AC 4355 STPAN 78 Metropolitan Borongh of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. T. SHADICK HIGGINS, M.D., B.S., B.Sc., Lond., D.P.H. Cantab. Printed by F. P. Lewingdon, 26 and 27, Eversholt Street, London, N.W. 1. Metropolitan Borongh of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. T. SHADICK HIGGINS, M.D., B.S., B.Sc., Lond., D.P.H. Cantab. 2 034 CONTENTS. page. Public Health Committee 4 Staff of Public Health Department 5 Introduction 7 Section I.—Yital Statistics. Population 9 Marriages 9 Births 9 Notification of Births 10 Illegitimacy 10 Deaths 10 Infantile Mortality 12 Section II.—Maternity and Child Welfare. 15 Advice Cards 15 Home Visiting 15 Centres 16 Dental Clinic 20 Clinic for Sick Mothers and Children 20 Supply of Food to Mothers and Children 21 Home for ailing Children 21 Day Nurseries 21 Home Helps 22 Home Nursing 22 Midwifery Work 22 Government Grants 24 Puerperal Fever 24 Ophthalmia Neonatorum 25 Measles and German Measles 26 Whooping Cough 27 Section III.—Prevalence of and control over Infectious Diseases. Table of Notifiable Diseases 28 Do. Weekly Number of Notifications 29 Do. Weekly Number of Deaths 29 Do. Notifications past 10 years 29 Do. do. and Deaths in Wards 30 page. Disinfecting and Cleansing Station 31 Tuberculosis 32 St. Pancras Scheme 37 Visiting 37 Dispensaries , 38 Sanatoria, etc 39 Smallpox 39 Scarlet Fever 39 Diphtheria 40 Typhoid Fever 42 Acute Anterior Polioencephalitis and Poliomyelitis 43 Epidemic Cerebrospinal Meningitis 43 Encephalitis Lethargica 44 Malaria 45 Dysentery 45 Pneumonia 45 Other Notifiable Infectious Diseases 46 Anthrax in shaving brushes 47 Trachoma 47 Influenza 47 Diarrhoea and Enteritis 47 Syphilis 49 Cancer 49 Section IY.—Sanitary circumstances of the District. Inspections 50 Notices served and result of service 50 Nuisances—Legal Proceedings 51 Premises and Occupations which can be controlled by by-laws and regulations 52 Offensive Trades 52 Registered Tenement Houses 52 Smoke Prevention 52 Constructional Drain Work 52 Drain Tests 52 Drainage Register 53 Water Service 53 3 CONTENTS—continued. page. Canal Boats Acts 53 Inhabited House Duty 53 The Rag Flock Act, 1911 53 Public Mortuaries and Coroner's Court 53 Factory and Workshop Acts 54 Inspections 54 Defects found 54 Home Work 55 Registered Workshops 55 Schools 57 Medical Inspection of Children 57 Infectious'Diseases in Schools 58 School Clinics 58 Section Y.—Food. (a) Milk Supply 59 Bacteriological Examination of Milk 59 Dairies, Cowsheds and Milkshops 68 Milk and Cream Regulations 68 Milk (Mothers and Children) Order, 1919 69 (b) Other Foods 71 Slaughter-houses 71 Fried Fish and Fish Curing Premises 72 Ice Cream Premises 72 Bakehouses and Restaurant Kitchens 72 (c) Sale of Food and Drugs Acts 72 Prosecutions 73 Administration of Food Controller's Orders 73 Section YI.—Sanitary Administration. Staff 73 Page. Office accommodation 74 Chemical and Bacteriological Work 74 Section YII.—Other Services. 75 Home Nursing 75 Section YIII.—Housing 75 General Housing conditions 75 Overcrowding 76 Fitness of Houses 76 Unhealthy Areas 77 Tenement House By-laws 77 General and Miscellaneous 77 Statistics 77 Work of Special Housing Committee 78 Appendix. Table No. 1. Vital Statistics 84 Do. 2. Deaths from all causes 85 Do. 3. Summary of above 89 Do. 4. Births, Deaths and Infantile Deaths 90 Do. 5. Do., certain large towns and Metropolitan Boroughs 91 Do. 6. Meteorology 92 Do. 7. Inspections and reinspections (District and other Inspectors) 93 Do. 8. Do. (Food Inspectors) 94 Do. 9. Visits by Women Inspectors 96 Do. 10. Inspections and reinspections by individual Inspectors 97 Tables Nos. 11, 12, 13 and 14. Details of Intimation Notices served and resulting Statutory Notices 98 St. Pancras Borough Council. PUBLIC HEALTH COMMITTEE. November, 1919 to October, 1920. CHAIRMAN. Alderman Major George Frederick Cosburn, J.P. DEPUTY-CHAIRMAN. Councillor Miss Edith Maurice Vance (Ward 3). EX=OFFICIO. The Right Worshipful The Mayor. (Councillor William Carter, J.P.). ALDERMEN. Brown, Henry Joseph, J.P. Tapping, Dan. Williams, Lt.-Col. 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 Grbgg, 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. November, 1920 to Octobtr, 1921. CHAIRMAN. Alderman Major George Frederick Cosbubn, J.P DEPUTY-CHAIRMAN. Councillor Miss Edith Maurice Vance (Ward 3). EX-OFFICIO. The Right Worshipful The Mayor. (Alderman Henry Joseph Brown, J.P.). ALDERMEN. Combes, Frank Lawrence. Kendrick, Charles. Williams, Lt.-Col. Charles. COUNCILLORS. Ward. 2 Barrett, Edward. 5 Blount, George. 8 Bridgman, Walter George. 8 Crosby. Miss Ada, M.B.E. 8 Davis, Abraham. 1 Ebury, Mrs. Susan Jane. 1 Flight, Henry. 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. 4 Mundella, Anthony John. 1 Newman, Israel Arthur. 5 Paterson, Mrs. Louisa Sophia. 3 Shepherd, Joseph George. 7 Swift, Mansell James. 2 White, George William. 1 AVoodley, William George. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1920. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. T. Shadick Higgins, M.D., B.S., B.Sc., Lond., D.P.H. TUBERCULOSIS OFFICER. G. T. Calthrop, M.A., M.B , B.Ch., Cantab., D.P.H. ASSISTANT MEDICAL OFFICER. Gladys M. Miall Smith M.B., B.S., B.Sc., Lond., D.P.H. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS AND HEALTH YISITORS. Inspectors of Food and Food Placc/t. W. G. Auger. H. R. Child. Inspector of Workshops and Factories. B. H. Thompson. District Inspectors. G. Rackham. G. W. Adkins. J. I. Lonnon. R. C. Akers. W. L. Brown. M. Jaffa. E. M. Dillon. S. W. Capel. A. H. Walker. H. K. Nixon. R. E. James. Women Sanitary Inspectors. Miss M. E. Bibby, B.A. Lond. Miss V. Blaxland.* Miss C. Smith.* Miss D. M. Parnell. Miss H. Payne. Miss G. Anthony. Health Visitors. Mrs. A. Hunter. Miss F. a. Anderson. Miss J. Cam man. Miss G. B. steggles.† CLERICAL STAFF. Chief Clerk A. Powel Coke, Barrister-at-Lair. First Clerk A. G. Capel. Second Clerk A. Carpenter. Clerk G. N. Cove. F. G. Crick.‡ " T. H. Hague. " Mrs. F. E. Henderson. Junior Clerk (Vacant). Boy Clerk S. Barker. Temporary Clerk C. Batter. ,, L. Higgins. ,, E. Winchester. ,, E. Rogers. „ Miss G. Wood. * Miss Smith and Miss Blaxland are appointed as Sanitary Inspectors and Health Visitors. + Temporary. ‡ Away ill. 6 BOROUGH COUNCIL STAFF AT THE MATERNITY AND CHILD WELFARE CENTRES. Medical Officers. No, of Consultations per week. Dr. B. Marion Cockerell 3 (and 3 per month) Dr. A. Gertrude Grogan 2 Dr. J. Finch Haines 1 Dr. Janie Lorimer Hawthorne 2 Dr. Ethel F. Iredell 1 Dr. Lydia A, Leney 3 Dr. Jessie S. Muir 3 Dr. Balfour Neill 2 Dr. J. Sherwood New 1 Dk. Margaret R. Paterson 1 Dr. Mary J. Pirret 3 Dr. Francis L. Provis 3 (and 1 per month) Dr. Muriel Radford 1 Dr. Alfred R. Roche 1 Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist 2 Dr. Jas. Maughan, Anœsthetist. Superintendents of Centres. Miss K. L. Allfrey. Miss M. H. Landel Jones. Miss M. Andrews. Miss E. L. Savory. Miss E. Boyd-Johnston. Miss M. Smyth. Miss G. R. Bristow. Miss M. Templeton. Mrs. E. Crockart. Assistant Visitors at Centres. Miss L. Auger. Miss A. Kennedy. Miss M. L. Blair. Mrs. E. Lurie. Miss F. Brayshaw. Miss M. Manger. Mrs. E. E. Bruck. Miss E. L. May. Mrs. S. C. Chapman. Miss F. T. Peacock. 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 Court J. Root. Goldington Buildings J. H. Ambrose. Flaxman Terrace J. Evans. Prospect Terrace (and Baths) A. N. Reid. Male Attendant W. Smith. Female Attendant Mrs. C. Reid. 7 Public Health Department, Town Hall, Pancras Road, N.W. 1. September, 1921. 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-Fifth 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 eighth annual report which it has been my duty to submit. The year 1920 was remarkable, both for the increase in the number of births and for the decline in the various death-rates which are usually recorded as an index of health conditions. For many years there has been a gradual diminution in the birth-rate, and this fall was accentuated during the period of mobilization for the war, until during 1919 the rate had fallen to its lowest level. With demobilization a remarkable recovery took place, beginning about the middle of 1919, and in 1920 the births occurred in St. Pancras at about double the rate prevailing in the first six months of 1919. The birth-rate for 1920 (25.4 per 1,000 population) was the highest recorded for the Borough since 1904. In regard to deaths the record of 1919 was surpassed, the death-rate for 1920 (12.4 per 1,000 population), being 14 per cent, less than the average of the five peace years preceding the war (1909-1913). The rate of infantile mortality in St. Pancras was also much lower in 1920 than in any previous year. There were 73 deaths of infants under one year of age per 1,000 birtbs. This represents a reduction of 26 per cent. on the five war years (1914-1918), and 28 per cent. on the five years preceding the war (1909-1913). A similar reduction has taken place in the mortality from tuberculosis, there having been in 1920, 31 per cent. less deaths than in the average of the five war years, and 23 per cent, less than in the average of the preceding five peace years. The death statistics indicate that the health of the St. Pancras population was better than in any former year. This is no doubt associated with the improvement in the general social conditions, and it is to be feared that if a period of trade depression and unemployment occurs it will have a bad effect on health, which will be reflected in the death rates. It is most important that the Council's efforts to improve the general health conditions of the Borough should not be relaxed. So far as infantile mortality and deaths from tuberculosis are concerned, there is no doubt that, although the death-rates have fallen to an unprecedented degree, there is still room for great improvement. 8 The changes in the birth and death-rates are vividly illustrated by the fact that in St. Pancras in 1918 there was an excess of deaths over births amounting to 596, while in 1919 and 1920 there was an increase of population through excess of births over deaths, amounting to 894 and 3,039 respectively. With reference to infectious diseases, there has fortunately been no recrudescence of the great outbreak of influenza of 1918 and 1919. Scarlet fever and diphtheria were both more prevalent in 1920 than in the years immediately preceding, and there was a considerable amount of illness and mortality from measles and whooping cough. The deaths from diarrhoea and enteritis, which have been so fatal amongst young children in hot summers in the past, were fewer than ever before recorded. The work of the Public Health Department during the year is recorded in detail in the report. Considerable development took place in the Borough scheme for Maternity and Child Welfare. This was necessitated largely by the circumstance that babies were being born at almost double the rate of the preceding years, and that the child population to be served was correspondingly increased. It is satisfactory to record that a very high percentage of the children born were taken to the infant welfare centres (probably approaching 70 per cent), and, as mentioned above, that the rate of infantile mortality was very greatly reduced. In compiling this annual report, I have followed closely the suggestions made by the Ministry of Health, but have varied somewhat the order of the Sections. In ccnclusion, I once more have the pleasure of expressing my appreciation of the manner in which I have been assisted throughout the year by the staff of the Public Health Department. I have also to thank your Public Health Committee for the support which they have invariably given me, and the Council for the personal consideration which they have shown me. I am, Ladies and Gentlemen, Your obedient Servant. Medical Officer of Health. Metropolitan Borough of St. Pancras. R E P O R T of the MEDICAL OFFICER OF HEALTH For the Year 1920. For the purpose of this Report, the year 1920 is taken to be the 53 weeks ended 1st January, 1921. The annual rates are corrected so as to make them comparable with those for other (fifty-two weeks) years. Section I.—VITAL STATISTICS. * POPULATION. The total population of St. Pancras for 1920, as estimated by the Registrar-General, was 228,980, the civilian population being estimated at 228,178. The latter (civilian) population has been used in estimating death-rates, and the former (total) in estimating marriage and birth-rates. The population is largely industrial and includes a considerable element of the poor. It was found in the 1911 census that the 22,246 " inhabited houses " were occupied by 52,994 " families or separate occupiers"; that there were 11,452 one-room tenements, 15,568 tworoom 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. MARRIAGES. The number of marriages celebrated in 1920 was 2,407 (including marriages of soldiers and sailors). This is equal to a rate of 10.5 per 1,000 total population. BIRTHS. The net number of births for St. Pancras registered in 1920 was 5,934, making an annual birth-rate of 25.4 per 1,000 total population. The number of births registered as having taken place in the Borough was 6,191, and the net figure is obtained by deducting 257, which, according to information supplied by the Registrar-General, is the excess of births .to non-parishioners occurring within the Borough over births to parishioners occurring outside the Borough. The corresponding figures for previous years and for the different wards and regis- tration sub-districts in the Borough will be found in Tables 1 and 4 on pages 84 and 90. As will be seen by reference to table 1 the birth-rate for 1920 was much greater than in any recent year. Indeed the number of births and vhe rate were greater than in any * In the Annnal Report for 1919 particulars were included in regard to certain matters connected with the natural and social condition of the Borough, which are omitted from the present Report. 10 previous year since 1904. The increase is to be regarded as much as a result of the war as the great decrease in births which took place previously, and there are already indications of a decline. The variations in the birth-rate will be seen from the following table which gives the quarterly figures for 8½ years:— 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 842 840 848 809 3339 3318 1919 775 747 977 1305 3804 3824 1920 1806 1581 1453 1351 6191 5934 1921 1325 1308 — — — — 1266 births occurred in Public Institutions in St. Pancras, equal to 20.4 per cent. of the total births which took place in the Borough. Table 5, on page 91, shows the birth-rate for 1920 of England and Wales, the County of London, the several Metropolitan Boroughs, and certain of the large towns with populations exceeding 125,000. Illegitimacy. Of the 5,934 net St. Pancras births, 332, or 5.6 per cent., were returned as illegitimate. The corresponding figures for 1919, 1918, 1917, 1916, 1915, 1914 and 1913, were 8.4, 9 5, 7.2, 7.0 5.4, 4.4, and 4.7 per cent, respectively. Of the 6,191 births in St. Pancras (uncorrected) 393 or 6.3 per cent. were returned as illegitimate. Notification of Births. 5958 notifications of births were received during 1920, including 177 still-births and 5781 live births, or 93 per cent. of the births registered as having taken place in the Borough. Details in regard to the notifications will be found on page 22. DEATHS. Deaths of civilians only are included in the following figures. The net number of St. Pancras (civil) deaths registered during the year was 2,895, making an annual death rate of 12.4 per thousand civil population. The number of (civil) deaths registered during the year as having taken place in the Borough was 3,007. Of these, 713 were of persons whose residence was not in St. Pancras (non-parishioners), 630 dying in St. Pancras institutions, and 83 in other parts of the 11 Borough. There were also reported by the Registrar-General 564 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London and institutions connected therewith, and 37 who died in other parts of England and Wales. The net figure on which the death-rate is based is corrected for these outward and inward transfers. In Table 1, on page 84, will be found the corresponding figures for the past ten years. It will be seen that the death-rate in 1920 was considerably lower than in any previous year, the "record" made in 1919 being again surpassed. This progressive lessening of mortality is no doubt closely associated with the gradual improvement in the social conditions of the poor and of the working classes in general, and is an encouragement to continue the public health policy which has been pursued in recent years by the local and central authorities. The leading causes of death are set out in the following Table for the ten years 1910-1919 and for 1920:— Diseases. 1910 191 1 1912 1913 1914 1915 1916 1917 1918 1919 Average for 10 years. 1920 Enteric Fever 4 7 2 6 4 8 5 6 5 2 5 1 Small-pox — — — — — — — — — 1 — — Chicken-pox — 1 1 1 — 1 1 — — — — — Measles 143 113 94 36 53 63 42 118 75 15 75 65 Scarlet Fever 17 10 5 6 19 22 8 4 7 5 10 11 Whooping Cough 92 48 47 36 49 52 39 27 80 7 48 60 Diphtheria and Croup 21 37 27 19 30 24 23 25 31 21 26 33 Influenza 20 15 14 42 15 35 35 21 700 260 116 46 Erysipelas 7 10 7 10 9 11 3 3 11 9 8 12 Tuberculosis—Pulmonary 297 230 318 325 365 398 340 353 403 268 33o 249 Ditto Other forms 76 83 83 67 67 102 83 91 82 73 81 63 Cancer, Malignant Disease 266 274 247 285 251 258 267 281 269 245 264 =99 Rheumatic Fever 8 6 5 6 10 11 7 7 8 7 8 6 Cerebral Haemorrhage, Em­ bolism, and Apoplexy 131 147 227 116 141 169 119 116 131 91 139 98 Heart Disease 282 283 217 276 319 422 359 393 378 360 329 423 Bronchitis, Pneumonia, and Pleurisy 630 560 525 691 566 664 535 514 618 489 579 445 Diarrhoea and Enteritis 75 248 45 148 142 114 72 97 56 68 107 54 Nephritis and Blight's Disease 97 86 110 101 112 132 103 104 98 61 100 95 Puerperal Fever — 4 7 2 7 5 4 5 2 9 5 8 Corgenital Debility and Mal– formations, including Pre— mature Birth 108 130 207 191 164 187 176 144 132 162 163 201 Injuries 148 156 161 148 150 150 112 125 119 108 138 92 12 This analysis shows a considerable decline in the last two years in deaths from tuber­ culosis, “bronchitis, pneumonia, and pleurisy," and cerebral apoplexy, but the returns for heart disease, cancer, and congenital causes of death are less favourable. In regard to the essentially fluctuating causes of death, measles and whooping cough were productive of con ­ siderable mortality, while deaths from diarrhoea were few in comparison with other years. The phenomenal mortality from influenza which occurred in 1918 and 1919 had practically disappeared in 1920. The deaths for the year are fully classified for causes, age, and sex in Table 2, on page 85. The deaths and deathirates for the different wards and registration sub-districts will be found in Table 4 on page 90, and in Table 5 on page 91 are set out the death rates for 1920 of England and Wales, the County of London, the several Metropolitan Boroughs, and certain of the large towns with populations exceeding 125,000. 1,662 deaths occurred in Public Institutions in the Borough in 1920. Taking from these the number which were of non-parishioners (630) and adding the number of deaths of St. Pancras parishioners in Public Institutions without the Borough (601)—both from the Registrar-General's figures—the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,663, or 57 per cent, of the total deaths. Infantile Mortality. 435 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of 73 per thousand births. In Table 1 on page 84 the corresponding rates for the last ten years are set out, and from this it will be seen that the infantile mortality rate for 1920 was very much lower than that for any previous year. The reduction was equivalent to 17 per cent. on 1919, 26 per cent. on the five war years (1914-1918), and 28 per cent. on the five years preceding the war (1909-1913). It is highly satisfactory to be able to record that the Borough scheme for maternity and child welfare, to the development and administration of which so much attention has been given in recent years, has been associated with such a saving of child life. In Table 4 on page 90 the figures will be found for the different wards and registration sub-districts, and in Table 5 on page 91 the infantile mortality rates in England and Wales, the County of London, the several Metropolitan Boroughs, and certain of the large towns with populations exceeding 125,000. In the Tables on the next two pages are shown :— (1) The causes of death of children under 12 months of age (1920) classified according to age at death. (2) The causes of death of children under 12 months of age in 1920 and in the ten previous years. In this Table the number of births in each year is also stated for reference. 13 1920. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week. 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 107 31 19 14 171 80 82 57 45 435 Uncertified — — — — — — — — — — Small-pox — — — — — — Chicken-pox — — — — — — — — — Measles — — — — — — 2 10 9 21 Scarlet Fever — — — — — — — — — Whooping-Gough — — — — — 2 5 6 5 18 Diphtheria and Croup — — — — — — 1 1 — 2 Erysipelas — — — — — — — — — Influenza ... — — — — — 1 1 — 2 Tuberculous Meninigitis — — — — — — 2 3 1 6 Abdominal Tuberculosis — — — — — — — — — _ Other Tuberculous Diseases — — — — — — 1 1 — 2 Meningitis (not Tuberculous) — — — — — 1 3 2 1 7 Convulsions 2 4 — — 6 — 1 — 7 Laryngitis — — — — — — — — — Bronchitis 1 1 4 2 8 24 22 14 19 87 Pneumonia (all forms) — — — 1 1 3 1 3 1 9 Diarrhoea — — 1 — 1 3 6 — 1 11 Enteritis — 2 2 1 5 9 7 2 3 26 Gastritis — — 1 — 1 — 1 — — 2 Syphilis 1 1 2 — 4 3 3 4 1 15 Rickets — — — — — — — 1 — 1 Suffocation (overlying) — — — — — 1 — 1 — 2 Injury at birth 5 — — — 5 — — — — 5 Atelectasis 10 — — — 10 — — — — 10 Congenital Malformations 12 6 2 4 24 4 4 1 — 33 Premature birth 70 12 3 4 89 14 1 — 1 105 Atrophy, Debility and Marasmus 4 5 3 1 13 10 11 5 1 40 Other causes (including Influenza) 2 — 1 1 4 6 11 3 2 26 Totals 107 31 19 14 171 80 82 57 45 435 Nett Births in the year legitimate 5602 illegitimate 332 Nett Deaths in the year of legitimate infants 372 illegitimate iufants 63 14 Nett Deaths from stated causes under 1 year of Age for 10 Years, 1910—1919, and 1920. CAUSE OF DEATH. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Aver ­ age for 10 years. 1920 All causes ( Certified 580 623 472 512 481 497 385 402 340 336 463 435 (Uncertified — — — — — — — — — — — — Small-pox — — — — — — — — — Chicken-pox — — 1 1 — 1 — — — — — — Measles 42 17 13 10 8 17 14 30 16 4 17 21 Scarlet Fever — — — 1 — —- — — — 1 — — Whooping-Cough 40 16 21 12 23 24 15 14 27 2 19 18 Diphtheria and Croup 2 3 j 1 4 — 2 1 1 — 1 2 Erysipelas 1 1 — 3 2 2 — 1 1 — 1 — Influenza — 1 — —- 1 _ 1 — 18 11 3 2 Tuberculous Meninigitis 6 8 11 5 3 8 5 4 8 4 6 6 Abdominal Tuberculosis — 1 3 — 2 1 1 2 1 1 1 — Other Tuberculous Diseases 7 2 2 8 3 6 5 7 3 2 5 2 Meningitis (not Tuberculous) 8 12 8 8 4 8 7 10 3 6 7 7 Convulsions 14 6 21 16 11 5 9 5 3 6 10 7 Laryngitis — —- 1 — — 1 — 1 — — — — Bronchitis 29 90 57 105 76 84 57 63 46 47 65 87 Pneumonia (all forms) 77 15 13 9 16 12 10 13 15 9 19 9 Diarrhoea 38 70 8 22 24 15 6 8 6 10 21 11 Enteritis 14 98 24 73 82 64 35 52 31 37 51 26 Gastritis 8 2 7 2 — 3 2 4 1 3 3 2 Syphilis 12 8 9 14 15 9 14 16 13 11 12 15 Rickets 4 2 4 —- 1 1 4 2 — — 2 1 Suffocation (overlaying) 17 18 22 14 18 8 9 13 6 1 13 2 Injury at Birth 2 4 6 4 3 10 4 3 2 6 4 5 Atelectasis 9 6 9 3 5 6 9 9 8 7 7 10 Congenital Malformations 13 21 21 24 23 25 34 19 17 31 23 33 Premature Birth 100 93 97 93 84 92 75 61 50 68 81 105 Atrophy, Debility and Marasmus 89 80 63 53 38 47 43 44 46 45 55 40 Other causes (including Influenza) 48 50 50 31 36 48 25 20 36 35 38 26 Totals 580 623 472 512 481 497 385 402 340 336 463 435 Nett Bibths 5385 5555 5367 5517 5225 4754 4530 3796 3318 3824 4727 5931 The number of deaths of illegitimate children under one year of age was 63, equal to a death rate of 190 per thousand illegitimate births. 15 Section II.- MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 9, 10,12, 13 and 14 of this Report. The number of children born in 1920 reached a total of 5934 in the year, which was an increase of 55 per cent on the number born in the previous year. This was the chief cause of the increase in the attendances at the Maternity and Child Welfare Centres which necessitated some expansion of the staff at the centres. To those responsible for the Borough Child Welfare Scheme it is a matter for great satisfaction that the rate of infantile mortality fell in 1920 to a point (73 per 1000 births) far below that of any previous year. The borough scheme for Maternity and Child Welfare includes the following activities:— (a) The dispatch by post of cards of advice to the individual mothers immediately after the receipt of the notification of birth required by law. (b) The home visitation of expectant and nursing mothers and babies by the Council's staff of health-visitors, who work (a) from the Town Hall and (b) from the Centres. (c) The provision and maintenance of 13 Maternity and Child Welfare Centres. These centres are partly maintained on a voluntary basis, but the whole of the professional staff (medical officers and health visitors) are paid and controlled by the Council, who also pay the rent, rates and taxes of the centre premises. (d) The provision of a clinic for ailing mothers and young children, the expenses being borne partly municipally and partly from voluntary funds. (e) The provision of a municipal dental clinic for mothers and young children. (f)The subsidization of a Home for ailing young children. (g) The supply of milk free or at reduced price for necessitous mothers (nursing or expectant) and young children ; and the subsidization of a voluntary fund for the provision of cheap dinners for such persons. (h) The subsidization of a voluntary fund for the provision of Home Helps. (i) The subsidization of the four voluntary Day Nurseries in the borough. (j) The subsidization of voluntary agencies providing intern and extern midwifery for St. Pancras women free or at reduced fees. (k) The payment for the home nursing of sick infants in certain cases. The work done in 1920 in connection with the scheme will now be referred to in detail: — Advice Cards.—Cards of advice have been posted to the mothers of all infants whose 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 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 confinements through the institutions. Home Visiting.—This has been done by the health visitors at the Town Hall and by the Council's staff of health visitors (superintendents and assistants) at the Centres who visit the mothers attending the Centres and also such notified births as are referred to them by the Medical Officer of Health. 