STPAN 83 Metropolitan Boruugh of Saint Pancras. Annual Report of M.O.H. Please circulate as quickly as possible. ORT s.M.O. S.Mii. 0. the S.M.O. S.M.O. ek of health S.M.O. General library. YEAR 1925. G. SOWDEN, M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister-at-Law, Fellow of the Royal Institute of Public Health. Printed by F. P. Lewiagdon, 26 and 27, Everaholt Street, London N.W. 1. Metropolitan Borough of Saint Pancras. REPORT of the medical officer of health FOR THE YEAR 1Q25. G. SOWDEN, M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister-at-Law, Fellow of the Royal Institute of Public Health. 3 CONTENTS. PAGE Map of Borough, showing statistics by Wards 2 Public Health Committee 5 Staff of Public Health Department 6 Introduction 8 Summary of Report 11 Section I.—Vital Statistics, and Economic and General Conditions. Population and General Statistics 12 Marriages 12 Births 12 Illegitimacy 13 Notification of Births 13 Deaths. 14 Infantile Mortality 16 Economic Conditions 22 Poor Law Relief 22 Hospital Accommodation 23 Health Week 23 National Rat Week 24 Section II —Maternity and Child Welfare 25 Advice Cards 25 Home Visiting 20 Centres 28 Proposed re-organization of Maternity and Child Welfare Work 31 Artificial Sunlight Treatment 34 Dental Clinic 37 Clinic for Sick Mothers and Children 38 Supply of Food to Mothers and Children 38 Home for Sick Poor Children 40 Day Nurseries 40 Home Helps 41 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 41 Home Nursing 41 Midwifery 42 Government Grants 44 Section III.—Prevalence of and control over Infectious Diseaaes. Table of Notifiable Diseases 45 Do. Monthly Number of Notifications 46 PAGE Table of Monthly Number of Deaths 47 Do. Notifications past 10 years 48 Do. do. and Deaths in Wards 49 SmallpoxZ 50 Vaccination 50 Scarlet Fever 51 Diphtheria 51 Typhoid or Enteric Fever 52 Tuberculosis 53 Dental Treatment 58 X-ray Examinations and Reports 58 Public Health (Tuberculosis) Regulations, 1925 58 Boarding-out of Children from Tuberculous Homes 58 Cessation of Supervision 59 Home Visits and Inquiries 60 Dispensaries 61 Report by Tuberculosis Officer 62 Sanatoria, etc 63 Care Committee 64 Puerperal Fever. 66 Ophthalmia Neonatorum 67 Epidemic Cerebrospinal Meningitis 67 Acute Poliomyelitis and Polioencephalitis 68 Encephalitis Lethargica 68 Pneumonia 69 Measles and German Measles 70 Other Notifiable Infectious Diseases 71 Whooping Cough 71 Diarrhoea and Enteritis 71 Influenza 2 Syphilis 72 Cancer 73 Section IY.—Other Services. Disinfecting and Cleansing Station 74 Mortuary 75 Inquests and Post-mortemsz 76 Section V.—Sanitary Circumstances of the District. Inspections 76 Notices served and result of service 77 Nuisances—Legal Proceedings 78 4 CONTENTS—continued. Page Premises and Occupations controlled by bye-laws and regulations 79 Offensive Trades 79 Registered Tenement Houses 79 Underground Rooms 79 Smoke Prevention 79 Constructoinal Drain Work 79 Drainage Register 79 Water Service 80 Canal Boats Acts 80 The Rag Flock Act, 1911 80 Rag and J 5one Dealers 80 Rent & Mortgage Restrictions Act, 1923 80 Factory and Workshop Acts 81 Inspections 81 Defects found. 81 Home Work 82 Registered Workshops 82 Other matters 82 Schools Medical Examination of School Children 84 Feeding of School Children 80 Section YI.—Food. (а) Milk Supply 86 Cowsheds, Dairies and Milkshops 86 Registration of Purveyors 87 Milk (Special Designations) Order, 1923 88 Milk and Cream Regulations 89 Milk and Dairies Consolidation Act, 1915 90 Public Health Tuberculosis) Regulations, 1925 90 Public 1 lealth (Meat) Regulations, 1924 91 Bye-laws—Slaughter Houses— Humane Killing 91 Meat Inspection—Tuberculosis Order, 1925, No. 2. 92 (b) Other Foods 92 Unsound food condemned destroyed and seized 92 Slaughter-houses 92 Fried Fish and Fish Curing Premises 93 Page Ice Cream Premises 93 Bakehouses and Restaurant Kitchens 93 Public Health (Preservatives, etc., in Food) Regulations, 1925 93 (c) Sale of Food and Drugs Acts 94 Prosecutions :— Sale of F'ood and Drugs Acts 94 Margarine Act, 1887 95 Meat Regulations, 1924 95 Section YII.—Sanitary Administration. Staff 95 Principal changes in Public Health Services during 5 years 96 Chemical and Bacteriological Work. 97 Section YIII.—Housing 97 Housing Act, 1925 98 Statistics 98 Housing Schemes 100 Work of the Estates Committee 102 Appendix. Table No. 1. Vital Statistics for 11 years 104 Do. 2. Deaths Classified for all causes. 105 Do. 3. Summary of above 109 Do. 4. Births and Deaths in Wards 110 Do. 5. Do., certain large towns and Metropolitan lioroughs 1ll Do. 6. Meteorology 112 Do. 7. Inspections and reinspections (District and other Inspectors) 113 Do. 8. Do. (Food Inspectors) 114 Do. 9. Visits by Women Inspectors 116 Do. 10. Inspections and reinspections by individual Inspectors 117 Do. 11. Inspections by indiv idual Inspectors for 5 years 118 Tables Nos. 12, 13, 14 and 15. Details of Intimation Notices served and resulting Statutory Notices 119 5 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. November, 1924, to October, 1925. CHAIRMAN. Councillor Mansell Jambs Swift (Ward 7). DEPUTY-CHAIRMAN. Councillor Alfred Solomon, J.P. (Ward 1). EX-OFFICIO. The Right Worshipful Thk Mayor Councillor Frederick Brown Gubney, 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 Gf.orge Edward. 8 Campion, John Sisnons. 8 Crosby, Miss Ada, M.B.E. 8 Evans, Evan. 6 French, Alexander George. 5 Gregg, Dr. Edward Andrew. 1 Ivempton, 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, November, 1925, to October, 1926. CHAIRMAN. Alderman Mansell James Swift. DEPUTY-CHAIRMAN. Alderman Alfred Solomon, J.P. EX-OFFICIO. The Right Worshipful The Mayor (Alderman Dr. Edward Andrew Gregg, J.P.). ALDERMEN. Davies, David, J.P., L.C.C. Rolles, Harry. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 6 Bambridge, Mrs. Mary Winifred. 1 Bateman, William Edward. 2 Bland, Mrs. Violet. 8 Campion, John Sissons. 8 Crosby, Miss Ada, M.B.E. 8 Evans, Evan. 3 Hf.wson, Fbederick. 7 Jenkins, Edwin. 4 Johnson, Job, J.P. 5 Kemp, Frederick William Isaac. 6 Martin, Arthur Henry. 3 Morrell, Rev. Roger Conyers, M.A. 5 Paterson, Mrs. Louisa Sophia. 2 Salmon-Brunsdon, Mrs. Elizabeth. 5 Saunders, Edward John. 1 Spry, William Palmer. 5 Williams, Lt.-Col. Charles. 7 Wood, William Charles, 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1925. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. G. Sowden, M.D., D.P.H., M.R.C.S., L.R.C.P. TUBERCULOSIS OFFICERS. +N. M. Donnelly, M.B., B.Ch., R.A.O., D.P.H. A. Vinry, M.R.C.S., L.R.C.P., O.P.H. PUBLIC ANALYST. J. Kear Colwell, F.I.C. SANITARY INSPECTORS AND HEALTH VISITORS. Inspectors oj Food and Food Places. §¶W. G. Auger. §¶H. R. Child. Inspector of Workshops and Factories. ‡§B. H. Thompson. District Inspectors. §G. Rackham. ¶‡G. W. Adkins. .‡§¶J. I. Lonnon. ‡R. C. Akers. ‡§W. L. Brown. ‡M. Jaffa. §E. M. Dillon. ‡¶TS. W. Cafel. .‡§¶A. H. Walker. ‡¶H. K. Nixon. ‡§R. E. James. §H. G. West (Temporary). Senior Woman Sanitary Inspector. ‡ Miss M. E. BiiiRY, B.A. (Lond.). Women Sanitary Inspectors and Health Visitors. ‡||Miss C. Smith. ‡||Miss V. K. Blaxland. ‡§||Miss F. A. Anderson. ‡||+..Miss J. A. J. Camman, ‡§Mrs. A. Hunter. ‡||Miss A. Holland. CLERICAL STAFF. Chief Clerk A. D. Corrick. First Clerk A. G. Capel. Second Clerk A. Carpenter. Clerk G. N. Cove (attached to the Estates Dept.). „ J. D. Holiday. „ T. H. Hague. „ Miss A. Andrews. Junior Clerk W. C. Mansfield. „ H. G. Avril. „ F. A. J. Goodchild. † Resigned September, 1925. . Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Royal San. Inst. ¶ Cert. Meat and other Foods, || Health Visitor's Certificate. + C m H. Certificate, QneenJCharlotte's Hospital, 7 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. Medioal Qffioers, No. of Consultations per month Dr. Margaret E. Alden 1 Dr. Chas. II. A. Ali»erton 4 Dr. H. Searle Baker 4 Dr. B. Marion Cockerell 15 Dk. P. Ruth Elliott 1 Dr. A. Gertrude Grogan 8 Dr. J. Finch Haines 12 Dr. Janie Lorimer Hawthorne 6 Dr. Ethel F. Iredell 4 Dr. Kathleen F. Lander 2 Dr. Lydia A. Leney 12 Dr. Jessie S. Muir 9 Dr. J. Balfour Neill 8 Dr. Martin Oldershaw 1 Dr. Margaret 11. Paterson 4 Dr. Mary J. Pirret 13 Dr. Francis L. Provis 13 Denial Clinic. Mrs. W. A. Murch, L.D.S., Dentist 10 Dr. Jas. Maughan, Anmthetizt. 2 Sunlight Clinic. Dr. William Beaumont 12 Dentists at Tuberculosis Dispensary. Mr. Southcomb May, L.D.S. Mr. A. J. Maurice, L.D.S. (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. ‡§Iiss E. M. Robinson. ‡§Mrs. S. C. Chapman. ¶Miss M. Smyth. J§Mrs. E. Crockart. §Miss M. Templeton. Assistant Visitors at Maternity and Child Welfare Centres. §¶Miss E. B. Bagnall. .§‡Miss M. E. Jacobs. §Mrs. E. E. Bruce. §Mrs. E. Lurie. •JMiss M. A. Clarke. .‡§Mrs. J. Lynn. ‡§Miss B. M. Harris. ‡§Mrs. M. A. Smith. ‡Miss A. M. U. Harrop. .§Miss Y. B. Woodruff. Tuberculosis Dispensaries. Nurse Visitor, .§Miss S. A. Long. Clerical and General Assistant, Miss Margaret Deed. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station H. Catch. Stoker and General Assistant T. Bartholomew. Assistant Disinfector J. Stanley. ,, A. J. 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. Koyal San. Inst, ‡ Health Visitor'i Certificate. § C.M.B. ¶ Midwifery .Certificate, Qneen Charlotte's Hospital, 8 Public Health Department, Town Hall, Pancras Road, N.W. 1, To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras, Ladies and Gentlemen, I have the honour to present to you the 70th Annual Report on the vital statistics and sanitary condition of the Borough, including also particulars of the work carried out during the year by the staff of the Department. This is the third annual report which it has been my duty to submit to the Members of the Council. A summary of the principal statistics for the year 1925 will be found on page 11, and it will be noted that, as compared with previous years, the health of the Borough has been satisfactorily maintained. The general death-rate (12.7 per 1000 of population), and the rate of Infantile Mortality (72 per 1000 Births), were both lower than the corresponding rates of the previous year. The Birth-rate was also lower, being only 17.9 per 1000 of population. The Ministry of Health has intimated that the reports of Medical Officers of Health for the year 1925 should be what are termed "Survey Reports" and should deal comprehensively with:— (a) "The measure of progress made during the preceding: 5 vears in the improvement of the Public Health." This progress has been indicated in the Report by giving, in connection with most of the principal tables, the average rates for the previous 5 years for comparison with the corresponding rate of 1925. (b) " The extent and character of the changes made during the period in the Public Health services." These changes will be found summarized on page 96. (c) " Any futher action of importance in the organization or development of Public Health services contemplated by the Local Authority or considered advisable by the Medical Officer of Health," 9 In connection with the foregoing paragraph, I should like briefly to rofor to the subjeots of Child Welfare, Infant Mortality and Housing, although further details concerning those subjects will be found in the body of this report, St. Pancras has always been a pioneer in work relating to Child Welfare. This work was initiated and carried on for many