AC 4342 Don. 5305 HOL. 29 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 1931. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1932 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 1931. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1932 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C.1. To the Mayor, Aldermen and Councillors of THE Metropolitan Borougii of Holborn. Ladies and Gentlemen, Herewith I beg to present a Report upon the Health and Sanitary Conditions of the Borough for the year 1931. 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 11 Deaths 12 Seasonal Mortality 13 Infantile Mortality 13 General Provision of Health Services 14 Sanitary Circumstances Scavenging. Removal of House Refuse 14 Dust Inspector 15 Removal of Offal 15 Litter on Public Way 15 Removal of Manure 15 Sanitary Inspection of District 16 Notices served 17 By-laws as to Houses let in Lodgings 19 Rag and Bone Dealers 19 Rats and Mice (Destruction) Act, 1919 19 Rat Week 21 Smoke Abatement 21 Inspection of Workshops 21 Factories 22 Outworkers 24 Rag Fllock Act 24 Offensive Trade 24 Housing Statistics 24 Common Lodging Houses 26 Boswell Court Housing Scheme 26 Housing Accommodation on L.C.C. Estates 27 Inspection and Supervision of Food. Dairies, Cowsheds and Milk Shops 27 Residue from Milk Clarifiers 27 Milk and Dairies Order, 1926 28 Milk (Special Designations) Order, 1923 28 Dried Milk 28 Margarine 28 Bakehouses 29 Sale of Fish 29 Fried Fish Shops 29 Market Streets and Exposure of Food Generally 29 Street Trading 30 Ice Cream 30 Meat Regulations 32 Places where Food is Prepared for Sale 32 Inspection of Restaurant Kitchens 33 Unsound Food 33 Preservatives in Food Regulations 34 Food and Drugs (Adulteration) Act, 1928 34 Articles Analysed 34 Borough Analyst, Notes by 36 Cheese 37 Condensed Milk 38 Milk 38 The Merchandise Marks Act, 1926 39 Agricultural Produce (Grading and Marking) Act, 1928 40 A 2 4 Pagg Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 41 Smallpox 42 Vaccination 43 Public Health (Smallpox Prevention) Regulations, 1917 44 Information Supplied through L.C.C 44 Diphtheria 44 Diphtheria in Hospitals 45 Diphtheria Contacts 46 Schick Test and Immunisation against Diphtheria 46 Scarlet Fever 51 Acute Rheumatism in Children 51 Rheumatism Supervisory Clinic 52 Typhoid and Paratyphoid Fevers 55 Typhus Fever 56 Cerebro-Spinal Fever 56 Dysentery 56 Malaria 56 Encephalitis Lethargica 56 Acute Poliomyelitis 57 Pneumonia 58 Influenza 58 Anthrax 58 Cliickenpox 59 Mumps 59 Bacteriological Work 59 Disinfections 59 Cleansing of Persons Act 59 Shelter during Disinfection 60 Verminous Condition and Scabies 60 Extermination of Vermin 60 Tuberculosis 61 Notifications 61 Correction of Register 64 Sleeping Conditions 64 Classification of Homes 65 Delay in Notification 66 Institutional Treatment 66 Visits to Home 66 Contacts 67 Prevention of Spitting 67 Deaths from Tuberculosis 67 Tuberculosis Dispensary 68 Tuberculosis Care Committee 74 Public Health (Prevention of Tuberculosis) Regulations, 1925 75 Home Nursing 75 Dental Clinic 75 General Dental Clinic 75 Cancer 76 Foundling Hospital Site 76 Maternity and Child Welfare Notification of Births 77 Number of Births 77 Births in Crowded Homes 77 Home Visiting 78 Attendances at Infant Welfare Centres 78 Work at Centres 78 10, John Street 78 Short's Gardens 79 Ante-natal Hygiene 79 Confinements in Institutions in relation to Housing Conditions 79 Ante-natal Centres 80 Post-natal Consultations 81 Instruction in Mothercraft and Hygiene 81 Maternal and Infant Consultations 82 Breast Massage 83 5 Page Pre-Sohool Children 83 School Entrants 84 Stillbirths 84 Illegitimate Births 85 Dental Treatment 85 Supply of Milk and Food for Mothers and Infants 85 Home Help 86 Convalescent Home Treatment 86 Saffron Hill Maternity and Child Welfare Centre 87 Deaths of Children, One to Five Years 87 Deaths of Infants under One Year 88 Infectious Diseases among Mothers and Children 89 Puerperal Fever and Pyrexia 89 Ophthalmia Neonatorum 90 Midwives Acts, 1902 and 1918 91 Whooping Cough 91 Measles 92 Measles, Control in Schools 93 German Measles 93 Epidemic Diarrhoea 93 Nursing Arrangements 93 Health and Baby Week 93 Minor Ailments Clinic 95 Medical Inspection and Treatment of School Children 95 Deaths of Children, 5-15 Years 98 Sanitary Administration Mortuary 88 Inquests 98 Removal of Aged Persons 99 Rent and Mortgage Interest (Restriction) Acts 99 Nuisances—Notified by Relieving Officers 99 Dogs—Nuisance from—By-laws 99 Nuisance from Pigeons 100 Old Buildings—Demolition of 100 Children's Country Holiday Fund 100 Propaganda 100 Schick Film 100 Better Health 101 Other Propaganda 101 Noise from Loud Speakers, etc., By-law 101 APPENDIX. Table I. Vital Statistics, 1931, and ten previous years 102 Table II. Causes of and Ages at Death, 1931 103 Table III. Infectious Diseases Notified during 1931 104 Table IV. Infectious Diseases in Holborn during 1931 and ten previous years 105 Table V. Information required by L.C.C. 106 Table VI. Factories, Workshops, &c. (1) Inspections 107 (2) Defects found 107 (3) Home Work 108 (4) Registered Workshops 109 (5) Other Matters 109 Table VII. Meteorology of London, 1931 110 Legal Proceedings l1l List of Notifiable Diseases (see back of cover). 6 PUBLIC HEALTH COMMITTEE. 1930-31. 1931-32. Chairman— Chairman— Councillor The Rev. Wilfred H. Davies, M.A. Councillor Harold J. Jewell. Vice-Chairman Vice-Chairman- CounciUor Harold J. Jewell. Alderman Albert J. Clark. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Councillor Bracewell Smith, B.Sc., J.P. Alderman Albert J. Clark. Alderman Charles Shortland. ,, Charles Shortland. Councillor Edmund Balding. Councillor Edmund Balding. „ John H. Boraston, C.B. „ John H. Boraston, C.B. „ The Rev. Wilfred H. Davies, M.A „ Henry W. Ellis. ,, Herbert H. V. Harrison. „ Herbert H. V. Harrison. „ Sidney Parks. ,, William M. Morgan. „ Ernest Partridge. „ Robert Portwine. „ Robert Portwine. „ Sir William R. Smith,D.L.,J.P.,M.D. „ Sir William R. Smith,D.L.,J.P.,M.D. ,, George Witherby. „ William R. Wheatley. HOUSING OF THE WORKING CLASSES COMMITTEE. 1930-31. 1931-32. Chairman— Chairman— Councillor Roland H. Haxell. Councillor Roland H. Haxell. Vice-Chairman- Vice-Chairman- Councillor Horace W. Langdon, F.S.I. Councillor Horace W. Langdon, F.S.I. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Councillor Bracewell Smith, B.So., J.P. Alderman James W. Coade. Alderman James W. Coade. Councillor Robert P. Bristow. » Percy Hill, L.C.C. Rev. Wilfred H. Davies, M.A. Councillor Robert P. Bristow. Henry W. Ellis. " Rev. Wilfred H. Davies, M.A. Miss Frances M. Graves, F.R.Hist.S. " Miss Frances M. Graves, F.R.Hist.S., Albert E. Hunter. „ Albert E. Hunter. Raymond A. Miles. „ George D. Pooley. ,, George D. Pooley. ,, Aslier Rosenberg. Asher Rosenberg. „ J. St. Laurenoe Stallwood. „ J. St. Laurence Stallwood. „ Alfred R. Taylour, M.A. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1930-31. 1931-32. Chairman— Chairman— Councillor Robert P. Bristow. Councillor Robert P. Bristow. Vice-Chairman— Vice-Chairman— Councillor George D. Pooley. Councillor George D. Pooley. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Percy Hill, J.P., L.C.C. Councillor Bracewell Smith, B.So., J.P. Alderman Sir Robert Dibdin, J.P. Councillor Edgar C. A. Bliault. Councillor Claude Bouillon. „ Walter Cassey. „ Ernest Hamlin, M.B.E. ,, Wilfred E. Mullen. „ Albert E. Hunter. „ Harry Myers. „ Albert A. Mussett. „ George John Pooley. ,, Robert Portwine. „ Robert Poirtwine. „ William H. Rose. „ William H. Rose. „ Arthur Youngman. „ William R. Whleatley. The Mayoress (Mrs. Percy Hill). The Mayoress (Mrs. Bracewell Smith). Mrs. H. Warren Coleman. Miss Emily Dibdin. Miss Emily Dibdin. Mrs. Charles G. L. Du Cann. Mrs. Chairles G. L. Du Cann. Mrs. Percy Hill. Miss M. Wilmshurst. Miss M. Wilmshurst. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Councillor H. V. Harrison. Medical Officer of Health (Dr. C. W. Hutt). Tuberculosis Dispensary Councillor Sir William Smith,D.L., J.P., M.D. Tuberculosis Officer (Dr. J. A. Struthers). London County Council Dr. F. C. Lewis. Miss H. Bell. Public Assistance Committee Councillor R. P. Bristow. Charity Organisation Society Miss E. F. Bolton. Local Association of Children's School Care (Vacancy.) Committees. Invalid Children's Aid Association Miss Munro. Metropolitan' District Nursing Association Miss M. Wilmshurst. Almoners of hospitals Miss J. G. Salmon. Miss Voelcker. Insurance Committee for the County of Mr. H. A. Teakle. London. Northern London War Pensions Committee Councillor R. H. Haxcll. British Red Cross Emergency Help Fund Major-General Patrick B. Sangster, C B., C.M.G., D.S.O. National Council of Social Service Mrs. Richmond (to October, 1931). (Vacancy.) Other social workers (co-opted) Mrs. E. C. Bedford. Mrs. Percy Hill. Miss O. Lazarus. Miss H. M. Mathieson. Cav. R. Terroni. 8 STAFF. The following was the Staff during- 1931. 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, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. 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 Rawlinson, M.D., L.R.C.P., D.P.H. Public Analyst—James Kear Colwell, F.I.C. Sanitary Inspectors—Albert Bennett. George F. Clark. Samuel Larard, M.R.San.I. Dust Inspector—Charles Luckman. 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 Fitoh. Arthur Long. Albert R. Shott, Inter.B.Com. (Lond.). Lena Beadle. Dentist—Sidney Adams, L.D.S. (British Dental Hospital) (to 31st March, 1931). J. C. Sinclair, L.D.S. (from 1st April, 1931). Anesthetist—P. Lloyd Williams, M.R.C.S., L.R.C.P. (to 31st March, 1931). Maurice Hudson, M.B., B.S. (Lond.) (from 1st April, 1931). Nurses—The Metropolitan District Nursing Association. Mortuary Keeper and Superintendent of Cleansing Station—Bertie Downing. Superintendent of Women's Cleansing Station—Nellie M. Downing. Caretaker of Maternity Centre—Elizabeth Alderton. Home Help—Ellen Bohling. (Address If, Peabody Buildings, Herbrand Street, W.C. 1.) And Panel of Emergency Home Helps. Disinfector—Henry Emms. Assistant Disinfector—E. E. Denny. Deputy Disinfector—James Sullivan. 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. Terminus 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. Hours 3 to 5 p.m. daily. Temple Bar 1040. 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, 1931. Area of Borough in acres 405.1 Resident population—estimated to middle of 1931 (as supplied by the Registrar-General) for birth and death rates 34,470 Enumerated population—Census, 1931 38,816 Number of inhabited houses (1921) 6,494 Number of families or separate oocupiers (1921) 9,682 Rateable value 1st November, 1931 £1,702,458 Rate of Id. in the £ estimated to yield £6,754 Total M. F. Live Births Legitimate 308 158 150 352 illegitimate 44 23 21 Annual rate of births per 1,000 estimated resident population 10.21 Still births 15 Rate per 1,000 total births 43 Deaths 492 Annual rate of deaths per 1.000 estimated resident population 14.27 Percentage of total deaths occurring in Public institutions 68 Number of women dying in, or in consequence from sepsis 0 of, childbirth ,, other causes 0 Death rate of infants under one year of age :— All infants per 1,000 live births 74 Legitimate infants per 1,000 legitimate live births 71 Illegitimate infants per 1,000 illegitimate live births 91 Deaths from measles (all ages) 1 „ „ diphtheria (all ages) 0 ,, „ whooping cough (all ages) 4 „ „ diarrhoea (under two years of age) 3 Zymotic death rate* 0.17 Tuberculosis, all causes, death-rate per 100,000 110 Excess of registered births over deaths — Excess of registered deaths over births 140 * Excluding deaths from Epidemic diarrhœa. Population and Houses. The Census of England and Wales, 1931, was taken on the night of the 26th-27th April. The Preliminary Report issued by the Registrar-General gives the following as the Census population of the Borough: — Males. Females. Persons. Census, 1921 20,732 22,460 43,192 Census, 1931 18,179 20,637 38,816 Decrease 2,553 1,823 4,376 10 The decrease is equal to 101 per cent. of the 1921 population, being, with the exception of the City of London, the largest rate of decrease in the Metropolitan area. The decrease indicates the growing extent by which the Borough is becoming less residential and more professional and commercial. In the same period in the Administrative County of London, including the City, a decrease was reported representing a numerical loss of 87,702 (2 per cent.). Commenting on these decreases the Registrar-General in his Preliminary Census Report says:— " This loss . . . does little more than mark a further stage in the " process of decentralisation which has been observed since 1901 and which " is inseparable from the increasing commercial and industrial importance of " the region. The decline is relatively heaviest, as would be expected, in the " central portion, a maximum percentage decrease of 19.8 per cent. being " recorded in respect of the City of London, followed by HOLBORN " Metropolitan Borough with 10.1 per cent." The density of population in Holborn based on the Census population is 95.8 persons per acre in comparison with 107 persons per acre in 1921. In the Adminis¬trative County of London the density is 58.7 in comparison with 60 persons per acre in 1921. Since the publication of the Preliminary Report on the Census information has been received from the Registrar-General estimating the " resident" population of the Borough as 34,470 at the middle of 1931. It may be pointed out that the figures of population given in the Preliminary Report of the Census relate to the " enumerated " population (i.e., the persons actually present and enumerated in the area on the Census night), whereas the estimated population at the middle of the year relates to the " resident " popular tion, obtained by eliminating from the enumerated population all persons whose " usual residence " as returned at the Census was recognised by the local registrars as being outside the boundaries of the area of enumeration, and redistributing such visitors by (a) crediting areas containing boarding schools with numbers corresponding to their absent boarders, and (b) distributing the balance of visitors over all areas in proportion to their population. It will be recognised that this variation in the Census system, providing for the presentation of results according to the area of usual or legal residence instead of the area of actual enumeration, must produce a much lower population figure in a Borough where there are many hotels and boarding houses regularly occupied by visitors. It will be seen above that the effect of the revision in Holborn is to reduce the enumerated population of 38,816 persons to an estimated resident population of 34,470. The birth, death and other rates given in this Report are calculated on the latter figure. The character of population shows wide and striking contrasts, including as it does the occupants of expensive residential flats, the migratory population in 11 the large hotels, the student class in the Bloomsbury boarding houses, residents in large commercial, social and philanthropic hostels, working class population in model dwellings and tenement lodging houses (many of whom are very poor), and a relatively large proportion of very poor people in common lodging houses. Although the number of hotels and boarding houses keeps increasing, the Borough 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 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 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. Vital Statistics, 1931. 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 15.8 12. 3 66 London 15.0 12.4 65 Holborn 10.21 14.27 74 Registered Births. The total number of births registered as occurring in the Borough was 211 (120 males and 91 females). Of these, 198 were legitimate and 13 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 123 legitimate infants and 33 illegitimate infants whose mothers were residents of the Borough. Fifteen of the births occurring in the Borough, 13 legitimate and 2 illegitimate, were infants of mothers who were non¬residents of the Borough. The corrected number of births is therefore 352, and the corrected birth-rate 10.21. 12 The following is the corrected number of births and the corrected birth-rates for the year 1931: — Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate per 1,000 of Population. No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. 1931 352 10.21 308 8.93 875.0 44 1.28 125. 0 In London the corrected birth-rate in 1931 was 15.0 per 1,000 in comparison with 15.7 for 1930. 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 1931 being only 10.21 per thousand in comparison with 18.73 in 1911 (20 years ago). Mortality. The total number of deaths registered as occurring in the Borough was 787, of which 441 were males and 346 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough: — Institution. Residents. Non-Residents. St. Giles and Bloomsbury, Holborn. St. Giles and Bloomsbury. Holborn. French Hospital 5 — 34 — Royal Westminster Ophthalmic Hospital — — 2 — Children's Hospital 1 4 305 National Hospital — 3 125 London Homœopathic Hospital 3 5 68 Italian Hospital 1 9 — 32 St. Paul's Hospital — 17 — Private — — 13 5 Total 10 21 66 535 There were 303 deaths of civil " residents " in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 36 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 1931 gives the total deaths for the Borough as 492. 13 Corrected Deaths and Death-Rates, 1931, compared with 1930. 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 †l3.48 11. 4 1931 787 614 598 303 492 †14.21 12.4 For details of causes of and ages at death, see Table II, page 103. Seasonal Mortality. The mortality in the four quarters of the year as given in the Quarterly Reports of the Registrar-General is shown below : —* Death-rate London Deaths. per 1,000. Rate. First Quarter 170 17'8 16'7 Second ,, 101 11.7 10'7 Third „ 93 10.8 91 Fourth 113 131 122 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 1931 26 71 91 74 65 Death-rate per 1,000 corrected births in 1931 and ini ten preceding years. 