5°CTI967 HOL 28 AC 43 42 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of Health, C. W. HUTT, M.A., M.D., M.R.C.P., D.P.H. For the Year 1930. London: Printed by DIPROSE, BATEMAN & CO., SheffIeld Street, Kingsway, W.C.2. 1931 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of Health, C. W. HUTT, M.A., M.D., M.R.C.P., D.P.H. For the Year 1930. London: Printed by PIPROSE, BATEMAN A CO., Sheffield Street, Kingsway, W.C.2. 1931 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C. 1. March, 1931. 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 1930. Believe me, Ladies and Gentlemen, Yours obediently, C. W. HUTT, Medical Officer of Health INDEX. Page Public Health Committee 6 Housing of the Working Classes Committee 6 Maternity and Child Welfare Committee 7 Tuberculosis Care Committee 7 Staff 8 Statistics and Social Conditions Statistical Summary 9 Population and Houses 9 Births 10 Deaths 12 Seasonal Mortality 13 Infantile Mortality 13 Poor Law and Hospital Relief 13 General Provision of Health Services 14 Sanitary Circumstances Scavenging. Removal of House Refuse 18 Appointment of Dust Inspector 18 Litter on Public Way 19 Improved Type of Dust Cart 18 Removal of Manure 19 Sanitary Inspection of District 20 Notices served 21 By-law as to Houses let in Lodgings 23 Rag and Bone Dealers 23 Rats and Mice (Destruction) Act 23 Rat Week 25 Smoke Abatement 25 Inspection of Workshops 26 Factories 27 Outworkers 28 Rag Flock Acts 28 Housing Statistics 29 Housing Conditions 30 Common Lodging Houses 32 Betterton House Scheme 33 Boswell Court Site 33 Housing Accommodation on L.C.C. Estates 33 Underground Room 34 St. George the Martyr Ward—Special Survey 34 Food. Dairies, Cowsheds and Milk Shops 44 Residue from Milk Clarifiers 45 Bacteriological Examination of Milk 45 Tubercle in Milk 46 Consumption of Milk 47 Milk and Dairies Order, 1926 47 Milk (Special Designations) Order, 1923 47 Condensed Milk 47 Dried Milk 48 Margarine 48 Bakehouses 48 Sale of Fish 48 Fried Fish Shops 48 Market Streets and Exposure of Food Generally 49 Street Trading 49 Ice Cream 50 Meat Begulations 51 Places where Food is Prepared for Sale 52 Unsound Food 53 Preservatives in Food Regulations 53 A 2 4 Page Food and Drugs (Adulteration) Act, 1928 53 Articles Analysed 53 Borough Analyst, Notes by 55 Cream Cheese 57 Milk 58 The Merchandise Marks Act, 1926 59 Agricultural Produce (Grading and Marking) Act, 1928 61 Better Beef 61 Food Standards 62 Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 63 Smallpox 64 Vaccination 65 Diphtheria 66 Schick Test and Immunisation against Diphtheria 68 scarlet Fever 78 Acute Rheumatism in Children 78 Typhoid and Paratyphoid Fevers 85 Typhus Fever 86 Cerebro-Spinal Fever 86 Dysentery86 Malaria 86 Encephalitis Lethargica 86 Acute Poliomyelitis 88 Pneumonia 89 Influenza 89 Anthrax 89 Chickenpox 89 Mumps 90 Bacteriological Work 90 Disinfections 90 Cleansing of Persons Act 90 Shelter during Disinfection 91 Verminous Condition and Scabies 91 Extermination of Vermin 91 Tuberculosis 92 Notifications 92 Correction of Register 94 Sleeping Conditions 94 Classification of Homes 95 Delay in Notification 96 Institutional Treatment 96 Visita to Home 96 Contacts 96 Prevention of Spitting 97 Deaths from Tuberculosis 97 Tuberculosis Dispensary 98 Tuberculosis Care Committee 104 Public Health (Prevention of Tuberculosis) Regulations, 1925 106 Home Nursing 106 Dental Clinic 106 Employment of Tuberculous Persons 106 General Dental Clinic 107 Cancer 108 Maternity and Child Welfare 108 Notification of Births 108 Number of Births 109 Births in Crowded Homes 109 Home Visiting 109 Attendances at Infant Welfare Centres 110 Work at Centres 110 10, John Street 110 Short's Gardens 110 Ante-natal Hygiene 111 Confinements in Institutions in relation to Housing Conditions 111 Ante-natal Centres 113 Poet-natal Consultations 114 5 I'sge Instruction in Mothercraft and Hygiene 114 Summer Outing 114 Maternal and Infant Consultations 115 Breast Massage 115 Diarrhœa 116 Stillbirths 116 Illegitimate Births 116 Dental Treatment 116 Supply of Milk and Food for Mothers and Infants 117 Home Help 117 Convalescent Home Treatment 118 Saffron Hill Maternity and Child Welfare Centre 118 Deaths of Children, One to Five Years 118 Deaths of Infants under One Year 119 Infectious Diseases among Mothers and Children 120 Puerperal Fever and Pyrexia 120 Ophthalmia Neonatorum 121 Whooping Cough 122 Measles 123 Measles, Control in Schools 124 German Measles 124 Epidemic Diarrhœa 124 Nursing Arrangements 124 Health and Baby Week 125 Minor Ailments Clinio 126 Medical Inspection and Treatment of School Children 126 Deaths of Children, 5-15 Years 129 Sanitary Administration Mortuary 129 Inquests 129 Removal of Aged Persons 130 Rent and Mortgage Interest Restriction Acts 130 Nuisances—Notified by Relieving Officers 130 Dogs—Nuisance from—By-laws 130 Nuisance from Pigeons 131 Old Buildings—Demolition of 131 Children's Country Holiday Fund 131 Propaganda 131 Soluck Film 131 Better Health 132 Noise 132 APPENDIX. Table I. Vital Statistics, 1930, and ten previous years 133 Table II. Causes of and Ages at Death, l'J30 134 Table III. Infectious Diseases Notified during 1930 135 Table IV. Infectious Diseases in Holborn during 1930 and ten previous years 136 Table V. Information required by L.C.C 137 Table VI. Factories, Workshops, &c. (1) Inspections 138 (2) Defects found 138 (3) Home Work 139 (4) Registered Workshops 140 (5) Other Matters 140 Table VII. Meteorology of London, 1930 141 Table VIII. Legal Proceedings 142 List of Notifiable Diseases (see back of cover). 6 PUBLIC HEALTH COMMITTEE. 1929-30. Chairman— Councillor The Rev. Wilfred H. Davies, M.A. Vice-Chairman— Councillor Harold J. Jewell. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P. Alderman Albert J. Clark. ,, Charles Shortland. Councillor Edmund Balding. „ John H. Boraston, C.B. „ Henry W. Ellis. „ Herbert H. Y. Harrison. ,, Robert Portwine. „ Sir William R. Smith,D.L.,J.P.,M.D. „ George Witherby. „ Arthur Youngman. 1930-31. Chairman— Councillor The Rev. Wilfred H. Davies, M.A. Vice-Chairman— Councillor Harold J. Jewell. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Alderman Albert J. Clark. „ Charles Shortland. Councillor Edmund Balding. ,, John H. Boraston, C.B. „ Henry W. Ellis. „ Herbert H. V. Harrison. „ William M. Morgan. ,, Robert Portwine. „ Sir William R. Smith,D.L.,J.P.,M.D „ George Witherby. HOUSING OF THE WORKING CLASSES COMMITTEE. 1929-30. Chairman— Councillor Roland H. Haxell. Vice-Chairman— Councillor Horace W. Langdon, F.S.I. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P. Alderman James W. Coade. ,, H. Warren Coleman. Councillor Robert P. Bristow. „ Rev. Wilfred H. Davies, M.A. ,, Miss Frances M. Graves, F.R.Hist.S. „ Albert E. Hunter. „ Raymond A. Miles. „ George D. Pooley. ,, Asher Rosenberg. ,, J. St. Laurence Stallwood. 1930-31. Chairman— Councillor Roland H. Haxell, Vice-Chairman— Councillor Horace W. Langdon, F.S.I. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Alderman James W. Coade. Councillor Robert P. Bristow. ,, Rev. Wilfred H. Davies, M.A. ,, Henry W. Ellis. ,, Miss Frances M. Graves, F.R.Hist.S. ,, Albert E. Hunter. „ Raymond A. Miles. „ George D. Pooley. ,, Asher Rosenberg. ,, J. St. Laurence Stallwood. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1929-30. Chairman— Councillor George D. Pooley. Vice-Chairman— Councillor Robert P. Bristow. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P. Councillor Claude Bouillon. „ Miss Frances M. Graves. „ Ernest Hamlin. „ Albert E. Hunter. „ William M. Morgan. „ Albert A. Mussett. „ Robert Portwine. Mrs. Cecil J. Coade. Mrs. H. Warren Coleman. Miss Emily Dibdin. Mrs. Percy Hill. Miss M. Wilmshurst. 1930-31. Chairman— Councillor Robert P. Bristow. V ice-Chairman— Councillor George D. Pooley. Ex-Officio— His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Alderman Sir Robert Dibdin, J.P. Councillor Claude Bouillon. ,, Ernest Hamlin, M.B.E. ,, Albert E. Hunter. „ Albert A. Mussett. ,, Robert Portwine. ,, William H. Rose. ,, Arthur Youngman. Mrs. H. Warren Coleman. Miss Emily Dibdin. Mrs Charles G. L. DuCann. Mrs. Percy Hill. Miss M. Wilmshurst. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Tuberculosis Dispensary London County Council Guardians of the Holborn Union Charity Organisation Society Local Association of Children's School Care Committees. Invalid Children's Aid Association Metropolitan District Nursing Association Almoners of hospitals Insurance Committee for the County of London. Northern London War Pensions Committee British Red Cross Emergency Help Fund Other social workers (co-opted) Councillor H. V. Harrison. Medical Officer of Health (Dr. C. W. Hutt). Councillor Sir William Smith. D.L., J.P., M.D. Tuberculosis Officer (Dr. J. A. Struthers). Dr. F. C. Lewis. Miss H. Bell. Councillor Alfred Humphreys (to March, 1930). Miss E. F. Bolton. Miss A. E. Dove (to April, 1930). Mrs. A. Clarke (from June, 1930). Miss Butler. Miss M. Wilmshurst. Miss J. G. Salmon. Miss A. M. Smith. Miss S. Double (to June, 1930). Mr. H. A. Teakle (from July, 1930). Councillor R. H. Haxell. Major - General Patrick B. Sangster, C.B., C.M.G., D.S.O. (from 1930). Mrs. E. C. Bedford. Mts. C. J. Coade. Mrs. Percy Hill. Miss O. Lazarus. Miss H. M. Mathieson. Cav. R. Terroni. 8 STAFF. Tlie following was the Staff during 1930. Medical Officer of Health—C. W. Hutt, M.A., M.D., M.R.C.P., D.P.H. Medical Officers of Maternity Centres— 10, John Street—Richenda Gillett, M.D.Brux., L.S.A. Winefride M. Gibson, H.B., B.S., M.R.C.S., L.R.C.P. (temporary). Short's Gardens—James Arthur Struthers, M.D., B.Ch., M.R.C.P., D.P.H. Consultant Medical Officer—Puerperal Pyrexia and Puerperal Fever Regulations (1926-1928)— J. D. Barris, M.B., F.R.C.P., F.R.C.S., 50, Welbeck Street, W. 1. Medical Officer of Tuberculosis Dispensary— James Arthur Struthers, M.D., B.Ch., M.R.C.P., D.P.H. Medical Officer—Diphtheria Immunisation—E. Goodwin ltawlinson, 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. Dust Inspector—Charles Luckman (from 2nd June, 1930). Sanitary Inspector and Health Visitor—Ethel Jane Charlesworth, C.M.B. Health Visitor—Muriel G. Stockwell, C.M.B. Tuberculosis Health Visitor—M. Watson. Chief Clerk and Committee Clerk—Edwin Kent. Assistant Clerks—Frank Fitch. Arthur Long. Albeit R. Shott, Inter.B.Com. (Lond.) (from May, 1930). Mary E Slielton (to June, 1930). Lena Beadle (from July, 1930). Dentist— Sidney Adams, L.D.S. (British Dental Hospital). Anœsthetist—P. Lloyd-Williams, M.R.C.S., L.R.C.P. Nurses—The Metropolitan Nursing Association. Mortuary Keeper and Superintendent of Cleansing Station—Arthur C. Britton (to July, 1930). Bertie Downing (from July, 1930). Superintendent of Women's Cleansing Station—Bertha R. Britton (to July, 1930). Nellie M. Downing (from July, 1930). Caretaker of Maternity Centre—Elizabeth Alderton. Home Help—Ellen Bohling. (Address 1f, Peabody Buildings, Herbrand Street, W.C. 1.) And Panel of Emergency Home Helps. Disinfector— Henry Emms. Assistant Disinfector—E. E. Denny. Deputy Disinfector—J. Jefferson. Addresses of other Public Officials more or less connected with Public Health Work. PUBLIC VACCINATORS. Holborn District, Eastern part of Borough (East of Southampton Row)— Dr. P. J. Connolly, 43, Rosebery Avenue, E.C. 1. Telephone No. Terminous 4624 Hours 11 a.m. to 12 noon, and 6.30 to 8 p.m. (except Thursday evenings). St. Giles and Bloomsbury District, Western part of Borough (West of Southampton Row)— Dr. Ernest G. Wheat, Gloucester Mansions, Cambridge Circus Telephone No. Temple Bar 1040. Hours 3 to 5 p.m. daily. 24, Meredith Street, Rosebery Avenue, E..C. 1. Telephone No. Clerkenwell 8065 Hours 6 to 8.30 p.m. (except Thursday evenings). Vaccination Officer—Mr. Percy E. Capps, Town Hall, 197, High Holborn, W.C. 1. Registrars of Births and Deaths—Mr. E. J. Comfort, 20a, Harpur Street. Mr. Percy H. Durrant, 14, 16 and 18, Bloomsbury Street. Certifying Surgeon (Factory & Workshop Acts)—Dr. W. D. Brunton, 72, Euston Square, N.W.I H.M. Inspector of Factories—Mr. H. Clarke, 68-70, Baker Street, W. 1. District Surveyor—Mr. William G. Perkins, 11, Gray's Inn Square, W.C. 1. H.M. Coroner—S, Ingleby Oddie, Esq. Coroner's Officer—Mr. James Stabb, 46, Baker Street, Lloyd Square, W.C. 1. 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1930. Area of Borough in acres 405 1 Population —estimated to middle of 1929 (as supplied by the Registrar-General) for birth and death rates 38,380 Population—Census, 1921 43,192 Number of inhabited houses (1921) 6,494 Number of families or separate occupiers (1921) 9,682 Rateable value 1st November, 1929 £1,650,869 Rate of 1d in the £ estimated to yield £6,604 Live Births [ Total M. F. 405 Legitimate 354 183 171 .Illegitimate 51 15 36 Annual rate of births per 1,000 population 106 Still births 22 Rate per 1,000 total births 54 Deaths 488 Annual rate of deaths per 1.000 population 12.7 Percentage of total deaths occurring in Public institutions 71 Number of women dying in, or in consequence of, childbirth from sepsis 1 „ other causes 1 Deaths of infants under one year of age per 1.000 births 89 Deaths from measles (all age«) 12 „ „ Diphtheria (all ages) 2 ,, „ whooping cough (all ages) 1 „ „ diarrhœa (under two years of age) 5 Zymotic death rate* 0.39 Tuberculosis death-rate per 100,000 112 Excess of registered births over deaths — Excess of registerel deaths over births 83 * Excluding deaths from Epidemic diarrhœa. Population and Houses. The following estimate of papulation as supplied by the Registrar-General for the year 1929 has been adopted for the calculation of the death-rate and birth-rate of the Borough for the year 1930—38,380. The density of the population in 1921, according to the Census of that year, 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, 10 Although the number of hotels and boarding houses keeps increasing, the Borough continues to become less residential 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 29, a death-rate of 8-3 per 1,000, considerably below the average death-rate for the whole of the Borough. On the other hand the number of deaths of residents of Common Lodging Houses in the Borough, which contain 835 beds, was 44 which, calculated on the number of beds, was a rate of 53 per 1,000. The birth-rates and death-rates given in this report are the crude rates, that is to say no correction has been made for sex and age distribution. The population of the Borough, however, is such that probably a truer indication of the birth and death incidence would be indicated by rates corrected for such distribution. As. however, the Registrar-General in his summary tables and statistical review gives crude rates only, it is thought better for comparison purposes to adopt the same principle for this report. The report of the Census, 1921, points out that the City of London and Holborn stand rather apart from the other Boroughs, owing to the general unsuitability of their dwellings for private family occupation. Here the relatively high population of males is similar to that found in the industrial areas; but there are fewer young children and the population is in consequence above the normal as regards age. In rateable value Holbom ranks only lower than the Cities of London and Westminster and eight other London Boroughs, and is higher than such extended Boroughs as Battersea, Camberwell. Hackney, Lewi sham and Southwark. Yital Statistics, 1930. England and Wales, London and Holborn. Annual Rates per 1,000 living. Deaths under 1 year to 1,000 Births. Births. Deaths. England and Wales 16.3 11.4 60 London 15.7 11.4 59 Holborn 10.5 12.7 89 Registered Births. The total number of births registered as occurring in the Borough was 255 (128 males and 127 females). Of these, 238 were legitimate and 17 illegitimate. 11 Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 129 legitimate infants and 40 illegitimate infants whose mothers were residents of the Borough. Nineteen of the births occurring in the Borough, 13 legitimate and 6 illegitimate, were infants of mothers who were nonresidents of the Borough. The corrected number of births is therefore 405, and the corrected birth rate 10-55. The following table gives the corrected number of births and the corrected birth-rates for the twenty years 1910-1930: — 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. Bate per 1,000 of population. Proportion per 1,000 total Registered Births. 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 12.61 919.3 48 1.10 80.7 1924 578 13.36 532 12.30 920.4 46 1.06 79.6 1925 527 12.16 490 11.31 929.8 37 0.85 70.2 1926 535 12.38 489 11.32 914.0 46 1.06 86.0 1927 505 11.96 452 10.71 895.0 53 1.25 105.0 1928 473 12.04 436 11.10 921.8 37 0.94 78.2 1929 392 10.21 350 9.12 892.9 42 1.09 107.1 1930 405 10.55 354 9.22 874.1 51 1.33 125.9 In London the corrected birth rate in 1930 was 15.7 per 1,000 in comparison with 15.7 for 1929. In Holborn, as in most other districts, there has been a marked reduction in the birth-rate in the last 20 years, the rate for 1930 being only 10.55 per thousand in comparison with 20.27 in 1910 (20 years ago). 12 Mortality. The total number of deaths registered as occurring in the Borough was 693, of which 421 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 Bloomsburj'. Holborn. French Hospital 2 - 38 - Children's Hospital 1 7 _ 233 National Hospital - _ - 122 London Homoeopathic Hospital 1 9 — 56 Italian Hospital 2 4 — 23 St. Paul's Hospital 2 — 30 — Private — 1 15 2 Royal Westminster Ophthalmic Hospital — — 4 — Total 8 21 87 436 There were 318 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 44 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 1930 gives the total deaths for the Borough as 488. Corrected Deaths and Death-Rates, 1930. compared with 1929. 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. 1930 693 534 523 318 488 12.7 11.4 1929 766 554 545 377 598 15.6 13.8 For details of causes of and ages at death, see Table II, page 134. The principal cause of decrease in the death-rate, as compared with 1929, was the deaths from influenza, 1 as compared with 44 in the preceding year. 13 Seasonal Mortality. Thu 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 ... 132 13'8 137 Second ,, 130 13'6 10 "8 Third „ 93 97 9'3 Fourth „ 135 131 117 490 12 8* 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:— 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. 1930 36 85 118 89 59 1929 29 77 48 74 70 Death-rate per 1,000 corrected births in 1930 and in ten preceding years. 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 Avge, 1920-29 1930 Holborn Borough 66 79 72 79 81 63 90 38 57 74 69.9 89 London 75 80 74 60 69 67 64 59 67 70 68.5 59 See also Table, page 119. 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. Poor Law and Hospital Relief. The Local Public Assistance Officer 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 1930:— Indoor Relief 1,215 persons Outdoor Relief 321 cases Outdoor Medical Relief 185 persons * These figures, as published in the Registrar-General's Quarterly Returns for 1930, are for the 53 weeks ended 3rd January, 1931; tho complete corrections for the year 1930 decrease the number of deaths to 488 and the rate to 12.7 per 1,000. The corresponding rate for London was 11.4. 14 Deaths in Public Institutions. Of the total number of 488 deaths, 347 died in hospital and public institutions either within or without the Borough. General Provision of Health Services in the Borough. 1. Public Health Officers.—See page 8. 2. Nursing in the Home. (a) General.—Nursing service for the sick poor is supplied by the Metropolitan District Nursing Association, 31, Bedford Place, W.C. 1. (b) Infectious Diseases. By arrangements made by the Borough Council with the Nursing Association, nurses are available for cases of:— Summer Diarrhœa (in children under 2 years of age). Measles with severe complications. Whooping Cough with severe complications. Lobar Pneumonia. Influenzal Pneumonia. Ophthalmia Neonatorum. Pemphigus Neonatorum. Puerperal Fever. Puerperal Pyrexia. Tuberculosis. Maternity.—By arrangement with the Metropolitan District Nursing Association, skilled maternity nursing' is available for necessitous maternity cases subject to the prior approval of the Maternity and Child Welfare Committee or the Medical Officer of Health, also for complications after confinement, including deficient lactation. Contributions towards the service are required in connection with maternity nursing and the nursing of puerperal fever and puerperal pyrexia, the amount being assessed according to ability to pay. Some Helps.—Home Helps are available for service in homes during confinements— contributions towards the cost are required in accordance with ability to pay. 3. Midwives. The Borough Council does not employ or subsidise midwives. 4. National Health Insurance. No necessity has arisen for any special co-operation. 5. Poor Law Medical Relief.—See page 13. 6. Laboratory Facilities. Bacteriological examinations (sputum, swabs, etc.), carried out at the laboratory of the Royal Institute of Public Health, 37, Russell Square, W.C. 1. Chemical analysis, milk and foodstuffs, carried out by the Borough Analyst at his laboratory, Finsbury Town Hall, Rosebery Avenue, E.C. 1. 7. Legislation in Force:— Local Acts.—The London County Council (General Powers) Acts. Special Orders.-—The Holborn (Acute Rheumatism) Regulations, 1929, requiring the notification of acute rheumatism in children up to the age of 16 years (see page 78). April, 1929. By-laws relating to Public Health. (i) Made by the Holborn Borough Council:— Public Health (London) Act, 1891:— Prevention of nuisances arising from matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces Aug., 1893 Keeping of waterclosets supplied with sufficient water Aug., 1893 Securing cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water Aug., 1893 The decent conduct of persons using the public lavatories Mar., 1897 15 Municipal Corporations Act, 1882, Local Government Act, 1888, London Government Act, 1899. For the suppression of street cries Oct., 1904 Prevention of nuisances by dogs (deposit of excrement on footway) April, 1926 Prevention of nuisances from wireless loud speakers and gramophones Decr., 1930 Baths and Washhouses Act, 1846. For the regulation of public baths and washhouses May, 1877 London County Council (General Powers) Act, 1927. Regulation of street trading Feby., 1928 (ii) Regulations inade by the Holborn Borough Council:— Housing Acts. Underground rooms habitually used as sleeping places Feby., 1915 (iii) By-laws made by the London County Council:— Public Health (London) Act, 1891. Closing of cesspools and privies June, 1893 Removal of fæcal and offensive matter June, 1893 With respect to ashpits and receptacles for dung June, 1893 Bone boiler, manure manufacturer or tallow melter Nov., 1907 Gut scraper and catgut maker Nov., 1907 Fat melter Nov., 1907 Fellmonger Nov., 1907 Dresser of fish skins Nov., 1907 Dresser of fur skins Mar., 1922 Glue and size manufacturer Nov., 1907 Knacker Nov., 1907 Slaughterer of poultry Decr., 1923 Soap boiler Nov., 1907 Tripe boiler Nov., 1907 Slaughter houses (conduct of business) April, 1923 and July, 1925 Waterclosets, urinals, etc. Aug., 1930 London County Council (General Powers) Act, 1903. Rag and bone dealer Sept., 1923 Rag and bone dealer (balloons and toys) June, 1928 Fish curer Feb., 1914 Vendor of fried fish Mar., 1930 London County Council (General Powers) Act, 1903. Conveyance of carcases of dead horses Feb., 1905 London County Council (General Powers) Act, 1927. Demolition of buildings Nov., 1929 Metropolis Management Act, 1855. Drainage Mar., 1930 Slaughterhouse, etc. (Metropolis) Act, 1874. Local Government Act, 1888. Slaughterer of cattle Oct., 1891 Public Health (London) Act. 1891, and Housing Act, 1925. With respect to houses divided into separate tenements Mar., 1926 8. Hospitals. Hospitals provided or subsidised by the Local Authority or by the London County Council fever and Smallpox.—Hospitals for patients suffering from these diseases are provided by the London County Council—one of the hospitals of the Council (St. Margaret's) is also available for cases of Marasmus and Ophthalmia Neonatorum. Tuberculosis—Residential institutional treatment for tuberculosis is provided by the London County Council. The Borough Council's Tuberculosis Dispensary is situated at, and linked up with, the University College Hospital. Maternity.—The Borough Council has arranged for the reservation of beds for maternity cases at the University College Hospital. Contributions towards cost of maternity service are paid by the Council to :- University College Hospital; City of London Maternity Hospital; Royal Free Hospital; and other hospitals providing maternity service for Holborn mothers. 16 Hospitals Situated in the Borough of Holborn—Not Subsidised by the Local Authority. Name. Situation. Purpose. Number of Beds. Management. Special Departments. Arrangements for Pathological Work. X-Ray. Dental. Ophthalmic. Massage. Other. French Hospital Shaftesbury Avenue Genera1—for all poor who speak French 70 Voluntary body Yes Yes Yes Visiting masseuse Genito-urinarydept. gynæcological dept. Honorary Pathologist and Assistant Pathologist work daily in the department for this special purpose Hospital for Sick Children Great Ormond Street For treatment of sick children 252 Voluntary body Yes Yes Yes Yes Pathological laboratories; research laboratories for Rheumatism and Asthma Italian Hospital Queen Square Genera1—for people of Italian extraction especially, but all nationalities treated 58 Voluntary body Yes Yes Yes Yes Gynæcologicaldept. ear, nose & throat dept. Slides and microscopic by House Surgeon ; sectioning and bacteriological work by arrangement with Hospital for Sick Children National Hospital ... Queen Square ... Nervous system, paralysis and epilepsy 265 Voluntary body Yes Yes Yes Yes Remedial exercises, electrical, aural, psychiatric, orthopaedic, pathological research. Large laboratory with a number of research workers. Pathologist and Assistant Pathologist. Bio-chemical examinations are carried out Royal Westminster Ophthalmic Hospital Broad Street ... Eye 86 Voluntary body Yes No Yes No Artificial light dept. Laboratory for bacteriology and pathology London Homœopathic Hospital Great Ormond Streetand Queen Square General 172 Voluntary body Yes Yes Yes Skin; throat, nose and ear; orthopaedic ; ultra-violet light Laboratory under a pathologist and two lay assistants St. Paul's Hospital Endell Street Genito- urinary and skin (includes venereal disease) 33 Voluntary body Yes Yes No Yes Ultra-violet light... The "Pickett-Thomson" Laboratory (St. Paul's Hospital) does all pathological work N.B.—The use of the above hospitals extends to residents outside the Holborn Borough area. 17 9. Maternity and Nursing Homes. The Local Supervising Authority in London under the Nursing Homes Registration Act, 1927, is the London County Council. 10. Maternal Mortality. Maternal deaths are investigated by the Medical Officer of Health; cases of puerperal fever and puerperal pyrexia by the Health Visitors. 11. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. There are no institutions for unmarried mothers, illegitimate children or homeless children in the Borough, but St. Faith's Home, Myddelton Square, receives such mothers from the Holborn area. 12. Institutions for the Care of Mental Defectives. There is no institution in the Borough for the care of mental defectives. 13. Ambulance Facilities. For Infectious Cases—Provided by the London County Council ('Phone : City 7200). For Non-Infectious Cases—The Ambulances of the London County Council. (Minimum fee 10/-.) For Accidents—The London County Council and the St. John Ambulance Association. For Maternity—The London County Council Ambulances ('Phone Hop 5000). 14. Clinics and Treatment Centres. Ante-natal and Post-natal Clinic. 10, John Street (Municipal) Tuesday at 2 p.m. Maternity and Child Welfare. 10, John Street (Municipal) {Tuesday} {Wednesday} {Thursday} {Friday} at 2 p.m. St Giles' Buildings (Municipal) (Short's Gardens) {Monday} {Thursday} at 2 p.m. Saffron Hill, Onslow Street {Thursday} { Friday} 2-1 p.m. 6-7.30 p.m. Pre-School Child. 10, John Street (Municipal) Monday at 2 p.m. Minor Ailments Clinic. 10, John Street (Municipal) {Tuesday} {Friday} at 2 p.m. Diphtheria Schick Test and Immunisation. 10, John Street (Municipal) Wednesday at 2.30 p.m General. Bloomsbury Dispensary, 12, Bloomsbury Street Daily. Acute Rheumatism (Children), up to age of 12 years. Hospital for Sick Children, Great Ormond Street Daily. Dental. 10, John Street, for expectant and nursing mothers and children up to 5 years (Municipal) Thursday at 2 p.m. 10, John Street, General and for Tuberculous Patients Tuesday at 6 30 p.m. School Clinics—Provided by the London County Council (see page 126). Day Nurseries.—Established and controlled privately :— Kingsway Creche, Kingsway Hall, Kingsway. field Lane Institution Creche, Vine Street, Clerkenwell Road St. Alban's Day Nursery, Greville Street. B 18 Tubereulosis Dispensury. At University College Hospital (ertrance in Hantley Street) Venereal Diseases.—Treatment clinics are arranged by the London County Council. Those in the Borough are: — St. Paul's, Endell Street, daily 8 a.m. to 10 p.m., Hospital for Sick Children (for children only), Great Ormond Street, 9-10 a.m. daily and 2-4 p.m., except Wednesday and Saturday. Cleansing Station for Verminous Persons. Goldsmith Street, Drury Lane. Births and Deaths—Registration. Holborn Sub-District (Eastern half of Borough). 20a, Harpur Street Theobalds Road. Daily, 9.30 a.m. to 1C.30 a.m. Wednesday evening, 6 to 8 p.m St. Giles and Bloomsbury Sub-District (Western half of Borough). Oakley House, 14, Bloomsbury Street. Daily, 11 a.m. to 12 noon. Monday and Friday, 2 to 3 p.m. 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 collection of house refuse from the main streets is 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 works well on the whole. 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 134. During the year the contractors brought into use three modern dust collecting vehicles of the low loading type, and improved the vehicles of the high loading type by providing sectional covers. Appointment of Dust Inspector. The Inspector appointed to supervise the removal of house refuse commenced his duties on the 2nd June, 1930. He is required to report to the Medical Officer of Health daily respecting: — (a) Early morning collections from main streets. (b) Condition of ashbins placed on the footways in streets where there :'s a daily collection. (c) The use of bins failing to comply with the by-laws. (d) Litter on the public way. (e) Regularity of collection from streets where the removal is bi-weekly. 19 (f) Break-down of vehicles causing delay in collection of refuse. (g) Complaints received of non-collection, delay, etc. (h) Spillage or litter made by dustmen and not properly cleared up. (i) Generally on any matters relating to or arising in connection with the removal of refuse. Litter on the Public Way. Much attention continued to be paid to the question of litter on the public highways. Part of the litter, but by no means all, is from refuse bins placed on the footway in front of houses in main streets waiting the early morning daily collection. Generally the litter from this source comes from one or more of the following causes: — (a) Refuse blown from overloaded bins. In this connection efforts are made to ensure the provision and use of sufficient ashbins to contain the refuse produced and so avoid overloading. (b) The use of uncovered bins. Communications drawing attention to the use of uncovered bins are sent to occupiers whenever bins without lids are found put out on the public way. Also every opportunity is taken to advocate the use of a special bin now on the market with an attached lid. A considerable number of occupiers of premises in the Borough have adopted this type of bin which in actual use is proving satisfactory. It ensures a covered bin, and is moreover an advantage to the occupier because it avoids the loss of the bin lid, an experience so often complained of when the lids are detachable. (c) Spilling resulting from the turning over of the refuse by " totters " or children. To prevent interference with the refuse by " totters " or children, the police have been invited to co-operate by taking any possible action to stop the practice. Teachers in elementary schools have also been asked to include in their lessons on hygiene reference to the practice common amongst children—boys particularly—of searching in the dustbins for cigarette cards, etc., a habit at once objectionable and unhygienic. (d) The use of improper or/and defective bins. The use of improper receptacles such as cardboard boxes, tea chests, crates, paper parcels, etc., is a frequent source of trouble, as is also the use of defective metal receptacles. It is necessary constantly to direct attention to the use of such containers. A large part of the litter on our highways does not come from dustbins, such as smokers' refuse, cigarette cartons, used matches, empty match boxes, etc. Towards the end of 1929, as an attempt in some way to meet the position a suggestion was made to a largo firm of tobacconists with many retail shops, that the Company concerned should lead the way in placing litter bins in their shops, and, if possible, persuading restaurants where their goods are sold to do the same. A reply was received from the Chairman and Managing Director of the Company appreciating the suggestion and the spirit in which it was made and promising consideration. Action in this direction would have an educational value in addition to its immediate practical benefit. Reference may also be made to the action taken by the London General Omnibus Company, Limited, in the display of notices in their vehicles asking passengers to leave used tickets in the omnibus; in a number of their omnibuses the Company have provided boxes, conveniently placed for use as receptacles for used tickets. 