AC 4342 M HOL 32 The Metropolitan Borough of Holborn, ANNUAL REPORT OF THE Medical officer of Health, For the Year 1934 London: Printed by DlPROSE,, BATEMAN & CO, Sheffield Street, Kingsway WC2 1935 . The Metropolitan Borough of Holborn, ANNUAL REPORT OF THE Medical officer of Health, For the Year 1934 London: Printed by DIPROSE, BATEMAN & CO, Sheffield Street, Kingsway WC2 1935 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C.1. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn Your Worship, Ladies and Gentlemen, Herewith I beg to present a report upon the health and sanitary conditions of the Borough for the year 1934 The larger part of the work dealt with in this report was done while Dr Hutt was in charge of the Public Health Department By his untimely death, Holborn lost one who was whole-heartedly devoted to its service, and Preventive Medicine one of its leaders and foremost exponents Personally I suffered the loss of one to whose teaching and guidance I owed a great debt I am, Your obedient Servant, J. A. STRUTHERS, Medical Officer of Health INDEX Page Public Health Committee 6 Housing- of the Working Classes Committee 6 Maternity and Child Welfare Committee 7 Tuberculosis Care Committee 7 Staff 8 Statistics and Social Conditions Statistical Summary 9 Population and Houses (Census 1931) 9 Births 10 Deaths 11 Seasonal Mortality 12 Infantile Mortality12 Deaths in Public Institutions 12 General Provision of Health Services 12 Sanitary Circumstances Survey of Health Services 13 Scavenging 14 Dust Inspector 14 Removal of Offal 14 Removal of Manure 14 Sanitary Inspection of District 15 Notices served 16 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 Drainage Work, Supervision of 20 Smoke Abatement 20 Inspection of Workshops 21 Factories 22 Outworkers 23 Rag Flock Acts 23 Housing Statistics 23 Common Lodging Houses 24 Housing Accommodation on LCC Estates 25 Housing Schemes 25 Holborn Housing Trust, Ltd 25 Inspection and Supervision of Food Dairies, Cowsheds and Milk Shops 26 Milk (Special Designations) Order, 1923 26 Milk—Bacteriological Examination 27 Dried Milk 28 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 Dnsound Food 31 Preservatives in Food Regulations 31 Food and Drugs (Adulteration) Act, 1928 32 Articles Analysed 32 Borough Analyst, Notes by34 The Merchandise Marks Act, 1926 37 London County Council (General Powers) Act, 1932 38 Registration of Food Premises 31 Notification of Food Poisoning 38 Slaughter of Animals Act, 1933 38 A 2 4 Page Prevalence of and Control over Infectious. Diseases Infectious Diseases Generally 39 Smallpox 40 Vaccination 41 Diphtheria 42 Diphtheria in Hospitals 42 Diphtheria Contacts 43 Schick Test and Immunisation against) Diphtheria 43 Diphtheria in Children Treated with Immunising Injections 46 Immunisation of Nursing Staff at London Homoeopathic Hospital 47 Immunisation of School Children 48 Scarlet Fever 48 Acute Rheumatism in Children 48 Holidays for Rheumatic Children 51 Typhoid and Paratyphoid 51 Typhus Fever 52 Cerebro-Spinal Fever 52 Bacillary Dysentry 52 Malaria 52 Encephalitis Lethargica 52 Acute Poliomyelitis and Acute Polioencephalitis 54 Pneumonia 55 Influenza 55 Anthrax 55 Chickenpox 55 Mumps 55 Bacteriological Work 55 Disinfections 50 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 61 Prevention of Spitting 62 Deaths from Tuberculosis 62 Tuberculosis Dispensary Return 63 Tuberculosis Care Committee 65 Public Health (Prevention o£ Tuberculosis) Regulations, 1925 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 Work at Centres 69 10, John Street 69 Short's Gardens 70 Ante-natal Hygiene 70 Confinements in Institutions in relation to Housing Conditions 70 Baths 71 Ante-natal Centres 71 Post-natal Consultations 72 Instruction in Mothercraft and Hygiene 72 5 Page Maternal and Infant Consultations 73 Breast Massage 73 Pre-School Children 74 Foundling Site Bay Nursery 74 School Entrants 74 Stillbirths 75 Illegitimate Births 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 88 Deaths of Children, 5-15 Years 86 Birth Control 87 Health and Baby Week 87 Sanitary Administration Mortuary 88 Inquests 88 Removal of Aged Persons 88 Rent and Mortgage Interest (Restriction) Acts 89 Nuisances caused by Dogs 89 Nuisance from Pigeons 89 Old Buildings—Demolition of 89 Children's Country Holiday Fund 90 Propaganda 90 Marking Ink, Alleged Poisoning from 90 APPENDIX Table I. Vital Statistics, 1932, and ten previous years 91 Table II. Causes of and Ages at Death, 1932 92 Table III. Infectious Diseases Notified during 1932 93 Table IV. Information required by LCC 94 Table V. Factories, Workshops, &c (1) Inspections 95 (2) Defects found 95 (3) Home Work 96 (4) Registered Workshops 97 (5) Other Matters 97 Legal Proceedings 98 Ambulance Service (see inside of back cover) List of Notifiable Diseases (see back of cover) 6 PUBLIC HEALTH COMMITTEE 1933-34 1934-35 Chairman— Chairman- Alderman Albert J Clark Councillor John W. Roberts Vice-Chairman— Vice-Chairman— Councillor William R Cons Councillor Robert Portwine Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Wilfred E Mullen, JP Alderman Albert A Mussett, JP The Deputy Mayor, Alderman Albert A Mussett. The Deputy Mayor, Councillor Fred Howard Alderman Ernest Hamlin, MBE Alderman Charles Shortland Councillor Thomas Aubertin, MA J C St Laurence Stallwood ,, John H.Boraston, C.B. Councillor Edmund Balding ,, Mrs. Edith Elliott " John H. Boraston, C.B. Mrs Charlotte Harris „ The Rev Wilfred H Davies, MA Herbert H. V. Harrison ,, Edgar L.Pilditch B.A. Harold J Jewell ,, Robert H.R. Tasker. William M Morgan ,, John O.M. Turnbull Sidney Parks ,, Theodore M. Wechsler, LL.B William R Wheatley „ William R. Wheatley HOUSING OF THE WORKING CLASSES COMMITTEE 1933-34 1934-35 Chainnan— Chairman— Councillor Horace W Langdon, F.S.I. Alderman Robert P Bristow Vice-Chairman— Vice-Chairman— Councillor Robert P Bristow Councillor Robert H R Tasker Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Alderman Albert A Mussett, JP Councillor Wilfred E Mullen, JP The Deputy Mayor, Councillor Fred Howard The Deputy Mayor, Alderman Albert A Mussett Alderman Percy Hill, LCC Councillor George J Bailey Councillor Joseph Baker ,, Alan P Good, BA „ Rev Wilfred H Davies, MA ,, Alcwyn Harries, „ Roland H Haxell ,, Roland H Haxell „ Albert E Hunter ,, Miss Florence M Herbert „ Wilfred E Mullen ,, James F Howes, A.R.I.B.A. „ George D Pooley ,, Harry Myers „ Asher Rosenberg „ George D Pooley. Alfred R Taylour, MA „ John O M Turnbull Francis W Yates, B.A. ,, Theodore M. Wechsler, LL.B. 7 MATERNITY AND CHILD WELFARE COMMITTEE 1933-34 1934-35 Chairman— Chairman— Councillor George D Pooley. Councillor Mrs Edith Elliott. Vice-Chairman— Vice-Chairman— Councillor Wilfred E Mullen. Councillor Thomas Aubertin, M.A. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Alderman Albert A Mussett, J.P. Councillor Wilfred E Mullen, JP. The Deputy Mayor, Councillor Fred Howard. The Deputy Mayor, Alderman Albert A Mussett. Councillor Robert P Bristow. Councillor Alcwyn Harries. „ Charles G L Du Cann. „ Mrs Charlotte Harris. „ Lawrence T Locan. ,, Miss Florence M Herbert.. ,, Harry Myers. ,, Thomas LI. Humberstone, B.Sc. „ Robert Portwine. „ Horace W Langdon, FSI. ,, John W Roberts. „ George D Pooley. „ William H Rose. ,, William R Wheatley. ,, William R Wheatley. Mrs. Wilfred E Mullen (Mayoress). The Mayoress (Mrs A A Mussett). Miss. E Emly. Miss Emily Dibdin. Mrs. Percy Hill.. Miss E Emly. Mrs Albert A. Mussett, Mrs Percy Hill. ,, John W. Roberta. „ W.E. Mullen. TUBERCULOSIS CARE COMMITTEE Holborn Borough Council Councillor W R Wheatley (to December 1934) Councillor J. W. Roberts (from January, 1935) Medical Officer of Health (Dr C .W. Hutt to August, 1934) Tuberculosis Dispensary Tuberculosis Officer (Dr J. A. Struthers). Councillor William R. Wheatley. London County Council Dr. Margaret Hogarth. Miss H. Bell (to July, 1934), Miss M. Ball (from September, 1934). Public Assistance Committee Councillor R. P. Bristow (to March, 1934). Mr W.J. Marchant (from April, 1934). Local Association of Children's School Care Miss M Savary (to February, 1934). Committees Miss K.J. Swayne (from February, 1934). Juvenile Advisory Committee Mrs.J.L. Dicker. Insurance Committee for the County of Mr H.A. Teakle. London Almoners of hospitals Miss J.G. Salmon Miss Voelcker (Vice-Chairman from November, 1934; Chairman to November, 1934) British Legion and United Services Fund Mr H. Brodie (to July, 1934); Mr R.F. Freeman Benevolent Committee (from October, 1934). British Red Cross Emergency Help Fund Major-General Patrick B Sangster, CB, CMG,DSO Charity Organisation Society Miss E.F. Bolton. Invalid Children's Aid Association Miss Butler (except from April to November). Miss Nippiard (April to November, 1934) Metropolitan District Nursing Association Miss E. Emly. National Council of Social Service Sir Ewan R Logan, M.A. (from May, 1934) Northern London War Pensions Committee Vacancy. Other social workers (co-opted) Mrs E.C. Bedford. Mrs Percy Hill (Vice-Chairnan to October, 1934— Chairman from November, 1934). Miss O. Lazarus. Miss H. M. Mathieson (Honorary Secretary). 8 STAFF The following was the Staff during 1934 Medical Officer of Health—C. W. Hutt, M.A. MD, M.R.C.P., D.P.H. (to August, 1934). Acting Medical Officer of Health—James A Struthers, M. D., B.Ch., M.R.C.P. D.P.H. (from August, 1934). Medical Officers of Maternity Centres— 10, John Street—Richienda Gillett, M.D.Brux, LSA 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, Regents Park, N.W. 1. Medical Officer of Tuberculosis Dispensary— James Arthur Struthers, M.D., B.C.h., M.R.C.P., D.P.H. Medical Officer—Diphtheria Immunisation—E. Goodwin Rawlinson, M.D., L.R.C.P., D.P.H. Public Analyst—James Kear Colwell, F.I.C. Sanitary Inspectors—Albert Bennett. George F. Clark Samuel Larard, M.R.San.I. Dust Inspector—Charles Luckman (to 31st July, 1934). Sanitary Inspector and Health Visitor—Ethel Jane Charlesworth, CMB 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 M Shimmin. Dentist—J.C. Sinclair, L.D.S. (British Dental Hospital). Ancesthetist— 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, Gower Street, W.O. 1 Telephone No Museum 0691. Hours 9 to 10 a.m. and 6 to 7 p.m. (except Wednesdays). Vaccination Officer—Mr. Percy E. Capps, Town Hall, 197, High Holborn, W.C.1. Registrar of Births and Deaths—Mr Percy H Durrant, 14, 16 and 18, Bloomibury Street Certifying Surgeon (Factory & Workshop Acts)—Dr W D Brunton, 72, Euston Square, N.W.1 H. M. Inspector of Factories—N.W. London District, 68-70, Baker Street, W 1 District Surveyor—Mr F P Scott, 5-11, Theobald's Road HM Coronet—S, Ingleby Oddie, Esq. Coroner's Officer—Mr. James Stabb, 46, Baker Street, Lloyd Square, WC 1 9 STATISTICS AND SOCIAL CONDITIONS Statistical Summary, 1934 Area of Borough in acres 405'1 Resident population—estimated to middle of 1934 (as supplied by the Registrar-General) for birth and death rates 36,000 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 October, 1934 £1,747,495 Rate of Id in the £, estimated to yield £6,640 Total M. F. Live Births Legitimate 274 151 123 309 Illegitimate 35 19 16 Annual rate of births per 1,000 estimated resident population 8.58 Still births Legitimate 5 Illegitimate 1 6 Rate per 1,000 total births 19 Deaths Males 230 Females 210 440 Annual death rate per 1,000 estimated resident population (crude) 12.2 ,, ,, ,, ,, ,, (adjusted) 1305 Percentage of total deaths occurring in Public institutions 73 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 712 Legitimate infants per 1,000 legitimate live births 66 Illegitimate infants per 1,000 illegitimate live births 114 Deaths from measles (all ages) 4 ,, ,, typhoid fever 1 ,, „ diphtheria (all ages) 5 „ „ whooping cough (all ages) 2 „ „ diarrhoea (under two years of age) 4 Zymotic death rate* 0.33 Tuberculosis, all causes, death-rate per 100,000 88.8 Excess of registered births over deaths — Excess of registered deaths over births 131 * Excluding deaths from Epidemic diarrhoea Population and Houses The Census of England and Wales 1931, was taken on the night of the 26th-27th April of that year The enumerated population of Holborn was as follows — Males Females Persons Census, 1931 18,187 20,673 38,860 Census, 1921 20,732 22,460 43,192 Decrease 4,832=10% The estimated population as given by the Registrar-General at the middle of 1934 was 36,000 10 Vital Statistics, 1934 England and Wales, London and Holborn Annual Gates per 1,000 living Deaths under 1 year to 1,000 Births Births Deaths England and Wales 14•8 11•8 59 London 13•2 11•9 67 Holborn 8•68 12•2 71 Registered Births The total number of births registered as occurring in the Borough was 150 (83 males and 67 females) Of these, 146 were legitimate and 4 illegitimate Corrected Births and Birth-Rate I received from the Registrar-General information of the births in outlying institutions in London of 132 legitimate infants and 31 illegitimate infants whose mothers were residents of the Borough Four of the births occurring in the Borough were infants of mothers who were non-residents of the Borough The corrected number of births is therefore 309, and the corrected birth-rate 8.58 The following is the corrected number of births and the corrected birth-rates for the year 1934: — 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. 1934 309 8•58 274 7• 61 886•7 35 0•97 113•3 In London the corrected birth-rate in 1933 was 13•2 per 1,000 in comparison with 13•2 for 1934. In Holbom, as in most other districts, there has been a marked reduction in the birth-rate in the last 20 years, the rate for 1934 being only 8•58 per thousand in comparison with 16•4 in 1914. 11 Mortality. The total number of deaths registered as occurring in the Borough was 699, of which 385 were males and 314 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough:— Institution. Residents. Non-Residents. St. Giles and Bloomsbury. Holborn. St. Giles and Bloomsbury. Holborn. French Hospital 1 1 53 - Royal Westminster Ophthalmic Hospital - - 2 - Children's Hospital 1 6 — 234 National Hospital 1 4 — 143 London Homoeopathic Hospital 2 7 — 59 Italian Hospital 1 4 — 20 St. Paul's Hospital 1 — 21 — Other places — — 18 2 Total 7 22 94 458 There were 293 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 28 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 1934 gives the total deaths for the Borough as 440. Corrected Deaths and Death-Rates, 1934, compared with 1933. 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. Net Deaths at all ages. Death Rate for Borough (crude). Death Rate for Borough. (adjusted). Rate for London 1934 699 581 552 293 440 † l2•2 13•05 11•9 1933 681 522 521 326 486 † 13•48 - 12•2 For details of causes of and ages at death, see Table II, page 92. † These rates are calculated on the Registrar-General's estimated populations at the middle of the year 1933 and 1934 respectively. 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:—* Deaths. Death-rate per 1,000. London Rate. First Quarter 136 15•1 15•8 Second ,, 101 11•2 11•4 Third „ 88 9•8 8•9 Fourth ,, 104 11•6 11•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. 1934 22 66 114 71 67 1933 24 59 130 70 59 Death-rate per 1,000 corrected births in 1934 and in ten preceding years. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Avge. 1924-33 1934 Holborn 81 63 90 38 57 74 89 74 72 70 70•8 71 Borough London 69 67 64 59 67 70 59 65 67 59 64•6 67 See also Table, page 78. 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 440 deaths, 322 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 1934: — Acts of Parliament. The Milk Act, 1934. Shops Act, 1934. Regulations and Orders. Public Health (Shell Fish) Regulations, 1934. * These figures, as published in the Registrar-General's Quarterly Returns for 1934, are for the 52 weeks ended 29th December, 1934; the complete corrections for the year 1934 increase the number of deaths to 440 and the rate to 12•2 per 1,000. The corresponding rate for London was 11•9. 