HOL 24 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of Health, C. W. HUTT, M.A., M.D., D.P.H., For the Year 1926. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1927 2 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C. 1. March, 1927. 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 1926. Believe me, Ladies and Gentlemen, Yours obediently, C. W. HUTT, Medical Officer of Health INDEX. Public Health Committee 6 Housing of the Working Classes Committee 6 Maternity and Child Welfare Committee 7 Staff 7 Statistical Summary 8 Natural and Social Conditions 9 Population and Houses 9 Births 9 Deaths 10 Seasonal Mortality 11 Infantile Mortality 11 Poor Law and Hospital Relief 12 Sanitary Circumstances 13 Scavenging. Removal of House Refuse 13 Removal of Manure 18 Sanitary Inspection of District 18 Notices served 20 By-law as to Houses let in Lodgings 21 Rats and Mice (Destruction) Act 21 Rat Week 23 Inspection of Workshops 23 Factories 24 Factories Bill 25 Smoke Abatement 28 Common Lodging Houses 28 Food 28 Dairies, Cowsheds and Milk Shops 28 Residue from Milk Clarifiers 28 Bacteriological Examination of Milk 28 Dirt in Milk 29 Milk (Special Designations) Order, 1923 32 Public Health (Milk and Cream) Regulations, 1912-17 32 Condensed Milk 32 Dried Milk 33 Margarine 33 Bakehouses 33 Fried Fish Shops 34 Fish Shops and Stalls 34 Market Streets and Exposure of Food Generally 34 Ice Cream 35 Sale of Sweets 37 Meat Regulations 39 Places where Food is Prepared for Sale 40 Restaurants, Sanitary Accommodation for Customers 40 Unsound Food 41 Sale of Food and Drugs Acts 41 Preservatives in Food Regulations 41 Apples—Contamination by Arsenic 41 Cake 43 Calomel Ointment 43 Cheese 43 Jam 43 Sausages 44 Swiss Roll 44 Cockles 44 Winkles45 Milk—Fat Content 46 Table of Samples Purchased 48 Food Poisoning 49 Prevalence of and Control over Infectious Diseases 51 Infectious Diseases Generally 51 Smallpox 52 Vaccination 52 Diphtheria 53 A 2 Page 4 Page Schick Test and Immunisation against Diphtheria 55 scarlet Fever 63 Enteric Fever 64 Typhus Fever 64 Cerebro-Spinal Fever 64 Dysentery 64 Malaria 65 Encephalitis Lethargies 65 Acute Poliomyelitis 65 Pneumonia 66 Influenza 67 Anthrax 67 Chickenpox 67 Mumps 67 Bacteriological Work 67 Disinfections 68 Cleansing of Persons Act 68 Verminous Condition and Scabies 68 Shelter during Disinfection 68 Tuberculosis 69 Notifications 69 Correction of Register 71 Sleeping Conditions 71 Classification of Homes 72 Delay in Notification 73 Institutional Treatment 73 Visitation of Home 73 Contacts 74 Prevention of Spitting 74 Deaths from Pulmonary Tuberculosis 74 Tuberculosis Dispensary 75 Public Health (Prevention of Tuberculosis) Regulations, 1925 77 Tuberculosis Care Committee 78 Home Nursing 80 Dental Clinic 80 Cancer 81 Maternity and Child Welfare 81 Notification of Births 81 Number of Births 82 Births in Crowded Homes 82 Home Visiting 83 Attendances at Infant Welfare Centres 83 Work at Centres 84 10, John Street 84 Short's Gardens 84 Ante-natal Hygiene 86 Maternal and Infant Consultations 87 Artificial Sunlight 88 Breast Massage 89 Diarrhoea 89Still-Births Illegitimate Births 89 Dental Treatment 89 Assistance with Denture 90 Supply of Milk and Food for Mothers and Infants 90 Home Help 91 Convalescent Home Treatment 91 Visitors to Centre 91 Saffron Hill Maternity and Child Welfare Centre 91 Deaths of Infants under One Tear 92 Deaths of Children, One to Five Tears 93 Infectious Diseases among Mothers and Children 93 Puerperal Fever 94 Ophthalmia Neonatorum 94 Whooping Cough 97 Measles 98 German Measles 99 Epidemic Diarrhoea 99 5 Page Nursing Arrangements 100 Widows', Orphans', and Old Age Contributory Pension Act, 1925 100 Health and Baby Week 101 Minor Ailments Clinic 104 Medical Inspection and Treatment of School Children 104 Deaths of Children, 5-15 Years 105 Sanitary Administration 108 Mortuary 108 Inquests 108 Revenue Acts 108 Dirty Tenants 108 Removal of Aged Persons 108 Rent and Mortgage Interest Restriction Acts 109 Dogs—Nuisance from—By-laws 109 Choked Water Closets 109 Vita Glass—Use of 110 Cab Shelter—Nuisance from 110 Old Buildings—Demolition of 110 Children's Country Holiday Fund 111 Effluvia from Trade Processes 111 Water Supply—Private Wells 111 Other Propaganda 112 Housing 112 Betterton Street Scheme 113 Housing Conditions 114 APPENDIX. Table I. Vital Statistics, 1926, and ten previous years 116 Table II. Causes of and Ages at Death, 1926 117 Table III. Infectious Diseases Notified during 1926 118 Table IV. Infectious Diseases in Holborn during 1926 and ten previous years 119 Table V. Information required by L.C.C 120 Table VI. Factories, Workshops, &c. 121 (1) Inspections 121 (2) Defects found 121 (3) Home Work 122 (4) Registered Workshops 123 (5) Other Matters 123 Table VII. Legal Proceedings 124 6 PUBLIC HEALTH COMMITTEE. 1926-27. Chairman— Alderman Francis J. Pullen. 1925-26. Chairman— Alderman Francis J. Pullen. Vice-Chairman— Councillor John H. Boraston, C.B. Vice-Chairman— Councillor John H. Boraston, C.B Ex-Officio— The Eight Worshipful The Mayor, Alderman Harold Warren Coleman, J.P. Councillor Albert J. Clark. Ex-Officio— The Right Worshipful The Mayor, Alderman Harold Warren Coleman, J.P. Councillor Albert J. Clark. „ Rev. Wilfred H. Davies, M.A. „ Henry W. Ellis. „ Harold Jewell. ,, Horace W. Langdon. „ Miss Marjorie R. Lovelock. ,, Rev. Henry Ross. „ Sir William R. Smith, D.L., J.P., M.D. „ Mrs. Ethel M. Wilson. ,, Arthur Toungman. „ Rev. Wilfred H. Davies, M.A. „ Henry W. Ellis. ,, Harold J. Jewell. „ Horace W. Langdon. ,, Miss Marjorie R. Lovelock. „ Samuel W. Price. ,, Rev. Henry Ross. ,, Sir William R. Smith, D.L., J.P., M.D ,, Mrs. Ethel M. Wilson. HOUSING OF THE WORKING CLASSES COMMITTEE. 1926-27. Chairman— Councillor J. C. St. Laurence Stallwood. Vice-Chairman— Alderman James W. Coade. 1925-26. Chairman— Councillor J. C. St. Laurence Stallwood. Vice-Chairman— Alderman James W. Coade Ex-Officio— The Right Worshipful The Mayor, Alderman Harold Warren Coleman, J.P. Alderman Sir Robert W. Dibdin, J.P. Councillor Rev. Wilfred H. Davies, M.A. „ Miss Emily Dibdin. „ Henry W. Ellis. ,, Ernest Hamlin. „ Roland H. Haxe. „ Alfred Humphreys. „ Horace W. Langdon ,, Raymond A. Miles. „ George D. Poclty. Ex-Officio— The Right Worshipful The Mayor, Alderman Harold Warren Coleman, J.P. Councillor Rev. Wilfred H. Davies, M.A. „ Miss Emily Dibdin. „ Henry W. Ellis. Ernest Hamlin. ,, Alfred Humphreys. ,, Horace W. Langdon. ,, Raymond A. Miles. Albert A. Mussett. George D. Pooley. Arthur Youngman. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1926-27. Chairman— Councillor The Rev. Henry Ross. Vice-Chairman— Councillor Miss Emily Dibdin. Ex-Officio— The Right Worshipful The Mayor, Alderman Harold Warren Coleman, J.P. Councillor Edmund Balding. „ Richard Davies. „ Percy Hill. „ Miss Marjorie R. Lovelock. „ Albert A. Mussett. „ Lady Smith, J.P. „ Mrs. Ethel M. Wilson. ,, George Witherby. Mr. Thomas W. J. Coffin. The Mayoress (Mrs. H. Warren Coleman). Mrs. Wilfred H. Davies. Miss Norah H. March, B.Sc. „ M. Wilmsliurst. 1925-26. Chairman— Councillor The Rev. Henry Ross. Vice-Chairman— Councillor Lady Smith, J.P. Ex-Officio— The Right Worshipful The Mayor, Alderman Harold Warren Coleman, J.P Alderman Francis J. Pullen. Councillor Richard Davies. „ Miss Emily Dibdin. „ Percy Hill. „ Miss Marjorie R. Lovelock. ,, Albert A. Mussett. „ Mrs. Ethel M. Wilson. „ George Witherby. Mr. Thomas W. J. Coffin. The Mayoress (Mrs. H. Warren Coleman). Mrs. Wilfred H. Davies. Miss Norah H. March, B.Sc. ,, M. Wilmsliurst. STAFF. The following was the Staff during 1926. Medical Officer of Health—C. W. Hutt, M.A., M.D., D.P.H. Medical Officers of Maternity Centres— 10, John Street—(Temporary) Richenda Gillett, M.D.Brux., L.S.A. Short's Gardens—James Arthur Struthers, M.B., B.Ch., M.R.C.P., D.P.H. Medical Officer of Tuberculosis Dispensary— James Arthur Struthers, M.B., B.Ch., M.R.C.P., D.P.H. Medical Officer—Diphtheria Immunisation—E. Goodwin Rawlinson, M.D., L.R C P., D.P.H. 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 Visitors—Elizabeth Lister Shinnie, C.M.B. (to 31st May). Muriel G. Stockwell (from 1st July). Tuberculosis Visitor—M. Watson (from 18th January). Chief Clerk and Committee Clerk—Edwin Kent. Assistant Clerks— Frank Fitch. Arthur Long. Phyllis Bull. Doris Brown (temporary). Dental Clinic—(10, John Street). Dentist—Cecil O. Gray, L.D.S. (British Dental Hospital). Ancpsthetist—G. C. Nelson Younger, M.R.C.S., L.R.C.P. Nurses—The Metropolitan Nursing Association. Mortuary Keeper and Superintendent of Cleansing Station—Charles H. Day. Superintendent of Women's Cleansing Station—Adeline Day. Caretaker of Maternity Centre—Elizabeth Alderton. Home Help—Margaret Smith. And Panel of Emergency Home Helps. Disinfector—Henry Emms. Assistant Disinfector—E. E. Denny. 8 STATISTICAL SUMMARY, 1926. Population—estimated to middle of year (as supplied by the Registrar-General) for birth and death rates 43,200 Population—Census, 1921 43,192 Births 535 Annual rate of births per 1,000 population 1238 Deaths 522 Annual rate of deaths per 1.000 population ... 12.10 Zymotic death rate* 0.27 Tuberculosis death-rate per 100,000 81 Excess of registered births over deaths 13 Excess of registered deaths over births — Infantile mortality per 1,000 births 90 Area of Borough in acres 4051 Rateable value 1st November £1,617,098 Rate of 1d. in the £ estimated to yield £6,434 * Excluding deaths from Epidemic diarrhœa Vital Statistics, 1926. 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 17.8 11.6 70 London 17.1 11.6 64 Holborn 12.38 12.10 90 9 NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population and Houses. 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 1926—43,200. The density of the population, according to the Census, 1921, was 107 persons per acre contrasted with 60 persons per acre for the County of 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 (many of whom are very poor), and a relatively 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 large and crowded day population of London's workers. The population in the 999 L.C.C. tenements in the Borough was estimated at 3,490. The number of deaths was 36, a death-rate of 10.3 per 1,000, considerably below the average death-rate for the whole of the Borough (12.5). On the other hand the number of deaths of residents of Common Lodging Houses in the Borough, which contain 920 beds, was 53, which, calculated on the number of beds, was a rate of 57.3 per 1,000. Registered Births and Birth-Rate. The total number of births registered as occurring in the Borough was 330 (175 males and 155 females). Of these, 314 were legitimate and 16 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 190 legitimate infants and 33 illegitimate infants whose mothers were residents of the Borough. Eighteen of the births occurring in the Borough, viz., 15 legitimate births and 3 illegitimate births, were infants of mothers who were non-residents of the Borough. 10 The following table gives the corrected number of births and the corrected birth-rates for the nineteen years 1908-1926:— Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate per 1,000 of Population. No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. 1908 1,066 20. 41 1,020 19.53 956.8 46 0.88 43.2 1909 986 19.26 935 18 .27 948.2 51 0.99 51.8 1910 1,017 20.27 959 19.11 943 0 58 1 16 57.0 1911 920 18.73 865 17.61 940.2 55 1.12 59.8 1912 901 18.76 835 17.38 926.7 66 1 .38 73.3 1913 798 16.99 743 15.82 931.1 55 1.17 68.9 1914 765 16 33 705 15.05 921.6 60 1.28 78.4 1915 670 14.44 616 13.28 919.4 54 1.16 80.6 1916 649 15.63 585 14.09 901.4 64 1.54 98.6 1917 571 14.50 496 12.60 868.7 75 1.90 131.3 1918 497 12.06 428 10.38 861.2 69 1.68 138.8 1919 539 13.56 477 12 00 885 0 62 1.56 115.0 1920 827 20.84 749 18.87 905.7 78 1.97 94.3 1921 648 14.88 593 13.62 915.1 55 1.26 84.9 1922 664 15.49 602 14.04 906.6 62 1.45 93.4 1923 595 13.71 547 1.2.61 919.3 48 1.10 80.7 1924 578 13.36 532 12.30 920 .4 46 106 79 .6 1925 527 12.16 490 11.31 929.8 37 0.85 70.2 1926 535 12.38 4S9 11.32 914.0 46 1.06 86.0 In London the corrected birth rate in 1926 was 171 per 1,000 in comparison with 18 0 for 1925. Mortality. The total number of deaths registered as occurring in the Borough was 629, of which 357 were males and 272 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough:— Institution. Residents. Non.Residents. St. Giles and Bloomsbury. Holborn. St. Giles and Bloomsbury. Holborn. French Hospital 1 1 36 — Children's Hospital — 7 — 258 National Hospital — 3 — 80 London Homoeopathic Hospital 2 8 — 46 Italian Hospital — — — 1 St. Paul's Hospital — — 6 — Private — — 19 8 Total 3 19 61 393 11 There were 347 deaths of Civil "Residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 53 of whom were removed from Common Lodging Houses in the Borough. The deaths are further corrected by the Registrar-General by the inclusion of all deaths registered in the calendar year as distinct from the registration year of 52 weeks. This correction, together with deaths transferred from extra Metropolitan Institutions, accounts for the variation in the number of deaths given in the four quarterly reports of the Registrar-General and in his Annual Report. The final correction supplied by the Registrar-General for 1926 gives the total deaths for the Borough as 522. Corrected Deaths and Death- Rates, 1926, compared with 1925. 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. 1926 629 476 454 347 522 12.1 11-6 1925 725 533 513 330 542 12.5 11.7 For details of causes of and ages at death, see Table II., page 117. Seasonal Mortality. The mortality in the four quarters of the year as given in the Quarterly Reports of the Registrar-General is shown below : — Deaths. Death-rate per 1,000. London Rate. First Quarter 151 14.0 13.5 Second ,, 139 12.9 11.1 Third 103 9.5 8.8 Fourth ,, 114 10.6 12.4 507* 11.7* 11.4* 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: — *In these figures as published in the Registrar-General's Quarterly Returns for 1926, the complete corrections for deaths are not included. These corrections increase the nett deaths in Holborn to 522 giving a corrected death-rate of 121 per 1,000, the corresponding rate in London being 11.6 per 1,000. 12 Year. Deaths under 1 year of age. Deaths under 1 year per 1000 corrected legitimate Births. Deaths under 1 year per 1000 corrected illegitimate Births. Deaths under 1 year per 1000 corrected Births. London. Deaths under 1 year per 1000 Births. 1926 48 80 196 90 64 1925 33 57 135 63 67 Death-rate per 1,000 corrected births in 1926 and in ten preceding years during which details respecting births have been supplied. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Av'ge, 1916-25 1926 Holborn Borough 97 107 141 96 66 79 72 79 81 63 88.1 90 London 89 103 107 85 75 80 60 69 67 80.9 64 See also Table, page 92. The figures on which the rates given in the Registrar-General's Quarterly Reports are based are necessarily only partly corrected; the final correction including the transference of births in institutions to the residential area of the parents is made before the publication of the Registrar-General's Annual Report. The corrections considerably modify the Holborn rates as will be seen from the following figures: — Year 1926. Infantile Death-rate in Holborn per 1,000 Births Registrar-General's Quarterly Report Corrected 1st Quarter 184 177 2nd ,, 80 38 3rd ,, 118 81 4th ,, 212 137 It will be seen from the analysis on page 92 of the ages at which these infantile deaths took place that no fewer than 22 occurred under the age of four weeks. Such deaths are not considered to be due to the environment of the baby, but to indefinite alterations to the health of the mother; they are recognised as being especially difficult to prevent. Poor Law and Hospital Relief. The Clerk to the Guardians of the Holborn Union has kindly supplied mo with the following information relating to persons from the Holborn Division of 13 the Union who received Poor Law Belief during the year 1926 : — Indoor Relief 1,156 persons Outdoor Relief 482 cases Outdoor Medical Relief 294 persons Of the total number of 522 deaths, 370 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. The Council has made arrangements with the contractor for the substitution of motor vehicles in place of horse-drawn waggons for the removal of house and trade refuse. Two horse-drawn vehicles are retained for use in streets where large motor vehicles would be inconvenient and in streets congested with market traffic. The collection of house refuse from the main streets is now completed by 9 a.m., the householders being required to put the bins on the kerb of the footway in front of their premises between the hours of 6 and 8 a.m. This earlier daily collection has worked well. In a very large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins. The number of notices served for the absence of, or defective, ashbins was 57. The Disposal of Holborn House Refuse. When the refuse is removed from the Borough it is taken first to the contractor's depot where it is "forked" over for the extraction of paper, straw and other combustible matter which is at once destroyed by burning in destructors. In the course of the "forking" parts of the refuse are salvaged, e.g., tin cans and other metal articles, bottles, glass, rags, bones, also bread and other food material for sale to pig breeders. The remaining refuse, including cinders directly from the household refuse, is loaded into barges and conveyed, at present, to dumps on brickfields at Sittingbourne, for use in brick-making. The "forking" at the contractor's yard is carried out immediately on the delivery of the refuse and there is regular daily barging so that undue accumulations of Holborn refuse or nuisances arising therefrom are avoided. Occasional visits are paid to the contractor's depot to supervise the arrangements for dealing with the refuse from the Borough. The refuse is conveyed by barge from the contractor's wharf at Vauxhall to fields outside Sittingbourne belonging to a large firm of brick-makers. The refuse is deposited on to the land for subsequent use in connection with the industry carried on there. The site of the brick-making fields is on the banks of the River Thames, a short distance from Sittingbourne, the nearest residences being about one mile away, at the village of Conyer, 14 The site occupied for the tipping and sorting of the refuse and the brick-making industry extends over about four acres. The refuse as brought from the barge, is stacked into large heaps and remains for about three years before it is used. At the end of the storage period the refuse is sifted through a sieve, 3/8" mesh. This sifting separates the fine ash; the "hard core" is picked out leaving the breeze. The fine ash and breeze are used in connection with the brick-making. A sufficient quantity for the effectual burning of the bricks is mixed with the clay and the remainder is used for fuel either in kilns or clamps. The " hard core " is used entirely for road making or the making up of the land of the brickfields which, owing to its marshy nature, shows frequent subsidence. At the time of inspection refuse was seen newly deposited and at varying periods of storage up to the maximum of three years. A heap deposited three years previously, or thereabout, was in course of sifting and sorting into three types, fine ash, breeze and "hard core." No objectionable smell or other nuisance was observed from either the newly deposited refuse or the storage heaps. In reply to questions, the local manager and the foreman of the brickfields stated that rats were rarely found in the refuse: neither rats nor flies had given rise to nuisance: so far as they were aware no complaint had ever been received of any nuisance arising from the deposit or storage of the refuse or the making of bricks on the fields. In reply to questions relative to the use of earth for covering layers of refuse, the London Manager of the brick-making company intimated that the cost of treating the refuse in this way would prohibit the use by the company of London refuse in the industry. He pointed out that the fields and surrounding lands by reason of their nature would not permit cf excavation, so that it would be necessary to obtain the earth elsewhere and import it to the tips. This cost, added to that incurred for sifting and sorting refuse, would increase the expense so much that the use of coal for brick-making would become more economical than the use of London refuse. The brick-making works were subsequently inspected. Two methods were in use; first, the kiln method for machine-made bricks, dried by hot air and passed through long tunnel kilns for burning; no nuisance from smell was observed from this work; the Manager intimated that this method had been in operation in the brick industry about 25 years only. In the second, the clamp method, hand-made bricks were dried in the open air and fired in clamps, breeze being used for fuel. It was stated that a fair-sized clamp would take about three months to burn; considerable smell is given off during burning, and it would seem that these fumes might become a source of nuisance if carried out near dwellings. As, however, the nearest houses are, as previously stated, nearly a mile away, there seems no reason to suppose that the burning of the clamps on these fields gives rise to nuisance. The Council was invited to co-operate with the Ministry of Health and other Metropolitan Authorities in an investigation into the composition of house and trade refuse in the Metropolitan area. In connection with this, efforts were made to obtain reasonably reliable data as to the composition of such refuse. Arrangements were made with the Contractor to obtain thoroughly representative classified samples of the refuse obtained from Winter, Spring, Summer and Autumn yields. The samples of house refuse were divided into three groups, namely:— (a) From houses with nett rateable value of £30 and under. (b) „ „ „ „ „ „ „ £31 to £80. (c) ,, ,, ,, over £80. 15 The samples were obtained on the following dates: — Winter yield, January 13th. Spring yield, April 14th. Summer yield, July 14th. The arrangement for obtaining an Autumn yield on October 13th was cancelled owing to the abnormal conditions then existing as a result of the General Strike. About five tons of refuse from each of the above-mentioned three classes was obtained at each collection. The samples of refuse were conveyed to the Contractor's depot where, after careful weighing, analyses were proceeded with. First, the whole of a sample was passed over a hand riddle having a mesh of 5/16th of an inch; the fine material passing this mesh was designated " fine dust." The rejected material was then passed over a second screen having a mesh of ¾ of an inch. From the material passing this mesh all foreign matter, such as glass, pottery, stone, wood, etc., was eliminated, and the product resulting from this second screening was designated "small cinder." A third riddle, 1½ inch mesh, was then used followed by the elimination of the smaller foreign matter, the result being "large cinder." The foreign material already eliminated and the remainder of the sample were then hand sorted into the following divisions :— Vegetable. Putrescible. Paper. Metal. Bag. Glass. Bones. Combustible debris not classified. Incombustible debris not classified. At the conclusion of the division of the sample into these eleven parts each part was carefully weighed and the weights together with the percentage of the weight of the original sample were recorded. From the data obtained by analyses of the three samples of house refuse a calculation was made on the basis of a sample of ten tons of refuse, made up in the proportions the three classes of property mentioned above bore to the total properties in the Borough. The results of these analyses are given in the following table: — 16 [Form No. 5] Quantitative Analysis of 10 Tons of Seasonal House Refuse. [###{ Winter Refuse, 13th January, 1926. Spting Refuse, 14th April, 1926. Summer Refuse, 14th July, 1926. Average. lbs. % lbs. % lbs. % lbs. % (a) Fine Dust Content (under 5/16 in.) 7,325 32.702 6,978 31.152 3,056 13.642 5,787 25.832 (b) Small Cinder „ (between 5/16 in. and ¾ in.) 4,187 18.694 4,382 19.563 2,383 10.640 3,651 16.299 (c) Large „ ,, (over 5/4 in.) 3,468 15.480 4,175 18.638 1,826 8.154 3,156 14.091 (d) Vegetable and Putrescible Content 16 .072 48 .214 356 1.589 140 .625 (E) Paper Content 5,585 24.934 5,267 23.513 12,504 55.822 7,786 34.756 (f) Metal ,, (1) Metal Containers 567 2.531 483 2.156 520 2.320 523 2.336 (2) Other Metals 8 .036 10 .045 160 .715 59 .265 (G) Rag ,, including bagging and all textiles 117 .522 203 .906 327 1.459 216 .962 (h) Glass ,, (1) Bottles and Jars 234 1.040 321 1.433 304 1.357 286 1.277 (2) Broken Glass (Cullet) 231 1.031 62 .277 147 .656 147 .655 (I) Bones ,, 60 .268 65 .290 182 .813 102 .457 (J) Combustible Debris not classified above: (wood, straw, leather, etc.) 29 .130 6 .027 8 .034 14 .64 (k) Incombustible Debris not classified above : (bricks, stone, pottery, etc.) 573 2.560 400 1.786 627 2.799 533 2.381 22,400 100.000 22,400 100.000 22,400 100.000 22,400 100.000 On each of the three days when the samples of house refuse were obtained sample of trade refuse was also obtained, about one ton on each occasion. 17 [Form No. 5] Quantitative Analysis of Seasonal Trade Refuse. These samples of trade refuse were subjected to analyses similar to those applied to house refuse with the result shown in the following table :— Winter Refuse, 13th January, 1926. Spring Refu.se, 14th April, 1926. Summer Refuse, 14th July, 1926. Average. lbs. % lbs. % lbs. % lbs. % (a) Fine Dust Content (under 5/16 in.) 728 30.952 26 1.009 41 1.722 265 11.228 (b) Small Cinder „ (between 5/16in. and ¾ in.) 252 10.714 17 .659 22 .924 97 4.099 (c) Large ,, ,, (over ¾ in.) 124 5.272 13 .504 19 .798 52 2.191 (d) Vegetable and Putrescible Content 62 2.636 1,820 70.597 1,929 81.051 1,270 51.428 (e) Paper Content 450 19.133 252 9.775 215 9. 034 306 12.647 (f) Metal ,, (1) Metal Containers 8 0.340 16 .621 108 4.538 44 1.833 (2) Other Metals nil - nil - nil - nil - (G) Rag ,, including bagging and all textiles nil - nil - nil - nil - (h) Glass ,, (1) Bottles and Jars nil - nil - 14 .588 5 .196 (2) Broken (Glass (Cullet) nil - nil - nil - nil - (I) Bones ,, nil - 6 .233 nil - 2 .078 (j) Combustible Debris not classified above : (wood, straw, leather, etc.) 442 18.793 414 16.059 nil - 285 11.617 (K) Incombustible Debris not classified above : (bricks, stone, pottery, etc.) 286 12.160 14 .543 32 1.345 4.683 b 18 Removal of Manure. The removal of manure from the various mews in the Borough was satisfactorily carried out during the year. Again no complaint was received. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-Laws and Regulations. In addition to my inspections, the Sanitary Inspectors made 21,923 various inspections and visits as set out in the following table. Each inspection frequently covers a number of different sanitary matters. Sanitary Inspectors' and Health Visitors' Work, Year 1926. Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Shinnie Miss Stock well Total Complaints received 39 58 66 ... ... ... 163 Do. found to be justified 39 58 65 ... ... ... 162 Inspection of Houses— Dwelling-houses 57 160 80 1 ... ... 298 Houses let in lodgings 322 296 216 37 ... ... 871 Common lodging-houses ... 1 2 ... ... ... 3 Drains tested by smoke ... 5 2 ... ... ... 7 ,, ,, ,, water ... ... ... ... ... ... ... ... ,, ,, ,, chemicals 1 ... ... ... ... ... 1 Re underground rooms ... ... ... ... ... ... ... „ Rent (Restriction) Act ... 2 ... ... ... ... 2 ., New Buildings 1 1 ... ... ... ... 2 Housing (Inspection of District) Regulations ... ... ... ... ... ... • •• Factories — Bakehouses 5 24 6 ... ... ... 35 Food preparation (other than above) ... ... 4 ... ... ... 4 Other 23 114 141 ... ... ... 278 Workshops and Workplaces- Food premises: Dairies and Milkshops 28 76 53 ... ... ... 157 Ice Cream, Manufacture 15 9 150 ... ... ... 174 Do. Storage or Sale 8 3 ... ... ... ... 11 Slaughter-houses ... 6 ... ... ... ... 6 Hotels and Restaurants 63 45 90 ... ... ... 198 Butchers 231 22 372 ... ... ... 625 Bakehouses 3 18 10 ... ... ... 31 Fried Fish shops 185 17 24 ... ... ... 226 Market Streets 296 72 423 ... ... ... 791 Other food shops 128 28 76 ... ... ... 232 Other workshops 153 193 160 51 60 ... 617 Other workplaces 76 88 57 ... ... ... 221 Outworkers' Registers 23 26 53 ... ... ... 102 Stable and Stable yards 46 81 ... ... ... ... 127 Rag and Bone shops 114 8 ... ... ... ... 122 Outworkers' rooms 32 53 54 2 ... ... +141 Sweetstuff stalls and shops 37 37 62 ... ... ... 136 Inspections carried forward 1,847 1,385 2,036 91 60 - 5.418 19  Mr. Bennett Mr. Clark Mr. Larard Miss Charles, worth Miss Shinnie Miss Stockwell Total Brought forward 1,817 1,385 2,035 91 60 — 5,418 Miscellaneous— Black smoke 136 53 151 ... ... ... 340 Dust, Special Inspections 100 132 36 ... ... ... 268 Bats and Mice (Destruction) Act 79 90 121 ... ... ... 290 Public Urinals and Lavatories . ... 1 ... 12 ... ... 