16 The Town Hall infant visitors include two full-time health visitors and two who are health visitors as to half their time, as well as one other health visitor who devotes her time primarily to the visiting of cases of measles. These ladies made during the year 3290 visits to 1607 infants (apart from 4930 visits to cases of measles and visits for certain other special purposes). They also made 338 visits to 160 expectant mothers, from lists of expectants supplied by University College and Middlesex Hospitals. The work of these visitors is detailed in Table 9 on page 96. The Council's visitors at the Infant Welfare Centres included at the end of the year 19 full-time workers and one part-time worker, who divide their time between the necessary work in the centres, and home visiting. In addition there was one voluntary (trained) worker at the Argyle Square group of centres, and two visitors (part-time so far as St. Pancras is concerned) working from the centre at University College Hospital whose salaries are paid by the hospital and not by the Council. In 1920 these centre visitors made 41,208 visits to 6,895 children and 4667 visits to 1998 expectant mothers. The visits made by the health visiting staff at the Town Hall and the centres therefore numbered in all 44,498 visits to 8,502 children, and 5,005 visits to 2,158 expectant mothers. The figur es for individual cases visited are, however, overstated, owing to a number of instances in which the same case will have been counted at more than one centre, particularly where cases have been passed on to other centres by University College Hospital and by the Town Hall visitors. The figures are detailed on page 17. In the previous "year (1919) the total visits were 28,122 to children and 4,392 to expectant mothers, and in 1918 19,937 and 2,011. Maternity and Child Welfare Centres. The nature of the work carried out at the Centres has been described in detail in previous Annual Reports. Each centre (or group of centres) is managed by a voluntary committee, who find the funds for the maintenance of the centre other than those referred to on page 15 as provided by the Council. The Council has two representatives on each committee, and the Medical Officer of Health and members of his staff are also on nearly all of them. Each committee also sends a representative to the Council's Maternity and Child Welfare Sub-Committee. The University College Hospital Centre is not, however, subsidized by the Council. During the year two centres (North St. Pancras and Camden Town) have been provided with full-time premises, so that there are now four centres with houses of their own. In the table on the next page the work of the centres in 1920 is staistically7 detailed. It will be seen that at the end of the year 31 infant consultations were held per week, and 35 ante-natal consultations per month. During 1920 the children who have attended the consultations for the first time have numbered 4375 under one year and 237 older than one year. The children under one amount to 73 per cent. of the births registered for the year. The number is probably somewhat overstated owing to a limited number moving from one centre to another. The children made a total of 47,625 attendances (compared with from one centre to another. The children made a total of 47,625 attendances (compared with 26,252 in 1919). 1,254 expectant mothers also attended, making in all 3,577 attendances (compared with 3,343 in 1919). 17 Centre. Attendances at Consultations. Visits by Trained Visitors. Infant Consultations. Expectant Mothers Consultations. Number of Trained 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 (quas St, Pan­ cras). Under 1 year. Over 1 year. Total. Under 1 year. Over 1 year. Total. Town Hall Health Visitors — — — — — — — — 160 338 1607 3290 — — — —_ — —_ St. Pancras School for Mothers— Ampthill Square 264 5461 499 30 529 — — 76211 768 1448 1688 7557 52 208 4 49 4a — Chalton Street 115 601 307 52 359 4447 1081 5528 335 671 409 6341 33 128 24 44 25 — North St. Pancras School for Mothers — 6Rhyl Street and Queen's Crescent 141 329 602 39 641 5628 1114 6742 44 400 541 4839 47 177 48 42 310 _ Grafton Road - 238 12 250 2177 322 2429 603 2125 29 54 _ — 110 — South Highgate Mothers' and Infants' Welfare Centre 6 38 113 5 118 1894 272 2166 7 62 216 1794 l11 5111 – – 112 – 112 Mary Ward Settlement School for Mothers 15 43 288 35 323 2010 687 2697 106 217 403 1668 313 105 – – 114 _ 15 Camden Town Mothers' and Infants' Welfare Centre, Greenland Street and Camden road 65 180 448 42 490 5173 1280 6453 85 304 677 2696 416 116 417 36 318 – Argyle Square Group of Centres — Argyle 46 158 152 — 152 1971 270 2241 J 183 655 734 19 6531 1¼ 61 2 23 320 — Oseney Crescent 81 233 205 16 221 2509 576 3085 1½ 68 2 24 Falkland Road — — 96 — 96 1090 — 1090 1 37 — — 21 Maternity Nursing Association, Oakley Square 164 180 340 340 — — 3376 317 451 1036 2230 222 67 1 12 1 — University College Hospital — — 937 — 937 — — 314623 —■ — 45323 495623 2 105 — — — 224 Royal Free Hospital ■ Grav's Inn Road 175 717 81 6 87 692 48 740 153 459 135 471 1 52 8 100 — 1 Marlborough Maternity Section .. . . .. 182 552 69 — 69 241 — 241 — —_ — — 1 52 8 104 — Totals 1254 3577 4375 237 4612 — — 47625 2158 5005 8502 44498 31¾ 1281 35 394 19 3 (a) 3 until June. (1) In addition to 2651 attendances of » ailing mothers." (2)3 at beginning of 1M). (3) 1 at be^nnmg^of 1920 2'«Non|eb^ebfr°Tem^ri UoreN^nbe^ (221 1 before November. (-23) Approx. (24) Not paid by Borough Council. 18 In the following statement certain additional details of the individual centres are set out: — St. Pancras School for Mothers.— This institution has two centres :— (a) 1, Ampthill Square, N.W. 1. This is a detached house used solely for the purpose, the rent. rates and taxes being paid by the Council. In addition to the usual consultations the centre maintains (out of voluntary funds) :— A dental clinic (dental surgeon, Mr. Geo. Thomson, L.D.S.) at which the total attendances of mothers in 1920 were 301, and of young children 72. An observation day-nursery for children who need special care, at which there were 2207 daily attendances in 1920. A massage clinic, during the last 4 months of the year only, during which time 164 attendances of children were made. Cbeap dinners for mothers and children : 2347 dinners for mothers and 2483 for toddlers were provided in 1920. During the year the weekly infant consultations were increased from 3 to 5, one being conducted by the Council's Assistant Medical Officer. (b) 6, Chalton Street, N.W. 1. These are mission premises in part-time use, and the rent is re-paid by the Council. In 1920 the weekly infant consultations were increased from 1 to 3, and a fortnightly ante-natal consultation was started, the latter and one infant consultation being taken by the Council's Assistant Medical Officer. Dr. Matilda Hunt resigned in June on going abroad, Dr. M. J. Pirret was appointed in January. The number of consultations was also increased during the year by the Council's Assistant Medical Officer taking consultations at Ampthill Square and at Chalton Street. In June the health visiting staff at Ampthill Square was increased by the appointment of Mrs. S. C. Chapman as assistatnt and at Chalton Street by converting the appointment of the Superintendent, MissE. L. Savory, to full-time, and the appointment of Miss M. Manger as assistant. North St. Pancras School for Mothers.—This institution has two centres :— (a) 129, Queen's Crescent, N. W. 5. The centre was moved to this address in September from the part-time mission building premises at 39, Rhyl Street. The new centre is a private house used solely for the purpose, and the Council pay the rates and taxes and an annual sum in lieu of rent. At the same time the weekly infant consultations were increased from 2 to 4, Dr. J. Finch Haines and Dr. Muriel Radford being appointed for the new work. (b) Grafton Road Centre.—This is held in rooms provided by the Council at the Public Baths, Prince of Wales Road, N.W. 5. In November the weekly infant consultations were increased from 1 to 2, Dr. A. R. Roche being appointed for the purpose. At the end of 1920 the management of this centre was taken over from the North St. Pancras School for Mothers by a special voluntary committee. The health visiting staff of the centres was strengthened by the appointment, in September, of Miss Eva'Boyd Johnston as superintendent of the Grafton Road Centre, leaving the three other health visitors for the work of the Queen's Crescent Centre only. In June Mrs. E. E. Bruce was appointed in place of Miss L. Benedict, resigned. 19 South Highgate Mothers' and Infants' Welfare Centre, Chester Road, N. 19.— Is held in rooms provided by the Council at the Public Library, Chester Road. In May the work was increased by the Council's Assistant Medical Officer taking a second infant consultation at the same time as Dr. Neill's infant consultation, and in June the appointment of the superintendent Miss K. L. Allfrey was converted to full-time. The premises being available only on one afternoon a week are not convenient for the work of the centre, and better accommodation is badly needed. Mary Ward (formerly Passmore Edwards) Settlement School for Mothers, Tavisiock Place, W.C. 1.—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. In March the appointment. of the superintendent, MissiM. Templeton, was converted to full-time, and in November a third weekly infant consultation was undertaken by Dr. Leney. Camden Town Mothers' and Infants' Welfare Centre. 62, Camden Road, N.W. 1. The centre was moved to this address in August from the part-time premises at St. Michael's Mission Building, Greenland Street. The new centre is a full-time suite of rooms in the house occupied by the Central St. Pancras District Nursing Association, and the inclusive rent is paid by the Council. An additional weekly infant consultation was undertaken in May by the Council's Assistant Medical Officer, who also took over the ante-natal consultations, and a fourth weekly infant consultation was started in November, Dr. M. R. Paterson being appointed for the purpose. The health-visiting staff was increased to 3 in November by the appointments of Miss L. Auger and Miss M. L. Blair as assistants. The Argyle Square Group of Centres.—This consists of three centres: — 4O, Argyle Square, W.C. 1.—The greater part of this house is used exclusively for the purposes of the centre. and the Council repay a proportionate part of the rent, rates, and taxes. Oseney Crescent Centre.—This is held in part-time premises at the Crescent Club, Busby Place, Oseney Crescent, N.W. 5, the rent being paid by the Council. It was opened in January. Wesleyan Schoolroom, Falkland Road, N. W. 5. These premises are used part-time, the rent being paid by the Council. At these centres Dr. Cockerell holds two weekly consultations for babies, three monthly consultations for older children (2 for children between 1 and 2, and one for children between 2 and 5), and four ante-natal consultations per month. In addition Dr. Margaret Alden holds a weeklydnfant consultation, but is not paid by the Council. On account of the opening of the additional centre the staff of paid visitors was increased to 3 by the appointment of Miss F. T. Peacock in May. Miss P. Campbell was appointed in February in place of Miss Donnell, resigned, and Miss A. Kennedy in April, in place of Miss Campbell, resigned. Maternity Nursing Association, Oakley Square, N.W. 1—This Institution holds ante-natal and infant consultations in connection with its maternity work. They take place at the St. Pancras Dispensary, 39, Oakley Square, the Council paying the rental for the use of the rooms. In November a second weekly infant consultation was undertaken by Dr. Provis. The Superintendent, Miss M. Andrews, resigned in November, but continued in office to the end of the year. University College Hospital, Gower Street, W.C. 1.—The consultations here arc restricted mainly to infants who are actually ailing. Mothers attended in their 20 ment by the hospital are referred to the various infant welfare centres in the district, and the Medical Officer of Health is supplied with lists of these cases. The hospital consultation deals with sick children referred from the various centres, and the Medical Officer of Health is supplied with lists of these. The Council does not pay any of the expenses of the hospital centre. Royal Free Hospital, Gray's Inn Road, W.C. 1.—This hospital maintains antenatal and infant consultations here, and at the Marlborough Maternity Section, 21, Endsleigh Street. The St. Pancras cases are in a minority, and the Council contributes towards the salary of the paid visitor. Dental Clinic.—The Borough Council dental clinic for mothers and children was continued during 1920 at the British Dentists' Hospital, 31, Camden Road, N.W. 1. The services were confined to mothers and children attending and referred from the various maternity and child welfare centres in the Borough. The clinics were held twice a week, and the work done was as follows:— Number of Clinics 85 „ with nitrous oxide anaesthesia 20 „ of new cases (mothers) 362 I „ „ (children) 156 } Total number of attendances 1575 Number of attendances for extractions under nitrous oxide 214 „ „ „ local anaesthesia 153 „ „ when fillings were done 202 „ „ „ scalings 119 ,, „ for impressions, fitting dentures, &c. 526 „ „ „ examinations, etc. 391 No charge was made for extractions, fillings and scalings, but the patients were 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, and the patients' contributions amount to about one half. In 1920, 92 patients were fitted with dentures. The total cost of these was £317, of which £184 3s. was paid by the patients themselves, £58 lis. by the Borough Council, £9 7s. by the voluntary fund kindly raised by Mr. A. Escott for that purpose, and £64 19s. from other sources, particularly the Metropolitan Hospital Sunday Fund. Mothers and children are also dealt with at the dental clinic (voluntary) at the St. Pancras Dispensary, and the centres at University College and Royal Free Hospitals are able to refer cases to their own dental departments. Clinic for Sick Mothers and Children under School Age.—A weekly clinic (Dr. F. L. Provis) is held at the St.jPancras Dispensary, 39, Oakley Square, N.W. 1, to which patients are referred from the infant welfare centres, the health visitors, and other sources. During 1920, 478 new cases under five years of age were treated at the dispensary, the total number of attendances of sick children being 1459 (at Dr. Provis' clinic the corresponding figures were 265 and 806). 228 ailing mothers (42 expectant and 186 nursing) were also treated at the clinic, who made 561 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' Nursing Fund. 21 Supply of Food to Mothers, and Children under School Age.—Reference is made on page 69 to the supply of milk for mothers and children. In January, 1920, the Council made a grant of £50 to the Kentish Town Dining Room for Mothers, then housed at Lyndhurst Hall, Warden Road. Here nursing mothers and young children were supplied with cheap dinners. The work was interrupted in the latter part of the year, but was started again by a new committee early in 1921. Meals for mothers and children are also supplied by the St. Pancras School for Mothers (see page 18), and for ailing mothers and children, amongst other sick persons, by the Invalid Kitchen, Crowndale Road. Home for Ailing Children under School Age.—A grant of £500 per annum is made by the Council in aid of the Mayoress of St. Pancras Home for Sick Poor Children, 1, St. Alban's Road, N.W. 5, which has accommodation for 18 ailinsr children. In 1920, 108 children were admitted and discharged, the home being empty at the beginning and end of the year. They are classified for age as follows :— 0 to 1 16 3 to 4 17 1 to 2 23 4 to 5 14 2 to 3 27 5 and over 11 The conditions for which the children were admitted were as follows:— Debility 25 Rickets 17 Other nutritional disorders, tardy development, &c. 19 Convalescence after Measles 14 Pneumonia and Bronchitis 15 Whooping Cough 5 Other conditions 13 — 47 The Home was open on 309 days during the year, and the average length of stay of the patients 40.88 days. A good deal of trouble was experienced owing to children being admitted in the incubation stage of infectious disease, and the Homo was closed in March on account of whooping cough, in April because of measles, and in October for scarlet fever. Day Nurseries.—In pursuance of resolutions passed in December, 1919, as amended later, the Council assists the four approved day nurseries in the Borough by the payment of one quarter of the net expenditure as approved by the Ministry of Health (after the deduction of the payments made by the mothers). The effect of this is that the expense is shared as to one half by the Ministry, one quarter by the Council, and one quarter by voluntary funds. The four institutions are the Whitfield Day Nursery, 53, Whitfield Street, W. 1; the St. Pancras Day Nursery, 26, Cartwright Gardens, W.C. 1; the Kentish Town Day Nursery, Gospel Oak Grove, N.W. 5; and the Margaret Day Nursery, 44, Ampthill Square, N.W. 1. The attendances at the day nurseries in the year ended 31st March, 1921, were as follows:— Whitfield Day Nursery 6563 *St. Pancras „ 7362 Kentish Town „ 8078 Margaret „ 2752 * From 1st April, 1920, to 11th June, 1921. 22 Home Helps.—The St. Pancras Home Helps Committee provides domestic assistance for families when the mother is laid aside through sickness or child-birth. In 1920 the Council made the Committee a subsidy at the rate of £150 per annum in respect of maternity cases. 58 cases were assisted in 1920, as follows:— Maternity 38 Influenza 1 Consumption 1 Care of children during absence of mothers 2 Old age infirmity 5 Other sickness 11 Three home helps were employed during most of the year. Home Nursing.—The work of the four local district nursing associations in this connection (see page 75) includes the nursing of mothers and children. The home nursing of cases of measles, whooping cough, and ophthalmia neonatorum by the nursing associations for the Mayoress' Nursing Fund is referred to on pages 26 and 27. The Maternity Nursing Association undertakes "monthly nursing" as well as supplying midwives. Midwifery Work. The notifications of births in St. Pancras are 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 214 121 35 64 251 27 359 158 1229 Private Midwives 225 27 17 62 152 7 320 371 1181 Doctors from the Elizabeth Garrett Anderson Hospital 33 16 3 32 61 15 17 47 224 Medical Students from— University College Hospital 133 326 3 13 221 463 6 30 1195 Royal Free Hospital 1 — 2 64 3 — — — 70 „ St. Bartholomew's Hospital — — — 3 — — — — 3 Midwives from— Middlesex Hospital — 39 61 3 — 2 — — 105 „ University College Hospital 7 16 32 162 8 22 — 3 250 „ Maternity Nursing Association, Myddleton Square — 1 — 74 — — — — 75 „ Maternity Nursing Association, Oakley Square Branch 44 84 14 4 116 57 24 17 360 Attended in Institutions— University College Hospital — — 200 — — — — — 200 Royal Free Hospital — — — 213 — — — — 213 Royal Free Hospital (Marlborough Maternity Section) — — 573 — — — — — 573 Elizabeth Garrett Anderson Hospital — — — — — 59 — — 59 Lying-in Ward of St. Pancras House — — — — — 220 1 — 221 23 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) 224 University College, Hospital (medical students) 1195 „ „ „ (midwives) 250 Middlesex Hospital (midwives) 105 Royal Free Hospital (medical students) 70 St. Bartholomew's Hospital (medical students) 3 *Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 435 2282 (or 38 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 115 Royal Free Hospital 32 Royal Free Hospital (Marlborough Maternity Section) 162 Elizabeth Garrett Anderson Hospital 18 St. Pancras House 164 Ou t of St Pancras:— Middlesex Hospital 136 Queen Charlotte's Lying-in Hospital 159 City of London Maternity Hospital 46 Other hospitals 65 897 (or 15 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 the grants in previous years having been at the rate of 5s. per extern case and 10s. per intern case. In 24 December, 1920, the payment per intern case was increased from 10s. to £1. The amounts paid in respect of 1920 were as follows:— Royal Free Hospital and Marlborough Maternity Section 108 15 0 Elizabeth Garrett Anderson Hospital 60 5 0 Maternity Nursing Association 96 10 0 Queen Charlotte's Lying-in Hospital 65 10 0 City of London Maternity Hospital 24 10 0 £355 10 0 Government Grants. Government Grants were made during the year ended March 31st, 1921, in respect of Maternity and Child Welfare as follows:— £ s. d. St. Pancras Borough Council 7154 19 5 St. Pancras School for Mothers (Ampthill Square) 487 14 7 „ „ (Chalton Street) 58 0 0 North St. Pancras School for Mothers (and branches) 77 0 9 *Mary Ward Settlement School for Mothers 40 3 9 Camden Town Mothers' and Infants' Welfare Centre 93 14 5 Centres at Argyle Square and Falkland Road 244 1 10 South High gate Mothers' and Infants' Welfare Centre 24 10 0 Maternity Nursing Association (for Infant Welfare Centre) 30Є 4 10 *Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 750 0 0 *University College Hospital (for extern Midwifery and Infant Welfare Centre) 1857 0 1 *Royal Free Hospital (for Extern Midwifery and Maternity Nursing) . . 106 0 0 „ „ (in respect of Marlborough Maternity Hospital) 1856 0 0 *City of London Maternity Hospital (for midwifery and Maternity Nursing) 100 0 0 St. Pancras Dispensary (Infant Clinic) 207 9 0 St. Pancras Dental Clinic 13 5 0 Mayoress of St. Pancras Nursing Fund (Home Nursing) 77 2 1 Mayoress of St. Pancras Home for Sick Children 581 0 0 St. Pancras Home Helps Committee 23 0 0 St. Pancras Day Nursery 410 4 4 Whitefield's Day Nursery 326 9 2 Kentish Town Day Nursery 481 9 2 Margaret Club and Day Nursery 337 10 11 *Including expenditure on work amongst residents outside St. Pancras. PUERPERAL FEVER. 18 patients were notified during 1920 to be suffering from puerperal fever, and in one case the diagnosis was afterwards reversed. The number of actual cases notified was therefore 17, equal to an incidence rate of 2.9 per 1,000 births. 8 deaths occurred amongst these, giving a case mortality of 47 per cent. 10 cases followed the birth of live-born infants, 5 the birth of a non-viable foetus, and 2 the birth of a dead viable infant. 25 8 of the patients were primiparae (i.e., women who had not previously borne children), and 9 multipara. In 3 cases "instruments" had been used at the confinement, and in one case the patient had undergone an operation in hospital two days after supposed miscarriage. 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 per 1000 births. Doctors 7 1453 4.8 Midwives from Institutions 1 790 1.3 Private Midwives 1 1181 0.8 Medical Students 3 1268 2.4 In Hospital 2 — — In 3 cases the mother had no skilled attention at the time of miscarriage, and doctors were called in some hours later. OPHTHALMIA NEONATORUM.. 69 infants were notified during 1920 to be suffering from ophthalmia neonatorum. Two of these cases were afterwards cancelled because the inflammation had started when the infants were over three weeks of age, and also one hospital case where the mother's home was out of the borough. The corrected number of cases was therefore 66, or 11*1 per 1,000 births. 55 of these were notified by medical practitioners, 6 by midwives, and 5 by both. 8 of the cases were regarded as grave, 27 as moderate, and 31 as slight. 3 of the cases have since died. 5 were illegitimate. The cases are classified below according to the manner in which the mothers were attended at their confinement. Confinement attended by No. of cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births. Doctors 16 1453 11.0 Midwives from Institutions 16 790 20.3 Private Midwives 14 1181 11.9 Medical Students 5 1268 3.9 In Hospitals and Institutions 15 — — Every case was visited on the day of the receipt of notification. 23 cases were removed to hospital, and 42 were treated at home, with the help of a visiting nurse in 27 cases. One case died in the institution where born within ten days of birth. The results of treatment were as follows:— Complete recovery 59 Blind (but died when 10 months old) 1 Sight damaged 1 Died before recovery 2 Removed and lost trace of 3 26 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 1920 the visiting nurses made 570 visits to 35 cases in this connection. MEASLES AND GERMAN MEASLES. These diseases were made compulsorily notifiable throughout the country by an Order of the Local Government Board as from January 1st, 1916, the Order being known as the Public Health (Measles and German Measles) Regulations, 1915. Under these regulations all cases 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. Full use was made of the regulations in St. Pancras, practically every case of measles being promptly visited and investigated by a health visitor upon notification, and a leaflet of instructions left with the parent. In all cases where it appeared necessary on the health visitor's report the Medical Officer of Health was able to send a visiting nurse daily, and also to supply medical necessaries, such as milk or coals in cases of necessity. These facilities were available through the Mayoress' Nursing Fund for Sick Children. Where removal to hospital was essential, this could often be arranged through the Metropolitan Asylums Board or the Guardians. Towards the end of 1919 the Ministry of Health announced that the Regulations would be revoked as from the 31st December, 1919, and at the same time stated that if any local authority desired that the diseases should continue to be notifiable in their district the Ministry would make a local Order to that effect, provided it was satisfied that the authority had a complete scheme for dealing with the cases notified. The St. Pancras Borough Council were satisfied as to the value of notification, and on their request the Ministry made an Order providing for the compulsory notification of measles and german measles in St. Pancras on the same lines as those laid down in the 1915 Regulations. This arrangement was made definite by the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920. In June, 1920, the Council, on the consideration of a communication in that sense received from the Metropolitan Borough of Chelsea, informed the Ministry of Health that they were of opinion that measles should be made a compulsorily notifiable disease throughout London. With a view to indicating the value of compulsory notification, the cases of measles (463) reported in St. Pancras from June to December (inclusive), 1920, were analysed accordingly as the information was derived from compulsorv notification, or by the system of reporting cases from the public elementary schools. The results were as follows:— Primary Cases, Secondary Cases. All Cases. Reported by compulsory notification only 163 106 269 Reported both by compulsory notification and by the schools 76 13 89 Reported by the schools only 90 15 105 The "primary" cases were those which were the first cases in the houses in which they occurred, and the "secondary" cases were the subsequent cases in those houses. Only cases of measles are included, not german measles. The figures indicate that one-half of all the cases reported were heard of through compulsory notification only. It was also found that many of the school reports of cases were too much delayed to be of real service. 27 Subject to correction for diagnosis in certain instances, 3,093 cases of measles, and 195 of german measles were notified or otherwise discovered in 1920. This represents an incidence rate of 13.3 per 1,000 civil population for measles and 0.84 for german measles. 65 deaths from measles were registered during the year, equal to a death-rate of 0.28 per 1,000 civil population, and a case mortality of 2.1 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 2151 167 „ parents and guardians 529 10 Discovered otherwise 413 18 3093 195 Further statistical facts in regard to the disease will be found on pages 11, 13, 14, 28, 29 and 30. Through the Mayoress' Nursing Fund all cases where it was considered necessary have been attended by a visiting nurse once or twice a day. In the year 325 cases of measles were nursed, 1907 nursing visits being made. In 220 families the patients were supplied with milk, etc., from the Fund. The cases notified, the number of deaths, and the percentage case mortality for the 5 years during which the disease has been notifiable, were as follows:— Cases notified. Deaths. Percentage case mortality. 