HOL 22 The Metropolitan Borough of Holborn. 0 ANNUAL REPORT OF THE Medical Officer of Health, C. W. HUTT, M.A., M.D., D.P.H. For the Year 1921 London: THE MORGAN REEVE CO., LTD., 20-22, goldsmith street, kingsway, w.c. 2. 1922. INDEX. Page. Public Health Committee 1 Housing of the Working Classes Committee 1 Maternity and Child Welfare Committee Staff 2 Statistical Summary 3 Natural and Social Conditions 5 Population 5 Social Conditions and Chief Occupations 5 Births 6 Deaths 7 Infantile Mortality 7 Poor Law and Hospital Relief 8 Sanitary Circumstances 8 Scavenging 8 Removal of Manure 8 Sanitary Inspection of District 8 Notices Served IO By-laws as to Houses let in Lodgings 11 Rat Repression 11 Smoke Abatement 13 Common Lodging Houses x3 Food 14 Milk Supply 14 Public Health (Milk and Cream) Regulations, 1912 14 Bakehouses 14 Places where Food is Prepared for Sale 14 Fried Fish Shops 15 Ice Cream 15 Market Streets 16 Meat 16 Unsound Food 17 Reconditioning Dried Fruit 18 Sale of Food and Drugs Acts 18 New Orders relating to Milk 20 Sale of Food Order, 1921 21 Prevalence of and Control over Infectious Diseases 21 Infectious Diseases Generally 21 Smallpox 21 Diphtheria 22 Scarlet Fever 24 Puerperal Fever 24 Enteric Fever 24 Cerebro-Spinal Fever 25 Dysentery 25 Malaria 25 Encephalitis Lethargica 25 Pneumonia 25 Influenza 26 Anthrax 26 Bacteriological Work 27 Disinfections 27 Cleansing of Persons Act 27 Tuberculosis Notifications 28 Tuberculosis Dispensary 28 Tuberculosis Care Committee 30 Dental Clinic 31 Maternity and Child Welfare 32 Notification of Births 32 Home Visiting 32 Work at Centre 33 Ante-natal Hygiene 34 Infant Consultations 35 Dental Treatment 35 Illegitimate Births 36 Still-Births 36 Deaths of Infants under One Year 37 Supply of Milk and Food for Mothers and Infants 37 Home Help 38 Convalescent Treatment 39 Infectious Diseases among Mothers and Children 39 Puerperal Fever 39 Ophthalmia Neonatorum 39 Measles 42 Whooping Cough 43 Epidemic Diarrhoea 43 Poliomyelitis 44 Nursing Arrangements 44 Health and Baby Week 45 Medical Inspection and Treatment of School Children 45 Sanitary Administration 49 Mortuary 49 Inquests 49 Revenue Acts 49 Housing 49 APPENDIX. Table I. Vital Statistics, 1921, and ten previous years 52 Table II. Causes of and Ages at Death, 1921 53 Table III. Infectious Diseases Notified during 1921 54 Table IV. Infectious Diseases in Holborn during 1921 and ten previous years 55 Table V. Information required by L.C.C.56 Table VI. Factories, Workshops, &c 57 (1) Inspections 57 (2) Defects found 57 (3) Home Work 38 (4) Registered Workshops59 (5) Other Matters 59 Table VII. Meteorology 60 Table VIII. Legal Proceedings 61 1 Public Health Committee. 1920-21. 1921-22. Chairman— Chairman— Councillor Richard Davies. Councillor Sir William R. Smith, D.L., J.P., M.D. Vice-Chairman— Vice-Chairman— Councillor Sir William R. Smith, D.L., J.P., M.D. Councillor Francis J. Pullen. Ex-Officio— Ex-Officio— The Right Worshipful The Mayor, The Right Worshipful The Mayor, Councillor George Harvey, J.P. Councillor George Harvey, J.P. Alderman Henry Jewell. Alderman Henry Jewell. Councillor Rev. Lancelot F. Andrewes, M.A. Councillor W. B. Foster Boviil. ,, Thomas W. J. Coffin. ,, Thomas W. J. Coffin. ,, Rev. Wilfred H. Davies, M.A. ,, Richard Davies. ,, William H. Edwards. ,, Rev. Wilfred H. Davies, M.A. ,, Henry W. Ellis. ,, William H. Edwards. ,, Miss Norah H. March, B.Sc. ,, Henry W. Ellis. ,, Francis J. Pullen. ,. Miss Norah H. March, B.Sc. ,, Rev. Henry Ross. ,, Rev. Henry Ross. ,, John H. Worrall. „ John H. Worrall. Housing of the Working Classes Committee.- 1920-21. 1921-22. Chairman— Chairman— Councillor Alfred Humphreys. Councillor The Rev. Wilfred H. Davies, M.A Vice-Chairman— Vice-Chairman— Councillor The Rev. Wilfred H. Davies, M.A. Alderman Henry Jewell. Ex-Officio— Ex-Officio— The Right Worshipful The Mayor. The Right Worshipful The Mayor. Councillor George Harvey, J.P. Councillor George Harvey, J.P. Alderman Robert VV. Dibdin, J.P. Alderman Robert W. Dibdin, J.P. ,, Henry Jewell. ,, W. Gipps Kent. ,, W. Gipps Kent. ,, Sir George P. Parker, O.B.E. ,, Sir George P. Parker, O.B.E. Councillor Miss Emily Dibdin. Councillor James J. Claydon. ,, Henry W. Ellis. „ Miss Emily Dibdin. ,, Alfred Humphreys. Henry W. Ellis. „ Miss Norah H. March, B.Sc. „ Miss Norah H. March, B.Sc. ,, Raymond A. Miles. ,, Raymond A. Miles. ,, William B. Shearn. „ Howard Ruff. ,, J. St. Lawrence Stallwood. „ J. St. Lawrence Stallwood. 2 Maternity and Child Welfare Committee. 1920-21. 1921-22. Chairman— Chairman— Councillor Miss Norah H. March, B.Sc. Councillor Miss Norah H. March, B.Sc, Vice-Chairman— Vice-Chairman— Alderman Sir George P. Parker, O.B.E. Alderman Sir George P. Parker. O.B.E Ex-Officio— Ex-Officio— The Right Worshipful The Mayor. The Right Worshipful The Mayor. Councillor George Harvey, J.P. Councillor George Harvey, J.P. Councillor W. B. Foster Bovill. Councillor W. B. Foster Bovill. Richard Davies. ,, Thomas W. J. Coffin. ,, Miss Emily Dibdin. ,, Richard Davies. ,, Francis J. Pullen. ,, Miss Emily Dibdin. Rev. Henry Ross. ,, Francis J. Pullen. Lady Smith. ,, Rev. Henry Ross. ,, Sir William R. Smith, D.L., J.P. ,, Lady Smith. Mrs. Ethel M. Wilson. ,, Mrs. Ethel M. Wilson. Nurse M. Baylee. Nurse M. Bavlee. Miss M. R. Lovelock. Miss M. R. Lovelock. ,, Alice Michelmore. ,, A. F. Filley. Mrs. Emily R. Thouless. „ AL'ce Michelmore. Miss M. Yeaxlee. ,, Emily R. Thouless. STAFF. The following was the Staff during 1921. Mcdical Officer of Health—WILLIAM A. BOND. M.A., M.D., D.P.H.Camb., M.R.C.P.Lon. (To 30th April). C. W. HUTT, M.A., M.D., D.P.H., (From 1st May). Medical Officer of Maternity Centres—BEATRICE MARY KIDD, M.B.Lond. Medical Officer Tuberculosis Dispensary—S. J. COWELL, B.A., M.R.C.S. (to 27th November). HARRY EVANS, M.B., D.P.H. (from 28th November) 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, C.M.B. Health Visitor—ELIZABETH LISTER SHINNIE, C.M.B. Tuberculosis Visitor—ESTHER BAYLEY. Chief Clerk and Committee Clerk—-EDWIN KENT. Assistant Clerks—FRANK FITCH. ARTHUR LONG. PHYLLIS BULL. Dental Clinic—(10 John Street). Dentist—CECIL O. GRAY, L.D.S. (British Dentists Hospital) Anaesthetist—JAMES MAUGHAN, M.D., M.R.C.S, Attendant—MAUD CATER. Moituary Keeper and Superintendent of Cleansing Station—CHARLES II. DAY. Superintendent of Women's Cleansing Station—ADELINE DAY. Caretaker of Maternity Centre—ELIZABETH ALDERTON. Home Help—ELIZABETH MOORE. Disinfector—HENRY EMMS. 3 STATISTICAL SUMMARY, 1921. Population, estimated to middle of year (as supplied by the Registrar-General) for birth and death-rates. 43.520 Population—Census, 1921 42,796 Births 648 Annual Rate of Births per 1,000 population 14-8 Deaths 556 Annual Rate of Deaths per 1,000 population 12-8 Zymotic Death Rate 0-24* Excess of Registered Births over Deaths 92 Infantile Mortality per 1,000 Births 79 Area of Borough in Acres 405.1 Rateable Value. 1st November, 1921 £i,334,908 A Rate of id. in the £ is estimated to yield £5,412 * Excluding deaths from Epidemic diarrhoea. Vital Statistics. England and Wales, London and Holborn. (###) Annual Kates per 1,000 living. Deaths under 1 year to 1,000 Births. Births. Deaths. England and Wales 22.4 12.1 83 London 22.3 12.4 80 Holborn 14.8 12.8 79 4 PUBLIC HEALTH DEPARTMENT, COUNCIL OFFICES, 197, HIGH HOLBORN, W.C. I. March, 1922. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn. Ladies and Gentlemen, Herewith I beg to present a Report upon the Health and Sanitary Conditions of the Borough for the year 1921. I would like to pay a tribute to the work carried out for 26 years on behalf of the Borough by my predecessor, Dr. W. A. Bond. Believe me, Ladies and Gentlemen, Yours obediently, C. W. HUTT, Medical Officer of Health. 5 NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population and Houses. The enumerated population at the Census taken on Sunday, June 19th, 1921, was 42,796, a reduction of 6,561 on the previous census of 1911 or 13.3 per cent. During the previous decennium 1901-1911 there was a reduction of 10,048 or 16.9 per cent. The following estimate of population as supplied by the Registrar-General has been adopted for the calculation of the death-rate and birth-rate of the Borough for the year 1921—43,520. 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. 33.1 per cent. of the population lived in tenements of only one or two rooms and 59.5 per cent. in tenements of 1-4 rooms. The density of the population was 122 persons per acre in comparison with 61 for London. The character of population shows wide and striking contrasts, including as it does the occupants of expensive residential flats, the migratory population in the large hotels, the student class in the Bloomsbury boarding houses, residents in large commercial, social and philanthropic hostels, working class population in model dwellings and tenement lodging houses, and a large proportion of very poor people in common lodging houses. 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 are adding to our very large and crowded day population of London' sworkers. 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. The population in the 999 L.C.C. tenements in the Borough was estimated at 3,688. The number of deaths was 30 or a death-rate of 8.1 per 1,000. 6 On the other hand the number of deaths of residents of Common Lodging Houses in the Borough, which contain 1,220 beds was 55 which, calculated on the number of beds, was a rate of 45 per 1,000. Registered Births and Birth-Rate. The total number of births registered as occurring in the Borough was 486, being 262 males and 224 females. Of the 486, 465 were legitimate and 21 illegitimate. The registered birth-rate per 1,000 of the population was II.2. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 145 legitimate infants and 36 illegitimate infants whose mothers were residents of the Borough. Nineteen of the births occurring in the Borough, viz., 17 legitimate births and 2 illegitimate births, were infants of mothers who were non-residents of the Borough. The following table gives the number of corrected births and the corrected birth-rate for the ten years 1912-1921:— (###)Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate. No. Birth Rate. No. Birth Rate. 1912 901 18.8 835 17.4 66 1.4 1913 798 16 .9 743 15.8 55 1.1 1914 765 16.4 705 151 60 1.3 1915 670 14.4 616 13.2 54 1.2 1916 649 15.7 585 141 64 1.6 1917 571 14.5 496 12.6 75 1.9 1918 497 12.1 428 10.4 69 1.7 1919 539 13.6 477 12.0 62 1.6 1920 827 20.8 749 18.9 78 1.9 1921 648 14 .8 593 13 6 55 1.2 In London the corrected birth-rate in 1921 was 22.3 per 10,00 in comparison with 26 5 for 1920. Mortality. The total number of deaths registered as occurring in the Borough was 859, of which 471 were males and 388 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough:— 7 INSTITUTION. Residents. Non-Residents. St. Giles and Bloomsbury. Holborn. St. Giles and Bloomsbury. Holborn. French Hospital 7 2 44 Children's Hospital 5 9 410 National Hospital — 1 — 65 London Homoeopathic Hospital — 4 — 62 Italian Hospital 1 3 — 17 Alexandra Hospital — — — Private 19 5 Total 13 19 63 559 There were 319 deaths of Civil "Residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 55 of whom were removed from Common Lodging Houses in the Borough. Corrected Deaths and Death-Rates, 1921, compared with 1920. 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. Death Rate for Borough. Death Rate. Registration London. 1921 859 630 622 319 556 12.8 12.4 1920 827 596 566 339 603 15.2 12.4 For details of causes of and ages at death, see Table II., page 53. 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:— Year. Deaths under 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. one year of age. Deaths under 1 year per 1000 Births. 1921 51 77 91 79 80 1920 55 60 128 66 75 Death-rate per 1,000 corrected births in 1921 and in ten preceding years during which details respecting births have been supplied. 8  I911. 1912. 1913. 1914. I9I5. 1916. 1917. 1918. 1919. 1920. Av ge, 1911-20 1921. Holborn Borough 113 78 100 88 96 97 107 141 96 66 98 79 London 129 91 105 101 112 89 103 107 85 75 100 80 See also Table, page 37. Deaths of Children. The number of deaths of children from 1 to 2 years was 11, from 2 to 5 years, 11, and from 5 to 15 years, 9. . . .... Poor Law and Hospital Relief. ihe Clerk to the ijuardians 01 tne ttoiDorn union nas Kindly supplied me witn the following information relating to persons from the Holborn Division of the Union who received Poor Law Relief during the year 1921. Number of Persons. Indoor Keliel 990 Outdoor Relief 389 Outdoor Medical Relief 153 Total 1,532 Of the total number of 556 deaths, 351 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 is carried out by Contract. In the main thoroughfares, and in a number of other principal streets, there is a daily collection. In the remainder of the streets the collection is twice weekly. In a very large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins ; this replacement was continued during 1921. The number of notices served for the absence of, or defective, ashbin was 116. 