13 Sale of Food and Drugs Act, sampling 178 213 235 ... ... ... 626 Other Inspections Periodical Inspections: 1 ... ... 28 ... 6 35 Includes W.C. and yards, dust bins, especially houses let in lodgings, and other suitable buildings 1,713 2,299 2,901 ... ... ... 6,913 Keeping of Animals 3 2 3 ... ... ... 8 Re-Inspections— Houses 725 904 527 38 ... ... 2,194 Factories ... 3 16 ... ... ... 19 Workshops and Workplaces ... 53 93 107 9 ... ... 267 Miscellaneous 2 ... ... 72 71 221 366 Visits re Infectious Diseases 55 144 108 281 205 22 815 Do. on School Reports ... ... 1 ... ... ... 1 Tuberculosis—First visits 2 1 ... ... ... ... 3 Do. Re-visits 1 3 ... ... ... ... 4 Scabies ... ... 1 35 8 2 46 Vermin ... ... ... ... ... 16 16 Other Visits— Police Courts 3 2 3 ... ... ... 8 Various 158 295 229 3 ... l 686 Maternity— Visits: ††Children under 1 year ... ... ... 229 103 170 502 Do. 1 to 5 years ... ... ... 10 2 6 17 Expectant Mothers ... ... ... 65 11 19 85 Re-visits ... ... ... 850 444 1,105 2,399 Do. Expectant Mothers ... ... ... ... 30 8 22 60 Other Maternity Visits ... ... ... 105 47 18 170 Attendances at Maternity Centres ... ... ... 183 60 111 354 Total 5,061 5,620 6,474 2,031 1,019 1,718 21,923 †All outworkers' rooms in houses let in lodgings (these comprise the larger majority), have been inspected but the visits have been counted under inspections of houses let in lodgings. †† See page 83. The total number of notices served for nuisances found in dwelling houses and factories, workshops and workplaces, and premises subject to various By-laws, including 577 notices requiring annual cleansing of houses let in lodgings, was 1,503, viz; — B 2 20 Public Health (London) Act, 1891— Intimation Notices 543 Statutory Notices 76 By-laws— Houses let in Lodgings 818 Fish Curer 1 Removal of Refuse 1 London County Council (General Powers) Acts— Verminous rooms 57 Rats and Mice (Destruction) Act, 1908 7 1,503 The following table shows the work done to abate nuisances for which intimation notices were serves:- Water Supply— Houses. Factories, Workshops and Workplaces Provided 6 - Cisterns cleansed, repaired, etc. 30 6 Waterclosets— Cleansed 16 14 Water supplied, flushing cistern repaired, etc. 19 6 Repaired, new pans, etc. 124 16 Ventilation improved - 11 ,, to lobby provided or improved ... - 6 Separate accommodation for sexes provided - 7 Position or construction improved - 16 Direct communication with workrooms remedied ... - 5 Accommodation provided 1 2 Soil Pipes— Repaired, renewed and ventilated 1 - Rainwater Pipes— Repaired or renewed 12 4 Drains— Repaired 10 2 Unstopped, cleansed, etc. 25 8 Sinks, etc. Waste pipes repaired, renewed, etc. ... 30 8 Yards, Areas and Washhouses— Cleansed 20 7 Paved and paving repaired 28 2 Houses and Workshops, etc. - Cleansed 58 51 Dilapidations repaired and made good 65 8 Ventilation improved 2 - 21  Houses Factories, Workshops and Workplaces. Dampness— Roofs repaired 90 5 Gutters repaired 17 2 Other works to prevent dampness 11 2 Ashbins— Provided, repaired, etc. 46 11 Urinals— Repaired, cleansed, etc. - 2 Various— Underground Rooms vacated 2 - Smoke—Emission of black smoke abated ... - 6 Accumulations of Refuse—Removed 33 10 Overcrowding abated 2 5 Animals—Improper keeping discontinued ... 3 - Other nuisances abated 12 24 The following table shows the nuisances for which the 76 Statutory Notices were issued under the Public Health (London) Act. 1891. Houses. Factories, Workshops and Workplaces. Section 2 (a) Dirty and dilapidated premises, etc. ... 32 6 ,, (b) and Section 37, Ashbins 4 - ,, (c) Drains and W.C.'s 26 8 ,, (d) Accumulation of rubbish 5 1 ,, (e) (g) (i.) Overcrowding 1 1 ,, (f) and Section 48. Water supply 2 - ,, 38 W.C.'s communicating with workrooms - 1 ,, ,, W.C. Absence of separate accommodation for sexes - 2 ,, ,, Insufficient accommodation - 2 ,, 96 Underground rooms 2 - By-laws as to Houses let in Lodgings. At the end of the year 577 houses were registered under these By-laws. Of these, 285 are in St. Giles and Bloomsbury and 292 in the Holborn District. There were 871 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 241 notices were served for breaches of the By-laws, exclusive of 577 notices that were served for annual cleansing as required by the By-laws. Rats and Mice (Destruction) Act, 1919. During the year 247 premises were inspected under the above Act, the total inspections being 290. Seven notices for breaches of the Act were served. As a result, in one case the drains were reconstructed and in the others accumulations of refuse in vaults under the pavement were cleared out and rat runs sealed up. 22 WARD. Number of premises inspected. Number rat infested. Action for Rat Repression. RESULT. crf- pr* cd p H ja P" CJ CD & -H 2P- tz cd O * 2 cd e* CO P c CTQ ct- 73 C §- 3 £ 5 £. v ^ co • a4 o 3 Ui c+- sr cd O o P & e-t- o" P O c p a. o p 5' Hi cd o <Tt- o" P ctp- cd 8 c+- o" p Traps. Poisons. Rat catchers. Dogs. Cats. Proofing. Council. Other. A. 13 1 1 — 1 - — 1 Rats still caught 1 B. 20 — — — — — — — C. 27 3 I 2 — 1 — — 1 Free 3 D. 22 1 — — — — — — 1 Rats occasionally seen 1 E. 9 6 2 3 — — — — 5 Free 4 Numbers reduced 2 F. 24 12 2 1 — — 1 — 9 Free 11 Numbers reduced 1 G. 15 9 •2 1 — — — — 7 Free 7 Numbers reduced 1 Work in progress 1 H. 72 17 3 4 1 4 3 2 Free 9 Numbers reduced 2 Rats occasionally seen 6 I. 45* 31* 6 8 3 4 C 9 1 Free 6 Numbers reduced 17 Hats occasionally seen 10 Rats still teen 1 247 83 17 19 4 10 7 12 27 Free 40 Numbers reduced 23 Rats only occasionally seen 17 Rats still seen 2 Work still in progress I * Includes 12 Premises dealt with us an infested island site. 23 Rat Week. In accordance with the suggestion of the Ministry of Agriculture and Fisheries, "Rat Week" was observed during the first week in November. The importance of this annual attack on the rodent population has long been recognised; it forms a fitting opportunity to remind the public of their duties under the Eats and Mice (Destruction) Act and, by means of suitable propaganda, to urge the necessity for rat destruction. But it would be a mistake to regard " Eat Week " as an end in itself; to concentrate all effort into a single week would at best produce a sporadic response and court comparative failure. The Sanitary Inspector and the occupiers of premises that are, or may be, rat infested, can only be assured of success by systematic routine work all the time. An essential for the success of any rat week is co-operation. The need for concerted action against rats can hardly be overemphasised. This applies particularly in an old built up area such as Holborn where individuals are handicapped in their efforts to destroy rats by the difficulty or impossibility of dealing with conditions beyond their immediate control; the solution of the problem often depends on simultaneous action by all occupiers and owners of premises in infested areas. The failure of one occupier in an infested block will effectually mitigate against the successful extermination of rats in the area concerned. In the observation of "Eat Week" in the Borough we endeavoured to secure, during the six days, intensive action and complete co-operation by occupiers in rat infested blocks, and efforts were made to deal effectively with the various causes at the roots of infestations. As a corollary to this, the importance of continuous systematic routine work for the extermination of rats and the prevention of re-infestation was emphasised. The general arrangements made by the Council for rat repression included: — (1) Systematic baiting in the Council's sewers, the bait used being small cubes of bread soaked in liquid extract of red squills, which is found to be more effective than barium carbonate. The baits were laid in the sewers 46 times during the year, including four times during the first week in November. A quarter of a gallon of the poison, making 1,000 baits, is used each time. The men who work in the sewers report that the baits are taken although dead rats are very rarely seen. (2) The services of the Council's workmen were available for rat proofing subject to the cost of such service and the material used being defrayed by the owners or occupiers of the premises where the work was carried out. (3) Arrangements were continued with a firm of rat catchers for dealing with rat infested premises at the cost of the occupiers. This arrangement has proved useful and reports are from time to time received from the rat catchers employed respecting their inspections of the premises and the work ultimately carried out. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 317 factories were inspected, 617 workshops and 2,935 workplaces. 24 It is found that changes frequently occur in the occupation of workshops. To obtain information of such changes and further details of industrial conditions in the Borough a large number of visits and inspections were made in addition to the routine inspections mentioned above. As the result of these visits 123 premises no longer used for the purpose for which they had been registered were removed from the register of workshops. In eleven cases, owing to the introduction of machinery, former "workshops" had become "factories" and the necessary transfer to the factory register was effected. Variations in the staff employed were also frequently reported. During the year 173 workshops were added to the register. It was necessary to serve the following notices for the abatement of sanitary nuisances in factories, workshops and workplaces. Intimation Notices. Statutory Noticcs. Factories 38 6 Workshops 80 9 Workplaces 51 2 169 17 Of the 694 workshops on the register at the end of the year 373 employed men only, 62 employed women only, and 259 employed both men and women. The number of employees is often very small and many of the workshops are in tenement houses (houses let in lodgings). No fewer than 167 different industries are carried on in these workshops, among the principal being the following :— No. of Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 23 - 1 24 Builders 12 - - 12 Cabinetmakers 7 - - 7 Carpenters 11 - - 11 Clock and watch makers 16 - 1 17 Dressmakers and ladies 'tailors - 23 17 40 Diamond mounters 9 - 4 13 Engravers 21 - - 21 Glass blowers 6 - 3 9 Jewellers 43 1 14 58 Lamp shade makers - 3 3 6 Leather goods makers 5 - 7 12 Metal workers 9 - 1 10 Picture framers 11 - 2 13 Tailors 31 4 92 127 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. Steps are being taken for the gradual compilation of a register of such places, and at the end of the year 400 factories had 25 been entered on the register. Workshops are automatically converted, at a very small cost, into factories by the installation of a small electric motor; the health conditions then may no longer be inspected by the Borough Council's staff except as regards sanitary accommodation. The 400 factories include 54 different industries. In 209 cases men only were employed, in 8 women only, and in 183 both sexes. The more important industries carried on in these factories are :— Bookbinding 15 Engineering 43 Jewellers' work 13 Metal work 13 Printing 73 Factories (No. 2) Bill, 1920. This Bill was introduced in the House of Commons by the Home Secretary on the 2nd August, 1926, to consolidate, and amend, the law relating to factories and workshops. In connection therewith I submitted the following report to the Public Health Committee: — In a memorandum issued by the Home Office it is stated that the Bill has been introduced in order that the different industries affected may have an opportunity during the autumn and winter of examining the proposals for the amendment of the Factory Acts which are being put forward by the Government. Although on the same general lines as the Bill introduced by the preceding Government in 1924, the present Bill differs in many respects from the former and some of the objections of local authorities to the earlier Bill have been partially met. Distinction between "Factory" and "Workshop" to be abolished. The Bill abolishes the distinction which exists under the present law between factories and workshops, and employs only one term "Factory," and, except where otherwise expressly provided, the provisions of the Bill apply indifferently to factories of all descriptions. Sanitary control—as now administered. Under existing Acts the provisions relating to the sanitary conditions of workshops, cleanliness, overcrowding, ventilation and the drainage of floors, are enforced in the first instance by the local sanitary authority, and not by the Factory Inspectors. In the case of factories, the Factory Inspectors are responsible. The provisions as to sanitary conveniences in both factories and workshops are, in London and places where Section 22 of the Public Health Acts (Amendment) Act, 1890, is in force, also enforced by the sanitary authorities. Sanitary Authority's control to be transferred to Factory Inspector. Under the Bill all the corresponding provisions are enforceable by the Factory Inspectors, except in any factory in which mechanical power is not used and which forms part of a dwelling-house or shop, or is adjacent to a dwelling-house or shop in the same occupation. In these instances, which are few in number and of comparatively slight importance, the local sanitary authority would still be the administrative body. Delegation of Duty to Local Authorities. In the earlier Bill it was proposed that the Secretary of State might arrange for the enforcement of the provisions by the local authority in factories in which mechanical power was not used. 26 The Bill now before Parliament provides that where the Secretary of State is satisfied that the duty of enforcing the general health provisions of the measure, in all factories in which mechanical power is not used, will be satisfactorily performed by a local authority willing to undertake the duty he shall delegate the duty to such Council. Moreover, where the Secretary of State is satisfied that in London, or places where Section 22 of the Public Health Acts (Amendment) Act, 1890, is in force, the duty of enforcing as respects all factories the provisions of the Act as to sanitary conveniences, would be satisfactorily performed by a Council willing to undertake the duty, he is to delegate.the duty to such Council. The effect of these provisions in those areas where local Councils are willing to do this work, and can satisfy the Secretary of State that they could satisfactorily perform the duties, would be to maintain the status quo, and to this extent some of the objections to the former Bill have been met. On the other hand, the undesirable principle of the removal from local authorities of the enforcement of sanitary provisions and their transfer to Factory Inspectors is retained in the Bill and the provisions as now drafted would not seem to make for uniformity in administration. Workshops (factories) in dwelling houses. Dual inspection. Many workshops, factories under the definition of the Bill, are situate in, or adjacent to tenement houses, although these workshops are not "in the same occupation" as the part of the house used for dwelling purposes. The enactment of a measure on the lines of the present Bill would result in inspection and supervision of part of such houses by the Factory Inspectors, and part by the local sanitary authority. Supervision of Drainage work—apart from Factory Law. Under the existing law all drainage work and the construction or reconstruction of all sanitary conveniences have to be carried out under the supervision and to the satisfaction of the local authority; the suggested transfer to the Factory Inspector of control respecting the sanitary condition of factories would not remove this responsibility but might complicate this important branch of the work of local authorities by unnecessary overlapping. Food Factories. It may also be mentioned that the work carried on in a large number of factories and workshops is connected with the preparation, manufacture, or packing of various foods. The supervision of such places so far as the food is concerned is a responsible duty of the local authority; it would seem desirable that the sanitary conditions under which the work is done should remain under the control of the authority responsible for securing the purity of the food. The Bill admits this principle to the extent of providing that the Section respecting underground bakehouses is to be administered by the local authority, but on the other hand the section dealing with other underground workshops now extended to include places where food is prepared for human consumption, is to be administered by the Factory Inspector. This is much to be regretted. Bill creates startling precedents. It appears to be a matter of very considerable importance that the sanitary authority should be responsible for the sanitation of all places within its jurisdiction. This is the first piece of legislation which has removed any premises from the sanitary control of a local authority. With the exception of buildings occupied by H.M. Government in all branches, the hygienic arrangements of every building in an area comes under the local Council. When the Act establishing the Ministry of Health was passed it was contemplated that all future steps would be in the direction of unifying and concentrating the duties and powers concerning public health under the public health authority. In 1921 certain duties relating to health enacted under the Factory and Workshops Act, 1901, were transferred from the Home Office to the Ministry of Health; at this time an official circular stated that:—"it seems to the Minister that the enforcement of the provisions relating to bakehouses can better be undertaken locally than centrally, especially as the work is of the same character as that 27 at present performed by the sanitary staff of local authorities in relation to retail bakehouses under Section 102 of the Act of 1901." The proposals in the Factory Bill go directly against this movement. No saving effected by new proposals. It has been stated that the handing over of the duties hitherto carried out by Sanitary Inspectors to Factory Inspectors is designed to prevent duplication of inspection work which is stated to cause needless expense and trouble. It is difficult to conceive that such statements can be justified; the work is carried out by an existing sanitary staff; no new duties are imposed by the Factory Bill on the existing staff as far as is known; no new sanitary staff is wanted. We have worked out that only 13 per cent. of the inspections made by the Sanitary Inspectors in this Borough would be affected; there is no question of lessening the cost of sanitary inspections in this Borough. At present the only expense involved is the cost of very infrequent letters from the Factory Inspectors stating that they have found an infringement of a sanitary regulation and calling the attention of the Public Health Department to the matter. Efficiency of service by Sanitary Inspectors. No complaints generally have been raised as to the visits of Sanitary Inspectors who, from their long experience of the work, have been able to form practical judgments of the various requirements under the Acts so that the work can be carried on in the spirit rather than in the letter of the law. On the contrary, there is reason to believe that employers in the district as regards such matters as sanitation would prefer that the local authority supervised them rather than a Central Body. I recommend: — (a) "That the attention of the Minister of Health be directed to the proposals contained "in the Factories (No. 2) Bill, 1926, relative to the sanitary control of workshops and factories "and he be informed that in the opinion of the Council existing powers of control should "continue to be a responsibility of sanitary authorities." (b) "That a copy of the above resolution be forwarded to the Corporation of the City of "London, the Metropolitan Borough Councils, the Metropolitan Boroughs Standing Joint "Committee, the Municipal Corporations Association and the Loudon Chamber of Commerce, "and that they be asked if in agreement therewith to take similar action." The Public Health Committee agreed with the foregoing recommendations and at its meeting on the 24th November, 1926, the Council adopted the following recommendation:— "That the attention of the Minister of Health be directed to the proposals contained in the Factories (No. 2 Bill, 1926, relative to the sanitary control of workshops and factories and he be informed that, in the opinion of the Council, existing powers of control should continue to be a responsibility of sanitary authorities." Copies of the foregoing resolution were forwarded to the Minister of Health, the Corporation of the City of London, the Metropolitan Borough Councils, the Metropolitan Boroughs Standing Joint Committee, the Municipal Corporations Association and the London Chamber of Commerce. At the date of preparation of this report replies have been received from 17 Metropolitan Boroughs, 13 of whom adopted a similar resolution, three referred the matter to the Metropolitan Boroughs' Standing Joint Committee and one took no action because the Bill was not being proceeded with in the, then, current session of Parliament. It would appear that progress of the measure is likely to be further postponed, but it is essential that, in the meantime, opportunity should be taken by local authorities to express their view that there should be no curtailment of their powers and duties in connection with the sanitary supervision of factories, workshops and workplaces. 28 Smoke Abatement. The smoke shafts in the Borough were frequently kept under observation and in 340 cases the inspections were recorded. Some of these observations were made in the early morning when smoke pollution is more prevalent. Generally the observations extended over periods of not less than one hour. Seven complaints were also received. As the result of the inspections six intimation notices were served. Much of the black smoke nuisance arises from careless or inefficient stoking. Stoking is usually considered an unskilled employment, and the stoker commonly receives but little instructions how to carry out his work. With a view to encouraging careful and efficient stoking, poster cards giving practical instruction as to stoking, and suitable for hanging in boiler rooms, were obtained and a number of employers agreed to exhibit them. During a part of the year, owing to the coal strike, nuisances were caused from black smoke due to the use of inferior coal, but every effort was made to ensure that as soon as possible the use of suitable coal was resumed. Common Lodging Houses Acts, 1851 and 1853. Twelve Common Lodging Houses are registered in the Borough for 920 lodgers, viz., 842 males and 78 females. The Common Lodging House accommodation in Holborn is equal to 21 beds per 1,000 of the population. The death-rate amongst common lodging house residents is very high ; in this Borough it was 57'6 per 1,000 in 1926. FOOD. Dairies, Cowsheds and Milkshops. The number of registered dairies and milkshops in the Borough at the end of the year was 124. Eleven retail dairies and milkshops were newly registered, and sixteen removed from the register. In addition to my inspections the Sanitary Inspectors made 157 inspections of these premises. It was not necessary for any notice to be served for sanitary defects or breaches of regulations. Residue from Milk Clarifiers. As it would seem probable that pigs have been infected with tuberculosis as a result of feeding with infected milk and slime from clarifiers, enquiry was made at the various establishments in the Borough where milk is cleansed by clarifiers to ascertain what is done with the residue after the milk has been passed through the cleansers. It was found in one case that this residue is at once destroyed by burning in a furnace used in connection with a pasteurising plant, in all other cases it is at once washed down the drains. Bacteriological Examination of Milk. Twenty-five samples of milk were examined for the presence of tubercle bacilli; five of these were also examined to ascertain the number of organisms per cubic centimetre and the smallest volume containing B. coli. 29 Examinations for tubercle bacilli were carried out by animal inoculation ; three of the samples examined were found to contain tubercle bacilli. The following table refers to the samples examined as mentioned above :— Date sample taken. Nature of Shop where purchased. No. of Organisms per cc. grown at 37° C for 24 hours. Minimal volume containing Bacillus Coli. 1926 Aug. 3 Large milkshop 5,600,000 0.0001 CC. Aug. 11 Large milkshop 25,000,000 0.00001 cc. Oct. 26 Large milkshop 125,000 0.001 cc. Not. 18 Small milkshop 3,900,(00 0.00001 cc. Dec. 10 Refreshment rooms 90,000 1 cc. Dirt in Milk. During the year 100 samples were examined in the Health Office for dirt; no dirt was found in any sample. The problem of securing a clean milk supply in a Central London area is one of considerable difficulty. It is only partially met by the institution of the "designated" milk. Comparatively few retailers have much demand for this milk and the amount retailed by some licence holders is very small; the public is not disposed to pay the higher price charged for designated milk; indeed, many of the poorer inhabitants could not afford to do so. The extra cost of producing Grade A Tuberculin Tested milk is creditably stated to be 2.86d. per gallon. The extra price obtained by the farmer is only 3d. a gallon. Thus for all his trouble the farmer only receives 0.14d. per gallon. Small though this profit be, once farmers are licensed for the production of designated milk they do not revert to the old methods of production. The expense is chiefly involved in the collection of a herd of suitable cattle. Owing to the elimination of tuberculosis and the supervision by veterinary surgeons (a requirement for the granting of a licence for the production of designated milk) the general health of the cows is improved with the result that the quantity of milk is maintained at a high level and there are very few, if any, "wasters" and no loss when the milch cows are sold for meat. The consumer obtains milk from healthy cows which is free from tubercle bacilli, contains a minimum of other bacteria, is clean and will keep fresh for a reasonable period, an advantage of considerable importance to the town dweller who cannot get milk fresh from the cow. The value of the Milk (Special Designations) Order is, to no small extent, in its educational effects. The existence of such arrangements shows milk producers that clean milk can be produced on farms and that medical opinion has been able to convince the representatives of the public of the importance of keeping milk as free as possible from bacteria and, above all, from tubercle bacilli. Tn the year 1922 arrangements were instituted in Holbom for the systematic examination of samples of milk for the presence of dirt. The routine covers the ascertainment of the amount of dirt deposited by a certain volume of milk; it is found useful in that it is a handy measurement, the examination being readily 30 carried out in the absence of a bacteriological laboratory. In cases where dirt has been found in any considerable quantity further samples have been obtained and submitted to the Borough Analyst for examination. In the five years 1922-26, 455 samples were examined for dirt in the Public Health Department. In 13 of these dirt was disclosed, ranging from a trace up to 17 parts per 100,000 by volume. During the same period 23 samples were submitted to the Borough Analyst, 21 being certified as containing dirt, the amount ranging from a trace up to 2.2 parts per 100,000. It will, therefore, be seen that in the five years of routine work seven per cent. of the samples examined gave evidence of the presence of dirt. This examination for dirt cannot, of course, be compared for efficiency with bacteriological examination. In the same five years (1922-26), 103 samples were submitted for bacteriological examination for (1) tubercle bacilli, (2) organisms per c.c. at 37° C., and (3) minimal volume containing B. coli. Ten samples showed definite evidence of tuberculous infection, whilst amongst the organisms found in addition to tubercle bacilli and B. coli were B. fæcalis alkaligenes, B. enteritides sporogenes and streptococci. The number of organisms found on bacterial counts, as will be seen from the following table, ranged from 9,760 to 25,000,000 per c.c. Date of Examination. Number of organisms per c.c. grown at 37° C for 24 hours. Year. Month. 