AC4342 HOL 36 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of health, For the Year 1938. / London: Printed By DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1939 The Metropolitan Borough of Holborn. ANNUAL REPORT OF THE Medical Officer of health, For the Year 1938. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, VV.C.2. 1939 PUBLIC HEALTH DEPARTMENT, TOWN HALL, 197, HIGH HOLBORN, W.C. 1. June, 1939. 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 1938. I am, Your obedient Servant, J. A. STRUTHERS, Medical Officer of Health. INDEX. Page Public Health Committee 6 Housing of the Working Classes Committee 6 Maternity and Child Welfare Committee 7 Tuberculosis Care Committee 7 Staff 8 Statistics and Social Conditions Statistical Summary 9 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 16 Sanitary Inspection of District 16 Notices served 17 By-laws as to Houses let in Lodgings 19 Rag and Bone Dealers 19 Rats and Mice (Destruction) Act, 1919 19 National Rat Week 21 Drainage Works 21 Smoke Abatement 21 Inspection of Workshops 22 Factories 23 Outworkers 23 Rag Flock, Regulation of Sale and Use of 24 Shops Acts 24 Inspection of Private Swimming Baths 25 Housing Statistics 25 Sousing Accommodation on L.C.C. Estates 26 Abatement of Overcrowding 26 Re-Housing 8 Removal Expenses 28 Section and Supervision of Food. Dairies, Cowsheds and Milk Shops 28 Milk (Special Designations) Order, 1936 28 Milk—Bacteriological Examination 29 Margarine 30 Bakehouses 30 Sale of Fish 30 Fried Fish Shops 30 Market Streets and Exposure of Food Generally 31 Street Trading 31 Ice Cream 31 Meat Regulations 33 Places where Food is Prepared for Sale 33 Inspection of Restaurant Kitchens 33 Unsound Food 34 preservatives in Food Regulations 36 Food and Drugs (Adulteration) Act, 1928 36 Articles Analysed 36 Report of Borough Analyst for Year 1938 40 The Merchandise Marks Act, 1926 42 Public Health (London) Act, 1936, Section 187 43 Registration of Food Premises 43 Notification of Food Poisoning 43 Slaughter of Animals Act, 1933 43 42 4 Page Prevalence of and Control over Infectious Diseases, including Tuberculosis Infectious Diseases Generally 43 Smallpox 44 Vaccination 44 Diphtheria 45 Diphtheria in Hospitals 45 Schick Test and Immunisation against Diphtheria 46 Diphtheria in Children Treated with Immunising Injections 46 Immunisation of Nursing Staff at London Homoeopathic Hospital 48 Scarlet Fever 48 Acute Rheumatism in Children 48 Holidays for Rheumatic Children 49 Typhoid and Paratyphoid Fevers 49 Typhus Fever 49 Cerebro-Spinal Fever 49 Dysentry 49 Malaria 49 Encephalitis Lethargica 49 Acute Poliomyelitis and Acute Polioencephalitis 50 Pneumonia 50 Influenza 50 Anthrax 50 Chickenpox 50 Mumps 50 Bacteriological Work 50 Disinfections 50 Cleansing of Persons Act 51 Shelter during Disinfection 51 Extermination of Vermin 51 Cancer 52 Tuberculosis 52 Summary of Notifications and Deaths 52 Public Health (Tuberculosis) Regulations, 1930 53 Supplemental Return 54 Notification Register 54 Tuberculosis Notifications 55 Classification of Homes 55 Non-attendance at Tuberculosis Dispensary 55 Institutional Treatment 56 Visits to Home 56 Contacts 56 Tuberculosis Dispensary Return 57 Deaths of Tuberculous Persons 59 Tuberculosis Care Committee 59 Public Health (Prevention of Tuberculosis) Regulations, 1925 60 Home Nursing 60 Dental Clinic 60 Extra Nourishment 61 General Dental Clinic 61 Maternity and Child Welfare Notification of Births 61 Number of Births 62 Home Visiting 62 Work at Centres 63 10, John Street 63 Short's Gardens 63 Ante-natal Hygiene 63 Confinements in Institutions in relation to Housing Conditions 64 Baths 64 Ante-natal Centres 64 Post-natal Consultations 65 Physical Culture Classes for Mothers 65 Instruction in Mothercraft and Hygiene 65 Maternal and Infant Consultations 66 Breast Massage 67 Pre-School Children 67 Foundling Hospital Day Nursery 67 School Entrants 67 Stillbirths 68 Illegitimate Births 68 5 Page Dental Treatment 68 Supply of Milk and Food for Mothers and Infants 69 Home Help 69 Convalescent Home Treatment 70 Emergency Homes 70 Saffron Hill Maternity and Child Welfare Centre 70 Infantile Mortality 70 Deaths of Infants under One Year 71 Infectious Diseases among Mothers and Children 72 Puerperal Fever and Pyrexia 72 Maternal Mortality 73 Ophthalmia Neonatorum 73 Midwives Acts, 1902 and 1918 73 Whooping Cough 74 Measles 74 Measles Control in Schools 75 German Measles 75 Diarrhoea and Enteritis under 2 years 75 Nursing Arrangements 75 Minor Ailments Clinic 75 Medical Inspection and Treatment of School Children 76 Infant Life Protection 78 Birth Control 78 Health and Baby Week 78 Sanitary Administration Mortuary 79 Inquests 79 Removal of Aged Persons 79 Rent and Mortgage Interest, Restriction Acts, 1920 1933 79 The Pharmacy and Poisons Act, 1933 80 Nuisance from Pigeons 80 Old Buildings—Demolition of 80 Propaganda 80 APPENDIX. Table I. Vital Statistics, 1938, and ten previous years 81 Table II. Causes of and Ages at Death, 1938 82 Table III. Infectious Diseases Notified during 1938 83 Table IV. Information required by L.C.C 84 Table V. Factories, Workshops, &c. (1) Inspections 86 (2) Defects found 86 (3) Home Work 87 Ambulance Service (see inside of back cover). List of Notifiable Diseases (see back of cover). 6 DEPARTMENTAL COMMITTEES OF THE COUNCIL. The Mayor and Deputy Mayor are ex-officio members of all Standing Committees of the Council. The Mayor in 1937/38 was Councillor John W. Roberts, J.P., and in the current year is Councillor Thomas Aubertin, M.A., J.P. The Deputy Mayor in 1937/38 was Alderman Roland H. Haxell, F.A.I., and in the current year is Councillor John W. Roberts. PUBLIC HEALTH COMMITTEE. 1937-38. 1938-39. Chairman— Chairman— Councillor William E. Cons. Councillor William H. M. Smeaton, F.R.San.I. Vice-Chairman— Vice-Chairman— Councillor Alcwyn Harries. Councillor Alcwyn Harries. Alderman Ernest Hamlin, M.B.E. Alderman Ernest Hamlin, M.B.E. Albert A. Mussett. " Albert A. Mussett. Councillor Thomas Aubertin. M.A. Councillor John H. Boraston, C.B. John H. Boraston, C.B. MrS. Mary A. M. Chance. „ Mrs. Mary A. M. Chance. " William E. Cons. „ William E. 0. Penny. "Miss Enid Jeeves. William C. Shortland. " William E. C. Penny. William H. M. Smeaton, F.R.San.I " William C. Shortland. John 0. McN. Turnbull. " John °. MEN- Turnbull. „ George Wansbrough. " William R. Wheatley. HOUSING OF THE WORKINC CLASSES COMMITTEE. 1937-38. 1938-39. Chairman— Chairman— Alderman Robert P. Bristow. Alderman Percy Hill. Vice-Chairman— Vice-Chairman— Alderman Percy Hill. Alderman Horace W. Langdon, F.S.I. Alderman Horace W. Langdon, F.S.I. Alderman Robert P. Bristow. „ Wilfred E. Mullen. " Ernest Hamlin, M.B.E. Councillor George J. Bailey. " Wilfred E. Mullen. ,, Frank P. Brindley. Councillor George J. Bailey. „ George E. Cox. " Frank P. Brindley. „ Percival A. Kenward. " Richard W. B. Clarke. „ Harry Myers. „ George E. Cox. „ William G. C. Shebbeare. „ Ronald A. Duncan. „ Henry H. R. Ward. „ Harry Myers. „ William R. Wheatley. ,, William C. Shortland. 7 MATERNITY AND CHILD WELFARE COMMITTEE. 1937-38. 1938-39. Chairman— Chairman— Councillor Thomas Aubertin, M.A. Councillor Henry H. R. Ward. Vice-Chairman— Vice-Chairman— Councillor Henry H. R. Ward. Councillor Harry Myers. Alderman Percy Hill. Alderman Ernest Hamlin, M.B.E. „ Horace W. Langdon, F.S.I. „ Percy Hill. „ Wilfred E. Mullen. „ Horace W. Langdon, F.S.I. Councillor Mrs. Mary A. M. Chance. „ Wilfred E. Mullen. George E. Cox. Councillor Frank P. Brindley. " Ronald A. Duncan. .. Mrs. Mary A. M. Chance. Henry W. Ellis. " Alcwyn Harries. Miss Enid M. Jeeves. .. Miss Enid M- Jeeves. Jaque V. Reynolds. .. Percival A. Kenward. George M. Roberts. " K. W. C. Sinclair Loutit, M.A. ,, William C. Shortland. „ Jaque V. Reynolds. „ John O. McN. Turnbull. „ William C. Shortland. „ Arthur G. Warne. „ John O. McN. Turrnbull. „ William R. Wheatley. „ William R. Wheatley. Mrs. John W. Roberts (Mayoress). Mrs. Thomas Aubertin (Mayoress). Miss E. Emly. Miss E. Emly. Mrs. Charlotte Harris. Mrs. Charlotte Harris. ,, Marjorie Hetherington „ Marjorie Hetherington. „ Percy Hill. „ Percy Hill. „ Percival A. Kenward. „ Horace W. Langdon. „ Horace W. Langdon. „ Wilfred E. Mullen. ,, Wilfred E. Mullen. ,, John W. Roberts. TUBERCULOSIS CARE COMMITTEE. Hoiborn Borough Council Councillor William R. Cons. „ Alcwyn Harries. Medical Officer of Health (Dr. J. A. Struthers). Tuberculosis Dispensary Tuberculosis Officer (Dr. A. J. Morland). Councillor William R. Wheatley. London County Council Dr. M. C. Polhill. Miss M. Ball. Public Assistance Committee Paul Bradshaw, Esq. 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 Mrs. J. W. Dixon. London. Almoners of hospitals Miss F. M. C. Nicholl. Miss Yoelcker (Vice-Chairman) British Legion and United Services Fund Benevolent Committee R. F. Freeman, Esq. British Red Cross Emergency Help Fund Major-General Patrick B. Sanester, C.B., C.M.G., D.S.O. Charity Organisation Society Miss E. F. Bolton. Invalid Children's Aid Association Miss Bolten. 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 1938. 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)— W. J. H. M. Beattie, M.D., F.R.C.S., M.C.O.G., 20, Upper Wimpole Street, W.l. 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—Harry D. Bailey. George F. Clark. Joseph H. R. Crabtree. S. G. Fisher. Sanitary Inspector and Health Visitor—Miss E. J. Cliarlesworth, C.M.B. Health Visitors—Miss M. G. Stoekwell, C.M.B. Miss Pamela R. Williamson, S.R.N., S.C.M. (to 30th November, 1938). Miss Evelyn J. St. Clair Webley, S.N.R., C.M.B. (from 1st December, 1938). Tuberculosis Health Visitor—Miss M. Watson, S.R.N. Chief Clerk and Committee Clerk—Albert R. Shott. Assistant Clerks—Frank Fitch. Arthur Long. Miss Knorette Hand. Reginald R. Stent. Miss Evelyn Foster. John Branston. Miss Helen W Blelloch. Inquiry Clerk and Messenger—Frank W. Grosse (from 7th June, 1938). Dentist—J. C. Sinclair, L.D.S. (British Dental Hospital). Anaesthetist— Maurice Hudson, M.B., B.S. (Lond.). Nurses—The Metropolitan District Nursing Association. Mortuary Keeper and Superintendent of Cleansing Station—Bertie Downing. Superintendent of Women's Cleansing Station—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. Air Raid Precautions Section. Assistant Medical Officer—R. E. W. Fisher, M.B., B.Ch., B.A.O. Sanitary Inspector—Gecffery Rollinaon. Temporary Clerical Assistants—Miss E. Robertson. Miss C. Deaner. 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. Giles 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.I. Certifying Surgeon (Factory & Workshop Acts)—Dr. J. C. McGregor, 6, Laystall Street, E.C.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. A. E. Dunn, Police Station, Marylebone Lane, W. 1. Honorary Secretary, Tuberculosis Care Committee— Miss H. M. Mathieson, Town Hall, High Holborn, W.C. 1. 9 STATISTICS AND SOCIAL CONDITIONS. Statistical Summary, 1938. Area of Borough in acres 405 1 Resident population—estimated to middle of 1938 (as supplied by the Registrar-General) for birth and death rates 34,350 Number of inhabited houses (1931) 6,462 Number of private families or separate occupiers (1931) 9,355 Rateable value 1st October, 1938 £1,690,538 Rate of Id in the £ estimated to yield £6,616 Total M. F. Live Births Stillbirths (Legitimate 213 110 1031 Birth Rate per 1,000 of the esti- (Illegitimate 37 21 16 mated resident population 7.28 16 8 8 Rate per 1,000 total (live and still) births 6015 Deaths 358 197 161 Death Rate per 1,000 of the esti- mated resident population 1051 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 1 376 Total 1 376 Death Rate of Infants under one year of age :— All infants per 1,000 live births 76.0 Legitimate infants per 1,000 legitimate live births 75.1 Illegitimate infants per 1,000 illegitimate live births 81.1 Deaths from cancer (all ages) 61 ,, „ measles (all ages) 1 ,, „ whooping cough (all ages) 0 „ „ diarrhoea (under 2 years of age) 5 Tuberculosis, all causes, death-rate per 100,000 932 Excess of registered births over deaths — Excess of registered deaths over births 111 Vital Statistics, 1938. England and Wales, London and Holborn. Annual Rates per 1,000 living Deaths under 1 year to 1,000 Births. Births. Deaths. England and Wales 151 11.6 53 London 13.4 11.4 57 Holborn 7.28 10.51 76 B 10 Registered Births. The total number of births registered as occurring in the Borough was 80 (39 males and 41 females). Of these, 76 were legitimate and 4 illegitimate. Corrected Births and Birth-Rate. I received from the Registrar-General information of the births in outlying institutions in London of 147 legitimate infants and 32 illegitimate infants whose mothers were residents of the Borough. Nine of the births occurring in the Borough were infants of mothers who were not resident in the Borough. The corrected number of births is therefore 250, and the corrected birth-rate 7.28. The following is the corrected number of births and the corrected birth-rates for the year 1938: — 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 Resgjstered Births No. Rate per 1,000 of population. Proportion per 1,000 total Registered Births. 1938 250 7.28 213 6.20 852 37 1.08 148 In London the corrected birth rate in 1938 was 13 .4 per 1,000 in comparison with 13 .3 for 1937. Mortality. The total number of deaths registered as occurring in the Borough was 611 of which 350 were males and 261 females. Of these deaths the following occurred in Public Institutions, etc., within the area of the Borough: — Institution. Residents. Non-Residents. French Hospital 4 40 Hospital for Sick Children 4 181 Italian Hospital 2 28 London Homoeopathic Hospital 5 73 National Hospital 1 143 Royal Westminster Ophthalmic Hospital — 2 St. Paul's Hospital - 26 Other places 2 13 Total 18 506 There were 252 deaths of civil "residents" in the various Workhouses, Infirmaries, Asylums, Hospitals, etc., outside the Borough, 20 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 Annua) Report. The final correction supplied by the Registrar-General for 1938 gives the total deaths for the Borough as 361. Corrected Deaths and Death-Rates. 1938, compared with 1937. 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 Bate for Borough. (adjusted;. Death Rate for London 1938 611 524 504 251 358 †10.51 11.25 11.4 1937 715 603 585 280 410 †11.85 12.68 12. 3 For details of causes of and ages at death (see Table II, page 82). 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 Birth 8. 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. 1938 19 75 81 76 57 1937 22 79 75 79 60 Death-rate per 1,000 corrected births in 1938 and in ten preceding years. 1928 1929 1930 1931 1932 1933 11134 1935 •936 1937 1938 Holborn Borough 57 74 89 74 72 70 71 88 62 79 76 London 67 70 59 65 67 59 67 58 66 60 57 See also Table II, page 82. 