AC 4355 STPAN 82 Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. G. SOWDEN, M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister.at.Law. Printed by F. P. Lewingdon, 26 and 27, Eversholt Street, London N.W. 1. Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. G. SOWDEN, M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister.at.Law. 8163 3 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 and General Conditions. Population and General Statistics 10 Marriages 10 Births 10 Illegitimacy 11 Notification of Births 11 Deaths 11 Infantile Mortality 13 Economic Conditions 17 Poor Law Relief 17 Hospital Accommodation 17 Health Week 18 Section II —Maternity and Child Welfare 19 Advice Cards 20 Home Visiting 20 Centres 22 Artificial Sunlight Treatment 24 Dental Clinic 25 Clinic for Sick Mothers and Children 26 Supply of Food to Mothers and Children 26 Home for Sick Poor Children 27 Day Nurseries 28 Home Helps 28 Home Nursing 29 Midwifery 29 Government Grants 31 Section III.—Prevalence of and control Over Infectious Diseases. Table of Notifiable Diseases 32 Do. Monthly Number of Notifications 33 page Table of Monthly Number of Deaths 34 Do. Notifications past 10 years. 35 Do. do. and Deaths in Wards 36 Smallpox 37 Vaccination 37 Scarlet Fever 38 Diphtheria 39 Typhoid Fever 40 Tuberculosis 40 Home Visits and Inquires 46 Dispensaries 46 Reports by Tuberculosis Officers 48, 50 Sanatoria, etc. 51 Care Committee 52 Puerperal Fever 51 Ophthalmia Neonatorum 55 Epidemic Cerebrospinal Meningitis 55 Acute Polioencephalitis and Poliomyelitis 55 Encephalitis Lethargica 56 Pneumonia 56 Measles and German Measles 56 Other Notifiable Infectious Diseases 58 Whooping Cough 58 Diarrhoea and Enteritis 58 Influenza 59 Syphilis 59 Cancer 60 Section IV.—Other Services. Disinfecting and Cleansing Station 61 Mortuary 62 Inquests 63 Section V.—Sanitary Circumstances of the District. Inspections 63 Notices served and result of service 64 Nuisances—Legal Proceedings 64 Premises and Occupations controlled by by.laws and regulations 66 CONTENTS 4 CONTENTS—continued. page Offensive Trades 66 Registered Tenement Houses 66 Underground Rooms 66 Smoke Prevention 66 Constructional Drain Work 66 Drainage Register 66 Water Service 67 Canal Boats Acts 67 The Rag Flock Act, 1911 67 Rag and Bone Dealers 67 Rent & Mortgage Restrictions Act, 1923 68 Factory and Workshop Acts 68 Inspections 68 Defects found 69 Home Work 69 Registered Workshops 69 Other matters 70 Schools 72 Medical Examination of School Children 72 Feeding of School Children 74 School Clinics 74 Section VI.—Food. (а) Milk Supply 76 Dairies, Cowsheds and Milkshops 76 Milk (Special Designations) Order, 1923 77 Milk and Cream Regulations 78 Public Health (Condensed Milk) Regulations, 1923 78 Public Health (Dried Milk) Regulations, 1923 79 (б) Other Foods 79 Unsound food condemned destroyed and seized 79 Slaughter.houses 79 Page Fried Fish and Fish Curing Premises 79 Ice Cream Premises 80 Bakehouses and Restaurant Kitchens 80 (c) Sale of Food and Drugs Acts 80 Prosecutions 81 Wholesale Dealers in Margarine 81 Section VII.—Sanitary Administration. 81 Re.organisation of Public Health Department, &c 82 Staff 88 Chemical and Bacteriological Work 89 Section VIII.—Housing 89 Statistics 90 Work of the Estates Committee 91 Appendix. Table No. 1. Vital Statistics for 11 years 98 Do. 2. Deaths Classified for all causes. 99 Do. 3. Summary of above 103 Do. 4. Births and Deaths in Wards 104 Do. 5. Do., certain large towns and Metropolitan Boroughs 105 Do. 6. Meteorology 106 Do. 7. Inspections and reinspections (District and other Inspectors) 107 Do. 8. Do. (Food Inspectors) 108 Do. 9. Visits by Women Inspectors 110 Do. 10. Inspections and reinspections by individual Inspectors 111 Tables Nos. 11, 12, 13 and 14. Details of Intimation Notices served and resulting Statutory Notices 112 5 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. 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. Cosburn, 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, Arthcr, 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. November, 1924, to October, 1925. CHAIRMAN. Councillor Mansell James Swift (Ward 7). DEPUTY.CHAIRMAN. Councillor Alfred Solomon, J.P. (Ward 1). EX.OFFICIO. The Right Worshipful The Mayor (Councillor Frederick Brown Gurney, F.A.I., J.P.). ALDERMEN. Cosburn, Major George Frederick, J.P., M.A.B. Davies, David, J.P., L.C.C. Johnson, Job, J.P. Rolles, Harry. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 2 Bland, Mrs. Violet. 2 Brown, Percival George Edward. 8 Campion, John Sissons. 8 Crosby, Miss Ada, M.B.E. 8 Evans, Evan. 6 French, Alexander George. 5 Gregg, Dr. Edward Andrew. 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. 5 Saunders, Edward John. 8 Towers, George Andrew. 5 Williams, Lt..Col. Charles. 6 STAFF OF THF. PUBLIC HEALTH DEPARTMENT at END of 1924. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. G. Sowden. M.D., D.P.H.. M.R.C.S., L.R.C.P. TUBERCU LOSIS OFFICERS. N. M. DONNELY, M.B.. B.CH.. R.A.O., D.P.H. J. A struttrerss. B.A. (Cantab). M.R.C.S.. L.R.C.P., M.B.. B.Ch. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS AND HEALTH VISITORS. Inspector of Food and Food Places §W. G. Arcim. §H. R. CHILLD Inspector of Workshop and Factories. ‡§B. H, Thompson. District Inspector. §G. Rackham. ‡G. W. Adkins. ‡§I. Lnxuox. ‡R. C. Akers ‡§W.L. Brow*. ‡ M. Jaffa. §E. M. Dillon. ‡¶S.W. Capel ‡§.A. H. walker. ‡¶H. K. Nixon. ‡§R. E. James Senior Woman Sanitary Inspector. ‡Miss M. E. Birry, B.A. (Land.). Women Sanitary Inspector and Health Visitors. ‡¶|Miss C. Smith. ‡¶lMiss V. K. Blaxland. ‡¶Miss F. A. Anderson ‡¶Miss J. A J. Canman. ‡§Miss. A. Hunter. ‡¶Miss A. Holland. CLERICAL STAFF. ChIef Clerk A. Powell Coke, Barrister.at.Law. First Clerk A. G. Capel. Second Clerk A. Carpenter. Clerk G. N. Cove (attecked to the EstateDept). „ T. H. Hague. Miss A. Andrews. JuniorClerk S. W. Barker. *W. C. Mansfield. Teniporary Clerk L. Higgins. J.B. Richards. Temporary Mill Enquiry Officer—H G. West.§ ' Gen Unmcipal aim Gouutt £.ncioeert. ~ Gen.. Son ii.Hf. FiX»miT»T.wm fto&rd. | t»c IiMf. Oer. TojJ Sail. InsL * G«ri .i.eu; anc oiuer i mat Heulli. Visitor £ Ceruficait. . c.*i 7 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. Medical Officers. Dr. Margaret E. Alden Dr. Chas. II. A. Alderton Dr. B. Marion Cockerell Dr. A. Gertrude Grogan Dr. J. Finch Haines Dr. Janie Lorimer Hawthorne Dr. Ethel F. Iredell Dr. Lydia A. Leney Dr. Jessie S. Muir Dr. Balfour Neill Dr. J. Sherwood New Dk. Margaret R. Paterson Dr. Mary J. Pirret Dr. Francis L. Provis Dr. Muriel Radford Dr. Alfred R. Roche Dental Clinic. No, of Consultations per month 5 4 15 8 8 8 4 12 12 8 4 4 14 13 4 4 Mrs. W. A. Murch, L.D.S., Dentist .. 8 Dr. Jas. Maughan, Anaesthetist. Mr. Southcomb May, L.D.S., Dentist at Tuberculosis Dispensary. (The above are part.time officers.) Superintendents of Maternity and Child Welfare Centres. ¶ Miss K. L. Allfrey. ‡§Miss M. H. Landel Jones. +§Miss M. L. Blair. §Miss M. Manger. •‡Miss G. R. Bristow. ‡§Miss E. M. Robinson. ‡§Mrs. S. C. Chapman. ¶Miss M. Smyth. ‡§Mrs. E. Ckockart. §Miss M. Templeton. Assistant Visitors at Maternity and Child Welfare Centres. *§‡Miss J. M. Anderson. ‡Miss A. M. U. Harrop. §§Miss E. B. Bagnall. §Mrs. E. Lurie. §Mrs. E. E. Bruce. *‡§Mrs. J. Lynn. *‡Miss M. A. Clarke. ‡§Mrs. M. A. Smith. ‡§Miss B. M. Harris. *§Miss V. B. Woodruff. Tuberculosis Dispensaries. Nurse Visitor, *§Miss S. A. Long. Clerical and General Assistant, Do. *§Miss R. Adlis. Miss Margaret Deed. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station H. Catch. Stoker and General Assistant T. Bartholomew. Assistant Disinfector J. Stanley. „ A. J. Dibben. Matron of Personal Cleansing Station Mrs. E. Mace. Assistant at „ „ Mrs. A. Styles. „ „ „ Mrs. 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. Royal San. Inst. i Health visitor's Certificate. § C.M.B. § Midwifery Certificate, Queen Charlotte's Hospital. 8 Public Health Department, Town Hall, Pancras Road, N.W. 1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough oe St. Pancras. Ladies and Gentlemen, I have the honour to present to you the Sixty.ninth Annual Report on the vital statistics and sanitary condition of the Borough, including particulars of the work carried out during the year by the staff of the Public Health Department. This is the second annual report which it has been my duty to submit to the Borough Council. The statistics for the year 1924 are somewhat less favourable than those of the preceding year. The birth.rate again decreased. "With the exception of the years which were affected by the war, this rate is the lowest hitherto recorded. The general death.rate was slightly higher, being 13 per 1,000 of population, as compared with 12.1 in the preceding year. The rate of infant mortality was also higher, the increase being almost entirely due to an epidemic of measles of a severe type, which occurred during the first quarter of the year. Housing conditions continued to be unsatisfactory. During the year about 100 houses were erected in the north of the Borough ; but these chiefly attracted now residents, and did little to remedy existing overcrowding. During the year a special report was made on the re.organisation of the Health Department. A summary of this is included in the present report for purpose of reference. In conclusion, I wish to record my appreciation of the work of the staff and their loyal and willing co.operation in carrying out any duties tending to promote the work of Public Health in the Borough. I am, Ladies and Gentlemen, Your obedient Servant, March, 1925. Medical Officer of Health. 9 SUMMARY OF REPORT FOR 1924. 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 Higligate in the north, and averages about a mile in width. Population (1921 Census), 211,366. Population (1924). Total, 214,600. „ Civilian, 214,300. Number of persons per acre, 80. Number of inhabited houses (1921 Census), 24,660. Number of births, 4,112; birth.rate, 18.8 per 1,000 of population. Number of deaths, 2,848; death.rate, 13 per 1,000 of population. Excess of births over deaths, 1,264. Infantile mortality, 74 per 1,000 births. Maternal mortality (deaths of women from causes associated with child.birth), 16. Maternal death.rate, 3.9 per 1000 births. Tuberculosis (all forms), death.rate l.2 per 1,000 of population. Rateable value, £1,821,364. Sum produced by a penny rate, £7,489. Total rainfall, 33.08 inches. Comparative Statistics. [###[ Rate per 1,000 of Population. Rate per 1,000 Births. Birth.rate. Death.rate. Infant Mortality. St. Pancras 18.8 13.0 74 England and Wales 18.8 12.2 75 105 Great Towns 19.4 12.3 80 County of London 18.7 121 69 10 Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1924. For the purpose of this Report, the year consists of the 53 weeks ended 3rd January, 1925. The annual rates are corrected in order to make them comparable with those for other (fifty.two weeks) years. Section 1.—VITAL STATISTICS AND ECONOMIC AND GENERAL CONDITIONS. POPULATION AND GENERAL STATISTICS. The population of the Borough at the Census of 1921 was 211,366. The total population of St. Pancras for the year 1924, as estimated by the Registrar.General, was 214,600, the civilian population being estimated at 214,300. The latter estimate (civilian) has been used in calculating the death.rates in this report, and the former (total) in calculating the marriage and birth.rates. For the previous year (1923) the Registrar.General estimated the population of the Borough to be 214,400, no reference being made to civilian population. This change of method is to be deprecated as tending to render comparison with other years more difficult. I am also of opinion that, for the year 1924, the Registrar.General has somewhat under.estimated the population of the Borough, thus causing the various rates which are based on this estimate to appear unduly high. MARRIAGES. The number of marriages celebrated in 1924 was 1,836. This is equal to a rate of 8.4 per 1,000 of total population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 4,112, making an annual birth.rate of 18.8 per 1,000 of population. The total number of births actually registered as having taken place in the Borough was 4,447. This figure has to be corrected by deducting the births of non.residents, which occurred in various public institutions in the Borough—these numbered 893, and adding the births of parishioners which occurred outside the Borough—these numbered 558. The corrected figure is therefore as stated above, 4,112. CHART shewing BIRTH RATE for the Borough during the PAST 20 YEARS. Rate per lOOO POPULATION CHART shewing DEATH RATE for the BOROUGH during the Rate per IOOO Population PAST 20 YEARS 11 The corresponding figures for previous years will be found in Table 1 on page 98. The chart facing this page shows, in graphic form, the variations in the birth.rate during the past twenty years. The following table gives the number or births and the birth.rate in each ward or the the Borough for the past year:— Ward. No. of Births. Birth Rate. 1 613 16.7 2 490 21.7 3 679 18.5 4 510 19.1 5 657 21.1 6 497 23.3 7 . 196 12.5 8 470 16.8 1269 births occurred in Public Institutions, equal to 28.5 per cent, of the total births belonging to the Borough. Table 5, on page 10.5, shows for 1924 the birth.rate 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 4,112 net St. Pancras births, 242 were returned as illegitimate. This equals 5.9 per cent, of the total births. The corresponding figures for the preceding 10 years were as follows :— Year. Rate. Year. Rate. 1914 4.4 per cent. 1919 8.4 per cent. 1915 54 1920 5.6 „ 1916 7.0 1921 5.5 1917 7.2 „ 1922 5*6 „ 1918 9.5 1923 5.7 „ Notification of Births. 4,357 notifications of births were received during the year: this includes 123 stillbirths and 4,234 live births, and represents 95 per cent, of the births registered as having taken place in the Borough. The Notification of Births Act (1907) states information with regard to the event shall be given to the Medical Officer of Health within 36 hours of the occurrence of the birth of a child, alive or dead, which has issued forth from its mother after the twenty.eighth week of pregnancy. This notification is in addition to, and not in substitution for, registration of birth, which must be carried out at a Registry Office within forty.two days of the birth. DEATHS. The net number of St. Pancras deaths registered during the year was 2,848 ; this equals an annual death.rate of 13 per 1,000 of population. 12 The actual number of deaths registered as having occurred in the Borough was 2,937. This figure has to be corrected by the exclusion of 640 deaths of persons who were not St. Pancras residents, and by the inclusion of 551 deaths of residents which occurred and were registered outside the Borough. The corrected figure of 2,848 is used in calculating the rates in this report. In Table 1, on page 98, will be found the corresponding figures for previous years, and the chart adjoining this page gives, in graphic form, the variation in the death.rate during the previous twenty 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: — Diseases. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Average for 10 years. 1921 Heart Disease 358 439 375 404 389 370 442 435 461 394 407 398 Bronchitis 250 322 290 250 228 301 236 2; 6 308 223 268 304 Cancer 251 258 267 281 269 245 299 290 302 319 278 298 Tuberculosis—all forms 432 500 423 444 485 341 312 304 315 272 383 271 Pneumonia 311 331 232 254 376 179 197 173 265 201 252 200 Premature Birth, Debility and Congenital Defects 164 187 176 144 '32 162 201 149 '34 134 158 118 Cerebral Haemorrhage, Embolism, and Apoplexy 141 169 119 116 131 91 98 126 120 112 122 118 Injuries 150 150 112 125 119 108 92 88 127 113 118 114 Influenza 15 35 35 21 700 260 46 57 142 24 134 80 Nephritis and Bright's Disease 112 132 103 104 98 61 95 60 67 79 91 75 Measles 55 63 42 118 75 r5 65 23 107 5 57 74 Diarrhœa and Enteritis 142 114 72 97 56 68 54 98 47 61 81 63 Whooping Cough 49 52 39 27 80 7 60 38 29 28 41 46 Diphtheria and Croup 30 24 23 25 31 21 33 51 44 20 30 22 Scarlet Fever 19 22 8 4 7 5 11 7 20 3 11 12 Pleurisy 5 11 13 10 14 9 i 2 7 10 8 10 8 Rheumatic Fever 10 11 7 7 8 7 6 16 15 8 10 5 Puerperal Fever 7 5 4 5 2 9 8 4 4 9 6 4 Erysipelas 9 11 3 3 11 9 12 3 12 4 8 4 Enteric Fever 4 8 5 6 5 2 1 3 1 3 4 2 It will be noted that the deaths from heart disease, tuberculosis and pneumonia were about the average ; those from cancer, though somewhat fewer than during the preceding year, exceeded the average for the past ten years; the deaths from bronchitis were more numerous, chiefly owing to the very inclement weather during the winter months. DIAGRAM shewing Relative Importance of Various Diseases as Causes of DEATH during 1924. Heart Disease Bronchitis Cancer Tuberculosis (All Forms) Pneumonia Premature Birth, Debility & Congenital Defects Cerebral Hemorrhage Embolism & Apoplexy J Injuries Influenza Nephritis &Brights Disease Measles Diarrhœa & Enteritis Whooping Cough Diphtheria Scarlet Fever Pleurisy Rheumatic Fever Puerperal Fever Erysipelas Enteric Fever Total Deaths in the Borough from all Causes Males 1472 Females 1376 2848 13 The five diseases above mentioned were responsible for more than half of the total deaths which occurred in the Borough from all causes. The deaths from the infectious diseases—measles, whooping cough, influenza, and scarlet fever—were also considerably higher than during the previous year. The deaths during the year are fully classified for causes, age and sex in Table 2 on page 99. For purpose 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 105. It will be noted that twenty-one Metropolitan Boroughs had a lower and six a higher death-rate than St. Pancras, One was the same. Of the total 2,848 St. Pancras deaths which occurred during the year, no less than 1,669 took place in public institutions, either within or without the Borough ; this equals a proportion of 59 per cent, of the total deaths. Ward Death-Rates. The number of deaths and the death-rates per 1,000 of population for each of the wards were as follows:— Death-rates. Death-rates. 1923 1924 1923 1924 Ward 1 10.9 12.6 Ward 5 12.5 14.3 Ward 2 10.7 13.2 Ward 6 13.4 12.7 Ward 3 12.1 13.0 Ward 7 11.2 12.3 Ward 4 12.9 12.6 Ward 8 11.7 12.0 Infantile Mortality. 303 deaths of infants under one year of age took place in St. Pancras during the year. This is equal to a rate of 74 per thousand births, and is considerably higher than that of the previous year. This increase, which was more or less general throughout the country, was almost entirely due to the prevalence of measles, and to a lesser degree of whooping cough, together with the complications arising from these diseases. The deaths from diarrhoea and enteritis were well below the average, and there was a marked decrease in those due to premature birth, debility and congenital defects. In Table 1, on page 98, the corresponding rates for previous years are given, and in Table 4, on page 104, the figures will be found for the different wards and registration subdistricts. Table 5, on page 105, gives the infant mortality rates for England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns with populations exceeding 125,000. In the Tables on the next three pages arc shown:— 1. The causes of death of all children under 12 months of age during 1924, classified according to age at death. 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 given for reference. 3. The principal causes of death of children under 5 years of age, at various age periods, during 1924, and the five preceding years. 14 1924. Next Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OP DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 6 9 15 Scarlet Fever - - - - - - - - - - Whooping-Cough — — — — — 1 1 4 7 13 Diphtheria and Croup - - - - - - - - - - Erysipelas — — — — — 1 1 — — 2 Influenza - - - - - - 2 3 1 6 Tuberculous Meningitis - - - - - - 1 1 1 3 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - 2 2 1 5 Convulsions 1 2 — — 3 — 1 — — 4 Laryngitis - - - - - - - - - - Bronchitis — — 1 — 1 1 4 1 5 12 Bronchopneumonia — 4 - 3 7 13 9 13 9 51 Lobar-pneumonia - - - - - - - 1 2 3 Pneumonia (type not stated) — — — — — 2 — 1 — 3 Diarrhœa - - - - - - 5 — 1 6 Enteritis — — 2 2 4 7 20 8 7 46 Gastritis - - - - - - - - - - Syphilis — — — — — 1 — — 1 2 Rickets - - - - - - - - - - Suffocation (overlying) 1 — — — 1 — — — — 1 Injury at Birth 4 — — — 4 — — — — 4 Atelectasis 5 1 — — 6 1 — — — 7 Congenital Malformations 7 4 - 1 12 5 5 — 1 23 Premature Birth 30 10 5 2 47 9 2 1 — 59 Atrophy, Debility and Marasmus 2 1 2 2 7 7 10 — — 24 Other causes 2 — 2 — 4 — 3 2 5 14 Totals 52 22 12 10 96 48 66 43 50 303 Nett Births in the year legitimate 3870 illegitimate 242 Nett Deaths in the year of legitimate infants 268 illegitimate infants 35 15 Deaths from Stated Causes under 1 Year of Age for 1924 and 10 preceding Years. cause of death. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Average for 10 years. 1924 Small-pox — — — — — — - - - - - - Chicken-pox — 1 — — — — — — — — — — Measles 8 17 14 30 16 4 21 7 15 1 13 15 Scarlet Fever — — - — — 1 — — 3 — — — Whooping Cough 23 24 15 14 27 2 18 18 11 8 16 13 Diphtheria and Croup 4 - 2 1 1 — 2 2 — - 1 — Erysipelas 2 2 — 1 1 — — — 1 1 1 2 Influenza 1 — 1 — 18 11 2 2 7 — 4 6 Tuberculous Meningitis 3 8 5 4 8 4 6 4 3 4 5 3 Abdominal Tuberculosis 2 1 1 2 1 1 — 1 1 1 1 - Other Tuberculous Diseases 3 6 5 7 3 2 2 3 7 2 4 - Meningitis (not Tuberculous) 4 8 7 10 3 6 7 3 2 3 5 5 Convulsions 11 5 9 5 3 6 7 8 8 5 7 4 Laryngitis — 1 - 1 - - - - - 1 — — Bronchitis 17 27 17 16 17 23 27 13 21 12 19 12 Broncho-pneumonia 59 57 40 47 29 24 60 39 54 34 44 51 Lobar-pneumonia 6 3 4 4 6 1 5 1 3 1 3 3 Pneumonia (type not stated) 10 9 6 9 9 8 4 3 6 1 7 3 Diarrhœa 24 15 6 8 6 10 11 11 4 6 10 6 Enteritis 82 64 35 52 31 37 26 63 27 37 45 46 Gastritis — 3 2 4 1 3 2 2 — 1 2 - Syphilis 15 9 14 16 13 11 15 14 8 5 12 2 Rickets 1 1 4 2 — — 1 1 1 - 1 - Suffocation (overlying) 18 8 9 13 6 1 2 2 5 1 7 1 Injury at Birth 3 10 4 3 2 6 5 3 3 6 5 4 Atelectasis 5 6 9 9 8 7 10 8 4 9 8 7 Congenital Malformations 23 25 34 19 17 31 33 25 31 27 27 23 Premature Birth 84 92 75 61 50 68 105 75 61 70 74 59 Atrophy, Debility and Marasmus 38 47 43 44 46 45 40 34 28 21 39 24 Other causes 35 48 24 20 18 24 24 18 23 15 25 14 Totals 481 497 385 402 340 336 435 360 337 272 385 303 Nett Births 5225 4754 4530 3796 3318 3824 5934 4764 4559 4348 4485 4112 16 Table showing Deaths of Children under 5 Years of Age, at various Age periods, and the principal causes of DEATH, Year. Total Number of Births. Number of Deaths from all causes of children:— Number of Deaths from Diarrhœa and Enteritis. Number of Deaths from Measles and Whooping Cough. Number of Deaths from Bronchitis and Pneumonia. Number of Deaths from Injury at Birth, Debility, Premature Birth, 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 4559 337 153 128 618 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 1924 4112 303 102 110 515 52 5 1 28 46 38 69 31 11 48 76 117 17 Economic Conditions. The amount of out-relief granted during the past 8 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 871 852 Lady day, 1918 3382 Michaelmas, 1918 3461 771 754 Lady day, 1919 3814 Michaelmas, 1919 4557 823 899 Lady day, 1920 6146 Michaelmas, 1920 8161 1079 1660 Lady day, 1921 13081 Michaelmas, 1921 21400 3529 6429 Lady day, 1922 40081 Michaelmas, 1922 34591 6325 6425 Lady day, 1923 34193 Michaelmas, 1923 28312 5489 5290 Lady day, 1924 31690 Michaelmas, 1924 26607 4723 4319 Lady day, 1925 26766 For purposes of comparison, the number of inmates of the House are given below, the figures being also supplied by 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 July let, 1924 1029 January 1st, 1925 1146 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. 18 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, 1924. Number of new outpatients treated in 1924. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 387 2310 - Highgate Hospital, Dartmouth Park Hill 554 2541 - Metropolitan Asylums Board Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum) 58 299 — Voluntary Hospitals. University College Hospital, Gower Street 353 5141 72157 Royal Free Hospital, Gray's Inn Road 240 3608 41837 Royal Free Hospital Maternity Home, Endsleigh Street 33 597 416 London Temperance Hospital, Hampstead Road 120 1022 12066 Elizabeth Garrett Anderson Hospital, Euston Road 75 1497 10447 West End Hospital for Nervous Diseases, Regent's Park 76 541 4987 Hospital for Tropical Diseases, Endsleigh Gardens 58 576 — Central London Throat, Nose and Ear Hospital, Gray's Inn Road 43 880 10748 Central London Ophthalmic Hospital. Judd Street 40 614 13728 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 591 2617 St. Saviour's Hospital, Osnaburgh Street 21 164 — North-West London, Bayham Street - - ¶ St. Pancras Dispensary, Oakley Square - - 2780§ London Skin Hospital, Fitzroy Square - - 2266 Western Skin Hospital, Hampstead Road - - 1720 British Dentists' Hospital, Camden Road - - 562 § Not including the work of the Tuberculosis Dispensary (see page 46), but including the clinic for mothers and young children (see page 26). ¶ Information not to hand. Health Week. During the week beginning October 5th, arrangements were made to bring before the inhabitants of the Borough matters relating to individual and communal health. In order to awaken general interest in this subject, it was considered necessary for the propaganda to be in several forms. To many, instruction through the senses of sight and touch is more effective than through the ear alone. In the more thoughtful the latter may suffice. The following programme was therefore arranged: — 1.—An Exhibition in the Town Hall, at which, throughout the week, demonstrations were given of Infant Welfare Consultations, Massage, Home Nursing (by the staff of the local Nursing Association), a Nursery School, Food Demonstration by the 19 Inspectors (illustrating sound and unsound food, diseased meat, &c.), Artificial Sunlight treatment by the Sunlight League, free distribution of health literature not only at the Exhibition, but this was also kindly undertaken by many prominent business firms in the Borough. A demonstration of the uses of electricity in the home with special reference to smoke abatement, &c., &c. 2. — A Cinema performance with lecture, given in association with the National Council for Combating Venereal Disease. 3.—Lectures, on various health subjects, by well-known authorities, were given every evening in the Town Hall. 4.—A special meeting to which all the Medical Practitioners in the Borough were invited in order to discuss with the Chairman of the Public Health Committee, the Medical Officer of Health, the Tuberculosis Officer, &c., matters of Public Health of mutual interest, and to promote good feeling and co-operation in any necessary administrative prccedures. The Exhibition was opened by His Worship the Mayor, Councillor R. F. W. Fincham, F.C.A., J.P., and the Chairman of the Public Health Committee, Councillor Dr. Gregg, also spoke. The response on the part of the public was good ; the Exhibition, Lectures, &c., were very well attended, and considerable interest was shown. 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, 11 and 13 to 16 of this report. The Borough scheme for Maternitv and Child Welfare includes the following activities:— (a) The dispatch by post of cards of advice to the individual mothers immediately after the receipt of the notification of birth required by law. (b) The home visitation of expectant and nursing mothers and babies by the Council's staff of health visitors, who work (a) from the Town Hall and (b) from the Centres. (c) The provision and maintenance of Maternity and Child Welfare Centres. These Centres are partly maintained on a voluntary basis; but the whole of the professional staff (medical officers and health visitors) are paid and controlled by the Council, who also pay the rent, rates and taxes of the Centre premises. (d) The provision of a clinic for ailing mothers and young children, the expenses being borne partly 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. 