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 Avge. 1921-30 1931 Holborn Borough 79 72 79 81 63 90 38 57 74 89 72.2 74 London 80 74 60 69 67 61 59 67 70 59 66.9 65 See also Table, page 88. * These figures, as published in the Registrar-General's Quarterly Returns for 1931, are for the 52 weeks ended 2nd January, 1932; the complete corrections for the year 1931 increase the number of deaths to 492 and the rate to 14-2 per 1,000. The corresponding rate for London was 12-4. The3e rates are calculated on the Registrar-General's estimated population's at the middle of the year 1930 and 1931 respectively. 14 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. Deaths in Public Institutions. Of the total number of 492 deaths, 334 died in hospitals and public institutions either within or without the Borough. General Provision of Health Services in the Borough. In the Annual Report for 1930 detailed information was given as to the health services provided in the Borough. In addition to the arrangements set out therein, the following may be noted : — Legislation in Force. Further by-laws were made by the London County Council under the Public Health (London) Act, 1891, and the Housing Act, 1925, with respect to houses occupied by members of more than one family. The by-laws were approved by the Minister of Health and came into operation in June, 1931. A by-law was also made by the London County Council regulating the emission of smoke within the County of London. The by-law was allowed by the Minister of Health and came into force in May, 1931. Ambulance Facilities. During the year the Council entered into an agreement with the London County Council for the ambulances of the County Council to be available for the conveyance of non-urgent maternity cases between 8 a.m. and 11 p.m. Pre-School Children. A special clinic for pre-school children, 2 to 5 years, was opened at the Municipal Maternity and Child Welfare Centre, No. 10, John Street, on Monday, the 13th April, 1931. 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. In a few streets (Bloomsbury Street, south of Great Russell Street, Coptic Street, and Museum Street) the collection is completed by 10 a.m. daily; the bins in these streets have to be placed on the kerb ready for emptying not later than 9 a.m. each morning. This earlier daily collection works well on the whole. 15 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 96. The use of horse vehicles in the removal of house refuse has been discontinued (except in cases of emergency) in favour of a fleet of motor vehicles consisting of both the high loader type and the more modern low loaders. Dust Inspector. The Inspector appointed to supervise the removal of house refuse reports 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 is 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. (/) Breakdown 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 cleaned up. (i) Generally on any matters relating to, or arising in connection with, the removal of refuse. Removal of Offal. On two occasions during the year the Inspectors reported breaches of the by-laws made by the London County Council respecting the removal of offal. In both cases unsatisfactory receptacles were being used, and in one the removal was at a later hour than allowed by the by-law. The attention of the contractors concerned was called to the matter and no further breaches were observed. Litter on the Public Way. Nuisances arising from litter on the public highway have been considerably mitigated. This result follows steps taken by the Dust Inspector to secure the use of properly covered ashbins in streets where the refuse is put out on to the footway. At the same time repeated efforts have been made to prevent the turning over of the refuse by " totters " or children. A large part of street litter, however, does not come from dustbins; it consists of smokers' refuse (cigarette cartons, empty match boxes, used matches, etc.), omnibus and tramcar tickets, etc. The ticket litter is being lessened by the provision in omnibuses and tramcars of 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. 16 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 19,604 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, 1931. Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Complaints received 33 52 40 ... ... 125 Do. found to be justified 33 52 40 ... ... 125 Inspection of Houses— Dwelling-houses 87 198 84 ... ... 369 Houses let in lodgings 315 308 113 40 ... 776 Common lodging-houses 15 13 2 ... ... 30 Drains tested by chemicals 1 1 ... ... ... 2 Drains tested by water ... ... 2 ... ... 2 Drains tested by smoke ... 4 2 ... ... 6 Re underground rooms 2 1 ... ... 3 ,, Rent (Restriction) Act ... ... ... ... ... „ New Buildings 2 ... ... ... 2 Factories— Bakehouses 18 25 4 ... ... 47 Food preparation (other than 73 above) 9 ... ... ... 82 Other 73 80 267 8 ... 428 Workshops and Workplaces— Food premises: 49 Dairies and Milkshops 43 35 ... ... 127 Ice Cream, Manufacture .. 7 39 ... ... 46 Do. Storage or Sale ... 5 1 ... ... 6 Slaughter-houses ... 5 ... ... 5 Hotels and Restaurants 157 119 229 ... ... 505 Butchers 326 27 339 ... ... 692 Bakehouses 10 8 4 ... 22 Fish shops 29 17 6 ... ... 52 Fried Fish shops 207 27 27 ... ... 261 Market Streets 318 55 564 ... ... 927 Licensed Premises ... 2 ... ... 2 Other food shops 358 190 152 ... ... 700 Other workshops 145 165 284 57 ... 601 Other workplaces 105 107 68 ... ... 280 Outworkers' Registers 7 39 51 ... ... 97 Stable and Stable yards 36 65 ... ... 101 Bag and Bone shops 31 12 ... ... 43 Outworkers' rooms † 14 19 "ii ... ... 44 Offices 6 6 9 ... ... 21 Miscellaneous— Black smoke 77 82 106 ... ... 265 Dust, Special Inspections 2 3 I ... ... 6 Rats and Mice (Destruction) Act 68 193 68 ... ... 329 Food and Drugs (Adulteration) Act, sampling 193 191 210 ... ... 594 Demolition of buildings 2 2 3 ... 8 Other Inspections ... 2 ... l 14 17 Keeping of Animals ... 2 1 ... ... 3 Periodical Inspections: Includes W.C. and yards, dust¬- bins, especially houses let in lodgings, and other suitable buildings 1399 2,112 2,340 ... .. 5,851 Inspections carried forward 4,056 4,141 5,035 106 14 13,352 † 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. 17  Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Brought forward 4,056 4,141 5,035 106 14 13,352 Houses 633 946 521 7 ... 2,107 Factories 2 11 7 1 ... 21 Workshops and Workplaces 83 108 99 4 ... 294 Restaurants 27 23 11 ... ... 61 Licensed premises 6 ... ... ... ... 5 Miscellaneous ... 7 10 72 89 Visits re Infectious Diseases 89 128 0O 21 67 365 Do. on School Reports ... ... ... ... Scabies ... ... 1 3 5 9 Other Visits— Police Courts 1 5 6 Various 210 689 288 23 4 1,114 Maternity— Visits: Children under 1 year ... ... ... 65 186 25l ... ... ... 17 21 S8 Expectant Mothers ... ... ... 34 68 102 Re-visits : ... ... ... 70 412 482 Do. 1 to 5 years ... ... ... 142 358 500 Expectant Mothers ... ... ... 40 119 159 Other Maternity Visits ... ... ... 80 131 214 Attendances at Maternity Centres ... ... .. 226 209 435 Total 5,105 5,947 6,034 849 1,669 19,604 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 1,190, viz. :— Public Health (London) Act, 1891— Intimation Notices 440 Statutory Notices 71 By-laws— Houses let in lodgings 643 London County Council (General Powers) Acts— Verminous rooms 27 Rats and Mice (Destruction) Act, 1919 9 1,190 18 The following table shows the work done to abate nuisances for which intimation notices were served : — Water Supply— Houses. Factories, Workshops and Workplaces. Provided 3 2 Cisterns cleansed, repaired etc. 19 1 Waterclosets— Cleansed 7 5 Water supplied, flushing cistern repaired, etc. 6 10 Repaired, new pans, etc. 63 15 Ventilation improved 3 3 Separate accommodation for sexes provided — 12 Position or construction improved 2 7 Direct communication with workrooms remedied 3 Accommodation provided — 1 Soil Pipes— Repaired, renewed and ventilated 4 2 Rainwater Pipes— Repaired or renewed 20 4 Drains— Repaired 9 15 Unstopped, cleansed, etc 20 7 Sinks, etc.— Waste pipes repaired, renewed, etc. 19 10 Yards, Areas and Washhouses— Cleansed 6 2 Paved and paving repaired 24 1 Houses and Workshops, etc.— Cleansed 54 32 Dilapidations repaired and made good 56 4 Ventilation improved 2 — Dampness— 36 Roofs repaired 7 Gutters repaired 7 — Other works to prevent dampness 16 1 Ashbins— Provided, repaired, etc. 87 9 Various— Underground Rooms vacated 20 — Smoke—Emission of black smoke abated 1 7 Accumulations of Refuse—Removed 18 2 Overcrowding abated 1 1 Other nuisances abated 12 6 Animals improperly kept 1 — Statutory Notices. The following table shows the nuisances for which the 71 Statutory Notices were issued under the Public Health (London) Act, 1891. Houses. Factories. Workshops and Workplaces Section 2 (a) Dirty and delapidated or damp premises, &c. 28 7 „ (b) and Section 37, Ashbins 13 2 „ (c) Drains and W.C.'s 14 „ (d) Accumulation of rubbish 3 1 ,, (/) and Section 48. Water supply ... 5 •• (9) Ventilation 1 2 „ 38 W.C. communicating with workroom — 2 „ ,, W.C. dirty or defective — 7 ,, ,, W.C. absence of separate accommodation for sexes — 2 „ „ Insufficient accommodation 1 „ 24 Black smoke ... 1 1 „ 96 Underground rooms 10 — 19 By-Laws as to Houses let-in-lodgings. At the end of the year 484 houses were registered under these By-laws. Of these, 236 are in St. Giles and Bloomsbury and 248 in the Holborn District. There were 776 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. Two hundred notices were served for breaches of the By-laws, in addition to 484 notices that were served for annual cleansing as required by the By-laws. During the year an Inspector reported the failure of a tenant to admit work¬men instructed by the landlord to carry out cleansing work required by the By-laws. A communication addressed to the tenant pointing out the right of entry conferred on the owner by the Housing Act, 1925, secured the necessary facilities for the admission of the workmen. Rag and Bone Dealers. Forty-three inspections of rag and bone shops were made in the year 1931; 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 239 premises were inspected under the above Act, the total inspections being 329. Nine notices for breaches of the Act were served. As a result in eight cases rat proofing was carried out and in the ninth case proofing work was in hand at the end of the year. In addition to the proofing, poisons and traps were used. At the end of the year all the premises were reported to be clear of infestation. 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, a total of approximately 30,000 baits being used during the year. The men who work in the sewers report that the baits were taken and 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. b 2 20 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 8 — — — — — 8 Free 8 B. 19 19 — — — — — 19 Free 19 C. 23 7 1 1 1 — 2 2 Free 6 Rats occasionally seen 1 D. 29 26 — — — — — 26 Free 26 F. 6 3 1 2 — 1 — 1 Free 2 Numbers reduced 1 F. 52 20 3 9 2 — 16 Free 13 Numbers reduced 7 G. 17 6 3 1 — — 5 Free 5 Rats occasionally seen 1 H. 59 17 2 2 9 5 2 Free 15 Rats occasionally seen 2 I. 22 7 — — 3 2 2 Free 5 Rats occasionally seen 2 239 113 10 15 15 1 9 81 Free 99 Numbers reduced 8 Rats only occasionally seen 6 21 Rat Week. In the observation of Eat Week in the Borough we endeavoured as in previous years to secure during the six days, 2nd to 7th 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 520 baits per week. During Rat Week the number was increased to about 2,600. The sewermen reported that dead rats are sometimes 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 Rat Week are included in the summary table on page 20. Smoke Abatement. The smoke shafts in the Borough were kept under frequent inspection, 265 observations being recorded. A number of these were made in the early morning when smoke pollution is more prevalent and frequently the observations extended for periods of not less than one hour. Thirteen complaints were received of nuisances from the emission of smoke. As the result of inspections made eight intimation notices and two statutory notices were served. In order to avoid any recurrence of the nuisances the owners of one building converted their boilers to make then suitable for oil feeding. In another case the proprietor of an hotel adopted a suggestion made by the Public Health Department to discontinue using coal dust with coke as fuel for their boilers and subsequently arranged to have their entire plant thoroughly overhauled. During the year the London County Council made a By-law under Section 2 of the Public Health (Smoke Abatement) Act, 1926, for regulating the emission of smoke within the County of London. The By-law provides that the emission of black smoke for a period of three minutes in the aggregate within any continuous period of thirty minutes from any one chimney of a building other than a private dwelling house shall, until the contrary is proved, be presumed to be a nuisance liable to be dealt with summarily under the Public Health (London) Act, 1891. At the end of five years the period of emission allowed is to be reduced to two minutes. The By-law should prove of considerable assistance to local authorities in dealing with smoke nuisances. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 557 factories were inspected, 623 workshops and 3,768 workplaces. 22 It is found that changes frequently occur in the occupation of workshops. To obtain information of such changes and further details of industrial conditions in the Borough a large number of visits and inspections were made in addition to the routine inspections mentioned above. As the result of these visits 57 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 56 workshops were added to the register. At the end of the year there were 610 workshops on the register. 330 employed men only, 53 employed women only, and 227 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 152 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 12 — — 12 Carpenters 10 — — 10 Clock and watch makers 13 — 2 15 Dressmakers and ladies' tailors 1 17 21 39 Diamond mounters 8 3 11 Engravers 13 — 2 15 Glass blowers 6 — 2 8 Jewellers 46 — 11 57 Leather goods makers 6 — 6 12 Metalworkers 6 — 4 10 Tailors 31 4 59 94 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. Steps are being taken for the gradual compilation of a register of such places, and at the end of the year 438 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 no longer be inspected by the Borough Council's staff except as regards sanitary accommodation. The 438 factories include 50 different industries. In 213 cases men only were employed, in 18 women only, and in 207 both sexes. The more important industries carried on in these factories are :— Bookbinding 18 Engineering 45 Jewellers' work 14 Metal work 12 Printing 98 23 The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1931: — Mr. Bennett. Mr. Clark Mr. Lar&rd. Miss Charlesworth. Total. Factories— Inspections 82 80 340 8 510 Re-inspections 2 11 7 1 21 Workshops— Inspections 145 165 234 57 601 Re-inspections] 15 49 36 4 104 Workplaces— Inspections 105 107 68 — 280 Re-inspections 68 59 63 — 190 Offices— Inspections 6 6 9 — 21 Re-inspectios — — 3 — 3 Bakehouses— Inspections 28 33 8 — 69 Re-inspections — 16 — — 16 Restaurants— Inspections 157 119 229 — 505 Re-inspections Licensed Premises— 27 7 11 45 Inspections — 2 — — 2 Re-inspections 5 5 Defects Found— Want of cleanliness 9 20 10 4 43 ,, ventilation — — 1 1 2 Overcrowding — — 1 — 1 Storage cistern defective — 1 — — 1 Accommodation for refuse 1 4 2 - 7 Accumulation of refuse 1 1 1 — 3 Insufficient Sanitary (Unsuitable accommodation - Defective (Not separate for sexes 2 5 _- 7 5 8 3 1 17 2 7 5 14 Other nuisances 11 26 22 4 63 Total defects 29 69 5O 10 158 Action taken. Matters referred to H.M. Inspector :— Failure to affix abstract 10 Matters referred by H.M. Inspector:- Notified by H.M. Inspector 17 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charlesworth. Total. Factories— Intimation 2 6 5 1 14 Statutory — — 2 — 2 Workshops— Intimation 13 14 14 6 47 Statutory 2 2 1 — 5 Workplaces— Intimation 1 19 16 — 36 Statutory 2 6 1 — 9 Offices— Intimation — 1 4 — 5 Statutory — — 2 — 2 Restaurants — 22 Intimation 3 11 8 — Statutory — 3 2 — 5 Licensed Premises— 2 Intimation — 2 — — Legal Proceedings — — — — — 24 Outworkers. Lists received from Holborn Firms 106 Names and addresses received from other Authorities . 279 Names and addresses sent to other Authorities 384 Notices served on Employers 110 Firms visited 113 Infectious diseases in outworkers premises nil 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. Offensive Trade. In November, 1931, a Sanitary Inspector reported that at a house in the Borough an "offensive trade" was being carried on contrary to the provisions of the Public Health (London) Act, 1891, and the By-laws made by the London County Council. The business was one in which rabbit skins were dried in order to retain or preserve the wool or hair thereon. A communication was addressed to the proprietor of the business calling attention to the matter and the ''offensive trade " was at once discontinued. HOUSING. In the year 1930, under the Housing Act, 1925, a number of houses were dealt with in the Italian Colony entailing much revisiting, inspection and office work in the year under report. The following is the summary of information asked for in the Ministry of Health Circular 1206: — I —INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 853 (b) Number of inspections made for the purpose 1.145 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 nil (b) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 314 25 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 HI.