years with much energy and enthusiasm by voluntary workers who equipped welfare centres in many parts of the Borough. When the Maternity and Child Welfare Act was passed in 1918 these centres and the whole of the staff were taken over by the Borough Council, which, since that date, has maintained them at an annual estimated cost of nearly £13,000 (a part of this is repaid by the Ministry of Health). When these centres were originally started, from 10 to 15 years ago, the number of births in the Borough, each year, was from 5000 to 6000, equal to a birth-rate of 23 to 24 per 1000 of population. During reoent years there has been a steady decrease, and last year the number of births was only 3880, equal to a birth-rate of 17-9 per 1000 of population. Despite this large decrease in the number of births, the same staff and organization for dealing with the work of Child Welfare is still maintained. It is therefore obvious that this particular branch of Public Health work is receiving the very fullest attention. Although St. Pancras is spending so lavishly on Child Welfare work, probably more lavishly than any other Metropolitan Borough, it is disconcerting to find that the rate of infantile mortality does not compare favourably with that of London us a whole, or with the majority of the Metropolitan Boroughs. Last year 18 of the Metropolitan Boroughs had a lower infantile mortality rate and only 9 a higher rate than St. Pancras. During the past five years (1921-1925) the average Infantile Mortality rate for St. Pancras was 72 per 1000 births, the corresponding rate for London as a whole being 71. In the five preceding years (1916-1920) the average rate for St. Pancras was 91 and for London as a whole 92 per 1000 births. As the work of the Centres has been so fully maintained, it would appear that some adverse factor is present which nullifies the teaching which is given and prevents the improvement we have a right to expect. Is this adverse factor due to overcrowding, the result of inadequate housing accommodation? Support is given to this suggestion by the table on page 16 relating to an inquiry into the deaths of children under 5 years of age during the two years 1924-1925. It is there seen that the death rate of children living under overcrowded conditions, from diseases likely to be accentuated by such conditions, was almost double that of children who were not living under conditions of overcrowding. It would therefore appear that the time has arrived when it is desirable (owing to altered conditions) to revise certain items of Public Health activity in order to obtain a more suitable proportion in expenditure, and also in the hope of securing better results. The expenditure on Child Welfare work has been disproportionately great in comparison with the expenditure on other branches of Public Health work. To some extent this is doubtless due to the popularity of the subject—the appeal of the child meets with an instant and ready response; but it appears to be open to criticism to spend, for example, on Tuberculosis only one-fifth of the amount spent on Child Welfare, when, as a cause of death, Tuberculosis is so important. I venture to suggest that it is possible to reduce the direct expenditure on the Maternity and Child Welfare departments without any loss of efficiency, and this view is endorsed by the recent communication received from the Ministry of Health, which was forwarded after a visit of inspection and investigation of this work by one of the Medical Officers of the Ministry. In Public Health, as in any other subject, the aim should be to secure the best possible results for the money expended, and I would suggest that any money saved as a result of decreased expenditure on the activities mentioned should be devoted to the provision of housing accommodation. This would probably do more to promote the public health, to diminish the 10 general death-rate, the rate of infantile mortality and the incidence of Tuberculosis than a similar expenditure in any other direction. Taking a wide view, it would not really mean any diminution in expenditure on the work of child welfare, for money spent on Housing is just as potent a factor in the promotion of maternal and child welfare as direct expenditure on that subject. The housing problem in the Borough, for many reasons, is admittedly one of great difficulty, but the table 011 page 17 shows that, despite the difficulties, during the four years ended March, 1926, St. Pancras made some progress in the provision of new houses; but owing to increase of population, this provision has done little or nothing to relieve existing overcrowding. The Borough Council's scheme in the Wolcot Street area should, at an early date, be of some value, and at a later date, the larger scheme of the London County Council in the Ossulston Street area will be of immense value, but much more will be necessary before the requirements of the Borough are adequately provided for. In conclusion, I wish to state that the routine duties of the department have been actively carried out during the year, and the work of the staff, to whom I am much indebted, has maintained a high standard of efficiency. I am, Ladies and Gentlemen, Your obedient Servant, May, 1926. Medical Officer of Health. 11 SUMMARY OF REPORT FOR 1925. Area of Borough, 2,694 acres. Area of various open spaces, 501 acres. Soil and Situation.—Practically the whole of the Borough is situated on London clay. There are a few superficial deposits of gravel in the south, and lower Bagshot sands in the extreme north. The Borough is about four miles long, extending from near Oxford Street in the south to Highgate in the north, and averages about a mile in width. Population (1921 Census), 211,366. Population (1925) Civilian, 215,900. Total, 216,300. Number of persons per acre, 80. Number of inhabited houses (1921 Census), 24,660. Births. Males, 1,989; females, 1891. Total, 3,889. Legitimate births, 3,637; illegitimate births, 243. Birth.rate, 17.9 per 1,000 of population. Excess of births over deaths, 1,135. Deaths. Males, 1,452; females, 1,293. Total, 2,745. Death.rate, 12.7 per 1,000 of population. Infantile Mortality Rate. Legitimate, 69; illegitimate, 119. Total, 72 per 1,000 births. Maternal Mortality. (Deaths of women from causes associated with child.birth.) From Sepsis, 4; from other causes, 7. Total, 11. Maternal death.rate, 2.8 per 1,000 births. Tuberculosis. (Pulmonary). Deaths 180; death.rate 0.8 per 1,000 of population. (All forms). Deaths, 231; death.rate, 1.1 per 1,000 of population. Notifiable Diseases. 4,502 notifications of cases of infectious diseases (including Measles and German Measles) were received during the year, this number being no less than 2,715 below that of the previous year. Rateable value, £1,835,804. Sum produced by a penny rate, £7,602. Total rainfall, 24'91 inches. Comparative Statistics. Rate per 1,000 of Population. Rate per 1,000 Births. Birth.rate. Death.rate. Infant Mortality. St. Pancras 17.9 12.7 72 England and Wales 18.3 12.2 75 105 Great Towns 18.8 12.2 79 County of London 18.0 11.7 67 12 Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1925. For the purpose of this Report, the year consists of the 52 weeks ended 2nd January, 1926. 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. Tiie total population of St. Pancras for the year 1925, as estimated by the Registrar-General, was 216,300, the civilian population being estimated at 215,900. The latter estimate (civilian population) has been used in calculating the death-rates in this report, and the former (total population) in calculating the marriage and birth-rates. The civilian population of the Borough shows an estimated increase during the year of 1,600. The natural increase, that is, the excess of births over deaths, was 1,135, the remainder, 465, represents the estimated increase flue to new residents coming into the Borough. MARRIAGES. The number of marriages celebrated during the year was 1,901. This is equal to a rate of 8.8 per 1,000 of total population. The average yearly number of marriages during the preceding five years was 2,039, equal to a rate of 9.4 per 1,000 of total population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 3,880, equal to an annual birth-rate of 17.9 per 1,000 of population. With two exceptions, and these were the two years at the termination of the war, this is the lowest birth-rate hitherto recorded in the Borough. The average yearlv number of births during the preceding five years was 4,743 equal to a rate of 21.7 per 1,000 of total population. The total number of births actually registered as having taken place in the Borough during the past year was 4,111. This figure has to be corrected by deducting the births of non-residents, which occurred chiefly in various public institutions in the Borough, these numbered 846, and adding the births belonging to St. Pancras which occurred outside the Borough, these numbered 615. The corrected figure is therefore as stated above, 3,880. The corresponding figures for previous years will be seen in Table 1, on page 104. The chart opposite this page shows, in graphic form, the variations which have occurred in the birth-rate during the last twenty years. The following table gives the number of births and the birth-rate in each ward of the the Borough for the past year. For comparison the figures for the previous year are also given:— CHART shewing BIRTH RATE for the BOROUGH during the 13 Ward Births and Birth Rates. Ward. Number of Births. Birth Kate. 1924. 1925. 11121. 1925. 1 613 597 16.7 16.5 2 490 444 21.7 19.9 3 679 671 18.5 18.4 4 510 480 19.1 18.2 0 657 591 21.1 19.2 6 497 467 23.3 22.2 7 196 164 12.5 10.6 8 470 466 16.8 16.9 Borough 4112 3880 18.8 17.9 It will be noted that the fall in the birth.rate is general throughout the Borough, with the exception of Ward 8, which shows a very slight increase. 1,175 births took place in Public Institutions equal to 28.6 per cent. of the total births which took place in the Borough. Table 5, on page 111, shows for 1925 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 3,880 net St. Pancras births, 243 were returned as illegitimate. This represents 6.3 per cent. of the total births registered during the year. The illegitimate birth.rate was very high during the years of the war, and, although lower now, it has never fallen to the pre.war level. During the last five years this rate has shown a slight and steady increase. The figures for the previous ten years arc given in the following table: — Year. llate. Year. Rate. 1915 5.4 per cent. 1920 5.6 per cent. 1916 7.0 „ 1921 505„ 1917 7.2 ,, 1922 5.6 „ 1918 9.5 „ 1923 5.7 „ 1919 8.4 „ 1924 5.9 „ Notification of Births. 4,074 notifications of births were received during the year: this includes 133 stillbirths and 3,941 live births, representing 96 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. 