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. The probability of nuisances arising from the irregular removal of manure is considerably reduced by the substitution of motor for horse traffic. Less manure is produced and the demand for it is correspondingly increased. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-Laws and Regulations. In addition to my inspections, the Sanitary Inspectors made 23,500 varied inspections and visits as set out in the following table. Each inspection frequently covers a number of different sanitary matters.  Inspector Bennett Inspector Clark Inspector Larard Inspector Charlesworth Inspector Shinnie Whole Borough Inspections. Infectious Diseases 115 157 156 115 84 627 Dwelling Houses 116 297 104 — — 517 Houses let in lodgings * 345 235 163 150 12 905 Common Lodging Houses — 4 4 — — 8 Dairies, Cowsheds and Milkshops 40 89 45 — — 174 Ice Cream—Manufacture or Storage 51 42 186 — — 279 Slaughter-house — 8 — — — 8 Market Streets 343 73 444 — — 860 Butchers' Shops 458 30 366 — — 854 Bakehouses 14 60 39 — — 113 Fried Fish Shops 100 20 141 — — 261 Other Food Shops 284 109 279 — — • 672 Laundries — — — — — — Rag and Bone Dealers 208 11 75 — — 294 Other Workshops 74 118 67 1 — 260 Out-Workers' Rooms and Registers . . 25 29 28 112 — 194 Other Workplaces 73 101 134 — — 308 Factories (excluding Bakehouses and Laundries) 31 36 46 1 — 114 Smoke shafts 21 41 99 — — 161 Urinals — 2 2 — — 4 Miscellaneous 32 37 33 3 — 105 Rats and Mice (Destruction) Act 114 94 111 — — 319 Periodical Inspections † 1,883 2,104 3,817 — — 7,804 Dust ‡ 11 67 15 — — 93 Mews 36 62 1 — — 99 Maternity — — — 344 349 693 Total Inspections 4.374 3,826 6,355 726 445 15,726 No. of Re-Inspections 1,157 1,386 715 247 37 3,542 Do. do. Maternity — — — 649 820 1,469 Visits other than Inspections and Re-Inspections 515 831 716 20 16 2,098 Do. do. Maternity — — — 46 72 118 Maternity Centres : Attendances — — — 258 283 541 Total 6,046 6,043 7,786 1,946 1,673 23,494 *See also Periodical Inspections. †The majority of these are weekly inspections of houses let in lodgings. ‡A large number of inspections respecting the removal of refuse is also made during general and periodical inspections of houses. 10 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 1920, viz.:— Public Health (London) Act, 1891— Intimation Notices 824 Statutory Notices 99 By-laws as to Houses let in Lodgings 908 London County Council (General Powers) Act, 1904— Vermin 69 Rats and Mice (Destruction) Act, 1919 20 1,920 The following table shows the work done to abate nuisances for which intimation notices were served:— Water Supply— Provided 7 Cisterns, cleansed, repaired, covered, etc. 52 Waterclosets— Cleansed 50 Water supplied, flushing cistern repaired etc. 83 Repaired, new pans, etc. 177 Ventilation improved 13 New supplied where accommodation insufficient 3 Separate accommodation for sexes provided 8 Soil Pipes— Repaired, renewed and ventilated 6 Rainwater Pipes— * Repaired or renewed 25 Drains— Repaired 21 Unstopped, cleansed etc. 37 Sinks, etc. Waste pipes, repaired, renewed etc. 46 Yards, Areas and Washhouses— Cleansed 55 Paved and paving repaired 33 Houses and Workshops, etc. Cleansed 243 Dilapidations repaired and made good 118 11 Dampness- Roofs repaired 66 Gutters repaired 13 Floor cavities ventilated 3 Other works to prevent dampness 37 Ashbins— Provided, repaired etc. 119 Urinals— Repaired, cleansed etc. 5 Various— Underground Rooms vacated 6 Smoke—Emission of black smoke abated 7 Animals—Improper keeping discontinued 8 Accumulations of Refuse—Removed 60 Overcrowding abated 2 By-Laws as to Houses let in Lodgings. At the end of the year, 601 houses were registered under these By-laws, of these, 302 are in St. Giles and Bloomsbury, and 299 in the Holborn District; 5 such houses were removed from the Register and 3 were added. During the year, there were 905 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. One notice was served for an overcrowded room, and 304 notices for other breaches of the By-laws, exclusive of 603 notices that were served for annual cleansing as required by the By-laws. 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 a "Rat Week" should be arranged in the district of every Local Authority, from October 31st to November 5th. The following Table shows the nuisances for which the 99 Statutory Notices were issued under the Public Health (London) Act, 1891. Section 2 (a) Dirty and dilapidated premises, etc. 66 ,, 2 (b) and Section 37, Ashbins 18 ,, 2 (b) Drains and W.C.'s 33 ,, 2 (c) Animals improperly kept 3 ,, 2 (d) Accumulation of rubbish 12 ,, 2 (e) Overcrowding 1 ,, 2 (f) and 48. Water supply 7 ,, 2 (g) Ventilation of Workshop 3 ,, 24 Smoke 2 ,, 96 Underground rooms 1 12 Arrangements were made for the observance of this "Rat' Week" in the Borough accordingly. By way of preparation a circular was issued to the owners of all premises where rats were found to exist, drawing attention to the damage done by rats and emphasizing the desirability of a special concerted effort to destroy these vermin from time to time, also intimating that the Sanitary Inspectors would visit the premises and give any information or advice desired. Another circular letter was sent to the owners of all other premises where there was reason to suspect rats might be present, similarly drawing attention to the necessity for their destruction and offering to arrange for a visit by the Inspector if desired. With both these letters I issued, and drew special attention to, a memorandum on rat proofing, seeing that it is very desirable to encourage this most effective means for the prevention of nuisance from rats, as far as possible. Subsequently a report was presented to the Public Health Committee on the subject. The following recommendations embodied in the report were approved by the Committee and adopted by the Council:— (1) That arrangements be made for the preparation of suitable rat poisons and that the same be supplied at cost price to occupiers of rat-infested premises in the Borough. (2) That the Works and General Purposes Committee be requested to arrange for the services of one of the Council's workmen being available for the purposes of rat proofing on condition that the cost of such services and the material used be defrayed by the occupiers of premises where the work is carried out. (3) That the Council do enter into a contract with a reliable firm of ratcatchers and that a scale of fees be agreed upon with such firm with a view to the occupiers of rat infested premises being referred to such firm when necessary. (4) That a communication be addressed to the Ministry of Health, the Ministry of Agriculture and Fisheries, and the London County Council, urging that legislation be introduced to provide for:— (a) The registration of rat-catchers. (b) For placing on owners or occupiers of property an obligation to notify the Local Sanitary Authority on ceasing to use any drain or similar sanitary fitting and for making it an offence to cease to use any such drain or other similar sanitary fitting without efficient sealing off. (c) For extending liability under the Rats and Mice (Destruction) Act, 1919, to the " owner " as well as the occupier of rat-infested premises. 13 In accordance with the foregoing resolutions the Council made arrangements with the following firms of rat-catchers to carry out work connected with rat repression for owners and occupiers in the Borough:— Small Houses 8 rooms. Stables 10 horses. Shops small Hotels &c., and large shops. Dalton & Son 10/- per night — — £110s. per night. Howard & Sons £15s. per house £110s. £2 2S. To be quoted for separately. Arrangements were also made for suitable rat poisons to be supplied to the occupiers of rat-infested premises at cost price. At our request a film illustrating the harm done by rats and showing suitable means for catching them was shown at a local cinema for a week. Smoke Abatement. The smoke shafts in the Borough were frequently kept under observation and in 161 cases the inspections were recorded. Ten complaints were received and nine notices served, including two Statutory notices. In several cases the persons concerned have supplied a better quality coal, and taken care not to burn coal dust. Cases have been brought to our notice where stokers have no means of knowing that black smoke is being emitted from the chimney. This difficulty has been overcome by a suitable arrangement of mirrors. Common Lodging Houses Acts, 1851 and 1853. Seventeen Common Lodging Houses are registered in the Borough for 1,220 lodgers, viz.,1,058 males and 162 females. The Common Lodging House accommodation in Holborn is equal to 28 beds per 1,000 of the population, a higher rate than in any other Metropolitan area except the City of London. The death rate amongst common lodging house residents is very high; in this Borough it was 45 per 1,000 in 1921. Dairies, Cowsheds and Milkshops. The number of registered dairies and milkshops in the Borough at the end of the year was 154. Seven dairies and milkshops were newly registered, and nine removed from the register. In addition to my inspections the Sanitary Inspectors made 174 inspections of these premises, and five notices were served for sanitary defects or breaches of regulations. Public Health (Milk and Cream) Regulations, 1912 and 1917. The Public Health (Milk and Cream) Regulations, 1912 and 1917, were enforced in the Borough during the year. Two hundred and forty-nine samples of milk were examined and no sample found to contain preservative. Twelve samples of cream were examined,—four were preserved with small amounts of boric acid. The vendors were interviewed by the Public Health Committee and in each case submitted a satisfactory explanation. Seven samples of preserved cream were examined and found to be in accordance with the Regulations, the statement on the label as to the amount of preservative being in each case correct. No other contravention of the Regulations was discovered during the year. Bakehouses. At the end of the year, 1921, there were 29 bakehouses in the Borough of which 16 were factory bakehouses. Although these are described as "factories" they are not large and only supply local needs; a number were formerly workshops and are now classified as "factories" owing to the installation of machinery. During the year, in addition to my inspections, there were 113 inspections of bakehouses. Four notices were 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. FOOD. 15 The number of such places on the register at the end of the year was as follows:— Hotels, Restaurants and Eating Houses 173 Slaughter-houses 1 Tripe, offal and other meat shops 33 Fish shops 23 Ice Cream (Manufacture) 64 Poulterers 3 During the year 2,208 inspections of food premises were made and 53 notices served for sanitary defects found. The supervision of the many places in the Borough where food is sold, stored, or prepared for sale is of considerable importance; much attention has to be devoted to this work to ensure the cleanliness both of premises and utensils, and sound condition of the food. Fried Fish Shops. The fried fish shops in the Borough are regularly inspected to see that they are kept in conformity with the by-laws made by the London County Council. Two hundred and sixty-one inspections of such premises were made last year. At the same time a careful look-out is kept on the soundness of the fish and the wholesomeness of the materials used in frying. Ice Cream. During the year there were 64 premises in the Borough where ice cream was manufactured, and in addition to my inspections 279 inspections of these premises were made. In one case ice cream was found being made in an unsatisfactory basement. Arrangements were at once made for the manufacture in this basement to be forthwith discontinued. The existing powers of Local Authorities in London for dealing with the manufacture, storage and sale of ice cream are not entirely adequate for the purpose. The manufacture and sale of this commodity is essentially an industry that should be subject to registration. The registration should extend to itinerant vendors so that the premises where ice cream containers, and other utensils used in connection with the trade are stored, could be kept under proper supervision. Further powers for enforcing cleanliness in the conduct of the business by street vendors are also desirable. It is the ordinary practice for manufacturers of ice cream to prepare the "custard" ready for freezing and store it until required for use, when it is frozen. It has been held that this unfrozen material is not ice cream or any similar commodity. This decision minimizes the advantage of 16 the section of the London County Council (General Powers)Act, 1902, dealing with the subject, and it is desirable that the term "ice cream or other similar commodity" should be defined to include such substance while in process of manufacture for ice cream. Ice cream is manufactured in the Italian Colony as follows:— Premises on which 22 gallons made daily1 „ „ 10 „ „ „ 3 „ „ 8 „ >> „ 2 „ „ 4 „ „ „ 10 „ „ 2 „ „ „ 12 In addition ice cream is also manufactured on the following premises:— Mr. Bennett's District. Mr. Clark's District. Mr. Larard's District. Restaurants 1 1 5 Tea Shops — — 10 Confectioners 2 9 2 Other 1 2 2 Market Streets. In addition to the inspections of places where food is prepared for sale, there were also 860 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. It is desirable that further powers should be conferred on Local Authorities to control the sale of food and other commodities in street markets. These powers should be sufficient to prevent contamination by street dust, animals, etc., particularly of such articles as butter, margarine, cheese, etc., which are not cooked or washed before consumption. A supply of clean water would be of especial value, particularly to the vendors of fish, vegetables, ice cream and refreshments, including coffee stalls. Such powers might also extend to the control of street vendors of food generally. Meat. All the butchers shops were frequently inspected. The meat was found to be dealt with under cleanly conditions and no diseased meat was discovered. There is only one slaughter-house in the Borough. This was inspected on eight occasions during the year. Sheep only are slaughtered. 