STPAN 8 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. T. SHADICK H1GGINS, M.D., B.Sc., Lond., D.P.H. Cantab. 2 CONTENTS. page. Public Health Committee 4 Staff of Public Health Department 5 Introduction 7 Section I.—Natural and Social Conditions of the Borough. Population 9 Physical features and general character 9 Open Spaces 10 Occupations of Residents 11 Vital Statistics 12 Marriages 12 Births 12 Deaths 13 Infantile Mortality 16 Section II.—Sanitary circumstances of the District. Closet accommodation 17 Scavenging 17 Inspections 17 Notices served and result of service 18 Nuisances—Legal Proceedings 19 Premises and Occupations which can be controlled by by-laws and regulations 20 Offensive Trades 20 Registered Tenement Houses 20 Smoke Prevention 20 Constructional Drain Work 20 Drain Tests 21 Water Service 21 Canal Boats Acts 22 Inhabited House Duty 22 The Rag Flock Act, 1911 22 Public Mortuaries and Coroner's Court 22 PAGE. Factory and Workshop Acts 22 Inspections 22 Defects found 23 Home Work 23 Registered Workshops 24 Schools 25 Medical Inspection of Children 26, 27 Infectious Diseases in Schools 27 School Clinics 27 Section III.—Food. (a) Milk Supply 29 Dairies, Cowsheds and Milkshops 29 Milk and Cream Regulations 30 Milk (Mothers and Children) Order, 1918 30 (b) Other Foods 30 Slaughter-houses 30 Fried Fish and Fish Curing Premises 31 Ice Cream Premises 31 Bakehouses and Restaurant Kitchens 31 (c) Sale of Food and Drugs Acts 32 Prosecutions 33 Administration of Food Controller's Orders 33 Section IY.—Prevalence of and control oyer Infectious Diseases. Table of Notifiable Diseases 34 Do. Weekly Number of Notifications 35 Do. Weekly Number of Deaths 35 Do. Notifications past 10 years 35 do. and Deaths in 3 CONTENTS—continued. page. Disinfecting and Cleansing Station 37 Tuberculosis 38 St. Pancras Scheme 43 Visiting 43 Tuberculosis Dispensaries 44 Sanatoria, etc 45 Smallpox 45 Scarlet Fever 46 Diphtheria 48 Typhoid Fever 49 Acute Anterior Poliomyelitis 50 Epidemic Cerebrospinal Meningitis 50 Encephalitis Lethargica 51 Malaria 52 Dysentery 52 Trench Fever 52 Pneumonia 52 Other Notifiable Infectious Diseases 53 Influenza 53 Diarrhoea and Enteritis 53 Syphilis 53 Cancer 55 Section Y.— Maternity and Child Welfare 55 Notification of Births 55, 62 Advice Cards 56 Home Visiting 57 Centres 57 Dental Clinic 60 Clinic for Sick Mothers and Children 61 Supply of Food to Mothers and Children 61 Home for ailing Children 62 Midwifery Work 62 Widowed, deserted and unmarried mothers and their children 64 Home Helps 74 Home Nursing 75 Government Grants 75 Puerperal Fever 76 Ophthalmia Neonatorum 76 Measles and German Measles 77 page. Whooping Cough 78 Infantile Diarrhoea 79 Section YI.—Sanitary Administration. Staff 79 Chemical and Bacteriological Work 80 Section YI1—Other Services. 81 Home Nursing 81 Section YIII.—Housing 81 Tenement House evil 81 General Housing conditions 86 Overcrowding 86 Fitness of Houses 87 Water Supply 90 Closet accommodation 90 Refuse Disposal 90 Unhealthy Areas 91 By-laws relating to Houses let in Lodgings, etc 91 General and Miscellaneous 91 Work of Special Housing Committee 92 Appendix. Table No. 1. Vital Statistics 100 Do. 2. Deaths from all causes 101 Do. 3. Summary of above 105 Do. 4. Births, Deaths and Infantile Deaths 106 Do. 5. Do., certain large towns and Metropolitan Boroughs 107 Do. 6. Meteorology 108 Do. 7. Inspections and reinspections (District and other Inspectors) 109 Do. 8. Do. (Food Inspectors) 110 Do. 9. Visits by Women Inspectors 112 Do. 10. Inspections and reinspections by individual Inspectors 113 Tables Nos. 11, 12, 13 and 14. Details of Intimation Notices served and resulting Statutory Notices 114 St Pancras Borough Council. PUBLIC HEALTH COMMITTEE. November, 1918 to October, 1919. CHAIRMAN. Councillor Abraham Davis (Ward 7). DEPUTY-CHAIRMAN. Councillor Arthur Escott (Ward 4). EX-OFF1CIO. The Right Worshipful The Mayor. (Councillor G. F. Parsons, J.P.) ALDERMEN. Bryan, James Thomas. Davies, David, J.P., L.C.C. Tapping, Dan. Williams, Charles. COUNCILLORS. Ward. 6 Bayly, Christopher Hodgson. 5 Blount, George. 3 Bolsom, Sidney. 2 Brown, Henry Joseph, J.P. 1 Coggan, Cornish Arthur. 3 Cooke, Joseph John. 6 Cosburn, George Frederick, J.P. 8 Crosby. Miss Ada, M.B.E. 2 Gardner, George. 8 Hensman, William. 2 Idris, Emeline Tkkve^a Williams (Mrs.). 4 Lloyd-Taylor, William, J.P., L.C.C. 5 Mayes, Henry Arthur. 8 Newton, William. 3 Rolles, Harry. 5 Saunders, James. 1 Shearing, Arthur George. 7 Swift, Mansell James. 7 Wood, William Charles. November, 1919 to October, 1920. CHAIRMAN. Alderman Gborge Frederick Cosburn, J.P. DEPUTY-CHAIRMAN. Councillor Miss Edith Maurice Vance (Ward 3). EX-OFFICIO. The Right Worshipful The Mayor. (Councillor W. Carter, J.P.). ALDERMEN. Brown, Henry Joseph, J.P. Tapping, Dan. Williams, Charles. COUNCILLORS. Ward. 2 Barrett, Edward. 5 Blount, George. 8 Chamberlayne, S. 8 Crosby, Miss Ada, M.B.E. 8 Davis, Abraham. 1 Ebury, Mrs. Susan Jane. 5 Gregg, Dr. Edward Andrew. 5 Kent, Miss Beatrice. 3 Kough, Miss Kathleen Beulah. 6 Levy, Mark Joshua. 4 Lloyd-Taylor, William, J.P., L.C.C. 7 May, Joseph, J.P. 4 Mundella, Anthony John. 1 Newman, Israel Arthur. 6 Reed, William Russell. 3 Shepherd, Joseph George. 7 Swift, Mansell James. 2 White, George William. 1 Woodley, William George. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1919. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. T. Shadick IIiggins, M.D., B.Sc., D.P.IL TUBERCULOSIS OFFICER. G. T. Calthrop, M.A., M.B , D.P.H. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS AND HEALTH VISITORS. Inspectors of Food and Food Places. W. G. Auger. H. R. Child. Inspector of Workshops and Factories. H. G. West. District Inpsectors. G. Rackham. J. landen.† J. I. Lonnon. W. L. Brown. E. J. Dillon. A. H. Walker. R. E. James. G. W. Adkins. B. H. Thompson. R. C. Akers. M. Jaffa. J. B. Molloy, Temporary Sanitary Inspector. Women Sanitary Inspectors. Miss M. E. Bibby, B.A. Miss C. Smith.‡ Miss H. Payne. Miss M. Mackenzie. Miss V. Blaxland.‡ Miss D. M. Parnell. Health Visitors. Mrs. A. Hunter. Miss F. A. Anderson. Miss J. Camman. CLERICAL STAFF. Chief Clerk A. Powel Coke, Barrister-at-Law. First Clerk A. G. Capel. Second Clerk. A. Carpenter. Clerk G. N. Cove. „ F. G. Crick.f „ J. W. Ivnight. Junior Clerk (Vacant). Boy Clerk S. Barker. Temporary Clerk C. Batter. „ L. Higgins. „ T. H. Hague. ,, Miss A. West. * Prior to Dr. Calthrop's appointment in November. 1919, Or. E H, felieehan acted temporarily as Tuberculosis Officer. Tuberculosis Officer at University College Hospital, Dr. D. W. Fenwick Jones. † Away ill. ‡ Miss Smith and Miss Blaxland are appointed as Sanitary Inspectors and Health Visitors. 6 BOROUGH COUNCIL STAFF AT THE MATERNITY AND CHILD WELFARE CENTRES. Medical Officers. No, of Consultations per week. Dr. B. Marion Cockerell 3 Dr. Rowntree Gillett (2 per month) Dr. A. Gertrude Grogan 2 Dr. Janie Lorimer Hawthorne 2 Dr. Matilda Hunt 2 Dr. Ethel F. Iredell 1 Dr. Lydia A. Licney 2 Dr. Jessie S. Muir 2 Dr. Balfour Neill 2 Dr. J. Sherwood New 1 Dr. F. L. Provis 2 Denial Clinic. Mrs. W. A. Murch, L.D.S., Dentist 1—2 Dr. Jas. Maughan, Anmthetist. Superintendents of Centres. Full Time— Part Time— Miss G. R. Bristow. Miss K. L. Alj.frey. Mrs. E. Crockart. Miss E. T. Savory. Miss M. H. Landel Jones. Miss M. Tkmplf.ton. Miss M. Smyth. Assistant Visitors at Centres.—Full Time. Miss M. Andrews. Miss H. Ff.rme. Miss F. Brayshaw. Mrs. E. Lurie. Miss L. Donnfi.l. Miss E. L. May. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station H. Catch. Stoker and General Assistant T. Bartholomew. Assistant Disinfector J.Stanley. „ A. J. Dibben. Matron of Personal Cleansing Station Mrs. E. Mace. Assistant at „ „ Mrs. L. Cook. RESIDENT CARETAKERS, &c. Mortuaries and Coroner's Courts J. Root. Goldington Buildings J. H. Ambrose. Flaxman Terrace J. Evans. Prospect Terrace (and Baths) A. N. Rf.id. Male Attendant W. Smith. Female Attendant Mrs. C. Reid. 7 Public Health Department, Town Hall, Pancras Road, N.W. 1. July, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Ladies and Gentlemen, I have the honour to present to you the Sixty-Fourth Annual Report on the vital statistics and sanitary condition of the Sanitary District of St. Pancras, including particulars of the year's work of the Public Health Department. It is the seventh annual report which it has been my duty to submit. It is satisfactory to record that the mortality during 1919 has been the lowest on record, in spite of the fact that the ravages of the influenza epidemic continued during the earlier months. For the first time the net St. Pancras deaths for the year were less than three thousand, and the annual death-rate was down to 13.4 per 1000 civil population. It is noteworthy that the wartime conditions, some of which still continue, have not had a more unfavourable effect on the mortality figures. The deaths of infants under one year of age also were less in number than in any previous year, but there is reason to believe that they are still more numerous than they need be, and that patient effort in this direction is yet required. In regard to births the continuous decline which had been observed during the war reached its greatest depth in the middle of 1919, but during the last two quarters there was a marked increase, with the result that the recovery shows itself in an increase over last year in the figures for the year. As a result of the favourable variation in the births and deaths, there was an excess of births over deaths of 894 for the year, as compared with an excess of deaths over births of 596 which was recorded in 1918. In regard to infectious diseases, the outstanding feature of the year was the cessation of the phenomenal outbreak of influenza. This raged during part of the summer and autumn of 1918, and was still grave in the spring of 1919, but had almost spent itself by the end of the first quarter, since which time there has been no serious recrudescence. The total St. Pancras deaths certified during the year 1919 as being caused by this disease numbered 260, as compared with 700 in the previous year, but the mortality actually due to the epidemic was no doubt even greater. 8 The mortality from tuberculosis (341 deaths) was lower than usual, and from both measles and whooping cough, diseases which fluctuate from year to year, much lower than for many years. Scarlet fever was more prevalent than in the previous three years, though the deaths were very few, the cases being of a mild character. The increase was not observable with respect to Diphtheria. Typhoid fever reached a lower point than ever, only seven cases being notified, and it is satisfactory to note that the decline in cerebrospinal fever since the outbreak of 191-5 was continued. A considerable number of men suffering from malaria and dysentery acquired abroad on active service have returned to civil life, but there appears to be no tendency for the diseases to spread, not one case acquired in England having been reported in St. Pancras. The administration of the Borough schemes for Maternity and Child Welfare and for the dispensary treatment of tuberculosis, as well as the general work of the Public Health Department, are recorded in detail in the report. The most noteworthy development during the year was the work of the Special (Housing) Committee which will also be found detailed in the text. During the year the remaining members of the staff of the Department who were still serving with H.M. Forces returned to their civil duties. The annual report which I submit herein has been arranged on an entirely new plan as compared with my previous annual reports, in order to comply with the suggestions which have been made by the Ministry of Health to all Medical Officers of Health with a view to securing a measure of uniformity in such reports throughout the country. In conclusion I have the pleasure of once more expressing my appreciation of the manner in which I have been assisted by the staff of the Department during a strenuous year's work. I would like also to offer my thanks to your Public Health Committee for the support they have given me; and to the Council for the personal consideration which they have always shown me. I am, Ladies and Gentlemen, Your obedient Servant, J. Ahsdick Hijjim Medical Officer of Health, Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1919. Section I-NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. POPULATION. The total population of St. Pancras for 1919 as estimated by the RegistrarGeneral was 228,585, the civilian population being estimated at 219,434. The figures have been arrived at on the basis of the rationing returns. The population enumerated in the 1911 census was 218,387. Since that date the Registrar-General's estimates have been based on the assumption that the populatiou was decreasing (the 1901 census was 235,317), and in 1918 his estimate was as low as 196,883 for the total population, and 175,716 for the civilian population. There is reason to believe that throughout the intercensal period the estimate was too low. The doubt as to the exact population diminishes the value of annual rates calculated on the estimated population, and our vital statistics would be greatly improved by the taking of censuses more often than once in ten years. PHYSICAL FEATURES AND GENERAL CHARACTER. The Borough of St. Pancras extends over the area of the parish of the same name. It is about four miles long north and south, extending from near Oxford Street to Highgate, and about one mile east and west. It includes the districts of Kentish Town, Camden Town and Somers Town, and portions of Clerkenwell, Bloomsburv and Highgate, as well as less well defined districts spoken of as "Chalk Farm," "Regent's Park," "Euston" and "King's Cross," and a quarter—largely foreign -to the west of Tottenham Court Road, 10 The area of the Boro ugh is 2,694 acres, but by no means the whole of that area is built over. Preserved open spaces exist in Begent's Park, Parliament Hill Fields, Higligate Cemetery and Waterlow Park and elsewhere, and there is a good deal of land devoted to railway purposes. The open spaces are shown in the following table:— Acres. 1 Ampthill Square 1.00 2 Argyle Square .80 3 Brunswick Square 2.30 4 Camden Gardens .47 5 Camden Square 2.07 6 Cartwright Gardens 1.45 7 Clarence Gardens .70 8 College Gardens .10 9 The Crescent, Camden Road .54 10 The Crescent closure, Euston street .22 11 Endsleigh Gardens 2.40 12 Euston Square 2.20 13 Fitzroy Square .75 14 Goldington Crescent .50 15 Gordon Square 2.30 16 Harrington Square 1.00 17 Highgate Road Open Spaces .86 18 Leighton Crescent closure .29 19 Lismore Circus closure .66 20 Maitland Park Villas Enclosure .64 21 Mecklenburgh Square 2.50 22 Mornington Crescent 2.84 23 Munster Square .46 Acres. 24 Oakley Square 1.75 25 Parliament Hill (total area 267¾ acres) 194.00 26 Pond Square Enclosure .80 27 Primrose Hill Park 30.00 28 Regent's Park (total area 400 acres) 72.50 29 Regent's Park Terrace Enclosure .20 30 Regent Square .70 31 Rochester Square 1.08 32 St. Andrew's Gardens 1.25 33 St. George's Gardens (including burial ground) 2.50 34 St. George's Square .43 35 St. James's Gardens 2.66 36 St. Martin's Gardens 1.75 37 St. Pancras Gardens 5.25 38 Tavistock Square 2.30 39 Waterloo Park 29.00 40 Whitfield Recreation Grounds, Tottenham Court Road 0.50 373.72 There is also a limited amount of other unbuilt-on land in the north of the Borough. The main lines and other property of the Great Northern, Midland and North-Western Railways, divide up the Borough to a considerable degree and tend to isolate one district from another. Geologically, the whole Borough has for subsoil the London clay, except for superficial deposits of gravels in the extreme south, and of lower Bagshot sand in the extreme north (Highgate). The occupations of the residents in the Borough at the time of the 1911 census are shown in the following Table, which is a summary of the census returns:— 11 Occupations (Condensed List) of Males and Females 10 Years and Upwards, (1911 Census.) ages of males. 10 years and upwards. AGES OF FEMALES. 10 years and upwards. 10 to 14 inclusive. 15 to 19 inclusive. 20 to 5o inclusive. 65 and upwards Total Males. OCCUPATIONS at apes 10 years and upwards. Total Females. Unmarried. Married. Widowed. 10 to 14 inclusive. 15 to 19 inclusive. •20 to 55 inclusive. 65 and upwards. 9014 9300 63470 4381 86165 Total occupied and unoccupied 90997 41369 39714 9914 9059 9460 66148 6330 7822 720 1708 1772 12022 Retired or unoccupied 54679 14895 34310 5474 8361 2143 38963 5212 1192 8580 61762 2609 74113 Engaged in occupations 36318 36318 5404 4440 698 7317 27185 1118 46 275 2458 43 2822 General or Local Government of the country 561 480 31 50 - 28 531 2 — 69 559 15 643 Defence of the country Professional occupations and their — — — —- — — — 20 240 3427 222 3909 subordinate services 2873 2244 369 260 4 155 2626 88 23 329 2345 76 2813 Domestic offices or services 12121 7944 1890 2287 155 1870 9615 451 60 1046 4841 173 6120 Commercial occupations conveyance of Men, Goods, and Messages— 1849 1750 68 31 20 533 1293 3 22 368 4002 71 4463 1. On railways 61 32 3 26 — 9 48 4 120 636 5582 186 6524 2 On reads 14 7 5 1 — 1 13 — 531 1285 2185 87 4388 3. Others Agriculture (on farms, woods, and 206 196 8 2 40 98 68 - 1 16 314 32 363 gardens) 8 2 3 3 — — 6 2 - - 2 - 2 Fishing In and about, and working and dealing in the products of mines and - - - - - - - - 1 3 149 6 159 quarries Metals, Machines, Implements, and 15 6 7 2 - - 15 ~~ 41 644 4036 170 4891 Conveyances Precious Metals, Jewels, Watches, 180 143 33 4 10 51 114 o 56 445 2472 147 3120 Instruments, and Games 765 704 41 20 54 294 408 9 5 204 5967 377 6553 Building and Work of Construction Wood, Furniture, Fittings, Decorations 3 — — 3 — — 1 2 22 351 3490 210 4073 916 662 153 101 25 213 656 22 2 22 278 18 320 Brick, Cement, Pottery, and Glass Chemicals, Oil, Grease. Soap, &c Skins, Leather. Hair and Feathers Paper, Prints, Books and Stationery Textile Fabrics Dress 46 38 5 3 J 13 32 — 13 135 684 21 853 247 219 17 11 8 85 151 3 8 71 427 42 548 296 228 16 22 14 91 182 - 48 459 2510 107 3124 1743 1473 185 85 73 607 1047 16 3 142 806 31 982 1071 905 110 56 24 293 735 19 28 319 3348 226 3921 8299 6250 1181 868 217 2073 5676 333 54 1127 7977 178 P336 Food, Tobacco, Drink and Lodging Gas, Water and Electricity Supply, and Sanitary Service Other, General, and undefined 4175 2611 1063 501 23 689 3333 130 - 23 538 16 577 6 2 2 2 - 2 4 - 88 371 3025 155 3639 Workers and Dealers Without specified occupations or unoccupied 863 578 184 101 30 209 1125 23 7822 720 1708 1772 12022 54679 14895 34310 5474 8361 2143 38963 5212 12 Considerable alterations have taken place since 1911 in the occupations owing to the War and to other circumstances. It will be seen from the Table that. St. Pancras is largely industrial. This is reflected in the housing conditions, of which the most characteristic feature is the prevalence of the "tenement house." These details in regard to housing are set out at some length in Section VIII. (page 81), and it may be sufficient at this place to mention that in 1911 the 22,246 "inhabited houses" were inhabited by 52,994 "families or separate occupiers"; that there were 11,452 one-room tenements, 15,568 two-room tenements, and 10,421 three-room tenements; and that a population of 51,214, or 25.5 per cent, of the total population in "private families" were living in 8,875 tenements with more than two occupants per room. The overcrowding and the tenement-house system and their attendant evils constitute one of the gravest problems in the Borough, and an important factor in the housing position in the metropolis as a whole. In connection with the housing and industrial position, it is to be noted that there is a considerable population working in St. Pancras and living elsewhere, and vice versa. VITAL STATISTICS. For the purposes of this Report, the year 1919 consists of the fifty-two weeks ended 27th December, 1919. MARRIAGES. The number of marriages celebrated in 1919 was 2,633 (including marriages of soldiers and sailors). This is equal to a rate of 11.5 per 1,000 total population. BIRTHS. The net number of births for St. Pancras registered during 1919 was 3,824, making an annual birth-rate of 16.7 per 1,000 total population. The number of births registered as having taken place in the Borough was 3,804, and the net figure is obtained by adding 20, which, according to information received from the Registrar-General, is the excess of births to parishioners occurring outside the Borough over births to non-parishioners occurring inside the Borough. The corresponding figures for previous years and for the different wards and registration sub-districts in the Borough will be found in Tables 1 and 4 on pages 100 and 106. It will be seen (page 100) that there was a tendency for the birthrate, which had been falling for some years, to recover in 1919. From the following quarterly Table it will be seen that this recovery took place mainly in the last quarter of the vear. The table shows also the nrst two quarters of 1920, in which the increase in births was still more pronounced:— 13 Year. No. of Births. Total for Year (Uncorected). Total for Year (Corrected).[/$$$] 1st Qtr. 2nd Qtr. 3rd Qtr, 4th Qtr. 1913 1335 1268 1266 1298 5167 5517 1914 1222 1234 1271 1218 4945 5225 1915 1259 1129 1036 1034 4458 4754 1916 1048 1140 1050 1072 4310 4530 1917 1046 974 797 818 3635 3796 1918 842 840 818 809 3339 3318 1919 775 747 977 1305 3804 3824 1920 1806 1581 _ — — — 725 births occurred in Public Institutions in St. Pancras, equal to 191 per cent, of the total births which took place in the Borough. Table 5, on page 107, shows the birth-rate for 1919 of England and "Wales, the County of London, the several Metropolitan Boroughs, and the thirty large towns with populations exceeding 125,000. Illegitimacy. Of the 3,804 births which took place in the Borough during 1919, 302, or 7.9 per cent., were returned as illegitimate. Of the 3,824 births to parishioners within and without the Borough, 222, or 8.4 per cent., were returned as illegitimate. The corresponding figures for 1918, 1917, 1916, 1915, 1914 and 1913, were 9.5, 7.2, 7.0, 5.4 4.4, and 4.7 per cent, respectively. Notification of Births. This subject is dealt with at pages 55 and 62. DEATHS. Deaths of civilians only are included in the following figures. The net number of St. Pancras (civil) deaths registered during the year was 2,930, making an annual death rate of 13.4 per thousand civil population. (The death rate calculated upon the estimated total population would be 12.8 per thousand). The number of (civil) deaths registered during the year as having taken place in the Borough was 3,104. Of these 670 were of persons whose residence was not in St. Pancras (non-parishioners), 578 dying in St. Pancras institutions, and 92 in other parts of the Borough. There were also reported 14 bv the Registrar-General 457 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London and institutions connected therewith, and 39 who died in other parts of England and Wales. The net figure on which the death rate is based is corrected for these inward and outward transfers. In Table 1, on page 100, the corresponding figures for the past ten years will be found. It will be seen that the mortality for 1919 was the lowest on record. There were 984 less deaths than in 1918, when the mortality was swollen by the influenza epidemic. The increased mortality from that disease continued during 1919, especially in the early part of the year, and there were 260 deaths attributed to influenza. It would appear, therefore, that except for that particular cause of death, the death rate for the year would have been still lower. The leading causes of death are set out in the following Table for the ten years 1909-l918 and for 1919:— Diseases. 1909 1910 1911 191 2 I913 1914 1915 1916 1917 1918 Average for 10 years. 1919 Enteric Fever 6 4 7 2 6 4 8 5 6 5 5 2 Small-Pox — — - - - - - - - - - 1 Chicken-pox — — 1 1 1 - 1 1 — — — — Measles 102 143 113 94 36 53 63 42 118 75 84 15 Scarlet Fever 16 17 10 5 6 19 22 8 4 7 11 5 Whooping Cough 27 92 48 47 36 49 52 39 27 80 49 7 Diphtheria and Croup 28 21 37 27 19 30 24 23 25 31 26 21 Influenza 61 20 15 14 42 15 35 35 21 700 96 260 Erysipelas 10 7 10 7 10 9 11 3 3 11 8 9 Tuberculosis—Pulmonary 374 297 230 318 325 365 398 340 353 403 340 268 Ditto Other forms 78 76 83 83 67 67 102 83 91 82 81 73 Cancer, Malignant Disease 232 266 274 247 285 251 258 267 281 269 263 245 Rheumatic Fever 12 8 6 5 6 10 11 7 7 8 8 7 Cerebral Hemorrhage, Embolism, and Apoplexy 168 131 147 227 116 141 169 119 116 131 146 91 Heart Disease 300 282 283 217 276 319 422 359 393 378 323 360 Bronchitis, Pneumonia, and Pleurisy 732 630 560 525 691 566 664 535 514 618 603 489 Diarrhoea and Enteritis 101 7S 248 45 148 142 114 72 97 56 109 68 Nephritis and Blight's Disease 138 97 86 110 101 i 12 132 103 104 98 108 6l Puerperal Fever — — 4 7 2 7 5 4 5 2 4 9 Congenital Debility and Malformations, including Premature Birth 149 138 130 207 191 164 187 176 144 132 162 162 Injuries 130 148 156 161 148 150 150 112 125 119 140 108 15 It will be seen that there was unusually little mortality from measles and whooping cough, pulmonary tuberculosis, cerebral apoplexy, bronchitis, pneumonia and pleurisy, and kidney disease; partly set off by the influenza mortality. The deaths for the year are fully classified for causes, age, and sex in Table 2. on page 101. The depths and death rates for the different wards and registration subdistricts will be found in Table 4 on page 106, and in Table 5 on page 107 will be found the death rate for 1919 'of England and Wales, the County of London, the several Metropolitan Boroughs, and the 30 large towns with populations exceeding 125,000. 1,648 deaths occurred in Public Institutions in the Borough in 1919. Taking from these the number which were of non-parishioners (578), and adding the number of deaths of St. Pancras parishioners in Public Institutions outside the Borough (486)—both from the Registrar-Genral's figures—the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,556, or 53 per cent. of the total deaths. Infantile Mortality. 336 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of 88 per thousand births. In Table 1 on page 100 the corresponding rates for the last ten years will be found. From this it will be seen that the infantile mortality compares favourably with previous years. In Table 4 on page 106 the figures will be found for the different wards and registration sub-districts, and in Table 5 on page 107 infantile mortality rates in England and Wales, the County of London, the several Metropolitan Boroughs and the 30 large towns with populations exceeding 125,000. The causes of death are shown in the following table, classified also according to agp at death:— 16 1919. Next Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week. i 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. All causes Certified 92 25 18 8 143 68 51 41 33 336 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — 1 — 1 2 4 Scarlet Fever — — — — — — — 1 — 1 Whooping-Cough — — — — — 1 — 1 — 2 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Influenza — 1 — — 1 — 1 6 3 11 Tuberculous Meninigitis 1 — — — 1 1 — 1 1 4 Abdominal Tuberculosis — — — — — — 1 — — 1 Other Tuberculous Diseases — — 1 — 1 — 1 — — 2 Meningitis (not Tuberculous) — — — — 1 3 1 1 — 6 Convulsions 2 — — — 2 1 — 2 1 6 Laryngitis — — — — — — — — — — Bronchitis - 5 1 — 6 14 6 11 10 47 Pneumonia tall forms) 1 — 1 — 2 — 1 2 4 9 Diarrhoea — — 1 — 1 2 5 1 1 10 Enteritis 2 1 — — 3 7 14 8 5 37 Gastritis — — — — — 1 — 2 — 3 Syphilis 1 — 1 — 2 4 4 — 1 11 Rickets — — — — Suffocation (overlying) — — 1 — 1 — — — — 1 Injury at birth 6 — — — 6 — — — — 6 Atelectasis 7 — — — 7 — — — — 7 Congenital Malformations 14 5 2 1 22 5 3 1 — 31 Premature birth 48 8 2 4 62 5 — 1 — 68 Atrophy, Debility and Marasmus 7 2 4 — 13 17 11 1 3 45 Other causes (including Influenza 3 4 3 3 13 6 4 7 5 35 Totals 92 25 18 8 143 68 51 41 33 336 Nett Births in the year legitimate 3502 illegitimate 322 Nett Deaths in the year of legitimate infants 270 illegitimate infants 66 17 The number of deaths of illegitimate children under one year of age was 66, equal to a death rate of 205 per 1000 illegitimate births. Section II-—SANITARY CIRCUMSTANCES OF THE DISTRICT. Closet Accommodation. The only closet accommodation to be found in the Borough is of the watercloset type, privies of other types being completely absent. Except for a relatively small number of trough latrines in factories and workshops, schools and institutions, these are all provided with separate flushing cisterns. In connection with dwelling-houses, some of these are in outhouses and some within the house itself. In Section VIII. (Housing) of this Report (page 81) reference is made to the circumstance that in tenement houses one closet has to serve more than one tenement, with the result that there is lack of convenience and privacy in this respect, and a division of responsibility in the maintenance of the closets which frequently become insanitary in consequence. Scavenging. Reference is made to this subject in the Housing Section (see page 90). SANITARY INSPECTION OF THE BOROUGH. Inspections.—In connection with the following statement, reference may be made to the statement as to staff on page 79. Altogether 66,353 inspections, including 7,636 Food Control inspections were made in 1919 by the staff of Inspectors and Visitors. These consisted of 39,399 initial inspections, including 7,631 Food Control inspections, and 26,954 re-inspections, including 5 Food Control re-inspections. Of these inspections, 38,345 were made.by the District Sanitary Inspectors, 3,402 by the Sanitary Inspector for Factories and Workshops, 7,124 by the Sanitary Inspectors for Food and Food places, and 17,482 by the Women Sanitary Inspectors and Health Visitors. The inspections made by each individual Inspector and Visitor arc shown in table 10, on page 113. The work of the various classes of Inspectors and Visitors is set out in tables 7, 8 and 9, on pages 109 to 112. The inspections dealt with above are exclusive of the visits made by the Council's Superintendents and Visitors working in connection with the Maternity and Child Welfare Centres, who made 22,811 visits during the year, (see page 59); and of the visits made by trained workers not paid by the Council and working from the Centres; nor do they include the work of the disinfecting stuff. 18 Notices sewed and result of sere we.—3,307 intimation notices (comprising 7,011 items) were served by the Sanitary Inspectors during 1919. These were made up as follows — District Inspectors. Factory & Workshop Inspector. Food Inspector Women . Inspectors. Total. In respect of Nuisances 4320 12 1 284 4617 In respect of the Tenement House By-laws 764 - - 764 In respect of Breaches of Statutes in Factories, Workshops and Work places - 515 - - 515 In respect of other Breaches of Statutes and Bylaws 1057 5 53 1115 6141 532 1 337 7011 These intimations are classified in tables 11, 12, 13 and 14, on pages 114 and 115. 1,756 Statutory notices (comprising 2,810 items) were served during 1919 and the early part of 1920, following non-compliance with these intimation notices. These arc also classified in tables 11, 12, 13 and 14, on pages 114 and 115. The following prosecutions were undertaken during the year in respect of general sanitary work:— i9 Summonses. Under the Public Health (London) Act, 1891 (except in respect of food). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 101, Kentish Town Road House without a proper and sufficient supply of water 191 . March 4th Closing Order to be obeyed within 11 days Tudor Place Offensive smells from Tallow Factory „ 18th Summons withdrawn, costs £21 3, St. John's Gardens Mam and washhouse roofs and dust-bin defective May 16th Summons withdrawn, costs £2 8s, 35, Queen's Crescent Water fittings and dust-bin defective ; waste pipe of sink foul and choked „ 23rd Abatement Order made costs £1 Is. 30, Rhyl Street Walls and ceilings dirty; domestic water cistern dirty and water fittings defective „ Abatement Order made costs £1 Is. 15, Winscombe Street Walls and ceilings dirty June 13th Do. 142. Weedington Road Room and w.c. dirty „ Summons withdrawn, costs £2 2s. 46, Castle Road Walls and ceilings of rooms and scullery dirty; addition room dirty and damp; roof and water fittings and rain water pipe defective July 12 th Order to abate nuisance within 28 days, costs £1 5s. 14, Pratt Street Walls and ceilings dirty and absence of dust-bin Aug. 21st Summons withdrawn, costs £l 5s. 123, Drummond Street Drain defective and stopped „ Order to abate nuisance within 28 days. costs £l 5s. 127, Drummond Street Walls and ceilings dirty; watercloset basin, waste pipe of sink and dust-bin defective ,, Do. 133, Whitfield Street Walls and ceilings and staircase dirty Sept. 5th Fined ls„ costs £3. 101, Kentish Town Road Failing to comply with Closing Order 9th Fined £20, in default 2 months' imprisonment. 30, Rhyl Street Failing to comply with Nuisance Order „ Fined £5. 125, Drummond Street Do. do. Oct. 29th Fined £5. 127, Do. do. Fined £0. 10, Bramshill Gardens Walls and ceilings dirty Nov. 14th Fined 1s., costs ,£2 5s. Whiffin's Yard Nuisance from trade, business or process of soap making at factory ,, Adjourned sine die, costs £5 5s. 11, Dickenson Street Walls and ceilings dirty; water closet apartment and scullery dirty ; main and addition roofs defective ,, Order made for nuisances to be abated within 14 days, costs £1 3s. 4, Stucley Place Walls and ceilings dirty; roofs and guttering defective „ Ordered to abate nuisance within 14 days. 45, Wcrrington Street Accumulation of refuse in front area and vaults; absence of proper receptacle for dust „ 21st Summons withdrawn, costs £2 2s. 131, Whitfield Street Walls and ceilings dirty Dec. 3rd Fined £3. 