14 DEATHS. The net number of St. Puncras deaths registered during the year was 2,745; this equals an annual death-rate of 12.7 per 1,000 of population. The average yearly death-rate of the Borough during the previous five years was 13.0 per 1,000 of population. The actual number of deaths registered as having occurred in the Borough during the year 1925 was 2,864. This figure has to be corrected by the exclusion of 680 deaths, which occurred in the Borough, of persons who were not St. Pancras residents, and by the inclusion of 561 deaths of residents which occurred and were registered outside the Borough. The corrected figure of 2,745 is used in calculating the death-rates in this report. In Table 1, on page 104, will be found details of the corresponding figures for previous years, and the chart on the opposite page shews in graphic form, the variation in the death-rate during the last 20 years. Causes of Death. The principal causes of death during the year are stated in the following table, and, for comparison, the figures and averages for the previous 10 years are also given:— Diseases. 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 Average for 10 years 1925 Heart Disease 439 375 404 389 370 442 435 461 394 398 411 381 Cancer ,, 267 281 269 245 299 290 302 319 298 283 324 Bronchitis 322 290 250 228 301 236 276 308 223 304 274 274 Tuberculosis—all forms 500 423 444 485 34i 312 304 315 272 271 367 231 Pneumonia 33i 232 254 37& 179 197 173 265 201 2CO 241 204 Cerebral Hemorrhage, Embolism, and Apoplexy 169 119 116 131 91 98 126 120 112 118 120 123 Injuries 150 112 125 119 108 92 88 127 113 114 115 118 Premature Birth, Debility and Congenital Defects 187 176 144 132 162 201 149 134 134 118 154 105 Nephritis and Blight's Disease 132 103 104 9. 61 95 60 67 79 75 87 75 Whooping Cough 52 39 27 80 7 60 38 29 28 46 41 71 Diarrhoea and Enteritis 114 72 97 5& 68 54 98 47 61 63 73 55 Influenza 35 35 21 700 260 46 57 142 24 So 140 41 Diphtheria and Croup 24 23 25 31 21 33 5i 44 20 22 29 34 Rheumatic Fever » 7 7 8 7 6 16 15 8 5 9 18 Pleurisy I I 13 10 14 9 12 7 10 8 8 10 16 Erysipelas 11 3 3 11 9 12 3 12 4 4 7 12 Puerperal Fever 5 4 5 2 9 8 4 4 9 4 5 4 Enteric Fever 8 5 6 5 2 1 3 1 3 2 4 3 Measles 63 42 118 75 15 65 23 107 5 74 59 3 Scarlet Fever 22 8 4 7 5 11 7 20 3 12 10 — CHART shewing DEATH RATE for the BOROUGH during the DIAGRAM shewing Relative Importance ofVariqitsDiseases as Causes of DEATH during 1925. 15 It will be noted that diseases of the heart still head the list of causes of death, although the numbers show a decrease as compared with the previous year, and are below the average rate of the previous 10 years. Deaths from Cancer again show an increase, and this disease now occupies the second place on the list. The numbers show an increase as compared with those of the previous year, and arc considerably above the average rate of the previous 10 years. Deaths from Bronchitis were about the average, whilst those due to Tuberculosis show a welcome and considerable decrease. With reference to deaths from infectious diseases, for the first time in the records of the Borough, not a single death occurred from Scarlet Fever, although 651 cases of this disease were notified. Deaths from Measles numbered only 3, but those due to Whooping Cough and Diphtheria showed an increase. The diagram on the opposite page shows in graphic form the relative importance of various diseases as causcs of death in the Borough during 1925. The deaths which occurred during the year are fully classified for causes, age and sex in Table 2 on page 105. 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 111. It will be noted that 21 Metropolitan Boroughs had a lower and 5 a higher general death-rate than St. Pancras, One was the same. Of the total 2,745 St. Pancras deaths which occurred during the year, not less than 1,621 took place in public institutions, either within or outside the Borough ; this equals a proportion of 59 per cent, of the total deaths. Ward Deaths and Death-Rates. The number of deaths and the death-rates per 1,000 of population for each of the Wards during the past year were as follows, the figures for the preceding year being also given for comparison:— Ward. Number of Deaths. Death-rate per 1000 of population. 1924 1925 1924 1925 l 462 435 12.6 12.0 2 296 258 13.2 11.6 3 478 443 13.0 12.2 4 336 341 12.6 12.9 5 444 434 14.3 14.1 6 271 292 12.7 13.9 7 193 181 12.3 11.7 8 335 333 12.0 12.0 No address 33 28 - - Borough 2848 2745 13 .0 12.7 Infantile Mortality. 280 deaths of infants under 1 vear of age occurred in the Borough during the yeai'. This is equal to a rate of 72 per thousand births, and represents a decrease of 2 per 1000 as compared with the previous year. With one exception, this is the lowest number of Infant Deaths and lowest rate of Infantile Mortality hitherto recorded in any year. In Table 1, on page 104, the corresponding rates for previous years are given, and in Table 4, on page 110, the figures for each ward will be found. Attention is directed to Table 5, on page 111, which gives the infant mortality rates for England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns. It will be noticed that 18 of the London Boroughs had a lower rate of Infant Mortality and only 9 a higher rate than St. Pancras. The chief causes of Infant deaths during the year were Prematurity, etc., which was responsible for no less than 103 deaths out of a total of 230 from all causes ; Bronchitis and Pneumonia, from which diseases 57 infants died; Diarrhoea and Enteritis, which caused 45 deaths under 1 year of age; and Measles and Whooping Cough, from which 30 infants died. Deaths of infants from Prematurity and Congenital defects probably have little connection with their environment, as the majority of such deaths occur within the first few weeks of life. The other principal causes of death affecting infants and young children, namely Diarrhoea and Enteritis, Bronchitis, Pneumonia, Measles and Whooping Cough are, no doubt, to a considerable extent, accentuated by bad environment. At my request Dr. Back made an investigation with reference to infant mortality and overcrowding, and as to the percentage of children under 5 years of age dying from the diseases above mentioned and the conditions under which they were living. The result is as follows : — Figures based on the Census report of 1921, show that in St. Pancras in that year, 206 per cent, of the population were living under conditions of overcrowding, the definition of overcrowding used being that of the Registrar General, namely, more than two persons per room. This proportion (20 6 per cent.) is high and was exceeded in only 6 other Metropolitan Boroughs. It is shown in Table A that all these Boroughs have also higher average infant mortality rates for the 5 years 1920-1924. Table A. Boroughs, Percentage of Population living under overcrowded conditions. Average Infant Mortality Rates for 5 years, 1920-1924, Finsbury 33.3 77 Shoreditch 31.1 95 Stepney . 27.6 79 Bethnal Green 27.0 86 Bermondsey 22.6 87 Southwark 22.5 79 St. Pancras 20.6 72 1(5 17 It is obvious that many factors arc responsible for high infant mortality rates. The above figures show that overcrowding is one of some importance. Since 1921 more houses have been provided, but at the same time populations have increased. The extent to which this has occurred in the above-mentioned Boroughs is shown below in Table B. TAKLF, B. Boroughs. Increase of Population, 1921-1924. Number of houses completed between Jan. 1, 1922, and March 1,1926. State aided. Unassisted. Total.[/### Finsbury 1185 - 5 5 Shoreditch 2252 115 5 120 Stepney 4683 39 11 50 Bethnal Green 1962 166 4 170 Bermondsey 2648 43 2 45 Southwark 3310 — 9 9 St. Pancras 3234 254 168 422 The above table shows that more houses have been built in St. Pancras than in the six oilier boroughs put together, which is a matter for congratulation. There is, however, abundant evidence that overcrowding in St. Pancras is still a serious problem. Many of the houses built in the Borough have, in fact, done more to attract new residents than to relieve overcrowding. With the object of demonstrating what effect overcrowding still has on the health of children in the Borough, an analysis has been made of the deaths of children under 5 years of age, showing the relation of these deaths to housing conditions. During the two years 1924 and 1925 there were 949 deaths of children under 5 years of age in the Borough. It was possible in 434 cases to obtain particulars of the housing conditions, and it was found that 279, or 64'3 per cent., had occurred under conditions of overcrowding, as defined above. If this percentage figure is compared with the figure showing the percentage of the population living under overcrowded conditions in the census year 1921 (20*6 per cent.), the conclusion must be drawn that a large proportion of these "deaths would not have occurred if adequate housing accommodation could have been provided. This conclusion is borne out by the figures given in Table C, which shows the causes of death and percentages in children living under normal and under overcrowded conditions. Deaths from Gastro-Intestinal and Respiratory diseases may to some extent be regarded as preventable by adequate and sanitary housing conditions. Deaths from Developmental and other causes are not so much influenced by this factor. 18 Table C. Diseases. Total, Deaths of children under 5 years of age, 1924-1925 Housing conditions investigated. Overcrowded. Not overcrowded. Number, Per cent. Number. Per cent. G astro-intestinal 107 62 41 66 21 34 Respiratory (including Measles) 392 191 132 69 59 31 Developmental (and all other causes) 450 181 106 58 75 42 Totals 949 434 279 64.3 155 35.7 It will be seen that the proportion of deaths due to preventable diseases is much lower in the group of children who were not living under overcrowded conditions; in fact, these diseases are largely responsible for the difference in the number of deaths occurring under bad and good housing conditions. In the Tables on the next three pages arc shown : — 1. The causes of death of all children under 12 months of age during 1925, 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 ill 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 1925 and the five preceding years. 19 1925. Nett Deaths from stated causes at various Ages under 1 Year of Age. cause of death. Under 1 week. 1 —2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months aud under 6 months. 6 months and under 9 months. 9 months aud under 12 months. Total Deaths under 1 year. Small-pox Chicken-pox — — — — — — — Measles — — — — — 1 1 — — 2 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — 1 9 8 7 4 29 Diphtheria and Croup — — — — — — — — 1 1 Erysipelas 1 — — 1 1 — — 2 Influenza — — — — — 1 — — 1 2 Tuberculous Meningitis — — — — — 2 2 Abdominal Tuberculosis — — — — — — — — Other Tuberculous Diseases — — — — — 1 1 Meningitis {not Tuberculous) 1 2 1 — 4 Convulsions — — 1 1 — 1 1 1 4 Laryngitis — — — — - — — — — - Bronchitis 1 - — - 1 5 8 1 4 19 Broncho-pneumonia 1 — 3 — 4 7 12 2 9 34 Lobar-pneumonia - i — — 1 — 1 1 1 4 Pneumonia (type not stated) — — Diarrhoea — — — — — 5 3 1 — 9 Enteritis — 1 1 — 2 5 12 12 5 36 Gastritis — — — — — — 2 — — 2 Syphilis — — — 2 2 2 — 1 — 5 Rickets Suffocation (overlying) — — 1 — 1 2 1 — — 1 Injury at Birth 6 1 — — 7 — — — 7 Atelectasis 2 — — 2 — — — — 2 Congenital Malformations 8 4 — — 12 5 2 1 — 20 Premature Birth 42 7 31 i 53 4 — — — 57 Atrophy, Debility and Marasmus 2 — - 3 5 4 6 2 17 Other causes . — — 1 1 2 2 3 6 4 17 Totals 62 15 9 9 95 54 62 36 33 280 Nett Births in the year legtimate 3637 Nett Deatha in the °f * Germam Measles. (legitimate infants 251 I illegitimate infants 29 Deaths from Stated Causes under 1 Year of Age for 1925 and 10 preceding Years. CAUSE OF DEATH. 