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 taransference of births in institutions to the residential area of the parents is made before the publication of the Registrar-General's Annual Report. T Tlieie rates are calculated on tho Registrar-General's estimated population at the middle of the year 1937 and 1038 respectively. b2 12 Deaths in Public Institutions. Of the total number of 358 deaths, 268 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 1938 are recorded :— Miss Pamela R. Williamson, S.R.N., S.C.M., Health Visitor, retired on the 30th November. Miss Evelyn J. St. C. Webley, S.R.N., C.M.B., was appointed to fill the vacancy and commenced her duties on the 1st December. Miss Helen W. Bullock and Mr. Frank W. Grosse were appointed to the Clerical Staff and took up their duties on the 14th March and the 7th June respectively. 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 in so far as it is not provided for by the M:dwivcs Act, 1936 is available for necessitous maternity cases subject to approval by the Maternity and Child Welfare Committee, on the recommendation of 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. Midwives are appointed under the Midwives Act, 1936, by the London County Council. 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 of milk and other foodstuffs is carried out by the Borough Analyst at his laboratory, Finsbury Town Hall, Rosebery Avenue, E.C. 1. 13 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 Liondon 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 beds to be available 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 256 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 Homoeopathic Hospital Great Ormond Street & 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 use of the above hospitals extends to residents outside the Holborn Borough area. 14 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 and cases of puerperal fever and puerperal pyrexia are investigated by the Medical Officer of Health and by the Health Visitors, to such extent as may be necessary, acting under his directions. 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, Myddelton 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 Infections 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 Maternity—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 at 2 p.m. Maternity and Child Welfare. Tuesday | at 2 p.m. 10, John Street (Municipal) Wednesday Thursday Friday St. Giles' Buildings (Municipal) (Short's Gardens) Thursday at 2 p.m. Saffron Hill, Qnslow Street (Voluntary Committee) Thursday 2-4 p.m. Friday 6-7.30 p.m. Pre-School Child. 10, John Street (Municipal) Monday at 2 p.m. Minor Ailments Clinic. 10, John Street (Municipal) Tuesday at 2 p.m. Friday 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 to 5 years (Municipal) Monday at 2 p.m. 10, John Street, General and for Tuberculous Patients Tuesday at 6.30 p.m. 15 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, Stukeley 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) Homoeopathic Hospital. (7) Hospital for Sick Children. (8) Italian Hospital. (9) Metropolitan Ear, Nose and Throat Hospital. (10) Middlesex Hospital. (11) Royal Free Hospital. (12) Tuberculosis Dispensry-, 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 : Hospital for Sick Children (for children only), Great Ormond Street, 9-10 a.tn. daily and 2-4 p.m., on Tuesdays, Wednesdays and Fridays. Cleansing Station for Verminous Persons. Stukeley 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 Wednes lay evening. 16 SANITARY CIRCUMSTANCES OF THE BOROUGH. Removal of Offal. No breach of the by-laws made by the London County Council was recorded during the year. Sanitary Inspection of the District, including Premises and Occupations which can be controlled by By-Laws and Regulations. In addition to my inspections, the Sanitary Inspectors made 15,921 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, 1938. Mr. Bailey Mr. Clark Mr. Crabtree Mr. Fisher Miss Charlesworth Miss Stockwell Miss Webley Miss Williamson Total Complaints received 86 62 18 1 ... ... ... ... 167 Do. found to be justified 83 51 17 1 ... ... ... ... 2.52 Inspection of Mouses— Dwelling-houses 261 308 131 2 ... ... ... ... 702 Houses let in lodgings 137 267 281 ... ... ... ... ... 686 Common lodging-houses 4 12 ... ... 3 ... ... ... 19 Drains tested by chemical 5 1 ... ... ... ... ... ... 6 Do. smoke 11 18 2 ... ... ... ... ... 31 Do. air 11 11 7 ... ... ... ... ... 29 Do. water 78 81 34 3 ... ... ... ... 196 Underground rooms 5 27 ... ... ... ... ... ... 32 factories— Bakehouses 1 ... ... 39 ... ... ... ... 40 Food preparation ... ... 1 69 ... ... ... ... 60 Other 199 76 5 ... ... ... ... ... 280 Laundries ... ... ... ... ... ... ... ... ... Workshops and Workplaces— Food premises: Dairies and Milkshops 7 2 ... 481 ... ... ... ... 490 Ice Cream, Manufacture 1 ... ... 2 ... ... ... ... 3 Do. Storage or Sale ... i 46 60 ... ... ... ... 61 Slaughter-houses 1 ... ... 2 ... ... ... ... 3 Hotels and Restaurants 9 i 46 1,000 ... ... ... ... 1,055 Butchers 1 ... ... 265 ... ... ... ... 266 Bakehouses 1 ... 1 66 ... ... ... ... 57 Fish shops 2 ... ... 18 ... ... ... ... 20 Fried Fish shops ... ... ... 49 ... ... ... ... 49 Market Streets 15 24 26 202 ... ... ... ... 266 Licensed Premises 11 ... ... 19 ... ... ... ... 30 Other food Bhops 5 ... 21 871 ... ... ... ... 897 Merchandise .Marks Act, 192-6 ... ... • •• 54 ... ... ... ... 54 Other workshops 113 142 8 ... ... ... ... ... 264 Other workplaces 201 100 50 2 ... ... ... ... 353 Outworkers' Registers 26 28 7 ... ... ... ... ... 61 Do. Rooms ... ... ... ... ... ... ... ... ... Laundries ... ... ... ... ... ... ... ... ... Stables and Stable yards ... ... 1 ... ... ... ... ... ... Rag and Bone shops ... 5 ... 7 ... ... ... ... 12 Offices 2 ... ... ... ... ... ... ••• 2 Shops (Shops Act) 12 12 2 ... ... ... ... ... 26 Pharmacy and Poisons ... ... ... 69 ... ... ... ... 69 Inspections carried forward 1,119 1,116 621 3,259 4 ... ... ... 6,119 17  Mr. Bailey Mr. Clark Mr. Crabtree Mr. Fisher Miss Charlesworth Miss Stockwcll Miss Weblej Miss William, son Total Brought forward 1,119 1,116 621 3,259 4 ... ... ... 6,119 Miscellaneous— Black smoke 49 30 110 ... ... ... ... ... 189 liats and Mice (Destruction) Act 90 160 144 6 400 Food and Drugs Act—Sampling 4 ... 4 592 ... ... ... ... 600 Demolition of buildings 76 24 31 ... ... ... ... ... 131 Other Inspections ... ... ... ... ... ... ... ... ... Keeping of Animals 2 3 3 ... ... ... ... ... 8 Periodical Inspections: Including W.C. and yards, dust-bins, especially houses let in lodgings, and other similar dwellings 129 1,520 418 ... ... ... ... ... 2,067 R E • INSPEOTIONS— houses 72i9 881 820 2 ... ... ... ... 2,432 Factories 67 10 ... 4 ... ... ... ... 81 Workshops 40 39 4 1 ... ... ... ... 84 Workplaces 644 812 603 55 ... ... ... ... 1,614 Restaurants 3 ... 28 226 ... ... ... ... 257 Licensed premises 27 ... ... 40 ... ... ... ... 67 Miscellaneous ... ... ... 1 ... ... ... ... 1 Visits re Infectious Diseases 107 82 97 8 43 103 5 75 620 Scabies ... ... ... ... 1 6 ... 3 10 Verminous persons ... ... ... ... ... ... ... ... ... Otiiek Visits— l'olice Courts 2 2 ; 8 ... ... ... ... 8 Various 527 448 293 34 11 4 ... 16 1,333 Total 8,616 4,627 3,177 1,231 59 113 5 94 15,921 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 926, viz. :— Public Health (.London) Act, 1936— Intimation Notices 299 Statutory Notices 44 Verminous rooms 1 By-laws— Food premises 90 Houses let in lodgings 465 Rats and Mice (Destruction) Act, 1919 27 926 18 The following table shows the work done to abate nuisances for which intimation notices were served: — Water Supply— House Facto ries, Workshops and Workplaces Provided 3 1 Cisterns cleansed, repaired etc. 6 1 Waterclosets— Cleansed 7 10 Water supplied, flushing cistern repaired, etc. 8 1 Repaired, new pans, etc. 24 14 Ventilation improved 1 9 Artificial light provided — 24 Separate accommodation for sexes provided — 1 Position or construction improved ... 1 Direct communication with workrooms remedied 1 1 ,, ,, ,, dwelling room 1 Accommodation provided 1 4 Unstopped 8 2 Urinals, repaired, cleansed, etc. — 3 Soil Pipes— Repaired, renewed and ventilated 112 1 Rainwater Pipes— Repaired or renewed 9 5 Drains— Repaired 8 5 Unstopped, cleansed, etc. 6 6 Sinks, etc.— Waste pipes repaired, renewed, etc. 20 28 Yards, Areas and Washhouses— Cleansed 11 4 Paved and paving repaired 6 1 Drained — — Houses and Workshops, etc.— Cleansed 24 23 Dilapidations repaired and made good 28 3 Ventilation improved — 1 Dampness— Roofs repaired 13 2 Gutters repaired 2 2 Other works to prevent dampness 10 2 Ashbins— Provided, repaired, etc. 17 13 V arious— Underground Rooms vacated ... — Smoke—Emission of black smoke abated — — Accumulations of Refuse—Removed 21 17 Overcrowding abated - — Animals improperly kept — 1 Manure Receptacles—Provision of — — Other 3 1 * This applies to overcrowding' under the Public Health (London) Act, 1936. For overcrowding dealt with under the Housing Acts, see page 27, 19 The following table shows the nuisances for which the 44 Statutory Notices were issued under the Public Health (London) Act, 1936 : — Houses. Factories, etc Section 82 (1)— (a) Dirty, dilapidated, damp premises, ctc. 10 2 (b) W.C.'s, drains, etc. 3 11 (c) Accumulation of refuse 4 8 (d) Overcrowding — — Section 95—Water supply 1 — Section 104—Waterclosets, dirty, defective, etc. 4 10 Section 105—Ashbins 4 — Section 105—W.C., provision of 1 1 Section 106—W. C. accommodation for sexes - 2 Section 107—Receptacles for dung — — Section 128—Nuisance from Factories, etc. — By-Laws as to Houses let-in-lodgings. At the end of the year, 358 houses were registered under these By-laws. Of these, 143 were wholly or partly decontrolled under the Rent Acts at the end of 1938. There were 685 inspections of these premises, excluding a large number of periodical inspections and re-inspections. 68 notices were served for breaches of the By-laws, in addition to 393 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 1938, 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, 243 separate premises were inspected, ranging from small dwelling houses to large blocks of offices and business premises. c'2 20 In 99 cases the Inspectors discovered evidence of rat infestation. Notices under the Act were served as necessary, and advice given with a view to adequate steps being taken to eradicate the vermin. 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. 4 2 — — — — 2 Free 2 b. lot 13 — — 1 — 12 Free 12 Under observation 1 C. 12 12 3 — 7 — - 5 Free 9 Under observation 3 d. 19 11 — — 1 — — 10 Free 11 e. 12 8 1 1 2 — — 4 Free 6 Under observation 2 F. 4.i 23 6 4 8 — — 5 Free 13 Under observation 10 G. 24 7 3 — 1 — — 3 Free 4 Under observation 3 h. 18 16 8 3 5 — — 9 Free 14 Under observation 2 i. 7 7 2 — 5 — — 3 Free 5 Under observation 2 243 99 23 8 30 — — 53 Free 76 Under observation 23 21 National Rat Week. In response to the request of the Ministry of Agriculture and Fisheries, " Rat Week " was observed in the Borough in the week commencing 6th November, 1938:— 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 3,000, and during the last week in December this increased number was repeated by placing 3,000 baits in the same sewers. In connection with this the Borough Engineer and Surveyor writes: — " Rat repression is so successful in the sewers of the Borough that difficulty is experienced in getting all the baits taken owing to the continuous cleansing of the sewers and systematic laying of baits. In fact, in many sewers it is quite unusual to find any rats or traces of them. " The Sewer Foreman and the Sewer Gangers all speak highly of the efficiency of the baits 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 dd systems and alterations to existing drainage, is supervised by the Sanitary Inspectors. During the year 129 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, 180 observations being recorded. A number of these were made in the early morning, when smoke pollution is more prevalent; and frequently the observations extended 22 for periods of not less than one hour. Nine complaints were received of nuisances from the emission of smoke. The use of unsatisfactory coal is the common cause of smoke nuisance; such use sometimes 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 (London) Act, 1936, 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. 380 factories were inspected, 264 workshops and 1,440 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 60 premises no longer used for the purpose for which they had been registered were removed from the register of workshops. In some cases; owing to the introduction of machinery, former"workshops" had become "factories" and the necessary transfer to the factory register was effected. Variations in the staff employed were also frequently reported. During the year 35 workshops were added to the register. At the end of the year there were 605 workshops on the register. 