1922 November 9,760 1923 ,, 11,750 1922 ,, 12,600 ,, ,, 14,940 1925 ,, 21,700 1923 ,, 28,000 ,, ,, 32,000 1924 ,, 33,100 ,, ,, 37,250 1925 ,, 44,000 ,, ,, 51.000 1924 ,, 51,250 1925 ,, 52,400 1923 ,, 55,000 1924 ,, 57,650 1922 December 86,000 1926 ,, 90,000 1925 November 96,000 1926 October 125,000 1923 November 240,000 1922 December 279,000 1924 November 328,400 1922 December 352,000 1923 November 420,000 1924 ,, 423,000 1926 ,, 3,900,000 ,, July 5,600,000 1925 November 11,250,000 1926 August 25,000,000 31 Having discovered a dirty or infected milk, all possible action is taken to improve the retail conditions, and to prevent contamination in the shop or on the round; but in most cases it is impracticable to supplement this with effective action to deal with the milk at the place of production, because the place of production cannot be ascertained, owing to the practice of collecting milk from many farms to large creameries and milk depots where the milks are mixed and pasteurised before distribution to the retailers. As mentioned above three samples in 1926 showed evidence of tuberculous infection. In the first of these the vendor Company stated that the milk undoubtedly came from one of the Company's farms, but, as it was cooled and mixed at their refrigerating depot in the country and again mixed and cooled before being put into cold store, it was impossible to tell from which farm the actual sample came. The facts connected with the purchase and examination of this sample were furnished to the Medical Officer of Health of the County where the vendor's farms are situated. Subsequently information was received from this County Medical Officer of Health that samples of milk from ten farms supplying the Holborn Dairy had been examined; four were found to contain acid fast bacilli indistinguishable microscopically from tubercle bacilli. In respect of the four farms from which the positive samples were obtained the veterinary surgeon reported that he examined all the cows and, with one exception, found them free from clinical symptoms of tuberculosis, including tuberculosis of the udder. The one cow referred to was reported on as follows:— "This cow is sound in udder, but may be tuberculous and should be removed. This cow has been isolated for some time." In the second case the Holborn retailer obtained the milk from a large wholesale Company. In reply to enquiries this Company stated that it was impossible to tell where the particular milk came from, but thought it might have been taken "direct from the station without pasteurising" contrary to their regulations. In the third case also the retailer obtained the milk from a large wholesale dealer, who, in turn, obtained supplies from provincial wholesale milk, cream and butter merchants. In this case it was possible to ascertain the creamery, but not the farm, from which the milk came. Milk was received at this creamery from 38 farms. In co-operation with the County Medical Officer of Health, the wholesalers arranged for all the herds on these farms to be examined by the County Veterinary Surgeon. As a result it appeared that at all farms but two the herds were found in good condition and free from infectious and contagious diseases. At one of the two exceptions, however, a cow was ordered to be turned out of the dairy, and at the other a cow was reported under the Tuberculosis Order. It will thus be seen that, as in previous years, the action taken by the Council, loading to the discovery of infected milk, is largely stultified by the modern practice of mixing milk at large creameries, often rendering it impossible to trace a milk supply to the place of production. The remedy would seem to be in the direction of sufficient examination of milk as it enters the large creameries and 32 mixing depots, and more stringent supervision at the sources of production. Examination of milk as it leaves these places would he required in order to control the carrying out of the routine. The Milk (Special Designations) Order, 1923. During the year 1926 licences available up to the 31st December, 1926, for the sale of designated milk in the Borough were issued as follows: — Certified Milk 5 Grade A (Tuberculin Tested) 6 Grade A 2 Pasteurised 3 Up to the date of preparation of this report licences for the year 1927 have been issued as follows: — Certified Milk 4 Grade A (Tuberculin Tested) 4 Grade A 2 Pasteurised 3 Public Health (Milk and Cream) Regulations, 1912 and 1917. The Public Health (Milk and Cream) Regulations, 1912-1917, were enforced in the Borough throughout the year. One hundred and seventy-nine samples of milk were examined ; none was found to contain preservative; 6 samples of cream were examined, 1 of which was found to contain a trace of preservative, viz., boric acid. Sixteen samples of preserved cream were examined and found to be in accordance with the Regulations, the statement on the labels as to the amount of preservative being in each case correct. In all the samples of preserved cream the fat exceeded 35 per cent. No contravention of the Regulations, other than that mentioned above, was discovered during the year. Condensed Milk. The Public Health (Condensed Milk) Regulations, 1923, came into operation on the 1st November, 1923. During the year 1926, 17 samples of condensed milk, viz., seven full cream, and ten skimmed sweetened, were examined by the Borough Analyst under the Regulations. All the samples complied with the requirements of the Regulations as to labelling. All the samples were examined for standard of composition and all were found to be equal to or above the standard required, 33 The following table gives the percentages of the milk fat and milk solids found: — Milk fat per cent. Milk solids (including fat) per cent. Full cream unsweetened 9.00 32.8 ,, ,, 9.10 3.16 ,, ,, 9.10 33.0 Full cream sweetened 9.20 31.8 ,, ,, 9.20 32.2 ,, ,, 9.00 32.8 ,, ,, 9.20 32.8 Skimmed ,, 1.0 28.6 ,, ,, 1.0 27.3 ,, ,, 0.6 27.4 ,, ,, 0.6 28.8 ,, ,, 0.5 33.1 ,, ,, 0.4 33.3 ,, ,, 0.4 26.2 ,, ,, 0.3 26.4 ,, ,, 0.2 27.0 ,, ,, 0.2 26.1 Public Health (Dried Milk) Regulations, 1923. These Regulations came into operation on the 1st day of May, 1924, and are generally similar to the Regulations with regard to condensed milk. Very few brands of dried milk are sold in the Borough. Eight samples, covering those generally used, were obtained during the year, and found to comply with the Regulations. Margarine. The registration of wholesale margarine dealers is required by Section 9 of the Margarine Act, 1887, as extended by Section 7 of the Sale of Food and Drugs Act, 1899. Under this Section every wholesale dealer in margarine is required to keep a register showing the quantity and destination of each consignment and the register is open to inspection by any officer of the Board of Agriculture. The Local Authority has no power to refuse registration or to set up any standard of requirements before effecting such registration. There are five registered dealers in the Borough. Bakehouses. At the end of the year 1926 there were 24 bakehouses in the Borough of which 19 were factory bakehouses. Although these are described as "factories" they are not large and only supply local needs; a number were formerly workshops and arc now classified as "factories" owing to the installation of machinery. Five bakehouses, including four underground bakehouses, were removed from the register on account of disuse. During the year, in addition to my inspections, there were 66 inspections of bakehouse-, C 34 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 twenty six 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. Sale of Fish. In addition to the fried fish shops referred to in the previous paragraph, fish is sold in the Borough at five fish shops and eight stalls. There are also two shops where shellfish is sold and one where stewed eels are sold. All these shops and stalls were regularly inspected during the past year. In four of the five fish shops the fish was exposed for sale on stallboards extending beyond the front line of the shop, but in all these cases the fish was protected by sun blinds and side screens. In one case the shop, particularly the floor, was found in a dirty condition and the boxes containing the fish, prior to unpacking, were stored on the pavement in positions where it was possible for the fish to be fouled by passing dogs. The attention of the proprietor was called to the matter and steps were taken by him to improve the conditions; the shop is nou swept every day and the floor washed at least once every week, the boxes with the fish are no longer put on to the pavement. In no other case was there any evidence of contamination of the fish by flies, dust, soot, etc. Three of the eight stalls where fish is regularly sold are in the Central Markets and are almost in the nature of shops. At seven of the stalls both fresh and dried fish was sold and at one fresh fish only. On four of the stalls the fish was protected by tarpaulin or canvas covers or screens over the top and at the sides and back, but in four no such protection was provided. In three of the stalls in the Central Markets water supply is laid on to the slabs on which fish is exposed for sale. Market Streets. There were 791 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are regularly inspected daily and on Saturday evenings and Sunday mornings. The daily inspection of these market streets helps to secure the maintenance by the regular stallholders of good, sound food only, and, in addition, has the effect of keeping away from these markets casual and unsatisfactory hawkers, who generally avoid markets subject to regular and strict supervision. In order to minimise as far as practicable any contamination of the food exposed for sale in market streets from dust arising during street cleansing, the Borough Surveyor has arranged for these streets to be sufficiently watered before the scavenging to prevent dust arising. 35 Ice Cream. During the year there were 64 premises in the Borough where ice cream was manufactured, and in addition to my inspections 174 inspections of these premises were made, and five notices were served. Ice cream is manufactured in the Italian colony as follows:— Premises on which 20 gallons made daily 1 ,, ,, ,, 10 ,, ,, ,, 3 ,, ,, ,,8 ,, ,, ,, 1 ,, ,, ,,4,, ,, ,, 8 ,, ,, ,, 2,, ,, ,, 9 In addition ice cream was also manufactured on the following premises :— Mr. Bennett's District. Mr. Clark's District. Mr. Larard's District. Restaurants 5 2 2 Confectioners 6 7 6 Other 2 9 3 During the summer of 1926 ten samples of ice cream were purchased and submitted to bacteriological examination. The result of the bacteriological examination is shown in the following table: — Sample and date purchased. Where purchased. Organisms per cc. growing on Agar at 37° C for 24 hours. Streptococci present in 1 cc. Minimum volume showing eoliform organisms.* Minimum volume showing B enteritidis sporogenes. 1 13/8/26 Street barrow 20,000 million present .0001 cc. .0001 cc. 2 ,, Street stall 700 „ present (longchained) .0001 cc. not observed in 1 cc. 3 ,, Street barrow 1,000 „ none observed .00000l cc. not observed in 1 cc. 4 ,, Street barrow 5,000 „ present .01 cc. .00001 cc. 6 ,, Street stall 1,500 none observed 1 cc. not observed in I cc 6 6/8/26 Dairy 600 „ present .000001 cc. .0000l cc. 7 ,, General shop 400 „ present 1 cc. .00001 cc. 8 ,, Restaurant 800 ,, present .0001 cc. .00001 cc. 9 ,, Restaurant 600 „ present (longchained) .01 cc. 1 cc. 10 „ Confectioner 400 „ none observed not observed in 1 cc .00001 cc, *Types of coliform organisms present approximated to B. coli group, B. lactis ærogenes group, and B. fæcalis alkaligenes. The bacteriological examinations were carried out at the Royal Institute of Public Health. Samples were delivered at the laboratory of the Institute C 2 36 immediately after purchase and arrangements were made for the examinations to be commenced forthwith. The ice cream from which sample No. 1 in the above table was purchased was exposed for sale in small blocks on a barrow. The blocks of frozen material were entirely uncovered and unprotected from contamination by dust. It will be seen that the examination disclosed a very large number of organisms. The ice cream was made at premises situated in the Borough where the conditions of manufacture were satisfactory. As a result of representations made to the vendor the exposure for sale of the commodity unprotected from contamination was discontinued. One of the ten samples examined, No. 3, was purchased because the cleanliness of the vendor-maker had been reported as unsatisfactory and the cleanliness of the premises, where the commodity was made, was also unsatisfactory. The making of ice cream in the room complained of has been discontinued until the premises have been rendered suitable for the purpose. The samples Nos. 1 to 5 were purchased from vendors considered to be amongst the less satisfactory of those dealing with this commodity in the Borough, and the samples Nos. 6 to 10 were purchased from better class vendors. It will be seen that the former group gave evidence of more contamination than the latter. In nine cases the ice cream was made at premises in the Borough all of which are kept under regular supervision. In one case, No. 8, the ice-cream was made at a large manufactory outside the Borough. Following the examination of these samples of ice cream a circular letter with a series of suggestions for improving the condition of manufacture and storage and sale of this commodity was prepared and sent to all ice cream makers in the Borough. It is hoped in this way to secure the co-operation of ice cream makers in efforts to prevent its contamination. Where ice cream sold in the Borough is made at premises outside Holborn, it is our practice to ask for information as to the conditions of manufacture from the Medical Officer of Health of the area concerned. On the other hand, we receive a number of such enquiries from other districts respecting ice cream made in Holborn, principally in the " Italian Colony," and sold in other districts. Ice cream is being consumed in increasing quantities in this country and its growing popularity, particularly during the summer months, adds urgency to the suggestion that this food should be subject to a standard and its manufacture controlled by regulations similar to those in some British Dominions and elsewhere. 37 In Queensland for example ice cream is to contain not less than ten per cent, milk fat and no thickening substance other than gelatine may be added. In Western Australia ice cream is a foodstuff composed of milk and cream with sugar, with or without fresh eggs, flavoured with fruit or with the juice or pulp of fruit or nuts or harmless vegetable flavouring substances; the addition of more than one per cent. thickening substance is prohibited. In New Zealand there is a bacteriological standard by which ice cream and ices are not to contain more than 50,000 micro-organisms to the cubic centimetre nor any harmful or pathogenic organisms. In New South Wales ices have to be kept so as to be protected from contamination; also there is a bacteriological standard similar to that in NewZealand. In Victoria ice cream is to contain not less than ten per cent. fat derived from eggs and milk. Sale of Sweets. In the early part of the year a complaint was received respecting the condition of sweets exposed for sale in the window of a retail sweet shop. On inspection it was found that sweets cont aining nuts, exposed in the window, were badly eaten by mice although there was no further evidence of mice in the remaining part of the shop. The shop was managed by an assistant about seventeen years of age, the proprietor being there only occasionally. It was reported that the window was dressed every two or three weeks. Requests were made to the occupier for the immediate clearing of the window for examination and mouse proofing, also for the removal of unnecessary boxes stored in the basement and ground floor, and for the keeping of a cat or the use of a mouse poison. As a result of the representations made to the occupier effective steps were taken by him to clear the premises of mice and at the date of the preparation of this report the premises were reported to be still clear. Detailed inspections were made of other shops in the Borough where sweets are sold. In all 129 such premises were inspected, in 19 of these sweets only were sold, in 58 the trade was associated with the sale of refreshments, and in the remaining instances with some other trade. In only two cases were the sweets made on the premises. In 113 shops the sweets were suitably covered at night and in only one out of the whole number was definite evidence of dust discovered on the sweets; no case was reported where the sweets were contaminated by flies. 38 The following table gives details of the inspections: — Sweet Shops Inspected. Mr. Bennett Mr. Clark Mr. Larard Total Number of Shops inspected 35 37 57 129 Type of trade— Large 4 13 14 31 Medium 17 11 18 46 Small 14 13 25 52 Trade carried on — Sweets only 2 7 10 19 Newspapers 4 — 2 6 Tobacco 3 5 4 12 Grocery 3 5 8 16 General 4 6 6 16 Refreshments 19 14 25 58 Other — — 2 2 Sweets made on premises 0 1 1 2 Evidence of mice 0 2 0 2 Dust on sweets 0 0 1 1 Sweets covered at night 30 34 49 113 Windows dressed Daily 9 7 11 27 Weekly 18 9 18 45 Fortnightly 5 12 24 41 Monthly 2 8 4 14 Longer intervals 1 1 2 No window display 1 — — 1 Scoops used 3 12 33 48 Cleanliness of person and clothing of assistants Satisfactory 35 34 55 124 Fair only 3 1 4 Dirty — — 1 1 Provision for washing hands 35 37 56 128 Evidence of flies 0 0 0 0 In the one case where dust was reported steps were taken, at the request of the Inspector, for the better protection of the sweets and considerable improvement effected. In both cases where there was evidence of mice the necessary steps were taken for the extermination of the vermin and on subsequent inspections, up to the date of the preparation of this report, the premises were found free from mice. In one case a notice served for cleansing the premises was at once complied with and in another case cleansing was carried out without the necessity of a notice being served. In addition to the above, nine stalls for the sale of sweets were inspected, all of these were found to have top covers, eight had side screens and two were also provided with back screens. No evidence cf contamination by dust or flies was found on the sweets exposed for sale on any of the nine stalls. In five cases 39 the hands and clothing of the servers were reported as clean but in four cases as only fairly so. In all cases where the hands or clothing of servers were not satisfactory the proprietors of the shops or stalls concerned were interviewed and at subsequent inspections considerable improvements were observed in all cases. Public Health (Meat) Regulations, 1924. These Regulations came into operation on the 1st April 1925; they deal with slaughter-houses, meat marking, the handling of meat in wholesale markets, conditions of transport, the protection of meat in butchers' and other shops and on stalls from contamination by flies, mud and other contaminating substance. The following summary shows the number of butchers' shops and meat stalls in the Borough, and the number of other shops where meat is sold: — Butchers' shops 27 Butchers' stalls 3 Provision dealers 25 Provision dealers' stalls 3 Offal shops 3 Cooked meats 10 Wholesale (bacon; sausage) 3 74 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the regulations; during the year 625 such inspections were made. It is regretted that in a few cases (seven) the undesirable practice continues of exposing meat for sale outside the shop on stallboards projecting beyond the building line. If all butchers selling from shops were required to discontinue the practice of exposing meat in front of their shops it is difficult to see that any hardship would be caused. It is noteworthy that during the hot weather, in the best shops, very little meat is displayed; it is in the cold storage plant, but no one contends that the sale of meat is thereby prejudiced. Any attempt to convert the benches into imitation stalls is not in accordance with hygienic ideals. The existence of stalls in market streets in the form allowed by the Regulations is countenanced because it is thought their existence enables meat to be sold at competitive prices and so tends to bring down the prices generally at which meat is sold to the public. In all cases in the Borough, where meat is exposed for sale outside shops or on stalls, suitable screens are provided and used for the protection of meat, as far as practicable, from dust, mud and other contaminating substances. The practice of handling meat by customers before purchase has generally ceased in the Borough. In the shops where "pieces" are sold, a notice is exhibited urging customers not to handle meat before purchase, and in most of these shops forks are provided to enable the pieces to be turned over by purchasers without direct handling. As a result of their observations and enquiries the Inspectors report that the forks so provided are generally used. It is satisfactory to record that it has not been necessary in any case to serve notice for breach of the Regulations. 40 In the early part of the present year (1927), a conference on the Public Health (Meat) Regulations was held at the Royal Sanitary Institute. Attention was drawn to the lack of uniformity in carrying out the Regulations in different administrative areas, and consequent dissatisfaction in the meat trade. Reference was also made to the different experiences by local authorities in their efforts to obtain glass fronts to butchers' shops; there was, however, evidence that butchers who had studied the question, from the economical standpoint, kept their meat behind closed glass windows and so prevented the meat losing its bloom, thus necessitating sale at a cheaper rate. It was pointed out that in a large provincial town two firms, one with fifty and one with forty branches, had provided fixed glass windows to all their shops with no loss of trade when the practice of hanging up meat outside the shops was discontinued. In connection with the difficulties arising from the sale of meat from street stalls, reference was made to the practice in some continental towns where all meat exposed for sale on meat stalls has to be kept behind glass. 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. The number of such places on the register at the end of the year was as follows: — Hotels, Restaurants and Eating Houses 235 Slaughter-houses 1 Tripe, offal and other meat shops 33 Fried Fish shops 11 Fish shops 14 Ice Cream (Manufacture) 64 Poulterers 3 During the year 2,587 inspections of food premises and market streets were made and 27 notices served for sanitary defects found. Sanitary Accommodation for Customers at Restaurants, etc. The question arises from time to time of the necessity for the provision in restaurants of sanitary accommodation for customers of both sexes. Many of the larger and better equipped restaurants provide suitable accommodation, a much appreciated boon, particularly in Central London, where such restaurants are largely used by strangers to the Metropolis. There is something to be said in favour of such provision being required in all restaurants, or at least in all the larger establishments, although everyone recognises that in crowded areas where space is valuable it is not always easy to spare the superficial area. At times the nearness of public sanitary conveniences renders provision in a restaurant less imperative. Under various local Acts relating to provincial towns sanitary accommodation must be provided for customers. 41 Unsound Food. The following unsound food was condemned during the year 1926:— Commodity. Quantity. Condition. Result of Action taken. Fish : — Plaice 6 stone Decomposed Surrendered Cod 6 stone Do. Do. Whelks ½ cwt. Do. Do. Fruit:— Apples 48 barrels (1 ton, 1 cwt.) Rotten Do. Bananas 2½ tons Do. Do. Black Currants 9½ cwt. Do. Do. Lemons 76 cases Do. Do. Oranges 5 tons Do. Do. Vegetables:— Onions 2J tons Do. Do. Meat :— Bacon 35 lbs. Decomposed Do. Sale of Food and Drugs Acts. In December, 1026, the Public Health (Preservatives, etc., in Food) Amendment Regulations, 1926, were issued postponing the operation of the 1925 regulations so far as certain foods are concerned and making certain minor alterations in those Regulations. The dates on which the principal Regulations as now amended came, or will come, into operation are as follows: — (1) All foods except those specified below 1st January, 1927. (2) Bacon, ham, egg yolk and articles of food containing preservative necessarily introduced by the use in their preparation of preserved margarine 1st July, 1927. (3) Butter, cream and articles of food containing preservative necessarily introduced by the use in their preparation of preserved bacon, preserved ham, preserved egg yolk or preserved cream 1st January, 1928. (4) Articles of food containing preservative necessarily introduced by the use in their preparation of preserved butter 1st July, 1928. In the year 1926, only four articles of food (other than butter, margarine and preserved cream) purchased in the Borough, were found to contain preservative, viz., cake 2, Swiss roll 1, sausages 1. The following observations refer to samples purchased and analysed during the year:— Apples. Thirty-five samples of imported apples were examined for the presence of arsenic. In 12 of these no arsenic was found. In 22 the amount of arsenic was 42 leas than 1/100 grain per pound and, therefore, no proceedings were called for. In one case the amount of arsenic was certified by the Public Analyst to be 0.000167 percent., equal to 1/64 of a grain of arsenic trioxide per pound. In this case legal proceedings were taken; the summons against the vendor was dismissed on payment of .£5 costs. The following table gives particulars of the 35 samples above referred to: — Variety. Amount of Arsenic (if any). Newtown Oregon 1/700 grain Per pound Newtown Oregon 1/475 do Newtown Oregon 1/800 do Newtown Oregon 1/840 do Newtown Oregon 1/475 do Newtown Oregon 1/430 do Newtown Oregon 1/285 do Newtown Oregon 1/750 do Newtown Oregon 1/357 do Newtown Oregon 1/64 do Newtown Oregon nil Newtown Oregon nil Newtown Oregon 1/110 grain Per Pound Jonathan 1/130 do. Jonathan 1/950 do Jonathan 1/240 do Jonathan 1/530 do Jonathan - 1/110 do Jonathan 1/325 do Jonathan nil Stunner Pippin 1/1100 grain per pound Sturnier Pippin 1/210 do Sturmer Pippin nil, Sturnier Pippin — nil Cleopatra 1/530 grain per pound Cleopatra nil Cleopatra nil Dunn's Favorite 1/145 grain per pound Dunn's Favorite nil York Imperial 1/900 grain Per pound South African nil Cox's Orange Pippin 1/715 grain Per pound New York Pippin nil London Pippin nil King David 1/1000 grain per pound 43 Cake. Nine samples were examined; only two disclosed the presence of boric acid, the quantity being 4.34 and 9.52 grains per pound respectively. In the previous year, 1925, when a similar number of samples of cake were examined all the nine disclosed presence of boric acid. The result of the examination last year would seem to indicate that cakes are being made without the use of preserved liquid egg. Letters were sent to the vendors of the two samples in which preservative was found, drawing their attention to the matter and urging the desirability of the use of preservative being discontinued in the food. Calomel Ointment. Four samples of calomel ointment were examined, one of which was deficient in calomel to the extent of 40 per cent. Proceedings were instituted against the vendor, who was convicted and fined £14 and £2. 2s. 0d. costs. The same vendor was convicted for a similar offence in the year 1925. Cheese. Thirteen samples of cheese were examined. The samples were obtained at dairies, provision dealers, general shops and restaurants, and included Colonial and English cheese in the Cheddar, Cheshire, Stilton and soft cheese varieties. All the samples were reported to be genuine. Legislation has not yet been enacted in this country to standardise this article of food; this is the more to be regretted as cheese is an important item in the dietary of the poorer part of the community. It is very desirable that in all such foods a high nutritive value should be secured. Jam. Two samples of jam were found to be adulterated by the addition of 10 per cent. apple matter. In one case the addition was disclosed on the label attached to the container in which the jam was sold and no proceedings were taken. In the second case proceedings were instituted. The retailer pleaded a warranty defence on which the summons was dismissed. Subsequently, proceedings were instituted against the makers who gave the warranty. The defendants were convicted and fined £20 and £15. 15s. 0d. costs. Milk. One hundred and seventy-nine samples of milk were purchased and analysed, of which four only were certified as not genuine. In one of these the deficiency in fat was very slight, and no action was taken. In three cases action was taken with the following results: — (a) Abstracted fat 5 per cent.; withdrawal on payment of 20s. costs. (b) Abstracted fat 6-6 per cent.; dismissed on payment of three guineas costs. (c) Abstracted fat 32 per cent.; convicted; fined 40s. and 21s. costs. 