13 Public Health (Treatment of Infectious Diseases) Regulations, 1934 The Milk (Special Designations) Order, 1934 By-laws L.C.C. Drainage By-laws (July, 1934). Ambulance Service Particulars of the ambulance services available in the Borough are given on the inside page of the back cover SANITARY CIRCUMSTANCES OF THE BOROUGH Survey of Health Services In March, 1934, a communication was received from the Ministry of Health respecting a report made by Officers of the Ministry following a survey of the public health services in the Borough After referring to the reasonable standard of efficiency and progress maintained by the Council, the Minister recommended certain matters for consideration Two of these were concerned with Maternity and Child Welfare, and arrangements were made by the Maternity and Child Welfare Committee to give effect to the Minister's suggestions: — Other matters to which attention was directed were the following: — (a) Tuberculosis It was suggested that an increase in the amount of home visiting carried out by the Tuberculosis Officer would be beneficial Arrangements for this were made by the Medical Officer of Health in consultation with the Tuberculosis Officer (b) Sanitary Inspectors The Minister suggested that the question of the adequacy of the sanitary inspection staff for the needs of the Borough should be considered Having regard to the trend of much recent legislation to impose additional work on local authorities and their staffs, particularly in connection with Housing and Food, resulting in a considerable extension of, and addition to, the work of the Sanitary Inspectors, the Council decided to appoint an additional male Sanitary Inspector The actual appointment, however, was suspended pending the appointment of a Medical Officer of Health in the place of the late Dr C W Hutt (c) Supervision of Food Supplies The communication suggested that milk shops and dairies should be more frequently inspected and that the sampling of milk for tubercle bacilli and general bacterial content should be resumed Arrangements were at once made for sampling to be resumed as suggested, and for the more frequent inspection of milk shops and dairies to be effected on the appointment of the additional sanitary inspector (d) Public Cleansing As regards this service generally (refuse collection and disposal, and street cleansing) the Minister expressed the opinion (i) that arrangements for dealing with the refuse at the Contractor's depot in Lambeth should be discontinued, (ii) that the Council should consider the question of putting the work in charge of a special Cleansing Officer The Contractors having expressed their willingness to carry out work with a view to improving their depot, the Council decided, subject to the approval of the Minister, to accept the offer for an experimental period* * Subsequently the Contractors' dep6t was closed 14 On considering the suggestion for the appointment of a special Cleansing Officer, the Council expressed the view that as long as the principle of contract work is continued, appointment of such special officer would be unnecessary, and further that the Minister's suggestion would be met in principle if the whole service were placed under the control of one officer, instead of being divided, with house and trade refuse under the Medical Officer of Health and the street cleansing under the Borough Engineer and Surveyor To implement this view the Council at its meeting on the 11th July, 1934, adopted a resolution transferring the supervision of the collection and disposal of house and trade refuse from the Medical Officer of Health to the Borough Engineer and Surveyor as from the 1st August, 1934 In submitting their report on the matter the Public Health Committee expressed appreciation of the excellent manner in which the work had been carried out by the Medical Officer of Health and his department during the previous twenty-nine years 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 In a very large majority of the houses in the Borough, the old large fixed ashpits have been replaced by movable sanitary ashbins The supervision of the work connected with the removal and disposal of house and trade refuse was, as previously mentioned, transferred from the Medical Officer of Health and the Public Health Department, to the Borough Engineer and the Works and General Purposes Department, as from the 1st August, 1934 Dust Inspector The Inspector appointed to supervise the removal of house refuse reported to the Medical Officer of Health daily up to the 31st July respecting: — (a) Early morning collections from main streets (b) Condition of ashbins placed on the footways in streets where there is a daily collection (c) The use of bins failing to comply with the by-laws (d) Litter on the public way (e) Regularity of collection from streets where the removal is bi-weekly (f) Breakdown of vehicles causing delay in collection of refuse (g) Complaints received of non-collection, delay, etc (h) Spillage or litter made by dustmen and not properly cleaned up (i) Generally on any matters relating to, or arising in connection with, the removal of refuse Removal of Offal No breach of the by-laws made by the London County Council respecting the removal of offal was reported during the year Removal of Manure The removal of manure from the various mews in the Borough was generally satisfactorily carried out during the year, but it was necessary to serve two Statutory Notices for the provision of proper manure receptacles The notices were at once complied with 15 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 20,904 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, 1934. Mr. Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Complaints received 46 32 27 ... ... 105 Do. found to be justified 46 32 27 ... ... 105 Inspection of Houses— Dwelling-houses 143 418 169 ... ... 730 Houses let in lodgings 340 285 125 28 ... 778 Common lodging-houses 23 12 14 6 ... 54 Drains tested 21 36 31 ... ... 88 Re underground rooms 618 640 51 ... ... 1,308 New buildings ... 3 1 ... ... 4 Factories — Bakehouses 10 13 ... ... ... 23 Food preparation (other than above) 1 ... 83 ... ... 84 Other 33 40 241 3 ... 317 Workshops and workplaces - Food premises: Dairies and Milk shops 94 86 94 ... ... 274 Ice Cream, Manufacture ... 16 32 ... ... 48 Do. Storage or Sale 33 13 1 ... ... 47 Slaughter-houses ... 10 ... ... ... 10 Hotels and Restaurants 120 104 227 ... ... 451 Butchers 281 9 281 ... ... 571 Bakehouses 13 9 6 ... ... 28 Fish shops † 7 10 1 ... ... 18 Fried Fish shops 234 16 12 ... ... 262 Market Streets 327 88 680 ... ... 1,095 Licensed Premises ... 2 ... ... ... 2 Other food shops 161 55 49 ... ... 265 Merchandise Marks Act, 1926. 307 211 105 ... ... 703 Other workshops 75 94 271 37 ... 477 Other workplaces 58 85 81 4 ... 228 Outworkers' Registers 16 45 44 ... ... 105 Stables and Stable yards 6 35 ... ... ... 41 Hag and Bone shops 11 1 ... ... ... 12 Outworkers' rooms * ... ... ... ... ... ... Offices 14 3 20 ... ... 37 Miscellaneous — Black smoke 10 47 99 ... ... 156 Dust, Special Inspections ... 5 ... ... ... 5 Rats and Mice (Destruction) Act, 1919 114 174 78 ... ... 366 Food and Drugs (Adulteration) Act. 1928 (sampling) 193 196 209 ... ... 598 Demolition of Buildings 7 12 5 ... ... 24 Other Inspections ... ... ... 1 6 7 Keeping of Animals 1 ... 2 1 ... 4 Periodical Inspections: Includes W.C. and yards, dustbins, especially houses let in lodgings, and other similar dwellings 1,227 1,676 2,535 ... ... 5,438 In-pections carried forward 4,677 4,449 5,546 80 6 14,658 *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 + The fish shops are also inspected in connection with daily inspections of market streets, or weekly pjriodical inspections 16  Mr. . Bennett Mr. Clark Mr. Larard Miss Charlesworth Miss Stockwell Total Brought forward 4,677 4,449 5,646 80 6 14,658 Re-Inspections— Houses 817 743 423 8 ... 1,991 Factories 4 5 19 ... ... 28 Workshops and Workplaces 54 82 173 3 ... 312 Restaurants 4 21 16 ... ... 41 Licensed premises ... ... ... ... ... ... Offices ... 1 ... ... ... 1 Miscellaneous ... ... ... 81 147 228 Visits re Infectious Diseases 81 158 116 106 164 624 Scabies ... ... ... 3 ... 3 Other Visits— Police Courts • •• 1 3 ... • •• 4 Various 126 395 227 24 ... 772 Maternity— Visits: Children under 1 year ... ... ... 124 177 301 Do. 1 to 5 years ... ... ... 33 31 64 Expectant Mothers ... ... ... 69 75 144 Infant Life Protection ... ... ... 10 27 37 Re-visits: Children under 1 year ... ... ... 98 317 415 Do. 1 to 5 years ... ... ... 197 317 514 Expectant Mothers ... ... ... 39 119 158 Infant Life Protection ... ... ... 7 32 39 Other Maternity Visits ... ... ... 99 85 184 Attendances at Maternity Centres ... ... ... 213 173 386 Total 5,663 5,856 6,522 1,194 1,670 20,904 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 1,067, viz :— Public Health (London) Act, 1891— Intimation Notices 396 Statutory Notices 56 By-laws— Houses let in lodgings 582 London County Council (General Towers) Acts— Verminous rooms 25 Rats and Mice (Destruction) Act, 1919 8 1,067 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 6 0 Cisterns cleansed, repaired etc. 32 4 Waterclosets— Cleansed 11 9 Water supplied, flushing cistern repaired, etc. 8 6 Repaired, new pans, etc. 52 10 Ventilation improved 2 3 Separate accommodation for sexes provided — 6 Position or construction improved 1 1 Direct communication with workrooms remedied — 2 Accommodation provided 4 2 Urinals, repaired, cleansed, etc. — 4 Soil Pipes— Repaired, renewed and ventilated 3 2 Rainwater Pipes— Repaired or renewed 15 6 Drains— Repaired 17 6 Unstopped, cleansed, etc. 18 5 Sinks, etc.— Waste pipes repaired, renewed, etc. 28 8 Yards, Areas and Washhouses— Cleansed 5 2 Paved and paving repaired 14 5 Houses and Workshops, etc.— Cleansed 50 38 Dilapidations repaired and made good 35 8 Ventilation improved 2 11 Dampness— Roofs repaired 27 2 Gutters repaired 4 4 Other works to prevent dampness 12 13 Ashbins— Provided, repaired, etc. 56 6 Various— Underground Rooms vacated 5 — Smoke—Emission of black smoke abated — 6 B 18 Accumulations of Refuse—Removed 20 9 Overcrowding abated 3 1 Other nuisances abated 7 11 Animals improperly kept 1 — Manure Receptacles—Provision of — 2 Statutory Notices. The following table shows the nuisances for which the 56 Statutory Notices were issued under the Public Health (London) Act, 1891:— Houses. Factories, etc Section 2 (1)— (a) Dirty, dilapidated, damp premises, etc. 21 5 (b) W.C.'s, drains, etc. 15 2 (c) Water cisterns and water supply 4 1 (d) Animals improperly kept — — (e) Accumulation of refuse 3 — (f) Overcrowding 2 — Section 21 (1)—Effluvia — — Section 24—Smoke — 1 Section 37—Ashbins 8 2 Section 37—Waterclosets 1 — Section 38—W.C. dirty or defective, etc. — 4 Section 38—W. C. accommodation for sexes — 5 Seotion 96—Underground rooms — — By-Laws as to Houses let-in-lodgings. At the end of the year 462 houses were registered under these By-laws. Of these, 281 are in St. Giles and Bloomsbury and 231 in the Holborn District. There were 778 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 120 notices were served for breaches of the By-laws, in addition to 462 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. Twelve inspections of rag and bone shops were made in the year 1984; 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 301 premises were inspected under the above Act, the total inspections being 366. Eight notices for breaches of the Act were served. At the end of the year the eight premises were reported to be clear 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 for Rat Repression. RESULT. Traps. Poisons. Rat catchers. Dogs. Cats. Proofing; A. 9 — — — — — — — B. 35 12 — 3 — — — 12 Free 12 C. 14 — — — — — — — D. 52 — — - — — — E. 9 6 — — — — — 6 Free 6 F. 61 23 — 5 3 — — 16 Free 18 Rats occasionally seen 3 Under observation 2 G. 33 9 1 1 — — — 9 Free 9 H. 50 23 7 8 6 — 7 5 Free 23 I. 38 18 10 8 8 — 1 6 Free 16 Rats occasionally seen 2 301 91 18 25 17 - 8 54 Free 84 Rats only occasionally seen 5 Under observation 2 * A number of rats were seen and caught in this Ward during excavations of the London University site. Poisons and traps were used and the numbers much reduced. 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 5th November, 1934. The following is a summary of the action taken: — (i) 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, to advise concerted action on the part of occupiers during Rat Week. (ii) In a number of cases advice was given respecting rat proofing. B 2 20 (iii) Suitable poison baits were on sale in the Public Health Department (iv) Where desired, occupiers of rat-infested premises were placed in communication with reliable firms of rat catchers (v) Communications were sent to chemists and hardware dealers asking them to stock and display suitable poisons and traps before and during Eat Week (vi) Eat repression posters were exhibited on the Council's buildings and advertisement boards (vii) Baits in all the Council's sewers were increased in Rat Week, 3,000 baits were laid In this connection the Borough Engineer and Surveyor writes: — "Following the success found with 'Ratin' and 'Ratinin' the "same procedure was adopted in November last as in the former "year Baits of 'Ratin' were laid for three months commencing in "November last, and this month (February) 'Ratinin' was used, " which completes the course" Supervision of Drainage Work The attention of the Council was directed to the arrangement which had operated in the Borough for a number of years by which all drainage work had been carried out under the supervision of the Borough Engineer and Surveyor and his staff, thus differing from the practice almost invariably prevailing in other metropolitan areas where such work is supervised by the Sanitary Inspectors under the direction of the Medical Officer of Health, all qualified Sanitary Inspectors being specially trained for this technical work The Public Health Committee expressed the opinion that it would be an advantage if the practice in Holborn was brought into conformity with that usual in London, and the Council decided that as from the 1st August, 1934, the supervision of work connected with the construction and/or repair of drains should be transferred from the department of the Borough Engineer and Surveyor to the Public Health Department From the time of transfer until the end of the year fifty-five applications for the Council's approval to proposed work were received In some instances it was not possible to approve the plans until amendments had been made to bring them into conformity with the London County Council drainage by-laws and the Regulations of this Council relative to such work At the end of the year all applications had received approval with the exception of three which were approved during the first few days of 1935 Smoke Abatement The smoke shafts in the Borough were kept under frequent inspection, 156 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 Sixteen complaints were received of nuisances from the emission of smoke As the result of inspections made, six intimation notices and one statutory notice were served, 21 The use of unsatisfactory coal is the common cause of smoke nuisance in the Borough; such use arises when attempts are 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 397 factories were inspected, 520 workshops and 3,212 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 37 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 registei was effected Variations in the staff employed were also frequently reported During the year 44 workshops were added to the register At the end of the year there were 611 workshops on the register 364 employed men only, 41 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 156 different industries are carried on in these workshops, among the principal being the following:— No of Workshops Employing Men only Women only Both Sexes Total Boot makers and repairers 15 — 1 16 Builders 12 — — 12 Carpenters 11 — — 11 Clock and watch makers 19 — 1 20 Dressmakers and ladies' tailors — 14 21 35 Diamond mounters 10 — 1 11 Engravers 15 — 2 17 Glass blowers 6 — 2 8 Jewellers 35 1 10 46 Leather goods makers 6 1 4 11 Metal workers 7 — 4 11 Tailors 27 3 50 80 22 Factories These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough At the end of the year 476 factories were on the register Workshops are automatically converted, at a very small cost, into factories by the installation of a small electric motor; the health conditions then may no longer be inspected by the Borough Council's staff except as regards sanitary accommodation The 476 factories include 57 different industries In 233 cases men only were employed, in 17 women only, and in 226 both sexes The more important industries carried on in these factories are :— Printing 119 Engineering 46 Jewellers' work 23 Bookbinding 19 Metal work 10 The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1934:— Mr. Bennett. Mr. Clark. Mr. Larard Miss Charlesworth. Total. Factories— Inspections 34 40 324 3 401 Re-inspections 4 5 19 — 28 Workshops— Inspections 75 94 271 29 469 Re-inspections 9 10 58 3 80 Workplaces— Inspections 58 85 81 — 224 Re-inspections 45 62 125 — 232 Offices— Inspections 14 3 20 — 37 Re-inspections — 1 — — 1 Bakehouses— Inspections 23 22 6 — 51 Re-inspections — 1 — — 1 Restaurants— Inspections 120 104 227 — 451 Re-inspections 4 20 16 — 40 Licensed Premises— Inspections — 2 1 — 2 Re-inspections - - - - - Defects Found— Want of cleanliness 5 14 18 — 39 ,, ventilation — 2 1 — 3 Overcrowding — 1 1 — 2 Storage cistern defective — — — — — Accommodation for refuse 1 — 2 - 3 Accumulation of refuse 3 2 4 — 9 Sanitary accommodation Insufficient 1 — — — i Unsuitable — 1 2 — 3 Defective 3 8 3 — 14 Not separate for sexes 1 2 2 — 5 Other nuisances 12 29 22 — 63 Total defects 26 59 55 — 142 23 Action taken Matters referred to HM Inspector :— Failure to affix abstract 7 Matters referred by HM Inspector Notified by HM Inspector 7 Notices served. Mr. Bennett. Mr. Clark. Mr. Larard. Miss Charlesworth. Total. Factories— Intimation 1 6 14 21 Statutory - 1 3 - 4 Workshops— Intimation 13 12 12 2 39 Statutory 2 - 3 — 5 Workplaces— Intimation — 9 10 1 20 Statutory — 5 — — 5 Offices— Intimation 1 1 1 - 3 Statutory — - — — — Restaurants— Intimation 2 6 10 — 18 Statutory - 1 1 — 2 Licensed Premises— Intimation - - - - — Legal Proceedings — - — — — Outworkers. Lists received from Holborn Firms 95 Names and addresses received from other Authorities 403 Names and addresses sent to other Authorities 225 Notices served on Employers 95 Firms visited 102 Infectious diseases in outworkers premises nil Rag Flock Acts, 1911 and 1928. There are no premises in the Borough on which rag flock, as defined by tho above Acts, is manufactured, used or sold. HOUSING. The following is the summary of information asked for in the Ministry of Health Circular 1417 (England):— 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 670 (b) Number of inspections made for the purpose 1,508 (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 70 (b) Number of inspections made for the purpose 139 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 216 24 II.—REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers ... Not known III.—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (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 - * Time not expired at end of year. B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — fa) by owners 216 (b) by Local Authority in default of owners nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 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 2 Common Lodging-Houses. The Public Health Committee considered and granted applications for the renewal of licences for the twelve months ending 30th June, 1935, in respect of the following common lodging houses: — 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 During the year the common lodging-house at Nos. 2.8, Kennedy Court was closed, on the sale of the property by the owners. Part of the common lodginghouse at Nos. 7-11, Short's Gardens was also closed, reducing the total accommodation to 70 males. Accommodation on L.C.C. Estates, During the year 56 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 30 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 are furnished with a memorandum of advice 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. Housing Schemes. The Council has constructed two blocks of tenement dwellings, viz., Betterton House, Betterton Street, containing 30 tenements, and Boswell House, Boswell Court, containing 62 tenements. Many applications were made during the year for accommodation in these dwellings, but as the movement of families occupying the flats is rare it was possible to offer accommodation to only a very small number of those applying. Holborn Housing Trust, Ltd. In the Annual Report for the year 1933, reference was made to the formation of the Holborn Housing Trust under the Presidency of Mr. Stuart Bevan, K.C., M.P., and the Chairmanship of Alderman Percy Hill, L.C.C., the objects of the Trust being the erection of working class dwellings in Holborn at the lowest economic rent. It is a pleasure to include in this Report the following information kindly supplied by Mrs. P. J. S. Bevan, the Honorary Secretary of the Trust "1934 has seen the beginning of Bevan House, Devonshire Street, W.C. 1. Ten flats have been completed, consisting of two bedrooms, a large living room, and bathroom, etc. There is a roof playground wired in for the children. Of the forty -four occupants, twenty-four are children. The rent of these flats is £1 per week, but it is hoped to reduce this later when more shares bearing interest at 2½ per cent. have been taken up. The two adjacent houses have been acquired by the Trust, and demolition will shortly begin. The new building will be to the plans of Mr. R. T. Beck, A.R.I.B.A., in conjunction with Messrs. Elcock & Sutcliffe." '26 INSPECTION AND SUPERVISION OF FOOD. Dairies, Cowsheds and Milkshops. In connection with the duties imposed on the Council respecting registration of milkshops, opportunity is taken before entering the premises or the name of the applicant on the register to inspect the premises proposed to be used, to ascertain whether they are suitable for the sale of milk. 