—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (&) by owners — (b) by Local Authority in default of owners — B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 314 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) by owners 314 (b) by Local Authority in defaut of owners nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 2 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 D. Proceedings under Section 20 of the Housing Act, 1930: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil E. Proceedings under Section 3 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil (2) Number of dwelling-houses which were rendered fit after service of formal notices : — (a) By owners - (b) By local authority in default of owners - (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil 26 F. Proceedings under Sections 11, -14, and 15 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which Closing Orders were made nil (2) Number of dwelling-houses in reepect of which Closing Orders were determined, the dwelling-houses having been rendered fit 1 (3) Number of dwelling-houses in respect of which Demolition Orders were made nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders nil Common Lodging Houses. The common lodging house accommodation in the Borough is equal to 24 beds per 1,000 of the estimated resident population. The death-rate amongst common lodging house residents is very high; in this Borough it was 36 per 1,000 in 1930. The following table gives details of the accommodation available in the common 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 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-the- Martyr 40, Eagle Street Joseph Benton 50 — 50 St. GeorgetheMartyr 35, Devonshire Street Ada Elizabeth Chesterton — 45 45 Boswell Court Housing Scheme. This scheme is the outcome of protracted consideration and negotiation by the Holborn Council and its Housing of the Working Classes Committee in their efforts to meet the need for more housing accommodation in the Borough. The Committee was faced with many difficulties, one of the greatest being the high value of land in Central London. Ultimately, however, a scheme prepared by the Borough Engineer and Surveyor, Mr. J. E. Parr, A.M.Inst.C.E., was adopted by the Council, and was approved by the Ministry of Health for assistance under the Housing (Financial Provisions) Act, 1924, and by the London County Council. The dwellings to be erected will comprise three separate blocks containing in all 62 flats. The Council accepted the tender of Messrs. H. C. Horswill, Ltd., for the construction of the buildings, and the foundation stone was laid on Thursday, 27 the 29th October, by the Mayor of the Borough (Councillor Percy Hill, J.P., L.C.C'.). At the time of the preparation of this Report satisfactory progress has been made with two of the three blocks; it is expected that these will be ready for occupation in October next. A very large number of applications for the flats has already been received. Accommodation on L.C.C. Estates. During the year 29 applications for accommodation on L.C.C. estates were submitted through the Council's Public Health Department. This arrangement with the L.C.C. is primarily to secure reduction in overcrowding, that is, to provide housing accommodation for families residing more than tiwo per room, but other cases of hardship are also eligible for consideration. During the year 1931 we received information that 15 of the families had removed to L.C.C. estates, making a total of 190 such families from Holborn for whom suitable accommodation has been secured. INSPECTION AND SUPERVISION OF 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 1931, the number of registered dairies and milk shops in the Borough was 130. Four shops were newly registered for the sale of milk. In eight cases alterations in the register became necessary owing to alteration in ownership. One itinerant vendor was registered and one wholesaler. In addition to my inspections the Sanitary Inspectors made 127 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. 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 28 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. Milk and Dairies Order, 1926. Information was received respecting the use by a Holborn milk seller of churns which did not comply with the provisions of the above Order. On inspection it was found that of nearly 100 churns used by the trader, two were fitted with sunken lids permitting contamination of the contents of the churns. The use of both churns was at once discontinued, and ultimately these churns were scrapped. The Milk (Special Designations) Order, 1923. During the year 1931 licences available up to the 31st December, 1931, for the sale of designated milk in the Borough were issued as follows: — Certified Milk 2 Grade A (Tuberculin Tested) 5 Pasteurised 7 14 Up to the date of preparation of this report licences for the year 1932 have been issued as follows: — Certified Milk 2 Grade A (Tuberculin Tested) 3 Pasteurised 5 Supplementary— Grade A (T.T.) 1 Pasteurised 3 14 Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Five 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. 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 as butter. Until this is done the menace of health arising from the continual and ever increasing substitution of butter by margarine will remain serious. 29 Bakehouses. At the end of the year 1931 there were 23 bakehouses in the Borough of which 17 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 69 inspections of bakehouses. Sale of Fish. During the past year 52 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 261 inspections of these premises were made. At the same time a careful look-out has been kept on the soundness of the fish and the wholesomeness of the materials used for frying. During the year a petition was received signed by a considerable number of residents and occupiers of business premises in a main thoroughfare in the Borough objecting to the proposed establishment of a new fried fish shop in the thoroughfare owing to the "obnoxious odour arising therefrom." The ground landlords eventually refused to allow the premises to be used for this purpose. Market Streets. There were 927 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are regularly inspected daily and on Saturday evenings and Sunday mornings. The daily inspection of these market streets helps to secure the maintenance by the regular stallholders of good, sound food only, and, in addition, has the effect of keeping away from these markets casual and unsatisfactory hawkers, who generally avoid markets subject to regular and strict supervision. In order to minimise as far as practicable any contamination of the food exposed for sale in market streets from dust arising during street cleansing, the Borough Surveyor has arranged for these streets to be sufficiently watered before the scavenging to prevent dust arising. 30 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 the articles exposed for sale, is being undertaken by the Public Health Department. I received information from the Borough Engineer respecting 93 applications from street traders for annual licences to sell various articles of food as follows: — Coffee stalls 6 Confectionery 5 Confectionery and drinks 3 Eels and shell fish 3 Fish—wet and dry 7 Fruit 26 Fruit and vegetables 10 Groceries 3 Ice cream 4 Ice cream and chestnuts 6 Meat 3 Poultry, eggs and provisions 6 Vegetables 11 93 All the storage places situated in the Borough were inspected. Ice Cream. With a view to dealing more efficiently 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 31 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.B., 1928, p. 42). During the year there were 25 premises in the Borough where ice cream was manufactured, and in addition to my inspections 46 inspections of these premises were made. In one case an Inspector reported that a basement ice cream store was dirty and lumbered up, the unfrozen cream not properly covered and the approach to the basement dirty. A communication sent to the responsible occupier resulted in steps being at once taken to remedy the objectionable conditions. Ice cream is manufactured in the Italian colony as follows :— Premises on which 10 gallons are made daily 2 ,, ,, 4 ,, ,, 1 ,, ,, 2 ,, ,, 2 ,, ,, 1 ,, ,, 2 In addition ice cream was also manufactured on the following premises:— Mr. Bennett's District. Mr. Clark's District. Mr. Larard's District. Restaurantd 3 1 3 Confectioners 1 — 8 Other — 1 1 Nowadays the hygienic standard m 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, 32 Public Health (Meat). Regulations, 1924. These Regulations came into operation on the 1st April, 1925; they deal with slaughter-houses, meat marking, the handling of meat in wholesale markets, conditions of transport, the protection of meat in butchers' and other shops and on stalls from contamination by flies, mud and other 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 29 Butchers' stalls 1 Provision dealers 27 Provision dealers' stalls 3 Offal shops 3 Cooked meats 5 Wholesale (bacon; sausage) 5 73 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 692 such inspections were made. 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. 33 The number of such places on the register at the end of the year was as follows: — Hotels, Restaurants and Eating Houses 275 Slaughter-houses 1 Tripe, offal and other meat shops 37 Fried fish shops 11 Fish shops 15 Ice cream (Manufacture) 25 Poulterers 6 During the year, 2,494 inspections of such food premises and market streets were made and 25 notices served for sanitary defects found. Inspection of Restaurant Kitchens. The large day population in the Borough calls for many eating houses ranging from the "cook shop" where cheap. meals are provided to the high-class restaurant. The inspection of the kitchens of such places has become a routine but important part of the work of the Public Health Department. Generally the kitchens are found to be satisfactory and the food clean and wholesome. Occasionally, however, some action is necessary to ensure compliance with a reasonable standard of efficiency. For instance, in the year 1931 the attention of the proprietors of two small restaurants was called to the lack of suitable accommodation for the storage of meat and similar perishable goods. The suggestions made by the Public Health Department for dealing with the defects were adopted and satisfactory improvements effected. In all 24 notices were served during the year respecting unsatisfactory conditions at hotels, restaurants and eatine houses. Unsound Food. The following unsound food was condemned during tho year 1931 :— Commodity. Quantity. Condition. Result of Action taken. Fish :— Tons. Cwta. Qrs. lbs. Cod ... ... 1 — Decomposed Surrendered Dabs ... 11 — 26 do. do. Kippers ... ... 2 14 do. do. Plaice ... ... 2 7 do. do. Skate ... 2 - — do. do Whiting ... ... 2 14 do. do. Fruit :— Cherries ... ... 1 22 Rotten do. Grapes ... 5 1 12 do. do. Raspberries ... 2 2 10 do. do. Tomatoes ... 1 1 20 do. do. M eat : — Bacon ... 8 2 2 Abscess—decomposed do. Beef ... 6 1 17 Brine stained do. Geese ... 7 3 25 Decomposed do. Other Food :— Cheese ... ... 2 16 Damaged and decomposed do. Chestnuts ... 1 — — Decomposed do. Tomatoe puree 1 4 1 20 do. do. Total 8 8 — 9 C 34 The Public Health (Preservatives, etc., in Food) Regulations. In the year 19B1 only one sample of food was found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., sausages (see page 36). Food and Drugs (Adulteration) Act, 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, camo into force. The Margarine Act of 1877 and the Butter and Margarine Act of 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 Costs. Genuine. | Adulterated. Ale 4 4 ... ... ... ... Almond oil 2 2 ... ... ... ... Apricots, canned 2 2 ... .. ... ... Amin. tincture of quinine 1 1 ... ... ... ... Beans, canned 1 1 ... ... ... ... Beef, corned 3 3 ... ... ... ... Beef, glazed 3 3 ... ... ... ... Beef, pressed 3 3 ... ... ... ... Bicarbonate of soda 3 3 ... ... ... ... Bismuth tablets 2 2 ... ... ... ... Borax 2 2 ... ... ... ... Brandy 1 1 ... ... ... ... Brawn 5 5 ... ... ... ... Bread and butter 6 6 ... ... ... ... Butter 39 39 ... ... ... ... Cake 2 2 ... ... ... ... Cheese 19 19 ... ... ... ... Christmas pudding 3 3 ... ... ... ... Cinnamon (ground) 3 3 ... ... ... ... Coffee extract 1 1 ... ... ... ... Coffee and chicory extract 5 5 ... ... ... ... Cornflour 4 4 ... ... ... ... Cream 21 21 ... ... ... ... Creme de Menthe 1 1 ... ... ... ... Custard powder 1 1 ... ... ... ... Dripping 6 6 ... ... ... ... Egg substitute 4 4 ... ... ... ... Fish paste 9 9 ... ... ... ... Fruit cordial 3 3 ... ... ... ... Fruit salad (canned) 1 1 ... ... ... ... Gelatine 3 3 ... ... ... ... Gin 1 1 ... ... ... ... Ginger (crystallised) 2 2 ... ... ... ... Ginger (ground) 3 3 ... ... ... ... Ginger beer 1 1 ... ... ... ... Ginger wine 4 4 ... ... ... ... Ice cream 9 9 ... ... ... ... Jam 2 2 ... ... ... ... Lard 3 3 ... ... ... ... 35 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs Genuine. Adulterated. Lemonade 2 2 ... ... ... ... Lemonade powder 5 5 ... ... ... ... Lemon squash 5 5 ... ... ... ... Lime juice 5 5 ... ... ... ... Lime juice cordial 1 1 ... ... ... ... Liniment of iodine 1 1 ... ... ... ... Liniment of turpentine 3 3 ... ... ... ... Liniment, white 1 1 ... ... ... ... Linsted, crushed 2 2 ... ... ... ... Lobster (canned) 3 3 ... ... ... ... Margarine 18 18 ... ... ... ... Marmalade 5 5 ... ... ... ... Meat paste 2 2 ... ... ... ... Meat, minced 3 3 ... ... ... ... Meat pie 2 2 ... ... ... ... Milk 189 188 1 1 ... Dismissed under P.O. Act. Costs £2. 2s. 0d. Milk, condensed 7 7 ... ... ... ... Milk, dried 5 5 ... ... ... ... Mince pio 3 3 ... ... ... ... Nitrate of mercury ointment 2 2 ... ... ... ... Oil, camphorated 2 2 ... ... ... ... Ointment, blue 1 1 ... ... ... ... Ointment, boric 2 2 ... ... ... ... Ointment, calomel 5 5 ... ... ... ... Ointment, mercurial 1 1 ... ... ... ... Ointment, sulphur 2 2 ... ... ... ... Orange crush 1 1 ... ... ... ... Orange quinine wine 1 1 ... ... ... ... Paregoric 4 4 ... ... ... ... Pastries 3 3 ... ... ... ... Peas (canned) 16 16 ... ... ... ... Pickles 4 4 ... ... ... ... Pineapple (crystallised) 1 1 ... ... ... ... Prescriptions 2 2 ... ... ... ... Rice 3 3 ... ... ... ... Roll and butter 6 6 ... ... ... ... Salad oil 3 3 ... ... ... ... Salmon, canned 3 3 ... ... ... ... Sardines 1 1 ... ... ..... Sauce 4 4 ... ... ... ... Sauce, miat 1 1 Sausages 1 9 18 1 1 ... Summons withdrawn on payment of £1. Is. Costs. Sausage roll 2 2 ... ... ... ... Soup 3 3 ... ... ... ... Spinich, cannel 1 1 ... ... ... ... Sponge cake 9 9 ... ... ...... ... Suet, shredded 4 4 ... ... ... ... Swiss roll 2 2 ... ... ... ... Swetts 5 5 ... ... ... ... Tea 3 3 ... ... ... ... Tincture of iodine 1 1 ... ... ... ... Tincture of rhubarb 2 2 ... ... ... ... Tomatoes, canned 1 1 ... ... ... ... Tomato puree 5 5 ... ... ... ... Vinegar 9 9 ... ... ... ... Whisky 1 1 ... ... ... ... Wine, cherry 1 1 ... ... ... ... Wine, raisin 1 1 ... ... ... ... Total 687 585 2 2 ... Costs, £3 3s. C 2 36 Informal Samples. Article. Number Taken. Result of Analyses. Oenuine. | Adulterated. Butter 1 1 Brandy 1 ... 1 Cream, canned 1 1 Milk 3 3 Milk, condensed 6 6 Sweets 2 2 Total 14 13 1 The Borough Analyst, J. Kear Colwell, Esq., F.I.C., has kindly supplied the following notes: — During the year 1931, 601 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 587 having been purchased with the usual formalities and 14 obtained informally. Of this total only three (0-5 per cent.) proved to be adulterated—two being formal and one an informal sample. These were samples of brandy, milk and sausages. Brandy.—The sample of brandy certified to be adulterated was obtained informally and fulfilled the legal requirements as regards the spirit strength, but was deficient in esters to the extent of at least 26-24 per cent., indicating that it had been blended with plain spirit, practically pure alcohol, or distilled in a patent still, either of which would have reduced the ester content to the extent found. It may be explained, that the character and value of spirits depend upon the presence of what are termed secondary bodies which pass over with the alcohol in the process of distillation in the pot still and are subsequently elaborated during the maturing of the spirit. In the case of brandy the determination of the esters would give an indication that these valuable bodies are present and if so if they are in something like the proper proportion. It is generally held that brandy should contain at least 80 parts of esters per 100,000 of absolute alcohol (by volume). It may be added that the patent still which is employed in the manufacture of pure alcohol practically prevents these secondary bodies from distilling with the alcohol and a spirit like brandy, though manufactured from the grape, may lose much of its value if treated in this way. Milk.—One of the samples of milk was deficient in fat to the extent of at least 34-3 per cent. The Sale of Milk Regulations, 1901, provide that where the percentage of fat in a sample of milk falls below 3-0 per cent. a presumption is raised that the sample is not genuine. Sausages.—The sample of sausages certified to be adulterated contained 100 parts of sulphur dioxide per million. If a vendor desires to sell preserved sausages he may use not more than 450 parts per million of sulphur dioxide, but the fact that they are preserved must be declared in some suitable way to the purchaser. 37 Cheese.—A number of samples of cheese were analysed during the year, but in no case was adulteration found. It may be of interest to add some of the results obtained especially as at the present time there are no standards of composition for cheese. Hard Cheeses. Sample marked. Water. Fat. Protein. No. 95 36.4 30.6 201 per cent. No. 96 36.4 29.7 23.0 „ „ No. 97 37.8 29.7 22.4 „ „ No. 383 ... 17.5 31.2 Not ascertained. Soft Cheeses. No. 381 40.5 23.8 24.7 „ „ No. 382 36.5 26.6 27.0 „ „ No. 384 45.0 26.8 Not ascertained. Full-Cream Cheese. No. 37 35.5 31.7 25.0 per cent. Double-Cream Cheeses. No. 48 49.1 43.6 5.1 ,, ,, No. 551 ... 45.4 43.5 6.7 ,, No. 572 50.0 40.8 61,, ,, Bondon Cheese. No. 582 67.9 6.9 170 „ „ Miscellaneous—no description. No. 46 14.3 77.9 4.6 „ „ No. 101 26.4 34.1 27.2 „ „ No. 113 22.5 38.6 28.8 „ „ No. 118 30.9 39.4 20.9 „ „ No. 122 28.3 351 27.2 ,, „ No. 400 33.5 32.7 Not ascertained. No. 410 23.2 37.5 23.4 per cent. Condensed Milk.—During the year 13 samples of condensed milk were examined, three " evaporated full-cream," three "sweetened full-cream," and seven " sweetened machine-skimmed." 38 The following results were obtained:— Evaporated Full-Cream Milks. Sample marked. Fat. Total Milk Solids. No. 372 9.1 32.4 per cent. No. 414 10.4 36.2 ,, „ No. 541 9.2 31.9 ,, „ 39 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 11 12.88 9.13 3.76 February 20 12.