20 (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. (l) A Centre for Artificial Sunlight treatment. The work done in 1924 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 health visitors, six in number, give approximately half of their time to this work. These ladies in 1924 made 1404 visits to 348 infants (apart from visits made to cases of measles and for other special purposes). They also made 449 visits to 255 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 volunte rs (unpaid) at Chalton Street, in addition to two visitors (working in neighbouring boroughs as well as St. Pancras) at the University College Hospital Centre, whose salaries were paid by the hospital, and not by the Council. In 1924 the Council's staff at the various Centres made 40,793 visits to 3,438 children, and 3,782 visits to 1,458 expectant mothers; the trained workers not paid by the Council made 11,687 visits to 785 children, and 390 visits to 208 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 255 449 348 1404 Staff at Centres paid by the Council 1458 3782 3438 40793 Trained staff at Centres not paid by Council 208 390 785 11687 Total visits by all trained workers 1921 4621 4571 53884 Total visits in 3 previous years were— 1923 2084 4953 5401 52759 1922 2342 4770 6194 50347 1921 2547 5730 7280 53547 21 Centre. Attendances at Consultations. Visits by Trained Visitors. Consultations. Number of Trained Visitors. Expectant Mothers. Children. Expectant Mothers. Children. Infants, 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 Borough 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 — - — — — — — 255 — 449 — 348 - 1404 - - - - - - - St. Pancras School for Mothers— Ampthill Square 175 588 301 36 337 3991 3047(1) 7038 367 — 916 — 627 12768 23 (2) 273(3) 4 48 4 Chalton Street 64 141 195 32 227 2534 2291 4825 244 — 490 61(4) 347 - 4484 2286(5) 12 150 2(6) 20 2 2(7) North St. Pancras School for Mothers, 110 306 317 32 349 4266 3375 7641 71 — 296 — 493 — 5239 — (8) 18(9) 219 4(10) 35 3 — Queen's Crescent South Highgate Centre 3 12 63 14 77 1206 728 1934 15 — 52 — 130 — 1136 — 8 97 — — 1 — Grafton Road Centre 65 223 200 51 251 3037 1645 4682 139 — 427 — 391 12 5277 977 13 157 1 10 2 — Mary Ward Settlement school for Mother 20 107 101 29 130 1614 1529 3143 63 — 168 — 240 — 2310 — 12 144 — — 1 — Camden Town Centre, Camden Road 70 264 320 38 358 3689 1756 5445 212 — 490 — 561 — 2699 — 16 214(11) 4(10) 38 3 — (12) Berkeley Road Centre — — 20 3 23 412 171 583 - - - - - - - - 4 33 — — — — Argyle Square Centre 21 33 126 14 140 1212 467 1679 95 — 270 - 216 — 1881 — 5 60 1 11 1 — Caversham Road Centre 97 461 288 16 304 4276 1397 5673 90 — 435 6 164 194 2818 2045 12 142 4 49 2(13) — (l4) Maternity Nursing Association, Oakley Square 133 155 167 4 171 2393 1620 4013 — 208 — 323 212 151 1713 779 8 96 1 12 1 - University College Hospital 1760 3334 — — 752 — — 3255 — — — — — 428 — 5600 8 101 4 49 — —(15) Royal Free Hospital, Gray's Inn Road 216 653 76 40 116 509 361 870 162 — 238 — 57 — 468 - 8 103 8 103 - 2 Marlborough Maternity Section 416 2376 — — 88 — — 511 — — — — — — — — 4 48 8 96 — — Totals 3150 8653 - - 3323 — — 51292 1713 208 4231 390 3786 785 42197 11687 151 1837 41 471 20 — (1) Including 744 at voluntary consultations. (2) Including 3 per month held voluntarily. (3) Including 33 held voluntarily. (4) In addition to 8 visits by untrained voluntary workers (5) In addition to 161 visits by untrained voluntary workers (6) August to December, 1 only. (7) Voluntary trained workers. (8) 458 visits were made by unqualified students. (9) Including 2 per month held voluntarily. (10) August to December, 2 only. (11) Including 21 special "toddlers" sessions held by Assistant M O H. (12) Centre closed from 3rd September. (13) In addition to 1 full-time trained voluntary worker. (14) Year ended 31st March, 1925. (15) Paid by hospital and not by Council. 22 Maternity and Child Welfare Centres. These are 13 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 page 21 gives statistics concerning the work of all the Centres during 1924. It will be seen that 1,837 infant consultations and 471 ante-natal consultations were held during the year. The children who attended for the first time numbered 3,323. The total attendances of all children were 51,292, compared with 55,265 in 1923, and 51,426 in 1922. The total attendances of expectant mothers numbered 8,653, as compared with 6,389 and 6,033 in the two preceding years. Details concerning the work, together with some of the special activities of the individual Centres, are given in the following paragraphs: — 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 744 attendances were made. Classes for Mothers. At infant care classes there were 571 attendances; ante-natal care, 252 attendances; and at needlework, etc., classes, 619 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,072 dinners were supplied to nursing and expectant mothers, and 1,892 to young children. Observation Day Nursery. This is for children needing special care. There were 1,611 attendances during the year, of which 792 were made by infants under one year of age, and 819 by children over one year. Massage Clinic. 91 consultations were held, at which 897 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. During the year 34 consultations were held, at which 367 attendances were made. Details of the work done are given in the following table:— Mothers. Children. Extractions with anaesthetics 45 10 „ without anaesthetics 3 5 Fillings 55 85 Scalings 21 — Impressions and fitting dentures, etc. 34 — Examinations 25 84 Totals 183 184 23 Interviews with mothers by the Superintendent other than at clinics or classes numbered 5,398. Holidays were also provided for 15 mothers and 22 children. Argyle Square Centre. This continues to make good progress, the number of new cases, both as regards children and expectant mothers, being higher than in the preceding year. In addition to the consultations, classes for mothers have been held. Berkeley Road Centre. This was opened in February, 1923, as a branch of the Camden Road Centre. The attendances have not been sufficient to justify its continuance, and the Council decided to close it as from September 3rd, 1924. The mothers and children living in this area now attend the Camden Road Centre. Camden Road Centre. Some re-arrangement of the infant consultations was made during the year, and the ante-natal consultations since August have been held on alternate weeks instead of weekly. Miss Allfrey has been in charge since November 3rd in place of Miss Bristow, who was transferred to South Highgate. Consultations for children from two to five years of age have been held, and classes for mothers every other Wednesday. Caversham Road Centre. In addition to the work performed by staff paid by the Borough Council, a considerable number of visits were made by trained workers paid out of voluntary funds. A number of additional consultations have also been held, the cost of which was similarly defrayed. Interviews with mothers by the Superintendent averaged about 100 weekly. Chalton Street Centre. Various classes were held, at which 537 attendances were made. 1,133 dinners were provided for nursing and expectant mothers. Massage Clinic.—91 consultations were held, at which 512 attendances were recorded. 58 children were referred to the Borough Clinic for dental treatment. Holidays, either at the sea or in the country, were provided for 33 mothers and 52 children. National Mothercraft Competition, 1924.—Out of 94 competing Centres in this competition, the Chalton Street Centre obtained the most marks for all classes, getting honours in each class, and 72 out of 72 possible marks for the whole. This Centre also received special distinction for the mothers' records, and were asked to supply a set for exhibition. Grafton Road Centre. A voluntary consultation for older children has been held since February. A trained voluntary worker gives half-time service at this Centre. Owing to continued ill-health, the Superintendent, Miss May, tendered her resignation in June. This was accepted by the Council with regret. Mrs. Chapman was appointed to fill the vacancy and commenced duty on 18th August. Mary Ward Settlement School for Mothers. The additional activities at this Centre include massage clinics, at which 125 attendances were made, work classes, savings bank, etc. Country holidays, of two weeks' duration, were provided free for 12 mothers with 1 or 2 children. 24 North St. Pancras School for Mothers, Queen's Crescent. Two voluntary consultations for older children were given each month by Dr. J. Finch Haines. A "health talk" for young mothers was given twice monthly by the Superintendent. The attendances at these numbered 437. Interviews with mothers by the Superintendent, other than at classes or clinics, numbered 7,928. These are a popular feature at this Centre. A holiday scheme was also arranged, by which mothers were sent away, either free of charge or assisted according to their needs. Oakley Square Centre. The Superintendent holds a monthly meeting for mothers. The average attendance at the children's consultations and ante-natal clinics continued to be very good. Holidays.—32 mothers, 30 babies and 13 children were sent away for two weeks' holiday out of funds raised by members of the Voluntary Committee. South Highgate Centre. The attendances here again show a decrease as compared with previous years. A class for mothers was held twice monthly. During the year three cookery demonstrations were given by Miss Petty ("The Pudding Lady "). Artificial Sunlight Treatment. Very successful results having recently been reported from the above treatment in connection with cases of anaemia, debility, rickets, surgical tuberculosis, etc., it appeared to be desirable that the benefit of this form of treatment should be available for St. Pancras children who were suffering from these diseases. It was ascertained that the Committee of the "Save the Children Fund" might be willing to present to the Borough Council a lamp suitable for this treatment. As a result of inquiries which were made, a letter was received from the Committee of this Fund in November, definitely offering a lamp to be used for suitable children attending the various welfare centres in the Borough. The Council accepted this generous offer, agreed to provide the necessary supply of electricity, etc., and decided to instal the lamp at the South Highgate Centre in Eaydon Street. These premises could readily be adapted for the purpose, and Dr. Beaumont, who is experienced in this work, and whose residence is near, generously offered his services free, for a period of six months, to supervise the work. The treatment was not commenced until early in the present year (1925), when the Centre was opened by His Worship The Mayor, Councillor F. B. Gurney, F.A.I., J.P. At the opening ceremony, which was well attended by Members of the Borough Council, representatives of the Committee of the Centre, Medical Practitioners, etc., speeches were made by Sir Alfred Fripp, K.C.V.O., C.B., and Professor Leonard Hill, F.R.S., M.B., both of whom spoke in the highest terms as to the value of this treatment. The lamp, which is now working regularly on three days per week, is a Westminster Eidinow, that is a carbon arc type with a long flame rich in heat, visible and ultra-violet rays. The results obtained at the time of writing are very encouraging, and will be fully reported next year. 25 The illustration below shews a number of children undergoing treatment:— Reproduced by kind permission of "The Municipal Journal." The Borough Council's Dental Clinic, 40, Argyle Square.—At this, dental treatment is provided for the mothers and children attending the various Maternity and Child "Welfare Centres. No charge is made for extractions, fillings or scalings; but the patients are required to contribute what they can reasonably afford towards the cost of dentures. Consultations have been held twice weekly, and the work done is summarised in the following table:— Number of Clinics .. 96 „ with nitrous oxide anæsthesia .. 24 ,, of new cases (mothers) 221 366 „ ,, (children) 145 Total number of attendances (mothers) 1284 1757 „ „ (children) 473 Number of attendances for extractions under nitrous oxide .. 306 ,, ,, „ local anaesthesia .. 118 „ „ when fillings and dressings were done .. 300 „ „ „ scalings were done .. 67 ,, „ for impressions, fitting dentures, &c. .. 490 „ „ „ examinations and advice .. 477 Actual number of fillings and dressings .. 434 During the year 83 patients were fitted with dentures. The total cost of these was £284 6s., of which £176 3s. 6d. was paid by the mothers themselves, £36 by the Borough 26 Council, £46 by the Metropolitan Hospital Sunday Fund, and £9 10s. by the Hospital Saturday Fund. Besides these sums, £16 12s. 6d. was raised by Voluntary Societies (mostly through the C.O.S.) towards helping necessitous cases; nine mothers paid the whole cost of two dentures themselves, i.e., £4 each, and seven mothers paid for one denture, i.e., £2 each. One mother paid £6 6s. for a special set of dentures. In addition to these payments for new dentures, the mothers paid £5 for repairs and additions to old dentures. The Dentist (Mrs. Murch, L.D.S.) and her staff are to be congratulated on the above record of valuable work. That this Clinic is appreciated is shewn by the steadily increasing number of attendances, in fact the numbers now are too great to be dealt with at the two weekly consultations, which must therefore be increased during the coming year. Dental treatment is also provided at the voluntary clinic at the St. Pancras School for Mothers (see page 22). The Centres held in connection with the University College and Royal Free Hospitals are also able to refer cases to their own dental departments. Clinic for Sick Mothers, and Children under School Age.—A weekly clinic is held by Dr. F. L. Provis at the St. Pancras Dispensary, 39, Oakley Square. To this patients are referred from the Town Hall, from the welfare centres, by the health visitors, etc. During 1921 new cases under five years of age numbered 312, ailing mothers 37, and expectant mothers (new cases) 59. The total attendances at this clinic were 1236 of children under five, 152 of ailing mothers, and 95 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, 898; attendances, 3593; ailing mothers and expectant mothers: new cases, 107; attendances, 298. The Dispensary Resident Medical Officer also made 1180 home visits to sick children under five. The Medical Officer of the above-mentioned Special Clinic is paid by the Borough Council. He is assisted by a Nurse (half-time), who is paid from voluntary funds. During the year the Nurse made 1097 visits to the homes of children under five. The other work of the Dispensary amongst women and young children is supported by funds from voluntary sources, and is also subsidised by the Ministry of Health. Supply of Food to Mothers, and Children under School Age.—The Council continued during 1924 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. 27 The extent of the distribution of milk in 1924 is shown in the following figures Pints of Milk Granted Free. Pints of Milk Granted Half-price. Cost to Council. 1924. £ s. d. January 8167 790 142 14 0 February 8826 838 154 1 8 March 9057 710 136 13 3 April 7399 716 96 19 3 May 7177 628 93 12 9 June 6719 626 87 18 0 July 6133 828 81 16 9 August 6542 588 85 9 0 September 6202 776 82 7 6 October 6981 576 106 0 1 November 6739 924 105 0 3½ December 7203 944 111 18 6½ Total 87145 8944 1284 11 1 At the end of 1923 there were 205 families in receipt of milk through the Council's scheme. 359 new families were added to the list of recipients during 1924, and at the end of 1924 there were 191 families in receipt of milk. As will be seen from the table above, there were supplied in 1924, 87,145 pints of milk free and 8,944 pints at half-price, at a cost to the Council of £1,284 11s. 1d., half of which sum is repayable by the Ministry of Health. This figure does not include the cost of administration. Cases arc investigated by Mr. H. G. West, if there is any doubt as to the circumstances of the family. Dinners for Necessitous Expectant Mothers.—This work is organised by a voluntary committee, the Borough Council making 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 are recommended by the staff of the various welfare centres. The Mayoress of St. Pancras Home for Sick Poor Children.—This is situated at "Avalon," 1, St. Alban's Road, and accommodates 18 children. The Borough Council makes an annual grant of £500. Many alterations and improvements were made during the year. The premises were redecorated, additional sanitary accommodation was provided, and an external staircase for use in case of fire was erected. In order to carry out this work the house was closed from February 27th to July 1st. Advantage was taken of this opportunity to reorganise the staff—a new matron, Miss Carruthers, with the necessary assistants, being appointed. The cases admitted are children under 5 years of age who are either convalescent after illness, or who are weakly, badly nourished, and need good food and special care. At the beginning of the year 14 children were in residence. During the year 102 were admitted, and 15 were in residence at the end of the year. 101 were discharge 1 during the year, after an average stay in the Home of 25¾ days. Of the 101 cases discharged, 44 were in good health and 48 were much improved; 9 showed no marked improvement; but 4 of these were 28 discharged because of infectious diseases, the others by the temporary closing of the Home in January for redecoration, etc. The chief conditions for which the children were admitted were—general debility and anaemia, convalescence after measles, whooping cough, bronchitis, pneumonia, tonsillitis, etc. 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 total expenses are shared, as to one-half by the Ministry of Health, one quarter by the Council, and one quarter by voluntary funds. The three institutions are the Whitefield 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. Particulars in regard to the day nurseries for the year ended 31st March, 1925, are as follows:— - Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. £ s. d. Whitefield Day Nursery 202 2 11 224 6,726 30.0 Kentish T. Day Nursery 184 7 8 242 6,074 25.1 Margaret Day Nursery 171 6 5 237 4,478 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. During the past year 75 cases were assisted, 50 of these being maternity cases and 25 cases of other illness. The following list gives the social and other agencies applying, during the year, for the services of Home Helps:— Infant Welfare Centres 14 Town Hall Staff 37 Maternity Nursing Association 12 Medical Practitioners 5 Hospitals 4 The Mayoress 1 Maternity Home 1 District Nurses 1 75 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. 29 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 1924 in St. Pancras is indicated by the following figures:— No. of cases No. of home nursed. visits paid. Central St. Pancras District Nursing Association 262 3031 Metropolitan Nursing Association (St. Pancras cases) 163 1810 Hampstead District Nursing Association (St. Pancras cases) 107 1088 North London Nursing Association (St. Pancras cases) 55 408 Midwifery. The infants born in St. Pancras during 1924 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 81 69 16 45 125 23 208 67 634 Private Midwives 173 18 13 32 103 13 238 235 825 Doctors from the Elizabeth Garrett Anderson Hospital 22 22 2 15 32 20 12 36 161 Medical Students from— University College Hospital 93 267 4 6 148 303 5 35 861 Royal Free Hospital - — — 25 3 1 — — 29 St. Bartholomew's Hospital — — — 4 - — — — 4 Midwives from— Middlesex Hospital — 17 33 5 - 1 — — 56 University College Hospital — 7 35 102 1 6 — 1 152 Maternity Nursing Association, Myddleton Square - - 51 - 1 - - 52 Maternity Nursing Association, Oakley Square Branch 49 61 4 5 71 40 21 21 272 B. Attended in Institutions- University College Hospital — — 192 - - - - - 192 Royal Free Hospital — — — 363 - — — — 363 Royal Free Hospital (Marlborough Maternity Section) - - 539 - - - - - 539 Elizabeth Garrett Anderson Hospital - - - - - 50 - - 50 Lying-in Ward of St. Pancras House - - - - - 167 — — 167 Totals 418 461 838 653 483 625 484 395 4357 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. 30 The following Tables give the number of St. Pancras women who were attended at their own homes in their confinement by the staff of the various institutions undertaking this -work in the Borough, and the number of St. Pancras women who were admitted for their confinements as in-patients to these Institutions:— Midwifery. Attended at Home. Cases. Elizabeth Garrett Anderson Hospital (doctors) 161 University College Hospital (students) 861 „ „ „ (midwives) 152 Middlesex Hospital (midwives) 56 Royal Free Hospital (students) 29 St. Bartholomew's Hospital (students) 4 Maternity Nursing Association (midwives) 324 1587 (or 39 per cent, of the total number of births). Admitted as In-patients. University College Hospital 108 Royal Free Hospital 85 Royal Free Hospital (Marlborough Maternity Section) 157 Elizabeth Garrett Anderson Hospital 23 St. Pancras House 122 Middlesex Hospital 160 Queen Charlotte's Lying-in Hospital 173 City of London Maternity Hospital 70 Queen Mary's Hospital, Hampstead 56 Other hospitals 37 991 (or 24 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 as out-patients. 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 481 1230 153 229 Midwives (Private) 749 76 Institutions 550 1037 31 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 are at the rate of 5s. for each approved case attended at the patient's own home, and £1 for each approved case admitted into the institution concerned. Lists of the cases to be attended are supplied by the various institutions. Each case is investigated by the staff of the Maternity and Child Welfare Centre in whose area the patient resides. Attendance at the ante-natal clinic can thus in suitable cases be advised, and after the confinement the mother is urged to bring the baby to the Infant Consultations. The following table gives particulars of the amounts paid to the various institutions for attending necessitous St. Pancras cases during 1924: — Grants for Midwifery Attendance (Necessitous Cases). £ s. d. Royal Free Hospital and Marlborough Maternity Section 73 5 0 Elizabeth Garrett Anderson Hospital 47 15 0 Maternity Nursing Association 31 10 0 Queen Charlotte's Lying-in Hospital 85 0 0 City of London Maternity Hospital 34 0 0 Middlesex Hospital 140 15 0 £412 5 0 The corresponding grants for the two previous years were £705 and £713 5s. od. The considerable reduction for 1924 is due to the investigation now made, which excludes cases not necessitous, or which are not residents of the Borough. Government Grants. Government Grants were made during the year ended March 31st, 1925, in respect of Maternity and Child Welfare, as follows:— £ s. d. St. Pancras Borough Council 6684 13 9 St. Pancras School for Mothers (Ampthill Square) 653 18 9 „ „ (Chalton Street) 158 8 8 North St. Pancras School for Mothers 90 12 2 Grafton Road Mothers’ and Infants’ Welfare Centre 44 17 5 * Mary Ward Settlement School for Mothers 13 14 9 Camden Town Mothers’ and Infants’ Welfare Centre 72 5 2 Argyle Square Mothers’ and Infants’ Welfare Centre 40 14 2 Caversham Road Mothers’ and Infants’ Welfare Centre 234 6 11 South Highgate Mothers’ and Infants’ Welfare Centre 45 6 3 Maternity Nursing Association (for Maternity and Child Welfare Centre) 56 2 11 * Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 607 0 0 * University College Hospital (for Maternity and Child Welfare) 861 8 7 „ ,, (for Midwifery and Nursing) 212 10 0 * Royal Free Hospital (for extern Midwifery and Maternity Nursing) 94 10 0 „ ,, (for Maternity and Child Welfare Centre) 245 10 0 „ ,, (in respect of the Marlborough Maternity Section) 1163 9 7 St. Pancras Dispensary (Infant Clinic) 254 0 0 Mayoress of St. Pancras Home for Sick Children 483 13 11 Whitefield Day Nursery 404 5 11 Kentish Town Day Nursery 368 15 4 Margaret Club and Day Nursery 342 12 10 *ncluding expenditure on work amongst residents outside St. Pancras. 32 Section III.—PREVALENCE OF 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 I. 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 1 - — — — 1 — 2. Scarlatina or Scarlet Fever 759 16 270 289 113 50 21 — 3. Diphtheria and Membianous Croup 623 14 198 204 112 46 48 1 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 12 — — 1 — 5 6 — 6. Fever, Simple or Continued — — — — — — — — 7. Relapsing Fever — — — — — - — — 8. Puerperal Fever 16 — — — — 1 15 — 9. Erysipelas 108 6 8 3 7 13 57 14 10. Cholera — — — — — — — — 11. Plague — — — — — — — - 12. Anthrax - — — — — — — — 13. Glanders — — — — — — — — Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 3 1 — — 1 1 — — 16. Anterior Poliomyelitis and Polioencephalitis 5 2 2 1 — — — — 17, Ophthalmia Neonatorum 52 52 — — — — — — 18. Encephalitis Lethargica 45 1 3 5 4 8 23 1 19. Acute Primary Pneumonia 293 22 93 30 11 25 92 20 20. Acute Influenzal Pneumonia 131 6 15 18 8 12 64 8 21. Malaria 1 — — — — — 1 — 22. Dysentery — — — — — — — - 23. Trench Fever — — — — — - — — 24. Measles 4332 256 2620 1287 88 53 27 1 25. German Measles 270 10 91 117 29 17 6 — 26.Tuberculosis Pulmonary 447 — 4 7 11 96 304 25 Other Forms 119 6 28 26 12 23 23 1 Totals 7217 392 3332 1988 396 350 688 71 • 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. 33 The following tabic gives the number of notifications of the notifiable infectious diseases received in each month of the year:— Monthly Number of Cases of Infectious Disease Notified during 1924. 1st Quarter. 2nd QUARTER. 3RD Quarter. 4th Quarter. Total. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Small-pox — — — — — — — 1 - — - 1 Scarlet Fever 22 36 39 47 66 49 47 86 95 92 111 69 759 Diphtheria and Membranous Croup 23 30 54 44 76 54 40 53 45 64 74 66 623 Enteric Fever — 1 — 1 I — 4 _ 2 — 1 2 12 Puerperal I ever 1 1 4 1 — 1 1 — 1 1 3 2 16 Erysipelas 6 7 12 12 9 6 6 10 6 9 '5 10 108 Cerebrospinal Meningitis 1 — — — 1 1 - 3 Polioencephalitis and Pjliomyelitis — — 1 1 1 1 - 1 5 Ophthalmia Neonatorum 6 4 5 4 4 5 4 4 S 3 5 3 52 Encephalitis Lethargica — 2 5 13 11 3 2 1 2 3 3 45 Acute Primary Pneumonia 37 49 29 25 22 17 23 10 9 16 35 21 293 Acute Influenzal Pneumonia 19 40 37 6 5 6 1 4 2 8 3 131 Malaria — i - - - - - - - - — - 1 Measles 171 507 1685 1011 411 160 174 54 11 22 63 63 4332 Gei man Measles 5 8 7 14 32 39 46 19 16 18 20 46 270 Tubeiculosis (Pulmonary) 39 42 43 38 44 39 32 43 27 26 45 29 447 Tuberculosis (Oilier Forms) 4 7 9 12 19 10 12 10 14 7 9 6 119 Totals 334 33 1927 12:0 703 397 394 296 234 263 392 324 7217 34 The following Table gives the number of deaths from the notifiable and certain other diseases during each month of the year:— Monthly Number of Deaths fhom Notifiable and some other Diseases during 1924. 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 1 — 1 1 1 2 1 12 Diphtheria and Membranous Croup 2 1 3 3 4 2 1 i 1 2 1 1 22 Enteric Fever - - 1 - - - - - - - - 1 2 Puerperal Fever — — — 1 1 — 1 - - — - 1 4 Erysipelas — — — — 2 1 - - - - - 1 4 Cerebrospinal Meningitis 1 - - - - - - - - - - - 1 Dysentery - 1 — 1 — 1 — i — — — — 4 Polioencephalitis and Poliomyelitis 1 - - - - 1 - - - - - - 2 Encephalitis Lethargica — — 1 3 1 1 1 - 1 1 1 3 13 Measles 6 2 27 19 11 1 4 3 — — 1 _ 74 Tuberculosis (Pulmonaiy) 10 25 22 14 27 23 16 15 19 12 24 20 227 Tuberculosis (Other Forms) 2 4 4 6 5 3 5 5 5 1 3 1 44 Totals—Notifiable Infectious Diseases 23 33 59 47 54 34 28 26 27 17 32 29 409 Whooping Cough — 1 11 6 7 1 2 5 2 4 4 3 46 Diarrhcea and Enteritis 2 1 2 5 5 5 4 10 4 7 12 6 63 Influenza 8 29 24 9 2 — — — 2 1 1 4 80 35 In the following table the number of notifications are set forth for the past 10 years: — Diseases. 1915 1916 1917 1918 1919 1920 1921 192 2 1923 1924 Variola or Small-pox - - 1O 1 1 Scarlatina or Scarlet Fever 1009 448 246 332 558 863 1713 1156 487 759 Diphtheria and Membranous Croup 446 424 451 399 348 747 723 725 512 623 Typhus Fever - - - - - - - - - - Enteric or Typhoid Fever 36 38 24 '7 7 18 28 14 20 12 Fever, Simple or Continued — 1 — — — — — — — — Relapsing Fever — — - — — 1 — — — — Puerperal Fever 14 18 9 5 13 18 11 11 20 16 Erysipelas 202 120 126 121 134 126 87 118 92 108 Cholera - - - - - - - - - - Plague - - - - - - - - - - Anthrax — 1 — 1 — — — — — — Glanders - - - - - - - - - - Hydrophobia - - - - - - - - - - Cerebrospinal Meningitis 40 23 25 13 10 6 4 7 2 3 Anterior Poliomyelitis and Polioencephalitis 8 9 1 1 4 2 4 1 6 5 Ophthalmia Neonatorum 31 38 31 40 39 69 101 59 51 52 Encephalitis Lethargica .. .. .. .. 3 11 8 5 5 45 Acute Primary Pneumonia .. .. .. •• 86 142 242 384 286 293 Acute Influenzal Pneumonia .. .. .. .. 213 108 99 189 46 131 Malaria .. .. .. .. 98 58 18 13 13 1 Dysentery .. .. .. .. 6 4 1 3 3 — Trench Fever .. .. .. .. 1 — — — — — Measles .. 1855 3681 2144 1034 3093 1149 3728 327 4332 German Measles •• 381 609 311 268 195 81 253 134 270 Chicken-pox 247 •• .. 401 .. .. .. .. .. .. Tuberculosis Pulmonary 933 735 825 1034 799 684 546 534 440 447 Other Forms 150 138 169 203 206 132 153 148 137 119 Totals 31 1 6 4229 6197 5022 3837 6277 4968 7349 2581 7217 36 The notifications of, and deaths from, the notifiable infectious diseases are classified in the following table according to their Wards and Registration Sub-Districts:— INFECTIOUS DISEASES. Notifications. Deaths. West. Ward South Ward East. Ward North. Ward Whole Borough West. Ward South. Ward East. Ward North. Ward Whole Borough. 