1916 1885 42 2.2 1917 3681 118 3.2 1918 2144 75 3.5 1919 1034 15 1.5 1920 3093 65 2.1 WHOOPING COUGH. The number of St. Pancras deaths from whooping cough in the past ten years are as follows:— 1911 48 1916 39 1912 47 1917 27 1913 36 1918 80 1914 49 1919 7 1915 52 1920 60 17 cases of whooping cough were nursed in 1920 through the Mayoress' Nursing Fund, 122 nursing visits being made. ANTERIOR POLIOMYELITIS. See page 43. 28 Section III—PREVALENCE OP AND CONTROL OVER INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1920 is shown in the table below, where they 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 i. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1. Variola or Small-pox — — — — — — — — 2. Scarlatina or Scarlet Fever 863 12 159 425 178 63 26 — 3. Diphtheria and Membranous Croup 747 8 140 331 142 75 50 1 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 18 — — 4 — 6 8 — 6. Fever, Simple or Continued — — — — — — — — 7. Relapsing Fever 1 — — — — — — 1 8. Puerperal Fever 18 — — — 3 15 — 9. Erysipelas 126 1 4 3 6 13 84 15 10. Cholera — — — — — — — — 11. Plague — — — — — — — - 12. Anthrax — — — — — — — — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 6 2 1 1 1 — 1 — 16. Anterior Poliomyelitis and Polioencephalitis 2 — 1 1 — — — — 17, Ophthalmia Neonatorum 69 69 — 18. Encephalitis Lethargica 11 — — 1 1 2 7 — 19. Acute Primary Pneumonia 142 16 26 20 9 22 45 4 20. Acute Influenzal Pneumonia 108 1 5 1 1 27 70 3 21. Malaria 58 — — — — 7 51 — 22. Dysentery 4 — — — — — 4 — 23. Trench Fever — — — — — — — — 24. Measles 3093 177 1445 1292 95 50 34 — 25. German Measles 195 7 56 91 23 12 6 — 26.*Tuberculosis:— Pulmonary 684 1 10 35 36 111 459 32 Other Forms 132 5 15 36 22 20 28 6 *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 1920. 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 3 10 17 24 31 7 14 21 28 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 4 11 18 25 Jan. 1 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 i 44 45 46 47 48 49 50 51 52 53 Number of Week Scarlet Fever .. .. .. .. .. 2 .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. • • .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. 11 Scarlet Fever Diphtheria and Memb. Croup 2 1 1 .. .. 1 .. .. .. 1 1 .. .. 1 .. 1 1 .. 1 1 1 • • 1 .. .. 2 .. .. .. .. 2 .. 1 .. 1 2 1 .. 3 .. .. .. .. 1 .. .. 1 .. .. 3 1 .. 1 33 Diphtheria and Memb. Croup Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 • • 1 Enteric Fever Puerperal Fever .. .. 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 8 Puerperal Fever Erysipelas .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 2 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 1 1 .. .. 12 Erysipelas Cerebrospinal Fever .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Cerebrospinal Fever Poliomyelitis .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Poliomyelitis Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Ophthalmia Neonatorum Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Malaria Dysentery .. .. .. .. .. 2 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 7 Dysentery Measles .. .. .. .. .. 3 2 4 8 2 2 4 6 2 7 5 3 3 2 2 2 3 • • .. .. 1 .. 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 65 Measles Tuberculosis (Pulmonary) 7 7 3 4 3 5 5 5 2 4 7 10 10 5 5 4 10 3 6 6 5 4 6 3 1 6 1 2 7 4 3 3 4 5 4 3 3 3 1 3 9 4 3 4 6 4 5 7 6 2 9 5 3 249 Tuberculosis (Pulmonary) Do. Other Forms 2 1 3 .. 1 .. 2 .. .. 2 1 2 .. 1 1 3 3 1 1 .. .. 3 1 1 2 3 4 .. 2 .. 1 .. 3 1 1 3 1 1 .. .. .. 2 .. 1 .. 1 1 1 2 2 .. 2 .. 63 Do. Other Forms Whooping Cough .. 1 1 1 2 .. 3 7 2 4 6 3 3 5 1 3 3 3 3 4 1 1 .. .. .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 60 Whooping Cough Diarrhœa and Enteritis .. 1 2 .. 1 1 1 .. 3 .. 2 .. 4 1 1 1 • • 2 .. .. 1 1 .. .. 2 .. 1 2 2 3 .. 2 1 1 .. 1 2 1 .. 1 2 3 2 1 1 .. 1 .. 1 .. .. 1 1 54 Diarrhœa and Enteritis SAINT PANCRAS, LONDON. WEEKLY NUMBER OF INFECTIOUS CASES CERTIFIED TO THE MEDICAL OFFICER OF HEALTH DURING THE YEAR 1920. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals Quarters Months January. February. March. April. May. June. J iily. August. September. October. November. December. Months Week ending 3 10 17 24 31 7 14 21 28 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 4 11 18 25 Jan. 1 .. 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 53 .. Number of Week Scarlet Fever 27 13 19 19 12 14 14 12 22 7 13 14 12 13 10 9 4 8 10 10 8 3 12 6 17 8 19 14 8 14 14 13 9 9 22 13 16 16 16 18 30 28 39 30 31 33 35 20 15 19 29 11 26 863 Scarlet Fever Diphtheria and Memb. Croup 9 5 9 16 15 14 12 7 21 16 17 9 12 21 16 20 11 6 18 22 13 4 7 12 8 20 14 6 11 11 10 8 11 10 17 18 18 16 19 21 13 19 20 20 25 14 19 15 18 19 15 7 13 747 Diphtheria and Memb. Croup Enteric Fever 2 .. 1 .. 1 .. .. .. 2 .. .. .. .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. .. .. .. 2 .. 1 1 .. .. 1 .. 1 .. .. .. 18 Enteric Fever Relapsing Fever .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Relapsing Fever Puerperal Fever .. 2 2 .. 1 .. .. 1 1 .. .. .. 2 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. 18 Puerperal Fever Erysipelas 7 2 2 3 2 1 4 2 2 4 4 1 3 3 4 .. 1 2 3 4 .. 2 1 .. 4 1 1 3 5 1 .. 2 1 3 .. 1 2 4 4 3 1 4 2 2 .. 3 3 3 3 2 4 3 1 126 Erysipelas Cerebrospinal .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 6 Cerebrospinal Fever Fever Poliomyelitis and Polioencephalitis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 2 Poliomyelitis and Polioencephalitis Ophthalmia Neonatorum 1 .. 1 .. 1 .. 1 .. 1 4 2 2 2 1 1 2 1 1 2 2 .. 1 2 2 1 .. 3 .. 1 1 1 .. 2 .. .. 2 2 .. 1 2 1 1 4 1 .. 2 .. 1 4 6 1 1 1 69 Ophthalmia Neonatorum Encephalitis Lethargica 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 11 Encephalitis Lethargica Acute Primary Pneumonia .. 1 2 8 11 6 7 3 5 1 8 1 2 4 3 3 6 3 2 1 6 2 4 1 .. .. 5 1 .. 1 1 .. .. 1 .. 1 1 3 3 1 2 1 3 2 2 5 5 3 2 1 2 1 5 142 Acute Primary Pneumonia Acute Influenzal Pneumonia .. .. 2 1 .. 2 1 4 3 1 7 7 3 12 13 4 6 .. 5 2 6 1 .. .. 1 .. 2 1 .. 1 1 1 2 .. .. .. .. 2 2 .. .. .. .. .. 1 1 6 1 1 .. 2 .. 3 108 Acute Influenzal Pneumonia Malaria 1 1 2 1 2 2 4 2 2 6 .. 2 1 .. .. 3 2 2 2 3 4 1 2 1 2 1 1 2 .. .. 1 1 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 58 Malaria Dysentery .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 4 Dysentery Measles 22 18 44 47 66 93 134 138 151 162 221 232 252 154 204 176 134 108 74 95 79 73 76 55 58 36 27 22 29 20 15 6 2 6 1 3 2 1 2 9 7 2 2 2 1 2 2 1 2 7 4 10 4 3093 Measles German Measles 5 2 3 2 5 7 5 4 2 5 6 2 10 10 12 5 7 1 2 5 4 11 7 6 3 7 6 6 6 5 3 2 2 1 1 2 .. 3 2 1 2 .. .. .. .. 3 1 1 4 1 2 3 195 German Measles Tuberculosis (Pulmonary) 5 14 13 12 8 15 12 17 13 14 9 22 12 17 12 11 24 15 9 18 19 17 7 13 15 25 7 15 15 17 10 16 8 15 10 7 14 11 8 5 10 20 15 10 6 8 11 13 4 18 18 11 14 684 Tuberculosis (Pulmonary) Tuberculosis (Other Forms) .. 1 4 2 2 2 3 6 4 2 .. 6 4 4 3 1 1 4 4 1 .. 5 4 2 4 3 5 4 4 1 .. 1 5 1 1 1 4 3 1 2 .. 3 .. 4 .. 2 .. 4 3 8 1 2 .. 132 Tuberculosis (Other Forms) 29 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. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Small-pox — — — — — — — — 10 — Scarlet Fever 445 598 568 1207 1009 448 246 332 558 863 Diphtheria and Membranous Croup 419 550 440 458 446 424 451 399 348 747 Typhus Fever — — — — — — — — — — Enteric or Typhoid Fever 66 29 41 44 36 38 24 17 7 18 Fever, simple or continued — — 1 1 — 1 — — — — Relapsing Fever — — — — — — — — — 1 Puerperal Fever 16 20 11 18 14 18 9 5 13 18 Erysipelas 201 190 210 223 202 120 126 121 134 126 Cholera — — — — — — — — — — Plague — — — — — — — — — — Hydrophobia — — — — — — — — — — Anthrax — — — — — 1 — 1 — — Glanders — — — — — — — — — — Cerebrospinal Meningitis 7 3 5 2 40 23 25 13 10 6 Anterior Poliomyelitis and Polioencephalitis 2 3 9 3 8 9 1 1 4 2 Ophthalmia Neonatorum 26 18 23 34 31 38 31 40 39 69 Chicken-pox 198 .. .. .. 247 .. .. 401 .. .. Measles .. .. .. .. .. 1855 3681 2144 1034 3093 German Measles .. .. .. .. .. 381 609 311 268 195 Encephalitis Lethargica .. .. .. .. .. .. .. .. 3 11 Acute Influenzal Pneumonia .. .. .. .. .. .. .. .. 213 108 Acute Primary Pneumonia .. .. .. .. .. .. .. .. 86 142 Malaria .. .. .. .. .. .. .. .. 98 58 Dysentery .. .. .. .. .. .. .. .. 6 4 Trench Fever .. .. .. .. .. .. .. .. 1 — Tuberculosis— Pulmonary 1464 1735 928 893 933 735 825 1034 799 684 Other Forms 230 121 150 138 169 203 206 132 30 The notifications of, and deaths from, the notifiable infectious diseases, are classified in the following tabic according to their Wards and Registration Sub-Districts:— INFECTIOUS DISEASES. Notifications. Deaths. West. Ward South. Ward East. Ward North. Ward No Address. whole Borough. West. Ward South. Ward East Ward North. Ward No Address. Whole Borough. 4 5 7 8 3 6 1 2 * 5 7 8 3 6 1 2 1. Variola or Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2. Scarlatina or Scarlet Fever 106 132 48 123 138 50 110 156 .. 363 1 .. 1 4 2 1 2 .. .. 11 3. Diphtheria and Membranous Croup 41 85 22 91 104 64 135 205 .. 747 2 2 .. 6 5 2 6 10 33 4. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Entericor Typhoid Fever 3 1 .. 3 7 .. 4 .. .. 18 .. .. .. .. 1 .. .. .. .. 1 6. Fever, Simple and Continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Relapsing Fever .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 8. Puerperal Fever 1 1 3 4 2 2 3 2 .. 18 2 .. .. 2 1 1 2 .. .. 8 9. Erysipelas 10 15 5 14 20 20 19 23 .. 126 2 2 .. 1 1 1 3 2 .. 12 10. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15. Cerebrospinal Meningitis 3 .. .. 1 1 .. 1 .. .. 6 .. .. .. .. 1 .. 1 .. .. .. 16. Anterior Poliomyelitis and Polioencephalitis .. .. 1 .. .. .. 1 .. .. 2 .. .. .. .. .. .. 1 .. .. 1 17. Ophthalmia Neonatorum 8 10 15 4 8 10 6 8 .. 69 .. .. 1 .. .. .. .. .. .. 1 18. Encephalitis Lethargica 1 2 2 .. 2 1 1 2 .. 11 .. .. .. .. .. .. .. .. .. .. 19. Acute Primary Pneumonia 18 21 1 26 17 14 26 9 .. 142 .. .. .. .. .. .. .. .. .. .. 20. Acute Influenzal Pneumonia 9 18 2 9 32 9 24 5 .. 108 .. .. .. .. .. .. .. .. .. .. 21. Malaria 10 7 2 2 22 4 10 1 .. 58 .. .. 1 .. .. .. .. .. 1 2 22. Dysentery .. .. .. .. 1 .. 2 1 .. 4 .. .. .. 2 •• .. 3 .. 2 7 23. Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 24. Measles 442 304 129 400 505 297 591 425 .. 309 6 5 5 11 7 15 10 6 .. 65 25. German Measles 21 48 9 11 22 .. 40 33 .. 195 .. .. .. .. .. .. .. .. .. .. 26, †Tuberculosis:— Pulmonary 69 83 62 97 89 87 105 74 18 684 42 35 19 34 32 28 31 24 4 249 Other Forms 9 12 14 11 22 21 20 15 5 132 8 8 2 9 6 8 14 7 1 63 †Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms A, B, C, or D. 31 DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of Cases. No. of Houses. No. of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Small-pox — — — — Scarlet Fever 764 748 880 875 Diphtheria 630 627 700 711 Enteric Fever 17 17 17 9 Erysipelas 73 73 72 38 Puerperal Fever 17 17 17 12 Cerebrospinal Meningitis 3 3 4 4 Consumption 75 75 78 79 Measles 48 48 59 53 Cancer 33 33 32 26 Vermin and Scabies 67 67 65 15 Other Diseases 160 160 176 110 Totals 1887 1868 2100 1932 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. Disinfected. Beds, mattresses and palliasses 28 2134 1 62 Bolsters and pillows 13 3960 3 73 Sheets, blankets and counterpanes 1 5923 — 698 Rugs, mats, cushions, carpets, covers, and curtains 7 958 — 31 Wearing apparel 7 2873 3 28 Books 42 77 — — Sundries 5 578 — 9 Total 103 16503 7 901 These figures include 478 blankets, 15 mattresses, 9 bolsters and sheets, 26 pillows, and 11 articles of wearing apparel and sundries which were disinfected on account of verminousness for voluntary bodies (such as the Y.M.C.A.) 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. 32 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 1 5 — Puerperal Fever — 12 — Diphtheria 1 — — Venereal — 1 — Cleansing Station. The amount of work done here during the year is indicated in the following tabic. 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 521 16 3638 *4175 Scabies 111 72 2183 2366 Cases from outside St. Pancras Vermin 109 2 1014 1125 Scabies 1 — 569 570 Vermin 630 18 4652 5300 Scabies 112 72 2752 2936 Total 742 90 7404 8236 *Includes 251 males and 5 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 conferrfd 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 7381 baths were paid for on this scale during the year. 110 verminous persons from common lodging houses outside the borough were paid for by the London County Council at the rate of Is. per attendance. TUBERCULOSIS. The number of notifications of civilian cases of tuberculosis received during 1920 are set out in the following table, in the form required by the Ministry of Health:— 33 Public Health (Tuberculosis) .Regulations, 1912. Summary of Notifications during the period from 29th December, 1919, to the 1st January, 1921 (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 (i.e.,including cases previously notified by other Doctors), Primary Notifications. Total Notifications (i.e,, including cases previously notified by 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 — 5 10 10 11 30 59 78 46 29 17 295 350 — 2 2 4 6 161 122 103 100 „ Females 1 3 10 17 14 28 48 25 20 13 8 187 224 — 3 2 5 6 73 53 38 47 Non-pulmonary—Males 4 7 12 8 5 3 8 2 2 — 2 53 50 — 1 — 1 1 10 4 8 5 „ Females 1 7 14 3 4 6 4 — — 2 3 44 46 — 3 3 6 6 4 10 9 9 Totals 6 22 46 38 34 67 119 105 68 44 30 579 676 — 9 7 16 19 248 189 158 161 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 15 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 — 2 6 1 5 10 19 33 31 16 7 130 — — 1 — — — 1 3 1 2 — 8 „ Females — — 3 2 3 8 15 14 3 — — 48 — — — 2 1 1 1 2 — — — 7 Non-pulmonary—Males — — 3 3 — — — 3 1 2 1 13 — — — 1 — — — 1 — — — 2 „ Females — 1 2 1 2 — 2 — — — — 8 — — 1 3 — — — — — 1 — 5 Totals — 3 14 7 10 18 36 50 35 18 8 199 — — 2 6 1 1 2 6 1 3 — 22 34 The number of primary notifications (civilian) received during the year on Forms A. B. C. and D. was 816 (684 pulmonary, 132 non-pulmonary) equal to a notification rate of 3.51 (2.94 pulmonary, 0.57 non-pulmonary) per 1,000 (civil) population. They are analysed for age and sex in the next table:— Primary Notifications during 1920. Ages. Pulmonary Tuberculosis. Other Tuberculosis. Total all Forms. Males. Females. Total. Males. Females. Total. 0—1 — 1 1 4 1 5 6 1—6 7 3 10 7 8 15 25 5—10 19 16 35 16 20 36 71 10—15 13 23 36 12 10 22 58 15—25 56 55 111 8 12 20 131 25—35 79 64 143 8 6 14 157 35—45 114 41 155 6 — 6 161 45—55 78 23 101 3 — 3 104 65—65 47 13 60 2 3 5 65 65 upwards 24 8 32 3 3 6 38 Totals 437 247 684 69 63 132 816 The deaths from tuberculosis during the year numbered 312, of which 249 were from phthisis and 63 from other forms of tuberculosis. They are analysed for age and sex in the following table:— Deaths from Tuberculosis during the Year 1920. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0-1 — — — 5 3 8 8 1—2 1 1 2 — 3 3 5 2—5 — 1 1 5 3 8 9 5—10 1 2 3 I 4 8 11 10—15 — 2 2 3 4 7 9 15—25 21 21 42 3 9 12 54 25—36 23 21 44 5 2 7 51 35—45 39 17 56 3 — 3 59 45—55 37 13 50 1 — 1 51 55—65 21 8 29 1 — 1 30 65—75 14 3 17 1 1 2 19 75—85 2 1 3 1 2 3 6 85 & upwards — — — — — — — Totals at all Ages 159 90 249 32 31 63 312 35 The figures are equal to a death-rate of 1.34 (l.07 pulmonary, 0.27 non-pulmonary) 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. In regard to age incidence, 77 per cent, of the deaths and 75 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, 54 per cent, of the deaths and 59 per cent, of the new cases notified were of children aged 15 years or under. The deaths in 1920 are classified in the following table according to the part of the body affected as well as for age and sex:— 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 0—1 5—15 15—25 25—35 35—45| | 45—55 | 55—65 65-75 | 75—85 | 85 up. Total Females. Total Persons. Pulmonary Tuberculosis — 1 1 20 23 38 34 20 12 - 151 - 2 4 18 20 17 13 7 2 1 84 235 Fhthisis (n[]ot defined as tuberculous) — — - 1 - 1 3 1 2 — — 8 - - — 3 1 - - 1 1 - - 6 6 Total Pulmonary Tuberculosis — 1 1 21 23 39 37 21 14 2 - 159 - 2 4 21 21 17 13 8 3 1 90 249 Acute Phthisis — — — — — — — — — — — — — — — — — — — — — — — — — Acute Miliary Tuberculosis 1 — — — 2 — — — — — — 3 — — — 1 — — — — — — — 1 4 Tuberculous Meningitis 3 5 6 2 — 2 1 — — — — 19 3 5 7 4 — — — — — — — 19 38 Tabes Mesenterica — — — — — — — — — — — — — — — — — — — — — — — — — Other Peritoneal and Intestinal Tubercle — — 1 1 2 — — — — — — 4 — 1 1 4 — — — — — 1 — 7 11 Tuberculosis of Spinal Column — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of Join — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 Lupus — — — — — — — — — — — — — — — — — — — — — — — — — Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of other Organs 1 — — — 1 1 — 1 1 1 — 6 — — — — 1 — — — 1 — — 2 8 Disseminated Tuberculosis — — — — — — — — — — — — — — — — 1 — — — — — — 1 1 Total Non-Pulmonary Tuberculosis 5 5 7 3 5 3 1 1 1 1 — 32 3 8 9 2 - 1 2 - 31 63 Total all forms of Tuberculosis 5 6 8 24 28 42 38 22 15 3 — 191 3 8 12 30 23 17 1 8 4 3 — 121 312 In the next table the new cases notified during 1920 are similarly classified. 36 Location of Disease. Ages. Total. 0-5 5—15 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 7 4 32 39 398 204 684 Bones and Joints — 1 7 3 8 2 21 Meninges 5 6 4 7 3 4 29 Glands 2 — 9 10 6 6 33 Abdominal 1 — 2 5 — 1 9 Genito-Urinarv — — — — — — — General 1 — — — — — 1 Other Organs 2 2 6 5 13 11 39 Total Non-pulmonary Tuberculosis 11 9 28 30 30 24 132 Total all forms of Tuberculosis 18 13 60 69 428 228 816 The following table shows the number of new notifications and deaths from Tuberculois, together with the corresponding rates for the past ten years: — Year. Estimated Population. Primary Notifications. Deaths. Notification Kate. Death Bate. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms All forms. 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 933 150 1083 398 102 500 4.27 •69 4.96 1.82 •47 2.29 1916 218387 735 138 873 340 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 1305 268 73 341 3.66 •94 4.60 1.23 •33 1.56 1920 218387 684 132 816 249 63 312 3.07 •59 3.67 1.12 •28 1.40 37 During the past decade there had appeared to be a noticeable check in that decline in mortality from tuberculosis which had been proceeding for half a century, and during the war years there had even been a small increase in the annual figures. These manifestations, taken in conjunction with "the active work which had been done during the past ten years in the direct campaign against the disease (compulsory notification, home visitation, work of the tuberculosis dispensaries, sanatorium treatment, etc.), were somewhat disappointing; and it is reassuring to observe that during 1919 and 1920 the decline in mortality has been renewed. So much so is this the case that the number of deaths from all forms of tuberculosis in 1920 (312) was 31 per cent, less than the corresponding average annual figure for the five war years (1914-1918). The St. Pancras Tuberculosis Scheme. Emphasis has been laid in previous annual reports on the division of responsibility for anti-tuberculosis work between different authorities. (1) The Borough Council was originally the only local authority concerned, is still responsible by reason of the fact that all cases of tuberculosis are compulsorily notifiable to its Medical Officer of Health, and that it provides the tuberculosis dispensaries and appoints and pays the tuberculosis officers and tuberculosis visitors. (2) The London County Council arranges for the institutional treatment of tuberculous persons (chiefly through other bodies), and, to a great extent, controls the policy to be followed in connection with the admission of cases to sanatoria and other institutions and their after-care. The effect of this is that the work of the tuberculosis officers is very largely controlled by the County Council, though, at the same time, he is the Borough Council's officer and administratively an integral part of the Borough Medical Officer of Health's Department. (3) Other authorities are also closely concerned. The London Insurance Committee continued in 1920 to be responsible for the institutional treatment of insured persons, but this responsibility has since been transferred to the London County Council. The Board of Guardians fulfil a very important function in the provision of beds, chiefly for advanced cases, in the Poor Law hospitals. The Metropolitan Asylums Board also plays an important part in the matter by the provision and maintenance of sanatoria and hospitals. As the result of this splitting of responsibility, the Borough Council and its Medical Officer of Health are not the controlling agents in the development and administration of the anti-tuberculosis work, and have, to a great extent, to shape their actions in order to conform with the policy of the other authorities. Visiting Work.—The home visiting of notifledand other cases of tuberculosis, and contacts, has been carried out by certain of the women inspectors working from the Town Hall, and by the nurses at the tuberculosis dispensaries. The papers in connection with all notified cases are filed at the Town Hall, and clinical and other records of those cases which pass through the hands of the tuberculosis officers are kept at the dispensaries. At the Town Hall Miss Bibby undertakes co-ordinating and advisory work in connection with tuberculosis, and Miss lilaxland and Miss Parnell are responsible for tuberculosis home visiting, to which they give part of their time. There is one nurse at the St. Pancras Dispensary (and its branch) who devotes to home visiting such of her time as is available for that purpose, and one nurse (part-time so far as St. Pancras is concerned) at the University College Hospital Dispensary. 38 The visiting (and certain other) work carried out in the Borough in connection with tuberculosis during 1920 was as follows:— Home visits* by— Tuberculosis officers 163 Women inspectors— (a) First visits to notified cases 572 (b) Subsequent visits 2062 Tuberculosis dispensary nurses 980 — 3777 Attendance of women inspectors at dispensaries 201 Other visits of women inspectors for various purposes 57 No. of cases in which disinfection was carried out 75 Tuberculosis Dispensaries. The staff at the St. Pancras Dispensary (39, Oakley Square, and branch at 132, Maiden Road), which serves the part of the Borough lying north of Euston Road (population in 1911, 173,132) consists of the Borough Council's tuberculosis officer, one tuberculosis nurse, and one (woman) clerical and general assistant, all full time officers. The lastmentioned officer was appointed in 1920. The tuberculosis dispensary at University College Hospital serves the whole of the Borough of Holborn (population in 1911, 49,357), in addition to the part of St. Pancras lying north of Euston Road (population in 1911, 45,255), as do also its staff, which consists of a part-time tuberculosis officer and a full-time tuberculosis nurse. The work done at the dispensaries in 1920 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 neiv cases 94 80 174 240 208 448 13 81 94 No. found to be suffering from pulmonary tuberculosis 70 19 89 130 37 167 8 9 17 Ditto non-pulmonary do. 4 5 9 7 25 32 — 7 7 Ditto non-tuberculous 14 47 61 69 109 178 5 37 42 No. in whom diagnosis was found to be doubtful 6 9 15 34 37 71 28 28 Total attendances 765 517 1282 1518 1802 3320 45 681 726 No. of above attendances at which physical examinations and records were made . . 299 221 520 788 940 1728 42 324 366 Home visits by Tuberculosis Officer 4 1 5 114 44 158 Included in Oakley Square Ditto by Dispensary Nurse 486 375 861 62 47 109 — 10 10 No. of persons referred to the hospital to which this Dispensary is affiliated 14 8 22 78 72 150 2 16 18 No. of consultations with Medical Practitioners — — — — 7 7 — — — No. of written reports to:— (a) Public Authorities 260 79 339 1040 403 1443 5 84 89 (b) Practitioners 13 5 18 220 90 310 3 19 22 No. of Specimens of sputum examined 51 15 66 532 266 798 Included in Oakley Square *Exclusive of visits made by members of the Interim Tuberculosis Care Committee. 39 Treatment of Tuberculosis in Sanatoria and Hospital. No. of applications made in 1920:— To Loudon Insurance Committee— Soldiers 82 Others 70 — 152 To London County Council 82 — 234 No. of cases admitted in 1920:— By London Insurance Committee— Soldiers 79 Others 49 — 128 By the London County Council 62 — 190 These figures may be compared with the following:— No. of cases notified on Form C in 1920 as having been admitted to sanatoria, 189 „ „ „ „ Poor Law Institutions, 248 SMALLPOX. No cases of smallpox occurred in St. Pancras in 1920. There have been no cases in the Borough since 1904, except the 10 cases which occurred in 1919. There were 19 cases in the County of London in 1920. SCARLET FEVER. 863 (civil) patients were notified in 1920 as suffering from scarlet fever. Of these 53 were afterwards reported not to be suffering from the disease by medical superintendents of the Metropolitan Asylums Board, and 2 by other medical practitioners. The corrected number of scarlet fever cases (civil) notified was, therefore, 808, equal to an incidence rate of 3.47 per 1,000 civil population. The number of deaths from scarlet fever certified during the year was 11, equal to a death-rate of 0.05 per 1,000 civil population, and a case mortality of 1.36 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. ntage of Cases removed to Hospital. 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 1920 808 3.5 11 0.05 1.4 96 *From 1913 onwards the figures have been corrected for errors of diagnosis. 40 It will be seen from the table that there has been a wave of increasing prevalence of the disease since 1917, when it reached the lowest point on record. The case mortality fortunately remains low. Of the notified cases of scarlet fever, 831 (or 96.3 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board hospitals 823 To other hospitals 8 831 (Other statistical facts will be found on pages 28 to 30). 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 19 such cases in 1920, occurring in 19 houses. In each of two instances two previous cases had returned within the 28 days, and it was not possible to determine which were the infecting agents. The (?) infecting cases are therefore taken as numbering 21. In every instance the return case was in the same family as the (?) infecting case or cases. In 8 instances the (?) infecting case had rhinitis and nasal discharge since return (accompanied by sore-throat in one case, ear discharge in one, glandular enlargements in two, and desquamation on the feet in one), in one other instance ear discharge, and in three other instances desquamation on the feet. There were no obvious signs of infectiousness in the other 10 cases, though chronic enlargements of the tonsils, often with some glandular swelling, was found in a considerable proportion of the cases. The intervals between the return of the (?) infecting case and the onset of the illness of the return case were respectively 2, 3, 3, 3, 3, 3, 4, 5, 5, 5, 6, 8, 8, 8, 15, 16, 17, 21, 21, 24 and 26 days. There was in addition one return case occurring 41 days after the return in the same family of a previous case, which suffered from rhinitis and nasal discharge, and another occurring 45 days after the return in another family in the same house of a previous patient, who was found to have a catarrhal "cold" giving a negative nasal swab. There were three instances in which cases of scarlet fever developed within 28 days of the return from hospital to the same house of a previous case of diphtheria. In each of the 3 cases the scarlet fever and corresponding previous case of diphtheria were in the same family. In one instance the returned diphtheria case had sores on the face, and in the other two no signs of infectiousness. In one of the three instances the case of scarlet fever was followed by a second case taking its onset a day later than the first. In addition to these three there was one other instance in which a case of scarlet fever occurred 31 days after the return in the same family of a previous case of diphtheria, which showed no signs of infectiousness. DIPHTHERIA. 