-61 8.93 3.68 March 18 12.33 8.79 3.64 April 16 12.40 8.91 3.46 May 12 12.46 8.87 3.69 June 12 12.22 8.73 8.49 July 12 12.65 8.97 8.68 August 21 12.33 8.72 3.61 September 14 12.92 9.04 3.88 October 18 12.90 9.05 3.86 November 15 13.00 9.10 8.90 December 26 12.58 8.86 8.72 Whole year 192 12.60 8.92 3.68 Legal minimum 11.60 8.50 3.00 Merchandise Marks Act, 1926. During the year a new Order-in-Council was made under the above Act requiring an indication of origin to be applied to imported frozen and chilled salmon and sea trout. The Order came into force on the 29th December, 1931, and is entitled the " Merchandise Marks (Imported Goods) No. 8 Order, 1931. A copy of the Order was sent to all fishmongers in the Borough. The Orders now in force provide for imported foodstuffs of the following kinds to be marked to show where they came from: — 1. Fresh Apples. 2. Eaw 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. 8. Salmon and Sea Trout. The total number of inspections made by the Officers appointed under the Act was 4,838. Of these, 1,825 related to shops, 2,960 to licensed street traders and 53 to non-licensed street traders. During the year 62 breaches of the various Orders were found, viz:- 40 Order No. Article. • Number of breaches. 3. Fresh apples 42 4. Raw tomatoes 12 5. Currants, sultanas and raisins 4 5. Eggs 3 5. Oat products 1 Total 62 In proportion to the inspections made non-licensed street traders showed themselves to be the greatest offenders against the various Orders, for eight of the breaches found (apples, seven) (tomatoes, one) related to such persons. These itinerant vendors are the most difficult to supervise; often it is only at long intervals and irregular times that these vendors are found trading; the personnel, 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 their barrows. When the necessary information as to the source of the articles is not visible owing to the label having fallen down the Inspector calls the attention of the vendor to the fault, but it is not recorded as a breach. In all cases where breaches were found in shops or on the barrows of licensed street traders marking was carried out after either a verbal caution from the Inspector, or a letter of warning from the Medical Officer of Health. No case of continued failure to comply with the Orders was found and the question of legal proceedings being instituted did not therefore arise. 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. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The relative importance of the commoner infectious diseases as rsgards numbers of deaths caused is shown by ihe following table :— ENGLAND AND WALES. Common Infectious Diseases. Deaths at all Ages. 1951. 1922. 1923. 1924. 1925. 1926. 1927. 192a 1929. 1950 Yearly average 1921-1930 Pneumonia (all forms) 34,708 40,930 33,413 38,970 36,990 32,339 37,242 31,014 43,846 27,724 35,717 Pulmonary Tuberculosis 33,505 33,919 32,097 32,690 32,382 30,108 31,06(i 29,799 31,425 29,414 31,640 Measles 2,241 5,694 5,316 4,834 5,337 3,483 3,622 4,302 3,388 4,188 4,240 Whooping Cough 4,576 6,370 4,162 3,983 6,058 4,118 3,681 2,976 6,332 2,037 4,429 Diphtheria 4,772 4,075 2,722 2,501 2,774 2,994 2,732 3,191 3,446 3,497 3,270 Scarlet Fever 1,305 1,382 993 888 988 677 579 580 717 740 850 Enteric Fever 613 465 450 496 388 367 367 438 382 313 428 42 The total number of notifications relating to Holborn residents received during the year was 348 in comparison with 474 in the year 1930. The decrease is accounted for by the lesser number of notifications received of the following diseases: — Smallpox 3 in comparison with 14 in 1930. Diphtheria 69 „ „ 80 ,, Scarlet Fever 57 ,, ,, 90 ,, Erysipelas 17 ,, ,, 29 ,, Rheumatism 6 ,, ,, 13 ,, *Chicken-pox 0 ,, „ 60 ,, * Not notifiable in 1931. 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 287 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 84 Dysentery 12 Erysipelas 11 Typhoid Fever 4 Measles 10 Scarlet Fever 51 Tuberculosis '78 Whooping Cough 20 Pneumonia 2 Cerebro Spinal Fever 4 Acute Poliomyelitis 5 Encephalitis Lethargica 3 Mumps 1 287 Smallpox. This disease continued to be prevalent in London throughout the year 1931. Three notifications were received of cases occurring in Holborn residents during the year 1931. All three patients were removed to hospital. In two of 43 the three the diagnosis was not confirmed and the patients were returned to their homes. During the same period information was received of the occurence of this disease in four non-resident workers. The steps taken to prevent the spread of the disease were similar to those set out in the 1929 Annual Report as the routine procedure in smallpox cases. In the County of London 1,452 cases were notified, a notification rate of 033 per 1,000. Vaccination. The following table gives information respecting the vaccination of children born in the Borough during the year ended 30th June, 1931: — Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Postponed by Medical Ceitificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-District : 12 months ended 30th June, 1931 142 83 4 31 0 6 11 4 St. Giles and Bloomsbory Sub-District : 12 months ended 30th June, 1931 78 45 2 8 1 9 11 2 220 128 (58%) 6 42 1 15 22 6 During the same period 152 births were transferred to Holborn of children born in various institutions outside the Borough, Holborn being the district of the usual or last known home address of the mothers. Of the 152, at the date of the preparation of this report, 62 (41 per cent.) were known to be vaccinated. The remainder are accounted for as follows: — Removed from the Borough—no information as to vaccination 46 Conscientious objectors—Exempted 21 Died before vaccination 10 Not vaccinated 10 No information 3 44 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 baby or for the older person. Public Health (Smallpox Prevention) Regulations, 1917. Under the above Regulations 101 vaccinations were also performed during the year, viz. : (a) primary, 14 vaccinations; and (b) revaccinations 87. Information Supplied Through the London County Council. Following the arrangements operating in previous years, information of all cases of smallpox in the Greater1 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 1,452 cases in the County of London and 1,125 cases in extra-Metropolitan district was received. Diphtheria. We received notifications relating to 69 cases of diphtheria occurring in residents in the Borough; of these, four were sent in as being " carriers " of diphtheria bacilli. Sixty-eight were removed to hospital. The " carriers " were also removed to hospital. Age at Notification of 69 Notified Cases of Diphtheria. 0—1 1—5 5—15 15—25 25—45 45—65 Total 2 25 28 7 6 1 69 No death occurred. Fourteen of the notified cases were returned from hospital certified as not Suffering from diphtheria. 45 Secondary clinical cases were nine in number; details follow: — Primary Case Age Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises D. S. (Hospital Nurse) E. M. 20 10/1/1931 K. D. 18 14/1/1931 Hospital (nurse) 2 13/5/1931 W.M 3 30/5/1931 House let in lodgings B. M. 3 31/5/1931 ,, ,, W. S. Hospital ill-patient) 1 11/6/1931 J. S. 5 19/6/1931 Hospital (in-patient) V. L. 3 26/6/1931 ,, ,, B. B Hospital in-patient) C 9/6/1931 D. C. 3 13/6/1931 Hospital (in-patient) E. S. 42 18/6/1931 ,, ,, J. C. 7/12 18/6/1931 ,, ,, E. S. 2 3/7/1931 ,, ,, 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. In London, 8,384 cases were notified giving rise to 262 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 82 cases of diphtheria occurring among in-patients or staffs at two 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 60 notifications of which 58 were clinical cases (42 were notified "nasal") and one was notified as a " carrier." Of these 60 notifications three related to Holborn residents, being nurses at the hospital. Fifty-seven 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 are admitted. From a second hospital 22 cases were removed, 14 clinical (four nasal) and eight " carriers " only. Of the 22 cases notified, eight were Holborn residents (three nurses and five in-patients); the remaining 14 were in-patients admitted from outside the Holborn area. Diphtheria in Hospitals. Hospital. Cases Notified. Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 3 57 58 1 3 57 60 B. 3 19 14 8 8 14 22 46 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 ... ... ... 55 Negative at first examination ... ... 40 Positive at first examination ... ... ... 15 (27 "27 percent.) Virulence tests made ... ... ... ... 2 (negative) Analysis of the swab results relating to the contacts is given below: — Contacts swabbed. Poaitiv# Results. Contacts positive. Nose and Throat. Nose only. Throat only. First Examination 65 2 12 1 15* Second „ 13 — 2 — 2 Third „ 2 1 1 2«» * 2 positive contacts removed to L.C.C. Fever Hospital. ** Virulence test made in the case of these contacts—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 applicat:on by medical practitioners. In two cases doses were supplied of 8,000 units each, and in two cases doses of 500 units. 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 are 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. TABLE I. HOLBORN MUNICIPAL INFANT WELFARE CENTRE, 1922-1931. Summary of Wokk Done. Ages. 6 to 12 months 1 to? years 2 to 3 years 3 to 4 years 4 to 5 years 6 toS years 6 to 7 years 7 to 8 year^ 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 Adultq 15 and above years Total for lOyears, 1922-31 78 226 157 129 105 87 72 59 52 64 54 43 37 35 235 Total Schick Tested = 1440 Result of Schick Trst. so <2 hi 0> oi o 04 ti 4> 1 O Z 00 O CM tit SJ cu ti V ■s O b d 0 Yi «ri o Oh Not read m O 0- ti sc 1 0> L. 0 ; 0 fc \ P* ti 4) 55 to o ch fell v w £ ti o 55 0 01 ti fc 0 ch ti Q> 25 » £ to 0 fc co 0 cm ti fc to o p- to 0 oi o 0« to £ co o cu tio o 55 1 9 k 0 is Total for 10 years. 72 6 214 9 3 149 8 109 19 1 75 28 2 53 32 2 47 25 43 16 33 19 27 37 24 30 22 21 16 21 12 23 5 2 115 116 4 1016 Pos. 412 Neg. 12 Not read. Immunised without preliminary Schick test (Jan. 1927end of 1931). 6 5 112 57 29 25 5 2 2 0 1 0 0 1 Total immunised without preliminary Schick test 299 Total immunised (includes above). 124 283 173 118 83 50 57 45 26 25 19 20 13 7 2 72 Total immunised (includes above). 1117 TABLE II. HOLBORN MUNICIPAL INFANT WELFARE CENTRE. Schick Test and Diphthekia Immunisation. Ten years, 1922-31. A B C Result op Test. D E Immunisation of Positives. F G H l J Total number of individuals who attended clinic Total tested Total immunised without pre. liminary Schick test Positive. Nega- tive Not read. Found NEGATIVE to Ke Schick Test after Found NEGATIVE to Re Schick Test after First immunised with T A. F. and found NEGATIVE to Ke Schick after 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. Failed to complete 3 inoculatns. Inoculatns. not begun. Inoculatns still in progress. 1 com T.A.M. 2 ccm 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 doses of T.A.F. 3 ccm T.A.M. Given further inoculation but not yet retested. No further inoculation given. Children Adults C A 0 A C A 0 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 o: A C A o A 1 O A 1505 234 1206 234 299 0 9011 115 295 118 9 3 24 0 22 2 676 34 22 1 8 1 10 0 1 0 3 0 3 0 28 4 9 3 803 48 210 15 21 I 87 19 76 15 9 10 1,739 1,440 299 1,015 413 12 24 24 710 23 9 10 1 3 3 32 12 851 ft 225 § 22 106 f 91 t 19 1,314 * These columns refer to 93 cases—82 were Schick positive on retesting after 3 ccm T.A.M. 11 were Schick positive on retesting after T.A.F. ‡81 of these removed from the Borough. § 25 of these have removed from the Borough, ‡‡These retests include those made up to 31st January, 1332. NotE.—Columns E F G H give details of the total 851 given in Column I, Columns I J give details of the total 1,214 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, hut proceed at once to tl.e immunisation. 49 The following table gives particulars of the nine cases of diphtheria:— TABLE III. 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 Diphtheria Interval between last injection and date of onset of disease Confirmation of diagnosis by Character of Attack 1. A.C. 44/12 M. Artizan— moderately satisfactory; house let in lodgings 30/1/24 7/2/24 20/2/24 (Third) none — 18/3/25 13 months Metropolitan Asylums Board (N.E. Hospital) Very severe 2. G.L. 63/12 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. 33/12 F. Higher Artiznn— 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. 63/12 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. 13/12 F. Artizan— model dwellings 5/9/23 12/9/23 26/9/23 (Third) none — 26/10/27 4 years Metropolitan Asylums Board (N.E. Hospital) Mild 7. J.F. 110/12 F. Higher Artizan— model dwellings 13/5/25 20/5/25 10/6/25 (Third) yes negative 11/11/25 19/2/28 29/12 years Metropolitan Asylums Board (N.E. Hospital) Mild 8. V.C. 33/12 F. Poor, one room; house let in lodgings 9/4/24 30/4/24 18/6/24 (Third) yes negative 12/9/24 21/2/28 38/12 years Metropolitan Asylums Board (N.E. Hospital) Mildattack of n.asal diphtheria 9. W..T. 3 3/12 F. Fair, two rooms; house lot in lodgings 12/1/27 19/1/27 9/3/27 (Third) yes negative 19/10/27 15/4/29 21/12 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. 50 Diphtheria in Children Treated with Immunising Injections. Up to the end of the year 1931 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 III. Diphtheria was also notified as having ocourrcd in ten other children who had completed their course of inoculation, but the diagnosis in these cares was eventually not confirmed. Two of these (brother and sister) were removed to hospital 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; ono case after his return from hospital gave a negative reaction to the re-Schick test. Tho ninth waa notified as suffering from scarlet fever and diphtheria, but was later diagnosed as suffering from scarlet fever only; the tenth, also removed to licspital with diphtheria was returned as a case of catarrhal sore throat and not diphtheria. Immunisation of Nursing Staff at the London Homoeopathic Hospital. The arrangements made in June, 1930, with the authorities of the London Homoeopathic Hospital for the Medical Officer of the Council's Immunisation Clinic to Schick test and immunise the nursing staff was continued during 1931. At this hospital Schick testing of all newcomers and immunisation of positives is now compulsory. From June, 1930, till the end of December, 1931, 91 nurses were tested, 40 of these were tested for the first time in 1931, 28 of these were positive (all of these were immunised) and 12 were negative. Less Diphtheria in Holborn than in London. The following table shows the diphtheria notification rates in England and Wales, London, and Holborn during the nine years 1922-30. 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 1930 1.84 3.03 2.08 The figures for England and Wales and London are taken from the Registrar-General's Statistical Reviews for the years 1922-30. 51 Scarlet Fever. There were 57 notifications of scarlet fever. All but two were removed to hospital. Three cases were returned as not suffering from scarlet fever; one was found to be suffering from measles, one erythema and one was diagnosed as " common cold." One notification of a "secondary" case was received. From three hospitals in the Borough 36 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. 12,025 cases of scarlet fever were notified in London with 71 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. 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. Fifteen cases were notified in 1931. As regards the source of information relating to the total number of notifications from 1929 to 1931, seven were notified by doctors in private practice, seven were notified by an Assistant School Medical Officer, 17 were notified by doctors in institutional practice, 13 were notified by the Medical Officer of the Rheumatism Supervisory Clinic, and 38 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 68 cases reported by parents to the Health Visitors, the diagnosis of rheumatism was confirmed in 26. The total notifications received up to the end of 1931 are classified as:— Rheumatic tendency 3 Sub-acute rheumatism ... 38 Acute rheumatism 29 Post-rheumatic ... 12 82 P 2 52 Age and Sex Distribution of notified cases. Sex Age in years. M. F. Total. 3 1 — 1 4 3 2 5 5 1 2 3 6 2 3 5 7 3 6 9 8 5 5 10 9 5 10 15 10 3 4 7 11 — 3 3 12 2 8 10 13 2 2 4 14 — 5 5 15 2 3 5 Totals 29 53 82 Particulars of cases of acute rheumatism in children are recorded in a register under the following main headings:—Name; Classification and Symptoms; Tonsils, Adenoids and Teeth; Treatment; Home Conditions; Sleeping Conditions; Hours of Sleep; Clothing; Food; Assistance Required; Family History; and Health of Contacts. 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. A similar clinic also attended by Holborn children is held at the Royal Free Hospital on Thursday of each week at 1.30 p.m., and is available for children up to school leaving age. The presence of rheumatism is by no means always easy to determine: in ths 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, during which time the child attends regularly at the Clinic. At the Clinics 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 above Clinics 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 Homes, where the child resides for 6-9 months, 53 Enquiries in Notified Cases of Rheumatism. Enquiries into the housing conditions of the notified cases showed that 28 lived in satisfactory artisan self-contained fiats; 19 lived in satisfactory artisan homes in divided houses of a comfortable type (a better class of house let in lodgings); 28 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; and two were not; traced as a result of incorrect addresses, ix of these children have removed from the Borough. It is somewhat curious to note the incidence of acute rheumatism in satisfactory homes. 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 wc"ll 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 three 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—79 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 a.nd Children 1 2 3 1 2 3 1 1 2 3 5 1 2 3 1 2 3 1 2 1 3 79 6 • 5 4 5 0 10 5 0 1 2 4 1 6 0 0 21 5 0 1 1 1 1 79 6 5 32 34 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 rcom; thirty-two had a separate bed in a shared room; thirty-four shared a bed, seven of these with more than one person; seven ohildren 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 earlyisli hour in the morning. In some instances where the 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. Social Conditions. Five children live in one-room homes. In eight homes there is a history of chronic poverty, but without acute distress; in one of these the mother has been many years widowed; 54 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 are living on widows' pensions. 