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 Average for 10 years. 1925 Small-pox — — - - - - - - Chiclien-pox 1 — - — — - - - - Measles 17 14 30 16 4 21 7 15 1 15 14 2 Scarlet Fever — - - — 1 — — 3 - Whooping Cough 24 15 14 '27 2 18 18 11 8 13 15 29 Diphtheria and Croup — 2 1 1 — 2 2 1 1 Erysipelas 2 — 1 1 — — — 1 1 2 1 2 Influenza - 1 - 18 11 2 2 7 — 6 5 2 Tuberculous Meningitis 8 5 4 8 4 6 4 3 4 3 5 2 Abdominal Tuberculosis 1 1 2 1 1 — 1 1 1 1 — Other Tuberculous Diseases 6 5 7 3 2 2 3 7 2 4 1 Meningitis (not Tuberculous) 8 7 10 3 6 7 3 2 3 5 5 4 Convulsions 5 9 5 3 6 7 5 8 5 4 6 4 Laryngitis 1 — 1 — — — — — 1 - Bronchitis 27 17 16 17 23 27 13 21 12 12 18 19 Broncho-pneumonia 57 10 17 29 24 60 39 54 34 51 43 34 Lobar-pneumonia 3 1 4 6 1 5 1 3 1 3 3 4 Pneumonia (type not stated) & g 9 9 8 4 3 6 1 3 6 - Diarrhoea 15 6 8 6 10 11 11 4 6 6 8 9 Enteritis 64 35 52 31 37 26 63 27 37 46 12 36 Gastritis 3 2 4 1 3 2 2 — 1 — 2 2 Syphilis 9 14 16 13 11 15 14 8 5 2 11 5 Rickets 1 4 2 - — 1 1 1 — — 1 - Suffocation (overlying) 8 9 13 6 1 2 2 5 1 1 5 4 Injury at Birth 10 4 3 2 6 5 3 3 6 4 5 7 Atelectasis 6 9 9 8 7 10 8 4 9 7 8 2 Congenital Malformations 25 34 19 17 31 33 25 31 27 23 26 20 Premature Birth 92 75 61 50 68 105 75 61 70 59 72 57 Atrophy, Debility and Marasmus 47 43 44 46 45 40 34 28 21 21 37 17 Other causes 48 24 20 18 24 24 18 23 15 14 23 17 Totals 497 385 102 340 336 435 360 337 272 303 367 280 Neit Birth 4754 45.30 3796 3318 3824 5934 4761 1559 1348 1112 4391 3880 30 Table showing Deaths ok 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 Diarrhcea 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. U ndei 1 year. 1 to 2 years. 2 to 5 years. Under 1 year. 1 to 2 years. 2 to 5 years. U nder I week. Total under 4 weeks. Total under 1 year. 1920 5934 435 99 91 625 37 5 2 39 50 30 96 21 9 101 141 193 1921 4704 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 1925 3880 280 73 81 434 45 3 1 30 19 20 57 29 14 60 79 103 21 22 Economic Conditions. The amount of out-relief granted during the past 9 years is indicated in the following table (kindly supplied bv 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-Vear ending Amount spent in the half year. Numbers chargeable in the middle weelt of the half-year. £ Michaelmas, 1917 3079 871 Lady day, 1918 3382 852 Michaelmas, 1918 3461 771 Lady day, 1919 3814 754 Michaelmas, 1919 4537 823 Lady day, 1920 6146 899 Michaelmas, 1920 8161 1079 Lady day, 1921 13081 1660 Michaelmas, 1921 21400 3529 Lady day, 1922 40081 6429 Michaelmas, 1922 34591 6325 Lady day, 1923 34193 6425 Michaelmas. 1923 28312 5489 Lady day, 1924 31690 5290 Michaelmas, 1924 26607 4723 Lady day, 1925 26766 4319 Michaelmas, 1920 31290 4267 Lady day, 1926 36061 5427 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 1st, 1924 1029 January 1st, 1925 1146 July 1st, 1925 1110 January 1st, 1926 1130 2.3 Hospital Accommodation, "With the exception of the two hospitals of the St. Pancras Guardians, the use of the hospitals in St. Pancras is by no means confined to the residents in the Borough, They are rather London than St. Pancras institutions, especially on the in-patient side, and many of them receive patients even from beyond the metropolis. On the other hand, hospitals outside of the . Borough are largely used by St. Pancras residents. The following table has been constructed from figures kindly supplied by the secretaries of the various institutions, to show the work done by the hospitals in St. Pancras, without reference to the home addresses of the patients. Hospitals. Number of Beds. Number of in-patients admitted, 1925. Number of new outpatients treated in 1925. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 404 2539 Highgate Hospital, Dartmouth Park Hill 554 2427 - Metropolitan Asylums Board Hospital. St. Margaret's Hospital, Leigliton Road (for ophthalmia neonatorum) 51 302 — Voluntary Hospitals. University College Hospital, (lower Street 345 5175 73853 Royal Free Hospital, Gray's Inn Road 240 4504 14512 London Temperance Hospital, Hampstead Road 120 1047 13198 Elizabeth Garrett Anderson Hospital, Euston Road 75 1513 11179 West End Hospital for Nervous Diseases, Regent's Park 80 526 4587 Hospital for Tropical Diseases, Endsleigh Gardens 58 622 — Central London Throat, Nose and Ear Hospital, Gray's Inn Road 43 1022 10877 Central London Ophthalmic Hospital, Judd Street 40 644 14320 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 608 3581 St. Saviour's Hospital, Osnaburgh Street 21 t North-West London, Bayham Street 128 1655 16267 St. Pancras Dispensary, Oakley Square - - 2587 London Skin Hospital, Fitzroy Square - Western Skin Hospital, Hampstead Road — - 1740 British Dentists' Hospital, Camden Road 540 | Hospital temporarily closed. § Not including the work of the Tuberculosis Dispensary (see page 61), but including the clinic for mothers and young children (see page 38). Information not to hand. Health Week. This was observed during the week commencing October 4th, and the following report with reference to the arrangements which were made was presented to the Council, through the Public Health Committee, 24 14th October, 1925, To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, Health Week—October 4tli to 10th. During the week above mentioned leaflets on a variety of health subjects was distributed to nearly every house in the Borough. This procedure ensured far more publicity, and reached a far greater number of people than had been secured in previous years by means of lectures, etc., in the Town Hall. Altogether over 100,000 leaflets were distributed. With the object of stimulating interest in the leaflets in the homes and to ensure their perusal, His Worship the Mayor generously offered a number of prizes to children attending the elementary schools in the Borough for the best essay on any one of the leaflets. The head teachers of the boys' and girls' departments cordially supported this suggestion and supervised the writing of the essays. They also agreed to select and forward to me the three best essays from each school. From these the prize winners were chosen. The work of preparation and distribution of the leaflets was very great. The whole of the clerical staff of the department worked very hard in getting the leaflets ready and arranging them in bundles for each street. A number of voluntary workers also rendered assistance. The scheme could not, however, have been carried out but for the assistance of Councillor Bev. Conyers Morrell, M.A., who very kindly organised a staff of 100 boys from his Church Lads' Brigade, and these, under his supervision, undertook the task of delivering the leaflets. Assistance was also given by the 2nd St. Pancras Troop of Boy Scouts under Mr. H. Van Winsen, and Mr. Gerrard, of the St. Pancras Cadets. Two meetings were also held during Health Week. One, for senior school children, took place at the St. Pancras House of Fellowship, His Worship the Mayor, presiding, and Councillor Dr. Gregg and Councillor Mrs. Alliston and others spoke. This was a very successful meeting, between 500 and 600 persons being present. The other meeting for both parents and school children was arranged by Mr. Suffling, Headmaster of the Brecknock School, and at this an address was given by Dr. Vawdrey, School Medical Officer. I am, etc., G. Sowden, Medical Officer of Health. In addition to the above your Medical Officer of Health prepared a booklet on the various public health activities of the Borough Council, together with other local information likely to be useful to members of the profession, and this was printed and circulated to all medical practitioners in the Borough. National Rat "Week. Rats and Mice (Destruction) Act, 1919. The Ministry of Agriculture and Fisheries issued a notice suggesting that the above should he observed during the week commencing November 2nd, 1925. This suggestion was accepted and the measures enumerated below were adopted : — (a) A circular was forwarded to the occupiers of all premises particularly likely to be infested—such as railway sheds and sidings, goods yards, wharves, slaughter-houses, corn chandlers, etc. Attention was also called to the necessity of abolishing refuse and rubbish heaps of all kinds. (b) The chemists and hardware dealers in the Borough were asked to stock, exhibit, or advertise suitable raticides, traps, etc., during the week. 25 [c) The Borough Engineer kindly oo-operated ns regards premises and sewers, etc , under the control of the Council. Two hundred-weights of rat bait were laid in 270 places in the sewers. (d) A leaflot on the subject was prepared by the Medical Officer of Health for general distribution, but copies were specially circulated where action was considered to be most necessary and valuable. Section II.—MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 12, 13 and 16 to 21 of this report. The Borough scheme for Maternity and Child Welfare includes the following activities:— (a) The dispatch by post of cards of advice to the individual mothers immediately after the receipt of the notification of birth required by law. (/>) The visiting of expectant and nursing mothers and babies by the Council's staff of health visitors, who work (a) from the Town Hal] 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. (/) The subsidisation of a Home for ailing young children. (g) The supply of milk, free or at reduced price, for necessitous mothers (nursing or expectant) and young children ; and the subsidisation of a voluntary fund for the provision of dinners for nursing and expectant mothers. (h) The subsidisation of a voluntary fund for the provision of Home Helps. (i) The subsidisation of the three voluntary Day Nurseries in the Borough. (J) The subsidisation of voluntary agencies providing, either free or at a reduced rate, in hospital or at home, midwifery attendance for necessitous St. Pancras women. (k) The payment for the home nursing of sick infants in certain cases. (/) A Centre for Artificial Sunlight treatment. (m) The visiting and supervision of necessitous children under 5 years of age upon discharge from the Borough Poor Law Hospitals. The work done in 1925 in connection with the scheme will now be referred to in detail:— Advice Cards.—Besides the posting of cards of advice to the mothers of all infants whose births have been notified, cards of advice to expectant mothers have been distributed through University College Hospital, Middlesex Hospital, the Maternity Nnrsing Association, and other agencies. 