HOL 18 The Metropolitan Borough of Holborn. REPORT FOR THE YEAR 1919 OF The Medical Officer of Health, WILLIAM ARTHUR BOND, M.A., M.D., D.P.H., Camb., Bach. Surgery Camb., M.R.C.P.Lond., Fellow, Member of Council and late President of Metropolitan Branch, of the Society of Medical Officers of Health; Fellow, and Member of Council, late Hon. Sec. of the Royal Institute of Public Health; Member, late Lecturer and Demonstrator, of the Royal Sanitary Institute; late Medical Officer of Health of the St. Olave District, Southwark, and the Holborn District Board of Works. London: MORGAN REEVE CO., LTD., 20/22, GOLDSMITH STREET, KINGSWAY, W.C. 2. 1920 INDEX. Page. Introduction and Brief Abstract of Report 1 The New Ministry of Health 2 Self-Help to Health 2 Population 5 Chief Occupations 5 Birth-rate 5 Death-rate 5 Infantile Mortality 5 Deaths in Institutions 5 Principal Causes of Deaths 5 Deaths from Infectious Diseases 5 Scavenging 6 Sanitary Inspection of District 6 Food 7 Prevalence of and Control over Infectious Diseases 7 Maternity and Child Welfare 8 Sanitary Administration and other Services 9 Tuberculosis Dispensary 9 Bacteriological Work 10 Sale of Food and Drugs Acts 10 Cleansing of Persons Act 10 Nursing Arrangements 10 Housing 11 ADDITIONAL DETAILS. Natural and Social Conditions of the District 13 Population and Houses. 13 Vital Statistics 13 Registered Births and Birth-rate 13 Corrected Births and Birth-rate 14 Mortality 14 Corrected Deaths and Death-rates 15 Deaths of Children under 15 years of Age 15 Infantile Mortality 15 Poor Law and Hospital Relief 16 Sanitary Circumstances of the Borough 16 Scavenging 16 Removal of Manure 16 Sanitary Inspection of District 16 Premises and Occupations Controlled by By-laws or Regulations 16 Common Lodging Houses 16 National Rat Campaign 17 Food 18 Dairies, Cow-sheds and Milk-shops 18 Public Health (Milk and Cream) Regulation, 1912 18 Milk (Mothers and Children) Order 1918 19 Unsound Food 19 Bakehouses 19 Slaughter-House 19 Places where Food is Prepared for Sale 19 Ice Cream 20 Sale of Food and Drugs Act 20 Prevalence of and Control over Infectious Diseases 20 Infectious Diseases Generally 20 Disinfections 20 Nursing Arrangements 20 Tuberculosis Notifications 21 Tuberculosis Dispensary 21 Report of Tuberculosis Officer 21 Page Maternity and Child Welfare 23 Sanitary Administration 23 Staff 23 Bacteriological Work 24 Cleansing of Persons Act 24 Other Services 24 Housing 24 APPENDIX. Table I. Vital Statistics of Borough during 1919 and ten previous years 25 Table II. Causes of and Ages at Death—year 1919 26 Table III. Infantile Mortality during year 1919 27 Table IV. Cases of Infectious Disease Notified during year 1919 28 Table V. Notifications of Infectious Diseases 1919 and ten preceding years 29 Table VI. Proportion of Notifications of Infectious Diseases to Estimated Population in 1919 and preceding ten years 30 Table VII. Deaths from Epidemic Diseases 1919 and ten preceding years 31 Table VIII. Sanitary Inspectors' Work—Inspections, &c. 32 Table IX. Ditto Notices served 33-34 Table X. Summary as required by L.C.C. 35 Table XI. Factories, Workshops, &c. 36 (1) Inspections 36 (2) Defects found 36 (3) Home Work 37 (4) Registered Workshops 38 (5) Other matters 38 Table XII. Legal Proceedings 39 Table XIII. Meteorology 40 Introduction to and brief Abstract of the REPORT OF THE Medical Officer of Health FOR THE YEAR 1919. PUBLIC HEALTH DEPARTMENT, 193-197, HIGH HOLBORN, W.C. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn. Ladies and Gentlemen, In accordance with the Memorandum of the New Ministry of Health this Annual Report for 1919 gives fuller details than had been required during the War, and the various subjects are dealt with on the lines indicated, and the order specified therein. It is also suggested that there should be much increased distribution of the same in order to engender a popular interest in the subject, and an enlightened public opinion which shall support the Local Authority in realising its high responsibilities for the health of its area. The War-worn nation, suffering from the sacrifices and strain of the prolonged struggle followed by the anticipated re-action and unrest, hailed the advent of the Ministry of Health with its bright promises of improved conditions of life. As the supreme efforts of co-operation of our Empire and the Allies brought victory on earth, water, under the water and in the air, so the victory against our even more relentless foes of health, many of which are invisible to our unaided senses, and many of which have still eluded much patient research, will only be accomplished by co-operation amongst the nations and their units, guided by intelligent foresight and forethought, and aided by the laborious research of scientists. Much improvement has already been accomplished on earth and water especially in our larger towns by good drainage schemes, purification of sewage, supervision of food supplies and provision of good water, clearance of insanitary areas . and improved housing, etc., under the varied existing Health Legislation, but very much still remains to be done especially for the purification of the air of our larger towns by the abatement of smoke nuisances, thus giving more beneficent sunshine and light. 2 The Ministry of Health, aided by its able staff of experts and Advisory Councils, has already done much excellent work, and much is being developed. Its co-operation with the League of Nations in the establishment of an International Health Organisation for matters affecting public welfare, will be of the utmost importance in the progressive development of civilisation. The Minister of Health is also associated with the newly formed Medical Research Council, which is a most valuable development of the Medical Research Committee, which was initiated during the War, and issued many important reports. The Minister of Health has also recently appointed a Departmental Committee on Smoke Abatement. The Coal Smoke Abatement Society has for many years been a pioneer in this direction, and eight years ago the Holborn Council distributed more than 10,000 copies of a pamphlet "More Sunshine for London" emphasizing the great importance of increased gas and electricity and smoke-consuming stoves and furnaces. While co-ordination of International, Central and Local Health Authorities are essential, of no less value is Self-Help, and this side of the problem is to be the special feature of this year's Health Week. The necessity for this Self-Help has been shown by the statistics of the examination of recruits for the War, which disclosed an appalling amount of the C 3 population. The medical examination of schoolchildren has shewn that a million were so defective as to be unable to derive reasonable benefit at school. The latest Insurance returns showed that more than half of the Insured persons received medical treatment every year, and that among these there were more than 14,000,000 weeks of sickness a year, equal to a loss of working time of 270,000 years. In order to obtain an A 1 population, it is therefore essential that the laws of Health should not only be taught, but the importance of Self-Help inculcated, and a Health conscience developed, so that these beneficent laws may be willingly obeyed, for Nature is very benignant if her laws are obeyed, but very ruthless to all who ignorantly or wilfully disobey them. The gradual recuperative power of living organisms is, however, very great under improved conditions of life. Children and adolescents ought to be taught the love of truth, knowledge of the marvellous universe in which they live, obedience to discipline, selfcontrol by the development of the higher centres of the brain, and to play the game strenuously and fairly. Thehuman being, like any of the higher animals, consists of many millions of small complex cells, each specially developed to carry out its special duty and function for the benefit of the whole. The Science of Embryology 3 has proved that the human being, like an animal, is evolved from a small cell —the female reproductive ovum—after fertilisation by the male some period before birth, being about nine months for a full-time child. In order to obtain improved stocks and herds, the best kinds are used for breeding, so also to obtain more healthy children, men and women must do all they can to keep themselves healthy, especially as the sins of the parents are generally visited upon their children. The human body can in many ways be compared with a very complicated automatic machine. It is one which every one of us has to drive every day and night until the end of life's journey. One of the simplest comparisons has been with a steam engine. In order to obtain the most efficient working, the engine must be regularly fed with the proper amount and kind of fuel, the refuse must be regularly cleared away, it must have a sufficiency of water and air, the machinery must be kept clean and well oiled, it must not be kept out of use, or it will rust and will need overhauling and repair before it, can be efficiently used again. One of the most interesting popular descriptions of the human body in lucid language is a recent publication by Professor Arthur Keith, M.D,, F.R.S., etc., "The Engines of the Human Body," giving the substance of his Christmas Lectures at the Royal Institution. He went to the workshop of the engineer and selected examples of his inventive ability to illustrate the creative'genius displayed by Nature in the construction of the human body. For instance the heart is a pump, one which in the ingenuity of its construction, the delicacy of its regulation, and the effectiveness of its work, far surpasses any model of man's invention. The master contrivance, the organisation of the brain, spinal cord and nerves, is compared with an extensive telephone system with automatic telephone exchanges. The animal kingdom abounds with Nature's wonderful methods of defence, not only against their larger enemies, but also against their unseen foes, the germs of disease. Man's ingenuity has also devised many artificial methods of defence against foes of both kinds, which methods have reached their climax during the past terrible war. Medical men have studied the battles which are fought between the invading legions of germs and the defensive forces of the body, and have discovered some of Nature's methods, so that they can assist recovery from disease by acting as Nature's assistants. Therefore, when ill, at once