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 1934, the number of registered dairies and milkshops in the Borough was 144. Sixteen entries were made in the register during 1934. Of these, 7 related to premises registered for the first time, 6 to premises where a change of occupier had necessitated re-registration, and 3 to wholesale milk premises. Four premises were removed from the register on closing or demolition. The Sanitary Inspectors recorded 274 inspections of milk premises. It was not necessary to serve notice for any breach of the Order or sanitary defect. The Milk (Special Designations) Order, 1923. During the year 1934 licences available up to the 31st December 1934, for the sale 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 In addition, 3 dealers' licences in respect of " Pasteurised" milk were issued in September, 1934, and made available until 31st December, 1935, having regard to the short period of availability remaining in the year 1934. Up to the date of the preparation of this report licences for the year 1935 have been issued as follows: — Certified 2 Grade A (Tuberculin Tested) 2 Grade A (Pasteurised) 1 Pasteurised 8* Supplementary— Grade A (Tuberculin Tested) 1 Pasteurised 3 17 * This number includes the three licences referred to immediately above. 27 Bacteriological Examination of Milk. Twenty-five samples of milk were examined for the presence of tubercle bacilli. One sample only disclosed evidence of tuberculous infection. In this case post-mortem examination of two guinea pigs, killed at the end of three and six weeks respectively after inoculation, showed enlarged and nodular spleens: the second animal also showed abscess at the site of inoculation in which tubercle bacilli were noted microscopically. This milk was not sold as " pasteurised " but was in fact a milk pasteuried under the Holder method. The milk came to a London distributing depot from a receiving station in the North of England where the supply is derived from a thousand farms. At the receiving depot the milk is mixed and brine cooled before transport in insulated rail tanks to London where it is pasteurised. Communications on the subject were sent to the retail vendor, the wholesalers, and to the Medical Officers of Health of the districts where the milk is mixed and where it is subsequently pasteurised. Cleanliness of Milk. Four of the twenty-five samples were also examined to ascertain the number of organisms per cubic centimetre and the smallest volume containing B. Coli. The results of these examinations are shown in the following table: — Date of sample obtained. Nature of shop where purchased. No. of organisms per c.o. grown at 37C for 24 hours. Minimal volume containing Bacillus Coli. 1934 15th August Small general 68,000 0.0001 c.c. Do. Dairy and provisions 8,400 0'01 c.c. Do. Dairy and refreshment 104,000 0.00001 c.c. Do. Dairy and provisions 128,006 0 01 c.c. Designated Milk. Four samples of designated milks were submitted for bacteriological examination for the presence of Brucella Abortus infections. The milks examined were "Certified," "Grade A (T.T.)," "Grade A Pasteurised" and " Pasteurised." From the following report it will be seen that no sample gave evidence of Brucella Abortus infection:— Four series of guinea pigs were inoculated with deposits and cream " from each of the milks respectively. " The animals were killed at intervals after a period of three weeks. " Samples of blood were collected from each, and agglutination tests " carried out with Standard Br. Abortus cultures. Portions of spleen and " liver of each were cultured and incubated under C02 conditions. " Neither by agglutination or culture was any evidence obtained of the " presence of Brucella Abortus infections." 28 Public Health (Dried Milk) Regulations, 1923. Very few brands of dried milk are sold in the Borough. Three samples were obtained during the year, and found to comply with the Regulations, which are generally similar to those with regard to condensed milk. Margarine. There are eight registered wholesale 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 substitution of butter by margarine will remain serious. Bakehouses. At the end of the year 1934 there were 20 bakehouses in the Borough of which 14 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 51 inspections of bakehouses, and two notices were served. Sale of Fish. During the past year 18 inspections were made of the fish shops and fish stalls in the Borough, exclusive of market street inspections. There were 14 fish shops of which eight were in the Central Fish Market (a part of the Smithfield Central Markets, Farringdon Road, the fish being sold by retail). Both wet and dried fish were found to be sold at all the shops; at five, shell fish was also sold. In addition to the shops referred to above, there are eight 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 14 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 262 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 1,095 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 b\ the regular stallholders of good, sound food only, and, in addition, has the eSect of keeping away from these markets casual and unsatisfactory hawkers, who generally avoid markets subject to regular and strict supervision. In order to minimise as far as practicable any contamination of the food exposed for sale in market streets from dust arising during street cleansing, the 29 Borough Surveyor has arranged for these streets to be sufficiently watered before the scavenging to prevent dust arising. Street Trading, I received information from the Borough Engineer respecting 103 applications from street traders for annual licences to sell various articles of food as follows: — Coffee stalls 6 Confectionery and drinks 15 Fish—wet and dry, including shell fish 8 Fruit and vegetables 48 Groceries 4 Ice cream or chestnuts 15 Meat 3 Poultry, eggs and provisions 4 103 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 Holborn 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, 1928, 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 18 Storage and sale 2 Sale only 19 42 30 In addition to my inspections, 95 inspections of these premises were made. On one occasion during the year an Inspector found, on a barrow from which ice cream was being sold, that the inner sides of the receptacle covers were dirty. A letter on the subject was sent to the vendor and to the Medical Officer of Health of the district of registration, and the unsatisfactory conditions were at once remedied. 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 deal with slaughter-houses, meat marking, the handling of meat in wholesale markets, conditions of transport, the protection of meat in butchers' and other shops and on stalls from contamination by flies, mud and other substance. The following summary shows the number of butchers' shops and meat stalls in the Borough, and the number of other shops where meat is sold: — Butchers' shops 29 Butchers' stalls 1 Provision dealers 36 Provision dealers' stalls 3 Offal shops 3 Cooked meats 19 Wholesale (bacon; sausage) 5 96 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 571 such inspections were made. Places where Food is prepared (or 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 298 Slaughter-houses 1 Tripe, offal and other meat shops 48 Fried fish shops 14 31 Fish shops 14 Ice cream (Manufacture) 21 Poulterers 9 During the year, 2,457 inspections of such food premises and market streets were made and 26 notices served for sanitary defects found. Inspection of Restaurant Kitchens. The large day population in the Borough calls for many eating houses ranging from the " cook shop " where cheap meals are provided to the high-class restaurant. The inspection of the kitchens of such places has become a routine but important part of the work of the Public Health Department. Generally the kitchens are found to be satisfactory and the food clean and wholesome. Occasionally, however, some action is necessary to ensure compliance with a reasonable standard of efficiency. In all 21 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, 1934:— Commodity. Quantity. Condition. Result of Action taken. Fish :— Sole dabs Tons. ... Cwts. 4 Qrs. 2 lbs. 0 Decomposed Surrendered Fruit :— Apples ... 7 2 0 Decomposed and damaged do. Bananas ... ... ... 14 Damaged do. Grapes 1 12 0 16 Decomposed do. Peaches ... ... 3 16 Damaged do. Pears ... ... 2 11 Decomposed do. Plums ... ... 2 4 Decomposed do. Meat :— Bacon ... 2 0 19½ Diseased do. Chickens ... ... 1 12 Decomposed do. Tongue, tinned ... ... ... 11 Decomposed do. Other Food :— Beans ... 16 0 24 Decomposed do. Margarine ... 1 2 12 Unsound do. Tomato puree ... 8 2 21 Blown do. Total 3 16 1 20½ The Public Health (Preservatives, etc., in Food) Regulations. In the year 1934 two samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., sausages and pepper (see p. 33). 32 Food and Drugs (Adulteration) Act, 1928. On the 1st January, 1929, the Food and Drugs (Adulteration) Act, 1928, consolidating the four Food and Drugs Acts of 1875, 1879, 1899 and 1928, came into force. The Margarine Act of 1877 and the Butter and Margarine Act of 1907 are also included in the scope of the new Act. Much progress has been made by the consolidation of these Acts; the consolidation is a great convenience. Although the proportion of articles found adulterated is low the careful administration of the Act is valuable as a preventive measure. Articles Analysed. Formal Samples. article. Number Purchased Result of Analyses Proceedings taken. Convictions. Fines And Coats. Genuine. Adulterated A mm. tincture of quinine 5 5 ... ... ... ... Apricots, canned 1 1 ... ... ... ... Beans, canned 3 3 ... ... ... ... Beef, corned 2 2 ... ... ... ... Beef, minced 5 5 ... ... ... ... Beer 8 8 ... ... ... ... Bicarbonate of soda 3 8 ... ... ... ... Borax 2 2 ... ... ... ... Brandy 2 2 ... ... ... ... Brawn 4 4 ... ... ... ... Bread and butter 3 3 ... ... ... ... Butter 46 46 ... ... ... ... Cake 3 3 ... ... ... ... Camphorated oil 2 2 Cheese 10 10 ... ... ... ... Cheese, cream 2 2 ... ... ... ... Christinas pudding 2 2 ... ... ... ... Coffee 2 2 ... ... ... ... Coffee and chicory 3 3 ... ... ... ... Coffee and chicory extract... 3 3 ... ... ... ... Cornflour 2 2 ... ... ... ... Cornish pattie 1 1 ... ... ... ... Cream 12' 12 ... ... ... ... Cream, canned 7 7 ... ... ... ... Cream buns 3 3 ... ... ... ... Cream doughnuts 2 2 ... ... ... ... Cream Soda 1 1 ... ... ... ... Dripping 6 6 ... ... ... ... Egg substitute 4 4 ... ... ... ... Fish paste 5 5 ... ... ... ... Fruit cordial 3 3 ... ... ... ... Gelatine 2 2 ... ... ... ... Gin 2 2 ... ... ... ... Grape fruit cordial... 1 1 ... ... ... ... Grape fruit squash... 1 1 ... ... ... ... Ice cream 6 6 ... ... ... ... Jam 6 6 ... ... ... ... Lemonade 1 1 .. ... ... ... Lemonade powder 2 2 .. ... ... ... Lemon squash 1 1 .. ... ... ... Liine juice cordial 1 1 ... ... ... ... Liniment of iodine 2 2 ... ... ... ... Liniment of turpentine 1 1 ... ... ... ... Linseed, crushed 2 2 ... ... ... ... Margarine 22 21 *1 ... ... ... Marmalade 9 3 ... ... ... ... * The margarine sample reported to be not genuine was found to contain 50 per cent. of butter fat, and a letter was addressed to the vendor drawing his attention to the technical breach of the law. 33 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs Genuine. | Adulterated. Meat paste 2 2 ... ... ... ... Milk 224 118 †6 4 3 (i) Fine 10s. Costs 21s. (ii) Fine 20s. Costa 20s. (iii) Fine £5, Milk, condensed 6 6 ... ... ... ... Milk, dried 3 3 ... ... ... ... Mince pies 2 2 ... ... ... ... Ointment boric 2 2 ... ... ... ... Ointment, calomel 2 2 ... ... ... ... Ointment, gall and opium 2 2 ... ... ... ... Ointment, nitrate of mercury 2 2 ... ... ... ... Ointment, sulphur 2 2 ... ... ... ... Ointment, white precipitate 2 2 ... ... ... ... Olive oil 4 4 ... ... ... ... Orange squash 1 1 ... ... ... ... Paregoric 4 4 ... ... ... ... Peaches, canned 1 1 ... ... ... ... Pears, canned 1 1 ... ... ... ... Teas, canned 13 13 ... ... ... ... Pepper 6 5 ‡1 ... ... ... Plums, canned 1 1 ... ... ... ... Prescriptions 2 2 ... ... ... ... Raspberries, canned 1 1 ... ... ... ... Raspberryade 1 1 ... ... ... ... Relish 1 1 ... ... ... ... Rice 2 2 ... ... ... ... Roll and butter 2 2 ... ... ... ... Rum 1 1 ... ... ... ... Salad oil 2 2 ... ... ... ... Salmon, canned 3 3 ... ... ... ... Sauce 1 1 ... ... ... ... Sauce, mint 1 1 ... ... ... ... Sauce, tomato 1 1 ... ... ... ... Sausage, cooked 1 1 . ... ... ... Sausages 13 11 **2 ... ... ... Sausage roll 3 3 ... ... ... ... Soup, desiccated 2 2 ... ... ... ... Sponge cake 8 8 ... ... ... ... Sponge cake and jam 2 2 ... ... ... ... Sponge fingers 8 3 ... ... ... ... Suet, chopped I 1 ... ... ... ... Suet, shredded 3 3 ... ... ... ... Sugar 3 3 ... ... ... ... Sweets 5 5 ... ... ... ... Tea 2 2 ... ... ... ... Tincture of rhubarb 2 2 ... ... ... ... Treacle 2 2 ... ... ... ... Vinegar 10 10 ... ... ... ... Whisky 2 2 ... ... ... ... White oil 1 1 ... ... ... ... Wine, ginger 2 2 ... ... ... Wine, orange 1 1 ... ... ... ... Wine, orange quinine 1 I ... ... ... ... Total 681 571 10 4 3 ... † Two of the milk samples reported to be not genuine were found to have had fat abstracted to a small extent only, and warning letters were addressed to the vendors. In one of the four oases in which proceedings were taken the summons was withdrawn upon proof of warranty. ‡ The pepper sample reported to be not genuine was found to contain a very small proportion of sulphur dioxido, and letters to the vendors and producers of the article elicited the fact that the adulterant had been introduced by the use of a bleaching agent. As a result of the action taken, the producers agreed to discontinue the use of this bleaching agent. ** The two samples of sausages reported to be not genuine were found to contain small proportions of sulphur dioxide preservative. In the one case, a notice exhibited in the vendor's shop disclosed the presence of preservative, and no action was necessary. In the other case, having regard to the small proportion of preservative used, a warning letter only was addressed to the vendor of the sample drawing attention to the requirements of the Public Health (Preservatives, etc., in Food Regulations. 34 Informal Samples. article. Number of Samples Taken. Result of Analyses. Genuine. Adulterated. Antacid (Birley's) 1 1 ... Cream 1 1 ... Fish paste 1 I ... Lemonade powder 1 1 ... Meat paste 1 1 ... Milk, condensed 1 1 ... do. dried 2 2 ... Pickles 2 2 ... Salad cream 1 1 ... Stomach powder 1 I ... Tomato puree 7 ... *7 Total 19 12 7 * During the year information was received respecting a considerable amount of Tomato Puree reported to be in London at that time. It was stated that the commodity contained a fair amount of tin and copper which in several cases had caused enteritis. Information was received that a sample examined in another London Borough was found to contain as much as 5.2 grains per pound tin and 0 25 grains per pound copper. Enquiries were made by the Inspectors to ascertain if any of the puree indicated was on sale in Holborn. Supplies of the brand concerned were found to be stocked by several Holborn retailers. Seven samples were procured for chemical analysis. All were reported by the Borough Analyst to contain both tin and copper in varying quantities. Arrangements were made with the retailers for the sale of the commodity to be suspended pending further investigation. The names and addresses of the wholesalers and/or importers were obtained and letters were addressed to them on the subject. As a result of the enquiries made it transpired that the whole of the consignment in the various Holborn shops came through the same importing company. This Company had arranged for a conference between their Analyst and the Medical Officer of Health of the district of importation and agreed to a temporary informal embargo on the sale of the goods in Holborn. As a result of the conference arrangements were made for the whole consignment to be returned to the importers and withdrawn from the British Market. Notes of the Borough Analyst on Samples Examined During the Year 1934. During the year 1934, 600 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 581 having been purchased with the required formalities and 19 obtained informally. Of this total, 17 (2.83 per cent.) proved to be adulterated, ten being samples submitted formally and seven informally. In the previous year 1.16 per cent. of the samples were certified to be " not genuine." The adulterated articles consisted of milk, margarine, pepper, sausages and tomato puree. Milk.—Two hundred and twenty-four samples of milk were analysed, and six of these (2.5 per cent.) fell below the limits required by the Board of Agriculture Regulations—3.0 per cent, of fat and 8.50 per cent. of non-fatty solids—and were certified to be adulterated accordingly. One sample had been diluted with water to the extent of at least 8.2 per cent., and from the five others fat had been abstracted to the extent of from 4.6 to 35.0 per cent. respectively. It may be of interest to insert here two tables prepared by the Public Health Department from the returns of the Borough Analyst showing (1) the Fat Content of the 224 samples of milk, indicating their places of origin, and (2) the Monthly Variation in the Chemical Composition:— 35 No. 1. Fat Content. Percentage of Fat Number of Samples. Shops. Restaurants. Streets. Total. Less than 3.0 2 3 2 7 3.0 2 - 1 3 3.1 6 6 12 3.2 14 8 22 3.3 16 8 24 3.4 21 2 9 35 3.5 15 3 12 30 3.6 25 — 7 32 3.7 20 — 7 27 3.8 9 — 4 13 3.9 4 — 2 6 4.0 2 1 — 3 4.1 2 — — 2 4.3 1 — — I 1 4.5 1 — — 4.6 1 — — 1 4.8 1 — — 1 4.9 1 — — 1 5.2 1 — — 1 5.7 1 — — 1 7.6 I — — 1 149 9 66 224 Average fat content 3.68% 3.20 % 3.43% 3.52% No. 2. Monthly Variation of Chemical Composition of Milk. Month. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 20 12.87 8.99 3.88 February 20 12.50 9.04 3.46 March 18 12.22 8.77 3.45 April 14 12.26 8.93 3.36 May 18 12.36 8.91 3.45 June 17 12.20 8.91 3.26 July 20 12.41 9.02 3.39 August 20 12.60 9.0: 3.59 September 19 12.54 8.99 3.55 October 21 12.37 8.89 3.18 November 19 12.57 9.00 3.57 December 18 12.67 8.93 3.74 Whole year 224 12.47 8.95 3.52 Legal minimum — 11.50 8.50 3.00 c 2 36 The average composition of the samples returned as genuine was 3.55 per cent. of fat and 8.96 per cent. of non-fatty solids which must certainly be regarded as satisfactory. Margarine.—One of the samples of margarine was found to be a mixture of equal parts of butter and margarine. The Margarine Act permits the addition of butter fat to margarine, but the proportion so added must not exceed 10 per cent, of butter fat. Pepper.—One of the samples of pepper contained 55 parts per million of sulphur dioxide. This body, or one of its compounds called a sulphite, is permitted to be added only to certain specified articles of food as a preservative, but in this case it was undoubtedly used as a bleaching agent to improve the appearance of an inferior pepper. Practices of this kind which enable an inferior article to be sold to a purchaser who has no means of ascertaining its proper value, are strongly to be condemned. Sausages.—Both the samples of sausages certified to be adulterated had been preserved with sulphur dioxide, in one case without due notice being given to the purchaser. Sausages are permitted to be preserved with sulphur dioxide or a sulphite, the quantity of the preservative added not to exceed 450 parts per million in terms of sulphur dioxide, but notice of this addition must be given to the purchasers. Tomato Puree.—Seven informal samples of canned tomato puree were all found to contain considerable quantities of copper and tin, probably dissolved from the vessels in which the puree was prepared and afterwards put on the market. On the facts being reported to the importers by the Medical Officer of Health, I understand the consignment was collected and withdrawn from sale. Attention must once again be drawn to the desirability of the appointment of some small Committee which should be empowered, officially, to fix or amend standards of what may or may not be sold to a purchaser under a given name. Instances of the necessity of some such action may be found in the present unsatisfactory nature of articles stated to be filled with cream such as cream buns. Some makers use a mixture of fats and sugar as a filler while others put in genuine cream, but both are sold as " Cream Buns " without notice to the purchaser, frequently giving the vendor of the mixture a much greater profit. Cream cheese is at present often a soft cheese which may contain as little as 20 per cent. of fat, whereas, what was originally, and still is, known as cream cheese contains 50 to 60 per cent. of fat. Some years ago a standard for jam was stated to have been fixed by a joint conference of Jam Manufacturers and certain Public Analysts, but this can in no way be considered to be an official standard of what any particular jam ought to be. It may be interesting to add that this " agreement " was concluded after the prolonged hearing of a case in 37 which the Holborn Borough Council obtained conviction against a well-known firm of jam manufacturers, for the addition of " other fruit pulp " to jam without due notice being given. These are only one or two examples of the urgent necessity for the appointment of some body having official authority which could consider the questions of standards, and fix and prescribe limits; or with increasing knowledge and experience and improved methods of analysis, amend any such standards to suit the needs and changes which are constantly taking place in the production and preparation of food. Merchandise Marks Act, 1926. The Orders under the above Act now in force provide for the marking of the following imported foodstuffs to show their origin: — 1. Fresh Apples. 2. Raw Tomatoes. 3. Eggs (hen or duck eggs in shell). 4. Dried Eggs. 5. Currants, Sultanas and Raisins. 6. Oat Products (oatmeal, rolled oats, oat flour and groats). 7. Honey. 8. Salmon or Sea Trout, frozen or chilled. 9. Butter. 10. Bacon and ham. 11. Dead poultry. 12. Frozen beef, mutton, lamb, pork and veal; chilled beef; salted beef and pork; boneless beef and veal; edible offals. The Order applying the marking requirements to the imported foodstuffs set out under No. 12 above, was made in 1934, but did not come into force until early in 1935, being then slightly varied and its operation in part temporarily suspended by Exemption Directions made under the Act of 1926. During the year under review 703 inspections under the Orders in force were made by the Inspectors appointed for the purposes of the Act, resulting in the detection of 50 breaches of the Orders. In 42 of these cases the breach was remedied following a verbal caution from the Inspector, while in the remaining 8 cases it was found necessary to address a cautionary letter to the offender before compliance with the particular Order in question could be secured. 38 London County Council (General Powers) Act, 1932. Registration of Food Premises. Section 5 of this Act requires the registration with the sanitary authority of premises used for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale. Power is given to the sanitary authority to refuse to register, or to remove from the register, any premises that are unsuitable; a person aggrieved by such action has a right of appeal to a Court of Summary Jurisdiction. The requirement to register does not apply to premises used as a club, hotel or restaurant. At the date of the preparation of this report the following premises were registered in accordance with the requirements of the Act: — Sausages 18 Preserved meat 19 Pickled meat 6 Preserved fish 1 Total 44 All the premises concerned were carefully inspected prior to registration. Notification of Food Poisoning. The London County Council (General Powers) Act, 1932, 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. No case of food poisoning was notified in Holborn during 1934. Slaughter of Animals Aot, 1933. This Act came into operation on the 1st January, 1934, and its major provisions were set out in the Annual Report for last year. During the year the question of applying Section 1 of the Act by resolution to sheep, ewes, wethers, rams and lambs, was considered, but no action was taken by the Council in the matter, having regard to the existing London County Council by-laws on the subject. One application was received and granted from a slaughterman for a licence to slaughter under Section 3 of the Act. 39 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES, ETC., INCLUDING TUBERCULOSIS. 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. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. Yearly average 1924-1933 Pneumonia (all forms) 38,970 36,990 32,339 37,242 31,014 43,846 27,724 33,573 29,588 30,059 34,131 Pulmonary Tuberculosis 32,690 32,382 30,108 31,060 29,799 31,425 29,414 29,658 27,627 27,854 30,202 Measles 4,834 5,337 3,483 3,622 4,302 3,388 4,188 3,288 3,411 1,937 3,779 Whooping Cough 3.983 6,058 4,118 3,681 2,976 6,332 2,037 2,512 2,956 2,270 3,692 Diphtheria 2,501 2,774 2,994 2,732 3,191 3,446 3,497 2,673 2,339 2,646 2,879 Scarlet Fever 888 988 677 579 580 717 740 540 530 729 697 Enteric Fever 496 388 367 367 438 382 313 251 258 222 348 40 The total number of notifications relating to Holborn residents received during the year was 411 in comparison with 332 in the year 1933. The increase is accounted for by the larger number of notifications received of the following diseases:— Scarlet Fever 115 in comparison with 96 in 1933. Tuberculosis 89 ,, ,, 59 ,, Whooping Cough 65 ,, ,, 23 ,, 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 310 notifications respecting patients not residing in Holborn, many being in-patients of hospitals in the Borough. All these were forwarded to the Medical Officers of Health of the districts concerned. The diseases notified were :— Chicken-pox 2 Diphtheria 71 Erysipelas 3 Paratyphoid Fever 2 Measles 19 Scarlet Fever 59 Tuberculosis 76 Whooping Cough 31 Pneumonia 19 Cerebrospinal Fever 7 Acute Poliomyelitis 11 Acute Parotitis 1 Dysentery 7 Ophthalmia Neonatorum 1 Mumps 1 310 Smallpox. No case of smallpox occurred in a Holborn resident during the year 1934. During the same period information was received of the occurrence of this disease in two non-resident workers. In the County of London 146 cases were notified, a notification rate of 0.03 per 1,000. One death was recorded from the disease. 41 The following table gives information respecting the vaccination of children born in the Borough during the year ended 30th June, 1934: — Total Number of Births Vaccinated Died before Vaccination Cons. Objectors Insusceptible Tostponed by Medical Certificate Removed. No information as to Vaccination Temporarily unaccounted for Holborn Sub-Distuiot : 12 months ended 30th June, 1934 112 65 4 21 0 7 13 2 St. Giles and ISloomsbury Sub-Distriot : 12 months ended 30th June, 1934 63 36 2 11 0 5 9 1 175 100 (57%) 6 32 0 12 22 3 During the same period 170 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 170, at the date of the preparation of this report, 92 (54 per cent.) were known to be vaccinated. The remainder are accounted for as follows: — Removed from the Borough—no information as to vaccination 36 Conscientious objectors—Exempted 12 Died before vaccination 13 Postponed—medical certificate 1 Not traced—incorrect address 14 Temporarily unaccounted for 2 As in previous years a leaflet respecting the advantages of vaccination was sent to the parents of all infants born in, or belonging to, the Borough. No opportunity is lost of speaking about the vital importance of vaccination whether for the baby or for the older person. Under the Public Health (Smallpox Prevention) Regulations, 1917, 61 vaccinations were also performed during the year, viz.: (a) primary, 9 vaccinations; and (b) revaccinations 52. 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. 42 Diphtheria. We received notifications relating to 74 cases of diphtheria occurring in residents in the Borough. Seventy-three were removed to hospital. Age at Notification of 74 Notified Cases of Diphtheria. 0—1 1—5 5—15 16—36 35—45 45—65 Total. 2 22 31 16 3 — 74 Four deaths occurred. Thirteen of the notified cases were returned from hospital certified as not suffering from diphtheria. Secondary clinical cases were three in number; details follow : — Primary Case Age Date notified Secondary Case Age 36 Date notified Remarks e. g. Character of Premises E. R. 6/5 2 1/2/1934 F. R. 20/2/1934 Tenement House R. H. 4 19/3/1934 P. H. 3 23/3/1934 Flat in dwellings J. M. 7 21/5/1934 E. M. 9 24/5/1934 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 case. In London, 11,782 cases were notified, giving rise to 481 deaths. We endeavour to co-operate with the Medical Superintendents of the Fever Hospitals serving the County of London; and 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 64 cases of diphtheria occurring among inpatients and staff at one hospital 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. All the 64 were clinical cases (20 were notified "nasal"). Of the total number, six notifications related to Holborn residents, five being members of the resident medical or nursing staff. Fifty-eight were in-patients admitted from areas outside the Holborn Borough. Copies of the notifications of these cases if sent to the Holborn Public Health Department are forwarded to the Medical Officers of Health of the districts from which the patients are admitted. 43 Diphtheria in Hospitals. Hospital. Cases Notified. Disease Notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 5 59 64 — 6 58 64 Diphtheria Contacts. Analysis of the swab results relating to the contacts is given below: — Contacts swabbed. Positive Results. Contacts positive. Ear only. Nose only. Throat only. First Examination 69 4 8 1 8* Second ,, 6 1 1 — 2 Third „ 2 - I — I† * 2 positive contacts removed to L.C.C. Fever Hospital. + 1 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. 59,000 units were supplied for three 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." 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 imprope ly-made toxin untitoxin. TABLE I. Schick Test and Diphtheria Immunisation. Twelve years, 1922-34. A B C Result or Test. D E Immunisation op Positivbs. F G H I J Total number of individuals who attended clinic Total tested Total immunised without preliminary 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 NEGATIVE to 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. or with T.A.F. Not retested. Given 1 ccm not yet retested. Failed to complete 3 inoculatne. Inoculatns. not begun. Inoculatns. still in progress 1 ccm T.A.M. 2 ccm T.A.M. 3 ccm T.A.M. or with t .A.F. 4 ccm T. a. M. 5 ccm T.A.M. 6 ccm T.A.M. 8 ccm T.A.M. Further doses of T.A.F. 3 ccm T.A.M. Given further inoculation but not yet retested. No further inoculation given. Children Adults C A C A C A C A C A C A C A C A C A C A C a C a C A C A C A C A C A C A C A C A O a C A 0 937 372 1340 372 597 0 976 204 356 164 9 3 25 1 27 2 955 95 22 2 9 1 11 0 1 0 3 0 4 0 31 6 10 3 1097 111 271 49 22 1 98 20 84 19 5 2,3 09 1,712 597 1,180 520 12 26 29 1,050 24 10 11 1 3 4 37 13 1208 ‡ 320 § 23 118 † 103 † 5 1,777 • * These columns refer to 103 cases—92 were Schick positive on retesting after 3 ccm T.A.M. 11 were Schick positive on retesting after T.A.F. t 88 of these removed from the Borough. § 41 of these have removed from the Borough, ft These retests include those made up to 31st March, 1935. Nots.—Columns E F G H give details of the total 1,208 given in Column I. Columns I J give details of the total 1,777 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. 45 TABLE II. Summary. Ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 6 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 79 228 158 133 112 108 89 74 66 76 68 54 42 44 9 372 Total Schick Tested = 1712 Result of Schick Test. | Pos. Neg Pos. Neg Notread Pos. Neg Pos. Neg Notread Pos. Neg. Not read Pos. Neg Not read Pos. Neg. Pos. N eg.| Pos. Neg. Pos. Neg Pos. Neg. P0s. Neg. Pos. Neg. Pos. Neg Pos. Neg. Pos. Neg. Not read Total for 12 years. 73 6 215 10 3 149 9 in 21 1 79 31 2 69 37 2 56 33 49 85 39 27 33 43 32 36 28 26 19 23 19 25 5 4 204 164 4 1180 Pos. 520 Neg. 12 Not read Immunised without preliminary Schick test (Jan. 1927 end of 1932). 107 209 114 72 58 18 9 4 2 3 0 0 1 - - - Total immunised without preliminary Schick test 597 Total immunised (includes immunisation of Schick positives as shown above). 155 350 209 148 106 66 61 53 28 31 23 24 13 14 2 170 Total immunised (includes above). 1453 46 One case of diphtheria occurred in an immunised child during the year 1934, the illness commencing before the child was due for retesting; since starting the work ten cases in all have occurred, particulars of which are given in the following table: — The following table gives particulars of the ten cases of diphtheria :— TABLE III. Diphtheria in Children Schick-Tested and Treated with Immunising Injections. Initials Age in years at date of Schick Test Sex Type of Home Date of Schick Test First Injection Final Injection Retest Result of Retest Date of onset of Diphtheria Interval between last injection and date of onset of disease Confirmation of diagnosis by Character of Attack 1. A.C. 4¾ M. Artizan— moderately satisfactory ; house let in lodgings 30/1/24 7/2/24 20/2/24 (Third) none — 18/3/25 13 months Metropolitan Asylums Board (N.F. Hospital) Very severe 2. G.L. 6¾ M. Higher Artizan— model dwellings 4/4/23 11/4/23 25/4/23 (Third) none - 29/5/25 13 months Metropolitan Asylums Board (N.E. Hospital) Very mild 3. M.T. 3¾ F. Higher Artizan— model dwellings 24/9/24 1/10/24 15/10/24 (Third) none - 5/4/26 18 months Metropolitan Asylums Board (N.E. Hospital) Mild 4. L.P. 6½ F. Higher Artizan— part of private house 11/11/26 17/11/26 1/12/26 (Third) none - 23/12/26 22 days* Metropolitan Asylums Board (N.W. Hospital) Severe 5. R.H. 7 M. Residential, separate private house 28/9/27 5/10/27 19/10/27 (Third) none - 21/10/27 2 days* Cuddington Isolation Hospital Mild 6. P.P. ??? F. Artizan— model dwellings 5/9/23 12/9/23 26/9/23 (Third) none - 26/10/27 4 years Metropolitan Asylums Board (N.E. Hospital) Mild 7. J.F. 1½ F. Higher Artizan— model dwellings 13/5/25 20/5/25 10/6/25 (Third) yes negative 11/11/25 19/2/28 2½ years Metropolitan Asylums Board (N.E. Hospital) Mild 8. V.C. 3T8t7 F. Poor, one room; house let in lodgings 9/4/24 30/4/24 18/6/24 (Thiid) yes negative 12/9/24 21/2/28 3r85 years Metropolitan Asylums Board Mildattack of nasal 9. W.J. 3T8t7 F. Fair, two rooms; house let in lodgings 12/1/27 19/1/27 9/3/27 (Third) yes negative 19/10/27 15/4/29 2½ y ears (N.E. Hospital) Metropolitan Asylums Board ("N.W. Hospital) diphtheria Mild 10. I.S. 5¾ M. Higher Artizan 7/2/34 21/2/34 7/3/34 (Third) no - 9/6/34 3 months L.C.C. Brook Hospital Mildattack of nasal, faucial and laryngeal diphtheria *These two cases occurred before the elapse of 9 months, the period laid down at Edinburgh as required to secure artificial immunisation. The above table shows that only three of the children were retested after the last injection. It cannot be assumed that immunity invariably follows the administration of three immunising injections, nor that immunity even when once established is invariably permanent. Drs. Parish and Okell have shown that of 440 Schick positive children who were rendered Schick negative by immunisation, 5 per cent. were found to be positive when re-tested 1-7 years later. 