26 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 1925 made 1200 visits to 131 infants (apart from visits made to cases of measles and for other special purposes). They also made 2-54 visits to 113 expectant mothers. The last mentioned activity (" in " in the above list) was initiated during the year, and was rendered possible by the co-operation of the Medical Superintendents, who agreed to supply a weekly list of children discharged from their respective institutions. The work is proving valuable, as advice and assistance during convalesence are not only frequently necessary, but in many cases help to prevent a relapse or recurrence of the illness for which the child was originally admitted to hospital. The Council's visitors at the Infant Welfare Centres, 20 in number, are full-time workers, who divide their time between the necessary work at the Centres and visiting the homes of the mothers and children. In addition there was one full-time trained worker, not paid by the Council, at the Caversham Road Centre, and one part-time trained voluntary (unpaid) worker at the Chalton Street and Grafton Road Centres. There were also two trained visitors at the University College Hospital Centre, who worked in neighbouring boroughs as well as in St. Pancras, and whose salaries were paid by the hospital authorities, and not by the Council. During 1925 the Council's staff at the various Centres made 42,427 visits to 3,476 children, and 4,388 to 1711 expectant mothers; the trained workers not paid by the Council made 11,920 visits to 935 children, and 337 visits to 183 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 113 254 131 1200 Centre Staff, paid by Council 1711 4388 3476 42427 Trained Centre staff, not paid by Council 183 337 935 11920 Total of all trained workers 2007 4979 4542 55547 Corresponding totals for 5 previous years— 1924 1921 4021 4571 53884 1923 2084 4953 5401 52759 1922 2342 4770 6194 50347 1921 2547 5730 7200 53547 1920 2158 5005 8502 44498 27 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 — - - — - — - — 113 — 251 — 131 - 1200 - - - - - - - 5t. Pancras School for Mothers— Ampthill Square 191 701 301 54 355 3143 3185 6328 382 — 1039 — 578 - 12785 — 19 (1) 246 4 48 4 - Chalton Street 58 259 173 18 196 2383 24)44 4427 261 — 572 60 3-23 - 4300 1643 12 1 145 1 13 2 1(2) North St. Pancras School for Mothers, Queen's Crescent 97 234 347 35 332 4532 3099 7631 75 — 378 — 530 - 4891 — (3) 18 217 2 23 3 - South Highgate Centre — — 81 24 105 1365 1041 2406 17 — 29 — 122 — 990 — 8 98 — — - - Grafton lload Centre 57 189 223 34 257 2753 1988 4741 129 — 456 - 343 17 5290 1172 13 157 1 11 - 1(2) M iry Ward Settlement School for Mothers 16 65 135 31 166 1947 1568 3515 91 - 158 - 251 — 1653 - 12 145 — - 1 — Crtitfden Town Centre, Camden Road 86 199 320 38 358 3692 1881 5573 358 - 755 — 680 — 5602 — 16 187 2 23 3 - Afgyle Square Centre 47 91 126 21 147 1390 480 1870 62 — 364 — 189 - 2620 — 5 61 1 12 1 Caversham Road Centre 83 485 271 7 278 3842 1379 5221 83 4 244 15 176 153 2397 2507 (4) 12 142 4 48 2<5) — (6) Maternity Nursing Association, Oakley Square 140 155 173 5 178 2082 1514 3596 — 179 _ 262 129 110 1282 794 8 96 1 12 1 — University College Hospital 1111 3276 — — 614 — — 3355 - — — — — 655 — 5804 8 102 4 49 — —(7) Royal Free Hospital Gray's Inn Road 290 1079 85 54 139 487 320 807 250 — 393 — 150 - 614 - 8 103 16 207 — 2 Totals 2176 6736 — — 3175 — — 49470 1824 183 4642 1 337 3607 935 43627 11920 139 693 36 451 20 — (1) January to May, 23 consultations per month. (2) Voluntary trained worker. (3) 319 visits were made by unqualified students. (4) In addition to 96 visits by untrained voluntary workers. (5) In addition to 1 full-time trained voluntary worker. (6) Year ended 31st March, 1926. (7) Paid by hospital, and not by Council. 2S Maternity anii Child Welfare Centres, These are 12 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 activities associated with the work of each Centre. The Council has representatives on each committee, and each committee sends ono representative to the Council's Maternity and Child Welfare Sub-Committee. The Centres at University College Hospital and the Royal Free Hospital are not subsidised by the Council. The table on page 27 gives statistics concerning the work of all the Centres during 1925. It, will be seen tbat 1,699 infant consultations and 451 ante-natal consultations were held during the year. The children who attended for the first time numbered 3,175. The total attendances of all children was 49,470, as compared with 51,292 in 1924, and 55,265 in 1923. The total attendances of expectant mothers numbered 6,736, as compared with 8,653 and 6,389 in the two preceding years. Details concerning the work, together with some of the special activities of the individual Centres, arc 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. Classes for Mothers. At infant care classes there were 622 attendances; ante-natal care, 344 attendances; and at needlework, etc., classes, 774 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,953 dinners wore supplied to nursing and expectant mothers, and 2,921 to young children. Observation Dai/ Nursery. This is for children needing special care. There were 1,746 attendances during the year, of which 708 were made by infants under ono year of ago, and 1,038 by children over one year. Massage Clinic. 91 consultations were held, at which 792 attendances were recorded. There were 60 new cases. 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 35 consultations were held, at which -)25 . Details of the work done are "riven in the following table :— Mothers. Children. Extractions with anajsthetics 36 23 „ without anaesthetics 2 17 Fillings 63 135 Scalings 27 — Impressions and fitting dentures, etc. 68 — Examinations 30 124 Totals 226 299 '26 Interviews with parents bv the Superintendent, other than at elinies or classes, numbered 5,957. Early in the year the attention of the Committee of this Centre was directed to the reduction which had taken place in the average attendance at the infant consultations. The matter was considered by them, and a letter was forwarded to the Council, stating that they have considered the low average attendances at the infant consultations at the Ampthill Square Centre, and expressed the opinion that the number of babies dealt with by that Centre does not justify five weekly infant consultations. They advise that Dr. Jessie Muir's weekly Wednesday morning infant consultation should be closed, and that she should be paid for the one " toddlers " consultation a month, which she has hitherto held voluntarily. The Committee state that they appreciate the help which the Borough Council have given them with the extra consultation during the years of high birth-rate following the war, and they are glad to be able to reduce their expenditure now. On April 22nd, 1925, the Council decided that the proposal to discontinue the weekly Wednesday morning infant consultation at the Ampthill Square Centre be approved, and that the Council do take over the financial responsibility of the one " toddlers " consultation per month held by Dr. Jessie Muir at that Centre. Argyle Square Centre. This Centre makes little progress as regards numbers, and the amount of work is quite inadequate to fully occupy a full-time worker. The total number of new cases (children) during the year was 147, the corresponding figure for the previous year being 140. The total number of visits paid to children was 2,620. Only one consultation per week for infants is held. Mary Ward Settlement School for Mothers. This also is a small Centre, and the duties are insufficient to fully occupy a full-time worker. The total number of new eases (children) was 166, and the total number of visits paid to children was 1,653. It will be noted that at the Argyle Centre, with a smaller number of cases, nearly 1,000 more visits were paid. The Mary Ward Centre has been a joint one with the Borough of Holborn, and as this Authority had notified its intention to withdraw as from December 31st to a new Centre within its own Borough, the St. Pancras Borough Council decided to transfer on the same date, their portion of the work and staff to the Argyle Square premises. These were suitably situated, though expensive to maintain owing to the small number of consultations. The amalgamation will help to reduce the cost. Further details as to this amalgamation will be found on page 31. At the request of the Mary Ward Committee the Council agreed to defer the transfer and amalgamation until March 31, 1926. Camden Road Centre. The number of new cases at the ante-natal consultations shows an increase, and the number of new cases (children) was exactly the same as in the previous year. 90 massage clinics were held during the year, the attendances at which numbered 840. A needlework class is held on alternate weeks. Cavbrsham Road Centre. The total number of new cases during the year was 361, the corresponding figure for the previous year being 401. The decrease affected both expectant mothers and children. 30 A number of consultations were held, the cost of which was defrayed out of funds from voluntary sources. The cost of a full-time trained worker was similarly met. 47 classes were held during the year on various subjects, the average attendance being 11. A number of mothers and children were sent away on holiday or to convalescent homes, the St. Pancras Women's Holiday Fund assisting in this work. Trained voluntary workers paid 15 visits to expectant mothers and 2,507 to children. Chalton Street Centre. In addition to the usual consultations, massage clinics were held, the attendances at which numbered 394. Attendances at sewing, etc., classes were 537, and at 25 of the sewing classes Health talks were also given. Interviews with parents bv the Superintendent, other than at classes or clinics, numbered 3,278. Voluntary trained workers made 60 visits to expectant mothers and 1,643 visits to children. Grafton Road Centre. A voluntary consultation for children from 2 to 5 years of age is held monthly. 15 Mothers and 25 children were sent on holiday with the help of funds from the St. Pancras Women's Holiday Association. 1,197 Free Dinners were given to nursing or expectant mothers, with the assistance of members of the Voluntary Committee. A large number of suitable woollen garments were supplied at cost price to necessitous mothers. 17 visits were paid to expectant mothers, 1,172 to children, by a Voluntary Trained worker. North St. Pancras School for Mothers, Queen's Crescent. The number of new cases (expectant mothers) shows a decrease as compared with the previous year, but this is the case at the majority of the centres, and is to be expected owing to the lower birth-rate in the Borough. In addition to the consultations, provided by the Borough Council, two voluntary consultations for children from 2 to 5 years of age were held each month. Health talks were given, the attendance numbering 275. Oakley Square Centre. The number of new cases shows an increase as compared with the previous year. 16 mothers aud 23 children were sent for a fortnight's holiday, the greater part of the cost being raised voluntarily. South Highgate Centre. The total number of new cases was 105, as compared with 80 for the previous year.The number of attendances was also greater. 