747 (civil) patients were notified in 1920 as suffering from diphtheria or membranous croup. Of these, 66 were afterwards found not to be suffering from the disease by Medical Superintendents of the Metropolitan Asylums Board, and one by other medical practitioners. The corrected number of diphtheria cases (civil) notified was therefore 680, equal to an incidence rate of 2.92 per 1,000 civil population. 41 The number of deaths from diphtheria certified during the year was 33, equal to a death-rate of 0.14 per 1,000 civil population and a case mortality of 4.8 per cent, of cases notified. In the following Table are set out the corresponding figures for the past 10 vears 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 remored to hospital. 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 1918 340 1.9 31 0.17 9.1 93 1919 283 1.3 21 0.09 7.4 97 1920 680 2.9 33 0.14 4.8 97 *From 1913 onwards the figures have been corrected for errors in diagnosis. The prevalence of diphtheria was greater in 1920 than in recent years. The case mortality however, was comparatively low. Of the notified cases of diphtheria, 723 (or 96.8 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 720 To other hospitals 3 Other statistical facts will be found on pages 28 to 30. 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 was 9 such cases in 1920, occurring in 9 houses. In 7 instances the cases were in the same family, and in 2 instances in different families in the same house. The condition of the (?) infecting cases was as follows:—(1) suffering from measles; (2) nasal discharge, giving negative swab, but positive swab ffom throat; (3) sore throat; (4) sores on the face; (5) nasal discharge (negative swabs from nose and throat); (6) no signs of infectiousness; (7) no signs of infectiousness, but positive swab from nose and negative from throat; (8) nasal discharge (negative swabs from nose and throat); (9) nasal discharge (negative swab from nose). In a number of cases there was chronic enlargement of the tonsils. The intervals between the return of the (?) infecting case and the onset of the illness of the return case were respectively 1, 3, 5, 11, 12, 13, 15, 19, and 24 days. In addition there was one case of diphtheria occurring 33 days after the return in the same family of a previous case of diphtheria, which showed no signs of infectiousness and gave a negative swab from the throat. In three instances, cases of diphtheria occurred a few days after the return from hospital to the same family of a previous case of scarlet fever, the intervals being 7, 9 and 14 42 days respectively. The condition of the scarlet fever convalescent is each case was as follows:— (1) Rhinitis and glandular enlargement (negative swabs from nose and throat, but later a positive swab obtained from the nose). (2) No signs of infectiousness, but positive swab from throat. (3) No signs of infectiousness, and negative swabs from nose and throat. In one of the instances (1 above), the case of diphtheria was followed by a series of cases of nasal and throat diphtheria. TYPHOID OR ENTERIC FEVER. 18 cases were notified during 1920 as suffering from this disease. Of these, 4 were afterwards found not to be suffering from the disease, the number of actual cases being 14. Only 1 of the cases was fatal. 2 of the cases were paratyphoid B. Other statistical facts will be found on pages 28 to 30. The 18 cases were treated as follows:— Cases notified. Not typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 9 3 6 In other hospitals 8 1 7 In their own homes 1 — 1 The cases were all in different houses. In one case the patient arrived from Cork (Ireland), in the early stage of the disease. One case was a nurse who had been nursing a fatal case of typhoid fever until a fortnight before the onset of her own illness. One case (para-typhoid B) was one of a series of cases which occurred at the Bedford College for Women, where the patient was a student. In the other 11 cases the source of illness was not traced. The number of cases of typhoid fever, corrected for errors of diagnosis, which have been notified since 1913, and the number of these cases which have died, are shown in the following table:— Year. Cases notified. Fatal cases. 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 1920 14 1 7 43 ACUTE ANTERIOR POLIOENCEPHALITIS AND POLIOMYELITIS. Two cases were notified in 1920, one as polioencephalitis, and one as poliomyelitis. The latter case was fatal. The particulars were as follows:— W. C. H., male, aged 8. Ward 1 (D). Onset, January 17. Pain in back, vomiting; afterwards persistent temperature, pains in head, head retraction, increasing paralysis (from January 20) of legs, afterwards involving the arms, tenderness of limbs, Kernig's sign, knee jerks abolished. Died January 23, probably from respiratory paralysis. No P.M. C.s. fluid under pressure, clear, colourless, sterile, deposit almost nil. Albumen very faint trace, Fehling's reduction trace. The death was certified as due to poliomyelitis. W. C., male, aged 2. Ward 7 (U). Onset October 11. Notified October 21. Malaise, drowsiness, vomiting, fever, constipation first three days, pain at back of head and neck, knee jerks absent, Kernig's sign, Babinski's sign doubtful, paralyis of right lower limb and right external rectus. Admitted to Middlesex Hospital, October 16. On January 21, 1921, eye muscles and left leg normal; right leg—still paralysis of thigh and leg muscles, but marked progress still continuing. EPIDEMIC CEREBROSPINAL MENINGITIS. 6 patients were notified in 1920 as suffering from cerebrospinal meningitis, of which one was afterwards found to have been wrongly diagnosed. The actual number of cases reported was therefore 5. 3 of the 5 cases were fatal (1 of the 3 deaths occurred in 1921). Particulars in regard to the 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. February 9 February 2 1 Recovered 58 F IV. O. C.s. fluid "positive for c.s. fever." „ 25 21 February 27 10 F III. H. "Gram-positive" cocci found in c.s. fluid (not pneumococci).* April 23 March 12 April 24 3 mths. F I. C. Meningococcus isolated from c.s. fluid. Diagnosis confirmed P.M. September 20 August 27 2 Recovered 2 9 mths. M IV. P. "Gram-Negative" intracellular diplococci found in c.s. fluid. December 30 December 13 Jan. 3 (1921) 3 mths. F IV. P. C.s. fluid (turbid) showing "grampositive" diplococci resembling pneumococci. P.M.—Purulent meningitis showing the same organisms.* * Diagnosis of cerebrospinal meningitis nevertheless maintained on clinical grounds. 1. On 22nd January, 1921, patient still suffered from weakness, debility, and giddiness. No paralysis. deafness, or mental impairment. 2. Complete recovery. No connection between the cases and no source of infection was found. The cases were treated in the Highgate Hospital, Paddington Green Children's Hospital, the Great Ormond Street Children's Hospital, and the North-Western (M.A.B.) Hospital (two cases). From 1913 the number of cases of cerebrospinal meningitis notified or otherwise reported (corrected for errors of diagnosis, etc.), and the number of these cases which died, were as follows:— 44  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 1920 5 3 60 ENCEPHALITIS LETHARGICA. In the 53 weeks ended January 1st, 1921, 11 patients were notified as suffering from encephalitis lethargica, of which 4 were afterwards found not to be suffering from that disease. One other case was reported without being formally notified. The number of actual cases reported was therefore 8. * Two of the cases were fatal, making a case mortality of 25 per cent. The particulars of the cases were as follows:— W. H. C. Male. Aged 56. Ward 8 (N). Office caretaker. Not notified. Ill from about November 13, 1919, with frontal headaches, drowsiness (but restless), and lack of interest; diplopia apparently dating from a month earlier; marked constipation ; in bed from about November 28 with lethargic condition (but could be roused), and stiffness of lower limbs. Admitted to Royal Free Hospital on December 13. Very marked leghargy (but answered questions), no other paralysis (but difficulty in keeping eyes open for long), or mental impairment, fundus oculi normal, obstinate constipation, temperature for first two days only. Progressive weakness, difficulty in breathing, died December 23. Wassermann of blood and c.s.f. negative, c.s.f. lymphocytes and albumen slightly +: white cells 25,800. P.M.— brain—surface extremely congested; localised patches of slight meningitis, with exudation showing cells but no organisms; pin-point haemorrhages about sylvian fissures, spinal cord congested, but less so. E. J. S. Male. Aged 54. Ward 3 (G). Schoolmaster. Notified December 30, 1919. Onset December 14, 1919, with giddiness, vomiting, fever, and diplopia (no headache or constipation then). In bed from December [20, with evening temperature, some degree of constipation, marked lethargy (could be roused), no mental impairment, ptosis, diplopia and fine nystagmus, tremor of hands, a certain heaviness of speech, and no other paralysis. Not removed to hospital. Recovered, but vision not good and eyes have a staring appearance. (February 25, 1920.) F. H. Male. Aged 16. Ward 3 (I). Engineer. Notified May 5th, 1920. Onset a few days before April 17. Fell from bicycle. Sleeplessness and drowsiness, headaches, constipation, no pain, diplopia, "eyes crossed" on April 19. Admitted to Middlesex Hospital on April 21. In hospital—evening temperature, lethargy, no other mental impairment, knee jerks absent on left side, no paralysis, resented interference at first. Recovery followed by relapse. Report on February 8, 1921—Movements slow and laboured, face dull and expressionless. Ocular movements full, but reverse nystagmoid jerks on lateral deviation, slight rigidity and weakness of right arm with slight tremor, but not on movement, slight rigidity of right leg, walks stiffly, reflexes normal. F. R. M. Male. Aged 36. Ward 2 (F). No occupation. Notified June 6, 1920. Onset about May 18. Pains in shoulders and arms—later generalised—lasted three weeks, loss of appetite, restless at night, shouted in sleep, diplopia, slight squint, drowsy from 7th June. Admitted to Higligate Hospital on 8th June. Only symptoms T 99, marked constipation, extreme drowsiness. Condition on January 21, 1921—No ocular or other paralysis, or tremors; inclined to be lethargic, slow mental processes and unreliable memory, general debility, headaches, insomnia and constipation persistent, unable to work. H. T. Male. Aged 14. Ward 6 (J). Cabinet making. Notified July 8, 1920. Onset about May 29. Lethargy, constipation, weakness of left arm and legs, pain in left leg, no • These two deaths are counted to 1919 and 1921 (see details of cases). 45 squint or diplopia, later tendency to dribble. Admitted to University College Hospital on July 5th—Extreme lethargy, lateral nystagmus (no ptosis or squint), slight left facial paralysis, paresis of left leg, tremor left hand, mental condition dull, speech slow. Condition on 24th January, 1921—General weakness, gets tired easily, slowness of speech and movements, marked weakness of back and left arm and leg, left knee jerks weaker than right, paralysis of left superior oblique, marked lateral nystagmus. E. A. Male. Aged 39. Ward 4 (P). Unemployed. Notified August 20, 1920. Onset before July 28. Headache, drowsiness, constipation, "queer in the head." Admitted to St. Pancras Hospital on August 11. On admission—No fever, marked lethargy (could not be roused), slight nystagmus, but no ptosis or squint, no paralysis, but general weakness, very slow cerebration, memory very bad, speaks slowly and with jaws nearly closed. Condition on January 29, 1921—Still in St. Pancras Hospital, just able to sit up, cerebration slow, rather irritable, right pupil smaller than left, marked constipation, some athetosis. E. O. Female. Aged 36. Ward 5 (Q). Notified December 10, 1920. Onset August 28. Constipation, stiff neck, very sleepy and tired. On November 16 all her teeth were extracted, but no improvement, prominence of eyes noticed. Admitted to St. Mary's Hospital on November 19. Condition in hospital—No fever, very marked lethargy, eyes slight and passing divergence, temporary loss of accommodation-reflex of pupil and temporary ptosis, bilateral facial paralysis, tongue kept protruded, general wasting of arm and leg muscles, temporary foot drop on left side, mental condition quite clear, patient "fussy," voice monotonous and articulation imperfect, heart dilated, pulse rapid. Condition on February 3rd, 1921—Still in hospital, getting up, much improved, facial paralysis diminishing, cannot walk owing to arthritis of the hip joints, with scoliosis. L. C. Female. Aged 20. Ward 7 (T). Notified December 27, 1920. Onset December 11. Giddiness, gradual onset of drowsiness, diplopia, constipation, twitching of face from December 18. Admitted to University College Hospital on December 21. Condition in hospital—Maximum temperature 103 deg., extreme lethargy, no ptosis or nystagmus, (?) slight squint, (?) some slight bilateral lower facial weakness, no paralysis, but general weakness, mental condition obscured by lethargy, no delirium, slight tremor, incontinence. Pyrexia of typhoid type continued, and patient died on January 4, 1921. P.M.—Diagnosis confirmed. Microscopic examination of brain showed diffuse perivascular round-cell infiltration of small lymphocytes. The lesions most marked in the pons, especially the seventh nerve nucleus. MALARIA. 58 cases of malaria were notified in 1920, and 2 deaths were recorded. In all cases the infection had been contracted abroad. All the cases were visited and such assistance was given as was necessary. dysentery. 4 cases of dysentery were notified in 1920, the diagnosis in one case being afterwards altered. They were all contracted abroad. Seven deaths from dysentery were registered during the year. pneumonia. During the year there were 142 cases of Acute Primary Pneumonia notified, and 108 of Acute Influenzal Pneumonia. There is reason to believe that the notification of these diseases is far from complete. This is partly due to uncertainty of definition. During 1920 there were registered 112 deaths ascribed to broncho-pneumonia, 46 to lobar pneumonia, and 39 to pneumonia (type not stated). Every case notified has been promptly visited by a lady sanitary inspector and such assistance given as the case seemed to require. The District Nursing Associations are paid by 46 the Council for the nursing of case of pneumonia and influenza at the rate of 1s. per visit. In 1920, 54 cases of influenza and pneumonia were dealt with at the Council's expense, 533 nursing visits being paid. The following is an analysis of the cases notified and visited :— Age and Sex. Acute Primary Pneumonia. Influenzal Pneumonia. Males 96 67 Females 46 41 0—1 18 1 1—5 27 3 5—15 26 5 15—25 21 26 25—55 43 64 55 and over 7 9 Of the 142 cases of acute primary pneumonia, 60 were treated in their own homes and 82 in hospitals. Of the hospital cases, 35 were treated in the St. Pancras Poor Law Hospitals and 47 in voluntary hospitals. The 82 cases were already in hospital when visited after notifiation, with the exception of 3 which were sent to hospital after being visited. In regard to the 60 cases which were treated at home, 25 were under the care of visiting nurses (in 17 of the cases the nurse was sent in as a result of the sanitary inspector's visit). With regard to the 108 cases of acute influenzal pneumonia, 57 were nursed at home and 51 in hospitals. Of the hospital cases, 37 were treated in the St. Pancras Poor Law Hospitals and 14 in voluntary hospitals. The 51 cases were already in hospital when visited, with the exception of 9 who were sent to hospital after being visited. In regard to the 57 cases which were treated at home, 20 were under the care of visiting nurses (in 12 of these cases the nurse was sent in as a result of the sanitary inspector's visit). Most of the hospital cases were notified by the hospital authorities. That the accommodation for home nursing was inadequate for many of the cases which were not removed to hospital is shown by the fact that only 20 out of the 60 acute primary pneumonia cases and 21 out of the 57 acute influenzal pneumonia cases were nursed in a sick room devoted to their exclusive use. In the other cases the patient was nursed in a room used as a family living room or as a bed room for other members of the family. In many of the homes where the family succeeded in providing the patient with a separate sick room this was only done at the expense of grave overcrowding of the rest of the family. Our experience in this respect shows that there is a necessity for a greater provision of hospital beds for cases of non-infectious acute illness. After-care visits were made to 12 of the cases under two years of age (11 acute primary, 1 acute influenzal). OTHER NOTIFIABLE INFECTIOUS DISEASES. Puerperal fever, ophthalmia neonatorum, and measles (as well as whooping cough) arc dealt with on pages 24 to 27. No cases of typhus, cholera, plague or human anthrax, glanders or hydrophobia, were reported in St. Pancras in 1920. 47 A number of persons who had proceeded to St. Pancras after having been in contact with small-pox and other dangerous diseases (mostly on shipboard) were reported and kept under observation, with negative results in all cases. Anthrax in Shaving Brushes. In the latter part of 1919 certain cases of anthrax (not in St. Pancras) occurred, which were believed to be due to the use of shaving brushes imported from Japan. Anthrax germs were found in the brushes, which were believed to be made from horse-hair infected with anthrax discharges. The brushes were made in imitation of badger-hair brushes. Enquiry was made at various shops in the borough, and brushes from the suspicious source, to the number of 33½ doz., were found at 16 shops. The owners of the brushes were induced to give up the brushes for destruction. By Order in Council, dated 9th February, 1920, the importation of Japanese shaving brushes into this country was forbidden. In February, 1921, in consequence of a letter from the Ministry on the subject, a circular letter was sent to all chemists, barbers, and other retailers who might be selling shaving brushes in St. Pancras, indicating the action which they should take with a view to the prevention of danger from infected Japanese brushes. TRACHOMA. In November, 1920, the Ophthalmic Registrar at University College Hospital informed the Medical Officer of Health of certain cases of Trachoma in a Grower Street lodging house. On enquiries being made it was found that in the house there were four cases (aged 24, 15, 7 and 5) in a party of Syrians, and 4 cases (all adults) in a party of Mesopotamian Armenians. The two parties were en route from the East to Canada and the United States, respectively. They had been admitted into this country, and were precluded from embarking for America on account of the immigration laws of Canada and the United States in regard to trachoma. Ultimately some of the cases were able to get through, while the remainder proceeded to another London address. The appropriate medical officer of health was duly informed. The Ministry of Health were advised of the facts and their attention called to the undesirability of cases of trachoma being allowed to enter this country under such circumstances. INFLUENZA. The force of the pandemic of 1918 and 1919 had spent itself in the latter year so far as St. Pancras was concerned. In 1920, 46 deaths were certified as due to Influenza. In the table on the next page the deaths from influenza, and from heart diseases, bronchitis, pneumonia and pulmonary tuberculosis (causes of death which were found to vary in fatality with influenza) are set out for each week in 1918, 1919, and 1920. DIARRHŒA AND ENTERITIS. 54 deaths from diarrhoea and enteritis were registered during 1920, equal to a deathrate of 0.23 per 1,000 population. Of these, 44 were in children under five years of age, and 37 in babies under one. 48 Deaths from Influenza, Heart Disease, Bronchitis, Pneumonia, and Pulmonary Tuberculosis reported in each week in 1918, 1919, and 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 – 7 6 – 7 2 – 14 8 5 12 2 3 9 3 – 11 2 – 8 8 4 7 3 – 12 6 13 10 3 2 3 6 2 5 3 2 3 6 4 3 4 – 12 – 8 7 4 1 12 6 7 5 4 4 7 5 5 4 5 1 10 2 3 6 5 4 12 10 8 4 5 8 2 8 3 6 1 10 7 3 5 6 6 7 11 6 7 6 2 10 8 9 9 5 7 – 6 4 4 4 7 22 11 25 12 11 7 1 12 5 5 8 – 5 4 4 10 8 40 13 31 26 6 8 2 8 8 11 5 9 – 11 3 4 7 9 51 7 27 18 10 9 1 11 6 11 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 11 7 12 – 6 10 6 6 12 12 10 12 6 5 12 1 8 7 5 10 13 – 5 5 3 9 13 7 14 7 2 6 13 2 10 9 6 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 6 8 5 7 5 16 – 11 4 8 7 16 4 13 5 1 5 16 5 5 6 11 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 18 3 11 6 3 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 – 6 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 6 27 8 8 3 2 13 27 – 1 – 2 9 27 – 5 2 2 1 28 21 5 1 11 9 28 – 7 3 1 3 28 – 5 1 2 2 29 8 7 2 9 4 29 – 4 5 – 5 '29 1 2 2 1 7 30 6 7 2 5 9 30 2 – 3 – 4 30 – 6 1 1 4 31 1 6 2 2 2 31 – 3 3 – 3 31 – 5 1 – 3 32 1 4 2 3 10 32 – 6 – 1 1 32 – 8 1 2 3 33 2 7 – 1 1 33 1 3 2 3 6 33 – 3 3 – 4 34 – 2 – 2 6 34 1 8 2 4 5 34 1 11 2 3 5 35 3 4 1 1 2 35 – 4 1 2 7 35 – 5 – – 4 36 3 4 1 5 3 36 – 3 – 3 2 36 – 11 2 1 3 37 3 5 1 – 5 37 – 4 2 – 3 37 – 9 1 3 3 38 – 7 1 3 9 38 – 4 1 1 3 38 – 5 2 3 3 39 2 3 1 5 8 39 1 3 – – 6 39 – 3 2 3 1 40 3 7 5 6 3 40 1 5 4 1 3 40 – 6 3 – 3 41 10 3 5 10 2 41 1 9 7 2 4 41 – 7 2 1 9 42 31 13 6 15 12 42 2 6 7 2 4 42 – 12 1 2 4 43 99 12 15 28 12 43 3 11 7 4 9 43 – 6 2 1 3 44 144 17 12 19 12 44 1 3 7 6 5 44 – 10 3 1 4 45 111 10 10 20 13 45 – 10 8 3 2 45 – 10 7 3 6 46 71 7 15 15 19 46 2 8 6 3 2 46 – 13 6 – 4 47 49 10 10 10 13 47 – 10 4 1 3 47 1 11 5 2 5 48 46 9 7 17 12 48 – 7 7 3 2 48 — 13 6 4 7 49 34 5 13 11 4 49 1 5 4 3 10 49 – 6 8 3 6 50 16 7 6 3 10 50 1 10 6 3 6 50 – 13 9 3 2 51 9 8 6 6 7 51 – 10 4 1 6 51 1 10 5 6 9 52 10 3 4 5 14 52 2 4 2 5 4 52 1 18 6 9 5 53 – 14 9 9 3 49 SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1920 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—85 85 up. Total Females. Total Persons. Syphilis 9 1 — — — 1 2 — — — — 13 6 — — — 1 — - 1 — — — 8 21 Locomotor ataxy — — — — — 2 2 — 1 — — 5 - — — — — — — — — — — — 5 General paralysis of the insane — — — — 2 5 3 — — — — 10 — — — — — — — — — — — — 10 Aortic aneurysm — — — — — 1 1 4 2 — — 8 — — — — — 2 — — 2 1 — 5 13 CANCER. 299 deaths were registered during 1920 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, sarcoma, &c. This is equal to a death-rate of 1.28 per 1,000 population, and 1.29 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 150 1.38 Females 149 1.31 Both Sexes 299 1.34 The deaths registered as due to cancer are set out in the following table for the past 13 years: — Sex, 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Average for 12 years. 1920 Males — — — — — 127 127 120 125 135 125 114 — 150 Females — — — — — 158 140 138 142 146 144 131 — 149 Both Sexes 288 232 266 274 247 285 267 258 267 231 269 245 265 299 50 Section IV—SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.—Altogether 73,154 inspections, including 3,759 inspections in connection with Ministry of Food Orders, were made in 1920 by the staff of Inspectors and Visitors. These consisted of 40,317 initial inspections (including the 3,759 Food Control inspections), and 32,837 re-inspections. Of these inspections, 42,742 were made by the District Sanitary Inspectors, 7,366 by the Sanitary Inspectors for Food and Food places, 2,604 by the Sanitary Inspector for Factories and Workshops, and 20,442 by the Women Sanitary Inspectors and Health Visitors. The inspections made by each individual Inspector and Visitor are shown in table 10, on page 97. The work of the various classes of Inspectors and Visitors is set out in tables 7, 8 and 9, on pages 93 to 96. The inspections dealt with above are exclusive of the visits made by the Council's staff at the Maternity and Child Welfare Centres (see page 17), and by the staff of the Tuberculosis Dispensaries (see page 38) ; nor do they include the work of the disinfecting staff (see pa ere 31). These intimations are classified in tables 11, 12, 13 and 14, on pages 98 and 99. 1,862 Statutory notices (comprising 3,027 items) were served during 1920 and the early part of 1921, following non-compliance with these intimation notices. These are also classified in tables 11, 12, 13 and 14, on pages 98 and 99. The following prosecutions were undertaken during the year in respect of general sanitary work :— Notices served and result of service.—3,719 intimation notices (comprising 8,422 items) were served by the Sanitary Inspectors during 1920. These were made up as follows— District Inspectors. Factory & Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 5139 61 1 — 5201 In respect of the Tenement House By-laws 1297 — — — 1297 In respect of Breaches of Statutes in Factories, Workshops and Workplaces 5 458 — — 463 In respect of other Breaches of Statutes and By-laws 1448 7 6 — 1461 7889 526 7 — 8422 51 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. 133, Drummond Street Occupied house without a proper and sufficient supply of water Jan. 6th Abatement Order made, costs £1 5s. Od. 125, ,, Failing to comply with Nuisance Order „ 8th Fined £2, coats £1 1s. 1-7, ,, Do. do. ,, 8th Do. 1, Evangelist Road Rooms damp and roof defective „ 30th Abatement Order, costs £1 3s. 22, Castle Road Walls and ceilings dirty, guttering and rainwater pipe defective „ 30th Do. costs £1 3s. 38, Highgate Road Walls and ceiling dirty; roof defective ,, 30th Do. costs £1 3s. 3, Haverstock Place Walls and ceiling dirty; roof, rain-water pipe and dustbin defective „ 30th Do. costs £1 3s. 5, Stucley Place Room dirty and rain-water pipe defective March 6th Abatement Order, costs £1 5s, 6, ,, Roof of w.c. defective, guttering defective, and offensive accumulatiou in yard ,, 6th Fined £1, costs £1. 5, Willingham Terrace Walls and ceilings dirty and dilapidated, and walls damp; guttering defective and absence of proper dust receptacle „ 6th.. Order to abate nuisance within 28 days. 9a, Medburn Street Walls and ceilings dirty; ceiling and dustbin defe3tive April 30th Adjourned sine die, ,, Water closet with an insufficient flush of water ,, 30th Fined 10s. 32, Queen's Crescent Drain defective, unventilated soil pipe, and w.c. without a seat May 13th Abatement Order, costs £1 5s. 66, Falkland Road Fixing new w.c. basin and trap without notice May 13th Fined 20s, 56, William Street Ceilings dirty, roof defective; insufficient flush of water June 11th Summons withdrawn, costs £2 2s. 225, Hampstead Road Walls and ceilings dirty; washhouse roof defective „ 11th Abatement Order, costs £2 2s. 9a, Medburn Street Walls and ceilings ditty; ceiling and dustbin defective „ 11th Abatement Order, costs ,£1 3s. 3, Howland Street Walls and ceilings dirty ; w.c. basin defective, and w.c. apartment foul „ 25th Summons withdrawn, costs £2 2s. 8, Sidmouth Mews Drain defective July 9th Abatement Order, costs £2 2s. 29, Argyle Square Drain stopped and defective ,, 22nd Do, do. £1 1s. 30, „ Do- do. ,, 22nd Do. do. £1 1s. 41, Stibbington Street Yard paring defective* Aug, 6th Fined £5. 41, „ Roof defective „ 6th Abatement Order, costs £1 5s. 39, „ Do. „ 6th Do. do. £15s. 69, Osnaburgh Street Walls, ceilings and w.c. apartment dirty; roof defective and an offensive accumulation in yard „ 13th Do. do. £2 2s. 4, St. Silas Street Walls and ceilings dirty, w.c. basin foul, and manhole cover defective Sept. 20th Order to abate nuisance within 8 weeks 4, „ Yard paving defective „ 20th Summons withdrawn. 