — — — — — — — — — — — Lace, Lace Curtains and Nets — — — — — — — — — — — — — — — Curtains and Furniture — — — — — — — — — — — — — — — Hangings — — — — — — — — — — — — — — — Furniture and Upholstery — — — — — — — — — — — — — — — Electro Plate — — — — — — — — — — — — — — — File making — — — — — — — — — — — — — — — Brass and Brass Articles — — — — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables and Chains — — — — — — — — — — — — — — — Anchors and Grapnels — — — — — — — — — — — — — — — Cart Gear — — — — — — — — — — — — — — — Locks, Latches and Keys — — — — — — — — — — — — — — — Umbrellas, &c. — — — — — — — — — — — — — — — Artificial Flowers — — — — — — — — — — — — — — — Nits, other than Wire Nets.. — — — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — Sacs — — — — — — — — — — — — — — — Racquet and Tennis Balls — — — — — — — — — — — — — — — Paper Bags and Boxes 2 — 27 1 — 5 2 — — — — — — — — Brush making — — — — — — — — — — — — — — — Pea Picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, &c., of Buttons, &c. — — — — — — — — — — — — — — — Stuffed Toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Total 90 223 307 6 10 18 95 — — — — — — — — * if an occupier gives out work of more than one of the classes specified in column 1, and sub-divides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2, (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in column 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer-—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be approximately double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 42 TABLE XI.—continued. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (0 (*) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses (including 16 factory bakehouses) 29 Other Workshops 1.137 Total number of workshops on Register 1,166 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5) Notified by H.M. Inspector Report (action being taken) sent to H.M. Inspector 52 52 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 19 43 TABLE XII. LEGAL PROCEEDINGS. PUBLIC HEALTH (LONDON) ACT, 1891. Date Name and Address. Offence. Result. Dec. 11, 1919 1920 James Niven, 17, Betterton Street. Breach of Lodging House Bylaws. [Order made for work to be completed within 14 days. £5 5s. costs. Jan. 8, 22 James Niven, 21, Betterton Street. Breach of Lodging House Bylaws. " James Niven, 23, Betterton Street. Breach of Lodging House Bylaws. ) Jan. 30 J. Planter 54, New Compton Street. Dirty Workshop. Work done, Fined is. Costs 20s. Jan. 30 Alfred Humber, 69, New Compton Street. Breach of Lodging House Bylaws. Fined 40s. Costs 20s. Jan. 30 Alfred Humber, 70, New Compton Street. Breach of Lodging House Bylaws. Fined 40s. Costs 20s. Jan. 30 Alfred Humber, 71, New Compton Street. Breach of Lodging House Bylaws. Fined 40s. Costs 20s. Feb. 5 Whale & Co. 12, Hatton Garden. Dirty Workshop. W.C. stopped and defective. Work done. Summons withdrawn. Costs 21s. Jan. 30 J. Planter, 133, Shaftesbury Avenue. Breach of Lodging House Bylaws. Work done. Fined is. Costs. 21s. Feb. 25 Wheat & Luker, 6, Summer Street. Roof defective. Ceiling of 1st floor back broken. Work done. Summons withdrawn on payment of 10s. 6d. costs. May 3, 10 George F. Parsons, 153. High Holborn. Defective rainwater pipe. Work done. Ordered to pay 21s. costs. May 3 A. Neville, (The Regal Chocolate Co.) 23, Red Lion Street. Defective water-closet. Work done. Ordered to pay £2 2S. costs. June 8 Edgar Ball, 47, Eagle Street. Existing nuisance Summons withdrawn. £2 2s. costs. June 15 Edgar Ball, 49, Eagle Street. Existing nuisance and noncompliance with order. Work done. Summons withdrawn. Further order to complete in 14 days. June 15 Edgar Ball 49, Eagle Street. Existing nuisance and noncompliance with order. Further order to complete in 14 days. Oct. 7 F. D. W. Payne, 50, Devonshire Street. Breach of Lodging House Bylaws. 20s. costs. Oct. 7 F. D. W. Payne, 51, Devonshire Street. Breach of Lodging House Bylaws. 20s. costs. Oct. 7 F. D. W. Payne, 52, Devonshire Street. Breach of Lodging House Bylaws. 