4 5 1 8 3 6 1 2 4 5 7 8 3 6 1 2 I. Variola or Small-pox — — - 1 — — — 1 — — - 2. Scarlatina or Scarlet Fever 74 96 28 83 168 89 113 108 759 — 3 1 - 2 2 1 3 12 3. Diphtheria and Membranous Croup 62 68 17 51 150 117 87 71 623 2 2 1 — 6 5 4 2 22 4. Typhus Fever — — — — — — — — — — — — — — — — — — 5. Enteric or Typhoid fever 2 3 1 4 1 — 1 — 12 — — 1 — — 1 — — 2 6. Fever, Simple and Continued - - - - - - - - - - - - - - - - - - 7. Relapsing Fever - - - - - - - - - - - - - - - - - — 8. Puerperal Fever 1 1 2 2 2 1 6 1 16 — 1 1 — 1 — 1 — 4 9. Erysipelas 4 20 4 17 17 12 21 13 108 — 1 — 1 — 1 — 1 4 10. Cholera — — — — — — - — — — — — — — — — — 11. Plague - - - - - - - - - - - - - - - - - — 12. Anthrax - - - - - - - - - - - - - - - - - — 13. Glanders — — — — — — — — — — — — — — — — — — 14. Hydrophobia - - - - - - - - - - - - - - - - - — 15. Cerebrospinal Meningitis — — — — 2 1 — — 3 — — — — 1 — — — 1 16. Poliomyelitis and Polioencephalitis — — — 1 1 1 2 — 5 1 1 - - - - - - 2 17. Ophthalmia Neonatorum 5 8 2 8 4 10 8 7 52 - - - - - - - - — 18. Encephalitis Lethargica 11 3 3 5 8 1 10 4 45 3 2 1 1 — 1 4 1 13 19. Acute Primary Pneumonia 31 42 9 38 72 46 31 24 293 - - - - - - - - — 20. Acute Influenzal Pneumonia 14 13 — 20 36 13 18 17 131 - - - - - - - - — 21. Malaria 1 — - - - - - - 1 - - - - - - - - — 22. Dysentery — — — — — — — — — 1 — — — — 1 2 4 23. Trench Fever — — — — — — — - — — — — — — — — — 24. Measles 522 631 162 438 857 605 510 607 4332 13 7 5 13 12 10 5 9 74 25. German Measles 31 32 12 12 59 23 58 43 270 - - - - - - - - — 26, * Tuberculosis, Pulmonary 74 65 20 63 70 26 73 23 47‡ 29 30 15 32 35 22 34 26' 22711 „ Other Forms 11 26 4 8 22 '4 24 8 119† 1 11 3 1 10 4 9 5 44 *Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912,011 Forms A, B, C, or D, and .also cases first coming under notice by means of Special Death Reports, † Including 2, the home addresses of which were not known. ‡ „ 12 „ „ † „ 3, „ „ 37 SMALL-POX. A case of this disease was notified on August 26th. The patient was at once removed to hospital, the premises were disinfected and all contacts vaccinated. No other cases occurred. The patient was a widow, aged 54, stated to have been vaccinated in infancy only. The illness began on August 10th, the rash appearing on the 13th; but the nature of the complaint was not recognised until the 26th. Fortunately the patient never left her room from the first day of the illness until she was removed to hospital. In investigating the source of infection, it was found that a young girl living in the same house had recently suffered from what had been diagnosed as “Chicken-pox.” On examining this girl, it was evident, from the distribution of the rash, that she had really suffered from an attack of very mild small-pox. The primary source of infection could not be ascertained; but it was probably brought from the Midlands or North of England, where mild small-pox has been prevalent for some time. During the summer, a constant succession of visitors from these districts had been coming to London for the Wembley Exhibition, and had stayed at the house in question. It is therefore possible that the infection may have originated from this source, and this view is supported by the fact that the type of disease was similar to that prevalent in the districts mentioned. In addition to the above, cases of small-pox occurred during the year in several Boroughs within the Metropolitan area, and contacts with these cases were kept under observation during the requisite incubation period. VACCINATION. Tue 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, 1923:— Vaccinations. 1 it January to 31.st December, 19243. Number. Percentage of Births registered. North. East. West. South.. Whole Borough North. East. West. South. Whole Borough Births registered 961 1264 908 1549 4682 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 43 77 37 61 218 4.5 6.1 4.1 3.9 4.7 Successfully vaccinated 475 664 484 868 2491 49.4 52.6 53.3 56.0 53.2 Had smallpox — — — — — — — — — — Insusceptible of vaccination 2 3 3 2 10 02 0.2 0.3 0.1 0.2 Received certificate of conscientious objection 396 350 318 345 1409 41.2 27.7 35.0 22.3 30.1 Postponed by medical certificate 5 12 12 10 39 0.5 0.9 1.8 0.6 0.8 Moved to known address in other districts 10 51 6 156 223 1.0 4.0 0.7 10.1 4.8 Lost sight of by removal 27 95 36 93 257 2.8 7.5 4.0 6.4 5.5 Unvaccinated and not accounted 3 12 12 8 35 0.3 0.9 1.3 0.5 0.7 for in previous columns 38 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. 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 1923 4682 2491 53.2 1444 30.8 SCARLET FEVER. This disease was more prevalent than daring the previous year, and the case mortality was also higher. 759 cases were notified during the year; but of this number 101 were subsequently reported by the hospital authorities not to be suffering from this disease. The correct number of cases was therefore 658, equal to an attack rate of 3.0 per 1,000 of population. The number of deaths certified as being due to Scarlet Fever was 12, equal to a death-rate of 0.05 per 1,000 of population, and a case mortality of 1.82 per cent, of cases notified. The following table gives the corresponding figures for the past 10 years, corrected for errors in diagnosis:— Year. No. of Notifications. Notification rate per 1,000 population. No. of Deaths. Death rate per 1,000 population. Case Mortality per cent. Percentage of Cases removed to Hospital. 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 1924 658 3.0 12 0 05 1.8 98 Of the 759 cases notified, 747, or 98.4 per cent., were removed to hospital. 39 Return Cases.—This term is applied to cases of Scarlet Fever which occur in a house within 28 clays of the return from hospital of a previous case. 12 such cases occurred during the year, one of which proved fatal. Special inquiries are made into these cases, with the object of discovering any possible source of infection. Considerable interest has been taken in this disease during the year, owing to research work carried out in America by Drs. G.. F. and G. H. Dick. These workers claim to have definitely identified a certain germ (Streptococcus Hsemolyticus) as the cause of the disease. They have devised a method of testing susceptibility to infection, and also a process of immunisation against the disease. Further research is being made; but there appears to be every reason to assert that the above work has definitely increased our knowledge concerning Scarlet Fever, and may ultimately lead to the introduction of methods which will give protection against infection. DIPHTHERIA. 62.3 cases were notified during the year. It was subsequently found that in 118 cases the diagnosis was incorrect and these patients were not suffering from this disease. The corrected number of cases was, therefore, 505, equal to an incidence rate of 2.3 per 1,000 of population. The number of deaths certified during the year as being due to Diphtheria was 22, equal to a death rate of 0.10 per 1000 of population, and a case mortality of 4.4 per cent, of the cases notified. This rate of mortality is the lowest yet recorded for the Borough. The following table gives particulars relating to the disease for the past 10 years, corrected for errors in diagnosis:— Year. No. of Notifications. Notification rate per 1,000 population. No. of Deaths. Death rate per 1,000 population. Case mortality per cent. Percentage of cases removed to hospital. 1915 311 1.7 24 0.11 6.3 95 1916 383 1.9 23 0.12 6.0 95 1917 381 2.0 25 0.13 5.5 99 1918 340 1.9 31 0.17 9.1 93 1919 283 1.3 21 0.09 7.4 97 1920 680 2.9 33 0.14 4.8 97 1921 657 3.1 51 0.24 7.8 98 1922 612 2.9 44 0.21 7.2 98 1923 399 1.9 20 0.09 5.0 98 1924 505 2.3 22 0.10 4.4 99 Of the 623 cases notified, 616 (98.9 per cent.) were removed to hospital. 612 were admitted to Metropolitan Asylums Board Hospitals, and 4 cases to other hospitals. 40 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. Nine cases of this description occurred during the year. Two cases were in one house, and one in each of seven other houses. In three cases bacteriological examination showed the original patient still had diphtheria bacilli in either nose or throat. TYPHOID OR ENTERIC FEYER. Twelve cases were notified during the year; but on further investigation three of these were found to have been incorrectly diagnosed. The actual number of cases was, therefore, nine. With the exception of the year 1919, when 7 cases only occurred, this is the lowest number recorded in any year. Based on bacteriological examination, 5 eases were reported to be suffering from Typhoid and 4 from Paratyphoid fever. In one case only was there a history of having consumed fish or shell-fish within the incubation period. In two instances the disease was imported, the patients having recently arrived in this country from abroad. One case had been away on holiday, and the infection was probably contracted during that period. In the other cases, no definite source of infection could be discovered. Two of the cases proved fatal. Particulars relating to this disease during the past 10 yebrs, corrected for errors in diagnosis, will be found in the following table:— Year. Cases notified. Deaths. Case Mortality per cent. 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 1924 9 2 22 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:— 41 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 30the December, 1923, to the 3rd January, 1925 (inclusive). Age Periods. Number of Notifications on Form A, Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors), Primary Notifications. Total Notifications (i.e,, including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to 1 l to 5 5 to 10 10 to 15 I5 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 '5 Total, Pulmonary Males — 2 2 4 16 24 48 47 41 22 11 217 234 — 1 1 2 2 121 163 51 120 Females — 2 3 5 28 23 45 27 20 5 5 163 169 - - - - - 74 88 29 59 Non-pulmonary | Males 2 12 13 1 4 3 6 I 2 1 — 45 47 — — 3 3 4 3 32 — 16 Females 2 10 12 S 3 12 4 1 3 1 — 53 53 — — — — 3 5 5 2 15 Totals 4 26 30 15 51 62 103 76 66 29 16 478 503 — 1 4 5 9 203 308 82 210 Age Periods. Number of Primary Notifications on Form C, included in above. Number of Primary Notifications on Form D, included in above. 0 to 1 1to 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 5S 55 to 65 65 and upwards. Total. Pulmonary Males - - - - - 3 6 5 7 1 2 24 - - - - - - - - - - 1 - Females — — 1 1 — 1 1 5 5 — — 14 — — — — — — — — — — — Non-pulmonary Males — I 1 2 - - - - - - - 4 - - - - - - - - - - - - Females - - - - - - - - - - - - - - - - - - - - - - - - Totals — 1 2 3 — 4 7 10 12 1 2 42 - - - - - - - - - - - - 42 Cases not Notified—Information obtained from Special Death Reports. Age Periods. 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 — 1 3 1 3 5 14 Females - - - - - - 1 4 4 2 2 13 Non-Pulmonary Males 2 8 - - - - - - - 1 1 7 Females — 2 - 1 1 — 1 1 1 — — 7 Totals 2 5 — 1 2 — 3 8 6 6 8 41 It will be seen that the number of primary notifications on forms A, B, C and I), was 525. In addition to this, 41 other cases were not notified, but first came to knowledge by means of special death reports (see table). The total number of new cases during the year was therefore 566, equal to a notification rate of 2.59 per 1000 of the population. The corresponding figure for the previous year was 577 cases, with a notification rate of 2.69 per 1000. Of the total 566 new cases, 447 were suffering from pulmonary tuberculosis, and 119 were non-pulmonary in character, equal to a notification rate of 2.05 and 0.54 respectively. In the following table all the cases occurring during the year are classified for age and sex:— Total Notifications during 1924. Ages. Pulmonary Tuberculosis. Other forms of Tuberculosis. Total, all Forms. Males. Females. Total. Males. Females. Total. 0—1 — — — 4 2 6 6 1—5 2 2 4 16 12 28 32 5—10 3 4 7 14 12 26 33 10—15 5 6 11 6 6 12 23 15—25 44 52 96 7 16 23 119 25—35 55 47 102 6 5 11 113 35-45 55 36 91 1 2 3 94 45—55 49 29 78 2 4 6 84 55—65 26 7 33 2 1 3 36 65 & upwards 18 7 25 1 — 1 26 Totals 257 190 447 59 60 119 566 43 Deaths from Tubercuilosis. The deaths from all forms of tuberculosis during the year were 271; of these 227 were from pulmonary and 44 from other forms of tuberculosis. These figures are equal to a death rate of 1.24 (1.04 pulmonary, 0.20 non-pulmonary) per 1,000 of population. In the following table these deaths are classified as regards age and sex:— Deaths from Tuberculosis during the Year 1924. Ages. Pulmonary Tuberculosis. Other forms of Tuberculosis. Males. Females. Total. Males. Females. Total. Total. 0-1 — — — 2 1 3 3 1—2 — — - 1 3 4 4 2—5 — 2 2 7 3 10 12 5—10 — 1 1 — 1 1 2 10—15 2 1 3 1 2 3 6 15—25 14 24 38 3 5 8 46 25-35 20 21 41 — 2 2 43 35—45 25 18 43 — 4 4 47 45-55 38 19 57 3 2 5 62 55—65 21 6 27 1 1 2 29 65 & upwards 10 5 15 1 1 2 17 Totals 130 97 227 19 25 44 271 In the above table it will be noted that deaths from Pulmonary Tubercubosis (Consumption) were most numerous at the age periods from 25 to 55 years, no less than 141 deaths occurring between these ages, out of a total of 227 at all ages. This large proportion of deaths during the most useful and productive years of life is a serious loss to the community. Although the loss of life from Tuberculosis is still very great, various remedial measures have effected a material reduction during recent years, the figures for the past 2 years, both as regards notification rates and death rates, being lower than in any previous years. This is shown in the following table, which gives these statistics for the past 10 years:— 44 Year. Estimated Population. Primary Notifications. Deaths. Notification Rate. Death Bate. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. I915 218387 933 150 1083 398 I02 500 4.27 0.69 4.96 1.82 0.47 2.29 1916 218387 735 138 873 340 83 423 3.36 0.63 3.S9 1.55 0.38 1.93 1917 218387 825 169 994 353 91 444 3.78 0.77 4.55 1.62 0.42 2.03 1918 218387 1034 203 1237 403 82 485 4.74 0.93 5.67 1.85 0.37 2.22 1919 218387 799 206 1005 268 73 341 3.66 0.94 4.60 1.23 0.33 1.56 1920 218387 684 132 816 249 63 312 3.07 0-59 3-67 1.12 0.28 1.40 1921 212900 546 153 699 250 54 304 2.56 0.72 3.28 1.17 0.25 1.43 1922 212500 534 148 682 257 58 315 2.51 0.70 3.21 1.2 I 0.27 1.48 1923 214400 440 137 577 211 61 272 2.05 0.64 2.69 0.98 0.28 1.27 1924 214300 447 119 566 227 44 271 2.05 0.54 2.59 1.04 0.20 1.24 The total 271 deaths which occurred during the year from all forms of tuberculosis include 41 deaths of cases which had not been notified. Of these, 27 deaths were due to Pulmonary and 14 to other forms of tuberculosis, which represent 11.9 per cent, and 31.8 per cent, respectively of the total deaths from these causes. 54 cases of tuberculosis were only notified within 1 month of death, and 20 other cases within 3 months of death. It is therefore obvious, either many patients do not seek treatment until the disease is far advanced, or that notification is in many cases unduly delayed. In the following table the notification and death rates are classified according to sex. The figures are based on the sex population as determined at. the last Census (1921):— 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 2.50 0.57 3.07 1.26 0.18 1.45 Females 1.65 0.52 2.16 0.81 0.22 1.06 Both Sexes 2.05 0.54 2.59 1.04 0.20 1.24 45 The table below shows the number of notifications and the number of deaths, together with the corresponding rates for each Ward of the Borough: — Tuberculosis (All Forms). No. of Ward. Notifications. Deaths. No. Rate. No. Rate. 1 97 2.6 43 1.2 2 31 1.4 31 1.4 3 92 2.5 46 1.3 4 85 3.2 30 1.1 5 92 3.0 41 1.3 6 40 1.9 26 1.2 7 44 2.8 18 1.2 8 71 2.5 33 1.2 No address 14 - - - Totals 566 2.6 271 1.2 The following table gives details of the new cases occurring during 1924, classified according to the part of the body affected, as well as for age and sex distribution:— New Cases of Tuberculosis during 1924. Location of Disease. Ages. Total. 0—5 years. 5—15 years. 15 years and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 2 2 8 10 247 178 447 Bones and Joints 4 2 7 3 5 8 29 Meninges 8 6 — — 1 — 15 Glands 5 3 10 14 5 9 46 Abdominal 1 1 2 — 2 7 13 Genito-Urinarv — — — — 4 1 5 General 1 1 1 1 — 1 5 Other Organs 1 1 - — 2 2 6 Total—Non-pulmonary Tuberculosis 20 14 20 18 19 28 119 Total—all forms of Tuberculosis 22 16 28 28 266 206 566 46 Home Visits and Inquiries. This is carried out, both as regards notified cases and contacts, by women inspectors of the Town Hall staff and by two nurses attached to the dispensaries. From the Town Hall each of the six women inspectors investigates cases and contacts in the area of the Borough allotted to her. The nurse at the St. Pancras Dispensary devotes to home visiting in Wards 1—6 so much of her time as is available, chiefly for special inquiries required by the Tuberculosis Officer. The nurse at the joint Holborn and St. Pancras Dispensary (which is at University College Hospital) devotes half of her time to St. Pancras cases in Wards 7—8. The visiting work carried out by the above staff during the year in connection with tuberculosis was as follows:— Visits by Tuberculosis Officers 244 Women inspectors—(a) First visits 760 „ (b) Subsequent visits 3,297 Visits by Dispensary Nurses 1,107 5,408 Attendance of women inspectors at dispensaries 471 Other visits of women inspectors for various purposes 208 Number of cases in which disinfection was carried out 127 Tuberculosis Dispensaries. There are three dispensaries, situated as follows:— 39, Oakley Square, N.W.I. 132, Maiden Road, N.W.5. University College Hospital, W. 1. The two first mentioned are for patients residing in the six wards of the Borough north of Euston Road (Census population, 169,276). The staff consists of the Tuberculosis Officer (Dr. Donnelly), a nurse, and a clerical and general assistant, all full-time officers. In this area the cases of tuberculosis notified during the year numbered 437 (332 pulmonary, 105 non-pulmonary), which represent attack rates of 1.9 and 0 6 respectively per 1000 of the population. The deaths in this area registered as being due to tuberculosis numbered 217 (177 pulmonary, 40 non-pulmonary), representing death rates of l.0l and 0.23 respectively per 1000 of population. The dispensary at University College Hospital is a joint one serving the two wards of St. Pancras south of the Euston Road (Census population, 42,090), and the whole of the Borough of Holborn. The staff here consists of a part-time Tuberculosis Officer (Dr. Hilton, January to September; Dr. Struthers, October to December), and a full-time nurse who devotes half of her time to St. Pancras cases. In this area of St. Pancras (Wards 7 and 8), the cases of tuberculosis notified during the year numbered 115 (103 pulmonary, 12 non-pulmonary), representing attack rates of 2.37 and 0.27 respectively per 1000 of population. The deaths in this area registered as being due to tuberculosis numbered 51 (47 pulmonary, 4 non-pulmonary), representing death rates of 1.08 and 0.09 respectively per 1000 of population. The following table gives a summary of the work done at the three dispensaries during the year:— TUBERCULOSIS DISPENSARIES. Tuberculosis Dispensary at St. Pancras Dispensary, 39, Oakley Square. Branch Tuberculosis Dispensary at 132, Maiden Road. Tuberculosis Dispensary at University College Hospital. Adults. Under 15 Total. Contacts included in Total. Insured Persons included in Total. Adults. Under 15 Total. Contacts included in Total. Insured Persons included in Total. Adults. Under 15 Total. Contacts included in Total. Insured Persons included in Total. M. F. M. F. M. F. M. F. M F. M. F. Under observation January 1st pending diagnosis 15 37 24 9 85 28 26 7 5 6 6 24 7 4 4 2 1 2 9 4 2 Examined for first time during the year 160 177 106 113 556 219 206 29 49 37 40 155 76 47 56 55 25 21 157 49 58 Total 175 214 130 122 641 247 232 36 54 43 46 179 83 51 60 57 26 23 166 53 60 Found to be suffering from Tuberculosis Pulmonary 86 69 1 1 157 13 100 12 17 0 3 32 6 18 32 17 1 2 52 1 27 Non-pulmonary 8 3 4 6 21 0 7 4 1 2 1 8 3 3 4 5 3 — 12 1 5 Not suffering from Tuberculosis 53 93 89 100 335 206 75 11 22 29 31 93 54 17 20 33 22 21 96 51 25 Under observation on December 31st pending diagnosis 20 36 29 8 93 19 39 7 6 9 8 30 16 6 0 0 0 0 0 0 0 Ceased attendance before completion of diagnosis 8 13 7 7 35 9 11 2 8 3 3 16 4 6 4 2 0 0 6 0 3 39, Oakley Square. 132, Maiden Road. University College Hospital. 39, Oakley Square. 132, Maiden Road. University College Hospital. Patients under supervision (excluding persons under observation or domiciliary treatment) on 31st December 411 130 197 Reports received from Insurance Practitioners re insured patients under domiciliary treatment during the year 54 1 14 Total number of attendances during the year— Persons referred to affiliated hospital Consultations with medical practitioners at the homes of patients— 0 0 73 Insured 1525 251 529 Uninsured 1380 622 426 Insured 3 1 1 Persons placed under observation for the 0 0 0 purpose of diagnosis during the year 201 77 23 Other visits paid by Tuberculosis Officers to the homes of patients Cases in which the period of observation 195 36 8 exceeded two months 41 14† 0 Visits by Dispensary Nurses to the homes of patients for dispensary purposes Insured persons under domiciliary treatment 352 86 669 on December 31st 141 12 136 Specimens of sputum examined for dispensary purposes 881 173 130 *34 due to non-attendance. †9 due to non-attendance. 47 48 The following reports have been furnished by the Tuberculosis Officers giving particulars concerning the clinical duties carried out by them at the dispensaries under their charge and in their respective areas:— REPORT by Dr. N. M. DONNELLY.—Wards 1 to 6. Year. Wards 1—6. Oakley Square. Maiden Road. Total Attendances. Home Visits. Sputa Examd. Notifications. Deaths. New Cases. Contacts includedin new cases. New Cases. Contacts included in new cases. Oakley Square. Maiden Road. T.O. Nurse. 1921 541 229 462 133 62 24 2886 439 187 296 990 1922 514 250 475 139 91 36 3675 587 193 423 987 1923 432 216 619 278 164 75 3050 703 141 457 891 1924 437 217 556 219 155 76 2905 873 231 438 1054 The Oakley Square and Maiden Road Dispensaries deal with cases of tuberculosis in Wards 1 to 6. In the above table, for the years 1921, 1922, 1923, 1924, the Notifications and Deaths in Wards 1 to 6, new cases seen at dispensaries and total attendances, etc., is given. This shows that, though the notifications and deaths have fallen, the number of new cases seen at dispensaries has increased. It will be seen that the new cases for 1924 are below those for 1923. This decrease is due almost entirely to the decrease in the number of contacts examined during the year. In 1922 and 1923 an endeavour was made to obtain better results in this important branch of the work, i.e., the examination of contacts, by trying to induce all contacts of notified cases to attend for examination at the dispensary ; but in 1924 visitors were instructed to advise contacts to be examined by their own panel or private doctor if they had one ; if not, to attend at the dispensary for examination. As regards total attendances, these are shown not to have increased since 1921 proportionately with the new cases. The reason for this is that, since 1921, it has also been endeavoured to limit treatment at the dispensaries to those requiring some special treatment, or to those who had no panel doctor and were unable to obtain adequate treatment otherwise. The number on treatment at the dispensaries in 1924: is 73 greater than that for 1923. With reference to cases put on observation at the dispensary, it is considered more satisfactory to put on a period of observation all cases which, especially if they are “contacts,” are not in good health, even though there are no definite signs of Tuberculosis present. This number is increasing, and is about 100 more for 1924 than for 1923. Many of these doubtful cases are referred for X-ray examination, a note being sent to the radiographer on the clinical findings. Fifty-one such cases were sent for X-ray report in 1924. A definite decsion is generally arrived at in two months. Of 55 cases, which were during the year over two months on observation, the cause in 43 of these was non-attendance or irregular attendance on the part of the patient. In many cases this is probably due to the clearing up of some suspicious condition present when the child or person comes first to the dispensary, so that re-attendance is not considered necessary. Such irregular attenders are visited when they do not come at the time fixed, to ascertain the cause and try to secure re-attendance. The number of Insured patients under Domiciliary Treatment is increased by 52 over the 1923 figure, and the number of reports received from Insurance Practitioners in respect of these patients is increased bv 30. As a rule reports are required three monthly from practitioners, 49 but, as many of the patients keep under regular supervision at the dispensary, reports are not asked for in these cases. Cases doubtful, even after a period of observation at the dispensary, are, if it seems advisable, referred to the Loudon County Council for observation in hospital. During 1924, 8 cases were referred for observation, and 5 found to be tubercular. Under the heading “Consultations” are classed only consultations with the doctor at the home of the patient. As almost all the doubtful cases are fit to get about, they are generally referred by the doctor to the dispensary. This accounts for the small number of entries here. Visits by Tuberculosis Officer to homes of patients are 90 over those in 1923. Sputum examinations are 163 over those for 1923. Nurses' visits are 142 more than in 1923. There is a large amount of dispensary work not included in this return. A copy of all the notifications in this area is sent each week to the Tuberculosis Officer. These notifications may be those of cases under practitioners or attending hospital out-patient departments, or may be notifications of cases under treatment in hospitals. The Health Visitors from the Public Health Department visit at the homes to ascertain the circumstances, report on sanitary conditions, give advice to patient and those in contact with him, and take steps as regards disinfection and the prevention of infection in others. Inquiry is made as to whether the patient is receiving the necessary treatment, or if the patient's doctor wishes him to attend at the dispensary. Any doubt in this matter is dealt with by writing the doctor and asking if he wishes to consult with the Tuberculosis Officer re the form of treatment most suitable to the circumstances of the case. If the patient is in hospital a report is asked for, and forwarded to the London County Council if the doctor in charge of the case wishes to recommend the case for institutional treatment. From these inquiries, if it is ascertained that patient's attendance is desired, he is instructed to attend. No bar is placed on the attendance of any patient at the dispensary where tuberculosis is suspected. Such cases come of their own accord, or may be referred by School Medical Officers, Health Visitors, or social workers. In the year 1924, 177 recommendations were made to the London County Council for institutional treatment. These included second recommendations and patients of other years. Progress reports are furnished yearly on cases which have had institutional treatment, and 306 of these were furnished in 1924. 406 reports were made to the Ministry of Pensions on cases sent for opinion as to diagnosis or treatment. Re Co-operation with Prac/itinner.—A report is made on every case referred for opinion, stating in full the patient's condition, if ho is recomimnded for institutional treatment, and again a full report is made on his condition on discharge, when he goes back again under his own doctor. 161 reports were made on insured cases, and 355 letters or other reports about cases. Co-operation with School Medical Service.—Cases referred for opinion by the School Medical Officer are reported on. 211 school cards have been made out for school contacts of notified cases, and a report made on the child's condition if it has been seen at the dispensary. If not seen, the card is so marked and sent to the School Medical Officer, so that these children can be specially observed at school. Every year the Divisional School Medical Officer goes over these cases with the Tuberculosis Officer for further consideration. Reference of cases is made to the School Care Committee or clinic for the treatment of teeth, eyes, ears, nose and throat. 50 Children not definitely tubercular, but in a poor state of health, are, if considered advisable, referred to the Invalid Children’s Aid Association for convalescent treatment. During 1924, 20 children were referred for such treatment. Cases of lupus are sent to the London Hospital for Finsen Light treatment, payment being made by the Borough Council at a fixed rate for each exposure. Five cases were under this treatment during 1924. A number of cases considered suitable for Pneumothorax treatment have been receiving this at Brompton Hospital, payment at a fixed rate per “refill” being made also in these cases by the Borough Council. Eight were receiving this form of treatment in the year. Recommendations are made to the Medical Officer of Health for grants for extra nourishment from the special fund for this purpose in the case of patients who are likely to derive permanent benefit from it, and whose circumstances seem to require it. Such cases are those who are out of work and awaiting institutional treatment, or who, after a period of institutional treatment, require it to maintain their condition till re-emploved. Fifty-two cases were recommended during the year. Recommendations are also made for the provision of extra bed or bedding, and reports made re sanitary conditions observed as needing attention on visits of Tuberculosis Officer at the homes of patients. Under the Borough Council Scheme for treatment, dental treatment is given to patients in need of it and dentures supplied. In the case of insured patients, part of the cost is borne by approved societies if dental benefit is accorded to their members. The remainder of the cost, or part thereof, is borne by the Council. The Care Committee assist by advising the Medical Officer of Health as to the capacity of the patient to contribute to the cost. In 1924, fifty-two cases were sent for dental treatment, and dentures supplied in ten cases. Reference to the Care Committee.