call in a well trained doctor, as Nature can be assisted most efficaciously at the beginning of the disease before much damage has been caused. Much money is worse than wasted, because of the harm that is so frequently done by the indiscriminate use of drugs and specious quack medicines. Prevention is much better than cure, and everyone can act as Nature's assistant, especially in the prevention of disease by Self- 4 Help. Man is "a bundle of habits" and this "Self-Help" is simply the formation of good habits by perseverance and determination. Good habits are most easily formed during childhood and adolescence, hence the great importance of proper guidance by parents and teachers. The good habits necessary for the healthy enjoyment of life and work include the following: Avoidance of excesses of all kinds. Sufficient food, unadulterated and undeteriorated by the removal of essential vitamines, in fair variety inclusive of fresh vegetables or fruit. If properly masticated appetite will generally indicate the amount. The regular daily attention to N ature's call in order to prevent constipation. As the water contained in food is not as much as that excreted by the skin, lungs and kidneys, a sufficiency of liquid, in the form of good drinking water, tea, coffee, etc., is required. Fresh air by means of well ventilated and lighted rooms, bedrooms, workrooms, and places of indoor amusement and exercise, or work in the open air. Cleanliness of body, clothing, homes and workrooms and extermination of all insect pests, such as lice, fleas, etc., which are the cause of many diseases. Activity of body and mind. Strenuous exercise, short of undue fatigue, whether at work or play, the latter especially by means of games in the open air; or drill, dancing, etc., in well ventilated rooms. Healthy clothing to maintain the temperature of the body, sufficiently porous to allow evaporation from the skin; loose enough to allow complete freedom of movement and avoidance of tightness; and varying in amount and kind (especially the underclothing) according to the climate. Sound, strong well fitting boots to keep the feet warm, comfortable and dry. Sufficient sleep, Nature's sweet restorer, especially in well ventilated bedrooms. Healthy recreations by change of work, good literature, etc., varying with the person's occupation. By this Self-Help each one will not only promote his own healthy enjoyment of life and work, but also assist the welfare of his family and the community, and the forming of an enlightened public opinion which will lead to enduring peace, goodwill, and the highest civilisation. 5 At the last Census on April 2nd, 1911, the population of the Borough was 49,357, and the density 122 persons per acre in comparison with 61 for London. 33'1 per cent, of the population lived in tenements of only one or two rooms, and 59'5 per cent, in tenements of one to four rooms. Although the number of Hotels and Boarding Houses keeps increasing, the Borough is becoming less and less residential and more and more important as a business centre. The number of factories, workshops, workplaces and offices keeps increasing so that we have now a very large day population. The chief occupations of the Borough are: Professional (Law, Architecture, etc.); Public, Societies' and Commercial Offices; Hotels and Boarding Houses; Printing and Bookbinding; Metal Refining; Precious stones and general trades and businesses. The birth-rate of the Borough was 13.6 per 1,000, in comparison with 12.1 per 1,000 in 1918. The death-rate was 16.4 per 1,000 in comparison with 22.3 in 1918. The death-rates for the past two years have been very high especially on account of the very large number of deaths from influenza and respiratory diseases, many of which were really complications of influenza. The infantile mortality—i.e., the number of deaths of young children under one year of age per 1,000 corrected births was 96 for the year 1919 in comparison with 141 for the year 1918. Although the legitimate infantile mortality was only 75 per 1,000 the illegitimate mortality was 258 per 1,000— i.e., more than three times as much. Of the 624 deaths at all ages, 367 died in hospitals and public institutions either within or without the Borough. The principal causes of death for the year 1919 in comparison with 1918, were as follows:— 1919 1918 Influenza 46 138 Respiratory Diseases 112 130 Tuberculosis (all forms) 75 112 Cancer, Malignant Disease 60 41 Organic Heart Disease 58 58 Premature Birth, Congenital Malformation and Debility 18 30 Violent (including Suicide) 29 51 Seven Principal Epidemic Diseases, viz:— Small-pox, Measles, Scarlet Fever, Diphtheria and Membranous Croup, Whooping Cough, Typhoid and Typhus Fevers and Diarrhoea (under two years) 14 36 6 Although the number of deaths from tuberculosis increased during the latter years of the war it will be seen from the above table that last year there was a marked reduction, also in the number of deaths from the other causes, with the exception of Organic Heart Disease and Cancer. In the case of Cancer, although the exact cause is still to be determined by co-operative patient research, it is well-known that a factor in its prevention is the avoidance of irritation, e.g.,—the prevention of cancer of the stomach by the avoidance of irritating food and by careful mastication, also that a radical cure can be effected by the earliest possible diagnosis followed by operation. In the case of Organic Heart Disease, much careful research work is now being carried on by Sir James Mackenzie and others. Since the passing of the Public Health Act, 1875, the mortality from the seven principal infectious diseases has enormously diminished for the number of deaths per million in England and Wales has been reduced from an average of 2,942 per 1,000,000 in the five years 1871-75, to 709 per 1,000,000 for the five years ending 1917, that is, less than one-fourth. During the same period there has also been a large reduction in the number of deaths from tuberculosis. Scavenging. The removal of house refuse is carried out by contract, under the supervision of the Public Health Department. In the main thoroughfares and in a number of other principal streets, there is a daily collection. In the remainder of the streets before the war there used to be a collection at least twice in every week. During the War in a number of streets in which there was not a daily collection, it was found to be impracticable to continue the at least twice weekly collection, but this removal twice each week is now being gradually resumed; specially during the summer months. Taking into consideration war conditions, the removal of house refuse was generally satisfactorily carried out. In a large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins. Sanitary Inspection of District. In addition to my many inspections, the Sanitary Inspectors made about 21,000 varied inspections, each inspection frequently covering a number of different sanitary matters. The total number of notices served for nuisances found in dwelling houses and factories, workshops and workplaces, and premises that are subject to various by-laws, was 2,118. The smoke shafts in the Borough were frequently kept under observation, and notices served where necessary. In no case was legal proceedings required. 7 Food. In addition to my many inspections, the total number of recorded inspections of dairies, milkshops, ice cream premises, market streets, butchers shops, bakehouses, restaurants, and other food shops, was 2,853. and the number of notices served was 60. The market streets are inspected daily, and also on Sundays and after office hours on Saturdays. Prevalence of and Control over Infectious Diseases. Excluding the 38 cases of infectious disease of which the notification only came into force during the year 1919, the total number of notifications received during the year was 457 in comparison with 502 in the year 1918. The principal notifications were : 1919 1918 Diphtheria 88 79 Scarlet Fever 54 23 Measles and German Measles 181 187 Tuberculosis (all forms) 94 163 Scarlet Fever and Diphtheria were also very prevalent during last year in London generally. For some reason which has not yet been satisfactorily explained, the prevalence of Scarlet Fever in London during 1916 to 1918 was the lowest recorded since 1891 Of the 88 cases of Diphtheria 81 were removed to the London Fever Hospital or Hospitals of the Metropolitan Asylums Board, the remaining 7 being principally mild cases of bacterological diphtheria which had recovered by the time the notifications were received. Of the 54 cases of Scarlet Fever 52 were so removed. Of the 181 cases of Measles and German Measles only 18 were removed to Hospitals or the Infirmary. There were disinfections of 287 rooms and 5,420 articles. It was ascertained that a large number of Japanese Shaving Brushes infected with Anthrax had been sold by Holborn Wholesale Merchants to chemists, etc. in many parts of the United Kingdom and the matter required much careful attention. The principal Bacteriological Examinations included 90 suspected cases Diphtheria of which 44 were positive and 58 suspected cases of Phthisis of which only 7 were positive. 