AC 4342 Library HOL 44 The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health, For the Year 1946. J. A. STRUTHERS, M.D , M.R.C.P., D.P.H. London: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.C.2. 1947. 65957 The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health For the Year 1946. J. A. STRUTHERS, M.D., M.RC.P., D.P.H. $ London : Printed by DIPROSE, BATEMAN & CO , Sheffield Street, Kingsway, W.C.2. 1947. To the Mayor, Aldermen and Councillors, Metropolitan Borough of Holborn. In accordance with the Ministry of Health Circular 13/47, this report on the health of the Borough in 1946 has been prepared on abridged lines similar to the Annual Reports during the war years. It will be seen from the report that the year under review was a satisfactory one from the health point of view. The birth rate of 14.06 per 1,000 of the population shows an increase on the pre-war years. The death rate was 13.78 per 1,000 of the population and compares very favourably with the years from 1940, and the tendency has been for it to improve for the last few years. It will be noticed that the birth rate has now overtaken the death rate, but how long this will continue is a matter of conjecture in a central London Borough. The infant mortality rate was 40.27, and is considerably less than in the previous year and lower than the rate for London as a whole. The Borough's infant mortality rate will no doubt be still further improved as time goes by. More use is being made of the facilities provided in the Council's. Maternity and Child Welfare Centres, and it was consequently found necessary to increase the number of sessions held towards the end of the year. The Child Guidance Clinics which are held at the Centre made good progress during the year. It has been found necessary to increase the number of sessions, and to appoint a part-time Psychiatric Social Worker to assist the Medical Officer of the clinic. Reference is made in the report to the extended Home and Domestic Help Scheme which got under way during the year and is serving a real need. It was found necessary to appoint a social worker for this service. The service is proving of value to the aged, infirm and the blind—persons who often live alone and who, until the institution of the Domestic Help Service, usually had to depend upon neighbours and friends to give them attention in time of need. There was a marked prevalence of measles in 1946, as in 1945, but cases of other infectious diseases were infrequent. Scabies continued to be prevalent. The tabulated record of infectious diseases over the last 10 years has been inserted in this report. Diphtheria immunization has been continued, and the number of children immunized in the Borough compares favourably with that of the rest of London. This is gratifying in view of the pioneer work in diphtheria immunization carried out by this Borough in the early stages. The work of sanitary inspection was carried on under conditions complicated by the restriction on building work and materials, and owing to these restrictions it may be some time before the standard which one expects to find in this Borough is again realised. 4 During the year the Department was to some extent re-organised and an attempt made, so far as present conditions and the shortage of staff allow, to return to pre-war standards. The full effects of these efforts will not, however, be felt until later. It gives me pleasure to express my thanks to the Chairmen, and members of the Public Health and Maternity and Child Welfare Committees for their support in the task of meeting the changing demands made upon the local health services by post-war conditions. J. A. STRUTHERS, Medical Officer of Health. 