AC 4342 Hol 30 The Metropolitan Borough of bolborn. 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 1932. London: Printed by DIPROSE. BATEMAN &. CO., Sheffield Street, Kingsway W.C.2. 1933 The Metropolitan Borough of bolborn. 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 1932. London: Printed by DIPROSE, BATEMAN & CO. Sheffield Street, Kingsway W.C.2. 1933 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBOEN, W.C. I To the Mayor, Aldermen and Councilors of the Metropolitan Borough of Holborn. Ladies and Gentlemen, Herewith I beg to present a Report upon the Health and Sanitary Conditions of the Borough for the year 1932. 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 (Census 1931) 9 Births 12 Deaths 13 Seasonal Mortality 14 Infantile Mortality 14 Deaths in Public Institutions l5 General Provision of Health Services 15 Sanitary Circumstances Scavenging. Removal of House Refuse 15 Dust Inspector 10 Removal of Offal 16 Litter on Public Way 18 Removal of Manure 16 Sanitary Inspection of District 17 Notices served 18 By-laws as to Houses let in Lodgings 20 Rag and Bone Dealers 20 Rats and Mice (Destruction) Act, 1919 20 National Rat Week 21 Smoke Abatement 22 Inspection of Workshops 22 Factories 23 Outworkers 25 Rag Flock Act 25 Housing Statistics 25 Common Lodging Houses 27 Boswell Court Housing Scheme 27 Housing Accommodation on L.C.C. Estates 28 Inspection and Supervision of Food. Dairies, Cowsheds and Milk Shops 28 Sale of Milk in General Shops 28 Residue from Milk Clarifiers 29 Milk (Special Designations) Order, 1923 29 Dried Milk 30 Margarine 30 Bakehouses 30 Sale of Fish 30 Fried Fish Shops 30 Market Streets and Exposure of Food Generally 30 Street Trading 31 Ice Cream 31 Meat Regulations 32 Places where Food is Prepared for Sale 33 Inspection of Restaurant Kitchens 34 Unsound Food 34 Preservatives in Food Regulations 34 Food and Drugs (Adulteration) Act, 1928 35 Articles Analysed 35 Borough Analyst, Notes by 37 Milk 39 The Merchandise Marks Act, 1926 40 Agricultural Produce (Grading and Marking) Act, 1928 41 London County Council (General Powers) Act, 1932 41 Registration of Food Premises 41 Notification of Food Poisoning 41 4 Page Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 42 Smallpox 43 Vaccination 44 Diphtheria 45 Diphtheria in Hospitals 46 Diphtheria Contacts 46 Schick Test and Immunisation against Diphtheria 47 Soarlet Fever 51 Acute Rheumatism in Children 52 Rheumatism Supervisory Clinic 53 Typhoid and Paratyphoid Fevers 56 Typhus Fever 57 Cerebro-Spinal Fever 57 Dysentery 57 Malaria 57 Encephalitis Lethargies 57 Acute Poliomyelitis 58 Pneumonia 59 Influenza 60 Anthrax 60 Chickenpox 60 Mumps 60 Bacteriological Work 60 Disinfections 60 Cleansing of Persons Act 60 Shelter during Disinfection 61 Verminous Condition and Scabies 61 Extermination of Vermin 61 Tuberculosis 62 Summary of Notifications and Deaths 62 Public Health (Tuberculosis) Regulations, 1930 63 Supplemental Return 63 Notification Register 64 Sleeping Conditions 64 Classification of Homes 5 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 70 Public Health (Prevention of Tuberculosis) Regulations, 1925 71 Home Nursing 71 Dental Clinic 71 General Dental Clinic 72 Cancer 72 Maternity and Child Welfare Notification of Births 73 Number of Births 73 Births in Crowded Homes 73 Home Visiting 74 Attendances at Infant Welfare Centres 74 Work at Centres 74 10, John Street 74 Short's Gardens 75 Ante-natal Hygiene 75 Confinements in Institutions in relation to Housing Conditions 75 Baths 76 Ante-natal Centres 76 Post-natal Consultations 77 Instruction in Mothercraft and Hygiene 77 5 Page Maternal and Infant Consultations 78 Breast Massage 70 Pre-School Children 79 Foundling Site Day Nursery 80 School Entrants 80 Stillbirths 80 Illegitimate Births 81 Dental Treatment 81 Supply of Milk and Food for Mothers and Infants 81 Home Help 82 Convalescent Home Treatment 83 Saffron Hill Maternity and Child Welfare Centre 83 Deaths of Children, One to Five Tears 83 Deaths of Infants under One Year 84 Enteritis, Deaths from 85 Infectious Diseases among Mothers and Children 86 Puerperal Fever and Pyrexia 86 Ophthalmia Neonatorum 87 Midwives Acts, 1902 and 1918 88 Whooping Cough 88 Measles 88 Measles Control in Schools 88 German Measles 89 Epidemic Diarrhœa 89 Nursing Arrangements 89 Health and Baby Week 89 Minor Ailments Clinic 90 Medical Inspection and Treatment of School Children 90 Deaths of Children, 5-15 Years 93 Sanitary Administration Mortuary 93 Inquests 93 Removal of Aged Persons 93 Rent and Mortgage Interest' (Restriction) Acts 93 Dogs—Nuisance from—By-laws 94 Nuisance from Pigeons 94 Old Buildings—Demolition of 94 Children's Country Holiday Fund 94 Propaganda 94 Scliick Film 95 "Better Health" 95 Other Propaganda 95 Noise from Loud Speakers, etc., By-law 95 Acid Effluent in Sewers 95 Silver, Recovery of—Nuisance from 96 APPENDIX. Table I. Vital Statistics, 1932, and ten previous years 97 Table II. Causes of and Ages at Death, 1932 98 Table III. Infectious Diseases Notified during 1932 99 Table IV. Information required by L.C.C. 100 Table V. Factories, Workshops, &c. (1) Inspections 101 (2) Defects found 101 (3) Home Work 102 (4) Registered Workshops 103 (5) Other Matters 103 Table VI. Meteorology of London, 1932 104 Legal Proceedings 105 List of Notifiable Diseases (see back of cover). 6 PUBLIC HEALTH COMMITTEE. 1931-32. 1932-33. Chairman— Chairman— Councillor Harold J. Jewell. Councillor Harold J. Jewell. Vice-Chairman— Alderman Albert J. Clark. Vice-Chairman— Ex-Officio Alderman Albert J. Clark. His Worship The Mayor, Councillor Bracewell Smith, B.Sc., J.P., M.P. Ex-Ofjicio Alderman Charles Shortland. His Worahip The Mayor' Councillor Edmund Balding. Councillor Fred Howard, J.P. „ John H. Boraston, C.B. Alderman Charles Shortland. „ The Rev. Wilfred H. Davies, M.A Councillor Edmund Balding. „ Herbert H. V. Harrison. „ John H. Boraston, C.B. „ William M. Morgan (from June, „ The Rev. Wilfred H. Davies, M.A 1932). ,, Herbert H. V. Harrison. „ Sidney Parks. „ William M. Morgan. „ Ernest Partridge. „ Robert Portwine. „ Sidney Parks. Sir William R. Smith, D.L., J.P., „ Robert Portwine. M.D. (to April, 1932). „ William R. Wheatley. „ William R. Wheatley. „ George Witherby. HOUSING OF THE WORKING CLASSES COMMITTEE. 1931-32. 1932-33. Chairman— Chairman— Councillor Poland H. Haxell. Councillor Horace W. Langdon, F.S.I. Vice-Chairman— Vice-Chairman— Councillor Horace W. Langdon, F.S.I. Councillor Robert P. Bristow. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Bracewell Smith, B.Sc., J.P., M.P. Councillor Fred Howard, J.P. Alderman James W. Coade. Alderman Percy Hill, L.C.C. „ Percy Hill, L.C.C. Councillor 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 FrancesM. Graves, F.R.Hist.S., M.P. M.P. „ Roland H. Haxell., ,, Albert E. Hunter. „ Albert E. Hunter. ,, George D. Pooley. „ Wilfred E. Mullen. „ Asher Rosenberg. „ George D. Pooley. „ J. St. Laurenoe Stallwood. „ Asher Rosenberg. „ Alfred R. Taylour, M.A. „ Alfred R. Taylour, M.A. 7 MATERNITY AMD CHILD WELFARE COMMITTEE. 1931-32. 1932-33. Chairman— Chairman— Councillor Robert P. Bristow. Councillor George D. Pooley. Vice-Chairman— Vice-Chairman— Councillor George D. Pooley. Councillor Wilfred E. Mullen. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Bracewell Smith, B.Sc., J.P., M.P. Councillor Fred Howard, J.P. Councillor Edgar C. A. Bliault. Councillor Robert P. Bristow. „ Walter Cassey. „ Ernest Hamlin, M.B.E. „ Wilfred E. Mullen. „ Mrs. Gertrude Howard, M.A. „ Harry Myers. „ Harry Myers. (Mayoress) „ George John Pooley. ,, Robert Portwine. ,, Robert Portwine. „ William H. Rose. „ William H. Ross. „ J. C. St. Laurence Stallwood. „ William R. Wheatley. „ William R. Wheatley. The Mayoress (Mrs. Bracewell Smith). Miss Emily Dibdin. Miss Emily Dibdin. Mrs. Charles G. L. Du Cann. Mrs. Charles G. L. Du Cann. Miss E. Emly. Mrs. Percy Hill. Mrs. Percy Hill. Miss M. Wilmshurst. Mrs. Bracewell Smith. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Councillor H. V. Harrison (Vice-Chairman to November, 1932). Medical Officer of Health (Dr. C. W. Hutt). Tuberculosis Dispensary Councillor Sir William Smith.D.L., J.P., M. D. (to March, 1932). Tuberculosis Officer (Dr. J. A. St'ruthers). Councillor William R. Wheatley (from February, 1933). 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 Mrs. Clarke (to September, 1932). Committees. Miss M. Savary (from September, 1932). Invalid Children's Aid Association Miss Munro. Metropolitan District Nursing Association Miss M. Wilmshurst (to May, 1932). Miss E. Emly (from September, 1932). Almoners of hospitals Miss J. G. Salmon. Miss Voelcker (Vice-Chairman from November, 1932). Insurance Committee for the County of Mr. H. A. Teakle. London. Northern London War Pensions Committee Councillor R. H. Haxcll. British Rod Cross Emergency Help Fund Maior CJeneral Patrick B. Sangster, C.B., C.M.G., D.S.O. National Council of Social Service Mrs. Richmond (to October, 1931). Sir Alexander Kaye Butterworth (from February, 1933). British Legion and United Services Fund Benevolent Committee Mr. H. Brodie. Other social workers (co-opted) Mrs. E. C. Bedford. Mrs. Percy Hill (Chairman). Miss O. Lazarus Miss H. M. Mathieson (Honorary Secretary), Cav. R. Terroni. 8 STAFF. The following was the Staff during 1932. Mcdical 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. 1). Barris, M.B., F.R.C.P., F.R.C.S., 10, Cornwall Terrace, Regents Park, N.W. 1. Medical Officer of Tuberculosis Dispensary— James Arthur Sfcruthers, 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.K.San.I. Harry Wood (Temporary 13th June to 16th July) 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 Fitch. Arthur Long. Albert R. Shott, F.S.S. Lena Beadle. Dentist—J. C. Sinclair, L.D.S. (British Dental Hospital). Anaesthetist— Maurice Hudson, M.B., B.S. (Lond.). 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. Holbom 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 How)— Dr. George D. Fairley, 15a, Gower Street, W.C. 1. Telephone No. Museum 0691. Hours 9 to 10 a.m. and 6 to 7 p.m. (except Wednesdays). 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 1 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. Qoroner's Officer—Mr. James Stabb, 46, Baker Street, Lloyd Square, W.C. 1 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1932. Area of Borough in acres 4051 Resident population—estimated to middle of 1932 (as supplied by the Registrar-General) for birth and death rates 36,440 Enumerated population—Census, 1931 38,816 Number of inhabited houses (1931) 6,462 Number of private families or separate occupiers (1931) 9,355 Rateable value 1st November, 1932 £1,721,350 Rate of Id. in the £ estimated to yield £6,540 Total M. F. Live Births {Legitimate 295 154 141 } 349 Illegitimate 54 24 30 Annual rate of births per 1,000 estimated resident population 9.57 Still births 13 Rate per 1,000 total births 37 Deaths 517 Annual rate of deaths per 1,000 estimated resident population 14.18 Percentage of total deaths occurring in Public institutions 73 Number of women dying in, or in consequence {from sepsis 2 of, childbirth {„ other causes 0 Death rate of infants under one year of age :— All infants per 1,000 live births 72 Legitimate infants per 1,000 legitimate live births 64 Illegitimate infants per 1,000 illegitimate live births 111 Deaths from measles (all ages) 1 „ „ diphtheria (all ages) 2 „ „ whooping cough (all ages) 0 ,, „ diarrhoea (under two years of age) 11 Zymotic death rate* 0.08 Tuberculosis, all causes, death-rate per 100,000 104 Excess of registered births over deaths - Excess of registered deaths over births 168 *Excluding deaths from Epidemic diarrhoea. Population and Houses. The Census of England and Wales 1931, was taken on the night of the 26th-27th April of that year. Enumerated Population. The enumerated population of Holborn was as follows:— Males. Females. Persons. Census, 1931 18,187 20,673 38,860 Census, 1921 20,732 22,460 43,192 b 10 showing a decrease of 4,332, or ten per cent., in ten years, a decrease-rate larger than that shown in any other London area, except the City of London, where the rate of decrease was 19.8 per cent. During the same period the numerical loss in the County of London was 87,520, equal to 2 per cent. The decline in population in Holbom is a natural corollary of increasing congestion at the centre created by industry and commerce which drives resident population farther outwards. The Census report points out, however, that the rate of loss disclosed at the last Census was less than that in the previous decade. Resident Population. The resident population, on which birth and death rates are calculated, is 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. This principle, now introduced into the Census system, produces a lower resident population figure in areas like Holborn where there are many hotels and boarding houses regularly occupied by visitors; actually 25.9 per cent, of the enumerated population in Holborn was in such dwellings. The effect of the revision is to reduce an "enumerated" population in Holborn of 38,860 to a "resident" population, estimated by the Registrar-General at the middle of 1932, to be 36,440. The following further information extracted from the Census is of interest:— Dwellings, rooms and families. Holborn. London. Structurally separate dwellings 6,462 748,930 Rooms in do. do. 27,162 4,348,166 Increase (+) or decrease ( —) in occupied dwellings -317=4.88% + 4.22% Private families 9,355 1,190,030 Increase or decrease in number of private families - 327=3.38% + 6.17% Percentage of families living in: — 1-room homes 20.8 12.2 2-room homes 33.1 21.5 3-room homes 24.0 25.1 4-room homes 11.2 18.4 Five or more rooms 10.9 22.8 Density more than two per room:— Private families 8.9 7.5 Population 17.1 13.1 Population in non-private families:— Hotels, boarding houses, etc. 10,049 (25.9%) 156,019 (3.6%) Schools and educational institutions 82 (0.2%) 12,599 (0.3%) Hospitals and nursing homes 1,162 (3.0%) 54,179 (1.2%) 11 Age and sex distribution per 1,000 of each sex:— M. F. M. F. 0-4 50 43 73 63 5-19 195 171 254 225 20-39 359 398 331 340 40 and over 396 388 342 372 Average age 34.8 320 Marital condition per 1,000 of each sex:— Single 545 555 524 517 Married 416 335 438 384 Widowed or divorced 39 110 38 99 Commenting on the sex and age distribution in the County of London, the Registrar-General says:— "The City of London and, to a lesser extent, Holborn, stand rather apart from other Boroughs owing to the general unsuitability of their dwellings for private family occupation. The proportion of males is above the average, there being an actual excess in the City itself; there are few young children and the population is above the normal as regards average age. But, notwithstanding, the married are fewer rather than higher, proportionately, than those of other Boroughs or of the County as a whole." The Ward population of the Borough is given as follows:— Ward Acreage Population 1921 1931 Persons Persons Males Females Central St. Giles 35 5,432 4,934 2,590 2,344 Lincolns Inn 54 2,575 2,043 1,194 849 North Bloomsbury 34 5,348 4,979 2,388 2,591 North St. Andrew 29 3,442 3,268 1,499 1,769 North St. Giles 43 3,082 2,976 1,003 1 ,973 Saffron Hill 30 825 727 334 393 St. George-the-Martyr 39 7,220 6,981 3,183 3,798 South Bloomsbury 78 6,528 5,305 2,397 2,908 South East St. Andrew 64 8,740 7,647 3,599 4,048 Whole Borough 406 43,192 38,860 18,187 20,673 The character of population shows wide and striking contrasts, including as it does the occupants of expensive residential flats, the migratory population in the large hotels, the student class in the Bloomsbury boarding houses, residents 12 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, 1932. 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 15.3 12.0 65 London 14.3 12.3 67 Holborn 9.57 14.18 72 Registered Births. The total number of births registered as occurring in the Borough was 180 (98 males and 88 females). Of these, 174 were legitimate and 12 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 126 legitimate infants and 45 illegitimate infants whose mothers were residents of the Borough. Eight of the births occurring in the Borough, 5 legitimate and 3 illegitimate, were infants of mothers who were nonresidents of the Borough. The corrected number of births is therefore 349, and the corrected birth-rate 9 57. 13 The following is the corrected number of births and the corrected birth-rates for the year 1932 : — Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate per 1,000 of Population. No. Kate 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. 1932 349 9.57 295 8.09 845.3 54 1.48 154.7 In London the corrected birth rate in 1932 was 14.3 per 1,000 in comparison with 15.0 for 1931. 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 1932 being only 9.57 per thousand in comparison with 18-8 in 1912. Mortality. The total number of deaths registered as occurring in the Borough was 773, of which 448 were males and 325 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 Bloomshury. Holborn. French Hospital 4 - 29 - Royal Westminster Ophthalmic Hospital - - 3 - Children's Hospital 1 9 - 312 National Hospital - 2 - 121 London Homoeopathic Hospital 1 5 - 68 Italian Hospital 1 3 - 19 St. Paul's Hospital 1 1 31 - Private - 3 7 17 Total 8 23 70 537 There were 351 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 37 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 1932 gives the total deaths for the Borough as 517. 14 Corrected Deaths and Death-Rates, 1932. compared with 1931 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 1932 773 611 607 351 517 †14.18 12.3 1931 787 614 598 303 492 †14.21 12.4 For details of causes of and ages at death, see Table II, page 98. Seasonal Mortality. The mortality in the four quarters of the year as given in the Quarterly Reports of the Registrar-General is shown below:—* Deaths. Death-rate per 1,000. London Rate. First Quarter 150 17.5 16.0 Second ,, 102 11.9 11.4 Third „ 96 11.2 9.3 Fourth ,, 140 10.3 11.4 Infantile Mortality. The number of deaths of children under one year of age, and the number of deaths of children under one year of age per 1,000 corrected births, were the following:— Year. Deaths under 1 year of age. Deaths under 1 year per 1000 corrected legitimate Births. Deaths under 1 year per 1( 00 corrected illegitimate Births. Deaths under 1 year per 1000 corrected Births. London. Deaths under 1 year per 1000 Births. 