366 employed men only, 40 employed women only, and 199 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 loo different industries are carried on in these workshops, among the principal being the following :— No. of Workshops Employing Men only. Women only. Both Sexes. Total. Boot makers and repairers 11 1 2 14 Builders 11 — 11 Carpenters 13 — 1 14 Clock and watch makers 17 2 19 Dressmakers and ladies' tailors - 11 21 32 Diamond mounters 8 1 9 Engravers 19 1 20 Glass blowers 8 2 10 Jewellers 32 3 12 47 Leather goods makers 5 - 3 8 Metalworkers 8 4 12 Tailors 24 3 47 74 23 Factories. These visits also afforded an opportunity for extending and revising information relating to "factories" in the Borough. At the end of the year 493 factories were on the register. The 493 factories include 57 different industries. In 240 cases men only were employed, in 15 women only, and in 238 both sexes. The more important industries carried on in these factories are :— Printing 123 Engineering 43 Jewellers' work 33 Bookbinding 16 Metal work 13 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 1938: — Mr. Bailey. Mr. Clark Mr. Crabtree Mr. Fisher. Miss Charles worth. Total. Factories Inspections (including factory bakehouses) 200 76 6 98 - 380 Re-inspectious 67 10 — 4 - 81 Workshops— Inspections 113 142 8 — 1 264 Re-inspections 40 39 4 1 - 84 Workplaces— Inspections 201 100 50 2 - 353 Re-inspections 644 312 603 55 — 1,614 Offices— Inspections 2 — — — - 2 Re-inspections — — — — - — Bakehouses— Inspections (excluding factory bakehouses) 1 — 1 55 — 57 Re-inspections — — — — - — Restaurants— Inspections 9 1 45 1,000 - 1,055 Re-inspector 3 _ 28 226 257 Licensed Premises— Inspections 11 — — 19 - 30 Re-inspections 27 - 40 - 6 Defects Found— Want of cleanliness 8 14 — 1 - 23 ,, ventilation — 1 — — - 1 Overcrowding — — — — - — Storage cistern defective — — — — - — Accommodation for refuse 1 3 4 6 - 14 Accumulation of refuse 4 1 3 12 - 20 Sanitary accommodation Insufficient 4 1 — — - 5 Unsuitable 8 22 — - 30 Defective 8 4 2 6 - 20 Not separate for sexes - 1 — — — 1 Other nuisances 22 26 19 19 — 86 Total defects 55 73 28 44 — 200 24 Action taken Matters referred to H.M. Inspector :— Failure to affix abstract 12 Matters referred by H. M. Inspector:- Notified by H.M. Inspector 11 Notices served. Mr. Bailey. Mr. Clark. Mr Crabtree. Mr. Fisher. Miss Charlesworth. . Factories— Intimation 15 25 — - - 40 Statutory — 1 — — — 1 Workshops— Intimation 10 17 1 - - 28 Statutory 1 2 — — — 3 Workplaces— Intimation 6 9 7 1 — 23 Statutory 5 3 5 — — 13 Offices— Intimation - 1 — - - 1 Statutory — — — — — — Restaurants— Intimation 2 2 6 29 — 39 Statutory - 1 4 2 — 7 Licensed Premises— Intimation 1 - - - — 1 Legal Proceedings - - - - - - Outworkers. Lists received from Holborn Firms 98 Names and addresses received from other Authorities 343 Names and addresses sent to other Authorities 392 Notices served on Employers 98 Firms visited 61 Infectious diseases in outworkers premises nil Regulation of Sale and Use of Rag Flock. There are no premises in the Borough on which rag flock, as defined by the Public Health (London) Act, 1936, is known to be manufactured, used or sold. The Shops Act, 1934. During the year 26 inspections were made under this Act; in 3 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. Two applications from owners or occupiers for certificates of exemption under Section 10 of the Act (provision of sanitary conveniences) were received during the year. 25 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. HOUSING. The following is the summary of information asked for in the Ministry of Health Circular 1728 (England):— 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 702 (b) Number of inspections made for the purpose 1,299 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1025 and 1932 124 (6) Number of inspections made for the purpose 255 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 41 (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 138 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 26 III.—ACTION UNDER STATUTORY POWERS DURING THE YEAR. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (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 espect of which notices were served requiring defects to be remedied 138 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 138 (b) by Local Authority in default of owners nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 23 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 18 (3) Number of undertakings accepted respecting the future user of, or the execution of work to, dwelling houses 16 D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 64 (2) Number of separate tenements or underground rooms closed in pursuance of Closing Orders 56 (3) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil (4) Number of undertakings accepted respecting the future user of, or the execution of works to, separate tenements or underground rooms 8 27 IV.—HOUSING ACT, 1936.— PART IV.—OVERCROWDING A.— (i) Number of dwellings overcrowded at the end of the year 289 (ii) Number of families dwelling therein 289 (iii) Number of persons dwelling therein 1,554 B.—Number of new cases of overcrowding reported during the year 59 C.—(i) Number of cases of overcrowding relieved during the year. 154 (ii) Number of persons concerned in such cases 696 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 below Accommodation on L.C.C. Estates. During the year information was received of 68 Holborn families for whom accommodation was provided by the London County Council. Abatement of Overcrowding. The following table shows the position with regard to overcrowding in the Borough during the year 1938:— Overcrowding, 1938. No. of cases of overcrowding on record on 1st January 384 No. of new cases of overcrowding recorded during the year 59 443 No. of cases of overcrowding abated during the year:— Survey cases 113 Other 41 154 No. of cases of overcrowding remaining on record at 31st December 289 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 63 Accommodation provided by Borough Council 9 Accommodation secured otherwise 42 Abatement by alteration in constitution of family 40 154 d2 28 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, 1936. During the year 54 cases were approved by the Council for inclusion in the agreement and of these, 27 families had been rehoused by the end of the year. Housing Act, 1936, Section 18. Allowances towards Removal Expenses. During the year the Council made allowances towards the cost of removal of 20 families displaced in consequence of action taken by the Council under Part II of the Housing Act, 1936. 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 1938, the number of registered dairies and milkshops in the Borough was 155. Ten entries were made in the register during 1938. All these were new registrations, 4 being itinerant vendors with premises outside the Borough. The Sanitary Inspectors recorded 490 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, 1936. During the year 1938 licences available up to the 31st December, 1938, for the sale of designated milk in the Borough were issued as follow:- Accredited — Tuberculin Tested 2 Pasteurised 5 Supplementary— Accredited — Tuberculin Tested 3 Pasteurised 3 13 29 Bacteriological Examinations of Milk. The following table shows the results of examinations in 1938:- Nature of premises where sample obtained Grade No. of bacteria per c.c. Minimal amount showing coliform bacteria Phosphatase test Methylene Blue test Evidence of Tuberculous Infection Sample Letter School Pasteurised 90,000 1 c.c. Negative ... ... B.l School Pasteurised 100,000 1 c.c. Negative ... ... B.2 School Pas teurised 100,000 1 c.c. Negative ... None B.3 Milk Bar Pasteurised (Homogenised) 100,000 + 1 c.c. ... ... ... B.4 Milk Bar Pasteurised (Homogenised) 100,000 + 1 c.c. Positive ... ... B.5 Milk Bar Pasteurised (Homogenised) 100,000 + 1 c.c. Negative ... ... B.6 Milk Bar Pasteurised (Homogenised) 100,000 + 1 c.c. Negative ... ... B.7 Dairy Ungraded 4,500 Absent in 1 c.c. ... ... None B.8 Dairy Ungraded 35,100 0·1 c.c. ... ... None B.9 Dairy Ungraded 20,000 0·1 c.c. ... ... None B.10 Dairy Pasteurised 9,000 1 c.c. Negative ... ... B.11 Dairy Pasteurised 26,000 1 c.c. Negative ... ... B.12 Dairy Pasteurised 13,000 1 c.c. Negative ... None B.13 Street Ungraded 5,000 0·001 c.c. ... ... ... B.19 Dairy Pasteurised 80,000 1 c.c. ... ... ... B.24 Dairy Ungraded 30,000 0·001 c.c. ... ... ... B.31 Dairy Ungraded 1,000,000+ 0·00001 c.c. ... ... ... B.32 Dairy Ungraded 1,000,000+ 0·00001 c.c. ... ... ... B.33 Dairy Ungraded 7,000 0·1 c.c. ... ... ... B.34 Dairy Ungraded 20,000 0·00l c.c. ... ... ... B.35 Dairy Ungraded 1,000,000 0·00001 c.c. ... ... ... B.36 Dairy Ungraded 25,000 1 c.c. ... ... ... B.37 Dairy Ungraded 20,000 0·01 c.c. ... ... ... B.38 Street Ungraded 15,000 0·01 c.c. ... ... ... B.39 Dairy Ungraded 30,000 0·00001 c.c. ... ... ... B.40 Dairy Ungraded 200,000 0·01 c.c. ... ... ... B.41 Dairy Ungraded 32,000 0·00l c.c. ... ... ... B.42 Dairy Ungraded 3,900 Absent in 1 c.c. ... ... ... B.48 Dairy Ungraded 3,250 Absent in 1 c.c. ... ... ... B.49 Dairy Ungraded 49,000 0·00l cc. ... ... ... B.50 Dairy Ungraded 16,000 0'0001 c.c. ... ... ... B.51 30 Nature of premises where sample obtained Grade No. of bacteria per e.c. Minimal amount showing coliform bacteria Phosphatase test Methylene Blue test Evidence of Tuberculous Infection Sample Letter Milk Bar Ungraded 96,000 0·01 c.c. ... ... ... B.52 Dairy Ungraded 10,000 0·0l c.c. ... ... ... B.53 Dairy Ungraded 54,000 0·0l c.c. ... ... ... B.54 Dairy Ungraded 5,500 0·01 c.c. ... ... ... B.55 Dairy Ungraded 1.300 Absent in 1 c.c. Negative ... ... B.56 Dairy Ungraded 52,000 0·0l c.c. ... ... ... B.57 Dairy Ungraded 21,000 0·0l c.c. ... ... ... B.58 Street Ungraded 5,800 Absent in 1 c.c. Negative ... ... B.59 Dairy Ungraded 43,000 1 c.c. ... ... ... B.60 Dairy Ungraded 640,000 0·00l c.c. ... ... ... B.61 Dairy Ungraded 21,000 Absent in 1 c.c. Negative ... ... B.62 Street Pasteurised 30,000 Absent in 1 c.c. Negative ... ... B.66 Street Pasteurised 40,000 Absent in 1 c.c. Negative ... ... B.67 Street Ungraded 45,000 0.1 c.c ... ... ... B.68 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 inspections were made of the fish shops and fish stalls in the Borough in addition to market street inspections. There are 10 fish shops, of which four are in the Central Fish Market (a part of the Smithfield Central Markets, Farringdon Boad, the fish being sold by retail). Both wet and dried fish are sold at all the shops; at four, shell fish also is sold. In addition to the shops referred to above, there are nine stalls in the Borough for the general sale of fish. There is also a shop in the Borough for the sale of shell fish only and two for the sale of stewed eels. These premises were also kept under observation. Fried Fish Shops. There are also 14 fried fish shops. These are inspected to see that they are kept in conformity with the By-laws made by the London County Council. 31 Market Streets. There were 266 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 85 tions from street traders fro annual licences to sell various articales of food as follows;- Coffee stalls 5 Confectionery and drinks 12 Fish—wet and dry, including shell fish 8 Fruit and vegetables 44 Groceries 3 Ice cream or chestnuts 7 Meat 3 Poultry, eggs and provisions 3 85 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 sale 1 Manufacture, storage and sale 8 Storage and sale 50 Sale only 29 88 32 In addition to my inspections, 64 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 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. Bacteriological Examinations of Ice Cream. The following table shows the results of examinations in 1938:- Sample letter Description Nature of premises where sample obtained No. of bacteria per c.c. Minimal amount showing coliform bacteria B 14 Ice Cream Street 400,000 0·000l c.c. B 15 do. do. 30,000 0·0l c.c. B 16 Water Ice do. 1,500 Strands of debris present in 1 c.c. B 17 Ice Cream Milk Bar 8,000 0.01 c.c. B 18 Water Ice do. 20,000 0·1 c.c. B 20 Ice Cream do. 30,000 0·0l c.c. B 21 do. do. 80,000 0·00l c.c. B 22 do. do. 50,000 0·000l c.c. B 23 do. do. 50,000 0'00001 c.c. B 25 do. Street 40,000 0·00001 c.c. B 26 do. do. 10,000 0·00001 c.c. B 30 do. do. 8,500 Absent in 1 c.c. B 43 do. Milk Bar 32,000 0·0l c.c. B 44 do. do. 30,000 0·0l c.c. B 45 do. do. 50,000 0·00l c.c. B 47 do. do. 16,000 0 001 c.c. B 48 Ice Cream Powder do. 8,000 per gramme Absent in 1 g. Remarks.—The examinations have shewn considerable variations in quality of ice cream. Continuous attention is given to the subject by the Council's Food Inspector with a view to improving conditions. Careful consideration is also given to the premises concerned when applications are made for new licences. 33 Public 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 28 Butchers' stalls 3 Provision dealers 36 Provision dealers' stalls 3 Offal shops 2 Cooked meats 21 Wholesale (bacon; sausage) 4 97 All the butchers' shops and meat stalls in the Borough are regularly inspected to ensure compliance with the Regulations; during the year 266 such inspections were made. Places where Food Is prepared for Sale. Under this head are included kitchens of hotels, restaurants, and eating-houses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food is prepared for sale excluding bakehouses. The number of such places on the register at the end of the year was as follows:— Hotels, Restaurants and Eating Houses 437 Slaughter-houses 1 Tripe, offal and other meat shops 51 Fried fish shops 14 Fish shops 10 Ice cream (Manufacture) 9 Poulterers 8 During the year 1,662 inspections of such food premises and market streets were made and 72 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. 34 Unsound Food. The following unsound was condemned during the year 1938:- Cert. No. Article. Amount. Country of origin. Cwts. Qrs. Lbs. 168 Chocolate Wafers ... ... 4 England U.S.A. 9 Quantity of Tinned Goods 12 ... ... England Spain France 170 1 Tin Puree and 2 Tins Anchovy Fillets ... ... 6 Portugal Spain 1 14 Tins Tomatoes ... 3 14 Hungary 2 160 jars Meat Paste ... 1 12 England 3 12 tins Spinach ... 1 3 Belgium 4 3 tins Apples ... ... 21 Canada 5 1 tin Tomato Puree ... ... 14 Italy 6 9 tins Victoria Plums ... ... 21 England 7 1 tin Peas ... ... 2 Belgium Italy 8 Quantity of Tinned Foods, various 1 ... 18 U.S.A. England 9 11 Tins Victoria Plums ... 1 ... England 180 1 tin Tomato Puree ... ... 2 Italy 1 3 tins Tomato Paste ... ... 10 Hungary 2 4 tins Plums, 3 tins Gooseberries ... 1 14 England 3 8 tins Salmon ... ... 8 Canada 4 2 tins Peaches, 1 carton Gingerade Powder ... ... 8 U.S.A. England 5 Quantity of Tinned Foods, Tomato, Beans, Celery ... 3 7 Italy Belgium 6 1 tin milk, 1 tin Peaches ... ... 4 U.S.A. 7 3 tins Milk ... ... 2 Holland 8 2 tins Plums, 2 tins Raspberries ... ... 8 England 9 1 tin Salmon ... ... 1 Canada 190 1 tin Sardines ... ... 2 Portugal u.s.a. 1 Quantity of Tinned Foods, various 5 2 17 Portugal England 2 Quantity of Tinned Milk ... 3 10 Holland 3 Quantity of Tinned Peas 6 2 12 Belgium 4 4 tins Tomatoes ... 1 ... Italy u.s.a. 5 Quantity of Tinned Foods, various ... 8 19 England Belgium 6 Quantity of Tinned Foods, various 3 1 6 CzeckoSlovakia 7 Quantity of Tinned Foods, various ... 3 19 Italy Belgium U.s.A. 8 Quantity of Tinned Foods, various ... 1 13 Canada Italy 9 3 tins Tomato Puree ... ... 21 Italy 200 3 tins Figs ... • •• 6 Canada 1 1 tin Peas ... ... 2 England 2 1 tin Celery Hearts ... ... 2 England 3 2 tins Tomato Puree ... ... 14 Hungary 4 2 tins Mushrooms ... ... 2 Belgium 5 1 tin Pineapple ... ... 2 U.S.A. 6 1 tin Grapefruit, 1 tin Asparagus ... ... 4 Canada 7 1 tin Fruit Salad ... ... 2 U.S.A. 8 1 tin Green Gooseberries ... ... 10 England 9 2 tins Tomatoes ... ... 14 Italy 210 2 tins Figs ... ... 6 Canada 1 1 tin Apricots ... ... 8 U.S.A. 2 1 tin Asparagus ... ... 2 U.S.A. 3 Quantity of Tinned Fish, Vegetables and Fruit 1 2 7 Italy England U.S.a. 4 2 tins Peas ... ... 6 U.S.A. 5 7 tins Sardines ... ... 7 Portugal 6 Quantity of Orange Juice 1 ... 6 Italy 35 Cert No. Article. Amount. Country of origin. Cwts. Qrs. Lbs. 217 Quantity of Tinned Vegetables ... 3 17 England Belgium 8 Quantity of Tinned Vegetables ... 1 10 England 9 Quantity of Tinned Fruit ... 2 17 England 220 Quantity of Tinned Fruit 3 2 16 England 1 2 jars Honey ... ... 4 England 2 Quantity of Fruit Syrup ... 3 9 France 3 4 jars Gooseberries ... ... 10 England ... ... 5 Canada 4 1 packet Quaker Oats ... ... 2 England 5 1 jar Chicken Jelly ... ... 2 England 6 1 bottle Orange Juice ... 1 14 England 7 6 jars Pickles ... 1 14 England 8 6 jars Red Cabbage 3 ... ... England 9 3 cases Corn Flakes ... 1 ... England 230 2 tins Biscuits Italy ... Belgium 1 Quantity of Tinned Fruit, Fish, Vegetables 12 3 U.S.A. 12 England 2 1 tinned gammon ... ... Denmark 3 4 tine Tomato Puree ... ... 