a HOL31 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of Health, C. W. HUTT, M.A., M.D., M.R.C.P., D.P.H. For the Year 1933. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway W.C.2. 1934 72652 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C. 1. To the Mayor, Aldermen and Councillors op the Mktropolitan 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 1933. Believe me, Ladies and Gentlemen, Yours obediently, C. W. HUTT, Medical Officer of Health. A 2 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 10 Deaths 11 Seasonal Mortality 12 Infantile Mortality 12 Deaths in Public Institutions 12 General Provision of Health Services 12 Sanitary Circumstances Scavenging. llcmoval of House Refuse 13 Dust Inspeotor Removal of Offal 14 Litter on Public Way 14 Removal of Manure 15 Sanitary Inspection of District 15 Notices served 10 Water Supply in Block Dwellings 18 By-laws as to Houses let in Lodgings 18 Rag and Bone Dealers 18 Rats and Mice (Destruction) Act, 1919 18 National Rat Week 19 Smoke Abatement 20 Inspection of Workshops 20 Factories 21 Out workers 23 Rag Flock Acts 23 Housing Statistics 23 Common Lodging Houses 24 Boswell Court Housing Scheme 25 Housing Accommodation on L.C.C. Estates 25 Holboru Housing Trust, Ltd 25 Flatlets 25 Inspection and Supervision of Food. ,. Dairies, Cowsheds and Milk Shops 26 Residue from Milk Clarifiers 26 Milk (Special Designations) Order, 1923 26 Milk—Bacteriological Examination 27 Dried Milk 27 Margarine 28 Bakehouses 28 Sale of Fish 28 Fried Fish Shops 28 Market Streets and Exposure of Food Generally 28 Street Trading 29 Ice Cream 29 Meat Regulations 30 Places where Food is Prepared for Sale 30 Inspection of Restaurant Kitchens 31 Unsound Food 31 Preservatives in Food Regulations 31 Food and Drugs (Adulteration) Act, 1928 32 Articles Analysed 32 Borough Analyst, Notes by 34 Milk 36 The Merchandise Marks Act, 1926 37 Agricultural Produce (Grading and Marking) Act, 1928 38 London County Council (General Powers) Act, 1932 38 Registration of Food Premises 38 Maggots in Chocolate 39 Notification of Food Poisoning 39 Slaughter of Animals Act, 1933 40 4 Page Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 41 Smallpox 42 Vaccination 43 Diphtheria 43 Diphtheria in Hospitals 44 Diphtheria Contacts 45 Si-liit-k Test anil Immunisation against' Diphtheria 45 Immunisation of Nursing Stuff at London Homoeopathic Hospital 48 Immunisation of School Children 48 Scarlet Fever 48 Acute Rheumatism in Children 48 Holidays for Rheumatic Children 52 Typhoid and Paratyphoid Fevers 52 Typhus Fever 52 Corobro-Spinal Fever 52 Bacillary Dysentry 52 Malaria 52 Encephalitis Lethargies 52 Acute Poliomyelitis and Acute Polioencephalitis 54 Pneumonia 55 Influenza 55 Anthrax 55 Cliickenpox 55 Mumps 55 Bacteriological Work 55 Disinfections 56 Cleansing of Persons Act 56 Shelter during Disinfection 56 Extermination of Vermin 56 Tuberculosis 57 Summary of Notifications and Deaths 57 Public Health (Tuberculosis) Regulations, 1930 58 Supplemental Return 58 Notification Register 59 Tuberculosis Notifications 59 Sleeping Conditions 59 Classification of Homes 60 Non-attendance at Tuberculosis Dispensary 61 Delayed Notification 61 Institutional Treatment 61 Visits to Home 61 Contacts 62 Prevention of Spitting 62 Deaths from Tuberculosis 62 Tuberculosis Dispensary 63 Tuberculosis Care Committee 65 Public Health (Prevention of Tuberculosis) Regulations, 1925 66 Tuberculosis: Extra Nourishment 66 Home Nursing 66 Dental Clinic 67 General Dental Clinic 67 Cancer 67 Maternity and Child Welfare Notification of Births 68 Number of Births 68 Births in Crowded Homes 68 Home Visiting 69 Attendances at Infant Welfare Centres 69 Work at Centres 69 10, John Street 69 Short's Gardens 70 Ante-natal Hygiene 70 Confinements iu Institutions in relation to Housing Conditions 70 Baths 71 Aute-natal Centres 71 Post-natal Consultations 72 InstTuction in Mothercraft and Hygiene 72 5 Page Maternal and Infant Consultations 73 Breast Massage 73 Prc-School Cliildren 74 Foundling Site Day Nursery 74 School Entrants 74 Stillbirths 75 Illegitimat 75 Dental Treatment 75 Supply of Milk and Food for Mothers and Infants 76 Home Help 76 Convalescent Home Treatment 77 Saffron Hill Maternity and Child Welfare Centre 77 Deaths of Children, One to Five Years 77 Deaths of Infants under One Tear 78 Enteritis, Deaths from 79 Infectious Diseases among Mothers and Children 80 Puerperal Fever and Pyrexia 80 Ophthalmia Neonatorum 81 Midwives Acts, 1902 and 1918 82 Whooping Cough 82 Measles 82 Measles Control in Schools 82 German Measles 82 Diarrhoea and Enteritis under 2 years 83 Nursing Arrangements 83 Minor Ailments Clinic 83 Medical Inspection and Treatment of School Children 83 Infant Life Protection 86 Birth Control 87 Health and Baby Week 87 Deaths of Children, 5-15 Tears 88 Sanitary Administration Mortuary 88 inquests 88 Removal of Aged Persons 89 Kent and Mortgage Interest' (Restriction) Acts 89 Rent Restriction Regulations, 1933 89 Nuisances caused by Dogs 89 Nuisance from Pigeons 90 Old Buildings—Demolition of 90 Children's Country Holiday Fund 90 Propaganda 90 Schick Film 91 Other Propaganda 91 Noise from Loud Speakers, etc., By-law 91 Private Swimming Baths APPENDIX. Table I. Vital Statistics, 1932, and ton previous years 92 Table II. Causes of and Ages at Death, 1932 93 Table III. Infectious Diseases Notified during 1932 94 Table IV. Information required by L.O.C. 95 Table V. Factories, Workshops, &c. (1) Inspections 96 (2) Defects found 96 (3) Home W ork 97 (4) Registered Workshops 98 (5) Other Matters 93 Table VI. Meteorology of London, 1932 99 Legal Proceedings 100 Ambulance Service (see inside of back cover). List of Notifiable Diseases (seo back of cover). 6 PUBLIC HEALTH COMMITTEE. 1932-33. Chairman— Councillor Harold J. Jewell. Vice-Chairman— Alderman Albert J. Clark. Ex-Officio— His Worship The Mayor, Councillor Fred Howard, J.P. Alderman Charles Sliortland. Councillor Edmund Balding. ,, John H. Boraston, C.B. ,, The Bcv. Wilfred H. Davies, M.A „ Herbert H. V. Harrison. „ William M. Morgan. „ Sidney Parks. ,, Robert Portwine. ,, William R. Wheatlcy. .. George Withcrby. 1933-34. Chairman— Alderman Albert J. Clark. Vice-Chairman— Councillor Robert Portwine. Ex-Officio— His Worship The Mayor, Alderman Albert A. Mussctt, J.P. The Deputy Mayor, Councillor Fred Howaid. Alderman Charles Sliortland. ,, J. C. St. Laureuce Stallwood. Councillor Edmund Balding. ,, John H. Boraston, C.B. „ The Rev. Wilfred H. Davies, M.A „ Herbert H. V. Harrison. ,, Harold J. Jewell. ,, William M. Morgan. „ Sidney Parks. William R. Wheatley. HOUSING OF THE WORKING CLASSES COMMITTEE. 1932-33. Chairman— Councillor Horace W. Langdon, F.S.I. Vice-Chairman— Councillor Robert P. Bristow. Ex-Officio— His Worship The Mayor, Councillor Fred Howard, J.P. Alderman Percy Hill, L.C.C. Councillor Rev. Wilfred H. Davics, M.A. ,, Henry W. Ellis. „ Miss Frauces M. Graves.F.R.Hist.S., M.P. „ Roland H. Haxell. „ Albert E. Hunter. ,, Wilfred E. Mullen. ,, George D. Pooley. ,, As her Rosenberg. ,, Alfred R. Taylour, M.A. 1933-34. Chairman— Councillor Horace W. Langdon, F.S.I. Viee-Chairman— Councillor Robert P. Bristow. Ex-Officio— His Worship The Mayor, Alderman Albert A. Mussctt, J.P. The Deputy Mayor, Councillor Fred Howard. Alderman Percy Hill, L.C.C. Councillor Joseph Baker. „ Rev. Wilfred H. Davics, M.A. „ Poland H. HaxelJ. ,, Albert E. Hunter. ,, Wilfred E. Mullen. ,, George D. Pooley. „ Asher Rosenberg. „ Alfred R. Taylour, M.A. „ Francis W. Yates, B.A. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1932-33. 1933-34. Chairman— Chairman— Councillor George D. Pooley. Councillor George D. Pooley. Vice-Chairman— Vice-Chairman— Councillor Wilfred E. Mullen. Councillor Wilfred E. Mullen. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Fred Howard, J.P. Alderman Albert A. Mussett, J.P. Councillor Robert P. Bristow. The DeputyMayor, Councillor Fred Howard. „ Ernest Hamlin, M.B.E. Councillor Robert P. Bristow. „ Mrs. Gertrude Howard, M.A. „ Charles G. L. Du Cann. „ Harry Myors. (Mayoress) ,, Lawrence T. Locan. „ Robert Portwine. ,, Harry Myers. William H. Rose. ,, Robert Portwine J. C. St. Laurence Stallwood. ,, Jobn Wl Roberts- ,, William H. Rosa. „ William R. Wheatley. ,,William R. Wheatley. Miss Emily Dibdin. The Mayorcss (Mrs A. A. Musgett). Mrs. Charles G. L. Du Cann. Miss Emily Dibdin. Miss E. Emly. Miss E- Emly. Mrs. Percy Hill. Mrs. Percy Hill. Mrs. Bracewell Smith. Mrs. W. E. Mullen. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Councillor H. V. Harrison (to November. 1933). Councillor W. R. Wheatley (from November, 1933). Medical Officer of Health (Dr. C. W. Hutt). Tuberculosis Dispensary Tuberculosis Officer (Dr. J. A. Struthers). Councillor William R. Wheatley (from February, 1933). London County Council Dr. F. C. Lewis (to November, 1933). Miss H. Bell. Public Assistance Committee Councillor R. P. Bristow. Charity Organisation Society Miss E. F. Bolton. Local Association of Children's School Care Miss M. Savary. Committees. Invalid Children's Aid Association Miss Munro (to September, 1933), Miss Butler (from December, 1933). Metropolitan District Nursing Association Miss E. Emly. Almoners of hospitals Miss J. G. Salmon. Miss Voelcker (Vice-Chairman to October, 1933, Chairman from November, 1933). Insurance Committee for the County of Mr. H. A. Teakle. London. Northern London War Pensions Committee Councillor R. H. Haxell. British Red Cross Emergency Help Fund Major-General Patrick B. Sangster, C.B., C.M.G., D.S.O. National Council of Social Service 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 to October, 1933— Vice-Chairman from November, 1933). Miss O. Lazarus. Miss H. M. Mathieson (Honorary Secretary). Cav. R. Terroni. 8 STAFF. The following was the Staff during 1933. Medical Officer of Health—C. W. Hutt, M.A., M.D., M.R.C.P., DP.H. Medical Officers of Maternity Centres— 10, John Street—Richenda Gillett, M.D.Brux., L.S.A. Winefride M. Gibson, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Short's Gardens—James Arthur Struthers, M.D., B.Ch., M.R.C.P., D.P.H. Consultant Medical Officer—Puerperal Pyrexia and Puerperal Fever Regulations (1926-1928)— J. D. Barris, M.B., F.R.C.P., F.R.C.S., 10, Cornwall Terrace, Begents Park, N.W. 1. Medical Officer of Tuberculosis Dispensary— James Arthur Struthers, M.D., B.Ch., M.R.C.P., D.P.H. Medical Officer—Diphtheria Immunisation—E. Goodwin Rawlins on, M.D., L.R.C.P., D.P.H. Public Analyst—James Hear Colwell, F.I.C. Sanitary Inspectors—Albert Bennett. George F. Clark. Samuel Larard, M.R.San.I. Dust Inspector—Charles Lucknian. 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. Lena Beadle. Dentist—J. C. Sinclair, L.D.S. (British Dental Hospital). Ancestlietist— 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—Panel of Home Helps. Disinfector—Henry Emms. Assistant Disinfector—E. E. Denny. Deputy Disinfector—James Sullivan. Addresses of other Public Officials more or less connected with Public Health Work. Public Vaccinators. Holborn District, Eastern part of Borough (East of Southampton Row)— Dr. P. J. Connolly, 43, Rosebery Avenue, E.C. 1. Telephone No. Terminus 4624 Hours 11 .a.m. to 12 noon, and 6.30 to 8 p.m. (except Thursday evenings). St. Giles and Bloomsbury District, Western part of Borough (West of Southampton Row)— Dr. George D. Fairley, 15a, Cower Street, W.C. 1. Telephone No. Museum 6691. 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, Ing'eby Oddie, Esq. Coroner's Officer—Mr. James Stabb, 46. Baker Street, Lloyd Square, W.C. 1. 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1933. Area of Borough in acres 405.1 Resident population—estimated to middle of 1933 (as supplied by the Registrar-General) for birth and death rates 36,050 Enumerated population—Census, 1931 38,860 Number of inhabited houses (1931) 6,462 Number of private families or separate occupiers (1931) ... 9,355 Rateable value 1st November, 1933 £1,717,507 Rate of Id. in the £ estimated to yield £6,526 Live Births Total M. F. 342 {Legitimate 288 137 151 {Illegitimate 54 28 26 Annual rate of births per 1,000 estimated resident population 9.49 Still births Legitimate 15. Illegitimate 3 18 Rate per 1,000 total births 50 Deaths Males 269 Females 217 486 Annual rate of deaths per 1,000 estimated resident population 13.48 Percentage of total deaths occurring in Public institutions 70 Number of women dying in, or in consequence from sepsis 1 of, childbirth other causes 0 Death rate of infants under one year of age :— All infants per 1,000 live births 70 Legitimate infants per 1,000 legitimate live births 59 Illegitimate infants per 1,000 illegitimate live births 130 Deaths from measles (all ages) 1 ,, ,, diphtheria (all ages) 3 ,, ,, whooping cough (all ages) 0 ,, ,, diarrhoea (under two years of ago) 6 Zymotic death rate* 0.17 Tuberculosis, all causes, death-rate per 100,000 800 Excess of registered births over deaths — Excess of registered deaths over births 144 • Excluding deaths from Epidemic diarrhœa. Population and Houses. The Census of England and Wales 1931, was taken on thp night of the 20th-27th April of that year. Enumerated Ponulation. The enumerated ponulation of Holborn was as follows: — Males. Females. Persons. Census, 1931 ... 18,187 20,073 38,800 Census, 1921 ... 20,732 22,400 43.192 Dccrcasc 4,332=10%, P 10 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, 1933. 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 14.4 12.3 64 London 13.2 12.2 59 Holborn 9.49 13.48 70 Registered Births. The total number of births registered as occurring in the Borough was 180 (83 males and 97 females). Of these, 166 were legitimate and 14 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 133 legitimate infants and 42 illegitimate infants whose mothers were residents of the Borough. Thirteen of the births occurring in the Borough, 11 legitimate and 2 illegitimate, were infants of mothers who were nonresidents of the Borough. The corrected number of births is therefore 342, and the corrected birth-rate 9.49. The following is the corrected number of births and the corrected birth-rates for the year 1933: — Year. Total Births. Legitimate Births. Illegitimate Births. No. Rate per 1,000 of Population. No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. No. Rate per 1.000 of population. Proportion per 1,000 total Registered Births. 1933 342 9.49 288 7.99 842.1 54 1.50 157.9 In London the corrected birth-rate in 1933 was 13.2 per 1,000 in comparison with 14 3 for 1932. 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 1933 being only 9.49 per thousand in comparison with 13.7 in 1913. 11 Mortality. The total number of deaths registered as occurring in the Borough was 681, of which 381 were males and 300 females. Of these deaths the following occurred in Public Institutions, etc., within the urea of the Borough: — Institution. Residents. Non-Residents. St. Giles and Bloomsbury. Holborn. St. Giles and Bloomsbury. Holborn. French Hospital — — 37 — Royal Westminster Ophthalmic Hospital — — 4 — Children's Hospital 3 — — 229 National Hospital — 2 — 99 London Homeopathic Hospital 1 4 — 74 Italian Hospital — 5 — 28 St. Paul's Hospital — 1 35 — Private — — 10 5 Total 4 12 86 435 There were 326 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 36 of whom were removed from Common Lodging Houses in the Borough. The deaths are further corrected by the Registrar-General by the inclusion of all deaths registered in the calendar year as distinct from the registration year of 52 weeks. This correction, together with deaths transferred from extra Metropolitan Institutions, accounts for the variation in the number of deaths given in the four quarterly reports of the Registrar-General and in his Annual Report. The final correction supplied by the Registrar-General for 1933 gives the total deaths for the Borough as 486. Corrected Deaths and Death-Rates, 1933. compared with 1932. 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 61l 607 351 517 †14.18 12.3 1933 681 522 521 326 486 †13.48 12.2 For details of causes of and ages at death, see Table II, page 93. † These rates are calculated oil the Registrar-General's estimated populations at the middle of the year 1932 and 1933 respectively. B 2 12 Seasonal Mortality. The mortality in the four quarters of the year as given in the Quarterly Reports of the Registrar-General is shown below:—* Death-rate London Deaths. per 1,000. Rate. First Quarter 161 17.7 17.3 Second ,, 90 9.9 10.2 Third „ 89 9.8 8.9 Fourth ,, 135 14.9 12.0 Infantile Mortality. The number of deaths of children under one year of age, and the number of deaths of children under one year of age per 1,000 corrected births, were the following:— Year. Deaths under 1 year of age. Deaths under 1 year per 1000 corrected legitimate Births. Deaths under 1 year per 1000 corrected illegitimate Births. Deaths under 1 year per 1000 corrected Births. London. Deaths under 1 year per 1000 Births. 1932 25 64 111 72 67 1933 24 59 130 70 59 Death-rate per 1,000 corrected births in 1933 and in ten preceding years. 1023 1924 1925 1920 1927 1928 1929 1930 1931 1932 Avge. 1923-32 1933 Holborn Borough 79 81 63 90 38 57 74 89 74 72 717 70 London 60 60 67 64 59 67 70 59 65 67 64.7 59 See also Table, page 92. The figures on which the rates given in the Registrar-General's Quarterly Reports are based are necessarily only partly corrected; the final correction including the transference of births in institutions to the residential area of the parents is made before the publication of the Registrar-General's Annual Report. Deaths in Public Institutions. Of the total number of 486 deaths, 342 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, and in subsequent reports, the following may be noted : — Legislation in Force. The following came into operation during 1933: — Acts of Parliament. Children and Young Persons Act, 1933. Slaughter of Animals Act, 1933. * These figures, as published in the Registrar-General's Quarterly Returns for 1933, are for the 52 weeks ended 30th December, 1933; the complete corrections for the year 1933 increase the number of deaths to 486 and the rate to 13.48 per 1,000. The corresponding rate for London was 12.2. 13 Rent and Mortgage Interest Restriction (Amendment) Act, 1983. Regulations. Rent Restriction Regulations, 1933. 19th July, 1933. Holborn (Acute Rheumatism) Regulation, 1933. 1st January, 1933. Order. The Transfer of Towers (London) Order, 1933. The Transfer of Powers (London) Order, 1933. The above Order, dated the 9th March, 1933, was made by the Minister of Health under Sec. 64 of the Local Government Act, 1929. As from the 1st day of April, 1933, certain functions of the London County Council as set out in the schedule to the Order were transferred to the Council of each Metropolitan Borough and to the Common Council of the City of London. The functions so transferred, so far as concerns public health services, are as follows: — (i) Licensing, inspection and supervision of seamen's lodging-houses. (ii) Registration, licensing, inspection and regulation of common lodging- houses. (iii) Licensing of dairymen to use premises as cowhouses. (iv) Licensing and inspection of slaughterhouses and knacker's yards. (v) Sanctioning of establishment or enlargement of premises used for offensive trade. (vi) Infant Life Protection—duties under Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932. The Holborn Council delegated to the Public Health Committee the duties under (i) to (v) above inclusive, and to the Maternity and Child Welfare Committee the duties under (vi) above. In connection with the duties respecting common lodging-houses, the Council extended the appointments of the Sanitary Inspectors to include the inspection and supervision of common lodging-houses, and in connection with the duties under item (vi) the Council appointed the Medical Officer of Health, the Health Visitors and Sanitary Inspectors as visitors under the Act, it being arranged that the employment of the male Sanitary Inspectors would be restricted to necessary inspections on visits relative to penal cases. Administrative action and other information relative to the several matters enumerated above are given under their respective headings in the appropriate sections of this report. Ambulance Service. Particulars of the ambulance services available in the Borough are given on the inside page of the back cover. SANITARY CIRCUMSTANCES OP 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. 