1932 25 64 111 72 67 1931 26 71 91 74 65 Death-rate per 1,000 corrected births in 1932 and in ten preceding years. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Avge. 1922-31 1932 Holborn 72 79 81 63 90 38 57 74 89 74 71.7 72 Borough London 74 60 69 67 64 59 67 70 59 65 65.4 67 See also Table, page 97. * These figures, as published in the Registrar-General's Quarterly Returns for 1932, are for the 52 weeks ended 31st December, 1932; the complete corrections for the year 1932 increase the number of deaths to 517 and the rate to 14-18 per 1,000. The corresponding rate for London was 12.3. † These rates are calculated on the Registrar-General's estimated populations at the middle of the year 1931 and 1932 respectively. 15 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 517 deaths, 379 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. The following came into operation during 1932: — London County Council (General Powers) Act, 1932 (see page 41). The Holborn (Acute Rheumatism) Regulations, 1932 (see page 52). Merchandise Marks, No. 1 Order, 1932 (see page 40). Housing Consolidated Amendment Regulations, 1932. Agricultural Produce (Grading and Marking):— Regulations and Orders came into operation during the year relating to:— Raw Cherries, 3rd May. Plums, 18th May. Bottled Fruits, 25th May. Bottled Vegetables, 25th May. Honey, 17th June. Canned Fruits, 24th August. Cider, 24th August. Importation of Meat (Wrapping Materials), 1st November. 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 o'clock each morning. This earlier daily collection works well on the whole. In a very large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins. 16 The number of notices served for the absence of, or defective, ashbins was 112. 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. The new refuse removal contract, which will come into operation in 1933, arranges for the discontinuance of high loading vehicles. 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. (f) 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 one occasion during the year an Inspector reported breaches of the by-laws made by the London County Council respecting the removal of offal, uncovered receptacles being used. 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. 17 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 19,037 various inspections and visits as set out in the following table. One inspection frequently covers a number of different sanitary matters. Sanitary Inspectors' and Health Visitors' Work Year, 1932. Mr. Bennett Mr. Clark Mr. Larard *Mr. Wood. Miss Charlesworth Miss Stockwell Total Complaints received 32 54 46 7 ... ... 139 Do. found to be justified 32 54 46 7 ... ... 139 Inspection of Houses— Dwelling-houses 76 252 79 16 ... ... 423 Houses let in lodgings 309 365 140 15 32 ... 861 Common lodging-houses 8 7 4 ... ... ... 19 Drains tested by chemicals ... 1 ... ... ... ... 1 Drains tested by smoke 2 3 ... ... ... 5 Re underground rooms 8 9 ... ... ... ... 17 Factohies— Bakehouses 14 16 7 ... ... ... 37 Food preparation (other than above) 1 ... 81 ... ... ... 82 Other 81 72 270 1 2 ... 426 Workshops and workplaces— Food premises: Dairies and Milkshops 49 133 60 5 ... ... 247 Ice Cream, Manufacture 5 7 69 ... ... ... 71 Do. Storage or Sale 2 8 6 ... ... ... 16 Slaughter-houses ... 2 ... ... ... ... 2 Hotels and Restaurants 139 93 241 6 ... ... 479 Butchers 282 24 319 1 ... ... 626 Bakehouses 6 10 8 ... ... ... 24 Fish shops 10 18 7 2 ... ... 37 Fried Fish shops 183 22 24 ... ... ... 229 Market Streets 283 58 635 9 ... ... 985 Licensed Premises ... 3 2 ... ... ... 5 Other food shops 332 266 155 69 ... ... 822 Other workshops 130 132 248 3 13 ... 526 Other workplaces 41 90 58 6 ... ... 195 Outworkers' Registers 26 47 47 ... ... ... 120 Stables and Stable yards 37 74 ... ... ... ... 111 Rag and Bone shops 14 5 ... ... ... ... 1??? Outworkers' rooms† ... ... ... ... ... ... ... Offices 7 3 17 . ... ... 27 Miscellaneous— Black smoke 75 54 80 ... ... ... 209 Dust, Special Inspections 2 2 4 ... ... ... 8 Rats and Mice (Destruction) Act 75 204 89 ... ... ... 3???8 Public Lavatories and Urinals; Men ... ... 1 ... ... ... 1 Food and Drugs (Adulteration) Act, 1928, sampling . 194 196 198 ... ... ... 588 Demolition of Buildings 4 4 8 4 ... ... 20 Other Inspections ... 1 2 ... 4 11 18 Keeping of Animals 2 5 3 ... ... ... 10 Periodical Inspections: Includes W.C. and yards, dustbins. especially houses let in lodgings, and other suitable buildings 1,312 2,149 2,302 1 4 ... ... 5,767 Inspections carried forward 3,707 4,334 5,157 141 51 11 13,401 † 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. * Temporary Inspector, 13th June to 16th July, during illness of permanent officer. C 18  Mr. Bennett Mr. Clark Mr. Larard Mr. Wood. Miss Charlesworth Miss Stockwell Total Brought forward 3,707 4,334 5,157 141 61 11 13,401 Re-Inspections— Houses 604 739 474 136 5 ... 1,958 Factories 14 6 12 ... ... 32 Workshops and Workplaces 49 103 67 1 2 ... 222 Restaurants 15 9 6 ... ... ... 30 Licensed premises 2 2 4 ... ... ... 8 Offices 11 ... ... ... 11 Miscellaneous ... ... ... ... 38 121 159 Visits re Infectious Diseases 110 169 92 6 183 152 662 Scabies ... ... ... ... ... 2 2 Vermin ... ... ... ... ... 3 4 7 Othek Visits— Police Courts ... 1 2 ... ... ... 3 Various 131 367 298 18 31 2 847 Maternity— Visits: Children under 1 year ... ... ... ... 100 172 272 Do. 1 to 6 years ... ... ... ... 9 23 32 Expectant Mothers ... ... ... ... 62 61 123 Re-visits: Children under 1 year ... ... ... ... 97 229 326 Do. 1 to 5 years ... ... ... ... 105 216 321 Expectant Mothers ... ... ... ... 47 79 126 Other Maternity Visits ... ... ... ... 50 92 142 Attendances at Maternity Centres ... ... ... ... 194 159 353 Total 4,632 5,730 6,123 302 927 1,323 19,037 * Temporary Inspector, 13th June to 16th July, during illness of permanent officer. 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 1,123, viz. :— Public Health (London) Act, 185)1— Intimation Notices 427 Statutory Notices 51 By-laws— Houses let in lodgings 612 London County Council (General Powers) Acts— Verminous rooms 31 Rats and Mice (Destruction) Act, 1919 2 1,123 19 The following table shows the work done to abate nuisances for which intimation notices were served:— Water Supply— Houses. Factories, Workshops and Workplaces Provided 2 1 Cisterns cleansed, repaired etc. 21 3 Waterclosets— Cleansed 7 12 Water supplied, flushing cistern repaired, etc. 9 6 Repaired, new pans, etc. 67 9 Ventilation improved 11 8 Separate accommodation for sexes provided — 2 Position or construction improved — 1 Direct communication with workrooms remedied - 1 Accommodation provided 1 — Soil Pipes— Repaired, renewed and ventilated 2 3 Rainwater Pipes— Repaired or renewed 17 4 Drains— Repaired 15 6 Unstopped, cleansed, etc 20 9 Sinks, etc.— Waste pipes repaired, renewed, etc. 17 3 Yards, Areas and Washliouses— Cleansed 13 4 Paved and paving repaired 7 3 Houses and Workshops, etc.— Cleansed 46 38 Dilapidations repaired and made good 53 3 Ventilation improved 3 6 Dampness- Roofs repaired 44 3 Gutters repaired 8 — Other works to prevent dampness 11 1 Ashbins— Provided, repaired, etc. 104 8 Various— Underground Rooms vacated 8 — Smoke—Emission of black smoke abated — 3 Accumulations of Refuse—Removed 20 6 Overcrowding abated 1 1 Other nuisances abated 13 6 Animals improperly kept 1 — Statutory Notices. The following table shows the nuisances for which the 51 Statutory Notices were issued under the Public Health (London) Act, 1891: — Houses. Factories, etc. Section 2 (1)— (a) Dirty, dilapidated, damp premises, etc. 23 6 (b) W.C.'s, drains, etc. 14 4 (d) Accumulation of refuse — 1 (g) Factories and workshops — 4 Section 21 (1)—Effluvia — 1 Section 38—W.C. dirty or defective — 3 Seotion 96—Underground rooms 4 — 20 By-Laws as to Houses let-in-lodgings. At the end of the year 474 houses were registered under these By-laws. Of these, 232 are in St. Giles and Bloomsbury and 242 in the Holborn District. There were 861 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 238 notices were served for breaches of the By-laws, in addition to 474 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. Nineteen inspections of rag and bone shops were made in the year 1932; 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 255 premises were inspected under the above Act, the total inspections being 368. Two notices for breaches of the Act were served. In both cases rat proofing was carried out. At the end of the year the two premises were reported to be clear of infestation. 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. 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. 21 Rats and Mice (Destruction) Act, 1919. Summary of conditions found on inspections, action taken and results obtained. RESULT. Free 2 Free 6 Free 1 Free 12 Rata occasionally seen 2 Free 6 Free 24 Rats occasionally seen 7 Under observation 3 Free 6 Rats occasionally seen 3 Free 19 Rats occasionally seen 5 Free 11 Rats occasionally seen 1 Free 87 Rats only occasionally seen 18 Under observation 3 Action for Rat Repression. Proofing 2 6 1 14 4 21 4 4 '2 58 Cats. — — — — — — — 5 3 8 Dogs. — 1 — — — — — — — 1 Rat catchers. — — — — 1 3 1 10 5 20 Poisons. — 1 — — 1 9 — 9 1 21 Traps. — — — — — 9 4 5 2 20 Number rat infested. 2 6 1 14 6 34 9 24 12 108 Number of premises inspected. 13 17 27 24 17 63 30 48 16 255 WARD. a. b c. d. e. f. g. h. i. National Rat Week. In response to the request of the Ministry of Agriculture and Fisheries " Rat Week " was observed in the Borough in the week commencing 7th November, 1932. Prior to that date visits were made by the Sanitary Inspectors to premises known, or suspected to be infested with rats and to adjoining premises in the same blocks so as to point out the desirability of concerted action on the part of occupiers during the week. Advice was given respecting rat proofing. Suitable poison baits were on sale in the Public Health Department and, where desired, occupiers of rat infested premises were placed into communication with reliable firms of rat catchers. 22 As a matter of routine baits are regularly laid in the Council's sewers. In Eat Week the number of such baits was increased fourfold. The Borough Engineer and Surveyor reports that the result of using the increased quantity of bait is that there is more evidence of dead rats and, speaking generally, the rat " content " of the sewers is undoubtedly diminishing. In addition, communications were sent to chemists and hardware dealers asking them to stock and display suitable poisons and traps both before and during Eat Week. To a limited extent the request was complied with, more especially by hardware dealers. Literature on rat proofing was distributed, including copies of the Ministry of Agriculture Bulletin No. 30. The results obtained from the special work in Eat Week are included in the summary table on page 21. Smoke Abatement. The smoke shafts in the Borough were kept under frequent inspection, 209 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. Eight complaints were received of nuisances from the emission of smoke. As the result of inspections made three intimation notices were served. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 545 factories were inspected, 550 workshops and 3,871 workplaces. It is found that changes frequently occur in the occupation of workshops. To obtain information of such changes and further details of industrial conditions in the Borough a large number of visits and inspections were made in addition to the routine inspections mentioned above. As the result of these visits 36 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 40 workshops were added to the register. 23 At the end of the year there were 620 workshops on the register. 344 employed men only, 52 employed women only, and 224 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 155 different industries are carried on in these workshops, among the principal being the following:— No. or Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 16 — 1 17 Builders 12 — — 12 Carpenters 11 — — 11 Clock and watch makers 14 — 1 15 Dressmakers and ladies' tailors — 17 21 38 Diamond mounters 9 — 3 12 Engravers 13 — 2 15 Glass blowers 6 — 2 8 Jewellers 25 — 11 63 Leather goods makers 6 — 4 10 Metalworkers 7 — 4 11 Tailors 30 4 56 90 Factories. These visits also afforded an opportunity for extending and revising information .elating 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 448 factories were on the register. Workshops arc 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 448 factories include 50 different industries. In 225 cases men only were employed, in 18 women only, and in 205 both sexes. The more important industries carried on in these factories are :— Bookbinding 18 Engineering 46 Jewellers' work 17 Metal work 12 Printing 102 The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1932:— 24  Mr. Bennett. Mr. . Clark. Mr. Larard. Mr. Wood. Miss Charles worth. Total. Factories— Inspections 79 72 349 1 2 503 Re-inspections 14 6 11 — — 31 Workshops— Inspections 130 132 248 3 7 520 Re-inspections 8 14 35 — 2 59 Workplaces— Inspections 41 90 58 — — 189 Re-inspections 41 89 32 — — 162 Offices— Inspections 7 3 17 — — 27 Re-inspections — — 11 — — 11 Bakehouses— Inspections 21 26 13 — — 60 Re-inspections — 4 — — — 4 Restaurants— Inspections 139 93 241 1 — 474 Re-inspections 15 5 6 — — 26 Licensed Premises— Inspections — 3 2 — — 5 Re-inspections 2 2 4 — — 8 Defects Found— Want of cleanliness 9 12 18 — — 39 ,, ventilation — 2 4 — — 6 Overcrowding — — 1 — — 1 Storage cistern defective — — — — — — Accommodation for refuse 2 2 2 — — 6 Accumulation of refuse 1 1 4 — — 6 Sanitary accommodation Insufficient — — — — — — Unsuitable 1 — G — — 7 Defective 1 6 7 — — !4 Not separate for sexes — 1 1 — — 2 Other nuisances 6 15 18 — — 39 Total defects 20 39 61 — — 120 Action taken. Matters referred to H.M. Inspector :— Failure to affix abstract 1 Matters referred by H.M. Inspector Notified by H.M. Inspector 18 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charlesworth. Total. Factories— Intimation 1 6 14 21 Statutory — — 2 — 2 Workshops— Intimation 6 10 15 — 31 Statutory — 2 2 — 4 Workplaces— Intimation 2 7 12 21 Statutory 1 2 3 Offices— Intimation — 1 — 1 Statutory — 1 1 Restaurants— Intimation 9 7 3 19 Statutory — 1 1 Licensed Premises— Intimation 1 _ 1 Legal Proceedings — — — — — 26 Outworkers. Lists received from Holborn Firms 112 Names and addresses received from other Authorities 345 Names and addresses sent to other Authorities 230 Notices served on Employers 110 Firms visited 110 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. HOUSING. The following is the summary of information asked for in the Ministry of Health Circular 1269: — 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) 897 (6) Number of inspections made for the purpose 1.28-1 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 107 (6) 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 4 (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 252 II.—REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers ...Not known III.—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under 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: — (a) by owners (b) by Local Authority in default of owners — D 26 ]>. Proceedings under i'ublic Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 252 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) by owners 252 (b) by Local Authority in default 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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 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 but an undertaking not to use a basement room was accepted in one case. (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 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 respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 3 (3) Number of dwelling-houses in respect of which Demolition Orders were made ni (4) Number of dwelling-houses demolished in pursuance of Demolition Orders nil but 5 demolished after Closing Orders without Demolition Orders being made. 27 Common Lodging Houses. The common lodging house accommodation in the Borough is equal to 23 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 44 per 1,000 in 1932. The following table gives details of the accommodation available in the common lodging houses in the Borough:— Ward. Situation of House. Licensee. No. of Lodgers for which licensed. Total. Males. Females Central St. Giles 7 & 11, Short's Gardens William George Parker 234 — 234 Lincoln's Inn Parker House, Parker Street Frank Hunt (L.C.C.) 349 — 349 Lincoln's Inn 1-7, Maeklin Street Leslie Campbell Ruttledge 79 — 79 Lincoln's Inn 2-8, Kennedy Court John Samuel Walters — 78 78 St. George-theMartyr 40, Eagle Street Joseph Benton 50 — 50 St. George the. Martyr 35, Devonshire Street Ada Elizabeth Chesterton — 45 45 Boswell Court Housing Scheme. During the year two of the three blocks comprised in this scheme were completed, and were formally opened by the Mayoress, Mrs. Bracewell Smith, on the 28th October. In order to make the fullest use of the available site (less than a third of an acre) the buildings are seven storeys in height, the two top floors being arranged as maisonettes. The rents range from 15s. 4d. for a three-room flat to 21s. 7d. for a flat with four rooms and a kitchenette. When the scheme is completed a total of 62 flats will be provided designed to comply with the Ministry of Health's requirements under the Housing (Financial Provisions) Act, 1924. Sixteen of the flats will have in addition to the living room and bedrooms, a combined kitchen and scullery. In the remaining flats and maisonettes the living room and kitchen are combined. All the flats will have a well-ventilated larder, sink, draining board, dresser-cupboard, gas cooker, copper-boiler, bath room and W.G., coal bunker, cupboards, shelving, hat and coat racks, etc. Two service lifts are provided and a number of perambulator sheds. The balconies, from which access to the flats above ground is obtained, connect all three blocks of flats together for fire escape purposes. A playing yard is provided for children, and the blocks of flats have been so arranged as to provide the maximum amount of sunshine, light and air for the dwellings. The flats, balconies, staircases and* the yard will be lighted at night by electric light. The dwellings were designed by the Borough Engineer and Surveyor (Mr. J. E. Parr, A.M.Inst.C.E.). and the work has been carried out under his direction and supervision, the building work being entrusted to Messrs. H. C, Horswill, Ltd, 28 When the list of applications for tenancies was closed, four months before the date of opening, more than 400 applications had been received for the flats. Applicants were selected from Holborn residents living in unsatisfactory conditions, in a number of cases there being large families in single room tenements. Many of the tenants are employed in market work, in hotels and restaurants, or other occupations where the hours of labour necessitate residence near to the places of work. Accommodation on L.C.C. Estates. During the year 35 applications for accommodation on L.C.C. estates were submitted through the Council's Public Health Department. During the same period information was received of 34 Holborn families for whom accommodation was provided by the London County Council. 