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 thirty-four children the condition of the tonsils was normal. Thirty-five children had their tonsils removed, fifteen 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 thirty-five children referred to above, in ten oases the removal of the tonsils ooincided 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 fifteen 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 nine others the children were found to have had tonsils removed as part of treatment for rheumatism. Teeth. In five children dental caries was still present: in five others extractions had been made as part of the treatment for rheumatism. Heredity. As a result of enquiries of parents it was found that there was a family history of varying degrees of rheumatism in 32 families. In fourteen of these the mother was reported to have suffered, in seven the father, in two both parents; in nine cases there was a more or less definite history of rheumatism in other relations. Contacts. Fifteen 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. During 1931 six patients have ceased to attend school and are occupied as follows;— (1) Girl (P. M., set 15) is an embroidercss. (2) Girl (G. A., set' 14) is a needlewoman. (3) Girl (I. A., set' 14) is a needlewoman. (4) Boy (R. B., set 14) is a shop assistant. (5) Girl (V. B., set 14) is a cracker maker. (6) Boy (E. C., Bet 14) is a goods stamper. Five children (R. O., M. C., G. H., G. M., and R. P.), reached the age of 16 during 1930 and still continue in their previous employment. Obviously the nature of employment to be followed by any child who has suffered from rheumatism requires careful consideration from all concerned. 55 Typhoid Fever and Paratyphoid Fever. Four cases were notified during the year with no death. In London 186 cases were notified giving rise to 24 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. L.D.M. 16 F. Dressmaking 25th Feb.. 1931 Typhoid Fever Agglutination test Typhoid Fever Italian Hospital Yes No information A.F. 22 F. Waitress 7th June ,, Typhoid Fever Agglutination test Paratyphoid B L.C.C. (N.W.) Hospital Yes No information E.W. 25 F. Housemaid 3rd Sept. ,, Paratyphoid B Agglutination test Paratyphoid B St. Thomas's Hospital Yes No information F.H. 18 M. Engineer 29 th Sept. „ Paratyphoid B Agglutination test Typhoid Fever L.C.C. (N.W.) Hospital No Visitor from provincial town 56 Typhus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-Spinal Fever. Four cases of cerebro-spinal fever were notified in the Borough. One hundred and seventy-five cases were notified in London, giving rise to 131 deaths. Bacillary Dysentery. Two cases of bacillary dysentery occurred. One was a child age seven years, a resident of Holborn, who at the date of notification was an in-patient in a hospital to which he had been admitted for treatment for injuries resulting from a motor accident. The other was a nurse at a hospital. Malaria. No case of malaria was notified. Encephalitis Lethargica. No case of encephalitis lethargica was notified in the Borough during the year. The following table gives information up to the end of 1931 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 WAV 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. (Was an in-patient for 3 weeks) 29/5/26 H.P. M 33 years Disease fatal 30/5/26 22/7/29 C.M. M 47 years Returned to West Indiea; no 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.. 57 In February, 1928, 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 cases 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 particulars of these inses:— Date of Onset. Patient. Sex Date of Birth. Where Treated. Condition at end of 1030. 1/9/20 P.L. F 1904 St. Bartholomew's Hospital In Archway Hospital—is kept in bed and seems worse. 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.). Nov., 1924 K.M. F 1911 London Homoeopathic Hospital— in-patient Removed from Holborn. Acute Poliomyelitis and Acute Polioencephalitis. One case of acute poliomyelitis or polioencephalitis was notified. Fifty-one cases were notified in London, giving rise to four deaths. From the coming into operation of the Poliomyelitis Order, 1912 to the end of 1931, 16 cases were notified in the Borough. The following table gives particulars of these cases with the condition at the end of 1931 Date of Not ification. Patient. Sex Age at Rate of Notification. Where Treated. Subsequent History. 17/7/13 F.D. M 13/12 years Hospital Died from diphtheria. 23/10/13 F.H. F 2 „ „ Wears specially made shoes. Health satisfactory. 26/1/16 A.C. F 4 „ „ Died 26/1/16. 27/1/16 T.B. M 4 „ „ Working—keeping well has slight limp only. 5/9/16 F.B. M 2 months „ Died. 6/6/20 I. P. F 31/2 years „ Recovered—no crippling. 23/7/20 E.W. M 15 „ „ No use of lower limbs. Does occasional clerical work. 17/9/20 E H. F 13/12 „ „ Recovered—no crippling, "thinness" of leg only. Health satisfactory- 4/9/22 Y.R F 116/12 „ Home Died in Paris. 5/2/23 J.N. M 31/2 „ Hospital Recovered—no crippling. 58 Date of Notification. Patient. Sex. Age at date of Notification. Where Treated. Subsequent History. 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 111/12 „ „ O.P. In-patient Queen Mary's Hospital—improving. 14/9/31 P.C. M 3/12 „ Hospital Died 18/9/31. The table excludes one case notified 4/12/18 who was subsequently found not to be suffering from this disease. Pneumonia. Forty cases of pneumonia were notified during the year. Nine of these were influenzal pneumonia. Thirty-eight deaths were recorded from all forms of pneumonia. The 31 cases of primary pneumonia were notified at the following ages:—Under 1 year, 2; from 1, to 5 years, 6; from 5 to 15 years, 1; from 15 to 25 years, 1; from 25 to 45 years, 7; from 45 to 65 years, 9; and 65 years and upwards, 5. Ten were treated at home; 12 were removed to L.O.C. hospitals; and 8 to voluntary hospitals. In one case the patient was not known at the address given. Twelve of the patients were nursed by the Metropolitan Nursing Association under the arrangements made by the Council, in all 198 visits being paid to these patients. Enquiry respecting the cases of primary pneumonia elicited the following information:— 13 resided in tenement lodging houses, 10 in separate private dwelling houses or model dwellings, and 3 in common lodging houses, 2 in boarding houses, and 2 in caretakers' apartments on business premises. The cleanliness of the houses was reported satisfactory in 20 cases, but only fairly so in 5; and in 1 case unsatisfactory. The economic conditions of the families concerned were found to be good in 2 cases, fair in 19, poor in 5; 5 out of the 10 cases treated at home were nursed in a separate room. In 4 cases information as to the economic condition was not obtainable. Influenza. There were 13 deaths from influenza in comparison with 1 in 1930, 44 in 1929, 3 in 1928, 20 in 1927, 8 in 1926, 9 in 1925, and 11 in 1924. The deaths were of seven males and six females. Of the 13 four were above 65 years of age. Anthrax. No case of anthrax was notified in the Borough during the year. 59 Chicken-pox. This disease is not notifiable, but during the year 1931 we received information of 84 cases. These were visited and where necessary kept under observation until the possibility of the case being one of smallpox had passed. Mumps. Information was received from school teachers and others of 16 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year:— Diphtheria Pulmonary Tuberculosis Number Submitted Result of Examination Number Submitted Result of Examination 353 Bacilli not found 315 76 Bacilli not found 65 Diphtheria Vincents organisms found 14 Bacilli found 11 Disinfections. During the year 430 rooms and 4,254 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Thirty-two rooms and 212 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. Fifty-two books and 38 toys were disinfected; also two boxes of addressed envelopes and an attach case. The disinfections also included three lockers, two hospital wards, and one L.C.C. ambulance. Cleansing of Persons Act. During the year 467 persons (443 men and 24 women) infested with vermin had their bodies and 3,118 articles of clothing disinfested, free of charge, at our cleansing station (Goldsmith Street). 60 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 the disinfection of their homes after infectious disease. In the year 1931 the accommodation was used by six Holborn families comprising 27 persons. 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 1931 information was received of 17 children suffering from scabies. Seven homes were affected. All were visited and kept under observation, disinfection of bedding, clothing and rooms being carried out on recovery of the patients. In one case on inspection of the home it was found that the father, mother and brother of the patient were also suffering. In another a family of six children and the mother all were suffering. All these patients were receiving treatment either at hospitals or by private doctors. In all cases disinfections were carried out, and no recurrence of the disease was brought to our notice. Extermination of Vermin. With a view to encouraging active 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. 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 gallons of the solution in small quantities were sold to 35 purchasers. 61 One hundred and seventy-eight verminous rooms were disinfested by the Council's staff. 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 93 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 1931 in the form required by the Ministry of Health:— Age periods. New Cases. Death Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 — — — — — — — — 1 — — — 1 — — — 5 2 1 2 — — 1 — 1 10 1 — — 1 — — — — 15 2 5 1 — 1 1 3 1 20 9 2 1 — — — — — 25 16 5 — 1 4 — — — 35 8 5 — — 2 1 — — 4 9 2 — — 6 4 — — 65 8 1 — — 7 3 — — 65 3 1 — 1 2 1 — 1 58 22 4 4 21 11 3 3 62 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, 1931 343 Number of these patients residing in common lodging houses 44 The average number of cases notified annually during the past ten years 90 The number notified in the year 1931 88 Of the 89 cases notified in 1931, the number who attended the Dispensary 33 Total number of new cases examined at the Dispensary for the first time in 1931, included the above 33, and all contacts 111 Total attendances at the Dispensary in 1931 901 Supervision of home conditions; visits paid by— Tuberculosis Officer 39 Dispensary Nurse 1,189 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 area 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. 63 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1932, in the Metropolitan Borough of Holborn. Formal Notification Age-periods. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 65- 65- Total (all ages). Pulm mary Males — — 2 — 2 — 12 0 6 5 2 41 58 ,, Females — - 1 — 3 2 5 4 1 — — 16 22 Non-pulmonary Males — — 3 — 1 I — — — — — 5 6 ,, Females — — — — — — 1 — — — — 1 1 Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age-periods. 0— l— 6- 10— 16— 20— 25— 35- 45- 55— 65— Total. Pulmonary Males — — — — — — 4 2 3 3 1 13 ,, Females — — — — 2 — — 1 1 1 1 6 Non-pulmonary Males — — — — — — — — — — — — „ Females — 1 — 1 — — — — — — 1 3 64 The source or sources from which inf6rmation as to the above-mentioned cases was obtained are stated below:— Source of Information No. of Cases. Pulmonary Non -Pulmonary Death Returns From local Registers 5 1 Transferable deaths from Registrar General 2 — Posthumous notifications 1 1 " Transfers " from other areas (other than transferable deaths) 11 1 Other Sources if any (specify) — — Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1931, on the Registers of Notifications 182 97 279 39 23 64 343 Number of eases removed from the Registers during the year by reason inter alia of:— Withdrawal of notification — — — — — — — Recovery from the disease 2 5 7 — — — 7 Death 24 13 37 1 1 2 39 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1931 was 66; 22 other cases were brought to my knowledge (making 88 new cases in the year). These were:—Private cases 13, hospital cases 35, Public Assistance cases 18, from death returns 8, transfer from other districts 12, and 2 were posthumous notifications. Of the 88 cases entered on the Register in 1931, 80 were pulmonary tuberculosis and eight non-pulmonary tuberculosis. Fifty-six of the cases were removed for treatment to hospital, or sanatorium. Sleeping Conditions. In 65 of the 88 new cases of tuberculosis in 1931 it was possible to obtain information as to the sleeping conditions at the date of notification. Fifteen of the remaining cases were residents in common lodging houses; in eight cases incorrect addresses were given, or the patients no longer resided in the Borough. 65 The following is a summary of the information in the 60 cases above referred to:— Patient slept in— Separate bed room 25 Separate bed in living room 8 Separate bed in room shared with— 1 adult 4 2 adults 2 3 adults 2 1 child 1 Shared bed with— No others in room 1 adult (Husband or Wife) 7 1 adult (not Husband or Wife) 7 1 child 1 Shared bed with— Other persons in bedroom 1 adult 2 children 1 1 adult 1 child 1 1 adult 1 adult 1 1 adult 1 adult, 1 child 3 1 child 2 children 1 1 child 2 adults 1 65 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 12 " 13."—Fair. Separate bed, but not separate bedroom 42 "C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 9 63 Summary. The following summary gives the position at the end of 1931 of the 88 new cases respecting which information was received during the year:— Dead 21 Cases removed to Nursing home, Hospital or Infirmary and still in-patients at the end of year 13 In-patients in Sanatoria at end of year 14 Removed from Borough 15 Home Treatment—Private or Panel Doctor 15 Away in country 2 No information 8 83 E 66 Non-attendance at Tuberculosis Dispensary. Thirty-three of the 88 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 18 Dead before notification or died before attendance at Dispensary 20 Treatment at home by private doctor 2 Not traced and common lodging house cases 2 Removed from Borough 13 55 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 tho patient or shortly before death takes place. In the past year two cases were notified only at death, seven within one month of death, three within three months and one within six months of death. By tho 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 83 admissions to institutions. These admissions represent 66 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 45 Institutions of the London County Council 16 Other institutions 22 Visits to Homes, etc. During 1931 the Tuberculosis Officer made 39 visits to the homes of patients. The general visitation of the patients and supervision of home conditions is carried out by the Tuberculosis Nurse who made 1,189 visits, 67 Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. Forty-one contacts, viz., 20 adults and 21 children under fifteen years of age, responded to this invitation and were examined for the first time during the year 1931. Of these, four adults were found to be definitely suffering from tuberculosis. Thirty-six were definitely diagnosed as not suffering from the disease. In one the diagnosis was not completed at the end of the year. 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 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 104 perl thousand the same rate as in 1929. There were also three deaths from other forms of tuberculosis, a rate of 0.08 per thousand. Tho following table shows whether the patients died in their own homes or institutions:— Showing (he number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions. All Agea • 0- 1- 5 10- 15- 20_ 25- 35- 45- 55- 65- Males. Females Total. Number of patients who died at home — — — — — 1 2 1 1 2 — 4 3 7 Number of patients who died in hospitals, etc. — 1 — l 3 2 2 2 8 8 4 20 11 31 — 1 — 1 3 3 4 8 9 10 4 24 14 38 E 2 68 Tuberculosis Dispensary. The following is the Repcrt of the Tuberculosis Officer, J. A. Struthers, M.D.,B.Ch., M.R.C.P., D.P.H.. for the year 1931:— Return showing the work of the Dispensary during the year 1931. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 25 13 2 1 3 2 1 1 28 15 3 2 (6) Doubtfully tuberculous — — — — — — — - — — — (c) Non-tuberculous — — — — — — — — 7 7 0 3 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 1 — — 1 — — — 3 1 — — (6) Doubtfully tuberculous — — — — — — — — 1 — — — (c) Non-tuberculous — — — — — — — — 5 10 11 10 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) — — — — — — — — 12 17 16 13 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 95 68 7 4 13 15 14 7 108 83 21 11 (b) Diagnosis not completed — — — —- — — — — 1 — — — 69 1. Number of persons on Dispensary Register on January 1st, 1931 200 2. Number of patients transferred from other areas and of "lost sight of" cases returned 10 3. Number of patients transferred to other areas cases not desiring further assistance under the schema and cases "lost sight of" 20 4. Died during the year 13 5. Number of attendances at the Dispensary (including contacts) 901 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 49 7. N umber of consultations with medical practitioners:— (a) Personal 13 (b) Otherwise 53 8. Number of other visits by Tuberculosis Officers to Homes 39 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1189 10. Number of (a) Specimens of sputum, &c., examined 148 (b) X-ray examinations made in connection with Dispensary work 18 11. Number of "Recovered" Cases restored to Dispensary Register in A (a) and A (b) on page 68) 0 12. Number of " T.B. plus" cases onDispensary Register 31st December, 1931115 70 71 Pulmonary Tuberculosis Supplementary Annual Return showing in summary Form (a) the condition at the end of 1931 all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the Patients (?) entered on the Dispensary Register as definite cases of Pulmonary Tuberculosis and their classification at that time. 