5 statistics for the year 1946. Resident Population. Estimated to middle of 1946 (as supplied by the RegistrarGeneral) for birth and death rates 21,190 Live Births. Total. M. F. Legitimate 250 113 137 Illegitimate 48 23 25 Birth rate per 1,000 estimated population 14.06 Stillbirths 9 6 3 Rate per 1,000 (live and still births) 29.31 Deaths. Total. M. F. 292 170 122 Death rate per 1,000 estimated population 13.78 Classification of Deaths: The causes of death are tabulated (see Table No. 1, page 6. Deaths from Puerperal Causes. There were no deaths from puerperal causes during 1946. Death Rate of Infants Under One Year of Age. All infants per 1,000 live births 40.27 Legitimate infants per 1,000 live legitimate births 32.00 Illegitimate infants per 1,000 live illegitimate births 83.33 During the year there were 12 deaths of infants under one year of age, of whom 4 were illegitimate. The causes of death were as follows: — Diarrhoea 1 Other digestive diseases 1 Premature birth 2 Congenital malformation, birth injury and infantile diseases 6 Violent causes 1 All other causes 1 6 Causes of, and Ages at, Death.—Table No. 1. Net Deaths at the Subjoined Aires of " Resident*" whether occurring within or without the District. All ages. Under 1 year. 1 and under 5 years. 5 and under 1 15 years. 15 and under 45 years. 45 and under 65 years. 66 and upward s Tuberculosis of Respiratory System 13 5 6 2 Syphilitic Disease 2 1 1 Influenza 3 1 2 Cancer of Buccal Cavity and Oesophagus 2 2 Cancer of Uterus 4 1 3 Cancer of Stomach and Duodenum 7 2 5 Cancer of Breast 4 1 2 1 Cancer of all Other Sites 22 1 10 11 Diabetes 3 1 2 Intra-Cranial Vascular Disease 24 1 5 18 Heart Disease 66 3 20 43 Other Diseases of the Respiratory System 25 2 7 16 Bronchitis 30 1 12 17 Pneumonia 28 1 9 18 Other Respiratory Diseases 1 1 Ulceration of Stomach or Duodenum 3 1 2 Diarrhoea (under 2) 1 1 Other Digestive Diseases 7 1 2 4 Nephritis 10 4 6 Premature Birth 2 2 Congenital Malformations. Birth Injury. Infantile Disease 6 6 Suicide 4 3 1 Road Traffic Accidents 3 1 2 Other Violent Causes 9 1 1 2 1 4 All other Causes 13 1 1 3 3 5 Total 292 12 1 2 24 91 162 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. During the year no major changes took place in the health services in the Borough, but it was found necessary to increase the existing services. Infectious Diseases. 392 cases were notified. These are tabulated in age groups (see Table No. 2, page 7). Comparative figures of infectious disease for the years 1936-1946 are also shown (see Table No. 3, page 8). Scabies. 106 cases were notified and 14 cases came to the knowledge of the Department other than by formal notification. The Council has an agreement for the treatment of scabies with St. John's Hospital for Diseases of the Skin, Lisle Street. Disinfection of patients' clothing is carried out at the Council's Disinfecting Station during the course of the treatment and the baths at the Cleansing Station are available to persons notified as suffering from scabies. Homes are visited by the Health Visitors, when advice is given and arrangements made for the disinfection of bedding, etc. 7 TABLE No. 2. Summary of Infectious Disease Notifications 1946. Age Groups. Disease. Under 1 1-2 2-3 3—1 4—5 5—10 10-15 16—25 25—45 45—65 55 & over Age U.K. Total M F M P M F M F M F 11 F M F M F M F M F M F M F Cerebro-spinal Fever – – – – – – – – – – – – 1 – 1 – – – – – – – – – 2 Diphtheria – – 1 – – – – – – – 2 1 1 3 3 1 – – – – – – – – 12 Dysentery – – 2 – 1 – 1 – – – 1 – – – 1 – – – – – – – – – 6 Enteric Fever – – – – – – – – – – – – – – – – – – – – – – – – 1 Erysipelas – – – – – – – – – – – – – – – – – – – – – – – – 4 Measles 1 6 5 11 11 6 11 12 4 6 11 14 4 1 — 3 — 1 — — — — — — 107 Ophthalmia Neonatorum 3 1 – – – – – – – – – – – – – – – – – – – – – – 4 Puerperal Pyrexia – – – – – – – – – – – – – – – 1 – 4 – – – – – – 5 Pneumonia 1 1 3 1 5 3 1 2 — — 17 Poliomyelitis & Polioencephalitis – – – – – – – – – – – – 1 – – – – – – – – – – – 1 Scarlet Fever — — — — 2 1 2 1 1 1 7 4 – 3 1 1 – – – – – – – – 24 Scabies 1 3 — 2 — 2 — 1 — 1 4 2 5 2 17 14 29 13 3 4 1 1 1 — 106 Tuberculosis— Pulmonary — — 1 — — 1 1 — — — 2 1 1 1 6 4 11 7 11 3 3 2 — — 55 Non-Pulmonary — — — — — — — — — — 1 1 — — 1 — 1 — – 1 — — — — 5 Whooping Cough 3 3 2 6 1 1 4 5 1 4 7 4 — – 1 1 — — — – — — – — 43 8 TABLE No. 3. Comparative Figures of Infectious Disease for the years 1936 to 1946. Disease. 