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 two per room, but other cases of hardship are also eligible for consideration. 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 1932, the number of registered dairies and milk shops in the Borough was 141. Sixteen shops were newly registered for the sale of milk. In 18 cases alterations in the register became necessary owing to alteration in ownership. One itinerant vendor was re-registered on removal to new premises. Five shops were removed on closing or demolition. In addition to my inspections the Sanitary Inspectors made 247 inspections of milk premises and it is satisfactory to record that it was found necessary to serve notice for sanitary defects or breach of the Orders in only two cases. Sale of Milk in " General " Shops. During the year special detailed inspections were made of " general " shops registered for the sale of milk. In all, 35 such shops are on the register. At 10 of these milk is sold in sealed containers only, viz., at four in bottles only, at three in cartons and at three in both bottles and cartons. The storage of the milk at 29 all the shops was found to be satisfactory, all counter pans being provided with suitable covers. At 17 of the shops the stock on sale included some offensive or oderous substances or articles likely to cause dust or dirt, e.g., pickles, vinegar, apples, cured fish, firewood, hearthstone, etc.; paraffin was sold at three shops, but in each case was stored in a yard away from the shop. All the traders stocked some goods likely to attract flies such as jam tarts, open jams, open sugar, sweets, cooked meats, etc. The cleanliness of the premises was reported as satisfactory in 30 cases, but only fairly so in the remaining five. In all the utensils were in a clean and satisfactory condition. The personnel engaged in these small retail premises was found clean in 31 shops and fairly clean in the remaining four. Although this survey disclosed reasonably satisfactory conditions within the limits of this type of business, it may nevertheless be suggested that the time is not far distant when the sale of milk from open receptacles should be discontinued from " general " shops. Milk in cartons can now be retailed at practically the same price as loose milk and very little hardship would fall on the majority of these traders if the sale of this commodity in " general " shops was limited to milk in sealed containers. 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 one establishment in the Borough where milk is cleansed by clarifiers to ascertain what is done with the residue after the milk has been passed through the cleansers. It was found that this residue is at once destroyed by burning in a furnace used in connection with a pasteurising plant. The Milk (Special Designations) Order, 1923. During the year 1932 licences available up to the 31st December, 1932, for the sale of designated milk in the Borough were issued as follows: — Certified Milk 2 Grade A (Tuberculin Tested) 5 Pasteurised 14 Up to the date of preparation of this report licences for the year 1933 have been issued as follows: — Certified Milk 2 Grade A (Tuberculin Tested) 2 Grade A (Pasteurised) 1 Pasteurised 5 Supplementary— Grade A (T.T.) 1 Pasteurised 2 13 30 Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Four 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. Bakehouses. At the end of the year 1932 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 61 inspections of bakehouses. Sale of Fish. During the past year 37 inspections were made of the fish shops and fish stalls in the Borough exclusive of market street inspections. There were 13 fish shops of which eight 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 12 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 229 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 Market Streets. There were 965 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. 31 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. 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 stationaryposition 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 106 applications from street traders for annual licences to sell various articles of food as follows : — Coffee stalls 6 Confectionery 7 Confectionery and drinks 5 Eels and shell fish 4 Fish—wet and dry 7 Fruit 26 Fruit and vegetables 12 Groceries 3 Ice cream 6 Ice cream and chestnuts 6 Meat 4 Poultry, eggs and provisions 7 Vegetables 13 106 All the storage places situated in the Borough were inspected. 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 32 used for the manufacture, storage or sale of ice cream. The London County Council (General Powers) Act, 1932, amends the registration requirement so that the sanitary authority may now refuse to register, or may remove from the register, any premises that are unsuitable. These provisions do not apply to any premises used as a club, hotel or restaurant. It is to be regretted that opportunity was not taken in connection with the promotion of this legislation to include a definition of ice cream. At the end of the year the following premises were on the register: — Manufacture only 1 Manufacture and storage 1 Manufacture and sale 3 Manufacture, storage and sale 10 Storage and sale 2 Sale only 10 27 In addition to my inspections, 87 inspections of these premises were made. The matter is of some importance in Holborn because of the large quantity of ice cream manufactured in the area known as the " Italian Colony;" although, owing to the closing and demolition of a number of houses in this area, the quantity of ice cream made in the Borough is much less than in previous years. In connection with the registration of such premises in the Borough a memorandum on the manufacture, storage and sale of ice cream was prepared by the Medical Officer of Health in 1928, and a copy is furnished to every applicant for registration (see A.R., 1928, p. 42). Ice cream is manufactured in the Italian colony as follows :— Premises on which 12 gallons are made daily 1 ,, ,, 10 ,, ,, 1 ,, ,, 2 ,, ,, 1 ,, ,, 2 quarts ,, 1 ,, ,, 1 ,, ,, 1 In addition ice cream was also manufactured on the following premises :— Mr. Bennett's District. Mr. Clark's District. Mr. Larard's District. Restaurants 5 — 5 Confectioners 1 1 4 Other — 3 1 Where ice cream sold in the Borough is made at premises outside Holborn. it is our practice to ask for information as to the conditions of manufacture from the Medical Officer of Health of the area concerned. On the other hand, we receive a number of such enquiries from other districts respecting ice cream made in Holborn, principally in the " Italian Colony," and sold in other districts. Public Health (Meat) Regulations, 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. 33 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 36 Provision dealers' stalls 3 Offal shops 3 Cooked meats 16 Wholesale (bacon; sausage) 5 93 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 626 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. 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. The number of such places on the register at the end of the year was as follows: — Hotels, Restaurants and Eating Houses 296 Slaughter-houses 1 Tripe, offal and other meat shops 48 Fried fish shops 12 Fish shops 17 Ice cream (Manufacture) 15 Poulterers 7 During the year, 2,450 inspections of such food premises and market streets were made and 30 notices served for sanitary defects found. e 34 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. In all 25 notices were served during the year respecting unsatisfactory conditions at hotels, restaurants and eating houses. Unsound Food. The London County Council (General Powers) Act, 1932. This Act extends the scope of Section 47 of the Public Health (London) Act, 1891, respecting unsound food exposed for sale so as to include articles of food offered as prizes at any entertainment or given away for advertisement purposes. The following unsound food was condemned during the year, 1932: — Commodity. Quantity. Condition. Result of Action taken. Fish:— Tons. Cwts. Qrs. lbs. Anchovies ... 6 - - Decomposed Surrendered Dabs ... 6 - 14 do. do. Lemon Soles ... 3 - - do. do. Witches ... ... 2 12 Unsound do. Fruit, etc:— Apples ... ... 1 22 Crushed do Bananas 1 - 1 18 Unsound do. Cherries ... ... 1 12 Crushed do. Grapes 1 16 1 21 Unsound do. Oranges ... ... 3 - Crushed do. Peaches ... ... 2 - do. do. Plums ... 3 - 12 Unsound do Tomatoes ... ... 1 2 Decomposed do. Meat:— Bacon ... ... ... 14 Abscess do. Beef (Chilled) ... 1 1 20 Unsound do. Fowls ... 3 2 8 Gotten do. Ham (Tinned) ... 4 2 22 Blown do. Turkeys ... ... ... 24 Decomposed do. Other Food:— Lettuce ... 1 2 7 Unsound do. Melons 2 13 - - Decomposed do. Spanish Peas ... 3 ... 14 do. do. Tomato Puree 1 5 ... — Unsounu do. Total 8 10 1 26 The Public Health (Preservatives, etc., in Food) Regulations. In the year 1932 three samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., sausages (see page 37). 35 The breach in each of these cases was the sale of the sausages without disclosing the presence of the preservative. The conditions under which the offences were committed were not found to call for legal proceedings, but in each case a letter of warning was sent to the vendor concerned. 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, came 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. Format, Samples. ARTICLE. Number Purchased Result of Analyses Proceedings taken. Convictions. Fines and Costa Genuine. Adulterated. Ale 3 8 ... ... ... ... Almond oil 2 2 ... ... ... ... A mm. tincture of quinine 5 5 ... ... ... ... Apricots, canned 1 1 ... ... ... ... Beef, corned 3 3 ... ... ... ... Beef, minced 1 1 ... ... ... ... Bicarbonate of soda 2 2 ... ... ... ... bismuth lozenges compound 1 1 ... ... ... ... Bismuth tablets 4 4 ... ... ... ... Borax 2 2 ... ... ... ... Brandy 2 2 ... ... ... ... Brawn 3 3 ... ... ... ... Bread and butter 11 11 ... ... ... ... Butter 62 62 ... ... ... ... Cake 6 6 ... ... ... ... Caviare 2 2 ... ... ... ... Cheese 16 16 ... ... ... ... Cheese sandwich 3 3 ... ... ... ... Christmas pudding 1 1 ... ... ... ... Coffee and chicory extract 5 5 ... ... ... ... Cornflour 3 3 ... ... ... ... Crab (canned) 1 1 ... ... ... ... Cream 12 12 ... ... ... ... Custard powder 3 3 ... ... ... ... Dripping 6 6 ... ... ... ... Egg substitute 1 1 ... ... ... ... Fish paste 2 2 ... ... ... ... Fruit (crystallised) 3 3 ... ... ... ... Gelatine 3 3 ... ... ... ... Gin 2 o ... ... ... ... Ginger wine 2 2 ... ... ... ... Ice cream 10 10 ... ... ... ... Jam 7 7 ... ... ... ... Lemonade 2 2 ... ... ... ... Lemonade powder 2 2 ... ... ... ... Lemon squash 5 5 ... ... ... ... Lime juice cordial 3 3 ... ... ... ... Liniment of iodine 2 2 ... ... ... ... Liniment of turpentine 2 2 ... ... ... ... 36 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convietions. Fines and Costs Genuine. Adulterated. Linseed, crushed 4 4 ... ... ... ... Lobster (canned) 2 2 ... ... ... ... Margarine 17 17 ... ... ... ... Marmalade 6 6 ... ... ... ... M eat paste 4 4 ... ... ... ... Meat, minced 1 1 ... ... ... ... Milk 177 175 2 2 ... (i) Dismissed on payment of £3 3s. Costs ... ... ... (ii) Fine £1, Costa £ 1. 1s Milk, condensed 4 4 ... ... ... ... Milk, dried 4 4 ... ... ... ... Mince pie 1 1 ... ... ... ... Oil, camphorated 2 2 ... ... ... ... Oil. olive 5 5 ... ... ... ... Ointment, blue 2 1 ... ... ... ... Ointment, boraeie 2 2 ... ... ... ... Ointment, calomel 10 10 ... ... ... ... Ointment, gall and opium 3 3 ... ... ... ... Ointment,nitrate of mercury- 2 2 ... ... ... ... Ointment, sulphur 2 2 ... ... ... ... Ointment, white precipitate 3 3 ... ... ... ... Onions, pickled 1 1 ... ... ... ... Orange quinine wine 1 1 ... ... ... ... Orange squash 1 1 ... ... ... ... Paregoric 4 4 ... ... ... ... Pastries 3 3 ... ... ... ... Pate de foie 1 1 ... ... ... ... Peaches, caaned 1 1 ... ... ... ... Peas (canned) 13 13 ... ... ... ... Piecallili 2 2 ... ... ... ... Pickles 3 3 ... ... ... ... Pineapple (canned) 1 1 ... ... ... ... Plum pudding 1 1 ... ... ... ... Prescriptions 4 4 ... ... ... ... Raspberries, canned 1 1 ... ... ... ... Raspberry syrup 2 2 ... ... ... ... Rice 2 2 ... ... ... ... Rum 2 2 ... ... ... ... Salad oil 1 1 ... ... ... ... Salmon, canned 2 2 ... ... ... ... Sauce 3 3 ...... ... ... ... Sausage, cooked 1 1 ... ... ... ... Sausage meat 4 4 ... ... ... ... Sausages 12 9 ... ... ... ... Sausage roll 3 3 ... ... ... ... Soup 8 8 ... ... ... ... Sponge cake 11 11 ... ... ... ... Suet, shredded 6 5 ... ... ... ... Swetts 14 14 ... ... ... ... Swiss roll 1 1 ... ... ... ... Tea 5 5 ... ... ... ... Thyme, dried 3 3 ... ... ... ... Tincture of rhubarb 2 2 ... ... ... ... Tomato puree, canned 1 1 ... ... ... ... Treacle 3 3 ... ... ... ... Vinegar 13 13 ... ... ... ... Whisky 2 2 ... ... ... ... Wine, raisin 2 2 ... ... ... ... Yeast 2 2 ... ... ... ... Total 689 583 6 2 ... Fines £ 1 Costs. £4 4s. 37 Informal Samples. article. Number Taken. Result of Analyses. Genuine. Adulterated. Gin 2 2 Lime juice cordial 1 1 Milk, condensed 1 1 Pepper 5 5 Whiskey 2 2 Total 11 11 The Borough Analyst, J. Kear Colwell, Esq., F.I.C., has kindly supplied the following notes: — During the year 1932, 600 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1028, 589 having been purchased with the usual formalities and 11 obtained informally. Of this total only six (1.01 per cent.) proved to be adulterated—all being formal samples. These were, one sample of blue ointment, two of milk and three of sausages. Blue Ointment.—The sample of blue ointment certified to be adulterated consisted of 100 per cent, of mercury ointment (B.P.) and not the B.P.C. (British Pharmaceutical Codex) article unguentuin mercuriale, or blue ointment, which should contain only 10 per cent, of mercury. Milk.—The two samples of milk certified to be adulterated were deficient in fat to the extent of at least 16.3 per cent. and 180 per cent. respectively. 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. In this connection it may be noted that the milk supplied to the Borough generally during the year was of good quality, the average fat being 3.71 per cent. and the non-fatty solids 8.92 per cent. If the two samples certified to be adulterated had been judged by this average figure for fat the deficiency in that constituent would have been 32.3 and 33.7 per cent. respectively or approximately one-third of the fat originally present—a serious loss in so important an article of food. Preservatives were not found in any sample of milk. Sausages.—The three samples of sausages certified to be adulterated contained 230, 100 and 300 parts of sulphur dioxide per million respectively. If a vendor desires to sell preserved sausages he may do so, but he must use a sulphite preservative, and the finished sausages must not contain more than 450 parts per million of sulphur dioxide, and the fact that they are preserved must be declared in some suitable manner to the purchaser. 38 Brandy.—Two samples of brandy gave ester figures of 135 and 122 respectively, and fulfilled the requirements usually regarded as essential to potstill brandy of good quality. Cheese.—The results obtained from the analyses of cheese and so-called cream cheese are of interest especially as they emphasise the necessity for standards for cheese, so that the purchaser may have some idea of the food value of the article he is paying for. Sample marked:— Water. Fat. Protein. No. H72 43.3 29.6 19.5 No. H74 29. 0 9.0 24.3 No. H82 28.8 33.1 22.3 No. H113 264 35.9 24.3 No. HI43 30.3 38.1 24.6 No. H145 30.6 38.6 24.4 No. H365 43.8 22.8 26.3 No. H.367 31.1 34.1 28. 7 No. H368 38.1 28.4 25.0 Nc. H419 28.6 35.4 26.0 No. H422 27.9 37.4 26.9 No. H436 30.8 35.6 22.5 These figures speak for themselves. No. H365 was a Dutch cheese and No. H368 was wrapped in tin foil (tin was not found in the cheese). Cream Cheese. Water. Fat. No. H561 (Bondon) 68.6 5.8 No. H566 (Cream) 53.9 21.8 No. H571 (Double Cream) 51.2 41.5 No. H573 (Double Cream) 42.8 44.9 Cream.—The 12 samples of cream were all sold loose (not canned) and were found to contain from 45.9 to 54 per cent. of milk-fat. Dried Milk.—The two samples of dried milk contained 27.3 and 26.4 per cent. and the two samples of dried modified milk (humanised) contained 18 7 and 19.5 per cent. of fat respectively. Lime Juice Cordial.—One of the samples of lime juice cordial had been preserved with benzoic acid, but the quantity used was within the prescribed limit for this article. Prescriptions.—The prescriptions analysed had all been property dispensed. Vinegar.—All the samples of vinegar were correctly described and contained over 4-0 per cent, of acetic acid. Yeast.—The two samples of yeast were in good condition and exhibited proper activity. 