20s. costs. Oct. 7 F. D. W. Payne, 53, Devonshire Street. Breach of Lodging House Bylaws. 20s. costs. Oct. 27 & Nov. 5 Wheat & Luker, Nos. 13, 15, 17, Back Hill. Breach of Lodging House Bylaws. [Order made to complete work in 14 days. is. line on each Summons and three guineas costs. Nov. 5 Wheat & Luker, Nos. 6, 7, 10, 11, 14, 16, 18, 20, 22, 23, 24, 25, Eyre St. Hill. Breach of Lodging House Bylaws. Nov. 5 Wheat & Luker, 4J, Little Bath Street. Breach of Lodging House Bylaws. Nov. 5 Wheat & Luker, Nos. 2, 5, 6, 7, 8, 15, 16, 17 and 18,119, Summer Street. Breach of Lodging House Bylaws. 44 TABLE XII. Continued. Date 1920. Name and Address. Offence. Result. Nov. 11 John Planter, 45, New Compton Street. Nuisances. Fined 20s. ,, John Planter, 45, New Compton Street. Nuisances. Fined £3. ,, John Planter, 46, New Compton Street. Nuisances. Fined £3. ,, John Planter 47, New Compton Street. Nuisances. Fined £3. ,, John Planter, 47, New Compton Street. Nuisances. Fined £3. ,, John Planter, 53, New Compton Street. Nuisances. Fined 40s. ,, John Planter 53, New Compton Street. Nuisances. Fined 40s. ,, John Planter, 54, New Compton Street. Nuisances. Fined £3. ,, John Planter, 54, New Compton Street. Nuisances. Fined 40s. L.C.C. (GENERAL POWERS) ACT, 1904. Oct. 7 F. D. W. Payne, 52, Devonshire Street. Verminous Rooms. 20s. Costs. Nov. 5 Wheat & Luker, 17, Back Hill. Verminous Rooms. Order made to complete work in 14 days, is. Fine on each Summons and three guineas costs. ,, Wheat & Luker, Nos. 10, 22, 23, Eyre Street Hill. Verminous Rooms. ,, Wheat & Luker, 4½ Little Bath Street. Verminous Rooms. ,, Wheat & Luker, 4, 16-17, & 18-19, Summer St. Verminous Rooms. Nov. 11 John Planter, 47, New Compton Street. Verminous Rooms. Work done. Summons withdrawn. Nov. 11 John Planter, 53, New Compton Street. Verminous Rooms. Work done. Summons withdrawn. SALE OF FOOD AND DRUGS ACT. Date 1920 Name and Address. Offence. Result. May 25 W. W. Bates (Sudbury Dairy Co.), 66, Broad Street. Selling Milk deficient in fat. Warranty proved. Summons dismissed. May 28 Santa Perella, 13, Eyre Street Hill. do. Fined 10s. costs 28s. 6d. to include Interpreter 7s. 6d. June 30 Fanny Bullock, 53, Old Gloucester Street. do. Convicted. 20s. Costs. July 2 Friern Manor Dairy, 3, Charles Street, E.C. do. Warranty proved. July 16 A. M. Blunden, 21, High Street, W.C. do. Warranty summons dismissed. Aug. 21 Ferdenzi Guido, 24, Coptic Street, W.C. do. Fined 40s. Sep. 30 E. Castali, 7, New Turnstile. do. Fined £5. Sep. 30 A. Bullock, v 53, Old Gloucester Street. do. Fined £4. Oct. 1 G. Caccavalla, 40, Warner Street, E.C. do. Fined 40s. Costs 10s. 6d. Oct. 15 B. Koskie, 75, Leather Lane, E.C. Selling Golden Syrup containing Glucose. Fined 10s. Costs 10s. 6d. Nov. 12 W. J. Jeffries, 122, Theobalds Road, W.C. Selling Golden Syrup containing Glucose. Fined 20s. Costs 40s. 45 TABLE XIII. Meteorology of London, 1920. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal.) 1920. AIR TEMPERATURE. BRIGHT SUNSHINE. Rain and other forms of precipitation. Mean of— Mean of A. & B. Difference from Average.* Daily Mean. Difference from Average.* Per cent. of possible. Total Fall. Difference from Average.* Maximum. A. Minimum. R. °F °F *F °F hrs. hrs. % m.m. m.m. January 47.4 37.0 42.2 + 3.7 1.59 + 0.35 19 58 + 15 February 51.0 36.4 43.7 + 4.0 3.03 + 0.99 31 15 -25 March 55.7 38.1 46.9 + 4.4 4.21 + 0.81 36 35 -9 April 56.9 41.6 49.2 + 1.6 2.56 -2.46 19 68 + 31 May 66.9 45.6 56.2 + 2.2 7.20 + 0.73 46 18 -26 June 71.0 50.1 60.5 + 0.6 7.18 + 0.48 44 44 -7 July 69.5 51.9 60.7 -2.8 4.91 -1.59 31 82 +25 August 67.7 49.7 58.7 -3.9 4.79 +1.41 33 41 -15 September 66.6 49.4 58.0 0.0 3.59 -1.36 29 88 + 43 October 61.0 43.1 52.0 + 1.8 5.19 + 2.07 49 28 -36 November 50.5 36.8 43.7 -0.3 2.34 + 0.62 26 20 -38 December 44.5 36.7 40.6 + 0.4 0.88 -0.18 11 49 + 8 Year 59.1 43.0 51.0 + 1.0 3.96 -0.09 32 546 or 21.50 ins. -50 orab't -2 ins. * The averages used are obtained from observations extending over 35 years (1881-1915).