C 4342 HOL 45 The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health, For the Year 1947. J. A. STRUTHERS, M.D., M.R.C.P., D.P.H. London : Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kingsway, W.O.2. 1948. The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health For the Year 1947. J. A. STRUTHERS, M.D., M.R.C.P., D.P.H. Lonbon: Printed by DIPROSE, BATEMAN & CO., Sheffield Street, Kiugsway, W.C.2. 1948. To the Mayor, Aldermen and Councillors, Metropolitan Borough of Holborn. This report on the health of the inhabitants of the Borough in 1947 is again an abridged one, prepared in accordance with the requirements of the Ministry of Health. It will be seen from the report that the year under review was again a satisfactory one from the health point of view. The birth rate of 14.41 per 1,000 of the population shows a further increase on the pre-war years. The death rate of 12.57 per 1,000 of the population, and the tendency for this to improve for the last few years has again been exemplified this year. The infant mortality rate was 35.50, the lowest in the history of the Borough. Diphtheria immunisation was maintained at a high level throughout the year. The Child Guidance Clinic has made further progress during the year, which is shown by the increase in numbers attending. The Home and Domestic Help Service is one which has become firmly established and one of which greater use is being made. The same problem of recruitment of suitable workers in this service is still with us, but every applicant was provided with the required service. The work of sanitary improvement and repair was again carried out with the handicap resulting from various restrictions, so that the standard achieved in the Borough has not been as high as one would wish. The Department is now making every effort to carry out its functions satisfactorily under present conditions. An early improvement in these conditions is much to be hoped in the interests of public health. 4 It gives me pleasure to express my appreciation of the consideration and support shown me by the Chairmen and members of the Public Health and Maternity and Child Welfare Committees, and chief officers of the Council, and to thank the staff of my Department for their loyal assistance throughout the year. J. A. STRUTHERS, Medical Officer of Health. 5 STATISTICS FOR THE YEAR 1947. Resident Population. Estimated to middle of 1947 (as supplied by the RegistrarGeneral) 23,460 Live Births. Total. M. F. Legitimate 294 147 147 Illegitimate 44 24 20 Birth rate per 1,000 estimated population 14.41 Stillbirths 10 4 6 Rate per 1,000 (live and still births) 28.74 Deaths. Total. M. F. 295 167 128 Death rate per 1,000 estimated population 12.57 Classification of Deaths: The causes of death are tabulated (see Table No. 1, page 6). Deaths from Puerperal Causes. During 1947 there was 1 death from puerperal causes, and one from other maternal causes. In each case, death followed abortion. Death Rate of Infants Under One Year of Age. All infants per 1,000 live births 35.50 Legitimate infants per 1,000 live legitimate births 37.41 Illegitimate infants per 1,000 live illegitimate births 22.73 During the year there were 12 deaths of infants under one year of age, of whom 1 was illegitimate. The causes of death were as follows: — Diarrhœa 1 Bronchitis 1 Premature birth 7 Congenital malformation, birth injury and infantile diseases 1 Pneumonia 1 All other causes 1 6 Causes of, and Ages at, Death.—Table No. 1. Net Deaths at the Subjoined Ages of "Residents," whether occurring within or without the District All ages. Under 1 year. land under 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 65 years. 