The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of Health, For the Year 1936. London: Printed bt DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1937 The Metropolitan Borough of Ibolborn. ANNUAL REPORT OF THE Medical Øfftcer of hbealth, For the Year 1936. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1937 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C. 1. July, 1937. 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 1936. 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 9 Statistics and Social Conditions Statistical Summary 9 Vital Statistics 9 Births 10 Deaths 10 Infantile Mortality 11 Deaths in Public Institutions 12 General Provision of Health Services 12 Sanitary Circumstances Removal of Offal l8 Sanitary Inspection of District 18 Notices served 19 By-laws as to Houses let in Lodgings 21 Rag and Bone Dealers 21 Rats and Mice (Destruction) Act, 1919 21 National Rat Week 23 Drainage Work, Supervision of 23 Smoke Abatement 23 Inspection of Workshop 24 Factories 25 Outworkers 26 Rag Flock Acts 26 Shops Acts 26 Inspection of Private Swimming Baths 27 Housing Statistics 27 Housing Accommodation on L.C.C. Estates 28 New North Street (North and South) Areas 29 Warner Street Areas 29 Abatement of Overcrowding 29 Re-Housing 30 Underground Rooms-—Regulations 30 Overcrowding Suivey 30 Holborn Housing Trust 30 Council's Housing Estates 31 Housing Act, 1935—Appointed Day 31 Removal Expenses 31 Inspection and Supervision of Food. Dairies, Cowsheds and Milk Shops 31 Milk (Special Designations) Order, 1923 32 Milk—Bacteriological Examination 32 Margarine 33 Bakehouses 33 Sale of Fish 33 Fried Fish Shops 33 Market Streets and Exposure of Food Generally 34 Street Trading34 Ice Cream 34 Meat Regulations 35 Places where Food is Prepared for Sale 35 Inspection of Restaurant Kitchens 35 Unsound Food 36 Preservatives in Food Regulations 37 Food and Drugs (Adulteration) Act, 1928 38 Articles Analysed 38 Borough Analyst, Notes by 41 The Merchandise Marks Act, 1926 44 London County Council (General Powers) Act, 1932 45 Registration of Food Premises 45 Notification of Food Poisoning 45 Slaughter of Animals Act, 1933 45 4 Page Prevalence of and Control over Infectious Diseases Infectious Diseases Generally 46 Smallpox 47 Vaccination 47 Diphtheria 48 Diphtheria in Hospitals 48 Schick Test and Immunisation against Diphtheria 49 Diphtheria in Children Treated with Immunising Injections 51 Immunisation of Nursing Staff at London Homoeopathic Hospital 62 Immunisation of School Children 52 Scarlet Fever 52 Acute Rheumatism in Children 62 Holidays for Rheumatic Children 54 Typhoid and Paratyphoid Fevers 55 Typhus Fever 55 Cerebro-Spinal Fever 55 Bacillary Dysentry 55 Malaria 55 Encephalitis Lethargica 55 Acute Poliomyelitis and Acute Polioencephalitis 56 Pneumonia 56 Influenza 56 Anthrax 56 Chickenpox 56 Mumps 56 Bacteriological Work 57 Disinfections 57 Cleansing of Persons Act 67 Shelter during Disinfection 57 Extermination of Vermin 57 Cancer 58 Tuberculosis 58 Summary of Notifications and Deaths 58 Public Health (Tuberculosis) Regulations, 1930 59 Supplemental Return 60 Notification Register 60 Tuberculosis Notifications 61 Sleeping Conditions 61 Classification of Homes 61 Non-attendance at Tuberculosis Dispensary 62 Institutional Treatment 62 Visits to Home 62 Contacts 62 Tuberculosis Dispensary Return 63 Deaths of Tuberculous Persons 65 Tuberculosis Care Committee 65 Public Health (Prevention of Tuberculosis) Regulations, 1925 67 Home Nursing 67 Extra Nourishment 67 Dental Clinic 67 General Dental Clinic 68 Maternity and Child Welfare Notification of Births 68 Number of Births 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 Poet-natal Consultations 72 Instruction in Mothercraft and Hygiene 72 Maternal and Infant Consultations 72 Rreast Massage 73 Pre-School Children 74 5 Page Foundling Hospital Day 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 76 Saffron Hill Maternity and Child Welfare Centre 76 Deaths of Infants under One Year 77 Infectious Diseases among Mothers and Children 78 Puerperal Fever and Pyrexia 78 Ophthalmia Neonatorum 79 Midwives Acts, 1902 and 1918 80 Whooping Cough 80 Measles 80 Measles Control in Schools 80 German Measles 81 Diarrhoea and Enteritis under 2 years 81 Nursing Arrangements 81 Minor Ailments Clinic 81 Medical Inspection and Treatment of School Children 82 Infant Life Protection 84 Birth Control 84 Health and Baby Week 84 Sanitary Administration Mortuary 85 Inquests 85 Removal of Aged Persons 85 Rent and Mortgage Interest, Restriction Acts, 1920-1933 86 New Legislation 86 Nuisance from Pigeons 87 Old Buildings—Demolition of 87 Propaganda 87 APPENDIX. Table I. Vital Statistics, 1936, and ten previous years 88 Table II. Causes of and Ages at Death, 1936 80 Table III. Infectious Diseases Notified during 1936 90 Table IV. Information required by L.C.C. 91 Table V. Factories, Workshops, &c. (1) Inspections 93 (2) Defects found 93 (3) Home Work 94 (4) Registered Workshops 95 (6) Other Matters 95 Ambulance Service (see inside of back cover). List of Notifiable Diseases (see back of cover). 6 PUBLIC HEALTH COMMITTEE. 1935-36. 1936-37. Chairman— Chairman— Councillor John W. Roberts. Councillor William R. Cons. Vice-Chairman— Vice-Chairman— Councillor William R. Cons Councillor Alfred R. Taylour, M.A. Ex-Officio— Ex-Officio His Worship The Mayor, His Worship The Mayor, Councillor Horace W. Langdon, J.P., F.S.I. Councillor Roland H. Haxell, F.A.I., J.P. The Deputy Mayor, Councillor Wilfred E. The Deputy Mayor, Mullen. Councillor Horace W. Langdon, F.S.I. Alderman Ernest Hamlin, M.B.E. Alderman Ernest Hamlin, M.B.E. Albert A. Mussett. "Albert A. Mussett. Councillor Thomas Aubertin, M.A. Councillor Thomas Aubertin, M.A. "John H. Boraston, C.B. "John H. Boraston, C.B. " Mrs. Edith Elliott. " Mrs. Edith Elliott. " Mrs. Charlotte Harris. "Alcwyn Harries. " William H. M. Smeaton, F.R.San.I. „ Harry Myers. " Robert H. R. Tasker. „ John W. Roberts. " John O. M. Turnbull. "John O. M. Turnbull. " William R. Wheatley. „ William R. Wheatley. HOUSING OF THE WORKING CLASSES COMMITTEE. 1935-36. 1936-37. Chairman— Chairman— Alderman Robert P. Bristow. Alderman Robert P. Bristow. Vice-Chairman— Vice-Chairman- Councillor Robert H. R. Tasker. Councillor Robert H. R. Tasker. Ex-Officio— Ex-Officio His Worship The Mayor, His Worship The Mayor, Councillor Roland H. Haxell, F.A.I., J.P. Councillor Horace W. Langdon, F.S.I., J.P. The Deputy Mayor, The Deputy Mayor, Councillor Wilfred E. Councillor Horace W. Langdon, F.S.I. Mullen Alderman Percy Hill, L.C.C. Alderman Albert A. Mussett. Councillor George J. Bailey. Councillor George J. Bailey. " Alcwyn Harries. " Frank P. Brindley. "Roland H. Haxell. "Alcwyn Harries. "Miss Florence M. Herbert. " Miss Florence M. Herbert. " James F. Howes, A.R.I.B.A. " Wilfred E. Mullen. „ George D. Pooley. " George D. Pooley. ,, Alfred R. Taylour, M.A. "John O. M. Turnbull. „ John O. M. Turnbull. ,, Henry H. R. Ward. „ T. Magnus Wechsler, LL.B. „ T. Magnus Wechsler, LL.B. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1935-36. 1936-37. Chairman— Chairman— Councillor Mrs. Edith Elliott. Councillor Thomas Aubertin, M.A. Vice-Chairman— Vice-Chairman— Councillor Thomas Aubertin, M.A. Councillor Mrs. Charlotte Harris. Ex-Officio— Ex-Officio— His Worship The Mayor, His Worship The Mayor, Councillor Horace W. Langdon, F.S.I., J.P. Councillor Roland H. Haxell, F.A.I., J.P The Deputy Mayor, Councillor Wilfred E. The Deputy Mayor, Mullen. Councillor Horace W. Langdon, F.S.I. Alderman Robert P. Bristow. Alderman Albert A. Mussett. „ Albert A. Mussett. Councillor Mrs. Edith Elliott. Councillor Mrs. Charlotte Harris. „ Alan P. Good, B.A. „ Harry Myers. „ J. Thompson Halsall. ,, George D. Pooley. „ William M. Morgan. „ John W. Roberts. „ John W. Roberts. „ Henry H. R. Ward. „ Henry H. R. Ward. „ William R. Wheatley. „ William R. Wheatley. The Mayoress (Mrs. Horace W. Langdon). Mrs. Roland H. Haxell (Mayoress). Miss E. Emly. Miss E. Emly. Mrs. Percy Hill. Mrs. Percy Hill. „ W. E. Mullen. Mrs. Horace W. Langdon. „ John W. Roberts. „ Wilfred E. Mullen. TUBERCULOSIS CARE COMMITTEE. Holborn Borough Council Councillor J. W. Roberts. Medical Officer of Health (Dr. J. A. Struthers). Tuberculosis Dispensary Tuberculosis Officer (Dr. A. J. Morland). Councillor William R. Wheatley. London County Council Dr. Margaret Hogarth. Miss M. Ball. Public Assistance Committee Mrs. F. M. Keen. Local Association of Children's School Care Miss K. J. Swayne. Committees. 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 Yoelcker (Viøe-Chairman). British Legion and United Services Fund Benevolent Committee Mr. R. F. Freeman. Briish Rod Cross Emergency Help Fund Major-General Patrick B. Sangster, C. B., C.M.G., D.S.O. Charity Organisation Society Miss E. F. Bolton. Invalid Children's Aid Association Miss Butler. Metropolitan District Nursing Association Miss E. Emly. National Council of Social Service Sir Ewan R. Logan, M.A. Northern London War Pensions Committee Vacancy. Other social workers (co-opted) Mrs. E. C. Bedford. Mrs. Percy Hill (Chairman). Miss O. Lazarus. , Miss H. M. Mathieson (Honorary Secretary). 8 STAFF. The following was the .Staff during 1936. Medical Officer of Health—J. A. Struthers, M.D., B.Ch., M.R.C.P., D.P.H. Medical Officers of Maternity Centres— 10, John Street—Richenda Gillett, M.D.Brux., L.S.A. Winefride M. Gibson, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Short's Gardens—Olive Lloyd, M.R.C.S., L.R.C.P. Consultant Medical Officer—Puerperal Pyrexia and Puerperal Fever Regulations (1926-1928)— J. D. Barris, M.B., F.R.C.P., F.R.O.S., 10, Cornwall Terrace, Regents Park, N.W. 1. Medical Officer of Tuberculosis Dispensary—Andrew Morland, M.D., M.R.C.P., M.R.C.S. 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 (to 30th June, 1936). George F. Clark. Samuel Larard, M.R.San.I. S. G. Fisher. Joseph H. R. Crabtree (from 1st June, 1936). Sanitary Inspector and Health Visitor—Miss E. J. Cliarlesworth, C.M.B. Health Visitor—Miss M. G. Stockwell, C.M.B. Tuberculosis Health Visitor—Miss M. Watson, S.R.N. Chief Clerk and Committee Clerk—Edwin Eent. Assistant Clerks—Frank Fitch. Arthur Long. Albert R. Shott. Miss Knorette Hand. Reginald R. Stent (from 1st May, 1936). 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—Mrs. Nellie M. Downing. Caretaker of Maternity Centre—Mrs. 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. F. Robinson, 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. Oiles and Bloomsbury District, Western part of Borough (West of Southampton Row)— Dr. George D. Fairley, 15a, Gower Street, W.C. 1. Telephone No. Museum 0691. Hours 9 to 10 a.m. and 6 to 7 p.m. (except Wednesdays). Vaccination Officer—Mr. Percy E. Capps, Town Hall, 197, High Holborn, W.C. 1. Registrar of Births and Deaths—Mr. W. J. Clark 14, 16 and 18, Bloomsbury Street, W.C. 1. Certifying Surgeon (Factory & Workshop Acts)—Dr. W. D. Brunton, 72, Euston Square, N.W.I. 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, W.C. 1. H.M. Coroner—S, Ingleby Oddie, Esq. Coroner's Officer—Mr. James Stabb, 46, Baker Street, Lloyd Square, W.C. 1 Honorary Secretary, Tuberculosis Care Committee— Miss H. M. Mathieson, Town Hall, High Holborn, W.C. 1. 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1936. Area of Borough in acres 405 1 Resident population—estimated to middle of 1936 (as supplied by the Registrar-General) for birth and death rates 34,850 Number of inhabited houses (1931) 6,462 Number of private families or separate occupiers (1931) 9,355 Rateable value 1st October, 1936 £1,640,325 Rate of Id. in the £ estimated to yield £6,355 Total M. F. Live Births (Legitimate 257 139 118) Birth Rate per 1,000 of the esti I11egitimate 32 19 131 mated resident population 8.29 Stillbirths 9 5 4 Rate per 1,000 total (live and still) births 30.2 Deaths 418 220 198 Death Rate per 1,000 of the estimated resident population 11 .99 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis Nil — No. 30 Other Puerperal causes Nil - Total — - Death Rate of Infants under one year of age :— All infants per 1,000 live births 62 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 187 .5 Deaths from measles (all ages) 2 „ whooping cough (all ages) 2 „ „ diarrhoa (under 2 years of age) 3 Tuberculosis, all causes, death-rate per 100,000 1004 Excess of registered births over deaths — Excess of registered deaths over births 129 Vital Statistics, 1936. England and Wales, London and Holborn. Annual Rates per 1,000 living Deaths undur 1 year to 1,000 Births. Births. Deaths. England and Wales 148 12.1 59 London 13.6 12.5 66 Holborn 8.29 11.99 62 10 Registered Blrtbs. The total number of births registered as occurring in the Borough was 121 (60 males and 61 females). Of these, 114 were legitimate and 7 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 145 legitimate infants and 26 illegitimate infants whose mothers were residents of the Borough. Three of the births accurring in the Borough were infants of mothers who were not resident in the Borough. The corrected number of births is therefore 289, and the corrected birth-rate 8.29. The following is the corrected number of births and the corrected birth-rates for the year 1936:— 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. 1936 289 8 29 257 7.37 889 32 0. 92 1ll In London the corrected birth-rate in 1936 was 13 6 per 1,000 in comparison with 13.3 for 1935. Mortality. The total number of deaths registered as occurring in the Borough was 731, of which 407 were males and 324 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough: — Institution. Residents. Non-Residents. French Hospital 6 37 Hospital for Sick Children 2 259 Italian Hospital 4 27 London Homoeopathic Hospital 6 99 National Hospital 2 126 Royal Westminster Ophthalmic Hospital — 2 St. Paul's Hospital — 23 Other places — 13 Total 20 586 There were 273 deaths of civil "residents" in various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 41 of whom were removed from Common Lodging Houses in the Borough. 11 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 1936 gives the total deaths for the Borough as 418. Corrected Deaths and Death-Rates, 1936, compared with 1935. 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). Death Rate for London 1936 731 606 586 273 418 †11 99 12.83 12. 5 1935 668 547 526 278 420 †11.9 12.7 11.4 For details of causes of and ages at death (see Table II, page 89). 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 of legitimate-infants under 1 year per 1000 corrected legitimate Births. Deaths of illegitimate infants under 1 year per 1000 corrected illegitimate Births. Deaths, all infants under 1 year per 1000 corrected Births. London. Deaths under 1 year per 1000 Births. 1936 18 47 187 .5 62 66 1935 24 78 14.3 88 58 Death-rate per 1,000 corrected births in 1936 and in ten preceding years. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Avge 1926-35 1936 Holborn Borough London 90 64 38 59 57 67 74 70 89 59 74 65 72 67 70 59 71 67 88 58 72 3 63.5 62 66 See also Table, page 88. 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. † These rates are calculated 0n the Registrar-General's estimated populations at the middle of the year 1935 and 1936 respectively. 12 Deaths in Public Institutions. Of the total number of 418 deaths, 298 died in hospitals and public institutions either within or without the Borough. General Provision of Health Services in the Borough. Public Health Officers. The following changes in the staff during the year 1936 are recorded:— Sanitary Inspector Bennett retired on the 30th June after 43 years service with tlio Council or its predecessor, the Holborn Board of Works. Mr. Joseph H. R. Crabtree was appointed to fill the vacancy and commenced his duties on the 1st June. The clerical staff was increased by the appointment of Mr. Reginald R. Stent, who took up his duties on the 1st May. Nursing in the Home. (a) General.—Nursing service for the sick poor is supplied by the Metropolitan District Nursing Association, 31, Bedford Place, W.C. 1. (b) Infectious Diseases.—By arrangements made by the Borough Council with the Nursing Association, nurses are available for cases of :— Summer Diarrhoea (in children under 2 years of age). Measles with severe complications. Whooping Cough with severe complications. Lobar Pneumonia. Influenzal Pneumonia. Ophthalmia Neonatorum. Encephalitis Lethargica. Pemphigus Neonatorum. Puerperal Fever. Puerperal Pyrexia. Tuberculosis. (c) Maternity.—By arrangement with the Metropolitan District Nursing Association, skilled maternity nursing is available for necessitous maternity cases subject to prior approval of the Maternity and Child Welfare Committee or the Medical Officer of Health, also for complications after confinement, including deficient lactation. Contributions towards the service are required in connection with maternity nursing and the nursing of puerperal fever and puerperal pyrexia, the amount being assessed according to ability to pay. Home Helps. Home Helps are available for service in homes during confinements and in special circumstances prior to confinements—contributions towards the cost are required in accordance with ability to pay. Midwives. The Borough Council does not employ or subsidise midwives. National Health Insurance. No necessity has arisen for any special co-operation. Laboratory Facilities. Bacteriological examinations (sputum, swabs, etc.), carried out at the laboratory of the Royal Institute of Public Health, Queen Square. Chemical analysis, milk and foodstuffs, carried out by the Borough Analyst at his laboratory, Finsbury Town Hall, Roscbery Avenue, E.C. 1. 13 Legislation in Force. Local Acts.—The London County Council (General Powers) Acts, 1893-1935. Special Orders.—The Holborn (Acute Rheumatism) Regulations, 1935, requiring the notification of acute rheumatism in children up to the age of 16 years. Transfer of Powers (London) Order, 1933—transferring certain duties from the London County Council to the Borough Council in respect of (a) Building Lines; (b) Disused Burial Grounds; (c) Seamen's Lodging Houses; (d) Thames and other Embankments; (e) Common Lodgingi Houses; (f) Cow houses and places for keeping cows; (g) Infant Life Protection; (h) Offensive Trades; (i) Slaughter houses and Knackers' yards. Merchandise Marks Act, 1926.