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, but one notice was served in respect of an unsatisfactory manure receptacle; the necessary improvement was effected. B 2 20 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 18,859 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, 1930. Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Complaints received 51 45 56 ... ... 152 Do. found to be justified 51 45 56 ... ... 152 Inspection of Houses — Dwelling-houses 74 260 84 ... ... 418 Houses let in 1odgings 308 340 147 29 ... 824 Common lodging-houses 11 8 4 ... ... 23 Schools ... ... ... ... ... ... Drains tested by water 2 ... 1 ... ... 3 Drains tested by smoke ... ... 10 ... ... 10 Re underground rooms ... l ... ... ... 1 „ Rent (Restriction) Act 1 2 ... ... ... 3 „ New Buildings 4 ... ... ... ... 4 Factories — Bakehouses 13 18 3 ... ... 34 Food preparation (other than above) 9 ... 53 ... ... 62 Other 60 47 144 5 ... 256 Workshops and Workplaces — Food premises: Dairies and Milkshops 25 51 18 ... ... 94 Ice Cream, Manufacture ... 5 47 ... ... 52 Do. Storage or Sale ... 2 ... ... ... 2 Slaughterhouses ... 3 ... ... ... 3 Hotels and Restaurants 125 62 197 ... ... 384 Butchers 327 14 272 ... ... 613 Bakehouses 16 3 6 ... ... 25 Fish shops 185 9 8 ... ... 202 Fried Fish shops 32 12 7 ... ... 51 Market Streets 327 43 451 ... ... 821 Licensed Premises 1 1 ... ... ... 2 Other food shops 290 133 104 ... ... 527 Other workshops 119 108 196 36 ... 459 Other workplaces Outworkers' Registers 27 35 71 3 ... 136 18 46 55 ... ... 119 Stable and Stable yards 34 57 ... ... ... 91 Rag and Bone shops 88 2 ... ... ... 90 Outworkers' rooms † ... ... ... ... ... ... Offices 5 3 7 ... ... 15 Miscellaneous — Black smoke 37 2 68 ... ... 107 Dust, Special Inspections 26 202 47 ... ... 275 Rats and Mice (Destruction) Act 83 122 98 ... ... 303 Food and Drugs (Adulteration) Act, sampling 210 205 177 ... ... 592 Demolition of buildings 17 3 3 ... ... 23 Other Inspections 10 2 33 4 11 60 Keeping of Animals 2 1 3 1 ... 7 Periodical Inspections: Includes W.C. and yards, dustbins, especially houses let in lodgings, and other suitable buildings 1,479 1,511 1,947 ... ... 4,937 Inspections carried forward 3.965 3,313 4,261 78 11 11,628 † 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. 21  Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Brought forward 3,965 3,313 4,261 78 11 11,628 Re-Inspections— Houses 598 912 497 ... ... 2,037 Factories 2 10 8 ... ... 20 Workshops and Workplaces 40 49 78 ... ... 167 Restaurants 16 2 6 ... ... 23 Licensed premises ... ... ... ... ... ... Miscellaneous ... ... ... 21 128 149 Visits re Infectious Diseases 63 180 176 141 218 778 Do. on School Reports ... ... ... ... ... ... Scabies 1 2 ... 3 1 7 Vermin ... ... 6 ... ... 6 Other Visits— Police Courts ... 10 4 ... ... 14 Various 316 601 696 11 ... 1,824 Maternity — Visits: Children under 1 year ... ... ... 123 208 331 Do. 1 to 5 years ... ... ... 4 5 9 Expectant Mothers ... ... ... 46 69 115 Re-visits : Children under 1 year ... ... ... 96 411 507 Do, 1 to 5 years ... ... ... 90 276 866 Expectant Mothers ... ... ... 61 162 223 Other Maternity Visits ... ... ... 120 141 261 Attendances at Maternity Centres ... ... ... 202 192 394 Total 5,000 5,109 5,932 996 1,822 18,859 Notices Served. 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 notices requiring annual cleansing of houses let in lodgings, was 1,240, viz. :— Public Health (London) Act, 1891— Intimation Notices 479 Statutory Notioes 86 By-laws— Houses let in Lodgings 635 London County Council (General Powers) Acts— Verminous rooms 35 Rats and Mice (Destruction) Act, 1908 5 1,240 22 The following table shows the work done to abate nuisances for which intimation notices were served: — Houses. Factories, Workshops and Workplaces. Water Supply— Provided 2 — Cisterns cleansed, repaired etc. 17 2 Waterclosets— Cleansed 13 6 Water supplied, flushing cistern repaired, etc. 12 3 Repaired, new pans, etc. 77 10 Ventilation improved — 6 Separate accommodation for sexes provided 9 Position or construction improved ... 1 5 Direct communication with workrooms remedied 1 Accommodation provided 1 3 Soil Pipes— Repaired, renewed and ventilated 2 4 Rainwater Pipes— Repaired or renewed 12 7 Drains— Repaired 16 11 Unstopped, cleansed, etc. 21 5 Sinks, etc.— Waste pipes repaired, renewed, etc. 21 1 Yards, Areas and Wash houses— Cleansed 10 3 Paved and paving repaired 20 4 Houses and Workshops, etc.— Cleansed 56 64 Dilapidations repaired and made good 42 3 Ventilation improved 2 — Dampness— Roofs repaired 50 5 Gutters repaired 8 2 Other works to prevent dampness 14 3 Ashbins— Provided, repaired, etc. 107 27 Various— Underground Rooms vacated 7 — Smoke—Emission of black smoke abated 1 2 Accumulations of Refuse—Removed 26 12 Overcrowding abated 6 — Other nuisances abated 13 10 Manure receptacle — 1 Animals improperly kept 4 — Statutory Notices. The following table shows the nuisances for which the 86 Statutory Notices were issued under the Public Health (London) Act, 1891. Houses. Factories, Workshops and Workplaces. Section 2 (a) Dirty and delapidated or damp premiess, &c. 29 5 „ (b) and Section 37, Ashbins 18 3 „ (c) Drains and W.C.'s 18 7 „ (d) Accumulation of rubbish 8 1 „ (e) Overcrowding 2 — „ (f) and Section 48. Water supply 2 — „ (g) Ventilation 2 3 ,, 38 W.C. absence of separate accommodation for sexes — 4 „ ,, Insufficient accommodation 2 — „ 96 Underground rooms 2 — 23 By-Laws as to Houses let in Lodgings. At t he end of the year 493 houses were registered under these By-laws. Of these, 237 are in St. Giles and Bloomsbury and 256 in the Holborn District. There were 824 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 142 notices were served for breaches of the By-laws, in addition to 493 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. Ninety inspections of rag and bone shops were made in the year 1930; no breach was found of the By-laws made by the London County Council for regulating the conduct of this business. Rats and Mice (Destruction) Act, 1919. During the year 174 premises were inspected under the above Act, the total inspections being 303. Five notices for breaches of the Act were served. As a result in all five cases' rat proofing was carried out; at one premises this included new drainage, at another the front cellar was repaired, and at another the proofing included repair of the paving in the basement. In addition to the proofing, poisons and traps were used. At the end of the year four of the five premises were reported to be clear of infestation ; at the fifth a rat is only occasionally seen. A complaint was received of the presence of rats in the playground of an elementary school, access thereto being by way of defective air bricks) from under the floor of the school. Inspection of the premises afforded no evidence of rats in the cellars under the school building or in the adjoining premises. The School Managers were advised to employ a rat catcher to deal with the nuisance at the moment and to carry out rat proofing during the following summer holiday. This course was adopted and no further nuisance has occurred. 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 and "Dalroc" which are found to be more effective than barium carbonate. The baits were laid in the sewers weekly during the year and four times during the first week in November. Thirteen gallons of the poison were used, making 19,600 baits. The men who work in the sewers report that the baits were taken aud dead rats occasionally seen, some probably being washed away. (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 firms 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. Where rat catchers are employed under the arrangements made by the Council, information is given to the Medical Officer of Health by the firms employed as to the work done and the results, but in many cases these or other firms are called in apart from the Council's arrangements and information in such cases may not be given to the local authority. 24 The question might be thought worthy of consideration whether it would be advisable and useful if statutory obligation were, placed on all persons carrying out rat repression work to notify the presence of rats to the local authority. In the absence of a statutory obligation to do so, it would be unreasonable to expect the contracting firm to notify,, as strong objection to such action might be taken by occupiers. On the other hand, knowledge of the presence of rats in a particular building might enable the local authority to initiate concerted action by owners of other property in an infested block and so enhance the prospect of dealing effectually with the pest. The firms who undertake rat repression work in the Borough under the arrangements made by the Council have agreed to furnish information of all their work in the Borough. Rats and Mice (Destruction) Act, 1919. Summary of conditions found on inspections, action taken and results obtained. WARD. Number of premises inspected. Number rat infested. Action for Rat Repression. RESULT. Traps. Poisons. Rat catchers. Dogs. Cats. Proofing a. 12 2 — — 2 - — 1 Free 2 b. 19 4 1 — 1 — — 3 F ree 3 Numbers reduced 1 C. 10 2 1 1 - — 2 1 Free 1 Rats occasionally seen 1 d. 24 12 2 - — - - 11 Free 10 Rats occasionally teen 2 e. 1 1 - - — 1 - — Numbers reduced 1 F 31 13 4 7 1 1 8 Free 6 Numbers reduced 4 G. 13 • 4 2 1 - - - 2 Rats occasionally seen Free 3 Rats occasionally seen 1 Premises demolished 1 H. 43 19 3 5 10 — 3 5 Free ... ... 13 Rats occasionally seen 4 i. 21 14 1 2 5 1 3 4 Free 11 Rats occasionally seen 3 ' ^ 174 71 14 16 19 3 8 35 Free 50 Numbers reduced 6 Rats only occasionally seen 14 Premises demolished 1 25 In one case where the department was asked to advise respecting the employment of a rat catcher the action resulted in the Company concerned arranging for the permanent employment of the firm undertaking the rat repression work. Rat Week. In the observation of Eat Week in the Borough we endeavoured as in previous years to secure during the six days, 3rd to 8th November, intensive action and co-operation by occupiers in rat infested blocks. As a corollary to this, the importance of systematic routine work for the extermination of rats and the prevention of rat infestation was emphasised. Suitable poisons were sold in the Public Health Department and an increased quantity of rat baits laid in the sewers under the Council's control. It is customary to put down about 400 baits per week. During Eat Week the number was increased to about 2,800. The sewermen reported that dead rats are not often seen and they expressed the view that when dead the rats are washed away down the sewers, and further that there has been a decrease in the number of rats seen in the sewers during the past few years. The results obtained from the special work in Eat Week are included in the summary table on page 24. Smoke Abatement. The smoke shafts in the Borough were frequently kept under observation and in 107 cases the inspections were recorded. A number of the observations were made in the early morning when smoke pollution is more prevalent. Frequently the observations extended for periods of not less than one hour. Two complaints were received during the year of nuisances from the emission of smoke; as the result of the inspections made three notices were served. It is gratifying to know that the domestic smoke problem is now receiving more attention and the control of domestic smoke appears to be reaching a more practical stage. Greater interest is being taken in the production and supply of smokeless fuel. In this connection it may be observed that gas coke is still largely neglected as a domestic fuel yet a good dry gas coke gives an ideal fire where the householder is sufficiently interested to learn how to use it. Unfortunately much coke is supplied to the public in a wet condition; all coke burnt should be quite dry. Vertical coke, i.e., gas coke prepared in modern vertical retorts yields excellent fires in the all fire-brick grate; it only costs half as much as a coal fire. It would seem possible that we are nearing the time when the burning of raw coal in a domestic grate will be prohibited. Personal observation by burning smokeless fuel in a slow combustion open grate shows that given ordinarily careful addition of fuel to the fire in time to prevent it going down a satisfactory fire is achieved with a warm dull red glow. Smokeless fuel should be invaluable in those instances, both domestic and office where for some reason down draught is difficult to prevent. We must all be cognisant of some chimneys where in spite of the careful attention of competent engineers their efforts do not result in removal of down draught, and in stormy weather the room, supposed to be ventilated by the chimney, becomes full of smoke with consequent defilement of valuable papers, some of which have to be handled frequently. 26 In previous Annual Reports reference has been made to the need for classes for stokers. It is interesting to record that at the Northampton Polytechnic, St. John Street, E.G. 1, arrangements were made during the winter 1980-31 for courses of twelve lectures on boiler house technology and eight lectures on the theory and practice of stoking. Some indication of the extent of the London smoke haze may be gathered from a declaration made by Mr. Entwistle, Superintendent of the Aviation Services Division of the Meteorological Office who says that if the smoke cloud could be removed many more flying days per year would be possible over the London area. As it is on the London-Continental air route an appreciable haze due to the smoke of London is met with over the Channel some miles from the Kent coast. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 352 factories were inspected, 484 workshops and 2,993 workplaces. 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 through a large number of visits and inspections were made in addition to the routine inspections mentioned above. As the result of these visits 39 premises no longer used for the purpose for which they had been registered were removed from the register of workshops. In some 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 37 workshops were added to the register. Of the 611 workshops on the register at the end of the year 325 employed men only, 60 employed women only, and 226 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 149 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 15 - 1 16 Builders 13 - - 13 Cabinet makers 7 - - 7 Carpenters 10 - - 10 Clock and watch makers 11 - 1 12 Dressmakers and ladies' tailors 1 22 22 45 Diamond mounters 8 - 3 11 Engravers 14 - 2 16 Class blowers 8 - 2 10 Jewellers 39 - 12 51 Lamp shade makers - 3 2 5 Leather goods makers 5 - 5 10 Metal workers 6 - 1 7 Picture framers 9 - 1 10 Tailors 33 5 54 92 27 Factories. These visits also afforded all 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 436 factories were 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 110 longer be inspected by the Borough Council's staff except as regards sanitary accommodation. The 436 factories include 50 different industries. In 210 cases men only were employed, in 18 women only, and in 208 both sexes. The more important industries carried on in these factories are :— Bookbinding 19 Engineering 46 Jewellers' work 13 Metal work 11 Printing 98 The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1930: — Mr. Bennett. Mr. Clark Mr. Larard. Miss Charlesworth. Total. Factories— Inspections 55 32 167 2 256 Re-inspections 2 8 9 19 Workshops— Inspections 105 65 188 17 375 Re-inspections 4 9 13 — 26 Workplaces— Inspections 24 23 63 3 113 Re-inspections 17 16 51 — 84 Offices— Inspections 3 3 7 — 13 Re-inspections - 1 - 1 Bakehouses— Inspections 26 16 8 — 50 Restaurants— Inspections 123 31 195 — 349 Re-inspections 13 1 6 — 20 Licensed Permises- Inspections 1 2 - - 3 Defects Found— Want of cleanliness 23 19 23 1 66 ,, ventilation 2 3 2 — 7 Accommodation for refuse 5 15 2 - 22 Accumulation of refuse 2 3 4 1 10 Sanitary accommodation Insufficient 2 1 1 - 4 Unsuitable 1 1 3 - 5 Defective 1 2 6 1 10 Not separate for sexes 1 4 4 — 9 Other nuisances 11 19 26 - 56 Total defects 48 67 71 3 189 28 Action taken. Matters referred to H.M. Inspector :— Failure to affix abstract 3 Matters referred by H.M. Inspector Notified by H.M. Inspector 19 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charles- worth. Total. Factories— Intimation — 7 9 — 1G Statutory — 1 1 — 2 Workshops— Intimation ... 21 24 14 2 61 Statutory — 4 4 — 8 Workplaces— Intimation ... 1 15 19 — 35 Statutory 4 4 — 8 Offices— Intimation ... - 1 - — 1 Restaurants— Intimation ... 16 11 15 — 42 Statutory 1 - — 1 Licensed Premises— Intimation ... — — - — 1 Legal Proceedings - - - - - Outworkers. Lists received from Holborn Firms 109 Names and addresses received from other Authorities . 418 Names and addresses sent to other Authorities 303 Notices served on Employers 105 Firms visited 105 Infectious diseases in outworkers premises nil Glass Permeable to Ultra-Violet Radiation. The use of such glass for windows in schools, work buildings and homes cannot but be regarded as highly desirable from a health point of view. This glass transmits the biological and therapeutic wave-lengths of the ultra-violet rays and its general use, particularly in towns, would confer a benefit on school children at their lessons, workers in offices and shops, sick people confined to bed and residents generally in the crowded houses of our mean streets. Rag Flock Acts, 1911 and 1928. There are no premises in the Borough on which rag flock, as defined by the above Acts, is manufactured, used or sold. 29 HOUSING. Statistics. Number of New Houses erected during the Year: — (a) Total (including numbers given separately under (fa)). (i) By the Local Authority (one block) 15 tene. ments (ii) By other Local Authorities nil (iii) By other bodies and persons nil (fa) With State assistance under the Housing Acts: (i) By the Local Authority: (a) For the purpose of Part II of the Act of 1925} nil (fa) For the purpose of Part III of the Act of 1925} (c) For other purposes} (ii) By other bodies or persons} 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 911 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 233 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 15 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 324 II. — REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Not known III.— ACTION UNDER STATUTORY POWERS DURING THE YEAR. A. Proceedings under Section 3 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) by owners 2 (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 30 B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 322 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) by owners 322 (b) by Local Authority in default of owners nil C. Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925: — (1) Number of representations made with a view to the making of Closing Orders 15 (2) Number of dwelling-houses in respect of which Closing Orders were made 11 (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 IV. NUMBER OF HOUSES OWNED BY THE LOCAL AUTHORITY distinguishing those built in the last two years and held under out (1) Part III of the Housing Act, 1925, (2) Part II of the Housing Act, 1925, and (3) other powers. Part III Housing Act, 1926. One block containing 30 tenements (15 of the tenements constructed during the past two years) HOUSING CONDITIONS. (1) General Observations as to Housing Conditions. The types of houses in the Borough show, striking contrasts ranging from oxpensive high-class residential flats to poor-class tenements and common lodging houses. Also there is a number of) large hotels and many private hotels and boarding houses. The working-class population is housed (1) in tenement lodging houses of which 493 are registered; (2) in blocks of tenement dwellings including some of an earlier and less satisfactory type as well as many modem selfcontained tenements. A total of 2,525 tenements is provided in this type of accommodation contained in 49 blocks of dwellings; (3) in six common lodging houses providing accommodation for 835 persons, viz., 712 males and 123 females. 31 (2) Sufficiency of Supply of Houses. Undoubtedly there is in the Borough a shortage of house accommodation at reasonable rents for the working-classes. A number of industries in and adjacent to the Borough (e.g., central vegetable and fruit and meat markets, hotels and restaurants, printing (newspaper) works, etc.) calls for a supply of workers residing near their places of employment. Also there is a large number of single women or widows employed as office cleaners whose hours of labour and limited income prevent residence away from Central London with its consequent extra time and cost for travelling. At the same time the value of land in the Borough is so high that its acquisition becomes impracticable for the construction of houses to be let at rents within the means of working-class families. (3) Overcrowding. The extent of overcrowding is less than might be expected if the standard is taken of cubic space per person required by the By-laws as to houses let in lodgings. It will be seen from a report on the survey of a working-class ward in the Borough (pages 35-44) that only 13 cases of overcrowding were detected. Two of these cases were dealt with by an alteration in the sleeping arrangements without the tenants being required to vacate the holding although in one case the alteration was not made until after legal proceedings had been taken. In all 14 cases of overcrowding were dealt with during the year. (4) Fitness of Houses. With a view to Closing Orders being made 15 houses were represented by the Medical Officer of Health as unfit for human habitation. In two of these (adjoining houses the property of one owner) notices were served under Section 3 of the Housing Act, 1925. The owner carried out all the work specified and so rendered both houses fit for habitation. In 11 cases Closing Orders were made, nine of which became operative. In two cases appeals were entered; one resulted in a schedule of work to render the premises fit for human habitation being agreed between the Council and the owner; in the second the Closing Order was quashed. One of the 15 houses represented was closed and demolished as a dangerous structure before a Closing Order could be made. The remaining house has since been dealt with in accordance with the procedure provided by the Housing Act, 1930; a Demolition Order was made in, this case in February, 1931. With the exception of 18 houses referred to below all the dwelling-houses in the Borough have an adequate internal water supply provided by the Metropolitan Water Board. Of the 18 houses with no such internal water supply 15 have an adequate supply in yards within the curtilages of the premises. In three cases the water supply is entirely separated from the dwelling. These three small houses were formerly dwellings over stables; the ground floors, no longer used as stables, are in separate occupation. Water supply for the occupiers of the residential portions of these premises is from a draw-off tap in the mews in which the houses are situated; the tap is in reasonably close proximity to the three houses. 32 The three houses referred to above also have no watercloset or other adequate sanitary accommodation within their own cutilage; the waterclosets, common to the three houses, are in the mews outside the actual curtilage of the residential premises. The accommodation is sufficient for the number of persons living in the houses. (5) Unhealthy Areas. During the year the Housing of the Working Classes Committee considered a report from the Medical Officer of Health respecting the desirability of dealing with a small site (28 houses) as an unhealthy area. Particulars of the area were furnished to the London County Council who intimated that the area was not of sufficient size or importance to warrant its being dealt with by the London County Council who would not be disposed to make an improvement scheme under Part II of the Housing Act, 1925, in respect of the area, and expressed the opinion that if such scheme were considered desirable it should be undertaken by the Borough Council. After careful consideration and viewing the property the Housing Committee were of opinion that an improvement scheme was undesirable but that individual houses on the site found to be unfit for human habitation should be dealt with as individual insanitary houses. This course was adopted and 13 houses were so represented, these being part of the 15 representations referred to above. Ten houses were demolished by the owners without the necessity of formal representation. The remaining five houses on the site continued to be occupied for dwelling purposes, their condition not calling for representation. (6) By-laws Relating to Houses. Four hundred and ninety-three houses in the Borough are registered under the By-laws with respect to houses divided into separate tenements or occupied by members of more than one family. During the year there were 824 inspections of such houses. One hundred and forty-two notices were served for breaches of the By-laws, and in addition 493 notices were served respecting the annual cleansing required by the By-laws. The operation of a number of By-laws made by the London County Council with respect to houses intended to be used for occupation by the working classes and let in lodgings or occupied by more than one family is suspended. The Holborn Council has expressed the view that with the exception of the By-law dealing with air space the suspension should be discontinued so far as decontrolled houses are concerned. Common Lodging Houses. The common lodging house accommodation in the Borough is equal to 22 beds per 1,000 of the population. The death-rate amongst common lodging house residents is very high; in this Borough it was 53 per 1,000 in 1930. 33 The following table gives details of the accommodation available in the common1 lodging houses in the Borough : — Ward. No. of Lodgers for which licensed. Total. Males. Females. Central St Giles 7 & 11, Short's Gardens William George Parker ... 234 — 234 Lincoln's Inn Parker House, Parker Street Frank Hunt (L.C.C.) 349 — 349 Lincoln's Inn 1-7, Macklin Street Leslie Campbell Ruttledge | 79 — 79 Lincoln's Inn 2-8, Kennedy Court John Samuel Walters - 78 78 St. George-theMartyr 40, Eagle Street Joseph Benton 50 — 50 St George theMartyr 35, Devonshire Street... Ada Elizabeth Chesterton - 45 45 Betterton House Housing Scheme. The Betterton House Housing Scheme was completed during the year, the second group of 15 flats (making 30 in all) being available for occupation in April, 1930. A very large number of applications for these flats was received, many being from the head of families where hours of work necessitate residence in the immediate locality or whose weekly income is too small to meet travelling expenses incurred by residence in an outlying district. Boswell Court Site. The Housing of the Working Classes Committee again devoted much time to the consideration of proposals for a housing scheme on land in Boswell Court. Although for some years there has been no buildings on this land many difficulties, including the very high value of land in Central London, have hindered its use for housing purposes. Strenuous efforts were made by the Committee to overcome all difficulty and provisional plans prepared by the Borough Engineer for the construction of about 70 tenements were approved by the Council. Some modification of the plans was subsequently made to bring the proposed dwellings into conformity with the requirements of the Ministry of Health for houses to rank for grant under the Housing (Financial Provisions) Act, 1924. At the date of the preparation of this report provisional approval has been received from the Minister of Health for the scheme to rank for contribution under the Housing (Financial Provisions) Act, 1924, and the London County Council has sanctioned the necessary loan. Accommodation on L.C.C. Housing Estates. In the year 1924 arrangements were made by the London County Council for a certain number of houses on several of that Council's housing estates to bo available for applicants nominated and recommended by the Metropolitan Borough Councils. The arrangement was primarily to secure reduction in overcrowding, that is, to provide housing accommodation for families residing more than 2 per room. It was however, recognised that other cases of hardship existed and the C 34 scheme was extended to include these. Applications for such accommodation are submitted by residents in this Borough to the Public Health Department where they are examined and before submission to the London County Council the applicants are in all cases interviewed. During the year 1930, 45 applications were submitted through the Public Health Department to the London County Council for such accommodation. During the same period we received from the London County Council information that accommodation had been provided for 26 Holborn applicants. This brings the total number of cases from the Borough for whom accommodation has been provided up to 175 or about 62 per cent, of the applications submitted. Underground Rooms. The use of underground rooms in London is subject to compliance with the provisions of the Public Health (London) Act, 1891, and the Housing Acts, and especially with Regulations made by local authorities under the latter Acts. From time to time, however, difficulty arises in connection with the construction of underground rooms. No machinery seems to exist whereby plans of dwellings are examined to ascertain whether it is contemplated to construct underground rooms which would not comply with the Regulations. It may sometimes happen that the examination of drainage plans results in the detection of a proposed construction of rooms the occupation of which for sleeping purposes as intended would be illegal. It would be more satisfactory if the law required that plans of new buildings in which any underground room is to be constructed should be examined and passed by the Medical Officer of Health seeing that he is the person concerned afterwards with the occupation of such dwellings if they fail to comply with the Regulations. A resolution in favour of legislation in this direction adopted by the Holborn Council in 1929 was considered by a number of metropolitan and provincial local authorities. Of 42 authorities who communicated the result of their consideration of the matter 33 supported the resolution. It might be useful to point out that Section 4 of the London County Council (General Powers) Act, 1920, although it deals with the erection and occupation of newly built houses does not include the construction of underground rooms. This Section makes it unlawful to occupy any house newly built unless the drains are provided to the satisfaction of the local authority, although there appears to be no penalty for contravention. It would be an advantage if legislation required that any newly erected house should not be occupied until a general certificate of fitness for occupation had been obtained from the local authority specifying that the house (1) had a proper water supply, (2) had satisfactory drainage, (3) that underground rooms (if any) complied with the Regulations and could be used for sleeping purposes, and (4) was in all other respects fit for human habitation. St. George-the-Martyr Ward. During the year, at the request of the Council, a genera] housing survey was made of the St. George-the-Martyr Ward (Ward F). The survey was made by the Sanitary Inspector of the district, Mr. G. F. Clark, 35 The following is the report on the survey: — General Description of Ward F. The St. George-the-Martyr Ward (Ward F) of the Metropolitan Borough of Holborn is a fairly densely populated area of 39 acres, partly residential and partly commercial and professional. It lies between Guilford Street on the north, Eagle Street on the south, Southampton Row on the west and Lamb's Conduit Street and Eed Lion Street on the east. Within the Ward there are a number of institutional buildings, viz., the Hospital for Sick Children; National Hospital for Paralysed and Epileptics (Queen Square Hospital); London Homoeopathic Hospital; Italian Hospital; the Examination Hall of the English Conjoint Board of Physicians and Surgeons; the L.C.C. Day Training College and School of Arts and Crafts; St. George-the-Martyr Church and School; and St. John the Evangelist Church and School. There are two open spaces, Queen Square (⅝ acre) and Bed Lion Square ( ⅔acre). The commercial and professional part includes local shopping centres such as Theobald's Road, Bed Lion Street and Lamb's Conduit Street. The residential part includes boarding houses (e.g., in Guilford Street), mixed residential property (e.g., Great Ormond Street and Queen Square) and a number of flats or tenement dwellings (e.g., Dalmeny Mansions, Theobald's Boad; Halsey House, Bed Lion Square; Kingsgate Mansions, Bed Lion Square; Kingsway Mansions, Bed Lion Square; Bedford House, New North Street; and Princeton Mansions, Bed Lion Street). In a number of highways in the Ward, e.g., Lansdowne Mews, Gage Street, and Harpur Mews, the whole or by far the greater number of the premises are used for business purposes only. At the 1921 Census the Ward was occupied (as regards sleeping) by 7,220 persons (185 persons per acre)* residing in 634 structually separated dwellings and occupying 4,109 rooms, i.e., 0.75 room per person. The following gives the rooms per person in all the Wards of the Borough, in the County of London, and for comparison purposes, the corresponding figure in some other London Boroughs: — Ward. Rooms per person. South Bloomsbury 1.49 North St. Giles 1.37 Saffron Hill 1.20 North Bloomsbury 1.00 Lincoln's Inn 0.81 North St Andrew 0.81 South-East St. Andrew 0.80 St. George-the-Martyr 0.75 Central St. Giles 0.73 Whole Borough 0.89 County of London 0.96 Certain other Metropolitan Boroughs : — Poplar 0.76 Stepney 0.69 Bethnal Green 0.68 Finsbury 0.67 Shoreditch 0.65 * The density of the Borough at the Census, 1921, was 107 persons per acre, and of Jjondon as a whole, 60 persons per acre. c 2 36 Decrease in Proportion of Residential Property; Rents per room. There is a tendency in St. George-the-Martyr Ward, as in other parts of the Borough, to increase the proportion of industrial and commercial property at the expense of residential property, and it is not unreasonable to believe that, but for the difficulty of obtaining vacant possession of houses owing to the operation of the Kent Restrictions Acts, this change in the usage of property in the Ward would have been more marked. Of 233 houses in the Ward inspected in detail, it was found that in 72 all the tenements were subject to control under the Rents Eestrictions Acts; in 105 the houses were only partly controlled; in 41 the houses were entirely decontrolled; in 15 no information on this point was obtained. In the controlled tenements the rents averaged about 4s. 6d. per room unfurnished; in decontrolled tenements 7s. 9d. per room unfurnished. For furnished rooms the average rent was 14s. 6d. per room. Control under Rents Restriction Acts. STREET. HOUSES (not holdings). Controlled entirely Partly controlled Decontrolled No information Total Dane Street 4 2 — 1 7 Devonshire Street 13 23 5 1 42 Eagle Street 5 1 — — 6 East Street 14 17 1 — 32 Fisher Street — 1 1 — 2 Harpur Mews ... 