STPAN 79 Metropolitan Borough of Saint Pancras. Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1921. T. SHADICK HIGGINS, M.D., B.S., B.Sc. Lond., D.P.H. Cantab. (10495) A 2 CONTENTS. page Public Health Committee 4 Staff of Public Health Department 5 Introduction 7 Section I.—Vital Statistics and Economic Conditions. Population 9 Marriages 10 Births 10 Illegitimacy 10 Notification of Births 10 Deaths 11 Infantile Mortality 12 Economic Conditions 15 Poor Law Relief 15 Hospital Accommodation .. 16 Section II.—Maternity and Child Welfare 17 Advice Cards .. 17 Home Visiting 17 Centres 18 Massage Clinics 20 Dental Clinic 21 Clinic for Sick Mothers and Children 22 Supply of Food to Mothers and Children 22 Home for Ailing Children 24 Day Nurseries 25 Home Helps 25 Home Nursing 26 Midwifery 26 Government Grants 27 Diarrhoea and Enteritis 28 Puerperal Fever 30 Ophthalmia Neonatorum 31 Measles and German Measles 33 Whooping Cough 33 page Section III.—Prevalence of and Control over Infection Diseases. Table of Notifiable Diseases 34 Do. Weekly Number of Notifications 35 Do. Weekly Number of Deaths 35 Do. Notifications past 10 years 35 Do. do. and Deaths in Wards 36 Disinfecting and Cleansing Station 37 Tuberculosis 38 Visiting 43 Dispensaries 43 Sanatoria, etc. 45 Smallpox 46 Vaccination 46 Scarlet Fever 47 Diphtheria 48 Typhoid Fever 50 Acute Anterior Polioencephalitis and Poliomyelitis 52 Epidemic Cerebrospinal Meningitis 53 Encephalitis Lethargica 54 Malaria 55 Dysentery 55 Pneumonia 55 Other Notifiable Infectious Diseases 56 Influenza 57 Syphilis 57 Cancer 57 Section IV.—Sanitary Circumstances of the District. Inspections 58 Notices Served and Result of Service 58 Nuisances—Legal Proceedings .. 59 Premises and Occupations which can be Controlled by By-laws and Regulations 60 3 CONTENTS—continued. page Offensive Trades 60 Registered Tenement Houses 60 Underground Rooms 60 Smoke Prevention 60 Constructional Drain Work 60 Drain Tests 61 Drainage Register 61 Water Service 62 Canal Boats Acts 62 Inhabited House Duty 62 The Rag Flock Act, 1911 62 Public Mortuaries and Coroner's Court 62 Factory and Workshop Acts 63 Inspections 63 Defects Found 63 Home Work 64 Registered Workshops 64 Schools 65 Medical Inspection of School Children 66 Feeding of School Children 68 Infectious Diseases in Schools 68 School Clinics 68 Section V.—Food. (a) Milk Supply 69 Dairies, Cowsheds and Milkshops 70 Milk and Cream Regulations 70 (b) Other Foods 72 Slaughterhouses 72 Fried Fish and Fish Curing Premises 72 Ice Cream Premises 72 Bakehouses and Restaurant Kitchens 72 (c) Sale of Food and Drugs Acts 73 Prosecutions 74 Wholesale Dealers in Margarine 74 (10495) page Section VI.—Sanitary Administration. Staff 75 Chemical and Bacteriological Work 76 Section VII.—Other Services. 76 Home Nursing 76 Section VIII.—Housing. 77 General Housing Conditions 77 Statistics 77 Work of Special (Housing) Committee 79 Appendix. Table No. 1. Vital Statistics for 12 years 86 Do. 2. Deaths Classified for all Causes 87 Do. , 3. Summary of above 91 Do. 4. Births and Deaths in Districts 92 Do. 5. Do., certain large towns and Metropolitan Boroughs 93 Do. 6. Meteorology 94 Do. 7. Inspections and Reinspections (District and other Inspectors) 95 Do. 8. Do., (Food Inspectors) 96 Do. 9. Visits by Women Inspectors 98 Do. 10. Inspections and Reinspections by individual Inspectors 99 Tables Nos. 11, 12, 13 and 14. Details of Intimation Notices served and resulting Statutory Notices 100 A 2 4 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. November, 1920, to October, 1921. CHAIRMAN. Alderman Major George Frederick Cosburn, 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, Prank 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 Plight, 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 Woodley, William George. November, 1921, to October, 1922. CHAIRMAN. Councillor William Lloyd-Taylor, J.P. (Ward 4). DEPUTY-CHAIRMAN. Councillor Miss Edith Maurice Vance (Ward 3). EX-OFFICIO. The Right Worshipful The Mayor (Councillor Thomas William McCormack, J.P.). ALDERMEN. Brown, Henry Joseph, J.P. Combes, Frank Lawrence. Cosburn, Major George Frederick, J.P. Williams, Lt.-Col. Charles. COUNCILLORS. Ward. 2 Barrett, Edward. 5 Blount, George. 8 Crosby, Miss Ada, M.B.E. 8 Davis, Abraham. 1 Ebury, Mrs. Susan Jane. 5 Gregg, Dr. Edward Andrew. 3 Isaacs, Edwin. 4 Johnson, Job. 5 Kent, Miss Beatrice. 3 Kough, Miss Kathleen Beulah. 7 May, Joseph, J.P. 3 Shepherd, Joseph George. 2 Steer, John Whiddon. 7 Swift, Mansell James. 1 TIbbles, Henry Montague. 5 Washington, Alfred Charles. 2 White, George William. I Woodley, William George. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1921. MEDICAL OFFICER OF HEALTH.* 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 VISITORS Inspectors of Food and Food Places. 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. K. Blaxland.‡ Miss C. Smith.‡ Miss D. M. Parnell. Miss A. Holland. Miss G. Anthony. Health Visitors. Mrs. A. Hunter. Miss F. A. Anderson. Miss J. A. J. Camman. Miss G. B. Steggles.§ CLERICAL STAFF. Chief Clerk .. .. A. Powell Coke, Barrister-at-Law. First Clerk .. .. A. G. Capel. Second Clerk .. .. A. Carpenter. Clerk .. .. .. G. N. Cove. „ .. .. .. F. G. Crick (acting as Mills Enquiry Officer). „ .. .. .. T. H. Hague. „ .. .. .. Miss A. Andrews. Junior Clerk .. .. (Vacant.) Boy Clerk .. .. S. Barker. Temporary Clerk .. C. Batter. „ .. .. L. Higgins. „ .. .. E. Winchester. „ .. .. E. Rogers. „ .. .. Miss G. Wood. * And Administrative Tuberculosis Officer. † Both these officers left the Council's service before the end of the year. ‡ Miss Smith and Miss Blaxland are appointed as Sanitary Inspectors and Health Visitors. § Temporary. 6 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. Medical Officers. No. of Consultations per week. Dr. B.1 Marion Cockerell 3 (and 3 per month) Dr. AGertrude Grogan 2 Dr. J. Finch Haines 5 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 Dr. Margaret R. Paterson 1 Dr. Mary J. Pirret 3 (and 2 per month) 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, Anaesthetist. Mr. Southcomb May, L.D.S., Dentist at Tuberculosis Dispensary. Superintendents of Maternity and Child Welfare Centres. Miss K. L. Allfrey. Miss A. Mullock Jones. Miss E. Boyd-Johnston. Miss M. Manger. Miss G. R. Bristow. Miss M. Smyth. Mrs. E. Crockart. Miss M. Templeton. Miss M. H. Landel Jones. Assistant Visitors at Maternity and Child Welfare Centres. Miss L. Auger. Miss M. A. Clarke. Miss M. L. Blair. Mrs. S. Kahan. Miss F. Brayshaw. Mrs. E. Lurie. Mrs. E. E. Bruce. Miss E. L. May. Mrs. S. C. Chapman. Mrs. M. A. Smith. Tuberculosis Dispensary. Nurse Visitor, Mrs. M. E. Baxter. Clerical a?id General Assistant, Miss Margaret Deed. 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. A. Wright. RESIDENT CARETAKERS, &c. Mortuaries and Coroner's Court J. Root. Goldington Buildings J. H. Ambrose. Flaxman Terrace C. Hanson. Prospect Terrace (and Baths) A. N. Reid. Male Attendant W. Smith. Female Attendant Mrs. L. Arnold. 7 Public Health Department, Town Hall, Pancras Road, N.W. 1. July, 1922. To the Mayor, Aldermen and Councillors op the Metropolitan Borough of St. Pancras. Ladies and Gentlemen, I have the honour to present to you the Sixty-Sixth Annual Report on the vital statistics and health conditions of the Sanitary District of St. Pancras, including particulars of the year's work of the Public Health Department. It is the ninth annual report which it has been my duty to submit. The year 1921 was remarkable for two circumstances, viz., the great prevalence of unemployment, and the exceptionally severe heat and drought. Both of these conditions might have been expected to react unfavourably on health conditions, and it is all the more satisfactory therefore to be able to report that the number of St. Pancras deaths recorded during the year was smaller than in any former year. The rate of mortality amongst children under one year of age (76 per 1,000 births) was slightly higher than in the previous year, when the figure was 73, but was lower than in any former year. The increase in infantile mortality was due to the prevalence of diarrhoea as a result of the hot and dry summer. The number of deaths from that disease was, however, much smaller than might have been anticipated by comparison with former hot years, and there is reason to believe that if other conditions had been as they were ten years earlier the climatic events of the year would have produced much greater mortality. There is no doubt, however, that the rate of infantile mortality is still higher than it need be, and that many of the deaths of infants from diarrhoeal and other diseases are preventible. There was considerable prevalence of scarlet fever and diphtheria in 1921. Owing to the great mildness of the former disease the mortality was small, but there were more deaths from diphtheria than in any recent year. Apart from these diseases and summer diarrhoea there was no special epidemic prevalence during the year. The decline in the mortality from tuberculosis which appeared in the last two years was continued in 1921. The details of the work done in the Public Health Department in the course of the year are embodied in the report. With regard to staff, I have to record the departure of Dr. Calthrop, Tuberculosis Officer, and Dr. Miall-Smith, Assistant Medical Officer. Their positions had not been filled permanently at the end of the year. It is with great regret, also, that I have to refer 8 to the loss we experienced in the death of Miss Savory, Superintendent of the Chalton Street Maternity and Child Welfare centre. This report has been arranged so as to follow as closely as possible the suggestions of the Ministry of Health. In conclusion I have once again to express my appreciation of the assistance I have received from the staff of the Public Health Department; and to thank your Public Health Committee for the support which they have given me, and the Council for the personal consideration that they have shown me. I am, Ladies and Gentlemen, Your obedient Servant. J. Ahadhik thwin Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1921. For the purpose of this Report, the year 1921 consists of the 52 weeks ended 31s£ December, 1921. Section I.—VITAL STATISTICS AND ECONOMIC CONDITIONS. PULATION. The national census having been taken on 19th June, 1921, it is possible this year to give comparatively accurate figures for the population of the borough. The population of St. Pancras as recorded at the census was 210,986, comprising 99,528 males and 111,458 females. The Registrar-General concluded that the annual holiday movement had already begun at the time of the census, and that there was an appreciable number of visitors at the various holiday resorts. He made a correction for this error in estimating the 1921 mid-yearly population, and for St. Pancras his estimate of the population at the middle of 1921 is 212,900. The rates in this report are based on the latter figure. The census figure represents a decline of 3.4 per cent. since the 1911 census, when the St. Pancras population was 218,387. According to the Registrar-General's estimate of the 1921 mid-year population the decline was only 2.5 per cent. On the census figures the decline in the male population was 6.7 per cent. and of the female 0.2 per cent. Further details of the 1921 census returns are not available at the time of writing. The following table gives the population of St. Pancras at decennial intervals since 1811:— Year. Males. Females. Total. *1811 19,822 26,511 46,333 *1821 31,796 40,042 71,838 *1831 46,058 57,490 . 103,548 *1841 — — 129,763 1851 — — 166,955 1861 91,113 107,675 198,788 1871 103,283 118,182 221,465 1881 112,516 123,742 236,258 1891 113,514 121,235 234,749 1901 114,305 121,012 235,317 1911 106,728 111,659 218,387 1921 99,528 111,458 210,986 * From "St. Pancras Vestry. 1718-1900," by Walter E. Brown. 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. (10495) B 10 MARRIAGES. The number of marriages celebrated in 1921 was 2,071. This is equal to a rate of 9.8 per 1,000 total population. BIRTHS. The net number of births for St. Pancras registered in 1921 was 4,764, making an annual birth-rate of 22.4 per 1,000 total population. The number of births registered as having taken place in the borough was 5,099, and the net figure is obtained by deducting 335. 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 registration sub-districts in the borough will be found in Tables 1 and 4 on pages 86 and 92. It will be seen on reference to Table 1 that the birth rate for 1921 was smaller than for 1920, when there had been a great increase, due evidently to temporary post-war conditions. The following table shows the quarterly figures in recent years. Year. Number of Births (Uncorrected). Total for Year (Uncorrected). Total for Year (Corrected). 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 1913 1,335 1,268 1 266 1,298 5,167 5,517 1914 1,222 1,234 1,271 1,218 4,945 5,225 1915 1,259 1,129 1,036 1,034 4,458 4,754 1916 1,048 1,140 1,050 1,072 4,310 4,530 1917 1,046 974 797 818 3,635 3,796 1918 842 840 848 809 3,339 3,318 1919 775 747 977 1,305 3,804 3,824 1920 1,806 1,581 1,453 1,351 6,191 5,934 1921 1,325 1,308 1,241 1,225 5,099 4,764 1922 1,326 1,288 - - - - 1,335 births occurred in Public Institutions in St. Pancras, equal to 26.2 per cent. of the total births which took place in the borough. Table 5, on page 93, shows the birth-rate for 1921 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 4,764 net St. Pancras births, 264, or 5.5 per cent., were returned as illegitimate. The corresponding figures for 1920, 1919, 1918, 1917, 1916, 1915, 1914 and 1913, were 5.6, 8.4, 9.5, 7.2, 7.0, 5.4, 4.4 and 4.7 per cent. respectively. Of the 5,099 births in St. Pancras (uncorrected) 352 or 6.9 per cent. were returned as illegitimate. Notification of Births. 5,107 notifications of births were received during 1921, including 173 still-births and 4,934 live births, or 97 per cent. of the births registered as having taken place in the borough. Details in regard to the notifications will be found on page 26. 11 DEATHS. The net number of St. Pancras deaths registered during the year was 2,778, making an annual death rate of 13.0 per thousand population. The number of deaths registered during the year as having taken place in the borough was 2,836. Of these, 651 were of persons whose residence was not in St. Pancras (non-parishioners), 582 dying in St. Pancras institutions, and 69 in other parts of the borough. There were also reported by the Registrar-General 545 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London and institutions connected therewith, and 48 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 86, will be found the corresponding figures for the past 11 years. It will be seen that the tendency for the amount of mortality to diminish has continued, and that the number of deaths in 1921 was smaller than in any previous year. The leading causes of death are set out in the following table for the 10 years 1911-1920 and for 1921. Diseases. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Average for 10 years 1921. Enteric Fever 7 2 6 4 8 5 6 5 2 1 5 3 Small-pox - - - - - - - - - - - - Chicken-pox 1 1 1 - 1 1 - - - - - - Measles 113 94 36 53 63 42 118 75 15 65 67 23 Scarlet Fever 10 5 6 19 22 8 4 7 5 11 10 7 Whooping Cough 48 47 36 49 52 39 27 80 7 60 45 38 Diphtheria and Croup 37 27 19 30 24 23 25 31 21 33 27 51 Influenza 15 14 42 15 35 35 21 700 260 46 118 57 Erysipelas 10 7 10 9 11 3 3 11 9 12 9 3 Tuberculosis- Pulmonary 230 318 325 365 398 340 353 403 268 249 325 250 Other forms 83 83 67 67 102 83 91 82 73 63 79 54 Cancer, Malignant Disease 274 247 285 251 258 267 281 269 245 299 268 290 Rheumatic Fever 6 5 6 10 11 7 7 8 7 6 7 16 Cerebral Haemorrhage, Embolism and Apoplexy 147 227 116 141 169 119 116 131 91 98 136 126 Heart Disease 283 217 276 319 422 359 393 378 360 423 343 411 Bronchitis,Pneumonia and Pleurisy 560 525 691 566 664 535 514 618 489 445 561 455 Diarrhoea and Enteritis 248 45 148 142 114 72 97 56 68 54 104 98 Nephritis and Bright's Disease 86 110 101 112 132 103 104 98 61 95 100 60 Puerperal Fever 4 7 2 7 5 4 5 2 9 8 5 4 Congenital Debility and Malformations, including Premature Birth 130 207 191 164 187 176 144 132 162 201 169 149 Injuries 156 161 148 150 150 112 125 119 108 92 132 88 (10495) 12 This analysis shows that the decline noticed in 1920 in deaths from tuberculosis and from "bronchitis, pneumonia and pleurisy," has persisted in 1921. The number of deaths from heart disease and from cancer, on the other hand, fail to show that tendency to decline exhibited by the mortality statistics as a whole. The deaths from diphtheria and from diarrhoea and enteritis were more numerous than usual, while the mortality from the other zymotic diseases was low. The deaths for the year are fully classified for causes, age and sex in Table II, on page 87. The deaths and death-rates for the different wards and registration sub-districts will be found in Table 4, on page 92, and in Table 5, on page 93, are set out the death-rates for 1921 of England and Wales, the County of London, the several metropolitan boroughs, and certain of the large towns with populations exceeding 125,000. 1,613 deaths occurred in Public Institutions in the borough in 1921. Taking from these the number which were of non-parishioners (582) and adding the number of deaths of St. Pancras parishioners in Public Institutions without the borough (593)—both from the RegistrarGeneral's figures—the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,624, or 58 per cent. of the total deaths. Infantile Mortality. 360 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of 76 per thousand births. In Table 1, on page 86, the corresponding rates for the past 11 years are set out. The rate for 1921 (76) is slightly greater than that for 1920 (73), which was unprecedentedly low. The increase is due to the increased prevalence of diarrhoea and enteritis, the result of the great drought of 1921. If the mortality from diarrhoea and enteritis amongst children under one year had been in 1921 at the same rate as 1920, the infantile death-rate for 1921 would have been considerably lower than in 1920. Reference to the abnormal summer season and the consequent mortality from diarrhoea is made on page 28 of this report. In Table 4, on page 92, the figures will be found for the different wards and registration sub-districts, and in Table 5, on page 93, 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 (1921), classified according to age at death. (2) The causes of death of children under 12 months of age in 1921 and in the ten previous years. In this Table the number of births in each year is also stated for reference. 13 1921. net 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 81 26 20 8 135 60 73 54 38 360 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — 1 1 1 1 2 2 7 Scarlet Fever — — — — — — - — — — Whooping Cough — — — 1 1 2 3 4 8 18 Diphtheria and Croup — — — — — — — — 2 2 Erysipelas — — — — — — — — — — Influenza — — — — — — 1 — 1 2 Tuberculous Meningitis — — — — — — 1 2 1 4 Abdominal Tuberculosis — — — — — — — 1 — 1 Other Tuberculous Diseases — — — — — 1 1 1 3 Meningitis (not Tuberculous) — — — — — 1 1 — 1 3 Convulsions 3 1 — — 4 — 1 1 2 8 Laryngitis — — — — — — — — — — Bronchitis — 3 2 2 7 10 19 8 8 52 Pneumonia (all forms) — — — — — — 1 3 — 4 Diarrhoea — — — 1 1 3 3 4 — 11 Enteritis — 2 2 — 4 8 23 19 9 63 Gastritis — — — — — 1 1 — — 2 Syphilis 1 2 2 1 6 8 — — — 14 Rickets — — — — — — — — 1 1 Suffocation (overlying) — — 1 — 1 — 1 — — 2 Injury at birth 2 - — — 2 — — 1 — 3 Atelectasis 8 — - — 8 — — — — 8 Congenital Malformations 11 4 2 — 17 8 — — — 25 Premature birth 49 8 6 — 63 11 1 — — 75 Atrophy, Debility and Marasmus 5 6 4 — 15 4 11 3 1 34 Other causes (including Influenza) 2 — 1 2 5 3 5 5 2 20 Totals 81 26 20 8 135 60 73 54 38 360 Net Births in the year legitimate 4,500 Net Deaths in the year of legitimate infants 318 illegitimate 264 illegitimate infants 42 14 Net Deaths from stated causes under 1 Year of Age for 10 Years, 1911-1920 and 1921. Cause of Death. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Average for 10 years. 1921 All causes— Certified 623 472 512 481 497 385 402 340 336 435 448 360 Uncertified — — — — — — — — — - - - Small-pox - - - - - - - - - - - - Chicken-pox — 1 1 - 1 - - - - - - - Measles 17 13 10 8 17 14 30 16 4 21 15 7 Scarlet Fever — — 1 - - - - - 1 - - - Whooping Cough 16 21 12 23 24 15 14 27 2 18 17 18 Diphtheria and Croup 3 1 1 4 - 2 1 1 - 2 2 2 Erysipelas 1 — 3 2 2 - 1 1 - - 1 - Influenza 1 — — 1 1 - 18 11 2 3 2 Tuberculous Meningitis 8 11 5 3 8 5 4 8 4 6 6 4 Abdominal Tuberculosis 1 3 - 2 1 1 2 1 1 - 1 1 Other Tuberculous Diseases 2 2 8 3 6 5 7 3 2 2 4 3 Meningitis (not Tuberculous) 12 8 8 4 8 7 10 3 6 7 7 3 Convulsions 6 21 16 11 5 9 5 3 6 7 9 8 Laryngitis — 1 — — 1 1 - - — - - Bronchitis 90 57 105 76 84 57 63 46 47 87 71 52 Pneumonia (all forms) 15 13 9 16 12 10 13 15 9 9 12 4 Diarrhœa 70 8 22 24 15 6 8 6 10 11 11 11 Enteritis 98 24 73 82 64 35 52 31 37 26 52 63 Gastritis 2 7 2 — 3 2 4 1 3 2 3 2 Syphilis 8 9 14 15 9 14 16 13 11 15 12 14 Rickets 2 4 — 1 1 4 2 1 2 1 Suffocation (overlying) 18 22 14 18 8 9 13 6 1 2 11 2 Injury at Birth 4 6 4 3 10 4 3 2 6 5 5 3 Atelectasis 6 9 3 5 6 9 9 8 7 10 7 8 Congenital Malformations 21 21 24 23 25 34 19 17 31 33 25 25 Premature Birth 93 97 93 84 92 75 61 50 68 105 82 75 Atrophy, Debility and Marasmus 80 63 53 38 47 43 44 46 45 40 50 34 Other causes (including Influenza) 50 50 31 36 48 25 20 36 35 26 36 20 Totals 623 472 512 481 497 385 402 340 336 435 448 360 Net Births 5,555 5,367 5,517 5,225 4,754 4,530 3,796 3,318 3,824 5,934 4,782 4,764 The number of deaths of illegitimate children under one year of age was 42, equal to a death-rate of 159 per thousand illegitimate births. 15 ECONOMIC CONDITIONS.* There is a close connection between public health and such conditions as bad housing, poverty and vice. Although housing conditions in St. Pancras remain bad, there is good reason for believing that the improvement in health which is indicated by the decline in the death rates in recent decades has been associated with a general social amelioration. It is to be feared that the want and distress accompanying the great wave of unemployment which characterised the year 1921 and is still continuing, will have a bad effect on the public health. It is a matter for congratulation that it has not made a greater impress in the vital statistics for the year, which cannot be described as other than favourable. Such statistics have an interesting bearing in the estimation of the adequacy or otherwise of the relief measures which have been taken to meet the unemployment situation. The amount of out-relief granted during the past 5 years is indicated in the following table (kindly supplied by Mr. Bernard Chapman, Clerk to the St. Pancras Guardians), which gives for half-yearly periods the amount spent in outdoor relief and the numbers chargeable in this respect in the middle week of each half-year:— Half-Year ending. Amount spent in the half-year. Numbers chargeable in the middle week of the half-year. Michaelmas, 1917 £ 3,079 871 Lady day, 1918 3,382 852 Michaelmas, 1918 3,461 771 Lady day, 1919 3,814 754 Michaelmas, 1919 4,557 823 Lady day, 1920 6,146 899 Michaelmas, 1920 8,161 1,079 Lady day, 1921 13,081 1,660 Michaelmas, 1921 21,400 3,529 Lady day, 1922 40,081 6,429 This table illustrates the great increase in outdoor relief which has been found necessary to deal with unemployment in 1920-22. This increase is not shown in the number of inmates of the workhouse, particulars of which are given in the following table, also supplied by Mr. Chapman :— Date. Numbers chargeable in St. Pancras House. July 1st, 1917 1,074 January 1st, 1918 1,058 July 1st, 1918 1,027 January 1st, 1919 913 July 1st, 1919 877 January 1st, 1920 902 July 1st, 1920 908 January 1st, 1921 982 July 1st, 1921 974 January 1st, 1922 1,069 * In the Annual Reports for 1919 and 1920 particulars were included in regard to certain matters connected with the natural and social condition of the borough, which are omitted from this report. 16 Hospital Accommodation. With the exception of the two hospitals of the St. Pancras Guardians the use of the hospitals in St. Pancras is by 110 means confined to the residents in the borough. They are rather London than St. Pancras institutions, especially on the in-patient side, and many of them receive patients even from beyond the metropolis. On the other hand hospitals outside of the borough are largely used by St. Pancras residents. The following table has been constructed from figures kindly supplied by the secretaries of the various institutions to show the work done by the hospitals in St. Pancras, without reference to the home addresses of the patients. Hospital. Number of beds. Number of in-patients admitted 1921. Number of new outpatients treated in 1921. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 387 2,480* - Highgate Hospital, Dartmouth Park Hill 554 2,360* - Metropolitan Asylums Board Hospitals. Children's Infirmary, Cleveland Street 200 394 - St. Margaret's Hospital, Leighton Road (for Ophthalmia neonatorum) 40† 213‡ — Voluntary Hospitals. University College Hospital, Grower Street 353 5,006 66,685 Royal Free Hospital, Gray's Inn Road 240 3,961 48,328 Royal Free Hospital Maternity Home, Endsleigh Street 35 632 - London Temperance Hospital, Hampstead Road 120 1,425 18,666 Elizabeth Garrett Anderson Hospital, Euston Road 73 1,349 9,678 West End Hospital for Nervous Diseases, Regent's Park 72 462 — Hospital for Tropical Diseases, Endsleigh Gardens 58 651 — Central London Throat, Nose and Ear Hospital, Gray's ilnn Road 43 988 11,423 Central London Ophthalmic Hospital, Judd Street 40 694 12,837 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 515 2,617 St. Saviour's Hospital, Osnaburgh Street 21 134 — North-West London Hospital, Bayham Street — — 10,725 St. Pancras Dispensary, Oakley Square — — 2,587§ London Skin Hospital, Fitzrov Square 2,758 Jr ' J u. Western Skin Hospital, Hampstead Road ... 1,210 British Dentists' Hospital, Camden Road - - 385|| * Year ended Lady-day, 1922. † In addition to 16 beds for the patients' mothers. ‡ In addition to 121 admissions of patients' mothers. § Not including the work of the Tuberculosis Dispensary (see page 43) but including the clinic for mothers and young children (see page 22). ||Not including the municipal clinic (see page 21). 17 Section II—MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 10 14 of this Report. The number of births in 1921 numbered 4,764, a reduction of 20 per cent, on the number born in 1920. This has shown itself in a decline in the number of young babies who have been brought to the infant welfare centres. 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 from the Town Hall and from the Centres. (c) The provision and maintenance of thirteen 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. (/) The subsidisation 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 subsidisation of a voluntary fund for the provision of cheap dinners for such persons. (h) The subsidisation of a voluntary fund for the provision of Home Helps. (i) The subsidisation of the four voluntary Day Nurseries in the borough. (j) The subsidisation of voluntary agencies providing intern and extern midwifery for St. Pancras women free or at reduced fees. (Jc) The payment for the home nursing of sick infants in certain cases. The work done in 1921 in connection with the scheme will now be referred to in detail:— Advice Cards.—Besides the posting of cards of advice to the mothers of all infants whose births have been notified, cards of advice to expectant mothers have been distributed through University College Hospital, Middlesex Hospital, the Maternity Nursing Association, and other agencies. Home Visiting.—This has been done by the health visitors at the Town Hall and by the Council's staff of health visitors 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. 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 in 1921 made 3,182 visits to 1,178 infants (apart from visits made to cases of measles and for other special purposes). They also made 447 visits to 205 expectant mothers whose names had been supplied by University College and Middlesex Hospitals. The Council's visitors at the Infant Welfare Centres numbered 19 full-time workers and one part-time, who divided their time between the necessary work in the centres and homevisiting. In addition there was one full-time voluntary (unpaid) trained worker at the Argyle Square group of centres, and two part-time trained volunteers (unpaid) at Chalton Street, in addition to two visitors (working in neighbouring boroughs as well as St. Pancras) at the University College Hospital Centre, whose salaries were paid by the hospital and not by the (10495) c 18 Council. In 1921 the Council's centre visitors made 37,798 visits to 5,464 children, and 5,139 visits to 2,250 expectant mothers; and the trained workers not paid by the Council made 12,567 visits to 638 children, and 153 visits to 92 expectant mothers. The visiting work is set out in detail in the table on the next page and is summarised in the following statement:— No. of Expectant Mothers Visited. Total Visits to Expectant Mothers. No. of Children Visited. Total. Visits to Children. Town Hall health visitors 205 447 1,178 3,182 Staff at the Centres paid by the Council 2,250 5,139 5,469 37,798 Total work by Council visitors 2,755 5,586 6,642 40,980 Staff at the Centres paid by the Council 2,250 5,139 5,464 37,798 Trained staff at the Centres not paid by the Council 92 153 638 12,567 Total work by Centre visitors 2,342 5,292 6,102 50,365 Total visits by all trained visitors— 1921 2,547 5,739 7,280 53,547 1920 2,158 5,005 8,502 44,498 Maternity and Child Welfare Centres. In previous Annual Reports details have been given in regard to the various maternity and child welfare centres comprised in the Council's scheme. A list of them will be found in the Table on the next page. 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 17 as provided by the Council. The Council has representatives on each committee, and each committee sends a representative to the Council's maternity and child welfare subcommittee. The centres at University College Hospital and the Marlborough Maternity Section of the Royal Free Hospital are not, however, subsidised by the Council. In the Table on the next page the work of the centres in 1921 is statistically detailed. It will be seen that at the end of the year 33¼ infant consultations and 9¾ ante-natal consultations were held per week, 1,634 infant consultations and 500 ante-natal consultations having been held during the year. The children who attended in 1921 for the first time numbered 3,592 under one year of age, and 373 over one year. The children under one amount to 75 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 52,600 attendances (compared with 47,625 in 1920); 2,771 expectant mothers also attended, making in all 6,332 attendances. Other work done at certain of the centres is indicated in the following paragraphs :—- St. Pancras School for Mothers, 1, Ampthill Square. Dental clinic (dental surgeon, Mr. Geo. Thomson, L.D.S.). The total attendances of mothers in 1921 was 234, and of young children 25. The number of new cases in 1921 was 40 mothers and 23 children. 19 The attendances are classified as follows:— Centre. Expectant Mothers. attendances at consultations. Visits by Trained Visitors. Infant Consultations. Expectant Mothers' Consultations. Number of Trained Visitors. Children. Expectant Mothers. Children. New cases. Total attendances. New cases. Total attendances. First visits. Total visits. First visits. Total visits. Under 1 year. Over 1 year Total. Under 1 year. Over 1 year. Total. Visitors paid by Borough Council. Trained workers not paid by Visitors paid by Borough Council. Trained workers not paid by Visitors paid by Borough Council. Trained workers not paid by Borough Council. Visitors paid by Borough Council. Trained workers not paid by Borough .Council. Per week. Total. Per week. Total. Whole Time. Part Time. Town Hall Health - - - - - - - - 205 - 447 - 1,178 - 3,182 - - - - - - - Visitors St. Pancras School for Mothers— Ampthill Square 250 738(1) 363 23 386 - - 8,700 745 - 1,266 - 1,166 - 9,192 75 5½ 266 1 50 4 - Chalton Street 67 278 153 43 196 2,414 2,716 5,130 425 - 821 - 493 - 3,744 4,732(2) 3 151 ½ 25 2 2(3) North St. Pancras 148 330 496 35 531 6,342 1,979 8,321 30 - 380 - 680 - 4,396 - 4 202 1 52 3 - School for Mothers, Queen's Crescent South Highgate Centre 10 31 70 4 74 1,323 459 1,782 18 - 82 - 89 - 1,542 - 1 51 - 15 1 - Grafton Road Centre 16 37 300 126 426 2,726 1,175 3,901 78 - 78 - 506 - 1,709 -(4) 2 99 - - 1 - Mary Ward Settlement 32 100 122 26 148 1,657 947 2,604 106 14 242 20 332 41 2,105 389(5) 3 147 - - 1 - School for Mothers Camden Town Centre, Camden Road Argyle Square Group of 125 267 420 88 508 4,368 1,793 6,161 283 78 550 133 683 79 3,918 508 4 200 1 50 3 - Centres— Argyle Square 35 88 100 1 101 1,594 250 1,844 138 2,18(8) 1½ 62 ½ 21 3(6) Oseney Crescent 74 190 145 14 159 2,677 756 3,433 - 585 - 628 57(7) 7,698 1½ 75 ½ 24 - Falkland Road - - 138 - 138 2,266 - 2,266 1 51 - - (10) Maternity Nursing Association, Oakley Square 215 241 376 - 376 - - 4,431 207 - 295 - 668 - 2,586 - 2 102 ½ 12 1 - University College Hospital 1,424 2,833 742 - 742 - - 3,239 - - - - - 410 - 4,631 2 103 1 49 - 2(9) Royal Free Hospital— Gray's Inn Road 185 720 58 13 71 378 143 521 220 - 840 - 219 51 908 51 2 73 2 102 - 1 Marlborough Maternity Section 190 473 109 - 109 267 - 267 - - - - - - - - 1 52 2 100 - - Totals 2,771 6,332 3,592 373 3,965 - - 52,600 2,455 92 5,586 153 6,642 638 40,980 12,567 33¼ 1,634 9¾ 500 19 5 (1) In addition to 1,374 attendances of "ailing mothers." (2) In addition to 20 visits by unqualified students. (3) Voluntary trained workers. (4) 160 visits by untrained voluntary workers. (5) In addition to 22 visits by untrained workers. (6) In addition to one full-time trained voluntary worker. (7) In addition to 10 visited by unqualified students. (8) In addition to 336 visits by unqualified students. (9) Paid by the hospital and not by Borough Council. (10) Year ended 31st March, 1922. (10495) c 2 20 Attendances of Mothers. Children. Extractions with gas 42 — Filings 47 21 Scalings 12 — Impressions, fitting dentures, &c. 75 — Examinations, &c. 58 4 Observation day-nursery for children who need special care: 1,090 daily attendances in 1921. Cheap dinners for mothers and children : 2,970 dinners for mothers and 2,244 for young children were provided in 1921. At the classes for mothers in 1921 there were 729 attendances at the classes on infant care, 249 at the ante-natal classes, and 887 at the knitting and needlework classes Towards the end of 1921 two consultations a month for children over 18 months of age were started, the doctors giving their services voluntarily. Six of these consultations were held in 1921 (included in table on page 19). North St. Pancras School for Mothers, 129, Queen's Crescent. From July, 1921 onwards, special periodical consultations were held for children aged from 2 to 5 years. Eight such consultations were held in 1921, at which 118 children attended, making 313 attendances (included in Table on page 19). South Highgate Centre. At 15 consultations during the year special arrangements were made for children aged from 2 to 5 years; 47 attendances were made (included in Table on page 19). Argyle Square Group of Centres. Special consultations for older children (included in Table on page 19):— Ages. No. of Consultations No. of New Children. No. of Individual Children. Total Attendances. Argyle Square 1 to 5 11 1 73 250 Oseney Crescent 1 to 2 12 6 150 440 „ „ 2 to 5 12 8 113 316 Massage for Young Children. Under the direction of a voluntary committee massage clinics twice a week were instituted in December, 1920, at three centres in the borough, viz., Ampthill Square, Chalton Street, and Camden Road. Cases from three other centres, viz., South Highgate and the centres of the Maternity Nursing Association and the Mary Ward Settlement have been also dealt with at these three clinics. In November, 1921, a fourth clinic was started at the Queen's Crescent Centre, receiving children from the Grafton Road Centre also. Only children under five attending the infant consultations have been treated, and the massage has been given in accordance with the direction of the doctors in charge of the consultations. The masseuses have been paid at the rate of 1s. per treatment, with a minimum payment of 6s. per clinic. The mothers 21 have been charged in accordance with their means, 3d. per treatment being the most usual charge. The massage treatment has usually been administered twice a week. The cost of the scheme has been defrayed mainly from the voluntary funds of the centres sending the cases, but some of the initial expenses have been met from the special fund raised by the massage clinics committee for the purpose. Dr. Gladys Miall-Smith took a leading part in the institution of the work and the raising of the original fund, and was Hon. Treasurer of the committee. Miss M. E. Bibby, B.A., was Hon. Secretary, and the Medical Officer of Health, Chairman. The masseuses were Mrs. M. Stanford and Miss D. M. Griffin. The former resigned in June. The work done from December 6th, 1920, to December 31st, 1921, is indicated in the following masseuses were Mrs. M. Stanford and Miss D. M. Griffin. The former resigned in June. The work done from December 6th, 1920, to December 31st, 1921, is indicated in the following Table:- No. of Clinics Held. No. of New Cases. Total No. of Attendances. Ampthill Square Clinic 105 - - From Ampthill Square Centre - 64 800 „ Maternity Nursing Association — 23 337 Centre Chalton Street Clinic 103 - — From Chalton Street Centre — 32 317 „ Mary Ward Settlement Centre — 12 179 Camden Road Clinic 103 — — From Camden Road Centre — 53 869 „ South Highgate Centre —- 6 96 „ Grafton Road Centre .—. 6 74 Queen's Crescent Clinic 12 .—. - From Queen's Crescent Centre —. 3 24 „ Grafton Road Centre — 4 23 Dental Clinic —The Borough Council dental clinic for mothers and children was continued during 1921 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 .. 93 „ with nitrous oxide anaesthesia. .. 22 „ of new cases (mothers) 245 359 „ ,, (children).. 114 Total number of attendances (mothers) 1,329 1,632 „ „ (children) 303 Number of attendances for extractions under nitrous oxide .. 268 „ „ „ local anaesthesia .. 120 „ ,, when fillings were done .. 267 „ „ „ scalings „ .. 106 ,, „ for impressions, fitting dentures, &c. .. 541 „ „ examinations, &c. 373 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. 22 In 1921, 105 patients were fitted with dentures. The total cost of these was £384, of which £234 9s. was paid by the patients themselves, £61 14s. by the Borough Council, £14 by the voluntary fund kindly raised by Mr. A. Escott for that purpose, and £73 17s. from other sources, particularly the Metropolitan Hospital Sunday Fund. £9 7s. 6d. was also paid by patients for repairs and additions to old dentures. Mothers and children are also dealt with at the dental clinic (voluntary) at the St. Pancras School for Mothers, 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. Pancras Dispensary, 39, Oakley Square, N.W.l, to which patients are referred from the Town Hall, from the infant welfare centres, by the health visitors, and from other sources. During 1921, 213 new cases under five years of age and 118 ailing mothers or expectant mothers (new cases) were treated at Dr. Provis' clinic. The total attendances at this clinic were 845 of children under five and 413 of ailing mothers and expectant mothers. The corresponding figures for the Dispensary as a whole (including Dr. Provis' clinic, but not the tuberculosis department) were:—children under five, new cases, 462; attendances, 1,627: ailing mothers and expectant mothers; new cases, 202; attendances, 626. The dispensary resident medical officer also made 298 home visits to sick children under 5. The medical officer of the above-mentioned special clinic is paid by the Borough Council. He is assisted by a half-time nurse who is paid from voluntary funds. She made 803 home visits to children under five during the year. The other work of the Dispensary amongst women and children is supported from voluntary sources. Supply of Food to Mothers and Children under School Age.—During 1921 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. In last year's Annual Report full details were given of the scheme as it developed in the course of 1920 and the early part of 1921. In May, 1921, the Council had under consideration a circular from the Ministry of Health, as a result of which the following scale of income was adopted by the Council as a basis for deciding whether grants of milk should be made:— No. in Family. Scale 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 11s. 6d. 8s. „ „ 4 10s. 6d. „ „ 7s. ,, 5 9s. 6d. 6s. 6d. „ „ 6 9s. 6s. „ Families in receipt of less income than that indicated in the table would be entitled to receive milk. The working of the milk scheme is as follows:—Ordinarily, application must be made at once 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 23 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 milk-sellers' 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 medical 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. There has been a growing tendency for the Committee to depart from the scale and to decide what milk should be granted from general considerations. The great majority of the recipients now belong to the families of unemployed men. The extent to which milk has been granted 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 6½ March 17,021 14,442 547 8 2½ April 15,969 12,724 465 4 7 May 14,119 8,503 306 3 4 June 12,219 4,517 239 12 4 July 12,835 2,412 241 8 6 August 13,097 1,810 262 10 9 September 12,018 1,836 242 11 0 October 12,495 1,627 249 10 10½ November 12,678 1,240 249 6 9½ December 11,894 1,954 241 6 7½ Total for 1921 162,079 79,037 4,001 4 4 24  Pints of Milk Granted Free. Pints of Milk Granted Half-price. Cost to Council. 1922. £ s. d. January 11,632 1,428 264 6 9 February 12,440 1,408 246 9 0 March 13,833 1,880 276 19 9 April 12,780 1,490 144 14 10½ May 12,495½ 1,335 137 2 3½ June 10,451 1,094 114 11 3 At the end of 1920 there were 729 families in receipt of milk through the Council's scheme. 842 new families were added to the list of recipients during 1921, and at the end of 1921 there were 472 families in receipt of milk. As will be seen from the table above, there were supplied in 1921, 162,079 pints of milk free and 79,037 pints at half-price, at a cost to the Council of £4,001 4s. 4d., half of which sum is repayable. by the Ministry of Health. This figure does not include the cost of administration. The Council have continued to make an annual grant of £50 to the voluntary committee of the Kentish Town Dining Room for Mothers. This organisation supplies meals for necessitous mothers and young children from the neighbouring maternity and child welfare centres at the National Kitchen, Prince of Wales Road. The Council have placed a room at the committee's disposal for this purpose, and the National Kitchens Committee have charged 9d. a head for dinners consisting of meat, two vegetables and pudding for the mothers, and 3d. a head for lighter meals for children under school age. The price for the mothers' dinners has since been reduced to 7½d. (from 20th February, 1922). The mothers are charged 3d. for their dinners and 1d. for the children's dinners, the rest of the cost being met by the voluntary committee. In many cases of necessity, the whole or part of the mothers' contributions have been found from the voluntary funds of the welfare centre recommending them for dinners. The dining room has been open every weekday and Bank holiday since 8th March, 1921, and from that date until the end of February, 1922, 5,806 dinners to mothers and 1,066 dinners to children under school age have been served. Meals for mothers and children are also supplied by the St. Pancras School for Mothers (see page 20), and for ailing mothers and children, amongst other sick persons, by the Invalid Kitchen, Seymour Street. Particulars will be found on page 68 as to the feeding of school children by the London County Council. 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 ailing children. In 1921, 81 children were admitted. There were no children in the home at the beginning of the year and at the end of the year there were 16 children in residence. The admissions are classified for age as follows:— 0 to 1 7 3 to 4 14 1 to 2 28 4 to 5 10 2 to 3 21 5 1 25 The conditions for which the children were admitted were as follows:— Debility and anaemia 26 Rickets 9 Other nutritional disorders 17 Other conditions 1 Convalescence after- Measles 6 Pneumonia and bronchitis 12 Other conditions 10 — 28 The Home was open on 340 days during the year, and the average length of stay of patients was 69.5 days. No case of infectious disease occurred in the Home during the year. Day Nurseries.—The Council assists the three 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 three institutions are the Whitefield Day Nursery, 53, Whitfield Street, W.l; the Kentish Town Day Nursery, Gospel Oak Grove, N.W.5 ; and the Margaret Day Nursery, 44, Ampthill Square, N.W.1. The St. Pancras Day Nursery, 26, Cartwright Gardens, W.C.I, was closed in June, 1921. Particulars in regard to the day nurseries for the year ended 31st March, 1921, are as follows:— Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. Whitefield Day Nursery £ 164 s, 8 d. 5 225 6,748 30.0 Kentish Town Nursery 289 16 0 259 4,816 18.6 Margaret Nursery 246 4 9 248 4,060 16.4 Home Helps.—The St. Pancras Home Helps Committee provides domestic assistance for families when the mother is laid aside through sickness or child-birth. The Council make the Committee a subsidy at the rate of £150 per annum in respect of maternity cases. 79 cases were assisted in 1921, as follows Maternity 42 Influenza 1 Consumption 2 Care of children during absence of mothers 4 Old age infirmity 1 Sickness connected with maternity 20 Other sickness 9 Three home helps were employed during most of the year. (10495) D 26 Home Nursing.—The work of the four local district nursing associations in this connection (see page 76) includes the nursing of mothers and children. The home nursing of cases of measles, whooping cough, ophthalmia neonatorum and infantile diarrhoea is referred to in the Sections under those headings. The Maternity Nursing Association undertakes "monthly nursing" as well as supplying mid wives. Midwifery. The notifications of births in St. Pancras (1921) 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 180 112 29 60 169 29 266 112 957 Private Mid wivs 189 16 14 49 120 4 275 302 969 Doctors from the Elizabeth Garrett 30 15 4 20 43 20 14 23 169 Anderson Hospital Medical Students from— University College Hospital 99 271 4 3 192 334 2 14 919 Royal Free Hospital 1 1 - 48 1 4 1 — 56 St. Bartholomew's Hospital — — — 2 — — — — 2 Midwives from— Middlesex Hospital — 26 60 3 — 7 — — 96 University College Hospital 1 10 25 135 3 6 — - 180 Maternity Nursing Association, — — — 55 2 1 — — 58 Myddleton Square Maternity Nursing Association, Oakley Square Branch 60 81 18 4 111 61 17 14 366 Attended in Institutions— University College Hospital — — 201 — — — — — 201 Royal Free Hospital — — — 228 — — — — 228 Royal Free Hospital (Marlborough Maternity Section) — — 651 — — — — — 651 Elizabeth Garrett Anderson Hospital — — — — — 38 — — 38 Lying-in Ward of St. Pancras House - - - - - 217 - - 217 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 tables the figures for 1921 are given for St. Pancras women only :— " Extern " Midwifery. *Elizabeth Garrett Anderson Hospital (doctors) 169 University College Hospital (medical students) 919 „ „ „ (midwives) 180 Middlesex Hospital (midwives) 96 Royal Free Hospital (medical students) 56 St. Bartholomew's Hospital (medical students) 2 *Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 424 1,846 (or 39 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. 