—All notified cases whose conditions are such as seem to require it are, if willing, referred to the Care Committee to deal with such circumstances as fall within its province. The Sub-Committee of the Care Committee meets weekly and is attended by the Tuberculosis Officer. In cases of urgency letters are given to be taken at once to the Hon. Secretary. To assist in the very difficult task of obtaining employment for the tuberculous patient who is fit for it, letters are given to the local employment exchange, stating what the patient's occupation was, whether he is now considered fit for it, and if not, suitable occupations are suggested. To overcome the reluctance of employers to take, or of others to work with, tuberculous patients, a certificate is given re freedom from infection. If the patient cannot be certified as definitely non-infectious, a “conditional” certificate is given, stating under what conditions he is not likely to be infectious. 18 cases were referred during the year to the Exchanges. REPORT by Dr. STRUTHERS.-Wards 7 and 8. Report of the Tuberculous Dispensary (University College Hospital) for the year 1924. The following report follows the lines suggested in Memorandum 37/T of the Ministry of Health:— Close co-operation has been maintained with the Local Authorities. Frequent consultations take place between the Tuberculosis Officer and the Medical Officer of Health for the Borough, and at the end of the month the latter is furnished by the former with reports of the work done in the dispensary. Numerous reports and returns have also been prepared for the London County Council and other Authorities. 51 Many of the children seen at the dispensary have been sent by the Medical Officers of school clinics and child welfare centres for further opinion. On the other hand, use has been made of the arrangements whereby the School Medical Service keep under observation children referred to them, either as unexamined contacts (vide infra) or as being in an unsatisfactory state of health. Close co operation has also been maintained, both with the local medical practitioners and with the Hospital, and it is from these sources that the majority of patients have come. Full advantage has been taken of the valuable facilities offered by the Hospital for the diagnosis of obscure cases, particularly in the matter of X-ray work, laryngoscopy and pathological investigations. It is also a great help to have at hand an institution to which tuberculous patients can be referred for treatment of non-tuberculous ailments to which they may be subject, the treatment of which adds so much to their welfare. The dispensary is also used by the Hospital as a channel for furnishing the various reports sent to the County Councils concerning in-patients who come under their scheme for the institutional treatment of Tuberculosis. Patients referred to the dispensary from the out-patient department of the Hospital are put in touch with the Tuberculosis Offier of their district and arrangements for their removal to sanatoria, etc., thus facilitated. Special mention must be made of the help given by the Tuberculosis Care Committee, and the organisation which it represents, in the amelioration of home conditions and in assisting the families of those who have gone to sanatoria, and in other matters, which, though not strictly medical, are of the greatest importance in treatment. All patients attending the dispensary are visited periodically by the dispensary nurse and reports made. Every effort has been made, through the agency of the dispensary nurse and otherwise, to get into touch with contacts; but in this matter considerable difficulty has been experienced, not only in securing primary examination, but in following the subsequent history of the individuals concerned. The arrangements under the heading of General Supervision, include :— 1. Periodic examination at the dispensary, when advice is given as to mode of life and prevention of infection. 2. The supply of medicine to non-insured patients. 3. The supervision of home conditions by the dispensary nurse. Treatment of Tuberculosis in Sanatoria and Hospitals. All cases recommended for institutional treatment are dealt with by the London County Council. Patients admitted to sanatoria are usually early or moderately early cases, and there is little or no delay in their admission. For advanced cases the accommodation is not so adequate, and it is regrettable that the number of these who have been refused admission has increased during the past few years. This is a grave defect, which should be promptly remedied, for these advanced and generally highly infectious cases constitute a serious risk to others, especially children, living under the conditions of close contact so prevalent at the present time. A number of these advanced cases are referred to poor law institutions. Some patients decline to accept this form of accommodation, and for these we endeavour to find vacancies in homes for the dying or other similar institutions. Failing this, these cases must remain at home. 52 The following table gives the number of cases of pulmonary tuberculosis notified during each of the past three years, and the number and percentage of those refused institutional treatment :— Year. Notified cases of Pulmonary Tuberculosis. Number refused Institutional Treatment. Percentage of cases  Notified. 1922 534 18 3 per cent. 1923 440 24 5 1924 447 46 10.3 „ The necessity for increasing institutional accommodation for advanced cases will probably be better appreciated from the following particulars concerning the 71 Persons whose death, from pulmonary tuberculosis, occurred in their own homes. The number of persons in the families of these 71 cases was 297, and the number of rooms occupied by these 297 persons was only 205. In some of the cases the conditions were even more unsatisfactory. For instance, in nine of the above cases the number of persons in the families, including the patients, totalled 70, and these were all living in 21 rooms. A very valuable step was taken by the Borough Council during the past year in the provision of beds and bedding to be lent to tuberculous patients who were compelled to share a bed with another or other persons. These have proved of great value. They are much appreciated by those to whom they are lent, and should tend to limit the spread of infection. Tuberculosis Care Committee. The functions of this Committee were indicated in a circular issued by the Ministry of Health to be as follows:—"The primary duty of the Committee should be to consider the economic position of the family of every patient suffering from tuberculosis as soon as he comes within the purview of the dispensary scheme, and to render such advice and assistance as the circumstances of the case dictate, with a view to enabling the family to adjust their circumstances to the new conditions, to maintain their economic independence, and to derive the fullest possible advantage from the medical treatment prescribed. Certain kinds of assistance may be needed in particular cases, viz., additional food, change of air, clothing, better home conditions, more suitable occupation; the provision of financial or other assistance, when necessary, for the family of a patient who is under treatment in a residential institution, or temporarily for a patient and his family on his return home from such an institution. Where the necessity for financial assistance arises, it can be better provided through the agency of existing charitable or public organisations than from a fund administered by the Care Committee, and in such cases it should be the function of the Care Committee to bring the family into touch with the appropriate organisation. A subsidiary but important function is to undertake, on behalf of the London County Council, the assessment of charges made in respect of residential treatment afforded to children and to adults whose income exceeds a certain figure. It is important, however, to secure that the activities of Care Committees are not absorbed by the routine work falling under this head to the detriment of the main functions which are mentioned above." Although the Ministry of Health is of opinion that it is neither necessary nor desirable that Care Committees should be in possession of funds, in practice it is difficult, if not impossible, to carry out all the duties enumerated without having some funds available. The following particulars concerning the work of the Committee and cases dealt with have been supplied by the Hon. Secretary, Miss Bibby:— 53 The St. Pancras Tuberculosis Care Committee. Report of the Hon. Secretary on the Work for the year ended 31st December, 1924. The work of the Committee during the year 1924 proceeded generally on the lines laid down by the Ministry of Health in Circular 308. Its activities and its possibilities have, however, been limited by lack of adequate clerical assistance and by lack of money, so that there is no great record of achievement to present and no sufficiently satisfactory statistical account for review. The Committee has met on five occasions; the Sub-Committee on thirty-seven occasions during the year 1924. The Sub-Committee, which meets weekly, except at times of holiday or for special reasons, deals mainly with questions of assessment. When desirable it makes special reports and recommendations to the parent Committee. The parent Committee has been asked to deal with the wider questions and problems relating to the work, including the suitability of the provision made for various classes of cases, the consideration of special problems, and the consideration of needed new developments. Recommendations to the Borough Council have been made as to:— The provision of accommodation for advanced cases. The urgent need for additional housing. The payment of nurses for patients in their own homes. The provision of extra beds and bedding for patients in their own homes. The Borough Council complied with the request of the Committee as to beds, etc., and the provision has proved of great value. The Committee organised a Conference on the Care of Advanced Cases of Tuberculosis, held at the St. Pancras Town Hall on 24th July, 1924. Representatives of all the Care Committees of London were invited to attend. There was a general agreement as to the need for further provis on for the care of advanced cases; but no specific resolutions were put forward, as it was hoped to continue the Conference at a later date. Since Care Committees arc requested by the London County Council to recommend as to the payments to be made by or on behalf of patients receiving residential institutional treatment, much time is occupied in inquiring into and considering the financial circumstances of such persons. Inquiry of this kind must, obviously, be made with great care if injury to the patient as to his employment and living arrangements is to be avoided, so that assessment is frequently made on unchecked information. The County Council (having less complete knowledge of the patients than the Care Committee) make the final decision. During 1924, 141 cases were considered as to assessment, and 87 cases in other connections. Cases were referred for assistance to:— The Charity Organization Society. The King's Roll Committee of the Labour The Invalid Children's Aid Association. Exchange. The British Red Cross. Spero Leather Workers. The Invalid Kitchens of London. Theatrical Ladies' Guild. The St. Pancras Home Helps Committee. Queen Mary's Needlework Guild. In certain approved cases, extra nourishment is provided by the Borough Council. 54 There are, however, other cases for which this provision is not available. The difficulties dealt with have included:— 1. Employment. 5. The provision of open-air school 2. Housing. accommodation. 3. Unsuitability for such help as is available. 6. Provision for advanced cases. 4. Difficulties of character and mentality 7. Provision of medical care for non- which unfit the patient for the full pauper ton-panel patients in their utilization of help provided. own homes. The one completely satisfactory section of the Committee's work has been the Children's Section, which has been entirely in the hands of Mrs. Philipson. Twenty-seven children were sent away under the London County Council scheme. Two were referred to the I.C.A.A. for special care. The Committee is deeply indebted to Mrs. Philipson, who, in addition to the work for the children, has undertaken the whole of the collection of the adults' payments, and has given to the Committee in every direction assistance of which it is impossible to speak too cordially. In the latter part of the year, Miss Lawrence gave valuable help in clerical work and in visiting, but was unable to continue. The emergency provision of clothing for patients who have not any suitable equipment is of importance. The cases of urgency so far arising have been met in part by the help of private friends and by Queen Mary's Needlework Guild. It is hoped later to establish a needlework guild for the Committee. Among many pressing needs are: — 1. Means of subsidizing the earnings of partially recovered patients. 2. Further provision of employment specially adapted for patients. 3. Further provision of tenement workshops of hygienic construction for such patients. 4. Living accommodation for cases in crowded homes, or for those without adequate attention who are not yet hospital cases. 5. More complete assistance to recovery for pneumonia and pleurisy patients by way of preventive work. 6. Some provision for medical care in the patient's own home for the necessitous who have no panel doctor, and, though not " destitute," are unable to pay ordinary medical fees, when too ill to attend the dispensary. PUERPERAL FEVER. Sixteen cases were notified during the year. Two of these were non-residents, who had come to homes in the Borough for their confinements. Four deaths occurred from this cause, one of these being a non-resident. As the result of an inquest, one other death was recorded of a case which had not been notified. There were therefore 15 St. Pancras cases, with three deaths. This equals an incidence rate of 3.6 per 1,000 births and a case mortality of 20 per cent. Of the 14 notified cases, 5 were primiparæ (women who had not previously had children) and 9 were multiparæ. Five cases followed the birth of dead or premature children, and 9 were after the birth of living children. Four cases were attended in their confinements by doctors, 6 by midwives, 3 by students, and 1 case was unattended at the birth. All the patients were admitted to hospitals. Twelve of the confinements took place in the patients' own home, two were in institutions. 55 OPHTHALMIA NEONATORUM. Fifty-two cases were notified or otherwise discovered during the year. This equals an attack rate of 12-6 per 1,000 births. One child died owing to coincident bronchitis. Of the 52 cases, 27 were regarded as slight, 21 of moderate severity, and 4 were grave. Eighteen cases were admitted to the special hospital provided for this disease—St. Margaret's, Leighton Road ; 20 were treated at home with the help of a visiting nurse, and 14 attended the outpatient department of hospitals. In 2 cases, the sight of both eyes was permanently affected. Thirty-five of the cases had been born at home, and 17 in Institutions. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever.) Three cases were notified, but on further investigation, two of these were found to have been incorrectlv diagnosed. There was therefore onlv one definite case, and this proved fatal. The following table gives the number of cases (corrected for errors in diagnosis) 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. 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 1918 9 8 89 1924 1 1 100 ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Six cases of poliomyelitis and one of polioencephalitis were either notified or otherwise discovered during the year. It was subsequently found that one case of poliomyelitis had been incorrectly diagnosed, and was not suffering from this disease. The case of polioencephalitis proved fatal, and one case of poliomyelitis died, being complicated by broncho-pneumonia. These affections are important, owing to the fact that long-continued treatment is necessary in order to limit, as far as possible, permanent crippling and physical deformity. During the year the Ministry of Health had under consideration the lack of facilities for dealing adequately with the after-effects of these and other "crippling" diseases, and desired information as to the prevalence of these conditions. A special inquiry was therefore made at all the Infant Welfare Centres as to the number of cases in attendance who were suffering from "crippling" diseases, and the following were found:- Poliomyelitis (Infantile Paralysis) 16 cases. Paralysis (other forms) 6 „ Talipes and other deformites 25 „ Rickets (mild and severe) 71 „ From the information obtained,it has appeared to be necessary to make more adequate arrangements for the residential treatment of such cases, and the London County Council has now arranged for suitable cases to be admitted to Queen Mary's Hospital, Carshalton, where beds will be available early in the year (1925). 56 ENCEPHALITIS LETHIARGICA. This is commonly termed "Sleepy Sickness;" but it is quite a different disease to the tropical illness known as " Sleeping Sickness." The popular term is therefore an unfortunate one, and tends to confuse the two diseases. Forty-five cases were notified during the year; but on further investigation six of these were found to have been incorrectly diagnosed. Two recovered cases were discovered which had not been notified. The corrected number of cases was therefore forty-one. Thirteen deaths were registered during the year as being due to this disease. Two of these were of cases notified in 1920, and the patients had been chronic invalids during these four years. Another case had improved for a time, moved to an adjoining Borough and died here. This death, though not registered in St. Pancras, is included for calculating case mortality. One fatal case included in the above had not been notified, but the notification has since been received. Another case notified late in 1924 died early in 1925, this death will not appear in the death returns until next year, but is included for calculating case mortality. Up to the present time, therefore, of the 41 cases which occurred during the year, 13 have proved fatal, which equals a case mortality of 31.7 per cent. This disease is becoming a very serious problem. It is markedly increasing in prevalence, it is accompanied by a high death-rate, and, what is even more serious, many of those who recover, suffer from physical weakness or mental or moral degeneration, and these very distressing after effects may gradually develop long after apparent recovery. Inquiries have recently been made concerning the 29 cases which recovered last year, and their present condition is as follows:12 are quite well, 9 still complain of either headaches, eye trouble, etc., 1 has left the Borough, and 7 are mentally defective. PNEUMONIA. During the year, 293 cases of acute primary pneumonia, and 131 of acute influenzal pneumonia, were notified. Pneumonia, in various forms, is a frequent complication of other diseases; but when occurring in this way is not notifiable. All notified cases are visited, and, if requested by the Medical Attendant, a nurse is supplied to necessitous cases, the cost being defrayed by the Borough Council. During the year, 152 cases were undertaken at the Council's expense, 2358 nursing visits being paid. Of the 293 cases of acute primary pneumonia, 147 were treated in their own homes and 146 in hospitals. Of the hospital cases, 94 were admitted to the St. Pancras Hospital (Poor Law) and 52 to voluntary hospitals. With regard to the 131 cases of acute influenzal pneumonia, 85 were treated at home and 46 were admitted to hospitals. Of the hospital cases, 25 were treated in the St. Pancras Hospital and 21 in voluntary hospitals. With regard to deaths from pneumonia, the following were registered during the year: 112 attributed to broncho-pneumonia, 50 to lobar-pneumonia, and 38 to pneumonia, type not stated. 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 57 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. During recent years measles has tended to be prevalent in alternate years. In 1923, the number of cases was remarkably few; it was therefore anticipated that an epidemic would occur in 1921. The disease is highly infectious, and, when occurring in a house, children unprotected by a previous attack seldom escape. The outbreak was severe in type and was the cause of many deaths in young children, these deaths being chiefly due to its common complications—bronchitis and broncho-pneumonia. The great increase in infant mortality during the past year was chiefly due to this epidemic of measles. During the year, 4,332 cases of measles and 270 of German measles were notified or discovered. This represents an incidence rate of 19*8 per 1,000 of population for measles and 1*2 for German measles. Seventy-four deaths were registered as being due to measles, 69 being of children under five years of age. This equals a death-rate of 0*34 per 1,000 of population, and a case mortality of 1*7 per cent, of cases notified. There were no deaths from German measles. The cases were notified or reported as follows :— , German Measles. , Measles. Notified by medical practitioners .. .. 3307 262 „ parents and guardians .. . . 593 5 Discovered otherwise .. . , . . 432 3 4332 270 Further statistical facts in regard to the disease will be found on pages 32 to 36. All cases where it was considered necessary were attended by a visiting nurse once or twice a day. During the year, 408 cases of measles were nursed, 3,371 nursing visits beiner made. The number of cases notified, the deaths, and the case mortality per cent. for the nine 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 1924 4332 74 1.7 58 OTHER NOTIFIABLE DISEASES. Malaria.—Onecase was notified. The disease had origiually been contracted in Salonika during the War. Arrangements were made for the adequate treatment of the case. Dysentery. —No cases were notified; but information was received concerning a "carrier case" who had been accidentally discovered whilst under treatment for another illness. A bacteriological examination of the feces revealed the presence of the germs which cause this disease (Flexner bacilli). This form of dysentery, common in some parts of the world, was seldom seen in this country before the Great War. Since then cases have occurred, chiefly due to infection carried by persons who have served abroad. The patient in the present instance was a child, and the source of infection could not be discovered. The father had served in the air force, but had not been abroad, neither had another soldier staying in the same house. The patient was referred to hospital for treatment. Four deaths were recorded as being due to Dysentery; but this does not relate to the tropical Forms of Amæebic or Bacillary dysentery, but the more chronic form common in elderly persons. No cases of typhus, cholera, plague, anthrax, glanders, or hydrophobia were notified. WHOOPING COUGH. There were 46 deaths from this disease during the year, and of this number 43 were of children under five years of age. Of the total 46 deaths, 22 were of males and 24 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. The following table gives the number of deaths from Whooping Cough during the past ten years :— Year. Deaths. Year. Deaths. 1915 52 1920 60 1916 39 1921 38 1917 27 1922 29 1918 80 1923 28 1919 7 1924 46 Of the total 406 deaths in the past 10 years, 171 were of males and 235 of females. DIARRHŒA AND ENTERITIS. Sixty-three deaths were recorded during the year from the above causes. Of these 58 were of children under 5 years of age, and of this number 52 were under 1 year. Deaths from these diseases are more numerous in summer and early autumn, especially if the weather is hot and dry, and flies very numerous. Young infants are the principal victims, especially if artificially fed, the infection being due to food contamination by flies. Breast fed babies suffer to a much less extent. 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 10 years; — 59 DiarrhŒa and Enteritis. Deaths from Diarrhæa and Enteritis. Infantile Mortality— from all Causes— per 1000 Births. Year. Births Registered. All Ages. Under 5. Under 1. Deaths under 1 per 1000 Births. 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 1924 4112 63 58 52 13 74 INFLUENZA. Since the serious epidemic of 1918, there have been several small recurrences, but none so extensive in distribution or so severe in character. During the past year one of these small recurrences occurred, and 80 deaths were recorded from this disease—more than three times the number of the preceding year. The following table gives the number of deaths from years:— Influenza during the past seven Year. Deaths. Year. Deaths. 1918 700 1922 142 1919 260 1923 24 1920 46 1924 80 1921 57 SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1924 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—35 85 up. Total Males. 0—1 1 15—25 25-35 35-45 45—55 55—65 65—75 75—85 85 up. Total Females. Total Persons Syphilis 1 1 — — 2 3 2 2 — — _ 11 1 — — — 1 — — — 1 — — 4 15 Locomotor ataxy — _ — — — — 1 1 — — — 2 — — — — —- 1 — — — —- —- 1 3 General paralysis of the insane — — — — — 3 12 5 — _ — 20 — — — — 1 1 — — — — 2 22 Aortic aneurysm — — — — — — 4 1 — — 5 - — — — — 1 — — — — 1 6 60 CANCER. 298 deaths were registered as being due to this cause, as compared with 319 and 302 in the two preceding years. This is equal to a death-rate of l.36 per 1,000 of civil population. The sex distribution of the deaths and death-rates is shown in the following table :— Sex. No. of Deaths. Death-rates per 1,000 males or females living (based on estimated civil population 1924). Males 133 1.29 Females 165 1.43 Both Sexes . 298 1.36 The deaths registered during the following table :— the past ten years as being due to Cancer are set out in Sex. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Average for 10 years. 1924 Males 127 120 125 135 125 114 150 140 157 159 135 133 Females 140 138 142 146 144 131 149 150 145 160 145 165 Both Sexes 267 258 267 281 269 245 299 290 302 319 280 298 A special enquiry was made during 1924 concerning the deaths which had occurred from Cancer of the Breast during the previous year. 39 such cases had been registered. No information could be obtained concerning 8 cases, the relatives having left the Borough. Of the remaining 31 cases, 23 were operated upon, and 8 had no operation. Two of the former died during the operation and are excluded. This gives 21 operation cases for consideration. 12 of these were operated upon within 1 year of the growth being noticed. The average duration of life after operation was 2 years and 10 months. The remaining 9 cases were operated upon more than 1 year after the growth was first noticed; the average duration of life after operation in these cases was 1 year and 5 months. Of the 8 cases not operated upon, one lived 10 years, another 8 years, and another 5 years after the growth was first noticed. These were elderly women, who probably had what is termed Atrophic Scirrhus, a form in which the disease lasts many years without much extension. In the remaining 5 cases not operated upon, the average duration of life after the growth was first noticed was 1 year only. 61 Section IV.—OTHER SERVICES. 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 1 1 4 2 Scarlet Fever 708 701 780 729 Diphtheria 558 542 559 559 Enteric Fever 10 10 10 1 Erysipelas 68 68 68 2 Puerperal Fever 13 18 18 — Encephalitis Lethargica 19 19 21 17 Cerebrospinal Meningitis 3 8 3 8 Poliomyelitis 1 1 1 — Tuberculosis 127 125 132 97 Measles 44 44 47 87 Vermin aud Scabies 47 45 52 88 Other Diseases (not notifiable) 165 165 168 84 Totals 1764 1787 1808 1514 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. 1 Destroyed. Disinfected. Beds, mattresses and paliasses 59 1691 10 28 Bolsters and pillows 16 3477 10 32 Sheets, blankets and counterpanes 11 5170 2 36 Rugs, mats, cushions, carpets, covers and curtains 13 2311 1 5 Wearing apparel 6 748 — 2 Books — 191 — — Sundries 8 370 8 2 Totals 113 13958 26 100 The tables above are exclusive of the disinfection of the clothing of persons attending the cleansing station for vermin or scabies. 62 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 1 — — Scarlet Fever 1 1 . Puerperal Fever — 2 — Cleansing Station. The amount of work done here during the year is indicated in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. Men. Women. Children under 15. Total. St. Pancras Cases Vermin 1088 31 3769 *4888 Scabies 11 7 603 621 Cases from outside St. Pancras Vermin 32 3 739 774 Scabies 2 — 133 135 Vermin 1120 34 4508 5662 Scabies 13 7 736 756 Totals 1133 41 5244 6418 • Includes 568 males and 8 females who had no home address, THE MORTUARY. This is an old building and very inadequate as regards accommodation. The postmortem room is small and its fittings antiquated in type, insanitary and defective. These conditions tend to make the duties which have to be performed there even more difficult and unpleasant. Early in the year a Sub-Committee was appointed to consider the matter, and the following recommendations have been approved:—The present viewing room to be used as a post-mortem room, the floor to be relaid, the walls enamelled, and the lighting and ventilation improved. Two new post-mortem tables of modern type to be provided, together with handbasin, sinks, etc., and a constant supply of hot water from the boiler of the disinfecting station, which is near. The adjoining room to be used as a viewing room and made to communicate with the post-mortem room by means of folding doors; the old post-mortem room to be used as a mortuary for the reception of infectious cases. The work of carrying out the above very necessary improvements is now in progress, and should be completed early in the year. 63 INQUESTS. 