17 Unsound Food. The following is a list of unsound food condemned during the year 1921. Commodity. Condition. t of Action taken. 1box, 12 stone, Catfish Decomposed Surrendered. 1box Witches (Soles) Stale and decomposed. Do. 103 18 oz. tins Sardines Tins blown Do. 1 box Lemon Soles Decomposed Do. 100 11 lb. tins Tomatoes Decomposed Do. 1trunk Cod, 6 stone Decomposed Do. 25 cwt. Californian Plums Very old and sour Do. 22 pads William Pears Rotten Do. 64 Rabbits Decomposed Do. 6 lbs. Ox Kidney Decomposed Do. 373 tins Mixed Vegetables Decomposed;tins blown Do. 13 cases 2½lb tins Cherries Do. Do. 6 tins Evaporated Milk Do. Do. 6tins Apricots Do. Do. 46 tins Raspberry Pulp Do. Do. 20 tins Strawberry Pulp Do. Do. 2 bottles Cherries Decomposed Do. 1 box Witches (Soles), 11 stone Decomposed Do. 19 tins Milk Cocoa Tins blown Do. 12 Rabbits Decomposed Do. 27 tins Lobster Decomposed Do. 142 tins Herrings Do. Do. 338 tins Kippered Herrings Do. Do. 123 tins Herrings in tomatoes Do. Do. 681 tins Sardines Do. Do. 230 lbs. Dried Mixed Vegetables Do. Do. 69 packets Lemon Crystals Do. Do. 1Turkey Diseased and Decomposed Do. Included in the above table is a considerable quantity of tinned and dried food which was examined at the request of the Y.M.C.A. The goods were carefully examined by one of the Council's Inspectors and found to be in a decomposed condition. 18 Re-conditioning Food. During the year information was received that a dealer in this Borough had purchased a quantity of Californian plums, which were said to be in an unsound condition, and had asked for permission to remove the same to this Borough for the purpose of sorting the good plums from the bad under my supervision. Permission was given for 10 boxes to be drawn. These were inspected and subsequently reinspected after treatment. At the first inspection the majority of the plums appeared to be unfit for food on account of a deposit found on them. This deposit was examined by the Public Analyst who found, by chemical and microscopical examination, that it consisted of crystallised sugar which, although making the plums unattractive did not render them unsound. After careful sorting and washing the plums in the boxes sampled, were found to be sound and fit for food. Consent was, therefore, given for the remainder of the consignment to be released for similar treatment, so that, after inspection and approval they could be placed on the market. • 'Re-conditioning of dried fruit should receive careful supervision and should be carried on only in premises suitably constructed and under proper control. The dealer in question has now removed from this Borough. Sale of Food and Drugs Acts. The following is a list of articles purchased during 1921:— ARTICLE Purchased Genuine Adulterated Proceedings taken Convictions and Costs Ammoniated Tincture of Quinine 3 3 — — — Baking Powder 3 3 — — — — Barley 3 3 — — ' — — Borax 6 3 3 — — Boric Acid 1 1 — — — — Boric Ointment 1 1 — — — — Brandy 4 4 — — — — Bread and Butter 10 9 1 — — — Butter 63 61 2 — — — Calomel Ointment (33%) 5 3 2 2 0 Costs, £5 5s. Camphorated Oil 6 6 — — — — Cheese 3 3 — — — — Chocolate 3 3 — — — — Coffee 3 3 — — — — Cream 12 8 4 — — — Do. Preserved 7 7 — — — — Dripping 9 9 — — — 19 ARTICLE Purchased Genuine Adulteated Proceedings taken Convictions and Costs Fish Paste 2 1 1 — — — Flour 4 4 — — — — Gin 1 1 — — — — Ginger Wine 2 2 — — — — Gregory's Powder 2 2 — — — Honey 7 7 — — — — Jam 4 4 — — — . — Lard 3 3 — — — — Margarine 5 5 — — — — Milk 247 242 5 3 0 Costs, £2 14s. 6d. Condensed 7 7 — — — — Do. Separated 2 2 — — — — Meat, Potted 5 5 — — — — Mustard 9 8 1 — — — Olive Oil 5 5 — — — — Rice 6 6 — — — — Rum 1 1 — — — Sausages ... 3 1 2 — — — Salad Oil 6 6 — — — Suet 3 3 — — — — Do. (shredded) ... 3 0 3 — — — Sweet Spirits Nitre 5 5 — — — _ Syrup, Golden 3 3 — — — _ Sweets 4 4 — — — — Salmon, Tinned 1 1 — — — — Tomato Sauce 1 1 — — — Vinegar (Malt) 14 14 — — — — Vinegar 1 1 — — — — Whiskey 1 0 1 1 — Costs, £5 5s. Zinc Ointment 1 1 — — — — 500 475 25 6 0 Costs, £13 4s. 6d. Summary:— 247 Milk 5 not genuine — 2.0% 63 Butter 2 — 3.1% 30 Drugs 5 16.0% 160 Various foods 13 — 8.1% 20 Details of proceedings taken will be found in Table VIII., page 61. The following observations refer to samples reported to be not genuine where no legal proceedings were taken. Butter.—In both cases the samples contained a very small excess of water. Both vendors were cautioned. Borax.—The three samples were sold as commercial borax, and were found to contain arsenic in excess of the quantity allowed for refined borax by the B.P. The vendors were communicated with and satisfactory replies received as to steps taken to safeguard the sale of the commodity. Bread and Butter.—Purchased at a Restaurant. The "butter" was found to be margarine. The vendor was protected by a suitable notice exhibited in his shop. Cream.—Four samples contained preservatives. The cases were dealt with under the Public Health (Milk and Cream) Regulations. All the vendors submitted satisfactory explanations. Fish Paste.—One sample contained boracic acid. The quantity was too small to warrant proceedings. Mustard.—One sample adulterated with a foreign ingredient—starch. The vendor was protected by a declaration on the tin in which the article was sold. Sausages.—Two samples contained boracic acid, the quantity being too small to warrant proceedings. Suet {shredded).—Three samples contained rice flour. The quantity was not more than is reasonable for ordinary commercial purposes. The thoughtful and careful administration of these Acts is of special importance owing to the fact that so many people residing in London dormitories have their midday and afternoon meals in the Borough. The small number of samples found to be adulterated is satisfactory evidence of the purity of the food supply and the efficient administration of the Acts. New Orders relating to Milk. The Milk (England and Wales) Order, 1921, made by the Food Controller, was issued in March, 1921, together with the ancillary Order, the Local Authorities (Milk) Order, 1921, made by the Ministry of Health. The effect of the Orders is to continue in force provisions contained in previous Orders of the Food Controller with regard to milk of special hygienic quality, and the forbidding of the addition of colouring matter and water to milk. 21 Grade"A" (Certified) and Grade"A" Milk. Licences for the sale of Grade A (Certified) and Grade A milk will now be issued by the Ministry of Health instead of the Food Controller. Milk of this quality is now sold in the Borough. The Order prohibits the addition of colouring matter or water to milk or cream. This provision is a useful supplement to the powers of local authorities under the Sale of Food and Drugs Acts. No breach of the Orders was discovered during the year. Sale of Food Order, 1921. Under the Sale of Food Order, 1921, local authorities for the purpose of the Sale of Food and Drugs Acts were invested with the power of enforcing requirements as to the labelling of imported produce, the composition of jam and marmalade, and the composition of dripping, margarine and other edible fats. Subsequently by an Order, dated December 14th, 1921, the requirements as to the labelling of imported lard and the composition of jam, marmalade, dripping, margarine and other edible fats were revoked. The revised Order requires that imported meat, bacon or ham exposed for sale by retail shall be so labelled. Also that imported eggs shall not be sold as fresh or new laid unless the word " imported " is included in the description or the country of origin disclosed. A communication was sent to traders in the Borough calling attention to the Order. No contravention of the Order has been discovered. 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 685 in comparison with 489 in the year 1920. Attention has had especially to be called to the non-notification of whooping cough, primary pneumonia and ophthalmia neonatorum. A list of the notifiable diseases has been supplied to all doctors practising in the Borough. Smallpox. One case of smallpox was notified. The patient was a stewardess temporarily residing with friends in the Borough, after the arrival in port of the ship on which she had been employed. A case of smallpox had been landed from the 22 ship at Gibraltar. The stewardess occupied a cabin next to that in which the case was isolated prior to landing. The patient was removed to the Hospital of the Metropolitan Asylums Board. The Public Vaccinator immediately visited the home and the contacts were re-vaccinated the same evening or early next morning. No secondary case occurred. In order that parents should have the advantages of vaccination brought home to them, since October a leaflet dealing with the subject has been sent to the home shortly after the birth of any child in the Borough. Two cases of smallpox were notified in London. Diphtheria. Of 167 cases of diphtheria notified, 21 were returned as not diphtheria. Five were apparently only "carriers," as diphtheria bacilli were found in the swabs taken before the removal of the patients. Only three of the notified cases remained at home; in two of these cases the second bacteriological examinations were negative; the third case was a "carrier." There was one "Return" case of diphtheria notified 17 days after the return home of the primary case (a brother). In two or possibly three cases of diphtheria, the disease was apparently contracted from a boy who was evidently a "chronic intermittent carrier." This boy was removed to hospital with diphtheria in November, 1920, and returned home at the end of February, 1921. Four weeks afterwards he was again notified as suffering from diphtheria and was re-admitted to hospital. In May he was returned home diagnosed as not suffering from diphtheria. Bacteriological examination of swabs, however, gave positive results and continued to do so until at the end of July he was again notified and removed to hospital. In one family where four cases of diphtheria occurred, there was evidence of probable infection from a fifth member of the family, who had recently returned from hospital, convalescent from scarlet fever. The scarlet fever patient returned home on the 25th April. The first case of diphtheria was notified on the 11th May, followed by other cases on the 22nd May and 3rd and 6th June. Swabs from the throat and nose of the scarlet fever patient gave positive results. The case illustrates the close association between these two diseases. On account of the occurrence of a case at the Kingsway Creche, 21 of the children were swabbed—16 were found to be positive. Information respecting the children not residing in this Borough was sent to the Medical Officers of Health of the districts concerned. All the children giving positive results were excluded until they were found no longer to harbour diphtheria bacilli. One patient notified as suffering from diphtheria was a milk carrier working in a district adjoining the County of London. Information respecting the case was sent to the Medical Officer of Health of that district. The patient was removed 23 to a Hospital of the Metropolitan Asylums Board. Arrangements were made with the Medical Superintendent of the Hospital for the results of the bacteriological examinations made prior to the patient's discharge to be furnished to prove that he would not spread infectious disease by carrying on his trade. In consequence of the extreme prevalence of diphtheria (and scarlet fever) in London the number of bacteriological examinations made for the presence of diphtheria bacilli was much larger than usual. A large number of child contacts were also swabbed. As a rule swabs of the noses of the contacts as well as of the throats were taken. The parents or others in charge of children harbouring diphtheria bacilli were given written directions as to the precautions necessary; these are detailed below:— 1. Until the Holborn Health Department or the London County Council notifies the parent or guardian to the contrary, attendance of the "carrier" at day school, Sunday school, cinemas, theatres, music halls, teas or treats or any gatherings is forbidden. The child must be kept away from all other children and no other child be allowed to visit the house. 