27 " Intern " Midwifery. In St. Pancras :— University College Hospital 116 Royal Free Hospital 42 Royal Free Hospital (Marlborough Maternity Section) 239 Elizabeth Garrett Anderson Hospital 15 St. Pancras House 142 Out of St. Pancras:— Middlesex Hospital 145 Queen Charlotte's Lying-in Hospital 130 City of London Maternity Hospital 61 "Cedar Lawn," Hampstead 59 Other hospitals 67 1,016 (or 21 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 subsidises the provision of midwifery for St. Pancras residents, the grants being at the rate of 5s. per extern case and £1 per intern case. The amounts paid in respect of 1921 were as follows:— £ s. d. Royal Free Hospital and Marlborough Maternity Section 250 5 0 Elizabeth Garrett Anderson Hospital 52 5 0 Maternity Nursing Association 91 10 0 Queen Charlotte's Lying-in Hospital 90 0 0 City of London Maternity Hospital 56 0 0 . Middlesex Hospital (3 months) 33 10 0 £573 10 0 Government Grants. Government Grants were made during the year ended March 31st, 1922, in respect of Maternity and Child Welfare as follows:— £ s. d. St. Pancras Borough Council 5,171 8 4 St. Pancras School for Mothers (Ampthill Square) 589 1 11 „ „ (Chalton Street) 172 12 6 North St. Pancras School for Mothers 159 1 4 Grafton Road Mothers' and Infants' Welfare Centre 3 9 7 (10495) D 2 28 £ s. d. *Mary Ward Settlement School for Mothers 38 19 4 Camden Town Mothers'and Infants'Welfare Centre 258 0 3 Centres at Argyle Square, Oseney Crescent and Falkland Road 276 9 2 South Highgate Mothers' and Infants' Welfare Centre 24 10 0 Maternity Nursing Association (for Maternity and Child Welfare Centre) 70 1 5 *Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 575 0 0 *University College Hospital (for Maternity and Child Welfare) 1,507 15 1 *Royal Free Hospital (for extern Midwifery and Maternity Nursing) 132 0 0 * „ „ (for Maternity and Child Welfare Centre) 146 10 0 * „ „ (in respect of the Marlborough Maternity Section) 1,900 0 0 St. Pancras Dispensary (Infant Clinic) 283 15 0 Mayoress of St. Pancras Nursing Fund (Home Nursing) 69 18 4 Mayoress of St. Pancras Home for Sick Children 754 0 0 White field Day Nursery 328 16 10 Kentish Town Day Nursery 579 12 0 Margaret Club and Day Nursery 492 9 6 * Including expenditure on work amongst residents outside St. Pancras. DIARRŒA AND ENTERITIS. The year 1921 was characterised by an abnormal amount of sickness and mortality from these causes. This was due to the unusual heat and dryness of the summer season. Particulars as to the weather conditions for the year will be found in Table 6 on page 94, which shows that in every month in the year except January and September the rainfall was less than the average, and that in every month except November the mean air temperature was higher than the average. The rainfall for the year was 14.59 inches, which was less than the average by 9-92 inches. There were in the year 98 deaths from diarrhœa and enteritis of which 83 were of children under five years of age, and 74 of children under one year. The disease is eminently one of the summer and autumn, the infantile form being commonly known as summer diarrhoea, and in the table inset at pages 34 and 35 will be seen the number of deaths from these causes registered week by week. Thirteen were registered in August (4 weeks), 36 in September (5 weeks) and 13 in October (4 weeks); 62 of the total of 98 deaths being reported in these three months. It is satisfactory to record that the amount of mortality from diarrhoea and enteritis was substantially less than in previous years similarly characterised by a hot and dry summer. It has been found that the diarrhœal mortality tends to follow closely the temperature of the earth at a depth of 4 feet. That is to say, it increases at the season when the 4 foot earth temperature is high, and is greatest in the years when this temperature is highest. For purposes of comparison the following particulars are submitted for the past 18 years, the mean of the earth temperatures at 4 feet depth (Camden Square) recorded for the months of August, September and October, being given as an index of the extent to which meteorological conditions favoured the incidence of diarrhceal conditions:— 29 Diarrhoea and Enteritis. Year. Births Registered. Deaths from Diarrhœa and Enteritis. Infantile Mortality— from all Causes— per 1,000 Births. 4-foot Earth Temperature (Mean for Aug., Sept. and Oct.). All Ages. Under 5. Under 1. Deaths under 1 per 1,000 Births. Deg. F. 1904 6,116 257 237 205 34 152 57.3 1905 5,801 202 192 159 27 136 57.5 1906 5,744 234 228 189 33 131 58.9 1907 5,484 104 89 75 14 113 56.5 1908 5,546 142 135 107 19 115 57.3 1909 5,238 105 99 80 15 108 56.9 1910 5,385 82 78 59 11 107 56.8 1911 5,555 248 218 168 30 112 59.5 1912 5,367 45 35 32 6 88 55.3 1913 5,517 148 127 95 17 93 56.8 1914 5,225 142 127 106 20 92 57.6 1915 4,754 114 107 79 17 105 56.5 1916 4,530 72 56 41 9 85 56.8 1917 3,796 97 80 61 16 106 57.4 1918 3,318 56 47 37 11 102 57.0 1919 3,824 68 55 47 12 88 57.2 1920 5,934 54 44 37 6 73 57.9 1921 4,764 98 83 74 16 76 60.1 It will be seen from this table that the infantile diarrhœal mortality in 1921, although higher than in certain recent years, compares very favourably with the mortality in former hot years. The rate for 1921 was 16, whereas in 1911 it was 30, and in certain years before that date even more. Yet the weather conditions in 1921 as judged by the earth temperature (60.1° Fahr.) can be regarded as actually worse than in 1911 (59.5) or any previous year included in the table. With a view to a more graphic representation of the improvement in this respect the chart on the next page is presented showing the infantile diarrhœal mortality rate and the 4-foot earth temperature for the years in question. There is good reason to believe that the decline in the infantile mortality caused by hot and dry summer conditions, like the diminution in the infantile mortality from all causes, is a manifestation of the good results of the campaign of recent years for the promotion of maternity and child welfare. During the hot months of the year a bill was posted throughout the borough warning parents of the danger of summer diarrhoea and giving advice as to the prevention of the disorder and the steps to be taken if it supervened. The practice which has been in operation for many years of sending during the hot months to all mothers of newly-born infants special advice in connection with the risk of infantile diarrhoea was also continued. The advice is printed on a special leaflet which, during the hot season, is enclosed with the advice-card that is always sent to the mother upon receipt of a birth-notification. The Council undertake to pay the district nursing associations for the home nursing of cases of infantile diarrhoea. In the year 1921 only 34 nursing visits were made (to 8 cases) under this arrangement. 30 Chart showing the Infantile death rate from Diarrhoea and Enteritis and the Four Foot Earth Temperature in August, September and October for the Years 1904 to 1921. The figures on the left and the continuous line represent the mortality from diarrhœa and enteritis of children under one year of age, per 1,000 births. The figures on the right and the dotted line represent the mean of the mean monthly 4.foot earth temperature (fahrenheit) at camden Square for August, September and October. PUERPERAL FEVER. Eleven cases of puerperal fever were notified during 1921, equal to an incidence rate of 2.3 per 1,000 births. Four deaths occurred amongst these, giving a case mortality of 36 per cent. Two cases were treated at home, and nine in hospitals. Eight cases followed the birth of live-born infants, two the birth of a non-viable foetus, and 1 the birth of a dead viable infant. 31 Three of the patients were primiparae (i.e., women who had not previously borne children), and 8 multiparae. In one case "instruments" had been used at the confinement. 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:— 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 1,000 births. Doctors 4 1,126 3.6 Midwives from Institutions 2 700 2.9 Private Midwives 2 969 20 Medical Students — 977 — In Hospital 2 — — In one case the mother had no skilled attention at the time of miscarriage, the doctor not being called in until three days later. OPHTHALMIA NEONATORUM. One hundred and one cases were notified in 1921, equal to 21-2 per 1,000 births—89 of these were notified by medical practitioners, 7 by midwives and 5 by both. Twelve of the cases were regarded as grave, 37 as moderate and 52 as slight. Five of the cases have since died. Twelve 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 1,000 births. Doctors 15 1,126 13.3 Midwives from Institutions 25 700 35.7 Private Midwives 15 969 15.5 Medical Students 26 977 26.6 In Hospitals and Institutions 20 - - Every case was visited on the day of the receipt of notification. 15 cases were removed to hospital, and 84 were treated at home, with the help of a visiting nurse in 59 cases. In two other cases the patient was treated at home at first with the help of a visiting nurse and afterwards removed to hospital. The results of treatment were as follows:— Complete recovery (3 of these afterwards died) 85 Blind Sight damaged (4 gravely ; 1 slightly) 5 Died before recovery 2 Removed and lost trace of 9 It is interesting to note that in all the five cases in which the eyes were permanently injured, either the Public Health Department had not been able to exercise early supervision, or the advice given had not been followed. This will be seen from the following details:— H.D.—Both eyes injured by opacities, and at 3½ months the sight was imperfect (after which time the baby went abroad and is said to have improved). The mother was advised at the time of 32 notification to let the child be admitted to hospital. This she refused to do until the fourteenth day of the disease, when the baby was admitted. In the meantime treated by private doctor and visiting nurse. Private midwife's case. K. D.—Slight opacity of one eye, the other normal. Onset not until about the sixteenth day, and not notified until admitted to the fever hospital when 36 days old because the mother had diphtheria. W. T.—One eye destroyed and is to be removed, the other has opacities which have improved, and the baby can see. The inflammation is said to have begun on the first day, and the case was not notified until the eleventh day. The confinement was attended by a medical student, and the patient was treated as an out-patient until notification. Upon notification a visiting nurse was called in at once. B. K.—One eye badly damaged, the other normal. The damage occurred before the baby was discharged from the hospital in which it was born. R. O.—One eye completely lost, and the other so much damaged that for a time the child was quite blind. An operation, however, has restored the sight of the latter eye. The case was never notified, and was unknown to the department until after it was admitted to hospital when 17 days old. Born in hospital. In the cases known to the Department from the first the results have been most favourable. The system of admitting the worst cases to hospital and sending in a visiting nurse to the others (under skilled medical supervision) has given good results. For the purpose of comparison a table is set out below showing certain particulars for nine years. It will be seen that there has been a considerable increase in notified cases in the last two years. A considerable portion of the increase was amongst the slight cases, but there has also been an increase amongst the moderate and grave cases. Until 1920 there was apparently a smaller incidence in the practice of medical students and midwives from institutions, which we were inclined to attribute to the regular prophylactic use of silver solutions, but in the last two years the figures have been reversed in this respect. 1913 1914 1915 1916 1917 1918 1919 1920 1921 Number of cases 27 34 29 34 27 38 38 66 101 Slight - 14 14 12 12 18 13 31 52 Moderate - 13 16 14 11 15 17 27 37 Grave - 7 3 8 4 5 8 8 12 Notification rate per 1,000 births 4.9 6.5 6.1 7.5 7.1 11.5 9.9 11.1 21.2 Notification rate per 1,000 births in the practice of— Doctors 7 8 5 7.3 5.7 2.4 9.9 11.0 13.3 Private Midwives 5 13 7.3 13.8 6.6 18.6 16.3 11.9 15.5 Midwives from Institutions 0 0 6.7 1.0 4.9 4.6 20.3 35.7 Medical Students 0.9 1.5 3.4 3.6 1.2 9.9 3.8 3.9 26.6 Results of treatment— Complete recovery (qua eyes) 23 27 23 27 21 29 28 59 85 Sight damaged 1 2 2 2 1 3 1 1 5 Complete blindness — — — — 1 — — 1 — Died before recovery — 1 1 1 2 2 4 2 2 Lost trace of 3 4 3 4 2 4 5 3 9 Illegitimate - — - 8 8 11 9 5 12 The same facilities as in the case of measles (see below) are available for the home nursing of cases of Ophthalmia Neonatorum, and in 1921 the visiting nurses made 1,495 visits to 58 cases of ophthalmia. 33 MEASLES AND GERMAN MEASLES. These diseases are compulsorily notifiable in St. Pancras in virtue of the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920. All cases are notifiable by parents and guardians, but only the first case occurring in an outbreak in a household or institution is notifiable by medical practitioners, an interval of two months since the last case constituting an outbreak. Subject to correction for diagnosis in certain instances 1,149 cases of measles and 81 of german measles were notified or otherwise discovered in 1921. This represents an incidence rate of 5.4 per 1,000 population for measles and 0.38 for german measles. Twenty-three deaths from measles were registered during the year, equal to a death-rate of 0.11 per 1,000 population, and a case mortality of 2.0 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 759 80 „ parents and guardians 258 — Discovered otherwise 132 1 1,149 81 Further statistical facts in regard to the disease will be found on pages 34-36. 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 102 cases of measles were nursed, 858 nursing visits being made. In 99 families the patients were supplied with milk, &c., from the fund. The cases notified, the number of deaths, and the percentage case mortality for the six years during which the disease has been notifiable, were as follows:— Year. Cases Notified. Deaths. Percentage Case Mortality. 1916 1,885 42 2.2 1917 3,681 118 3.2 1918 2,144 75 3.5 1919 1,034 15 1.5 1920 3,093 65 2.1 1921 1,149 23 2.0 WHOOPING COUGH. The number of St. Pancras deaths from whooping cough in the past 10 years are as follows:— 1912 47 1917 27 1913 36 1918 80 1914 49 1919 7 1915 52 1920 60 1916 39 1921 38 Six cases of whooping cough were nursed in 1921 through the Mayoress' Nursing Fund, 74 nursing visits being made. In 26 families the patients were supplied with milk, &c., from the fund. ANTERIOR POLIOMYELITIS. See page 52, (10495) E 34 Section III.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1921 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 1. 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 Smallpox — — — — — — — 2. Scarlatina or Scarlet Fever 1,713 22 314 779 415 128 55 — 3. Diphtheria and Membranous Croup 723 13 168 258 149 77 58 — 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 28 — 1 3 — 9 15 — 6. Fever, Simple or Continued 7. Relapsing Fever — — — — — — — — 8. Puerperal Fever 11 — — — — 2 9 — 9. Erysipelas 87 1 4 5 6 8 47 16 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax — — — — — — — — 13. Glanders — — — — — — — — 14. Hydrophobia — —. — — — — — — 15. Cerebrospinal Meningitis 4 2 — — 1 — 1 — 16. Anterior Poliomyelitis and Polioencephalitis 4 1 2 1 — — — — 17. Ophthalmia Neonatorum 101 101 — — — — — — 18. Encephalitis Lethargica 8 — — — 1 — 6 1 19. Acute Primary Pneumonia 242 38 66 24 7 20 74 13 20. Acute Influenzal Pneumonia 99 1 4 5 5 8 58 18 21. Malaria 18 — 1 — 1 1 15 — 22. Dysentery 1 — — — — — 1 — 23. Trench Fever — — — — — — — — 24. Measles 1,149 86 496 474 70 10 13 — 25. German Measles 81 11 21 35 11 1 2 — 26. *Tuberculosis— Pulmonary 546 1 4 19 23 86 392 21 Other Forms 153 10 22 38 41 20 21 1 * 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 prom the Dangerous Infectious Diseases during the Year 1921. 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 8 15 22 29 5 12 19 26 5 12 19 26 April 2 9 16 23 30 7 14 21 28 4 11 18 25 July 2 9 16 23 30 6 13 20 27 3 10 17 24 Oct. 1 8 15 22 29 5 12 19 26 3 10 17 24 31 ... Week Ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 .16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ... Number of Week. Scarlet Fever - - - 1 - - - - - - - - - - - - 1 1 - - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 7 Scarlet Fever. Diphtheria and Memb. Croup - - 2 - 4 3 1 - - - 1 - 2 1 1 3 1 1 - - 1 1 - - - - 1 2 1 - - 2 - 1 2 1 - 1 2 - - - - 2 2 3 1 1 2 - 2 3 51 Diphtheria and Memb. Croup. Enteric Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 - - - - - - - - - - - - 1 3 Enteric Fever. Puerperal Fever 1 - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 4 Puerperal Fever. Erysipelas - - - - - 1 - 1 - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Erysipelas. Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Malaria. Cerebrospinal Fever 1 - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - 4 Cerebrospinal Fever. Dysentery - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 Dysentery. Encephalitis Lethargica 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - 3 Encephalitis Lethargica. Measles - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - 2 1 - - - - - - 1 2 - - 3 3 3 1 2 1 3 23 Measles. Tuberculosis (Pulmonary) 4 1 6 7 7 2 7 5 5 6 3 6 1 9 8 5 4 1 3 5 5 4 5 10 7 3 2 2 5 4 6 3 2 2 5 3 5 6 1 5 5 3 2 6 8 5 8 7 7 9 5 250 Tuberculosis (Pulmonary). Tuberculosis (Other Forms) - - 1 1 2 1 2 3 1 - - 2 1 1 3 1 3 1 - 3 2 2 - - 2 1 1 - - - - - 1 - 1 1 1 2 1 1 2 - - - 2 - 4 2 - - 1 1 54 Tuberculosis (Other Forms). Whooping Cough - - 2 - - 1 - 1 2 1 2 2 1 - 1 1 1 - 2 1 - 1 2 1 - 2 1 1 - 1 1 - - 2 - 1 - - - 1 1 - - - - - - - - 1 2 2 38 Whooping Cough. Diarrhœa and Enteritis 2 - 3 3 2 - 2 - 1 3 1 - 1 - - - - 1 - - 1 - 2 - 2 - 1 2 - - 1 3 5 4 7 5 7 9 8 3 4 3 3 1 2 1 1 1 - 1 1 1 98 Diarrhœa and Enteritis. (10495) SAINT PANCRAS, LONDON. Weekly Number of Infectious Cases certified to the Medical Officer of Health during the Year 1921. 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 8 15 22 29 5 12 19 26 5 12 19 26 April 2 9 16 23 30 7 14 21 28 4 11 18 25 July 2 9 16 23 30 6 13 20 27 3 10 17 24 Oct. 1 8 15 22 29 5 12 19 26 3 10 17 24 31 ... Week Ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ... Number of Week. Scarlet Fever 14 26 17 27 26 25 21 13 22 22 14 25 19 26 18 14 16 16 18 27 23 28 22 25 23 16 21 26 25 27 18 14 30 20 31 49 52 34 47 72 74 75 61 65 43 70 62 45 44 40 56 69 1,713 Scarlet Fever. Diphtheria and Memb. Croup 9 6 18 10 17 11 8 15 12 9 9 16 19 12 16 19 15 16 6 4 9 11 12 14 8 11 13 11 13 4 6 4 8 9 12 21 25 15 18 15 16 23 16 28 25 27 21 21 16 16 18 10 723 Diphtheria and Memb. Croup. Enteric Fever - 1 1 - - - 1 - - - - - - - - - - - 1 - 1 - - - - 3 1 - 3 1 - 1 - - 3 - - - - 1 1 2 2 2 - 1 - - - 1 - 1 28 Enteric Fever. Puerperal Fever - - - - - - - - - - - - - - - - - 2 - - - - 1 1 - - - - - 2 - - - - - 1 - - - 1 - - - - 1 - - 1 - - - 1 11 Puerperal Fever. Erysipelas 2 5 3 1 - 2 5 1 1 3 4 2 1 1 1 3 - 2 1 - 2 - 1 1 2 2 2 - - 2 - 1 1 4 1 - 1 - 1 4 2 2 3 3 5 1 2 1 - 2 1 2 87 Erysipelas. Cerebrospinal Fever 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - 4 Cerebrospinal Fever. Poliomyelitis - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - 1 - - - - - - - 1 - - - - - - - - 4 Poliomyelitis. Ophthalmia Neonatorum 4 4 - 4 4 3 1 1 4 2 2 3 4 2 - 5 - 1 1 - 6 4 3 2 3 2 1 2 2 3 - 1 2 - 2 - 1 4 - - 2 3 1 3 - 1 1 4 1 1 - 1 101 Ophthalmia Neonatorum. Encephalitis Lethargica 1 1 1 - - 1 - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - - - - - - - - - 8 Encephalitis Lethargica. Acute Primary Pneumonia 7 22 15 8 6 4 13 8 7 14 4 6 9 7 5 4 2 2 2 - 3 2 2 - 1 6 - 1 5 1 2 - - 1 2 - 4 5 1 2 2 1 1 2 5 4 9 9 2 8 4 12 242 Acute Primary Pneumonia. Acute Influenzal Pneumonia 5 1 - - 1 1 3 10 14 3 1 3 1 5 1 6 3 - 2 2 - 1 4 - - - - 1 1 - 1 - - - 1 - - - 1 - 1 1 - - - 1 2 - 1 1 3 21 99 Acute Influenzal Pneumonia. Malaria - 2 - - - 2 - - 2 2 - - - - - - 1 - - - - 1 1 1 1 1 1 1 - - - - - - - - - - - - - - - - 1 - - 1 - - - - 18 Malaria. Dysentery - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 Dysentery. Measles 9 6 5 4 2 2 2 3 7 3 9 3 8 10 - 7 6 8 5 1 2 3 4 5 6 2 4 4 3 1 6 6 4 9 5 5 6 5 5 21 36 33 45 50 66 35 122 87 74 185 72 138 1,149 Measles. German Measles - - - 1 - 2 1 2 - 2 2 1 4 - - 4 1 - 1 - 1 1 2 1 3 2 - 7 4 4 2 2 - - - 2 3 2 - - - 2 1 2 1 1 3 3 2 2 5 2 81 German Measles. Tuberculosis (Pulmonary) 4 12 20 8 5 14 12 14 7 12 11 10 1 14 18 15 13 4 20 12 11 2 16 11 10 10 5 12 8 13 2 6 12 13 6 14 4 6 8 15 10 10 12 8 6 15 16 10 12 6 8 23 546 Tuberculosis (Pulmonary). Tuberculosis (Other Forms) 1 3 5 3 5 7 4 4 3 3 - 2 2 5 1 9 4 4 5 2 7 1 6 3 1 1 5 3 2 1 1 1 3 3 2 4 - 2 1 7 2 4 4 - - 2 5 2 2 1 2 3 153 Tuberculosis (Other Forms). (10495) 35 In the accompanying tables (inset) are shown the number of notifications of the notifiable infectious diseases received in each week of the year, and also the corresponding weekly number of deaths from these and certain other diseases. In the following table the number of notifications are set forth for the past 10 years Diseases. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Variola or Smallpox — — — — — — — 10 — — Scarlatina or Scarlet Fever 598 568 1,207 1,009 448 246 332 558 863 1,713 Diphtheria and Membranous Croup 550 440 458 446 424 451 399 348 747 723 Typhus Fever — — — — — — — — — — Enteric or Typhoid Fever 29 41 44 36 38 24 17 7 18 28 Fever, Simple or Continued — 1 1 — 1 Relapsing Fever — — — — — — — — 1 — Puerperal Fever 20 11 18 14 18 9 5 13 18 11 Erysipelas 190 210 223 202 120 126 121 134 126 87 Cholera — — — — — — — — — — Plague — — — — — — — — — — Anthrax — — — — 1 — 1 — — — Glanders — — — — — — — — - — Hydrophobia — — — — — — — — — — Cerebrospinal Meningitis 3 5 2 40 23 25 13 10 6 4 Anterior Poliomyelitis and Polioencephalitis 3 9 3 8 9 1 1 4 2 4 Ophthalmia Neonatorum 18 23 34 31 38 31 40 39 69 101 Encephalitis Lethargica ... ... ... ... ... ... ... 3 11 8 Acute Primary Pneumonia ... ... ... ... ... ... ... 86 142 242 Acute Influenza] Pneumonia ... ... ... ... ... ... ... 213 108 99 Malaria ... ... ... ... ... ... ... 98 58 18 Dysentery ... ... ... ... ... ... ... 6 4 1 Trench Fever ... ... ... ... ... ... ... 1 — — Measles ... ... ... ... 1,855 3,681 2,144 1,034 3,093 1,149 German Measles ... ... ... ... 381 609 311 268 195 81 Chicken-pox ... ... ... 247 ... ... 401 ... ... ... Tuberculosis— Pulmonary 1,735 928 893 933 735 825 1,034 799 684 546 Other Forms 230 121 150 138 169 203 206 132 153 (10495) E 2 36 The notifications of, and deaths from, the notifiable infectious diseases, are classified in the following table according to their Wards and Registration Sub-Districts Infectious Diseases. Notifications. Deaths. West. Ward. South. Ward. East. Ward.. North. Ward. No Address. Whole Borough. West. Ward. South. Ward. East. Ward. North. Ward. No Address. Whole Borough. 4 5 7 8 3 6 1 2 4 5 7 8 3 6 1 2 1. Variola or Smallpox - - - - - - - - - - - - - - - - - - - - 2. Scarlatina or Scarlet Fever 149 257 94 250 252 198 302 211 — 1,713 — 3 2 — 2 — — — — 7 3. Diphtheria and Membranous Croup 81 116 35 86 79 81 126 119 — 723 5 6 1 6 12 6 11 4 — 51 4. Typhus Fever ... — — — - — — — — — — — — — — — — — — — — 5. Enteric or Typhoid Fever 3 4 4 1 3 4 4 5 — 28 — 1 1 — — — 1 — — 3 6. Fever, Simple and Continued - - - - - - - - - - - - - - - - - - - - 7. Relapsing Fever - - - - - - - - - - - - - - - - - - - - 8. Puerperal Fever 2 1 — 1 — 1 3 3 — 11 1 1 — — — — 1 1 — 4 9. Erysipelas 11 11 6 11 14 11 12 11 — 87 — 1 1 — — 1 — — - 3 10. Cholera - - - - - - - - - - - - - - - - - - - - 11. Plague - - - - - - - - - - - - - - - - - - - - 12. Anthrax - - - - - - - - - - - - - - - - - - - - 13. Glanders - - - - - - - - - - - - - - - - - - - - 14. Hydrophobia - - - - - - - - - - - - - - - - - - - - 15. Cerebrospinal Meningitis — — — 2 — — 1 1 — 4 1 — — 2 — — — — — 3 16. Anterior Poliomyelitis — - 3 — — 1 — — — 4 — - — — — — — — — — 17. OphthalmiaNeonatorum 4 28 19 14 11 13 7 5 — 101 - - - - - - - - - - 18. Encephalitis Lethargica 3 — — 2 — 2 1 — — 8 — — 1 1 — — 1 — — 3 19. Acute Primary Pneumonia 28 41 6 20 68 36 23 20 — 242 - - - - - - - - - - 20. Acute Influenzal Pneumonia 10 12 2 13 25 18 14 5 — 99 - - - - - - - - - - 21. Malaria 2 4 — — 8 1 1 2 — 18 - - - - - 1 — — — 1 22. Dysentery — — — 1 — — — — — 1 — — — 1 — — — — — 1 23. Trench Fever - - - - - - - - - - - - - - - - - - - - 24. Measles 197 134 11 162 319 43 109 174 — 1,149 2 1 — - 11 3 1 5 — 23 25. German Measles 13 9 5 5 5 6 22 16 — 81 - - - - - - - - - - 26. †Tuberculosis— Pulmonary 78 73 61 55 74 57 56 67 25 546 31 35 24 34 25 27 36 30 8 250 Other Forms 18 23 3 10 22 28 24 21 4 153 6 6 3 5 11 7 4 11 1 54 † Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912 on Forms "A," "B," "C," or "D." 37 DISINFECTING AND CLEANSING STATION. Disinfection. I he 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. Smallpox - - - - Scarlet Fever 1,576 1,554 1,565 1,566 Diphtheria 676 640 664 654 Enteric Fever 22 22 22 - Erysipelas 63 63 63 — Puerperal Fever 10 10 10 — Cerebrospinal Meningitis — — — — Consumption 74 72 58 53 Measles 17 17 12 12 Cancer 32 32 32 11 Vermin and Scabies 47 47 45 7 Other Diseases 208 208 207 27 Totals 2,725 2,665 2,678 2,330 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 79 2,784 5 28 Bolsters and pillows 19 5,056 2 34 Sheets, blankets and counterpanes 8 7,990 1 143 Rugs, mats, cushions, carpets, covers, and curtains 10 1,355 7 23 Wearing apparel 2 4,150 7 41 Books 5 23 — — Sundries 4 825 5 31 Total 127 22,183 27 300 The tables above are exclusive of the disinfection of the clothing of persons attending the cleansing station for vermin or scabies. 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 2 1 - Puerperal Fever — 6 — Other Diseases 2 2 — 38 Cleansing Station. The amount of work done here during the year is indicated in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. Men. Women. Children under 15. Total. St. Pancras Cases— Vermin 613 18 2,529 *3,160 Scabics 71 35 1,725 1,831 Cases from outside St. Pancras— Vermin 77 1 1.043 1,121 Scabies — 2 728 730 Vermin 690 19 3,572 4.281 Scabies 71 37 2,453 2,561 Total 761 56 6,025 6,842 * Includes 268 males and 3 females who had no home address. The school children included in the above table have, in the main, been brought to the cleansing station from the public elementary schools by officials of the London County Council as the Education Authority under the powers conferred upon them by their General Powers Act, 1904, sec. 36 and the Children Act, 1908, sec. 122. As from the beginning of the year the basis of payment by the County Council to the Borough Council in respect of this work was altered from 1s. per bath to 2s. per child cleansed, so far as concerned pediculosis. This alteration was made in view of the institution of a more intensive method of dealing with the hair of verminous children, whereby the time spent over the cleansing was increased, but the operation of disinfestation limited in many cases to one cleansing only. The payment in respect of children suffering from scabies remained at 1s. per bath, as before. 