47 Diphtheria in Children Treated with Immunising Injections. Up to the end of the year 1934 ten cases of diphtheria occurred in children who had been found positive on Schick test and treated with three immunising injections; the details of these are given in Table III. Diphtheria was also notified as having occurred in a child who had been found negative to a first Schick test, but the diagnosis was not confirmed. Diphtheria was also notified as having occurred in fourteen other children who had completed their course of inoculation, but the diagnosis in these cases was eventually not confirmed. Two of these (brother and sister) were removed to hospital as suffering from diphtheria, but they were diagnosed as suffering from rubella and " carrying " diphtheria bacilli but not suffering from diphtheria. A third child was removed with diphtheria and found to have measles. Two cases removed with diphtheria were returned as cases of coryza, not diphtheria; a sixth was removed with faucial diphtheria, but the diagnosis was not confirmed. A seventh was removed with diphtheria but was found to be a case of follicular tonsillitis. An eighth was notified as a case of nasal diphtheria, but the diagnosis was not confirmed, and the child was not removed to hospital. All these children had been found negative to the retest some time previously. Four others were removed to L.C.C. hospitals as suffering from diphtheria, but were shortly afterwards discharged as being not cases; neither had been re-Schicked since being inoculated; one case after return from hospital gave a negative reaction to the re-Schick test. The twelfth was notified as suffering from scarlet fever and diphtheria, but was later diagnosed as suffering from scarlet fever only; the thirteenth and fourteenth, also removed to hospital as suffering from diphtheria, were returned as cases of catarrhal sore throat and not diphtheria. One adult who had been retested after immunisation was removed with diphtheria, but the diagnosis was not confirmed. One case of nasal diphtheria occurred in an adult who had been found negative to a first Schick test. Four adults who had completed their course of inoculation but had not been retested were removed to L.C.C. hospitals as suffering from diphtheria, but were returned as not diphtheria; one was suffering from follicular tonsillitis and one from tonsillitis; in one there was no evidence of clinical diphtheria, but the patient had virulent diphtheria bacilli in the throat; in the fourth the diagnosis w as not confirmed. 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 1934. At this hospital Schick testing of all newcomers and immunisation of positives is now customary. From June, 1930, till the end of December, 1934, 164 nurses were tested: 19 of these were tested for the first time in 1934, 11 being positive and eight negative. Ten were immunised, one probationer not remaining at the hospital. 48 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 115 notifications of scarlet fever. All but one were removed to hospital. Five of these were returned from hospital diagnosed as not suffering from this disease. From two hospitals in the Borough 62 in-patients were notified as so suffering; none was resident in Holborn. There was no " return " case of scarlet fever. Fourteen notifications of "secondary" cases were received. There was no death from this disease. 18,238 cases of scarlet fever were notified in London with 68 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. Thirteen cases were notified in 1934. Age and Sex Distribution of notified cases. Age in years. M. Sex F. Total. 2 1 — 1 3 1 — 1 4 4 3 7 5 1 5 6 6 8 4 12 7 3 6 9 8 7 8 15 9 7 12 19 10 6 11 17 11 4 5 9 12 4 11 15 13 4 2 6 14 2 11 13 15 4 3 7 Totals 56 81 137 49 Particulars of cases of acute rheumatism in children are recorded in a register under the following main headings:—Name; Classification and Symptoms; Tonsils, Adenoids and Teeth; Treatment; Home Conditions; Sleeping Conditions; Hours of Sleep; Clothing; Food; Assistance Required; Family History; and Health of Contacts. 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 59 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); 43 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. 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 sleeping arrangements are given in the following table :— Sleeping Arrangements—127 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 2 3 4 5 1 2 3 1 2 3 1 2 1 2 3 127 12 10 6 8 0 15 s 0 4 6 1 1 10 0 0 30 9 1 1 1 2 1 1 127 12 10 49 52 4 * Exclusive of two cases where wrong addresses given, one where the patient died shortly after the date of notification, and seven where the child removed immediately after notification. D 50 Social Conditions. Seven children live in one-room homes. In fourteen 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. Value of Notification of Rheumatism in Children. The notification of rheumatism in children enables research to be made into conditions 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 bringhome to the parents the need of intensive care for the child and of giving consideration to 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 secure for him the best conditions within the reach of the parents. 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 means. There arc, 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 be 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-four children the condition of the tonsils was stated to be normal. Sixty-one children had their tonsils removed, thirty-four of these also had adenoids removed. In eleven cases tonsillectomy was advised, four of the eleven 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 sixty-one 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 51 of tonsilitis. In thirty-three tonsillectomy had been performed at varying periods considerably before the symptoms of rheumatism were observed (from seventeen 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. All children are reported to be under dental supervision, with treatment if required, as part of the school organisation. Contacts. Twenty-five 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 be observed and examined if necessary. History of Patients after leaving school. During 1934 seven children ceased to attend school and are occupied as follows :— (1) Boy (V. B., æt. 15) is a shop assistant. (2) Girl (C. B., æt. 14) is a shorthand typist. (3) Girl (E. M., æt. 14) is a waitress. (4) Boy (G. M., æt. 14) works irregularly, chiefly as an errand boy (5) Girl (F. T., æt. 14) in a pipe-making factory. (6) Boy (S. S., æt. 14) is an office messenger. (7) Boy (G. B., æt. 15) is a stable yard assistant. Five children reached the age of 16 during 1934 and still continue their previous employment. 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. In 1934 the co-operation of the school organisation was secured, and in nearly every case a holiday was arranged for each child who was physically fit for a holiday home, special arrangements being made for those attending schools for the physically defective. Typhoid and Paratyphoid Fever. Enteric Fever. Three cases were notified. In the first, bacteriological examination was positive for Paratyphoid B. The patient was an infant, aged 3 months. The source of infection was not traced although information was furnished that the child had been "playing with drain and dirty water." The second case was a nurse at a voluntary hospital. Bacteriological examination gave a Widal reaction positive to B. Typhosus; and a diagnosis of enteric fever was thus confirmed. The illness began on the 23rd July, the patient having arrived from Northern Ireland on the 1st July. d 2 52 The third case, notified as Paratyphoid C was a male, aged 19 years. This patient came to a hostel in the Borough from a casual ward in another Metropolitan area, having previously tramped the country for some nine months. He was ill on arrival at the hostel and was removed the same day to hospital. He was subsequently found to be suffering from an intestinal infection caused by B. Suipestifer, that organism having been recovered from his blood and urine. He made a complete recovery and was discharged from the hospital eight weeks after admission. There were 109 cases of enteric fever in London with 15 deaths. Typhus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-Spinal Fever. One case of cerebro-spinal fever was notified in the Borough. One hundred and thirty-seven cases were notified in London, giving rise to 78 deaths. Bacillary Dysentery. Two cases were notified. One, a female child, 5½ years, notified as bacillary dysentery (Flexner Z type). This child had not been out of England and had no known overseas contact. The patient was treated in hospital and recovered; up to the time of the preparation of this report (after an interval of fifteen months) the child had had no recurrence of the illness. The second case was that of a male, aged 26 years, notified as suffering from chronic amoebic dysentery and from malaria. The onset of the diseases occurred as long ago as 1930 in India; the patient returned to England in 1933 and was reported to have been ill ever since. Fifty-eight cases were notified in London, with seven deaths. Malaria. One case of malaria was notified. The patient returned from India in 1933. The disease was contracted in that country about 1930. Thirty cases were notified in London, with two deaths. 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 1934 respecting the 16 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. Condition reported to be satisfactory 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 6/1/34 S.B. M 48 years Disease fatal 1/1/34 The table excludes one patient, 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 cases in the Borough was forwarded in order that where the patients were not of school age they could be kept under observation in the same way as notified cases. The following gives particulars of these cases: — Date of Onset. Patient. Sex Date of Birth. Condition at end of 1934. 1/9/20 P.L. F 1904 Disease fatal 20/1/32. Jan., 1920 W.P. M 1910 Died 1929. Feb., 1924 W.B. M 1913 In Northern Hospital (L.C.C.); Condition worse. Nov., 1924 K.M. F 1911 General condition improved. Attending West End Hospital for Nervous Diseases. In London 29 cases of acute encephalitis lethargica were notified during the year 1934, and in the same period 36 deaths were registered as due to this disease. 54 Acute Poliomyelitis and Acute Polioencephalitis. No case of acute poliomyelitis or polioencephalitis was notified. Sixty-eight cases were notified in London, giving rise to six deaths. From the coming into operation of the Poliomyelitis Order, 1912 to the end of 1934, 18 cases were notified in the Borough. The following table gives particulars of these cases with the condition at the end of 1934:— 1 Date of N otification. 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 thoes. 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 I. 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. Limps slightly. 4/9/22 Y.R F 1 10/12 „ 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 30/10/5 V.H. F 5 „ „ Removed from Borough —lost sight of 24/11/30 R.H. M 1 11/12 „ 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. Wears appliances—remaining at school 3/6/32 G.C. M 6 mths. Hospital Removed from London— Address unknown 30/8/32 L.P. M 13 years „ Left arm useless. Still at school The table excludes one patient notified 4/12/18 who was subsequently found not to be suffering from this disease. 55 Pneumonia. Thirty-eight cases of pneumonia were notified during the year. Six of these were influenzal pneumonia. Seven deaths were recorded from all forms of pneumonia. The 32 cases of primary pneumonia were notified at the following ages :—Under 1 year, 3; from 1 to 5 years, 7; from 5 to 15 years, 3; from 15 to 35 years, 6; from 35 to 45 years, 3; from 45 to 65 years, 7; and 65 years and upwards, 3. Thirteen were treated at home; 7 were removed to L.C.C. hospitals; 10 to voluntary hospitals; and one to a nursing home; in one case where a wrong address was given the patient could not be be traced. Six of the patients were nursed by the Metropolitan Nursing Association under the arrangements made by the Council, in all 136 visits being paid to these patients. Enquiry respecting the cases of primary pneumonia elicited the following information: — 20 resided in tenement lodging houses, 4 in self-contained flats, 2 in model dwellings, 5 in hotels and boarding houses, and 1 in an institution. The cleanliness of the houses were reported satisfactory in 22 cases, but only fairly so in 6 and in 4 cases no information was obtainable. The economic conditions of the families concerned were found to be good in 7 cases, fair in 7, poor in 12, very poor in 1; in 5 cases information as to economic oondition was not obtainable. Influenza. There were only 3 deaths (all males) from influenza in comparison with 25 in 1933, 12 in 1932, 13 in 1931, 1 in 1930, 44 in 1929, 3 in 1928, 20 in 1927, 8 in 1926, 9 in 1925, and 11 in 1924. Anthrax. No case of anthrax was notified in the Borough during the year. Chicken-pox. This disease is not notifiable, but during the year 1934 we received information of 105 cases. These were visited and where necessary kept under observation. Mumps. Information was received from school teachers and others of 34 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year: — Diphtheria Pulmonary Tuberculosis Other Diseases Numter Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination. 659 { Bacilli not found 516 Diphtheria 100{ Bacilli not found 89 3 Negative 3 Bacilli found 43 Vincent's Bacilli found 11 organisms found 8 56 Disinfections. During the year 494 rooms and 4,544 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Forty-three rooms and 425 articles of bedding, clothing, etc., were disinfected on account of tuberculosis. Special attention is devoted to toys and more particularly to any toy put in the mouth. One hundred and nine books and 93 toys were disinfected. The disinfections also included eleven lockers, and four hospital wards. Cleansing of Persons Act. During the year 162 persons (149 men, 9 women and 4 children) infested with vermin had their bodies and 1661 articles of clothing disinfected, free of charge, at our cleansing station (Goldsmith Street). Shelter daring Disinfection. For some years past an 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 1934 the accommodation was used by three Holborn families comprising twelve persons. Extermination of Vermin. With a view to encouraging active steps for the extermination of vermin, arrangements were continued for a supply of a vermin-killing solution to be stocked in the Health Department and to be available at cost price for occupiers of infested homes and tenements. The solution has been found effective for the destruction of bugs, cockroaches, fleas and other small insect pests, and the convenience of being able to obtain a small quantity has been appreciated by a number of occupiers of small tenements. During the year six gallons of the solution in small quantities were sold to 24 purchasers. One hundred and fifty-five verminous rooms were disinfested by the Council's staff. When fumigating verminous rooms we endeavour, whenever practicable, to repeat the fumigation at the end of 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 124 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 1934 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 - — — 1 — — — 1 6 2 - — — — — 1 — JO 1 1 — — — — — 15 2 4 — 1 — 1 — — 20 9 4 — — 2 1 — — 25 11 5 1 — 3 1 1 — 35 14 5 - — 3 1 i 1 45 7 4 1 — 4 1 — — 65 6 3 - — 6 1 — — 65 5 — — 1 3 — — — 57 26 3 3 21 6 3 2 Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1934 333 Number of these patients residing in common lodging houses 41 The average number of cases notified annually during the past ten years 88 The number notified in the year 1934 89 Of the 89 casees notified in 1934, the number who attended the Dispensary 35 Total number of new cases examined at the Dispensary for the first time in 1934, including the above, and all contacts 104 Total attendances at the Dispensary in 1934 930 Supervision of home conditions; visits paid by— Tuberculosis Officer 70 Dispensary Nurse 1,207 58 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during, the period from the, 1st January, 1934, to the 31st December, 1934, in the Metropolitan Borough of Holborn. Age-periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- l- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary Males – – 1 1 2 8 7 11 4 5 5 44 50 ,, Females – – – 1 4 4 4 5 4 2 – 24 27 Non-pulmonary Males – – – 1 – – 1 – 1 – – 3 3 ,, Females – – – – 1 – – – – – 1 2 2 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– 6– 10– 15– 20– 26– 85– 45– 55– 65– Total. Pulmonary Males – – 1 – – 1 4 3 3 1 – 13 ,, Females – – – – – – 1 – – 1 – 2 Non-pulmonary Male – – – – – – – – – – – – „ Females – 1 – – – – – – – – – 1 59 The source or sources from which information as to the above-mentioned cases was obtained are stated below: — Source of Information No. of Cases. Pulmonary Non-Pulmonary Death Returns From local Registrars... 1 1 Transferable deaths from Registrar General 6 – Posthumous notifications 1 – " Transfers " from other areas (other than transferable deaths) 7 – Other Sources if any (specify) – – Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1934, on the Registers cf Notifications 178 94 272 33 28 61 333 Number of cases removed from the Registers duiing the year by reason inter alia of :— Withdrawal of notification – – – – – – Recovery from the disease 4 4 8 8 2 10 18 Death 25 12 37 1 – 1 38 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Form A or B during the year 1934 was 73; 16 other cases were brought to my knowledge (making 89 new cases in the year). These were:—Private cases 18, hospital cases 39, Public Assistance cases 20, from death returns 5, transfer from other districts 7. Of the 89 cases entered on the Register in 1934, 83 were pulmonary tuberculosis and 6 non-pulmonary tuberculosis. Sixty-four of the cases were removed for treatment to hospitals, sanatoria, &c. Sleeping Conditions. In 64 of the 89 new cases of tuberculosis in 1934 it was possible to obtain information as to the sleeping conditions at the date of notification. 60 The following is a summary of the information in the 64 cases above referred to : — Patient slept in— Separate bed room 22 Separate bed in living room 7 Separate bed in room shared with— 1 adult 8 2 adults 5 4 adults 1 2 children 1 — 44 Shared bed with— No others 1 adult (Husband or Wife) .. 12 in room 1 adult (not Husband or Wife) 6 Shared bed with— 1 adult Other persons in bedroom 1 child 2 — 20 64 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 9 " B."