114, Torriano Avenue No proper drain and w.c. to house ,, 16th Abatement Order, costs £,2 2s. 2, Clarence Gardens Roof defective „ 19th Do. 38, Calthorpe Street w.c. basin choked ,, 18th Summons not served. 15, Sidmouth Street Guttering to addition roof defective „ 16th Summons withdrawn, costs £2 6s. 20 PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BY-LAWS AND REGULATIONS. Offensive Trades.—There are two licensed premises for such trades in St. Pancras, viz., a tripe-dresser's in Kentish Town Road, and a tallow-melter's in Tudor Place. 38 visits were made to these premises in 1919, a number of these being special night observations of the tallow-melting premises. In connection with the tallow-melter's premises proceedings were taken in March, 1919, under Section 21 of the Public Health (London) Act, 1891, upon a certificate to the Council signed by more than ten inhabitants of the district that the premises were a nuisance or dangerous to health. The summons was withdrawn on the defendants undertaking to make certain alterations in the premises with a view to preventing the nuisance. Proceedings were instituted in November under the same section in connection with a soap-making works in Whiffen's Yard, Sharpleshall Street, which had recently been established. This case was settled on the defendants agreeing to discontinue the processes which caused the nuisance. Reference is made in Section III. of this Report to Dairies, Cowsheds, Milkshops, Bakehouses, Slaughter-houses, Fried Fish and Fish Curing premises, and other food premises. Tenement houses and underground rooms are dealt with in Section VIII. (Housing). Registered Tenement Houses. At the end of 1919 there were 2365 such houses on the Register. Statistics as to inspection of these and other houses will be found in tables, Nos. 7 and 12, on pages 109 and 114. Smoke-Prevention. During the year 79 observations of smoke shafts were made. There were no prosecutions. Constructional Drain Work. The sanitary inspectors have the duty of supervising all work upon drains, including construction, reconstruction and repairs. During the year the following work has been done under this heading:— First inspections. Consequent re-inspections. , Drainage work done under notice 200 2039 Voluntary drainage work 1500 2910 Drains of new buildings 109 199 1809 5148 21 The tests which have been applied to drains during 1919 are shown in the following table:— After Infectious Disease. Upon Complaint. Upon systematic Inspection Old Buildings. New Buildings at completion of work. Total. At commence ment of work. At completion of work. By Grenade. 1. Defects found 25 37 1 — — — 63 2 No result 83 82 6 — 12 — 183 3. Total 108 119 7 — 12 — 246 By Smoke. 1. Defects localised — — — — — — — 2 ' No result — — — 2 — 2 3. Total — — — — 2 — 2 By Water. l. Not found water-tight 1 — 7 3 11 2. Found water-tight — — — 146 S3 179 3. Total — 1 — — 153 36 190 Total 25 38 1 — 7 3 74 83 82 6 — 160 33 364 108 120 7 — 167 36 438 Drainage Register.—The following; is an analysis of the Drainage Register during 1919 :— Plans deposited—Old Buildings under Notice 6 „ „ Old Buildings, Voluntary 17 „ „ New Buildings and Additions 4 187 Applications without Plans 23 Total number of Applications and Plans 10 Water Service. The following notices have been receive during the year from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition - 2.—Empty 4 3.—Leakage 4 4.—Non-payment of Rates — 5.—No statement (withdrawals) — 6.—By request - 7.—Broken Supply Pipe 3 11 22 Canal Boats Acts. During the year Inspector Auger inspected 5 canal boats, which were registered for the occupation of 11 adults and 6 children, and were occupied by 10 adults and 8 children. He served a notice in respect of the damp and dirty condition of one boat, which has since ceased to be occupied. The regulations were complied with on the other four boats. Inhabited House Duty. Applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1918 in respect of 2 houses comprising 4 tenements. These were granted. The Rag Flock Act, 1911. No samples were taken under this Act during 1919. Public Mortuaries and Coroner's Court. Number of bodies deposited in the General Mortuary in 1919 345 „ „ Infectious „ „ 5 Total 350 Inquests held during 1919— In the Coroner's Court—General Cases 306 „ ,, Poor Law 38 Elsewhere in St. Pancras 22 Total 366 FACTORY AND WORKSHOP ACTS. The following five tables are those asked for by the Home Secretary:— 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Written Prosecutions. (1) (2) (3) (4) Factories (including factory laundries and bakehouses) 798 169 - Workshops (including workshop laundries and bakehouses) 1502 280 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 363 69 Total 2663 518 - 23 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to h.m. Inspectors. (4) Nuisances under the Public Health Acts*: — Nil. Want of cleanliness 92 92 Want of ventilation 1 1 Overcrowding — — Want of drainage of floors — — Other nuisances 114 110 Sanitary accommodation Insufficient.. 7 4 Unsuitable or defective 154 151 Not separate for sexes 5 3 0ffences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) . . 2 2 Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 130 130 Other offences Excluding offences relating to outwork which are included in Part 3 of this Report) 10 8 Total 515 501 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health A.cts. 3.—Home Work. The only matter to report under this heading is the receipt of the following lists of outworkers for employers sending twice in the year:—19 in respect of the making, etc., of wearing apparel, comprising the names of 24 outworkers (contractors) and 105 outworkers (workmen), and 1 in respect of brushmaking, containing the name of 1 outworker (contractor). 24 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year. Numbers. (1) (2) Bakehouses 134 Restaurant kitchens 422 Laundries 35 Domestic workshops — Other workshops where women are employed 367 Other workshops 802 Total number of workshops on Register 1760 5.—Other Matters, Class Number (1) (2) Matters notified to H.M. 31. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) _ Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 39 39 Other — Underground bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 88 The number of factories, workshops and workplaces added to and removed from the register during1919 was as follows: — Added to register. Removed from register. Bakehouses— Workshop 0 l Factory 0 0 Laundries— Workshop 0 0 Factory 0 0 Restaurant kitchens 9 4 Other workshops and workplaces 70 0 Other factories 33 0 25 The number of inspections that were made during 1919 were as follows:- Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 350 283 — — 350 283 Restaurant kitchens 141 149 — — 141 149 Laundries 1 — — — 1 — Domestic workshops — — — — — — Other workshops 438 594 — — 438 594 Other workplaces 26 47 — — 26 47 Other factories 270 363 l — 271 363 Total 1226 1436 l — 1227 1436 Bakehouses and restaurant kitchens are dealt with in Section III. SCHOOLS. The medical inspection and treatment of children in Elementary Schools in St. Pancras is carried out by the London County Council independently of the Borough Council. The County Medical Officer has kindly furnished me with the following particulars of medical inspections of school children in St. Pancras during 1919. They are classified in the following Tables:— 26 Medical Inspection of Children in Elementary Schools in St, Pancras. 1919. Entrants. Age 8. Age 12. Boys. Girls. Boys. Girls. Boys. Girls. Number examined 1343 1470 1465 1458 1477 1564 Number requiring treatment 630 699 760 761 589 706 Defects— Skin F 49 40 62 32 41 35 X 40 25 48 21 30 22 Teeth X 351 418 451 407 312 336 Tonsils F 342 407 278 313 178 210 Adenoids F 196 184 134 110 38 36 Tonsils or Adenoids X 134 143 98 112 50 73 Other Nose or Throat defects F 146 138 92 76 71 51 X 47 34 35 14 15 18 Glands of Neck F 283 289 274 258 167 106 X 7 4 10 11 3 2 Eye disease F 58 79 61 58 54 43 X 41 55 27 23 18 13 Vision X Not tested 152 184 183 196 Ear disease F 42 51 53 73 55 49 X 25 30 33 48 35 33 Hearing F 21 25 33 33 26 24 X 2 6 12 12 13 11 Speech F 18 20 25 13 16 8 X — — 3 — 1 — Heart F 31 37 35 46 45 70 X — 4 5 3 7 12 Anæmia F 47 46 58 51 45 79 X 21 20 16 19 11 38 Lungs F 121 118 87 67 48 44 X 49 51 42 20 19 12 Nervous disease F 32 38 30 41 21 37 X — 2 3 5 2 7 Phthisis F 7 7 5 12 6 11 X 5 4 4 7 3 8 Other Tubercular F 9 6 2 2 2 7 X 3 3 2 1 2 3 Rickets F 60 45 44 17 28 24 X 7 10 1 — — 4 Deformities F 31 24 34 35 52 73 X 1 6 6 8 10 24 Infections disease F 3 6 1 3 — 1 X 3 5 1 3 — 1 Malnutrition F . 7 13 9 8 5 4 X 4 8 4 4 3 4 Other defects F 82 99 91 93 80 133 X 35 55 41 53 36 59 F signifies a defect found x signifies a, defect noted for treatment, 27 Clothing. Nutrition. Cleanliness of Head. Cleanliness of Body. Condition . of Teeth. Vision. 1 2 3 1 2 3 4 1 2 3 1 2 3 1 2 3 1 2 3 Entrants. Boys 871 453 19 633 674 36 — 1265 76 2 1271 67 5 676 376 291 — — — Percentage 649 33.7 1.4 47.1 50.2 2.7 — 94.1 5.7 0.1 94.6 5.0 0.4 50.3 28.0 21.7 — — — „ Girls 997 458 15 619 794 57 1193 263 14 1373 93 4 691 477 302 Percentage 67.8 31.2 1.0 42.1 54.0 3.9 — 81.2 17.9 0.9 93.4 6.3 0.3 47,1 32, 4 20,5 — — — Age 8. Boys 804 647 14 444 958 63 1399 61 5 1377 87 1 637 503 325 520 633 290 Percentage 54.8 44.0 1.0 36.3 65.4 4.3 — 95.5 4.2 0.3 94.0 5.9 0.1 43.5 34.3 22.2 36.0 43.9 20.1 „ Girls 905 545 8 430 979 49 1099 345 14 1374 81 3 644 520 294 479 616 338 Percentage 62.1 37.4 0.5 29. 5 67.2 0.3 — 75.4 23.6 1.0 94.2 5.6 0.2 44.2 35.7 20.1 33.4 43.0 23.6 Age 12. Boys 938 522 17 568 868 41 1429 48 1395 79 3 797 580 100 779 421 276 Percentage 63.5 35.3 1.2 38.4 58.8 2.8 — 96.7 3.3 — 94.5 5.3 0.2 54.0 39.2 6.8 52.8 28.5 18. 7 „ Girls 1035 525 4 559 961 44 — 1269 288 7 1457 106 1 881 583 100 840 419 304 Percentage 66.2 33.6 0.2 35.7 61.5 2.8 81.2 18.4 0.4 93 .2 6.7 0.1 56.3 37.3 6.4 53.7 26. 8 19.5 * Classification of children examined. Clothing1, good; 2. fair; 3, bad. Nutrition 1, excellent; 2, normal; 3, below normal; 4, bad. Cleanliness—Head 1, clean; 2, nits only ; 3, pediculi. ,, Body 1, clean ; 2, dirty ; 3, pediculi. Teeth 1, sound ; 2, less than 4 decayed ; 3, 4 or more decayed. Vision 1, 6.6 in both eyes ; 2, 6.9 in either eye ; 3, 6.12 or worse in either eye. (Vision tested with Snellan test type at a fixed distance of 6 metres). Infectious Diseases in Schools. In the investigation of cases of scarlet fever, diphtheria, etc., and of measles, the school teachers are promptly advised in • regard to cases and contacts, so that the London County Council rules in regard to the exclusion from school of these can be brought into operation. It has not been necessary during the year to close any school on account of infectious disease, but in a number of instances the "unprotected" children in certain schoolrooms were temporarily excluded on account of measles. St. Pancras School Clinics. The following account of the work of the two London County Council treatment Centres for school children has been kindly furnished by Dr. A. K. Roche, the Secretary-Superintendent There are two centres in St. Pancras for the medical treatment of children attending the primary schools, one at 26, Prince of Wales Road and the other at Lancing Street, Euston Road, They are conducted in virtue of annual agreements between the London County Council and the St. Pancras Public Medical Service, a voluntary association of medical men practising in the Borough formed expressly for this purpose. The executive body in this Association is a small Committee, with Dr. J. Wigg as its Chairman and Dr. A. R. Roche as Secretary and Superintendent of the Centres. In virtue of this agreement the County Council authorities, as the result of the medical inspections of the schools by their own medical officers, refer such cases as 28 require treatment, not provided by their parents, to the Centres for treatment, the connecting links between the schools and the Centres being the School Care Committees and the Council organisers. The Public Medical Service, for its part, rents, equips (in this it is initially financially assisted by the County Council) and maintains suitable premises and appoints medical officers (the appointments are approved by the Council) who carry out the necessary medical and dental treatment. Generally speaking, the medical officers and dental surgeons live and practice in the Borough, and are appointed annually by the Committee. The actually working of the Centres and management is in the hands of the Secretary-Superintendent, who is most ably assisted by a whole-time nurse provided by the County Council at each Centre. As regards the financial arrangements, the County Council pays a fixed session rate for the remuneration of the medical and dental staff, and also a fixed capitation fee for each case treated at the Centres. All the expenses of maintenance are defrayed out of these grants. For the last period of twelve months for which the accounts have been made up the County Council made payments amounting to £2,098 13s. 6d. The cases treated may be grouped as follows : — Eye Cases. — Children whose eyes are found to be defective are referred to the Centre, their refractions are carefully done, and suitable spectacles are ordered. An optician attends at the Centre, measures the children and subsequently sees that the spectacles fit. There is a special tariff for spectacles, and all arrangements for payment are made by one of the County Council's organisers. Apart from errors of refractions, all needful eye treatment is carried out, with the exception of operations demanding in-patient treatment. Eye treatment is only done at the Prince of Wales Road Centre, as in the Southern portion of the Borough there are so many hospitals that there are not enough cases to warrant an eye department at Lancing Street. At Prince of Wales Road 925 eye cases were dealt with in 1919. Ear, Throat and Nose Cases. — Defects of these organs are very common amongst school children, and include enlarged tonsils and adenoids and running ears, besides less common ailments. The cases needing operations are dealt with once a week at each Centre by the Surgeon and Anaesthetist, and no child is sent home until the Nurse in charge is satisfied that it is quite safe. Occasionally there are cases of haemorrhage, which require further treatment, and then if necessary the child is kept at the Centre all night. After being sent home each case is visited by a district nurse until well, if necessary by the Surgeon who did the operation, and is subsequently inspected before final discharge. Arrangements are being made for each child to have a course of remedial breathing exercises by which it is hoped that recurrence will be avoided. The treatment of discharging ears is carried out by the Minor Ailment Nurse (to be referred to later) under the direction of the Aural Surgeon, and each child attends daily or if necessary twice a day. The numbers for the Aural Departments are for 1919 :— Prince of Wales Road . . . . 784 Lancing Street (6 months only) .. 261 Dental Cases.—These departments are very busy, and the children's teeth 29 are stopped, cleaned, and where necessary extracted, either under gas or a local anaesthetic. The number for 1919 :— Prince of Wales Road .. 2,003 Lancing Street .. . . 1,385 Minor Ailment Department.—It is difficult to explain the wide scope of these departments. Skin cases of all kinds are dealt with, unclean heads, running ears are treated daily, cuts, bruises, sores dressed, and a wide variety of disabilities redressed. The department at each Centre is in charge of a doctor, who attends once or twice a week as arranged to see new cases and supervise treatment. At each Centre, by arrangement with the District Nursing Association, a nurse is exclusively maintained for this work. She attends the Sessions held by the doctor, and attends daily at each Centre at 12 and again at 4 for the routine treatment of the cases. The value of this work both remedially and educationally can hardly be exaggerated, and the hygienic influence ot the nurses is very great. The number of cases of 1919 are:— Prince of Wales Road .. 1,205. Lancing Street.. 1,159. As giving some idea of the work done, I may say the attendances at Lancing Street for 1919 in the Minor Ailment Department totalled 26,450, and at Prince of Wales Road, 28,819. A. R. Roche. The number of home visits made by the nurses in connection with the school clinics was 585 from the Prince of Wales Road Centre and 661 from the Lancing Street Centre. These were made by the Central St. Pancras District Nursing Association. Section III —FOOD. (a) MILK SUPPLY. Almost the whole of the milk used in St. Pancras is brought in from the country by train. The cowsheds in the Borough, though registered for 96 cows, only contained about 30 cows in 1919. Much milk is also delivered at the large railway termini in the Borough for distribution in other parts of London. The methods of transporting and handling the milk and the conditions in many of the milkshops are by no means satisfactory. The administration in regard to the control of the milk supply from the point of view of its content of tubercle bacilli is in the hands of the London County Council. Dairies, Cowsheds and Milkshops. Cowsheds.—There were at the end of 1919 four licensed cowsheds in the Borough. They were registered for 96 cows. 30 Milkshops and Dairies.—22 applications for registration under the Dairies, Cowsheds and Milkshops Orders, in respect of milkshops were considered during 1919. They were all acceded to. The figures in regard to the registration of milkshops are set out below : — No. of purveyors of milk at retail milkshops on register at end of 1918 214 Deduct No. of purveyors removed from register during 1919 23 Add No. of purveyors added to register by resolution of Council during 1919 22 No. of purveyors of milk at retail milkshops on register at end of 1919 213 At the end of 1919 there were on the register in addition to these 213 retail milkshops and 4 cowsheds (which arc attached to retail milkshops included in the 213), 2 persons in respect of premises where only a wholesale milk trade is done, and 3 itinerant vendors without milkshops. Public Health (Milk and Cream) Regulations, 1912 & 1917. The following is a report of the work done under the regulations during the year ended the 27th December, 1919 : — 384 samples of milk were taken and analysed, and in no case were preservatives reported to be found. N'j other contraventions of the regulations were discovered. Milk (Mothers and Children) Order, 1918. During 1919 milk was supplied under the above-mentioned Order to 213 new families, the milk being granted free in 207 cases and at half price in 6 cases. The supply was also continued in a few cases commenced in 1918. The total cost to the Council of the milk supplied during the year was £285 0s. 5d. (b) OTHER FOODS. The Food Inspectors have kept under regular inspection food exposed or deposited for sale in slaughter-houses, shops (especially butchers', cooked meat, and fishmongers' shops), stalls, and market places. No seizures of unsound food were made during 1919. On 106 occasions during the year unsound food has been surrendered by the owners to the Food Inspectors and destroyed as trade refuse. The work of the Food Inspectors is shown in detail in table No. 8, on pages 110 and 111. Slaughter-Houses. The greater part of the English-killed meat sold in St. Pancras is killed outside of the Borough. There were 9 licensed slaughter-houses (private) in 31 the Borough at the end of 1919. They do not conform to a high standard of excellence. The Food Inspectors pay visits at intervals to the slaughter-house and inspect the meat therein at each visit. During 1919 they made 143 visits. Fried Fish and Fish Curing Premises. At the end of 1919 there were 49 fried fish vendors' premises in the Borough, at 2 of which fish curing was also carried on. There were 14 fish curers' premises, including these two. 143 visits were made by the Food Inspectors to these premises during the year. A large number of these premises are not in compliance with the by-laws as regards the structure of their premises and apparatus, but as most of them have been in use for some years they arc exempt from the operation of the by-laws in this respect. Ice-Cream Premises. 132 visits were paid to these premises by the Food Inspectors during 1919. No legal proceedings were taken. Bakehouses and Restaurant Kitchens At the end of 1919 there were 172 bakehouses on the register, including 38 factory bakehouses and 41 bakehouses not in use.* 127 of the 172 were underground bakehouses, of which 25 were factory bakehouses, and 41 not in use. i i At the end of the year 422 restaurant kitchens were on the register. Bakehouses and restaurant kitchens arc visited by the Factory and "Workshop Inspector, and particulars in regard to his inspections of them will be found on page 25. 32 (c)—SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 704 of these proved to be genuine and 46, or 6.1 per cent., adulterated. The details are given in the following table: — Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Arrowroot 9 9 — Baking Powder 14 14 — Butter 24 23 l Camphorated Oil 24 22 2 Cocoa 40 40 — Custard Powder 18 18 — Dripping 19 19 — Egg Powder 6 6 — Flour 2 2 — Flour (Self-Raising) 56 56 — Glycerine 12 12 — Honey 1 1 — Lard 8 8 — Margarine 6 6 — Milk 384 355 29 Mustard 21 20 1 Olive Oil 6 6 — Pepper 19 19 — Rice 4 4 — Salad Oil 3 2 1 Vinegar 32 31 1 Vinegar (Malt) 42 31 11 Total 750 704 46 The 750 include 1 informal sample of butter. Prosecutions were undertaken in respect of 33 of the 46 samples which were reported as being adulterated. These are set out in the following table (page 33):— Inspections Made and Samples Taken under the Orders of the Food Controller, 1919. Samples. Mr. West. Mr. Rackham. Mr. Brown. Mr. Dillon, Mr. Akers. Mr. Walker. Mr. James, Mr. Jaffa. Mr. Lonnon. Mr. Pottier. Mr. Adkins. Mr. Thompson. Mr. Auger. Mr. Child. All Inspections. In accordance with order. Jn contravention of order. Warning letters sent. No. of prosecutions. Result of Proceedings, Fines. Costs. £ s. a. £ s. d. Ale — — — — — — — — — — — — 10 17 27 24 3 _ 3 65 0 0 10 10 0 Apples — — 3 6 5 — 4 — — — — — — 18 17 1 1 0 10 0 1 1 O Bacon — 1 9 — 8 4 — 6 I — — — — — 29 27 2 — 2 11 0 0 4 4 0 Beans — 10 12 10 10 8 6 15 5 2 1 — 79 79 — — — — Beer — — — — — — — — — — — — 16 13 29 24 5 — 5 14 0 0 6 5 0 Brandy — — — — — — — — — — — — 4 — 4 4 — — — — — Bread — — — — — — — — — — — — 36 53 89 80 9 — 9 21 10 0 13 13 0 Butter — — — 1 — 1 — — 1 — — — 3 — 6 6 — — — — — Cheese — 2 7 2 1 4 2 7 5 — — — — — 30 29 1 1 — — — — Cocoa — 105 47 34 53 72 68 45 116 29 12 4 55 — — 748 747 1 1 — — — Cocoanut — — — — — 1 — — — 1 — 1 — — 3 3 — — — — — Coffee — 32 25 17 24 25 27 39 15 l6 17 15 — — 252 240 12 7 5 10 3 0 9 9 0 Currants — 20 26 9 15 24 31 30 13 17 13 42 — 240 239 1 — 1 2 0 0 2 2 0 Dates — 1 — 2 2 5 — — 1 — 1 — 12 12 — Dripping — 4 3 6 6 1 12 4 2 8 1 47 46 1 1 _ Eggs — 17 10 12 18 18 14 12 3 — — 2 106 105 1 1 I1 0 0 2 2 0 Figs — — 2 1 — 1 1 — — — — 5 2 3 3 — _ Fish — — — 1 — — — — 11 12 12 — — — — — Flour — 77 67 88 61 67 90 33 51 19 54 47 35 60 749 736 13 8 5 4 5 0 7 7 0 Fruit (Dried) — 1 1 1 — — — 5 1 2 — 2 — — 13 12 1 — 1 0 10 0 0 10 6 Gin — — — — — — — — — — — — 19 4 23 15 8 5 3 38 0 0 10 7 0 Grape Nuts — — — — — — 1 — — — — — — — 1 1 — — — — — — Jam — 42 59 36 57 50 62 60 31 5 25 49 1 477 443 34 22 12 18 10 0 21 0 0 Lard — 1 14 3 1 3 2 5 1 — — — — — 30 29 1 — 1 5 0 0 1 1 0 Lentils — — 1 — — — 1 — — — — — — — 2 2 — — — — — Margarine — 2 — 4 4 3 2 1 — — — — — 26 42 42 — — — — — Meat — — 1 — — — — _ — — 128 96 225 203 22 6 16 263 4 0 43 1 0 Milk — — — — — — — — — 1 82 83 77 6 4 2 6 0 0 1 0 0 Milk ( Tinned) — 72 76 30 76 54 109 97 83 35 77 68 2 779 774 5 2 3 2 10 0 3 3 0 Oatmeal — 4 6 26 6 6 6 3 1 2 1 — — — 61 59 2 2 — — — Oats — 3 25 13 5 6 3 24 11 — 14 104 104 — — — — — Onions — 11 6 1 4 10 — — 7 1 1 — — — 41 38 3 — 3 1 10 0 3 3 0 Oranges — — — 1 — — — — — — — — 1 1 — — — — — Peaches — — — — — — — — — 1 1 2 2 — — — — — Peas — 6 2 5 12 9 10 1 3 1 2 — 51 51 — — — — — Potatoes — — 2 1 — — — — — — — — — — 4 3 1 1 — Poultry — — _ — — — — — — 6 — 6 4 2 — 2 12 10 0 6 10 0 Prunes — — 5 — 1 1 4 1 1 8 8 — — 29 29 — — — — Raisins — 4 5 — 4 2 1 4 8 1 7 20 — — 86 56 — — Rice — 107 93 85 106 69 84 75 77 44 97 80 — — 917 906 11 5 6 3 15 0 5 5 0 Run — — — — — — — — — — — 24 9 33 22 11 7 4 5 11 0 8 7 0 Salmon — 65 80 135 62 45 105 123 63 31 50 30 — — 789 741 48 25 23 26 16 0 27 16 6 Sardines — 18 4 4 13 7 13 — 34 1 6 4 — — 104 99 5 2 3 2 0 0 4 4 0 Suet — 7 8 2 13 7 9 1 6 4 5 10 — 1 73 68 5 3 2 1 11 0 3 3 0 Saltanas — 5 6 4 2 1 1 — 4 1 3 5 — — 32 32 — — — — — Sugar — — — — 3 1 — 2 — — — — — 1 7 7 — — — — — Sweets and Chocolates — — 9 2 — — — 2 3 — — — 10 15 1 — 1 1 0 0 2 2 0 Syrup — — 7 — — — — 4 2 4 3 — 20 20 — — — — — Tea — — — — — — 2 6 — — — — 8 8 — — — Whiskey — — — — — — — — — — — — 122 153 275 186 89 22 67 441 5 6 231 5 0 Sundries — — — 2 — — — — 1 1 — — 1 — 5 5 — — — — — Total samples purchased — 617 621 543 572 504 662 6.9 542 231 504 454 405 531 6794 6486 308 127 181 959 0 6 428 11 0 Total visits made 697 580 699 598 580 500 527 494 226 239 393 367 746 990 76.6 Other Prosecutions :— Failing to keep Records 3 2 0 0 2 2 0 „ display Notice 13 11 16 0 7 7 0 „ Legibly Mark Prices • 14 27 0 0 13 6 0 Waste of Foodstuffs Selling without authority 1 25 0 0 5 5 0 1 0 10 0 1 1 0 Refusing to Sell 1 20 0 0 2 2 0 Selling in Saloon Bar bu» not in Public Bar Failing to keep Open 8 17 2 0 24 18 0 1 — 8 8 0 ' 223 1062 8 6 493 0 0 33 Summonses—Under the Sale of Food and Drugs Acts. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. 1919. £ s. d. £ s. d. A. 4 Milk Deficient in milk fat, 10 per cent. 14th Jan Summons Warranty dismissed proved A. 14 ,, 9.3 „ 21st Feb. 3 0 0 — A. 1S Mustard Added starch, 8 per cent. 14th March 2 10 0 1 0 0 A. 36 Milk Added water, 37.1 per cent. 14th „ 5 0 0 2 2 0 A. 43 ,, ,, 19.1 14th „ A. 37 ,, ,, 27.7 14 th ,, A. 42 „ ,, 16.4 ,, 14th ,, C. 43 ,, ,, 13.6 „ 15th April 2 10 0 2 6 6 C. 44 ,, ,,12.4 „ 15th „ 2 10 0 — C. 45 ,, ,, 15.7 15th „ 2 10 0 — C. 46 ,, ,, 12.0 15th ,, 2 10 0 A. 64 ,, Deficient in milk fat, 6.6 per cent. 24th — 0 10 6 C. 105 ,, Added water, 12.9 per cent. 22nd May Warranty relied upon 3 3 0 A. 122 ,, Deficient in milk fat, 6.6 per cent. 15th July — 2 2 0 A. 135 ,, ,,6.0 „ 25th „ 2 0 0 110 C. 158 ,, Added water, 4.7 per cent. 19th „ 2 0 0 0 10 6 Obstructing the Inspector in the course of his duties 19th ,, 5 0 0 or 1 month's A. 160 ,, Deficient in milk fat, 34.6 per cent. 27th „ imprisonment Summons upon defence in default dismissed of Warranty C. 174 ,, ,, 8.6,, 19th ,, 5 0 0 0 10 6 C. 176 ,, Added water, 8.4 per cent. 19th Aug 2 0 0 0 12 6 A. 206 Salad Oil Added mineral oil, 30 per cent. 24th „ 5 0 0 — C. 204 Milk Added water, 13.2 per cent. 19th Oct. 3 3 0 C. 242 ,, ,, ,, 19th „ Summons Defendant not served gone away C. 249 ,, ,, ,, 19th „ 2 0 0 0 10 6 A. 251 ,, Deficient in milk fat, 5 per cent. 14th Nov. 2 0 0 0 10 6 A. 257 Malt Vinegar Vinegar, other than malt vinegar, 100 per cent. 14th „ 3 0 0 0 10 6 A. 261 „ ,, ,, ,, 2nd Dec. — 0 12 6 C. 287 ,, ,, ,, ,, 12th ,, 0 10 0 1 1 0 C. 295 ,, ,, ,, ,, 2nd ,, 10 0 0 1 1 0 C. 306 ,, ,, ,, ,, 2nd ,, 5 0 0 1 1 0 C. 336 Milk Added water, 15.7 per cent. 2nd „ Summons Defendant not served gone away A. 309 „ ,, ,, ,, 1st „ 2 0 0 — A. 310 ,, ,, ,, ,, 1st „ 2 0 0 A. 311 Malt Vinegar Vinegar, other than malt vinegar, 100 per cent. 1st „ 3 0 0 — ADMINISTRATION OF THE FOOD CONTROLLER'S ORDERS. The male Sanitary Inspectors continued during 1919 to make the necessary inspections and purchases of samples, under the supervision of the Medical Officer of Health as Enforcement Officer of the St. Pancras Local Food Control Committee, for the purpose of securing the enforcement of these Orders. This work has been done mainly after ordinary working hours. The details are set out in the table inset. 34 Section IV—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1919 is shown in the table below, where thev are also classified according to ages. The figures have not been corrected for subsequent revision of diagnosis. DISEASES. At all Ages. At Ages—Years. Under 1. I and under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. I. Variola or Small-pox 10 1 — 2 1 2 4 2. Scarlatina or Scarlet Fever 558 4 114 246 128 45 21 3. Diphtheria and Membranous Croup 348 6 78 141 48 47 28 — 4. Typhus Fever — — — — — — — 5. Enteric or Typhoid Fever 7 — — — 3 1 2 1 6. Fever, Simple or Continued — — — — — — — — 7. Relapsing Fever — — — — — — — — 8. Puerperal Fever 13 — — — — 4 9 — 9. Erysipelas 134 5 4 6 7 8 87 17 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax — — — — — — — — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 10 2 1 1 — 2 4 — l6. Anterior Poliomyelitis 4 — 2 — 1 — 1 17, Ophthalmia Neonatorum 39 39 — — — — — 18. Encephalitis Lethargica 3 — — — — 1 2 19. Acute Primary Pneumonia 86 9 17 13 4 8 3o 5 20. Acute Influenzal Pneumonia 213 4 16 15 7 29 129 13 21. Malaria 98 — — — — 19 79 — 22. Dysentery 6 — — — — 1 5 — 23. Trench Fever 1 — — — — 1 — 24. Measles 034 53 487 424 29 22 19 — 25. German Measles 268 8 45 145 26 28 16 — 26.Tuberculosis :— Pulmonary 799 2 18 81 52 126 505 15 Other Forms 206 4 36 62 39 16 39 10 * Including all Primary .Notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms "A," "B," " C " or " D." SAINT PANCRAS, LONDON. WEEKLY NUMBER OF CERTIFIED DEATHS FROM THE DANGEROUS INFECTIOUS DISEASES DURING THE YEAR 1919. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals. Quarters Months January. February. March. April. May. June. July. August. September. October. November. December. Months Week Ending 4 11 18 25 1 8 15 22 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 6 13 20 27 .. Week Ending Number of Week 1 2 3 4 s 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 .. Number of Week Small Pox .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Small Pox Scarlet Fever .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Scarlet Fever Diphtheria and Memb. Croup 1 1 1 1 .. 1 1 .. .. 1 .. .. .. 1 2 .. .. .. 1 1 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 .. .. .. .. .. .. 1 1 .. .. 1 .. 21 Diphtheria and Memb. Croup Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 Enteric Fever Puerperal Fever .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 1 .. .. .. .. .. 9 Puerperal Fever Erysipelas .. .. .. .. .. .. .. .. 1 1 .. 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 9 Erysipelas Cerebrospinal Fever .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. 6 Cerebrospinal Fever Polio-Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Polio-Myelitis Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 5 Ophthalmia Neonatorum Dysentery .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 5 Dysentery Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 1 1 .. .. 1 1 2 .. 3 .. 1 .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 15 Measles Tuberculosis (Pulmonary) 7 11 5 5 4 7 11 6 10 6 3 5 6 3 5 5 8 5 6 6 5 5 7 4 1 5 9 3 5 4 3 1 6 5 7 2 3 3 6 3 4 4 9 5 2 2 3 2 10 6 6 4 268 Tuberculosis (Pulmonary) Do. Other Forms 2 .. 1 2 2 3 2 2 1 1 2 1 1 .. 2 2 2 3 .. 1 .. .. 1 3 4 .. 1 2 1 2 1 1 1 .. 1 2 2 2 .. 1 .. 2 4 1 3 2 2 2 1 1 .. .. 73 Do. Other Forms • Whooping Cough .. .. .. .. .. .. 2 .. • • 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 .. .. .. .. .. 7 Whooping Cough Diarrhoea and Enteritis 1 2 .. .. 3 1 2 2 • • .. 2 1 .. 3 1 1 .. 3 .. .. .. .. .. .. 1 .. .. .. .. 2 .. 1 1 .. 2 5 3 3 10 3 2 1 2 1 2 .. 1 2 2 2 .. .. 68 Diarrhoea and Enteritis SAINT PANCRA'S, LONDON. WEEKLY NUMBER OF INFECTIOUS CASES CERTIFIED TO THE MEDICAL OFFICER OF HEALTH DURING THE YEAR 1919. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals Quarters Months January. February. March. April. May. June. July. August. September. October. November. December. Months Week ending 4 11 18 25 1 8 15 22 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 6 13 20 27 .. Week ending Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 .. Number of Week Small-pox .. 2 .. .. 2 .. .. .. .. 3 2 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Small Pox Scarlet Fever 2 4 7 3 4 7 6 11 5 6 6 4 6 8 14 6 4 10 9 3 8 4 4 6 7 9 11 10 3 6 6 7 5 6 7 8 7 8 13 28 15 32 30 38 15 19 14 28 27 12 24 16 558 Scarlet Fever Diphtheria and Memb. Croup 15 9 11 14 6 4 4 14 4 4 5 9 7 6 4 5 5 3 4 1 5 8 5 5 4 1 5 11 6 10 6 5 4 5 6 1 3 6 10 11 7 3 8 13 6 4 8 15 8 6 12 7 348 Diphtheria and Memb. Croup Enteric Fever .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 • • 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 7 Enteric Fever Puerperal Fever .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. • .. .. 3 .. .. .. .. 2 .. .. .. 2 .. .. .. 13 Puerperal Fever Erysipelas 3 2 .. 1 2 1 4 .. 2 7 1 1 .. 5 2 2 4 2 2 2 2 1 .. 1 3 3 2 2 3 3 3 2 2 .. 4 2 3 3 3 3 3 4 5 2 4 8 3 5 3 5 3 1 134 Erysipelas Cerebrospinal Fever .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 10 Cerebrospinal Fever Polio-Myelitis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Polio-Myelitis Ophthalmia 1 .. .. 3 .. .. .. .. .. .. 1 .. .. 1 .. 1 .. 1 .. .. 3 1 1 2 1 3 .. 2 1 .. 2 .. 2 .. 1 2 .. 2 .. 2 .. .. 1 .. 1 .. 1 1 1 .. 1 .. 39 Ophthalmia Neonatorum Encephalitis 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Encephalitis Lethargica Primary Pneumonia .. .. .. .. .. .. .. .. .. 