2. The child must sleep by himself or herself. 3. Special cups, saucers, plates, spoons, knives and forks should be reserved for the use of the carrier and washed up separately after the others have been washed up. 4. The child should use pieces of rag instead of handkerchiefs. These rags should be burnt as soon as possible. 5. No books belonging to a public library should be read by the "carrier," or any book which the parents or guardian are not prepared to destroy or have disinfected by the Public Health Department. Swabs of these "carriers" were taken fortnightly until the child was no longer found to harbour diphtheria bacilli. The results of the examinations were communicated to the School Medical Department of the London County Council so that children harbouring diphtheria bacilli could be kept from school. For a few of the contacts we were able to make arrangements for the Schick reaction test to be carried out and for the immunisation of those found susceptible. Of the 167 cases of diphtheria notified there were only four deaths, i.e., a death-rate of only 2.4 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 30 cases. 16,344 cases of diphtheria were notified in London in 1921. 24 Scarlet Fever. All the 190 cases of scarlet fever were removed to hospital with the exception of five which were satisfactorily isolated at home. In connection with 26 of the cases during the year there were 38 secondary cases. Twenty-nine of these were notified either at the same time or within a few days of the primary case. The nine remaining were "return" cases. A "return" case of scarlet fever is one occurring within 28 days of the return from hospital to the same house of a previous case of scarlet fever. These nine cases occurred in nine houses. In seven the "return" case was in the same family as the original, or primary, case; in one, in the same household (an institution). In one instance the "return" case, although in the same house, was not. connected by family circumstances. In two instances the primary cases had nasal discharge after their return home. The intervals between the return of the primary cases and the notification of the "return" case were respectively 7, 8, 8, 13, 16, 21, 22, 23 and 24 days. Secondary cases of this type occur when patients are treated at home and in much the same proportion. 32,755 cases of scarlet fever were notified in London. Puerperal Fever. One case of puerperal fever was notified. The patient was admitted to the Holborn Infirmary on October 30th where she died on November 5th. 353 cases were notified in London. Enteric Fever. Six cases were notified during the year. In at least two cases the disease was not contracted in the Borough, one having been contracted abroad a month prior to notification; the second case was notified within two days of arrival in the Borough. In two cases there was no evidence of the probable source of infection. One patient was a medical practitioner engaged in bacteriological work. who apparently contracted the disease from the laboratory. It was ascertained that, during the previous month he had frequently been working with paratyphoid bacilli and to a less extent with typhoid bacilli; the latter was found in his blood. In one case there was evidence of the patient becoming ill after eating ice cream. The illness continued and ultimately enteric fever was diagnosed. 331 cases were notified in London. 25 Cerebro-Spinal Fever. Two notifications of cases of cerebro-spinal fever were received. The first case, a female, aged 10 weeks, came to our knowledge when the death, which occurred on January 23rd, 1921, in an out-lying institution, was transferred by the Registrar-General. The patient was taken ill on December 6th, 1920, admitted to hospital on December 15th, and died on January 23rd, 1921. The second case was a male, aged 48 years. He was taken ill on May 10th, removed to a hospital the following day where he subsequently died, the death being certified as due to "meningitis." 104 cases were notified in London. Dysentery. One case of dysentery was notified, a male aged 48 years. The patient had no fixed abode and became ill whilst an inmate of the Holborn Casual Ward. He was removed to the Holborn Institution. 48 cases were notified in London. Malaria. One case of malaria was notified, a male aged 35 years. The disease was contracted abroad. 214 cases were notified in London. Encephalitis Lethargica. No case of encephalitis lethargica was notified in the Borough during the year. 233 cases were notified in London. Pneumonia. Forty-four cases of pneumonia were notified during the year. Two of these were influenzal pneumonia. The 42 cases of primary pneumonia were notified at the following ages:— under 1 year, 1; from 1 to 5 years, 5; from 5 to 15 years, 8; from 15 to 25 years, 7; from 25 to 45 years, 7; from 45 to 65 years, 10; and 65 years and upwards, 4. Seventeen of the 42 died.—Twenty-seven were treated at home; nine were removed to voluntary hospitals and six to Poor Law Infirmaries.—Seven of the patients were nursed by the nurses of the Metropolitan and National Nursing Association, six of these being under the nursing arrangements made by the Council. Of the patients treated at home only five were nursed in a separate bedroom. In three cases the homes were found to be in a dirty condition and 26 in 14 others the homes were only fairly clean. In four cases there was evidence of exposure; one by immersion in the sea; two by getting very wet during work, and one by getting wet whilst under the influence of alcohol. In one case a brother of the patient had died from "(1) septic sore leg and (2) pneumonia" six weeks before the development of the disease in the notified case. With the exception of notifications from hotels and boarding houses, it would seem that notification has been confined to the poorer part of the community. Influenza. There were only 8 deaths from influenza in comparison with 11 in 1920, 46 in 1919 and 138 in 1918. A minor wave of influenza passed over the country during the latter part of 1921 and the early part of the present year. The disease is not notifiable and the extent of its prevalence has therefore to be estimated on the number of deaths recorded. This number showed signs of increase in the early part of December, 1921 and continued to increase until the middle of January, 1922, from which date the outbreak subsided. Having regard to the population of Holborn in comparison with the whole of London the deaths recorded in the Borough are a fraction less than the numerical proportion. Moreover, as we have a large amount of common lodging house accommodation and our population probably includes more than the normal proportion of old people, it would appear that the incidence of the disease in the Borough was somewhat less severe than in London as a whole. Steps taken to deal with the outbreak included a supply of anti-influenza vaccine ; the exhibition of warning posters ; the distribution of a special leaflet ; the maintenance of efficient and uninterrupted ventilation in theatres and cinemas, churches and other places of assembly; and a communication to proprietors of restaurants respecting the necessity for thoroughly cleansing all glasses, drinking utensils, etc. Anthrax. No case of anthrax was notified during the year. At the end of January a communication was received from the Ministry of Health, drawing attention to cases of anthrax in man, in which infection had been traced to the use of shaving brushes imported from Japan before the prohibition of importation under the Order in Council, dated February 9th, 1920, made in pursuance of the Anthrax Prevention Act, 1919. In consequence of 27 this communication a circular was issued to all chemists and other retailers in the Borough, who, it was thought, might possibly be selling Japanese shaving brushes, indicating the action which they should take with a view to the prevention of danger from such brushes. No infected brush was traced in the Borough. In October, 1921, a further circular on the subject was received from the Ministry of Health, suggesting that there would be a great advantage if Local Authorities, possessing efficient steam disinfecting apparatus, would offer brush manufacturers in their districts facilities for the disinfection of hair upon terms to be mutually agreed upon. A communication was issued to brush manufacturers accordingly. Bacteriological Work. 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 Examination. 658 449, bacilli not found 4 4, Negative 106 87, bacilli not found 2 2, Negative 209, bacilli found 0, Positive 19,bacilli found 0, Positive Disinfections. During the year 389 rooms and 6,785 articles of bedding, clothing, etc., were disinfected after various infectious diseases. Special attention is devoted to toys and more particularly to any toy put in the mouth. These latter are as a rule destroyed. In addition to the above, 2,798 articles of bedding, clothing etc., were disinfected at the request of the Medical Officer of Health of Finsbury, during repairs to the disinfecting apparatus in that Borough. Arrangements were also made at the request of two firms for the disinfection at the cost of such firms, of a large quantity of second-hand clothing, prior to exportation to South Africa. One hundred and twenty-four thousand articles were so disinfected and certificates given. Cleansing of Persons Act. During the year 165 persons (142 men and 23 women) infested with vermin had their bodies and 2,370 articles of clothing disinfested, free of charge, at our cleansing stations at the Public Mortuary, Goldsmith Street, 28 TUBERCULOSIS. Tuberculosis 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 117, of which 28 were private cases, 59 hospital cases, 29 poor-law cases and 1 school case. Of these 96 were pulmonary cases and 21 non-pulmonary. Of the total number of cases 23, or 20 per cent., were residents of common lodging houses, and were all but one at once or soon afterwards removed to infirmaries. With few exceptions the remaining 94 lived in tenement houses, and 30 of these were removed to infirmary or hospital, 65 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. In 1921, two cases were notified only at death, five cases within one month of death, five within three months and three within six months of death. The number of deaths from phthisis during the year was 42, or a death-rate of 0.96 per 1,000, in comparison with 1.13 for 1920. During the past year of the 42 deaths, 2 had been removed to infirmaries from common lodging houses in the Borough. Arrangements have been made for the home visitation of all notified cases by the Sanitary Inspectors. When necessary, contacts are invited to attend at the Tuberculosis Dispensary. Any patients attending the Tuberculosis Dispensary come under the care of the Tuberculosis Nurse ; all others are re-visited at least once a quarter by the Sanitary Inspectors in order to secure the proper disposal of the sputum and the best use possible of the sleeping accommodation. 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. 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. 29 The following is the report of the Tuberculosis Officer, Harry Evans, M.D., D.P.H., for the year 1921. Number of cases examined, for the first time in 1921. Insured Non Insured Total Males. Females Males Females under 16 58 21 7 12 39 137* *This number includes 42 contacts. Analysis of 137 New Cases in 1921. INSURED NON-INSURED Diagnosis Male Female Male Female under 16 Totals Pulmonary Tuberculosis 24 9 5 5 3 46 Non-Pulmonary Tuberculosis 4 0 0 0 3 7 Non-Tuberculous 10 8 1 3 22 44 Doubtful Cases 20 4 1 4 11 40 Totals 58 21 7 12 39 137 Attendances, etc. Insured Non-Insured Totals Attendances 648 404 1052 Examinations 362 219 581 Referred to other Hospital Departments 3 4 7 Sputa examined 100 | 19 119 Supervision of Home Conditions, etc. Visits to Homes. Insured Non- Insured Totals Nurses' Visits 821 628 1449 Medical Officer's Visits 9 I 10 830 629 1459 42 Contacts. Adults Children Totals Found to be Tuberculous 2 2 4 Non-Tuberculous 10 21 31 Doubtful 3 4 7 15 27 42 30 Reports and Communications. Insured Non Insured Totals To Public Authorities 324 93 417 To Practitioners 20 6 26 Totals 344 99 443 Summary of Work done in 1921 as compared with 1920. 