—Orders relating to imported Fresh Apples; Currants, Sultanas and Raisins; Eggs (Hen or Duck) in shell; Dried Eggs; Oat products; Raw Tomatoes; Bacon and Ham; Dead Poultry; Meat; Frozen or Chilled Salmon; Butter; Honey. New Legislation. (a) Acts of Parliament— (1) Housing Act, 1936. (2) The Public Health (London) Act, 1936. (3) The Shops Act, 1936. (4) The Midwives Act, 1936. (b) Orders and Regulations— (1) Milk (Special Designations) Order, 1936. (2) Housing Acts (Forms of Orders and Notices) Regulations, 1936. (3) Housing Acts (Overcrowding and Miscellaneous Forms) Regulations, 1936. (4) Housing Acts (Extinguishment of Public Right of Way) Regulations, 1936. (5) Housing Acts (Equalisation Account) Regulations, 1936. (6) The Poisons (Colouring) Rules, 1936. (7) The Poisons (Appeals to Quarter Sessions) Rules, 1936. By-Laws and Regulations in force, relating to Public Health, made dy London County Council. Subject. Act under which made. Date. Ash pits and receptacles for dung ditto Public Health (London) Act, 1891 ditto 28th June, 1893 11th July, 1913 Bone boiler, manure manufacture ditto 25th November, 1907 or tallow melter Common lodging houses L.C.C. (General Powers) Act, 1902 14th August, 1903 Conveyance of dead horses ditto 1903 21st February, 1905 Cleansing and disinfection of lairs Foot and Mouth Diseases Order, 1928 1st April, 1931 and vehicles for conveyance of animals Drainage Metropolis Local Management Act, 1885 28th July, 1934 Demolition of buildings L.C.C. (General Powers) Act, 1927 4th November, 1929 Dresser of fish skins Public Health (London) Act, 1891 28th November, 1907 Dresser of fur skins ditto ditto Fat melter ditto ditto Fishmonger . ditto ditto 14 By-Laws and Regulations in force, relating to Public Health, made by London County Council, continued. Subject. Act under which made. Date. Fish curer L.C;C. (General Powers) Act, 1908 28th February, 1914 Food, protection of L.C.C. (General Powers) Act, 1932 July, 19336 Fried fish, vendors of L.C.C. (General Powers) Act, 1908 March, 1914 Gut scraper and catgut maker Public Health (London) Act, 1891 28th November, 190" Glue and size manufacturer ditto ditto Hairdressers' establishments in which massage treatment is given L.C.C. (General Powers) Act, 1915 15th June, 1921 Knacker, business of Public Health (London) Act, 1891 25th November, 1907 Massage establishments ... L.C.C. (General Powers) Act, 1920 28th July, 1921 Nursing homes Nursing Homes Registration Act, 1927 1st March, 1929 Offensive matter, removal of Public Health (London) Act, 1891 26th November, 1901 Rag and bone dealers LC.c. (General Powers) Act, 1908 18th September, 1921 ditto ditto 20th June, 1928 Receptacles for dung Public Health (London) Act, 1891 3rd January, 1905 Seamen s lodging houses Merchant Shipping Act, 1894 1st April, 1917 Spitting in public places Municipal Corporation Act, 1882, 12th May, 1903 and Local Government Act, 1888 Soapboiler Public Health (London) Act, 1891 25th November, 1907 Slaughter of poultry ditto ditto ditto ditto 31st July, 1935 Slaughter houses Slaughter houses, etc. (Metropolis) Act, 1887, and Local Government Act. 1888 27th October, 1891 Smoke emission Public Health (Smoke Abatement) Act, 1926 19th May, 1931 Tripe boiler Public Health (London) Act, 1891 25th November, 1907 Tenement houses Public Health (London) Act, 1891, and Housing Act, 1925 5th March, 1926 ditto ditto 8th June, 1931 Water closets, urinals, etc. Public Health (London) Act, 1891, and LC.C. (General Powers) Act, 1928 21st August, 1930 Waste paper and refuse in streets Municipal Corporations Act, 1882, and Local Government Act, 1888 29th May, 1906 Made by the Holborn Borough Council. Subject. Act under which made. Date Prevention of Nuisances, snow, ice, Public Health (London) Act, 1891 19th August, 1923 salt, dust, rubbish, offal, carrion, fish, filth or other matter or thing in any street Offensive matterfrom manufactory, etc. ditto ditto Keeping of animals Paving of yards ditto ditto ditto ditto Decent conduct of persons using ditto 15th March, 1897 public lavatories Nuisance from wireless loud speakers or gramophones Municipal Corporation Act, 1882, and Local Government Act, 1888, and London Government Act, 1889 7th November, 1930 S uppression of s treet cries ditto 12th October, 1900 Cleansing of cisterns Public Health (London) Act, 1891 19th August, 1893 Nuisances by dogs (excrement on public way) Municipal Corporation Act, 1882, and Local Goverment Act, 1888, and London Government Act, 1899 April, 1926 Regulation of Public Baths and Washhouses Baths and Washhouses Act, 1846 May, 1877 Street trading, regulations of L.C.C. (General Powers Act, 1927) Feb. 1928 Underground rooms Housing Act, 1925 ... February, 1936 15 Hospitals. Hospitals provided or subsidised by the Local Authority or by the London County Council. Fever and Smallpox.—Hospitals for patients suffering from these diseases are provided by the London County Council—one of the hospitals of the Council (St. Margaret's) is also available for cases of Marasmus and Ophthalmia Neonatorum. Tuberculosis.—Residential institutional treatment for tuberculosis is provided by the London County Council. The Borough Council's Tuberculosis Dispensary is situated at, and linked up with, the University College Hospital. Maternity.—The Borough Council has arranged for the reservation of beds for maternity cases at the University College Hospital. Contributions towards cost of maternity service are paid by the Council to : University College Hospital; City of London Maternity Hospital; Royal Free Hospital; and other hospitals providing maternity service for Holborn mothers. Hospitals Situated in the Borough of Holborn—Not Subsidised by the Local Authority. Name. Situation. Purpose. Number of Beds. Management. Remarks. French Hospital and Dispensary Shaftesbury Avenue General — for all poor who speak French 70 Voluntary body Hospital for Sick Children Great Ormond Street A general hospital for the treatment of sick children from birth up to 12 years of age 2,6 Voluntary body Italian Hospital Queen Square General — for people of Italian extraction especially, but all nationalities treated 53 Voluntary body National Hospital Queen Square Nervous system, paralysis and epilepsy 186 Voluntary body Royal Westminster Ophthalmic Hospital Broad Street Eye 88 Voluntary body London Homoepathic Hospital Great Ormond Streets Queen Square General 200 Voluntary body St. Paul's Hospital Endell Street... For diseases (including cancer) of the genitourinary organs and skin 33 Voluntary body N.B —The me of the above hospitals extends to residents outside the Holborn Borough area. 16 Maternity and Nursing Homes. The Local Supervising Authority in London under the Nursing Homes Registration Act, 1927, is the London County Council. Maternal Mortality. Maternal deaths are investigated by the Medical Officer of Health; cases of puerperal fever and puerperal pyrexia by the Health Visitors. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. There are no institutions for unmarried mothers, illegitimate children or homeless children in the Borough, but St. Faith's Home, Myddleton Square, receives such mothers from the Holborn area. Institutions for the Care of Mental Defectives. There is no institution in the Borough for the care of mental defectives. Ambulance Facilities (see inside of back cover). For Infectious Cases—Provided by the London County Council ('Phone : Waterloo 3311). For Non-Infectious Cases—The Ambulances of the London County Council. (Minimum fee 10/-.) For Accidents—The London County Council and the St. John Ambulance Association. For Maternityr-The London County Council Ambulances ('Phone Waterloo 3311). Clinics and Treatment Centres. Ante-natal and Post-natal Clinic. 10, John Street (Municipal) Tuesday at 2 p.m. Short's Gardens (Municipal) Thursday 2 p.m. Maternity and Child Welfare. Tuesday ] 10, John Street (Municipal) Thurrday at 2 p.m. Friday St. Giles' Saffron Hill, On.low Stre.t Pre-School Child. 10, John Street (Municipal) Monday at 2 p.m. Minor Ailments Clinic. 10, John Street (Municipal) {Friday at 2 p.m. Diphtheria Schick Test and Immunisation. 10, John Street (Municipal) Wednesday at 2.30 p.m. General. Bloomsbury Dispensary, 12, Bloomsbury Street ... Daily. Acute Rheumatism (Children), up to age of 12 years. Hospital for Sick Children, Great Ormond Street Daily. Dental. 10, John Street, for expectant and nursing mothers and children up t« 5 years (Municipal) ... Thursday at 2 p.m. (Altered to Monday at 2 p.m. from May 10th, 1937.) 10, John Street, General and for Tuberculous Patients Tuesday at 6.30 p.m. 17 School Clinics. The following treatment Centres are provided under the L.C.C. Schemcs :— (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. (6) Cleansing Station (Pediculosis Capitis) Holborn Borough Council Cleansing Station, Goldsmith Street. 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) Homcepathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nooe and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensary, University College Hospital. (13) University College Hospital. Day Nurseries.—Established and controlled privately :— Kingsway Creche, Kingsway Hall, Kingsway. Field Lane Institution Creche, Vine Street, Clerkenwell Road. St. Alban's Day Nursery, Greville Street. Tuberculosis Dispensary. At University College Hospital (entrance in Huntley Street). Venereal Diseases.—Treatment clinics are arranged by the London County Council. Those in the Borough are : St. Paul's Endell Street, daily 8 a.m. to 10 p.m. Hospital for Sick Children (for children only), Great Ormond Street, 9-10 a.m. daily and 2-4 p.m., except Wednesday and Saturday. Cleansing Station for Verminous Persons. Goldsmith Street, Drury Lane. Births and Deaths—Registration. Oakley House, 14, Bloomsbury Street. Daily, 10 a.m. to 12 noon, and 2 to 3 p.m. Saturdays, 10 a.m. to 12 noon. Public Vaccinators. Eastern part of Borough—East of Southampton Row. Dr. Robinson, 43, Rosebery Avenue. 11 am. to 12 noon; and 6.30 to 8 p.m., except Thursday evening. Western part of Borough—West of Southampton Row. Dr. G. D. Fairley, 15a, Gower Street. 9 to 10 a.m.; and 6 to 7 p.m., except Wednesday evening. Ambulance Service. Particulars of the ambulance services available in the Borough are given on the inside page of the back cover. 18 SANITARY CIRCUMSTANCES OF THE BOROUGH. Removal of Offal. One breach of the by-laws made by the London County Council came to our notice. In this case particulars were furnished by the Police of high smelling offensive liquid running from the side of an uncovered commercial lorry on to a roadway in the Borough. A letter was addressed to the owner of the lorry, who at once undertook to ensure that no repetition of the offence should occur. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-Laws and Regulations. In addition to my inspections, the Sanitary Inspectors made 18,325 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, 1936. Mr. Bennett Mr. Clark Mr. Crabtree Mr. Fisher Mr. Larard Miss Charlesworth Miss Stock well Total Complaints received 9 35 24 1 45 … … 114 Do. found to be justified 9 35 24 1 45 … … 114 Inspection of Houses— Dwelling-houses 83 320 138 8 140 1 … 685 Houses let in lodgings 74 314 148 … 186 1 … 723 Common lodging-houses 3 13 2 … 3 1 … 22 Drains tested by chemical 1 1 3 ... 1 … … 6 Do. smoke 2 27 4 … 14 … … 47 Do. water 30 66 70 6 56 … … 218 Underground rooms 3 15 9 … 1 ... … 28 FacTOHIES — Bakehouses ... 1 ... 8 … … … 9 Food preparation 45 1 29 … … … 29 Other 55 17 260 … … 378 Laundries ... … ... … ... … … … WonKSHors and Workplaces — Food premises: Dairies and Milkshops 2 1 … 186 … … … 189 Ice Cream, Manufacture … 1 … 9 … … … 10 Do. Storage or Sale … … ... 100 … … … 100 Slaughter-houses … 1 12 1 … … … 2 Hotels and Restaurants … 6 552 4 … … 674 Butchers … … ... 221 1 … … 222 Bakehouses … … … 2 … … … 2 Fish shops … 2 … 2 1 … … 5 Fried Fish shops … 1 … 5 … … … 6 Market Streets 1 31 11 240 94 … … 377 Licensed Premises … … … 1 2 … … 3 Other food shops 1 4 1 666 2 … … 674 Merchandise Marks Act, 1926 1 7 … 14 … … … 22 Other workshops 90 92 13 1 276 27 … 499 Other workplaces 44 144 89 8 201 … … 489 Outworkers' Registers 6 40 7 … 33 … … 86 Do. Rooms … ... ... … ... … … … Laundries ... … … … … … … … Stables and Stable yards 1 14 … … … … … 15 Rag and Bone shops 3 2 … ... ... … … 5 Offices 3 3 … … 21 … … 28 Shops (Shops Act) 3 190 22 … 165 2 … 382 Pharmacy and Poisons … •• ... 235 … … … 235 Inspections carried forward  Mr. Bennett Mr. Clark Mr. Crabtree Mr. Fisher Mr. Larard Miss Charlesworth Miss Stockwell Total Brought forward Miscellaneous— Black smoke 6 21 43 1 66 ... ... 137 Rats and Mice (Destruction) Act 9 140 126 1 69 ... ... 345 Food and Drugs Act—Sampling ... ... ... 596 ... ... ... 596 Demolition of Buildings 42 35 20 ... 7 ... ... 104 Other Inspections ... ... ... ... ... ... 1 1 Keeping of Animals 1 1 ... ... ... ... ... 2 Periodical Inspections: Including W.C. and yards, dust-bins, especially houses let in lodgings, and other similar dwellings 441 1,839 250 ... 2,521 ... ... 5,051 Re-Inspections— Houses 651 892 904 4 452 ... ... 2,903 Factories 1 16 ... 3 8 ... ... 28 Workshops 2 10 . 1 39 1 ... 53 Workplaces 253 462 252 10 555 ... ... 1,532 Restaurants ... ... ... 1 ... ... ... 1 Licensed premises ... ... ... ... ... ... ... ... Miscellaneous ... ... 1 1 ... 33 121 166 Visits re Infectious Diseases 23 92 36 9 42 110 178 490 Scabies ... ... ... ... ... 1 5 6 Verminous persons ... ... ... ... ... ... ... ... Other Visits— Police Courts 1 ... ... 1 ... ... ... 2 Various 120 361 97 94 165 8 2 847 Total 1,955 5,200 2,254 3,033 5,386 185 310 18,323 19 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 947, viz.:— Public Health (London) Act, 1891— Intimation Notices 342 Statutory Notices 59 By-laws— Houses let in lodgings 518 London County Council (General Powers) Acts— Verminous rooms 19 Rats and Mice (Destruction) Act, 1919 9 947 20 The following table shows the work done to abate nuisances for which intimation notioce were served: — Water Supply— Houses. Factories, Workshops and Workplaces Provided — 4 Cisterns cleansed, repaired etc. 12 3 Waterclosets— Cleansed 9 12 Water supplied, flushing cistern repaired, etc. 1 4 Repaired, new pans, etc. 38 13 Ventilation improved 1 9 Separate accommodation for sexes provided — 8 Position or construction improved 3 9 Direct communication with workrooms remedied 6 Accommodation provided 2 3 Unstopped 26 1 Urinals, repaired, cleansed, etc. — 2 Soil Pipes— Repaired, renewed and ventilated 4 3 Rainwater Pipes— Repaired or renewed 5 7 Drains— Repaired 11 12 Unstopped, cleansed, etc 8 7 Sinks, eto.— Waste pipes repaired, renewed, etc. 17 5 Yards, Areas and Washhouses— Cleansed 7 2 Paved and paving repaired 5 — Drained — 3 Houses and Workshops, etc.— Cleansed 29 22 Dilapidations repaired and made good 24 1 Ventilation improved — 10 Dampness— Roofs repaired 40 7 Gutters repaired 6 2 Other works to prevent dampness 11 2 Ashbins— Provided, repaired, etc. 28 3 V arious— Underground Rooms vacated 3 — Smoke—Emission of black smoke abated — 5 Accumulations of Refuse—Removed 29 14 •Overcrowding abated — 1 Animals improperly kept — — Manure Receptacles—Provision of — — Other 12 16 * This applies to overcrowding under the Public Health (London) Act, 1891. For overcrowding dealt with under the Housing Acts, see page 21 The following table shows the nuisances for which the 59 Statutory Notices were issued under the Public Health (London) Act, 1891: — Houses. Factories, etc Section 2 (1)— (a) Dirty, dilapidated, damp premises, etc. 21 2 (b) W.C.'s, drains, ete. 21 — (c) Water cisterns and water supply 1 2 (d) Animals improperly kept — — (e) Accumulation of refuse 12 1 (f) Overcrowding — — (g) Ventilation 1 — Section 21 (1)—-Effuvia — — Section 24—Smoke — 5 Section 37—Ashbins 4 — Section 37—Waterclosets 1 2 Section 38—W.C. dirty or defective, etc. 18 1 Section 38—W.C. accommodation for sexes — — Seotion 96—Underground rooms — — By-Laws as to Houses let-in-lodgings. At the end of the year, 427 houses were registered under these By-laws. Of these, 192 were wholly or partly decontrolled under the Bent Act at* the end of 1936. There were 723 inspections of these premises, excluding a large number of periodical inspections and re-inspections. 191 notices were served for breaches of the By-laws, in addition to 427 notices that were served for annual cleansing as required by the By-laws. Rag and Bone Dealers. On inspection of rag and bone shops made in the year 1936, 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, under the provisions of the above Act, 215 separate premises were inspected, ranging from small dwelling houses to large blocks of offices and business premises. In 70 cases the Inspectors discovered evidence of rat infestation. Notices under the Act were served as necessary, and advice given with a view to adequate 22 steps being taken to eradicate the vermin. In 13 cases traps were used, 5 occupiers laid down poison baits. In 18 cases professional rat catchers were employed, and in 26 cases the nuisances were abated following new drainage or satisfactory methods of rat-proofing. The Eat Officers reported that in a number of cases where no evidence of rats was found at their inspections the satisfactory condition was the result of continued efforts, initiated in previous years, for rat repression, such as the regular use of traps, cats, poisons, or the employment of professional rat catchers. The following is a summary in tabular form of the conditions found and action taken in the various wards of the Borough: — Rats and Mice (Destruction) Act, 1919. Summary of conditions found on inspections, action taken and results obtained. WARD. Number of premises inspected. Number rat infested. Action for Rat Repression. RESULT. Traps. Poisons. Rat catchers. Dogs. Cats. Proofing a. 9 - - - - - - - B. 64 10 1 1 - - - 8 Free 8 Rats occasionally seen 1 Under observation 1 C. 3 1 1 — — ' — — 1 Free 1 d. 52 9 1 1 — — — 8 Free 9 e. 2 2 — — 1 — — 2 Free 1 Under observation 1 F. 17 11 2 1 1 — — 7 Free 10 Under observation 1 g. 12 12 4 — — — — 10 Free 9 Rats occasionally seen 1 Under observation 2 H. 44 14 3 2 10 — 1 5 Free 7 Under observation 5 Reported free o I. 12 9 1 6 1 1 Free 7 Under observation 2 215 68 13 5 18 — 2 42 Free 54 Rats only occasionally seen 2 Under observation 12 23 National Rat Week. In response to the request of the Ministry of Agriculture and Fisheries, " Eat Week " was observed in the Borough in the week commencing 2nd November, 1936: — The following is a summary of the action taken: — (i) Prior to the week the District Sanitary Inspectors visited premises known or suspected to be rat infested, and advised that intensive action for dealing with the nuisance should be taken during rat week. In a number of cases definite arrangements for such action were made. (ii) The preparatory visits were followed by revisits during or after rat week when the Inspectors reported that the agreed action had been taken. (iii) Letters were sent to all chemists and hardware dealers in the Borough asking them to stock and display, during rat week, suitable poisons and traps. (iv) The Ministry of Agriculture Poster was exhibited throughout the Borough. (v) The rat baits laid in the Council's sewers were increased in rat week to 4,000 " Eatin " baits, and during the month of January this increased number was repeated by placing 4,000 " Batinin " baits in the same sewers. In connection with this the Borough Engineer and Surveyor writes:— '' Eat repression is definitely successful in the sewers of the Borough, to such an extent that we now have to select sewers in which to lay the major number of baits, as certain sewers are so free from infestation that the baits are not taken. " The Sewer Foreman and the Sewer Gangers all speak very highly of the efficiency of the ' Ratin ' and ' Batinin ' which is used." Drainage Works. Every house in the Borough is connected with the water carriage system for the disposal of sewage. Work connected with new drainage, reconstruction of old systems and alterations to existing drainage, is supervised by the Sanitary inspectors. During the year 155 applications were received for the Council's approval to proposed drainage and sanitary works. All the applications received were approved, subject in some instances to amendments being made which were necessary in order to secure compliance with the London County Council Drainage By-laws. Smoke Abatement. The smoke Shafts in the Borough were kept under frequent inspection, 137 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. Six complaints were received of nuisances 24 from the emission of smoke. As the result of inspections made, five intimation notices and five statutory notices were served. The use of unsatisfactory coal is the common cause of smoke nuisance, 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. 