2 5 5 2 7 3 1 .. 1 2 .. 1 1 .. 1 2 1 1 1 2 1 1 1 2 2 4 1 3 .. .. .. 2 6 2 4 2 1 2 5 3 2 1 3 86 Primary Pneumonia Influenzal Pneumonia .. .. .. .. .. .. .. .. .. 76 29 15 11 9 12 9 8 2 5 3 2 2 .. 1 .. .. .. .. .. 2 .. 1 .. .. .. .. .. 1 1 6 3 4 3 3 1 .. 1 2 .. 1 .. 213 Influenzal Pneumonia Malaria .. .. .. .. .. .. .. .. .. .. 1 .. 2 .. 2 .. 3 .. 1 3 4 .. 5 2 2 1 2 6 5 2 1 3 4 1 6 5 4 2 1 4 1 3 .. 8 4 4 2 1 2 .. .. 1 98 Malaria Dysentery .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. 6 Dysentery Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Trench Fever Measles 9 3 7 11 1 3 4 2 2 3 5 4 5 6 12 11 17 19 22 24 26 27 39 36 70 47 64 58 75 56 53 46 40 31 16 15 7 10 6 9 9 10 9 11 14 8 8 12 4 21 14 13 1034 Measles German Measles 2 3 3 .. 2 4 2 4 1 9 7 7 10 3 6 11 3 8 8 23 16 9 11 3 9 7 7 8 2 2 3 4 2 2 2 1 1 2 .. 3 1 3 3 5 3 1 10 7 9 8 7 1 268 German Measles Tuberculosis 13 11 34 16 12 20 17 29 18 19 24 23 23 12 21 11 11 12 29 22 18 21 20 7 14 7 18 19 10 19 9 13 8 16 23 10 17 8 13 9 4 13 4 9 33 12 18 9 15 13 5 8 799 Tuberculosis (Pulmonary) Tuberculosis (Other Forms) .. 6 6 2 5 6 .. 5 4 6 6 5 5 4 8 6 • • 6 2 4 5 4 3 3 8 5 7 6 1 2 2 4 .. 4 5 1 12 4 4 2 3 3 3 4 9 4 2 3 1 1 2 3 206 Tuberculosis (Other Forms) 35 In the accompanying tables (inset) are shown the number of notifications of the notifiable infectious diseases received in each week of the year, and also the corresponding weekly number of deaths from these and certain other diseases. In the following table the number of notifications are set forth for the past 10 years : — Diseases. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Small-pox — — — — — — — — — — 10 Scarlet Fever 774 681 445 595 568 1207 1009 448 246 332 558 Diphtheria and Membranous Croup 315 262 419 550 440 458 446 424 451 399 348 Typhus Fever — — — — — — — — — — — Enteric or Typhoid Fever 50 61 66 29 41 44 36 38 24 17 7 Fever, simple or continued — — — — 1 1 — 1 — — — Relapsing Fever — — — — — — — — — — — Puerperal Fever 15 14 16 20 11 18 14 18 9 5 13 Erysipelas 160 186 201 190 210 223 202 120 126 121 134 Cholera — 1 — — — — — — — — — Plague — — — — — — — — — — — Hydrophobia — — — — — — — — — — — Anthrax — — — — — — — 1 — 1 — Glanders — — — — — — — — — — — Cerebrospinal Meningitis 6 10 7 3 5 2 40 23 25 13 10 Anterior Poliomyelitis — — 2 3 9 3 8 9 1 1 4 Ophthalmia Neonatorum •• • • 26 18 23 34 31 38 31 40 39 Chicken-pox • • • • 198 • • • • • • 247 •• • • 401 • • Measles • • • • • • • • • • • • • • 1855 3681 2144 1034 German Measles • • • • • • • • • • • • • • 381 609 311 268 Encephalitis Lethargica • • • • • • • • • • • • • • • • • • • • 3 Acute Influenzal Pneumonia • • • • • • • • • • • • • • • • • • • • 213 Acute Primary Pneumonia • • • • • • • • • • • • • • • • • • • • 86 Malaria • • • • • • • • • • • • • • • • • • • • 98 Dysentery • • • • • • • • • • • • • • • • • • • • 6 Trench Fever • • • • • • • • • • • • • • • • • • • • 1 Tuberculosis— Pulmonary 936 872 1464 1735 928 893 933 735 825 1034 799 Other Forms 230 121 150 138 169 203 206 36 The notifications of, and deaths from, the notifiable infectious diseases, are classified in the following table according to their Wards and Registration Sub-Districts:— INFECTIOUS DISEASES. Notifications. Deaths. West. Ward South. Ward East. Ward North. Ward .No Address. W hole Borough. West. Ward South. Ward East. Ward North. Ward .No Address. Whole Borough. 4 5 7 8 3 6 1 2 4 5 7 8 3 6 1 2 1. Variola or Small-pox 1 •• •• 2 1 •• 6 •• •• 10 •• •• •• •• •• •• 1 •• •• 1 2. Scarlatina or Scarlet Fever 48 112 40 81 77 33 55 102 •• 558 •• •• 2 1 1 1 •• •• •• 5 3. Diphtheriaand Membranous Croup 42 48 22 44 56 24 54 58 •• 348 3 .. •• 6 4 4 3 1 •• 21 4. Typhus Fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 5. Enteric orTyphoid Fever 1 1 1 •• •• •• 4 •• •• 7 1 •• •• •• •• 1 •• •• •• 2 6. Fever, Simple and Continued •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 7. Relapsing Fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 8. Puerperal Fever 1 2 1 2 4 1 2 •• •• 13 1 •• 2 5 1 •• •• •• 9 9. Erysipelas 13 18 5 25 25 19 13 16 •• 134 2 1 •• 3 1 1 •• 1 • • 9 10.Cholera •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 11.Plague •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 12.Anthrax •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 13.Glanders •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 14.Hydrophobia •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 15- Cerebrospinal Meningitis* •• 1 •• 2 2 4 •• 1 •• 10 1 1 •• •• 3 •* •• 1 •• 6 16. Anterior Poliomyelitis •• 1 •• •• 2 1 •• •• •• 4 •• •• •• •• 1 •• •• •• •• 1 17, Ophthalmia Neonatorum 5 5 4 5 6 4 7 3 •• 39 1 •• 1 •• 1 •• 2 •• •• 5 18. Encephalitis Lethargica •• 1 •• •• 1 •• 1 •• •• 3 •• •• •• •• •• •• •• •• •• •• 19. Acute Primary Pneumonia 15 10 6 11 6 13 14 11 •• 86 •• •• •• •• •• •• •• •• •• •• 20. Acute Influenzal Pneumonia 25 56 9 13 60 29 23 18 •• 213 •• •• •• •• •• •• •• •• •• •• 21. Malaria 8 14 3 5 37 13 9 9 •• 98 •• •• •• •• •• •• •• •• •• •• 22.Dysentery •• •• •• 1 1 3 •• 1 •• 6 •• 1 1 •• 1 •• 1 •• 1 5 23.Trench Fever •• •• •• •• •• •• •• 1 •• 1 •• •• •• •• •• •• •• •• •• •• 24. Measles 78 378 81 70 217 96 48 66 •• 1034 1 4 .. •• 2 5 •• 3 •• 15 25. German Measles 27 33 21 63 23 18 54 29 •• 268 •• •• •• •• •• •• •• •• •• •• 26. †Tuberculosis:— Pulmonary 115 115 61 107 104 91 114 62 30 799 35 33 21 37 38 27 28 30 10 268 Other Forms 27 31 5 28 35 30 29 15 6 206 7 9 4 13 10 12 12 5 1 73 • Includes two deaths from Posterior Basic Meningitis. t Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912, 011 Forms] A, B, C, or D. 37 DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in following table: — Disease. No. of Cases. No. of Houses. No of Rooms 1 Contents Disinfected or Destroyed. j No. of Rooms Sprayed and Fumigated. Small-pox 11 10 10 19 Scarlet Fever 514 508 621 617 Diphtheria 823 818 359 361 Enteric Fever 10 10 8 8 Erysipelas 78 78 55 32 Puerperal Fever 11 11 9 7 Cerebro-spinal Meningitis 7 7 7 7 Consumption 70 70 69 70 Measles 41 41 42 33 Cancer 37 37 33 24 Vermin and Scabies 149 149 120 20 Other Diseases 120 123 101 100 Totals 1371 1362 1434 1298 Below is shown the number of articles destroyed or disinfected during the year on account of infectious disease and verminousness :— Infectious Disease Verminousness. Destroyed. Disinfected. Destroyed. Disinfested Beds, mattresses and palliasses 17 1076 5 157 Bolsters and pillows 12 3141 3 211 Sheets, blankets and counterpanes 9 4881 1097 Rugs, mats, cushions, carpets, covers, and curtains 4 947 1 72 Wearing apparel 4 2296 — 80 Books 9 45 — — Sundries 5 617 — 53 Total 60 13503 9 1670 These figures include 671 blankets, rugs, and covers, 12 beds and mattresses, 152 bolsters, counterpanes and sheets, 12 pillows, and 96 articles of wearing apparel and sundries which were disinfected on account of verminousness for the military authorities, or for voluntary bodies (such as the Salvation Army) who provide accommodation for soldiers. The tables above are exclusive of the disinfection of the clothing of persons attending the cleansing station for vermin or scabies. 38 The following table shows the number of persons cleansed and disinfected after having been in contact with infectious disease :— Males. Females. Children under 10. Scarlet Fever 3 2 — Puerperal Fever — 5 — Small Pox 1 2 — Cleansing station. The amount of work done here during the year is indicated in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. Men. Women. Children under 15. Total. St. Pancras Cases Vermin 380 7 1415 *1802 Scabies 50 51 2333 2434 Cases from outside St. Pancras Vermin 10 2 525 537 Scabies — — 893 893 Vermin 390 9 1940 2339 Scabies 50 51 3226 3327 Total 440 60 5166 5666 * Includes 158 males and 2 females who had no home address. The school children included in the above table have in the main been brought to the cleansing station from the Public Elementary Schools by officials of the London County Council as the Education Authority under the powers conferred upon them by their General Powers Act, 1904, Sec. 36, and the Children Act, 1908, Sec. 122. A sum of one shilling per bath is paid by the County Council to the Borough Council, according to an agreement between the two Authorities, and 5127 baths were paid for on this scale during the year. 12 verminous persons from common lodging houses outside the borough were paid for by the London County Council at the rate of 1s. per attendance. TUBERCULOSIS. The number of notifications of civilian cases of tuberculosis received during 1919 are set out in the following table, in the form required by the Ministry of Health ;— 39 Public Health (Tuberculosis) .Regulations, 1912. Summary of Notifications during the period from 30th December, 1918, to the 27th December, 1919 (inclusive). Age Periods. Number of Notifications on Form A. Number of. Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. Total Notifications including cases previously notified by other Doctors), Primary Notifications. Total Notifications including cases previously notified hy other Doctors). Poor Law- Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10 10 to 15 Total, Pulmonary—Males 1 7 22 15 15 26 92 62 45 3J 5 32 347 3 22 6 31 34 110 131 62 103 ,, Females — 3 19 4 35 33 68 39 33 21 5 270 289 1 13 12 26 34 73 61 42 59 Non-pulmonary—Males 1 14 17 12 3 2 6 4 3 2 7 71 76 2 10 6 18 23 22 9 13 4 „ Females 2 18 13 10 4 4 6 2 3 3 3 68 73 1 16 5 22 27 *5 3 14 5 Totals 4 42 71 51 57 65 172 107 84 57 20 730 785 7 61 29 97 118 220 204 131 171 Age Periods. Number of Primary Notifications on Form C. included in above. Number of Primary Notifications on Form D. included in above. 0 to 1 1 to 5 5 to 10 10 to '5 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and Upwards. Total. Pulmonary—Males 1 3 1 3 3 2 18 16 20 3 2 82 - - - - - - 3 2 5 — — 10 „ Females — 1 3 2 5 4 10 9 12 2 2 50 — — 1 — 1 2 2 1 1 — 1 9 Non-pulmonary—Males 1 1 3 2 1 — 1 — 1 2 — 12 — — — 1 — — — — — 2 — 3 „ Females — — 3 2 2 — — 1 - 1 — 9 — — — 1 — — 1. — 1 — — 3 Totals 2 5 10 9 11 6 9 26 33 18 4 '53 — — 1 2 1 2 6 3 7 2 1 25 40 The number of primary notifications (civilian) received during the year on Forms A. B. C. and D. was 1,005 (799 pulmonary, 206 non-pulmonary) equal to a notification rate of 4.58 (3.64 pulmonary, 0.93 non-pulmonary) per 1,000 (civil) population. They are analysed for age and sex in the next table:— Primary Notifications during 1919. Ages. Pulmonary Tuberculous. Other Tuberculosis. Total all Forms. Males. Females. Total. Males. Females. Total. 0—1 2 - 2 2 2 4 6 1—5 13 5 18 17 19 36 54 5—10 45 36 81 30 32 62 143 10—15 24 28 52 21 18 39 91 15—25 46 80 126 6 10 16 142 25—35 113 80 193 7 7 14 207 35—45 80 49 129 4 3 7 136 45—55 70 46 116 4 4 8 124 55—65 44 23 67 6 4 10 77 65 upwards .. 7 8 15 7 3 10 25 Totals 444 355 799 104 102 206 1005 The deaths from tuberculosis during the year numbered 341, of which 268 were from phthisis and 73 from other forms of tuberculosis. They are analysed for age and sex in the following table:— Deaths from Tuberculosis during the Year 1919. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0-1 2 — 2 5 — 5 7 1—2 1 — 1 6 6 12 13 2—5 1 — 1 8 11 19 20 5—10 — 1 1 2 1 3 4 10—15 2 6 8 4 2 6 14 15—25 17 30 47 2 6 8 55 25-35 36 30 66 3 2 5 71 35—45 40 14 54 3 1 4 58 45—55 21 20 41 2 2 4 45 55—65 26 13 39 — 1 1 40 65—75 1 5 6 6 — 6 12 75—85 1 1 2 — — — 2 85 & upwards — — - — — — — Totals at all Ages 148 120 268 41 32 73 341 41 The figures are equal to a death rate of l oo (1*22 pulmonary, 0.33 nonpulmonary) per 1,000 (civil) population. The present sex constitution of the population is too uncertain to give precise rates for males and females, but it is evident that the incidence and mortality rates are greater amongst males than females. This difference, however, is less than was the case in recent years. In regard to age incidence, 73 per cent. of the deaths and 71 per cent. of the notifications were of persons aged from 15 to 55 years, so far as concerns pulmonary tuberculosis, while in regard to other forms of tuberculosis, 62 per cent, of the deaths and 68 per cent. of the new cases notified were of children aged 15 years or under. The deaths in 1919 are classified for age and sex in the following table:— 0-1 1-5 6-15 15—-25 25—35 35—45 45—55 55—65 65-75 75—85 85 up. Total Males. 0-1 1-5 5—15 15—25 25—35 35—45 45—55 55—65 65-75 75—85 85 up. Total Females. Total Persons. Pulmonary Tuberculosis 2 2 2 16 33 37 20 25 1 1 — 139 — — 7 28 29 13 19 11 5 1 - 113 252 Phthisis (not defined as tuberculous) - - - 1 3 3 1 1 — - — 9 - — - 2 1 1 1 2 — - - 7 16 Total Pulmonary Tuberculosis 2 2 2 17 36 40 21 26 1 1 - 148 - - 7 30 30 14 20 13 5 1 - 120 268 Acute Phthisis - - - - - - 1 - - - - 1 - - 1 2 - - - - - - - 3 4 Acute Miliary Tuberculosis — 1 - - — 1 — - 1 — - 3 - 2 — — — 1 — — - - — 3 6 Tuberculous Meningitis 4 10 3 - - 1 — - - — - 18 - 12 2 1 — — — - - — - 15 33 Tabes Mesenterica - - - - - - - - - - - - - - - 1 - - - - - - - 1 1 Other Peritoneal and Intestinal Tubercle 1 1 - - - - - - - - - 3 - 2 - - - - - - - - - 2 5 Tuberculosis of Spinal Column - - - - - - - - 1 - - 3 - - - - 2 - - - - - - 2 5 Tuberculosis of Joints - - - - - - - - 2 - - 4 - - - 1 - - - - - - - 1 5 Lupus Scrofula Tuberculosis of other Organs - 2 1 - - - 1 - 2 - - 6 - - - - - - 1 1 - - - 2 8 Disseminated Tuberculosis — — 2 1 — — — - - - 3 - 1 — 1 — - 1 - - - — 3 6 Total Non-Pulmonary Tuberculosis 5 14 6 2 3 3 2 6 - - 41 - 17 3 6 2 1 2 1 - — - 32 73 Total all forms of Tuberculosis 7 16 8 19|39 43 23 26 7 1 - 189 - 17 10 36 32 15 22 14 5 1 - 152 341 In the next table the new cases notified during 1919 are similarly classified. 42 Location of Disease. Ages Total. 0-5 5—15 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 15 5 69 64 360 286 799 Bones and Joints 2 4 14 16 20 14 70 Meninges 9 8 7 3 - 1 28 Glands 3 5 25 23 1 10 70 Abdominal 3 2 1 2 - - 8 Genito-Urinarv — - - - 1 - 1 General 1 1 1 - 2 1 6 Other Organs 1 1 3 6 7 5 23 Total Non-pulmonary Tuberculosis 19 21 51 50 34 31 206 Total all forms of Tuberculosis 34 26 120 114 394 317 1005 The following table shows the number of new notifications and deaths from Tuberculosis, together with the corresponding rates for the past ten years:— Year. Estimated Population. Primary Notifications. Deaths. Notification Bate. Death Rate. Phthisis. Other forms. All forms. Phthisis. Other Forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms All forms. 1910 237247 872 872 297 76 373 3.68 1.25 •32 1•57 1911 237129 1464 1464 330 83 413 6.17 1.39 •35 1.74 1912 220353 1735 1735 326 75 401 7.87 1.48 •32 1.82 1913 218387 928 230 1158 325 67 392 4.17 1.03 5.20 1.49 •30 1.79 1914 218387 893 121 1014 365 67 432 4.09 ..55 4-64 1.67 .30 1.97 1915 218387 933 130 1083 398 102 503 4.27 .69 4-96 1.82 •47 2.29 1916 218387 735 138 873 310 83 423 3.36 .63 3'99 1.55 •38 1.93 1917 218387 825 169 994 353 91 444 3.78 .77 4'55 1.62 •42 2.03 1918 218387 1034 203 1237 403 82 485 4.74 .93 5-67 1.85 •37 2.22 1919 218387 799 206 1005 268 73 341 3.66 .94 4* 60 1.23 •33 1.56 43 St. Pancras Tuberculosis Scheme. The anti-tuberculosis work is divided between three authorities, viz:—the Borough Council, which provides the tuberculosis dispensaries and whose Medical Officer of Health receives the notifications of all cases of the disease and is the administrative tuberculosis officer; the London County Council which arranges (chiefly through other bodies) for the residential treatment of uninsured persons; and the London Insurance Committee which arranges for similar treatment for injured persons. The Metropolitan Asylums Board is also an important authority in connection with the actual provision and maintenance of institutions, and the Board of Guardians fulfil an important function in the provision of beds in the Poor Law hospitals. The notified cases are visited by the Horough Council staff, and all the work in connection with the cases, including the search for, and examination of contacts, rest with them until after the patient lias been examined by the Tuberculosis Officer at the dispensary and recommended for the institutional treatment. The treatment of the case then passes to a large extent out of the hands of the Borough Council staff and the decision as to the admission of the patient to an institution rests with the officers of the London County Council and London Insurance Committee: The effect of this division of work is that the initiative in regard to the direction and extension of the direct campaign against tuberculosis, especially in connection with the provision of institutions, is to a very great extent removed from the Borough Council and its Medical Officer of Health. The latter officer's position in relation to the selection of consumptive cases for institutional treatment, and the following up of their after-history is most unsatisfactory, and his work in this connection becomes largely controlled by the county authorities and therefore from his point of view mechanical. This is not in the best interests of the work. It should undoubtedly be performed by the officer who himself and through his staff has an intimate local knowledge of public health conditions: and this officer should be free to develop the work on his own lines, subject of course to the kind of control which is exercised by the central authorities in other public health work and which ought never to be such as to stifle initiative. Visiting Work.—The visiting work done during 1919 by the female visiting staff at the Town Hall was as follows:— Number of visits to homes of notified cases— (a) First visits 949 (b) Subsequent visits 1839 Number of cases in which disinfection was carried out 70 Attendances of visitors at the dispensaries 33 Other visits made for various purposes 31 In consequence of additional work required in connection with the care of tuberculous ex-service men and their families, Miss Parnell was appointed to the work of visiting consumptive cases in addition to Miss Blaxland. Both these ladies have also other duties in the department. Miss Bibby devoted a good deal of her time to co-ordinating and advisory work in connection with tuberculosis. 44 Tuberculosis Dispensaries.—The staff at the dispensaries in 1919 consisted of a tuberculosis officer and nurse at the St. Pancras Dispensary (including its Maiden Road branch) which serves the part of the borough lying north of Euston Road (wards 1 to 6), and a part-time tuberculosis officer and full-time nurse at the dispensary at University College Hospital which serves the part lying south of Euston Road (wards 7 and 8) together with the Borough of Holborn. The expenses of the dispensaries are re-imbursed sed by the Borough Council and through them by the Ministry of Health, the London County Council and the London Insurance Committee. During 1919 the work at St. Pancras Dispensary continued to be performed by a temporary tuberculosis officer who also had certain other duties at the dispensary. At the end of the year a full-time tuberculosis officer was appointed directly by the Borough Council for the position. The work done at the dispensaries in 1919 is shown in the following table:— Tuberculosis Dispensary at University College Hospital. Tuberculosis Dispensary at StPancras Dispensary 39, Oakley Square. Branch Tuberculosis Dispensary of St. Pancras Dispensary at 132, Maiden Road. Insured persons. Uninsured persons. Total. Insured persons. Uninsured persons. Total. Insured persons. Uninsured persons. Total. No. of new cases 78 54 132 167 247 414 9 112 121 No. found to be suffering from pulmonary tuberculosis 49 13 62 102 68 170 2 26 28 Ditto non-pulmonary do. a 7 10 7 11 18 1 8 9 Ditto non-tuberculous 11 20 31 20 29 49 1 13 4 No. in whom diagnosis was found to be doubtful 15 14 29 38 139 1 77 5 65 70 Total attendances 597 587 1184 772 2616 3388 27 1267 1294 No. of above attendances at which physical examinations and records were made 192 185 377 675 1442 2117 26 714 740 Home visits by Tuberculosis Officer 16 2 18 83 70 153 Included in Oakley Sq uare Ditto by Dispensary Nurse 322 311 633 52 192 244 23 152 175 No. of persons referred to the hospital to which this Dispensary is affiliated 9 7 16 8 10 18 - 12 12 No. of consultations with Medical Practitioners 1 - 1 1 - 1 - - - No. of written reports to:— (a) Public Authorities 118 67 185 526 384 910 10 118 128 (b) Practitioners 5 2 7 66 12 78 5 12 17 No. of Specimens of sputum examined 23 10 33 101 83 184 Included in Oakley Square 40 Treatment in Sanatoria, Etc. The number of applications made to London Insurance Committee for Institutional treatment was as follows:— Soldiers 55 Others 64 No. admitted to various Institutions was:— Soldiers 52 Others 56 No. of applications to London County Council 103 No. admitted 76 SMALLPOX. For the first time since 1904 cases of smallpox were reported in St. Pancras during the year. Ten cases in all were reported, and were removed to hospital. One other patient was removed who was found to be a case of chicken-pox. There was one fatal case. They occurred in three groups, us follows:— The first case (not counted to St. Pancras) was in a woman living at an apartment house in Burton Street, who fell ill on 25th December, 1918 (rash 28th December), while staying at an address in Battersea, from which she was removed straight to hospital on 31st December. Two other cases, a man (aged2l) and wite (aged 21), developed in the same Burton Street house on 31st December (rash prior to 6th January, 1919) and 2nd January (rash 5th January) respectively. All the contacts were promptly vaccinated and kept under observation, and there were no further cases in the locality. The outbreak was afterwards traced to an Australian soldier who slept at the Burton Street address on the nights of December 8th, 9th and 10th, and was found to have smallpox on 11th December. The second outbreak consisted of two cases in a tenement house in Dewsbury Terrace. The first case was a girl of 13, who fell ill on 1st January and developed a rash a few days later, and was diagnosed as suffering from chicken-pox. Her mother (aged 37) fell ill on 18th January (rash said to be first noticed on 22nd January). This case was diagnosed as chicken-pox, but on admission to the St. Pancras (North) Infirmary on 25th January was discovered by the Medical Superintendent (Dr. (Jhilcott) to be a case of smallpox, and was immediately sent off to the smallpox hospital. The daughter (the first case) was diagnosed by the medical officer of health and removed on 26th January. The contacts were vaccinated and kept under observation, and there were no further cases. No connection was traced between these cases and any previous ones in St. Pancras or elsewhere. The third outbreak numbered six cases in St. Pancras. The first (Countess Road) was in the person of the wife (aged 40) of one of the disinfectors who (i.e., the disnfector had on 27th January handled the infected bedding from the Dewsbury Terrace cases, but had not visited the infected house. The history was that she fell ill on 7th February, the rash being noticed on 11th February. She was seen by a doctor, who diagnosed fish poisoning. Her son (aged six months) afterwards sickened, the rash appearing on 25th February, and was diagnosed 46 by a doctor as chicken-pox; and her daughter (aged 9½) fell ill on 26th February, the rash being noticed on 2nd March, and was also diagnosed by the doctor as chicken-pox. A woman (42) living next door attended the first case in her illness, and sickened on 27th February, the rash appearing on 1st March). (She died in hospital on 9th March.) On 4th March the doctor in her case called in the Medical Officer of Health, who found her to be suffering from smallpox, as well as the three cases next door, of which he had not previously been informed in any way. The four were at once removed to hospital. A fifth case developed on 5th March (rash 7th March) in a girl aged six, living in Leverton Street, who had visited on February 22nd or 23rd the Countess Road house where the three cases occurred. Two resulting cases also occurred in neighbouring streets in Islington, and there was a sixth St. Pancras case in the person of a doctor (Dartmouth Park Road) who attended one of them (onset 4th March: rash 6th March: last attended 10th March), and was not re-vaccinated. He fell ill on 22nd March, developed the rash on 24th March and was removed to hospital on 26th March. All the contacts in this outbreak were re-vaccinated where possible and kept under observation in their homes. The offer of vaccination was refused in very few instances. The results of prompt vaccination and observation of all contacts in these outbreaks were most satisfactory. The history as to vaccination of the 10 cases was as follows:— Age Sex 1 21 M Vaccinated in infancy only. 2 21 F Unvaccinated until 2nd January, the date of onset of the smallpox. 3 13 F Unvaccinated. 4 37 F "Vaccinated in infancy and when aged about 20. 5 40 F Vaccinated in infancy only. 6 6 mths. M Unvaccinated. 7 9½ F Unvaccinated. 8 42 F Vaccinated in infancy only. 9 6 F Unvaccinated. 10 56 M Vaccinated in infancy only. 26 cases of smallpox were notified in the County of London during 1919, and two died. SCARLET FEVER. 558 (civil) patients were notified in 1919 as suffering from scarlet fever. Of these, 38 were afterwards found not to be suffering from the disease by medical superintendents of the Metropolitan Asylums Board, and 4 by other medical practitioners. The corrected number of scarlet fever cases (civil) notified was, therefore, 516, equal to an incidence rate of 2'35 per 1,000 civil population. The number of deaths from scarlet fever certified during the year was 5, equal to a death-rate of 0'02 per 1,000 civil population, and a case mortality of 0*97 per cent, of cases notified. 47 In the following table are set out the corresponding figures for the past 10 years:— Year. No. of Notifications. Notification rate per 1,000 population. No. of Deaths. Death rate per 1,000 population Case Mortality per cent. Percentage of Cases removed to Hospital. 1909 774 3.3 17 0.07 2.2 97 1910 681 2.9 17 0.07 2.0 96 1911 445 1.9 10 0.04 2.2 95 1912 598 2.7 5 0.02 0. 08 97 1913 536 2.4 6 0.03 *1.1 94 1914 1180 5.4 19 0.09 1.6 91 1915 900 4.1 22 0.10 2.4 96 1916 404 2.0 8 0.04 2.0 96 1917 224 1.2 4 0.02 1.8 97 1918 289 1.6 7 0.04 2.4 96 1919 516 2.3 5 0.02 1.0 96 * From 1913 onwards the figures have been corrected for errors of diagnosis. Of the notified cases of scarlet fever, 537 (or 96-2 per cent.) were removed to hospital, as follows :— To Metropolitan Asylums Board hospitals .. 526 To other hospitals .. .. 11 537 (Other statistical facts will be found on pages 34 to 36 j. After-care work amongst discharged cases of scarlet fever similar to that mentioned in the Annual Report for 1918 was continued during 1919. Return Cases.—(Definition :—A case of scarlet fever occurring within 28 days of the return from hospital to the same house of a previous case of scarlet fever). There were 13 such cases in 1919, occurring in 10 houses (there being three houses in each of which there were two cases following the return of a previous case from hospital). In 12 instances (9 houses) the return case or cases was in the same family as the (?) infecting case, and in one case in a different family in the same house. In five instances the (?) infecting case had nasal discharge after return from hospital, in two other instances otorrhcea, in one other instance a recurrence of scarlet fever, and in two cases no obvious signs of infectiousness. The intervals between the return of the (?) infecting case and the onset of the illness of the first or only return case were respectively 3, 3, 4, 5, 9, 10, 10, 14, 18 and 21 days. The second return cases began 1, 4 and 10 days respectively after the first return cases. There was, in addition, one case of scarlet fever occurring 33 days after the 48 return from hospital to the same family of a previous case, which suffered from "rheumatism" and a sore ear after return. There was also one case of scarlet fever occurring five days after the return from hospital to the same family of a previous case of diphtheria. The diphtheria case showed no signs of infectiousness. DIPHTHERIA. 348 (civil) patients were notified in 1919 as suffering from diphtheria or membranous croup. Of these 64 were afterwards found not to be suffering from the disease by Medical Superintendents of the Metropolitan Asylums Board, and 1 by other medical practitioners. The corrected number of diphtheria cases (civil) notified was therefore 283, ecpial to an incidence rate of 1.29 per 1,000 civil population. The number of deaths from diphtheria certified during the year was 21, equal to a death-rate of 0.09 per 1,000 civil population and a case mortality of 7.4 per cent, of cases notified. In the following Table are set out the corresponding figures for the past 10 years:— Year. No. of Notifications. Notification rate per 1,000 population. No of Deaths. Death rate per 1,000 population Case mortality per cent. Percentage of cases removed to hospital. 1909 315 1.3 28 0.12 8.9 93 1910 262 1.1 20 0.08 7.6 97 1911 419 1.8 37 0.15 8.8 94 1912 550 2.5 26 0.11 4.7 98 1913 *391 1.8 19 0.08 *4.9 97 1914 426 1.9 30 0.14 7.0 87 1915 311 1.7 24 0.11 6.3 95 1916 383 1.9 23 0.12 6.0 95 1917 381 2.0 25 0.13 5.5 99 191S 340 1.9 31 0.17 9.1 93 1919 283 1.5 21 0.09 7.4 97 * From 1913 onwards the figures have been corrected for errors in diagnosis. Of the notified cases of Diphtheria, 337 (or 96.8 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 333 To other hospitals 4 Other statistical facts will bo found on pages 34 to 36. 49 After-care work amongst discharged cases of Diphtheria, similar to that mentioned in the Annual Report for 1918, was continued during 1919. The same remark applies to the examination of household contacts with nasal discharge, with a view to the discovery of the nasal cases of the disease, which are probably responsible for a good deal of its spread. Return Cases.—(Definition: A case of Diphtheria occurring within 28 days of the return from hospital to the same house of a previous case of Diphtheria). There were two such cases in 1919 in two houses. In one the (P) infecting case had rhinitis and showed diphtheria bacilli, and the return case (in a different family in the same house) developed Diphtheria 6 days after its return. In the other instance the cases were in one family, the interval was 5 days, and the (?) infecting case had slight rhinitis. There was also a "return cage" of Diphtheria where the interval was 40 days. In this the (?) infecting case had suffered from Diphtheria and Scarlet Fever and had no discharges, and the "return case" was in the same family. In two instances cases of Diphtheria occurred a few days after the return from hospital to the same family of a case of Scarlet Fever. In both instances the (?) infecting case (S.F.) had rhinitis showing Diphtheria bacilli, and in one instance otorrhœa also. The return cas s occurred 5 days and 14 days respectively after the return of the corresponding S.F. cases. TYPHOID FEVER. 7 cases of Typhoid Fever were notified during 1919, of which 2 died, the case mortality being 29 per cent. Of these 5 were treated in Metropolitan Asylums Board Hospitals, 1 in a general hospital, and 1 at home. In one case the infection was contracted while the patient was in New York or on board an Atlantic liner, and in no other case could the source of infection be traced. One of the patients was a nurse. The number of cases of Typhoid Fever, corrected for errors of diagnosis, which have been notified since 1913, and the number of deaths which occurred amongst these is shown in the following Table, from which it will be seen that the disease has declined very much in the last few years:— Year. Cases notified. Fatal uses. Case Mortality per cent. 1913 26 6 23 1914 27 4 15 1915 16 8 31 1916 29 5 17 1917 17 5 29 1918 11 5 45 1919 7 2 29 50 ACUTE ANTERIOR POLIOMYELITIS. 4 patients were notified as suffering from poliomyelitis during 1919, of which one was afterwards found to have been wrongly diagnosed, the number of actual cases reported being therefore 3. One of these cases was fatal. The particulars of the cases were as follows:— G. C., male, aged 10. Ward 6 (E 4). Onset, shortly before Christmas, 1918. Notified March 26. No marked acute illness ; left arm only affected. Illness at home. Permanent wasting and paralysis of arm (March, 1920). E. C., female, aged 2. Ward 3 (E 2). Onset, August 20. Notified August 27. Fever, vomiting, convulsions, drowsiness; complete paralysis of both legs. Admitted to Great Ormond Street Hospital, August 23. March, 1920, right log quite recovered; left leg still weak and wasted above and below knee. W. E., male, aged 3 years and eight months. Ward 5 (W 3). Onset, August 24. Notified September 8. Sore throat, headache, drowsiness, vomiting; paralysis of both arms, right leg, muscles of neck and muscles of respiration, especially diaphragm. Hyperesthesia of right hip and thigh. Admitted to Great Ormond Street Hospital on August 28. Died August 31. P.M.— Acute inflammation of cervical region of cord and congestion of meninges. No cases of Polioencephalitis were reported. EPIDEMIC CEREBROSPINAL MENINGITIS. 