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. 1931. 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. 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). Group 1. Group 2. Group 3. Total (Class T.B. plus). (a) Remaining on Dispensary Register on 31st December Disease arrested. Adults M. 2 1 1 1 1 - - - - - - - - - - - - - - F. 3 8 8 1 2 - - - - - - - - - - - - - - - Children 1 - - - - - - - - - - - - - - Disease not arrested. Adults M. 10 6 1 17 1 1 4 1 1 5 5 1 6 5 3 2 3 8 6 8 5 13 7 4 13 17 F. 9 6 2 17 4 1 1 2 4 1 1 6 4 2 4 6 3 4 6 10 Children 1 1 1 1 1 1 2 1 1 3 Condition not ascertained during the year. 1 Total on Dispensary Register at 31st December. 6 29 12 3 44 3 2 2 11 1 1 9 6 1 7 7 7 4 4 15 10 10 9 19 13 8 19 27 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults M. 11 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - F. 14 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - Children 3 - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register. 35 27 18 5 50 8 5 4 2 11 4 1 6 1 8 5 3 1 9 3 1 1 2 4 2 1 3 1 5 1 3 4 Dead. Adults M. 2 3 5 7 15 1 5 6 5 10 3 19 4 5 1 1 4 3 8 1 4 2 7 1 1 F. 3 4 2 6 1 4 5 1 1 2 2 2 4 1 4 5 1 1 1 3 Children 1 1 1 Total written off Dispensary Register. 68 34 27 75 9 7 13 2 22 9 12 5 6 23 8 11 10 1 22 3 3 9 5 17 2 3 8 5 16 4 5 Grand Totals 74 63 39 17 119 12 9 13 2 24 20 12 6 6 21 17 17 11 1 29 10 10 13 9 32 12 13 17 5 35 13 9 23 32 72 73 Non-Pulmonary Tuberculosis Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written on the .Register. 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. 1931. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Boned and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones 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. Bones and Joints. Abdominal. Other Organs. Peripheral Glands Total. a) Remaining on Dispenary Register on 31st December. Disease arrested. Adults M. 1 1 1 1 F. 1 1 Children 2 2 2 2 1 1 Disease not arrested. Adults M. 1 1 2 1 1 .) 1 1 2 2 2 2 1 3 F. 3 2 1 1 7 1 1 1 1 2 1 1 1 1 1 1 2 Children 1 1 1 1 1 2 1 3 4 2 1 1 4 2 2 condition not ascertained during the vear. Total on Dispensary Regi ster at 31st Decsmber. 6 2 3 3 14 1 2 1 2 1 1 2 3 2 2 7 2 3 5 1 2 1 7 2 1 4 7 Transferred to Pulmunary (6) Not now on Dispensary Register and reasons for removal theretiom. Discharged as recovered. Adults M. 1 1 — — — — — — — — — — — — — — — F. 1 1 — — — — — — — — — — — — — — — Children 1 1 1 1 4 — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register. 8 4 4 8 21 1 1 3 5 1 2 2 1 3 1 2 1 i 5 1 1 1 1 Dead. : Adults M. 1 1 F. 2 2 Children 1 1 1 1 I 1 Total written off Dispensary Register. 11 7 5 9 32 3 1 4 8 1 2 J 2 1 3 1 2 2 1 6 1 1 1 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 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 2 2 4 8 74 During the year 70 new cases were examined, and of these, 48 were found to be tuberculous. The numbers of contacts were smaller than in the previous year as it so happened that very few of the original cases had any relatives, or, if there were any relatives, they were living at a distance; many of them, for instance, were single men or widowers living in common lodging houses. Of the 41 contacts who were examined, however, four, or 10 per cent., were found to be tuberculous, thus again proving the value of this side of the work. If these last-mentioned numbers be added to those given in last year's report it will be seen that in eight years the examination of 556 contacts has resulted in the discovery of 24 new cases, just over 4 per cent. The number of deaths was 13 as compared with 14 in the previous year, and they were all due to tuberculosis. Six patients were removed from the register as being cured. As in previous years the local medical practitioners have continued to make good use of the dispensary, and there have been frequent occasions for referring patients from the dispensary to University College Hospital. Once again it is a pleasure to record the valuable help received in many ways from the members of the Tuberculosis Care Committee, both as a body and individually. One feature of the modes of. onset this year has again been that several have started with haemoptysis; this onset is a rather terrifying one for the patient, but it is in some ways a blessing in disguise, in that it calls his attention to his trouble at once and induces him to seek advice and undergo treatment, whereas otherwise he might be inclined to delay matters and, by persuading himself that he "only had a cold" or was "run down " to put off the attempt to secure treatment until the disease had a firm hold on him. Report of the Tuberculosis Care Committee for 1931. The Committee has met 11 times during the year. The average attendance of members at each meeting has been 8.9. Fifty-two cases have been considered—27 new (23 adults and four children) and 25 old cases (22 adults and three children). Twenty-four cases—20 adults and four children—were referred to the Committee for assessment. Two of these refused to go away for treatment and were not considered. Twelve adults and two children were recommended for free treatment. Eight adults and two children were assessed to pay contributions varying from two shillings to thirty shillings per week towards the cost of their treatment and maintenance. In six instances assessments were re-considered on account of changes in circumstances. Contributions towards the cost of treatment and maintenance amounting to £171. 10s. Od. were collected on behalf of the London County Council in 20 cases— 14 adults and six children. Ten of these were still under treatment at the close of the year. One case was referred to the Council's Official Collector on account of non-payment of contributions, and in one case arrears were cancelled as irrecoverable. 75 Thirteen progress reports, on six children, were received from the London County Council, and the information contained therein conveyed to the parents. During the year 648 visits have been paid to patients or their families, in addition to many other visits 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 Bed Cross Emergency Help Fund, the Charity Organisation Society, and the Invalid Children's Aid Association. Convalescence has been arranged in 14 cases; five were sent away through the Invalid Children's Aid Association, four through Stafford's Charity, two through the United Services Fund, two through Convalescent Home letters, and one through the Public Assistance Committee. In addition, two children were sent away through the London County Council's Contact Scheme. Twenty patients known to the Committee have removed from the district during the year, and 12 have died. Of the latter, two died at home, one in a voluntary hospital, one in a London County Council institution, five in London County Council general hospitals, and three in Homes for the Dying. 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. It was not necessary during the year 1931 for any tuberculous patient to be nursed under the arrangements made by the Council with the Metropolitan District Nursing Association. 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. Extractions with general anaesthetic were made in one case. One denture was provided. The Clinic is held by the British Dental Hospital at the Council's Maternity Centre, 10, John Street, on Tuesday evenings. General Dental Clinic. By arrangement with the British Dental 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. 76 The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1931:— Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1931. Number of sessions held 49 Number of patients' attendances 319 Number of iillings 73 Number of scalings 10 Without anaesthetic 2 Number otf With local anaesthetic 32 extraction cases With gas 25 Number of teeth extracted 184 Number of dentures (including repairs) 25 Number of dressings 45 Number for advice 45 Number of denture visits 57 Number of new patients 82 Cancer. During the year 1931, 79 deaths were recorded as due to Cancer in comparison with 69 in the previous year. The deaths in 1931 were equal to a rate of 2.29 per thousand, the corresponding rate in 1930 being 1.79 per thousand. In the year 1911 the death rate from Cancer in the Borough was 1.10, the decennial average rate was 1-29 for the ten years, 1911-1920, and 1.47 for the ten years, 1921-1930. It will be seen that the death rate from Cancer in the Borough in 1931 was higher than in the previous year, being 2.29 per thousand in comparison with 1.79 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, 1911-1920 was 1.29, the corresponding rate for the ten years, 1921-1930, was 1.47. Some part of this increase may reasonably be attributed to improved facilities for diagnosis. The figures indicate the high mortality from malignant diseases. The Foundling Hospital Site. The establishment of a day nursery and a play centre for children at the Foundling Hospital Site has been referred to in previous Annual Reports. These activities were maintained during 1931. The most recent information available at the date of preparation of this report is that the Appeal Council have successfully negotiated a contract for the purchase of a space equal in area to one quarter of the site, and adjoining two portions previously purchased by Lord Rothermere. The whole of this is to be administered by the same committee. In area it is equal to five-eighths of the whole site. 77 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 211 births were registered as occurring in the Borough. During the same period 194 notifications of births occurring in the Borough were received. Of these, 176 were from doctors and midwives, 18 from parents. The mothers were attended at their confinement by: — Private Doctors 26 Private Midwives 37 Out-patient Midwifery Departments of General Hospitals and Institutions: — Externs and others 49 Midwives.—University College Hospital 21 Middlesex Hospital16 Other Institutions 15 Training Institution for Midwives, Myddelton Square 30 194 Ten of these notifications related to stillbirths. Number of Births. The number of births transferred to the Borough from outlying institutions was 156 The number of births transferred from the Borough to other districts was 15 The net number of births belonging to the Borough was 352 There are no maternity hospitals or public lying-in institutions in the Borough but maternity cases arc admitted to a nursing homo in the area. Births in Crowded Homes. The following table is an indication of the home conditions of 333 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 33 9.4 52 14.8 Two „ „ 93 26.4 65 18.5 Three ,, ,, 40 11.4 24 6.8 Four „ „ 14 4.0 12 84 Total 180 51.2 153 48.5 These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances. 78 Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 208 214 422 Post-natal Mothers 10 1 11 Children under 1 year of age 397 888 1,285 Children 1 to 2 years of age 19 421 440 Children over 2 years of age 42 1,007 1,049 Enquiries re stillbirths 16 „ re ophthalmia neonatorum 11 Other visits 247 hree hundred and seventy-five visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 234 were recorded as attending a Centre, i.e., 62-4 per cent. Thus nearly three-fifths of those visited attended an Infant Welfare Centre and of these nearly 81 per cent, attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following :— 156 attended the Council's M. & C. W. Centre at 10, John Street. 31 „ „ „ „ Short's Gardens. 4 attended the Centre at Onslow Street School, Saffron Hill. 7 „ „ Charing Cross Hospital. 9 ,, ,, Myddelton Square. 14 „ „ Middlesex Hospital. 4 „ „ University College Hospital. 6 ,, ,, Royal Free Hospital. 3 „ ,, other Centres. 234 attended an Infant Welfare Centre. Work at Centres. Hol,born Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre: Monday. Tuesday. Wednesday. Thursday. Friday. Medical Consultation Pre-school child 2—4.30 p.m. Medical Confutation 2—4.30p.m. Ante natal and Postnatal cases 2—4.30 p.m. Medical Consultation 2—4.30 p.m. Class 3—4 p.m. Dentist, 2—4 p.m. Medical Co: sultation 2—4.30 p.m. No. of Sessions 35 52 53 43 50 60 Totul attendances- Children 500 122 ... 1691 ... 113 1302 Mothers 47 50 250 275 281 2.6 238 Aycrape weekly attendances— children 14 2 33 ... 2 25 Mothers 1 1 5 6 7 4 5 79 St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year 1931, were as follows: — Monday* 2—4.30 p.m Thursday Medical Consultation 2—4.30 p.m. Class. Children weighed. No. of Sessions 36 36 03 Total attendances — Children — 81 470 Mothers 98 67 Expectant Mothers 2 24 Average weekly attendances— Children 2 9 Mothers 3 — 3 The total number of attendances made by the Health Visitors at the Municipal Centres in 1931 was 474, and in addition Health Visitor students made 240 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 5,085 attendances were made by 226 mothers and 71 expectant mothers, and 518 children, of whom 224 were under one year, 100 between one and two years old, and 194 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 748 attendances were made by 55 mothers and 83 children, of whom 39 were under one year, 14 from one to two years and 30 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 1931 as compared with 81 in 1930. 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, and if not already in attendance at an ante-natal centre they were advised to attend. 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. Special records have been kept of the home conditions of 149 expectant mothers visited during 1931, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. * As from the 1st October, 1931, the Monday session at the Short's Gardens Branch Centre was discontinued, 80 Of the 71 who went into hospital:— 22 (12 primigravidæ) lived in a one-roomed home; 48 (26 primigravidæ) lived in a two or more roomed home. Of the 78 who remained at home: — 8 (1 primigravidæ) lived in a one-roomed home; 45 (4 primigravidæ) lived in two rooms; 25 lived in more commodious premises. 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. Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 416 times during the year 1931. 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 354 mothers, about whom information was obtained, 285 (80.5 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under: — Number of enquiries made 375 Centre Attended: — Holborn Centre, 10, John Street 33 Holborn Centre, Short's Gardens 4 Royal Free Hospital 27 Middlesex Hospital 24 Charing Cross Hospital 33 University College Hospital 36 Myddelton Square Institution 28 St. Bartholomew's Hospital 24 City of London Hospital 15 Queen Charlotte's Hospital 3 Elizabeth Garrett Anderson Hospital 7 Other Centres 13 Ante-natal care from private doctors 28 Ante-natal care from midwives 10 285 81 Nature of defects found at Municipal Centres. 10, John Street, Short's Gardens. Holborn. St. Giles. No. of women attending ante-natal clinics 71 9 Women expectant for the first time 9 No. of attendances made 157 23 Defects found specially connected with pregancy :— Deformed pelvis 6 - Threatened miscarriage 3 - Retroverted gravid uterus 2 Breech presentation Excessive vomiting 7 - (Edema 5 - Varicose veins 16 1 Excessive vaginal discharge 3 1 High blood pressure 1 - Other defects 4 - Other defects :— Heart disease 5 - Anaemia 8 - Respiratory diseases 6 - Constipation 21 3 Dental caries 25 3 Dyspepsia 12 1 Pyorrhoea 13 - Rheumatism 2 - Other defects 8 - No. referred to materuity hospitals: — Normal 13 - Abnormal 10 - No. referred to dental clinic 24 3 No. of urine tests made 111 8 Post-natal Consultations. Twenty-six mothers attended the post-natal consultations at the Centre, 10, John Street, 13 of whom had attended the Centre as ante-natal cases. They made 46 attendances in all. The chief defects found were three cases of retroverted uterus, (two referred to hospital); six of cervicitis (all treated at the Centre); three of monorrhagia (one referred to hospital); four cases of anæmia; one case of metritis (referred to hospital); one of oedema of the legs; one case of laceration of the cervix (referred to hospital); one of pruritus; one of subinvolution of the uterus. In five cases no abnormality due to pregnancy was found. 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. 82 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. Mrs. Haywood, Honorary Secretary of the Infants Welfare Guild, has also supplied us with knitted and sewn garments made by her workers. 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. Two hundred and fifty hanks of wool of a special quality were sold at cost price to the value of £13. 1s. 3d. The maternity bags were used during the year by two mothers. Maternity outfits are placed on sale at the Centre at cost price, 5s. 10d. 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. 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 1931: — Reasons for attendance. 10, John Street. Short's Gardens Mothers: — Difficulty with breast feeding 25 4 Disorders of generative organs 22 1 Venereal disease 3 — Heart disease 3 — Anæmia 13 2 Respiratory disease 11 1 Digestive disorders 14 — Debility 27 1 Dental caries 51 2 Rheumatism 11 1 Other Diseases 44 — Children :— (Healthy) 149 44 Alimentary disorders 45 13 Rickets 23 4 Heart disease 4 — Rheumatism 2 — Respiratory dieorders 60 8 Marasmus 7 1 Debility 8 1 Hernia, umbilical 13 1 Hernia, inguinal 1 — Phimosis 25 1 Disease of skin 25 3 Disease of eye 19 2 Disease of ear 13 — Disease of nose and throat 29 1 Dental caries 38 2 Other diseases 52 2 (In this table, if the patient has more than one ailment, only the more important has been recorded.) 