8 Maternity and Child Welfare. Much increased work has been carried out during the year in connection with maternity and child welfare and the attendances at all the Centres have increased. Arrangements were made for the provision of a permanent Maternity Centre at No. 10, John Street, formerly one of the two public libraries in the Borough, and this year the arrangements were extended to include an Ante Natal Clinic, a Dental Clinic and two baths for the use of mothers attending the Council Centres. This new Centre was completed and opened the beginning of May, 1919. In accordance with the provisions of the Maternity and Child Welfare Act, 1918, the Maternity and Child Welfare Committee was continued and now consists of fifteen members, seven of whom are women qualified by training or experience in subjects relating to health and maternity, two of the seven being Councillors. The number of births during the year was 539. Of 485 children visited for the first time during the year 102 attended the Centre at 10, John Street, 44 attended the Branch Centre at 45, Short's Gardens, 21 at the Passmore Edwards Settlement Centre (used conjointly with South St. Pan eras), 6 at the Saffron Hill Centre, 1 at Myddleton Square, 1 at the Royal Free Hospital, and 7 at Charing Cross Hospital, a total of 182. In addition to these it is known that others, after these first visits, attended some of the non-Holborn Borough Council Centres, so that more than onethird attended a centre. Mothers attending the Centres at John Street and Short's Gardens took part in the National Mothercraft Competition in June and second place in this was won by the John Street Centre. An Exhibition of work done by mothers was held at John Street and prizes and certificates were distributed as well as those won in the " Baby Competition." On May 23rd the premises were used for the first heat in the "Daily Sketch" competition, and one Holborn baby was selected for competition in the second heat. Some of the mothers also competed for the Rhondda Mothercraft Challenge Shield, the selected essay being specially commended by the judge. Since the year 1906 arrangements have been made for the supply of prepared milk, for infants who cannot be breast fed, at a reduced rate per day on production of a Certificate from me. This milk was used by 69 infants, including 21 who were still taking the milk at the beginning of 1919. The results, when prepared milk is properly used are most satisfactory. Of the 48 new certificates issued during the year, 30 were for full price payments and 18 necessitous mothers were assisted. 9 The Milk (Mothers and Children) Order, February, 1918, the principle of which had previously been carried out in this Borough by voluntary assistance, was at once adopted and was also continued during the year 1919. During the year 176 necessitous expectant or nursing mothers, and young children under five years of age, received assistance in the supply of Milk, either free or at less than cost price; nine were assisted with dinners, principally at our National Kitchen, and a number of others also received assistance by a supply of eggs weekly. Milk and eggs were generally supplied by orders on their ordinary dairymen. Flannel for the making of baby garments, bandages and simple drugs were also supplied at cost price, except in the case of bandages for which consent was given for a reduced price in a few necessitous cases. The inauguration of the new Centre, new Clinics, changes of Medical and other Officers and additional staff, and the above Welfare undertakings, with the multitudinous records, orders, and examination of bills required, have involved an enormous amount of clerical and other work. This has unfortunately reduced to some extent the amount of home visiting and increased clerical assistance is therefore now under consideration. Sanitary Administration and other Services. Many changes had to be introduced on account of the war. I am glad to report that the following returned to duty during the year in the order named:— Mr. F. Fitch, Mr. A. Long, and Inspector G. F. Clark. Mrs. Lucy Harry, M.D., was appointed as successor to Mrs. Dorothea Colman, M.D., as Medical Officer of our Principal Maternity and Child Welfare Centre at the beginning of 1919, and on account of the lamented death of Dr. S. Andrews in February, 1919, succeeded him at our Short's Gardens Branch. Dr. Harry resigned at the end of the year and Miss B. M. Kidd, M.B., was appointed temporary Medical Officer. I much regretted the resignation, on account of promotion to the Ministry of Health, of Miss Enid Orange (now Mrs. Eve), who had carried out very much excellent work since her appointment in July, 1907, first as woman Sanitary Inspector and afterwards also as Chief Health Visitor. Miss E. J. Charlesworth, who was appointed Health Visitor (and also Sanitary Inspector during emergencies) in July, 1917, succeeded Miss Orange, and Miss E. L. Shinnie was appointed Health Visitor, beginning her duties here last September. Tuberculosis Dispensary. Since February, 1915, the Council has made arrangements with the University College Hospital, conjointly with South St. Pancras, for dealing with cases of tuberculosis, including contacts, both 10 insured and uninsured. These are examined by the Tuberculosis Officer on Tuesday and Friday afternoons and Thursday evenings and the reports sent me and arrangements made for their removal to hospital or sanitoria when required. They are visited at their homes by the Tuberculosis Nurse, who reports to and consults with me weekly, and at other times in emergency. Much valuable welfare assistance is rendered by the Tuberculosis Care Committee. Bacteriological Work. Bacteriological work in connection with assistance in the diagnosis of infectious diseases was continued at the Virol Research Laboratories, No. 10, Bedford Square. Sale of Fcod and Drugs Act. About 500 samples, of which 289 were milk and 63 butter, were purchased by the Inspector or their Agents and submitted to the Public Analyst. Of these only 15 or 30 per cent, were reported to be not genuine. Of these samples there were:— 289 Milk 11 not genuine = 3'8% 63 Butter 1 „ „ = 1'6% 15 Drugs 1 „ „ = 6'5% 125 Various foods 2 „ „ = 1'6% Cleansing of Persons Act. Daring the year 138 persons (118 men and 20 women) infected with vermin had their bodies and 2,016 articles of clothing disinfected, free of charge, at our Cleansing Stations at the Public Mortuary, Goldsmith Street. Nursing Arrangements have been made with the Metropolitan Nursing Association, 23 Bloomsbury Square, for the nursing, when required, of necessitous cases of measles, whooping cough, ophthalmia, diarrhœa and pneumonia. In addition to the Services rendered by the Ministry of Health, the Home Office in connection with Factories, etc., the London County Council, the Metropolitan Asylums Board, the Metropolitan Water Board, the Registrar General for Statistical Returns, other Services are rendered by the Holborn Board of Guardians for Vaccinations, the returns of births and deaths and the relief and treatment of the poor. Public Baths and Washhouses, a Public Library, a Public Mortuary and Coroner's Court are also provided. Additional War Services such as Food Control, War Pensions, War Savings and co-operation with the Military and Naval Services, Y.M.C.A. hostels, etc., occupied much time of the Public Health Department, frequently requiring much overtime and work at home. 11 Housing After the passing of the Housing, Town Planning, etc., Act, 1909, the Council at once made arrangements for the detailed inspection of the less sanitary houses. Regulations respecting underground rooms habitually used as sleeping places were also prepared and finally adopted, and a very large number of houses were dealt with, the worst of which were closed, either by Closing Order, or, in many cases, voluntarily, after communications with the owners, and the remainder made fit for human habitation, either under this Act or the Public Health Act. All the less sanitary houses are carefully inspected annually, and are dealt with from time to time, in accordance with the requirements. Unfortunately on account of the War, and in accordance with the instructions of the Local Government Board, it was often impracticable to stringently enforce some of the requirements. The Housing Act of 1919 has received very careful attention by the Council. With a view to the erection of additional houses for the working classes, the following four sites were inspected, plans and estimates of expenditure and receipts were prepared, and carefully considered by the Housing Committee:—The Italian Colony which was represented by me in 1905, and, after a Local Government Board Inquiry, was very much improved by the closing and demolition of the houses in all the small courts, and other sanitary defects remedied.—A vacant site at the corner of Coram Street and Herbrand Street.—Another vacant site in Herbrand Street and a vacant site in Short's Gardens, which had been purchased by the Council for housing and plans and estimates prepared in 1914. These sites, however, were finally not approved by the Ministry of Health in the early part of this year Although from a purely public health point of view there is at present necessity existing in the Borough for better housing accommodation for members of the working classes, many other factors have to be taken into consideration by the Council. These factors have to be considered not only in connection with Holborn in particular, but with the housing question of London as a whole. They include the outward movement of the population from Central London districts; cheaper and better housing accommodation in suburban districts; increased facilities for cheap travelling and locomotion; the increased importance of Holborn as a business centre, with its large increase of factories, workshops, and other business premises, and its convenient position as a centre for Official and Societies' Offices, and for visitors to London. The probable changes that will take place in the Borough, and the cost of the erection and maintenance of working class dwellings, especially as many of the large dwellings in central districts of London on account of the high value of the sites—have led to heavy charges on the rates. On account of these various factors, very many of the houses that originally were generally well constructed for and occupied by one family are now occupied by many families. In Holborn we have a very large 12 number of such houses, as many as 611 of them at the beginning of the year 1919 being on our register of houses let in lodgings. These houses have not been altered or adapted for suitable occupation by separate families, but will be very much improved under the new L.C.C. by-laws under the Housing, Town Planning, etc., Act, 1919, which have been drafted and are now under further consideration. These changes have also led to a general increase in the value of land in Holborn, and it becomes increasingly difficult to find suitable sites for the erection of working class houses without a heavy charge on the rates. Excluding tenement houses the number of houses constructed for the working classes in the Borough include 2616 tenements, of which 999 are L.C.C. dwellings, 1495 other dwellings and 122 older and less satisfactory ones. There is also a large but diminishing number of common lodging houses in the Borough, containing accommodation for 1,220 persons—1,058 men and 162 women. In accordance with the Housing Act of 1919, much time and attention was given to the preparation of a Survey of Housing needs, with Ordnance Map, showing the unhealthy areas and any considerable areas, which, although in fair sanitary condition, nevertheless, for one reason or another, fall definitely below the ultimate standard at which it is reasonable to aim. As usual a detailed inspection of all the less sanitary houses was made last year, and many houses which were more or less unfit for human habitation were dealt with under the Public Health (London) Act, 1891. A Closing Order was made for No. 36, New North Street, and the two adjoining houses were voluntarily closed by the owners and a Demolition Order has been withheld as the alterations required are now being carried out. In several other cases of houses which were reported on in detail for representation, the work required was voluntarily carried out by the owners, or the houses closed. Further details under the respective headings are given in the following Report. I desire to express my high appreciation of the willing assistance and hearty co-operation that I have received from the Mayor, the Ex-Mayor, the Chairmen, Vice-Chairmen and Members of my Committees and the Council generally, the principal officers of the Council and the staff of the Public Health Department during the year. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, W. A. BOND, M.A., M.D., B.C., D.P.H. Camb., M R.C.P. Lond., Medical Officer of Health. 13 ADDITIONAL DETAILS. Natural and Social Conditions of the District. Population and Houses. The enumerated population at the-Census taken on Sunday, April 2nd, 1911, was 49,357, a reduction of 10,048 on the previous census of 1901 or 16.9 per cent. During the previous decennium 1891-1901 there was a reduction of 7,376 01 11.0 per cent. The following estimates of population have been adopted for the calculation of the death-rate and birth-rate of the Borough for the year 1919. For the death-rate 38,156 „ „ birth-rate 39,747 The death-rate population excludes all non-civilian males, whether serving at home or abroad. This is necessary for the purposes of local death-rates because it had proved impossible to transfer the deaths of non-civilians to their areas of residence or to deal in any other satisfactory manner with the local mortality of this element in the population. These estimates are based mainly upon the rationing returns kindly placed at the disposal of the Department by the Ministry of Food. The birth-rate (and marriage rate) population, on the other hand, is intended to include all the elements of the population contributing to the birth and marriage rates. It consists therefore of the death-rate or civilian population plus all noncivilians enlisted from this country, whether serving at home or abroad. This non-civilian element has been distributed over all the districts in the country in proportion to their estimated civilian population. At the Census 1911 the number of inhabited buildings was 7,985, and uninhabited (i.e. used for business purposes only) 1,393, and 38 were in course of erection. 33.1 per cent, of the population lived in tenements of only one or two rooms and 59.5 Per cent, in tenement, of 1-4 rooms. (See also page 5). Vital Statistics. The following additional details respecting Vital statistics may be given :— Registered, Births and Birth-Rate. The total number of births registered in the Borough was 397, being 218 males and 179 females. Of the 397, 376 were legitimate and 21 illegitimate. The registered birth-rate per 1,000 of the population was 10.0. 14 Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 108 legitimate infants and 45 illegitimate infants whose mothers were residents of the Borough. Seven of the 376 registered legitimate births and 4 of the 21 illegitimate births were infants of mothers who were nonresidents of the Borough. The corrected numbers therefore are as follows :— Year. Corrected number of Births of Residents. Corrected Birth-rate per 1000. Legitimate. Illegitimate. Total. 1919 447 62 539 13.6 1918 428 69 497 12.1 In London the corrected number of births was 85,152 or a rate of 18.3 per 1,000, in comparison with 16.1 for 1918. Mortality. The total number of deaths registered in the Borough was 920, of which 543 were males and 377 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. Holbora. King Albert's Hospital – – 4 – Military Hospital, Kndell Street 1 – 69 – French Hospital 8 – 44 – Children's Hospital 2 9 – 309 National Hospital 2 2 – 78 London Homoeopathic Hospital 3 9 – 73 Italian Hospital 2 7 – 17 Alexandra Hospital – – – – Private – 1 14 10 T otal 18 28 131 487 There were 322 deaths of Civil "Residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 64 of whom were removed from Common Lodging Houses in the Borough. 15 Corrected Deaths and Death-Rates, 1919. Year. Total Deaths at all ages registered in District. Deaths in Public Institutions in District. Deaths of nonresidents of Borough registered in District. Deaths of Residents registered beyond the District. Deaths at all ages. Nett, 1919. Death Rate for 1919. Registration London. 1919 920 639 618 322 624 16.4 13.4 1918 862 561 532 490 820 22.3 18.9 For details of causes of and ages at death, see Appendix, Table II. Deaths of Children under 15 years of age. The total number of deaths of children under 15 years of age was 93, of which 52 were under one year of age, 9, from 1 to 2 years, 20 from 2 to 5 years, and 12, from 5 to 15 years. Infa it He 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 1000 corrected births, were the following Year. Deaths under one year of age. Deaths under 1 year per 1000 corrected legitimate Births. Deaths under 1 year periooo corrected illegitimate Births. Deaths under 1 year per 1000 corrected Births. London. Deaths under 1 year. Deaths under 1 year per 1000 Births. 1919 52 75 258 96 7039 85 1918 70 126 232 141 7659 107 Death-rate per 1,000 corrected births in 1919 and in ten preceding years during which details respecting births have been supplied. 1909. 1910. 1911. 1912. 1913 1914. 1915. 1916. 1917. 1918. Av'ge, 1909-18 1919. Whole Borough 101 100 113 78 100 88 96 97 107 141 102 96 London 108 103 129 91 105 101 112 89 103 107 104 85 See also Appendix, Table III. i6 Poor Law and Hospital Relief. The Clerk to the Guardians of the Holborn Union has kindly supplied me with the following information relating to persons from the Holborn Division of the Union who received Poor Law Relief during the year 1919. Number of Persons Indoor Relief 1,452 Outdoor Relief 195 do. Medical Relief 250 Total 1,897 Of the total number of deaths 367 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 was transferred to the Public Health Department in June 1905. The number of complaints received was gradually reduced until in 1913, the year before the war, only seven genuine complaints respecting the non-removal of house refuse were received from householders in the whole Borough. It was impracticable to maintain this very high standard during the war. See also page 6. Removal of Manure. The removal of manure from the various mews in the Borough was satisfactorily carried out during the year. No complaint was received. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-laws or Regulations. See pages 6, 7, 11, 12 and Tables VIII., IX., X., XI. Common Lodging Houses Acts, 1851 and 1853. The following is a list of the Common Lodging Houses registered in this Borough at the end of the year 1919:— Of these 14 are in St. Giles and Bloomsbury for 1,060 lodgers „ 3 „ Holborn District for 213 „ Total 17 in the Borough for 1.273 „ 17 St. Giles and Bloomsbury. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. 6, Better ten Street 83 M 1-7, Macklin Street 96 M 2, Kennedy Court 8 W 19, do. 40 W 3. do. 10 W 21, do. 26 w 4, do. 19 W Parker Street Municipal 345 M 5, do. 8 W 7, 9, and 11, Shorts ) 311 M 6, do. 8 w Gardens, and 7, do. 9 w 3, Neal's Yard ) 8, do. 34 w 6 and 7, Wild Court 63 M Holborn District. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. 40, Eagle Street 50 M 12 and 13, Took's Court 110 M * 4, Greville Street 53 M *No. 4, Greville Street, is now closed. These are principally under the supervision of the London County Council. NATIONAL RAT CAMPAIGN. With a view to inaugurating an effective campaign throughout the country, it was suggested by the Board of Agriculture and Fisheries, that "Rat Weeks" should be arranged in the district of every Local Authority, namely, October 20th to 27th 1919, 29th December, 1919 to January 3rd, 1920 and February 23rd to March 1st, 1920. The matter received my careful attention and "Rat Weeks" were accordingly arranged in this Borough for each of those weeks. The premises where the rats had not been completely exterminated, also received attention during the intervals. Prior to the first rat week, a very large number of restaurant and other premises known to harbour rats were inspected and directions given for steps to be taken for the extermination of the rats. In the majority of cases the rats have been exterminated, or their numbers very much reduced. The work required a very large number of inspections and re-inspections and the work is still being continued. The Rats and Mice (Destruction) Act 1919 came into operation on the 1st day of January 1920 and the Council authorised the Medical Officer of Health and the sanitary inspectors to enforce the Act in the Borough. 18 Food. Dairies, Coivnlieds and Milkshops. The number of registered dairies and milkshops in the Borough at the end of the year was 159. Seven dairies and milkshops were newly registered, and six were removed from the register. In addition to my inspections the Sanitary Inspectors made 75 inspections of these premises, and one notice was served for sanitary defects or breaches of regulations, and in some cases alterations were carried out without the service of notices. Public Health (Milk & Cream) Regulations, 1912. The following particulars of proceedings taken in the year 1919, under the above Regulations made in pursuance of the Public Health (Regulations of Food) Act, 1907, are given in the form suggested by the Local Government Board in their circular letter dated 27th October, 1913, and a copy was sent to the Ministry of Health in February, 1920. 1.—Milk and Cream not sold as Preserved Cream. Number of Samples examined for the presence of preservatives. Number in which a preservative was reported to be present. Milk 228 0 Cream 5 0 Nature of Preservative found (а) Milk. nil. (б) Cream. nil 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives were correct:— (I.) Correct statements made 1 (II.) Statements incorrect 0 Total 1 (b) Determination made of milk fat in cream sold as preserved cream :— (I.) Above 35 per cent. 1 (II.) Below 35 per cent. 0 Total 1 19 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (i) and the proviso in Article V. (2) of the Regulations have not been observed :— None. 3.