10 patients were notified in 1919 as suffering from cerebrospinal meningitis, of which 3 were afterwards found to have been wrongly diagnosed. In addition, one case was reported after de .th, thougli never notified. The number of actual cases reported was therefore 8. Seven of the 8 cases were fatal, making a case mortality of 87.5 per cent. As far as could be ascertained, the recovery of the one non-fatal case was complete. One of the cases died in 1920, the deaths in 1919 being 6 in number, equal to a death-rate of 0.03 per 1000 (civil) population. Particulars in regard to the 8 cases are set out in the following table:— Date of Notification. Date of Onset. Date of Death. Age. Sex. Ward and District. Bacteriological Examination, etc, Jan. 17 Dec. 12 (1918) Jan. 2 6 F VI. E 5 No micro-organisms found in c.s. fluid. Post-basic meningitis found P.M. Apr. 5 Jan. 2 Mar. 16 2 F V. W 3 Meningococcus of type 2 cultured from c.s. fluid. No. P.M. Apr. 22 Mar. 1 Apr. 20 22 F III. E 3 Meningococci seen in c.s. fluid, no growth. No. P.M. Apr. 28 In Feb. May 20 42 M IV. W 2 Meningococci seen in c.s. fluid, no growth. May 19 May 5 — 30 F III. E 2 Meningococci seen in c.s. fluid, no growth. Aug. 28 Aug. 22 Aug. 28 28 M III. E 1 Meningococci found in brain, etc. Diagnosis confirmed P.M. — July 10 Aug. 17 1 mth. M III. E 3 Diagnosis of post-basic meningitis made P.M. No bacteriological examination. Dec. 12 Nov. 15 Jan. 22 (1920) 5 mth. M VI. E 5 Meningococci seen in c.s. fluid and cultured, Diagnosis confirmed P.M. 51 No connection between the cases and no source of infection was traced. Four of the cases were in one ward. Three of the cases were treated in the North-Western Hospital (M.A.B.), three in general hospitals, and one in the Infirmary (South). From 1913 the number of cases of cerebrospinal meningitis in the borough notified, or otherwise reported (corrected for errors of diagnosis, etc.), and the number of these cases which died, were as follows:— Cases notified. Fatal cases. Case mortality per cent. 1913 3 2 67 1914 3 2 67 1915 38 21 55 1916 20 12 60 1917 21 16 76 1918 9 8 89 1919 8 7 87 ENCEPHALITIS LETIIARGICA. This disease was made compulsorily notifiable throughout the country from 1st January, 1919. Five cases of the disease had been reported in St. Pancras in 1918. In the 52 weeks ended 27th December, 1919, 3 cases of encephalitis lethargica were notified. There were no deaths. (2 cases—one fatal—were reported during the remaining four days of. 1919, and are not included in this report). The particulars of the cases were as follows:— A. F. Male. Aged 21. Ward! (N2). 2nd Lieut, in R.A.F., Harlaxton,Lines. Came home on 19th December, 1918. Onset 21st December. Notified 1st January, 1919. Headache, lethargy, ptosis, diplopia, pupils unequal, mask-like and wretched facies, inability to whistle, difficulty in swallowing, paresis of right arm, steps slow and short, knee jerks very weak, slow mentality, slight tremor, marked constipation from first. Admitted R.A.F. Hospital 3rd January. Patient was in an aeroplane smash 6 months previously. Report on 2nd March, 1920—Working as bank clerk, irritable and passionate, bad memory, sleeps badly, tremor and weakness of right arm, now has to wear glasses. H. L. Male. Aged 45. Ward 5 (W 4). Motor works. Sore throat 16th December. 1918 (no membrane), followed by pneumonia. After 23rd December, pain in back, lethargy, ptosis, indistinct vision, pupils normal, no squint, facial paralysis, inability to swallow (nasal regurgitation—no diphtheria bacilli), delirium 2 weeks, some stiffness of neck. Notified 6th January, 1919. Report on 2nd March, 1920—Completely recovered, motor driving. E. P. Male. Aged 56. Ward 3 (E 1). Shopkeeper. Onsetevery gradual. Not well from 12th January. Great lethargy (would go to sleep in the midst of various actions), delirious, slight ptosis, no paralyses, but weakness, twitcliings and hiccough, mask-like face, tongue very dirty, constipation marked from first. Notified 4th February. Delirious during convalescence. Report on 25th February, 1920— Irritability ("can't sit still"), short memory, sleeps well, tremors, especially of right leg, no paralysis, sees well, but eyes "glare." 52 PNEUMONIA, MALARIA, DYSENTERY AND TRENCH FEVER. Malaria. All cases of this disease were compulsorily notifiable from March 1st, 1919. During the nine months 98 cases were notified. No deaths were recorded. Without exception the cases notified had contracted the infection abroad, and most of them on military service. There was no evidence whatever of spread of the disease or of any endemic cases. Every case has been visited, and such assistance and advice as was possible (including the arranging of removal to hospital in suitable cases) given in relation to the treatment and nursing of the patients. This also applies to the dysentery cases (see below). Dysentery. All cases of this disease were compulsorily notifiable from March 1st, 1919. During the nine months six cases were notified. Five deaths from dysentery were certified during the year. The fatal cases had not been notified, and it is probable that a number of imported cases of dysentery came under medical notice without having been notified. Without exception the cases reported had contracted the infection abroad, and there was no evidence of the spread of the disease. Trench Fever. This disease was compulsorily notifiable from March 1st, 1919. Only one case was reported, who had contracted his infection on military service abroad. There were no deaths. Pneumonia. Cases of Acute Primary Pneumonia and Acute Influenzal Pneumonia were compulsorily notifiable from March, 1919. In the nine mouths there were notified 86 cases of the former and 213 of the latter. There is reason to believe that the notification of these diseases is by no means complete, and this is largely due to the fact that in so many instances it is not clear to the medical attendant whether the case is to be regarded as one of "acute primary" or "influenzal" pneumonia on the one hand or of a kind of pneumonia which is not included in these terms,, and is consequently not " notifiable " on the other. Of the notified cases of Primary Pneumonia a considerable proportion were notified after they have been admitted to hospital. In regard to influenza as a cause of pneumonia, reference may be made to page 53 of this report. During the year there were 179 deaths ascribed to Broncho-Pneumonia, Lobar Pneunlonia, and Pneumonia (unqualified). Every case notified has been visited, and such assistance given as the case seemed to require. In this connection we have been able to arrange for help through the local district nursing associations and the St. Pancras Home Helps Committee, payment being made to these bodies by the Borough Council, and in some cases removal to the Infirmaries. 53 OTHER NOTIFIABLE INFECTIOUS DISEASES. Puerperal fever, ophthalmia neonatorum and measles (as well as whooping cough) are dealt with on pages 76, 77 and 78. No cases of typhus, cholera, plague, or human anthrax, glanders or hydrophobia were reported in St. Pancras in 1919. As usual, persons who had been in contact with smallpox and other dangerous diseases (mostly on shipboard) were reported and kept under observation, with negative results in all cases. INFLUENZA. The tremendous epidemic of influenza involved St. Pancras with the rest of London in 1318, and was reported on in the annual report for that year. It continued to a less extent in 1919, but was practically over by the middle of the year. 260 deaths were certified during 1919 as due to Influenza. In the table on the next page the deaths from influenza, heart diseases, bronchitis, pneumonia and pulmonary tuberculosis will be found for each week in 1918, 1919, and the first half of 1920. The two inserted graphic charts may also be consulted. DIARRHŒA AND ENTERITIS. 68 deaths from diarrhoea and enteritis were registered during 1919, equal to a death-rate of 0.30 per 1,000 population. Of these, 55 were in children under five years of age, and 47 in babies under one. Reference is made on page 79 to infantile diarrhœa. SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1919 as due to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are believed by most experts to be late manifestations of the disease, and (c) aortic aneurysm, which many authorities now consider to be at any rate frequently caused by it:— 0-1 1-5 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 up. Total Males. 0-1 1-5 5-15 15—25 25 -35 35-45 45—55 55-65 65—75 75—S5 85 up. Total Females. Total Persons. Syphilis 9 2 — — — 1 — 1 — — — 13 2 — — — — — — — — — — 2 15 Locomotor ataxy — — — — — — — — — — — 4 — — — — — — — — — — — 1 5 General paralysis of the insane — — — — — 2 1 — — — — 3 — — — — 1 2 — — — — 3 6 Aortic aneurysm — — — — 1 2 3 2 2 — — 10 — — — — — — — — — — — — 10 54 Deaths from Influenza, Heart Disease, Bronchitis, Pneumonia, and Pulmonary Tuberculosis reported in each week in 1918, 1919, and the first half of 1920. Week No. 1918 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. Week No. 1919 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. Week No. 1920 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. 1 — 13 8 9 5 1 1 9 4 2 7 1 - 6 6 - 7 2 — 14 8 5 12 2 3 9 3 — 11 2 — 6 8 4 5 3 — 12 6 13 10 3 2 3 6 2 5 3 2 3 6 4 2 4 — 12 — 8 7 4 1 12 6 7 5 4 4 7 5 5 3 5 1 10 2 3 6 5 4 12 10 8 4 5 — 8 2 7 3 6 1 10 7 3 5 6 6 7 11 6 7 6 2 10 9 9 4 7 — 6 4 4 4 7 22 11 25 12 11 7 1 8 13 7 3 8 — 5 4 4 10 8 40 13 31 26 6 8 1 8 8 9 5 9 — 11 3 4 7 9 51 7 27 18 10 9 1 11 6 10 2 10 — 8 6 11 6 10 30 10 12 5 6 10 — 12 7 5 4 11 — 7 6 9 4 11 33 13 14 9 3 11 3 8 10 10 7 12 — 6 10 6 6 12 12 10 12 6 5 12 1 8 7 5 9 13 — 5 5 3 9 13 7 14 7 2 6 13 2 10 9 7 10 14 — 5 5 4 9 14 4 5 6 1 3 14 4 8 4 3 5 15 — 4 5 14 8 15 7 10 5 2 5 15 5 8 6 0 5 16 — 11 4 8 7 16 4 13 5 1 5 16 5 5 7 10 4 17 1 11 3 4 6 17 3 2 3 3 8 17 2 11 6 6 10 18 — 8 1 5 5 18 5 7 4 5 5 18 — 7 4 7 3 19 — 5 3 4 5 19 2 4 5 2 6 13 3 11 6 2 6 20 — 11 1 3 9 20 1 6 2 3 6 20 — 10 6 4 6 21 — 9 4 2 10 21 1 4 2 — 5 21 1 6 2 — 5 22 — 3 2 2 6 22 1 5 2 1 5 22 — 3 6 — 4 23 — 5 1 5 10 23 — 11 — 2 7 23 2 5 1 — 5 24 — 3 2 3 7 24 — 4 2 1 4 24 — 4 — 1 3 25 — 6 4 4 11 25 1 5 2 1 1 25 — 4 1 2 1 26 2 7 2 7 5 26 — 6 — — 5 26 — 7 2 4 0 27 8 8 3 2 13 27 — 1 — 2 9 28 21 5 1 11 9 28 — 7 3 1 3 29 8 7 2 9 4 29 — 4 5 — 5 30 6 7 2 5 9 30 2 — 3 — 4 31 1 6 2 2 2 31 — 3 3 — 3 32 1 4 2 3 10 32 — 6 — 1 1 33 2 7 — 1 1 33 1 3 2 3 6 34 — 2 — o 6 34 1 8 2 4 5 35 3 4 1 1 2 35 — 4 1 2 7 36 3 4 1 5 3 36 — 3 — 3 2 37 3 5 1 — 5 37 — 4 2 — 3 38 — 7 1 3 9 38 — 4 1 1 3 39 2 3 1 5 8 39 1 3 — — 6 40 3 7 5 6 3 40 1 5 4 1 3 41 10 3 5 10 2 41 1 9 7 2 4 42 31 13 6 15 12 42 2 6 7 2 4 43 99 12 15 28 12 43 3 11 7 4 9 44 144 17 12 19 12 44 1 3 7 6 5 45 111 10 10 20 13 45 — 10 8 3 2 46 71 7 15 15 19 46 2 8 6 3 2 47 49 10 10 10 13 47 — 10 4 1 3 48 46 9 7 17 12 48 — 7 7 3 2 49 34 5 13 11 4 49 1 5 4 3 10 50 16 7 6 3 10 50 1 10 6 3 6 51 9 8 6 6 7 51 — 10 4 1 6 52 10 3 4 5 14 52 2 4 2 5 4 Chart shewing the total number of Deaths occurring from Influenza during each year from 1857 to 1919. Chart shewing the weekly number of Deaths occurring from(A) Influenza, and (B) Diseases of the Heart, Bronchitis,Pneumonia and Pulmonary Tuberculosis, during 1918 and I9I9.anotheFirstSixMonthsof1920. Deaths from Influenza are indicated by the thick line Deaths from Diseases of the Heart, Bronchitis, Pneumonia and Pulmonary Tuberculosis are indicated by the thin line 55 CANCER. 245 deaths were registered during 1919 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, sarcoma, &c. This is equal to a death-rate of 1.07 per 1,000 population, and 112 per 1,000 civil population. The sex distribution of the deaths and death-rates is shown in the following table:— Sex. No. of Deaths. Death-rates per 1,000 males or females living (based on 1911 Census). Males 114 1.07 Females 131 1.17 Both Sexes 245 1.12 Section V—MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 12, 13, 15 and 16 of this Report. The notifications of births received in 1919 numbered 4,053, including 3918 live births, a.s compared with 3824 births registered. Details in regard to the notifications will be found on page 62. The Borough Council have charge of all matters relating to maternity and children under school age with the exception of (1) tbe inspection of midwives and other activities of the supervising authority under the Midwives Acts; (2) the supervision of boarded-out Children under the Children Act.; and (3) the licensing and inspection of Lying-in Homes. These matters are dealt with by the London County Council, and there is consequently a division of executive responsibility between the two Authorities in regard to Maternity and Child Welfare to this extent. The outstanding characteristic of the St. Pancras Maternity and Child Welfare Scheme is the satisfactory fusion of the activities of the municipal and the voluntary elements. Until 1918 the official work of the Council had been confined to the administration of the Notification of Births Act, and the appointment of some four Health Visitors working from the Town Hall. Maternity and Child Welfare Centres had, however, been instituted and maintained by voluntary funds, and though the money was not derived from the rates the work was very largely guided by the Medical Officer of Health and his staff. Several of the Centres were in fact founded on his suggestions. In 1907 the St. Pancras School for Mothers was opened in Somers Town, largely owing to the influence of the late Dr. Sykes, then Medical Officer of Health, and was the prototype of tbe Centres which have since sprung up throughout the country. This was followed in 1912 by the North St. Pancras 56 School for Mothers, and in 1919 there were as many as 13 Centres at work in the Borough. In 1914 the purely voluntary system was departed from by the Treasury undertaking one-half of the approved expenditure of the Centres, and in October, 1918, the Borough Council itself assumed responsibility (subject to 50 per cent. grants from the Government) for (a) doctor's fees (b) salaries of Superintendents and Health Visitors, and (c) the sums paid by the Centres for the rent of their premises, and rates and taxes. The co-ordination between the Council and the voluntary agencies is secured by the composition of the Maternity and Child Welfare Sub-Committee, a Sub-Committee of the Public Health Committee, which is the Maternity and Child Welfare Committee, under the Maternity and Child Welfare Act, 1918, subject to an instruction that it is to consider the Report of the Sub-Committee before reporting to the Council on matters of Maternity and Child Welfare, except in case of urgency. The Sub-Committee at the end of 1919 consisted of 14 members of the Council, 18 representatives of Centres and Day Nurseries, and seven other co-opted members. (The composition has since been altered putting Council members in a majority). The Council is also represented by two members on the Committee of each of the subsidized Centres, and the Medical Officer of Health and members of his staff are also on nearly all of them. There is close co-ordination between the office of the Medical Officer of Health and the Centres. The visitors at the Centres carry out a considerable part of the initial visiting following upon the notification of births, being supplied by the Medical Officer of Health with case papers with the names and addresses. Copies of these case papers are afterwards kept by the Medical Officer of Health, and are entered up from time to time from the case papers kept at the Centres. These records, with those of the Town Hall visitors, enabled a card index file to be kept of all children whose births have been notified in St. Pancras, and it is hoped to keep the records entered up until the children reach school age. There is similar exchange between the Town Hall and the Centres in regard to expectant mothers whose names are obtained from University College Hospital and the Middlesex Hospital. There is close co-operation also between the Town Hall and the Centres in connection with the Council's scheme under the Milk (Mothers and Children) Order referred to below. In addition to Health Visiting and the Maternity and Child Welfare Centres the Council's scheme also provides for (a) a Borough Dental Clinic for mothers and young children (b) a Clinic for sick mothers and childien (c) the subsidization of a home for ailing children under school age (d) the subsidization of extern and intern midwifery (e) the provision of milk under the Milk (Mothers and Children) Order, and (f) the subsidization of the four day nurseries in the Borough. Home helps, home nursing of measles, whooping cough and ophthalmia, and the provision of hospital accommodation are matters which are dealt with by voluntary agencies. Reference is made below to these various subjects. Work Done During 1919. Advice Cards.—Cards of advice have been posted to the mothers of all infants where births have been notified. These give particulars in regard to the Infant Welfare Centres, as well as advice in regard to the nurture of the 57 child. Cards of advice to expectant mothers have also been distributed through University College Hospital, Middlesex Hospital, and the Maternity Nursing Association to those expectants who have arranged for their confinement through the institutions. Home Visiting.—This has been done by the health visitors at the Town Hall, and by the superintendents and visitors at the various centres who are paid by the Council, and visit the mothers attending the centres, and also such newly notified births as are referred to them for the purpose by the Medical Officer of Health. The Town Hall infant visitors include two full-time health visitors, and two who are health visitors as to half their time and sanitary inspectors as to the other half, as well as one other health visitor who devotes her time to the visiting of cases of measles. These ladies made during the year 3,523 visits to 1,474 infants (apart from 2,078 visits to cases of measles). They also made 417 visits to 205 expectant mothers, from lists of expectants supplied by University College and Middlesex Hospitals. The visitors at the Infant Welfare Centres included 11 full-time officers and 7 part time. Of these 10 full-time and 4 part-time were paid by the Council, one was a full-time voluntary (trained) worker (Argyle Square group), two parttime were paid by University College Hospital, and one part-time by the Camden Town Centre. During 1919 these visitors made 24,599 visits to 3,470 infants, and 3,975 visits to 1,366 expectant mothers. The visits made by the Town Hall visitors and the visitors at the centres therefore numbered in all 28,122 visits to 4,944 infants, and 4,392 visits to 1,571 expectants. The figures for individual cases visited are however, overstated, owing to occasional instances in which the same case will have been counted at more than one centre. The total number of visits made in 1919 is almost double those in the previous year. The figures for home visiting will be found tabulated on page 59. Maternity and Infant Welfare Centres.—The work done at these institutions is now fairly well known. It is based primarily on medical consultations and home visiting. The infants are brought up by the mothers at intervals; weekly at first, and less frequently as a rule later; and an endeavour is made to secure their occasional attendance for examination up to the time of their entraile into a school. At each visit the baby is weighed, the mother keeping a record of weight-progress, and examined by the doctor, who interviews and advises the mother. The mother also gets the benefit of conversation with the skilled workers, voluntary helpers, and the other mothers. Simple drugs and special foods as ordered are supplied at cost price; special baby clothing can be purchased; and instruction in general hygiene, cooking, the making of garments, &c., is provided both by individual instruction and by means of classes. Mothers and babies needing further attention are referred to their private doctors or to the clinics at University College Hospital and St. Pancras Dispensary or to other hospitals and institutions ; and to the Borough dental clinic. An important feature is the home-visiting by skilled workers to see that the doctor's instructions are as far as possible actually carried out. Several or the cantres also have special consultations for expectant mothers. 58 In the table on the next page will be fonnd details of the work in 1919 of the centres, and some of the special features of each are mentioned in the following account: - St. Pancras School for Mothers.—This Institution has two centres:— (a) 1, Anipthill Square, N.W. 1.—This is a detached house used solely for the purpose, the rent, rates and taxes being paid by the Borough Council. It comprises a day nursery for infants needing observation and special attention, and also provides dinners for needy and expectant and nursing mothers and young children. In the year ended 31st March, 1920, there were 1,394 attendances in the nursery, and 2,474 dinners were supplied to mothers and 2,160 to young children. The mothers pay 4d. for dinner. There is a dental clinic at the centre, and in the same twelve months this was held on 39 occasions, and 348 mothers had extractions, stoppings, or new dentures, and 81 children between two and five received attention. A home help is also engaged for work in special cases in the homes of mothers attending the Centre. (b) 6, Chalton Street, N.W.I.—The branch was opened in 1918, and serves Somers Town. The premises are part of the buildings of the West London Mission and are engaged for part-time only, the rent being repaid by the Council. North St. Pancras School for Mothers.—This Institution has two centres:— (a) Rhyl Street, N.W. 5.—The premises are mission buildings which are rented for certain days in the week, the rent being repaid by the Council. The Borough scheme provides for full-time premises for this Centre, and a house has been taken for this purpose in an excellent position at 129, Queen's Crescent, N.W.5, and will be brought into use during 1920. (b) Grafton Road Centre, N.W. 5.—This is in rooms placed at its disposal on one day per week by the Borough Council at the Public Baths, Prince of Wales Road, N.W.5. South Highgate Mothers and Infants Welfare Centre, Chester Road, N. 19, is held in rooms placed at its disposal on one afternoon p r week by the Borough Council at the Public Library, Chester Road. Passmore Edwards Settlement Schools for Mothers, Tavistock Place, W.C. 1, —This is held in the Settlement premises, no rent being paid. Holborn cases are also dealt with, but the St. Pancras cases are in the majority. Camden Town 31others and Infants Welfare Centre, Greenland Street, N.W.I.—'This is held in mission buildings rented for the purpose on certain days in the week, the rental being repaid by the Council. The Borough scheme provides for full time premises for this Centre, and a suite of rooms has been taken for the purpose at 62, Camden Road, N.W.I, and will be brought into use during 1920. The Arggle Square group of Centres.—This consists of two centres which were started through the munificence of Miss J. de Pass, and are now subsidized by the Council like the other Centres, Miss de Pass bearing the 59 Centre. Attendances. Visits by Trained Visitors. Infant Consultations. Expectant Mothers Consultations. Visitors. Expectant Mothers. Children. Expectant Mothers. Children. New cases. Total attendances. New cases. Total attendances. First visits. Total visits. First visits. Total Visits. Per week. Total. Per month. Total. Whole Time. Part Time. Under 1 year Over 1 year. Total. Under 1 year. Over 1 year. Total. Borough Health Visitors — — — — — — — — 205 417 1474 3523 — — — — — — St. Pancras School for Mothers:— Ampthill Square 150 330 300 50 350 — — 4719 332 926 609 5073 3 137 4 46 3 — Chalton Street 45 130 132 16 148 1896 170 2066 398 762 400 1294 1 47 — — — 1 North St. Pancras School for Mothers:— Rhyl Street 91 197 263 23 286 2871 834 3705 50 234 169 2520 2 97 2 24 3 — Grafton Road — — 129 18 147 1228 257 1485 — — 220 1341 1 49 — — South Highgate Mothers' and Infants Welfare Centre 8 48 45 28 73 590 353 943 10 91 126 848 1 49 — — — 1 Passmore Edwards Settlement School for Mothers 12 74 54 32 86 892 456 1348* 59 133 232 487 2 100 — — — 1 Camden Town Mothers' and Infants' Welfare Centre 53 126 215 38 253 2217 1232 3449 66 320 290 1539 2 88 2 15 1 1 Argyle Square and Falkland Road Centres:— Argyle Square 56 151 117† 5† 122 1419† 151† 1570 127 4901 614 50802 1† 50‡ 2 23 3 — Falkland Road 37 133 219† 17† 236 2690† 235† 2925 1 50 2 24 Maternity Nursing Association 150 1698 259 — 259 — — 1717 187 321 366 915 1 52 1 12 1 — University College Hospital3 2018 4160 — — 770 — — 3141 — — 451 5793 — — — — — — — — 537† — 537† — — 2128 — — 315 4055 2 86 — — — 2 Royal Free Hospital 142 456 41 3 44 190 7 approx. 197 137 698 approx. 129 approx. 1447 1 46 8 104 — 1 Totals 744 3343 2311 230 2541 13993 3695 26252 1571 4392 4944 28122 18 851 21 248 11 7 *Not including 110 attendances of mothers without their infants. The total attendances from all boroughs was 2379. †Dnder and over 18 months. ‡Not including 12 monthly consultations for children from 18 months to 5 years. (1) Including 178 by an unpaid trained worker. (2) „ 1530 „ (3) Figures in italics represent all boroughs 60 remainder of the expense. A third centre has been opened at Oseney Crescent during 1920. A feature of the centres are special consultations for children aged from one to two years (monthly at Oseney Crescent) and from two to five (monthly at Argyle Square and at Oseney Crescent). There is a Mother's Committee who assist in the management. The two Centres are at:— 40, Argyle Square, W.C.I. This is a house rented for the purpose, and well equipped as a full-time Centre. The rent is repaid by the Council. Weslyan Schoolroom, Falkland Road, N. W. 5. These are rooms in school premises rented for part time, the rent being repaid by the Borough Council. Maternity Nursing Association, Oakley Square, N W.1. This institution, which sends out midwives and maternity nurses, maintains ante-natal and infant consultations for the mothers it atteuds in confinement. These are held at the St. Pancras Dispensary, 89, Oakley Square, no rent being paid. University College Hospital, Gower Street, W.C.I. The consultations here are now restricted mainly to infants who are actually ailing. They are held in the hospital premises, and the Borough Council docs not bear any of the expense. Mothers attended in their confinement by the hospital, either intern or extern, are referred to the various local infant wellare centres serving the localities in which they live, lists being 1 supplied to the Medical Officer of Health. The hospital consultations then serve for ailing babies who are referred back from the local centres and otherwise. Royal Frez Hospital, Gray's Inn Road, W.C.I This hospital maintains ante-natal and infant consultations here, and at. the branch maternity hospital at No. 21, Ensleigh Street, for women attended by them in confinement. The St. Pancras cases are in a minority, and the Borough Council contributes towards the salary of the paid visitor. At the centres 18 infant consultations per week (851 in the year) and 21 special ante-natal consultations per month (248 in the year) have been held during 1919. The medical fees have been paid by the Borough Council, except in the case of the consultations at the hospitals. As mentioned above, the consultations have been attended by 11 full-time and 7 part-time (qua. St. Pancras) paid superintendents and assistants, who also carry out the home visiting. Of these 10 full-time and 4 part-lime are paid by the Council. They have been assisted by a devoted band of ladies who give their services in helping at the consultations. A great debt of gratitude is due to these ladies, and more volunteers are wanted for this important work. The number of medical consultations and of paid workers has been increased since the end of the year. During 1919 the children who have attended the consultations for the first time have numbered 2,311 under one year of age and 230 over that age. The children under one amount to 60.4 per cent. of the births registered for the year. The total number of attendances made by children was 26,252. 744 expectant mothers also attended during the year for the first time, the total number of attendances of expectants being 3,343. This figure does not include the outpatient work at University College Hospital. Details of the attendances at the centres will be found in the table on page 59. Dental Clinic for Mothers and Children under school age.—The Borough Council dental clinic for mothers and children attending at and referred from the maternity and child welfare centres in the Borough was continued for its 61 second year at the British Dentists' Hospital, 31, Camden Road, N.W. 1. The hospital is paid by the Council for the use of its premises and equipment and the services of the matron, the Council paying its own dentist (Mrs. Winifred Murch, L.D.S.) and anaesthetist (Dr. J. Maughan). In 1919 the clinics were held rather more often than once a week, and the work done was as follows: — Number of Clinics 55 „ with nitrous oxide 13 „ new cases (mothers) 214 ,, „ (children) 101 315 Total number of attendances 902 Number of attendances for extractions under nitrous oxide 140 ,, „ „ „ local anaesthesia 80 ,, „ when fillings were done 115 ,, ,, ,, scalings were done 88 „ „ for impressions, fitting dentures, etc. 355 „ „ „ examinations, etc. 103 No charge is made for extractions (with or without "gas"), fillings and scalings, but the patients are required to pay towards the expense of dentures. For these the dentist is paid separately at the rate of £2 for one denture, and £4 for two dentures. The patients obtain assistance from the Metropolitan Hospital Sunday Fund, pay themselves according to our assessment, and the remainder of the fees have been paid from a special voluntary fund which has been raised by A. Escott, Esq., Chairman of the Maternity and Child Welfare Sub-Committee during the earlier part of the year. In general the patients themselves pay about half the cost of the dentures. In 1919, 57 patients were fitted with dentures. The total cost of these was £181 10s., of which £96 10s. was paid by the patients themselves, £40 (for 44 patients) by the local voluntary fund, and £45 (50 patients) by the Hospital Sunday Fund. The work of the dental clinic is growing, and the number of sessions has been increased since the end of the year. Clinic for Sick Mothers and Children under school age.—The weekly clinic (Dr. F. L. Provis) has been continued at the St. Pancras Dispensary, 39, Oakley Square, N.W. 1. The patients are referred to the clinic from the infant welfare centres, the health visitors, and other sources. During 1919 394 new cases under five years of age were treated, the total number of attendances of sick children being 1,523 ; 141 women were also treated for illness associated with pregnancy or the puerperium, who made 520 attendances. The medical officer is paid by the Council, and there is a half-time visiting nurse, half of whose salary is repaid to the Dispensary by the Mayoress of St. Pancras Nursing Fund for Sick Poor Children. In 1919 the nurse made 913 visits to children under 5. Supply of food to mothers and children under school age.—Reference is made to the supply of milk for mothers and children on page 30. In regard to other food, the Council in January, 1920, made a grant of £50 to the Kentish Town Dining Room for Mothers, Lyndhurst Hall, where nursing mothers and young children attending the North St. Pancras School for Mothers are supplied with cheap dinners. 63 Meals for mothers and children are also supplied by the St. Pancras School for Mothers, 1, Ampthill Square (see page 58), and good work is also done for ailing mothers and children, amongst other sick persons, by the Invalid Kitchen, Crowndale Road. These are not subsidized by the Borough Council. Home for ailing children under school aye.