STPAN 80 Metropolitan Borough of Saint Pancras. Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 192 2. T. SHADICK HIGGINS, M.D., B.S., B.Sc. Lond., D.P.H. Cantab. (7947) A 2 CONTENTS. page Public Health Committee 4 Staff of Public Health Department 5 Introduction 7 Section I.—Vital Statistics and Economic Conditions. Population and General Statistics 9 Census(1921) 9 Marriages 10 Births 10 Illegitimacy 11 Notification of Births 11 Deaths11 Infantile Mortality 13 Economic Conditions 16 Poor Law Relief 16 Hospital Accommodation 17 Section II.—Maternity and Child Welfare.18 Advice Cards 18 Home Visiting 18 Centres 19 Massage Clinics 22 Dental Clinic 23 Clinic for Sick Mothers and Children 23 Supply of Food to Mothers and Children 24 Home for Ailing Children 25 Day Nurseries 26 Home Helps 26 Home Nursing 27 Midwifery 27 Government Grants 29 Diarrhoea and Enteritis 29 Puerperal Fever 30 Ophthalmia Neonatorum 31 Measles and German Measles 31 Whooping Cough 32 Section III.—Prevalence of and Control over Infectious Diseases. Table of Notifiable Diseases 33 Do. Notifications past 10 years 34 page Table of Notifications and Deaths in Wards 35 Do. Weekly Number of Notifications 35 Do. Weekly Number of Deaths 35 Disinfecting and Cleansing Station 36 Disinfection of Verminous Articles 37 Tuberculosis 38 Visiting 43 Dispensaries 43 Sanatoria, etc 46 Smallpox 46 Vaccination 46 Scarlet Fever 47 Outbreak at Foundling Hospital 49 Diphtheria 52 Typhoid Fever 54 Acute Anterior Polioencephalitis and Poliomyelitis 55 Epidemic Cerebrospinal Meningitis 55 Encephalitis Lethargica 56 Malaria 57 Dysentery 57 Pneumonia 57 Other Notifiable Infectious Diseases 58 Influenza 58 Syphilis 60 Cancer 60 Section IV.—Sanitary Circumstances of the District. Inspections 61 Notices Served and Result of Service 61 Nuisances—Legal Proceedings 62 Premises and Occupations Controlled by By-laws and Regulations 63 Offensive Trades 63 Registered Tenement Houses 63 Underground Rooms 63 Smoke Prevention 64 Constructional Drain Work 64 Drain Tests 64 Drainage Register 64 Water Service 65 Canal Boats Acts 65 Inhabited House Duty 65 3 CONTENTS—continued. page The Rag Flock Act, 1911 65 Public Mortuaries and Coroner's Court 65 Factory and Workshop Acts 66 Inspections 66 Defects Found 66 Home Work 67 Registered Workshops 67 Schools 68 Medical Examination of School Children 69 Feeding of School Children 71 Infectious Diseases in Schools 71 School Clinics 71 Section V.—Food. (а) Milk Supply 73 Dairies, Cowsheds and Milkshops 73 Milk and Cream Regulations 74 (б) Other Foods 75 Slaughterhouses 75 Fried Fish and Fish Curing Premises 75 Ice Cream Premises 75 Bakehouses and Restaurant Kitchens 76 (c) Sale of Food and Drugs Acts 76 Medical Prescriptions 77 Prosecutions 78 Wholesale Dealers in Margarine 78 Section VI.—Sanitary Administration. Staff 79 Chemical and Bacteriological Work 79 Section VII.—-Other Services. 80 Home Nursing 80 Section VIII.—Housing. 80 General Housing Conditions 80 Statistics 81 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 82 Work of the Estates Committee 82 (7947) page 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 Special Appendix. Population and Intercensal Variations, Administrative County and Metropolitan Boroughs 104 Acreage, Population, Private Families and Dwellings 105 Buildings, Dwellings, Rooms and Families 106 Private Families classified by size of family, rooms occupied and density of occupation 107 Ages (Quinquennial Groups) and Marital conditions 108 Occupations by Marital condition; Industrial Status and Age Groups 109 Occupations—-Comparative Figures Ill Birthplaces of the Population Ill Foreign Born Population by Country of Birth and Nationality 112 Orphanhood of Children under 15 in Age Groups 113 A 2 4 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. 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. 6 Washington, Alfred Charles. 2 White, George William. 1 Woodley, William George. November, 1922, to October, 1923. CHAIRMAN. Councillor Dr. Edward Andrew Gregg (Ward 5). DEPUTY-CHAIRMAN. Councillor Mansell James Swift (Ward 7). EX-OFFICIO. The Right Worshipful The Mayor (Alderman Harold Trill, J.P., M.W.B.). ALDERMEN. Cosburn, Major George Frederick, J.P. Davis, Abraham. Johnson, Job, J.P. Rowden, Peter Rickard. COUNCILLORS. Ward. 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 2 Bland, Mrs. Violet. 1 Caunt, Charles George. 8 Crosby, Miss Ada, M.B.E. 5 Escott, Arthur. 8 Evans, Evan. 6 French, Alexander George. 1 Garner, James Alfred. 1 Kempton, Thomas. 5 Kent, Miss Beatrice. 2 Leach-Williams, Arthur. 4 Lloyd-Taylor, William, J.P. 3 Morrell, Rev. Roger Conyers, M.A. 6 Perry, James. 3 Rolles, Nathaniel. 8 Towers, George Andrew. 5 Washington, Alfred Charles. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1922. MEDICAL OFFICER OF HEALTH.* T. Shadick Higgins, M.D., B.S., B.Sc. Lond., D.P.H. TUBERCULOSIS OFFICER. N. M. Donnelly, M.B., B.Ch., BA.O., D.P.H. ASSISTANT MEDICAL OFFICER. Stella Churchill, M.R.C.S (Eng.), L.R.C.P. (Lond.), D.P.H. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS AND HEALTH VISITORS. Inspectoi-s of Food and Food Places. W. G. Auger. H. R. Child. Inspector of Workshops and Factories. B. H. Thompson. District Inspectors. G. Rackham. J. I. Lonnon. W. L. Brown. E. M. Dillon. A. H. Walker. R. E. James. G. W. Adkins. R. C. Akers. M. Jaffa. S. W. Capel. H. K. Nixon. Women Sanitary Inspectors. Miss M. E. Bibby, B.A. Lond. Miss C. Smith.J Miss A. Holland. Miss V. K. Blaxland.j Miss D. M. Parnell. Miss G. Anthony. Mrs. A. Hunter. Miss J. A. J. Camman. Health Visitors. Miss F. A. Anderson. Chief Clerk First Clerk Second Clerk Clerk „ „ „ Junior Clerk Junior Clerk Temporary Clerk „ „ „ „ CLERICAL STAFF. A. Powell Coke, Barrister-at-Law. A. G. Capel. A. Carpenter. ¶G. N. Cove. §F. G. Crick (acting as Milk Enquiry Officer). T. H. Hague. Miss A. Andrews. S. Barker. (Vacant.) †C. Batter. L. Higgins. E. Winchester. J. B. Richards. Miss G. Wood. Temporary Milk Enquiry Officer—H. G. West.|| * And Administrative Tuberculosis Officer. ‡ Miss Smith and Miss Blaxland are appointed as Sanitary Inspectors and Health Visitors. § Away ill from 13th October, 1922. †Died 11th December, 1922. || From December 14th, 1922. ¶ Mr. Cove is attached to the Estates Dept. 6 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. Medical Officers. Dr. B. Marion Cockerell .. Dr. A. Gertrude Grogan Dr. J. Finch Haines Dr. Janie Lorimer Hawthorne Dr. Ethel F. Iredell Dr. Lydia A. Leney Dr. Jessie S. Muir Dr. Balfour Neill Dr. J. Sherwood New Dr. Margaret R. Paterson Dr. Mary J. Pirret Dr. Francis L. Provis Dr. Muriel Radford Dr. Alfred R. Roche No. of Consultations per week. 3 (and 3 per month) 2 2 2 1 3 3 2 1 1 3 (and 2 per month) 3 (and 1 per month) 1 1 Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist .... 2 Dr. Jas. Maughan, Ancesthetist. Mr. Southcomb May, L.D.S., Dentist at Tuberculosis Dispensary. Superintendents of Maternity and Child Welfare Centres. Miss K. L. Allfrey. Miss G. R. Bristow. Mrs. E. Crockart. Miss M. H. Landel Jones. Miss A. Mullock Jones. Miss M. Manger. Miss E. L. May. Miss M. Smyth. Miss M. Templeton. Assistant Visitors at Maternity and Child Welfare Centres. Miss L. Auger. Miss M. L. Blair. Miss F. Brayshaw. Mrs. E. E. Bruce. Mrs. S. C. Chapman. Miss M. A. Clarke. Mrs. S. Kahan. Mrs. E. Lurie. Miss E. M. Robinson. Mrs. M. A. Smith. Tuberculosis Dispensary. Nurse Visitor, Miss S. A. Long. Clerical and General Assistant, Miss Margaret Deed. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station Stoker and General Assistant Assistant Disinfector ,, . . . • • • • • Matron of Personal Cleansing Station Assistant at „ „ .... j) jj » .... Resident Caretaker, Mortuaries and Coroner's Court H. Catch. T. Bartholomew. J. Stanley. A. J. Dibben. Mrs. E. Mace. Mrs. A. Styles. Mrs. L. Blaby. J. Root. 7 Public Health Department, Town Hall, Pancras Road, N.W. 1. May, 1923. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Ladies and Gentlemen, I have the honour to present to you the Sixty-Seventh 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 tenth annual report which it has been my duty to submit to the Borough Council. The total mortality in 1922 was somewhat greater than in the years immediately preceding. The death-rate was, in fact, 14.6 per 1,000 population, compared with 13.0, 13.6 and 13'8 in 1921, 1920 and 1919, respectively.* This increase in the death-rate was due in part to a recrudescence of influenza, which, with associated causes of death, chiefly respiratory, caused considerable mortality in the first ten weeks of the year ; and the fact that measles was epidemic during the early part of the year. No doubt the unfavourable economic conditions continuing to prevail in 1922 also had an adverse influence. The mortality amongst children under one year of age was less than in the preceding year, when it was increased somewhat by the summer drought, and was the smallest ever recorded in the borough except for 1920. The birth-rate in 1922 again showed a decline. In regard to infectious diseases, the chief feature of the year was the outbreak of influenza referred to above. In the first ten weeks of the year the number of deaths certified as due to influenza was 120, as compared with 24 in the corresponding weeks of 1921; and from diseases of the heart, bronchitis and pneumonia, which are influenced by influenza, 360, as compared with 238. The periodical outbreak of measles occurred in 1922 and caused 100 deaths of children in the months from January to May inclusive. The incidence of, and mortality from, scarlet fever and diphtheria remained at a high level, but both of these diseases had begun to decline by the end of the year. Deaths from tuberculosis remained at about the same level as in 1920 and 1921, and much lower than during the war years. Certain detailed results of the Census of June, 1921, have now been published, and the figures in regard to housing in St. Pancras again disclose an extremely unsatisfactory position. * Based on the Census population, corrected to the middle of 1921. 8 This is indicated by the facts that in the borough more than one-half (53"6 per cent.) of all private families are living in tenements of only one or two rooms ; that 9,975 dwellings are occupied by one family each, as compared with 14,685 dwellings which are occupied by more than one family ; and that for the 56,653 private families in the borough there are only '24,660 structurally separate houses or other dwellings. The evil conditions which result from the occupation by several families of houses which have proper accommodation for one only have been dealt with at length in former reports. The housing conditions in St. Pancras and other parts of the Metropolis constitute a problem of the utmost gravity. As my term of office as Medical Officer of Health of St. Pancras will come to an end in June, 1923, I take this opportunity of recognising the unstinted support which I have received during the past ten years from the members of the staff of the Public Health Department, the other officers of the Council, and the voluntary workers associated with the various social agencies in the borough which deal with maternity and child welfare and other problems of public health. I offer my sincere thanks to all these, and also to the members of the Borough Council, who have throughout shown me the greatest personal kindness. I am, Ladies and Gentlemen, Your obedient Servant, METROPOLITAN BOROUGH OF ST. PANCPAS. REPOET of the MEDICAl OFFICER OF HELTH for the Year 1922. ERRATA. Page 9. paragraph 2, line 9.— for 19732 please read 3383. ,, 22192 ,, 22195. ,, 2459 ,, 671. Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1922. For the purpose of this Report, the year 1922 consists of the 52 weeks ended 31s< December, 1922. Section I.—VITAL STATISTICS AND ECONOMIC CONDITIONS. POPULATION AND GENERAL STATISTICS. The Registrar-General's estimate of the population of St. Pancras at the middle of 1922 is 212,500. All rates in the present report are based on this estimate. Area (acres), 2,694. Number of families or separate occupiers Population (1921), 211,366. (1921), 56,653. Number of inhabited houses (1921), 24,660. Rateable value, £1,845,518. Sum represented by a penny rate, £7,509. 1921 Census. In a special Appendix to this report (page 103) the chief tables of the census which was taken on 19th-20th June, 1921, are set out in so far as they concern St. Pancras. Special attention is directed to the tables on pages 105-107, which deal with housing conditions. It was found that on the date of the census the 56,653 private families in the borough (comprising a population of 195,345) were housed in 24,660 dwellings, or 2.3 families per dwelling. The number of dwellings including the 556 which were vacant on census night was 25,216, and they were made up of 16,890 undivided private houses (housing 162,261 persons), 232 structurally divided private houses (housing 712 persons), 4,040 dwellings in blocks of flats, tenements, &c. (housing 11,714 persons), 19,732 shops (housing 22,192 persons), and 2,459 others (housing 14,484 persons). These comprised 164,545 rooms, of which 2,651 were in dwellings vacant on Census night. Of the occupied dwellings 9,975 were occupied by one family each, 4,685 by two families each, and 10,000 by three or more families each. The size of the tenements in St. Pancras is indicated by the following figures : 12,811 families (22.6 per cent, of all families) were living in one-room tenements, with a population of 22,136 ; 17,584 families (31.0 per cent.) in two-room tenements, with a population of 57,720 ; 11,997 families (21.2 per cent.) in three-room tenements, with a population of 46,386; and 7,298 families (12.9 per cent.) in four-room tenements, with a population of 33,340. The number of families living in tenements containing more than four rooms was 6,963 (12.3 per cent.) and comprised a population of 35,763. 53.6 per cent, of all private families were living in tenements of only one or two rooms, while only 7.7 per cent, of families were living in tenements of more than five rooms. In regard to density of population, 127,616 persons in private families were living at a density of more than one person per room, 43,687 at a density of more than two persons per room, and 10,928 at a density exceeding that of 0.3 of a room per person. (7947) B 10 A study of the foregoing figures and of the tables on pages 105-107 reveals a most grave condition of housing, which being more or less repeated in a number of the other metropolitan boroughs constitutes one of the most serious public health problems confronting the nation. Occupations.—As will be seen from the Census table on pages 109-110 the principal occupations of the St. Pancras population are as follows :— Males. Transport workers 13,741 Commercial and financial occupations 7,641 In personal service 5,676 Metal workers 5,158 Clerks, draughtsmen, typists, &c. 4,643 Workers in wood and furniture 4,282 Public administration and defence 3,156 General or undefined labourers 2,989 Makers of textile goods and articles of dress 2,383 Builders, bricklayers, &c. 2,297 Professional occupations 2,266 Painters and decorators 2,242 Warehousemen, packers, &c. 2,028 Paper workers, printers, &c. 1,771 Makers of foods, drinks and tobacco 1,285 Females. In personal service 13,350 Makers of textile goods and articles of dress 5,523 Clerks, typists, &c 4,928 Commercial and financial occupations 3,003 Professional occupations 2,832 Paper workers, printers, &c. 1,606 Warehousewomen, packers, &c. 1,163 Birthplaces.—Of the St. Pancras population 191,175 were born in England, 1,731 in Wales, 2,583 in Scotland, 2,967 in Ireland, 277 in the Isle of Man and Channel Islands, 1,752 in other British Dominions, Colonies, &c., 8,994 in foreign countries, 72 at sea. and 896 at birthplaces not stated. Of the residents born in foreign countries, 1,470 were born in France, 1,378 in Italy, 1,035 in Poland, 837 in Russia, 735 in Germany, 657 in Switzerland, 641 in Belgium, 310 in the United States, 260 in Czecho-Slovakia, 233 in the Netherlands, 153 in Denmark, 125 in Sweden, and 101 in Austria. MARRIAGES. The number of marriages celebrated in 1922 was 1,982. This is equal to a rate of 9*3 per 1,000 total population. BIRTHS. The net number of births for St. Pancras registered in 1922 was 4,559, making an annual birth-rate of 21-5 per 1,000 total population. The number of births registered as having taken place in the borough was 4,865, and the net figure is obtained by deducting 306, 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 continues to decline. The following table shows the quarterly figures in recent years, 11 Year. Number of Births (Uncorrected). Total for Year (Uncorrected). 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 1,169 1,082 4,865 4,559 1,364 births occurred in Public Institutions in St. Pancras, equal to 28-0 per cent, of the total births which took place in the borough. Table 5, on page 93, shows the birth-rate for 1922 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 4,559 net St. Pancras births, 254, or 5-6 per cent., were returned as illegitimate. The corresponding figures for 1921, 1920, 1919, 1918, 1917, 1910, 1915, 1914 and 1913, were 5-5, 5-6, 8-4, 9-5, 7-2, 7-0, 5-4, 4-4 and 4-7 per cent, respectively. Of the 4,865 births in St. Pancras (uncorrected) 293 or 6-1 per cent, were returned as illegitimate. Notification of Births. 4,850 notifications of births were received during 1922, including 146 still-births and 4,704 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 27. DEATHS. The net number of St. Pancras deaths registered during the year was 3,107, making an annual death rate of 14-6 per thousand population. The number of deaths registered during the year as having taken place in the borough was 3,219. Of these, 715 were of persons whose residence was not in St. Pancras (non-parishioners), 628 dying in St. Pancras institutions, and 87 in other parts of the borough. There were also reported by the Registrar-General 563 deaths of St. Pancras parishioners who died in institutions in other parts of the County of Ijondon and institutions connected therewith, and 40 who died in other parts of England and Wales. The net figure on which the death-rate is based is corrected for these out ward and inward transfers. In Table 1, on page 86, will be found the corresponding figures for previous years. It will be seen that the death-rate for 1922 was higher than in the previous years. (7947) 12 The leading causes of death are set out in the following table for the 10 years 1912-1921 and for 1922. Diseases. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Average for 10 years. 1922 Enteric Fever ... 2 6 4 8 5 6 5 2 1 3 4 1 Small-pox 1 1 Cbicken-pox 1 1 — 1 1 — — — — — — — Measles ... 94 36 53 63 42 118 75 15 65 23 58 107 Scarlet Fever ... 5 6 19 22 8 4 7 5 11 7 9 20 Whooping Cough 47 36 49 52 39 27 80 7 60 38 44 29 Diphtheria and Croup... 27 19 30 24 23 25 31 21 33 51 28 44 Influenza 14 42 15 35 35 21 700 260 46 57 123 142 Erysipelas 7 10 9 11 3 3 11 9 12 3 8 12 Tuberculosis Pulmonary 318 325 365 398 340 353 403 268 249 250 327 257 Other forms 83 67 67 102 83 91 82 73 63 54 77 58 Cancer, Malignant Disease 247 285 251 258 267 281 269 245 299 290 269 302 Rheumatic Fever 5 6 10 11 7 7 8 7 6 16 8 15 Cerebral Hæmor- rhage, ism and plexy 227 116 141 169 119 116 131 91 98 126 133 120 Heart Disease 217 276 319 422 359 393 378 360 423 411 356 431 monia and Pleurisy 525 691 566 664 535 514 618 489 445 456 550 583 Diarrhoea and Enteritis 45 148 142 114 72 97 56 68 54 98 89 47 Nephritis and Bright's Disease 110 101 112 132 103 104 98 61 95 60 98 67 Puerperal Fever 7 2 7 5 4 5 2 9 8 4 5 4 Congenital bility and formations, cluding mature Birth 207 191 164 187 176 144 132 162 201 149 171 134 Injuries 101 148 150 150 112 125 119 108 92 88 125 127 This analysis shows that the increased mortality in 1922 was due largely to the prevalence of influenza, with an increase in the associated causes of mortality, especially bronchitis, pneumonia and pleurisy, and of measles and scarlet fever. On the other hand, there was less mortality from diarrhoea and enteritis than in 1921. The figures for mortality from cancer and from heart disease continue to show an increase. The deaths for the year are fully classified for causes, age and sex in Table 2, 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. The ward populations are based on the results of the 1921 Census now available, and are more reliable than those used in recent years, which were based on the " stale " 1911 census. The death-rate per 1,000 population in each ward was as follows :— Ward 6 Ward 4 Ward 3 Ward 5 1922 18.3 15.6 15.2 15.0 1921 15.3 12.8 12.5 13.1 Ward 2 Ward 7 Ward 8 Ward 1 1922 14.9 12.6 125 12.1 1921 13.7 12.7 13.2 11.4 13 In Table 5 on page 93 are set out the 1922 death-rates for England and Wales, the County of London, the several metropolitan boroughs, and certain of the large towns. It will be seen that there were five boroughs in London with a worse death-rate than St. Pancras, and 23 with a better death-rate. 1,904 deaths occurred in Public Institutions in the borough in 1922. Taking from these the number which were of non-parishioners (628) and adding the number of deaths of St. Pancras parishioners in Public Institutions without the borough (603)—both from the RegistrarGeneral's figures—the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,879, or 60 per cent, of the total deaths. Infantile Mortality. 337 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of 74 per thousand births. In Table 1 on page 86 the corresponding rates for previous years are set out; 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 (1922), classified according to age at death. (2) The causes of death of children under 12 months of age in 1922 and in the ten previous years. In this Table the number of births in each year is also stated for reference. It will be seen that the deaths from influenza and bronchitis were more numerous than in the previous year. This was the result of the outbreak of influenza in the beginning of the year, and caused a considerable increase in the infantile mortality rate for the year. 14 1922. 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. G months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. All causes Certified 71 15 20 11 117 60 52 71 37 337 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — 1 — 1 1 1 7 5 15 Scarlet Fever — — — — — — — 2 1 3 Whooping Cough — — — — — 1 3 3 4 11 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — 1 — — — 1 Influenza — — — 1 1 3 — 1 2 7 Tuberculous Meningitis — — — — — — 2 1 — 3 Abdominal Tuberculosis — — — — — — — 1 — 1 Other Tuberculous Diseases — — — — — 1 1 3 2 7 Meningitis (not Tuberculous) — — — — — — 1 — 1 2 Convulsions 1 2 ] 2 6 — 1 1 — 8 Laryngitis — — — — — — — — — — Bronchitis 1 3 2 — 6 15 13 27 14 75 Pneumonia (all forms) 1 1 — — 2 3 — 4 — 9 Diarrhoea — — — — — 2 2 — — 4 Enteritis 1 1 1 1 4 7 10 5 1 27 Gastritis — — — — — — — — — — Syphilis 1 1 — — 0 2 2 — 2 8 Rickets — — — — — — — 1 — 1 Suffocation (overlying) 2 1 — — 3 1 1 — — 5 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 3 1 — — 4 — — — — 4 Congenital Malformations 14 2 1 1 18 8 2 3 — 31 Premature Birth 39 2 9 4 54 5 — 1 1 61 Atrophy, Debility and Marasmus 4 — 3 1 8 8 6 4 2 28 Other causes (including Influenza) 1 1 2 2 6 5 7 8 4 30 Totals 71 15 20 11 117 60 52 71 37 337 Net Births in the year legitimate 4,305 illegitimate 254 Net Deaths in the year of legitimate infants 299 illegitimate infants 38 15 Net Deaths from Stated Causes under 1 Year of Age for 10 Years, 1912-1921 and 1922. Caose of Death. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Average for 10 years. 1922 All causes— Certified 472 512 481 497 385 402 340 336 435 360 422 337 Uncertified — — — — — — — — — — — — Small-pox Chicken-pox 1 1 1 — — — — — — Measles 13 10 8 17 14 30 16 4 21 7 14 15 Scarlet Fever — 1 1 — — — 3 Whooping Cough 21 12 23 24 15 14 27 o 18 18 17 11 Diphtheria and Croup 1 1 4 2 1 1 — 2 2 1 Erysipelas — 3 2 2 — 1 1 — — — 1 1 Influenza — — 1 — 1 — 18 11 o 2 4 7 Tuberculous Menin gitis 11 5 3 8 5 4 8 4 6 4 6 3 Abdominal Tuberculosis 3 — 2 1 1 2 1 1 — 1 1 1 Other Tuberculous Diseases 2 8 3 6 5 7 3 2 2 3 4 7 Meningitis {not Tuberculous) 8 8 4 8 7 10 3 6 7 3 6 2 Convulsions 21 16 11 5 9 5 3 6 7 8 9 8 Laryngitis 1 — — 1 — 1 — — — — — — Bronchitis 57 105 76 84» 57 63 46 47 87 52 67 75 Pneumonia (all forms) 13 9 16 12 10 13 15 9 9 4 11 9 Diarrhoea 8 22 24 15 6 8 6 10 11 11 12 4 Enteritis 24 73 82 64 35 52 31 37 26 63 49 27 Gastritis 7 2 3 2 4 1 3 2 2 3 — Syphilis 9 14 15 9 14 16 13 11 15 14 13 8 Rickets 4 — 1 1 4 2 — — 1 1 1 1 Suffocation (overlying) 22 14 18 8 9 13 6 1 2 2 10 5 Injury at Birth 6 4 3 10 4 3 2 6 5 3 5 3 Atelectasis 9 3 5 6 9 9 8 7 10 8 7 4 Congenital Malformations 21 24 23 25 34 19 17 31 33 25 25 31 Premature Birth 97 93 84 92 75 61 50 68 105 75 50 61 Atrophy, Debility and Marasmus 63 53 38 47 43 44 46 45 40 34 45 28 Other causes (including Influenza) 50 31 36 48 25 20 36 35 26 20 33 30 Totals 472 512 481 497 385 402 340 336 435 360 422 337 Net Births 5,367 5,517 5,225 4,754 4,530 3,796 3,318 3,824 5,934 4,764 4,703 4,559 The number of deaths of illegitimate children under one year of age was 38, equal to a death-rate of 150 per thousand illegitimate births. 16 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 has characterised recent years will have a bad effect on the public health. The figures for 1922 in regard to total deaths, infant deaths and tuberculosis are not quite so good as the experience of immediately preceding years might have led us to anticipate, and it is probable that this is a result of the persistent economic depression. that this is a result of the persistent economic depression. The amount of out-relief granted during the past six 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 Ladyday, 1918 3,382 852 Michaelmas, 1918 3,461 771 Ladyday, 1919 3,814 754 Michaelmas, 1919 4,557 823 Ladyday, 1920 6,146 899 Michaelmas, 1920 8,161 1,079 Ladyday, 1921 13,081 1,660 Michaelmas, 1921 21,400 3,529 Ladyday, 1922 40,081 6,429 Michaelmas, 1922 34,591 6,325 Ladyday, 1923 34.193 6,425 The table illustrates the great increase in outdoor relief which has been found necessary to deal with unemployment in 1920-22. The same 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 July 1st, 1922 1,099 January 1st, 1923 1,122 17 Hospital Accommodation. With the exception of the two hospitals of the St. Pancras Guardians the use of the hospitals in St. Pancras is by no 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 :rom figures kindly supplied by the secretaries of the various institutions to show the work done Dy the hospitals in St. Pancras, without reference to the home addresses of the patients. Hospital. Number of beds. Number of in-patients admitted 1922. Number of new outpatients treated in 1922. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 387 2,104* Highgate Hospital, Dartmouth Park Hill 554 2,185* Metropolitan Asylums Board Hospital. St. Margaret's Hospital, Leighton Road (for Ophthalmia neonatorum) 40† 213‡ — Voluntary Hospitals. University College Hospital, Gower Street 353 4,991 67,321 Royal Free Hospital, Gray's Inn Road 240 3,596 42,528 Royal Free Hospital Maternity Home, Endsleigh Street London Temperance Hospital, Hampstead Road 120 1,042 13,141 Elizabeth Garrett Anderson Hospital, Euston Road 72 1,507 9,919 West End Hospital for Nervous Diseases, Regent's Park 72 481 — Hospital for Tropical Diseases, Endsleigh Gardens 58 591 — Central London Throat, Nose and Ear Hospital, Gray's Inn Road 43 899 9,984 Central London Ophthalmic Hospital, Judd Street 40 504 12,082 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 490 2,915 St. Saviour's Hospital, Osnaburgh Street 21 157 — North-West London Hospital, Bayham Street — — 15,372 St. Pancras Dispensary, Oakley Square — — 2,781§ London Skin Hospital, Fitzroy Square — — 2,279 Western Skin Hospital, Hampstead Road — — 1,413 British Dentists' Hospital, Camden Road — — 373|| * Year ended Lady day, 1923. †f In addition to 16 beds for the patients' mothers. ‡ In addition to 135 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 23). || Not including the municipal clinic (see page 23). (7947) c 18 Section II—MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 10-15 of this Report. 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 three 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. (k) The payment for the home nursing of sick infants in certain cases. 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 1922 made 2,371 visits to 789 infants (apart from visits made to cases of measles and for other special purposes). They also made 366 visits to 177 expectant mothers. 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 Council. In 1922 the Council's centre visitors made 38,159 visits to 4,765 children, and 3,866 visits to 1,861 expectant mothers ; and the trained workers not paid by the Council made 9,817 visits to 640 children, and 538 visits to 304 expectant mothers. 