31 Needlework classes were held oil alternate Tuesday afternoons, the attendances at which numbered 96. The Artificial Light Clinic, which was started in February, 1925, is held at this centre, and although assistance at the consultations is given by health visitors from other centres, the work of the Superintendent, Miss Bristow, has been enormously increased by the initiation of this special work. I wish to place on record the admirable spirit with which Miss Bristow has undertaken this additional duty, and the excellent manner in which she has performed it. The report on the work of the Artificial Light Centre will be found on page 34. Propose]) re-organisation of Maternity and Child Welfare Work. It having been reported to the Maternity and Child Welfare Committee that, owing to the diminished birth-rate in the Borough, and also in view of the contemplated demolition of the Chalton Street Centre, and the unsuitable situation of certain other centres, it appeared to be desirable to consider if some centralisation of this work would not conducc both to efficiency and economy. The Committee requested your Medical Officer of Health to report ujjon the matter, and the following report was submitted :— To the Chairman and Members of the Maternity and Child Welfare (Advisory) Sub-Committee. Ladies and Gentlemen, In accordance with the resolution of the Committee, I beg to report on the question of amalgamating certain of the Maternity and Child Welfare Centres. At the present time there are ten Centres in the Borough. The number of staff at each Centre varies from one to four, and the number of consultations varies from six to twenty-four per month. Despite these variations in number of staff, number of consultations and amount of responsibility, all superintendents are of equal rank and receive equal remuneration. The smaller Centres, especially those staffed by one worker, are proportionately more expensive to maintain, and are also more difficult to work. As regards expense, such items as rent, rates, taxes, salaries, etc., are fixed charges, irrespective of the number of consultations which are held. Where the staff consists of one worker only, any sudden illness or absence causes considerable difficulty, and temporary staff has to be obtained. Such an occurrence is easily dealt with at large Centres which have a more numerous staff. In suggesting any combination of Centres, it is necessary to bear in mind the convenience of the mothers and the distance they would have to travel. Centres should be adequately equipped and large enough to work easily, and yet not too far apart to cause inconvenience to those attending. The map produced shows the position of the existing Centres. At the present time I would not suggest any change as regards the Centres at South Highgate, Queen's Crescent, Caversliani itoad and Amphill Square, and as regards the Mary Ward and Argyle Square Centres, these have recently been merged by resolution of the Council. This leaves for consideration the Centres at Grafton Road, Camden Road, Oakley Square and Chalton Street. The premises at Chalton Street are situated in an area which is to be cleared in consequence of the London County Council Housing Scheme, and new premises therefore will have to be secured. The present positioii of this Centre is not good ; a better situation would be in a position farther north ; this would bring it close to the Oakley Square Centre. I am therefore of opinion that these two Centres (Chalton Street and Oakley Square) can well be merged when a favourable opportunity occurs. With reference to the Grafton Road Centre, the premises are inadequate, and as regards situation too near the Caversham Road Centre. The accommodation at Grafton Road comprises one large room and a very small one for the Doctor. The one large room has to serve the purpose of waiting room, weighing room, dressing room, etc. This is very inadequate, especially as regards ante-natal work. A much better situation for this Centre would be farther south. This would bring it fairly close to the Camden Road Centre. I am therefore of opinion that, at a favourable opportunity, the Grafton Road and Camden Road Centres should be merged into one building on a site about midway between these two Centres. 32 Amalgamations on the above lines would effect economy in rent, working expenses and staff. At the same time more adequate and convenient buildings might be obtained. It is difficult to estimate the economy in rent and working expenses until suitable buildings are secured. As regards staff, the Ministry of Health suggest one Health Visitor for every 400 births. The number of births in the Borough is about 4,000 per annum, and the rate is decreasing. According to the scale mentioned, a staff of 10 Health Visitors is necessary. At the present time the total Centre staff number 20—of these 10 are Superintendents and 10 are Assistants— this large staff to some extent being required owing to the number of small Centres. It is probable that some further economy would result from the proposed grouping, as the attendances at the consultations would be more uniform, and probably one or two consultations might be dispensed with. The table attached gives for each Centre details as to Staff, number of attendances, number of visits, total cost, etc. A study of this table shows the wide variations which at present exist. It is not suggested that any change is possible at the moment; but, if after consideration the Committee is of opinion that the policy indicated is desirable, and this policy is approved by the Council, the proposed changes might be adopted as and when opportunity arises. I have, etc., G. Sowden, Mcdical Officer of Health. Maternity and Child Welfare Centres. Bet urn of work done during 52 weeks ended 28th November, 1925, and Statement of Annual Cost on present basis. Centre. Staff. New Cases sent to Centre. Total Visits. Consultations. Annual Cost. A verage Cost per Consultation. Average Cost per Attendance. No. Held. Total Attendances. Average Attendance. £ £ s. d. s. d. Ampthill Square 4 1015 13890 266 6497 24 1392 5 9 7 4 3 Chalton Street 2 645 4949 156 4812 31 778 4 19 9 3 3 Queen's Crescent 3 591 5237 216 7343 34 1123 5 4 0 3 1 Grafton Road 2 562 7495 155 4812 31 689 4 8 11 2 10 South Highgate 1 201 1321 96 2423 25 530 5 10 5 4 4 Mary Ward 1 347 2212 143 4599 32 412 2 17 7 1 10 Camden Town 3 1102 7728 214 5734 27 1013 4 14 8 3 6 Argyle Square 1 258 3185 72 1785 25 481 6 13 7 5 5 Caversham Road 2 430 2469 128 3843 30 746 5 16 7 3 11 Oakley Square 1 120 1815 107 3957 37 471 4 8 0 2 5 20 5271 50301 1553 45805 29 7635 4 19 1 3 4 Attendances at Voluntary Consultations and visits by Voluntary Workers are $xcluded. 33 An additional reason for the amalgamation of certain of the centres and for a centralisation of this work is afforded by the great variation in method which exists at present. To some extent this is probably due to the origin of the centres; these were started by voluntary workers who, doubtless, had their own views as to the manner in which the work should be carried out. The Superintendents of each centre also vary somewhat in their procedure, but to a certain extent work in the lines initiated by the voluntary committees who still manage each centre. The following tabie gives the number of new cases at each centre, the number of attendances, and the number of visits paid by the staff during the past five years:— MATERNITY AND CHILD WELFARE SCHEME. Number of New Cases, Attendances and Visits at each Centre during five years (1921-1925)). Attendances at Consultations. expectant mothers. children. Centre. New cases. Attendances. Centre. New cases. Attendances. Total. Average No. per case. Total. Average No. per case. Caversham Road 283 1317 4.7 South Highgate 432 10001 23.2 Chalton Street 309 1224 4.0 Chalton Street 1059 24252 22.9 Grafton Road 193 768 4.0 Ampthill Square 1769 36457 20.6 Ampthill Square 978 3105 3.2 Mary Ward 725 14335 19.8 Mary Ward 145 449 3.1 Queen's Crescent 2114 40912 19.4 Argyle Square 69 191 2.8 Caversham Road 914 16858 18.4 Camden Town 510 1330 2.6 Oakley Square 1179 21590 18.3 Queen's Crescent 644 1571 2.4 Grafton Road 1445 22673 15.7 South Highgate 41 100 2.4 Camden Town 2003 30255 15.1 Oakley Square 727 830 1.1 Argyle Square 422 5445 12.9 Visits (Including visits bv Voluntary trained workers). EXPECTANT MOTHERS. CHILDREN. Centre, New cases. Visits. Centre. New cases. Visits. Total. A verage No. per case. Total. AverEge No. per case. Argyle Square 69 786 11.4 Chalton Street 1059 36747 34.7 Chalton Street 309 3469 11.2 Ampthill Square 1769 53451 30.2 South Highgate 41 358 8.7 South Highgate 432 7743 17.9 Grafton Road 193 1463 7.6 Caversham Road 914 15269 16.7 Ampthill Square 978 5880 6.0 Grafton Road 1445 23292 16.1 Mary Ward 145 870 6.0 Mary Ward 725 11187 15.4 Camden Town 510 2892 5.7 Argyle Square 422 6157 14.6 Caversham Road 283 1103 3.9 Queen's Crescent 2114 23445 11.1 Queen's Crescent 644 1630 2.5 Oakley Square 1179 11866 10.1 Oakley Square 727 1518 2.1 Camden Town 2003 19247 9.6 34 The figures in the above tables in respect of Argyle Square and Caversham Road Centres are for three years only (1923-1925). With reference to expectant mothers, it will be seen that the attendances varied from 1.1 to 4.7 per case, the visits paid to these mothers varied from 2.1 to 11.4 per case. As regards children, the number of attendances per child varied from 12.9 to 23.2, and the visits to the homes range from 9.6 to 34.7 per child. Too strict a uniformity may not be advisable, but variations so great would appear to be undesirable and steps are to be taken to remedy this. Artificial Light Treatment. A centre for providing this treatment was opened on February 24th, 1925, a lamp, giving the necessary rays, having been presented to the Council by the Committee of the "Save the Children Fund. In June, an anonymous donor presented two lamps of improved type, and this generous gift has made it possible to treat a larger number of children, and there is no longer the delay in dealing with cases which unavoidably existed when one lamp only was available. This was the first Municipal Light Centre to be opened in the Metropolis, and it has been visited and inspected by representatives of many other authorities who contemplated opening similar centres. In July, at the request of the Executive Committee of the National Baby Week Council, permission was given for a large number of members and delegates of the School of Maternity and Child Welfare to visit the centre. The following report which has been presented to the Council gives particulars concerning the centre and the work carried out from the date of opening up to December 31st, 1925:— To the Chairman and Members of the Maternity and Child Welfare Sub-Committee. Ladies and Gentlemen, I beg to submit the following report on the work carried out at the Artificial Light Clinic at South Higligate, from its commencement on February 24th to December 31st, 1925. The Clinic was opened in order to provide this special treatment for children of the Borough who were suffering from Rickets, Tuberculous Glands, Incipient Tuberculosis, Delayed Development, Debility or other affections for which this form of treatment is indicated. The children are selected from those who are attending the various Welfare Centres. Medical Practitioners can also recommend suitable cases. As the work forms part of the Child Welfare Scheme, it is necessarily limited to children under 5 years of age. Staff.—Dr. William Beaumont, m.r.c.s., l.r.c.p., is in charge of the treatment. Prior to his appointment, he had experience in this work when acting as Clinical Assistant in the Light Department of the London Hospital. The nursing staff consists of the Superintendent of the Centre, Miss G. R. Bristow, who is assisted during the consultations by two Health Visitors from other Centres. Lamps.—There are now three in use. One is a "Westminster" single open carbon arc, working at 28 amps, across the single arc, and was presented by the Committee of the "Save the Children" Fund; it has been in use since the opening of the Clinic. 