AC 4342 HOL 46 The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health, For the Year 1948. J. A. STRUTHERS, M.D. M.RC.P., D.P.H. London: Printed by DIPROSE, BATEMAN & CO., 5& 6, Creed Lane, London, E.C.4. 1949. The Metropolitan Borough of Holborn. ABRIDGED REPORT OF THE Medical Officer of Health, For the Year 1948. J. A. STRUTHERS, M.D., M.R.C.P., D.P.H. London: Printed by DIPROSE, BATEMAN & CO., 5 & 6, Creed Lane, London, E. C.4, 1949. To the Mayor, Aldermen and Councillors, Metropolitan Borough of Holborn. This report on the health of the inhabitants of the Borough in 1948 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 14.46 per 1,000 of the population shows a further increase on last year and on the pre-war years. This is encouraging in view of the fact that the birth rate for England and Wales shows a decline on the two previous years. The death rate of 11.34 per 1,000 of the population is, with the exception of 1938, the lowest recorded in the history of the Borough. The infant mortality rate of 19.39 was not only the lowest in the history of the Borough, but was considerably better than the previous lowest figure of 35.5 in 1947. On the 5th July, 1948, the National Health Service Act came into operation, and the control of the Borough's Maternity and Child Welfare Services passed to the London County Council. Part of the Tuberculosis Services, including the Chest Clinic, passed to the Regional Hospital Board, and part, including the Tuberculosis Care Committee work, passed to the London County Council. The tuberculosis notification registers, measures for the prevention of tuberculosis, and supervision of the environment of tuberculous persons remain with the Borough Council. Despite some improvement in supplies of building materials and some relaxation in connection with the issue of building licences, the work of sanitary improvement and repair during the year remained handicapped by various restrictions, so that the standard achieved has again not been as high as one would wish. Under the National Assistance Act, 1948, the Borough Council has now taken over from the London County Council responsibility for the burial of 4 dead persons where it appears that no suitable arrangements for the disposal of the bodies are being made. Where such persons die in hospital, however, arrangements for burial may be made by the Regional Hospital Board, and where such persons die in welfare homes (previously known as Public Assistance Institutions) responsibility for burial remains with the London County Council. It gives me pleasure to express my appreciation of the consideration and support shown me by the Chairman 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 1948. Resident Population. Estimated to middle of 1948 (as supplied by the RegistrarGeneral) 24,960 Live Births. Total. M. F. Legitimate 323 176 147 Illegitimate 38 22 16 Birth rate per 1,000 estimated population 14.46 Still births 8 5 3 Rate per 1,000 (live and still births) 21.68 Marriages. During the year 415 marriages were solemnised in the Borough. Rate per 1,000 estimated population 16.63 Deaths. Total. M. F. 283 170 113 Death rate per 1,000 estimated population 11.34 Classification of Deaths: The causes of death are tabulated (see Table No. 1, page 6). Deaths from Puerperal Causes. During 1948 there were no deaths from puerperal or other maternal causes. Death Rate of Infants Under One Year of Age. All infants per 1,000 live births 19.39 Legitimate infants per 1,000 live legitimate births 18.58 Illegitimate infants per 1,000 live illegitmate births 26.32 During the year there were 7 deaths of infants under one year of age, of whom 1 was illegitimate. The causes of death were as follows:— Diarrhœa 1 Whooping Cough 1 Premature birth 3 Congenital malformation, birth injury and infantile diseases 2 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. 