1921 1920 New Cases 137 138 Attendances 1,052 943 Examinations 581 431 Nurses Visits 1,459 1,308 Letters written 443 380 Examination of Sputum 119 51 Interim, Tuberculosis Care Committee. This Committee meets monthly at the Council Offices. Miss H. M. Mathieson, the Honorary Secretary, has kindly supplied me with the following summary of the valuable work done during the year. During the greater part of 1920 the work of the Holborn I.T.C.C. was in abeyance, owing to the lack of an Honorary Secretary. In consequence of this the year 1921 has been, in some respects, abnormal. The Committee has met nine times during the year and has dealt with 44 case, (26 new and 18 old), 23 of these having been considered for assessment. Up till April 30th, 1921, the I.T.C.C. only dealt with the assessment of uninsured cases, but, when Sanatorium benefit ceased to be included among the benefits conferred by the National Health Insurance Acts, the I.T.C.C. had also to deal with such insured cases as were not exempt from contributions towards cost of maintenance. Of the cases on the register of the I.T.C.C. from 1916 to December 31st, 1921, 38 have died and 56 have left the Borough; of the latter, 21 were transferred to other I.T.C. Committees. During the year the number of case-sheets has increased from 186 to 301; 225 cases have been visited, and a total of 680 visits have been paid. Contributions towards the cost of maintenance of patients in residential institutions have been collected on behalf of the L.C.C. in 14 cases; 8 of these were still under treatment at the close of the year. 31 Various reports have been obtained from institutions on behalf of relatives, in addition to the periodical Progress Reports received from the L.C.C. In connection with cases, 8 different hospitals have been visited, and over 450 letters and postcards have been written. Various attempts have been made to obtain employment, but, owing to the present abnormal state of the labour market, these attempts have, unfortunately, mostly been unsuccessful. Various cases have been assisted through the co-operation of the Charity Organisation Society, the Soldiers and Sailors Families Association, the Italian Benevolent Society, etc. Three children have been away for convalescence through the Invalid Children's Aid Association and three through the Guardians. DENTAL CLINIC. The Dental Clinic for (a) tuberculous persons and (b) poorer inhabitants, which with the approval of the Ministry of Health was opened at the beginning of October, 1920, for a limited period of 12 months, was continued during the year on Tuesday evenings. In October, 1921, the Ministry of Health intimated that, as regards the poorer inhabitants, sanction for dental service which was purely temporary and tentative could not be extended beyond the 31st December, 1921. The agreement with the British Dentists Hospital for this Clinic therefore terminated on that date. The Hospital Authorities decided, as an experiment, to continue the Clinic as a voluntary service subject to their being granted the free use of the premises one evening each week. The Council agreed to this proposal and provisional arrangements have been made for tuberculous persons referred from the Tuberculosis Dispensary to receive dental treatment at this Clinic as part of the Council's Tuberculosis Dispensary Scheme. From the opening of the Clinic in October, 1920, to its closing at the end of December, 1921, 132 new patients were admitted, namely, tuberculous persons 11, poorer inhabitants 121. These patients made 469 attendances, namely, tuberculous persons 25, poorer inhabitants 444. Scaling and gum treatment was given in 11 cases, all poorer inhabitants. Extractions with local anaesthetic were made in 105 cases, 3 being tuberculous patients and with general anaesthetic in 21 cases, one being a tuberculous patient. In 38 cases fillings were provided for poorer inhabitants. The provision of dentures for these patients was not undertaken by the Council, but 19 upper dentures and 16 lower dentures were provided by the Hospital Authorities the cost being wholely or partly born by the patients. Of the dentures provided, two upper and one lower were for tuberculous cases. 32 MATERNITY AND CHILD WELFARE. During the year 486 births were registered as occurring in the Borough. From the notification of birth forms we are able to give the following information as to by whom the mothers were attended at the confinement:— Private doctors 137 Private Midwives 72 Outpatient Midwifery departments of General Hospitals:— Externs and others 49 Midwives.—Charing Cross Hospital 48 University College Hospital 46 Middlesex Hospital 28 Training Institutions for Midwives:— Myddelton Square 49 Notified by parents only 26 Not notified 31 The number of births transferred from outlying institutions was 181. There are no maternity hospitals or lying-in institutions in the Borough. An analysis has been made of the birth cards to ascertain where the mothers living in crowded houses were confined. The information obtained is given below:— living In Confined at Home. In Hospital No. Percentage No. Percentage One roomed homes 39 67 19 33 Two „ „ 128 80 32 20 Three roomed ,, 62 71 15 19 These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances. HOME VISITING. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits Revisits. Total Expectant Mothers 48 97 145 Children under 1 year of age 650 850 1,506 Children over 1 year of age 3 638 641 Enquiries re stillbirths 14 „ re ophthalmia neonatorum 12 Other Visits 110 In addition 569 visits were made by three student Health Visitors. 33 The noting of cases for revisiting on street cards has enabled a larger number of visits to be paid this year. Of the 653 children visited for the first time 228 attended Infant Welfare Centres. Of these 185 attended at the Council's Centre No. 10, John Street, and 17 at the Mary Ward Settlement Centre; the remainder attended at one of nine other Centres. It was not possible for 126 to attend at any Centre. Some two-fifths of the possible number, therefore were under the care of an Infant Welfare Centre; in 1920 the proportion was one-half. Comparison of the figures relating to the Holborn and St. Giles Districts shows that the diminution of attendances occurred especially in regard to babies from the St. Giles district, and was due in a large part to the unavoidable closure of the Short's Gardens Centre. WORK AT CENTRES. In addition to the maintenance of the Council's Maternity and Child Welfare Centre at 10, John Street, the grant towards the Mary Ward Voluntary Centre formerly called the Passmore Edwards Settlement School for Mothers (used jointly with South St. Pancras) was continued during the year. Unfortunately we were not able to make any suitable arrangements to reestablish a Centre in place of the Short s Gardens Centre (which had, unfortunately, to be closed in 1920, owing to the premises being required for other purposes) so that mothers living in the St. Giles District could attend at a Centre near to their homes. Much effort has been expended on the teaching of mothers attending the Centre. Talks on the various branches of mothercraft have been given weekly throughout the year; they have often been based on the various leaflets drawn up by the Medical Officer of Health on, Breast Feeding; Bottle Feeding; Feeding of Children 9 months old to 7 years; The Care of the Teeth; How to prevent Epidemic Diarrhœa; Whooping Cough; Advice to Expectant Mothers. The talks are made as topical as possible; the third quarter of the year the Health Visitor dealt with epidemic diarrhœa; later a needlework class was started, affording the mothers the opportunity of learning the most suitable patterns and materials for their children's garments. Pictures and mottos dealing with health are displayed on the walls of the rooms and changed from time to time; opportunities are taken to speak to the mothers individually on health matters. In February Mr. Gray the Clinic Dentist gave an address on the need for care of the teeth. 34 An exhibition of work was held in May when the Mayoress distributed the prizes kindly given by the Mayor. Selected articles and papers were sent in for the National Mothercraft Competition in July 1921, when four honours certificates were gained. A similar exhibition was held in July, during National Baby Week. The Council's Centre and Clinics were open during the year as follows:— Sessions. Day and Time of Meeting. Average Attendance. Medical Supervision and Descripion of Session. Weekly Mon., 2 to 4 p.m. Mothers 12 Class for Mothers. Fortnightly Tues., 2 to 4 p.m. Children 18 Med. Off. for Infant Consultations. Do. Do. Mothers 12 Class. Weekly Wed., 2 to 4 p.m. Children 31 Med. Off. attends for Infant Consultations. Fortnightly Wed., 10 a.m. to 12 noon Expectant Mothers 5 Med. Off. attends for Ante-natal Clinic. Weekly Thurs., 2 to 4 p.m. Mothers 13 Class. Do. Do. Mothers & Children 7 Dental Clinic. Do. Fri., 2 to 4.30 p.m. Children 23 Med Off. attends for Infant Consultations The total number of attendances made by the Health Visitors at the Centres was 542. At the Municipal Centre, 4,895 attendances were made by 47 expectant mothers and 466 children of whom 320 were under 1 year and 146 over 1 year old. At the Mary Ward Centre, 562 attendances of Holborn children were made by 56 children of whom 34 were under 1 year and 22 over 1 year. Ante-Natal Hygiene. At the Ante-natal Clinic 52 women attended during the year ; of these 47 were ante-natal cases, five others attended after confinement; 113 attendances were made. Thirteen of the ante-natal cases were expectant mothers for the first time; a number of the expectant mothers were found to have defects either due to or especially of concern in view of their pregnancy, the number and kind of defect present being as follows:— Deformed pelvis 6 Threatened abortion 1 Excessive vomiting 1 Oedema 6 Varicose veins 9 Excessive vaginal discharge 5 Albuminuria (slight) 8 Other defects 6 35 Other defects present were pulmonary tuberculosis 1; heart disease 2; anœemia 8; respiratory diseases 2; constipation 8; dental caries 22; other defects 3. Eleven expectant mothers were referred to Maternity Hospitals for confinement (five normal, six abnormal); twenty to the Dental Clinic for treatment; three with other complaints to other hospitals. The time of holding the Clinic has now been altered to Tuesday afternoons (alternately) in order to suit the convenience of the mothers. Infant Consultations. Details as regards the work at the Infant Consultations at 10, John Street during the second half of the year are as follows:— Reason for Attendance No. attending. Mothers— Difficulty with breast feeding 70 Children— Congenital syphilis 3 Alimentary disorders 154 Rickets 36 Respiratory diseases 83 Hernia, umbilical 23 ,, inguinal 3 Phimosis 19 Rash 7 Disease of eye 6 ,, ear 12 „ nose and throat 16 Attendances 1,474 Mothers Children Total Number referred to Clinic Dentist 49 5 54 „ „ „ Hospitals 11 42 47 „ „ ,, Metropolitan Nursing Association 26 Assisted Milk Supply 51 Advised Convalescent Home Treatment 29 7 36 Accepted „ „ „ 6 6 12 Dental Treatment. A number of nursing and expectant mothers and young children were treated at the Council's Dental Clinic held at 10, John Street. The number of new patients during the year was 69, viz., 44 women and 25 children; the number of attendances 351. 36 Assistance with Dentures. Extractions with local anaesthetic were made in 33 cases (women) and with general anaesthetic in 50 cases, including 17 children. Fillings were provided in 39 cases, including 15 children. Dentures, 17 upper and 11 lower, were provided for 24 patients, 23 of whom contributed towards the cost. Illegitimate Births. An enquiry was made into the present circumstances of all the illegitimate babies (56) whose birth was registered in 1921. Four lived with their mothers who remained in their parent's home; if in these circumstances the mother has to go out to work the grandmother minds the baby. Four lived with their mothers; these women had work which enabled them to stay at home and keep their babies with them. Two lived with their mothers who went out to work, the baby being in a creche in the daytime. Three were boarded out with foster-mothers, two of whom were registered, the other being the baby's grandmother. Five babies died in early infancy. Eleven were living with both parents, who lived together permanently. In 27 instances no information could be obtained; the majority of these mothers were domestic servants employed in hotels or boarding houses who had entered a hospital or infirmary for the confinement and had not returned to their previous address. In view of the high death rate among illegitimate babies it is regrettable that so large a proportion of the babies born of Holborn unmarried mothers cannot be visited so as to offer them the benefit of Child Welfare Schemes. STILL BIRTHS. During the year there were 19 still births in the Borough. Enquiries were made in the cases of fourteen. A definite reason can be assigned for the death of twelve; seven were due to difficult labour, two more to accidents during labour, the cord in one of the cases prolapsed before the arrival of the attendant, in the other the death was due to a strangulating cord. In two other cases the mothers suffered antepartum haemorrhages, in another the mother was chronically invalid. Information was obtained as to the presentation in six of the deaths due to difficult labour. Four were vertex presentations; one a breech; in the remaining case the feet presented. 