Ac 4355 Stpan81 Metropolitan Borough of St. Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR - 1923. G. SOWDEN, M.D., D.P.H., Barrister-at-Law. Printed by F. P. Lewingdon, 26 and 27, Eversholt Street, London N.W. 1. Metropolitan Borough of St. Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1923. G. SOW DEN, M.D., D.P.H., Barrister-at-Law. 2 a CONTE NTS. page. Map of Borough, showing statistics by Wards 2 Public Health Committee 5 Staff of Public Health Department . 6 Introduction 8 Summary of Report 9 Section I.—Vital Statistics and Economic Conditions. Population and General Statistics 10 Marriages 10 Births 10 Illegitimacy 11 Notification of Births 11 Deaths11 Infantile Mortality 13 Deaths—Illegitimate Infants 17 Economic Conditions 17 Poor Law Relief. 17 Hospital Accommodation 18 Section II. —Maternity and Child Welfare. 19 Advice Cards 19 Home Visiting 19 Centres 20 Dental Clinic 24 Clinic for Sick Mothers and Children 24 Supply of Food to Mothers and Children 25 Home for Sick Poor Children 26 Day Nurseries 26 Home Helps 27 Home Nursing 27 Midwifery 28 Government Grants 30 Section III.—Prevalence of and control oyer Infectious Diseases. Table of Notifiable Diseases 31 Do. Monthly Number of Notifications 32 page. Table of Monthly Number of Deaths 33 Do. Notifications past 10 years 34 Do. do. and Deaths in Wards 35 Smallpox 36 Vaccination 36 Scarlet Fever 37 Diphtheria 38 Typhoid Fever 39 Tuberculosis 39 Home Visits and Investigations 45 Dispensaries 45 Sanatoria, etc 47 Special Methods of Diagnosis and Treatment 47 Care Committee 47 Puerperal Fever 49 Epidemic Cerebrospinal Meningitis 49 Acute Polioencephalitis and Poliomyelitis 50 Ophthalmia Neonatorum 51 Encephalitis Lethargica 51 Pneumouia 52 Other Notifiable Infectious Diseises 52 Measles and German Measles 53 Whooping Cough 63 Diarrhoea and Enteritis 54 Influenza 55 Syphilis 55 Cancer 55 Disinfecting and Cleansing Station 56 Disinfection of Verminous Articles 58 Section IV.—Sanitary circumstances of the District. Inspections 58 Notices served and result of service 59 Nuisances—Legal Proceedings 60 Premises and Occupations controlled by by-laws and regulations 61 4 CONTENTS—continued. page. Offensive Trades 61 Registered Tenement Houses 61 Underground Rooms 61 Smoke Prevention 61 Constructional Drain Work 61 Drainage Register 61 Water Service 62 Canal Boats Acts 62 Inhabited House Duty 62 The Rag Flock Act, 1911 62 Inquests 62 Factory and Workshop Acts 63 Inspections 63 Defects found 63 Home Work 64 Registered Workshops 64 Schools 65 Medical Examination of School Children 66 Feeding of School Children 68 Infectious Diseases in Schools 68 School Clinics 68 Section V.—Food. (a) Milk Supply 70 Dairies, Cowsheds and Milkshops 70 Milk and Dairies (Amendment) Act, 1922 70 Milk (Special Designations) Order, 1923 71 Pasteurised Milk 72 Milk and Cream Regulations 72 (b) Other Foods 74 Unsound food condemned and destroyed 74 Slaughter-houses 74 Fried Fish and Fish Curing Premises 74 Page. Ice Cream Premises 74 Bakehouses and Restaurant Kitchens 74 (c) Sale of Food and Drugs Acts 75 Prosecutions 76 Wholesale Dealers in Margarine 76 Section VI.—Sanitary Administration. Staff 76 Chemical and Bacteriological Work. . 77 Section VII.—Other Services 77 Section YIII.—Housing 77 General Housing conditions 77 Statistics 78 Work of the Estates Committee 79 Appendix. Table No. 1. Vital Statistics for 11 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 Horoughs 93 Do. 6. Meteorology .94 Do. 7. Inspections and reinspections (District and other Inspectors) 95 Do. 8. Do. (Food Inspectors) 9t! Do. 9. "Visits by Women Inspectors 98 Do. 10. Inspections and reinspections by individual Inspectors 99 Tables Nos. 11, 12, 13 and 11. Details of Intimation Notices served and resulting Statutory Notices 100 5 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. 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. Cosbdrn, 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. November, 1923, to October, 1924. CHAIRMAN. Councillor Dr. Edward Andrew Gregg (Ward 5). DEPUTY-CHAIRMAN. Councillor Mansell James Swift (Ward 7). EX-OFFICIO. The Right Worshipful The Mayor (Councillor Rupert Frederick William Fincham, J.P.). ALDERMEN. Cosbcrn, Major George Frederick, J.P., M.A.B. Davies, David, J.P., L.C.C. Davis, Abraham, J.P. Johnson, Job, J.P. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 2 Bland, Mrs. Violet. 2 Brown, Percival George Edward. 1 Caunt, Charles George. 8 Crosby, Miss Ada, M.B.E. 5 Escott, Arthur, M.A.B. 8 Evans, Evan. 6 French, Alexander George. 1 Kempton, Thomas. 5 Kent, Miss Beatrice. 4 Lloyd-Taylor, William, J.P. 3 Morrell, Rev. Roger Conyers, M.A. 3 Nicholls, Henry. 6 Perry, James. 7 Porter, Henry Thomas. 1 Solomon, Alfred, J.P. 8 Towers, George Andrew. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1923. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. G. Sowden, M.D., D.P.H. TUBERCULOSIS OFFICER. N. M. DONNELLY, M.B., B.CH., B.A.O., D.P.H. ASSISTANT MEDICAL OFFICER. Stella Chukchii.i., 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. Inspectors of Food and Food Places. §11W. G. Auger. §¶H. R. Child. Inspector of Workshops and Factories. J§B. H. Thompson. District Inspectors. §G. Rackham. ‡G. W. Adkins. *‡§¶J. I. Lonnon. ‡R. C. Akers. ‡§W. L. Brown. ‡M. Jaffa. §E. M. Dillon. ‡¶US. W. Capel. *‡§¶A. H. Walker. ‡¶H. K. Nixon. ‡§R. E. James. Woven Sanitary Inspectors. ‡Miss M. E. Bibby, B.A. (Lond.) JIIMiss Y. K. Blaxland.† ‡||Miss C. Smith.t ‡||Miss D. M. Parnell. ‡||Miss A. Holland.? ‡||+Miss J. A. J. Camman.† Health Visitors. ‡§Mrs. A. Hcntek. ‡§||Miss F. A. Anderson. CLERICAL STAFF. Chief Clerk A. Powell Coke, Barrister-at-Laic. First Clerk A. G. Capel. Second Clerk A. Carpenter. Clerk G. N. Cove [attached to the Estates Dept.). „ (Vacant) „ T. H. Hague. „ Miss A. Andrews. Junior Clerk S. Barker. Junior Clerk (Vacant.) Temporary Clerk . . L. Higoins. „ E. Winchester.†† „ J. B. Richards. ,, Miss G. Wood. Temporary Milk Enquiry Officer—II. G. West.§ + Sanitary Inspectors and Health Visitors, †† Resigned in December, 1923. * Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Koyal San. Inst. ¶ Cert. .Meat and other Foods. || Health Visitor's Certificate, + C.M.B. * BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. Medical Officers. No, of Consultations per month. Dr. Margaret E. Alden 5 Dr. Chas. H. A. Alderton 4 Dr. B. Marion Cockerell 15 Dr. A. Gertrude Gkogan 8 Dr. J. Finch Haines 8 Dr. Janie Lorimer Hawthorne 8 Dr. Ethel F. Iredell 4 Dr. Lydia A. Leney 12 Dr. Jessie S. Muir 12 Dr. Balfour Neill 8 Dr. J. Sherwood New 4 Dr. Margaret R. Paterson 4 Dr. Mary J. Pirret 14 Dr. Francis L. Provis 13 Dr. Muriel Radford 4 Dr. Alfred R. Roche 4 Dental Clinic. Mrs. W. A. Murch, L.D.S., Daitist 8 Dr. Jas. Macghan, Anaesthetist. Mr. Southcomb May, L.D.S., Dentist at Tuberculosis Dispensary. (The above are part-time officers.) Superintendents oj Maternity and Child Welfare Centres. ¶Miss K. L. Allfrey. §Miss M. Manger. *‡Miss G. R. Bristow. †§Miss E. L. May". ‡§Mrs. E. Crockart. ¶Miss M. Smyth. ‡§Miss M. H. Landel Jones. §Miss M. Templeton. §Miss A. Mullock Jones. Assistant Visitors at Maternity and Child Welfare Centres. •†Miss L. Auger. ‡ Miss A. M. U. Harrop. ‡§Miss M. L. Blair. §Mrs. E. Lukie. §Mrs. E. E. Bruce. *‡§Mrs. J. Lynn. ‡§Mrs. S. C. Chapman. ‡§Miss E. M. Kobinson. *‡Miss M. A. Clarke. ‡§Mrs. M. A. Smith. ‡§Miss B. M. Harris. Tuberculosis Dispensary. Nurse Visitor, Miss S. A. Long. Clerical and General Assistant, Miss Margaret Deed. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station H. Catch. Stoker and General Assistant T. Bartholomew. Assistant Disinfector J. Stanley. ,, A. J.Dibbf.n. Matron of Personal Cleansing Station .Mrs. E. Mace. Assistant at „ ,, Mrs. A. Styles. M rs. L. Blaby. Resident Caretaker, Mortuaries and Coroner's Court J. Root. (The above are full-time officers.) * Cert. San. Insp., Examination Board, †San. Insp. Cert, lio.yal San. Inst. ‡ Health Visitor's Certificate. § O.M.B. ¶Midwifery Certificate, Queen Charlotte's Hospital. 8 Public Health Department, Town Hall, Pancras Road, N.W. 1. April, 1924. 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-Eighth Annual Report on the vital statistics and sanitary conditions of the Borough, including particulars of the work carried out during the year by the staff of the Public Health Department. This is the first annual report which it has been my duty to submit to the Borough Council. The statistics for the year present several highly satisfactory features: the death-rate, the rate of infant mortality, and the incidence of notifiable infectious diseases all being the lowest hitherto recorded in the borough. The deaths from tuberculosis were 43 less than during the previous year, the deathrate from this disease also being the lowest yet recorded. The birth-rate shows a further decline, being lower than any one of the preceding three years. The most unsatisfactory feature is that relating to housing conditions. Overcrowding continued to be prevalent; but, owing to the absence of any other accommodation, it was in most cases, not only useless, but undesirable to take action in the matter. I must not omit to place on record the resignation of my predecessor, Dr. T. Shadick Higgins, which took effect in June last, after ten years' service. In conclusion, I should like to express my appreciation of the valued assistance so willingly accorded to me by the staff of the Public Health Department during the period I have held office. I am, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. 9 SUMMARY OF REPORT FOR 1923. Area of Borough, 2,694 acres. Area of various open spaces, 373 acres. Soil and Situation.—Practically the whole of the Borough is situated on London clay. There are a few superficial deposits of gravel in the south, and lower Bagshot sands in the extreme north. The Borough is about four miles long, extending from near Oxford Street in the south to Highgate in the north, and averages about a mile in width. Population (J 921 Census), 211,366. Population (1923), 214,400; persons per acre, 80. Number of inhabited houses, 24,660 (1921 Census). Births, 4,348; birth-rate, 20'3 per 1,000 of population. Deaths, 2,585; death-rate, 12.1 per 1,000 of population. Excess of births over deaths, 1,763. Infantile mortality, 63 per 1,000 births. Tuberculosis (all forms), death-rate, 1.3 per 1,000 of population. Rateable value, £1,817,133. Sum produced by a penny rate, £7,393. Total rainfall, 27.03 in. Comparative Statistics. Rate per 1,000 of Population. Rate per 1,000 Births. Birth-rate. Death-rate. Infant Mortality. England and Wales 19.7 11.6 69 105 Great Towns 20.4 11.6 72 Countv of London 20.2 11.2 60 St. Pancras 20.3 12.1 63 16 Metropolitan Borough of Saint Pancras. R E PORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1923. / For the purpose of this Report, the year consists of the 52 weeks ended 29tli December, 1923. Section I.—VITAL STATISTICS AND ECONOMIC CONDITIONS. POPULATION AND GENERAL STATISTICS. The population of the Borough at the Census in 1921 was 211,366. The RegistrarGeneral's estimate of the population at the middle of 1923 was 214,400. All the rates in this report are calculated on the above estimate. This estimated population shows an increase of 1,900 over that for the preceding year. The natural increase, that is the excess of births over deaths, was 1,763; the difference represents the allowance for immigration to the Borough. This latter figure is necessarily small, as the building of new houses proceeds with lamentable slowness. Any marked increase in population at present merely results in accentuating the overcrowding of persons in existing houses and tenements MARRIAGES. The number of marriages celebrated in 1923 was 1,900. This is equal to a rate of 8-9 per 1,000 of total population. BIRTHS. The number of births belonging to St. Pancras registered during the year was 4,348, making an annual birth-rate of 20.3 per 1,000 of population. The total number of births actually registered as having taken place in the Borough was 4,654. This figure has to be corrected by adding the births of parishioners which occurred outside the Borough—these numbered 610—and by deducting ihe births of non-residents which occurred in various institutions, &c., in the Borough—these numbered 916. The corrected figure is therefore 4,348 as stated above. The corresponding figures for previous years, and for the different wards and registration sub-districts, will be found in Tables 1 and 4, on pages 86 and 92. CHART shewing BIRTH RATE for the BOROUGH during the past 20 Years. CHART shewing DEATH RATE for the borough during the past 2OYears 11 The following table shows the figures for each quarter during the past ten years :— Year. Number of Births (Uncorrected). Total for Year (Uncorected). Total for Year (Corrected). 1st Qtr. 2nd Qtr. 3rd Qtr, 4th Qtr. 1914 1222 1234 1271 1218 4945 5225 1915 1259 1129 1036 1034 4458 4754 1916 1048 1140 1050 1072 4310 4530 1917 1046 974 797 818 3635 3796 1918 842 840 848 809 3339 3318 1919 775 747 977 1305 3804 3824 1920 1806 1581 1453 1351 6191 5934 1921 1325 1308 1241 1225 5099 4764 1922 1326 1288 1169 1082 4865 4559 1923 1215 1193 1167 1079 4654 4348 1338 births occurred in Public Institutions in St. Paneras, equal to 29-0 per cent, of the total births which took place in the Borough. Table 5, on page 93, shows the birth-rate for 1923 of England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns having populations exceeding 125,000. Illegitimacy. Of the 4,348 net St. Paneras births, 247, or 5.7 per cent., were returned as illegitimate. The corresponding figures for the preceding 10 years were as follows:— Year. Rate, Year. Rate. 1922 5.6 per cent. 1917 7.2 per cent. 1921 5.5 ,, 1916 7.0 ,, 1920 5.6 ,, 1915 5.4 ,, 1919 8.4 „ 1914 4-4 1918 9.5 ,, 1913 4-7 „ Notification of Births. 4,569 notifications of births were received during the year, including 121 still-births and 4,448 live births, or 96 per cent, of the births registered as having taken place in the Borough. Details in regard to notification will be found on page 28. DEATHS. The net number of St. Paneras deaths registered during the year was 2,585; this equals an annual death-rate of 12,1 per 1,000 of population. This is the lowest death-rate hitherto recorded in the Borough. The actual number of deaths registered as having occurred in the Borough was 2,735. This figure has to be corrected by the exclusion of 634 deaths of persons who were not St. Paneras residents, and by the inclusion of 484 deaths of residents which occurred and were registered outside the Borough. The corrected figure of 2,585 is used in calculating the rates in this report. In Table ], on page 86, will be found the corresponding figures for previous years. The principal causes of death during the year are stated in the following table, and for comparison, the figures for the previous 10 years are also given:— 12 Diseases. 1913 1914 191.S 1916 '917 1918 1919 1920 1921 1922 Average for 10 years. 1923 Heart Disease 305 358 439 375 404 389 370 442 435 461 398 394 Cancer 285 251 258 267 281 269 245 299 290 302 275 319 Tuberculosis—All forms 392 432 500 423 441 485 311 312 304 315 395 272 Bronchitis 338 250 322 290 250 228 301 236 276 308 280 223 Pneumonia 34' 311 331 232 254 376 179 197 173 265 266 201 Premature Birth, Debility and Congenital Defects 191 164 187 176 144 132 162 201 149 134 164 134 Injuries 148 150 15° 112 125 119 108 92 88 127 122 113 Cerebral Hemorrhage, Embolism, and Apoplexy 116 141 169 119 116 131 91 98 126 120 123 112 Nephritis and Bright's Disease 101 112 132 103 104 98 61 95 60 67 93 79 Diarrhoea and Enteritis 148 142 114 72 97 56 68 54 98 47 90 61 Whooping Cough 36 40 52 39 27 80 7 60 38 29 42 28 Influenza 42 13 35 35 21 700 260 46 57 142 135 24 Diphtheria and Croup 19 3° 24 23 25 31 21 33 51 44 30 20 Puerperal Fever 2 7 5 4 5 2 9 8 4 4 5 9 Rheumatic Fever 6 10 11 7 7 8 7 6 16 15 9 8 Pleurisy 12 5 11 13 10 14 9 12 7 10 10 8 Measles 36 S3 63 42 118 75 15 65 23 107 60 5 Erysipelas 10 9 11 3 3 11 9 12 3 12 8 4 Scarlet Fever 6 19 22 8 4 7 5 11 1 20 11 3 Enteric Fever., 6 4 8 5 6 5 2 1 3 1 4 3 This analysis shows a decrease in deaths from the respiratory diseases—bronchitis, pneumonia and pleurisy; the deaths from heart disease were about the average ; those from cancer show a further increase. Deaths from infectious diseases of all forms were very few in number, and it is chiefly due to this factor that the death-rate for the year is so low. The deaths during the year are fully classified for causes, age, and sex in Table 2 on page 87. For purposes of comparison the death-rates for England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns, are given in Table 5 on page 93. It will be noticed that 21 Metropolitan Boroughs have a lower and six a higher deathrate than St. Pancras. Of the total 2,585 St. Pancras deaths which occurred during the year, 1,549 took place in Public Institutions, either within or without the Borough; this equals a proportion of 60 per cent, of the total deaths. DIAGRAM shewing Relative Importance qfVarious Diseases as Causes of DEATH during 1925. 13 Ward Death-Kates. The death-rates per 1,000 of population for each of the wards were as follows. The figures for the previous year are also given for comparison:— Death-rate. Death-rate. 1922 1923 1922 1923 Ward 1 12.1 10.9 Ward 5 15.0 12.5 Ward 2 14.9 10.7 Ward 6 18.3 13.4 Ward 3 15.2 12.1 Ward 7 12.6 11.2 Ward 4 . 15.6 12.9 Ward 8 12.5 11.7 Further details of tlie deaths and death-rates for the different wards and registration sub-districts will be found in Table 4, on page 92. Infantile Mortality. 272 deaths of infants under one year of age took place in St. Pancras during the year. This is equal to a rate of 63 per thousand births. It is one of the most gratifying features of this report to be able to state that the infant death-rate during the past year was by far the lowest ever recorded in the Borough. The previous lowest rate was in 1920, when the infant death-rate was 73 per thousand births. The figure for the past year shows, therefore, an improvement of no less than 10 per thousand over the lowest previously recorded. In Table 1, on page 86, the corresponding rates for previous years are given, and in Table 4, on page 92, the figures will be found for the different wards and registration subdistricts, and in Table 5, on page 93, the infant mortality rates in England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns with populations exceeding 125,000. The principal factors which contributed to the low infant death-rate of 1923 were the small number of deaths from measles and whooping cough, and, consequently, fewer deaths from bronchitis and pneumonia, which are common complications of the two first-named diseases. The number of deaths due to diarrhoea and enteritis was also low. These complaints are usually prevalent in hot, dry, summer months, and, being largely caused by food contamination, chiefly attack artificially-fed infants. In this connection it is fair to assume that the work and teaching of the Infant Welfare Centres of the Borough have especially contributed to the success achieved. Excluding the above-mentioned diseases, the other chief causes of infant mortality were premature birth, congenital malformations, and debility. During the past year these affections were responsible for 46 per cent., and during the past 10 years were the cause of from 30 to 40 per cent. of the total annual infant mortality. It is important also to note that in nearly all these cases the infants died daring the first week of life—it is obvious that infant welfare work can do little to diminish mortality at so early a period. The causes, no doubt, are primarily due to parental affections, and it is to be hoped that an extension of work in the ante-natal clinics will be successful in reducing this high mortality. In the Tables on the next three pages are shown:— (1) The causes of death of children under 12 months of age during 1923, classified according to age at death ; and (2) The causes of death of children under 12 months of age during the ten previous years. In this Table the number of births in each year is also stated for reference. (3) The principal causes of death of children under 5 years of age during 1923 and the four previous years. 14 1923. Nett Deaths from stated cadses at various Ages under 1 Year of Age. CAUSE OF DEATH. Under I week. 1 —2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks & under 3 mouths. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox — — —; — — - Chicken-pox - — — — - - — — — — Measles — — - — — — 1 — — 1 Scarlet Fever — —. — — — — — — — — Whooping-Cough — — — — — 1 2 3 2 8 Diphtheria and Crough — — — — — — — — — - Erysipelas — — — — — — 1 — — 1 Influenza — — — . — - — — — — — Tuberculous Meningitis - - - - - i 1 1 1 4 Abdominal Tuberculosis — — — - — — — 1 — 1 Other Tuberculous Diseases . — — — — — — — — 2 2 Meningitis (not Tuberculous) - - - - - - 2 1 3 Convulsions 4 — — - 4 — — — 1 5 Laryngitis 1 — — — 1 - — — — 1 Bronchitis — - 1 1 2 2 6 2 — 12 Broncho-pneumonia 3 1 5 3 12 3 6 7 6 34 Lobar-pneumonia ... - — — — -- — — — 1 1 Pneumonia (type not stated) — — — — — — 1 — — 1 Diarrhoea — — — — — 2 1 2 1 6 Enteritis — — — — — 5 14 14 4 37 Gastritis — — — — — 1 — — — 1 Syphilis - — — — — 2 2 1 — 5 Rickets - - - - - - - - - - Suffocation (overlying) 1 — — — 1 — — — — 1 Injury at birth 6 — — — 6 — — — — 6 Atelectasis 8 — 1 — 9 — — — — 9 Congenital Malformations 11 2 2 2 17 6 3 — 1 27 Premature birthh 55 4 5 2 66 4 — — — 70 Atrophy, Debility and Marasmus 5 2 2 — 9 7 5 — — 21 Other causes 1 — - 1 2 2 2 6 3 15 Totals 95 9 16 9 129 36 45 39 23 272 Nett Births in the year Ilegitimate 1101 'illegitimate.247 Nett Deaths in the year of legitimate infants 234 illegitimate infants 38 15 Deaths from Stated Causes under 1 Year of Age for 1923 and 10 preceding Years. CAUSE OF DEATH. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Average for 10 years. 1923 Small-pox — — — — - - - - Chicken-pox 1 — 1 — — - - Measles 10 8 17 14 30 16 4 21 7 15 14 1 Scarlet Fever 1 — — - — — 1 3 Whooping Cough 12 23 24 15 14 27 2 18 18 11 16 8 Diphtheria and Croup 1 4 — 2 1 1 2 2 1 Erysipelas 3 2 2 — 1 1 1 1 1 Influenza - 1 — 1 — 18 11 2 2 7 4 Tuberculous Meningitis 5 3 8 5 4 8 4 6 4 3 5 4 Abdominal Tuberculosis — 2 1 1 2 1 1 — 1 1 1 1 Other Tuberculous Diseases 8 3 6 5 7 3 2 2 3 7 5 2 Meningitis (not Tuberculous) 8 4 8 7 10 3 6 7 3 2 6 3 Convulsions 16 11 5 9 5 3 6 7 8 8 8 5 Laryngitis — — 1 — 1 — 1 Bronchitis 26 17 27 17 16 17 23 27 13 21 20 12 Broncho-pneumonia 79 59 57 40 47 29 24 60 39 54 49 34 Lobar-pneumonia 2 6 3 4 4 6 1 5 1 3 4 1 Pneumonia (type not stated) 7 10 9 6 9 9 8 4 3 6 7 1 Diarrhœa 22 24 15 6 8 6 10 11 11 4 12 6 Enteritis 73 82 64 35 52 31 37 26 63 27 49 37 Gastritis 2 — 3 2 4 1 3 o 2 — 2 1 Syphilis 14 15 9 14 16 13 11 15 14 8 13 5 Rickets - 1 1 4 2 — — 1 1 1 1 Suffocation (overlying) 14 18 8 9 13 6 1 2 2 5 8 1 Injury at Birth 4 3 10 4 3 2 6 5 3 3 4 6 Atelectasis 3 5 6 9 9 8 7 10 8 4 7 9 Congenital Malformations 24 23 25 34 19 17 31 33 25 31 26 27 Premature Birth 93 84 92 75 61 50 68 105 75 61 76 70 Atrophy, Debility and Marasmus 53 38 47 43 44 46 45 40 34 28 42 21 Other causes 31 35 48 24 20 18 24 24 18 23 27 15 Totals| 512 431 497 385 402 340 336 435 360 337 408 272 Nett Births 5517 5255 4754 4530 3796 3318 3824 5934 4764 4559 4622 4343 16 Table showing Deaths of Children under 5 Ye\rs of Age, at various Age periods, and the principal causes of death, Yeak. Total Number of Births. Number of Deaths from all causes of children:— Number of Deaths from Diarrhcea and Enteritis. Number of Deaths from Measles and Whooping Cough. Number of Deaths from Kronchitis and Pneumonia. Number of Deaths from Injury at Birth, Debility, Premature Firth, and Congenital Defects. Under 1 year. 1 to 2 years. 2 to 5 years. Total under 5. Under 1 year. 1 to 2 years. 2 to 5 years. Under 1 year. 1 to 2 years. 2 to 5 years- Under 1 year. 1 to 2 years. 2 to 5 years. Under 1 week. Total under 4 weeks. Total under 1 year. 1919 3824 336 73 77 486 47 5 3 6 4 8 56 23 17 82 110 157 1920 5934 435 99 91 625 37 5 2 39 50 30 96 21 9 101 141 193 1921 4764 360 81 54 495 74 8 1 25 24 11 56 19 12 75 105 145 1922 4^59 33? 