14 In a very largc majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins. The contract for the removal and disposal of house and trade refuse which had been in operation for some years came to an end on the 31st Oct., 1933. The Council decided to issue advertisements inviting tenders for this work and for the removal and disposal of street and gully refuse and the hire of horses, carts and motor vehicles. The requirements embodied in the new contract included the provision of new pattern modern motor vehicles of low-loading or interior-loading type. This requirement was introduced to ensure that the most satisfactory modern methods of refuse removal should operate in the Borough and also to meet the recommendation of the Departmental Committee on London Cleansing that all existing unsatisfactory types of collecting vehicles, particularly those having a high loading line, should ho dispensed with. Advertisements inviting tenders were inserted in "The Times," "The Daily Telegraph" and "The Contract Journal." In all, ten tenders wore received. Of these, the tender of Messrs. \V. Clarkson & Sons, Ltd., was the lowest and the tender of this company was accepted by the Council for a period of seven years from the 1st November, 1933. Dust Inspector. The Inspector appointed to supervise the removal of house refuse reports to the Medical Officer of Health daily respecting: — (а) 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 during prohibited hours. The attention of the contractor concerned was called to the matter and no further breach was 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. 15 Removal of Manure. The removal of manure from the various mews in the Borough was satisfactorily carried out during the year. 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 19,840 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, 1933. Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Complaints received 35 41 39 ... ... 115 Do. found to be justified 35 41 39 ... ... 115 Inspection or Houses— Dwelling-houses 137 346 132 3 ... 618 Houses let in lodgings 348 391 129 20 .. 891 Common lodging-houses 21 29 25 4 ... 79 Drains tested by smoke ... 4 2 ... ... 6 Re underground rooms 1 8 ... ... ... 9 Factories — Bakehouses 14 15 3 ... ... 32 Food preparation (other than above) in 11 83 ... 94 Other 92 57 290 ... ... 439 Workshops and Workplaces— Food premises: Dairies and Milkshops 61 65 19 ... ... 135 Ice Cream, Manufacture 2 6 54 ... ... 62 Do. Storage or Sale 27 5 1 ... ... 33 Slaughter-houses ... 12 238 ... ... 12 Hotels and Restaurants 144 104 ... ... 486 Butchers 334 17 351 ... ... 702 Bakehouses 19 8 10 ... ... 37 Fish shops 111 23 6 ... ... 140 Fried Fish shops 169 23 25 ... ... 217 Market Streets 314 94 628 ... ... 1,046 I.icensed Premises ... 27 1 ... ... 28 Other food shops 145 26 94 ... ... 265 Merchandise Marks Acts, 1926 389 170 101 ... ... 669 Other workshops 192 138 271 13 ... 614 Other workplaces Outworkers' Registers 49 63 64 ... ... 176 18 29 51 ... ... 98 Stables and Stable yards 6 29 ... ... ... 35 Rag and Bone shops 10 3 ... ... ... 13 Outworkers' rooms ... ... ... ... ... ... Offices 11 3 12 ... ... 26 Miscellaneous— Black smoke 41 41 104 ... ... 186 Dust, Special Inspections 2 2 ... ... 4 Rats and Mice (Destruction) Act, 1919 96 251 118 ... ... 463 Food and Drugs (Adulteration) Act. 1928 (sampling) 206 183 191 ... ... 580 Demolition of Buildings 1 6 ... 7 Other Inspections ... ... ... ... 23 23 Keeping of Animals 3 3 5 ... ... 11 Periodical Inspections: Includes W.C. and yards, dustbins. especially houses let in lodgings, and other similar dwellings 1,369 1,974 2,467 ... .. 5,810 Inspections carried forward 4,353 4,159 5,475 40 23 14,050 •All outworkers' rooms in houses let in lodgings (these comprise the large majority), have been inspected but the visits have been counted under inspections of houses let in lodgings 16  Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miis Stockwell Total Brought forward 4,353 4,159 5,475 40 23 14,050 Re-Inspections- Houses 768 793 547 ... ... 2,108 Factories 1 15 20 ... ... 36 Workshops and Workplaces 46 42 128 ... ... 216 Restaurants ... 24 4 ... ... 28 Licensed premises ... ... ... ... ... ... Offices 4 ... ... ... ... 4 Miscellaneous 2 ... 2 25 92 121 Visits re Infectious Diseases 55 118 96 95 134 498 Scabies ... ... ... 1 ... 1 Other Visits- Police Courts 2 5 1 ... ... 8 Various 122 344 134 18 ... 668 Maternity- Visitl: Children under 1 year ... ... ... 149 178 327 Do. 1 to 5 years ... ... ... 80 31 61 Expectant Mothers ... ... ... 76 111 187 Infant Life Protection ••• ... ... 1 19 20 Re-visits: Children under 1 year ... ... ... 282 470 752 Do. 1 to 5 years ... ... ... 329 619 948 Expectant Mothers ... ... ... 80 147 227 Infant Life Protection ... ... ... 2 29 31 Other Maternity Visits ... ... ... 63 174 237 Attendances at Maternity Centres ... ... ... 217 190 407 Total 5,353 5,500 6,457 1,408 2,217 20,935 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 1,199, viz.:- Public Health (London) Act, 1891- Intimation Notices 496 Statutory Notices 58 By-laws— Houses let in lodgings 601 London County Council (General Powers) ActsVerminous rooms 36 Rats and Mice (Destruction) Act, 1919 8 1,199 17 The following table shows the work done to abate nuisances for which intimation notices were served:- Water Supply- Houses Factories, Workshops and Workplaces. Provided 3 4 Cisterns cleansed, repaired etc 38 8 Cleansed 8 9 Water supplied, flushing cistern repaired, etc. 12 5 Repaired, new pans, etc. 63 23 Ventilation improved - 5 Separate accommodation for sexes provided - 1 Position or construction improved - 1 Direct communication with workrooms remedied - 11 Accommodation provided 5 - Soll Pipes- Repaired, renewed and ventilated 3 2 Rainwater Pipes- Repaired or renewed 16 6 Drains- Repaired 11 3 Unstopped, cleansed, etc. 29 4 Sinke, etc.- Waste pipes repaired renewed, etc. 36 3 Yards,Areas and Washhouses- Cleansed 31 1 Paved and paving repaired 25 3 Houses and Workshops, etc.- Cleansed 92 33 Dilapidations repaired and made good 86 4 Ventilation improved 3 5 Dampness- Roofs repaired 49 2 Gutters repaired 7 1 Other works to prevent dampness 20 - Ashbins- Provided, repaired, etc. 58 10 Various- Underground Rooms vacated 4 - Smoke-Emission of black smoke abated 1 7 Accumulations of Refuse-Removed 33 8 Overcrowding abated 2 — Other nuisances abated 16 2 Animals improperly kept 2 - c 18 Statutory Notices. The following table shows the nuisances for which the 58 Statutory Notices were issued under the Public Health (London) Act, 1891:- House Factories, etc Section 2 (1)- (a) Dirty, dilapidated, damp premises, etc. 22 4 (b) W.C.'s, drains, etc. 30 - (b) Water cisterns and water supply 2 - (c) Animals improperly kept 1 - (d) Accumulation of refuse 6 - (g) Factories and workshops - 1 Section 21 (1)—Effluvia - - Section 17-Ashbins 3 - Section 38—W.C. dirty or defective — 6 Section 96—Underground rooms 2 — Water Supply In Block Dwellings. Ninety-two blocks of flats or blocks of dwellings were visited in connection with the water supply to 3,209 separate flats or tenements. In 46 of the blocks the drinking water was found to be direct from the main. In 15 cases only cisterns were reported as not entirely satisfactory—10 being dirty and 5 being reported both dirty and having defective covers. Communications were sent to the owners and where necessary notices were served. As a result the unsatisfactory conditions were dealt with in all cases. By-Laws as to Houses let-in-lodgings. At the end of the year 461 houses were registered under these By-laws. Of these, 231 are in St. Giles and Bloomsbury and 230 in the Holborn District. There were 891 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 140 notices were served for breaches of the By-laws, in addition to 461 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. Thirteen inspections of rag and bone shops were made in the year 1933; 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 295 premises were inspected under the above Act, the total inspections being 465. Eight notices for breaches of the Act were served. At the end of the year the eight premises were reported to be blear of infestation. 19 Rats and Mice (Destruction) Act, 1919. Summary of conditions found on inspections, action taken and results obtained. WARD. Number of premises inspected. Number rat infested. Action (or Rat Repression. RESULT. Traps. Poisons. Rat catchers. Dogs. Cats. Proofing a. 8 1 1 1 — — — — Rats occasionally seen 1 B. 26 — — — — — — — c. 5 4 2 1 1 — 1 — Free 4 D. 28 — — — — — — — E. 9 6 1 — 1 — — 4 Free 6 F. 92 28 9 7 1 — — 17 Free 19 Rats occasionally seen 7 Under observation 2 G. 41 10 4 2 — — — 5 Free 8 Rats occasionally seen 2 H. 60 21 4 2 8 — 4 8 Free 21 I. 26 14 5 5 3 — 4 5 Free 14 295 84 26 18 14 — 9 39 Free 72 Rats only occasionally seen 10 Under observation 2 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 6th November, 1033. 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, c2 20 As in previous years the baits in the Council's sewers were increased during National Rat Week. From the 6th to 11th November, 1,500 baits of "Batin" were prepared and laid in suitable places in the sewers and at side entrances to the sewers and nearly all the baits were taken. It is unusual to find dead rats in the sewers after they have taken the bait because if they die they are usually washed away to the sewer outfall. 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 19. Smoke Abatement. The smoke shafts in the Borough were kept under frequent inspection, 186 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. Ten complaints were received of nuisances from the emission of smoke. As the result of inspections made eight intimation notices were served. The use of unsatisfactory coal is the common cause of smoke nuisance in the Borough; such use arises when attempts arc made to effect economy in running plant. Usually a visit by the Inspector or a letter from the Medical Officer of Health secures immediate abatement of the nuisance. In accordance with its powers under the Public Health (Smoke Abatement) Act, 1926, the Council made a small contribution towards the cost of the work for smoke abatement carried on by the National Smoke Abatement Society. Inspection of Workshops, etc. The routine inspection of factories, workshops and workplaces has been carried out during the year. 533 factories were inspected, 614 workshops and 3,376 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 61 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 45 workshops were added to the register. 21 At the end of the year there were 604 workshops on the register. 353 employed men only, 45 employed women only, and 206 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. of Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 15 — 1 16 Builders 11 — — 11 Carpenters 11 — — 11 Clock and watch makers 16 — 1 17 Dressmakers and ladies tailors — 16 21 37 Diamond mounters 9 — 2 11 Engravers 15 — 2 17 Glass blowers 6 — 2 8 Jewellers 31 1 8 40 Leather goods makers 6 1 2 9 Metal workers 7 — 4 11 Tailors 29 3 46 78 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. At the end of the year 469 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 bo inspected by the Borough Council's staff except as regards sanitary accommodation. The 469 factories include 50 different industries. In 237 cases men only were employed, in 18 women only, and in 214 both sexes. The more important industries carried on in these factories are:- Printing 117 Engineering 47 Jewellers' work 22 Bookbinding 18 Metal work 12 The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1933: — 22  Mr. Bennett. Mr. Clark Mr. Larard. Miss Charles. worth. Total. FactoriesInspections 103 57 373 — 533 Re-inspections 1 15 20 — 36 Workshops— Inspections 192 138 271 13 614 Re-inspections 10 9 67 — 86 Workplaces- Inspections 49 63 64 — 176 Re-inspections 35 34 61 — 130 Offices- Inspections 11 3 12 — 26 Re-inspections 4 — — — 4 Bakehouses- Inspections 33 23 13 — 69 Re-inspections — — — — — Restaurants- Inspections 144 104 238 — 486 Re-inspections — 24 4 — 28 Licensed Premises- Inspections — 27 1 — 28 Re-inspections — — — — — Defects Found- Want of cleanliness 9 20 14 — 43 „ ventilation — 3 3 — 6 Overcrowding — — — — — Storage cistern defective 1 1 1 — 3 Accommodation for refuse 3 4 — — 7 Accumulation of refuse 3 2 2 — 7 Sanitary accommodation Insufficient — — 1 — 1 Unsuitable 2 3 2 — 7 Defective 1 6 8 — 15 Not separate for sexes — 1 — — 1 Other nuisances 11 24 25 — 60 Total defects 30 64 56 — 150 Action taken. Matters referred to H.M. Inspector:Failure to affix abstract 6 Matters referred by H.M. Inspector:Notified by H.M. Inspector 8 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charlesworth. Total. Factories- Intimation 3 1 12 — 16 Statutory — — 3 — 3 WorkshopsIntimation 16 7 16 — 39 Statutory 1 2 3 — 6 Workplaces- Intimation 1 10 10 — 21 Statutory — 3 — — 3 Offices- Intimation — 1 — — 1 Statutory — — — — — Restaurants- Intimation 5 18 8 — 31 Statutory 1 2 1 — 4 Licensed Premises- Intimation — — — — — Legel Proceedings — 1 — — 1 23 Outworkers. Lists received from Holborn Firms 98 Names and addresses received from other Authorities 323 Names and addresses sent to other Authorities 334 Notices served on Employers 107 Firms visited 57 Infectious diseases in outworkers premises nil Rag Flock Acts, 1911 and 1928. There arc 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 1346 (England):- 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) 615 (b) Number of inspections made for the purpose 1,509 (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 142 (b) Number of inspections made for the purpose 378 (3) Number of dwelling-houses found to bo in a state so dangerous or injurious to health as to bo unfit for human habitation 4 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to he in all respects reasonably fit for human habitation 288 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, 1030:- (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 — 24 B. Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 288 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) by owners 288 (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 nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders nil 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 Common Lodging-Houses. In accordance with the Transfer of Powers (London) Order, 1933, made by the Minister of Health under Section 64 of the Local Government Act, 1929, functions relating to the registration, licensing, inspection and regulation of common lodginghouses and the enforcement of by-laws relating to such houses, passed from the London County Council to the Metropolitan City and Borough Councils as from the 9th March, 1933. The Council delegated its powers in this respect to the Public Health Committee. At the date of the transfer all the common lodging-houses in the Borough were subject to licences expiring on the 30th June, 1933. Prior to that date the Committee considered applications for the renewal of licences for the twelve months ending 30th June, 1934, and licences were granted as follows:- Premises. Licensed Keeper. Authorised number of Lodgers. Number of Rooms Males. Females. 1-7, Macklin Street Leslie Campbell Ruttledge 79 — 12 7 & 11, Short's Gardens William George Parker 234 — 16 35, Devonshire Street Mrs. A. E. Chesterton — 45 9 40, Eagle Street Joseph Benton 50 — 10 Parker Street House Frank Hunt 349 — 10 2-8, Kennedy Court John Samuel Walters — 78 17 25 Boswell Court Housing Scheme. During the year the third block comprised in this scheme became ready for ocupation thus completing the scheme for the provision of 62 tenements for working-class families. (A description of the flats was given in the Annual Report for 1932, page 27.) 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 52 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 43 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. With a view to preventing vermin infestation in the Council's dwellings, the homes of applicants are inspected before the tenants are accepted and, in addition, incoming tenants arc furnished with a memorandum of advice drawn up by me, which is explained to them where necessary by the Public Health Staff. A careful watch is kept by the Sanitary Inspectors and Health Visitors for the appearance of bugs in these dwellings and the tenants are instructed as may be necessary. Holborn Housing Trust Ltd. Tn connection with the provision of suitable housing accommodation for Holborn workers it is a pleasure to record the formation, under the Presidency of Mr. Stuart Bevan, K.C., M.P., and the Chairmanship of Alderman Percy Hill, L.C.C., of the Holborn Housing Trust Ltd., with the object of erecting workingclass dwellings in Holborn at the lowest economic rent. In a communication received during the preparation of this report, the Honorary Secretary of the Trust (Mrs. P. J. S. Bevan) writes: " At present the Trust has secured a small site, Xos. 36 and 37, Devonshire Street, and plans have been prepared for the building of ton flats with a roof playground." Flatlets. Arising out of the growing practice of converting residences into one-room flatlets, a number of which have in Holborn been so converted, after careful inspections of these premises had been made by the Public Health Staff and a report issued, the Council supported a suggestion that legislation should be introduced to enable appropriate local authorities to make and enforce by-laws to control premises thus converted, somewhat on the lines of the by-laws relating to houses let-in-lodgings. In such flatlets questions arise respecting refuse bins, 26 ventilation, provision of baths, sanitary accommodation, storage of food, etc., all of which could conveniently be controlled by by-laws. There is a great demand for this type of flat and there is ample reason for conferring powers on local authorities to enable them to exercise control. INSPECTION AND SUPERVISION OF FOOD. Dairies, Cowsheds and MIlkshops. In connection with the duties imposed on the Council respecting registration of milk shops, 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 1933, the number of registered dairies and milk shops in the Borough was 140. Seventeen entries were made in the register during 1933. Of these, 3 related to premises registered for the first time, 10 to premises where a change of occupier had necessitated re-registration, 3 to itinerant vendors with premises outside the Borough registered for the first time and 1 to an itenerant vendor where premises had. changed hands. In addition, one entry was made in the register of wholesale dairies, the trade being carried on from premises outside the Borough. Four premises were removed from the register on closing or demolition. The Sanitary Inspectors recorded 135 inspections of milk premises. A milk roundsman was found selling milk from a hand can and barrow neither of which were marked with the name and address of the vendor as required by Section 6 of the Milk and Dairies Consolidation Act, 1915. The attention of the proprietor was called to the matter and the breach was at once abated. It was not necessary to serve notice for any other breach of the Order or sanitary defect. 