83 Mothers and children attending the Municipal Centres during 1931 were referred to other departments or organisations as follows:— Mothers. Children. Ante-natal Clinic 7 — Tuberculosis Dispensary — — Minor Ailments Clinic 34 75 Dental Clinic 67 52 Metropolitan Nursing Association 4 3 Nursery School - 1 Massage Clinic 4 — Hospitals 7 47 Convalescent Homes 4 19 Assistance Sub-Committee (for milk) 31 32 Relieving Officer 1 — Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1931:- John Street. Short's Gardens. Number referred to Metropolitan Nursing Association 7 3 Results:— Breast secretion re-established, but small bottle feeds required in addition to breast feeding 3 2 Massage unsuccessful 4 1 Pre-school Children. Mothers are apt to think that when their babies are well on into their third year they no longer require medical supervision. The result has been that children from two to five years of age gradually develop defects which are not noticed by their parents, and when these defects are subsequently detected by the school doctor after admission to school valuable time has been lost. The Maternity and Child Welfare Committee in consequence determined to provide for the routine medical inspection of these children in Holborn. On Monday, April 13t>h, 1931, an additional session for them was started at No. 10, John Street. Much propaganda work amongst parents has been done, and will be necessary for a long while to come, to persuade parents of the need for attendance of a child at a clinic after the age of two; a separate session is useful as a means of emphasising the value of such attendance. Thirty-six sessions were held; 127 individual children, two to five years of age attended. The total attendances were 436 (190 two-three years, 138 three-four years, and 108 were four-five years). In addition to the above, 67 other children between the ages of two to five years attended the John Street Centre on Wednesdays or Fridays, and were seen at the clinics held on those days. At their first attendance 22 children were found to be cf normal weight and height for their respective ages, 55 were below, and 50 above normal. Those who were below standard have, in nearly every case, responded satisfactorily to the advice given at the clinic. 84 Forty-four children were suffering from dental caries and were referred to the dental clinic. Thirty-three had enlarged tonsils, nine enlarged tonsils and adenoids, and one with adenoids only. In 13 cases these were removed at hospital with subsequent improvement in the health of the children. Two cases of pharyngitis occurred. There were eight cases of enlarged cervical glands, seven of otorrhoea, and five of other ear conditions; three of external eye diseases, and one of strabismus which was referred to an ophthalmic hospital for glasses. Two cases of delayed talking are having educational treatment. Nine children suffered from enuresis and all have responded to advice. During the early winter months, 13 cases of malnutrition, four of nasal catarrh, and 19 of cough occurred, while one case of rheumatism was notified. There were four cases of nervous disorders including one after poliomyelitis, one with habit-spasm, and two who were referred to the Tavistock (Child Guidance) Clinic. Twentytwo children were treated for skin diseases, of which 15 were for lichen urticatus, three for eczema, and four for impetigo. Of the four cases of rickets, two had returned from Queen Mary's Hospital, Carshalton, and two are having artificial sunlight treatment. Two children with non-tuberculous lung disease were referred to hospital. All cases requiring constant medical supervision are advised to consult their own doctor or are sent to hospital. School Entrants. During the year information was received from the London County Council that 161 children living in Holborn had been entered as attending school for the first time. Particulars of the child's pre-school physical history and his record of attendance at an Infant Welfare Centre were forwarded to the head teacher of the infants department of the school concerned. This information is set out on a form supplied by the London County Council and is intended for the use of the School Medical Officer when examining school entrants. Notice of attendance at school has brought to our knowledge families hitherto unknown to us, having recently entered the Borough. This knowledge has been very useful in connection with Maternity and Child Welfare Work generally. Stillbirths. During 1931 fifteen stillbirths were registered, all of which were legitimate. In all I received information of 16 stillbirths; enquiry as to possible causes was made in each case. Three occurred in the private practice of doctors, four in the extern practice of an institution, and in nine instances the confinement took place in hospitals. Difficult labour was responsible for nine; in four, abnormal presentation occurred; in one thore was abnormality of the umbilical cord; in two there was abnormality of the foetus, both being abnormally large; in two no definite reason could be assigned. Toxaemia of pregnancy accounted for six. In one ante-partum haemorrhage was the most likely cause of stillbirth. 85 Illegitimate Children. The births of 44 illegitimate children were registered; one of these was above the standard for enquiry; eight lived with both their parents who had a permanent home together; two with their mothers who worked to support them; five with their mothers who remained in their parents' home; one was boarded out with a foster mother; one was placed in an institution; two died in early infancy; one was stillborn; 23 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 1931 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 38 43 81 Total attendances 216 113 329 Extractions- Ordinary — 2 2 With local anæsthetic 3 — 3 With general anæsthetic 37 31 68 Scaling 18 — 18 Fillings— Simple 41 36 77 Root 1 — 1 Dentures (including 2 repairs) 16 — 16 Advice 58 48 106 In three cases where the patients were very poor the dentures were provided free of charge; contributions towards the cost were required in five cases and in eight instances the patients were required to pay the whole cost. 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 250 applicants received free or assisted milk under the scheme. This number included 117 who were receiving such assistance at the end of 1930. Grants were made to 133 new applicants. 86 At the end of the year 1931, 103 applicants were receiving assistance, viz: Mothers. Children. Total Free milk 41 58 99 Half-price milk — 3 3 Prepared milk — 1 1 41 62 103 — — The following table shows in detail how the 133 new applicants were assisted in 1931:— Milk. Prepared Milk. Free. Part Cost. Free. Part Cost. Expectant mothers 26 1 — — Nursing mothers 24 1 — — Children 64 4 10 3 Home Help. The Council's Home Helps attended 26 cases during the year in comparison with 19 in the year 1930. In six of these the whole-time officer attended entirely and in 15 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 five cases 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 six 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 2s. 6d. 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. Convalescent Homes. Four mothers and their babies were sent away, two being also accompanied by a second child. In two cases the applicants were required to contribute towards the cost. These mothers with babies were admitted to convalescent homes belonging to the Church Army. 87 Nineteen applications were granted for convalescent home accommodation for children under five years of age, but in two cases the parents failed to take advantage of the facilities provided. Eight children were sent away 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, 1931, 175 infants and children under five attended the consultations, 52 of the total number coming from the Holborn Borough. The 175 children made 1,711 attendances. Extra food and nourishment was provided, also convalescent treatment at country and seaside Homes (40 mothers and 56 children); 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, 1931. Nine 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 3-4 4-5 M. F. M. F. M. F. M. F. M. F. Both Sexes Measles ... ... ... 1 ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... 1 ... ... ... 1 ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 1 Pneumonia 1 2 ... ... ... ... ... ... 1 2 3 Pneumococcal Meningitis 1 ... ... ... ... ... ... ... 1 ... 1 Peritonitis 1 ... ... ... ... ... ... ... 1 ... 1 Epileptic Convulsions ... 1 ... ... ... ... ... ... ... 1 1 Totals 3 3 ... 1 1 ... ... 1 1 5 9 Totals—Both Sexes 6 1 1 1 9 88 Deaths of Infants under One Year of Age, 1931 The homes were visited in a largo proportion of the infant deaths, and any requisite information obtained, and when required, suitable advice given. The causes of and age at death are given in the following Table:— Cause of Death Under 1 Week 1-2 Weeks 2-3 Week 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12Months Total under 1 Year M F M F M F M F M F Both sexes M F M F M F M F M F Both sexes Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 2 1 3 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 1 2 2 4 Diarrhæa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 2 Congenital Malformations 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 2 ... 2 Premature Births 2 3 1 ... ... ... ... ... 3 4 7 1 ... ... ... ... ... ... ... 4 4 8 Congenital Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... l Violence ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 l Other causes 2 ... ... ... ... ... ... ... 2 ... 2 1 ... ... ... ... ... 1 ... 4 ... 4 Totals 5 4 1 1 ... ... ... ... 6 5 11 5 ... 2 2 ... 1 4 1 17 9 26 Total both sexes 9 2 ... ... 11 5 4 1 5 26 Net births registered during the calendar year. Males Females Both sexes Legitimate Infants 158 150 308 Illegitimate Infante 23 21 44 Net deaths registered during the calendar year. Males Females Both sexes Legitimate Infants 14 8 22 Illegitimate Infants 3 1 4 89 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—Two Cases. 1 R. B. 26-2-31 Multipara Yes Home - Partial retention of membranes Recovered Patient removed to hospital 2 C. P. 1-5-31 Multipara - - Institution Incomplete abortion Recovered - PUERPERAL PYREXIA—Four Cases. 1 C. U. 17-2-31 Multipara Yes - Institution Influenzal bronchopneumonia Died, la. Pulmonary embolism. 1b. Parturition. 2. Influenzal broncho-pneumonia Stillbirth 2 E. S. 22-6-31 Primipara - - Institution No definite reasons could be assigned Recovered Stillbirth 3 E. R. 26-8-31 Primipara Yes - Institution Acute mastitis Recovered Full time pregnancy. Patient removed to hospital 4 B. P. 31-12-31 Multipara Yes Home - Partial retention of placenta Recovered Full-time pregnancy Patient removed to hospital 90 Ophthalmia Neonatorum. During the year 8 cases of ophthalmia neonatorum were brought to our notice, 7 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, 5 from the Medical Officers of hospitals, and 1 from the Medical Officer of a Dispensary. 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. Seven Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations, Birth Notified by. Extern Department, Hospital Extern Department, Hospital Extern Department, Hospital Extern Department, Hospital Doctor, Private Practice Extern Department, Hospital Extern Department, Hospital Result. Cured Child's sight apparentlyimpaired. Removed to country at5mths of age Cured Cured Cured Cured Cured Medical Attendance and Nursing. Doctor (Extern Practice) —Hospital and District Nurse Maternity Ward, Middlesex Hospital — later In-patient St. garet's Hospital Doctor (Dispensary) and District Nurse Maternity Ward, St. Paneras Hospital—later Inpatient St. Margaret's Hospital Doctor (Private Practice), later In-patient St. Marcaret's Hospital Doctor (Extern Practice) Hospital. Nurse (Extern Practice) Hospital Doctor (Extern Practice) Hospital and District Nurse Where Treated. At home In hospital At home In hospital At home— later in hospital At home At home Type of Disease on Health Visitor's first call. Moderate - Moderate - Moderate Very slight Might By whom Notified. Doctor (Hospital) Doctor (Hospital) Doctor (Dispensary) Doctor (Hospital) Doctor (Private Practice) Doctor (Hospital) Doctor (Hospital) Age at Onset. 6 days 7 days 10 days 6 days 3 days 3 days 9 days Age when Notified. 7 days 11 days 7 days 7 days 6 days 4 days 10 days Case Number. 1 3 4 5 6 7 8 One Case not Notified in accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Extern Department, Hospital Cured Maternity Wards, Chel- sea Institution Later, ln-patient St Margaret's Hospital In hospital - Source of Information: London County Council 12 days 13 days 3 91 Midwives Acts, 1902 and 1918. In connection with these Acts we received information from the Medical Officer of Health of the London County Council with regard to the eyes of three other infants, viz.:— B. Slight inflammation of eyes; subsequently cured. P.A. Slight inflammation of one eye; subsequently cured. D. Slight inflammation of eyes; subsequently cured. Whooping Cough. Visits were paid to 55 persons suffering from whooping cough. Of these, 44 were notified by doctors; in 5 others the information was derived from the schools; 2 from health visitors; 4 from the L.C.C. Age. Fourteen were children under 1 year, 31 were aged 1 to 5, and 10 were 5 to 16 years. Deaths. Three died; 2 were under 1 year, and 1 was 2 years old. Spread of Infection in Family. The 55 cases occurred in 44 families. In 36 families 1 case occurred; in 5 families 2 cases occurred, and in 3 families 3 cases occurred. Removal. Twenty-four children were removed to hospital, approximately 44 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. 92 The treatment of children suffering: with whooping cough in outpatient departments is viewed by many Medical Officers of Health with disfavour. Surely some, possibly many, of these children are still infectious. They travel to the hospitals in public vehicles : although admitted to canteens now provided by many hospitals, some 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 oneThe 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 24 children (44 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 1931 I received information of 66 cases of measles. Of these 15 were notified by school teachers and 37 by medical practitioners; information of 7 was given by hospital authorities, 4 by health visitors, 3 by parents. Age. Nine were under 1 year, 33 were between 1 and 5 years, 15 were between 5 and 16 years, and 9 were over 16. Deaths. One child died 2 years of age. Spread in Family. The 66 cases occurred in 50 families. In 41 families 1 case occurred, in 4 families 2 cases occurred, in 3 families 3 cases occurred, and in 2 families there were 4 cases. Removals. Forty-three patients (67 per cent.) were removed to hospital, 37 to L.C.C infectious diseases hospitals, and 6 to the London Fever Hospital. 93 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 7 oases; 2 were notified by doctors and information of 1 case was received from soliool, 3 from L.C.C., and 1 from a parent. Ages. 2 were between 1 and 5 years. 3 were between 5 and 16 years. 2 were over 16 years. Removals. Three cases were removed to the London Fever Hospital, and two to L.C.C. Hospitals. Epidemic Diarrhoea. The disease is notifiable in only a few districts in London, and is not notifiable in Holborn. The number of deaths of young children under two years of age classified under the head Diarrhoea and Enteritis was 3, all 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 1931: — Deficient Lactation 13 Cases 122 Visits. Complications after Pregnancy 6 „ 89 „ Ophthalmia Neonatorum 4 „ 390 „ Pneumonia 12 „ 198 „ Influenza 8 „ 47 ,, Tuberculosis - ,, Measles 5 „ 28 „ Chicken-pox 1 Case 13 „ Total 49 Cases 887 Visits. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week commencing Sunday, October 4th. The programme included the following : — Exhibition of Health Films. Health films were shown in the Court Room at the Town Hall. In addition to the evening shows special displays for school children were arranged in the 94 mornings and afternoons; lunch hour exhibitions were provided for non-resident workers. The following films were used: — " Prevention of Diphtheria," showing the Holborn Council's work in connection with diphtheria immunisation. " Bottled Health," a milk film lent by the Central Council for Health Education. " Don't Wait Till It Hurts," lent by the Dental Board of the United Kingdom. " Dirty Bertie " and " Cleanliness is Happiness," lent by the Health and Cleanliness Council. " Air and Sun," lent by the National Association for the Prevention of Tuberculosis. " Food, Digestion and Air," lent by the Food Education Society. " Public Health Twins " and " Third Party Risks," lent by the British Social Hygiene Council. " Through Life's Windows," lent by Messrs. Key Films, Ltd. Co-operation with the School Organisation. Arrangements were made for about 1,000 senior children from all the elementary schools in the Borough to visit the Town Hall to see ft selection of the films. Subsequently these children wrote essays on the lessons learnt from the pictures. The best three essays in each school department were selected by the Head Teachers for sending in to the Public Health Office for prize award; two prizes, one for boys and one for girls were assigned to each school. The Mayor and Mayoress (Councillor Percy Hill, J.P., L.C.C., and Mrs. Hill) kindly entertained to tea the prize winners and the children whose essays were selected from the various schools. We are much indebted to the teachers for their kind and invaluable co-operation. It is they who establish in the minds of the children a " health conscience." Health Poster Designs. Children in the elementary schools were again invited to enter a competition in the designing of health posters. Thirty-six designs were submitted from three schools. Two prizes were awarded, one going to St. John's School and one to St. Peter's. Arrangements were made for children from the various schools to see the posters at the Town Hall. Special Meeting for Mothers. On Thursday in Health Week instead of the usual class, Dr. Hyslop Thomson, Medical Officer of Health of the County of Hertfordshire, spoke on the " Care of the Child from Two to Five Years." 95 The Mayor presided, and the Mayoress kindly distributed certificates to the mothers of those children who had attended the Centre regularly since infancy, and who had recently attained the age of five years. A number of certificates were also distributed to those children who had recently been immunised against diphtheria. Minor Ailments. The Minor Ailments Clinic has been carried on as usual on Tuesday and Friday afternoons. One hundred and forty-eight patients attended the clinic making 362 attendances. The ailments dealt with were chiefly among children and included otorrhæa, conjunctivitis, impetigo, ringworm, cuts, grazes and burns, sores, sore buttocks and constipation. Some were treated for such conditions as mastitis, tonsillitis, wax in ears causing deafness, and varicose veins. Medical Inspection and Treatment of School Children. The medical inspection and treatment of children attending Public Elementary Schools in Holborn is carried out by the London County Council. The following treatment Centres are provided under the L.C.C. Schemes: — (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries :— (1) St. Bartholomew's Hospital. (2) Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) 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. 