39 MILK. The table below shows the fat content of 177 samples of milk examined:- Percentage of Fat Number of Samples. Shops. Restaurants Streets. Total Less than 3.0 1 2 — 3 30 1 — 1 3.1 2 2 3.2 4 — 8 12 3.3 10 — 3 13 3.4 14 — 9 23 3.6 12 1 8 21 3.6 18 — 8 26 3.7 9 3 3 15 3.8 10 — 4 14 3.9 8 1 4 13 4.0 3 — 3 6 4.1 4 1 5 4.2 1 1 2 4 4.3 5 5 4.4 1 — 1 2 4.6 1 — 1 4.6 2 — 2 4.7 2 1 3 4.8 1 1 2 4.9 — 1 1 5.0 1 1 2 9.0 1 — — 1 109 11 67 177 Average fat content 3.75 3.67 3.65 3.71 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 16 12.54 8.89 3.65 February la 12.34 8.84 3.49 March 16 12.58 8.99 3.69 April 9 12.34 8.83 3.51 May 16 12.40 8.87 3.53 June 17 12.80 9.08 3.72 July 10 12.34 8.78 3.56 August 20 12.37 8.83 3.54 September 18 12.73 8.98 3.75 October 21 13.15 8.96 4.19 November 12 12.86 9.03 3.83 December 8 13.00 8.96 4.04 Whole year 177 12.63 8.92 3.71 Legal minimum 11.60 8.50 3.00 40 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 butter. The Order came into force on the 17th June, 1932, and is entitled the " Merchandise Marks (Imported Goods) No. 1 Order, 1932." A copy of the Order was sent to all butter retailers 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. Raw Tomatoes. 3. Eggs (hen or duck eggs in shell). 4. Dried Eggs. 5. Currants, Sultanas and Raisins. 6. Oat Products (oatmeal, rolled oats, oat flour and groats). 7. Honey. 8. Salmon and Sea Trout. 9. Butter. The total number of inspections made by the Officers appointed under the Act was 1,466. Of these, 801 related to shops, 622 to licensed street traders and 43 to non-licensed street traders. During the year 82 breaches of the various Orders were found, viz.: — Order No. Article. Number of breaches. 1. Butter 26 3. Fresh apples 43 4. Raw tomatoes 11 5. Currants, sultanas and raisins 2 Total 82 In proportion to the inspections made non-licensed street traders showed themselves to be the greatest offenders against the various Orders, for four of the breaches found (apples) 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. 41 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 Regulations made by the Ministry of Agriculture and Fisheries under the above Act were enumerated in the Annual Report for 1931. London County Council (General Powers) Act, 1932. Registration of Food Premises. This Act received the Royal Assent and came into operation on the 12th July, 1932. Part II (Public Health) contains provisions empowering the London County Council to make By-laws for promoting sanitary and cleanly conditions in the manufacture, storage, preparation, transport or exposure for sale of any article to be sold for food. In addition, this Part of the Act (Section 5) requires the registration with the sanitary authority of premises used for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale. Power is given to the sanitary authority to refuse to register, or to remove from the register, any premises that are unsuitable; a person aggrieved by such action has a right of appeal to a Court of Summary Jurisdiction. The requirement to register does not apply to premises used as a club, hotel or restaurant. At the date of the preparation of this report the following premises were registered in accordance with the requirements of the Act:— Sausages 14 Preserved meat 13 Pickled meat 5 Total 32 All the premises concerned were carefully inspected prior to registration and in 12 cases improvements were required before the registration was effected. The improvements included repair or alteration of sanitary arrangements, cleansing of premises and the provision of suitable and adequate facilities for persons engaged in the business to wash their hands. Section 5 of the Act also extends the powers of sanitary authorities in connection with the registration of ice cream premises (see page 31). Other provisions of this part of the Act (Part II) relate to the notification of Food Poisoning (see below) and Unsound Food (see page 34). Notification of Food Poisoning. This Act requires medical practitioners to notify all cases of food poisoning occurring in their practice. This early information of such cases will enable prompt measures to be taken for dealing with any suspected source of infection. Information of all cases in the County of London is distributed to Medical Officers of Health by the London County Council. Up to the end of the year I received 11 notifications of food poisoning in Holborn.Enquiries were made in each case, but no special action was called for. 453 cases were notified in London from the coming into force of the Act to he end of the year, p 42 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The relative importance of the commoner infectious diseases as regards numbers of deaths caused is shown by the following table :— ENGLAND AND WALES. Common Infectious Diseases. Deaths at all Ages. 1922. 1923. 1924. 1925. 1928. 1927. 1928. 1929. 1930 1931. Yearly average 1922-1931 Pneumonia (all forms) 40,930 33,413 38,970 36,990 32,339 37,242 31,014 43,846 27,724 33,573 35,604 Pulmonary Tuberculosis 33,919 32,097 32,690 32,382 30,108 31,066 29,799 31,425 29,414 29,658 34,416 Measles 5,694 5,316 4,834 5,337 3,483 3,622 4,302 3,388 4,188 3,288 4,344 Whooping Cough 6,370 4,162 3,983 6,058 4,118 3,681 2,976 6,332 2,037 2,512 4,223 Diphtheria 4,075 2,722 2,501 2,774 2,994 2,732 3,191 3,446 3,497 2,673 3,060 Scarlet Fever 1,382 993 888 988 677 579 580 717 740 540 808 Enteric Fever 465 450 496 388 367 367 438 382 313 251 392 43 The total number of notifications relating to Holborn residents received during the year was 402 in comparison with 348 in the year 1931. The increase is accounted for by the greater number of notifications received of the following diseases: — Diphtheria ... 76 in comparison with 69 in 1931. Whooping Cough ... 108 ,, ,, 44 ,, 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 306 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 7 Diphtheria 71 Dysentery 15 Erysipelas 5 Paratyphoid Fever 1 Measles 54 Scarlet Fever 62 Tuberculosis 60 Whooping Cough 19 Pneumonia 1 Oerebro Spinal Fever 2 Acute Poliomyelitis 5 Encephalitis Lethargica 2 Ophthalmia Neonatorum 1 Meningitis 1 306 Smallpox. This disease continued to be prevalent in London throughout the year 1932. Only one notification was received of a case occurring in a Holborn resident during the year 1932. The patient was removed to hospital. During the same period information was received of the occurrence of this disease in 18 non-resident workers, and seven cases among children attending an elementary school in Holborn, all being non-resident in the Borough. The steps taken to prevent the spread of the disease weire similar to those set out in the 1929 Annual Report as the routine procedure in smallpox cases. In the County of London 1,131 cases were notified, a notification rate of 0-26 per 1,000. 44 Vaccination. The following table gives information respecting the vaccination of children born in the Borough during the year ended 30th June, 1932:- Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Postponed by Medical Certificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-Distriot : 12 months ended 30th June, 1932 131 72 8 27 0 7 14 3 St. Giles and Bloomsbury Sub-District : 12 months ended 30th June, 1932 72 42 1 6 0 10 11 2 203 114 (56%) 9 33 0 17 25 5 During the same period 158 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 158, at the date of the preparation of this report, 69 (44 per cent.) were known to be vaccinated. The remainder are accounted for as follows : — Removed from the Borough—no information as to vaccination 50 Conscientious objectors—Exempted 18 Died before vaccination 10 Postponed—medical certificate 9 Not vaccinated 2 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. Under the Public Health (Smallpox Prevention) Regulations, 1917, 678 vaccinations were also performed during the year, viz.: (a) primary, 131 vaccinations; and (6) revaccinations 547. Following the arrangements operating in previous years, information of all cases of smallpox in the Greater London area giving particulars of the illness and 45 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 1,128 cases in the County of London and 366 cases in the extra-Metropolitan district was received. Diphtheria. We received notifications relating to 76 cases of diphtheria occurring in residents in the Borough; of these, five were sent in as being '* carriers " of diphtheria bacilli. Seventy-five were removed to hospital, including the five " carriers." Age at Notification of 76 Notified Cases of Diphtheria. 0—1 1—5 5—15 16—25 25—45 45—65 Total. 2 21 34 8 12 1 76 Two deaths occurred. Twelve of the notified cases were returned from hospital certified as not suffering from diphtheria. 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 A. E. W. 8 15/1/1932 E. W. 4 23/1/1932 House let in lodgings J. E. 3 23/2/1932 M. E. J. E. 8 6 25/2/1932 25/2/1932 ,, ,, ,, ,, G. P. 10 5/8/1932 E. P. J. P. 12 4 5/8/1932 5/8/1932 ,, ,, ,, ,, P. S. 4 4/8/1932 F. S. E. S. 7 9 7/8/1932 16/8/1932 Flat in dwellings ,, ,, B. N. 6 24/10/1932 G. N. G. N. 9 32 26/10/1932 26/10/1932 House let in lodgings ,, ,, 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, 8,087 cases were notified giving rise to 313 deaths. 46 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 53 cases of diphtheria occurring among in-patients or staffs at three hospitals in the Borough. The information was obtained from the notifications of removal received from the London County Council, or from the ordinary notification certificates furnished by the doctors diagnosing the disease. From one hospital there were 37 notifications of which 35 were clinical cases (22 were notified " nasal ") and two were notified as " carriers." Of these 37 notifications four related to Holborn residents, being members of the resident medical or nursing staff. Thirty-three 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 from the districts from which the patients are admitted. From a second hospital 12 cases were removed, five clinical (one nasal) and seven " carriers " only. Of the 12 cases notified, six were Holborn residents (four nurses and two in-patients); the remaining six were in-patients admitted from out-side the Holborn area. From a third hospital four cases were notified, three clinical and one " carrier "; two were Holborn residents (nurses at the hospital) and two were inpatients admitted from outside the Borough. Diphtheria in Hospitals. Hospital. Cases Notified. Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 4 33 35 2 4 33 37 B. 4 8 5 7 6 6 12 C. 2 2 3 1 2 2 4 Diphtheria Contacts. As in former years we have continued to swab all diphtheria contacts among school children and toddlers. 47 Results of Bacteriological Examinations and Virulence Tests. No. of contacts swabbed 65 Negative at first examination 42 Positive at first examination 23 (35.38 per cent.) Virulence tests made 2 (positive 1) Analysis of the swab results relating to the contacts is given below: — Contacts swabbed. Positive Results. Contacts positive. Nose and Throat. Nose only. Throat only. First Examination 65 2 17 4 23* Second ,, 21 2 6 — 8** Third „ 7 — 2 — 2 Fourth ,, 2 — 1 - 1† * 2 positive contacts removed to L.C.C. Fever Hospital. ** 1 positive contact removed to L.C.C. Fever Hospital. † Virulence test made in the case of these contacts—negative 1, positive 1 (referred for treatment to St. Mary's Hospital). The parents or others in charge of children harbouring diphtheria bacilli were given written directions as to the precautions necessary. The results of the examinations of child contacts were communicated to the School Medical Department of the London County Council so that children harbouring diphtheria bacilli could be kept from school providing there was no evidence that the organisms were avirulent. Diphtheria antitoxin was available free of charge on application by medical practitioners. 31,000 units were supplied for six cases, two of these being for prophylaxis. Diphtheria " Carriers." Information was received from the School Medical Officer (L.C.C.) of three children excluded from school as suspected diphtheria " carriers." Two of these were referred for treatment to special clinics for diphtheria " carriers." 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. Schick Test and Diphtheria Immunisation. Eleven years, 1922-32. A Total number of individuals who attended clinic B Total tested C Total immunised without preliminary Schick test Result of Test. D Immunisation of Positives. e f g h i j Positive. tive Not read. Found NEGATIVE to Re Schick Test after Found NEGATIVE to Be Schick Test after First immunised With T A.F. and found NEGATIVE to lie 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 ccm 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 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 c A C A C A C A c A C A C A 1649 284 1254 284 395 0 931 153 315 127 9 3 24 1 24 2 755 61 22 2 9 1 11 0 1 0 3 0 4 0 28 4 10 3 890 75 265 27 22 1 85 18 78 15 3 0 1,933 1,538 395 1,084 442 12 25 26 816 24 10 11 1 3 4 32 13 965 †† 292 § 23 103 † 93 † 3 1,479 * * These columns refer to 98 cases—87 were Schick positive on retesting after 3 ccm T. A.M. 11 were Schick positive on retesting after T.A.F. † 83 of these removed from the Borough. § 29 of these have removed from the Borough, †† These retests include those made up to 28th February, 1933. Note.—Columns E F G H give details of the total 965 given in Column Columns I J give details of the total 1,479 positives given in Column CD. We have not altered the routine procedure, except that owing to the increased confidence of the public in the measure we no longer find it necessary to test children under 5 years of age, but proceed at once to the immunisation. TABLE II. HOLBORN MUNICIPAL INFANT WELFARE CENTRE, 1922-1932. Summary of Work Done. to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 8 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years 27 157 130 109 92 81 62 57 71 57 48 39 38 8 Neg. Not read Pos.. Neg. Pos. Neg. Notread Pos. Neg. Notread Pos. Neg. Notread Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. 10 3 149 8 110 19 1 77 30 2 55 35 2 54 27 45 17 35 22 32 39 26 31 26 22 17 22 14 24 5 3 149 79 43 36 6 5 3 0 2 0 0 1 318 193 135 94 54 67 48 28 30 21 23 13 10 2 table gives particulars of the nine cases of diphtheria : — TABLE III. Diphtheria in Children Schick-Tested and Treated with Immunising Injections. Type of Home Date of Schick Test First In jection Final Injection Retest Result of Retest Date of onset of Diphtheria Interval between last injection and date of onset of disease Confirm of diag by Artiza.n— moderately satisfactory ; house let in lodgings 30/1/24 7/2/24 20/2/24 (Third) none — 18/3/25 13 months Metropolitan Asylums E (N.E. H Higher Artizan— model dwellings 4/4/23 11/4/23 25/4/23 (Third) none — 29/5/25 13 months Metropolitan Asylums E (N.E. H Higher Artizan— modol dwellings 24/9/24 1/10/24 15/10/24 (Third) none — 5/4/26 18 months Metropolitan Asylums E (N.E. H Higher Artizan—part of private house 11/11/26 17/11/26 1/12/26 (Third) none — 23/12/26 22 days* Metropolitan Asylums E (N. W. H Residential, separate private house 28/9/27 5/10/27 19/10/27 (Third) none — 21/10/27 2 days* Cuddingto tion Hos Artizan— model dwellings 5/9/23 12/9/23 26/9/23 (Third) none — 26/10/27 4 years Metropolitan Asylums E (N.E. H Higher Artizan— model dwellings 13/5/25 20/5/25 10/6/25 (Third) yes negative 11/11/25 19/2/28 2 9/12 years Metropolitan Asylums B (N.E. H 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 3 8/12 years Metropolitan Asylums B (N.E. H Fair, two rooms; house let in lodgings 12/1/27 19/1/27 9/3/27 (Third) yes negative 19/10/27 15/4/29 2 1/12 years Metropolitan Asylums E (N.W. H occurred before the elapse of 9 months, the period laid down at Edinburgh as required to secure artificial immun shows that only three of the children were retested after the last injection. It cannot be assumi e administration of three immunising injections, nor that immunity even when once establish arish and Okell have shown that of 440 Schick positive children who were rendered Sc cent. were found to be positive when retested 1-7 years later. 51 Diphtheria in Children Treated with Immunising Injections. Up to the end of the year 1932 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 occurred in eleven other children who had completed their course of inoculation, but the diagnosis in these cases was eventually not confirmed. Two of these (brother and sister) were removed to 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; one case after his return from hospital gave a negative reaction to the re-Schick test. The ninth was notified as suffering from scarlet fever and diphtheria, but was later diagnosed as suffering from scarlet fever only; the tenth and eleventh also removed to hospital with diphtheria were returned as cases of catarrhal sore throat and not diphtheria. Two adults who had completed their course of inoculation but had not been retested were removed to L.C.C. hospitals as suffering from diphtheria, but were returned as not diphtheria; one was suffering from follicular tonsillitis and one from tonsillitis. 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 1932. At this hospital Schick testing of all newcomers and immunisation of positives is now compulsory. From June, 1930, till the end of December, 1932, 121 nurses were tested, 30 of these were tested for the first time in 1932 , 24 of these were positive (all of these were immunised) and six were negative. Scarlet Fever. There were 57 notifications of scarlet fever. All but two were removed to hospital. 52 Three notifications of " secondary " cases were received. From two hospitals in the Borough 62 in-patients were notified as so suffering; none was resident in Holborn. There was no " return " case of scarlet fever. There was no death from this disease. 14,119 cases of scarlet fever were notified in London with 85 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. The Regulations are superseded from the 1st January, 1933, by the Holborn (Acute Rheumatism) Regulations, 1932. 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. Eighteen cases were notified in 1932. As regards the source of information relating to the total number of notifications from 1929 to 1932 seven were notified by doctors in private practice, eight were notified by an Assistant School Medical Officer, 23 were notified by doctors in institutional practice, 13 were notified by the Medical Officer of the Rheumatism Supervisory Clinic, and 49 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 73 cases reported by parents to the Health Visitors, the diagnosis of rheumatism was confirmed in 28. The total notifications received up to the end of 1932 are classified as :— Rheumatic tendency 4 Sub-acute rheumatism 46 Acute rheumatism 35 Post-rheumatic 15 100 53 Age and Sex Distribution of notified cases. Sex Total. Age in years. M. F. 2 1 — 1 3 1 — 1 4 4 3 7 5 1 5 6 6 5 3 8 7 3 6 9 8 6 6 12 9 6 10 10 10 5 6 11 11 — 3 3 12 3 9 12 13 2 2 4 14 — 5 5 15 2 3 5 Totals 39 61 100 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 the early stages when obviously a diagnosis is of the greatest value, this can often only be done by watching the child over a period of three to six months, 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. 