37 DEATHS OF INFANTS UNDER ONE YEAR OF AGE. The homes were visited in a large proportion of the infant deaths, and any requisite information obtained. The cause and age at death are given in the following table:— 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 Total Deaths under One Year. All Causes Certified 13 3 2 2 20 12 13 3 3 51 Uncertified — — — — — — - - - - Whooping Cough — — — — — — 1 1 1 3 Meningitis (not Tuberculosus) - - - - - - 1 — — 1 Convulsions 1 1 — — 2 — 1 — — 3 Laryngitis - - - - - - - - - - Bronchitis — — — — — 1 1 — — 2 Pneumonia (all forms) 1 — — — 1 3 — — 2 6 Diarrhœa — — — — - — 1 - 1 Enteritis — — — 3 3 - - 6 Injury at birth 1 — — — 1 — — — - 1 Congenital Malformations 1 — — — 1 1 — 2 Premature Birth 3 1 1 5 1 - - - 6 Aurophy, Debility, Marasmus 4 — 1 1 6 1 3 — - 10 Other causes 2 1 1 — 4 2 2 2 - 10 13 3 2 2 20 12 13 3 3 51 Nett Births registered legitimate, 593 Nett Deaths registered legitimate infants 46 during the calendar year illegitimate 55 during the calendar year of illegitimate ,, 5 Supply of Milk and Food for Expectant and Nursing Mothers and for Infants. In March, 1921, an Order was issued by the Ministry of Health revoking the Local Authorities Milk (Mothers and Children Order), 1919. At the same time a circular was issued by the Ministry setting out the revised conditions on which sanction would be given to schemes under the Maternity and Child Welfare Act, 1918, for the supply of milk, to expectant and nursing mothers and children under five years of age. These conditions limited the supply of milk at less than cost price to— (a) Nursing Mothers; (b) Expectant mothers in the last three months of pregnancy; (c) Children up to three years of age and, exceptionally, to children between three and five years of age. 38 A scheme submitted by the Council early in 1920 under the Maternity and Child Welfare Act, 1918, for the supply of milk and food to necessitous mothers and infants had received the approval of the Ministry of Health, and been in operation for some time when the revised conditions were issued. It was found that this scheme agreed closely with the new conditions of the Ministry of Health, and, subject to the slight modifications required, approval was given for the scheme to be continued. Applications received for milk free or at less than cost price are carefully investigated. Enquiries are made to verify statements of wages and other income ; information is obtained from the Guardians of the Poor as to relief given for unemployment or other necessitous conditions. Other possible sources of assistance are investigated, and all practicable steps taken to prevent overlapping. The applications are considered by an Assistance Sub-Committee of the Maternity and Child Welfare Committee meeting fortnightly for the purpose. Where grants are made the cases are reviewed by the Sub-Committee at intervals not exceeding one month. In October the graduated scale of income was revised in view of the decrease in the cost of living, and the new reduced scale has received the approval of the Ministry of Health. During the year 337 applicants received free or assisted milk or food under the Scheme. This number included 120 who were receiving such assistance at the end of the year 1920. Grants were made in 217 new cases. At the end of the year 1921, 72 cases were receiving assistance. The following table shows new cases assisted in 1921. Milk. Food. Prepared Milk. Free. Part Cost Free. Part Cost. Free. Part Cost. Expectant Mothers 23 3 2 — — — Nursing Mothers 62 30 8 1 — — Children 80 36 4 4 29 16 Home Help. The Council's Home Help has attended 19 cases during the year, and has assisted at the Centre when not at work in a home; the Emergency Home Help has been engaged six times. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In live cases of extreme necessity the services of the Home Help were granted free. In 14 cases the applicants were required to contribute towards the cost, contributions ranging from 20s. to 5s. per week. The services of the Home Help have been much appreciated, and it has been found that the Council's provision meets a much felt want in the Borough. 39 Convalescent Treatment. Convalescent Treatment was provided for eight nursing mothers with their babies at the Shooters Hill Convalescent Home of the National League for Health Maternity and Child Welfare; the Council reserved a bed at the Home for the summer months. Full use was made of the provision, the bed being occupied for 24 weeks out of the 26 available. Two of these mothers were experiencing difficulty with their breast milk, but were so recuperated by their stay in the Home that breast feeding was wholly restored. In addition to the above, six children under five years of age were sent to convalescent homes. INFECTIOUS DISEASE AMONG MOTHERS AND CHILDREN. Only one case of puerperal fever was notified. The patient was removed to hospital and soon afterwards died. Ophthalmia Neonatorum. During the year, 10 cases of ophthalmia neonatorum occurring in babies born in the Borough were brought to our notice. Six of the 10 cases were notified in accordance with the Public Health (Ophthalmia Neonatorum) Regulations, 1914, four of the notifications being from hospitals, and two from private medical practitioners. Four of the cases were not notified by the doctor or midwife in attendance. In one of these, a midwife was in attendance from an institution for training midwives, and in a second case, a midwife from the same institution was in attendance as a maternity nurse. Correspondence ensued with the Institution respecting nonnotification. One of the non-notified cases came to our notice through the attendance of the mother with her baby at the Council's Maternity Centre several weeks after the birth. The baby was still suffering from discharge from the eyes, and as there was evidence that the discharge had occurred within twenty-one days of birth, the case was formally notified by the Medical Officer of the Centre, and arrangements made for the removal of the patient to St. Margaret's Hospital. In the fourth unnotified case the mother was attended at confinement by a midwife from the Maternity Department of a General Hospital. The midwife sent a medical aid notice in respect of a discharge from eye, to the Medical Officer of Health of the London County Council, and the mother and child were removed to St. Margaret's Hospital for treatment. Correspondence respecting the non-notification of this case took place between the Public Health Department and the Lady Almoner of the Maternity Department of the Hospital, the Midwives Supervising Authority and the Ministry of Health. As a result of this correspondence, an expression of opinion was obtained from the Ministry of Health that, notwithstanding any notice or information which may be sent by a midwife to the Local Supervising Authority respecting a purulent discharge from the eyes of an infant, such midwife is required to send a notification to the Medical Officer of Health for the district, in accordance with Article VI of the Public Health (Ophthalmia Neonatorum) Regulations, 1914, unless the case has already been notified by a medical practitioner under Article 5 of these Regulations. Unless each case is notified to the Local Medical Officer of Health the public will be ignorant of the real extent of the disease : the whole of the cases cannot be followed up to ascertain the amount of permanent damage done to the eyesight. 40 In the following tables particulars are given as to each case:— Six Cases notified in accordance with the Public Health (Ophthalmia Neonatorum) Regulations, 1914. Case Number Age when Notified Age at Onset By whom Notified Type of disease on Health Visitor's first visit Where treated Medical Attendance and Nursing Result Birth Notified by REMARKS. 1 8 days 3 days Doctor (Hospital) Slight Home Doctor (Hospital) Midwife then District Nurse Cured Midwife (Hospital) 2 10 days Shortly after birth Doctor (Private) Moderate Home Doctor (Private) District Nurse Ditto Doctor. 3 11 days 2 days Doctor (Hospital) Slight Home Doctor (Hospital) Midwife and District Nurse Ditto Midwife (Hospital) (Doctor also present at birth). 6 7 days 3 days Doctor (Hospital) Moderate Home Doctor (Hospital) Midwife and then District Nurse. Ditto Midwife (Hospital) 7 6 days 3 days Doctor (Private) Severe Home, then St. Margaret's Hospital. Admitted when 12 days old Doctor (Private) and Maternity Nurse till removed to St. Margaret's Hospital. Ditto Doctor (Nurse also in attendance). 10 8 days - Doctor (Hospital) Slight Maternity Hospital and Ophthalmic Hospital Hospital Ditto Born in Maternity Hospital. 41 Four Cases not notified in accordance with the Public Health (Ophthalmia Neonatorum) Regulations, 1914. Case Number Age when Information received Age at Onset Information Type of disease on Health Visitor's first visit. Where treated Medical Attendance and Nursing. Result Birth Notified REMARKS. 5 15 days 3 days L.C.C. through Medical assistance form. Slight Home. O.P. Moorfields Hospital. — Cured Midwife (Institution) Institution written to re non-notification. 4 7 days - Ditto ditto Severe St. Margaret's Hospital. Admitted when 7 days old. Hospital Corneal opacity one eye Midwife (Hospital) Hospital, L.C.C and Ministry of Health written to. 8 2 months From birth On attendance at M. & C. W. Centre. Moderate Home till 12th Oct., 1921, then removed to St. Margaret's Hospital. Admitted when 2 months old. Doctor (10 days) Nurse (3 weeks) then District Nurse Cured Doctor. Doctor written to. 9 6 weeks 6 days Discovered by Health Visitor when visiting. Slight Home Doctor and Maternity Nurse, then District Nurse Cured Doctor Maternity Nurse bathed eyes but did not inform doctor of discharge. Intitution written to. 42 One other case of ophthalmia neonatorum brought to our notice was that of a patient born in the Borough of St. Pancras, whose mother afterwards moved into this Borough. This case was notified to the Medical Officer of Health of St. Pancras, the disease was of moderate severity and no injury to the sight resulted. In addition to the foregoing we received information of a case of slight inflammation of the eyes in a newly born child. The tables show that many agencies are available for treatment of Holborn cases; full use has been made of the Council's arrangements for providing services of the District nurses, six of the babies being attended to in their own homes by these nurses. Three patients were admitted to St. Margaret's Hospital, Kentish Town, an Institution of the Metropolitan Asylums Board set apart for the in-patient treatment of this disease. Any infant requiring such treatment can be admitted with its mother on the application to the Metropolitan Asylums Board of a medical practitioner or of a midwife. The baby should be sent in as early as possible and especially before any haziness of the cornea sets in. In this connection earlier notification of the disease would be of service. As regards prevention, the routine application of a suitable preparation of silver to the eyes of a child at birth would undoubtedly very much lessen the disease. This has been the experience in the United States of America. In practically every Federal State the midwife is required by law to treat the eyes of every new born infant with a solution of nitrate of silver; the Government supply small doses in sterilised containers free of charge. Recently, a circular has been issued by the Scottish Board of Health to medical practitioners" strongly recommending the installation of silver nitrate solution into the eyes of newly born children and intimating that they will in future require a report with particulars of treatment from Medical Officers of Health on all cases in which there occurs loss of vision." The procedure recommended is a practical means of prevention, ready to-day, and proved to be efficacious. The only difficulty is to have its advantages brought home to those concerned. Measles. The notification of measles was discontinued at the end of 1919, but during the last year I received information, principally from school teachers, of 12 cases. All were visited except those that were at once removed to hospital. 