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 1933 licences available up to the 31st December, 1933, for the sole of designated milk in the Borough were issued as follows: — Certified 2 Grade A (Tuberculin Tested 2 Grade A (Pasteurised) 1 Pasteurised 5 Supplementary— Grade A (Tuberculin Tested) 1 Pasteurised 2 13 27 Up to the date of the preparation of this report licences for the year 1934 have been issued as follows: — Certified 2 Grade A (Tuberculin Tested) 2 Grade A (Pasteurised) 1 Pasteurised 3 Supplementary— Grade A (Tuberculin Tested) 2 Pasteurised 2 13 Milk—Bacteriological Examinations. Designated Milk. Five samples of designated milk were taken and submitted to bacteriological examination with the following results: — Grade. Approx. age of Sample. Temperature on arrival at Laboratory. Number of bacteria per c.c. Presence of coliform bacilli in 0.1 c.c. Remarks. Certified 24.30 hrs. 16°0 4,960 Nil Grade A (T.T.) 24.30 „ 16°C 1,673 Nil Grade A (T.T.) 24 .30 „ 16°C 4,610 Nil Grade A (Pasteurised) 24.30 „ 16.5°C 428 Nil Pasteurised 24.30 16°C 10,400 — It will be seen that all five samples conformed to the prescribed conditions for the designations concerned. Animal inoculation for the presence of tubercle bacilli was carried out in respect of each sample, all giving negative results. The samples were also subject lo chemical analysis with results as follows: — Grade. Water. Fat. Non-fatty solids. Certified 86.22 4.7 9.08 Grado A (T.T.) 87 0.3 3.7 9.27 Grade A (T.T.) 871.5 3.6 9.25 Grade A (Pasteurised) 87.17 3.7 91.8 Pasteurised 87.52 3.4 9.08 Arrangements were made early in 1934 for four samples of designated milk to be examined for the presence of Brucella Abortus. Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Seven 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. D 2 28 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 seriotls. Bakehouses. At the end of the year 1933 there were 23 bakehouses in the Borough of which 17 were factory bakehouses. Although these are described as "factories" they are not large and only supply local needs; a number were formerly workshops and are now classified as " factories " owing to the installation of machinery. During the year, in addition to my inspections, there were 69 inspections of bakehouses. Sale of Fish. During the past year 140 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 Boad, 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 217 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 1,046 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are regularly inspected daily and on Saturday evenings and Sunday mornings. The daily inspection of these market streets helps to secure the maintenance by the regular stallholders of good, sound food only, and, in addition, has the effect of keeping away from these markets casual and unsatisfactory hawkers, who generally avoid markets subject to regular and strict supervision. In order to minimise as far as practicable any contamination of the fool 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. 29 Street Trading. I received information from the Borough Engineer respecting 97 applications from street traders for annual licences to sell various articles of food as follows: — Coffee stalls 6 Confectionery and drinks 12 Fish—wet and 'dry, including shell fish 9 Fruit and vegetables 48 Groceries 3 Ice cream or chestnuts 12 Meat 3 Poultry, eggs and provisions 4 97 All the storage places situated in the Borough were inspected. Where the storage place is outside the Borough information as to suitability is obtained from the Medical Officer of Health of the district concerned. In like manner information respecting storage places in Holbon used by stallholders trading in other areas is sent to the Medical Officer of Health of the district in which the licence is applied for. Ice Cream. Provision was included in the London County Council (General Powers) Act, 19.28, for the registration with the sanitary authority of premises proposed to be 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 1 Manufacture, storage and sale 11 Storage and sale 1 Sale only 13 28 In addition to my inspections, 95 inspections of these premises wore made. 30 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 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 butehes and other shops and On stalls from contamination by llios, mud and other submtsance. The following summary shows the number of butchers' shops and moat stalls in the Borough, and the number of other shops where meat is sold:— Butter shops 28 Buter stalls 2 Promasim henirs 36 ler isaer 35 Offical shops 3 cooked means 16 Wholesale (bacon.; sausage) 5 92 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 702 such inspections were made. 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 47 Fried fish shops 14 Fish shops 13 Ice cream (Manufacture) 14 Poulterers 9 During the year, 3,024 inspections of such food premises and market streets were made and 38 notices served for sanitary defects found. 31 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 35 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, 1933: — Commodity. Quantity. Condition. Result of Action taken. Fish:— Tons. Cwts.. Qrs. lbs. Haddock • •• ... 1 14 Decomposed Surrendered Kippers ... ... 1 21 do. do. Pknte 2 Unsound do. Whiting ... ... 1 21 do. do. Fruit :— Apples 4 0 - Rotten do. Bananas ... 2 3 — do do. Pears ... 4 1 6 Unsound do. Meat :— Bacon ... 3 n 26£ Unsound do. Ham, Tinned ... 1 Blown do. Turkeys (3-1 birds)... ... 3 - 4 Unsound do. Other Food :— Potatoes ... 2 - — Diseased do. Turnips ... 6 - — Unsound do. Tomato Paste, tinned ... 13 o — Blown do. Sweets .. ... - 6 Maggots present do. Total 6 7 1 13½ The Public Health (Preservatives, etc.-, in Food) Regulations. In the year 1933 two samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., sausages and jam {see page 35). The breaches in these cases were the sale of the goods without disclosing the presence of the preservative. The conditions under which the offences were committed wero found to call for legal proceedings in one case, but in the other case a letter of warning only was sent to the vendor concerned. 32 Food and Drugs (Adulteration) Act, 1928. On the 1st January, 11)29, 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. Formal Samples. Article. Number Purchased Result of Analyses Proceedings taken. | Convictions. r Fines and Costs. Genuine. Adulterated Ale 6 5 … … … … Almond oil i 2 ... … •.. … A nun. tincture of quinine «> 2 ... … … … Apricots, canned 1 1 ... … ... … Beans, cannod 4 4 … … .. … lieef. corned 3 3 ... … ... … Beef, minced 2 2 ... … ... … Bicarbonate of soda 3 3 ... … ... … Blackcurrant juice 1 1 ... ... ... … Borax 2 2 ... ... ... … Brandy 1 1 ... ... ... ... ... ... Brawn 4 4 ... ... ... ... Bread and butter 9 2 ... ... ... ... Butter 64 5 ... ... ... ... Cuke 6 6 ... ... ... ... Cheese 10 10 ... ... ... ... Cheese, cream 3 o ... ... ... ... Christmas pudding 4 4 ... ... ... .. Coffee 3 3 ... ... ... ... Coffee and chicory extract 5 5 ... ... ... ... Cornflour 2 ... ... ... ... ... Cream 11 11 ... ... ... ... Cream, canned 1 ... ... ... ... ... Cream pastri, etc. 5 «*» * ... ... ... Custard powler 3 3 ... ... ... ... OyJrax 1 I ... ... ... ... Dripping 5 5 ... ... ... ... Dyspepsia tablets 2 2 ... ... ... ... Egg substitute 4 4 ... ... ... ... Fish paste 6 6 ... ... ... ... Fruit cordial 3 3 ... ... ... ... Fruit syrup 2 2 ... ... ... ... Gelatine 2 2 ... ... ... ... Gin 1 1 ... ... ... ... (iingcr, crystallised l 1 ... ... ... ... Ginger wine 2 2 ... ... ... ... Golden syrup 1 1 ... ... ... ... Gooseberries, bottled 2 2 ... ... ... ... Ice cream 11 11 ... ... •• ... Iodine, Strang, tincture of... 1 4) •> 1 ... ... ... Jam Lemonade powder 2 o ... ... ... ... Lemon squash 2 2 ... ... ... ... Lime juice cordial 3 3 ... ... ... Liniment of iodino 1 1 ... ... ... ... Liniment of turpontino 2 2 ... •• ... ... 33 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs Genuine Adulterated. Linseed, crushed 6 5 ... ... ... ... Loganberries, canned 1 1 ... ... ... ... Margarine 18 18 ••• ... ... ... Marmalade 7 7 ... ... ... ... M eat paste 4 4 ... ... ... (i) Dismissed on payment of 15s. Costs (ii) Fine £2, Costs £1. Is. Milk 191 189 2 2 1 Milk, condensed 0 2 ... ... Milk, dried 4 4 ... ... ... ... Mince pio 4 4 ... ... ... ... Mineral water 2 2 ... ... ... ... Oil, camphorated 2 2 ... ... ... ... Oil, olivo 2 2 ... ... ... ... Ointment, blue 2 2 ... ... ... ... Ointment, horacic 2 2 ... ... ... ... Ointment,nitrate of mercury 2 2 ... ... ... ... Ointment, sulphur 2 2 ... ... ... ... Ointment, white precipitate 3 3 ... ... ... ... Orange quinine wino 2 2 ... ... ... ... Orange wine 1 1 ... ... ... ... Paregoric 4 4 ... ... ... ... Pastries 1 1 ... ... ... • • Peas, canned 10 10 ... ... ... ... I'ickled cabbage 1 1 ... ... ... •• Pickles 4 4 ... ... ... ...1'ineapplo, crystallised 1 1 ... ... ... ... ltaisin wine 1 I ... Rice ... ... ... ... ... ... Hum 1 1 ... ... ... ... Salad oil .1 .1 ... ... ... ... Salmon, canned 2 ... ... ••• ... ... SaUCO . 2 2 ... ... ... ... sause meat 1 1 ... ... ... Sausages 5 1 1 1 ... Summons misted, £2 2s. Costa against Council Sausage roll 2 2 ... ... ... ... Soup powder 2 2 ... ... ... ... Sponge cake 6 6 ... ... ... ... Suet, chopped 1 1 ... ... ... ... Suet, shredded 5 5 ... ... ... ... Sugar, demcrrara 3 3 ... ... ... ... Sweets 5 5 ... ... ... ... Tincture of rhubarb 2 2 ... ... ... ... Treacle l 1 ... ... ... ... Vinegar 7 7 ... ... ... ... Whisky 2 2 ... ... ... ... Total 638 534 4 3 1 Fines £2 Costs, £1 16s. Costs against Council, £2 2s 34 Informal Samples. article. Number of Samples Taken. Result of Analyses. Genuine. Adulterated. Arrowroot 2 1 1 Bacon 1 1 ... Brandy 1 1 ... Chocolate 3 3 ... Cocoa 3 3 ... Cream pastries 3 2 1 Gin 1 1 ... Jam 23 22 1 Marmalade 1 1 ... Milk 5 5 ... do. condensed 5 5 ... do. dried 3 3 ... Mint, dried 2 2 ... Mint sauce 2 2 .. Mustard 2 2 ... Pears 2 2 ••• Rum 2 2 ... Rum essence 1 1 ... Total 62 59 3 In connection with the sample of tincture of iodine reported to be not genuine, a letter was addressed to the retail vendor concerned, and, having regard to the explanation received from him, further action was deemed unnecessary. In the case of the informal samples reported to be not genuine, a warning letter was sent to the vendor of the sample of jam; the vendor of the arrowroot sample was found to have discontinued the sale of this commodity and no action was called for in respect of the cream pastry sample. The Borough Analyst, J. Kear Colwell, Esq., F.I.C., has kindly supplied the following notes:— During the year 1933, 600 samples were submitted to me for analysis in nccordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 538 having been purchased with the required formalities and 62 obtained informally. Of this total only seven (1.16 per cent.) proved to be adulterated, four being samples submitted formally and three informally. The adulterated samples consisted of milk, sausages and tincture of iodine [formal) and arrowroot, jam and cream buns (informal). Arrowroot.—The sample of arrowroot certified to contain 100 per cent, of starch and farinaceous matter other than arrowroot, consisted of corn flour, which is, as is well known, prepared from maize. Cream Buns.—One sample of the, various forms of pastry stated to contain "cream" was found to be made, with fat of which at least 70 per cent, was not derived from the fat of milk or butter and was, therefore, certified to be adulterated. 35 I understand that this mixture has been held to fulfil the requirements of the Aet, but I cannot help feeling that the sale of such a "cream" without due noticc to the purchaser is most unjust, and places those makers and vendors of these and similar articles, who use and sell real cream derived from milk, at a serious disadvantage, not to mention the purchasing public, who in my opinion, are seriously prejudiced by this substitution. Tine lure of Iodine (Strong).—This sample was found to be deficient in iodine to the extent of at least 52 per cent, and in potassium iodine to the extent of at least 50 per cent. The British Pharmacopoeia provides for two preparations of tincture of iodine—one strong and the other weak—the latter being one quarter the strength of the strong, so that the sample in question conformed to neither specification. Jam.—Only one sample of jam contained a slight excess of preservative—15 pads per million of sulphur di-oxide in excess of the amount allowed—40 parts per million. Milk.—Two samples of milk fell below the requirements of the Board of Agriculture Standard and were certified accordingly—one to contain at least 5-2 per cent, of added water and the other to be deficient in fat to the extent of at least 10 per cent. It is again satisfactory to note that the milk supply of the Borough must be regarded as well above the minimum limits, as the average composition of the 196 samples obtained from shops, restaurants and in the streets was 3-60 per cent, for fat and 8.88 per cent, for non-fatty solids. This is slightly below the average for last year, when the figures were 3.71 and 8.92 respectively. Preservatives were not found in any sample. Undoubtedly the quality of the milk supply of the Borough has been well maintained and offers further evidence of the advantages to be derived from systematic sampling. Sausages.—One of the samples of sausages had been preserved with sulphite preservative without notice to that effect having been given to the purchaser, and therefore a breach of the Preservatives Regulations was committed. A maker may add sulphite preservative to sausages provided that notice be given of the addition and that the quantity docs not excecd 450 parts per million expressed in terms of sulphur di-oxide. Dried. Mint.—It may be interesting to mention the samples of dried mint and mint sauce all of which proved to be genuine. The samples were obtained owing to the fact that it had been found that certain imported dried mint had been adulteratod with other leaves, in particular those of the ailanthus or tree of heaven, but its timely detection has practically put a stop to the admixture of these leaves which appears to have taken place on the Continent but not in this country. Rum Essence.—The chief point of interest about this sample and other similar essences and flavouring liquids put on the market about the same time was that E 2 36 they had been prepared with iso-propyl alcohol, a much cheaper solvent medium than the ordinary ethyl alcohol. The rum essence contained roughly 60 per cent, of iso-propyl alcohol, 34 per cent, of water, and 2 per cent, of ethyl alcohol with appropriate mixture of esters and fusel oil. Iso-propyl alcohol has been stated to be 1½ times to twice as intoxicating as ordinary ethyl alcohol, but I have been unable to find any authentic evidence on the point. It is interesting to add that when public attention had been called to this preparation and extra label was added "highly concentrated, must not be drunk as a beverage." There are no standards for this type of food ingredient, and if used as directed, there is no evidence that their consumption would have harmful effects. Standards for Cream, Cheese and Other Food Products.—Once again it is necessary to refer to the urgent need of some definite standards for food products. A Committee has been appointed with reference to this subject and has already heard certain evidence, but I do not think the question can bo dealt with efficiently by a large body sitting for a comparatively short time, and feel that the appointment of a small Permanent Committee or Board of Reference which might consider standards, or, any necessary alteration of standards, from time to time, as occasion arose, with power to make recommendations or amendments, would be the best way of dealing with all these matters. The great advances which have been made in the scientific investigation of the properties and composition of many foodstuffs have made new standards imperative and such a body should be in a position to consider the new methods, etc., of examination, which are constantly being evolved, and to prescribe the appropriate value to be attached to them in determining the purity, or otherwise, of articles of food. MILK. The table below shows the fat content of 196 samples of milk examined:- Percentage of Fat. Number of Samples. Shops. Restaurants. Streets. Total. Less than 3.0 1 — — 1 3. 0 — — - — 3.1 4 1 1 6 3.2 10 — 2 12 3. 3 16 1 2 19 3.4 17 — 3 20 3. 5 19 2 13 34 3.6 20 1 8 29 3.7 21 — 8 29 3.8 16 — 2 18 3.9 9 — 5 14 4.0 3 — — 3 4.1 2 — — 2 4.2 4 — — 1 4. 3 1 — — 1 4.7 1 — — 1 4.8 1 — — 1 5.1 1 — — 1 5 2 1 — — 1 147 5 44 196 Average fat content 3.61 3.40 3.58 3.60 37 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 18 12. 44 8. 33 3.61 February 20 13. 46 8.92 3.54 March 20 12.38 8.84 3.54 April 12 12.28 8.78 3. 50 May 15 12.30 8.88 3.42 June 17 12.32 8.81 3.51 July 20 12.45 8.85 3.60 August 12 12. 33 8.82 3.51 September 6 12.29 8 .82 3.47 October 32 12.75 8.95 3.80 November 16 12.73 9.01 3.72 December 8 12.72 8. 99 3.73 Whole year 194 12.48 8.88 3.60 Legal minimum 11. 50 8.50 3.00 Merchandise Marks Act, 1926. 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. Haw 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 or Sea Trout, frozen or chilled. 9. Butter.* The total number of inspections made by the Officers appointed under the Act was 669. Of these, 224 related to shops, 364 to licensed street traders and 81 to non-licensed street traders. During the year 68 breaches of the various Orders were found, viz.:— * Two further Orders have been made during the time which this report has been in course of preparation. These are The Merchandise Marks (Imported Goods) No. 3 Order, 1934, relating to imported bacon and ham, and The Merchandise Marks (Imported Goods) No. 5 Order, 1934, relating to imported dead poultry. 38 Order No. Article. Number of breaches. 1. Butter 8 3. Fresh apples 32 4. Raw tomatoes 21 5. Currants, sultanas and raisins 7 Total 68 In proportion to the inspections made non-licensed street traders showed themselves to be the greatest offenders against the various Orders, for three 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. Agricultural Produce (Grading and Marking) Act, 1928. 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. Tlio Regulations made by the Ministry of Agriculture and Fisheries under the above Act were enumerated in tlie Annual Report for 1931. London County Council (General Powers) Act, 1932. Registration of Food Premises. Section 5 of this Act requires the registration with tho 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 17 Preserved meat 18 Pickled meat 5 Preserved fish 1 Total 41 All the premises concerned were carefully inspected prior to registration. 