35 The other two are "Alpine Sun" quadruple open carbon arc lamps, working at 16 amps, across each arc, and were presented by an anonymous donor in June, 1925. The current is direct, and the voltage 220. Treatment.—Consultations of two hours' duration are held on Tuesday, Thursday and Saturday from 11 to 1. From the opening of the Clinic until December 31st, 1925, 118 consultations have been held, 119 patients have been treated, and the attendances have numbered 2,559. Up to the beginning of July, with only one lamp in use, the average attendance at each session was 15. Since then, with three lamps, the average attendance has been 27. All patients, of whatever clinical type, receive as a routine three exposures a week. Those exposed to the Alpine Sun Lamps begin with 5 or 10 minutes, and this is increased to 20 minutes at each exposure. The time of exposure to the Westminster Lamp gradually increases from 20 to 60 minutes. The total number of exposures given to a patient has varied from 15 to 70 according to the disease, the reaction and the degree of improvement obtained. The number of patients treated, grouped according to their diseases, is shown in the following table:— Disease. Number Treated. Remarks. Rickets 48 Indicated by bone manifestations. Late eruption of teeth. Delayed closure of Anterior Fontanelle. Alimentary manifestations. Tuberculosis— Incipient 6 Patients losing weight, with occasional febrile attacks, general malaise, hectic pink and white complexion and rapid pulse were regarded as having Incipient Tuberculosis. Glandular 3 Bronchial Affections 20 These patients had repeated colds and attacks of bronchitis, but did not have large tonsils and adenoids or other obvious causes of this condition. Nervous Instability 8 Sleepless, peevish children, but without signs of rickets, tuberculosis or mental deficiency. Delayed Development 11 Children with delayed teething, walking or talking and with slow mentality, but without other signs of rickets. Debility 23 Children whose nutrition is below normal, but who do not fall into any other group. Total 119 The following table gives particulars as to cases and attendances, and indicates the Centres from which the children were sent:- 36 Artificial Light Clinic. Centres from which cases were referred. Number of Cases. Number of Attendances. Argyle Square 11 140 Camden Road 4 175 Caversham Road 51 1039 Grafton Road 12 212 Mary Ward 7 181 Queen's Crescent 2 39 South Highgate 22 690 Non-Centre cases 10 83 Totals 119 2559 The total number of consultations held was 118. Clinical observations and results. Temperature.—This is taken in the groin before and after each treatment. The temperature of the skin after exposure is never found to be above normal, provided a few minutes elapse before it is taken. Sub-normal pre-exposure temperatures tend to become normal during a course of treatment. Pulse.—The pulse records have little clinical significance owing to the fact that most of the patients are babies whose pulses vary considerably for reasons unconnected with the treatment. Blood pressure, X-ray, and photographic records have not been made. Weights.—These are recorded for each patient once a week. It has been found that over-fat, flabby children lose weight until normal, and then maintain a normal increase. Children who are under weight gain steadily after three or four exposures. Mental condition.—One of the most striking and often the first effect of the treatment is to make a dull child bright and alert. Local lesions.—The only local lesions treated have been tubercular glands. These have been observed to disappear after six exposures. Skin reactions.—Patients have been grouped according to colour and texture of hair colour of skin. It has been found that children apparently in the same group react quite differently, so that it is necessary to give separate attention to each case in order to regulate dosacre. The total cost from the opening in February up to December 81st, 1925, has been as follows:— £ s. d. Fitting up of Centre 100 13 3 Electric Current 13 16 6 Cleaning 8 16 0 Postage and stationery 1 13 9½ Thermometers 1 5 0 Miscellaneous 5 19 8 Consultation fees (Dr. Beaumont) 78 15 0 Total £210 19 2½ 37 Omitting thE cost of fitting up the Centre, the average cost per child has been 18s, 6d, (eighteen shillings and sixpence) and the average cost per attendance 10d. (tenpence). Dr. Beaumont gave his services free of charge for the first six months, but a fee of 1½ guineas per consultation has been paid since September 1st, 1925. The average cost, therefore, during the first six months was less than it will be in future. Assuming the doctor's fee had been paid throughout the entire period, the average cost per child would have been £1 16s. 6d. (one pound, sixteen shillings and sixpence), and the average cost per attendance 1s. 8d. (one shilling and eightpence). No part of the salary of the Superintendent has so far been allocated to this particular work, the duties being performed as part of the work of the Welfare Centre. The average cost of current per hour with all three lamps working is about one shilling. With better organisation it has recently been found possible to treat from 35 to 40 children at each consultation. If this average can be maintained, the cost per attendance and per child should show a reduction in future. The clinical details in this report have been based on notes supplied by Dr. Beamont, who states that his general impression of the ten months' work is good, the results have been gratifying, and in some cases exceptionally so, both for rapidity of action and permanence. He considers the work of the Artificial Light Clinic will have real and lasting value, and has immense possibilities. I am, etc., G. Sowden, Medical Officer of Health. The Borough Council's Denial Clinic, 40, Arygle Square. At this clinic dental treatment is provided for mothers and children who attend the various Maternity and Child Welfare Centres in the Borough. Consultations had been held twice weekly (on Monday and Wednesday), but owing to the steady increase in the number of patients this amount of time proved to be insufficient, and since March 30th, 1925, an additional consultation has been held on alternate Fridays. No charge is made for extractions, fillings or scaling; but the patients are expected to contribute what they can reasonably afford towards the cost of dentures. The work done during the year is summarised in the following table, the figures for the two previous years (1923-1924) also being given for comparison:— Work carried out at the Dental Clinic. 1923. 1924. 1925. Number of new cases Mothers 234 221 233 Children 143 145 213 Total 377 366 446 Number i of Attendances For extractions under nitrous oxide (gas) 287 306 369 ,, ,, local anæsthesia 150 118 100 ,, fillings and dressings 296 300 301 „ sealing 62 67 47 „ impressions and fitting dentures 506 490 571 „ examination and advice 458 477 634 Total attendances 1759 1758 2022 Total number of clinics held 96 96 111 Number of clinics with nitrous oxide anæsthesia 23 24 24 38 The following table shows the number and cost of the dentures supplied during the year:— Number of Patients supplied with dentures 97 Total cost £334 Proportion paid by mothers 729 per cent. Proportion paid by Borough Council 9.1 „ Proportion paid by various Societies 18.0 „ 24 mothers paid the entire cost of two dentures each. 22 mothers paid the entire cost of one denture each. The Societies who made contributions towards the cost of dentures were the Metropolitan Hospital Sunday Fund, £35 10s.; the Metropolitan Hospital Saturday Fund, £12 10s., and various other societies (chiefly through the Charity Organisation Society), £7 10s. The general supervision of the work as regards attendances, collection of contributions, etc., continues to be efficiently carried out by Miss C. Smith, one of the Council's Women Inspectors. Dental treatment is also provided at the voluntary clinic, which is held at the St. Pancras School for Mothers, see page 28. The Centres held in connection with the University College and Royal Free Hospitals are also able to refer cases needing dental treatment to the Dental Departments of their own Hospitals. Clinic fok 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 1925 new cases under five years of age numbered 211, ailing mothers 30, and expectant mothers (new cases) 58. The total attendances at this clinic were 483 of children under five, 137 of ailing mothers, and 116 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, 667; attendances, 2759; ailing mothers and expectant mothers : new cases 95; attendances 269. The Dispensary Resident Medical Officer also made 483 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 737 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 Childrkn under School Age.—The Council continued during 1925 to make grants of milk, either free or at half-price, for the use of expectant and 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. 39 The extent of the distribution of milk in 1925 is shown in the following figures Pints of Milk Granted Free. Pints of Milk Granted Half-price. Cost to Council. 1925. £ s. d. January 7762 856 122 7 1 February 7455 868 115 1 1½ March 7580 1128 118 15 4 April 6588 1102 89 4 9 May 6121 788 81 8 9 June 5283 706 70 8 6 July 5226 720 69 16 6 August 4754 710 63 17 3 September 4736 774 64 0 9 October 6040 904 94 13 6 November 6438 883 100 12 2½ December 7536 939 117 3 10 Total 75519 10378 1107 9 7 At the end of 1924 there were 191 families in receipt of milk through the Council's scheme. 314 new families were added to the list of recipients during 1925, and at the end of 1925 there were 178 families in receipt of milk, etc. The scale in use was based on weekly income, as follows:— Number in Family. After deduction of rent. Free. Half Cost. £ s. d. £ s. d. 1 0 13 0 0 15 0 2 1 0 0 1 5 0 3 1 4 0 1 10 0 4 1 8 0 1 14 0 5 1 12 6 2 0 0 6 1 16 0 2 5 0 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. If there was any doubt as to the circumstances of a family, the case was investigated by Mr. H. G. West, who acted as Milk Inquiry Officer until October 24th, 1925, on which date he was appointed Temporary Sanitary Inspector. Since the date mentioned, cases have been investigated by the Women Sanitary Inspectors and Health Visitors. Dinners for Necessitous Expectant or Nursing Mothers.—This work is organised by a voluntary committee, to the funds of which the Borough Council make an annual contribution of £50. The dinners are provided at a restaurant in Prince of Wales Crescent, Kentish Town, a special room being provided for this purpose. The mothers are recommended by the staff of the various Welfare Centres. In September a letter was received from the Chairman of the Committee in charge of this work, stating that, as the number of nursing and 40 expectant mothers applying for and receiving relief during the past year has decreased, they have arranged to transfer the work to the Committees of the Welfare Centres at Queen's Crescent and Grafton Road. The Committee had sufficient funds to carry on the work for some months, and they did not feel justified in applying to the Borough Council for a grant last summer. They hope that the grants (which the Council have contributed since 1921) will be held in abeyance, and renewed in case the need for further financial assistance should arise later. 