43 Whooping Cough. Whooping cough was first made notifiable in the Borough in 1914 for a period of five years, which was extended for a further period of five years from the 1st July, 1919. Visits were paid to 173 persons suffering from the disease during the year; these cases occurred in 123 families. In 86 families one case occurred; 25 families had two cases; 11 had three; in one family four suffered. Twenty-six of the cases were discovered by the Health Visitors and three by the Medical Officer of Health; 107 were children under five years of age, and 63 were aged 5 to 14 years. Sixteen children were removed to hospitals (six to the M.A.B. Hospital, eight to Holborn Poor Law Infirmary); 18 more would have been removed to a M.A.B. Hospital had accommodation been available. In 61 instances the source of infection was apparently a sufferer in another household. Even if it be granted that the disease is difficult to diagnose until the whoop appears, in a large proportion of these instances the contact occurred after the child had whooped and at a time when the diagnosis was obvious; the extent of the disease would therefore have been lessened had the infecting children been removed to hospital shortly after diagnosis. Housing conditions in Central London make it difficult for parents to keep sufferers away from other children for so long a time as six weeks from the commencement of the illness, the period of isolation necessary to prevent its spread. Epidemic Diarrhœa. This disease is notifiable in only a few districts in London, and is not notifiable in Holborn. The number of deaths of young children under two years of age classified under the head, Diarrhœa and Enteritis, was eight, and included seven under one year. Some of these, however, were not real cases of epidemic diarrhoea, although classified under this head. The deaths were equal to a rate of 12.2 per 1,000 in comparison with 21.3 for all London. All practicable methods are adopted to diminish mortality and permanent injury to health caused by this disease. A special leaflet was printed on the prevention of summer diarrhoea, emphasising the importance of young babies being kept in the cooler part of the house or in the shade out of doors, and of keeping them lightly clad, also drawing attention to the necessity of cleanliness and the danger of spreading disease by flies. 44 In July, August and September, special and frequent visits were paid to those living in streets and houses where epidemic diarrhoea seemed most likely to occur. The symptoms, the spread, the prevention and the necessity for the prompt treatment of this disease were pointed out, and the special leaflet on the subject given to each mother. Although the realisation of danger and the knowledge of treatment is greater and more widespread than formerly, there is still much room for education in the prevention of this disease, judging from the number of homes where uncovered food is left about, lids left off from dustbins and refuse thrown carelessly about instead of being put carefully into the dustbin or burnt. Disinfectant fluid was supplied from the Council's Centre for the use of mothers whose infants were suffering from diarrhœa. The need for cleansing the streets by flushing was recognised, and was carried out as far as the diminished water supply would permit. The hot rainless third quarter of the year was fortunately not associated with the devastating attacks of summer diarrhoea that might have been anticipated in the light of the experience of the summers of 1899 and 1911. At the English Speaking Conference on Infant Welfare held in July last, it was suggested that the number of infantile diarrhoeal deaths in the year 1921 would serve as a measure of the value of the increased supervision of infants instituted during the last decade. Fortunately judged by this severe standard the work has been abundantly justified. The death rate from diarrhoeal diseases has remained consistently low during the last five years of varying meteorology; this year the records available at present show that, in London at least, although the weekly number of deaths has been considerably above the average of the last five years, nothing like the loss of life which occurred in 1911 has taken place. In 1911, during the weeks ending July 1st to September 23rd, 4,097 deaths from diarrhoea and enteritis under two years occurred—in 1921 for the same period the number of deaths was 1,173. Poliomyelitis. No case of poliomyelitis (infantile paralysis) was notified. 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. Their services were used as follows :— Whooping Cough 1 Case 4 Visits. Ophthalmia Neonatorum 7,, 133 ,, Pneumonia 11,, 177 ,, Total 19 Cases 314 Visits. 45 Health Week and Baby Week. Health Week and Baby Week were combined and celebrated in the Borough from 9th to 15th October, 1921. Among the steps taken to secure success of this special week in the Borough were the following (1) Special lessons were given in the various day schools and prizes were offered for the best essays written in each school. About 1,700 children in 23 school departments in the Borough wrote essays. The Mayor and Mayoress subsequently entertained the selected writers to tea when the prizes were distributed. (2) A lecture was delivered in the Court Room by Councillor Norah March, B.Sc., on " The Woman Citizen's Responsibility for Public Health." (3) A lecture illustrated with limelight views on "The Care of the Teeth" was given at the Maternity and Child Welfare Centre, No. 10, John Street, by Mr. Cecil O. Gray, L.D.S., the dentist at the Council's Dental Clinic. (4) Arrangements were made for the exhibition of a film, "Our Children," at one of the local cinemas. (5) The Clergy and Sunday School teachers of all denominations in the Borough were invited to co-operate. (6) Arrangements were made for the distribution of a very large number of leaflets and other literature through the co-operation of a number of retail shop-keepers. Medical Inspection and Treatment of School Children. The medical inspection and treatment of children attending Public Elementary Schools in Holborn is carried out by the London County Council. The following treatment Centres are provided under the L.C.C. Schemes:— (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries:— (1) St. Bartholomew's Hospital. (2) Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) Homeopathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nose and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensary, University College Hospital. (13) University College Hospital. We endeavoured to co-operate with the Education Authority by giving information respecting children suffering from infectious disease and child contacts attending public elementary schools. The County Medical Officer of Health has kindly furnished me with particulars of medical inspections of school children in Holborn in 1921. They are classified in the following tables:— 46 Medical Inspection of School Children in Holborn, 1921. Entrants. Age 8. Age 12 Age 14 Boys Girls Boys Girls Boys Girls Boys Girls Number Examined 310 334 268 329 253 296 342 306 Number requiring Treatment 124 111 102 136 94 103 129 91 Defects:— Skin F 3 2 1 2 2 - 1 - X 3 1 1 — 1 — — - Teeth F 150 142 110 138 74 82 99 78 X 83 84 72 97 63 65 80 68 Tonsils F 55 54 29 47 20 22 15 17 X 18 24 17 25 7 15 5 12 Adenoids F 5 5 4 6 - 1 1 - X 4 1 2 2 — — 1 — Tonsils and Adenoids F 2 2 - 3 - - - X 2 2 - 1 — — — — Other Nose and Throat Defects F 1 - - 1 3 - 6 - X 1 - - - - - 4 — Lymphatic Glands F 18 11 5 6 4 9 5 7 X —- 2 - - — — 1 — Eye Diseases F 14 13 3 7 6 4 2 4 X 8 3 2 3 4 2 2 — Vision X Not tested. 11 24 27 31 47 22 Ear Diseases F 3 2 1 7 4 4 7 2 X 2 1 1 4 1 3 5 1 Hearing F - - - 2 - 2 1 1 X - — - 1 — 1 — - Speech F 1 - - - 2 - 1 - X - - - - - - - - Heart F 4 7 4 10 8 6 6 5 X — 1 — - 1 — — - Anœmia F 6 6 4 4 4 3 2 1 X - 1 — 1 2 1 — — Lungs F 26 17 10 11 9 5 2 3 X 8 1 1 - 3 - — 1 Nervous System F 2 3 - - - 1 1 3 X — 2 - - - - - 1 Tuberculosis, Phthisis F - - - 2 - 1 1 1 X — — - 1 — — 1 — Other Tuberculosis F 2 1 1 — — — 2 X 1 — — 1 — — — 1 Rickets F 14 6 3 1 4 1 2 X 2 - - - - - - - Deformities F 2 - 1 1 2 6 2 2 X 1 — - - 1 3 - - 47.  Entrants. Age 8 Age 12 Age 14 Boys Girls Boys Girls Boys Girls Boys Girls Infectious Diseases - - 1 - - - - - X - - - - - - - - Malnutrition F - - 2 1 1 3 - - X - - 1 - - - - - Other defects F 4 5 - - - 4 - 1 X 3 2 — - - 3 - - F signifies defects found. X signifies treatment required. 48  Clothing Nutrition Cleanliness of Head. Cleanliness of Body. Condition of Teeth Vision Mental Condition. 1 2 3 1 2 3 4 i 2 3 1 2 3 1 2 3 1 2 3 1 2 3 4 Entrants, Boys 70 221 19 52 243 15 302 8 - 303 7 - 160 95 55 Percentage 22.6 71.3 6.1 16.8 78.4 4.8 97.4 2.6 97.1 2.3 51.6 30.6 17.8 Entrants, Girls 77 243 14 63 261 10 266 61 7 324 9 1 192 94 48 Percentage 23.0 72.8 4.2 18.9 78.1 3.0 79.6 18.3 2.1 97.0 2.7 0.3 57.5 28.1 14.4 Age 8, Boys 65 155 48 36 219 13 258 7 3 262 5 1 158 76 34 138 65 55 - 253 13 2 Percentage 24.3 57.8 17.9 13.4 81.7 4.9 96.3 2.6 1.1 97.8 1.8 0.4 58.9 28.4 12.6 51.5 24.2 20.5 94.4 4.8 0.8 Age 8, Girls 95 203 31 66 243 19 1 208 110 11 312 14 3 191 104 34 170 76 78 2 323 4 Percentage 28.9 61.7 9.4 20.0 73.9 5.8 0.3 63.2 33.4 3.4 94.8 4.3 0.9 58.1 31.6 10.3 51.6 23.1 23.7 0.6 98.2 1.2 Age 12, Boys 54 153 46 42 194 17 245 8 251 2 179 61 13 143 41 68 - 246 7 Percentage 21.3 60.5 18.2 16.6 76.7 6.7 96.8 3.2 99.8 0.8 70.8 24.1 5.1 58.5 16.2 26.9 97.2 2.8 Age 12, Girls 69 199 28 99 187 10 196 88 12 289 7 214 64 18 181 47 68 2 290 4 Percentage 23.3 67.2 9.5 33.4 63.2 3.4 66.2 29.7 4.1 97.6 2.4 72.3 21.6 6.1 61.2 15.9 22.9 0.7 97.9 1.4 Age 14, Boys 82 206 54 92 240 10 334 7 1 338 4 243 86 13 218 46 77 328 14 Percentage 24.0 60.2 15.8 27.0 70.1 2.9 97.7 2.0 0.3 98.8 1.2 71.1 25.1 3.8 63.7 13.5 22.5 96.0 4.0 Age 14, Girls 75 204 27 123 172 11 194 104 8 294 11 1 228 68 10 194 47 64 292 13 1 Percentage 24.5 66.7 8.8 40.2 56.2 3.6 63.4 340 2.6 96.1 3.6 0.3 74.5 22.2 3.3 63.4 15.4 20.9 95.4 4.3 0.3 Clothing 1 = good; 2 = fair; 3 = bad. Nutrition 1 = excellent; 2 = normal; 3 = below normal; 4 = bad. Cleanliness—Head 1 = Clean; 2 = nits only; 3 = pediculi. Body 1 = Clean; 2 = dirty; 3 = pediculi. Teeth 1 = sound; 2 = less than four decayed; 3 = more than three decayed. Vision 1 = 6-6 both eyes; 2 = 6-9 in cither eye; 3 = 6-12 or worse in either eye. Mental Condition 1 = bright; 2 = norma.; 3 = dull; 4 = backward. 49 SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 32 bodies were deposited. There were 24 post mortem examinations made, and 21 inquests held. The inquests are held in the Court Room at the Council Offices. On eight occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes. Inquests. During the year forty-eight inquests were held on the bodies of Holborn parishioners. Many of these died outside the Borough and the inquests were held in the district where death took place, the deaths being subsequently transferred to Holborn. The causes of death certified as a result of such inquests were:—Natural causes, 21; Accidents, 17 ; Suicide, 7 ; Manslaughter, 2 ; Wilful Murder, 1. Revenue Acts. One application was received for a certificate that a block of tenements in the Borough are so constructed as to afford suitable accommodation for the families or persons inhabiting the same. The premises were inspected and a certificate granted subject to the condition that the certificate did not imply that the house would comply in all respects with the requirements of the By-laws to be issued under Section 26 of the Housing, Town Planning, &c. Act, 1919. HOUSING. In Holborn a large proportion of the resident population belonging to the working classes are housed in tenements in block buildings provided by the London County Council or by philanthropic enterprise. Many others live in houses let in lodgings, houses originally intended for the middle classes, but now let off in apartments of one, two, three, four or more rooms. There are also a number of caretakers residing on office premises and a number of people living in mews over stables, most of which have been converted into garages. There are practically 110 small dwelling houses such as are met with in the suburbs. In 1919 the housing survey established the need for sufficient dwellings to rehouse about 200 persons who were about to be displaced by the clearance of the Wild Street area by the Incorporated Society for Improving the Condition of the Labouring Classes. This clearance is in course of progress: the Society intend to provide housing accommodation on the site for the displaced tenants. The Italian Colony, covering nearly three-quarters of an acre, was first represented as an unhealthy area in 1901 and 1905. An enquiry was held by the Local Government Board, in 1906. As a result 48 houses forming the courts were demolished, and the lighting and ventilation of the remaining houses much improved. The structural 50 condition, however, of the remaining 79 houses (accommodating about 150 persons) was in most cases poor : practically all these houses are old and worn, but when necessary the general sanitary defects found are always remedied. During the last year two of these houses were declared unfit for human habitation, but the defects were dealt with without the necessity of formal representation, and the houses made fit. A few of the houses remaining after the agreed clearance in 1906 have been demolished, and replaced by factories; the area will probably continue to be cleared and used for industrial purposes. The vacant site in Short's Gardens was acquired by the Council for housing purposes in 1914; the work was deferred till after the War, when, owing to the altered conditions, the Ministry of Health considered the site not suitable for housing purposes. Owing to the extreme difficulty of finding alternative accommodation it has not been found possible to deal with more than a few cases of overcrowding during the year. One of the most unsatisfactory features with regard to housing in the district is the presence of so many houses let in lodgings. These houses were not built for the purpose to which they are now put : the using of the staircases, water supply, washhouses, yards, waterclosets, ashbins, &c., in common leads to misuse and neglect; the tenants suffer much inconvenience in carrying out their ordinary housework. In most of the houses there is no suitable provision for the storage of food and cooking. The structure of these houses is in many cases satisfactory; the conversion into selfcontained tenements would much improve the accommodation. HOUSING CONDITIONS. Statistics. Year Ended 31st December, 1921. 