415 factories were inspected, 505 workshops and 3,103 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 54 premises no longer used for the purpose for which they had been registered were removed from the register of workshops. In some cases, owing to the introduction of machinery, former"workshops" had become "factories" and the necessary transfer to the factory register was effected. Variations in the staff employed were also frequently reported. Daring the year 55 workshops were added to the register. At the end of the year there were 620 workshops on the register. 377 employed men only, 38 employed women only, and 205 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. or Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 14 - 2 16 Builders 11 — — 11 Carpenters 14 — 1 15 Clock and watch makers 19 — 1 20 Dressmakers and ladies' tailors — 11 21 32 Diamond mounters 8 — 1 9 Engravers 18 — 1 19 Glass blowers 8 — 2 10 Jewellers 35 2 12 49 Leather goods makers 5 1 5 11 Metalworkers 7 — 4 11 Tailors 25 3 51 79 25 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. At the end of the year 494 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 494 factories include 57 different industries. In 237 cases men only were employed, in 17 women only, and in 240 both sexes. The more important industries carried on in these factories are:— Printing 126 Engineering 42 Jewellers' work 30 Bookbinding 17 Metal work 12 Factory and Workshop Inspection—Summary. The following is a summary in tabular form of the work done by the Inspectors in factories, workshops and workplaces in the year 1936:— Mr. Bennett. Mr. Clark Mr. Crabtree Mr. Larard Mr. Fisher. Miss Charles worth. Total. Factories— Inspections (including factory bakehouses) 55 46 1 260 54 — 416 Re-inspections 1 16 — 8 — — 25 Workshops— Inspections 90 92 13 276 1 22 494 Re-inspections 2 10 — 39 — 1 52 Workplaces— Inspections 44 144 89 201 8 3 489 Re-inspections 253 462 252 555 10 — 1,532 Offices— Inspections 3 3 — 22 — — 28 Re-inspections — 2 — — — — 2 Bakehouses— Inspections (excluding factory bakehouses) — 1 — — 10 — 11 Re-inspections — — — — 3 — 3 Restaurants— Inspections — 6 12 4 552 — 574 Re-inspections — — — — 1 — I Licensed Premises— Inspections — — — 2 1 — 3 Re-inspections — - — - - — — Defects Found— Want of cleanliness — 8 — 14 — — 22 ,, ventilation 1 10 — — — — 11 Overcrowding — — — 1 — — 1 Storage cistern defective 1 — — — — — 1 Accommodation for refuse — 1 — 2 — — 3 Accumulation of refuse 3 2 2 7 — — 14 Sanitary accommodation Insufficient 1 — — — — — 1 Unsuitable — 3 — 6 — — 9 Defective — 5 1 8 — — 14 Not separate for sexes - 1 - 7 - - 8 Other nuisances 7 22 2 39 - — 70 Total defects 13 52 5 84 - — 154 26 Action taken. Matters referred to H.M. Inspector:— Failure to affix abstract 3 Matters referred by H.M. Inspector Notified by H.M. Inspector 17 Notices served. Mr. Bennett. Mr. Clark. Mr. Crabtree. Mr. Larard. Miss Charlesworth. Total. Factories— Intimation 4 — - 12 — 16 Statutory — — — — — — Workshops— Intimation 15 7 - 18 - 40 Statutory 3 — — — — 3 Workplaces— Intimation 19 4 4 45 — 72 Statutory 2 2 — 6 — 10 Offices— Intimation 1 — — — — 1 Statutory — — — — — — Restaurants— Intimation 1 - — — — 1 Statutory — — — - — — Licensed Premises— Intimation — - — — - — Legal Proceedings - - - - - — Outworkers. Lists received from Holborn Firms 105 Names and addresses received from other Authorities 387 Names and addresses sent to other Authorities 279 Notices served on Employers 96 Firms visited 103 Infectious diseases in outworkers premises nil Rag Flock Acts, 1911 and 1928. There are no premises in the Borough on which rag flock, as defined by the above Acts, is known to be manufactured, used or sold. The Shops Act, 1934. This Act came into force on the 30th December, 1934. It applies to retail and wholesale shops and warehouses. The Act contains provisions for the health and comfort of shop workers, dealing with ventilation, temperature, lighting, sanitary conveniences, washing facilities and facilities for taking meals, if these have to be taken in the shop. The responsibility was placed on Metropolitan Borough Councils for the administration of the sections dealing with ventilation, heating and the provision of sanitary conveniences. The Act requires adequate means of ventilation and lighting to be provided and maintained and, unless the shop is specially exempt, suitable and sufficient sanitary conveniences must be provided for those employed in or about the shop. 27 During the year 382 inspections were made under this Act; in 21 cases it was found that the requirements respecting ventilation, heating, or the provision of sanitary conveniences were not complied with. In all cases the attention of owners and occupiers was called to the matter and the necessary steps taken to effect compliance with the requirements of the Act. In 7 cases on applications from owners or occupiers certificates of exemption under Section 10 of the Act (provision of sanitary conveniences) were granted, the Public Health Committee being satisfied that suitable sanitary conveniences could not be provided in the shops but were otherwise conveniently available. Inspection of Private Swimming Baths. In conjunction with the Baths Manager-Engineer the customary inspection was made of the private swimming baths at the Y.M.C.A. Central Club, Great Russell Street, and Messrs. Bourne and Hollingsworth's, Warwickshire House, Gower Street. In both of these baths, the condition of the water was found to be satisfactory, and the purification plants to be working efficiently. The auxiliary hygienic measures were also satisfactory. Advice to the operators responsible for maintaining the desirable standard of purity and hygiene in the Borough's Private Bathing establishments is given by the Baths Department, as and when required. It would appear desirable for an advisory supervision to be exercised over any projected schemes in the Borough which propose to include private swimming baths. Such an arrangement would ensure that the high standard maintained by existing establishments would be applied to new ones. HOUSING. The following is the summary of information asked for in the Ministry of Health Circular 1561 (England):— [.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 708 (b) Number of inspections made for the purpose 1,179 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 107 (b) Number of inspections made for the purpose 184 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (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 185 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 23 III.—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) by owners nil (b) by Local Authority in default of owners — B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 185 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 185 (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 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6* 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 62† (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil IV.—HOUSING ACT, 1935.—OVERCROWDING:— A.— (i) Number of dwellings overcrowded at the end of the year 664 (ii) Number of families dwelling therein 664 (iii) Number of persons dwelling therein 3,461 B.—Number of new cases of overcrowding reported during the year 51 C.—(i)Number of cases of overcrowding relieved during the year 87 (ii) Number of persons concerned in such cases 267 D.—Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding nil E.—Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. See p. 29. Accommodation on L.C.C. Estates. During the year information was received of 46 Holborn families for whom accommodation was provided by the London County Council. *Three other houses were demolished, pursuant to Demolition Orders, early in 1937. †In addition, undertakings as to future user of, or the execution of works to, underground rooms and parts of buildings were accepted in seven cases. 29 New North Street (North and South) Areas. On the 10th June, 1936, the Council defined two areas in the Borough, known as the New North Street (North and South) Areas, as clearance areas under Section 1 of the Housing Act, 1930, as amended by the Housing Act, 1935. The Northern Area comprises the dwelling-houses Nos. 7-14, inclusive, New North Street, and No. 1, East Street, and the Southern Area comprises the houses Nos. 2-5, inclusive, New North Street. The total of the two areas is 0.54 acre. Prior to the areas being defined by the Council, an assurance was received from the London County Council that that Authority would provide all the rehousing accommodation required in connection with the clearance operations, subject to contribution by the Borough Council towards the cost of providing the accommodation. Later in the year (11th November, 1936), the Council approved a housing scheme proposed to be erected on the sites of the areas together with certain additional lands, and application was made to the London County Council for sanction to borrow for the purposes of the scheme. Warner Street Areas. On the 12th May, 1936, the London County Council passed a resolution declaring the Warner Street (Nos. 1, 2, 3 and 4) Areas, Holborn, to be clearance areas under Section 1 of the Housing Act, 1930, as amended by the Housing Act, 1935. The London County Council proceeded to deal with the areas by making compulsory purchase orders in respect of areas 3 and 4, and certain additional lands for the purposes of development; and clearance orders in respect of areas 1 and 2. The London County Council propose to develop the land acquired by erecting flats for the working classes thereon. A local enquiry into the orders mentioned above was held by direction of the Minister of Health by W.J. Brown, Esq., F.R.I.B.A. (Inspector), at the Holborn Town Hall, on the 10th, 11th and 12th December, 1936. During the preparation of this report, information has been received that the Minister of Health on the 9th March, 1937, confirmed the orders made by the London County Council with regard to areas Nos. 2, 3 and 4, and did not confirm the order with regard to area No. 1. Abatement of Overcrowding. The following table shows the position with regard to overcrowding in the Borough during the year 1936:— Overcrowding, 1936. No. of cases of overcrowding on record on 1st January 700 No. of new cases of overcrowding recorded during the year 51 751 No of cases of overcrowding abated during the year:— Survey cases 83 Other 4 — 87 No. of cases of overcrowding remaining on record at 31st December 664 30 The number of cases of overcrowding abated during the year were recorded as having been dealt with in the following manner:— Accommodation provided by London County Council 51 Accommodation provided by Borough Council 5 Accommodation secured otherwise 27 Abatement by alteration in constitution of family 4 87 The Housing of the Working Classes Committee of the Council continued to give attention to the provision of new housing accommodation for the further abatement of overcrowding. As a result the Council on the 11th November, approved a scheme on a site in New North Street (referred to above). The scheme provides for the erection of a block of 45 flats, consisting of 8 flats of 3 rooms, 34 of 4 rooms, 1 of 5 rooms, and 2 of 6 rooms. The total number of persons who could be accommodated in these flats on the basis of 1½ persons per room is 265. The total number of persons who would be displaced by the demolitions incidental to the scheme is 246. At the end of the year a further scheme for the erection of 49 flats on a site on the Northern side of East Street was being considered by the Committee. It is hoped that in the report for 1937, it will be possible to record a considerable advance in connection with these two proposed housing schemes. Rehousing. The Council continued to take advantage of the agreement with the London County Council for the provision of rehousing accommodation for families displaced by this Council's operations under the Housing Act, 1930. During the year 9 cases were approved by the Council for inclusion in the agreement and of these, 5 families had been rehoused by the end of the year. Regulations as to Underground Rooms. On the 8th January, 1936, the Council prescribed regulations for securing the proper ventilation and lighting of rooms to which Section 18 (1) of the Housing Act, 1925 (now Section 12 of the Housing Act, 1936), applies, and the protection thereof from dampness, effluvia or exhalation. The regulations were submitted to the Minister of Health, and approved by him on the 20th February, 1936. These regulations repeal the regulations as to underground rooms habitually used as sleeping places which were prescribed by the Council on the 3rd December, 1914, and to which consent of the Local Government Board was given on the 2nd February, 1915. Overcrowding Survey. The preliminary survey of overcrowding was completed early in 1936, and a summary of the results was given in last year's Annual Report'. During the early part of the year under review, the measurement of rooms in all the houses covered by the survey was completed. Holborn Housing Trust. The extension of Bevan House, Devonshire Street, referred to in my Annual Report for 1935, consisting of 12 three-room flats and 4 one-room flats, was 31 pleted by the Trust and ready for occupation on the 1st July, 1936. During the year, the Council entered into an agreement with the Holborn Housing Trust pursuant to Section 27 of the Housing Act, 1935, whereby these dwellings were placed at the disposal of the Council for rehousing of working class persons displaced in consequence of action taken under Part I or Part II of the Housing Act, 1930. The Minister of Health approved the proposed arrangements, and the flats were let by the Trust to the Council's nominees shortly afterwards. Council's Housing Estates. (a) Review of Bents at Betterton House. The Council reviewed the rents charged to tenants of the 30 flats at Betterton House, and general reductions were made for all types of flats. The reduction in rents was intended to bring the rents charged at Betterton House into line with the rents charged for comparable accommodation at the Council's dwellings at Boswell House. (b) Appointment of Caretaker at Betterton House. The Council appointed a caretaker to be employed at Betterton House, Betterton Street, with a view to securing better management and supervision of the tenants and of the building. Housing Act, 1935. Fixing of Appointed Days. During the year the Council had under consideration the question of the appointed days to be fixed for the purposes of Sections 3, 4, 6, 8 and 68 of the Housing Act, 1935, and on the 13th January, 1937, agreed to ask the Minister of Health to fix the 1st January, 1938, as the appointed day for the purposes of Sections 3, 4, 8 and 68 of the Housing Act, 1935, and the 1st July, 1937, for the purposes of Section 6 of the Act. Housing Act, 1930, Section 41. Allowances towards Removal Expenses. During the year the Council made allowances towards the cost of removal of 16 families displaced in consequence of action taken by the Council under Part II of the Housing Act, 1930. 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 1936, the number of registered dairies and milkshops in the Borough was 137. 32 Eight entries were made in the register during 1936. Of these, 3 were cases where a change of occupier had necessitated re-registration, and 5 were new registrations, one being of an itinerant vendor with premises outside the Borough. The Sanitary Inspectors recorded 189 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 1936 licences available up to the 31st December, 1936, for the sale of designated milk in the Borough were issued as follows: — Certified 2 Grade A (Tuberculin Tested) 3 Grade A (Pasteurised) 1 Pasteurised 7 Supplementary— Certified 1 Grade A (Tuberculin Tested) 2 Pasteurised 4 20 Bacteriological Examinations of Milk. The following table shows the results of examinations in 1936:— Nature of premises where sample obtained. Grade No. of organisms per c.c. grown at 37C for 24 hours. Minimal volume containing Bacillus Coli. Evidence of Tuberculous Infection Remarks. Street Ungraded 20,000 0.1 c.c. None Street Ungraded 80,000 0.1 c.c. None General Shop Ungraded 300,000 1 c.c. None Dairy Ungraded 140,000 0.01 c.c. None Dairy Ungraded 200,000 0.001 c.c. None Dairy Ungraded 10,000 1 c.c. None School Pasteurised — — — See footnote* School Pasteurised 12,000 Absent in 1 c.c. None School Pasteurised 80,000 Absent in 1 c.c. None Street Ungraded 65,000 0.01 c.c. None School Pasteurised 11,000 1 c.c. — See footnote* School Pasteurised 200,000 1 c.c. None See footnote† School Pasteurised 50,000 1 c.c. None School Pasteurised 200,000 1 c.c. None See footnote† Street Pasteurised 90,000 1 c.c. None General Shop Ungraded 2,000 Absent in 1 c.c. Nona *Examined for Haemolytic Streptococcus. Direct examination showed the presence of a streptococcus. Cultures showed the presence of a streptococcus of a haemolytic type. †Found not to comply with requirements of Milk (Special Designations) Order, 1923. 33 Of the sixteen samples submitted for bacteriological examination, fourteen were examined for the presence of tubercle bacillus. The animals inoculated with respect to these milks were killed at the end of six weeks. It is satisfactory to record that in no case was any evidence disclosed of tuberculous infection. Fifteen of the samples were examined to ascertain the number of organisms per cubic centimetre, and the smallest volume containing coliform bacilli. It will be seen from the table that in two cases the milk did not comply with the condition laid down by the Milk (Special Designations) Order, 1923. These two samples were each found to contain 200,000 organisms per c.c. in comparison with 100,000 permitted by the Order. Information respecting these samples was forwarded to the Medical Officer of Health of the District in which the pastuerising plant was situated, and, as both were samples of milk supplied at schools, the School Medical Officer of the London County Council was also informed. Inspection of the premises in the Borough from which the milk in question was sold gave evidence of unsatisfactory conditions. Special consideration was given to the matter by the Public Health Committee, and an undertaking by the milk vendor was accepted, by which he agreed to carry out extensive works of improvement and take other necessary steps to ensure strict compliance with the Orders dealing with the retail sale of milk. Margarine. There are eight registered wholesale dealers in the Borough. Bakehouses. At the end of the year 1936 there were 19 bakehouses in the Borough of which 12 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. Sale of Fish. The necessary routine inspeetions were made of the fish shops and fish stalls in the Borough in addition to market street inspections. There are 14 fish shops, of which eight are 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 are sold at all the shops; at five, shell fish also is 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 15 fried fish shops. These are inspected to see that they are kept in conformity with the By-laws made by the London County Council. 