19 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 Hal] health visitors 177 366 789 2,371 Staff at the Centres paid by the Council 1,861 3,866 4,765 38,159 Total work by Council visitors 2,038 4,232 5,554 40,530 Staff at the Centres paid by the Council 1,861 3,866 4,765 38,159 Trained staff at the Centres not paid by the Council Total work by Centre visitors 304 538 640 9,817 2,165 4,404 5,405 47,976 Total visits by all trained visitors— 1922 2,342 4,770 6,194 50,347 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 Lave 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 18 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 1922 is statistically detailed. It will be seen that at the end of the year 33£ infant consultations and 9| ante-natal consultations were held per week, 1,718 infant consultations and 494 ante-natal consultations having been held during the year. The children who attended in 1922 for the first time numbered 3,056 under one year of age, and 259 over one year. The children under one amount to 67 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 51,426 attendances (compared with 52,600 in 1921 and 47,625 in 1920); 2,689 expectant mothers also attended, making in all 6,033 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.). In 1922, 42 clinics were held and the total attendances of mothers was 243, and of young children 68. The number The attendances are classified as follows:— (7947) c 2 Centre. Attendances at Consultations. Visits by Trained Visitors. Infant Consultations. Expectant Mothers' Consultations. Number of Trained Visitors. Expectant Mothers. Children. Expectant Mothers. Children. New cases. Total attendances. New cases. Total attendances. First visits. Total visits. First visits. Total visits. Under 1 year. Over 1 year. Total. Under 1 year. Over 1 year. Total. Visitors paid by Borougli Council. Trained workers not paid by Borough Council. Visitors paid by Borough Council. Trained workers not paid by Borough Council. Visitors paid by Borough Council. Trained w orkers not paid by Borough Council. Visitors paid by Borough Council. Trained workers not paid by Borough .Council. a* 41 it 8 Total. Per eek. Total. Whole Time. Part Time. Town Hall Health Visitors — — — — — — — — 177 — 366 — 789 — 2,371 — — — — — — — St. Pancras School for Mothers— Ampthill Square 173 510(1> 297 13 310 6,395 494 6,889 648 — 1,154 — 824 — 8,922 — 5¾ (2) 279 (3) 1 51 4 1 Chalton Street 59 2981*1 164 29 193 2,419 2,103 4,522 407 — 691 74 601 — 5,642 2,094 3 152 1 26 2 2(5) North St. Pancras School for Mothers, 156 356 403 48 451 5,221 3,168 8,389 20 — 251 — 495 — 4,931 — 4 206 1 52 3 — Queen's Crescent South Highgate Centre 11 23 64 6 70 1,362 530 1,892 21 — 100 — 159 — 1,917 — 1 (6) 66 — 8 1 — Grafton Road Centre 44 128 197 57 254 2,720 1,617 4,337 150 — 177 — 723 12 2,907 64(7) 2(8) 109 — — 1 1 Mary Ward Settlement School for Mothers 60 106 121 23 144 1,588 963 2,551 86 — 138 — 398 — 2,152 — 3 142 — — 1 1 Camden Town Centre, Camden Road 86 224 393 52 445 4,831 1,701 6,532 250 78 369 94 641 91 3,373 442 4 212 1 49 3 Argyle Square Group of Centres— Argyle Square 20 47 61 6 67 1,704 260 1,964 184 — 657 — 647 108 6,137 1,4641(9) 1¼ 64 ½ 21 3(10) — Oseney Crescent 67 258 154 9 163 2,134 791 2,925 1½ 74 ½ 22 Falkland Road — — 129 1 130 2,321 298 2,619 1¼ 63 — — I11) Maternity Nursing Association, Oakley Square 115 133 265 — 265 — — 5,183 — 214 — 344 204 46 1,439 791 2 102 ¼ 11 1 University College Hospital 1,564 2,932 687 — 687 — — 2,956 — — — — 369 4,691 2 96 1 48 2(12) Royal Free Hospital— Gray's Inn Road 181 494 71 15 86 380 121 501 95 12 329 26 73 14 739 271 2 101 2 102 — 2 Marlborough 153 522 50 — 50 166 — 166 — — — — — — — — 1 52 2 104 — — ity Section Totals 2,689 6,033 3,056 259 3,315 51,426 2,038 304 4,232 538 5,554 640 40,530 9,817 33¾ 1,718 9¾ 494 19 9 (1) In addition to 1,137 attendances of " ailing mothers." (2) Including 3 per month held voluntarily. (3) Including 29 held voluntarily. (4) In addition to 436 attendances of "ailing mothers. (5) Voluntary trained workers. (6) 2 from 14th September. (7) In addition to 194 visits by untrained voluntary workers. (8) 3 from 9th November. (9) In addition to 114 visits by unqualified students. (10) In addition to one full-time trained voluntary worker. (11) Year ended 31st March, 1923. (12) Paid by hospital and not by Borough Council. 20 21 Extractions with gas „ without gas Fillings Scalings Impressions, fitting dentures, &c. Examinations, &c. Attendances of Mothers. Children. 38 3 47 16 77 62 8 4 41 – 3 12 Observation day-nursery for children who need special care : there were 1,628 daily attendances in 1922, of which 725 were made by 32 children under a year old, and 903 by 23 children over a year old. Cheap dinners for mothers and children: 2,114 dinners were served to 61 mothers in 1922 and 1,491 to young children of these mothers. At the classes for mothers in 1922 there were 673 attendances at the classes on infant care, 270 at the ante-natal classes, and 321 at the knitting and 312 at the needlework classes In addition to the six weekly consultations held by the Council's medical officers, three consultations per month for children from 2 to 5 years old have been held by the medical officers voluntarily: there were 29 such consultations in 1922. Chalton Street Centre. There were 969 attendances at the classes during the year. Older children were seen at the ordinary infant consultations. North St. Pancras School for Mothers, Queen''s Crescent. Young mothers' health talks were held twice a month, 557 attendances being made. During the year 16 of the infant consultations were set apart for children from 1 to 5 years old. A special monthly consultation (voluntary) was started in November and held twice in 1922. South Highgate Centre. A needlework class was started on 10th October, and 46 attendances were made before the end of the year. The older children (2-5) were seen on two of the consultations each month. Grafton Road Centre. Owing to the great pressure of work an assistant health visitor has been appointed by the Borough Council for this centre. She began work on 2nd February, 1923. Previously the superintendent had no permanent assistant. A third weekly consultation was instituted at the centre on 9th November. No classes have been held. Camden Town Centre. Special consultations for children 2 to 5 years old were held once a month from March, and 184 attendances were made before the end of the year. A sewing class was held once a week at which 305 attendances were made in the year. A branch centre has been started in the schoolroom premises of the Baptist Church, Berkeley Road, Regent's Park, to serve the needs of the somewhat isolated area enclosed by Regent's Park Road and Gloucester Road. The weekly consultations for infants began on 21st February, 1923. The work is looked after by the staff and committee of the Camden Town Centre, though most of the visiting is being done for the present by one of the Town Hall visitors. The rental and the fees of the medical officer are paid by the Borough Council. 22 Argyle Square Group of Centres. At the Argyle Square Centre a special consultation for children between 1 and 5 years old was held once a month. At Oseney Crescent special consultations for children between 1 and 2, and 2 and 5 respectively, were held once a month each. At Falkland Road a special consultation for children between 1 and 5 was held once a month. A rearrangement of the work at these three centres and at the centre at the Mary Ward Settlement has been effected. The Oseney Crescent and Falkland Road Centres have both been closed and their place taken by a new centre at 14, Caversham Roid, which was opened on 9th February, 1923. The lease of the Caversham Road house was acquired by Miss J. de Pass, who has equipped the premises in a very beautiful manner as a full-time centre. The Borough Council make a payment to the centre towards the rent, rates and taxes, but no public funds have been asked for by Miss de Pass in connection with the alterations and equipment. With a view to a more advantageous distribution of work the Argyle Square Centre has been dissociated from the new Caversham Road Centre, and the committee and staff of the latter have now nothing to do with the former. The Caversham Road superintendent has the help of one assistant health visitor on the Council's staff. A new voluntary committee has accordingly been founded in connection with the Argyle Square Centre, as the result of a successful meeting called by the Mayor (Alderman Harold Trill, J.P., M.W.B.) on 19th January, 1923. The superintendent at the Mary Ward Settlement School for Mothers has been put in charge of the Argyle Square Centre also, and is assisted by one of the Council's assistant health visitors who previously worked at Argyle Square when that centre was staffed jointly with Oseney Crescent and Falkland Road. As from 31st January, 1923, the Council have taken financial responsibility for the payment of the medical officer conducting the weekly consultation for infants and the monthly consultation for older children at Falkland Road (afterwards moved to Caversham Road), formerly borne by voluntary funds. Sixteen young mothers' classes were held at Oseney Crescent during the year, at which 150 attendances were made. There were no classes in 1922 at Argyle Square and Falkland Road. Mary Ward Settlement School for Mothers. A weekly sewing and knitting class was held throughout the year, and ante-natal classes from January to May. The total attendances at the classes were 320, of which 282 were from St. Pancras. Massage for Young Children. The work of the massage clinicS for young children has been continued during the year. The clinics have been held twice a week at four centres, viz., Ampthill Square, Chalton Street, Camden Road and Queen's Crescent. Cases have been dealt with at these centres from certain other centres 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 masseuse, Miss D. M. Griffin, has been paid at the rate of Is. per treatment, with a minimum payment of 6s. per clinic. The mothers 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 administrative expenses have been met from the special fund raised for the purpose by Dr. Gladys Miall-Smith last year. The work done in 1922 is indicated in the following table:— 23 No. of Clinics Held. No. of New Cases. No. of Attendances. Ampthill Square Clinic 101 – From Ampthill Square Centre — 57 1,120 „ Maternity Nursing Association Centre — 10 184 Chalton Street Clinic 101 — — From Chalton Street Centre 27 324 „ Mary Ward Settlement Centre 7 179 „ Ampthill Square Centre — 43 Camden Road Clinic 98 — — From Camden Road Centre — 41 946 „ South Highgate Centre — 11 31 Queen's Crescent Clinic 93 — — From Queen's Crescent Centre — 19 268 „ Grafton Road Centre — 7 136 Dental Clinic.—The Borough Council dental clinic for mothers and children was continued during 1922 at the British Dentists' Hospital, 31, Camden Road, N.W.I. The services were confined to mothers and children attending and referred from the various maternitv and child welfare centres in the Borough. 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.. . . 23 „ of new cases (mothers) . . .. 2101 339 „ „ (children).. .. 129 J Total number of attendances (mothers^ 1,176\ 1,537 „ „ (children) . . .. 361J Number of attendances for extractions under nitrous oxide 275 55 55 55 local anaesthesia 115 „ „ when fillings and dressings were done 225 „ „ „ scalings were done 65 „ „ for impressions, fitting dentures, &c. 427 „ „ „ examinations and advice 455 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 over one-half. In 1922, 70 patients were fitted with dentures. The total cost of these was £252, of which £148 3s. was paid by the patients themselves, £49 14s. by the Borough Council, and £54 3s. from voluntary sources, particularly the Metropolitan Hospital Sunday Fund. £7 13s. 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 (see p. 19), 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.I, to which patients 24 are referred from the Town Hall, from the infant welfare centres, by the health visitors, and from other sources. During 1922, 302 new cases under five years of age, 61 ailing mothers and 56 expectant mothers (new cases) were treated at Dr. Provis' clinic. The total attendances at this clinic were 824 of children under five, 294 of ailing mothers, and 92 of 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, 648; attendances, 2,254; ailing mothers and expectant mothers: new cases, 163 ; attendances, 496. The dispensary resident medical officer also made 548 home visits to 96 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 894 home visits to children under five during the year. The other work of the Dispensary amongst women and young children is supported from voluntary sources, and subsidised by the Ministry of Health. Supply of Food to Mothers, and Children under School Age.—The Council continued during 1922 to make grants of milk either free or at half-price for the use of expectant or nursing mothers or children under school age. As a rule the grants were restricted to the last three months of pregnancy and to children under three years of age. Until 18th October, 1922, the scale of income in use was as follows:— No. in Family. Free. Half cost. 1 15s. after deduction of rent. 18s. after deduction of rent. 2 10s. per head, after deduction of rent. 14s. 6d. per head, after deduction of rent. 3 8s. ,, ,, 11s. 6d. ,, ,, 4 7s. ,, „ 10s. 6d. ,, ,, 5 6s. 6d. „ „ 9s. 6d. „ ,, 6 6s. „ „ 9s. „ „ As from that date the scale was revised at the suggestion of the Ministry of Health to the following:— No. in Family. Free. Half cost. 1 13s.* after deduction of rent. 15s. after deduction of rent. 2 10s. per head, after deduction of rent. 12s. 6d. per head, after deduction of rent. 3 8s. „ „ 10s. ,, ,, 4 7s. ,, ,, 8s. 6d. „ „ 5 68. 6d. „ „ 8s. „ „ 6 6s. „ „ 7s. 6d. „ „ *15s. until 22nd November, 1922. Families in receipt of less income than that indicated in the table would be entitled to receive milk. The working of the scheme has been fully indicated in previous annual reports. 25 Che extent of the distribution of milk in 1922 is shown in the following figures:— 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 12,495* 1,335 137 2 3½ June 10,451 1,094 114 11 3 July 10,386 1,035 133 12 5½ August 10,132 965 132 7 3 September 9,973 1,150 131 9 6 October 11,202 1,062 196 17 8 November 12,280 1,151 214 5 0 December 12,259 1,929 219 5 0 Total for 1922 139,863½ 15,927 2,212 0 9½ At the end of 1921 there were 472 families in receipt of milk through the Council's scheme. 559 new families were added to the list of recipients during 1922, and at the end of 1922 there were 350 families in receipt of milk. As will be seen from the table above, there were supplied in 1922, 139,8631 pints of milk free and 15,927 pints at half-price, at a cost to the Council of £2,212 0s. 9½d., half of which sum is repayable by the Ministry of Health. This figure does not include the cost of administration. Meals for Mothers and Children.—In August and September 360 free dinners were supplied to nursing and expectant mothers at the National Kitchen, Prince of Wales Road, at a cost to the Council of 7d. a meal, or £10 10s. At the end of September this practice was discontinued owing to the closing of the National Kitchen. 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 in the Kentish Town neighbourhood. Until 30th September they were supplied at the National Kitchen, Prince of Wales Road, at a cost to the committee of 9d. until February 20th, 1922, and afterwards 7½d., for a dinner consisting of meat, two vegetables and pudding for the mothers, and 3d. a head for lighter meals for children under school age. The mothers were ordinarily charged 3d. for their dinners and 1d. for the children's dinners, but in many cases even these charges were remitted. In October, November and December no satisfactory arrangements were made to take the place of the National Kitchen, but by 8th January, 1923, a restaurant in Prince of Wales Crescent undertook to set apart a room for the mothers' dinners, for which the committee pay 9d. per head for an excellent meal of meat, two vegetables and pudding. Children are not at present included in the scheme. During the 13 months from 1st March, 1922, to 31st March, 1923, 4,064 dinners were supplied to mothers and 1,438 to children. 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. (7947) d 26 At the beginning of 1922 there were 17 children in residence. In the course of the year 96 children were admitted and 97 discharged, leaving 16 in residence at the end of the year. The admissions are classified for age as follows:— 0 to 1 – 1 to 2 2 2 to 3 53 3 to 4 26 4 to 5 15 5 – The conditions for which the children were admitted were as follows:— Debility and anaemia 39 Rickets 7 Other nutritional disorders 6 Other conditions 5 Convalescence after— Measles 18 Pneumonia and bronchitis 13 Other conditions 8 — 39 Of the 97 children discharged, 52 were in good health, 41 improved, and 4 showed no improvement. The Home was open on 330 days, and the average length of stay of patients was 55.1 days. The only case of infectious disease in the Home during the year was one of whooping cough, who was discharged on the same day as the disease was diagnosed. The infection was taken by the patient before the date of his admission. 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, Aimpthill Square, N.W.1. Particulars in regard to the day nurseries for the year ended 31st March, 1923, are as follows:— Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. £ s. d. Whitefield Day Nursery 135 4 4 219 6,342 29.0 Kentish T. Day Nursery 224 18 11 296 4,750 16.05 Margaret Day Nursery 222 14 1 252 3,982 15.8 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. 27 81 cases were assisted in 1922, as follows:— Maternity 52 Influenza 6 Consumption 1 Old age infirmity 1 Sickness connected with maternity 18 Other sickness 3 Three home helps were employed throughout the year, and temporary helps were employed during 272 working days also. Home Nursing.—The work of the four local district nursing associations in this connection (see page 80) 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 midwives. Midwifery. The notifications of births in St. Pancras (1922) 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 111 86 25 67 137 29 243 93 791 Private Midwives 181 11 11 45 134 2 260 260 904 Doctors from the Elizabeth Garrett 21 11 2 25 50 10 16 39 174 Anderson Hospital Medical Students from— University College Hospital 109 265 — 5 194 324 3 21 921 Royal Free Hospital — 1 — 30 1 1 — — 33 St. Bartholomew's Hospital — — — 5 — — — — 5 Midwives from— Middlesex Hospital 1 22 56 4 1 1 — — 85 University College Hospital — 1 31 126 — 2 — — 160 Maternity Nursing Association, — 1 — 56 1 1 — — 59 Myddleton Square Maternity Nursing Association, 39 82 10 16 124 45 23 15 354 Oakley Square Branch Attended in Institutions— University College Hospital — — 208 — — — — — 208 Royal Free Hospital — — — 282 — — — — 282 Royal Free Hospital (Marlborough Maternity Section) — — 607 - — — — — 607 Elizabeth Garrett Anderson Hospital — — - - — 50 — — 50 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 (7947) d 2 28 other hand, a number of St. Pancras mothers were confined in institutions outside of the borough. In the following tables the figures for 1922 are given for St. Pancras women only:— "Extern" Midwifery. Elizabeth Garrett Anderson Hospital (doctors) 174 University College Hospital (medical students) 921 „ „ „ (midwives) 160 Middlesex Hospital (midwives) 85 Royal Free Hospital (medical students) 33 St. Bartholomew's Hospital (medical students) 5 Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 413 1,791 (or 39 per cent. of the total number of births). "Intern" Midwifery. In St. Pancras:— University College Hospital 118 Royal Free Hospital 47 Royal Free Hospital (Marlborough Maternity Section) 153 Elizabeth Garrett Anderson Hospital 16 St. Pancras House 155 Out of St. Pancras:— Middlesex Hospital 150 Queen Charlotte's Lying-in Hospital 135 City of London Maternity Hospital 54 St. Mary's Hospital, Hampstead 43 Other hospitals 35 906 (or 20 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 1922 were as follows:— £ s. d. Royal Free Hospital and Marlborough Maternity Section 206 0 0 Elizabeth Garrett Anderson Hospital 54 15 0 Maternity Nursing Association 92 10 0 Queen Charlotte's Lying-in Hospital 135 0 0 City of London Maternity Hospital 54 0 0 Middlesex Hospital 171 0 0 £713 5 0 29 Government Grants. Government Grants were made during the year ended March 31st, 1923, in respect of Maternity and Child Welfare as follows:— £ s. d. St. Pancras Borough Council 7,233 19 8 St. Pancras School for Mothers (Ampthill Square) 595 5 9 „ „ (Chalton Street) 108 0 6 North St. Pancras School for Mothers 123 1 1 Grafton Road Mothers' and Infants' Welfare Centre 51 18 11 *Mary Ward Settlement School for Mothers 27 7 1 Camden Town Mothers' and Infants' Welfare Centre 7 10 9 Centres at Argyle Square, Oseney Crescent and Falkland Road 320 18 0 South Highgate Mothers' and Infants' Welfare Centre 20 11 9 Maternity Nursing Association (for Maternity and Child Welfare Centre) 65 17 3 *Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 469 0 0 *University College Hospital (for Maternity and Child Welfare) 859 19 7 * ,, „ (for Midwifery and Nursing) 242 0 0 *Royal Free Hospital (for extern Midwifery and Maternity Nursing) 164 0 0 *„ „ (for Maternity and Child Welfare Centre) 200 0 0 *„ „ (in respect of the Marlborough Maternity Section) 1,881 8 4 St. Pancras Dispensary (Infant Clinic) 315 10 0 Mayoress of St. Pancras Nursing Fund (Home Nursing) 79 17 11 Mayoress of St. Pancras Home for Sick Children 694 18 5 Whitefield Day Nursery 270 8 8 Kentish Town Day Nursery 449 17 10 Margaret Club and Day Nursery 445 8 2 *Including expenditure on work amongst residents outside St. Pancras. DIARRHOEA AND ENTERITIS. The year 1922 was much more favourable than 1921 in regard to these diseases. There were 47 deaths in all, of which 37 were of children under five years of age, 36 of children under two, and 31 of children under one year. The cause of these favourable figures is no doubt the favourable climatic conditions of the year, which were in contrast with the drought of the previous year. The following table will enable the figures for recent years to be compared. It will be seen that 1922 ranked with 1920 and 1912 as highly favourable years. The meteorological records for 1922 will be found in Table 6 on page 94. 30 Diarrhœa and Enteritis. Year. Births Registered. Deaths from Diarrhoea 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 1922 4,559 47 37 31 7 74 55.7 The weekly distribution of the deaths in 1922 will be found in the table inset at pages 34-35. PUERPERAL FEVER. Eleven cases of puerperal fever were notified during 1922, equal to an incidence rate of 2.4 per 1,000 births. Three deaths occurred amongst these, giving a case mortality of 27 per cent. One other death was recorded of a St. Pancras patient who died in an institution outside of the borough and was not notified. Nine cases were treated in hospitals, and two in the private nursing home where the confinement took place. Ten cases followed the birth of live-born infants, and 1 the birth of a dead viable foetus. Three of the patients were primiparae (i.e., women who had not previously borne children), and 8 multiparae. In three cases "instruments" had been used at the confinement. In three cases there had been scarlet fever in the home recently. No other source of infection was traced. In the following table the cases are classified according to the manner in which the patients were attended in their confinements:— 31 Confinement attended by No. of cases of Puerperal Fever. Total number of births notified. No. of cases per 1,000 births. Doctors 5 965 5.2 Midwives from Institutions — 658 – Private Midwives 3 904 3.3 Medical Students 2 959 2.1 In Hospital 1 — — OPHTHALMIA NEONATORUM. Fifty-nine cases were notified in 1922, equal to 12.9 per 1,000 births. Forty-five of these were notified by medical practitioners, 9 by midwives and 5 by both. Seven of the cases were regarded as grave, 17 as moderate and 35 as slight. Seven of the cases have since died (5 before recovery, and 2 since). Five 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 eases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1,000 births. Doctors 5 965 5.2 Midwives from Institutions 15 658 22.8 Private Midwives 14 904 15.5 Medical Students 13 959 13.6 In Hospitals and Institutions 12 — — Every case was visited on the day of the receipt of notification. 12 cases were removed to hospital, and 44 were treated at home, with the help of a visiting nurse in 25 cases. In 3 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 (2 of these died later) 54 Died before recovery 5 Sight damaged Nil 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 3,728 cases of measles and 253 of german measles were notified or otherwise discovered in 1922. This represents an incidence rate of 17.5 per 1,000 population for measles and 1.19 for german. measles. 107 deaths from measles were registered during the year, equal to a death-rate of 0.50 per 1,000 population, and a case mortality of 2.9 per cent. amongst notified cases. Of these deaths 15 were of children under one and 96 of children under five. There were no deaths from german measles. 32 The cases were notified or reported as follows:— Measles. German Measles. Notified by medical practitioners 2,696 77 „ parents and guardians 535 171 Discovered otherwise 497 5 3,728 253 Further statistical facts in regard to the disease will be found on pages 33 to 35. All cases where it was considered necessary have been attended by a visiting nurse once or twice a day. In the year 355 cases of measles were nursed, 1,954 nursing visits being made. In 171 families the patients were supplied with milk, &c., from the Mayoress' Nursing Fund. The cases notified, the number of deaths, and the percentage case mortality for the six years during which measles 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 1922 3,728 107 2.9 This table shows the periodic character of measles outbreaks. The high figures for 1922 are the result of an epidemic which began in October 1921, reached its height in March and had subsided by the end of August. The tables inset at pages 34 and 35 show the weekly incidence during 1922 in regard both to cases and deaths. WHOOPING COUGH. The number of St. Pancras deaths from whooping cough in the past 10 years are as follows:— 1913 36 1914 49 1915 52 1916 39 1917 27 1918 80 1919 7 1920 60 1921 38 1922 29 Twelve cases of whooping cough were nursed in 1922, 142 nursing visits being made. In 6 families the patients were supplied with milk, &c., from the Mayoress' Nursing Fund, ANTERIOR POLIOMYELITIS. See page 55. 33 Section III.-PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1922 is shown in the table below, where they are also classified according to ages. The figures have not been corrected for subsequent revision ot 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 1 — — — — — 1 — 2. Scarlatina or Scarlet Fever 1,156 10 .249 441 325 87 44 — 3. Diphtheria and Membranous Croup 725 9 224 221 111 92 67 1 4. Typhus Fever – – – – – – – – 5. Enteric or Typhoid Fever 14 — — 2 1 2 9 — 6. Fever, Simple or Continued – – – – – – – – 7. Relapsing Fever — — — — — — — — 8. Puerperal Fever 11 — — — — 2 9 — 9. Erysipelas 118 5 6 2 5 14 65 21 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax — — — — — — — — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 7 2 2 — 1 1 1 — 16. Anterior Poliomyelitis and Polioencephalitis 1 1 – – – – – – 17. Ophthalmia Neonatorum 59 59 — — — — — — 18. Encephalitis Lethargica 5 — — — 1 2 2 — 19. Acute Primary Pneumonia 384 37 129 50 12 39 103 14 20. Acute Influenzal Pneumonia 189 5 29 8 5 28 94 20 21. Malaria 13 — — — — 3 9 1 22. Dysentery 3 — — — 1 — 2 — 23. Trench Fever — — — — — — — — 24. Measles 3,728 287 1,953 1,374 51 39 24 — 25. German Measles 253 10 27 105 107 3 1 — 26. Tuberculosis— Pulmonary 534 5 10 15 25 90 372 17 Other Forms 148 9 27 38 21 23 28 2 *Including all Primary Notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms "A," "B," "C," or "D." (7947) 34 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. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Variola or Smallpox — — — — — — 10 — — 1 Scarlatina or Scarlet Fever 568 1,207 1,009 448 246 332 558 863 1,713 1,156 Diphtheria and Membranous Croup 440 458 446 424 451 399 348 747 723 725 Typhus Fever — — — — — — — — — — Enteric or Typhoid Fever 41 44 36 38 24 17 7 18 28 14 Fever, Simple or Continued 1 1 — 1 – – – – – – Relapsing Fever — — — — — — — 1 — — Puerperal Fever 11 18 14 18 9 5 13 18 . 11 11 Erysipelas 210 223 202 120 126 121 134 126 87 118 Cholera — — — — — — — — — — Plague — — — — — — — — — — Anthrax — — — 1 — 1 — — — — Glanders — — — — — — — — — — Hydrophobia – – – – – – – – – – Cerebrospinal Meningitis 5 2 40 23 25 13 10 6 4 7 Anterior Poliomyelitis and Polioencephalitis 9 3 8 9 1 1 4 2 4 1 Ophthalmia Neonatorum 23 34 31 38 31 40 39 69 101 59 Encephalitis Lethargica ... ... ... ... ... ... 3 11 8 5 Acute Primary Pneumonia ... ... ... ... ... ... 86 142 242 384 Acute Influenzal Pneumonia ... ... ... ... ... ... 213 108 99 189 Malaria ... ... ... ... ... ... 98 58 18 13 Dysentery ... ... ... ... ... ... 6 4 1 3 Trench Fever ... ... ... ... ... ... 1 — — — Measles ... ... ... 1,855 3,681 2,144 1,034 3,093 1,149 3,728 German Measles ... ... ... 381 609 311 268 195 81 253 Chicken-pox ... ... 247 ... ... 401 ... ... ... ... Tuberculosis— Pulmonary 928 893 933 735 825 1,034 799 684 546 534 Other Forms 230 121 150 138 169 203 206 132 153 148 SAINT PANCRAS, LONDON. Weekly Number of Certified Deaths from the Dangerous Infectious Diseases during the Year 1922. 