3,559 cases were paid for during the year at the rate of 2s. per case, and 2438 cleansings at the rate of 1s. per bath. School children with head lice have also been dealt with by the London County Council at the Prince of Wales Road Clinic. 86 verminous persons from common lodging houses outside the borough were paid for by the London County Council at the rate of 1s. per attendance, and also 3 persons from Finsbury, paid for by the Finsbury Borough Council at the same rate. TUBERCULOSIS. The number of notifications of civilian cases of tuberculosis received during 1921 are set out in the following table, in the form required by the Ministry of Health:— Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 3rd January, 1921, to the 31st December, 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 1 - 5 4 16 27 59 65 46 36 10 269 286 - 2 1 3 4 91 153 100 105 Females — 4 6 11 17 16 44 32 20 5 6 161 179 .—. 1 3 4 5 58 69 36 44 Non-pulmonary— Males 4 15 10 8 3 1 4 6 3 - - 54 56 - 5 5 10 13 6 7 2 6 Females 5 6 15 14 9 6 3 3 1 — 1 63 64 — 4 8 12 12 1 5 — 5 Totals 10 25 36 37 45 50 110 106 70 41 17 547 585 - 12 17 29 34 156 234 138 160 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 15 to 55 55 to 65 65 and upwards. Total. Pulmonary— Males — — 3 2 2 2 14 8 18 9 3 61 - - - - - - 2 1 6 2 — 11 Females — — 2 1 3 2 7 6 4 4 2 31 — — — 1 1 - - 1 3 - — — 6 Non-pulmonary— Males 1 1 1 3 1 — — — — 1 — 8 — — 1 — — — — — - — — 1 Females — — 1 2 — — — — — — — 3 — — 1 1 — — — — - — — 2 Totals 1 1 7 8 6 4 21 14 22 14 5 103 — 2 2 2 1 - 3 4 6 2 — 20 39 40 The number of primary notifications (civilian) received during the year on Forms A, B, C and D was 699 (546 pulmonary, 153 non-pulmonary) equal to a notification rate of 3-28 (2.56 pulmonary, 0.72 non-pulmonary) per 1,000 population. They are analysed for age and Sex in the next table:— Primary Notifications during 1921. Ages. Pulmonary Tuberculosis. Other Tuberculosis. Total all Forms. Males. Females. Total. Males. Females. Total. 0—1 1 1 5 5 10 11 1—5 — 4 4 16 6 22 26 5—10 10 9 19 17 21 38 57 10—15 7 16 23 16 25 41 64 15—25 47 39 86 5 15 20 106 25—35 75 52 127 4 3 7 134 35—45 74 41 115 6 3 9 124 45—55 70 24 94 3 1 4 98 55—65 47 9 56 1 - 1 57 65 upwards 13 8 21 - 1 1 22 Totals 344 202 546 73 80 153 699 The deaths from tuberculosis during the year numbered 304, of which 250 were from phthisis and 54 from other forms of tuberculosis. They are analysed for age and sex in the following table:— Deaths from Tuberculosis during the Year 1921. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0—1 1 - 1 2 5 7 8 1—2 — — — 4 4 8 8 2—5 — 1 1 3 2 5 6 5—10 1 —. 1 4 8 12 13 10—15 1 5 6 3 5 8 14 15—25 18 22 40 2 2 4 44 25—35 22 22 44 - 1 1 45 35—45 31 23 54 3 1 4 58 45—55 38 10 48 2 1 3 51 55—65 27 9 36 — - — 36 65—75 12 5 17 —. 2 2 19 75—85 — 2 2 - - — 2 85 and upwards — — — — — — — Totals at all ages 151 99 250 23 31 54 304 41 The figures are equal to a death rate of 1.43 (1.17 pulmonary, 0.25 non-pulmonary) per 1,000 population. The sex distribution of the notification rates and death rates for 1921 is shown in the following table:— Notification rates per 1,000 Males or Females Living. Death rates per 1,000 Males or Females Living. Pulmonary. Nonpulmonary. Total. Pulmonary. Nonpulmonary. Total. Males 3.42 0.73 4.15 1.50 0.23 1.73 Females 1.80 0.71 2.51 0.88 0.27 115 Both Sexes 2.56 0.72 3.28 117 0.25 1.43 In regard to age incidence, 74 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, 74 per cent. of the deaths and 73 per cent, of the new cases notified were of children aged 15 years or under. The deaths 111 1921 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 1-5 5-15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 | 85 up. Total Females. Total Persons. Pulmonary Tuberculosis 1 - 2 18 21 28 34 27 11 - - 142 - 1 4 18 19 21 8 9 4 2 - 86 228 Phthisis (not defined as tuberculous) — - — - 1 3 4 — 1 — - 9 - — 1 4 3 2 2 - 1 - - 13 22 Total Pulmonary Tuberculosis 1 — 2 18 22 31 38 27 12 — - 151 — 1 5 22 22 23 10 9 5 2 - 99 250 Acute Phthisis - - - — - - - - - - - - - - - - - - - - - - - - - Acute Miliary Tuberculosis 1 2 — — — 2 1 — — — — 6 1 — — 1 — — — — — - 2 8 Tuberculous Meningitis 1 5 5 - - - - - - - - 11 3 5 6 - - - - - - - - 14 25 Tabes Mesenterica - - - - - - - - - - - - - - - - - - - - - - - - - Other Peritoneal and Intestinal Tubercle — — — 1 — 1 1 — — — - 3 1 — 4 - 1 - - - - - - 6 9 Tuberculosis of Spinal Column - - - 1 - - - - - - - 1 - - - - - 1 — — 1 — - 2 3 Tuberculosis of Joints - - 1 - - - - - - - - 1 - - - - - - - - - - - — 1 Lupus - - - - - - - - - - - - - - - - - - - - - - - - - Scrofula - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis of other Organs - - - - - - - - - - - - - - 3 1 — — — — 1 — - 5 5 Disseminated Tuberculosis - — 1 - — — — - — — — 1 — 1 — — — — 1 — — — - 2 3 Total Non-Pulmonary Tuberculosis 2 7 7 2 - 3 2 - - - - 23 5 6 13 2 1 1 1 — 2 - - 31 54 Total all forms of Tuberculosis 3 7 9 20 22 34 40 27 12 - - 174 5 7 18 24 23 24 11 9 7 2 - 130 104 (104951 r 42 In the next table the new cases notified during 1921 are similarly classified. Location of Disease. Ages. Total. 0—5. 5—15. 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 1 4 17 25 326 173 546 Bones and Joints 2 1 8 9 5 10 35 Meninges 9 7 4 4 - - 24 Glands 5 2 14 21 7 9 58 Abdominal 2 — 6 7 1 1 17 Genito-Urinary — — — - 2 1 3 General 2 2 - - 1 - 5 Other Organs — — — 4 5 2 11 Total Non-Pulmonary Tuberculosis 20 12 32 45 21 23 153 Total all forms of Tuberculosis 21 16 49 70 347 196 699 The following table shows the number of new notifications and deaths from Tuberculosis, together with the corresponding rates for the past ten years :— Year. Estimated Population. Primary Notifications. Deaths. Notification Rate. Death Rate. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. 1912 220,353 1,735 1,735 326 75 401 7.87 1.48 0.32 1.82 1913 218,387 928 230 1,158 325 67 392 4.17 1.03 5.20 1.49 0.30 1.79 1914 218,387 893 121 1,014 365 67 432 4.09 0.55 4.64 1.67 0.30 1.97 1915 218,387 933 150 1,083 398 102 500 4.27 0.69 4.96 1.82 0.47 2.29 1916 218,387 735 138 873 340 83 423 3.36 0.63 3.99 1.55 0.38 1.93 1917 218,387 825 169 994 353 91 444 3.78 0.77 4.55 1.62 0.42 2.03 1918 218,387 1,034 203 1,237 403 82 485 4.74 0.93 5.67 1.85 0.37 2.22 1919 218,387 799 206 1,005 268 73 341 3.66 0.94 4.60 1.23 0.33 1.56 1920 218,387 684 132 816 249 63 312 3.07 0.59 3.67 1.12 0.28 1.40 1921 212,900 546 153 699 250 54 304 2.56 0.72 3.28 1.17 0.25 1.43 43 Home Visiting. The home visiting of notified and 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. From the Town Hall, Miss Blaxland 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. The visiting (and certain other) work carried out in the borough in connection with tuberculosis during 1921 was as follows:— Home visits* by— Tuberculosis officers 193 Women inspectors— (a) First visits to notified cases 558 (b) Subsequent visits 2,053 Tuberculosis dispensary nurses 1,272 4,076 Attendance of women inspectors at dispensaries 470 Other visits of women inspectors for various purposes 218 No. of cases in which disinfection was carried out 74 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. In that part of the borough (Wards 1-6) the cases of tuberculosis notified in 1921 numbered 541 (405 pulmonary and 136 nonpulmonary) and the deaths registered 229 (184 pulmonary and 45 non-pulmonary). 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 south 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. In that part of the borough (Wards 7 and 8) the cases of tuberculosis notified in 1921 numbered 149 (136 pulmonary and 13 non-pulmonary) and the deaths registered 66 (58 pulmonary and 8 non-pulmonary). The Tuberculosis Officer at St. Pancras Dispensary (Dr. G. T. Calthrop) left on 1st October, 1921, and his place was taken temporarily by Dr. G. F. Hardy until 3rd May, 1922, when the new Tuberculosis Officer,Dr. N. M. Donnelly, took up his duties. At University College Hospital Dr. W. Fenwick Jones, the Tuberculosis Officer, left at the end of March and his place was taken temporarily by Dr. S. J. Cowell. The new Tuberculous Officer, Dr. H. Evans, began work in December. Co-operation with hospitals, &c.—Cases referred by the school medical officer to the Tuberculosis Officer are examined and appropriately treated where necessary. Children attending the dispensary and needing such treatment as is provided at the school clinic, especially dental treatment, are referred there for that purpose. At the St. Pancras Dispensary considerable use is made by the Tuberculosis Officer of the general dispensary, particularly in referring ear, nose and throat and skin cases. The use of hospitals for X-ray diagnosis, &c., is referred to below. * Exclusive of visits made by members of the Interim Tuberculosis Care Committee. (10495) F 2 44 Co-operation with general practitioners.—Progress has been made in 1921 in securing the personal co-operation between the Tuberculosis Officer and general practitioners; and steps are now being taken with a view to making more complete the system whereby practitioners should report periodically on insured persons under domiciliary treatment. Following up of doubtful cases.—Special note is made of those cases who are required to attend again for observation, and in the event of their failing to do so they are specially visited on the subject. Home contacts.—The visitors endeavour to secure the attendance at the dispensary of all home contacts, and continue the supervision of them in the course of their visiting. Special methods of diagnosis and treatment.—(a) X-ray diagnosis : cases are referred for this purpose to University College Hospital. There were 14 such cases in 1921. (b) Light treatment for lupus: payment has been made for treatment of 2 cases in 1921 at the London Hospital. Dental clinic.—In 1921 a dental clinic for tuberculous persons was equipped at the St. Pancras Dispensary, 39, Oakley Square, and Mr. Southcomb May, L.D.S., was appointed as dental surgeon. The first clinic was held on 4th April. All cases dealt with are referred to the dentist by the Tuberculosis Officer. From 4th April to the end of 1921, 21 clinics were held, at which 80 cases made 112 attendances. No. of attendances for extractions under nitrous oxide 59 „ „ when fillings were done 32 „ „ „ scalings were done 27 „ „ for examinations, &c. 7 Care and After-care.—Efforts are made to obtain help for the patients from the various agencies that are able to assist them; particularly the Guardians, the Invalid Children's Aid Association, the War Pensions authorities, the Soldiers' and Sailors' Families Association, the British Red Cross, the Charity Organisation Society, parochial charities, &c. The work of the Interim Tuberculosis Care Committee has not yet been taken over by a definitive committee. 45 The work done at the dispensaries in 1921 is shown in the following table:— Tuberculosis Dispensary at University College Hospital. Tuberculosis Dispensary at St. Pancras Dispensary 39, Oakley Square. Branch Tuberculosis Dispensary of St. Pancras Dispensary at 132, Maiden Road. Insured Persons. Uninsured Persons. Total. Insured Persons. Uninsured Persons. Total. Insured Persons. Uninsured Persons. Total. No. of new cases 89 85 174 254 208 462 18 44 62 No. found to be suffering from— Pulmonary Tuberculosis 51 26 77 121 34 155 10 11 21 Non-Pulmonary Tuberculosis 7 9 16 12 27 39 1 3 4 Non-Tuberculous 10 36 46 99 119 218 6 18 24 No. in whom diagnosis was found to be doubtful 21 14 35 22 28 50 1 12 13 Total attendances 755 577 1,332 1,760 1,126 2,886 83 356 439 No. of above attendances at which physical 443 323 766 1,354 769 2,123 74 248 322 examinations and records were made Home visits by-— Tuberculosis Officer 2 4 6 123 64 187 * * * Dispensary Nurse 571 405 976 96 115 211 17 68 85 No. of persons referred to the hospital to 3 5 8 124 99 223 14 24 38 which this Dispensary is affiliated No. of consultations with Medical Practitioners — - " 20 4 24 * * * No. of written reports to— (a) Public Authorities 290 98 388 1,402 534 1,936 36 96 132 (b) Practitioners 10 6 16 171 37 208 4 8 12 No. of Specimens of sputum examined 86 14 100 817 173 990 * * * * Included in Oakley Square. Treatment of Tuberculosis in Sanatoria and Hospitals. Until 1st May, 1921, the institutional treatment of insured persons was undertaken by the London Insurance Committee and of uninsured persons by the London County Council. After that date the London County Council took over all of this work. In the following figures (St. Pancras) the cases dealt with by the two authorities are not distinguished:— 1921. No. of Applicacations for institutional Treatment. No. of these Applicants who were admitted. Ex-service men 96 93 Others 134 115 Total 230 208 These figures may be compared with the following:— No. of cases notified on Form C in 1921 as having been admitted to sanatoria 234 „ „ „ „ „ Poor Law Institutions 156 46 SMALLPOX. No cases of smallpox occurred in St. Paneras in 1921. One patient was admitted to the Smallpox Hospital (M.A.B.) from a St. Paneras address during the year, but was afterwards found not to be suffering from the disease. There were 2 cases in the County of London in 1921. Vaccination. The following table is drawn up from returns kindly supplied by the Clerk to the Guardians in respect of children whose births were registered in the Parish of St. Paneras from 1st January to 31st December, 1920, inclusive :— Number. Percentage of Births registered. North. East. West. South. Whole Borough. North. East. West. South. Whole Borough. Births registered 1,404 1,726 1,335 1,621 6,086 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 60 88 77 67 292 4.3 5.1 5.8 4.1 4.8 Successfully vaccinated 590 747 648 708 2.693 42.0 43.3 48.5 43.7 44.3 Had Smallpox — — — - — — — — — — Insusceptible of vaccination 2 3 1 4 10 0.1 0.2 0.1 0.2 0.2 Received certificates of conscientious objection 700 609 418 317 2,044 49.9 35.3 31.3 19.6 33.6 Postponed by medical certificate 5 31 51 55 142 0.4 1.8 3.8 3.4 2.3 Moved to known address in other districts 5 69 11 322 407 0.4 4.0 0.8 19.9 6.7 Lost sight of by removal 39 159 105 121 424 2.8 9.2 7.9 7.5 7.0 Unvaccinated and not accounted for in previous columns 3 20 24 27 74 0.2 1.2 1.8 1.7 1.2 The corresponding figures for the past ten years are as follows :— Year. Births. Successfully Vaccinated. Per cent. Conscientious Objections, and Children otherwise escaping Vaccination. Per cent. 1910 5,394 2,787 51.7 953 17.6 1911 5,139 2,353 45.8 1,235 24.4 1912 5,079 2,318 45.6 1,149 22.6 1913 5,074 2,050 40.4 1,494 29.4 1914 4,965 1,767 35.6 1,332 26.8 1915 4,536 1,587 35.0 1,205 26.6 1916 4,322 1,594 36.9 1,179 27.3 1917 3,664 1,581 43.1 1,014 27.7 1918 3,338 1,281 38.4 932 27.9 1919 3,874 1,733 44.7 1,155 29.8 1920 6,086 2,693 44.3 2,118 34.8 47 SCARLET FEVER. 1,713 patients were notified in 1921 as suffering from scarlet fever. Of these 61 were afterwards reported not to be suffering from the disease by medical superintendents of the Metropolitan Asylums Board, and 3 by other medical practitioners. The corrected number of scarlet fever cases notified was, therefore, 1,649, equal to an incidence rate of 7.7 per 1,000 population. The number of deaths from scarlet fever certified during the year was 7, equal to a deathrate of 0.03 per 1,000 population, and a case mortality of 0.42 per cent. of cases notified. This is the lowest case mortality for the disease ever recorded for St. Pancras. 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 Kate per 1,000 Population. Case Mortality per cent. Percentage of Cases removed to Hospital. 1912 598 2.7 5 0.02 0.8 97 1913 *536 *2.4 6 0.03 *1.1 94 1914 1,180 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 1921 1,649 7.7 7 0.03 ' 0.4 96 * From 1913 onwards the figures have been corrected for errors of diagnosis. 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. Fortunately the mortality has not increased at the same rate. Of the notified cases of scarlet fever, 1,642 (or 95.9 per cent) were removed to hospital, as follows:— To Metropolitan Asylums Board hospitals 1,634 To other hospitals ,. 8 1,642 (Other statistical facts will be found on pag es 34 to 36.) 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.) Such return cases occurred at 67 houses during 1921. In 54 instances only one return case occurred in the house, but in the other 13 houses other cases of scarlet fever followed the occurrence of the return case; in each of 9 houses there was one such additional case, in each of 2 houses, 2 additional cases, and in each of 2 houses, 3 additional cases, the total number of return cases being 86. In the following analysis only the 67 first return cases are considered. Their distribution according to the month in which they occurred was as follows :— January 6 April 1 July 1 October 4 February 2 May 3 August 5 November 12 March 4 June 6 September 6 December 17 In 59 instances the return case occurred in the family to which the (?) infecting case returned, and in 8 in a different family in the same house. 48 Of the 67 (?) infecting cases 25 were found to have rhinitis in varying degrees (two of these had also otorrhœa, one conjunctivitis and impetigo, three enlarged glands in the neck with enlarged tonsils, one other enlarged tonsils, one epistaxis, one jaundice, and one psoriasis); 6 had enlarged glands in the neck (of which 3 had enlarged tonsils); one had enlarged tonsils; two had sore throat; and one each had epistaxis and rheumatism, a sore on the face, and vaginitis. The remaining 30 had no signs of infectiousness, though 4 of them had slight enlargement of the tonsils and 3 palpable glands in the neck, but not greatly enlarged. In 10 of the cases of rhinitis swabs were taken from the nose and bacilli indistinguishable morphologically from diphtheria bacilli were found in 4 cases, and negative results in 6. The four " positives " were readmitted to hospital. The intervals between the return of the (?) infecting case and the onset of illness in the return case in the various instances were as follows:— Days. Cases. Days. Cases. Days. Cases. Days. Cases. 1 1 8 4 15 1 22 0 2 3 9 3 16 1 23 1 3 1 10 5 17 1 24 1 4 5 11 4 18 3 25 2 5 5 12 6 19 6 26 0 6 1 13 1 20 0 27 0 7 7 14 2 21 3 28 0 Scarlet fever after diphtheria.—There were also 4 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 two of these there was one further case of scarlet fever after the return case, and in one other there were two further cases. In all 4 houses the return cases of scarlet fever were in the same family as the previous case of diphtheria. In three instances the previous case of diphtheria was found to be suffering from rhinitis, and the one other showed no signs of infectiousness. The intervals between the return of the case of diphtheria and the onset of the case of scarlet fever were 6, 11, 22 and 26 days. /fter-care.—A proportion of the children who have been discharged from hospital after scarlet fever have been visited to ascertain their condition and to secure treatment for sequelae if necessary. 329 such children have been visited in 1921, of whom 275 are reported to have recovered satisfactorily and 54 to have required treatment. The conditions needing treatment were as follows : Debility 15, nose and throat 15, ears 3, enlarged glands 5, rheumatism 4, kidney 3, eyes 2, heart 2, cough or "chest trouble" 2, other conditions 3. Sixteen of the cases were treated at the St. Pancras Dispensary, 22 at hospitals, 2 at the School Clinics, and 14 by private doctors. DIPHTHERIA. 723 patients were notified in 1921 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. The corrected number of diphtheria cases notified was therefore 657, equal to an incidence rate of 3.1 per 1,000 population. The number of deaths from diphtheria certified during the year was 51, equal to a deathrate of 0.24 per 1,000 population and a case mortality of 7.8 per cent. of cases notified. 49 In the following Table are set out the corresponding figures for the past 10 years:— Year. No. of Notifications. Notification rate per 1,000 Population. No. of Deaths. Death Rate per 1,000 Population. Case Mortality per cent. Percentage of Cases removed to Hospital. 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 1921 657 3.1 51 0.24 7.8 98 * From 1913 onwards the figures have been corrected for errors in diagnosis. Of the notified cases of diphtheria, 710 (or 98.2 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 708 To other hospitals 2 {Other statistical facts will be found on pages 34 to 36.) Return cases.—(Definition : A case of diphtheria occurring within 28 days of the return irom hospital to the same house of a previous case of diphtheria.) Such cases occurred in 11 houses, in 9 of which there was one return case of diphtheria, and in two there were two return cases. In 7 instances the return case occurred in the family to which the (?) infecting case returned, and in 4 in a different family in the same house. Five of the (?) infecting cases were found to have rhinitis (one of these had also enlarged tonsils, and one a pustule on the eyelid), one otorrhœa, and one a septic finger. The other 4 showed no signs of infectiousness, though one of them had chorea and two slight enlargement of the tonsils. Nasal swabs were taken from all the 5 rhinitis cases and the diphtheria bacilli (morphological) was found in one case only (which was readmitted): diphtheria bacilli were also found in the ear-discharge of the case with otorrhoea, and in the nose and throat of the case with chorea (re-admitted). Swabs were taken from two other (?) infecting cases with negative results. The intervals between the return of the first case and the occurrence of the return case were 2, 3, 3, 5, 6, 7, 9, 15, 18, 19 and 23 days. Diphtheria after scarlet fever.—In 10 houses cases of diphtheria occurred within 28 days after the return from hospital to the same house of a previous case of scarlet fever. In 7 of these there was only one case of diphtheria, but in each of two there were two cases, and in one there were three cases. In 8 instances the case of diphtheria was in the family to which the previous case of scarlet fever returned, and in two instances in a different family in the same house. In three instances the (?) infecting case was found to have rhinitis. These were all swabbed, and diphtheria bacilli (morphological) found in one case only (re-admitted). There was one case with enlarged tonsils, which gave a " negative " throat swab. The other 6 cases showed no obvious signs of infectiousness. Four of these were swabbed, and diphtheria bacilli (morphological) were found in the nasal swab from two of them, who were re-admitted. (10495) G 50 The intervals between the return of the scarlet fever cases and the onset of the diphtheria were 2, 3, 4, 6, 7, 8, 8, 12, 21 and 24 days. After-care.—A proportion of the children who have been discharged from hospital after diphtheria have been visited to ascertain their condition and to secure treatment for sequelae if necessary. 144 such children have been visited in 1921, of whom 116 are reported to have recovered satisfactorily and 28 to have required treatment. The conditions needing treatment were as follows : Debility 13, nose and throat 7, ears 2., paralysis 3, enlarged glands 1, heart 1, cough 1. Eleven of the cases were treated at the St. Pancras Dispensary, 9 at hospitals, 1 at the School Clinics, and 7 by private doctors. TYPHOID OR ENTERIC FEVER (INCLUDING PARATYPHOID). Twenty-eight cases were notified during 1921 as suffering from this disease. Of these, two were afterwards found not to be suffering from enteric, the number of actual cases being 26. Two of these cases were fatal (one typhoid and one paratyphoid B), equal to a case mortality of 8 per cent. (There was a third death from typhoid fever during the year in the person of a St. Pancras resident who caught the disease and died while staying in another part of the country . This case is not included in the 26.) In 24 of the 26 cases information as to the serum (agglutination) reaction is available. 