65 and upwards Tuberculosis of Respiratory System 17 5 7 5 Other forms of Tuberculosis 1 1 Syphilitic Disease 1 1 Cancer of Buccal Cavity and Oesophagus 5 2 3 Cancer of Stomach and Duodenum 7 5 2 Cancer of Breast 7 4 3 Cancer of all Other Sites 35 5 8 22 Diabetes 5 2 3 Intra-Cranial Vascular Disease 26 12 14 Heart Disease 64 1 17 46 Other Diseases of the Respiratory System 15 1 2 12 Bronchitis 23 1 4 18 Pneumonia 15 1 1 4 9 Other Respiratory Diseases 8 1 3 2 2 Ulceration of Stomach or Duodenum 4 3 1 Diarrhoea (under 2) 1 1 Appendicitis 1 1 Other Digestive Diseases 5 2 1 2 Nephritis 4 1 2 1 Puerperal and Post-Abortive Sepsis 1 1 Other maternal causes 1 1 Premature Birth 7 7 Congenital Malformations. Birth Injury. Infantile Disease 1 1 Suicide 5 1 3 1 Road Traffic Accidents 4 1 1 2 Other Violent Causes 10 1 2 2 5 All other Causes 22 1 1 1 6 13 Total 295 12 1 3 25 90 164 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Infectious Diseases. 348 cases were notified. These are tabulated in age groups (see Table No. 2, page 7). Comparative figures of infectious disease for the years 1937-1947 are also shown (see Table No. 3, page 8). Scabies. 43 cases were notified and 4 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. Other Diseases Coming to the Notice of the Department. German Measles 11 Chicken Pox 21 Mumps 3 Impetigo 2 Gastro-Enteritis 6 7 TABLE No. 2. Summary of Infectious Disease Notifications 1947. Age Groups. Diseases Under 1—2 2—3 3—4 4—5 5—10 10-16 15—25 25—15 45—65 65 & over Age U.K. Total M F M F M F M F M F M F M F M F M F M F M F M F Cerebro-spinal Fever - - - 1 - - - - - - - - - - 1 - - - - - - - - - 2 Diphtheria - - - - - - - - - 1 - - - - - - - 1 1 - - - - - 3 Erysipelas - - - - - - - - - - - - - - - - - 4 1 2 — 1 — — 8 Measles 4 5 16 11 8 3 12 8 16 13 26 18 2 3 — 3 — 9 — — — — — - 157 Ophthalmia Neonatorum 1 2 - - - - - - - - - - - - - - - - - - - - - - 3 Puerperal Fever - - - - - - - - - - - - - - - - - 1 - - - - - - 1 Puerperal Pyrexia - - - - - - - - - - - - - - - 2 - 3 - - - - - - 5 Pneumonia - - 1 - - 1 - - - - 1 - - - 1 — 1 1 5 4 — — — — 15 Poli encephalitis - - - - - - - - - - - - - - - - - - 1 - - - - — 1 Poliomyelitis - - - - - - - - - - 1 - - - - 3 — 1 - - - - - — 5 Scarlet Fever 2 1 — — 1 2 — 1 2 1 5 5 1 3 3 — 1 — .1 - — — — — 29 Scabies 1 — — 1 2 1 — — — 1 3 1 - 1 5 8 9 5 2 2 — 1 — - 43 Tuberculosis— Pulmonary - - - - - - - 1 - - 1 - - 1 3 7 5 8 10 3 8 — — — 47 Non-Pulmonary - - - - - - - - - - 1 - - - - 1 - 1 - - 1 - - - 4 Whooping Cough 2 1 2 4 1 2 2 — — 1 4 3 - - - - - 1 - - - - - - 23 Paratyphoid - - - 1 - - - - - - - - - - - - - - - - - - - - 1 Food Poisoning - - - 1 - - - - - - - - - - - - - - - - - - — — 1 8 TABLE No. 3. Comparative Figures of Infectious Disease for the years 1937 to 1947. Diseases. 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 Cerebro-spinal Fever 2 2 1 — 1 1 7 7 3 1 1 Diphtheria 3 12 11 5 17 17 14 7 19 49 76 Dysentery — 6 12 13 2 — — - — 1.0 10 Enteric Fever - 1 — 1 6 1 3 1 1 — — Erysipelas 8 4 3 8 3 7 3 12 13 15 10 Encephalitis Lethargica — - 1 — — — — — 2 — — Food Poisoning 1 — 1 - - - - - - - - Malaria — — — - 1 — — — 1 — 3 Measles 157 107 103 33 219 58 34 39 8 — — Ophthalmia Neonatorum 3 4 1 4 4 5 1 4 4 5 3 Puerperal Fever 1 — 2 2 2 2 1 - — — 4 Puerperal Pyrexia 5 5 4 1 3 7 2 3 3 2 2 Pneumonia (acute influenzal and primary) 15 17 6 14 22 20 18 14 28 21 34 Polioencephalitis 1 1 - - - - - - - - - Poliomyelitis 5 — 1 - - - - - - - - Scarlet Fever 29 24 14 20 30 23 16 20 56 59 38 Scabies* 43 106 125 99 54 - - - - - - Tuberculosis—Pulmonary 47 55 59 41 51 45 47 44 64 71 66 do. Non-Pulmonary 4 5 9 9 3 8 6 3 5 8 10 Whooping Cough 23 43 11 30 38 48 42 7 71 53 60 Paratyphoid Fever 1 - - - - - - - - - - *Notifiable as from 1st August, 1943. 9 Disinfection. During the year 112 rooms were disinfected after cases of infectious or other disease. Of these, 11 were rooms which had been occupied by tuberculous persons. In addition, 267 rooms of private dwellings were disinfested of vermin. At the Disinfecting Station 4,075 articles of bedding, clothing ,etc., 191 books and 65 toys were disinfected. The following table shows the total disinfection carried out in 1937-1947: — Comparative Table of Total Disinfections carried out 1937 to 1947. 