74, Falkland Road Room damp „ 24th Summons withdrawn, costs £2 2s. 9, Litcham Street Dustbin defective „ 24th Do. £1 3s 18, „ Do. „ 24th Do. .£1 3s. 1, Hawley Mews Drain and roof defective Oct. 22nd Abatement Order, costs £3 3s. Torriano Cottages—Yard at rear Van used as a human habitation „ 22nd Summons withdrawn. 5, Willingham Terrace Dirty, damp, and dilapidated rooms, and defective guttering „ 22nd Do. 33. Oseney Crescent Walls damp and rain-water pipe defective ,, 22nd Summons withdrawn, costs £1 3s. 21, Little Randolph Street Water closet in such a position as to be a nuisance 22nd Do. do. £2 2s. 72, Gaisford Street Dustbin defective Nov. 5th Do. do. £2 2s. 35, Harrison Street Do. „ 22nd Summons withdrawn, costs £5 5s. 15, „ Roof defective ,, 22nd 3, „ Do. ,, 22nd 59, „ Drain ventilating pipe defective ,, 22nd 33a, „ Absence of proper metal dustbin ,, 22nd 54, Willes Road Walls and ceilings dirty and drain defective Dec. 7th Abatement Order, costs £1 7s. 69, Osnaburgh Street Failing to comply with Nuisance Older ,, 17th Fined £55, Two months' imprisonment in default. 1, Hawley Mews Do. do. ,, 17th Fined £5, costs £1, Metropolis Management Act, 1855. Situation of Property. Offence, Date of Hearing of Summonses. Result of Proceedings. 337, Kentish Town Road Constructing soil and vent pipe with improper joints Oct. 22nd Summons withdrawn, costs 23s. PREMISES AND OCCUPATIONS CONTROLED 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. 39 visits were made to these premises in 1920. Registered Tenement Houses. At the end of 1920 there were 2365 such houses on the Register. Statistics as to the inspection of these and other houses will be found in tables, Nos. 7 and 12, on pages 93 and 98. Smoke-Prevention. During the year 477 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 194 2903 Voluntary drainage work 1660 2365 Drains of new buildings 207 553 2061 5821 The tests which have been applied to drains during 1920 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 36 50 6 — 4 — 96 2. No result 271 109 94 — 11 1 486 3. Total 307 159 100 — 15 1 582 By Smoke. 1. Defects localised — 1 — — — — 1 2. No result — — — — 1 1 2 3. Total — 1 — — 1 1 3 By Watar. 1. Not found water-tight — — — — 31 — 31 2. Found water-tight — — — — 336 47 383 3. Total — — — — 367 47 414 Total 36 51 6 — 35 — 128 271 109 94 — 348 49 871 307 160 100 383 49 999 53 Drainage Register.—The following is an analysis of the Drainage Register during 1920:— Plans deposited—Old Buildings under Notice 82 „ „ Old Buildings, Voluntary 112 „ „ New Buildings and Additions 29 223 Applications without Plans 124 Total number of Applications and Plans 347 Water Service. The following notices have been receive 1 during the year from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition — 2.—Empty 2 3.—Leakage 1 4.—Non-payment of Rates 1 5.—No statement (withdrawals) — 6.—By request 1 7.—Broken Supply Pipe 6 11 Canal Boats Acts. During the year Inspector Auger examined 3 canal boats, which were occupied by 6 adults and 3 children. Two of the boats were registered for 3 adults each, and in the other case the registration certificate was not on board. No other contravention of the Acts were found. A weekly inspection of the canal and wharves has been made and the absence of a greater number of boats inspected is attributed by the Inspector to the great reduction in the local trade in building materials. Inhabited House Duty. Applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1920 in respect of 2 houses comprising 15 tenements. These were granted. The Rag Flock Act, 1911. No samples were taken under this Act during 1920. Public Mortuaries and Coroner's Court. Number of bodies deposited in the General Mortuary in 1920 280 „ „ Infectious „ „ 2 Total 282 Inquests held during 1920— In the Coroner's Court—General Cases from St. Pancras 314 „ „ Poor Law Cases „ 43 „ „ General Cases from other Boroughs 25 Total 382 54 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. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. ##] Factories (including factory laundries and bakehouses) 849 203 — Workshops (including workshop laundries and bakehouses) 1387 228 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 188 32 — Total 2424 463 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Arts*:— Want of cleanliness 108 108 Nil. Want of ventilation — — Overcrowding 1 1 Want of drainage of floors 2 2 Other nuisances 133 133 Sanitary accommodation Insufficient 12 12 Unsuitable or defective 50 46 Not separate for sexes 17 17 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) 1 1 Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 107 107 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) 32 32 Total 463 459 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 55 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 21 outworkers (contractors) and 99 outworkers (workmen), and 1 in respect of brushmaking, containing the name of 1 outworker (contractor). 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year. Numbers. (1) (2) Bakehouses 136 Restaurant kitchens 420 Laundries 32 Domestic workshops — Other workshops where women are employed 408 Other workshops 767 Total number of workshops on Register 1763 5.—Other Matters. Class Number (1) (2) Mutters notified to H.M. 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 51 Reports (of action taken) sent to H.M. Inspector 51 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 14 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 88 56 The number of factories, workshops and workplaces added to and removed from the register during 1920 was as follows: — Added to register. Removed from register. On Register at end of 1920. Bakehouses— Workshop 3 1 136 Factory 1 0 39 Laundries— Workshop 0 3 32 Factory 1 2 12 Restaurant kitchens 2 4 420 Other workshops where women are employed 49 8 408 Other workshops 37 72 767 Other factories 31 12 687 The number of inspections that were made during 1920 were as follows:— Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Ee-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 378 256 — — 378 256 Restaurant kitchens 48 64 28 l 76 65 Laundries 17 8 — — 17 3 Domestic workshops — — — — — — Other workshops 344 554 — — 344 554 Other workplaces 24 23 — — 24 23 Other factories 232 447 — — 232 447 Total 1043 1352 28 1 1071 1353 Bakehouses and restaurant kitchens are also referred to in Section V. (page 72). 57 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 particulars of medical inspections of school children in St. Pancras during 1920. They are classified in the following Tables:— Medical Inspection of Children in Elementary Schools in St. Pancras, 1920. Entrants. Age 8. Age 12. Age 14. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Number examined 1737 1510 1446 1301 1595 1564 433 385 Number requiring treatment 654 587 622 528 513 544 115 127 Defects— Skin F 52 28 25 17 20 18 6 4 X 38 17 18 13 13 11 2 8 Teeth X 335 317 278 238 139 170 37 44 Tonsila F 198 198 120 159 126 142 11 27 X 29 31 25 27 27 38 2 2 Adenoida F 188 149 55 50 48 34 6 7 X 53 46 31 18 22 19 5 4 Tonsils and Adenoids F 172 158 59 53 27 23 1 3 x 72 68 21 20 22 16 1 2 Other Nose or Throat defects F 82 47 55 36 20 15 1 3 X 45 20 23 9 6 7 — 2 Glands of Neck F 318 276 186 169 147 103 27 22 X 11 6 1 5 5 3 — — Eye disease F 73 57 39 35 26 37 6 3 X 63 44 28 17 14 17 3 3 Vision X Not tested 222 193 217 257 50 62 Ear disease F 42 44 30 41 29 19 16 10 x 30 22 18 19 13 11 10 2 Hearing F 22 28 20 11 30 17 8 2 X 9 4 7 4 14 7 5 — Speech F 31 20 20 16 14 3 — — X 1 — 1 — 1 — — — Heart F 27 20 25 23 36 36 11 9 X 4 1 3 2 3 8 — — Anæmia F 41 45 68 45 47 47 16 16 X 25 29 49 31 38 34 12 9 Lungs F 104 86 36 29 30 19 4 1 X 29 23 7 8 7 6 1 — Nervous disease F 22 18 17 18 21 15 3 2 X 5 3 3 3 8 — 1 1 Phthisis F 1 — — — 1 6 1 1 X — — — — — 2 1 — Other Tubercular F 1 2 — 3 3 3 — 2 X 1 1 — 1 1 2 — — Rickets F 41 18 19 10 11 8 5 — X 10 2 4 — 1 — — — Deformities F 11 15 26 13 35 50 27 24 X 3 2 7 3 6 12 4 5 Infectious disease F 3 2 3 — 2 — — — X 2 2 3 — 1 — — — Malnutrition F 19 27 34 26 22 20 6 5 X 18 26 33 25 22 19 6 5 Other defects F 59 51 27 38 26 49 11 10 X 35 33 15 21 14 31 5 3 F signifies a defect found. x signifies a defect noted for treatment. 58  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 Percentage 989 732 16 585 1299 58 — 1657 78 2 1653 79 5 692 742 303 — — — 56.9 42.1 1.0 22.2 74.8 3.0 — 95.4 4.5 0.1 95.2 4.5 0.3 39.8 42.7 17.5 — — — „ Girls Percentage 916 589 5 338 1120 52 — 1346 152 12 1440 68 2 633 582 295 — — — 60.6 39.0 0.4 22.4 74.2 3.4 — 89.1 10.1 0.8 95.4 4.5 0.1 41.9 38.6 19.5 — — — Age 8. Boys Percentage 680 745 21 199 1162 85 — 1389 57 — 1349 96 1 502 749 195 635 493 303 47.0 51.5 1.5 13.8 80.4 5.8 — 96.1 3.9 — 93.3 6.6 0.1 34.7 51.8 13.5 44.4 34.5 21.1 „ Girls Percentage 688 603 10 205 1018 78 — 1083 209 9 1236 64 1 474 648 179 509 477 291 52.8 46.4 0.8 15.8 78.2 6.0 — 83.2 16.1 0.7 95.0 4.9 0.1 36.5 49.7 13.8 39.9 37.4 22.7 Age 12. Boys Percentage 802 765 28 310 1223 62 — 1531 63 1 1404 181 10 581 934 80 841 441 308 50.3 48.0 1.7 19.4 76.7 3.9 — 95.9 4.0 0.1 88.0 11.4 0.6 36.4 53.6 5.0 52.9 27.8 19.3 „ Girls Percentage 827 728 9 402 1113 49 — 1310 240 14 1460 103 1 685 802 77 797 414 348 52.9 46.5 0.6 25.7 71.3 3.1 — 83.8 15.3 0.9 93.4 6.5 0.1 43.8 51.3 4.9 51.1 26.6 22.3 Age 14. Boys Percentage 298 130 5 103 320 10 — 428 4 1 413 18 2 162 250 21 278 78 77 68.8 30.0 1.2 23.8 73.9 2.3 — 98.9 0.9 0.2 95.4 4.1 0.5 37.4 57.7 4.9 64.2 18.0 17.8 „ Girls Percentage 237 147 1 141 235 9 — 336 47 2 374 9 2 173 202 10 204 95 86 61.5 38.2 0.3 36.6 61.1 2.3 — 87.3 12.2 0.5 97.2 2.3 0.5 44.9 52.5 2.6 530 24.7 22.3 * Classification of children examined., Clothing 1, good; 2, fair; 3, bad. Nutrition 1, excellent; 2, mormal; 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. R. Roche, the SecretarySuperintendent:— At the request of the Medical Officer of Health I wrote a short explanatory account of these Centres for incorporation in his report on the health of the Borough in 1919. During the L.C.C. school year, which ended on March 31, 1921, the work has been carried on at both Centres on the same lines. The number of cases treated have been as follows:— Dental Cases. Aural Cases. Eye Cases. Minor Ailments. Prince of Wales Road Centre 2160 863 989 1329 Lancing Street Centre 1502 420 Nil 1246 59 Many of these cases attended on several occasions; for instance, at Prince of Wales Road there were over 33,000 attendances in the minor ailment department, and at Lancing Street over 31 ,000. In addition to this, many hundreds of home visits were paid by the nurses of the Central St. Pancras District Nursing Association. A very important feature of the work at both Centres is the operative treatment of enlarged tonsils and adenoids, and other throat, nose, and ear conditions. The operations are performed under a general anaesthetic, and after a suitable interval the child is sent home, and subsequently visited for a few days by a nurse, and, if necessary, by the doctor in charge of the case. If any complication occurs, subsequent to the operation, the child is detained at the Centre for the night. From time to time an anxious case necessarily occurs, but fortunately since their inception no fatal case has occurred at either Centre. This year a new development has occurred at the Prince of Wales Road Centre, the Council having entered into an agreement for the treatment of 5,000 cases of children with verminous heads. To enable the Centre to do th's work a central water heating system has been installed, special shampoo basins and a head drying apparatus fixed. This has cost a considerable sum of money, towards which the Council made a grant of £100. Needless to say, the grant did not nearly cover the cost entailed. Two women are fully engaged in carrying on this work, under the supervision of a nurse, which consists in thoroughly shampooing the children's heads with a special vermicidal soap, thoroughly combing out the dead nits with special combs, and then thoroughly drying the head. After this the child's head is minutely inspected, the standard aimed at being the absence of a single nit. In view of the prevalence of this distressing condition in so many children attending the Council's schools, the evil effects on their general health, and the many complications it so often leads to, this work appears to be very valuable, and we hope will be more and more appreciated, and lead to a higher standard of cleanliness in the children's homes. I wish again to express my appreciation of the good work of the doctors at these Centres, local medical practitioners, and also of the County Council nurses who are in charge of the work, and to whom the good results are so largely due. A. R. Roche, Secretary and Superintendent. The number of home visits made by the nurses in connection with the school clinics during the year 1920 was 530 from the Prince of Wales Road Centre, and 442 from the Lancing Street Centre. These were made by the Central St. Pancras District Nursing Association. Section V —FOOD. (a) MILK SUPPLY. Almost the whole of the milk supply of St. Pancras is derived from dairy farms in the provinces and is brought into London by train. A great deal of milk also comes into the great railway stations in the Borough for distribution in other parts of London. In February, March, and April, 1920, 50 samples of milk were taken in the Borough and submitted for bacteriological examination to Dr. F. H. Teale, of University College Hospital. The samples were taken by the Food Inspectors, Messrs Auger and Child, and fall 60 into four groups, viz.:—those taken (l) from farmers' deliveries at railway stations; (2) at dairies where pasteurisation is carried out; (3) as produced in cowsheds in the Borough; and (4) when exposed for sale in milk shops (both "dairy shops" and general shops) or on street rounds. In certain cases the milk was sampled at successive stages, e.g., at the railway station, in the wholesaler's premises, and in the hands of the retailer. Dr. Teale's Report. Report on the examination of 50 specimens of milk carried out for the St. Pancras Borough Council at the request of Dr. Higgins, Medical Officer of Health. The specimens were collected in sterile bottles and transported to the laboratory in an ice chest. The specimens were examined directly after arrival. The examinations were conducted in the ordinary way for the presence of B. Coli, etc. For the counting of the number of colonies plates were made with 1/100, 1/1000, 1/10,000 and 1/100,000 ccm. of the milks. In some cases the numbers with the smallest dilution wore too large to count and so have been entered up as innumberable. The cases where tubercle bacilli were found were further investigated to see whether these bacteria were of bovine or human origin. This was a lengthy process and greatly added to the time taken in the examination, necessitating a period of nearly six months. Table I. Examinations of Farmers' Milks sampled on delivery at railway stations in St. Pancras. Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies ' growing at 37 deg. C per ccm. Colonies growing at 22 deg. C per ccm. Streptococci per ccm. Feb. 24th l 1,000,000 Absent in 50 ccm. 8,000 5,000 540 „ 2 1,000 Do. 1,200 1,000 420 „ 3 100,000 Present in 50 ccm. 130,000 Innumerable 15,000 „ 4 1,000,000 Present in 10 ccm. 1,030,000 Do. 140,000 „ 5 1,000 Absent in 50 ccm. 16,000 Do. 1,800 „ 6 10,000 Do. 16,000 10,000 22,000 Mar. 2nd 9 100,000 Present in 5 ccm. 118,000 Innumerable Innumerable „ 10 10,000 Do. 12,000 Do. 1,800 Mar. 2nd 11 100 Absent in 50 ccm. 6,100 10,200 1,700 „ 12 1,000,000 Present in 10 ccm. 1,480,000 331,000 510,000 „ 13 1,000 Present in 25 ccm. 5,000 46,300 4,800 61 Table I.— continued. Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C per ccm. Colonies growing at 22 deg. C per ccm. Streptococci per ccm. Mar. 9th 17 1,000,000 Present in 10 ccm. 1,140,000 Innumerable 1,280,000 „ 18 100 Absent in 50 ccm. Nil. Do. Nil. 19 100 Do. 300 300 300 Mar. 16 th 25 100 Present in 10 ccm. 1,000 62,000 — „ 26 10,600,000 Do. Innumerable Innumerable Innumerable „ 27 10 Present in 1 ccm. Nil. 4,000 Nil. „ 28 10,000 Do. 18,000 102,000 1,000 Tubercle bacilli of bovine origin were found in specimen 9 and specimen 26, and B. paratyphosus B. in specimen 28. Table II. Effect of Pasteurisation carried out on Milks traced from Railway Depots to the Dairy. Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C per ccm. Colonies growing at 22 deg. C per ccm. Streptococci per ccm. Feb. 24th 2 100 Absent in 50 ccm. 1,200 1,000 420 „ 3 100,000 Present in 50 ccm. 130,000 Innumerable 15,000 „ 4 1,000,000 Present in 10 ccm. 1,030,000 Do. 140,000 „ 5 1,000 Absent in 50 ccm. 16,000 Do. 18,000 „ 8 only in 10 ccm. Present in 50 ccm. Nil. Nil. Nil. Mar. 2nd 11 100 Absent in 50 ccm. 6,100 10,200 1,700 „ 12 1,000,000 Present in 10 ccm. 1,480,000 331,000 510,000 „ 14 100,000 Present in 25 ccm. 316,000 Innumerable 250 Mar. 9th 17 1,000,000 Present in 10 ccm. 1,140,000 1,140,000 1,280,000 „ 18 100 Absent in 50 ccm. Nil. Innumerable Nil. „ 23 10 Do. Nil. Do. Nil. 62 Table III. Examination of Pasteurised Milk. Date of Sampling 1920. No. of Specimen. B. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg C. per ccm. Colonies growing at 22 deg. C. per ccm. Streptococci per ccm. Feb. 24th 7 Present 10 Present 50 ccm. Nil Nil Nil „ 8 Do. Do. Do. Do. Nil Mar. 2nd 14 100,000 Present 25 ccm. 316,000 Innumerable 250 „ 9th 23 10 Absent 50 ccm. Nil Do. Nil „ 16th 32 100 Do. 2,000 700,000 2,000 No tubercle bacilli found in any specimen. Table IV. Local Cow Shed Milk. Date of Sampling 1920. No. of Specimen. B. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C. per ccm. Colonies growing at 22 deg. C. per ccm. Streptococci per ccm. Mar. 23rd 38 10 Present 10 ccm. 3,000 180,000 Nil „ 39 100 Do. 11,000 50,000 Do. „ 40 10 Do. 140,000 60,000 Do. None of these specimens contained tubercle bacilli. The heavy growth of bacteria at 22 deg. C. and 37 deg. C. were due to large numbers of B. proteus. Specimens 38 and 39 were from the milk of individual cows taken from the pail in the cowshed. Specimen 40 was taken in the adjoining retail shop from the mixture of the same milk of these two and other cows in the cowshed. 63 Table V. Milks traced from Wholesale Dairy to Retailers. Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C. per ccm. Colonies growing at 22 deg. C. per ccm. Streptococci per ccm. Mar. 2nd 14 100,000 Present 25 ccm. 316,000 Innumerable 250 „ 15 10,000,000 Present 10 ccm. Innumerable Do. Innumerable „ 13 1,000 Present 25 ccm. 5,000 Do. 3,000 „ 16 1,000,000 Present 5 ccm. Innumerable Do. Innumerable April 13th 42 1,000,000 Present 1 ccm Do. Do. Do. „ 43 1,000,000 Do. Do. Do. Do. „ 44 1,000,000 Do. Do. Do. Do. Specimen 15 was from a retail shop, and specimen 14 was from the wholesale dairy which supplied the shop. Specimen 16 was from a retail dairy shop, and specimen 13 from milk consigned to the shopkeeper by a farmer, and sampled at a railway station. Specimen 42 was from a dairy shop doing a wholesale and retail trade; 43 from a hand-can on a street round of the same firm; and. 44 from another retail shop supplied by the aforementioned firm. Specimen 14 is the mixture of specimens 11 and 12 Pasteurised (vide tables VI. and II.) Table VI. A specimen of milk traced from its arrival at the railway depot (specimens 11 and 12) to the wholesale dairy where it was pasteurised (specimen 14), to when it was sold in a retail general shop (specimen 15). Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C. per ccm. Colonies growing at 22 deg. C. per ccm. Streptococci per ccm. March 2nd 11 100 Absent in 50 ccm. 6,100 10,200 1,700 „ 12 1,000,000 Present in 10 ccm. 1,480,000 331,000 510,000 „ 14 100,000 Present in 25 ccm. 316,000 Innumerable 250 „ 15 10,000,000 Present in 10 ccm. Innumerable Do. Do. % N.B.—Specimens 11 and 12 were of farmers' milks. Specimen 14 was of pasteurised milk made from farmers' milks of earlier delivery. Specimen 15 was of the same milk as specimen 14, but kept in a retail general shop instead of the wholesale dairy. 64. Table VII. Examinations oj specimens of retail milk. Date of Sampling, 1920. No. of Specimen. b. Coli per ccm. Spore-bearing Anaerobes present. Colonies growing at 37 deg. C. per ccm. Colonies growing at 22 deg. C. per ccm. Streptococci per ccm. Mar. 2nd 15 10,000,000 Present in 10 ccm. Innumerable Innumerable Innumerable „ 16 1,000,000 Present in 5 ccm. 3,000,000 Do. Do. Mar. 9th 20 1,000 Absent in 50 ccm. 10,000 Do. 5,000 „ 21 1,000,000 Present in 5 ccm. Innumerable Do. Innumerable „ 22 1,000 Absent in 50 ccm. 28,000 Do. 16,000 „ 24 10,000 Do. 26,000 Do. 8,000 Mar. 16 th 29 1,000,000 Present in 5 ccm. Innumerable Do. Innumerable „ 30 10,000,000 Do. Do. Do. Do. „ 31 10,000 Absent in 50 ccm. 21,000 14,000 6,000 Mar. 23rd 33 1,000,000 Present in 10 ccm. 1,260,000 520,000 100,000 „ 34 1,000,000 Do. 2,030,000 Innumerable 81,0,000 „ 35 1,000,000 Do. 3,040,000 4,800,000 2,000,000 „ 36 1,000,000 Do. 2,100,000 Innumerable 500,000 „ 37 100,000 Present in 25 ccm. 270,000 240,000 80,000 April 13th 41 1,000,000 Present in 1 ccm. 5,000,000 Innumerable 2,400,000 „ 42 1,000,000 Do. Innumerable Do. Innumerable „ 43 1,000,000 Do. Do. Do. Do. „ 44 1,000,000 Present in 10 ccm. Do. Do. Do. „ 45 10,000 Do. 50,000 Do. 10,000 „ 46 1,000,000 Absent in 50 ccm. 2,400,000 Do. 1,000,000 „ 47 1,000,000 Present in 10 ccm. 3,200,000 Do. 800,000 „ 48 1,000,000 Present in 25 ccm. 1,800,000 Do. 20,000 April 20th 49 10,000 Present in 10 ccm. 52,000 3,000,000 14,000 „ 50 100,000 Do. 112,000 Innumerable 10,000 Tubercle bacilli of bovine origin were found in specimen 21. Specimens 16, 21, 22, 29, 31, and 42 were taken from retail dairy shops, though several of them might well be described as general shops. Specimens 15, 24, 30, 34, 37, 41, 44, 46, 47, 48, 49 and 50 were obtained from general shops. Specimens 20, 33, 35, 36, 43 and 45 were taken from sellers in the street. 65 Conclusions that can be drawn from the examination of the specimens of milk as they arrive from the farmer at the railway depots:— (1) Bovine tubercle bacilli were found in two specimens out of 18, making a percentage of 11. (2) Human tubercle bacilli were not found, showing that none had gained access to the milk during the process of handling it. (3) The only other pathogenic organism found was in one specimen where the B. paratyphosus B. was found. This was typical in all its reactions. Diphtheria and other important organisms were not found in any sample. (4) Taking the amount of the spores of anaerobic organisms in the excreta of cows as 1-10 millions per gram, and remembering that these do not multiply in the milk under ordinary conditions and so can be taken as a non-multiplying factor, it must follow that the contamination of milk by the excreta of the cow is very slight as seen in these samples. Even in the worst specimens where the reaction for these organisms was given in quantities of 1 ccm. of the milk and not in 0.1 ccm., it follows that the amount of contamination must be with about 1/100,000 to 1/1,000,000 of a gramme of the excreta per ccm. Taking this as a standard it follows that the number of B. Coli which originally got into the milk in this way would have been 100-1000 per ccm. of the milk, taking the dung to have 100 million B. Coli per gramme, but in many of the milks the contamination must have been much less, because anaerobic spores could only be demonstrated when much larger quantities of milk were examined. Taking this as a guide it follows that the B. Coli. have multiplied greatly from the time of the original contamination to the time when the milk arrived at the railway depot. It thus follows that the milk was transported at too high a temperature, viz., a temperature which allowed these organisms to multiply at a great rate. (5) Finally, the great number of saprophytic organisms found in the milks show that enough care has not been taken in the preliminary cleansing and scalding of the containers. Conclusions from the examination of the Pasteurised specimens examined. There are three examples seen in Table II. Specimen 8 was a sample of pasteurised milk resulting from the pasteurisation of a mixture of farmers' milks sampled under the specimen numbers 2, 3, 4 and 5, and other farmers' milks not sampled. It was taken immediately after pasteurisation. It is a fairly good result. The contaminating organisms were practically all destroyed, and care was taken with the utensils in the dairy. Specimen 14 was a sample of pasteurised milk resulting from the pasteurisation of a mixture of various farmers' milks. Specimens 11 and 12 were farmers' milks supplied to the same dairy later in the same day. Here the process was not by any means as effectual as it should be, and in addition the dairy utensils could not have been properly cleaned or the milk was exposed in some way after sterilisation, whereby the milk became grossly contaminated with saprophytic organisms. Specimen 23 was a sample of pasteurised milk resulting from the pasteurisation of a mixture of the two farmers' milks sampled under the specimen numbers 17 and 18, with no other milks. Here the process was like the previous one, and there was the same defect allowing gross contamination with saprophytic organisms. 66 Tabic III shows two further samples (7 and 82). Sample 7 is the same as sample 8, except that sample 8 was taken from the receiver of the pasteurising plant, and 7 from the churn into which the milk was immediately afterwards received. Sample 32 was taken immediately after pasteurisation. It shows the same defect re the presence of gross contamination with saprophytic organisms, and the sterilisation was not perfect. Specimens 8, 14, 23, 32 were all from different dairies. The defect in the process whereby gross contamination with saprophytic organisms has occurred is dangerous not only from the changes that can be set up in milk by their presence, but it means that there is a defect which may on occasion allow more dangerous organisms to gain access to the milk. Cowshed, milk obtained locally. The milk from these sources showed very little contamination re intestinal organisms but the utensils were either very improperly cleansed or the milk was subjected to some exposure whereby it had become grossly contaminated with saprophytic organisms. Changes occurring in milk that can be traced from wholesale dairies to the retailers. Table Y gives the figures. Here it will be seen that there is a great multiplication of both fecal and saprophytic organisms. Table VI follows two specimens of milk from the railway depot through the process of pasteurisation to the time of being retailed. Here the pasteurisation was very inefficient, then subsequently there was a great multiplication of all types of bacteria. Milk obtained from the retailers. No appreciable difference can be detected in the bacteriological purity of specimens obtained from dairy shops, general shops or from street vendors. The specimens on the whole show an increase in bacterial contamination when compared with the series of specimens as they arrive at the depots. There is also a great increase in the heaviness of the saprophytic contamination. Tubercle bacilli of bovine origin were found in only one specimen of the 24, making 4 per cent. No other pathogenic bacteria were found. Among the anaerobic organism found were B. Welchii, Vibrion septique, B. sporogenes. From the examination of the specimens as a whole:— (1) Bovine tubercle bacilli were found in three specimens out of 50, making 6 percent. (2) Pathogenic bacteria besides the above were seen in only one case and the organism isolated was B. paratyphosus B. (3) Excremental organisms were present in large numbers in the majority of the specimens. (4) Saprophytic organisms were also present in large amount. 