153 128 618 31 5 1 26 60 36 84 47 33 63 87 127 1923 4348 272 67 69 408 43 9 — 9 17 6 48 25 18 85 107 133 17 Deaths of Illegitimate Infants. Of the 272 deaths of Infants under 1 year of age, 38 were illegitimate, equal to a deathrate of 154 per thousand illegitimate births, as compared with a death-rate of 57 per 1000 legitimate births. Economic Conditions. Whilst there is, doubtless, a close connection between public health and such conditions as bad housing, unemployment and consequent poverty, yet statistics seem to indicate that the effects of these conditions have not been so deleterious as might have been anticipated. During the year under review housing conditions in the Borough were very bad, and unemployment was acute, yet, notwithstanding these factors, the death-rale was the lowest recorded. The probable explanation is that the various relief measures (unemployment grant, relief by the Guardians, etc.) were sufficient to obviate any actual want, and so long as the body is fairly well nourished there is considerable natural resistance to disease, despite bad conditions of environment. The amount of out-relief granted during the past 7 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 on out-door relief and the number 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 3079 871 Lady day, 1918 3382 852 Michaelmas, 1918 3461 771 Lady day, 1919 3814 754 Michaelmas, 1919 4557 823 Lady day, 1920 6146 899 Michaelmas, 1920 8161 1079 Lady day, 1921 13081 1660 Michaelmas, 1921 21400 3529 Lady day, 1922 40081 6429 Michaelmas, 1922 34591 6325 Lady day, 1923 34193 6425 Michaelmas, 1923 28312 5489 Lady day, 1924 31690 5290 The table shews a considerable decrease in the numbers has taken place during the past two half-yearly periods. For purposes of comparison, the number of inmates of the House are given below, the figures being: also supplied bv Mr. Chapman. Date. Numbers chargeable in St. Pancras House. July 1st, 1917 1074 January 1st, 1918 1058 July 1st, 1918 1027 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 1069 July 1st, 1922 1099 January 1st, 1923 1122 July 1st, 1923 1045 January 1st, 1924 1173 18 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 from figures kindly supplied by the secretaries of the various institutions, to show the work done by the hospitals in St. Pancras, without reference to the home addresses of the patients. Hospitals. Number of Beds. Number of in-patients admitted, 1923. Number of new outpatients treated in 1923. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 387 2277 — Highgate Hospital, Dartmouth Park Hill 554 2258 — Metropolitan Asylums Board Hospitals. St. Margaret's Hospital, Leigliton Road (for ophthalmia neonatorum) 42† 225‡ — Voluntary Hospitals. University College Hospital, Gower Street 353 5001 76246 Royal Free Hospital, Gray s Inn Road 240 3764 41785 Royal Free Hospital Maternity Home, Endsleigh Street 33 711 620 London Temperance Hospital, Hampstead Road 120 633 11559 Elizabeth Garrett Anderson Hospital, Euston Road 75 1387 9964 West End Hospital for Nervous Diseases, Begent's Park 76 375° 4202 Hospital for Tropical Diseases, Endsleigh Gardens 60 533 Central London Throat, Nose and Ear Hospital, Gray's Inn Road 43 914 11177 Central London Ophthalmic Hospital, Judd Street 40 574 13218 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22* 444 3667 St. Saviour's Hospital, Osnaburgh Street 21 174 — North-West London, Bayham Street — — ¶ St. Pancras Dispensary, Oakley Square — — 3096§ London Skin Hospital, Fitzroy Square — — 2384 Western Skin Hospital, Hampstead Road — — ¶ British Dentists' Hospital, Camden Road — — 516|| a In-patient Department closed from July 23rd to November 19th. In addition to 2 cots. † In addition to 18 beds for the patients' mothers. ‡ In addition to 164 admissions of patients' mothers. § Not including the work of the Tuberculosis Dispensary (see page 45), but including the clinic for mothers and young children (see page 24). || Not including the municipal clinic (see page 24). ¶ Information not to hand. 19 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 to 16 of this report. The Borough scheme for Maternity and Child Welfare includes the following activities:— (а) The dispatch by post of cards of advice to the individual mothers immediately after the receipt of the notification of birth required by law. (b) The home visitation of expectant and nursing mothers and babies by the Council's staff of health visitors, who work (a) from the Town Hall and (6) from the Centres. (c) The provision and maintenance of Maternity and Child Welfare Centres. These centres are parily 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 by municipal and partly by voluntary funds. (e) The provision of a municipal dental clinic for mothers and young children. (f) 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 dinners for nursing and expectant mothers. (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, either free or at a reduced rate, in hospital or at home, midwifery attendance for necessitous St. Pancras women. (k) The payment for the home nursing of sick infants in certain cases. The work done in 1923 in connection with the scheme will now be referred to in detail:— Advice Cards.—Besides the posting of cards of advice to the mothers of all infants whose births have been notified, cards of advice to expectant mothers have be n 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 four who are health visitors as to part of their time. These ladies in 1923 made 2850 visits to 581 infants (apart from visits made to cases of measles and for other special purposes). They also made 360 visits to 164 expectant mothers. The Council's visitors at the Infant Welfare Centres numbered 20 full Time workers, who divide their time between the necessary work in the Centres and home-visiting. In addition there was one full time voluntary (unpaid) trained worker at the Caversham Road Centre, 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. 20 In 1923 the Council's Centre staff made 37,701 visits to 4,154 children, and 4,140 visits to 1,714 expectant mothers; the trained workers not paid by the Council made 12,208 visits to 666 children, and 453 visits to 206 expectant mothers. The visiting work is set out in detail on the next page, and is summarised in the following statement:— No. of Expectant Mothers Visited. Total Visits to Expectant Mothers. No. of Children Visited. Total Visits to Children. Town Hall health visitors 164 360 581 2850 Staff at the Centres paid by the Council 1714 4140 4154 37701 Total work by Council visitors 1878 4500 4735 40551 Staff at the Centres paid by the Council 1714 4140 4154 37701 Trained staff at the Centres not paid by the Council 206 453 666 12208 Total work by Centre visitors 1920 4593 4820 49909 Total visits by all trained visitors— 1923 2084 4953 5401 52759 1922 2342 4770 6194 50347 1921 2547 5730 7280 53547 Maternity and Child Welfare Centres. These are now 14 in number, each Centre is managed by a Committee, the members of which not only give valuable help at the various consultations, but also provide additional funds for the maintenance of many other useful and very necessary activities associated with the work of each Centre. The Council has representatives on each committee and each committee sends one representative to the Council's Maternity and Child Welfare SubCommittee. The Centres at University College Hospital, the Royal Free Hospital, and its Marlborough Maternity Section are not subsidised by the Council. The table on the next page gives statistics concerning the work of all the Centres during 1923. It will be seen that 1,827 infant consultations and 514 ante-natal consultations were held during the year. The children who attended for the first time numbered 3,135 under one year of age and 367 over one year of age. The children under one year of age attending for the first time amounted to 72 per cent. of the births registered during the year. The total attendances of all children were 55,265, compared with 51,426 in 1922, and 52,600 in 1921. The total attendances of expectant mothers were 6,389, as compared with 6,033 in 1922. 21 Centre. Attendances at Consultations. Visits by Trained Visitors. Consultations. Number of Trained Visitors. Expectant Mothers. Children. Expectant Mothers. Children. Infant, Expectant Mothers. New cases. Total attendances. New cases. Total attendances. First visits. Total visits. First visits. Total visits. Under 1 year. Over 1 year. Total. Under 1 year. Over 1 year. Total. Visitors paid by Borough Council. Trained workers not paid by Borough Council. Visitors paid by Borough Council. Trained workers not paid by Borough Council. Visitors paid by Borough Council. Trained workers. not paid by Borougn Council. Visitors paid by Borough Council. Trained workers not paid by Borough Council. Per month Total. Per month. Total. Whole time. Part time. Town Hall, Health Visitors – – – – – – – – 164 – 360 – 581 – 2850 – – – – – – – St. Pancras School for Mothers— Ampthill Square 189 568 352 29 381 4703 2799 7502 565 – 1505 – 763 – 9709 – 23 (1) 274(2) 4 . 4 Chalton Street 61 248 217 30 247 2766 2588 5348 295 – 566 134 369 – 3896 3926 12 150 2 25 2 2(3) North St. Pancras School for Mothers, Queen's Crescent 133 345 349 52 401 5037 3893 8930 87 – 325 – 562 – 3985 – (4) 19(5) 228(6) 4 51 3 — South Highgate Centre 17 34 87 19 106 1474 513 1987 22 – 95 – 157 – 2158 – 8 102 – 19 1 — Grafton Road Centre 191 191 199 58 257 3107 1905 5012 161 – 325 – 541 – 5896 – 12 150 – 2 Mary Ward Settlement School for Mothers 17 71 115 22 137 1569 953 2522 66 – 144 – 233 – 2578 – 12 160 – — 1 Camden Town Centre, Camden Road 143 376 294 40 334 4439 2105 6544 263 – 501 – 561 23 2664 41 18 214 4 48 3 (7) Berkeley Road Centre – – 67 15 82 755 118 873 – – – – – – – – 4 43 – — __ — Argyle Square Centre 16 89 109 26 135 1501 395 1896 85 – 152 – 263 – 1656 – 5 62 2 19 1 Caversham Road Centre 103 371 312 20 332 4638 1326 5964 72 13 378 25 475 113 3060 2442 (8) 12(9) 141(6) 4(10) 41(6) 2(11) — (12) Maternity Nursing Association, Oakley Square 124 146 179 10 189 2607 1760 4367 – 193 – 294 166 135 1683 799 8 49 1 11 1 - University College 1561 2836 744 – 741 – – 3352 – – – – – 395 – 5000 8 101 1 48 2(13) Royal Free Hospital, Gray's Inn Road 125 455 61 46 107 544 268 812 93 – 149 – 64 – 416 – 8 101 8 102 2 Marlborough Maternity Section 220 659 50 – 50 156 – 156 – – – – – – – – 4 52 8 100 — — Totals 2900 6389 3135 367 3502 – – 55265 1878 206 4500 453 4735 666 40551 12208 153 1827 38 514 20 6 (1) including 3 per month held voluntiry. (2) including 30 held volunitry. (3) volunitry trained worker. (4) 66 visits were made by unqualified students. (5) including 3 per month held voluntiry. (6) including voluntiry consultaion. (7) first 22 A few details are given in the following paragraphs concerning other work carried out at each Centre:— St. Pancras School for Mothers, 1, Ampthill Square. In addition to the consultations provided by the Council, the Medical Officers have held voluntary consultations for children from two to five years of age. At these 1,019 attendances were made. Classes for Mothers. At infant care classes there were 515 attendances; ante-natal care, 397 attendances; and at needlework, etc., classes, 630 attendances. Dinners for Mothers and Children. These are supplied at a very small chirge for necessitous cases. 2,260 dinners were supplied to nursing and expectant mothers, and 1,785 to young children. Observation Day Nursery. This is for children needing special care. There were 1,420 attendances during the year, of which 637 were made by infants under one year of age and 783 by children over one year. Massage Clinic. 89 consultations were held, at which 910 attendances were recorded. Dental Clinic. This also is provided out of funds from voluntary sources. The Dental Surgeon is Mr. George Thomson, L.D.S. Durinir the veur 36 consultations were held, at which 310 attendances wepe made. Details of the work done are given in the following table:— Mothers. Children. Extractions with anaesthetics 65 8 „ without anaesthetics 4 6 Fillings 32 43 Scalings 13 – Impressions and fitting dentures, etc. 105 – Examinations 18 16 Totals 237 73 Interviews of mothers by the Superintendent other than at clinics or classes numbered 5,569. Argyle Square Centre. The work of this Centre was re-organised during the year. In January a meeting was called by the then Mayor (Alderman H. Trill, J.P., M.W. B.), as a result of which an active voluntary committee was formed, which has done good work. In addition to the consultations, various classes for mothers have been held. Berkeley Road Centre. This was opened in February, 1923, to serve the needs of the rather isolated area situated between Gloucester Road and Regent's Park Road. It is supervised by the committee of the Camden Road Centre, and worked by the staff of that Centre, assisted on consultation days by one of the Town Hall health visitors. 23 Camden Road Centre. In addition to the Infants' and Ante-Natal Clinics, special consultations for children from two to five years of age have been held. Classes and health talks for mothers have also been arranged. Caversham Road Centre. This was opened on February 9th, 1923, to take the place of the Oseney Crescent and Falkland Road Centres, which were closed. The district is densely populated, and the attendances are large and steadily increasing. The Borough Council, as at other centres, provides staff, and pays rent, rates and taxes; but the premises were acquired, adapted and decorated, and the Centre most adequately equipped, through the generosity of Miss J. de Pass. Since May, two additional ante-natal and one additional infant consultations have been held, the cost of which has been defrayed out of funds obtained from voluntary sources. Various classes and lectures have been held during the year, including lectures by Dr. Robert Hutchison, Physician to the Hospital for Sick Children, Great Ormond Street. Chalton Street Centre. Various classes were held, at which 660 attendances were made. 1,357 dinners were provided for nursing and expectant mothers. Massage Clinic.—89 consultations were held, at which 458 attendances were recorded. 66 children were referred to the Borough Clinic for dental treatment. Two voluntary workers have given regular and valuable assistance daring the year. Grafton Road Centre. The attendances here having materially increased, additional staff became necessary. An assistant health visitor was therefore appointed, and commenced duty on 2nd February, 1923. Mary Ward Settlement School for Mothers. For a time the work at this Centre was done by an assistant health visitor, supervised by the Superintendent of the Argyle Square Centre. This arrangement did not prove satisfactory, and the two centres are now worked independently. North St. Pancras School for Mothers, Queen's Crescent. Voluntary consultations have been held for older children, and well-attended meetings for mothers have been held by the Superintendent twice a month. Oakley Square Centre. The attendances at this Centre have been particularly good. In addition to other useful activities, during the summer 29 mothers, 26 infants, and 13 childreu were sent away for two weeks' holiday, a sum of £124 13s. 4d. having been raised for this purpose by members of the voluntary committee. A meeting for mothers is held monthly by the Superintendent. South Highgate Centre. The attendances here have not been so numerous, especially at the Wednesday consultations. The Superintendent has a class for mothers twice a month. 24 The Borough Council Dental Clinic.—This provides dental treatment for the mothers and children attending the various maternity and child welfare centres. The work is carried out at the British Dentists' Hospital, 31, Camden Road, N. W. 1. The Council pays a fixed sum for the use of the premises and equipment, and also pays the fees for the services of the dentist and anæsthetist. Consultations have been held twice weekly, and the work done is shown in the following table:— Number of Clinics 96 „ with nitrous oxide anaesthesia 23 ,, of new cases (mothers) 234 377 „ ,. (children) 143 Total number of attendances (mothers) 1311 1713 ,, „ (children) 402 Number of attendances for extractions under nitrous oxide 287 „ ,, ,, local anaesthesia 150 ,, ,, when fillings and dressings were done 296 ,, ,, „ scalings were done 62 ,, „ for impressions, fitting dentures, &c. 506 „ ,, ,, examinations and advice 458 Actual number of fillings and dressings 388 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 1923, 93 patients were fitted with dentures, including one mother who had her old denture remodelled at a cost of £1. The total cost of these was £321, of which £184 6s. 0d. was paid by the patients themselves, £70 19s. 0d. by the Borough Council, and £65 15s. 0d. from voluntary sources, particularly the Metropolitan Hospital Sunday Fund and the Hospital Saturday Fund. 10 mothers paid the whole cost of one denture themselves, i e., £2 each, and 9 paid the whole cost of two dentures, i.e., £4 each. £5 15s. 6d. was also paid by patients for repairs and additions to old dentures. It has been decided to discontinue the use of the British Dentists' Hospital premises from the end of 1923. A new clinic has been equippe 1 for the purpose in Argyle Square in premises belonging to the Borough Council, and after this year the dental work will be carried on in these premises. Mothers and children are also dealt with at the dental clinic (voluntary) at the St. Pancras School for Mothers (see p. 22), 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. 1, to which patients are referred from the Town Hall, from the infant welfare centres, by the health visitors, and from other sources. During 1923, 327 new cases under five years of age, 57 ailing mothers and 62 expectant mothers (new cases) were treated at Dr. Provis' clinic. The total attendances at this clinic were 842 of children under five, 273 of ailing mothers, and 81 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 972; attendances 2908; ailing mothers and expectant mothers: new cases, 140; attendances, 441. The dispensary Resident Medical Officer also made 482 home visits to 116 sick children under five. 25 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 1158 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 1923 to make grants of milk, either free or at half-price, for the use of expectant or nursing mothers and 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. The scale of income in use was as follows 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 6s. 6d. „ „ 8s. „ „ 6 6s. „ „ 7s. 6d. „ „ 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. The extent of the distribution of milk in 1923 is shown in the following figures:- Pints of Milk Granted Free. Pints of Milk Granted Half-price. Cost to Council. 1923. £ s. d. January 12218 1408 215 7 4 February 11757 1406 207 13 4 March 12546 1266 219 13 0 April 10651 1108 140 1 3 May 10585 1062 138 19 0 June 10026 700 129 14 0 July 10064 516 129 0 6 August 9398 714 121 18 9 September 8672 662 113 2 9½ October 8849 972 136 2 8½ November 9056 1036 139 12 5 December 8864 832 154 13 4 Total 122686 11682 1845 18 5 At the end of 1922 there were 350 families in receipt of milk through the Council's scheme. 471 new families were added to the list of recipients during 1923, and at the end of 1923 there were 205 families in receipt of milk. As will be seen from the table above, there were supplied in 1923, 122,686 pints of milk free and 11,682 pints at half-price, at a 26 cost to the Council of £1,845 18s. 5d., half of which sum is repayable by the Ministry of Health. This figure does not include the cost of administration. Cases are investigated by Mr. H. G. "West, if there is any doubt as to the circumstances of the family. On June 28th, as a result of one such investigation, proceedings were taken against E. J. Mostyn for obtaining milk under false pretences. At Clerkenwell Police Court he was sentenced to three months' imprisonment with hard labour. Dinners for Necessitous Expectant Mothers.—This work is organised by a voluntary committee, the Council contributing an annual grant of £50. The dinners are provided at a restaurant in Prince of Wales Crescent, Kentish Town, a special room being set apart for the purpose. The mothers attending are recommended by the staff of the various welfare centres, who are cognisant of their circumstances and needs. During the year 4,539 dinners, consisting of meat, vegetables, and pudding, were supplied. The quality of the food is good, and the general arrangements are fairly satisfactory. Home for Sick Poor Children.—The Council makes an annual grant of £500 towards the Mayoress of St. Pancras Home for Sick Poor Children. The Home is situated at "Avalon," 1, St. Alban's Road, N.W. 5, and accommodates 18 children. The cases admitted are either convalescent after illness, or are weakly, badly nourished children needing feeding and special care. At the beginning of the year 16 children were in residence. During the year 83 were admitted, and 9 were in residence at the end of the year. 90 were discharged during the year, after an average stay in the Home of 43| days. Of the 90 cases discharged, 21 were in good health, 51 were much improved, 11 showed no marked improvement; but some of these were sent home in May and June (owing to an epidemic of whooping cough) without having had an adequate chance of improvement. The conditions for which the children were admitted were as follow:— Debility and anæmia 24 Rickets 10 Tardy development 8 Various nutritional disorders 4 Other causes 5 Convalescence after— Pneumonia and bronchitis 15 Measles and whooping cough 5 After operations 9 Other conditions 3 Total 83 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 Whitetield Day Nursery, 53, Whitfield Street, W. 1; the Kentish Town Day Nursery, Gospel Oak Grove, N.W. 5; and the Margaret Day Nursery, 44, Ampthill Square, N.W. 1. 27 Particulars in regard to the day nurseries for the year ended 31st March, 1924, are as follows:— Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. Whitefield Day Nursery £ 164 s. 9 d. 10 222 5,423 24.4 Kentish T. Day Nursery 240 10 0 259 5,084 19.6 Margaret Day Nursery 167 18 11 248 4,683 18.9 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 grant of £150 per annum in respect of maternity cases. 85 cases were assisted in 1923, as follows:— Maternity 40 Influenza 2 Consumption 6 Old age infirmity 1 Sickness connected with maternity 29 Other illness 7 Three home helps were employed throughout the year, and temporary helps were employed during 419¾ working days also. In the majority of cases very little can be contributed towards the cost of this work by the mothers who are helped, as the illness itself diminishes the resources of the home. The subsidy of the Council is only available in connection with Maternity cases, and for all other illnesses funds must be obtained from voluntary sources. This useful and most practical work is very deserving of encouragement and support. 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 a fee of 1s. 6d. per visit for the nursing of cases of measles, whooping cough, ophthalmia neonatorum, infantile diarrhoea, influenza and pneumonia; but the bulk of their work is supported by voluntary funds. The home nursing is of very great public health importance, and the need for its extension and support from public funds is very great. The home nursing work done during 1923 in St. Pancras is indicated by the following: figures:— No. of cases nursed. No. of home visits paid. Central St. Pancras District Nursing Association 74 1,219 Metropolitan Nursing Association (St. Pancras cases) 29 693 Haspstead District Nursing Association (St. Pancras cases) 21 428 North London Nursing Association (St. Pancras cases) 18 264 28 Midwifery. The infants born in St. Pancras during 1923 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 A. Attended in their own homes by— Private Doctors 96 79 16 67 146 30 249 95 778 Private Midwives 160 31 13 38 120 25 230 205 822 Doctors from the Elizabeth Garrett Anderson Hospital 30 12 1 18 34 15 16 36 162 Medical Students from— University College Hospital 98 268 — 1 161 335 5 39 907 Royal Free Hospital — — — 28 2 2 — — 32 St. Bartholomew's Hospital — — — 7 — — — 7 Midwives from— Middlesex Hospital — 22 44 — 1 3 — — 70 University College Hospital — 2 22 116 — 1 — — 141 Maternity Nursing tion, Myddleton Square — — 58 — 1 — — 59 Maternity Nursing Association, Oakley Square Branch 36 63 8 3 68 28 9 16 231 B. Attended in Institutions- University College Hospital — — 204 — — — — — 204 Royal Free Hospital — — — 287 — — — — 287 Royal Free Hospital (Marlborough Maternity Section) 613 613 Elizabeth Garrett Anderson Hospital 39 39 Lying-in Ward of St. Pancras House 216 1 — 217 Totals 420 477 921 623 532 1 695 510 391 4569 Some of the births in the preceding Table recorded, as having taken place in St. Pancras institutions were of infants the mothers of whom were not St. Pancras residents. On the other hand, a number of St. Pancras mothers gave birth to children in institutions situated outside the Borough. In the following Tables the figures are given for 1923 relating to all St. Pancras women who were attended in their confinements, either at home or as in-patients, by the staff of various institutions situated either within or outside the Borough. Midwifery. Attended at Home. Elizabeth Garrett Anderson Hospital (doctors) 162 University College Hospital (medical students) 907 J o 1 x ' „ „ „ (midwives) 141 Middlesex Hospital (midwives) 70 Royal Free Hospital (medical students) 32 St. Bartholomew's Hospital (medical students) 7 Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 290 1609 (or 37 per cent, of the total number of births). 