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 Cerebro-spinal Fever 2 1 — 1 1 7 7 3 1 1 2 Diphtheria 12 11 5 17 17 14 7 19 49 76 60 Dysentery 6 12 13 2 — — — — 10 10 6 Enteric Fever 1 — 1 6 1 3 1 1 — — 2 Erysipelas 4 3 8 3 7 3 12 13 15 10 19 Encephalitis Lethargica – 1 – – – – – 2 – – – Food Poisoning — 1 – – – – – – – – — Malaria — — — 1 — — — 1 — 3 2 Measles 107 103 33 219 58 34 39 8 — — 252 Ophthalmia Neonatorum 4 1 4 4 5 1 4 4 5 3 3 Puerperal Fever — 2 2 2 2 1 — — — 4 2 Puerperal Pyrexia 5 4 1 3 7 2 3 3 2 2 3 Pneumonia (acute influenzal and primary) 17 6 14 22 20 18 14 28 21 34 30 Poliomyelitis and Polioencephalitis 1 1 – – – – – – – – – Scarlet Fever 24 14 20 30 23 16 20 56 59 38 67 Scabies* 1C6 125 99 54 – – – – – – – Tuberculosis—Pulmonary 55 59 41 51 45 47 44 64 71 66 77 do Non-Pulmonary 5 9 9 3 8 6 3 5 8 10 13 Whooping Cough 43 11 30 38 48 42 7 71 53 60 76 *Notifiable as from 1st August, 1943. 9 Disinfection. During the year 100 rooms were disinfected after cases of infectious or other disease. Of these, 5 were rooms which had been occupied by tuberculous persons. In addition, 149 rooms of private dwellings were disinfested of vermin. At the Disinfecting Station 6,105 articles of bedding, clothing, etc., 130 books and 53 toys were disinfected. The following table shows the total disinfection carried out in 1936-1946: — Comparative Table of Total Disinfections carried out 1936 to 1946. 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 Number of rooms 249 213 566 347 268 284 390 305 473 434 487 Number of articles bedding, clothing, etc.) 6105 6727 5525 10376 13414 4793 6644 5174 5287 5975 5641 Number of books 130 254 209 329 57 9 61 60 137 130 242 Number of toys 53 68 15 61 17 8 13 75 58 125 91 Cleansing Station. The number of verminous persons cleansed at the Cleansing Station during the year was 227 men and 23 women, including 117 men from Bruce House Westminster. Comparative Table of Verminous Persons Cleansed 1936 to 1946. 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 Males 227 248 106 380 417 174 105 98 90 98 97 Females 23 10 14 3 2 4 7 1 24 4 2 Public Mortuary. During the year 373 bodies were received into the Public Mortuary, and of this number 49 were those of residents of the Borough. 365 post-mortem examinations were made. Inquests. During the year 18 inquests were held on the bodies of Holborn residents. Vaccination. The number of cases dealt with by the Vaccination Officer during the year totalled 298. 132 were successfully vaccinated, and 5 conscientious objections were received. 10 maternity and child welfare work. Very full use was made of the facilities at the Maternity and Child Welfare Centres in the Borough and it was found necessary, towards the end of the Year, to increase the number of sessions. During the year there were registered 298 live births and 9 still births, giving a total of 307. Home Visiting. It necessarily follows that, owing to the increased sessions at the Maternity and Child Welfare Centres, home visiting by the Health Visitors had to be curtailed to some extent. The visits paid were as follows: — First Visits. Revisits. Total. Expectant Mothers 310 326 636 Post-Natal Mothers 28 43 71 Children under 1 year of age 398 1,171 1,569 Children 1—2 years of age 45 598 643 Children 2—3 years of age 41 383 424 Children 3—4 years of age 24 319 343 Children 4—5 years of age 30 304 334 Child Life Protection 13 34 47 Infectious Diseases — — 290 Other visits 218 Attendances at Centres. (1) 10, John Street. The following is an analysis of attendance at this Centre: — No. of Sessions. Total attendances, Children. Mothers. Total. Monday Medical Consultation 49 1344 275 1619 Dental 49 63 164 227 Tuesday Ante and Post-Natal 98 1166 1166 Other attendances — — 5 5 Wednesday...Medical Consultation 51 1622 262 1884 Diphtheria Immunization 51 739 — 739 Whooping Cough Immunization 51 202 — 202 Thursday Physical Culture 48 357 420 777 Other Attendances — — 73 73 Friday Medical Consultation 51 1809 327 2136 (2) St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the year were as follows:— No. of Sessions. Total Attendances. Children. Mothers. Total. ThursdayMedical Consultation 51 886 114 1000 Ante-natal and Post-natal — — 5 5 11 The total number of attendances made by the Health Visitors at both Centres during the year was 656. Ante-Natal Hygiene. Under the scheme for the voluntary notification of pregnancy, 38 notifications were received during 1946, as compared with 31 in 1945. All these expectant mothers, as well as those already known to the Health Visitors through other sources, were visited in their homes. 