17 were reported as positive for B. typhosus, 4 for B. paratyphosus B, and 1 for B. paratyphosus A, while 2 were negative, though diagnosed as typhoid on clinical grounds. (One case in which the reaction was equally strongly positive for B. typhosus and B. paratyphosus is included in the 17 for B. typhosus and not in the 4 for B. paratyphosus.) The 26 cases were treated as follows:— Cases Notified. Not Typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 14 2 12 In the London Fever Hospital 1 - 1 In other hospitals 7 - 7 In a private nursing home 1 - 1 In their own homes 5 - 5 One case occurred in January following upon a previous case in the same family at the end of 1920; there were two instances in each of which three members of the same family were reported; and the remaining 19 cases were all in separate houses. The cases took their onset 2 in December, 1920, 1 in February, 1921, 3 in May, 3 in June, 4 in July, 3 in August, 4 in September, 4 in October, and 2 in November. Two of the cases (both typhoid) were non-parishioners staying in St. Pancras, who took the infection at their homes before coming to London. Three others (two typhoid, one no bacteriological information) were St. Pancras residents who probably took the infection while staying out of London. [Two of these five cases who probably caught the disease out of London had eaten shellfish, viz., cockles and periwinkles and whelks, respectively, and may have taken the infection from that source.] Of the other cases, one (typhoid) was a hospital nurse who had been nursing a case of typhoid fever; and two (one typhoid and one equally typhoid and 51 paratyphoid B) gave a history of having recently eaten oysters, but not from suspicious sources. Besides these, in addition to the one case (typhoid) which was secondary to a previous case in the same family, and the 6 cases (typhoid) in two families (see below), there were 11 cases (5 typhoid, 4 paratyphoid B, one paratyphoid A and one no bacteriological information) in which no likely source of infection was traced. [Of these one (paratyphoid B) had drunk shallow well water in the country two days before the onset of the illness, and one (typhoid) had been eating every day for months boiled fish and watercress and other salads.] No part of the borough was specially affected, the cases being widely scattered. The history of the two larger family outbreaks was as follows:— 1. Three notified cases in a middle-class family in Cumberland Terrace, N.W.1 (with other possible cases not notified). (In this statement the children are denoted by the letters B or G according to sex and their age in years.) B. (12) had a short feverish illness from about 13th May, Widal reaction negative for typhoid and paratyphoid A and B on 20th May and 30th June (Lister Institute). This case was not notified as enteric. B. (8) fell ill with feverishness a week later. Recovered early in June after being in bed for three weeks, and relapsed towards the end of that month, the disease simulating appendicitis, when he was again in bed for three weeks. Widal reaction negative for typhoid and paratyphoid A and B on 20th May (Lister Institute), and on 25th June positive for B. typhosus 1 in 200, B. enteritidis Gaertner 1 in 50 (slightly), and Y type of dysentery bacillus 1 in 25, and negative for paratyphoid A and B and the Flexner and Shiga type of dysentery bacillus (Dr. J. G. Greenfield). Notified as enteric on 27th June. Housemaid (25) entered the family's service on 3rd May. She had diarrhœa and sickness for a few days from about 17th May. Widal reaction negative for typhoid and paratyphoid A and B on 30th June (Lister Institute). Not notified. Daily man-servant (slept at his own home in Islington) had diarrhoea and sickness for five days from about 1st June. Widal reaction on 30th June positive for B. typhosus 1 in 100 and definite traces 1 in 200, negative for paratyphoid A and B (Lister Institute). Notified in Islington as enteric fever. G. (16) after being indisposed for about three weeks was found on 24th June to have a temperature of 103° and was in bed for four weeks from that date. Widal reaction negative for typhoid and paratyphoid A and B on 30th June (Lister Institute). Notified as enteric on 26th June. The father (46) became ill on June 25th; the illness was serious and he was in bed for six weeks. Widal reaction negative on 30th June for typhoid and paratyphoid A and B (Lister Institute). Notified as enteric on 26th June. In investigating the cause of this series of cases attention was directed to the cook (E. H.) who was in the family's service from 22nd April to about the end of May. She had been previously in service with a family in Hampstead from 21st January to 22nd April, and from 5th April to 3rd May Mr. , her employer, was ill in bed with an illness characterised by headache, high temperature and loss of appetite, and diagnosed as influenza. The doctors in charge of that case stated that they did not consider that there was any doubt about the diagnosis of influenza, and no bacteriological tests were made either during the illness or subsequently. The cook was reported to be of dirty habits, and her Hampstead employer stated that "she thought she suffered from some intestinal trouble." She was believed to be a naturalised British subject of Austrian birth. Efforts to trace her subsequent movements were unsuccessful. It may also be recorded that the housemaid referred to above came from the country and that her husband had died about six months before her entering the family's service on 3rd May from dysentery contracted in India. A resident nursery governess left the family on the same day as the cook. E. H., having been with them for rather more than two months. There was no special history in connection with her, and her subsequent movements were unknown. The family were at the seaside from 8th June to 20th June but the series of cases began before that time. The household consisted of the above-mentioned persons only, including a cook who took the place of E. H. on 2nd June, and about whom there was no suspicious history. Enquiries revealed no other facts bearing upon the causation of the outbreak of illness. None of the cases were fatal. (10495) G 2 52 2. The other family outbreak of enteric was in a family living in a tenement house in Ossulston Street, Somers Town. The cases were as follows:— B. (5) Severe case. Became ill about 5th July and was admitted to University College Hospital on 13th July. Clinically a case of typhoid fever, and Widal reaction positive for typhoid, but stools and urine negative. (His brother, aged 7, was ill from about 22nd June, with feverishness and headache. He was treated as an out-patient at University College Hospital and was also admitted on 13th July. The hospital authorities stated that they had no definite reason for thinking that he was a case of typhoid, but that the Widal reaction was not tested; stools and urine negative.) Mrs. C. (27), mother of above-mentioned children. Ill from about 12th July with feverishness, diarrhœa and abdominal pain. Admitted to St. Pancras Hospital on 19th July. Clinically typhoid, and Widal reaction positive for B. typhosus 1 in 50, and partial for 1 in 100. G. (3) (sister of B. (5) and B. (7) ). Ill from about 16th July with feverishness and abdominal pain. Clinically typhoid, and Widal reaction positive for B. typhosus 1 in 100. The family consisted of Mr. and Mrs. C., the above-mentioned children and a baby (G. (1 1/12) ). Mr. C. and the baby were not ill, and there was no sickness amongst the other three families in the tenement house. The source of infection was not traced. None of the cases were fatal. 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 1921 26 2 8 It will be noticed that in 1920 and 1921 there was an increase in the number of cases corresponding to the decline shown in 1917-19, but that the number of fatal cases has remained very low. ACUTE ANTERIOR POLIOENCEPHALITIS AND POLIOMYELITIS. Four cases were notified in 1921, all as poliomyelitis. None of them were immediately fatal, but one died three months after the beginning of the illness (see below). The particulars were as follows:— B. F., female, aged 3. Ward 7 (T). Onset, 13th April, when she fell while walking and there was some feverishness. Admitted to Great Ormond Street Hospital on 18th April. On admission the arms and legs were affected, the right hand being stronger than the left; flexion poor in left leg, and extension limited in both legs; tenderness on movement. Notified 14th May. Improved. Developed scarlet fever on 1st July. Continued as an out-patient at Great Ormond Street. The arms soon recovered and in July, 1922, the legs had almost completely recovered. E. G., male, aged 1. Ward 6 (K). Onset 7th June. Fretful, off food, irritable, drowsy, twitching of face, pain at back of neck; both legs affected (went off feet on 9th June). Notified 53 20th June. Admitted to Great Ormond Street Hospital 21st June. On admission, right leg affected more than left, especially flexor group above knee; arms not affected. Plaster casts made for both legs. In July, 1922, the patient could just walk and was improving slowly; the left leg was in splints and he was still having massage and electrical treatment at Great Ormond Street. A. B., male, aged 3 months. Ward 5 (S). Onset 30th August, when right arm noticed to be powerless (no movement in arm or forearm; fingers moved slightly). No other symptoms, and no other part affected. Bad family history (11 pregnancies: one still-birth; 7 children died—3 premature; one mentally deficient). Notified 7th September. Attended Great Ormond Street Hospital as out-patient, where the diagnosis was considered doubtful. "Found dead" on 4th December, and after an inquest and P.M. the death was certified as due to "exhaustion, pneumonia, chronic wasting ; natural." E. W., female, aged 6. Ward 7 (U). Onset 30th October. Vomiting, headache, fever, glands of the neck swollen and painful, delirium, hyperæsthesia around body just below axillae and down legs. On 1st November suddenly lost power of both legs, and arms became weak. Admitted to Middlesex Hospital on 2nd November and notified on that day. In July, 1922, the patient was reported to be quite recovered. EPIDEMIC CEREBROSPINAL MENINGITIS. Four cases of this disease were notified in 1921. Three of the 4 cases were fatal. The actual number of deaths from the disease in 1921 was 4, one of these being a case notified in 1920. (In two of the cases, both fatal, the diagnosis was doubtful—see below.) Particulars in regard to, the cases are set out in the following table:— Date of Notification. Date of Onset. Date of Death. Age and Sex. Ward and District. Bacteriological Notes, &c. 5th Jan. 2nd Jan. Recovered* 10 F. 2 F C.s. fluid under considerable pressure and cloudy. Meningococcus found; it agglutinated with type II serum. 26th March 23rd March 8th April 1/1 ½ M. 1 B C.s. fluid purulent. "Gram-negative" diplococci, intracellular and extracellular; cells practically all polynuclear. No P.M. examination. 9th Nov. 9th Nov. 9th Nov. 5/12 F. 8 L The infant was admitted to a convalescent home in Woolwich with mother on 17th October, then well. Taken suddenly ill on 9th November and died in a few hours. No examination of c.s. fluid or P.M. examination. Diagnosis doubtful. – 5th Dec. 7th Dec. 2 M. 8 M Sudden onset on 5th December. Admitted to hospital on the 6th and died on the 7th without regaining consciousness. C.s. fluid "negative," but under some pressure. P.M.— The basal ganglia showed definite round celled infiltration, and the case was regarded as one of encephalitis rather than cerebrospinal meningitis. (It had already been certified as c.s.m.) * The recovery is almost complete (July, 1922), but there are occasionally pains in the limbs. 54 No connection between the cases and no source of infection was found. They were treated in the Middlesex Hospital, the Hampstead General Hospital, the Woolwich institution above mentioned, and Great Ormond Street Children's Hospital. From 1913 the number of cases of cerebrospinal meningitis notified or otherwise reported (corrected for errors of diagnosis), and the number of these cases which died, were as follows:— Year. 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 1921 4 3 75 ENCEPHALITIS LETHARGICA. In 1921 eight patients were notified as suffering from this disease, of which two cases (treated in the M.A.B. hospitals) were afterwards found not to.be suffering from encephalitis, the actual number of cases being 6. Two of these 6 cases were fatal. (The number of deaths from the disease registered in 1921 was 3; one of these was a case notified in 1920.) The particulars of the cases were as follows:— L.J., male, aged 32. Ward 1 (D). Horsekeeper. Onset 4th December, 1920. Initial symptoms—giddiness, impairment of vision, diplopia, difficulty in opening eyes, headaches, delirium, drowsiness, some facial paralysis, and constipation. Admitted to St. Pancras Hospital, 14th December, 1920. Temperature subnormal; lethargy very marked (only answered questions after lumbar puncture and after stryclnine); squint marked, but disappeared after lumbar puncture; urine incontinent; B.O. with enemata; reflex on tapping for knee-jerk was a flexor response instead of a kick; speech— whispers only; hemorrhage from gums, with pyorrhœa and dirty mouth; tendency to bed sores. Notified 1st January, 1921; died 5th September, 1921. P.M. showed no signs of recent encephalitis. E.A.F., male, aged 50. Ward 3 (G). Painter. Onset 24th December, 1920. Initial symptoms—headaches, dimness of vision, diplopia, loss of energy and lethargy. Admitted to St. Pancras Hospital, 1st January, 1921. Evening temperature of 99° or 100° for two or three days after admission; afterwards generally 97°; lethargy; marked ptosis and no squint; incontinence of urine and fæces; spoke very lowly when roused. C.s. fluid 4th January—albumen 0.008 per cent., globulin slight excess, dextrose present, very few leucocytes and no organisms seen. In hospital seven months. On 28th August—At work, tendency to sleepiness since discharge, but gradually improving; more talkative than before illness memory good; eats and sleeps well; no headaches; bowels regular; eyesight normal; some weakness of the arms at times. M.S., female, aged 34. Address and occupation not known. Found wandering by the police; drowsy condition and thought to be under the influence of alcohol or drugs; admitted to St. Pancras Hospital, 7th December, 1920. Temperature in the early stages frequently 97° and never over 99° except once; lethargy marked; for one week would not eat except at the commands: "Open your mouth; shut your mouth; swallow"; plantar response (?) extensor for 14 days. C.s. fluid—under slight pressure—no other definite abnormality. Became troublesome and was kept in the mental ward from 23rd December to 5th January. Notified 13th January, 1921. February. 1921—Slight hemorrhage from lungs with crepitations and dulness at bases; sputum occasionally blood-stained for some months. July, 1921—Intention tremor of hands, no abdominal reflex, knee-jerks +, ankle clonus, plantar reflex flexor, right lateral nystagmus and slight internal strabismus. August, 1921—General joint pains and evening pyrexia 99° to 100°. Discharged 10th March, 1922, complete recovery; no mental sequelae. 55 H.G., male, aged 57. Ward 8 (N). Accountant. Onset about 10th February. When first seen by doctor, nine days before death, patient was very lethargic, gradually becoming stuporose; could be roused for food, &c.; wasting; temperature 101°-102°; incontinence of urine; no headache; thirst; difficulty in swallowing. Admitted to Nursing Home 19th February. Temperature 100o-102°, with morning remissions; lethargy and stupor; temporary partial ptosis of left eye; paralysis of sphincter ani and atony of bladder; menially only partially receptive, and mechanical; tremor present and mild delirium towards the end; inclined to dysarthria. Lumbar puncture on 23rd February—C.s. fluid sterile. Died 26th February and notified same day. No post-mortem examination recorded. T.M., male, aged 65. Ward 8 (L). Porter at dining room. Onset 13th March. Fell and cut his head on that day, and was unconscious; 14th—still unconscious, weakness of right arm; 15th—speech muddled, depressed; 17th—went to work, gait tottering, tired; 19th—loss of memory, rhythmic movements of right arm and leg; 20th—increasing lethargy, doctor called in. Admitted to Royal Free Hospital, 21st March. Temperature 99°-99.4°; face expressionless; limbs very rigid and arms flexed; lethargy extreme at first, but answered when roused, gradually improved; ptosis for one week; no squint; incontinence of urine and fæces; speech indistinct at times. Lumbar puncture on 24th March— C.s. fluid blood-stained on withdrawal but seemed otherwise clear. Wassermann reaction negative. Notified 3rd April. Good recovery, and discharged 12th May. On 19th August—Considerable weakness; headaches; easily fatigued; memory impaired but improving; depressed and emotional; speech slow and rather halting; some weakness of left arm and leg; slight left ptosis. J. L., male, aged 63. A broker, resident in Scotland, and staying at a hotel in St. Pancras temporarily. Known to be well until 1 p.m. on 7th September, and at 10 p.m. reeled into the hotel speechless, ataxic and covered with road dust, and fell on the stairs. His condition could easily be mistaken for alcoholism (which was not present). When seen that night by the doctor he was semi-comatose and abusive when roused; incontinence of urine and fæces; no vomiting; about 1/10 albumen in urine. This condition persisted for four days; restless at night but slept by day; temperature sometimes 100.6° for three days, and afterwards normal; no paralysis, but slight twitching of hands and temporary strabismus occasionally; severe frontal headache until lumbar puncture; albumen cleared up entirely by 14th September (after venesection); Babinsky reaction in left foot only. Lumbar puncture on 15th September, followed by marked improvement; C.s. fluid under considerable pressure, clear, no bacteria seen, sterile, total cells (all small mononuclears) 10 per c.mm., globulin increase test positive (globulin detectable in a dilution of 1 in 3). Dr. J. S. Collier saw the patient in consultation on 15th September and confirmed the diagnosis. Patient removed to Nursing Home on 16th September and notified same day. Went home to Scotland on 28th September recovered physically but not yet mentally: no further history available. MALARIA. 18 cases of malaria were notified in 1921, and 1 death was recorded. In all cases the infection had been contracted abroad. All the cases were visited and such assistance was given as was necessary. DYSENTERY. One case of dysentery was notified in 1921. The case was fatal, the diagnosis being made following the post-mortem examination, which was ordered by the coroner on account of the sudden death of the deceased. The origin of the infection, which was thought to be probably bacillary, was not traced. PNEUMONIA. During the year there were 242 cases of acute primary pneumonia notified, and 99 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 1921 there were registered 89 deaths ascribed to broncho-pneumonia 47 to lobar pneumonia, and 37 to pneumonia (type not stated). 56 Every case notified was promptly visited by a lady sanitary inspector and such assistance given as the case seemed to require. The District Nursing Associations were paid by the Council for the nursing of cases of pneumonia and influenza. In 1921, 125 cases of influenza and pneumonia were dealt with at the Council's expense, 1,379 nursing visits being paid. The following is an analysis of the cases notified and visited:— Age and Sex. Acute Primary Pneumonia. Influenzal Pneumonia. Males 135 44 Females 107 55 0—1 46 1 1—5 59 6 5—15 31 8 15—25 16 8 25—55 58 47 55 and over 32 29 Other statistical details will be found on pages 34 to 36. Of the 242 cases of acute primary pneumonia, 165 were treated in their own homes and 77 in hospitals. Of the hospital cases, 34 were treated in the St. Pancras Poor Law Hospitals and 43 in voluntary hospitals. The cases were already in hospital when visited after notification, with the exception of 6 which were sent to hospital after being visited. In regard to the 165 cases which were treated at home, 73 were under the care of visiting nurses (in 62 of the cases the nurse was sent in as a result of the sanitary inspector's visit). With regard to the 99 cases of acute influenzal pneumonia, 56 were nursed at home and 43 in hospitals. Of the hospital cases, 30 were treated in the St. Pancras Poor Law Hospitals and 13 in voluntary hospitals. The cases were already in hospital when visited, with the exception of 7 who were sent to hospital after being visited. In regard to the 56 cases which were treated at home, 28 were under the care of visiting nurses (in 22 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 40 out of the 165 acute primary pneumonia cases and 16 out of the 56 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. After-care visits were made to 21 of the cases (20 acute primary, 1 acute influenzal). OTHER NOTIFIABLE INFECTIOUS DISEASES. Puerperal fever, ophthalmia neonatorum, and measles (as well as whooping cough) are dealt with on pages 30 to 33. No cases of typhus, cholera, plague or human anthrax, glanders or hydrophobia, were reported in St. Pancras in 1921. A number of persons who had proceeded to St. Pancras after having been in contact with smallpox and other dangerous diseases (mostly on shipboard) were reported and kept under observation, with negative results in all cases. 57 INFLUENZA. There was no serious recrudescence in St. Pancras in 1921 of the epidemic of 1918 and 1919. Fifty-seven deaths were certified as due to Influenza during the year. SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1921 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 8 — — — 1 — 1 — — — — 10 6 — — — — — 1 — 1 — — 8 18 Locomotor ataxy — — — — — — 2 2 1 — — 5 — — — — — — — — — — — — 5 General paralysis of the insane — — — 1 1 3 1 2 — — — 8 — — — — — 1 1 — — — — 2 10 Aortic aneurysm — — — — — 2 1 3 2 — — 8 — — — — — — — — — — — — 8 CANCER. 290 deaths were registered during 1921 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, sarcoma, &c. This is equal to a death-rate of 1.36 per 1,000 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 estimated population 1921). Males 140 1.39 Females 150 1.33 Both Sexes 290 1.36 The deaths registered as due to cancer are set out in the following table for the past 14 years:— Sex. 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 Average for 13 years. 1921 Males — — — — — 127 127 120 125 135 125 114 150 — 140 Females — — — — — 158 140 138 142 146 144 131 149 — 150 Both Sexes 288 232 266 274 247 285 267 258 267 281 269 245 299 267 290 (10495) H 58 Section IV.— SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.— Altogether 69,668 inspections were made in 1921 by the staff of Inspectors and Visitors. These consisted of 36,632 initial inspections and 33,036 re-inspections. Of these inspections, 40,526 were made by the District Sanitary Inspectors, 6,423 by the Sanitary Inspectors for Food and Food places, 3,430 by the Sanitary Inspector for Factories and Workshops, and 19,289 by the Women Sanitary Inspectors and Health Visitors. The inspections made by each individual Inspector and Visitor are shown in table 10, on page 99. The work of the various classes of Inspectors and Visitors is set out in tables 7, 8 and 9, on pages 95 to 98. 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 19), and by the staff of the Tuberculosis Dispensaries (see page 45); nor do they include the work of the disinfecting staff (see page 37). Notices served and result of service.— 4,409 intimation notices (comprising 9,564 items) were served by the Sanitary Inspectors during 1921. These were made up as follows— District Inspectors. Factory and Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 6,177 5 7 — 6,189 In respect of the Tenement House By-laws 841 — – — 841 In respect of Breaches of Statutes in Factories, Workshops and Workplaces – 611 – – 611 In respect of other Breaches of Statutes and By-laws 1,910 6 7 – 1,923 Totals 8,928 622 14 — 9,564 These intimations are classified in tables 11, 12, 13 and 14, on pages 100 to 102. 1,953 Statutory notices (comprising 3,027 items) were served during 1921 and the early part of 1922, following non-compliance with these intimation notices. These are also classified in tables 11, 12, 13 and 14, on pages 100 to 102. The following prosecutions were undertaken during the year in respect of general sanitary work:— 59 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. 86, Osnaburgh Street Insufficient w.c. accommodation Jan. 7th Fined £24. 86, „ „ Part of premises dirty, roof defective, and w.c. apartment foul „ 7th Taken into consideration on previous summons. 