44 Sausages. One of five samples of sausages was found to contain boric acid, but the amount was too small to justify any proceedings pending the regulations as to preservatives coming into operation. Swiss Roll. One of the two samples of Swiss roll purchased was found to contain preservative, but having regard to the arrangements made by the Ministry of Health with the Bakers Allied Traders' Association, it was considered inadvisable to institute legal proceedings. Letters were, however, sent to the retailers and the makers of the roll drawing attention to the recognised objection to this preservative especially in the case of sponge cakes and expressing the hope that its use in articles of food made with sponge mixture would be discontinued. Cockles. In view of the important part played by shellfish in the spread of disease, notably enteric fever, it is thought useful from time to time to examine samples of this kind of food bacteriologically. During the past year a sample of cockles was purchased from a stall in a condition ready to be eaten, and detailed and thorough examinations of each of ten cockles were made; they were found to be clean. The following report of the examinations may be of interest:— The cockles were washed in running water, then in sterile tap water and finally in sterile distilled water. Ten cockles were cut up with sterile scissors and made up to 100 cc. with sterile distilled water— 10 cc.=1 cockle. Further dilutions were made up to 1/millionth part of a cockle and used as follows:— 1. MacCovkeys' Bile Salt Lactose Broth for presumptive test of B. Coli. Readings after two days' incubation at 37° C. 10 cc. into double strength Acid and gas present. 5 cc. „ „ „ Acid and gas present. 1 cc. ,, single ,, Nil. .1 cc. to 00001 cc. (1/millionth part of cockle) Nil. 2. Glucose Formate Broth for Streptococci.—Readings microscopically after two days' incubation showed streptococci present in 0001 cc. or 1/100,000 part of a cockle, but absent in .00001 cc. or 1/millionth part of a cockle. 3. Litmus Milk for Presumptive B. Welchii.—Parte of the original dilution and varying dilutions to 00001 cc. (l/millionth part of cockle) were heated to 80° C. for ten minutes and inoculated into the Litmus Milk and cultured anærobically for three days. 45 No raft clotting was observed in 10 cc. (1 cockle) nor in any dilution up to .00001 cc. (1/millionth part of cockle). 4. Number of colonics present on plated agar incubated at 37° C. for two days= approximately 75,000 per cockle. 5. Number of colonies present on plated gelatine incubated at 20° C. for two days= approximately 6,400 (of which 10 per cent. liquefied the media) per cockle. The above results must be read in the light of the fact that the cockles were unshelled, therefore, any liquor present in the shell was not examined. Also the presence of ealt would inhibit in some degree the growth of organisms. The presence of B. Coli in half a cockle and in no lesser part and the absence of B. Welchii in one cockle or part of a cockle points to a good standard of cleanliness. (Sd.) E. GOODWIN RAWLINSON, M.D., D.P.H. Winkles. A sample of winkles was purchased from a fish shop in the Borough. Ten of the winkles were examined for bacteriological cleanliness and found to be satisfactory. The following is the report of the examination: — Ten winkles were cut up with sterile scissors and made up to 100 cc. with sterile water. Both the body and liquor were used. 10 cc. of the fluid = l winkle, and dilutions were made up to 1/millionth part of a winkle. 1. MacCotikeys' Bile Salt Lactose Broth for presumptive test for B. Coli. Readings were taken after two days' incubation at 37° C. 10 cc. = l winkle gave acid and gas (Positive). 5 cc. = ½ „ „ „ „ „ (Positive). 1 cc.=l/10 „ „ no reaction (Negative). 2. Glucose Formate Broth for Streptococci.—Microscopical examination after two days' incubation at 37° C. showed streptococci to be present in 1/1,000 part of a winkle. 3. Litmus Milk for Presumptive B. Welchii.—The fluid and dilutions of the fluid were heated to 80° C. for ten minutes, inoculated into Litmus Milk and cultured anserobically for three days at 37° C. No raft clotting was observed in any instance. 4. Number of colonies present on plated agar incubated at 37° C. for two days = l,780 per winkle. 5. Complete liquefaction occurred on plated gelatine incubated at 20° C. for two days. Remarks. The presence of Coliform organisms in only half a winkle and the absence of B. Welehii in one winkle points to a good standard of cleanliness. E. GOODWIN RAWLINSON, M.D., D.P.H, 46 Milk. The following tablo shows the fat content of the 179 samples of milk :— Percentage of Fat, Number of Samples. Shops. Restaurants. Streets. Total. Less than 3.0 8 1 — 4 3.0 6 — 4 10 3.1 6 — 1 7 3.2 16 2 3 21 3.3 10 — 3 13 3.4 17 1 8 26 3.5 12 2 2 16 3.6 16 2 6 24 3.7 9 — 6 15 3.8 10 — 3 i:t 3.9 7 — 1 4.0 6 — — 6 4.1 2 — — 2 4.2 1 — — 1 4.3 4 — — 4 4.4 1 — — 1 4.5 — 1 — I 4.8 1 — — 1 4.9 — 1 — 1 5.4 1 — — 1 5.7 1 1 — 2 5.9 1 — — 1 11.12 1 — — 131 11 37 179 Average 3.41 3.62 3.48 3.53 Twelve per cent. of the samples contained 4 per cent, or more fat. Milk with this fat content does not appear to be uncommon 47 In 22 cases where the fat content subsequently proved to be four per cent. or over observations made at the time of purchasing the sample showed that in 16 instances the milk was stirred with a hand measure before serving. In one case only a plunger was used; in one case (street sample) the agent reported that the milk was not stirred at all prior to sale; in three cases the pans from which the milk was served could not be seen by the purchasers; and in the remaining case the counterpan was filled from a churn at the time of purchase of the sample and so was presumably well mixed. It is probable that even distribution of the milk fat is not secured by casual mixing with a hand measure; the use of efficient plungers would secure this end; on the other hand, where there is reason to believe milk is properly plunged an analysis has shown the presence of over 4 per cent. of fat. Of the 22 samples referred to above ten were purchased at dairies or milk shops, eight at general shops, two from street vendors, and two at restaurants. But to my knowledge analyses of the contents of individual churns show (hat the percentage of fat in very many is considerably above 3 per cent.; in some the fat contents of the milk were over 4 per cent. The following table shows the average composition of milk samples purchased during each month of 1920. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. Jnnuary 19 12.53 8.93 3.6 February 20 12.49 8.89 3.6 March 22 12.49 8.99 3.5 April 21 12.44 9.04 3.4 May 16 12.43 9.03 3.4 June 12 12.18 8.98 3.2 July 9 12.49 8.99 3.5 August 10 12.71 9.01 3.7 September 9 12.68 8.98 3.7 October 9 12.51 8.81 3.7 November 15 12.84 9.04 3.8 December 17 12.31 8.81 3.5 Whole year 179 12.51 8.96 3.55 Legal Minimum 11.50 8.50 3.00 48 It will be seen that the seasonal variations are not very marked ; (he highest percentage of fat was in November and the lowest in June. From this, as well as the figures given above, it would seem that the legal minimum for fat in milk is too low. The regulations issued in 1923 respecting condensed milk and dried milk prescribe that the equivalent of fat must be calculated on a 3.6 per cent. basis, and it seems reasonable to suggest that the legal minimum for ordinary milk should be raised. Articles Analysed. Formal Samples. article. Purchased Genuine. Adulterated. Proceedings taken. Convictions. Fines and Costs. Almonds, grcund 8 8 ... ... ... ... Apples 35 34 1 1 0 £5 0s. 0d. costs Asparagus, preserved 3 3 ... ... ... ... Bacon 2 9 ... ... ... ... Beans, preserved 1 1 ... ... ... ... Borax 6 6 ... ... ... ... Boric ointment 3 3 ... ... ... ... Brandy 3 3 ... ... ... ... Butter 59 59 ... ... ... ... Cake 9 7 2 0 ... ... Calomel ointment 4 3 1 1 1 £14 0s. 0d. fine £2 2s. 0d. costs Camphorated oil 7 7 ... ... ... ... Cheese 13 13 ... ... ... ... Chocolate 7 7 ... ... ... ... Cinnamon, ground 4 4 ... ... ... ... Cocoa 3 3 ... ... ... ... Coffee 4 4 ... ... ... ... Crab, preserved 1 1 ... ... ... ... Cream 6 6 ... ... ... ... Cream, preserved 16 16 ... ... ... ... Cream of tartar 1 1 ... ... ... ... Currants 3 3 ... ... ... ... Egg powder 1 1 ... ... ... ... Egg substitute 4 4 ... ... ... ... Epsom salts 3 3 ... ... ... ... Gall and opium ointment 3 3 ... ... ... ... Gin 3 3 ... ... ... ... Ginger, ground 1 1 ... ... ... ... Gregory powder 1 1 ... ... ... ... Herrings in tomato sauce 5 5 ... ... ... ... Ice cream 12 12 ... ... ... ... Jam 17 15 2 1 ... ... Jelly crystals 3 3 ... ... ... ... Lard 1 1 ... ... ... ... Loganberries 1 1 ... ... ... ... Lemonade powder 2 2 ... ... ... ... Liniment of iodine 5 5 ... ... ... ... Margarine 23 23 ... ... ... ... Marmalade 9 9 ... ... ... ... Milk 179 175 4 2 0 £4 4s. 0d. costs Milk, condensed 17 17 ... ... ... ... Milk, dried 8 8 ... ... ... ... Milk, sterilised 1 1 ... ... ... ... Mincemeat 3 3 ... ... ... ... Olive oil 4 4 ... ... ... ... Paregoric 5 5 ... ... ... ... Pears, tinned 2 2 ... ... ... ... Peas, tinned 3 3 ... ... ... ... Pickled walnuts 1 1 ... ... ... ... Pickles 3 3 ... ... ... ... Pineapple, tinned 1 1 ... ... ... ... Pork and beans 1 1 ... ... ... ... 49 ARTICLE. Purchased. Genuine. Adulterated. Proceedings taken. Convictions. Fines and Costs. Prescriptions 7 7 ... ... ... ... Rice 3 3 ... ... ... ... Rum 3 3 ... ... ... ... Rum and coffee 1 1 ... ... ... ... Salmon, tinned 1 1 ... ... ... ... Sausages 5 4 1 0 ... ... Sponge cake 1 1 ... ... ... ... Sponge fingers 2 2 ... ... ... ... Suet, shredded 3 3 ... ... ... ... Sweets 2 2 ... ... ... ... Swiss roll 1 0 1 0 ... ... Treacle 2 2 ... ... ... ... Tomatoes, ketchup 2 2 ... ... ... ... do. patte 1 1 ... ... ... ... do. sauce 1 1 ... ... ... ... do. soup 2 2 ... ... ... ... Vinegar 13 12 1 0 ... ... Whiskey 3 3 ... ... ... ... Wine 1 1 ... ... ... ... Total 574 561 13 5 1 Fines,£140s.0d Costs,£ 116s 0d. Informal Samples. article. Purchased. Genuine. Adulterated. Proceedings taken. Fines and Convictions. Castor oil 1 1 ... ... ... Cocoa 1 1 ... ... ... Coffee extract 1 1 ... ... ... Cream 3 3 ... ... ... Cream cheese 6 6 ... ... ... Honey 1 1 ... ... ... Jam 1 1 ... ... ... Jelly-table 1 1 ... ... ... Marmite 1 1 ... ... ... Rissole 1 1 ... ... ... Sardines, tinned 3 3 ... ... Sauce 1 1 ... ... ... Spice 1 1 ... ... ... Strawberries 1 1 ... ... ... Syrup of figs 1 1 ... ... ... Milk 1 1 ... ... ... Liquid egg 1 0 1 ... ... Total 26 25 1 — — Total all Samples 600 586 — — — Food Poisoning. A small outbreak of food poisoning occurred in the Borough during the year. Six male workers in a Holborn firm were so attacked on May 7th. A small canteen had been in operation since March 1st; it was in a part of the building away from all chemicals and was operated by the staff of an eating D 50 house in the neighbourhood; the food and utensils were locked up in a cupboard when not in use. On the morning of the 7th May. N.M. opened a 6-lb. tin of corned beef bought via a retail firm, from wholesalers in the City. The label stated, "Compressed Corned Beef. Inspected and passed by Department of Agriculture Establishment 1-ARA. Packed in Argentine Republic." All those who purchased and ate the meat (six in number as in the following table) were taken ill; the meat was eaten at about 10.45 a.m. They were all taken to hospital. Age in years Quantity of meat eaten Time taken ill Initial symptoms Discharged from Hospital Returned to work lt.J.M. 22 (Bread roll &) 1½ ozs. 1.45 p.m. Abdominal pain, vomiting, forcible evacuation of bowels 8/5/26 10/5/26 A.J 3 4 ozs. 2 p.m. Abdominal pain and vomiting 9/5/26 „ K. B.E. 32 (Bread roll &) 1½ ozs. ,, „ ,, ,, „ „ K. B. 37 4 ozs. ,, „ ,, ,, „ „ H. K. 22 2 ozs. ,, „ ,, ,, „ „ H. C. 16 (Bread roll &) 1½ ozs. ,, „ ,, ,, 8/5/26 ,, All the patients had diarrhoea after admission to hospital, but they had all been given castor oil. In all probability the corned beef was responsible. All of those who ate it were ill; some bought corned beef, others bought corned beef made into a sandwich with bread rolls, but some 60 of these rolls were sold in all and as no one who ate them without meat suffered they can be ruled out as a cause of the illness. The bacteriological examination by Dr. Canti at St. Bartholomew's Hospital, of the meat from the bread roll sandwiches did not find any definite organism which could be held responsible. A mouse fed (on May 8th) with bread soaked in juice made from the meat pounded in a pestle suffered no ill effects. Further bacteriological examinations of two meat rolls were made by a laboratory on the instance of the wholesalers, but with no definite result. This, together with the rapid onset of symptoms, would seem to point to the illnesses being due to the ingestion of toxins. There is no evidence as to how the meat became affected. The tin opener and knife used to cut the meat were stated to be clean. The only person to handle the meat, N.M., although she had a "bad bilious attack" headache at 12 o'clock and vomiting at 3.40 p.m. on Friday, May 7th, and had been suffering from her "stomach" of late, had not had diarrhœa. She had not suffered from lyoboid or paratyphoid fe\'er or dysentry or diarrhœa; no one else in the family had recently been ill It would seem that the meat was infected with the organisms of food poisoning at the time of packing and that these were destroyed, leaving the toxins, 51 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The relative importance of the commoner infectious diseases as regards numbsrs of deaths caused is shown by the following table:— ENGLAND AND WALES. Common Infectious Diseases. Deaths at all Ages. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. Y early average 1916-1925. Pneumonia (all forms) 37,916 39,832 59,666 38,949 37,149 34,708 40,930 33,413 38,970 36,990 39,851 Pulmonary Tuberculosis 40,769 42,335 45,338 35,984 32,791 33,505 33,919 32,097 32,690 32,382 36,181 Measles 5,413 10,538 9,787 3,534 7,190 2,241 5,694 5,316 4,834 5,337 6,698 Whooping Cough 6,075 4,509 9,898 2,605 4,401 4,576 6,370 4,162 3,983 6,058 5,810 Diphtheria 5,366 4,477 4,803 4,888 5,648 4,772 4,075 2,722 2,501 2,774 4,654 Scarlet Fever 1,381 768 1,020 1,221 1,430 1,305 1,382 993 888 988 1,265 Enteric Fever 1,122 977 950 577 537 613 465 450 496 388 732 52 The total number of notifications relating to Holborn residents received duiing the year was +16 in comparison with 415 in the year 1925. Attention has had again especially to be called to the non-notification of whooping cough, primary pneumonia and ophthalmia neonatorum. During last year a special reference card with complete list of notifiable diseases was sent to all doctors practising iu the Borough. In addition to the above there were received 189 notifications respecting patients not residing in Holborn, many being in-patients of hospitals in the Borough. All these were forwarded to the Medical Officers of Health of the districts concerned forwarded to the Medical Officers of Health of the dietric ts concerned. The 189 notifications so received were as follows: — Diphtheria 76 Scarlet Fever 46 Whooping Cough 2 Pneumonia 2 Measles 3 Cerebro-spinal Meningitis 1 Acute Poliomyelitis 5 Tuberculosis 54 189 Smallpox. No case of smallpox was notified in the Borough during the year; five cases of the disease were notified in London. Information of 46 passengers or staff arriving on vessels on which smallpox had occurred during the voyage or which came from infected" ports was received and, where practicable, the necessary visits for keeping such contacts under observation were made. In 43 of the cases the addresses given in this Borough were at hotels or boarding houses. In 13 cases the addresses or the names given could not be traced. In 11 other cases although the travellers had visited the hotel mentioned, they had gone prior to the Inspector's visit, usually leaving no address ; in two cases, however, new addresses were furnished and the information sent on. In the remaining cases the travellers were seen and found to be in good health. lhe following table kindly supplied by the Vaccination Officer of the Holborn Union on 2nd March, 1927, gives information respecting vaccination in the Borough of Holborn: — 53  Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Postponed by Medical Certificate Removed. No information as to Vaccination Temporaril.v unaccounted for Holborn Sob-District: 12 months ended 30th June, 1926 239 101 19 41 0 25 28 25 St. Giles and Bloomsbury Sub-Distbict: 12 months ended 30th June, 1926 136 59 15 25 0 15 13 9 375 160 34 66 0 40 41 34 43% As in previous years a leaflet respecting the advantages of vaccination was sent to the parents of all infants born in, or belonging to, the Borough. Diphtheria. Notifications relating to 73 cases of diphtheria occurring in residents in the Borough were"received. Of these, 70 were removed to hospital. Ten were found not to be suSering from diphtheria, and three cases, notified from a hospital staff, were notified as " carriers " only. Of the 60 cases of diphtheria:— 1 was under 1 year. 20 were 1 to 5 years. 28 ,, 5 ,, 15 ,, 8 „ 15 „ 25 „ 2 ,, 25 ,, 45 ,, 1 was 45 ,, 65 ,, One of the 60 was a patient who had previously been notified in another Borough where the family lived before removal to Holborn. Four deaths occurred. Twenty-one "secondary" cases were notified. A "secondary" case is one occurring in the same household as the primary case. Nine of the 21 " secondary " cases were nurses or staff at a hospital in the Borough; from the same hospital 45 in-patients were notified as suffering from diphtheria (27 clinical and 18 carriers), none of these were resident in the Borough. 54 Six "return" cases were notified, of these, two were subsequently found not to be suffering from diphtheria, the remaining four were notified, 12, 14, 13 and 17 days, respectively, after the return of the primary cases from hospital. The four "return" cases occurred in two homes; medical examination of the primary case in each of these homes disclosed evidence that the primary patients were still suffering from diphtheria. In each case they were re-notified and returned to hospital for further treatment. In London 13,526 cases were notified giving rise to 538 deaths. We endeavour to co-operate with the Medical Superintendents of the Metropolitan Asylums Board Fever Hospitals; information is now sent to them as to any bacteriological examinations before admission or after discharge of the patients, and also with regard to return cases of scarlet fever. Diphtheria in Hospitals. During the year notifications were received from a hospital in the Borough of 55 cases of diphtheria. Of the 55 cases, 34 were reported as clinical diphtheria (including ten nasal cases) and 21 as harbouring diphtheria bacilli. Forty-five of the cases were in-patients, all being non-residents of Holborn. The remaining ten were members of the hospital staff; of these seven were clinical diphtheria, viz., resident medical officer 1, nurses 5, maid 1, and three harboured diphtheria bacilli, viz., nurses 2, maid 1. The number of cases of diphtheria occurring from year to year amongst the nursing staff of hospitals suggests the need for the immunisation of hospital nurses. It would seem to be obvious that fever hospital nurses should be protected against diphtheria and it is difficult to avoid the conclusion that all hospital nurses, nursing in children's wards, should be immunised. It must be within the experience of many that nurses in children's hospitals and subsequently the children themselves are often attacked. The possible objection that a nurse would have to be immunised against diphtheria, scarlet fever and typhoid and paratyphoid fevers does not carry much weight. Many during the war were immunised against more diseases than these —those going East were protected against smallpox, typhoid and the paratyphoid fevers, cholera, dysentery and plague. Who can show that they suffered any harm by taking advantage of the progress of science? The Schick test and immunisation against diphtheria is already being successfully applied to the nursing and domestic staffs in certain hospitals, including those of the Metropolitan Asylums Board. 55 Diphtheria Contacts. Bacteriological Examination of Nose and Tiiroat Swabs. Total Contacts swabbed 64 Negative . 50 Positive 14 (22 per cent.) Contacts swabbed. Positive Results. Contacts positive. Nose and Throat. Nose only. Throat only. First Examination Second ,, Third „ Fourth ,, 61 10 4 1 2 - - 1 8 2 1 1 4 2 - - 14 (A) 4 2 (n) 1 (c) (a) Four of these developed diphtheria before the date for taking the second swab; they were notified by the doctor in attendance and removed to hospital. (b) The swabs in one of these two cases were tested for virulence and gave a positive result. The patient was therefore notified as suffering from diphtheria and removed to hospital. (c) The swab front this contact was tested for virulence and found positive. The patient was therefore notified and removed to hospital. The parents or others in charge of children harbouring diphtheria bacilli were given written directions as to the precautions necessary. The results of the examinations of child contacts were communicated to the School Medical Department of the London County Council so that children harbouring diphtheria bacilli could be kept from school providing there was no evidence that the organisms were avirulent. Three virulence tests were made in 1926. In two the results were positive and the patients were notified and removed to hospital. Diphtheria antitoxin was supplied free of charge on application by medical practitioners. During the year it was supplied in seven cases. The Schick Test and Immunisation against Diphtheria. This work is carried on at the Council's Maternity and Child Welfare Centre, 10, John Street, on Wednesday afternoons. Enquiries as to the effect of the testing and inoculation on the individual were made as a routine; we are able to record that any disturbance caused was negligible. 56 Information as to the work carried out for five years, ending December, 1926 follows:— TABLE I. HOLBORN MUNICIPAL INFANT WELFARE CENTRE, 1922, 1923, 1924, 1925, 1926. Ages of Persons Schick Tested with Result of Test. Ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years 15 and above years Total for 5 years, 1922-26. 66 188 135 112 89 66 52 37 39 52 38 24 22 27 4 67 = 1018 Result of Schick Test. Pos. Neg. Pos. Neg. Notread Pos. Neg. Pos. Neg. Notread Pos. Neg. Notread Pes. Neg. Not read Pos. Neg. Pos. Neg. Pos. Neg. Pos. Nog. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Notread Total for 5 years. 60 6 177 8 3 138 7 96 15 1 65 22 2 43 21 2 36 16 26 11 24 15 23 29 19 19 11 13 10 12 8 19 2 2 24 39 4 752 Pos. 254 Neg. 12 Not read. TABLE II. Ages of Persons Immunised. Age. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years 15 and above years Total for 5 years 49 140 106 75 49 34 37 21 17 19 13 9 8 5 2 8 = 591 57 TABLE III. HOLBORN MUNICIPAL INFANT WELFARE CENTRE. Schick Test and Diphtheria Immunisation. Five years, 1922-23-24-25-26. Total Tested. Result of Test. Immunisation of Positivrs. a b C d E F Negative. Positive. Not read. Found NEGATIVE to Re Schick Test after Found NEGATIVE to Re Schick Test after Found POSITIVE to Re Schick Test after 3 ccm T.A.T. Total Re Schick Tested Given 3 ccm T.A.T. Not Retested. Failed to complete 3 inoculatns. Inoculatns. not begun. Inoculatns. still in progress. Given 1 ccm not yet Re-tested 1 ccm T.A.T. 2 ccm T.A.T. 3 ccm T.A.T. 4 ccm T.A.T. 5 ccm T.A.T. 6 ccm T.A.T. 8 ccm Given further inoculation but not yet Retested. No further inoculation given. c a c a C a C a C A C A C A C a C A C A C A C A C A C A C a C a C A C A C A 952 66 213 41 730 22 9 3 12 0 15 1 376 4 12 0 9 1 4 1 1 0 24 1 10 1 473 9 127 0 61 4 62 7 7 0 12 0 1,018 254 752 12 13 17 388 12 10 5 1 25 11 482†† 118†† 65 69 $ 7 11 * These columns refer to 64 cases that were Schick positive on Retesting after 3 ccm T.A.T. † 34 of these are dead or removed from the Borough. 89 of these have removed from the Borough, †† These retests include those made up to the end of May 18, 1927. Note.—Columns B C D give details of the total No. 472 given in Column E. Columns E F give details of the total No. 752 of positives given in Column A. 58 In view of the satisfactory results obtained by R. A. O'Brien in the Holborn (Poor-law) schools, arrangements were made in 1922 to render the measure available for the general child population of Holborn. The results obtained are summarised in Tables I., II., and III. The results of the Schick testing were very much the same as those found in all other urban areas; we have, however, analysed them in connection with the immunity to diphtheria of various members of the families dealt with. The last column in Table IV. shows the number of exceptions (9.7 per cent.) to the expectation that positive reactions will be manifested only in the younger members. TABLE IV. No. of children in family. No of families. Of which the members are— All Schick positive. All Schick negative. One or more elders negative, younger positive. One or more elders positive, younger negative. 2 129 98 9 15 7 3 57 32 4 15 6 4 18 7 — 6 5 5 8 2 — 4 2 6 2 — — 2 — 7 2 — — 1 1 — 216 139 13 43 21 In one family of five children, twins (F.) of 2-3 years of age were both positive: of twins of 7-8 years, one (M.) was positive, the other (F.) was negative. In one family of three children one twin (M.) was negative, the other (F.) was positive; the latter had already been in hospital with diphtheria. In another family, twins, one male aged 2 years when tested and one female aged 5 years when tested were both Schick positive. 59 In another family, one male aged 2 years when tested and one female aged 5 years when tested were both Schick positive. In one family of four, all Schick positive to the first test, two members were found to be Schick positive to the second test. The first of these (F. 4) was immunised some months previously to the second one (M. 1), and was further inoculated, being negative to the second test; the second child is not yet retested. In another family of four (Fs.), all Schick positive to the first test, the eldest only was Schick posit ive to the retest; this child was still Schick positive after a second course of 3 c.cm.; she became Schick negative after a total of 8 c.cm. had been given. Routine Procedure. The routine of the procedure carried out is as follows. The child is Schick tested at the Council's Maternity and Child Welfare Centre, and if susceptible to diphtheria is brought up by the parent at weekly intervals for the next three weeks for immunisation, and then at the end of another three months (formerly we tried for the period six to eight weeks) for re-Schick testing, when, if it happens to be still positive, it receives further inoculation. A modification of the routine occurs if from the Schick test it is seen that the child is particularly susceptible to protein reactions; in this case the 3 c.cm. of toxoid antitoxin mixture are given in four or five doses at weekly intervals Some difficulty has been experienced in securing the necessary number of immunising injections owing to the children belonging to families who remove from the district; some of these however attend to finish the course. A few adolescents at times fail to complete the course by reason of being employed and it no longer being convenient for them to attend. Although Park and Zingher recommend that Schick testing should only be applied to children over 5 years, it would seem inadvisable to dispense with the test as a routine at the present time in Holborn. It is a great satisfaction to nervous parents to think that there will be no inoculation unless susceptibilityis proved. Retesting is unpopular with parents, and the need for it does not help to increase their confidence in immunisation. Of 482 that have been retested 64 were found to be still Schick positive after three inoculations. The facts relating to these are given in Table V. 60 TABLE V. Re-Schick tested after an interval of years or fraction of years. Number retested after this interval. No. found positive. Age in years and sex of positives when first tested. Negative to 2nd re Schick test and total of T.A.T. given in all. 5/52 M F 1 13, F. Neg.;4 c.cm. 10 (6 4) 6/52 3 (1 2) - - 7/52 6 (4 2) 2/12 20 (10 10) 1 9, M. Neg.; 6 c.cm. 2½/12 13 (4 9) — - 3/12 85 (40 46) 11 (a) 8, F. Neg.; 4 c.cm. (b) Ad., F. - (c) 3, M. - (d)9, M. - (e) 6, M. Neg.; 6 c.cm. (f)11/12,M. Neg.; 4 c.cm. (g) 5, M. (h) 2, M. - (i) 5, F. - (j) 7, F. - (k) 6 F. - 3½/12 18 (8 10) 2 (a) 4. F. Neg.; 5 c.cm. (b) 1, F. - 4/12 54 (25 29) 7 (a) 4, F. *Neg.; 4 c.cm. (b) 6, F. Neg.; 8 c.cm. (c)10/12,M. Neg.; 4 c.cm. (d) 2, F. Neg.; 5 c.cm. (e) 1, K. Neg.; 5 c.cm. (f) 6, F. - (g) 4, F. — 4½/12 4 (0 4) 4) (a) 5, F. Neg.; 6 c.cm. 5/12 27 (10 17) ( b) 2, F. Neg.; 4 c.cm. (a) 2, F. Neg.; 6 c.cm. (b)2, M. Neg.; 4 c.cm. (c) Ad., F. — 6/12 37 (17 20) 8 (a) 1,M. — (b) 2, M. Neg.; 5 c.cm. (c) 3, M. — (d) 4, F. - (e) 2,M. — (f) 6, M. (g) 3,M. Neg,; 6 c.cm. (b) 3,M. — 7/12 18 (8 10) 1 9, F. Neg.; 6 c.cm. 8/12 11 (4 7) 2 (a) 11, F. — (b) 1, F. — 9/12 9 (5 41 2 (a) 1,M. — / (b) 8, M - 10/12 11 ( 4 7) 1 4, F. †Neg.; 5 c.cm. 11/12 5 ( 3 2) 1 1, M. — / 1 7 (1 6) 1 9/12 F. Neg.; 4 c.cm. 1-2 84 (41 43) 15 (a) 1, F. Neg.; 4 c.cm. (b) 2, M. Neg.; 4 c.cm. (c) 2, M. (d) 2, M. — (e) 2, F. Neg.; 4 c.cm. (f) 6, M. Neg.; 4 c.cm. (g) 7, F. Neg. ; 4 c.cm. (h) 8, F. (i) 9, M. - (j) 9, F. — (k) 11, F. - (l)12, M. - (m) 12, F. - (n) Ad., F. Neg. ; 5 c.cm. (o) 1, F. Neg ; 4 c.cm. 2-3 60 (26 34) 6 (a) 2, F. — (b) 5, F. Neg. ; 4 c.cm. (c) 12, F. — (d) 2, F. — (e) 4, M. — (f) 2, F. — Total 482 (217 265) 64 M. 26 F. 38 * Another child in same family (F.), aged 4 years, was negative. † Three children in this group were members of one family: 2 negatives (M.), aged 2 years, (F.), aged 6 years; 1 positive (F.), aged 4 years. 