1 — 2 — 3 Lamb's Conduit Passage 4 3 4 2 13 New North Street 6 8 3 1 18 Old Gloucester Street 9 26 8 3 46 Old North Street 3 1 2 — 6 Ormond Yard 10 11 1 3 25 Princeton Street — 2 — 2 4 Red Lion Passage 3 7 4 1 15 Red Lion Street — 3 10 1 14 Totals 172 105 41 15 233 Factories and Workshops. There are 8-1 workshops and 44 factories registered in the Ward, employing 913 males and 366 females. It is important that such firms and other employers in the vicinity should have a supply of labour residing in the neighbourhood. There is no special industry peculiar to the Ward; more than 50 different occupations are carried on in the various factories and workshops; the more numerous are tailors and dressmakers 33, printers 15, and photographers 5. Classification of Residential Property. The residential property may be classed into four categories: — (i) Good Class Houses and Flate. Of these the best examples of the former are in Guilford Street and Queen Square, and of the latter in Red Lion Square. (ii) Less Expensive Houses and Flats. These would include houses such as those* in Great Ormond Street and Orde Hall Street, and flats such as those comprised in Bedford House in New North Street. (iii) Good Class Tenements. In this category would be included houses in Princeton Street and Harpur Street. (iv) Poorer Class Tenement Houses. These include all the houses in the Ward registered under the By-laws as to houses let in lodgings and other houses similarly occupied although not so registered. The houses in this category are in the following streets; the table gives the number of houses in the streets concerned that are, occupied as working class dwellings, the number registered as lodging houses and the number inspected in detail in connection with the present survey. Street. Houses used for working class dwellings. Registered under By-laws. Inspected in connection with Survey. Dane Street 7 7 7 Devonshire Street 42 37 42 Eagle Street 6 6 6 East Street 32 5 32 Fisher Street 2 — 2 Harpur Mews 3 — 3 Lamb's Conduit Passage 13 4 13 New North Street 18 14 18 Old Gloucester Street 46 43 46 Old North Street 6 6 6 Ormond Yard 27 17 25 Princeton Street 5 — 4 Red Lion Passage 15 11 15 Red Lion Street 14 — 14 236 150 233 37 38 Tenements. The 233 houses were let out into 1,066 tenements,viz. : — One-room holdings 410 (38 per cent.) Two-room holdings 395 (37 per cent.) Three-room holdings 181 (17 per cent.) Four-room holdings 55 (5 per cent.) Five-or-more-room holdings 25 (2 per cent.) Rooms per Tenement. The following table shows the number of rooms per tenement in the various streets in which houses were inspected: — Number of Rooms per Tenement in Inspected Streets. Number of houses inspected. Rooms per tenement. Total number of tenements. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. Dane Street 7 8 10 7 — 1 26 Devonshire Street 42 85 81 33 11 5 215 Eagle Street 6 11 11 3 2 — 27 East Street 32 79 70 28 7 3 187 Fisher Street 2 2 — 1 1 1 5 Harpur Mews 3 - 1 2 — — 3 Lamb's Conduit Passage 13 4 5 4 4 2 19 New North Street 18 23 34 25 8 2 92 Old Gloucester Street 46 119 115 41 7 3 285 Old North Street 6 27 7 1 1 — 36 Ormond Yard 25 9 27 24 6 5 71 Princeton Street 4 8 3 1 1 — 13 Red Lion Passage 15 26 17 6 4 — 53 Red Lion Street 14 9 14 5 3 3 34 Totals 233 410 395 181 55 25 1,066 39 Rooms per Family. Number of Persons per Family and Nuviber of Rooms Occupied. Number of persons in family. Number of Rooms occupied. Total. 1 2 3 4 5 or more 1 184 49 3 1 1 238 2 126 107 29 8 1 271 3 50 81 43 11 2 187 4 21 80 48 15 4 168 5 20 40 28 9 9 106 6 5 18 la 6 2 44 7 4 12 12 4 4 36 8 8 5 1 2 16 410 395 181 55 25 1,066 The estimated population of the above 1,066 tenements is 3,207 persons, the room accommodation per person being 0 65 in comparison with the Census figure of 0-75 for the whole Ward as mentioned on page 35. General Sanitary Condition of Tenements. Highway. Condition. Total. (iood. Fair. Poor. Dane Street l4 10 2 26 Devonshire Street ... 67 135 13 215 Eagle Street — 14 13 27 East Street 56 121 10 187 Fisher Street 1 2 2 5 Harpnr Mews - 2 1 3 Lamb's Conduit Passage 3 8 8 19 New North Street 27 59 6 92 Old Gloucester Street 70 193 22 285 Old North Street 14 18 4 36 Ormond Yard 6 60 5 71 Princeton Street 6 3 4 13 Red Lion Passage 15 38 — 53 Red Lion Street 11 20 3 34 290 683 93 1,066 For the purposes of the survey, the general sanitary condition of the tenements has been classified into three categories as shown in the above table, viz. : — Good, i.e., structure sound, holding generally clean and in reasonable state of repair. Fair, i.e., generally old houses, structure somewhat worn, but still reasonably fit. Poor, i.e., structure old and worn, holding generally in unsatisfactory condition by reason of state of repair or tenant's failure to keep holding in clean and good condition. 40 Overcrowding. Only 13 cases of actual overcrowding were discovered, i.e., cases where the number of persons occupying a room or holding exceeded the number for which the available cubic space was sufficient on the standard of the By-laws as to houses let in lodgings. These have been reported to the Public Health Committee and the necessary action is being taken. A copy of the report submitted to the Public Health Committee follows: — Overcrowding in Ward " F." On a survey of Ward " F " recently undertaken at the request of the Housing of the Working Classes Committee only 13 cases of overcrowding were discovered, i.e., cases where the number of persons occupying a room or holding exceeded the number for which the available cubic space was sufficient on the standard of the By-laws as to houses let in lodgings. Three Cases where Noticcs Served. In three of these where the overcrowding had to be regarded as serious notices to reduce the number of persons living in the tenements were served on the occupiers, viz. : — 1. No Old Gloucester Street. 3 adults and 5 children in one room. ( — 1,232 cubic feet.) 2. No Old Gloucester Street. 4 adults and 3 children in one room. ( — 770 cubic feet.) 3. No New North Street 5 adults and 2 children in one room. ( — 1,232 cubic feet.) The first of these is the case in which legal proceedings were taken. In the second there is reason to believe that two other persons also sleep in the room which of course would make the condition still worse. Three Other Cases of Overcrowding. In three cases the extent of the overcrowding was small being under 200 cubic feet, viz. : — No Old Gloucester Street. 2 adults in 675 cubic feet. (—125 cubic feet.) No Eagle Street 3 adults and 4 children in 1,982 cubic feet. (-18 cubic feet.) No Red Lion Street 4 adults and 5 children in 2,458 cubic feet. (-142 cubic feet.) Having regard to the difficulty of obtaining other accommodation, and the small extent of the overcrowding, action in these cases may not be considered desirable at present. 41 Two Cases where Abatement possible in same Tenement. In two cases the overcrowding could be abated by the use for sleeping purposes of available second rooms. This the occupiers have promised to do, but have up to the present failed. No, Old Gloucester Street. ( — 689 cubic feet.) No , Devonshire Street (-710 cubic feet.) Notices have been served with a letter explaining that if they would use the second room as promised for sleeping, the overcrowding would be abated. Five Cases of Moderate Overcrowding—Action Suspended. In the remaining five cases action has been suspended having regard to the difficulty of obtaining other suitable accommodation. The extent of the overcrowding in these five cases is as follows : — 4 adults in 1,348 cubic feet ( — 252 cubic feet.) 2 adults and 1 child in 778 cubic feet. (-222 cubic feet.) 2 adults and 1 child in 553 cubic feet. (-447 cubic feet.) 4 adults and 1 child in 1,366 cubic feet. (-434 cubic feet.) 5 adults and 1 child in 2,097 cubic feet. ( — 303 cubic feet.) Sanitary Accommodation. All the 233 houses inspected were found to have sufficient W.C. accommodation. In 64 cases the accommodation was inside the house, in 117 it was outside in tho yard or area and in 52 there was both inside and outside watercloset accommodation. Cooking Arrangements. Of the 1,066 tenements inspected 287 (27 per cent.) had gas cookers; 207 (19 per cent.) had open ranges and gas cookers; 147 (14 per cent.) had open ranges with no gas cookers; 96 (9 per cent.) had close ranges and gas stoves. Other means of cooking were open range and gas ring, 43; gas ring only, 26; close range, 17; open register and gas stove, 40; open register and gas ring, 14; open register only, 32; close range and gas ring, 28; close range and oil stove, 6; open range and oil stove, 7; in 88 cases where the tenants took no meals in the tenement no faoilities for cooking were provided; in 28 cases it was impracticable to obtain information on this point. In only 14 per cent, of the tenements could the cooking facilities be regarded aa completely satisfactory; these all had close ranges. The use of gas cookers in small tenements often gives rise to nuisance, particularly as in nearly all cases these cooking stoves are not provided with suitable hood and flue for carrying off the fumes. The practice of placing the stoves on the landings is also objectionable, resulting in the fumes pervading the whole staircase and, in consequence, often most of the house. Many of the tenants who were found to take no meals in their holding were single occupants of one or two room tenements employed as kitchen hands or in some similar occupation where meals are supplied as part remuneration. 42 Storage of Food in Households. The following table gives particulars of the arrangements for food storage : — Street. No. of tenements. Unventilated cupboard. Ventilated cupboard. Safe. Shelf. Dresser. *Othor. None. Holding used for sleeping only. No information. Dane Street 26 10 - 6 2 1 1 6 - - Devonshire Street 215 90 — 14 13 21 5 56 6 10 Eagle Street 27 14 1 4 8 — — East Street 187 85 6 14 19 17 2 44 — — Fisher Street 5 2 — 1 1 — — 1 Harpur Mews 3 2 — . 1 — — — Lamb's Conduit Passage 19 6 — 2 3 1 1 4 — 2 New North Street 92, 49 1 7 4 12 3 16 — — Old Gloucester Street 285 101 — 32 24 20 16 71 21 — Old North Street 36 12 5 1 1 6 11 —: Ormond Yard 71 34 — 2 7 20 2 6 — — Princeton Street 13 3 — - - 10 — — Red Lion Passage 53 19 — 4 9 4 5 12 — — Red Lion Street 34 15 — 8 2 2 - 7 — - 1,066 412 7 91 93 99 37 246 38 13 * e.g., drawer, sideboard, boxes, earthenware pan. It will be seen from the above that the facilities for the storage of food were most unsatisfactory. In 246 (or 23 per cent.) no food storage accommodation was provided, whilst in 442 tenements (over 41 per cent), the only accommodation was unventilated cupboards. The absence of suitable storage accommodation for food is one of the commonest insanitary faults resulting from the letting for tenement purposes of houses not built for such occupation. Arrangements for Washing Clothes and Person. The following table shows the arrangements for laundry work and personal washing:— No. of tenements. Laundry work. Personal washing-. No information. Washhouse available. Bowl in room. Bowl at sink. Bath. Dane Street 26 21 11 11 - 4 Devonshire Street 215 142 193 10 3 9 Eagle Street 27 6 27 — — — East Street 187 154 162 7 — 18 Fisher Street 5 3 5 — — Harpur Mews 3 — 1 1 1 — Lamb's Conduit Passage 19 7 19 — New North Street 92 65 86 3 3 — Old Gloucester Street 285 193 238 38 9 OH North Street 36 18 33 3 — Ormond Yard 71 43 56 15 Princeton Street 13 — 9 4 Red Lion Passage 53 10 45 2 6 — Red Lion Street 34 1 32 1 1 — 43 In some cases washhouse accommodation, although provided, was not used; a few tenants find it more convenient to avail themselves of the facilities for laundry work provided at the public baths and washhouses; others send the laundry out to a " bag wash " and some do the washing in the living room. Constant efforts are made by the Inspectors to persuade tenants to discontinue this latter practice and use the washhouse in houses where this accommodation is available. General Defects. The following is a summary of the general defects and unsatisfactory conditions found at the inspections: — Cleansing. Dirty rooms 104 Dirty staircases 18 Rooms verminous 23 Structure. Houses generally old and worn 7 Roofs defective 30 Floors defective or uneven 38 Staircase treads, walls, etc., worn and defective 35 Walls bulging or defective 10 Walls and ceilings dilapidated 16 Window sashes and frames defective 30 Sash lines broken and defective 19 Other defects. Dampness 10 Ventilation; rooms or staircases 18 Lighting; rooms dark or insufficiently lighted 26 Drain defective 1 Open gully in room 1 Waterclosets; defective 3 Waterclosets; ventilation defective 3 The cleansing of the dirty rooma has in many cases heen carried out since the date of the inspection, or will be done in connection with the next annual cleansing as required by the lodging house By-laws. In connection with the other unsatisfactory conditions enumerated above, the works required to remedy the defects have been carried out in a number of houses; in others notices have been served where the defects could be regarded as " nuisances " under the Public Health (London) Act, 1891. It must of course be remembered that nearly all the houses in the area that have been inspected are by no means new houses, and conditions similar to those indicated in the above table must be expected in such property, particularly when a house, not' designed for the purpose, is used for housing a number of families. All these houses and similar property in other parts of the Borough need constant supervision to ensure the required standard of cleanliness and general sanitation. 44 Underground Room's. Twenty-one basement rooms were found to be illegally occupied. For some years past steps have been taken to prevent reoccupation of such rooms after death or removal of a tenant. This is of course only a first step; others must sooner or later be taken as there is not much prospect of the movement of any considerable number of occupiers from such rooms in the ordinary course of events. The matter is one which will doubtless soon receive careful consideration by the Holborn Housing of the Working Classes Committee and the Holborn Public Health Committee. Housing Act, 1930. Members of the Council are aware that the Boswell Court site is in the Ward; the new flats proposed on this site might probably be used directly or indirectly to deal with the comparatively few cases of overcrowding in the Ward, and with overcrowding elsewhere in the Borough, also with the largish number of underground occupations both here and in the rest of the Borough. Constant supervision will of course be maintained, and it is probable that the Housing Committee will consider, ab no very distant date, the desirability of defining a part of this Ward as an " Improvement Area " under the Housing Act, 1930. FOOD. Dairies, Cowsheds and Milkshops. By the provisions of the Milk and Dairies Order, 1926, made under the Milk and Dairies Consolidation Act, 1915, no person is allowed to carry on the trade of a dairyman or use any premises as a dairy unless he and such premises are registered with the local sanitary authority. Power is given to the sanitary authority under the Milk and Dairies (Amendment) Act, 1922, under certain conditions to refuse to register a retail purveyor of milk or to remove such person or premises from the register. In connection with the duties imposed on the Council respecting registration, opportunity is taken before entering the premises or the name of the applicant on the register to inspect the premises proposed to be used for the dairy purpose, to ascertain whether they are suitable for the sale of milk thereon. From time to time it has been necessary to postpone registration pending the completion of works found to be required. At the end of the year 1930, the number of registered dairies and milk shops in the Borough was 126. In addition to my inspections the Sanitary Inspectors made 83 inspections of milk premises and it is satisfactory to record that it was not found necessary to serve notice for sanitary defects or breach of the Orders in any case. One retail dairy was removed from the register on the closure and demolition of the shop. In nine cases alterations in the register became) necessary owing to alteration in ownership. An application was received from a Company trading as wholesale dairymen and provision merchants for registration of premises in the Borough for the sale of milk wholesale. On inspection it was found that the premises previously registered for the retail sale of milk had become unsuitable for the purpose and that arrangements for the storage, etc., of milk were unsatisfactory. The Public Health Committee therefore refused the application for registration and removed 45 from the register the name of the retail seller. Subsequently the wholesale business was transferred to other premises and arrangements for the sale of milk by retail being satisfactorily improved the registration for retail sale was again effected. In another case application was received for registration of premises as a dairy to be used for the storage of fresh cream. The premises were found to be unsuitable for use as a dairy and the application was withdrawn. Itinerant Milk Vendors. In connection with the sale of milk in the Borough by itinerant vendors, it is our practice, when such milk sellers are not registered by the Council, to communicate with the Medical Officer of Health of the district in which the vendor states he is registered, or in which is situated the address appearing on the barrow, in order to obtain confirmation of registration and ascertain whether tha premises of the milk seller, where the milk is stored, utensils cleansed, etc., are in a satisfactory state. 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-four samples of milk were examined for the presence of tubercle bacilli; six of these were also examined to ascertain the number of organisms per cubic centimetre and the smallest volume containing B. coli. Examinations for tubercle bacilli were carried out by animal inoculation ; five of the samples examined were found to contain tubercle bacilli. Cleanliness of Milk Examined. 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. 1 930 Dec. 8 Milksliop (large trade) 185,000 0.01 cc. Nor. 10 Milkshop (do ) 75,000 0.01 cc. Dec. 8 Milkshop (do.) 50,000 0.1 cc. Oct 20 Small general shop 41,000 0.001 cc. Nov. 3 Milkshop (large trade) 27,000 1 cc. Oct. 20 Milkshop (do.) 13,000 0.01 cc. 46 The cleanliness of the milk thus investigated is more or less satisfactory, but obviously there is room for improvement. Cleaner methods of milk production are being promoted by " clean milk competitions," fortunately more of these are being held and the number of entries are inrceasing. The hygiene of milk premises is being pulled up in accordance with powers given under the Milk and Dairies Order, 1926. But at the same time there is much to be said in favour of a suggestion that the Minister of Health should be asked to define a bacteriological standard of cleanliness for ordinary (ungraded) milk. Tubercle Bacilli in Milk. Twenty-four samples of milk were examined for the presence of tubercle bacilli. Of these five (20 per cent.), gave evidence of such infection. The following are the brief paiticulars of the five infected samples :— Sample I.—Purchased in the street from a roundsman. Sold as a designated milk "pasteurised." Information was supplied by the vendors that the temperature and period charts showed that pasteurisation had lieen properly carried out. Animal inoculation gave the following results :—Guinea pig killed at end of three weeks—normal. The guinea pig killed at the end of six weeks showed tubercles on both liver and spleen and the presence of an e llarged gland of the mesentery. Sample II.—Purchased from a retail dairy. Not sold as " pasteurised," although there is good reason to believe that the milk was in fact pasteurised. Guinea pigs inoculated with this milk were killed, one at the end of three weeks and the other at the end of six weeks. Post-mortem examination showed the three-weeks guinea pig to be normal. The six-weeks guinea pig showed an enlarged spleen with tubercles. Tubercles were also present in the liver and enlarged glands were noted in the mesentery. Sampi.f, III.—Purchased from a retail dairy. Not sold as " pasteurised " but probably was in fact pasteurised. Post-mortem examination showed the three-weeks guinea pig to be normal. The six-weeks animal showed a few tubercles on the liver and some enlargement of mesenteric glands affording evidence of slight tuberculous infection. Sample IV.—Purchased from a retail dairy. Served from a counter pan. Was not sold as " pasteurised," but probably was in fact pasteurised. On post-mortem examination the three weeks animal appeared normal. The six-weeks animal showed a few tubercles in the liver; evidence of slight tuberculous infection was thus afforded. Sample V.—Purchased from a retail dairy. Not sold as " pastourised," but information was given by the retailer that the milk was supplied to him as pasteurised. Post-mortem examination of three-weeks animal showed enlarged spleen. The six-weeks guinea pig showed tubercles on liver, spleen, mediastinal glands, peritoneal wall and mesentery, evidence of tuberculous infection being thus afforded. Information furnished by the vendors showed that the milk in Samples I, II, III and IV came from the same wholesalers. No information could be obtained from them as to the farms from which the milk came ; the milks were mixed milks derived from a very large number of farms. The fifth sample wes a mixed milk obtained by the retailer from a firm of large wholesale dealers. In this case information was sent to the Medical Officer of Health of the county in which the wholesale depot is situated. Subsequently information was received from him that as a result of enquiry about the method of pasteurisation employed it had been ascertained that in the winter the milk was not heated at the usual temperature, 140° F. only being used with a "flash" pasteuriser. The district Medical Officer of Health requested that in future the milk should be brought to the proper heat for the correct time. The County Medical Officer of Health also referred the matter to the Director of Agriculture with a view to having the supplying herds inspected to discover the source of infection but as 90 herds of cattle were involved it did not appear that the expenditure would be justified; arrangements were to be made however for samples to be taken at the depot as the milk came in from the farms. 47 Consumption of Milk. An opinion has been expressed that the development of milk production for sale as liquid milk has almost reached saturation point, but the consumption of liquid milk in this country is very little more than a quarter-pint per head per day. In far too many households milk is used not as a food but as a colouring agent for tea. To reach saturation point the daily consumption should be in the neighbourhood of one pint per head per day. We preach this doctrine day in and day out whenever a suitable opportunity arises. Milk and Dairies Order, 1926. Some difficulty is experienced in securing strict compliance with the provisions of the above Order, so far as the cleansing of vessels and appliances is concerned. The Order provides for every vessel, lid and appliance to be thoroughly washed as soon as may be after use and to be cleansed and scalded with boiling water or steam before its use again. The cost of providing proper steam chests is such that the small retail milk seller is not willing to comply with a suggestion that this course should be taken. In shops where there is only a counter trade probably the vendors cannot reasonably be expected to buy a relatively expensive steam chest, but in milk businesses where there is a round entailing the use of cans or bottles it is essential for strict compliance with the Order that proper plant should be installed. The Milk (Special Designations) Order, 1923. During the year 1930 licences available up to the 31st December, 1930, for the Sale of designated milk in the Borough were issued as follows: — Certified Milk 3 Grade A (Tuberculin Tested 4 Pasteurised 3 Up to the date of preparation of this report licences for the year 1931 have been issued as follows: — Certified Milk 2 Grade A (Tuberculin Tested) 4 Pasteurised 6 12 Condensed Milk. Samples were taken and examined in order to see that the Public Health (Condensed Milk) Regulations, 1923, were satisfactorily carried out. During the year 1930, seven samples of condensed milk, viz., two full cream, and five skimmed sweetened, were examined by the Borough Analyst. All the samples complied with the requirements of the Regulations as to labelling and as regards the standard of composition they were found to be equal to or above the standard required. The results are seen below;—. 48 Chemical Examination of Condensed Milk. Percentage of milk fat. Percentage of milk solids (including fat). Full cream sweetened 10.0 36.8 ,, ,, 9.85 35.1 Skimmed ,, 1.5 29.2 ,, ,, 0.35 34.1 ,, ,, 0.30 30.9 ,, ,, 0.25 34.2 ,, ,, 0.20 31.0 Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Two samples, covering those generally used, were obtained during the year, and found to comply with the Regulations which are generally similar to those with regard to condensed milk. Margarine. The registration with the local Food and Drugs Authority of wholesale margarine dealers was 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 was 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 lias no power to refuse registration or to set up any standard of requirements before effecting such registration. The provision is continued by Section 8 of the Food and Drugs (Adulteration) Act, 1928, There are five registered dealers in the Borough. Margarine is one of the chief articles of fatty food eaten by the poorer part of the community; it is therefore highly desirable that this substitute for butter should be brought up to the same standard of vitamin potency ae butter. Until this is done the menace of health arising from the continual and ever increasing substitution of butter by margarine will remain serious. Bakehouses. At the end of the year 1930 there were 23 bakehouses in the Borough of which 18 were factory bakehouses. Although these are described as " factories " they are not large and only supply local needs; a number were formerly workshops and are now classified as " factories " owing to the installation of machinery. During the year, in addition to my inspections, there were 59 inspections of bakehouses. Sale of Fish. During the past year 51 inspections were made of the fish shops and fish stalls in the Borough, exclusive of market street inspections. There were 12 fish shops of which five were in the Central Fish Market (a part of the Smithfield Central Markets, Farringdon Road, the fish being sold by retail). Both wet and dried fish were found to be sold at all the shops; at five, shell fish was also sold. In addition to the shops referred to above, there are five stalls in the Borough for the general sale of fish. There is also a shop in the Borough for the sale of shell fish only and two for the sale of stewed eels. These premises were also kept under observation. Fried Fish Shops. There are also 11 fried fish shops. These are regularly inspected to see that they are kept in conformity with the By-laws made by the London County Council. During the past year 202 inspections of these premises were made, At the same 49 time a careful look-out has been kept on the soundness of the fish and the wholesomeness of the materials used in frying. Market Streets. There were 821 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 eSect 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. Street Trading. The London County Council (General Powers) Act, 1927, by Part VI, conferred powers on Local Authorities in London to issue licences to street traders and made it unlawful for any person to sell or expose, or offer for sale, any article or thing from or upon any barrow, cart, stall, or other receptacle occupying a stationary position at a place in the carriage way or footway of any street in any Metropolitan Borough, without such licence. The Act also provided for the making of By-laws by the Borough Council relative to various matters cognate to such street trading, including the storage of and the sanitary supervision (while at the place of intended sale or exposure or offering for sale) of articles of food intended to be sold or exposed or offered for sale under the authority of the licence. By-laws made by the Holborn Council in pursuance of these powers were approved by the Home Secretary and came into operation in the early part of 1928. The enforcement| of the By-laws, so far as they deal with the sanitary supervision of th« articles exposed for sale, is being undertaken bv the Public Health Denartment. I received information from the Borough Engineer respecting 92 applications from street traders for annual licences to sell various articles of food as follows: — Coffee stalls 6 Confectionery 3 Confectionery and drinks 3 Eels and shell fish 3 Fish—wet and dry 6 Fruit 29 Fruit and vegetables 7 Groceries 4 Ice cream 6 Ice cream and chestnuts 7 Meat 3 Poultry, eggs and provisions 3 Vegetables 12 92 50 All the storage places situated in the Borough were inspected. In connection with the renewal of licences for street trading enquiry was made into an allegation that a trade carried on from a stall in one of the market streets (a second-hand clothes dealer) resulted in the diffusion of dirt and dust which appeared likely to contaminate food exposed for sale at an adjoining stall, but it was found that the garments exposed for sale were scrupulously clean, most had been washed before being placed on the stall. Ice Cream. With a view to more efficiently dealing with the manufacture, storage and sale of ice cream, provision was included in the London County Council (General Powers) Act, 1928, for the registration with the sanitary authority of premises proposed to be used for such purposes. The provision does not apply to premises occupied as a factory or workshop, respecting which notice is required by Subsection I of Section 127 of the Factory and Workshop Act, 1901, nor to any premises used as an hotel, restaurant or club. Although the provision requiring registration of these premises is welcomed as a progressive step towards the better control of the manufacture, storage and sale of this commodity, it is to be regretted that no power is given to local authorities, to refuse registration of unsuitable premises. It is also to be regretted that opportunity was not taken in connection with the promotion of this legislation to include a definition of ice cream. Previous legislation dealing with the matter is contained in the London County Council (General Powers) Act, 1902. The advantage of registration is that the existence of premises where ice cream is made, stored or sold, will be brought to the knowledge of the local authority; this information will enable the officers of the local authority to see that the provisions of the Act of 1902 are complied with. The matter was of some importance in Holborn because of the large quantity of ice cream manufactured in the area known as the " Italian Colony;" although, owing to the closing and demolition of a number of houses in this area, the quantity of ice cream made in the Borough is much less than in previous years. In connection with the registration of such premises in the Borough a memorandum on the manufacture, storage and sale of ice cream was prepared by the Medical Officer of Health in 1928, and a copy is furnished to every applicant for registration (see A.R., 1928, p. 42). During the year there were 30 premises in the Borough where ice cream was manufactured, and in addition to my inspections 54 inspections of these premises were made. It was not found necessary to serve any notice. Ice cream is manufactured in the Italian colony as follows Premises on which 20 gallons made daily 1 ,,10 „ 2 8 „ ., 2 ,, ,, 4 ,, ,, 1 ,, ,, 2 ,, ,, 3 51 In addition ice cream was also manufactured on the following premises :— Mr. Bennett's District. Mr. Clark's District. Mr. Larard's District. Restaurants 4 1 2 Confectioners 1 5 3 Other — 4 1 Nowadays the hygienic standard in large factories where ice cream is made is so high that the arrangements for making ice cream in smaller places suffer by comparison. There is no essential reason why ice cream should not be manufactured hygienically in these smaller places, but at the same time owing to this increasing tendency of large manufacturers to undertake the making of ice cream it behoves the makers of smaller quantities to have careful regard to the conditions under which the commodity is made. 