260 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. 5—15 years. 15—25 years. 25—65 years. 65 and over. Totals. Natural— Heart Disease 2 1 26 27 56 Pneumonia 8 3 — — 6 2 19 Cerebral Haemorrhage. — — — 1 3 2 6 Tuberculosis — 1 1 — 3 1 6 Cancer — — — — 8 1 4 Diarrhoea and Enteritis — 1 — — - — 1 Other causes 5 — 1 — 12 10 28 Accidents— Street Vehicles — 6 8 3 14 9 38 Burns and Scalds — 5 — 1 2 2 10 Railway — — — 2 10 — 12 Other causes* 6 1 3 5 21 11 46 Suicides† — — — 1 21 5 27 Murder — — — — 1 1 2 Manslaughter — — 1 — — — 1 Open Verdict. 1 — — — 3 — 4 Totals 21 16 14 13 125 71 260 * Includes 2 cases of coal gas poisoning. † ,, 8 cases,, ,, Section V.—SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.—Altogether 68,577 inspections were made in 1924 by the staff of Inspectors and Visitors. These consisted of 35,546 initial inspections and 33,031 re-inspections. Of these inspections, 38,871 were made by the District Sanitary Inspectors, 7,369 by the Sanitary Inspectors of Food and Food places, 3,606 by the Sanitary Inspector of Factories and Workshops, and 18,731 by the Women Sanitary Inspectors and Health Visitors. The inspections made by each individual Inspector and Visitor are shown in Table 10, on page 111. The work of the various classes of Inspectors and Visitors is set out in Tables 7, 8 and 9, on pages 107 to 110. 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 47) ; nor do they include the work of the disinfecting staff (see page 61). 64 Notices served and result of service.—3,587 intimation notices (comprising 8,419 items) were served by the Sanitary Inspectors during 1924. These were made up as follows:— District Inspectors. Factory and Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 5631 — 1 — 5632 In respect of the Tenement House By-laws 639 — — — 639 In respect of Breaches of Statutes in Factories, Workshops and Workplaces — 471 — — 471 In respect of other Breaches of Statutes and By-laws 1671 — 6 — 1677 Totals 7941 471 7 — 8419 These intimations are classified in Tables 11, 12, 13 and 14, on pages 112 and 113. 1,646 Statutory notices (comprising 2,621 items) were served during 1924 and the early part of 1925, following non-compliance with these intimation notices. These are also classified in Tables 11, 12, 13 and 14, on pages 112 and 113. The following prosecutions were undertaken during the year in respect of general sanitary work :— Summonses. Under the Public Health (London) Act, 1891 {except in respect of Food). Situation of Property. Offence. Date of Hearing of Summons. Result of  Proceedings. 117, Stanhope Street Walls and ceilings of ground floor front room, staircase, passage, walls of washhouse, yard, area, top front and back rooms, dirty; roofs and washhouse paving defective; inlet of drain improperly trapped; w.c. improperly constructed; absence of a proper receptacle for house refuse Jan. 11th Fined £l, costs £2. 81, Chalton Street Roofs and guttering defective ,, 29th Withdrawn—work being carried out. 152, Seymour Street Walls and ceilings dirty; basement front and ground floor front and back rooms Feb. 12th Costs £1 3s.—Order to abate nuisance within 28 days. 154, Roof, guttering and rainwater pipe defective 12th Do. 154, Absence of proper portable metal dust bin ,, 12th. Fined 10s. 156, Walls and ceilings dirty ; roof defective „ 12th Costs £1 3s.—Order to abate nuisance within 28 days. 160, Absence of proper portable metal dust bin „ 12th Fined 10s. 160, Water fittings in water-closet defective „ 12th Costs £1 3s.—Order to abate nuisance within 14 days. 11, Sidmouth Street Drain defective and rainwater pipe in direct communication with drain „ 12th. Costs £1 3s.—Order to abate nuisance within 28 days. 24, Barclay Street Walls and ceilings dirty, and roof defective „ 12th Costs £1 3s.—Order to abate nuisance within 21 days. 10b, Gospel Oak Grove Roof and rainwater pipe defective „ 22nd. Costs £2 2s.—Order to abate nuisance within 14 days. 65  Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 160, Seymour Street Water-closet without proper door and fastenings Feb. 12th Fined 10s. 10b, Gospel Oak Grove Failing to comply with nuisance order April 4th Fined .£8, costs £2. In default, 51 days' imprisonment. 239, Gray's Inn Road Absence of proper and sufficient supply of water „ 16th. Fined Is., costs £2 2s. 152, Seymour Street Failing to comply with nuisance order „ 22nd Do. 24, Werrington Street " Failing to provide and maintain sufficient water-closet accommodation ,, 8th Fined £2, costs £3 3s. 34, Regent's Park Road Walls of kitchen and bathroom damp May 14th Costs £1 3s.—Order to abate nuisance within 28 days. 22, Barclay Street Walls and ceilings dirty „ 13th Fined 10s., costs .£1 5s.—Order to abate nuisance within 28 days 19, Carlton Road Walls of basement room damp Sept. 26th Costs £2 2s.—Order to abate nuisance within 14 days. 55, Fitzroy Road Soil pipe and drain defective Oct. 9th Costs £1 3s.—Order to abate nuisance within 28 days. 53, Leighton Road Insufficient supply of water Sept. 26th Costs £2 2s.—Withdrawn, notice complied with. 114, Seymour Street Absence of proper and sufficient supply of water Oct. 13th Costs £1 Is.—Order to abate nuisance within 14 days. 110, „ Roof defective and walls damp „ 13th. Do. 182, „ Absence of proper and sufficient supply of Nov. 13th Fined £1, coses £2 2s. 30, Sidney Street water Insufficient water-closet accommodation „ 13th. Fined £3 3s , costs £2 2s. 23, Barclay Street Absence of proper and sufficient supply of water; walls and ceiling dirty; roof defective Dec. 10th Costs 10s.—Order to abate nuisance within 28 days. 46, „ Absence of proper and sufficient supply of water; walls and ceiling dirty; rooms damp; roof and stove defective; space below ground floor insufficiently ventilated ,, 10th Costs 10s.— do. 47, Absence of proper and sufficient supply of water; roof and dust bin defective, and sink waste untrapped „ 10th Costs 10s.— do. 48, Absence of proper and sufficient supply of water ; rooms damp ; roof defective; space below ground floor insufficiently ventilated „ 10th Costs 10s, — do. 24. Absence of proper and sufficient supply of water ; walls and ceilings dirty „ 10th Costs 10s.— do. 97, Aldenham Street Absence of proper and sufficient supply of water; area paving defective „ 30th Costs 4s.— do. 99, „ Rooms damp; vent pipe and fresh air inlet defective; space below basement unventilated „ 30th Costs 4s.— do. 99, „ Yard improperly paved „ 30th Costs 10s.— 99, „ Insufficient water-closet accommodation „ 30th Costs 10s.— 97, „ Do. „ 30th Costs 10s.— Under the London County Council (General Powers) Act, 1922. Situation of Property. Offence, Date of Hearing of Summons. Result of Proceedings. 156, Seymour Street Rooms verminous Feb. 32th Fined 10s. 152, ., „ ., 12th Do. 46, Barclay Street ,, Dce. 10th Do. 47, „ „ „ 10th Do. 66 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. Eightyseven visits were made to these premises in 1924. Registered Tenement Houses. At the end of 1924 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 107 and 112. 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 719 observations of smoke shafts were made. There were no prosecutions. Constructional Drain Work. The sanitary inspectors have the duty of supervising all work upon drains, including construction, reconstruction and repairs. During the year the following work has been done under this heading :— First Consequent inspections. re-inspections. Drainage work done under notice 348 3884 Voluntary drainage work 881 3298 Drains of new buildings 171 2364 1400 9546 Drainage Register.—The following is an analysis of the Drainage Register during 1924:— Plans deposited—Old Buildings under Notice 106 „ „ Old Buildings, Voluntary 181 „ „ New Buildings and Additions 57 344 Applications without Plans 177 Total number of Applications and Plans 521 67 Water Service. The following notices have been received during the year from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Empty 1 2.—Non-payment of Rates 4 Canal Boats Acts. During the year Inspector Auger examined 10 canal boats, which were registered for the occupation of 24 adults and 9 children, and were occupied by 19 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. The Rag Flock Act, 1911. No samples of rag flock were taken during 1924. Rag and Bonk Dealers. New by-laws made by the London County Council for regulating the business of the above were sanctioned by the Ministry of Health in September, 1923. Some portions were not to take effect until the expiration of a period of 12 months from the above date, and therefore came into force during the past year. Special visits were made to all persons engaged in this business, and their attention was drawn to the new regulations. The following table gives the names and addresses of all rag and bone dealers at present trading in the Borough : — Name. Address. Mr. Andrews 17, Drummond Street, n.w. 1. Mr. John T. Bowling 116, Whitfield Street, w. 1. Mr. W. Budd 41, Little Albany Street, n.w. 1. Mr. A. Churley 2, Little Randolph Street, n.w. 1. Mr. O. R. Churly 74, Weedington Road, n.w. 5. Mr. Cotier 8, Murray Street, n.w. 1. Mr. H. Cox 19, Warren Street, w. 1. Mrs. Davis 31, Ferdinand Street, N.w. 1. Mr. Disley 107, Drummond Street, n.w. 1. Mr. J. A. Duker 31, Stibbington Street, n.w. 1. Mr. A. J. Gregory 81, Peckwater Street, N.w. 5. Mr. B. W. Harris 11, Stanhope Street, n.w. 1. Do. 103, Stanhope Street, n.w. 1. Mr. Hillier 2, James Street, n.w. 1. Mrs. Hobbs 3, Buck Street, n.w. 1. Mr. A. Hyam 92, Cleveland Street, w. 1. Mr. Hyams 25, King Street, n.w. 1. Mr. James Jones 153, Whitfield Street, w. 1. Mr. T. Kidd 88, Osnaburgh Street, n.w. Mr. Charles Marshall 56, Litcham Street, n.w. 5. 68 Mr. Messenger 1, Kingstown Street, n.w. 1. Mr. Phillips 109, Dartmouth Park Hill, n. 19. Miss Ralph 98, Euston Street, n.w. 1. Mr. T. Scagell 72, William Street, n.w. 1. Messrs. Sear & Court 9, Fitzroy Mews, w. 1. Mrs. E. Shell 91, Ossulston Street, n.w. 1. Mr. Smith 62, Hawley Road, n.w. 5. Mr. A. Sprules 25, Brecknock Road, n. 19. Mr. Marcel Walter 35, Tottenham Street, w. 1. Mrs. M. Whitmarsh 1, Dalby Street, n.w. 5. RENT AND MORTGAGE INTEREST RESTRICTIONS ACT, 1923. During the year 122 applications were received from tenants for certificates under this Act, and in 121 cases certificates were granted specifying the works required to be executed to put the dwelling houses into a reasonable state of repair. In accordance with Section 5 of the Act, 22 applications were made by landlords for the "release" of certificates previously granted to their tenants, the necessary work to the premises having been carried out. The nature of the work specified on the certificates embraced such items as repairing, cleansing, and decorating the walls and ceilings, and, in addition, many items not ordinarily dealt with by the sanitary inspectors, c.g., repair of chimney flues, stoves, mantel boards, staircase rails and balusters, door furniture, window fasteners, floor boards, cupboard doors, etc. In the majority of cases where an examination of premises by an inspector for the purpose of issuing a certificate under the Act was made, opportunity was also taken of serving, where applicable, Intimation Notices on the owners for the abatement of nuisances or for remedying breaches under the Public Health (London) Act, the London County Council (General Powers) Acts, By-laws, etc. FACTORY AND WORKSHOP ACTS. The following five tables are those asked for by the Home Secretary :— 1. —Inspections made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including factory laundries and bakehouses) 822 184 — Workshops (including workshop laundries and bakehouses) 1422 237 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 359 50 — Total 3603 471 — 69 2.—Defects Found. Particulars. Number of Defects Number of rosecutions. Found. Remedied. Referred to h.m, Inspectors. (1) (2) (3) (1) (5) Nuisances under the Public Health Acts*: — Want of cleanliness 131 131 Want of ventilation 5 5 Overcrowding 3 3 Want of drainage of floors 1 1 Other nuisances 82 82 Sanitary accommodation— Insufficient. . 16 16 Unsuitable or defective 35 35 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) Other offences (excluding offences relating to outwork, which are 104 104 included in Part 3 of this Report) 81 81 Total 471 471 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Home Work. The only matter to report under this heading is the receipt of the following lists of outworkers for employers sending twice in the year:—18 in respect, of the making, etc., of wearing apparel, comprising the names of 53 outworkers (contractors) and 82 outworkers (workmen). 4.—Registered Workshops. Workshops on the Register (See. 131) at the end of the year. Number. (1) (2) Bakehouses 114 Restaurant kitchens 392 Laundries 29 Domestic workshops — Other workshops where women are employed 453 Other workshops 816 Total number of workshops on Register 1804 70 5.—Othkk 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 56 Reports (of action taken) sent to H.M. Inspector 56 In regard to workshops where protected persons have been found to be employed (Public Flealth (London) Act, 1891, section 27) 19 Underground bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 87 The number of factories, workshops and workplaces added to and removed from the register during 1924 was as follows : — Added to Register. Removed from Register. On Register at end of 1924. Bakehouses— Workshop — 6 114 Factory Laundries— 4 — 46 Workshop — 1 29 Factory — — 12 Restaurant kitchens 6 17 392 Other workshops where women are employed 47 33 453 Other workshops 34 33 816 Other factories 30 17 737 71 The number of inspections that were made during 1924 were as follows: — Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 325 225 - - 325 225 Restaurant kitchens 59 233 - - 59 233 Laundries 8 6 - - 8 6 Domestic workshops - - - - - - Other workshops 390 1737 l - 391 1737 Other workplaces 25 42 l - 26 42 Other factories 134 417 - - 134 417 Total 941 2660 2 - 943 2660 Bakehouses and restaurant kitchens are also referred to in Section VI. (page 80). 72 SCHOOLS. The medical inspection and treatment of children in Elementary Schools in St. Pancras is carried out by the London County Council independently of the Borough Council. The County Medical Officer has kindly furnished me with particulars of medical inspections of school children in St. Pancras during 1924. They are classified in the following Tables : — Medical Examination ok Elementary School Children in St. Pancras, 1924. Complaint. Boys. Girls. Entrants. Age 8. Age 12. Entrants. Age 8. Age 12. Number examined 1759 1315 1648 1594 1350 1623 Malnutrition Cases 9 * 9 Cases 9 * 8 Cases 9 * 8 Cases 14 * 9 Cases. 12 * 11 Cases 4 * 4 Skin disease 28 23 13 10 18 13 12 7 11 8 19 12 Defective teeth - 376 — 262 — 225 — 382 274 — 222 Enlarged tonsils (only) 109 30 78 16 72 19 121 48 131 39 87 22 Adenoids (only) 105 55 35 20 20 9 70 29 32 13 8 4 Tonsils and adenoids (together) 143 69 41 24 18 9 117 48 52 27 14 11 Other nose and throat defects 19 9 12 10 8 8 16 10 16 12 9 6 Enlarged glands 180 3 85 3 98 3 151 1 101 - 88 4 Eye disease 51 44 23 16 21 13 34 25 33 24 11 8 Defective vision Not tested — 147 — 207 Not tested 168 — 224 Otorrhoea 41 31 15 11 18 16 33 23 17 14 19 15 Other ear disease 4 3 4 1 6 4 5 - 5 4 7 5 Defective hearing 8 3 10 5 13 8 2 1 12 2 9 5 Speech defects 5 1 5 2 6 3 2 — 1 — — — Heart defects 23 5 15 3 30 10 24 2 26 5 41 17 Anaemia 44 29 28 22 47 30 30 21 32 25 29 21 Lung defects (non.tuberculous) 67 34 32 15 14 4 68 35 28 12 8 1 Defects of nervous system 5 — 11 4 3 1 4 1 9 3 4 — Phthisis 2 1 9 2 4 2 10 6 2 — 6 2 Other tubercular disease — — 1 1 4 2 2 2 1 1 3 2 Rickets 18 14 4 1 4 1 9 7 4 1 2 1 Spinal deformities — — 6 4 6 3 — — 11 5 21 16 Other deformities 7 3 3 1 22 2 2 — 6 1 10 — Other defects 44 28 24 12 21 13 57 35 36 22 46 27 Number of children noted for treatment 631 496 524 588 541 541 Note:—Defects, however slight, are included under "Cases." Those severe enough to require treatment are shown under *. Borough of St. Pancras, 1924. 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. Niits 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 1759 1193 564 2 309 1427 22 1 1699 56 4 1712 43 4 874 656 229 Not test ed Girls 1591 1089 504 1 321 1247 26 - 1455 122 17 1566 27 1 779 599 216 „ „ - Age 8 Boys 1315 775 533 7 170 1116 28 1 1278 36 1 1298 13 4 684 495 136 628 405 255 Girls 1350 860 486 4 200 1120 30 - 1180 156 14 1328 22 — 731 485 134 688 377 261 Age 12 Boys 1648 1043 596 9 208 1403 37 1606 41 1 1608 40 1043 537 68 1035 307 304 Girls 1623 1131 487 5 317 1270 36 — 1422 187 14 1604 17 2 1070 511 42 914 325 366 Total 9289 6091 3170 28 1525 7583 179 2 8640 598 51 9116 162 11 5181 3283 825 3265 1414 1186 % St. Pancras 65.6 34.1 0.3 16.4 81.7 1.9 93.0 6.4 0.6 98.2 1.7 0.1 55.8 35.3 8.9 55.7 24.1 20.2 % London 58.6 40.0 1.4 19. 7 74.1 6.2 89.7 9.6 0.7 95.2 4.6 0.2 62.1 29. 4 8.5 50.9 29.4 19.7 73 74 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, 1925:— - Weekly average Number of children fed. Number of meals provided. Cod Liver Oil and Malt. Dinners. Breakfasts. Milk. Ordinary Schools. (a) Necessitous 213 13120 27376 960 (b) Non-necessitous 464 7924 — 76375 2888 Special Schools, (a) Necessitous 75 12539 - 2605 199 (6) Non-necessitous 313 53767 — 14482 — Totals 1065 87350 - 120838 3947 The schools were closed for normal holidays during the following periods:— Easter—17th to 28thApril, 1924. Whitsuntide—9th and 10th June, 1924. Summer—24th July to 25th August, 1924, inclusive. Autumn—27th and 28th October, 1924. Christmas—19th December, 1924, to 5th January, 1925, inclusive. St. Pancras School Clinics. The following interesting account of the valuable work carried out on behalf of school children at the three Treatment Centres in St. Pancras has been supplied by Dr. A. R. Roche, the Secretary-Superintendent. This work is not only curative, but, as will be seen from the report, is also preventive. The benefit to the general health and physical well-being as a result of the attention given to dental defects, ear, eye, nose and throat, etc., troubles is enormous, and, as Dr. Roche observes, " as regards the volume of work done, the numbers speak for themselves." School Treatment Centres. It gives me great pleasure to accede to the request of the Medical Officer of Health for a brief account of the activities of the School Treatment Centres in the Borough. As is probably well known, this work is done by voluntary agencies under agreement with the London County Council. The school doctors, appointed by the Council, periodically inspect the children in the schools, and those needing treatment are either referred, at the option of the parents, to their own doctors, or to the School Treatment Centres. In this Borough there are three Centers the Highgate New Town Clinic, Chester Road, the St. Pancras Centre in Prince of Wales Road, and the Lancing Street Centre in Churchway, Euston Road. The Highgate New Town Clinic has its own Committee, and the two other Centres are managed by the St. Pancras Medical Service. The writer of this short statement acts as Secretary and Superintendent to both bodies. 75 To tabulate the number of cases dealt with during the school year, April 1st, 1924, to March 31st, 1925:— Dental Cases. Aural Cases. Ophthalmic Cases. Minor Ailment Cases. Operations. Highgate New Town Clinic 1153 517 418 968 1691 15210 attendances St. Pancras Centre 1919 589 964 1245 Operated on at Highgate 25819 attendances Lancing Street Centre 1274 339 Nil 1040 Operated on at Highgate 25136 attendances In addition to these numbers, 3,749 cases of verminous heads were dealt with at the St. Pancras Centre, 700 home visits were paid in connection with the St. Pancras Centre, and 759 in connection with Lancing Street. To deal a little more in detail with the features of the work and how it is done. Each of these Centres is stuffed by doctors and dentists appointed by their respective Committees, and approved by the Council as specially qualified for the work they undertake. The nursing is done by County Council Nurses, or by the Nurses of the Camden Town District Nursing Association, who, under an agreement, do the necessary nursing connected with the minor ailment departments at the St. Pancras and Lancing Street Centres, The management of the Centres is vested in the Committees acting through their Secretary, subject to the approval of the Council, who, under the agreements, provide the necessary funds. To the uninitiated, the whole scheme may seem somewhat cumbersome; but years of experience have proved that in practice it works smoothly, efficiently and economically. As regards the volume of work done the numbers speak for themselves. The need and nature of the dental and ophthalmic work is obvious. In the minor ailment departments many skin complaints, minor injuries, and such like every-day troubles, are seen by the doctors and attended to by the nurses until cured. As an off-shoot of this work, at St. Pancras Centre we have two women specially trained for the work under the supervision of a nurse, devoting their whole time to cleansing and treating the heads of children infected with vermin. Any one who knows how prevalent this trouble is in the schools, and how much unpleasantness and ill-health is caused by it, will appreciate how valuable this work is. I should like specially to refer to the Aural work. Children with affections of the ear, throat and nose are seen at all three Centres, and those cases requiring operations are dealt with by the surgeons who are treating them at Highgate New Town Clinic. I have alluded before to this Clinic, and I should like once more to say how fortunate the Borough is in having such an institution within its boundaries. It is not only a model of what a school treatment centre should be; but it is the prototype of an operating centre in connection with this work. It is visited by medical officers of health and others interested in such work from all parts of the world, In fact, its popularity and renown have become almost an embarrassment to its management. It was built by Mr. and Mrs. Kolmstamm as a war memorial to their two sons, and Mr. Kolmstamm most generously defrays the financial deficit on the annnal working. But it is only fair to say that he feels amply compensated by the pleasure and happiness he derives from the success that has attended his gift. As an operating centre, at the present time it serves St. Pancras, Islington, Hampstead and Holboru; but it has become so popular with parents and Care Committees, that every contributory centre has long lists of cases awaiting admission, and it is clear that its watershed area will have to be reduced. 76 The children come between 9 and 10 in the morning, are bathed and prepared for operation, and are admitted to the wards. They are operated on early in the afternoon, and remain in the wards two nights. In the event of any untoward symptoms arising they are kept in longer. During the past year nearly 1,700 cases have been operated on, and, although some have caused anxiety, we have had no fatalities. In conclusion, I should like to thank the County Council and their officials for their reasonable and harmonious co-operation, the school teachers for their helpful appreciation, the doctors and dentists for their skilful work, and the nurses for their sympathetic and devoted attention to the children— including in this category the work of the St. Pancras District N urses. June, 1925. A. R. Roche, Secretary to the St. Pancras Public Medical Service and the Highgate New Town Clinic. Section VI.—FOOD. (a) MILK SUPPLY. Almost the whole of the milk supply of the Borough is derived from farms in the Provinces and is brought into London by train. During the year some samples were taken early in the morning at railway stations, from various churns, immediately on arrival. These were examined for obvious (macroscopic) dirt, in order to ascertain if the general conditions at the farms of origin could be assumed to be fairly satisfactory. The report of the bacteriologist stated that as regards visible "dirt" the samples "appeared to be very clean." The quantity of dirt in the different samples being from 1½ to 6½ parts only in 100,000 of milk. The " dirt" examined microscopically was found to consist chiefly of soil, foecal material, hairs, etc. In November, a customer noticing a deposit in a bottle of milk delivered at his house reported the matter. A sample was taken which,on analysis, was found to contain "some pus, blood, and many bacteria, probably indicating an abscess in the udder of at least one cow." It was then ascertained that the milk was a " mixed milk " obtained from eight different sources in the counties of Cheshire, Derby and Leicester. Samples from each source were therefore taken at the station before being mixed, in order to trace the source of contamination. This was discovered, the supply of milk stopped, and the local authority informed. An examination of the herd was made by a veterinary surgeon, and a cow with a diseased udder was discovered. During the year, samples of " Certified Milk " were regularly submitted to bacteriological examination. " Certified Milk " is milk produced under conditions licensed by the Ministry of Health, and should attain the highest standard of purity. On one occasion, a sample was found to contain organisms of intestinal origin (Bacillus Coli) above the permissible limit, and the case was reported to the Ministry of Health. Dairies, Cowsheds, and Milkshops. Cousheds.—At the end of 1924 there were two licensed cowsheds in the Borough. They are registered for 43 cows, but were occupied by 7. Milkshops and Dairies.—37 applications for registration under the Dairies, Cowsheds, and Milkshops Orders, in respect of milkshops, were considered during 1924, of which 18 were acceded to and 19 refused. Ten applications in respect of itinerant vendors were also considered, of which 7 were acceded to and 3 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 1923 213 Deduct number of purveyors removed from register during 1924 20 Add number of purveyors added to register by resolution of Council during 1924 18 Number of purveyors of milk at retail milkshops on register at end of 1924 211 77 At the end of 1924, there were on the register, in addition to these 211 retail milkshops and 2 cowsheds (which are attached to retail milkshops included in the 211), one person in respect of premises where only a wholesale milk trade is done, and 12 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. South Grove Carrying on trade or business of a purveyor of milk without being registered Feb 12th 1 0 0 - - - 130, Seymour Street Do. do. Mar. 18th 0 10 0 - - - 57A, Charrington Street Do. do. Mar. 20th 0 2 0 - - - 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 1924, 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.P 5th February Manor Farm Dairy Co., Ltd., 39, High Road, N. 2 " Pasteurised " Supplementary licence to sell in St. Pancras. Do. Lord Rayleigh's Dairies, Ltd., 12, Gt. Russell Street, W.C. 1 "Certified " Do. Do. Do. Grade A Tuberculin tested " Do. Do. Welfords & Premier Dairies, Ltd., 233, Seven Sisters Road, N. 4 " Certified " Do. Do. Welford & Sons, Ltd., Elgin Avenue, W.9 Do. 63, Park Street. Do. Do. Do. 69, Albany Street. Do. Manor Farm Dairy Co., Ltd., 39, High Road, N. 2 " Grade A " 26, High Street, Highgate. Do. Belgravia Dairy Co., Ltd., 4-6, Exhibition Road, S.W. 7 " Certified " 177, Albany Street. Do. Vicarage Farm Dairy Co., Ltd., 277 & 279, Kentish Town Road, N.W. 5 " Grade A " 277 & 279, Kentish Town Road. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. Do. Marshall's Dairies, Ltd., 19, Tudor Place, W.C. 1 "Grade A Tuberculin tested " 19, Tudor Place. Do. J. R. Mills & Sons, 23, Francis Street, W.C. 1 " Grade A " 23, Francis Street. Do. Express Dairy Co., Ltd., 26-30, Tavistock Place, W.C. 1 " Certified " 12, South Grove. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. " Certified " 26, Tavistock Place. Do. Do. " Grade A Tuberculin tested '' Do. Do. E. Jones, 137, King's Cross Road, W.C. 1 " Certified " 137, King's Cross Road. Do. J. Evans, 35, Southampton Street, W. 1 " Grade A " 35, Southampton Street. 78 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, 1924. 1. Milk, and Cream not sold as Preserved Cream. - (a) Number of samples examined for the presence of a preservative. (&) Number in which a preservative was reported to be present. Milk 348 — Cream 9 2 Nature of preservative in each case in column (b), and action taken under Regulations in regard to it:- A. 206. Cream. 0.119 per cent, of boron trioxide, equal to 0 .211 per cent, of boric acid. C. 221. Cream. 0.094 per cent, of boron trioxide, equal to 0166 per cent, of boric acid. In the above cases an explanation was asked of and furnished (by letter) by the vendors, and a warning letter addressed to the vendors by order of the Public Health Committee. No legal proceedings were instituted. 2. Cream sold as Preserved Cream. (а) Instances in which samples have been submitted for analysis to ascertain if the statements on the labels as to Preservatives were correct: - (i) Correct statements made 11 (ii) Statements incorrect — Total 11 (iii) Percentage of preservative found in Percentage stated on statutory each sample: Boric acid, 0.198, label: 0.4. 