8 Hungary 4 1 bottle Lemon Barley ... ... 2 England 5 17 cases Apples 17 ... ... Canada 11 casse Tinned Spinach 11 ... ... Belgium 6 3 Legs Lamb ... ... 16 N. Zealand 7 3 tinned Gammons ... 1 8 Denmark 8 34 tins Tomato Puree ... 2 12 Italy 9 2 tins Cherries ... ... 4 England 240 1 tin Beans ... ... 2 England 1 1 tin Vegetables ... ... 2 England 2 Quantity of Bacon 1 10 Holland 3 52 Rabbits 1 ... ... England 4 1 Gammon ... ... 11 Holland 5 24 tins Molasses and 5 packets flour ... 2 2 U.S.A. 6 17 tins Pork and Beans ... 1 6 England 7 3 tins Lambs' Livers ... 1 6 N. Zealand 8 8 tins Figs ... ... 6 Greece 9 1 tin Asparagus, 1 tin Grapefruit ... ... 3 U.S.A. 251 1 tin Raspberries ... ... 2 England 2 3 tins Sardines ... ... 2 Portugal 3 2 tins Cherries ... ... 4 England 4 1 tin Tomatoes ... ... 2 Italy 5 1 tin Haricot Verts ... ... 2 Belgium 6 1 tin Loganberries ... ... 2 England 7 1 tin Champigons ... ... 2 France 8 15 tins Prunes ... 1 6 Australia 9 34 tins Pears ... 2 14 U.S.A. 260 5 tins Salmon ... ... 10 Canada 1 2 tins Lobster ... ... 2 Japan 2 9 tins Beans ... ... 20 England 3 5 tins Vegetables ... ... 10 England U.S.A. 5 Quantity of Meat, Fish and Fruit 2 2 7 Italy Denmark 6 1 tin Ox Tongue ... ... 10 Denmark 7 1 box of Kippers ... ... 14 England 8 2 tinned Gammons ... ... 24 Denmark Italy 9 Quantity of Tinned Fruits and Vegetables ... 2 17 England 270 1 tin Ox Tongue ... ... 10 England 1 122 Rabbits 2 1 9 England 2 Quantity of Tinned Foods ... 3 7 Japan Italy 3 Quantity of Tinned Fish 1 1 4 Japan 4 7 tins of Pineapple ... ... 16 Japan 5 Quantity of Honey and Malted Milk ... 1 12 England N. Zealand 6 One bottle Sweets ... 6 England 7 Quantity of Boiled Sweets 5 3 12 England 8 Quantity of Tinned Food 12 2 9 U.S.A. Italy England TOTAL amount of unsound food surrendered during 1938— 6 tons 4 cwts. 0 qtrs. 23 lbs. e2 36 The Public Health (Preservatives, etc., in Food) Regulations. In the year 1938 ten samples of food were found on analysis to contain preservatives contrary to the provisions of the above Regulations, viz., Lager beer, jam, marmalade, sausages, and sausage roll (sse page 42). Food and Drugs (Adulteration) Act, 1928. Articles Analysed. Formal Samples. Article. Number Purchased Result of Analyses Proceedings taken. Conviction. Fines and Costs. Cenuine. Adulterated. Ale 4 4 ... ... ... ... Almonds 1 1 ... ... ... ... Almonds, ground 3 3 ... ... ... ... ,, salted 1 1 ... ... ... ... Apricots, canned 2 2 ... ... ... ... Arrowroot 1 1 ... ... ... ... Beer 3 3 ... ... ... ... Bitter 3 3 ... ... ... ... Brandy 2 2 ... ... ... ... Brawn 2 2 ... ... ... ... Butter 15 15 ... ... ... ... Cake 4 4 ... ... ... ... Candied peel 1 1 ... ... ... ... Capais 1 1 ... ... ... ... Cheesu 5 5 ... ... ... ... Chocolate 2 2 ... ... ... ... Chutney 1 1 ... ... ... ... Cocoa 1 1 ... ... ... ... Corned beef 1 1 ... ... ... ... Cookeen 2 2 ... ... ... ... Cream, coffee 1 1 ... ... ... ... Cream, tinned 3 3 ... ... ... ... Custard powder 1 1 ... ... ... ... Dripping 1 1 ... ... ... ... Fish paste 1 1 ... ... ... ... Fruit salad, canned 1 1 ... ... ... ... Gelatine 1 1 ... ... ... ... Gin 3 3 ... ... ... ... Ginger, crystallised 1 1 ... ... ... ... Ginger wine 4 4 ... ... ... ... Glace cherries 1 1 ... ... ... ... Grape fruit, canned 1 1 ... ... ... ... Grape fruit juice 2 2 ... ... ... ... Honey 1 1 ... ... ... ... Ice Cream 4 4 ... ... ... ... 37 ARTICLE. Number Purchased. Result of Analyses. Proceedings taken. Convictions. Fines and Costs. Genuine Adulterated. Jam 6 5 1 ... ... ... Jel 4 4 ... ... ... ... Lager beer 8 8 ... ... ... ... Lard 3 3 ... ... ... ... Lemon barley powder 1 1 ... ... ... ... Margarine 8 8 ... ... ... ... Marmalade 2 1 1 ... ... ... Milk 157 153 4 ... ... ... 1. Defendant convicted and fined £1 and f1 costs. 2. Defendant convicted and fined £1 and £1 costs. Milk pudding powder 1 1 ... ... ... ... Minced beet 1 1 ... ... ... ... Mint 1 1 ... ... ... ... Mixed spice 2 2 ... ... ... ... Mustard 8 8 ... ... ... ... Nut chocolate 1 1 ... ... ... ... Olive oil 1 1 ... ... ... ... Orange juice 4 4 ... ... ... ... Orange and quinine wine 5 5 ... ... ... ... Paste, meat 1 1 ... ... ... ... Peas, canned 2 2 ... ... ... ... Pepper 1 1 ... ... ... ... Pineapple, canned 1 1 ... ... ... ... „ juice 1 1 ... ... ... ... Pork pie 1 1 ... ... ... ... Raspberries, canned 1 1 ... ... ... ... Rum 2 2 ... ... ... ... Salmon, canned 1 1 ... ... ... ... Sardines 4 4 ... ... ... ... Sausages 4 4 ... ... ... ... Saveloy 1 1 ... ... ... ... Steak pie 1 1 ... ... ... ... Stout 2 2 ... ... ... ... Strasbourg paste 1 1 ... ... ... ... Sweetbreads 1 1 ... ... ... ... Tea 2 2 ... ... ... ... Tomato juice 2 2 ... ... ... ... „ paste 1 1 ... ... ... ... „ soup 2 2 ... ... ... ... Trez 1 1 ... ... ... ... Turkish delight 1 1 ... ... ... ... Vinegar 2 2 ... ... ... ... Whiskey 8 8 ... ... ... ... Total 338 332 6 ... ... ... 38 Informal Samples article. Number of Samples taken. Result of Analyses. Oenuine. Adulterated Ammoniated tine, of Quinine 1 1 ... Anchovy fillets 1 1 ... Apples 1 1 ... Apricots, dried 1 1 ... Beans (with pork sausage) canned 1 1 ... Beef fluid 1 1 ... Beef paste 1 1 ... Black currant flavour wine 1 1 ... Bloater paste 1 1 ... Brawn 5 5 ... Bread 1 1 ... Bun flour 1 1 ... Butter 11 11 ... Cade ointment 1 1 ... Cake 5 5 ... Capers 2 2 ... Celery cheese 1 1 ... Cheese 9 8 1 Christmas pudding 4 4 ... Cocoa 1 1 ... Coffoe and chicory 1 1 ... Cookeen 1 1 ... Corned beef 1 1 ... Cream 1 1 ... Cream, canned 3 3 ... Cream porridge, canned 1 1 ... Creamed rice 1 1 ... Dates 1 1 ... Dripping 3 3 ... Eucalyptus ointment 1 1 ... Elder aud eucalyptus oint 1 1 ... Figs 5 5 ... Fish, cake 2 2 ... ,, fried 1 1 ... „ paste 10 10 ... Flour, self raising 1 1 ... Fruit salad, dried 1 1 ... „ pie 1 1 ... Fruits, assorted 1 1 ... ,, crystallised 4 4 ... ,, preserved 1 1 ... Ginger, preserved 1 1 ... ,, wine 1 1 ... Gravy powder 1 1 ... Ham 2 2 ... „ and tongue paste 1 ... 1 Herrings, smoked 1 1 ... Honey 2 2 ... „ cakes 1 1 ... Iodine 2 2 ... „ smelling salts 1 1 ... Jelly 7 7 ... Jam 5 5 ... Lager beer 3 2 1 Lard 2 2 ... 39 ARTICLE. Number of Samples taken. Result of Analysis. Genuine. Adulterated. Lemon cheese 1 1 ... ,, squash 4 4 ... „ barley powder 1 1 ... „ „ water 1 1 ... Lemonade powder 2 2 ... Margarine 9 9 ... Marmalade 1 1 ... Meat paste 6 6 ... Meat pie 4 4 ... Meat roll 2 2 ... Meringue trifle 1 1 ... Milk 4 4 ... „ condensed 2 2 ... „ shape 1 1 ... Mincemeat 2 2 ... Mince pie 1 1 ... Mixed spice 1 1 ... Muscatels 2 2 ... Mustard 3 3 ... Oatcakes 1 1 ... Olive oil 7 7 ... Orange squash 1 1 ... „ wine 1 1 ... Oranges, canned 1 1 ... Feas, canned 2 2 ... Pepper 5 5 ... Pickle 2 2 ... Pineapple, canned 1 1 ... Prunes 1 1 ... Pudding fruit 2 2 ... „ powder 1 1 ... Puff pastry 2 2 ... Pork fat 1 1 ... Raisin flavour wine 1 1 ... Raisins 2 2 ... Salmon, canned 1 1 ... Sardines 8 8 ... Sauerkraut 1 1 ... Sauce 10 10 ... „ mint 2 2 ... Sausage roll 2 1 1 „ Mortadella 1 1 ... „ Salami 1 1 ... Sausages 13 10 3 Seidlitz powder 4 4 ... Sherry, old English 1 1 ... Shortening 1 1 ... Shredded suet 1 1 ... Sugar 2 2 ... Sultanas 1 1 ... Sweets 2 2 ... Tomato, concentrated, canned 1 1 ... „ puree 2 2 ... Turkey and tongue paste 1 — 1 Vinegar 7 7 ... Total 263 255 8 40 Report of Borough Analyst for Year 1938. During the year 1938, 601 samples were submitted to me for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 338 having been purchased with the required formalities and 263 informally. Of this total 15 (2•5 per cent.) proved to be adulterated, seven being samples submitted formally and eight informally. In the previous year (1937) 1•8 per cent. of the samples were certified to be "not genuine." The adulterated articles consisted of milk, beer, cheese, jam, marmalade, meat paste, sausages and sausage rolls. Milk.—One hundred and sixty-one samples of milk were submitted for analysis and four of these, 2•5 per cent., fell below the limits required by the Board of Agriculture Begulations—3•0 per cent, of fat and 8•50 per cent, of non-fatty solids and were accordingly certified to be adulterated. The four samples referred to in the previous paragraph, all purchased formally, were deficient in fat to the extent of at least 2•0 per cent., 3•0 per cent., 5•0 per cent., and 6•0 per cent., respectively. Two tables which have been prepared by the Public Health Department from the returns of the Borough Analyst afford valuable information concerning the places from which samples were purchased and the monthly variation in the chemical composition of the milk supply of the Borough. No. 1. Fat Content. Percentage of Fat Number of Samples. Shops. Restaurants. Street. School. Total. Less than 3•0 ... 2 2 ... 4 3•1 ... ... 3 ... 3 3•2 2 3 7 1 13 3•3 1 4 25 2 32 3•4 5 1 28 1 35 3•5 1 2 20 1 24 3•6 2 3 10 ... 15 3•7 1 ... 17 ... 18 3•8 ... 2 3 ... 5 3•9 2 2 3 ... 7 4•1 1 1 1 ... 3 4•2 1 ... 1 ... 2 Total Samples 16 20 120 5 161 Average fat content 3•47% 3•36% 3•36% 3•24% 3•37% 41 No. 2. Monthly Variation of Chemical Composition of Milk, 1938. Month. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January ... ... ... ... February 12 12•62 9•18 3•44 March 19 12•44 9•08 3•36 April 24 12•06 8•83 3•23 May 17 12•34 9•06 3•28 June 28 12•13 8•93 3•20 July 18 12•25 8•90 3•35 August 8 12•32 8•87 3•45 September 16 12•56 8•97 3•59 October 19 12•63 9•00 3•63 November ... ... ... ... December ... ... ... ... Whole year 161 12•34 8•97 3•37 Legal minima ... 11•50 8•50 3•00 It will be observed that the average composition of the genuine milk supplied to the Borough during the year was fat 3•37 per cent, and non-fatty solids 8•97 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). 1934 224 12•47 3•52 8•95 1935 218 12•48 3•55 8•93 1936 132 12•49 3•50 8•99 1937 212 12•35 3•43 8•92 1938 161 12•34 3•37 8•97 It is regrettable to notice that the gradual fall of the average fat content in the genuine samples continues, and whatever may be the causes or causes to which this can be attributed, it demands the closest attention of all milk producers with a view to ascertaining the remedial measures which may be taken, not only to prevent a further reduction, but also to restore the milk supply to its former quality. 42 Beer.—One sample of Lager beer contained an excess of sulphite preservative, the quantity found being 93 parts per million of sulphur dioxide. The limit permitted in beer is 70 parte per million. Cheese.—The practice of wrapping cheese in tin-foil, presumably to maintain it in moist condition, requires to be kept under observation as in some samples the wrapped cheese has been found to have attacked the foil and absorbed part of the metal, thereby rendering the consumption of the cheese a possible danger to health. One sample of this article submitted contained 3•12 grains of tin per pound, the limit of tin usually permitted in articles of food is two grains per pound. Jam.—One of the samples of jam contained an excess of sulphite preservative, the total quantity found being 75 parts per million. The limit for jam is 40 parts per million, therefore the jam in question was certified to be adulterated to the extent of the excess of 35 parts per million. Marmalade.—A sample of marmalade had also been found to contain an excess of preservative amounting to 29 parts per million and was certified accordingly. Meat Paste.—Three samples of meat paste had been preserved with sulphite preservative, the quantities found being 41, 82 and 164 parts per million respectively. Meat paste should be entirely free from preservative. Sausages.—The use of sulphite preservative is permitted in sausages provided the quantity does not exceed 450 parts per million and that due notice of the addition is given to the purchaser on the label in the manner prescribed by the Regulations—block letters of a certain size, etc., but in three instances no notice was given and the amounts found being 247, 274 and 288 parts per million of sulphur dioxide respectively, they were certified accordingly. It may be pointed out that the reputable manufacturers of sausages who supply the trade, or smaller retailer, do label the pounds and supply free bands to be used when the pound is to be broken up, so that there is really no excuse for the careless vendor. Sausage Roll.—The sausage roll certified to be adulterated contained a trace of sulphite preservative equal to 27 parts per million of sulphur dioxide—doubtless owing to the fact that the roll had been made with a preserved sausage. New Act.—The new Food and Drugs Bill mentioned in the last report has now been passed into law and will come into force on the first day of October, 1939. Merchandise Marks Act, 1926. The Orders under the above Act now in force provide for the marking of the following imported foodstufis to show their origin:— 1. Fresh Apples. 2. Raw Tomatoes. 3. Eggs (hen or duck eggs in shell). 4. Dried Eggs. 43 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; no breaches were found. Public Health (London) Act, 1936, Section 187. Registration of Food Premises. At the date of the preparation of this report 45 premises were registered in accordance with the requirements of the Act, for the purposes shown below: — Sausages 16 Preserved meat 17 Pickled ment 7 Preserved fish 1 Other foods 4 All the premises concerned were carefully inspected prior to registration. Notification of Food Poisoning. During the year 1938 two cases of food poisoning were notified. In one case the poisoning was stated to be due to the patient partaking of mushroom pie and the other case was due to the patient partaking of cold chicken. Both the patients recovered. Information on 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 for renewal of a licence to slaughter under Section 3 of the Act. Prevalence of, and Control oyer Infectious Diseases, including Tuberculosis The total number of notifications relating to Holborn residents received during the year was 295 in comparison with 321 in the year 1937. F2 44 The following are the principal variations: — Scarlet Fever 59 in comparison with 38 in 1937. Tuberculosis 79 „ ,, 76 ,, Whooping Cough 53 „ „ 60 „ Diphtheria 49 ,, „ 76 ,, A spscial reference card with complete list of notifiable diseases is supplied to all doctors practising in the Borough. In addition to the above we received 185 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 diseaseB notified were :— Chicken-pox 3 Diphtheria 36 Erysipelas 2 Measles 8 Scarlet Fever 19 Tuberculosis71 Whooping Cough 4 Pneumonia 2 Acute Poliomyelitis 5 Encephalitis Lethargica — Dysentery 26 Mumps 1 Para-typhoid — Ophthalmic Neonatorum 2 Rheumatic Fever — Cerebro-Spinal Fever 6 185 Smallpox. No case of smallpox occurred in a Holborn resident during the year 1938. Vaccination. The following table gives information respecting the vaccination of Holborn children during the year ended 30th .Tune, 1938: — Total Number of Births Vaccinated Died before Vaccination Cons. Objections Insusceptible Postponed by Medical Certificate Removed from Borough Incorrect AddressNot traced. Temporarily unaccounted for 239 131 (54%) 11 12 33 1 13 31 7 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. 