21, Crown Place Part of premises dirty and dilapidated „ 7th Fined 10s., costs £2 2s. 6, Willis Road Rainwater pipe in direct communication with drain „ 7th Order to abate nuisance within 28 days. 16a, Clarendon Square Absence proper metal dustbin „ 10th Costs 10s. 6d. Order to abate nuisance within 7 days. 18, „ „ Defective dustbin „ 10th Costs 10s. 6d. 33, Victoria Road Defective roof „ 14th Fined £6. Order to abate nuisance within 14 days. 36, Balmore Street Roof, water fittings of w.c. and vent pipe defective Feb. 3rd Costs £1 3s. Work carried out. 3, Howland Street Walls dirty and defective, offensive accumulation and absence of proper dustbin „ 12th Costs £3 3s. Work carried out. 41, South Grove Yard paving defective March 3rd Costs £3 3s. Work carried out. 54, Doynton Street Walls and ceiling dirty April 21st Costs £2 2s. Work carried out. 55, „ „ Walls and ceilings dirty and dilapidated „ 24th Fined 5s. Costs £2 2s. 55, „ „ Roofs defective June 9th Costs £2 2s. Order to abate nuisance within 21 days. 145, High Street Stopped drain „ 29th Costs £2 2s. Prohibition order made. 145, „ „ Acting contrary to prohibition order July 29th Fined £1. Costs £1 1s. 15, Winscombe Street Walls and ceilings dirty Aug. 26th Fined £2 11s. Costs £2 4s. 145, High Street Acting contrary to prohibition order Sept. 23rd Costs £2 2s. Order complied with. 18, Wellesley Road Part of premises dirty and roof defective „ 23rd Costs £1 5s. Order to abate within 21 days. 23, Cromer Street Drain defective „ 30th Costs £1 5s. Order to abate within 28 days. 6, St. Pauls Road Walls and ceilings dirty; walls damp, roof, guttering, water fittings, dustbin and ceiling defective „ 30th Costs 12s. 6d. Order to abate within 28 days. 1, Lyme Street Walls and ceilings dirty; roof and dustbin defective „ 30th Costs 12s. 6d. Order to abate within 6 weeks. 29, St. Leonards Square Drain defective Nov. 1st Costs £1 5s. Order to abate within 7 days. 48, Litcham Street Insufficient w.c. accommodation „ 18th Costs £3 3s. Work carried out. 18, Wellesley Road Failing to comply with provisions of a nuisance order „ 24th Fined £7. 21 days' imprisonment in default. 41, Litcham Street Walls dirty Dec. 22nd Fined 10s. Costs £2 2s. 41, „ No dust bin „ 22nd Fined 10s. Costs £2 2s. 4, Haverstock Place No dust bin „ 22nd Fined £1. 4, „ Roof, guttering and rain water pipe defective „ 22nd Costs £2 2s. Order to abate within 21 days. 18, Clarendon Square Insufficient w.c. accommodation „ 23rd Fined 1s. Costs £2 2s. 33, Stibbington Street Walls and ceilings dirty „ 23rd Costs £2 2s. Order to abate within 21 days. 41, „ „ „ „ „ 23rd Costs £2 2s. Order to abate within 21 days. 43, „ „ „ „ „ 23rd Costs £2 2s. Order to abate within 21 days. 41, Camden Park Road Walls and ceilings dirty, basement damp, soil pipe, waste pipe of lavatory and rain water pipe defective. „ 15th Costs £1 5s. Order to abate within 4 weeks. London County Council (General Powers) Act, 1904 Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 33, Stibbington Street Rooms verminous Dec. 23rd Fined 10s. 41, „ „ „ „ 23rd Fined 10s. 43, „ „ „ „ 23rd Fined 10s. (10495) H 2 60 PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS AND REGULATIONS. Offensive Trades.— There are two licensed premises for such trades in St. Pancras, viz., a tripe-dresser's in Kentish Town Road, and a tallow-melter's in Tudor Place. 42 visits were made to these premises in 1921. Registered Tenement Houses. At the end of 1921 there were 2,365 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 95 and 101. Underground Rooms. During the period of stringency in housing accommodation which has followed the war a large number of underground rooms, the use of which for sleeping purposes had in former years been effectually forbidden under the Public Health (London) Act, 1891, and the Housing, Town Planning, &c., Act, 1909, have again become occupied as sleeping places. Except in a very few cases it has not been found possible to secure the discontinuance of their use for this purpose. The reason for this is that the occupants have no place to go to in the event of their being ejected from the rooms in question. There has been a similar difficulty in dealing with cases of overcrowding, the families concerned being often unable to obtain more accommodation. Smoke-Prevention. During the year 704 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 248 3,113 Voluntary drainage work 994 1,918 Drains of new buildings 69 585 1,311 5,616 61 The tests which have been applied to drains during 1921 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 41 63 — – — – 104 (2) No result 331 117 — — 3 — 451 (3) Total 372 180 — — 3 — 555 By Smoke— (1) Defects localised — —. — — — — — (2) No result — — — — 1 — 1 (3) Total — — — — 1 — 1 By Water— (1) Not found watertight — — — — 21 2 23 (2) Found water-tight — — — — 305 82 387 (3) Total — — — — 326 84 410 Total (1) 41 63 – – 21 2 127 (2) 331 117 — — 309 82 839 (3) 372 180 — — 330 84 966 Drainage register.— The following is an analysis of the Drainage Register during 1921:— Plans deposited—Old Buildings under Notice 87 „ „ Old Buildings, Voluntary 101 „ „ New Buildings and Additions 11 199 Applications without Plans 147 Total number of Applications and Plans 346 62 Water Service. The following notices have been received during the year from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition — 2.—Empty 4 3.—Waste 7 4.—Non-payment of Rates 1 5.—No statement (withdrawals) — 6.—By request 1 7.—Broken Supply Pipe 6 19 Canal Boats Acts. During the year Inspector Auger examined 1 canal boat, which was registered for the occupation of 4 adults and 2 children and was occupied by 2 adults and 4 children. No contraventions 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 due to the small number of registered boats using the canal. Inhabited House Duty. No applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1921. The Rag Flock Act, 1911. Three samples of rag flock were taken under this Act during 1921. They were found to contain 10.8, 19.8 and 21.8 parts of chlorine per 100,000 respectively. Public Mortuaries and Coroner's Court. Number of bodies deposited in the General Mortuary in 1921 196 „ „ „ Infectious Mortuary in 1921 — Total 196 Inquests held during 1921— In the Coroner's Court—General Cases from St. Pancras 279 „ „ Poor Law Cases from St. Pancras 20 „ „ General Cases from other Boroughs 7 Total 306 63 FACTORY AND WORKSHOP ACTS. The following five tables are those asked for by the Home Secretary:— 1.— Inspections made by Male and Female Sanitary Inspectors. Premises. Number of Prosecutions. Inspections. Written Notices. (1) (2) (3) (4) Factories (including factory laundries and bakehouses) 1,328 294 — Workshops (including workshop laundries and bakehouses) 1,710 255 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 429 62 — Total 3,467 611 — 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 Acts*— Nil Nil Want of cleanliness 170 170 Want of ventilation — — Overcrowding 1 1 Want of drainage of floors — — Other nuisances 130 130 Sanitary accommodation— Insufficient 7 7 Unsuitable or defective 84 84 Not separate for sexes 35 35 Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouses (s. 101) — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 84 84 Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 100 100 Total 611 611 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 64 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, &c., of wearing apparel, comprising the names of 57 outworkers (contractors) and 77 outworkers (workmen). 4.—Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. Number. (1) (2) Bakehouses 134 Restaurant kitchens 410 Laundries 31 Domestic workshops — Other workshops where women are employed 412 Other workshops 793 Total number of workshops on Register 1,780 5.—Other Matters. Class. Number. (1) (2) Matters 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 57 Reports (of action taken) sent to H.M. Inspector 57 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 23 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 88 The number of factories, workshops and workplaces added to and removed from the register during 1921 was as follows:— Added to Register. Removal from Register. On Register at end of 1921. Bakehouses— Workshop 1 3 134 Factory — — 39 Laundries— Workshop — 1 31 Factory — — 12 Restaurant kitchens 5 15 410 Other workshops where women are employed 29 25 412 Other workshops 49 23 793 Other factories 32 22 697 65 The number of inspections that were made during 1921 were as follows:— Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 360 234 – – 360 234 Restaurant kitchens 67 158 36 — 103 158 Laundries 2 7 – — 2 7 Domestic workshops — — 1 — 1 — Other workshops 352 939 1 — 353 939 Other workplaces 62 106 — — 62 106 Other factories 230 912 — — 230 912 Total 1,073 2,356 38 – 1,111 2,356 Bakehouses and restaurant kitchens are also referred to in Section V. (page 72). 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 1921. They are classified in the following Tables:— (10495) I 66 Medical Examination of Elementary School Children in St. Pancras, 1921. Boys. Girls. Entrants. Age 8. Age 12. Leavers (nearly 14). Entrants. Age 8. Age 12. Leavers (nearly 14). Number examined 2,061 1,517 1,666 1,492 2,030 1,539 1,670 1,533 Cases. † Cases. † Cases. † Cases. † Cases. † Cases. † Cases. † Cases. † Skin diseases 57 42 33 18 39 25 27 17 64 45 25 16 33 19 45 29 Teeth — 427 — 299 — 186 — 196 — 431 — 313 — 218 — 221 Enlarged tonsils (only) 291 42 176 28 158 19 103 21 297 32 178 34 224 30 157 25 Adenoids (only) 170 57 71 26 29 13 19 11 156 56 51 19 13 3 8 2 Tonsils and adenoids (together) 242 102 75 28 36 19 20 10 188 88 78 43 37 20 24 12 Other nose and throat defects 166 107 74 47 41 14 27 10 131 70 58 30 61 24 22 6 Cervical and submaxillary glands enlarged 354 9 260 1 169 3 116 5 300 4 200 1 141 2 121 3 Eye disease 75 51 33 18 50 24 25 10 64 39 71 18 42 15 23 14 Defective vision Not tested. — 181 — 223 — 158 Not tested. — 200 — 213 — 164 Otorrhæa 47 28 20 16 20 20 9 9 48 39 19 16 14 13 16 12 Other ear defects 17 6 17 5 26 8 16 9 18 6 25 8 24 8 17 8 Defective hearing 33 5 26 7 27 8 18 6 34 6 19 4 26 5 19 6 Speech defects 36 1 20 — 17 4 10 — 29 1 25 — 18 — 10 — Heart defects 41 4 35 4 36 3 35 4 37 8 35 9 61 7 50 3 Anæmia 59 38 50 22 52 24 39 16 52 38 58 34 68 30 79 43 Lungdefects(non-tuberculous) 169 59 41 15 40 9 18 4 148 44 43 12 36 9 12 2 Defects of nervous system 24 7 15 2 22 4 9 — 30 4 22 5 39 3 21 1 Phthisis 9 4 5 3 4 2 4 2 4 3 3 1 2 — 4 2 Other tubercular disease 1 1 4 3 5 2 3 1 5 3 1 — 4 2 4 3 Rickets 58 6 32 3 16 — 23 — 43 7 17 1 13 — 7 — Spinal deformities 2 – 9 2 36 5 48 3 6 3 5 2 35 7 52 9 Other deformities 16 6 13 1 23 4 18 2 14 2 7 2 18 2 21 4 Malnutrition 33 29 25 22 21 18 17 17 44 38 22 19 24 18 14 11 Other defects or disease 102 56 63 35 45 22 18 8 114 69 71 46 88 34 78 37 Total number of children noted for treatment 910 623 541 465 821 663 569 533 Note.— Defects, however slight, are included under "cases." Those severe enough to require treatment are shown under †. 67 (10495) Borough of St. Pancras, 1921. Degree of Cleanliness, Nutrition, Condition of Teeth, Acuity of Vision, in Elementary School Children. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Total number of children examined. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits only. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either eye. Entrants— Boys 1,270 760 31 396 1,595 70 — 1,930 129 2 1,920 140 1 697 987 377 — — — 2,061 Girls 1,310 695 25 416 1,537 75 2 1,725 284 21 1,917 110 3 728 955 347 — — — 2,030 Age 8— Boys 1,028 465 24 179 1,252 85 1 1,416 101 — 1,417 99 1 559 736 222 837 347 295 1,517 Girls 953 576 10 216 1,241 82 — 1,223 292 24 1,446 89 4 606 704 229 795 423 304 1,539 Age 12— Boys 921 725 20 231 1,376 58 1 1,563 101 2 1,533 132 1 829 752 85 986 350 322 1,666 Girls 961 696 13 345 1,238 87 — 1,297 349 24 1,528 141 1 903 685 82 905 418 342 1,670 Leavers— Boys 922 556 14 322 1,131 39 — 1,407 83 2 1,394 97 1 742 674 76 999 227 259 1,492 Girls 932 599 2 466 1,011 56 — 1,239 275 19 1,438 95 — 812 649 72 970 260 301 1,533 Total 8,297 5,072 139 2,571 10,381 552 4 11,800 1,614 94 12,593 903 12 5,876 6,142 1,490 5,492 2,025 1,823 13,508 % St. Pancras 61.4 37.6 1.0 19.0 76.9 4.1 87.4 11.9 0.7 93.2 6.7 0.1 43.5 45.5 11.0 58.8 21.7 19.5 * % London 59.0 38.7 2.3 22.9 71.6 5.5 85.5 13.6 0.9 91.3 8.5 0.2 57.9 34.2 7.9 53.1 26.2 20.7 * * Percentage of children whose vision was tested. I 2 68 Feeding of School Children. The County Medical Officer has also kindly furnished the following particulars in regard to the feeding of school children in St. Pancras during the year ended 31st March, 1922. Number of individual children fed. Number of meals provided. Cod Liver Oil and Malt. Dinners. Breakfasts. Milk. (a) Necessitous 1,583 104,123 154 61,433 1,723 (b) Non-necessitous 447 57,805 Nil 31,619 109 Totals of (a) and (b) 2,030 161,928 154 93,052 1,832 The schools were closed for holidays during the following periods:— Easter—24th March, 1921, to 4th April, 1921. Whitsuntide—16th and 17th May, 1921. Summer—21st July, 1921, to 22nd August, 1921. Autumn—31st October, 1921, and 1st November, 1921. Christmas—23rd December, 1921, to 9th January, 1922. During these periods dinners and breakfasts were provided for the necessitous children only. No feeding of any kind took place on Saturdays and Sundays throughout the year, the statutory Bank Holidays, Good Friday, or Tuesday, 27th December, 1921, the day following Boxing Day. Infectious Diseases in Schools. In the investigation of cases of scarlet fever, diphtheria, &c., 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 Secretary-Superintendent:— St. Pancras School Clinics. At the request of the Medical Officer of Health I have on previous occasions had the opportunity of detailing the work done at these Centres in the Borough. At the present time there are two Clinics at work, in Prince of Wales' Road and Lancing Street, dealing with cases in the north and south of the Borough respectively. The Clinics work in agreement with the London County Council and treat cases referred to them from the School inspections of the Council's School Medical Officers and Nurses. The cases dealt with fall into the following categories, errors of refraction and eye diseases, 69 ear, throat and nose defects including the operative treatment of tonsils and adenoids, minor ailments, dental cases, and the treatment of verminous heads. Number of Cases for the year 1st April, 1921, to 31st March, 1922:— Dental. Aural. Eyes. Minor Ailments. Prince of Wales' Road 2,032 874 1,180 1,408 Lancing Street 1,547 392 Nil 1,035 These figures represent new cases and not attendances. At Prince of Wales' Road there were 28,080 attendances in the Minor Ailment Department, and at Lancing Street 27,383. In connection with Prince of Wales' Road 733 visits were paid to children at their homes, and with Lancing Street 338. These home visits were made by the Central St. Pancras District Nursing Association. At Prince of Wales' Road 3,273 children had their heads cleansed. At Prince of Wales' Road operations were performed on 485 children and at Lancing Street on 226. In all operation cases, the greatest care is taken that all bleeding has stopped and that the children are quite fit to return home. In 6 cases the child was detained for the night. These figures represent a large amount of work, and the greatest credit is due to the Doctors, Dental Surgeons, Nurses in charge, and Nurses of the Central St. Pancras Nursing Association, for the devoted work that they have done. There will be a new development this year (1922). Mr. and Mrs. R. Kohnstamm of Hampstead are building a new clinic in Chester Road in memory of their two sons who were killed in the war. The foundation stone of this, the Highgate New Town Clinic, was laid on 11th May, 1922, by Mr. F. R. Anderton, the Chairman of the London County Council, and when finished it will be a spacious, beautiful and model building for this class of work. It is hoped to build and equip this Clinic ready for work by 1st January, 1923. A. R. Roche, Secretary and Superintendent. 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. A bacteriological investigation into the condition of the milk brought into and sold in the borough was conducted in 1920, which showed that the state of the milk generally was most unsatisfactory. The results of the investigation were fully reported in the Annual Report for 1920 (pages 59-58). 70 Dairies, Cowsheds and Milkshops. Cowsheds.— At the end of 1921 there were two licensed cowsheds in the Borough. They are registered for 43 cows, but were occupied by 13. Milkshops and Dairies.— 36 applications for registration under the Dairies, Cowsheds and Milkshops Orders, in respect of milkshops, were considered during 1921, of which 34 were acceded to and two refused. Eleven 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 1920 211 Deduct No. of purveyors removed from register during 1921 42 Add No. of purveyors added to register by resolution of Council during 1921 34 No. of purveyors of milk at retail milkshops on register at end of 1921 203 At the end of 1921 there were on the register in addition to these 203 retail milkshops and 2 cowsheds (which are attached to retail milkshops included in the 203), one person in respect of premises where only a wholesale milk trade is done, and 10 itinerant vendors without retail milkshops. Legal proceedings were taken in one instance against a vendor carrying on the trade of purveyor of milk without being registered. His premises were considered to be unsuitable for the sale of milk. The particulars were as follows:— Dairies, Cowsheds and Milkshops Order, 1885-6. Address. Offence. Date of Hearing. Penalty. Costs. 3, Heathcote Mews Carrying on trade or business of a purveyor of milk without being registered 10th Jan. 5s. £2 2s. 0d. The Public Health (Milk and Cream) Regulations, 1912 and 1917. The following is the Report of the Administration in connection with the above regulations asked for by the Ministry of Health. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. Report for Year ended 31st December, 1921. 1. Milk, and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 382 — Cream 13 7 Nature of preservative in each case in column (b) and action taken under Regulations in regard to it:— C. 177. Cream. 0.028 per cent. boron trioxide, equal to 0.0496 per cent. of crystallised boric acid. Proceedings taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Summons withdrawn on payment of £2 2s. costs, 7th October. 71 C. 191. Cream. 0.126 per cent. boron trioxide, equal to 0.223 per cent. of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Summons withdrawn. 7th October. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. (See C. 192.) C. 192. Cream. 0.112 per cent. boron trioxide, equal to 0.198 per cent. of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Summons withdrawn. 7th October. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Fined £2, costs 10s. 6d. 7th October. (In respect of Samples C. 191 and C. 192.) C. 200. Cream. 0.108 per cent boron trioxide, equal to 0.191 per cent. of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling cream which was not of the nature, substance and quality of the article demanded. Ordered to pay £2 2s. costs. 6th September. Summons also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. 6th September. C. 201. Cream. 0.126 per cent. boron trioxide, equal to 0.223 per cent. of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Ordered to pay £2 2s. costs. 6th September. Summons also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 202. Cream. 0.07 per cent. boron trioxide, equal to 0.124 per cent. of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. Costs 10s. 6d. 9th September. Summons also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 203. Cream. 0.126 per cent. boron trioxide, equal to 0.223 per cent.of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. Costs 10s. 6d. 9th September. Summons also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (i) Correct statements made 8 (ii) Statements incorrect — Total 8 (iii) Percentage of preservative found in each sample: Boric acid, 0.322, 0.186, 0.273, 0.198, 0.124, 0.248, 0.157 and 0.198 per cent. Percentage stated on Statutory label: 0.4. (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 8 (ii) Below 35 per cent. — Total 8 72 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed: None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken: None. 3. Thickening Substances.— Any evidence of their addition to cream or to preserved cream. Action taken where found: None. Milk (Mothers and Children) Order, 1919. See page 22 (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 78 occasions during the year unsound food has been voluntarily surrendered by the owners to the Food Inspectors and destroyed as trade refuse. No seizures of unsound food have been made. Details in regard to the work of the Food Inspectors are shown in table No. 8, on pages 96 and 97. Slaughter-Houses. At the end of 1921 there were 8 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 159 inspections in this connection in 1921. Fried Fish and Fish Curing Premises. In 1921 there were 76 fried fish vendors' premises in the Borough, at 8 of which fish curing was also carried on. There were 22 fish curers' premises, including these 8. 294 visits were made by the Food Inspectors to these premises during the year. Ice-Cream Premises. 247 visits were paid to these premises by the Food Inspectors during 1921. Bakehouses and Restaurant Kitchens. At the end of 1921 there were 173 bakehouses on the register, including 39 factory bakehouses. Forty-seven of these bakehouses were not in use. 126 of the 173 were underground bakehouses, of which 25 were factory bakehouses, and 38 not in use. At the end of the year 410 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 pages 63-65. 73 (c)—SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 704 of these proved to be genuine and 46, or 6.1 per cent., adulterated. The details are given in the following table:— Articles of food of which Samples have been taken. Total number of Samples. Genuine. Adulterated. Arrowroot 2 2 – Brawn 2 2 – Butter 128 126 2 Cheese 5 5 — Cocoa 31 31 — Coffee 26 26 — Cream 13 6 7 Preserved cream 8 8 – Custard powder 5 5 – Dripping 22 22 — Fish paste 2 1 1 Flour (Self Raising) 5 5 – Jam 10 10 – Lard 23 23 — Margarine 5 5 — Milk 382 351 31 Mustard 6 6 — Olive oil 10 10 — Pepper 9 9 — Rice 26 26 – Sausages 8 5 3 Vinegar 16 16 — Vinegar (Malt) 6 4 2 Total 750 704 46 Note.— The 750 include 1 informal sample of butter and 1 of cream. (10495) K 74 Prosecutions were undertaken in respect of 25 of the 46 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. Costs. 1921. £ s. d. £ s. d. C. 9 Milk Added water, 8.3 per cent. 22nd March 5 0 0 5 5 0 C. 58 „ „ „ 36.3 per cent. 22nd April – 6 6 0 C. 59 „ ,, ,, 32.2 per cent. „ C. 57 „ „ „ 8.7 per cent. „ C. 60 „ „ „ 11.8 per cent. „ C. 79 „ Deficient in milk fat, 18.3 per cent. „ 2 10 0 — C. 80 „ „ „ 13 per cent. „ 2 10 0 — A. 94 „ Added water, 17.4 per cent. 13th May 5 0 0 — A. 136 „ „ „ 11.1 per cent. 15th July — 2 2 0 A. 142 „ Deficient in milk fat, 48.0 per cent. „ 1 0 0 2 2 0 A. 145 „ „ ,, „ 44.6 per cent. „ 1 0 0 — A. 152 „ „ „ „ 11.0 per cent. 7th July 2 0 0 0 10 6 C. 168 „ Added water, 12.2 per cent. „ 3 0 0 2 2 0 C. 201 Cream Admixture of boric acid, 0.223 per cent. 6th Sept. — 2 2 0 C. 200 „ ,, „ 0.191 per cent. „ — 2 2 0 C. 202 „ „ „ 0.124 per cent. „ 3 0 0 0 10 6 C. 203 „ „ „ 0.223 per cent. „ 3 0 0 0 10 6 C. 251 Milk Added water, 4.2 per cent. 17th Nov. 5 0 0 0 10 6 C. 252 „ Deficient in milk fat, 7.0 per cent. „ 1 0 0 — C. 264 Batter Foreign fat, 25 per cent. 16th Nov. 40 0 0 2 2 0 C. 343 Milk Deficient in milk fat, 11.6 per cent. 4th Nov. 0 10 0 0 10 6 A. 255 Butter Foreign fats, 85 per cent. 17th Nov. 3 0 0 — A. 269 Milk Added water, 3.1 per cent. 9th Dec. 6 0 0 0 10 6 A. 280 „ „ „ 9.7 per cent. 8th Dec. 3 0 0 0 10 6 Milk and Cream Regulations. 1912 and 1917. Article. Offence. Date of Hearing. Result of Proceedings. Preserved cream Delivering cream at 277, Kentish Town Road in a receptacle not labelled preserved cream. 7th Oct. Fined £2. Costs 10s. 6d. Preserved cream Selling preserved cream not labelled as such 7th Oct. Costs, £2 2s. Summons withdrawn. Wholesale dealers in Margarine.— No Certificates of registration as Wholesale Dealers in Margarine under the provisions of the Sale of Food and Drugs Acts were issued during the year. 75 Section VI.