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. Public Health (Meat) Regulations, 1925. These Regulations came into operation on the Ist 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 28 Butchers' stalls 3 Provision dealers 28 Provision dealers' stalls 3 Offal shops 3 Cooked meats 5 Wholesale (bacon; sausage) 3 73 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 613 such inspections were made. It is regretted that in a few cases (eight) 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 P2 52 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 instances 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 such as soot; frequent; reinspections are made to see this is done. Steps are being constantly taken to ensure that customers do not handle butchers' meat; improvement has occurred. In shops where " pieces " are sold a notice is exhibited urging customers not to handle meat before purchase, and 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. That these Regulations are reasonable is shown by the ready response of the vendors to remedy any temporary omission either on their part or on the part of their assistants; it has not been necessary to serve a notice for any breach of the Regulations. 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. I he number of such places on the register at the end of the year was as follows: — Hotels, Restaurants and Eating Houses 249 Slaughter-houses 1 Tripe, offal and other meat shops 33 Fried fish shops 11 Fish shops 12 Ice cream (Manufacture) 30 Poulterers 4 During the year 2,042 inspections of such food premises and market streets were made and 45 notices served for sanitary defects found, Unsound Food. The following unsound food was condemned during tlio year 1930 :— Commodity. Quantity. Condition. Result of Action taken. Fish :— Tons. Cwta. Qrs. lbs Cods' fillets ... 2 — — Decomposed Surrendered Haddocks ... ... ... 14 do. do. Halibut ... ... 3 do. do. Kippers ... ... 1 do. do. Skate ... ... 1 14 do. do. Witches ... 1 — — do. do. Fruit :— Apples 1 11 1 20 Rocten do. Meat : — Bacon 2 8 3 18½ Decomposed do. Chickens ... ... 1 - do. do. Pork ... ... 21 do. do. Tinned Hams ... 3 — ... do do. Vegetables :— Carrots 1 - - Rotten do. Lettuce ... 11 3 2 do. do. Onions 5 2 4 do. do. Tomatoes 4 2 2 — do. do. Total 14 18 — 12½ The Public Health (Preservatives, etc., in Food) Regulations. In the year 1980 ten samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., white of egg preparation 4, icing and iced cake 2 (see page 56), sausages 4 (see page 56). Food and Drugs (Adulteration) Aat, 1928. On the 1st January, 1929, the Food and Drugs (Adulteration) Act, 1928 consolidating the four Food and Drugs Acts of 1875, 1879, 1899 and 1928, came into force. The Margarine Act of 1877 and the Butter and Margarine Act cf 1907 are also included in the scope of the new Act. Much progress has been made by the consolidation of these Acts; the consolidation is a great convenience. Although the proportion of articles found adulterated is low the careful administration of the Act is valuable as a preventive measure. Articles Analysed. Formal Samples. ARTICLE. Number Purchased Result of Analyses Proceedings taken. Convictions. Fines and Cost3. Genuine. Adulterated. Ale 5 5 .. .. .. .. A lmond oil 3 3 .. .. .. .. Almonds, ground 3 3 .. .. .. .. Amm. tincture of quinine 3 3 .. .. .. .. Asparagus, canned 1 1 .. .. .. .. Beef, corned 3 3 .. .. .. .. Beef, glazed 1 1 .. .. .. .. 53 54 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken Convictions. Fines and Costs. Genuine. Adulterated. Beef, pressed 2 2 ... ... ... ... Bicarbonate of soda 2 2 ... ... ... ... Borax 8 8 ... ... ... ... Brandy 2 1 1 ... ... ... Brawn 9 9 ... ... ... ... Bread and butter 6 6 ... ... ... ... Butter 47 47 ... ... ... ... Cake 3 3 ... ... ... ... Calomel ointment 4 4 ... ... ... ... Carbonate of soda 1 — 1 ... ... ... Cheese 10 10 ... ... ... ... Chocolates 3 3 ... ... ... ... Christmas pudding 5 5 ... ... ... ... Cinnamon 2 2 ... ... ... ... Coffee extract 1 1 ... ... ... ... Coffee and chicory extract 6 6 ... ... ... ... Comp. tincture of rhubart 3 3 ... ... ... ... Cream 18 18 ... ... ... ... Cream, canned 3 3 ... ... ... ... Cream pastries 2 2 ... ... ... ... Crystallised fruit 2 2 ... ... ... ... Doughnuts 2 2 ... ... ... ... Dripping 9 9 ... ... ... ... Egg substitute 7 7 ... ... ... ... Fish paste 9 9 ... ... ... ... Fruit cordial 2 2 ... ... ... ... Gin 2 2 ... ... ... ... Glycerine 3 3 ... ... ... ... Grape fruit juice 1 1 ... ... ... ... Ice cream 18 18 ... ... ... ... Jam 3 3 ... ... ... ... Lard 3 3 ... ... ... ... Lemonade 1 1 ... ... ... ... Lemonade powder 2 2 ... ... ... ... Lemon squash 2 2 ... ... ... ... Lime juice cordial 4 4 ... ... ... ... Liniment of iodine 5 5 ... ... ... ... Liniment of turpentine 5 5 ... ... ... ... Lozenges, cough 4 4 ... ... ... ... Margarine 10 10 ... ... ... ... Marmalade 5 5 ... ... ... ... Meat paste 5 5 ... ... ... ... Meat, minced 2 2 ... ... ... ... Milk 151 147 4 1 1 Fine 40s. Costs, 10s. 6d. Milk, condensed 7 7 ... ... ... ... Milk, dried 2 2 ... ... ... ... Mincemeat 5 5 ... ... ... ... Mineral water 1 l ... ... ... ... Oil, camphorated 2 2 ... ... ... ... Oil, olive 3 3 ... ... ... ... Ointment, blue 2 2 ... ... ... ... Ointment, boracic 2 2 ... ... ... ... Ointment, gall and opium 1 1 ... ... ... ... Ointment, sulphur 3 3 ... ... ... ... Ointment, white precipitate 3 3 ... ... ... ... Orange crush 1 1 ... ... ... ... Paregoric 6 6 ... ... ... ... Pearl barley 3 3 ... ... ... ... Peas, dried 2 2 ... ... ... ... Peas, tinned 7 7 ... ... ... ... Pepper 3 3 ... ... ... ... Peroxide of hydrogen 2 2 ... ... ... ... Pickles 2 2 ... ... ... ... Prescriptions 1 1 ... ... ... ... Quinine and orange wine 1 1 ... ... ... ... Salad oil 4 4 ... ... ... ... Salmon, canned 3 3 ... ... ... ... 55 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs. Genuine. Adulterated. Sauce « 3 ... ... ... ... Sausages 23 19 4 2 1 (a) Costs £3 3s. (b) Fine £2. Sausage roll 4 4 ... ... ... ... Sponge cake 3 3 ... ... ... ... Sponge fingers 4 4 ... ... ... ... Sugar 3 3 ... ... ... ... Suet, shredded 5 5 ... ... ... ... Swiss roll 3 3 ... ... ... ... Sweets 10 10 ... ... ... ... Tea 4 4 ... ... ... ... Tea dust 3 3 ... ... ... ... Tea sittings 1 1 ... ... ... Treacle 2 2 ... ... ... ... Vinegar 11 10 1 1 Costs, £5 5s. Whisky 2 2 ... ... ... ... White of egg preparation 1 1 ... ... ... Wine- 3 3 ... ... ... ... Yellow crystals 3 3 ... ... ... ... Total 567 555 12 4 9 Fines, £4-. Costs, £81 8s 6d Informal Samples. article. Number Taken. Result of Analyses. Genuine. | Adulterated. Black currants, canned 1 1 ... Black pudding 1 1 ... Borax 1 1 ... Brawn 1 1 ... Bread and butter 1 1 ... Cake, iced 1 ... Cheese 11 11 ... Cream, canned 1 1 ... Cinnamon, ground 1 1 ... Curry powder 1 1 ... Fish, cooked 1 1 ... Gelatine 1 1 ... Icing 1 — 1 Nutrreg, ground 1 1 ... Oil of almonds 2 2 ... Raisin wine 1 1 ... Shrimps, bottled 1 1 ... Sulphur ointment 1 1 ... Sweets 8 8 ... Tomatoes, canned 1 1 ... White of egg preparation 3 — 3 Total 41 36 5 The Borough Analyst, J. Kear Colwell, Esq., F.I.C., has kindly supplied the following notes: — During the year 1930, 608 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 567 having been purchased with the usual formalities and 41 obtained informally. 56 Of this total 17 (2.8 per cent.) prove I to be adulterated—12 being1 formal and five informal samples. They comprised brandy, carbonate of soda, milk, sausages, vinegar, iced cake, icing and white of egg preparation, these last three being informal samples. Brandy.—A sample of brandy was found to be 38.93 degrees under proof. The bottle in which the brandy was sold was labelled not more than 40 degrees under proof. No offence was therefore established and no action called for. Carbonate of Soda.—In the case of carbonate of soda certified to be adulterated it was found that bicarbonate of soda had been substituted, probably by mistake. Milk.—The milk supply again has been well maintained only four of the 151 samples (2.6 per cent.) having been certified to be adulterated, two by the abstraction of at least 2 and 3.3 per cent, of fat respectively and two by the addition of 2 and 20 per cent, of water respectively. 11 is interesting to be able to note that most of the samples of milk have been of good quality. The four cases reported to be adulterated were dealt with by cautionary letters to the vendors of three samples and by legal proceedings in the fourth (20 per cent, added water), the defendant being convicted and fined 40s. with 10s. 6d. costs. Vinegar.—The sample of vinegar was slightly deficient in acetic acid which should not fall below 4 per cent. Sausages.—Twenty-three samples of sausages were examined and four found to be preserved with sulphite preservative, the quantity varying from 120 to 330 parts of sulphur dioxide per million. The Preservative Regulations permit the use of sulphite preservative in sausages provided the quantity does not exceed 450 parts per million expressed in terms of sulphur dioxide, and that the fact is duly notified on the label in the manner prescribed. Iced Cake, etc.—Iced cake, icing and white of egg preparation may be grouped together conveniently as the white of egg is used for making the icing used on the cake. All these were found to contain sulphite preservative, the quantity in the white of egg preparation varying from 1,043 to 1,317 parts of sulphur dioxide per million, and the icing and iced cake 40 and 90 parts respectively, The wholesaler stopped the sale of the white of egg preparation. Pharmaceutical Preparations.—All these proved to have been dispensed with due care and attention to the requirements of the Pharmacopœia. Cheese.—Recently it hasi become customary to sell cheese wrapped in tin foil and there can be little doubt that in nearly all cases the cheese does attack the metal wrapper with the result that some tin compound is formed in or on the cheese. In the early parti of the year 10 samples of an Italian soft cheese which had been packed in tin foil were examined for that metal. The foil had become much disintegrated in some of the samples and before making the analysis the visible portions of the metal were picked out so that as far as possible any tin found could be attributed to the chemical action of the cheese on the metal. The results were 57 as follows:—Three samples contained 3.88, 2.70 and 1.85 grains of tin per pound of cheese, four contained only traces too small to estimate and in three no indication of the presence of tin could be obtained. Views differ considerably on the toxicological effect of tin and its compounds, but it is obvious that the use of metallic wrappers for foodstuffs needs careful watching. It may be interesting to add that in no case was preservative found to be present in any sample of milk or cream. J. KEAR COLWELL. Efforts are repeatedly made to co-operate in any way possible with the vendors of food in the Borough and to assist them in the observance of the Regulations. In this connection a communication was sent to the retailers of sausages drawing attention to the provision respecting the sale of sausages containing preservative, and opportunity is taken by the Inspectors during their visits to retail shops to remind the proprietors or managers that preserved sausages can be sold without a label being attached to the package handed to the customer if a notice to the effect that the article contains preservative is exhibited in a conspicuous place in the shop so as to be easily readable by a customer. This provision conveniently meets cases where sausages already packed by the wholesaler are divided in the retail shop for sale in smaller quantities. In such cases it happens that when sold by retail one-half of the divided package has on it the wholesaler's declaration of the presence of preservative, but the second portion has no such declaration. The retailer is protected if a general notice as mentioned above is exhibited in the shop. Cream Cheese. A request was received from a company of provision dealers that an examination should be made of a quantity of cream cheeses of Italian production delivered to them from a warehouse where they had been deposited two months previously. The cheese was divided, into small portions each being wrapped in tin foil. The consignment consisted of 104 cases of Petit Gruyere, each case containing 50 boxes with 12 portions of cheese in each box. On inspection it appeared that the moisture in the cheese had acted on the metallic covering. Ten samples of the cheese from different cases were taken for chemical examination. The Borough Analyst reported that in seven of the 10 samples examined evidence of the presence of tin was disclosed; also that on opening the boxes it was observed that the metallic wrappings of the cheese were in many cases in a state of disintegration and it was difficult to separate the particles of foil from the cheese. For the purposes of the examination the metallic wrapping was removed as far as possible and the tin content of the cheese wasi then determined. Following the examination of the cheese a communication was sent to the Company concerned that the 104 cases of cream cheese from which; the samples were taken should not be sold in this country for human consumption but could be disposed of for pig food. Subsequently a communication was received from the Company that the whole consignment of 104 cases had been shipped to another country. 58 MILK. The table below shows the fat content of 151 samples of milk examined : — Percentage of Fat. Number of Samples. Shops. Streets. Total. Less than 3.0 3 1 4 3.1 3 - 8 3.2 8 3 11 3. 3 17 3 20 3. 4 10 3 13 3. 5 14 3 17 3.6 10 5 15 3.7 19 1 20 3.8 14 2 16 3.9 6 - 6 4.0 1 2 3 4.1 4 1 5 4.2 5 2 7 4.3 1 - 1 4. 4 3 - 3 4. 5 1 - 1 4.9 1 - 1 5.1 2 - 2 5.2 1 - 1 5.3 1 - 1 5.4 1 - 1 125 26 151 Average fat content 3.69 3.57 3.67 Monthly Variation of Chemical Composition of Milk. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 12 12.19 8. 69 3. 50 February 12 12.20 8.79 3.41 March 16 12. 70 9. 04 3.62 April 10 12. 66 8.93 3.73 May 21 12.69 8.95 3. 65 June 13 12.11 8.90 3.50 July 12 12.46 8.81 3.65 August 7 12. 38 8.76 3. 63 September 6 12.85 8. 85 4.00 October 16 12.55 8.96 3.69 November 15 12.90 8. 95 3. 95 December 11 12.72 8. 93 3.79 Whole year 151 12.55 8.88 3. 67 Legal minimum 11.50 8.50 3.00 59 Merchandise Marks Act, 1926. In November, 1930, a communication was received from the Ministry of Agriculture and Fisheries respecting an informal conference which had recently taken place between the Officers of the Ministry and representatives of the County Councils' Associations, and the Association of Municipal Corporations, regarding the enforcement of the Orders in Council made under the above Act. The general opinion of the conference was that much of the failure on the part of the traders to comply with the requirements was due to ignorance, and that a considerable advantage would be gained by the wide distribution of notices, couched in simple terms, explaining the requirements. To effect this, a suitable notice was prepared by the Ministry with the assistance of the Federation of Grocers' Association, which leaflet, it was suggested, might be of service to the better class of shopkeepers, and simpler form of notice was suggested as more appropriate to small shopkeepers and street traders. It had been our practice in Holborn, on the coming into operation of the various Orders, to furnish to the traders concerned a simple epitome of their requirements. Again, to remind them of their obligations in the matter, the opportunity was taken to issue to shopkeepers and street traders the notices as suggested by the Ministry of Agriculture and Fisheries. The simpler form of notice used for small shopkeepers and street traders more particularly was as follows: — MARKING OF IMPORTED GOODS. Short Notice to Traders. Imported foodstuffs of the following kinds must, by law, be marked to show where they came from: — 1. Fresh apples; 2. Raw tomatoes; 3. Eggs (hen or duck eggs in shell); 4. Dried eggs; 5. Currants, sultanas and raisins; 6. Oat products (oatmeal, rolled oats, oat flour, and groats); 7. Honey. If the goods are from foreign countries, they must be marked either with the word "Foreign" or with words which show the country from which they came, such as "Grown in France," "Dutch Produce" or "Danish." If they are imported from overseas parts of the Empire, they must be marked with the word "Empire" or with the words showing the country from which they came, such as "Australian Produce," " Grown in Guernsey " or " Canadian." Fresh apples, raw tomatoes, loose currants, sultanas and raisins, and loose oat products must be clearly marked with a show ticket having letters not less than half an inch high when exposed for sale in any quantity. These goods must also be marked when actually sold if they are sold in quantities of more than 14 lb., but when sold in quantities of 14 lb. or less, they may be handed to the purchaser in unmarked bags. Packages of currants, sultanas and raisins made up before reaching the retailor; packages of dried eggs made up before reaching the retailer; containers of honey; and packages of oat products made up before reaching the retailer, should be marked in capital letters not less than one-twelfth of an inch in height where the longest side of the package is not more than six inches, and not less than one-eighth of an inch in height when the longest side is more than six inches. Blends or mixtures of oat products, or of honey, may be marked simply "Blended Imported." Imported eggs must be plainly stamped on the shell of each egg in letters not less than one-twelfth of an inch high. This notice is intended only to give short particulars of what is required when these goods are exposed for sale in shops, or on stalls and barrows, and when they 60 are sold by shopkeepers, stallholders and barrowmen. Further details about the Orders made under the Merchandise Marks Act, 1926, can be obtained from : — The Public Health Department, Holborn Town Hall, 197, High Holborn, W.C. 1. Traders can be prosecuted and fined if they do not carry out these marking Orders. C. W. HUTT, M.D., D.P.H., Medical Officer of Health. Town Hall, 197, High Holborn, W.C. 1. December, 1930. The following notes refer to the general enforcement of the Orders in the Borough: — All shops selling the foods specified in the Orders have been visited once and a circular giving an extract of the appropriate Order has been left with the shopkeeper; re-visits have been made to many of the shops. Generally speaking there has been no trouble in getting currants, sultanas, raisins, oat products and tomatoes marked as required. Foreign eggs, which are marked by the exporter, have been found in a number of cases to have the mark illegible owing to careless stamping. Letters have been sent to shopkeepers selling such eggs and in one instance the wholesaler was written to. Some improvement occurred in consequence; certain of the shopkeepers adopted the practice of themselves restamping any eggs not legibly marked. Considerable trouble has been experienced with regard to the marking of apples. The Medical Officer of Health has personally called the attention of shopkeepers and stallholders to breaches of this Order and a considerable number of letters have been sent to shopkeepers on this point drawing their attention to infringements of the Order. The greatest offenders at present arc itinerant fruit vendors; the personnel and pitch vary so much from day to day that it is not easy to keep in touch with them. Unfortunately they are not required to show the names of the persons responsible and their addresses on the barrows; information obtained from the stallholders may be correct or incorrect. Some improvement has, however, occurred of late in respect of these stallholders. The following are brief particulars of some typical breaches of the Orders rej>orted during the year : — April Imported eggs exposed for sale in a shop not marked or the marking illegible. Letter sent to importer. Replied that every care taken to comply with Order; rubber stamp for re-marking the eggs to be supplied to the retailer. July. Imported apples exposed for sale in a shop not marked. Letter sent to shopkeeper. Reply promising to provide more labels and complaining that apples on street barrows not marked (itinerant vendors). do. Imparted apples exposed for sale on a street stall not marked. Itinerant vendor cautioned. November. Imported apples exposed for sale on street stall not marked. Letter of warning sent to street trader. do. Imported apples exposed for sale in large fruit shop not marked. Nine batches exposed for sale—only two marked. Letter of warning sent to shopkeeper. December. Imported tomatoes on street stall not marked. Copy of short notice sent to the licensed street trader. do. Complaint received that imported tomatoes on stalls in a market street not marked. Special visits paid and copies of short notice left with stallholders and attention drawn to the requirements of the Order. 61 In the above cases so far as shops or licensed stalls in market streets were concerned improvement was effected, although even in the more regular businesses constant supervision is required to ensure strict compliance with the Orders. The itinerant vendors are more difficult to supervise; often it is only at long intervals and at irregular times that these vendors are found trading; the personnel and pitch and round vary from day to day. It would facilitate efficient administration of the Orders if all such vendors were required to have their names and addresses exhibited on the barrows. In the early part of the year 1930, legal proceedings were instituted against a shopkeeper in the Borough for breach of the Merchandise Marks (Imported Goods) No. 3 Order. In this case batches of imported apples, bearing no indication of the countries of origin, were exposed for sale in the window and round the interior of the shop. The Manager of the retail shop was verbally warned by the Inspector, and a written communication drawing attention to the breach of the Order was sent by the Medical Officer of Health to the proprietor of the establishment. As the breach continued, samples of the imported apples were taken from five different batches of the fruit, and particulars of the marks on the packages, invoices and consignment notes were obtained. Following this action information was laid before a magistrate at the Police Court, and after several hearings the defendants were convicted and fined £5 and five guineas costs.* Agricultural Produce (Grading and Marking) Act, 1926. This Act provides for the grading and marking of agricultural produce and gives power to the Ministry of Agriculture and Fisheries by regulations to prescribe "designations" and " marks " to indicate the quality of such produce. The following Regulations have been made under the Act :— Agricultural Produce (Grading and Marking) (General) Regulations, 1928. Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1928 (Revoked, March, 1930). Agricultural Produce (Grading and Marking) (Apples and Pears) Regulations, 1929. Agricultural Produce (Grading and Marking) (Tomatoes and Cucumbers) Regulations, 1929. Agricultural Produce (Grading and Marking) (Wheat Flour) Regulations, 1929. Agricultural Produce (Grading and Marking) (Beef) Regulations, 1929. Agricultural Produce (Grading and Marking) (Malt Flour and Malt Extract) Regulations, 1929. Agricultural Produce (Grading and Marking) (Potatoes) Regulations, 1929. Agricultural Produce (Grading and Marking) (Broccoli) Regulations, 1930. Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1930. Agricultural Produce (Grading and Marking) (Strawberries) Regulations, 1930. Agricultural Produce (Grading and Marking) (Cherries) Regulations, 1930. Agricultural Produce (Grading and Marking) (Canned Fruits, Peas and Beans) Regulations, 1930. Agricultural Produce (Grading and Marking) (Cider) Regulations, 1930 Agricultural Produce (Grading and Marking) (Dressed Poultry) Regulations, 1930 Better Beef. An Inter-Departmental Committee reports that the grading and marking of beef has been a success in London. The report states that the scheme attracted to London a better average * Reference to this case was included in the Annual Report for 1929—the breach having been committed in that year. 62 quality beef, and that on the whole the demand for marked beef has been most noticeable in the East End. Members of the public desiring to purchase home killed beef of high quality can be assured of obtaining it by asking for "National Mark" beef. Every carcase of "National Mark "beef is graded and marked by experts appointed by the Government. There are three grades: — "GOOD" into which the greater part of the home-killed supplies of good average quality beef naturally falls. Meat in this grade carries less fat than meat in the other grades. "SELECT" is from choice young animals. It is of exceptional tenderness, but these specially fed young animals are costly to produce and are in comparatively small supply. Hence beef of this grade cannot be cheap. "PRIME" has most of the good qualities of the select grade, but is from slightly older animals; the finest steak and stewing meat come from this class. The outward and visible sign of this graded beef is the National Mark. This is in the form of a ribbon stamp drawn down the side of the carcase, the colouring matter used being vegetable and entirely harmless. The mark bears the grade name "Good," "Select" or "Prime," the words "home killed" and a silhouette map of England and Wales. The mark conveys a guarantee of origin and quality. Food Standards. It is very encouraging to those who are working for the purity and quality of food to see the action which is being taken by Parliament to promote this end. Although in this country we have not yet reached the level of the Dominions, there is reason to hope that this matter is more and more engaging the attention of workers in Public Health in this country and, even more important still, that part of the general public whose thoughts turn towards the improvement of the Public Health. The path is devious and may appear insignificant. For several years new attempts have been made to establish a standard of purity of ice cream—a chemical standard has been formulated—within a reasonable time we may expect the formulation of a bacteriological standard. Is it coo much to hope that this may eventually lead to a bacteriological standard for ordinary milk? For such reasons we must welcome the efforts; made in connection with vinegar in a Bill introduced into the House of Commons in the Session 1928, the object of which was to fix a standard of quality for vinegar. True vinegar is a brewed product prepared by the alcoholic and subsequent acetous fermentation of barley or some other cereal, the starch of which has been converted by malt. It is possible to produce more chcaply an imitation prepared by diluting commercial acetic acid, staining and flavouring it to resemble the true article. The Food and Drugs (Adulteration) Act is designed to ensure that a customer shall get what he pays for, but for want of a standard of quality, the purchaser may be supplied with spurious vinegar unless he demands malt vinegar. The Bill proposed to establish a standard of quality and to enforce labelling of imitation vinegar. Enactments standardising vinegar are in force in Canada, Australia, New Zealand, South Africa and the United States of America. The desire of the public to consume a natural product or at any rate to know when they were offered an artificial product found expression in the Artificial Cream Act of 1928. We, welcome the action taken jointly by a Committee of the Society of Public Analysts and the Food Manufacturers' Federation to arrive at agreed standards and definitions for jams, and note with satisfaction the conclusions reached. The agreement extends to marmalade and fruit jellies. The general adoption of the agreement reached by these two bodies would do much to meet the difficulties of local authorities in dealing with these classes of food, where, on the one hand, competition has resulted in the production of a low quality article so far as fruit content is concerned, and on the other hand public analysts have had no standard by which they could judge the genuineness or otherwise of the jam under examination, 63 PREVALENCE OP AND CONTROL OVER INFECTIOUS DISEASES. The relative importance of the commoner infectious diseases as regards number) of deaths caused is shown by the following table :— ENGLAND AND WALES. Common Infectious Diseases. Deaths at all Ages. 1020. 1921. 1922. 1923. 1924. 192o. 1926. 1927. 1928. 1929. Yearly average 1920-1999 Pneumonia (all forms) ... 37,149 34,708 40,930 33,413 38,970 36,990 32,339 37,242 31,014 43,846 36,660 Pulmonary Tuberculosis 32,791 33,505 33,919 32,097 32,690 32,382 30,108 31,06ti 29,799 31,425 31,978 Measles 7,190 2,241 5,694 5,316 4,834 5,337 3,483 3,622 4,302 3,388 4,540 Whooping Cough 4,401 4,576 6,370 4,162 3.983 6,058 4,118 3,681 2,976 6,332 4,665 Diphtheria 5,648 4,772 4,075 2,722 2,501 2,774 2,994 2,732 3,191 3,446 3,485 Scarlet Fever 1,430 1,305 1,382 993 888 988 677 579 580 717 953 Enteric Fever . 537 613 465 450 496 388 367 367 438 382 450 64 The total number of notifications relating to Holborn residents received during the year was 474 in comparison with G43 in the year 1929. The decrease is accounted for by the lesser number of notifications received of the following diseases : — Smallpox 14 in comparison with 43 in 1929. Scarlet Fever 90 ,, ,, 130 ,, Whooping Cough 33 ,, ,, 153 ,, Pneumonia 49 ,, ,, 89 ,, Rheumatism 13 ,, ,, 25 ,, Attention has had again especially to be called to the non-notification of whooping cough and primary pneumonia. A special reference card with complete list of notifiable diseases is supplied to all doctors practising in the Borough. In addition to the above we received 175 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. The diseases notified were : — Chicken-pox 2 Diphtheria 88 Dysentery 1 Erysipelas 3 Enteric Fever 1 Measles 29 Scarlet Fever 22 Tuberculosis 28 Whooping Cough 1 175 Smallpox. This disease continued to be prevalent in London throughout the year 1930. In the Borough of Holborn the Public Health Department was called on to deal with 65 cases, viz., 13 residents, 51 non-resident workers and one common lodging house inmate who removed from the Borough just before the disease was diagnosed. Eight of the residents were notified by the Medical Officer of Health. Two residents, other than the 13 mentioned above, were also notified, but the diagnosis was not confirmed. The 13 cases among residents occurred in nine houses. In one house there were three cases, in each of two there were two cases and from each of six house one case was notified. Five of the nine houses were tenement lodging houses, two were self-contained working-class flats and one was a common lodging house. In contact with these were 80 persons exclusive of the contacts at the common lodging houses. The 52 non-resident cases occurred at 47 workplaces and one common lodging house; in each of four workplaces two cases occurred. In contact with the 52 cases there were upwards of 3,711 persons excluding the residents at the common lodging house and students at a school where a non-resident patient was employed. 65 Procedure. The routine procedure carried out was similar to that detailed in the Annual Report for 1929 both with regard to resident and non-resident cases. The action includes daily visits to infected houses and to business premises concerned in order to deal promptly with any suspicious illness among contacts and also the exchange of information with the Medical Officers of Health of the areas where patients or contacts reside or work. Vaccination. The active campaign to promote vaccination referred to in the Annual Report for 1929 was continued throughout the year; 1,634 vaccinations and revaccinations were performed during 1930. Under the London Government Act, 1929, as from the 1st April, 1930, the duties of the Holborn Board of Guardians with relation to vaccination were transferred to then Holborn Borough Council for the part of the Union in the Holborn area, the Act providing that the functions relating to vaccination should be discharged by the Borough Councils as functions relating to public health. The Council delegated to the Public Health Committee its powers with respect to vaccination and gave instructions that the Public Vaccinators and the Vaccination Officer should be placed on the staff of the Public Health Department. In pursuance of the powers so delegated, the Public Health Committee appointed the following as Public Vaccinators: — Dr. P. J. Connolly, of No. 3, Mecklenberg Square, and No. 40, Ttoseberv Avenue, to act in the eastern half of the Borough, i.e., in St. George-the- Martyr, North St. Andrew, South-Bast St. Andrew and Saffron Hill Wards. Wards. Dr. Ernest) G. Wheat, of 104, Charing Cross Boad, to act in the western half of the Borough, i.e., in North St. Giles, Central St. Giles. Lincoln's Inn. North Bloomsbury and South Bloomsbury Wards. The Committee also appointed Mr. Percy E. Capps as Vaccination Officer, an arrangement being made with the Finsbury Borough Council that Mr. Capps should also act in that area, two-thirds of his time to be allotted to work in Finsbury and one-third to work in Holborn. The following table gives information respecting vaccinations performed by the Public Vaccinators: — Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Postponed by Medical Certificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-District : 12 months ended 30th June, 1930 174 108 15 17 0 15 14 5 St. Giles and Bloomsbury Sub-District : 12 months ended 30th June, 1930 100 57 9 9 1 9 12 3 274 165 24 26 1 24 26 8 e 66 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. No opportunity is lost of speaking about the vital importance of vaccination whether for the baby1 or for the older person. Information Supplied Through the London County Council. Following the arrangements operating in previous years, information of all cases of smallpox in the Greater London area giving particulars of the illness and the names and addresses of contacts was distributed to the Borough Medical Officers of Health by the Medical Officer of the London County Council. During the year information of 5,140 eases in the County of London and 1,887 cases in extra-Metropolitan district was received. The lists included the names and addresses of 252 patients or contacts residing or working in the Holborn Borough. Diphtheria. We received notifications relating to 80 eases of diphtheria occurring in residents in the Borough; of these two were sent in as being "carriers" of diphtheria bacilli. All were removed to hospital. The " carriers " were also removed to hospital. Age at Notification of 80 Notified Cases of Diphtheria. 