39 Maggots in Chocolate. Complaint was received from a resident' in the Borough of the presence of maggots in a small packet of patent medicine prepared with chocolate. On examination there appeared to be no doubt that larvao inside the "chocolates" were thoso of one of the species of Ephestia; the regular moths in chocolate. On investigating the matter with the manufacturers it was found that the commodity is imported from Canada twico yearly, in tablet form wrapped in. tinfoil as sold, the tablets being also wrapped in tissue paper and packed in wooden cases. After arrival the tablets are put into tin boxes for retail sale. The Canadian factory is fumigated monthly, and the English warehouse after tlio arrival of each supply, with hydrocyanic gas. It was admitted that complaints of maggots are fairly common in America and that two or three complaints had recently been received in England. There was some indication that the goods sold by the Holborn retailor were old stock issued at least three months before sale. The producers intimated that they had now instituted a date code for use on the boxes. The principal moth attacking cocoa is Eplicstia elutella; others are Eplicstia luhniella, E. cautclla and Plodia interpunciella. It has been proved that the roasting of cocoa beans, subsequent cleaning operations and other processes of manufacture of chocolate render it sterile as so far as insect eggs are concerned. Manufacturers of these goods are well aware of the danger to their trade which may be occasioned by these moths and take every practicable step to eradicate them. In the case of insects so ubiquitous as these it is difficult for producers to guarantee any product to bo free from accidental infestation unless packed in hermetically sealed containers, which is not a practical proposition, commercially, in all cases. Notification of Food Poisoning. The London County Council (General Powers) Act, 1032, requires medical practitioners to notify all cases of food poisoning occurring in their practice. This early information enables 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. In the year 1933 five notifications of food poisoning in Holborn were received. Enquiries were made in each case. In four cases the illness was limited to the patient notified and was of no serious import. The fifth case attracted much attention and was fully reported in the lay and medical press. . On October 9th information was received that, a boy, A. S., aged 11 years, residing in the Borough, had died in Highgate Hospital from suspected food poisoning. Subsequently we learnt that another Holborn boy, W. H., was in University College Hospital dangerously ill with suspected food poisoning. These hovs were soon found to form two of a series of thirteen cases, eleven in St. Paneras and two in Holborn. An inquest was held on the two children who died, the one from Holborn, and one from St.Pancras; it was finally established that a young girl, 0 years old, living in a ham and beef shop in St. Pancras, who had been suffering from dysentery contaminated some pease pudding with her fingers; this pease pudding when consumed by the patients gave rise to baeillary dysentery of the Sonne type. 40 Slaughter of Animals Act, 1933. This Act came into operation on the 1st January, 1934. The local authorities for enforcing the Act are for the City of London and the Metropolitan Cattle Market, the Common Council of the City of London, elsewhere in London the Metropolitan Borough Councils, and outside London, Town Councils and District Councils. The Act provides (by Sec. 1) that every animal to be slaughtered shall be instantaneously slaughtered, or shall by stunning be instantaneously rendered insensible to pain until death supervenes, such slaughtering or stunning to be effected by means of a mechanically-operated instrument. This requirement does not apply to sheep unless the local authority apply it by resolution:, and the local authority is required within twelve months of the passing of the Act to consider whether they will by resolution apply the Section to sheep; on the other hand by resolution goats can be excluded. The requirement applies to pigs subject to a proviso that if electrical energy is not available, that is a defence to proceedings for contravention of the Section unless the prosecution show that it could reasonably be made available. Slaughter by a Jew or Mohammedan for food for his co-religionists is exempt from the Section subject to the former (Jew) being licenced by a. Rabbinical Commission constituted in accordance with the first schedule of the Act. A new duty placed on local authorities is that of licensing slaughtermen (Sec. 3). These licences may only be granted to persons of the age of eighteen years or upwards who are, in the opinion of the local authority, fit and proper to hold a licence. The licence is to be in force for such period not exceeding three years as is specified therein and may be renewed from time to time at the discretion of the local authority. A fee not exceeding two shillings may be charged by the local authority for each licence and a fee not exceeding one shilling for each renewal. Provision is made for suspension or revocation of licences; aggrieved persons have the right of appeal to a court of summary jurisdiction. It is important to note that a licencc is available not only in the district of the authority granting it but also throughout England and Wales; the licence must, however, be produced on demand to the local authority in whose district the licensee is working. Sec. 4 and the second schedule of the Act gives statutory force to requirements respecting slaughter-houses and knackers' yards most of which have long been normal in by-laws made by local authorities with respect to slaughter-houses. Other provisions of the Act are that local authorities who have established a slaughter-house are by Sec. 6 given power to employ a person- to slaughter or stun animals and to make reasonable charge for the services of persons so employed. Right of entry for inspection is given to Medical Officers of Health and Sanitary Inspectors. (Sec. 7.) The Act impliedly supersedes by-laws covering the same ground, but existing by-laws dealing with matters not covered by the Act. are not affected, nor is the power and duly to make by-laws for the licensing and registering of slaughterhouses and for securing their sanitary condition. 41 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. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. Yearly average 1923-1932 Pneumonia (all forms) 33,413 38,970 36,990 32,339 37,242 31,014 43,846 27,724 33,573 29,588 34,467 Pulmonary Tuberculosis 32,097 32,690 32,382 30,108 31,066 29,799 31,425 29,414 29,658 27,627 30,627 Measles 5,316 4,834 5,337 3,483 3,622 4,302 3,388 4,188 3,288 3,411 4,117 Whooping Cough 4,162 3,983 6,058 4,118 3,681 2,976 6,332 2,037 2,512 2,956 3,881 Diphtheria 2,722 2,501 2,774 2,994 2,732 3,191 3,446 3,497 2,673 2,339 2,887 Scarlet Fever 993 888 988 677 579 580 717 740 540 530 723 Enteric Fever 450 496 388 367 367 438 382 313 251 258 371 42 The total number of notifications relating to Holborn residents received during the year was 332 in comparison with 402 in the year 1932. The decrease is accounted far by the lesser number of notifications received of the following diseases:— Tuberculosis 59 in comparison with 89 in 1932. Whooping Cough 23 ,, ,, 108 „ On the other hand; there were 90 notifications of scarlet fever in comparison with 57 in 1932. 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 224 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 8 Diphtheria 73 Erysipelas 6 Paratyphoid Fever 1 Measles 9 Scarlet Fever 43 Tuberculosis 54 Whooping Cough 12 Pneumonia 1 Cerebrospinal Fever 1 Acute Poliomyelitis 6 Acute Rheumatism 10 224 Smallpox. This disease continued to be prevalent in London throughout the year 1933. Only one notification was received of a case occurring in a Holborn resident during the year 1933. The patient was removed to hospital, and was subsequently returned not suffering from smallpox, the diagnosis of chicken-pox and scabies being established. During the same period information was received of the occurrence of this disease in three non-resident workers, and seven cases among children attending an elementary school in Holborn, all being non-resident in the Borough. In the County of London 531 cases were notified, a notification rate of 012 per 1,000. 43 Vaccination. The following table gives information respecting the vaccination of children born in the Borough during the year ended 30th June, 1933:— Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Postponed by Medical Certificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-District : 12 months ended 30th June, 1933 144 78 8 30 0 8 16 4 St. Giles and Bloomsbury Sub-District : 12 months ended 30th June, 1933 48 25 2 7 0 5 8 1 192 103 (54%) 10 37 0 13 21 5 During the same period 144 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, 66 (46 per cent.) were known to be vaccinated. The remainder are accounted for as follows:— Removed from the Borough—no information as to vaccination 41 Conscientious objectors—Exempted 19 Died before vaccination 5 Postponed—medical certificate 2 Not traced—incorrect address 11 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, 48 vaccinations were also performed during the year, viz.: (a) primary, 12 vaccinations; and (b) revaccinations 36. Following the arrangements operating in previous years, information of all cases of smallpox in the Greater London area giving particulars of the illness and the names and addresses of contacts was distributed to the Borough Medical Officers of Health by the Medical Officer of the London County Council. During the year information of 515 cases in the County of London and 80 cases in the extra-Metropolitan district was received. Diphtheria. Wo received notifications relating to 75 cases of diphtheria occurring in residents in the Borough; of these, one was sent in as being a "carrier" of diphtheria bacilli. Seventy-five were removed to hospital, including the one "carrier." F 2 44 Age at Notification of 75 Notified Cases of Diphtheria. 0-1 1—5 5—15 15—25 25-45 45-65 Total. 1 21 31 8 12 2 75 Three deaths occurred. Seventeen of the notified cases were returned from hospital certified as not suffering from diphtheria. Secondary clinical cases were three in number; details follow:— Primary Gate Age Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises L. G. 3 5/3/1933 G. G. 8 20/3/1933 One family house M. A. 6 28/3/1933 G. A. 4 30/3/1933 House lot in lodgings P. S. 3 29/8/1933 H. S. 20 30/8/1933 Flat in dwellings 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 ease. In London, 9,557 cases were notified giving rise to 362 deaths. We endeavour to co-operate with the Medical Superintendents of the Fever Hospitals serving the County of London; information is now sent to them as to any bacteriological examinations before admission or after discharge of the patients, and also with regard to return cases of diphtheria or scarlet fever. Diphtheria in Hospitals. Information was received of 82 cases of diphtheria occurring among in-patients or staffs at two hospitals in the Borough. The information was obtained from the notifications of removal received from the London County Council, or from the ordinary notification certificates furnished by the doctors diagnosing the disease. From one hospital there were 67 notifications of which 66 were clinical eases (63 were notified "nasal") and one was notified as a "carrier." Of these 07 notifications six related to Holborn residents, being members of the resident, medical or nursing staff. Sixty-one 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 15 cases were removed, 11 clinical (six "nasal") and four "carriers" only. Of the 15 cases notified, six were Holborn residents (nurses); the remaining nine were in-patients admitted from outside the Holborn area. Diphtheria in Hospitals. Hospital. Cases Notified. Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 6 61 66 1 6 61 67 B. 6 9 11 4 6 9 15 45 Diphtheria Contacts. As in former years we have continued to swab all diphtheria contacts among school children and toddlers. Results of Bacteriological Examinations and Virulence Tests. No. of contacts swabbed 53 Negative at first examination 46 Positive at first examination 7 (13.2 per cent.) Virulence tests made nil 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 53 — 7 - 7* Second ,, 6 - - — — * 1 positive contact removed to L.C.C. Fever 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. 85,000 units wore supplied for five cases, two of these being for prophylaxis. Diphtheria "Carriers." Information was received from the School Medical Officer (L.C.C.) of four children excluded from school as suspected diphtheria "carriers;" all 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. Schick Test and Diphtheria Immunisation. Eleven years, 1922-33. A B c Result of Test. Immunisation of Positives. J D E F G H I Total number of individuals who Attended clinic Total tested Total immunised without liminary Schick test Positive. Negative Not read. Found NEGATIVE to He Schick Test after Found NEGATIVE to Re Schick Test after First immunised with T. A. F. and found NEGATIVES Re 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. of 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. Nofurther inoculation given. Chil- dren Ad- ults c A c A c A C a c A C A C A C A c A c A c A C A C A C A C A C A C A C a C A C A C A C A 1787 333 1293 333 494 0 951 182 334 147 9 3 24 1 27 2 846 77 22 2 9 1 11 0 1 0 3 0 4 0 29 5 10 3 985 92 273 41 22 1 88 20 81 18 6 0 2,120 1,626 494 1,133 481 12 25 29 923 24 10 11 1 3 4 34 13 1077 †† 314 § 23 108 † 99 † 6 1,627 * * These columns refer to 100 cases—89 were Schick positive on retesting after 3 ccm T.A.M. 11 were Schick positive on retesting after T.A.F. † 85 of these removed from the Borough. § 37 of these have removed from the Borough. †† These retests include those made up to 10th January, 1934. Note.—Columns E F G H give details of the total 1,077 given in Column I. 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 in most cases at once to the immunisation. 47 TABLE II. Summary. ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years adults 15 and above years Total for 12years, 1922-33 79 227 158 132 111 98 84 70 61 73 61 50 42 39 8 333 Total Schick Tested = 1626 result of Schick test. Pos. Neg. Pos. Neg. Not read Pos. Neg. Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Not read Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Not read Total for 12 years. 73 6 214 10 3 149 9 111 20 1 78 31 2 60 36 2 55 29 48 22 38 23 32 41 27 34 27 23 19 23 15 24 5 3 182 147 4 1133 Pos. 481 Neg. 12 Not read. Immunised without preliminary Schick test (Jan. 1927end of 1932). 91 180 93 56 48 10 8 4 1 2 0 0 1 - - - Total immunised without preliminary Schick test 494 Total immunised (includes above). 155 349 209 148 106 58 60 52 28 30 21 23 13 10 2 149 Total immunised (includes above). 1413 48 No cases of diphtheria have occurred among the immunised children during tho year; since starting the work nine cases in all have occurred, particulars as to these were set out in last year's Annual Report. 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 1933. At this hospital Schick testing of all newcomers and immunisation of positives is now compulsory. From June, 1930, till the end of December, 1933, 145 nurses were tested, 24 of these were tested for the first time in 1933, 16 of these were positive (all of these were immunised) and eight were negative. Immunisation of School Children. Attendances of London public elementary school children to be immunised against diphtheria at Municipal Centres are now allowed to count as attendances at school. Scarlet Fever. There were 96 notifications of scarlet fever. All but two were removed to hospital. Six of these were returned from hospital diagnosed as not suffering from this disease. Five notifications of "secondary" cases were received. From two hospitals in the Borough 39 in-patients were notified as so suffering; none was resident in Holborn. There was no "return" case of scarlet fever. There were two deaths from this disease. 21,911 cases of scarlet fever were notified in London with 84 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 were 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. Twenty-four cases were notified in 1933. As regards the sources of information relating to the total number of notifications from 1929 to 1933 eight 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, 71 were notified by the 49 District Organiser of the L.C.C. Care Committee, and one by the Invalid Children's Aid Association, as having been definitely stated medically to be suffering from rheumatism. Eighty-three cases have been reported to the health visitors by parents, and in 33 of these the diagnosis of rheumatism has been confirmed. The total notifications received up to the end of 1933 are classified as; — Rheumatic tendency 5 Sub-acute rheumatism 61 Acute rheumatism 43 Post-rheumatic 15 124 Age and Sex Distribution of notified cases. Age in years. Sex . Total. M. F. 2 1 — 1 3 1 — 1 4 4 3 7 5 1 5 6 6 6 4 10 7 3 6 9 8 7 6 13 9 7 10 17 10 5 9 14 11 4 4 8 12 4 10 14 13 4 2 6 14 2 10 12 15 3 3 6 Totals 52 72 124 Particulars of cases of acute rheumatism in children arc 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. The Holborn children attend Rheumatism Supervisory Clinics at the Hospital for Sick Children, Great Ormond Street, and at the Royal Free Hospital. Enquiries in Notified Cases of Rheumatism. Enquiries into the housing conditions of the notified cases showed that 52 lived in satisfactory artisan self-contained flats; 25 lived in satisfactory artisan homes in divided houses of a comfortable type (a better class of house let in lodgings); 37 lived in houses let in lodgings; 8 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. It is somewhat curious to note the incidence of acute rheumatism in satisfactory homes. G 50 Dampness in Houses. Dampness was found in only four houses, due to temporary nuisances which were remedied. Lighting and Ventilation. Three children lived: in a semi-basement flat, and although the lighting was not good, the flat was well built and the street and courtyard adjoining fairly wide, so that lighting and ventilation compared not unfavourably with upper floors in narrow streets and small courtyards. In eight other cases the lighting was unsatisfactory. 