— SANITARY ADMINISTRATION. THE STAFF. The names of the staff of the Public Health Department at the end of 1921 will be found on pages 5 and 6. Dr. G. T. Calthrop, Tuberculosis Officer, resigned his position in July, but continued to act until 1st October. His place was taken from 3rd October by Dr. G. F. Hardy, M.C., who was appointed temporarily. Dr. Gladys Miall-Smith, Assistant Medical Officer for Maternity and Child Welfare, left the Council's service on 19th November, in consequence of her marriage. Her medical consultations at the Council's Centres were undertaken temporarily by part-time medical officers. In consequence of the same resolution of the Council on the subject of the employment of married women whose husbands were in a position to support them, Mrs. Barrett and Mrs. Cook, assistants at the Personal Cleansing Station, and Mrs. Reid, assistant at the Prospect Terrace Baths, left in July. Mrs. Baxter's place was filled temporarily and Mrs. A. Wright and Mrs. A. Styles were appointed at the Cleansing Station on 13th July. Mrs. Wright afterwards resigned and Mrs. L. Blaby was appointed in her place on 16th November. Mrs. L. Arnold was appointed in Mrs. Reid's place on 13th July. Miss H. Payne, sanitary inspector, left the Council's service at the end of May in consequence of her approaching marriage, and Miss A. Holland was appointed in her place on 22nd June. Miss G. B. Steggles, temporary health visitor, left on grounds of health on 24th December. Miss M. Deed was appointed on 26th January to the new post of secretary and general assistant to the Tuberculosis Officer. Mrs. F. E. Henderson, clerk, left on 25th October in consequence of her approaching marriage, and Miss A. Andrews was appointed in her place on 30th November. Mr. J. Evans, caretaker at the Council dwellings, Flaxman Terrace, left the service on 13th July, and Mr. C. Hanson was appointed as his successor on 5th October. Staff at the Maternity and Child Welfare Centres. Miss A. Mullock Jones was appointed as superintendent of the Maternity Nursing Association Centre on 26th January, upon the resignation of Miss M. Andrews. Miss Mullock Jones was transferred to the position of superintendent of the Mary Ward Settlement School for Mothers in August, and Miss M. Templeton, superintendent of the latter centre, took her place as superintendent of the Maternity Nursing Association Centre. Miss A. Kennedy, assistant health visitor at the Argyle Square group of centres, resigned in March, and Mrs. M. Ashwood Smith was appointed in her place on 25th May. Miss F. T. Peacock, assistant health visitor at the same group of centres, resigned in June and Mrs. S. Kahan was appointed in her place on 22nd June. Shortly afterwards Mrs. Kahan was transferred to the Camden Town Centre, Miss Blair, of the latter centre, taking her place at the Argyle Square group. Mrs. Ashwood Smith was transferred in December to the Ampthill Square Centre, Mrs. Chapman, of the latter centre, taking her place at the Argyle Square group. It is with great regret that I have to record the death, in May, 1921, of Miss E. L. Savory, superintendent of the Chalton Street centre. Miss Savory had been in charge of that centre from its opening in 1918, had given devoted service and had gained the esteem and affection of all who had been brought in contact with her. Miss M. Manger, assistant at the centre, was promoted to be superintendent on 25th May, and Miss M. A. Clarke was appointed as assistant health visitor in her place on 22nd June. (10495) K 2 76 CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.1, for the bacteriological examination at the expense of the Council of material from St. Pancras cases sent to them through medical practitioners in regard to diphtheria, tuberculosis, and typhoid fever. The work done in 1921 was as follows:— Total. Positive. Negative. Examination of— Swabs for B. diphtheriae 501 111 390 Sputum for B. tuberculosis 259 44 215 Blood for Widal reaction (typhoid, &c.) 13 4 9 Examinations of sputum have also been made at the tuberculosis dispensaries (see page 45). Facilities for the examination of cerebrospinal fluid in suspected cases of cerebrospinal fever, &c., 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 73. 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 British Red Cross, the Soldiers' and Sailors' Families Association, the National Society for the Prevention of Cruelty to Children, the Invalid Kitchens, the Mary Ward Settlement, Lyndhurst Hall, &c. Voluntary agencies subsidised by the Council are referred to particularly in Section II of this Report (Maternity and Child Welfare). Home Nursing. As regards district nursing, the Borough comprises the whole of the district of the Central St. Pancras District Nursing Association, and large portions of the districts of the Metropolitan Nursing Association, the Hampstead District Nursing Association, and the North London Nursing Association. The associations were paid by the Council or the Mayoress' Nursing Fund 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 1921 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 10,639 Metropolitan Nursing Association (St. Pancras cases) 300 4,988 Hampstead District Association (St. Pancras cases) 190 2,303 North London Nursing Association (St. Pancras cases) 241 2,915 Reference is made on page 16 to the work of the voluntary hospitals. 77 Section VIII.— HOUSING. The housing problem in St. Pancras has been dealt with at some length in former Annual Reports, and there is no change to record in 1921. The shortage of houses continued, and it was in many instances found impossible to deal with cases of over-crowding and with the illegal occupation of underground rooms as sleeping places. Apart from the special difficulties which have appeared since the war the great problem in St. Pancras is the compression of several families into single houses which were originally intended for one family only and have never been altered so as to provide accommodation for more than one family. The majority of the working-class population in the borough live in such tenement houses. It is hoped that the tenement house byelaws to be made by the London County Council under the Housing Act of 1919 will not be delayed much longer, as the Borough Council's programme in regard to such houses must necessarily depend upon the form which these byelaws take. The Council's scheme of building at Prince of Wales Road and Brookfield was proceeded with during the year, and particulars as to this matter will be found on page 79, where reference is also made to the public inquiry which was held by the Ministry of Health on 25th October, 1921, into the Council's Somers Town Improvement Scheme, No. 1. Statistics for the year ended 31st December, 1921 (as required by the Ministry of Health). 1.— General. (1) Estimated population 212,900 (2) General death-rate 13.0 (3) Death-rate from tuberculosis 1.43 (4) Infantile mortality 76 per 1,000 births (5) Number of dwelling-houses of all classes 23,345 (1911 Census) (6) Number of working-class dwelling-houses 20,982 (estimated) (7) Number of new working-class houses erected 12 flats 2.—Unfit Dwelling-Houses. I.— Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) *2,574 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 916 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation — II.— Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Nil. * Excluding 4,576 visits to house and other premises on complaint. 78 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit— (a) by owners Nil. (b) by Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,039 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 4,039 (b) by Local Authority in default of owners Nil. C. Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 1 (4) Number of dwelling-houses in respect of which tion Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 3.—Unhealthy Areas. Areas represented to the Local authority with a view to Improvement Schemes under (a), Part I, or (6), Part II, of the Act of 1890 :—- (1) Name of area Nil. (2) Acreage Nil. (3) Number of working-class houses in area Nil. (4) Number of working-class persons to be displaced Nil. 4.—Number of houses not complying with the building byelaws erected with consent of Local Authority under section 25 of the Housing Town Planning, &c., Act, 1919 Nil. 5.—Staff engaged on housing work, with briefly, the duties of each officer. Eleven District Sanitary Inspectors devote as much time as possible to housing work. The necessary assistance is afforded by the Clerical Staff. 79 WORK OF THE SPECIAL (HOUSING) COMMITTEE. The following summary of the principal matters which were considered by the Special (Housing) Committee during the past year has been prepared by Mr. A. Powell Coke, Clerk of that Committee and of the Estates Committee which has taken its place since the end of 1921. In regard to some of the questions which will be referred to, the summary has been brought up to the end of July, 1922. The work of the Special (Housing) Committee, which has been in existence since 27th November, 1918, is now merged in the Estates Committee, following the decision of the Council on the 22nd February, 1922, when it was decided to set up a Housing Department to control and manage all houses built and owned by the Council, except such as are occupied by employees of the various departments in connection with their work. The duties of the Estates Committee have been laid down as follows :— " To take over, control and manage all houses and other properties of the Council except such as are used by any department of the Council for its own purposes ; to see that such houses and properties are kept in tenantable condition and let at reasonable rents ; to prepare schemes under the Housing of the Working Classes Acts for the improvement or reconstruction of insanitary areas, and to supervise the erection of houses for the working classes ; and to deal with such other matters as may be referred to the Committee by the Council." The first meeting of the new Committee was held on the 20th June, when Councillor W. Carter was appointed Chairman, and Councillor A. Davis, Deputy Chairman. Brookfield Estate. Description.—The Estate comprises 98 flats in 10 blocks, 90 maisonettes in 19 blocks and two cottages, giving a total accommodation for 190 families. The Estate occupies an area, including roads, of 10¼ acres. It is on sloping ground having a difference in level of 29 feet from south to north, is situated within three minutes of Parliament Hill Fields, and has the wooded heights of Highgate and Hampstead as a background. The lay-out was governed by the winding road through allotments called Croftdown Road, leading from good modern residential property at the south end, to Highgate New Town at the north end. A second through road has been formed from near the upper end of Croftdown Road extending to and in continuation of St. Alban's Road, with a subsidiary crossroad at the south end known as Kingswear Road. The upper part of the estate is laid out for flats, four stories in height, in blocks of 8, 10 and 16, of three and four rooms, besides cooking sculleries, bathrooms, &c., and the lower portion with maisonettes, in blocks of four and five, of three and five rooms each, besides cooking scullery, bathroom, &c., finishing with a pair of six-room cottages. An allotment is planned for each flat in the rear of the buildings, and each maisonette has its own front and back gardens with direct access. The front boundary and party fences are formed of oak posts and wire strands planted with privet. The blocks of buildings are set out on centre lines with clear vistas between each block, or terminated at the end of roads by a building and each one placed so as to obtain the maximum amount of sunshine and air in and around the buildings. 80 All buildings are wired for electric light, and gas installed for domestic hot-water services and cooking purposes, the living-rooms being fitted as sitting-rooms with tiled register hob-grates. The facings of the flats are red-brick, with blue brick plinths and artificial Portland stone dressings and main moulded cornice and roofs covered with hand-made sand-faced roof tiles. The maisonettes are roofed with similar tiles and faced with red bricks and brown plinths, the upper part of each intermediate block being roughcast, the eaves being formed with tile soffits. The windows of the flats are boxed sash and frames and wooden casements for the maisonettes, and all floors of steel and concrete covered with wood. The interior decorations are both cheery and serviceable. The subsoil is a poor clay, necessitating special care with the foundations laid in cement, concrete and London stock footings, the trenches being exposed as long as possible for shrinkage before concrete was put in. The scheme is exceptional in that it provides accommodation for as many as 20 tenancies to the acre, and at the same time gives large gardens and ample open space about and around the buildings, this being only possible by adopting as a principle the combined use of flats and maisonettes, thus saving actual building-site area on land too costly for the usual lay-out of groups of houses. The general effect is very pleasing, and the whole scheme is unique as a housing scheme, an entire departure from the usual stereotype planning, and shows that in designing the scheme care has been taken not to deteriorate the values of adjoining properties. The scheme is designed and supervised by Mr. Albert J. Thomas, M.S.A., L.R.I.B.A. The contractor is Mr. Albert Monk, of Lower Edmonton. Selection of tenants.—Careful consideration has been given to allocating the Estate. I n selecting tenants, preference has been given to those whose existing accommodation was overcrowded. The Committee received hundreds of applications in excess of the accommodation available. These were'reduced to a manageable number and referred to a Visiting Sub-Committee, who called upon the applicants, and thus obtained first-hand information of the conditions under which the families were living. The Estate was formally opened by the Mayor, Councillor T. W. McCormack. J.P., on the 24th June, 1922, and some 60 flats and maisonettes are tenanted. School Treatment Centre.—On the 23rd March, 1921, the Council resolved that application be made to the Ministry of Health for sanction to let on building lease to Mr. R. Kohnstamm for a period of 99 years at a ground rent of £35 per annum, a piece of land on the Brookfield Estate, surplus to housing requirements, with a frontage on Chester Road, for the erection of a School Treatment Centre. The Ministry sanctioned the proposal, and rapid progress is being made with the buildings. Agreement with the Mansfield Bowling Club, Limited.—A commilnication was received on behalf of the Club, drawing attention to the fact that in one of the blocks of maisonettes, a door and window opening had been formed immediately overlooking the Company's land. While not desiring to do anything to hamper the building scheme, the Company desired to protect their rights by entering into an agreement with the Council in the matter. The Committee were advised that the Council as freeholders should formulate an agreement with the Club setting out their mutual rights so as to obviate any misunderstanding in the future, and thus avoid the erection of a hoarding on the party fence. An agreement was accordingly entered into on these lines. 81 Chester House. Privet hedge.—A petition was received from the residents of these flats calling attention to the fact that as a result of the building frontage being open to the public, considerable annoyance was caused by neighbouring children making a general playground of the forecourt, and finding their way up the staircase and to the courtyard at the rear. In order to remedy this nuisance, instructions were given for the planting of a privet hedge along the boundary and returns to the entrance. Proposed pram sheds.—The petition from the residents (referred to in the previous paragraph) also called attention to the inconvenience arising from the absence of pram sheds. Estimates were obtained for the erection of sheds in the courtyard, and submitted to the Ministry for their approval. The Ministry suggested a much cheaper form of building which the Committee considered would not prove desirable, and decided to defer the matter until the Brookfield Estate was occupied, when the whole question could be considered together. " Una House," Prince of Wales Road. Opening of flats.—These flats were formally opened by the Mayor, Councillor T. W. McCormack, J.P., on the 25th February, 1922. The tenants took up possession early in March. In selecting tenants for the scheme, which comprises five 2-room fiats, thirty-four 3-room flats and twenty-five 4-room flats, the same methods were applied as in the case of the Brookfield Estate referred to previously. The scheme was designed by Messrs. Ashley and Newman, F.F.R.I.B.A., and the flats erected by Messrs. Chessums, Ltd., of Tottenham. Certain minor improvements have been carried out since the buildings were occupied. The Architects were requested to obtain estimates for fixing lead drips or alternatively, slate creasings, over the windows of the top floors, owing to complaints from the tenants that the rain beats in. Lead aprons were included in the original scheme, but were omitted by the Ministry. The Architects expressed the opinion that the suggested remedy would be both difficult and costly to carry out, and that it would not be possible to do the work effectively. They suggested that the brickwork should be treated with a special solution which renders it waterproof, and instructions were given for the work to be carried out. It is proposed to ask the Ministry's consent to the expenditure which will be incurred. For some time past the Committee have had under consideration the maintenance of the hot water supply. At the present time a full hot water service is available from approximately 9 a.m. till 8 p.m., which entails continual attendance from 7.30 a.m. till 8 p.m. Temporary arrangements were made whereby the Boiler Attendant and the Caretaker worked the plant together. The expenditure already incurred for the hot water supply has been extremely heavy, and the Committee are endeavouring to arrange for the supply to be maintained without further cost. Rentals. The following table gives the accommodation and the rents of the Assisted Housing Schemes agreed to by the Council after prolonged negotiations with the Ministry :— (10495) L 82 Number of Flats, Maisonettes or Houses. Description. Net Rent. *Gross Rent. Chester House. Flats. s. d. s. d. 3 Living room and one bedroom 10 0 13 10 2 Living room and one bedroom 10 4 14 2 6 Living room and three bedrooms 16 6 23 2 1 Living room and four bedrooms 18 9 26 5 Brookfield Estate. Flats. 20 Living room and two bedrooms (Blocks A and B.) 14 0 19 9 41 Living room and two bedrooms (Blocks C to J inclusive.) 14 6 20 6 12 Living room and three bedrooms (Blocks A and B.) 16 9 23 6 25 Living room and three bedrooms (Blocks C to J inclusive.) 17 3 24 0 Maisonettes. 4 Living room and two bedrooms (Blocks S, Q.) 16 0 22 4 6 Living room and two bedrooms (Blocks O, P, R.) 15 6 21 10 19 Parlour, living room and three bedrooms) (Blocks, S, A, B, C, Q.) 21 0 29 3 61 Parlour, living room and three bedrooms (Blocks D to P and R.) 20 6 28 9 Houses. 2 Parlour, living room and three bedrooms 21 6 30 2 Una House. Flats. 5 Living room and one bedroom 10 4 14 6 4 Living room and two bedrooms 12 6 18 0 30 Living room and two bedrooms 13 0 18 6 25 Living room and three bedrooms 16 0 22 2 * These gross rents are based on existing rates and water charges and are therefore subject to variation in the rate demands. Somers Town Improvement Scheme No. 1, 1921. In last year's report detailed reference was made to the Council's proposals in regard to this subject. On the 25th October, 1921, a Public Local Enquiry was held before Mr. H. S. Stewart, one of the Inspectors of the Ministry, in regard to the petition of the Council for the issue of an order sanctioning the scheme under Part II of the Housing of the Working Classes Act, 1890, for the improvement of the above-mentioned area. On the 10th April, 1922, a letter was received from the Ministry suggesting a Conference with representatives of the Council for a discussion of the matter. The interview took place on the 20th, when the Ministry requested that revised figures of the cost of the proposed scheme should be supplied, which has since been done. The matter is still under their consideration. 83 Goldington Buildings. Dampness.—The Committee's attention was called to the dampness in certain parts of these buildings, arising out of an inspection by the Medical Officer of Health and the Borough Engineer. The dampness in the ground floor flats was caused by rain water collecting upon the north portion of the yard and draining away through holes in the surface to the foundations of the buildings, and also by water draining to the sides of the courtyard and collecting against the walls before discharging to the gulleys. The Committee gave instructions for the defective cement floating to be relaid, which would allow the water to run off ; to provide a cement fillet around the courtyard, and to treat the gable end with a waterproof solution, at an estimated cost of £97. Flaxman Terrace. The Committee gave instructions to the Works Department to carry out the external painting of these flats at an estimated cost of from £600 to £650, some years having elapsed since the exterior was last painted. Instructions were also given for the staircases, caretakers' residences, and workshops, &c., at Flaxman Terrace and Prospect Terrace to be lighted by electricity in substitution of gas, at an estimated cost of £190 10s. (10495) l 2 APPENDIX. 86 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1921 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Rates for 1910-12 calculated on the 1911 census population and for 1919-21 on the 1921 population (212,900). 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 237,178 – 5,385 – 22.7 3,415 14.4 710 562 580 107 3,267 13.8 15.0 1911 237,129 — 5,135 5,555 23.4 3,418 14.4 673 611 623 112 3,356 14.1 15.4 1912 220,353 — 5,008 5,367 24.4 3,147 14.3 595 605 472 88 3,157 14.3 14.5 1913 218,387 — 5,167 5,517 24.7 3,409 15.6 728 662 512 93 3,343 15.0 — 1914 218,387 — 4,945 5,225 23.9 3,386 15.5 721 677 481 92 3,342 15.3 — 1915 218,387 200,322 4,458 4,754 21.8* 3,523 17.6† 672 692 497 105 3,543 17.7† — 1916 214,135 196,813 4,310 4,530 21.2* 2,991 15.2† 565 619 385 85 3,045 15.5† — 1917 208,006 186,600 3,635 3,796 18.2* 3,099 16.6† 608 718 402 106 3,142 16.8† — 1918 196,883 175,716 3,339 3,318 16.8* 3,789 21.5† 626 751 340 102 3,914 22.3† — 1919 228,585 219,434 3,804 3,824 16.7* 3,104 141l† 670 496 336 88 2,930 13.4† 13.8 1920 228,980 228,178 6,191 5,934 25.4* 3,007 12.9† 713 601 435 73 2,895 12.4† 13.6 1921 212,900 — 5,099 4,764 22.4 2,836 13.3 651 593 360 76 2,778 13.0 13.0 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 (of. Census, Vol. V). * Based on total population. † Based on civil population. 87 Table No. 2.—Deaths Registered from all Causes for the Year 1921. Note.—The deaths of Non-Residents occurring in Public Institutions situated in the Borough are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Borough are included. Cause of Death. Ages. 0 to 1 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. ivt, f. m. f. M. f. m. f. m. f. m. f. m. f. m. f. m. f. perSONS 1.—General Diseases. 1. Enteric Fever 1 1 1 3 3 2. Typhus Fever 3. Relapsing Fever 4. Malaria 1 1 1 5. Small Pox— (a) Vaccinated (6) Not Vaccinated (c) Doubtful 6. Measles 6 1 5 5 3 2 14 8 1 15 8 23 7. Scarlet Fever 2 2 1 1 1 1 1 4 3 7 8. Whooping Cough 8 10 6 8 6 14 24 14 24 38 9. (a) Diphtheria 1 4 4 1 8 7 13 9 12 8 3 2 1 1 1 1 28 23 51 (6) Croup 10. Influenza 2 2 1 3 3 2 2 1 2 1 2 4 6 6 10 2 7 3 19 38 57 11. Miliary Fever 12. Asiatic Cholera 13. Cholera Nostras 14. Dysentery 1 1 1 15. Plague 16. Yellow Fever 17. Leprosy 18. Erysipelas 1 1 1 2 1 3 19. (a) Mumps (b) German Measles (c) Varicella (d) Other Epidemic Diseases 20. (a) Pyæmia 1 1 1 2 1 1 1 3 4 7 (6) Septicaemia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 8 5 13 (c) Vaccinia 21. Glanders 22. Anthrax (Splenic Fever) 23. Rabies 24. Tetanus 1 1 1 25. Mycoses 1 1 1 26. Pellagra 27. Beri-Beri 28. (a) Pulmonary Tuberculosis 1 1 1 1 1 1 4 18 18 21 19 28 21 34 8 27 9 11 4 2 142 86 228 (b) Phthisis (not defined as tuberculous) 1 4 1 3 3 2 4 ?, 1 1 9 13 22 29. (a) Acute Phthisis (b) Acute Miliary Tuberculosis 1 1 1 1 3 1 1 2 1 6 2 8 30. Tuberculous Meningitis 1 3 3 4 2 1 6 8 3 3 2 3 11 14 25 31. (a) Tabes Mesenterica (b) Other peritoneal & intestinal tubercle 1 1 1 2 2 1 1 1 1 3 6 9 32. Tuberculosis of Spinal Column 1 1 1 1 2 3 33. Tuberculosis of Joints 1 1 1 34. (a) Lupus (b) Scrofula (c) Tuberculosis of other Organs 3 1 1 5 6 35. Disseminated Tuberculosis 1 1 1 1 1 1 2 3 36. Rickets, Softening of Bones 1 1 1 1 1 1 2 37. Syphilis 8 6 8 6 1 1 1 1 10 8 18 38. Other Venereal Diseases 39. Cancer of the Buccal Cavity 5 3 3 1 1 13 13 40. „ Stomach, Liver, &c. 5 13 3 20 13 14 10 4 5 1 56 32 88 41. ,, Peritoneum, Intestines, and Rectum 1 1 5 7 9 16 7 9 4 3 26 36 62 42. ,, Female Genital Organs 2 5 14 10 8 2 41 41 43. ,, Breast 2 3 9 5 3 22 22 44. ,, Skin 1 2 1 2 4 2 6 45. Cancer of other or unspecified Organs 1 1 1 1 2 1 11 4 11 4 12 6 9 1 1 41 17 58 46. Other Tumours (situation undefined) 1 2 2 1 2 4 6 47. Rheumatic Fever 1 1 2 1 1 1 2 5 2 8 8 16 48. (a) Chronic Rheumatism 1 1 1 (b) Osteo-Arthritis 2 2 1 5 5 (c) Gout 1 1 1 49. Scurvy 1 1 1 1 88 Deaths Registered from all Causes for the year 1921—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 1. General Diseases—contd. 