29 Admitted as In-patients. University College Hospital 114 Royal Free Hospital 40 Royal Free Hospital (Marlborough Maternity Section) 176 Elizabeth Garrett Anderson Hospital 10 St. Pancras House 157 Middlesex Hospital 156 Queen Charlotte's Lying-in Hospital 136 City of London Maternity Hospital 71 Queen Mary's Hospital, Hampstead 70 Other hospitals 53 983 (or 23 per cent. of the total number of births). It will be seen from the above tables that there are a large number of institutions available for midwifery for St. Pancras women, and that considerable use is made of them. The majority of these institutions are situated in the south of the Borough, and in this area a very large proportion of the cases accept this treatment. In the north of the Borough the out-patient hospital service is not so available, the result being that the majority of the cases are attended by medical practitioners or midwives. The following table illustrates this:— Cases attended at Home. Attended by North (Wards 1—4). South (Wards 5—8). Medical Practitioners 586 1301 192 299 Midwives (Private) 715 107 Institutions 551 1058 The Council subsidises the provision of midwifery for necessitous St. Pancras residents by paying a grant to institutions which attend these cases, either free or at a reduced charge, the grants being at the rate of 5s. for each case attended at the patient's own home, and £1 for each case admitted into the institution concerned. 30 The amounts paid during 1923 were as follow:— £ s. d. Royal Free Hospital and Marlborough Maternity Section 216 5 0 Elizabeth Garrett Anderson Hospital 49 10 0 Maternity Nursing Association 70 0 0 Queen Charlotte's Lying-in Hospital 134 0 0 City of London Maternity Hospital 62 0 0 Middlesex Hospital 173 5 0 £705 0 0 Government Grants. Government Grants were made during the year ended March 31st, 1924, Maternity and Child Welfare, as follows:— in res £ 3ect s. of d. St. Pancras Borough Council 6924 7 4 St. Pancras School for Mothers (Ampthill Square) 572 0 1 „ „ (Chalton Street) 138 3 8 North St. Pancras School for Mothers 131 11 5 Grafton Road Mothers' and Infants' Welfare Centre 29 0 11 * Mary Ward Settlement School for Mothers 38 3 8 Camden Town Mothers' and Infants' Welfare Centre 90 10 10 Argyle Square Mothers' and Infants' Welfare Centre 231 5 1 Caversham Road Mothers' and Infants' Welfare Centre South Highgate Mothers' and Infants' Welfare Centre 49 19 5 Maternity Nursing Association (for Maternity and Child Welfare Centre) 83 13 3 * Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 493 0 0 * University College Hospital (for Maternity and Child Welfare) 832 8 8 * „ „ (for Midwifery and Nursing) 232 0 0 * Royal Free Hospital (for extern Midwifery and Maternity Nursing) 110 0 0 * „ „ (for Maternity and Child Welfare Centre) 243 0 0 „ „ (in respect of the Marltorough Maternity Section) 1423 7 4 St. Pancras Dispensary (Infant Clinic) 277 0 0 Mayoress of St. Pancras Home for Sick Children 662 16 11 Whitefield Day Nursery 328 19 7 Kentish Town Day Nursery 481 0 0 Margaret Club and Day Nursery 335 17 11 * Including expenditure on work amongst residents outside St. Pancras. 31 Section III.—PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during the year is shown in the following table, where they are also classified according to ages. The figures have not been corrected for any subsequent revision of the diagnosis. DISEASES. At all Ages. At Ages—Years. Under 1. I and under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. , 65 and upwards. 1. Variola or Small-pox – – – – – – – – 2. Scarlatina or Scarlet Fever 487 11 54 162 99 36 25 – 3. Diphtheria and Membranous Croup 512 14 173 149 76 54 46 – 4. Typhus Fever – – – – – – – – 5. Enteric or Typhoid Fever 20 – 3 3 3 4 7 – 6. Fever, Simple or Continued – – – – – – – – 7. Relapsing Fever – – – – – – – – 8. Puerperal Fever 20 – – – – 8 12 – 9. Erysipelas 92 5 5 4 5 11 54 8 10. Cholera – – – – – – – – 11. Plague – – – – – – – – 12. Anthrax – – – – – – – – 13. Glanders – – – – – – – – 14. Hydrophobia – – – – – – – – 15. Cerebrospinal Meningitis 2 1 1 – – – – – 16 Anterior Poliomyelitis and Polioencephalitis 6 1 4 1 – – – – 17, Ophthalmia Neonatorum 51 51 – – – – – – 18. Encephalitis Lethargica 5 – – – – – 4 1 19. Acute Primary Pneumonia 286 21 77 31 10 32 94 21 20. Acute Influenzal Pneumonia 46 1 3 2 1 4 29 6 21. Malaria 13 – – – – 1 12 – 22. Dysentery 3 – – – 1 1 1 – 23. Trench Fever – – – – – – – – 24. Measles 327 33 160 99 12 16 7 – 25. German Measles 134 8 53 56 9 5 3 – 26.Tuberculosis Pulmonary 440 – 4 16 14 85 310 11 Other Forms 137 8 36 25 24 22 18 4 Totals 2581 154 673 548 254 279 622 51 * Including all Primary Notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms "A," "B," "C" or "D,"and also cases first coming under notice by means of special Death Reports. 32 In the following tables are shown the number of notifications of the notifiable infectious diseases received in each month of the year, and also the corresponding monthly number of deaths from these and certain other diseases:— Monthly Number of Cases of Infectious Disease Notified during 1923. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Scarlet Fever 61 64 44 46 47 37 23 19 34 41 40 31 487 Diphtheria and Membranous Croup 58 63 47 32 42 43 35 46 34 40 41 31 512 Enteric Fever 2 4 – – 3 1 1 ??? 3 3 1 1 20 Puerperal Fever 1 3 3 1 2 1 2 2 1 1 – 3 20 Erysipelas 11 15 10 8 4 4 7 8 8 7 6 4 92 Cerebrospinal Meningitis – – – – – – – – – 1 – – 2 Poliomyelitis – – – – 3 1 1 – – – 1 – 6 Ophthalmia Neonatorum 3 4 2 7 9 5 4 3 2 5 4 3 51 Encephalitis Lethargica 1 1 – – 2 – – – – – 1 – 5 Acute Primary Pneumonia 38 40 27 26 23 16 20 13 12 15 28 28 286 Acute Influenzal Pneumonia 6 3 9 5 2 2 3 3 3 1 5 4 46 Malaria 2 2 3 1 1 2 1 1 – – – – 13 Dysentery – – – 1 1 – – – – – 1 – 3 Measles 14 29 35 49 39 34 27 18 11 11 24 36 327 German Measles 13 4 15 6 18 26 14 8 4 10 7 9 134 Tuberculosis (Pulmonary) 38 57 42 28 40 29 32 42 31 40 32 29 440 Tuberculosis (Other Forms) 16 13 12 12 8 14 19 6 6 10 12 9 137 Totals 264 302 250 222 244 215 189 170 149 185 203 188 2581 33 Monthly Number of Certified Deaths from the Dangerous Infectious Diseases during 1923. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Scarlet Fever 1 1 – – – – – – – – – – 3 Diphtheria and Membranous Croup 3 2 – 2 – – 1 5 2 1 – 4 20 Enteric Fever 1 – – – – – 1 – 1 – – – 3 Puerperal Fever – 2 1 1 – 2 1 1 – – – 1 9 Erysipelas – – 2 – 1 – – – 1 – – – 4 Cerebrospinal Meningitis – – 1 – – – – – – 1 – – 2 Dysentery – – – – – – – – – – – – 1 Encephalitis Lethargica 1 – – – 1 – – – – – – – 2 Measles – – 2 – 3 – – – – – – – 5 Tuberculosis (Pulmonary) 20 28 17 21 22 15 12 17 12 16 18 13 211 Tuberculosis (Other Forms) 12 4 8 4 5 2 6 5 1 3 8 3 61 Totals—Notifiable Infectious Diseases 38 37 31 29 32 19 21 28 18 21 26 21 321 Whooping Cough 2 2 3 6 3 5 1 2 2 – – 2 28 Diarrhœa and Enteritis 1 3 3 – 5 3 8 9 9 13 4 3 61 34 In the following table the number of notifications are set forth for the past 10 years:— Diseases. 01914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Variola or Small-pox – – – – – 10 – – 1 – Scarlatina or Scarlet Fever 1207 1009 448 246 332 558 863 1713 1156 487 Diphtheria and Membranous Croup 458 446 424 451 399 348 747 723 725 512 Typhus Fever – – – – – – – – – – Enteric or Typhoid Fever 44 36 38 24 17 7 18 28 14 20 Fever, Simple or Continued 1 – 1 – – – – – – – Relapsing Fever – – – – – – 1 – – – Puerperal Fever 18 14 18 9 5 13 18 11 11 20 Erysipelas 223 202 120 126 121 134 126 87 118 92 Cholera – – – – – – – – – – Plague – – – – – – – – – – Anthrax – – 1 – 1 – – – – – Glanders – – – – – – – – – – Hydrophobia – – – – – – – – – – Cerebrospinal Meningitis 2 40 23 25 13 10 6 4 7 2 Anterior Poliomyelitis and Polioencephalitis 3 8 9 1 1 4 2 4 1 6 Ophthalmia Neonatorum 31 31 38 31 40 39 69 101 59 51 Encephalitis Lethargica .. .. .. .. .. 3 11 8 5 5 Acute Primary Pneumonia .. .. .. .. .. 86 142 242 384 286 Acute Influenzal Pneumonia .. .. .. .. .. 213 108 99 189 46 Malaria .. .. .. .. .. 98 58 18 13 13 Dysentery .. .. .. .. .. 6 4 1 3 3 Trench Fever .. .. .. .. .. 1 – – – – Measles .. .. 1855 3681 2144 1034 3093 1149 3728 327 German Measles .. .. 381 609 311 268 195 81 253 134 Chicken-pox .. 247 .. .. 401 .. .. .. .. .. Tuberculosis Pulmonary 893 933 735 825 1031 799 684 546 534 440 Other Forms 121 150 138 169 203 2o6 132 153 148 137 Totals 3004 3116 4229 6197 5022 3837 6277 4968 349 2581 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 Whole Borough. West. Ward South. Ward East. Ward North. Ward Whole Borough. 4 5 7 8 3 6 1 2 4 5 7 8 3 6 1 2 1. Variola or Small-pox – – – – – – – – – – – – – – – – – – 2. Scarlatina or Scarlet Fever 48 51 28 53 101 40 99 67 487 – 1 – – 1 – 1 – 3 3. Diphtheria and Membranous Croup 28 78 22 81 72 132 58 41 512 1 3 – 2 2 10 1 1 20 4. Typhus Fever – – – – – – – – – – – – – – – – – – 5. Enteric or Typhoid Fever – 2 2 1 8 3 4 – 20 – – – – 2 – – – 3† 6. Fever, Simple and Continued – – – – – – – – – – – – – – – – – – 7. Relapsing Fever – – – – – – – – – – – – – – – – – – 8. Puerperal Fever 5 3 3 1 2 – 2 4 20 2 1 2 – – – 2 2 9 9. Erysipelas 8 14 4 11 18 16 15 6 92 – 1 – – – – 1 2 4 10. Cholera – – – – – – – – – – – – – – – – – – 11. Plague – – – – – – – – – – – – – – – – – – 12. Anthrax – – – – – – – – – – – – – – – – – – 13. Glanders – – – – – – – – – – – – – – – – – – 14. Hydrophobia – – – – – – – – – – – – – – – – – – 15. Cerebrospinal Meningitis – – – 1 – – – 1 2 – – – 1 – – 1 – 2 16. Anterior Poliomvelitis 1 1 1 – 1 – 2 – 6 – – – – – – – – – 17. Ophthalmia Neonatorum 5 8 5 9 7 7 9 1 51 – – – – – – – – – 18. Encephalitis Lethargica – 1 – 1 1 1 1 – 5 – – 1 1 – – – – 2 19. Acute Primary Pneumonia 28 42 9 23 90 43 54 27 286 – – – – – – – – – 20. Acute Influenzal Pneumonia 6 5 1 2 9 5 14 4 46 – – – – – – – – – 21. Malaria 2 3 1 – 5 1 1 –— 13 – – – – – – – – – 22. Dysentery – 1 1 1 – – – – 3 1 – – – – – – – 1 23. Trench Fever – – – – – – – – – – – – – – – – – – 24. Measles 22 55 16 34 41 30 72 57 32 – – 1 – – 1 1 2 5 25. German Measles 21 15 4 4 33 23 12 22 134 – – – – – – – – – 26. Tuberculosis, Pulmonary 58 59 33 74 52 57 55 42 440‡ 34 17 13 27 37 28 32 22 211† ,, Other Forms 10 20 7 20 27 21 20 11 137† 6 9 2 13 8 8 12 3 61 * Including all primary notifications made under the Public Health (Tuberculosis) Regulations. 1912, on Forms A, B, C, or D, and also cases first coming under notice by means of Special Death Reports. † Including 1, the home address of which was not known. ‡ ,, ,, ,, 36 SMALLPOX. No cases of this disease were notified in the Borough during the year. There were 11 cases in the County of London during 1923, and 1 death. Towards the end of the year chicken-pox was very prevalent in the Borough, and many of the cases were of a severe type. This frequently caused some difficulty in diagnosis, as these cases resembled small-pox. Many were seen in consultation with the medical practitioner who was in attendance. A number of persons were reported, who had come to the Borough after having been in contact with cases of small-pox, usually on board ship. These were visited and kept under observation during the requisite period. 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 January 1st to December 31st, 1922:— Vaccination's. 1st January to 31st December, 1922. Number. Percentage of Births registered. North. East. West. South. Whole Borough North. East. West. South. Whole Borough Births registered 995 1363 971 1552 4881 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 35 75 56 74 240 3.5 5.5 5.8 4.8 4.9 Successfully vaccinated 412 606 484 758 2260 41.4 44.5 49.9 48.8 46.3 Had smallpox – – – – – – – – – – Insusceptible of vaccination – 2 1 4 7 – 0.1 0.1 0.3 0.1 Received certificate of conscientious objection 507 489 344 421 1761 51.0 35.9 35.4 27.1 36.1 Postponed by medical certificate 4 12 16 13 45 0.4 0.9 1.6 0.8 0.9 Moved to known address in other districts 10 59 9 217 295 1.0 4.3 0.9 14.0 6.1 Lost sight of by removal 25 114 59 61 259 2.5 8.4 6.1 3.9 5.3 Unvaccinated and not accounted for in previous columns 2 6 2 4 14 0.2 0.4 0.2 0.3 0.3 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. 1912 5079 2318 45.6 1149 22.6 1913 5074 2050 40.4 1494 29.4 1914 4965 1767 35.6 1332 26.8 1915 4536 1587 35.0 1205 26.6 1916 4322 1594 36.9 1179 27.3 1917 3664 1581 43.1 1014 27.7 1918 3338 1281 38.4 932 27.9 1919 3874 1733 44.7 1155 29.8 1920 6086 2693 44.3 2118 34.8 1921 5102 2085 40.9 1934 37.9 1922 4881 2260 46.3 1775 36.4 37 SCARLET FEVER. 487 cases were notified during the year. Of these, 62 were subsequently reported by the Hospital Authorities not to be suffering from this disease. The corrected number of cases of Scarlet Fever was, therefore, 425, equal to an incidence rate of 2'0 per 1,000 of population, as compared with 1102 cases and an incidence rate of 5.2 per 1000 of population in the previous year. The number of deaths certified as being due to Scarlet Fever during the year was 3, equal to a death-rate of 0.0l per 1,000 of population, and a case mortality of 0.71 per cent, of cases notified. 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. 1914 1180 5.4 19 0.09 1.6 91 1915 900 4.1 22 0.10 2.4 96 1916 404 2.0 8 0.04 2.0 96 1917 224 1.2 4 0.02 1.8 97 1918 289 1.6 7 0.04 2.4 96 1919 516 2.3 5 0.02 1.0 96 1920 808 3.5 11 0.05 1.4 96 1921 1649 7.7 7 0.03 0.4 96 1922 1102 5.2 20 0.09 1.8 99 1923 425 2.0 3 0.01 0.7 99 It will be observed that the number of cases notified was exceptionally low, also that the number of deaths and the death-rate were the lowest hitherto recorded. Of the 487 cases notified, 480, or 98.6 per cent., were removed to hospital. Return cases.—This term is applied to cases of Scarlet Fever occurring in the same house within 28 days of the return from hospital of a previous case. Such return cases occurred in 10 houses during 1923, the total number of patients being 12. In each of nine houses one return case occurred, and in one house three other cases occurred. In four instances the patients on return from hospital either had, or soon developed, some nasal discharge, but in the remaining cases no obvious source of infection could be discovered. In three instances the return case occurred in the same house, though not in a member of the same family. The home in which three return cases occurred was particularly interesting: there was no nasal or other discharge present in any of the cases and every care was taken. The only explanation seems to be that this family possessed a marked susceptibility to the disease. 38 Scarlet Fever followed by Diphtheria. In one instance a child returned home from hospital after an attack of Scarlet Fever, and within nine days the father of this child was attacked with Diphtheria An examination was made of the child, but with negative results; the infection, therefore, was probably due to some other source. DIPHTHERIA. 512 cases were notified during the year. On further examination, 113 of these were subsequently found not to be suffering from tho disease. The corrected number of cases of Diphtheria was, therefore, 399, equal to an incidence rate of 1.9 per 1000 of population, as compared with 612 cases, and an incidence rate of 2.9 per 1000 of population, during the previous year. The number of deaths certified as being due to Diphtheria during the year was 20, equal to a death rate of 0.09 per 1000 of population, and a case mortality rate of 5.0 per cent. of the cases notified. The following table gives statistics relating to the disease for the past 10 years, corrected for error in diagnosis. It will be noticed that in this disease also, both the number of cases notified and the death-rate are considerably lower than those of the three previous years:– Year. No. of Notifications. Notification rate per 1,000 population. No of Deaths. Death rate per 1,000 population. Case mortality per cent. Percentage of cases removed to hospital. 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 310 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 41 0.21 7.2 98 1923 399 1.9 20 0.09 5.0 98 Of the notified cases of Diphtheria, 501 (or 97.9 per cent.) were removed to hospital, as follows: — To Metropolitan Asylums Board Hospitals 496 To other hospitals 5 501 Return Cases.—This term is applied to cases of Diphtheria occurring in the same house within 28 days of the return from hospital of a previous case. Cases of this description occurred in nine houses during 1923, the number of patients being 10. 39 In eight instances one return case occurred in each house. Two of these, however, were in a different family, though living in the same house. In one instance, two return cases occurred in the same house after the return of a patient from hospital. All the above cases were investigated: one was found to have diphtheria germs present in both nose and throat and was re-admitted to hospital. Another had some bacilli in the throat only, and was isolated and medically attended at home until free from infection. In the other cases no definite source of infection was ascertained. TYPHOID OR ENTERIC FEVER (INCLUDING PARATYPHOID).. Twenty cases were notified during the year to be suffering from this disease; on further investigation six of these were found not to be suffering from Typhoid Fever. The number of actual cases was therefore 14. Based on bacteriological examination, 13 of these were reported to be cases of typhoid and one of paratyphoid fever. In six of the cases there was a history of having consumed fish or shell-fish: in two instances there were two cases in the same house. One case, a nurse, in the course of her duties, had been in contact with Typhoid patients. In the other cases, no source of infection could be discovered. Only one of the above cases proved fatal. Two other deaths from enteric were reported of St. Pancras residents, but these occurred outside the district, and were therefore not notified here. The number of cases of Typhoid Fever, corrected for errors of diagnosis, which have occurred each year since 1913, are shown in the following table, which also gives the number of deaths and the death-rate per cent. Year. Cases notified. Deaths. 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 1923 14 1 7 TUBERCULOSIS. The number of cases of tuberculosis notified during the year is given in the following table in the form required by the Ministry of Health:— 40 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 31st December, 1922, to the 29th December, 1923 (inclusive). Age Periods. Number of Notifications on Form A, Number of Notifications on Form B. Number of Notifications on Form C. .Numuei of Notifications on Form D. Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors), Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10 10 to 15 Total. Pulmonary Males – 1 5 – 7 18 48 41 30 11 3 164 173 1 3 3 7 9 144 165 58 114 Females – 1 2 3 16 30 34 34 13 7 4 144 166 – 4 3 7 8 58 97 20 86 Non-pulmonary Males 2 11 7 9 6 2 2 1 – 1 1 42 46 – 1 – 1 2 9 27 3 15 Females 2 9 8 8 2 4 5 3 – 1 1 43 45 – – 1 1 1 6 28 2 20 Totals 4 22 22 20 31 54 89 79 43 20 9 393 430 1 8 7 16 20 217 317 83 235 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 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males – – 1 3 2 5 11 16 11 8 1 58 – – – 1 – – – 3 6 – 1 11 Females – – 1 – 2 2 8 ??? 2 2 – 18 – – – – – – – – – – – 1 Non-pulmonary Males – 3 2 1 1 – – – – – – 7 – – 1 – 2 – – – – – – 3 Females 1 1 3 3 1 – – – – – – 9 – – – – – – – – – – – – Totals 1 4 7 7 6 7 19 17 13 10 1 92 – – 1 1 2 1 – 3 6 – 1 15 41 Age Periods. Cases not Notified-—Information obtained from Special Death Reports. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males — 1 — — — 7 6 5 2 1 22 Females — — 1 — 2 3 — — — 2 8 Non-Pulmonary Males 1 5 2 2 4 — 2 1 — 2 — 13 Females 2 7 1 - - - - - - - 2 12 Totals 3 13 3 3 4 2 12 7 5 4 5 61 In previous years the above were included in the table of "Primary Notifications on Form A." This year they are shown separately. It will be seen that the number of primary notifications on forms A, B, C and D, was 516. In addition to this, 61 other cases were not notified, but first came to knowledge by means of special death reports (see table). The total of new cases during the year was therefore 577, equal to a notification rate of 2.69 per 1000 of the population. The corresponding figure for the previous year was 682 cases, with a notification rate of 3.21 per 1000. Of the total 577 new cases, 440 were suffering from pulmonary tuberculosis, and 137 were non-pulmonary in character, equal to a notification rate of 2.05 and 0.64 respectively. In the following table all the cases occurring during the year are classified for age and sex:— Total Notifications during 1923. Ages. Pulmonary Tuberculosis. Other forms of Tuberculosis. Total, all Forms. Males. Females. Total. Males. Females. Total. 0—1 — — — 3 5 8 8 1—5 3 1 4 19 17 36 40 5-10 9 7 16 13 12 25 41 10—15 7 7 14 12 12 24 38 15—25 32 53 85 15 7 22 107 25—35 06 45 111 4 5 9 120 35-45 66 35 101 2 3 5 106 45—55 52 15 67 — — — 67 55—65 21 9 30 3 1 4 34 65 & upwards 6 6 12 1 3 4 16 Totals 262 178 440 72 65 137 577 42 Deaths from Tuberculosis. The deaths from all forms of tuberculosis during the year were 272; of these 211 were from pulmonary and 61 from other forms of tuberculosis. These figures are equal to a death rate of 1.27 (0.98 pulmonary, 0.28 non-pulmonary) per 1,000 of population. In the following table these deaths are classified as regards age and sex:— Deaths from Tcjbehcui.osis during the Year 1923. Ages. ruluionary Tuberculosis. Other forms of Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0-1 — 1 1 3 3 6 7 1-2 1 — 1 3 2 5 6 2—5 — — — 5 6 11 11 5—10 — — — 2 3 5 5 10—15 — 3 3 3 1 4 7 15—25 17 17 34 7 4 11 45 25 -35 32 21 53 1 3 4 57 35—45 28 14 42 2 — 2 44 45—55 39 12 51 1 1 2 53 55—65 14 5 19 3 3 6 25 65 & upwards 6 1 7 2 3 5 12 Totals 137 74 211 32 29 61 272 In the preceding table it will be observed that deaths from pulmonary tuberculosis were most numerous at the age periods 25 to 55 years, no less than 146 deaths occuring between these ages out of a total of 211 at all ages. It is thus seen what a large proportion of these deaths occur at the most usef ul period of life, when men and women are most efficient and most valuable to the community. It is also at the period when so many have incurred the responsibility of families, and these are not only exposed to infection, but in addition, owing to the chronic nature of the illness, are so often ultimately left unprovided for. Although the loss of life from tuberculosis is still great, various remedial measures have effected a material reduction in the mortality during recent years, the figures for 1923, both as regards notification rate and death rate, being the lowest hitherto recorded in the Borough. In the following table the notification rates and death rates are classified according to sex:— 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 2.59 0.71 3.30 1.36 0.32 1.68 Females 1.67 0.57 2.14 0.65 0.26 0.91 Both Sexes 2.00 0.64 2.69 0.98 0.28 1.27 43 The figures in the previous 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 double that amongst females, while for non-pulmonary tuberculosis the death rate amongst males only slightly exceeded that amongst females. The deaths during 1923 are classified in the following table according to the part of the body affected, as well as for age and sex :— , O-l 1-5 5—15 15—25 | 25—35 35—45 | 45—55 | 55—65 | 65 up. | Total Males. °-! _ .±=*1 5—15 | 15—25 25—35 35—45 | 45—55 | 55- 65 | 65 up. Total Females 2 a § EL 0D Pulmonary Tuberculosis — 1 - 17 32 27 39 13 6 135 1 • 15 21 14 12 5 i 72 207 Ththisis (not defined as tuberculous; — - - - — 1 1 - 2 — 2 - — 2 4 Total Pulmonary Tuberculosis — 1 — IT 32 28 39 14 6 137 1 - 3 17 21 14 12 5 i 74 211 Acute Phthisis 1 1 — — 2 — 1 — 2 1 1 1 — 6 8 Acute" Miliary Tuberculosis — 2 1 — — 1 — 4 1 ~ — 1 5 Tuberculous Meningitis 2 5 3 1 1 — - 12 0 5 4 11 23 Tabes Mesenterica - — — Other Peritoneal and Intestinal Tubercle 1 — 0 1 4 1 1 1 2 1 i 7 11 Tuberculosis of Spinal Column — 1 2 — 3 — 1 — 1 2 6 Tuberculosis of Joints ... 2 n i 1 3 Lupus — — Scrofula — — Tuberculosis of other Organs — 1 - — — 1 2 — 2 Disseminated Tuberculosis 1 — 1 - 1 3 — — - i 1 4 Total Non-Pulmonary Tuberculosis 3 8 5 7 ] 2 1 3 2 32 3 8 4 4 3 1 3 3 29' 61 Total all forms of Tuberculosis 9 5'24 33130 ±0 17 8 169 4 8 7.21 24 14 13 8 4 103 272 The following table gives details of the new cases occurring during 1923, classified according to the parts of the body affected, as well as for age and sex distribution: — 44 Location of Disease. Ages. Total. 0—5 years. 5—15 years. 