67 The points which therefore can be emphasised are:— (1) That the milk is not transported from the farmer to the depots at a sufficiently low temperature so that the small number of excremental organisms originally present multiply greatly. (2) That there is a want of care in the cleanliness of the receptacles into which the milk is put, or the milk is left exposed to sources from which it gets infected with saprophytic organisms. (3) That there is a great multiplication of bacteria during the passage of the milk from the wholesaler to the retailer and public. (4) That the pasteurisation is not always as efficiently carried out as it should be, and that there is a want of care in the cleanliness of the subsequent handling of the milk. For the supply of good milk as free as possible from bacterial contamination:— (1) In 'addition to care re tubercle, health of the cows, scrupulous cleanliness of the person who performs the operation of milking and the cleanliness of the vessels, (2) the milk should either immediately be placed in a refrigerator or should be as quickly pasteurised as possible either at the farm or in some "creame y" in the district where all farmers could take their milk for this purpose. Here the same great care should be exercised re cleanliness of the whole procedure. (3) The milk then can be conveyed to London in sealed receptacles in cooled vans and sent to the dairies. (4) In the dairies it should not be exposed, should be kept at a low temperature and the best way would be to bottle it into sterile bottles for conveyance to the consumer. (5) All places where pasteurisation is carried out should be thoroughly and constantly inspected to ensure proper cleanliness. (Signed) F. H. TEALE. Dr. Teale's detailed results may be considered in the light of the fact that the Government's bacteriological standard for "Grade A (Certified) Milk" is that on examination at any time before delivery to the consumer it must not contain Bacillus coli in one tenth cubic centimetre (i.e. not more than 10 per cubic centimetre), or more than 30,000 bacteria per cubic centimetre. The Government standard for Bacillus coli may also be applied to Streptococci and spore-bearing anaerobes. Farmers milk as delivered at the railway stations. The 18 samples (see table I) are almost without exception very bad as judged by the above mentioned standard It will be seen that Dr. Teale does not consider the original excremental pollution to have been serious and that the bad condition of the milk was due to its transportion at too high a temperature, and the absence of proper care as to the cleanliness of the containers, etc. The remedies for these conditions would be found in proper cooling of the milk and in improved methods of handling and transporting it. The presence of living bovine tubercle bacilli in 2 out of the 18 samples illustrates the present unsatisfactory state of affairs in regard to bovine tuberculosis and milk. 68 Samples of milk taken at milkshops and on milk rounds. As might be expected the result of the examination of these 24 samples (table VII) are definitely worse than in the case of the farmers' milk newly arrived in town. They indicate a further stage in the ill-effects of bad methods of transportation and storage, lack of cleanliness and the keeping of the milk at too high a temperature. The comparison in table V shows a similar progressive deterioration in the milk as it passes from hand to hand. Samples from a local cowshed. These were distinctly better in some respects than the imported milk, but there is here also evidence of considerable unnecessary bacterial contamination. Examination of pasteurised milk. It appears from Dr. Teale's report that at three of the four pasteurising plants brought under examination the process is not satisfactorily carried out. Pasteurisation is, of course, not compulsory at present, but it is most undesirable that it should be done ineffectively. Conclusions There is no doubt that the present system whereby the milk is passed (generally uncooled) from vessel to vessel, and handled under unsuitable conditions, is thoroughly bad. It is most desirable that the Milk and Dairies (Consolidation) Act, 1915, at present in suspense, which gives the Ministry of Health power to deal with the problem in a stringent manner, should be brought into active operation without delay. Dairies, Cowsheds and Milkshops. Cowsheds.—At the end of 1920 there were two licensed cowsheds in the Borough. They are registered for 41} cows, but were occupied by 13. Milkshops and Dairies. — 39 applications for registration under the Dairies, Cowsheds and Milkshops Orders, in respect of milkshops were considered during 1920, of which 38 were acceded to and one refused. Two applications in respect of itinerant vendors were also considered and 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 1919 213 Deduct No. of purveyors removed from register during 1920 40 Add No. of purveyors added to register by resolution of Council during 1920 38 No. of purveyors of milk at retail milkshops on register at end of 1920 211 At the end of 1920 there were on the register in addition to these 211 retail milkshops and 4 cowsheds (which are attached to retail milkshops included in the 211), one person in respect of premises where only a wholesale milk trade is done, and 5 itinerant vendors without retail 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 1st January, 1921:— 383 samples of milk and none of cream were taken and analysed, and in no case were preservatives reported to be found. No other contravention of the regulations was discovered. 69 Milk (Mothers and Children) Order, 1919. During 1920 the Council continued to make grants of milk either free or at half-price for the use of expectant or nursing mothers or children under five years of age. At the beginning of the year all applications were dealt with by the Medical Officer of Health, who required the tilling up of a schedule of particulars in each case. He was guided by the following scale of income approved by the Council in Ja .uary, families in receipt of an income greater than that indicated in the scale being as a rule ineligible for grants of milk:— £ s. d. One parent. 1 15 0 per week. Two parents 2 0 0 " „ and one child 2 15 0 " „ „ two children 3 10 0 " „ „ three „ 4 5 0 and 10s. a week extra tor each additional child. In most cases milk was granted free at the rate of one pint for one child under 5 or an expectant mother, and 1^ pints for two such persons in a family, and in some cases 2 pints for 3 in a family. The cost of the scheme increased greatly month by month, and in May it was decided that the milk should be granted as a rule at half-price, and free only Jin special cases of great necessity. *- Further consideration was given to the matter in June, and a Special Sub-Committee was set up to meet weekly and consider and decide upon all applications for milk under the Council's scheme. The Sub-Committee met for the first time on July 30th, 1920. It was also decided that the grant of milk should be restricted to expectant mothers in the last three months of pregnancy, and children under three years of age. Further arrangements were also made for the making of enquiries where the accuracy of the information given on the application form was doubted. Moreover, a new scale of income win set up. It was, however, to be used as a guide only, the amount and price of milk to be granted being left to the discretion of the Sub-Committee. ' The new scale was as follows:— £ s. d. One parent 1 15 0 per week. Two parents 2 0 0 99 Two parents and one child 2 10 0 99 „ „ two children. 3 0 0 99 „ „ three 3 10 0 99 „ „ four 3 15 0 „ „ „ five 4 0 0 „ Larger families to be given special consideration. All the above-mentioned rates were made subject to the right of the Sub-Committ e to vary them in cases in which they considered it advisable. One of the Health Visitors, Miss Camman, was designated to make the necessary enquiries into applications for milk, and Mr. L. Iliggins, temporary clerk, to give his whole time to the clerical work connected with the milk scheme. It has been found necessary for part of the time of another clerk to be devoted to the same work. In 1921 Mr. F. G. Crick, clerk in the department, who, on account of his health, needed out-door employment, was appointed to make the necessary enquiries into the circumstances of applicants for milk, in place of the health visiting staff. 70 In February, 1921, proceedings were instituted against a father who had made false statements as to his income in an application for milk, and a fine of £5 and 5 guineas costs were inflicted. With a view to deterring applicants from making such false statements, particulars in regard to the case were placarded at the centres and attached to the application forms in use. In May, 1921, the Council had under consideration a circular from the Ministry of Health on the subject of the supply of milk for mothers and children. It was found that the scheme in operation in St. Pancras agreed closely with the requirements of the Ministry, except that the rate of income was on a different basis from that suggested by the Ministry. Accordingly the following scale was adopted bv the Council, and afterwards approved by the Ministry. No. in family. Soale for distribution of milk at half-price, Scale for distribution of free milk. 1 18s. per head after deduction of rent 15s. per head after deduction of rent. 2 14s. 6d. „ „ ... 10s. „ „ 3 lis. 6d. „ „ ... 8s. „ „ 4 10s. 6d. „ „ ... 7s. „ „ 5 9s. 6d. „ „ ... 6s. 6d. „ „ 6 9s. ,, „ ... 6s. ,, „ The working of the milk scheme is as follows:—Ordinarily, application must be made at one of the Borough Infant Welfare Centres, though, in exceptional cases, application can be made direct to the Medical Officer of Health at the Town Hall. The application form setting out details as to the needs and circumstances of the family has to be filled up by the parents and signed by both father and mother. The signature of the medical officer at the Centre is required to the effect that the grant of milk is necessary on medical grounds, and the superintendent of the centre has also to sign the form indicating that she has examined it to see that it is properly filled up, and that, from her knowledge of the home, she has no reason to doubt the correctness of the statements. The forms are then sent by the superintendent to the Medical Officer of Health, who examines them (personally or by deputy); orders such further enquiries to be made as seem called for, and makes a preliminary recommendation as to the amount of milk to be granted. They then come before the Milk Sub-Committee at their weekly meeting, who order such further enquiries as they deem necessary and prescribe finally the grant of milk to be made. The grant is in the form of an order on the applicant's usual milk-seller, the applicant paying half-price or nil according to the decision. The milksellers' accounts are rendered monthly, and the customer's signature is required by the Council to vouch for the correct delivery of milk. Where dried milk is specially ordered by the n edical officer it is usually supplied on the Council's order by the Infant Welfare Centres in their capacity of purveyors of that commodity. The Sub-Committee's orders are issued for one month only, at the end of which time a further application is required and considered. 71 The extent of the scheme is indicated in the following figures:— Pints of Milk granted free. Pints of Milk granted half-price. Cost to Council. 1920. £ s. d. January 8,743 441 224 2 0 February 14,028 1,882 343 0 9 March 26,698 2,247 637 11 9 April 32,999 2,401 712 9 7 May 29,400 14,664 616 19 3 June 18,906 31,041 573 15 4 July 19,948 30,611 587 11 0 August 15,165 23,630 448 0 0 September 11,203 15,264 326 17 11 October.. 11,511 16,910 415 19 2 November 13,274 15,996 447 11 5 December 13,660 15,880 495 0 0 Total for 1920 215,535 170,967 5,828 18 2 1921. £ s. d. January 13,726 14,845 484 12 10 February 14,008 13,127 471 8 6i March 17,021 14,442 547 8 2J April 15,969 12,724 465 4 7 May 14,119 8,503 306 3 4 June 12,219 4,517 239 12 4 At the end of 1919 there were 160 families in receipt of milk through the Council's scheme. 1908 new families were added to the list of recipients during 1920, and at the end of 1920 there were 729 families in receipt of milk. As will be seen from the table above, there were supplied in 1920, 215,535 pints of milk free and 170,967 pints at half-price, at a c st to the Council of £5,828 18s. 2d., half of which sum is repayable by the Ministry of Health. This figure does not include the cost of administration. (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. On one occasion during the year a seizure of unsound food was made by one the Food Inspectors. It consisted of 3 uncooked hams in a decomposed condition. No legal action was taken. On 99 occasions during the year unsound food has been voluntarily surrendered by the owners to the Food Inspectors and destroyed as trade refuse. Details in regard to the work of the Food Inspectors are shown in table No. 8, on pages 94 and 95. Slaughter-Houses. At the end of 1920 there were 9 licensed slaughter-houses (private) in the Borough. They do not conform to a high state of excellence. These are kept under periodical inspection by the Food Inspectors, who made 144 inspections in this connection in 1920. 72 Fried Fish and Fish Cumng Premises. In 1920 there were 71 fried fish vendors' premises in the Borough, at 2 of which fish curing was also carried on. There were 16 fish curers' premises, including these two.' 198 visits to the premises were made during the year by the Food Inspectors. Ice-Cream Premises. 208 visits were paid to these premises by the Food Inspectors during 1920. Bakehouses and Restaurant Kitchens At the end of 1920 there were 175 bakehouses on the register, including 39 factory bakehouses. 49 of these bakehouses were not in use. 127 of the 175 were underground bakehouses, of which 25 were factory bakehouses, and 39 not in use. At the end of the year 420 restaurant kitchens were on the register. Bakehouses and restaurant kitchens are visited by the Factory and Workshop Inspector, and further particulars in regard to the work will be found on pagrs 54-56. (c)—SALE OF FOOD AND DRUGS ACTS. 753 samples have been taken under these Acts, and 723 of these proved to be genuine and 30, or 40 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 8 8 Baking Powder 6 6 — Butter 61 61 — Cheese 16 16 — Cocoa 19 19 — Coffee 15 15 — Custard Powder 9 9 — Dripping 27 27 — Egg Powder 6 6 — Flour (Self-Raising) 40 40 — Ground Ginger 2 2 — Jam 1 1 — Lard 28 28 — Margarine 4 4 — Milk 383 363 20 Milk (Condensed) 1 — 1 Mustard 26 25 1 Oatmeal 4 4 — Olive Oil 1 1 — Pepper 16 16 — Salad Oil 7 7 — Tea 1 1 — Toffee 2 2 — Vinegar 30 26 4 Vinegar (Malt) 20 16 4 Total 753 723 30 The 753 include 1 informal sample of butter, 1 of lard, 2 of milk, 1 of condensed milk, and 1 of tea. 73 Prosecutions were undertaken in respect of 17 of the 30 samples which were reported as being adulterated. These are set out in the following table:— 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. Coats. 1920. £ s. d. £ s. d. C. 8 Milk Added water, 13 .8 per cent 27th Feb. 15 0 0 — C. 17 " Deficient in milk fat, 16 per cent. 30th April 5 0 0 0 15 0 C. 22 Malt Vinegar Vinegar, other than malt vinegar, 100 per cent. 9th ,, — 0 12 6 C. 32 " " 9th .. — 0 12 6 A. 43 Mustard Added starch, 7 per cent. 23rd Dismissed. Proceedings not taken within 28 days from purchase. C. 112 Milk Deficient in milk fat, 4 per cent. .. 14th May — 2 2 0 C. 113 " 23.6 14th „ .. — 4 4 0 A. 97 " Added water, JO per cent. 28th „ .. Summons j dismissed Warranty proved A. 129 " 6.9 18th June — 2 2 0 C. 130 " Deficient in milk fat, 13 per cent. 8th July .. 4 0 0 2 2 0 C. 140 " Added water, 6.1 per cent. 8th „ .. 7 0 0 3 3 0 A. 194 " Deficient in milk fat, 16.6 per cent. 18th Aug. Dismissed :under the Probation of Offenders Act. A. 222 " 250 24th Sept. 7 0 0 0 10 6 A. 262 " Added water, 5.2 per cent. 12th Nov. 0 10 0 0 10 6 A. 291 " 6.8 10th Dec. 0 10 0 2 2 0 1921 A. 335 Vinegar Deficient in acetic acid, 13 per cent. 10th Jan. 0 10 0 2 2 0 A. 371 Milk Added water, 5.5 per cent 2nd Feb. 5 0 0 2 2 0 Wholesale dealers in Margarine.—Certificates of registration as Wholesale Dealers in Margarine under the provisions of the Sale of Food and Drugs Acts were issued during the year in respect of two premises in the Borough. ADMINISTRATION OF THE FOOD CONTROLLER'S ORDERS. The work of inspection and purchase of samples for the enforcement of these Orders, which had been carried out in previous years by the male Sanitary Inspectors, under the supervision of the Medical Officer of Health as Enforcement Officer of the St. Pancras Local Food Control Committee, was terminated at the end of June, 1920. Up to this time the male Inspectors made 3759 visits in 1920 in this connection. Section VI.—Sanitary Administration. THE STAFF. The names of the staff of the Public Health Department at the end of 1920 will be found on pages 5 and 6. The visiting work of the staff will be found tabulated in Tables Nos. 7-10 on pages 93-97, and on page 17. G. T. Calthrop, Esq., M.A., M.B. Cantab, D.P.H , who was appointed as Tuberculosis Officer on 26th November, 1919, took up his duties on January 1st, 1920. 74 Miss Gladys Miall-Smith, B.Sc., M.B., B.S. Lond., D. P.H., was appointed as Assistant Medical Officer for Maternity and Child Welfare on March 3rd, and took up her duties on 12th April. Mr. J. Landen, Sanitary Inspector, was superannuated on 28th July. Mr. Landen entered the Council's service in 1899, and his retirement was necessitated bv ear trouble, the result of smallpox, which he contracted some years ago in the faithful performance of his duty. Mr. H. G. West, Sanitary Inspector for factories and workshops, who had also been in the Council's service since 1899, resigned in February to go abroad. Mr. B. H. Thompson, one of the district sanitary inspectors, was appointed in his place to the post in connection with factories and workshops. Mr. J. B. Molloy, temporary sanitary inspector, also resigned in February on being appointed as sanitary inspector in Shoreditch, and Mr. S. W. Capel and Mr. H. K. Nixon were appointed as sanitary inspectors on March 31st. Miss G. Anthony was appointed as Sanitary Inspector in March, and Miss G. B. Steggles as a temporary Health Visitor on January 5th. Mr. J. W. Knight, Clerk, was transferred to another department in February, and Mr. T. II. Hague, temporary Clerk, was appointed as Clerk in his place in March. Mrs. F. E. Henderson was transferred to the department as Clerk in March. In February Miss A. West, temporary Clerk, resigned, and Miss G. Wood was appointed as temporary Clerk in her place. Mr. E. Winchester and Mr. E. Rogers were appointed as temporary Clerks in March and May respectively. The changes in the Council's staff at the Maternity and Child Welfare Centres are set out on pages 18-20. OFFICE ACCOMMODATION. In a report of the Medical Officer of Health, dated April 15th, 1920, attention was called to the unsuitability and insufficiency of the accommodation at present at the disposal of the department, and on 21st April the Public Health Committee resolved that the Parliamentary and General Purposes Committee be asked to consider this matter. Upon Dr. Miall-Smith being appointed it was found necessary, owing to lack of accommodation, to rent an office for her use in the premises of the St. Pancras Dispensary, 30 Oakley Square, N.W. 1. If suitable premises were obtained for the department outside the Town Hall the congestion in certain other departments would thereby be considerably relieved. CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W. I, for the bacteriological examination at the expense of the Council of material from St. Pancras cases sent to them through medical practitioners in regard to diphtheria, tuberculosis, and typhoid fever. The work done in 1920 was as follows:— Total. Positive. Negative. Examination of swabs for B. diphtherias 612 153 459 „ sputum for B. tuberculosis 288 58 230 ,, blood for Widal reaction (typhoid, etc.) 13 3 10 Examinations of sputum have also been made at the tuberculosis dispensaries (tee page 38), 75 Facilities for the examination of cerebrospinal fluid in suspected cases of cerebrospinal 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 72. Section VII.—Other Services. Cordial co-operation exists between the work of the Council and the voluntary agencies performing work of public health and social importance. These agencies include the various hospitals and dispensaries, the local District Nursing Associations, the Maternity Nursing Association, the Invalid Children's Aid Association, the Charity Organisation Society, the National Society for the Prevention of Cruelty to Children, the Invalid Kitchens, the Mary Ward Settlement, Lyndhurst Hall, the Kentish Town Dining Room for Mothers, etc. Voluntary agencies subsidized by the Council are referred to particularly in Section II. of this Report (Maternity and Child Welfare). Home Nursing. As regards district nuising, 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 May< ress' Nursing Fund at the rate of Is. 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. The home nursing work done during 1920 in St. Pancras is indicated by the following figures: — No. of cases No. of home nursed. visits paid. Central St. Pancras District Nursing Association 842 8656 Metropolitan Nursing Association (St. Pancras cases) 384 7628 Hampstead District „ „ „ 274 2403 North London Nursing „ „ . 211 3769 Section VIII.—HOUSING. 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) General Housing Conditions.—The outstanding feature of the housing conditions in the district is the circumstance that, except for a limited number of blocks of selfcontained flats, almost the only accommodation- available for the working classes is the tenement house. Emphasis has been laid in many reports in the past on the evils of tbis system of housing, and in last year's Annual Report the matter was gone into at some length. 76 (2) (a) Holding shortage. There is a chronic condition of housing shortage in St. Pancras associated with the occupation by more than one family, and the consequent overcrowding of most of the houses in the Borough. This condition has been aggravated since the war and at the end of 1920 there were practically no tenements to let, though there was a considerable demand for houses. Some indication of the demand is indicated by the fact that there were 823 names on the waiting lists of applicants for the houses which the Council were building. (b) Measurei taken or contemplated, tot relieve this shortage. —No private building of dwelling houses was in progress during the year. In regard to the Council's building programme see page 78. II.—Overcrowding. (1), (2) and. (3) Extent, causes, and measures taken or contemplated.—Details in regard to these points were given in last year's Annual Report. (4) In 32 instances in 1920 intimation notices were served in regard to the overcrowding in dwelling houses. Most of these were complied with, but in no cases were proceedings taken. It was found to be very difficult and even impossible in some cases to secure compliance with such notices by reason of the inability of the tenants to find additional or alternative accommodation. In view of this many cases of overcrowding were observed by the Sanitary Inspectors without any action being taken beyond a verbal recommendation to seek more rooms. A similar difficulty was found in dealing with the illegal occupation of underground rooms for sleeping purposes. III.—Fitness of Houses. (1) (a) and (b) The general standard of housing in the Borough is indicated under the headings I and II above, and in greater detail in last year's Annual Report. The structural defects are mainly those resulting from the letting of houses to more than one family, without the necessary sanitary and other provisions having been made. Amongst these are the occupation of unwholesome underground rooms, which has greatly increased since the war. A large number of houses also are in a condition of disrepair, and need a great deal of money to be spent on them to rtmedy dilapidations, apart from structural alterations. (c) How far defects are due to the lack of proper management and supervision by owners. It is very difficult to apportion the responsibility for the bad conditions existing in so many tenement houses. It would seem that the prime responsibility rested with the persons who originally allowed the houses to be occupied by more than one family without proper structural accommodation being provided; that, however, occurred many years ago in most districts, though the process is still proceeding in certain parts of the Borough. The houses having been sublet in this way, a very great deal of damage has been done in many cases by reason of the carelessness or active destructiveness of the tenants or sub-tenants, and it is difficult to blame the owners for this. At the same time a comparison of the houses occupied by "good" and "bad" owners (from this point of view) shows clearly that by good management and supervision the houses can be to a great extent protected from deterioration through the habits of the tenants. It must be admitted, however, that a great part of this management consists in letting the houses only to "good" tenants and excluding "bad" tenants, and this must simply force the "bad" tenants into other people's houses. The dilapidated state of the houses of many owners is due to their refusal to spend the money necessary to remedy the defects which are legitimately due to the age and overcrowding of the property. It would undoubtedly make for improvement if all tenement houses were managed and supervised by 77 or on behalf of their owners in the manner that is now practised by certain "good" owners. An instance of such management is to be found in the Marylebone Farm Estate, the leases on which are now rapidly reverting to the Crown. This ought, nevertheless, to be combined with extensive rebuilding as soon as it is possible. There is 110 doubt, also, that much house property, which is in a bad condition, would have been preserved from such deterioration if the ground landlords had taken care that their lessees conformed to the obligations placed upon them by their covenants. (2) Details as to action taken as regards unfit houses under (a) the Public Health (London) Act, etc., will be found on pages 50 and 51; and (b) the Housing Acts, on this page. (3) Difficulties in remedying unfitness, and special treasures taken or suggested.—The institution of a complete house-to-house inspection has been postponed until the London County Council By-Laws in regard to tenement houses have been brought into operation. With regard to house management, the experiment 011 the Crown Estate, where the houses are being put under the management of a staff of women house-managers as the leases fall in, will be watched with great interest. The management is on the lines associated with the name of Miss Octavia Hill. (4) Water supply, closet accommodation, and refuse disposal.—These matters were dealt with in last year's Annual Report. IV.—Unhealthy Arkas. Particulars in regard to this matter were given in last year's Annual Report. I11 regard to developments since 1919 reference may be made to pages 80 to 82. V.—Tenement House By-laws. It is most desirable that the London Count}' Council by-laws in this respcct should be brought into operation without delay. It is difficult to fix standards for tenement houses until this has been done. VI. — General and Miscellaneous. (See "Work of the Special (Housing) Committee," page 78). VII.