45 Diphtheria. We received notifications relating to 49 cases of diphtheria occurring in residents in the Borough. All were removed to hospital. Age at Notification of 49 Notified Cases of Diphtheria. 0—1 1—5 5—15 15—35 35—45 45—65 65 upwards Total. - 17 17 13 1 1 — 49 No deaths occurred. Ten of the notified cases were returned from hospital certified as not suffering from diphtheria. There was one secondary clinical case; details follow:— Primary Case Age Date notified Secondary Case Age Date notified Remarks e.g. Character of Premises J. B 5 12/9/1938 S. B. 2 14/9/1938 Private house 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, 7,736 cases were notified, giving rise to 197 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 48 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 dcctors diagnoi ing the disease. Of the 48 cases, 34 were clinical cases (14 were notified as " nasal "). Of the total number, three notifications related to Holborn residents, two being members of the resident medical or nursing staff. Forty-five were in-patients admitted from areas outside the Holbom 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. 46 Diphtheria in Hospitals. Hospital. Cases Notified. Disease notified as Holborn Cases. NonHolborn Cases. Total. Staff. Inpatients. Clinical. Carrier. A. 2 38 40 — 2 38 40 B. — 8 8 — 1 7 8 Diphtheria antitoxin is available free of charge on application by medical practitioners. No antitoxin was supplied during 1988. 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. 183 persons attended this clinic during 1938, making a total of 2,995 since 1922. Of the 183 (144 children and 39 adults) 125 children, nearly all of whom were under five years, were inoculated without preliminary Schick test. Schiclc Testing. Nineteen children (mostly over five years) were tested, of whom— 8 gave a positive reaction to the test. 11 gave a negative reaction. Thirty-nine adults (over fifteen years) were tested, of whom— 20 gave a positive reaction to the test. 19 gave a negative reaction. Immunisation. One hundred and fifty-three persons (133 children and 20 adults) received inoculation. Of these, 123 completed the routine course, while 20 (14 children and 6 adults) failed to complete. Re-Sehick Testing. Seventy-three persons (62 children and 11 adults) were tested two months or more after completion of the course. These included 11 who attended prior to 1938. All the children gave a negative reaction to retest, but three of the adults were positive and received further inoculations. Diphtheria among Immunised Children. There was no case of diphtheria among immunised children in 1938. One child was removed to a London County Council hospital suspected as suffering from diphtheria, but the diagnosis in this case was not confirmed. 47 Age groups of 183 persons attending during 1938. Ages. 6 to 12 months 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 6 years 6 to 7 years 7 to 8 years 8 to 9 years 9 to 10 years 10 to 11 years 11 to 12 years 12 to 13 years 13 to 14 years 14 to 15 years Adults 15 years and above Total for 1938 0 0 0 1 2 4 4 3 1 1 1 0 1 0 1 39 Total Schick Tested 58 Result of Schick Test. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. 28 Pos. 30 Neg. - - - - - - - 1 1 1 3 1 3 1 - 3 - 1 - 1 - 1 - - 1 - - - - 1 20 19 Received inoculation without preliminary Schick test. - 59 27 20 12 3 1 2 - - - 1 - - - - Total inoculated without preliminary Schick test 125 Total received inoculation (includes inoculation of Schick positives as shown above). - 59 27 20 13 6 4 2 _ _ - 1 1 - - 20 Total 153* * 20 of these failed to complete the routine inoculation. 48 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 1938. At this hospital Schick testing of all newcomers and immunisation of positives is now customary. From June, 1930, till the end of December, 1938, 231 nurses were tested; 19 of these were tested for the first time in 1938, 12 being positive and 7 negative. Eight positive cases were inoculated, the remainder left the hospital before completion of the course of immunisation. Scarlet Fever. There were 59 notifications of scarlet fever. All were removed to hospital. Eight of these were returned from hospital diagnosed as not suffering from this disease. From one hospital in the Borough 15 in-patients were notified as so suffering; all non-residents of Holborn. There were no "return" cases of scarlet fever, i.e., secondary cases occurring after the return home of the primary case. Eight notifications of "secondary" cases were received. There was no death from this disease. 9,325 cases of scarlet fever were notified in London with 28 deaths. Acute Rheumatism in Children. Acute rheumatism has been notifiable in Holborn since 1st April, 1929, under a series of regulations made by the Minister of Health. The present regulations are the Holborn (Acute Rheumatism) Regulations, 1938, dated 6th December, 1938, which continue in force the requirements as to notification until 31st December, 1941. 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. Information of five cases was received in 1938. Age and Sex Distribution of notified cases. Age in years. Sex Total. M. F. 9 — 2 2 11 1 — 1 14 1 1 2 Totals 2 3 5 49 The Holborn children attend Rheumatism Supervisory Clinics at the Hospital for Sick Children, Great Ormond Street, and at the Royal Free Hospital. Housing Conditions. Enquiries into housing conditions of the notified cases showed that one lived in a satisfactory self-contained flat; four lived in houses let in lodgings; one of these houses has since been closed and the family removed to a self-contained flat. In two cases there was overcrowding which is being dealt with. Three children had separate beds in shared rooms, the other two shared a bed. Social Conditions. In one home the circumstances were such that there was a constant struggle against poverty. Contacts. The names of all contacts going to school were passed on by the London County Council district organiser to the Divisional School Medical Officer in order that they might be observed and examined if necessary. 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. Typhoid and Paratyphoid Fever. Enteric Fever. No notifications were received of Holborn residents suffering from enteric fever. Typhus Fever. No case of typhus fever was notified in the Borough during the year. Cerebro-Spinal Fever. No case of cerebro-spinal fever was notified in the Borough. Dysentery. There were ten 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. Two other cases also occurred in hospital; and in these instances also the source of infection was not discovered; seven occurred in private houses. Malaria. No case of malaria was notified. Encephalitis Lethargica. No case of encephalitis lethargica was notified in the Borough during the year. Or 50 Acute Poliomyelitis and Acute Polioencephalitis. No case of these diseases was notified as occurring in the Borough during 1938. Pneumonia. Twenty-one cases of pneumonia were notified during the year. One of these was influenzal pneumonia. One death was recorded from pneumonia. The 20 cases of primary pneumonia were notified at the following ages:—From 1 to 5 years, 3; from 5 to 15 years, 2; from 15 to 35 years, 6; from 35 to 45 years, 2; from 45 to 65 years, 5; and 65 years and upwards, 2. Eight were treated at home; 8 were removed to L.C.C. hospitals; 4 to voluntary hospitals. Three of the patients were nursed by the Metropolitan Nursing Association, under the arrangements made by the Council. Eighty visits were made to these patients—all recovered. Influenza. There was 1 death of an adult male from influenza, in comparison with 10 in 1937, 2 in 1936, 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, and 9 in 1925. Anthrax. No case of anthrax was notified in the Borough during the year. Chicken-pox. This disease is not notifiable, but during the year 1938 we received information of 91 cases. These were visited and where necessary kept under observation. Mumps. Information was received from school teachers and others of 41 cases of mumps. Bacteriological Work. The following table gives details of the examinations made during the year:— Diphtheria Pulmonary Tuberculosis Other Diseases Number Submitted Result of Examination Number Submitted Result of Examination Number Submitted Result of Examination. 342 Bacilli not found 306 Diphtheria 64 Bacilli not found 57 6 Negative 6 Bacilli found 36 Vincent's Bacilli found 7 Positive 0 organisms found 6 Disinfections. During the year 473 rooms and 4,179 articles of bedding, clothing, etc., were disinfected after various infectious diseases, inclusive of tuberculosis. Twenty-seven rooms and 266 articles of bedding, clothing, etc., were disinfected on account of tuberculosis. 51 Special attention is devoted to toys. One hundred and thirty-seven books and 58 toys were disinfected. Cleansing of Persons Act. During the year 114 persons (90 men and 24 women) infested with vermin had their bodies and 1,108 articles of clothing disinfected, free of charge, at our cleansing station (Stukeley 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 1938 the accommodation was used by five Holborn families comprising six persons. Extermination of Vermin. The number of Council dwellings found to be infested with vermin was 17 and the number of other dwellings 59, all these were disinfested. The total number of rooms disinfested was 176. This work was carried out by the Council's staff. The usual treatment is by sulphur dioxide generated by burning flowers of sulphur with 5 per cent. of powdered saltpetre. Six pounds of sulphur is used to each 1,000 cubic feet, distributed in small tins, each containing ½ lb. to 1 lb., in order to give a maximum early concentration of gas. Before fumigation, wallpapers and lining papers are removed and in some cases woodwork is stripped. Usually the bedding, if any, is removed at the same time and treated by steam. In some cases, where fumigation is impracticable or undesirable, the room and its contents are sprayed with a 5 per cent. solution of "Lethane" in an odourless distillate of petroleum. This spraying is also used as an adjunct to the normal method of fumigation, especially to such things as bedsteads. 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 23 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 risk of such infestation, particularly in regard to new occupations of municipal G 2 52 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. Where infestation occurs, the tenants are advised as to the remedies and precautions to be adopted and warned of the risk of reinfestation from secondhand furniture, etc. Information on these points is incorporated in a leaflet which is left with tenants wherever necessary. A copy of this leaflet is left with each tenant of the Council's flats periodically. Cancer. During the year 1938, 61 deaths were recorded as due to Cancer in comparison with 66 in the previous year. The deaths in 1938 were equal to a rate of 1.77 per thousand, the corresponding rate in 1937 being 1.81 per thousand. 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 1938 in the form required by the Ministry of Health:— Age periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M F M F M F M F 0 1 - - - 1 - - - 1 1 — — 2 - - — 5 2 — 2 — — — — — 10 1 1 — — 1 1 — — 15 3 3 2 — — 2 - - 20 9 5 — — 2 3 — — 25 10 8 — 1 1 3 — — 35 3 6 — — 3 1 — — 45 7 1 — — 6 1 — — 55 7 1 — 1 5 — — — 65 2 — — — 1 1 — — 46 25 4 4 20 12 — — 53 Total number of cases on the Register of Tuberculosis in the Borough on the 31st December, 1938 318 Number of these patients residing in common lodging-houses 46 The average number of cases notified annually during the past ten years 82 The number notified in the year 1938 79 Of the 79 cases notified in 1938 the number who attended the Dispensary 41 Total number of new cases examined at the Dispensary for the first time in 1938, including the above, and all contacts 126 Total attendances at the Dispensary in 1938 676 Supervision of home conditions; visits paid by— Tuberculosis Officer 21 Dispensary Nurse 947 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1938, to the 31st December, 1938, in the Metropolitan Borough of Holborn. Age-periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary Males — 1 2 1 3 7 5 3 4 6 2 34 45 „ Females — — — 3 4 8 4 1 — 1 22 32 Non-pulmonary Males — - 1 - 2 — — — — — — 3 4 „ Females — - 2 — — — 1 — — — 1 4 6 54 Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age-periods. 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— . Pulmonary Males 1 — — — — 2 5 — 3 1 — 12 „ Females — — — — — 1 — 2 — — — 3 Non-pulmonary Males — — 1 — — — — — — — — 1 „ Females — — — — — — — — — — — — The source or sources from which information as to the above-mentioned cases was obtained are stated below:— Source of Information No. of Cases. Pulmonary Non-Pulmonary Death Returns From local Registrars 1 - Transferable deaths from Registrar General 6 — Posthumous notifications — — "Transfers" from other areas (other than transferable deaths) 8 1 Other Sources if any (specify) — — Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December 1938, on the Registers of Notifications 171 82 253 34 31 65 318 Number of cases removed from the Registers during the year by reason inter alia of:— Withdrawal of notification 2 - 2 - 1 1 3 Recovery from the disease - - — - - - - Death 20 12 32 - - - 32 Otherwise 10 11 21 1 2 3 24 55 Tuberculosis Notifications. Excluding duplicates the total number of notifications received on Forms A or B during the year 1938 was 63. Sixteen other cases were brought to my knowledge by other means, making 79 new cases in the year. These were:— Private cases 7, hospital cases 35, Public Assistance cases 21, from death returns 7, transfer from other districts 9, posthumous notification 0. Of the 79 cases entered on the Register in 1938, 71 were pulmonary tuberculosis and 8 non-pulmonary tuberculosis. Seventy-four of the cases were removed for treatment to hospitals, sanatoria, &c. 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 27 " B."—Fair. Separate bed, but not separate bedroom 22 "C."