—Thickening Substances. Any evidence of their addition to cream or to preserved cream. Action taken where found. None found. 4.—Other observations, if any:— None. There was much difficulty in obtaining samples of cream during the year. Milk (Mothers and Children) Order, 1918.—See page 9. Unsound Food. Applications were received for removal and destruction as trade refuse of the following articles of food, all of which were unsound and unfit for the food of man :— 15½ Cwt. Bacori. 11 lbs. Beef. 6 lbs. Tin Corned Beef. 76 Crates Bananas. 69¼ Butter. 88 Sacks Chestnuts. 179 cases Dates. 2 tins Liquid Eggs. 7 Crates Figs. 24 Stone Dog Fish. 6 cases Lemons. 12 Tins Condensed Milk. 6 tins Evaporated Milk. 30 cases Oranges. 3 cwt. Potatoes. 3 cases Australian Rabbits. 168 Bundles Tomatoes. 1 Barrel Whiting. Bakehouses. At the end of the year 1919 there were 29 bakehouses in the Borough of which 15 were factory bakehouses. During the year in addition to my inspections, there were 99 inspections of bakehouses, including 35 inspections of factory bakehouses. Eight notices were served for Sanitary defects. Slaughter House. There is now only one slaughter house in the Borough, viz., 29 Red Lion Street, which, in addition to my inspections was inspected on two occasions during the year. Sheep only are occasionally slaughtered." Places u'here Food is prepared for Sale. Under this head are included kitchens of hotels, restaurants and eating-houses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food is prepared for sale, excluding bakehouses which are given above. 20 The number of these places on the Register at the end of 1919 was 396; 1,939 inspections were made, and 52 notices were served during the year for sanitary defects found. In addition to the above inspections of places where food is prepared for sale, there were also 815 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are also regularly inspected on Saturday evenings and Sunday mornings. Ice Cream. During the year there were 31 premises in the Borough where ice cream was manufactured or sold, and in addition to my inspections 50 inspections of these premises were made. As ice cream is often made in the early morning, inspections between 6 and 9 a.m. were also occasionally made in order to ascertain whether there were any infringements of the London County Council (General Powers) Act, 1902. Sale of Food and Drugs Acts. See page 10. Prevalence of and Control over Infectious Diseases. Infectious Diseases Generally. See page 7 and Appendix Tables IV, V, VI and VII. Diphtheria Anti-toxin is supplied free of charge on application by Medical Practitioners. In the year 1919 this was supplied in 16 cases. There was only one "return" case of scarlet fever which was notified two days after the return of the previous case from hospital. Disinfections. During the year 287 rooms, and 5,420 articles of bedding, clothing etc., were disinfected after various cases of infectious disease. Nursing Arrangements. Nursing arrangements have been made with the Metropolitan Nursing Association, No. 23 Bloomsbury Square for the nursing, when required, of necessitous cases of measles, whooping cough, ophthalmia neonatorum, diarrhoea and pneumonia. Fortunately there was no epidemic of measles, german measles or whooping cough, so that the cases requiring nursing were comparatively few, and only 336 visits were made by the nurses of the Association, viz.:— Measles 19 Cases 306 Visits German Measles 1 Case 4 ,, Whooping Cough 1 „ 6 „ Ophthalmia Neonatorum 1 „ 9 „ Pneumonia 1 „ 11 „ Total 23 Cases 336 Visits 21 Tuberculosis Notifications. By the Public Health (Tuberculosis) Regulations, 1912, the notification of all forms of Tuberculosis was made compulsory. Excluding duplicates and military and naval cases the total number of notifications received was 94, of which 26 were private cases, 51 hospital cases, and 15 poor-law cases. Of these 76 were pulmonary cases and 18 non-pulmonary. Of the total number of cases 12, or 12-7 per cent., were residents of common lodging houses, and were all but 3 at once or soon afterwards removed to workhouse infirmaries. With few exceptions the remaining 82 lived in tenement houses, and 28 of these were removed to infirmary or hospital, 54 remaining at home, but some of these had previously been in infirmaries, hospitals or sanatoria. The number of deaths from phthisis during the year was 67, or a death-rate of 1-76 per 1,000, in comparison with 2-47 for 1918. During the past year of the 67 deaths, 9 had been removed to infirmaries from common lodging houses in the Borough, that is about 13-4 per cent. Tuberculosis Dispensary. See pages 9 and 10. The following is the report of the Tuberculosis Officer, David William Fenwick Jones, M.B., B.S., for the year, 1919. Introductory Remarks. The present Tuberculosis Officer took over the work at the Dispensary from Dr. Khan on July 1st, 1919. On that date there was also a change of nurses, Miss Bayley taking over from Miss Sage. An endeavour was at once made to get into touch with every patient on the register who had not attended since 1918. A part only of this work has been accomplished and is still proceeding. In this way a number of patients were crossed off the register as seen below. Suitable patients, who have been under observation for some time, are encouraged to place themselves under the care of their own doctors and are requested to attend the Dispensary at specified times. In this way the number of attendances has been diminished, thus enabling more time to be spent on new cases and those requiring continuous observation with frequent systematic examinations. The Interim-Care Committee under the Chairmanship of Dr. W. A. Bond, M.O.H., meets at the Dispensary every month—the work of this committee is most valuable. Cases. Analysis of the Old Cases Dispensed With. Male. Female. Totals. Definitely not Tuberculous 10 8 18 Left the Borough 16 4 20 Refused to attend 1 0 1 Died 7 0 7 34 12 46 22 Remaining Patients. Number of Old Patients on register on December 31st 1919—246 New Patients during 1919—98 Total number on reqister 344 Analysis of these 344 Cases. INSURED NON INSURED Male Female Male Female under 16 Totals Old Patients 91 39 12 32 72 246 New Patients 38 17 4 10 29 98 Totals 129 56 16 4-2 101 344 185 159 Further Analysis of the 98 New Cases. INSURED NON INSURED Male Female Male Female under 16 Totals Pulmonary Tuberculosis 20 6 1 3 2 32 Non-Pulmonary Tuberculosis 1 1 0 0 2 4 Non-Tuberculous 11 6 1 2 14 34 Doubtful 6 4 2 5 11 28 Total New Cases 38 17 4 10 29 98 55 43 Attendances, Examinations, etc. Insured Non Insured Totals Attendances 630 444 1074 Systematic Examinations 178 151 329 Referred to other Hospital Departments 4 4 8 (*= positive) Sputa examined .. 21 (8*) 7 (1*) 28 Superri.-iion of Home Conditions. Insured Non Insured Totals Nurses' Visits 575 457 1032 Medical Officer's Visits 7 0 7 (♦ — found Tuberculous) Contacts Examined 9 (3*) 18 27 Rerorts. Insured Non Insured Totals Written Reports to Public Authorities 135 40 175 Do. to Practitioners 17 0 17 Totals 152 40 192 23 Maternity and Child Welfare. See pages 8 and 9. Sanitary Administration. See pages 9 and 10 and Appendix Tables. Staff.—'The following was the staff during 1919. Medical Officer of Health. WILLIAM A. BOND. M.A., M.D., B.C., D.P.H. CAMB., M.R.C.P. LOND. Medical Officer of Maternity Centres. LUCY B. HARRY, M.B. LOND. Medical Officer of Tuberculosis Dispensary. M. M. KHAN, M.B.., B.S., M.R.C.S., L.R.C.P. (To end of June, 1919). DAVID W. FENWICK-JONES, M.B., B.S. (from end of June, 1919). Public Analyst. JAMES KEAR COLWELL, F.I.C. Sanitary Inspectors. ALBERT BENNETT. GEORGE FREDERICK CLARK. SAMUEL LARARD, -M.R. San. I. Chief Health Visitor and Sanitary Inspector. ENID ORANGE (Resigned June 1919). Sanitary Inspector and Health Visitor. ETHEL JANE CHARLESWORTH. Health Visitor. ELIZABETH LISTER SHINNIE. Tuberculosis Nurse. J. S. SAGE. (To end of June.) ESTHER BAYLEY. (From June.) Chief Clerk and Committee Clerk. EDWIN KENT. First Assistant Clerk. FRANK FITCH. Second Assistant Clerk. ARTHUR LONG. Mortuary Keeper and Superintendent of Cleansing Station. CHARLES H. DAY. Superintendent of Cleansing Station for Women. ADELINE DAY. Caretaker of Maternity Centre. ELIZABETH ALDERTON. The following returned to duty from active service. Inspector Clark 30th August, 1919 Frank Fitch 7th February, 1919 Arthur Long 17th February, 1919. 24 Bacteriological Work. Bacteriological work for the Council is carried out by the Virol Research Laboratory at 10 Bedford Square, W.C. i. The following table gives details of the examinations made during the year. Diphtheria Enteric Fever. Consumption. Malaria. Number Submitted Result of Examination. Number Submitted Result of Examination Number Submitted Result of Examination. Number Submitted Result of Examination 90 46 bacilli not found 1 1 Negative 58 51 bacilli not found 1 1 Positive 44 bacilli found 0 Positive 7 bacilli found Cleansing of Persons Act.— See page 10. Other Services. See pages 9 and 10. Housing. See pages 11 and 12 APPENDIX. TABLE I. Vital Statistics of Whole District during 1919 and Ten Previous Years. Name of District—The Metropolitan Borough of Holborn. Year Population estimated to Middle of each Year. Uncorrected Number Births. Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Under 1 Year of Age At all Ages Nett Number Rate of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate 1 2 3 Number 4 Rate 5 6 7 8 9 10 11 12 13 1909 51,191 1,436 986 19.3 1,067 20.9 637 377 100 101 807 15.8 1910 50,148 1,352 1,017 20.3 943 18.9 567 392 102 100 768 15.4 1911 49,092 1,273 920 18.8 923 18.9 588 407 104 113 742 15.2 1912 48,026 1,250 901 18.8 907 18.9 549 357 70 78 715 14.9 1913 46,949 868 797 16.7 910 19.9 583 358 80 100 685 14.4 1914 46,832 703 765 16.3 888 19.0 558 408 67 88 738 15.8 1015 40,405 594 670 14.4 876 21.8 559 385 64 96 702* 17.4 1916 38,161 564 649 15.7 768 20.2 498 395 63 96 665* 17.5 1917 35,303 474 571 14.5 865 24. 567 390 62 109 688* 19.5 1918 36,769 340 497 12.1 862 23. 532 490 70 141 820* 22.3 1919 38,156 Civil Population 397 539 13.6 920 27.1 618 322 52 96 624* 16.4 Area of District in acres (exclusive of area covered by water) 405.1 Total population at all ages 49,357 at Census of 1911. Number of inhabited houses 7,895 „ ,, Average number of persons per house 6.2 „ „ Total families or separate occupiers.. 