34 Market Streets. There were 377 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, including Saturday evening inspections. In order to minimise as far as practicable any contamination of the food exposed for sale in market streets from dust arising during street cleansing, the Borough Surveyor has arranged for these streets to be sufficiently watered before the scavenging. Street Trading. I received information from the Borough Engineer respecting 94 applications from street traders for annual licences to sell various articles of food as follows:— Coffee stalls 5 Confectionery and drinks 11 Fish—wet and dry, including shell fish 7 Fruit and vegetables 45 Groceries 7 Ice cream or chestnuts 11 Meat 4 Poultry, eggs and provisions 4 94 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. At the end of the year the following premises were on the register:— Manufacture and storage 1 Manufacture and sale — Manufacture, storage and sale 20 Storage and sale 17 Sale only 22 60 In addition to my inspections, 110 inspections of these premises were made. Where ice cream sold in the Borough is made at premises outside Holborn, it is the practice to ask for information as to the conditions of manufacture from the 35 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. Publio Health (Meat) Regulations, 1924. 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 27 Butchers' stalls 1 Provision dealers 35 Provision dealers' stalls 3 Offal shops 3 Cooked meats 20 Wholesale (bacon; sausage) 5 94 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 222 such inspections were made. Places where Food is prepared for Sale. Under this head are included kitchens of hotels, restaurants, and eating-houses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food is prepared for sale excluding bakehouses. The number of such places on the register at the end of the year was us follows:— Hotels, Restaurants and Eating Houses 479 Slaughter-houses 1 Tripe, offal and other meat shops 48 Fried fish shops 15 Fish shops 14 Ice cream (Manufacture) 21 Poulterers 8 During the year 1,892 inspections of such food premises and market streets were made and 7 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" 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. 36 Unsound Food. The following unsound food was condemned during the year 1936:— Article. Country of origin. Tons. Cwt. Qrs. Lbs. 5 tins Pineapple and 1 tin Apricot Pulp Singapore ... ... ... 16 Spain 14 crates Egyptian Bananas Egypt ... 14 0 0 400 tins Fruit, Vetgetables and Fish Spain ... 6 0 0 Norway U.S.A. 14 crates South African Peara S. Africa ... 14 0 0 264 tins Tomato Paste Italy 2 0 0 6 tins Spinach France ... ... ... 12 12 tins Loganberries English ... ... ... 12 10 tins Spinach France ... ... ... 20 3 tins Peas English ... ... ... 6 31 tins Tomato Paste Hungary ... ... ... 10 1 tin Peas France ... ... ... 2 3 tins Tomatoes, 1 tin Tomato Paste and 1 tin Sardines Italy ••• ... ... 8 Portugal 4 ting Black Currants English ... ... ... 8 1 tin Ox Tongue English ... ... ... 12 4 tins Artichokes France ... ... ... 6 4 tins Peas English ... ... ... 8 1 tin Peas English ... ... ... 2 1 tin Pineapple Singapore ... ... ... 2 1 tin Tomato Puree Hungary ... ... ... 7 1 tin Celery Hearts France ... ... ... 2 20 cases Peeled Tomatoes Italy 1 0 0 0 8 cases and 11 tins Sliced Salami Sausage Italy 1 0 0 0 Quantity of Tinned Fruit, Vegetables and Fish U.S.A. 1 17 0 0 France do. do. Spain 1 19 0 0 Russia do. do. Italy 1 17 0 0 Hungary do. do. S. America 1 3 0 0 Australia Holland Poland Belgium 9 tins Olives Spain ... ... 1 0 7 cases, 33 tins Tomato Paste, 4 cases Tinned Tomatoes, 3 cases Tinned Beans Italy ... 10 0 0 Belgium 34 tins Gherkins Holland ... 3 0 0 4½ cases Tinned Carrots France ... 4 8 0 12 tins Sardines Portugal ... ... ... 12 1 case Avocado Pears France ... ... ... 28 Quantity of Tinned Fruit, Vegetables and Fish U.S.A. 3 0 0 Spain English France do. do. England ... 2 0 0 U.S.A. do. do. Japan ... 8 0 0 32 tins Peeled Tomatoes Italy ... ... 3 0 64 do Hungary ... 1 2 0 Quantity of Chocolate and Glace Fruits England ... 4 0 0 France Quantity of Tinned Foods, Preserves and Custard Powders U.S.A. ••• 10 0 0 England do. do. Spain ... 2 0 0 Costa Rica do. do. England ... 2 0 0 2 bags New Potatoes Jersey 2 0 0 28 jars Pickles, etc., 4 Puddings, 1 tin Beef, 1 tin Biscuits England ... ... 1 17 5 tins Fish, 1 tin Tomatoes, 1 tin Sphagetti Russia ... ... ... 14 Italy 37 Article. Country of origin. Tons. Cwt. Qrs. Lbs 6 tins Chicken in Jelly Poland ... ... ... 12 75 tins Mandarins Japan ... ... 3 0 Quantity of Chocolates England ... 2 0 0 do. England ... 4 0 0 3 Chickens Holland ... ... ... 6 3 Chickens Holland ... ... ... 6 11 bags Potatoes Holland ... 11 0 0 53 tins Pineapple Singapore ... 3 0 0 34 cases Melons Spain 1 14 0 0 64 do. Spain 3 4 0 0 12 do. Spain ... 12 0 0 15 tins Peeled Muscats Spain ... ... ... 15 3 tins Figs, 5 tins Tomato Puree Italy ... ... ... 16 1 tin Haricot Verts France ... ... ... 2 2 tins Grapes Spain ... ... ... 2 Quantity of Tinned Fruits and Milk France ... ... 3 0 Italy Singapore 6 tins Fruit and Quantity of Dried Fruit Italy ... ... ... 12 36 tins Tomato Soup Canada ... ... 1 8 18 tins Rhubarb, 1 tin Sweet Potatoes Japan ... ... 1 8 28 lbs. Bacon Denmark ... ... 1 0 Quantity of Tinned Fruit and Vegetables Belgium ... ... ... 24 20 tins Liver Paste Denmark ... ... 2 4 1 crate Bananas Canary Isles ... 1 0 0 12 tins Sardines Portugal ... ... ... 6 4 tins Raspberries, 2 tins Cherries English ... ... ... 6 12 tins Cherries, 1 tin Asparagus, 2 tins Vegetables, 1 and Garlic U.S.A. ... ... ... 20 Italy England Quantity of tinned Fruits, Vegetables and Fish Sweden ... ... ... 14 England France 1 tin Asparagus, 2 tins Loganberries and 1 tin Peaches Canada ... ... ... 6 U.S.A. Italy 11 gallon tins Peas England ... 1 0 20 43 tins Salmon Canada ... ... 1 16 1 tin Mushrooms, 3 tins Celery England ... ... ... 10 France 2 tins Black Currants England ... .. ... 4 Quantity of Tinned Foods, etc France ... 10 0 0 England Spain U.S.A. Quantity of Bacon Dutch ••• ... ... 7 do. Dutch ... ... ... 21 3 tins Black Currants, 1 tin Tomato, 1 Tinned Ham England ... ... ... 20 Italy England Total 20 9 1 20 The Public Health (Preservatives, etc., in Food) Regulations. In the year 1936 two samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., mustard and sausages (see page 43). 38 Food and Drugs (Adulteration) Act, 1928. Articles Analysed. Formal Samples. article. Number Purchased Result of Analyses Proceedings taken. Convictions. Fines and Costs. Genuine. Adulterated. Ale 4 4 ... ... ... ... Ale, ginger 1 1 ... ... ... ... Almonds, ground 3 3 ... ... ... ... Apricots, dried 4 4 ... ... ... ... Asparagus, canned 1 1 ... ... ... ... Bacon 1 1 ... ... ... ... Beans, baked 1 1 ... ... ... ... Beans, canned 2 2 ... ... ... ... Beer 6 6 ... ... ... ... Bicarbonate of soda 3 3 ... ... ... ... Brandy 4 4 ... ... ... ... Brawn 3 3 ... ... ... ... Bread 1 1 ... ... ... ... Bread and butter 2 2 ... ... ... ... Browning 1 1 ... ... ... ... Butter 34 34 ... ... ... ... Butter milk 1 1 ... ... ... ... Cake 1 1 ... ... ... ... Cake, fish 1 1 ... ... ... ... Cake, sponge 1 1 ... ... ... ... Candy, cokernut 1 1 ... ... ... ... Celery and Cheese 1 1 ... ... ... ... Celery, canned 1 1 ... ... ... ... Cheese 15 15 ... ... ... ... Cheese, cream 2 2 ... ... ... ... Cheese, lemon 1 1 ... ... ... ... Chocolate 1 1 ... ... ... ... Cocoa 1 1 ... ... ... ... Coffee 3 3 ... ... ... ... Coffee and chicory 2 2 ... ... ... ... Coffee and gloria 1 1 ... ... ... ... Cookeen 1 1 ... ... ... ... Cordial, cherry 1 1 ... ... ... ... Cordial, ginger 1 1 ... ... ... ... Cordial, lime juice 4 4 ... ... ... ... Cordial, raspberry 1 1 ... ... ... ... Cordial, strawberry 2 2 ... ... ... ... Cornflour 2 2 ... ... ... ... Cream 5 5 ... ... ... ... Cream, canned 6 5 ... ... ... ... Cream, ice 1 1 ... ... ... ... Cream, horse-radish 4 4 ... ... ... ... Crystals, jelly 1 1 ... ... ... ... Dripping 2 2 ... ... ... ... Egg substitute 2 2 ... ... ... ... Extract, coffee 1 1 ... ... ... ... Extract, coffee and chicory 2 2 ... ... ... ... Fish, fried 5 5 ... ... ... ... Fish, fillets 1 1 ... ... ... ... Frankfurters 1 1 ... ... ... ... Galantine, veal and ham 1 1 ... ... ... ... Gin 6 6 ... ... ... ... Glycerine 4 4 ... ... ... ... Honey 1 1 ... ... ... ... Iodine 2 2 ... ... ... ... Isinglass 1 1 ... ... ... ... Jam 11 11 ... ... ... ... Jelly 4 4 ... ... ... ... Juice, black currant 1 1 ... ... ... ... Juice, grape 2 2 ... ... ... ... Juice, lemon 1 1 ... ... ... ... 39  ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Pines and Costs. Genuine. Adulterated. Lard 3 3 ... ... ... ... Lemonade 1 1 ... ... ... ... Liniment of turpentine 1 1 ... ... ... ... Loganberries, canned 2 2 ... ... ... ... Macaroni, with cheese 1 1 ... ... ... ... Macaroni, egg 1 1 ... ... ... ... Margarine 13 13 ... ... ... ... Marmalade 7 7 ... ... ... ... Mayonnaise 1 1 ... ... ... ... Milk 132 129 3 1 1 Fine 40s. Costs 42s. Milk, condensed 3 3 ... ... ... ... Mincemeat 1 1 ... ... ... ... Mince pies 4 4 ... ... ... ... Mustard 5 2 3 ... ... ... Noodles, egg macaroni 1 1 ... ... ... ... Oil, camphorated 1 1 ... ... ... ... Oil, olive 7 7 ... ... ... ... Ointment, blue 1 1 ... ... ... ... Ointment, boracic 2 2 ... ... ... ... Ointment, gall and opium 1 1 ... ... ... ... Ointment, sulphur 2 2 ... ... ... ... Ointment, white precipitate 2 2 ... ... ... ... Oranges, canned 1 l ... ... ... ... Oysters, canned 1 l ... ... ... ... Onions, pickled 1 1 ... ... ... ... Paregoric 3 3 ... ... ... ... Paste, fish 6 6 ... ... ... ... Paste, meat 3 3 ... ... ... ... Piccalilli. 1 1 ... ... ... ... Pickles 1 1 ... ... ... ... Peas, canned 2 2 ... ... ... ... Pepper 6 6 ... ... ... ... Pimientoes, marrones 1 1 ... ... ... ... Powder, baking 2 2 ... ... ... ... Powder, custard 1 1 ... ... ... ... Powder, gelatine 1 1 ... ... ... ... Powder, ice cream 1 1 ... ... ... ... Powder, lemonade 5 3 ... ... ... ... Powder, lemon and barley 1 1 ... ... ... ... Prawns 1 1 ... ... ... ... Prescription 1 1 ... ... ... ... Pudding, Christmas 3 3 ... ... ... ... Pudding, fruit 1 1 ... ... ... ... Pudding, plum 1 1 ... ... ... ... Quinine, ammo, tinct. of 2 2 ... ... ... ... Quenchers, thirst 1 1 ... ... ... ... Raisins 2 2 ... ... ... ... Rhubarb, comp, tinc, of 1 1 ... ... ... ... Rice 2 2 ... ... ... ... Rolls, sausage 2 2 ... ... ... ... Rum 3 3 ... ... ... ... Ryvita 1 1 ... ... ... ... Salts. Epsom 1 1 ... ... ... ... Salad cream 1 1 ... ... ... ... Salad, fruit 1 1 ... ... ... ... Salad, mayonnaise 1 1 ... ... ... ... Salad, potato 1 1 ... ... ... ... Salmon, canned 3 3 ... ... ... ... Sardines 11 11 ... ... ... ... Sauce 5 6 ... ... ... ... Sausages 10 9 1 ... ... ... Sherry 1 1 ... ... ... ... Sirop, lime 1 1 ... ... ... ... Slices, French cream 1 1 ... ... ... ... Snack, hot 1 1 ... ... ... ... Sponge roll 1 1 ... ... ... ... Spread, tasty 1 1 ... ... ... ... 40 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken Convictions. and Costs. Genuine Adulterated. Spry (vegetable lard) 1 1 ... ... ... ... Squash, grape fruit 4 4 ... ... ... ... Squash, lemon 3 3 ... ... ... ... Squash, orange 5 5 ... ... ... ... Stout 1 1 ... ... ... ... Suet, shredded 3 3 ... ... ... ... Sugar 5 5 ... ... ... ... Sweets 5 5 ... ... ... ... Syrup, golden 1 1 ... ... ... ... Syrup, grenadine 1 1 ... ... ... ... Syrup, peppermint 1 1 ... ... ... ... Syrup, pineapple 1 1 ... ... ... ... Syrup, strawberry 1 1 ... ... ... ... Soup 1 1 ... ... ... ... Tea 4 4 ... ... ... ... Tomatoes, canned 1 1 ... ... ... ... Tomato, cream 1 1 • •• ... ... ... Treacle 1 1 ... ... ... ... Velard 1 1 ... ... ... ... Vinegar 22 21 1 ... ... ... Wafers 1 1 ... ... ... ... Water, lemon and barley 1 1 ... ... ... ... Whisky 6 6 ... ... ... ... Wine, black currant 1 1 ... ... ... ... Wine, cherry 1 1 ... ... ... ... Wine, ginger 8 8 • •• ... ... ... Wine, port 1 1 ... ... ... ... Wine, raisin 3 3 • •• ... ... ...... Wine, orange 3 3 ... ... ... ... Witch Hazel 1 1 ... ... ... ... Total 557 549 8 1 1 Fines 40s. Costs 42s. The following information is given respecting the samples which were reported to be adulterated, but in respect of which legal proceedings were not taken:— Milk.—Warning letters were sent to the vendors in two cases where the deficiency in fat was small. In one of these the sale of milk from the shop concerned was discontinued. Mustard.—In one case the vendor was protected by a declaration on the container in which the mustard was sold. In two cases the samples were imported products, and correspondence ensued with the Consul-General of the country of export with a view to the matter being brought to the notice of the exporter and the food authority of the country concerned. Sausages.—The vendor in this case was able to establish evidence that the sausages were sold subject to a notice exhibited in the shop disclosing the presence of preservative. Vinegar.—This case was met by correspondence with the producer of the vinegar. 41 Informal Samples. article. Number of Samples Taken. Result of Analyses. Genuine. Adulterated. Black currants, canned 1 1 ... Bread and butter 1 1 ... Caramel 1 1 ... Chicken, breast in jelly 1 1 ... Chocolate, milk 1 1 ... Chocolate. nut 3 3 ... Chocolate, nut milk 1 1 ... Chocolate, waste 1 1 ... Macaroons, chocolate 1 1 ... Meat, pieces 2 2 ... Oil, olive 1 1 ... Ointment, iodine 1 1 ... Paint, iodine 1 1 ... Pudding, steak and kidney 1 1 ... Puree, tomato canned 3 3 ... Rolls, sausage 1 1 ... Sardines 8 7 1 Sauce 4 4 ... Sild, canned 1 1 ... Sugar 1 1 ... Tomatoes, canned 1 1 ... Vinegar 7 3 4 Total 43 38 5 Notes of the Borough Analyst on Samples examined during the Year 1936. During the year 1936, 600 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 557 having been purchased with the required formalities and 43 obtained informally. Of this total 13 (2.2 per cent.) proved to be adulterated, eight being samples submitted formally and five informally. In the previous year 1.8 per cent. of the samples were certified to be "not genuine." The adulterated articles consisted of Milk, Mustard, Sardines, Sausages and Vinegar. Milk.—One hundred and thirty-two samples of Milk were analysed and three . of these (2.3 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. All three samples were deficient in fat to the extent of at least 5 0, 3.0 and 40 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 132 samples of Milk indicating their places of origin, and (2) the Monthly Variation in the Chemical composition. 42 No. 1. Fat Content. Number of .Samples. Percentage of Fat Number of Samples. Shops. Restaurants. Streets. School. Total Less than 3.0 2 ... 1 ... 3 3.1 3 1 ... ... 4 3.2 11 ... 3 ... 14 3.3 18 2 4 ... 24 3.4 7 1 7 ... 15 3.6 17 ... 4 1 22 3.6 12 1 3 ... 16 3.7 6 1 1 ... 8 3.8 12 ... 1 ... 13 3.9 6 ... 1 ... 7 4.0 2 ... ... ... 2 4.1 1 ... ... ... 1 4.3 1 ... ... ... 1 4.8 2 ... ... ... 2 Total Samples 100 6 25 1 132 Average fat content 3.52% 3.40% 3.40% 3.5% 3.50% No. 2. Monthly Variation of Chemical Composition of Milk, 1936. Month. Number of Samples examined. Total Solids. Per cent. Average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 14 12.65 9.09 3.56 February 13 12.51 9.11 3.40 March 10 12.62 9.12 3.50 April 14 13.17 9.58 3.59 May 8 12.35 9.05 3.30 June 8 12.49 8.92 3.40 July 8 12.52 8.91 3.61 August 13 12.24 8.87 3.37 September 17 12.47 8.91 3.56 October 17 12.18 8.43 3.75 November 7 12.57 8.94 3.63 December 3 12.30 8.94 3.36 Whole year 132 12.50 8.99 3.50 Legal minimum ... 11.50 8.50 3.00 43 It will be observed that the average composition of the milk supplied to the Borough during the year was fat 3.5 per cent. and non-fatty solids 8.99 per cent. These figures approximate very closely to those of the previous four years, averages of which are tabulated below:— Year. No. of samples examined Total solids. (average). Fat. (average). Non-fatty solids. (average). 1932 177 12.60 3.71 8.89 1933 196 12.40 3.60 8.80 1934 224 12.47 3.52 8.95 1935 218 12.48 3.55 8.93 1936 132 12.49 3.50 8.99 These results indicate that the milk supplied to the Borough during the past five years has been of good quality as far as the content of fat and non-fatty solids is concerned. Mustard.—Two of the samples of mustard sold as "prepared mustard" were found to contain 151 and 137 parts per million of sulphur di-oxide respectively, and were certified accordingly. It has been suggested that, as mustard (in common with other cruciferous plants) naturally contains certain sulphur compounds, the sulphur di-oxide found in these cases, is derived from the natural component which exists in the mustard in the form of sulphide and that this is converted into a sulphate during the process of the estimation of any added sulphite present, and is thus responsible for the apparent presence of sulphur di-oxide. I may point out that other samples of "prepared mustard" examined by me have been found to be free from sulphur di-oxide, and that the sulphur naturally present in the cases in question, was removed before the sulphur di-oxide was estimated. It may be of interest to mention that these particular adulterated samples were from a foreign source. Sausages.—One of the samples of sausages had been preserved with a sulphite preservative; the quantity found was 103 parts per million of sulphur di-oxide. A limited quantity of sulphite preservative may be used in sausages provided that notice of its presence is given to the purchaser. Vinegar.—One of the samples of vinegar contained 55 parts per million of sulphur di-oxide, thereby contravening the Preservative Regulations. The quantity was somewhat small and was possibly due to some carelessness rather than to actual adulteration. Four other samples of vinegar were deficient in acetic acid or had been diluted with water, so as to reduce the quantity of acetic acid below the recognised standard. In these cases the shortage was from 18 to 20 per cent. Vinegar should contain at least 4, per cent. of acetic acid, but at present there is no definite legal standard or limit for this article. 44 This last observation only serves to emphasise once more the neccessity for the appointment of some small, permanent Committee with official power to make or revise standards for all articles of food as, and when, the necessity arises. For instance, Public Analysts and the trade generally, are practically agreed that (vinegar shall not contain less than 4 per cent. of acetic acid, and this limit has received official recognition, but it has not been legalised in any way. The question also arises as to the definition of vinegar itself. Some authoritites appear to regard any dilute solution of acetic acid containing at least 4 per cent. of that body as vinegar, whilst others are of opinion that only the liquid obtained from the fermented extract of malt or grain or, possibly wine, can be so regarded, and that liquors derived from the treatment of wood, etc., ought not to be called vinegar. What is needed is that a definite standard should be laid down for each type of vinegar, and it should be made obligatory to label or indicate to the purchaser what it is he really buys. A case has recently been before the Courts on this question which clearly emphasises some of the difficulties which confront all those who are concerned in the legal or scientific administration of the Food and Drugs Act. This is only one of many instances calling for some further action on this subject. 