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 7 14 21 28 4 11 18 25 4 11 18 25 April 1 8 15 22 29 6 13 20 27 3 10 17 24 July 1 8 15 22 29 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 2 9 16 23 30 ... Week Ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ... Number of Week. Small Pox – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 Small Pox. Scarlet Fever – 2 3 – — 1 1 1 — — — — 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 20 Scarlet Fever. Diphtheria and Memb. Croup – 1 3 – 2 1 1 2 2 2 — 1 2 — 1 — 2 2 — 1 2 — — 3 1 1 1 — 1 1 — 1 1 — 1 — — — 1 1 1 — 1 1 1 — 1 — — 1 — — 44 Diphtheria and Memb. Croup. Enteric Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – 1 Enteric Fever. Puerperal Fever – – – 1 – – – 1 – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – – – 4 Puerperal Fever. Erysipelas – – – – 1 – – – – – – – – – – 1 – 2 – – – – – – – – 1 – – – – – – – – – – – – – – – – – – – – – 1 — 1 1 12 Erysipelas. Malaria – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 Malaria. Cerebrospinal Fever 2 – – – 1 – – – – – – – – 1 – – – – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 6 Cerebrospinal Fever. Dysentery – – – – – – 1 – – – – – – – 1 – – – – – – – – – – – 1 – – – – – – – 1 – – – – – 1 – – – – – – – – – – — 4 Dysentery. Encephalitis Lethargica – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – 1 Encephalitis Lethargica. Measles 4 3 4 7 5 3 2 5 4 9 9 11 9 6 5 1 7 3 1 – 3 1 1 – 1 – 1 – – – – – 1 – – – – – – – 1 – – – – – – – – – – – 107 Measles. Tuberculosis (Pulmonary) 2 10 14 7 7 6 9 5 4 4 8 2 2 9 7 4 4 3 4 7 5 3 3 3 6 5 6 5 4 2 7 2 3 3 2 — 6 5 10 5 3 6 2 5 5 4 4 6 7 7 2 3 257 Tuberculosis (Pulmonary). Tuberculosis (Other Forms) 1 1 1 2 1 — – ' — — 2 — 2 1 1 1 1 1 2 – 1 1 2 – 2 1 2 2 — 1 1 1 2 — – 1 1 2 1 2 1 1 1 1 3 1 — 2 1 2 2 2 1 58 Tuberculosis (Other Forms). Whooping Cough — 1 3 3 1 1 3 1 1 1 1 — 1 2 3 — — 3 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 29 Whooping Cough. Diarrhoea and Enteritis 1 2 –— — — — 1 2 1 1 2 1 — — 1 2 1 .1 — — – 3 — — — 1 2 — 1 1 — 1 1 2 1 4 2 1 — — – – – — 2 — 2 3 1 2 1 47 Diarrhoea and Enteritis. (7947) SAINT PANCRAS, LONDON. Weekly Number of Infectious Cases certified to the Medical Officer of Health during the Year 1922. 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 7 14 21 28 4 11 18 25 4 11 18 25 April 1 8 15 22 29 6 13 20 27 3 10 17 24 July 1 8 15 22 29 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 2 9 16 23 30 ... Week Ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ... Number of Week. Small Pox – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 Small Pox. Scarlet Fever 47 56 45 32 31 43 30 24 20 10 22 24 16 28 24 29 28 23 14 14 16 15 16 20 27 20 14 24 22 25 14 13 8 18 20 17 17 20 15 27 21 23 22 11 23 23 19 18 21 22 12 13 1,156 Scarlet Fever. Diphtheria and Memb. Croup 19 12 15 12 10 20 19 19 12 19 19 17 10 13 10 14 12 15 14 24 17 20 15 12 13 11 13 14 15 19 10 4 6 8 10 18 20 9 9 17 14 10 22 19 11 7 15 11 17 12 14 8 725 Diphtheria and Memb. Croup. Enteric Fever – – 1 – 2 – – – – – 1 – – 1 1 – – – – – – – 1 1 — — — — — — – — — – – 1 2 – 1 – – – – 1 – – – – 1 — — — 14 Enteric Fever. Puerperal Fever 1 – – 1 1 1 1 1 – — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — 2 – – — – — — 1 1 – – – – – 11 Puerperal Fever. Erysipelas 3 – 1 3 1 1 1 4 1 3 2 2 – 3 2 2 3 3 – 2 2 7 2 3 6 3 3 2 3 3 1 1 1 3 3 3 4 1 1 – – – 4 2 4 4 4 3 4 1 2 1 118 Erysipelas. Cerebrospinal Fever 2 1 – – – – – – – – – – – – – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – – 7 Cerebrospinal Fever. Poliomyelitis 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 Poliomyelitis. Ophthalmia Neonatorum – – 4 1 – 2 1 1 3 — 1 2 1 2 — 1 2 1 2 — — 3 1 1 2 1 1 1 2 — — — — — 2 2 — 1 2 3 3 — — 3 — — 1 — 1 2 1 2 59 Ophthalmia Neonatorum. Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — – – – – 1 – – – – – – – – – – – — — — — 1 – 2 5 Encephalitis Lethargica. Acute Primary Pneumonia 21 17 20 12 5 4 5 16 6 5 6 4 17 14 14 11 9 9 6 16 7 5 8 5 1 – 4 2 5 6 1 – 3 2 1 2 4 6 7 5 5 6 7 7 7 5 10 6 14 9 9 8 384 Acute Primary Pneumonia. Acute Influenzal Pneumonia 19 38 31 27 9 10 6 12 4 1 — 2 2 2 2 1 — 1 — — — 1 — 4 — — – — 1 – – – – – – – – – – – – 2 2 – 1 2 — — 2 3 3 1 189 Acute Influenzal Pneumonia. Malaria — — — 1 — — 1 1 — — — — 1 — — — 1 — — 1 — — — — — — — — — 1 1 – – – 1 – 1 – – – – – – – — — — — – 1 1 1 13 Malaria. Dysentery – – – – – 2 – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – 3 Dysentery. Measles 133 116 127 111 138 149 155 276 205 282 258 263 235 183 135 106 116 79 81 57 67 53 41 38 23 20 28 17 30 26 26 24 11 10 3 3 8 13 9 14 5 11 3 4 7 1 4 10 5 1 – 8 3,728 Measles. German Measles — 2 1 1 1 2 — 3 2 — — 2 2 — 21 3 13 1 53 1 41 29 20 1 1 1 17 2 2 2 2 — — — — 1 1 4 1 2 1 — 1 1 2 1 — 2 3 2 3 2 253 German Measles. Tuberculosis (Pulmonary) 7 18 21 8 10 20 16 7 6 10 29 5 20 11 9 11 9 1 12 15 12 5 12 12 11 8 8 12 8 16 11 5 6 6 3 11 8 7 11 13 14 12 6 8 8 14 11 5 3 3 7 13 534 Tuberculosis (Pulmonary). Tuberculosis (Other Forms) 2 2 5 4 1 5 2 1 2 3 6 1 — 6 2 3 — 4 6 4 4 3 2 3 3 4 5 6 7 1 3 2 1 – 2 2 2 3 2 3 2 3 1 3 5 3 2 2 3 1 2 4 148 Tuberculosis (Other Forms). (7947) 35 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 Add ress. Whole Borough. 4 5 7 1 8 3 6 1 2 4 5 7 8 3 6 1 2 1. Variola or Smallpox — 1 – – – – – – – 1 — 1 – – – – – — — I 2. Scarlatina or Scarlet Fever 130 93 54 240 194 91 191 163 – 1,156 3 3 2 1 2 — 3 6 — 20 3. Diphtheria and Membranous Croup 72 111 36 105 85 69 147 100 – 725 5 7 1 3 4 5 9 10 – 44 4. Typhus Fever – – – – – – – – – – – – – – – – – – – – 5. Enteric or Typhoid Fever — — — 3 3 3 4 1 — 14 — — — 1 — — — – – 1 6. Fever, Simple and Continued – – – – – – – – – – – – – – – – – – – – 7. Relapsing Fever – – – – – – – – – – – – – – – – – – – – 8. Puerperal Fever — 1 1 — 3 1 3 2 – 11 1 – – – – – 2 1 — 4 0. Erysipelas 10 14 3 16 15 23 14 23 — 118 2 4 — 1 1 2 1 1 — 12 10. Cholera – – – – – – – – – – – – – – – – – – – – 11. Plague – – – – – – – – – – – – – – – – – – – – 12. Anthrax – – – – – – – – – – – – – – – – – – – – 13. Glanders – – – – – – – – – – – – – – – – – – – – 14. Hydrophobia – – – – – – – – – – – – – – – – – – – – 15. Cerebrospinal Meningitis — 2 — — — — 3 2 — 7 — 1 — — — — 3 2 — 6 16. Anterior Poliomyelitis — — — 1 — — — — — 1 — – 1 — — 1 — — — 2 17. Ophthalmia Neonatorum 5 14 5 8 14 4 4 5 — 59 – – – – – – – – – – 18. Encephalitis Lethargica 1 — — — 2 1 1 — — 5 — 1 — — — — — — — 1 19. Acute Primary Pneumonia 40 78 4 32 102 54 38 36 — 384 — – – – – – – – – – 20. Acute Influenzal Pneumonia 23 19 7 26 41 25 27 21 – 189 – – – – – – – – – – 21. Malaria 3 1 — 1 5 2 — 1 — 13 1 — — – – – – – – 1 22. Dysentery — — — 1 — 1 1 — — 3 — — 1 1 1 1 — — — 4 23. Trench Fever – – – – – – – – – – – – – – – – – – – – 24. Measles 417 642 149 451 615 505 642 307 — 3,728 11 19 4 8 15 22 11 15 2 107 25. German Measles 8 8 2 181 23 4 15 12 — 253 – – – – – – – – – – 26. fTuberculosis— Pulmonary 70 85 47 60 79 59 63 39 32 534 39 45 20 31 38 33 30 18 3 257 Other Forms 12 26 7 16 28 22 14 17 6 148 8 9 4 6 10 8 4 8 1 58 † Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms "A," "B," "C," or "D." (7947) e 2 36 DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of Cases. No. of Houses. No. of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Smallpox 1 1 4 4 Scarlet Fever 992 966 1,003 1,012 Diphtheria 656 647 674 676 Enteric Fever 9 9 9 4 Erysipelas 79 78 79 — Puerperal Fever 9 9 9 1 Cerebrospinal Meningitis 7 7 7 7 Consumption 74 74 80 55 Measles 19 19 18 8 Cancer 21 21 25 8 Vermin and Scabies 104 77 75 4 Other Diseases 161 161 160 11 Totals 2,132 2,069 2,143 1,790 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 57 2,525 22 75 Bolsters and pillows 30 4,578 11 96 Sheets, blankets and counterpanes 21 7,428 10 124 Rugs, mats, cushions, carpets, covers, and curtains 12 907 4 39 Wearing apparel 15 4,248 — 51 Books 19 46 — — Sundries 34 1,042 7 9 Totals 188 20,774 54 394 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. Small Pox 3 7 — Scarlet Fever 2 6 — Diphtheria — 1 — Puerperal Fever — 6 — Other Diseases 1 — — 37 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 845 21 3,623 *4,489 Scabies 12 4 998 1,014 Cases from outside St. Pancras— Vermin 59 2 714 775 Scabies — — 223 223 Vermin 904 23 4,337 5,264 Scabies 12 4 1,221 1,237 Totals 916 27 5,558 6,501 * Includes 382 males and 1 female 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 Ceneral Powers Act, 1907, sec. 36, and the Children Act, 1908, sec. 122. In respect of cases of pediculosis in school children dealt with in this way, payment is made by the County Council to the Borough Council at the rate of 2s. per child cleansed. In these cases an intensive method of dealing with the hair is employed, whereby the operation of disinfestation is limited in many cases to one cleansing only. The payment in respect of children suffering from scabies, who generally receive a series of baths, is 1s. per bath. 4.311 cases were paid for during the year at the rate of 2s. per case, and 1,215 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. 58 verminous persons from common lodging houses outside the borough were paid for by the London County Council at the rate of 1s. per attendance. There were no Finsbury cases in 1922. Apart from the above-mentioned classes of cases, in respect of which payment is received from other authorities, any verminous person resident in St. Pancras is dealt with without payment. Disinfection of Verminous Articles.—Very useful new powers in this respect have been conferred on metropolitan borough councils by Section 9 of the London County Council (General Powers) Act, 1922, which enables the borough council to disinfect or destroy, compulsorily, not only articles which are verminous, filthy, dangerous or unwholesome or likely to endanger health or promote infectious disease, but also any articles which are likely to be verminous by reason of having been used by any person infested with vermin. These powers are exercisable on a report from the medical officer of health, and the definition of verminousness include scabies, as well as lice, bugs and fleas. They are much more useful than the corresponding provisions in Section 19 of the London County Council (General Powers) Act, 1904, which only dealt with articles which the medical officer of health could certify as being filthy, dangerous or unwholesome or likely to endanger health or promote infectious disease. The latter section was not found a 38 convenient means of securing the disinfection of bedding, &c., used by the verminous persons, chiefly school children, dealt with at the cleansing station. The new Act was promoted as the result of a Conference on the subject called by the London County Council on February 25th, 1922, at which the views of the St. Pancras Borough Council were expressed by the Medical Officer of Health, who also gave evidence at the House of Commons in support of the Bill. The procedure which has been adopted in St. Pancras is as follows:—Every morning a list is received from the Matron of the cleansing station of all cases of scabies and body lice and all bad cases of head lice, and a notice is sent by post forthwith to the responsible person informing him that the Council's staff will call for the bedding and clothing used by the verminous person. Next day these articles are fetched from the house by the disinfecting staff, and after disinfection are returned on the same or following day. This procedure was brought into operation on October 17th, 1922, and by December 31st, 35 such notices had been served and the disinfection carried out. No difficulties arose, and the procedure appears to be having a salutary effect. TUBERCULOSIS. The number of notifications of civilian cases of tuberculosis received during 1922 are set out in the following table, in the form required by the Ministry of Health:— 39 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 1st January, 1922, to the 30th December, 1922 (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 (jreviously 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 3 6 7 8 23 47 61 47 31 9 243 280 – 1 2 3 5 137 178 70 120 Females 4 6 3 14 18 32 48 32 16 10 3 186 211 – 2 — 2 3 57 114 30 71 Non-pulmonary— Males 3 9 16 6 2 6 4 1 1 3 1 52 54 1 2 1 4 6 6 18 3 10 Females 6 14 10 6 6 6 4 5 5 2 1 65 66 — 4 2 6 7 6 21 4 9 Totals 14 32 35 33 34 67 103 99 69 46 14 546 611 1 9 5 15 21 206 331 107 210 Age Periods. Number of Primary Notifications on Form C, included in above. Number of Primary Notifications on Form D, included in above. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and u pwards. Total. Pulmonary— Males – 1 1 – 1 4 6 24 18 8 3 66 – – – – – – – – – – – – Females — — 2 2 1 3 4 9 4 3 2 30 – – – – – – 2 2 – – – 4 Non-pulmonary— Males — 1 4 4 — — 1 — 1 — — 11 — 1 – – 1 – – 1 – – – 3 Females — 1 1 2 1 — — — — — — 5 — — 1 — 1 — — — — — — 2 Totals — 3 8 8 3 7 11 33 23 11 5 112 — 1 1 — 2 — 2 3 — — – 9 40 The number of primary notifications (civilian) received during the year on Forms A, B, C and D was 682 (534 pulmonary, 148 non-pulmonary) equal to a notification rate of 3.21 (2.51 pulmonary, 0.70 non-pulmonary) per 1,000 population. They are analysed for age and sex in the next table:— Primary Notifications during 1922. Ages. Pulmonary Tuberculosis. Other Tuberculosis. Total all Forms. Males. Females. Total. Males. Females. Total. 0—1 1 4 5 3 6 9 14 1—5 4 6 10 12 15 27 37 5—10 8 7 15 22 16 38 53 10—15 9 16 25 11 10 21 46 15—25 36 54 90 9 14 23 113 25—35 53 54 107 5 4 9 116 35—45 85 43 128 2 5 7 135 45—55 65 20 85 2 5 7 92 55—65 39 13 52 3 2 5 57 65 upwards 12 5 17 1 1 2 19 Totals 312 222 534 70 78 148 682 The deaths from tuberculosis during the year numbered 315, of which 257 were from phthisis and 58 from other forms of tuberculosis. They are analysed for age and sex in the following table:— Deaths from Tuberculosis during the Year 1922. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0—1 1 2 3 3 5 8 11 1—2 1 1 2 — 5 5 7 2—5 1 1 2 6 5 11 13 5—10 1 1 2 4 2 6 8 10—15 3 2 5 1 4 5 10 15—25 16 19 35 3 6 9 44 25—35 19 24 43 — 1 1 44 35—45 34 23 57 1 1 2 59 45—55 43 12 55 2 2 4 59 55—65 32 9 41 3 2 5 46 65—75 8 3 11 — — — 11 75—85 1 — 1 — 1 1 2 85 and upwards — — — 1 — 1 1 Totals 160 97 257 24 34 58 315 41 The figures are equal to a death rate of 1.48 (1.21 pulmonary, 0.27 non-pulmonary) per 1,000 population. In regard to age incidence it will be seen that 74 per cent, of the deaths and 77 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 60 per cent. of the deaths and 64 per cent. of the new cases notified were of children aged 15 years or under. The sex distribution of the notification rates and death rates for 1922 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 3.11 0.70 3.81 1.60 0.24 1.84 Females 1.98 0.69 2.67 0.86 0.30 1.17 Both Sexes 2.51 0.70 3.21 1.21 0.27 1.48 The figures in the above table are based on the sex population as determined by the 1921 Census. They show that the death rate amongst males from pulmonary tuberculosis was nearly double (1.86 times) that amongst females; while for non-pulmonary tuberculosis the death rate amongst males was less (0 80 times) than amongst females. The deaths in 1922 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 1 35—45 45—55 55—65 65—75 75—85 1 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 1 4 16 19 33 42 29 7 1 – 153 2 2 3 19 23 19 12 7 2 – – 89 242 Phthisis (not defined as tuberculous) – 1 – — — 1 1 3 1 – — 7 — – – – 1 4 – 2 1 – – 8 15 Total Pulmonary Tuberculosis 1 2 4 16 19 34 43 32 8 1 – 160 2 2 3 19 24 23 12 9 3 – – 97 257 Acute Phthisis – – – – – – 1 2 – – – 3 – – 2 1 1 – – – – – – 4 7 Acute Miliary Tuberculosis — 2 — 1 — — — — – — 3 3 1 – 1 — — — — — — – 5 8 Tuberculous Meningitis 2 1 5 1 — — — — – — 9 1 8 3 1 — — — — — — – 13 22 Tabes Mesenterica – – – – – – – – – – – – – – – – – – – – – – – — — Other Peritoneal and Intestinal Tubercle — 2 – – – – – – – – – 2 1 1 — 1 – – – – – – – 3 5 Tuberculosis of Spinal Column — — — 1 – – – 1 — – — 2 — — — 1 — 1 — 1 — — – 3 5 Tuberculosis of Joints – – – – – – – – – – – – – — 1 – – – — 1 – 1 – 3 3 Lupus – – – – – – – – – – – – – – – – – – – – – – – — — Scrofula – – – – – – – – – – – – – – – – – – – – – – – – – Tuberculosis of other Organs 1 1 — — – — 1 — — – 1 4 — — — — — — 1 — — — — 1 5 Disseminated Tuberculosis – – – – – 1 – – – – – 1 – – – 1 – – 1 – – – – 2 3 Total Non-Pulmonary Tuberculosis 3 6 5 3 – 1 2 3 — – 1 24 5 10 6 6 1 1 2 2 — 1 — 34 58 Total all forms of Tuberculosis 4 8 9 19 19 35 45 35 8 1 1 184 7 12 9 25 25 24 14 11 3 1 – 131 315 In the next table the new cases notified during 1922 are similarly classified. (7947) f 42 Location of Disease. Ages. Total. 0—5. 5—15. 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 5 10 17 23 290 189 534 Bones and Joints 2 11 7 12 10 42 Meninges 4 10 5 1 1 2 23 Glands 4 7 12 15 3 13 54 Abdominal 1 — 3 1 4 9 Genito-Urinary — — 1 — 3 – 4 General 3 1 — — – – 4 Other Organs 1 3 1 2 3 2 12 Total Non-Pulmonary Tuberculosis 13 23 33 25 23 31 148 Total all forms of Tuberculosis 18 33 50 48 313 220 682 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. 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 1922 212,500 534 148 682 257 58 315 2.51 0.70 3.21 1.21 0.27 1.48 43 The number of deaths of tuberculous patients who were not notified before death or only at the time of death was as follows:— No. of cases. Percentage of all tuberculosis deaths. Pulmonary 58 22.6 Non-pulmonary 29 50.0 All forms 87 27.6 10 of the cases (9 pulmonary and 1 non-pulmonary) died in asylums and in 36 others (17 pulmonary and 19 non-pulmonary) death took place after a short illness only, or before a diagnosis of tuberculosis was made (including 17 deaths from meningitis, 8 from miliary or acute tuberculosis, 8 diagnosed only after P.M. examination, and 3 others). Allowing for this correction, the number of tuberculosis deaths in which there was failure to notify before death was as follows:— No. of cases. Percentage of all tuberculosis deaths. Pulmonary 32 12 5 Non-pulmonary 9 15.5 All forms 41 13.0 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 1922 was as follows:— Home visits* by— Tuberculosis officers 210 Women inspectors— (а) First visits to notified cases 513 (b) Subsequent visits 2.525 Tuberculosis dispensary nurses 1,175 4,423 Attendance of women inspectors at dispensaries 473 Other visits of women inspectors for various purposes 297 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 1921, 169,276), 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 * Exclusive of visits made by members of the Interim Tuberculosis Care Committee. (7947) f 2 44 1-6) the cases of tuberculosis notified in 1922 numbered 514 (395 pulmonary and 119 nonpulmonary) and the deaths registered 250 (203 pulmonary and 47 non-pulmonary). The tuberculosis dispensary at University College Hospital serves the whole of the Borough of Holborn (population in 1921, 43,192), in addition to the part of St. Pancras lying south of Euston Road (population in 1921, 42,090), 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 1922 numbered 130 (107 pulmonary and 23 non-pulmonary) and the deaths registered 61 (51 pulmonary and 10 non-pulmonary). At St. Pancras Dispensary the Tuberculosis Officer, Dr. N. M. Donnelly, took up his duties on 3rd May, 1922, Dr. G. F. Hardy acting temporarily until that date. At University College Hospital Dr. H. Evans continued as Tuberculosis Officer throughout the year. The work done at the dispensaries in 1922 is shown in the following table:— 45 TUBERCULOSIS DISPENSARIES. Tuberculosis Dispensary at St. Pancras Dispensary, 39, Oakley Square. Branch Tuberculosis Dispensary at 132, Maiden Road. Tuberculosis Dispensary at University College Hospital. Adults. Under 15. Total. Contacts included in Total. Insured Persons included in Total. Adults. Under 15. Total. Contacts included in Total. Insured Persons included in Total. Adults. Under 15. Total. Contacts included in Total. Insured Persons included in Total. M. F. M. F. M. F. M. F. M. F. M. F. Under observation on January 1st pending diagnosis 12 10 13 15 50 16 22 1 — 7 5 13 3 1 — — — — — — — Examined for first time during the year 155 154 97 69 475 139 197 18 26 22 25 91 36 28 64 41 19 16 140 26 63 Total 167 164 110 84 525 155 219 19 26 29 30 104 39 29 — — — — — — — Found to be :— Suffering from tuberculosis— Pulmonary 73 51 o 5 134 4 96 5 5 1 2 13 — 6 37 20 1 2 60 1 37 Non-pulmonary 8 2 15 12 37 17 7 — 1 o 3 6 — 1 3 — 5 7 15 4 o Not suffering from tuberculoais 02 76 65 45 248 98 76 8 18 19 19 64 35 18 18 16 12 6 52 20 17 Under observation on December 31st pending diagnosis 12 25 12 7 56 14 18 5 2 — 1 8 1 1 8 4 ] 4 17 3 8 Ceased attendance before conpletion of diagnosis 12 10 13 15 50 22 22 1 — 7 5 13 3 3 1 2 — — 3 — — 39, Oakley Square. 132, Maiden Road. University College Hospital. 39, Oakley Square. 132, Maiden Road. University College Hospital. Patients under supervision (excluding persons under observation or domiciliary treatment) on 31st December 332 75 487 Reports received from Insurance Practitioners re insured patients under domiciliary treatment during the year 18 — — Total number of attendances during the vear— Persons referred to affiliated hospital — — 19 Insured 2,118 136 832 Consultations with medical practitioners at the homes of patients— Uninsured 1,557 451 642 Persons placed under observation for the purpose of diagnosis during the year 167 18 15 Insured 0 2 1 Uninsured — 1 1 Cases in which the period of observation exceeded two months 39 8 19 Other visits paid by Tuberculosis Officers to the homes of patients 175 18 10 Insured persons under domiciliary treatment on December 31st 52 4 3 Visits by Dispensary Nurses to the homes of patients for dispensary purposes 364 59 752 Specimens of sputum examined for dispensary purposes 883 104 196 40 Treatment of Tuberculosis in Sanatoria and Hospitals. The St. Pancras cases dealt with by the London County Council scheme for institutional treatment are shown in the following figures :— 1922. No. of Applicacations for institutional treatment. No. of these Applicants who were admitted. Ex-service men 71 68 Others 187 172 Total 258 240 These figures may be compared with the following :— No. of cases notified on Form C in 1922 as having been admitted to sanatoria 260* „ „ „ „ „ „ Poor Law Institutions 206 SMALLPOX. One fatal case of smallpox occurred in St. Pancras in 1922, and there were no further cases in the borough. The patient was an unmarried man of 30 who lived with his mother and her family in two basement rooms at 110, Stanhope Street. The illness began on the night of 22nd July. On the 23rd the patient was delirious and a scarlatiniform prodromal rash appeared. On the 24th he was admitted to the North-Eastern Hospital as a case of scarlet fever. On the 26th the diagnosis of smallpox was made, the papular eruption being then considered to be in its second day, and the patient was moved to the smallpox hospital, where he died on 30th July. He had never been vaccinated. Other cases of smallpox were afterwards reported in East London, and it was found that the St. Pancras case was the first recognised of an outbreak comprising 12 cases. The first case was a youth of 16 living at Crispin Street, Spitalfields, who fell ill on 1st July and developed the rash on 3rd-4th July. His illness was diagnosed as chicken-pox, and he appears to have spread the disease in the neighbourhood of Houndsditch and Middlesex Street. The source of infection of this case was not known. The St. Pancras case was considered to have contracted his infection in the course of his visits to this neighbourhood, where he bought his stock in trade as an itinerant vendor of " fancy articles." The patient's family comprised 8 persons and there were 4 other lettings in the house, comprising 9 persons. Seven other personal contacts were traced. These persons and others were kept under observation and most of them were revaccinated. There were no secondary cases ; nor were there any at the hospital where the patient w as first treated. There were no St. Pancras cases in the larger outbreak of smallpox which began later in the year at the Poplar workhouse. There were 64 cases of smallpox in the County of London in 1922, and 20 deaths. 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. Pancras from 1st January to 31st December, 1921, inclusive :— * Corrected so as to represent individual courses of treatment. 47  Number. Percentage of Births registered. North. East. West. South. Whole Borough. North. East. West. South. Borough. Births registered 1,065 1,343 1,106 1,588 5,102 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 35 83 65 75 258 3.3 6.2 5.9 4.7 5.1 Successfully vaccinated 396 494 495 700 2,085 37.2 36.8 44.8 44.1 40.9 Had smallpox — — — — — — — — — Insusceptible of vaccination 1 2 — 1 4 0.1 0.1 — 0.1 0.1 Received certificates of conscientious objection 580 524 373 407 1,884 54.5 39.0 33.7 25.6 36.9 Postponed by medical certificate 7 12 56 43 118 0.7 0.9 5.1 2.7 2.3 Moved to known address in other districts 7 88 7 227 329 0.7 6.6 0.6 14.3 0.4 Lost sight of by removal 37 120 94 123 374 3.5 8.9 8.5 7.7 7.3 Unvaccinated and not accounted for in previous columns 2 20 16 12 50 0.2 1.5 1.4 0.8 1.0 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. 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 1921 5,102 2,085 40.9 1,934 37.9 SCARLET FEVER. 1,156 patients were notified in 1922 as suffering from scarlet fever. Of these 54 were afterwards reported not to be suffering from the disease by medical superintendents of the Metropolitan Asylums Board. The corrected number of scarlet fever cases notified was, therefore, 1,102, equal to an incidence rate of 5.2 per 1,000 population. The number of deaths from scarlet fever certified during the year was 20, equal to a deathrate of 0.09 per 1,000 population, and a case mortality of 1.73 per cent, of cases notified. 48 In the following table are set out the corresponding figures for the past 10 years, corrected for errors of diagnosis :— 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. 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 1922 1,102 5.2 20 0.09 1.7 99 It will be seen from the table that the wave of increased prevalence reached its maximum at a time which has caused the figures for 1922 to be less than those for 1921. The number of deaths and the case mortality rate were much higher than in 1921 (c.p. 1915, when the last wave of prevalence was subsiding). Of the notified cases of scarlet fever, 1,143 (or 98.9 per cent) were removed to hospital, as follows:— To Metropolitan Asylums Board hospitals 1,138 To other hospitals 5 1,143 (Other statistical facts will be found on pages 33 to 35.) 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 in 53 houses in 1922. In43 instances onlv one return case occurred in the house, but in the other 10 instances other cases of scarlet fever followed the occurrence of the return case : in each of 9 instances there was one such additional case, and in one house there were 2 additional cases, the total number of return cases being 64. In the following analysis only the 53 first return cases are considered. Their distribution according to the month in which they occurred was as follows :— 1921— December 2 1922— January 9 April 3 July 1 October 6 February 5 May 3 August 4 November 7 March 6 June 0 September 4 December 3 In 44 instances the return case occurred in the family to which the (?) infecting case returned, and in 9 in a different family in the same house. In 50 instances only one case had returned from hospital in the 28 days prior to the onset of illness in the return case, and in each of 3 instances 2 cases had returned from hospital within that period. The number of possible infecting cases was therefore 56. Of these 22 had 49 rhinitis in varying degree (one of these had also otorrhcea, one earache and enlarged glands, one epistaxis, 2 enlarged glands, one sore throat, one sores about the face, and one a septic finger); 6 had sores about the face ; 4 had otorrhoea (one of these had also nephritis); 2 had enlarged glands ; and one had epistaxis. The remaining 21 were considered to show no signs of infectiousness, though a number of them had enlarged tonsils. Swabs from the nose or throat (or both) were taken from the (?) infecting cases in some instances, and the cultures from them examined in smears for the B. diphtheriae in the ordinary routine manner, chiefly at the Lister Institute. 15 cases were examined in this way with the following results Nose and throat both " positive," 4 ; nose " positive " (throat not swabbed), 3 ; nose " negative " (throat not swabbed), 7 ; nose and also a swab from the ear " negative " (throat not swabbed), I. In every case swabbed there was rhinitis. In 5 instances the return of the original case of scarlet fever was followed within 28 days by a return case or cases of that disease, and also by a case of diphtheria in the house. Three of the above-mentioned " positive " results (N +T +, N + T and N +) were obtained in these instances, no swabs being taken in the other two instances. The intervals between the return of the (?) infecting cases and the onset of illness in the first return case were as follows :— Days. Cases. Days. Cases. Days. Cases. Days. Cases. 1 1 6 5 11 3 17 1 2 4 7 5 12 2 18 2 3 2 8 6 13 1 23 1 4 4 9 7 14 1 25 2 5 2 10 2 16 2 28 3 Scarlet fever after diphtheria.