1 Under 1 year. 1 and under 5 years. 5 and under 15year8. 15 and under 45 years. 45 and under 65 years. 66 and upwards Cerebro-Spinal Fever 1 1 Whooping Cough 1 1 Tuberculosis of Respiratory System 12 4 5 3 Other forms of Tuberculosis 1 1 Syphilitic Disease 5 2 1 2 Cancer of Uterus 1 1 Cancer of Stomach and Duodenum 10 7 3 Cancer of Breast 7 1 5 1 Cancer of all Other Sites 48 1 17 30 Intra-Cranial Vascular Disease 29 1 7 21 Heart Disease 65 6 20 39 Other Diseases of the Circulatory System 11 2 9 Bronchitis 17 5 12 Pneumonia 11 1 1 9 Other Respiratory Diseases 5 2 1 2 Ulceration of Stomach or Duodenum 1 1 Diarrhoea (under 2) 1 1 Appendicitis 3 1 1 1 Other Digestive Diseases 3 1 2 Nephritis 6 2 2 2 Premature Birth 3 3 Congenital Malformations. Birth Injury. Infantile Disease 3 2 1 Suicide 4 3 1 Road Traffic Accidents 2 2 Other Violent Causes 9 1 2 3 3 All other Causes 24 4 9 11 Total 283 7 3 1 27 91 154 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Infectious Diseases. 268 cases were notified. These are tabulated in age groups (see Table No. 2, page 7). Comparative figures of infectious disease for the years 1938-1948 are also shown (see Table No. 3, page 8). Scabies. 16 cases were notified and 5 cases came to the knowledge of the Department other than by formal notification. Other Diseases Coming to the Notice of the Department. German Measles 1 Chicken Pox 43 Mumps 68 Impetigo 1 Gastro-Enteritis 4 Septic Abortion 1 7 TABLE No 2. Summary of Infectious Disease Notifications 1948. Age Groups. Disease. Under 1 1—2 2—3 3—4 4—5 5—10 10-15 15—25 25—45 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 Diphtheria - - 1 - 1 - - - - - - - - - - - - - - - - - - - 2 Dysentery - - 1 - - - 1 - - - 1 - - - - - - 1 - - - - - - 4 Enteric Fever - - - - - - - - - - - - - - 1 - - - - - - - - - 1 Erysipelas - - - - - - - - - - - - - - - - 2 — 1 1 1 1 — — 6 Food Poisoning — 1 - - - - - - - 1 - - - - - - - - - - - - - - 2 Measles 4 1 3 6 8 10 7 7 4 8 11 12 1 - — 4 1 — — — — — — — 87 Ophthalmia Neonatorum 3 - - - - - - - - - - - - - - - - - - - - - - - 3 *Puerperal Fever - - - - - - - - - - - - - - - - - 1 - - - - - - 1 Puerperal Pyrexia - - - - - - - - - - - - - - - 1 - 1 - - - - - — 2 Pneumonia - - 1 - - - 2 - - - - - - - - - — — 3 1 1 1 — — 9 Poliomyelitis - - - - - - - 1 - - - - - - - - - - - - - - - — 1 Scarlet Fever - - - - - 2 1 1 — 1 5 — 1 — — — 2 — — — — — — — 13 Scabies 1 — — — 1 1 — — — 2 1 — 1 2 1 1 2 — 1 1 1 — — 16 Tuberculosis— Pulmonary — 1 - - - - - - - - - - - - 1 1 13 8 9 2 3 — — — 39 Non-Pulmonary - - - - - - - - - - - - - - - - - 4 - - - - - - 8 Whooping Cough 8 5 9 5 4 7 5 4 3 7 11 6 - - - - - - - - - - - - 74 * Ceased to be notifiable as from 30th July, 1948. 8 TABLE No. 3. Comparative Figures of Infectious Disease for the years 1938 to 1948. Disease. 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 Cerebro-spinal fever 2 2 1 - 1 1 7 7 3 1 Diphtheria 2 3 12 11 5 17 17 14 7 19 49 Dysentery 4 — 6 12 13 2 — — — — 10 Enteric Fever 1 1 1 — 1 6 1 3 1 1 — Erysipelas 6 8 4 3 8 3 7 3 12 13 15 Encephalitis Lethargica - - - - - - - - - 2 — Food Poisoning 2 1 — 1 - - - - - - - Malaria — — — — — 1 — — — 1 — Measles 87 157 107 103 33 219 58 34 39 8 - Ophthalmia Neonatorum 3 3 4 1 4 4 5 1 4 4 5 Puerperal Fever 1 1 — 2 2 2 2 1 — — — Puerperal Pyrexia 2 5 5 4 1 3 7 2 3 3 2 Pneumonia (acute influenzal and primary) 9 15 17 6 14 22 20 18 14 28 21 Polioencephalitis — 1 1 - - - - - - - - Poliomyelitis 1 5 — 1 - - - - - - - Scarlet Fever 13 29 24 14 20 30 23 16 20 56 59 Scabies 16 43 106 125 99 54 - - - - - Tuberculosis—Pulmonary 39 47 55 59 41 51 45 47 44 64 71 do Non-Pulmonary 8 4 5 9 9 3 8 6 3 5 8 Whooping Cough 74 23 43 11 30 38 48 42 7 71 53 *Ceased to be notifiable as from 30th July, 1948. 