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. During the year under review daily inspections under the Orders in force were made by the Inspector appointed for the purposes of the Act, resulting in the detection of 17 breaches of the Orders. In all of these cases the breach was remedied following a verbal caution from the Inspector. 45 London County Council (General Powers) Act, 1932. Registration of Food Premises. At the date of the preparation of this report 54 premises were registered in accordance with the requirements of the Act, for the purposes shown below:— Sausages 19 Preserved meat 20 Pickled meat 7 Preserved fish 8 All the premises concerned were carefully inspected prior to registration. Notification of Food Poisoning. During the year 1936 three cases of suspected food poisoning were notified. In one case the poisoning was said to be due to roast chicken with sausage stuffing purchased at a retailer's shop in the Borough. On enquiry it was ascertained that the chicken in question was from an imported consignment, received frozen and subsequently thawed, gutted, stuffed and cooked. The premises occupied by the retailer, and the food stored or exposed for sale, were carefully inspected. The patient recovered. No other cases arose from the same suspected source of infection. The other two patients were members of one family (female, aged 25, and male, aged 22 years). Both suffered from acute gastritis thought by them to arise from the eating of cherries. Of the three members in the family, two, the patients, both partook of the cherries; the third member, did not eat cherries and was not ill. On enquiry it was found that the cherries had been boiled in an enamel saucepan with white sugar. Some cherries similar to those eaten, and the saucepan, were examined by the Borough Analyst who reported that he found no trace of antimony, zinc, or other poisonous metal. A portion of the enamel of the saucepan was also examined, but on analysis no antimony, arsenic, lead or zinc was detected. A reaction was obtained for a trace of tin. Both patients recovered. In view of the risk of antimony poisoning due to the use of enamelled vessels of inferior quality for the preparation of lemonade and other acid drinks, opportunity was taken to issue a circular letter to the proprietors of confectionery shops and restaurants, where such beverages are sold, drawing attention to the outbreaks of food poisoning arising from this source in recent years and stressing the importance, not only of every possible care being taken in the preparation of acid drinks, but also that the greatest care should be given to the choice of jugs and other vessels in which such drinks are stored. Information of all notified cases of food poisoning in the County of London is distributed to Medical Officers of Health by the County Medical Officer. Slaughter of Animals Act, 1933. One application was received and granted from a slaughterman for renewal of licence to slaughter under Section 3 of the Act. 46 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. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. Yearly average 1926-1935 Pneumonia (all forms) 32,339 37,242 31,014 43,846 27,724 33,573 29,588 30,059 28,623 26,786 32,079 Pulmonary Tuberculosis 30,108 31,066 29,799 31,425 29,414 29,658 27,627 27,854 25,682 29,201 29,183 Measles 3,483 3,622 4,302 3,388 4,188 3,288 3,411 1,937 3,768 1,346 3,273 Whooping Cough 4,118 3,681 2,976 6,332 2,037 2,512 2,956 2,270 2,049 1,584 3,051 Diphtheria 2,994 2,732 3,191 3,446 3,497 2,673 2,339 2,646 4,085 3,488 3,109 Scarlet Fever 677 579 580 717 740 540 530 729 963 573 663 Enteric Fever 367 367 438 382 313 251 258 222 159 174 293 47 The total number of notifications relating to Holborn residents received during the year was 369 in comparison with 383 in the year 1935. The following are the principal variations:— Scarlet Fever 67 in comparison with 50 in 1935. Tuberculosis 90 ,, ,, 73 ,, Whooping Cough 76 ,, ,, 99 ,, Diphtheria 60 „ ,, 93 „ 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 202 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 77 Erysipelas 1 Measles 6 Scarlet Fever 27 Tuberculosis 46 Whooping Cough 18 Pneumonia 1 Acute Poliomyelitis 2 Encephalitis Lethargica - Dysentery 22 Mumps — 202 Smallpox. No case of smallpox occurred in a Holborn resident during the year 1936. Vaccination. The following table gives information respecting the vaccination of Holborn children during the year ended 30th June, 1936:— Total Number of Births Vaccinated Died before Vaccination Cons. Objections Insusceptible Postponed by Medical Certificate Incorrect Address- Not traced. Temporarily unaccounted for 299 160 (54%) 12 37 — 11 71 8 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. 48 Diphtheria. We received notifications relating to 60 cases of diphtheria occurring in residents in the Borough. All were removed to hospital. Age at Notification of 60 Notified Cases of Diphtheria. 0—1 1—5 5—15 15—35 35—45 45—65 65 upwards Total. 1 17 22 18 — 1 1 60 Three deaths occurred. Seven of the notified cases were returned from hospital certified as not suffering from diphtheria. Secondary clinical cases were two in number; details follow: — Primary Case Age Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises G. N 20 19/7/1936 G. D. 21 22/7/1936 Tenement house M. H. 7½ 2/10/1936 J. H. 3 2/10/1936 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, 7,030 cases were notified, giving rise to 226 deaths. There is co-operation with the Medical Superintendents of the Fever Hospitals serving the County of London; and information is exchanged as to bacteriological and other details; and also with regard to return cases of diphtheria or scarlet fever. Diphtheria in Hospitals. Information was received of 76 cases of diphtheria occurring among inpatients and staff at two hospitals in the Borough. The information was obtained from the notifications of removal received from the London County Council, or from the ordinary notification certificates furnished by the doctors diagnosing the disease. Of the 76 cases, 70 were clinical cases (29 were notified "nasal"). Of the total number, seven notifications related to Holborn residents, all being members of the resident medical or nursing staff. Sixty-nine 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. 49 Diphtheria in Hospitals. Hospital. Cases Notified. Disease notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 4 62 60 6 4 62 66 B. 3 7 10 — 3 7 10 Diphtheria antitoxin was available free of charge on application by medical practitioners. 10,000 units were supplied for one case. Diphtheria " Carriers." Information was received from the School Medical Officer (L.C.C.) of three 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 prophylactics used are toxoid antitoxin for children, and toxoid antitoxin floccules (suspension) for adults. 177 persons attended this clinic during 1936, making a total of 2,654 since 1922. Of the 177 (144 children and 33 adults) 123 children, nearly all of whom were under five years, were inoculated without preliminary Schick test. Schick Testing. Twenty-one children (mostly over five years) were tested, of whom— 16 gave a positive reaction to the test. 5 gave a negative reaction. Thirty-three adults (over fifteen years) were tested, of whom— 18 gave a positive reaction to the test. 15 gave a negative reaction. Immunisation. One hundred and fifty-seven persons (139 children and 18 adults) received inoculation. Of these, 145 completed the routine course, while 12 (8 children and 4 adults) failed to complete. Re-Schick Testing. Sixty-two persons were tested two months or more after completion of the course. These included 8 who attended prior to 1936. Fifty-four were children and 8 were adults— 52 children gave a negative reaction to retest. 2 children gave a positive reaction. These two received further inoculations and will be retested in due course. All the adults were negative to the retest. 50 Age groups of 177 persons attending during 1936. Ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years Adults 16 years and above Total for 1936 0 1 0 2 1 4 1 4 2 1 3 1 1 0 0 33 Total Schick Tested 54 Result ok Schick Tbst. | Pos. | Neg. Pos. Neg. Poe. Neg. Pos. Neg. Pos. | Neg. | POB. | Neg. Pos. | Neg. Pos. | Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. |Pos. Neg. - - - 1 - - 1 1 1 - 3 1 1 - 4 - 2 - 1 - 2 1 - 1 1 - - - - - 18 15 34 Pos. 20 Neg. Received inoculation without preliminary Schick test. 3 37 27 22 26 7 1 - - - - - - - - - Total inoculated without preliminary Schick test 123 Total received inoculation (includes inoculation of Schick positives as shown above). 3 37 27 23 27 10 2 4 2 i 2 - 1 - - 18 Total 157* *12 of these failed to complete the routine inoculation. 51 The following table gives particulars of two cases of diphtheria in children Schick-tested and treated with immunising injections. Initials Age in years at date of Schick Test Sex 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 M.W. 1 F. 25/10/33 8/11/33 yes negative 14/3/36 2½ years L.C.C. (N.E. Hospital) Moderate faucial diphtheria J.B. 4 F. 10/5/33 24/5/33 yes negative 27/7/36 3 years L.C.C. (N.E. Hospital) Clinical appearances were rather doubtful ; more like diphtheria than not Diptlitheria was also notified as having occurred in one other child who had been found negative to retest, but the diagnosis was not confirmed. 52 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 were continued during 1936. At this hospital Schick testing of all newcomers and immunisation of positives is now customary. From June, 1930, till the end of December, 1936, 204 nurses were tested; 21 of these were tested for the first time in 1936, 12 being positive and 9 negative. Nine were inoculated, three probationers not remaining at the hospital. 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 67 notifications of scarlet fever. Sixty-four were removed to hospital. Seven of these were returned from hospital diagnosed as not suffering from this disease. From one hospital in the Borough 22 in-patients were notified as so suffering; none was resident in Holborn. There were two " return " cases of scarlet fever, i.e., secondary cases occurring after the return home of the primary case. In one of the two, however, the primary patient was not removed from Holborn although he returned to Holborn from hospital to the home address to which his parents had removed. Seven notifications of " secondary " cases were received. There was no death from this disease. 10,705 cases of scarlet fever were notified in London with 42 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, which have been extended to the 31st December, 1938, by the Holborn (Acute Rheumatism) Regulations, 1935, dated 10th December, 1935. 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. 53 Information of thirteen cases was received in 1936. Age and Sex Distribution of notified cases. Age in years. Sex M. F. Total. 6 2 — 2 7 1 — 1 9 1 1 2 10 2 3 5 11 1 1 12 1 — 1 13 — 1 1 Totals 8 5 13 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 7 lived in satisfactory artisan self-contained flats; one lived in a satisfactory artisan home, a divided house of a comfortable type (a better class of house let in lodgings); 5 lived in houses let in lodgings. Dampness in Houses. No signs of dampness were found in any of the houses in which the thirteen children were resident. Lighting and Ventilation. One child lived in a semi-basement flat, and another in a flat in which 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. The remaining homes were well ventilated and the lighting good; in only one case was ventilation or lighting markedly unsatisfactory. Overcrowding. There was overcrowding within the meaning of the Housing Act, 1936, in two of the houses, and steps were taken to remedy this condition. Sleeping Arrangements. One child had a separate room; four children had separate beds, two of these in rooms shared with another child, one in a room shared with two children and one in a room with three adults. Eight children shared a bed, five with one other child, one with two other children, and two with one adult. Social Conditions. In three homes there was a history of chronic poverty; in two of these the mother had been many years widowed. Value of Notification of Rheumatism in Children. The periodic visiting which follows upon notification enables the health visitor to bringhome to the parents the need of special 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 made to secure for him the best conditions within the reach of the parents. 54 There are often 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. 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 this work or run the risk of losing it, it is no solution of the difficulty to suggest that the family shall remove to some other 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 thie night. Condition of the Nose and Throat. In seven children the condition of the tonsils was stated to be normal. Four children had their tonsils removed; and one of these also had adenoids removed. In two cases tonsillectomy and removal of adenoids were advised as part of the treatment for rheumatism. Of the four children referred to above, in two cases the removal of the tonsils coincided with the reported onset of rheumatism, in that the diagnosis of the rheumatic condition was made in connection with the attendance of the children at hospital on account of tonsilitis. Teeth. All children are reported to be under dental supervision, with treatment if required, as part of the school organisation. Contacts. A history of pains in limbs was reported in the contacts of six 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 Officcr in order that they might be observed and examined if necessary. History of Patients after leaving school. During 1936 six children, previously notified, ceased to attend school and are occupied as follows : — (1) Boy (A.S., æt. 15) is a casual worker. ('2) Girl (J. R., æt. 14) tailor's assistant. (3) Girl (J. G., æt. 14) is a messenger. (4) Girl (R. W., æt. 14) is a shop assistant. (5) Girl (J. N., æt. 14) dressmakers' apprentice. (6) Girl (B. M., æt. 14) is a cracker factory hand. Two children reached the age of 16 during 1936, 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. Co-operation with the school organisation was continued, 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. 55 Typhoid and Paratyphoid Fever. Enteric Fever. Two notifications were received of Holborn residents suffering with enteric fever. In the first, a female, aged 40, the bacteriological examination gave a positive agglutination against B. Typhosus (0) in a dilution of 1 in 250, but was negative against B. Typhosus (H), B. Paratyphosus A and B, and Paratyphosus B. No evidence was obtainable of infection in England. It was, however, found that the patient had recently been spending a holiday on the Continent. The second case was that of a female, aged 22. In this case the Widal reaction was positive for B. Typhosus in a concentration in 1 in 1,000: Typhoid Bacilli were isolated from the stools and the blood count showed a leucopenia with a relative lymphocytosis. The patient arrived at an hotel in the Borough from Poland the day before the illness began. Two hundred and fifty-five cases were notified in London giving rise to 31 deaths. Typhus Fever. No case of typhus fever was notified during the year in the Borough or in London. Cerebro-Spinal Fever. Two cases of cerebro-spinal fever were notified in the Borough. One hundred and thirteen cases were notified in London, giving rise to 71 deaths. Dysentery. Amoebic. Three cases were notified. In two of these the history showed that the illness had been contracted in India. All cases were treated in hospital. Bacillary. No cases of Flexner or Shiga type were notified. There were three cases of Sonne Dysentery. The patient in one case was a nurse in the ward of a hospital where there were several cases. The source of the infection was not traced. The other two cases also occurred in hospital; and in this instance also the source of infection was not discovered. Three hundred and four cases were notified in London with 16 deaths. Malaria. Two cases of malaria were notified. Thirty-five cases were notified in London with 2 deaths. Encephalitis Lethargica. No case of encephalitis lethargica was notified in the Borough during the year. Since the Public Health (Encephalitis Lethargica) Regulations came into force on the 1st January, 1919, twenty-one cases of the disease have been brought to our notice as occurring in Holborn. In thirteen of these it is known that the disease proved fatal, and three cases had left the British Isles. At the end of 1936 two patients were still in hospital; one was an out-patient at a hospital; one 56 was reported as completely recovered; and in one case the report was " seems well, attends no hospital, nervous at times." In London twelve cases of acute encephalitis lethargica were notified during the year 1936, and in the same period 54 deaths were registered as due to this disease. Acute Poliomyelitis and Acute Polioencephalitis. No case of these diseases was notified as occurring in the Borough during 1936. Thirty-eight cases were notified in London, giving rise to 11 deaths. From the coming into operation of the Poliomyelitis Order, 1912, to the end of 1936, eighteen cases were notified in the Borough. Of these five have died; three are reported as recovered with no crippling or only a slight limp; one is sufficiently recovered to work but has surgical footwear and has a slight limp; one has lost the use of left arm, but is attending Polytechnic classes; three go to school and five cannot be traced at the addresses given or have been lost sight of on removal from the Borough. Pneumonia. Thirty cases of pneumonia were notified during the year. Four of these were influenzal pneumonia. Two deaths were recorded from all forms of pneumonia. The 26 casea of primary pneumonia were notified at the following ages :—From 1 to 5 years, 4; from 5 to 15 years, 2; from 15 to 35 years, 6; from 35 to 45 years, 5; from 45 to 65 years, 7; and 65 years and upwards, 2. Twelve were treated at home; 3 were removed to L.C.C. hospitals; 11 to voluntary hospitals. Three of the patients were nursed by the Metropolitan Nusing Association, under the arrangements made by the Council. Eighty-six visits were made to these patients—all recovered. Enquiry respecting the cases of primary pneumonia elicited the following information :— 16 resided in tenement lodging houses, 1 in self-contained flats, 5 in model dwellings, 1 in a hotel, and 1 in a hostel and 2 in boarding houses. The cleanliness of the houses were reported satisfactory in 21 cases, but only fairly so in 1, and the other cases no information was obtained. The economic conditions of the families concerned were found to be good in 6 cases, fair in 13, poor in 3. Influenza. There were 2 deaths (1 male, 1 female) from influenza, in comparison with 3 in 1935, 3 in 1934, 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 1936 we received information of 31 cases. These were visited and where necessary kept under observation. Mumps. Information was received from school teachers and others of 10 cases of mumps. 