—There were also 5 instances in which a case 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 these only one case of diphtheria had returned within that period. In one instance the diphtheria case was in the same family as the scarlet fever case, and in 4 instances in a different family in the same house. In one case the diphtheria convalescent showed nasal discharge (negative swab) and sores about the mouth, and in one other some injection of the throat; the others were not regarded as showing evidence of scarlatinal infectiousness. The intervals between the return of the diphtheria case and the onset of the case of scarlet fever were 4, 11, 18, 23 and 25 days. The return cases took their onset in March, April, May, July and December respectively. After-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; 839 such children have been visited in 1922, of whom 682 are reported to have recovered satisfactorily and 157 to have required treatment. The conditions needing treatment were as follows* :—Nose and throat, 42; debility, 35; ears, 33 ; cough or " chest trouble," 13; kidney, 11 ; enlarged glands, 8 ; rheumatism, 8 ; eyes, 6 ; heart, 5. Thirty-five of the cases were treated at the St. Pancras Dispensary, 56 at hospitals, 11 at the school clinics, and 44 by private doctors. Scarlet Fever at the Foundling Hospital. An outbreak of this disease, serious from the point of view of numbers, occurred at the Foundling Hospital in 1921-22. There were 140 cases in all; 56 in the Boys' Department, 70 in the Girls' Department, 10 in the Infants' Department, and 4 in the resident staff. Fortunately, the cases were of very mild type, and there were no deaths. The total population of * Some of the patients suffered from two or more complaints. (7947) G 50 the institution at the time of the beginning of the outbreak was 169 in the Boys' Department, 132 in the Girls' Department, 77 in the Infants' Department, and 40 in the resident staff. The ages of the " boys " ranged from 7 to 14£, of the " girls " from 8 to 14£, and of the " infants " (both sexes) from 5 to 8. The boys were living in four dormitories, the girls in four, and the infants in four. In the normal life of the institution the children of the three departments are more or less separate, there being separate sleeping, dining, lavatory and school accommodation, and separate playgrounds are adhered to, but mixing may take place as the children pass in the passages and grounds of the institution, and the two older groups, viz., bovs and girls, meet on occasion at chapel services, choir practices, drill, &c. The children attend school and chapel inside the institution and do not visit houses outside, but visitors from without are not excluded. The first case was a " girl," who, after being kept under observation for about 36 hours in the Infirmary (an isolated hospital in the grounds), was removed to the Metropolitan Asylums Board hospital on November 26th. At this time the institution was recovering from a large outbreak of measles, and the measles convalescents were being kept together and away from the others in a separate dormitory on the boys' side, one on the girls' side, and one in the infants' department, which for convenience were called the boys', girls' and infants' measles convalescent wards. The second case of scarlet fever sickened on December 6th in the boys' measles convalescent ward, and was removed on December 7th. Two more cases were removed from the same ward on December 13th, and one on December 19th. On December 20th an " infant " developed scarlet fever while in the measles ward of the Infirmary. On December 22nd the disease appeared in the girls' measles convalescent ward, when three girls sickened and were removed to hospital, and on December 23rd another girl was removed from the same ward and a boy from the boys' measles convalescent ward. On December 24th cases developed for the first time in the general girls' dormitories, and two girls were removed from these on that day. Two more went from the girls' dormitories on December 29th, one on January 1st, and then more in rapid succession until, by January 21st, 42 cases in all had been removed from the girls' dormitories, after which there were only a few more cases amongst the girls. After December 23rd cases also fell rapidly in the boys' measles convalescent ward and the girls' measles convalescent ward. In all there were 14 cases in the former and 13 in the latter until January 19th, by which time the distinction between these wards and the boys' and girls' general dormitories respectively was no longer maintained. There were only 3 cases in the infants' measles convalescent ward ; they were removed on December 26th. 29th and 31st. The disease appeared in the general infants' department on January 19th, when there was one case, and a girl of 14 who was living with the " infants " was also removed on January 25th. There were subsequently only four more cases amongst the " infants." The general boys' dormitories were invaded on January 15th, when one of the boys sickened with scarlet fever ; another fell ill on January 21st, after which the disease spread in these dormitories until, by March I4th, 31 cases had been removed from them. After that date the cases in the boys' dormitories fell less rapidly, there being none in May, but, bv July 26th, when the whole outbreak ceased, 11 more boys in the general boys' dormitories had fallen ill and been removed. After January 21st (see above) 11 more cases from the general girls' dormitories were removed, the last being on May 19th. The only other cases to be mentioned are a nurse in the measles ward of the Infirmary, who was removed with scarlet fever on January 6th, and an " infant " in the same ward who developed scarlet fever on January 17th ; two girls who developed the rash of the disease in another ward of the Infirmary on January 28th and 30th, after they had each been there 10 days with influenzal symptoms ; two women members of the staff on the girls' side, who became ill on February 1st, and a housemaid, who sickened on March 26th. The outbreak of scarlet fever was associated with the occurrence of 8 cases of diphtheria, which were removed to hospital on April 8th (a girl who had recently returned after scarlet fever), 9th, 17th (boys), 17th (girl), and 20th, May 9th and 16th (boys), and June 19th (infant). 51 A great deal of pains was taken with a view to checking the outbreak. Dr. W. M. Fairlie, the medical officer of the institution, was indefatigable in his attention and worked in co-operation with the Medical Officer of Health, who visited on several occasions, and Dr. Bruce Low, of the Ministry of Health, whose attention was called to the outbreak at an early stage, also visited and advised. There was no reason to suspect the milk supply, which was distributed largely in London without causing cases outside the institution. Dr. Fairlie has kindly supplied me with the following notes on the precautions taken:— Measures taken to limit spread of the infection.—As the outbreak of scarlet fever began during an epidemic of measles, isolation of the children in groups as far as possible was in force, and this was continued. The accommodation available and the administration of the institution did not permit of this being absolute. The infants were satisfactorily isolated in two separate buildings, but the boys and girls were each in four large wards in the same block (four wards in each of two wings), and could not'be further subdivided owing to the lack of separate lavatory and dining accommodation, except in the case of one boy's ward, which had separate lavatory, &c., and was used to isolate the measles convalescents among the boys. These groups, viz., infants, four wards of girls, three wards of boys, and one ward of boys, were kept quite apart at all times and the only possible contact arose from the coming and going from each group to a supply of food and stores common to all, the staffing not being such as to permit of all stores being sent to each group. Contact was minimised by supervising as far as possible the coming and going of the children (the older ones being used only) to the points .common to them. The Chapel was closed prior to the outbreak and remained closed for many months. Services were held separately for each group. School was not discontinued, but was separate for each group. The periods were shortened, with more frequent intervals during which the children were outside and the class-rooms well ventilated. The children were frequently inspected. Those with discharges were isolated and treated, and any suspicious children were removed for isolation and observation. All children used a mild antiseptic gargle, viz., Pot. Permang. and Sod. C'hlor., throughout the epidemic. Special attention was paid to ventilation of the dormitories. The children slept head to the top of the bed and then head to the foot of the bed alternately all round the wards. After the epidemic had existed a short time a general spring cleaning of the hospital was undertaken. All wards were scrubbed out and the walls sprayed with 1 per cent. Izal solution, and these procedures were repeated. All the children's lockers were cleared out, and all papers, books of no value and rubbish were destroyed. The use of the swimming bath was stopped, and later, when it was used (after the last case) the same water was not used for children of different groups. Disinfection of all clothing and bedding of the infected children was done as each case occurred, and there was also destruction of old things likely to harbour infection. All toys and papers in contact with the cases were destroyed as each case occurred. The staff were inspected and supplied with gargle. The staff were instructed in the signs suspicious of infection and every endeavour was made to separate as early as possible any who showed the slightest sign suggesting infection. The children were arranged in the wards so that those coming in contact at one part of the day remained in contact at other parts, e.g., the children of one class in school slept in the same dormitory. It frequently happened that infection was greatest in one section, and the children of this section were kept separate as far as possible and kept more in the open air when the weather permitted. Cases of scarlet, on returning from the M.A.B. hospitals, received careful attention. All with discharges or who developed discharges were isolated and treated in the Infirmary till well after these had ceased. Those without discharges were isolated in the Infirmary until 12 weeks had elapsed from the onset of the disease, and at the same time no case had less than two weeks' isolation after returning to the Foundling. During this period of isolation the throats were treated, being painted with an iodine paint. After the epidemic had ceased still more care was taken of the returning cases. The period of isolation was extended to one month. The main body of children went to camp at Bognor in July, and of the returning cases only those were sent to camp who had had a month of isolation in the Foundling and were in time to get three weeks at the camp. The others were drafted to the country before the main body returned to the Foundling in September, and after that no child returned to the Hospital after scarlet unless it had had at least two months in the country after discharge from M.A.B. Hospitals. The importance of this was shown by the fact that one case was sent to camp in error after only two weeks' isolation in the Foundling after return from M.A.B. Hospital, and within a week of its going to camp a case of scarlet occurred in the same tent. This was the only case that occurred at camp. Other general precautions.—Visits of the children to places outside were discontinued and visitors from outside were not admitted; only those with business at the office were admitted inside the grounds. (7947) G 2 52 Former Outbreaks.—There has been a succession of outbreaks of infectious disease at the Foundling Hospital. Dr. Sykes, the late Medical Officer of Health, reported on an outbreak of enteric fever in 1891, involving 35 cases, and of scarlet fever in the same year, involving 42 cases (see Annual Report of M.O.H., 1891, page 17, and 1893, page 25). As a result of Dr. Sykes' recommendation the present convenient Infirmary in the institution grounds was built at that time. Another outbreak of scarlet fever took place in 1905, of which an account by Dr. Sykes will be found in the M.O.H.'s Annual Report for that year, page 68. There were 103 cases (17 boys, 30 girls, 54 infants, and 2 staff), in addition to 46 who were removed to the fever hospital and found not to be suffering from scarlet fever. The first case fell ill on August 26th, 1905, and the last on January 5th, 1906. There were 27 cases who sickened in the six days of August, 37 in September, 10 in October, 21 in November, 4 in December, and 4 in January. In his report Dr. Sykes wrote : " I can confidently assert that greater care could not have been taken in the prompt removal of suspicious cases and the repeated and thorough disinfection and cleaning, often on a large scale. The repeated examinations of the whole of the children in the institution made by the medical officer was also as thorough as could be desired." No further large outbreak is recorded until 1912 (see Annual Report, 1912, page 45), when there was an epidemic of diphtheria, involving 70* cases, of which 53 were boys, 3 girls, and 14 children of 7 years and under. A large proportion of these cases were diagnosed on bacteriological grounds only, without any exudation in the throat. At that time the drainage system of the premises was examined and some minor alterations made, but no serious defect was found. The diphtheria appeared again in the following year, 1913 (Annual Report, 1913, page 55), when there was an outbreak of 36 cases, including 6 carriers, entirely confined to the girls' side. In 1914 there was a single case of diphtheria (girl), and in 1915 6 cases (4 girls, 1 boy and 1 staff). There was another single case in 1918 (girl) and 1 in 1919 (staff). From January to August, 1920, there were 31 cases of diphtheria (17 girls, 13 boys and 1 staff), and 25 cases of scarlet fever (17 boys and 8 girls), and from October, 1920, to January, 1921, 30 cases of scarlet fever (27 infants and 3 girls). There were 2 cases of diphtheria (infants) in November and December, 1920, and in 1921 12 cases of diphtheria (10 girls and 2 boys), and 3 of scarlet fever (2 girls and 1 infant) prior to the 1921-22 outbreak, the subject of this report. The last of these cases of scarlet fever was removed on May 21st. There were 6 cases of diphtheria in October, 1922 (1 boy, 1 girl and 4 infants), and no further cases of these diseases have since been reported except one case of scarlet fever (boy) in April, 1923. Just before and during the early stages of the 1921-22 outbreak of scarlet fever there was a considerable epidemic of measles in the institution, involving 127 cases (56 boys, 35 girls and 36 infants), and from April to July, 1922, there was an outbreak of 168 cases of german measles (80 boys, 64 girls and 24 infants). The buildings of the institution are old and in a central part of London, and the repeated outbreaks of infectious disease provide an additional reason for carrying into effect as soon as possible the scheme for removing the children permanently to the country, which it is understood has been determined upon by the Governors. DIPHTHERIA. 725 patients were notified in 1922 as suffering from diphtheria or membranous croup. Of these, 111 were afterwards found not to be suffering from the disease by Medical Superintendents of the Metropolitan Asylums Board, and 2 by other medical practitioners. The corrected number of diphtheria cases notified was therefore 612, equal to an incidence rate of 2-9 per 1,000 population. * The figure 54 given in the 1912 Report did not extend to the end of the epidemic. 53 The number of deaths from diphtheria certified during the year was 44, equal to a deathrate of 0-21 per 1,000 population and a case mortality of 7.2 per cent, of cases notified. In the following Table are set out the corresponding figures for the past 10 years corrected for errors in diagnosis :— 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. 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 1922 612 2.9 44 0.21 7.2 98 Of the notified cases of diphtheria, 713 (or 98.3 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 709 To other Hospitals 4 713 (Other statistical facts will be found, on pages 33 to 35.) Return cases.—(Definition : A case of diphtheria occurring within 28 days of the return from hospital to the same house of a previous case of diphtheria.) Four such cases occurred in 1922, in February, May, August and November, respectively. In three instances the return case was in the family to which the (?) infecting case returned, and in one instance in a different family in the same house. The intervals between the return of the first case and the onset of the return case were 7, 17, 18 and 28 days. In two instances the (?) infecting case showed nasal discharge (" positive " swab from the nose), and nasal discharge and otorrhcea (" positive " swab from the nose, " negative " from the throat). The other two (?) infecting cases showed no clinical signs of infectiousness. Diphtheria after scarlet fever.—In 18 houses cases of diphtheria occurred within 28 days of the return from hospital to the same house of a previous case of scarlet fever. In 16 of these there was only 1 case of diphtheria, but in one instance there were 2 cases of diphtheria and in one instance 4 cases, the total number of such cases of diphtheria being 22. Only the 18 first cases of diphtheria are considered in the following analysis. Their distribution according to the month of onset of the diphtheria cases was as follows :— December, 1921, one ; January, 1922, 2 ; February, 7 ; March, 3 ; April, 2 ; May, one ; October, one; December, one. In 12 instances the scarlatinal convalescent and the diphtheria case were in the same family, and in 6 instances in different families in the sail)" house. In 17 houses only one case of scarlet fever had returned from hospital within the 28 days, and in one house 2 cases had returned within that period, the number of possible infecting cases 54 being, therefore, 19. Of these, 9 had rhinitis in varying degrees, one sore throat, one an abscess in the neck, and one sores about the face, while in 6 there was no clinical evidence of infection. In one instance the scarlatinal convalescent had developed clinical diphtheria and was removed to hospital on the day of onset of the " return case " of diphtheria. Swabs from the nose or throat (or both) were taken from 14 of the (?) infecting cases and the cultures from them examined in smears for the B. diphtheriae in the ordinary routine manner, chiefly at the Lister Institute. The results were as follows (T = throat, N = nose):— T + N + 4, N + 2, T - N + 1, T - N — 4, T — 3. The intervals between the return of the scarlatinal convalescents and the onset of illness in the first diphtheria cases were as follows :— Days. Cases. Days. Cases. Days. Cases. Days. Cases. 2 2 8 2 18 1 24 1 3 1 9 2 21 1 26 1 4 1 10 1 22 1 5 2 15 1 23 1 The foregoing statement includes the 5 instances in which a return case or cases of scarlet fever as well as a case of diphtheria followed the return home of the scarlatinal convalescent. These five cases are referred to on page 49. 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. 356 such children have been visited in 1922, of whom 289 are reported to have recovered satisfactorily and 67 to have required treatment. The conditions needing treatment were as follows: Debility 17, nose and throat 19, ears 8, paralysis 3, enlarged glands 3, heart 5, cough 6, eyes 2, other defects 4. Eleven of the cases were treated at the St. Pancras Dispensary, 27 at hospitals, 2 at the School Clinics, and 20 by private doctors. TYPHOID OR ENTERIC FEVER (INCLUDING PARATYPHOID). Fourteen cases were notified in 1922 as suffering from this disease. Of these, 5 were afterwards found not to be suffering from enteric, the number of actual cases being 9. Only one case (Paratyphoid B.) was fatal. On serological grounds 5 of the 9 cases were regarded as infectious with B. typhosus, and 4 with B. paratyphosus B. Two cases were treated at home, 9 in the North-Western Hospital, M.A.B. (including the 5 in which the diagnosis was not confirmed) and 3 in other hospitals. The cases took their onset: 2 in December, 1921, one in May, 1922, one in June, 3 in August, one in September, and one in October. One case arrived in this country already ill, and one probably took the infection in Sheffield. No source of infection was traced in any of the other cases. There was no history of shellfish in any of them. One was in Edinburgh when the disease began, but probably took the infection in London. Six of the cases lived in St. Pancras and worked in other parts of London. In no instance was there more than one case in a household. 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:— 55 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 1922 9 1 11 ACUTE ANTERIOR POLIOENCEPHALITIS AND POLIOMYELITIS. One case of poliomyelitis was notified in 1922, which recovered. There were two deaths from the disease, both of which cases took their onset before the beginning of the year and were never notified. The particulars were as follows:— L. H., female, aged 11 months. Ward 8 (L). Onset 30th December, 1921, when arm was found to be limp ; no other marked symptoms. Notified 31st December, 1921 (received 3rd January, 1922). Complete recovery. F. Z., female, aged 4. Ward 7 (V). Admitted to German Hospital on 25th December, 1921, with paralysis, said by parents to have begun on that day. There was paralysis of both legs, with abolition of knee jerks, and paresis of the abdominal muscles. No other defects. Died in the hospital on 18th March, the death being certified as being due to (1) poliomyelitis anterior and (2) chronic bronchitis and spondylitis. Not notified. D. G., female, aged 6. Ward 6 (J). The paralysis developed about March, 1920, all the limbs being paralysed on the day after the onset of a febrile illness with pains in the head ; no incontinence. The patient was admitted to the London Temperance Hospital, and there was gradual partial recovery, the child being able to walk with the aid of a jacket. On 30th March, 1922, she was admitted to the Great Ormond Street Hospital for acute dyspnoea, and died on 3rd April. P.M. : Nil, except massive collapse and oedema of lung. Death certified as due to (1) infantile paralysis, 2 years, and (2) acute bronchitis. The case was not notified at the time of onset, nor was the patient's brother, who is said to have had infantile paralysis at the same time, and now to have a lame right leg. EPIDEMIC CEREBROSPINAL MENINGITIS. Five cases were notified in 1922 as suffering from this disease, of which one was found not to be a case after admission to the North-Western Hospital (M.A.B.). There were two other cases reported after death, but never notified, the total number of reported cases of the disease in the year being six. All the cases were fatal. The particulars were as follows :— W. B. 0., male, aged 2J. Ward 1 (D). Onset January 2nd. Malaise, followed by sudden insensibility and convulsions, with extreme retraction of head and upper part of spine. No vomiting. Knee jerks absent. Died at home January 3rd, within 12 hours of onset of acute symptoms. Notified January 3rd. No bacteriological or P.M. examination. S. F. R., male, aged 2£. Ward 1 (B). Onset December 10th, 1921. Vomiting, somnolent, sighing respiration, internal strabismus of R. eye, head retraction, Babinski's sign doubtful. Died at home December 29th, 1921. Not notified. No bacteriological or P.M. examination. Regarded by doctor as a case of posterior basic meningitis. N. L., female, aged fa. Ward 5 (Q). Onset January 5th. Drowsy, feverishness, vomited, head retraction, muscular rigidity, especially in the neck, strabismus, screaming. Admitted to London Temperance Hospital January 8th. Notified January 11th. Diplococcus intracellularis found in c.s. fluid and grown in culture by Dr. Sanguinetti. Died January 21st. No P.M. 56 G. S., male, aged Ward 2 (F). Onset April 6th. Drowsiness, with difficulty in breathing, passing on to coma. Died April 7th. Not notified. No bacteriological or P.M. examination. H. W., male, aged 13. Ward 2 (E). Onset May 4th. Headache, feverishness, vomiting, delirium, muscular rigidity. Notified May 10th and admitted to Nortli-Western Hospital (M.A.B.) the same day. C.s. fluid turbid, and found to contain a diplococcus pneumonia?. Died May 12th. No P.M. J. F. M., male, aged 24. Ward 1 (C). Onset June 16th. Notified June 30th and admitted to Eastern Hospital (M.A.B.) on the same day. Comatose, stertorous breathing, pupils dilated and react to light. Koenig's sign present, knee jerks very exaggerated. Babinski's sign present, no head retraction, but head flexion resisted, incontinence and analgsesia. T. 103 ; P. 128. Chronic morbus cordis. C.s. fluid turbid, depositing large fibrinous clots ; excessive polymorphs with extra- and intra-cellular gram-negative diplococci. Died July 2nd. No P.M. It will be noticed that four of the cases were in young children, and that in three of these there was no bacteriological confirmation of the diagnosis. Four of the five cases were in the north of the borough (Wards 1 and 2). No connection between the cases and no source of infection was traced. There were no cases after June. The following table shows the number of cases of cerebrospinal meningitis notified or otherwise reported (corrected for errors of diagnosis) since 1913 :— 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 1922 6 6 100 ENCEPHALITIS LETHARGICA. Five cases of this disease were reported in 1922, all in females. One case was fatal. No connection between these cases or source of infection was traced. The particulars were as follows :— G. E. P., female, aged 47. Ward 1 (B). Onset 18th June, with diarrhoea and headache. Seen by doctor on 22nd June, when temperature was 103 deg., tongue dirty, headache and severe pain in back of neck and back, abdomen distended, slight ptosis, drowsiness though patient complained of insomnia, consolidation of base of right lung, knee jerks (left sluggish, right brisk), marked clonus of right ankle. Widal reaction negative. Temperature remained 103—4 in the evening and 100-1 in the morning until 3rd July. Pulse never over 90, generally 70-86. Bowels costive. Occasional syncopal attacks. By 6th July the evening temperature was only 99 and the lung was clearing. The chief symptoms in the case were : Intense headache with drowsiness ; delirium at night, and marked prostration. These were associated with ptosis and slight squint. Notified 29th June. Diagnosis confirmed by Dr. M. A. Cassidy. On 21st September patient felt well, but could not walk far without a stick. Slight pains and swelling in lower limbs. Slept well and no head symptoms. E. R., female, aged 25. Ward 5 (Q). Onset early in July. Initial symptoms : Pain in legs, attacks resembling petit mal, excessive thirst and polyuria, drowsy. Admitted to Highgate Hospital 28th July. Occasional pyrexia, some rigidity of lower extremities, flexor plantar reflexes, no 57 cranial nerve affection, very dull and lethargic, lethargy becoming extreme towards the end (would fall asleep while holding feeder or being spoken to). Cerebrospinal fluid macroscopically normal. Wassermann reaction negative. Died 21st August. Notified 23rd August. P.M.: Nil, except macroscopically the vessels seen on section of the brain were congested and very conspicuous. G. B., female, aged 15. Ward 4 (P). Onset a few days after being vaccinated on 30th November. Initial symptoms : Increasing drowsiness and irritability, vomited and violent headache; 11th December, lethargy developed (but could be roused), with some pyrexia. Notified and admitted to North-Western Hospital (M.A.B.) on 13th December. After admission the symptoms cleared up rapidly, and the case at first was thought not to be E. lethargica, but on comparison with certain other cases the diagnosis was confirmed. Report on 9th March, 1923 : In good health ; requires glasses for near work. L. L., female, aged 20. Ward 6 (J). Admitted to North-Western Hospital (M.A.B.) on 31st October with a mild attack of diphtheria, and was convalescent when, on 13th December, she began to exhibit delusions and hallucinations, followed in a few days by gradually increasing lethargy and some pyrexia. Very slight ptosis for one day on 22nd December. Slight delirium at times. Tremor of upper limbs. Slight Kernig's sign. Irregular moderate pyrexia from 15th to 31st December. No lumbar puncture. At her worst about 20th December, and discharged apparently quite well on 17th January, 1923. The girl was very hysterical and excitable, and there was a history of " fits " resembling petit mal. Report on 9th March, 1923 : Still has " fits," six or eight a week, suffers from headaches, looks well. L. S., female, aged 10. Ward 3 (H). Onset 26th December, 14 days after being successfully vaccinated. Drowsiness, followed by vomiting and headache. Notified on 29th December and admitted to North-Western Hospital (M.A.B.) on same day. Lethargy was so marked for a day or two after admission as to amount almost to coma ; it then decreased and was quite gone by 2nd January, 1923. Incontinence of urine and faeces. Mental condition normal after lethargy disappeared. Temperature 101'6 deg. on admission, normal by 31st December. C.s. fluid free from meningococci and tubercle bacilli. Discharged apparently quite well on 12th January. Report on 9th March, 1923 : Quite well and attending school. MALARIA. Thirteen cases of malaria were notified in 1922, 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. Three patients were notified in 1922 as suffering from dysentery. In two of these the diagnosis was afterwards revised. The one actual case was fatal, and the patient had contracted the infection in the tropics some years before. There were three other deaths from the disease, not notified, one (bacillary) contracted in the tropics, and two in outlying asylums. PNEUMONIA. During the year there were 384 cases of acute primary pneumonia notified, and 189 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 1922 there were registered 155 deaths ascribed to broncho-pneumonia. 66 to lobar pneumonia, and 44 to pneumonia (type not stated). 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 1922, 177 cases of influenza and pneumonia were dealt with at the Council's expense, 2,465 nursing visits being paid. The following is an analysis of the cases notified and visited :— (7947) h 58 Age and Sex. Acute Primary Pneumonia. Influenzal Pneumonia. Males 224 105 Females 160 84 0-1 46 7 1-5 124 28 5-15 56 14 15-25 47 30 25-55 80 77 55 and over 31 33 Other statistical details will be found on pages 33 to 35. Of the 384 cases of acute primary pneumonia, 231 were treated in their own homes and 153 in hospitals. Of the hospital cases, 70 were treated in the St. Pancras Poor Law Hospitals and 83 in voluntary hospitals. The cases were already in hospital when visited after notification, with the exception of 12 which were sent to hospital after being visited. In regard to the 231 cases which were treated at home, 97 were under the care of visiting nurses (in 71 of the cases the nurse was sent in as a result of the sanitary inspector's visit). With regard to the 189 cases of acute influenzal pneumonia, 95 were nursed at home and 94 in hospitals. Of the hospital cases, 72 were treated in the St. Pancras Poor Law Hospitals and 22 in voluntary hospitals. The cases were already in hospital when visited, with the exception of 8 who were sent to hospital after being visited. In regard to the 95 cases which were treated at home, 25 were under the care of visiting nurses (in 19 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 59 out of the 231 acute primary pneumonia cases and 25 out of the 95 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 44 of the cases (32 acute primary, 12 acute influenzal). OTHER NOTIFIABLE INFECTIOUS DISEASES. Puerperal fever, ophthalmia neonatorum, and measles (as well as whooping cough) are dealt with on pages 30 to 32. No cases of typhus, cholera, plague or human anthrax, glanders or hydrophobia, were reported in St. Pancras in 1922. 