—The Mayoress of St. Pancras Home for Sick Poor Children, Avalon, 1, St. Albans Road, N.W.5, which was founded in 1918 by the Mayoress' Nursing Fund for Sick Poor Children, continued its work during 1919. It receives a grant of £500 per annum from the Borough Council. The house is well appointed for the reception of 18 children, and has good grounds. It is used for the reception of cases who are ailing and needing observation or better treatment than can be given them in their own homes, and are not of the kind which are admitted to ordinary hospitals. The work has been recognised by the Ministry of Health by the award of a 50 per cent. grant in respect of maintenance expenditure. During 1919 there were 82 admissions, and the ages were as follows:— 0 to 1 2 3 to 4 19 1 to 2 15 4 to 5 15 2 to 3 18 5 and over 13 The Home was open on 308 days during the year, and the average stay of each child was 30.82 days. Midwifery Work. The notifications of births in St. Pancras arc classified below (in wards and registration sub-districts) according to the manner in which the mothers were attended in their confinements:— Births. W. S. E. N. Total 4 5 7 8 3 6 1 2 Attended in their own homes by— Private Doctors 137 107 10 52 189 33 250 99 877 Private Mid wives 172 15 11 47 88 4 267 255 859 Doctors from the Elizabeth Garrett Anderson Hospital 19 5 2 24 31 7 24 23 135 Medical Students from— University College Hospital 89 237 7 11 182 138 5 10 679 „ Middlesex Hospital — 19 33 1 — — — — 53 Royal Free Hospital 2 — 2 49 3 6 — — 62 „ St. Bartholomew's Hospital — — — 5 — — — — 5 Midwives from— University College Hospital 3 17 41 103 10 194 3 1 372 ,, Maternity Nursing Association, Myddleton Square — — — 61 1 1 — — 63 „ Maternity Nursing Association, Oakley Square Branch 26 54 14 5 65 43 9 7 223 Attended in Institutions- University College Hospital — — 172 — — — — — 172 Elizabeth Garrett Anderson Hospital — — — — — 43 — — 43 Royal Free Hospital (Marlborough Maternity Section) — — 361 — — — — — 361 Homes of Hope, Regent's Square — — — — — — — — — Lying-in Ward of Workhouse — — — — — 140 1 — 141 Royal Free Hospital — — — 8 — — — — 8 63 Certain of the notified births set out in the above table as having taken place in St. Pancras institutions were of infants of mothers who were not St. Pancras residents. On the other hand, a number of St. Pancras mothers were confined in institutions outside of the borough. In the following paragraph the figures for 1919 are given for St. Pancras women only:— "Extern" Midwifery. *Elizabeth Garrett Anderson Hospital (doctors) 135 University College Hospital (medical students) 679 „ „ „ (mid wives) 372 Middlesex Hospital (medical students) 53 Royal Free Hospital „ 62 St. Bartholomew's Hospital (medical students) „ 5 *Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 286 1592 (or 42 per cent. of the total number of births). All the above-mentioned cases were treated gratuitously except those marked with an asterisk, in which reduced fees were charged. "Intern" Midwifery. In St. Pancras:— University College Hospital 107 Royal Free Hospital (Marlborough Maternity Section) 101 Elizabeth Garrett Anderson Hospital 17 St. Pancras House 117 Out of St Pancras:— Middlesex Hospital 62 Queen Charlotte's Lying-in Hospital 166 City of London Maternity Hospital 48 Other hospitals 58 676 (or 18 per cent. of the total number of births). It will be seen from these tables that a very substantial amount of midwifery is available for St. Pancras women from various voluntary agencies. The facilities for home midwifery in much of the tenement house property are so bad, however, that an increased amount of accommodation in the way of maternity homes or hospitals is desirable. In the northern part of the borough the extern service from hospitals, &c., which is found in the south does not exist. The Council subsidizes the provision of midwifery for St. Pancras residents 64 by paying grants to the various agencies at the rate of as. per extern case and 10s. per intern case. The amounts paid in respect of 1919 were as follows:— Royal Free Hospital and Marlborough Maternity Section £ s. d. 58 0 0 Elizabeth Garrett Anderson Hospital 21 15 0 Maternity Nursing Association 62 5 0 Queen Charlotte's Lying-in-Hospital 68 10 0 City of London Maternity Hospital 23 0 0 £233 10 0 Widowed, deserted and unmarried mothers and their children.—Attention was given to this subject during the year, and the Medical Officer of Health was asked to report upon it. His report is set out below in full:— To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, On April 30th last the Council had before them a report from your Committee on the question of the care of widowed, deserted and unmarried mothers and their children, but in view of the confusion arising from the fact that the Guardians of the Poor undertake certain responsibility for such cases 110 action was then recommended. On July 23rd the matter was again before the Committee, and the Council on July 30th approved of an instruction that your Medical Officer of Health should present a report on the subject. The question has also been considered by the Board of Guardians, and on July 30th a deputation of that Board was received by the Council, and expressed the view that the Council ought to exercise their powers in this direction and that it was desirable that they should co-operate with the Guardians in the matter. The representatives of the Guardians also conferred with the Public Health Committee on September 24th. The powers of the Council in this connection are derived from the Maternity and Child Welfare Act, 1918, which enables them to make such arrangements as may be sanctioned by the Ministry of Health for attending to the health of expectant and nursing mothers and of children under five. The Regulations made by the Local Government Board on August 9th, 1918, include the following amongst the services in respect of which the Board (now the Ministry of Health) will pay grants to local authorities and others, which will as a rule be at the rate of one-half expenditure incurred with the Board's approval, viz.:— " (10.) Expenses of creches and day nurseries and of other arrangements for attending to the health of children under live years of age whose mothers go out to work." " 12.) The provision of homes and other arrangements for attending to the health of children of widowed, deserted and unmarried mothers, under five years of age", and 65 "(13.) Experimental work for the health of expectant and nursing mothers and of children under five years of age carried out by Local Authorities or voluntary agencies with the approval of the Board." In their Circular accompanying the Regulations the Board say:— "The health of infants and young children who lack the support of a father often needs special attention, and it is on all grounds desirable that the mother and child should be kept together in such cases, especially during the first year. It is notorious that the death rate of illegitimate infants, the only infants in this category for whom separate statistics are published, is about twice the death rate of legitimate infants The Board have therefore obtained the Treasury assent to the extension of the grant to homes at which mothers and children can be kept together in certain cases, and to such other arrangements as the Board may approve for attending to the health of the children under consideration. In some cases it may be desirable to pay a good foster-mother to look after a child whose mother cannot afford the whole of its keep, or to assist the mother to stay at home to attend to the child. Any scheme for the purpose should be submitted for the Board's approval before expenditure is incurred on it if a grant is desired." It is not necessary to add much to this statement of the predecessors of the Ministry of Health as to the desirability of helping the fatherless children and their mothers. During the five years 1914-18 the death rate in St. Pancras of illegitimate children was 2.4 times as great as that amongst the legitimate, and, apart from the humanitarian aspect, it is clearly desirable in the interest of the State that the deaths of the children should be as far as possible prevented and the survivors reared into healthy citizens to be an asset rather than a source of expense to the community. I need say nothing of the needless suffering on the part of the unforlunate mothers and the children. . Few, I think, at the present time, will advocate the abandonment of the mothers and the sacrifice of the children on the ground that it is a just punishment or a necessary deterrent. It is clearly desirable, however, that any help which is given to the unmarried mothers should be extended at least equally to the married mothers who lack the support of a husband; and it is also important that while the women should be helped to bear what would otherwise be an insupportable burden, they should not be relieved of their general responsibility and such financial responsibility as they can reasonably bear. It is important, moreover, that the measures taken should not make it easier for the fathers of the children to evade their liability. It should be noticed that the powers of the Borough Council in the matter are limited to children under five years of age. Of course, the problem by no means ends when the child reaches that age. The Regulations are less explicit as to the powers for making provision for the mothers than for the children themselves. It would seem, however, that if the mother and child are to be kept together assistance for the mother in the interest of the child comes within the scope of the Regulations. A statement of the powers and work of the Guardians in this respect is necessary. The following memorandum has been kindly supplied bv the Clerk of the Guardians:— 66 Town Hall, Pancras Road, N.W. 1, 16th October, 1919. Dear Sir, In reply to your letter of the 22nd ultimo 1 have to inform you:— 1.—dumber of children under 5 years of age chargeable to the Guardians are classified as follows:— ILLEGITIMATE. Institution. Mothers. Foundling. Total. Widowed. Married. Deserted. Unmarried. Leavesden Schools — 2 4 12 5 23 Lady Somerset Home, Dewhurst — — — — 4 4 Craythorne, E. Finchley — — — 2 — 2 Goldie Leigh, M.A.B. — 1 — — — 1 North Infirmary 8 — 5 20 8 41 South Infirmary 1 1 — 6 1 9 House — 1 — 10 — 11 Totals 9 5 9 50 18 91 LEGITIMATE. Institutions. Orphan. Motherless. Fatherless. Parents Living. Deserted. Total. North Infirmary 3 — — 35 — 38 South Infirmary — — — 14 — 14 Leavesden Schools 2 3 8 9 3 25 Totteridge (R.C.) — — — — 1 1 Carshalton, M.A.B. — 1 1 — — 2 Cleveland Street, M.A.B. — — — 1 — 1 Goldie Leigh, M.A.B. — — — 2 — 2 Lady Somerset. Home, Dewhurst — — — 1 — 1 Totals 5 4 9 62 4 84 67 There are 42 orphan and deserted children boarded out under Boarding-Out Committees, but only one of these is under 5 years of age. 2.—There appears to have been a slight increase recently in the number of applications received in respect of cases of mothers with young children. 3.—The cost varies according to the Institution as follows At Leavesden Schools the total cost is about 18s. per week, being a flat rate for children of all ages. For children boarded out the total cost is about 11s. per week per head. The cost of maintenance at the House for all cases, including children, is about 14s. 6d. per week, and at the present time the cost at the Infirmaries for the sick is about 30s. per week. This cost is based on the total number of persons chargeable irrespective of age. It is difficult to say generally whether a child would cost less than an adult. As regards assessment of payments to be contributed by the mothers, each case is dealt with on its merits by the Out-Relief or other Committee dealing with such cases, and payments are fixed according to the presumed ability of the mother to pay, such payments varying from about 1s. to 5s. per week. With regard to the grant of out-door relief the cases are dealt with by the Guardians upon the actual necessity of each case. It is, however, a principle that the income of each widow with children in receipt of out-door relief shall not be less than 6s. per week per head of the family, the Guardians making up this amount after taking into consideration the other sources of income. In nearly every case the 6s. per head is exceeded. There is no special grant allowed in respect of young children under 5 years of age. Unmarried mothers are not granted out-relief in money, as this would be contrary to the Orders of the Local Government Board (Ministry of Health). The total number of widows, &c., with children in receipt of out-door relief, including non-resident cases, is:—Women 78, children 255 (61 of these children being under 5 years of age). The Guardians desire to add that during the past three months there have been 50 applications from women having illegitimate children, the classification of such cases being as follows:— Admission to the House 22 ,, ,, Infirmary 13 ,, ,, Schools (2 granted) 4 Medical Attendance 4 Out-relief granted subject to consent of the Ministry of Health 2 Convalescent treatment granted 1 M.A.B. Fever Hospital 1 Temporary relief in kind 2 Referred to Medical Officer of Health 1 50 I am also desired to inform you that during the past three months 27 cases have been admitted to the maternity wards, viz., 25 single women and 2 married women, who have been confined of illegitimate children. 24 applications were made to the Committee during the past half-year by mothers for permission to leave the House without their illegitimate children for the alleged purpose of finding work and making a home, and in 14 such cases the applications were granted, the children being retained by the Guardians, and 10 were refused. In some of these cases arrangements were made lor the mothers to make contributions towards the cast of the 68 maintenance of these ehildren. All such cases are carefully reviewed at intervals by Committees of the Guardians. Yours faithfully, J. E. P. Hall, Clerk to the Guardians. Dr. T. Shadick Hjggins, Medical Officer of Health, Borough of St. Pancras, Town Hall, Pancras Road, N.W.1. P.S.—The addendum gives a summary of a. few typical oases dealt with by the Ladies' Reference Committee during the month of September, 1919. ADDENDUM REPORT. Summary of typical cases arising during the month of September, and dealt with at the last meeting of the LADIES REFERENCE COMMITTEE held on October 1st, 1919. With one exception, all these children are under one year:— E. B., age 24. Domestic. To remain with child in Workhouse pending the Warrant Officer's inquiries as to affiliation. A. A. E., age 33, Domestic. Child retained in Workhouse contrary to regulations. Mother allowed out to seek a situation. E. E , aged 30. Child many months in Infirmary and Convalescent Home. Mother working outside and contributing 5s. per week. Child convalescent now and discharged. Mother can find no home for it and came to beg for its admittance to Workhouse. Child taken in temporarily, contrary to regulations. V. G., age 30, Dressmaker. Mother and child both unfit to leave at present. E. H,, age 24. Maid and Machioist. Admitted to Workhouse with her child as destitute. Discharged to find employment. Child retained in Infirmary. K. M., age 20, Domestic. Unfit for discharge. C. S., age 23, Domestic. Remain till Matron secures a situation, L. S., age 25, good class of Domestic Seduced under promise of marriage. Father of child untraceable. Mother allowed out on daily pass to find employment. Could pay 10s. per week. E, T., age 23, Maid. Child in Infirmary. Mother could earn sufficient to pay for its support if a home could be found for the child on its recovery. It was felt by the Committee that all these cases emphasised the immediate necessity for the provision of (a) A hostel where the mothers could be kept with their children for a time. (b) An adequate allowance for the support of themselves and children in homes of their own. («) Scattered Homes. (d) Reliable and closely inspected Foster-Mothers. These women all showed an interest in and devotion to their children not to be surpassed. The great majority of these deserted mothers are domestic servants or needlewomen, for whom the present day demand is very great. The sympathetic interest shown by our Matron and the members of our Committee has been instrumental in securing many situations already, thus enabling the women to make small payments for the children, and the Committee submits that the provision of immediate After-Care for these children, giving the mothers their share of the responsibility, must have a healthy influence upon the future conduct of these women. (Signed) Edith M. Vance, On behalf of the Ladies' Reference Committee. 13th October, 1919. 69 Before considering the question of the division of responsibility in the matter between the Borough Council, who are the authority for promoting measures for Maternity and Child Welfare, and the Guardians, who are the authority for relieving destitution, I propose to indicate certain lines on which the children (other than sick children) of widowed, deserted and unmarried mothers might be dealt with. I am of the opinion that the view expressed in the Local Government Board's circular (mentioned above) that the mother and child should wherever possible be kept together, is important. The preservation and exercise of the maternal affection should be aimed at for the future welfare and happiness both of the mother and child. There are some cases where the occupation or character of the mother make it necessary that they should be kept apart, and in the majority of cases the mother will have to leave the child by day. But wherever possible mother and child should live together. It should be possible to meet nearly all cases by one or more of the following measures:— (1) The maintenance of the child in a Home (such as the Guardians' at Leavesden), where the mother and child must be parted. (2) Entrusting the child to a foster-mother, approved and subject to supervision, the mother living in the same house or elsewhere. (3) The provision of a day-nursery, where the child would be cared for by day, while the mother was at work, the child being taken home by the mother every evening or dealt with as indicated under (4). (4) The provision of a hostel for mothers where they can be sent after the lying-in, the babies being cared for in a day-nursery on or near the premises while the mother is at work, and by the mother in the hostel at night and other times. (5) The making of a money allowance to those mothers who are able to keep their children satisfactorily at home, but whose earnings are insufficient to do so without assistance. Tke adoption of the child by persons who desire to take sole responsibility for it would also, of course, solve the difficulty in certain cases. A certain amount of provision is already made in St. Pancras by nearly all the methods, and I propose now to consider how a complete scheme could be developed by the Borough Council. (1.) Children's Homes.—The Guardians already have accommodation at their institution at Leavesden, near Watford, for infants and children of all ages, and it should be unnecessary for the Borough Council themselves to provide an institution. It would probably be better for an arrangement to be made whereby the Council would pay the Guardians for the maintenance of children referred to Leavesden by the Council. The extension of the arrangement to other authorities and bodies, providing suitable homes or the direct provision of homes by the Council would be a matter for future consideration. The Leavesden Institution would only be suitable in cases where there was no occasion for the mother to visit the child frequently. (2.) Foster-mothers.—The difficulty of finding suitable foster-mothers is probably due to the fact the the mothers are unable to make a sufficient 70 payment to repay the foster-mother for the expense and trouble. A system whereby the Council augmented the mothers' payments, provided that the foster-mother were approved by them and kept under regular supervision by a competent visitor, would probably meet a number of cases where it was not possible or desirable for the mother to live with the child. In some instances the mother might also lodge with the foster-mother. Inquires would need to be made for suitable women to act as foster-mothers. I leave for future consideration the question of the weekly sum which the foster-mother ought to receive. (3.) Day-Nurseries.—In regard to the question of day nurseries, there are already four such institutions in the borough, which have together places for 145 children. At one of these, the Margaret Day Nusery, 44, Ampthill Square, opened in May last, where there is accommodation for 20 children, the major part is definitely kept for the children of the unmarried: at two others, the Whitefield Day Nursery, 53, Whitfield Street (40) places), and the Kentish Town Day Nursery, Gospel Oak Grove (45 places), illegitimate children are received equally with legitimate: while at the fourth, the Edith Rendel Day Nursery, 26. Cartwright Gardens (40 places) preference is given to widowed and deserted mothers over the unmarried though illegitimate children are not excluded if there are places for them. It is probable that if the responsibility for fatherless children is accepted by the Council additional day nursery accommodation will be found necessary; but in regard to this it will be best to wait upon experience. In the meantime the most satisfactory method will probably be to follow the successful precedent of the infant welfare centres and subsidize the existing day nurseries from municipal funds, on condition that they comply with the Coun' il's conditions and undertake to receive as far as possible children referred to them by the Council. They receive at present a 50 per cent. grant from the Ministry of Health upon the deficit on the approved expenditure after the deduction of the payments made by the mothers. The four voluntary day nurseries fulfil a greatly felt want in the borough, and should on general grounds be assisted. It will be more satisfactory to give them a proportional subsidy on their whole work (in so far as it is for St. Pancras children)—as the Council are empowered to do—than to make payment for certain cases referred to them and not for others. I would recommend the payment by the Council of grants equal to one half of those paid by the Ministry. The total approved expenditure would then be met as to one half by the Government, and as to one quarter each by the Council and the voluntary funds of the institutions. This help would assist the day nurseries to improve and extend their work. The system would have the advantage that the Council's grant would in effect be conditional on the approval by the Ministry of Health of the work of the day nurseries. Last year the Ministry's grants to the four institutions amounted to about £1,265, and the cost to the Council of subsidisation on the basis suggested can therefore be estimated at about £633 a year. To bring this about it would be necessary for twice this amount (i.e , one half of the total net expense) to be paid by the Council. One half of this would be repayable to the Council by the Ministry, whose direct grant to the day nurseries would then be one half of the remainder of their net expenditure. It should be mentioned that it is proposed to build a day nursery in connection with the Council's proposed flats at Prince of Wales Road. 71 (4.) Hostels for Mothers.—There is a need for hostels for mothers in connection with the day nurseries, both for unmarried mothers who have just completed their lying-in and have to make their plans for facing the world, and for mothers who, while they have to leave their children when they are at work during the day, are able to join them again in the evening, and yet have no home to go to. A properly managed hostel would doubtless help many such mothers to retrieve their characters by shielding them from the dangers presented by a return to the conditions under which they have fallen. The committee of three day nurseries indicate that they are not able to undertake the establishment of a hostel, but that of the Margaret Day Nursery, Ampthill Square, are anxious to see one started in connection with their institution. Certain ladies of the committee would be willing to help if financial assistance were forthcoming. A hostel for 12 mothers and their babies would probably cost nearly £1,000 a year apart from the initial cost of equipping (say £500). I suggest that the committee of the Margaret Day Nursery be approached in the matter. (5.) Payments to Mothers.—In regard to payment by the Council of direct money grants to mothers of the classes under consideration who, but for lack of means, could keep their children at home, this in suitable cases would probably be a more economical way of dealing with the matter than by the use of institutions. If approved by the Ministry it would seem simple in the case of unmarried mothers to whom the Guardians, as I understand, are precluded from granting out-relief in money. But in the case of widows the Guardians already give out-relief in respect both of the women and their children, the number of children under five for whom such grants are made being 61 at present time. This opens up the question whether this particular form of relief should be dealt with by the Council instead of the Guardians. It would certainly be undesirable if unmarried mothers received assistance from the Council without recourse to the Poor Law that widows should still be compelled to seek relief through that channel. Subject to some method of assessment such as that indicated later in this report, I should be prepared to recommend that both classes be dealt with alike by the Borough Council. The approval of the Ministry of Health would, of course, first have to be obtained, and presumably widows needing relief, though having no children, would still remain in the care of the Guardians and not of the Council. The financial basis on which such grants should be made would remain the subject of later consideration. The fathers of motherless children often find very serious difficulty in getting them properly cared for, and any scheme which the Council adopted on the foregoing lines would no doubt be found useful in dealing with these difficult cases. I have recommended that the Council should assume the responsibilities indicated in the preceding part of this report, being persuaded that the work is to be regarded as an essential part of Maternity and Child Welfare. It would be in harmony with the policy of concentrating in the hands of a single local authority all matters which directly affect the Public Health. 72 It is especially desirable in view of the fact that the Guardians are unable to grant out-relief in money to unmarried mothers, and are also precluded from becoming responsible for the care of an illegitimate child unless the mother remains in "the House"—surely a hopeless position ! A factor which is of importance in this connection is that if the expense were incurred by the Council with the approval of the Ministry of Health, the Government would bear half the cost, whereas the whole of the expense now incurred by the Guardians in respect of widowed, deserted and unmarried mothers and their children has to be borne by the local rates. A committee would need to be set up for the consideration of applications made to the Council under this scheme. They would need to consider in regard to each case such points as the particular form in which assistance should be given ; its duration ; the payments which the mother should be required to make; and the steps that shonld be taken to require an adequate payment by the father. This would probably be a Sub-Committee of the Public Health Committee or of its Maternity and Child Welfare Sub-Committee, and it would appear desirable that it should include co-opted members of the Guardians skilled in this kind of work. No doubt it would be necessary to authorise the Medical Officer of Health to take certain action in emergencies between the Meetings of the Committee. There remain two phases of the work of the Guardians amongst illegitimate and other mothers and their children to which I have not referred. One is the treatment of sick children in the infirmaries and elsewhere, and in regard to this I am not suggesting any action by the Council. The other is the reception of expectant mothers for confinement in their maternity wards. In regard to this, the Council's scheme of subsidizing intern and extern midwifery irrespective of the question of legitimacy already enables the Medical Officer of Health to secure admission for any woman for whom application is made to him to one of the maternity hospitals in or near the borough. There does not appear to be any need for arrangements in this way to be made by the Council specially for unmarried women, the question being one rather concerning maternity generally. Estimatet.—In the absence of experience of the working of such a scheme it is not possible to give a definite estimate of its cost. One cannot even estimate in advance the number of mothers for whom application would be made. During the years 1918, 1917, 1916, 1915 and 1914 the number of illegitimate births that were notified in St. Pancras were 314, 275, 318, 256, and 230 respectively. Probably only a part of these would have applied for assistance. On the assumption that 100 cases came up for consideration in the first year of the scheme, and that 50 of them were dealt with through Leavesden or fostermothers, 20 by day nurseries only, 12 at a hostel, and 16 by subsidization, the cost might be estimated as follows (apart from initial equipment). Per Annum. £ 50 children at 18s. a week (the Leavesden figure) 2,340 Annual cost of hostel for 12 mothers 1,000 Gross annual subsidy to the four day nurseries 1,265 16 mothers subsidized at 6s. a week 250 £4,855 73 If the women paid half the cost of the first two items, a sum of £1670 could be deducted, leaving an expenditure of £3,185. The deduction of a 50 per cent. government grant (subject to approval) then leaves a total cost to the rates of about £1,600 for the year. This is on the basis of the whole cost of the hostel being paid by the Council. It does not take into account the cost of assistance to widows, who are already dealt with by the Guardians; but in regard to this point, the saving due to the expense being borne by the Council and subject to a 50 per cent. grant would furnish a set-off to such additional expense as the Council might incur over what would have been incurred by the Guardians. I wish it to be definitely understood that these figures are submitted by way of illustration and in no sense as a definite estimate. In conclusion, I would call attention to the circumstance that a state system of Mothers' Pensions for all mothers, married or unmarried, who lack the support of a husband and are in need, would greatly lessen the provision which the Council would require to make on the lines indicated in this report. The Council have already (see minutes, 22nd January, 1919) informed the Government of their opinion that a system of Mothers' Pensions is desirable. I have the honour to be, &c., T. Shadick Higgins, 19th November, 1919. Medical Officer of Health. The report was accepted by the Borough Council who passed the following resolutions on December 17th, 1919:— (a) That the foregoing report of the Medical Officer of Health be approved and adopted. (b) That the St. Pancras Guardians of the Poor be asked whether they are willing to receive at the Leavesden Institution, by the request and at the expense of the Council, children under five years of age such as are referred to in the foregoing report, and for what payment. (c) That, subject to the approval of the Ministry of Health, the Council do make grants to the Whitfield Day Nursery, 53, Whitfield Street; the Edith Rendell Day Nursery, 26, Cartwright Gardens; the Kentish Town Day Nursery, Gospel Oak Grove; and the Margaret Day Nursery, 44, Ampthill Square, to the extent of one-half of the deficit on the total approved expenditure after the deduction of the payments made by the mothers ; the grants to be paid six-monthly, the first grant being payable on March 31st, 1920, in respect of the expenditure incurred during the six months ending on that date: these grants being payable on condition that the day nurseries are conducted to the satisfaction of the Council; that they undertake so far as possible to receive cases referred by the Council; and that the day nurseries be requested to consider the advisability of opening earlier in the morning and closing later in the evening. 74 (d) That the Committee of the Margaret Day Nursery, 44, Ampthill Square, be asked whether they are willing to co operate with the Council in the establishment of a hostel for mothers in connection with their day nursery. (e) That a Sub-Committee of the Public Health Committee be constituted for the purpose of considering applications for assistance on behalf of widowed, deserted and unmarried mothers and their children under five years of age ; with power to deal with the cases on the lines indicated in the foregoing report, to assess the sums that shall be contributed by or paid to the mother, and to take steps where necessary for securing payment from the fathers of the children. (f) That the provisions of the Maternity and Child Welfare Regulations as to the reception of expectant and nursing mothers be put into force, and that the Council do make arrangements accordingly. (g) That a copy of the foregoing report and resolutions be forwarded to the Minister of Health with a request for his general approval and sanction to the proposed expenditure ranking for Government grant under the Regulations dated August 9th, 1918. (h) That, pending the foregoing proposals being carried into effect, the St. Pancras Guardians be asked to make temporary arrangements for the reception of expectant and nursing mothers and children on the distinct understanding that the cost will be paid by the Council. The Ministry of Health subsequently approved of the scheme so far as concerned the subsidization of the day nurseries and the institution of a hostel for mothers and the institution of a Sub-Committee for the consideration of cases, &c.; but withheld their approval of the other proposals. It will not be possible therefore to institute at present a complete scheme for dealing with the problem through the Borough Council. The proposal indicated in resolution (h) has also been postponed. Work by Voluntary Agencies in connection with Mothers and Young Children not paid for by the Borough Council. Home Helps.—The St. Pancras Home Helps Committee (Hon. Sec. Miss M. E. Bibby, B.A.) was instituted towards the end of 1917 to provide domestic assistance for mothers of families in sickness and childbirth. The work was continued in 1919, during which year 62 cases were dealt with, as follows:— Maternity 26 Influenza 19 Pneumonia 1 Consumption 3 Other illness 7 Neglect 1 Old age and infirmity 3 . Taking child to hospital 2 Two home helps were regularly employed, and occasional temporary home helps. 75 In most cases, either no payments or nominal payments only were received, but in certain midwifery cases the home help was employed full-time in connection with the confinement and lying-in, and substantial payments were made by the women for the service. The funds were obtained voluntarily, and the Ministry of Health has given 50 per cent. grants in respect of the deficit on confinement cases only. It is most desirable that the grant should be extended to the work of home helps in all cases where they give assistance to ailing necessitous mothers for the benefit of the mothers and their young children. Payment was made by the Borough Council in 1919 for the service of the home helps in cases of influenza and pneumonia, but no grants in respect of maternity work were made by the Council until after the end of the year. Home Nursing.