—Statistics for the 12 months ended 1st January, 1921. (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 47 Subsequent „ 1098 1145 (b) Number of dwelling-houses which were considered to be unfit for human habitation— As regards the whole house Nil. „ underground rooms (2 rooms) 1 1 78 (c) Number of dwelling-houses the defects in which were remedied without the making of closing orders 1145 (3) Acion Uuder 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 Nil, „ underground rooms Nil. (b) Number of Closing Orders made— As regards the whole house Nil. ,. underground rooms Nil. (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, etc. ,, 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 following is a summary of the principal matters which were considered by the Special (Housing) Committee during the past year. In regard to some of the questions which will be referred to, the summary has been brought beyond the end of 1920:— On the 16th November, 1920, Councillor W. Carter and Councillor A. Davis were appointed Chairman and Deputy- Chairman respectively. Chester House. Allocation of Flats.—With the view to facilitating the allocation of the twelve flats at Chester House and the principles which should be applied in the selection of the tenants, a small Sub-Committee was appointed to deal with the matter. The Sub-Committee had before them the numerous applications which had been received and came to the conclusion that the question of overcrowding should be the first guiding principle in the allocation of these flats, and that the applicants be allotted accommodation not larger than was deemed sufficient to meet the reasonable needs of the families taking into consideration the sex and ages of the children and the bedroom accommodation required. The applications were carefully analysed, and the Sub-Committee visited numerous families in the Borough, who were living under conditions of serious overcrowding in one room, as a result of which the selection of tenants was made. Rating of new Flats.—The Committee considered the question of the rating of Chester House, and made representations to the Rating Committee to adopt some kind of uniformity of rating of the new flats in relation to accommodation as compared with that provided in 79 pre-war flats, and pressing for the maximum reduction in order to arrive at the gross assess ments. The Rating Committee accepted this principle. Opening of Flats —The flats were formally declared opened on June 18th, 1921, and the tenants moved in in the early part of July. Brookfield Estate. Tenders.—The Committee received and considered seven tenders for the erection of 19 blocks of maisonettes, 2 cottages, and 10 blocks of flats on this Estate comprising accommodation for 190 families. The lowest tender received was that of Mr. Albert Monk, of Lower Edmonton, in the sum of £229,619 for the buildings and £12,928 for the roads and sewers. The London Housing Board authorised the Council to accept the tender subject to the following conditions: — (a) to the Contract being based on the Ministry of Health's Form D. 88a; (b) to the Council satisfying themselves of the Contractor's financial ability to carry out his obligations; (c) to every effort being made to effcct savings during the progress of the work by modifications; (d) to good rents being obtained; and (e) to the modifications already submitted to the Council being adopted in view of the high contract price. Foundations.—Owing to the nature of the ground and especially in view of the fact that there was a slight settlement in Chester House, which has since been remedied, the Housing Board agreed to the use of cement conerete in the trenches with a layer of heavy hoop iron in the brick footings in lieu of blue lias concrete, in order to minimise any possible risk of settlement. Progress of Work.—The contractor took possession of the site towards the end of 1920, and good progress is still maintained. It is anticipated that several flats and maisonettes will soon be ready for occupation. Proposed School Treatment Centre.—The Committee considered an application from Mr. R. Kohnstamm to convey to him a site on the Brookfield Estate on which to erect a suitable building where treatment of school children may be carried on under the management of a Committee more or less on the lines of the Centres already established in St. Pancras. It was agreed, with the sanction of the Ministry of Health, to let on building lease to Mr. Kohnstumm for a term of 99 years at the ground rent of £35 per annum, a piece of land on the Estate surplus to the housing requirements. The draft lease is now under consideration. Prince of Wales Road. Progress of Work.—The work is progressing steadily, but still slowly, owing to the shortage of labour, the real outstanding trouble being the difficulty of obtaining the necessary number of men particularly bricklayers and plasterers, but more especially the latter. This deficiency has been made good to some extent, but additional plasterers are still needed. It is anticipated that the block of 64 flats will be ready for occupation early in the new year. Provision of Coppers.—The question of providing coppers in connection with this scheme was discussed in the early stages when it was thought that no special provision need be made in view of the close proximity of the Public Baths and Washhouses. As the Public Washhouses are fully occupied, and as it is clearly desirable that each tenant should have facilities for washing, the Committee instructed the Architects to make the neces-ary provision. The extra cost was estimated between £350 to £400, but the contingency sum provided in the contract, unless otherwise allocated, should be sufficient to meet the extra expenditure. 80 Perambulator Sheds.—A letter was received from the Ministry of Health slating that they have had under reconsideration the position, the amount of work, and the cost that would be entailed in the erection of the pram sheds as shown on the drawings. With a view to reducing the cost of the scheme, the Ministry requested the Committee to consider the omission of the sheds as they considered that the sheds could be provided in another position and in a more economical method, if they were still considered essential. In the opinion of the Committee it was considered essential that provision should be made for the sheds in a block of flats of this size, an opinion which was based upon the experience already obtained from other blocks of buildings erected by the Council. The Ministry were informed of this decision and the question has since been discussed on the site with one of their representatives. Somers Town Improvement Scheme, No. 1, 1921. On the 17th December, 1919 the Committee were authorised by the Council to prepare reconstruction schemes under Part II of the Housing of the Working Classes Act, 1890, in regard to fifteen areas in Somers Town. The details of these areas were enumerated in the report of the Medical Officer of Health, who advised that the areas were insanitary and could not be satisfactorily dealt with otherwise than by schemes of reconstruction. This was a considered opinion following upon a detailed inspection of all the streets and houses in the district in question. A copy of the Committee's report was sent to the London Housing Board on the 20th December, 1919. Meanwhile, the Council's Architect (Mr. A. J. Thomas, l.r.i.b.a.), was instructed to prepare the necessary plans of these areas and of the proposed buildings, and to supply such other infomation as would enable schemes to be compiled in accordance with the provisions of the Act. This was done and a comprehensive report submitted to the Ministry. On the 12th April, 1920, the Medical Officer of Health and the Chief Clerk had an interview with the Ministry's representatives on the subject, when it was arranged for one of their Inspectors to visit the areas in order that the Ministry might, be in a better position to advise the Council before steps were taken to prepare the petitions under Part IT. It was clearly desirable to obtain an indication of the views of the Ministry before putting into motion the complicated machinery involved in the preparation of reconstruction schemes. The areas were inspected by a representative of the Ministry on the 21st April. Letters of enquiry were addressed to the Ministry on the 28th April and 19th May, and on the 5th July the following reply was received:— 735/202 Ministry of Health, Whitehall, S.W. 1. July, 1920. Sir, Somers Town. With reference to your letter of the 19th May, I am directed by the Minister of Health to state that he has had under consideration a report made by Mr. Stewart with reference to a number of small areas, in regard to which the Metropolitan Borough Council of St. Pancras have authorised the preparation of improvement schemes under Part It of the Housing of the Working Classes Act, 1840. There appears to be a prima facie case for dealing with these areas or some of them in the manner proposed, but there are certain points in regard to which the Ministry desire further information. They would be glad if representatives of the Council would call at this office and confer with the officials of the Ministry on the subject. I am to request that notice may be given as to the date on which the Counc'ls representatives propose to come. I am, Sir, Your obedient Servant, (Signed) C. B. R. Ellis, A. P. Coke, Esq. For Assistant Secretary. 81 Following upon the receipt of this communication, Councillor A. Davis (then Chairman), the Medical Officer of Health, and the Chief Clerk conferred with the Ministry's officials on the 14th July, when the whole subject was again reviewed. In the meantime the Council had received an offer for the sale of the freehold of several blocks of property in Somers Town. The District Valuer was consulted, who advised that the price asked for the land exceeded the market value. Proposals for dealing with the first section of the Somers Town scheme were submitted to the Committee by the Architect on the 16th November. This was followed by a further conference with the Ministry's officials on the 3rd December, Councillors W. Carter (Chairman), A. Davis (Deputy Chairman), the Architect and the Chief Clerk representing the Council. The plans for dealing with the first section were placed before the Ministry's representatives, and were the subject of considerable discussion. The area includes property bounded on the north by Crawley Mews, on the south by Aldenham Street, on the east by Clarendon Street, and on the west by Seymour Street. The Ministry's representatives promised to give the matter their careful consideration, and to advise the Council before the District Valuer was asked to report upon the value of the interests involved in the proposals. It was explained at the interview that, although there are other areas contemplated in Somers Town which wholly or mainly consist of insanitary property, it was not considered practicable under present conditions to deal with them owing to the difficulty of demolition and de-housing, whereas the advantage of the first scheme was that it was possible to erect new blocks of dwellings on the vacant land fronting Aldenham Street and the south end of Wolcot Street without any displacement. Indeed, it was this fact which prompted the submission of the first scheme. It was hoped also that the accommodation provided in the first scheme would afterwards make it possible to prepare schemes for the neighbouring areas. A further letter was addressed to the Ministry on the 24th December, asking whether the Committee could proceed to prepare the scheme and so commence a much needed improvement in the unhealthy conditions which exist in Somers Town. No reply was received to this communication, but the area was once more visited by the Ministry's Inspector on the 27th January, 1921, followed again by a discussion at the Ministry on the 25th February, with Councillors Carter and Davis and the Chief Clerk, when our representatives were urged to defer the matter owing to prevailing financial considerations. The result of these prolonged negotiations was reported to the Council on the 23rd March, when the Housing Committee were authorised to prepare a scheme for the improvement of the first area under Section 39 (1) (b) of the Housing of the Working Classes Act, 1890. The displacement of 558 persons of the working classes is involved, and it is proposed to provide re-housing accommodation on the cleared area, as follows:—84 flats of three rooms, and 56 flats of four rooms, with scullery, bath room and w.c., in addition for each flat—a total of 476 rooms. Based on an average of 2 persons per room, accommodation will thus be provided for 952 persons. The Architect's estimate of the cost of erecting three blocks of 10 flats, four blocks of 20 flats, and one block of 30 flats is £116,800, in addition to which he provides the sum of £11,850 for pulling down existing buildings, foundations, paving work, iron railings, etc., making a total estimated cost of £128,650. 82 On the 27th July, the Council resolved as follows:— (а) That the scheme under Section 39 (1) (b) of the Housing of the Working Classes Act, 1890, as amended by subsequent Acts, now submitted for the improvement of the area (more particularly specified as the Somers Town Improvement Scheme, No. 1, 1921), including the vacant land on the north side of Aldenham Street, lying between Seymour Street and Clarendon Street; 1-28 (consecutive inclusive), Wolcot Street; 36-39 (consecutive inclusive), Johnson Street; gardens at the rear of 39, 40, 63 and 61, Clarendon Street; the vacant land on the west side of Wolcot Street, lying between Aldenham Street, and including No. 44, Wolcot Street; 45-54 (consecutive inclusive), Wolcot Street; 35, 34, Johnson Sreet, and the strip of land approached between Nos. 34 and 33, Johnson Street, extending to the party fence wall in the rear between 166 and 168, Seymour Street; parts of gardens at the rear of 140. 112 and 166, Seymour Street; 21-81 (consecutive inclusive), Johnson Street; 188, 190 and 192, Seymour Street, and the garden at the rear of 194, Seymour Street; the whole of the premises and land in Crawley Mews; 54, 56, 58 and 60, Werrington Street; 35, 36 and 37, Clarendon Street, together with the plans, particulars, and estimates relating to the said scheme, be and the same are hereby made and adopted. (b) That the Special Housing Committee be authorised to take all necessary steps for obtaining sanction thereto, and that the Seal of the Council be affixed to the Scheme and plans, and the petition to the Ministry of Health for an Order confirming the Scheme. The Petition was lodged with the Ministry on the 29th August, 1921. General Matters. Prospect Terrace.— The Committee had under consideration the report of the Special (Prospect Terrace) Committee with reference to the decision of the Council on the 25th May, 1921, to purchase the land belonging to the Governors of the Foundling Hospital adjoining Prospect Terrace, and referring the matter to the Housing Committee with an instruction to take steps to obtain the necessary consent of the Ministry of Health to agreements being entered into for the acquisition of the land for housing purposes. A sketch plan was prepared by the Borough Surveyor showing how the site could be developed, and providing for the erection of 26 flats at an estimated cost of between £25,000 to £28,000. In the special circumstances which have arisen in connection with the roadway of Prospect Terrace, and to avoid costly and expensive litigation, the Ministry were rcquest on the 18th July, 1921, to sanction the purchase of the site under Part III. of the Act of 1890 as part of the Council's Assisted Housing Scheme. London Guild of Builders.—A. deputation was received from the St Pancras Area Committee of the London Guild of Builders for utilizing the services of the Guild in work to be done in the Borough. The principal object of the interview was to give the Guild the same opportunity of tendering for any future housing schemes as was given to private builders, in support of which it was stated that the Guild were carrying out housing contracts with the approval of the Ministry in other London boroughs. The Committee decided that in all future housing schemes an opportunity should be given to the Guild to submit tenders. Demolition of Houses.—The Committee addressed a communication to the London County Council asking them to give instructions that in all cases of application for sanction to the demolition of premises under Section 6 of the Housing (Additional Powers) Act, 1919, the Metropolitan Borough Council concerned should be consulted before any decision upon the application was taken. The County Council adopted this suggestion, with the result that it has been possible to communicate the observations of the Committee upon the applications made under Section 6, which deals with prohibition on demolition or change of user of dwelling houses. The Government have been urged to promote legislation for the extension of these provisions of the Act of 1919, which otherwise will expire on the 23rd December, 1921. APPENDIX. 84 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1920 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferarle 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. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 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 4751 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 3u45 15.5. 1917 208006 186600 3635 3796 18.2* 3099 16.6† 608 718 402 106 3142 16.8t 1918 196883 175716 3339 3318 16.8* 3789 21.5† 626 751 340 102 3914 22.3f 1919 228585 229434 3804 3824 16.7* 3104 14.1† 670 496 336 88 2930 13.4† 1920 228980 228178 6191 5934 25.4* 3007 12.9f 713 601 435 73 2895 12.4† 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.). *Baaed on total population. † Baaed on Civil population. 85 Table No. 2. Deaths Registered from all Causes for the Year 1920. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Borough are exoluded, and the Deaths of Residents occurring in Public lnstitutions situated beyond the limits of the Borough are included. 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 58 and Upward Totals. 1.—General Diseases. 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. PERSO NS — — — — _ — — _ — — — — 1 — — — — — — — — — — I — 1 2. Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3. Relapsing Fever 0— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Malaria — — — — — — — — — — — — — — — 2 — — — — — — — — — — — 2 — 2 5. Small Pox — (a) Vaccinated — — — — — — — — _ — — — — — — — — — — — — — — — — — — — — — (b) Not Vaccinated — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — (c) Doubtful — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Measles 10 11 41 15 4 5 28 31 2 3 — — 1 — — — — — — — — — — — — — — 30 35 65 7. Scarlet Fever — 1 1 3 — 4 1 — — — 1 1 — — — 6 5 11 8. Whooping Cough 6 12 11 10 6 15 ■23 37 — — — — — — — — — — — — —- — — — — — — — 23 37 60 9. (a) Diphtheria — — 1 — 9 6 12 9 5 4 — 2 — — — — — — _ — — 1 — — — — — — 17 16 33 (b) Croup — — — — — — — — — — — — — — — — — — — — — — — 10. Influenza — — 1 1 — — — 1 — — — — 1 3 2 6 5 3 5 7 2 — — 3 — 1 — — 22 24 46 11. Miliiary Fever — — — — — — — — — — — — — — — — — — 12. A. satic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cholera Nostras — — — — — — — — — — — — — — — — — — 14. Dysentery — — — — — — — — — — — — 1 1 1 — 1 — 1 — 9, 1 6 7 15. Plague — — — — — — — — — — — — — — — — — — — — — 16. Yellow Fever — — — — — — — — — — — — — — — _ — — — — — 17. Leprosy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 18. Erysipelas — — — — — — — — — — — — 3 — 2 1 — — — 1 2 — 2 — 1 — — 2 10 12 19. (a) Mumps — — — — — — —— 1 — — — — — — — — — — — — — I — — — — — 2 (b) German Measles — — — — — — — — — — — — — — — — _ — — — — — — — — — (c) Varicella — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other Epidemic Diseases — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — 20. (a) Pyœmia 1 — — — — — — — — — — — — — — — — — — 1 — — — — 1 — — 3 J 4 (b) Septicaemia — — — — 1 — I 1 — — — — 1 — — — 1 1 — 1 1 1 1 — — 6 7 13 (c) Vaccinia — — — — — — — :— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 22. Anthrax (Splenic Fever) — — — — — — — — — — — _ — — — — — — — 23. Rabies — — — — — — — — — — — — — — — — — — — — — 24. Tetanus — — _ — — — — — — — — — — — _ _ — — 25. Mycoses — — — — — — — — — — — — — — 1 — 1 — — l 1 2 26. Pellagra — — — — — — — — _ — — — — — — — — — — — — 27. Beri-Beri — — — — — — — — — — — — — — — — — — — — — — — — — — — 28. (a) Pulmonary Tuberculosis — 1 1 — 1 1 2 — — — 2 20 18 23 9.0 38 17 34 13 20 7 — 2 2 1 — 151 84 235 (b) Phthisis (not defined as tuberculous) — — — — — — — — — — — — 1 3 — 1 — 3 — 1 1 — 1 — — — — 8 6 14 29. (a) Acute Phthisis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Acute Miliary Tuberculosis 1 — — — — — — — — — — — — 1 2 — — — — — — — — — — — — 3 1 4 30. Tuberculous Meningitis 3 3 3 5 2 8 8 — — 2 3 2 4 — 2 1 — — — — — — — 19 19 38 31. (a) Tabes Mesenterica — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (6) Other peritoneal & intestinal tubercle — — — — — — — 1 — — 1 1 1 1 2 — — — — — — — — — — 1 — — 4 7 11 32. Tuberculosis of Spinal Column — — —: — — — — — — — — — — — — — — — — — — — — — — — — — — — — 33. Tuberculosis of Joints — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 1 34. (a) Lupus — — — — — — — — — — — — — — — — — — — — — — — — — — — (6) Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Tuberculosis of other Organs 1 — — — — — 1 — — — l_ — — _ 1 1 1 — 1 1 1 I — 6 2 8 35 Disseminated Tuberculosis — — — — — — — — — — — — — — 1 — — — — — —— — — — — — — 1 1 36. Rickets, Softening of Bones 1 — 1 — — — — 1 — — — — —— — — — — — — — — — — — — — 9 9 4 37. Syphilis 9 6 — — 1 — 10 6 — — — — — — _ 1 1 2 — — 1 — — — — — 13 8 21 38. Other Venereal Diseases 1 — — — — — 1 — — — — — — 1 _ — — — — — — — — — — — — — 1 1 2 39. Cancer of the Buccal Cavity — — — — — — — — — — — 1 — — — — 1 2 3 — — 2 — 1 — — 13 3 16 40. ,, Stomach, Liver, &c. — — — — — — — — — — — — — — — — 3 1 8 6 20 11 94 12 1 3 — 56 33 89 41. „ Peritoneum, Intestines, and Rectum — — — — — — — — — — — — — — 1 2 1 1 9 1 13 8 5 8 4 — — 1 26 21 47 42. „ Female Genital Organs — — — — — — — — — — — — — v — — — 6 8 — 11 — 5 — 3 — — — 33 33 43. ,, Breast — — — — — — — — — — — — — — — 9 — — — 19 — 8 1 — — 2 — — 1 33 34 41. ,, Skin — — — — — — — — — — — — — — — — — 1 2 1 — — — — 2 1 — — 1 8 19 45. Cancer of other or unspecified Organs — — — — — — — — — — 9 — 4 1 3 3 9 7 91 3 4 4 5 — — — 50 18 68 45. Other Tumours (situation undefined) — — — — — — — — — — — — — — — — — — — 1 — — — 1 1 _ 3 9, 5 47. theumatic Fever — — — — — — — — — — — — — — — — 1 2 — 1 — — — 1 — — — — 2 4 6 48. (<i) Chronic Rheumatism ... — — — — — — — _ — — — — — — — — — — — — — — — — — — — — — — (6) Ostno-Arthritis ... — — — — — — — — — — — — — — — — — — 1 — — 1 9 — — 1 — _ 3 4 7 (c) Gout — — — — — —— — — — — — — — — — — — — — — — 1 — — — 1 _ 9 — 9 49. Scurvy — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — 86 Deaths Registered from all Causes for the Year, 1920—continued. Cause of Death. ages 0 to 1 1 to 2 2 to 5 lotal 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. 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 1. General Diseases—con. 50. Diabetes — 1 — — — — — — — — — — — — — — — — — 1 3 3 1 — — _ 4 5 9 51. Exophthalmic Goitre — — — — — — — — — — 1 _ 1 1 52. Addison's Disease — — — — — — — — — — — — — — — — — — — — — — 53. Leucocythgemia Lymphadenoma — — — — — — — — — — — — 1 — — — 1 — 1 — 1 — — — — — — 3 1 4 54. Anaemia, Chlorosis 1 — — — — — 1 — — — — — — 1 1 — — — 1 1 — — — 3 — — — — 3 5 8 55. (a) Diabetes insipidus — — — — — — — — — — — — — — — — — — — — — — — (b) Purpura — 1 — — — — — — — — — — — _ — (c) Haemophilia — — — — — — — — — — — — — — (d) Other General Diseases — — 1 — — — 1 — — — — 1 — — — 1 — 2 — — — — — — — _ 1 4 5 56. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 57. (a) Occupational Lead Poisoning — — — — — — — — — — — — — — — — — — — (b) Non-occupational Lead Poisoning — — — — — — — — — — — _j_ — — — — — — — — — — — — — — — — — — 58. Other Chronic Occupational Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 59. Other Chronic Poisonings — — — — — — — — — — — — — — — — — — — — — — — - — — 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. (a) Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Encephalitis, other forms — — — — — 1 — 1 — _ 1 2 — — — 4 1 5 61. (a) Cerebrospinal Fever — 1 — — — — 1 — 1 — — — — — — — — 2 2 (b) Posterior Basal Meningitis — — — — — — — — — — — — — — — — — — (c) Meningitis, other forms 3 3 — 2 — — 3 5 — — — 1 — 2 2 — — — — — — — 6 7 13 62. Locomotor Ataxy — — — — — — — — 2 — 2 1 — — 5 5 63. (a) Anterior Poliomyelitis — — — — — 1 — — — — — — — — 1 1 (b) Other Diseases of the Spinal Cord — — — — — — — 1 _ — — _ 1 2 1 5 1 2 2 — 1 — — 9 7 16 64. Cerebral Haemorrhage, Apoplexy — — — — — — — — — — — — — 6 1 6 3 16 3 11 11 6 11 1 2 16 31 77 65. Softening of Brain — — — — — — — — — — 1 1 1 — — — 1 1 2 3 5 66. Paralysis without specified cause — — — — — — — — — — — — — — 1 2 2 5 3 2 8 _ 9 14 23 67. General Paralysis of the Insane — — — — — — — — — 2 5 — 3 — — — — — — 16 — 10 68. Other forms of Mental Alienation — — — — — — — — l 1 1 1 1 1 — — — — 3 3 6 69. Epilepsy — — — — — — — — 1 1 1 2 — — — 1 — 1 — 1 — — — 7 1 1 8 70. Convulsions (Non-puerperal; 5 years and over) — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 71. Infantile Convulsions (under 5 years) 3 4 — 1 — — 3 5 — — — — — — — — — — — — — — — — — 3 5 8 72. Chorea — — — — — — — — — — — — — — — — — — — — — — — — — — 73. Hysteria, Neuralgia, Neuritis — — — — — — — — __ — — — — — — 1 — — 1 — 1 — — — — — 2 1 3 74. Other Diseases of the Nervous System — 2 — — 2 — 2 2 1 _ — — — — — — 1 2 — 2 1 1 1 — — — — 5 10 15 75. Diseases of the Eyes and Annexa — — — — — — — — — — — — — — — — — — — — — — — — 76. (a) Mastoid Disease — — 1 — — — 1 — — 1 — 1 1 — — — — — — — — — — — — — 2 2 1 (b) Other Diseases of the Ears 1 2 3 3. Diseases o f the Circulatory System. 77. Pericarditis — — — — — 2 1 — — 1 1 1 1 — — — — 3 7 78. Acute Myocarditis and Endocarditis — — — — — — — 1 — — — — 2 1 1 2 2 2 3 o 1 — 1 — — — — 9 10 19 79. (a) Valvular Disease — — — — — — — 1 4 1 2 1 6 3 5 5 11 8 22 15 18 12 10 1 2 72 64 136 (b) Fatty Degeneration of the Heart — — — — — — — — — — — — — — 1 — 3 1 5 4 7 8 — 6 1 _ 17 19 36 (c) Other Organic Disease of the Heart — — 1 — 1 2 1 — 1 2 — 1 1 7 4 13 14 •2(' 1933 16 26 39 7 13 113 138 251 80. Angina Pectoris 1 — — — — 1 — — — — — — — — — — 1 1 — 1 _ 4 — 4 81. (a) Aneurysm — — — — — — — — — — — — — — 1 2 1 — 4 2 i 2 — 1 — — s 5 13 (b) Arterial Sclerosis — — — — — — — — — — — — — — 1 — 1 1 5 2 10 6 7 10 2 1 26 26 46 (c) Other Diseases of Arteries — — — — — — — — — — — — — — — 1 i 1 1 — — — 2 2 4 82. (a) Cerebral Embolism and Thrombosis — — — — — — — — — — — — — — — — — — — — 1 1 6 6 1 4 1 — 9 12 21 (b) Other Embolism and Thrombosis — — — — — — — — — — — — — — — — — 1 1 l 1 — — 3 2 5 83. DiseasesoftheVeins(Varices,Haemorrhoids Phlebitis, etc.) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 84. (a) Status Lymphaticus — — — — — — — — — — — — — — — — — — — — — — — (b) Other Diseases of the Lymphatic System — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 85. Hemorrhage; other Diseases of the Circu latory System — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 87. Diseases of the Larynx — — — — 1 —1 1 1 — — — — — — — — — — — — — — — — — — — — 1 1 2 88. Diseases of the Thyroid Body — — — — — — — — — — — — — — — — — — 2 — — — — — — 3 3 89. & 90. Bronchitis 1. 