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. INFLUENZA. Since the pandemic of 1918, which affected London very severely, there have been smaller recrudescences from time to time (see Annual Reports for 1918, 1919 and 1920). One of these recrudescences began in the last two weeks of 1921 and lasted through the first ten weeks of 59 1922, reaching its height in the second week of 1922. During these twelve weeks there were 129 deaths certified as being due to influenza. There was a corresponding increase in the number of deaths certified as being caused by diseases of the heart, bronchitis, pneumonia and pulmonary tuberculosis, which was due to the same infection. The number of influenza deaths in 1922 was 142. The following table brings up to date the tables given in the above-mentioned annual reports:— Deaths from Influenza, Heart Disease, Bronchitis, Pneumonia and Pulmonary Tuberculosis reported in each week in 1920, 1921 and 1922. Week No. 1920 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. Week No. 1921 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. Week No. 1922 Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. 1 — 7 6. — 7 1 — 11 5 5 4 1 19 17 18 15 2 2 — 8 8 4 7 2 — 13 6 5 1 2 28 21 25 14 10 3 2 3 6 4 3 3 1 10 7 8 6 3 19 17 25 21 14 4 4 7 5 5 4 4 — 7 4 1 7 4 20 11 21 12 7 5 — 8 2 8 3 5 — 7 8 5 7 5 13 7 14 7 7 6 2 10 9 9 5 6 — 14 9 4 2 6 4 11 10 3 6 7 1 8 12 5 5 7 — 11 6 3 7 7 6 10 10 6 9 8 2 8 8 11 5 8 4 7 7 6 5 8 5 11 5 9 5 9 1 11 6 11 2 9 13 8 11 15 5 9 3 13 8 2 4 10 — 12 7 5 4 10 6 10 17 8 6 10 3 7 5 5 4 11 3 8 10 11 7 11 2 9 11 4 3 11 — 10 8 5 8 12 1 8 7 5 10 12 1 11 8 o 6 12 — 10 6 2 2 13 2 10 9 6 10 13 1 7 7 4 1 13 2 9 6 6 2 14 4 8 4 3 5 14 3 12 9 3 9 14 3 12 9 8 9 15 6 8 5 7 5 15 2 6 6 2 8 15 — 6 10 7 7 16 5 5 6 11 4 16 i 8 6 3 5 16 — 10 9 7 4 17 2 11 6 6 10 17 2 7 7 — 4 17 1 7 5 3 4 18 — 7 4 7 3 18 1 10 5 1 1 18 — 8 2 3 3 19 3 11 6 3 6 19 1 6 7 5 3 19 — 10 3 5 4 20 — 10 6 4 6 20 1 3 3 5 5 20 1 4 3 4 7 21 1 6 2 — 5 21 — 7 1 1 4 21 1 9 3 5 5 22 — 3 6 — 4 22 10 1 — 5 22 — 7 6 3 3 23 2 5 1 — 6 23 3 1 1 5 23 — 4 5 2 3 24 — 4 — 1 3 24 — 6 — 2 10 24 1 5 2 5 3 25 4 1 2 1 25 1 4 1 5 7 25 — 2 3 2 6 26 — 7 2 4 6 26 — 1 2 1 3 26 — 9 2 1 5 27 5 2 2 1 27 — 5 — — 2 27 1 5 1 3 6 28 5 1 2 2 28 4 3 — 2 28 1 7 3 1 5 29 1 2 2 1 7 29 1 6 2 — 5 29 — 9 — 2 4 30 _ 6 1 1 4 30 8 2 1 5 30 — 2 4 3 2 31 — 5 1 3 31 5 1 4 4 31 — 4 1 2 7 32 — 8 1 2 3 32 5 3 2 6 32 — 4 2 2 2 33 — 3 3 4 33 4 — 4 3 33 — 7 — — 3 34 1 11 2 3 5 34 10 1 1 2 34 — 7 1 1 3 35 5 4 35 — 5 — 3 2 35 — 10 1 1 2 36 — 11 2 1 3 36 — 7 2 — 5 36 — 5 1 3 — 37 — 9 1 3 3 37 — 7 2 4 3 37 — 9 — 4 6 38 5 2 3 3 38 1 5 2 3 5 38 — 6 3 1 5 39 — 3 2 3 1 39 — 3 1 — 6 39 — 3 1 3 10 40 — 6 3 3 40 1 4 2 4 1 40 — 6 1 5 5 41 — 7 2 1 9 41 2 7 2 1 5 41 — 9 1 8 3 42 — 12 1 2 4 42 — 6 — 1 5 42 1 4 3 7 6 43 6 2 1 3 43 — 7 1 4 3 43 1 5 7 3 2 44 10 3 1 4 44 — 7 3 2 o 44 — 10 4 6 5 45 — 10 7 3 6 45 — 8 5 5 6 45 2 5 1 8 5 46 — 13 6 4 46 1 6 15 8 8 46 1 10 4 5 4 47 1 11 5 2 5 47 — 8 14 6 5 47 — 9 7 4 4 48 13 6 4 7 48 1 14 16 5 8 48 2 5 6 3 6 49 — 6 8 3 6 49 — 17 12 7 7 49 2 11 8 8 7 50 13 9 3 2 50 1 16 13 3 7 50 — 10 10 11 7 51 1 10 5 6 9 51 3 13 10 2 9 51 — 9 8 4 2 52 1 18 6 9 5 52 6 16 9 4 5 52 2 13 7 5 3 s3 — 14 9 9 3 — — — — — — — — — — (7947) h 2 60 SYPHILIS. In the following table are given the age and sex distribution of deaths certified daring 1922 as due to (a) declared syphilis, (6) locomotor ataxy and general paralysis of the insane, which are believed by most authorities 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- 05 65—75 75—65 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 2 — — — — — — 1 — — — 3 6 — — 1 — 1 1 — — — — 9 12 Locomotor ataxy — — — — — — 4 1 1 — — 6 — — — — — — — — — — — 6 General paralysis of the insane — — — — 2 7 7 2 18 1 1 1 2 5 23 Aortic aneurysm — — — — — — 3 1 1 — — 5 — — — — — — — — 2 — 2 7 CANCER. 302 deaths were registered during 1922 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, sarcoma, &c. This is equal to a death-rate of 1.42 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 1922). Males 157 1.57 Females 145 1.29 Both Sexes 302 1.42 The deaths registered as due to cancer are set out in the following table for the past 15 years:— Sex. 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Average for 14 years. 1922 Males — — — — — 127 127 120 125 135 125 114 150 140 — 157 Females — — — — — 158 140 138 142 146 144 131 149 150 — 145 Both Sexes 288 232 266 274 247 285 267 258 267 281 269 245 299 290 269 302 61 Section IV.—SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.—Altogether 70,817 inspections were made in 1922 by the staff of Inspectors and Visitors. These consisted of 36,342 initial inspections and 34,475 re-inspections. Of these inspections, 40,772 were made by the District Sanitary Inspectors, 6,909 by the Sanitary Inspectors for Food and Food places, 3,225 by the Sanitary Inspector for Factories and Workshops, and 19,911 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 20), and by the staff of the Tuberculosis Dispensaries (see page 45); nor do they include the work of the disinfecting staff (see page 36). Notices served and result of service.—4,206 intimation notices (comprising 8,323 items) were served by the Sanitary Inspectors during 1922. These were made up as follows— District Inspectors. Factory and Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 5,546 23 4 — 5,573 In respect of the Tenement House By-laws 643 — — — 643 In respect of Breaches of Statutes in Factories, Workshops and Workplaces 2 484 — — 486 In respect of other Breaches of Statutes and By-laws 1,607 5 9 ~ 1,621 Totals 7,798 512 13 — 8,323 These intimations are classified in tables 11, 12, 13 and 14, on pages 100 to 102. 1,486 Statutory notices (comprising 2,293 items) were served during 1922 and the early part of 1923, 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:— 62 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. 29, Drummond Street Walls and ceiling dirty, waste pipe of sink in washhouse and washhouse paving defective. Offensive accumulation in basement and front vaults Jan. 3rd Order to abate nuisance within 21 days. Costs £1 5s. 29, „ „ Yard paving defective „ 3rd Fined £1. 27, „ Walls and ceilings dirty ; offensive accumulation of refuse in basement and rainwater pipe defective. „ 3rd Order to abate nuisance within 14 days. Costs £1 5s. 13, Clarendon Place Basement damp „ 27th Fined £1 Is. Work carried out. 16Clarendon Square Insufficient watercloset accommodation „ 27th Fined £3. Costs £1 Is. 17, „ „ Dilapidated condition Feb. 22nd Costs £2 2s. Order to abate within 28 days. 17, „ Dustbin without suitable cover „ 22nd Fined 16s. 17, „ „ Yard paving defective „ 22nd Fined 10s. 17, „ „ Watercloset and its accessories not in proper condition „ 22nd Fined 10s. 33, Drummond Street Wal Is and ceiling dirty, waste pipe of sink and joint of watercloset defective and an offensive accumulation in basement front area and cellars „ 22nd Adjournal sine die—the defendant endeavouring to obtain possession. 27, „ „ Failing to comply with nuisance order „ 22nd Fined 15s. 29, Failing to comply with nuisance order „ 22nd Fined £1 10s. 50, Torriano Avenue Roof defective March 10th Costs £1 1 Is. 6d. Work carried out. 1, Rothwell Street Roof defective „ 10th Costs £1 lis- 6d. Work carried out. 9, Carlton Street Part of premises dirty and roof defective ... „ 10th Adjourned sine die. 1a, Raglan Place Part of premises dirty ; drain, w.c. basin, ventilating pipe and flooring defective. Premises infested with rats „ 10th Costs £1 3s. Order to abate nuissances within 6 weeks. 1a, „ Yard paving defective „ 10th Adjourned sine die. 33, Stibbington Street Failing to comply with nuisance order ,, 15th Fined £3 8s. 43, ,, ,, „ 15th Fined £3 8s. 41, „ „ ,, ,, ,, 15th Fined £3 8s. 39, ,, ,, Walls and ceilings dirty „ 15th Order to abate within 21 days. 39, ,, ,, Failing to provide portable metal dustbin „ 15th Fined 2s. 6d. 45, ,, ,, Roof defective ; w.c. basin foul; rainwater pipe, windows and grates defective „ 15th Order to abate within 21 days. 37, ,, ,, Walls and ceilings dirty, basement floor damp and defective ; space below floor insufficiently ventilated ,, 15th Order to abate within 21 days. 37, ,, ,, Absence of portable metal dustbin ,, 15th Fined 2s. 6d. 35, ,, ,, Roof, stove and windows defective „ 15th Order to abate within 21 days. 35, ,, ,, Walls and ceilings dirty „ 15th Fined 12s. 6d. 3, Fitzroy Street Walls and ceilings dirty „ 17th Withdrawn—work carried out. 7, Phoenix Place Chimney (not being chimney of a private dwelling house) sending forth black smoke „ 23rd £5 5s. costs. Prohibition order made. 18, Wellesley Road Failing to comply with muisance order „ 24th Fined 10s. Costs £3 3s. 8, Priory Place Dustbin and roof defective April 21st ^ Costs £2 2s. Work carried out. 8, „ ,, Yard paving defective „ 21st 3, Kelly Street Walls and ceilings dirty ; roof guttering and rainwater pipe defective ; w.c. basin foul „ 21st Order to abate nuisance within 28 days. 3, „ ,, Yard paving defective „ 21st Adjourned sine die. 3, „ „ Absence of a portable metal dustbin ,, 21st »» »» 3, Queen Street... Walls and ceilings dirty ; roof, rainwater pipe and floor boards defective May 23rd Costs £1 6s. Order to abate nuisance within 28 days. 100, Bayham Street Walls and ceilings dirty ; roof, dustbin and grate defective ; w.c. basin foul „ 23rd Costs £1 6s. Order to abate nuisance within 28 days. 47, Queen Street Walls and ceilings dirty ; roof and plaster of walls defective and floor boards defective „ 23rd Costs £3 3s. Order to abate nuisance within 28 days. 47, „ „ Yard paving defective „ 23rd Withdrawn—defendant agreeing to carry out work. 5, Piatt Street Part of premises dirty; dustbin defective and an offensive accumulation in area June 13th Costs 12s. 6d. Work carricd out. 43, Islip Street Soil pipe defective and improperly ventilated and rainwater pipe defective „ 16th Costs £1 5s. Order to abate nuisance within 28 days. 37, Stibbington Street Failing to comply with nuisance order „ 28th Fined £22 19s. 35, „ „ ,, ,, 45, ,, ,, ,, ,, 33, „ „ ,, ,, 41, „ ,, ,, ,, 43, ,, ,, ,, ,, 39, ,, ,, ,, ,, 63 Summonses—contd. Under the Public Health (London) Act. 1891 (except in respect of Food)—contd. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 3, Queen Street Failing to comply with nuisance order Aug. 22nd Fined £5. 100, Bayham Street »» ,, „ 22nd Fined £5. 18, Little Randolph Street Walls and ceilings dirty ; rooms damp, roof, guttering and rainwater pipe defective ; plaster of walls and ceilings and floor boards defective Oct. 30th Costs £2 2s. Order to abate nuisance within 6 weeks. 13, Lady Somerset Road Roof defective ; ceilings down, flooring defective and rotting away Nov. 2nd Costs £2 2s. Order for roof to be made sound within 7 days and remainder of work within 21 days. 41, Stibbington Street Failing to comply with nuisance order „ 7th Fined £40 19s. 37, ,, ,, ,, ,, 43, ,, ,, ,, ,, 33, ,, ,, ,, ,, 39, ,, ,, ,, ,, 45, ,, ,, ,, ,, 35, „ ,, ,, ,, 11, Sidmouth Mews Failing to provide portable metal dustbin Dec. 14th Costs £1 Is. Notice complied with. 8, ... „ 14th Costs £1 Is. Notice complied with. 12, „ 14th Costs £1 Is. Notice complied with. 65, Cromer Street Manhole cover defective ; walls and ceilings dirty „ 21st Costs £1 Is. Notice complied with. 73, Walls and ceilings dirty, dustbin defective „ 21st Costs £1 Is. Notice complied with. 13, Lady Somerset Road Failing to comply with nuisance order 1923 Jan. 8th Fined £3. Costs £2 2s. 29, Lyme Street Drain stopped „ 9th Order to carry out work within 7 days Under the Tendon County Council (General Powers) Act, 1904. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 17, Clarendon Square Rooms verminous Feb. 22nd Fined 10s. 1a, Raglan Place Room verminous Mar. 10th Adjourned sine die. 39, Stibbington Street Rooms verminous „ 15th Fined £2 10s. 45, ,, ,, ,, ,, „ 15th Fined £1 10s. 37, ,, ,, ,, ,, ,. 15th Fined £1 5s. 35, ,, ,, ,, ,, „ 15th Fined 10s. 6d. 47, Queen Street Room verminous May 25th Withdrawn—defendant agreeing to earrv out, the work. 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. 73 visits were made to these premises in 1922. Registered Tenement Houses. At the end of 1922 there were 2,365 such houses on the Register. Statistics as to the inspection of these and other houses will be found in tables 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. 64 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 775 observations of smoke shafts were made. There was one prosecution. 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 275 3,309 Voluntary drainage work 849 3,033 Drains of new buildings 115 580 1,239 6,922 The tests which have been applied to drains during 1922 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— Defects found 34 43 1 2 80 No result 330 96 16 — 5 — 447 Total 364 139 17 — 7 — 527 By Water- Not found water- tight — — — — 21 2 23 Found water-tight — — — — 329 71 400 Total — — — — 350 73 423 There were also 3 smoke tests. Drainage register.—The following is an analysis of the Drainage Register during 1922 :— Plans deposited—Old Buildings under Notice 81 „ „ Old Buildings, Voluntary 143 „ „ New Buildings and Additions 19 243 Applications without Plans 173 Total number of Applications and Plans 416 65 Water Service. The following notices have been received duiing the year from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition — 2.—Empty — 3.—Waste 2 4.—Non-payment of Rates 8 5.—No statement (withdrawals) — 6.—By request 2 7.—Broken Supply Pipe 5 17 Canal Boats Acts. During the year Inspector Auger examined 4 canal boats, which were registered for the occupation of 7 adults and 7 children and were occupied by 4 adults and 11 children. One notice was served, viz., for non-production of registration certificate. The certificate was produced at the next inspection. 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. One application for a certificate under Section 11 of the Inland Revenue Act, 1903, was received during 1922, in respect of two buildings containing 96 rooms, some of which were separately occupied and others occupied as dwellings of more than one room. The certificate was not granted, the application being held over pending the consideration of alterations. The Rag Flock Act, 1911. No samples of rag flock were taken during 1922. Public Mortuaries and Coroner's Court. Number of bodies deposited in the General Mortuary in 1922 211 „ „ „ Infectious Mortuary in 1922 3 Total 214 Inquests held during 1922— In the Coroner's Court—General Cases from St. Pancras 340 „ „ Poor Law Cases from St. Pancras 27 „ „ General Cases from other Boroughs 9 Total 376 (7947) i 66 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. (4) (1) (2) (3) Factories (including factory laundries and bakehouses) 1,002 166 — Workshops (including workshop laundries and bakehouses) 1,522 230 — Workplaces (other than Outworkers' premises included in Part 3 of this Report ) 704 90 — Total 3,228 486 — 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*— Want of cleanliness 106 106 Nil Nil Want of ventilation — — Overcrowding —. — Want of drainage of floors — — Other nuisances 103 103 Sanitary accommodation—- Insufficient 8 8 Unsuitable or defective 76 76 Not separate for sexes 18 18 Offences under the Factory and Workshop Act— Illegal occupation of underground — — houses (s. 101) Breach of special sanitary requirements 112 112 for bakehouses (ss. 97 to 100) Other offences (excluding offences 63 63 lating to outwork which are included in Part 3 of this Report) Total 486 486 67 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 :—18 in respect of the making, &c., of wearing apparel, comprising the names of 61 outworkers (contractors) and 71 outworkers (workmen). 4.—Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. (1) Number. (2) .Bakehouses 129 Restaurant kitchens 400 Laundries 32 Domestic workshops — Other workshops where women are employed 427 Other workshops 815 Total number of workshops on Register 1,803 5.-—Other Matters. Class. (1) Number. (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 30 Reports (of action taken) sent to H.M. Inspector 30 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 10 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 87 The number of factories, workshops and workplaces added to and removed from the register during 1922 was as follows Added to Register. Removal from Register. On Register at end of 1922. Bakehouses— Workshop — 5 129 Factory — — 39 Laundries- Workshop 1 — 32 Factory — — 12 Restaurant kitchens 2 12 400 Other workshops where women are employed 34 19 427 Other workshops 44 22 815 Other factories 24 16 705 (7947) I 2 68 The number of inspections that were made during 1922 were as follows :— Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 344 323 — — 344 323 Restaurant kitchens 137 375 7 — 144 375 Laundries 2 1 2 1 Domestic workshops — — — — — — Other workshops 275 799 — — 275 799 Other workplaces 37 148 — — 37 148 Other factories 124 656 — — 124 656 Total 919 2,302 7 — 926 2,302 Bakehouses and restaurant kitchens are also referred to in Section V. (page 76). 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 1922. They are classified in the following Tables •— 69 Medical Examination of Elementary School Children in St. Pancras, 1922. Complaint. Boys. Girls. Entrants Age 8. Age 12. Leavers (nearly 14). Entrants . Age 8. Age 12. Leavers (nearly 14). Number examined 1,434 1,392 1,679 1,240 1,196 1,463 1,691 1,188 Cases. † Cases. † Cases, † Cases. † Cases, † Cases, † Cases. † Cases, † Malnutrition 7 7 5 5 6 6 8 7 5 5 5 12 11 6 6 Skin disease 26 24 31 28 24 10 20 13 25 17 24 16 16 12 23 16 Defective teeth — 270 — 238 — 174 — 165 — 274 — 280 193 — 161 Enlarged tonsils (only) 124 23 101 19 103 20 81 10 120 24 101 30 110 36 84 16 Adenoids (only) 59 24 37 27 21 12 5 1 42 18 24 15 13 11 5 1 Tonsils and adenoids (together) Other nose and throat defects 71 51 35 20 23 29 10 14 21 43 11 19 9 21 6 12 55 44 32 27 32 37 18 18 15 45 9 22 5 39 2 32 Enlarged glands (cervical and submaxillary) Eye disease 97 38 4 23 76 36 3 20 67 37 3 24 77 19 2 8 58 37 4 24 57 53 2 26 85 30 2 14 51 14 3 7 Defective vision Not tested. — 180 — 185 — 103 Not tested. — 216 — 245 — 147 Otorrhcea 15 8 18 12 30 25 20 18 14 7 29 24 29 23 13 12 Other ear disease 17 2 14 1 12 2 14 6 14 4 12 7 16 8 15 6 Defective hearing 15 5 22 7 33 10 15 7 12 4 16 4 18 8 17 8 Speech defects 8 1 6 — 13 1 4 — 11 — 6 — 8 — 5 — Heart defects 27 3 27 4 44 3 25 1 19 5 26 3 53 8 29 5 Anaemia 23 15 26 16 18 11 21 14 19 8 27 16 25 10 31 18 Lung defects (non-tubercular) 53 23 30 12 16 3 19 5 49 15 24 11 27 10 17 6 Defects of nervous system 11 2 10 5 27 3 1 — 18 1 7 2 27 6 10 2 Phthisis 3 — 3 1 4 3 5 3 3 1 1 1 5 2 1 — Other tubercular disease 5 2 1 1 — — 1 — 2 1 1 1 4 4 1 1 Rickets 29 3 15 — 21 — 10 — 13 3 7 — 4 — 6 — Spinal deformities 2 — 5 3 21 3 27 3 3 0 6 2 19 7 33 12 Other deformities 6 2 3 1 6 — 6 2 6 2 2 1 8 — 9 5 Other defects or disease 45 30 32 20 37 26 22 12 39 29 37 21 60 31 49 26 Number of children noted for treatment 471 507 464 335 429 573 5521 410 Note.—Defects, however slight, are included under " cases." Those severe enough to require treatment are shown under † 70 Borough of St. Pancras, 1922. Degree of Cleanliness, Nutrition, Condition of Teeth, and Acuity of Vision. Age Group. Number examined. Clothing and Roots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits only. Pcdiculi. Clean. Dirty. Pcdiculi. 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 1,434 883 537 14 358 1,047 29 — 1,386 48 1,383 51 — 614 605 215 Not te sted. Girls 1,196 784 399 13 361 801 34 — 1,048 130 18 1,123 67 3 516 458 222 ,, „ Age 8— Boys 1,392 907 441 44 188 1,159 45 — 1,336 54 2 1,320 72 — 537 679 176 690 373 302 Girls 1,463 1,005 444 14 251 1,162 50 — 1,153 282 28 1,392 69 2 604 659 200 594 506 340 Age 12— Boys 1,679 1,198 450 31 309 1,332 38 — 1,594 83 2 1,588 91 — 766 813 100 942 399 338 Girls 1,691 1,130 551 10 322 1,311 58 — 1,400 273 18 1,591 96 4 849 769 73 883 419 389 Leavers— Boys 1,240 889 330 21 253 958 29 — 1,186 55 — 1,189 50 1 534 661 45 780 231 229 Girls 1,188 863 316 9 350 801 37 — 1,027 152 9 1,141 45 2 568 580 40 670 248 270 Total 11,283 7,659 3,468 156 2,392 8,571 320 — 10,129 1,077 77 10,730 541 12 4,988 5,224 1,071 4,559 2,176 1,868 % St. Pancras 67.9 30.7 1.4 21.2 76.0 2.8 89.8 9.5 0.7 95.1 4.8 0.1 44.2 46.3 9.5 51.3 26.2 22.5 % London 60.1 38.0 1.9 21.8 72.7 5.5 87.8 11.5 0.7 93.8 6.2 0.2 60.7 31.5 7.8 51.9 27.8 20.3 71 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, 1923. — Weekly average Number of children fed. Number of meals provided. Cod Liver Oil and Malt. Dinners. Breakfasts. Milk. Ordinary Schools. (a) Necessitous 308 26,211 — 31,090 1,230 (b) Non-necessitous 223 2,189 — 40,589 262 Special Schools. (a) Necessitous 101 17,167 — 1,852 — (b) Non-necessitous 345 56,767 — 12,628 — Totals 977 102,334 — 86,159 1,492 The schools were closed for normal holidays during the following periods:— Easier—14th to 24th April, 1922, inclusive. Whitsuntide—5th and 6th June, 1922. Summer—27th July to 28th August, 1922, inclusive. Autumn—30th and 31st October, 1922. Christmas—22nd December, 1922, to 8th January, 1923, inclusive. 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. It. Roche, the Secretary-Superintendent:— St. Pancras School Treatment Centres. For the third year in succession the Medical Officer of Health has asked me to give some details of the work done in these centres for incorporation in his annual report. I gladly accede to his request. As is probably well known, the medical inspection of children attending the elementary and secondary schools is in the hands of the medical service of the London County Council. 72 The children who are found to have defects are referred for treatment to their own private doctors or arrangements are made for their treatment by the Council. The nature of these arrangements vary a good deal, but in this borough they are referred to the school treatment centres, of which there are now three. Two of them, at 26, Prince of Wales Road and 1 Churchway, respectively, are managed by the St. Pancras Public Medical Service, and the third, the Highgate New Town Clinic in Chester Road, by a separate committee. I happen to be secretary to both these bodies, and can therefore briefly and comprehensively refer to the work done at all three. The year's work under review is from April 1st, 1922, to March 31st, 1923. To deal first with the work of the old-established centres in rnnce of Wales Koad and Churchway (Lancing Street):— Dental Cases. Eye Cases. Ear Cases. Minor Ailments. Prince of Wales Koad 1,792 1,139 588 1,244 Lancing Street 1,425 — 359 1,013 These numbers represent cases seen, and not the number of attendances of these cases. For instance, whilst at Prince of Wales Road, 1,244 children were treated for minor ailments, these children actually attended nearly 25,000 times, and 1,013 cases seen at Lancing Street represent 22,281 attendances. In addition to this, at Prince of Wales Road, 3,141 children had their heads shampooed and cleansed when in a verminous condition. This shampoo department has now completed two years of work, and two women, under the supervision of a nurse, are fully employed. I think this work is valuable and prevents in many cases the stigma attached to an attendance at a cleansing station. I wish again to express my appreciation of the good work done by the doctors and dental surgeons, the nursing sisters and nurses, and the nurses of the Central St. Pancras Nursing Association who are responsible for the minor ailment nursing. To turn now to the Highgate New Town Clinic. Some years ago, Sir W. H. Hamer approached the St. Pancras Public Medical Service with a view to the provision of a new centre in the northern portion of the borough. For many reasons this did not seem a feasible proposition, as there were many difficulties in the way. It so happened that Mrs. Kohnstamm, the wife of Mr. R. Kohnstamm, of Hampstead, being greatly interested in the work at Lancing Street, was able to interest Mr. Kohnstamm in school treatment work. These two generous and large-minded people, having lost two sons in the war, conceived the idea of perpetuating their memory by providing a school treatment centre in St. Pancras. After somewhat prolonged negotiations with the County Council a scheme was worked out, and a suitable site was procured from the Borough Council in Chester Road. In May of last year Mr. F. R. Anderton, the chairman of the County Council, laid the foundation stone, and in January of this year the centre commenced to work. This new building and venture will be a lasting tribute to the generosity of Mr. and Mrs. Kohnstamm, the brave sons they wish to commemorate, the architect, Mr. Oeorge Vicary, who took endless pains to embody and work out the ideas of those who had a vision of what such a place should be, and it will be of lasting benefit to the children of St. Pancras. It is too soon to give exact details of its work, but I can briefly indicate what work it is doing. The building is in two floors; on the ground floor it functions as a general school treatment centre, and eye cases, throat cases, minor ailment cases, and dental cases are dealt with, the provision and equipment for such work being of the most modern character. 73 The special feature of the institution is, however, to be seen on the upper floor, where there is a modern operating theatre and two large wards containing 20 beds, with the necessary adjuncts of ward kitchen and bathing and disinfecting arrangements. By special arrangements with the County Council, all the children in St. Pancras and Islington requiring operation, under their schemes, for throat, nose and other similar conditions, are received here and remain in the wards for 48 hours, or longer if their condition requires it. This work is now in full operation and it is expected that in the year something under 2,000 cases will be treated. I need hardly say that this scheme is far in advance of any that has been hitherto attempted and will, I hope, prove to be of great value. I hope, perhaps, later, if I am given the opportunity, to detail the work done at this new centre at greater length, but I trust I have indicated that the borough has now another notable institution added to those it already possesses. A. R. Roche, May, 1923. Secretary to the St. Pancras Public Medical Service and the Hiyliyate New Town Clinic. 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 59-68). Dairies, Cowsheds and Milkshops. Cowsheds.—At the end of 1922 there were two licensed cowsheds in the Borough. They are registered for 43 cows, but were occupied by 11. Milkshops and Dairies.—50 applications for registration under the Dairies, Cowsheds and Milkshops Orders, in respect of milkshops, were considered during 1922, of which 40 were acceded to and 10 refused. 31 applications in respect of itinerant vendors were also considered, of which 27 were acceded to and 4 refused. 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 1921 203 Deduct No. of purveyors removed from register during 1922 40 sidd No. of purveyors added to register by resolution of Council during 1922 40 No. of purveyors of milk at retail milkshops on register at end of 1922 203 At the end of 1922 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 32 itinerant vendors without retail milkshops. (7947) K 74 Legal proceedings were taken in the following cases against vendors carrying on the trade of purveyors of milk without being registered:— Dairies, Cowsheds, and Milkshops Order, 1885-6. Address where offence committed. Offence. Date of Hearing. Penalty. Costs. £ s. d. 3, Heathcote Mews Carrying on trade or business of a purveyor of milk without being registered March 9 3 0 0 — In street Carrying on trade or business of a purveyor of milk without being registered in the district of the local authority June 9 2 0 0 In default 21 days. In street Carrying on trade or business of a purveyor of milk without being registered Dec. 21 1 0 0 — In street Ditto Ditto 2 0 0 — 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, 1922. 1. Milk, and Cream not sold as Preserved Creairi. — (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 379 1 Cream 10 5 Nature of preservative in each case in column (6) and action taken under Regulations in regard to it:— C. 157. Milk. 0.02 per cent. of boron trioxide, equal to 3.1 grains per pint of crystallised boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £2, costs £1. 21st July. No proceedings taken under the Milk and Cream Regulations. A. 166. Cream. 0.119 per cent. of boron trioxide, equal to 0.210 per cent. of crystallised boric acid. A. 167. Cream. 0.168 per cent. of boron trioxide, equal to 0.297 per cent. of crystallised boric acid. A. 168. Cream. 0.088 per cent. of boron trioxide, equal to 0.156 per cent. of crystallised boric acid. A. 169. Cream. 0.035 per cent. of boron trioxide, equal to 0.062 per cent. of crystallised boric acid. A. 170. Cream 0.203 per cent. of boron trioxide, equal to 0.359 per cent. of crystallised boric acid. In all of these cases an explanation was asked of and furnished (by letter) by the vendors, and a warning letter addressed to the vendors by order of the Public Health Committee. No legal proceedings were instituted. 