—Bad. Dirty environment, dirty ill-kept home, no separate bed, bad management as to food and clothing — 49 Non-attendance at Tuberculosis Dispensary. Forty-one of the 79 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 11 Dead before or soon after notification 9 Treatment at home by private doctor 2 Hostels and common lodging house cases 10 Removed from Borough 3 No information 2 Notification withdrawn 1 38 56 Institutional Treatment. During the year notifications were received of 90 admissions to institutions. These admissions represent 65 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 68 Other institutions 22 Visits to Homes, etc. During 1938 the Tuberculosis Officer made 21 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 969 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-four contacts, viz., 31 adults and 23 children under fifteen years of age, were examined for the first time during the year 1938. Of these, five adults were found to be definitely suffering from tuberculosis. Forty-nine were definitely diagnosed as not suffering from the disease. The routine examination of contacts is desirable as a means of discovering not only cases of tuberculosis in early stages of infection but 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. 57 Tuberculosis Dispensary. The following is the Report of the Tuberculosis Officer, Andrew Morland, M.D., M.R.C.P., for the year 1938:— Return showing the work of the Dispensary during the year 1938. 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 19 17 2 1 1 1 2 1 20 18 4 2 (b) Doubtfully tuberculous — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 13 22 2 5 B.—Contacts examined during the year:— (a) Definitely tuberculous — 5 — — — — — — — 5 — — (b) Doubtfully tuberculous — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 5 21 17 6 C.—Cases written off the Dispensary Register as (a) Recovered — 1 — — — — — — — 1 — — (b) Non-tuberculous (including any such cases previously diagnosed and entered in the Dispensary Register as tuberculous) — — — — — — — — 18 43 19 11 D.—Number of Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 107 76 8 9 16 18 9 10 123 94 17 19 (b) Diagnosis not completed — — — — — — — — — — — — 58 1. Number of persons on Dispensary Register on January 1st, 1938 240 7. Number of consultations with medical practitioners: — (a) Personal 45 (b) Otherwise 74 2. Number of patients transferred from other areas and cases returned after discharge under Head 3 in previous years 2 8. Number of other visits by Tuberculosis Officers to Homes 21 3. Number of patients transferred to other areas, cases not desiring further assistance under the scheme and cases "lost sight of" 24 9. Number of visits by Nurse3 or Health Visitors to Homes for Dispensary purposes 947 10. Number of 4. Cases written off during the year as dead (all causes) 13 (a.) Specimens of sputum, &c., examined 120 (b) X-ray examinations made in connection with Dispensary work 229 5. Number of attendances at the Dispensary (including contacts) 988 11. Number of "Recovered" Cases restored to Dispensary Register in A (a) and A (b) 0 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 49 12. Number of "T.B. plus" cases on Dispensary Register 31st December, 1937 122 59 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. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- All Ages Males. Females Total. Number of patients who died at home — - — — 1 - - — 2 1 - 2 2 4 Number of patients who died in hospitals, etc. 1 — — 2 1 5 4 4 5 4 2 18 10 28 1 — — 2 2 5 4 4 7 5 2 20 12 32 Holborn Tuberculosis Care Committee. Report for 1938. The Committee has met four times during the year; in January, April, July and October. The Committee is composed of 23 members; and at present there are two vacancies. The average attendance of members at each meeting has been 7.22. Sixty-nine cases have been brought to the notice of the Committee during the year—49 new cases (41 adults and 8 children). Sixty-four adults and six children were admitted to Institutions for treatment. Six adults took their discharge before the completion of treatment. One more child was boarded out under under the Council's Contact Scheme (to enable her mother to accept treatment) making a total of four children away under the Scheme during the year. Eighteen Progress Reports on eight children, were received during the year; and the information contained therein was conveyed to the parents. In the course of the year 520 visits have been paid to patients and their homes (this does not include visits paid to Offices, Societies, etc., in connection with the welfare of patients or their families). Convalescence was arranged for two adults—one through Stafford's Charity, and the other through the Approved Society. Holidays were arranged for two adults and two children. Three cases were referred to the Borough Council for the provision of dentures. Two received grants from their Approved Societies, and the balance of the cost was met by the Borough Council, while in the third case the entire cost was defrayed by the Borough Council. Grants of extra nourishment were obtained from the Borough Council, the Public Assistance Committee and, in one instance, from the Unemployment Assistance Board. Applications for clothing, for patients undergoing treatment, were met by the British Legion and United Services Fund Benevolent Department and by the London County Council. H 2 60 Seventeen patients known to the Committee have died during the year, 15 of these died in Institutions, and 2 died at home. Twenty patients and families known to us have left the Borough during the year. The majority have left to go to better accommodation, but a few did not return to the district after discharge from treatment because their work there was gone. One family, consisting of husband, wife and two small children had migrated to London in search of work—but the result was tragedy. The husband was unsuccessful in his search, the younger child was found to be suffering from tuberculosis, and the other child was taken ill and admitted to hospital. The mother, who was very run down, was sent away for convalescence. They appeared to be a very devoted couple but, most unexpectedly, the husband suddenly deserted his wife and children and could not be traced. The wife had no friends in London, so she was assisted to return, with her children, to her relatives in Glasgow. In spite of the numbers who have left us, we still know of about a dozen families who are waiting for better accommodation—some of them urgently. The Committee gratefully acknowledge the co-operation and assistance afforded by a number of organisations, including the British Legion and United Services Fund Benevolent Department, the British Red Cross Emergency Help Committee, the Charity Organisation Society, the Invalid Children's Aid Association, the London Philanthropic Society—(who made us a welcome grant of 34 coal tickets and 60 milk tickets), The National Association for the Prevention of Tuberculosis, the Public Assistance Committee, and the Society for the Relief of Distress. To Alderman Mullen we once more tender our very grateful thanks for his generous gift of coal at Christmas time, and to Councillor Bailey for distributing it. We would also express our gratitude to His Worship the Mayor and to members of the Borough Council, and all those who, by their contributions, made it possible for us to obtain Christmas Dinners for many of our families. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations during the year 1938. Home Nursing for Tuberculous Patients. It was necessary during the year 1938 for only two tuberculous patients to be nursed under the arrangements made by the Council with the Metropolitan District Nursing Association; 140 visits were made to these patients before their 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.1. 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. 61 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. Grants were made during 1938 to six patients. 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 1938:— Summary of Work carried out at Dental Clinic, 10, John Street, Holborn, on Tuesday Eveninqs, durinq 1938. Tuberculous Patients. All Patients Number of sessions held — 48 Number of patients' attendances 17 296 Number of fillings — 72 Number of scatings — 17 Number of extraction cases Without anæsthetic — — With local anæsthetic 3 52 With gas - 2 Number of teeth extracted 4 207 Number of dentures (including repairs) 5 33 Number of dressings — 32 Number for advice 2 53 Number of denture visits 15 92 Number of new patients 1 43 MATERNITY AND CHILD WELFARE. Notification of Births. During the year 89 births were registered as occurring in the Borough. During the same period 74 notifications of births occurring in the Borough were received. The mothers were attended at their confinement by:— Private Doctors 15 Private Midwives 5 62 Out-patient Midwifery Departments of General Hospitals and Institutions:— Externs and others 30 Midwives.—University College Hospital 6 Middlesex Hospital 1 Other Institutions 5 Training Institution for Midwives, Myddelton Square 12 74 Three of these notifications related to stillbirths. Number of Births. The number of births transferred to the Borough from outlying institutions was 179 The number of births transferred from the Borough to other districts was 9 The net number of births belonging to the Borough was 250 There are no maternity hospitals or lying in institutions in the Borough, but maternity cases are admitted to a nursing home in the area. Home Visiting. The visits paid to the homes by the Health Visitors during the year were as follows:— First Visits Revisits. Total. Expectant Mothers 161 205 366 Post-natal Mothers 16 3 19 Children under 1 year of age 265 745 1,010 Children 1 to 2 years of age 15 320 335 Children over 2 years of age 43 649 692 Enquiries re stillbirths 14 „ re ophthalmia neonatorum 9 Other visits 214 Three hundred and fourteen visits related to infants who came under further observation in their own homes or at Infant Welfare Centres; of this number 216 were recorded as attending a Centre, i.e., 63 per cent. Thus more than two-thirds of those visited attended an Infant Welfare Centre and of these 81.5 per cent. attended at the Council's Centres. Attendances at Infant Welfare Centres. The Centres attended were the following:— 143 attended the Council's M. & C. W. Centre at 10, John Street. 33 „ „ „ Short's Gardens. 9 attended the Centre at Charing Cross Hospital. 3 „ „ Myddelton Square. 6 „ „ Middlesex Hospital. 7 „ ,, University College Hospital. 3 „ „ Royal Free Hospital. 12 „ „ other Centres. 216 attended an Infant Welfare Centre. 63 Work at Centres. Holborn Cenyre, 10, John Street. The following is an analysis of the this Municipal Centre: No. of Sessions Total Attendances of Average Attendance per Session Children Mothers Total Children Mothers Total Monday Medical Consultation Dental 48 929 79 1,008 19 2 21 48 130 261 391 3 5 8 Tuesday Ante-natal & Post-natal 51 — 233 233 — 5 5 Wednesday Medical Consultation 52 2,272 422 2,694 44 8 52 Thursday Class 50 — 638 638 — 13 13 Friday Medical Consultation 51 1,649 313 1,962 32 6 38 300 4,980 1,946 6,926 14 5 22 St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year 1938 were as follows:— No. of Session Total Attendances of Average Attendance per Session Children Mothers Total Children Mothers Total Thursday Medical Consultation 52 1,183 143 1,326 23 3 26 Ante-natal 52 — 43 43 — 1 1 Total 104 1,183 186 1,369 11 2 13 The total number of attendances made by the Health Visitors at the Municipal Centres in 1938 was 551 and in addition Health Visitor students made 186 attendances at the Municipal Centres. At the Holborn Centre, No. 10, John Street, 5,897 attendances were made by 390 mothers and expectant mothers; and 500 children of whom 227 were under one year, 89 between one and two years old, and 184 aged 2-5 years on the date of their first attendance. At the St. Giles' Centre, Short's Gardens, 1,369 attendances were made by 60 mothers and expectant mothers and 120 children, of whom 64 were under one year, 18 from one to two years and 38 between two and five years. Ante-natal Hygiene. Under the scheme for the voluntary notification of pregnancy which came into force in January, 1928, 25 voluntary notifications were received during 1938 as compared with 40 in 1937. All these expectant mothers, as well as those already 64 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 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 154 expectant mothers visited during 1938, each case being followed up either to a successful issue or until it became clear that the woman would not enter hospital. Of the 120 who went into hospital: — 30 (22 primigravidæ) lived in a one-room home; 90 (47 primigravidæ) lived in a two or more roomed home. Of the 34 who remained at home:— 2 (2 primigravidæ) lived in a one-roomed home; 12 (3 primigravidæ) lived in two rooms; 20 lived in three or more rooms. Baths. The baths provided at the John Street Centre for expectant and nursing mothers were used 318 times during the year 1938. Ante-natal Centres. During the year, enquiries were made of mothers as to their attendance at an Ante-natal Centre immediately previous to the birth of the child visited. Of 270 mothers, about whom information was obtained, 261 (96.4 per cent.) were found to have attended Ante-natal Centres or received ante-natal care as under:— Centre Attended:— Holborn Centre, 10, John Street 21 Holborn Centre, Short's Gardens 22 Royal Free Hospital 12 Middlesex Hospital 10 Charing Cross Hospital 23 University College Hospital 34 Myddelton Square Institution 15 St. Bartholomew's Hospital 37 City of London Hospital 21 Elizabeth Garrett Anderson Hospital 2 St. Pancras Hospital 32 Other Centres 21 Ante-natal care from private doctors 9 Private midwives 2 261 65 Nature of defects found at Municipal Centres. 10, John Street, Holborn. Short's Gardens, St. Giles. No. of women attending ante-natal clinics 69 22 Women expectant for the first time 23 7 No. of attendances made 196 40 Defects found specially connected with pregnancy:— Deformed pelvis 2 — Threatened abortion 1 - Retroverted gravid uterus 1 - Breech presentation 2 - Excessive vomiting 7 - Œdema 5 1 Varicose veins 8 4 Ante-partum hæmorrhage 2 - High blood pressure 4 - Other defects 9 1 Other defects:— Heart disease 4 - Anæmia 2 1 Respiratory diseases 5 1 Constipation 21 1 Dental caries 32 2 Dyspepsia 5 - Pyorrhœa 6 - Other defects 7 3 No. referred to maternity hospitals:— Normal 13 12 Abnormal 11 2 No. referred to dental clinic 27 2 No. of urine tests made 93 18 Post-natal Consultations. Twenty-five attended the post-natal consultations at the Centre, 10, John Street. They made 47 attendances in all. The conditions found included four cases of prolapse of uterus, three cases of retroverted uterus, two cases of leucorrhœa, three of cervicitis, four of menorrhagia, one vaginitis and one case of appendicitis referred to hospital. Post-natal consultations were attended at the hospitals where the mothers were confined. Physical Culture Classes for Mothers. At the request of mothers attending 10, John Street, classes in physical culture were started informally early in 1938. The response was so satisfactory that the Council decided to appoint a fully qualified instructress for a weekly class. On the recommendation of the Central Council for Recreative Physical Training, Mrs. Ursula Thompson was so appointed. The class is held from 2.30 p.m. to 3.30 p.m. every Thursday at 10, John Street. 