9 Disinfection. During the year 118 rooms were disinfected after cases of infectious or other disease. Of these, 12 were rooms which had been occupied by tuberculous persons. In addition, 213 rooms of private dwellings were disinfested of vermin. At the Disinfecting Station 4,312 articles of bedding, clothing, etc., 246 books and 65 toys were disinfected. The following table shows the total disinfection carried out in 1938-1948:— Comparative Table of Total Disinfections carried out 1938 to 1948. 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 Number of rooms 331 379 249 213 566 347 268 284 390 305 473 Number of articles (bedding, clothing, etc.) 4312 4075 6105 6727 5525 10376 13414 4793 6644 5474 5287 Number of books 246 191 130 254 209 329 57 9 61 60 137 Number of toys 65 65 53 68 15 61 17 8 13 75 38 Summary of 4,312 Articles disinfected:— Mattresses 532 Pillows 799 Pillow Cases 346 Bolsters 84 Bolster Cases 25 Blankets 923 Sheets 389 Clothing 1,214 Cleansing Station. The number of verminous persons cleansed at the Cleansing Station during the year was 129 men and 6 women, including 98 men from Bruce House, Westminster. Comparative Table of Verminous Persons Cleansed 1938 to 1948. 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 Males 129 113 227 248 106 380 417 174 105 98 90 Females 6 7 23 10 14 3 2 4 7 1 24 Public Mortuary. During the year 340 bodies were received into the Public Mortuary, and of this number 38 were those of residents of the Borough. 330 post-mortem examinations were made. Inquests. During the year 18 inquests were held on the bodies of Holborn residents. 10 MATERNITY AND CHILD WELFARE WORK. (Up to 4th July, 1948). Very full use was made of the facilities at the Maternity and Child Welfare Centres in the Borough. Home Visiting. The visits paid by Health Visitors were as follows:— First Visits. Revisits. Total. Expectant Mothers 142 122 264 Mothers after Confinement 11 9 20 Children under 1 year of age 234 767 1,001 Children 1—5 years of age 50 761 811 Child Life Protection 5 15 20 Infectious Diseases 72 66 138 Other visits 1 34 35 Attendances at Centres. (1) 10, John Street. The following is an analysis of attendance at this Centre:— Clinic. No. of Sessions. Attendances. Medical— Under 1 year 96 2,068 1—5 years 1,326 Mothers 571 Ante-Natal 52 659 Post-Natal 56 Child Guidance 54 96 Immunisation— Under 5 years 26 793 5—15 years 28 Comprehensive 26 124 Dental 24 177 Minor Ailments 24 101 Physical Culture 26 236 (2) St. Giles' Centre, Short's Gardens. The attendances at this Branch Centre during the half-year were as follows:— No. of Sessions. Total Attendances. Children. Mothers. Total. Thursday—Medical Consultation 26 593 93 686 11 The total number of attendances made by the Health Visitors at both Centres during the half-year was 413. The sales of baby foods, milks, vitamins, drugs, etc., at the Centres had increased to such an extent that it was found necessary to appoint staff solely for this purpose. Ante-Natal Hygiene. Under the scheme for the voluntary notification of pregnancy, 28 notifications were received during the half-year. 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 for the half-year 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 — — 24 Number of new patients 27 18 45 Total attendances 124 53 177 Emergency Obstetric Unit. A service was 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 was required. Foot Clinic. The Council had an arrangement with a Chiropodist for foot treatment for expectant and nursing mothers, and mothers of children under 5 years of age, who were referred for such treatment by the Medical Officers of the Infant Welfare Centres. 