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. Dental Treatment. The following is a summary of the work during 1946 at the Council's Dental Clinic, 10, John Street, W.C.1, open on Monday afternoons for nursing or expectant mothers, and children under 5 years of age. Women. Children. Total. Number of sessions held — — 49 Number of new patients 38 29 67 Total attendances 164 63 227 Emergency Obstetric Unit. A service is available, under an arrangement with the University College Hospital, for possible emergencies in connection with confinements taking place in the Borough where a blood transfusion is required. During the year this service was used twice, once in the case of miscarriage, and once in the case of a difficult confinement subsequently requiring admission of the mother to hospital for operation. Foot Clinic. The Council has an arrangement with a Chiropodist for foot treatment for expectant and nursing mothers, and mothers of children under 5 years of age, who are referred for such treatment by the Medical Officers of the Infant Welfare Centres. Child Life Protection. On the 1st January, 1947, there was one foster mother on the register. No foster mothers were registered during the year. Child Guidance Clinic. At the end of 1945 a Child Guidance Clinic was set up in the Borough under Section 251 of the Public Health (London) Act, 1936. The Clinic is 12 held at the Welfare Centre, 10, John Street, and is an integral part of the Centre, the cases being referred to the Clinic by the Medical Officers of the Maternity and Child Welfare Centres. The total number of cases dealt with was 73. Of this number, there were 41 girls and 32 boys, of whom 11 were under 1 year of age. Approximately 53% of the cases dealt with were "only children," i.e., 39 out of the 73. The main complaints dealt with were as follows (this number is greater than 73 as each child is listed under its outstanding symptoms):— Feeding difficulties 18 Persistent undesirable habits 12 Restless, over-active, generally difficult 11 Sleeping difficulties 11 Specific fears and phobias 9 Miserable, jealous, unsociable 6 Difficult over toilet training 5 Slow in walking and talking 4 Tics and blinks 2 Stammer and stutter 1 Mother generally anxious 1 Tempers and defiance 7 In the majority of cases the difficulties arose through faulty handling, so that the main work lay in helping the individual mother to modify her attitude and handling, and to build up gradually a better relationship with the child. Many of the cases were first babies, so that the mothers were inexperienced. Although in some cases advice and one or two follow-up talks were sufficient, in others, contact with the families over a considerably longer period was necessary. At the end of the year the number of cases completed was 41, and the number outstanding was 32. Diphtheria Immunization. The' immunization of children against diphtheria is carried out at the Council's Welfare Centre, and the Medical Officer attends at the Kingsway Creche for the same purpose. During the year, 266 children were recorded as immunized, 201 under 5 years of age, and 65 between the ages of 5 and 15. Home and Domestic Help Service. It has been found difficult during the year to obtain the services of women to undertake this work, although it was possible to give every applicant the help required. During the year a Social Worker was appointed to deal with all applications for the above service, as the increased work caused by the putting into operation of the Domestic Help Service, under Ministry of Health Circular 110/46, necessitated a full-time worker. The Council's Home Helps attended 19 cases during the year, and the Domestic Helps attended 13 cases. In one case of extreme necessity the services of a Home Help were granted free and in two cases the services of a Domestic Help were granted free. The majority of the applicants were required to contribute towards the cost in accordance with the scale recommended by the Metropolitan Boroughs' Standing Joint Committee. At the end of 1946, 3 Home and Domestic Helps were employed. These services have been much appreciated, and it has been found that they have met a much felt need in the Borough. 