—The work of the four local district nursing associations in this connection (see page 81), includes the nursing of mothers and children. The work done in cases of measles, whooping cough and ophthalmia neonatorum by the nursing associations at the expense of the Mayoress of St. Pancras Nursing Fund for Sick Poor Children is referred to on pages 77 and 79. The Maternity Nursing Association undertakes "monthly nursing" as well as supplying midwives. Government Grants. Government Grants were made during the year ended March 31st, 1920, in respect of Maternity and Child Welfare as follows:— St. Pancras Borough Council (on account) 2967 4 1 St. Pancras School for Mothers (Ampthill Square) 617 8 5 „ „ (Chalton Street) 40 16 11 North St. Pancras School for Mothers (and branches) 173 9 10 *Passmore Edwards Settlement School for Mothers 72 18 3 Camden Town Centre, Greenland Street 75 16 5 Centres at Argyle Square and Falkland Road 450 12 7 South Highgate Mothers' and Infants' Welfare Centre 20 2 0 Maternity Nursing Association (for Infant Welfare Centre) 100 15 10 *Maternity Nursing Association (for extern Midwifery and Maternity Nursing) (on account) 500 0 0 *University College Hospital (for extern Midwifery and Infant Welfare Centre) 1208 19 11 *Royal Free Hospital (for Extern Midwifery) 42 0 0 „ „ (for Infant Welfare Centre) 114 4 9 „ „ (in respect of Marlborough Maternity Hospital) 800 0 0 St. Pancras Dispensary (Infant Clinic) 183 5 3 Mayoress of St. Pancras Nursing Fund (Home Nursing) 52 17 1 Mayoress of St. Pancras Home for Sick Children 104 0 0 St. Pancras Home Helps Committee 23 0 0 *Turner Home, St. George's Square 328 0 0 St. Pancras Day Nursery 266 19 5 Whitefield's Day Nursery 233 1 1 Kentish Town Day Nursery 380 19 9 *Including expenditure on work amongst residents outside St. Pancras. 76 PUERPERAL FEVER. 13 cases were notified during 1919, equal to an incidence rate of 3.4 per 1,000 births. 9 deaths occurred amongst these, giving a case mortality of 69 per cent. 10 cases followed the birth of live-born infants, and 3 the birth of a nonviable fœtus. 7 of the patients were primiparæ (i.e., women who had not previously borne children), and 6 multiparæ. In 2 cases "instruments" were used at the confinement, including one fatal case following an illegal operation performed by an unqualified woman. In no case was there any obvious source of infection in the house. In the following table the cases are classified according to the manner in which the patients were attended in their confinements :— Confinement attended by No. of cases of Puerperal Fever. Total number of births notified. No. of cases pe 1000 births. Doctors 4 1012 3.9 Midwives from Institutions 2 658 3.0 Private Midwives 3 859 3.5 Medical Students 1 799 1.3 In Hospital 2 — — Unqualified Persons 1 — — OPHTHALMIA NEONATORUM. 39 cases of ophthalmia neonatorum were notified during 1919, 33 by doctors, 4 by midwives, and 2 by both. One of the cases was found to belong to another district, and to have been notified there, the corrected number of St. Pancras cases being therefore 38, or 9 9 per 1,000 births. 8 of the cases were regarded as grave, 17 as moderate, and 13 as slight. 6 of the cases have since died. 9 were illegitimate. The cases are classified below according to the manner in which the mothers were attended at their confinement. Attended at birth by No. of cases of ophthalmia Neonatorum. Total number of births notified. No. of oases per 1000 births notified. Doctors 10 1012 9.9 Midwives from Institutions 3 658 4.6 Private Midwives 14 859 16.3 Medical Students 3 799 3.8 In Hospitals and Institutions 8 — — Every case was promptly visited, and where necessary advice and help was given to secure prompt and adequate treatment. A visiting nurse was called in in 13 cases. 13 cases were removed to hospital, 77 11 cases were nursed by their own family, and 1 case was kept until recovery in the institution in which it was born. The results of treatment were as follows:— Complete recovery (including 2 who afterwards died) 28 Blind — Sight damaged (opacity of one eye only) 1 Died before recovery 4 Removed and out of touch 5 The same facilities, as in the case of measles (see below), are available for the home nursing of cases of Ophthalmia Neonatorum, through the Mayoress' Nursing Fund. In 1919 the visiting nurses made 377 visits to 17 children in this connection. MEASLES AND GERMAN MEASLES. All cases of these diseases were notifiable by parents and guardians, but only the first case occurring in an outbreak in a household or institution was notifiable by medical practitioners, an interval of two months since the last case constituting a new outbreak. Subject to correction for diagnosis in certain instances, 1,034 civil cases of measles, and 268 of german measles were notified or otherwise discovered in 1919. This represents an incidence rate of 4.7 per 1,000 civil population for measles and 1.2 for german measles. 15 deaths from measles were registered during the year, equal to a deathrate of 0.06 per 1,000 civil population, and a case mortality rate of 1.4 per cent. amongst notified cases. There were no deaths from german measles. The cases were notified or reported as follows:— Measles. German measles. Notified by medical practitioners 783 205 ,, parents and guardians 140 32 Discovered otherwise 111 31 1034 268 Further statistical facts in regard to the cases will be found on pages 34, 35 and 36. Practically every case has been visited without delay by one of the women visitors, and 2,078 visits were made in this connection during 1919. One health visitor is engaged almost entirely in the visiting of cases of measles. In every case, also, a card of advice and a printed postcard form of notification (unstamped) have been delivered to the parent. By reason of facilities placed at the disposal of the Medical Officer of Health by the Mayoress' Nursing Fund for Sick Poor Children it has been possible to send a visiting nurse once or twice a day to all cases where the visitor reported that such help was necessary, and where arrangements were not made for the removal of the patient to hospital. Milk, eggs, and coal were also paid for out of the fund in certain cases. In the course of this work 101 cases of measles in 77 families were nursed during the year, 562 nursing visits being made. In 103 families the patients were supplied with milk, &c. In the following table are set out the deaths and death-rates from measles 78 for the past 10 years for the whole borough and the four registration subdistricts. Year. Deaths. Rate per 1,000 population. West. South. East. North. No address Whole Borough West. South. East. North. Whole Borough 1909 30 9 30 33 • • 102 0.48 0.16 0.50 0.55 0.43 1910 39 21 60 23 • • 143 0.65 0.37 1.00 0.38 0.60 1911 26 28 19 40 • • 113 0.42 0.50 0.32 0.68 0.47 1912 25 11 33 25 • • 94 0.41 0.24 0.58 0.43 0.42 1913 8 5 6 17 • • 36 0.13 0.10 0.10 0.29 0.16 1914 10 10 21 12 • • 53 0.17 0.22 0.36 0.19 0.24 1915 20 14 14 15 • • 63 0.34 0.31 0.24 0.26 0.29 1916 12 6 8 16 • • 49 0.20 0.13 0.14 0.28 0.19 1917 35 17 32 33 1 118 0.60 0.38 0.56 0.57 0.54* 1918 15 7 25 27 1 75 0.25 0.15 0.43 0.47 0.34* 1919 5 — 4 6 — 15 0.08 — 0.07 0.10 0.07* *Based on census population. Of the 15 deaths, 4 were in children under one year of age, and 12 in children under five years of age. WHOOPING COUGH. In the following table will be found the deaths and death-rates from whooping cough for the past ten years for the whole borough and for the four registration sub-districts:— Year. Deaths. Rate per 1,000 population. West. South. East. North. No address Whole Borough West. South. East. North. Whole Borough 1909 2 6 9 10 .. 27 0.03 0.10 0.15 0.16 0.11 1910 31 5 41 15 .. 92 0.50 0.08 0.68 0.25 0.38 1911 13 7 12 16 .. 48 0.22 0.12 0.20 0.26 0.20 1912 6 14 22 5 .. 47 0.10 0.30 0.38 0.09 0.21 1913 8 3 8 17 .. 36 0.13 0.06 0.13 0.29 0.16 1914 11 1 16 21 .. 49 0.19 0.02 0.27 0.36 0.22 1915 10 13 15 12 2 52 0.17 0.29 0.26 0.21 0.24 1916 13 .. 17 9 .. 39 0.22 .. 0.36 0.16 0.18 1917 6 3 10 8 .. 27 0.10 0.07 0.17 0.14 0.12* 1918 19 11 26 22 2 80 0.32 0.24 0.45 0.38 0.36* 1919 — 2 2 3 — 7 — 0.04 0.03 0.05 0.03* *Based on census population. 79 Of the 7 deaths, 2 were of children under one year of age and 6 of children under five years of age. The same facilities, as in the case of Measles (see page 77), are available for the home-nursing of cases of Whooping Cough, through the Mayoress' Nursing Fund, but the disease not being notifiable, fewer cases are brought to the notice of the department. In 1919, the visiting nurses paid 66 nursing visits to2 patients in 2 families, and milk, etc., was supplied to patients in 6 families. Infantile Diarrhœa. 47 deaths of infants under one year of age from diarrhoea and enteritis were registered during 1919. The number of such deaths in each quarter of the year was as follows:— First Quarter11 Second „ 4 Third „ 20 Fourth „ 12 The number of deaths of children under 5 years of age from diarrhoea and enteritis was 55. The Council have an arrangement whereby they make payments to the district nursing associations for the home nursing of cases of infantile diarrhoea. Anterior Poliomyelitis. See page 50. Section VI,—Sanitary Administration. THE STAFF. The names of the staff of the Public Health Department at the end of 1919 will be found on pages 5 and 6. The visiting work of the staff will be found tabulated in tables No. 7.10 on pages 109-113, and also on page 59. At the beginning of 1919 the permanent staff was still depleted by the absence of 3 sanitary inspectors (Messrs. Lonnon, Adkins and Thompson) and 4 clerks (Messrs. Spokes, Mullis, Cove, and Pottier) serving with H.M. Forces. Mr. Landen, sanitary inspector, was away throughout the year owing to illness. The 3 inspectors on service returned to civil life and resumed their duties as sanitary inspectors; Mr. Lonnon on March 3rd, and. Mr. Adkins and Mr. Thompson on March 24th. Mr. Pottier, junior clerk and temporary sanitary inspector, also resumed duty in the latter capacity on returning from military service on March 3rd. Miss D. M. Parnell was appointed as temporary inspector on March 26th, her work consisting of the investigation of cases of influenza, pneumonia, and tuberculosis. Mr. P. W. Pottier and Mr. M. Jaffa, 80 previously acting temporarily, were appointed permanently as sanitary inspectors on May 28th. Mr. J. B. Molloy, junior clerk, was appointed as temporary sanitary inspector on October 22nd. Mr. Pottier resigned and left the Council's service on 16th August. Miss M. Mackenzie, temporary sanitary inspector, resigned and left on December 24th, 1919. On the clerical staff Mr. Spokes returned from military service on February 14th, Mr. Cove on May 12th, and Mr. Mullis on July 28th. Of the temporary clerks Miss H. M. Loder left on June 7th, Miss H. Henderson on May 31st, land Miss M. Gardner on October 18th. Mr. L. Higgins was appointed as temporary clerk on October 16th. On November 10th Mr. Spokes and Mr. Mullis were transferred to other departments, and Mr. Carpenter, Mr. Knight and Mr. Crick came into the public health d partment. The latter since that time has been away on sick leave. Mr. R. Capel, boy clerk, left the department (by transfer) on November 17th, and Mr. S. Barker was appointed in his place. Mr. T. H. Hague was appointed as temporary clerk on December 1st. Mrs. A. Oakey resigned her position as Matron of the Personal Cleansing Station and left on May 3rd, 1919, Mrs. E. Mace being promoted to her place. It has unfortunately to be recorded that Mr. H. Jackson, caretaker of the Goldington Buildings dwellings, met his death by accident on August 16th ; Mr. J. H. Ambrose was appointed in his place on November 3rd. CHEMICAL AND BACTERIOLOGICAL WORK. • The Borough Council has an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W. 1, for the bacteriological examination at the expense of the Council of material from St. Pancras cases sent to them through medical Dractitioners in regard to dinhtheria. tuberculosis, and typhoid fever. The work done in 1919 was as follows:— Total. Positive. Negative. Examination of swabs for B. diphtherias 258 57 201 „ sputum for B. tuberculosis 266 49 217 „ blood for Widal reaction (typhoid, etc.) 7 1 6 Examinations of sputum have also been made at the tuberculosis dispensaries (see page 44). Facilities for the examination of cerebrospinal fluid in suspected cases of cerebospinal fever, etc., are available to the medical officer of health through the London County Council laboratory, and for the examination of the blood in suspected malaria through the Ministry of Health. The chemical work of the Public Analyst (Mr. J. Kear Colwell, F.I.C.) in connection with the Sale of Food and Drugs Acts is referred to on page 32. 81 Section VII—Other Services. It is satisfactory to record that most cordial co-operation exists between the work of the Council and the various voluntary agencies carrying out work of public health and social importance. This is the case in connection with the various hospitals and dispensaries, the local District Nursing Associations, the Maternity Nursing Association, the Iavalid Children's Aid Association, the Charity Organisation Society, the National Society for the Prevention of Cruelty to Children, the Invalid Kitchcns, the Passmore Edwards Settlement, the Lyndhurst Hall, and the Kentish Town Dining Room for Mothers, etc. Reference to various voluntary institutions which are subsidized by the Council will be found elsewhere in this report, particularly in Section V. (Maternity and Child Welfare). Useful co-operation exists with the work of the St. Pancras Guardians, and the system of removal of cases of various infectious diseases to the hospitals of the Metropolitan Asylums Board works admirably. There is need, however, for much closer co-ordination of the medical work carried out by the Borough Council, the Guardians, and the London County Council. Reference is made to activities of the County Council on pages 22-29, 45 and elsewhere. Home Nursing. As regards district nursing, the borough comprises the whole of the district of the Central St. Pancras District Nursing Association, and large portions of the districts of the Metropolitan Nursing Association, the Hampstead District Nursing Association, and the North London Nursing Association. The associations are paid by the Council or the Mayoress' Nursing Fund at the rate of 1s. per visit for the nursing of cases of measles, whooping cough, ophthalmia neonatorum, infantile diarrhoea, influenza and pneumonia, but the bulk of their work is supported by voluntary funds. The home nursing is of very great public health importance, and the need for its extension and support from public funds is very great. So far as London is concerned, it is work which could eminently well be organized by the Borough Councils as the local sanitary authorities, and it would be an important step in advance if they were empowered to undertake this work. The home nursing work done during 1919 in St. Pancras is indicated by the following figures:— No. of cases nursed. No. of home visits paid. Central St. Pancras District Nursing Association 549 7911 Metropolitan Nursing Association (St. Pancras cases) 315 3785 Hampstead District ,, ,, „ 389 2757 North London Nursing „ „ „ 229 Section VIII.-HOUSING. For several years I have made reference in these annual, reports to the gravity of the tenement house evil in the borough. The matter is of such great importance that I venture to insert in this place a statement in regard to it which I put forward at an earlier date*:— The tenement house is a house which was originally built for one family only, * Eridence given by the Medical Officer of Health before the Departmental Committee on Unhealthy Areas on 17th December, 1919. 82 and has adequate convenience for only one family, and which is now occupied by several families in separate lettings. With the exception of a comparatively small number of working-class flats, such tenement houses are the only dwellings available for working-class people in the borough, the number of small houses occupied by one family each being pratically negligible. I believe that the general statement that the tenement house is at present the ordinary accommodation for the working-class applies also to many other parts of London. Most of the tenement house districts in the liorough have been occupied as such for many years, the problem not being of recent growth; but the "making down " process is still continuing and there are a number of streets wholly or partly sublet, where the houses were all occupied privately until recent years. The causes which have led to the system are complex, and> include the following factors:— (1) The continual migration of the " better-class " population to the more peripheral parts of the town or suburbs, their houses becoming occupied by people of a lower class, who for various reasons prefer or find it necessary to live more centrally. (2) The districts in question becoming entirely ringed in by built up areas and consequently incapable of lateral expansion. (3) The compression becoming still more severe by the abolition of dwelling-houses to make room for commercial and industrial premises, places of amusement, town improvements, &c. Such developments notonly diminish dwelling accommodation, but may also attract additional population. (4) The increase in ground values and rentals. This makes it impossible in many cases for the tenants to pay the rent of a whole house, even in the case of small houses which were probably orignally let to people of a similar status to themselves. In this connection it is to be noted that the rents of the dwellings in the tenement houses are not lower than those paid for whole houses in towns where the working class commonly occupy separate houses. I find that although the evils of the tenement house system are familiar enough to social and other workers whose labours make them well acquainted with the internal economy of these places, yet amongst the general public, and even amongst housing reformers who have not a close acquaintance with London conditions, there is not a complete appreciation of the real seriousness of the position. I therefore beg leave to describe the conditions in some detail. The type of tenement house most commonly found in the borough is a single fronted terrace house with two rooms on each floor, one front and one back, the staircase also being at the rear. There is a ground floor with one, two or three storeys above and frequently also an underground basement floor. The arrangement of the houses is satisfactory, as there are pratically no courts and the streets in general are wide and airy, and the space at the rear of the terraces not too restricted. There is generally only one w.c. to the house, 83 usually in the hack-yard or basement, but sometimes a second, and one washhouse which is either an out-building in the yard, or the back basement room. Such houses as these—many of which are about a hundred years old or even more —are occupied in a way that can be roughly expressed as one family on each floor, the commonest tenement consisting of two rooms. There are, however, a considerable number of one-room tenements, and also tenements of three, and less commonly four rooms, which in such houses are necessarily spread over more than one floor. Besides the houses with two rooms to the floor, there is another considerable class of tenement house, generally not quite so old, where there are three rooms to the floor, through the device of a " back addition", and in these, of course, three-roomed tenements on a single floor are to be found. The principal faults in these tenements are the following:— (1) The insufficiency of the number of rooms. It may be laid down with confidence that in a dwelling for a family with several children, there should be at the very least four rooms —one living room, and one bedroom each for the parents, the boys and the girls respectively—apart from a scullery and other necessary offices. In contrast with this, in a two-room or even a three-room tenement occupied by such a family, there is no room that can be set apart as a kitchen or sitting room which is not already appropriated as a bedroom. (2) The absence of the necessary offices. It is in this respect that the London tenement house is particularly noxious Take for instance a typical two-roomed tenement on the second floor. The only w.c. available for the occupants is one at basement or groundfloor level, or in the back yard, which is used in common by all the families in the Louse. There is no place out of the two rooms and landing where the house-refuse can be kept except a bin in the yard or area. There is no available scullery at all, so that the washing up has to be done in the living room (which is also a bedroom) and the nearest source of clean water or place for the discharge of foul water is on the ground floor or basement, and only to be reached by climbing several flights of stairs The common washhouse often contains no proper scullery accommodation and is commonly dilapidated. An attempt to meet the water difficulty has been made in many houses by providing a tap and small sink for common use on certain of the landings. This by no means makes up for the absence of a scullery, and in the worst class house is often the cause of serious nuisance. In such dwellings also there is usually no proper accommodation for the storage of food and other domestic supplies, which have to be kept on shelves or in cupboards in the living and sleeping room; no accommodation for coal except in one of the rooms ; and often no suitable cooking range in either of them. (3) The lack of privacy. The dwellings are not shut off by an outer door from the rest of the house, but consist merely of a number 84 of rooms each opening from a passage or staircase used in common by all the tenants and their visitors, and not directly connected with the appurtenant offices. The letting is done on one of two principles. In one case there is a resident tenant who rents the whole house and lets off the various rooms and may or may not exercise some care or control of the parts of the house used in common. In the other, the landlord is not resident, and collects the rents individually from each separate tenant. Thus in many cases there is no proper supervision and the passages, staircases, w.c., washhouse, yard and areas, are neglected, dirty, often dilapidated, and have a most dreary if not actually beggarly aspect. I know of few more depressing and distressing experiences than a house-to-house inspection of our worst type of tenement house. The general result of these various defects is very serious. The families have to live in a room which fulfils almost every domestic function. In it the food is stored, prepared and cooked, the meals are eaten, and the " washing up" of the cooking and feeding utensils is done; and besides serving as a kitchen, scullery, larder, dining-room, sitting-room and bedroom, it may also have to serve as a sickroom or for a confinement. I judge it to be unnecessarv to labour the point that it is idle to expect that a healthy population will be reared under such conditions as these or that the social improvement that is desired will be obtained. It must not be supposed that such conditions as these are uncommon or that they are confined to districts that are obviously slums: the majority of the working-class people in St. Pancras and other parts of London have to endure them. There are many streets which present quite a good appearance to the passer-by, where the internal accommodation is no better. If the front of the houses and the window furniture arc well kept, the general appearance of the street is not such as will impress public opinion with the seriousness of the evils which it conceals. It is, however, in the districts where the lowest class live that the tenementhouse evils are seen at their worst. In these quarters the houses are frequently worn out, the woodwork and plastering decayed, the window frames out of order, the roof leaking and sometimes the brickwork itself sunken and defective. The fabric too is often thoroughly infested with bugs. These conditions are the combined result of the overcrowding, the dirty and destructive habits of the tenants living under hopeless conditions, and the usual complete absence of any adequate system of supervision and control. When we come to consider the question of remedies, the most discouraging feature of the tenement house problem is its vast size. In St. Pancras alone it involves nearly all the working-class accommodation in the Borough, and a serious attempt to deal with it would necessitate the re-building or radical alteration of the majority of the existing houses. Nevertheless, I regard some such programme as urgently necessary. I realise that a comprehensive consideration of the problem in London as a whole will take account of the need for and the possibilities of spreading the working population over large outlying areas where they can be adequately housed on approved modern lines, 85 and the devoting to other purposes of central areas which are at present congested with such tenements as I have described. But as I endeavour to show below, provision needs to be made for the rehousing of a very considerable working class population in the central areas. It appears to me that to secure the proper amelioration of tenement house conditions it needs to be recognised that such a house affording for the families occupying it only such accommodation as that which I have described is to be regarded, without entering into the question whether it is dilapidated, damp, partly underground, etc., as being in such a state as to be unfit for human habitation, and that an area composed mainly of such houses, even if there is no bad arrangement of the houses, courts, alleys or streets, is to be regarded as an insanitary area such as is contemplated by Part I and Part II of the 1890 Act. A full realisation of the evils of our tenement houses should relegate them to the " insanitary" category. The practical difficulty is to give the families adequate dwellings in undiminished numbers in the same districts as they now occupy. Where the condition of the houses is such that they must be cleared and the area rebuilt, the only possible mode of rehousing on the site is by the erection of " block " buildings several storeys high. For instance, in an area of 50 acres in Somers Town there is a population of not less than 11,000, or over 200 persons to the acre. In such an area nearly all the displaced population would need to be rehoused on the site, as there is no other available land at a convenient distance. In the tenement house district, where the property is structurally sound, the proposition arises of altering the houses instead of clearing and rebuilding. Various suggestions have been made as to how this might be done, but I have not seen any satisfactory scheme carried through. Unless additional storeys are built the alterations must diminish the number of families occupying the houses. The only suggestion of which I have heard that would provide satisfactory self-contained flats on each floor is that put forward by Bannister Fletcher some fifty years ago, and referred to with other suggested methods in Sykes' "Public Health and Housing," 1901, p. 174, and this would considerably diminish the number of dwellings in the houses. It must be remembered that the greatest part of the population in a borough like St. Pancras is housed in tenement houses, and although I am advocating that the typical tenement house should be recognised as insanitary, I realize that they cannot all be dealt with in the near future. The problem ought, however, to be dealt with by an adequate inspection of all the tenement houses, and by the utilization of existing powers as far as possible ; and by dealing with the worst areas by schemes under Part I and Part II of the 1890 Act. If there had been during the past century a law definitely and effectively forbidding the letting of an ordinary dwelling house to more than one family unless alterations where necessary were made to the satisfaction of a competent authority for adequate accommodation in all respects for every individual family the present tenement house difficulty in London need never have arisen. The problem would have been dealt with piecemeal instead of 86 accumulating to the vastness that now confronts us. The new by-laws ought to go to the limit of their terms of reference in forbidding the further subletting of houses beyond their real capacity, but it would be better if the control of the practice in future were definitely enacted by Statute. In the following section are set out particulars in regard to housing asked for in the Ministry of Health's Memorandum (9 Med.), and tabulated as required therein:— I.—General Housing Conditions in the District. (1) Total number of houses in St. Pancras (1911 census) 23,345 Number of houses for the working classes (estimated) 20,982 „ „ families or separate occupiers (1911 census) 52,994 New houses for the working classes erected during the year, or in course of erection Nil. (2) Population. The chronic state of overcrowding in the Borough was accentuated in 1919 by the increase in the population. Compare the 1911 census population (218,387) with the Registrar-General's estimate for 1919 (228,585). (3) (a) The shortage of dwellings is indicated by the fact that in 1911 51,214 persons lived in 8,875 dwellings with more than two occupants per room. At the present time there is undoubtedly a greater shortage than in 1911. (b) There is no indication of the shortage being met by private enterprise, and the measures taken by the Borough Council are indicated on page 92. 11.—Overcrowding. (1) The extent of overcrowding in 1911 is indicated by the following figures from the census returns of that year. The degree of overcrowding is now still greater. Number of Rooms per Tenement. Total number of private families (or tenements). ation. 1 11,452 22,486 Tenements with more than two occupants per room :— Number 8,875 Population, all ages 51,214 „ under 10 years of age 19,043 Percentage of population in " private families" living more than two in a room 25.5 2 15,568 55,963 3 10,421 43,284 4 5,890 28,541 5 2,551 13,649 6 1,962 10,319 7 1,245 6,727 8 978 5,483 9 708 4,231 10 and upwards 1,535 10,052 Totals 52,310 200,735 87 (2) The causes of overcrowding are referred to on page 82. (3) Measures taken or contemplated to deal with overcrowding. — In reference to the building of houses, see I. (3) above. During 1919 serious cases of overcrowding beyond the limits set by the tenement house by-laws were dealt with by the Sanitary Inspectors by the service of notices. (4) 28 intimations in regard to overcrowding were served during the year. In no cases were proceedings taken. As the year progressed it became increasingly difficult to deal with overcrowding, by reason of the inability of tenants to find additional or alternative accommodation. A similar difficulty was found in securing the evacuation of underground rooms illegally occupied for sleeping purposes. III.—Fitness of Houses. (1) (a) General standard of housing. (b) General character of the defects found to exist in unfit houses.— The housing defects in St. Pancras are discussed in some detail on pages 81-86. Apart from the structural faults dealt with on those pages, the principal defects are in the nature of dilapidations. (2) Details as to action taken in regard to unfit houses under (a) the Public Health (London) Act, etc., will be found on pages 18 and 19 ; and (b) the Housing Acts on pages 91 and 92. (3) Difficulties in remedying unfitness, special measures taken, and any suggestions in the matter.—In this connection the Borough Council decided on 4th February, 1920, that a complete house-to-house inspection of the borough should be undertaken, and although the matter belongs to the year 1920, the questions under this heading may best be answered by setting out in full the Medical Officer of Health's report on the proposal:— Town Hall, Pancras Road, N.W. 1. 15th April, 1920. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, In accordance with your request I have to submit the following report in reference to the Council's instruction to the Committee that an inspection of all the houses in the borough is to be undertaken. Since your last consideration of the matter, the position has been made clearer by the submission by the London County Council for the observations of the borough councils of draft bye-laws with respect to working-class tenement houses under Sec. 26 of the Housing, Town Planning, etc., Act, 1919. These proposed bye-laws deal with the following matters:— Air-space and the number and sex of occupants. The provision of sinks and water-taps. The provision of means of ventilation. The cleanliness of houses and bedding. 