0—1 1—5 5—15 15—25 25—45 45—65 Total. 2 32 22 17 6 1 80 Two deaths occurred, one at the age of 11 months, the other at the age of 4 years. Eight of the notified cases were returned from hospital certified as not suffering from diphtheria. Secondary clinical cases were 10 in number; details follow: — Primary Case Age. Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises — F. (Hospital Nurse) 22 yrs 31/12/1929 N. W. C. L. W. N. S. B. 50 yrs 21 yrs 2 yrs 19 yrs 31/12/1929 3/1/1930 5/1/1930 20/1/1930 Hospital (in-patient) Hospital (nurse) Hospital in-patient) Hospital (nurse) J. C. 6 yrs 14/7/1930 A. C. H. C. D. C. W. C. 2 yrs 5 yrs 3 yrs 1/1½ yrs 17/7/1930 17/7/1930 19/7/1930 28/7/1930 Tenement house Notified by M. O. H. Notified by 11. O. H. Died R. L. 3 yrs 26/7/1930 J. L. . J. L. 5 yrs 1 5/12 28/7/1930 13/11/1930 Tenement house There was no "return" case, i.e., no secondary case was notified from any family within four weeks after the return home of a primary case, but in one case 67 the return home of a patient was followed two months after by the notification of another case in the same family; swabs then taken from the original patient proved nose positive and throat negative. A week later swabs of the throat and nose of the original patient were negative. In London, 13,411 cases were notified giving rise to 460 deaths. We endeavour to co-operate with the Medical Superintendents of the Fever Hospitals serving the County of London; 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 diphtheria or scarlet fever. Diphtheria in Hospitals. Information was received of 86 cases of diphtheria occurring among in-patients, or staffs at three hospitals in the Borough. The information was obtained from the notifications of removal received from the London County Council, or from the ordinary notification certificates furnished by the doctors diagnosing the disease. From one hospital there were 64 notifications of which 53 were clinical cases (33 were notified "nasal") and 11 were notified as "carriers" only. Of these 64 notifications six related to Holborn residents, namely, four nurses and one ward maid at the hospital and one in-patient admitted to the institution from a home address in the Borough. Fifty-eight were in-patients admitted from areas outside the Holborn Borough. Copies of the notifications of these cases if sent to the Holborn Public Health Department are forwarded to the Medical Officers of Health of the districts from which the patients were admitted. Information kindly furnished by the hospital indicated that in nine cases the disease was contracted prior to admission to the institution; in 39 the disease might be regarded as contracted after admission; in five definite information as to the time or source of infection was not available. From a second hospital eight cases were removed, three nurses and five inpatients (two of whom were notified as "nasat diphtheria"). In addition to the three nurses three of the five in-patients were also Holborn residents; the other two in-patients had been admitted from outside the Holborn area. From a third hospital 14 cases were removed, two were nurses (one male, one female), three were ward maids (one of whom was notified as a carrier) and nine were in-patients. All the in-patients had been admitted to the hospital from outside the Holborn area. Diphtheria in Hospitals. Hospital. Cases Notified Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 5 59 53 11 6 58 64 B. 3 5 8 — 6 2 8 C. 5 0 13 1 5 9 14 E 2 68 Diphtheria Contacts. As in former years we have continued to swab all diphtheria contacts among school children and toddlers. Results of Bacteriological Examinations and Virulence Tests. No. of contacts swabbed 66 Negative at first examination 39 Positive at first examination 27 (40.91 percent.) Virulence tests made 1 (negative) Analysis of the swab results relating to the contacts is given below: — Contacts swabbed. Nose and Throat. Positive Results. Contacts positive. Nose only. Throat only. First Examination 66 9 18 - 27* Second 23 — 9 — 9 Third 9 - 1 - 1** * 4 positive contacts removed to L.C.C. Fever Hospitals. ** Virulence test made in the case of this contact—negative. 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. Diphtheria antitoxin was available free of charge on application by medical practitioners. In three cases doses were supplied of 8,000 units each. The Schick Test and Immunisation against Diphtheria. This work has been carried on since 1922 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 arc able to record that any disturbance caused was negligible. The use of toxoid antitoxin does away with the risk of fatality incurred by using improperly-made toxin antitoxin, 69 TABLE 1. HOLBORN MUNICIPAL INFANT WELFARE CENTRE, 1922-1930. Summary Of Work Done. 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 Adults 15 and above years Total Schick Tested = 1335 Total for 9 years, 1922-30. 78 226 167 127 104 83 65 56 49 60 50 37 29 32 6 176 Result of Schick Test. pos. Neg. Pos. Neg. Not read | Pos. Neg. Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Not read Total for 9 years. 72 6 214 9 3 149 8 109 17 1 74 28 2 51 30 2 43 22 41 15 32 17 25 35 24 26 20 17 14 15 11 21 4 2 80 92 4 963 Pos. 360 Neg 12 Not read. Immunised without preliminary Schick test (Jan. 1927. end of 1930). 49 93 38 20 17 2 1 1 0 1 0 0 1 Total immunised without preliminary Schick test 223 Total immunised (includes above). 108 264 154 109 75 43 50 41 25 23 19 17 10 7 2 42 Total immunised (includes above). 989 TABLE II. HOLBORN MUNICIPAL INFANT WELFARE CENTRE. Schick Test and Diphtheria Immunisation Nine years, 1922-30. A Total number of individuals who attended clinic B Total tested C Total immunised without pre. liminary Schick test Result of Test. D E Found NEGATIVE to He Schick Test after Immunisation of Positives. H Found POSITIVE to Re Schick Test after 3 ccm T.A. M or with T.A.F. Total Re Schick tested Given 3 ccm T.A. M. or with T.A.F. Not retested. Given 1 ccm not yet retested. J Failed to complete 3 inoculatns. Inoculatns. not begun. Inoculatnsstill in progress. F Found NEGATIVE to Re Schick Test after G First immunised with T.A.F. and found NEGATIVE to Re Schick after Positive. Nega- tive Not read. 1 ccm T.A.M. 2 com T. A.M. 3 ccm T. A.M. or with T.A.F. 4 ccm T. A.M. 5 ccm T. A.M. 6 ccm T.A.M. 8 ccm T.A.M. Further (losis of T.A.F. 3 ccm T.A.M. Given further inoculation but not yet retested. No further inoculation given. Children ' Ad- ults 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 C A C A C A 1383 175 1160 175 288 0 882 80 267 94 9 3 21 0 20 2 621 20 21 0 8 1 9 0 1 0 3 0 3 0 24 1 9 3 740 27 204 8 18 0 80 12 78 17 0 1 1,558 1,335 223 962 361 12 21 22 641 21 9 9 1 3 3 25 12 767†† 212 § 18 92 95 † 1 1,185 * These columns refer to 83 cases—72 were Schick positive on retesting after 3 ccm T. A.M. 11 were Schick positive on retesting after T.A.F. t 79 of these removed from the Borough. § 20 of these have removed from the Borough. †† These retests includ those made up to 28th February, 1931. Note.—Columns E F G H give details of the total 767 given in Column I. Columns I J give details of the total 1,185 positives given in Column CD. We have not altered the routine procedure, except that owing to the increased confidence of the public in the measure we no longer find it necessary to test children under 5 years of age, but proceed at once to the immunisation. 71 The following table gives particulars of 707 cases re-tested, of whom 81 were found to be Schick positive after immunisation with either 3 c.cms. of T.A.M. or one inoculation with T.A.F. TABLE III. Re-Schick tested after an interval of years or fraction of years Number re-tested after this interval Number found positive Age in years and sex of positives when first tested Further particulars (Unless otherwise stated the dose refers to Toxoid-antitoxin mixture.) Total. M. F. 767 (3.38 429) 83 M. 35 F. 48 5/52 10 ( 6 4) 1 13, F. Negative after further inoculation; 4 c.cm. n all 6/52 3 ( 1 2) Nil Nil Nil 7/52 6 ( 4 2); Nil Nil Nil 2/12 28 (14 14) 4 (a) 9, M. Negative after further inoculation; 6 c.cm. in all (b)' 5, M. Given further inoculation ; not re-tested (c)' 1, F. Negative after further inoc.; 1.1 c.cm. T.A.F. in all (d) 1, F. Negative after further inoc.; 1.1 c.cm. T.A.F. in all 2½/12 18 ( 6 12) 1 6, F. Negative after further inoculation: 3 c.cm. T.A.M. + 0.5 c.cm. T.A.F. in all 3/12 199 (86 113; 15 (a) 8, M. Negative after further inoculation; 4 c.cm. in all (b) Ad., F. Given further inoculation; not re-tested (c) 3, M. Given further inoculation; not re-tested (d) 9, M. Negative after further inoculation ; 4 c.cm. in all (e) 6, M. Negative after further inoculation ; 6 c.cm. in all (f) 11/12 M. Negative after further inoculation; 4 c.cm. in all (g) 5, M. Given further inoculation; not re-tested (h) 2, M. Given further inoculation; not re-tested (i) 5, F. Negative after further inoculation: 6 c.cm. in all (j) 7, F. Given further inoculation; not re-tested (k) (6, F. Given further inoculation; not re-tested (l) 6, M. Given further inoculation ; not re-tested (m) 7, F. Given further inoculation; not re-tested (n) 4, F. Negative after further inoculation; 6 c.cm. in all (o) 5, F. Negative after further inoculation; 4 c.cm. in all 72 Re Schick tested after an interval of years or fraction of years Number re-tested after this interval Number found positive Age in years and sex of positives when first tested Further particulars (Unless otherwise stated the dose refers to Toxoid-antitoxin mixture.) 3½/12 36 (14 22) 3 (a), 4, F. Negative after further inoculation; 5 c.cm. in all (b) 1, F. Negative after further inoculation; 5 c.cm. in all (c) Ad., F. No further inoculation at present 4/12 106 (44 6-2) 12 (a) 4, F. *Negative after further inoculation: 4 c.cm. in all (b) 6, F. Negative after further inoculation; 5 c.cm. in all (c) 10/12, M. Negative after further inoculation; 4 c.cm. in all (d) 2, F. Negative after further inoculation ; 5 c.cm. in all (e) 1, F. Negative after further inoculation; 5 c.cm. in all (f) 6, F. Given further inoculation : not re-tested (g) 4, F. Negative after further inoculation; 5 c.cm. in all (h) 1. M. Negative after further inoc.; 1 c.cm. T.A.F. in all (i) 1, F. Negative after further inoculation ; 0.5 c.cm. T.A.F. 3 c.cm. T.A.M. in all (j) 6, M. Negative after further inoculation ; 4 c.cm. in all (k) 7, F. Given further inoculation ; not re-tested (l) 1. M- Given further inoculation ; not re-tested 44/12 7(2 5) 2 (a) 5, F. Negative after further inoculation ; 6 c.cm. in all (b) 2, F. Negative after further inoculation ; 4 c.cm. in all 5/12 50 (20 30) 6 (a) 2, F. Negative after further inoculation ; 6 c.cm. in all (b) 2, M. Negative after further inoculation ; 4 c.cm. in all (c) Ad., F. Given further inoculation ; not re-tested (d) 3. M. Given further inoculation; not re-tested (e) 1, F. Given further inoculation; not re-tested (f) l.M. Given further inoculation ; not re-tested 6/12 49 (24 25) 8 (a) 1, M. No re-attendance (b) 2, M. Negative after further inoculation ; 5 c.cm. in all (c) 3, M. Given further inoculation; not re-tested (d) 4, F. Negative after further inoculation; 5 c.cm. in all (e) 2, M. No re-attendance (f) 6, M. Negative after further inoculation: 4 c.cm. in all (g) 3, m. Negative after further inoculation; 6 c.cm. in all (h) 3, M. No re-attendance 7/12 24 (10 14) 1 9, F. Negative after further inoculation ; 6 c.cm. in all 8/12 24 (10 14) 3 (a) 11, F. No re-attendance (b) 1, F. No re-attendance (c) 8, M. No re-attendance * Another child in same family (F.), aged 4 year was negative. 73 In addition, one child re-Schick tested 15 months after 1 ccm. T. A.M., was found positive, and two children retested after 3 c.cm. were on the information given by the mother considered to be slightly positive. Sixty-seven of those positive on re-Schicking have been further inoculated, and 46 of them further tested and found negative. Efforts are being Re-Schick tested after an interval of years or fraction of years Number re-tested after this interval Number found positive Age in years and sex of positives when first tested Further particulars (Unless otherwise stated the dose refers to Toxoid-antitoxin mixture.) 9/12 16 (10 6) 3 (a) 1, M. No re-attendance (b) 9, M. Given further inoculation : not re-tested (c) Ad. M. Given further inoculation ; not re-tested 10/12 15 ( 6 9) 1 4 F. †Negative after further inoculation ; 8 c.cm. in all 11/12 9(3 6) 1 1 M. Negative after further inoculation ; 4 c.cm. in all 1 10 ( 3 7) 1 9/12 F. Negative after further inoculation ; 4 c.cm. in all 1-2 85 (42 43) 15 (a) 1, F Negative after further inoculation ; 4 c.cm. in all (b) 2, M. Negative after further inoculation ; 4 c.cm. in all (c) 11/12, M. Negative after further inoculation; 0.5 c.cm + 3 c.cm TAM (d) 2. M. Negative after further inoculation ; 4 c.cm. in all (e) 2, F. Negative after further inoculation : 4 c.cm. in all (f) 6, M. Negative after further inoculation ; 4 c.cm. in all (g) 7, F. Negative after further inoculation ; 4 c.cm. in all (h) 8, F. Given further inoculation ; not re-tested (i) 9, M. Given further inoculation ; not re-tested (j) 9, F. No re-attendance (k) 6, F. No re-attendance (l) 12, M. No re-attendance (m) 12, F. Given further inoculation ; not re-tested (n) Ad. F. Negative after further inoculation ; 5c.cm. in all (o) 1, F. Negative after further inoculation ; 4 c.cm. in all 2- 3 63 (28 35) 6 (a) 2, F. Negative after further inoculation ; 6 c.cm. in all (b) 5, F. Negative after further inoculation ; 4 c.cm. in all (c) 12, F. Given further inoculation ; not re-tested (d) 3, F. Given further inoculation ; not re-tested (e) 4, M. Given further inoculation : not re-tested (f) 8. F. No re-attendance 4-5 1(1 0) Nil Nil Nil 767 (338 429) 83 M. 35 F. 48 † 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. 74 made to continue the inoculation of the remainder One-child (F., aged 1 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 antitoxin as the eldest. Of the 767 persons retested, 338 were males and 429 were females. Of those found positive 35 were males and 48 were females. Neither age nor interval seems to have any influence on the phenomenon. It would seem conceivable that some batches of toxin 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 mixtures used were all 3 L + per c.cm. mixtures, the toxoid antitoxin contained toxoid diluted 1-10 with added antitoxin. Use has also been made of T.A.F. (flocculated toxin-antitoxin) in the case of 23 persons found Schick positive. Of these 23 persons, 22 have been retested; in five of these the reaction to the first test was so slight that they were recorded as suitable for immunisation with only one dose, if T.A.M. had been used. 11 of these (nine children and two adults) were negative to the retest. Eleven (ten children and one adult) were positive to the re-Schick test; of these, six were further inoculated with T.A.F. (three of these were negative to the second re-Schick), five were further inoculated with toxin-antitoxin (three of these were negative to the retest). The use of T.A.F. has been discontinued for the time being. An interesting use of the Schick test was made in connection with a family in which a baby, A.G., six weeks old, developed diphtheria. There were three other children in the same family, a boy, L.G., aged 10 years, and girls, M.G. and O.G., aged 9 and 8, as well as the mother and father. Swabs from children contacts were taken; the boy and the girl aged 9 years were shown to be harbouring diphtheria bacilli in their noses. On reswabbing a fortnight later the bacilli in the nose of the girl morphologically resembled diphtheria bacilli, but the virulence test proved negative. On the 26th February last O.G. and A.G. both gave a negative Schick reaction and on the nth March L.G. and M.G. also gave negative reactions. As a matter of interest the mother was tested and gave a positive Schick reaction. Retesting. Retesting is unpopular with parents, and the need for it does not help to increase their confidence in immunisation. Of 767 that have been retested 72 were found to be still Schick positive after three inoculations and 11 after T.A.F. The facts relating to these are given in Table III. Diphtheria in Children Treated with Immunising Injections. Up to the end of the year 1930 nine cases of diphtheria occurred in children who had been found positive on Schick test and treated with three immunising injections; the details of these are given in Table IV. Diphtheria was also notified as having occurred in six other children who had completed their course of inoculation, but the diagnosis in these cases was eventually not confirmed. Two of these (brother and sister) were removed to M.A.B. hospitals as suffering from diphtheria, but they were diagnosed as suffering from rubella and "carrying" diphtheria bacilli but not as suffering from diphtheria. A third child was removed with diphtheria and found to have measles. A fourth removed with diphtheria was returned as a case of coryza, not diphtheria, and a fifth was removed with faucial diphtheria, but the diagnosis was not confirmed. All these children had been found negative to the retest some time previously. Three others were removed to M.A.B. hospitals as suffering from diphtheria, but were shortly afterwards discharged as not cases; neither had been re-Schicked since being inoculated; one case after his return from hospital gave a negative reaction to the re-Schick test. Tho ninth was notified as suffering from scarlet fever and diphtheria, but was later diagnosed as suffering from scarlet fever only. 75 The following table gives particulars of the nine cases of diphtheria : — TABLE IV. Diphtheria in Children Schick-Tested and Treated with Immunising Injections. Initials Age in years at date of Schick Test Sex Type of Home Date of Schick Test First Injection Final Injection Retest Result of Retest Date of onset of Diplitheria Interval between last injection and date of onset of disease Confirmation of diagnosis by Character of Attack 1. A.C. 4 4/12 M. Artizan— moderately satisfactory ; house let in lodgings 30/1/24 7/2/24 20/2/24 (Thitd) none - 18/3/25 13 months Metropolitan Asylums Board (N.E. Hospital) Very severe 2. G.L. 6 5/12 M. Higher Artizan— model dwellings 4/4/23 11/4/23 25/4/23 (Third) none - 29/5 25 13 months Metropolitan Asylums Board (N.E. Hospital) Very mild 3. M.T. 3 5/12 F. Higher Artizan— model dwellings 24/9/24 1/10/24 15/10/24 (Third) none - 5/4/26 18 months Metropolitan Asylums Board (N.E. Hospital) Mild 4. L.P. 6 8/12 F. Higher Artizan— part of private house 11/11/26 17/11/26 1/12/26 (Third) none - 23/12/26 22 days* Metropolitan Asylums Board (N. W. Hospital) Severe 5. R.H. 7 M. Residential, separate private house 28/9/27 5/10/27 19/10/27 (Third) none - 21/10/27 2 days* Cuddington Isolation Hospital Mild 6. P.P. 1 8/12 F. Artizan— model dwellings 5/9/23 12/9/23 20/9/23 (Third) none - 26/10/27 4 years Metropolitan Asylums Board (N.E. Hospital) Mild 7. J.F. 1 10/12 F. Higher Artizan— model dwellings 13/6/25 20/5/25 10/6/25 (Third) yes negative 11/11/25 19 2/28 2 9/12 years Metropolitan Asylums Board (N.E. Hospital) Mild 8. V.C. 3 5/12 F. Poor, one room; house let in lodgings 9/4/24 30/4/24 18/0/24 (Third) yes negative 12/9/24 21/2/28 3 8/12years Metropolitan Asylums Board (N.E. Hospital) Mild attack of nasal diphtheria 9. W..T. 3 3/12 F. Fair, two rooms; house let in lodgings 12/1/27 19/1/27 9/3/27 (Third) yes negative 19/10/27 15/4/29 2/1/12 years Metropolitan Asylums Board (N.W. Hospital) Mild •These two cases occurred before the elapse of 9 months, the period laid down at Edinburgh as required to secure artificial immunisation. The above table shows that only three of the children were retested after the last injection. It cannot be assumed that immunity invariably follows the administration of three immunising injections, nor that immunity even when once established is invariably permanent. Drs. Parish and Okell have shown that of 440 Schick positive children who were rendered Schick negative by immunisation, 5 per cent, were found to be positive when retested 1-7 years later. 76 The question of the advisibility of using T.A.M. from a bottle that has already been opened has arisen from time to time. In Holborn to save waste we buy T.A.M. in a bottle containing 25 c.c. which is a quantity in excess of that which we are likely to use at one session. This procedure has been found to be safe; every week as a routine aerobic and anaerobic cultures are made from the bottle of toxoid anti-toxin mixture in use; no organism has ever grown. What of the Future ? The aim of everyone who takes up the work must be to get all the children living in the area immunised as soon as possible after they reach the age of 6 months. In Holborn we have not reached 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, supported by necessary advice and information to parents. 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. Immunisation of School Children against Diphtheria. The decision of the London County Council not yet to take up the matter of diphtheria immunisation in the schools though willing to help the work started in the various boroughs, by affording facility in the schools for the circularisation of information to parents, was somewhat of a disappointment to several Medical Officers of Health of Metropolitan Boroughs. Where a Borough Council has definitely decided in favour of diphtheria immunisation and offers it to children under five years of age, each young child is brought to the Immunisation Centre as a result of individual effort, but the organisation of a public elementary school lends itself so eusily to the mass immunisation of a large body of children that it seems very unfortunate that the Borough who has approved the principle should lose this advantage. Immunisation of Nursing Staffs at Hospitals. In June, 1980, arrangements were made with the authorities of the Italian Hospital and the London Homoeopathic Hospital for the Medical Officer of the Council's Immunisation Clinic to Schick test and immunise the nursing staffs of these hospitals. 77 Up to the end of December 59 nurses were tested; 31 were found positive and 24 of these were immunised. At the London Homoeopathic Hospital at the time of starting the work attendance for testing and subsequent immunisation was voluntary, but the results of immunisation have been so satisfactory that Schick testing of all newcomers and immunisation of positives, is now compulsory. Four of the seven nurses who were found positive but refused immunisation have since then left the hospital. The 59 nurses referred to above are included in tlx' total tested as given in Table II, page 70. Some of the nurses at the Hospital for Sick Children, Great Ormond Street, are immunised against diphtheria by the hospital staff. Diphtheria Immunisation is Worthy of an Extensive Trial. It should be pointed out that the results obtained in Holborn from antidiphtheria immunisation are not necessarily those which would be obtained from the widespread practice of the procedure throughout the whole of the country. It is a commonplace in the public health world that satisfactory statistics cannot be compiled from a relatively small number of cases. If we are to reduce the incidence of diphtheria further we are to all intents and purposes forced to employ a method of this nature and for this reason. Diphtheria is a very difficult disease to control; it is spread mainly by healthy "carriers," that is to say, by healthy persons who harbour virulent diphtheria bacteria chiefly in their throats or noses or both, these bacilli are often passed on during the act of coughing or even loud speaking, or perhaps for a very short distance by ordinary breathing, especially in the case of overcrowded vehicles or passenger lifts, or by means of incompletely cleansed drinking vessels or eating utensils placed in the mouth such as spoons, forks, etc. Diphtheria immunisation is worthy of an extensive trial. The procedure has already gained wide acceptance in the United States of America; other countries nearer home, such as Germany, France and Belgium are immunising their children in this way. In these islands it has proved its worth as a means of preventing diphtheria in hospital nurses and in stamping out diphtheria in institutions where the disease has been present for a considerable time and has given rise to case after case. The Edinburgh statistics relating to school children are, to say the least, very encouraging. The control of smallpox obtained by vaccination is so complete that progressive members of the medical profession have been stimulated to obtain a similar control of other infectious diseases including not only diphtheria, but also scarlet fever and measles, and the measure of success already obtained in controlling diphtheria warrants further effort, 78 Less Diphtheria in Holborn than in London. The following table shows the diphtheria notification rates in England and Wales, London, and Holborn during the eight years 1922-29. As the Schick test and immunisation against diphtheria were started in Holborn in the early part of 1922 the figures are of interest: — Diphtheria—Notification rate per 1,000 population. England and Wales London Holborn 1922 1.37 3.37 2.52 1923 1.05 2.27 2.25 1924 1.07 2.31 1.58 1925 1.23 2.73 1.75 1926 1.31 2.96 1.69 1927 1.33 2.71 1.28 1928 1.55 2.75 1.45 1929 1.59 2.68 1.88 The figures for England and Wales and London are taken from the Registrar-General's Statistical Reviews for the years 1922-29. Scarlet Fever. There were 90 notifications of scarlet fever. All but four were removed to hospital. Two cases were returned as not suffering from scarlet fever; one was found to bo suffering from measles, no obvious disease was found in the other. Four notifications of "secondary" cases were received. From five hospitals in the Borough 22 in-patients were notified as so suffering; none was resident in Holborn. There were no "return" cases of scarlet fever. There was no death from this disease. 16,699 cases of scarlet fever were notified in London with 112 deaths. Acute Rheumatism in Children. The Holborn (Acute Rheumatism) Regulations of 1929 came into force on the 1st April, 1929; these require the notification of acute rheumatism in children up to the age of sixteen years. 79 Acute rheumatism as defined by the Regulations means— (i.) Rheumatic pain or arthritis, if accompanied by a rise in temperature; (ii.) Rheumatic chorea (St. Vitus' dance); (iii.) Rheumatic carditis. Nineteen cases were notified in 1930. As regards the source of information relating to the total number of notifications in 1929 and 1930:— 6 were notified by doctors in private practice. 7 were notified by an Assistant School Medical Officer. 12 were notified by doctors in institutional practice. 13 were notified by the Medical Officer of the Rheumatism Supervisory Clinic. 29 were notified by the District Organiser of the L.C.C. Care Committee as having been definitely stated medically to be suffering from rheumatism. Rheumatism in children attending school is from time to time reported to the Health Visitors by parents; if the child is not already notified as suffering from rheumatism, the information is given to the District Organiser of the L.C.C. Care Committee (Miss H. Bell, to whom we have reason to be grateful) at a monthly conference between the Organiser and the Health Visitors. Miss Bell arranges for medical examination of the child at school. Of fifty-seven cases reported by parents to the Health Visitors, the diagnosis of rheumatism was confirmed in nineteen. The total notifications received up to the end of 1930 are classified as:— Rheumatic tendency 3 Sub-acute rheumatism 28 Acute rheumatism 24 Post-rheumatic 12 67 Age and Sex Distribution of notified cases. Sex Age in years. M. F. Total. 4 3 1 4 5 1 1 2 6 2 2 4 7 3 3 6 8 4 5 9 9 3 10 13 10 3 4 7 11 — 3 3 12 1 5 6 13 2 1 3 14 — 5 5 15 2 3 5 Totals 24 43 67 80 Particulars of cases of acute rheumatism in children coming to our knowledge are recorded in a register under the following headings:— Name, &c. Surname Christian name Sex Date of birth Address School Source of information Classification and Symptoms Rheumatic tendency Sub-acute rheumatism Acute rheumatism Post-rheumatic Arthritis accompanied by rise of temperature Rheumatic chorea Rheumatic carditis Tonsils, Adenoids and Teeth. Condition of tonsils Presence of adenoids Teeth including oral sepsis Treatment. Private doctor — date of first attendance Out-patient at hospital— name of hospital and date of first attendance In-patient at hospital— name of hospital and date of first attendance Convalescent home—name of home and date of admission Home Conditions. Position of rooms in house Evidence of Dampness Lighting Ventilation Overcrowding Sleeping Conditions. Separate room Separate bed in room Room shared with— Adults (number) Children (number) Bed shared with— Adults (number) Children (number) Hours of Sleep. Time of getting into bed Time of rising Help wanted for patient Clothing Boots Stockings Dispensary letter In-patient treatment Convalescent home Name of organisation referred to Clothing. Condition of clothing and boots History of Rheumatic Fever. Rheumatic heart disease in family— Father Mother Brother Sister Other members of family Food. Quantity Suitability Contacts. Name Sex Age Any sore throat Any pains in muscles, joints Any shortness of breath Any fidgetiness or extreme nervousness The intention is that no rheumatic child requiring help in any way shall go without it. The Sanitary Inspection of the homes is made by experienced Sanitary Inspectors; we are requiring for these children as high a standard of environmental hygiene as can reasonably be achieved, 81 Rheumatism Supervisory Clinic. A Rheumatism Supervisory Clinic is held every weekday at the Hospital for Sick Children, Great Ormond Street, beginning at 9 a.m.; it is available for children up to 12 years of age. After this age they are automatically transferred to St. Bartholomew's or King's College Hospital, or to the hospital they have attended before they came to Great Ormond Street Hospital. The presence of rheumatism is by no means always easy to determine: in the early stages when obviously a diagnosis is of the greatest value, this can often only be done by watching the child over a period of three to six months, durirg which time the child attends regularly at the Clinic. At the Clinic comprehensive records are kept as to the children's physical condition. Advice is given on such matters as clothing, exercise, diet, and any alteration desirable to the child's curriculum at school. At the Great Ormond Street Hospital Clinic all stages of rheumatism are treated, not only the early stages. For the child who is not damaged beyond repair protracted treatment is possible at the Lancing Convalescent Home, where the child resides for 6-9 months, Enquiries in Notified Cases of Rheumatism. Enquiry was made in sixty-seven cases in relation to: — (a) the type of house in which the patient lived; (b) the presence of dampness and absence of light and ventilation; (c) sleeping accommodation, overcrowding, and the standard of comfort and living; (d) the condition of the nose, throat and teeth; (e) heredity. Type of House. 24 lived in satisfactory artisan self-contained flats. 14 lived in satisfactory artisan homes in divided houses of a comfortable type (a better class of house let in lodgings). 22 lived in houses let in lodgings. 5 lived in artisan dwellings of an old type, not self-contained but superior to ordinary houses let in lodgings. 