13 Convalescent Treatment. During the year, 10 toddlers were sent to the Beaconsfield Convalescent Home for Children, and 2 were sent to the Hart's Leap Toddlers' Convalescent Home. Insulin. This was supplied free of charge, in accordance with Ministry of Health Circular 2734, in 3 cases, at a cost to the Council of £15 3s. Od. SANITARY CIRCUMSTANCES IN THE BOROUGH. The work of sanitary inspection was carried on under conditions complicated by restrictions on building work and building materials. Many applications for building licences were referred during the year for an opinion as to the necessity or urgency of the work required to be executed. Following is a summary of work carried out by Sanitary Inspectors during the year: — Complaints of nuisances received 367 PUBLIC HEALTH (LONDON) ACT, 1936. Dwelling houses inspected 936 Houses let in lodgings inspected 570 Common Lodging Houses inspected 3 Offices inspected 85 Rag and Bone Shops inspected 11 Smoke observations 23 Drainage work and testing 2,998 Other inspections 1,378 Re-inspections of above 2,168 HOUSING ACT, 1936. Houses inspected 28 Underground rooms inspections 45 Overcrowding visits 184 Re-inspections of above 32 FACTORIES ACT, 1937. Factories with mechanical power inspected 182 Factories without mechanical power inspected 104 Other inspections 6 Re-inspections of above 198 FOOD AND DRUGS ACT, 1938. Dairies and milk shops inspected 130 Ice cream premises inspected 51 Restaurants and kitchens inspected 895 Bakehouses inspected 81 Butchers' shops inspected 103 Fish shops inspected 36 Fried fish shops inspected Other food shops inspected 599 Market streets 198 Licensed premises 110 Re-inspections of above 963 MISCELLANEOUS INSPECTIONS. Pharmacy and Poisons Act 6 Rats and Mice Act, 1919 496 Shops Act 38 Other inspections 70 Re-inspections of above 618 14 VISITS, Etc., re Infectious Disease 454 Scabies 53 Aged and infirm persons 4 Police Courts 22 Various 1,597 Total 15,498 NOTICES SERVED. PUBLIC HEALTH (LONDON) ACT, 1936. Intimation Notices. Dwelling Houses 169 Houses let in lodgings 130 Offices 24 Food premises 20 Statutory Notices 51 FACTORIES ACT, 1937. Power Factories 26 Non-power Factories 47 FOOD AND DRUGS ACT, 1938. Food premises 64 SHOPS ACT, 1934 — RATS AND MICE (DESTRUCTION) ACT, 1919 12 Food and Drugs Act, 1938. During the year, 600 formal samples of foods and drugs were taken and submitted to the Borough Analyst for chemical analysis. Of these, 214 were of milk. Five samples were found to be adulterated, viz.: — Milk.—10% abstracted fat. Milk.—13.3% abstracted fat. Milk.—4.1% added water. Milk.-—2.3% abstracted fat and 5% added water. Mustard.—Deficient in allyl isothiocyanate 94%. In connection with these, four vendors were prosecuted. The results of the prosecutions will be found in the table of legal proceedings. In the case of the sample of mustard, a cautionary letter was sent on the instruction of the Public Health Committee. The registration of one milk vendor was cancelled owing to the unsatisfactory condition of his premises, and of the milk sold therefrom. Bacteriological Examination of Milk. 43 samples of milk were taken during the year, 41 of milk supplied to schools in the Borough. Four were found to be unsatisfactory, of which 3 were of milk supplied to schools by dairymen whose premises were registered outside the Borough. In these cases the Medical Officers of Health of the Districts from which the milk was obtained were notified, in order that investigations might be made. In the case of the remaining sample, which was purchased in the street, a letter of warning was sent to the vendor. 15 Monthly Variation of Chemical Composition of Milk, 1946. Month. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 17 12.60 8.95 3.65 February 17 12.00 8.65 3.35 March 17 12.26 8.81 3.45 April 19 12.15 8.79 3.36 May 19 12.20 8.90 3.30 June 22 12.18 8.81 3.37 July 15 12.30 8.78 3.52 August 17 12.24 8.70 3.54 September 19 12.49 8.85 3.64 October 16 12.53 8.83 3.70 November 18 12.62 8.84 3.78 December 18 12.43 8.75 3.68 Whole year 214 12.33 8.80 3.53 Legal minimum — 11.50 8.50 3.00 It will be observed that the average composition of milk supplied to the Borough during the year was fat 3.53 per cent. and non-fatty solids 8.80 per cent. These figures approximate closely for those of the previous seven years, averages of which are tabulated below: — Year. No. of samples examined. Total Solids, (average). Fat. (average). Non-fatty solids, (average). 1939 97 12.42 3.42 9.00 1940 172 12.45 3.56 8.89 1941 124 12.63 3.73 8.96 1942 94 12.46 3.60 8.86 1943 96 12.42 3.51 8.91 1944 100 12.29 3.48 8.81 1945 94 12.45 3.58 8.87 lj)46 214 12.33 3.53 8.81 Ice Cream. Thirty premises were on the register at the end of the year for the manufacture, storage or sale of ice cream. Legal proceedings were taken in two instances during the year, one for manufacturing and storing ice cream on unregistered premises, and one for storing ice cream on unregistered premises and failing to take steps to prevent contamination. (See table of Legal Proceedings). Bacteriological Examination of Ice Cream. Fourteen samples of ice cream were submitted for bacteriological examination. Nine of these were found to be unsatisfactory. Letters of warning were sent to the vendors. 16 Inspection and Supervision of Food. Milk: Fifty-nine premises were on the register at the end of the year (18 dairies, 13 restaurants and 28 general shops). These premises were all inspected as occasion required during the year. In addition, 19 retailers were registered for itinerant sale of milk from premises in the areas of other local authorities. In the case of one dairy it was necessary to cancel the registration. Milk (Special Designations) Order: The number of licences granted during the year were:— Licences. Supplementary. To sell pasteurized milk 5 4 To sell tuberculin tested milk 1 3 To sell accredited milk 1 — Public Health (Meat) Regulations, 1924: Three hundred and one inspections of butchers' shops and market stalls were made during the year. Inspection of Other Premises where Food is Prepared or Offered for Sale: 1,228 inspections of such premises were made during the year. Sixty-four notices under the Food and Drugs Act, 1938, were served requiring defects to be remedied. Legal proceedings were taken in respect of two restaurant premises during the year, one for failing to display a notice stating that horseflesh was sold, and one for failing to take steps to prevent contamination of food. (See table of Legal Proceedings). Unsound Food'. 3 tons 56 lbs. of tinned meat, fish and other foods were surrendered and destroyed or disposed of otherwise. Legal Proceedings, 1946. Offence. Result. Selling milk 10% abstracted fat. Fined £25 and £5 5s. Od. costs. Fined £20 and £5 5s. Od. costs. Selling milk 13.3% abstracted fat. Dismissed under Probation of Offenders Act on payment of £3 3s. Od. costs. Selling milk 4.1% added water. Dismissed under Probation of Offenders Act on payment of £7 7s. Od. costs. Failing to display notice stating that horseflesh was sold. Fined £5. Selling milk 2.3% abstracted fat and 5% added water. Each Defendant fined £2 and £1 1s. Od. costs. Using a room for storage of ice cream without being registered. Failing to cleanse the floor of same. Fined £2 in respect of non-registration and £7 and £5 costs for failing to take steps to prevent contamination. Manufacturing and storing ice cream on premises without being registered. Fined £20 and £6 6s. Od. costs. Having in their possession for sale, food intended for, but unfit for, human consumption, contrary to Section 9 of Food and Drugs Act, 1938. Dismissed under Probation of Offenders Act on payment by each Defendant of £3 3s. Od. costs. 