0.236, 0.236, 0.211, 0.298, 0.335, 0.273, 0.285, 0.211, 0.285, 0.260. (б) Determinations made of milk fat in cream sold as preserved cream;— (i) Above 35 per cent 11 (ii) Below 35 per cent — Total 11 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed: None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken : None. 3. Thickening Substances.—Any evidence of their addition to cream or to preserved cream. Action taken where found: None. The Public Health (Condensed Milk) Regulations, 1923. Under these regulations, which came into force on November 1st, 1923, every tin of condensed milk must comply with certain rules as to labelling. Standards of composition are also laid down, both as regards fat and total milk solids. The equivalent quantity of milk or skimmed milk contained in the tin must also be stated. 79 The Public Health (Dried Milk) Regulations, 1923. These came into force on May 1st, 1921. All packages must be labelled in a prescribed manner; certain percentages of milk fat are specified, as in the following table:— Description. Percentage of Milk Fat. Dried Full-Cream Milk 26 Dried ¾-Cream Milk 20 Dried ½-Cream Milk 14 Dried ¼-Cream Milk 8 Dried Skimmed Milk must be marked " unfit for babies," and the partly-skimmed varieties must be marked " should not be used for babies except under medical advice." The above regulations are to be enforced by the Borough Council. (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. During the year the unsound food, set out below, was voluntarily surrendered by the owners to the Food Inspectors, and destroyed as trade refuse. On one occasion a seizure of unsound food was made. Unsound Food Condemned and Destroyed. Apples, 1 bushel Liver (Pig's), 1 Bananas, 1 truck Milk, 5 tins Beef, 10 lbs. Mussels, 1 bag „ (corned), 7 lbs. Onions, 10 cases and 20 bags Bacon, 176 lbs. Oranges, 20 boxes Cheeses, 1200 Peas, 95 bags Cherries, 23 bushels Pears, 58 baskets and 3 barrels Cucumbers (pickled), 1/3rd cask „ 3 tins Dabs, 4 cases and 4 stone Peaches, 2 tins Dates, 1 parcel of boxes Pigs' Carcases, etc., 9 cwt., 1 qr., 7 lbs. Ducks, 10 Potatoes, 38 bags Greens, 11 trucks and 56 bags Salmon, 2 tins Grapes, 85 boxes Skate, 2 boxes and 3 cwt., 3 qrs., 7 lbs. Haddocks, 4 cases Strawberries, 9 tubs Herrings, 1 case Tomatoes, 10 boxes Kidneys, 1 cwt., 2 qrs., 21 lbs. Whelks, 1 bag Kippers, 25 boxes Whiting, 1 box Liver (Bullock's), 1 Seized. Beef, 4½ lbs. Steak, 3 ozs. Mutton, 3 lbs. Veal, 2¾ lbs. Details in regard to the work of the Food Inspectors are shown in Table No. 8, on pages 8 and 9. Slaughter-houses. At the end of 1924 there were 6 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 tbe Food Inspectors, who made 140 inspections in this connection in 1924. Fried Fish and Fish Curing Premises. In 1924 there were 83 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 18 fish curers' premises, including these 4. 390 visits were made by the Food Inspectors to the premises during the year. 80 Ice-Cream Premises. In 1924, 324 ice-cream premises were known to the department; 402 visits were paid to them by the Food Inspectors during the year. Bakehouses and Restaurant Kitchens. At the end of 1924 there were 160 bakehouses on the register, including 46 factory bakehouses. Forty of these bakehouses were not in use. 118 of the 160 were underground bakehouses, of which 41 were factory bakehouses, and 32 not in use. At the end of the year 392 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 oa pages 68 to 71. (c)—SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 704 of these proved to be genuine and 46, or 6.1 per cent., adulterated. The details are given in the following table: — Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Arrowroot l l - Bacon 7 4 3 Brawn 2 2 - Butter 156 156 - Cocoa 28 28 — Coffee 28 28 - Cream 9 7 2 Do. (Preserved) 11 11 — Custard Powder 5 5 — Dripping 11 11 — Fish Paste 2 — 2 Flour (Self-Raising) 15 15 — Jelly Crystals 1 1 — Lard 14 14 — Margarine 10 10 — Milk 348 317 31 Milk, Dried 5 5 — Mustard 21 20 1 Oatmeal I 1 — Pepper 21 21 — Prescriptions (L.I.P.) 6 6 — Rice 8 8 — Salad Oil 1 1 -- Sausages 7 5 2 Suet 1 1 — Sugar 1 1 — Vinegar 20 18 2 Vinegar (Malt) 10 7 3 Total . . 750 704 46 Note.—The 750 include two informal samples of milk. 81 Prosecutions were undertaken in respect of 32 of the 46 samples which were reported as being adulterated. These are set out in the following table:— Summonses. Under the Sale of Food and Drugs Acts. No. of Sample. Article. Result of Analysis Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. £ s. d. <£ s. a. C. 8 Milk Deficient in milk fat, 8'3 per cent. .. • • Mar. 7th 1 0 0 1 1 0 C. 7 „ „ 8.6 „ 1 0 0 1 1 0 A. 23 „ Added water, 11.3 per cent Mar. 18th Dismissed. Warranty proved. c. 19 „ „ 3.5 „ „ 3 0 0 1 1 0 c. 18 „ „ 9.6 „ „ 3 0 0 1 1 0 C. 20 „ „ 10.8 „ „ 3 0 0 1 1 0 C. 88 „ Deficient in milk fat, 9.0 per cent. May 16th 2 0 0 -— A. 84 „ Added water, 5.5 per cent. ,, 22nd 2 0 0 1 11 6 A. 85 „ „ 12.7 ,, „ 2 0 0 1 11 6 A. 151 „ „ 4.7 „ July 10th -— 1 1 0 A. 148 „ ,, 5.0 ,, „ - 2 2 0 A. 145 „ Deficient in milk fat, 15.0 per cent. „ — 3 3 0 A. 161 „ ,, 26.6 „ July 8th 2 0 0 0 10 6 c. 161 „ „ 13.0 „ „ 11th Dismissed. Warranty proved. c. 159 ,, „ 8.6 „ „ ,, ,, C. 160 „ „ 3.3 ,, „ „ ,, C. 172 Malt vinegar Vinegar other than malt vinegar, 100 per cent. July 18th 2 0 0 0 10 6 C. 174 Vinegar Deficient in acetic acid, 25 per cent „ 1 0 0 0 10 6 C. 179 Milk Deficient in milk fat, 5 per cent. July 22nd Dismissed. Warranty proved. A. 177 Malt vinegar Deficient in acetic acid, 8.5 per cent. July 29th 3 0 0 — A. 180 Vinegar „ 7.0 „ „ 2 0 0 — C. 188 Milk Deficient in milk fat, 13.0 per cent. Aug. 20th 1 0 0 1 10 6 C. 190 „ „ 7.0 „ „ 1 0 0 —- C. 198 „ „ 20.0 „ „ 5 0 0 — C. 192 Malt vinegar Deficient in acetic acid, 14.5 per cent. „ 2 0 0 — c. 333' Milk Added water, 4.7 per cent. Dec. 23rd Two months' hard labour, without opti on of fine. C. 183 „ Deficient in milk fat, 23.6 per cent. Jan. 6th Dismissed, Warranty proved. C. 178 „ „ 5.0 „ „ ,, „ C.176 „ „ 19.0 „ „ ,, „ C. 343 „ ,, 9.3 „ Jan. 8th „ „ A. 331 Bacon Admixture of boric acid, 15. 61 grains per lb. „ 6th Adjourned sine die. A. 330 „ „19.95 „ „ „ „" „" * Summons also taken for wilfully obstructing an Inspector in the course of his duties—withdrawn. Wholesale Dealers in Margarine.—No certificates of registration under the provisions of the Sale of Food and Drugs Acts were issued during the year. Section VII.—SANITARY ADMINISTRATION. In consequence of a special report submitted to the Council, some reorganisation of the work of the department has been made during the year. The areas and duties of the Inspectors were somewhat modified; a concentration of the work of the Tuberculosis Dispensaries was agreed to be adopted. The Berkeley Road Welfare Centre was closed, and some rearrangement made in certain consultations at other centres. The conditions governing the Council's contributions to institutions undertaking midwifery attendance for necessitous cases were more clearly defined. A summary of these and other matters dealt with will be found in the following report:— 82 Summary of Report on the Reorganisation of the Public Health Department, etc., too ether with the Recommendations of the Council. General. 1.—We have considered the proposals of the Medical Officer of Health as to economies that can be effected in the administration of the work of the Public Health Department. It is important to note that we " do not suggest that any part of the work at present done in the Department should be discontinued, the suggestions made tending to economy being obtained as a result of reorganisation only, and not by the omission of any useful work." Male Sanitary Inspectors. 2.—The Medical Officer of Health has suggested that inquiries into infectious diseases should be carried out by the male sanitary staff, as was the practice prior to the war. Dr. Sowden, in support of his suggestion, reports as follows: — "At present certain of the women inspectors inquire into the illness, and the male inspectors investigate the drains and sanitary condition of the house concerned. This dual visiting is unnecessary, and not desirable from the householder's point of view. This proposal, whilst not appreciably increasing the work of the male inspectors, will result in a further advantage in epidemic times; during these periods three or four women inspectors are overwhelmed by the large number of cases, but when these are divided amongst the twelve male inspectors the situation is far more manageable." With regard to the districts of the male inspectors, the Medical Officer of Health points out that the building of property in the Highgate district has increased during recent years, and building is now taking place upon the Holly Lodge Estate, Highgate. Dr. Sowden suggests that, the boundaries of the inspectors' districts should be revised, chiefly with a view to the lessening in size of the Highgate district, which is at present too large in comparison with the other districts. We recommend— (a) That in future the male sanitary inspectors inquire into cases of infectious diseases, with the exception of tuberculosis, puerperal fever, and ophthalmia in babies — the latter cases to be inquired into, as at present, by the women staff. (b) That the Medical Officer of Health be authorised to revise the boundaries of the districts of the male sanitary inspectors. Women Sanitary Inspectors and Health Visitors. 3.—With reference to the work done by the women staff, the Medical Officer of Health advise3 that Miss Bibby is fully occupied and should continue her present duties, as he finds her services of the utmost value. As regards the work which should be done by the rest of the women inspectors, Dr. Sowden considers that it should comprise the following:—Visiting cases of tuberculosis, puerperal fever and ophthalmia in babies. 1 he inspection of outworkers and home work where women are employed has not been carried out of late years, and Dr. Sowden considers such inspections important and advises that they should be resumed. Dr. Sowden states that the foregoing duties are essentially suitable for women visitors, and suggests that the present practice of their each carrying out visits all over the Borough in respect of one type of health work, which involves overlapping, should be discontinued, and all visiting duties in Wards 1 to 4 should be carried out by one section of the women staff, and similar duties in Wards 5 to 8 by another section. 83 We have discussed this matter very fully with the Medical Officer of Health, who, in the first instance, suggested that two women for each half of the Borough would be sufficient for the duties referred to. Upon reconsideration, and in view of the fact that the women inspectors could also carry out temporary duties which are often required at the maternity and child welfare centres, and so save the expense of engaging temporary health visitors (there being three of these at the present time), we are of opinion that, in addition to Miss Bibby, the present six women inspectors, who have been in the Council's service for periods of from six to thirteen years, should be utilised, three for each half of the Borough. It should be mentioned that Miss C. Smith supervises the Council's Dental Clinic, and Dr. Sowden suggests that she should retain this work as well as taking her part in the visiting duties. There are two vacant positions on the women sanitary staff which have not been filled, one vacancy that occurred about a year ago and the other quite recently. By the adoption of the foregoing proposals it will be unnecessary to fill these vacancies. We recommend— (a) That Miss M. E. Bibby be designated as Senior Woman Sanitary Inspector, her duties to be such as may be assigned by the Medical Officer of Health. (b) That the duties as proposed in the foregoing report be allocated to the women sanitary inspectors and health visitors as may be arranged by the Medical Officer of Health, and that Miss C. Smith do retain her present duties in connection with the Council's Dental Clinic. Tuberculosis. 4.—The report of the Medical Officer of Health on this subject is as follows: — " This clinical work is at present done at three dispensaries: Oakley Square, Maiden Road and University College Hospital. I suggest that all patients should be seen at the dispensary in Oakley Square. The dispensary at University College Hospital is a joint one with the Borough of Ilolborn, and I understand that this Authority does not propose to continue the arrangement. The question, therefore, of other accommodation must be considered. With regard to Maiden Road, patients are seen there on Wednesday afternoon and Friday evening only, the numbers are small, and all patients have to come to Oakley Square to bring their sputum for examination, and also have to come there to obtain their medicine. It would, therefore, seem to be in the interest of the patients to examine them at Oakley Square, and so avoid the additional journeys. The present Tuberculosis Officer, Dr. Donnelly, deals with all cases at Oakley Square and Maiden Road ; but he would not be able to see the additional cases transferred from University College Hospital. The Tuberculosis Officer, Dr. Hilton, at University College Hospital, gives half-time service only, and this includes both Ilolborn and St. Pancras cases. The services of a quarter-time officer, therefore, would be sufficient for St. Pancras cases. If we had the services of a Male Assistant Medical Officer of Health who was experienced in tuberculosis work, that officer could easily give the quarter time necessary, as the work at present done by the Assistant Medical Officer of Health by no means fully occupies that officer. By this reorganisation a further saving of from £500 to £600 per annum would be effected. Another advantage would also result during the period of annual leave : one officer could act as locum tenens for the other during that period and effect an additional economy." We are of opinion that the dispensary treatment of tuberculosis for the whole of the Borough can very well be concentrated at the St. Pancras Dispensary, 39, Oakley Square, where the Council have the full-time use of a part of the premises. 84 It will be necessary, if these proposals are adopted, for a further report to be submitted by the Medical Officer of Health at a later date in regard to the staffing under the altered conditions. We recommend— (а) That the necessary arrangements be made for the dispensary treatment of persons suffering from tuberculosis to be carried out for the whole of the area of St. Pancras at the St. Pancras Dispensary, 39, Oakley Square. (b) That the agreement with the University College Hospital for the dispensary treatment of tuberculosis be not renewed after 31st March, 1925. (c) That six months' notice be given for the determination of the agreement as to the occupation by the Council of a part of 132, Maiden Road. Maternity and Child Welfare Centres. 5.— The Medical Officer of Health was requested to report as to the possibility of the present maternity and child welfare consultations being held at four centres in the Borough, and as to whether it would be a better plan to engage two lull-time medical officers to conduct the consultations, instead of the present system of engaging part-time doctors. Dr. Sowden reports upon this question as follows:— " This suggestion would not be practicable on the terms expressed in the above resolution. At present, 147 consultations are held each month. Of these, 123 are taken by general practitioners, and 24 per month by the Assistant Medical Officer of Health, Dr. Churchill. A full-time medical officer could undertake one consultation each morning and afternoon on five days a week. This would equal 40 per month, and the two officers suggested could, therefore, do 80 consultations per month, but as 147 are actually held, this would leave 67 consultations not provided for. The services of four full-time officers would be necessary to continue the present work, and this would leave room for some extension. Three officers would be inadequate. As to cost, four full-time medical officers at £600 per annum would be £2,400. If all the work were done by general practitioners, at 1½ guineas per consultation, the cost would be £2,546. As the latter, however, provide and pay for their own locum tenens during illness and holidays, the difference in cost is not great. A great disadvantage to the idea of four centres for the whole of the Borough, would be the longer distances the mothers and infants would have to travel; also, difficulty might be experienced in obtaining suitable premises in the four districts decided upon." We are not prepared to advise the appointment of full-time medical officers to conduct the consultations, as the adoption of that policy would prevent the co-operation of local medical practitioners in the Council's maternity and child welfare work, which is found most desirable and valuable. For the reasons given by Dr. Sowden, we are not in favour of reducing the number of centres to four. We are making suggestions in the following paragraphs for lessening the number of clinics now held; but we wish to strongly emphasise the fact that, by the adoption of our recommendations, there will be no diminution whatever in the service available for mothers and children. Berkeley Road Centre. 6.—The Medical Officer of Health states that the attendances at the Berkeley Road Centre are very small, there being an average of only twelve attendances per clinic, and he suggests that the cases could be seen at the Camden Road Centre, 62, Camden Road, as was previously done. 85 The Berkeley Road Centre was established for the purpose of serving directly the Primrose Hill district of Ward 4, and for staff purposes it was attached to the Camden Town Centre. We are of opinion that the Centre has not justified its existence for separate consultations, and agree that the work should be transferred to Camden Road. We recommend— That the work of the Berkeley Road Centre be transferred to the Camden Road Centre, and that the agreement for the use of Ihe schoolroom be determined. Grafton Road Centre. 7.—There is a vacancy at this Centre for a Medical Officer, caused by the death of Dr. J. Sherwood New. A temporary arrangement has been made for Dr. P. Ruth Elliott to continue the Friday clinics that were held by Dr. New. When the question of filling the vacancy was before the Council on 16th April, 1924, it was adjourned pending consideration as to the Berkeley Road Clinic. We recommend— That in the event of the work of the Berkeley Road Centre being transferred, as recommended in the preceding paragraph, Dr. Charles II. A. Alderton be appointed to the vacancy for a Medical Officer at the Grafton Road Centre, on the usual terms and conditions relating to the appointment. Ante-natal work. 8.—The report of the Medical Officer of Health with regard to the ante-natal clinics held in the Borough is as follows: — " The average attendance at many of the Centres would certainly point to economy being possible here. The following figures give the average attendances at some of the Centres during the past three months:— Centre. Number of consultations monthly. Average number of cases seen. Time occupied. Oakley Square l 18 1½ hours. Chalton Street 2 6 2 Queen's Crescent 4 5 2 Ampthill Square 4 9 2-2½ „ Camden Road 4 8 1½-2 „ Caversham Road 4 8 2 I would suggest that at Chalton Street one ante-natal consultation per month be held instead of two, and that at Queen's Crescent and Camden Road two ante-natal consultations per month be held instead of four. This would effect a saving of about £90, with no loss of efficiency." We recommend— That the foregoing proposals of the Medical Officer of Health be approved and adopted. Midwifery Grants. 9.—We have considered the following report of the Medical Officer of Health on this subject:— 86 " In 1918 the Council decided to grant 10s. for each case admitted to Hospital, if the patient was necessitous and if either a reduced or no charge was made. In December, 1920, the contribution of the Council was increased to £1. No amount was fixed as to what constituted a ' reduced fee,' and for some time past this contribution of £1 has been paid for every St. Pancras case admitted to Hospital." That this universal contribution is not justified is evident from the figures placed before us. " In cases of midwifery attended at home, a grant of 5s. is paid by the Council to the Hospital or institution attending the case. This also was for necessitous cases, or where a reduced or no fee is charged. In these cases the matter has drifted, and the 5s. is now paid for every case. The following table shows the total payments made since 1919:— COST. YEAR. j Intern at 10s. ^ Intern at £1. Extern at 5s. Total. £ s. d. £ s. d. £ s. d. £ s. d. 1919 146 10 0 — 87 0 0 233 10 0 1920* 155 0 0 40 0 0 160 10 0 355 10 0 1921 — 429 0 0 144 10 0 573 10 0 1922 - 549 0 0 164 5 0 713 5 0 1923 — 569 0 0 136 5 0 705 5 0 * Payment for intern cases increased from 10s. to £1 per case in December, 1920. " I suggest that, in future, the contribution of the Council should be based on definite figures, and I advise that for each in-patient the contribution should only be paid where the patient pays less than £3, and for every out-patient case the contribution should only be made where the patient pays less than £.1, and this should only apply to cases definitely recommended from the "Welfare Centres, or by the Town Hall staff, and after reference to the Medical Officer of Health." The result of our enquiries into this matter reveals the fact that there has been considerable laxity in dealing with the accounts for midwifery grants, so that the amounts paid to Hospitals and Institutions for their services have been in excess of what they should have been. We recommend— That the proposals of the Medical Officer of Health in regard to the system of paying midwivery grants be approved and adopted, and that, in future, such accounts be submitted to the Public Health (Audit) Sub-Committee. Compulsory Notification of Measles. 10.—The Medical Officer of Health has reported fully on this subject. He states:— " Measles was made notifiable throughout the country from 1916 to the end of 1919, and, after four years' trial, was abandoned by the Ministry of Health. It is generally conceded that the results obtained do not justify the expenditure, and the figures for St. Pancras support this view. If notification was not in force, the majority of the cases would still be known through the schools and maternity and child welfare centres. Nurses, etc., could then be supplied where their service were needed." When the Ministry of Health decided to withdraw their general order respecting the compulsory notification of measles, local authorities were permitted to make their own local 87 orders, which the Borough Council did for the year 1920, as they considered that notification was a useful adjunct to their measles work. The cost to the Council for measles notification fees for the past seven years is as follows:—1917, £147 19s.; 1918, £91 4s.; 1919, £74 5s.; 1920, £99 2s.; 1921, £54 8s.; 1922, £253 15s.; 1923, £108 l1s.; or on an average of £118 9s. per annum. From April, 1922, the expense of nursing in necessitous cases was undertaken by the Council, which had previously been paid for out of voluntary funds. The cost of this during 1922 was £185 16s. 6d , and in 1923 was £59 2s. There is at present a severe epidemic of measles prevailing, and the expenditure already, for a period of three months, is over £330, which includes notification and nursing fees. In considering this matter, it has been urged that measles is a dangerous disease, its mortality amongst children being greater than the mortality from all other infectious diseases put together, and notification does tend to impress upon the public the importance of taking the greatest care in nursing measles. On the other hand, statistics show that the death rate from measles in the non-notifiable years is very little larger than in the notifiable years. We recommend— That the compulsory notification of measles be continued. Clerical Staff', Public Health Department. 11.—In 1914, the male permanent clerical staff consisted of a Chief Clerk and seven other clerks, and at the present time there is the same number, but three of them are temporary clerks. These are Mr. L. Higgins, 41 years of age, who has been temporarily engaged since October, 1919; Mr. J. B. Richards, 62 years of age, who has been in this Department since 1923; but has been in the temporary service of different departments of the Council since November, 1914; and Mr. J. Brooks, 24 years of age, who has been temporarily engaged since 24th January, 1924. In addition to the above, the Department has also the part services of Mr. G. N. Cove, a permanent clerk, who is attached to the Estates Department, which has the first claim on his time. It follows that any development of the Council's housing schemes, e.g., Somers Town, would probably result in the whole of his services being required for housing work. The Health Department also has the temporary services of Mr. H. G. West as Milk Enquiry officer, and should at any time the milk scheme be abandoned, his services would no longer be required, and it is desirable that his appointment should remain a temporary one. There are two women clerks working with the Women Inspectors and Health Visitors:— Miss A Andrews (permanent), and Miss G. Wood (temporary). The Medical Officer of Health considers that the retention of Miss Andrews will be adequate at present for the needs of the women's department, so that the services of the temporary clerk can be dispensed with. With regard to the three male temporary clerks, we are satisfied that, for the necessities of the Department, three clerks are required. As far back as October, 1920, the Public Health Committee recommended the permanent appointment of Mr. L. Higgins, who is a very competent clerk, and we think this recommendation should be sent forward again. In reference to Mr. J. B. Richards, we feel that, as he is 62 years of age and has already been for ten years in the temporary service of the Council, he should be retained; but as soon as a temporary position in another Department is available, he should be transferred, and then a permanent j unior clerk appointed in his place. As regards Mr. J. Brooks, who has been engaged temporarily for three months, we consider that his services should be replaced by the appointment of a permanent junior clerk. We further consider that the services of Miss G. Wood should now be dispensed with. We recommend accordingly. 88 Assistant Medical Officer of Health. 12.—We requested the Medical Officer of Health to report fully upon the position and duties of the Assistant Medical Officer of Health. After careful consideration, we have come to the conclusion that, having regard to the duties at present allocated to the position, it is not necessary to continue such office. The principal duty of this officer is to conduct consultations at the Council's maternitv and child welfare centres. Under the reorganisation proposals which we have submitted in regard to the Public Health Department, the general duties of the position of Assi-tant Medical Officer of Health will become practically negligible, and it will be a substantial economy for the consultations now conducted by this officer to be performed by medical officers separately paid for each clinic. We are of opinion that the present co-operation of local medical practitioners in taking consultations at the centres is valuable, and the extension of that co-operation desirable. Tbeir practical interest and experience in the Council's maternity and child welfare work is thus obtained, and has the advantage of influencing the attendance of expectant and nursing mothers at the clinics. We recommend— That the Council be advised to arrange for the consultations at the maternity and child welfare centres, now conducted by the Assistant Medical Officer of Health, to be carried out by medical officers, at a fee of 1½ guineas per consultation, and to determine the appointment of Dr. Stella Churchill as Assistant Medical Officer of Health. THE STAFF. The names of the staff of the Public Health Department at the end of 1924 will be found on pages 6 and 7. The following changes occurred during the year:— Dr. J. A. Struthers, appointed Tuberculosis Officer (part time) at the University College Hospital Dispensary, in place of Dr. R. Hilton, resigned. Dr. Stella Churchill, Assistant Medical Officer of Health, appointment terminated. Miss G. Wood and Mr. J. Brooks, Temporary Clerks, appointments terminated. Miss D. M. Parnell, Sanitary Inspector, resigned. Mr. W. C. Mansfield, appointed Junior Clerk. Miss R. Aldis appointed as Nurse at the Tuberculosis Dispensary, University College Hospital, in place of Miss E. C. Ballard, resigned. Staff at Maternity and Chii.d Welfare Centres. Dr. C. II. A. Alderton appointed Medical Officer, Grafton Road Centre, owing to the death of Dr. J. Sherwood New. Dr. Margaret E. Alden resigned one of her consultations at the Caversham Road Centre. Her successor, Dr. Amy Hodgson, is being remunerated from funds provided from voluntary sources. Miss M. L. Blair promoted Superintendent at Argyle Square Centre, in place of Miss Mullock Jones, resigned. Miss E. M. Robinson promoted Superintendent, Mary Ward Centre, September 1st, 1924. Miss K. L. Allfrey, Superintendent, transferred to Camden Road Centre. Miss G. Bristow, Superintendent, transferred to South Highgate Centre. Mrs. S. C. Chapman promoted Superintendent at Grafton Road Centre, in place of Miss E. L. May, resigned. 