15 years and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 3 l 16 14 243 163 440 Bones and Joints 5 4 4 5 11 3 32 Meninges 8 8 5 4 3 1 29 Glands 6 5 12 12 3 8 46 Abdominal 1 3 3 2 4 5 18 Genito-TJ rinarv — 1 1 6 General 2 2 __ 2 Other Organs — — 1 1 2 1 5 Total Non-pulmonary Tuberculosis 22 22 25 24 25 19 137 Total all forms of Tuberculosis 25 23 41 38 268 182 577 lor purposes of comparison the following table is given, showing the number of notifications and the number of deaths, together with the corresponding rates during 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. '9'4 •• 218387 893 121 1014 365 67 432 40c, 055 464 1*67 030 1 97 19' 5 •• 218387 933 150 1083 398 IC2 500 427 069 4-96 1 '8 2 °'47 2-29 1916 218387 735 13s *73 340 83 423 3'3& 0-63 3'99 i*55 0-38 '93 1917 .. 218387 825 169 994 353 9' 444 378 077 4*55 1*62 0-42 2-03 1918 218387 1034 203 '237 4°3 82 485 474 0-93 5467 1-85 0-37 2-22 1919 .. 218387 799 205 1005 268 73 34' 3-66 ° 94 4-60 1-23 0'33 '•56 1920 00 00 G84 132 816 249 63 312 3-07 0'59 3-67 1 12 028 I'-i° 1921 212900 546 153 699 250 54 304 2-36 072 3-28 1 * 17 0-25 ''43 1922 212500 534 148 682 257 58 315 2-5! 0'70 3'2( I '2 I 0-27 i-48 1923 .. 214400 440 137 577 211 61 272 2-05 0*64 2.69 0*98 0'28 1-27 45 The total 272 deaths from all forms of tuberculosis which occurred during the year 1923 include 61 deaths of cases which had not been notified, and information concerning them was only obtained from the death returns. Of these 61 deaths, 30 were due to pulmonary and 31 to other forms of tuberculosis, which represent 14.2 per cent. and 50.8 per cent, respectively of the total deaths from these causes. Home Visits and Investigation. This is carried out, both as regards notified case3 and contacts, by won, en inspectors of the Town Hall staff and by nurses attached to the dispensaries. From the Town Hall, Miss Blaxland and Miss Parnell visit a large number of the cases, to which work they devote the greater part of their time. There is one nurse at the St. Pancras Dispensary who devotes to home visiting so much of her time as is available for the purpose, and one nurse attached to the joint Holborn and St. Pancras Dispensary (which is at University College Hospital), who gives half of her time to St. Pancras cases. The work carried out by the above staff in connection with tuberculosis during 1923 was as follows:— Visits by Tuberculosis Officers 152 Women inspectors—(«) First visits 609 „ (0) Subsequent visits 2,759 Visits by Dispensary nurses 1,041 4,561 Attendance of women inspectors at dispensaries 699 Other visits of women inspectors for various purposes 426 Number of cases in which disinfection was carried out 106 Tuberculosis Dispensaries. The Council's tuberculosis dispensary is at 39, Oakley Square, and a branch dispensary is situated at 132, Maiden Road. These serve that part of the Borough lying north of the Euston Road, comprising Wards 1 to 6 (population, Census 1921, 169,276). The staff consists of the tuberculosis officer, a nurse, and a clerical and general assistant (woman), all full-time officers. In this area, the cases of tuberculosis notified during the year numbered 432 (323 pulmonary and 109 non-pulmonary), and the deaths registered as being due to tuberculosis numbered 210 (170 pulmonary and 40 non-pulmonary). The joint dispensary at University College Hospital serves the whole of the Borough of Holborn, and that part of the Borough of St. Pancras (Wards 7 and 8) south of the Euston Road (population, Census 1921, 42,090), The staff here consists of a part-time tuberculosis officer and one full-time nurse. In this area (Wards 7 and 8) the cases of tuberculosis notified during the year numbered 134 (107 pulmonary, 27 non-pulmonary), and the deaths from tuberculosis were 61 (46 pulmonary, 15 non-pulmonary). At the St. Pancras Dispensary, Dr. N.. M. Donnelly continued as tuberculosis officer throughout the year. At University College Hospital, Dr. H. Evans resigned in June, Dr. R. Hilton acting as deputy pending the new appointment. The work done at the dispensaries during 1923 is shown in the following table:— 46 TUBERCULOSIS DISPENSAHIES. Tuberculosis Dispensary at tit. Pancras Dispensary, 39, Oakley Square. Branch Tubereulo* is Dispensary at 132, Maiden Road. Tuberculosis Dispensary at University College Hospital. Adults. Cinder 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 1'«roona included in Total. M. P. M. F. M. F. M. F. M. F. M. F. Under observation January 1st pending diagnosis 12 25 12 7 56 14 1.S 5 1 0 2 8 i 1 8 4 1 4 17 3 8 Examined for first time during the year 182 186 147 104 019 278 238 34 48 43 39 164 75 44 45 42 j 37 32 156 67 40 Total 194 211 159 111 675 292 256 39 49 43 41 172 76 45 53 46 38 36 173 70 48 Found to be suffering from :— Tuberculosis Pulmonary 98 55 3 7 163 7 96 5 14 0 1 20 2 10 28 11 2 1 42 3 19 Non-pulmonary 6 5 5 4 20 4 7 2 1 3 1 7 0 3 0 7 5 4 16 3 1 Not suffering from tuberculosis 7.1 107 126 90 396 244 117 23 26 34 33 116 67 28 19 26 30 29 104 59 26 Under observation on December 31st pending diagnosis 15 37 24 9 85 31 28 7 5 6 6 24 6 2 4 2 1 2 9 4 2 Ceased attendance before completion of diagnosis 2 7 1 1 11 6 8 2 3 0 0 5 1 2 2 0 0 0 2 1 0 39, Oakley Square. 132, Maiden Road. University College Hospital. 39, Oakley Square. 13?, Maiden Koad. University College Hospital. Patients under supervision (excluding persons under observation or domiciliary treatment) on 81st December 371 109 549 Reports received from Insurance Practitioners re insured patients under domiciliary treatment during the year 25 0 10 Total number of attendances during the year— Person referred to affiliated hospital Consultations with medical practitioners at 0 0 47 Insured 1591 204 578 the homes of patients— Uninsured 1459 439 655 Insured 3 0 0 Persons placed under observation for the purpose of diagnosis during the year 165 50 43 Uninsured 0 0 0 Other visits paid by Tuberculosis Officers to the homes of patients 124 17 8 Cases in which the period of observation exceeded two months 28* 13† 4 Visits by Dispensary Nurses to the homes of patients for dispensary purposes 377 80 584 Insured persons under domiciliary treatment on December 31st ... 93 6 4 Specimens of sputum examined for dispensary purposes 767 124 134 * 23 due to non-attendance. †10 due to non-attendance. 47 Treatment of Tuberculosis in Sanatoria and Hospitals. All cases recommended for institutional treatment are dealt with by the London County Council. Those admitted to sanatoria are usually early cases, in which the disease has not made much progress. Advanced cases, the most dangerous as regards infection, are usually referred to Poor Law institutions. Many patients decline to enter the latter, and so remain at home, a danger to others. During the year 285 cases were recommended for Institutional treatment, and 261 of these were admitted. Special Methods of Diagnosis and Treatmknt. (a) X-ray examination.—All cases requiring this are referred to University College Hospital. There were 46 such cases in 1923. (b) Finsen light treatment for lupus.—These cases are dealt with at the London Hospital. Payment has been made for the treatment of 4 cases, who made 84 attendances during the year. (c) Pneumothorax treatment.— This is carried out at Brompton Hospital, 2 cases being so dealt with during 1923. (d) Tuberculosis dental clinic.—A special clinic for tuberculous persons is held at 39, Oakley Square; the dental surgeon is Mr. Southcomb May, l.d.s. Cases needing treatment are referred to the dentist by the tuberculosis officer. Tuberculosis Care Committee. The social and economic factors in the tuberculosis problem are of so great importance that it has been found necessary to make special provision for dealing with the non-medical aspects of the question. In May, 1922, the Ministry of Health issued a Circular (No. 308), suggesting to Borough Councils that the time was opportune for the organisation of Care Committees as part of the machinery for dispensary schemes. Previously, in April, 1915, a similar suggestion had been made; but, for various reasons, this side of the work had not been developed, although an Interim Care Committee, appointed by the London County Council, which held its first meeting on 13th April, 1916, had been at work in the Borough. Prior to 1916, an effective scheme of co-operation between the Public Health Department and the various charitable, religious, and social agencies of the Borough, as assembled by the Public Welfare Association (now the Council of Social Service), was in existence in St. Pancras. After full consideration of the Ministry's Circular, the Borough Council, on the 18th October, 1922, passed the following resolutions:— (a) "That the Borough Council do form a Tuberculosis Care Committee for St. Pancras, to be constituted as a Sub-Committee of the Public Health Committee, as follows:— Ten members of the Borough Council, one representative of the St. Pancras Guardians of the Poor, the Medical Officer of Health, the Tuberculosis Officer, the senior lady sanitary inspector, one representative each of the departments of the London County Council dealing with School Care Committees and the Schools Medical Service; one representative each of the three following committees— Juvenile Advisory Committee of the Employment Exchange (Ministry of Labour), War Pensions Committee, and London Insurance Committee; and one representative each of the following ten St. Pancras organisations—Employers, Trade Unions, Friendly Societies, Federation of Maternity and Child Welfare Centres, Medical Practitioners, Invalid Children's Aid Society, Charity Organisation Society, Council of Social Service, Women's Co-operative Guild, British Bed Cross Society. 48 (b) That the Tuberculosis Care Committee have power to add to their number, subject to the approval of the Borough Council. (c) That the proposal be submitted to the Minister of Health and the London County Council for approval. In reply, a communication was received from the Ministry of Health, expressing the opinion that, in view of the nature of the work to be carried out, better results will be secured from an efficient voluntary body, working in close touch with, but independently of, the Borough Counci1, than from a committee directly responsible to the Borough Council or their Public Health Committee. In these circumstances, the Minister is unable to approve the proposals of the Council in their present form; but he would be willing to approve the establishment of a voluntary Care Committee of the same constitution'as described in the Council's resolution, subject to the addition of representatives of the local nursing associations. The London County Council had written, stating that they agree with tbe views expressed by the Minister of Health in regard to the establishment of the Care Committee. The Public Health Committee then recommended that the Tuberculosis Care Committee for St. Pancras be a voluntary committee, and not constituted as a Sub-Committee of the Public Health Committee, and on 28th February, 1923, this was approved by the Borough Council. A preliminary meeting of the members of the Committee was held on the 25th June, 1923, under the chairmanship of Councillor Dr. E. A. Gregg. The Committee was organised on the lines laid down in the Circular of the Ministry of Health, and formally took up its duties on 1st October, 1923. Councillor A. Escott, m.a.b., was elected as chairman. During October, November, and December, 1923, the Committee considered 128 cases. Of these there were referred to:— Red Cross 13 Guardians 4 Charity Organisation Society 4 United Services Fund and Soldiers' and Sailors' Families Association 4 British Legion 1 Hospital Almoner 2 Private persons 3 Borough Council for extra nourishment 5 Borough Council for dentures 3 Home Helps Committee 2 In addition, 33 cases of children suffering from tuberculosis were dealt with by Mrs. Philipson, Hon. Secretary of the Children's Aid Association, who has kindly consented to continue under the new Committee the valuable work for children which she did as lion. Secretary of the Interim Tuberculosis Care Committee. The Committee has had under consideration, for reference to appropriate agencies, the general problems of relief, and, in addition, the special difficulties arising from lack of accommodation for advanced cases (7 cases were refused by the London County Council in the three months in question), from want of proper housing accommodation, from the need for a scheme of employment for cases returning from sanatoria, and from the absence of an open-air school for affected children. These cases have entailed a considerable amount of work, and the labours of the Committee and secretaries are rendered more difficult, in many cases owing to the fast thit tho 49 Tuberculosis Care Committee has no funds; all assistance has to be accomplished indirectly through various societies, institutions, ete. It has also been the duty of the Committee to make inquiries in relation to the assessment of the sums payable by patients for residential treatment provided for them by the London County Council. PUERPERAL FEYER. Twenty cases were notified during the year, equal to an incidence rate of 4.6 per 1,000 births. Fourteen cases followed the births of living children, five the birth of a dead foetus, and one followed a septic miscarriage. Ten of the patients were primiparae (women who had not previously had children), and ten were multipara}. Eighteen cases were treated in hospitals and two at home. A "handy woman" was present in eight cases, and an assistant trained nurse in seven cases. Instruments were used in ten cases. Of the total 20 cases, nine proved fatal, giving a case mortality of 45 per cent. One death followed a septic miscarriage, one the birth of a dead child, and seven followed the birth of living children. Of the total nine deaths, two were of unmarried mothers. In the following table the oases are classified according to the manner in which the patients were attended in their confinements:— Confinement attended by Total Number of Births Notified. Number of Cases of Puerperal Fever. Rate per 1000 Births. Doctors 940 10 10.6 Institution Midwives 501 2 4.0 Private Midwives 822 6 7.3 Medical Students 946 2 2.1 EPIDEMIC CEREBROSPINAL MENINGITIS. Two cases were notified during the year, both of which proved fatal. The diagnosis in each case was verified by bacteriological examination. The particulars were as follows:— H. S., male, aged 4 months. Onset 27th February. Admitted to hospital 5tli March. Notified 17th March. Died on 27th April. J. W., male, aged 2} years. Onset 4th October. Admitted to hospital 6th October. Notified 10th October. Died on 9tli October. No source of infection was discovered. In each case the room and bedding were disinfected. 50 The following table gives the number of cases notified each year since 1912, when the disease first became compulsorily notifiable:— Year. Cases Notified. Deaths. Case Mortality per cent. Year. Cases Notified. Deaths. Case Mortality per cent. 1912 3 — 1918 9 8 89 1913 3 2 67 1919 8 7 87 1914 3 2 67 1920 5 3 60 1915 38 21 55 1921 4 3 75 1916 20 12 60 1922 6 6 100 1917 21 16 76 1923 2 2 100 ACUTE POLIOENCEPHALITIS AND POLIOMYELITIS. Six cases of Poliomyelitis were notified during the year, and there were no deaths. The following table gives particulars of the cases:— Date of Notification. Name. Age and Sex. Date of Onset. Removal to Hospital. Result and Remarks. 1923. May 5 A. B. 9 months (M.) 1923. April 25 Middlesex Hospital Recovered, but right arm paralysed, and weakness in left leg. May 5 A. C. 13 months (M.) April 23 Do. Recovered, with loss of power in left arm. May 25 W. T, 3 years (M.) May 21 London Temperance Hospital Recovered. Still has paralysis of right leg and arm. June 4 E.B. 3 years (F.) May 28 University College Hospital Recovered. Right leg paralysed. July 11 S. C. 6 years (M.) June 27 Middlesex Hospital Recovered practically completely. October 29 B. L. 3£ years (F.) October 10 Do. Recovered completely. Doubtful case. This affection is chiefly prevalent during the summer months, and the above table illustrates that fact, five out of the six cases having occurred between May and July. The death-rate from the disease is always low; but the cases are important, owing to the fact that permanent paralysis follows in a majority of those attacked by the disease. The following table gives the number of cases each year since 1912, when the disease first became compulsorily notifiable:— Year. Cases Notified. Cases Fatal Year. Cases Notified. Cases Fatal. 1912 3 0 1918 1 0 1913 9 1 1919 4 1 1914 3 1 1920 2 1 1915 8 0 1921 4 0 1916 9 1 1922 1 2* 1917 1 0 1923 6 0 * These two cases were only heard of after death, and had not been notified. 51 OPHTHALMIA NEONATORUM. Fifty-one cases were notified. This equals an attack rate of ll-7 per 1,000 births. Forty-eight of these were notified by medical practitioners, one by a midwife, and two bv both. Twenty-eight cases were regarded as slight, 18 as of moderate severity, five were grave, of which one lost the sight of an eye. Six of the cases occurred in illegitimate children. in the tollowing table the cases are classified according to the manner in which the mothers were attended at their confinement: — Confinement attended by Total number of Births. Total cases of Ophthalmia Neonatorum. Rate per 1000 Births. Doctors 940 8 8.5 Institution Midwives 501 3 6.0 Private Midwives 822 15 18.2 Medical Students 946 9 9.5 Hospital (In patients) - 16 - Sixteen cases were removed to hospital, nine of these being admitted to St. Margaret's Hospital, Leighton Road, Kentish Town. This Institution, managed by the Metropolitan Asylums Board, is reserved for cases of this disease. The very excellent practice is also adopted of admitting the mother as well as the baby, so that the natural nutrition of the child may be continued. Of the other cases, 35 were treated at home, with the help of a visiting nurse—provided by the Council—in 23 cases. ENCEPHALITIS LETIIARGICA. Commonly described as " Sleepy Sickness." Five cases of this disease were notified during the year, and one other case came to knowledge from the death returns, but had not been notified. Of the five notified cases, two, on further investigation, were found not to be suffering from the disease. There were, therefore, four definite cases of this illness during the year, and three of these proved fatal. Particulars relating to the cases are as follows: — A. C., female, aged 45. The initial symptoms were headache, drowsiness, and retention of the urine. Ptosis; no fever. Later there was weakness in the limbs, but no definite paralysis. The lethargy increased, and patient died on January lltli, 1923, the day after admission to hospital. Blood tests were negative, and post-mortem examination was refused. M. M., male, aged 29. Onset of illness January 27th. Admitted to hospital on February 7th. The chief symptoms were fever, lasting three weeks; ptosis, delirium, retention of urine and lethargy. Later there was wasting of the muscles of the limbs, with rigidity and bi-lateral facial paralysis. The lethargy increased and the patient died on May 9th, having also suffered for three days previously from septic broncho pneumonia. The Wassermann test in both blood and cerebro spinal fluid was negative. (In 1922 the patient had suffered from iritis, and the Wassermann test at this time was positive. He was treated then at Moorfields Hospital.) F. P., female, aged 54. Few particulars could be obtained in this case. The onset of the illness was May 1st, with headache, fever, and backache. Later the patient became delirious and drowsy. The case was notified on May 4th, and removal to hospital was requested, but when the ambulance arrived the patient was dead. 52 L. G., female, aged 30. Onset of illness October 1st, with headache, vomiting, lethargy, but no fever. The pupils were fixed and contracted. The case was notified on November 7th. Later there was incontinence, and the patient became unconscious. The bacteriological examination supported the diagnosis of encephalitis letliargica. This case is still in hospital, and appears to be improving. PNEUMONIA. During the year 286 cases of acute primary pneumonia, and 46 of acute influenzal pneumonia, were notified. Pneumonia, in various forms, is a frequent complication of other diseases, and also a common cause of death. During 1923 there were registered 103 deaths attributed to bronchopneumonia, 45 to lobar-pneumonia, and 53 to pneumonia (type not stated). All notified cases are visited, and in necessitous cases a nurse from the District Nursing Association is instructed to attend, the cost being defrayed by the Borough Council. In 1923, 108 cases of influenza and pneumonia were dealt with at the Council's expense, 1,767 nursing visits being paid. The following is an analysis of the cases notified and visited :— Age and Sex. Acute Primary Pneumonia. Influenzal Pneumonia. Males 191 25 Females 95 21 0—1 17 1 1—5 79 3 5—15 42 4 15—25 33 3 25—55 79 26 55 and over 36 9 Other statistical details will be found on pages 31 to 35. Of the 286 cases of acute primary pneumonia, 151 were treated in their own homes and 135 in hospitals. Of the hospital cases, 85 were treated in the St. Pancras Poor Law Hospitals and 50 in voluntary hospitals. The hospital cases had already been admitted when the homes were visited after notification, with the exception of six which were sent to hospital after the inspector's visit and report. In regard to the 151 cases which were treated at home, 99 were under the care of visiting nurses (in 67 of the cases the nurse was sent in as a result of the inspector's visit). With regard to the 46 cases of acute influenzal pneumonia, 31 were nursed at home and 15 in hospitals. Of the hospital cases, nine were treated in the St. Pancras Poor Law Hospitals and six in voluntary hospitals. In regard to the 31 cases which were treated at home, 18 were under the care of visiting nurses (in 17 of these cases the nurse was sent in as a result of the inspector's visit). Most of the hospital cases were notified by the hospital authorities. After-care visits were made to 23 of the cases under five years of age. OTHER NOTIFIABLE INFECTIOUS DISEASES. Malaria.—13 cases were notified, but no death was recorded. Dysentery.—Three cases were notified, one of which proved fatal. No cases of typhus, cholera, plague, anthrax, glanders, or hydrophobia were reported. 53 MEASLES AND GERMAN MEASLES. These diseases are compulsorily notifiable in St. Pancras under the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920. All cases are notifiable by parents or guardians; but only the first case occurring in a house, etc., during an outbreak, is notifiable by the medical practitioner in attendance, an interval of two months since the previous case constituting an outbreak. From 1916 to 1919, these diseases were compulsorily notifiable throughout England and Wales; but at the end of 1919 notification was abandoned by order of the Ministry of Health. In a few districts, St. Pancras being one, notification was retained by means of special regulations. The borough was singularly free from these diseases, during the past year only 327 cases of measles and 134 cases of german measles being notified or otherwise discovered. This represents an incidence rate of 1.5 per 1,000 of population for measles, and 0.62 for german measles. Five deaths were registered as being due to measles, all being of children under five years of age. This equals a death-rate of 0'02 per 1,000 of population, and a case mortality of l.5 per cent. of notified cases. There were no deaths from german measles. The cases were notified or reported as follows:— Measles. German Measles. Notified by medical practitioners 261 111 „ parents and guardians 35 6 Discovered otherwise 31 17 327 134 Further statistical facts in regard to the disease will be found on pages 31 to 35. All cases where it was considered necessary were attended by a visiting nurse once or twice a day. During the year five cases of measles were nursed, 37 nursing visits being made. The number of cases notified, the deaths, and the case morality per cent. for the eight years during which measles has been notifiable, will be found in the following table: — Year. Cases Notified. Deaths. Case Mortality, per cent. 1916 1885 42 2.2 1917 3681 118 3.2 1918 2144 75 3.5 1919 1034 15 1.5 1920 3093 65 2.1 1921 1149 23 2.0 1922 3728 107 2.9 1923 327 5 1.5 WHOOPING COUGH. There were 28 deaths from this disease during the year, and of this number 27 were of children under five years of age. Of the total 28 deaths, 9 were of males and 19 females. It is a curious fact, for which no explanation is forthcoming, that whooping cough is the one cause of death which kills more girls than boys. 54 The following table gives the number of deaths from whooping cough during the past ten years:— Year. Deaths. Year. Deaths. 