75 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 7 (ii) Statements incorrect — Total 7 (iii) Percentage of preservative found in each sample: Boric acid, 0.285, 0.298, 0.360, 0.161, 0.211, 0.260, and 0.384 Percentage stated on Statutory label: 0.4. (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 7 (ii) Below 35 per cent. — Total 7 (e) 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. (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 45 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 1922 there were 8 licensed slaughter-houses (private) in the Borough. Structurally they do not conform to a high state of excellence. These are kept under periodical inspection by the Food Inspectors, who made 133 inspections in this connection in 1922. Fried Fish and Fish Curing Premises. In 1922 there were 78 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 18 fish curers' premises, including these 4. 386 visits were made by the Food Inspectors to these premises during the year. Ice-Cream Premises. In 1922, 268 ice-cream premises were known to the department; 412 visits were paid to them by the Food Inspectors during the year. (7947) K 2 76 Bakehouses and Restaurant Kitchens. At the end of 1922 there were 168 bakehouses on the register, including 39 factory bakehouses. Forty-four of these bakehouses were not in use. 124 of the 168 were underground bakehouses, of which 30 were factory bakehouses, and 37 not in use. At the end ol the year 400 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 66-68. (c)—SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 682 of these proved to be genuine and 68, or 9.1 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 4 4 — Brawn 1 1 — Butter 120 120 — Cocoa 32 31 1 Coffee 26 26 — Cream 10 5 5 Preserved cream 7 7 — Custard powder 2 2 — Dripping 3 3 — Fish paste 1 — 1 Flour (Self Raising) 25 25 — Ground Ginger 4 4 — Jam 1 1 — Lard 21 21 — Maize Meal 1 1 — Milk 377 346 31 Milk (Condensed) 2 1 1 Mustard 19 19 — Qatmeal 1 1 — Pepper 15 15 — Prescriptions (L.I.P.) 56 38 18 Sausages 6 1 5 Vinegar 3 3 — Vinegar (Malt) 7 6 1 Whiskey 6 1 5 Total 750 682 68 Note.—The 750 include 43 informal samples of prescriptions (L.I.P.), 2 of milk and 1 of butter. 77 Medical Prescriptions.—At the request of the Loudon Insurance Committee an investigation was made into the accuracy of dispensing insurance prescriptions. Forty-three prescriptions signed by a medical practitioner on the usual Insurance Act forms were presented to chemists and analysed as informal samples. Of these 13 were wrongly dispensed as follows:— Date. Prescription. Defect. September 22nd M. Pot. Bromid. Deficient in Potassium Bromide, 18.3 per cent. Ditto Ditto Ditto 48.8 per cent. October 17th Ditto Ditto 83.6 per cent. Ditto Ung. Flav. Deficient in Hyd. Ox. Flav., 33 per cent. Ditto M. Quinin. Deficient in Quin. Sulph., 22 per cent. Ditto Ditto Ditto 26 per cent. Ditto Pot. Bromid. Deficient in Potassium Bromide, 35.4 per cent. October 18th M. Pot. Bromid. Ditto 14.7 per cent. October 24th M. Quinin. Deficient in Quin. Sulph., 20.5 per cent. Ditto Ditto Ditto 82 per cent. November 1st Pot. Bromid. Deficient in Potassium Bromide, 10.3 per cent. Ditto Ditto Ditto 57 per cent. Ditto Ditto Ditto 22 per cent. Further prescriptions were presented to the chemists who had dispensed the abovementioned faulty medicines and dealt with formally under the Sale of Food and Drugs Acts. Of these 5 were wrongly dispensed, as follows:— Date. Prescription. Defect. November 21st M. Quinin. Deficient in Quinine Sulphate, 72 per cent. Ditto M. Pot. Bromid. Deficient in Potassium Bromide, 14 per cent. Ditto Ditto Excess of Potassium Bromide, 44 per cent. Ditto M. Quinin. Deficient in Quinine Sulphate, 47 per cent. Ditto M. Pot. Bromid. Deficient in Potassium Bromide, 12.9 per cent. The results of proceedings in the latter five cases will be found in the table on the next page. 78 Prosecutions were undertaken in respect of 20 of the 68 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. ot Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. £ s. d. £ s. d. A. 32 Whiskey Under proof, 37.38 degrees May 30th 2 0 0 — C. 77 Milk Added water, 6 per cent. „ 10th 20 0 0 — A. 88 „ „ „ 6.8 „ ,, 17th 4 0 0 0 10 6 C. 117 „ „ „ 14.7 „ June 9th 15 0 0 3 3 0 c. 153 „ Deficient in milk fat, 36 per cent. July 14th 50 0 0 2 2 0 C. 162 „ Added water, 5.1 per cent. „ 14th 3 0 0 1 1 0 C. 157 „ Admixture of boric acid, 3.1 grains per pint „ 21st 2 0 0 1 0 0 C. 186 „ Deficient in milk fat, 6.6 per cent. „ 21st — 2 2 0 C. 191 „ „ „ 33.0 „ Aug. 22nd 2 0 0 — C. 192 „ „ „ 10.3 „ „ 22nd 2 0 0 — A. 186 „ Added water, 6.5 per cent. „ 31st — 2 2 0 a. 220 Malt vinegar Vinegar other than malt vinegar, 100 percent. Sept. 7th 2 0 0 0 12 6 C. 140 Milk Deficient in milk fat, 10 per cent. „ 20th — 4 4 0 C. 284 „ „ „ 59.6 „ Dec. 1st 1923 Withdrawn — †C. 303 „ „ „ 30.6 „ Jan. 2nd 10 0 0 — C. 310 Mist. Pot. Bromid. (L.I.P.) Deficient in Potassium Bromide, 12.9 per cent. „ 9th Dismissed under the Probation of Offenders Act. 1 11 6 A. 296 Mist. Quin,(L.I.P.) „ in Quinine Sulphate, 47 per cent. „ 9th „ „ 1 11 6 A. 288 Mist. Quin.(L.I.P.) „ in Quinine Sulphate, 72 percent. „ 10th „ „ 4 4 0 A. 293 Mist. Pot. Bromid. (L.I.P.) Excess of Potassium Bromide, 44 per cent. „ 11th 5 0 0 0 10 6 A. 291 Mist. Pot. Bromid. Deficient in Potassium Bromide, 14 percent. ,, 31st. Dismissed under the Probation of Offenders Act. 4 4 0 Milk and Dairies (Amendment) Act, 1922. Address where offence committed. Offence. Date of hearing. Penalty. Costs. * In street Selling milk to which had been added skimmed or separated milk 1922 Dec. 1 Dismissed under the Probation of Offenders Act. £1 † Ditto Ditto 1923 Jan. 2 Withdrawn—fined for adulteration. — * These proceedings both referred to the same sample of milk, † These proceedings both referred to the same sample of milk. A summons was also taken under the Sale of Food and Drugs Act, 1899, for selling milk in the street without the name and address of seller being conspicuously inscribed on the vehicle. Heard on December 21st. Fined £1. Wholesale Dealers in Margarine. One certificate of registration under the provisions of the Sale of Food and Drugs Acts was issued during the year. 79 Section VI.—SANITARY ADMINISTRATION. THE STAFF. The names of the staff of the Public Health Department at the end of 1922 will be found on pages 5 and 6. Dr. N. M. Donnelly was appointed as Tuberculosis Officer on 22nd February. Dr. Stella Churchill was appointed as Assistant Medical Officer of Health for Maternity and Child Welfare and for general purposes on 2nd August. Mr. S. Barker, boy clerk, was appointed as junior clerk on 28th June. The late Mr. F. G. Crick, who was acting as Milk Enquiry Officer (in connection with the grants of milk to mothers and young children) was unable to attend to his duties from 13th October owing to ill health, and Mr. H. G. West was appointed to act in his place from 14th December. I regret to have to record that Mr. Crick died on 6th May, 1923. I regret to have to record that Mr. E. Rogers, temporary clerk, died on 9th July, and that Mr. C. Batter, temporary clerk, died on 11th December. Mr. J. H. Richards was transferred to the department as temporary clerk on 23rd October. In consequence of the prevalence of measles, Miss G. B. Steggles was re-engaged as temporary health visitor on 16th March, and her place was taken on 3rd April by Miss E. M. Robinson, who left on 20th May, owing to the cessation of the disease. Miss S. A. Long was appointed on 22nd March as nurse at the Tuberculosis Dispensary, 39, Oakley Square, in place of Mrs. M. E. Baxter, resigned. The appointment of Miss E. C. Ballard as Nurse at the Tuberculosis Dispensary at University College Hospital was approved by the Council on 24th May. Miss E. Boyd-Johnston, Superintendent of the Grafton Road Centre, resigned on account of her approaching marriage, and left on 7th April. Miss E. L. May, Assistant Health Visitor at St. Pancras School for Mothers, Ampthill Square, was promoted to her position on 26th April. The vacancy thus caused at Ampthill Square was filled by transferring Mrs. S. C. Chapman from the Argyle Square Centre, her place at Argyle Square being filled by Miss E. M. Robinson, who was appointed as Assistant Health Visitor on 20th September. Mrs. S. Kahan, Assistant Health Visitor at the Camden Town Centre, resigned on going abroad, and left on 1st December. CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.I, for the bacteriological examination at the expense of the Council of material from St. Pancras cases sent to them through medical practitioners in regard to diphtheria, tuberculosis, and typhoid fever. The work done in 1922 was as follows:— Total. Positive. Negative. Examination of— Swabs for B. diphtheriae 510 124 386 Sputum for B. tuberculosis 245 48 197 Blood for Widal reaction (typhoid, &c.) 5 2 3 80 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 76. 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 If 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 1922 in St. Pancras is indicated by the following figures:— No. of cases No. of home nursed. visits paid. Central St. Pancras District Nursing Association 287 2,856 Metropolitan Nursing Association (St. Pancras cases) 133 922 Hampstead District Nursing Association (St. Pancras cases) 59 748 North London Nursing Association (St. Pancras cases) 92 500 The Council took over from the Mayoress' Nursing Fund, as from 1st April, the responsibility of paying the Nursing Associations for the home nursing of cases of measles, whooping cough and ophthalmia neonatorum. Payment is made at the rate of Is. 6d. a visit. Reference is made on page 17 to the work of the voluntary hospitals. Section VIII.—HOUSING. The housing situation constitutes perhaps the gravest public health problem in St. Pancras and forms part of the larger problem of London housing. The 1921 census returns, to which reference is made at page 9 (see also tables on pages 104-113) show that there is a very grave deficiency of houses in the borough, and there is, therefore, most urgent need for the building of new houses. The amount of land available for this purpose in the borough is limited, and St. Pancras must necessarily depend to a great extent on the general situation in Greater London 81 in regard to the building of new houses. Local building is rather a contribution to London housing than to the St. Pancras problem, because as the local accommodation increased, greater numbers of population would be attracted into the borough. The housing stringency renders the work of the department much more difficult. In normal times a house was very readily dealt with, if its condition became very bad, by the making of a closing order, and this fact had a salutary effect. It is now regarded as impossible to make closing orders except under very exceptional circumstances, and this very seriously weakens the power of the local authority in keeping up the standard of the poorer class of dwelling. In connection with the use of underground rooms as sleeping places there is a similar difficulty, and many are now so occupied in regard to which the Council successfully prohibited the use as sleeping places in pre-war days. The suggestion that the families occupying them should be ejected is met by the fact that there is no alternative accommodation. Similar arguments apply to overcrowding, except in extreme cases. It is greatly to be regretted that the by-laws in regard to tenement houses to be made under the 1919 Act have not yet been made operative. Reference was made to the point in last year's report, and it is regrettable that we have to wait so long for the lead which the by-laws should give. Since the end of the year the Ministry of Health have disapproved the Council's proposals in regard to the rebuilding of the first of the insanitary areas in Somers Town which had been recently represented. This matter is referred to below (page 84). It is much to be regretted that the urgent problem of dealing with the truly awful conditions which exist in this area should be still further delayed. Statistics for the year ended 31st December, 1922 (as required by the Ministry of Health):— Number of new houses erected during the year:— (a) Total 254 maisonettes and flats. (b) As part of a municipal housing scheme 254 maisonettes and flats. 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,959 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 871 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation r 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. Nil. 2. 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. 3. 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. (7947) l 82 (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 3,861 (2) Number of dwelling-houses in which defects were remedied:— (a) by owners 3,861 (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 Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. Considerable use has been made by tenants of the provisions in this Act to the effect that the permitted increase of rent is only allowed so long as the dwelling is in a reasonable state of repair. The Act provides that the Local Authority may issue certificates in regard to dwellings which are not in such a state, and 128 such certificates were issued during 1922 on the application of tenants. WORK OF THE ESTATES COMMITTEE. The following summary of the principal matters dealt with by the Estates Committee during the past year has been prepared by Mr. A. Powell Coke, Clerk to the Committee. The Estates Committee (Alderman A. Davis, J.P., Chairman) controls 478 dwellings, consisting chiefly of flats in different parts of the borough. The demand for housing accommodation continues unabated. Flats seldom become empty, less than 10 having been vacated during the past 12 months. No difficulty is experienced in filling the vacancies from the long waiting list. Brookfield Estate. At the time of writing last year's report, this estate, which comprises a total accommodation for 202 families, had just been opened, and about 72 tenancies had been taken up. Arrangements were made with the contractor by which the various blocks of maisonettes and flats were completed systematically and handed over for occupation from time to time, the last blocks being occupied in December, 1922, nearly six months before the contract time for completion. The earlier tenants had to endure the discomforts of unmade roads, and in many cases could not have the use of their gardens owing to the storage of materials, but the fact that many of the tenants had been given preference owing to their previous lack of sufficient accommodation, made them willing to suffer conditions which are inevitable to building operations. 83 The Committee decided that the open spaces in front of the blocks of flats should be covered at the appropriate season with turf, and that a number of trees should be planted at different parts of the estate. The trees are already in leaf, and as they were well-grown specimens, they greatly improve the appearance of the estate. The land at the rear of the blocks of flats was divided into plots for use as drying purposes and as a small garden, with the exception of three blocks where the land was found to be too limited to give each tenant a plot. It was therefore made into a common drying-ground. Castiron clothes post sockets have been fixed in the gardens, two to each plot, leaving the tenants to provide their own clothes posts, the intention being that the posts should be removed after use. One of the features of the estate is the turf panels inserted into the tarmac paving alongside the road. Whilst the idea is a good one where the road is not much used by people outside the estate, in the busier parts like St. Albans Road, the soft turf appears to attract pedestrians, and consequently the grass is soon worn off. Over a mile of privet hedges has been planted, and to protect them from damage it has been found necessary to fix a quantity of wire netting, which appears to be effective. In October, 1922, and again in April, 1923, the rents were reduced in accordance with the reduction of rates, the gross weekly rents now varying from 13s. 2d. to 29s., according to the number of rooms and position. On the 20th September, 1922, the Council sanctioned the erection of a two-storey building on the estate to provide a workshop and store for the purpose of housing materials and plant required for minor repairs. The proposal was submitted to the Ministry of Health for approval. The Minister was of opinion that the plan submitted indicated a building in excess of the needs of the scheme, but ultimately stated that he was prepared to allow a sum of £400 in respect of the proposed workshop, to rank as a capital charge against the assisted scheme. The repayment was to be charged against the maintenance account. Eventually, it was decided to utilise the large wooden hut on the estate which belonged to and was formerly used by the contractor as an office and store, although it would not be of the capacity originally contemplated. Several applications have been received from tenants for permission to instal wireless sets. These have been acceded to, subject to the work being carried out to the satisfaction of the Chief Electrical Engineer, and to the installations remaining at the pleasure of the Council. Una House, Prince of Wales Road. This scheme comprises 64 flats. The building is planned as a unit surrounding a triangular courtyard which has a raised playground in the centre, beneath which are arranged sheds for prams and bicycles. At the extremities of the buildings, fronting Prince of Wales Road, the irregular-shaped plots have been levelled and sown with grass seeds, and with a bed of shrubs in the centre, which improve the amenities of the scheme. The hot-water service which is provided to each of the flats, and to which the Committee devoted considerable attention owing to the somewhat high cost of running, has now been arranged so that an almost full service is given without undue expenditure. The problem revolved around the need for an ample supply of hot water during week ends. This was got over by the caretaker and boiler attendant working alternate week ends, each man having time off in lieu of the extra hours, and also by slightly reducing the supply available at either end of the day. The arrangement has now been in operation several months, and appears to be working satisfactorily. The tenants much appreciate the advantage of obtaining an almost constant supply of hot water. The present gross rents vary from 13s. 6d. to 21s. 5d. weekly, according to the accommodation. (7947) l 2 84 Goldington Buildings. This is the oldest of the Council's dwellings, and consists of 56 flats, varying in size from one to four rooms at rentals ranging from 6s. 1d. to 19s. One of the smaller flats which had hitherto been used as a workshop for the caretaker was thoroughly redecorated and renovated and made available for letting. To enable this to be done, the temporary coal shed in the courtyard was converted into a workshop and store. Flaxman Terrace, and Prospect Terrace. The former scheme comprises 84 flats, consisting of two and three rooms, with rents ranging from 8s. lrf. to 16s. lid. The latter consists of 70 flats of similar size and the rents vary from 9s. 5d. to 16s. 2d. In connection with this scheme there is also a small block of 12 slipper baths which is available to the public. Somers Town Improvement Scheme. The following communication was received from the Ministry of Health in regard to the Council's proposals for dealing with Somers Town:— (Copy.) Ministry op Health, Whitehall, S.W.I., Reference:—IX 735/202. 12th April, 1923. Sir, SOMERS TOWN IMPROVEMENT SCHEME. I am directed by the Minister of Health to advert to your letters of the 2nd and 29th ultimo regarding the above scheme, and to state that he has given this matter further consideration. As your Council are no doubt aware, the Minister has allocated to the London County Council the annual amount of £50,000 out of the £200,000 allotted for Improvement Schemes, on the understanding that the London County Council will contribute a like amount. The Minister has again consulted the London County Council with regard to the Somers Town area, and is informed that the area does not appear to them to be one of those most urgently requiring attention. In these circumstances, and in view of the limited amount at his disposal, the Minister does not feel justified in promising assistance towards meeting the loss which would be incurred in connection with a scheme for the area in question. There would seem, therefore, to be no advantage in the attendance of the proposed deputation from your Council to discuss the question of a scheme which has already been dealt with at the interview referred to in your letter of the 2nd ultimo. I am, however, to add that should your Council feel disposed to undertake an Improvement Scheme for the Somers Town area without financial assistance from the State, the Minister would be ready to consider the matter further on this basis. I am, Sir, Your obedient Servant, The Town Clerk, (Signed) E. F. MORSE. Borough of St. Pancras. Having regard to the Ministry's decision in this matter, the Estates Committee have appointed a special sub-committee to consider what further steps can usefully be taken to deal with the pressing need for improving the conditions in this district. The Allotments Act, 1922. A special sub-committee, together with the necessary co-opted members, was appointed under this Act to deal with the administration of the few remaining allotments in the borough. Staff. The administrative work in connection with the Committee is carried out by Mr. A. P. Coke, the Clerk to the Committee, who is assisted by Mr. G. N. Cove and Mr. L. Barnard, the Housing Superintendent. The resident caretakers at the several blocks of buildings are as follows:—Prospect Terrace, Mr. H. A. Reid; Brookfleld Estate, Mr. H. J. Ambrose; Flaxman Terrace, Mr. C. Hanson; Una House, Mr. J.F. Clegg; Goldington Buildings, Mr. G. S. Tunbridge. 85 APPENDIX. 86 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1922 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. Death Rates for 1911-13 calculated on the 1911 census population and for 1920-22 on the Registrar General's estimate for the middle of 1921 based on the 1921 Census. (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. 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 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† 066 619 385 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 14.l† 670 496 336 88 2,930 13.4† — 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 1922 212,500 — 4,865 4,559 21.5 3,219 15.1 715 603 337 74 3,107 14.6 14.6 Area of district in acres (land and inland water), 2694.4; total population at all ages, 211,366; number of inhabited houses, 24.660; average number of persons per house, 8.57; at Census, 1921. * Based on total population. † Based on civil population. 87 Table No. 2.—Deaths Registered from all Causes for the Year 1922. 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. 1.—General Diseases. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. ai. f. m. f. m. f. m. f. SONS 1. Enteric Fever – – – – – – – – – – – – – – – – – – 1 – – – – – – – – – 1 – 1 2. Typhus Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 3. Relapsing Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 4. Malaria – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – – 1 1 5. Small Pox— (a) Vaccinated – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Not Vaccinated – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – 1 – 1 (c) Doubtful – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 6. Measles 7 8 27 24 15 15 49 47 5 4 – 1 – 1 – – – – – – – – – – – – – – 54 53 107 7. Scarlet Fever 1 2 4 – 3 4 8 6 3 – 1 1 – – – 1 – – – – – – – – – – – – 12 8 20 8. Whooping Cough 9 2 4 5 2 4 15 11 1 2 – – – – – – – – – – – – – – – – – – 16 13 29 9. (a) Diphtheria – – 6 5 7 9 13 14 4 7 – 3 2 – – – – – – – – – 1 – – – – – 20 24 44 (b) Croup – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 10. Influenza 3 4 5 2 3 1 11 7 – – 2 – 5 3 7 3 7 9 9 8 9 5 14 24 7 10 1 1 72 70 142 11. Miliary Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 12. Asiatic Cholera – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 13. Cholera Nostras – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 14. Dysentery – – – – – – – – – – – – – – 1 – – 1 1 – 1 – – – – – – – 3 1 4 15. Plague – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 16. Yellow Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 17. Leprosy – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 18. Erysipelas 1 – – – – – 1 – – – – – – – 1 – 1 – 1 – 2 – 2 1 2 – – 1 10 2 12 19. (a) Mumps – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) German Measles – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (c) Varicella – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (d) Other Epidemic Dieases – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 20. (a) Pyæmia – – – – – – – – 2 – 1 – – – – – – – – 1 – – – – – – – – 3 1 4 (b) Septicæmia 3 – – – – – 3 – – – 1 – – – 2 – – – – – – 1 – 1 1 – – – 7 2 9 (c) Vaccinia – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 21. Glanders – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 22. Anthrax (Splenic Fever) – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 23. Rabies – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 24. Tetanus – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 25. Mycoses – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – 1 – 1 26. Pellagra – – – – – – – – – – – – – – – – – 1 – – – – – – – – – – – 1 1 27. Beri-Beri – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 28. (a) Pulmonary Tuberculosis 1 2 1 1 – 1 2 4 1 1 3 2 16 19 19 23 33 19 42 12 29 7 7 2 1 – – – 153 89 242 (b) Phthisis (not defined as tuberculous) – – – – 1 – 1 – – – – – – – – 1 1 4 1 – 3 2 1 1 – – – – 7 8 15 29. (a) Acute Phthisis – – – – – – – – – 1 – 1 – 1 – 1 – – 1 – 2 – – – – – – – 3 4 7 (b) Acute Miliary Tuberculosis – 3 – 1 2 – 2 4 – – – – 1 1 – – – – – – – – – – – – – – 3 5 8 30. Tuberculous Meningitis 2 1 – 4 1 4 3 9 4 1 1 2 1 1 – – – – – – – – – – – – – – 9 13 22 31. (a) Tabes Mesenterica – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Other peritoneal & intestinal tubercle – 1 – – 2 1 2 2 – – – – – 1 – – – – – – – – – – – – – – 2 3 5 32. Tuberculosis of Spinal Column – – – – – – – – – – – – 1 1 – – – 1 – – 1 1 – – – – – – 2 3 5 33. Tuberculosis of Joints – – – – – – – – – – – 1 – – – – – – – – – 1 – – – 1 – – – 3 3 34. (a) Lupus – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Scrofula – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (c) Tuberculosis of other Organs 1 – – – 1 – 2 – – – – – – – – – – – 1 1 – – – – – – 1 – 4 1 5 35. Disseminated Tuberculosis – – – – – – – – – – – – – 1 – – 1 – – 1 – – – – – – – – 1 2 3 36. Rickets, Softening of Bones 1 – – – – – 1 – – – – – – – – – – – – – – – – – – – – – 1 – 1 37. Syphilis 2 6 – – – – 2 6 – – – – – 1 – – – 1 – 1 1 – – – – – – – 3 9 12 38. Other Venereal Diseases – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 39. Cancer of the Buccal Cavity – – – – – – – – – – – – – – – – 1 – 7 – 7 – 6 1 – – – – 21 1 22 40. ,, Stomach, Liver, &c. – – – – – – – – – – – – – – – – 1 2 15 9 24 12 15 7 8 1 – – 63 31 94 41. „ Peritoneum, Intestines, and Rectum – – – – – – – – – – – – – – – – 2 2 2 5 11 7 9 9 8 5 – 1 32 29 61 42. ,, Female Genital Organs – – – – – – – – – – – – – – – 1 – 6 – 5 – 10 – 8 – 3 – – – 33 33 43. ,, Breast – – – – – – – – – – – – – – – 1 – 3 – 6 – 6 – 7 1 4 – – 1 27 28 44. ,, Skin – – – – – – – – – – – – – – – – – – – – 2 – 1 1 1 2 – – 4 3 7 45. Cancer of other or unspecified Organs – – – – – – – – – – – – – – – – – 2 7 5 14 6 10 5 5 3 – – 36 21 57 46. Other Tumours (situation undefined) – – – – – – – – – – – – – – – – – – 1 4 1 – – – – – – – 2 4 6 47. Rheumatic Fever – – – – – – – – – – 1 – 2 1 1 – – – 1 1 – 5 2 1 – – – – 7 8 15 48. (a) Chronic Rheumatism – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – (b) Osteo-Arthritis – – – – – – – – – – – – – – – – – 2 1 – – – 1 2 3 – – – 5 4 9 (c) Gout – – – – – – – – – – – – – – – – – – 1 – – 1 2 – – – – – 3 1 4 49. Scurvy – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 88 Deaths Registered from all Causes for the year 1922—continued. Cause of Death. Ages. 0 to 1 1 to 2 2 to 5 Total under 5. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. 1. General Diseases—contd. 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. SONS 50. Diabetes — — — — — — — — — — 1 — — 1 1 — 1 2 — 2 — 2 2 1 1 — — — 6 8 14 51. Exophthalmic Goitre — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 52. Addison's Disease — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 53. Leucocythæmia, Lymphadenoma — — — — — — — — — — 1 — — — — — — — 1 — 1 — — — — — — — 3 — 3 54. Anæmia, Chlorosis — — — — — — — — — — 1 — — 1 — 1 — 1 — — — 1 — 1 — — — — 1 5 6 55. (a) Diabetes insipidus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Purpura 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 (c) Hæmophilia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other General Diseases 1 1 — — — — 1 1 — — — — — — 1 — — — — — 1 1 — — — — — — 3 2 5 56. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 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 (b) Encephalitis, other forms — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 61. (a) Cerebrospinal Fever 1 1 — — 2 — 3 1 — — 1 — 1 — — — — — — — — — — — — — — — 5 1 6 (b) Posterior Basal Meningitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Meningitis, other forms — — — 2 — — — 2 — — — — — — — — — — 1 — — — 1 — — — — — 2 2 4 62. Locomotor Ataxy — — — — — — — — — — — — — — — — — — 4 — 1 — 1 — — — — — 6 — 6 63. (a) Anterior Poliomyelitis — — — — — 1 — 1 — 1 — — — — — — — — — — — — — — — — — — — 2 2 (b) Other Diseases of the Spinal Cord — — — — — 1 — 1 — — — — 1 — — — 2 — 2 1 1 1 2 2 — 1 — — 8 6 14 64. Cerebral Hæmorrhage, Apoplexy — 1 — — — — — 1 — — — — — — — — 1 — 4 5 12 6 14 21 12 13 1 3 44 49 93 65. Softening of Brain — — — — — — — — — — — — — — — — — — — 1 1 1 1 2 1 1 — — 3 5 8 66. Paralysis without specified cause — — — — — — — — — — — — 1 — — — — 1 1 — — 2 1 3 1 3 — — 4 9 13 67. General Paralysis of the Insane — — — — — — — — — — — — — — 2 1 7 1 7 1 2 2 — — — — — — 18 5 23 68. Other forms of Mental Alienation — — — — — — — — — — — — — — — 4 — — — 1 1 1 — 1 — — — — 1 7 8 69. Epilepsy — — — — — — — — — — — 1 — — — — 1 — — — — — — — 1 — — — 2 1 3 70. Convulsions (Non-puerperal; 5 years and over) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 71. Infantile Convulsions (under 5 years) 6 2 — 1 — — 6 3 — — — — — — — — — — — — — — — — — — — — 6 3 9 72. Chorea — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 73. Hysteria, Neuralgia, Neuritis — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 74. Other Diseases of the Nervous System — 1 — 1 — — — 2 — — — — — — 1 — — — 1 1 — 1 — 1 — — — — 2 5 7 75. Diseases of the Eyes and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 76. (a) Mastoid Disease — — — — 1 — 1 — 1 — — 1 — — — 1 — 1 1 — — — — — — — — — 3 3 6 (b) Other Diseases of the Ears 1 — — 1 — 1 1 2 — 1 — 2 — — — 1 — — — — — — — — — — — — 1 6 7 3. Diseases of the circulatory System. 77. Pericarditis — — — — 1 — 1 — 1 — — — — — 1 — 1 — — 2 1 — — — — — — — 5 2 7 78. Acute Myooarditis and Endocarditis — — — — — — — — — 1 — 1 3 2 6 1 5 1 3 5 1 — — 1 — — — — 18 12 30 79. (a) Valvular Disease — — — — — — — — — — 1 — — 4 — 2 7 2 7 4 13 11 14 14 7 13 — 2 49 52 101 (b) Fatty Degeneration of the Heart — — — — — — — — — — — — — 1 — — 1 — 4 2 3 3 5 7 — 1 1 — 14 14 28 (c) Other Organic Disease of the Heart — — — — — — — — — — — 1 2 3 2 5 5 2 20 8 38 29 42 43 25 55 8 14 142 160 302 80. Angina Pectoris — — — — — — — — — — — — — — — — — — — — — — 2 — 1 — — — 3 — 3 81. (a) Aneurysm — — — — — — — — — — — — — — — — — — 3 — 1 — 1 2 — — — — 5 2 7 (b) Arterial Sclerosis — — — — — — — — — — — — — — 1 — — 1 4 — 3 4 15 6 7 7 3 1 33 19 52 (c) Other Diseases of Arteries — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 82. (a) Cerebral Embolism and Thrombosis — — — — — — — — — — — — — — — — — — — 4 1 1 5 6 4 2 — 4 10 17 27 (b) Other Embolism and Thrombosis — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 2 2 83. Diseases of the Veins (Varices, Haemorrhoids, Phlebitis, &c.) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 84. (a) Status Lymphaticus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Other Diseases of the Lymphatic System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 85. Hæmorrhage; other Diseases of the Circulatory System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 1 87. Diseases of the Larynx — — — — 1 — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 88. Diseases of the Thyroid Body — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — 2 2 89 & 90. Bronchitis 14 7 4 4 2 1 20 12 — 1 1 — — — 3 — 6 4 21 5 25 15 44 40 33 53 7 18 160 148 308 91. Broncho-Pneumonia 36 18 14 18 16 10 66 46 — — 1 — — — 1 1 4 1 4 1 5 6 6 5 2 4 2 — 91 64 155 92. (a) Lobar Pneumonia 1 2 3 — — 2 4 4 — 1 — — 2 — 3 1 10 1 9 4 7 3 8 4 4 — — 1 47 19 66 (b) Pneumonia (type not stated) 3 3 2 2 2 — 7 5 — — — — 1 2 1 — 3 — 7 1 5 1 4 3 3 — — 1 31 13 44 93. Pleurisy 2 — — — 1 — 3 — — — — — — 1 — — 1 — 1 — 1 — 1 1 1 — — — 8 2 10 89 Deaths Registered from all Causes far the Year 1922—continued. Cause of Death. Ages. 0 to 1 1 to 2 2 to 5 Total under 5. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. 4. Diseases of the Respiratory System—contd. 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. SONS 94. Pulmonary Congestion, Pulmonary Apoplexy 1 1 — — — 1 1 2 — — — — — — — —— — — — — — 1 2 3 1 2 — — 4 8 12 95. Gangrene of the Lung — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 96. Asthma — — — — — — — — — — — — — — — — 1 1 — — — — — — — — — — 1 1 2 97. Pulmonary Emphysema — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 98. (a) Fibroid Disease of the Lung — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 1 (b) Other Diseases of the Respiratory System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Other Diseases of the Mouth and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 1 100. Diseases of Pharynx, Tonsillitis — 1 — — — — — 1 — 1 2 1 — 1 — — — — — — — — — — — — — — 2 4 6 101. Diseases of Œsophagus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 102. Perforating Ulcer of Stomach — — — — — — — — — — — — — — — 1 2 — 2 4 1 2 — 1 1 — — — 6 8 14 103. (a) Inflammation of Stomach — — — — — — — — — 1 — — — — — — — — — — 1 — — 1 — — — — 1 2 3 (b) Other Diseases of Stomach — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 104 & 105. (a) Infective Enteritis 1 4 — 1 — 1 1 6 — — — — — — — — — — — — — — — — — — — — 1 6 7 (b) Diarrhœa (not returned as infective) 1 3 — — — — 1 3 — — — — — — — 1 — — — 1 — — — 1 — — — 2 6 8 (c) Enteritis (not returned as infective) 1 1 — — 1 1 — — — — — — — 1 — — — — — — — — — — — 1 1 3 4 (d) Gastro-Enteritis (not returned as infective) 10 11 2 1 12 12 — — — — — — — — 1 — — 1 — — — 2 — — — — 13 15 28 (e) Dyspepsia (under 2 years of age) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Colic — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (g) Ulceration of Intestines — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 (h) Duodenal Ulcer — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 106. Ankylostomiasis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 107. Other Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 108. Appendicitis — — — — 1 — 1 — — — 2 — 1 3 — — 4 — 1 1 — 2 1 1 — — — — 10 7 17 109. (a) Hernia — — — — — — — — — — — — — — — — 1 — — 2 2 1 1 — 1 — — 1 5 4 9 (b) Intestinal Obstruction 3 — — — — — 3 — 1 — — — — 1 — — — 4 — 3 3 1 2 2 1 — — 1 10 12 22 110. Other Diseases of the Intestines — — — — — — — — — — — — — — — — 1 — 1 — — — 2 — — — — — 4 — 4 111. Acute Yellow Atrophy of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 112. Hydatid of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 113. (a) Cirrhosis of the Liver (not returned as alcoholic) — — — — — — — — — — — — — — — — 1 2 5 1 2 1 1 1 1 — — — 10 5 15 (b) Cirrhosis of the Liver (returned as alcoholic) — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 114. Biliary Calculi — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 115. Other Diseases of the Liver — — 1 — — — 1 — — — — — — — — — — — 1 1 — 1 — — — — — — 2 2 4 116. Diseases of the Spleen — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 117. Peritonitis (cause unstated) 1 — — — — — 1 — — 1 — — 2 — — — — 1 — — — — — — — — — — 3 2 5 118. Other Diseases of the Digestive System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Non-Venereal Diseases of the Genito-Urinary System and Annexa. 119. Acute Nephritis — — — — — — — — 1 — — — — — 1 1 1 — 4 — 1 1 2 — — — — — 10 2 12 120. Bright's Disease — — — — — — — — — — — — 1 — — 1 2 3 4 7 8 7 6 8 2 3 1 2 24 31 55 121. Chyluria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 122. Other Diseases of the Kidney and Annexa — — — — — — — — — — — — — — — 2 — — 1 — — — — 1 — — — — 1 3 4 123. Calculi of the Urinary Passages — — — — — — — — — — — — — 1 1 — — 1 — — — — — — — — — — 1 2 3 124. Diseases of the Bladder — — — — — — — — — — — — — — — 1 — — 1 1 1 — 1 — 2 — — — 5 2 7 125. Diseases of the Urethra, Urinary Abscess, &c. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 126. Diseases of the Prostate — — — — — — — — — — — — — — — — — — — — 1 — 1 — 9 — — — 11 — 11 127. Non-Venereal Diseases of Male Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 128. Uterine Hæmorrhage (Non-puerperal) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 129. Uterine Tumour (Non-cancerous) — — — — — — — — — — — — — — — — — 2 — 1 — — — — — — — — — 3 3 130. Other Diseases of the Uterus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 131. Ovarian cyst. Tumour (Non-Cancerous) — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 1 132. Other Diseases of the Female Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 133. Non-puerperal Diseases of the Breast (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (7947) M 90 Deaths Registered from all Causes for the Year 1922—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. 7. The Puerperal Slate. 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. Pursons 134. Accidents of Pregnancy — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 135. Puerperal Hæmorrhage — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 1 136. Other Accidents of Childbirth — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 137. Puerperal Fever — — — — — — — — — — — — — — — 3 — 1 — — — — — — — — — — — 4 4 138. ,, Albuminuria and Convulsions — — — — — — — — — — — — — — — 2 — 3 — — — — — — — — — — — 5 5 139. ,, Phlegmasia Alba Dolens, Embolism and sudden death — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 1 140. ,, Insanity — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 141. „ Diseases of the Breast — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 8. Diseases of the Skin and of the Cellular Tissue. 142. (a) Senile Gangrene — — — — — — — — — — — — — — — — — — — — 1 — 1 4 4 1 1 — 7 5 12 (b) Gangrene (other types) — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — 1 1 143. Carbuncle, Boil — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 144. Phlegmon, Acute Abscess — — — — — 1 — 1 — — — — — — — — 1 — — — — — — — — — — — 1 1 2 145. Diseases of the Integumentary System — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bones — — — — — — — — 1 — — — — — — — — — — 1 — 1 — — — — — — 1 2 3 147. Diseases of the Joints — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 148. Amputations — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 149. Other Diseases of Locomotor System — 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 10. Malformations. 150. Congenital Malformations 17 14 1 2 — 1 18 17 1 — — — — — — — — — — — — — — — — — — — 19 17 36 11. Diseases of Early Infancy. 151. (a) Premature Birth 38 23 — — — — 38 23 — — — — — — — — — — — — — — — — — — — — 38 23 61 (b) Infantile Debility, Icterus, and Sclerema 20 8 1 — — — 21 8 — — — — — — — — — — — — — — — — — — — — 21 8 29 152. Other Diseases peculiar to early Infancy 4 4 — — — — 4 4 — — — — — — — — — — — — — — — — — — — — 4 4 8 153. Lack of Care — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Old Age. 154. (a) Senile Dementia — — — — — — — — — — — — — — — — — — — — — — 3 1 4 — — 1 7 2 9 (b) Senile Decay — — — — — — — — — — — — — — — — — — — — 3 2 17 6 18 30 8 27 46 65 111 13. Affections Produced by External Causes. 155 to 163. Suicides — — — — — — — — — — — — 1 — 1 3 6 1 7 5 4 1 2 — 2 — — — 23 10 33 164. Poisoning by Food — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 165. Other Acute Poisonings — — — — — — — — — — — — — — 2 — — — — 2 — — — — — 3 — — 2 5 7 166. Conflagration — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — 1 1 167. Burns (Conflagration excepted) 1 — — — — — 1 — 1 — — — — — — — — — — — — — — — — — — 1 2 1 3 168. Absorption of Deleterious Gases (Conflagration excepted) 2 4 — — 1 — 3 4 — — — — 1 — — — — — 2 1 1 — — — — 1 — — 7 6 13 169. Accidental Drowning — — — — — — — — 1 — — — 2 — 1 — — — 2 — 2 — 1 — — — — — 9 — 9 170 to 176. Injuries — — — 1 3 — 3 1 7 1 2 1 8 1 4 — 5 1 5 — 2 — 3 7 4 2 — — 43 14 57 177. Starvation — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 178. Excessive Cold — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 179. Effects of Heat — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 180. Lightning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 181. Electricity (Lightning excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 182 to 184. Homicide 1 — — — — — 1 — — — — — 1 — — — — — — — — — — — — — — — 2 — 2 185. Fractures (cause not specified) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 186 Other Violence — — — — 1 — 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) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 189. (a) Heart Failure (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 (c) Teething — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Pyrexia. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (e) Other ill-defined Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Cause not specified — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 9i 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 63 89 76 228 36 24 62 67 104 155 177 145 67 5 1,070 Diseases of the Nervous System and of the Organs of Special Sense. 13 5 6 24 4 5 3 11 14 32 32 50 33 4 212 Diseases of the Circulatory System — — 1 1 2 3 15 18 25 67 109 163 122 34 559 Diseases of the Respiratory System 88 47 36 171 3 2 7 10 33 53 70 122 103 29 603 Diseases of the Digestive System 36 6 2 44 4 5 8 3 18 25 18 17 6 3 151 Non-Venereal Diseases of the Genitourinary System and Annexa. — — — — 1 — 2 7 9 19 20 19 16 3 96 The Puerperal State — — — — — — 1 7 5 — — — — — 13 Diseases of the Skin and of the Cellular Tissue. — 1 1 — — — — 1 — 3 5 6 1 17 Diseases of the Bones and of the Organs of Locomotion. 1 — ' — 1 1 — — ' — — 1 1 — — — 4 Malformations 30 3 1 34 1 — — — — — — — — — 35 Diseases of Early Infancy 98 1 — 99 — — — — — — — — — — 99 Old Age — — — — — — — — — — 5 27 52 36 120 Affections produced by External Causes 8 1 5 14 10 4 14 11 13 24 11 13 12 1 127 Ill-defined Causes — 1 — 1 — — — — — — — — — — 1 Totals 337 153 128 618 62 43 112 134 222 376 446 561 417 116 3,107 (7947) m 2 92 Table No. 4. Total Births, Total Deaths, Infantile Deaths and Deaths from Tuberculosis, ivith corresponding rates for each Ward and Registration Sub-District. Population.—The estimated population for the year is distributed amongst the Wards and Sub-Districts in the same proportion as at the 1921 Census. Births.—Outward transfers are excluded, and then births in St. Pancras institutions are classified according to home address and inward transfers distributed amongst the Wards and Sub-Districts in proportion to their respective populations. Deaths.—Outward transfers are excluded, and then deaths in public institutions and inward transfers are classified according to home address. Registration Sub-Districts. Wards. Net Births. Birthrate per 1,000 population. Net Deaths. Deathrate per 1.000 population. Deaths under 1 year of age. Infantile Deathrate per 1,000 Births. Deaths, Tuberculosis (all forms). Deathrate, Tuberculosis (all forms), per 1,000 population. 4 566 21.8 405 15.6 43 76 47 1.8 5 641 21.2 452 15.0 52 81 54 1.8 West 1,207 21.5 857 15.3 95 79 101 1.8 7 228 15.0 191 12.6 23 101 24 1.6 8 524 19.3 339 12.5 37 71 37 1.4 South 752 17.8 530 12.5 60 80 61 1.4 3 847 23.7 543 15.2 55 65 48 1.3 6 538 26.0 379 18.3 53 99 41 2.0 East 1,385 24.5 922 16.3 108 78 89 1.6 1 690 19.4 432 12.1 34 49 34 1.0 2 525 24.0 326 14.9 38 72 26 1.2 North — 1,215 21.1 758 13.2 72 59 60 1.0 No address — — — 40 — 2 — 4 — Whole Borough — — 21.5 3,107 14.6 337 74 315 1.5 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 1922. (52 weeks ended 30th December, 1922.) — Adjusted Population, Mid. 1921. Birth Rate. Death Rate. Infantile Mortality. — Adjusted Population, Mid. 1921. Birth Rate. Death Rate. (Crude.) Infantile Mortality. England and Wales †37,885,242 20.6 12.9 77 Birmingham 936,000 21.6 11.9 85 County of London 4,514,405 21.0 13.4 74 Liverpool 817,000 26.4 14.5 94 West. Manchester 744,000 21.9 14.0 94 Paddington 145,600 18.8 12.8 69 Sheffield 519,239 21.0 11.6 81 Kensington 177,300 17.8 13.4 84 Leeds 465,500 20.5 13.7 97 Hammersmith 128,708 21.0 13.3 71 Bristol 381,700 20.1 12.8 71 Fulham 159,400 20.3 12.0 68 West Ham 307,000 27.1 13.3 77 Chelsea 64,290 16.6 13.1 63 Hull 291,800 24.6 14.3 106 City of Westminster 139,893 13.2 12.5 55 Bradford 291,100 18.1 13.8 86 North. Newcastle-on-Tyne 278,400 26.8 14.2 86 St. Marylebone 105,200 16.0 13.5 67 Stoke-on-Trent 273,238 26.2 14.3 115 Hampstead 86,890 14.8 10.9 54 Nottingham 266,400 21.3 12.2 81 St. Pancras 212,900 21.4 14.5 73 Salford 239,100 22.3 13.9 103 Islington 333,000 22.7 13.8 76 Leicester 237,900 19.9 12.6 85 Stoke Newington 52,590 17.8 13.6 66 Portsmouth 233,929 22.4 12.3 63 Hackney 224,200 21.2 12.7 72 Cardiff 222,089 22.5 12.8 79 Central. Plymouth 199,869 20.1 14.1 72 Holborn 43,520 15.3 12.8 74 Croydon 191,500 18.9 12.3 67 Finsbury 76,690 25.2 ie.2 79 Bolton 182,200 18.6 13.5 94 City of London 13,527 10.9 13.9 81 Willesden 167,200 18.7 10.5 59 East. Rhondda 166,600 24.4 12.0 80 Shoreditch 105,200 28.1 16.3 102 Southampton 162,200 20.5 12.0 67 Bethnal Green 118,300 25.2 15.3 90 Sunderland 161,100 29.0 15.7 105 Stepney 252,000 23.9 13.9 80 Swansea 159/00 21.4 12.8 81 Poplar 164,100 26.9 14.4 78 Tottenham 149,200 18.8 11.2 73 South. Oldham 148,300 19.1 15.5 107 Southwark 186,000 24.6 15.6 79 Birkenhead 147,800 23.4 13.1 94 Bermondsey 120,500 27.0 17.0 101 East Ham 145,500 19.4 10.9 67 Lambeth 305,700 20.8 13.7 77 Brighton 134,800 17.4 13.6 64 Battersea 169,200 21.7 13.1 69 Middlesbrough 133,400 28.7 14.7 111 Wandsworth 331,500 16.6 11.2 61 Derby 131,800 20.9 11.2 71 Camberwell 269,600 21.5 13.4 78 Coventry 130,300 19.3 10.5 68 Deptford 113,500 23.2 13.8 74 Leyton 130,100 16.7 10.7 71 Greenwich 101,400 21.0 12.9 58 Walthamstow 129,800 18.8 10.7 63 Lewisham 175,800 18.2 11.1 54 Blackburn 129,682 17.1 14.0 96 Woolwich 137,604 20.8 11.5 62 Gateshead 126,700 25.4 15.2 110 Stockport 125,500 17.5 13.0 76 93 † Enumerated population in 1921 (unrevised). 94 Table No. 6.—Meteorological Table for Saint Pancras, 1922. (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 29.722 29.812 29.776 29.668 30.009 29.902 29.824 29.857 29.89 29.949 30.09 29.743 Air temperature— Mean of— Maximum A 45.4 47.3 48.0 52.3 70.4 70.5 67.6 67.7 63.7 56.1 49.1 47.7 Minimum B 34.8 34.9 37.0 37.3 48.7 51.6 52.2 51 .5 48.5 41.9 37.9 39.5 Mean of A and B 40.1 41 . 42.5 44.8 59.5 611 59.9 59.6 56.1 49.0 43.5 43 6 Difference from average +1.3 +1.1 -0.4 -3.6 +4.4 +0.1 -4.4 -3.6 -2.5 -1.7 -0.8 +31 Humidity.—Morning 87 85 81 74 66 64 73 77 83 82 87 88 Earth temperature at 4 ft. depth 44.8 42.8 44.2 44.1 49.1 57.2 56.8 57.4 56.4 53.4 48.2 46.0 Bright sunshine— Total observed (daily mean) Hrs. 11.8 3.0 3.58 5.05 9.03 7.96 5.16 4.65 3.78 4.05 1.56 1.45 Per cent, of total possible 14 30 30 37 58 48 32 32 30 38 18 19 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of days 20 15 17 17 7 9 22 17 14 12 9 18 Total fall Ins. 2.81 2.20 1.51 3.02 0.83 112 3.84 2.54 2.13 1.02 1.44 3.15 Difference from average „ +0.95 +0.55 -0.35 + 1.50 -0.95 -0.91 + 1.42 +0.32 +0.32 -1.61 -0.87 +0.75 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. 106 Buildings, Dwellings, Rooms and Families. Note.—The following table contains analyses of (1) the buildings and (2) the structurally separate dwellings of each area. In the upper part of each section the several classes (Groups I-V) are analysed both in the left-hand columns (a-c) in respect of their characteristics as buildings, and in the right-hand 'columns (f-p) in respect of the dwellings which they comprise. In the lower part of each table the subjects of analysis on the left and right respectively are different; on the left the " buildings " analysis is continued in respect of an expanded classification of one of the five groups ; while on the right the analysis according to dwellings is continued in respect of certain selected classes of private family occupations. BUILDINGS (left-hand columns (a-c) ).—In the enumeration of buildings, a building has generally been regarded as a structure wholly detached or separated from another by a vertical party wall. A block of flats would be one building though there might be one or more separate flats on each floor. The allocation of buildings among the several classes shown in Column (e) is based on the descriptions furnished by the local enumerators. The varieties of type encountered in the buildings enumerated have, however, inevitably given rise to some difference of practice on the part of enumerators in describing borderline cases ; and the numbers of buildings assigned to the several classes in Column (e) should therefore be regarded as approximate. The classification differs from that adopted in 1911 in the following respects :— (a) Structurally divided private houses are separately shown for the first time, with a view to affording an indication of the extent to which houses originally built for the occupation of single families have been structurally divided to provide separate and independent accommodation for two or more families. There is evidence, in the returns, that it has not always been possible for enumerators to distinguish between buildings originally erected to comprise, e.g., maisonettes and those subsequently converted for the purpose. (b) Inns and Public Houses in which the business of the establishment is primarily that of retailing liquors are classed with Shops (Group IV) instead of with Hotels (Group V), which are thus limited in the table to those of a residential character. STRUCTURALLY SEPARATE DWELLINGS (right-hand columns (f-p) ).—Above the "total" line dwellings are classified according to the type of building in which they occur, while below, the " total " line the same premises are classified according to the number of families enumerated within them. Dwellings " Vacant on Census night " include those imoccupied through the temporary absence of the usual occupier as well as those without a tenant. The total rooms in dwellings occupied by private families as shown in the following table is usually slightly in excess of the total rooms occupied (Tables pages 105 and 107), owing to the fact that in certain dwellings inhabited bv two or more families, part of the dwelling was unoccupied on Census night. 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 1922. Duties and Premises. Male Inspectors. Women Inspectors. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. District Inspectors. Inspections of Dwelling Houses— After Infectious Disease 1,217 2,433 - - 1,217 2,433 Upon Complaint (whole house inspected) 864 4,542 - - 864 4,542 Registered tenement houses (as such) 353 1,587 - - 353 1,587 Other inscribed dwellings (as such) 98 454 - - 98 454 Housing Act, 1909 : 17 (1) First inspection - - - - — — Subsequent routine inspections 420 2,322 - — 420 2,322 Other house to house inspections 7 41 - - 7 41 Complaints(not involving the complete inspection of a dwelling house) 3,243 7,962 - - 3,243 7,962 Drainage— Under notice. Plans, supervision, &c. 275 3,309 - - 275 3,309 Voluntary. Do. do. 849 3,033 - - 849 3,033 New Buildings. Do. do. 115 580 - - 115 580 Yards of Mews and Stables 5,457 2 - - 5,457 2 Smoke Shafts observed 724 51 - - 724 51 Regulated Trades— Offensive trades 48 — - - 48 — Rag and bone dealers 28 1 - - 28 1 Other effluvia businesses - - - - — — Inspection of Market Streets — — - - — — Visits to closed underground rooms 155 1 - - 155 1 Infectious Diseases. Inquiry, removal, fection, &c. 16 - 4,364 - 4,380 - Other duties †359 †226 14 - 373 226 Totals 14,228 26,544 4,378 — 18,606 26,544 Factory and Workshop (Male) Inspector. Bakehouses— Workshop 245 200 — - 245 200 Factory 99 123 — - 99 123 Restaurant kitchens 137 375 — - 137 375 Laundries— Workshop 2 1 — - 2 1 Factory — — — - — — Other Factories 124 656 — - 124 656 Other Workshops 275 799 — - 275 799 Other Workplaces 37 148 — — 37 148 Other Duties 4 — — - 4 — Totals 923 2,302 — 923 2,302 † Includes 251 inspections and 218 re-inspections to transmigrants' lodging houses. 96 Table No. 8.—Inspections and Re-inspections and other work of the Food Inspectors during 1922. Duties and Premises. Visits and Inspections. Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Milkshops 188 431 619 - - - Dairies 138 20 158 3 - 3 Cowsheds 5 10 15 - - — Other Premises of Milk Purveyors — 64 64 - - — Margarine Factories — — — - - — Butter Factories 1 — 1 - - — Ice Cream Premises 189 223 412 - - — Slaughter Houses 14 119 133 - - — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 54 205 259 - - - Butchers' Shops 26 19 45 - - — Fishmongers' Shops 4 10 14 - - — Fried Fish Shops and Fish Curers' Premises 93 292 385 1 - 1 Marketing Places 2,024 1,702 3,726 - - — Other Premises where Food or Drugs are sold 17 — 17 - - — Other Visits 80 178 258 - - — Total 2,833 3,273 6,106 4 — 4 Samples, &c., Taken. For mal Sam ples. Info rmal Sa mples. No. of Milk samples 168 207 375 - 2 2 „ Cream samples 10 7 17 — — — „ Butter and Margarine samples 52 67 119 — 1 1 „ Other samples (specified below)— Arrowroot 4 — 4 — — — Brawn 1 — 1 — — — Cocoa 20 12 32 — — — Coffee 19 7 26 — — — Custard Powder - 2 2 — — — Dripping — 3 3 — — — Fish Paste 1 — 1 — — — Flour 10 15 25 — — — Ground Ginger 4 — 4 — — — Jam - 1 1 — — — Lard 8 13 21 — — — Maize meal 1 — 1 — — — Milk, condensed 2 - 2 — — — Mustard 11 8 19 — — — Oatmeal 1 - 1 — — — Pepper 10 5 15 — — — Prescriptions (L.I.P.) 10 3 13 26 17 43 Sausages 6 — 6 — — — Vinegar 5 5 10 — — — Whiskies 6 — 6 — — — Total 349 355 704 26 20 46 97 Table No. 8 (contd.).—Inspections and Re-inspections and other work of the Food Inspectors during 1922. Duties and Premises. Visits and Inspections. Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Unsound Food. No. of surrenders and seizures :— Surrendered. Seized. Meat, &c. 3 1 4 — — - Fish 12 6 18 — — - Shellfish 1 2 3 — — - Other Foods (specified below):— Farm produce — 1 1 — — - Fruit 5 8 13 — — - Vegetables 2 4 6 — — - Totals 23 22 45 — — — Inspections of Registered Canal Boats 4 — 4 — — - 98 Table No. 9. Visits, etc., made by Women Inspectors during 1922. First Visits. Subsequent Visits. Call made but admission not obtained. Miss Bibby. Miss Smith. Miss Anthony. Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss C'amman. Miss Parnell. †Miss Steggles. †Miss Robinson. Total. Miss Bibby. Miss Smith. Miss Anthony. Miss Holland. Mrs. Hunter. iss Anderson. Miss Blaxland. Miss C'amman. Miss Parnell. Miss Steggles. tMiss Robinson. I Total. .Mis- Bibby. Miss Smith. ♦Miss Anthony. ♦Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Cam man. Miss Parnell. fMiss Steggles. ' M iaa Robinson. Total. Grand Total. Infants - 246 - - 283 257 3 789 242 203 374 13 832 266 121 360 3 750 2371 Expectant Mothers — 55 — — 70 52 - — — — — 177 — 36 — 38 35 2 — — — — 111 — 54 — — 6 18 — — — — — 78 366 Ophthalmia Neonatorum . . 63 — — 1 — 6 — — — 70 — 9/ — — 1 — — 18 — — — 116 — 50 — — — — — 3 — — —j 53 239 Puerperal Fever — 14 14 18 8 8 40 1 243 — 269 — — 913 — — — — — — 1196 — 804 — 200(1 — — — — — 317 — 208 — —■ 525 3038 Measles and German Measles 5 154 255 177 481 474 349 1657 379 90 292 4313 21 20 10 21 25 27 263 5 24 12 428 — 10 20 — 1 19 36 98 25 27 9 245 4986 Whooping Cough - 1 — 2 14 — — 10 — — — 21 — — — — 19 — — — — — - 19 — 1 — — — — — — — — — 1 47 Scabies - - 41 9 - - - - - 55 ?8 17 101 20 128 189 374 - - 8s7 10 — 29 18 37 41 31 - - 166 - 9 - 5 7 11 13 32 - 77 1100 Verminous Persons 128 100 — — — 228 — — 1 13 — — — — — — — 14 1 7 — — — — — — — 8 250 To Hospitals and other Voluntary Institutions 236 499 _ 191 182 452 65 497 4 2126 _ 24 24 6 4 1 — 11 2161 Domestic Workshops — Home Workplaces — Laundries—Factory — „ Workshop — Restaurant Kitchens - 7 Other Factories — „ Workshops — — Enquiries re milk grants .. — _ — — 3 4 — 78 1 — — 86 — — — — 1 — 7 — — — 8 — — — — — — 5 - - — 5 99 Attendances at Committees, - 200 Other Visits and Inspections 58 25 4 18 113 11 100 130 28 — 1 488 1 — — 8 1 50 — — — 62 2 — — 11 — — - — 15 Totals 474 1118 445 3061266 10001275 2135 I 1 1548 90 297 9934 425 21 28 319 454 1325 355 840 24 12 3803 - 400 21 7 133 412 382 120 265 27 9 1776 15533 * Exclusive of those shown in Table 7. f Temporary. 99 Table No. 10.—Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1922. Inspector. Inspections. Re-inspections. Call made but admission not obtained. Total. 1. Mr. Rackliam 1,091 2,278 — 3,3)9 2. „ Lonnon 1,261 1,824 — 3,085 3. „ Brown 1,223 2,322 — 3,545 4. „ Dillon 590 2,434 — 3,024 5. „ Walker 1,241 2,657 — 3,898 6. „ James 978 3,153 — 4,131 7. „ Adkins 955 2,701 — 3,656 8. „ Akers 1,950 1,540 — 3,49(1 9. „ Jaffa 1,950 1,815 — 3,765 10. „ Capel 1,303 2,477 — 3,780 11. „ Nixon 1,550 3,316 — • 4,866 12. „ Thompson (Factories and Worl shops). 13. „ Auger") (Food and 1,059 3,209 2,329 30 3,388 3,239 14. „ Child J Food Premisss) 3,650 20 — 3,670 15. Miss Bibby 474 — — 474 16. „ Smith 1,118 425 400 1,943 17. „ Anthony 2,318 21 21 2,360 18. „ Holland 2,811 28 7 2,846 19. Mrs. Hunter 1,266 319 133 1,718 20. Miss Anderson . 1,000 454 412 >•*1 1,866 21. „ Blaxland 1,275 1,325 382 2,982 22. „ Camman 2,135 355 120 2,610 23. , Parnell 1,548 840 ' 235 2,653 24. „ Steggles* (Temporary) 90 24 27 141 25. „ Robinson* do. 297 12 9 318 Totals 36,342 32,699 1,776 70,817 * Part year only. (7947) n 2 100 Table No. 11.—Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1922, and the resulting Statutory Notices in 1922 and the early part of 1923. Schedule of Nuisances. Intimations. Statutory Notices. 1. Part of the house in a dirty condition 1,148 329 2. Part of the house in a damp condition 209 65 3. Roof defective 947 296 4. Guttering defective 175 53 5. Water fittings defective 254 61 6. Water-closet apartment with absence of external ventilation 21 8 7. Water-closet apartment so foul as to be a nuisance or dangerous to health 14 5 8. Water-closet basin foul 60 20 9. Water-closet basin defective 114 22 10. Water-closet basin choked 112 22 11. Urinal in a foul condition I — 12. Privy in a foul condition 1 1 13. Soil pipe defective 30 8 14. Soil pipe unventilated 9 4 15. Soil pipe improperly ventilated 11 2 16. Absence of waste pipe to sink, lavatory or bath 6 1 17. Waste pipe of sink, lavatory, or bath connected with drain 8 1 18. Waste pipe of sink, lavatory, or bath defective 97 27 19. Waste pipe of sink, lavatory or bath foul 31 11 20. Inlet of drain improperly trapped 3 1 21. Drain defective 148 44 22. Drain stopped 134 14 23. Drain ventilating pipe defective 85 26 24. Rain-water pipe in direct communication with drain 14 1 25. Rain-water pipe defective 175 59 26. Unpaved condition of roadway 11 10 27. Undrained condition of roadway 12 11 28. Area or part unpaved 1 — 29. Area undrained — — 30. Yard or space unpaved 1 — 31. Yard or space undrained 1 1 32. Defective condition of washhouse paving ... 