54 Enquiries in Notified Cases of Rheumatism. Enquiries into the housing conditions of the notified cases showed that 39 lived in satisfactory artisan self-contained flats; 20 lived in satisfactory artisan homes in divided houses of a comfortable type (a better class of house let in lodgings); 32 lived in houses let in lodgings; 7 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. Eleven of these children have removed from the Borough, and one died in 1932 of rheumatic carditis. It is somewhat curious to note the incidence of acute rheumatism in satisfactory homes. Dampness in Houses. Dampness was found in only throe houses, due to temporary nuisances which were remedied. Lighting and Ventilation. Two children lived in semi-basement flats, and although the lighting was not good, the flats Were well built and the street and courtyard adjoining fairly wide, so that lighting and ventilation compared not unfavourably with upper floors in narrow streets and small courtyards. In five 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—96 Cases of Notified Rheumatism * No. of Rheu matic Children Separate Room Separate Bed in Living Room Separate Bed in Room shared with Bed shared with Bed shared in living room with Adults Children Adults and Children Adults Children Adults and Children Child Adults and Children 1 2 3 1 2 3 1 2 3 5 1 2 3 1 2 3 1 2 1 3 96 8 6 4 7 0 12 6 0 1 2 6 1 6 0 0 25 7 1 1 1 1 1 96 8 6 39 41 2 * Exclusive of two cases where wrong addresses given, and one where the patient died shortly after the date of notification, and one where the child removed immediately after notification. It will be seen that only eight children had a separate room; thirty-nine had a separate bed in a shared room; forty-one shared a bed, ten of these with more than one person; eight children had a bed in the living room, a very unsatisfactory arrangement, seeing the child is disturbed by the late and uncertain hours of going to bed kept by the rest of the family, and also the possibility of disturbance at an early or earlyish hour in the morning. In some instances where 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. Six children live in one-room homes. In nine homes there is a history of chronic poverty, but without acute distress; in two of these the mother has been many years widowed; 55 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. In one case last year boots were provided by the Public Assistance Committee. Condition of the Nose and Throat. In forty-two children the condition of the tonsils was normal. Forty-three children had their tonsils removed, twenty-two of these also had adenoids removed. In seven cases tonsillectomy was advised, two of the seven also requiring removal of adenoids. In the remaining four cases the tonsils were enlarged at the time of examination but no special treatment was recommended. Of the forty-three children referred to above, in eleven cases the removal of the tonsils coincided with the reported onset of rheumatism, in that the diagnosis of the rheumatic condition was made in connection with the attendance of the children at hospital on account of tonsilitis. In twenty tonsillectomy had been performed at varying periods considerably before the symptoms of rheumatism were observed (from seven of these also adenoids had been removed); in twelve 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 seven others treatment had been given. Heredity. As a result of enquiries of parents it was found that there was a family history of varying degrees of rheumatism in 36 families. In sixteen of these the mother was reported to have Buffered, in eight the father, in two both parents; in ten cases there was a more or les6 definite history of rheumatism in other relations. Contacts. Twenty of the notified cases had no contacts. A history of rheumatic pains was reported in the contacts of ten cases. Eleven of the contacts were examined at the Rheumatism Supervisory Centre, and as a result two are 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 1932 one patient ceased to attend school and is occupied as follows: — (1) Girl (D. L., æt 14) is a clerk. Five patients who ceased to attend school in 1931 continue occupation as follows : — (1) Girl (G. A., æt 14) is a needlewoman. (2) Girl (I. A., æt 14) is a needlewoman. (3) Boy (R. B., æt 14) is a shop assistant. (4) Girl (V. B., æt 14) is a cracker maker. (5) Boy (R. C., æt 14) is a goods stamper. One child (P. M.), reached the age of 16 during 1932 and still continues in her previous employment. Obviously the nature of employment to be followed by any child who has suffered from heumatism requires careful consideration from all concerned. 56 Typhoid Fever and Paratyphoid Fever. Four cases were notified during the year with no death. In London 195 cases were notified aivine rise to 20 deaths. The following table gives particulars of the cases notified in Holborn:— Probable Source of Disease. No information Abroad during the two months preceding onset Visitor from provincial town Contracted in Borough. Yes Yes No No Where treated. North Western Hospital Home Nursing Home Home Final Diagnosis. Acute Bronchitis Paratyphoid B Typhoid Fever Typhoid Fever Nature of Laboratory Examination. Agglutination test Agglutination test Agglutination test Agglutination test Notified as. Typhoid Fever Paratyphoid Fever Typhoid Fever Typhoiil Fever Date of Notification. 18th May. 1932 18th June „ 15th Oct. ,, 23rd & Nov. ,, Occupation. Shop assistant Student Optician Student Sex. F. M. M. F. Age. 32 24 37 18 Case. M.C. B.H. O.R. H.B. 57 Typhus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-Spinal Fever. One case of cerebro-spinal fever was notified in the Borough. Two hundred and forty-seven cases were notified in London, giving rise to 148 deaths. Bacillary Dysentery. One case of bacillary dysentery occurred in a nurse at a hospital. Four other cases were notified from the same hospital, all being in-patients, non-residents of Holborn. Malaria. One case of malaria was notified. The patient had been residing in China and was temporarily staying in Holborn before proceeding to America. Encephalitis Lethargica. One case of encephalitis lethargica was notified in the Borough during the year. This case was not formally notified until after the death of the patient, but had previously been included in a list of non-notified cases of the disease received from the London County Council in February, 1928 (see below). The following table gives information up to the end of 1931 respecting the 13 real eases of encephalitis lethargica notified in the Borough since the Public Health (Encephalitis Lethargica) Regulations came into force on the 1st January, 1919:— Date of Notification Patient. Sex. Age when notified. Subsequent History. 13/1/20 B.R. F 32 years Disease fatal 13/1/20 6/2/20 P.P. M 8 years Disease fatal 28/2/20 7/2/20 W.W. M 47 years Disease fatal 7/2/20 26/4/22 W.H. M 14 years Disease fatal 19/4/22 4/4/24 A.K. F 28 years Disease fatal 28/3/24 16/5/24 G.C. M 36 years Returned to Italy ; no further information 20/6/24 R.V.M. M 40 years Went to Australia. Complete recovery reported 9/7/24 F.H. F 7 years Complete recovery 26/9/24 B.V. F 53 years Disease fatal 21/9/24 4/5/25 C.S. F 28 years Improved but right arm tremulous. O.P. at National Hospital. (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 Indies; no further information 26/5/30 W.W. M 32 years Disease fatal 30/5/30 4/2/32 P. L. F 26 years Disease fatal 20/1/32 The table excludes one case notified 15/11/24 who was subsequently found not to be suffering from this disease. 58 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 gives particulars of these cases: — Date of Onset. Patient. Sex Date of Birth. Where Treated. Condition at end of 1932. 1/9/20 P.L. F 1904 St. Bartholomew's Hospital Disease fatal 20/1/32. Jan., 1920 W.P. M 1910 University College Hospital Died 1929. Feb., 1924 W.B. M 1913 Royal Free Hospital— in-patient since 1926 In Northern Hospital (L.C.C.). Nov., 1924 K.M. F 1911 London Homœopathic 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 Notification. Patient. Sex Ageat date of Notification. Where Treated. Subsequent History. 17/7/13 F.D. M 1 8/12 year9 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—slight pain occasionally in leg. 5/9/16 F.B. M 2 months " Died. 6/6/20 I. P. F 3½ years " Recovered—no crippling. Health good. 23/7/20 E.W. M 15 " " No use of lower limbs. Does occasional clerical work. 17/9/20 E.H. F 18/12 " " Recovered—no crippling, "thinness" of leg only. Health satisfactory 4/9/22 Y.R F 110/12 Home Died in Paris. 5/2/23 J.N. XI 3½ " Hospital Recovered—no crippling. 59 Date of Notification. Patient. Sex. Age at date of Notification. Where Treated. Subsequent History. 2/5/23 M.H. F 11 mths Hospital In-patient at Queen Mary's Hospital, four months, walks well with appliances — at night wears two light metal splints for feet. 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. Goes to school—attends hospital monthly — condition satisfactory. 14/9/31 P.C. M 9/12 " " Died 18/9/31. 3/6/32 G.C. M 6 mths. " Out-patient St. Bartholomew's Hospital — support for right foot when in bed. 30/8/32 L.P. M 13 years " Attends University College Hospital daily for massage—left arm in splint. The table excludes one case notified 4/12/18 who was subsequently found not to be suffering from this disease. Pneumonia. Twenty-eight cases of pneumonia were notified during the year. Eight of these were influenzal pneumonia. Thirty-three deaths were recorded from all forms of pneumonia. The 20 cases of primary pneumonia were notified at the following ages :—Under 1 year, 1; from 1 to 5 years, 1; from 5 to 15 years, 5; from 15 to 35 years, 2; from 35 to 45 years, 4; from 45 to 65 years, 4; and 65 years and upwards, 3. Seven were treated at home; 5 were removed to L.C.C. hospitals; and 8 to voluntary hospitals. Two of the patients were nursed by the Metropolitan Nursing Association under the arrangements made by the Council, in all 7 visits being paid to these patients. Enquiry respecting the cases of primary pneumonia elicited the following information ; — 7 resided in tenement lodging houses, 3 in separate private dwelling houses, 4 in model dwellings, 1 in common lodging houses, 2 in hotels, and 2 in caretakers' apartments on business premises, and 1 in a hospital (staff). The cleanliness of the houses were reported satisfactory in 13 cases, but only fairly so in 1, and in 1 case unsatisfactory. The economic conditions of the families concerned were found to be good in 5 cases, fair in 8, poor in 2, very poor in 2; 4 out of the 7 oases treated at home were nursed in a separate room. In 3 cases information as to economic condition was not obtainable. 60 Influenza. There were 12 deaths from influenza in comparison with 13 in 1931, 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 eight males and four females. Of the 12 three were above 65 years of age. Anthrax. No case of anthrax was notified in the Borough during the year. Chicken-pox. This disease is not notifiable, but during the year 1932 we received information of 189 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 19 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year:— Diphtheria Pulmonary Tuberculosis Other Diseases Number Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination. 351 Bacilli not found 290 62 Bacilli not found 62 3 2 Ringworm positive Diphtheria bacilli found 61 Vincent's organisms found 9 Bacilli found 10 1 Malaria positive Disinfections. During the year 544 rooms and 4,985 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Fifty-three rooms and 414 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. One hundred and thirty-two books and 21 toys were disinfected. The disinfections also included five lockers, and nine hospital wards. Cleansing of Persons Act. During the year 332 persons (316 men and 16 women) infested with vermin had their bodies and 2,217 articles of clothing disinfested, free of charge, at our cleansing station (Goldsmith Street). 61 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 1932 the accommodation was used by two Holborn families comprising nine 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 1932 information was received of five children suffering from scabies. Two homes were affected. Tn the case of one home it was found that the family had removed from the Borough; in the other the family was visited and kept under observation, disinfection of bedding, clothing and rooms being carried out on recovery of the patients. Seven children in three homes were notified as verminous (head lice). These children were treated at a London County Council cleansing station, and together with other children in the homes concerned were kept under observation by the Health Visitors. In one case the bedding and clothing was found to be dirty and cleansing by boiling or otherwise washing was carried out. 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 homes and tenements. 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 3½ gallons of the solution in small quantities were sold to 19 purchasers. One hundred and thirty-four 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 112 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. 62 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 1932 in the form required by the Ministry of Health: — Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary, Pulmonary. Non-pulmonary. M F V F M F M F 0 — 1 — — — 1 — — 1 — — 1 — — — 1 — 5 — — — — — 1 — — 10 — 2 — 1 — — — — 15 1 3 1 1 1 4 1 — 20 4 4 4 1 — — — — 25 8 11 2 2 2 1 — 1 35 9 5 — 1 5 3 — — 45 9 4 1 — 6 4 1 — 55 7 3 1 — 4 1 — — 65 1 1 — — 1 — — — 39 34 10 6 19 16 3 1 Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1931 336 Number of these patients residing in common lodging houses 48 The average number of cases notified annually during the past ten years 88 The number notified in the year 1932 89 Of the 89 cases notified in 1932, the number who attended the Dispensary 40 Total number of new cases examined at the Dispensary for the first time in 1932, including the above 40, and all contacts 110 Total attendances at the Dispensary in 1932 1,172 Supervision of home conditions; visits paid by— Tuberculosis Officer 43 Dispensary Nurse 1,180 63 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 3rd January, 1932, to the 3l st December, 1932, in the Metropolitan Borough of Holbom. Age-peridos Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary Males — — — — 1 3 7 7 6 7 1 32 40 ,, Females — — — 2 2 3 6 2 3 2 1 21 27 Non-pulmonary Males — — — — 1 4 1 — 1 1 — 8 8 „ Females — — — — 1 1 1 — — — — 3 4 Supplemental Return. New eases 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— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total. Pulmonary Males — — — — — 1 1 2 3 — — 7 ,, Females 1 — — — 1 1 5 3 1 1 — 13 Non-pulmonary Males — 1 — — — — 1 — — — — 2 „ Females — — — 1 — — 1 1 — — — 3 64 The source or sources from which information as to the above-mentioned cases was obtained are stated below: — Source of Information t No. of Cases. Pulmonary Non-Pulmonary Death Returns "From local Registrars 2 — Transferable deaths from Registrar General 3 1 Posthumous notifications — 1 "Transfers " from other areas (other than transferable deaths) 15 3 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 1932, on the Registers of Notifications 172 96 268 40 28 68 336 Number of cases removed from the Registers during the year by reason inter alia of :— Withdrawal of notification — — — — — — — Recovery from the disease 7 6 13 3 2 5 18 Death 24 14 38 1 1 2 40 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1932 was 64; 25 other cases were brought to my knowledge (making 89 new cases in the year). These were:—Private cases 15, hospital cases 30, Public Assistance cases 19, from death returns 6, transfer from other districts 18, and 1 was a posthumous notification. Of the 89 cases entered on the Register in 1932, 73 were pulmonary tuberculosis and 16 non-pulmonary tuberculosis. Sixty of the cases were removed for treatment to hospital, or sanatorium. Sleeping Conditions. In 69 of the 89 new cases of tuberculosis in 1932 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 five 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 69 cases above referred to : — Patient slept in— Separate bed room 14 Separate bed in living room 13 Sepurate bed in room shared with— 1 adult 7 2 adults 1 3 adults and 3 children 1 2 adults and 1 child 2 — 38 Shared bed with— 1 adult (Husband or Wife) 13 No others adult (not Husband or Wif) 8 in room 1 child 1 Shared bed with— 1 adult 1 adult 1 adult 1 child Other persons in bedroom 1 child 4 1 adult, 2 children 1 1 adult, 1 child 2 3 children 2 —31 69 Classification of Homes. The classification of homes as suggested by the London County Council has been reported on as far as practicable with the following results: — " A."—Good environment, clean, well-kept, separate bedroom (or in the case of husband and wife, no other occupant of bedroom), good food and clothing 13 " B."