1914 49 1919 7 1915 52 1920 60 1916 39 1921 38 1917 27 1922 29 1918 80 1923 28 Ur the total 409 deaths in the above 10 years, 17o were oi males and S234 of iemales. Three cases of whooping cough were nursed in 19 23, 66 nursing visits being made. The cost was defrayed by the Borough Council. DIARRHCEA AND ENTERITIS. Sixty-one deaths were recorded during the year, of which 52 were of children under five years of age, and of these 43 were under one year of age. These diseases are chiefly prevalent during summer and early autumn, especially if the weather is hot and dry. The table on page 33 gives the number of deaths from the above causes during each month of the year. It will be seen that, of the total 61 deaths during the year, 26 occurred during the three months July to September. The following table gives particulars concerning the mortality from the above causes at different age periods, and the total rates of infant mortality from all causes during the past 20 years:— Diarhhœa and Enteritis. Year. Births Registered. Deaths from Diarrhoea and Enteritis. Infantile Mortalityfrom all Causesper 1000 Births. All Ages. Under 5. Under 1. Deaths under 1 per 1000 Births. 1904 6116 257 237 205 34 152 1905 5801 202 192 159 27 136 1906 5744 234 228 189 33 131 1907 5484 104 89 75 14 113 1908 5546 142 135 107 19 115 1909 5238 105 99 80 15 108 1910 5385 82 78 59 11 107 1911 5555 248 218 168 30 112 1912 5367 45 35 32 6 88 1913 5517 148 127 95 17 93 1914 5226 142 127 106 20 92 1915 4754 114 107 79 17 105 1916 4530 72 56 41 9 85 1917 3796 97 80 61 16 106 1918 3318 56 47 37 11 102 1919 3824 68 55 47 12 88 1920 5934 54 44 37 6 73 1921 4764 98 83 74 16 76 1922 4559 47 37 31 7 74 1923 4348 61 52 43 10 63 55 Since the serious epidemic of 1918, there have been several small recurrences, but none so severe in character. During 1923, St. Pancras was singularly free from this disease, only 24 deaths being recorded. The following table gives the number of deaths from Influenza during the past six years:— Year. Deaths. Year. Deaths. 1918 700 1921 57 1919 260 1922 142 1920 46 1923 24 SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1923 as due to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are late manifestations of the disease, and (c) aortic aneurysm, which many authorities now consider to be frequently caused by it:— 0-1 1-5 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 up. Total Males. 0-1 1-6 5-15 15-25 25 -35 35- 45 45—55 55—65 65—75 75—85 85 up. Total Females. Total Persons. Syphilis 5 - — - - 1 1 — — — 7 - - — — — 1 - — — — - 1 8 Locomotor ataxy - - - - - 1 1 3 1 — - 6 - - - - - - - - - - - — 6 General paralysis of the insane — — 1 5 3 1 — — - 10 — — — — — 1 — 1 — — - 2 12 Aortic aneurysm - - - - - 1 2 6 2 1 - 12 - — — — — — 1 1 1 — — 3 15 CANCER. 319 deaths were registered during 1923 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, sarcoma, &c. This is equal to a death-rate of 1.49 per 1,000 of 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 1923). Males 159 1.57 Females 160 1.41 Both Sexes 319 1.49 56 The deaths registered during the past ten years as due to cancer are set out in the following table:— Sex, 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 Average for 10 years. 1923 Males 127 127 120 125 135 125 114 150 140 157 132 159 Females. 158 140 138 142 146 144 131 149 150 145 144 160 Both Sexes 285 267 258 267 281 269 245 299 290 302 276 319 It will be noted that the number of deaths from cancer again shows a slight increase, and the increase is common to the whole country. During the past 20 years, the mortality in England and Wales due to cancer has increased by 20 per cent., and this increase is the more noteworthy when the fact is recorded that, during this same period of 20 years, the general death-rate has decreased by 32 per cent. The cause, or causes, of the disease in its various forms still remain unknown. In certain parts of the body, long continued irritation appears to provoke the disease. For instance, a rough tooth or pipe stem if causing a sore place may ultimately lead to cancer of the tongue or lip. In the same way, long continued irritation by clothing, or by pressure on the breast, etc., may induce the disease in that part. In the early stages there is no pain, hence the trouble often makes considerable progress before advice is obtained. Early diagnosis and early operation afford the best, and, at present, the only chance of cure; therefore it is essential that any persistent sore place, or any unusual "lump" or tumour, should be submitted to medical examination without the least delay. DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in the following table:- Disease. No. of Cases. No. of Houses. No. of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Small-pox - - - - Scarlet Fever 451 433 464 466 Diphtheria 495 481 514 516 Enteric Fever 17 17 17 1 Erysipelas 58 58 58 — Puerperal Fever 15 15 15 — Encephalitis Lethargica 2 2 2 2 Cerebrospinal Meningitis 4 4 4 1 Poliomyelitis . 4 4 4 1 Tuberculosis 106 106 123 103 Measles 7 7 14 11 Cancer 28 28 28 2 Vermin aud Scabies 102 79 81 10 Other Diseases 178 178 189 17 Totals 1467 1412 1513 1130 57 Below is shown the number of articles disinfected or destroyed during the year on account of infectious disease or verminous condition :— Infectious Disease. Verminous. Destroyed. Disinfected. Destroyed. Disinfected. Beds, mattresses and paliasses 47 1465 16 78 Bolsters and pillows 41 2947 3 107 Sheets, blankets and counterpanes 13 4115 2 156 Rugs, mats, cushions, carpets, covers and curtains 17 548 3 56 Wearing apparel 35 1576 — 82 Books — 98 — — Sundries 50 177 6 20 Totals 203 10926 30 499 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 2 3 — Scarlet Fever 3 3 — Diphtheria 5 3 — Enteric Fever — 1 — Puerperal Fever — 6 — 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 950 27 4003 *4980 Scabies 19 33 775 827 Cases from outside Vermin 48 2 817 867 St. Pancras Scabies — — 240 240 Vermin 998 29 4820 5847 Scabies 19 33 1015 1067 Totals 1017 62 5835 6914 * Includes 478 males and 3 females who had no home address, 58 The school children included in the above table have, in the main, been brought to the cleansing station from the public elementary schools by officials of the London County Council as the Education Authority, under the powers conferred upon them by their General Powers Act, 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. 4,812 cases were paid for during the year at the rate of 2s. per case, and 1,015 cleansings at the rate of Is. per bath. School children with head lice have also been dealt with by the London County Council at the Prince of "Wales Road clinic. Fifty-two verminous persons from common lodging houses outside the borough were paid for by the London County Council, at the rate of Is. per attendance, and three by Finsbury Borough Council. 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 Yermtnous 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 fo be verminous by reason of having leen 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 includes 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 convenient means of securing the disinfection of bedding, &c., used bv 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. 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. Section IV.—SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.—Altogether 66,164 inspections were made in 1923 by the staff of Inspectors and Visitors. These consisted of 31,732 initial inspections and 34,432 re-inspections. Of these inspections, 40,437 were made by the District Sanitary Inspectors, 7,115 by the Sanitary Inspectors of Food and Food places, 3,144 by the Sanitary Inspector of 59 Factories and Workshops, and 15,468 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 21), and by the staff of the Tuberculosis Dispensaries (see page 46); nor do they include the work of the disinfecting staff (see page 56). Notices served and result of service.—3,435 intimation notices (comprising 7,033 items) were served by the S initary Inspectors during 1923. These were made up as follows:— District Inspectors. Factory and Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 4591 — 1 — 4592 In respect of the Tenement House By-laws 632 — — — 632 In respect of Breaches of Statutes in Factories, Workshops and Workplaces 1 433 - - 434 In respect of other Breaches of Statutes and By-laws 1371 1 3 1375 Totals 6595 434 4 — 7033 These intimations are classified in Tables 11, 12, 13 and 14, on pages 100 and 101. 1,381 Statutory notices (comprising 2,072 items) were served during 1923 and the early part of 1924, following non-compliance with these intimation notices. These are also classified in Tables 11, 12, 13 and 14, on pages 100 and 101. The following prosecutions were undertaken during the year in respect of general sanitary work:— 60 Under the Public Health (London) Act, 1891 (except in respect of Food). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 16, Oseney Crescent Walls and ceilings dirty, and drain ventilating pipe defective Jan. 17th Order to abate nuisance within 14 davs, costs £1 5s. 13, Sidmouth Mews Soil pipe defective and unventilated 24th Order made to abate nuisance within 6 weeks, costs £1 5s. 33, Stibbington Street Failing to comply with Nuisance Order Feb. 21st Fined £7 14s. 6d. 35, ,, Do. do. ,, 21st Do. 37, ,, Do. do. ,, 21st Do. 39, ,, Do. do. ,, 21st Do. 41, ,, Do. do. „ 21st Do. 43, ,, Do. do. ,, 21st Do. 45, ,, Do. do. „ 21st Do. 88, Bartholomew Road Fixing new w.c, basin and trap without notice „ 27th Fined 10s., costs £2 2s. 9, Carlton Street Waste pipe of sink defective and foul, guttering and addition roof defective „ 27th Withdrawn—work carried out. Costs £3 3s. 42, Mornington Road Part of yard paving defective ,, 27th Withdrawn—work oarried out. 42, ,, Walls of staircase dirty; box guttering and walls of w.c. apartment defective Roof and box guttering defective March 27th Withdrawn—work carried out. Costs £2 2s. 43, ,, „ 27th 139, Albert Street Roof defective 27th 149, Stanhope Street Offensive accumulation in vaults 27th 105, Harrison Street Roof and guttering defective April 10th Withdrawn—work carried out. Costs £2 2s. 6, Burghley Road Dustbin defective „ 24th Withdrawn—work carried out. Costs £1 Is. 6, Maiden Crescent Overcrowded condition of rooms May 4th Order to abate nuisance within 21 days. Walls damp ; roof and water fittings defective 25, Medburn Street „ 25th Costs £1 5s.—Order to abate nuisance within 6 weeks. 103, Fortess Road Walls and ceilings, basement scullery dirty and dilapidated; walls and ceilings bathroom and basement kitchen damp and paper discoloured; roof and guttering defective; waste pipe of sink defective and bound with rag; lead aprons round top windows defective „ 31st Costs £2 2s.—Order made to abate nuisance within 14 days. G, Queen Street Walls and ceilings dirty; roof and ceiling defective July 3rd Costs £1 1s. 7, „ Walls and ceilings dirty; absence of front door ; kitchen damp; floor boards, plaster of ceiling, seat of w.c. and flushing cistern to pan of w.c., defective. ,, 3rd Costs £1 Is.—Order to abate nuisance within 28 days. 19, Bartholomew Villas .. Defective drain and unventilated soil pipe ... „ 13th ... Costs ,£1 5s.—Order to abate nuisance within 28 days. 6, Maiden Crescent Non-compliance with provisions of a Nuisance Order, ordering the abatement of nuisance arising from overcrowding „ 13th... Adjourned sine die, an Ejection Order having been obtained by the owner. 18, Hampshire Street ... Animals (rabbits) improperly kept „ 27th... Costs £2 2s.—Order to abate nuisance within 14 days. 18, Sidmouth Mews Soil pipe unventilated and drain defective ... Aug, 21st ... Costs £1 5s. Order to abate nuisance within 14 days. Do. Failing to comply with Nuisance Order Sept. 25th... Costs £2 2s.—Work being carried out. Under the London County Council (General Powers) Act, 1922. Situation of Property. Offence, Date of Hearing of Summons Result of Proceedings. 7, Queen Street Failing to strip, purify, and cleanse ground floor front room. July 3rd ... Fined £3. 61 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. Sixty-six visits were made to these premises in 1923. Registered Tenement Houses. At the end of 1923 there were 2,36.5 such houses on the Register. Statistics as to the inspection of these and other houses will be found in Tables Nos. 7 and 12, on pages 95 and 100. Underground *Rooms. During the period of stringency in housing accommodation which has followed the war, a large number of underground rooms, the use of which for sleeping purposes had in former years been effectually forbidden under the Public Health (London) Act, 1891, and the Housing, Town Planning, &c., Act, 1909, have again become occupied as sleeping places. Except in a very few cases, it has not been found possible to secure the discontinuance of their use for this purpose. The reason for this is that the occupants have no place to go to in the event of their being ejected from the rooms in question. There has been a similar difficulty in dealing with cases of overcrowding, the families concerned being often unable to obtain more accommodation. Smoke Prevention. During the year 915 observations of smoke shafts were made. There were no prosecutions. OnNSTRTirTTOIV at. drain wnrk. 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 350 3421 Voluntary drainage work 1287 4031 Drains of new buildings 89 1161 1726 8613 Drainage Register.—The following is an analysis of the Drainage Register during 1923:— Plans deposited—Old Buildings under Notice 81 „ ,, Old Buildings, Voluntary 193 „ „ New Buildings and Additions 18 292 Applications without Plans 224 Total number of Applications and Plans 516 62 Wateii Service. The following notices have been receivc during the year from the Metropolitan Water Board as to houses from which water has been cut off :— 1.—Demolition 9 2.—Empty 4 3.— Waste 5 4.—Non-payment of Rates 2 5.—Broken Supply Pipe 8 6.—Fittings (defective) 1 29 Canal Boats Acts. During the year Inspector Auger examined 7 canal boats, which were registered for the occupation of 17 adults and 7 children, and were occupied by 11 adults and 7 children. No notices were served. 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. Inhabititkd House Duty. Two applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1923, in respect of two houses comprising six tenements. The certificates were not granted. The Rag Flock Act, 1911. No samples of rag flock were taken during 1923. 288 inquests were held during the year. In the following table will be found the causes of death, as certified by the Coroner ; they are also further classified into age-periods:— Causes. Under 1 year. 1—5 years. 6—15 years. 15—25 years. 25—65 years. 65 and over. Totals. Natural— Heart Disease 8 2 30 22 57 Pneumonia 2 1 1 — 3 2 9 Cerebral Haemorrhage 1 — — - 2 6 9 Tuberculosis — 1 — — 5 2 8 Peritonitis — 1 — — 3 — 4 Cancer — — — — 2 1 3 Diarrhoea and Enteritis — — — — 2 1 3 Alcoholism — — — — 1 1 2 Other causes 2 1 1 1 10 3 18 Accidents— Street Vehicles — 4 8 4 9 7 32 Burns and Scalds 2 6 1 — 3 2 14 Railway — — 1 5 1 7 Other causes* 6 3 4 5 33 17 68 Suicidesf - — - 3 29 5 37 Murder 2 2 — — — 4 Open Verdxct‡ 4 — — 8 1 13 Totals 22 19 15 l(i 145 71 288 * Includes 1 case coal gas poisoning, † „ 16 cases „ „ ‡ ,, 2 cases ,, ,, 63 FACTORY AND WORKSHOP ACTS. The following live tables are those asked for by the Home Secretary:— 1.—Inspkctions made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Written Prosecutions. (1) (2) (3) (4) Factories (including factory laundries and bakehouses) 901 147 - Workshops (including workshop laundries and bakehouses) 1968 247 - Workplaces (other than Outworkers' premises included in Part 3 of this Report) 274 40 — Total 3143 434 — 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (1) (5) Nuisances under the Public Health Acts*: — Want of cleanliness 126 126 Want of ventilation 1 1 Overcrowding 1 1 Want of drainage of floors — — Other nuisances 80 80 Sanitary accommodation— Insufficient 11 11 Unsuitable or defective 62 62 Not separate for sexes 13 13 Nil. Nil. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 89 89 Other offences (excluding offences relating to outwork which are included in Part 3 of this Report; 51 61 Total 434 434 - — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 64 3.—Home Work. The only matter to report under this heading is the receipt of the following lists of outworkers for employers sending twice in the year:—17 in respect of the making, etc., of wearing apparel, comprising the names of 65 outworkers (contractors) and 72 outworkers (workmen). 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year. Number. (1) (2) Bakehouses 120 Restaurant kitchens 403 Laundries 30 Domestic workshops Other workshops where women are employed 439 Other workshops 815 Total number of workshops on Register 1807 5.—Other Matters. • Class Number. (1) (2) Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 58 Reports (of action taken) sent to H.M. Inspector 58 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 16 Underground bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 87 66 umber of factories, workshops and workplaces added to and removed from the register during 1923 was as follows:— Added to Register. Removed from Register. On Register at end of 1923. Bakehouses— Workshop — 9 120 Factory 4 1 42 Laundries— Workshop — 2 30 Factory — — 12 Restaurant kitchens 4 1 403 Other workshops where women are employed 27 15 439 Other workshops . . 36 36 815 Other factories 36 17 724 The number of inspections that were made during 1923 were as follows: — Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspec- 1 tions. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses. 319 267 - - 319 267 Restaurant kitchens 32 49 - - 32 49 Laundries .- 3 2 - - 3 2 Domestic workshops Other workshops 292 1340 - - 292 1340 Other workplaces 53 139 l 54 139 Other factories 141 505 - - 141 505 Total . . 840 2302 l — 841 2302 Bakehouses and restaurant kitchens are also referred to in Section V. (page 74). SCHOOLS. The medical inspection and treatment of children in Elementary Schools in St. Pancrau 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. P.merus during 1923. They are classified in tho following Tables:— 66 Medical Examination of Elementary School Children in St. Pancras, 1923. Boys. Girls. Entrants. Age 8. Age 12. Entrants. .Age 8. Age 12. Number examined 1591 1509 1661 1667 1397 1542 Malnutrition Cases. * 9 9 Cases. * 15 11 Cases. * 13 12 Cases. * 8 4 Cases. * 15 11 Cases. * 11 10 Skin disease 26 21 17 15 20 15 18 16 11 9 24 18 Defective teeth — 309 — 282 — 198 — 358 — 258 — 177 Enlarged tonsils (only) 68 23 70 20 58 12 89 34 74 26 78 19 Adenoids (only) 71 37 55 31 14 12 80 55 25 18 8 7 Tonsils and adenoids (together) 96 68 36 21 11 9 86 55 40 31 3 3 Other nose and throat defects 20 13 14 9 15 10 18 7 7 6 11 5 Enlarged glands (cervical and submaxillary) 68 7 76 5 66 1 48 — 59 2 23 3 Eye disease 41 30 34 22 19 10 49 36 30 17 16 8 Defective vision Not tested — 142 — 171 Not tested — 161 — 177 Otorrhœa 20 15 10 9 20 17 24 20 15 11 16 14 Other ear disease 7 — 5 2 12 5 9 2 6 3 11 3 Defective hearing 11 7 21 9 26 12 12 4 29 10 15 12 Speech defects 9 1 12 1 6 — 9 — 4 — 6 — Heart defects 22 1 31 3 32 5 27 4 22 3 33 9 Anaemia 13 8 32 25 32 23 25 17 20 16 30 19 Lung defects (non.tuberculous) 58 29 39 23 15 9 53 30 28 17 24 9 Defects of nervous system 4 2 11 4 12 2 12 3 7 1 16 3 Phthisis 1 — 2 — 2 1 2 1 2 1 1 1 Other tubercular disease 1 — 1 — 1 — 1 1 2 2 — — Rickets 12 2 5 1 — — 8 2 4 1 3 — Spinal defoimities — — 11 8 12 5 — — 5 3 12 6 Other deformities 7 1 5 2 10 — 5 1 10 — 9 3 Other defects or disease 36 24 46 34 20 10 34 25 31 18 41 24 Number of children noted for treatment 516 557 450 598 528 453 Note.—Defects, however slight, are included under "Cases.'' Those severe enough to require treatment are shown under *. 67 Borough of St. Pancras, 1923. Degree of Cleanliness, Nutrition, Condition of Teeth, and Acuity of Vision. Age Group. Number examined. Clothing and Boots. Nutrition. Cleanliness of head. Cleanliness of Body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits only. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either eye. Entrants- Boys 1591 1124 455 12 418 1145 27 1 1554 36 1 1568 23 — 780 604 207 Not tested Girls 1667 1144 516 7 352 1277 36 2 1475 172 20 1615 50 2 725 721 221 „ „ Age 8— Boys 1509 891 591 27 276 1180 49 4 1466 41 2 1479 30 — 737 588 184 766 435 269 Girls 1397 761 631 5 255 1078 62 2 1143 226 28 1357 37 3 693 546 158 630 475 275 Boys 1661 916 699 16 283 1325 52 1 1608 53 — 1605 53 3 860 747 54 1033 330 298 Girls 1542 943 586 13 272 1224 45 1 1285 240 17 1508 34 — 922 574 46 857 360 323 Total 9367 5809 3478 80 1856 7229 271 11 8531 768 68 9132 2.7 8 4717 3780 870 3286 1600 1165 % St. Pancras 62.0 37.2 0.8 19.8 77.2 3.0 91.1 8.2 0.7 97.5 2.4 0.1 50.3 40.4 9.3 54.3 26.4 19.3 % London 58.7 39.6 1.7 21.2 72.9 5.9 88.7 10.5 0.8 94.4 5.4 0.2 60.4 31.4 8.2 50.8 29.7 19.5 68 Feeding of School Children. The County Medical Officer has also kindly furnished the following particulars in regard to the feeding of school children in St. Pancras during the year ended 31st March, 1924:— — Weekly average Number of children fed. Number of meals provided. Cod Liver Oil and Malt. Dinners. Breakfasts. Milk. Ordinary Schools. (a) Necessitous 191 16657 — 21890 885 (b) Non-necessitous 317 9051 — 49326 1745 Special Schools. (a) Necessitous 86 14092 — 2119 179 (b) Non-necessitous 328 54463 — 14726 24 Totals 929 94263 — 88061 2833 The schools were closed for normal holidays during the following periods :—• Easter—29th March to 9th April, 1923, inclusive. Whitsuntide—21st and 22nd May, 1923. Summer—26th July to 27th August, 1923, inclusive. Autumn—29th and 30th October, 1923. Christmas—22nd December, 1923, to 7th January, 1924, inclusive. Infectious Diseases in Schools. In the investigation of cases of scarlet fever, diphtheria, measles, etc., 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. St. Pancras School Clinics. The following account of the work of the London County Council Treatment Centres for school children has been kindly furnished by Dr. A. R. Roche, the SecretarySuperintendent:— School Treatment Centres. It has been my privilege for some years past, at the request of Dr. Shadick Higgins, the former Medical Officer of Health for the Borough, to write a short report on the working of these Centres, for incorporation in his annual report. Dr. Higgins' successor, Dr. Sowden, has extended a similar invitation, and I avail myself of it with pleasure. There are three of these Centres in St. Pancras : the Highgate New Town Clinic in Chester Road, the St. Pancras Centre in Prince of Wales Road, and the Lancing Street Centre in Churchway, Euston Road. The first-named is under a Committee of Management, and the two others are managed by the St. Pancras Public Medical Service. I personally act as Secretary-Superintendent to both sides. The general nature of the work is, that, as the result of inspections at the schools by medical officers, cases are referred for treatment at the Centres, which are staffed by London County Council nurses, and local medical practitioners and dental surgeons. 