15 patients attended for treatment during the half-year. Child Life Protection. On the 1st January, 1948, there were three foster mothers on the register. Three foster mothers were registered during the half-year. 12 Child Guidance Clinic. The Child Guidance Clinic continued as an integral part of the Centre. Most of the cases were referred from the Clinic by the Medical Officers of the Maternity and Child Welfare Centres. During the period 1st Januaryy to 4th July, 1948, 50 sessions were held. The total number of cases dealt with was 52. Of this number, there were 22 girls and 30 boys, of whom 13 were under 1 year of age. The main complaints dealt with were as follows (this number is greater than 52 as each child is listed under its outstanding symptoms):— Feeding difficulties 5 Persistent undesirable habits 15 Excitable nervous difficulties 11 Sleeping difficulties 7 Jealousy 3 Specific fears and phobias 3 Difficult over toilet training 7 Stammer 3 Mother generally anxious 1 On 4th July, 1948, the number of cases completed was 16, and the number outstanding was 36. Diphtheria Immunization. The immunization of children against diphtheria is carried out at the Welfare Centre, and the Medical Officer attends at the Kingsway Creche for the same purpose. During the half-year, 103 children were recorded as immunized. Home and Domestic Help Service. This Council's Home Helps attended 14 cases during the half-year, and the Domestic Helps attended 71 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 4th July, 1948, 8 Home and Domestic Helps were employed. These services are filling a much felt need.in the Borough and are fully appreciated. Day Nursery. The Day Nursery at Clark's Buildings, opened in 1947 as a temporary nursery for children displaced by the closing down of the Nursery at the Field Lane Institution, continued to function satisfactorily, but was not large enough to cope with the demand for day nursery accommodation. Efforts were made during the half-year to obtain other premises suitable for a permanent nursery, but with little success. It proved to be impossible to make any such airangement. Convalescent Treatment. During the half-year two mothers, one with her baby, were sent to convalescent homes. 13 Insulin. Up to the 4th July, 1948, this was supplied free of charge, in accordance with Ministry of Health Circular 2734, in two cases at a cost to the Council of £10 18s. 3d. 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 771 Public Health (London) Act, 1936. Number of Inspections. Dwelling Houses 588 Houses let in lodgings 351 Common Lodging Houses 3 Offices 98 Rag and Bone Shops 14 Smoke observations 74 Drainage work and testing 2,702 Other inspections 1,428 Re-inspections of above 3,252 Housing Act, 1936. Number of Inspections. Houses 9 Underground rooms 35 Overcrowding visits 162 Re-inspections of above 2 Factories Act, 1937. Number of Inspections. Factories with mechanical power 134 Factories without mechanical power 42 Other inspections 7 Re-inspections of above 232 Food and Drugs Act, 1938. Number of Inspections. Dairies and milk shops 79 Ice cream premises 70 Restaurants and kitchens 1,122 Bakehouses 74 Butchers' shops 193 Fish shops 47 Fried fish shops 61 Other food shops 519 Market streets 140 Licensed premises 87 Re-inspections of above 992 Miscellaneous Inspections. Pharmacy and Poisons Act 11 Rats and Mice (Destruction) Act, 1919 340 Shops Act 27 Re-inspections of above 39 14 Visits, Etc., re Infectious Disease 211 Scabies 19 Aged and infirm persons 14 Police Courts 6 Various 1,777 Total 14,961 Notices Served. Public Health (London) Act, 1936. Intimation Notices. Dwelling Houses 131 Houses let in lodgings 164 Offices 21 Food premises 45 Shops 11 Factories 8 Statutory Notices 85 Notices under Section 106 3 Housing Act, 1936. Lodging Houses 38 Factories Act, 1937. Power Factories 13 Non-power Factories 7 Food and Drugs Act, 1938. Food Premises 99 Shops Act, 1934 2 Rats and Mice (Destruction) Act, 1919 7 In addition to the above, the Medical Officer of Health was asked to give observations upon 68 premises where applications had been received for building licences during the year. 61 orange forms in respect of families overcrowded in the Borough were submitted to the London County Council for rehousing, and 13 blue forms in respect of families recommended for preferential treatment owing to the health of the inhabitants. In addition, 5 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, 214 were of milk. Two samples were found to be adulterated, viz.:— Milk. —6.9% added water. Glycerine. —Glycerine 82% and Castor Oil 18%. In each case a cautionary letter was sent on the instruction of the Public Health Committee. 