—Fair. Separate bed, but not separate bedroom 42 " C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 10 65 Summary. The following summary gives the position at the end of 1932 of the 89 new cases respecting which information was received during the year :— Dead 22 Cases removed to Nursing home, Hospital or Infirmary and still in-patients at the end of year 10 In-patients in Sanatoria at end of year 7 Removed from Borough 17 Home Treatment—Private or Panel Doctor 29 Away in country 1 No information 3 89 66 Non-attendance at Tuberculosis Dispensary. Forty of the 89 cases attended the Holborn Tuberculosis Dispensary. The following indicate? the reasons for non-attendance in the remaining cases:— Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 13 Dead before notification or died before attendance at Dispensary 18 Treatment at home by private doctor 4 Not traced and common lodging house cases 3 Removed from Borough 11 49 Delayed Notification. The Public Health (Tuberculosis) Regulations, 1930, requires 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 eases 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 ten cases were notified only at death, five within one month of death, one within three months and two within six months of death. It is unfortunate that these 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 103 admissions to institutions. These admissions represent 70 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: — Institutions of the London County Council 80 Other institutions 23 Visits to Homes, etc. During 1932 the Tuberculosis Officer made 43 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 1,180 visits. The advice given by the Tuberculosis Nurse includes suggestions respecting food and cooking and suitable " cookery " books are supplied free of charge. Also the wives and mothers of tuberculous patients were invited to attend cookery demonstrations at the Council's Maternity and Child Welfare Centre, No. 10, John Street. 67 Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. Fifty-nine contacts, viz., 23 adults and 36 children under fifteen years of age, responded to this invitation and were examined for the first time during the year 1932. Of these, three adults and one child were found to be definitely suffering from tuberculosis. Fifty-two were definitely diagnosed as not suffering from the disease. In three 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 34, a death rate of 0.93 per thousand. There were also four deaths from other forms of tuberculosis, a rate of 0.11 per thousand. The following table shows whether the patients died in their own homes or institutions:— Showing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- All Ages. Males. Females. Total. Number of patients who died at home — — — — 1 — 1 3 3 — — 5 3 8 Number of patients who died in hospitals, etc. 1 1 — 2 9 2 3 6 9 4 2 20 12 32 1 1 — 2 3 2 4 9 12 4 2 25 15 40 Tuberculosis Dispensary. the Report of the Tuberculosis Officer, J. A. Struthers, M.D.,B.Ch., M.R.C.P., D.P.H., for Return showing the work of the Dispensary during the year 1932. gnosis. Pulmonary. Non-Pulmonary. Adults. Children. Adults. Children. Adults. M. F. M. F. M. F. M. F. M. F. examined during the ding contacts):— y tuberculous 21 10 — 2 2 — — 1 23 10 ly tuberculous — — — — — — — — 2 — erculous — — — — — — — — 6 5 amined during the tuberculous — 2 — 1 — 1 — — — 3 ly tuberculous — — — — — — — — — — circulous — — — — — — — — 8 12 off the Dispensary 6 8 — — 1 — 1 2 _ 8 erculous (including ion of cases notified — — — — — — — — 14 17 Persons on Disister on December tuberculous 93 64 8 4 13 18 12 7 106 82 not completed — — — — — — — — 2 — ons on Dispensary Register on 932 224 7. Number of consultations with medical prac tioners: — (a) Personal (b) Otherwise nts transferred from other areas turned after discharge under vious years 13 8. Number of other visits by Tuberculo Officers to Homes ents transferred to other areas, ring further assistance under the ses " lost sight of " 20 9. Number of visits by Nurses or Heal Visitors to Homes for Dispensary purpose 10. Number of (а) Specimens of sputum, &e., examined (б) X-ray examinations made in connectin with Dispensary work off during the year as dead 20 1172 tendances at the Dispensary tacts) 11. Number of "Recovered" Cases restored Dispensary Register in A (a) and A (6) page 68 ured Persons under Domiciliary on the 31st December 41 12. Number of " T.B. plus" cases on Dispens; Register 31st December, 1932 70 Report of the Tuberculosis Care Committee for 1932. The Committee has met 11 times during the year. The average attendance of members at each meeting has been 10.36. Sixty cases have been considered—37 new ('29 adults and eight children) and 23 old cases (18 adults and five children). Thirty-four cases (28 adults and six children) were referred to the Committee for assessment. The average cost of treatment and maintenance provided by the London County Council is about £2. 10s. Od. a week for each patient. Eighteen adults and one child were recommended for free treatment. Ten adults and five children were assessed at amounts varying from 2s. 6d. to 15s. per week. In three instances assessments were re-considered subsequently, and reduced, owing to changes in circumstances. Two cases had to be referred to the Council's Official Collector, and in one of these the arrears were cancelled as irrecoverable. Contributions towards the cost of treatment and maintenance, amounting to £86. 14s. 7d., were collected on behalf of the London County Council in 20 cases— 11 advdts and nine children. Six of these were still under treatment at the close of the year. Twenty-one Progress Reports, on eight children, were received from the London County Council and the information contained therein was conveyed to the parents. Convalesence has been arranged in ten cases. Seven were sent away through the Invalid Children's Aid Association, and three through Stafford's Charity. Two children were boarded out through the United Services Fund, to enable their mother to accept treatment. During the year 710 visits have been paid to patients and their families, and many other visits have been paid on their behalf. Fifteen patients known to the Committee have removed from the district during the year, and four have been transferred to us from other districts. On the completion of treatment a grant from the Benevolent Society of St. Patrick enabled one patient to return to her relatives in Ireland. Sixteen patients known to the Committee have died. Six of these died at home and ten died in Institutions. The Committee gratefully acknowledges the co-operation and assistance given by such organisations as the British Legion and United Services Fund Benevolent Committee, the British Red Cross Society's Emergency Help Fund, the Charity Organisation Society, the Invalid Children's Aid Association, etc. 71 The general depression in trade and employment has been reflected in the Committee's work during the year. The amount collected in respect of the cost of treatment and maintenance, on the same number of cases, was fifty per cent. less than in 1931, and a larger number of patients required assistance with clothing. Help with clothing has been granted by the Charity Organisation Society, the Destitute Sailors' Fund, the St. Vincent de Paul Society, the Public Assistance Committee and the United Services Fund. We are glad to note that the housing problem seems to be somewhat less acute. During the year two families that were unable to remove from Central London were accepted by the London County Council as tenants and given suitable accommodation in the Borough. Six families known to the Committee were fortunate enough to obtain accommodation in Boswell House; four of these were displaced owing to the pulling down of the houses in which they lived, and two were selected by the Borough Council on account of their overcrowded conditions. Notice has been received that, under powers conferred in the Local Government Act, 1929, a new procedure will be adopted with regard to the treatment of tuberculous patients. As from the 1st April, 1933, all classes of cases will be dealt with under one section of the London County Council, instead of under two sections as heretofore, and all assessments will be made, in the first place, by the local tuberculosis care committees. Although this alteration in procedure will increase the work of the care committees, it is felt that it will be to the ultimate advantage of the patients. 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 1932 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. 72 Extractions were made in two cases, one with a general and. one with a local anaesthetic. 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. The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1932: — Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1931. Number of sessions held 48 Number of patients' attendances 276 Number of fillings 69 Number of scalings 11 Number { Without anæsthetic 1 extraction cases With local anaesthetic 13 With gas 31 Number of teeth extracted 176 Number of dentures (including repairs) 32 Number of dressings 36 Number for advice 42 Number of denture visits 59 Number of new patients 44 Cancer. During the year 1932, 71 deaths were recorded as due to Cancer in comparison with 79 in the previous year. The deaths in 1932 were equal to a rate of 1.95 per thousand, the corresponding rate in 1931 being 2.29 per thousand. In the year 1912 the death rate from Cancer in the Borough was 1.33, the decennial average rate was 1.31 for the ten years, 1911-1920, and 1.57 for the ten years, 1922-1931. It will be seen that the death rate from Cancer in the Borough in 1932 was lower than in the previous year, being 1.95 per thousand in comparison with 2.29 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, 1912-1921 was 1.31 the corresponding rate for the ten years, 1922-1931, was 1.57. Some part of this increase may reasonably be attributed to improved facilities for diagnosis. The figures indicate the high mortality from malignant diseases. 73 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 186 births were registered as occurring in the Borough. During the same period 164 notifications of births occurring in the Borough were received. Of these, 156 were from doctors and midwives, 8 from parents. The mothers were attended at their confinement by: — Private Doctors 34 Private Midwives 25 Out-patient Midwifery Departments of General Hospitals and Institutions: — Externs and others 38 Midwives.—University College Hospital 6 Charing Cross Hospital 4 Middlesex Hospital 4 St. Bartholomew's Hospital 3 Other Institutions 8 Training Institution for Midwives, Myddelton Square 34 156 Five of these notifications related to stillbirths. Number of Births. The number of births transferred to the Borough from outlying institutions was 171 The number of births transferred from the Borough to other districts was 8 The net number of births belonging to the Borough was 349 There are no maternity hospitals or public lying in institutions in the Borough but maternity cases are admitted to a nursing home in the area. Births in Crowded Homes. The following table is an indication of the home conditions of 313 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 38 10.9 52 14.9 Two „ „ 83 23.8 59 16.9 Three „ „ 36 10.3 29 8.3 Four „ „ 10 2.8 6 1.7 Total 167 47.8 146 41.8 These figures show that many of the women are confined under very uncomfortable nnd unfavourable circumstances. 74 Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 204 214 418 Post-natal Mothers 8 2 10 Children under 1 year of age 393 739 1,132 Children 1 to 2 years of age 21 415 436 Children over 2 years of age 33 748 781 Enquiries re stillbirths 13 re ophthalmia neonatorum 12 Other visits 165 Two hundred and sixty-one visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 249 were recorded as attending a Centre, i.e., 95 per cent. Thus more than five-sixths of those visited attended an Infant Welfare Centre and of these nearly 85 per cent. attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following:— 175 attended the Council's M. & C. W. Centre at 10, John Street. 38 Short's Gardens. 2 attended the Centre at Onslow Street School, Saffron Hill. 8 Charing Cross Hospital. 5 Myddelton Square. 10 Middlesex Hospital. 4 University College Hospital. 8 Royal Free Hospital. 9 other Centres. 249 attended an Infant Welfare Centre. Work at Centres. Holborn Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre: Monday. Tuesday. Wednesday. Thursday. Friday. Medical Consultation Pre-school child 2—4.30 p.m. Antenatal 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 Consultation 2—4.30 p.m. No. of Sessions 48 51 52 43 51 51 Total attendances — 650 ... 1724 ... 95 1170 Mothers 39 220 309 461 155 257 Average weekly attendances— Children 14 ... 33 ... 2 23 Mothers 1 4 6 11 3 5 75 St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year 1932, were as follows:— Thursday—Medical Consultation—2—4.30 p.m. No. of Sessions 2 Total attendances—Children 650 Mothers 43 Expectant Mothers 28 Average weekly attendances—Children 12 Mothers 2 The total number of attendances made by the Health Visitors at the Municipal Centres in 1932 was 560, and in addition Health Visitor students made 178 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 5,080 attendances were made by 217 mothers and 73 expectant mothers, and 529 children, of whom 244 were under one year, 108 between one and two years old, and 177 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 721 attendances were made by 31 mothers and 86 children, of whom 43 were under one year, 14 from one to two years and 29 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 78 voluntary notifications were received during 1932 as compared with 81 in 1931. 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 197 expectant mothers visited during 1932, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. Of the 114 who went into hospital:— 47 (24 primigravidæ) lived in a one-roomed home; 39 (18 primigravidæ) lived in a two or more roomed home. 76 Of the 83 who remained at home:— 10 (2 primigravidæ) lived in a one-roomed home; 44 (5 primigravidæ) lived in two rooms; 29 lived in three or more rooms. 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 190 times during the year 1932. 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 338 mothers, about whom information was obtained, 284 (84 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under:— Number of enquiries made 338 Centre Attended:— Holborn Centre, 10, John Street 38 Holborn Centre, Short's Gardens 16 Royal Free Hospital 25 Middlesex Hospital 17 Charing Cross Hospital 35 University College Hospital 30 Myddelton Square Institution 29 St. Bartholomew's Hospital 19 City of London Hospital 9 Queen Charlotte's Hospital 2 Elizabeth Garrett Anderson Hospital 10 Other Centres 20 Ante-natal care from private doctors 28 Ante-natal care from midwives 6 284 77 Nature of defects found at Municipal Centres. 10, John Street, Holborn. Short's Gardens, St. Giles. No. of women attending ante-natal clinics 73 11 Women expectant for the first time 13 5 No. of attendances made 162 26 Defects found specially connected with pregnancy:— Deformed pelvis 6 — Threatened miscarriage 2 — Retroverted gravid uterus 2 — Breech presentation 2 — Excessive vomiting 5 — Œdema 6 — Varicose veins 15 1 Excessive vaginal discharge 9 — High blood pressure 2 — Other defects 10 — Other defects:— Albuminuria 2 — Heart disease 4 — Anaemia 3 — Respiratory diseases 7 — Constipation 26 2 Dental caries 20 2 Dyspepsia 16 1 Pyorrhœa 2 — Rheumatism 4 — Other defects 7 — No. referred to maternity hospitals:— Normal 13 4 Abnormal 14 — No. referred to dental clinic 15 2 No. of urine tests made 111 5 Post-natal Consultations. Twenty-nine mothers attended the post-natal consultations at the Centre, 10, John Street, 12 of whom had attended the Centre as ante-natal cases. They made 74 attendances in all. The chief defects found were three cases of retroverted uterus (one referred to hospital); eight of cervicitis (all treated at the centre); three cases of anaemia; one case of metritis (referred to hospital); one case of laceration of the cervix (referred to hospital); one of subinvolution of the uterus; one cystocele and rectocele (referred to private doctor). 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. 78 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. Miss Audrey Stables has also given assistance at the Centre on Wednesdays whenever required. 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. Up-to-date model garments for babies and young children are always on view at the Centres. Two hundred and twenty-four hanks of wool of a special quality were sold at cost price to the value of £10. 3s. 5½d. Maternity outfits are placed on sale at the Centre at cost price, 5s. lOd. 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 1932:— Reasons for attendance. 10, John Street. Short's Gardens. Mothers:— Difficulty with breast feeding 35 3 Disorders of generative organs 24 — Constipation 11 — Heart disease 2 — Anœmia 17 — Respiratory disease 11 1 Digestive disorders 4 — Debility 39 6 Dental caries 31 1 Rheumatism 12 — Other Diseases 37 3 Children:— (Healthy) 171 44 Alimentary disorders 47 13 Rickets 22 2 Heart disease 6 — Rheumatism 2 — Respiratory disorders 65 9 Marasmus 10 — Debility 14 2 Hernia, umbilical 16 — Hernia, inguinal 2 — Phimosis 18 — Disease of skin 35 5 Disease of eye 20 — Disease of ear 11 3 Disease of nose and throat 23 — Dental caries 23 2 Other diseases 43 6 (In this table, if the patient has more than one ailment, only the more important has been recorded.) 79 Among the more unusual diseases was a case of erythrodœna polyneuritis (the so-called "Pink Disease") in a previously healthy breast fed baby, aged 3 months. A rash and photophobia developed at 4 months old. Hands and feet became red and somewhat swollen with desquamation of the palms of hands and soles of feet. The child gained no weight for two months and at 5½ months she was admitted to the Hospital for Sick Children, Great Ormond Street, with the complication of intussusception which was operated on and the child recovered from the operation, and at 8 months old had recovered from the symptoms of 1 ink Disease and is now a healthy child. Another was a case of marked scoliosis in a healthy baby of 5 months old, breast fed, weight 13 lbs. 13 ozs. (parents both healthy). He was sent to the Orthopædic Hospital which ordered a Bradford frame cradle, and the child's back is now straight. Mothers and children attending the Municipal Centres during 1932 were referred to other departments or organisations as follows:— Mothers. Children. Ante-natal Clinic 5 — Tuberculosis Dispensary l — Minor Ailments Clinic 47 164 Dental Clinic 44 24 Metropolitan Nursing Association 5 3 Nursery School — 2 Massage Clinic 3 — Hospitals 23 41 Convalescent Homes 5 23 Assistance Sub-Committee (for milk) 29 35 Relieving Officer 5 23 Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1932:— John Street. Short's Gardens. Number referred to Metropolitan Nursing Association Results:— 10 1 Breast secretion re-established, but small bottle feeds required in addition to breast feeding 5 1 Massage unsuccessful 5 — Pre-school Children. During the year 1932, 81 children were found to be under the normal weight, and 62 under the normal height for their respective ages, whilst the weights of 24, and the heights of 14, were above the average. The rest of the children were about normal in weight and height. Sixteen suffered from dental caries and were referred to the dental clinic. At the same time special dietetic treatment was instituted to harden the enamel and to prevent further decay. Nine had enlarged tonsils and adenoids, eight had enlarged tonsils and one child was found to be suffering from adenoids. In seven cases these were removed and the children have improved in health. One case of nasal diphtheria occurred. 