—Fair. Separate bed, but not separate bedroom 46 " C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 9 64 Summary. The following summary gives the position at the end of 1934 of the 89 now cases respecting which information was received during the year : — Dead 19 Cases removed to Nursing home, Hospital or Infirmary and still in-patients at the end of year 19 In-patients in Sanatoria at end of year 8 Removed from Borough 14 Home Treatment—Private or Panel Doctor 21 No information 8 89 61 Non-attendance at Tuberculosis Dispensary. Thirty-five of the 89 cases attended the Holbom 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 15 Dead before notification or died before attendance at Dispensary 17 Treatment at home by private doctor 3 Not traced and common lodging house cases 5 Removed from Borough 11 No information 3 54 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, four 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 1012 by which a medioal practitioner is not required to notify a case of tuberculosis if he has reasonable grounds for believing that the case has already been notified. It would seem that any disadvantage accruing from duplication would be easily outweighed by the advantage of the additional encouragement to promote early notification which would ensue from the withdrawal of this proviso from the Regulations. Institutional Treatment. During the year notifications were received of 108 admissions to institutions. These admissions represent 71 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 82 Other institutions 26 Visits to Homes, etc. During 1934 the Tuberculosis Officer made 70 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 1,207 visits. The advice given by the Tuberculosis Nurse includes suggestions respecting food and cooking and suitable cookery books are supplied free of charge. Contacts. All contacts are invited to attend for examination at the Tuberculosis Dispensary. 62 Forty-four contacts, viz., 29 adults and 15 children under fifteen years of age, responded to this invitation and were examined for the first time during the year 1934. Of these, eight adults and one child, were found to be definitely suffering from tuberculosis. Thirty-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 cases which may be disseminating infection although remaining undiscovered and untreated. Arrangements were continued during the year for co-operation with the school medical service to ensure that no contacts of school age remain unexamined; if such examination cannot be carried out at the Dispensary the School Medical Officers are notified so that the examination may be carried out at the school. Information as to the results of such examinations, whether at the Dispensary or the schools, is interchanged as necessary. Prevention of Spitting. The necessity for the prevention of spitting, with a view to minimising the spread of tuberculosis, has been emphasised by the issue of warning cards on the subject. These have been exhibited in the various buildings in the control of the Council, also in common lodging houses, and in the workrooms of a number of large firms in the Borough. In addition specially designed opal plates have been placed on the Council buildings. They ask people not to spit and so prevent not only tuberculosis, but pneumonia and other diseases the germs of which are carried in the mouth and nose. It is very conceivable that such a disease as encephalitis lethargica is spread in this way in towns. Deaths from Tuberculosis. The number of deaths from pulmonary tuberculosis during the year was 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 eases 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- 46- 55- 65- All Ages Males. Females. Total. Number of patients who died at home – – – – – 1 2 1 – 1 – 3 2 5 Number of patients who died in hospitals, etc. – l – 1 1 3 2 6 5 6 3 21 6 27 – 1 – 1 1 4 4 6 5 7 3 24 8 32 63 Tuberculous Dispensary. The following is the Report of the Tuberculosis Officer, J. A. Struthers, M.D.,B.Ch., M.R.C.P., D.P.H., for the year 1934 :— Return showing the work of the Dispensary during the year 1934. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 22 15 1 – 1 1 2 – 23 16 3 – (b) Doubtfully tuberculous – – – – – – – – – – – – (c) Non-tuberculous – – – – – – – – 4 8 5 1 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 6 – 1 – – – – 2 6 – 1 (b) Doubtfully tuberculous – – – – – – – – – – – – (c) Non-tuberculous – – – – – – – – 7 14 5 9 C.—Cases written off the Dispensary Register as (a) Recovered 6 6 2 1 – – 2 1 6 6 4 2 (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as tuberculosis) – – – – – – – 11 24 10 10 D.—Number of Persons on Dispensary Register on December 31st — (a) Definitely tuberculous 102 67 6 7 12 17 11 10 114 84 17 17 (b) Diagnosis not completed – –— – – – – – – – 2 – – 64 1. Number of persons on Dispensary Register on January 1st, 1934 240 2. Number of patients transferred from other areas and cases returned after discharge under Head 3 in previous years 6 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) 20 5. Number of attendances at the Dispensary (including contacts) 930 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 64 7. Number of consultations with medical tioners :— (а) Personal 33 (b) Otherwise 95 8. Number of other visits by Tuberculosis Officers to Homes 70 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1207 10. Number of (а) Specimens of sputum, &c„ examined 126 (б) X-ray examinations made in connection with Dispensary work 39 11. Number of "Recovered" Cases restored to Dispensary Register id A (a) and A (6) 12. Number of " T.B. plus" cases on Dispensary Register 31st December, 1933 125 65 Holborn Tuberculosis Care Committee. Report for 1934. The Committee has met eleven times during the year. The average attendance of members at each meeting has been. 10.3. Sixty-two cases have been considered: 33 new (29 adults and four children), and 29 old cases (28 adults and one child). Thirty-five cases (31 adults and four children) were referred to the Committee for assessment. Five of these (all adults) were old cases recommended for further periods of Institutional Treatment. Twenty-three adults and one child were recommended for free treatment: eight adults and three children were assessed to pay amounts varying from 2s. to 50s. per week towards the cost of their treatment and maintenance. Eight cases were referred for re-assessment, owing to altered circumstances; in each case a reduction in assessment was recommended. Contributions, towards the cost of treatment and maintenance, amounting to £200. 18s. 6d., were collected on 25 cases—19 adults and six children. This is the highest amount collected in the Borough in any year, with the exception of 1929 when £248. 10s. Od. was collected on 36 cases. In July, 1934, the London County Council decided that treatment for tuberculosis should be provided free of cost to patients in their area. The County Council, however, is still prepared to accept voluntary contributions should the patients (or those responsible for them) desire to make any. Between the time of the passing of the Resolution and the end of the year, £13. 2s. 6d. was collected in voluntary contributions. The change in the London County Council's policy has considerably altered the work of the Committee. Prior to the passing of the Resolution that treatment should be free from contribution, every patient recommended for Institutional Treatment was referred to the Committee, but this became no longer necessary when assessments were done away with. In the nature of things, actual care work must be dealt with at once, as the need becomes known, so, in the majority of cases, it now falls to the Honorary Secretary merely to report to the Committee what action has been taken during the past month. Eleven Progress Reports, on six children, were received from the County Council, and the information contained therein was conveyed to the relatives. Convalescence was arranged in six cases—four through Stafford's Charity, one through the Invalid Children's Aid Association, and one through the United Services Fund. Three children were admitted to the L.C.C. Open Air School, Holly Court. Another child was accepted for admission, but the mother refused to allow him to go. During the year 833 visits have been paid to patients, and their families, and, in addition, many miscellaneous calls have been made in connection with the needs of those families. E 66 Twenty-one patients, or families, known to the Committee, have removed from the Borough during the year; three of these were transferred to other Committees. There is still need for better housing accommodation in the Central London area. It is very seldom that families can avail themselves of the accommodation provided by the London County Council in out-lying Estates. For financial, and physical reasons the workers require to live within easier access of their work. Of the 21 families that removed, two accepted accommodation on out-lying Estates. One bitterly regretted having done so owing to length of journeys to work. The other moved because the wage earner, having obtained employment on the railway, found it more convenient for his work; this was an exceptional case. Twenty patients known to the Committee have died during the year. Three of these died in their homes, the other 17 died in Hospitals. Shortly before he died, we were able to arrange for the admission of a Chinaman to St. Columba's Hospital for the Dying; he had no home, or relatives, in this country, but had friends who were willing to pay for his maintenance. On the recommendation of the Committee, one patient, who was under treatment in a residential institution, was granted dentures by the Council, free of cost, The Committee gratefully acknowledges the co-operation and assistance afforded by the British Legion and United Services Benevolent Committee, the British Red Cross Society's Emergency Help Committee, the Charity Organisation Society, the Invalid Children's Aid Association, the London Philanthropic Society (who made a much appreciated gift of coal tickets in February and in November), the Society of St. Vincent de Paul, the Trustees of Stafford's Charity, Regimental Funds, etc. The Committee is also greatly indebted to those who, by their contributions, enabled many of our families to spend a happier Christmas than they would otherwise have done. £11. 12s. 6d. was collected in cash, and we received a gift of one ton of coals for distribution. Dinners were supplied to 30 families (114 persons) through the Polytechnic Distress and Christmas Dinner Fund, and gifts of coal were made to 20 families. Public Health (Prevention of Tuberculosis) Regulations, 1923. It was not necessary to take any action under the above Regulations during the year 1934. Home Nursing for Tuberculous Patients. It was necessary during the year 1934 for only one tuberculous patient to be nursed under the arrangements made by the Council with the Metropolitan Distrct Nursing Association. Forty-two visits were made to this patient. 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 1934: — Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1934. Tuberculosis All Patients. Patients. Number of sessions held — 48 Number of patients' attendances 11 311 Number of fillings 2 39 Number of scalings — 8 Without anaesthetic — 1 Number of With local anaesthetic 2 41 extraction cases . With gas 4 19 Number of teeth extracted 22 206 Number of dentures (including repairs) 1 34 Number of dressings 1 32 Number for advice 2 53 Number of denture visits 2 79 Number of new patients 2 55 Cancer. During the year 1934, 52 deaths were recorded as due to Cancer in comparison with 61 in the previous year. The deaths in 1934 were equal to a rate of 1.44 per thousand, the corresponding rate in 1933 being 1.69 per thousand. It will be seen that the death rate from Cancer in the Borough in 1934 was lower than in the previous year, being 1.44 per thousand in comparison with 1.60 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, 1915-1924 was 1.36, the corresponding rate for the ten years, 1925-1934, was 1.66. Some part of this increase may reasonably be attributed to improved facilities for diagnosis, and can also be correlated with the age-distribution of the population. E 2 68 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 150 births were registered as occurring in the Borough. During the same period 97 notifications of births occurring in the Borough were received. Of these, 88 were from doctors and midwives, 9 from parents. The mothers were attended at their confinement by: — Private Doctors 14 Private Midwives 6 Out-patient Midwifery Departments of General Hospitals and Institutions:— Externs and others 31 Midwives.—University College Hospital 8 Middlesex Hospital 8 Other Institutions 8 Training Institution for Midwives, Myddelton Square 22 97 One of these notifications related to a stillbirth. Number of Births. The number of births transferred to the Borough from outlying institutions was 163 The number of births transferred from the Borough to other districts was 4 The net number of births belonging to the Borough was 309 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 264 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 12 3.9 33 10.7 Two „ „ 73 23.6 65 21.0 Three „ „ 36 11.7 21 6.8 Four or more „ 16 5.2 8 2.6 Total 137 44.4 127 41.1 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 178 187 365 Post-natal Mothers 9 3 12 Children under 1 year of age 327 767 1,094 Children 1 to 2 years of age 27 440 467 Children over 2 years of age 54 831 885 Enquiries re stillbirths 6 „ re ophthalmia neonatorum 6 Other visits 238 Three hundred and forty-two visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 248 were recorded as attending a Centre, i.e., 72.5 per cent. Thus nearly five-sixths of those visited attended an Infant Welfare Centre and of these 86 per cent, attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following:— 187 attended the Council's M. & C. W. Centre at 10, John Street. 23 „ „ „ „ Short's Gardens. 11 attended the Centre at Charing Cross Hospital. 3 „ „ Myddelton Square. 5 „ „ Middlesex Hospital. 10 „ „ University College Hospital. 7 „ ,, Royal Free Hospital. 2 „ „ other Centres. 248 attended an Infant Welfare Centre. Work at Centres. Holborn Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre: Monday. Tuesday. Wednesday. Thui sday. Friday. Medical Consultation Pre-school child 2—4.30 p.m. Ante-natal and Postnatal cases 2—4.30 p.m. Medical Consultation 2—4.30 p.m. Class 3—4 p.m. dentist. 2—4 p.m. Medical Consultation 2—4.30 p.m. No. of Sessions 47 60 50 48 48 50 Total attendances— Children 921 ... 1442 ... 60 1827 Mothers 19 191 275 226 219 229 Avorage weekly attendances— Children 18 ... 28 ... 1 36 Mothers ... 4 6 5 6 4 70 St. Giles' Centre, Short's Gardens. The attendance at this Branch Centre during the year 1934 were as follows: — Thursday—Medical Consultation—2—4.30 p.m. No. of Sessions 50 Total attendances—Children 475 Mothers 28 Expectant Mothers 12 Average weekly attendances 10 The total number of attendances made by the Health Visitors at the Municipal Centres in 1934 was 415, and in addition Health Visitor students made 158 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 5,409 attendances were made by 336 mothers and 56 expectant mothers, and 523 children, of whom 246 were under one year, 91 between one and two years old, and 186 aged 2.5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 515 attendances were made by 17 mothers and 77 children, of whom 38 were under one year, 15 from one to two years and 24 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 56 voluntary notifications were received during 1934 as compared with 58 in 1933. 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 139 expectant mothers visited during 1934, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. Of the 77 who went into hospital: — 12 (6 primigravidæ) lived in a one-room home; 65 (22 primigravidæ) lived in a two or more roomed home. Of the 62 who remained at home : — 3 lived in a one-roomed home; 33 (2 primigravidæ) lived in two rooms; 26 lived in three or more rooms. 71 Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 82 times during the year 1934. 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 270 mothers, about whom information was obtained, 220 (81 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under:— Number of enquiries made 270 Centre Attended: — Holborn Centre, 10, John Street 22 Holborn Centre, Short's Gardens 1 Royal Free Hospital 21 Middlesex Hospital . 15 Charing Cross Hospital 25 University College Hospital 37 Myddelton Square Institution 21 St. Bartholomew's Hospital 24 City of London Hospital 15 Queen Charlotte's Hospital 4 Elizabeth Garrett Anderson Hospital 4 St. Pancras Hospital 13 Other Centres 11 Ante-natal care from private doctors 3 Ante-natal care from midwives 4 220 Nature of defects found at Municipal Centres. 10, John Street, Short's Gardens, Holborn. St. Giles. No. of women attending ante-natal clinics 56 7 Women expectant for the first time 10 1 No. of attendances made 1ll 12 Defects found specially connected with pregnancy :— Deformed pelvis 1 – Threatened miscarriage 4 – Retroverted gravid uterus 2 – Breech presentation 3 – Excessive vomiting 4 2 (Edema 3 1 Varicose veins 10 – Excessive vaginal discharge 4 – High blood pressure 3 – Other defects 3 – Other defects :— Heart disease 2 – Anaemia 1 – Respiratory diseases – – Constipation 16 2 Dental caries 19 – Dyspepsia 5 – Pyorrhoea 1 – Rheumatism 2 – Other defects 8 – No. referred to maternity hospitals :— Normal 10 – Abnormal 4 – No. referred to dental clinic 9 – No. of urine tests made 54 – 72 Post-natal Consultations. Twenty-seven mothers attended the post-natal consultations at the Centre, 10, John Street, 10 of whom had attepded the Centre as ante-natal cases. They made 68 attendances in all. The chief defects found were one case of perineal tear, referred to hospital; cne case of fibroids, referred to hospital; three cases of retroverted uterus, two treated at Centre and one referred to hospital; two cases of prolapse, referred to hospital; four cases of cervicitis, treated at Centre; three cases of laceration of cervix, one referred to hospital; three cases of pruritus vulvae, treated at Centre; two cases of subinvolution, treated at Centre. Three mothers attended the post-natal clinic at the Short's Gardens Centre. In two cases there was considerable leucorrhoea, one of the patients was referred to hospital and the other to a 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. Mrs. Reynolds Bray, a qualified masseuse, has given valuable help by placing her services at the disposal of the Medical Officers of the John Street Centre, free of all fees. Miss Mary Carter and Miss Edith Joyce have continued to give us a great deal of valuable assistance during the year by making children's garments for busy mothers from materials supplied by the mothers and from their own resources. Miss Audrey Stables has also given assistance at the Centre on Wednesdays whenever required. 