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 evidence of legal overcrowding in only one of the houses and steps were taken to abate this nuisance; the legal standard of overcrowding is notably low however. The sleeping arrangements are given in the following table:— Sleeping Arrangements—117 Cases of Notified Rheumatism * No. of Rheumatic Children Separate Room Separate Bed in Living Room Separate Bed in Room shared with Bed shared with Bed shared in living room with Adults Children Adults and Children Adults Children Adults and Children Children Adults and Children 1 2 3 1 2 3 1 2 3 5 1 2 3 1 2 3 1 2 1 2 3 117 12 8 6 7 0 13 6 0 2 2 6 1 9 0 0 30 9 1 1 1 1 1 1 117 12 8 43 51 3 * Exclusive of two cases where wrong addresses given, one where the patient died shortly after the date of notification, and four where the child removed immediately after notification. It will be seen that only twelve children had a separate room; forty-three had a separate bed in a shared room; fifty-four shared a bed, twelve of these with more than one person and three in a living room; eight children had a separate 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 earlyish hour in the morning). Social Conditions. Six children live in one-room homes. In thirteen homes there is a history of chronic poverty, but without acute distress; in three of these the mother has been many years widowed; in another the mother has been rearing the illegitimate family of a man who also supports his wife and his own legitimate family on a moderate income; two 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. Value of Notification of Rheumatism in Children. The notification of rheumatism in children enables research to be made into cases which may possibly influence the incidence of the disease: it also calls attention to rheumatism as a disease of childhood. The periodic visiting which follows upon notification enables the health visitor to bring home to the parents the need of intensive care for the child and of giving consideration to 51 his future welfare. Without such visiting, the poor health of the child might be accepted as inevitable and no special effort might be made to sccure for him the best conditions within the reach of the parents. The value of fresh air, of sufficient rest and especially of the "early to bed" habit are insisted upon, as well as the meaning and importance of good nutrition. In Central London, where facilities for obtaining good fresh food at reasonable prices abound, the provision of a suitable diet is a matter of knowledge and mean. There are, however, many difficulties in the way of providing adequate sleeping accommodation for children. High rents must be paid for even few and small rooms and flats, and thus the condition which is frequently most harmful to the child, namely, a crowded sleeping room, is the most difficult to remedy. Children are not infrequently found sleeping two or three in a bed, because there is not enough floor space to allow of another bed being put up; spare beds, which could be used if there were room for them, must sometimes bo stored. A separate bed is especially desirable for a rheumatic child, but if this can be secured only by placing the bed in the living room, the child will go to bed too late and get up too early, and this may bo worse for him than sharing a crowded bedroom. Where the father must either live near his work or run the risk of losing it, it is no solution of the difficulty to suggest that the family shall remove to the Greater London area. At the same time, it is occasionally found that a child for whom ample and separate accommodation is provided is kept up until the parents' bedtime because the parents do not understand the vital importance to the child of sleep during the early hours of the night. Heredity. As a result of enquiries of parents it appeared that there was a family history of varying degrees of rheumatism in forty-three families. In twenty-three of these the mother was reported to have suffered, in nine the father, in two cases both parents; in thirteen cases there was a more or less definite history of rheumatism in other relations. Condition of the Nose and Throat. In fifty-one children the condition of the tonsils was normal. Fifty-six children had their tonsils removed, thirty-one of these also had adenoids removed. In nine cases tonsillectomy was advised, three of the nine 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 fifty-six children referred to above, in twelve 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-eight tonsillectomy had been performed at varying periods considerably before the symptoms of rheumatism were observed (from fourteen of these also adenoids had been removed); in fifteen others the children were found to have had tonsils removed as part of treatment for rheumatism. Teeth. In seven children dental caries was still present: in nineteen others treatment had been given. Contacts. Twenty-four of the notified cases had no contacts. A history of rheumatic pains was reported in the contacts of eleven cases. 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 bo observed and examined if necessary. History of Patients after leaving school. During 1933 nine children censed to attend school and are occupied no follows:— (1) Boy (F. A., æt. 14) is an optical lens maker. (2) Girl (F. B., æt. 14) is engaged in a tobacoo factory. (3) Girt (W. C., æt. 14) assists in a laundry receiving office. G 2 52 (4) Boy (F. F., æt. 14) is a clerk. (5) Girl (K. P., æt. 14) is unoccupied. (6) Boy (E. S., æt. 14) is unocoupied. (7) Girl (J. S., æt. 15) is a milliner's assistant. (8) Girl (D. C., æt. 14) is a shorthand-typist. (9) Girl (M. D., æt. 15) is a tailoress. One girl (D. L., æt. 15) who ceascd io attend school in 1932 continues her occupation as a clerk. Eight children reached the age of 16 during 1933 and still continue their previous employment. Obviously the nature of the employment to be followed by any child who has suffered from rheumatism requires careful consideration from all concerned. Holidays for Rheumatic Children. An annual holiday in the country or by the sea is of benefit to all children; it is even more necessary for children who are handicapped by rheumatism. Enquiry made in 1933 revealed that during that year 13 rheumatic children had a holiday (varying from one to four weeks) with their parents; 20 had a holiday in connection with their school or some social organisation; 18 went to convaleseont homes for periods of not less than two weeks (in most cases for several months). We went to much trouble in 1933 to endeavour to secure that as many as possible of these children should have a holiday; this year, 1934, the co-operation of the school organisation has been secured. Typhoid and Paratyphoid Fever. One notification only was received during the year of typhoid fever. Bacteriological examination at the South Eastern Hospital of the London County Council, to which the patient was removed, was negative, and a final diagnosis of influenzal pneumonia was made. There were 164 cases in London with 25 deaths. 0 Typhus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-Spinal Fever. Three cases of corebro-npinal fever were notified in the Borough. Two hundred and sixteen cases were notified in London, giving rise to 110 deaths. Bacillary Dysentery. No case of dysentery was notified. Thirty-one cases were notified in London, with seven deaths. Malaria. One case of malaria was notified. The patient had resided in India, where he contracted the disease in 1920. Twenty-one cases were notified in London, with one death. Encephalitis Lethargica. One case of encephalitis lethargica was notified in the Borough during the year. This case was not formally notified until after death of the patient. 53 The following table gives information up to the end of 1933 respecting the 13 real cases of encephalitis lethargica notified in the Borough since the Public Health (Encephalitis Lethargica) Regulations came into force on the 1st January, 1919:— Date of Notification Patient. Sex. Age when notified. Subsequent History. 13/1/20 B.R. F 32 years Disease fatal 13/1/20 6/2/20 P.P. M 8 years Disease fatal 28/2/20 7/2/20 W.W M 47 years Disease fatal 7/2/20 26/4/22 W.H. M 14 years Disease fatal 19/4/22 4/4/24 A.K. F 28 years Disease fatal 28/3/24 16/5/24 G.C. M 36 years Returned to Italy; no further information 20/6/24 R.V.M. M 40 years Went to Australia. Complete recovery reported 9/7/24 F.H. F 7 years Complete recovery 26/9/24 B.V. F 53 years Disease fatal 21/9/24 4/5/25 C.S. F 28 years In-patient in St. Pancras Hospital. 29/5/26 H.P. M 33 years Disease fatal 30/5/26 22/7/29 C.M. M 47 years Returned to West Indies; 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 19/9/33 J.C. M 16 years Disease fatal 17/9/33 The table excludes one case notified 15/11/24 who was subsequently found not to be suffering from this disease. 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 eases in the Borough was forwarded in order that where the patients were not of school ago 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 1933. 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.); Condition worse. Nov., 1924 K.M. F 1911 London Homæopathic Hospital-in-patient Removed from Holborn. 54 Acute Poliomyelitis and Acute Polioencephalitis. No case of acute poliomyelitis or polioencephalitis was notified. Sixty cases were notified in London, giving rise to nine deaths. From the coming into operation of the Poliomyelitis Order, 1912 to the end of 1033, 18 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 Age at date of Notification. Where Treated. Subsequent History. 17/7/13 F.D. M 1 8/12 years Hospital Died from diphtheria. 23/10/13 F.H. F 2 „ „ Wears specially made shoes. Health satisfactory. Working. 26/1/16 A.C. F 4 „ „ Died 26/1/16. 27/1/16 T.B. M 4 „ „ Working-slight limp; health good. 5/9/16 F.B. M 2 months „ Died. 6/6/20 P. F 3½ years „ Recovered—no crippling. Health fairly good. 23/7/20 E.W. M 15 „ „ No use of lower limbs. Does occasional clerical work. 17/9/20 E.H. F 1 8/12 „ „ Recovered. Health satisfactory. Working. 4/9/22 Y.R. F 1 1/1 0/2„ Home Died in Paris. 5/2/23 J.N. M 3½ „ Hospital Recovered—no crippling. 2/5/23 M.H. F 11 mths Hospital 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 1 1/1 1/2 „ „O.P. Goes to school, Improvement in use of arm 14/9/31 P.C. M 9/ 12 „ „ Died 18/9/31 —/11/31 B.C. F 10 „ Home Walks well 3/6/32 G.C. M 6 mths. Hospital Out-patient St. Bartholomew's Hospital — support for right foot when in bed 30/8/32 L.P. M 13 years „ No improvement in left arm The table excludes one case notified 4/12/18 who was subsequently found not to be suffering from this disease. 55 Pneumonia. Thirty-seven cases of pneumonia were notified during the year. Ten of these were influenzal pneumonia. Twenty-eight deaths were recorded from all forms of pneumonia. The 27 Cases of primary pneumonia were notified at the following ages:—Under 1 year, 1; from 1 to 5 years, 4; from 5 to 15 years, 1; from 15 to 35 years, 9; from 35 to 45 years 3; from 45 to 65 years, 6; and 65 years and upwards, 3. Nine were treated at home; 5 were removed to L.C.C. hospitals; 12 to voluntary hospitals; and one in a Police nursing home. Five of the patients were nursed by the Metropolitan Nursing Association under the arrangements made by the Council, in all 101 visits being paid to these patients. Enquiry respecting the eases of primary pneumonia elicited the following information: — 11 resided in tenement lodging houses, 3 in separate private dwelling houses, 7 in model dwellings, 5 in hotels and boarding houses, and 1 in a Police Section House. The cleanliness of the houses were reported satisfactory in 23 cases, but only fairly so in 3 and in 1 case no information was obtainable. The economic conditions of the families concerned were found to be good in 6 cases, fair in 8, poor in 4, very poor in 1; in 8 cases information as to economic condition was not obtainable. Influenza. There were 25 deaths from influenza in comparison with 12 in 1932, 13 in 1031, 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 11 males and 14 females. Of the 25, 13 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 1933 we received information of 38 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 20 eases 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. 321{ Bacilli not found 299 Diphtheria bacilli found 22 69{ Bacilli not fouud 56 - - Vincent's organisms found 4 Bacilli found 13 56 Disinfections. During the year 643 rooms and 5,058 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Forty-one rooms and 435 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. Ninety-seven books and 130 toys were disinfected. The disinfections also included ten lockers, and eight hospital wards. Cleansing of Persons Act. During the year 212 persons (196 men, 5 women and 11 children) infested with vermin had their bodies and 1,643 articles of clothing disinfested, free of charge, at our cleansing station (Goldsmith Street). 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 1033 the accommodation was used by four Holborn families comprising ten persons. Extermination of Yermin. 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 eight gallons of the solution in small quantities were sold to 41 purchasers. One hundred and ninety-one verminous rooms were disinfested by the Council's staff. When fumigating verminous rooms wo endeavour, whenever practicable, to repeat the fumigation at the end of twelve to sixteen days, 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 140 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. 57 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 1933 in the form required by the Ministry of Health: — Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 — — — — — — — _ 1 — — — 2 — — — 2 6 — — — 1 — — — — 10 — — 1 1 — — — — 15 1 2 — — 1 1 — — 20 4 4 1 — 2 1 — — 25 5 6 2 — 6 5 — — 35 9 3 — — 6 1 — — 45 2 4 1 — — 2 — — 55 7 — — — 7 1 — — 65 1 2 — — 1 1 — — 29 21 5 4 23 12 — 2 Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1933 323 Number of these patients residing in common lodging houses 56 The average number of cases notified annually during the past ten years 04 The number notified in the year 1033 50 Of tho 50 cases notified in 1033, tiie number who attended the Dispensary 21 Total number of new cases examined at tho Dispensary for tho first timo in 1033, including the above 20, and all contacts 95 Total attendances at the Dispensary in 1932 981 Supervision of home conditions; visits paid by— Tuberculosis Officer 30 Dispensary Nurse 1,17ft 58 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933, in the, Metropolitan Borough of Holborn. Age-periods 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 4 7 2 5 1 23 28 ,, Females — — — — 2 3 6 2 3 — — 16 22 Non-pulmonary Males — — — 1 — 1 — — 1 — — 3 4 „ Females — 1 — — — — — — — — — 1 1 Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age-periods. 0— 1— 5 — 10— 15— 20— 25— 35— 45— 55— 65— Total. Pulmonary Males — _ — — — 1 1 2 — 2 — 6 ,, Females — — — — — 1 — 1 1 — 2 5 Non-pulmonary Males — — — — — — 2 — — — — 2 ,, Females — 1 1 1 — — — — — — — 3 59 The source or sources from which information as to the above-mentioned cases was obtained arc stated below: — Source of Information No, of Cases. Pulmonary Non-Pulmonary Death Returns From local Registrars — 1 Transferable deaths from Registrar General 5 1 Post-humous notifications 2 — "Transfers" from other areas (other than transferable deaths) 4 2 Other Sources if any (specify) — 1 Notification Register. Pulmonary Non-pulmonary Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1933, on the Registers of Notifications 164 92 256 40 27 67 323 Number of cases removed from the Registers during the year by reason inter alia of:— Withdrawal of notification _ — Recovery from the disease — 1 1 3 — 3 4 Death 23 12 35 — 2 2 37 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1933 was 43; 10 other cases were brought to my knowledge (making 59 new eases in the year). These were:—Private eases 12, hospital cases 25, Public Assistance cases 7, from death returns 7, transfer from other districts 6, and 2 were posthumous notification. Of the 59 eases entered on the Register in 1933, 50 were pulmonary tuberculosis and 9 non-pulmonary tuberculosis. Fifty-two of the cases were removed for treatment to hospital, sanatorium. Sleeping Conditions. In 38 of the 59 new cases of tuberculosis in 1933 it was possible to obtain information as to the sleeping conditions at the date of notification, Nine of the remaining cases were residents in common lodging houses; in five eases incorrect addresses were given, or the patients no longer resided in the Borough. In three where the patients had died before notification no information was obtainable and four were temporary residents at hotels H 2 60 The following is a summary of the information in t'lie 38 eases above referred to: — Patient slept in— Separate bed room 14 Separate bed in living room 3 Separate bed in room shared with— 1 adult 4 2 adults 1 — 22 Shared bed with— No others in room 1 adult (Husband or Wife) 10 1 adult (not Husband or Wife) 3 1 child and 1 adult 1 Shared boa with— 1 adult 1 child Other persons in bed room 1 adult, 2 children 1 4 children 1 — 16 38 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 7 " B."—Fair. Separate bed, but not separate bedroom 2 "C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 10 45 Summary. The following summary gives the position at th® end of 1933 of the 59 new cases respecting which information was received during* the year:— Dead 15 Cases removed to Nursing home, Hospital or Infirmary and still in-patients at the end of year 18 In-patients in Sanatoria at end of year 4 Removed from Borough 6 Home Treatment—Private or Panel Doctor 11 Away in country 1 No information4 59 61 Non-attendance at Tuberculosis Dispensary. Twenty-one of the 59 eases attended the Holborn Tuberculosis Dispensary. The following indicates the reasons for non-attendance in the remaining cases:— Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 18 Dead before notification or died before attendance at Dispensary 13 Treatment at home by private doctor 1 Not traced and common lodging house cases 2 Removed from Borough 4 38 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 cases of this disease until tubercle bacilli have been found in the sputum and in a number of cases notifications are not received until the death of the patient or shortly before death takes place. In the past year nine cases were notified only at death, six within one month of death, and two within three 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 are 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 74 admissions to institutions. These admissions represent 64 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 55 Other institutions 19 Visits to Homes, etc. During 1933 the Tuberculosis Officer made 36 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 1,176 visits. The advice given by the Tuberculosis Nurse includes suggestions respecting food and cooking and suitable cookery books are supplied free of charge. 62 Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. Twenty-nine contacts, viz., 19 adults and 10 children under fifteen years of ago, responded to this invitation and were examined for the first time during the year 1933. Of these, four adults were found to be definitely suffering from tuberculosis. Twenty-five were definitely diagnosed as not suffering from the disease. The routine examination of contacts is desirable as a means of discovering not only cases of tuberculosis in early stages of infection but also advanced and infective eases 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 26, a death rate of 0.72 per thousand. There were also three deaths from other forms of tuberculosis, a rate of 0.08 per thousand. The following table shows 37 patients formerly on our tuberculosis register who died in their own homes or institutions, although in eight cases death was not attributed to tuberculosis:- 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 - 2 1 - 1 - 2 3 5 Number of patients who died in hospitals, etc. - 2 - - 1 3 9 6 2 7 2 21 11 32 - 2 - - 2 3 11 7 2 8 2 23 14 37 63 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, J. A. Struthers, M.D., B.Ch., M.R.C.P., P.P.H., for the year 1933:— Return showing the work of the Dispensary during the year 1933. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 23 11 — — 2 2 1 2 25 13 1 2 (b) Doubtfully tuberculous — — — — — — — — — 2 — — (c) Non-tuberculous — — — — — — — — 5 7 5 6 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 2 — — — — — — 2 2 — — (b) Doubtfully tuberculous — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 4 11 5 5 C.