57 Bacteriological Work. The following table gives details of the examinations made during the year : — Diphtheria Pulmonary Tuberculosis Other Diseases Number Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination. 279 Bacilli not found 252 Diphtheria Bacilli found 27 Vincent's organisms found — 80 Bacilli not found 72 2 Negative 1 Bacilli found 8 Positive 1 Disinfections. During the year 487 rooms and 4,538 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Thirty-seven rooms and 393 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. Two hundred and forty-two books and 91 toys were disinfected. The disinfections also included 16 lockers, and 8 hospital wards. Cleansing of Persons Act. During the year 99 persons (97 men and 2 women) infested with vermin had their bodies and 1,103 articles of clothing disinfected, free of charge, at our cleansing station (Goldsmith Street). Shelter during 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 1936 the accommodation was used by one Holborn family comprising two persons. Extermination of Yermin. One hundred and forty verminous rooms were disinfested by the Council's staff. In dealing with verminous rooms, the fumigation is repeated, whenever practicable, 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 130 cases last year this second fumigation was carried out. When this course was for any reason impracticable, the occupiers of the rooms were advised to use a disinfecting spray, and to take such other measures as appeared likely to prevent recurrence of the infestation. From time to time in recent years it has become necessary to deal with vermin infestation in new or comparatively new dwellings. It is found that usually the infestation arises from infested furniture brought by the incoming tenants into the new dwellings from verminous rooms formerly occupied by them. To prevent 58 risk of such infestation, particularly in regard to new occupations of municipal dwellings, arrangements have been made for furniture disinfestation by the hydrocyanic gas method. This has been made practicable by an agreement with the Council of the Royal Borough of Kensington. The procedure is that the infested furniture is removed in the morning in a special type van and after disinfestation is delivered in the evening of the same day at the new home. The bedding is collected by the Council's staff treated in the steam disinfector and delivered at the new home at approximately the same time as the furniture. Cancer. During the year 1936, 67 deaths were recorded as due to Cancer in comparison with 58 in the previous year. The deaths in 1936 were equal to a rate of 1.93 per thousand, the corresponding rate in 1935 being 1.64 per thousand. It will be seen that the death rate from Cancer in the Borough in 1936 was 0.29 per thousand higher than in the previous year. 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, 1917-1926 was 1.41 the corresponding rate for the ten years, 1927-1936 was 1.71. 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. 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 1936 in the form required by the Ministry of Health: — Age periods. New Casta. Deaths- Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 - - - - - - - - 1 1 1 2 5 4 — — 1 10 — 1 — — 16 1 1 — 1 — — — — 20 5 8 2 1 3 3 — — 25 9 7 2 2 — 2 — — 35 11 4 - 1 5 — — — 45 9 2 — — 3 1 — — 55 7 2 — 1 6 5 — 1 65 4 1 — — 4 — — — 50 27 5 8 22 11 — 1 59 Total number of cases on the Register of Tuberculosis in the Borough on the Blst December, 1936 340 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 1936 90 Of the 90 cases notified in 1936 the number who attended the Dispensary 38 Total number of new cases examined at the Dispensary for the first time in 1936, including the above, and all contacts 127 Total attendances at the Dispensary in 1936 854 Supervision of home conditions; visits paid by— Tuberculosis Officer 41 Dispensary Nurse 1,002 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1936, to the 31st December, 1936, in the Metropolitan Borough of Holborn. Age-periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notiflcations. 0- 1- 5- 10- 15- 20- 25- 35- 45- 65- 65- Total (all ages). Pulmonary Males — — 2 — 1 4 6 8 9 4 3 37 43 ,, Females — 1 — 1 1 6 4 2 1 2 1 19 22 Non-pulmonary Males — 1 — — — 2 2 — — — — 5 7 ,, Females • — 2 — — 1 1 1 1 — 1 — 7 8 60 Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age periods. 0— l— 5- 10— 15- 20— 25— 35— 45— 55— 85— Total. Pulmonary Males — — 2 — — 1 3 3 — 3 1 13 ,, Females - - - - - 2 3 2 1 — — 8 Non-pulmonary Males — — — — — — — — — — - — „ Females — — — — — — 1 — — — — 1 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 ("From local Registrars Death Returns Transferable deaths from Registrar (General 5 — Posthumous notifications 3 — " Transfers" from other areas (other than transferable deaths) 13 1 Other Sources if any (specify) — — Notification Register. Pulmonary Non-pulmonary Total Cases Males Femeles Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1936, on the Registers of Notifications 175 100 275 34 31 65 340 Number of cases removed from the Registers during the year by reason inter alia of :— Withdrawal of notification - - - 1 - 1 1 Recovery from the disease - - - - - - - Death 22 11 33 — 1 1 34 61 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Forms A or B during the year 1936 was 68, 22 other cases were brought to my knowledge (making 90 new cases in the year). These were:—Private cases 11, hospital cases 38, Public Assistance cases 22, from death returns 5, transfer from other districts 14. Of the 90 cases entered on the Register in 1936, 77 were pulmonary tuberculosis and 13 non-pulmonary tuberculosis. Seventy-three of the cases were removed for treatment to hospitals, sanatoria, Ac. Sleeping Conditions. In 67 of the 90 new cases of tuberculosis in 1936 it was possible to obtain information as to the sleeDinff conditions at the date of notification. The following is a summary of the information in the 67 cases above referred to :— Patient slept in— Separate bed room 12 Separate bed in living room 8 One person (one room) homes 8 Separate bed in room shared with— 1 adult 3 2 adults 6 3 adults 1 1 adult and 1 child 1 2 adults and 1 child 3 Shared bed with— 42 No other in room 1 adult (Husband or Wife) 13 1 adult (not Husband or Wifi) 1 Shared bed with— 1 child 4 1 adult Other persons in bedroom 3 children 1 1 adult 2 2 adults 2 4 adults 1 1 adult and 2 children 1 25 67 Classification of Homes. The classification of homes as suggested by the London County Council has been reported on as far as practicable with the following results: — " A."—Good environment, clean, well-kept, separate bedroom (or in the case of husband and wife, no other occupant of bedroom), good food and clothing 12 " B "—Fair. Separate bed, but not separate bedroom ... 45 " C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing 10 67 62 Non-attendance at Tuberculosis Dispensary. Thirty-eight of the 90 cases attended the Holborn Tuberculosis Dispensary. The following indicates the reasons for non-attendance in the remaining cases: — Removed to Hospitals, etc., for treatment without prior attendance at Dispensary 18 Dead before or soon after notification 15 Treatment at home by private doctor 1 Not traced and common lodging house cases 6 Removed from Borough 8 No information 3 Notification withdrawn 1 52 Institutional Treatment. During the year notifications were received of 88 admissions to institutions. These admissions represent 72 patients, some of whom were transferred from one institution to another, and others were discharged, or took their own discharge, and subsequently were readmitted. The admissions were to the following institutions: — Institutions of the London County Council 67 Other institutions 21 Yisits to Homes, etc. During 1936 the Tuberculosis Officer made 41 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 1,002 visits. The advice given by the Tuberculosis Nurse includes suggestions respecting food and cooking and suitable cookery books are supplied free of charge when required. Contacts. All contacts are urged to attend for examination at the Tuberculosis Dispensary. Fifty-seven contacts, viz., 26 adults and 31 children under fifteen years of age, were examined for the first time during the year 1936. Of these, one adult and three children were found to be definitely suffering from tuberculosis. Fiftytwo were definitely diagnosed as not suffering from the disease, and in one case (a child) the diagnosis was not completed by the end of the year. The routine examination of contacts is desirable as a means of discovering not only cases of tuberculosis in early stages of infection but even definitely 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. 63 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, Andrew Morland, M.D., M.R.C.P., for the year 1936 :— Return showing the work of the Dispensary during the year 1936. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 26 14 1 — 3 5 2 1 29 19 3 1 (6) Doubtfully tuberculous — — — — - — — — - (c) Non-tuberculous - - - - - - - — 8 6 3 1 b.—Contacts examined during the year:— (a) Definitely tuberculous — 1 1 2 - - - - - 1 1 2 (b) Doubtfully tuberculous 1 — (c) Non-tuberculous 5 20 13 14 C.—Cases written off the Dispensary Register as (a) Recovered — 1 — — - — - — — 1 — — (6) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as tuberculous) - - - - - - - - 15 28 19 15 D.—Number of Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 104 62 9 10 15 19 9 10 119 81 18 20 (b) Diagnosis not completed - - - - - - - - 1 - 1 - 64 1. Number of persons on Dispensary Register on January 1st, 1936 227 2. Number of patients transferred from other areas and cases returned after discharge under Head 3 in previous years 12 3. Number of patients transferred to other areas, cases not desiring further assistance under the scheme and cases " lost sight of" 31 4. Cases written off during the year as dead (all causes; 18 5. Number of attendances at the Dispensary (including contacts) 854 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 60 7. Number of consultations with medical tioners : — (а) Personal 37 (б) Otherwise 79 8. Number of other visits by Tuberculosis Officers to Homes 41 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,002 10. Number of (а) Specimens of sputum, &c., examined 112 (б) X-ray examinations made in connection with Dispensary work 86 11. Number of "Recovered" Cases restored to Dispensary Register in A (a) and A (b)0 12. Number of " T.B. plus" cases on Dispensary Register 31st December, 1936 115 65 Deaths of Tuberculous Persons. Showing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions. All Ages 0- 1- 6- 10- 16- 20- 25- 35- 45- 55- 65- Males. Females Total. Number of patients who died at home - - - - - 1 1 1 — 2 1 2 4 6 Number of patients who who died in hospitals, etc. — — 1 — — 5 1 4 4 10 3 20 8 28 — — 1 — — 6 2 6 4 12 4 22 12 34 Holborn Tuberculosis Care Committee. Report for 1936. The Committee has met four times during the year—in January, April, July and October. The average attendance of members at each meeting has been 10-5. Sixty-six cases have been considered in the course of the year—46 new cases (38 adults and eight children) and 20 old cases (16 adults and four children). Fifty-nine adults and nine children were admitted to Institutions for treatment. One child was sent away under the London County Council's Contact Scheme, to enable the mother to accept treatment. In July, 1934, the London County Council decided that treatment for tuberculosis should be given free of charge to patients in their area, but that voluntary contributions towards the cost of treatment would be accepted. In one instance, that of a child who had been under treatment since 1933, voluntary payments were continued until the date of discharge from treatment, and during 1936. the sum of £32 was collected for the L.C.C. No other contributions towards the cost of treatment have been offered. Twenty-four Progress Reports, on 11 children, were received from the L.C.C. and the information contained therein was transmitted to the relatives. One child was admitted to a L.C.C. Open Air School. Six adults were sent away for convalescence—one through the L.C.C., two through Stafford's Charity, two through the United Services Fund, and one with a Convalescent Home Letter. Convalescence was arranged for five children through the Invalid Children's Aid Association, and for one child through Stafford's Charity. Holidays were arranged for one adult and two children—the children being sent away through the kindness of the Women's Section of the British Legion. 66 Eight, or more, patients were advised and assisted in National Health Insurance difficulties and, in this connection, we would like to record our appreciation of the advice and help which is always so courteously given to us by the officials of the Ministry of Health. In two cases arrears were paid by the Society for the Relief of Distress; in one case by the Charity Organisation Society, and in one case by the Officers' Association. Four cases were referred for dental treatment; they received assistance from the Council, the Charity Organisation Society, the Red Cross, and the West Central Jewish Day Settlement, respectively. Ten applications for clothing for patients undergoing treatment were made to the London County Council. Three patients were supplied with clothing by the British Legion and United Services Fund Benevolent Department, and in other cases clothing was supplied by the Charity Organisation Society, the Red Cross, and the Officers' Association. One patient was granted assistance by the Red Cross pending his admission to hospital, and his family was given assistance pending an appeal to the Ministry for increase of pension. Unfortunately the appeal was unsuccessful, and the case was referred to the Public Assistance Committee. Five patients received grants of extra nourishment after discharge from treatment—one from the Borough Council, one from the Red Cross, and three from the Public Assistance Committee. Four families received help from the Public Assistance Committee while the breadwinner was undergoing treatment in Hospital. To all Organisations and Societies that have co-operated with us we tender our grateful thanks. Through the generosity of various friends, we were again able to supply a number of our families with Christmas dinners through the Polytechnic Distress and Christmas Dinner Fund. To Councillor Wheatley our sincere thanks are due for his gift of coal and milk tickets, and we would express to Councillor Mullen our own, and the recipients', grateful thanks for his generous gift of coal at Christmas time. During the year 680 visits have been paid to patients or their relatives, and many other visits have been paid in connection with matters concerning their welfare. Nineteen patients known to the Committee have left the Borough during the year. Of these, five were transferred to other Care Committees and one returned to the Borough before the end of the year. Nine cases were transferred to the Borough from other districts. Eighteen patients known to the Committee have died during the year. Five died at home, and thirteen died in Institutions. Representatives of the Committee attended the meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees which were held at County Hall on May 15th and November 27th, and the Hon. Secretary represented the Committee at the Conference of the National Association for the Prevention of Tuberculosis which was held in London in July. 67 The housing problem remains acute. Twenty-eight families known to the Committee were found to be living under unsuitable conditions. In nineteen cases application was made to the L.C.C. for preferential consideration. Eight of these have been given better accommodation—four of them on outlying estates. Three families have found improved accommodation in other ways. The majority are unable to remove from Central London on account of their employment. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations during the year 1936. Home Nursing for Tuberculous Patients. It was necessary during the year 1936 for only one tuberculous patient to be nursed under the arrangements made by the Council with the Metropolitan District Nursing Association; 210 visits were made to this patient before her death. 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. Extra Nourishment for Tuberculous Persons. During the year 1936 the Council approved a scheme for the supply of extra nourishment for necessitous tuberculous patients residing in the Borough. The scheme was prepared under the Public Health (Prevention of Disease) Act, 1913, which gives power to local authorities, subject to the approval of the Minister of Health, to supply such extra nourishment. A circular issued by the Ministry of Health specified the type of cases which the Minister considered could be suitably dealt with by such grants, viz. : — (i) Ex-sanatorium cases, where the medical condition is such that a grant of extra nourishment is necessary to enable the patient to maintain or recover full working capacity, and (ii) Patients with prospects of ultimate recovery of the disease who are waiting admission to sanatorium. A scheme on these lines was submitted to, and sanctioned by, the Minister of Health on the 16th May, 1936, and thereupon became operative in the Borough. 68 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 1936: — Summary of work carried out at Dental (clinic, 10, John Street, Holborn, on Tuesday Evenings, during 1936. Tuberculous Patients. All Number of sessions held — 47 Number of patients' attendances 11 332 Number of fillings — 69 Number of scalings — 10 Number of extraction cases Without anaesthetic — — With local anæsthetic 5 46 With gas 2 13 Number of teeth extracted 28 209 Number of dentures (including repairs) — 37 Number of dressings — 22 Number for advice 4 47 Number of denture visits 90 Number of new patients — 64 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 121 births were registered as occurring in the Borough. During the same period 93 notifications of births occurring in the Borough were received. All were from doctors and midwives. The mothers were attended at their confinement by: — Private Doctors 9 Private Midwives 9 Out-patient Midwifery Departments of General Hospitals and Institutions: — Externs and others 20 Midwives.—University College Hospital 13 Middlesex Hospital 3 Other Institutions 13 Training Institution for Midwives, Myddelton Square 26 93 Two of these notifications related to stillbirths. Number of Births. he number of births transferred to the Borough from outlying' institutions was 171 The number of births transferred from the Borough to other districts was 3 The net number of births belonging to the Borough was 289 There are no maternity hospitals or lying-in institutions in the Borough, but maternity cases are admitted to a nursing home in the area. 