15 Bacteriological Examination of Milk. 89 samples of milk were taken during the year, 64 of milk supplied to schools in the Borough. 2 samples were found to be unsatisfactory, both of which were supplied by dairymen whose premises were registered outside the Borough. The Medical Officers of Health of the districts from which the milk was obtained were notified, in order that investigations might be made. Monthly Variation of Chemical Composition of Milk, 1948. Month. Number of Samples examined. Total Solids. Per cent. average. Solids Non-fat. Per cent. average. Fat. Per cent. average. January 17 12.37 8.77 3.60 February 20 12.22 8.72 3.50 March 16 12.07 8.68 3.39 April 16 11.93 8.67 3.26 May 18 12.00 8.74 3.26 June 18 12.03 8.70 3.33 July 18 12.17 8.71 3.46 August 19 12.39 8.77 3.62 September 19 12.50 8.87 3.65 October 18 12.74 9.01 3.73 November 18 12.62 8.88 3.74 December 17 12.53 8.85 3.68 Whole year 214 12.29 8.78 3.51 Legal minimum — 11.50 8.50 3.00 These figures approximate closely to those of the previous nine 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 1948 214 12.29 3.51 8.78 16 Ice Cream. Forty premises were on the register at the end of the year for the manufacture, storage or sale of ice cream. Of these, 5 were for manufacture, storage and sale; 23 for storage and sale; 1 for storage only; and 11 for sale only. Ice Cream—Bacteriological Examinations. During the year 281 samples of ice cream were subjected to the Methylene blue test, and the results in the grading suggested by the Ministry of Health were as follows:— Grade 1.—45. Grade 2.—95. Grade 3.—54. Grade 4.—63. 24 were coloured ices which did not respond to the test. The samples were also examined for the presence of B. Coli, with the following results:— Absent in 1 c.c.—83. Present in 1 c.c.—64. Present in 0.1 c.c.—43. Present in 0.01 c.c.—36. Present in 0.001 c.c.—43. Present in 0.0001 c.c.—12. Inspection and Supervision of Food. Milk: Fifty-seven premises were on the register at the end of the year (16 dairies, 12 restaurants and 29 general shops). These premises were all inspected as occasion required during the year. In addition, 24 retailers are registered for itinerant sale of milk from premises in the areas of other local authorities. Milk (Special Designations) Order: The number of licences granted during the year were:— Dealers' Licences. Supplementary Licences. To sell pasteurized milk 9 6 To sell tuberculin tested milk 5 3 Public Health (Meat) Regulations, 1924: 333 inspections of butchers' shops and market stalls were made during the year. Inspection of Other Premises where Food is Prepared or Offered for Sale: 2,651 inspections of such premises were made during the year. 99 notices under the Food and Drugs Act, 1938, were served requiring defects to be remedied. 17 Unsound Food. During the year 1948 the undermentioned unsound food was surrendered and destroyed or disposed of otherwise. Commodity. Tons. Weight. Lbs. Cwt. Qtrs. DAIRY PRODUCTS. Butter — — — 8 Cheese — — 2 20 Milk (Evaporated, Unsweetened) (tinned) -- 3 2 24 Milk (Condensed, Sweetened) (tinned) — — 1 2 Milk (Skimmed) (8 pints) — — — 12 Ice Cream (5 gallons) - - 2 4 FISH. Bloaters - — l - Bream Fillet - — 5 — Cod Fillet - 2 3 — Codfish - — — 4 Cod Liver Roe - — 1 24 Crab (tinned) — — — 1 Dogfish - 2 - -- Dover Fillet - 2 1 - Fish Roll - 18 — - Golden Cutlet - — — 21 Haddock - —- — 14 Hake (tinned) - - — 7 Kippers - 2 1 4 Mackerel - - 