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. Three hundred and seventy-five hanks of wool of a special quality were sold at cost price to the value of £15. 12s. 2d. Maternity outfits are placed on sale at the Centre at cost price, 5s. 10d. 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. The death, during 1934, of Mrs. Thouless, formerly a member of the Holborn Maternity and Child Welfare Committee is noted with regret. The opportunity is taken to record appreciation of her interest in the Holborn Centres up to the time of her death. During many months of invalid life Mrs. Thouless made, and gave, a number of garments for use at the John Street Centre. 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 1934: — Reasons for attendance. 10, John Street. Short's Gardens. Mothers: — Difficulty with breast feeding 33 11 Disorders of generative organs 37 – Constipation 10 – Heart disease 1 – Anaemia 9 2 Respiratory disease 3 Digestive disorders 9 1 Debility 37 – Dental caries 27 2 Rheumatism 13 – Venereal Disease 1 – Other Diseases 37 1 Children :— (Healthy) 152 41 Alimentary disorders 38 14 Rickets 24 2 Heart disease 1 – Rheumatism 1 – Respiratory disorders 63 7 Marasmus 12 – Debility 6 – Hernia, umbilical 8 – Hernia, inguinal 5 – Phimosis 26 1 Disease of skin 36 4 Disease of eye 22 1 Disease of ear 22 – Disease of nose and throat 30 – Dental caries 22 1 Other diseases 54 4 (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 1934 were referred to other departments or organisations as follows: — Mothers. Children. Ante-natal Clinic 8 – Tuberculosis Dispensary – – Minor Ailments Clinic 64 197 Dental Clinic 17 57 Metropolitan Nursing Association 10 4 Nursery School – – Massage Clinic 2 – Hospitals 9 46 Convalescent Homes 1 16 Assistance Sub-Committee (for milk) 9 36 Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1934: — John Street. Short's Gardens Number referred to Metropolitan Nursing Association 9 1 Results :— Breast secretion re-established 2 1 Small bottle feeds required in addition to breast feeding 4 – Massage unsuccessful . – 74 Pre-school Children. During the year 1934, 75 of the children examined were found to be underdeveloped for their respective ages and'types, while 32 were above the average. The rest were about normal for their age and type. During the winter months there were many cases of the common cold; nine children were treated for tracheitis, 10 had bronchitis and one case of asthma was referred to hospital. Forty-two children suffered from abnormalities of the throat; of these 23 were cases of tonsilitis and of enlarged tonsils; 16 of enlarged tonsils and adenoids, w hile three had adenoids only. Nineteen have been operated on with beneficial result; in three cases only, the parents refused treatment, while the remaining cases are awaiting operation. Two cases of diphtheria carriers were detected and sent to hospital. There were 11 cases of enlarged cervical glands and six of otorrhcea, all of whom received treatment either at the Minor Ailments Clinic or at a hospital. Thirty-eight children were found to have dental caries and were referred to the Dental Clinic. Of the eye diseases, one child had styes and seven conjunctivitis. There was a case of strabismus and one of occluded lachrymal ducts, both of whom are under hospital treatment. The cases of skin diseases numbered 36; of these, 15 were of lichen urticatus, 12 of impetigo or septic lesions, five of eczema, while one child was infested with ringworm and one with pediculus capitis. Six children were found to be suffering from rickets, three requiring hospital treatment. During the year 10 cases were referred for sunray treatment for debility and have derived much benefit. As regards alimentary affections, four children harboured threadworms, 10 suffered from obstinate constipation and four cases of diarrhoea occurred, while one child was found to be suffering from mucous colitis and is being treated at hospital. Eight children suffered from enuresis, one had epileptic fits, one had recurring abdominal pain, one a club foot, one was a hypothyroid and one a mental deficiency case. Where necessary the children were referred for treatment to the appropriate hospitals. Ten cases were referred to the Institute of Medical Psychology for nervousness and bad habits and have derived much benefit from the treatment. 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 1934. 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 (£50) towards the cost incurred in connection with Holborn children. School Entrants. During the year information was received from the London County Council that 44 children living in Holborn had been entered as attending school for the 75 first time. Particulars of the child's pre-school physical history and his record of attendance at an Infant Welfare Centre were forwarded to the head teacher of the infants department of the school concerned. This information is set out on a form supplied by the London County Council and is intended for the use of the School Medical Officer when examining school entrants. Notice of attendance at school has brought to our knowledge families hitherto unknown to us, having recently entered the Borough. This knowledge has been very useful in connection with Maternity and Child Welfare Work generally. Stillbirths. During 1934 six stillbirths were registered, five of which were legitimate. Enquiry as to possible causes was made in each case. One occurred in the private practice of a doctor, in five instances the confinement took place in hospitals. Difficult labour was responsible for three; in two of these there was abnormal presentation (breech), the third were twins. In two cases no definite reason could be assigned and in one no information was obtainable. Illegitimate Children. The births of 36 illegitimate children were registered. One of these was above the standard for enquiry; seven lived with both their parents who had a permanent home together; one with her mother who worked to support her; three with their mothers who remained in their parents' home; two were placed in an institution; six died in early infancy; one was stillborn; 16 children could not be traced, the mother often not having stayed at the address given for more than one or two nights before the birth of the child. Dental Treatment. The following is a summary of the work during 1934 at the Council's Dental Clinic, No. 10, John Street, open on Thursday afternoons for nursing or1 expectant mothers, and children under five years of age: — Women Children Total Number of sessions held 48 48 48 Number of new Patients 31 29 60 Total attendances 219 59 278 Extractions With local anaesthetic 9 (17) — 9 (17) With general anaesthetic 28 (101) 23 (82) 51 (183) Scaling 32 5 37 Fillings— Simple 74 20 94 Root 4 1 5 Dentures (including repairs) 25 — 25 Advice 38 19 57 The figures in brackets relate to the number of teeth extracted. 76 In six cases where the patients were very poor the dentures were provided free of charge; contributions towards the cost were required in all other cases and in six 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 320 applicants received free or assisted milk under the scheme. This number included 162 who were receiving such assistance at the end of 1983. Grants were made to 158 new applicants. At the end of the year 1934, 196 applicants were receiving assistance, viz. : — Mothers. Children. Total. Free milk 52 132 184 Half-price milk 1 2 3 Prepared milk — 9 9 53 143 196 The following table shows in detail how the 158 new applicants were assisted in 1934:— Milk. Prepared Milk. Free. Part Cost. Free, Part Cost. Expectant mothers 30 — — — Nursing mothers 41 1 — — Children 66 2 4 14 Home Help. The Council's Home Helps attended 16 cases during the year in comparison with 24 in the year 1933. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In two 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 Convalescent Homes. Four mothers and their babies were sent away. In two cases the applicant was required to contribute towards the cost and in one half the cost was paid by the hospital where the confinement had taken place. Three of these mothers with babies were admitted to convalescent homes belonging to the Church Army. Eighteen applications were granted for convalescent home accommodation for children under five years of age; in five cases the parents failed to take advantage of the facilities provided, Thirteen children were sent away, 11 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, 1934, 139 children under five attended the consultations, 37 of the total number coming from the Holborn Borough. The 139 children made 2,673 attendances. Extra food and nourishment was provided, also convalescent treatment at country and seaside Homes (40 mothers and 72 children); classes and lectures on health, care of the home, food, economy and kindred subjects were held. The Chairman and Honorary Secretary is Miss Mary Canney, 75, Lamb's Conduit Street. Deaths of Children One to Five Years, 1934. Fifteen children between the ages of one and five years died from the following causes:— Cause of Death. 1—2 5—3 1—4 4—5 Total 1—& years M. F. m. F. m. F. M. F. m. F. Both Sexes. Diphtheria ... ... 1 ... ... ... 1 1 2 1 3 Measles 1 2 ... ... ... ... ... ... 1 3 4 Whooping Cough ... 1 ... ... ... ... ... ... ... 1 1 Pneumonia (all forms) 8 ... ... ... ... ... ... ... 3 ... 3 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 1 Gastro enteritis ... ... ... ... ... ... 1 ... 1 ... 1 Meningitis ... ... 1 ... ... ... ... ... 1 ... 1 Accidental—Scalds 1 ... ... ... ... ... ... ... 1 ... 1 Totals 5 4 2 ... ... 1 2 1 9 6 15 Totals, both sexes 9 1 1 3 15 78 Deaths of Infants under One Fear of Age, 1934. 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 Weeks 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 P M F M F M F Botl sexe Whooping Cough 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Cerebrospinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 2 Diarrhoea, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 8 4 Congenital Debility, Premature Birth, etc, 3 4 ... ... ... ... ... 1 3 5 8 ... ... ... ... ... ... ... ... 3 5 8 "Violence 2 ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... 2 ... 2 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 1 2 3 Totals 6 4 ... ... ... ... ... 1 6 5 11 1 3 2 1 1 1 1 1 11 11 22 Total both sexes 10 1 11 4 3 2 2 22 Net births registered during the calendar year. Net deaths registered during the calendar year. Males Females Both sexes Males Females Both sexes Legitimate Infants 151 123 274 Legitimate Infants 8 10 18 Illegitimate Infants 19 16 35 Illegitimate Infants 3 1 4 79 DIARRHœA AND ENTERITIS—Deaths under 1 Year.— L934. 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. M.S. 27.3.34 3/12 Respiratory failure, acute Gastro enteritis — Yes Yes Out-patient at one hospital for a week before admission to another hospital J.D. 28.7.34 6/12 Wasting, gastro-enteritis — Yes Yes Had been one month in hospital P.B. 2.9.34 6/12 Toxiemia, gastro-enteritis — Yes Yes Died in hospital eleven weeks after admission for wasting B.H. 25.12.34 1/12 Gastro-enteritis — Yes No Died in hospital where born 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 D. W. 22-1-34 Multipara No Home — Self-induced abortion Recovered Removed to hospital three days after abortion 2 M.D. 27-3 34 Primipara Yes Home — Local uterine sepsis; perineal sepsis Recovered Removed to hospital on fifth day after confinement 3 E. G. 29-12-34 Primipara No Home — Acute puerperal endometritis Died Removed to hospital 14 days after onset of disease PUERPERAL PYREXIA—Two Cases. 1 E. R. 10-2-34 Primipara Yes — Institution Syphilitic vulvitis Recovered — 2 M. M. 3-4-34 Primipara Yes Home — No localising signs Recovered Removed to hospital 14 days afer confinement 81 Ophthalmia Neonatorum. During the year three 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. Three Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Eegulations. Case Number. Age when Notified. Age at Onset. By whom Notified. Type of Disease on Health Visitor's first call. Where Treated. Medical Attendance and Nursing. Result. Birth Notified by. 1 6 days 4 days Doctor (Hospital) Moderate Hospital Maternity Ward—Hospital and In-Patient. St. Margaret's Hospital Cured Intern Department, Hospital 2 10 days 8 days Doctor (Hospital) Slight At home Maternity Ward—Hospital, and Doctor and Nurse, Out-patient Department—Hospital Cured Extern Department, Hospital 3 4 days 3 days Doctor (Hospital) Not seen At home Doctor (Home) and Inpatient, St. Margaret's Hospital Cured Extern Department, Hospital 82 Midwives Act, 1902 and 1918. In connection with these Acts we received information from the Medical Officer of Health of the London County Council, of slight inflammation in the eyes of three other infants, all of whom made complete recovery. Whooping Cough. Visits were paid to 65 persons suffering from whooping cough. Of these, 44 were notified by doctors; in nine others the information was derived from the schools, in six from health visitors, in five from the L.C.C., and one from a parent. Age. Eight were children under 1 year, 37 were aged 1 to 5 years, 19 were 5 to 16 years, and 1 was an adult. Spread of Infection in Family. The 65 cases occurred in 47 families. In 34 families 1 case occurred; in 10 families 2 cases occurred; in 1 family 3 cases occurred, and in 2 families 4 cases occurred. Removal. Twenty children were removed to hospital, approximately 31 per cent. All these were admitted to hospitals of the L.C.C. Deaths. One child died, set 4 months. Measles. During 1934 I received information of 237 cases of measles. Of these 93 were notified by school teachers and 50 by medical practitioners; information of 54 was given by L.C.C. hospital authorities, 18 by health visitors, 22 by parents. Age. Fourteen were under 1 year, 134 were between 1 and 5 years, 72 were between 5 and 16 years, and 17 were over 16. Deaths. Four children died, oet lj*,, 2 and 3 s years. Spread in Family. The 237 cases occurred in 197 families. In 163 families 1 case occurred, in 29 families 2 cases occurred, and in 4 families 3 cases occurred, and in 1 family there were 4 cases. Removals. Ninety-eight patients (41 per cent.) were removed to hospital (90 to L.C.C. infectious diseases hospitals, and 8 to the London Fever Hospital). Measles Control in Schools. The special arrangements of the London County Council for securing through the school organisation earlier information of measles was continued. German Measles. During the year information was received relating to 14 cases; 2 were notified by doctors, and information of 5 cases was received from schools, and 5 from L.C.C. hospitals, 2 by health visitors. Ages. 1 was under 1 year; 4 were between 1 und 5 years; 4 were between 5 and 16 years and 5 were over 16 years, 83 Diarrhoea and Enteritis under 2 years. The number of deaths was four; 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 1934:—Deficient lactation 6 cases, 52 visits; complications after pregnancy 3 cases, 53 visits; maternity nursing 4 cases, 53 visits. Minor Ailments. The Minor Ailments Clinic has been carried on as usual on Tuesday and Friday afternoons. Two hundred and twenty patients attended the clinic making 416 attendances. The principal ailments treated were as follows: — Conjunctivitis and blepharitis 78 Sores, including sore buttocks 65 Aural discharge 57 Syringing for wax 26 Umbilical hernia strapping 43 Impetigo 30 Attention to breast and nipples 36 Nasal catarrh 27 Tonsils 25 Constipation 20 Also, in smaller numbers: — Slight septic conditions of leg, finger, hand, arm; minor burns; splinters in finger; and stomatitis. Medical Inspection and Treatment of School Children. The medical inspection and treatment of children attending Public Elementary Schools in Holborn is carried out by the London County Council. The following treatment Centres are provided under the L.C.C. Schemes: — (1) Finsbury Centre, Spencer Street, Goswell Road. (2) Moorfields Ophthalmic Hospital, City Road. (3) Soho Centre, Gerrard Street. (4) Lancing Street Centre, Lancing Street, N.W. 1. (5) Cleansing Station (Scabies) Children's Baths, Central Street, E.C. 1. Centres are also provided at the following Hospitals and Dispensaries :— (1) St. Bartholomew's Hospital. (2") Bloomsbury Dispensary. (3) Central London Ophthalmic Hospital. (4) Central London Throat and Ear Hospital. (5) Dental Hospital. (6) Homoeopathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nose and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensary, University College Hospital. (13) University College Hospital. We endeavoured to co-operate with the Education Authority by giving information respecting children suffering from infectious disease and child contacts Attending public elementary schools. F 2 2 Routine Medical Inspection of Elementary School Children in Holborn, 1934. Number examined. Clothing and Boots. Nutrition Cleanliness of Head. Cleanliness of Body. Teeth. Good Fair. Poor. Good. Average. Below normal. Bad. Glean. Nits. Pediculi. Glean. . Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 224 47 174 3 53 146 25 — 216 215 7 2 144 77 3 . ... 195 62 133 — 50 132 13 — 186 8 1 191 4 — 116 78 1 . ... 117 40 77 — 17 £0 20 — 113 4 — 109 8 — 81 36 — . ... 111 31 80 — 29 71 11 — 104 7 — 110 1 — 80 28 3 . ... 173 51 122 — 27 108 38 — 167 6 — 170 3 — 143 30 — 1 . ... 173 53 120 — 48 93 32 — 154 18 1 171 2 — 144 29 — 1 ... 214 19 195 — 38 145 31 — 210 4 — 209 5 — 164 50 — 1 ... 202 40 161 1 66 110 26 — 192 10 — 193 9 — 159 43 — 1 ... 1,409 343 1,062 4 328 885 196 — 1,342 65 2 1,368 39 2 1,031 371 7 ... 24.3 75.4 0.3 23.3 62.8 13.9 95.3 4.6 0.1 97.1 2.8 0.1 73.2 26.3 0.5 5 ... 