69 To tabulate the actual number of cases dealt with:— Dental Cases. Aural Cases. Eye Cases. Minor Ailments. Highgate New Town Clinic 1088 302 271 653 Prince of Wales Road „ 1896 518 1032 1283 Lancing Street „ 1352 309 Nil. 1197 At each Centre, in connection with the minor ailment department, there is a very large daily attendance of cases at the surgery for dressing of wounds and skin diseases and treatment of ears. Thus at Highgate during the year there were 10,422 attendances, at Prince of Wales Road 23,937, and at Lancing Street 22,771. Such is a statement of the actual number of cases dealt with, and the numbers themselves prove that a great deal of useful work is done. There are two special features to be dealt with. At Prince of Wales Road we have a department dealing with the cleansing of verminous heads, and during the year 3,636 cases were treated. This department is under the supervision of a nurse, who has two shampoo women working under her. Children needing attention are referred here, and their heads are thoroughly cleansed and combed, and on leaving the Centre are immaculate in this respect. Anyone who has knowledge of how much discomfort and ill-health is caused amongst school children by this condition will appreciate the benefit of this work. The other feature I wish to allude to is the special work that is being done at Highgate New Town Clinic in connection with the operative treatment of children for tonsils and adenoids, and some other conditions. Formerly it was the custom for children requiring operation to be done at the Centres and then sent home, and this custom still largely prevails in London. There were many objections to his course. Highgate New Town Clinic, in addition to functioning as a treatment centre for that district, has now become an operating centre for a very wide district, taking in cases from Islington, St. Pancras, Ilolborn, Hampstead, and Kilburn. The procedure is as follows:—The children are seen by the doctors attached to the Centres in their district and those requiring operation are referred for that purpose for admission to Highgate New Town Clinic. Here they are operated on by the doctors who have seen them, and will subsequently see them in their own districts, and each case is kept in for at least 48 hours, or longer if necessary, and then returned home and referred back to their own Centre. On admission to Highgate, each child is bathed and prepared, and its clothes disinfected, operated on the same day, and kept in the wards for two nights. During this period any serious complication is detected and dealt with, and, if necessary, the child is kept in longer than the customary period. We have had a few exceptional cases that have been kept in for ten days or a fortnight. In all, 1,341 cases have been operated on. At Highgate New Town, all the nursing is done by nurses supplied by the County Council. At Prince of Wales Road and Lancing Street, the minor ailment nursing is done by Queen Victoria Jubilee nurses from the Central St. Pancras Nursing Association, who, in connection with it, have paid 536 home visits at Lancing Street, and 353 home visits at Prince of Wales Road. In conclusion, I wish to bear tribute to the skilled and patient work done by the doctors and dental surgeons, the able and clever way the sisters in charge superintend large establishments and a difficult class of patient, and the excellent work of the Council nurses and the Jubilee nurses of the Central St. Pancras Nursing Association. June, 1924. A. R. Roche, Secretary to the St. Pancras Public. Medical Sern'cc and the Highgate New Town Clinic, 70 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 1923 there were two licensed cowsheds in the Borough. They are registered for 43 cows, but were occupied by 7. Millishops and Dairies.—42 applications for registration under the Dairies, Cowsheds, and Milkshops Orders, in respect of milkshops, were considered during 1923, of which 32 were acceded to and 10 refused. Seven applications in respect of itinerant vendors were also considered, of which 3 were acceded to and 4 refused. The figures in regard to the registration of milkshops are set out below: — Number of purveyors of milk at retail milkshops on register at end of 1922 203 Deduct number of purveyors removed from register during 1923 22 Add number of purveyors added to register by resolution of Council during 1923 32 Number of purveyors of milk at retail milkshops on register at end of 1923 213 At the end of 1923, there were on the register, in addition to these 213 retail milkshops and 2 cowsheds (which are attached to retail milkshops included in the 213), one person in respect of premises where only a wholesale milk trade is done, and 25 itinerant vendors without retail milkshops. 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. £ s. d. 49, Harrison Street Carrying on trade or business of a purveyor of milk without being registered June 6th 3 0 0 1 1 0 67, Torriano Avenue Carrying on trade or business of a purveyor of milk without being registered Dec. 6th — 1 3 0 Milk and Dairies (Amendment) Act, 1922. This Act came into force on September 1st, 1922. It enables local authorities to refuse to register a retail purveyor of milk, or, if already registered, to remove any such person from the register, if they are satisfied that the public health is, or is likely to be endangered by any act or default of such person. The Act further prohibits the addition of any colouring matter, or of any dried or condensed milk, or any fluid re-constituted therefrom, to any milk intended for sale. It also prohibits the sale, or offering lor sale, of milk derived from any cow suffering from tuberculosis of the udder. 71 Other sections, which came into force on January 1st, 1923, regulate the conditions under which the sale of milk under special designations shall be permitted. Milk (Special Designations) Order, 1923. The special designations, under which milk may be sold, comprise the following:— "Certified," " Grade A (tuberculin tested)," "Grade A," and "Pasteurised." The order states the conditions which must be complied with before a licence can be granted in connection with the production, distribution and sale of such milk. Any such licence is valid for not more than one year and expires on December 31st in each year. During 1923 the following licences for the Sale of Graded Milk were granted:— Date of Licence. Name and Address of Licensee. Grades of milk in respect of which Licence is granted. St. Pancras Address at which graded milk will be sold. 1923. 7th February Welford & Sons, Ltd., Elgin Avenue, W. 9 "Certified" 69, Albany Street. Do. Do. Do. 48, Marchmont Street. Do. J. Richards, Ltd., 41, England's Lane, N. W. 3 Do. 63, Park Street. Do. Do. Do. 176, Gt. College Street. Do. Do. Do. 126, Regent's Park Road. Do. Marshalls Dairies, Ltd., 19, Tudor Place, W. 1 Do. 19, Tudor Place. Do. Do. "Grade A" Do. Do. Express Dairy Co., Ltd., 26, Tavistock Place W.C.1 "Certified" 26, Tavistock Place. Do. Do. "Grade A Tuberculin tested'' Do. Do. Vicarage Farm Dairy Co., Ltd., 277 & 279, Kentish Town Road, N.W. 5 "Certified" 277 & 279, Kentish Town Road. Do. Do. "Grade A" Do. Do. Do. "Pasteurised" Do. Do. W. T. Davies, 17, Hunter Street, W.C.1 "Certified" 17, Hunter Street. Do. Do. "Grade A Tubereulin tested " Do. Do. Do. "Grade A" Do. Do. Belgravia Dairy Co., Ltd., 4 6, Exhibition Road, S.W. 7 "Certified" 177, Albany Street. 5th March Express Dairy Co., Ltd., 26-30, Tavistock Place, W.C. 1 Do. 12, South Grove. Do. Do. "Grade A Tuberculin tested" Do. Do. John Evans, 35, Southampton Street, W. 1 "Certified" 35, Southampton Street. Do. J. R. Mills, 23, Francis Street, W.C. Do. 23, Francis Street. Do. Lord Rayleigh's Dairies. Ltd., 12, Gt. Russell Street, W.C. 1 "Certified" Supplementary licence to sell in St. Pancras. 5th April Manor Farm Dairy Co., Ltd., Highgate, N. 6 "Pasteurised" Do. Do. Welford & Co., Dairy Farmers, Ltd., 105-7, Stroud Green Road, N. 4 "Certified" Do. Do. Evan Jones, 137, King's Cross Road, W.C. 1 Do. 137, King's Cross Road. 2nd June Welford & Sons, Ltd., Elgin Avenue, W.9 Do. 63, Park Street. Do. Do. Do. 176, Gt. College Street. 6th December Griffiths Bros., 51, St. George's Road "Pasteurised" 51, St. George's Road and branches in St. Pancras. 72 Pasteurised Milk. Although milk can only be sold under this name if a licence is obtained, and if the process of pasteurisation has been carried out according to methods detailed in the Milk (Special Designations) Order, attention must be drawn to the fact that a considerable quantity of milk is now sold as ordinary raw milk, but which has been pasteurised by various methods. It is not sold as pasteurised, but us ordinary milk, therefore the order is not infringed ; but the fact that the milk has been treated by heat is not disclosed. Public Health (Milk and Cream) Regulations, 1912 & 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, 1923. 1. Milk, and Cream not sold as Preserved Cream. — (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 351 — Cream 20 10 Nature of preservative in each case in column (6), and action taken under Regulations in regard to it:— C. 193. Cream. 0'224 per cent.of boron trioxide, equal to 0'397 per cent.of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. 31st August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 194. Cream. 0.4 per cent.of boron trioxide, equal to 0.48 per cent.of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. 31st August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 197. Cream. 0.105cent.of boron trioxide, equal to 0.186 per cent.of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. 31st August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 199. Cream. 0.26 per cent.of boron trioxide, equal to 0'223 per cent.of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £1. Costs £1. 28th August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. C. 213. Cream. 0.9 per cent.of boron trioxide, equal to 0'16 per cent.of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. 31st August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. 73 C. 214. Cream. 0.098 per cent. of boron trioxide, equal to 0.173 per cent. of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £3. 31st August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. A. 233. Cream. 0147 per cent. of boron trioxide, equal to 0.26 per cent. of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined 15s. Costs 15s. 28th August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn, A, 234. Cream. 0.126 per cent. of boron trioxide, equal to 0.223 per cent. of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £1. Costs £1. 28th August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. A. 240. Cream. 0.154 per cent. of boron trioxide, equal to 0'273 per cent. of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Fined £2. 30th August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. A. 241. Cream. 0'126 per cent. of boron trioxide, equal to 0.223 per cent. of boric acid. Proceedings taken under the Sale of Food and Drugs Acts for selling to the prejudice of the purchaser. Ordered to pay .£2 2s. costs. 30th August. Proceedings also taken under the Milk and Cream Regulations, 1912, for delivering in a receptacle not labelled. Withdrawn. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (i) Correct statements made 14 (ii) Statements incorrect — Total 14 (iii) Percentage of preservative found in each sample: Boric acid, 0'198, 0.236, 0.149, 0.149, 0.149, 0.236, 0.198, 0.248, 0.236, 0.347, 0.223, 0"186, 0.372, 0.236 Percentage stated on statutory label: 0.4. (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 14 (ii) Below 35 per cent. — Total 14 (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. 74 (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 39 occasions during the year unsound food, as set out below, has been voluntarily surrendered by the owners to the Food Inspectors, and destroyed as trade refuse. No seizures of unsound food have been made. Unsound Food Condemned and Destroyed. Army Rations, 1 tin Beans, baked, 7 tins Beef, cooked, ½ cwt. and 1 tin „ salt, 5 cwt. Beef and Mutton, 28 lbs. Cherries, 1 tin Dog fish, 1 stone Fillets (smoked), 2 boxes Greengages, 7 baskets Haddocks, 3 boxes and 1 case Herrings, 21 barrels and 1 box Herring Roe, 10 boxes Eggs, ½ case Kidney (Bullock's), 1 Liver (Bullocks'), 2 Liver (Sheep's), 2 Milk (Condensed), 489 tins Pears, 2 barrels Plaice, 3 boxes and 2 cwt. Pigs' Heads, 3 Pig's mesentery, 1 Pork, 1 carcase and 37 stone Rabbits, 23 Pilchards, 54 tins Sardines, 38 tins Skate, 1 case and 1 cwt., 1 stone, 25 lbs. Salmon, 2 tins Trout (Salmon), 80 lbs. Tomatoes, 104 boxes Yeast, 10 cwt. 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 1923 there were 7 licensed slaughter-houses (private) in the Borough. Structurally they do not conform to a high standard of excellence. These are kept under periodical inspection by the Food Inspectors, who made 158 inspections in this connection in 1923. Fried Fish and Fish Curing Premises. In 1923 there were 81 fried fish vendors' premises in the Borough, at 3 of which fish curing was also carried on. There were 17 fish curers' premises, including these 3. 390 visits were made by the Food Inspectors to these premises during the year. Ice-Cream Premises. In 1923, 294 ice-cream premises were known to the department; 360 visits were paid to them by the Food Inspectors during the year. Bakehouses and Restaurant Kitchens. At the end of 1923 there were 162 bakehouses on the register, including 42 factory bakehouses. Thirty-nine of these bakehouses were not in use. 120 of the 162 were underground bakehouses, of which 35 were factory bakehouses, and 32 not in use. At the end of the year 403 restaurant kitchens were on the register. Bakehouses and restaurant kitchens are visited by the Factory and Workshop Inspector and further particulars in regard to the work will be found on pages 63 to 65. 75 (c)—SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 725 of these proved to be genuine and 25, or 3.3 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 3 3 — Baking Powder 3 3 — Butter 135 133 2 Calomel Powder 1 1 — Cocoa 40 40 — Coffee 33 33 — Cream 20 10 10 Do. (Preserved) 14 14 — Custard Powder 9 9 — Dripping 1 1 — Egg Powder 1 1 — Fish Paste 1 — 1 Flour (Self-Raising) 35 35 — Ground Ginger 1 1 — Jelly Crystals 1 1 — Lard 21 21 — Lemonade Crystals 2 — Margarine 1 1 — Milk 351 341 10 Mustard 17 17 — Oatmeal 2 2 — Pepper 16 16 — Rice 10 10 — Sausages 5 5 — Sugar 2 2 — Toffee 1 1 — Vinegar 16 15 1 Vinegar (Malt) 8 7 1 Total 750 725 25 Note.—The 750 include three informal samples of milk, one of cream, one of calomel powder, one of cocoa, and one of sugar. Prosecutions were undertaken in respect of 15 of the 25 samples which were reported as being adulterated. These are set out in the following table: — 76 Summonses. Under the Sale of Food and Drugs Acts. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. £ s. d. £ s. d. C. 19 Milk Added water, 117 per cent Mar. 6th Dismissed. 5 5 0 C. 18 „ 120 „ „ 5 5 0 a. 233 Cream 0.26 per cent. of boric acid „ 0 15 0 0 15 0 a. 234 „ 0.223 „ „ „ 1 0 0 1 0 0 C. 199 „ 0.223 „ „ Aug. 28th 1 0 0 1 0 0 C. 213 „ 0.16 „ „ 3 0 0 — C. 214 „ 0.173 „ „ „ 3 0 0 — A. 240 „ 0.273 „ „ Aug. 30th 2 0 0 — A. 241 „ 0.223 „ „ 2 2 0 — C. 193 „ 0.397 „ „ Aug. 31st 3 0 0 — C. 194 „ 0.248 „ „ 3 0 0 — C. 197 „ 0.186 „ „ „ 3 0 0 — C. 270 Milk Deficient in milk fat, 10 per cent. Oct. 19th 2 0 0 — C. 275 „ ,, 6.6 ,, „ Dismissed under the Probation of Offenders Act. 3 3 0 C. 319 „ „ 5.0 „ Dec. 20th 2 0 0 2 2 0 Two summonses were 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. Both were heard on January 23rd, and in one case a fine of 10s. was inflicted, and in the other 2s. costs were obtained. Wholesale dealers in Margarine.-—Two certificates of registration, under the provisions of the Sale of Food and Drugs Acts, were issued during the year. Section VI.—SANITARY ADMINISTRATION. THE STAFF. The names of the staff of the Public Health Department at the end of 1923 will be found on pages 6 and 7. The following changes occurred during the year:— Dr. T. S. Higgins resigned his position as Medical Officer of Health—this took effect on June 1st. Dr. G. Sowden was appointed Medical Officer of Health on October 24th. Dr. Stella Churchill was appointed Acting Medical Officer of Health until the new appointment was made. Dr. Donnelly, the Tuberculosis Officer, was appointed Honorary Consultant for Tuberculosis to the Highgate Hospital on April 1st. Mr. E. Winchester, Temporary Clerk, resigned and left in December. Miss Gr. Anthony, Sanitary Inspector, resigned and left in March. Miss J. A. J. Camman and Miss A. Holland. In accordance with requestof Ministry of Health, one quarter of their remuneration was assigned to work performed by them in connection with measles, as from April 1st. Staff at Maternity and Child Welfare Centres. Dr. C. H. A. Alderton was appointed Medical Officer, Berkeley Road Centre, on January 31st. Dr. M. Radford resigned on 25th April, and Dr. J. Finch Haines was appointed on 28th April to fill the vacancy at the North St. Pancras Centre, Queen's Crescent. 77 Miss B. M. Harris and Miss A. M. Harrop were appointed Assistant Health Visitors on January 31st. Miss F. Brayshaw, Assistant Health Visitor, resigned June 27th. Mrs. J. Lynn was appointed to fill the above vacancy, August 1st. Miss L. E. Auger was granted six months' leave of absence without salary to undertake training for C.M.B. examination. Miss E. B. Bagnall was appointed temporary Assistant Health Visitor to perform Miss Auger's duties. CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S. W. 1, for the bacteriological examination, at the expense of the Council, of material from St. Pancras cases sent to them throncrh medical practitinners in regard to diphtheria, tuberculosis, and typhoid fever. The work done in 1923 was as follow:- — Total. Positive. Negative. Examination of— Swabs for B. diphtheria 531 86 445 Sputum for B. tuberculosis 262 43 219 Blood for Widal reaction (typhoid, &c.) 6 0 6 Examinations of sputum have also been made at the tuberculosis dispensaries (see page 46). 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 though 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 75. Section VII.—OTHER SERVICES. Cordial co-operation exists between the work of the Council and the voluntary agencies performing work of public health and social importance. These agencies include the various hospitals and dispensaries, the local District Nursing Associations, the Maternity Nursing Association, the Invalid Children's Aid Association, the Charity Organisation Society, the British Red Cross, the Soldiers' and Sailors' Families Association, the National Society for the Prevention of Cruelty to Children, the Invalid Kitchens, the Mary Ward Settlement, Lyndhurst Hall, &c. Voluntary agencies subsidised by the Council are referred to particularly in Section II. of this Report (Maternity and Child Welfare). Section VIII.—HOUSING. The shortage of houses still constitutes the most serious public health problem in St. Pancras. The census returns shewed that 12,811 families were each living in one room, and 17,584 families were each living in a tenement of only two rooms. From a health point of view the number of rooms occupied by a family is of more importance than the number of persons living in a given area. 78 Where plenty of land is available, the ideal method, no doubt, is to have a low density of persons per acre, but in London where land is so expensive and where people must often live near their work, the many-storied buildings, so called model dwellings, if well constructed and designed, can constitute very healthy homes, although the number of persons per acre will be high. It is the overcrowding in individual rooms which chiefly tends to a high mortality, increased sickness, and poor type of physique. The shortage of houses renders the work of the Health Department much more difficult. At present it is obviously undesirable to close or demolish bad house property, as this would intensify overcrowding. Action has to be limited to getting as much repair work done as possible, so as to keep existing houses reasonably fit for habitation. Statistics for the year ended 31st December, 1923 (as required by the Ministry of Health):— Number of new houses erected during the year:— (a) Total 12 (b) with State assistance under the housing Acts, 1919 or 1923— (i) By Local Authority Nil. (ii) By other bodies or persons Nil. 1. Unfit dwelling-house*. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2218 (2) Numberof dwelling-houses which were inspectedand recorded under the Housing (Inspection of District) Regulations, 1910 879 (3) Number of dwelling-houses found to be in a st???tes??? dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1370 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. (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 3090 (2) Number of dwelling-houses in which defects were remedied:— (a) by owners 3090 (b) by Local Authority in default of owners Nil. 79 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. 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 Committee sustained a severe loss in the death of their Chairman, Alderman A. Davis, J.P. During his long association with the Council he had always specially identified himself with the problem of the housing of the people, and his practical knowledge and experience were ungrudgingly given in connection with the inception, development, and progress of the Council's schemes in that direction. As a result of his death, Councillor W. C. Wood was appointed Chairman, and Councillor R. J. Smerdon, Deputy Chairman. The Committee 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 twenty having been vacated during the past twelve months, and no difficulty is experienced in filling the vacancies from the waiting list. Brookfieid Estate. The Committee had under consideration a proposal that the pathway extending from the upper end of Croftdown Road to Chester Road should be closed to the public. This passage is the remainder of the pathway which originally extended to York Rise, the other portion having been closed by an Order of the Court of Sessions at the time when the new Croftdown Road was formed. Nuisances are committed in the public way, and its use by children is a source of annoyance to the tenants of the flats adjoining. The authorities of St. Anne's School, and the tenants and owners of one house in Chester Road and three houses in Bertram Street have access to it. The Council's solicitors advised that certain difficulties presented themselves in making application for a Closing Order, and suggested that the owners who have openings from their gardens on to the pathway might have to be accommodated with an alternative means of access. There was also the question of the ownership of the soil of the footpath in the event of a Closing Order being obtained. The estimated cost of the structural alterations consequent upon a Closing Order being made was £287, and there would have to be added probable compensation, apart from the cost of obtaining the Order. In view of the difficulties presented, the Committee adjourned the question sine die, but decided to consider later as to replacing the defective fencing along the pathway. Consideration was given to the necessity for erecting a fence along the portion of the gardens at the side of the last block of maisonettes in Croftdown Road, abutting upon the school path. The tenants complained of nuisances caused by children climbing over the dwarf wire fence, and it was decided to erect a length of palisade fencing, 6ft. in height, along the boundary. The temporary wooden fence along the block of flats fronting Chester Road has been taken down. This fence was retained when the contractor left the work, as it was thought necessary to protect the privet hedge until it became established. 