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. I 66 Mrs. Alia Gelson 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. Since October, Mrs. Sandheimer has assisted on Mondays at 10, John Street, and on Thursdays at St. Giles' Centre, Short's Gardens. Assistance is given at the centres in cutting out garments; 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-nine hanks of wool of a special quality were sold at cost price to the value of £6. 7s. 5½d. Maternity outfits are placed on sale at the Centre at cost price, 5s. 10d. One 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 1938:— Reasons for attendance. 10, John Street. Short's Gardens Mothers:— Difficulty with breast feeding 12 1 Disorders of generative organs 22 — Constipation 17 — Venereal Disease 1 — Anæmia 17 9 Respiratory disease 7 4 Digestive disorders 5 1 Debility 38 5 Dental caries 48 10 Rheumatism 8 — Pulmonary tuberculosis 3 — Other Diseases 43 8 Children:— (Healthy) 147 35 Alimentary disorders 53 10 Rickets 15 7 Heart disease 2 — Rheumatism 6 — Respiratory disorders 68 23 Marasmus 1 — Debility 3 21 Hernia, umbilical 14 — Hernia, inguinal 3 — Phimosis 14 — Disease of skin 48 9 Disease of eye 16 3 Disease of ear 15 1 Disease of nose and throat 17 — Dental caries 23 3 Tuberculosis contacts 4 — Other tubercular disease 1 — Other diseases 54 12 (In this table, if the patient has more than one ailment, only the more important has been recorded.) 67 Mothers and children attending the Municipal Centres during 1938 were referred to other departments or organisations as follows:— Mothers. Children. Post-natal Clinic 4 — Tuberculosis Dispensary — 5 Minor Ailments Clinic 87 260 Dental Clinic 66 63 Metropolitan Nursing Association 4 2 School Clinic - 1 Birth Control Clinic 2 - Hospitals 27 80 Convalescent Homes 58 40 Assistance Sub-Committee (for milk, etc.) 34 21 Emergency Home - 1 Institute of Ray Therapy - 22 L.C.C. Midwife 2 - The Church Army 2 - Private Doctor 1 2 Public Assistance Committee - 1 Breast Massage. Two mothers were referred to the Metropolitan District Nursing Association for breast massage, one was unsuccessful and the other improved and continued breast feeding for another six weeks. Pre-School Children. During 1938, 245 children between the ages of 2 and 5 years attended the clinic and of these 47 had dental caries and were referred for treatment. There were 12 children who were decidedly below weight and of these one was suffering from tubercular glands and 3 others were tuberculous contacts or suspects. Other defects in these children included a case of congenital deformity of arms, a mongol, a case of polyneuritis due to undetected nasal diphtheria and a case of strangulated inguinal hernia. 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 1938. 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 64 children living in Holborn had been entered as attending school for the first time. Particulars of the children's pre-school physical history and their records of attendance at an Infant Welfare Centre were forwarded to the head teacher of the infants department of the school concerned. This information is I 2 68 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 1938 information was received of 18 stillbirths, of which 15 were legitimate. Enquiry as to possible causes was made in fourteen cases, and in two cases no information was obtainable. In eleven instances the confinement took place in hospital, four at home, and in three no information was obtainable. Difficult labour was responsible for four stillbirths, of these, one was a hydrocephatic child; one due to prolapse of cord and one to breech presentation; in one the cause was not ascertainable. Four were due to albuminuria, one to prematurity, in three no definite reason could be assigned, in five others no information was obtainable, the mother not having returned to the address given on admission to hospital. Illegitimate Children. The births of 37 illegitimate children were registered. Dental Treatment. The following is a summary of the work during 1938 at the Council's Dental Clinic, No. 10, John Street, open on Monday afternoons for nursing or expectant mothers, and children under five years of age:— Women. Children. Total Number of sessions held 48 48 48 Number of new Patients 61 45 106 Total attendances 302 82 384 Extractions- Ordinary 1(1) — 1(1) With local anaesthetic 35(48) — 35(48) With general anaesthetic 41(223) 32(117) 73(340) Scaling 37 3 40 Fillings— Simple 92 11 103 Root 2 — 2 Dentures (including repairs) 95 — 95 Advice 55 54 109 Gum treatments 5 - 5 The figures in brackets relate to the number of teeth extracted. In two 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 ten instances the patients were required to pay the whole cost. 69 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 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 334 applicants received free or assisted milk under the scheme. This number included 147 who were receiving such assistance at the end of 1937. Grants were made to 187 new applicants. At the end of the year 1938, 169 applicants were receiving assistance, viz.:— Mothers. Children. Total Free milk 31 107 138 Dried milk — 10 10 Colact 21 — 21 52 117 169 The following table shows in detail how the 187 new applicants were assisted in 1938:— Milk. Dried Milk. Colact. Free. Part Cost. Free. Part Cost. Free. Part Cost. Expectant mothers 36 5 — — 19 3 Nursing mothers 19 6 — — 15 7 Children 58 7 11 1 — — Provision of Meals for Necessitous Expectant and Nursing Mothers. In July, 1937, the Council approved arrangements for the provision of meals for necessitous expectant and nursing mothers. The number of meals provided during 1938 was as follows:— No. of Mothers. No. of Meals. Part Cost. Free. 6 — 313 Home Help. The Council's Home Helps attended 17 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. 70 In one case of extreme necessity the services of the Home Help were granted free. In all other cases the applicants were required to contribute towards the cost, contributions ranging from 1s. 0d. per week up to 15s. 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. Thirteen mothers each with baby and one or more toddlers were sent to the Zachary Merton Convalescent Home. Forty-two mothers with infants only were sent to the Home. Twelve of the 55 cases referred to above were sent free of charge. Sixteen children under 5 years of age were sent to various convalescent homes, seven free of charge. Emergency Homes. Nineteen children were sent to emergency homes, 9 free of charge. 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, 1938, 20 children under five and 76 children over five, attended the consultations. The 96 children made 2,431 attendances. Extra food and nourishment were provided, also convalescent treatment at country and seaside Homes (95 mothers and 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, 36, Red Lion Street. Infantile Mortality. The rate this year was 76.0 per thousand corrected live births, as compared with 78.6 last year. The actual number of deaths among infants were 19 and 22 respectively. The following table gives information as to causes of and ages at death in these cases. 71 Deaths of Infants under One Year of Age, 1938. The homes were visited in all cases of the infant deaths, and any requisite information obtained, and when required, suitable advice given. 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 9-12 Months Total under 1 Year M F M F M F M F M F Both sexes M M F m M F M F Both saxes Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Pneumonia (all forms) ... ... ... 1 ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... 1 1 2 3 Diarrhœa, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... 3 1 4 Congenital Debility, Premature Birth, etc. 5 2 ... ... ... ... ... ... 5 2 7 ... ... 1 1 ... ... ... ... 6 3 9 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Totals 5 2 ... 1 ... ... ... ... 5 3 8 ... ... 3 1 2 1 2 2 12 7 19 Total both sexes 7 1 ... ... 8 ... 4 3 4 19 Net births registered during the calendar year. Males Females Both sexes Legitimate Infants 110 103 213 Illegitimate Infanta 21 16 37 Net deaths registered during the calendar year. Males Females Both sexes Legitimate Infants 10 6 16 Illegitimate Infants 2 1 3 72 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—No Cases Were Notified During the Year 1938. PUERPERAL PYREXIA—Two Cases. 1 P.P. 11-8-38 Multipara Yes Home - Thrombosis Recovered - 2 S. H. 15-8-38 Primipara Not known - Institution No information obtainable Recovered - 73 Maternal Mortality. There was one case during 1936 of a death associated with pregnancy. This resulted from a septic abortion occurring in an unmarried woman at the twentyfourth week of pregnancy. The circumstances of the case formed the subject of enquiries by the Coroner and by the Police. At the Coroner's inquest an open verdict was returned. Ophthalmia Neonatorum. During the year three cases of ophthalmia neonatorum were brought to 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. Five Cases Notified in Accordance with the Public Health (Ophthalmia Neonatorum) Regulations. Birth Notified by. Midwife Intern Department, Hospital Intern Department, Hospital Intern Department, Hospital Intern Department, Hospital Result. Cured Removed Removed Removed Cured, later removed Medical Attendance and Nursing. Doctor and Nurse In-patient at hospital In-patient at hospital In-patient at hospital Out-patient at Ophthalmic Hospital, and later In-patient at hospital Where Treated At home Hospital Hospital Hospital Home and Hospital Type of Disease on Health Visitor's first call. Slight Not seen Not seen Not seen Slight By whom Notified. Doctor Doctor Doctor Doctor Doctor Age at Onset. 6 days 13 days 7 days 3 days 9 days Age when Notified. 7 days 13 days 18 days 8 days 10 days Case Number. 1 2 3 4 5 74 Midwives 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 four infants, in addition to the notified cases of ophthalmia neonatorum; all these cases made complete recovery. Whooping Cough. Visits were paid to 57 persons suffering from whooping cough. Of these, 49 were notified by doctors; in 6 others the information was given by the Health Visitors, one from school authorities and one by parent. Age. Eight were children under 1 year, 37 were 1 to 5 years, 12 were 5 to 16 years. Removal. Twenty-eight children were removed to hospitals of the L.C.C., 25 of these were under 5 years. Deaths. Nil. Measles. During 1938 I received information of 95 cases of measles. Of these 18 were notified by school teachers and 50 by medical practitioners; information of 10 was given by L.C.C. hospital authorities, 8 by health visitors, 9 by parents. Age. Seven were under 1 year, 48 were between 1 and 5 years, 27 were between 5 and 16 years, and 13 were over 16. Removals. Fifty-five patients were removed to L.C.C. Infectious Diseases Hospitals, of these 32 were under 5 years. In addition 2 patients went to the London Fever Hospital. Deaths. Nil. 75 Measles Control in Schools. The special arrangements of the London County Council for securing through the school organisation earlier information of measles was continued. German Measles. During the year information was received relating to 20 cases; 12 were notified by doctors; information of 2 canes was received from school, 1 by Health Visitor, 2 from L.C.C. Hospital Authorities, 2 by Parents, and 1 from the Caretaker of Boswell House. Age. Fivo were between 1 and 5 years; 7 were between 5 and 16 years and 8 were over 16 years. Removals. Thirteen patients were removed to hospital; 2 to the London Fever Hospital and 11 to the L.C.C. Infectious Diseases Hospitals; of the patients removed to hospital, 4 were under 5 years Diarrhæa and Enteritis under 2 years. The number of deaths was four; all occurred under 1 year of age(see table on page 71). Nursing Arrangements. The services of the district nurses were used as follows in 1938:—Deficient lactation 4 cases, 47 visits; complications after pregnancy 9 cases, 133 visits; measles 3 cases, 85 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 49 Sores, including impetigo 88 Aural discharge 48 Umbilical hernia, strapping 87 Attention to breast and nipples 21 Septic fingers, hands, toes, etc 32 Constipation 15 Varicose veins 10 Other ailments, etc. 74 Also, in smaller numbers:— Attention to cervical glands, sprained ankle, nævus talipes, eyes, gums and teeth. J 2 Routine Medical Inspection of Elementary School Children in Holborn, 1938. Age Groups. Number examined. Clothing and Boots. Nutrition Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good Fair Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. | Clean. Dirty. Pediculi. All sound. Less than (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 137 54 81 2 18 108 16 134 3 130 6 1 80 63 4 Girls 126 58 67 1 22 94 10 — 120 4 2 126 1 — 72 48 6 — — — Age 7— Boys 100 31 69 — 12 70 18 — 97 2 1 95 6 — 63 36 1 45 36 16 Girls 91 38 53 — 15 66 10 — 82 8 1 90 1 — 60 29 2 39 42 10 Age 11— Boys 150 49 101 — 23 117 10 — 143 7 — 142 8 — 107 43 — 83 33 34 Girls 137 30 107 — 24 102 11 — 128 7 2 137 — — 97 40 — 70 33 34 Age 14— Boys 118 13 135 — 22 114 12 — 147 1 — 146 2 — 112 86 — 76 41 30 Girls 132 18 114 — 42 84 6 — 119 5 8 132 — — 101 29 2 66 39 37 Total 1,021 291 727 8 173 755 93 — 970 37 14 997 23 i 692 314 15 368 224 161 Percentage 28.5 71.2 0.3 17.0 73.9 9.1 95.0 3.6 1.4 97.6 2.3 0.1 67.8 30.7 1.5 48.9 29.7 21.4 London ... 5 4.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 26.3 3.5 67.8 19.0 13.2 77 Examination of Elementary School Children in Holborn in 1938. Defect. Boys. Girls. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number Examined 137 100 150 148 126 91 137 132 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 2 2 6 6 2 2 - - 1 1 1 1 3 3 - 1 Skin Disease 5 4 2 1 2 1 - - 1 - 2 2 2 1 3 2 Defective Teeth - 57 - 37 - 44 - 36 - 54 - 31 - 40 - 31 Enlarged Tonsils 28 2 11 4 2 - 3 - 14 3 8 4 10 1 6 1 Adenoids - - - - - - - - 2 - - - - - - - Enlarged Tonsils and Adenoids - - - - - - - - 1 1 1 1 - - - - Other Nose and Throat Defects 2 1 - - - - - - - - 1 1 1 1 - - Enlarged Glands 4 1 2 1 1 - - - 5 - 1 - - - - - Eye Disease 3 3 2 2 1 1 - - 7 4 1 - 1 - - - Vision Defect - - - 14 - 31 - 26 - - - 9 - 34 - 32 Otorrhæa 2 2 - - - - - - 1 - - - - - 1 1 Other Ear Disease 1 1 - - - - - - - - - - - - - - Defective Hearing 1 - - - - - 1 - - - - - - - - - Speech Defects - - - - - - - - - - - - - - - - Heart Defects 3 - 3 - 2 - 3 2 8 - 5 - 2 - 6 1 Anæmia 3 2 2 1 8 2 2 - 2 1 2 1 1 1 - - Lung Defects 6 - 4 - 1 - - - 3 - 1 1 - - 1 - Nervous Defects 1 1 2 1 2 - 1 1 - - - - 1 1 2 1 Phthisis - - - - - - - - - - - - - - - - Other T.B. Disease - - - - - - - - - - - - - - - - Rickets - - - - - - - - 1 - - - - - - - Spinal Deformities 1 - - - 1 - - - - - 2 1 - - 1 - Other Deformities 2 1 - - 1 1 - - 1 - - - 2 1 1 - Other Defects 1 1 2 1 2 1 1 - 3 1 5 2 3 - 5 3 Number of Children noted for treatment 67 57 77 57 62 47 70 59 * Defects, however slight, are included under " Cases " Those severe enough to require treatment are shown under*. 