2 not traced—incorrect addresses. It is somewhat curious to note the incidence of acute rheumatism in satisfactory homes, F 82 Dampness in Houses. Dampness was found in only three houses, due to temporary nuisances which were remedied. Lighting and Ventilation. One child lived in a semi-basement flat, and although the lighting was not good, the flat was well built and the street and courtyard adjoining fairly wide, so that lighting and ventilation compared not unfavourably with upper floors in narrow streets and small courtyards. In two other cases the lighting was poor. Most of the remaining homes were well ventilated and the lighting good; in no case was ventilation or lighting markedly unsatisfactory. Overcrowding and Sleeping Accommodation. There was no evidence of legal overcrowding in any of the houses; this standard is notably low however. The sleeping arrangements are given in the following table:— Sleeping Arrangements—64 Cases of Notified Rheumatism. * No. of Rheumatic Children Separate Room Separate Bed in Living Room Separate Bed in Room shared with Bed shared with Bed shared in living room with Adults Children Adults and Children Adults Children Adults and Children Child Adults and Children 1 2 3 1 2 3 1 2 3 5 1 2 3 1 2 3 1 2 1 3 64 6 5 2 5 0 9 3 0 1 1 1 1 5 0 0 17 4 0 1 1 1 1 61 6 5 23 28 2 * Exclusive of two cases where wrong addresses given, and one where the patient died shortly after the date of notification. It will be seen that only six children had a separate room, twenty-three had a separate bed in a shared room; twenty-eight shared a bed, six of these with more than one person; seven children had a bed in the living room, a very unsatisfactory arrangement, seeing the child is disturbed by the late and uncertain hours of going to bed kept by the rest of the family, and also the possibility of disturbance at an early or earlyish hour in the morning. In some instances where beds were shared, the reason given was the small size of the rooms which made it difficult to get other beds in; whether the bunk bed is a possible solution of this difficulty is not clear, ashore it is an innovation and therefore not popular. Moreover, it is not obtainable at many shops and second-hand stalls, and its existence is overlooked. It is not hygienic for anyone to share a bed, 83 Social Conditions. Six children lived in one-room homes. In eight homes there was a history of chronic poverty, but without acute distress; in one of these the mother has been many years widowed; in another the mother has been rearing the illegitimate family of a man who also supports his wife and his own legitimate family on a moderate income; two have been widowed and are living on widows' pensions; in another the father's occupaton (foreman in stables of a commerical firm) has become obsolete. In the last home, however, the food, owing to the mother's cominonsense and industry, is as good, if not better, than in many homes where there is a larger income. In all these homes difficulty of providing proper clothing, and more especially sufficient boots, may arise at any time, and if this does occur we hope to be able to solve the difficulty. Condition of the Nose and Throat. In twenty-five children the condition of the tonsils was normal. Twenty-nine children had their tonsils removed, thirteen of these also had adenoids removed. In five cases tonsillectomy was advised, two of the five also requiring removal of adenoids. In the remaining five cases the tonsils were enlarged at the time of examination but no special treatment was recommended. Of the twenty-nine children referred to above, in nine cases the removal of the tonsils coincided with the reported onset of rheumatism, in that the diagnosis of the rheumatic condition was made in connection with the attendance of the children at hospital on account of tonsilitis. In thirteen tonsillectomy had been performed at varying periods considerably before the symptoms of rheumatism were observed (from three of these also adenoids had been removed); in seven others the children were found to have had tonsils removed as part of treatment for rheumatism. Teeth. In four children dental caries was still present: in five others extractions had been made as part of the treatment for rheumatism. Heredity. Based on information derived from the parents (notably untrustworthy seeing that they include all forms of rheumatism including fibrositis) the following has been compiled: — In ten the mother suffered from rheumatism. In four the father, F 2 84 In one both mother and father. In one the father's relations. In one the brother. In one the sister. In three cases, the father, mother, brother and other relations. In four families the mother and her relations. In three families there were histories of rheumatism in the mother's relations only. Contacts. Fourteen of the notified cases had no contacts. A history of rheumatic pains was reported in the contacts of eight cases. Nine of the contacts were examined at the Rheumatism Supervisory Centre, and as a result one is being kept under observation. The names of all the other contacts going to school were passed on by the London County Council district organiser to the Divisional School Medical Officer in order that they might be observed and examined if necessary. History of Patients after leaving School. Eight of those notified have ceased to attend school and are at work, viz.:— (1) Boy (A.M.,æt 16) works as a lift attendant at a local store. (2) Girl (G.H., æt 15) works as a clerk. (3) Girl (G.M., æt 15) works as a relief stamper. (4) Girl (M.C., æt 15) is a box folder. (5) Girl (Q.W., æt 16) is a checker in a laundry receiving office. (6) Girl (R.P., æt 15) is a lamp-shade maker. (7) Girl (L.C., æt 15) is at home being unable to work owing to carditis. (8) Girl (P.M., æt 14) is an embroideress. Four of these (A.M., Q.W., R.P. and L.C.) reached 16 years of age during the year 1930 and are no longer under supervision as notified cases nor as "children" under any Children's Care Organisation. Three of these (A.M., Q.W. and R.P.) are keeping well, but would probably benefit by attendance at a Rheumatism Supervisory Centre in the Borough where they could be kept under observation and visited at home if required, the fourth (L.C.) is still receiving treatment from her own doctor. Obviously the nature of employment to be followed by any child who has suffered from rheumatism requires careful consideration by all concerned, 85 Typhoid Fever and Paratyphoid Fever. Four cases were notified during the year with no death. In London 291 cases were notified giving rise to 25 deaths. The following table gives particulars of the cases notified in Holborn:— Case. Age. Sex. Occupation. Date of Notification. Notified as. Nature of Laboratory Examination. Final Diagnosis. Where treated Contracted in Borough. Probable Source of Disease. A.C. 13 M. School 20th Mar., 1930 Paratyphoid B Agglutination test Paratyphoid Fever N.W. Hospital Yes No information E F.S. 41 F. Housework 14th April ,, Enteric Fever No information Influenza S.W. Hospital No Not Enteric Fever c.w. 30 F. Travelling for pleasure 17th July ,, Typhoid Fever Agglutination test Typhoid Fever Italian Hospital No Abroad. Arrived in England day before onset E.S. 17 F. Travelling for pleasure 25th Aug. „ Enteric Fever Agglutination test Typhoid Fever Pri vate Nursing Home No Abroad. Was ill on arrival from Continent 86 In addition to the above cases information was received, of a case in another Metropolitan Borough the patient being a cook employed, in a small restaurant (a lock-up shop) in Holborn; there was no evidence that she acquired the infection here. The patient was in charge of the kitchen where she worked single-handed. Only one other worker was employed, a waitress, who was found to be in good health. The restaurant was visited up to the end of the danger period. No secondary case occurred. Typhus Fever. No case of typhus fever was notified during the year in the Borough. Two were notified in London. Cerebro-Spinal Fever. No case of cerebro-spinal fever was notified in the Borough. Eighty-eight cases were notified in London, giving rise to 80 deaths. Bacillary Dysentery. One case of bacillary dysentery occurred which, however, was mistaken for food poisoning; we were informed by the Coroner of the post-mortem examination; all the steps required by the Ministry of Heath were accordingly taken. The following are brief notes of the case: — 17th April. Child apparently well, but took no breakfast; good dinner (stewed rabbit followed by custard); milk only for tea. Evening of same day became ill, shivering, retching and headache; diarrhœa ensued, the motions being reported as " blue, green and pink." Admitted to hospital the following day where death occurred a few horn's later. No other member of the family or residents in the house developed any illness. Examination in the Pathological Department of the Ministry of Health of samples of the organs taken from the body showed Flexner dysentery bacilli (Z type) in large numbers in the colon. Death was certified to be due to acute enteritis and bacillary dysentery. Malaria. No case of malaria was notified. Encephalitis Lethargica. One case of encephalitis lethargica was notified in the Borough during the year, 'the patient died four days after the date of notification. 87 The following table gives information lip to the end of 1030 respecting the 13 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 Patient. Sex. Age when notified. Subsequent History. 13/1/20 B.R. F 32 years Disease fatal 13/1/20 6/2/20 P.P. M 8 years Disease fatal 28/2/20 7/2/20 W.W. M 47 years Disease fatal 7/2/20 26/4/22 W.H. M 14 years Disease fatal 19/4/22 4/4/24 A.K. F 28 years Disease fatal 28/3/24 16/5/24 G.C. M 36 years Returned to Italy; no further information 20/6/24 R.V.M. M 40 years Went to Australia. Complete recovery reported 9/7/24 F.H. F 7 years Complete recovery 26/9/24 B.V. F 53 years Disease fatal 21/9/24 4/5/25 C.S F 28 years Improved but right arm tremulous. O.P. at National Hospital. 29/5/26 H.P. M 33 years Disease fatal 30/5/26 22/7/29 C.M. M 47 years Returned to West Indies; 110 further information 26/5/30 W.W. M 32 years Disease fatal 30/5/30 The table excludes one case notified 15/11/24 who was subsequently found not to be suffering from this disease. In February, 1028, a communication was received from the Medical Officer of Health of the London County Council respecting non-notified cases of encephalitis lethargica. Information of four such eases in the Borough was forwarded in order that where the patients were not of school age they could be kept under observation in the same way as notified cases. The following gives particulars of these cases: — Date of Ouset. Patient. Sex Birth. Date of Where Treated. Condition at end of 1930. 1/9/20 P.L. F 1904 Hospital (St. Bartholomew's) In Archway Hospital—became impossible to manage at home. Would not get up, and seemed Jan., 1920 W.P. M 1910 University College Hospital Died 1929. Feb., 1924 W.B. M 1913 Royal Free Hospitalin patient since 1926 In Northern Hospital (L.C.C.), Appears worse—mouth hanging Nov., 1924 K.M. F 1911 London Homœopathic Hospital- in patient No paralysis, but walks very slowly, O.P. at West End Hospital for Nervous Diseases 88 Acute Poliomyelitis and Acute Polioencephalitis. One case of acute poliomyelitis or polioencephalitis was notified. Thirty-seven cases were notified in London, giving rise to 11 deaths. From the coming into operation of the Poliomyelitis Order, 1912 to the end of 1930, 15 cases were notified in the Borough. The following table gives particulars of these eases with the condition at the end of 1930: — Date of Notification. Patient. Sex Age at date of Notification. Where Treated. Subsequent History. 17/7/13 F.D. M 1 8/12 years Hospital Died from diphtheria. 23/10/13 F.H. F 2 „ Wears surgical boot: still O.P. at Queen's Hospital, Hackney, when new surgical boot needed (about every nine mouths.) Health satisfactory. 26/1/16 A.C. F 4 ,, ,, Died 26/1/16. 27/1/16 T.B. M 4 ,, ,, Working — dragging of leg hardly noticeable. 5/9/16 F.B. M 2 months ,, Died. 6/6/20 I.P. F 3½ years ,, Recovered—no crippling. 23/7/20 E.W. M 15 ,, ,, No use of lower limbs. Does occasional clerical work. 17/9/20 EH. F 1 8/12 ,, ,, Recovered—no crippling, "thinness" of leg only. Health satisfactory. 4/9/22 Y R. F 1 16/12 ,, Home Died in Paris. 5/2/23 J.N. M 3½ ,, Hospital Recovered—no crippling. 2/5/23 M.H. F 11 mths. ,, Still an out-patient at Orthopaedic Hospital, wears surgical boot— goes to school. 14/9/25 B.T. M 26 years ,, Hotel guest; could not be traced. 30/10'25 V. H. F 5 ,, ,, Removed from Borough —lost sight of. 24/11/30 R.H. M 1 11/12 „ O.P. To be admitted to Queen Mary'sHospital. The table excludes one case notified 4/12/18 who was subsequently found not to be suffering from this disease. 89 Pneumonia. Forty-nine cases of pneumonia were notified during the year. Five of these were influenzal pneumonia. Thirty-five deaths were recorded from all forms of pneumonia. The 44 cases of primary pneumonia were notified at the following' ages:—Under 1 year, 0; from 1 to 5 years, 7; from 5 to 15 years, 3; from 15 to 25 years, 7; from 25 to 45 years, 11; from 45 to 65 years, 7; and 65 years and upwards, 9. Sixteen were treated at home; 14 were removed to voluntary hospitals; and 14 to Poor Law Infirmaries. Four of the patients were nursed by the Metropolitan Nursing Association under the arrangements made by the Council, in all 70 visits being paid to these patients. Enquiry respecting the cases of primary pneumonia elicited the following information:— 17 resided in tenement lodging houses, 12 in separate private dwelling houses or model dwellings, and 3 in common lodging houses, 2 in boarding houses, and 1 in an institution. The cleanliness of the houses was reported to be satisfactory in 25 cases, but only fairly so in 8; and in 3 cases unsatisfactory. The economic conditions of the families concerned were found to be good in 6 cases, fair in 14, poor in 16; 7 cases were nursed in a separate room. In a number of cases information as to the economic condition was not obtainable. In most cases the disease was not ascribed to any special cause, but the following was given in 16 instances:— Following bronchitis 1 Following influenza 3 Following " cold " 12 Influenza. There was only one death from influenza in comparison with 44 in 1929, 3 in 1928, 20 in 1927, 8 in 1926, 9 in 1925, and 11 in 1924. The death was that of an aged male over 75 years of age. 1 Anthrax. No case of anthrax was notified in the Borough during the year. Chioken-pox. Chicken-pox was notifiable in the Borough for six months from 3rd February to 2nd August, during which period 60 cases were notified. The notification was a precautionary measure in view of the presence of smallpox. All the notified cases were visited and where necessary kept under observation until the possibility of 90 The case being one of smallpox had passed. A number of doubtful cases were seen by the Medical Officer of Health. Subsequently all cases of chicken-pox coming to our notice have been similarly dealt with. Mumps. Information was received from school teachers and others of 53 cases of mumps. Mumps occurred in a, nurse at one of the hospitals in the Borough. It was difficult to isolate the case at the institution concerned and having regard to the risk of infection to older people, patients and nurses, and to remove the chance of any serious outbreak of the disease in the hospital, arrangements were made for the removal of the patient to a hospital of the London County Council. Bacteriological Work. The following table gives details of the examinations made during the year: — Diphtheria Pulmonary Tuberculosis Enteric Fever Number Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination 361 Bacilli not found 295 Diphtheria 70 Bacilli not found 56 3 Negative 2 bacilli found 66 Vincents Bacilli found 14 Positive 1 organisms found 15 Disinfections. During the year 600 rooms and 4,767 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Forty-four rooms and 304 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. Eighty-five books and 18 toys were disinfected; also two boxes of addressed envelopes and an attache case. The disinfections also included two lockers, three hospital wards, one workshop, and one factory. Cleansing of Persons Act. During the year 270 persons (245 men and 25 women) infested with vermin had their bodies and 2,740 articles of clothing disinfested, free of charge, at our cleansing station (Goldsmith Street). 91 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 Road, for residents of this Borough during tho disinfection of their homes after infectious disease. In the year 1980 the accommodation was used by one Holbom family comprising two adults and two children. This family were smallpox contacts; they remained at the shelter one night. Verminous Conditions and Scabies. In connection with our co-operation with the London County Council School Medical Service, for some years past information has been received from the Medical Officer of Health of the London County Council respecting Holborn children attending elementary schools found to be verminous or suffering from scabies. During 1030 only one such notice was received. This related to a case of scabies in a boy attending a London County Council school. On visiting the home it was found that a younger child had also suffered from the disease and recovered. The home was kept under observation until the complete recovery of the schoolboy; the premises and bedding were then thoroughly disinfected and the home reported to be clean. Information was received from the Out-Patient Almoner of a hospital of the recurrence of scabies in a family where previous infection was reported in the year 1929. On the previous occasion the infected children Mere admitted to the Poor Law hospital and discharged cut-ed after two months' treatment; reinfection of mother and one child occurred some two months later. Arrangements were made for the mother and child to have a course of sulphur baths daily at our cleansing station, and for the bedding and personal and bed linen to be thoroughly disinfected weekly. At the end of a month the family was reported to be well and the children again at school. At subsequent visits the home was reported to be clean and all the family well. We were consulted with regard to the occurrence of scabies in two chambermaids in a hotel probably contracted from infection derived from a hotel visitor. Extermination of Vermin. With a view to encouraging activc steps for the extermination of vermin, arrangements were continued for a supply of a vermin-killing solution to be stocked in the Health Department and to be available at cost price for occupiers of infested houses and tenements. A small sprayer for diffusing the solution was also made available on loan. 92 The solution has been found effective for the destruction of bugs, cockroaches, fleas and other small insect pests, and the convenience of being able to obtain a small quantity has been appreciated by a number of occupiers of small tenements. During the year 14½ gallons of the solution in small; quantities were sold to 62 purchasers. One hundred and nineteen verminous rooms were disinfested. When fumigating verminous rooms we endeavour, whenever practicable, to repeat the fumigation at the end of a week, by which time it is expected that any eggs of bugs will have hatched out; a single fumigation of any severely infested room cannot be regarded as satisfactory. In 99 cases last year this second fumigation was carried out. Where this course for any reason was impracticable the occupiers were encouraged to use the solution referred to above or take other effective steps to prevent any recurrence of the nuisance. 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 1930 in the form required by the Ministry of Health: — Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. 11 F M F M F M F 0 — — — — — — — — 1 — — — 2 — — — 1 6 — — 1 — — — — — 10 — 1 — 2 — — — — 15 3 4 — — 1 1 — — 20 10 8 2 — 4 2 1 — 25 5 5 — — 2 3 — — 35 7 4 1 — 3 4 — — 45 14 3 — — 5 2 — — 55 4 2 — — 5 2 — — 63 5 1 2 — 5 1 1 — 48 28 6 4 25 15 2 1 93 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 continue to prove beneficial; knowledge of the patients thus made available for the local public health staff 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, 1980 339 Number of these patients residing in common lodging houses 16 The average number of cases notified annually during the past ten years 94 The number notified in the year 1930 86 Of the 86 cases notified in 1930, the number who attended the Dispensary 34 Total number of new cases examined at the Dispensary for the first time in 1930, including the above 34, and all contacts 146 Total attendances at the Dispensary in 1930 997 Supervision of home conditions; visits paid by— Tuberculosis Officer 28 Dispensary Nurse 1,191 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 29th December, 1929, to the 21th December, 1930, in the Metropolitan Borough of Holborn. Age-periode Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. 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. 05 and upwards. Total Primary Notifications. Total Notifications on Form A. Under 5. 5 to 10. 19 to 15. Total Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Pulmonary Males ... ... ... ... 3 10 4 5 12 4 4 42 55 ... ... ... ... ... 31 21 „ Females ... ... ... 1 4 7 5 3 3 2 ... 25 36 ... ... ... ... ... 12 13 Non-pulmonnry Males ... ... 1 ... ... 1 ... 1 ... ... 2 5 5 ... ... ... ... ... 3 2 „ Females ... 1 ... 2 ... ... ... ... ... ... ... 3 4 ... ... ... ... ... 1 4 94 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 29th December, 1929, to the 27th December, 1930, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912, or by notification in pursuance of the Local Government (Emergency Provisions) Act, 1916. Age periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 15 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Cases. Pulmonary Males ... ... ... ... 1 2 2 ... 1 6 ,, Females ... ... ... ... 1 ... 1 ... ... 1 3 Non-pulmonary Males ... ... ... ... 1 ... ... ... ... ... 1 ,, Females 1 ... ... ... ... ... ... ... ... ... 1 Four of the 11 were ascertained from the death returns, four were transfers from other areas, and three were posthumous notifications. Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1930 was 75; 11 other cases were brought to my knowledge (making 86 new cases in the year). These were:—Private cases 20, hospital cases 28, Poor Law cases 27, from death returns 4, transfer from other districts 4, and 3 were posthumous notifications. Correction of Tuberculosis Register during the year 1930. Number of cases on Register, 31st December, 1929 320 New cases registered, 1st January to 31st December, 1930 86 406 Removed from the Register during the same period for following reasons: — Removed from Borough 24 Died 42 Not traced 1 67 Number on Register, 31st December, 1930 339 Of the 86 cases entered on the Register in 1930, 76 were pulmonary tuberculosis and 10 non-pulmonary tuberculosis. Sixty-two of the cases were removed for treatment to hospital, or sanatorium. Sleeping Conditions. In 60 of the 86 new cases of tuberculosis in 1930 it was possible to obtain information as to the sleeping conditions at the date of notification. Twelve of the remaining cases were residents in common lodging houses; in seven cases incorrect addresses were given, or the patients no longer resided in the Borough, and in seven cases the addresses given were temporary residences at hotels. 95 The following is a summary of the information in the 60 cases above referred to: — Patient slept in— Separate bed room 22 Separate bed in living room 6 Separate bed in room shared with— 1 adult 3 2 adults 3 3 adults 2 1 adult and 1 child 1 Shared bed with— No others in room 1 adult (Husband or Wife) 4 1 adult (not Husband or Wife) 5 1 child 3 2 children 1 3 children 1 1 adult and 2 children 1 Shared bed with— 1 adult Other persons in bedroom 2 adults 1 1 adult 1 adult and 2 children 2 1 adult 1 adult, 1 child 4 1 child 3 children 1 60 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 13 " B."—Fair. Separate bed, but not separate bed room 42 " C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 11 66 Summary. The following summary gives the position at t+ie end of 1930 of the 86 new cases respecting which information was received during the year:— Dead 27 Cases removed to Nursing home. Hospital or Infirmary and still in-patients at the end of year 17 In-patients in Sanatoria at end of year 11 Not traced—Incorrect address 3 Removed from Borough 6 Home Treatment—Private or Panel Doctor 15 Away in country 1 No information 6 86 96 Non-attendance at Tuberculosis Dispensary. Thirty-four of the 86 cases attended the Holborn Tuberculosis Dispensary. The following indicates the reasons for non-attendance in the remaining cases: — Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 12 Dead before notification or died before attendance at Dispensary 16 Treatment at home by private doctor 7 Not traced and common lodging house cases 14 Removed from Borough 3 52 Delayed Notification. The Public Health (Tuberculosis) Regulations, 1912, required 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 three cases were notified only at death, seven within one month of death, seven within three months and two within six months of death. By the Public Health (Tuberculosis) Regulations, 1930, which came into force on the 1st January, 1931, these Regulations are rescinded. It is unfortunate that the new Regulations continue the proviso in the Regulations of 1912 by which 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. Institutional Treatment. During the year notifications were received of 99 admissions to institutions. These admissions represent 74 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 admissions were to the following institutions: — Public Assistance Institutions 54 Institutions of the Metropolitan Asylums board (L.C.C. from 1st April) 30 Other institutions 15 Visits to Homes, etc. During 1930 the Tuberculosis Officer made 28 visits to the homes of patients, The general visitation of the patients and supervision of home conditions is carried out. by the Tuberculosis Nurses who made 1,191 visits. Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. 97 Eighty-three contacts, viz., 49 adults and 34 children under fifteen years of age, responded to this invitation, and were examined for the first time during the year 1980. Of these, three adults and two children were found to be definitely suffering from tuberculosis; one child was doubtfully tuberculous. Seventy-seven 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 to ensure that no contacts of school age 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 Tuberculosis. The number of deaths from pulmonary tuberculosis during the year was 40, a death rate of 1.04 per thousand the same rate as in 1929. There were also three deaths from other forms of tuberculosis, a rate of 008 per thousand. The following table shows whether 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- 66- All Ages. Males. Females. Total. Number of patients who died at home ... ... ... ... ... 1 ... 2 1 2 2 4 4 8 Number of patients who died in hospitals, ete. ... 1 ... ... 2 6 5 5 6 5 5 23 12 35 ... 1 ... ... 2 7 5 7 7 7 7 27 16 43 G 98 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, J. A. Struthers, M.D.,B.Ch., M.R.C.P., D.P.H., for the year 1930:— Return showing the work of the Dispensary during the year 1930. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adlults. Children. Adults. Children. Adults. Children. M. ¥. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 23 13 0 1 3 1 1 3 26 14 1 4 (6) Doubtfully tuberculous — — — - - — — - 5 4 1 1 (c) Non-tuberculous - - - - - - - - 0 7 0 0 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 0 0 0 0 0 2 1 2 0 2 (6) Doubtfully tuberculous — — - — - - - - 0 0 1 0 (c) Non-tuberculous - - - - - - - - 19 27 20 11 C.—Cases written off the Dispensary Register as (a) Cured 2 4 — — — — — — 2 4 — — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 25 39 22 12 D.—Number of Persons on Dis pensary Register on December 31st:— (a) Diagnosis completed 82 64 5 3 11 16 13 6 93 80 18 9 1b) Diagnosis not completed — — — — — — - — — — — — 99 G 2 1. Number of persons on Dispensary Register on January 1st, 1930 185 2. Number of patients transferred from other areas and of " lost sight of" cases returned 3 3. Number of patients transferred to other areas and cases"lost sight of" 14 4. Died during the year 5. Number of observation cases under A (b) and B (6) above in which period of observation exceeded 2 months 0 6. Number of attendances at the Dispensary (including contacts) 997 7. Number of attendances of non-pulmonary cases at Orthopœdic Out stations for treatment or supervision 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) " Light" treatment 44 (b) Other special forms of treatment 20* * Artificial pneumo thorax refills. 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 3 10. Number of consultations with medical practi- tioners :— (а) At Homes of Applicants 12 (б) Otherwise 67 11. Number of other visits by Tuberculosis Officers to Homes 28 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1413† 13. Number of (а) Specimens of sputum, &c„ examined 159 (б) X-ray examinations made 25 in connection with Dispensary work 14. Number of Insured Persons on Dispensary- Register on the 31st December 94 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 45 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 1 (b) Form G.P. 36 3 †Includes 222 visits by nurses for nursing purposes. 100 101 Pulmona Tuberculosis Annual Return showing in summary from the condition of all Patients whose case record to the years in which the Patients first came under Public Medical Treatmentare in the possession Dispensary at the end of 1930, arranged according for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. 1929. 1930. Class T.B. minus. Class T.B. plus. ClassT.B. minus. Class T.B. plus. Class T.B. minus. Class T. B. plus. Class T. B. minus. Class T.B. plus. Class T.B. minus. Class T. B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alivk. Discharged as cured. Adults M. 9 2 2 F. 10 2 2 Children M. 3 F. Disease arrested. Adults M. 5 3 1 4 F. 3 3 2 Children m. F. Disease not arrested. Adults M. 3 8 5 1 15 1 1 1 2 6 1 1 5 4 4 5 3 2 3 8 7 9 6 1 16 F. 3 14 6 2 22 4 3 3 1 4 3 4 2 2 8 4 2 5 1 8 Children M. 1 1 1 1 1 1 F. 1 1 Condition n. t ascertained during the Year. 1 1 1 Lost Sight of or otherwise re- moved from Dispensary Register. 35 27 18 5 50 7 5 4 2 11 4 1 1 Dead. Adults M. 1 2 5 7 14 1 1 4 5 5 10 3 6 19 7 4 2 1 7 2 1 1 1 3 1 1 1 2 F. 3 4 2 6 1 4 5 1 1 3 5 8 1 4 3 8 1 1 1 3 Children M. 1 1 1 2 3 1 3 4 1 1 2 F. Totals ... 73 63 39 17 119 11 9 13 2 24 20 12 6 6 24 17 15 10 1 26 10 10 13 9 32 12 13 14 5 32 102 103 Non- Pulmona Tuberculosis. Condition at the time of the lust record made during the year to which the Return relates. Previous to 1926. 1926. 1927 1928. 1929. 190. Bones and Joints. Abdominal. Other Organs. PeripheralGlands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bone and Joints. Abdominal. Other Organs. Peripheral Glands. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults M. 1 1 F. 1 1 Children M. 1 1 1 1 4 F. Disease arrested. Adults M. 1 1 F. 1 1 Children M. 2 2 F. 2 2 Disease not arrested. Adults M. 1 1 2 1 1 2 1 1 1 3 2 1 3 F. 3 2 1 1 7 1 1 1 1 2 1 2 1 4 1 1 Children M. 1 1 2 4 1 1 2 1 3 4 1 1 F. 1 1 2 1 3 Transferred to Pulmonary Condition not ascertained during the Year. Lost sight of or otherwise removed from Dispensary Register. 8 4 4 8 24 1 1 3 5 1 2 3 2 1 3 1 2 Dead. Adults M. 1 1 F. 2 2 Children M. 1 1 F. 1 1 1 1 Totals. 17 9 8 12 46 3 2 6 11 2 2 1 4 9 5 3 2 10 3 2 5 1 11 4 3 1 8 104 Report of the Tuberculosis Dispensary for the Year 1930. During the year 63 new cases and 83 contacts were examined. Of these 15 of the former and five of the latter were found to be suffering from tuberculosis. Of the new cases, the largest group of those suspected of tuberculosis, but afterwards considered not to be infected, were those suffering from debility, and in some instances showing evidence of myocarditis, following influenza. The number of deaths was 14 as compared with 24 in the previous year. Six patients, two adult males and four adult females, were removed from the register as cured. As in previous years the local medical practitioners have made good use of the dispensary; and the dispensary has made good use of University College Hospital. It is also a pleasure to acknowledge again the invaluable help received in numerous ways from the Tuberculosis Care Committee. A survey of the results of the examination of the contacts of 328 cases of tuberculosis during the last seven years shows that, of 515 contacts examined, 20 or 4 per cent. were found to be tuberculous. These cases would have escaped notice, at least for some time, had it not been for these routine examinations. Additional light from another angle is thrown on the importance of the familial factor in tuberculosis by an investigation of the family histories of patients suffering from pulmonary tuberculosis. The records of 246 cases were studied, in 195 of which tubercle bacilli had been found in the sputum, while in 51 the sputum examination had been negative. A history of pulmonary tuberculosis in the immediate family was found in 59, or 30 per cent., of the former, and in 27, or 52 per cent., of the latter. Such figures as these lend cogency to Karl Pearson's insistence on the inheritability of the tuberculous diathesis. It must not, however, be forgotten that a child of tuberculous parents, in addition to inheriting poor powers of resistance to tuberculous infection is also unduly exposed to such infection in early years. Report of the Tuberculosis Care Committee for 1930. The Committee has met 11 times during the year. The average attendance of members at each meeting has been 7.45. In February the time of meeting was altered from the third Thursday of the month at 5 p.m. to the second Tuesday of tho month at 4.30 p.m. Seventy-one cases have been considered—37 new (32 adults and five children) and 34 old cases (27 adults and seven children). Forty-two cases—37 adults and five children—were referred to the Committee for assessment. Twenty-one were assessed to pay contributions varying from 2s. 6d. to 30s. per week towards the cost of their treatment and maintenance. Four cases were reconsidered owing to subsequent changes in their circumstances and the assessments reduced. Eighteen adults and three children were recommended for free treatment. Contributions towards the cost of treatment and maintenance, amounting to £165. 