88 The provision of sufficient accommodation in respect of water-closets, the washing of clothes, and the storage, preparation and cooking of food ; and, where necessary, separate accommodation as aforesaid for every dwelling in the house. The repair and lighting of staircases and the provision of hand-rails where necessary. Stability, and the prevention of and safety from fires. Periodical cleansing and redecoration. The paving of yards. The lighting of rooms. In their present proposed form the bye-laws appear to apply to all workingclass tenement houses without any restrictions, and one of the principal objects of the new house-to-house inspection should be to secure that such houses—and they comprise the majority of the houses in the borough— should, so far as practicable, be brought into compliance with the bye-laws. It is, therefore, most desirable that the bye-laws in their final form should be in operation when the work is begun. Another important matter that should be dealt with in the course of the inspection is the compiling of the list of those houses which call for a fairly frequent periodical inspection. In addition to the utilization of the powers which will be conferred by the bye-laws, the proposed inspection will enable a list to be prepared of houses and underground rooms which can be regarded as unfit for human habitation within the meaning of Sec. 17 of the 1909 Housing Act. It will also call for the enforcement of work under Sec. 28 of the 1919 Act, in respect of various defects which cannot be dealt with under the Public Health (London) Act and other existing powers. A feature of this section is that, in default of the necessary work being executed after the service of notice, the Council would have to undertake it themselves and recover the cost from the owners. The task is one of considerable magnitude. There were in the borough, at the time of the 1911 census, 23,345 dwelling houses, and the figure is approximately the same to-day. In this enumeration an ordinary tenement house which is occupied by more than one family is counted as one house only. I estimate that some twenty thousand are to be classed as working-class houses, and most of these are tenement houses. To complete a routine inspection of all of these, including the service of notices and the seeing through of the consequent repairs and alterations, within a limited period such as (say) one year, would need a very large special staff of inspectors and clerks, and would, moreover, doubtless be impracticable on economic grounds. With our present staff of 11 district sanitary inspectors, who would, of course, have to continue their present duties also, the work could never be done at all, and it will certainly necessitate the employment of a considerable additional staff of inspectors and clerks even if it is extended over a period of a few years. There are difficulties in connection with the proposed work which must not be overlooked. The position in regard to the condition of the houses,is so serious, however, that I do not consider that they should lead the Council to abstain from action in this direction. They fall into three groups, as follows:— 89 1.—The evils of the housing problem in St. Pancras depend largely on the lack of a sufficient number of dwellings affording adequate accommodation. It is estimated that there are some 25,000 one and two room dwellings in tenement houses, usually unprovided with suitable sanitary and other offices. It is hardly possible, in the case of many of the dwellings, to make them really fit for such occupation by reasonable alterations to the houses. It must, therefore, be recognised, although dirt and dilapidation can and ought to be remedied, that the inspection of these tenement houses is not likely to result in their being made into adequate dwellings. There is an analogous difficulty in the case of many damp and otherwise insanitary basements, where it is practically impossible to make them dry and wholesome without incurring very great expense. 2.—The present urgent demand for dwellings makes it almost impossible to enforce closing orders on houses and underground dwellings which are obviously unfit for habitation ; there being no houses to receive the families who would be thereby dishoused. 3.—The very high cost of building work and repairs at the present time makes it difficult for owners to carry out housing improvements. Some of the matters which should receive attention if the house-to-house inspection is undertaken have already been referred to in this report. It will be convenient to set them out below:— (1) A carefnl record of the result of the inspection of every house should be made, preferably on a card index system. (2) A separate register should be prepared of houses which call for regular periodical re-inspection. (3) A record should be made of all underground rooms, distinguishing those which cannot legally be used as sleeping places. (4) In addition to serving notice for defects which can be dealt with under present powers, the powers of the Council under the proposed tenement house bye-laws and under Section 28 of the 1919 Housing Act, should be brought into operation where necessary. The latter will involve a great deal of administrative work in connection with the preparation of schedules of repairs and the following up of the procedure of the Act, includ ing the execution of work by the Council in default of the owners. In regard to the tenement house bye-laws it is desirable that the occupiers should be required to fulfil their responsibility as well as the landlords. I am of opinion that a routine inspection of dwelling-houses on these lines ought to be undertaken. So long as the existing houses continue to be neglected thev will obviously become less and less fit for habitation, and this must inevitably lead to a reduction in the number of available dwellings in spite of the efforts which are being put forward in the direction of the building of new houses. The care of the old houses is at least as important as the provision of new houses, 90 No important amount of routine inspection of those houses which are not already subject to periodical inspection can he looked for from the present inspectors so long as they have their present duties also to perform, and I consider that with a view to carrying out the proposed work at a reasonable rate, including the enforcement of the necessary repairs and alterations, six additional Sanitary Inspectors are the least that can be asked for. They should be restricted to this work only. In addition the present eleven district inspectors should devote as much of their time as can be spared for it, to the same work. At least one additional clerk will be needed to cope with the increased clerical work which will result, and it is possible that still more help in this direction may be required. It should be mentioned that the sanction of the Ministry of Health will be required to the proposal to appoint more Sanitary Inspectors, and that subject to this, one half of their salaries will be repayable to the Council through the London County Council. It is clearly desirable that the question of the salaries of the Saniiary Inspectors, now under consideration, should be settled before new appointments are made. The occasion is appropriate to draw attention to the present insufficient and unsuitable accommodation which is allotted to the Public Health Department. If the staff is further increased this difficulty will be accentuated and the efficiency of the department definitely hampered by the bad accommodation. The consideration of the question of the better housing of the department ought not long to be deferred. I am, Ladies and Gentlemen, Your obedient servant, T. Shadick Higgins, Medical Officer of Health. 4. Water Supply.—The principal defect in this respect is the lack of water supply and sinks in the separate dwellings in tenement houses. The matter is referred to on pages 81-86. Since the early days of the war, action in this respect under Section 78 of the London County Council (General Powers) Act, 1907, has been suspended. Closet Accommodation.—The provision of water-closets is universal throughout the borough, and the chief defect is the lack of separate private closets for the individual dwellings in tenement houses (see pages 81-86). Befuse Disposal.— There remains a small proportion of ash-bins of the fixed type, but the majority of houses in the borough are provided with moveable " sanitary bins." In the tenement houses there is usually a single bin in the yard for the whole house, and in such circumstances there is commonly a good deal of untidiness in the management of the dust-bin. The system of removal is weekly throughout most of the borough, though in the case of certain premises a more frequent removal is practised. The collection is effected by the Works Department and the bulk of the house refuse is burnt at the borough destructor. The remainder is taken by contract for dumping in the country by canal and rail as is also the destructor clinker. Owing to lack of labour at the destructor and difficulties in regard to transport experienced by the contractors, the weekly service was not maintained throughout the year, and at times there were considerable accumulations of refuse uncollected, 91 IV.—Unhealthy Areas. (1) No areas were represented in recent years prior to 1919. (2) On October 29th, 1919, the Medical Officer of Health reported to the Housing Committee in regard to 15 areas in Somers Town comprising 455 houses, containing about 2,625 rooms occupied in about 1,109 lettings by about 4,234 persons (2,767 adults and 1,467 children under 10). They were reported as being insanitary areas which could not be satisfactorily dealt with otherwise than by schemes of reconstruction. The particulars in regard to these areas and the action taken by the Council will be found on pages 95-97. (3) No complaints were received during the year that other areas were unhealthy. Reference to Sidmouth Street and Litcham Street areas will be found on page 97. V.—By-laws relating to Houses let in Lodgings, etc. The London County Council have not yet brought into operation the by-laws which they are to make under the Housing Act of 1919. Reference is made to them on pages 87 and 88. It appears scarcely possible under the existing housing stringency to enforce any raised standard of air-space per occupant, or accommodation in respect of water-closets and other offices separate (or even, in many cases, convenient) for every dwelling in tenement houses. VI. —General and Miscellaneous. (See " Work of the Special (Homing) Committee," page 92). VII.—Statistics for the 12 months ended 31st December, 1919. (1) Number of dwelling-houses in respect of which complaints were made that they were unfit for human habitation Nil. (2) Action under Sec. 17 of the Housing Act of 1909:— (a) Number of dwelling-houses inspected under and for the purpose of the section— First routine inspection 505 Subsequent „ 1424 1929 (b) Number of dwelling-houses which was sidered to be unfit for human habitation As regards the whole house 16 „ underground rooms (6 rooms) 4 20 (c) Number of dwelling-houses the defects in which were remedied without the making of closing orders 1914 (3) Action under Sec. 28 of the Housing Act, 1919 Nil. (4) (a) Number of representations made to the local authority with a view to the making of closing orders— As regards the whole house 16 „ underground rooms (4 rooms) 3 19 92 (b) Number of closing orders made— As regards the whole house 12 „ underground rooms (4 rooms) 3 15 (c) Number of dwelling-houses in regard to which closing orders were determined Nil. (5) (a) Number of demolition orders made Nil. (b) „ houses demolished in pursuance of demolition orders Nil. (6) Number of dwelling houses demolished voluntarily Nil. (7) Obstructive Buildings. Representations, demolitions, &c. Nil. (8) No staff is engaged exclusively on housing work. The 11 district inspectors carry out all inspections of houses, and the subsequent clerical work is performed by the general clerical staff. A large amount of negotiation and other work in connection with housing has devolved upon Mr. A. Powel Coke, Chief Clerk in the Public Health Department and Clerk of the Special (Housing) Committee, and the following section in regard to the work of that Committee has been compiled by him. WORK OF THE SPECIAL (HOUSING) COMMITTEE. The housing problem presents different features in every Borough. So far as St. Pancras is concerned, although there is vacant land in the North of the Borough suitable for housing schemes, the important problem is the improvement of housing accommodation in the old areas of the district. The evils of the tenement house system are well known. The chief difficulty in dealing with it is the vast size of the problem. The greater part of the housing in the Borough is involved in it, but in more limited areas the evils have become predominantly worse by reason of the houses having become more or less worn out by age or usage. On the other hand, there is an urgent and imperative demand for increased housing accommodation. The Borough Council are earnestly endeavouring to meet both these aspects of the problem, and on the 27th November, 1918, the Special (Housing) Committee was appointed. The Committee directed its attention mainly to the following matters:— (1) The erection of new dwellings under Part III. of the 1890 Act. (2) The conversion of vacant houses into suitable dwellings. (3) The question of insanitary areas. (1) Construction Schemes. Jhookfield Estate.—The Council purchased about 9 acres of vacant land on the Brookfield Estate, off Highgate Road, for the purpose of providing additional accommodation. The scheme when completed will house 202 families and the buildings will take the form of flats, maisonettes and single houses. The detailed accommodation is as follows:— 5, of Two rooms, exclusive of scullery. &c. 71, „ Three „ „ 43, „ Four „ „ 83, „ Five „ „ 93 Building operations have been commenced on the first section of the scheme, the tender of Messrs. J. W. Falkner & Sons being accepted in the sum of £11,239 for the erection of a block of twelve flats on the piece of ground situated between the public library and the schools in Chester Road. Plans for the development of the remainder of the Estate are now under the consideration of the Ministry of Health, and when complete will be a valuable addition in meeting the urgent need for accommodation. Prince of Wales Road.—The land was purchased in 1906 for library purposes at a cost of £13,500. The library scheme was not proceeded with, and on the 7th July, 1914, the Local Government Board gave their consent under the Public Libraries Act, 1892, and the London Government Act, 1899, to the alienation by way of absolute sale of the land. Having regard to the need for additional housing accommodation, and to the difficulty of obtaining suitable sites in the Borough, the Council agreed on the 22nd January, 1919, to the land being utilised for housing purposes. The Ministry of Health were informed of the Council's proposal, and on the 16th April, 1919, agreed to a limited competition for designs. On the 13th August, 1919, the Ministry consented to the appropriation of the site for housing purposes under Section 57 (3) of the Housing of the Working Classes Act, 1890. On the 5th January, 1920, the London Housing Board approved the plans for the erection of a block of 64 self-contained flats comprising 25 four rooms, 34 three rooms, and 5 two rooms. Tenders were invited, and after considerable negotiations with the Ministry, the tender of Messrs. Chessums, Ltd,, was accepted in the sum of £76,001 14s. Od. The contract was signed on the 23rd June, 1920, and building operations are in progress. Leighton Road.—On the 14th August, 1919, the approval of the London Housing Board was requested to the acquisition of certain property in Leighton Road for housing purposes, and sketch plans were submitted showing how the site could be developed. The complete scheme for dealing with this site, comprising 1.35 acres, provided for the erection of eight blocks of four room flats, each four stories high, accommodating 64 families in all, but in order to avoid displacement and to reduce the compensation, the Committee suggested the erection of four blocks, comprising 32 flats, on the back portion of the site, leaving the frontage land to be dealt with later. The Architect's estimate for the first scheme was £32,331, and for the complete scheme £61,000, exclusive in both cases of the cost of land. On the 12th December, the Housing Board approved of the scheme proceeding on these lines in view of the fact that no de-housing would be involved, and the District Valuer was requested to negotiate for the purchase of the freehold interests in the entire property, and such leasehold interests as would be affected by the first portion of the scheme. Correspondence subsequently took place with the Ministry of Health, and in a let er dated 1st April, 1920, they stated that on the information before them they would not be justified in approving the scheme. The proposal was therefore dropped. 94 Wakefield Mews and Gough Street.—The abortive negotiations in regard to these two schemes pursued much the same lines as in the case of Leighton Road. Schemes for both areas were submitted to the Housing Board on the 14th August, 1919, and rejected by the Ministry on 6th March, 1920, the intervening time being occupied with negotiations, interviews and correspondence. The complete scheme for Wakefield Mews provided for the erection of 136 flats at an estimated cost of £105,868, and 72 flats and 8 shops at Gough Street for £63,012, excluding the cost of the land. Wakefield Mews comprises 1.8 acres at an estimated value of £73,500, and Gough Street about 1 acre at £15,600. The Ministry withheld their sanction in view of the very heavy cost of the sites, valuations of which were supplied to the Housing Board in September, 1919. Williams Mens and South Crescent Meics*—Sketch plans were prepared for dealing with these two areas. The proposed schemes were not wholly satisfactory, and the Committee felt that no advantage would be gained in submitting them to the Ministry for consideration. (2) Conversion of Vacant Houses. On the 29th July, 1919, a circular letter was received from the Ministry of Health asking that, with a view to obtaining an immediate increase in the amount of accommodation available to relieve overcrowding, local authorities should at once consider the question of utilising the powers in regard to the conversion of existing houses into flats or tenement dwellings. It was pointed out that to secure one of the main objects of these schemes, it was essential they should be put in hand at once. Prior to this communication, the Housing Committee on the 17th July, 1919, had supplied their Architect with a list of vacant houses in the Borough with the object of ascertaining those which might be regarded as suitable for the purpose of conversion. A copy of such list was sent to the Housing Board on the 24th July, 1919. Under Section 12 of the Housing Act, 1919, the powers of a local authority to acquire land for the purpose of housing are deemed to include power to acquire any estate or interest in any houses which might be made suitable as houses for the working classes together with any lands occupied with such houses, and the local authority are empowered to alter, enlarge, repair and improve any such houses or buildings so as to render them in all respects fit for habitation. On the 6th August, 1919, the Committee were represented at a Conference of the Metropolitan Borough Councils convened by the Ministry of Health and addressed by the Minister on the subject of conversion. The Architect presented his report on the 16th August, 1919, a copy of which, dealing with the houses suitable for conversion, was sent to the Housing Board on the 25th August, 1919. The houses were divided into three groups—(a) those suitable for repair or conversion; (b) those which might possibly be used as a last resource, and (c) those which were entirely unsuitable. 95 Of the 204 premises which were examined, 60 fell into class "a" ; 13 into class " b " and 131 into class " c." The Housing Board then suggested that, through the Office of Works, they should undertake the work of conversion in the Borough and submitted draft resolutions to give effect to the proposal. The Housing Committee agreed to the suggestion in order to expedite this branch of the work and to leave them free to concentrate upon the schemes for the erection of houses, and on the 24th September, 1919, the Council resolved as follows:— " That, for the purpose of securing the immediate provision of dwelling accommodation, the Ministry of Health, acting through the London Housing Board, be requested to exercise on behalf of the St. Pancras Borough Council the powers of the Council under Section 12 of the Housing, Town Planning, &c., Act, 1919, and that such dwelling accommodation as and when provided be taken over by the Borough Council as part of the Council's housing scheme, provided that the plans of the proposed conversions are submitted to the Special (Housing) Committee for their approval before the actual work is commenced." With regard to results, not a single house in the Borough has been converted. Several representations were made to the Housing Board with reference to the block of 24 empty houses in Euston Road. The matter was considered by the Board from the conversion point of view, but having regard to the high cost of the freehold, the condition of the premises, and the total estimated cost of conversion, they decided that the scheme was not one which they would be prepared to proceed with. The Ministry did make a Compulsory Order for the purpose of acquiring No. 37, Sidmouth Street. This property forms part of the Sidmouth Street area, which it is proposed to deal with under Part II. It was represented to the Ministry that it would be unfortunate if any expenditure were incurred in acquiring or repairing property which, sooner or later, would be dealt with as part of a housing scheme, and the matter was therefore dropped. Having regard to the disappointing results under Section 12, the Ministry were urged to apply for powers giving local authorities the right to eater upon and to take possession of empty premises; to put such premises into a habitable state of repair to the satisfaction of the local authorities at the expense of the owners ; and to compel the owners to relet the premises. A Bill enabling local authorities to hire compulsorily vacant houses has now been introduced into Parliament by the Minister of Health. (3) Insanitary Areas. Somen Town.—The area known as Somers Town presents the evils of the tenement house system aggravated by bad social conditions to a greater degree and on a larger scale than any other part of the Borough. At a Conference at the Ministry of Health, the opinion was expressed that with a view to furthering the improvement of this area, it was desirable that reconstruction schemes should be undertaken under Part II. of the 1890 Act, and on the 17th December, 1919, the Council resolved that the Housing Committee 96 be authorised to prepare schemes in regard to the following 15 areas in Somers Town:— (a) The area occupied by 63, Stibbington Street, and 1-20 (consecutive, inclusive), Johnson Street. (b) The area occupied by 21-31 (consecutive, inclusive), Johnson Street; 188, 190, and 192, Seymour Street; 1, 2, 3, 4, 5, 6, 7, 11, 12, and 13, Crawley Mews; 54, 56, 58, and 60, Werrington Street; and 35, 36, and 37, Clarendon Street. (c) The area occupied by 1-17 (consecutive, inclusive), Bridgewater Street ; 47-61 (odd, inclusive), Stibbington Street; 41-57 (consecutive, inclusive), Johnson Street ; and 25-30 (consecutive, inclusive), Clarendon Street. (d) The area occupied by 18-33 (consecutive, inclusive), Bridgewater Street; 31-45 (odd, inclusive), Stibbington Street; 1-15 (consecutive, inclusive), and 15a, Sidney Street; and two premises in Sidney Street at the rear of No. 17, Clarendon Street; and 17-24 (consecutive, inclusive), Clarendon Street. (e) The area occupied by 16-30 (consecutive, inclusive), Sidney Street, and two premises in Sidney Street at the rear of No. 16, Clarendon Street. (f) The area occupied by 1-28 (consecutive, inclusive), Wolcot Street; 36-39 (consecutive, inclusive), John on Street; and the four empty houses on the north side of Aldenham Street lying between Woleot Street and Clarendon Street. (g) The area occupied by 24-38 (even, inclusive), 38a, and 40-74 (even, inclusive), Stibbington Street. (h) The area occupied by 130-li6 (even, inclusive), Seymour Street, 11-20 (consecutive, inclusive), Gee Street, 66-76 (consecutive, inclusive), Clarendon Street, and the vacant house on the south side of Aldenham Street next to St. Aloysius Boys' School. (i) The area occupied by 1-14 (consecutive, inclusive), and 17-30 (consecutive, inclusive), Drummond Crescent. (j) The area occupied by 14-24 (consecutive, inclusive), Little Drummond Street, 36-56 (consecutive, inclusive), Drummond Crescent, 14-36 (even, inclusive), Drummond Street. (k) The area occupied by 1-13 (consecutive, inclusive), Little Drummond Street, and 38-44 (even, inclusive), Drummond Street. (l) The area occupied by 5-35 (odd, inclusive), Drummond Street, and 23-26 (consecutive, inclusive , Lancing Street. (m) The area occupied by 1-18 (consecutive, inclusive), Lancing Street. (n) The area occupied by 5, 7, 8, and 11, Weir's Passage. 97 (o) The area occupied by 2-10 (even, inclusive), Weir's Passage, 2-23 (consecutive, inclusive), Wilsted Cottages, 1-29 (odd, inclusive), and 22-30 (even, inclusive), Chapel Grove, 1, Clarke's Yard, 9-25 (odd, inclusive), 37, 41, 43, 47, 49, 55-67 (odd, inclusive), Ossulston Street, and 9, 11, 13, 19 and 21, Chapel Street. These fifteen areas comprise 455 houses, which, according to information obtained by a house to house inspection, contain about 2,625 rooms occupied in about 1,109 lettings by about 4,234 persons (2,767 adults and 1,467 children). It has not been thought expedient to press forward with these reconstruction schemes for the time being, more especially as the proposals involve demolition of the property and displacement of the occupants, if any permanent good is to be eifected; but several interviews have taken place with the Ministry on the matter, and proposals are being put forward for dealing in the first instance with one of these areas on which there is a certain amount of vacant land. Sidmouth Street and Litcham Street.—The Committee also had under consideration the preparation of schemes under Part II. of the Act of 1890 for dealing with the unhealthy condition of this property, but pending the decision of the Ministry in regard to the procedure to be adopted with the Somers Town proposals, no definite steps have yet been taken to proceed with them. APPENDIX. 100 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1919 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Bate. Number. Rate per l,OOONett Births. Number. Rate. 1909 237247 5238 221 3688 15.4 738 591 570 108 3521 14.8 1910 237178 — 5385 — 22.7 3415 14.4 710 562 580 107 3267 13.8 1911 237129 — 5135 5555 23.4 3418 14.4 673 611 623 112 3356 14.1 1912 220353 — 5008 5367 24.4 3147 14.3 595 605 472 88 3157 14.3 1913 218387 — 5167 5517 24.7 3409 15.6 728 662 512 93 3343 15.0 1914 218387 — 4945 5225 23.9 3386 15.5 721 677 481 92 3342 15.3 1915 218387 200322 4458 4754 21.8* 3523 17.6† 672 692 497 105 3543 17.7† 1916 214135 196813 4310 4530 21.2* 2991 15.2† 565 619 385 85 3045 15.5.† 1917 208006 186600 3635 3796 18.2* 3099 16.6† 608 718 402 106 3142 16.8† 1918 196883 175716 3339 3318 16.8* 3789 21.5† 626 751 340 102 3914 22.3† 1919 228585 219434 3804 3824 16.7* 3104 14.1† 670 496 336 88 2930 13.4† Area of district in acres (land and inland water), 2694.4 ; total population at all ages, 218,387; number of inhabited houses, 22,246; average number of persons per house, 9.82; at Census, 1911 (cf. Census, "Vol. V.). * Based on total population. † Based on Civil population. 101 Table No. 2. Deaths Registered from all Causes for the Year 1919. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Borough are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Borough are included. Cause of Death. AGES. 0 to 1 l to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. 1.—General Diseases. 1. Eaterio Fever M. F M. F. M. F. M. F. M F. M F. M. F. M. F M. F M. F. M. F. M. F. M. F. M. F M. F PERSON — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — — — 2 2 2. Typhus ,, — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3. Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Small Pox— (a) Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Doubtful — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — i 1 6. Measles 3 1 j— 3 2 2 6 6 1 2 — — — — — — — — — — — — — — — — — — 7 8 15 7. Scarlet Fever — 1 — — 1 2 1 3 — 1 — — — — — — — — — — — — — — — — — — 1 4 5 8. Whooping Cough 1 — — — 2 2 3 3 — 1 — — — — — — — — — — — — — — — — — — 3 4 7 9. (a) Diphtheria — — 2 — — 5 2 5 8 4 1 — — 1 — — — — — — — — — — — — — — 11 10 21 (b) Croup — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Influenza 8 3 1 2 4 3 18 8 2 5 2 3 7 11 18 34 22 16 22 13 23 17 16 12 4 7 — — 134 126 260 11. Miliary Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cholera Nostras — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 14. Dysentery — — — — — — — — — — — — — — 1 — — — — — — 3 — — — 1 — — 1 4 5 15. Plague — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 16. Yellow Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 17. Leprosy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 18. Erysipelas — — — — — — — — — — — — — — — — 1 1 1 1 1 1 — — — 3 — — 3 6 9 19. (a) Mumps — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) German Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Varicella — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other Epidemic Diseases — — j— — — — — — — — — — — — — — — — — — — — — — — — — — — — — 20. (a) Pyœmia — — — — — — — — — — — 1 — — — — — — — — 1 — 1 — — — — — 2 1 3 (b) Septicaemia — 1 — — — — — 1 — — — — — — 1 1 1 — — — — 1 1 — — — — — 3 3 6 (c) Vaccinia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 21. Glanders — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 22. Anthrax (Splenic Fever) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 23. Rabies — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 24. Tetanus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 25. Mycoses — — — — — — _ — — — — — — — — — — — — — — — — i— — — — — — — — 26 Pellagra — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 27. Reri-Beri — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 28. (a) Pulmonary Tuberculosis 2 — l — 1 — 4 — — 1 2 6 16 28 33 29 37 13 20 19 25 11 1 5 1 1 — — 139 113 252 (b) Phthisis (not defined as tuberculous) — — — — — — — — — — — — l 2 3 1 3 1 1 1 1 2 — — — — — — 9 7 16 29. (a) Acute Phthisis — — — — — — — — — 1 — — — 2 — — — — 1 — — — — i— — — — — 1 3 4 (b) Acute Miliary Tuberculosis — — — 1 2 1 2 — — — — — — — — 1 1 — — — — 1 — — — — — 3 3 6 30. Tuberculous Meningitis 4 — 5 4 5 8 14 12 — — 3 2 — 1 — — 1 — — — — — — — — — — — 18 15 33 31. (a) Tabes Mesenterica — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — l 1 (b) Other peritoneal & intestinal tubercle 1 — — 1 1 1 2 2 — — — — — — — — 1 — — — — — — — — — — — 3 2 5 32. Tuberculosis of Spinal Column — — — — — — — — — — — — 1 — 1 2 — — — — — — 1 — — — — — 3 2 5 33. Tuberculosis of Joints — — — — — — — — — — — — l 1 1 — — — — — — — 2 — — — — — 4 1 5 34. (a) Lupus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Tuberculosis of other Organs — — 1 — 1 — 2 — — — 1 — — — — — — — — 1 1 1 2 — — — — — 6 2 8 35. Disseminated Tuberculosis — — — 1 — — — 1 2 — — — — 1 1 — — — — 1 —— — — — — — — — 3 3 6 36. Rickets, Softening of Bones — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 37. Syphilis 9 2 2 — — — 11 2 — — — — — — — — 1 — — — 1 — — — — — — — 13 2 15 38. Other Venereal Diseases 5 — — — — — 5 — — — — — — — — — — — 1 — — — — — — — — — 6 — 6 39. Cancer of the Buccal Cavity — — — — — — — — — — — — — — — — — — 6 1 3 3 6 1 — — — — 15 5 20 40. ,, Stomach, Liver, &c. — — — — — — — — — — — — — — — — l — 7 4 20 9 12 9 2 2 — — 42 24 66 41. ,, Peritoneum, Intestines, and Rectum — — — — — — — — — — — — 1 — — — — 1 5 4 5 9 7 6 — 4 — — 18 24 42 42. „ Female Genital Organs — — — — — — — — — — — — — — — — — 4 — 8 1 8 — 6 — 2 — — 1 28 29 43» ,, Breast — — — — — — — — — — — — — — — — — 5 — 7 — 7 — 4 — 2 — 2 — 27 27 44. ,, Skin — — — — — — — — — — — — — — — — — — — — 1 1 — 1 1 — — — 2 2 4 45. Cancer of other or unspecified Organs — — — 1 — — — 1 — — — 1 1 — 1 1 2 — 6 3 12 8 14 3 — 4 — — 36 21 57 46. Other Tumours (situation undefined) — — — — — — — — — — — — 1 — — — — — — — — — 1 1 — — — — 2 1 3 47. Rheumatic Fever — — — — — — — — 1 — l 1 1 — — — 1 — — 1 — — — 1 — — — — 4 3 7 48. (a) Chronic Rheumatism — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — 1 1 2 (b) Osteo-Arthritis — — — — — — — — — — — — — — — — — 1 — 1 1 1 1 1 — 2 — — 2 6 8 (c) Gout — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 49. Scurvy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 102 Deaths 'Registered from all Causes for the Year, 1919—continued. Cause of Death. AGES 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals 1. General Diseases—con. 50. Diabetes M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M F. M. F. M, F. M F. PERSONS — — — — — — — — — — 2 — 1 1 — — 2 1 2 4 2 5 1 2 — 1 — — 10 14 24 51. Exophthalmic Goitre — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 52. Addison's Disease — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 53. Leucocythæmia Lymphadenoma — — — — — — — — — — — — — — 1 — 1 — 1 — — — 1 — — — — — 4 — — 54. Anæmia, Chlorosis — — — — — — — — — — 1 1 — 1 — — — — — — 1 — 1 1 1 — — — 4 3 7 55. (a) Diabetes insipidus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Purpura — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Haemophilia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other General Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 56. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 57. (a) Occupational Lead Poisoning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Non-occupational Lead Poisoning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 58. Other Chronic Occupational Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 59. Other Chronic Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. Encephalitis — — — — — — — — — — — 1 — — — — — — 3 — 1 — — — — — — — 4 1 5 61. (a) Cerebrospinal Fever — — — — — 1 — 1 — — — — — 1 1 — 1 — — — — — — — — — — — 2 2 4 (b) Posterior Basal Meningitis l — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — — 1 1 2 (c) Meningitis, other forms 2 3 5 1 — — 7 4 2 1 — — — — 1 — 1 — — — 1 — — — — — — — 12 5 17 62. Locomotor Ataxy — — — — — — — — — — — — — — — — 1 — 3 — — 1 — — — — — — 4 1 5 63. (a) Anterior Poliomyelitis — — — — 1 — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 (b) Other Diseases of the Sninal Cord — — 1 — — — 1 — — — — — — — 1 1 — 1 1 3 4 — 1 — 1 — 1 — 16 5 15 64. Cerebral Haemorrhage, Apoplexy — — — — — — — — — — — — 1 — — 1 2 1 3 5 9 4 9 4 7 9 1 4 32 38 70 65. Softening of Brain — — — — — — — — — — — — — — — — — — — — 1 — — 1 — 1 — — 1 2 3 66. Paralysis without specified cause — — — — — — — — — — — — — — — — 1 — 1 1 1 3 4 5 2 4 1 — 10 13 23 67. General Paralysis of the Insane — — — — — — — — — — — — — — — — 2 1 1 2 — — — — — — — — 3 3 6 68. Other forms of Mental Alienation — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 69. Epilepsy — — — — — 1 — 1 — 1 — 1 1 — — — 2 — — 1 1 — 1 — — — — — 5 4 9 70. Convulsions (Non-puerperal; 5 years and over) — — — — — — — — — — — — — — — 1 1 — — — — — — 1 — — — — 1 2 3 71. Infantile Convulsions (under 5 years) 5 1 — 1 — — 5 2 — — — — — — — — — — — — — — — — — — — — 5 2 7 72 Chorea — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 73. Hysteria, Neuralgia, Neuritis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 74. Other Diseases of the Nervous System 1 — — — — — 1 — — — — — — — — — — 1 — 2 — — — — — — — — 1 3 4 75. Diseases of the Eyes and Annexa — — — — — — — — — — — — — — — — — — — — — — — 2 — — — — — 2 2 76. (a) Mastoid Disease — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 (b) Other Diseases of the Ears — 1 — 1 — — — 2 1 — — 1 — — 1 — — — — — — — — — — — — — 2 3 5 3. Diseases of the Circulatory System. 77. Pericarditis — — — — 1 — — — 1 1 — — 1 — — 2 — — — 1 — — — — — — — — 3 4 7 78. Acute Myocarditis and Endocarditis — — — — — — — — 1 — 1 1 — 2 1 1 — — 2 — — 1 — — — — — — 5 5 10 79. (a) Valvular Disease — — — — — — — — 1 — 3 3 1 4 2 7 9 2 8 11 11 15 22 14 13 13 1 4 71 73 144 (b) Fatty Degeneration of the Heart — — — — — — — — — — — — — 1 2 — 2 2 3 6 3 4 6 1 3 4 — 1 19 19 38 (c) Other Organic Disease of the Heart — — — — — — — — — — — 1 — 2 2 3 2 2 11 11 18 17 28 34 18 22 1 6 80 98 178 80. Angina Pectoris — — — — — — — — — — — — — — — — — — — — 3 — 3 — 1 — — — 7 — 7 81. (a) Aneurysm — — — — — — — — — — — — — — 1 — 2 — 3 — 2 — 2 — — — — — 10 — 10 (b) Arterial Sclerosis — — — — — — — — — — — — — — — — — — 3 1 2 3 11 7 3 2 1 — 20 13 33 (c) Other Diseases of Arteries — — — — — — — — — — — — — — — — — — 2 1 _1 — 1 — — — — 4 1 5 82. (a) Cerebral Embolism and Thrombosis — — — — — — — — — — — — — — — — 1 — — 3 1 6 4 1 3 2 — 10 11 21 (b) Other Embolism and Thrombosis — — — — — — — — — — — — — — — — — 1 1 — — — 2 1 — — — — 3 2 5 83. Diseases of the veins (Varices, Haemorrhoids, Phlebitis, etc.) — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 84 (a) Status Lymphaticus — 1 — — — — — 1 — — — — — — — — 1 — — — — — — — — — — — 1 1 2 (b) Other Diseases of the Lymphatic System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 85. Hæmorrhage; other Diseases of the Circulatory System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossæ — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 87. Diseases of the Larynx — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 88. Diseases of the Thyroid Body — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 89. & 90. Bronchitis 12 11 2 3 — 1 14 15 1 3 — — — — 3 1 11 5 14 9 4 27 40 44 25 44 5 18 135 166 301 91. Broncho-Pneumonia 9 15 9 4 4 8 22 27 2 — 1 1 — 2 2 3 — 1 3 2 5 2 5 3 5 4 — 1 45 46 91 92 (a) Lobar Pneumonia — 1 — 1 1 1 1 3 1 — — 1 3 2 2 — 3 2 5 — 3 2 4 2 2 1 — 2 24 15 39 (b) Pneumonia (type not stated) 3 5 4 — 2 — 9 5 — — — — 2 1 3 2 1 5 8 2 1 2 2 2 2 1 — 1 28 21 49 93. Pleurisy — — — — — 1 1 — — — 1 — — — — 1 — 2 1 1 — — 1 — — — — 5 4 9 103 Deaths Registered from all Causes for the Year, 1919—continued. Cause of Death. AGES. 0 to 1 1 to 2 ! 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. 4. Diseases of the Respiratory System—con. 94. Pulmonary Congestion, Pulmonary Apoplexy M. F. M. F. M : F M F M F M F M F M F M F M F |M F M. • F M. F M. F. M. F. PER SONS — — — 1 — — — 1 — — — — — — — — — — — 1 — 1 1 1 — 2 — 1 2 7 9 95. Gangrene of the Lung — — — — — — — — — — — — — — — — — — 1 — — 1 — — — — — — 1 1 2 96. Asthma — — — — — — — — — — — — — 1 — — — — 1 1 1 4 1 — — — — 1 3 7 10 97 Pulmonary Emphysema — — — — — — — — — — — — — — — — — — 1 — — — — — — — — 1 1 1 2 98. (a) Fibroid Disease of the Lung — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 (b) Other Diseases of the Respiratory System — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 1 5 Diseases of the Digestive System 99. (a) Diseases of the Teeth and Gums — 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 (b) Other Diseases of the Mouth and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 100. Diseases of Pharynx, Tonsillitis 1 — — — — — 1 — — — — 1 — — — — — — 1 — — — — — — — — — 2 1 3 101. Diseases of (Esophagus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 102. Perforating Ulcer of Stomach — — — — — — — — — — — — — 1 — 1 1 1 3 — 2 1 — 1 1 — — — 7 5 12 103 (a) Inflammation of Stomach 3 — — — — — 3 — — — — — — 1 1 — — — 1 1 — 1 — 1 1 1 — 1 6 6 12 (b) Other Diseases of Stomach 2 — — — — — 2 — — — — — — — — — — — 1 — 1 — 1 — — — — — 5 — 5 104 & 105. (a) Infective Enteritis 5 5 — — — — 5 5 — 1 — — — — — — — — — — — — — — — — — — 5 6 11 (b) Diarrhoea (not returned as infective) 4 6 — — — — 4 6 — — — — — — — — — — — — — — — 1 — 1 — — 4 8 12 (c) Enteritis (not returned as infective) 10 2 1 1 1 — 12 3 — — — — — — — 1 1 — — — — 2 — 2 — 1 — — 13 9 22 (d) Gastro-Enteritis (not returned as infective) 11 1 2 1 1 1 14 6 — — — — — — — — — 1 — — — — — 1 — 1 — — 14 9 23 (e) Dyspepsia (under 2 years of age 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — 1 1 (f) Colic — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (g) Ulceration of Intestines — — — — — — — — — — — — — — — — — — 1 — — — — 1 — — — — 1 1 2 (h) Duodenal Ulcer — — — — — — — — — — — — — — — — 1 — 1 1 — — — 1 — — — — 4 2 6 106 Ankylostomiasis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 107. Other Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 108. Appendicitis — — — — — — — — — 1 1 — 1 — — 2 1 — 1 — 1 — — — 1 — — — 6 3 9 109 (a) Hernia — — — — — — — — — — — — — — — — — 2 1 — 2 1 1 2 2 2 — 1 6 11 17 (b) Intestinal Obstruction — 1 — 1 — — — 2 — — — — — — — 1 — 1 — 1 2 3 — 1 — 1 — — 2 10 12 110. Other Diseases of the Intestines 1 — — — 1 — 2 — — — — — — — — — — — — — — — 1 — — — — — 3 — 3 111. Acute Yellow Atrophy of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 112. Hydatid of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 113 (a) Cirrhosis of the Liver (not returned as alcoholic) — — — — — — — — — — — — — — 1 — — — —— — 2 3 2 — — — — — 5 3 8 (b) Cirrhosis of the Liver (returned as alcoholic) — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder'' — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 114. Biliary Calculi — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — — — 3 3 115. Other Diseases of the Liver — — — — — — — — — — — — — — 1 — — — — — — 2 1 — — 1 — — 2 3 5 116. Diseases of the Spleen — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 117. Peritonitis (cause unstated) — — — — — — — — 2 — — — 1 — — 2 — — — — — — — — — — — — 3 2 5 118. Other Diseases of the Digestive System — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 6. Non-Venereal Diseases of the Genito-Urinary System and Annexa 119. Acute Nephritis — — — — — — — — — — — — — — — — — 1 — 2 3 — — 1 — — — — 5 4 9 120. Bright's Disease — — — — — — — — 1 — — — — — 3 1 1 4 — 3 7 6 7 5 4 4 — — 29 23 52 121. Chyluria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 122. Other Diseases of the Kidney and Annexa — — — — — — — — — — — — — — — 2 1 — — 1 1 — — — — — — — 2 3 5 123. Calculi of the Urinary Passages — — — — — — — — — — — — — — — — — — — — — — — — 5 — 1 — — — — 124. Diseases of the Bladder — — — — — — — — — — — — — — — — — — 1 — 3 — 8 — — 1 — — 18 1 19 125. Diseases of the Urethra, Urinary Abscess. &c. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 126. Diseases of the Prostate — — — — — — — — — — — — — — — — — — — — 4 — 5 — 3 — — — 13 — 13 127. Non-V«nereal Diseases of Male Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 128. Uterine Haemorrhage (Non-puerperal) — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 129. Uterine Tumour (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 130. Other Diseases of the Uterus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 131. Ovarian cyst, Tumour (Non-Cancerous) — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 132. Other Diseases of the Female Genital Organs — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 133. Non-puerperal Diseases of the Breast (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 104 Deaths Registered from all Causes for the Year, 1919—continued. Cause of Death. ages. 0 to 1 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. 7. The Puerperal State. M. F. M. F. M. F. M. F. M. F. M. F. M.. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. PERSONS 134. Accidents of Pregnancy — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 135. Puerperal Hæmorrhage — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 136. Other Accidents of Childbirth — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — 2 2 137. Puerperal Fever — — — — — — — — — — — — — 3 — 4 — 2 — — — — — — — — — — — 9 9 138. „ Albuminuria and Convulsions — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 139. ,, Phlegmasia Alba Dolens, Embolism and sudden death — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 140. „ Insanity — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 141. ,, Diseases of the Breast — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 8. Diseases of the Skin and of the Cellular Tissue 142. (a) Senile Gangrene — — — — — — — — — — — — — — — — — — — — 1 — 1 3 1 — — — 3 3 6 (b) Gangrene (other types) — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 143. Carbuncle, Boil — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — 2 2 144. Phlegmon, Acute Abscess 1 1 — — — — 2 1 — — — — — — — — — — — — 1 — 1 — — 1 — — 4 2 6 145. Diseases of the Integumentary System 1 — — — — — l — — — — — — 1 — — — — — — — 1 1 1 — — — — 2 3 5 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bones 1 — — — — — 1 — — — 1 — — — — — — — — — — |— 1 — — — — — 4 1 5 147. Diseases of the Joints — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 148. Amputations — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 149. Other Diseases of Locomotor System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Malformations. 150. Congenital Malformations 18 13 — — — — 18 13 — — 1 — 1 — — — — — — — — — — — — — — — 20 13 33 11. Diseases of Early Infancy. 151. (a) Prematuro Birth 43 25 — — — — 13 25 — — — — — — — — — — — — — — — — — — — — 43 25 68 (b) Infantile Debility, Icterus, and Sclerema 34 11 1 — — — 35 11 — — — — — — — — — — — — — — — — — — — — 35 11 46 152. Other Disease peculiar to early Infancy 6 8 — — — — 6 8 1 — — — — — — — — — — — — — — — — — — — 7 8 15 l53. Lack of Care — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Old Age. 154. (a) Senile Dementia — — — — — — — — — — — — — — — — — — — — — — — 1 1 2 — — 1 3 4 (b) Senile Decay — — — — — — — — — — — — — — — — — — 1 — — 2 19 20 26 59 22 34 68 115 183 13. Affections Produced by External Causes. 155 to 163. Suicides — — — — — — — — — — — — — — 1 2 1 5 5 1 3 — 1 1 — — — — 11 9 20 164. Poisoning by Food — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 165. Other Acute Poisonings — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — — — 2 2 166. Conflagration — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 2 2 167. Burns (Conflagration excepted) — — 2 —— — 2 3 2 — — 1 — — 2 — — — — — — — — — 1 — 1 — — 4 6 10 168. Absorption of Deleterious Gases (Conflagration excepted) 2 l — — — — 2 1 — — — — — — — — — 1 1 — — 1 — — — J— — — 3 3 6 169. Accidental Drowning — — — — — — — — — — — — 1 1 — — — — — — — 1 — — — — — — 1 2 3 170 to 176. Injuries — — — — 2 2 2 2 6 2 2 2 2 — 1 — 3 1 6 1 12 1 6 — 2 — 2 3 44 17 61 177. Starvation — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 178. Excessive Cold — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 179. Effects of Heat — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 180 Lightning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 181. Electricity (Lightning excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 182 to 184 Homicide — 1 — — — — — 1 — — — — — — — — — 1 — — — — — — — — — — — 2 2 185 Fractures (cause not specified) — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 186. Other Violence — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 14. Ill-defined Causes. 187.Dropsy — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 2 1 188 (a) Syncope (acred 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Sudden death (not otherwise defined) — — —i — — — — — — — — — — — — — — — — — — — — — — — — — — — — 189 (a) Heart Failure (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (a) Atrophy, Debility. Marasmus (age 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — 2 2 (c) Teething — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Pyrexia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (e) Other ill-defined Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Cause not specified — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 105 Table No. 3. Summary of Ages. 0 to 1 1 to 2 2 to 5 Total under 5 years. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. General Diseases 42 80 43 115 29 28 81 129 120 143 187 123 40 2 997 Diseases of the Nervous System and of the Organs of Special Sense 14 9 3 26 6 3 3 7 15 26 28 38 24 7 183 Diseases of the Circulatory System 2 — 1 3 4 9 11 21 24 67 F2 142 83 16 462 Diseases of the Respiratory System 56 25 18 99 8 4 11 16 29 51 72 108 88 30 516 Diseases of the Digestive System 57 6 4 67 4 2 4 13 9 14 27 18 14 2 174 Non-Venereal Diseases of the Genito-Urinary System and Annexa — — — — 1 — 1 6 8 16 24 27 17 1 101 The Puerperal State — — — — — 5 4 4 — — — — — 13 Diseases of the Skin and of the Cellular Tissue 3 1 4 — — 1 — 1 — 4 8 2 20 Diseases of the Bones and of the Organs of Locomotion 1 — — 1 1 1 — 1 — — — 1 — — 5 Malformations 81 — — 31 — 1 1 — — — — — — — 33 Diseases of Early Infancy 126 1 — 127 1 — — — — — — — — — 128 Old Age — — — — — — — — 1 2 40 88 56 187 Affections produced by External Causes 4 2 7 13 9 5 6 5 13 16 18 9 9 5 108 Ill-defined Causes — — — — — — — — — — 1 1 — 1 3 Totals 336 73 77 486 63 53 124 202 223 834 445 515 365 120 2930 106 Table No. 4. Total Births, Total Deaths, and Infantile Deaths, with corresponding rates, for each Ward and Registration Sub-District. In this Table the estimated population, total or civil, is distributed amongst the Wards and Sub-districts in the same proportion as at the 1911 Census; the transferred births are allocated to the Wards and Sub-districts in proportion to their respective populations, but some of the births which took place in St. Pancras institutions are not redistributed, but are allocated to the districts in which the institutions are situated; and deaths of residents which took place outside of the Borough and deaths in public institutions are classified in the respective Sub-districts and Wards of their previous residence. Registration Sub-Districts. Wards. Net Births. Birth-rate per 1,000 total population. Net Deaths. Death-rate per 1,000 civil population. Deaths under 1 year of age. Infantile Death-rate per 1.000 Births. West 4 461 16.7 368 13.9 45 97 5 478 14.3 409 12.8 45 94 939 15.4 777 13.3 90 95 South 7 473 24.9 231 12.7 30 63 8 403 14.2 380 13.9 48 119 876 18.5 611 13.4 78 89 East 3 569 15.6 521 14.9 40 70 6 483 20.3 303 13.3 55 114 1052 17.5 824 14.3 95 90 North I 563 15.1 396 11.1 44 78 2 394 17.2 266 12.1 28 71 — 957 15.9 662 11.5 72 75 No Address — — — 56 — 1 — Whole Borough — 3824 16.7 2930 13.4 336 88 107 Table No. 5.—Showing the Birth rates, Death rates, and Infantile Mortality rates of England and Wales and certain of the large Towns, and of London and the Metropolitan Boroughs for 191S. (53 weeks ending 3rd January, 1920.) Population (Civilian) as Estimated by the RegistrarGeneral in the middle of 1919. Birth Rate. Death Rate. Infantile Mortality. Population (Civilian) as Estimated by the RegistrarGeneral in the middle of 1919. Birth Rate. Death Rate. (Crude), Infantile Mortality. England and Wales 35 993,000 18.5 13.8 89 County of London WEST. 4,358,309 18.3 13.4 85 Birmingham 861,585 20.3 13.6 88 Paddington 143,938 15.5 13.0 92 Liverpool 772,665 23.5 16.8 107 Manchester 741,068 18.2 14.0 95 Kensington 157,886 16.3 14.9 102 Sheffield 473,695 21.1 13.7 96 Hammersmith 130.981 16.6 12.6 99 Fulham 152,543 18.6 12.1 83 Leeds 430,834 17.6 16.0 112 Chelsea ^0,573 14.7 14.6 80 Bristol 361,247 18.1 13.1 82 City of Westminster 127,533 12.0 13.9 89 West Ham 287,966 24.1 1.3 84 NORTH. Bradford 282,714 13.6 15.9 111 St. Man lebone 97,953 15.1 15.2 89 Hull 279,664 20.0 15.1 109 Hampstead 88,012 12.7 11.2 81 Newcastle-on-Tyne 275,099 23.3 16.9 119 St. Pancras 219.434 17.2 13.2 86 Islington 323,034 18.2 14.1 86 Nottingham 257,573 18.2 14.1 104 Stoke Newington 50,954 16.8 12.7 64 Portsmouth 224,846 22.3 12.6 71 Hackney 216,736 18.6 13.0 82 Stoke-on-Trent 239,316 22.3 15.7 110 CENTRAL. Salford 226,225 18.6 14.9 101 Holborn 38,156 13.6 16.2 94 Leicester 236,059 15.6 12.9 96 Finsbury 75,291 20.7 15.2 86 Cardiff 204 436 18.3 11.9 92 City of London 13,893 10.4 14.0 105 Bolton 177,462 16.1 14.4 88 EAST. Croydon 184,239 15.8 11.9 71 Shoreditch 98,134 23.6 15.7 104 Willesden 160,917 16.7 10.6 83 Bethnal Green 110,085 22.5 13.9 84 Rhondda 177,911 22.6 11.4 111 Stepney 232,506 22.5 14.4 79 Poplar 153,644 24.8 14.4 83 Sunderland 149,263 27.3 17.3 119 south. Oldham 137,668 16.1 15.9 95 Southwark 179,971 21.9 14.9 95 Tottenham 141,338 17.8 10.9 70 Bermondsey 124,239 21.6 13.7 92 West Ham 1 4,451 16.4 9.7 71 Lambeth 282,822 19.0 14.6 85 Birkenhead 118,052 22.2 13.5 96 Battersea 159,316 18.7 12.7 73 Blackburn 125,992 14.0 15.6 93 Wandsworth 333,693 14.7 11.2 72 Brighton 132,409 14.7 13.6 74 Camberwell 273,802 18.3 12.4 82 Deptford 111,205 20.6 12.8 85 Walthamstow 127,684 16.8 9.9 73 Greenwich 98,484 19.2 13.5 92 Leyton 123,896 10.1 11.0 75 Lewisham 167,754 16.4 11.4 60 Derby 123,930 19.6 12.9 90 Woolwich 136,237 19.3 12.2 85 108 Table No. 6. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1919. (Extracted from the Monthly Returns of the Meteorological Office.) Deduced from Observations at Camden Square, N.W., under the Superintendence of H. Robert Mill, d.sc., ll.d. January. February. March. April. May. June. July. : August. September. October. November. December. Barometer. Mean Pressure at 32° F. at Station Level 29.636 29.698 29.71 29.86 29.967 30.03 29.941 29.911 29.929 30.057 29.689 29.74 Air Temperature. Mean of Maximum A 42.6 41.0 47.4 55.1 70.8 72.3 68.9 76.0 69.4 54.7 44.1 48.1 Minimum B 33.1 30.5 34.5 38.1 47.5 50.7 51.5 55.0 49.4 38.2 34.6 37.1 Mean of A. and B 37.9 35.8 40.9 16.6 59.1 61.5 60.2 65.5 59.4 46.4 39.4 42.6 Difference from Average † —0.9 4.2 —2.0 —1.8 +4.0 +0.5 —41 +23 +0.8 —4.3 —4.9 +21 Humidity—Morning 91% 92% 85% 77% 66% 63% 74% 69% 80% 84% 91% 90% Earth Temperature at 4 ft. depth 45.1 41.0 42.1 43.5 48.9 56.1 56.9 59.2 59.0 53.3 47.4 45.1 Bright Sunshine. Total Observed (Daily mean) Hours 0.39 0.40 2.69 3.34 7.03 7.14 3.51 6.42 4.44 2.94 1.01 0.43 Per cent of total possible 5 4 23 24 46 44 22 45 36 28 Difference from Average † Hours —0.67 —1.34 —0.15 —1.29 +1.38 +1.17 —2.17 + 1.26 +0.31 +0.62 Bain and other forms of Precipitation. Number of Days 22 14 21 18 4 9 14 11 10 9 23 27 Total Fall Inches 3.22 2.65 3.62 3.93 0.33 1.51 1.75 2.37 1.29 0.69 1.38 3.47 Difference from Average † + 1.38 + 0.98 +1.77 +2.40 —1.46 —0.51 —0.67 +0.16 —0.51 —1.93 —0.98 +106 * The Readings for Pressure (Bar. 103 ft. above M.S.L.) given are those taken at Enfield; the hours of observation are 9 a.m. and 3 p.m., local time, no readings being recorded at Camden Square during 1919. † The averages used are obtained from observations extending over 35 years for Rainfall, Temperature, and Sunshine, 109 Table No. 7. Inspections and Re-inspections made by District Inspectors and temporary Women Inspectors and by Factory and Workshop (Male) Inspector during the year 1919. DUTIES AND PREMISES. Male Inspectors. Temporary Women Inspectors. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. DISTRICT INSPECTORS. Infectious Diseases—Inquiry, removal, disinfection, etc. r . 30 7 3396 5 3426 12 Subsequent sanitary inspection, etc. 487 351 1147 559 1634 910 Complaints 2825 8309 8 — 2833 8309 Drainage—Under notice. Plans, supervision, etc. 200 2039 — 200 2039 Voluntary 1500 2910 — — 1500 2910 New Buildings 109 199 — — 109 I99 Drain Tests 22 — — — 22 — Yards of Mews and Stables 3881 29 — — 3881 59 Housing, Town Planning, etc., Act, 1909: 17 (1).— First Inspections 505 1045 — — 505 1045 Subsequent routine Inspections 1424 43'2 — — 1424 4312 Inspections of registered tenement houses other than above 240 743 — — 240 743 Other house-to-house Inspections I 5 — — 1 5 Visits to closed underground rooms 8 — — — 8 — Smoke Shafts observed 79 — — — 79 — Regulated Trades. Offensive Trades 1 — — — 1 — Rag and Bone dealers 5 — — — 5 — Other effluvia businesses — — — — — — Inspections of Market Streets — — — — — — Other Duties 1856 20 — — 1856 20 Food Control 5199 4 — — 5199 4 Totals 18372 19973 455 564 22923 20537 FACTORY & WORKSHOP (MALE) INSPECTOR. Factories 270 363 — — 270 363 Laundries—Factories — — — — — Workshops 1 — — — 1 — Bakehouses—Factories 72 92 — — 72 92 Workshops 278 191 — — 278 191 Restaurant Kitchens 141 149 — — 141 149 Other Workshops 438 594 — — 438 594 Other Workplaces 26 47 — — 26 47 Other Duties 41 2 — — 41 2 Food Control 696 1 — — 696 1 Totals 1963 1439 — — 1963 1439 110 Table No. 8. 110 Inspections and Re-Inspections and other work of the Food Inspectors during 1910. DUTIES AND PREMISES. Visits and Inspections, Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child, Totals. Mr. Auger. Mr. Child. Totals. Milkshops 89 347 436 — — — Dairies 120 11 131 — — — Cowsheds 1 2 3 — — — Other Premises of Milk Purveyors 1 6 7 — — — Margarine Factories — — — — — — Butter Factories — — — — — — Ice Cream Premises 42 90 132 — — — Slaughter Houses 30 11 13 — — — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 21 101 122 — — — Butchers' Shops 11 112 136 — — — Fishmongers' Shops 8 41 49 — — — Fried Fish Shops and Fish Curer's premises i.S 128 13 — — — Marketing Places 1608 154 2962 — — — Other Premises where Food or Drugs are sold 8 7 15 — — — Other Visits 46 201 247 — — — Total 2000 2526 4526 — — — SAMPLES, &c., TAKEN. Formal Samples Informal Samples No. of Milk samples 183 201 384 — — — „ Cream samples — — — — — — ,, Butter and Margarine samples 27 2 29 — 1 1 ,, Other samples (specified below)— Lard — 8 8 — — — Dripping — 19 19 — — — Custard powder 6 12 18 — — — Flour 35 23 58 — — — Baking Powder 8 6 14 — — — Mustard 9 12 21 — — — Egg Powders 3 3 6 — — — Arrowroot — 9 9 — — — Rice 4 — 4 — — — Pepper 12 7 19 — — — Honey 1 — 1 — — — Cocoa 28 12 40 — — — Vinegar 36 38 74 — — — Olive oil 3 3 6 — — Camphorated oil 17 7 24 — — — Salad oil 2 1 3 — — — Glycerine — 12 12 — — — Total 374 375 749 — 1 1 111 Table No. 8—con. Inspections and Re-inspections and other work of the Food Inspectors during 1919. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. FOOD CONTROL (No. of Samples, Inspections, &c.) 746 990 1736 — — — UNSOUND FOOD. No, of surrenders and seizures:— Surrendered Seized Meat, &c. 5 17 22 — — — Fish 11 9 20 — — — Shellfish — 2 2 — — — Other Foods (specified below):- Fruit 1 — 6 — — — Eggs 1 1 2 — — — Dates 6 10 16 — — — Vegetables 1 8 — — — — Currants (Dried) 1 — — — — — Corned Beet 2 — — — — — Rabbits — — 9 — — — Hares 1 — — — — — Jam 1 2 3 — — — Cheese 4 5 9 — — — Margarine — 1 1 — — — Butter — 2 2 — — — Total 36 70 106 — — — Inspections of Registered Canal Boats 6 — 6 — — — 112 Table No. 9. Visits, etc., made by Women Inspectors during 1919. First Visits. Subsequent Visits. Call made but admission not obtained. Miss Bibby. Miss Smith. Miss Payne. *Miss Mac Knzie. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. fMiss Witt. Total. Miss Bibby. Miss Smith. * Miss Payne. *Miss MacKenzie. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. tMiss Witt, Total. | Miss Bibby. Miss Smith. *Miss Payne. *Miss MacKenzie. Mrs. Hunter. Miss Anderson. Miss Blaxland. MissCamman. Miss Parnell. †Miss Witt. Total. Grand Total. Infants — 317 2 — 452 680 4 14 1 4 1474 — 337 — — 270 418 17 5 — — 1047 — 305 — — 176 515 2 4 — — 1002 3523 Expectant Mothers — 104 — — 71 22 2 6 — — 205 — 72 — — 22 16 1 4 — — 115 — 77 — — 14 6 — — — — 97 417 Ophthalmia Neonatorum — 35 — — 1 — 1 3 — — 40 — 71 — — — — 2 4 — — 77 — 33 — — — — 1 1 — — 35 152 Puerperal Fever — 16 — — — — — — — — 16 — 2 — — — — — — — — 2 — 4 — — — — — — — — 4 22 Tuberculosis 9 — — — — 3 360 13 535 29 949 — 1 — — — 2 712 4 636 11 1366 — — — — — — 354 — 115 4 473 2788 Measles and German Measles — 17 13 16 108 172 54 1284 44 25 1733 — 12 2 — 35 56 11 116 5 1 238 — 2 — — — 24 13 64 — 4 107 2078 Whooping Cough — — — — 4 11 — 13 — — 28 — — — — 3 5 — 1 — — 9 — — — — — — — 1 — — 1 38 Scabies — — 41 23 — — — — — — 64 — — 10 — — — — — — — 10 — — 2 — — — — — — — 2 76 Other Cases of Illness — 22 30 68 142 108 16 51 176 613 — 9 23 1 30 46 52 6 68 — 235 — 2 2 — — 27 11 — 3 45 893 Verminous Persons — — 13 24 — 1 — — — — 38 — — 5 — — 2 — — — — 7 — — 5 — — 1 — — — — 6 51 To Hospitals and other Voluntary Institutions 267 491 — — 261 113 247 27 136 7 1549 — — — — — 1 — 10 — 3 14 — — — — — — 1 — — — 1 1564 Domestic Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Home Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Laundries—Factory — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, —Workshop — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Restaurant Kitchens — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other Factories 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 ,, Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Attendances at Committees, &c. 141 12 — — 1 — — — — — 154 — — — — — — — — — — — — — — — — — — — — — — 154 Other Visits and Inspections 51 26 6 — 203 33 3 185 1 18 526 — 1 — — 13 8 17 15 — 4 58 — 6 — — — 12 3 3 — 2 26 610 Totals 469 1040 105 131 * 1243 1143 687 1596 893 83 7390 — 505 40 * 1 * 373 554 812 165 709 19 3178 — 429 9 * — * 190 585 385 73 118 10 1799 12367 * Exclusive of those shown in Table 7. † Voluntary worker. 113 Table No. 10. Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1919. Inspector. Inspections. Re-inspections. Call made but admission not obtained. "Food Control." Total. Inspections. Re-inspections. 1. Mr. Rackham 798 2189 580 3567 2. „ Brown 874 2581 — 699 — 4154 3. „ 'Thompson 1071 1802 — 367 — 3240 4. „ *Pottier 1046 558 — 239 — 1843 5. „ Molloy (Temp. Inspector) 397 905 — — — 1302 6. ,, Dillon 744 2161 — 598 — 3503 7. „ James 1511 2528 — 523 4 4566 8. „ Akers 1850 1369 — 580 — 3799 9. „ *Lonnon 1145 1191 — 226 — 2562 10. „ *Adkins 960 1579 — 393 — 2932 11. „ Jaffa 1969 2010 — 494 — 4473 12. „ Walker 795 1075 — 500 — 2370 18. ,, †Landen — — — — — — 14. ,, West (Factories and Workshops) 1280 1459 — 696 1 3436 15. „ Auger (Food and Food premises.) 2416 — — 746 — 3162 16. „ Child 2971 1 — 990 — 3962 17. Miss Bibby 469 — — — — 469 18. „ Smith 1040 505 429 — — 1974 19. „ Payne 1887 337 9 — — 2233 20. „ MacKenzie 2900 268 — — — 3168 21. Mrs. Hunter 1243 373 190 — — 1806 22. Miss Anderson 1143 554 585 — — 2282 23. ,, Blaxland 687 812 385 — — 1884 24. ,, Camman 1596 165 73 — — 1834 25. „ Parnell 893 709 118 — — 1720 26. „ ‡Witt 83 19 10 — — 112 Totals 31768 25150 1799 7631 5 66353 Absent on military service during part of the year. † Absent sick leave. ‡ Voluntary worker. 114 Table No. 11. Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1919, and the resulting Statutory Notices in 1919 and the early part of 1920. Sohedule of Nuisances. Intimations. Statutory Notices. 1 Part of the house in a dirty condition 1005 546 2 „ damp „ 202 97 3 Roof defective 868 375 4 Guttering defective 129 64 5 Water fittings defective 341 107 6 Water-closet apartment with absence of external ventilation 14 5 7 ,, so foul as to be a nuisance or dangerous to health 43 18 8 Water-closet basin foul 80 48 9 „ ,, defective 125 30 10 ,, ,, choked 159 23 11 Urinal in a foul condition 2 – 12 Privy in a foul condition – – 13 Soil pipe defective 27 9 14 ,, unventilated 11 8 15 ,, improperly ventilated 2 1 16 Absence of waste pipe to sink, lavatory or bath 10 4 17 Waste pipe of sink, lavatory, or bath connected with drain 6 2 18 ,, ,, defective 88 44 19 „ ,, foul 25 4 20 Inlet of drain improperly trapped 4 2 21 Drain defective 110 46 22 „ „ stopped 164 25 23 ,, ventilating pipe defective 38 20 24 Rain-water pipe in direct communication with drain 12 4 25 ,, „ defective 175 83 26 Unpaved condition of roadway – – 27 Undrained ,, ,, 1 — 28 Area or part unpaved 3 — 29 ,, undrained – — 30 Yard or space unpaved 5 1 31 ,, ,, undrained – — 32 Defective condition of washhouse paving 55 31 33 Dust-bin defective 318 127 34 ,, in an improper position 2 — 35 Accumulation of stagnant water which is a nuisance dangerous to health 17 — 36 Accumulation or deposit which is a nuisance dangerous to health 117 37 37 Animals kept in such a manner as to be a nuisance dangerous to health 25 5 38 Part of the house so overcrowded as to be dangerous to health 22 18 39 Space below floor in basement or ground floor in sufficiently ventilated 26 9 40 Issuing of black smoke in such a quantity as to be a nuisance 5 1 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 2 – 42 Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates – – 43 Other nuisances 379 142 Total 4617 1931 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statutory Notices. 1 Overcrowding 6 – 2 Inadequate water supply – – 3 Contaminated water supply – – 4 Foul closet, basin or trap 18 – 5 Want of means of ventilation – – 6 Want of annual cleansing 4 – 7 Want of cleansing of the part or parts of premises used in common 338 134 8 „ ,, in sole use 370 156 9 Want of cleansing of the room or part of the dwelling 20 12 10 Animals improperly kept 1 – 11 Other breaches 7 1 Total 764 306 115 Table No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1 Want of cleanliness 92 34 2 Want of ventilation 1 — 3 Want of air space, overcrowding — — 4 Sanitary accommodation, absent or insufficient 7 2 5 ,, „ unsuitable or defective 154 25 6 ,, ,, not separate for sexes 5 2 7 Want of drainage of floors — — 8 Other nuisances 114 20 9 Illegal occupation of underground bakehouse 2 — 10 Breach of special sanitary requirements for bakehouses 130 6 11 Failure as regards list of outworkers — — 12 Giving out work to be done in premises which are unwholesome — — 13 „ ,, infected — – 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small pox – – 15 Other contraventions 10 2 Total 515 91 Table No. 14. Breaches of other Statutes and Statutory By-laws. Intimations. Statutory Notices. 1 An occupied house without a proper and sufficient supply of water 19 6 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet – 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 218 76 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 31 10 5 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes—absence of a proper cover to 28 13 6 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position 1 – 7 Animals so kept as to be likely to pollute the water supply 1 — 8 Offensive matters not deposited in manure receptacle 4 — 9 Manure not removed at proper intervals 4 — 10 Mauure—absence of proper receptacle for 5 1 11 Manure receptacle not properly constructed — — 12 Sufficient drain to stables or cowshed—absence of a 1 — 13 Receptacle for house refuse—absence of a proper 315 151 14 Receptacle for house refuse—absence of a proper cover for 9 i 15 Yard or open space unpaved 2 – 16 ,, paving defective 108 55 17 Insufficient water-closet accommodation to "lodging house" 20 12 18 A furnace improperly constructed or negligently used 1 — 19 Effluvia arising from premises used for trade, business, or manufacture which is a nuisance dangerous to the inhabitants of the district 1 – 20 Offensive matters suffered to run out of trade premises into an uncovered place – 21 Dairies and cowsheds—breach of By-laws as to — — 22 Slaughterhouses—breach of By-laws as to 1 — 23 Steam whistle—use of a. without authority 1 — 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansing 289 130 25 Articles in an unwholesome condition requiring to be purified or destroyed 5 2 26 Underground room illegally occupied as a dwelling 4 1 27 Other breaches 47 24 Total 1115 482