78 Infant Life Protection. On the 1st January, 1937, there was no foster mother on the register. No foster mothers were registered during the year. 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 continued 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 1938. Health and Baby Week. Health Week, with which Baby Week was combined, was observed in the Borough during the week 2nd to 8th October, 1938. The programme was as follows:— 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. John W. Roberts) 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. 79 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 a number of schools and four prizes were awarded. The designs were again judged by Dr. E. Goodwin Eawlinson. SANITARY ADMINISTRATION. Public Mortuary. The Public Mortuary provided by the Council is situated in Stukeley Street. During the year 43 bodies were deposited. There were 41 post-mortem examinations made, and 2 inquests held. On 3 occasions 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 three by the Police. Inquests. During the year 21 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, 3; Accidents, 9; Suicide, 5; Misadventure, 2; Open verdict, 2. The causes of death certified were as follows:- Natural Causes. Accidents. Various conditions 3 Falls 5 Street accidents 4 Misadventure. Suicide. Operation 1 Coal gas poisoning 3 Acute alcoholic poisoning 1 Jump from window 1 Poisoning 1 Open verdict. Drowning 1 Coal gas poisoning 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. In no case was it found necessary for the statutory powers to be exercised. Rent and Mortgage Interest Restriction Acts, 1920 to 1933. No application was received during the year for a certificate under the above Acts. 80 The Pharmacy and Poisons Act, 1933. At the end of the year 1938, 79 names were on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List. Before entry of any name on the list the premises concerned axe inspected to ensure that adequate provision is made for the storage of the poisons and for compliance with the rules governing the sale. 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 two different sites frequented by pigeons, and 114 birds were caught. It must, however, be recorded, that on many occasions, even after several hours work, 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 Buildings. The London County Council (General Powers) Act, 1927, gave power to that Council to make By-laws in relation to the demolition of old buildings. By-laws dealing with the subject were made by the London County Council in July, 1929, and were approved by the Minister of Health on the 14th November, 1929. These By-laws are enforceable by the Metropolitan Borough Councils. We are informed by the Borough Engineer's Department of licences issued for the erection of hoardings for the purpose of the demolition of buildings, and the sites are then visited by the Sanitary Inspectors concerned. 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. This Council also shared in the special campaign, inaugurated by the Prime Minister in September, 1937, for making health services better known. This campaign was carried on into 1938. 81 APPENDIX. TABLE I. Vital Statistics of Whole District during 1938 and Ten Previous Years. Births. Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District. Under 1 Year of Age At all Ages year Population estimated to Middle of each Year. Uncorrected Number Net Number of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Births Number Rate Number Rate 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 1930 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 36,410 186 349 9.67 773 607 351 25 72 517 14.2 1933 36,050 180 342 9.49 681 521 326 24 70 486 13.5 1934 36,020 150 309 8.58 699 552 293 22 71 440 12.2 1935 35,400 134 271 7.65 668 526 278 24 88 420 12.7 1936 34,850 121 289 8.29 731 586 273 18 66 418 11.99 1937 34,600 106 280 8.09 715 585 280 22 78.6 410 11.85 1938 34,350 72 250 7.28 611 504 251 19 76.0 358 10.61 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. 82 TABLE II. Causes of, and Ages at, Death, 1938. Causes oF Death. NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS," whether occurring within or without the Borough. Total Deaths whether of "Residents " or "NonResidents" in Institutions in the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All causes Certified 410 22 3 3 8 11 36 121 114 92 Uncertified ... •• ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... 2. Measles 1 1 ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... 1 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria ... ... ... ... ... ... ... ... ... ... 2 6. Influenza 1 ... ... ... ... ... ... 1 ... ... ... 7. Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... 2 8. Cerebro-spinal Fever 1 ... ... ... 1 ... ... ... ... ... 2 9. Tuberculosis of Inspiratory System 32 1 ... ... 4 5 8 12 2 ... 14 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 17 11. Syphilis 3 ... ... ... ... ... ... 2 1 ... 1 12 General Paralysis of the insane, Tabes Dorsalis 5 ... ... ... ... ... ... 4 1 ... ... 13. Cancer, malignant disease 61 ... ... ... ... ... ... 34 19 8 62 14. Diabetes 2 ... ... ... ... ... ... 1 1 ... 9 15. Cerebral Hæmorrhage 16 ... ... ... ... ... 1 7 6 2 29 16. Heart Disease 85 ... ... ... ... ... 3 27 21 33 25 17. Aneurysm 5 ... ... ... ... ... ... 3 2 ... 3 18. Other Circulatory Diseases 14 ... ... ... ... ... ... 4 5 5 3 19. Bronchitis 16 1 ... ... ... ... ... 2 5 7 5 20. Pneumonia (all forms) 19 2 ... ... ... ... ... 7 4 3 55 21 Other Respiratory Diseases 2 ... ... ... ... ... ... 1 1 ... 13 22. Peptic Ulcer 6 ... ... ... ... ... ... 5 1 ... 7 23. Diarrhæa, etc. 5 5 ... ... ... ... ... ... ... ... 40 24. Appendicitis 2 ... ... ... ... ... 1 1 ... ... 4 25. Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... ... 3 26. Other diseases of liver, etc. 1 ... ... ... ... ... ... ... 1 ... 1 27. Other digestive diseases 4 ... ... ... ... ... ... 3 l ... 14 28. Acute and Chronic Nephritis 10 ... ... ... ... ... 2 6 ... 2 17 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal Causes 1 ... ... ... ... ... 1 ... ... ... ... 31. Congenital Debility, Premature Birth, Malformation, etc. 9 9 ... ... ... ... ... ... ... ... 44 32 Senility 10 ... ... ... ... ... ... ... 2 8 1 33. Suicide 6 ... ... ... ... ... 3 1 1 1 2 34. Other Violence 12 ... ... ... ... ... 5 2 3 2 9 85. Other Defined Diseases 29 ... ... ... 2 2 2 11 6 6 126 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 358 19 ... 2 7 8 28 134 83 77 511 83 TABLE III. Cases of Infectious Disease notified during the year 1938. Disease. Total Under 1 lto2 2 to 3 3 to 4 4 to 5 6 to 10 10 to 15 15 to 20 20 to 35 35 to 45 15 to 66 65 up Total Deaths Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 49 ... 3 6 6 2 14 3 6 7 1 1 ... ... Erysipelas 15 ... ... ... ... ... ... ... ... 1 3 7 4 1 Scarlet Fever 59 ... 2 4 6 1 23 7 5 11 ... 1 ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... do. Pyrexia 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... Cerebro-spinal Fever 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 10 ... 1 ... ... 1 3 ... 1 1 1 1 1 ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia—Primary 20 1 2 ... ... ... 2 ... ... 6 2 5 2 1 do. Influenzal 1 ... ... ... ... ... ... ... ... ... 1 ... ... (Tuberculosis— Pulmonary 71 1 1 ... ... ... 2 2 6 32 9 15 3 32 do. Non-Pulmonary 8 ... ... ... ... ... 4 ... 2 1 ... ... 1 ... whooping Cough 53 8 6 8 8 13 10 ... ... ... ... ... ... 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 295 15 15 18 19 17 59 13 20 60 18 30 11 35 *Measles 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... *Whooping Cough ... ... ... ... ... ... ... •• ... ... ... ... ... ... * From 1st October, 1938, to 31st December, 1938, inclusive. 84 TABLE IV. INFORMATION REQUIRED BY THE LONDON COUNTY COUNCIL. PREMISES. Number in Borough at 31st December, 1938. Number of Inspections. Number of Prosecutions. Common Lodging houses 3 19 Nil Seamen's Lodging houses Nil — — Cowsheds (licensed) Nil — — Slaughter-houses (licensed) 1 3 Nil Other offensive trades Nil — — Milkshops 163 490 Nil Ice cream premises 84 64 Nil Restaurants and eating houses 553 1,055 Nil Registered foster mothers Nil 52 in connection with Child Life Protection — Nurse children kept Nil Smoke nuisances. (1) Number of observations 189 (5) Number of legal proceedings — (2) Number of intimations served (6) Number of convictions — (3) Number of complaints received 12 (7) Amount of penalty and costs imposed in each case — (4) Number of statutory notices served — Cleansing and Disinfection. Number of adults cleansed ll4 Number of premises cleansed— Number of children 3 (a) After infectious diseases 473 Water Supply of Tenement Houses. (b) For vermin 88 Number of premises supplied — Number of prosecutions — Sanitary Officers. Number of Sanitary Inspectors (whole-time) „ „ „ „ (part-time) Number of Health Visitors (whole-time) 2 Male 4 Female Male — Female 1 „ „ „ „ (part-time) 1 Housing. 1. Total number of houses in the Borough (Census 1931) 6,462 : (b) Number of houses demolished following representation by Borough Medical Officer under Sec. 25 of H.A., 1936 Nil Public Health Act. 2. Number of houses inspected on account of complaints or illness 687 7. Number of houses repaired under Sections 9 and 10 of H.A., 1936:- 3. Number of statutory notices served 44 (a) By owners Nil 4. Number of houses repaired or nuisances remedied 139 (b) By L.A. in default of owners Nil Housing Act, 1936. 8. Number of houses demolished : (a) In pursuance of orders under Section 11 of the Housing Act, 1936 18 5. Number of houses inspected— house to house (Housing Consolidated Regs., 1925) 124 (b) Voluntarily — 6. (a) Number of houses included in representations by the Borough Medical Officer under Sec. 25 of H.A., 1936 13 9 Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 7 85 TABLE IV.—continued. Housing—continued. 10. Number of Closing Orders determined (i.e., houses made fit) Nil 13. Underground Rooms— Number occupied but unfit 636 11. Overcrowding (Housing Act, 1936)— Number closed or modified occupation approved 33 Number of families found to be living in overcrowded conditions 289 14. Houses Let in Lodgings— Number in Borough 353 Number of overcrowded families who have obtained alternative accommodation 114 Number of inspections 685 Number of prosecutions — Number of complaints remedied under the By-laws (not included under any other heading) 152 12. Number of houses erected by the Borough Council for working classes during year Nil Infectious Diseases. Infectious diseases—cases notified under local orders (excluding cases coming to knowledge otherwise than by notification). Disease. Cases notified. Period Measles * 2 1938 German Measles * — „ Whooping Cough 53 „ Rheumatic Fever (0-16) * 1 „ Chicken Pox * 17 „ Zymotic Enteritis * 5 „ * Voluntary notifications. 86 TABLE V. Factories and Other Premises. 1.—Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. PREMISES. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories with mechanical power 380 41 ... Factories without mechanical power 264 31 ... * Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 353 37 ... Total 997 109 ... * Electrical Stations should be reckoned as factories. 2.—Defects Found. Particulars. (1) Number of Defects. Number of defects in respect of which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Want of cleanliness (S. 1) 23 23 ... ... Overcrowding (S. 2) ... ... ... ... Unreasonable temperature (S. 3) ... ... ... ... Inadequate ventilation (S. 4) ... ... ... ... Ineffective drainage of floors (S. 6) ... ... ... ... Sanitary Conveniences (S. 7) insufficient 5 5 ... ... unsuitable or defective 50 50 ... ... not separate for sexes 1 1 ... ... Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 121 121 ... ... Total 200 200 ... ... 87 TABLE V.—continued. OUTWORK IN UNWHOLESOME PREMISES. (Section 108 of Act of 1901; Section III. of Act of 1937.) NATURE OF WORK. (1) Instances. (2) Notices served. (3) Prosecutions (4) Wearing Apparel— Making, etc. ... ... ... Cleaning and washing .... .... .... Household linen .... .... .... Lace, lace curtains and nets .... .... .... Curtains and furniture hangings .... .... .... Furniture and upholstery .... .... .... Electro-plate .... .... .... File making .... .... .... Brass and brass articles .... .... .... Fur pulling .... .... .... Cables and chains .... .... .... Anchors and grapnels .... .... .... Cart gear .... .... .... Locks, latches and keys .... .... .... Umbrellas, etc. .... .... .... Artificial flowers .... .... .... Nets, other than wire nets .... .... .... Tents .... .... .... Sacks .... .... .... Racquet and tennis balls .... .... .... Paper, etc., boxes, paper bags .... .... .... Brush making .... .... .... Pea picking .... .... .... Feather sorting .... .... .... Warding, etc., of buttons, etc. .... .... .... Stuffed toys .... .... .... Basket making .... .... .... Chocolates and sweetmeats .... .... .... Cosaques, Christmas crackers, Christmas stockings, etc. .... .... .... Textile Weaving .... .... .... Lampshades .... .... .... Total .... .... .... 88 LEGAL PROCEEDINGS. Food and Drugs(Adulteration) Act, 1928. Date Name Address Offence Result 1938 Jan, 17th Regal Milk Bars, Ltd. 66, New Oxford Street Selling milk 2.6 per cent. deficient in fat Defendant convicted and fined £1. do. do. do. do. Defendant convicted and fined £2 and £3. 3s. costs on both summonses. Jan. 25th W. F. Stacey 156, Clerkenwell Road Selling whisky 41.3 degrees under proof Summons dismissed under P.O. Act, ordered to pay £4. 4s. costs. July 29th Edwards Dairy 71, Leather Lane Selling milk 3.0 per cent. deficient in fat Defendant convicted. Fined £1 and £1 costs. do. do. do. Selling milk 2.0 per cent. deficient in fat Defendant convicted. Fined £1 and £1 costs. Milk and Dairies Order, 1936. Feb. 1st George Oatley 24, Deny's Buildings Bottling milk other than on registered premises Defendant convicted and fined 15s. Public, Health(London) Act, 1936. Sections 181, 183 and 282. Jan. 27th D. R. Evans, Ltd. Farringdon Road Exposing for sale tinned goods which were unfit for human consumption Summons dismissed under P.O. Act ordered to pay £5. 5s. costs. Jan. 28th S. Veglio 24, St. Giles High Street Restaurant in dirty condition. Unsound food exposed for sale. Breach of bylaws Defendant convicted and fined £25, £5, £5 and £3. 5s. costs.