1 14 Megrims - — 2 14 Mussels (tinned) - -— 11 5 Pilchards (tinned) - — — 10 Salmon (tinned) - — — 21 Sardines (tinned) - — — 7 Skate - 2 2 14 Soft Herring Roe - — — 12 Whiting - — 3 — Witches - — 3 — FRUIT. Apples - — — 2 Apples (tinned) - — 2 16 Apricots (tinned) - — — 13 Cherries - — — 5 Figs - — — 12 Fruit Cocktail (tinned) - — — 3 Grapefruit - — — 4 Grapefruit (tinned) - 1 1 10 Grapes - 3 2 8 Grapes (tinned) - — 1 20 Lemons - — 1 3 Oranges - 9 2 5 Peaches (tinned) - — 8 18 Pears (tinned) - 1 1 24 Pimentos (tinned) - — — 6 Pineapples (tinned) - 1 — 16 Plums (tinned) - — 2 4 Prunes - — 1 13 Rhubarb - — — 15 Tomatoes (tinned) - 9 1 15 Commodity. Weight. Tons. Cwt. Otrs. Lbs. MEAT. Bacon 1 3 1 23 Brisket - - - 22 Calf Kidneys - - 1 16 Canned Corned Mutton - 1 - 8 Chicken - - 3 24 Corned Beef - 6 3 7 Duck - - 4 4 Galantine - - - 3 Ham - - 3 5 Jellied Veal (tinned) - - - 4 Luncheon Meat (tinned) - - 2 13 Minced Beef Loaf (tinned) - - - 8 Pork (tinned) - - - 17 Rabbit (tinned) - - - 20 Sausages - 1 1 26 Steak and Kidney (tinned) - - - 3 Stewed Steak (tinned) - - - 16 Tongue (tinned) - - - 24 Veal and Ham Loaf (tinned) - - - 27 Veal Loaf (tinned) - - - 19 Veal Pork and Beef Loaf (tinned) - - - 2 VEGETABLES. Beans (tinned) - - 1 - Beetroot (tinned) - - - 22 Carrots (tinned) - - 1 8 Onions - - - 2 Peas (tinned) - - 2 2 Pickled Onions (jars) - - - 4 Potatoes - 4 1 4 Red Cabbage - - - 8 Swedes 1 10 - - Turnips - - - 3 OTHER FOOD. Apple Jelly (tinned) - - - 3 Barley - - 1 20 Biscuits - - - 6 Bread - 1 2 2 Cake Mixture - - - 2 Cereals - 5 4 - Cocoa (tinned) - - - 10 Coffee (tinned) - - - 9 Confectionery - - - 21 Crab Spread - - - 1 Dried Egg - - - 2 Flour - - 1 18 Fruit Pudding - - - 1 Irish Stew (tinned) - - - 3 Jam (tinned) - - 4 6 Marmalade (tinned) - - - 26 Meal - - - 2 Meat Soup (tinned) - - - 20 Meat and Vegetable Ration (tinned) - - - 3 Nuts - 8 1 - Oats - - - 2 Orange Juice (tinned) - - - 7 Oxo Cubes - - - 2 Pineapple Juice (tinned) - - - 4 Soup - - - 17 Spaghetti - - - 19 Sugar - - 1 16 Syrup (tinned) - - 1 7 Tea - - 1 24 Tomato Juice (tinned) - - 1 27 TOTAL WEIGHT 8 9 1 13 18 19 Rodent Control. Block Control Scheme No. 1—Covent Garden Area. This scheme, approved by the Ministry of Food, was started in February, 1947, and was completed in March, 1948. It covered the whole of that part of the Borough which lies south of New Oxford Street and High Holborn and west of Kingsway, and was carried out in conjunction with the Westminster City Council, who dealt with part of their area adjoining the Borough. The results exceeded expectations. The work was carried out in three parts as follows:— (1) The Survey. This included the circularising of business firms; the inspection of all premises; pre-baiting in any cases of doubt; and also included investigation of bombed sites, derelict premises and empty buildings. The following figures show approximately the work carried out:— Total number of buildings 780 No. of business premises 980 } included in the No. of dwellings 1,100 } 780 buildings. No. of bombed sites and derelict buildings 70 Where information was obtained that service companies in rat repression work had been or were engaged by the firms, contact was made, and the Council's officers worked in close collaboration with representatives of the firms. (2) Treatment. The next step was the treatment of all premises found to be infested. The degree of infestation varied considerably. The following figures show the number of premises infested, the bombed sites being fully treated in every case:— Business premises 139 Dwellings 60 Bombed sites and derelict buildings 70 The numbers of premises re-treated were as follows:— Business premises 21 Dwellings 7 Bombed sites and derelict buildings 2 At the same time as treatment was carried out advice was given, and firms and property owners encouraged to carry out rat-proofing of