17 Offence. Result. Failing to take reasonable steps to prevent risk of contamination of food in room at 39, Leather Lane. Failing to cleanse the walls, ceiling and doors of such room. Failing to cleanse the floor of such room and failing to provide suitable ventilation, contrary to Section 13 of the Food and Drugs Act, 1938. Fined £3 and £3 3s. Od. costs for failing to take reasonable steps to prevent conamination of food. Other summonses not separately dealt with. Carrying on trade as a dairyman, not then being registered as a retail purveyor of milk in respect of such premises, contrary to Article 6 (2) of the Milk and Dairies Order, 1926. Fined £20 on each sumons and £31 10s. Od. costs or three months imprisonment on the first and 6 weeks each on second and third summonses, all concurrent. Do. Fined £5 on each summons and £5 5s. Od. costs or 1 month imprisonment on the first and 14 days on each of the second and third summonses, all concurrent. Water. 1. The water supply in this area has been satisfactory both in quantity and quality. There have been no complaints received. 2. There is a piped supply, and bacteriological examinations of the raw water are made by the Metropolitan Water Board, who also perform chemical analysis. 3. The water is not known to have any plumbo-solvent action. 4. No action has been necessary in respect of contamination. 5. All dwelling houses are supplied direct from the mains, and standpipes are normally used only in cases of emergency, such as repair of mains. TUBERCULOSIS. Dispensary. The total number of attendances at the dispensary was 706. Of these, 176 were new patients. (See table below). The number of contacts who attended the dispensary for investigation was 54. New Patients during 1946. M. F. Total. Pulmonary 29 21 50 Non-Pulmonary 2 — 2 Non-Tuberculosis 36 45 81 Doubtful 27 16 43 94 82 176 Health Visitor. The total number of visits made by the Tuberculosis Health Visitor was 392. Of these, 56 were first visits. 18 Number of Cases. The following tables give the number of new cases of tuberculosis and deaths from the disease during 1946:— Age periods. New Cases Deaihs Pulmonary Non-pulmonary Pulmonary Non-pulmonary M F M F M F M F 0 — — — — — — — — 1 2 1 — — — — — — 5 2 1 1 1 — — — — 10 3 1 — — — — — — 15 2 2 — — — — — — 20 8 4 3 — — 1 — — 25 12 13 — — 1 2 — — 36 4 2 1 — 1 i — — 45 10 3 — — 5 — — 55 8 — — 1 4 — — — 65 4 2 — — 3 — — — 55 29 5 2 14 4 — — The number of cases on the register at the end of the year was as follows: M. F. Pulmonary 73 52 Non-Pulmonary 21 26 Total 94 78 During the year 73 notified cases of tuberculosis were removed from the register for various reasons. Patients Admitted and Discharged from Institutions. During the year 49 patients were admitted to hospital and 22 to sanatoria. 55 patients were discharged from institutions. Miniature Mass Radiography. The Miniature Mass Radiography Unit operated by the L.C.C. at Saint Pancras Hospital became available. The number of persons examined was 1,907. Tuberculosis Care Committee. The Committee met four times during the year—in January, April, July and October. 307 cases were reported upon, of which 59 were new cases. The Secretary's interviews with patients, or relatives, including visits, totalled 789. 19 Allowances for Tuberculous Patients Undergoing Treatment. During the year 34 patients received allowances. 22 new applications were received, one of which was withdrawn, and 7 patients found to be not eligible for grants. The allowances were made up as follows: — Maintenance allowances 31 Special allowances 10 Discretionary allowances 11 The amount disbursed during the year was £1,024 18s. 3d. The number of current cases is 20. Artificial Pneumothorax Treatment. Twenty-six patients received treatment. The total cost of £218 7s. 9d. was borne by the Council. Extra Nourishment. Twenty-six patients were granted extra nourishment. The total cost of £223 16s. 4d. was borne by the Council. Dental Treatment. One patient received dental treatment and was supplied with dentures. The total cost of £3 0s. Od. was borne by the Council. "Light" Treatment. One patient received Finsen light treatment. The total cost of £2 Is. Od. was borne by the Council. Bedding. Sixteen patients were provided with bedding. Housing. During the year 11 families were rehoused by the Borough Council and 4 families by the London County Council. Rehabilitation. In consultation with the Tuberculosis Officer, the District Resettlement Officer interviewed six patients, who have since been placed in suitable employment or training centres.