61 In addition, one child re-Schick tested 15 months after 1 c.cm. T.A.T., was found positive, and two children retested after 3 c.cm. were on the information given by the mother considered to be slightly positive. Fifty-three of those positive on re-Schicking have been further inoculated, and 28 of them further tested and found negative. Efforts are being made to continue the inoculation of the remainder; in addition, two others, found positive to the second re-Schick. after 4 c.cm. have been further inoculated, and are awaiting a retest. As seen in the footnote to Table V. one child (F., aged 4 years) was positive to the second re-Schick after 6 c.cm., but was negative after 8 c.cm.; this child was the eldest of four girls; the three younger ones were negative after the routine 3 c.cm.; two of these receiving their routine injections on the same day and from the same batch of toxoid antitoxin as the eldest. Of the 482 persons retested, 217 were males and 265 were females. Among the positive were 26 males and 38 females. Neither age nor interval seems to have any influence on the phenomenon. It would seem conceivable that some batches of toxin antitoxin or toxoid antitoxin might prove to be less efficacious than others. An analysis of the results obtained in Holborn would seem to indicate clearly that this is so; also that the toxoid antitoxin used was as efficacious as the toxin antitoxin. The toxin antitoxin used were all 3 L + per c.c.m mixtures, the toxoid antitoxin contained toxoid diluted 1-10 with added antitoxin. (Table VI.) That considerable importance attaches to the retesting is shown by the fact that cur four cases of diphtheria among those treated occurred in children who were given the routine three injections, but had not been retested. The first case was a boy (aged 4) who suffered from a severe attack of the disease, but recovered without any complications or sequela; his recovery was ascribed certainly by his mother to the inoculations of T.A.T. given after Schick testing. A second case is said to have occurred in a boy (aged 8) also given the routine three injections. Two years later he was diagnosed (for the third time in his life) as suffering from diphtheria ; no swab was taken. On admission to the M.A.B. Hospital he was first found to be swab negative, later swab positive, but was diagnosed as a ease of diphtheria. The mother fortunately is still convinced that the boy did not suffer from diphtheria. A third child (a girl, aged 3) had a mild attack, and made a good recovery; in the fourth case (a girl, aged 6) a severe attack occurred four weeks after the last of the routine three injections had been given. It will be seen from Table V. that the length of the period before immunity is acquired varies considerably. 62 TABLE VI. Batches of Toxin Antitoxin and Toxoid Antitoxin Compared Designation of batch of toxin antitoxin mixture or toxoid antitoxin mixture. No. of persons inoculated and retested. Xo. of these persons found positive on retesting. Toxin antitoxin mixture B. 346 59 2 B. 475 28 3 B. 654 28 1 B. 671 74 18 B. 671a 2 1 B. 672a 30 2 B. 617 35 2 B. 675 1 - B. 672 1 — Toxoid antitoxin mixture B. 1017 33 4 B. 1090 16 1 B. 1038 13 — B. 1018 43 10 B. 1129 18 3 B 995 10 — B. 1148 8 2 B. 1197 21 9 B. 1198 14 3 B. 1205 17 3 B. 2060 1 B. 2079 22 B. 2081 8 - Total 472 64 Reactions. Oar experience is that the reaction after the injection of the toxin antitoxin and toxoid antitoxin is in practically every case negligible. All we have to record is that in one child considerable swelling of the whole of the arm occurred, but the next day, when at the centre, she was running about and helping the other children eat their cakes ; the swelling went down without any further result. Another, a boy of 10 years of age, his mother informed me, suffered with vomiting after each of his three inoculations and spent the next day in bed, but he and his mother stuck to it, and he was subsequently proved to have been satisfactorily immunised. In another child, a small, hard, slightly tender nodule developed above the extornal condyle, but the tenderness only remained for a few days. The use of toxoid antitoxin does away with the risk of fatality incurred by using improperly made toxin antitoxin. What of the Future ? Most of the attendances are the result of repeated efforts of persuasion and encouragement. Prejudice against inoculation is widespread; some of the most stubborn opponents of inoculation admit that if T.A.T. could be given in tabloid form 63 or in spoonfuls they would agree to it. They object, in fact, to the introduction of animal products by means of a hypodermic syringe into the human body, but continued propaganda is sure to produce its results. The aim of everyone who takes up the work must be to get all the children living in the area immunised as soon after they reach the age of 6 months as possible. In Holborn we have not reachcd this stage yet; the history of vaccination against small pox suggests we never shall. But a local health authority is justified in considering that it has done all in its power to prevent loss of life and illness from diphtheria if it offers immunisation. It might be expected that if the immunisation were carried out among the school population in a large town the parents would come to regard the procedure as more ordinary, and be prepared to allow the younger children to be immunised at infant welfare centres. Apparently it cannot be too often repeated that it is immunisation at a very early age that we want carried out; if it is delayed till school age half the deaths will have occurred. In London during five years 1921-25, of the total deaths from diphtheria, 57 per cent. occurred under five years of age. Certainly if the immunisation could be completed at one visit the energy spent in looking up those failing to attend could be used in getting new recruits, and the parents would bo spared much trouble. Scarlet Fever. There were 84 notifications of scarlet fever. All the 84 were removed to hospital and subsequently four were returned from hospital " not scarlet fever." In connection with five of the cases during the year, seven notifications of "secondary" cases were received. Two of these, ultimately removed to hospital, were found to be not suffering from scarlet fever. These secondary cases are exclusive of nine nurses at a hospital in the Borough who were notified as suffering from this disease, from the same hospital 30 in-patients were notified as so suffering. None was resident in Holborn. Four "return" cases were notified, i.e., cases occurring within 28 days of the return from hospital to the same house of a previous case of scarlet fever. Two of the "return" cases were found, on admission to hospital, not to be suffering from scarlet fever. There was one death from this disease. 12,294 cases of scarlet fever were notified in London with 82 deaths. 64 Enteric Fever. Five cases were notified during the year; none died. The facts relating to the cases are as follows:— Nos. 1 and 2. These were a mother and son, two members of a party of four travellers, staying temporarily at a hotel in the Borough. The patients were under medical treatment for four weeks before the disease was diagnosed and notified. During that period, the doctor in attendance had three Widal tests made, the first and second giving negative results. The illness in the mother commenced before her arrival at the hotel. The patients were removed to a nursing home and subsequently to a hospital of the Metropolitan Asylums Board. There seemed to be no doubt that both patients contracted the disease at Beyrout where they stayed ten or twelve days before the onset of the illness. Nos. 3 and 4. These patients also were travellers staying temporarily in a hotel. The onset of the illness synchronised with their arrival in the Borough. Both patients were American travellers who came to England from France where they had stayed in Paris, the disease having been contracted there. No. 5. This patient was a housekeeper in a restaurant. On enquiry it was ascertained that she had visited Lourdes and Paris where she stayed for some days. The patient became ill shortly after her return from Paris and it would appear that the disease was contracted there. 302 cases of this disease were notified in London, with 28 deaths. Typhus Fever. No case of typhus fever was notified during the year, either in the Borough or in London. Cerebrospinal Fever. Two cases of cerebro-spinal fever were notified. Both children were inpatients of voluntary hospitals. One patient died and one recovered. 93 cases were notified in London, with 54 deaths. Dysentery. No case of dysentery was notified. 13 cases were notified in London. 65 Malaria. No case of malaria was notified. 52 cases were notified in London. Encephalitis Lethiargica. One case of encephalitis lethargica was notified in the Borough during the year. This patient died in institution three days after admission, the death being certified as due to carcinoma of stomach. 224 cases were notified in London, with 87 deaths. The following table gives information up to the end of 1926 respecting the 11 real cases of encephalitis lethargica notified in the Borough since the Public Health (Encephalitis Lethargica) Regulations came into force on the 1st January, 1919:— Date of Notification. Pat ient. Age when notified. Subsequent History. 6/2/20 P.P. 8 years Died 28/2/20 7/2/20 W.W 47 years Died 7/2/20 13/1/20 B.R. 32 years Died 13/1/20 26/4/22 W H. 14 years Died 19/4/22 4/4/24 A.K 28 years Died 28/3/24 16/5/24 G.C. 36 years Returned to Italy 20/6/24 R.V.M. 40 years Complete recovery 9/7/24 | F.H. 7 years Complete recovery 26/9/24 B.V. 53 years Died 21/9/24 4/5/25 c.s. 28 years Right leg partially paralysed; right arm tremulous; extreme depression 29/5/26 H.P. 33 years Died 30/5/26 The table excludes one case notified 15/11/24 who was subsequently found not to be suffering from this disease. Acute Poliomyelitis. No case of acute poliomyelitis or polioencephalitis was notified. 85 cases were notified in London, with 15 deaths. From the coming into operation of the Poliomyelitis Order, 1912, to the end of 1926, a total of 14 cases of this disease were notified as occurring in the Borough. F. 66 The following table gives particulars of these cases with the condition at the end of 1926:— Date of Notification. Patient. Age at date of Notification. Where Treated. Subsequent History. 17/7/13 F.D. 1182 years Hospital Died from diphtheria 23/10/13 F.H. 2½ „ „ Wears surgical boot and still O.P. at Hospital 26/1/16 A.C. 4 „ „ Died 26/1/16 27/1/16 T.B. 4 „ „» Now working—dragging of leg hardly noticeable 5/9/16 F.B. 2 months „ Died 6/6/20 LP. 3J years „ Recovered—no crippling 23/7/20 E.W. 15 „ „ No use of lower limbs 17/9/20 E.H. 1 8 1 2 „ „ Recovered—no crippling 4/9/22 Y R. 11012 „ Home „ „ 5/2/23 J.N. 3½ „ Hospital „ „ 2/5/23 M.H. 11 mths. „ Again an in patient at Orthopœdic Hospital 14/8/25 B.T. 26 years „ Hotel guest; could not be traced 30/10/25 V.H. 5 „ Removed from Borough —lost sight of The table excludes one case notified 4/12/18 who was subsequently found not to be suffering from this disease. Pneumonia. Thirty-nine cases of pneumonia were notified during the year. Ten of these were influenzal pneumonia. Thirty-nine deaths were recorded from all forms of pneumonia. Three of these were from influenzal pneumonia. The 29 cases of primary pneumonia were notified at the following ages: — Under 1 year, 0; from 1 to 5 years, 9; from 5 to 15 years, 2; from 15 to 25 years, 2: from 25 to 45 years, 3; from 45 to 65 years, 7; and 65 years and upwards 6. Thirteen were treated at home; 7 were removed to voluntary hospitals; 8 to Poor Law Infirmaries; and one to a M.A.B. Hospital. One of the patients was nursed by the Metropolitan Nursing Association under the arrangements made by the Council, 67 Of the 29 cases of primary pneumonia, 17 resided in tenement lodging houses, 5 in separate private dwelling houses or model dwellings, 2 in boarding houses, 2 in hotels, and 3 in common lodging houses. The cleanliness of the homes was reported to be satisfactory in 21 cases, but only fairly so in 7, and in one case as unsatisfactory. The economic conditions of the families concerned was found to be good in 6 cases, fair in 12, poor in 8, and very poor in 3; 12 cases were nursed in a separate room. In the majority of cases the disease was not ascribed to any special cause, but the following was given in 14 instances:— Following chronic bronchitis 5 Following cold 8 Following change of climate from South Africa to England 1 Influenza. There were 8 deaths from influenza in comparison with 9 in 1925, 11 in 1924, 1 in 1923, and 21 in 1922. Anthrax. No case of anthrax was notified in the Borough during the year. Eight cases were notified in London. Chicken-pox. During the year information of 98 cases was received from school teachers and others. Mumps. Information was received from school teachers of 15 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year: — Diphtheria Pulmonary Tuberculosis Number Submitted Result of Examination Number Submitted Result of Examination 306 Bacilli not found 264 78 Bacilli not found 70 Bacilli found 42 Bacilli found 8 E 2 68 Disinfections. During the year 657 rooms and 3,413 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Thirty-two rooms and 265 articles of bedding, clothing, etc., were disinfected after tuberculosis. Special attention is devoted to toys and more particularly to any toy put in the mouth. These latter are as a rule destroyed. Cleansing of Persons Act. During the year 165 persons (163 men and 2 women) infested with vermin had their bodies and 2,605 articles of clothing disinfested, free of charge, at our cleansing station (Goldsmith Street). One hundred and thirty-four verminous rooms were disinfested. In connection with the fumigation of verminous rooms, it is now our practice to repeat the fumigation at the end of a week, by which time it is expected that any eggs will have hatched out; a single fumigation of any badly infested room cannot be regarded as satisfactory. In 77 cases last year this course was adopted. Verminous Conditions and Scabies. In connection with our co-operation with the London County Council School Medical Service, information is received from the Medical Officer of Health of the London County Council respecting children attending schools in the Borough found to be verminous or suffering with scabies. During the year information was received under the above arrangement respecting 95 children reported to be verminous. In three instances the same children were reported as verminous on three different occasions in the year, and in eight cases the children were reported a second time. All the cases were visited after receipt of each report, but it was not found necessary for any action to be taken in connection with the bedding or homes. In a number of cases a card of instructions for keeping the heads of children clean was left with the parent. One child was reported as suffering from scabies; arrangements were made for the disinfection of bedding and room. Shelter during Disinfection. For some years past the arrangement has been in operation with the Council of the Metropolitan Borough of Finsbury for accommodation to be provided at their Reception House, Northampton Boad, for residents of this Borough during the disinfection of their homes after infectious disease. 69 Tuberculosis. Summary of Notifications and Deaths. The following table gives the number of new cases of tuberculosis and deaths from the disease in the Borough during 1926 in the form required by the Ministry of Health:— Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 — — — — — — 2 — 1 — — 1 3 — — 1 1 5 1 _ 2 3 - - 2 1 10 1 1 2 — - — — 15 6 5 1 2 — 2 — — 20 1 2 1 1 1 - — 1 25 8 6 1 1 4 1 — — 35 6 3 1 1 3 1 — 1 45 5 5 1 1 3 2 — — 55 4 1 — — 4 3 — — 65 — 1 — — 1 1 — — 31 23 9 14 16 10 6 4 The initiation of the Tuberculosis Care Committee as a local institution and the administrative change whereby all correspondence concerning tuberculous patients is sent to the Borough Medical Officer of Health have proved beneficial; the knowledge of the local Public Health Staff of the patients is increased in a natural and easy way and the interest in the work encouraged. Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1926 295 Number of these patients residing in common lodging houses (about) 20 The average number of cases notified annually during the past ten years 116 The number notified in the year 1926 92 Of the 92 cases notified in 1926, the number who attended the Dispensary 43 Total number of new cases examined at the Dispensary for the first time in 1926, including the above 43, and all contacts 127 Total attendances at the Dispensary in 1926 872 70 Supervision of home conditions; visits paid by— Tuberculosis Officer 73 Dispensary Nurse 1,140 Sanitary Inspectors 7 The present arrangements for the Tuberculosis Dispensary are as follows:— The Dispensary is at the University College Hospital, Gower Street, in the Borough of St. Pancras. The Dispensary covers the whole of the Borough of Holborn. The Tuberculosis Officer attends three sessions each week, namely, Monday and Wednesday afternoons and Thursday evenings. The Dispensary Nurse assists at the Dispensary and visits cases in their homes. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from the 3rd January, 1926, to the 1st January, 1927, in the Metropolitan Borough of Holborn. Age-periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total Primary Notifications. Total Notifications on Form A. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary Males ... ... 1 ... 6 1 8 6 5 4 ... 31 43 ... ... ... ... ... 27 35 ,, Females ... ... ... 1 5 2 5 3 5 1 1 23 27 ... ... ... ... ... 4 18 Non-pulmonary Males ... 1 2 1 1 1 1 1 1 ... ... 9 11 ... ... ... ... ... 1 3 ,, Females 3 3 2 2 1 1 1 1 ... ... 14 15 ... ... ... ... ... ... 3 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 3rd January, 1926, to the 1st January, 1927, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. Age-periods. 0 to l 1 to5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Cases. Pulmonary Males ... ... ... ... ... ... 2 3 ... 3 ... 8 „ Females ... ... 1 ... ... 2 ... 1 ... ... ... 4 Non-pulmonary Males 1 ... 1 ... ... ... ... 1 ... ... ... 3 ,, Females ... ... ... ... ... ... ... ... ... ... ... ... 71 Nine of the 15 were ascertained from the death returns and six were transfers from other areas. Tuberculosis 'Notifications. Excluding duplicates the total number of notifications received on Forms A or B during the year 1926 was 77; 15 other cases were brought to my knowledge, (making 92 new cases in the year). These were:—Private cases 18, hospital cases 52, Poor Law cases 7, from death returns 9, transfers from other districts 6. Correction of Tuberculosis Register during the year 1926. Number of cases on Register, 1st January, 1926 270 New cases registered, 1st January to 31st December, 1926 92 362 Removed from the Register during the same period for following reasons:— Removed from Borough 35 Recovered 1 Died 30 Not suffering from tuberculosis 1 — 67 Number on Register 31st December, 1926 ... 295 Of the 92 cases entered on the Register in 1926, 66 were pulmonary tuberculosis and 26 non-pulmonary tuberculosis. Forty-seven of the cases were removed for treatment to hospital, infirmary or sanatorium. Sleeping Conditions. In 82 of the 92 new cases of tuberculosis in 1926 it was possible to obtain information as to the sleeping conditions at the date of notification. Six of the remaining cases were residents in common lodging houses; in three cases incorrect addresses were given, or the patients no longer resided in the Borough. The following is a summary of the infonnation in the 82 cases above referred to:— Patient slept in— Separate bed room 23 Separate bed in living room 6 Separate bed in room shared with— 1 person 10 2 persons 8 3 persons 3 4 persons 2 7 persons 1 72 Shared bed with— No others in room. 1 adult (H. or W.) 11 1 adult (not H. or W.) 6 1 child 2 Shared bed with— 1 adult Other persons in bedroom 1 child 4 1 adult 2 children 1 1 adult 2 adults 1 1 adult 2 adults, 2 children 1 2 adults 1 child 1 1 child 2 adults, 2 children 1 2 children 2 adults, 2 children 1 82 Classification of Homes. The classification of homes as suggested by the London County Council has been reported on as far as practicable with the following results:— "A."—Good environment, clean, well-kept, separate bedroom (or in the case of husband and wife, no other occupant of bedroom), good food and clothing 17 "B."—Fair. Separate bed, but not separate bedroom 55 "C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 10 82 The following summary gives the position at the end of 1926 of the 92 new cases respecting which information was received during the year:— Dead 16 Cases removed to Hospital or Infirmary and still inpatients at the end of year 29 Out-patients at Hospitals 12 In-patients in Sanatoria at end of year 13 Not traced—Incorrect addresses 2 Removed from Borough 6 Dispensary Treatment 6 Home Treatment 3 Convalescent Home 1 Waiting admission to Institution 1 Away in country 2 Diagnosed not tuberculous 1 92 Forty-three of the 92 cases attended the Holborn Tuberculosis Dispensary. 73 The following indicates the reasons for non-attendance in the remaining cases:— Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 23 Out-patients at other Hospitals or Dispensaries ... Dead before notification or died before attendance at Dispensary 5 13 Treatment at, home by private doctor 1 Not traced 2 Removed from Borough 5 49 Delayed Notification The Public Health (Tuberculosis) Regulations, 1912, require notification within 48 hours of the medical practitioner first becoming aware that the person is suffering from tuberculosis. It is still found that medical practitioners do not notify cases of this disease until tubercle bacilli have been found in the sputum and in a number of cases notifications are not received until the death of the patient or shortly before death takes place. In the past year two cases were notified only at death, five within one month of death, three within three months and one within six months of death. Both the cases notified at death died in hospital. It is unfortunate that by a proviso in the Regulations of 1912, a medical practitioner is not required to notify a case of tuberculosis if he has reasonable grounds for believing that the case has already been notified. It would seem that any disadvantage accruing from duplication would be easily outweighed by the advantage of the additional encouragement to promote early notification which would ensue from the withdrawal of this proviso from the Regulations. The Regulations also require notification of the admission and discharge of patients to poor law institutions and sanatoria. Institutional Treatment. During the year notifications were received of 91 admissions to institutions. These admissions represent 78 patients, some of whom are transferred from one institution to another, and others are discharged, or take their own discharge, and subsequently are re-admitted. The 91 admissions were to the following institutions:— Poor Law Institutions 31 Institutions of the Metropolitan Asylums Board 36 Other Institutions 24 Thirteen of these admissions were transfers from one institution to another or re-admissions. Visitation of Homes, etc. During 1926 the patients were visited by the Tuberculosis Nurse; the arrangements made whereby after March 31st, 1925, all such visits are paid by the Tuberculosis Nurse, continued. 74 Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. Sixty-six contacts, viz., 29 adults and 37 children under fifteen years of age, responded to this invitation and were examined for the first time during the year 1926. Of these, three adults and two children were found to be definitely suffering from tuberculosis; five adults were doubtfully so suffering. Fifty-six were definitely diagnosed as not suffering from the disease. The routine examination of contacts is desirable as a means of discovering not only cases of tuberculosis in early stages of infection, but also advanced and infective cases which may be disseminating infection although remaining undiscovered and untreated. Arrangements were continued during the year for fuller co-operation with the school medical service so as to ensure that no contacts of school age will remain unexamined; if such examination cannot be carried out at the Dispensary the School Medical Officers are notified so that the examination may be carried out at the school. Information as to the results of such examinations, whether at the Dispensary or the schools, is interchanged as necessary. Prevention of Spitting. The necessity for the prevention of spitting, with a view to minimising the spread of tuberculosis, has been emphasised by the issue of warning cards on the subject. These have been exhibited in the various buildings in the control of the Council, also in common lodging houses, and in the workrooms of a number of large firms in the Borough. In addition specially designed opal plates have been placed on the Council buildings. They ask people not to spit and so prevent not only tuberculosis, but pneumonia and other diseases the germs of which are carried in the mouth and nose. It is very conceivable that such a disease as encephalitis lethargica is spread in this way in towns. Deaths from Pulmonary Tuberculosis. The number of deaths from pulmonary tuberculosis during the year was 26, a death rate of 0.60 per thousand in comparison with 1.04 for 1925. The following table shows where the patients died in their own homes or institutions:— Showing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- All Ages. Males. Females. Total. Number of patients who died at home 1 ... ... ... l 1 2 ... 2 3 ... 6 4 10 Number of patients who died in hospitals, etc. 1 2 3 ... 1 2 2 5 3 4 2 15 10 25 2 2 3 - 2 3 4 5 5 7 2 21 14 35 75 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, J. A. Struthers, M.B., B.Ch., M.R.C.P., D.P.H., for the year 1926:— (Memo. 37/T.: Table I.) Return showing the work of the Dispensary during the year 1926. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 16 14 1 0 1 3 3 2 17 17 4 2 (b) Doubtfully tuberculous — — - — - - - — 14 2 2 2 (c) Non-tuberculous — — — — — — — — 0 4 6 1 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 0 0 1 1 1 2 1 1 (b) Doubtfully tuberculous - - - - - - - — 1 4 - - (c) Non-tuberculous — — — — — — — 5 16 21 14 C.—Cases written off the Dispensary Register as (a) Cured - — 1 - - - — — - - 1 - (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 24 57 40 26 D.—Number of Persons on Dispensary Register on December 31st— (a) Diagnosis completed 67 79 4 3 13 12 9 7 80 91 13 10 (b) Diagnosis not completed — — — — — — — — — 1 — — 16 1. Number of persons on Dispensary Register on January 1st 293 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 9 2. Number of patients transferred from other areas and of "lost sight of " cases returned 5 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 6 3. Number of patients transferred to other areas and cases "lost sight of" 75 (b) Otherwise 9 11. Number of other visits by Tuberculosis Officers to Homes 73 4. Died during the year 7 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1140 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 1 13. Number of (a) Specimens of sputum, &c., examined 176 6. Number of attendances at the Dispensary (including contacts) 872 (b) X-ray examinations made in connection with Dispensary work 34 7. Number of attendances of non-pulmonary cases at Orthopædic Out-stations for treatment or supervision 6 14. Number of Insured Persons on Dispensary Register on the 31st December 98 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 46 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment — 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 21+81 letters (b) Other special forms of treatment 73 (6) Form G.P. 36 12 77 Work this year has proceeded on lines similar to those indicated in last year's report; and co-operation has been maintained with the Public Health Department, the local practitioners and University College Hospital, as also with the School Medical Service and the Maternity and Child Welfare Centre. Special attention has been paid this year to the important question of dietary and cooking. It is frequently found that patients prejudice their chances of improvement, or fail to maintain progress already made, owing to unsuitable food and bad cooking; and when it is remembered that dyspepsia is a common accompaniment of tuberculosis in all forms and in all stages the importance of such matters as a factor in treatment becomes manifest. Small cookery books have been distributed by the Dispensary Nurse in suitable cases so as to help in the preparation of the dishes concerned. The alteration of the form of Annual Return required by the Ministry of Health, and the provisions of Memorandum 37/T, have involved a revision of the Dispensary Register together with a review of the case papers and changes in the method of keeping records. These changes are proceeding. In conclusion it is a pleasure to acknowledge the assistance which the work of the Dispensary continues to receive from the Tuberculosis Care Committee. J. A. STRUTHERS. Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations which came into force in August, 1925, are intended to prevent persons suffering with pulmonary tuberculosis from entering or continuing any employment or occupation in connection with a dairy which would involve the milking of cows, treatment of milk or the handling of vessels used for containing milk. During the past year the Council was asked to support representations to the Minister of Health that the Regulations should be amended so as to require that a person about to enter employment in connection with the milk trade should be required to produce to the local authority a recent certificate from a registered medical practitioner to the effect that the intending entrant into the employment was not suffering from tuberculosis. The Council expressed approval of the proposal to extend the Regulations so as to require a certificate of freedom from infection, but expressed the view that such certificate should be given by the Tuberculosis Officer, and should be produced, not to the local authority, but to the employer, and should be subject to annual renewal, and that it should be an offence for an employer to engage any such person without such medical certificate. A communication on these lines was forwarded to the Ministry of Health; in reply a communication was received drawing attention to the action taken by a Metropolitan Borough Council in circularising the milk purveyors in their area inviting them to arrange for the examination, by the Tuberculosis Officers, of all persons who applied to them for employment. The Minister expressed the view that this course had much to commend it and was one which might be adopted by other local authorities. Pursuant to this suggestion the Public Health Committee (irranged with the Tuberculosis Officer for the examination of prospective 78 employees in the milk trade in the Borough and a circular letter was addressed to the registered milksellers drawing attention to the facilities thus afforded and expressing the hope that the milk traders would in future require the production of such certificate before giving employment to any new applicants for work in their business. Although a great step forward has been made it may be pointed out that these Regulations apply only to employment in connection with a dairy and although this term includes farm, cowshed, milk store, milk shop or other place from which milk is supplied on or for sale, it does not include a shop or other place in which milk is sold for consumption on the premises only. No action, therefore, could be taken by a local authority to prevent the continued employment in, for example, a restaurant, of an employee suffering from tuberculosis, although the nature of the work carried on by such tuberculous person might entail the treatment of milk or the handling of vessels used for containing milk for human consumption. Information was received during the year respecting tuberculosis in the case of a cook employed in the preparation of meals for the staff at a large hotel. No action could be taken under the Regulations to require this employment to be discontinued. When the public is prepared to accept any extension of the Regulations they will probably be applied to all trades concerned with the preparation of food. Tuberculosis Care Committee. The Holborn Tuberculosis Care Committee constituted by the scheme prepared in the year 1922 took over the work of the Interim Care Committee on the 1st April, 1923. The Committee includes the following representation:— Holborn Borough Council Councillor Miss M. R. Lovelock. Medical Officer of Health (Dr. C. W. Hutt) Tuberculosis Dispensary Councillor Sir William Smith, D.L., J.P. Tuberculosis Officer (Dr. J. A. Struthers). London County Council Dr. F. C. Lewis. Miss H. Bell. Guardians of the Holborn Union Conncillor Alfred Humphreys. Charity Organisation Society Miss E. F. Bolton. Local Association of Children's School Mrs. A. E. Dove. Care Committees. Invalid Children's Aid Association Miss E. Fildes. Metropolitan District Nursing Association Miss M. Wilmshurst. Almoners of hospitals Miss J. G. Salmon. Miss A. M. Smith. Insurance Committee for the County of Miss S. Double. London. Northern London War Pensions Committee Councillor Richard Davies (from Feb. 1926). British Red Cross Emergency Help Fund Mrs. Paige. Other social workers (co-opted) Mrs. E. C. Bedford. Miss H. M. Matbieson. Rev. Wilfred H. Davies, M.A. 79 The duties o£ the Committee were defined to include enquiries as to the economic position of the family of a patient suffering from tuberculosis as soon as the patient comes within the purview of the Tuberculosis Dispensary Scheme with a view to rendering such advice and assistance as the circumstances of the case dictate; assistance in the provision, where necessary, of clothing as required by the institution to which the patient is sent, and any arrangements for the family to be properly looked after during the absence of father or mother; the securing of auxiliaries for domiciliary treatment which cannot be provided without charitable assistance; recommendations to the London County Council as to the amount of payment, if any, to be made towards institutional treatment and the collection of agreed amounts; advising the Borough Council whether the patients recommended for extra nourishment are in a position to pay for the same and, if not, the extent to which assistance should be given; advising the Borough Council as to the contributions, if any, to be made by patients in respect to the provision of dentures under any arrangement made by the Council for dental treatment. The Annual Report of the Committee is as follows:— The Committee has met 11 times during the year. Seventy-eight cases have been considered—48 new and 30 old cases. Fifty-four cases—44 adults and 10 children—were referred by the London County Council for assessment. Of these, 30 were granted free treatment, and 20 were assessed to pay contributions, varying from 2s. Cd. to 20s. per week, towards the cost of their treatment and maintenance. Two patients made other arrangements for their treatment, one left the district without notice, and one refused treatment. Four cases were re-assessed, owing to changes in financial circumstances. Contributions towards the cost of treatment and maintenance, amounting to £115. 7s. 6d., were collected on behalf of the London County Council in 29 cases—19 adults and 10 children. Twelve of these were still under treatment at the close of the year. Ten Quarterly Progress Reports, on eight children, were received from the London County Council, and the information contained therein conveyed to the parents. One case was transferred to the Care Committee of another Borough. One child was sent away through the London County Council's Contact Scheme. Two others were recommended, but the parents made their own arrangements for sending the children away. Four children were recommended to the Invalid Children's Aid Association for convalescence, and three of them were sent away. Two patients were sent away for convalescence through Stafford's Charity, one through the Charity Organisation Society, and one through the United Services Fund. Five families were referred to the Charity Organisation Society, and received assistance. Four were referred to the United Services Fund, and three were assisted. Two were referred to the Red Cross Emergency Help Fund, one was assisted financially, and the other was helped with an Appeal to the Ministry of Pensions. The Holborn Borough Council assisted with the provision of dentures to one patient, lent bedding to one family, and granted milk to the infant of one tuberculous mother. Five cases were advised and helped in National Health Insurance matters. Various efforts have been made to obtain work and improved housing accommodation— mostly unsuccessfully. In October the Central Fund for the Industrial Welfare of Tuberculous Persons opened their first workshop for unskilled labour—the Spero Firewood Factory. At present there is accommodation for 12 men, and only ex-service men with a disability pension for tuberculosis 80 are eligible for employment in this workshop. Eighty men applied for admission. Four Holborn men were recommended for employment, and of these two were accepted. In September, the following Resolution was unanimously passed by the Committee:— The Holborn Tuberculosis Care Committee considers it urgent that an Open Air Day School should be provided for the delicate children of Central London, and requests the London County Council to try to obtain a site for a permanent Open Air School, either on the Foundling Hospital site, or on the "Bloomsbury Site." The Resolution was forwarded to the Medical Officer, the Education Officer, and the Clerk to the London County Council. Copies were also sent to the Members of Parliament, the London County Council representatives, and the Town Clerks for the Boroughs of Finsbury, Holborn and St. Pancras; also to various associations and individuals interested in the welfare of children. WILFRED H. DAVIES, Chairman. H. M. MATHIESON, Hon. Secretary. Home Nursing for Tuberculous Patients. With the sanction of the Minister of Health arrangements were made for nursing of tuberculous patients by the Metropolitan Nursing Association. The nursing is limited to cases in which there is urgent need of skilled nursing. The service will be most useful both for diagnostic purposes and for nursing patients whose removal to hospital is not practicable or where removal for some reason is necessarily delayed; it will not be allowed to stand in the way of admission to institution. During the year six such cases were nursed, a total of 146 visits being paid to these patients. Dental Clinic for Tuberculous Persons. Arrangements were continued for tuberculous persons referred from the Tuberculosis Dispensary to receive dental treatment as part of the Council's Tuberculosis Dispensary Scheme, at the Clinic of the British Dental Hospital, No. 10, John Street, W.C. In the year 1926, eight new patients were treated. Fillings were carried out in two cases and scaling and gum treatment was given in one. Extractions with general anaesthetic in six cases. One denture was provided. The Clinic is held by the British Dental Hospital at the Council's Maternity Centre, 10, John Street, on Tuesday evenings. Before the tuberculous patients ire admitted the Clinic is open for inhabitants and workers of the neighbourhood. 81 The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1926:— Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1926. Number of sessions held 43 Number of patients' attendances 647 Number of fillings 47 Number of scalings 9 Number of extraction cases Without anæsthetic 2 With local anæsthetic 80 With gas 56 Number of teeth extracted 386 Number of dentures (including repairs) 51 Number of dressing 70 Number of advice 78 Number of denture visits 224 Number of new patients 120 Cancer. During the year 1926, 63 deaths were recorded as due to cancer, equal to a rate of 1.46 per thousand. In the year 1906 the death rate from cancer in the Borough was 1.16; in 1915, 1.41; the decennial average rate was 1.13 for the 10 years 1906-1915, and 1.37 for the 10 years 1916-1925. It will thus be seen that there is apparently an increase in the cancer death rate, and although some part of this increase, if not all, may reasonably be attributed to improved facilities for diagnosis, the figures, nevertheless, indicate the seriousness of and high mortality from malignant diseases. No certain cure has yet been found and the best hope at present is in the direction of early diagnosis and surgical treatment. During the year the distribution was continued of a special leaflet giving information as to the early signs and symptoms of cancer. Arrangements were also continued for this leaflet to be placed in "Please Take One" boxes in the Public Libraries, the Public Health Office, and the underground conveniences for both men and women. A large number of the leaflets were so distributed ana it is hoped that in this way a large part of the day as well as the resident, population was reached. MATERNITY AND CHILD WELFARE. Notification of Births. During the year 330 births were registered as occurring in the Borough. During the same period 311 notifications of births occurring in the Borough were received. Of these 294 were from doctors and midwives, 17 from parents. F 82 From the 294 notifications of birth forms from doctors or midwives, we are able to give the following information as to by whom the mothers were attended at the confinement, etc. : — Private Doctors 84 Private Midwives 46 Out-patient Midwifery Departments of General Hospitals and Institutions: — Externs and others 18 Midwives.—Charing Cross Hospital 19 University College Hospital 41 Middlesex Hospital 24 Royal Free Hospital 12 Other Institutions 13 Training Institution for Midwives, Myddelton Square 37 294 Eighteen notifications related to stillbirths, and one notified the birth of twins. Number of Births. The number of births transferred to the Borough from outying institutions was 223 The number of births transferred from the Borough to other districts was 18 The number of net births belonging to the Borough was 535 There are no Maternity Hospitals or Public Lying-in Institutions in the Borough but maternity cases are admitted to certain nursing homes in the area. Births in Crowded Homes. An analysis has been made of the birth cards in 432 cases where visits were made in connection with the births, to ascertain where the mothers living in crowded houses were confined. The information obtained is given below :— Living in Confined at Home. In Hospital. Percentage of Total Births No. Percentage of Total Births. No. One roomed homes 86 16 64 12 Two „ „ 146 27 65 12 Three „ „ 35 7 22 4 Four „ „ 14 3 - - These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances, 83 In 103 cases visits were not made for the following reasons: — Infants died before visit due 19 Infants died before information of birth received 10 Above the standard for visitation 74 103 Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 85 145 230 Children under 1 year of age 502 1,707 2,209 Children 1 to 2 years of age 6 501 507 Children over 2 years of age 11 712 723 Enquiries re stillbirths 12 „ re ophthalmia neonatorum 12 Other visits 169 In addition 323 visits were made by Student Health Visitors. Four hundred and twenty visits related to infants who came under further observation in their own homes or at Infant Welfare Centres, of these five died before reasonably old enough to attend an Infant Welfare Centre, and 35 removed from the Borough before the age of one month or did not return to the Borough after the birth of the child, leaving 380 infants as possible attendants at a Maternity and Child Welfare Centre; of this number 249 were recorded as attending a Centre, i.e., 66 per cent. The Centres attended were the following: — 192 attended the Council's M. & C. W. Centre at 10, John Street. 23 „ ,, Short's Gardens. 7 attended the Centre at Onslow Street School, Saffron Hill. 1 ,, ,, Charing Cross Hospital. 6 ,, ,, Myddelton Square. 9 ,, ,, Middlesex Hospital. 3 ,, ,, University College Hospital. 5 ,, ,, Royal Free Hospital. 3 ,, ,, Other Centres. 249 attended an Infant Welfare Centre. Thus more than one-half of those visited attended an Infant Welfare Centre, and of these well over four-fifths attended the Council's Centres. F 2 84 Work at Centres. Holborn Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre: Tuesday. Wednesday. Thursday. Friday. Medical Consultation (alternate weeks) 2—5.30 p.m. Ante-natal and Postnatal cases only (alternate weeks) 2—5.30 p.m. Children and Mothers seen at Antenatal Consultation Medical Consultation 2—5.30 p.m. Class 3—5.30 p.m. Dentist, 2—4 p.m. Medical Consultation 2—5.30 p.m. No. of Sessions 26 26 26 52 51 49 52 Total attendances— Children 529 ... 279 1408 19 191 1474 Mothers 113 109 59 189 435 416 243 Average weekly attendances— Children 20 ... 11 27 ... 4 28 Mothers ... 4 4 2 4 9 9 5 St. Giles' Centre, Short's Gardens. The most important development of the Maternity and Child Welfare work in the Borough during the past year was the opening of a Centre at Short's Gardens. For some time prior to 1921 arrangements were in operation for a Maternity and Child Welfare Centre at the premises of the London Medical Mission in Short's Gardens. In consequence of the closing of the Mission and disposal of their premises it became necessary to close this Centre at the end of 1920. Subsequent to that date the Maternity and Child Welfare Committee frequently had under consideration the desirability of other arrangements being made for re-organising a Centre in that part of the Borough, but it was found impracticable to find suitable premises at a reasonable cost. In the year 1924, when the Incorporated Society for Improving the Condition of the Labouring Classes were about to erect dwellings on a site in Short's Gardens, a suggestion was made that accommodation suitable for a Maternity and Child Welfare Centre might be reserved in the new buildings. In response to this suggestion the Society constructed in the forecourt of their new dwellings a one-storey building suitably designed and fitted for the purposes of a Maternity and Child Welfare Centre. The London Medical Mission became the tenants of this building and agreed to sublet the same to the Council two half-days each week for Maternity and Child Welfare purposes. The Minister of Health approved the proposed arrangement and the Branch Centre was opened on Monday, October 4th. As the opening synchronised with the beginning of Health and Baby Week, the opening of the Branch Centre was made the initial feature of the week, and special reference to the opening ceremony is made on page 102 of this Report in connection with Health and Baby Week. 85 The attendances at this Branch Centre during the three months ended 31st December, 1926, were as follows : — Monday Class 2—5.30 p.m. Thursday Medical Consultation 2—5.30 p.m. No. of Sessions 11 13 Total attendances— Children 4 122 Mothers 26 29 Average weekly attendances— Children ... 9 Mothers 2 2 The total number of attendances made by the Health Visitors at the Centres in 1926 was 355. At the Holborn Centre, No. 10, John Street, 5,462 attendances were made by a number of mothers, including 58 expectant mothers, and 507 children, of whom 267 were under one year, 110 between one and two years old, and 130 aged 2-5 years on the date of their first attendance. In addition, 25 persons attended this Centre until the opening of the Short's Gardens Centre when they transferred their attendance to that Centre. At the St. Giles' Centre, Short's Gardens, from the opening on the 4th October to the end of 1926, 181 attendances were made by 23 mothers and 60 children, of whom 29 were under one year, 12 from one to two years and 19 between two and five years. The attention of mothers of bottle fed infants is drawn to the necessity of supplying vitamin C in the diet by the giving of fruit juice daily in suitable quantities; orange or tomato juice is advised as a rule. For some years, both in the home and at the Centres, we have made use of simple leaflets dealing with the hygiene of infancy and maternity, and have hung the walls of the Centres with pictures and mottoes to give point to our teaching and to draw attention to the series of leaflets. At one time leaflets were received with indifference, but in the past year the demand for these has grown remarkably and there are signs that they are much appreciated and have been of real service to those using them. In addition to the health talk, assistance is given in the cutting out of garments; patterns of the most suitable woven garments are given away, also directions for making knitted garments and advice as to the choice of suitable materials. The model garments used for demonstration were overhauled during the year, obsolete types being withdrawn and replaced by modern ones. Three hundred and sixty-nine hanks of wool of a special quality obtained from Wales were sold at cost price to the value of £17. 3s. 6d. The maternity bags have been used during the year by three mothers. 86 A summer outing was arranged to Bricket Wood for about 150 mothers, most of whom carried inants in arms, and between 30 and 40 other children below school age. The cost of the fares of some mothers was defrayed in part from money collected by private subscriptions. Ante-natal Hygiene. During the year, enquiries were made of mothers as to their attendance at an Ante-natal Centre immediately previous to the birth of the child visited. Of 420 mothers, about whom information was obtained, 199 (47 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under: — Number of enquiries made 420 Centre Attended— Holborn Centre, 10, John Street 25 Royal Free Hospital 31 Middlesex Hospital 25 Charing Cross Hospital 19 University College Hospital 23 Myddelton Square Institution 20 St. Bartholomew's Hospital 26 City of London Hospital 10 Queen Charlotte's Hospital 6 Other Centres 9 Ante-natal care from private doctor 5 199 The following is a summary of the numbers of expectant mothers attending the ante-natal clinic, 10, John Street, found to have defects either due to or especially of concern in view of their pregnancy, during the year 1926: — No. of Women attending Ante-natal Clinic 61 No. of Ante-natal cases 58 No. of attendances made by ante-natal cases 99 Attending after confinement 3 No. of attendances made by post-natal cases 6 Expectant Mothers for first time 13 Defects, especially connected with pregnancy— Venereal disease 1 Deformed pelvis 1 Threatened miscarriage 1 Excessive vomiting 4 (Edema 1 Varicose veins 12 Excessive vaginal discharge 3 Albuminuria (slight) 2 Pendulous abdomen 3 Retroverted gravid uterus 1 Other defects 1 87 Other defects— Pulmonary tuberculosis 1 Heart disease 10 Anæmia 8 Respiratory diseases 1 Constipation 20 Dental caries 22 Sleeplessness 2 Dyspepsia 17 Pyorrhœa 8 Enlarged thyroid ... 1 Exophthalmic goitre 1 Other defects 2 No. referred to Maternity Hospitals 18 Normal 10 Abnormal ... 8 No. referred to Dental Clinic 21 No. of urine tests made 54 No. of Wassermann tests made 5 Ante-natal 2 Post-natal 3 The urine of one woman showed a cloud of albumin. Dietetic advice was afforded and arrangements made for her confinement to take place in a hospital. In one other case there was a faint trace only. In connection with the 3 post-natal cases attending the Ante-natal Clinic, the defects noted were: heart disease 1; venereal disease 1; and dyspepsia 1. Maternal and Infant Consultations. The following summary refers to maternal and infant consultations at 10, John Street and the Short's Gardens Centres during the year 1926 :— Reasons for Attendance. John Street. Short's Gardens. Mothers— Healthy 3 14 Difficulty with breast feeding 31 — Generative organs 10 2 Dental caries 54 3 Heart disease 2 1 Debility 19 — Anæmia 13 — Venereal disease 2 — Respiratory disease 7 1 Digestive disorders 11 — Other disorders 38 2 88 ChildRen— Healthy 169 34 Congenital syphilis 3 — Alimentary disorders 68 12 Rickets 37 2 Debility 10 — Respiratory diseases 41 8 Hernia, umbilical 17 — do. inguinal 1 1 Phimosis 23 1 Rash 7 2 Disease of eye 10 — Disease of ear ... 7 — Disease of nose and throat ... 23 1 Other diseases 91 In this table the more important ailment only has been recorded in each case. Artificial Sunlight. Eleven children were recommended to attend the artificial sunlight treatment centre in Tufton Street, Westminster, afterwards removed to Ranelagh Road, Pimlico. One had two courses of treatment with an improvement in general health. Three had a course of two to three months' treatment with definite improvement. One had a course of three weeks with no improvement. Four attended once, but found the treatment would be too costly and too far away for them to continue. Two did not attend at all. Mothers and children attending the Municipal Centres were referred to other departments for assistance during the year 1926 as follows:— Referred to. Mothers. Children. Dental Clinic 57 18 Hospitals 13 35 Metropolitan Nursing Association 16 2 Assisted Milk 23 38 Convalescent Homes 2 14 Ante-natal Clinic — — Private doctor — — Tuberculosis Dispensary 1 — Relieving Officer — 1 Minor Ailments Clinic 28 101 Light Treatment — 11 140 220 89 The following summary gives particulars of mothers referred for breast massage in 1926: — Number referred to Metropolitan Nursing Association 16 Results— Lactation completely restored 7 Breast secretion re-established, but small bottle feeds required in addition to breast feeding 3 Massage quite unsuccessful 5 Child died (æt. 20 days) 1 Diarrhœa. During the year the cases of diarrhœa occurring in children attending the Council's Centres were as follows: — 10, John Street. Short's Gardens. 1. Simple diarrhœa 28 cases 6 cases. 2. Ordinary summer diarrhœa none none. Stillbirths. During 1926 there were 18 stillbirths in the district. Difficult labour was responsible for 4 of these; of these 1 was due to contracted pelvis; in the remaining 3 enquiry did not elicit the determining factor. Of the other 14, accidental hæmorrhage was the most likely cause of 1; prematurity 1; in 7 cases the parent was unable to give any information which could be used in assigning a probable cause; suffocation due to breech presentation 3; in the remaining 2 no information could be obtained. Six of the 18 stillbirths occurred in the private practice of a doctor; 4 in the extern practice of an institution; 7 in an institution and 1 in the practice of a midwife. Illegitimate Births. The following table gives a summary of the information obtained as a result of enquiries respecting the circumstances of illegitimate babies in the year 1926 : Number of illegitimate births registered 46 Number respecting which enquiries were, made for further information 42* Lived with mothers who remained in parents' home 4 Lived with mothers who went out to work 1 Boarded out with foster mothers ... 4 Lived in Institution ... 4 Lived with both parents who lived together permanently 6 Died in early infancy ... 6 Stillborn 1 No information (gone away, etc.) ... 16 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 79, viz., 38 women and 41 children; the number of attendances 528 (women 378, children 150). *Four were above standard for enquiry. 90 Assistance with Dentures, etc. Extractions with local anæsthetic were made in 23 cases (21 women and 2 children), and with general anæesthetic in 72 cases, including 32 children. Scalings were carried out in 76 cases (all women). Small fillings were provided in 155 cases, including 59 children, and root fillings in 11 cases (mothers). Dentures were provided for 19 patients, 4 were required to pay the whole cost, 13 contributed towards the cost, and in the remaining 2 cases where the patients were very poor the dentures were provided free. In 2 cases dentures were remodelled; 1 was repaired and dressings were given in 29 cases. In the provision of dentures the cost is based on the charge approved for the time being for dentists on the Ministry of Pensions Panel. Supply of Milk and Food for Expectant and Nursing Mothers and for Infants. The supply of milk and food at less than coot price was continued during the year under the Maternity and Child Welfare Act, 1918, for: — (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. Scale of Necessity. The approved scale of necessity adopted by the Council on the 14th October, 1921, continued in force during the year 1926. 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. During the year 233 applicants received free or assisted milk under the Scheme. This number included 121 who were receiving such assistance at the end of the year 1925. Grants were made in 112 new cases. At the end of the year 1926, 120 cases were receiving assistance, viz., free milk 92, milk at halfprice 19. Prepared milk free 6. half-price 3. The following table shows new cases assisted in 1926: Milk. Free. Part Cost. Free, Part Cost. Expectant Mothers 11 — — — Nursing Mothers 33 1 — — Children 39 6 15 7 91 Home Help. The Council's Home Help attended 25 cases during the year in comparison with 29 in the year l925. In 10 of these the whole-time officer attended entirely and in 6 she attended during the earlier part of the lying-in period, being replaced later by one of the Home Helps from the emergency panel in order to take over new cases. In 9 cases emergency Home Helps only were employed. The latter were engaged when more than one case occurred at the same time and during the summer vacation leave. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In 5 cases of extreme necessity the services of the Home Help were granted free. In all other cases the applicants were required to contribute towards the cost, contributions ranging from 20s. to 2s. 6d. per week. The services of the Home Help have been much appreciated; it has been found that the Council's provision meets a much felt want in the Borough. Convalescent Homes. Two applications for convalescent home treatment for mothers and their babies were granted in comparison with 7 in the previous year. The smallness of the number was due to the difficulty in obtaining suitable accommodation for mothers and babies. In the 2 cases sent away small contributions towards the cost were required. Thirteen applications were granted for convalescent home treatment for children. In 1 case the application was subsequently withdrawn. Twelve children were sent away in comparison with 15 in 1925. Six of these were sent to the Marjorie Lumley or the Arkley Convalescent Homes where the Council reserved a bed, and 6 were admitted to the Hopedene Convalescent Home at Barnet, by the kind co-operation of Sister Hope of the West London Mission, Kingsway. In 2 eases the children were sent away free, and in 10 contributions were required towards the cost. In addition to these, 2 other applications were referred to the Poor Law Authorities for admission to a convalescent home of the Metropolitan Asylums Board, and 1 was referred to the Church Army. Visitors to Centre. Being centrally situated in London, during last year, as in previous years, we have been able to welcome a considerable number of visitors, both from the country and abroad, at the Municipal Centre, No. 10, John Street. Saffron Hill Maternity and Child Welfare Centre. Consultations in connection with this Voluntary Centre are held at the St. Winifred Club, St. Peter's School, Onslow Street, Saffron Hill. During the year ended 31st March, 1926, 413 infants and children under 5 attended the consultations, 121 of the total number coming from the Holborn Borough Extra food and nourishment was provided, also convalescent treatment at Homes; classes and lectures on health, care of the home, food economy and kindred subjects were held. The Chairman and Honorary Secretary is Miss Mary Canney, 75, Lamb's Conduit Street. 92 Deaths of Infants under One Year of Age, 1926. The homes were visited in a large proportion of the infant deaths, and any requisite information obtained, and when required, suitable advice given. The cause and age of 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 9-12Months Total under 1 Year M F M F M F M F M F Both sexes M F M F M F M F M F Both sexes Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 3 Tuberculous Disease (non-pulmonarv) ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... 2 Pneumonia (all forms) ... ... ... ... ... 2 ... ... ... 2 2 2 ... 1 ... ... ... ... 1 3 3 6 Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Enteritis ... ... ... ... ... ... ... ... ... ... ... 2 5 1 ... ... 1 ... 8 1 9 Syphilis ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... .. ... ... 1 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Births 6 5 ... 2 ... ... ... ... 6 7 13 ... ... ... ... ... 1 1 ... 7 8 15 Atrophy, Debility, Marasmus ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 2 Other causes 2 2 1 ... ... 1 ... ... 3 3 6 l ... ... 1 ... ... ... 1 4 5 9 Totals Total both sexes 8 7 1 3 0 3 0 0 9 13 22 8 0 7 2 0 3 3 3 27 21 48 15 4 3 0 22 8 9 3 6 48 Net births registered during the calendar year. Net deaths registered during the calendar year. Males Females Both sexes Males Females Both sexes Legitimate Infants 251 238 489 Legitimate Infants 25 14 39 Illegitimate Infants 25 21 46 Illegitimate Infants 2 7 9 93 Deaths of Children 1 to 5 Years, 1926. Twenty-three children between the ages 1 to 5 years died from the following causes:— Cause of Death. Ages. Tota1 1—5 1—2 2—3 3-4 4—5 M. F. M. F M. F. M. F.. M. F. Both Sexes. Measles 1 1 ... 1 ... ... ... ... 1 2 3 Whooping Cough ... ... ... ... ... ... 1 ... 1 ... 1 Diphtheria ... 1 2 ... ... ... ... ... 2 1 3 Tuberculosis (non-pulmonary) ... ... 1 ... ... 1 ... ... 1 l 2 Meningococcal Meningitis 1 ... ... ... ... ... ... ... 1 ... 1 Pneumonia 4 2 ... ... 1 ... ... ... 5 2 7 Bronchitis ... 1 ... ... ... ... ... ... 1 1 Diarrhœa 2 ... ... ... ... ... ... 2 ... 2 Other Causes 2 1 ... ... ... ... ... 2 1 3 Totals 10 6 3 1 1 1 1 1 15 8 23 Totals—Both Sexes 16 4 2 1 23 Infectious Diseases among Mothers and Children. Puerperal Fever. Three cases of puerperal fever and one case of puerperal pyrexia were notified in 1926. Two patients died. In the first case the disease followed the birth of the child in a women's hospital; the patient made a good recovery. The second case, which terminated fatally, was a married woman who had had seven previous pregnancies. The confinement took place at home, the patient's husband only being present. A doctor and a "handy woman" were afterwards sent for. The patient was removed to a Poor Law Hospital, where she died four clays after admission. The Medical Superintendent of the hospital to which the patient was removed expressed the view that the disease arose from septic absorption after miscarriage and retained placenta. The third case, puerperal pyrexia, was notified in November and followed the birth of a first child. The confinement took place in a Lying-in Hospital; instruments were used, the patient made good recovery. The fourth case, notified after correspondence, terminated fatally; death occurred in a women's hospital to which the patient, a visitor newly landed from Australia, had been removed from furnished apartments. The result of the inquest held on this patient was a verdict of death due to procured abortion. 94 Puerperal Fever and Puerperal Pyrexia Regulations, 1926. These Regulations, which came into operation on the 1st October, 1920, prescribed new forms for the notification of puerperal fever and required the notification of cases of puerperal pyrexia, in addition to the present notification of puerperal fever, thus placing an obligation upon medical practitioners to notify all cases of pyrexia during the puerperium irrespective of the cause to which the fever may be attributed. In a circular, dated the 9th August, 1926, issued from the Ministry of Health to Local Sanitary Authorities, it was pointed out that if this more complete fication was to have practical value it should be supplemented by the provision, when necessary, of facilities for assistance in diagnosis and for the treatment of patients who are not able to secure adequate treatment for themselves. In conformity with the suggestions of the Ministry, the Council made ments for the following facilities to be available: — (a) Consultations with an obstetric specialist in connection with diagnosis of suspected cases of puerperal fever or puerperal pyrexia. (B) The nursing of cases of puerperal pyrexia. (c) Bacteriological examinations in suspected cases of puerperal fever and puerperal pyrexia. Appropriate contributions towards the cost of such services are to be asked for in cases where the patient or her relatives are in a position to contribute. Notice was given to medical practitioners residing or practising in the Borough of the duties imposed on them by the Regulations. A supply of notification forms was also sent to them and information of the facilities provided for consultations, nursing and bacteriological examinations. Ophthalmia Neonatorum. During the year 12 cases of ophthalmia neonatorum were brought to our notice, 6 of which were notified in pursuance of the Public Health (Ophthalmia Neonatorum) Regulations, 1914; 2 of the notifications were from doctors in private practice and 4 from the Medical Officers of institutions. Three of these tions were received as the result of correspondence, after the existence of the cases had been brought to our notice. In 6 cases notifications in accordance with the Regulations were not received. of these, 3 were discovered by Health Visitors, 1 was ascertained from the death returns, and information respecting the other 2 came from the London County Council and the Metropolitan Asylums Board respectively. 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, 95 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 23 days 8 days Doctor Moderate Home Doctor and District Nurse Cured Doctor 2 15 days 2 days Doctor (Hospital) Slight Home and out-patient University College Hospital Midwife and out-patient treatment University College Hospital Cured Extern Department Hospital 5 22 days 7 days Doctor (Hospital) Not seen Maternity Ward, St. Stephen's Hospital and St. Margaret's Hospital In-patient, Hospital treatment Cured Not notified Information of child's existence obtained from a Social Worker 8 6 days Not ascertainable Doctor Not seen St. Margaret's Hospital Doctor and in-patient Hospital treatment Not seen Doctor Did not return to this Borough. Address could not be ascertained 10 3 ½ months 8 days Doctor (Hospital) Slight Maternity Ward, University College Hospital and Home In-patient and later out-patient treatment University College Hospital Cured Intern Department University College Hospital 12 20 days (about) - Doctor (Hospital) Not seen St. Margaret's Hospital In-patient, Hospital treatment Cured Not notified in Holborn Child found abandoned on a stairway in Holborn and taken to Poor Law Institution 96 Six 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 by. Remarks. 3 Died 14 days previously Not ascertainable. Death returns Not seen St. Margaret's Hospital In-patient, Hospital treatment Died, aged 11 days. Cause of death— congenital syphilis and gonorrhealoph thalmia Not notified in Holborn Not known at address given 4 13 days 12 days Health Visitor Very slight Home and Central London Ophthalmic Hospital Out-patient, Hospital treatment Cured Midwife 6 12 days 1 day Health Visitor Slight Home and Infant Welfare Centre Midwife and Minor Ailments Clinic, Maternity and Child Welfare Centre, 10, John Street Cured Extern Department Hospital 7 13 days 7 days Metropolitan Asylums Board Not seen St. Margaret's Hospital In-patient, Hospital treatment Cured Not born in London 9 14 days 10 days London County Council Slight Maternity Ward. Hospital and Home In-patient, and later outpatient, Hospital treatment Cured Extern Department Hospital 11 17 days 1 day Health Visitor Moderate Hospital and Home Maternity Ward, Hospital Cured Extern Department Hospital 97 Ophthalmia neonatorum is one of the most important- causes of blindness Fortunately, however, as far as we have been able to ascertain, no case coming to our knowledge last year in the Borough suffered permanent injury in this way. One child died in hospital when 11 days old. In one case reliable information could not be obtained because the mother of the infant did not return to this Borough, but in the remaining ten cases there was definite evidence that the patients were cured. This result was secured by the expenditure of much time and energy, and incidentally money, by all concerned; the occurrence of most, if not all, of the cases could have been prevented by a simple procedure. A year or so ago the Scottish Board of Health issued a circular to medical practitioners strongly recommending the installation of silver nitrate solution into the eyes of newly-bom children, and intimating that they will in future require a report with particulars of treatment from Medical Officers of Health in all cases in which there occurs loss of vision. In this country the installation has been recommended with fortunate results by at least several Medical Officers of Health to those attending childbirths in their areas, but legislation in some form advocating or requiring its adoption generally is required so that the whole country may benefit. Whooping Cough. Visits were paid to 145 persons suffering from whooping cough. Of these, 96 were notified by doctors; in 18 others the information was derived from the schools; 17 from the Health Visitors; 5 from parents; 7 from M.A.B.; and 2 from an Infant Welfare Centre. One died, between 1 year and 5 years. Age. Fifteen were children under 1 year, seventy-two were aged 1 to 5 years, and forty-eight 5 to 16 years. Contacts. (145 enquiries.) Thirty-four had no contacts; 111 had contacts. The number of contacts was 301, of whom 123 were susceptible, 178 already having suffered from an attack. No. of cases 29 35 12 8 9 2 3 7 and No. of contacts 1 2 3 4 5 6 7 8 No. of cases 44 14 3 1 2 2 0 2 and No. of susceptible contacts 1 2 3 4 5 6 7 8 Spread of Infection in Family. The 145 cases occurred in 112 families. In 80 families 1 case occurred; in 22 families 2 cases occurred, and in 7 families 3 cases occurred. G 98 Removal. Thirty-two children were removed to hospital, approximately 22.0 per cent. as opposed to 33 per cent. last year. Thirty-one were admitted to hospitals of the M.A.B., 1 to the Holborn and Finsbury Hospital. Spread of Infection. There is much difficulty in getting parents to realise that the child of preschool age must be sheltered from the risk of infection as much as the child attending school. Parents realise that the school child is a potential focus of infection for many other children, and should be guarded from infection; they fail to realise that the pre-school child, although less likely to spread the disease, is less able to resist the dangers of an attack; many parents state candidly that they send children with whooping cough into the squares and streets during school hours, when " there are no other children about." Measles. The notification of measles was discontinued at the end of 1919, but during 1923, I received information of 436 cases of measles. Of these 203 were notified by school teachers, 36 by medical practitioners, information of 40 was given by the Metropolitan Asylums Board, of 91 by the Health Visitors, 30 by parents, and 36 by the L.C.C. District Officer. Ages. 9 were under 1 year 192 were between 1 and 5 years. 216 were between 5 and 16 years. 19 were over 16. Contacts. One hundred and fifty-two had no contacts, the L.C.C. definition of a contact being used. Two hundred and fifty-four had contacts. The number of contacts was 652, of whom 342 were susceptible, 310 having already suffered from an attack. No. of cases 91 74 44 16 i 11 13 6 9 and No. of contacts 1 2 3 4 5 6 7 8 or more No. of cases 101 44 20 5 4 1 1 5 and No. of susceptible 1 2 3 4 5 6 7 8 or more contacts Spread in Family. The 436 cases occurred in 336 families. In 259 families 1 case occurred, in 56 families 2 cases occurred, in 19 families 3 cases occurred, and in 2 families 4 pases occurred, 99 Removals. In all about 14 per cent. of the patients were removed to institutions. 37 were removed to a M.A.B. Hospital. 10 ,, ,, ,, the Holborn and Finsbury Hospital. 14 ,, ,, ,, the London Fever Hospital. Home Nursing. Sixteen cases of measles were referred to the Metropolitan Nursing Association for home nursing under the Council's arrangements, 164 visits being paid. German Measles. During the year information was received relating to 20 cases; 1 was notified by a doctor and information of 9 cases was received from schools, 4 from the M.A.B., 1 from the Health Visitor, 2 from parents, 2 from a divisional surgeon of police, and 1 from an Infant Welfare Centre. Ages. 1 was under 1 year. 6 were between 1 and 5 years. 10 were between 5 and 16 years. 3 were adults. Contacts. The number of contacts was 43, of whom 25 were susceptible, 18 having already suffered from an attack: 6 had no contacts. No. of cases and No. of contacts 0 8 3 2 0 0 0 0 0 1 1 2 3 4 5 6 7 8 9 10 No. of cases and No. of susceptible contacts 6 3 1 0 0 0 0 0 0 1 1 2 3 4 5 6 7 8 9 10 Spread in Family. The 20 cases occurred in 14 families. In 9 families 1 case occurred, in 4 families 2 cases occurred, in 1 family 3 cases. Removals. About 20 per cent, of the cases were removed to institutions— 3 to the London Fever Hospital. 2 to M.A.13. Hospitals. Epidemic Diarrhoea. This disease is notifiable in only a few districts in London, and is not notifiable in Holborn. G 2 100 The number of deaths of young children under two years of age classified under the head, Diarrhœa and Enteritis, was 12, of whom 10 were under 1 year. The deaths were equal to a rate of 22.43 per 1,000 births in comparison with 11.8 for all London. The methods used to deal with the disease have been detailed in a previous report; the most important perhaps is that during the third quarter of the year extra visits are paid to those homes in which epidemic diarrhoea is more likely to occur. Nursing Arrangements. Nursing arrangements have been made with the Metropolitan Nursing Association of 31, Bedford Place, W.C. 1, for the nursing, when required, of necessitous cases of measles, whooping cough, ophthalmia neonatorum, epidemic diarrhoea, pneumonia, encephalitis lethargica, tuberculosis, maternity (including complications after confinements), puerperal fever and puerperal pyrexia. In cases of tuberculosis nursing is restricted to patients recommended for such services by the Tuberculosis Officer. Nursing in necessitous maternity cases is subject to the prior approval of the Maternity and Child Welfare Assistance Sub-Committee. In these cases and those relating to puerperal fever and puerperal pyrexia, it is expected that the patients or their relatives will contribute towards the cost in accordance with their means The services of the nurses were used as follows in 1926: — Deficient Lactation 20 Cases 225 Visits. Measles 16 „ 164 „ Ophthalmia Neonatorum 2 „ 83 „ Pneumonia 1 Case 3 „ Influenza 3 Cases 26 „ Tuberculosis 6 „ 146 „ Total 48 Cases 647 Visits. Widows', Orphans' and Old Age Contributory Pensions Act, 1925. This Act, passed in 1925, imposed certain limited duties on Local Authorities respecting cases where, in the interests of a child, a pension payable under the Act should be administered other than through the mother. The Local Authority in London for this purpose was the London County Council, but authority was conferred on that Council to delegate the powers and duties to the Metropolitan Borough Councils, and shortly after the Act came into operation, the London County Council delegated the whole of the powers and duties conferred on it by Section 6 of the Act to the Borough Council. The duty includes enquiry to ascertain the facts of any cases which may have to be dealt with, and ordinarily the widow or other person affected will be given an opportunity of presenting her case to the Local Authority before the particulars are submitted to the Minister of Health. No such case was referred to the Council during the year. 101 Health and Baby Week, 1926. Health and Baby Week was observed in the Borough from the 3rd to the 9th October. The arrangements made included the following: — Co-operation with Clergy. 1. A request was made to the Clergy of all denominations in the Borough to make special reference to the subject in the course of their Services on Health Sunday, October 3rd, and to co-operate by the distribution of literature to the members of their congregations. Replies were received promising co-operation from: — The Revd. Henry Ross, St. Albans. The Revd. Wilfred H. Davies, M.A., St. Giles-in-the-Fields. The Revd. E. C. Bedford, St. Andrew's. The Revd. W. S. Macgowan, Holy Trinity, Kingsway. The Revd. S. E. Jarvis, St. Etheldreda. The Revd. G. F. Haines, St. Peter's. Sister H. Camillus, St. Cecilia. The Revd. E. E. Baker, Wild Street (Baptist). Distribution of Leaflets by Retail Tradesmen. "2. Requests were issued to retail traders to co-operate by the distribution of literature from their counters during Health Week and the exhibition of posters. About 60 traders expressed their willingness to co-operate and in this way upwards of 20,000 leaflets were distributed. The leaflets used were:— "Save your Children from Diphtheria" (a four-paged leaflet on diphtheria immunisation); "Deafness" (a leaflet produced by the Middlesex Hospital Press); "London's Health"; "Sleep" (a leaflet used by arrangement with the National Baby Week Council); "Care of Milk in the Home" ; "Don't Spit" (a leaflet produced by the Health and Cleanliness Council); and " Our Daily Bread." Exhibition of Posters. 3. Arrangements were made for the exhibition of posters in shops, on advertising stations and by means of sandwich men. Six men were employed for five days in the week parading the main thoroughfares in the Borough. Posters were also displayed on the Council's buildings and water carts, and, with the co-operation of Messrs. W. Clarkson & Son, Ltd., on the dust carts and lorries and street refuse carts. The posters used included:— An illustrated poster on immunisation against diphtheria; one respecting the use of milk for children; a third dealing with the preservation of open spaces; and a fourth, specially displayed in the schools in the Borough, respecting cleanliness (this was produced by the Health and Cleanliness Council). 102 Opening of New Maternity and Child Welfare Centre. 4. Arrangements were made for the work at the new Maternity and Child Welfare Centre in Short's Gardens to commence on Monday, the 4th October. More than a hundred mothers attended at the opening when the Chairman of the Maternity and Child Welfare Committee (Councillor The Revd. Henry Ross) gave an informal address, and the Vice-Chairman (Councillor Lady Smith, J.P.), entertained the mothers to tea. Town Planning Conference. 5. On Wednesday, the 6th October, a Conference was held in the Court Room at the Town Hall on Town Planning for London and Greater London. In the absence of the Mayor, Councillor Charles Fitzroy Doll, J.P., presided; the speakers included:—Sir H. E. Bruce Bruce-Porter, Mr. Harold Swann (Chairman of the Town Planning Committee of the London County Council), Dr. R. King Brown (Medical Officer of Health of Bermondsey), Dr. S. J. C. Holden (Medical Officer of Health, Bucks County), Alderman Culpin, L.C.C., Capt. R. L. Reiss (Garden Cities' Association), and Mr. E. J. Elford (Borough Surveyor, Wandsworth). The Conference was attended by representatives of a number of Metropolitan and Greater London Local Authorities. Meeting for Mothers. 6. On Thursday, the 7th October, a special meeting for mothers attending the Maternity Centre at No. 10, John Street was held. Lady Islington presided and addresses of an educational character were given by Dr. Hugh Thursfield, Physician, Great Ormond Street Hospital for Sick Children, Dr. Letitia Fairfield, C.B.E., Divisional Medical Officer, L.C.C. (a resident of the Borough), and Dr. J. Fenton, M.O.H., Kensington. A large number of mothers were present and were subsequently entertained to tea. Co-operation with Schools. 7. Arrangements were made for the distribution through the schools of leaflets respecting the facilities offered by the Council for immunisation against diphtheria. The schools also co-operated, as in previous years, by arranging for health lessons to be given and for a series of health questions to be submitted to the children at the close of the week. The questions were prepared in the Public Health Department; the best three sets of answers in each school department were selected by the Head Teachers for examination in the Public Health Office, two prizes being awarded to each school, one for boys and one for girls. The Mayor and Mayoress kindly entertained to tea the prize-winners and the two next best examinees from each department. 103 8. Messrs. George Kent, Limited, again placed one of their windows at the disposal of the Committee for the exhibition of health pictures by means of an attractascope. The following is a copy of the questions submitted to the children in the schools:— Section A. (All four questions to be answered). (Put the number of each question before the answer). 1. Why must homes be kept clean? Mention the most important things to be done to keep the home and yard or garden clean. 2. Where and in what ways is it best to spend your free time out of school? Give reasons for your answer. 3. Describe your favourite game, say why you like it, and what good it does your mind and body. 4. At what time ought school children to go to bed when they are 6 years old, 10 years old, 13 years old? In the morning, before going to school, you should get up in good time. Give the reasons why. Section B. (Any two of the following questions to be answered). (Put the number of each question answered before the answer.) 5. Say what you know about the way in which the Public Health is looked after in Holborn. Mention what is done to lessen the spread of measles and diphtheria. 6. Explain the value of fresh air and exercise, and state how we can get these when living in a crowded city. 7. Why is it wrong to cat between meals? Why should we eat plenty of raw fruits, salad and green vegetables? When should fruit and sweets be eaten? 8. Why is it important to have clean food? If you are sent to fetch (a) a pint of milk, (b) a loaf of bread, how should you carry them through the streets, and how should they be taken care of at home? 9. Why is alcohol harmful to children? What are the best things for them to drink? 10. Give the reasons why rooms must be ventilated. What is the best way to do it? 11. Why is it important to breathe through the nose? Mention the causes of mouth breathing, and state how you can prevent it. 104 Minor Ailments clinic Arrangements were continued at the Municipal Child Welfare Centre, 10, John Street, for the treatment of minor ailments in children up to 5 years of age. The Clinic opened on the 12th April, 1925; it has been held every Tuesday and Friday afternoon to deal with such minor ailments as ringworm, impetigo, scabies, intertrigo, sores, cuts, grazes, burns, blepharitis, conjunctivis, ear discharge, etc. The Clinic is under the supervision of the Medical Officer of the Maternity and Child Welfare Centre and a qualified nurse is in attendance. 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) Homoepathic 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. 105 Medical Examination of School Children—Routine Inspections—Elementary Schools in Holborn, 1926. Age, Group. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Condition of Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more d ecayed. 6/6 in both eyes. 6 9 in either eye. 6/12 or worse in either eye. Entrants— Boys 292 184 9 1 9 41 237 14 265 25 2 291 1 ... 190 70 32 ... ... ... Girls 250 153 93 4 35 201 14 210 26 14 247 3 ... 150 77 23 ... ... ... Age 8— Boys 127 41 83 3 28 78 21 113 13 1 122 3 2 87 34 6 84 21 20 Girls 160 50 105 5 25 114 21 116 38 6 158 1| 1 96 60 4 105 27 19 Age 12— Boys 221 54 148 19 40 157 24 208 11 2 217 4 ... 175 43 3 155 23 42 Girls 210 53 149 8 43 149 18 151 48 11 208 2 ... 164 46 ... 137 25 48 Age 14— Boys 203 45 146 12 36 155 13 186 17 198 4 1 160 43 ... 145 18 39 Girls 228 59 161 8 58 164 6 175 41 12 228 ... ... 183 45 ... 163 16 49 Total 1.091 639 984 68 306 1,255 130 1,424 219 48 1,669 18 4 1,205 418 68 788 130 217 Holborn % 37.8 58.S 4.0 18.1 74.2 7.7 84.2 13.0 2.8 98.7 1.1 0.2 71.3 24.7 4.0 9.4 11.5 19.1 London % ... 60.2 38.5 1.3 21.4 72.8 65.8 92.5 6.9 0.6 96.0 3.9 0.1 64.2 28.5 7.3 54.7 25.5 19.8 106 Defects Found At Medical, Inspection, Holborn Elementary Schools, 1926. Defect. Boys. Girls. Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number Examined 292 127 221 203 250 160 210 228 Cases + Cases + Cases + Cases + Cases + Cases + Cases + Cases + Malnutrition — — 1 1 — — — — — — 1 1 — — — — Skin Disease 2 1 3 2 — — — — 2 2 — — — — 1 1 Enlarged Tonsils 15 2 6 2 3 2 3 3 15 6 13 3 8 7 4 4 Adenoids 3 3 1 1 — — — 1 1 — — 2 2 1 I Tonsils and Adenoids . 17 16 3 8 5 5 2 2 11 10 4 4 7 7 1 1 Other Nose and Threat — — — — 1 1 — — 3 1 1 1 — — — — Enlarged Glands — — — — — — — — — — — — — — — — External Eye Disease 8 5 3 3 3 2 — — 5 4 2 1 4 1 6 4 Vision for treatment — — — 12 — 35 — 22 — — — 12 — 38 — 29 Otorrhœa 6 4 1 1 2 2 1 1 3 1 1 1 2 2 1 1 Other Ear Disease 1 1 — — — — — — — — — — 2 1 1 1 Hearing 1 1 — — — — 2 2 1 1 — — 2 2 — — Speech defects — — — — 1 1 — — — — — — — — — — Heart 2 — 1 — 1 — 2 — 2 — 3 — 10 1 7 — Araemia 8 4 2 1 2 — 1 — 2 — 1 — 2 1 — — Lung Disease (excl. TB. 4 1 2 — 1 — 2 — 2 — 1 1 — — — — Nervous Disorders — — 1 — — — — — — — — — — — — — Phthisis ... — — — — 1 — — — — — — — — — — — Other Tblr. Disease — — — — — — — — — — — — — — — — Rickets 1 1 — — — — — — — — — — — — — — Spinal Deformities — — — — 2 1 4 2 1 1 4 1 3 1 1 — Other Deformities 1 — — — — — — — — — — — — — — 1 Teeth (treatment cases) — 75 — 31 — 31 — 34 — 73 — 52 — 40 — 35 Other Defects — — — — 2 2 2 2 — — 1 1 1 1 — — Number of Children noted for treatment 105 45 65 58 87 71 85 75 + = Cases referred for treatment. 107 Deaths of Children 5-15 years, 1926. Ages. Total. 