—Cases written off the Dispensary Register as (a) Recovered — 1 — — 1 — 2 — 1 1 2 — (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as tuberculosis) — — — — — — — — 9 18 10 11 D.—Number of Persons oil Dispensary Register on December 31st:— (a) Definitely tuberculous 106 67 7 5 13 19 12 9 119 86 19 14 (b)Diagnosis not completed — - — — — — — — — 2 — — 64 1. Number of persona on Dispensary Register on January 1st, 1933 224 2. Number of patients transferred from other areas and cases returned after discbarge under Head 3 in previous years 9 3. Number of patients transferred to other areas, cases not desiring further assistance under the scheme and cases "lost sight of" 25 4. Cases written off during the year as dead (all causes) 11 5. Number of attendances at the Dispensary (including contacts) 981 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 52 7. Number of consultations with medical tioners:— (а) Personal 25 (б) Otherwise 70 8. Number of other visits by Tuberculosis Officers to Homes 36 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1176 10. Number of (а) Specimens of sputum, Ac., examined 140 (б) X-ray examinations made in connection with Dispensary work 47 11. Number of "Recovered" Cases restored to Dispensary Register in A (a) and A (6) on page 68 0 12. Number of " T.B. plus" cases on Dispensary Register 31st December, 1933 125 65 Report of the Tuberculosis Care Committee for 1933. The Committee met 11 times during the year. The average attendance of members at' each meeting was 8-9. Seventy-one cases have been considered—44 new (42 adults and two children and 27 old cases (25 adults and two children). Forty-four cases (42 adults and two children) were referred to the Committee for assessment; seven of these were old cases, and one of them was referred for reconsideration owing to altered circumstances. Twenty-eight adults were recommended for free treatment. Fourteen adults and two children were assessed at amounts varying from 2s. 6d. to 30s. per week. The average cost of treatment is about £2. 10s. 0d. per week. Contributions towards the cost of treatment and maintenance, amounting to £98. 2s. 0d., were collected in 22 cases—15 adults and seven children. Eleven of these were still under treatment at the close of the year (eight adults and three children). Thirteen progress reports, on five children, were received from the London County Council, and the information contained therein was conveyed to the parents. Eleven cases were referred for convalescence, but three of these were withdrawn before arrangements were completed. Two were sent away through the Invalid Children's Aid Association, three through Stafford's Charity, two through the United Services Fund and British Red Cross Emergency Help Fund, and one through the Joint Nursing and V.A.D. Services Committee of the British Red Cross Society. During the year 836 visits nave been paid to patients and their families, and, in addition, numerous visits have been paid to Societies, etc., on their behalf. In the course of the year seven different Hospitals have been visited. Eighteen patients known to the Committee have removed from the district during the year, and two have been transferred from another district. Thirteen patients known to the Committee have died. Two of these died at home and eleven died in Hospitals. One patient was referred to the Borough Council for assistance with dentures, but he died before the work was carried out. Two children were boarded out under the London County Council's Contact Scheme, but the parents took them home again, contrary to advice. Owing to the change in National Health Insurance Arrears Regulations, many of our friends who had suffered from prolonged periods of unemployment found themselves in difficulties, and many did not realise the significance of the change until it was pointed out to them. It was found possible to afford assistance to a considerable number of these people. I 66 The Committee gratefully acknowledges the co-operation and assistance given by the British Legion and United Services Fund Benevolent Committee, the British Red Cross Emergency Help Committee, the Joint Nursing and V.A.D. Services Committee of the British Red Cross Society, the Charity Organisation Society, the Invalid Children's Aid Association, the Society of St. Vincent de Paul, the Trustees of Stafford's Charity, Regimental Funds, etc. With the kind assistance of various members of the Committee, several Borough Councillors, and other friends, we were able to ensure that 25 families were supplied with Christmas Dinners through the Polytechnic Distress and Christmas Dinner Fund, seven families received a gift of coal, and three families were helped with food tickets at Christmas time. Public Health (Prevention of Tuberculosis) Regulations, 1925. In July, a registered milk seller was notified as suffering from pulmonary tuberculosis. On enquiry it was found that the patient was proprietor of a small restaurant, selling also a few jugs of milk for consumption away from the restaurant. On being interviewed by the Medical Officer of Health the patient undertook not to engage personally in the milk part of the business. The giving and keeping of this undertaking, followed shortly afterwards by the disposal of the business and removal of the patient from London, obviated the necessity for action under the above Regulations. Tuberculosis: Extra Nourishment. Revised arrangements were approved by the London County Council respecting co-operation with the Metropolitan Borough Councils with regard to the treatment of tuberculosis, and particularly for extra nourishment for tuberculous persons in receipt of Public Assistance relief. In agreeing to the co-operation, the opportunity was taken of pointing out that an equally, if not more urgent, cognate question, was that of the supply of extra nourishment, or of adequate public assistance relief, to the families of such tuberculous persons. Obviously it is of first importance that these families should have a supply of nourishment adequate for the maintenance of resistance of the infection to which they are exposed. Subsequently a communication was received from the Chief Officer of Public Assistance suggesting that, if in any particular case the Tuberculosis Officer is of opinion that the circumstances are such that extra nourishment should also be supplied to other members of the family, he should draw the attention of the District Medical Officer to the fact in order that the latter might have regard thereto in submitting his recommendation to the District Sub-Committee. Home Nursing for Tuberculous Patients. It was not necessary during the year 1933 for any tuberculous patient to be nursed under the arrangements made by the Council with the Metropolitan District Nursing Association. 67 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. Particulars of this service are given in the table below (General Dental Clinic). 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. Tuberculous patients are also seen at the Tuesday evening Clinic by appointment at times outside the hours for the general public. The Secretary of the Hospital has kindly supplied the following information of the work at the Clinic during the year 1933:— Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1933. Tuberculosis Patients. All Patients. Number of sessions held — 48 Number of patients' attendances 16 250 Number of fillings 16 69 Number of scalings 2 9 Number of extraction cases Without anæsthetic — 2 With local anæsthetic — 14 With gas 2 22 Number of teeth extracted 10 126 Number of dentures (including repairs) — 23 Number of dressings 2 21 Number for advice 2 45 Number of denture visits - 57 Number of new patients 3 47 Cancer. During the year 1933, 61 deaths were recorded as due to Cancer in comparison with 71 in the previous year. The deaths in 1933 were equal to a rate of 1.69 per thousand, the corresponding rate in 1932 being 1.95 per thousand. In the year 1913 the death rate from Cancer in the Borough was 1.04, the decennial average rate was 1.34 for the ten years, 1914-1923, and 1.68 for the ten years, 1924-1933. It will been seen that the death rate from Cancer in the Borough in 1933 was lower than in the previous year, being 1.69 per thousand in comparison with 1.05 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, 1914-1923, was 1.34, the corresponding rate for the ten years, 1924-1933, was 1.68. Some part of this increase may reasonably be attributed to improved facilities for diagnosis. The figures indicate the high mortality from malignant diseases. I 2 68 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 180 births were registered as occurring in the Borough. During the same period 136 notifications of births occurring in the Borough were received. Of these, 132 were from doctors and midwives, 4 from parents. The mothers were attended at their confinement by:— Private Doctors 20 Private Midwives 19 Out-patient Midwifery Departments of General Hospitals and Institutions:— Externs and others 43 Midwives.—University College Hospital 2 Middlesex Hospital 10 Other Institutions 3 Training Institution for Midwives, Myddelton Square 39 136 Five of these notifications related to stillbirths. Number of Births. The number of births transferred to the Borough from outlying institutions was 175 The number of births transferred from the Borough to other districts was 13 The net number of births belonging to the Borough was 342 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 261 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 23 6.7 43 12.6 Two „ „ 79 23.1 60 17.5 Three „ „ 23 6.7 16 4.7 Four or more „ 13 3.8 4 1.1 Total 138 40.3 123 35.9 These figures show that many of the women are confined under very uncomfortable and unfavourable circumstances. 69 Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits. Revisits. Total. Expectant Mothers 187 227 414 Post-natal Mothers 10 8 18 Children under 1 year of age 327 752 1,079 Children 1 to 2 years of age 15 299 314 Children over 2 years of age 46 649 695 Enquiries re stillbirths 18 „ re ophthalmia neonatorum 4 Other visits 291 Two hundred and seventy visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 221 were recorded as attending a Centre, i.e., 82 per cent. Thus five-sixths of those visited attended an Infant Welfare Centre and of these nearly 84 per cent. attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following:— 165 attended the Council's M. &, C. W. Centre at 10, John Street. 21 „ „ „ „ Short's Gardens. 4 attended the Centre at Onslow Street School, Saffron Hill. 8 „ „ Charing Cross Hospital. 8 „ „ Myddelton Square. 3 „ „ Middlesex Hospital. 4 „ ,, University College Hospital. 6 „ „ Royal Free Hospital. 2 „ „ other Centres. 221 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. Tuesday. Wednesday. Thursday. Friday. Medical Consultation Pre-school child 2-4.30 p.m. Ante-natal and Postnatal cases 2-4.30 p.m. Medical Consultations. Medical Consultation 2-4.30 p.m. Class 3-4 p.m. Dentist. 2-4 p.m. Medical Consultation 2-4.20 p.m. No. of Sessions 49 51 51 52 43 52 51 Total attendances- Children 815 ... ... 2004 ... 107 1373 Mothers 2 220 54 311 384 180 320 Average weekly attendances— Children 17 ... ... 40 ... 2 27 Mothers ... 4 1 6 9 3 6 70 St. Giles' Centre, Short's Gardens. The attendance at this Branch Centre during the year 1933 were as follows:— Thursday—Medical Consultation—2—4.30 p.m. No. of Sessions 51 Total attendances—Children 477 Mothers 47 Expectant Mothers 27 Average weekly attendances—Children 9 Mothers 1 The total number of attendances made by the Health Visitors at the Municipal Centres in 1933 was 437, and in addition Health Visitor students made 199 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 5,770 attendances were made by 270 mothers and 76 expectant mothers, and 530 children, of whom 277 were under one year, 77 between one and two years old, and 176 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 981 attendances were made by 37 mothers and 85 children, of whom 44 were under one year, 14 from one to two years and 27 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 58 voluntary notifications were received during 1933 as compared with 78 in 1932. 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 180 expectant mothers visited during 1933, each case being followed up either to a successful issue or until it bccame clear that the woman would not enter hospital. Of the 96 who went into hospital:— 29 (14 primigravidæ) lived in a one-room homo; 67 (24 primigravidæ) lived in a two or more roomed home. Of the 84 who remained at home: — 7 (2 primigravidæ) lived in a one-roomed home; 51 (5 primigravidæ) lived in two rooms; 26 (1 primigravidæ) lived in three or more rooms; 71 Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 155 times during the year 1933. 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 300 mothers, about whom information was obtained, 246 (82 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under:Number of enquiries made 300 Centre Attended:— Holborn Centre, 10, John Street 25 Holborn Centre, Short's Gardens 1 Royal Free Hospital 18 Middlesex Hospital 21 Charing Cross Hospital 31 University College Hospital 37 Myddelton Square Institution 36 St. Bartholomew's Hospital 24 City of London Hospital 11 Queen Charlotte's Hospital 6 Elizabeth Garrett Anderson Hospital 8 St. Pancras Hospital 12 Other Centres 6 Ante-natal care from private doctors 7 Ante-natal care from midwives 3 246 Nature of defects found at Municipal Centres. 10, John Street, Holborn. Short's Gardens St. Giles. No. of women attending ante-natal clinics 76 12 Women expectant for the first time 12 — No. of attendances made 152 — Defects found specially connected with pregnancy:— Deformed pelvis 1 — Threatened miscarriage 3 - Retroverted gravid uterus 1 - Breech presentation 3 - Excessive vomiting 11 - Œdema 5 - Varicose veins 7 1 Excessive vaginal discharge 3 - High blood pressure 3 - Other defects 14 - Other defects:— Heart disease 2 1 Anæmia 5 1 Inspiratory diseases 3 - Constipation 23 1 Dental caries 26 2 Dyspopsia 5 1 Pyorrhœa 4 - Rheumatism 4 - Other defects 10 — No. referred to maternity hospitals:— Normal 11 - Abnormal 7 - No. referred to dental clinic 12 - No. of urine tests made 96 - 72 Post-natal Consultations. Twenty-eight mothers attended the post-natal consultations at the Centre, 10, John Street, 16 of whom had attended the Centre as ante-natal cases. They made 60 attendances in all. The chief defects found were two cases of venereal disease (both referred to hospital); one case of retroverted uterus (referred to hospital); and five cases of prolapse, one of which was referred to hospital and four were treated at the Centre; four of cervicitis (treated at Centre); two cases of anaemia., two of laceration of cervix (treated at Centre); four cases of pruritus valvæ (treated at Centre); in the remainder no abnormality due to pregnancy was found. Six mothers attended the post-natal clinic at the Short's Gardens Centre. The defects found included two cases of cervicitis (both referred to hospital); one case of retroversion of uterus (referred to hospital); and one case of slight prolapse (referred to hospital); and one case of mastitis required reference 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. Miss Mary Carter and Miss Edith Joyce have continued to give us a groat 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, continued to supply us with knitted and sewn garments made by her workers, until the end of March, 1934, when the Guild was disbanded. 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. Four hundred and eighty-eight hanks of wool of a special quality were sold at cost price to the value of £18. 6s. 7½. ' Maternity outfits are placed on sale at the Centre at cost price, 5s. l0d. Only one outfit was sold. 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. 73 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 1933:— Reasons for attendance. 10, John Street. Short's Gardens. Mothers:— Difficulty with breast feeding 30 3 Disorders of generative organs 21 3 Constipation 8 — Heart disease 1 — Anæmia 20 I Respirotry disease 7 2 Digestive disorders 7 1 Debility 22 — Dental caries 32 1 Rheumatism 10 - Venereal Disease 2 - Other Diseases 42 - Children:— (Healthy) 153 50 Alimentary disorders 39 11 Rickets 28 2 Heart disease 1 — Rheumatism 3 — Respiratory disorders 59 3 Marasmus 12 - Debility 13 1 Hernia, umbilical 13 — Hernia, inguinal 1 — Phimosis 28 3 Disease of skin 30 — Disease of eye 24 1 Disease of car 13 2 Disease of nose and throat 21 1 Dental caries 21 — Other diseases 53 — (In this table, if the patient has more than one ailment, only the more important has been recorded.) Mothers and children attending the Municipal Centres during 1933 were referred to other departments or organisations as follows:— Mothers. Children. Ante-natal Clinic 2 — Tuberculosis Dispensary — 1 Minor Ailments Clinic 74 209 Dental Clinic 23 39 Metropolitan Nursing Association 4 8 Nursery School — 1 Massage Clinic 16 — Hospitals 18 61 Convalescent Homes 2 27 Assistance Sub-Committee (for milk) 18 31 Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1933:— John Street. Short's Gardens Number referred to Metropolitan Nursing Association 15 — Results:— Breast secretion re-established 6 — Small bottle foods required in addition to breast feeding 4 - Massage unsuccessful 6 — K 74 Pre-school Children. During the year under report 69 of the children examined were found to be under-developed for their respective ages and types, while 24 were above the average. The rest were about normal for their age and type. Forty-four children suffered from throat abnormalities; of these, 25 were cases of enlarged or inflamed tonsils, 16 of enlarged tonsils and adenoids, while three had enlarged adenoids only. Twelve have been operated on with beneficial result to their health; in six cases the parents refused treatment, while the remaining cases requiring operation are awaiting admission to hospital. Twenty-eight children were found to have dental caries and were referred to the dental clinic. The cases of skin diseases numbered 35; of these, 11 were of impetigo, 13 were of lichen urticatus, 10 of eczema, one of vaccinia, while one child was infested with pediculus capitis. Eight children were found to be suffering from rickets; four required treatment and were referred to appropriate institutions. As regards alimentary affections, ten children harboured parasitic threadworms, eight suffered from obstinate constipation, and one case of diarrhoea and vomitting occurred. Three children suffered from enuresis; one had an umbilical hernia, one weak ankles, one a stutter and one had chilblains. Advice is being given and, where necessary, the cases will be referred to hospital. Four children were referred to the Child Guidance Clinic for nervousness and bad habits and derived much benefit from the treatment. One child suffering from hypothyroidism and hypopituitism was referred to hospital and is responding well to glandular therapy. There were eight cases of enlarged cervical glands, nine cases of otorrhœa, also one case of mastoid disease which was referred to hospital. Six children were found to be anæmic and five debilitated. Of the cases of eye disease, three had styes, four conjunctivitis, and oneblepharitis ; three cases of strabismus were referred to hospital for treatment. A diphtheria carrier was detected and sent to hospital; and three children were referred during the year for Sunray treatment for debility and loss of muscular tone. 