11,030 ,, ,, N.B. —In the above Table the populations, birth-rates and death rates for the years 1909 1914 inclusive have been estimated from the Census Populations of 1901 and 1911. From the year 1915 the population is the CIVIL population as estimated by the Registrar-General from the National Register; the birth rate for 1915 and onwards is calculated on the estimated population at the middle of the previous year, and the death-rates on the above estimated Civil populations. * Excluding Military and Naval cases. † 53 weeks in Registration year. 25 26 TABLE 11. CAUSES OF, AND AGES AT, DEATH, YEAR 1919. Causes of Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the District. Total Deaths whether of "Residents " or "NonResidents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 25 years. 15 and under 25 years. 25 and under 45 years. 45 and under 85 years. 65 and upward All causes | Certified 624 52 9 20 12 25 107 183 216 639 (Uncertified — — — — — — — — — 1. Enteric Fever 1 — — — — — 1 — — 1 2. Small Pox — — — — — — — — — — 3. Measles I — — — — — — — — — 4. Scarlet Fever — — — — — — — — — — 5. Whooping Cough — — — — — — — — — 7 6. Diphtheria and Croup 6 — 1 3 2 — — — — — 7. Influenza 46 1 — 1 — 7 16 16 5 59 8. Erysipelas 2 1 — — — — — I — 9. Phthisis (Pulmonary Tuberculosis) 67 1 1 — I 5 26 25 8 19 10. Tuberculous Meningitis 3 — 1 1 — 1 — — — 34 11. Other Tuberculous Diseases 5 — — 2 — — I 2 — 28 — — — — 2 7 29 22 40 13. Rheumatic Fever 3 — — — 1 — 2 — — 6 14. Meningitis 3 1 1 — 1 — — — — 20 15. Organic Heart Disease 58 — — — — — 5 17 36 21 16. Bronchitis .. .. .. .. 53 2 — 1 — — 4 I4 32 9 17. Pneumonia (all forms) 52 7 1 3 3 2 11 13 12 51 18. Otherdiseasesof respiratory organs 7 — — 1 — 1 2 1 2 8 19. Diarrhoea and Enteritis 7 6 — 1 — — — — — 53 20. Appendicitis and Typhlitis 5 — — — 2 1 — — — — 21. Cirrhosis of Liver .. 2 — — — — — — — — — 21a. Alcoholism — — — — — — — — — — 22. Nephritis & Bright's Disease 10 — — 1 — 1 2 4 2 10 23. Puerperal Fever 1 — — — — — — — — — 24. Other accidents and diseases of Pregnancy and Parturition — — — — — — — — — — 25. Congenital Debility and Malformation, including Premature Birth 18 16 — — 1 1 — — — 72 26. Violent Deaths, excluding Suicide 21 3 3 3 — — 3 5 4 13 8 — — — — — 4 2 2 4 28. Other Defined Diseases 185 14 1 2 1 4 22 51 90 183 29. Diseases ill-defined or unknown — — — — — — — — — — 624 52 9 20 12 25 107 183 216 639 Sub- Entries, included in above figures 14 (a). Cerebo-spinal — — — — — — — — — 2 28 (a). Poliomyelitis * * * — — — — — — — — — 1 *Sub-Entries should here be made for other deaths which it is desirable to distinguish on account of their administrative importance or special interest any deaths from Anthrax, Typhus, or Glanders, which have been included under 28.Other Defined Diseases; or deaths from pneumonia other than broncho pneumonia, which have been included under 17. Pneumonia all forms). 27 TABLE III. Infantile Mortality during the Year 1919. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12 Months Total Deaths under One Year. All Causes f Certified 14 2 3 19 17 7 4 5 52 — — — — — — — — — — Small Pox — — — — — — — — — — Chicken Pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — 1 — — — 1 Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — Other Tuberculous Diseases — — — — — — 1 — — 1 Meningitis (not Tuberculous) — — — — — — — 1 — 1 Convulsions 1 — — — 1 1 1 — 1 4 Laryngitis — — — — — — — — — — Bronchitis — — — — — 2 — — — 2 Pneumonia (all forms) 1 — — — 1 3 — 1 2 7 Diarrhœa — — — — — 1 — — — 1 Enteritis — — — — — 1 2 I 1 5 Gastritis — — — — — — — — — — Syphilis — — 1 — 1 1 — 1 — 3 Rickets — — — — — — — — — — Suffocation, overlying — — — — — 1 — — — 1 Injury at birth — — — — — — — — — — Atelectasis 1 — — — 1 — — — — 1 Congenital Malformations — — — — — — — — — — — Premature Birth 8 2 1 — 11 2 — — — 13 Atrophy, Debility, Marasmus — — — — — 2 1 — — 3 Other causes 3 — 1 — 4 2 2 — i 9 14 2 3 — 19 17 7 4 5 52 Nett Births registered during the calendar year legitimate, 477 .illegitimate 62 Nett Deaths registered during the calendar year of legitimate infants 36 illegitimate „ 16 TABLE IV. Cases of Infectious Disease notified during the year 1919. Name of District—Holborn. Notifiable Disease Nurnber of Cases Notified Total Cases notified in each Locality (e.g. Parish or Ward) of the District. Total Cases Removed to Hospitals At all Ages At Ages—Years. St. Giles and Bloomsbury. Holborn. Under 1. 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox — — — — — — — — — — — Cholera (C) Plague (P) — — — — — — — — — — — Diphtheria (including Membranous Croup) 88 2 23 38 15 10 — — 30 58 81 Erysipelas 25 — — 1 4 10 9 1 9 16 10 Scarlet Fever 54 — 9 35 6 4 — — 20 34 52 Typhus Fever — — — — — — — — — — — Enteric Fever 2 — — — — 2 — — 1 1 2 Relapsing Fever — — — — — — — — — — — Continued Fever 1 — — — — 1 — — 1 — 1. Puerperal Fever — — — — — — — — — — — Anthrax — — — — — — — — — — — Hydrophobia — — — — — — — — — — — Glanders — — — — — — — — — — — Cerebro-Spinal Fever 2 — 1 — 1 — — — 1 1 2 Acute Polio-myelitis — — — — — — — — — — — Ophthalmia Neonatorum 7 7 — — — — — — 3 4 3 Acute Polio Encephalitis — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — Dysentery 3 — — — 1 2 — — 2 1 — Malaria 7 — — — 3 4 — — 2 5 — Pneumonia—Primary 14 3 i 1 — 5 3 1 2 12 3 do. Influenzal 14 — — 1 3 7 3 — 4 10 5 Trench Fever — — — — — — — — — — — Tuberculosis Pulmonary 76 — — 4 14 33 21 4 4i 35 32 do. Non-Pulmonary 18 — 4 8 2 2 2 0 11 7 6 Measles 136 7 68 49 8 3 1 — 69 67 14 German Measles 45 2 11 17 10 5 — — 19 26 4 Whooping Cough 3 — 2 1 — — — — 2 1 — 495 21 119 155 67 88 39 6 217 278 215 29 TABLE V. NOTIFICATIONS OF INFECTIOUS DISEASES IN THE BOROUGH DURING 1919 AND DURING THE PRECEDING TEN YEARS. (Excluding Naval and Military Cases) Disease. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Annual Average 1919 Small-pox 1 0 0 0 0 0 0 0 0 1 0.2 0 Diphtheria and Membranous Croup 47 45 85 88 59 63 67 99 69 79 70 88 Erysipelas 41 42 37 48 29 22 28 22 15 10 29 25 Scarlet Fever 98 68 120 113 131 173 154 66 29 23 98 54 Typhus Fever 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever 16 25 10 12 7 15 6 9 2 2 10 2 Continued Fever 1 0 0 0 0 0 0 0 0 0 1 1 Puerperal Fever 3 0 2 0 1 4 2 2 0 0 1 0 Cerebro-spinal Fever 0 1 0 1 0 0 10 3 6 0 2 2 Acute Polio-myelitis — — 0 0 2 0 0 3 0 1 0.7 0 Ophthalmia Neonatorum — — 5 5 3 6 6 12 4 5 6 7 Tuberculosis Pulmonary 332 170 187 210 169 115 162 185 137 152 182 76 Do. Non-Pulmonary — — — — 35 20 36 33 12 11 25 18 Total.. 539 351 446 477 436 418 471 434 274 284 425 273 Chicken Pox was notifiable during the period in the above table as follows:— 1911 22nd March to 21st June - during which period 101 notifications were received. 1915 17th March to 30th June - „ „ ,, 27 „ „ „ 1918 27th March to 30th June - „ „ „ 33 „ „ „ Measles and German Measles were notifiable from the 1st January, 1916, to the 31st December, 1919, during which period the following notifications of civil cases were received:- Measles German Measles 1916 163 90 1917 496 145 1918 148 39 1919 136 45 Whooping Cough was made notifiable in Holborn for 5 years from the 1st April, 1914, and was continued for a further 5 years from 1st October, 1919. Notifications have been received as follows :— 1914 77 1917 15 1915 92 1918 31 1916 21 1919 3 30 TABLE VI. PROPORTION TO ESTIMATED POPULATION OF CASES OF INFECTIOUS DISEASES DURING 1919 AND DURING THE PRECEDING TEN YEARS. Disease. Annual Rate per 1,000 Estimated Population to Middle of each Year. Annual Average. Rate per 1000 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Small-pox 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 003 0.00 0.00 Diphtheria and Membranous Croup 0.92 0.90 1.74 1.83 1.23 1.35 1.66 2.60 1.95 2.15 163 2.31 Erysipelas 0.80 0.84 0.76 1.00 0.61 0.47 0.70 0.58 0.42 0.27 0.64 0.66 Scarlet Fever 1.92 1.36 2.45 2.36 2.75 3.71 3.82 1.73 0.82 0.63 2.16 1.41 Typhus Fever 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Enteric Fever 0.31 0.50 0.20 0.25 0.15 0.32 0.15 0.23 0.06 0.05 0.22 0.05 Continued Feve 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 Puerperal Fever 0.06 0.00 0.04 0.00 0.02 0.09 0.05 0.05 0.05 0.00 0.03 0.00 Cerebro.spinal Fever 000 0.02 0.00 0.02 0.00 0.00 0.24 0.07 0.17 0.00 0.05 00.5 Acute Polio.myelitis - — 0.00 0.00 004 0.00 0.00 0.07 0.00 003 0.01 0.00 Ophthalmia Neonatorum 0.10 0.10 0.06 0.13 0.15 0.32 0.11 0.13 0.11 0.18 TuberculosisPulmonary 6.48 3.39 3.81 4.37 3.60 2.45 4.00 4.84 3.88 4.13 4.10 1.99 Do. Non.Pulmonary — — - — 0.74 0.43 0.89 0.86 0.34 0.30 0.59 0.47 Total 10.53 7.01 0.10 9.93 9.20 8.95 11.66 11.35 7.80 7.72 9.54 7.14 31 TABLE VII. DEATHS FROM EPIDEMIC DISEASES OCCURRING IN THE BOROUGH DURING THE YEAR 1919 AND DURING THE PRECEDING TEN YEARS. Year Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa. * Total. Number. Rate per 1000 Number. Rate per 1000 Number. Rate per 1100 Number. Rate per 1000 dumber. Rate per 1000 Num ber. Rate per 1000 Number. Rate per 1000 Number. Rate per 1000 1909 14 0.27 3 0.08 3 0.06 15 0.29 1 0.02 7 0.14 43 0.84 1910 — — 13 0.26 — — 4 0.08 16 0.32 4 0.08 6 0.12 43 o.86 1911 — — T5 0.31 3 0.06 3 0.06 3 0.06 2 0.04 33* 0-67* 59 1.21 1912 — — 25 0.52 0 0.00 6 0.13 7 0.15 1 0.02 8* 0.17* 47 0.98 1913 — — 7 0.15 0 0.00 4 0.08 6 0.13 0 0.02 12 * 0.25* 29 0.16 1914 — — 11 0.24 2 0.04 3 0.06 9 0.19 6 0.13 11* 0.24* 42 0.90 1915 — — 19 0.47 1 0.02 11 0.27 12 0.30 1 0.02 11 0.27 55 1.37 1916 — — 3 0.08 2 0.05 10 0.26 4 0.11 — - 10 0.26 29 0.76 1917 — — 37 1.05 0 0.00 1 0.03 1 0.03 — - 9 0.25 48 1.35 1918 — — 6 0.16 0 0.00 5 0.14 13 0.35 3 0.08 9 0.24 36 0.98 Average 10 years 19091918 - — 15 0.35 1 0.02 5 0.11 9 0.19 2 0.04 12 0.26 43 0.98 1919 — — 1 0-03 — — 6 0.16 — — 1 0.03 6 0.16 14 0.37 London 1919 1 0.00 356 0.08 137 0.03 720 0.18 210 0.05 49 0.01 1434 0.33 2907 0.68 * The Registrar General since 1911 has taken the deaths from diarrhœa and enteritis under two years of age. TABLE VIII. Sanitary Inspectors' Work.—Inspections, &c. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Inspector Charlesworth. Inspector Shinnie & Temporary Inspector Whole Boro' Inspections. Infectious Diseases 70 34 139 15 117 68 443 Dwelling Houses 90 148 101 26 3 — 368 Lodging Houses 366 69 235 248 115 — 1.033 Common Lodging Houses — 2 1 — — — 3 Dairies, Cowsheds and Milkshops 1 47 27 — — — 75 Ice Cream—Manufacture or Storage — — 50 — — — 50 Slaughter-house — 2 — — — — 2 Market Streets 3m 34 467 — — — 815 Butchers' Shops 487 6 308 — — — 801 Bakehouses 20 49 30 — — — 99 Other Food Shops 498 73 440 — — — 1,011 Laundries — — — — — — Other Workshops 29 39 60 13 7 — 148 Out-Workers' Rooms and Registers — — 28 7 — — 35 Other Workplaces 26 24 16 — — — 66 Factories (excluding Bakehouses and Laundries) 10 11 23 1 1 — 46 Smoke shafts 3 5 3 — — — 11 Urinals — — 1 — — — 1 Miscellaneous 251 60 107 — — — 418 † Periodical Inspections 1,900 535 3,815 72 — — 6,322 ‡ Dust 51 10 19 — — — 80 Mews 74 7 14 — — — 95 Maternity — — — 130 175 151 456 Total Inspections 4,190 1,155 5,884 512 418 219 12,378 No. of Re-Inspections 1,158 711 1,053 315 151 — 3,388 Do. do. Maternity — — — 587 1,037 651 2.275 Visits other than Inspections and Re-Inspections 439 328 594 87 24 — 1,472 Do. do. Maternity — — — 44 188 115 347 Maternity Centres: Attendances — — — 71 161 112 344 Food Control—Visits and Inspections 302 — 268 — — — 570 Total 6,089 2,194 7,799 1,616 1,979 1,097 20,774 •See also Periodical Inspections. TThe majority of these are weekly inspections of Registered lodging houses. ♦A large number of inspections respecting the removal of Refuse is also made during General and Periodical Inspections of houses. TABLE IX. Sanitary Inspectors' Work. -Notices served 1919. Inspector Bennett. Inspector Clark. Inspector Larard. Inspectors Orange & Charlesworth Total. Intimation Notices—Total served 186 207 338 177 908 Houses 157 165 258 169 749 The house or part of the house in a dirty condition 52 75 51 33 211 The house or part of the house in a damp condition 12 2 17 13 44 The House in a dilapidated condition 18 39 40 15 112 The watercloset so foul as to be a nuisance 5 6 11 9 31 Do. without a water supply 24 7 15 — 46 Do. with a deficient supply of water 2 23 3 13 41 Do. improperly constructed — — — — — Do. so defective as to be a nuisance 32 22 66 57 177 Do. stopped 15 19 49 19 102 Do. placed in an improper position — — — — — Insufficient external ventilation to watercloset — — — — — Insufficient watercloset accommodation 3 2 — — 5 Absence of watercloset accommodation — — 1 — 1 Absence of proper watercloset accommodation for persons of each sex See under Workshops &c. The soil pipe defective — — — — — Do. unventilated — — — Do. improperly ventilated — — — — — The yard paving defective 10 1 4 — 15 Do. dirty 1 19 6 6 32 Do. undrained — — — — — The area improperly paved — — 1 — 1 Do. dirty — 30 11 — 41 Do. undrained — — — — The inlet of surface drain improperly trapped — — — — — A gully trap improperly placed within the house.. — — — — — The waste pipe of sink improperly connected with the drain — — — — — Do. do. improperly trapped — — 1 — 1 Do. do. untrapped 1 7 18 — 26 Do. of lavatory improperly connected with the drain — — — — — Do. do. improperly trapped — — — — — Do. do. untrapped .. — — — — — Do. of bath directly connected with the drain — — — — — Do. do. improperly trapped — — — — — Do. do. untrapped — — — — — The water cistern so foul as to be a nuisance 13 — 4 — 17 Do. being without a close fitting cover 4 — 2 — 6 Do. being placed in an improper position — — — — — Do. defective — 7 — 2 9 An accumulation or deposit of refuse 7 18 20 11 56 The absence of proper ashbin 24 8 10 10 52 The ashbin defective 22 8 11 4 45 The drain foul — — — — v Do. defective — 4 5 — 9 Do. choked or stopped 7 15 31 7 60 Do. unventilated — — — — — TABLE IX.—continued, Sanitary Inspectors' Work.—Notices served 1919.—continued. Inspector Bennett. Inspector Clark. Inspector Larard. Inspectors Orange and Charlesworth Total. Houses—continued. The rainwater pipe in direct communication with the drain .. — — 1 — 1 Do. do. do. with the soil pipe — -— — — — Do. do. defective .. 4 12 13 2 31 The water supply used for domestic purposes connected with the cistern which is used for flushing the watercloset — — — — — The absence of proper water supply 1 1 3 7 12 The roof defective 28 18 47 24 117 The guttering defective 3 2 3 — 8 The paving of wash-house defective.. — — 1 — 1 The want of proper manure receptacle — 1 1 — 2 An animal kept in such place or manner as to be a nuisance — — 2 — 2 The house or part of the house overcrowded — — — 1 1 An underground room occupied as a dwelling contrary to the provisions of the Act — — — — — The space below floor in the basement or ground floor being unventilated 1 — — — 1 Do. improperly or insufficiently ventilated 1 — — 1 A chimney sending forth black smoke in such quantity as to be a nuisance See under Workshops A urinal improperly constructed, drained or offensive 2 — — 2 Do. with no supply of water .. — — — — - Other nuisances 1 7 13 4 25 'Factories, Workshops and Work Places 29 42 79 8 158 Dirty 17 20 32 8 77 Waterclosets, defective or dirty 3 12 26 — 41 Do. insufficient — - 1 — 1 Do. absence of separate accommodation for sexes 1 4 2 7 Drains, soil pipes, &c., defective 4 3 5 — 12 Improperly ventilated — — — — - Overcrowded — — — — - Chimney sending forth black smoke 2 1 2 — 5 Other nuisances 4 13 15 — 32 Ashbins 1 1 — - 2 Breach of Bye-laws or Regulations— {Lodging-houses 66 21 104 106 297 Dairies, cowsheds, milkshops and slaughterhouses — — — — — Keeping of animals — — — — - Removal of Refuse — — — — — London County Council (General Powers) Acts Urinals — — — — — Verminous Rooms 17 27 28 32 104 Ashpits — — — — — Foodshops — — — — — Statutory Notices 33 35 70 42 180 *Many nuisances at workshops that are parts of dwelling houses, are included in the Intimation Notices served under "Houses." jMany breaches of bye laws are included in Intimation Notices served under " Houses." TABLE X. »• AS REQUIRED BY THE LONDON COUNTY COUNCIL. Premises. Number on register at end of 1919. Number of Inspections Number of prosecutions. Cowsheds 0 0 0 Milkshops 159 75 — Houses let in lodgings 6ll 1033 — Ice cream premises 31 50 — Slaughter houses 1 2 — Offensive Trades 0 0 0 Smoke Nuisances— Number of observations 11 Number of notices 6 Number of nuisances and complaints 8 complaints Number of summonses 0 Housing of the Working Classes— Number of houses inspected 1350 Number of houses dealt with under section 15 of the Housing, Town Planning, etc., Act, 1909 0 Number of representations by householders 0 Number of Closing Orders 1 Number of representations by Medical Officer.. 1 Number of houses included in such Closing Orders 1 Number of houses included in such representations 1 Number of Closing Orders determined 0 Number of houses remedied without Closing Orders 0 (A number of houses were remedied without the necessity for representation) Number of demolition orders 1 Number of houses demolished (a ) in pursuance of Orders 0 (b) voluntarily 0 Obstructive Buildings— Number of representations under Section 38 of the Housing Act, 1890 0 Number of buildings demolished 0 Number of representations still under consideration 0 Number of Orders for repairs issued under Section 28 of the Housing Act, 1919 . 0 Number of houses repaired by local authorities 0 Number of houses closed on notice by owner that they could not be made fit 0 Total number of houses in the borough 9416 Number of houses occupied by the working classes 9021 tenements Number of houses for the working classes— (a) erected during year 0 (b) in course of erection 0 Underground Rooms— Number illegally occupied 0 Number closed or illegal occupation discontinued 0 Overcrowding— Number of rooms overcrowded 4 Number remedied 4 Prosecutions 0 Cleansing— Number of adults cleansed 138 Number of children cleansed 0 Number of rooms or premises cleansed 104 (vermin) Water supply to tenement houses Premises supplied 12 Prosecutions 0 Sale of Food— Number of premises used other than ice cream premises, milk shops and cowsheds 394 Number of Inspections 1061 Disinfection shelter— Persons accommodated 0 Ophthalmia neonatorum regulations— Number of notifications received during the year from certified midwives.. 0 Sanitary officers— Number of Sanitary Inspectors (whole-time) - Male 3 Female 0 Number of Sanitary Inspectors (part-time) - Mal. 0 Female 1 Number of Health Visitors - whole time 1 part-time i 36 TABLE XI. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories (including Factory Laundries) 57 18 3 — Workshops (including Workshop Laundries) 247 68 9 — Workplaces 1,239 72 1 — Total 1,543 158 13 — 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 77 77 — i Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 51 5i — — Sanitary accommodation insufficient i 1 — — unsuitable or defective 41 41 — — not separate for sexes 7 7 — — Offences under the Factory and Workshop Act :— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) — — — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 177 177 — 1 * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. TABLE XI.—continued 3— HOME WORK. NATURE OF WORK.* Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping 01* sending lists. Prosecutions. Instances. Noticcs served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Sections 109,110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists t Outworkers, f Lists. Outworkers. Contractors. Workmen. Contractors Workmen. (i) (2) (3) (4) (5) (6) (7) (8) (9) (10) (ii) (12) (13) (14) (15) (16) Wearing Apparel— (l) Making, &c. 86 183 340 8 8 24 98 — — — — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household Linen — — — — — — — — — — — — — — Lace, Lace Curtains and Nets — — — — — — — — — — — — — — — Curtains and Furniture — — — — — — — — — — — — — — — Hangings — — — — — — — — — — — — — — — Furniture and Upholstery — — — — — — — — — — — — — — — Electro Plate — — — — — — — — — — — — — — — File making — — — — — — — — — — — — — — — Brass and Brass Articles — — — — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables and Chains — — — — — — — — — — — — — — — Anchors and Grapnels — — — — — — — — — — — — — — — Cart Gear — — — — — — — — — — — — — — — Locks, Latches and Keys — — — — — — — — — — — — — — — Umbrellas, &c. — — — — — — — — — — — — — — — Artificial Flowers — — — — — — — — — — — — — — — Nets, other than Wire Nets — — — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — Racquet and Tennis Balls — — — — — — — — — — — — — — — Paper Bags and Boxes 2 — 18 — — 2 — — — — — — — — Brush making 2 — 4 — — 2 — — — — — — — Pea Picking — — — — — — — — — — — — — — — —Feather sorting — — — — — — — — — — — — — — — Carding, &c., of Buttons, &c. — — — — — — — — — — — — — — — Stuffed Toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Total 90 183 362 8 8 24 102 — — — — — — — — *If an occupier gives out work of more than one of the classes specified in column 1, and sub-divides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column ?, (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in column 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2. 