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 Number of rooms 379 249 213 566 347 268 284 390 305 473 434 Number of articles (bedding, clothing, etc.) 4075 6105 6727 5525 10376 13414 4793 6644 5474 5287 5975 Number of books 191 130 254 209 329 57 9 61 60 137 130 Number of toys 65 53 68 15 61 17 8 13 75 38 125 Summary of 4,075 Articles disinfected: — Mattresses 385 Pillows 519 Pillow Cases 184 Bolsters 63 Bolster Cases 19 Blankets 559 Sheets 243 Clothing 2,103 Cleansing Station. The number of verminous persons cleansed at the Cleansing Station during the year was 113 men, 7 women and 3 children, including 66 men from Bruce House, Westminster. Comparative Table of Verminous Persons Cleansed 1937 to 1947. 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 Males 113 227 248 106 380 417 174 105 98 90 98 Females 7 23 10 14 3 2 4 7 1 24 4 Public Mortuary. During the year 341 bodies were received into the Public Mortuary, and of this number 40 were those of residents of the Borough. 339 post-mortem examinations were made. 10 Inquests. During the year 53 inquests were held on the bodies of Holborn residents. Vaccination. The number of cases dealt with by the Vaccination Officer during the year totalled 320. 165 were successfully vaccinated, and 28 notices of conscientious objection were received. MATERNITY AND CHILD WELFARE WORK. Very full use was made of the facilities at the Maternity and Child Welfare Centres in the Borough. During the year there were registered 338 live births and 10 still births, giving a total of 348. Home Visiting. The visits paid by Health Visitors were as follows:- First Visits. Revisits. Total.{/###] Expectant Mothers 189 252 441 Mothers after Confinement 10 20 30 Children under 1 year of age 377 1,715 2,092 Children 1—2 years of age 87 1,374 1,461 Child Life Protection 15 16 31 Infectious Diseases — — 224 Other visits — — 108 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 50 1552 396 1943 Dental 48 97 202 299 Tuesday Ante and Post-Natal 101 - 1402 1402 Wednesday Medical Consultation 53 1938 382 2320 Diphtheria Immunization 52 815 — 815 Whooping Cough Immunization 52 330 — 330 Thursday Physical Culture 48 366 364 730 Comprehensive Clinic 45 — 111 111 Child Guidance Clinic 80 179 — 179 Friday Medical Consultation 100 2399 426 2825 11 (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. Thrusday-Medical Consultation 51 977 15 992 The total number of attendances made by the Health Visitors at both Centres during the year was 805. During the year the sales of baby foods, milks, vitamins, drugs, etc., at the Centres had increased to such an extent that it will be necessary in the near future to appoint staff solely for this purpose. Ante-Natal Hygiene. Under the scheme for the voluntary notification of pregnancy, 33 notifications were received during 1947 as compared with 38 in 1946. 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. This is carried out by the Health Visitors at the Centres and in the homes. Use is made of leaflets, written in non-technical language, to supplement the oral instruction and demonstrations. Dental Treatment. The following is a summary of the work during 1947 at the Council's Dental Clinic, 10, John Street, W.C.1. open on Monday afternoon for nursing or expectant mothers, and children under 5 years of age. Women. Children. Total. Number of sessions held - - 48 Number of new patients 62 35 97 Total attendances 202 97 299 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 once, in the case of a retained placenta. 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. 