13s. 6d., were collected on behalf of the London County Council in 27 cases —20 adults and seven children; 11 of these were still under treatment at the close 105 of the year. In four instances arrears of contributions were cancelled as irrecoverable; three of these had previously been referred to the Council's official collector. In the other case the patient had been obliged to leave her husband and ho refused to support her; she was referred to the Divorce Law Reform Union, legal assistance was afforded her and ultimately she obtained a decree nisi. Seventeen progress reports, on eight children, were received from the London County Council: and the information contained therein conveyed to the parents. During the year 962 visits have been paid to patients or their families, in addition to visits to societies, schools, hospitals, Relieving Officer, Ministry of Health, Ministry of Pensions, etc., on their behalf. The Committee gratefully acknowledges the co-operation and assistance given by other organisations and societies, especially that of the British Legion and United Services Fund Benevolent Committee, the British Red Cross Emergency Help Fund, the Charity Organisation Society and the Invalid Children's Aid Association, Efforts have been made to obtain more suitable housing accommodation for patients. In all 14 patients have been helped in this way. Twenty patients known to the Committee have died during the year. Of these, four died at home, three in homes for the dying, one in a voluntary hospital, six in London County Council institutions, and six in London County Council general hospitals. Convalescence has been arranged in six cases; four were sent away through Stafford's Charity and two through the Invalid Children's Aid Association. Arrangements were made for two other children to go away through the Invalid Children's Aid Association, but the parents failed to let them go; in one case, however, the mother took the child away herself. Six children have been boarded out under the London County Council's Contact Scheme. One baby that had been boarded out at the end of last year was brought home by the parents contrary to medical advice. The mother, an advanced case, discharged herself from the institution to which she had been sent and, though every possible effort was made to try and induce the parents to allow the baby to remain away, they insisted on having her home. A holiday was arranged for one ex-patient who had had treatment for nonpulmonary tuberculosis and was in full work. In December, thanks to the intervention of the British Red Cross Representative, an ex-service man was granted an award " under special sanction " of 40s. per week plus allowances. Through the kindness of a friend four necessitous families were supplied with Christmas dinners. One case was referred to the Borough, Council for assistance for repairs to dentures; the whole of the amount advanced was repaid by instalments. Several widows have been assisted with their applications for pensions, many National Health Insurance difficulties have been cleared up, and a variety of other odd jobs have been attended to. A difficult claim for an Old Age Pension was successfully piloted through. 106 Meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees were held in January, June and November; representatives of the Committee were present on each occasion. At the January meeting the following resolution was submitted by the Committee and adopted by the Conference:— " That, in order to encourage patients to remain in institutions, the London County Council be asked to arrange for instructions in handicrafts or bedside occupations in all institutions under their jurisdiction where tuberculous patients are admitted." On March the 13th the Mayor and Mayoress, the Medical Officer and several members of the Committee supported the Exhibition and Sale of Handicrafts held in Carpenters' Hall under the auspices of the Standing Conference. The articles on exhibition and sale were the work of ex-sanatorium patients and had been made in handicraft classes which are carried on by the Care Committees in various Boroughs. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations dealing with persons suffering from tuberculosis engaged in the milk trade. Home Nursing for Tuberculous Patients. With the sanction of the Minister of Health arrangements were continued for nursing of tuberculous patients by the Metropolitan Nursing Association. The service is most useful for nursing patients whose removal to hospital is not practicable or where removal for some reason is necessarily delayed; it is not allowed to stand in the way of admission to institution. During the year five such cases were nursed, a total of 222 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. Scaling and gum treatment was given in two cases. Fillings in five cases. Extractions with local anaesthetic in one case. Three dentures were provided. The Clinic is held by the British Dental Hospital at the Council's Maternity Centre, 10, John Street, on Tuesday evenings. Employment of Tuberculous Persons. The problem of the employment of tuberculous persons still remains as acute as ever, and there is little hope that it will be diminished so long as the rate 107 of general unemployment remains as high as it is at present. The majority of the patients discharged from Sanatoria and Hospitals are either incapable of work, or are fit only for light work; their disability varies in degree from time to time and consequently their output is not dependable. In the few instances in which special workshops for tuberculous persons have been instituted, they have proved successful from the medical point of view, the employees have generally maintained their health and capacity for work. It seems desirable, therefore, that these people should be provided with work suited to their capacity, under hygienic conditions. Special workshops cannot be commercially sound propositions; they must be subsidised in some way. From physical and moral points of view it would seem to be more economical to give financial assistance to schemes for employment of tuberculous persons than to maintain such persons entirely at the public charge. Amongst the special workshops established for tuberculous persons mention may be made of the Spero Workshops started by the Central Fund for the Industrial Welfare of Tuberculous Persons to give employment under hygienic conditions to ex-service men and civilians after their discharge from sanatoria. These workshops attempt to deal with the problem of the tuberculous worker living at home who is unable to avail himself of the Tuberculosis Colony life. The Spero leather workshop is in Holborn. Opened in January, 1923, it is run on hygienic lines and the men are under strict medical supervision. The goods manufactured in the shop are guaranteed by expert medical authority to be free from infection. The shop affords employment for intelligent and skilled workers who have received preliminary treatment and training at King George V Sanatorium, Godalming. As might be expected more hours are lost through sickness than in an ordinary factory and the men's wages are not equal to the trade union standard. Such workshops cannot be wholly self-supporting, but money is well spent that gives employment and avoids the demoralising effects of idleness. General Dental Clinic. By arrangement with the British Denial Hospital, a Dental Clinic open for inhabitants and workers in the neighbourhood is held on Tuesday evenings at the Council's Maternity and Child Welfare Centre, No. 10, John Street. The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1930: — Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1930. Number of sessions held 51 Number of patients' attendances 276 Number of fillings 8 Number of scalings 18 Number of extraction cases Without anaesthetic None With local anaesthetic 5 With gas 64 Number of teeth extracted 276 Number of dentures (including repairs) 30 Number of dressings 1 Number for advice 91 Number of denture visits 74 Number of new patients 64 108 Cancer. During the year 1930, 69 deaths were recorded as due to Cancer in comparison with 61 in the previous year. The deaths in 1930 were equal to a rate of 1.79 per thousand, the corresponding rate in 1929 being 1.58 per thousand. In the year 1910 the death rate from Cancer in the Borough was 1.16, the decennial average rate, was 1.27 for the ten years, 1910-1919, and 144 for the ten years, 1920-1929. It will be seen that the death rate from Cancer in the Borough in 1930 was higher than in the previous year, being 1.79 per thousand in comparison with 1.58 per thousand. The rate, however, for one year in districts of comparatively small populations does not furnish a reliable indication of the prevalence of a particular disease. The decennial rates which afford much more reliable indication of the seriousness of Cancer show that in the past 20 years there has apparently been a marked increase in the death rate from this disease, for while the decennial average for the ten years, 1910-1919, was 1.27, the corresponding rate for the ten years, 1920-1929, was 1.44. Some part of this increase may reasonably be attributed to improved facilities for diagnosis. The figures indicate the high mortality from malignant diseases. Foundling Hospital Site. In the Annual Report, 1929, reference was made to the utilisation of a portion of the site of the Foundling Hospital as a play centre for children. Its use for the purpose was continued during 1930. In addition there was established on the site a day nursery towards the cost of which the Council was asked to contribute. The accommodation at the day nursery includes reception room, bath room, isolation room, play room, kitchen and staff rooms, milk store, perambulator shed and an outside sleeping place. Although the site is just outside the Borough border the Maternity and Child Welfare Committee were of opinion that the proposed day nursery would usefully serve a portion of the Holborn Borough. A contribution of £100 towards the cost was therefore made. At the same time a number of improvements were suggested by the Medical Officer of Health all of which the promoters of the nursery willingly accepted and carried out. Provision is also made on the site for a nursery school and open-air classes. MATERNITY AND CHILD WELFARE. Notification of Births. During the year 255 births were registered as occurring in the Borough. During the same period 221 notifications of births occurring in the Borough were received. Of these, '197 were from doctors and midwives, 24 from parents. The mothers were attended at their confinement by: — Private Doctors 27 Private Midwives 49 Out-patient Midwifery Departments of General Hospitals and Institutions: — Externs and others 52 Midwives.—University College Hospital 25 Middlesex Hospital 18 Other Institutions 9 Training Institution for Midwives, Myddelton Square 41 221 Six of these notifications related to stillbirths. 109 Number of Births. The number of births transferred to the Borough from outlying institutions was 169 Tho number of births transferred from the Borough to other districts was 19 The net number of births belonging to the Borough was 405 There are no maternity hospitals or public lying-in institutions in the Borough but maternity cases are admitted to a nursing home in the area. Births in Crowded Homes. The following table is an indication of the home conditions of 349 mothers in relation to their confinement: — Living in:— Confined at home. Confined in hospital. No. Percentage of Total Births. No. Percentage of Total Births One roomed homes 41 10.1 62 15.3 Two „ „ 100 24.7 57 14.1 Three „ „ 50 12.3 15 3.7 Four „ „ 16 3.9 8 2.0 Total 207 51.0 142 35.1 These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances. Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 158 313 471 Post-natal Mothers 10 1 11 Children under 1 year of age 486 860 1,346 Children 1 to 2 years of age 8 372 380 Children over 2 years of age 8 587 595 Enquiries re stillbirths 22 „ re ophthalmia neonatorum 6 Other visits 256 Three hundred and forty-six visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 172 were recorded as attending a Centre, i.e., 49 per cent. Thus nearly one-half of those visited attended an Infant Welfare Centre and of these nearly 64 per cent, attended the Council's Centres, 110 Attendances at Infant Welfare Centres. The Centres attended were the following : — 110 attended the Council's M. & C. W. Centre at 10, John Street. 24 „ „ ,, „ Short's Gardens. 2 attended the Centre at Onslow Street School, Saffron Hill. 5 „ „ Charing Cross Hospital. 7 „ „ Myddelton Square. 12„ „ Middlesex Hospital. 1 „ „University College Hospital. 8 „ „ Royal Free Hospital. 3 „ „ other Centres. 172 attended an Infant Welfare Centre. 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 2—4 .30 m. Ante-natal and Postnatal cases 2—4.30 p.m. Medical Consultation 2—1.30 p.m. Class 3—4 p.m. Dentist. 2—4 p.m. Medical Consultation 2—4.30 p.m. No. of Sessions 52 51 39 50 50 Total attendances — Children 143 ... 1797 ... 34 1405 Mothers 65 237 274 400 213 234 Average weekly attendances— Children 3 ... 35 ... 1 28 Mothers 1 4 5 10 4 5 St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year 1930, were as follows: — Monday 2—4.30 p.m Thursday Medical Consultation 2—4.30 p.m. Class Children weighed. No. of Sessions 45 45 51 Total attendances— Children 57 417 Mothers 60 31 Expectant Mothers 8 18 Average weekly attendances— Children - 1 8 Mothers 1 - 1 The total number of attendances made by the Health Visitors at the Centres in 1930 was 393. 111 At the Holborn Centre, No. 10 John Street, 4,802 attendances were made by 236 mothers and 77 expectant mothers, and 485 children, of whom 236 were under one year, 87 between one and two years old, and 162 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 591 attendances were made by 45 mothers and 91 children, of whom 55 were under one year, 12 from one to two years and 24 between two and five years. Ante-Natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 81 voluntary notifications were received during 1930 as compared with 124 in 1929. All these expectant mothers, as well as those already known to the Health Visitors through other sources, were visited in their homes and informed, both verbally and by means of a leaflet, of the special facilities available in Holborn; they also received instruction in the hygiene of pregnancy. Confinement in Institutions in Relation to Housing Conditions. Expectant mothers whose home circumstances make "confinement at home especially undesirable are advised to enter hospital for confinement. In order to provide accommodation for those who are willing to take this advice an arrangement has been made with one of the principal Maternity Hospitals within reach of Holborn to accept normal cases on social grounds only. Since November, 1929, special records have been kept of the home conditions of 173 expectant mothers visited, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. Of the 78 who went into hospital:— 37 (14 primiparse) lived in a one-roomed home; 41 (24 primiparse) lived in a two or more roomed home. Of the 95 who remained at home: — 16 (4 primiparse) lived in a one-roomed home; 53 (6 primiparse) lived in two rooms; 26 (2 primiparse) lived in more commodious premises. The following particulars relate to the 95 cases mentioned above where the mother remained at home for confinement: — One-room homes—16 confinements. Separate beds 2 Shared bed with an adult 13 Shared bed with adult and child 1 16 112 Two-room homes—53 confinements. Separate bedroom 14 Separate bed in living room 1 Separate bed in bedroom shared with child 1 Shared bed in living room with adult 10 Shared bed in living room with child 1 Shared bed in living room with adudt and child 1 Shared bed with adult 11 Shared bed with child 3 Shared bed with adult in room in which children also slept 9 Shared bed in room in which also other adults and children slept 2 53 Three-room homes—18 confinements. Separate bedroom 3 Separate bed in living room 1 Separate bed in room shared with child 1 Shared bed with adult 7 Shared bed with child 1 Shared bed with adult in room shared with child 5 18 Four-room homes—8 confinements. Separate room 3 Shared bed with adult 2 Shared bed with adult in room also used as bedroom for child 3 8 A mother who enters a hospital as a primipara is not as a rule eligible for admission to the same hospital for subsequent confinements; she often prefers to receive attention as a multipara in the extern practice of the same institution rather than seek admission elsewhere. In a number of cases the husband was said to be unwilling that his wife should leave home; in some instances the arrangements for staying at home had already been completed before the notification was received and there was reluctance to alter them; in others the mother was either unable to make arrangements for looking after the children, or had to remain at home in order to contrive ways and means of living on the very small family income. These enquiries emphasise the need for an increase in the number of hostels which admit children for a definite period, such as the mother's absence from home for a fortnight during confinement, or while she enters hospital for observation or rest during pregnancy, or post-natal care, 113 Ante-Natal Centres. 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 380 mothers, about whom information was obtained, 307 (81 per cent.) were found to have attended Ante-Natal Centres or received ante-natal care as under: — Number of enquiries made 380 Centre Attended: — Holborn Centre, 10, John Street 29 Holborn Centre, Short's Gardens 7 Royal Free Hospital 43 Middlesex Hospital 31 Charing Cross Hospital 20 University College Hospital 38 Myddelton Square Institution 34 St. Bartholomew's Hospital 22 City of London Hospital 10 Queen Charlotte's Hospital 2 Elizabeth Garrett Anderson Hospital 6 Other Centres 13 Ante-natal care from private doctors 39 Ante-natal care from midwives 13 307 Nature of defects found at Municipal Centres. 10, John Street, Holborn. Short's Gardens. St. Giles. No. of women attending ante-natal clinics 80 7 Women expectant for the first time 11 No. of attendances made 197 — Defects found specially connected with pregancy : — Deformed pelvis 5 — Threatened miscarriage 3 — Retroverted gravid uterus 1 — Breech presentation 1 — Transverse presentation 2 — Excessive vomiting 5 — Œdema 9 — Varicse veins 8 2 Excessive vaginal discharge 4 — Albuminuria 3 — Death of foetus in utero 1 — Other defects 4 — Other defects :— Heart disease 6 — Anaemia 6 1 Respiratory diseases 3 — Constipation 12 — Dental caries 24 3 Dyspepsia 9 — Pyorrhoea 8 — Disseminated sclerosis 1 — Other defects 11 — No. referred to maternity hospitals :— Normal 8 2 Abnormal 20 3 No. referred to dental clinic 21 3 No. of urine tests made 132 — The urine of three women showed a fair amount of albumin; dietetic advice was given and the patients referred to hospital for confinement. H 114 Post-Natal Consultations. Twenty-eight mothers attended the post-natal consultations at the Centre, 10, John Street, 10 of whom had attended the Centre as ante-natal cases. They made 47 attendances in all. In six no abnormality due to pregnancy was found. In twenty-two defects were found, including: — Laceration of cervix 2 Referred to hospital Laceration of perineum 1 Referred to hospital Fibroids 1 Referred to hospital Subinvolution of uterus 3 Referred to hospital Menorrhagia 2 Referred to hospital Prolapsed uterus 2 Treated at clinic Retroversion of uterus 2 Treated at clinic Cervicitis 7 Treated at clinic Vaginitis 2 Treated at clinic Instruction in Mothercraft and Hygiene. For some years, both in the home and in the Centres, we have made use of leaflets written in non-technical language 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. Propaganda posters are pasted on the outer walls at the Centres. There is also a glass-fronted case for the display of a special poster; this poster is changed frequently. Miss Mary Carter and Miss Edith Joyce have continued to give us a great deal of valuable assistance during the year by making children's garments for busy mothers from materials supplied by the mothers and from their own resources. Assistance is given at the Centres in cutting out garments at any time; 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. A sewing machine is available for use of the mothers at 10, John Street and instruction in its use is given at any time. We are careful to keep up-to-date model garments for babies and young children always on view at the Centres. Three hundred and six hanks of wool of a special quality obtained from Wales were sold at cost price to the value of £31 17s. 5½d. The maternity bags were used during the year by one mother. Maternity outfits are placed on sale at the Centre at cost price, 6s. 2d. It is to be regretted that the price of these puts them beyond the reach of the poorest, who are often the least well equipped, and therefore most in need of the outfit. Summer Outing. The Summer Outing was held at Burnham Beeches. The party consisted of 23 mothers, many of whom carried infants in arms, with 15 other children nearly all of whom were below school age. 115 Maternal and Infant Consultations The following summary refers to maternal and infant consultations at 10, John Street and Short's Gardens Centres during the year 1930:— Reasons for attendance. 10, John Street. Short's Garden.. Mothers: — (Healthy) 70 — Difficulty with breast feeding 26 4 Disorders of generative organs 28 4 Venereal disease 1 — Heart disease 2 — Anaemia 15 2 Respiratory disease 3 1 Digestive disorders 4 1 Debility 31 5 Other disorders 49 3 Dental caries 55 1 Rheumatism 7 — Children :— (Healthy) 170 39 Alimentary disorders 54 9 Rickets 19 3 Heart disease 1 — Rheumatism 2 — Respiratory disorders 37 4 Congenital syphilis 1 — Marasmus 4 — Debility 8 8 Hernia, umbilical 15 2 Hernia, inguinal 2 — Phimosis 20 2 Disease of skin 40 2 Disease of eye 12 3 Disease of ear 8 2 Disease of nose and throat 27 2 Dental caries 25 — Other diseases 37 1 (In this table, if the patient has more than one ailment, only the more important has been recorded.) Sixty-three of these children were referred to hospital for treatment, 17 for the removal of tonsils and adenoids, 18 for dental treatment; the other ailments, included talipes equinus, greenstick fracture, poliomvelitis, ringworm, foreign body in abdomen, cœliac disease, phimosis, and squint. Mothers and children attending the Municipal Centres during 1930 were referred to other departments or organisations for assistance as follows: — Mothers. Children. Ante-natal Clinic 1 — Tuberculosis Dispensary — 1 Minor Ailments Clinic 19 70 Dental Clinic 47 11 Metropolitan Nursing Association 6 5 'Nursery School — 1 Massage Clinic 3 — Hospitals 18 7 Convalescent Homes 9 10 Assistance Sub-Committee (for milk) 20 17 Relieving Officer 1 — Breast Massage. The following summary gives particulars of mothers referred for breast massage from 10, John Street in 1930:— Number referred to Metropolitan Nursing Association 10 Results : — Lactation completely restored 3 Breast secretion re-established, but small bottle feeds required in addition to breast feeding Massage unsuccessful 3 Information unobtainable 2 H2 116 Diarrhœa: Twenty children with simple diarrhoea were seen at 10, John Street, and eight at Short's Gardens; one child with summer diarrhoea was brought to the Short's Gardens Centre. Stillbirths. During 1930 twenty stillbirths were registered, 16 of which were legitimate. In all I received information of 22 stillbirths; enquiry as to possible causes was made in each case. Six occurred in the private practice of doctors, one in the private practice of a midwife, five in the extern practice of an institution, and in 10 instances the confinement took place in hospitals. Difficult labour was responsible for 11; for all of these a more or less definite reason can be assigned. In five abnormal presentation occurred; in one the mother's pelvis was contracted; in two there was abnormality of the umbilical cord; in three there was abnormality of the foetus, two being abnormally large. Constitutional maternal disorders appeared to account for six stillbirths; of these toxaemia of pregnancy accounted for three, prematurity for two, and degeneration of the placenta for another. In three no information was obtainable, the parents not being traceable. Illegitimate Children. The births of 51 illegitimate children were registered; two of these were above the standard for enquiry; seven lived with both their parents who had a permanent home together; six with their mothers who worked to support them; five with their mothers who remained in their parents' home; eight were boarded out with foster mothers; one was placed in an institution; two died in early infancy; four were stillborn; 16 children could not be traced, the mother often not having stayed at the address given for more than one or two nights before the birth of the child. Dental Treatment. The following is a summary of the work during 1930 at the Council's Dental Clinic, No. 10, John Street, open on Thursday afternoons for nursing or expectant mothers, and children under five years of age:— Women. Children. Total. Number of sessions held 50 50 50 Number of new Patients 42 22 64 Total attendances 240 34 274 Extractions— With local anaesthetic 7 — 7 With general anaesthetic 44 23 67 Scaling 18 — 18 Fillings— Simple 5 2 7 Dentures (including 6 repairs) 19 — 19 Advice 80 11 91 In three cases where the patients were very poor the dentures were provided free of charge; contributions towards the cost were required in nine cases and in seven instances the patients were required to pay the whole cost. 117 Supply of Milk and Food for Expectant and Nursing Mothers and for Infants. The supply of milk and food at less than cost price was continued during the year under the Maternity and Child Welfare Act, 1918, for nursing mothers, expectant mothers in the last three months of pregnancy, children up to three years of age and, exceptionally, to children between three and five years of age. During the year 207 applicants received free or assisted milk under the scheme. This number included 110 who were receiving such assistance at the end of 1929. Grants were made to 97 new applicants. At the end of the year 1930, 117 applicants were receiving assistance, viz. : Mothers. Children. Total. Free milk 38 70 108 Half price milk 4 — 4 Prepared milk — 5 5 • 42 75 117 The following table shows in detail how the 97 new applicants were assisted in 1930 Milk. Prepared Milk. Free. Part Cost. Free. Part Cost. Expectant mothers 20 3 - - Nursing mothers 13 1 — — Children 43 2 14 1 Home Help. The Council's Home Helps attended 19 cases during the year in comparison with 24 in the year 1929. In nine of these the whole-time officer attended entirely and in nine 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 one case an emergency Home Help only was employed. The emergency Home Helps were engaged when more than one case occurred at the same time and during the absence of the Home Help on summer vacation and sick 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 three 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 5s. Od. per week up to the full cost. 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. The scheme, of Home Helps could with advantage be extended to any illness of mothers occurring during pregnancy and after labour. It would also be very useful to heads of families if they could obtain through the Council the services of a reliable woman to carry out the duties of the mother when she is incapacitated by illness, the cost being borne by the applicant. 118 Convalescent Homes. Four mothers and their babies were sent away, one being also accompanied by a second child. In all four cases the applicants were required to contribute towards the cost. With one exception these mothers with babies were admitted to convalescent homes belonging to the Church Army. Eight other applications were granted for convalescent home accommodation for 10 children under five years of age, but in three cases the parents failed to take advantage of the facilities provided. Seven children were sent away, three free: the parents of the other children were required to pay part of the cost. All these children were admitted to the Hopedene Convalescent Home at Barnet through the kind co-operation of Sister Hope of the West London Mission, Kingsway. 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 December, 1930, 226 infants and children under five attended the consultations, 67 of the total number coming from the Holborn Borough. Extra food and nourishment was provided, also convalescent treatment at country and seaside 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. Deaths of Children One to Five Years, 1930. Eighteen children between the ages of one and five years died from the following causes: — Cause of Death. Ages. Total. 1—5 1—2 2—3 1-4 4-5 M. F. M. F. M. F. M. F. M. F. Both Sexes Measles 5 1 1 1 ... ... 1 ... 7 2 2 Whooping Cough ... ... ... 1 ... ... ... ... ... 1 1 Diphtheria ... ... ... ... ... ... ... 1 ... 1 1 Tuberculosis 1 ... ... ... ... ... ... ... 1 ... 1 Pneumonia ... 2 ... ... ... ... ... ... ... 2 2 Diarrhoea ... 1 ... ... ... ... ... ... ... 1 1 Appendicitis ... ... ... ... ... ... 1 ... 1 1 Violence ... ... ... ... 1 ... ... ... 1 ... 1 Otitis Media ... ... ... ... ... ... ... ... 1 ... 1 1 Totals 6 4 1 2 1 ... 1 3 9 9 18 Totals—Both Sexes 10 3 1 4 18 119 Deaths of Infants under One Year of Age, 1930. 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 Week 2-8 Weeks 3-4 Weeks Total under 4 Weeks 1-4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12 Months 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 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Pneumonia (all forms) ... 1 ... ... ... ... 1 ... 1 1 2 ... ... ... 3 1 1 1 1 3 6 9 Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 I ... ... ... 2 1 3 Meningococcal Menigitis ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 Congenital Malformations ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Premature Births 2 3 ... 1 ... ... ... ... 2 4 6 ... ... ... ... ... ... ... ... 2 4 6 Atrophy, Debility, Marasmus 1 ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 1 ... ... ... ... 1 3 4 Violence (Murder) ... 2 ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... 2 2 Other causes 3 ... ... ... ... ... ... ... 3 ... 3 ... ... ... ... 3 ... ... ... 6 ... 6 Totals 6 6 ... 2 ... ... 2 ... 8 8 16 1 2 ... 5 6 1 4 1 19 17 36 Total both sexes 12 2 ... 2 16 3 5 7 5 36 Net births registered during the calendar year. Males Females Both sexes Legitimate Infants 183 171 354 Illegitimate Infants 15 36 51 Net deaths registered during the calendar year. Males Females Both sexes Legitimate Infants 18 12 30 Illegitimate Infants 1 5 6 120 INFECTIOUS DISEASES AMONG MOTHERS AND CHILDREN. Puerperal Fever and Puerperal Pyrexia. No. Initials Date of Notification Primipara or Multipara Ante-natal Care Birth occurred in Onset subsequent to Recovery Remarks Patient's Home Institution PUERPERAL FEVER—Three Cases. 1 T.R. 12-2-30 Multipara - Home - Ante natal gonorrheal infection Died. Post-mortem а. Septicæmia b. Puerperal fever c. Gonorrhea Midwife summoned a doctor; patient removed to hospital 2 S.G. 17-12-30 Primipara - - Institution Erysipelas Recovered Infantdied 2 days old from prematurity 3 A.H. 13-8-30 Primipara Yes Home - Torn perineum. Bruising of parts Recovered Full-time pregnancy Patient removed to hospital PUERPERAL PYREXIA—Six Cases. 1 P.N. 14-1-30 Primipara - - Yes Septic throat Recovered - 2 A.R. 22-12-30 Primipara - - Yes Acute synovitis of left knee Recovered Full time pregnancy 3 D.A. 11-11-30 Primipara Yes - Yes Mastitis Recovered Full time pregnancy. Patient removed to hospital 4 R.O.L. 13-7-30 Primipara Yes - Yes Urinary infection Recovered Full time pregnancy 5 R.G.E. 23-4-30 Multipara - - Yes B. coli infection of kidney Recovered Full-time pregnancy 6 H.M. 19-2-30 Multipara Yes Yes - Extensive dental caries Recovered Patient removed to hospital on 5th day 121 Ophthalmia Neonatorum. During the year 6 cases of ophthalmia neonatorum were brought to our notice, 5 of which were notified in pursuance of the Public Health (Ophthalmia Neonatorum) Regulations, 1926 and 1928; 1 of the notifications was from a doctor in private practice and 4 from the Medical Officers of hospitals. In 1 case notification in accordance with the Regulations was not received; in this case information came from the London County Council. 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. Five Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Case Number. Age when Notified. Age at Onset. By whom Notified. Type of Disease on Health Visitor's first call. Where Treated. Medical Attendance and Nursing. Result. Birth Notified by. i 17 days 9 days Doctor (Private Practice) Moderate Nursing Horse and at Home Private doctor Cured Private Doctor 2 16 days 9 days Doctor (Hospital) Slight At Home Doctor (Extern Practice) —Hospital and District n urss Cured Extern Department, Hospital 4 19 days 17 days Doctor (Hospital) Not seen At Out - patient Department, and later in Hospital Out - patient—Moorfields Hospital District Nurse. In-patient, Holborn and Finsbury Hospital Dead Extern Department, Hospital 5 19 days 3 days Doctor (Hospital) Slight At Home Out-patient—Royal Free Hospital District Nurse Cured Doctor (Hospital) 6 13 days 13 days Doctor (Hospital) Not seen In Hospital Maternity Ward, Holborn and Finsbury Hospital. Later in-patient at St. Margaret's Hospital Cured Intern Department. Hospital One Case hot Notified in accordance with the Public Health (Ophthalmia Neonatorum) Regulations. 