5 6 7 8 9 10 11 12 13 14 Both Sexes. M F M F M F m F M F M F M F M F M F M F M F Diphtheria ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... .. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Meningoccal Meningitis ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Violence ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 Tuberculous Disease (non-pulmonary) ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Heart Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Total ... ... 4 ... 1 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 7 4 11 Total both sexes ... 4 3 2 ... ... ... ... ... 2 11 108 SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street During the year 40 bodies were deposited. There were 34 post mortem examinations made, and 33 inquests held. The inquests are held in the Court Room at the Town Hall. On 5 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes; 34 bodies were brought in by order of the Coroner, and 1 by the Police. Inquests. During the year 50 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, 22; Accidents, 10; Suicide, 11; Misadventure, 5: Drowning, 1; Homicide, 1. Revenue Acts. No application was received under these Acts. Dirty Tenants. From time to time complaints are received from owners respecting the difficulties experienced by them in keeping their property up to the standard required by local authorities owing to the dirty and destructive habits of tenants. It is repeatedly alleged that through carelessness or wilful damage by tenants repairs and cleansing become necessary with unreasonable frequency and that it is impossible to maintain even the minimum requirements of the local authorities without financial loss. These statements have sometimes been found to be well-founded, particularly in the poorer class tenement lodging houses where no responsible keeper or landlord is resident. In order to prevent or minimise difficulties of the owner we endeavour, as much as possible, to keep in view the considerable powers which the Council has of holding the tenant responsible for defects caused by his neglect or default. During the year the Inspectors have reported a number of cases where dirty conditions of tenements were clearly the fault of the tenants. In these cases the necessary action has been taken to secure the abatement of the nuisance by the tenants. The Removal of Aged, Infirm and Diseased Persons. Difficulty from time to time arises in connection with aged, infirm or physically incapacitated persons living alone, usually in single rooms. Many of these have nobody to look after them and gradually become feebler, eventually being unable to look after themselves or their homes properly and yet they are most unwilling to enter a Poor Law Institution. 109 At present persuasion is used, but the condition persists for a considerable time. It is difficult to suggest any solution of the problem other than the granting to local authorities of powers to compel removal to suitable institutions. The principle of such compulsory power has been established by the Bradford Corporation Act, 1025. Under this Act a Court of Summary Jurisdiction may, on the application of the Medical Officer of Health, issue an order for the removal of any aged, infirm or physically incapacitated person where it is shown that, in the public interest or in the interest of the person concerned, such removal is necessary. During the year the views of the Council were asked as to the desirability of similar provision being incorporated in the next London County Council (General Powers) Act, and the Council, on the recommendation of the Public Health Committee, adopted a resolution approving in principle that Metropolitan Boroughs and City Councils should be granted powers to obtain the removal of infirm and diseased persons in certain cases and also approving a request to the London County Council to insert such provision in their next Genpral Powers Bill. Rent and Mortgage Interest Restrictions Acts. On the application of tenants two certificates were issued under the above Acts that houses complained of were not in all respects reasonably fit for human habitation or were otherwise not in a reasonable state of repair. Two applications were refused. Nuisances Caused by Dogs. With a view to the prevention of nuisances from the fouling of footways by dogs the Council made the following by-law:— " No person being in charge of a dog in any street or public place and " having the dog on a lead shall allow or permit such dog to deposit its " excrement upon the public footway." The by-law is to remain in force until the 1st June, 1928. Choked Water Closets Nuisances frequently arise, particularly in tenement houses, due to the misuse of water closets resulting in repeated choking. It is found that tenants get into the habit of using one pail as a receptacle for refuse of all kinds, e.g., bedroom slops and waste water, tea leaves, vegetable parings, etc., the contents being ultimately thrown down the water closet. This practice inevitably leads to the water closet being stopped up; on the other hand it would be objectionable if the whole contents of these pails, often largely of a liquid nature, were placed in the dust bins. The use of a "scullery receptacle" would enable this difficulty to be met. This receptacle consists of an ordinary sized domestic pail with a movable drainer. The use of this article in the place of an ordinary pail enables solid matter, such as potato parings, to be separated from the liquid matter. The latter an be readily disposed of by emptying down the water closet or suitable gulley, ie former can be burnt or placed ip the dust bin. 110 Use of Vita Glass. Opportunity has been taken during the year to call attention to the desirability of the use of Vita glass. This glass lets actinic rays through, and its use in place of ordinary window glass is much to be desired where possible. Vita glass can be obtained at about the same cost as plate glass. Cab Shelter. Complaints were received respecting bad smells in the neighbourhood of a cabmen's shelter in the Borough. On inspection it was found that the shelter was kept in a very clean condition and no nuisance appeared to arise therefrom. On enquiry, however, it was discovered that liquid refuse was emptied down a large, old type street gulley situated about thirty feet away from the shelter; the nuisance complained of apparently was caused by the occasional foul state of such gulley resulting from its use for this purpose. In consultation with the Borough Surveyor arrangements were made, as a special concession, for a sink to be provided connected by a waste pipe to the drain of the street gulley. Subsequently the old gulley was replaced by one of modern type. In this way it is hoped that any further nuisance will be obviated. Demolition of Old Buildings. From time to time nuisances occur from dust arising from the demolition of old buildings. During the year a communication was received from the Metropolitan Boroughs Standing Joint Committee respecting a request to the London County Council to make provision, by a General Powers Bill, for powers of control to be administered by and at the discretion of the Borough Councils for the prevention of such dust nuisances. As long ago as the year 1915 the Holborn Council asked the Local Government Board for sanction to the making of a by-law to control the demolition of old buildings with a view to the prevention of nuisance from dust. The Board, however, was unable to assent to the proposal and suggested that proceedings should be taken for the abatement of any such nuisance under Section 2 of the Public Health (London) Act, 1891. Subsequently proceedings were so taken in the Police Court, the summons being dismissed on the ground that the nuisance did not arise within Section 2 of the before-mentioned Act. The Council, therefore, adopted a resolution in favour of the proposed provision, by a General Powers Bill, of powers of control for the prevention of this nuisance. In the meantime a series of suggestions for the prevention of such nuisances has been prepared and a copy is being forwarded to contractors proposing to commence demolition in the Borough. It is hoped that contractors will respond to these suggestions and in this way the prevention of nuisance will be effected. The following is a copy of the suggestions referred to: — 1. Provide and fix proper fans at first floor level and other floors if necessary. 2. Board up window openings from which sashes and glass have been removed. 111 3. Pull down internal partitions storey by storey before taking down external walls of the respective storeys. 4. Provide canvas or other suitable screens where necessary to prevent nuisance from dust. 5. Before and during the process of demolition and during subsequent removal all dust and material should be freely sprayed with a hose and rose jet. 6. So far as practicable any process connected with the demolition likely to cause nuisance from dust should not be carried out during ordinary business hours, particularly if the building to be demolished is in a main thoroughfare. 7. On completion of demolition all necessary steps should be taken effectually to seal off all drains so as to prevent any nuisance from rats. Children's Country Holidays. In connection with the arrangements made by the Children's Country Holiday Fund, and the Fresh Air Fund, for sending children away for country holidays, we receive and answer many enquiries during the summer months relative to the existence of infectious diseases in the houses from which the children are drawn. This routine co-operation between the local authority and the organisations concerned helps to ensure that children who have been directly exposed to infection shall not be sent away until danger of the development of disease in the contact child is past. Effluvia from Trade Processes. During the year two complaints of smell were received in connection with factories. The first related to premises where crude rubber is worked up. When the material ordinarily used is being dealt with no smell arises, but some "wild rubber, also called Lagos rubber, had been purchased and this gave rise to smell. The owner removed the Lagos rubber from premises. The cause of the second complaint was traced to the use of sulphuretted hydrogen for analytical purposes by a firm of manufacturing chemists. The analytical work was transferred to the country. Private Water Supplies. At the latter part of the year a complaint was received respecting illness thought to be caused by the drinking of impure water stated to have a bitter taste and to change colour when it was boiled. The suspected water came from a private source obtained from a well 650 feet deep. On enquiry it was found that the water complained of had been heated in a new aluminium kettle. On boiling in this kettle the water changed colour, but no change took place when the water was heated in a different kettle. A sample of water from this well, after boiling in the aluminium kettle, was examined by the Borough Analyst (Mr. J. Kear Colwell, F.T.C.), who reported as follows: — " I have examined the water and found it is an alkaline water having a total solid content of 78 0 parts per 100,000. 112 The alkalinity is due to the presence of sodium carbonate, the quantity of that body found being 26.5 parts per 100,000. The sample contained 3.4 parts per 100,000 of oxide of aluminium (Al2 O3) possibly due to the action of the alkaline water on the metal of which the kettle is made. It is doubtful if this quantity would have harmful effect on persons drinking the water." With this opinion I agree; there is no record up to the present of any harmful effect due to the ingestion of the oxides of aluminium. In connection with a large block of offices newly erected in the year 1926, the water supply was derived from a private well. A certificate was furnished to the owners by the Analyst who examined the water on their behalf expressing the following opinion:— "This is a soft water conforming to a high standard of purity. There is no evidence of any harmful contamination. The water is obtained from the ereon sand formation of the London geological basin." No water softeners are used in connection with either of the above supplies of well water. Other Propaganda Leaflets, etc. Arrangements were continued with the co-operation of the Library Committee for the distribution of two bookmarks, one for adults and one for children. On the front information was given as to health and educational facilities afforded by the Council. On the back of the bookmark for adults information was contained respecting diphtheria antitoxin and the arrangements for the prevention of diphtheria by immunisation. The back of the children's bookmark contained hints to boys and girls on how to keep healthy. A leaflet giving advice to women on constipation was also distributed by means of " Please Take One " boxes in the public conveniences for women. HOUSING. During the year 982 houses occupied by the working classes were inspected; this number consisted of 577 registered lodging houses and 405 non-registered houses occupied by working classes. The total number of buildings in the Borough occupied for dwelling purposes is given by the Census, 1921, as 3,473. The number of tenements occupied by working classes as returned to the London County Council is 8,571. This figure represents the total tenements in the Borough consisting of one, two, three or four rooms. 113 Housing Scheme No. 1. Betterton Street. The Housing of the Working Classes Committee have from time to time considered a number of schemes for the construction of houses for the working classes, but owing to the high cost of land in the Borough most of these have been found impracticable. The Committee were of opinion that useful improvements might be effected by the acquisition of unsatisfactory, old and worn houses, and their reconstruction or demolition and rebuilding. An opportunity occurred for a small scheme on these lines by the acquisition of three adjoining tenement houses in Betterton Street, together with the site of the fourth house which had already been demolished. The houses were not suitable for reconstruction as the existing walls were not in the required positions nor of the required thickness or condition. The Council decided to acquire the vacant site and the three houses for demolition and the construction of selfccntained flats. The scheme entails the displacement of about fifty persons occupying the three houses but the fifteen self-contained flats to be provided will probably provide accommodation for seventy persons, so that, in addition to securing much improved housing accommodation, a larger number of residents will be provided for. The plans of the new building were prepared in the Borough Surveyor's Department and the work is being carried out under the supervision of Mr. J. E. Parr, A.M.Inst.C.E., the Borough Surveyor. Describing the proposed building, Mr. Parr writes:— "It will be constructed of brickwork with fireproof floors and a tiled roof, and the basement will be used for storage purposes. The block will comprise 15 flats, three flats being on each of the five floors, giving accommodation for approximately 75 persons. With one exception, each flat will have a livingroom, two bedrooms, a scullery, W.C., bathroom and a coal bin. Entrance from Betterton Street will be through a doorway leading to a court at the back of the block, and there will be one principal fireproof staircase. Access to the flats on the upper floors will be by means of this staircase and balconies running the whole length of the rear of the building on each floor. Each living room will be provided with a dresser and other fittings, and the general equipment of the flats will contain all the latest improvements." The tender of the Canonbury Construction Company, Ltd., was accepted for the erection of the dwellings, and on the 27th October, 1926, the foundation stone of the new building was laid by the Mayor (Alderman H. Warren Coleman, J.P.). At its meeting in September, 1926, the Council agreed to extend the scheme to the sites of two adjoining properties, Nos. 25 and 27, Betterton Street. H 114 HOUSING CONDITIONS. Statistics. Year Ended 31 st December, 1926. 1.—GENERAL. (1) Estimated population 43,200 (2) General death rate 1210 (3) Death-rate from tuberculosis (all forms) 0'81 (4) Infantile mortality rate 90 *(5) Number of buildings containing dwellings (Census, 1921) 3,473 (6) Number of separate dwellings (Census, 1921) 7,202 $(6a) Number of working-class tenements (Census, 1921) 8,571 (7) Number of new working-class houses erected 1 Block—(15 tenements erection commenced) 2.—UNFIT DWELLING-HOUSES. J.—INSPECTION. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 982§ (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 nil (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 527 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 ... ? *"Buildings."—A structure wholly detached or separated from another by a party wall, e.g., a block of flats is one building. +" Separate dwelling," i.e., having separate access to street or common landing or staircase, e.g., each flat in a block is a separate dwelling, but a private house not structurally divided is a single unit whether occupied by one or more families. ‡ "Working-class tenements," i.e., separate occupations of one, two, three or four rooms only. § Practically all these houses were tenement houses containing a number of tenements. !!All the more insanitary houses are always annually inspected. 115 III.—ACTION UNDER STATUTORY POWERS. A. Proceedings under Section 28 of the Housing, Town Planning, etc., 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 owners 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 543 (2) Number of dwelling-houses in which defects were remedied: — (a) by owners 543 (b) by Local Authority in default of owners nil C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1919:— (1) Number of representations made with 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 ImprovementSchemes 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 By-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, etc. Act, 1919. H 2 116 APPENDIX. TABLE I. Vital Statistics of Whole District during 1926 and Ten Previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Uncorrected Number Net Number Rate of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rata Number Kate 1916 38,161 534 619 15.7 768 20.2 498 395 63 97 665 17.5 1917 35,303 474 571 14.5 865 21.5 567 390 62 107 688 19.5 1918 3g,769 310 497 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 11.8 859 19.7 622 319 51 79 556 12.8 1922 42,850 485 66t 15.5 746 17.4 513 312 43 72 570 13.3 1923 41.376 423 593 13.7 718 16.6 491 300 47 79 526 12.1 1924 43,250 394 578 13 .36 670 15.5 470 329 47 81 529 12.2 1925 43,315 364 527 12.16 725 16 ??? 513 330 33 63 542 12 .5 1926 43,200 330 635 12 .38 629 14.6 454 347 48 90 522 12.1 In the above table the population, birth rate and death rate are as estimated by me Registrar-General, founded upon his estimates of the civilian population. 117 TABLE II. Causes of, and Ages at, Death, 1926. Causes of Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the District. Total Deaths whether of " Resi. dents " 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. Certified 522 48 16 7 ii 15 62 154 113 96 All causes Uncertified ... 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... ... 3. Measles 6 3 2 1 ... ... ... ... ... ... ... 4 Scarlet Fever 1 ... ... ... 1 ... ... ... ... ... ... 5. Whooping Cough 1 ... ... 1 ... ... ... ... ... ... 2 6. Diphtheria and Croup 4 ... 1 2 1 ... ... ... ... ... 1 7. Influenza 8 ... ... ... ... ... 5 2 1 ... 1 8. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... 9. Meningo-coccal Meningitis 2 ... 1 ... 1 ... ... ... ... ... 1 10. Tuberculosis of Respiratory System 26 ... ... ... ... 4 8 12 2 ... 9 11. Other tuberculous Diseases 9 2 ... 2 3 1 1 ... ... ... 32 12. Cancer, malignant disease 63 ... ... ... ... ... 7 33 17 6 31 13. Rheumatic Fever ... ... ... ... ... ... ... ... ... ... 3 14. Diabetes 6 ... ... ... ... ... 1 3 2 ... 1 15. Cerebral Hemorrhage 25 ... ... ... ... ... 2 11 9 3 4 16. Heart Disease 58 ... ... ... 1 1 3 23 17 13 10 17. Arterio-sclerosis 43 ... ... ... ... ... ... 3 17 23 6 18. Bronchitis 67 ... 1 ... ... ... 1 16 20 29 9 19. Pneumonia (all forms) 39 6 6 ... ... ... 6 15 1 4 51 20. Other Kespiratory Diseases 2 ... ... ... ... ... ... 1 ... 1 8 21. Ulcer of Stomach or Duodenum 5 ... ... ... ... ... 1 2 2 ... 1 22. Diarrhœa, etc. 14 10 2 ... ... ... 1 1 ... ... 53 16. Appendicitis and Typhlitis 3 ... ... ... ... ... 2 ... ... ... 3 24. Cirrhosis of Liver 3 ... ... ... ... ... ... 1 1 1 3 25.Acute Chronic Nephritis 16 ... ... ... 1 ... 2 6 5 2 12 26. Puerperal Sepsis 9 ... ... ... ... ... 2 ... ... ... 1 27. Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... ... 1 28. congenital Debility and Malformation, Premature Birth 17 17 ... ... ... ... ... ... ... ... 56 29. Suicide 12 ... ... ... ... 2 4 5 1 ... 1 30. Other Deaths from Violence . 15 1 ... ... 3 3 2 2 3 1 8 31. Other Dehned Diseases 75 9 3 ... ... 3 14 18 15 13 146 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 522 48 16 7 11 15 62 154 113 96 454 118 TABLE III. Cases of Infectious Disease notified during the year 1926. 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 Agea—Tears, St. Giles and Bloomsbury. Holborn. At till Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and wards. Small-pox ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 73 2 23 31 13 3 1 ... 22 51 72 Erysipelas 14 1 ... 1 2 4 4 2 8 6 8 Scarlet Fever 84 ... 18 40 19 7 ... ... 34 50 84 Enteric Fever 5 ... ... 1 2 2 ... ... 5 ... 5 Puerperal Fever 3 ... ... ... ... 3 ... ... 2 1 3 do. Pyrexia 1 ... ... ... ... 1 ... ... 1 ... 1 Cerebro-spinal Fever 2 ... 1 1 ... ... ... ... 1 1 2 Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 4 2 3 Dysentery ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... Pneumonia—Primary 29 ... 9 2 2 3 7 6 14 15 16 do. Influenzal 10 ... ... ... 1 7 1 1 4 6 4 Tuberculosis—Pulmonary 66 ... ... 3 16 28 18 1 30 36 34 do. Non-Pulmonary 26 1 4 9 5 5 2 9 17 13 Whooping Cough 96 9 49 38 ... ... ... ... 17 79 25 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... 1 ... ... ... 1 1 416 19 104 126 60 64 33 10 151 265 271 119 TABLE IV. Infectious Diseases in Holborn for the last Eleven Years. NOTIFICATIONS DEATHS Decennial Average, 1914-1925 Year 1926 Decennial Average, 1918-1925 Year 1926 Number Rate per 1,000 London Kate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Small-pox 0.3 0.01 0.00 0 0.00 0.00 0 o.oo 0.00 0 0.00 0.00 Diphtheria 100 2.46 2.57 73 1.69 2.95 5 0.11 0.17 4 0.09 0.12 Erysipelas ... 18 0.43 0.51 14 0.32 0.39 ... ... ... ... ... ... Scarlet Fover 91 2.19 3.17 84 1.94 2.68 1 0.03 0.04 1 0.02 0 02 Enteric Fever 4 0.09 0.08 5 0.12 0.07 0.5 0.01 0.01 0 0.00 001 Cere'oro-spinal Fever 1.0 0.03 0.06 2 0.05 0.02 ... ... ... 0 o.oo ... Acute Poliomyelitis 1 0.03 ... 0 0.00 0.02 ... ... ... 0 0.00 ... Whooping Coughf 63 2.49 ... 96 2.25 ... 5 0.12 0.17 1 0.02 0.05 Measles ... ... ... ... ... ... 8 0.20 0.22 6 0.14 0.20 Tuberculosis—Pulmonary 101 2.57 ... 66 1.53 1.62 59 1.50 1.23 26 0-60 ... Ditto Non-Pulmonary .5 0.38 26 0.60 0.47 8 0.19 0.19 9 0 21 ... Puerperal Fever* Ditto Pyrexia 1 2.76 3.28 3 1 5.60 4.24 1 2.47 ... 2 3 74 ... Ophthalmia Neonatorum* 9 14.38 9.08 6 11.21 8-97 ... ... ... ... ... ... Diarrhoea (under 2 years)*J ... ... ... ... ... ... 8 12.5 13. 57 12 22.43 11.8 * Rates per 1,000 births. †Notifiable in Holborn (not in London) since 1914. ‡ Not Notifiable. (.) Average for 6 years. 120 TABLE V. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL PREMISES. Number in Borough at end of 1926. Number of Inspections. Number of Prosecutions. Cowsheds ... ... ... Milkshops 124 157 Registered houses let in lodgings 577 871 4 Ice cream premises 61 185 ... Slaughter-houses 1 6 ... Offensive Trades ... ... ... Restaurants and Eating Houses 235 198 ... Housing op the Working Classes— Number of houses inspected:— (a) On account of complaints or illness (Public Health Act) 982 (6) House to house (Housing Consolidated Regulations, 1925) Number of notices served : — (a) Under Public Health Act: — (i.) Intimation 543 (ii.) Statutory 76 (b) Under Housing Act 0 Number of houses repaired or nuisances remedied under Public Health Act Number of houses repaired under Section 3 of Housing Act :— 513 (a) By owners 0 (b) By local authority in default of owners 0 Number of houses closed on notice by owner that they could not be made fit Number of houses for the working classes :— 0 (a) Erected during year 0 (b) In course of erection 1 block (15 tenements) Number of representations by Medical Officer or other person 0 Number of houses included in such representations 0 Number of Closing Orders made 0 Number of Closing Orders determined (i.e., houses made fit) 0 Number of Demolition Orders 0 Number of houses demolished:— (a) In pursuance of Orders 0 (b) Voluntarily 0* Total number of houses in the borough 3473 (Census, 1921) Number of houses occupied by the working classes 8571 tenements (Census, 1921) Underground Rooms— Number illegally occupied, notices served 2 Number closed or illegal occupation discontinued 2 Overcrowding Number of cases of overcrowding found; notices served 4 Number of prosecutions 1 Number remedied 4 Smoke Nuisances— Number of observations 340 Number of notices 6 Number of complaints 7 Number of summonses 0 Cleansing and Disinfection— Number of adults cleansed 164 Number of children cleansed 0 Number of premises disinfected : — (a) After infectious diseases 223 (b) For vermin 134 Water Supply to Tenement Houses— Number of premises supplied 6 Nu nber of prosecutions 0 Sanitary officers Nuviber 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 * Three houses demolished by Local Authority for rebuilding as working-class tenement. 121 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 317 38 6 ... Workshops 648 80 10 ... Workplaces 3,031 45 4 ... Total 3.996 163 20 ... 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 51 51 ... ... Want of ventilation ... ... ... ... Overcrowding 5 5 ... ... Want of drainage of floors ... ... ... ... Other nuisances 113 113 ... ... Sanitary accommodation - insufficient 2 2 unsuitable or defective 68 68 ... ... not separate for sexes... 7 7 ... ... Offences under the Factory and Workshop Act : Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for hakehouses (S6. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 246 246 ... ... * Inrludine those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. I 122 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. Prosec utions. Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists Instances. Notices served Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Outworkers. Outworkers. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— (1) Making, Ac. 108 3:6 259 1 ... 3 110 ... ... ... ... ... ... ... ... (2) Cleaning and Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls 2 ... 56 ... ... ... 2 ... ... ... ... ... ... ... ... Coathangers ... ... 1 13 ... Paper Bags and Boxes 2 ... 14 ... ... ... 2 ... ... ... ... ... ... ... ... Total 112 316 329 2 ... 16 114 ... ... ... ... ... ... ... ... 123 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) 24 Other Workshops 694 Total number of workshops on Register 718 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) 16 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector 56 Heport (action being taken) sent to H.M. Inspector... 56 Other — Underground Bakehouses (S.101): — Certificates granted during the year — In use at the end of the year 1 124 LEGAL PROCEEDINGS. SALE OF FOOD AND DRUGS ACTS, 1875-1907. Date. Name. Address. Offence. Result. 1926 Mar. 10 Curtis & Co. 315, High Holborn Selling Calomel Ointment 40 % deficient in mercurou8 chloride Fined £14. Costs £2 2s. Od. Mar. 29 Rachel Scheie 2, Red Lion Passage Selling milk 6 6% deficient in fat Dismissed on payment of £3 3a. Od. costs May 18 The Friern Manor Farm Dairy, Ltd. 2, Portpool Lane ... Selling milk 5 0% deficient in fat Summons withdrawn on payment of 21s. costs May 31 & June 9 George Brampton 190, Drury Lane Selling apples containing 1/64 grains of arsenic per pound Summons dismissed on payment of £5 costs PUBLIC HEALTH (LONDON) ACT, 1891. Date. Nome. Address. Offence. Result. 1925 Nov. 30 & Dec. 7 1926 Jan. 11 Mr. James Trott ... 5, New North Street Overcrowding Nuisance abated 1925 Dec. 30 1926 Jan. 22 Mrs. N. Kelly 38, Emerald Street Breach of Lodging House By-laws (cleansing & absence of means of ventilation) Work done. Summons withdrawn on payment of £3 3s. costs do. do. 36, Emerald Street do. do. do. do. 9, Chapel Street do. do. do. do. 11, Chapel Street do. do. do. do. 9, Chapel Street Existing nuisance (accumulation of refuse) do. do. do. 11, Chapel Street Existing nuisance (premises dilapidated) do. do. do. 36, Emerald Street Existing nuisance (dampness and defective W.O.) do do. do. 38, Emerald Street Existing nuisance (premises dilapidated, absence of proper asllbin) do.