15 patients attended for treatment during the year. 12 Child Life Protection. On the 1st January, 1947, there was one foster mother on the register. Two foster mothers were registered during the year. Child Guidance Clinic. The Child Guidance Clinic continues as an integral part of the Centre. Most of the cases were referred from the Clinic by the Medical Officer of the Maternity and Child Welfare Centres. Five cases were referred from the Council's Day Nursery. 80 sessions were held during the year. The total number of cases dealt with was 84. Of this number, there were 49 girls and 35 boys, of whom 7 were under 1 year of age. Approximately 47% of the cases dealt with were "only children," i.e., 40 out of the 84. The main complaints dealt with were as follows (this number is greater than 84 as each child is listed under its outstanding symptoms):— Feeding difficulties 18 Persistent undesirable habits 5 Excitable nervous difficulties 15 Sleeping difficulties 13 Jealousy 7 Specific fears and phobias 3 Difficult over toilet training 12 Slow in walking and talking 5 Crying and screaming 3 Stammer 2 Mother generally anxious 4 Unclassified 2 At the end of the year the number of cases completed was 54, and the number outstanding was 30. 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, 236 children were recorded as immunized, 194 under 5 years of age, and 42 between the ages of 5 and 15. Home and Domestic Help Service. During the year this service increased at a rapid rate. By means of publicity it had become well known to the inhabitants of the Borough, and consequent upon this, more use was made of it. It was, however, still found difficult to obtain the services of women to undertake this kind of work, although it was possible to give every applicant the help required. This Council's Home Helps attended 35 cases during the year, and the Domestic Helps attended 48 cases. 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 1947, 15 Home and Domestic Helps were employed. These services are filling a much felt need in the Borough and are fully appreciated. 13 Day Nursery. In the early part of the year, as the Council were notified that the voluntary Day Nursery carried on by Field Lane Institute was closing down, they decided to open a temporary one for the children displaced until such time as a permanent Day Nursery could be set up in the Borough. After much labour and with all speed, a temporary Day Nursery was opened on 30th June, utilising a part of the Youth and Social Centre at Clark's Buildings, St. Giles High Street. Approval was given by the Ministry of Health for the reception of 20 children between the ages of 2 and 5. All children from Field Lane Day Nursery were accommodated there. Many difficulties arose with regard to staffing; and it must be pointed out that this arrangement is of a temporary nature. The health of the children in the Nursery is very satisfactory and medical inspection is carried out weekly. No cases of infectious disease were notified of children attending. Convalescent Treatment. During the year, 3 toddlers were sent to Beaconsfield Convalescent Home for Children, and 1 was sent to the Hart's Leap Convalescent Home. In addition, 3 mothers and their babies were sent to Eastwood Lodge. This convalescent home was recently opened by the Field Lane Institute, who have very kindly offered the Council the use of the home for mothers and babies who require convalescent treatment. 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 £26 16s. lOd. 