12 3 2 1 — 19 14 — — — — — — 2 — 2 2 12 8 25 16 37 21 28 29 6 15 131 105 236 91. Broncho-Pneumonia 34 26 7 7 1 5 42 38 — 2 — — — — — 1 — 1 2 2 2 7 7 1 2 2 — 1 57 55 112 92. (a) Lobar Pneumonia 3 2 — — — — 3 2 — 1 1 — — — 1 2 — 1 9 — 3 2 8 2 1 2 — — 34 12 46 (b) Pneumonia (type not stated) 2 2 — — 1 1 5 3 — — — — — — 2 — 1 5 6 1 1 2 1 1 _ — 27 12 39 93. Pleurisy — — 1 — — 2 1 2 — — — — — — 1 — — 1 1 — 1 1 1 — 1 2 — — 6 6 12 87 Deaths Registered from all Causes for the Year, 1920—continued. Cause of Death, ages. 0 to 1 1 tc 2 2 to 5 Total i 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. 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 4. Diseases of the Be toiratoru Rustem— con. 9 4. Pulmonary Congestion,Pulmonary Apoplexy — 1 — — 1 — 1 1 — — — — 1 — — 1 1 — — 2 2 — 1 — 2 4 1 — 9 8 17 95. Gangrene of the Lung — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 _ 2 96. Asthma 1 — — —— — 1 — — — — — — — — — 1 — 3 2 6 2 1 1 — — — — 12 5 17 97- Pulmonary Emphysema — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 98. (a) Fibroid Disease of the Lung — — — — — — — — — — — — — — — — 1 — — — — — 1 1 — — — — 2 i 3 (b) Other Diseases of the Respiratory System — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 1 3 5. Diseases of the Diaestivp. Rustem.. 99. (a) Diseases of the Teeth and Gums — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 2 (b) Other Diseases of the Mouth and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — 100. Diseases of Pharynx, Tonsillitis 1 — — — — — 1 — — — — — — — — — — 1 — — — — — — — — — 2 — 2 101. Diseases of (Esophagus — — — — — i— — — — — — — — 1 — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 1 1 6 — 2 3 1 2 — — — — 10 7 17 103. (a) Inflammation of Stomach 1 1 — — — — 1 1 — — — — — — — — — — 1 — — — 1 2 — — — — 3 4 7 (b) Other Diseases of Stomach — 1 1 — 1 — 2 1 3 — — — — — — — — — — — — — — — — — — — 2 104 & 105. (a) Infective Enteritis — — 1 — — — 1 — — — — — — — — — — — — — 1 — — — — |— — 2 (b) Diarrhoea (not returned as — tive) 6 5 — — 1 — 7 5 — — — — — — — — — — — — — — — — 2 — — — 9 5 14 (c) Enteritis (not returned as infective) 11 4 1 — 1 — 13 4 1 — — — — — — — — — — 1 — — — 1 1 — 1 — 16 6 22 11 •i (d) Gastro-Enteritis (not returned as infective) 4 7 1 2 — — 5 9 — — _ — — — — 1 — — 1 — — 5 11 16 (e) Dyspepsia (under 2 years of agcn — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Colic — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (g) Ulceration of Intestines — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — — 2 (h) Duodenal Ulcer — — — — — —_ — — — — — — — — — 1 — 3 — — 1 — — — — 4 1 5 106. Ankylostomiasis — — — — — — — — -— — — — — — — — — — — — — — — — — — — — — — 107. Other Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — — — — 108. Appendicitis — — — — — _ — 2 1 — — 1 — 1 — 1 — — 1 1 — — — — — 6 2 8 109. (a) Hernia 1 — — 1 — _ 1 1 — — — — — — — 2 — — 3 1 — 1 — 1 1 — — 6 5 11 (b) Intestinal Obstruction 2 — — — — — 2 — — — — — — — — — — 1 — — 1 1 1 2 2 — — 5 5 10 110. Other Diseases of the Intestines — — — — — — — — — — — — — — — 1 — — — — 1 — — — — — — 1 1 2 111. Acute Yellow Atrophy of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — 112. Hvdatid of Liver — — — — — _ — — — — — — — — — — — — — — — — — — — — — — 113. (a) Cirrhosis of the Liver (not. returned a3 alcoholic) — — — — — _ — — — — — — 1 — — — — 2 1 3 2 1 1 1 — — 8 4 12 (b) Cirrhosis of the Liver (returned as alcoholic) — — — — — — — — — — — — — — — — — — 1 1 — 1 1 2 (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" — — — — — — — — — — — — 1 — — — 1 1 114. Biliary Calculi — — — — — - — — — — — — — — — — — — — i — — — 1 — — — 2 — 2 115. Other Diseases of the Liver — — — — — — — — — — — — — — — — — — — — i — — 1 — — — — 1 1 2 116. Diseases of the Spleen — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 117. Peritonitis (cause unstated) — — — — — — — — — — — — 1 — 1 — 1 — — — 1 — — — — — — — 5 — 5 118. Other Diseases of the Digestive System — — — — — — — — — — — — — — — — — 1 — — 1 — — — — — — — 1 1 2 6. Non-Venereal Diseases of the Genito-Urinary System and Annexa- 119. Acute Nephritis — — — — — — — — 1 — — — — — — — — — — 1 3 — — — — — — — 4 1 5 120. Bright.'s Disease — — — — — — — — — | 1 1 1 — 1 1 3 1 16 3 15 11 13 7 2 9 — — 53 37 90 121. Chylura — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 122. other Diseases of the Kidney and Annexa — — — — — — — — — — — — — — — — — 1 1 2 — — 2 2 4 — — — 123. Calculi of the Urinary Passages — — — — — — — — — — — — — — — — — — — — — — — — — — — 124. Diseases of the Bladder — — — — — — _ — — — _ 1 — — 1 1 1 1 4 1 6 — — — 13 3 10 125. Diseases of the Urethra, Urinary abscess. &c. — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 126. Diseases of th a Prostate — — — — — — — — j— — — — — — — — _ 1 — 4 — 4 — 1 — 10 — 10 127. Non-Venereal Diseases of Male Genital Organs. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 128. Uterine Hemorrhage ^NTon-puerperal) — — — — — — — — — — — — — — — — — — — — — — — — — — — — 129. Uterine Tumour (Non-cancerous) — — — — __ — — — — — — — — — — — — — — — — — — — — — — 133. 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) — — — — — — — — — — — — — — — — — — — — — — — — — — — —1 — — — 88 Deaths Registered from all Causes for the Year, 1920—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. 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[/##] 7.The Purpural State. 134. Accidents of Pregnancy — — — — — — — — ——— — — — — — — — — 2 — — — — — — — — — — 2 2 135. Puerperal Ha3inorrhage — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — — — 2 2 136. Other Accidents of Childbirth — — — — — — — — — — — — — 1 — 1 — 3 — — — — — — — — — — — 5 5 137. Puerperal Fever — — — — — — — — — — — — — 1 — 5 — 2 — — — — — — — — — — — 8 8 138. ,, Albuminuria and Convulsions — — — — — — — — — — — — — 3 — 1 — — — — — —1 — — — — — — — 4 4 139. ,, Phlegmasia Alba Dolens, Em bolism and sudden death — — — — — — — — 1 _ — — — — — — _ — — — 1 1 140. ,, Insanity — — — — — — — — — — — — — — — — — — — — — — — — — — — — 141. ,, Diseases of the Breast — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 8. Diseases of the Skin and of the Cellular Tissue 142. (a) Senile Gangrene — — — — — — — — — — — — — — — — — — — — — 1 2 1 1 2 — — 3 4 7 (6) Gangrene (other types) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 143, Carbuncle, Boil — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 144. Phlegmon, Acute Abscess 2 1 — — — — 2 1 — — — — — — — — — — — — — — — 1 1 — — — 3 2 6 145. Diseases of the Integumentary System — — — — — — 1 — — — — — — — — — — — — — — — — — — — — 1 — 1 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of th Bones — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 147. Diseases of the Joints 1 — — — — — 1 — — — — — — 1 — — — — — — — — — — — — — — 1 1 2 148. Amputations — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 149. Other Diseases of Locomotor System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Malformations. 150. Congenital Malformations 16 17 — 3 — — 16 20 — — — — — — — — — — — — — — — — — — — — 16 20 36 11. Diseases of Early Infancy. 151. (a) Premature Birth 55 50 — — — — 55 50 — — — — — — — — — — — — — — — — — — — — 55 50 105 (b) Infantile Debility, Icterus, an Sclerema 23 17 — — — — 23 17 — — — — — — — — — — — — — — — — — — — — 23 17 40 152. Other Diseases peculiar to early Infancy 13 6 — — — — 13 6 — — — — — — — — — — — — — — — — — — — — 13 6 19 153. Lack of Care — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Old Age. 154, (a) Senile Dementia — — — — — — — — — — — — — — — — — — — — — — 1 1 1 1 — — 2 2 4 (b) Senile Decay — — — — — — — — — — — — — — — — — — — — — — 6 13 17 32 6 16 29 61 90 13. Affections Produced by External Causes. 155 to 163. Suicides — — — — — — — — — — — — — 1 — 1 1 3 2 — 1 1 1 1 1 — — — 14 5 19 164. Poisoning by Food — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 165. Other Acute Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 166. Conflagration — — — — 1 — 1 — — — — 1 — — — — — 1 — — — — — — 1 — — 1 3 4 167. Burns (Conflagration excepted) — — — — — 1 1 1 1 — — — — — — — — — — — — — — — — — — — 1 1 2 168. Absorption of Deleterious Gases (Conflagration excepted) 2 — — — — — — 2 — — — — — — — 1 — — — — — — — 1 — — — — 2 2 4 169. Accidental Drowning — — — — — — — — — 3 — 1 — — — — 1 — — 1 — 2 — — — — — — 7 1 8 170 to 176. Injuries — — — — — 1 — 1 — 5 1 3 2 4 — 5 4 1 — 4 5 6 2 — 1 — 1 38 12 51 177. Starvation — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 178. Excessive Cold — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 179. Effects of Lleat 1 — — — — — — 1 — — — — — — — — — — — — — — — — — — — — 1 — 1 180. Lightning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 181. Electricity (Lightning excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 182 to 184 Homicide — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 1 185. Fractures (cause not specified) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 186. Other Violence — — — — — 1 — 1 — — — — — — — — — — 1 1 — — — — — — — — 2 1 3 11. Ill-defined Causes. 187. Dropsy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 188. (a) Syncope (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (6) .Sudden death (not otherwise defined) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 189. (a.) Heart Failure (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — 2 2 (b) Atrophy, Debility, Marasmus (aged) 1 year and under 70) ed — — 1 — 1 1 2 1 — — — — — — — — — — — — — — — — — — — 2 1 3 (c) Teething — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — [d) Pyrexia ... — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (e Other ill-defined Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Cause not specified — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 89 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 85 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. General Diseases Diseases of the Nervous System and of the Organs of Special 70 62 65 197 36 15 69 74 106 138 156 113 38 2 944 Sense 16 4 2 22 4 3 4 9 29 25 34 40 81 4 205 Diseases of tbe Circulatory System 1 1 1 3 8 8 9 14 83 59 108 160 118 29 544 Diseases of the .Respiratory System 98 22 14 134 5 1 6 15 28 46 77 83 75 28 493 Diseases of the Digestive System 45 6 2 53 2 3 2 5 9 28 24 15 12 2 150 Non-Venereal Diseases of the Genito-Urinary System and Annexa _ _ _ _ 1 2 2 3 11 22 84 31 21 1 128 The Puerpsral State — — — I— — — 5 9 8 — — — — 22 Diseases of the Skin and of the Cellular Tissue 4 _ _ 4 _ _ 1 _ _ _ 1 4 4 _ 14 Diseases of the Bones and of the Ortaus of Locomotion 1 _ _ 1 _ _ 1 _ _ _ 1 _ _ 3 Malformations 88 3 — 86 — — — — — — — — — — 36 Diseases of Early Infancy 165 — — 165 — — — — — — — — — — 165 Old Age — — — — — — — — — — 21 41 22 94 Affections produced by External Causes 2 5 7 9 7 5 9 13 14 18 11 3 1 92 Ill-defined Causes — 1 2 3 — — — — — — 1 1 — — 5 Totals 435 99 91 625 65 39 104 138 237 827 444 479 843 84 2895 90 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. l ancras 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 p pulation. Net Deaths. Death-rate per 1,oco civil population. Deaths under 1 year of age. Infantile Death-rate per 1000 Births. West 4 695 24.6 369 131 62 89 5 721 21.2 407 12.0 69 95 1416 227 776 12.5 131 92 South 7 673 34.7 180 9.3 27 40 8 747 25.8 362 12.5 46 62 1420 29.4 542 11.2 73 51 East 3 911 24.5 477 12 9 66 72 6 727 29.9 293 12.1 57 78 1638 26.7 770 12.6 123 75 North 1 795 20.9 451 11.9 54 68 2 665 28.5 310 13.3 50 75 — 1460 23.8 761 12.5 104 71 No Address — — — 46 — 4 — Whole Borough — 5934 25.4 2895 12.4 435 73 91 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 1920. (52 weeks ended 1st January, 1921.) Population (Civilian) as Estimated by the Registrar. General in the middle of 1920. Birth Rate. Death Rate. Infantile Mortality. Population (Civilian) as Estimated by the Registrar. General in the middle of 1920. Birth Rate. Death Rate. (Crude), Infantile Mortality. England and Wales 37 609,600 25.4 124 80 County of London 4,531,971 26.3 12. 4 75 Birmingham 895,915 28.0 12.6 83 west. Liverpool 803,452 31.2 15.7 111 Paddington . . 149,673 22.8 11.1 78 Manchester 770,597 25.5 130 94 Kensington .. ,. Hammersmith . . 161,177 136,200 24.3 24.5 13.0 11.2 81 65 Sheffield 492,570 26.6 13.2 104 Fulham 158,621 27.2 11.3 74 Leeds 449,212 25.6 14.3 105 Chelsea 62,987 22.2 11.9 52 Bristol 375,H41 257 11.7 69 City of Westminster . . 132,615 16.2 11 6 71 West Ham 299,440 . 33.0 12.7 72 north. Bradford 293,979 20.7 13.1 92 St. Marylebone 101,856 21.6 12.5 65 Hull 290,808 29.2 13.2 98 Hampstead 91,519 17.1 9.0 48 Newcastle.on.Tyne 286,061 29.4 13.8 96 St. Pancras 228.178 25. 4 12.3 72 Nottingham 267,836 25.9 12.9 95 Islington Stoke Newington 907 52.984 28.2 23.1 13.3 12.8 71 80 Portsmouth 233,805 25.9 11.1 60 o Hacknev • . « . 225,372 26.6 12.6 81 Stoke.on.Trent 248,852 31.1 12.7 98 central. Salford 235,239 26.8 12.7 97 Holborn 39,676 20.8 14.9 64 Leicester 245,465 24.0 11.5 87 Finsbury 78,291 31.9 14.5 76 Cardiff 212,582 24.7 10.7 82 City of London 14,447 12.6 13.3 71 Bolton 184,533 22.7 13.6 98 fast. Crovdon 191,580 23.0 10.8 62 Shoreditch 102,044 36.6 15.4 91 J Willesden 167,328 25.2 9.8 65 Bethnal Greeu 114,471 33.7 14.7 95 Rhondda 184,999 27.3 11.7 104 Stepney Ponlar 241,770 159,766 31.2 34.2 14.4 14.6 87 82 Sunderland 155,211 35.0 15.8 103 south. Oldham 143,154 23.3 14.7 106 Southwark 187,142 31.8 14.1 86 Tottenham 146,970 25.5 9.7 64 Bermondsey 129,189 31.8 130 84 West Ham 299,440 33.0 12.7 72 Lambeth 293,572 27.8 13.0 67 Birkenhead 153,951 27.8 12.5 101 Battersea 165,664 28.1 12.3 82 Blackburn 131,012 21.5 13.4 110 Wandsworth 346,990 20.8 10.0 62 Brighton Walthamstow 137,685 132,771 22.7 23.9 12.0 9.6 65 62 Camberwell Deptford Greenwich 284,712 115,636 102,408 26.5 28.3 25.9 11.5 120 11.9 70 79 72 Leyton 128,832 22.8 9.9 69 Lewisham 174,438 23.1 10.8. 65 Derby 128,868 25.8 10.5 72 Woolwich 141,666 24.7 10.4 60 92 Table No. 6. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1920. (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 29315 30105 29.833 29.617 29.952 29.94 29.833 30.00 29.947 29.89 30.003 29.905 Air Temperature. Mean of ( Maximum a. 47.8 502 559 56.5 68.2 72.7 70.2 690 67.4 61.5 50.2 45.2 (. Minimum B. 36.1 365 38'7 42.8 47.8 52.2 53.2 50.4 50.5 44.9 36.9 36.8 Mean of A. and B 42.0 43.3 47.3 49.7 58.0 62.5 61.7 59.7 58.9 53.2 43.6 41.0 Difference from Average † +3.2 +33 +4.4 +1.3 +2.9 +1.5 .2.6 —35 +0.3 +2.5 —0.7 +0.5 Humidity—Morning 86% 86% 83% 88% 85% 68% 72% 73% 82% 90% 89% 90% • Earth Temperature at 4 ft. depth 44.3 44.0 44.0 47.0 51.0 55.7 58.1 61.2 57.2 55.4 49.6 45.7 Bright Sunshine. Total Observed (Daily mean) Hours 1.48 2.14 4.26 2.90 7.4.2 7.23 4.77 510 3.57 4.32 213 0.90 Per cent of total possible 18 22 36 21 48 44 30 35 28 40 24 12 . Difference from Average† Hours — — — — — — — — — — — — Rain and other forms of Precipita. tion. Number of Days 21 11 18 21 13 9 16 7 14 13 9 23 Total Fall Inches 2.5 0.58 1.42 3.07 0.69 1.59 4.06 1.75 3.27 1.09 1.12 2.36 Difference from Average † +0.75 —106 —0.43 +1.54 —1.06 .0.43 +1.65 —0.47 +1.46 —1.54 —1.26 —004 * 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. to 3 p.m., local time. The Readings for Humidity and Bright Sunshine are also those taken at Enfield; no readings being recorded at Camden Square during 1920. †The averages used are obtained from observations extending over 35 years for Rainfall, Temperature, and Sunshine, Table No. 7. Inspections and Re-inspections made by District Inspectors, by the Factory and Workshop (Male) Inspector and by Women Inspectors in connection with certain infectious diseases during the year 1920. Male Inspectors. Temporary Women Inspectors. Total. DUTIES AND PREMISES. Inspections. Re-inspections. | Inspections. Re-inspections. Inspections. Re-inspections. DISTRICT INSPECTORS. Infectious Diseases—Inquiry, removal, disinfection, etc. 47 39 3103 — 3150 39 Subsequent sanitary inspection, etc. 1172 2409 593 — 1765 2409 Complaints 3613 11042 — — 3613 11042 Drainage—Under notice. Plans, supervision, etc. 194 2903 — — 194 2903 Voluntary 1660 2365 — — 1660 2365 207 553 — — 207 553 Drain Tests 6 — — — 6 — Yards of Mews and Stables 5038 31 — — 5038 31 Housing, Town Planning, etc., Act, 1909: 17 (1).— First Inspections 47 284 — — 47 284 Subsequent routine Inspections 1098 4163 — — 1098 4163 Inspections of registered tenement houses other than above 244 1445 — — 244 1445 Other house-to house Inspections .. 117 176 — — 117 76 Visits to closed underground rooms 225 — — — 225 — Smoke Shafts Observed 459 18 — — 459 18 Regulated Trades. Offensive Trades 12 12 Rag and Bone dealers 33 — — — 33 — Other effluvia businesses 8 — — — 8 — Inspections of Market Streets — — — — — — Other Duties 400 23 1 — 401 23 Food Control 2711 — — — 2711 — Totals 17291 25451 3697 — 20988 25451 FACTORY & WORKSHOP (MALE) INSPECTOR. Factories 232 447 — — 232 447 Laundries—Factories 8 8 — — 8 8 9 — — — 9 — Bakehouses—Factories 79 75 — — 79 75 Workshops 299 181 — — 299 181 Restaurant Kitchens 48 64 — — 48 64 Other Workshops 344 554 — — 344 554 Other Workplaces 24 23 — — 24 23 Other Duties 46 5 — — 46 5 Food Control 158 — — — 158 — Totals 1247 1357 — — 1247 1357 93 94 Table No. 8. 94 Inspections and Re-Inspect ions and other work of the Food Inspectors during 1920. DUTIES AND PREMISES. V isits and Inspections. Re-Inspections after Intimation Notices, Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals, Milkshope 192 412 604 Dairies 224 16 240 — — — Cowsheds 4 9 13 — — — Other Premises of Milk Purveyors 1 8 9 — — — Margarine Factories — — — — — — Ice Cream Premises — — — — — — Slaughter Houses 72 136 208 — — — Slaughter Houses 29 115 144 — — — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 21 121 142 1 I Butchers' Shops 29 79 108 1 — I Fishmongers'Shops 16 18 34 — — — Fried Fish Shops and Fish Curer's premises .. 46 151 197 I — I Marketing Places 2037 1567 3604 — — — Other Premises where F'ood or Drugs are sold .. 28 2 30 — — — Other Visits 104 180 284 Total 2803 2814 5617 3 — 3 SAMPLES, &C., TAKEN. Form al Sa mples Infor mal S a mples No, of Milk samples 183 198 38i 2 — 2 ,, Cream samples .. — — — — — — ,, Butter aad Margarine samples 27 37 64 i — 1 ,, Other samples (specified below)— Lard 4 23 27 — 1 1 Dripping 12 15 27 — — — Oatmeal 3 1 4 — — — Custard powder 5 4 9 — — — Baking Powder 4 2 6 — — — Egg Powder 6 — 6 — — — Arrowroot 7 i 8 — — — Ground Ginger 2 — 2 — — — Condensed Milk — — — — 1 1 Pepper 11 5 16 — — — Mustard 14 12 26 — .— — Tea — — — — 1 1 Cocoa 6 13 19 — — — Coffee 5 10 15 — — — Vinegar 26 26 52 — — — Jam 1 — 1 — — — Salad oil 7 — 7 — — — Olive oil 1 — i — — — Toffee 12 8 20 — — — Cheese 14 2 16 — — — 25 15 40 Total 375 372 747 3 3 6 Table No. 8—con. Inspections and Re-inspections and other work of the Food Inspectors during 1920. 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.) 438 452 890 — — — UNSOUND FOOD. No, of surrenders and seizures :— surr ende red Sei zed Meat, &c 14 3 17 — — — Fish 12 8 20 — — — Shellfish 3 1 4 — — — Other Foods (specified below) :— Fruit 2 7 9 — — — Eggs 3 3 6 — — — Milk (tins of) 1 5 6 — — — Vegetable 2 1 3 — — — Corned Beet 2 4 6 — — — Rabbits — 5 5 — — — Turkey — 1 — — — Hams — — — — i I Butter 3 4 7 — — — Cheese 3 5 8 — Milk — 3 3 — — — Sugar — 1 1 — — — 3 — 3 — Total 48 51 99 — i i Inspections of Registered Canal Boats 3 — 3 — — — 95 96 Table No. 9. Visits, etc., made by Women Inspectors during 1920. First Visits. Subsequent Visits. Call made but admission not obtained. Miss Bibby. Miss Smith. *Miss Payne. *Miss Anthony. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. †Miss Steggles. Total. Miss Bibby. Miss Smith. *Miss Payne. Miss Anthony. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. †Miss Steggles. Total. Miss Bibby. | Miss Smith. *Miss Payne. *Miss Anthony. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. fMiss Steggles. Total. Grand Total. Infants _ 288 — — 500 807 8 1 3 — 1607 — 236 — — 231 255 37 — — — 759 — 245 — — 159 518 2 — — — 924 3290 Expectant Mothers — 63 — — 58 35 — 2 — 2 160 — 36 — 1 43 21 2 — — 3 106 — 59 — — 2 10 1 — — — 72 338 Ophthalmia Neonatorum — 67 — — — — — 10 — — 77 —_ 105 — — — — 1 8 — — 114 — 29 — — — — — 2 — — 31 222 Puerperal Fever 19 — — — — — 2 — — 21 — 6 — — — — — 1 — — 7 — 4 — — — — — — — 4 32 Tuberculosis 1 — — — — — 254 — 317 — 572 1 — — — — — 813 — 655 — 1469 — — — — — — 243 — 350 — 593 2634 Measles and German Measles 13 79 16 26 207 370 338 1080 374 1150 3653 — 19 8 5 30 38 32 83 20 644 879 — 9 2 — 1 15 26 53 15 277 398 4930 Whooping Cough — 1 — 8 2 7 1 10 — 1 30 — — — —- 2 6 1 1 — 1 11 — — — — — 1 — — — — 1 49 Scabies — — 21 57 — — — 1 — 11 90 — 8 — — — — — — — 8 — — 6 — — — — 2 .— — 8 106 Other Cases of Illness 4 28 2 1 92 80 37 147 221 29 641 — 5 2 — 20 20 97 18 39 10 211 — 2 — — — 19 14 7 15 1 58 910 Verminous Persons — 1 18 38 — — — — — — 57 — — 8 — — — — — — — 8 — — 2 — — — — — — — 2 67 To Hospitals and other Voluntary Institutions 243 489 — — 232 132 366 10 212 4 1688 — — — — — — — 5 — — 5 — — — — — 7 1 — — — 8 1701 Domestic Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Home Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Laundries—Factory — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, —Workshop — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Restaurant Kitchens — — — — 28 — — — — — 28 — — — — 1 — — — — — 1 — — — — — — — — — — — 29 Other Factories — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enquiries re milk grants — — 8 2 177 71 19 933 38 225 1473 — — 2 — 8 32 9 40 — 12 103 — —— — — — 17 11 57 2 64 151 1727 Attendances at Committees, &c 89 17 — — — — — — — — 106 — — — — — — — — — — — — — — — — — — — — — 106 Other Visits and Inspections 44 36 — — 324 8 3 77 23 8 523 — — — 2 2 22 2 — 2 30 — 5 — — — 2 1 1 — 49 58 611 Totals 394 1088 65 * 132 * 1620 1510 1026 2273 1188 1430 10726 1 407 28 * *6 337 374 1014 158 714 672 3711 — 353 10 * — * 162 589 299 122 382 391 2308 16745 * Exclusive of those shown in Table 7. † Temporary. 97 Table No. 10. Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1920. Inspector. Inspections. Re-inspections. Call made but admission not obtained. " Food Control." Total. Inspections. Re-inspections. 1. Mr. Eackham 852 2606 — 355 3813 2. „ Lonnon 1338 2149 — 52 — 3539 3. „ Brown 993 2447 — 353 — 3793 4. „ Dillon 701 2086 — 261 — 3048 5. „ Walker 1034 2803 — 289 — 4126 6. „ James 1122 3180 — 297 — 4599 7. „ Adkins 954 2594 — 284 — 3832 8. „ Akers 2133 1272 — 305 — 3710 9. „ Jaffa 3012 1449 — 285 — 4746 10. „ Capel 917 1622 — — — 2539 11. „ Nixon 961 1851 — — — 2812 12. „ Molloy 69 356 — — — 425 13. „ West (Factories & Workshops) 76 213 — 98 — 387 14. ,, Thompson* 1507 2180 — 290 — 3977 15. „ Auger 1 (Food and 3229 6 — 438 — 3673 16. ,, Child i Food premises) 3237 4 — 452 — 3693 17. Miss Bibby 394 1 — — — 395 18. ,, Smith 1088 407 353 — — 1848 19. „ Payne 2029 28 10 — — 2067 20. „ MacKenzie 100 — — — — 100 21. „ Anthony 1557 6 — . — — 1563 22. Mrs. Hunter 1620 337 162 — — 2119 23. Miss Anderson 1510 374 589 — — 2473 24. „ Blaxland 1026 1014 299 — — 2339 25. ,, Camman 2273 158 122 — — 2553 26. „ Parnell 1188 714 382 — — 2284 27. „ Steggles (Temporary) 1638 672 391 — — 2701 Totals 36558 30529 2308 3769 — 73154 * The figures for Mr. Thompson include district work as well as work in connection with factories and workshops. 98 Table No. 11. Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1920, and the resulting Statutory Notices in 1920 and the early part of 1921. Schedule of Nuisances. Intimations. Statutory Notices. 1 Part of the house in a dirty condition 1048 451 2 „ damp „ 291 134 3 Roof defective 848 348 4 Guttering defective 144 64 5 Water fittings defective 300 104 6 Water-closet apartment with absence of external ventilation 41 10 ,, ,, so foul as to be a nuisance or dangerous to health 30 11 8 Water-closet basin foul 87 33 „ ,, defective 106 29 10 ,, ,, choked 115 17 11 Urinal in a foul condition 2 1 14 Privy in a foul condition — — 13 Soil pipe defective 25 12 14 ,, unventilated 15 8 15 ,, improperly ventilated 3 2 16 Absence of waste pipe to sink, lavatory or bath 4 — 17 Waste pipe of sink, lavatory, or bath connected with drain 10 3 18 ,, ,, ,, defective 120 52 19 „ ,, „ ,, foul 20 4 20 lnlet of drain improperly trapped 10 5 21 Drain defective 151 63 24 ,, stopped 164 20 23 ,, ventilating pipe defective 85 29 24 Rain-water pipe in direct communication with drain 19 9 25 ,, ,, defective 197 82 26 Unpaved condition of roadway 2 — 27 Undrained ,, ,, 1 — 28 Area or part unpaved 2 — 29 ,, undrained — — 30 Yard or space unpaved 5 3 31 ,, ,, undrained 1 1 34 Detective condition of washhouse paving 97 43 33 Dust-bin defective 451 174 34 ,, in an improper position 7 — 35 Accumulation of stagnant water which is a uuisance dangerous to health 20 3 36 Accumulation or deposit which is a nuisance dangerous to health 132 29 37 Animals kept in such a manner as to be a nuisance dangerous to health 46 16 38 Part of the house so overcrowded as to be dangerous to health 32 16 39 Space below floor in basement or ground floor insufficiently ventilated 16 6 40 Issuing of black smoke in such a quantity as to be a nuisance 2 — 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 3 — 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 3 2 43 Other nuisances 546 197 Total 5201 1975 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statuterv Notices. 1 Overcrowding 14 2 Inadequate water supply 2 — 3 Contaminated water supply 1 4 Foul closet, basin or trap 16 1 5 Want of moans of ventilation 4 4 6 Want of annual cleansing — 7 Want of cleansing of the part or parts of premises used in common 560 193 8 ,, ,, ,, in sole use ... 654 210 9 Want of cleansing of the room or part of the dwelling 13 — 10 Animals improperly kept 2 — 11 Other breaches 31 3 Total 1297 411 99 Tajsle No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1 Want of cleanliness 108 14 2 Want of ventilation 3 Want of air space, overcrowding 1 — 4 Sanitary accommodation, absent or insufficient 12 6 5 ,, ,, unsuitable or defective 50 15 6 ,, ,, not separate for sexes 17 3 7 Want of drainage of floors 2 8 Other nuisances 133 22 9 Illegal occupation of underground bakehouse. 1 — 10 Breach of special sanitary requirements for bakehouses. 107 1 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 Total 32 4 463 65 Table No. 14. Braiches of other Statutes and Statutory By-laws. Intimations. Statutory Notices. 1 An occupied house without a proper and sufficient supply of water 13 i 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet 1 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 221 68 4 Tank, cistern, or other receptacle for storing of water used or likely to ba used by man for drinking purposes—dirty condition of 37 7 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 ... 27 10 6 Tank, cistern, or other recsptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position ... 3 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 1 — 10 Mauure— absence of proper receptacle for 1 — 11 Manure receptacle not properly constructed — — 12 Sufficient drain to stables or cowshed—absence of a 2 1 13 Receptacle for house refuse—absence of a proper 412 143 14 Receptacle for house refuse—absence of a proper cover for 11 2 15 Yard or open space un payed 1 — 16 ,, paving defective 189 94 17 Insu tieienc water-closet accommodation to " lodging house " 30 20 18 A furnac3 improperly constructed or negligently used ... — — 19 Effluvia arising from premises used for trade, business, or manufacture which is a nuisance dangerous to the inhabitants of the district 2 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 — — 23 Stea.n whistle—use of a without authority ... — — 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansing: 398 186 25 Articles in an unwholesome condition requiring to be purified or destroyed 12 4 26 Underground room illegally occupied as a dwelling 18 8 27 Other breaches 77 31 Total 1461 670 ' v .