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 205 271 476 Post-natal Mothers 3 8 11 Children under 1 year of age 307 603 910 Children 1 to 2 years of age 18 337 355 Children over 2 years of age 42 1,064 1,106 Enquiries re stillbirths 12 „ re ophthalmia neonatorum 3 Other visits 143 Two hundred and eighty visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 189 were recorded as attending a Centre, i.e., 68 per cent. Thus nearly five-sixths of those visited attended an Infant Welfare Centre and of these 82 per cent, attended the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following :— 126 attended the Council's M. & C. W. Centre at 10, John Street. 29 „ „ » .. Short's Gardens. 7 attended the Centre at Charing Cross Hospital. 8 „ ,, Myddelton Square. 6 „ „ Middlesex Hospital. 6 „ University College Hospital. 3 „ „ Royal Free Hospital. 4 „ „ other Centres. 189 attended an Infant Welfare Centre. Work at Centres. Holborn Centre, 10, John Street. The following is an analysis of the attendance at this Municipal Centre Monday. Tuesday. Wednesday. Thursday. Friday. Medical Consultation Pre-school child 2—4.30 p.m. 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 48 61 63 34 62 60 Total attendances— Children 569 1700 ... 68 1165 Mothers 16 208 271 221 208 217 ATerage weekly attendances— Children 12 ... 32 ... 1 21 Mothers ... 4 6 6 4 4 70 St. Giles' Centre, Shout's Gardens. The attendances at this Branch. Centre during the year 1936 were as follows: — Thursday—Medical Consultation—2—4.30 p.m. No. of Sessions 52 Total attendances—Children 601 Mothers 97 Expectant Mothers 22 Average weekly attendances 14 The total number of attendances made by the Health visitors at the Municipal Centres in 1936 was 385 and in addition Health Visitor students made 101 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 4,161 attendances were made by 586 mothers and expectant mothers; and 453 children, of whom 204 were under one year, 72 between one and two years old, and 177 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 667 attendances were made by 45 mothers and 87 children, of whom 42 were under one year, 12 from one to two years and 33 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 51 voluntary notifications were received during 1936 as compared with 61 in 1935. 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 domestic grounds only. Special records have been kept of the home conditions of 210 expectant mothers visited during 1936, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. Of the 132 who went into hospital:— 24 (15 primigravidæ) lived in a one-room home; 108 (20 primigravidæ) lived in a two or more roomed home. Of the 78 who remained at home: — 6 (3 primigravidæ) lived in a one-roomed home; 39 (3 primigravidse) lived in two rooms; 33 lived in three or more rooms. 71 Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 81 times during the year 1936. 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 275 mothers, about whom information was obtained, 244 (88 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under: — Number of enquiries made 275 Centre Attended:— Holborn Centre, 10, John Street 12 Holborn Centre, Short's Gardens 15 Royal Free Hospital 18 Middlesex Hospital 12 Charing Cross Hospital 28 University College Hospital 30 Myddelton Square Institution 27 St. Bartholomew's Hospital 26 City of London Hospital 16 Elizabeth Garrett Anderson Hospital 3 St. Pancras Hospital 30 Other Centres 19 Ante-natal care from private doctors 8 244 Nature of defects found at Municipal Centres. 10, John Street, Short's Gardens Holborn. St. Giles. No. of women attending ante-natal clinics 65 15 Women expectant for the first time 9 3 No. of attendances made 141 37 Defects found specially connected with pregnancy :— Deformed pelvis 3 — Threatened miscarriage 2 Retroverted gravid uterus 2 Transverse lie 1 Excessive vomiting 9 (Edema 2 2 Varicose veins 6 3 Ante-partum haemorrhage 1 - High blood pressure 2 - OthJer defects 3 — Other defects:— Heart disease 3 - Anaemia 5 — Respiratory diseases 3 — Constipation 25 1 Dental caries 15 4 Dyspepsia 7 Pyorrhoea 4 Rheumatism 2 Other defects 10 — No. referred to maternity hospitals :— Normal 6 12 Abnormal 7 2 No. referred to dental clinic 11 4 No. of urine tests made 68 2 72 Post-natal Consultations. Twenty-five attended the post-natal consultations at the Centre, 10, John Street. They made 61 attendances in all. The conditions found included one case of cancer, two cases of prolapse of uterus, one case of fibroids, five cases of retroverted uterus, four cases of leucorrhæa, two of cervicitis, and one case of prolapsed ovaries. Two mothers attended the post-natal clinic at Short's Gardens Centre. One had a normal puerperium following a miscarriage. The second failed to keep her appointment for examination. Instruction in Mothercraft and Hygiene. For some years, both in the home and in the Centres, use has been made of leaflets written in non-technical language dealing with the hygiene of infancy and maternity; and the walls of the Centres have been hung with instructive posters to give point to the teaching and to draw attention to the series of leaflets. Propaganda posters are pasted on the outer walls at the Centres. There is also a glass-fronted case for the display of a special poster; this poster is changed frequently. Miss Mary Carter and Miss Edith Joyce have continued to give us a great deal of valuable assistance during the year by making children's garments for busy mothers from materials supplied by the mothers and from their own resources. Mrs. Lauder Eaton has also given assistance at the Centre regularly on Wednesdays for many months. 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 as required. Up-to-date model garments for babies and young children are always on view at the Centres. One hundred and thirty-seven hanks of wool of a special quality were sold at cost price to the value of £7. 15s. 4d. Maternity outfits are placed on sale at the Centre at cost price, 5s. lOd. No outfit was sold. 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 1936: — Reasons for attendance. 10, John Street. Short's Gardens Mothers: — Difficulty with breast feeding 20 5 Disorders of generative organs 18 — Constipation 15 1 Venereal Disease 1 — Anaemia 10 — Respiratory disease 12 — Digestive disorders 3 — Debility 19 40 3 Dental caries 3 Rheumatism 5 - Other Diseases 34 2 73 Children :— (Healthy) 131 30 Alimentary disorders 39 11 Rickets 13 9 Heart disease 4 — Rheumatism 1 — Respiratory disorders 57 2 Marasmus 12 — Debility 3 5 Hernia, umbilical 13 1 Hernia, inguinal 2 — Phimosis 16 1 Disease of skin 37 2 Disease of eye 22 3 Disease of ear 16 3 Disease of nose and throat 25 3 Dental caries 23 3 Tuberculosis contacts 6 — Other diseases 31 9 (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 1936 were referred to other departments or organisations as follows: — Mothers. Children. Ante-natal Clinic 9 — Tuberculosis Dispensary — 1 Minor Ailments Clinic 61 244 Dental Clinio 52 39 Metropolitan Nursing Association 12 — Nursery School — 1 Massage Clinic — — Hospitals 25 68 Convalescent Homes 4 22 Assistance Sub-Committee (for milk) 39 38 Bloomsbury Dispensary 1 3 Institute of Ray Therapy - 16 Home for Unmarried Mothers 1 Institute of Child Psychology 3 Private Doctor 1 6 Public Vaccinator — 1 Breast Massage. The following summary gives particulars of mothers referred for breast massage in 1936 :— John Street. Short's Garden. Number referred to Metropolitan Nursing Association 9 3 Results :— Breast secretion re-established 3 2 Small bottle feeds required in addition to breast feeding 3 Massage unsuccessful 2 1 (co-operation of mother not obtained) Massage successful, but baby weaned as mother developed tuberculosis 1 - 74 Pre-School Children, 1936. During the year 1936, 41 of the Pre-School children attending the Monday afternoon Pre-School Clinic were found to be below the normal standard of weight and height'for their respective ages, while 39 were above it. The rest were up to standard both as regards weight and height. Thirty-six children were found to be suffering from skin diseases; 17 from impetigo and other septic skin conditions, 5 from eczema and 13 from lichen urticatus. There was 1 case of wool rash, 2 of fur dermatitis and 2 of insect bites. All were treated at John Street or referred to hospital. Respiratory diseases were less numerous than in 1935, there being 17 cases of cough, 4 of which were bronchitis, but many children suffered during the damp weather from nasal catarrh. Alimentary conditions included 10 cases of chronic constipation, 5 of diarrhœa, 1 of threadworms and 1 ulcerated mouth. Dental cases were found in 29 cases, and all were referred to the dentist. Nine children had enlarged cervical glands, chiefly owing to decayed teeth. There was 1 case of malnutrition and 2 of debility, the latter being sent to the Institute of Ray Therapy for Artificial Sunlight Treatment. Three children suffered from tonsilitis, 1 from laryngitis, 15 had enlarged tonsils, 7 had septic tonsils and adenoids, and 1 adenoids alone. Suitable cases were sent to hospital for treatment, and the rest responded to advice given at the Clinic. There were 2 cases of heart disease, which are undergoing hospital treatment, 4 of enuresis, and 1 case of night-terrors and stuttering. They were referred to the Institute of Medical Psychology for treatment. Earache occurred in 5 chilrren, and 2 had discharging ears which were treated successfully at the Minor Ailment Clinic. The eye diseases dealt with were two cases of blepharitis and 1 of conjunctivitis, while 2 children with strabismus were referred to hospital for lenses. There were 3 cases of umbilical hernia which responded to treatment by strapping, and 1 case of epistaxis. Many children were reported to sleep badly at night, but these cases appeared to be mostly due to domestic causes and bad training. Foundling Hospital Day Nursery. The establishment of a day nursery and play centre for children at Coram Fields (Foundling Hospital Site) has been referred to in previous Annual Reports. These activities were maintained during 1936. 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 (£100) towards the cost incurred in connection with Holborn children. School Entrants. During the year information was received from the London County Council that 127 children living in Holborn had been entered as attending school for the first time. Particulars of the child's pre-school physical history and his record of 75 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 1936 information was received of 12 stillbirths, 11 of which were legitimate. Enquiry as to possible causes was made in all cases. In ten instances the confinement took -place in hospital, one in the extern practice of an institution, and one in the private practice of a doctor. Difficult labour was responsible for three; one of which was a twin. In one case there was a history of toxaemia of pregnancy; in two there was placenta proevia; in five cases no definite reason could be assigned and in one no information was obtainable. Illegitimate Children. The births of 32 illegitimate children were registered. Four lived with both their parents who had a permanent home together; four with their mothers who worked to support them; nine with their mothers who remained in their parents' home; two were placed in an institution; one died in early infancy; one was stillborn ; one was adopted; three were boarded out with foster mothers; three removed from the Borough; four 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 1936 at the Council's Dental Clinic, No. 10, John Street, open on Thursday afternoons for nursing or expectant mothers, and children under five years of age: — Women. Children. Total Numher of sessions held 52 52 52 Number of new Patients 34 30 64 Total attendances 207 68 275 Extractions— With local anæsthetic 16 (38) — 16 (38) With general anæsthetic 25 (160) 28 (129) 53 (289) Scaling 21 1 22 Fillings— Simple 37 7 44 Root — — — Dentures (including repairs) 23 — 23 Advice 43 39 82 The figures in brackets relate to the number of teeth extracted. In three 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 two instances the patients were required to pay the whole cost. 76 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 306 applicants received free or assisted milk under the scheme. This number included 163 who were receiving such assistance at the end of 1935. Grants were made to 143 new applicants. At the end of the year 1936, 126 applicants were receiving assistance, viz.:— Mothers. Children. Total. Free milk 44 80 124 Half-price milk 1 1 Prepared milk 1 1 44 82 126 The following table shows in detail how the 143 new applicants were assisted in 1936:- Milk. Prepared Milk Free. Part Cost. Free. Part Cost. Expectant mothers 26 Nursing mothers 27 Children 76 3 4 7 Home Help. The Council's Home Helps attended 19 cases during the year. All applications for the services of the Home Help are considered by the Assistance Sub-Committee of the Maternity and Child Welfare Committee. In four 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 3s. 6d. per week up to £1 per week. The services of the Home Help have been much appreciated; and it has been found that the Council's provision meets a much felt want in the Borough. Convalescent Homes. Two mothers each with baby and toddler were sent away. In both cases the applicant was required to contribute towards the cost. Twenty-five applications were granted for convalescent home accommodation for children under five years of age; in eight cases the parents failed to take advantage of the facilities provided. Seventeen children were sent away, nine free; while the parents of the other children were required to pay part of the cost. All these children were sent to the Hopedene Convalescent Home at Barnet. One other child was sent by the Hospital for Sick Children to their Home at Southbourne. 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, 1936, 179 children under five attended the consultations. The 179 children made 2,571 attendances. Extra food and nourishment were provided, also convalescent treatment at country and seaside Homes (33 mothers and 74 children); classes and lectures on health, care of the home, food, household economy and kindred subjects were held. The Chairman and Honorary Secretary is Miss Mary Canney, 75, Lamb's Conduit Street. Deaths of Infants under One Year of Age, 1936. The homes were visited in all cases 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 F M F M F M F Both sexes Measles ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 2 1 3 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 2 3 Congenital Debility, Premature Birth, etc, . 2 4 ... ... ... ... ... 2 4 6 ... ... 2 ... ... ... ... ... 4 4 8 Violence ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Other defined diseases ... ... ... ... ... I ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Totals 2 4 ... ... 1 ... 3 4 7 1 1 5 1 1 1 1 ... 11 7 18 Total both sexes 6 ... ... 1 7 2 6 2 1 18 Net births registered during- the calendar year. Net deaths registered during the calendar year. Males Females Both sexes Males Females Both sexes Legitimate Infants 139 118 267 Legitimate Infants 8 4 12 Illegitimate Infants 19 13 32 Illegitimate Infants 3 3 6 77 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—Two Cases. 1 V. B. 25·2·36 Multipara Yes - Institution Difficult labour Recovered Stillbirth 2 G. M. 19·8·36 Primipara Yes Home - Pelvic cellulitis of long standing Recovered Removed to hospital eight days after confinement PUERPERAL PYREXIA—Three Cases. 1 M. O. B. 7·4·36 - - - Institution Influenza Recovered - 2 S. G. 17·5·36 Multipara Yes Home - Acute pyelitis Recovered - 3 M. F. 9·7·36 Primipara No - Institution - - This patient was a guest from Ireland at a Holborn address ; removed to hospital outside the Borough at onset of labour and did not return to the Borough. 78 79 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) Regulations. Birth Notified by. Midwife Private Doctor Extern Department, Hospital Result. Cured Cured Removed Medical Attendance and Nursing. Private Doctor and Nurse Private Doctor and District N urse In-patient at hospital and Out-patient at Ophthalmic Hospital Where Treated At home At home Hospital Type of Disease on Health Visitor's first call. Slight Moderate Moderate By whom Notified. Doctor Doctor Doctor (Hospital) Age at Onset. 1 day 9 days 13 days Age when Notified. 3 days 12 days 14 days Case Number. 1 2 3 80 Midwiyes Acts, 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 two other infants, both of whom made complete recovery. Whooping Cough. Visits were paid to 98 persons suffering from whooping cough. Of these, 72 were notified by doctors; in 13 others the information was derived from the schools, in five from health visitors, in six from the L.C.C., and two from parents. Age. Twelve were children under 1 year, 64 were aged 1 to 5 years, 22 were 5 to 16 years. Removal. Forty-three children were removed to hospital, approximately 44 per cent. Forty-two of these were admitted to hospitals of the L.C.C., and one to a voluntary hospital. Deaths. Two children died, aged respectively 7 months and 3 years. Measles. During 1936 I received information of 252 cases of measles. Of these 96 were notified by school teachers and 76 by medical practitioners; information of 49 was given by L.C.C. hospital authorities, 12 by health visitors, 19 by parents. Age. Seven were under 1 year, 141 were between 1 and 5 years, 90 were between 5 and 16 years, and 14 were over 16. Removals. One hundred and three patients were removed to L.C.C. Infectious Diseases Hospitals, 11 to the London Fever Hospital, and one to a Voluntary General 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. 81 German Measles. During the year information was received relating to 12 cases; 7 were notified by doctors information of 3 cases was received from schools, and 2 from L.C.C. hospitals. Ages. Three were between 1 and 5 years; 3 were between 5 and 16 years and 6 were over 16 years . Removals. Six patients were removed to hospital ; 1 to the London Fever Hospital and 6 to the L.C.C. Infectious Diseases Hospitals. Diarrhœa and Enteritis under 2 years. The number of deaths was three; all occurred under 1 year of age (see table on page 77). Nursing Arrangements. The services of the district nurses were used as follows in 1936:—Deficient lactation 10 cases, 95 visits; complications after pregnancy 4 cases, 47 visits; maternity nursing 1 case, 5 visits; measles 1 case, 20 visits; ophthalmia neonatorum 1 case, 19 visits. Minor Ailments. The Minor Ailments Clinic has been carried on as usual. The principal ailments treated were as follows : — Ailments. Attendances. Conjunctivitis and blepharitis 54 Sores, including sore buttocks 126 Aural discharge 19 Stomatitis 8 Umbilical hernia, strapping 55 Impetigo 18 Attention to breast and nipples 13 Post-Vaccination dressings 5 Tonsils 15 Constipation 8 Varicose veins 12 Also, in smaller numbers: — Slight septic conditions of leg, finger, hand, arm and gums; attention to varicose veins. 