79 28 33. Dust-bin defective 711 149 34. Dust-bin in an improper position 2 1 35. Accumulation of stagnant water which is a nuisance dangerous to health 16 4 36. Accumulation or deposit which is a nuisance dangerous to health 123 36 37. Animals kept in such a manner as to be a nuisance dangerous to health 19 5 38. Part of the house so overcrowded as to be dangerous to health ... 12 7 39. Space below floor in basement or ground floor insufficiently ventilated 10 4 40. Issuing of black smoke in such a quantity as to be a nuisance ... 3 2 41. Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health. 4 3 42. Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates 2 1 43. Other nuisances 759 202 Total 5,573 1,545 101 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statutory Notices. 1. Overcrowding 11 5 2. Inadequate water supply 1 — 3. Contaminated water supply — — 4. Foul closet, basin or trap 8 4 5. Want of means of ventilation 1 1 6. Want of annual cleansing — — 7. Want of cleansing of the part or parts of premises used in common 243 99 8. Want of cleansing of the part or parts of premises in sole use 358 132 9. Want of cleansing of the room or part of the dwelling 10 4 10. Animals improperly kept - — 11. Other breaches 11 4 Total 643 249 Table No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1. Want of cleanliness 106 26 2. Want of ventilation — — 3. Want of air space, overcrowding — — 4. Sanitary accommodation, absent or insufficient 8 3 5. Sanitary accommodation, unsuitable or defective 76 27 6. Sanitary accommodation, not separate for sexes 18 4 7. Want of drainage of floors — — 8. Other nuisances 103 18 9. Illegal occupation of underground bakehouse — — 10. Breach of special sanitary requirements for bakehouses 112 3 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 63 15 Total 486 96 102 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 19 6 2. Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet 3. Water-closet not supplied with a sufficient quantity of water for securing its effective action 162 38 4. Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 25 9 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 36 12 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 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 4 — 10. Manure—absence of proper receptacle for 13 — 11. Manure receptacle not properly constructed 3 1 12. Sufficient drain to stables or cowshed—absence of a — — 13. Receptacle for house refuse—absence of a proper 426 82 14. Receptacle for house refuse—absence of a proper cover for 3 — 15. Yard or open space unpaved 1 — 16. Yard paving defective 164 53 17. Insufficient water-closet accommodation to " lodging house " 18 12 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 — — 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 556 157 25. Articles in an unwholesome condition requiring to be purified or destroyed 6 3 26. Underground room illegally occupied as a dwelling 2 — 27. Name and address of Medical Officer of Health and of landlord, etc., not inscribed in rent book 42 - 28. Other breaches 141 30 Total 1,621 403 103 SPECIAL APPENDIX. 104 POPULATION and Intercensal Variations.—ADMINISTRATIVE COUNTY and METROPOLITAN BOROUGHS. Note.—(a) War deaths which occurred outside the Country are included in the end column as losses by migration. Estimates for individual districts arc not available, but for the whole of England and Wales they have been assessed at about 3.1 per cent. of the 1921 male population. District. POPULATION. Intercensal Variation. 1901. 1911. 1921. 1901-11. 1911-21. Persons. Persons. Males. Females. Persons. Males. Females. Inc. or Dec. (—). Amount. Inc. or Dec. (—). Excess of Births over Deaths (_ = Deficiency). Gain or Loss (—) by Migration (see Note (a) Amount. Per cent. ADMINISTRATIVE COUNTY (including the City of London) 4,536,267 4,521,685 2,126,341 2,395,344 4,484,523 2,071,579 2,412,944 —14,582 37,162 0.8 359,861 397,023 City of London (County Corporate) 26,928 19,657 10,080 9,577 13,709 6,722 6,987 - 7,266 - 5,948 — 30.3 —979 4,969 Metropolitan Boroughs. Battersea 168,907 167,743 80,916 86,827 167,739 78,658 89.081 — 1,164 4 — 0.0 15,473 — 15,477 Bermondsey 130,760 125,903 62,890 63,013 119/462 68,341 61,111 — 4,857 — 6,451 — 5.1 13,771 20,222 Bethnal Green 129,680 128,183 62,658 65,525 117,238 56.766 60,472 — 1,497 —10,945 — 8.5 11,871 — 25,816 Camberwell 259.339 261,328 124,255 137,073 267,198 125,548 141,650 1,989 5,870 2.2 24,401 — 18,531 Chelsea 73,842 66,385 28,470 87,915 63.697 25,794 37,903 — 7,457 - 2.688 — 4.0 1,929 — 4,617 Deftford 110.398 109,496 52,987 56,509 112,534 54,131 58,403 902 3,038 2.8 12,095 — 9,057 Finsbury 101.463 87.923 42,655 45,268 75,995 36,156 39,839 — 13,540 — 11,928 13.6 6,776 -18,704 Fulham 137,289 153,284 72,662 80,662 157,938 73,243 84,695 15,995 4.654 3.0 16,957 —12,303 Greenwich 95,770 95,968 47,241 48,727 100,450 48,850 51.600 198 4.482 4.7 8,953 — 4,471 Hackney 219,110 222,533 102,948 119,585 222,142 101,993 120,140 3,423 — 391 — 0.2 18,497 — 18,888 Hammersmith 112,239 121,521 58,084 63,437 130,295 62,479 67,816 9,282 8,774 7.2 9,737 963 Hampstead 81,942 85,495 32,807 52,688 86.153 33,263 ",2.900 3,553 658 0.8 3,154 2,496 Holborn 59,405 49,357 24,089 25,268 43,192 20.732 22,460 — 10,048 — 6,165 — 12.5 — 9 - 6,156 Islington 334,991 327,408 155,901 171,502 330,737 164,661 176,076 - 7,588 3,334 l.0 25,353 — 22,019 Kensington 176,628 172,317 66,497 105,820 175,859 67,805 108,054 - 4,311 3,542 2.1 6,845 - 3,303 Lambeth 301,895 298,058 142,080 155,978 302,868 141,528 161,340 - 3,837 4,810 1.6 22,243 — 17,433 Lewisham 127,495 160,834 72,780 88,054 174,194 79,165 95,029 33,339 13,360 8.3 13,244 116 Paddington 143,976 142,551 60,415 82,136 144,261 60,491 83,770 — 1,425 1,710 1.2 7,997 — 6,287 Poplar 168,822 162.442 80,912 81.530 162,578 80,420 82.158 — 6,380 136 0.1 19,688 — 19,552 St. Marylebone 133,301 118,160 49,685 68,475 104,173 41,007 63,166 — 15,141 — 13,987 11.8 3.102 — 17,089 St. Pancras 235,317 218,387 106,728 111,659 211,366 99,620 111,746 — 16,930 — 7,021 — 3 .2 15,531 — 22,552 Shoreditch 118,637 1 1 1.390 54,842 56,548 104,248 50.317 53,931 — 7,247 - 7.142 — 6.4 11,232 — 18,374 SoUTHWARK 206,180 191,907 95,532 96.375 184.404 89,653 94,751 —14,273 — 7.503 - 3.9 18,535 26;038 Stepne\ 298,600 279.804 140,116 139,688 249,657 122,616 127,142 — 18,796 — 30.147 - 10.8 30,922 61,069 Stoke Newington ... 51,247 50,659 22,663 27,996 52.172 23,461 28,711 — 588 1,513 3.0 2,831 1,318 Wandsworth ... 231,922 311,360 140,728 170,632 328,307 147,229 181,078 79,438 16.947 5.4 23,854 — 6,907 Westminster, City of 183,011 160,261 73,449 86.812 141,578 61,380 80,198 — 22.750 — 18.683 — 11.7 263 — 18,946 Woolwich 117,178 121,376 61,271 60,106 140,389 69,661 70,728 4,198 19,013 15.7 12,595 6,418 105 Acreage, Population, Private Families and Dwellings. DEFINITIONS. PRIVATE FAMILY.—Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) institutions or (ii) business establishments or boarding-houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). STRUCTURALLY SEPARATE DWELLINGS.—A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit; a private house which has not been structurally subdivided ia similarly a single unit whether occupied by one family or by several families. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least 3 rooms and is more than one-quarter of the whole. The dwellings shown in this table are those occupied by private families only ROOMS.—For the purpose of the Census the rooms enumerated are the usual living rooms, including bedrooms and kitchens but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. Area in Statute Acres (Land and Inland Water). TOTAL POPULATION. Private Families and Dwellings (See Definitions at beginning of table). 1911. 1921. Private Families. Population in Private Families. Structurally Separate Dwellings occupied. Rooms occupied. Rooms per Person. Persons. Persons. Males. Females. Persons per Acre. Ward — No. 1 990 35,540 35,435 15.964 19,471 36 9,821 34.388 4,619 33,351 0.97 No. 2 162 21,866 21,779 10.451 11,328 134 5.565 21,134 2.185 14.461 0.68 No. 3 452 34,728 35,559 16.717 18,842 79 10.322 35,176 4,405 29,810 0.85 No. 4 271 26,394 25,809 12,689 13,120 95 6.906 24,377 2,924 19,699 0.81 No. 5 342 31,881 30.124 13.892 16,232 88 8.747 28,306 3,240 22,977 0.81 No. 6 180 22,723 20,570 9.949 10,621 114 4,804 18.291 2.242 11,343 0.62 No. 7 118 18,130 15.126 7,129 7,997 128 3,327 11,275 1,383 9,887 0.88 No. 8 179 27,125 26.964 12.829 14,135 151 7,161 22,398 3,662 18,868 0.84 Total 2,694 218,387 211,366 99,620 111,746 78 56.653 195,345 24.660 160,396 0.82 106 Buildings, Dwellings, Rooms and Families. Note.—The following table contains analyses of (1) the buildings and (2) the structurally separate dwellings of each area. In the upper part of each section the several classes (Groups I-V) are analysed both in the left-hand columns (a-c) in respect of their characteristics as buildings, and in the right-hand 'columns (f-p) in respect of the dwellings which they comprise. In the lower part of each table the subjects of analysis on the left and right respectively are different; on the left the " buildings " analysis is continued in respect of an expanded classification of one of the five groups ; while on the right the analysis according to dwellings is continued in respect of certain selected classes of private family occupations. BUILDINGS (left-hand columns (a-c) ).—In the enumeration of buildings, a building has generally been regarded as a structure wholly detached or separated from another by a vertical party wall. A block of flats would be one building though there might be one or more separate flats on each floor. The allocation of buildings among the several classes shown in Column (e) is based on the descriptions furnished by the local enumerators. The varieties of type encountered in the buildings enumerated have, however, inevitably given rise to some difference of practice on the part of enumerators in describing borderline cases ; and the numbers of buildings assigned to the several classes in Column (e) should therefore be regarded as approximate. The classification differs from that adopted in 1911 in the following respects :— (a) Structurally divided private houses are separately shown for the first time, with a view to affording an indication of the extent to which houses originally built for the occupation of single families have been structurally divided to provide separate and independent accommodation for two or more families. There is evidence, in the returns, that it has not always been possible for enumerators to distinguish between buildings originally erected to comprise, e.g., maisonettes and those subsequently converted for the purpose. (b) Inns and Public Houses in which the business of the establishment is primarily that of retailing liquors are classed with Shops (Group IV) instead of with Hotels (Group V), which are thus limited in the table to those of a residential character. STRUCTURALLY SEPARATE DWELLINGS (right-hand columns (f-p) ).—Above the "total" line dwellings are classified according to the type of building in which they occur, while below, the " total " line the same premises are classified according to the number of families enumerated within them. Dwellings " Vacant on Census night " include those imoccupied through the temporary absence of the usual occupier as well as those without a tenant. The total rooms in dwellings occupied by private families as shown in the following table is usually slightly in excess of the total rooms occupied (Tables pages 105 and 107), owing to the fact that in certain dwellings inhabited bv two or more families, part of the dwelling was unoccupied on Census night. Difinitions:—For definitions of " Private Family," " Structurally Separate Dwelling " and " Rooms " see note at the head of table immediately preceding. Buildings Population 1921. d e Dwellings occupied by nonprivate families (excluded from cols. g-p). f Structurally Separate Dwellings occupied by Private Families or Vacant. in course of Erection. Cols, a completed Vacant on Census night. (inclu cols. g Occupied by Caretaker. ded in k-p) h 1-3 Rooms. k 4-5 Rooms. 1 6-8 Rooms. m 9 or more Rooms. n Total Dwellings. 0 Total Rooms. P not containing Dwellings, b containing Dwellings. c 3 17,126 162.261 I. Undivided Private Houses ... 236 150 10 520 2,113 9,038 5,219 16,890 129,540 — — 83 712 II. Structurally divided Private Houses - 10 - 83 115 33 1 232 918 1 — 302 11,714 III. Blocks of Flats, Tenements, etc. 12 241 - 3,139 527 371 3 4,040 11,896 2 710 3,392 22,195 IV. Shops 9 63 1 371 1.277 1,348 387 3,383 19,732 10 1,334 798 14.484 V. Others 127 92 3 394 209 50 18 671 2,459 16 2,044 2 l.701 211,366 Total 384 556 14 4,507 4.241 10,840 5,628 25,216 164,545 5 854 149 684 Principal Buildings in Group V (Others) above:— Vacant on Census night 263 126 97 70 556 2,651 Dwellings occupied by 1 private family 4,148 2,589 2,095 1,143 9,975 48,023 f Offices, Factories, „ 2 private families 85 1,146 2,692 762 4,685 31,459 Warehouses, Workshops. 3 or more private families 11 380 5,956 3,653 III.(Kill 82,412 — — 31 1.826 Hotels. Total Dwellings occupied by private) No. 4.244 4.115 10,743 5,558 24,660 161,894 — 2 44 5.069 Institutions. families % 17 17 43 23 100 — — 47 9 37 Places of Worship. 17 Places of Amusement. Total private families therein 4,351 6.093 28,285 17,924 56,653 107 Private Families Classified by Size of Family, Rooms Occupied and Density of Occupation. Note.—The following table contains an analysis of the private families within each area according to— (a) the number of persons in the family, and (b) the number of rooms occupied by the family. Where more than one family is enumerated within a structurally separate dwelling, each is classified according to the rooms it severally occupies and not to the total number of rooms in the dwelling. If, as occasionally happens, one of the rooms is shared by two families (the allotment to each family being say 4| and 3| in an 8-roomed dwelling) the families are classified to the next higher integral number of rooms (5 and 4 respectively), but in arriving at the totals (column (m) etc.) the actual figures (4i and 3^) have been used. For definitions of " Private family," " Structurally separate dwelling," and " Rooms," see note at heading of table on page 105. Number of Private Families occupying the Following Number of Rooms. Total Private Families. Population in Private Families. Rooms occupied. Average Number of Rooms per Person. Density of Occupation. Population at following densities of occupation (rooms per person). 1 2 3 4 5 6-7 8-9 10 & over. No. % Number of Persons in Family. under •3. • 3 and under •5. • 5 and under •7. •7 and under 10. Cols, a b c d e f g h i 3 k 1 m n o P q r 1 6,908 1,735 614 236 58 65 14 27 9,657 17.0 9,657 14,288 1.48 - - 20 - 2 3,651 5,049 2,575 992 270 299 94 51 12.981 23.0 25,962 30,017 1.16 2 — 7,300 4 3 1.468 4,275 2,851 1.437 395 415 139 89 11,069 19.5 33,207 31,054 0.94 3 4,401 12,825 — 4 513 2,920 2,290 1,376 518 482 182 131 8.412 14.8 33,648 27,343 0.81 2,052 — 11,680 9,160 5 199 1,725 1,497 1,106 438 375 168 144 5,652 10.0 28,260 20,170 0.71 995 8,625 7,485 5,530 6 47 988 929 815 337 311 112 78 3,617 6.4 21,702 13,557 0.62 282 5,928 10,464 2,022 7 14 513 580 545 228 205 91 97 2.273 4.0 15,911 9.345 0.59 3.689 4.060 3,815 2,667 8 8 234 353 378 161 154 59 72 1,419 25 11,352 6,233 0.55 1,936 2,824 4,312 1,232 9 1 104 176 210 93 110 44 58 796 1.4 7,164 3.845 0.54 945 3,474 1,458 666 10 — 28 88 128 61 64 35 30 434 0.8 4,340 2,228 051 280 2,160 990 610 11 2 6 31 42 18 32 25 26 182 0.3 2,002 1,091 0.54 429 660 352 374 12 — 4 9 20 12 19 7 14 88 0.2 1,056 533 0.50 192 384 276 84 13 — - 3 8 3 5 4 5 28 0.0 364 208 0.57 39 195 65 26 14 — - 1 5 — — 5 5 16 0.0 224 136 0.61 84 — 70 42 15 and over — - — — — 3 8 18 29 0.1 496 348 0.70 — 48 286 114 Total Private lies 12,811 17,584 11,997 7,298 2,592 2,539 987 845 56,653 100.0 - - - - - - - Population in vae Families 22,136 35,165 35,990 29,192 12,960 12,567 5,317 5,100 - - 195,345 - - 10,928 32,759 61,398 22,531 Rooms occupied 12,800 35,165 35,990 29,192 12,960 15,950 8,243 10,096 - - - 160,396 0.82 — — 22.6 31.-0 21.2 12.9 4.6 4.5 1.7 1.5 100.0 1921. Percentage of families living in various units of occupation. 21.8 29.7 19.9 11.3 4.9 0.2 3.3 2.9 100.0 1911. " " " " " " " 108 Ages (Quinquennial) Groups and Marital Conditions : Numbers and Percentages. Age last Birthday. Persons. Males. Females. Percentages. Total. Single. Married. Widowed. Divorced. Total. Single. Married. Widowed. Divorced. Males. Females. Sex Percentages. 47.1 52.9 All No 211,366 99,620 54,335 41,307 3,857 121 111,746 59,131 41,551 10,950 114 Acre Per centages. Ages /% - 100.0 54.5 41.5 3.9 0.1 100.0 52. 9 37.2 9.8 0.1 100.0 100.0 0 4,314 2,220 2,220 - - - 2,094 2,094 - - - 2.2 1.9 1 4.783 2,406 2,406 — — — 2,377 2,377 - - - 2.4 2.1 2 2,596 1,277 1,277 — — — 1,319 1,319 - - - 1.3 1.2 3 2.542 1.240 1,240 — — — 1,302 1,302 - - - 1.3 1.2 4 3,043 1,555 1,555 — — — l.488 1,488 - - - 1.5 1.3 5— 9 18,017 9,152 9,152 — — — 8,865 8,865 - - - 9.1 7.9 10—14 18,194 9,048 9,048 — — — 9,146 9,146 - - - 9.0 8.2 15—19. 17,735 8,337 8,277 60 — — 9,398 9,210 187 1 8.4 8.4 20—24 18,414 7,754 6,287 1,463 3 1 10,660 7,647 2,948 61 4 7.8 9.5 25—29 18,787 8,188 3,684 4.449 42 13 10,599 4,564 5,734 282 19 8.2 9.5 30—34 17,236 7.737 2,119 5,526 81 11 9,499 2,755 6,242 486 16 7.8 8.5 35—39 16.163 7,463 1,550 5,770 117 26 8,700 2,049 5,984 640 27 7.5 7.8 40—44 14,798 7,063 1,321 5,534 192 16 7.7:;:, 1,519 5.439 759 18 7.1 6.9 45—49 13,769 6,740 1,186 5,216 322 16 7,029 1,297 4,770 949 13 6.8 6.3 50—54 11,977 5,905 1,020 4,460 413 12 6,072 1,045 3.814 1,907 6 5.9 5.4 55—59 9,384 4.634 740 3,393 489 12 1,750 767 2,691 1,288 4 4.7 4.3 60—64 7.343 3,576 549 2,431 591 5 3,767 594 1.823 1,346 4 3.6 3.4 65—69 5,520 2,644 369 1,681 587 7 2,876 457 1.069 1,349 1 2.7 2.6 70—74 3,494 1,457 200 807 449 1 2,037 327 582 1,128 - 1.5 1.8 75—79 2,026 819 99 381 338 1 1,207 196 196 814 1 0.8 1.1 80—84 872 292 25 110 157 — 580 78 51 450 1 0..3 0.5 85—89 289 100 8 21 71 — 189 32 18 139 0.1 0.2 90—94 59 11 1 5 5 — 48 2 3 43 0.0 0.0 95 and over 11 2 2 — 9 1 — 8 — 0.0 0.0 109 Occupations (Condensed List), by Marital Condition, Industrial Status and Age Groups. Marital Condition. Industrial Status. Retired (excluded from other columns except in Order XXXII). ST. PANCRAS MET. B Age Groups. Total Popn. Ages 0-11 Ages 12 Total over 12. 12-14 14-18 18 upwards. Single. Married. Widowed or Divorced. Employers. Employees. Workers on own account. Males ... 99,620 21,584 78,036 Females 111,746 21,130 90,616 OCCUPATION OF PERSONS OVER 12. Excluding employers, managers and foremen. Males. 1 1 I. Fishermen 1 — — 1 * 106 249 32 12 301 74 17 II. Agricultural occupations 387 — 11 376 69 216 30 2 2.50 63 & Gardeners and their labourers 315 — 5 310 11 8 1 — 20 — 1 III. Mining and quarrying occupations 20 — 1 19 8 11 — — 19 — — IV. Makers of coke, lime, cement, &c 19 — — 19 132 121 11 5 254 5 3 V. Makers of bricks, pottery, glass 264 — 53 211 96 132 8 14 220 2 3 VI. Workers in chemicals, paints, &c. 236 — 29 207 2,295 2,672 191 98 4,828 232 53 VII. Metal workers 5,158 3 552 4,603 296 418 13 — 716 11 3 Fitters 727 — 31 696 176 188 17 25 336 20 8 VIII. Workers in precious metals, &c. 381 — 49 332 433 459 21 17 847 49 3 IX. Electrical appts. makers, fitters, &c. 913 — 111 802 130 148 12 15 232 43 3 X. Makers of watches, clocks, &c. 290 — 34 256 121 168 11 21 253 26 5 XI. Workers in skins ; leather gds. mkrs. 300 — 31 269 46 74 7 10 112 5 2 XII. Textile workers 127 — 9 118 769 1,475 139 227 1,796 360 53 XIII. Makers of tex. gds. & articles of dress. 2,383 124 2,259 441 737 58 - 1,064 172 23 Tailors * ... ... 1,236 — 79 1,157 192 375 50 — 459 158 21 Boot, shoe and clog makers * 617 — 34 583 446 776 03 64 1,175 46 26 XIV. Makers of foods, drinks & tobacco... 1,285 — 72 1,213 28-5 509 to 56 739 39 19 Makers of foods 834 — 49 785 131 225 21 6 370 1 5 Makers of drinks 377 — 19 358 1,396 2,631 255 106 3,936 240 115 XV. Workers in wood and furniture 4,282 — 328 3,954 206 555 53 — 774 40 38 Carpenters* 814 19 795 653 1,025 93 39 1.677 55 37 XVI. Paper workers ; printers, &c. 1,771 — 148 1,623 599 943 ,s.v 32 1,554 45 36 Printers, bookbinders, dec. 1,631 — 136 1.495 496 1,660 141 101 2,103 93 61 XVII. Builders, bricklayers, &c 2,297 — 36 2,261 53 260 27 — 322 18 8 Bricklayers and masons * 340 — 2 338 502 1,558 182 51 2,010 181 60 XVIII. Painters and decorators 2,242 — 32 2,210 773 86.1 92 43 1,603 84 32 XIX-XX. Workers in other materials (including makers of musical instruments). 1,730 207 1,523 16 77 \ — 97 — 8 XXI. Workers in gas, water and elec. supp. 97 — — 97 4,952 8,220 542 61 13,354 296 318 XXII. Transport workers ... 13.714 5 l,8ol 1 1,908 809 2,195 122 3,126 116 Railway workers 3,126 — 70 3,056 1,571 3,653 255 54 5,168 257 101 Road transport workers 5,479 — 473 5,006 2,037 1,434 116 — 3,551 36 22 Messengers and porters 3.587 5 1,212 2,370 2,824 4,464 324 766 4,883 1.963 183 XXIII. Commercial & financial occupations 7,612 1 487 7,124 444 1,840 111 683 611 1,101 89 Proprietors, etc., of dealing businesses 2,395 — 7 2,388 192 360 22 511 r,:; 9 Commercial travellers, canvassers ... 574 — 3 571 1,555 1,281 84 2,920 26 Salesmen, shop assistants, d-c. 2,920 1 435 2,484 41 165 6 3 196 13 9 Insurance officials, agents, efce. 212 212 1,457 1,642 57 3,156 134 XXIV. Public administration and dcfence ... 3,156 — 53 3,103 1,105 1,061 100 102 1,674 490 88 XXV. Professional occupations 2,266 — 51 2,215 120 358 196 544 21 in 4 18 274 769 59 155 15 7 Teachers ... XXVI. Persons empld. in entertainments,&c. 337 942 1 2 21 920 2,126 3,304 246 414 4,880 382 83 XXVII. Persons empld. in personal service ... 5,676 1 287 5,388 263 450 39 155 556 41 22 Innkeepers, barmen, dbc 752 — 13 739 2,595 1,886 162 4,638 5 60 XXVIII. Clerks, draughtsmen, typists, &c. ... 4,643 — 457 4,186 736 1,185 107 o 2,019 7 18 XXIX. Warehousemen, packers, &c. 2,028 — 131 1,997 64 227 14 — 305 — 5 XXX. Stationary engine drivers, &c. 305 — - 303 1,136 2,455 251 5 3,798 39 SI XXXI. All other occupations 3,842 — 79 3,763 951 1,855 183 — 2,989 — 57 General or undefined labourers 2,989 — 60 2,929 25,959 39,285 3,123 2,219 61,296 4,8)2 1,470 Total occupied 68,367 11 5,193 63,163 6,792 2,022 855 — — — — XXXII. Unoccupied, including retired 9,669 3,568 1,740 4,361 32,751 41,307 3,978 — — Total occupied and unoccupied 78,036 3,579 6,933 67,524 (7947) ° 3 110 Occupations (Condensed List), by Marital Condition, &c.—contd. Marital Condition. Industrial Status. Retired (excluded from other columns except in Order XXXII). ST PANCRAS MET. B. Total over 12. Age Groups. Single. Married. Widowed or Divorced. Employers. Employees. Workers on own account. Total Popn. Ages 0-11 Ages 12 12-14 14-18 18 upwards. Males ... 99,620 21,584 78,036 Females 111 746 21.130 90,616 OCCUPATION OF PERSONS OVER 12. *Excluding employers, managers and foremen. Females. 1,114 in 45 7 1,253 10 7 I-XI. See Males 1,270 — 368 902 370 5 4 — 379 — 1 Makers of bricks. pottery d- glass ... 37!) — 156 223 217 37 10 1 263 — 2 Metalworkers 264 — 64 200 141 30 14 1 180 4 3 Workers in skins, leather gds. mlcrs. 185 — 26 159 96 12 8 1 108 7 — XII. Textile workers 116 — 24 92 4,109 804 610 79 4,779 665 80 XIII. Makers of tex.gds. & articles of dress 5,523 1 881 4,641 005 284 187 — 1,307 69 12 Tailoresses 1,376 — 186 1,190 1,794 255 192 — 1,818 423 32 Dress and blouse makers 2,241 — 343 1,898 1,117 155 178 — 1,293 157 30 Embroiderers, milliners* dec. 1,450 1 306 1,143 481 136 45 5 655 2 5 XIV. Makers of foods, drinks, tobacco ... 662 — 106 556 513 97 61 657 14 12 XV. Workers in wood and furniture 671 133 538 1,387 142 77 3 1,595 8 6 XVI. Paper workers, printers, &c. 1,606 — 517 1,089 696 85 43 2 819 ■J 2 Printers, bookbinders, d:c. 824 — 261 563 835 (305 101 42 48 19 6 961 663 17 8 4 4 XVII-XXI. See Males XXII. Transport workers 984 666 — 240 226 744 440 280 8 1 — 289 — 3 Telegraph and telephone operators 289 — 34 255 2,038 629 336 89 2,472 442 20 XXIII. Commercial & financial occupations 3,003 301 2,642 172 203 188 78 130 355 11 Proprietors, dec., of dealing businesses 563 — 562 1,745 346 90 — 2,181 — 7 Shop assistants, <fee. ... 2,181 — 350 1,831 838 39 42 — 919 — 10 XXIV. Public administration and defence... 919 — 39 880 -.488 176 168 17 2,538 277 82 XXV. Professional occupations 2,832 — 25 2,807 1,100 37 85 9 1,101 112 30 Midwives, nurses, dec. 1.222 — 11 1,211 736 89 52 7 786 84 48 Teachers 877 — 2 875 311 168 40 3 455 61 4 XXVI. Persons emp'.d. in entertainments,&c. 519 32 487 6,994 3,407 2,949 207 12,661 482 167 XXVII. Persons empld. in personal service... 13,350 — 695 12,655 4,594 1,081 1,193 — 6,868 — 112 Domestic servants 6,868 — 494 6,374 175 235 212 104 185 333 o Lodging-house keepers 622 — 2 620 299 831 208 224 81 82 51 521 1,136 16 1 4 I I nnkeepers, barmaids Waitresses 588 1,137 — 10 65 578 1,072 238 249 152 578 55 21 Laundry workers 639 — 63 576 311 1,069 995 — 2,339 36 21 Charwomen 2,375 — 8 2,367 4,566 240 122 4,928 5 XXVIII. Clerks, typists, &c. ... 4,928 795 4,133 1,041 89 33 — 1,163 — 5 XXIX. Warehousewomen, packers, &c. 1,163 — 306 857 179 95 37 2 304 5 5 XXX-XXXI. See Males 311 — 44 267 27,595 6,288 4,640 419 36,111 1,993 416 Total occupied 38,523 1 4,792 33,730 10,406 35,263 6,424 — —■ — — XXXII. Unoccupied, including retired 52,093 3,655 2,490 45,948 38,001 41,551 11,064 — — — — Total occupied and unoccupied 90,616 3,656 7,282 79,678 111 Occupations : Comparative Figures. Proportion of Occupied Persons per Thousand total Persons in Various Age Groups, 1921 and 1911 (where known). Males. (Ages last birthday.) 12-13 14-15 16-19 20-44 45-64 65-69 70 & over 1921 3 589 928 964 953 852 456 1911 * 730 941 982 951 596 Females. (Ages last birthday.) Married Women only. 12-13 14-15 16-19 20-44 45-64 65-69 70 & over 44 and under 45 and over 1921 0 492 810 466 335 263 97 157 142 1911 * 532 800 441 336 177 * * * Information for 1911 not available. Birthplaces of the Population. Where Born. Males. Females. Total 99,620 111,746 England 89,134 102,041 Wales 748 983 Scotland 1,313 1,270 6 Northern Counties* Ireland Remainder of Ireland Part not defined 190 218 940 1,476 45 92 Isle of Man & Channel Islands ... 110 161 Other British Dominions, Colonies, &c 963 789 Europe: Gibraltar 15 10 Malta and Gozo 26 24 Cyprus 21 2 Asia : Indian Empire 231 232 Ceylon 35 24 Other Colonies in Asia 29 17 Africa : Union of South Africa 102 107 Egypt 35 11 West African Colonies 25 8 Other African Colonies 14 12 America : Dominion of Canada 110 113 Newfoundland 3 3 West Indies 85 44 Other Colonies in America 15 7 Australasia : Australian Commonwealth 150 140 New Zealand 61 34 Other Australasian Colonies — 1 Dominion, Colony, &c., notstated — Foreign Countries (see next table) 5,209 3,785 Born at Sea (see next table) 37 35 Birthplace not stated 919 896 112 Foreign-Born Population by Country of Birth and Nationality. Note.—The population bom at sea is included in this table also for convenience. For the number of persons of unknown (in some cases possibly of foreign) birthplace, see previous table. Country. Distribution by Country of Birth. Distribution by Country of Nationality of Aliens included in cols, i and j. Residents. Visitors. Total Persorts. British Subjects by Birth. British Subjects by Naturalization. Alien Nationality. Nation ality not stated. Cols, a b c d Males, e Females, f Males, g Females, h Males, i Females, j Males, k Females. 1 Males, m Females, n ALL FOREIGN COUNTRIES 8,709 357 9,066 233 256 311 360 3 663 2,448 1,039 756 3,663 2,448 Residents — - 8,709 227 251 309 357 3,512 2,317 1 001 735 3512 2317 Visitors — — 357 6 5 2 3 151 131 ' 38 21 151 2,317 131 EUROPE— 5 Austria 101 9 110 3 3 6 8 51 24 10 151 Belgium 641 12 653 7 13 8 21 202 244 82 76 22 Czecho-Slovakia 260 3 263 - - 13 5 161 25 48 11 232 Denmark 153 19 172 2 2 5 5 83 50 21 4 165 83 36 Finland 19 — 19 — — 1 1 8 8 1 6 53 5 France 1.470 39 1,509 38 40 14 66 478 596 107 170 457 541 Germany 735 3 738 26 23 57 69 268 182 61 52 265 541 Greece 37 4 41 3 1 2 1 23 6 2 3 265 150 Hungary 40 — 40 1 1 5 1 9 8 7 8 28 13 Italy 1,378 22 1,400 5 7 16 8 675 300 256 133 1U 693 14 322 Jugo-Slavia 28 1 29 - - 2 - 20 3 4 - Netherlands 233 11 244 4 6 12 12 105 71 21 13 23 3 Norway 36 7 43 1 - 2 3 14 14 6 3 110 82 Poland 1,035 46 1,081 5 3 75 48 424 337 110 79 14 16 Portugal 19 — 19 1 3 - - 10 5 - - 11 318 3 Roumania 98 8 106 1 4 3 45 37 9 7 38 36 Russia 837 11 848 23 28 59 55 298 228 82 75 341 Spain 78 17 95 4 4 4 53 16 11 3 <Hl 281 Sweden 125 10 135 2 4 3 76 22 19 9 56 76 15 Switzerland 657 26 683 1 6 7 14 400 143 81 y 31 405 21 160 Turkey 19 - 19 4 1 - 1 6 2 3 2 3 1 Other Countries in Europe 35 — 35 1 3 3 1 14 9 4 3 13 5 ASIA— Armenia 7 — 7 2 - - - 5 - - - 11 - China 78 2 80 5 8 2 - 35 7 22 1 32 4 Japan 47 8 55 1 4 37 5 9 4 1 Other Countries in Asia 37 5 42 5 5 1 1 23 4 3 4 10 2 113 AFRICA 15 - 15 4 — — 1 7 2 1 — 2 1 AMERICA— United States 310 76 386 41 47 12 26 95 86 40 39 112 85 Argentina 41 8 49 6 11 — 12 8 7 5 9 10 Brazil 11 3 14 6 1 — — 2 3 — 2 2 2 Chile 10 — 10 3 3 — 1 1 1 1 — 1 2 Mexico 8 2 10 — 4 — — 4 2 — — 5 — Other Countries in America 20 3 23 4 3 — — 16 — — — 11 4 UNSPECIFIED FOREIGN COUNTRY 21 — 21 4 4 1 — 3 — 3 6 — — BORN AT SEA 70 2 72 23 22 — 2 — — 14 11 — — Orphanhood of Children under 15, in Age Groups. Age last Birthday. Persons. Males. Females. Total. Both parents alive. Father dead. Mother dead. Both parents dead. Not known or no statement. Total. Both parents alive. Father dead. Mother dead. Both parents dead. Not known or no statement. 0-14 53,489 26,898 23,328 2,327 493 89 661 26,591 23,138 2,242 484 119 608 0- 4 17,278 8.698 8.153 320 47 3 175 8 580 8,057 293 63 10 157 5-9 18,017 9,152 7,827 881 172 31 241 8,865 7,590 862 151 44 218 10-14 18,194 9,048 7,348 1,126 274 55 245 9,146 7,491 1,087 270 65 233