3 11 days 4 days Source of Information: London County Council Slight At Home Private doctor and Extern Department, Myddleton Square Nursing Institute Cured Nursing Institution 122 Ophthalmia neonatorum is one of the most important causes of blindness. Fortunately, however, no case coming to our knowledge last year in the Borough suffered permanent injury in this way. Whooping Cough. Visits were paid to 40 persons suffering from whooping cough. Of these, 31 were notified by doctors; in 5 others the information was derived from the schools; 1 from health visitors; 8 from the L.C.C. Age. Five were children under 1 year, 24 were aged 1 to 5, and 11, 5 to 16 years. Contacts* (40 enquiries.) Twelve had no contacts; 28 had contacts. The number of contacts was 94, of whom 47 were susceptible, 47 already having suffered from an attack. No. of cases and 8 7 5 3 0 1 1 2 1 1 No. of contacts 1 2 3 45 6 7817 No. of cases and 16 2 3 1 1 No. of susceptible contacts 1 2 3 4 14 Spread of Infection in Family. The 40 cases occurred in 33 families. In 27 families 1 case occurred; in 5 families 2 cases occurred, and in 1 family 3 cases occurred. Removal. Twelve children were removed to hospital, approximately 30 per cent. All these were admitted to hospitals of the L.C.C. Spread of Infection in Whooping Cough. 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." The continued advice to parents to look upon a child suffering from whooping cough as a serious menace to others has drawn their attention to the fact that this disease is one which should be viewed with more concern than it is at present. Parents frequently express the view that there is need to educate public opinion in the dangers of whooping cough and the way in which it is caught. *This refers to children of and below school age—the L.C.C. definition being used. A susceptible contact is one who has not already had the disease. 123 The treatment of children suffering with whooping cough in outpatient departments is viewed by many Medical Officers of Health with disfavour. Surely some of these children, possibly many of these children, are still infectious. They travel to the hospitals in public vehicles s although admitted to canteens now provided by many hospitals, some of these children are taken into eating-places. There can be no doubt that the disease is spread in some measure by these practices. Again when a child contracts whooping cough in hospital or at a convalescent home surely all such children should be removed in an ambulance or some other suitable vehicle, not in a public conveyance. Once a child has been taken into a hospital, convalescent home or any such place on account of its health, it is a very poor result if the child has to be sent back home still suffering from disease, even if it is a new one. The job of improving- the child's health once undertaken ought to be finished. If the child falls ill with another disease and this new disease cannot be treated in the first institution, it would seem only fitting that the child should be transferred to another institution. Fortunately the London County Council fever hospitals accept patients with whooping cough. Last year 12 children (30 per cent, of the notified cases) were admitted from Holborn to hospitals of the L.C.C. Measles. The notification of measles was discontinued at the end of 1919 but during 1930 I received information of 392 cases of measles. Of these 102 were notified by school teachers and 169 by medical practitioners; information of 37 was given by hospital authorities, 42 by the health visitors, 30 by parents, 4 from death returns, 2 by sanitary inspectors and 6 from other sources. Age. Twenty-two were under 1 year, 205 were between 1 and 5 years, 139 were between 5 and 16 years, and 26 were over 16. Deaths. Fifteen died; 3 were under 1 year, 10 were between 1 and 5 years, and 2 were between 5 and 16 years. Contacts. One hundred and eighty-six had no contacts; 206 had contacts. The number of contacts was 669 of whom 255 were susceptible, 414 having already suffered from an attack. No. of cases and 71 42 33 18 8 9 10 4 1 2 2 1 1 2 1 1 No. of contacts 1 2 3 4 5 6 7 8 9 10 11 12 13 14 19 24 No. of cases and 68 35 16 10 2 — - 1 — — 1 - No. of susceptible contacts 1 2 3 4 5 6 7 8 9 10 11 124 Spread in Family. The 392 cases occurred in 331 families. In 287 families 1 case occurred, in 31 families 2 cases occurred, in 10 families 3 cases occurred, in 2 families there were 4 cases and in 1 family there were 5 cases. Removals. One hundred and thirty-nine patients (35.5 per cent.) were removed to hospital, 113 to L.C.C. infectious diseases hospitals, 14 to the London Fever Hospital, and 12 to the L.C.C. General Hospital, Archway Eoad. Measles Control in Schools. The special arrangements of the London County Council for securing through the school organisation earlier information of measles was continued. German Measles. During the year information was received relating to 5 cases; 2 were notified by doctors and information of 2 cases was received from schools, and 1 from hospital authorities. Ages. 2 were between 1 and 5 years. 2 were between 5 and 16 years. 1 was over 16 years. Contacts. Four enquiries were made relating to 4 cases under 16 years. Of the 4 cases where enquiry was made 1 had no contacts; the number of contacts with the other 3 cases was 3. all of whom were susceptible. Removals. One case was removed to the London Fever Hospital. Epidemic Diarrhoea. The disease is notifiable in only a few districts in London, and is not notifiable in Holbom. The number of deaths of young children under two years of age classified under the head Diarrhoea and Enteritis was 4, of whom 3 were under 1 year. 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. The services of the district nurses were used as follows in 1930: — Deficient Lactation 13 Cases 120 Visits. Complications after Pregnancy 11 „ 150 „ Ophthalmia Neonatorum 3 „ 32 ,, Pneumonia 4 „ 70 „ Influenza 3 „ 35 „ Tuberculosis 7 „ 219 „ Measles 12 „ 159 „ Total 53 Cases 785 Visits. 125 Health and Baby Week. Health Week was observed in the Borough during the week commencing Sunday, the 19th October. The programme included the following: — (1) Co-operation with the Elementary School Organisation. Arrangements were made for health lessons to be given and for the children to write essays during Health Week. The best three essays in each school department were selected by the Head Teachers for examination in the Public Health Office for prize awards. Two prizes, one for boys and one for girls, were awarded to each school. The Mayor and Mayoress (Councillor Percy Hill, J.P., and Mrs. Hill) kindly entertained to tea the prize winners and the children whose essays were selected from the various schools. All, the elementary schools in the Borough take part in this movement which has become a useful and wellestablished annual custom in Holborn. For the continued interest displayed by the girls and boys in this part of our Health Week we are indebted to the teachers. Everyone appreciates that it is largely by their efforts to inculcate the practising of good habits and to secure the higher aim that the older children should know why good habits promote health and bad habits are detrimental to health that success will come. The school teachers are instrumental in establishing in the minds of children a " health conscience." (2) Health Poster Designs. Children in the elementary schools were invited to enter a competition in the designing of health posters. Designs were submitted from six schools. Two prizes were awarded, both going to St. Peter's Italian School. (3) Exhibition of Health Films. Arrangements were made for free exhibitions of health films. The films were shown in the Court Boom at the Town Hall every day during Health Week. Lunch hour matinees were arranged for the non-resident workers. There were two special afternoon displays for Holborn mothers and two evening displays for Holborn residents. The attendances generally were very good, the hall at the evening displays being filled to capacity. The following films were exhibited : — "The Three Card Trick." The Holborn film on the prevention of diphtheria. "Giro the Germ." "Dangerous Handicap." "Almost a Tragedy." "Cleanliness is Happiness." Lent by the Health and Cleanliness Council. "The Production of Certified Milk." Lent by the National Association for the Prevention of Tuberculosis. "The Care of the Teeth." Lent by the Dental Board of the United Kingdom. "Deferred Payment." Lent by the British Social Hygiene Council. "Ways of Life." (4) Anti-Litter Campaign. Posters dealing with litter on the public way were exhibited throughout the Borough, and were displayed by means of sandwich board men in the main streets of the Borough. 126 (5) Exhibition of Work. An exhibition of work done by mothers attending the Council's Maternity and Child Welfare Centres and members of their families, including the fathers, was held in the Court Room on Monday, October the 27th. The exhibits consisted of needlework, knitting, baby shoe making, rug making, cookery, the hygiene of child life as illustrated in snapshots and photographs, and ingenious domestic contrivances made by any member of a family from which a child attended a Centre. The Mayor (Councillor Percy Hill, J.P.) opened the exhibition and generously provided the prizes which were distributed by the Mayoress (Mrs. Percy Hill). The interest taken by the Mayor and Mayoress in the Exhibition and in Health and Baby Week generally did much to enhance the success of the effort and was greatly appreciated. Minor Ailments. One of the features of the year has been the continued and increased success of the minor ailments clinic first opened in June, 1925. Here on Tuesday and Friday afternoons certain ailments in mothers and children are dealt with which tend to be neglected if left to home treatment and care only. One hundred and forty patients attended the clinic in 1930, making 374 attendances. Amongst the children's ailments dealt with in the order of frequency were:—Otorrhcea, conjunctivitis, impetigo, cuts, grazes, burns, protruding umbilicus, sore buttocks, nasal catarrh, constipation, tonsillitis and ringworm. Among the mothers, mastitis, varicose veins, leucorrhcea and pyorrhoea have been the most common complaints to receive treatment. 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. (21 Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) Homoeopathic 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. 127 Routine Medical Examination of Elementary School Children in Holborn in 1930. 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. Bad Clean. I Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6,9 in either eye. 6/12 or worse in either eye. Entrants— Boys 282 2 280 - 55 205 22 271 11 - 278 3 1 162 43 77 — Qirls 256 11 243 2 55 189 12 235 18 3 247 9 — 149 34 73 — — — Age 8— Boys 214 1 213 - 7 189 18 203 10 1 204 10 148 25 41 130 38 40 Girls 199 5 194 — 19 159 21 182 16 1 194 5 — 135 32 32 120 40 37 Age 12— Boys 115 - 115 - 4 101 10 112 3 - 108 7 95 16 4 72 18 23 Girls 122 — 122 — 33 78 11 115 6 1 118 4 — 97 18 7 86 13 23 Age 14— Boys 159 1 158 - 14 141 4 159 — — 158 1 — 129 19 11 115 16 29 Girls 151 2 149 — 31 119 1 143 7 1 150 1 — 119 22 10 100 14 30 Total 1,493 22 1,474 2 218 1,181 99 1,120 71 7 1,457 40 1 1,034 209 255 629 138 182 Holborn % 1.5 98.4 0.1 14.5 78.8 6.6 94.8 4.7 0.5 97.2 2.7 0.1 69.0 14.0 17.0 66.5 14.5 19.2 London % ... 59.7 39.5 6.8 20.5 75.0 4.5 94.9 4.5 0.6 97.4 2.5 0.1 65.2 27.7 7.1 56.6 24.9 18.5 128 Medical Routine Examination of Elementary School Children in Holborn in 1930. Defect. Boys. Girls. Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number Examined 282 214 115 159 256 199 122 151 Cases + Cases + Cases + Cases + Cases + Cases + Cases + Cases + Malnutrition 4 3 1 1 — — — — — — — — 3 — — — Skin Disease 1 1 - — 6 6 2 2 1 1 2 2 — — 1 1 Enlarged Tonsils 21 17 13 10 4 4 8 6 30 19 23 16 12 11 3 3 Adenoids — — — — — — — - 1 1 — — — — 1 1 Tonsils and Adenoids . 7 5 1 1 — — — — 4 3 - — — — — — Other Nose and Threat 1 — — — — — — — 1 _ 1 - — — 1 1 Enlarged Glands 1 1 — — — — — — 1 1 1 - - - - - External Eye Disease 9 8 - - - - - - 6 5 3 3 1 1 2 — Vision — — — 20 — 18 — 21 — - — 20 13 — 20 Otorrhoea 4 4 — — 3 3 — — 1 1 1 1 1 1 2 2 Other Ear Disease 1 1 - - - - - - - - - - 1 - - - Hearing — — 1 — — — — — — - — - 1 — 1 — Stammering and Speech 2 — 2 - - - 1 - - - - - - - - - Heart 2 — 1 — — — 1 — 2 - 2 2 3 — — — Araemia - — — — — — 1 — — — 1 1 2 1 1 — Lungs 9 5 2 — — — 2 — 4 3 1 1 1 — — — Nervous Disorders 2 — — — — — — — 2 2 1 — — — — — Phthisis — — — — — — — — — — — — — — — — Other T.B. Disease - - - - - - - - - - - - - - - - Rickets 1 - 1 1 - - - - - - - - - - - - Spinal Dcfects — - — — — — — — 1 1 1 — 1 1 1 1 Other Deformities 1 — 1 — — — — — — - — - — 1 1 Other Defects 10 8 3 — — — - — 4 4 4 2 1 — 1 1 Teeth — 114 — 66 — 18 — 27 — 105 — 63 25 32 Number of Children for troatment 152 87 42 51 125 95 46 65 Defects, however slight, are included under " Cases." Those severe enough to require treatment are shown under + 129 Deaths of Children 5 to 15 Years, 1930. Seven children (2 boys and; 5 girls) died during the year between the ages of 5 and 15 years. The deaths were due to the following causes, viz.: heart disease (girl, aged 6), pneumonia (boy, aged 7), measles (girl, aged 6), rheumatic fever (girl, aged 13), bacillary dysentery (girl, aged 11, see page 86), acute meningitis (boy, aged 8) and one death due to a street accident (a girl, aged 13). SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 67 bodies were deposited. There were 44 post-mortem examinations made, and 27 inquests held. The inquests are held in the Court Room at the Town Hall. On 20 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes; 40 bodies were brought in by order of the Coroner, and 7 by the police. Inquests. During this year 42 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, 8; Accidents, 16; Suicide, 8; Misadventure, 8; murder, 2. The causes of death certified as a result of such inquests were as follows:— Natural Causes. Accidents. Heart disease 3 Falls 7 Broncho-pneumonia 1 Motor accidents 5 Dysentery 1 Abortion 1 Convulsions 1 General septicæmia (swallowing of safety pin) 1 Alcoholism 1 Meningitis 1 Injury at birth 1 8 Injury to thumb (septic) 1 16 Misadventure. Suicide. Poisoning 2 Gas poisoning 6 Fall 1 Poison 2 Operation 4 8 Asphyxia (petrol vapour) 1 8 Murder. Strangulation 1 Poison 1 1 2 130 The Removal of Aged, Infirm and Diseased Persons. Tower to deal with this matter was included in the London County Council (General Powers) Bill, 1928, which received the Royal assent on the 3rd August of that year. This Act provides that if a Medical Officer of Health certifies in writing that any person:— (a) is aged or infirm or physically incapacitated and resides in premises in the district which are insanitary owing to any neglect on the part of the occupier thereof or under insanitary conditions; or (b) is suffering from any grave chronic disease; the Medical Officer of Health may under certain circumstances, and subject to the conditions specified in the Act, apply to a petty sessional court for an order for the removal of such person, to a suitable hospital, infirmary, poor law or other institution. Tbe power is not to be put into operation by a Medical Officer of Health unless he is authorised by a resolution of the sanitary authority so to do, either generally or in any particular case in which the powers are proposed to be executed. During the year three cases came to our knowledge of aged or infirm persons living under conditions that made removal to institution desirable. In two of these resulting from, personal persuasion by the Sanitary Inspector, the aged persons agreed voluntarily to such removal. In the third case an aged woman died before arrangements for removal could be completed. Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. Two applications were received during the year for certificates under the above Acts, that the houses concerned were not in all respects reasonably fit for human habitation or otherwise not in a reasonable state of repair. In both cases the certificates applied for were granted and the work needed to render the houses fit for habitation was carried out. Nuisances—Complaints from Relieving Officers. Under Section III of the Public Health (London) Act, 1891, it is the duty of every Relieving Officer in accordance with the regulations of the Authority having control over him, to give information to a Sanitary Authority of any nuisance liable to be dealt with summarily under the Act. This co-operation with the Officers of the Board of Guardians (now Public Assistance Committee) is found to be the most useful. Nuisances Caused by Dogs. With a view to the prevention of nuisances from the fouling of footways by dogs the Council, in the year 1926, 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 after being in force for an experimental period until 1st June, 1928, was made permanent; it. is administered by the Borough Surveyor's Department. 131 Nuisance from Pigeons. The London County Council (General Powers) Act, 1927, gives power to local authorities to deal with nuisances caused or which might be caused by the congregation at any place in the County of London of house doves or pigeons. The arrangements made for giving effect to the Act were fully dealt with in the Annual Report for 1928. During the year complaint was received of a nuisance from pigeons at premises in Hat ton Garden. The Council's Contractor visited the premises and reported that it was impracticable to trap the birds. It had been customary for workers employed on the premises to feed the pigeons and so encourage their presence. A suggestion was made to the occupiers by ona of the Council's, Inspectors that the feeding of the birds should be entirely discontinued. This course was adopted and followed by an early migration of the birds and the abatement of the nuisance. Complaint was also received of a similar nuisance at premises in Torrington Place, but in this case the pigeons migrated shortly afterwards. Demolition of Old Buildings. The London County Council (General Powers') Act, 1927, gave power to that Council to make By-laws in relation to the demolition of old buildings. By-laws dealing with the subject were made by the London County Council in July, 1929, and were approved by the Ministry of Health on the 14th November, 1929. These By-laws are enforceable by the Metropolitan Borough Councils. Copies of the By-laws were forwarded to 14 contractors during the year. In one case it was necessary also to send a letter to the contractor concerned calling attention to a breach of the By-laws; following this, steps were at once taken by the contractor to ensure strict compliance with the By-laws. 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. Propaganda. Tho propaganda work reported on in previous years has been continued. Schick Film. In the early part of the year the Council approved the production of a one-reel film depicting their work in connection with the Schick test and immunisation against diphtheria. The film was first exhibited during Health Week in October last, (see page 125). Arrangements were made for the film to be loaned for exhibition in other districts subject to payment of a small charge. 132 "Better Health." Arrangements were made in conjunction with the proprietors of the monthly magazine "Better Health" for two thousand copies of a local edition of this publication to be distributed free of charge in the Borough monthly. The distribution began in October and as a result of the first three issues there is evidence that already the publication is appreciated and the new number awaited with interest. The Public Health Department is indebted to various church, social and philanthropic organisations who co-operate in the distribution of the magazine in Holborn. Other Propaganda. Health leaflets were placed in ''Please take one'' boxes in the public conveniences. A poster directed against littering the streets was displayed by means of sandwich-board men. To assist in the display of health posters the Works and General Purposes Committee agreed to one of the notice boards on the front of the Town Hall building being framed and glazed and constructed to facilitate easy change of the posters exhibited. This arrangement also prevents the posters becoming torn, dirty and unsightly. Noise. During the year a complaint was made by the occupier of a flat of noise from work carried on in a neighbouring bakehouse. Part of the noise was alleged to be caused by the dropping of empty trays from a motor vehicle to the pavement during the early hours of the morning (from 1 a.m. onwards) and by the talking and shouting of workers in the bakehouse. Visits were made to the bakehouse and the proprietor was asked to use every endeavour to prevent the nuisance complained of. On enquiry there was reason to believe that part of the noise came from work being carried on at a railway (underground) in the immediate neighbourhood. Representations were made to the Superintendent in charge of the works who at once took all practicable steps to minimise the noise. No further complaints were received. Noise from Loud Speakers, etc., By-law. Pursuant to Section 23 of the Municipal Corporation Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1899, the Holborn Council made the following By-law:— "No person shall in any street or public place, or in any shop, business "premises, or place which adjoins any street or public place, and to which the "public are admitted, operate or cause or suffer to be operated, any wireless "loud-speaker or gramophone in such a manner as to cause annoyance to, or "disturbance of, occupants or inmates of any premises or passengers. "Any person offending against the foregoing By-law shall be liable upon "conviction to a penalty not exceeding forty shillings." 133 APPENDIX. TABLE I. Vital Statistics of Whole District during 1930 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 Non residents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate Number Rate 1919 38,156 397 539 13.6 920 24.1 618 322 62 96 624 16.4 1920 39,676 619 827 20.6 827 20.6 568 339 55 66 603 15.2 1921 43,520 483 648 14.8 859 19.7 622 319 51 79 556 12.8 1922 42,850 485 664 15.5 746 17.4 518 342 48 72 570 13.3 1923 43,376 423 593 13.7 718 16.6 491 300 47 79 526 12.1 1924 43,250 391 578 13,36 670 15.5 470 329 47 81 629 12.2 1925 43,315 364 527 12.16 725 16.7 513 330 33 63 542 12.5 1926 43,200 330 535 12.38 623 14.6 454 347 48 90 522 12.1 1927 42,209 320 505 11.96 728 17.2 531 333 19 38 530 12.5 1928 39,280 301 473 12.0 739 18.8 546 338 27 57 531 13.5 1929 38,380 256 392 10.21 766 19.9 545 377 29 74 598 15.6 1930 38,380 (1929) 255 405 10.66 693 18.1 523 318 36 89 488 12.7 In the above table the population, birth rate and death rate are as estimated by the Registrar-Ceneral, founded upon his estimates of the civilian population for the middle of the year 1929 134 TABLE II. Causes of, and Ages at, Death, 1930. 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 i years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All causes Certified 188 36 10 8 7 15 51 158 114 89 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... ... 3. Measles 12 2 6 3 1 ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough 1 ... ... 1 ... ... ... ... ... ... ... 6. Diphtheria and Croup 2 1 ... 1 ... ... ... ... ... ... ... 7. Influenza 1 ... ... ... ... ... ... ... ... 1 ... 8. Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... 2 9. Meningo-coccal Meningitis 1 1 ... ... ... ... ... ... ... ... 7 10. Tuberculosis of Kespiratory System 40 ... ... ... ... 8 12 14 6 ... 14 11. Other Tuberculous Diseases 3 ... 1 ... ... 1 ... ... 1 ... 25 12. Cancer, malignant disease 69 ... ... ... ... 1 5 32 20 11 43 13 Rheumatic Fever 1 ... ... ... 1 ... ... ... ... ... 7 1 4. Diabetes 8 ... ... ... ... ... ... 6 2 ... 2 15. Cerebral Hœmorrhage 31 ... ... ... ... ... 2 10 11 8 18 16. Heart Disease 74 ... ... ... 1 ... 7 30 25 11 22 17. Arterio-sclerosis 34 ... ... ... ... ... ... 2 12 20 6 18. Bronchitis 30 ... ... ... ... ... ... 7 12 11 3 19. Pneumonia (all forms) 35 9 2 ... 1 ... 4 5 9 5 93 20 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... 7 21. Ulcer of Stomach or Duodenum 14 ... ... ... ... ... 4 9 1 ... 6 22. Diarrhœa, etc. 5 4 1 ... ... ... ... ... ... ... 39 23. Appendicitis and Typhlitis 1 ... ... 1 ... ... ... ... ... ... 8 24. Cirrhosis of Liver 2 ... ... ... ... ... ... 2 ... ... 3 25. Acute and Chronic Nephritis 8 ... ... ... ... ... ... 4 2 2 26 20. Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... ... 1 27. Other accidents and diseases of Pregnancy and Parturition 1 ... ... ... ... 1 ... ... ... ... ... 28. Congenital Debility and Malformation, Premature Birth 11 11 ... ... ... ... ... ... ... ... 44 29. Suicide 8 ... ... ... ... ... 5 3 ... ... 1 30. Other Deaths from Violence 18 2 ... 1 1 2 3 4 3 2 1 31. Other Defined Diseases 76 6 ... 1 2 2 7 30 10 18 157 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 488 36 10 8 7 15 51 158 114 89 535 135 TABLE III. Cases of Infectious Disease notified during the year 1930. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality (e.g Parish or Wa rd) 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 ward Small-pox 14 •• 2 4 2 2 2 2 4 10 14 Diphtheria (including Membranous Croup) 80 2 32 22 17 6 1 ... 24 56 80 Erysipelas 29 ... ... ... 1 8 12 8 12 17 13 Scarlet Fever 90 ... 26 44 13 7 ... ... 18 72 86 Enteric Fever 0 4 ... ... 1 1 2 ... ... 3 1 4 Puerperal Fever 3 ... ... ... ... 3 ... ... 3 ... 3 do. Pyrexia 6 ... ... ... 3 3 ... ... 4 2 6 Corebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... 2 3 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... Pneumonia—Primary 41 ... 7 3 7 11 7 9 18 26 24 do. Influenzal 5 ... ... ... 1 ... 2 2 2 3 3 Tuberculosis —Pulmonary 76 ... ... 1 25 21 23 6 36 38 52 do. Non-Pulmonary 10 ... 2 3 2 1 ... 2 3 7 10 Whooping Cough 33 ... 21 7 ... ... ... ... 1 32 10 Acute Poliomyelitis 1 ... 1 ... ... ... ... ... ... 1 ... Encephalitis Lcthargica 1 ... ... ... ... 1 ... ... 1 ... 1 Rheumatism 13 ... 1 11 1 1 ... ... 5 8 ... Chicken Pox 60 1 25 33 1 ... ... ... 15 45 1 474 13 117 129 74 65 47 29 153 321 308 136 TABLE IV. Infectious Diseases in Holborn for the last Eleven Years. NOTIFICATIONS DEATHS Decennial Average, 1920-1929 Year 1930 Decennial Average, 1920-1929 Tear 1930 Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Number Rate per 1,000 London Rate Small-pox 0.46 0.12 0.05 14 0.36 1.15 0 0.00 0.00 0 0.00 0.00 Diphtheria 92 2.19 2.84 80 2.08 2.99 4 0.08 0.14 2 0.05 0.10 Erysipelas 18 0.44 0.45 29 0.75 0.53 ... ... 0.02 ... ... 0.04 Scarlet Fever 112 2.69 3.61 90 2.35 3.72 1 0.03 0.03 0 0.00 0.02 Enteric Fever 5 0.12 0.08 4 0.10 0.06 0.1 0.00 0.01 0 0.00 0.01 Cerehro-spinal Fever 1 0.02 0.02 0 0.00 0.02 ... ... ... ... ... 0.02 Acute Poliomyelitis 1 0.02 0.01 1 0.03 0.01 ... ... ... 0 0.00 0.00 Whooping Cought 99 2.58 ... 33 0.86 ... 5 0.11 0.14 1 0.03 0.03 M easiest ... ... ... ... ... 5 0.11 0.16 12 0.31 0.23 Tuberculosis—Pulmonary 79 1.88 ... 76 1.98 1.54 43 1.02 1.97 40 1.04 0.83 Ditto Non-Pulmonary 15 0.36 ... 10 0.26 0.36 7 0.17 0.17 3 0.08 0.11 Puerperal Fever* 2 1.66 3.71 3 22.22 4.15 1 2.34 1.43 1 2.47 1.69 Ditto Pyrexia 6 10.48 Ophthalmia Neonatorum* 9 15.28 9.57 5 11.11 8.74 ... ... ... ... ... ... Diarrhoea (under 2 years)* ‡ ... ... ... ... ... ... 7 12.01 10.91 4 9.88 9.86 *Rate per 1,000 births. †Notifiable in Holborn (not in London) since 1914. ‡Not notifiable. 137 TABLE V. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough at end of 1930. Number of Inspections. Number of Prosecution. Cowsheds ... ... ... Milkshops 126 94 ... Registered houses let in lodgings 493 824 ... Ice cream premises 30 54 ... Siaughter-houses 1 3 ... Offensive Trades ... ... ... Restaurants and Eating Houses 249 384 ... Housing of the Working Classes— Number of houses inspected :— (a) On account of complaints or illness (Public Health Act) 937 (b) House to house (Housing Consolidated Regulations, 1926) £21 Number of notices served :— (a) Under Public Health Act: — (i.) Intimation 479 (ii.) Statutory 86 (b) Under Housing Act 2 Number of houses repaired or nuisances remedied under Public Health Act 479 Number of houses repaired under Section 3 of Housing Act:— (a) By owners 2 (b) By local authority in default of owners 0 Number of houses closed on notice by owner that they could not be made fit 0 Number of houses for the working classes :— (o) Erected during year (erection completed) 1 block(l5 ments) (b) In course of erection 0 Number of representations by Medical Officer or other person 2 Number of houses included in such representations 12 Number of Closing Orders made 9 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 29 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 23 Number closed or illegal occupation discontinued 7 o v'ercrowding Number of cases of overcrowding found; notices served 14 Number of prosecutions 1 Number remedied 6 Smoke Nuisances— Number of observations 107 Number of notices 3 Number of complaints 2 Number of summonses 0 Cleansing and Disinfection— Number of adults cleansed 270 Number of children cleansed 0 Number of premises disinfected :— (a) After infectious diseases 600 (b) For vermin 119 Water Supply to Tenement Houses— Number of premises supplied Number of prosecutions 0 Sanitary Officers— Number of Sanitary Inspectors (whole-time) Male 3 Female 0 Number of Sanitary Inspectors (part-time) Male 0 Female Number of Health Visitors whole-time 1 part-time 1 138 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 290 16 2 ... Workshops 536 61 8 ... Workplaces 3,016 79 9 ... Total 3,812 156 19 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Pro«ecutions. Found. Remedied. Referred to MM. Inspector. *Nuisances under the Public Health Acts: Want of cleanliness 66 66 ... ... Want of ventilation 7 7 ... ... Overcrowding ... ... ...... ... Want of drainage of floors ... ... ... ... Other nuisances 88 88 ... ... Sanitary accommodation insufficient 4 4 ... ... unsuitable or defective 15 15 ... ... not separate for sexes 9 9 ... ... Offences under the Factoryand Workshop Act : Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bake houses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of th s Report) ... ... ... ... Total 189 189 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 139 TABLE VI.—continued. 3.—HOME WORK. Nature of Work Outworkers' Lists, Section- 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. In2 stances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the rear. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Outworkers. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— (1) Making, &c. 104 293 182 2 ... 5 106 ... ... ... ... ... ... ... ... (2) Cleaning and Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... 1 ... 10 ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 12 ... ... ... 2 ... ... ... ... ... ... ... ... Total 106 293 194 3 ... 15 108 ... ... ... ... ... ... ... ... 140 TABLE VI.—continued. 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. (1) Number. (2) Bakehouses (including 18 factory bakehouses) 24 Other Workshops 611 Total number of workshops on Register 636 5.—OTHER MATTERS. Class. (1) Number (2) Matters notified to H.M. Inspector of Factories : — Failure to affix Abstract of the Factory and Workshop Act (S. 133) 6 Action taken in matters referred by H.M. f Notified by H.M. Inspector Inspector as remediable under the 31 Public Health Acts, but not under the Report (action being taken) Factory and Workshop Act (S. 5) sent to H.M. Inspector 31 Other — Underground Bakehouses (S. 101):— Certificates granted during the year — In use at the end of the year 14 141 TABLE VII. METEOROLOGY OF LONDON, 1930. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal) 1930. Air Temprrature. Bright Sunshine. Rain and other forms of Prf.cipitation. Mean of— Mean of A.& B. Difference from Average.* aily Mean. Difference from Average.* Per cent, of possible. Total Fall. Difference from Average.* A. B. Maximum. Minimum. °F °F °F °F hrs. hrs. % m.m. m.m. January 48.9 38.5 43.7 +5.2 1.33 +0.09 16 63 +20 February 42.6 34.2 38.4 -1.4 1.43 -0.61 14 23 -17 March 51.5 36.2 43.9 +1.4 3.32 -0.08 28 37 -7 April 56.4 40.1 48. 5 +0.9 3.57 - 1.45 26 35 -2 May 63.3 45.6 54.5 +0.5 4.40 -2.07 28 77 +33 June 72.5 51.3 61.9 +2.0 7. 58 +0.88 46 90 +39 J uly 71.9 53.5 62.7 -0.8 5. 09 -1.41 32 46 -11 August 73.9 53. 5 63.7 +1.1 7.33 +1.13 51 70 +14 September 66.6 51.4 59.0 +1.0 3.98 -0.97 32 79 +34 October 60.6 44.9 52.7 +2.5 3.76 +0.64 35 27 -37 November 51.0 38.6 44.8 +0.8 1.69 -0.03 19 111 + 53 December 4.51 35.5 40.3 +0.1 0.46 -0.60 6 39 -18 Year 58.7 43.7 51.2 +1.1 3.66 -0.39 28 697 or 27.44 ins. +101 or + 3.98in. *The averages used are obtained from observations extending over 35 years (1881-1915). 142 LEGAL PROCEEDINGS. Public Health (London) Act, 1891, Date. Name. Address. Offence. Result. 1930 Apl. 30th Thomas Hears ... 9, Robert Street Breach of Lodginghouse By-laws Breaches aim ted. Summons withdrawn on payment of £2. 2s 0d. costs „ „ ... 10, „ „ „ „ „ „ ... II. „ „ „ „ „ „ ... 16. „ „ „ „ Oct. 31st & Nov. 28th A. Toghili ... 40, Old Gloucester Street Overcrowding Overcrowding abated Food and Drugs (Adulteration) Act, 1928. Date. Name. Address. Offence. Result. 1030 Mar. 10th A. H. Bray ... 14, Drury Lans Sale of vinegar deficient in acetic acid Ordered to pay £5. 5s. Od. costs Dec. 10th J. Benjamin ... 19, New North Street Selling milk 20% added water Fined £2. and 10s. fid. costs Public Health (Preservatives, etc., in Food) Regulations. Date. Name. Address. Offence. Result. 1930 Apl. 30th T. D. Northage 1, Lamb's Conduit Passage Selling sausages containing 0.012% sulphur dioxide preservative Dismissed under Probation Offenders Act. Ordered to pay £3. 3s. costs Merchandise Marks Act, 1926. Date. Name. Address, Offence. Result. 1930 Feb. 19th Mar. 5th & 12th Amalgamated Fruiterers, Ltd. Southampton Row Selling imported apples not marked with indication of country of origin Fined £5. and £5. 5s. costs