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column •> must necessarily be even numbers, as there will be two lists for each employer- in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be approximately double ol the number of individual outworkers whose names are given, since in the February and August lists of the same employer trie same out worker's name will often be reneated 38 TABLE XI.—continued. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses (including 15 factory bakehouses) 29 Other Workshops 1.151 Total number of workshops on Register 1,180 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) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5) Notified by H.M. Inspector 61 Report (action being taken) sent to H.M. Inspecto 64 Other — Underground Bakehouses (S101):— Certificates granted during the year — In use at the end of the year 19 HOL18 The Metropolitan Borough of Holborn |PUBLIC HEALTH DEPARTMENT, 193-197, HIGH HOLBORN, W.C. HOW TO BE HEALTHY. AIDS, HELPS AND HINTS by the Medical Officcr of Health (WILLIAM A. BOND, M.A., M.D., B.C.. D.P.H., Camb., M.R.C.P., Lond.). (From Information of (???) Raf. for 1919) The War-worn nation, suffering from the sacrifices and strain of the prolonged struggle followed by the anticipated reaction and unrest, hailed the advent of the Ministry of Health with its bright promises of improved conditions of life. As the supreme efforts of co-operation of our Empire and the Allies brought victory on earth, water, under the water and in the air, so the victory against our even more relentless foes of health, many of which are invisible to our unaided senses, and many of which have still eluded much patient research, will only be accomplished by co-operation amongst the nations and their units, guided by intelligent foresight and forethought, and aided by the laborious research of scientists. Much improvement has already been accomplished on earth and water, especially in our larger towns, by good drainage schemes, purification of sewerage, supervision of food supplies and provision of good water, clearance of insanitary areas and improved housing, etc., under the varied exisiting Health Legislation, but very much still remains to be done, especially for the purification of the air of cgir larger towns by the abatement of smoke nuisances, thus giving more beneficent sunshine and light. WHAT THE MINISTRY OF HEALTH DOES. The Ministry of Health, aided by its able staff of experts and Advisory Councils, has already done much excellent work, and much is being developed. 2556 2 Its co-operation with the League of Nations in the establishment of an International Health Organisation for matters affecting public welfare will be of the utmost importance in the progressive development of civilisation. The Minister of Health is also associated with the newly formed Medical Research Council, which is a most valuable development of the Medical Research Committee, which was initiated during the War, and issued many important reports. The Minister of Health has also recently appointed a Departmental Committee on Smoke Abatement. The Coal Smoke Abatement Society has for many years been a pioneer in this direction, and eight years ago the Holborn Council distributed more than 10,000 copies of a pamphlet "More Sunshine for London "emphasising the great importance of increased gas and electricity and smoke-consuming stoves and furnaces. While co-ordination of International, Central and Local Health Authorities is essential, of no less value is Self-Help, and this side of the problem is to be the special feature of this year's Health Week. HELP YOURSELF TO HEALTH. The necessity for this Selp-Help has been shown by the statistics of the examination of recruits for the War, which disclosed an appalling amount of the C 3 population. The medical examination of schoolchildren has shewn that a million were so defective as to be unable to derive reasonable benefit at school. The latest Insurance returns showed that more than half of the Insured persons received medical treatment every year, and that among these there were more than 14,000,000 weeks of sickness a year, equal to a loss of working time of 270,000 years. In order to obtain an A 1 population, it is therefore essential that the laws of Health should not only be taught, but the importance of Self-Help inculcated, and a Health conscience developed, so that these beneficent laws may be willingly obeyed, for Nature is very benignant if her laws are obeyed, but very ruthless to all who ignorantly or wilfully disobey them. The gradual recuperative power of living organisms is, however, very great under improved conditions of life. Children and adolescents ought to be taught the love of truth, knowledge of the marvellous universe in which they live, obedience to discipline, self-control by the development of the higher centres of the brain, "and to play the game strenuously and fairly. HOW THE BODY WORKS. The human being, like any of the higher animals, consists of many millions of small complex cells, each specially developed to carry out its special duty and function for the benefit of the whole. The Science of Embryology has proved that the human 3 being, like an animal, is evolved from a small cell—the female reproductive ovum—after fertilisation by the male some period before birth, being about nine months for a full-time child. In order to obtain improved stocks and herds, the best kinds are used for breeding, so also to obtain more healthy children, men and women must do all they can to keep themselves healthy, especially as the sins of the parents are generally visited upon their children. The human body can in many ways be compared with a very complicated automatic machine. It is one which every one of us has to drive every day and night until the end of life's journey. One of the simplest comparisons has been with a steam engine. In order to obtain the most efficient working, the engine must be regularly fed with the proper amount and kind of fuel, the refuse must be regularly cleared away, it must have a sufficiency of water and air, the machinery must be kept clean and well oiled, it must not be kept out of use, or it will rust and will need overhauling and repair before it can be efficiently used again. One of the most interesting popular descriptions of the human body in lucid language is a recent publication by Professor Arthur Keith, M.D., F.R.S., etc., " The Engines of the Human Body," giving the substance of his Christmas Lectures at the Royal Institution. He went to the. workshop of the engineer and selected examples of his inventive ability to illustrate the creative genius displayed by Nature in the construction of the human body. For instance the heart is a pump, one which in the ingenuity of its construction, the delicacy of its regulation, and the effectiveness of its work, far surpasses any model of man's invention. The master contrivance, the organisation of the brain, spinal cord and nerves, is compared with an extensive telephone system with automatic telephone exchanges. DEFENCES AGAINST DISEASES. The animal kingdom abounds with Nature's wonderful methods of defence, not only against their larger enemies, but also against their unseen foes, the germs of disease. Man's ingenuity has also devised many artificial methods of defence against foes of both kinds, which methods have reached their climax during the past terrible war. Medical men have studied the battles which are fought between the invading legions of germs and the defensive forces of the body, and have discovered some of Nature's methods, so that they can assist recovery from disease by acting as Nature's assistants. Therefore, when ill, at once call gi a well-trained doctor, as Nature can be assisted most efficaciously at the beginning of the disease before much damage, has been caused. Much money is worse than wasted, because of the harm that is so frequently 4 done by the indiscriminate use of drugs and specious quack medicines. Prevention is much better than cure, and everyone can act as Nature's assistant, especially in the prevention of disease by Self-Help. Man is "a bundle of habits" and this "Self-Help" is simply the formation of good habits by perseverance and determination. Good habits are most easily formed during childhood and adolescence, hence the great importance of proper guidance by parents and teachers. WHAT TO DO AND HOW TO LIVE. The good habits necessary for the healthy enjoyment of life and work include the following: Avoidance of excesses of all kinds. Sufficient food, unadulterated and undeteriorated by the removal of essential vitamines, in fair variety inclusive of fresh vegetables or fruit. If properly masticated appetite will generally indicate the amount. The regular daily attention to Nature's call in order to prevent constipation. As the water contained in food is not as much as that excreted by the skin, lungs and kidneys, a sufficiency of liquid, in the form of good drinking water, tea, coffee, etc., is required. Fresh air by means of well ventilated and lighted rooms, bedrooms, workrooms, and places of indoor amusement and exercise, or work in the open air. Cleanliness of body, clothing, homes and workrooms and extermination of all insect pests, such as lice, fleas, etc., which are the cause of many diseases. Activity of body and mind. Strenuous exercise, short of undue fatigue, whether at work or play, the latter especially by means of games in the open air; or drill, dancing, etc., in well ventilated rooms. Healthy clothing to maintain the temperature of the body, sufficiently porous to allow evaporation from the skin; loose enough to allow complete freedom of movement and avoidance of tightness; and varying in amount and kind (especially the underclothing) according to the climate. Sound, strong well fitting boots to keep the feet warm, comfortable and dry. Sufficient sleep, Nature's sweet restorer, especially in wellventilated bedrooms. Healthy recreations by change of work, good literature, etc., varying with the person's occupation. By this Self-Help each one will not only promote his own healthy enjoyment of life and work, but also assist the welfare of his family and the community, and the forming of an enlightened public opinion which will lead to enduring peace, goodwill, and the highest civilisation.