50. Diabetes 1 1 4 2 1 5 1 2 1 1 10 9 19 51. Exophthalmic Goitre 1 1 1 52. Addison's Disease 1 1 1 53. Leucocythsæmia, Lymphadenoma 2 1 1 1 3 2 5 54. Anæmia,Cholorosis 1 1 1 1 1 1 2 2 5 5 10 55. (a) Diabetes insipidus (6) Purpura (c) Hæmophilia (d) Other General Diseases 1 1 1 1 2 3 56. Alcoholism (acute or chronic) 57. (a) Occupational Lead Poisoning (b) Non-occupational Lead Poisoning 58. Other Chronic Occupational Poisonings 59. Other Chronic Poisonings 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. (a) Encephalitis Lethargica 1 1 1 2 1 3 (b) Encephalitis, other forms 1 1 1 61. (a) Cerebrospinal Fever 1 2 1 2 2 2 2 4 (b) Posterior Basal Meningitis 1 1 1 1 (c) Meningitis, other forms 1 1 1 1 1 2 2 3 5 62.Locomotor Ataxy 2 2 1 5 5 63. (a) Anterior Poliomyelitis (b) Other Diseases of the Spinal Cord 2 1 1 1 1 1 1 2 5 1 6 10 16 64. Cerebral Haemorrhage, Apoplexy 1 1 4 9 14 7 17 19 9 16 4 45 57 102 65. Softening of Brain 1 1 1 1 1 1 2 4 6 66. Paralysis without specified cause 1 1 3 3 1 5 4 9 67. General Paralysis of the Insane 1 1 3 1 1 1 2 8 2 10 68. Other forms of Mental Alienation 1 1 1 2 1 2 4 6 69. Epilepsy 1 1 1 1 1 2 1 2 1 1 5 6 11 70. Convulsions (Non-puerperal; 5 years and over) 71. Infantile Convulsions (under 5 years) 4 4 1 4 5 4 5 9 72. Chorea 1 1 1 73. Hysteria, Neuralgia, Neuritis 74. Other Diseases of the Nervous System 1 1 2 1 1 2 1 2 2 3 2 3 1 2 1 15 8 23 75. Diseases of the Eyes and Annexa 76. (a) Mastoid Disease 1 1 1 2 2 (6) Other Diseases of the Ears 1 1 1 1 1 1 1 1 1 5 3 8 3. Diseases of the circulatory System. 77. Pericarditis 1 1 1 2 1 1 1 1 1 7 2 9 78. Acute Myocarditis and Endocarditis 2 2 1 1 6 1 2 1 4 1 1 14 10 24 79. (a) Valvular Disease 1 2 2 7 4 3 6 2 7 5 10 16 11 10 3 13 2 2 41 59 106 (6) Fatty Degeneration of the Heart 1 1 2 3 2 4 4 3 2 11 11 22 (c) Other Organic Disease of the Heart 3 1 4 6 4 14 12 17 21 51 42 36 53 132 151 283 80. Angina Pectoris 1 1 1 2 1 6 6 81. (a) Aneurysm 2 1 3 2 8 8 (6) Arterial Sclerosis 4 2 8 2 10 4 8 6 2 30 16 46 (c) Other Diseases of Arteries 1 1 2 2 82. {a) Cerebral Embolism and Thrombosis 1 1 3 2 5 2 7 1 — 2 16 8 24 (6) Other Embolism and Thrombosis 1 1 2 2 2 4 83. Diseases of the Veins (Varices, Hæmorrhoids, Phlebitis, &c.) 84. (a) Status Lymphaticus 1 1 1 1 (b) Other Diseases of the Lymphatic System 85. Hæmorrhage; other Diseases of the Circulatory System 1 1 2 2 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae 87. Disease of the Larynx 1 1 1 88 Diseases of the Thyroid Body 89 & 90. Bronchitis 8 5 2 1 1 11 6 1 1 3 1 4 4 19 4 31 19 39 32 36 38 9 18 153 123 276 91. Broncho-Pneumonia 24 15 3 6 5 5 32 26 1 2 1 2 1 2 2 4 2 1 6 3 1 47 42 89 92. (a) Lobar Pneumonia 1 1 2 1 2 3 1 1 1 1 2 2 5 3 9 1 7 2 1 2 3 1 28 19 47 (6) Pneumonia (type not stated) 2 1 3 1 5 2 3 1 3 1 4 1 6 1 4 4 2 24 13 37 93. Pleurisy 89 Deaths Registered from, all Causes for the Year 1921—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. 4. Diseases of the Respiratory System—contd. sons 94. Pulmonary Congestion, Pulmonary Apoplexy 1 1 1 2 1 1 1 5 6 95. Gangrene of the Lung 1 1 1 96. Asthma 1 1 2 1 1 1 1 1 2 6 8 97. Pulmonary Emphysema 1 1 1 2 2 98. (a) Fibroid Disease of the Lung (b) Other Diseases of the Respiratory System 1 1 1 1 2 3 5. Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums (b) Other Diseases of the Mouth and Annexa 100. Diseases of Pharynx, Tonsillitis 1 1 1 1 2 101. Diseases of CEsophagus - 2 2 2 102. Perforating Ulcer of Stomach 1 3 2 1 1 2 1 1 7 5 12 103. (a) Inflammation of Stomach 1 1 1 2 1 1 4 5 (b) Other Diseases of Stomach 1 1 1 1 2 1 3 104 & 105. (a) Infective Enteritis 10 7 1 10 8 1 10 9 19 (b) Diarrhoea (not returned as infective 3 8 1 3 9 1 4 9 13 (c) Enteritis (not returned as infective) 8 3 1 8 4 1 1 1 1 2 10 8 18 (d) Gastro-Enteritis (not returned as infective) 27 8 2 3 1 29 12 1 1 1 1 2 32 16 48 (e) Dyspepsia (under 2 years of age) 1 1 1 (f) Colic (q) Ulceration of Intestines 1 1 1 (h) Duodenal Ulcer 1 1 1 106. Ankylostomiasis 107. Other Intestinal Parasites 108. Appendicitis 1 1 2 2 1 2 2 1 2 1 1 1 8 9 17 109. (a) Hernia 1 1 1 1 1 1 1 2 3 5 8 (6) Intestinal Obstruction 1 1 1 2 1 1 1 1 1 3 1 2 7 6 13 110. Other Diseases of the Intestines 1 1 1 1 1 1 1 3 4 111. Acute Yellow Atrophy of Liver 112. Hydatid of Liver 113. (a) Cirrhosis of the Liver (not returned as alcoholic) 1 1 2 1 3 l 2 2 2 3 1 8 9 17 (b) Cirrhosis of the Liver (returned as alcoholic) 1 1 2 2 (c) Diseases formerly classed to " Other Diseases of Liver and Gall Bladder " 1 1 1 114. Biliary Calculi 2 2 2 115. Other Disease of the Liver 1 1 2 1 2 3 116. Diseases of the Spleen 1 1 1 117. Peritonitis (cause unstated) 1 1 2 1 1 1 3 3 6 118. Other Diseases of the Digestive System 1 1 1 2 1 3 6. Non-Venereal Diseases of the Genito-Urinary System and Annexa. 119. Acute Nephritis 2 1 1 3 1 4 120. Bright's Disease 3 1 2 4 1 6 11 8 8 4 5 1 1 1 31 25 56 121. Chyluria1 122. Other Diseases of the Kidney and Annexa 1 2 6 6 123. Calculi of the Urinary Passages 1 1 1 124. Diseases of the Bladder 1 5 6 6 125. Diseases of the Urethra,Urinary Abscess, &c. 2 1 3 3 126. Diseases of the Prostate 1 8 4 2 15 15 127. Non-Venereal Diseases of Male Genital Organs 128. Uterine Haemorrhage (Non-puerperal) 129. Uterine Tumour (Non-cancerous) 2 1 3 3 130. Other Diseases of the Uterus 1 1 1 131. Ovarian cyst. Tumour (Non-Cancerous) 1 1 1 132. Other Diseases of the Female Genital Organs 1 1 2 2 133. Non-puerperal Diseases of the Breast (Non-cancerous) (10495) M 90 Deaths Registered from all Causes for the Year 1921—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.l m. f. m. f. m. f. m. f. m. f. m. f. per sons 7. The Puerperal State. 134. Accidents of Pregnancy 1 1 2 2 135. Puerperal Haemorrhage 2 2 2 136. Other Accidents of Childbirth 2 2 2 137. Puerperal Fever 3 1 4 4 138. ,, Albuminuria and Convulsions 1 1 1 3 3 139. ,, Phlegmasia Alba Dolens, Em bolism and sudden death 140. ,, Insanity 141. ,, Diseases of the Breast 8. Diseases of the Skin and of the Cellular Tissue. 142. (a) Senile Gangrene 2 2 4 4 (b) Gangrene (other types) 2 2 2 143. Carbuncle, Boil 1 1 1 144. Phlegmon, Acute Abscess 1 1 I 145. Diseases of the Integumentary System 2 2 2 9. Diseases of the Bones and of the Organs of Locomotion. 147. Diseases of the Bones J 1 2 1 3 1 4 147. Diseases of the Joints 1 1 2 2 148. Amputations 149. Other Diseases of Locomotor System 10. Malformations. 150. Congenital Malformations 16 9 1 17 9 17 9 26 11. Diseases of Early Infancy. 39 36 39 36 39 36 75 (b) Infantile Debility, Icterus, and Sclerema 22 13 1 23 13 23 13 36 152. Other Diseases peculiar to early Infancy 8 4- 8 4 8 4 12 153. Lack of Care 12. Old Age. 154. (a) Senile Dementia 1 1 1 (6) Senile Decay 1 1 9 4 22 27 4 17 36 49 85 13. Affections Produced by External Causes. 155 to 163. Suicides 1 2 1 1 6 6 3 1 5 16 10 26 164. Poisoning by Food 165. Other Acute Poisonings 1 1 2 2 166. Conflagration 1 1 ] 167. Burns (Conflagration excepted) 1 1 1 1 168. Absorption of Deleterious Gases (Conflagration excepted) 2 2 1 1 2 3 169. Accidental Drowning 1 1 2 1 3 1 1 1 6 3 9 170 to 176. Injuries _ 3 2 5 3 1 4 3 1 3 1 6 2 3 1 4 1 1 2 33 8 41 177. Starvation 178. Excessive Cold 179. Effects of Heat 180. Lightning 181. Electricity (Lightning excepted) 182 to 184. Homicide 1 1 1 1 2 185. Fractures (cause not specified) 1 1 1 186 Other Violence 1 1 2 2 14. Ill-defined Causes. 187. Dropsy 188. (a) Syncope (aged 1 year and under 70) (b) Sudden death (not otherwise defined) 1 1 1 189. (a) Heart Failure (aged 1 year and under 70) (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) (c) Teething (d) Pyrexia (e) Other ill-defined Deaths (f) Cause not specified 91 Table No. 3. Summary of Ages. 0 to 1. 1 to 2. 2 to 5. Total under 5 years. 5 to 10. 10 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards Totals. General Diseases 54 39 35 128 41 27 59 64 87 132 166 131 47 7 889 Diseases of the Nervous System and of the Organs of Special Sense. 13 5 3 21 2 4 9 14 16 33 36 54 29 4 222 Diseases of the Circulatory System 1 1 — 2 6 4 15 20 28 53 100 154 134 21 537 Diseases of the Respiratory System 58 19 12 89 8 2 5 15 23 46 79 87 91 32 477 Diseases of the Digestive System 84 11 1 96 7 2 4 5 16 7 19 26 16 4 202 Non-Venereal Diseases of the GenitoUrinary System and Annexa. – – – – – – – 6 10 12 26 23 17 4 98 The Puerperal State – – – – – – 2 4 7 – – – – – 13 Diseases of the Skin and of the Cellular Tissue. – – – – – – – – – – 3 2 4 — 10 Diseases of the Bones and of the Organs of Locomotion. — – — — — 1 — 2 — 2 — 1 — — 6 Malformations 25 1 — 26 — — — — — — — — — — 26 Diseases of Early Infancy 122 1 — 123 — — — — — — — — — — 123 Old Age — — — — — — ' — — — — 2 13 49 22 86 Affections produced by External Causes 3 4 3 10 5 8 6 6 7 22 10 11 3 — 78 Ill-defined Causes — — — — — — — — 1 — — — — — 1 Totals 360 81 54 495 69 48 101 136 195 307 441 502 390 94 2,778 92 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 is distributed amongst the Wards and Sub-districts in the same proportion as at the 1911 Census ; the transferred births are allocated to the Wards and Sub-districts in proportion to their respective populations, but some of the births which took place in St. Pancras institutions are not redistributed, but are allocated to the districts in which the institutions are situated ; and deaths of residents which took place outside of the Borough and deaths in public institutions are classified in the respective Sub-districts and Wards of their previous residence. Registration Sub-Districts. Wards. Net Births. Birth-rate per 1,000 population. Net Deaths. Death-rate per 1,000 population. Deaths under 1 year of age. Infantile Death-rate per 1,000 Births. 4 555 21.6 333 12.9 44 79 5 596 19.2 398 12.8 57 96 West 1,151 20.3 731 12.9 101 88 7 697 39.4 193 10.9 33 47 8 603 22.8 359 13.6 31 51 South 1,300 29.5 552 12.5 64 49 3 677 20.0 447 13.2 66 97 6 575 26.0 316 14.3 44 77 East 1,252 22.4 763 13.6 110 88 1 588 17.0 407 12.3 42 71 2 473 22.2 300 14.1, 42 89 North — 1,061 19.0 707 12.6 84 79 No address — — – 25 — 1 — Whole Borough — 4,764 22.4 2,778 13.0 360 76 93 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 1921. (52 weeks ended 31st December, 1921.) Enumerated Population, 1921. (Unrevised.) Birth Rate. Death Rate. Infantile Mortality. — Enumerated Population, 1921. (Unrevised. ) Birth Rate. Death Rate. (Crude.) Infantile Mortality. England and Wales 37,885,242 22.4 12.1 83 County of London 4,476,585 22.3 12.4 80 Birmingham 919,438 24.4 11.2 82 West. Liverpool 803,118 27.4 14.3 105 Paddington 144,273 20.0 11.9 90 Manchester 730,551 24.8 13.6 94 Kensington 175,686 19.4 13.5 104 Sheffield 490,724 24.4 12.5 98 Hammersmith 130,287 21.3 12.4 89 Leeds 458,320 22.8 13.5 96 Fulham 157,944 22.3 11.7 83 Bristol 377,061 22.3 11.0 66 Chelsea 63,700 17.2 13.4 80 West Ham 300,905 28.5 12.2 71 City of Westminster 138,402 13.6 11.5 79 Bradford 285,979 20.1 13.8 108 North. Hull 287,013 26.4 13.0 94 St. Marylebone 104,222 16.9 12.7 73 Newcastle.on.Tyne 274,955 28.1 14.1 91 Hampstead 86,080 15.6 11.0 65 Nottingham 262,658 23.4 13.1 102 St. Pancras 210,986 22.6 13.0 75 Portsmouth 234,218 22.9 11.2 63 Islington 330,028 23.7 13.2 81 Stoke.on.Trent 240,440 29.7 15.0 135 Stoke Newington 52,167 20.5 12.0 59 Salford 234,150 25.2 13.4 101 Hackney 222,159 22.4 11.6 65 Leicester 234,190 21.7 12.0 85 Central. Cardiff 200,262 25.1 11.6 91 Hoi born 43,144 15.0 12.6 77 Bolton 178,678 21.4 12.9 96 Finsbury 76,019 26.2 14.9 90 Croydon 190,877 19.5 10.7 78 City of London 13,706 9.6 11.9 114 Willesden 165,699 20.8 10.0 76 East. Rhondda 162,729 30.0 11.9 110 Shoreditch 104,308 29.3 14.2 110 Sunderland 159,100 30.6 15.4 113 Bethnal Green 117,238 25.6 13.0 99 Oldham 145,001 21.7 14.6 105 Stepney 249,738 24.8 13.1 90 Tottenham 146,695 21.2 10.5 75 Poplar 162,618 27.6 12.8 83 East Ham 143,304 20.7 10.2 67 South. Birkenhead 145,592 26.3 11 '2 75 Southwark 184,388 27.3 14.3 90 Blackburn 126,630 20.1 12.7 107 Bermondsey 119,435 27.9 13.8 92 Brighton 142,427 18.0 11 .5 77 Lambeth 302,960 22.2 12.1 76 Walthamstow 127,441 21.3 9.6 64 Battersea 167,693 22.3 12.1 73 Leyton 128,432 19.0 9.9 74 Wandsworth 328,656 18.9 10.6 67 Derby 129,836 23.2 11 .3 68 Camberwell 267,235 23.5 12 .1 73 Deptford 112,500 23.7 12.1 87 Greenwich 100,500 23.2 12.1 74 Lewisham 174,194 19.9 10.4 55 Woolwich 136,307 22.8 11.5 62 94 Table No. 6.—Meteorological Table for Saint Pancras, 1921. (Extracted from the Monthly Returns of the Meteorological Office.) January. February. March. April. May. June. July. August. September. October. November. December. Barometer— Mean pressure at 32° Fahr. at station level 29.587 30.189 29.949 30.006 29.872 30.066 29.955 29.83 30.027 30.072 29.689 29.665 Air temperature— Mean of— Maximum A 50.9 47.6 55.6 61.4 69.2 73.8 82.2 73.9 71.6 67.5 44.9 50.0 Minimum b 41.1 34.9 39.0 39.9 46.4 51.4 57.9 55.0 51.5 47.7 34.2 38.7 Mean of A and B 46.0 41.2 47.3 50.7 57.8 62.6 70.1 64.4 61.6 57.6 39.5 44.3 Difference from average +7.2 +1.2 +4.4 +2.3 +2.7 + 1.6 +5.8 + 1.2 +3.0 +6.9 .4.8 +3.8 Humidity—Morning 89 88 79 74 68 65 59 71 75 86 84 87 Earth temperature at 4 ft. depth 46.0 44.7 44.5 46.9 50.7 56.2 61.6 62.6 60.4 57.3 50.7 46.6 Bright sunshine— Total observed (daily mean) Hrs. 1.10 1.96 4.26 6.97 7.71 7.10 8.55 5.44 5.49 4.18 1.64 1.36 Per cent. of total possible 13 20 36 51 49 43 53 37 44 39 19 17 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of days 20 4 13 10 12 5 3 9 6 8 10 15 Total fall Ins. 2.48 0.18 1.19 1.29 1.03 0.37 0.13 1.65 2.50 0.63 2.01 1.13 Difference from average +0.63 -1.46 -0.67 -0.24 -0.75 -1.65 -2.28 -0.55 +0.67 -2.01 -0.35 -1.26 The.readings for pressure (Bar. 100 ft. above M.S.L. : hours of observations 9 a.m. to 3 p.m., local time), humidity and bright sunshine are taken at Enfield. The other readings are taken at Camden Square. The averages used are obtained from observations extending over 35 years for rainfall, temperature and sunshine. 95 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 1921. Duties and Premises. Male Inspectors. Women Inspectors. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. District Inspectors. Infectious diseases— Inquiry, removal, disinfection, &c. 4 1 3,491 — 3,495 1 Subsequent sanitary inspection, &c. 1,650 2,562 1,157 — 2,807 2,562 Complaints 4,576 12,075 1 — 4,577 12,075 Drainage— Under notice. Plans, supervision, &c. 248 3,113 — — 248 3,113 Voluntary 994 1,918 — — 994 1,918 New buildings 69 585 — — 69 585 Drain tests — — — — —- — Yards of Mews and Stables 5,306 37 — — 5,306 37 Housing, Town Planning, &c., Act, 1909, 17 (1)— First Inspections — 8 — — — 8 Subsequent routine inspections 799 3,366 — — 799 3,366 Inspections of registered tenement houses other than above 117 605 — — 117 605 Other house to house inspections 8 34 — — 8 34 Visits to closed underground rooms 152 — — — 152 — Smoke shafts observed 674 30 — — 674 30 Regulated Trades— Offensive trades 54 — — — 54 — Rag and bone dealers 9 — — — 9 — Other effluvia businesses — — — — — — Inspections of Market Streets — — — — — — Other Duties 11,457 †75 13 — 1,470 75 Totals 16,117 24,409 4,662 — 20,779 24,409 Factory and Workshop (Male) Inspector. Factories 230 912 — — 230 912 Laundries— Factories 1 7 — — 1 7 Workshops 1 — — — 1 — Bakehouses— Factories 102 76 — — 102 76 Workshops 258 158 — — 258 158 Restaurant Kitchens 67 158 — — 67 158 Other Workshops 352 939 — — 352 939 Other Workplaces 62 106 — — 62 106 Other Duties 1 — — — 1 — Totals 1,074 2,356 — — 1,074 2,356 + Includes 1,060 inspections and 61 re-inspections to transmigrants' lodging houses. 96 Table No. 8.—Inspections and Re-inspections and other work of the Food Inspectors during 1921. Visits and Inspections. Re-Inspections after Intimation Notices. Duties and Premises. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Milkshops 180 383 563 — — — Dairies 200 14 214 2 — 2 Cowsheds 6 12 18 — — — Other Premises of Milk Purveyors 3 12 15 — — — Margarine Factories — — — — — — Butter Factories 11 — 11 — — — Ice Cream Premises 106 141 247 — — — Slaughter Houses 30 129 159 — — — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 40 154 194 — — — Butchers' Shops 47 85 132 3 — 3 Fishmongers' Shops 3 17 20 — — — Fried Fish Shops and Fish Curers' Premises 119 174 293 1 — 1 Marketing Places 2,002 1,455 3,457 — — — Other Premises where Food or Drugs are sold 39 — 39 — — — Other Visits 60 166 226 — — — Total 2,846 2,742 5,588 6 — 6 Samples, &c., Taken. Formal Samples. Informal Samples. No. of Milk samples 191 190 381 — 1 1 „ Cream samples 10 10 20 1 — 1 „ Butter and Margarine samples 50 83 133 — — — „ Other samples (specified below)— Arrowroot 2 — 2 — — — Brawn 2 — 2 — — — Cheese — 5 5 — — — Cocoa 21 10 31 — — — Coffee 21 5 26 — — — Custard Powder — 5 5 — — — Dripping 5 17 22 — — — Fish Paste 2 — 2 — — — Flour 5 — 5 — — — Jam — 10 10 — — — Lard 8 15 23 — — — Mustard 6 — 6 — — — Olive Oil — 10 10 — — — Pepper 8 1 9 — — — Rice 24 2 26 — — — Sausages 8 — 8 — — — Vinegar 11 11 22 — — — Total 374 374 748 1 1 2 97 Table No. 8 (contd.).—Inspections and Re-inspections and other work of the Food Inspectors during 1921. Visits and Inspections. Re-Inspections after Intimation Notices. Duties and Premises. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Unsound Food. No. of surrenders and seizures :— Surrendered. Seized. Meat, &c. 8 5 13 — — — Fish 17 6 23 — — — Shellfish 2 5 7 — — — Other Foods (specified below):— Beans — 1 1 — — — Cheese 3 — 3 — — — Chestnuts 1 — 1 — — — Eggs — 1 1 — — — Fruit 6 5 11 — — — Fruit (tinned) 3 1 4 — — — Milk (tinned) 1 2 3 — — — Tomatoes 5 1 6 — — — Tomatoes (tinned) 1 — 1 — — — Vegetables — 3 3 — — — Yeast — 1 1 — — — Totals 47 31 78 — — — Inspections of Registered Canal Boats 1 — 1 — — — (10495) 98 Table No. 9. Visits, etc., made by Women Inspectors during 1921. First Visits. Subsequent Visits, Call made but admission not obtained. Miss Bibby, Miss Smith. *Miss Payne. *Miss Anthony. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. †Miss Steggles. Total. | Miss Bibby. Miss Smith. *Miss Payne. *Miss Anthony. Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. fMiss Steggles. Total. Miss Bibby. Miss Smith. *Miss Payne. *Miss Anthony. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Camman. Miss Parnell. †Miss Steggles. Total. Grand Total. Infants 206 373 384 7 125 9 74 1178 220 263 372 190 38 2 24 1109 206 113 410 39 34 2 98 895 3182 Expectant Mothers 51 1 56 78 19 205 47 27 39 2 7 6 128 39 3 69 2 1 114 447 Ophthalmia Neonatorum 91 2 4 9 106 194 2 2 12 210 60 3 63 379 Puerperal Fever 9 1 2 12 4 1 2 7 3 2 5 24 Tuberculosis 1 215 342 558 1 8 1016 573 1598 936 919 455 2611 Measles and German Measles 28 9 14 49 135 94 392 96 375 1192 1 9 10 8 65 44 370 507 7 11 94 2 160 904 1903 Whooping Couph 1 44 17 16 1 79 3 66 15 10 2 96 Scabies 19 74 3 1 25 122 5 2 16 23 9 19 28 173 Other Cases of Illness 49 141 82 33 415 289 21 1030 10 37 31 95 78 46 25 322 9 5 19 8 23 96 6 96 1448 Verminous Persons 27 80 23 66 196 2 8 4 14 14 97 41 251 To Hospitals and other Voluntary Institutions 319 498 199 157 485 138 463 21 2280 38 1 4 43 7 1 3 11 2334 Domestic Workshops 1 1 1 Home Workplaces Laundries-Factory „ Workshop Restaurant Kitchens 36 36 36 Other Factories „ Workshops 1 1 1 „ Workplaces Enquiries re milk grants 4 15 23 385 12 202 641 7 14 58 29 33 141 8 7 26 1 59 101 883 Attendances at Committees, &c. 159 45 1 205 205 Other Visits and Inspections 25 24 9 238 16 24 110 64 12 522 1 9 17 8 35 1 1 2 5 2 2 13 570 Totals 505 1002 59 164 40 1155 893 858 1605 1286 797 8364 1 479 22 10 404 483 1378 284 680 492 4233 318 24 121 524 300 113 253 377 2030 14627 * Exclusive of those shown in Table 7. † Temporary. 99 Table No. 10.—Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1921. Inspector. Inspections. Re-inspections. Call made but admission not obtained. Total. 1. Mr. Rackham 950 2,207 — 3,157 2. „ Lonnon 1,413 1,828 — 3,241 3. „ Brown 1,171 2,392 — 3,563 4. „ Dillon 988 2,274 — 3,262 5. „ Walker 1,268 2,844 — 4,112 6. „ James 1,135 2,646 — 3,781 7. „ Adkins 1,038 2,348 — 3,386 8. „ Akers 1,930 1,570 — 3,500 9. „ Jaffa 3,196 1,104 — 4,300 10. „ Capel 1,324 2,318 — 3,642 11. „ Nixon 1,607 2,872 — 4,479 12. „ Thompson (Factories and Work shops). 1,171 2,362 — 3,533 13. „ Auger (Food and 3,264 6 — 3,270 14. „ Child Food Premises) 3,147 — — 3,147 15. Miss Bibby 505 1 — 506 16. „ Smith 1,002 479 318 1,799 17. „ Payne* 820 22 24 866 18. „ Anthony 2,453 10 — 2,463 19. „ Holland* 1,386 — — 1,386 20. Mrs. Hunter 1,155 404 121 1,680 21. Miss Anderson 893 483 524 1,900 22. „ Blaxland 743 1,378 300 2,421 23. „ Camman 1,605 284 113 2,002 24. ,, Parnell 1,286 680 253 2,219 25. „ Steggles (Temporary) 1,063 492 377 1,932 Totals 36,513 31,004 2,030 69,547 * Part year only. (10495) n 2 100 Table No. 11.—Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1921, and the resulting Statutory Notices in 1921 and the early part of 1922. Schedule of Nuisances. Intimations. Statutory Notices. 1. Part of the house in a dirty condition 1,460 480 2. Part of the house in a damp condition 250 94 3. Roof defective 1,028 364 4. Guttering defective 189 76 5. Water fittings defective 251 68 6. Water-closet apartment with absence of external ventilation 45 12 7. Water-closet apartment so foul as to be a nuisance or dangerous to health 29 6 8. Water-closet basin foul 78 25 9. Water-closet defective 119 32 10. Water-closet choked 142 23 11. Urinal in a foul condition — — 12. Privy in a foul condition 1 — 13. Soil pipe defective 42 13 14. Soil pipe unventilated 15 6 15. Soil pipe improperly ventilated 8 4 16. Absence of waste pipe to sink, lavatory or bath 2 1 17. Waste pipe of sink, lavatory, or bath connected with drain 9 4 18. Waste pipe of sink, lavatory, or bath defective 112 38 19. Waste pipe of sink, lavatory or bath foul 31 7 20. Inlet of drain improperly trapped 11 4 21. Drain defective 142 53 22. Drain stopped 173 34 23. Drain ventilating pipe defective 72 24 24. Rain-water pipe in direct communication with drain 31 8 25. Rain-water pipe defective 197 61 26. Unpaved condition of roadway — —. 27. Undrained condition of roadway — — 28. Area or part unpaved 3 — 29. Area undrained 1 — 30. Yard or space unpaved 5 3 31. Yard or space undrained 1 — 32. Defective condition of washhouse paving 102 37 33. Dust-bin defective 569 144 34. Dust-bin in an improper position 4 1 35. Accumulation of stagnant water which is a nuisance dangerous to health 19 6 36. Accumulation or deposit which is a nuisance dangerous to health 142 28 37. Animals kept in such a manner as to be a nuisance dangerous to health 36 4 38. Part of the house so overcrowded as to be dangerous to health 27 10 39. Space below floor in basement or ground floor insufficiently ventilated 11 3 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 1 42. Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates – – 43. Other nuisances 827 309 Total 6,189 1,983 101 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statutory Notices. 1. Overcrowding 9 4 2. Inadequate water supply 1 1 3. Contaminated water supply — — 4. Foul closet, basin or trap 19 9 5. Want of means of ventilation 4 3 6. Want of annual cleansing — — 7. Want of cleansing of the part or parts of premises used in common 332 131 8. Want of cleansing of the part or parts of premises in sole use 454 166 9. Want of cleansing of the room or part of the dwelling 3 1 10. Animals improperly kept 1 1 11. Other breaches 18 7 Total 841 323 Table No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. l. Want of cleanliness 170 32 2. Want of ventilation — — 3. Want of air space, overcrowding 1 — 4. Sanitary accommodation, absent or insufficient 7 1 5, Sanitary accommodation, unsuitable or defective 84 25 6. Sanitary accommodation, not separate for sexes 35 9 7. Want of drainage of floors — — 8. Other nuisances 130 22 9. Illegal occupation of underground bakehouse — — 10. Breach of special sanitary requirements for bakehouses 84 — 11. Failure as regards list of outworkers — — 12. Giving out work to be done in premises which are unwholesome — — 13. Giving out work to be done in premises which are infected — — 14. Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox — – 15. Other contraventions 100 15 Total 611 104 102 Table No. 14. Breaches of other Statutes and Statutory By-laws. Intimations. Statutory Notices. 1. ! An occupied house without a proper and sufficient supply of water 30 11 2. Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet 2 — 3. Water-closet not supplied with a sufficient quantity of water for securing its effective action 241 57 4. Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 47 12 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 46 8 6. Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position 2 — 7. Animals so kept as to be likely to pollute the water supply — — 8. Offensive matters not deposited in manure receptacle — — 9. Manure not removed at proper intervals 2 1 10. Manure—absence of proper receptacle for 1 1 11. Manure receptacle not properly constructed — —. 12. Sufficient drain to stables or cowshed—absence of a 2 2 13. Receptacle for house refuse—absence of a proper 510 154 14. Receptacle for house refuse—absence of a proper cover for 15 5 15. Yard or open space unpaved 4 3 16. Yard paving defective 201 67 17. Insufficient water-closet accommodation to " lodging house " 32 16 18. A furnace 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 — — 20. Offensive matters suffered to run out of trade premises into an uncovered place — — 21. Dairies and cowsheds—breach of By-laws as to 1 — 22. Slaughterhouses—breach of By-laws as to — — 23. Steam whistle—use of a, without authority — — 24. Parts of houses infested with vermin requiring stripping, purifying, and cleansing 682 255 25. Articles in an unwholesome condition requiring to be purified or destroyed 9 1 26. Underground room illegally occupied as a dwelling 15 5 27. Other breaches 81 19 Total 1,923 617