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 Reports. These activities were maintained during 1933. , 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 143 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 75 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 1033 eighteen stillbirths were registered, 15 of which were legitimate. Enquiry as to possible causes was made in each case. Three occurred in the private practice of doctors, one in the extern practice of an institution, in twelve instances the confinement took place in hospitals, and in two cases no information was obtainable. Difficult labour was responsible for four; in two of these there was abnormal presentation (one was a breach andi in the other the umbilical cord presented), in two there was antepartum hæmorrhage, breach presentation. Constitutional maternal disorders appeared to account for three stillbirths; these were albuminuria, Blights disease, oedema and heart disease respectively. Prematurity accounted for one stillbirth. In three cases no definite reason could be assigned and in seven no information was obtainable. Illegitimate Children. The births of 57 illegitimate children were registered. One of these was above the standard for enquiry; nine lived with both their parents who had a permanent home together; two with their mothers who worked to support them; seven with their mothers who remained in their parents' home; four were placed in an institution; four died in early infancy; three were stillborn; 27 children could not be traced, the mother often not having stayed at the address given for more than one or two nights before the birth of the child. Dental Treatment. The following is a summary of the work during 1933 at the Councils Denial 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 33 30 63 Total attendances 208 82 290 Extractions- Ordinary 6 — 6 With local anæsthetic 6 (6) — 6 (6) With general anæsthetic 32 (172) 27 (89) 59 (261) Scaling 23 4 27 Fillings— Simple 43 21 64 Root 1 — 1 Dentures (including 6 repairs) 16 — 16 Advice 47 34 81 The figure in brackets relaid to the number of teeth extracted. X 2 76 In three cases where the patients were 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. Supply of Milk and Food for Expectant and Nursing Mothers and for Infants. The supply of milk and food at less than cost price was continued during the year under the Maternity and Child Welfare Act, 1918, for nursing mothers, expectant mothers in the last three months of pregnancy, children up to three years of age and, exceptionally, to children between three and five years of age. During the year 313 applicants received free or assisted milk under the scheme. This number included 157 who were receiving such assistance at the end of 1932. Grants were made to 156 new applicants. At tho end of the year 1933, 162 applicants were receiving assistance, viz. : Mother. Children. Total. Free milk 32 120 152 Half-price milk — 1 1 Prepared milk — 9 9 32 130 162 The following table shows in detail how the 150 new applicants were assisted in 1933: — Milk. Prepared Milk. Free. Part Cost. Free. Part Cost. Expectant mothers 41 - - - Nursing mothers 23 - - - Children 72 1 3 16 Home Help. The Council's Home Helps attended 24 cases during the year in comparison with 19 in the year 1932. In four of these the whole-time officer attended entirely and in nine she attended during the earlier part of the lying-in period, being replaced later by one of the Home Helps from the emergency panel in order to take over new cases. In 11 cases an emergency Home Help only was employed. Up to the 5th August 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. Early in August the whole-time Home Help resigned and she was replaced from August 5th onward by a panel of part-time Home Helps. The new arrangement has worked very well; a small saving has been effected. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In nine cases of extreme necessity the services of the Home Help were granted free. In all other cases the applicants were required to contribute towards the cost, contributions ranging from 2s. 6d. per week up to the full cost. The services of the Home Help have been much appreciated; it has been found that the Council's provision meets a much felt want in the Borough. 77 The scheme of Home Helps could with advantage be extended to any illness of mothers occurring during pregnancy and after labour. It would also be very useful to heads of families if they could obtain through the Council the services of a reliable woman to carry out the duties of the mother when she is incapacitated by illness, the cost being borne by the applicant. Convalescent Homes. Two mothers and their babies were sent away, one 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 belonging to the Church Army. Three other applications were granted, but the mothers failed to take advantage of the facilities offered. Thirty-two applications were granted for convalescent home accommodation for children under five years of age; in two cases the parents failed to take advantage of the facilities provided. Nineteen 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, 1933, 130 children under five attended the consultations, 38 of the total number coming from the Holborn Borough. The 130 children made 2,867 attendances. Extra food and nourishment was provided, also convalescent treatment at country and seaside Homes (78 mothers and children); classes and lectures on health, carc 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, 1933. Eight children between the ages of one and five years died from the following causes:— Cause of Death. 1—2 1—3 3-4 4—5 Total 1—5 years. M. F. M. F. M. F. M. F. M F. Both Sexes. Diphtheria 1 ... ... ... 1 ... ... ... 2 ... 2 Measles 1 ... ... ... ... ... ... ... 1 ... 1 Pneumonia (all forms) 1 ... ... ... ... ... 1 ... 2 ... 2 Tuberculous Meningitis ... 1 ... ... ... ... ... ... ... 1 1 Meningitis ... ... ... ... ... ... ... 1 ... 1 1 Other respiratory disease ... ... ... 1 ... ... ... ... ... 1 1 Totals 3 1 ... 1 1 ... 1 1 5 3 8 Totals, both sexes 4 1 1 2 8 78 Deaths of Infants under One Year of Age, 1933. 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 ages at death are given in the following Table:— Cause of Death Under 1 Week 1-2 Weeks 2-3 Week* 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3-6 Months 6-9 Months 9-12Months Total under 1 Year M F M F M F M F M F Both sexes M F M F M F M F M F Both sexes Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Pneumonia (all forms) ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 2 ... ... ... ... 1 2 3 Diarrhœa, etc. ... ... ... ... ... ... ... 1 ... 1 1 3 ... 2 ... ... ... ... ... 5 1 6 Congenital Debility, Premature Birth, etc, 3 4 ... ... ... ... ... ... 3 4 7 1 ... 1 ... ... ... ... ... 5 4 9 Violence ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 l Other Causes ... 1 ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... 2 1 3 Totals 3 6 ... ... ... ... 1 1 4 7 11 5 ... 4 2 ... 1 ... 1 13 11 24 Total both sexes 9 ... ... 2 11 5 6 1 1 24 Net births registered during the calendar year. Net deaths registered during the calendar year. Males Females Both sexes Males Females Both sexes Legitimate InfantS 137 151 288 Legitimate Infants 9 8 17 Illegitimate Infants 28 26 54 Illegitimate Infants 4 3 7 79 DIARRHŒA AND ENTERITIS—Deaths under 1 Year.—1933. 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. V.R. 8.3.33 5/12 Broncho - pneumonia, acute Gastroenteritis — Yes No Resident in Holborn only two weeks before death. P.H. 28.5.33 2/12 Broncho-pneumonia, acute — Yes No No knowledge of birth in P. H. Dept. until six days before death. Had been one month in hospital. R.C. 30.9.33 2/12 Diarrhœa and vomiting — Yes No Mother not known to P. H. Dept. Stayed occasionally at a common lodging-house in Holborn. C.M. 13.10.33 5/12 Gastro-enteritis — Yes No Died in hospital. S.B. 28.10.33 3/12 Diarrhœa and vomiting — Yes No Died in Maternity Hospital in which born; did not leave hospital. Mother had puerperal pyrexia. F.B. 16.11.33 2/12 Heart failure and acute enteritis — Yes Yes, at hospital In hospital one month before death. 80 INFECTIOUS DISEASES AMONG MOTHERS AND CHILDREN. Puerperal Fever and Puerperal Pyrexia. No. Initials Date of Notification Primipara or Multipara Ante-natal Care Delivery occurred in Onset subsequent to Results Remarks Patient's Home Institution PUERPERAL FEVER—Three Cases. 1 G.C. 6-5-33 Primipara No Home — Septic miscarriage of unknown origin Died Abortion occurred at home, removed immediately after to hospital, where death occurred. P.M. inquest 2 R.R. 15-6-33 Multipara Yes — Institution Acute puerperal endometritis Recovered — 3 F.H. 12-9-33 Primipara No Home — Septic abortion Recovered — PUERPERAL PYREXIA—Five Cases. 1 M.H. 8-3-33 Primipara No — Institution Uterine sapræmia, retroverted uterus Recovered — 2 E.F. 12-6-33 Primipara Yes — Institution Breast abscess Recovered — 3 R.C. 21-9-33 Multipara Yes — Institution Mild sapræmia Recovered — 4 E.G. 13-9-33 Primipara Yes — Institution Acute puerperal mastitis Recovered — 5 J.B. 24-10-33 Multipara Yes — Institution Acute bilateral mastitis Recovered Child died on 22nd day in hospital where born 81 Ophthalmia Neonatorum. During the year four cases of ophthalmia neonatorum were brought to our notice all notified in pursuance of the Public Health (Ophthalmia Neonatorum) Regulations, 1926 and 1928; all the notifications were from the Medical Officers of hospitals. Four Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Birth Notified by. Intern Department, Hospital Extern Department, Hospital Extern Department, Hospital Extern Department, Hospital Result. Cured Cured Cured Cured Medical Attendance and Nursing. Maternity Ward—Hospital, and Nurse from Hospital in home Doctor (Hospital), Nurse (Hospital) Doctor and Nurse, Outpatient Department— Hospital Maternity Ward—Hospital and In-Patient. St. Margaret's Hospital Where Treated. Hospital At home At home Hospital Type of Disease on Health Visitor's first call. Slight Slight Slight — By whom Notified. Doctor (Hospital) Doctor (Hospital) Doctor (Hospital) Doctor (Hospital) Age at Onset. 14 days 7 days 14 days 14 days Age when Notified. 16 days 7 days 16 days 17 days Case Number. i 2 3 4 L 82 Midwives Act, 1902 and 1918. In connection with these Acts we received information from the Medical Officor of Health of the London County Council, of slight inflammation in the eyes of nine other infants, all of whom made complete recovery. Whooping Cough. Visits were paid to 31 persons suffering from whooping cough. Of these, 19 were notified by doctors; in six others the information, was derived from the schools, in five from health visitors and in one from the L.C.C. Age. Three were children under 1 year, 13 were aged 1 to 5, and 15 were 5 to 16 years, and 1 was an adult. Spread of Infection in Family. The 31 cases occurred in 27 families. In 23 families 1 case occurred; in 4 families 2 cases occurred. Removal. Fourteen children were removed to hospital, approximately 45 per cent. All these were admitted to hospitals of the L.C.C. Measles. During 1933 I received information of 125 cases of measles. Of these 67 were notified by school teachers and 21 by medical practitioners; information of 23 was given by L.C.C. hospital authorities, 10 by health visitors, 4 by parents. Age. Six were under 1 year, 60 were between 1 and 5 years, 53 were between 5 and 16 years, and 6 were over 16. Deaths. One child died, set 1 10/12 years. Spread in Family. The 125 cases occurred in 100 families. In 81 families 1 case occurred, in 13 families 2 cases occurred, and in 6 families 3 cases occurred. Removals. Forty-three patients (34 per cent.) were removed to hospital (42 to L.C.C. infectious diseases hospitals, and 1 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. Ihiring the year information was received relating to 100 cases; 14 were notified by doctors, and information of 80 cased was received from schools, and 9 from L.C.C. hospitals, 10 by health visitors and 7 by parents and others. A get. 0 was under 1 year; 22 were between 1 and 5 years; 61 were between 5 and 16 years and 17 were over 16 years. Removals. Fourteen oases were removed to the London Fever Hospital, and two to L.C.C. Hospitals. 83 Diarrhœa and Enteritis under 2 years. The number of deaths was six; all occurred under 1 year of age (see table on page 79). Nursing Arrangements. The services of the district nurses were used as follows in 1933:—Deficient lactation 17 cases, 157 visits; complications after pregnancy 6 cases, 80 visits; maternity nursing 4 cases, 46 visits. Minor Ailments. The Minor Ailments Clinic has been carried on as usual on Tuesday and Friday afternoons. One hundred and forty-eight patients attended the clinic making 359 attendances. Skin troubles accounted for 59 attendances; they were chiefly impetigo, intertrigo behind the ear and septic abrasions. Pads and strapping were applied to the umbilical hernias of 44 babies; 27 babies were treated for constipation, an enema of soap and water being administered or a suppository inserted.. Tonsillitis was treated with a paint of perchloride of mercury (1/2,000) in glycerine. Four children were treated for aural discharge, two of whom were subsequently referred to hospital. The chief ailments receiving treatment among the mothers were mastitis, tonsillitis and varicose veins. Medical Inspection and Treatment of School Children. The medical inspection and treatment of children attending Public Elementary Schools in Holborn is carried out by the London County Council. The following treatment Centres are provided under the L.C.C. Schemes:— (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries : — (1) St. Bartholomew's Hospital. (2) Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) Homoeopathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nose and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensary, University College Hospital. (13) University College Hospital. We endeavoured to co-operate with the Education Authority by giving information respecting children suffering from infectious disease and child contacts ottonding public elementary schools. b 2 84 Routine Medical Examination of Elementary School Children in Holborn in 1933. 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 decays 6/6 in both eyes. 6 /9 in either or both eyes. 6/12 or worse in either or both eyss. Entrants— Boys 221 20 201 — 55 142 24 — 211 10 — 200 21 — 157 48 16 — — — Girl 211 32 177 2 55 139 17 — 195 14 2 187 24 — 146 47 18 — — — Age 8— Boys 115 8 107 — 12 76 27 — 111 4 — 101 14 — 84 24 7 66 32 15 Girls 98 8 90 — 16 61 20 1 85 12 1 88 10 — 66 25 7 61 20 16 Age 12— Boys 173 58 114 1 40 107 26 — 169 4 — 158 15 — 146 24 3 109 28 36 Girls 136 16 120 — 28 89 19 — 123 10 3 124 12 — 115 20 1 85 18 32 Age 14— Boys 187 3 183 1 30 129 28 — 186 1 — 170 17 — 149 34 4 130 14 43 Girls 172 6 166 — 49 107 16 — 156 15 1 160 12 — 140 28 4 110 30 32 Total 1,313 151 1,158 4 285 850 177 1 1,236 70 7 1,188 125 — 1,003 250 60 561 142 174 Percentage 11·5 88·2 0·3 21·7 64·7 13·6 94·2 5·3 0·5 90·5 9·5 — 76·4 19·0 4·6 64·0 16·2 19·8 London ... 54·5 44·8 0·7 20·8 74·9 4·3 96·4 3·2 0·4 98·2 1·7 0·1 69·4 26·0 4·6 63·2 20·3 16·5 85 Examination of Elementary School Children in Holborn in 1933. Defect. Boys. Girls. Entrants Age 8 Age 12 Age 14 Entrants Age 8 Age 12 Age 14 Number Examined 221 115 173 187 211 98 136 172 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 2 2 4 4 1 1 3 3 1 1 3 3 — — — — Skin Disease 3 — 2 2 2 1 2 2 3 2 1 — 1 — 2 1 Defective Teeth — 61 — 30 — 27 — 37 — 59 — 28 — 19 — 30 Enlarged Tonsils 73 13 12 7 17 1 16 5 84 24 13 1 16 3 23 7 Adenoids 1 — — — — — — — — — — — — — — — Enlarged Tonsils and Adenoids — — — — — — — — 1 — — — — — 1 1 Other Nose and Threat Defects 11 — — — 3 1 2 — 6 2 2 1 1 1 — — Enlarged Glands 4 — — — 1 — 1 — 3 — — — — — 1 — Eye Disease 10 5 3 1 3 — 5 — 11 6 2 — 4 1 4 2 Vision Defect — — — 19 — 34 — 25 — — — 14 — 24 — 28 Otorrhœa 3 2 — — 5 5 7 6 1 1 — — 1 — 2 2 Other Ear Disease 1 1 — — — — — — — — — — — — — — Defective Hearing — — — — — — — — — — — — — — — — Speech Defects — — — — — — — — — — — — — — 1 — Heart Defects 6 1 3 — 3 — 1 — 7 — 6 1 3 — 7 1 Anæmia 2 — 2 1 3 3 2 — 1 — 1 — — — 2 — Lung Defects 8 4 4 2 1 — 1 — 7 — 4 2 — — — — N ervous Defects — — 2 — 2 — 1 1 — — — — 1 1 1 1 Phthisis — — — — — — — — — — — — — — — — Other T.B. Disease — — — — — — — — — — — — — — — — Rickets 1 — — — — — 1 — 1 — — — — — — — Spinal Deformities — — — — — — — — — — — — 2 — 5 1 Other Deformities 2 — 1 1 4 2 4 — 1 — 2 1 2 — 1 — Other Defects 12 4 6 4 7 4 4 1 10 2 1 1 4 2 7 5 Number of Children noted for treatment 82 51 68 71 88 41 44 64 *Defects, however slight, arc included under " Cases." Those severe enough to require treatment are shown under *. 86 Infant Life Protection. By the Transfer of Powers (London) Order, 1933, certain duties were transferred from the London County Council to Metropolitan Borough Councils. Among such transferred functions were duties under Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932, respecting infant life protection. These duties are concerned with the reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants and the inspection of premises by Infant Life Protection Visitors or other persons appointed by the local authority for the purpose; fixing the number of infants to be kept in a dwelling in which any infant is received for reward and application to a Court of Justice for an order directing the removal of an infant to a place of safety. To provide for the proper administration of the Acts and Order the Council delegated its powers to the Maternity and Child Welfare Committee and appointed the Medical Officer of Health, the Health Visitors, and the Sanitary Inspectors as Infant Lifo Protection Visitors; the appointment of the male Sanitary Inspectors to be limited to inspections or visits required in connection with penal cases. Also, by advertisements in the local newspaper and the exhibition of posters, publicity was given to the various requirements of the Acts. The London County Council forwarded to the Medical Officer of Health information respecting five children in the care of five foster mothers in Holborn. During the year three other foster mothers were added to the register making a total of eight receiving infants for reward. By the end of 1933, however, four of these ceased to have the care of a foster child for the following reasons:— Child removed to care of another foster mother 1 Child removed to the care of parent 1 Child removed to the care of Public Assistance Authority 1 Child removal to care of relative (uncle) 1 leaving four foster mothers on the register at the end of the year. At the request of the London County Council arrangements have been, made to notify the School Care Committee when a foster child reaches the age of nine years, the age at which supervision under the Children Acts ceases. The supervision of the home conditions of these children becomes part of the routine work of the Health Visitors. In addition, a number of other visits and enquiries become necessary in connection with the administration of the Acts. For example, notices are frequently received of the return to their parents of children who have for a time been boarded out with foster mothers; these need visiting for verification and to ascertain whether the child is to be retained permanently with its parents or again to be boarded out. In one such case reported during the year information was given that at the parents' home there was no cot and the conditions were not satisfactory. The Health Visitor secured the provision of a, cot and was subsequently able to report that the child was being well cared for, In several 87 cases incorrect addresses were given and a number of enquiries had to be made before the children could be traced. In another case the almoner of a hospital drew attention to a child in the care of an aged relative. The Health Visitor found, however, that the child was well cared for and the aged relative agreed to bring the child to the Council's Centre from time to time. A number of visits have also been made in connection with the adoption of foster children through the organisation of an Adoption Society whose offices are in the Borough. Birth Control. Arrangements were made for contraceptive advice to be available for married women attending the Council's Centres in cases where further pregnancy would be injurious to health. The advice is to be given only where recommended by the Medical Officers of the Centres and approved by the Medical Officer of Health. The facilities offered by a voluntary birth control clinic are to be utilised and a small fee per case (5s.) will be paid by the Council. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 8th to 14th October, 1933. With a view to economy the programme was limited to the following:— Co-operation with the School Organisation. Arrangements were made for the 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 Fred Howard, J.P., and Councillor Mrs. Howard, M.A.) kindly entertained to tea the prize winners and the children whose essays were selected from the various schools. We are much indebted to the teachers for their kind and invaluable co-operation. It is they who establish in the minds of the children a " health conscience." Health Poster Designs. Children in the elementary schools were also again invited to enter a competition in the designing of health posters. About 100 designs were submitted trom four schools. Two prizes were awarded, one going to St. Peter's School and one to St. John the Evangelist School. Arrangements were made for children from the various schools to see the posters at the Child Welfare Centre, No. 10, John Street. 88 Deaths of Children 5 to 15 years. There were nine deaths in this age group during 1933, six males and three females. The deaths were from the causes shown below: — Scarlet fever F. (6 years) Appendicitis M. (10 years) Violence (Burned to death in baker's barrow) M. (6 years) Violence (Knocked down by motor van) M. (7 years) Epilepsy M. (14 years) *Acute dysentery M. (11 years) Myocardial weakness and syncope M. (6 years) Pulmonary tuberculosis F. (14 years) Septicaemia F. (5 years) *Sce page 39 respecting death from suspected food poisoning. SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 74 bodies were deposited. There were 59 post-mortem examinations made, and 5 inquests held. On 14 occasions bodies awaiting burial were removed to the mortuary on account of inadequate accommodation in the homes. Fifty-four bodies were brought in by order of the Coroner, and 6 by the Police. Inquests. During the year 46 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, 11; Accidents, 12; Suicide, 13; Misadventure, 5; Open Verdict, 4; Hanging, 1. The causes of death certified were as follows:— Natural Causes. Accidents. Alcoholism 1 Poisoning 1 Pneumonia 6 Falls 4 Heart disease 1 Street accidents 6 Other causes 3 Burns 1 Judicial hanging 1 Suicide. Misadventure. Coal gas poisoning 6 Coal gas poisoning 3 Other poisoning 5 Operation 2 Hanging 1 Jump from window 1 Open Verdict. Cause of death unknown 2 Asphyxia 1 Luminal poisoning 1 89 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 four cases of aged and infirm persons were brought to our knowledge and were visited to see if action was necessary and desirable under this Act. As a result of these visits three of the aged persons consented to removal to public assistance institutions and one was removed by friends. Application to the Court for compulsory removal Order was therefore not necessary in any case. Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. One application was received during the year for a certificate under the above Acts. On inspection the house was found to be in a satisfactory condition and a certificate was therefore not issued. Rent Restrictions Regulations, 1933. These Regulations, which came into force on the 19th July, 1933, require every rent book or similar document used by or on behalf of any landlord in relation to any dwelling-house to which the Rent and Mortgage Interest (Restriction) Acts apply, to contain a notice in a form set out in a schedule to the Regulations, giving, among other things, the name and address of the landlord and agent and particulars of the provisions under which a tenant is entitled to apply to the sanitary authority for a certificate, when he considers the premises are not in a reasonable state of repair. In furnishing particulars of this requirement to owners and agents of tenement houses to which the Acts apply, opportunity was taken also again to direct attention to sec. 5 of the Housing Act, 1925, which requires the name and address of the Medical Officer of Health of the district and the landlord or other person directly responsible for keeping the house fit for habitation to be inscribed in every rent book in the case of houses used or intended to be used by the working classes. The Sanitary Inspectors make a practice of inspecting the rent books; in a certain number of cases letters have been written calling the attention of owners to default; in all instances they have readily complied with the law. 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. M 90 Nuisance from Pigeons. London County Council (General Powers) Act, 1927. During the year several requests were received for steps to be taken to reduce the number of pigeons frequenting the precincts of buildings in the Borough. Owing to the difficulties met with in trapping pigeons in Central London, the contractors previously employed declined to continue the work. To meet the position trapping nets were obtained and arrangements were made for two members of the Health Department staff to trap the birds. Successful operations were earned out by them on various occasions at three different sites frequented by pigeons and, in all, 458 birds were caught. This number included 117 birds caught in Lincoln's Inn Fields. It must, however, be recorded, that on many occasions in Lincoln's Inn Fields, even after several hours work, no birds were caught. In open spaces such as this pigeon trappers are handicapped by members of the public who regularly feed the birds and who endeavour to prevent the effective use of the trapping nets. It is, of course, not desired to destroy all wild pigeons in Central London, but it is highly desirable that the number should be kept within reasonable limits. Nuisance from an excessive number of starlings threatens to become little less than that from pigeons, but the statutory powers given to London to deal with pigeons does not extend to starlings. 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. We are informed by the Borough Engineer's Department of licences issued for the erection of hoardings for the purpose of the demolition of buildings, and the sites are then visited by the Sanitary Inspectors concerned. 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 years has been continued. In addition the Council took over one of the disused Empire Marketing Board frames for use for health propaganda purposes. 91 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 haa been exhibited in the Borough and arrangements made for its loan for exhibition in other districts subject to payment of a small charge. 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." Private Swimming Baths. During the year 1933 detailed inspections were made of two private swimming baths in conjunction with the Superintendent of the Holborn Public Baths. They were both equipped with an up-to-date continuous aeration and filtration plant. Both baths were satisfactory. In the case of one bath, a model installation provided by a large firm for its employees, the sterilisation of bathing costumes and towels was recommended; the Borough Engineer and Surveyor went into the matter of the possibility of any contamination by the direct communication of the water in the bath with the contents of the sewer, but he was satisfied that no further apparatus need be installed to prevent this. A third private swimming bath was visited, but its use had been discontinued owing to the lateness of the season. The bath was in the basement of an hotel; it was of the canvas type used as swimming pools on the decks of lines. It was evident that almost everything possible under the circumstances had been done to lessen the contamination of the water by swimmers; the bath was cleansed at frequent intervals; the swimming costumes and towels, however, were not sterilised. M 2 92 APPENDIX. TABLE I. Vital Statistics of Whole District during 1933 and Ten Previous Years. Year Population estimated to Middle of each Year. Births. Total Deatha Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Unoorrected Number Net Number Rata of Nonresidents registered in the District of Reeidents not registered in the District Number Rate per 1,000 Births Number Rate Number Bate 1923 43,376 423 693 18.7 718 16.6 491 300 47 79 526 12.1 1924 43,260 394 678 13.36 670 15.5 470 329 47 81 529 12.2 1925 43,315 364 627 1216 725 16.7 513 330 33 63 542 12.5 1926 43,200 330 536 12.88 629 14.6 454 347 48 90 522 12 1 1927 42,209 320 505 11.96 728 17.2 531 333 19 38 530 12.6 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 8.9 488 12.7 1931 34,470 211 352 10.21 787 22.8 598 303 26 74 492 14.3 1932 36,410 186 349 9.57 778 - 607 351 25 72 517 14.2 1933 36,050 180 342 9.49 681 — 521 326 24 70 486 13.5 In the above table the population, birth rata and death rate are as estimated by the Registrar-General, founded upon his estimates of the resident population for the middle of the year 1933. 93 TABLE II. Causes of, and Ages at, Death, 1933. Causes or Death. NET DEATHS AT THE SUBJOINED AGES OP "RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Residents " or " NonResidents' in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 6 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All causes Certified 486 24 4 4 9 16 63 147 115 104 Uncertified ... ••. ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... 2. Measles 1 ... 1 ... ... ... ... ... ... ... ... 3. Scarlet Fever 2 1 ... ... 1 ... ... •• ... ... ... 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... 1 5. Diphtheria 3 1 1 1 ... ... ... ... ... ... 4 6. Influenza 25 ... ... ... ... . 6 6 4 9 5 ... ... ... ... 1 ... ... ... ... ... 8. Cerebro-spinal Fever 1 ... ... .. ... 1 ... ... ... ... 2 9. Tuberculosis of Inspiratory System 26 ... ... ... ... 2 14 8 2 ... 17 8 ... 1 ... ... 1 I ... ... .. 31 11. Syphilis 2 ... ... ... ... ... ... 2 ... ... 1 l2. General Paralysis of the insane, Tabes 2 ... ... ... ... ... 1 1 ... ... ... 13. Cancer, malignant disease 61 ... ... ... ... ... 4 26 21 10 72 14. Diabetes 6 ... ... ... ... ... ... 1 4 1 4 15. Cerebral Hænorrhage 21 ... ... ... ... ... 1 4 9 7 17 16. Heart Disease 113 ... ... ... ... 1 4 34 36 38 21 17. Aneurysm 4 ... ... ... ... ... 2 1 1 ... ... 18. Other Circulatory Diseases 31 ... ... ... ... ... ... 6 11 14 5 19. Bronchitis 12 . . ... ... ... ... 2 6 3 1 7 20. Pneumonia (all forms) 28 3 1 1 ... 1 4 8 3 7 57 21 Other Respiratory Diseases 1 ... ... l ... ... ... ... ... ... 7 22. Peptic Ulcer 11 ... ... ... ... 1 4 5 ... 1 6 23. Diarrhœa, etc. (under 2 years) 7 6 ... ... ... ... 1 ... ... ... 45 24. Appendicitis 5 ... ... ... 1 1 ... 3 ... ... 6 25. Cirrhosis of Liver 2 ... ... ... ... ... ... 1 1 ... 4 26 Other diseases of liver, etc. 2 ... ... ... ... ... ... ... 2 ... 1 27. Other digestive diseases 10 ... ... ... 1 1 2 2 4 19 28. Acute and Chronic Nephritis 12 ... ... ... ... ... 1 7 1 3 23 29. Puerperal Sepsis 1 ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal Causes 2 ... ... ... ... ... 2 ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 9 9 ... ... ... ... ... ... ... ... 40 32. Senility 3 ... ... ... .. ... ... ... 1 2 2 33. Suicide 13 ... ... ... ... 1 5 6 1 ... 1 34. Other Violence 19 1 ... ... 2 2 2 6 3 4 11 35. Other Defined Diseases 46 3 ... 1 4 3 7 15 10 3 121 36. Causes ill-defined o? unknown 1 ... ... ... ... ... 1 ... ... ... ... 186 24 4 4 9 16 63 147 115 104 530 94 TABLE III. Casks of Infectious Disease notified during the tear 1933. Disease. Total Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5to 10 10tol5 15 to 20 20 to 35 35 to 45 45 to 65 65 up Total Deaths Small-pox 1 • •• ... ... ... ... ... 1 ... .. ... ... ... ... Diphtheria 75 1 2 5 7 7 18 13 6 14 ... 2 ... 3 Erysipelas 19 ... 1 ... 1 ... ... ... 1 3 4 8 1 1 Scarlet Fever 96 1 5 6 10 9 35 15 6 7 1 1 ... 2 Enteric Fever 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Puerperal Fever 3 ... ... ... ... ... ... ... ... 3 ... ... ... 1 do. Pyrexia 5 ... ... ... •• ... ... ... ... 4 1 ... ... ... Cerebro-spinal Fever 3 1 ... ... ... ... ... ... ... 2 ... ... ... 1 Ophthalmia Neonatorum 6 6 • •• ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ••• ... ... •• ... Malaria 1 ... ... •• ... ... ... ... ... ... 1 ... ... ... Pneumonia—Primary 27 1 2 ... ... 2 1 ... ... 9 3 C 3 28 do. Influenzal 10 ... ... ... ... ... ... ... 2 1 1 5 1 Tuberculosis— Pulmonary 5O • •• ... ... ... ... ... ... 3 18 12 14 3 26 do. Non-Pulmonary 9 ... 1 ... 1 ... 1 2 ... 3 ... 1 ... 3 W hooping Cough 23 1 5 ... 1 4 12 ... ... ... .... ... ... ... Acute Poliomyelitis ... ... ... ... .. ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... .. 1 ... ... ... ... 1 Rheumatism 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... 332 11 16 11 20 22 68 32 20 64 23 37 8 66 95 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough at end of 1933. Number of Inspections. Number of Prosecutions. Common Lodging House 6 79 ... Cowsheds ... ... ... Milkshops 146 135 ... Registered houses lot in lodgings 461 891 ... Ice cream premises 28 95 ... Siaughter-houscs 1 12 ... Offen ive Trades ... ... ... Restaurants nnd Eating Houses 287 514 ... Housing of the Working Classes— Number of houses inspected :— (a) Oil account of complaints or illness (Public Health Act) 614 (b) House to house (Housing Consolidated Regulations, 1925) 142 Number of notices served : — (a) Under Public Health Act: — (i.) Intimation 496 (ii.) Statutory 58 (b) Under Housing Act — Number of houses repaired or nuisances remedied under Public Health Act 496 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) l block (28 flats) (b) In course of erection Number of representations by Medical Officer or other person 4 Number of houses included in such representations 4 part house Number of Closing Orders made Nil Number of Closing Orders determined (i.e., houses made fit) Nil Number of Demolition Orders Nil Number of houses demolished:— (a) In pursuance of Orders Nil (b) Voluntarily Total number of houses in the borough 6462 (Census, 1931) Number of houses occupied by the working classes 7285 Underground Booms— Number illegally occupied, notices served 4 Number closed or illegal occupation discontinued 4 0vercrowding- Number of cases of overcrowding found; notices served 2 Number of prosecutions Number remedied 2 Smoke Nuisances— Number of observations 186 Number of notices 8 Number of complaints Number of summonses _ Cleansing and Disinfection— Number of adults cleansed 201 Number of children cleansed 11 Number of premises disinfected :— (a) After infectious diseases 278 (b) For vermin 191 Water Supply to Tene.ment Houses— Number of promises supplied 7 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 96 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 533 16 3 ... Workshops 614 39 6 ... Workplaces 3,376 53 7 1 Total 4,523 108 16 1 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Proseoutione. Found. Remedied. Referred to H.M. Inspector. •Nuisances under the Public Health Acts: Want of cleanliness 33 33 ... ... Want of ventilation 5 6 ... ... Overcrowding ••• • •• ... ... Other nuisances 68 68 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 54 54 ... ... not separate for sexes. 1 1 ... ... 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 161 161 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 97 TABLE V.—continued. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lifts Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Work men. Wearing Apparel— Making, &c. 104 268 214 1 1 ... 105 ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 12 ... ... ... 2 ... ... ... ... ... ... ... ... Total 106 268 226 1 1 ... 107 ... ... ... ... ... ... ... ... N 98 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 604 Total number of workshops on Register 627 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. 183) 6 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector 9 Report (action being taken) sent to H.M. Inspector 9 Other — Underground Bakehouses (S. 101): — — Certificates granted during the year — In use at the end of the year 12 99 TABLE VI. METEOLOGY OF LONDON, 1933. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal) 1933. Air Temperature. Bright Sunshine. Rain and other forms of Precipitation. Mean of— Mean of A. & b. Difference from Average.* Daily Mean. Difference from Average.* Percent. of possible. Total Fall. Difference from Average.* A. B. Maximum. Minimum. °F °F °F °F hrs. hrs. % m.m. m.m. January 41.6 32.2 36.9 - 1.6 1.10 - 0.14 13 27 - 16 February 46.3 35.3 40.8 + 1.0 1.55 - 0.49 16 42 + 2 March 55.7 36.1 45.9 + 3.4 5.41 + 2.01 46 61 + 17 April 60.1 39.9 50.0 + 2.4 4.42 - 0.60 32 19 - 18 May 60.0 46.0 56.0 + 2.0 4.28 -219 28 57 + 13 June 72.7 50.8 61.7 + 1.8 7.80 + 1.10 47 39 - 12 July 78.4 56.8 67.6 + 4.1 7.20 + 0.70 45 35 - 22 August 79.4 55.8 67.6 + 5.0 7.78 + 1.58 54 13 - 43 September 70.4 52.1 61.3 + 3.3 6.34 + 1-39 50 68 + 23 October 58.2 44.7 51.5 + 1.3 3.09 - 0.03 29 38 - 26 November 47.5 38.4 42.9 -1.1 0.80 - 0.92 9 22 - 36 December 38.4 31.1 34.7 - 5.5 0.80 - 0.26 10 9 - 48 Year 59.6 43.3 51.4 + 1.3 4.21 + 0.18 32 430 or 16.93 ins. - 166 or - 6.54in. *The averages used are obtained from observations extending over 35 years (1881-1915). 100 LEGAL PROCEEDINGS Food and Drugs (Adulrteration) Act, 1928. Date. Name. Address. Offence. Result. 1933 Jan. 12th A. Previdi 11, Museum Street Selling milk 18% deficient in fat Defendant convicted and fined 20s. and 21s. costs. Apr. 4th E. J. Rose 71, Leather Lane Selling milk 10.0% abstracted fat Defendant convicted and fined 40s. and 21s. costs. May 25th E. D. Ellis 73, Mount Pleasant Selling milk containing 5.2% added water Summons dismissed. Costs 15s. Oct. 30th A. Cols 19, High Street Soiling sausages containing preservative Summons dismissed. £2. 2s. costs against Council. Public Health (London) Act, 1891. Date. Name. Address. Offence. Result. 1933 Jan. 26th W. Knowles 23, Theobald's Road Nuisance Order made for work to be done within 1 month. Costs 10s. 6d. March 22nd &. 29th R. N. Majumdar 8, Harpur Street Nuisance Order made for work to be done within 7 days. Costs 10s. 6d. ditto do. 1-6, Harpur Street Nuisance Order made for work to be done within 28 days. Costs 10s. Cd. Oct. 30th J. Goodman Talbot Mansions, Museum Street Nuisance. Defective flooring in basement Summons dismissed. Work done. Costs £2. 2s.