80 There were seven cases of enlarged cervical glands, four of otorrhcea, two of external eye diseases and one of strabismus. One child was found to be suffering from rickets, and eight had knock-knees, the result of rickets. Three cases of rheumatism were notified, and during the winter there were 13 cases of respiratory disease, including one of bronchietasis, whilst most of the children suffered from nasal catarrh. Four cases of anaemia were treated, also one child for debility and four for intestinal parasites, whilst many cf the children suffered from lack of appetite and constipation. There was one case of jaundice and one of epistaxis. One child suffered from night-terrors, four from enuresis, one from thumbsucking, two from nail-biting, and one from stuttering. One child was treated for backwardness in talking, and six suffered from nervousness, one being sent to the Child Guidance Clinic. Ten cases of lichen urticatus occurred, three of eczema, and three of impetigo. These all responded well to treatment. Two children were referred to hospital for artificial sunlight. Foundling Site Day Nursery. The establishment of a day nursery and play centre for children at the Foundling Hospital Site has been referred to in previous Annual lieports. These activities were maintained during 1932. The number of children from Holborn attending this day nursery is evidence of the need of such facilities in its immediate neighbourhood, and the Council decided again to make a contribution (£20) towards the cost incurred in connection with Holborn children. School Entrants. During the year information was received from the London County Council that 169 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 1932 thirteen stillbirths were registered, 9 of which were legitimate. Enquiry as to possible causes was made in each case. Two occurred in the private practice of doctors, two in the extern practice of an institution, in six instances the confinement took place in hospitals, and in three cases no information was obtainable. Difficult labour was responsible for seven; in six of these abnormal presentation occurred; in one there was abnormality of the umbilical cord. In one no definite reason could be assigned. Prematurity accounted for one, and in four no information was obtainable. 81 Illegitimate Children. The births of 54 illegitimate children were registered. Two of these were above the standard for enquiry; six lived with both their parents who had a permanent home together; five with their mothers who worked to support them; six with their mothers who remained in their parents' home; five were placed in an institution; six died in early infancy; four were stillborn; 20 children could not be traced, the mother often not having stayed at the address given for more than one or two nighty before the birth of the child. Dental Treatment. The following is a summary of the work during 1932 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 52 52 52 Number of new Patients 32 34 66 Total attendances 167 83 250 Extractions— Ordinary - 1(1) 1(1) With local anæsthetic 4(7) — 4(7) With general anæsthetic 28(115) 27(119) 55(234) Scaling 20 — 20 Fillings— Simple 52 20 72 Root 3 — 3 Dentures(including 2 repairs) 17 — 17 Advice 40 40 80 The figures in brackets relate to the number of teeth extracted. In one case where the patient was very poor the denture was provided free of charge; contributions towards the cost were required in all other cases and in five instances the patients were required to pay the whole cost. 82 During the year 270 applicants received free or assisted milk under the scheme. This number included 103 who were receiving such assistance at the end of 1931. Grants were made to 167 new applicants. At the end of the year 1932, 157 applicants were receiving assistance, viz.: Mothers. Children. Total. Free milk 38 116 154 Half-price milk 1 1 2 Prepared milk — 1 1 39 118 157 The following table shows in detail how the 167 new applicants were assisted in 1932:— Milk. Prepared Milk. Free. Part Cost. Free. Part Cost. Expectant mothers 36 1 — — Nursing mothers 28 3 — — Children 85 1 4 10 Home Help. The Council's Home Helps attended 19 cases during the year in comparison with 26 in the year 1931. In nine of these the whole-time officer attended entirely and in six 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 four 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 seven 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 1s. 0d. per week up to the full cost. The services of the Home Help have been much appreciated ; it had been found that the Council's provision meets a much felt want in the Borough. The schema 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. 83 Convalescent Homes. Four mothers and their babies were sent away, three being also accompanied by a second child. In one case the applicant was required to contribute towards the cost. These mothers with babies were admitted to convalescent homes belonping to the Church Army. Seventeen applications were granted for convalescent home accommodation for children under five years of age, but in three cases the parents failed to take advantage of the facilities provided. Five 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, 1932, 153 infants and children under five attended the consultations, 44 of the total number coming from the Holborn Borough. The 153 children made 2,479 attendances. Extra food and nourishment was provided, also convalescent treatment at country and seaside Homes (78 mothers and 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, 1932. Ten children between the ages of one and five years died from the following causes:— Causes of Death. 1—2 2-3 3-4 4-5 Age of Group 1—5 M. F. M. F. M. F. M. F. M. F. Both Sexes. Measles ... 1 ... ... ... ... ... ... ... 1 1 Tuberculous Meningitis ... ... 1 ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... 1 ... 1 1 ... ... ... 1 2 3 Nephritis ... ... 1 ... ... ... ... ... 1 ... 1 Other 1 ... ... 1 ... 2 ... ... 1 3 4 1 2 2 2 1 2 ... ... 4 6 10 84 Deaths of Infants under One Year of Age, 1932. The homes were visited in a large 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 Weeks 3 4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Month 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 Bronchitis 1 ... 1 ... ... ... ... ... 2 ... 2 ... ... ... ... 1 ... ... 3 ... 3 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 2 Diarrhœa and Enteritis ... ... ... ... ... ... ... ... ... ... ... 1 3 1 2 ... 1 1 2 3 8 11 Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 Congenital Debility and Premature Births 1 ... 1 ... 1 ... ... ... 3 ... 3 ... ... ... ... ... ... ... 3 ... 3 Influenza ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 Violence ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Other defined diseases ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 2 ... 2 All defined disease 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 Totals 3 1 3 ... ... ... ... ... 7 1 8 3 4 1 2 2 1 2 2 15 10 25 Total both sexes 4 3 1 ... 8 7 3 3 4 25 Net births registered during the calender year. Net deaths registered during the calender year. Males Females Both sexes Males Females Both sexes Legitimate Infants 154 141 295 Legitimate Infants 12 7 19 Illegitimate Infants 24 30 54 Illegitimate Infants 3 3 6 85 DIARRHŒA AND ENTERITIS.— DEATHS UNDER 1 YEAR.—1932. Name. Date of Death. Age at Death. Cause of Death stated in Certificate. Died at home. Died in hospital. Attended at M. & C.W. Centre. Remarks. R.S. 15.3.32 5/12 Gastro-enteritis – Yes Yes Died in hospital to which it was admitted with German Measles. M.P. 16.5.32 10/52 Gastro-enteritis, acute Bronchitis – Yes No Died in hospital to which it was admitted with Whooping Cough. S.W. 15.7.32 5/12 Acute infective enteritis. Defective – Yes Yes (Not 10, John Street) – E.S. 18.7.32 5/12 Gastro-enteritis, Bron. Pneumonia – Yes No Child lived most of its life in a Receiving Room of the L.C.C. Mother was advanced case of pulmonary tuberculosis; now dead. D.S. 18.10.32 9/12 Gastro-enteritis – Yes No – H.F. 11.10.32 2/12 Diarrhœa and vomiting – Yes Yes – A.G. 14.12.32 10/12 Gastro-enteritis, Prematurity – Yes Yes Died in hospital after two months' stay; referred to hospital from 10, John Street Mother was advanced case of pulmonary tuberculosis; now dead. B.C. 29.7.32 7/12 Marasmus, Gastro enteritis – Yes Yes Admitted to hospital with marasmus. A.T. 15.11.32 10/12 Intussusception, Gastro-enteritis – Yes Yes Primary cause of death was intussusception. R.H. 22.11.32 1/52 Convulsions, Diarrhœa, Congenital heart Yes – No Child had congenital heart disease. J.M. 29.11.32 2/12 Marasmus, Gastro-enteritis – Yes Yes Child admitted to hospital with marasmus 86 INFECTIOUS DISEASES AMONG MOTHERS AND CHILDREN. Puerperal Fever and Puerperal Pyrexia. No. Initials Date of Notification Primipara or Multipara Antenatal Care Birth occurred in Onset subsequent to Recovery Remarks Patient's Home Institution PUERPERAL FEVER—One CASE. 1 C. R. 21-11-32 Multipara No – Institution – Died Patient removed to hospital after 69 hours labour at home (a) Bronchopneumonia (b) Septiæmia (c) Puerperal sepsis PUERPERAL PYREXIA—Six Cases. 1 B. L. 29-3-32 Primipara No – Institution Local uterine and perineal sepsis Bronchitis Recovered Stillbirth 2 I. M. 23-5-32 Multipara Yes Home – Breast and urinary infection Recovered – 3 M. D. 17-7-32 Primipara Yes – Institution Toxic absorption from bowels and mild sapræmia Recovered Caesarian section performed 4 W. S. 7-7-32 Primipara No – Institution Acute mastitis Cracked nipple Recovered – 5 M. S. 24 4-32 Primipara Yes – Institution Extensive dental caries Recovered – 6 C. B. 27-10-32 Multipara Yes Home – Mild intrauterine infection by coliform bacilli following abortion Recovered Notified as puerperal pyrexia 87 Ophthalmia Neonatorum. During the year 5 cases of ophthalmia neonatorum were brought to our notice, 4 of which were notified in pursuance of the Public Health (Ophthalmia Neonatorum) Regulations, 19.26 and 1928; 1 of the notifications was from a doctor in private practice, 2 from the Medical Officers of hospitals, and 1 from the doctor of a Nursing Home. 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. Four Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Case Number. Age when Notified. Age at Onset. By whom Notified. Type of Disease on Health Visitor's first call. Where Treated. Medical Attendance and Nursing. Result. Birth Notified by. 1 10 days 8 days Doctor (Hospital) Slight Hospital and later at home Maternity Ward—Hospital and Nurse from Hospital in home Cured Extern Department, Hospital 3 7 days 4 days Doctor (Private Practice) Moderate At home Doctor (Private Practice) Nurse (Maternity Nurses Institution) Cured Midwife, Institution 4 12 days 9 days Doctor (Private Practice) Very slight At home Doctor and Nurse Cured Extern Department, Institution 5 8 days 6 days Doctor (Nursing Home) - Nursing Home Nursing Home Cured Nursing home One Case not Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. 3 25 days 15 days Source of Information: London County Council None apparent on 12th day In hospital North-Western Hospital Cured Extern Department, Hospital 88 Midwives Act, 1902 and 1918. In connection with these Acts we received information from tlie Medical Officer of Health of the London County Council, of slight inflammation in the eyes of eight other infants, all of whom made complete recovery. Whooping Cough. Visits were paid to 173 persons suffering from whooping cough. Of these, 107 were notified by doctors; in 38 others the information was derived from the schools, in 23 from health visitors and in 5 from the L.C.C. Age. Sixteen were children under 1 year, 99 were aged 1 to 5, and 57 were 5 to 16 years, and 1 was an adult. Spread of Infection in Family. The 173 cases occurred in 125 families. In 89 families 1 case occurred; in 25 families 2 cases occurred, and in 10 families 3 cases occurred, and in 1 family there were 4 cases. Removal. Forty children were removed to hospital, approximately 23 per cent. All these were admitted to hospitals of the L.C.C. Measles. The notification of measles was discontinued at the end of 1919 but during 1932 I received information of 295 cases of measles. Of these 113 were notified by school teachers and 109 by medical practitioners; information of 33 was given by hospital authorities, 21 by health visitors, 19 by parents. Age. Nine were under 1 year, 158 were between 1 and 5 years, 109 were between 5 and 16 years, and 19 were over 16. Deaths. One child died, set 1½ years. Spread in Family. The 295 cases occurred in 240 families. In 197 families 1 case occurred, in 33 families 2 cases occurred, in 9 families 3 cases occurred, and in 1 family there were 5 cases. Removals. One hundred and thirteen patients (38 per cent.) were removed to hospital, 110 to L.C.C. infectious diseases hospitals, and 3 to the London Fever Hospital. 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 8 oases; 4 were notified by doctors, and information of 2 cases was received from schools, and 2 from hospitals. 89 Ages. 1 was under 1 year, 2 were between 1 and 5 years. 2 were between 5 and l6 years 3 were over 16 years. Removals. Three cases were removed to the London Fever Hospital, and two to L.C.C. Hospitals. Death. One child died, æt 5/12 the death certificate gives gastro-enteritis as cause of death. Epidemic Diarrhœa. 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 Diarrhœa and Enteritis was 11, 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 (see table on page 85). Nursing Arrangements. The services of the district nurses were used as follows in 1932:— Deficient Lactation 11 Cases 109 Visits. Complications after Pregnancy 7 „ 123 „ Ophthalmia Neonatorum 1 Case 28 „ Pneumonia 3 Cases 20 „ Influenza 4 „ 62 „ Measles 7 „ 111 „ Whooping Cough 1 Case 17 Total 34 Cases 470 Visits. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 9th to 15th October, 1932. With a view to economy the programme was limited to the following:— Co-operation with the School Organisation. Arrangements were made for about 1,300 senior children from all the elementary schools in the Borough to write essays on health lessons previously given in the schools. 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 Bracewell Smith, B.Sc., M.P., and Mrs. Smith) kindly entertained to tea the prize winners and the children whose essays were selected M 90 from the various schools. We are much indebted to the teachers for t/heir 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 also again invited to enter a competition in the designing of health posters. About 90 designs were submitted from four schools. Three prizes were awarded, two going to St. Peter's School and one (for juniors) to St. George-the-Martyr School. Arrangements were made for children from the various schools to see the posters at the Child Welfare Centre, No. 10, John Street. Minor Ailments. The Minor Ailments Clinic has been carried on as usual on Tuesday and Friday afternoons. One hundred and fifty-six patients attended the clinic making 288 attendances. As usual the chief ailments of the children were those which come under the heading of sores, which includes impetigo. The children with these ailments made 81 of the 288 attendances. Next in number came umbilical hernia (42), conjunctivitis (30), constipation (19). Other ailments dealt with were cuts, grazes, burns, ear discharge and wax in ear, ring worm, nasal catarrh, etc. Among the mothers such complaints as mastitis, tonsillitis and leucorrhoea have received treatment. Medical Inspection and Treatment of School Children. The medical inspection and treatment of children attending Public Elementary Schools in Holborn is carried out by the London County Council. The following treatment Centres are provided under the L.C.C. Schemes: — (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries:— (1) St. Bartholomew's Hospital. (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. 91 Routine Medical Examination of Elementary School Children in Holborn in 1932. Age Groups. Number examined. Clothing and Boots. Nutrition Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants– Boys 187 9 175 3 23 141 23 – 179 8 – 161 26 – 117 42 28 – – – Girls 194 14 179 1 47 127 20 – 176 16 2 177 17 – 118 49 27 – – – Age 8– Boys 205 8 196 1 26 136 43 – 192 9 4 179 26 – 123 46 30 111 67 27 Girls 156 3 150 3 25 109 22 – 120 21 15 129 27 – 105 36 15 88 46 21 Age 12– Boys 241 11 228 2 32 169 40 – 234 5 2 215 26 – 193 40 8 155 33 53 Girls 225 4 221 – 50 143 32 – 199 21 5 208 17 – 188 33 4 144 31 50 Age 14– Boys 133 1 129 3 25 93 15 – 130 1 2 108 25 – 106 24 3 81 14 38 Girls 119 6 112 1 36 77 6 – 110 8 1 109 10 – 95 20 4 66 25 28 Total 1,460 56 1,390 14 264 995 201 – 1,340 89 31 1,28 6 174 – 1,051 290 119 645 216 217 Percentage ... 3.8 95.2 1.0 18.1 68.2 13.7 91.8 6.1 2.1 88.1 11.9 – 72.0 19.9 8.1 59.9 20.0 20.1 London ... 58.2 41.1 0.7 21.1 74.3 4.6 96.0 3.6 0.4 97.5 2.4 0.1 68.7 26.3 5.0 61.7 21.3 17.0 92 Examination of Elementary School Children in Holborn in 1932. Defect. Boys. Girls. Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number Examined 187 205 241 133 194 156 225 119 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 1 1 2 2 — — — — 1 1 2 2 1 1 — — Skin Disease 3 2 2 1 2 1 2 1 2 1 2 — 4 1 — — Defective Teeth — 66 — 71 — 48 — 26 — 70 — 48 — 35 — 24 Enlarged Tonsils 57 15 34 6 33 7 15 5 63 14 31 3 42 8 29 12 Adenoids — — — — — — 1 1 — — — — — — — — Enlarged Tonsils and Adenoids 1 1 3 1 — — — — 1 — — — — — — — Other Nose and Threat Defects 8 1 3 — 4 2 1 1 7 1 2 — 1 — 2 1 Enlarged Glands 3 — 2 — 1 — 1 — 3 — 1 — 1 — 1 — Eye Disease 4 3 5 — 4 2 3 — 10 8 1 — 4 1 1 — Vision Defect — — — 15 — 42 — 24 — — — 13 — 38 — 22 Otorrhaœa 3 3 2 2 6 5 1 1 6 3 — - 5 3 2 1 Other Ear Disease — — — — 1 — — — — — — — — — — — Defective Hearing — — — — — — — — - — - 2 — 2 1 Speech Defects — — — — — — — — — — — — — — — — Heart Defects 3 — — — 5 — 1 — 2 — 4 — 6 1 5 1 Anæmia — — 3 — 6 1 — — 2 1 1 - 1 1 1 — Lungs Defects 5 4 3 1 - — — — 6 4 — — 1 1 2 1 Nervous Defects 3 1 — — 1 — 1 — — 1 — 1 — 1 — 2 — Phthisis — — — — — — — — - — — —— — - - — Other T.B. Disease — — 1 1 — — — — — — — — — — — — Rickets 5 1 1 — — — — — — — — — — — — — Spinal Deformities — — — — — — 3 — 1 — - — 3 1 _ — Other Deformities 2 — 1 — 5 — 6 2 3 — — — 10 3 2 — Other Defects 13 4 9 5 5 3 1 — 13 6 9 1 9 5 3 — Number of Children noted for treatment 89 94 97 56 94 67 83 50 •Defects, hower slight, are included under "Cases." Those severe enough to require treatment are shown under*. 93 Deaths of Children 5 to 15 Years, 1932. Nine children (7 boys and 2 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 14), diphtheria (girl, aged 8; boy, aged 9), pneumonia (boy, aged 6), violence (boys, aged 11 and 12), rheumatic carditis (boy, aged 11), acute nephritis (boy, aged 10), and generalised pviemic abscesses (boy, aged 10). SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 07 bodies were deposited. There were 89 post-mortem examinations made, and 12 inquests held. The inquests are held in the Court Room at the Town Hall. On 8 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes. Eighty-three bodies were brought in by order of the Coroner, and 6 by the Police. Inquests. During the year 50 inquests were held on the bodies of Holborn parishioners. Many of these died outside the Borough and the inquests were held in the districts 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, 12; Accidents, 19; Suicide, 14; Misadventure, 3; Open Verdict, 2. The causes of death certified were as follows: — Natural Causes. Alcoholism 4 Pneumonia 4 Heart disease 2 Other causes 2 Misadventure. Coal gas poisoning 1 Wow on head 1 Operation 1 Open Verdict. Cause of death unknown 1 Asphyxia 1 Accidents. Poisoning 1 Airplane crash 1 Falls 7 Street accidents 7 Burns 1 Wounds 1 Crushed by lift 1 Suicide. Coal gas poisoning 5 Other poisoning 4 Hanging 2 Railway train 2 Razor wounds 1 The Removal of Aged, Infirm and Diseased Persons. Power to deal with this matter is given by the London County Council (General Powers) Act, 1928. During the year it was not found necessary to take any action in pursuance of these powers. Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. No application was received during the year for certificates under the above Acts. 94 Nuisances Caused by Dogs. With a view to the prevention of nuisances from the fouling of footways by dogs the Council, in the year 1926, made the following By-law:— "No person being in charge of a dog in any street or public place and "having the dog on a lead shall allow or permit such dog to deposit its "excrement upon the public footway." The By-law after being in force for an experimental period until 1st June, 1928, was made permanent; it is administered by the Borough Engineer'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 Report for 1928. At the request of the occupiers of a large block of offices steps were taken to reduce the number of pigeons frequenting the precincts of the building. Subsequently a letter was received thanking the Council for the action taken and notifying considerable improvement. At the request of the London County Council arrangements were made for reducing the number of pigeons in Lincoln's Inn Fields. 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 Minister 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 five 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 passed. Propaganda. The propaganda work reported on in previous yeas has been continued. 95 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 has been exhibited in the Borough and arrangements made for its loan for exhibition in other districts subject to payment of a small charge. "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. 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." Acid Effluent in Sewers. In March, 1932 information was received of the presence of acid fumes in a London County Council sewer in Holborn, the fumes being traced as coming from one of the Holborn Council's local sewers. Steps were at once taken to trace the source of the discharge and the works found to be concerned were visited. Particulars of the conditions complained of were furnished to the Chief Inspector 96 of Alkali, etc., Works who kindly co-operated with the Council's officers although the matter, being concerned with offensive liquid effluent, was not strictly within his jurisdiction. Oil investigation the accident was attributed to oxides of nitrogen being carried into the sewers in solution from nitric washing towers. Under normal conditions the bulk of the nitrogen oxides evolved in the industry is recovered for re-use, only traces being permitted to run to waste. It appeared, however, that owing to pressure of work the capacity of the recovery system was overtaxed and a greater proportion than usual of the nitrogen oxides reached the sewers. Steps were taken by the proprietors of the works to neutralise the acid effluent and prevent continuance of the trouble. Notwithstanding this action the trouble recurred in November. Exhaustive examination was therefore made of the interior of all the sewers in the vicinity of the area affected and the effluents from the various drain connections were examined. Information was obtained as to firms in the neighbourhood using acids in the process of their business and special attention was given to the drain connection from premises occupied by these firms, but the results were negative except in the case of the works originally responsible. The Chief Inspector of Alkali, etc.. Works again co-operated and on his suggestion further steps were taken by the management of the works effectively to avoid any recurrence of the dangerous conditions; a continuous stream of milk of lime is being discharged into the effluent. Recovery of Silver: Nuisance. During 1931 numerous complaints were received from occupiers of premises in the neighbourhood of Eed Lion Square regarding smells arising in the streets and in some cases entering the houses. The smell, which was similar to that of sulphuretted hydrogen, seemed to arise from the street gullies and ventilators. The sewer in the street principally concerned is a pipe sewer with a dead end. A sample of the sewage was submitted to the Public Analyst who reported that it consisted mainly of sodium hyposulphite, a substance used largely in photography. Following this report all premises in the street affected were inspected but in none was this chemical or anything similar used. It was then decided to trace the drainage from premises in adjoining streets and eventually it was found that the drain of a building in an adjoining street ran under premises at the rear into the affected sewer. This building was occupied by a firm who were treating the waste products from photography to recover the silver and turning the waste effluent into the drain. This was found to be the cause of the nuisance. The attention of the firm was drawn to the nuisance and they immediately agreed to seek advice as to the best method of abating it. The Public Analyst advised certain treatment which was adopted with excellent results. One complaint as to the smell was subsequently received, in March, 1932, and a slight modification was then made in the treatment. Since that time no nuisance has been experienced. 97 APPENDIX. TABLE I. Vital Statistics of Whole District during 1932 and Ten Previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Uncorrected Number Net ' Number Rate of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate Number Kate 1922 42,850 485 664 16.5 746 17.4 518 342 48 72 570 13. 3 1923 43,376 423 693 13.7 718 16.6 491 300 47 79 626 12.1 1924 43,250 394 678 13.36 670 15.6 470 329 47 81 529 12. 2 1925 43,816 364 527 12.16 725 16.7 513 330 33 63 542 12.5 1926 43,200 330 535 12.38 629 14.6 454 347 48 90 522 12.1 1927 42,209 320 605 11..96 728 17.2 531 333 19 38 530 12.5 1928 39,280 301 473 12.0 739 18.8 546 338 27 57 531 13.5 1929 38,380 256 392 10.21 766 19.9 545 377 29 74 598 15.6 1930 38,380 255 405 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 1932 36,440 186 349 9.57 773 — 607 351 25 72 517 14.2 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. N 98 TABLE II. Causes of, and Ages at, Death, 1932. causes of Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Resilient s "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 1 65 vears. 1 65 and under i 75 years. 75 and upwards. All causes Certified 517 25 3 7 9 14 60 147 124 128 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... 2. Measles 1 ... 1 ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 1 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 5. Diphtheria 2 ... ... ... 2 ... ... ... ... ... ... 6. Influenza 12 1 ... ... ... ... 3 5 1 2 5 7. Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... ... 8. Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... 10 9. Tuberculosis of Respiratory System 34 1 ... ... 1 5 11 15 1 ... 21 10. Other Tuberculous Diseases 4 ... ... 1 ... 1 1 1 ... ... 38 11. Syphilis 1 ... ... ... ... ... ... ... l ... 6 12. General Paralysis of the insane, Tabes Dorsalis 5 ... ... ... ... ... 1 3 1 ... 5 13. Cancer, malignant disease 71 ... ... ... ... ... 6 32 21 12 51 14. Diabetes 5 ...... ... ... ... 1 ... 2 1 1 4 15. Cerebral Hæmorrhage 21 ... ... ... ... ... 1 5 9 6 11 16. Heart Disease 127 ... ... ... ... 2 5 27 41 52 23 17. Aneurysm 10 ... ... ... ... ... l 6 2 1 ... 18. Other Circulatory Diseases 27 ... ... ... ... ... ... 2 11 14 4 19. Bronchitis 27 3 ... ... ... ... 3 2 7 12 6 20. Pneumonia (all forms) 33 2 1 2 1 3 2 9 6 7 93 21. Other Respiratory Diseases 2 ... ... ... ... ... 2 ... ... ... 18 22. Peptic Ulcer 8 ... ... ... ... ... 1 4 3 ... 3 23. Diarrhœa, etc. (under 2 years) 13 11 ... ... ... ... 2 ... ... ... 69 24. Appendicitis 3 ... ... ... ... 1 ... 2 ... ... 4 25. Cirrhosis of Liver 6 ... ... ... ••• ... 2 4 ... ... 3 26 Other diseases of liver, etc. 2 ... ... ... ... ... ... 2 ... ... 1 27. Other digestive diseases 6 1 ... ... ••• ... ... 2 2 1 16 28. Acute and Chronic Nephritis 13 ... ... 1 ... 1 3 2 3 3 34 29. Puerperal Sepsis 2 ... ... ... ... ... 2 ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ••• ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 3 3 ... ... ... ... ... ... ... ... 45 32, Senility 5 ... ... ... ... ... ... ••• 1 4 I 3?. Suicide 13 ... ... ... ... ... 4 8 1 ... 1 34. Other Violence 18 1 ... ... 2 ... 5 ... 4 6 5 35. Other Defined Diseases 40 1 1 3 3 ... 4 14 7 7 132 36. Causes ill-defined or unknown 2 1 ... ... ... ... ... ... 1 ... ... 517 25 3 7 9 14 60 147 124 128 611 99 TABLE III. Cases of Infectious Disease notified during the year 1932. Disease. Total Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 up Total Deaths small-pox 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Diphtheria 76 ... 4 2 7 8 27 7 5 14 1 1 ... ... Erysipelas 17 ... ... ... ... ... 1 1 1 3 1 6 4 1 Scarlet Fever 57 ... 4 2 4 4 25 5 5 7 1 ... ... ... Enteric Fever 4 ... ... ... ... ... ... ... 1 2 1 ... ... ... Puerperal Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... do. Pyrexia 6 ... ... ... ... ... ... ... 1 5 ... ... ... 1 Cerebro-spinal Fever 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Malaria 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Pneumonia—Primary 20 1 ... 1 ... ... 3 2 ... 2 4 4 ... 1 do. Influenzal 8 ... ... ... ... ... 1 ... 1 2 2 2 ... 3 Tuberculosis— Pulmonary 73 1 ... ... ... ... ... 2 4 27 14 23 ... 38 do. Non-Pulmonary 16 ... ... 1 ... ... ... 1 2 9 1 2 ... 2 Whooping Cough 108 12 25 10 18 13 29 ... ... 1 ... ... ... ... Acute Poliomyelitis 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 Rheumatism 5 ... ... 1 1 1 2 ... ... ... ... ... ... ... 402 18 33 17 30 26 89 21 20 75 36 38 9 49 100 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PRISMISES. Number in Borough at end of 1931. Number of Inspections. Number of Prosecutions. Cowsheds ... ... ... Milkshops 141 247 ... liegistered houses let in lodgings 474 861 1 Ice cream premises 27 87 ... Slaughter-houses 1 2 ... Offensive Trades ... ... ... Restaurants and Eating Houses 291 479 ... Housing of the Working Classes— Number of houses inspected :— (a) On account of complaints or illness (Public Health Act) 803 (b) House to house (Housing Consolidated Regulations, 1926) 106 Number of notices served :— (а) Under Public Health Act:— (i.) Intimation 427 (ii.) Statutory 51 (b) Under Housing Act — Number of houses repaired or nuisances remedied under Public Health Act 427 Number of houses repaired under Section 17 of Housing Act: — (a) By owners — (b) By local authority in default of owners — Number of houses closed on notice by owner that they could not be made fit Number of houses for the working classes :— (a) Erected during year (erection completed) 2 blocks (34 flats) (b) In course of erection 1 block (28 flats) Number of representations bv Medical Officer or other person 4 Number of houses included in such representations 3& 1 part house Number of Closing Orders made Nil Number of Closing Orders determined (i.e., houses made fit) 3 Number of Demolition Orders 3 Number of houses demolished : — (a) In pursuance of Orders 3 (b) Voluntarily — Total number of houses in the borough 6462 (Census, 1931) Number of houses occupied by the working classes 7285 Underground Rooms— Number illegally occupied, notices served 8 Number closed or illegal occupation discontinued 8 Overcrowding— Number of cases of overcrowding found; notices served 2 Number of prosecutions — Number remedied 2 Smoke Nuisances— Number of observations 209 Number of notices 3 Number of complaints 8 Number of summonses — Cleansing and Disinfection— Number of adults cleansed 382 Number of children cleansed — Number of premises disinfected :— (a) After infectious diseases 218 (b) For vermin 134 Water Supply to Tenement Houses— Number of premises supplied 2 Number of prosecutions — Sanitary Officers— Number of Sanitary Inspectors (whole-time) Male 3 Female - Number of Sanitary Inspectors (part-time) Male Female 1 Number of Health Visitors (whole-time) 1 part-time 1 101 TABLE V. Factories, Workshops, Laundries, Workplaces and Homework 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. PREMISES. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 545 21 2 ... Workshops 550 31 4 ... Workplaces 3,871 42 5 ... Total 4,966 94 11 ... 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 39 39 ... ... Want of ventilation 6 6 ... ... Overcrowding 1 1 ... ... Other nuisances 51 51 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 21 21 ... ... not separate for sexes 2 2 ... ... 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 120 120 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 102 TABLE V.—continued. 3.—HOME WORK. Outwork in Infected Premises, Sections 109, 110. Prosecutions (Sections 109, 110) ... ... ... ... ... ... Orders made (S. 110). ... ... ... ... ... ... Instances. ... ... ... ... ... ... Outwork in Unwholesome Premises, Section 108. Prosecutions. ... ... ... ... ... ... Notices served. ... ... ... ... ... ... Instances. ... ... ... ... ... ... Outworkers' Lists, Section 107. Prosecutions. Failing to send lists. ... ... ... ... ... ... Failing to keep or permit inspection of lists. ... ... .... ... ... ... Notices served on occupiers as to keeping or sending lists. 108 ... ... ... 2 110 Lists received from Employers. |Sending once in the year. Outworkers. Work' men. 14 ... ... ... 14 ... Contractors. ... ... ... ... ... ... Lists. 2 ... ... ... ... 2 Sending twice in the year. Outworkers. Workmen. 137 ... ... ... 14 151 Contractors. 283 ... ... ... ... 283 Lists. 108 ... ... ... 2 110 NATURE OF WORK. Wearing Apparel— (1) Making, &c. (2) Cleaning and Washing Racquet and Tennis Balls Umbrellas Paper Hags and Boxes Total 103 TABLE V.—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 620 Total number of workshops on Register 643 5—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H. M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 61) Notified by H.M. Inspector 18 Report (action being taken) sent to H .M. Inspector 18 Other — Underground Bakehouses (S. 101): - — Certificates granted during the year — In use at the end of the year 14 104 TABLE VI. METEOROLOGY OF LONDON, 1932. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal) 1930. Air Temperature. Bright Sunshine. 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.* Maximum. A | Minimum.. B °F °F °F °F hrs. hrs. % m.m. m.m. January 49.0 38.4 43.7 + 5.2 1.19 -0.05 14 40 - 3 February 42.6 33.1 37.9 -1.9 1.46 -0.58 15 8 -32 March 49.7 32.7 41.2 -1.3 3.79 + 0.39 32 37 -7 April 54.6 38.4 46.5 -1.1 3.71 -1.31 27 62 + 25 May 61.9 44.8 53.3 -0.7 3.46 -3.01 22 103 +59 June 69.7 49.1 59.4 -0.5 0.18 -0.52 37 17 - 34 July 73.5 53.7 63.6 + 0.1 4.36 -2.14 27 75 + 18 August 78.1 56.6 67.3 + 4.7 6.12 -0 .08 42 57 + 1 September 66.7 50.4 58.5 + 0.5 3.34 - 1.61 27 53 + 8 October 56.3 42.5 49.4 - 0.8 2.74 - 0.38 26 137 + 73 November 49.2 39.9 44.5 + 0.5 0.60 - 1.12 7 26 - 32 December 46.8 37.9 42.3 + 2.1 1.35 + 0.29 17 13 - 44 Year 58.2 43.1 50 .7 +0.6 3.19 -0.84 24 628 or 24.72 ins. + 32 or + l.26in. *The averages used are obtained from observations extending over 35 years (1881-1915). 105 LEGAL PROCEEDINGS. Food and Drugs (Adulteration) Act, 1928 Date. Name. Address. Offence. Result. 1932 Dec. 9th Stubneys Ltd. 89, Theobald's Road Selling milk 16.3% abstracted fat Dismissed on payment of £3. 3s. costs. 1933 Jan.12 th A. Previdi 11, Museum Street Selling milk 18.0% abstracted fat Defendant convicted Fine 20s.; Costs 21s. Public Health (London) Act, 1891. Date. Name. Address. Offence Result. 1932 Oct. 5th C. A. Mitchell 5, Devonshire Street Nuisance and breach of Lodging House By-laws Summons withdrawn on payment of 10s. 6d. costs in each case. Jan.26th W. Knowles 23, Theobald's Road Nuisance Order made for work to be done within 1 month. Costs 10s. 6d.