89 Miss J. M. Anderson appointed Health Visitor. Miss E. B. Bagnell „ „ Miss V. B. Woodruff „ „ Miss L. Auger, Health Visitor, resigned. Mrs. E. Perryman engaged as whole-time cleaner, Argyle Square Centre. The following held temporary appointments as Health Visitors during the year:— Miss Rodwell. Miss D. Landray. Mrs. H. Parsons. CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Bacteriologist of University College for the examination, at the expense of the Council, of material sent by medical practitioners in connection with suspected (St. Pancras) cases of diphtheria, typhoid fever and tuberculosis. The following specimens were examined during the year: — Nature of Specimen. Positive. Negative. Total. Swabs for Diphtherise Bacilli 135 727 862 Blood, re Typhoid Fever 1 11 12 Sputum for Tubercle Bacilli 48 348 396 Examinations of sputum in connection with cases attending the tuberculosis dispensaries is carried out by the staff at the dispensaries. Facilities for the examination of cerebrospinal fluid in suspected cases of cerebrospinal fever, encephalitis lethargica, &c., are available 10 the Medical Officer of Health through the London County Council laboratory, and for the examination of blood in suspected malaria through the Ministry of Health. The chemical work of the Public Analyst (Mr. J. Kear Colwell, F.T.C.) in connection with the Sale of Food and Drugs Acts is given on page 80. Section VIII.—HOUSING. During the year ended December 31st, 1924, 108 houses were erected in the Borough. These were all on the Holly Lodge Estate in Ward 1. 79 certificates were issued under the Public Health (London) Act, 1891, Section 48, stating that a proper and sufficient supply of water for sanitary and domestic purposes had been provided, showing that this number of houses had been occupied. The building of these houses has chiefly attracted new residents to the Borough, and has done practically nothing to remedy the overcrowding which is still so prevalent. Cases have been discovered during the year where as many as six, seven, and in one case, nine persons were living in one room. The London County Council now gives special consideration with regard to vacancies occurring in any of their blocks of dwellings to cases recommended by the Borough Medical Officers of Health, and these extreme cases are reported for preferential treatment. 90 Statistics for the year ended 31st December, 1924 (as required by the Ministry of Health):— Number of new houses erected during the year: — (a) Total 108 (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-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2238 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 628 (3) Number of dwelling-houses found to be in a st te so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1564 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 3234 (2) Number of dwelling-houses in which defects were remedied: — (a) By owners 3234 (b) By Local Authority in default of owners Nil. C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 91 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 controls 478 dwellings, chiefly consisting of flats, in different parts of the Borough. Flats seldom become empty, and no difficulty is experienced in filling the vacancies from the waiting list. Brookfield Estate. The Estate comprises 202 tenancies, which have been fully occupied throughout the year. The gross weekly rents range from 12s. 10d. to 28s. 4d., according to the number of rooms and position. Certain of the trees which were planted when the Estate was completed failed to survive and have since been replaced. The grass plots in front of the flats and the privet hedges throughout the Estate are 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. Further applications were received from tenants for permission to instal wireless receiving sets, and 80 aerials have been erected on the Estate. Una House. This scheme comprises 64 flats, and the present gross rents vary from 13s. 2d. to 20s. 9d. weekly, according to the accommodation. One of the deletions made by the Ministry of Health in this scheme was the provision of lead aprons over the windows, with the result that considerable trouble has been experienced by rain driving in over the window heads, particularly on the top floors. Experiments were carried out, with the result that the whole of the openings to the top floor windows and certain others have since been fitted with drips to throw off the water. An offer was received for the purchase of the piece of freehold land adjoining Una House, with a frontage in Grafton Mews, on which it was originally intended to erect a creche to serve the needs of the neighbourhood, but the proposal was abandoned owing to the heavy capital cost and the difficulty of obtaining the sanction of the Ministry of Health. The land was part of the site acquired for a public library, the major portion of which was utilised in erecting the flats, and was placed by the Education and Public Libraries Committee under the control of the Estates Committee and laid out with shrubs and grass in order to preserve the amenities of the buildings. The Committee decided not to entertain the offer, as, if the land was used for commercial purposes, it would probably be a source of annoyance to the tenants whose flats overlook the ground. Final Accounts, Assisted Housing Schemes. The final statements of accounts have been completed during the year. Una House.—With reference to Una House, the original amount of the contract was £76,001 14s. Od. In consequence principally of the increase in wages and the cost of materials during the course of construction (provided under the contract), the final account of the contractors, Messrs. Chessums, Ltd., was agreed at £82,153 9s. 6d., with the approval of the Ministry of Health, which was an excess over the contract of £6,151 15s. 6d. The cost of the work done by the Council direct amounted to £472 14s. 11d., bringing the total cost of the buildings to £82,626 4s. 5d. There were certain items included in the above sum of £82,626 4s. 5d., amounting to £350 1s. 8d., which the Ministry stated could not rank for financial assistance, such expenditure being for additional painting of pipes, ornamental rainwater heads, office 92 equipment, etc., and it was finally decided by the Council that the sum of £122 15s. 5d., part thereof, be paid out of the repairs fund connected with the buildings, and the balance of £227 6s. 3d. out of the rates. Brookfield.—In regard to the contract for the buildings on the Brookfield Estate (exclusive of the block of 12 flats comprising Chester House, under a separate contract), the original amount of the contract for the erection of 190 tenements and the construction of roads and sewers by Mr. Albert Monk, Contractor, was £242,547. The expenditure paid direct by the Courcil, otherwise than by contract, amounted to £1,833 12s. 1d., making a total estimated expenditure for the whole of the works of £244,380 12s. 1d. As in the case of Una House, the contract provided for any increase or decrease in the prices of materials and the claims for wages that might be affected during the course of the contract. The result has been that these prices (unlike Una House) decreased during that period to a ralher large extent, the Ministry of Health ultimately agreeing to a total payment to the Contractor of £216,949 8s. 4d. By these figures there was a saving of £25,597 11s. 8d. as compared with the contract price, and this contrasts with a loss of £6,151 15s. 6d. in respect of Una House. Included in the total cost of these works, the Ministry of Health, in the first instance, expressed the view that certain items of expenditure, amounting to £1,391 16s. 7d. (which by negotiations were afterwards reduced to £553 13s. 5d.), could not be regarded as ranking for financial assistance. The latter amount was in respect of £460 for gas services in excess of approved an ounts per house, and £93 13s. 5d. for time switches and office furniture. It was decided by the Council that this latter amount should be paid out of the repairs fund, and the former amount of £460 out oi the rates. Chester House.— In regard to the block of flats known as Chester House, which was erected by Messrs. J. W. Falkner & Sons, the original amount of the contract was £11,239; but in consequence of the increase in wages and cost of materials, the final amount payable to the contractors, and agreed to by the Ministry of Health, amounted to £13,414 3s. 6d., an excess of £2,175 3s. 6d. over the contract sum. The Ministry intimated that certain items of expenditure (in respect of garden work, alterations to living-room cupboards, etc.), amounting to £215 17s. 3d., subsequently reduced upon negotiations to £119 1s. 1d., could not rank 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. 3d. to 19s. 7d. At Flaxman Terrace there are 84 flats, with rents varying from 8s. 4d. to 17s. 5d. Prospect Ten ace contains 70 flats, and the rents vary from 9s. 9d. to 16s. 9d. Somkrs Town. Wolcot Street.—The negotiations were continued with the Ministry of Health in regard to the Council's proposals, which originated in 1919, for improving the unhealthy conditions existing in the Wolcot Street area. It is satisfactory to repcrt that the sanction of the Ministry has now been received. The Order confirming the Scheme is as follows:— Housing Acts, 1890 to 1924. METROPOLITAN BOROUGH OF SAINT PANCRAS. Saint Pancras (Somers Town Improvement Scheme) Order, 1925. Whereas the Metropolitan Borough Council of Saint Pancras (hereinafter referred to as "the Council") have caused a Scheme, dated the 29th August, 1921 (hereinafter referred to as "the Scheme"), to be prepared under Part II of the Housing of the Working Classes Act, 1890 (hereinafter referred to as "the Act of 1890''), for the improvement of the area therein described 93 and, having served notice of the Scheme in manner provided by the Housing Acts, 1890 to 1919, did on the 29th August, 1921, petition the Minister of Health (hereinafter referred to as "the Minister ") for an Order sanctioning the Scheme; And whereas the Minister has caused a Local Inquiry to be held and is satisfied that the carrying into effect of the Scheme, subject to certain conditions and modifications, would be beneficial to the health of the inhabitants of the buildings comprised in the area described in the Scheme and of the neighbouring dwelling-houses : Now Therefore, the Minister, in the exercise of his powers under the Housing Acts, 1890 to 1924, hereby makes the following Order:— 1. The Minister sanctions the Scheme as modified and set out in the Schedule hereto. 2. The Minister approves of the Council themselves undertaking the execution of the Scheme. 3. The provisions of the Lands Clauses Acts, as modified by the Housing Acts, 1890 to 1924, in relation to schemes under Parts I and II of the Act of 1890, and by the Acquisition of Land (Assessment of Compensation) Act, 1919, shall be incorporated with this Order. 4. For the purpose of determining the amount of any reduction of compensation to be made under the First Schedule to the Housing, Town Planning, &c., Act, 1919, any plans showing the proposed re-housing of persons of the working classes or the laying out of open spaces prepared by the Council and approved by the Minister before the date at which the compensation is determined shall be deemed to be incorporated in and form part of the Scheme. 5. The Council may, subject to the provisions of Section 46 (2) of the Act of 1890, borrow for the purpose of defraying any expenses incurred by them in connection with the Scheme, so far as such expenses are expenses properly chargeable to capital. 6. Nothing in this Order shall be deemed to constitute an approval of the Scheme by the Minister for the purpose of the Local Authorities (Assisted Housing Schemes) Regulations, 1919, or of any Regulations amending or extending those Regulations. 7. This Order may be cited as " The Saint Pancras (Somers Town Improvement Scheme) Order, 1925," and shall come into operation on the date hereof. SCHEDULE. Scheme made by the Metropolitan Borough Council of Saint Pancras under Part II of the Housing of the Working Classes Act, 1890, for the improvement of the Somers Toivn area as modified and sanctioned by the Minister of Health. 1. The lands coloured pink and blue on the Map, which lands are situate in the Metropolitan Borough of Saint Pancras, shall constitute the area to which this Scheme applies (hereinafter called " the area "). 2. The lands coloured pink are included in the area on account of the sanitary condition of the premises thereon or of those premises being dangerous or injurious to health, and the lands coloured blue are so included for the purpose only of making the Scheme efficient. 3. The lands constituting the area, or any of them, may for the purposes of this Scheme be taken either by agreement or compulsorily. 4. After obtaining possession of the lands included in the area, the Council shall, except so far as the Minister may otherwise direct, demolish all the buildings in the area: Provided that they shall not demolish any occupied house in the area until accommodation for a number of persons equivalent to the number of working class occupants of such house is available in new dwellings to be erected by the Council in pursuance of this Scheme, unless the Council are satisfied that suitable alternative accommodation for such occupants is available elsewhere. 5. The lands in the area shall, subject to the provision of any necessary streets and approaches, be used for the purposes of re-housing. 6. The Council shall provide on the cleared area, and in accordance with plans to be approved by the Minister, dwellings suitable for the accommodation of 309 persons of the working classes. 7. All lands upon which dwellings shall be erected in pursuance of the last preceding clause shall, for a period of 25 years from the date of the Order of the Minister sanctioning this Scheme, 94 be appropriated for the purpose of dwellings for persons of the working classes, except so far as the Minister may dispense with such appropriation, and every conveyance, demise or lease of any of these lands shall be indorsed with notice of this provision. 8. The Council may, with the consent of and in accordance with plans to be approved by the Minister, lay out and construct new streets and widen existing streets in the area and close or divert any highways in the area, and any lands ceasing to be or to form part of a highway under the provisions of this clause shall vest in the Council. 9. In this Scheme the expression "the Map" means the map prepared in duplicate and sealed with the official seal of the Minister and marked " Metropolitan Borough of Saint Pancras (Somers Town) Improvement Scheme, 1921, Map showing area of Scheme." One duplicate of the said Map is deposited in the Office of the Minister and the other in the Offices of the Council. 10. This Scheme may be cited as "The St. Pancras (Somers Town) Improvement Scheme, 1921." Given under the Official Seal of the Minister of Health, this Second day of May, in the year One thousand nine hundred and twenty-five. F. L. TURNER, Assistant Secretary, Ministry of Health. A copy of the Order has been served on the owners and lessees of the property proposed to be acquired under the Scheme, and the Council's Solicitors instructed to take all necessary steps to complete the purchase of the various interests after agreement with the District Valuer. The Council's Architect has also been instructed to prepare the working drawings for the proposed new buildings, which will comprise 40 two-room Hats and 30 threeroom fiats, exclusive of scullery, bathroom, w.c., etc. The lay-out also provides for a possible extension of the Scheme by incorporating certain property in Clarend' n Street, abutting on Wolcot Street. Ossulston Street.—An official representation, under Part I of the Housing of the Working Classes Act, 1890, was made to the London County Council by the Medical Officer of Health (Dr. G. Sowden), with regard to the unhealthy area known as Ossulston Street. This area is bounded by Hampden Street on the north, Ossulston Street on the east, Chalton Street on the west, and Euston Road on the south. The County Council, being satisfied that the conditions prevailing within the area could only be remedied by clearance and reconstruction, decided, on the 10th February, 1925, to make an Improvement Scheme. The execution of the Scheme, as proposed, which comprises about eight acres, will, it is assumed, involve the displacement of about 2,700 persons, and it is proposed that re-housing accommodation for no fewer than that number shall be provided within the area. General Matters. Redecorations.—During the past year, the Council decided that such decorations and repairs as may be required should be carried out under the direct supervision of the Housing Superintendent, who was authorised to engage, as far as possible, the services of the caretakers and such casual labour as maybe necessary. In accordance with that instruction, a programme of work was drawn up, under which the whole of the dwellings would be redecorated systematically, regard being had to the money set aside in the repairs funds, which is a fixed sum, and which cannot be diverted or used for any other purpose. The scheme is working satisfactorily, and a considerable amount of work has been done. Consultations with the London County Council.—A communication was received from the London County Council in regard to the desirability of arrangements being made whereby Metropolitan Borough Councils could be given further opportunities for discussing with the Central Authority matters relating to the bousing of the working classes. It was pointed out that to proceed by way of deputation was a somewhat cumbersome method, involving a 95 siderable loss of time, and a certain formality which prevented discussion of details essential to the good understanding of the questions raised. It was therefore suggested that informal meetings should take place betweem members and officials representing Borough Councils and the Chairman and Vice-Chairman of the Housing Committee of the County Council. The Estates Committee appointed their Chairman and Deputy-Chairman (or, in their absence, either Councillors Mrs. Alliston or Miss Kent), together with the appropriate officials, to confer with the representatives of the County Council as and when required. London Count;/ Council Dwellings.—A letter was received from the London County Council in reference to the arrangements in force for selecting tenants for houses and flats provided on their various estates, in regard to which they were desirous of establishing some relation between their own operations and the requirements of the Metropolitan Borough Councils. It was proposed, as an experiment for 12 months, to apportion among the Metropolitan Boroughs a certain number of new houses, based upon existing conditions of overcrowding according to the census of 1921, and to allocate to the residents in each Borough a definite proportion, not exceeding in the aggregate 50 per cent., of the new accommodation to be provided. The offer of the County Council was accepted, and cases of special hardship have been referred to them. Allotments.—Negotiations were concluded with the Kenwood Preservation Council, which resulted in the conveyance to the Borough Council of the triangular field, about 1.3 acres in extent, at Fitzroy Park, for providing allotments, so long as the same shall continue to be used for such purpose, and thereafter as an open space within the meaning of the Open Spaces Act, 1906. The number of allotments on this land is 27. With regard to the allotments at Fitzroy Farm, 13 in number, a notice was received from the owner of the land terminating on the 5th April, 1925, the Council's tenancy. There are still 21 allotments under cultivation at Millfield Lane; but as the land has been conveyed by the Kenwood Preservation Council to the London County Council as an open space for public purposes, in pursuance of the Open Spaces Act, 1906, the plot-holders have been given notice to give up possession in September, 1925; but negotiations are proceeding with a view to an extension of time. Staff. The administrative work in connection with the Committee (Chairman: Councillor W. C. Wood, Deputy-Chairman: Councillor R. J. Smerdon) is carried out by Mr. A. P Coke, the Clerk to the Committee, who is ass:sted by Mr. G. N. Cove and the Housing Superintendent, Mr. L. Barnard. 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 Buildings, Mr. G. S. Tunbridge. 97 APPENDIX. 98 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1924 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. 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 85 305 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 259434 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 1924 214600 214300 4447 4112 18.8* 2937 13.4† 640 551 303 74 2848 13.0† Area of district in acres (land and inland water), 2694.4; total population at all ages, 211,366; number of inhabited houses, 24,660; average number of persons per house, 8.57; at Census, 1921. *Based on total population. †Based on civil population. 99 Table No. 2. Deaths Registered from all Causes for the Year 1924. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the Borongh 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. SONS 1.—General Diseases. 1. Enteric Fever - - - - - - - - - - - - - - 1 1 - - - - - - - - - - - - 1 1 2 2. Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3. Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4. Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5. Small Pox— (a) Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Doubtful - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6. Measles 7 8 14 13 10 17 31 28 2 1 - - - 1 - - - - - - - - - 1 - - - - 33 41 74 7. Scarlet Fever - - 1 1 2 6 3 7 1 - - - 1 - - - - - - - - - - - - - - - 5 7 12 8. Whooping Cough 6 7 11 8 4 7 21 22 1 1 - - - 1 - - - - - - - - - - - - - - 22 24 46 9, (a) Diphtheria - - - 1 9 7 9 8 2 1 - 1 - - - - - 1 - - - - - - - - - - 11 11 22 (b) Croup - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10. Influenza 2 4 3 2 2 1 7 7 - - - 2 1 - 4 2 1 3 9 4 5 8 5 8 4 7 2 1 38 42 80 11. Miliary Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12. Asiatic Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13. Cholera Nostras - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14. Dysentery - - - - - - - - - - - - - - - - - - 1 1 - - 1 1 - - - - 2 2 4 15. Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16. Yellow Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 17. Leprosy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 18. Erysipelas 2 - 1 - - - 3 - - - - - - - - - 1 - - - - - - - - - - - 4 - 4 19. (a) Mumps - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - - - - - 2 - 2 (b) German Measles - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Varicella - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (d) Other Epidemic Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20. (a) Pyæmia - - - - - - - - - - 1 - - - - - - - - - - 1 - - 1 - - - 2 1 3 (b) Septicæmia - - - - - - - - - - - - - - 1 - 2 - - 2 1 - - - - 1 - - 4 3 7 (c) Vaccinia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 21. Glanders - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 22. Anthrax (Splenic Fever) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 23. Rabies - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 24. Tetanus - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 25. Mycoses - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 1 26. Pellagra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 27. Beri-beri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 28. (a) Pulmonary Tuberculosis - - - - - 2 - 2 - - 2 1 14 22 20 18 24 18 36 18 21 6 10 4 - - - 1 127 90 217 (b) Phthisis (not defined as tuberculous) - - - - - - - - - 1 - - - 2 - 3 1 - 2 1 - - - - - - - - 3 7 10 29. (a) Acute Phthisis - - - - - - - - - - - - - 1 - 2 - 2 3 - - - - - - - - - 3 5 8 (b) Acute Miliary Tuberculosis - - - 1 1 - 1 1 - - - 1 1 - - - - - - - - 1 - - - - - - 2 3 5 30. Tuberculous Meningitis 2 1 1 2 4 3 7 6 - - - - - 1 - - - 1 - - - - 1 - - - - - 8 8 16 31. (a) Tabes Mesenterica - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 (b) Other peritoneal & intestinal tubercle - - - - 1 - 1 - - - - - - 2 - - - - - 1 - - - 1 - - - - 1 - 1 32. Tuberculosis of Spinal Column - - - - - - - - - - 1 1 1 1 - - - - - 1 - - - - - - - - 2 3 5 33. Tuberculosis of Joints - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 34. (a) Lupus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Scrofula - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Tuberculosis of other Organs - - - - - - - - - 1 - - - - - - - - - - 1 - - - - - - - 1 1 2 35. Disseminated Tuberculosis - - - - - - - - - - - - 1 - - - - 1 - - - - - - - - - - 1 1 2 36. Rickets, Softening of Bones - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 1 1 37. Syphilis 1 1 - - - 2 1 - - - - - - 2 1 3 1 2 - 2 - - 1 - - - - 11 4 15 38. Other Venereal Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 39. Cancer of the Buccal Cavity - - - - - - - - - - - - - - - - - - 2 - 4 1 7 - 2 - 1 - 16 1 17 40. ,, Stomach, Liver, &c - - - - - - - - - - - - - - - 1 4 1 5 5 21 9 13 15 11 5 - 1 54 37 91 41. ,, Peritoneum, Intestines, and Rectum - - - - - - - - - - - - - - - - - 2 3 2 7 12 7 6 4 7 - 3 21 32 53 42. „ Female Genital Organs - - - - - - - - - - - - - - - - - 6 - 18 - 17 - 5 - 1 - - - 47 47 43. ,, Breast - - - - - - - - - - - - - - - - - 2 - 10 - 9 - 4 - 2 - 1 - 28 28 41. ,, Skin - - - - - - - - - - - - - - - - - - 2 - 3 - 2 - - - - - 7 - 7 45. Cancer of other or unspecified Organs - - - - - - - - - - - - 2 1 2 - 1 4 7 2 10 2 9 6 4 4 - 1 35 20 55 46. Other Tumours (situation undefined) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 47. Rheumatic Fever - - - - - - - - - - 2 - - - - - 1 - - - 1 1 - - - - - - 4 1 5 48. (a) Chronic Rheumatism - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 (b) Osteo-Arthritis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Gout - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 49. Scurvy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 100 Deaths Registered from all Causes for the Year 1924—continued. Cause of Death. Ages. 0 to 1 1 to 2 2 to 5 lotal under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Per sons 1. General Diseases—con. 50. Diabetes . . . . . 1 . 1 . . . . 1 . . 2 . 1 3 1 4 6 3 4 1 2 . . 12 17 29 51. Exophthalmic Goitre . . — . . . . . . . . . . 1 . 3 — . . . . . . . . . . . . 4 4 52. Addison's Diseases . . . . . . . . . . . . . . . . . . . . 1 . 1 . . . . . 2 . 2 53. Leucocythæmia Lymphadenoma . . . . . . . . 1 . . 2 . 1 . . 2 . 1 1 . . . . . . 4 4 8 54. Anæmia . . . . . . . . . . . . . . . . 1 1 3 . 2 1 1 . 1 . . 1 8 10 55. (a) Diabetes insipidus . — _ . . — . — . . . . . . . . . . . . . . — . . — — . . . — (b) Purpura . . . — . . . . . — . . — . . . . . . — . . — . . . . . . . — (c) Hæmophilia . . . . — . — . . . . . — . . . . . . — . — . . . . — . . . — (d) Other General Diseases — . . . . . . . . . . . . . . . . . — . — — — . . . — . . — — 56. Alcoholism (acute or chronic) — . . . . . — . . . . . . . . . . — — . . . . . . . . . — — — 57. (a) Occupational Lead Poisoning — . . . . . . . . . . . . . . . . — 1 . . — — . . . . . l — 1 (b) Non.occupational Laad 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 . . . 2 . 1 . . 1 1 . . 3 . 1 2 . 1 1 . . . . . 6 7 13 (b) Encephalitis, other forms. . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . 1 1 61. (a) Cerebrospinal Fever 1 . . . . . 1 . . . . . . . . . . . . . . . . . . . . . 1 . 1 (b) Posterior Basal Meningitis 3 1 . . . . 3 1 . . . . . . . . . . 1 . . . . . . . . . 4 1 5 (c) Meningitis, other forms . . . . 1 2 1 2 1 — 1 . 1 . . 1 . . — . . . . . . . . . 4 3 7 62. Locomotor Ataxy . . . . . . . . . . . . . . . . . 1 1 . 1 . . . . . . . 2 1 3 63. (a) Anterior Poliomyelitis . . . . . 1 . 1 . . . . . . . . . . . . . . . . . . . . . 1 1 (b) Other Diseases of the Spinal Cord 1 . . . 1 . 2 . . . . . . . . . . 1 2 2 2 2 3 1 2 — . . 11 6 17 64. Cerebral Hæmorrhage, Apoplexy . 1 . . — — . 1 . . . . 1 . . . 3 . 6 4 19 13 13 22 4 8 1 . 47 48 95 65. Softening of Brain . . . . — . . . . . . . . . . . . — 1 . — 1 . 1 1 1 . . 2 3 5 66. Paralysis without specified cause . . . . . — . . . . . . . . . . . . 1 1 — 1 . 2 2 1 . . 3 5 8 67. General Paralysis of the Insane . . . . . . . . . . . . . . . . 3 1 12 1 5 . . . . . . . 20 2 22 68. Other forms of Mental Alienation . . . . . . . . . . . . . . . . 1 . . 5 1 . . . . . . . 2 5 7 69. Epilepsy . — . . . . . . . 3 . . . 1 . . 2 3 . . . . 1 . . l . . 3 8 11 70. Convulsions (Nonpuerperal; 5 years and over) . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . 1 . 1 71. Infantile Convulsions (under 5 years) 4 . . . . . 4 . . . . . . . . — . . . . . . . . . . . . 4 . 4 72. Chorea . . . . . . . . . . . . . . . — . . . . . — . . . . . . . — . 73. Hysteria, Neuralgia, Neuritis . . . . . . . . . . . . . . . . . . . . . — . — . . . . — . . 74. Other Diseases of the Nervous System . . . . 1 . 1 . 1 . . . . . . 1 . . 1 1 1 . 1 . . 2 . . 