53.9 45.5 0.6 20.5 75.3 4.2 96.9 2.8 0.3 98.9 1.1 0.0 68.8 26.5 4.7 6 35 Examination of Elementary School Children in Holborn in 1934. Defect. Boys. Girls. Kntrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number Examined 224 117 173 214 195 111 173 202 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 1 1 1 1 1 1 2 2 2 2 1 1 3 3 1 1 Skin Disease 1 1 1 1 — — — — 2 1 — — 1 1 1 1 Defective Teeth — 74 — 32 — 30 — 48 — 74 — 28 — 28 — 41 Enlarged Tonsils 62 16 21 2 20 4 21 1 61 !3 13 1 13 3 19 4 Adenoids 3 2 — — 1 1 1 1 — — 1 1 — — — — Enlarged Tonsils and Adenoids — — — — — — — — — — — — — — 1 1 Other Nose and Threat Defects 12 2 1 — 2 — 2 — 8 — 4 — 1 1 1 — Enlarged Glands 1 — — — 1 — — — — — — — — — — — Eye Disease 5 3 4 1 2 1 4 4 c 5 3 — 5 1 2 — Vision Defect — — — 6 — 17 — 22 — — 11 — 20 — 33 Otorrhooa 5 3 1 1 5 2 4 4 4 3 2 1 2 2 2 — Other Ear Disease — — — — — — — — 1 1 1 — — — — — Defective Hearing 1 1 1 Speech Defects 2 Heart Defects 2 — — — 6 — 2 — 3 — 4 1 5 — 9 1 Arcemia 6 2 6 3 5 1 2 1 3 2 1 — 6 2 6 3 Lung Defects 6 2 1 1 — — 1 — 3 2 1 — 2 1 2 — Nervous Defects 1 — 2 1 4 1 — — — — 2 — 2 — — — Phthisis — — — — — — 1 — — — — — — — — — Other T.B. Disease — — — — — — — — — — — — — — — — Rickets 1 — — — — — — — — — — — — — — Spinal Deformities 2 — 2 — 1 — 1 — 1 1 3 2 — — 2 1 Other Deformities 3 — — — — — 1 — 1 1 — — 3 1 1 — Other Defects 8 4 6 2 6 3 3 1 4 1 2 — 9 5 9 5 Number of Children noted for treatment 97 46 66 75 90 43 57 80 •Defects, however slight, are included under " Cases." Those severe enough to require treatment are shown under *. 86 Infant Life Proteotion. On the 1st January, 1934, four foster mothers remained on the register. During the year four others were added to the register and six were removed; leaving two registered foster mothers in the Borough at the 31st December, 1934. The six removals were for the following reasons: — Child legally adopted by the foster mother 1 Child reached nine years of age 1 Child and foster mother removed from Borough 1 Child removed to care of Public Assistance Authority 1 Child removed to the care of parent 2 Under the arrangement made with the London County Council the School Care Committee is notified when a foster child reaches the age of nine years, at which age supervision under the Children Acts ceases. Notification is also sent to the Medical Officer of Health of the district concerned when foster children are removed into another area to the care of the parent, to another foster mother, or with the same foster mother. In one case during the year a proposal for placing a child with a foster mother was found to be unsatisfactory and the arrangement was therefore not effected. Applications are received from time to time from parents and others desirous of placing children with suitable foster mothers, but much difficulty is experienced in finding suitable homes where foster children can be received. In some cases it has been possible to effect satisfactory arrangements for the purpose through the co-operation of the Child Guidance Council. Deaths of Children 5 to 15 years. There were six deaths in this age group during 1934, three males and three females. The deaths were from the causes shown below: — Diphtheria F. (5 years) Ditto M. (6 years) Violence (Knocked down by motor van) M. (6 years) Tuberculous meningitis M. (12 years) Broncho-pneumonia F. (14 years) Status epilepticus, nodular sclerosis F. (5 years) 87 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. No case was referred for such advice in 1984. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 7th to 13th October, 1934. With a view to economy the programme was limited to the following: — Co-operation with the School Organisations. Arrangements were made for children attending elementary schools in the Borough to write answers to a series of questions, on health topics, prizes being awarded to the girl and boy writing the best answers in each school. The questions were divided into two sets, one for children in senior departments and one for those attending junior departments. The Mayor and Mayoress (Alderman and Mrs. A. A. Mussett) kindly entertained to tea the prize winners and four other children from each school (two girls and two boys) whose answers were adjudged as next best to those of the prize winners. We are much indebted to the Head Teachers and staffs of the various schools for their invaluable help and 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 competion in the designing of health posters. Seventy-nine designs were submitted from six schools. Two prizes were awarded, one going to St. Peter's School and one to St. George-the-Martyr School. Arrangements were made for children from the various schools to see the posters at the Town Hall. Meeting for Mothers. Following the usual custom during Health and Baby Week, the Thursday afternoon class at the John Street Centre, was made the occasion of a special address and of a distribution of certificates. The Deputy Mayoress (Councillor Gertrude Howard, M.A.) presided and kindly distributed the certificates of congratulation to those whose children had attended the Centre from early infancy until the age of five years; also to those who had recently beecome entitled to certificates for completing attendances for active immunisation against diphtheria. I Dr. Julia Browne Kutschback (formerly Medical Officer of Health of Stepney) spoke on " Child Care and Management." There was a good attendance. 88 SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 61 bodies were deposited. There were 55 post-mortem examinations made, and 3 inquests held. On 4 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 3 by the Police. Inquests. During the year 38 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, 2; Accidents, 18; Suicide, 11; Misadventure, 4; Open Verdict, 1; Manslaughter, 1; Murder, 1. The causes of death certified were as follows: — Natural Causes. Suicide. Alcoholism 1 Coal gas poisoning 0 Other causes 1 Hanging 1 Jump from window 2 Misadventure. Burns 1 Operation 1 Jump from top of stairs to Want of attention at birth 2 floor beneath 1 Fall down lift shaft1 Open Verdict. Fall 1 Manslaughter. Motor car 1 Accidents. Falls 8 Street accidents 7 Burns and scalds 2 Murder. Drowning 1 Stabbing 1 The Removal of Aged, Infirm and Diseased Persons. Power to deal with this matter is given by the London County Council (General Powers) Act, 1928. During the year 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 the visits two such persons were removed to institutions; in one case arrangements were made for the care of the aged person by nurses from a local organisation, and in one case the conditions wore not such as to call lor action under this Act. 89 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 condition of the house was found to justify the issue of a certificate. Nuisances Caused by Dogs. With a view to the prevention of nuisances from the fouling of footways by dogs the Council, in the year 1926, made the following By-law: — " No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its " excrement upon the public footway." The By-law after being in force for an experimental period until 1st June, 1928, was made permanent; it is administered by the Borough Engineer's Department. Nuisance from Pigeons. 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. The arrangements made in the previous year were continued under which two members of the Health Department staff endeavour to trap the birds. Successful operations were carried out by them on various occasions at four different sites frequented by pigeons and, in all, 379 birds were caught. This number included 74 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 not desired to destroy all wild pigeons in Central London, but it is 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. 90 Children's Country Holidays. In connection with the arrangement's 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, and included a lecture with illustrative film; three talks to girls, and three talks to boys, all being illustrated with films. The lecture and the six talks were all well attended and, evidently, much appreciated. The Mayor (Alderman Mussett) kindly presided at the lecture. Poison Alleged to be Due to Marking Ink. Towards the end of the year 1934 information was received of cases of illness with symptoms of poisoning, it being suggested that the illnesses arose from the inhalation of fumes from ink used to mark blankets. The circumstances being unusual, the following details may be of interest: — Four persons (female, aged 19; two adult males, aged 22 and 25 respectively and a boy, aged 10) who were sleeping in separate rooms on the top floor of a private hotel were taken ill after sleeping for one night in beds on which in each case, there was one blanket which had been marked with large stencils in several places the day before. The symptoms as reported by the doctor were headache, sickness, faintness and cyanosis. N'one of the patients was unconscious and in one (male 25 years) the only symptom was a feeling described as similar to " cold in the head." In one case there was slight jaundice. The dootor who was called in diagnosed poisoning due to a Benzine derivative. All the patients recovered completely within twenty-four hours. The blankets were marked with a permanent stamping ink which, on analysis, was found to contain nitrobenzene, aniline, ortho toluidine, aniline black, copper and ammonia salts. The blankets had not been washed, nor was the stencilling dry before the blankets were used. From the information disclosed it appeared certain that the case were instances of poisoning by nitrobenzene and other constituents which occur in commercial " aniline oil." The occurence suggests the desirability of including some precautionary instructions on labels of marking ink such as recommending the exposure of articles in the open air for some time after marking and before use. 91 APPENDIX. TABLE I. Vital Statistics of Whole District during 1934 and Ten Previous Years Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Net Deaths belonging to the District. Deaths Under 1 Year of Age At all Ages Uncorrected Number Net Number of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate Number Rate 1924 43,260 394 578 13.36 670 470 329 47 81 529 12.2 1926 43,315 364 527 12.16 725 513 330 33 63 542 12.5 1926 43,200 330 535 12.38 629 454 317 48 90 522 12.1 1927 42,209 320 605 11.96 728 531 333 19 38 530 12.5 1928 39,280 s01 473 12.0 739 546 338 27 57 531 13.5 1929 88,380 256 392 10.21 766 645 377 29 74 698 15.6 1930 38,380 25 5 405 10.65 693 523 318 36 89 488 12.7 1931 34,470 211 352 10.21 787 598 303 26 74 492 14.3 1932 36,410 186 349 9.57 773 607 351 25 72 517 14.2 1933 36,050 180 342 9.49 681 521 326 24 70 486 13.5 1934 36,000 160 309 8.58 699 552 293 22 71 440 12.2 In the above table the birth-rates and death-rates are calculated on the RegistrarGeneral's estimates of resident population as at the middle of each year. 92 TABLE II. Causes of, and Ages at, Death, 1934. Causes of Death. NET DEATHS AT THE SUBJOINED AGES OF " RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Residents " or " NonResidents' in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 85 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 aftd upwards. All causes Certified 440 22 9 6 6 15 44 141 102 95 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers 1 ... ... ... ... 1 ... ... ... ... 1 2. Measles 4 ... 3 1 ... ... ... ... ... ... 1 Searlet Fever ... ... ... ... ... ... ... ... ... 1 4. Whooping Cough 2 ... ... ... ... ... ... ... ... ... 3 5. Diphtheria 5 ... ... ... 2 ... ... ... ... ... 2 6. Influenza 3 ... ... ... ... ... 1 1 1 ... 1 7. Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... ... ... 8. Cerebro-spinal Fever 1 1 ... ... ... ... ... ... ... ... 7 9. Tuberculosis of Inspiratory System 27 ... ... ... ... 6 7 12 3 ... 12 10. Other Tuberculous Diseases 5 ... ... ... 1 ... 3 ... ... ... 18 11. Syphilis 2 ... ... ... ... ... ... 2 ... ... 2 2 General Paralysis of the insane, Tabes Dorsalis 2 ... ... ... ... ... ... 2 ... ... 4 13. Cancer, malignant disease 62 1 ... ... ... ... 4 22 16 10 67 14. Diabetes 7 ... ... ... ... ... ... 4 3 ... 1 lo. Cerebral Haemorrhage 12 ... ... ... ... ... ... 4 3 5 22 16. Heart Disease 119 ... ... ... ... ... 3 35 44 87 21 17. Aneurysm 2 ... ... ... ... ... ... 2 ... ... 1 18. Other Circulatory Diseases 27 ... ... ... ... ... 2 6 9 11 4 19. Bronchitis 19 ... ... ... ... ... ... 5 5 9 6 20. Pneumonia (all forms) 28 2 3 ... ... 1 1 12 6 4 61 21 Other Respiratory Diseases 4 ... ... ... ... ... 1 1 1 1 24 22. Peptic Ulcer 6 ... ... ... ... 1 ... 2 3 ... 2 23. Diarrhoea, etc. (under 2 years) 6 ... ... ... ... ... ... 1 ... ... 43 24. Appendicitis 1 ... ... ... ... 1 ... ... ... ... 3 25. Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... ... 3 26 Other diseases of liver, etc. 3 ... ... ... ... ... ... ... 1 2 4 27. Other digestive diseases 7 1 ... ... ... ... ... 4 ... 2 17 28. Acute and Chronic Nephritis 14 ... ... ... ... 1 3 6 2 2 28 29. Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 8 8 ... ... ... ... ... ... ... ... 42 32. Senility 3 ... ... ... ... ... ... ... ... 3 2 3?. Suicide 13 ... ... ... ... 1 6 4 1 1 3 34. Other Violence 27 2 1 ... 1 i 5 8 3 6 10 35. Other Defined Diseases 27 2 ... 1 2 3 7 7 3 2 155 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 440 22 9 6 6 15 44, 141 102 95 661 TABLE III. Cases ok Infectious Disease notified during the year 1934. Disease. Total Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 16 16 to 20 20 to 36 36 to 46 46 to;65 65 up Total Deaths Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 74 2 3 3 9 7 29 2 10 6 3 ... ... 4 Erysipelas 12 1 ... ... ... ... ... ... ... 4 2 3 2 ... Scarlet Fever 115 1 6 4 7 9 37 19 12 13 4 3 ... ... Enteric Fever 3 ... ... ... 1 ... ... ... 2 ... ... ... ... ... Puerperal Fever 3 ... ... ... ... ... ... ... ... 2 1 ... ... 1 do. Pyrexia 2 ... ... ... ... ... ... ... ... 2 ... ... ... 1 Cerebrospinal Fever 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... Malaria 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Pneumonia—Primary 32 3 4 ... 3 ... 3 ... 2 4 3 7 3 7 do. Influenzal 6 ... ... ... ... ... ... ... 1 1 2 2 ... Tuberculoma— Pulmonary 83 ... ... ... ... ... 2 2 6 29 19 20 5 37 do. Non-Pulmonary 6 ... 1 ... ... ... ... 1 1 1 ... 1 1 1 Whooping Cough 65 9 8 10 10 9 18 1 ... 1 ... ... ... 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... 412 22 22 17 30 25 90 25 34 65 31 37 11 53 94 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough at end of 1934. Number of Inspections. Number of Prosecutions. Common Lodging House 6 54 ••• Cowsheds ••• ••• ••• Milkshops 144 125 ••• Registered houses let in lodgings 462 778 ••• Ice cream premises 42 95 ••• Slaughter-houses 1 10 ••• Offensive Trades ••• ••• ••• Restaurants and Eating Houses 298 453 ••• Registered foster mothers 2 70 ••• Nurse children kept 2 Housing of the Working Classes— Number of houses inspected :— (a) On account of complaints or illnesB (Public Health Act) 600 (b) House to house (Housing Consolidated Regulations, 1926) 70 Number of notices served : — (a) Under Public Health Act: — (i.) Intimation 396 (ii.) Statutory 56 (b) Under Housing Act 2 Number of houses repaired or nuisances remedied under Publio Health Act 396 Number of houses repaired under Section 17 of Housing Act: — (a) By owners — (2 in hand at end of year) (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) 1 block (10 flats) (b) In course of erection — Number of representations by Medical Officer or other person 18 Number of houses included in such representations 20 Number of Closing Orders made 2 Number of Closing Orders determined (i.e., houses made fit) Nil Number of Demolition Orders 3 Number of houses demolished :— (a) In pursuance of Orders Nil (b) Voluntarily — A ction deferred pending pro vision of rehousing accommodation 3 Undertaking to close room accepted 1 Proceedings to be taken under Hect. 17 Housing Act !0."0 9 Total number of houses in the borough 6462 (Census, 1931) Number of houses occupied by the working classes — Underground Kooms— — Number illegally occupied, notices served 5 Number closed or illegal occupation discontinued 5 o vercrowding— Number of cases of overcrowding found; notices served 3 Number of prosecutions — Number remedied 2 Smoke Nuisances— Number of observations 156 Number of notices 7 Number of complaints 16 Number of summonses — Cleansing and Disinfection— Number of adults cleansed 158 Number of children cleansed 4 Number of premises disinfected : — 313 (a) After infectious diseases (b) For vermin 155 Water Supply to Tenement Houses— Number of premises supplied 6 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 95 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. Factorial 401 21 4 ... Workshops 477 39 5 ... Workplaces 8.212 41 7 ... Total 4,090 101 16 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Found. Kemedied. Referred to H.m. Inspector. Number of Prosecutions. •Nuisances under the Public Health Acts : Want of cleanliness 40 40 ... ... Want of ventilation 11 11 ... ... Overcrowding 1 1 ... ... Other nuisances 101 101 ... ... Sanitary accommodation insufficient 2 2 ... ... unsuitable or defective 31 31 ... ... not separate for sexes 6 6 ... ... Offhnoes 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 192 192 ... ... * Including those specified in Sections 2. 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 96 TABLE V.—continued. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Seotion 108. Outwork in Infected Premises. Sections 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— Making, &c. 92 241 174 1 ... 6 92 ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 10 ... ... ... 2 ... ... ... ... ... ... ... ... Total 94 241 184 1 ... 6 94 ... ... ... ... ... ... ... ... 97 TABLE V.—continued. 4.—REGISTERED WORKSHOPS. Workshops on the Register (8. 131) at the end of the year. Number. (1) (2) Bakehouses (including 17 factory bakehouses) 20 Othar Workshops 611 Total number of workshops on Register 631 5.—OTHER MATTERS. Class. Number. a) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 7 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (8. 5) Notified by H.M. Inspector 7 Report (action being taken) sent to H.M. Inspector... 7 Other — Underground Bakehouses (S. 101): — Certificates granted during the year — In use at the end of the year 11 98 LEGAL PROCEEDINGS. Food and Drug's (Adulteration) Act, 1928. Date. Name. Address, Offence. Result. 1934 May 7th H. J. Barham 49, Copenhagen Street, N. 1 Selling milk 8.2% added water Defendant convicted and fined 10s. and 21s. costs. June 7th R. Mansi 34, Charles Street Selling milk 35 0% abstracted fat Defendant convicted and fined 20s. and 20s. costs. Nov.29th Mrs. A. Mandara 8, Little Turnstile Selling milk 11% abstracted fat Defendant convicted and fined £5. 1935 Jan.10th J. Jones 67, Gray's Inn Road Selling milk 6% abstracted fat Warranty proved. Summons withdrawn.