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 743 PUBLIC HEALTH (LONDON) ACT, 1936. NUMBER OF INSPECTIONS. Dwelling houses 763 Houses let in lodgings 456 Common Lodging Houses 2 Offices 92 Rag and Bone Shops 8 Smoke observations 31 Drainage work and testing 2,669 Other inspections 1,502 Re-inspections of above 2,759 HOUSING ACT, 1936. NUMBER OF INSPECTIONS. Houses 6 Underground rooms 29 Overcrowding visits 186 Re-inspections of above 11 14 FACTORIES ACT, 1937. NUMBER OF INSPECTIONS. Factories with mechanical power 131 Factories without mechanical power 84 Other inspections 22 Re-inspections of above 11 FOOD AND DRUGS ACT, 1938. NUMBER OF INSPECTIONS. Dairies and milk shops 56 Ice cream premises 91 Restaurants and kitchens 846 Bakehouses 45 Butchers' shops 130 Fish shops 30 Fried fish shops 39 Other food shops 512 Market streets 146 Licensed premises 108 Re-inspections of above 975 MISCELLANEOUS INSPECTIONS. Pharmacy and Poisons Act11 Rats and Mice Act, 1919 515 Shops Act 39 Other inspections5 Re-inspections of above 54 Merchandise Marks Act 3 VISITS, Etc., Infectious Disease 213 Scabies 25 Aged and infirm persons 6 Police Courts 7 Various 1,963 Verminous persons 1 Total 14,582 NOTICES SERVED. PUBLIC HEALTH (LONDON) ACT, 1936. Intimation Notices. Dwelling Houses 179 Houses let in lodgings 192 Offices 15 Food premises 14 Shops 4 Bombed sites 3 Statutory Notices 86 FACTORIES ACT, 1937. Power Factories 23 Non-power Factories 11 FOOD AND DRUGS ACT, 1938. Food Premises 92 SHOPS ACT, 1934 1 RATS AND MICE (DESTRUCTION) ACT, 1919 In addition to the above, the Medical Officer of Health was asked to give observations upon 133 premises where applications had been received for building licences during the year. 77 orange forms in respect of families overcrowded in the Borough were submitted to the London County Council for rehousing, 15 and 14 blue forms in respect of families recommended for preferential treatment owing to the health of the inhabitants. In addition, 2 were recommended for rehousing on "general health grounds." 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, 216 were of milk. Three samples were found to be adulterated, viz.:— Milk.—8.2% added water. Milk.—8.0% added water. Gin.—36.02 degrees under proof. In connection with these, two vendors were prosecuted. The results of the prosecutions will be found in the table of legal proceedings. In the case of the sample of gin, 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. 84 samples of milk were taken during the year, 39 of milk supplied to schools in the Borough. 17 were found to be unsatisfactory, of which 4 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 samples letters of warning were sent to the vendors. Monthly Variation of Chemical Composition of Milk, 1947. Month. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 17 12.28 8.76 3.52 February 17 12.44 8.84 3.60 March 18 12.39 8.87 3.52 April 17 12.32 8.84 3.48 May 19 12.26 8.93 3.33 June 18 12.39 9.09 3.30 July 19 12.28 8.82 3.46 August 19 11.89 8.56 3.33 September 19 12.32 8.79 3.53 October 19 12.63 8.95 3.68 November 16 12.69 8.91 3.78 December 18 12.48 8.80 3.68 Whole year 216 12.36 8.84 3.52 Legal minimum — 11.50 8.50 3.00 16 These figures approximate closely to those of the previous eight 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 1946 214 12.33 3.53 8.81 1947 216 12.36 3.52 8.84 Ice Cream. Thirty-seven premises were on the register at the end of the year for the manufacture, storage or sale of ice cream. Of these, 7 were for manufacture, storage and sale; 19 for storage and sale; 1 for storage only; and 10 for sale only. Inspection and Supervision of Food. Milk: Fifty-eight premises were on the register at the end of the year (16 dairies, 12 restaurants and 30 general shops). These premises were all inspected as occasion required during the year. In addition, 23 retailers are 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:- Dealers' Licences. Supplementary Licences. To sell pasteurized milk 7 5 To sell tuberculin tested milk 3 3 Public Health (Meat) Regulations, 1924: 276 inspections of butchers' shops and market stalls were made during the year. Inspection of Other Premises where Food is Prepared or Offered for Sale: 2,702 inspections of such premises were made during the year. 92 notices under the Food and Drugs Act, 1938, were served requiring defects to be remedied. Unsound Food: 6 tons 17 cwt. 1 qr. 21 lbs. of tinned meat, fish and other foods were surrendered and destroyed or disposed of otherwise. 