5 4 9 75. Diseases of the Eyes and Annexa . . . . . . . . . — . . . . . . . . . . . . . . . . . . — — — 76. (a) Mastoid Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . — . — (b) Other Diseases of the Ears 1 . . . . . . . . . . . 1 . . . . . . . . . . . . . . . 2 . 2 3. Diseases of the Circulatory System. 77. Pericarditis . . . . . . . . 1 . . . 1 . . . 1 . 1 . . . 1 . . . . . 5 . 5 78. Acute Myocarditis and Endocarditis . . . . 1 . 1 . . . 1 . 1 2 . 2 3 3 2 2 1 1 . . . . . . 9 10 19 79. (a) Valvular Disease . . . . 1 . 1 . . . 2 5 2 3 1 1 3 5 9 12 14 12 13 19 5 11 1 3 51 72 123 (b) Fatty Degeneration of the heart . . . . . . . . . . . . . . . . 1 . 1 . 2 1 4 4 2 2 . 1 10 8 18 (c) Other Organic Disease of the Heart . . 1 . . 1 1 1 1 . . . 1 1 1 2 4 5 15 12 21 24 33 45 18 39 3 11 98 140 238 80. Angina Pectors . . . . . . . . . . . . . . . . . . . 1 1 . 3 . . 1 . . 4 2 6 81. (a) Aneurysm . . . . . . . . . . . . . . . . . . 4 1 1 . . . . . . . 5 1 6 (b) Arterial Sclerosis . . . . . . . . . . . . . . . . . . 3 . 5 6 10 11 9 11 2 5 29 33 62 (c) Other Diseases of Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82. (a) Cerebral Embolism and Thrombosis . . . . . . . . . . . . . . . . 1 . . 1 4 3 1 4 2 4 1 2 9 14 23 (b) Other Embolism and Thrombosis . . . . . . . . . . . . . . . . 1 . . . . . . . . . . 1 1 1 1 83. Diseases of the Veins (Varices, Hæmorrhoid Phlebitis, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84. (a) Status Lymphaticus 1 . . . . . 1 . . . . . . . . . . . . . . . . . . . . . 1 . 1 (b) Other Diseases of the Lymphatic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85. Hæmorrhage; other Diseases of the Circ latory System . . . . . . . . . . . . . 1 . . . . . . . . . . . 1 . . . 2 2 4. Diseases of the Respiratory System 86. Diseases of the Nasal Fossæ . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . 1 . 1 87. Diseases of the Larynx 1 . . . . . 1 . 1 . . . . . . . . . . . . . . . . . . . 2 . 2 83. Diseases of the Thyroid Body . . . . . . . . . . . — . . . . . . . . . . 1 . . . . . . 1 1 89 & 90. Bronchitis 6 6 . 2 . 1 6 9 . . . . . . 1 1 7 1 19 4 27 20 47 45 34 58 14 11 115 149 304 91. Broncho.Pneumonia 30 21 15 12 6 4 51 37 . . . . . . . 2 1 . 2 5 4 3 1 2 1 . 1 2 61 51 112 92. (a) Lobar Pneumonia . 3 2 . . . 2 3 2 . 1 1 1 1 3 1 2 2 4 2 7 2 7 2 2 1 . 1 32 18 50 (b) Pneumonia (type not stated) 3 . — — . . 3 . — . . 1 1 . 1 1 4 2 2 2 9 . 6 2 2 1 . — 29 9 38 93. Pleurisy 1 . . . . . 1 . . . . . . . . . 1 1 2 1 . 1 1 . . . . . 5 3 8 101 Deaths Registered from all Causes for the Year 1924—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 nnvrards 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. SONS 4. Diseases of the Respiratory System—con. 94. Pulmonary Congestion,Pulmonary Apoplexy — — — . — — — — — — . — — — — — 1 1 2 — 1 1 5 4 2 4 — 3 11 13 24 95. Gangrene of the Lung . — — . — . — — — — . — — — — — . — — — — — . — — — — — — . — 96. Asthma — — — . — . . — — — . — — — — — . — 4 1 3 4 3 1 — — — . 10 6 16 97. Pulmonary .Emphysema — — — . — . . — — . . — — — . — 1 — 1 — 1 — . — 1 — — — 4 . 4 98. (a) Fibroid Disease of the Lung — — . . — . . — — — . — — — — — . — 1 — . — — — 1 — — 1 1 2 (b) Other Diseases of the Respiratory System . . — — — . . — — — . — — — — — . 1 — — 1 — 1 . — — — — 2 1 3 5. Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums 1 . — — — . 1 — — — . — . — — — . — — — — — . — — — — — 1 . 1 (b) Other Diseases of the Mouth and Annexa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100. Diseases of Pharynx, Tonsillitis . . . 1 . . . 1 . . . . — — — — . . . . . — . . . . — — — 1 1 101. Diseases of Œsophagus . . . . . . . . . . . . — — — — . — . . 1 — . . . . — — 1 . 1 102. Perforating Ulcer of Stomach . . . . . . . . . . . . — — 2 — 3 — 4 3 2 1 2 . . 1 — — 13 5 18 103. (a) Inflammation of Stomach . . — — — . . — — . . . — — — — . — — . 1 — 2 . 1 1 — — 4 1 5 (b) Other Diseases of Stomach . . — — — . . — — . . — — — — — . 1 1 — — — . — — — — — 2 1 3 104 & 105. (a) Infective Enteritis 7 5 . 1 — . 7 6 — . . — — — — — . — — — . — . — . . — — 7 6 13 (b) Diarrhœa (not returned as infective) 6 . . . . . 6 . . . . . . . . . . . . 1 . . . . . . . 2 6 3 9 (c) Enteritis (not returned as infective) 11 12 . — — 1 11 3 — . . — — — . — . . — — — — . . — 1 — — 11 4 15 (d) Gastro.Enteritis (not returned as infective) 13 8 2 2 — . 15 10 . . — — . — . — . — . — — 1 . — — — — . 15 11 26 (e) Dyspepsia (under 2 years of age) — . . — . . . — . . . — . . . . . . . . . . . — — — . . . . — (f) Colic . . — — — . . — — . . . — — . — . — — — — — . — — — — — — . — (g) Ulceration of Intestines 1 . — — — . . — . . . — . . . — 1 . — — — — . — — — . . 2 . 2 (h) Duodenal Ulcer . . — — — . . — — . . — . . 1 — . 1 . — 3 — . — — — . . 4 1 5 106. Ankylostomiasis — . — — . . . — . . . — . . . . . . . . . . . — — — . . . . — 107. Other Intestinal Parasites — . — — — . . — — . . — — — . — . . . — — — . — — — — — — . — 108. Appendicitis . . — . — . . — 1 1 . . — 2 — — 1 2 . 1 1 2 1 . 1 — — — 5 8 13 109. (a) Hornia 1 . — — — . 1 . — . . . — — — — . — 1 1 2 1 2 2 1 2 — — 7 6 13 (b) Intestinal Obstruction . . — — 1 1 1 1 1 1 1 — 1 — — — . 1 1 1 2 3 . 2 — 2 — 1 7 12 19 110. Other Diseases of the Intestines . 1 . — — . . 1 — . . — — — 1 — . — — — 1 — . . — 1 — 1 2 3 5 111. Acute Yellow Atrophy of Liver . . . . — . . . . . . . — 1 — . . . — — . . . . . . — — — 1 1 112. Hydatid of Liver . . — . — . . . . . . . — — — — . . . — — — . . . — — . — . . 113. (a) Cirrhosis of the Liver (not returned a3 alcoholic) . . . . . . . . . . 1 . . . . . . . 5 2 2 2 1 . . . . . 9 4 13 (b) Cirrhosis of the Liver (returned as alcoholic) . . . — — . . — . . . . — . . . . . . . . . . . . . . . . . — (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder' . . . . . . . — — . . . . . . . . . . . . . . 1 . . . . . 1 1 114. Biliary Calculi . . — — — . . — — . . — — — . — . . . 1 . . . 1 . 1 . . . 3 3 115. Other Diseases of the Liver . . — — — . . . — . . . — — . 1 . — — . . . . 3 . 1 — . — 5 5 116. Diseases of the Spleen . . — . — . . — — . . . — — . . . . . . . . . . . . . . . . . 117. Peritonitis (cause unstated) . . . . — . . — . . . . . . . 1 . . 1 . . . . . . . . . 1 1 2 118. Other Diseases of the Digestive System . . — . — . . — — . . . — — . . 1 1 . . — — 1 — — . . . 2 1 3 6. Non. Venereal Diseases of the Genito.Urinary System and Annexa. 119. Acute Nephritis . . . . . . . . . . . . . 1 1 . . . 1 . . 1 . 1 . 1 . . 2 4 6 120. Bright's Disease . . . . . . . . . . . 1 1 . . 2 2 2 8 4 11 9 9 8 7 3 l 1 39 30 69 121. Chyluria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122. Other Diseases of the Kidney and Annexa . . . . . . . . . . . . . . . . . . 2 . 2 . 1 . . . . . 5 . 5 123. Calculi of the Urinary Passages . . . . . . . . . . . . . . . . . . . 1 . . . 1 . . . . . 2 2 124. Diseases of the Bladder . . . . . . . . . . . . . . . . . . 1 . . . 1 . 1 . . 1 3 1 4 125. Diseases of the Urethra, Urinary Abscess, &c. . . . . . . . . . . . . . . . . 1 . . . 1 . 1 . . . . . 3 . 3 126. Diseases of the Prostate . . . — — . . — . . . . . . . . . . . . . . 3 . 1 . 1 . 5 . 5 127. Non.Venereal Diseases of Male Genital Organs . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . 1 . 1 128. Uterine Hæmorrhage (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 . . . . . . . 1 3 132. Other Diseases of the Female Genital Organs . . . . . . . . . . . . . . . . . 1 . 1 . . . . . . . . . 2 2 133. Non.puerperal Diseases of the Breast (Non.cancerous) . . . . . . . . . — . . — . — . . . . . . . . . . . . . . . . 102 Deaths Registered from all Causes for the Year 1924—continued. Cause of Death. Ages. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. F. M F M. F. M. F M. F M. F M. F M. F. M. F. M. F M. F. M. F M. F. M F. SONS 7. The Puerperal State. 134. Accidents of Pregnancy . . . . . . . . . . . . . 1 — . . 2 . . . . . . . . . . . 3 3 135. Puerperal Hæmorrhage . — — . . . . . . . . . . . . 3 — 3 . . . . . . . . . . . 6 6 136. Other Accidents of Childbirth . — . . . . . . . . . . . 1 — 1 — 1 — . . . . . — . . . . 3 3 137. Puerperal Fever . . . . . . . . . . . . . . . 3 . 1 . . . . . . . . . . . 4 4 138. ,, Albuminuria and Convulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139. ,, Phlegmasia Alba Dolens, Embolism, and sudden death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140. ,, Insanity . . . . . . . . . . . . . . . . . — . . . . . . — . . . . . . 141. ,, Diseases of the Breast . . . . . . . . . . . . . . . . . . . — . . . . — . . . . — — 8. Diseases of the Skin and of the Cellular Tissue 142. (a) Senile Gangrene . . . . . . . . — . . . . . . . . . . . . . 3 2 4 1 1 1 8 4 12 (b) Gangrene (other types) . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . 1 . 1 143. Carbuncle, Boil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144. Phlegmon, Acute Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145. Diseases of the Integumentary System 1 . . . . . 1 . . . . . . . . . . . 1 1 . . . . . . . . 2 1 3 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bones . . . . 1 1 1 1 1 . 1 . . 1 . . . . 1 . . . . . . . . . 4 2 6 147. Diseases of the Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148. Amputations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149. Other Diseases of Locomotor System . . . . . . . . . . . . . . . . . . . — . . . — . . . . . — — 10. Malformations. 150. Congenital Malformations 15 8 . . . . 15 8 . 1 . . . . . . . . . — . . . — . . . — 15 9 24 11. Diseases of Early Infancy. 151. (a) Premature Birth 31 28 . . . . 31 28 . . . . . . . . . . . . . . . . . . . . 31 28 59 (b) Infantile Debility, Icterus, an Scleroma 15 7 — . . . 15 7 . . . . . . . . . . . . . . . . . . . . 15 7 22 152. Other Diseases peculiar to early Infancy 8 4 . . . . . 8 4 . . . . . . . . . . . . . . . . . . . 8 4 12 153. Lack of Care . 1 . . . . . . l . . . . . . . . . . . . . . . . . . . . 1 1 12. Old Age. 154. (a) Senile Dementia . . . . . . . . . . . . . . . . . . . . 2 . 12 . 21 2 12 1 47 3 50 (b) Senile Decay . . . . . . . . . . . . . . . . . . . . . 5 . 7 . 30 . 18 . 60 60 13. Affections Produced by External Causes. 155 to 163. Suicides . . . . . . . . . . . . . . 1 . 6 1 5 1 6 1 5 1 . 1 . . 23 5 28 16 A. Poisoning by Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165. Other Acute Poisonings . . . . . . . . . . . . . . . . . . 1 . . 1 . . . . . . 1 1 2 166. Conflagration . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . 1 1 167. Burns (Conflagration excepted) 1 . 1 1 1 2 3 3 . . . 1 1 . . . . . . . . . . . 1 . . . 5 4 9 168. Absorption of Deleterious Gases (Confla gration excepted) 1 . . . . . 1 . . . . . . . 2 . . 1 . . 1 . . . . . . . 4 1 5 169. Accidental Drowning . . . . . . . . . . . . . . . . 1 . . . . . 1 — . . . . 2 . 2 170 to 176. Injuries 1 . . 1 2 . 3 1 6 1 2 1 5 1 2 1 8 . 4 . 7 2 5 3 2 1 . 1 44 12 56 177. Starvation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178. Excessive Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79. Effects of Heat . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . 1 1 180. Lightning . . . . . . . . . . . . 1 . 1 . . . . . . . . . . . . . 2 . 2 181. Electricity (Lightning excepted) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 to 184. Homicide . . . . . . . . . . 1 . . . . . . 1 . . . . . . . 1 . . 1 2 3 185. Fractures (cause not .specified) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186. Other Violence . . . . . . . . . . 1 . . . 1 . 1 . . . 7 . . . . . 1 . 5 . 5 14. Ill.defined Causes. 187. Dropsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188. (a) Syncope (aged 1 year and under 70 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) Sudden death (not otherwise defined) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189. (a) Heart Failure (aged 1 year and under 70) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) Atrophy, Debility, Marasmus (aged year and uuder 70) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (c) Teething . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (d) Pyrexia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (e) Other ill.defined Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (f) Causes not specified . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . 1 1 103 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 41 60 80 181 11 13 57 64 82 148 161 122 57 11 907 Diseases of the Nervous System and of the Organs of Special Sense 13 1 6 20 6 1 8 2 18 42 47 45 22 1 212 Diseases of the Circulatory System 1 1 3 5 2 8 12 8 27 64 96 148 105 30 505 Diseases of the Respiratory System 71 31 11 113 3 3 3 10 25 54 87 127 108 32 565 Diseases of the Digestive System 56 6 3 65 4 2 4 6 12 23 25 19 13 4 177 Non.Venereal Diseases of the Genito.Urinary System and Annexa . . . . . 1 2 4 7 19 25 26 13 4 101 The Puerperal State . . . . . . 2 7 7 . . . . . 16 Diseases of the Skin and of the Cellular Tissue 1 . . 1 . — — 1 — 2 — 5 5 2 16 Diseases of the Bones and of the Organs of Locomotion . . 2 2 1 1 1 1 . . . . 6 Malformations 23 — — 23 1 . . . . . . . . . 24 Diseases of Early Infancy 94 — — 94 — — — — — — — . — . 94 Old Age . . . . . . . . . . 7 19 53 31 110 Affections produced by External Causes 3 3 5 11 8 6 8 8 19 12 19 15 6 2 114 Ill.defined Causes . — — — — — — . 1 . . . . . 1 Totals 303 102 110 515 36 35 97 110 198 365 467 526 382 117 2848 104 Table No. 4. Total Births, Total Deaths, Infantile Deaths, and Deaths from Tuberculosis, with corresponding rates for each Ward. 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. Wards. Births. Deaths. Deaths under 1 year. Deaths, Tuberculosis (all forms). No. Rate. No. Rate. No. Rate. No. Rate. 1 613 16.7 462 12.6 41 67 43 1.2 2 490 21.7 296 13.2 35 71 31 1.4 3 679 18.5 478 13.0 45 66 46 1.3 4 510 19.1 336 12.6 32 63 30 1.1 5 657 21.1 444 14.3 54 82 41 1.3 6 497 23.3 271 12.7 40 80 26 1.2 7 196 12.5 193 12.3 18 92 18 1.2 8 470 16.8 335 12.0 37 79 33 1.2 No Address — — 33 — 1 — 3 — Total 4112 18.8 2848 13.0 303 74 271 1.2 105 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 1924. (53 weeks ended 3rd January, 1925.) . Estimated Population, Mid. 1923. Birth Rate. Death Rate. Infantile Mortality. . Estimated Population, Mid. 1923. Birth Rate. Death Rate (Crude). Infantile Mortality. England and Wales. †38,690,000 18.8 12. 2 75 County of London 5,564,109 18.7 12.1 69 Birmingham 946,400 19.6 11.5 80 West. Liverpool 837,600 24.4 13.3 102 Paddington 146,200 17.1 12.9 78 Manchester 752,100 19.9 13.7 97 Kensington 178,500 16.3 12.7 76 Sheffield 524,200 18.6 11.5 88 Hammersmith 133,600 18.0 121 72 Leeds 469,900 18.8 14.1 102 Fulham 161,600 18.4 11.1 72 Bristol 885,600 18.4 12.0 69 Chelsea 64,480 14.4 13.0 63 West Ham 314,400 25.4 11.5 69 City of Westminster 140,430 11.2 11.6 58 Hull 296,900 21.7 13.3 90 North. Bradford 290,800 17.0 14.7 91 St. Marylebone 105,400 14.6 13.1 78 Newcastle-on- Tyne 283,800 24.3 13.1 89 Hampstead 87,410 13.6 11.4 52 Stoke-on-Trent 276,100 240 13.5 100 St. Pancras 214,400 19.0 12.9 73 Nottingham 269,300 19.4 12.7 84 Islington 336,600 20.0 12.8 66 Salford 241,600 192 14.0 119 Stoke Newington 52,820 16.6 11.4 56 Leicester 239,700 18.6 12.0 76 Hackney 226,400 18.7 11.2 60 Portsmouth 230,718 20.2 12.4 66 Central. Cardiff 226,200 22.0 11.8 75 Holborn 43,376 13.4 11.9 83 Croydon 193,400 18.3 11.6 55 Finsbury 77,230 21.6 14.1 78 Plymouth 193,017 18.2 13.6 78 City of London 13,480 70 11.5 115 Bolton 182,200 17.0 13.5 93 East. Willesden 168,700 15.7 10.2 76 Shoreditch 106,200 25.1 13.5 83 Rhondda 167,900 23.3 10.5 79 Bethnal Green 118,700 22.3 12.2 78 Southampton 165,200 19.1 11.6 62 Stepney 253,850 21.4 12.2 75 Sunderland 164,000 25.7 14.6 101 Poplar 166,400 23.1 120 71 Swansea 161,700 21.0 11.5 80 South. Tottenham 151,700 16.0 10.2 74 Southwark 187,464 22.5 14.0 71 Birkenhead 151,400 21.4 11.6 91 Bermondsey ] 21,700 24.4 13.5 77 Oldham 14.7,500 16.3 13.2 105 Lambeth 308,500 19.2 12.5 66 East Ham 146,200 15.8 9.6 65 Battersea 170,600 18.4 11.7 62 Brighton 136,700 16.0 18.0 58 Wandsworth 336,100 14.9 110 56 Middlesbrough 135,400 26.4 16.6 184 Camberwell 272,300 19.0 11.4 70 Derby 132,800 19.3 11.2 61 Deptford 114,900 20.7 11.9 74 Leyton 132,800 130 10.0 65 Greenwich 102,777 20.2 11.4 74 Coventry 131,200 16.8 9.7 77 Lewisham 182,400 16.7 10.4 47 Walthamstow 130,000 16.1 10.0 69 Woolwich 140,000 18.1 10.8 65 Blackburn 129,000 15.6 13.8 84 Gateshead 128,200 22.9 18.8 107 Stockport 125,700 16.2 18.4 84 † Estimated population to middle of 1924. 106 Table No. 6.—Meteorological Table for Saint Pancras, 1924. {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 32º F. at station level (Bar. 112 ft. above M.S.L.) 29.974 30.058 29.892 29.888 29.889 30.021 29.907 29.858 29.584 29.929 30.084 29.982 Air temperature— Mean of— Maximum A 45.0 41.8 49.3 55.0 65.2 69.6 72.3 68.1 64.5 57.3 50.2 48.0 Minimum B 37.0 33.2 33.5 39.7 48.2 52.8 54.2 53.0 52.7 47.2 41.4 40.9 Mean of A and B 41.0 37.5 41.4 47.3 56.7 61.2 633 60.5 58.6 52.3 45.8 44.5 Difference from Average +2.2 —2.5 —1.5 —1.1 + 1.6 +0.2 —1.0 —2.7 0.0 +.'6 +1.5 +4.0 Humidity—Morning 91 87 82 75 71 68 70 77 83 90 88 90 Earth Temperature at 4 ft. depth 42.7 42.4 40.5 42.8 48.3 53.9 58.6 58.3 57.0 54.3 50.5 47.8 Bright Sunshine— Total Observed (daily mean) Hrs. 1.43 1.67 4.97 4.72 6.47 7.16 7.56 4.84 3.52 2.32 1.24 1.14 Per cent. of total possible 17 17 42 34 4.2 43 47 33 28 22 14 15 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of Days 18 12 8 14 20 11 16 23 20 17 14 15 Total Fall Ins. 2.75 065 0.73 3.14 3.14 2.47 5.69 2.72 2.59 3.52 2.50 3.18 Difference from average ,, +0.91 —0.98 —1.10 +1.61 +1.38 +0.47 +3.31 +0.51 +0.79 +0.87 +0.12 +0.79 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. 107 Table No. 7. Inspections and Re.inspections made by District Inspectors, by the Factory and Workshop Inspector, and by Women Inspectors in connection with certain infectious diseases during the year 1924. DUTIES AND PREMISES. Male Inspectors. Women Inspectors. Total. Inspections. Re.inspections. Inspections. Re.inspections. Inspections. Re-.inspec. tions. District Inspectors. Inspection of Dwelling Houses— After Infectious Disease 924 1892 - - 924 182 Upon Complaint (whole house inspected) 686 2673 - - 686 2673 Registered tenement houses (as such) 205 1377 - - 205 1377 Other inscribed dwellings (as such) 52 138 - - 52 138 Housing Act, 1909: 17 (1) First Inspection — 4 - - — 4 Subsequent routine inspections 351 1495 - - 351 1495 Other house to house inspections 20 39 - - 20 39 Complaints (not involving the complete inspection of a dwelling house) 2917 7049 - - 2917 7049 Drainage— Under notice. Plans, supervision, &c. 348 3884 - - 348 3884 Voluntary, Do. do. 881 3298 - - 881 3298 New Buildings. Do. do. 171 2364 - - 171 2364 Yards of Mews and Stables. 5251 51 - - 5251 51 Smoke Shafts observed 683 36 - - 683 36 Regulated Trades— Offencive trades 42 - - - 42 - Rag and bone dealers 20 - - - 20 - Other effluvia businesses - - - - — - Inspection of Market Streets - - - - — - Visits to closed underground rooms 28 - - - 28 - Infectious Diseases. Inquiry, removal, disinfection, &c. 1082 125 1897 - 2979 125 Other duties 602 183 - - 602 183 Totals 14263 24608 1897 — 16160 24608 Factory and Workshop Inspector. Bakehouses— Workshop 192 99 — - 192 99 Factory 133 126 — - 133 126 Restaurant Kitchens 59 233 — - 59 233 Laundries— Workshops 3 — — - 3 — Factory 5 6 — - 5 6 Other Factories 134 417 1 - 135 417 Other Workshops 390 1737 1 - 391 1737 Other Workplaces 25 42 — - 25 42 Other Duties 5 — — - 5 — Totals 946 2660 2 - 948 2660 108 Table No. 8.— Inspections and Re.inspections and other work of the Food Inspectors during 1924. DUTIES AND PREMISES. Visits and Inspections. Re.inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Milkshops 287 392 679 - - - Dairies 230 20 250 - - - Cowsheds 6 24 30 - - - Other Premises of Milk Purveyors — 28 28 1 - 1 Margaine Factories - - - - - - Butter Factories 1 — 1 - - - Ice Cream Premises 154 248 402 1 - 1 Slaghter Houses 25 115 140 - - - Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 53 287 340 - - - Butchers'Shops 31 23 54 1 - 1 Fried Fish Shops and Fish Curer's premises 145 268 413 5 - 5 Marketing Places 2212 1792 4004 — - - Other Premises where Food or Drugs are sold 11 — 11 — - — Other Visits 18 165 184 — - — Total 3173 3363 6536 8 — 8 SAMPLES, &C., TAKEN. Formal Samples Informal Samples No, of Milk samples 158 188 346 — 2 2 ,, Cream samples 10 10 20 — — — ,, Butter and Margarine samples 69 97 166 — — — ,, Other samples (specified below)— Arrowroot 1 — 1 — — — Bacon 6 1 7 — — — Brawn 2 — 2 — — — Cocoa 18 10 28 — — — Coffee 19 9 28 — — — Custard Powder 1 4 5 — — — Dripping — 11 11 — — — Fish Paste — 2 2 — — — Flour (self.raising) 15 — 15 — — — Jelly Crystals 1 — 1 — — — Lard — 14 14 — — — Milk (Dried) 5 - 5 — — — Mustard 16 5 21 — — — Oatmeal 1 - 1 — — — Pepper 19 2 21 — — — Prescriptions (L.I.P.) 3 3 6 — — — Rice 3 5 8 — — — Salad Oil - 1 1 — — — Sausages 6 1 7 — — — Suet 1 — 1 — — — Sugar 1 — 1 — — — Vinegar 20 10 30 - - — Total 375 373 748 — 2 2 109 Table No. 8 (con.).—Inspections and Re-inspections and other work of the Food Inspectors during 1924. 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 3 6 — 1 1 Fish 13 2 15 — — — Shellfish 2 - 2 - - - Other Foods (specified below):— Cheese — 1 1 — — - Fruit 7 10 17 — — - Tinned Goods — 1 1 — — - Vegetables 2 20 22 - — - Total 27 37 64 — 1 1 Inspections of Registered Canal Boats 10 — 10 — — — 110 Table No. 9. Visits, etc., made by Women Inspectors during 1924. First Visits. Subsequent Visits. Call made, but admission not obtained. Miss Bibby. Miss Smith. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. *Miss Camman. Miss Parnell. Miss Carmichael. Total. Miss Bibby. Miss Smith. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. *Mis3 Camman. Miss Parnell. Miss Carmichael. Total. Miss Bibby. Miss Smith. *Miss Holland. Mrs. Hunter. Miss Anderson. Miss Blaxland. *Miss Camman. Miss Parnell. Miss Carmichael. Total. Grand Total. - 91 4 106 49 16 - - 82 348 106 5 301 303 34 - - 11 760 - 82 - 118 89 5 - - 9 296 11404 Expectant Mothers 71 17 96 5 1 9 — 56 - 37 7 18 9 1 2 — 16 90 - 50 - 38 4 1 1 - 10 104 449 - 5 43 2 9 15 7 - 2 76 - 9 56 - 1 6 12 - 91 86 - 4 1 3 - 9 6 - - 23 185 Puerperal Fever — 2 1 39 1 4 7 — 1 55 - - 6 4 2 1 12 — - 25 - 1 - 13 - 1 - - — 15 95 Tuberculosis—Discharged Soldiers & Sailors - - 17 3 5 18 4 5 - 52 - 33 - 9 258 - 35 - 335 - - 3 - - 37 - 1 - 41 428 Do. Others - 32 56 177 17 256 50 112 8 708 - 195 202 9 6 1026 807 122 4 2371 - 75 25 45 10 240 121 34 — 550 3629 Measles and German Measles - 365 906 888 592 397 777 182 296 4403 - 46 28 41 53 32 65 10 16 291 - 32 13 13 44 37 4 11 6 160 4854 Whooping Cough - 25 66 42 18 9 30 — 20 210 - 6 — 9 3 3 20 — 3 44 — 4 4 - 2 3 9 - - 20 276 Scabies - 3 18 11 — - 7 — - 39 - 1 1 2 - — 2 — — 6 — 2 - - - - - - - 2 47 Other Cases of Illness - 145 452 179 93 86 188 195 37 1375 - 38 — 12 19 34 22 8 2 135 — 26 6 1 28 13 8 25 2 109 1619 Verminous Persons 1 5 9 8 6 12 — 3 39 — - — 2 1 1 2 — — 6 — — 3 - - 1 - — 4 49 To Hospitals and other Voluntary Institutions 180 529 77 67 140 471 128 208 7 1807 - - - - 1 - 8 - - 9 - - - - 5 5 - - 1 11 1827 Domestic Workshops - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Home Workplaces - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Laundries—Factory - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,, —Workshop ... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Restautant Kitchens - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - 1 ,, Workshops 1 - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - 1 ,, Workplaces - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Attendances at Clinics .. — 96 75 25 67 66 8 — 56 393 - - - - - - - - - - - - - - - - - - - - 393 Attendances at Committees, &c. 196 88 - - - 2 - - - 286 - - - - - - - - - - - - - - - - - - - - 286 Other Visits and Inspections 31 27 308 247 3 136 153 1 128 1034 - 2 1 — 2 51 10 — 3 69 - 51 2 103 — 12 10 — 10 188 1291 Totals 409 1480 2045 1891 995 1483 1380 703 696 11082 - 440 339 398 409 1447 962 175 57 4227 - 327 54 337 175 363 160 71 38 1525 16834 * Exclusive of those shown in Table 7. 111 Table No. 10.—Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1924. Inspector. Inspections. Re-inspections. Call made, but admission not obtained. Total. 1. Mr. Rackham 559 2327 — 2886 2. „ Lonnon 1305 1798 — 3103 3. „ Brown 1185 2396 — 3581 4. „ Dillon 1220 2128 — 3348 5. „ Walker 1182 2641 — 3823 6. „ James 1039 2493 — 3532 7. „ Adkins 908 2127 — 3035 8. „ Akers 2516 1555 — 3711 9. „ Jaffa 1790 1713 — 3503 10. „ Capel 1342 2439 — 3781 11. „ Nixon 1503 2984 — 4487 12. „ Thompson (Factories and Workshops) 1020 2667 — 3687 13. „ Auger (Food and Food premises) 3585 8 — 3593 14. „ Child 3773 3 — 3776 15. Miss Bibby 409 — — 409 16. ,, Smith 1480 440 327 2247 17. „ Holland 3035 339 54 3428 19. Mrs. Hunter 1891 398 337 2626 19. Miss Anderson 995 409 175 1579 20. ,, Blaxland 1493 1447 363 3303 21. ,, Camman 2277 962 160 3399 22. „ Parnell 703 175 71 949 23. „ Carmichael (Temporary) 696 57 38 791 Totals 35546 31506 1525 68577 112 Table No. 11.—Intimations as to Nuisances and Breaches of Statutes and By-laics served by the Sanitary Inspectors during 1924, and the resulting Statutory Notices in 1924 and the early part of 1925. Schedule of Nuisances. Intimations. Statutory Notices. 1 Part of the house in a dirty condition 1174 356 2 „ „ damp „ 278 109 3 Roof defective 926 327 4 Guttering defective 202 77 5 Water fittings defective 189 51 6 Water-closet apartment with absence of external ventilation 24 7 7 ,, ,, so foul as to be a nuisance or dangerous to health 29 7 8 Water-closet basin foul 68 15 9 ,, ,, defective 108 34 10 ,, ,, choked 121 20 11 Urinal in a foul condition 1 — 12 Privy in a foul condition — — 13 Soil pipe defective 43 9 14 ,, unventilated 25 8 15 ,, improperly ventilated 10 4 16 Absence of waste pipe to sink, lavatory or bath 2 1 17 Waste pipe of sink, lavatory, or bath connected with drain 11 4 18 ,, ,, ,, ,, defective 105 34 19 „ ,, ,, ,, foul 55 9 'JO Inlet of drain improperly trapped 9 4 21 Drain defective 194 62 21 ,, stopped 139 16 23 ,, ventilating pipe defective 93 38 21 Rain-water pipe in direct communication with drain 14 5 25 ,, ,, defective 189 58 26 Unpaved condition of roadway — — 27 Undrained ,, ,, — — 28 Area or part unpaved 3 2 29 ,, undrained 1 1 30 Yard or space unpaved 1 1 31 ,, ,, undrained 3 — 32 Defective condition of washhouse paving 110 33 33 Dust-bin defective 370 104 34 „ in an improper position 2 1 35 Accumulation of stagnant water which is a nuisance dangerous to health 28 4 36 Accumulation or deposit which is a nuisance dangerous to health 129 31 37 Animals kept in such a manner as to be a nuisance dangerous to health 33 — 38 Part of the house so overcrowded as to be dangerous to health 25 5 39 Space below floor in basement or ground floor insufficiently ventilated 45 24 40 Issuing of black smoke in such a quantity as to be a nuisance 11 2 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 13 2 42 Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates - - 43 Other nuisances 849 263 Total 5632 1728 Table No. 12. Registered Tenement Houses—Breaches of By-Laws. Intimations. Statutory Notices. 1 Overcrowding 2 - 2 Inadequate water supply — — 3 Contaminated water supply — — 4 Foul closet, basin or trap 13 6 5 Want of means of ventilation — — 6 Want of annual cleansing — — 7 Want of cleansing of the part or parts of premises used in common 294 120 8 ,, ,, ,, in sole use 3.0 114 9 Want of cleansing of the room or part of the dwelling 2 — 10 Animals improperly kept — — 11 Other breaches 8 2 Total 639 242 113 Table No. 13. Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1 Want of cleanliness 131 28 2 Want of ventilation 5 - 3 Want of air space, overcrowding 3 - 4 Sanitary accommodation, absent or insufficient 16 6 5 ,, ,, unsuitable or defective 35 8 6 ,, ,, not separate for sexes 13 1 7 Want of drainage of floors 1 - 8 Other nuisances 82 15 9 Illegal occupation of underground bakehouse - - 10 Breach of special sanitary requirements for bakehouses 104 — 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 81 12 Total 471 70 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 101 68 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet - - 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 182 45 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 38 6 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 35 8 6 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position - - 7 Animals so kept as to be likely to pollute the water supply — — 8 Offensive matters not deposited in manure receptacle 2 — 9 Manure not removed at proper intervals 3 — 10 Manure—absence of proper receptacle for 2 — 11 Manure receptacle not properly constructed — — 12 Sufficient drain to stables or cowshed—absence of a — — 13 Receptacle for house refuse—absence of a proper 284 76 14 Receptacle for house refuse—absence of a proper cover for 4 — 15 Yard or open space unpaved 2 2 1(5 ,, paving defective 231 98 17 Insufficient water-closet accommodation to "lodging house " 61 40 18 A furnace improperly constructed or negligently used — — 19 Effluvia arising from premises used for trade, business, or manufacture which is a nuisance dangerous to the inhabitants of the district 1 - 20 Offensive matters suffered to run out of trade premises into an uncovered place — - 21 Dairies and cowsheds—breach of By-laws as to 1 — 22 Slaughterhouses—breach of By-laws as to — — 23 Steam whistle—use of a, without authority — — 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansing 480 179 25 Articles in an unwholesome condition requiring to be purified or destroyed . 18 4 26 Underground room illegally occupied as a dwelling 4 2 27 Name and address of Medical Officer of Health and of landlord, etc., not inscribed in rent book 38 — 28 Other breaches 190 53 Total 1677 581