1.—GENERAL. (1) Estimated population 43,520 (2) General death-rate 12.8 (3) Death-rate from tuberculosis (all forms) 1.10 (4) Infantile mortality rate 79 (5) Number of dwelling-houses of all classes 7,985 (6) Number of working-class dwelling-houses (Census, 1921) 9,021 (tenements) (7) Number of new working-class houses erected nil. 2.—UNFIT DWELLING-HOUSES. I.- INSPECTION. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts)1,120* (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 nil† (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 933 51 II.—REMEDY OF DEFECTS WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers ? III.—ACTION UNDER STATUTORY POWERS. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil (2) Number of dwelling houses which were rendered fit— (a) by owners nil (b) by Local Authority in default of owner's nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 935 (2) Number of dwelling-houses in which defects were remedied (a) by owners 935 (b) by Local Authority in default of owners — C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1919:- (1) Number of representations made w;ith a view to the making of Closing Orders nil (2) Number of dwelling-houses in respect of which Closing Orders were made nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit nil (4) Number of dwelling-houses in respect of which Demolition Orders were made nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders nil 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I., or (b) Part II., of the Act of 1890:- (1) Name of area nil (2) Acreage nil (3) Number of working-class houses in area nil (4) Number of working-class persons to be displaced nil 4. Number of houses not complying with the building byelaws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 nil * Practically all these houses were tenement houses containing a number of tenements. †All the more insanitary houses are always annually inspected, although none last year were formally recorded under the above Regulations. 52 APPENDIX. TABLE I. Vital Statistics of Whole District during 1921 and Ten Previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging 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 Number Rate 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 1913 46,949 868 798 16.9 910 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 97 665 17.5 1917 35,303 474 571 14.5 865 24.5 567 390 62 107 688 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 1921 43,520 483 648 14.8 859 19.7 622 319 51 79 556 12.8 In the above Table the populations, birth-rates and death-rates for the years 1911-1914 inclusive have been estimated from the Census Populations of 1901 and 1911. For the years 1915 to 1921 inclusive, the populations, births and birth-rates, deaths and deathrates, are as estimated by the Registrar-General, founded upon his estimates of the Civilian population. 53 TABLE II. CAUSES OF, AND AGES AT, DEATH. 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 2 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 under 75 years. 75 and upwards All causes Certified 556 51 11 11 9 24 68 153 117 112 Uncertified - - - - - - - - - - 1. Enteric Fever - - - - - - - - - - 2 2. Small Pox - - - - - - - - - - - 3. Measles - - - - - - - - - - - 4. Scarlet Fever 3 - 1 2 - - - - - - - 5. Whooping Cough 4 3 1 - - - - - - - 23 6. Diphtheria and Croup 4 — — 4 — — — — - - 2 7. Influenza 8 — — - — — 1 5 2 - 2 8. Encephalitis Lethargica — — — - — — — - - — 6 9. Meningo-coccal Meningitis 1 1 - - - - - - - - 3 10. Tuberculosis of Respiratory System 42 - 2 1 - 9 14 16 - - 16 11. Other Tuberculous Diseases 6 - 1 1 - 2 - 2 - - 49 12. Cancer, malignant disease 56 - - - 1 - 5 27 13 10 39 13. Rheumatic Fever 1 - - - - - - - - - 7 14. Diabetes 2 - - - - - - 1 1 - 2 15. Cerebral Hœmorrhage 35 - - - - - 1 12 13 9 2 16. Heart Disease 64 - - - - 1 9 18 20 16 20 17. Arterio-sclerosis 38 - - - - - - 5 15 18 0 18. Bronchitis 52 2 - - - — — 8 19 23 4 19. Pneumonia (all forms) 51 6 3 - 1 — 12 15 9 5 48 20. Other Respiratory Diseases 3 1 - 1 - — - 1 - - 10 21. Ulcer of Stomach or Duodenum 3 - - - - 1 1 1 - - 2 22. Diarrhœa &c. (under 2 years) 10 7 1 - - - - 1 1 - 138 23. Appendicitis and Typhlitis 5 - - - 2 2 - - 1 - 4 24. Cirrhosis of Liver 7 — - - - - 1 4 - 2 3 25. Acute Chronic Nephritis 18 — — - - - 3 8 5 2 5 26. Puerperal Sepsis 1 — - - - - 1 - - - - 27. Other accidents and diseases of Pregnancy and Parturition 1 - - - - - - - - - 3 28. Congenital Debility and Malformation,Premature Birth 19 18 - 1 - - - - - - 53 29. Suicide 4 — - - - - 1 2 1 - 3 30. Other Deaths from Violence 21 — - - 2 3 7 2 2 5 2 31. Other Defined Diseases 96 13 2 1 3 5 11 24 15 22 178 32. Causes ill-defined or unknown 1 - - - - - - 1 - - 4 556 51 11 11 9 24 68 153 117 112 630 54 TABLE III. Cases of Infectious Disease notified during the year 1921. 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 I5 to 25 25 to 45 45 to 65 65 and upwards Small-pox 1 - - - - 1 - - 1 - 1 Diphtheria (including Membranous Croup) 167 2 44 76 27 16 2 — 40 127 164 Erysipelas 18 — — 1 1 7 8 1 9 9 7 Scarlet Fever 190 2 32 120 27 9 — — 75 115 185 Enteric Fever 6 - — — 2 3 1 - 4 2 5 Puerperal Fever 1 - — — — 1 — — 1 - 1 Cerebro-Spinal Fever 2 1 — - — - 1 — 1 1 2 Ophthalmia Neonatorum *8 8 - - - - - - 5 3 3 Dysentery 1 - - - - - 1 — - 1 1 Malaria 1 — — — — 1 — — 1 - — Pneumonia—Primary 42 1 5 8 7 7 10 4 16 26 15 do. Influenzal 2 — - — — 1 1 — 2 - — Tuberculosis Pulmonary 96 — 3 4 21 43 23 2 48 48 41 do. Non-Pulmonary 21 1 3 6 5 4 1 1 9 12 11 Whooping Cough 129 21 68 38 1 1 - - 51 78 7 685 36 155 253 91 94 48 8 263 422 443 * Two of these were notified from the Public Health Department on discovery of notified cases. 55 TABLE IV. Infectious Diseases in Holborn for the last Eleven Years. NOTIFICATIONS. DEATHS. Decennial Average, 1911-1920. Year 1921. Decennial Average, 1911-1920. Year 1921. Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Small pox 0.1 0.00 0.00 1 0.02 0.00 0 0.00 0.00 0 0.00 0.00 Diphtheria 84 2.04 2.04 167 3.84 3.65 5 0.13 0.15 4 0.09 0.25 Erysipelas 26 0.60 0.79 18 0.41 0.48 1 0.03 — 1 0.02 — Scarlet Fever 99 2.28 3.15 190 4.37 7.32 1 0.03 0.04 3 0.06 0.06 Enteric Fever 7 0.16 0.13 6 0.14 0.07 1 0.03 0.02 0 0.00 0.01 Cerebro-Spinal Fever 2 0.05 0.06 2 0.05 0.02 — — — 1 0.02 — Acute Poliomyelitis 1 0.03 — 0 0.00 0.01 — — — 0 0.00 — Whooping Cough† 36 0.88 — 129 2.96 — 6 0.14 0.20 4 0.09 0.12 Measles‡ - - — — — — 13 0.32 0.36 0 0.00 0.05 Tuberculosis—Pulmonary 150 3.59 96 2.20 — 78 1.92 1.42 42 0.96 1.04 Ditto Non-Pulmonary 22 0.54 - 21 0.48 — 12 0.28 — 6 0.14 0.19 Puerperal Fever* 1 1.59 3.04 1 1.54 3.53 1 1.59 — 1 1.54 1.43 Ophthalmia Neonatorum* 7 11.13 — 8 12.32 10.77 — — — — — — Diarrhoea (under 2 years)* - — — — - — 12 16.4 21.7 8 12.3 21.3 † Notifiable in Holborn (not in London) since 1914. Average given for i years. ‡ Not Notifiable. * Rates per 1,000 births. TABLE V. Information required by the London County Council. Premises. Number on register at end of 1921. Number of Inspections Number of prosecutions. Cowsheds — — — Milkshops 154 174 — Houses let in lodgings 601 905 1 Ice cream premises 64 279 — Slaughter houses 1 8 — Offensive Trades — — — Smoke Nuisances— Number of observations 161 Number of notices 9 Number of nuisances and complaints 10 complaints Number of summonses 0 Housing of the Working Classes— Number of houses inspected 767 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 0 Number of houses included in such representations 0 Number of Closing Orders 0 Number of houses included in such Closing Orders 0 Number of Closing Orders determined 0 Number of houses remedied without Closing Orders 0 (A number of houses were remedied without the necessity for representation) Number of demolition orders 0 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 04 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 tenements Number of houses occupied by the working classes 9021 tenements Number of houses for the working classes— (a) erected during year 0 (b) in course of erection 0 Undf.rground Rooms— Number illegally occupied 6 Number closed or illegal occupation discontinued 6 Overcrowding— Number of rooms overcrowded 1 Number remedied 1 Prosecutions 0 Cleansing— Number of adults cleansed 165 Number of children cleansed 0 Number of rooms or premises cleansed 69 (vermin) Prosecutions (vermin) 0 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 232 Number of Inspections 1929 Disinfection shelter— Persons accommodated 0 Ophthalmia neonatorum regulations— Number of notifications received during the year from certified midwives 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 57 TABLE VI. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 114 25 5 — Workshops 373 74 9 — Workplaces 3,904 95 4 — Total 4,391 194 18 — 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 73 73 - — Want of ventilation - - — - Overcrowding - - — — Want of drainage of floors — — — — Other nuisances 131 131 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 68 68 — — not separate for sexes 8 8 — — 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 282 282 - — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 58 TABLE VI.—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. 110) 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. Lists. Outworkers. Contractors. Workmen. Contractors Workmen. Wearing Apparel— (1) Making, &c. 98 251 311 5 9 5 98 - - - - - - - - (2) Cleaning and washing - - - - - - - - - - - - - - - Racquet and Tennis Balls — — — 1 — 16 1 — — — — — — — — Paper Bags and Boxes 2 — 13 - - - - - - - - - - - - Total 100 251 324 6 9 21 101 - - - - - - - - 59 TABLE VI.—continued. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakehouses (including 16 factory bakehouses) 29 Other Workshops 1,130 Total number of workshops on Register 1,159 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) 1 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 38 Report (action being taken) sent to H.M. Inspector 38 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 18 60 TABLE VII. Meteorology of London, 1921. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal.) 1921. Air Temperature. Bright Sunshine. Rain and other forms of Precipitation. Mean of— Mean of A. & B. Difference from Normal.* Daily Mean. Difference from Normal.* Per cent. of possible. Total Fall. Difference from Normal.* Maximum.A Minimum. B °F °F °F °F hrs. hrs. % m.m. m.m. January 50.0 41.0 45.5 + 7.0 0.94 -0.30 11 44 + 1 February 47.8 35.0 41.4 + 1.6 2.l8 + 0.14 22 3 -37 March 55.2 38.0 46.6 + 4.1 4.46 +1.06 38 31 -13 April 59.3 38.7 49.0 + 1.4 6.73 + 1.71 49 30 -7 May 66.8 43.9 55.3 + 1.3 7.54 + 1.07 49 32 -12 June 71.8 48.8 60.3 + 0.4 7.39 + 0.69 45 11 -40 July 81.6 55.4 68.5 + 5.0 9.21 + 2.71 57 4 -53 August 74.2 53.4 63.8 + 1.2 5.77 -0.43 40 17 -39 September 71.5 49.3 60.4 + 2.4 5.81 +0.86 46 46 + 1 October 67.8 47.0 57.4 + 7.2 4.98 + 1.86 47 20 -44 November 45.3 34.6 39.9 -4.1 1.79 + 0.07 20 50 -8 December 49. 39.5 44.3 + 4.1 0.92 -0.14 12 30 -27 Year 61.7 43.7 52.7 + 2.6 4.81 + 0.76 39 318 or -278 orab't 12.40 ins. -10.84 ins. *he normals used are obtained from observations extending over 35 years (1881-1915). 61 TABLE VIII. LEGAL PROCEEDINGS. Public Health (London) Act, 1891. Date. Name. Premises. Offence. Result. 1921. Feb. 10 S. J. Soanes 1, Orde Hall Street Existing Nuisance 21s. costs. Order to complete work in 14 days. Do. do. 3, do. do. do. Do. do. 5, do. do. do. Jan. 21 Mrs. Watkins 42, Devonshire Street Breach of By-laws as to houses let in lodgings. Fine 5s. Housing of the Working Classes Act, 1890 to 1919. Date. Name. Premises. Offence. Result. Nov. 30 Frank Van Hollick 14, Red Lion Passage Continuing to occupy a dwelling-house after Closing Order has become operative. Order for ejectment 21 days. Sale of Food and Drugs Acts. Date. Name and Address. Offence. Result. 1921. Jan. 28 Boutalls, Ltd., 150, Southampton Row. Selling 33% calomel ointment 68.2% deficient in calomel. 5 guineas costs. Jan. 28 Wray's Drug Co., Ltd., 8, High Holborn. Ditto, 37.5% 3 guineas costs. Mar. 17 Squire & Co., Ltd., 72, Southampton Row, trading as Haynes, Coffin & Co. Selling 33% calomel ointment 31% deficient in calomel. 3 guineas costs. May 9 Karl Hanson, 5, New Oxford Street Selling milk 20% added water. Dismissed on payment of 12/6 costs. May 19 Robert Saxby, 18, Tower Street. Selling 33% calomel ointment deficient in calomel to the extent of 64.7%. 2 guineas costs. May 19 Frank, Thomas, 18, Tower Street. Ditto Ditto. June29 Alfred Jones, 1, East Street. Selling milk 7% added water Dismissed on payment of 1 guinea costs. Aug. 11 Fred. Lewis, 33, Portpool Lane. Selling milk 13.3% deficient in fat. Withdrawn on payment of 1 guinea costs on undertaking not to sell milk in future.