96 Routine Medical Examination of Elementary School Children in Holborn in 1931. Vision. 6/12 or worse in either eye. - - 45 81 46 23 21 15 181 19.3 18.0 6,9 in either eye. - - 68 51 22 26 22 21 205 21.8 23.5 6/6 in both eyes. - - 92 113 119 87 74 70 555 59.0 58.5 Condition of Teeth. Four or more decayed. 31 45 14 19 3 4 3 2 121 8.6 6.4 Less than four decayed. 58 69 42 60 43 31 29 17 339 24.0 27.4 All sound. 187 131 148 119 143 101 85 87 951 67.4 66.2 Cleanliness of Head. Pediculi. — 1 1 4 1 — 1 7 0.5 0.5 Nits. 14 29 10 1 21 5 13 2 6 99 7.0 4.0 Clean. 212 205 194 173 184 122 115 100 1,305 92.5 95.5 Nutrition Bad. 1 — 5 1 — — — 7 11.7 4 .5 Below normal. 28 22 25 26 23 12 11 11 168 Average. 168 176 158 162 156 102 98 68 j 1,078 76.4 7 4.9 Good. 29 87 16 19 10 22 8 27 168 11.9 20.6 Clothing and Boots. Poor. — 5 8 6 2 2 3 — 26 1.8 0.7 Fair 180 177 154 142 162 103 101 86 1,104 78.3 38.5 Good. 46 53 42 60 25 31 13 21 281 19.9 60.8 Number examined. 226 235 204 198 169 136 117 106 1,411 Holborn % London % . Age Group. Entrants— Boys Girls Age 8— Boys Girls Age 12— Boys Girls Age 14— Boys Girls Total 97 Medical Routine Examination of Elementary School Children in Holborn in 1931 Defect. Boys. Girl Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number Examined 226 204 189 117 235 198 136 106 Cases + Case. + Cases + Cases + Cases + Cases + Cases + cases + Malnutrition 6 6 6 6 1 1 — — 1 1 4 4 1 1 — — Skin Disease 4 1 6 3 3 1 2 1 4 4 2 1 5 2 1 1 Enlarged Tonsils 50 14 35 9 18 6 7 3 63 16 38 12 17 5 10 8 Adenoids 1 — — — — - — — 1 — 1 — — — — — Tonsils and Adenoids 1 1 — - - - - - - - - - - - - - Other Nose and Throat 7 2 6 3 1 1 1 — 5 — 4 2 — — — — Enlarged Glands 1 — 1 - - - - - - - 2 - - - - - External Eye Disease 11 8 3 3 1 — — — 13 9 2 1 2 — 2 1 Vision — — — 31 — 33 — 15 — — 16 — 20 — 16 Otorrhœa 7 6 3 3 — — 1 1 4 4 1 1 — 3 2 Other Ear Disease 1 - - - - - - - - - - - - - - - Hearing 2 1 — - - - - - 1 - - - - - - - Stammering and Speech — — 1 — 2 1 — — 1 — 1 — 1 — — — Heart 1 — 3 — 4 — — — 5 — 3 — 6 2 3 1 Anæmia 3 1 3 2 2 1 — — 3 3 — — — — Lungs 5 3 2 1 1 — — — 8 5 3 3 — - — — Nervous Disorders — — 1 1 — — - — 2 - — — 1 — 1 — Phthisis - - - - - - - - - - - - - - - - Other T.B. Disease — — - — — — - - — — — — Rickets 1 - — — 2 2 — - Spinal Defects — — 1 l — — 1 1 — — 2 1 1 — Other Deformities 1 — 1 1 — — 1 — 1 — — 1 — 4 1 Other Defects 4 1 7 1 4 2 2 — 9 2 6 3 2 — 3 — Teeth — 87 — 52 — 44 — 31 100 — 78 — 33 — 17 Number of Children for treatment 113 96 81 47 125 105 56 42 Defects, however slight, are included under " Cases." Those severe enough to require treatment are shown under +. 98 Deaths of Children 5 to 15 Years, 1931. Four children (1 boy and 3 girls) died during the year between the ages of 5 and 15 years. The deaths were due to the following causes, viz. : pulmonary tuberculosis (girl, aged 13); cachexia (girl, aged 13); street accident (girl, aged 5); and drowning (boy, aged 8). SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 115 bodies were deposited. There were 96 post-mortem examinations made, and 23 inquests held. The inquests are held in the Court Room at the Town Hall. On 15 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes. Ninety-seven bodies were brought in by order of the Coroner, and 3 by the police. Inquests. During this year 45 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, 6; Accidents, 23; Suicide, 10; Misadventure, 1; Murder, 1; Open verdict, 4. The causes of death certified as a result of such inquests were as follows: — Natural Causes. Accidents. Heart disease 2 Falls 7 Pneumonia 1 Motor accidents 9 Cerebral Hemorrhage 1 Burns 3 Ch. Pulmonary Tuberculosis 1 Cycle accident 1 Cirrhosis of liver 1 Injury at birth 1 — Drowning 2 6 — — 23 Misadventure. Suicide. Operation 1 Gas poisoning 6 — Poison 2 1 Revolver 2 Open Verdict. Murder. Gas poising 1 Strangulation 1 Drowning 1 — Fall over oliff 1 1 Killed on railway 1 — 4 99 The Removal of Aged, Infirm and Diseased Persons. Power 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. The 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. A communication was received respecting an elderly man living alone whose physical condition was reported to make his admission to an institution desirable. As a result of the personal persuasion of the Sanitary Inspector the man agreed voluntarily to such removal. Information was also received respecting an old couple, both 86 years of age, living under unsatisfactory conditions owing to old age and infirmities. As a result of the action taken the rooms occupied by these old people were properly cleansed and arrangements made for adequate attention to be given to them daily. Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. No application was received during the year for certificates under the above Acts. 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 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." G 2 100 The By-law after being in force for art experimental period until 1st June, 1928, was made permanent; it is administered by the Borough Surveyor's Department. 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 Beport for 1928. During the year complaint was received of nuisance from pigeons in Lincoln's Inn Fields. It was found that the birds nested in the buildings of Lincoln's Inn; as a result of action taken by the Benchers of the Inn in co-operation with the Council's Public Health Department the number of birds was considerably reduced. 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 four contractors during the year. 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. The propaganda work reported on in previous years has been continued. Schick Film. In 1930 the Council approved the production of a one-reel film depicting their work in connection with the Schick test and immunisation against diptheria. The film was exhibited during Health Week in October last. Arrangements were made for the film to be loaned for exhibition in other districts subject to payment of a small charge. 101 "Better Health." Arrangements were continued 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. There is evidence that 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 from Loud Speakers, etc., By-law. Pursuant to Section 23 of the Municipal Corporations 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." 102 APPENDIX. TABLE I. Vital Statistics of Whole District during 1931 and Ten Previous Years. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Year Population estimated to Middle of each Year. Uncorrected Number Not Number Rate of Non residents registered in the Dictrict of Residents not registered in the District Number Rate per 1,000 Births Number Rate Number Rate 1921 43,520 483 648 14.8 859 19.7 622 319 61 79 666 12.8 1922 42,850 485 664 16.5 746 17.4 518 342 48 72 670 13.3 192,1 43.37g 423 593 13.7 718 16 491 300 47 79 626 12.1 1924 43,250 394 578 13.36 670 15.5 470 329 47 81 629 12.2 1926 43,315 364 527 12.16 725 16.7 513 330 33 63 642 12.5 192c 43,200 330 635 12.38 62.1 14.6 454 347 48 90 522 12.1 1927 42,209 320 505 11.96 728 17.2 531 333 19 38 630 12.5 1928 39,280 301 473 12.0 739 18.8 546 338 27 57 631 13.5 1929 38,380 256 392 10.21 766 19.9 545 377 29 74 598 16.6 1930 38,380 255 405 10.55 693 18.1 523 318 36 89 488 12.7 1931 34,470 211 352 10.21 787 22 8 598 303 26 74 492 14.3 In the above table the population, birth rate and death rate are as estimated by the Registrar-General, founded upon his estimates of the resident population for the middle of the year 1931. 103 TABLE II. Causes of, and Ages at, Death, 1931. Causes ok Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Residents " or "NonResidents" in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under] 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All causes Certified 492 26 6 3 4 20 55 161 113 104 Uncertified ... ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers 1 ... ... ... ... 1 ... ... ... ... 1 2. Measles 1 ... ... 1 ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough 4 3 ... 1 ... ... ... ... ... ... 1 5. Diphtheria ... ... ... ... ... ... ... ... ... ... 4 G. Influenza 13 ... ... ... ... 1 2 6 2 ... 3 7. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever 1 ... ... ... ... ... ... 1 ... ... 7 9. Tuberculosis of Respiratory System 32 ... ... ... ... 2 7 13 3 ... 15 10. Other Tuberculous Diseases 6 ... ... 1 ... 4 ... ... 1 ... 33 11. Syphilis 3 1 ... ... ... ... 1 1 ... ... 3 12. General Paralysis of the insane Tabes Dorsalis 3 ... ... ... ... ... ... 1 2 ... 5 13. Cancer, malignant disease 79 ... ... ... ... ... 6 39 20 12 63 14. Diabetes 9 ... ... ... ... ... ... 5 3 1 4 15. Cerebral Haemorrhage 25 ... ... ... ... ... 1 6 9 9 19 16. Heart Disease 94 ... ... ... ... 3 11 27 28 25 27 17. Aneurysm 2 ... ... ... ... ... ... 2 ... ... ... 18. Other Circulatory Diseases 28 ... ... ... ... ... ... 2 8 18 6 19. Bronchitis 27 ... ... ... ... ... 1 7 8 11 6 20. Pneumonia (all forms) 38 ... ... ... ... 1 8 13 5 4 67 21 Other Respiratory Diseases 2 ... ... ... ... ... ... 1 ... 1 16 22. Peptic Dicer 2 ... ... ... ... ... ... 2 ... ... 7 23. Diarrhoea, etc. 4 ... ... ... ... ... ... ... ... 1 58 24. Appendicitis 2 ... ... ... ... 1 ... ... 1 ... 3 26. Cirrhosis of Liver 6 ... ... ... ... ... ... 1 1 ... 4 26 Other diseases of liver, etc. 2 ... ... ... ... ... ... 1 1 ... 1 27. Other digestive diseases 9 ... ... ... ... 2 ... 3 2 2 9 28. Acute and Chronic Nephritis 13 ... ... ... ... ... 1 7 3 2 31 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 12 12 ... ... ... ... ... ... ... ... 67 32. Senility 7 ... ... ... ... ... 1 ... 6 2 33. Suicide 12 ... ... ... ... 2 4 3 2 1 ... 34. Other Violence 28 1 ... ... ... 3 4 6 8 4 2 35. Other Defined Diseases 28 2 2 ... ... ... 9 4 6 5 134 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... • 492 26 6 3 4 20 55 161 113 104 598 104 TABLE III Gases of Infectious Disease notified during the year 1931, Disease. Total Under 1 1 to 2 2 to 3 3 to 4 4 to 5 6 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 up Total Death Small-pox 3 ... ... ... ... 1 ... ... ... 1 1 ... ... ... Diphtheria 69 2 5 6 8 6 20 9 2 10 1 ... ... ... Erysipelas 17 ... ... ... ... ... 1 ... 3 3 3 6 1 ... Scarlet Fever 57 3 1 3 1 7 21 7 4 6 4 1 ... ... Enteric Fever 4 ... ... ... ... ... ... ... 2 1 1 ... ... 1 Puerporal Fever 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... do. Pyrexia 4 ... ... ... ... ... ... ... ... 2 2 ... ... ... Cerebro-spinal Fever 4 ... ... ... ... ... ... ... 1 1 1 1 ... 1 Ophthalmia Neonatorum 7 7 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia—Primary 31 2 2 3 1 ... 1 ... ... 5 3 9 5 3 do. Influenzal 9 ... ... ... ... 1 ... ... 2 3 1 1 1 1 Tuberculosis— Pulmonary 80 ... ... ... ... ... 3 1 7 30 16 19 4 32 do. Non-Pulmonary 8 ... ... ... ... 1 2 1 1 2 ... ... 1 6 Whooping Cough 44 13 5 3 13 4 6 ... ... ... ... ... ... 4 Acute Poliomyelitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rhoumatism 6 ... ... 1 ... ... 3 2 ... ... ... ... ... ... 318 28 13 16 23 20 58 20 23 65 33 87 12 48 105 TABLE IV. Infectious Diseases in Holborn for the last Eleven Years. NOTIFICATIONS DEATHS Decennial Average, 1921-1930 Tear 1931 Decennial Average, 1921-1930 Year 1931 Number Rate per 1,000 London Kate Number Rate per 1,000 London Rate Number Rate per 1,000 London Kate Number Rate per 1,000 London Rate Small-pox 6 0.15 0.17 3 0.08 0.33 0 o.oo 0.00 0 0.00 0.00 Diphtheria 85 2.03 2.82 69 2.00 1.93 3 0.07 0.13 0 0.00 0.06 Erysipelas 19 0.46 0.45 17 0.49 0.53 ... ... ... ... 0.00 0.04 Scarlet Fever 108 2.60 3.48 67 1.65 2.76 1 0.03 0.02 0 0.00 0.02 Enteric Fever o 0.11 0.08 4 0.12 0.04 01 0.00 0.01 1 0.03 0.01 Orebro-spinal Fever 1 0.02 0.02 4 0.12 0.04 ... ... ... 1 0.03 0.03 Acute Poliomyelitis I 0.01 0.01 1 0.03 0.01 ... ... ... 0 0.00 0.00 Whooping Cought 100 2.42 ... 44 1.28 ... 5 0.11 0.13 4 0.12 0.07 Jleasles! ... ... ... ... ... ... 5 0.13 0.16 1 0.03 0.03 Tuberculosis—Pulmonary 75 1.81 1.15 80 2.18 1.61 42 1.02 1.96 32 0.93 0.90 Ditto Non-Pulmonary 15 0.36 0.40 8 0.44 0.32 6 0.15 0.16 6 0.17 0.13 Puerperal Fever* 0 4.17 3.75 2 5.68 4.44 1 2.41 1.46 0 0.00 Ditto Pyrexia * § 6 14.55 ... 4 11.36 12.64 0 0.00 2 .01 Ophthalmia Neonatorum* 8 14.87 9.49 7 19.88 9.60 ... ... ... ... ... ... Diarrhoea (under 2 years)*‡ ... ... ... ... ... ... 6 11.07 1094 3 8.52 9.71 * Kates per 1,000 births. † Notifiable in Holborn (not in London) since 1914. ‡ Not notifiable. § Average 4 years only. 106 TABLE V. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough At end of 1931. Number of Inspections. Number of Prosecutions. Cowsheds Milkshops 130 127 ... Registered houses let in lodgings 484 ... ... Ice cream premises 26 54 ... Slaughter-houses 1 5 ... Offensive Trades .. ... Restaurants and Eating Houses 276 605 ... Housing op the Working Classes— Number of houses inspected :— (a) On account of complaints or illness (Public Health Act) 499 (b) House to house (Housing Consolidated Regulation*, 1925) 0 Number of notices served :— (a) Under Public Health Act:— (i.) Intimation 453 (ii.) Statutory 71 (b) Under Housing Act 0 Number of houses repaired or nuisances remedied under Public Health Act 453 Number of houses repaired under Section 3 of Housing Act:— (a) By owners 2 (b) By local authority in default of ownere 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) 0 lb) In course of erection 3 blocks (62 tenements commenced) Number of representations by Medical Officer or other person 0 Number of houses included in such representations 0 Number of Closing Orders made 0 Number of Closing Orders determined (i.e., houses made fit) 1 Number of Demolition Orders 2 Number of houses demolished :— (a) In pursuance of Orders 2 (b) Voluntarily 0 Total number of houses in the borough 3473 (Census, 1921) Number of houses occupied by the working classes 8571 tenements (Census, 1921) Underground Rooms— Number illegally occupied, notices served 20 Number closed or illegal occupation discontinued 20 o verchowding— Number of cases of overcrowding found; notices served 6 Number of prosecutions 0 Number remedied 6 Smoke Nuisances— Number of observations 265 Number of notices 8 Number of complaints 1.3 Number of summonses 0 Cleansing and Disinfection— Number of adults cleansed 449 Number of children cleansed 10 Number of premises disinfected :— (a) After infectious diseases 262 (b) For vermin 178 Water Supply to Tenement Houses— Number of premises supplied 0 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 1 107 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 657 14 2 ... Workshops 623 47 5 ... Workplaces 3,768 65 16 ... Total 4,948 126 23 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. *Nuisances under the Public Health Acts: Want of cleanliness 32 32 ... ... Want of ventilation ... ... ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... ... Other nuisances 71 71 ... ... Sanitary accommodation insufficient 1 1 ... ... unsuitable or defective 35 35 ... ... not separate for sexes 12 12 ... ... Offences under the Factory and Workshop Act : Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 152. 152 ... ... * Including those specified in Suctions 2. 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 108 TABLE VI —continued. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making, etc. 108 195 114 1 2 ... 106 ... ... ... ... ... ... ... ... (2) Cleaning and Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 10 ... ... 2 ... ... ... ... ... ... ... ... Total 110 195 124 1 2 ... 108 ... ... ... ... ... ... ... ... 109 TABLE VI.—continued. 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. (1) (2) Bakehouses (including 17 factory bakehouses) 23 Other Workshops 610 Total number of workshops on Register 633 5.—OTHER MATTERS. Class. Number. (1) (2) .Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 10 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 61 Notified by H.M. Inspector 19 lieport (action being taken) sent to H.M. Inspector... 19 Other — Underground Bakehouses (8. 101): Certificates granted during the year — In use at the end of the year 14 110 TABLE VII. METEOROLOGY OF LONDON, 1931. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal) 1930. Air Temperature. Bright Sunshin. Rain and other forms of Precipitation. Mean of— Mean of A. & B. Difference from Average.* Daily Mean. Difference from Average.* Per cent, of possible. Total Fall. Difference from Average.* A. B. Maximum. Minimum. °F °F °F °F hrs. hrs. % m.m. m.m. January 43.1 34.1 38.6 +0.1 0.89 -0.35 11 29 - 14 February 45.3 33.5 39.4 -0.4 1.18 - 0.86 12 40 0 March 48.8 33.2 41.0 - 1.5 3.53 + 0.13 30 6 38 April 55.8 40.0 47.9 + 0.3 3.42 -1.60 25 97 + 60 May 63.8 45.3 54.5 + 0.5 5.22 - 1.25 34 73 + 29 June 71.4 51.6 61.5 + 1.6 5.96 - 0.74 36 31 - 20 July 72.4 53.5 62.9 -0.6 4.78 -1.72 30 63 + 6 August 68.6 52.4 60.5 -2.1 4.40 -1.80 30 159 +103 September 61.7 46.7 54.2 -3.8 3.46 - 1.49 27 39 - 6 October 58.0 41.3 49.7 - 0.5 2.59 -0.53 24 19 - 45 November 51.9 40.7 46.3 + 2.3 1.63 -0.09 18 62 + 4 December 46.3 38.0 42.1 + 1.9 0.44 -0.62 6 16 - 41 Year 57 3 42 5 49-9 -02 3 14 -091 26 634 or 24*96 ins. + 38 or + l'oOin. *The averages used are obtained from observations extending over 35 years (1881-1915). 1ll LEGAL PROCEEDINGS. Food and Drugs (Adulteration) Act, 1928. Date. Name. Address. Offence. Result. 1931 Sep.24th H. Goldberg 2, New North Street Selling milk 34 3% abstracted fat. Summons dismissed, P.O. Act. Costs £2. 2s. Od. Public Health (Preservatives, etc., in Food) Regulations. Date, Name. Address. Offence. Result. 1931 Feb. 2nd W. E. Childs 159, Drury Lane Selling sausages containing 260 parts per millon sulphur dioxide Defendant convicted and fined 40s. Mar. 10th Keith Radbone trading as J. Tdkner A Co. 620, Central Market Sfllingsausages containing 0 01 % sulphur dioxido Summons withdrawn on payment of 21s. costs