premises. (3) Re-survey. This, the third stage, was completed in March, 1948, and comprised a survey of all premises previously treated. The average time since treatment was 20 approximately 6 months and the following degree of infestation or re-infestation was found:— Business premises 10 Dwellings Nil Bombed sites and derelict buildings 1 Analysis of the 10 business premises re-infested shows that of 6 firms who were advised to carry out rat-proofing, 5 had failed to do so and the sixth had carried out this work unsatisfactorily. In the remaining 4 cases it has so far proved impracticable to rat-proof the premises. The number of visits to infested premises were:— Treatment visits 1,745 Post-bait visits 618 Poison check visits 309 The number of bodies recovered and the estimated kill was:— Rattus Rattus. Rattus Norvegicus. (Ship rat). (Common rat). Bodies recovered 503 153 Estimated kill 2,100 600 The estimated kill is a conservative figure based, in accordance with the Ministry of Food formula, on the amount of poison known to have been taken. An indication of the co-operation received from occupiers is indicated by the fact that the service of notices under the Rats and Mice (Destruction) Act was necessary in only 3 cases. Block Control Scheme No. 2. This scheme, which was started in March, 1948, has been approved by the Ministry of Agriculture and Fisheries. The scheme covers that part of the Borough lying North of High Holborn and New Oxford Street, and West of Southampton Row and Woburn Place. Particulars of work carried out during the year under this scheme are as follows:— Blocks surveyed 41 Blocks treated 25 Business premises treated 88 Dwelling houses treated 73 Bombed sites and derelict buildings treated 22 Treatment visits 771 Other visits 1,444 Estimated kill (rattus rattus) 843 Bodies recovered (rattus rattus) 223 Estimated kill (rattus norvegicus) 85 Bodies recovered (rattus norvegicus) 25 Apart from these two schemes, complaints of rat or mice infestation were received and investigated. There was a considerable increase in the 21 number of such complaints received during 1948, no doubt due to the houseto-house inspections carried out in connection with the two schemes and also to the wide publicity given to the question of rat repression. The following figures show the work carried out during the year arising from the complaints received:— Business premises. Dwelling houses. No. of premises visited 201 272 No. of premises treated 198 272 No. of premises revisited 948 1,111 Estimated kill 974 Bodies recovered (rattus rattus) 388 Bodies recovered (rattus norvegicus) 5 Mice 105 Baiting of Sewers. In connection with the Block Control schemes, rodent repression work was also carried out in the Council's sewers, and the Borough Engineer and Surveyor has kindly supplied me with the undermentioned information of the treatment carried out during the year. The normal procedure is for two treatments to be carried out; treatment No. 1 being the use of sausage rusk plus 2½% zinc phosphide, followed after a month's interval by treatment No. 2 with bread mash plus 10% arsenious oxide. It will be seen that the double treatment carries over at the beginning and end of the year. DETAILS. DATE OF TREATMENT. 12th to 21st January, 1948. 7th to 16th June, 1948. 5th to 14th July, 1948. 