17 Legal Proceedings. Offence. Result. Selling milk containing 8.2% added water. Dismissed under Probation of Offenders Act on payment of £3 3s. 0d. costs. Selling milk containing 8.0% added water. Dismissed under Probation of Offenders Act on payment of £3 3s. 0d. costs. Failing to provide effective lighting for the men's convenience, contrary to Section 7 of the Factories Act, 1937. Fined £5 and £3 3s. costs. Failing to comply with Statutory Notice in respect of defective W.C. pans and defective flooring, contrary to Section 82 of Public Health (London) Act, 1936. Summons withdrawn on payment of £3 3s. costs. Failing to comply with Statutory Notice in respect of damp walls, ceilings, etc., contrary to Section 82 of Public Health (London) Act, 1936. Order to abate nuisance within 28 days and to pay £3 3s. costs. Water. 1. The water supply in this area has been satisfactory both in quantity and quality. No complaints have been 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 805. Of these, 186 were new patients. (See table below). The number of contacts who attended the dispensary for investigation was 58. New Patients during 1947. M. F. Total Pulmonary 24 17 41 Non-Pulmonary 2 1 3 Non-Tuberculosis 38 70 108 Doubtful 21 13 34 85 101 186 18 Health Visitor. The total number of visits made by the Tuberculosis Health Visitor was 535. Of these, 68 were first visits. Number of Cases. The following tables give the number of new cases of tuberculosis notified, and deaths during 1947 of persons notified as suffering from the disease:- Age periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non-pulmonary M F M F M F M F 0 — — - — — — — — 1 1 - - - - - - 5 1 - 1 - - - - - 10 - 1 - - - - - - 15 1 3 — 1 — — — — 20 2 4 — — — — — — 25 4 4 — 1 2 3 — — 35 1 4 — — — 2 — - 45 5 3 — — 5 — — - 55 5 - — — 2 1 — 1 65 8 - 1 — 5 — — — 27 20 2 2 14 6 — 1 The number of cases on the register at the end of the year was as follows: M. F. Pulmonary 82 69 Non-Pulmonary 10 12 Total 92 81 During the year 33 notified cases of tuberculosis were removed from the register for various reasons. Patients Admitted and Discharged from Institutions. During the year 56 patients were admitted to hospital and 29 to sanatoria. 63 patients were discharged from institutions. Tuberculosis Care Committee. The Committee met four times during the year—in January, April, July and October. 417 cases were reported upon, of which 65 were new cases. The Secretary's interviews with patients, or relatives, including visits, totalled 868. 19 Allowances for Tuberculous Patients Undergoing Treatment. During the year 40 patients received allowances. 27 new applications were received, one of which is still under review, and 4 patients found to be not eligible for grants. The allowances were made up as follows:— Maintenance allowances 35 Special allowances 11 Discretionary allowances 16 The amount disbursed during the year was £1,374 18s. 9d. The number of current cases is 13. Artificial Pneumothorax Treatment. Twenty-one patients received treatment. The total cost of £224 3s. 6d. was borne by the Council. Extra Nourishment. Forty-five patients were granted extra nourishment. The total cost of £384 0s. 6d. was borne by the Council. Dental Treatment. One patient received dental treatment and was supplied with dentures. The total cost of £7 15s. Od. was borne by the Council. "Light" Treatment. One patient received Finsen light treatment. The total cost of 15s. was borne by the Council. Bedding. Four patients were provided with bedding. Housing. During the year 6 families were rehoused by the Borough Council and 1 family 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. Pensions. Five of our ex-Service patients were granted pensions.