82 Routine Medical Inspection of Elementary School Children in Holborn, 1936. Age Groups. Number examined. Clothing and Boots. Nutrition Cleanliness of Head. Cleanliness ot Body. Teeth. Vision. Good Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. | Clean. Dirty. Pediculi. All sound. Less than (our decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 130 25 104 1 16 94 19 1 125 5 — 126 4 — 65 57 8 — — — Girls 128 23 105 — 20 91 17 — 118 9 1 126 2 — 71 52 5 — — — Age 7— Boys 116 18 98 — 14 75 27 — 111 5 — 114 2 — 56 48 12 70 32 14 Girls 120 27 93 — 17 88 15 — 109 10 1 120 — — 55 51 14 77 30 13 Age 11— Boys 160 13 147 — 12 125 23 — 154 6 — 158 2 — 101 55 4 97 35 28 Girls 142 25 117 — 39 89 14 - 120 18 4 140 2 — 100 41 1 78 34 30 Age 14- Boys 161 49 112 — 30 118 18 — 154 6 1 161 — — 105 53 3 98 29 34 Girls 152 49 103 — 41 103 8 — 133 18 1 147 5 — 99 50 3 100 31 19 Total 1,109 229 879 1 189 783 136 1 1,024 77 8 1,092 17 — 652 407 50 520 191 138 Percentage 20·6 79 ·3 0·1 17·0 70·6 12·6 92·4 6·9 0·7 98·5 1·5 — 58·8 36·7 4·5 61·2 22·5 16·3 London ... 56·4 43·2 0·4 16·6 77·4 6· 6 97·5 2·2 0·3 99·2 0·7 0·1 70·5 26·1 3·4 66·2 19·3 14·5 83 Examination of Elementary School Children in Holborn in 1936. Defect. Boys. Girls. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number Examined 130 116 160 161 128 120 142 152 Cases * Cases * Cases * Cases * Oases * Cases * Cases * Cases * Malnutrition 9 8 15 15 10 10 5 5 8 8 5 5 6 6 — — Skin Disease — — 2 2 1 1 — — — — 2 2 2 2 1 1 Defective Teeth — 62 — 59 — 59 — 55 — 57 — 55 — 41 — 53 Enlarged Tonsils 17 6 11 7 7 2 8 — 17 4 18 6 7 4 9 5 Adenoids 2 — 2 — — — 1 1 2 — 1 1 — — — — Enlarged Tonsils and — — 1 — — — — — — — — — — — — — Other Nose and Throat Defects 3 - - - - - 1 — 1 1 1 — — — 1 — Enlarged Glands — — — — 1 — 1 — 1 — — — — — — — Eye Disease 9 8 3 2 6 2 4 1 7 5 4 2 4 1 4 2 Vision Defect — — — 9 — 21 — 22 — — — 11 — 22 — 13 Otorrhœa 2 2 3 1 — — — — 3 2 2 1 1 1 1 1 Other Ear Disease - - - - - - - - - - 1 - - - - - Defective Hearing - - - - - - - - 1 - - - 1 1 1 — Speech Defects — — — — — — 1 1 — — — — — — 1 1 Heart Defecs 2 — 1 — 4 — 2 — — — 6 — 4 1 1 — Anæsmia 4 1 2 1 2 1 — — 3 — 2 2 3 2 1 — Lung Defects 6 2 2 — — — - — 4 — 2 1 2 — — — Nervous Defects — — 1 — 2 — 1 1 — — — — 1 — 1 1 Phthisis - - - - - - - - - - - - - - - - Other T.B. Disease - - - - - - - - - - - - - - - - Rickets 1 1 - - - - - - - - -— — — — — — Spinal Deformities — — 1 — — — 3 1 - - — — 1 1 4 — Other Deformities 2 2 — — 1 1 1 — — — 2 2 — — 3 2 Other Defects 4 2 5 2 8 2 4 3 - - - - 3 1 4 2 Number of Children noted for treatment 73 76 79 78 64 71 62 70 Defects, however slight, are included under "Cases" Those severe enough to require treatment are shown under *. 84 Infant Life Protection. On the 1st January, 1936, one foster mother remained on the register. During the year three others were added to the register and two were removed; leaving two registered foster mothers in the Borough at the 31st December, 1936, having the care of three children. The removals were for the following reasons: — 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. 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. 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 hospital and a voluntary birth control clinic are utilised. Two cases were referred for such advice in 1936. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 4th to 10th October, 1936. 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 (Councillor and Mrs. H. W. Langdon) 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 in thus establishing in the minds of the children an interest in health. 85 Health Poster Designs. Children in the elementary schools were also again invited to enter a competition in the designing of health posters. Designs were submitted from four schools. Two prizes were awarded, and were both won by pupils of St. George-the-Martyr School. The designs were again judged by Dr. E. Goodwin Rawlinson. SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Goldsmith Street. During the year 42 bodies were deposited. There were 42 post-mortem examinations made, and one inquest held. On one occasion a body awaiting burial was removed to the mortuary on account of inadequate accommodation in the home. Thirty-seven bodies were brought in by order of the Coroner, and four by the Police. Inquests. During the year 31 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, 6; Accidents.. 11; Suicide, 10; Misadventure, 3; Murder, 1. The causes of death certified were as follows: — Natural Cautes. Accidents. Various conditions 6 Falls 5 Street accidents 6 Misadventure. Suicide. Immersion in hot bath 1 Coal gas poisoning 8 Operation 2 Jump from window 2 Murder. Murder 1 The Removal of Aged, Infirm and Diseased Persons. Power to deal with this matter is given by Section 224 of the Public Health (London) Act, 1936. During the year it became necessary to deal with the case of an aged male whose condition in his person and mode of living brought him within the category of persons contemplated by the section. The Council were satisfied that in the interests of the health of the man concerned and to prevent injury to the health of, or serious nuisance to, other persons, it was imperative that the man should be removed to hospital or institution. Every effort was made by the Sanitary Inspector and others to induce the man to accept such care but without success. The Council therefore gave a general authorisation to the Medical Officer of Health 86 to exercise the powers conferred on him by the Section, and on application being submitted to a Petty Sessional Court the magistrate made an Order for the removal of the man to institution and he was thereupon admitted to a L.C.C. General Hospital. Rent and Mortgage Interest Restriction Acts, 1920 to 1933. No application was received during the year for a certificate under the above Acts. New Legislation. Public Health (London) Act, 1936. ¥ This Act (with 309 sections and seven schedules) received the Royal Assent on the 31st July, 1936, and came into operation on the 1st October of the same year. The Act consolidates the Public Health law in the Metropolis, formerly contained in about 83 different Acts of Parliament. This consolidating Act, by which the health provisions of so many Acts of Parliament are brought into one statute, will be of great value to local authorities and will materially facilitate the administration of health law in London. Housing Act, 1936. This also is a consolidating Act. It received the Royal Assent on the 31st July, 1936, and came into operation on the 1st day of January, 1937. The measure consolidates the Housing Acts, 1925 to 1935, and certain other enactments relating to housing. To have the Housing law brought together into one Act will be of great advantage to all housing authorities and will simplify administration. The Pharmacy and Poisons Act, 1933. An important development of work of a Public Health Department was the coming into full effect on the 1st May, 1936, of the above Act together with the rules made under it. The new law controls the sale of poisons enumerated in a " Poisons List." This list is divided into two parts. The poisons scheduled in Part I may be sold only by " authorsed sellers " of poisons, usually persons keeping a pharmacy or chemist's shop; those in Part II of the list may be sold by any trader who is registered with the local authority for the purpose. The Registering Authorities are, in London (i) the Common Council of the City of London, and (ii) the Councils of the Metropolitan Boroughs. The Registering Authority may refuse to enter in, or may remove from the register, the name of any person who fails to pay the prescribed fee or who, in the opinion of the Authority is, for any sufficient reason relating either to him personally or to his premises, not fit to be on the register. It is the duty of the Registering Authority by means of inspection and otherwise to secure compliance by registered sellers of Part II poisons, and other persons not being authorised sellers of poisons, with the 87 provisions of the Act and Rules made thereunder relating to Part II poisons. For this purpose the Council on the recommendation of its Public Health Committee appointed Sanitary Inspector S. G. Fisher as an Inspector under the Act. During the year 1936, 75 names were entered on the register. Before entry the premises concerned were all inspected to ensure that adequate provision was made for the storage of the poisons and for general compliance with the rules governing the sale. A leaflet drawing attention to the provisions of the new law was circulated to traders in the Borough likely to stock or sell any of the listed poisons, and posters giving similar information were exhibited throughout the Borough. Nuisance from Pigeons. Public Health (London) Act, 1936—Section 121. During the year several requests were received for steps to be taken to reduce the number of pigeons in the Borough. The arrangements made in previous years were continued under which two members of the Health Department staff endeavour to trap the birds. Operations were carried out by them on various occasions at four different sites frequented by pigeons, and 65 birds were caught. It must, however, be recorded, that on many occasions, even after several hours works, no birds were caught. In open spaces 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. Demolition of Old Bnlldings. 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. Propaganda. Health propaganda work was continued during the year, and included the exhibition of health posters; the use for special display purposes of two Empire Marketing Board frames, and the distribution of various leaflets. 88 APPENDIX. TABLE I. Vital Statistics of Whole District during 1936 and Ten Previous Years year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages Uncorrected Number Net Number of Nonresidents registered in the District of Reeidents not reentered in the District Number Rate per 1,000 Births Number ] Number Rate 1926 43,200 330 585 12·38 629 454 347 48 90 522 12·1 1927 42,209 320 505 11·96 728 631 333 19 38 530 12 ·5 1928 39,280 301 473 12·0 739 546 338 27 57 531 13·5 1929 38,380 256 392 10·21 766 545 377 29 74 598 15·6 1980 38,380 255 405 10·55 693 523 318 36 89 488 12·7 1931 34,470 211 352 10·21 787 598 303 26 74 492 14·3 1932 36,440 186 349 9·67 773 607 351 26 72 517 14·2 1933 36,050 180 342 9·49 681 521 326 24 70 486 13·5 1934 36,000 150 309 8 ·58 699 552 293 22 71 440 12·2 1936 35,400 134 271 7·66 668 526 278 24 88 420 12·7 1936 34,850 121 289 8·29 731 586 273 18 66 418 11·99 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. 89 TABLE II. Causes of, and Ages at, Death, 1936. 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 orough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 6 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. Certified 418 18 1 5 5 8 35 137 111 98 All causes Uncertified ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... 2 2. Measles 2 1 ... 1 ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough 2 1 ... 1 ... ... ... ... ... ... 2 5. Diphtheria 3 ... ... 2 1 ... ... ... ... ... 1 6. Influenza 2 ... ... ... ... ... ... 1 ... 1 ... 7. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever 1 ... ... ... 1 ... ... ... ... ... 6 9. Tuberculosis of Respiratory System 32 ... ... ... 1 4 10 13 4 ... 9 10. Other Tuberculous Diseases 3 ... ... ... ... ... ... 3 ... ... 19 11. Syphilis 2 ... ... ... ... ... 1 1 ... ... 1 12. General Paralysis of the insane, Tabes Dorsalis 2 ... ... ... ... ... ... 2 ... ... 1 13. Cancer, malignant disease 67 ... ... ... ... 1 3 31 20 12 60 14. Diabetes 5 ... ... ... ... ... ... 2 2 1 8 15. Cerebral Haemorrhage 21 ... ... ... ... ... 1 7 9 4 11 16. Heart Disease 108 ... ... ... 1 ... 3 33 36 35 38 17. Aneurysm 3 ... ... ... ... ... ... 2 1 ... 1 18. Other Circulatory Diseases 16 ... ... ... ... ... 1 5 3 7 9 19. Bronchitis 13 ... ... ... ... 1 ... 3 5 4 18 20. Pneumonia (all forms) 34 3 1 ... ... 1 3 6 7 13 60 21, Other Respiratory Diseases 5 ... ... ... ... ... ... 2 1 2 14 22. Peptic Ulcer 9 ... ... ... ... ... 1 5 2 1 6 23. Diarrhœa, etc. 4 3 ... ... ... ... ... ... 1 ... 41 24. Appendicitis 3 ... ... ... ... ... ... 3 ... ... 6 26. Cirrhosis of Liver 3 ... ... ... ... ... 2 1 ... ... 1 26 Other diseases of liver, etc. 5 ... ... ... ... ... 1 1 3 ... 3 27. Other digestive diseases 5 ... ... 1 ... ... ... 1 ... 3 23 28. Acute and Chronic Nephritis 9 ... ... ... ... ... ... 4 5 ... 30 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. ... 8 8 ... ... ... ... ... ... ... ... 66 32. Senility 3 ... ... ... ... ... ... ... ... 3 ... 33. Suicide 10 ... ... ... ... ... 3 2 3 2 4 34. Other Violence 12 1 ... ... 1 1 1 ... 4 4 11 35. Other Defined Diseases 26 1 ... ... ... ... 5 9 5 6 159 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 418 18 1 6 5 8 35 137 111 98 609 90 TABLE III. Cases of Infectious Disease notified during the year 1936. 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 35 to 46 46 to 66 66 up Total Death Small-pox ... • •• ... ... ... ... ... ... ... ... ... ... ... ... .Diphtheria 60 1 1 3 12 1 15 7 5 13 ... 1 1 4 Erysipelas 19 ... ... ... ... ... 1 ... ... 5 2 4 7 ... Scarlet Fever 67 1 1 8 5 9 20 2 9 11 1 ... ... ... Enteric Fever 2 ... ... ... ... ... ... ... ... 1 1 ... ... 1 Puerperal Fever 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... do. Pyrexia 3 ... ... ... ... ... ... ... ... 3 ... ... ... 1 Cerebro-spinal Fever 2 ... ... ... ... ... 2 ... ... ... ... ... ... 1 Ophthalmia Neonatorum 3 3 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 6 ... .. ... ... ... ... ... 1 1 1 2 1 1 Malaria 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Pneumonia—Primary 26 ... 1 ... ... 3 1 1 2 4 5 7 2 do. Influenzal 4 ... ... ... ... ... ... ... ... 1 2 ... 1 2 Tuberculosis— Pulmonary 77 ... ... ... ... 1 4 1 2 29 15 20 5 33 do. Non-Pulmonary 13 ... 1 1 ... 1 ... ... 1 7 1 1 ... 1 Whooping Cough 76 9 9 14 17 10 15 2 ... ... ... ... ... 2 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism 3 ... ... ... ... ... 2 1 ... ... ... ... ... ... 365 14 18 26 34 25 60 14 20 78 29 35 17 46 91 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL PREMISES. Number in Borough at 31st December, 1936. Number of Inspections. Number of Prosecutions. Common Lodging houses 2 22 - Seamen's Lodging houses — Cowsheds (licensed) Slaughter-houses (licensed) 1 2 Other offensive trades _ Milkshops 137 189 Ice cream premises 60 110 Restaurants and eating houses 479 574 — Registered foster mothers 2 16 — Nurse children kept 3 Seen regularly at Council's Centres - Smoke nuisances. (1) Number of observations 137 (5) Number of legal proceedings — (2) Number of intimations served 5 (6) Number of convictions — (3) Number of complaints received 6 (7) Amount of penalty and costs (4) Number of statutory notices imposed in each case — served 5 Cleansing and Disinfection. Number of adults cleansed 112 Number of premises cleanse— Number of children 0 (a) After infectious diseases 257 (b) For vermin 140 Water Supply of Tenement Houses. Number of premises supplied 0 Number of prosecutions 0 Sanitary Officers. Number of Sanitary Inspectors (whole-time) Male 4 Female — „ „ „ „ (part-time) Male — Female 1 Number of Health Visitors (whole-time) 1 „ „ „ „ (part-time) 1 Housing. 1. Total number of houses in the (b) Number of houses de- Borough 6,462 molished following represen- (Census 1931) tation by Borough Medical 2. Number of houses occupied by Officer under Sec. I of H.A., the working classes 3,832 1930 Nil 8. Number of houses repaired Public Health Act. under Sections 17 and 18 of 3. Number of houses inspected H.A. 1930: on account of complaints or (a) By owners Nil illness 610 (b) By L.A. in default of 4. Number of statutory notices owners Nil served 59 9. Number of houses demolished: 5. Number of houses repaired or (a) In pursuance of orders under Section 19 of the nuisances remedied 180 Housing Act, 1930 5 Housing Acts (1925-35). (b) Voluntarily 42 6. Number of houses inspected— 10. Number of houses (wholly or house to house (Housing in part) the subject of Closing Consolidated Regs., 1925) 107 Orders (excluding under- 7. (a) Number of houses included ground rooms) 4 in representations by the 11. Number of Closing Orders Borough Medical Officer determined (i.e., houses made under Section I of H.A., 1930 13 fit) Nil 92 TABLE IV.—continued. Housing—-continued. 12. Number of houses erected by the Borough Council for working classes during year Nil Housing Act, 1935, at 31/12/36 Number closed or modified 746+ 13. Houses Let in Lodgings— occupation approved under Sec. 84, H.A., 1935 36 Number registered in Borough 427 Number of inspections 723 15. Overcrowding (Housing Act, Number of prosecutions — 1935)— Number of complaints remedied under the By-laws (not included under any other heading) 24 Number of houses inspected under Sec. I of H.A., 1935 Number of families found to be living in overcrowded con- 138 14. Underground Rooms— Number occupied but unfit under Sec. 18 of H.A., 1925, as modified by Sec. 84 of ditions, Sec. I of H.A., 1935 Number of overcrowded families who have obtained 51* alternative accommodation 87 Infectious Diseases. Infectious diseases—cases notified under local orders (excluding cases coming to knowledge otherwise than by notification). Disease. Cases notified. Period Measles Not notifiable German Measles do. Whooping Cough 76 1936 Rheumatic Fever (0-16) 3 do. Chicken pox Not notifiable Zymotic Enteritis do. * This figure relates to families not previously recorded as being overcrowded, t This figure is estimated having Tegard to the revised Regulations as to underground rooms adopted by the Council during 1936. 93 TABLE V. Factories, Workshops, Laundries, Workplaces and Homework 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. PREMISES. Number ot Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 416 16 ... ... Workshops 505 40 3 ... Workplaces 3,188 74 10 ... Total 4,109 130 13 ... • 2.—DEFECTS FOUND. Particulars. Number of Detects. Number of Prosecutione. Found. Remedied. Referred to H.M. Inspector. *Nuisances under the Public Health Acts: Want of cleanliness 22 22 ... ... Want of ventilation 11 11 ... ... Overcrowding 1 1 ... ... Other nuisances 88 88 ... ... insufficient 1 1 ... ... Sanitary accommodation -unsuitable or defective 28 23 ... ... not separate for sexes 8 8 ... ... Offbnoes under the Factorv 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 154 154 ... ... * Including those specified in Sections 2. 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Act*. 94 TABLE V—continued. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premisbs, Section 108. Obtwobk in Infbcted 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. 92 240 156 ... ... ... 92 ... ... ... ... ... ... ... ... Paper Bags and Boxes 2 ... 11 1 1 ... 11 3 ... ... ... ... ... ... ... ... Total 94 240 167 ... 11 95 ... ... ... ... ... ... ... ... 95 TABLE V.—continued. 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. (1) Number. (2) Bakehouses (including 13 factory bakehouses) 19 Other Workshops 620 Total number of workshops on Register 639 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Kactory and Workshop Act (S.5) Notified by H.M. Inspector 18 Iteport (action being taken) sent to H.M. Inspector 18 Other — Underground Bakohouses (S. 101): — Certificates granted during the year — In use at the end of the year 11