80 Attention was called to the desirability of fencing off the gardens of the tenants occupying the maisonettes. The original scheme contemplate the erection of fences between the several gardens, but the provision was deleted by the Ministry of Health on the ground of economy. The Committee decided to take no action in the matter, as the work would involve a very heavy expenditure. At the same time, the tenants were informed that no objection would be raised to the erection of fences at their own cost, if they so desired. An inspection was made of the ground at the rear of the flats in St. Alban's Road. It was not possible to allot garden ground to the tenants of these flats, as in the case on other parts of the Estate, because a portion of the land which would have been available was utilised by the School Clinic. The result was that the ground was rough and unsightly, and instructions were given for it to be tar sprayed so as to make a drying ground and children's playground. The necessity for providing compounds for the dustbins was taken into consideration. The dustbins were unsightly, and during high winds the lids blew off and the lighter refuse was disiributed around the blocks. As an experiment, three compounds were erected at the most exposed places. These proved satisfactory in abating the nuisance, and nineteen additional compounds have since been provided, with satisfactory results. The wooden hut which was taken over from the contractor has been re-erected and fitted up as a store and workshop for the use of the caretaker, and provision has been made for lavatory accommodation for the use of the workmen employed on the Estate. Many applications were received from the tenants for permission to instal wireless receiving sets, and the following regulations were laid down governing the matter:— (1) That previous written application lias been made to the Council. (2) That the aerial shall be attached at either end to masts, or other supports, firmly fixed into the ground or otherwise, entirely independent of the Council's buildings. (3) That the supports shall be stout enough or be stayed in order to preserve a vertical position and to avoid an unsightly appearance. (4) That the "lead-in" for connecting the aerial to the instrument shall be taken into the dwelling at a point to be approved by the Council. (5) The whole apparatus to be efficiently " earthed," and a suitable cut-out provided. (6) Any damage accruing as a result of the fixing or the use of the installation shall be made good at the expense of the tenant, at the discretion of the Council. (7) The installation shall remain at the discretion of, and shall be removed on the tenant receiving notice in writing from, the Council. Copies of the regulations have been circulated to the tenants interested, and about 40 aerials have so far been erected. Many complaints were received from the tenants of the flats of nuisances arising from smoky chimneys. Chimney pots were not provided when the buildings were erected, owing to the action of the Ministry of Health, who deleted them from the original scheme. Two pots were fixed as an experiment, and these proved successful in abating the nuisance. It was, therefore, decided to provide pots to the flues of all the living rooms of the flats, at a cost of £286 10s. Od. (96 pots). The Ministry agreed to the cost ranking for financial assistance. In a limited number of cases, pots have also been provided for the maisonettes. The grass plots in front of the flats, and the privet hedges and trees throughout the Estate are getting well established, and whilst they need considerable attention to keep them in good condition, it is generally agreed that the labour involved is well repaid by adding to the amenities of the Estate. The Estate comprises 202 tenancies, which have been fully occupied throughout the year. 81 During the year the rents have been reduced in accordance with the variation in the rates. The gross weekly rents now range from 12s. 10d. to 28s. 5d., according to the number of rooms and position. Una House. This scheme comprises 64 flats, and the present gross rents vary from 13s. 2d. to 20s. 9d. weekly, according to the accommodation. With a view to remedying the smoke nuisance in the upper flats, chimney pots were provided to the flues of the living rooms. This proved effective, except in the case of one of the chimney stacks adjoining the wall of the factory next to the dwellings. Experiments were made with various types of pots and cowls, which proved that the trouble was caused by the wind, when in a certain direction, striking the factory wall and rebounding on to the stack, and thus creating a strong down-draught. It was eventually decided to raise the height of the chimney above the level of the factory wall, and this proved successful in abating the nuisance. After a great deal of delay, the final statement of account for work done by the Contractors (Messrs. Chessums, Ltd.) has now been dealt with by the Ministry of Health, subject to review by the District Auditor in due course. The original amount of the contract for the buildings was £76,001 14s. 0d., and in consequence, principally of the increase in wages and the cost of materials during the course of erection, the final account payable to the contractorscame to £82,100 14s. 4d., which, with the sum of £472 14s. lid. for work done by the Council direct, brought the total cost of the buildings to £82,573 9s. 3d. This sum is exclusive of professional fees paid to the architects and quantity surveyors, prizes for original designs, and the salary of the Clerk of Works. The Ministry stated that certain items of expenditure, amounting to £350 Is. 8d., could not be regarded, on the information available, as ranking for financial assistance. It was, therefore, decided to meet the expenditure partly out of the Repairs Fund and partly out of the rates. Goldington Buildings, Flaxman Terrace, Prospect Terrace. At Goldington Buildings there are 56 flats, and the weekly rentals range from 6s. 7d. to 18s. 6d. At Flaxman Terrace there are 84 flats, with rents varying from 7s. 11d. to 16s. 6d. Prospect Terrace contains 70 flats, and the rents vary from 9s. 3d. to 15s. 10d. The external painting of Prospect Terrace was carried out during the year at a cost of £268. Somers Town Area. Negotiations were continued during the year with the Ministry of Health in regard to the Council's proposals for improving the unhealthy conditions existing in Somers Town. No satisfactory progress has been made, and it has been thought expedient to compile a summary of the negotiations, interviews and discussions, which have now occupied the past five years. The summary is as follows:— 28th May, 1919. Local Government Board informed that the Borough Council were preparing preliminary housing schemes for dealing with several areas in the Borough, including Somers Town. Special Housing Committee were authorised to engage three architects to prepare block sketch plans showing the possibility of these areas, and to assist the Committee in dealing with the matter. Mr. A. J. Thomas was appointed as one of the architects, with two others (Mr. Horace Field and Mr. J. E. Newberry) nominated by the President of the Royal Institute of British Architects. 4th June, 1919. Instructions given to Mr. Thomas to proceed with the preparation of block sketch plans relating to Somers Town. 17th December, 1919. Committee authorised to prepare reconstruction schemes under Part II of the Housing of the Working Classes Act, 1890, in regard to 15 areas in Somers Town. 82 Mr. Thomas instructed to prepare the necessary drawings. Committee's report forwarded to the London Housing Board. 15th April, 1920. Conference at the Ministry of Health. . , *21st April, 1920. Area visited by the Ministry's Inspector. 28th April, 1920. Letter to Ministry, asking for their decision. 19th May, 1920. Further letter to Ministry. —July, 1920. Letter received from the Ministry, stating that there appeared to be a primafacie case for dealing with these areas, or some of them, in the manner proposed, and suggesting a further Conference. 14th July, 1920. Conference at the Ministry. 16th November, 1920. Proposals received from the architect for dealing with the first section of the general scheme, including two of the 15 areas previously mentioned. 3rd December, 1920. Further Conference at the Ministry. 24th December, 1920. Letter to Ministry, urging approval of the scheme. 27th January, 1921. Area visited by the Ministry's Inspector. 25th February, 1921. Conference at the Ministry. 23rd March. 1921. Owing to the negative results of these prolonged negotiations, the Committee were authorised to prepare a draft scheme under Part II of the Act of 1890, and the architect instructed to prepare the necessary plans, particulars and estimates. 27th July, 1921. Scheme approved by the Council, and the Committee authorised to take all necessary steps for obtaining sanction thereto. 29th August, 1921. Petition to the Ministry of Health for an Order confirming the scheme. 25th October, 1921. Public Local Inquiry held before Mr. H. S. Stewart, the Ministry's Inspector. 7th December, 1921. Letter to Ministry, asking for their decision arising out of the Inquiry. 1st February, 1922. Letter to Ministry, asking for confirmation of scheme. 20th April, 1922. Further Conference at the Ministry, when the Ministry requested that revised figures should be presented to them. 19th October, 1922. Letter to Ministry, asking them to give the scheme immediate consideration and approval. 28th February, 1923. Letter to local Members of Parliament, asking them to approach the Minister of Health, with a view to sanction being given to the scheme. Minister requested to receive a deputation. 29th March, 1923. Further letter to Ministry. 12th April, 1923. Letter from Ministry, stating that, as the area does not appear to be one of those most urgently requiring attention, and in view of the limited amount of money at his disposal, the Minister does not feel justified in promising assistance towards meeting the loss which would be incurred. He considers there would be no advantage in the attendance of the proposed deputation; but should the Council feel disposed to undertake any Improvement Scheme for this area without financial assistance from the State, he would be ready to consider the matter further on this basis. 25th April, 1923. Mr. Hopkins, M.P., who represented the constituency, asked to address a question in the House of Commons to the responsible Minister, and the remaining local Members asked to support him. 9th May, 1923. In reply to question addressed by Mr. Hopkins, the Minister of Health stated that the area was not of the same urgency as others in London, and for which an Exchequer grant has been earmarked. In the circumstances, it was decided that the scheme could not at present properly form part of the London programme of Improvement Schemes, for which Exchequer assistance is available. 15th May, 1923. Special Sub-Committee appointed to confer with the architect and report. 12th June, 1923. Sub-Committee instructed architect to prepare sketch plans for a reduced and amended scheme, comprising property between the south side of Johnson Street and the north side of Aldenham Street, and including the east and west sides of Wolcot Street. 30th July, 1923. Amended scheme approved by Sub-Committee, and instructions given for estimates to be prepared. 83 llth September, 1923. Sub-Committee approved scheme and estimates, and submitted to parent committee, who recommended that it should be forwarded to the Minister of Health for sanction to make the necessary Order, and that he be requested under Section 1 (3) of the Housing Act, 1923, to contribute one-half of the estimated annual loss likely to be incurred in the carrying out of the scheme. 19th December, 1923. Council approved the alternative plans for the Wolcot Street area, and the Minister of Health was asked to sanction the scheme and to make a contribution under the Housing Act, 1923. 31st December, 1923. Letter from the Ministry, acknowledging the Council's communication, and stating that the Department were in communication with the London County Council. 7th February, 1924. Letter to Ministry, asking whether they had arrived at a decision in regard to the scheme. 22nd February, 1924. Letter to the Ministry, asking them to receive a deputation from this Council. 26th February, 1924. Letter from the Minister, stating that he desires, in the first instance, to have the views of the London County Council on the scheme in relation to the programme for London as a whole. 19th March, 1924. Council decided to address a communication to the members of the London County Council representing the Borough, strongly urging them to take all necessary steps in order that the County Council may expedite their report to the Ministry. 19th May, 1924. Letter from the London County Council, stating that the Housing Committee had requested their Chairman and Vice-Chairman to discuss the proposals with representatives of the Borough Council. 2nd June, 1924. Conference at the London County Council. Note. —The scheme now before the Ministrv for the Wolcot Street area provides for the erection of five blocks of model dwellings containing 43 two-room, 53 three-room, an I two five-room flats, with bathroom, cooking scullery, and offices, at an estimated cost of £50,000, which works out at ,£196 per room The average cost per flat, including value of land, cost of buildings, architect's and quantity surveyor's fees, and Clerk of Works' salary, is £673. The scheme would accommodate 510 persons, based on two persons per room, and the estimated annual loss is £1,415 17s. 10d. The number of persons to be displaced is 309. 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. If. 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; Brookfield Estate, Mr. H. J. Ambrose; Flaxman Terrace, Mr. C. Hanson; Una House, Mr. J. F. Clegg; Goldington Biddings, Mr. G. S. Tunbridge. 85 APPENDIX. 86 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1923 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1913 218387 — 5167 5517 24.7 3409 15.6 728 662 512 93 3343 15.0 1914 218387 — 4945 5225 23.9 3386 15.5 721 677 481 92 3342 15.3 1915 218387 200322 4458 4754 21.8* 3523 17.6† 672 692 497 105 3543 17.7† 1916 214135 196813 4310 4530 21.2* 2991 15.2† 565 619 385 85 3045 15.5† 1917 208006 186600 3635 3796 18.2* 3099 16.6† 608 718 402 106 3142 16.8† 1918 196883 175716 3339 . 3318 16.8* 3789 21.5† 626 751 340 102 3914 22.3† 1919 228585 . 219434 3804 3824 16.7* 3104 14.1† 670 496 336 88 2930 13.4† 1920 228980 228178 6191 5934 25.4* 3007 12.9† 713 601 435 73 2895 12.4† 1921 212900 — 5099 4764 22.4 2836 13.3 651 593 360 76 2778 13.0 1922 212500 — 4865 4559 21.5 3219 15.1 715 603 337 74 3107 14.6 1923 214400 — 4654 4348 20.3 2735 12.8 634 484 272 63 2585 12.1 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. †Baaed on civil population. 87 Table No. 2. Deaths Registered from all Causes for the Year 1923. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Borough are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Borough are included. Cause of Death. ages. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. M. F. M. F. M F. M. F. M. F. m. F. M. F. M. F. M F. M. F. M. F. M. F. M. F. M F. M. F. PERSONS 1.—General Diseases. 1. Enteric Fever — — — — — — — — — — — — — — 1 — — 1 — 1 — — — — — — 1 2 3 2. Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3. Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Small Pox— (a) Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — —- — — — (c) Doubtful — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Measles 1 — 2 1 — 1 3 2 — — — — — — — — — — — — — — — — — — — — 3 2 5 7. Scarlet Fever — — — — — 1 — 1 — 1 1 — — — — — — — — — — — — — — — — — 1 2 3 8. Whooping Cough 2 6 5 ; 9 2 ; 3 9 18 — 1 — — — — — — — — — — — — — — — — — — 9 19 28 9, (a) Diphtheria — — — 3 6 3 6 6 3 4 1 — — — — — — — — — — — — — — — — — 10 10 20 (b) Croup — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Influenza — — — 1 1 — 1 1 — — — — — — 1 2 — 1 4 1 3 1 1 4 1 3 — — 11 13 24 11. Miliary Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cholera Nostras — — — — — — — — — — — — — — — — — — — — — — — :— — — — — — — — 14. Dysentery — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 15. Plague — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 16. Yellow Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 17. Leprosy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 18. Erysipelas 1 — — — 1 — 2 — — — — — — — — 1 — — — — — 1 — — — — — — 2 2 4 19. (a) Mumps — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) German Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Varicella — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other Epidemic Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 20. (a) Pyæmia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Septicæmia — — — — 1 — 1 — — 1 — — 1 — — — — — — 1 — 1 — 1 — — — — 3 4 7 (c) Vaccinia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 21. Glanders — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 22. Anthrax (Splenic Fever) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 23. Rabies — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 24. Tetanus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 25. Mycoses — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 26. Pellagra — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 27. Beri-beri — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 28. (a) Pulmonary Tuberculosis — 1 — — 1 — 1 1 — — — 3 17 15 32 21 27 14 39 12 13 6 6 — — — — — 135 72 207 (b) Phthisis (not defined as tuberculous) — — — — — — — — — — — — — 2 — — — — — — 1 — — — — —:—— — — 2 2 4 29. (a) Acute Phthisis — — — — — 1 — 1 — — — — — 2 —: 1 — — 1 1 — 1 — — — — — — 2 6 8 (b) Acube Miliary Tuberculosis — — — — 2 1 2 1 — — — — 1 — — — — — — — 1 — — — — — — — 4 1 5 30. Tuberculous Meningitis 2 2 2 2 3 3 7 7 2 3 1 1 1 — 1 — — — — — — — — — — — — — 12 11 23 31. (a) Tabes Mesenterica — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Other peritoneal & intestinal tubercle — 1 1 — — 1 1 2 — — — — 2 1 — 2 1 — — — — 1 — — — 1 — — 4 7 11 32. Tuberculosis of Spinal Column — — — — — — — — — — 1 — 2 1 — — — — — — — 1 — — — — — — 3 2 5 33. Tuberculosis of Joints — — — — — — — — — — — — — — — — — — — — — — 1 1 1 — — — 2 1 3 34. (a) Lupus — — — — — — — — — — — — — — —: — — — — — — — — — — — — — — — — (b) Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Tuberculosis of other Organs — — — — — —_— — — — — — — 1 — — — — — — — 1 — — — — — — — 2 — 2 35- Disseminated Tuberculosis 1 — — — — — 1 — — 1 — — — —: — — — — — 1 — — 1 — — — — 3 1 4 36. Rickets, Softening of Bones — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 37. Syphilis 5 — — — — — 5 — — — — — — — — — 1 1 1 — — — — — — — — — 7 1 8 38. Other Venereal Diseases — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 39. Cancer of the Buccal Cavity — — — — — — — — — — — — — — — — — — — 2 10 — — 1 — 1 — — 19 4 23 40. Stomach, Liver, &c. — — — — — — — — — — — — — — —; — 6 1 10 4 16 9 20 14 1 6 — 1 57 35 92 41. „ Peritoneum, Intestines, and Rectum — — — — — — — — — — — — — — 2 1 1 2 8 5 9 11 2 8 2 2 1 — 25 29 54 42. „ Female Genital Organs — — — — — — — — — — — — — — — 2 — 4 — 12 — — — 2 — 3 — 1 — 33 33 43. ,, Breast — — — — — — — — — — — — — — — — — 2 — 9 — 14 — 9 1 5 — — 1 39 40 41. ,, Skin — — — — — — — — — — 1 — — — — — — — — — 1 — 1 — — — — — 3 1 4 45. Cancer of other or unspecified Organs — — — — — — — — — — — — — — 1 — — 3 9 4 19 5 19 — 6 1 — — 54 19 73 46. Other Tumours (situation undefined) — — — — — — — — — — — — — — — — — — 1 — — — — 1 — 1 — — 1 2 3 47. Rheumatic Fever — — — — — — — — — — — — — 1 — — — — 1 1 — — — — 1 — 2 6 8 48. (a) Chronic Rheumatism — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 1 (b) Osteo-Arthritis — — — — — — — — — — — — — — — — — — — 1 1 1 — 2 — 2 — 1 6 7 (c) Gout — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 2 49. Sourvy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 88 Deaths Registered from all Causes for the Year 1923—continued. Cause of Death. ages. 0 to 1 1 to 2 2 to 5 Total under 5 ft to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. f. m. f. m. f. M. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. persons 1. General Diseases—con. 50. Diabetes — — — — — — — — — — 1 — — 1 — — 1 2 2 1 — 3 1 3 — 1 — — 5 11 16 51. Exophthalmic Goitre — — — — — — — — — — — — — 1 — — — — — — — 1 — — — — — — — 2 2 52. Addison's Disease — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 53. Leucocythæmia Lymphadenoma — — — — 1 — 1 — 1 — — 1 — 1 1 — — 1 1 — — — — — — — — — 4 3 7 54. Anaemia, Chlorosis — — — — — — — — — — — — — 1 — — — 1 1 — 2 1 2 — — — 1 3 6 9 55. (a) Diabetes insipidus — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 1 (b) Purpura — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 (c) Hæmophilia 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — 2 (d) Other General Diseases — — — — — — — — — — — — — 1 — — — — — 2 — 1 — — — — — — 2 4 6 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 1 2 (b) Encephalitis, other forms — — — — — — — — — — — 1 — — 1 — — — — 1 — — — — — — — — 1 2 3 61. (a) Cerebrospinal Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — 2 (b) Posterior Basal Meningitis — — — — — ——— 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 (c) Meningitis, other forms — — 1 — — — 3 — — — 2 — — — — — — — — — — — — — — — — — 5 1 6 62. Locomotor Ataxy — — — — — — — — — — — — — — — — 1 — 1 — 3 — 1 — — — — — 6 — 6 63. (a) Anterior Poliomyelitis... — — — — — — — — — — — — — — — — — — — — — — — — — — — — —: — — (b) Other Diseases of the Spinal Cord — — 1 — — — 1 — — — — — — — — — — 1 3 2 3 — 1 — 1 1 — — 9 1 13 61 Cerebral Haemorrhage, Apoplexy — — — — — — — — — — — — — — — 1 2 — 3 3 11 14 19 12 9 12 — 4 41 46 90 65. Softening of Brain — — — — — — — — — — — — — — — — — — — — 1 — — — — — — 1 — 1 66. Paralysis without specified cause — — — — — — — — — — — — — — 1 — 7 — 2 — 4 3 2 — 1 — 1 1 11 4 15 67. General Paralysis of the Insane — — — — — — — — — — — — — — 1 — 5 1 3 — 1 1 — — — — — —: 11 2 12 68. Other forms of Mental Alienation — — — — — — — — — — — — — — — — — — 1 — — — — 1 — — — — 1 1 2 69. Epilepsy — — — — — — — — — — — — — — — 1 1 — 1 1 1 — 1 — — — — — 6 2 8 70. Convulsions (Non-puerperal; 5 years and over) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 71. Infantile Convulsions (under 5 years) — 4 1 2 — — — 6 1 — — — — — — — — — — — — — — — — — — — 6 1 7 72. Chorea — — — — — — — — — 1 —- — — — — — — — — — — — — — — — — — — 1 1 73. Hysteria, Neuralgia, Neuritis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 74. Other Diseases of the Nervous System — 1 — — — — — 1 — 1 — 1 — 2 — — — — 2 — 1 — — 1 1 1 — — 9 2 11 75. Diseases of the Eyes and Annexa — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 76. (a) Mastoid Disease — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — 1 1 2 (b) Other Diseases of the Ears — — — — 1 1 1 1 — — — — — 1 — 2 — 1 — — — 1 — — — — — — 1 6 7 3. Diseases of the Circulatory System. 77. Pericarditis — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 1 2 78. Acute Myocarditis and Endocarditis — — — — — — — — — — — — — 3 3 — 2 2 3 3 1 — — — 2 — — — 11 9 20 79. (a) Valvular Disease — — — — — — — — 1 1 1 1 2 1 2 4 2 3 11 6 9 15 12 18 5 14 — 2 45 65 110 (6) Fatty Degeneration of the Heart — — — — — — — — — — — — — — — — 2 — 4 4 — 1 6 3 1 3 — 2 13 14 27 (c) Other Organic Disease of the Heart — — — — — — — — — 1 2 — 1 — — 2 2 2 13 6 21 18 37 36 25 53 7 11 108 129 237 80, Angina Pectoris — — — — — — — — — — — — — — — — — — — — 3 — — 1 1 — — — 4 1 5 81. (a) Aneurysm — — — — — — — — — — — — — — — — 1 — 2 1 6 1 2 1 1 — — — 12 3 15 (6) Arterial Sclerosis — — — — — — — — — — — — — — 1 — 1 — 4 3 8 2 16 12 7 16 — 2 37 35 72 (c) Other Diseases of Arteries — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 1 82. (a) Cerebral Embolism and Thrombosis — — — — — — — — — — — — — — 1 — 1 — — 1 3 1 4 4 2 3 — 1 12 16 22 (b) Other Embolism and Thrombosis — — — — — — — — — — — — — — — 1 — — — — — 1 — — — — — — — 2 2 83. Diseases of the Veins (Varices, Haemorrhoids Phlebitis, etc.) — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 84. (a) Status Lymphaticus 1 1 1 — — — — 2 1 — 1 — — — — — — — — — — — — — — — — — 2 2 4 (b) Other Diseases of the Lymphati System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 85. Haemorrhage; other Diseases of the Circu latory System — — — — — — — — — — — — — 1 — — — — — — 1 - 1 — 1 — — — 4 4 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 87. Diseases of the Larynx 1 — — — — 1 — 2 — — — — — — — — — — — — — — — — — — 1 — 2 — 2 88. Diseases of the Thyroid Body — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 89 & 90. Bronchitis 6 6 1 2 2 2 9 10 — — 1 — — — — 2 1 2 10 4 22 19 34 38 33 18 9 11 119 104 223 91. Broncho-Pneumonia 19 15 9 7 6 2 2 34 24 — — — 1 — 1 1 2 2 6 2 4 3 5 11 2 3 1 1 56 47 103 92. (a) Lobar Pneumonia 1 — — — — 3 — 4 — 1 1 — — 1 4 — 5 2 3 1 9 4 1 3 3 3 — — 31 14 45 (b) Pneumonia (type not stated) 1 — 2 4 2 1 5 5 2 — — — 1 2 1 — 3 — 8 5 5 4 4 2 4 — — — 34 19 53 93. Pleurisy 1 — — — — — 1 — — — — — — — — — — — 3 — 2 — 1 — — — 1 — 8 — 8 89 Deaths Registered from all Causes for the Year 1923—continued. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 51 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. PERSONS 4. Diseases of the Respiratory System—con. 94. Pulmonary Congestion, Pulmonary Apoplexy 1 — — — — — 1 — — — — — — — — — — 1 — — 1 — 3 6 2 9 1 — - 9 17 95. Gangrene of the Lung — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 96. Asthma — — — — — — — — — — — — — — — — 1 — — 1 — 1 1 1 — 1 — — 2 4 6 97. Pulmonary Emphysema — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 98. (a) Fibroid Disease of the Lung — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 (b) Other Diseases of the Respiratory System — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 — 1 5. Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Other Diseases of the Mouth and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 100. Diseases of Pharynx, Tonsillitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 101. Diseases of Œsophagus — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 102. Perforating Ulcer of Stomach — — — — — — — — — — — — — 1 3 1 1 3 5 1 1 3 2 — — — — — 12 9 21 103. (a) Inflammation of Stomach 1 — — — — 1 — — — — — — — — — — — — — — — — — 1 3 — — 2 3 5 (b) Other Diseases of Stomach — — — — — — — — — — — — — — 1 — 1 1 — — — — — — 1 — — — 3 1 4 104 & 105. (a) Infective Enteritis 3 4 3 — — 6 4 — — — — — — — — — — — — — — — — — — — — 6 4 10 (b) Diarrhoea (not returned as infective) 2 1 — — — — 2 4 — — — — — — — — — — — — — — — — — — 1 — — 2 5 7 (e) Enteritis (not returned as infective) 3 1 — 1 — — 3 2 — — — — — — — 1 1 — — — — 1 1 1 1 — 1 — 7 5 12 (d) Gastro-Enteritis (not returned as infective) 14 12 2 3 — — 16 15 — — — — — — — — — — — — — — — 1 — — — — 16 16 32 (e) Dyspepsia (under 2 years of age) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Colic — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (g) Ulceration of Intestines — — — — — — — — — — — — — — — — — — — — 3 — — 1 — — — — 3 1 4 (h) Duodenal Ulcer — — — — — — — — — — — — — — — — — — 2 — 1 — — — — — — — 3 — 3 106. Ankylostomiasis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 107. Other Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 108. Appendicitis — — — — — 1 — 1 — — — — 1 1 — 1 — 1 — — — 1 — 1 — — — 1 6 7 109. (a) Hernia — 1 — — — — — 1 — — — — — — — — 1 — — 2 1 — 2 — 2 — 4 1 — 3 11 14 (b) Intestinal Obstruction — 1 — — 1 — 1 1 — — — — — 2 — 2 — 1 1 — 1 — 1 1 1 2 — — 5 9 14 110. Other Diseases of the Intestines — 1 — — — — — 1 — — — — — — — — — — — 1 — — 2 1 1 — — — 3 3 6 111. Acute Yellow Atrophy of Liver — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — 1 — 1 112. Hydatid of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 113. (a) Cirrhosis of the Liver (not returned as alcoholic) — — — — — — — — — — — — — — — — — — 2 2 6 1 1 1 — — — — 9 4 13 (b) Cirrhosis of the Liver (returned as alcoholic) — — — — — — — — — — — — — — — 1 — — — — — — 1 1 — — — — 1 2 3 (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 114. Biliary Calculi — — — — — — — — — — — — — — — — — — — — — 1 — 2 — — — — — 3 3 115. Other Diseases of the Liver — 1 — — — — — 1 — — — — — — — — — — — 1 — — 1 — 1 — — — 2 3 5 116. Diseases of the Spleen — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 117. Peritonitis (cause unstated) — — — — — 3 — 3 — — — — — — — — — 1 — 1 — 2 — 1 — — — — — 8 8 118. Other Diseases of the Digestive System — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 6. Non-Venereal Diseases of the Genito-Urinary System and Annexa- 119. Acute Nephritis — — — — — 1 — 1 — — — — 1 — 1 1 1 1 — — 1 — 1 1 — — — — 5 4 9 120. Bright's Disease — — — — — — — — — 1 — — 1 — 2 3 4 5 4 4 9 9 7 7 6 7 — 1 33 37 70 121. Chyluria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 122. Other Diseases of the Kidney and Annexa — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 1 123. Calculi of the Urinary Passages — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 124. Diseases of the Bladder — — — — — — — — — — — — — — — — — — — 1 — — — — 1 — — — 4 1 5 125. Diseases of the Urethra, Urinary Abscess, &c. — — — — — — — — — — — — — — — — — — — 1 2 — 1 — — — — — 5 — 5 126. Diseases of the Prostate — — — — — — — — — — — — — — — — — — — — 3 — 2 — 2 — — — 13 — 13 127. Non-Venereal Diseases of Male Genital Organs — — — — — — — — — — — — — — — — — — — — 2 — 6 — — — 3 — — — — 128. Uterine Haemorrhage (Non-puerperal) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 129. Uterine Tumour (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 130. Other Diseases of the Uterus — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 131. Ovarian Cyst, Tumour (Non-Cancerous) — — — — — — — — — — — — — — — 1 — 1 — — — 1 — — — — — — — 3 3 132. Other Diseases of the Female Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 133. Non-puerperal Diseases of the Breast (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 90 Deaths Registered from all Causes for the Year 1923—continued. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. M. m. F. M. F. M, F. M. F. M. F. M. F. M, F. M. F. M. F. M. F. M. F. M. F. M. F. persons 7. The Puerperal State. 134. Accidents of Pregnancy — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 135. Puerperal Haemorrhage — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — 1 1 136. Other Accidents of Childbirth — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 137. Puerperal Fever — — — — — — — — — — — — — 5 — 2 — 2 — — — — — — — — — — 9 9 138. ,, Albuminuria and Convulsions — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 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 1 2 — — 1 4 5 (b) Gangrene (othe types) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 143, Carbuncle, Boil 1 — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — 1 — 4 — 4 144. Phlegmon, Acute Abscess — — — — — — — — — — —— — — — — — — —— — — — — — — — — — — — — — 145. Diseases of the Integumentary System 1 — 1 — — — 2 —!_ — — — — — — — 1 1 — — — — — — — — — — — 3 1 4 9. Diseases of the Bones and of the Organs of Locomotion. — — — — — — — — — — — — — — — — — — — — — 14(5. Diseases of the Bones — — — — — — — — — — — 1 — — — — — — — — 1 — — — — — — — 1 1 2 147. Diseases of the Joints — — — — — — — —1"" — — — — — — — 1 — — 1 — — — 1 — — — — — 2 1 3 148. Amputations — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — 149. Other Diseases of Locomotor System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Malformations. — — — — — — — — — — — — — — — — — — — — — — 150. Congenital Malformations 16 11 — — — — 16 11 — — — — — — — — — — — — — — — — — — — — 17 11 28 11. Diseases of Early Infancy. — — — — — — — — — — — — — — — — — — — — — — 151. (a) Premature Birth 40 30 — — — — 40 30 — — — — — — — — — — — — — — — — — — — — 10 30 70 (b) Infantile Debility, Icterus, anc Sclerema 15 6 — — — — 15 6 — — — — — — — — — — — — — — — — — — — — 15 6 21 152. Other Diseases peculiar to early Infancy 7 8 — — — — 7 8 — — — — — — — — — — — — — — — — — — 1 — 7 8 15 153. Lack of Care — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 12. Old Age. — — — — — — — — — — — — — — — — — — — — 154. (a) Senile Dementia — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — 2 1 3 (6) Senile Decay — — — — — — — — — — — — — — — — — — — — 4 2 11 8 16 17 13 14 44 41 85 13. Affections Produced by External Causes. 155 to 163. Suicides — — — — — — — — — — — — 1 1 3 2 6 3 6 3 3 1 2 1 2 — — — 23 11 34 164. Poisoning by Food — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 1 165. Other Acute Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 166. Conflagration — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — 2 2 167. Burns (Conflagration excepted) 2 1 —- — 1 — 3 1 — 1 — — — — — — — —: — — — — — — 1 — — — 4 2 6 168. Absorption of Deleterious Gases (Conflagration excepted) 1 — — — — — 1 — — — — — 1 — — — — — — — — — 1 — — — — — 3 — 3 169. Accidental Drowning — — — — — — — — 1 — — — 1 — 11 — 1 1 1 — 3 1 — — — — — — 8 2 10 170 to 176. Injuries — — — — 5 — 5 — 2 3 3 — 2 — — 1 6 — 4 2 3 1 5 — 3 5 — — 33 16 49 177. Starvation — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 178. Excessive Cold — — — — — — — — — — — — — — — — — — —_ — — — — — — — — — — — — 179. Effects of Heat — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 — 1 180. Lightning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 181. Electricity (Lightning excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 182 to 184 Homicide — 1 — — — 2 — 3 — — — — — — — — — — — — — — — — — — — — — 3 3 185. Fractures (cause not specified) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 186. Other Violence — — — — — — — — — — — — — — 1 — 1 — — — 1 — — — — — — — 4 — 4 14. Ill-defined Causes. — — — — — — — — — — — — — — — — — — — — — — — — 187. Dropsy — — — — — — — — — — — — — — — — — — — —' — — — — — — — — — — 188. (a) Syncope (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — —! — — — — — — — — — — (6) Sudden death (not otherwise defined — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 189. (a) Heart Failure (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Teething — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Pyrexia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (e) Other ill-defined Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Cause not specified — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 91 Table No. 3. Summary of Ages. 0 to 1 1 to 2 2 to 5 Total under 5 years. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. General Diseases 23 27 32 82 16 15 51 70 72 143 146 117 46 5 763 Diseases of the Nervous System and of the Organs of Special Sense 9 4 4 17 4 5 5 8 12 25 44 88 26 6 190 Diseases of the Circulatory System 2 1 — 3 4 5 8 14 18 62 94 153 135 26 522 Diseases of the Respiratory System 51 25 19 95 4 2 7 12 20 43 74 111 71 24 463 Diseases of the Digestive System 48 9 5 62 — — 5 11 11 20 23 23 17 2 174 Non-Venereal Diseases of the Genito-Urinary System and Annexa — 1 1 1 — 2 8 13 9 27 26 17 4 108 The Puerparal State — — — — — — 6 4 2 — — — — —. 12 Diseases of the Skin and of the Cellular Tissue 1 1 — 2 — — — 1 1 — 2 2 4 1 13 Diseases of the Bones and of the Organs of Locomotion — — — — 1 — 1 — 1 1 1 — — 5 Malformations 27 — — 27 1 — — — — — — — — 28 Diseases of Early Infancy 106 — — 106 — — — — — — — — — — 106 Old Age — — — — — — — — — — 7 20 34 27 88 Affections produced by External Causes 5 8 13 7 3 6 9 19 17 14 13 11 1 113 Ill-defined Causes — — — — — — — — — — — — — — — Totals 272 67 69 408 37 31 90 138 168 320 432 504 361 96 2585 92 Table No. 4. Total Births, Total Deaths, Infantile Deaths and Deaths from Tuberculosis, with 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. Births. Deaths. Deaths under 1 year. Deaths, Tuberculosis (all forms). No. Rate. No. Rate. No. Rate. No, Rate. West 4 514 19.6 338 12.9 26 51 40 1.5 5 655 21.4 382 12.5 42 64 26 0.9 Total 1169 20.6 720 12.7 68 58 66 1.2 South 7 209 13.6 172 11.2 19 91 15 1.0 8 504 18.4 319 11.7 30 60 40 1.5 Total 713 16.7 491 11.5 49 69 55 1.3 East 3 736 20.4 436 12.1 37 50 45 1.2 6 561 26.9 280 13.4 44 78 36 1.7 Total 1297 22.8 716 12.6 81 62 81 1.4 North 1 648 18.0 390 10.9 40 62 44 1.2 2 521 23.6 237 10.7 31 60 25 1.1 Total 1169 20.1 627 10.8 71 61 69 1.2 No Address — — 31 — 3 — 1 — Whole Borough 4348 20.3 2585 12.1 272 63 272 1.3 93 Table No. 5.—Showing the Birth rates, Death rates, and Infantile Mortality rates of England and Wales and certain of the large Towns, and of London and the Metropolitan Boroughs for 1923. (52 weeks ended 29th December, 1923.) Adjusted Population, Mid. 1922. Birth Rate. Death Rate. Infantile Mortality. Adjusted Population, Mid. 1922. Birth Rate. Death Kate (Crude). Infantile Mortality. England and Wales +38,403,000 19.7 11.6 69 County of London West. 4,53,230 20.2 11.2 60 Birmingham 945,100 20.4 10.7 71 Liverpool 826,400 24.9 13.5 98 Paddington 145,300 18.1 11.5 63 Manchester 748,500 21.2 13.1 85 Kensington 179,100 17.5 12.0 71 Sheffield 522,600 19.6 11.3 89 Hammersmith 134,.100 20.2 10.8 63 Leeds 466,700 19.2 12.6 85 Fulham 159,500 19 6 10.5 63 Bristol 383,900 19.5 11.2 61 Chelsea 63,920 15.9 12.1 55 West Ham 310,200 26.2 10.6 58 City of Westminster North. 139,390 12.1 10.5 46 Hull 294,000 23.6 11.3 83 Bradford 291,300 18.1 13.5 78 St. Marylebone 105,2C0 15.8 11.5 68 Newcastle-on-Tyne 281,600 24.7 12.7 89 Hampstead 86,920 14.3 10.3 42 Stoke-on-Trent 274,300 24.8 12.7 93 St. Pancras 212,500 20.6 12.0 63 Nottingham 267,900 20.2 12.0 85 Islington 333,900 21.4 11.6 66 Salford 240,700 20.8 12.9 95 Stoke Newinwton 52,620 18.3 10.6 48 Leicester 238,800 19.4 11.4 81 Hackney Central. 225,400 19.7 10.6 58 Portsmouth 236,630 21.3 10.7 52 Cardiff 223,830 23.1 11.9 72 Holborn 42,850 13.9 12.1 76 Plymouth 2(0,370 20.0 11.9 50 Finsbury 76,840 24.1 13.1 60 Croydon 192,300 17.9 10.3 52 City of London East. 13,363 8.3 11.5 81 Boltou 182,700 17.3 12.7 86 Willesden 168,200 17.8 9.3 54 Shoreditch 105,800 27.1 12.9 80 Bhondda 167,500 28.1 10.7 88 Bethnal Green 118,400 24.4 11.3 69 Southampton 163,700 19.7 11.1 53 Stepney 252,170 23.5 11.6 63 Sunderland 162,900 25.2 13.7 97 Poplar South. 165,700 25.8 11.2 59 Swansea 161,000 21.2 11.4 77 Tottenham 150,500 17.7 9.2 67 Southwark 187,220 24.4 12.8 68 Birkenhead 149,200 21.7 10.6 62 Bermondsey 121,100 25.0 12.1 73 Oldham 148,300 17.7 15.8 112 Lambeth 307,000 20.4 11.4 58 East Ham 145,800 17.6 8.9 54 Battersea 169,200 20.4 10.7 48 Brighton 135,279 16.9 12.0 57 Wandsworth 334,900 16.4 10.1 52 Middlesbrough 134,800 27.6 12.9 86 Camberwell 270,300 21.0 11.0 56 Derby 132,400 19.7 11.4 63 Deptford 114,100 21.3 10.9 58 Leyton 131,600 15.4 91 50 Greenwich 102,000 20.8 10.8 62 Coventry 131,200 17.3 9.2 61 Lewisham 176,600 18.7 10.3 45 \Valthamstow 129,700 18.2 8.8 50 Woolwich 138,250 20.2 9.9 43 Blackburn 129,600 16.3 13.2 99 Gateshead 127,300 24.2 12.6 96 Stockport 125,800 17.5 12.2 90 †Estimated population to middle of 1923. 94 Table No. 6.—Metrological Table for Saint Pancras, 1923. (Deduced from observations at Camden Square, N. W. 1.) January. February. March. April. May. June. July. August. September. October. November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 30.206 29.547 30.049 29.772 29.926 30.136 30.011 29.955 30.003 29.734 29.803 29.980 Air temperature— Mean of— Maximum A 47.7 49.0 51.5 55.7 61.5 65.1 78.1 73.2 67.2 58.1 44.5 44.9 Minimum B 35.3 38.9 38.9 40.5 45.0 49.3 58.4 54.2 48.8 46.3 33.6 33.7 Mean of A and B 41.5 43.9 45.2 48.1 53.3 57.2 68.3 63.7 58.0 52.2 39.1 39.3 Difference from Average +2.7 +3.9 +2.3 —0.3 —1.8 —3.8 +4.0 +0.5 —0.6 + 1.5 —5.2 —1.2 Humidity—Morning 91 91 87 74 75 72 67 70 81 87 88 91 Earth Temperature at 4 ft. depth 44.0 43.9 43.9 46.1 49.5 51.7 58.0 60.4 57.3 54.2 49.3 41.3 Bright Sunshine— Total Observed (daily mean) Hrs. 1.64 1.73 2.51 3.93 5.29 4.04 7.37 7.79 5.86 2.94 2.29 1.26 Per cent of total possible 20 17 21 28 34 24 46 54 47 27 26 16 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of Days 15 24 19 14 17 9 11 11 13 21 9 19 Total Fall Ins. 1.28 3.04 2.39 1.37 2.28 0.42 3.24 2.01 1.29 5.94 1.46 2.31 Difference from average „ —0.55 +1.38 +0.55 —0.16 +0.51 —1.58 +0.83 —0.20 —0.51 +3.31 —0.91 —0.08 Hour of observation, 9 a.m. (Greenwich time). The readings for Bright Sunshine are those taken at Hampstead—no readings being recorded at Camden Square. 95 Table No. 7. Inspections and Re-inspedions made by District Inspectors, by the Factory and Workshop Inspector, and by Women Inspectors in connection with certain infectious diseases during the year 1923. DUTIES AND PREMISES. Male Inspectors. Women Inspectors. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. District Inspectors. Inspection of Dwelling Houses— After Infectious Disease 701 2083 — — 701 2083 Upon Complaint (whole house inspected) 638 3627 — — 638 3627 Registered tenement houses (as such) 463 1730 — — 463 1730 Other inscribed dwellings (as such) 13 88 — — 13 88 Housing Act, 1909: 17 (I) First Inspection — — — — — — Subsequent routine inspections 353 1787 — — 353 1787 Other house to house inspections 50 265 — — 50 265 Complaints (not involving the complete inspection of a dwelling house) 3027 7565 — — 3027 7565 Drainage— Under notice. Plans, supervision, &c. 350 3421 — — 350 3421 Voluntary. Do. do. 1287 4031 — — 1287 4011 New Buildings Do. do. 89 1l6l — — 89 1l6l Yards of Mews and Stables 5806 6l — — 5806 6l Smoke Shafts observed 822 93 — — 822 93 Regulated Trades— Offensive trades 31 — — — 31 — Rag and bone dealers 22 — — — 22 — Other effluvia businesses — — — — — — Inspection of Market Streets — — — — — — Visits to closed underground rooms 92 5 — — 92 5 Infectious Diseases, inquiry, removal, disinfection, &c, — — 3704 — 3704 — Other duties 482 294 — 482 294 Totals 14226 26211 3704 — 17930 26211 Factory and Workshop Inspector. Bakehouses— Workshop 204 127 — — 204 127 Factory 115 140 — — 115 140 Restaurant kitchens 32 49 — — 32 49 Laundries— Workshop 3 2 — — 3 2 Factory — — — — — Other Factories 141 505 — — 141 505 Other Workshops 292 1340 — — 292 1340 Other Workplaces 53 139 1 — 51 Other Duties 2 — — — 2 — Totals 842 2302 1 — 843 2302 96 Table No. 8.— Inspections and Re-inspections and other work of the Food Inspectors during 1923. DUTIES AND PREMISES. Visits and Inspections. Re-inspections after Intimation Notices, Mr. Auger. Mr. Child, Totals. Mr. Auger. Mr. Child. Totals. Milkshops 229 419 648 — — — Dairies 231 25 256 — — — Cowsheds 6 19 25 — — — Other Premises of Milk Purveyors 1 26 27 — — — Margarine Factories 1 — 1 — — — Butter Factories 1 — 1 — — — Ice Cream Premises 165 195 360 — — — Slaughter Houses 19 139 158 — — — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 44 292 336 — — — Butchers' Shops 11 44 55 — — — Fried Fish Shops and Fish Curer's premises 145 245 390 — — — Marketing Places 2130 1755 3885 — — — Other Premises where Food or Drugs are sold 28 — 28 — — — Other Visits 11 136 147 — — — Total 3022 3295 6317 — — — SAMPLES, &C., TAKEN. Formal Samples Informal Samples No. of Milk samples 155 193 348 1 2 3 „ Cream samples .. 15 18 33 — i 1 „ Butter and Margarine samples 64 72 136 — — — „ Other samples (specified below)— Arrowroot 3 — 3 — — — Baking Powder 2 1 3 — — — Calomel Powder — — — — 1 1 Cocoa 25 14 39 — 1 1 Coffee 24 9 33 — — — Custard Powder 4 5 9 — — — Dripping — 1 1 — — — Egg Powder — 1 1 — — — Fish Paste — 1 1 — — — Flour 20 15 35 — — — Ground Ginger 1 — 1 — — — Telly Crystals 1 — 1 — — — Lard 4 17 21 — — — Lemonade Crystals 1 1 2 — — — Mustard 13 4 17 — — — Oatmeal 2 — 2 — — — Pepper 14 2 16 — — — Rice 8 2 10 — — — Sausages 5 — 5 — — — Sugar 1 — 1 1 — 1 Toffee 1 — 1 — — — Vinegar 10 14 24 — — — Total 373 370 743 2 5 7 97 Table No. 8 (con.).—Inspections and Re-inspections and other work of the Food Inspectors during 1923. 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 5 8 — — — Fish 18 3 21 — — — Shellfish — — — — — — Other Foods (specified below):— Eggs 1 — 1 — — — Fruit 2 4 6 — — — Tinned Goods — 2 2 — — — Yeast — 1 1 — — — Total 24 15 39 — — — Inspections of Registered Canal Boats 9 — 9 — — — 98 Table No. 9. Visits, etc., made by Women Inspectors during 1923. 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 Camman. Miss Parnell. Total. Miss Bibby. Miss Smith. *Miss Anthony. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. *Miss Camman. Miss Parnell. Total. Miss Bibby. Miss Smith. *Miss Anthony. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. *Miss Camman. Miss Parnell. Total. Grand Total. Infants — 152 — — 265 156 — 8 — 581 — 349 — — 409 815 2 35 — 1610 — 217 — — 205 231 — 6 — 659 2850 Expectant Mothers — 63 — — 67 23 — 11 — 164 — 51 — — 10 30 — 7 98 — 60 — — 27 9 — 2 — 98 360 Ophthalmia Neonatorum — 55 — 3 — — — 3 — 61 — 92 — 6 — — — 1 99 — 45 — — — — — 2 — 47 207 Puerperal Fever — 15 — — — — — 5 — 20 — 6 — — — — — 6 — 12 — 5 — — — — — — — 5 37 Tuberculosis — — — — — — 259 — 350 609 — — — — — — 1463 — 774 2237 — — — — — — 295 — 227 522 3368 Measles and German Measles — 6 — 225 21 16 — 288 12 568 — 1 — 19 5 7 — 79 1 112 — 1 — 12 — — — 13 1 27 707 Whooping Cough — — — — 13 1 — 6 — 20 — — — 2 8 1 1 — — 12 — — — — — — — — — — 32 Scabies — — 2 17 — — — 3 — 22 — — — 2 — — — — — 2 — — — 1 — — — — — 1 25 Other Cases of Illness — 34 — 11 113 20 30 76 282 566 — 17 — — 20 12 24 3 45 121 — 8 — — 3 4 11 1 37 64 751 Verminous Persons — — 14 58 — — — 48 — 120 — — — 19 — — — 7 — 26 — — — 2 — — — 2 — 4 150 To Hospitals and other Voluntary Institutions 263 461 — 5 63 78 419 25 706 2020 — — — — 2 — 1 15 — 18 — — — — — 2 3 — — 5 2043 Domestic Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Home Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Laundries—Factory — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — „ —Workshop — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Restaurant Kitchens — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other Factories — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — „ Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — „ Workplaces 1 — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — 1 Attendances at Clinics — 88 — 1 32 91 58 10 7 287 — — — — — — — — — — — — — — — — — — — — 287 Attendances at Committees, &c. 176 73 — — 1 2 26 — — 278 — — — — — — — — — — — — — — — — — — — — 278 Other Visits and Inspections 46 11 3 51 228 9 79 88 20 535 — 1 — — 2 — 64 6 — 73 — 1 — — 47 2 10 — — 60 668 Totals 486 958 19 371 803 396 871 571 1377 5852 — 517 — 48 456 865 1555 159 820 4420 — 337 — 15 282 248 319 26 265 1492 11764 *Exclusive of those shown in Table 7. 99 Table No. 10.—Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1923. Inspector. Inspections. Re-inspections. Call made but admission not obtained. Total. 1. Mr. Rackham 914 2071 — 2985 2. „ London 1262 1917 — 3179 3. „ Brown 935 2619 — 3554 4. „ Dillon 1020 2594 — 3614 5. „ Walker 1230 2513 — 3743 6. „ James 899 2934 — 3833 7. „ Adkins 929 2736 — 3665 8. „ Akers 2309 1391 — 3700 9. „ Jaffa 177S 1754 — 3532 10. „ Capel 1182 2689 — 3871 11. „ Nixon 1638 2901 — 4539 12. „ Thompson (Factories and Workshops) 972 2394 — 3366 13. „ Auger (Food and Food premises) 3428 2 — 3430 14. „ Child 3680 5 — 3685 15. Miss Bibby 486 — — 486 16. „ Smith 958 517 337 1812 17. „ Anthony 237 — — 237 18. „ Holland 2310 48 15 2373 19. Mrs. Hunter 803 456 282 1541 20. Miss Anderson 396 865 248 1509 21. „ Blaxland 871 1555 319 2745 22. „ Camman 2118 159 26 2303 23. „ Parnell 1377 820 265 2462 Totals 31732 32940 1492 66164 *Part year only. 100 Table No. 11.—Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1923, and the resulting Statutory Notices in 1923 and the early part of 1924. Schedule of Nuisances. Intimations. Statutory Notices. 1 Part of the house in a dirty condition 932 273 2 „ „ damp „ 196 66 3 Roof defective 718 244 4 Guttering defective 173 59 5 Water fittings defective 157 42 6 Water-closet apartment with absence of external ventilation 15 9 7 „ „ so foul as to be a nuisance or dangerous to health 11 2 8 Water-closet basin foul 50 12 9 „ „ defective 80 16 10 „ „ choked 96 19 11 Urinal in a foul condition 1 — 12 Privy in a foul condition — — 13 Soil pipe defective 19 3 14 „ unventilated 18 8 15 „ improperly ventilated 22 3 16 Absence of waste pipe to sink, lavatory or bath 2 — 17 Waste pipe of sink, lavatory, or bath connected with drain 2 1 18 „ „ „ „ defective 85 29 19 „ „ „ foul 34 13 20 Inlet of drain improperly trapped 12 4 21 Drain defective ... 135 48 21 „ stopped 120 14 23 „ ventilating pipe defective 80 23 24 Rain-water pipe in direct communication with drain 14 6 25 „ „ defective 142 52 26 Unpaved condition of roadway 2 1 27 Undrained „ „ 2 1 28 Area or part unpaved — — 29 „ undrained 1 — 30 Yard or space unpaved 1 1 31 „ „ undrained 1 1 33 Defective condition of wash house paving 71 28 33 Dust-bin defective 485 100 34 „ in an improper position — — 35 Accumulation of stagnant water which is a nuisance dangerous to health 14 2 36 Accumulation or deposit which is a nuisance dangerous to health 135 36 37 Animals kept in such a manner as to be a nuisance dangerous to health 37 3 38 Part of the house so overcrowded as to be dangerous to health 40 24 39 Space below floor in basement or ground floor insufficiently ventilated 17 3 40 Issuing of black smoke in such a quantity as to be a nuisance 4 — 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 6 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 — — 43 Other nuisances 672 187 Total 4592 1336 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statutory Notices. 1 Overcrowding 2 1 2 Inadequate water supply — — 3 Contaminated water supply — — 4 Foul closet, basin or trap 12 8 5 Want of means of ventilation — — 6 Want of annual cleansing 1 — 7 Want of cleansing of the part or parts of premises used in common 242 99 8 „ „ „ in sole use 369 122 9 Want of cleansing of the room or part of the dwelling — — 10 Animals improperly kept 1 1 11 Other breaches 5 2 Total 632 233 101 Table No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1 Want of cleanliness 126 25 2 Want of ventilation 1 — 3 Want of air space, overcrowding 1 — 4 Sanitary accommodation, absent or insufficient 11 4 5 „ „ unsuitable or defective 62 19 6 „ „ not separate for sexes 13 5 7 Want of drainage of floors — — 8 Other nuisances 80 11 9 Illegal occupation of underground bakehouse — — 10 Breach of special sanitary requirements for bakehouses 89 — 11 Failure as regards list of outworkers — — 12 Giving out work to be done in premises which are unwholesome — — 13 „ „ „ infected — — 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox — — 15 Other contraventions 51 7 Total 434 71 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 22 10 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet 1 — 3 Water-closet not supplied with a sufficient quantity of water for securing it s3 effective action 138 32 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 26 7 5 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes—absence of a proper cover to 26 11 6 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position 2 1 7 Animals so kept as to be likely to pollute the water supply 1 — 8 Offensive matters not deposited in manure receptacle 3 1 9 Manure not removed at proper intervals 12 1 10 Manure—absence of proper receptacle for 2 — 11 Manure receptacle not properly constructed 1 — 12 Sufficient drain to stables or cowshed—absence of a 1 — 13 Receptacle for house refuse—absence of a proper 308 78 14 Receptacle for house refuse—absence of a proper cover for 4 — 15 Yard or open space unpaved 1 1 16 „ paving defective 158 65 17 Insufficient water-closet accommodation to "lodging house" 27 21 18 A furnace improperly constructed or negligently used 1 1 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 415 148 25 Articles in an unwholesome condition requiring to be purified or destroyed 12 — 26 Underground room illegally occupied as a dwelling 16 3 27 Name and address of Medical Officer of Health and of landlord, etc., not inscribed in rent book 39 1 28 Other breaches 159 51 Total 1375 432