6th to 15th December, 1948. Treatment No. 2 Treatment No. 1 Treatment No. 2 Treatment No. 1 1. Total numher of manholes in foul and connected systems 313 313 313 313 2. Bait base and poison used Bread mash and arsenious oxide Sausage rusk and zinc phosphide Bread mash and arsenious oxide Sausage rusk and zinc Phosphide 3. No. of manholes baited 291 290 290 269 4, No. of manholes showing prebait takes 242 249 235 241 5. No. of manholes shewing showing complete prebait take (on one or both days) 180 153 133 188 6. Schemes of baiting used Two preba its-one poison bait 7. No. of bodies found 175 136 126 28 22 Legal Proceedings. Offence. Failing to comply with Statutory notice in respect of dampness from defective roof contrary to Section 82 of Public Health (London) Act, 1936. Failing to comply with Statutory Notice in respect of nuisances contrary to Section 82 of Public Health (London) Act, 1936. Failing to comply with Statutory Notice in respect of nuisances contrary to Section 82 of Public Health (London) Act, 1936. Failing to comply with Statutory Notice in respect of nuisances contrary to Section 82 of Public Health (London) Act, 1936. Selling one loaf of bread which was intended for but unfit for human consumption in that it contained a whole unsmoked cigarette contrary to Section 9 of the Food and Drugs Act, 1938. Result. Summons withdrawn on payment of £3 3s. 0d. costs. Summons withdrawn. Order to abate nuisances and pay £1 1s. Od. costs. Order to abate nuisances in two months and pay £1 1s. Od. costs. Dismissed under Probation of Offenders Act on payment of £2 2s. Od. 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 1,011. Of these, 215 were new patients. (See table below). The number of contacts who attended the dispensary for investigation was 165. New Patients during 1948. M. F. Total. Pulmonary 28 13 41 Non-Pulmonary 2 7 9 Non-Tuberculosis 32 64 96 Doubtful 27 42 69 89 126 215 23 Health Visitor. The total number of visits made by the Tuberculosis Health Visitor was 409. Of these, 62 were first visits. Number of Cases. The following tables give the number of new cases of tuberculosis notified, and deaths during 1948 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 1 — — - — 10 - - - - - - - - 15 — - 1 - - - - 20 1 1 — 1 1 1 — — 25 7 6 — 2 1 1 — — 35 6 2 — 2 1 — — - 45 4 1 — — 1 — — — 55 5 1 — • — 2 — — — 65 3 — — — 4 — — — 26 13 1 7 10 2 — — The number of cases on the register at the end of the year was as follows: M. F. Pulmonary 108 90 Non-Pulmonary 12 23 Total 120 113 During the yeyar 46 notified eases of tuberculosis were removed from the register for various reasons. Patients Admitted and Discharged from Institutions. During the year 60 patients were admitted to hospital and 22 to sanatoria. 63 patients were discharged from institutions. Tuberculosis Care Committee. The Committee met five times during the year—in January, April, June, July and October. 361 cases were reported upon, of which 55 were new cases. The Secretary's interviews with patients, or relatives, including visits, totalled 788, 24 Allowances for Tuberculous Patients Undergoing Treatment. Prior to 5th July, 1948, 24 patients' received allowances. 11 new applications were received, and 2 patients were found to be not eligible for grants. The allowances were made up as follows:— Maintenance allowances 20 Special allowances 8 Discretionary allowances 7 The amount disbursed up to 4th July, 1948, was £613 14s. 6d. On 5th July, 1948, 16 current cases were transferred to the National Assistance Board. Artificial Pneumothorax Treatment. Twenty-three patients received treatment. The cost of £141 15s. 0d. was borne by the Council. Extra Nourishment. Thirty-seven patients were granted extra nourishment. The cost of £230 5s. 4d. was borne by the Council. Dental Treatment. Three patients received dental treatment and were supplied with dentures. The cost of £23 5s. 0d. was borne by the Council. "Light" Treatment. One patient received Finsen light treatment. The cost of £2 15s. 0d. was borne by the Council. Bedding. Two patients were provided with bedding. Housing. During the year 7 families were rehoused by the Borough Council and 6 families by the London County Council. Rehabilitation. In consultation with the Tuberculosis Officer, the District Resettlement Officer interviewed 11 patients, 7 of whom have since been placed in suitable employment or training centres. Pensions. Nine ex-Service patients were granted pensions,