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. 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, fresh air and special care. At the beginning of the year 11 children were in residence. During the year 117 were admitted, and 14 were in residence at the end of the year. 114 were discharged during the year, after an average stay in the Home of 26½ days; of this number, 41 were in good health, 63 were much improved; 13 showed no marked improvement; but owing to infectious disease, several of these were discharged earlier than would otherwise have been the case. The chief conditions for which the children were admitted, included—General debility, anæmia, convalescence after measles, whooping cough, bronchitis, etc. This home, like most small Institutions, is rather expensive to maintain, the average cost per child, per week during the past year being £2 5s. l0d. In fairness it must, however, be stated that ou several occasions the number of children in the home was very small, owing to outbreaks of infectious disease, and this tends to make the cost per child unduly high. Some difficulty has been experienced in finding sufficient suitable cases to occupy all the accommodation which is available: the fact that it is situated in the Borough also causing many mothers to hold the opinion that residence there does not constitute a "change of air." The question may probably arise as to what better use could be made of the home. That is a point of some difficulty, but if the necessary number of children cannot be regularly maintained some other use should be considered. 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, 1926, are as follows :— — Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. £ s. d. Whitefield Day Nursery 140 10 7 218 6,117 28.1 Kentish Tn. DayNursery 144 3 6 238 7,584 31.9 Margaret Day Nursery 120 14 6 251 4,643 18.5 41 Home Helps.—The St. Pancras Home Helps Committee provides domestic assistance for families when the mother is incapacitated through sickness or child-birth. The Borough Council makes an annual grant to the Committee of £150 for use in respect of maternity cases only. During the past year 77 cases were dealt with, 36 being sickness and 41 maternity cases. Three permanent helps were employed for 809 days. Three temporary helps were employed for 208 days, and four emergency helps for 46 days. A total of 1,063 days of service. The requests for the services of these women came from Nursing Associations and Midwives, Infant Welfare Centres, Medical Practitioners, the Town Hall Health Visitors, etc. Widows', Orphans' and Old Age Contruiutory Pensions Act, 1925. The duties of the Local Authority in connection with the above Act are chiefly those specified in Section 6 (2). The Local Authority for the County of London is the County Council; but under Section 41 12) of the Act it is provided that the County Council may make arrangements with any Sanitary Authority whose area is wholly or partly within the County for the execution and performance of any of the powers and duties of the County Council under the Act. The question was before the Council in July last, when it was pointed out that the organisation necessary already exists in the form of Maternity and Child Welfare Committees of the Borough Councils, and that the work is closely connected with the ordinary work now performed by those Committees. It was decided that the London County Council be informed that the Borough Council are prepared to administer Section 6 (2) of the above-mentioned Act, which will come into force in January, 1926. Home Nuksing. 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 1925 in St. Pancras is indicated by the following figures:— No. of cases nursed. No. of home visits paid. Central St. Pancras District Nursing Association 47 500 Metropolitan Nursing Association (St. Pancras cases) 52 903 Hampstead District Nursing Association (St. Pancras cases) 24 315 North London Nursing Association (St. Pancras cases) 12 134 42 Midwifery, All the infants born in St. Paneras during 1925 are classified below for each Ward according to the manner in which the mothers were attended in their confinements:— Births. 1 2 3 4 5 6 7 8 Total. A. Attended in their own homes by— Private Doctors 213 69 123 108 68 23 17 60 681 Private Mid wives 197 188 112 144 23 20 8 28 720 Doctors from the Elizabeth Garrett Andex'son Hospital 26 38 34 23 8 12 4 13 158 Medical Students from— University College Hospital 5 19 147 86 233 283 — 13 786 Royal Free Hospital — — 2 — 1 — — 20 23 St. Bartholomew's Hospital 5 5 Midwives from— Middlesex Hospital — — 2 1 16 6 40 7 72 University College Hospital — — 2 1 4 6 23 100 136 Maternity Nursing Association, Myddleton Square — — 1 — — — — 48 49 Maternity Nursing Association, Oakley Square Branch 16 16 53 38 60 22 3 3 211 B. Attended in Institutions— University College Hospital — — — — — — 189 — 189 Royal Free Hospital — — — — — — — — 758 Elizabeth Garrett Anderson Hospital — — — — — 51 — — 51 Lying-in Ward of St. Pancras House — — — — — 235 — — 235 Totals 457 330 476 401 413 658 284 1055 4074 Some of the births in the preceding Table recorded as having taken place in St. Pancras institutions were of infants the mothers of whom were not St. Pancras residents. On the other hand, a number of St. Pancras mothers gave birth to children in institutions situated outside the Borough. In the following Tables the figures arc given for 1925 relating to all St. Pancras women who were attended in their confinements, either at home or as in-patients, by the staff of various institutions situated either within or outside the Borough. Midwifery. Attended at Home. Cases. Elizabeth Garrett Anderson Hospital (doctors) 158 University College Hospital (medical students) 786 „ „ „ (midwives) 136 Middlesex Hospital (midwives) 72 Royal Free Hospital (medical students) 23 St. Bartholomew's Hospital (medical students) 5 Maternity Nursing Association, Oakley Square and Myddleton Square (midwives) 260 1440 (or 37 per cent. of the total number of births). 43 Admitted as In-patients. Cases. University College Hospital 103 Royal Free Hospital. 135 Elizabeth Garrett Anderson Hospital 13 St. Panceras House 150 Middlesex Hospital 142 Queen Charlotte's Maternity Hospital 174 City of London Maternity Hospital 55 Queen Mary's Hospital, Hampstead 19 Other hospitals 49 840 (or 22 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 513 1154 168 247 Midwives (Private) 641 79 Institutions. . 510 930 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 arc 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 1925;— 44 Grants for Midwifery Attendance (Necessitous Cases). £ s. d. Royal Free Hospital 29 0 0 Elizabeth Garrett Anderson Hospital 42 15 0 Maternity Nursing Association 28 0 0 Queen Charlotte's Maternity Hospital 65 0 0 City of London Maternity Hospital 29 0 0 Middlesex Hospital 81 15 0 £275 10 0 The corresponding grants for the three previous years were £412 5s. 0d., £705 and £713 5s. 0d. The considerable reduction for 1924 and 1925 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, 1926, in respect of Maternity and Child Welfare, as follows:- £. s. d. St. Pancras Borough Council 6115 11 4 St. Pancras School for Mothers (Ampthill Square) 595 9 4 ,, ,, (Chalton Street) 138 2 11 North St. Pancras School for Mothers 98 16 1 Grafton Road Mothers' and Infants' Welfare Centre 26 17 5 * Mary Ward Settlement School for Mothers 34 0 8 Camden Town Mothers' and Infants' Welfare Centre 100 7 6 Argyle Square Mothers' and Infants' Welfare Centre 10 2 6 Caversham Road Mothers' and Infants' Welfare Centre 290 16 6 South Highgate Mothers' and Infants' Welfare Centre 53 8 5 Maternity Nursing Association (for Maternity and Child Welfare Centre) 83 3 6 * Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 407 19 3 * University College Hospital (for Maternity and Child Welfare) 877 19 5 * „ ,, (for Midwifery and Nursing) 191 0 0 * Royal Free Hospital (for extern Midwifery and Maternity Nursing) 83 0 0 * „ ,, (for Maternity and Child Welfare Centre) 239 13 5 * „ „ (in respect of the Marlborough Maternity Section) 1021 8 8 St. Pancras Dispensary (Infant Clinic) 276 1 4 Mayoress of St. Pancras Home for Sick Children 575 0 0 Whitefield Day Nursery 281 1 3 Kentish Town Day Nursery ., 288 7 0 Margaret Club and Day Nursery 241 8 11 * Including expenditure on work amongst residents outside St. Paocras. 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 — — — — — — — — 2 Scarlatina or Scarlet Fever 651 8 196 257 109 54 27 — 3. Diphtheria and Membranous Croup .. 704 11 241 226 111 54 61 — 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 16 — 2 — — 5 8 1 6. Fever, Simple or Continued — — — — — — — — 7- Relapsing Fever — — — — — — — 8. Puerperal Fever 23 — — — — 4 19 — 9. Erysipelas 117 3 7 6 2 10 76 13 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax 1 — — — — — 1 — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningiis 7 2 4 1 — — — — 16. Anterior Poliomyelitis and Polioencephalitis 6 — 2 — 2 2 — — 17. Ophthalmia Neonatorum 37 37 — — — — — — 18. Encephalitis Lethargica 24 — 1 — 1 10 11 1 19. Acute Primary Pneumonia 231 15 53 23 9 18 98 15 20. Acute Influenzal Pneumonia 76 3 8 3 3 8 42 9 21. Malaria 6 — — — — 2 4 — 22. Dysentery 1 — — — — 1 — — 23. Trench Fever — — — — — — — — 24. Measles 1233 61 454 570 73 48 27 — 25. German Measles 877 40 228 410 109 56 34 — 26. Tuberculosis Pulmonary 389 — 7 9 7 76 279 11 Other Forms 103 5 18 13 13 24 24 6 Totals 4502 185 1221 1518 439 372 711 56 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. 46 The following table gives the number of notification of the notifiable infectious diseases received in each month of the year:— Monthly Number of Cases of Infectious Disease Notified during 1925. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Scarlet Fever 51 74 73 49 36 41 28 25 60 82 65 67 651 Diphtheria and Membranous Croup 57 62 78 40 62 52 57 31 73 91 55 46 704 Enteric Fever — — 1 1 1 1 4 4 1 — — 3 16 Puerperal Fever 4 2 3 — 2 — 2 3 4 2 1 — 23 Erysipelas 14 7 10 13 9 10 11 8 9 7 6 13 117 Anthrax — — — — — — — — 1 — — — 1 Cerebrospinal Meningitis — 1 — — 1 — 1 1 1 — 1 1 7 Poliomyelitis — — 2 — — — — — 1 2 1 — 6 Ophthalmia Neonatorum 4 2 10 1 2 2 4 3 1 3 3 2 37 Encephalitis Lethargica 2 1 — 4 2 4 1 2 3 2 2 1 24 Acute Primary Pneumonia 17 20 25 18 18 20 9 6 13 13 30 42 231 Acute Influenzal Pneumonia 10 29 14 6 — — 1 3 4 4 4 1 76 Malaria 2 — — — 1 — 1 — — — 1 1 6 Dysentery — — — — — — — — 1 — — — 1 Measles 42 79 207 170 106 65 87 45 32 71 57 272 1233 German Measles 52 55 196 229 157 84 37 24 13 13 4 13 877 Tuberculosis (Pulmonary) 34 29 45 23 28 43 31 23 47 33 21 32 389 Tuberculosis (Other Forms) 5 12 18 5 10 11 8 7 8 9 7 3 103 Totals 294 373 682 559 435 333 282 185 272 332 258 497 4502 The total number of cases of the compulsorily notifiable infectious diseases, namely, 4502, compares favourably with the corresponding figure for the previous year, when 7217 cases were notified, and with the average yearly number for the past 5 years, which is 5678. The decrease was principally due to the reduction in the number of cases of measles. Cases of scarlet fever and pneumonia were also less, the former showing a reduction of 108 and the latter of 117 cases as compared with the previous year. 4f There was 110 epidemic prevalence of either scarlet fever or diphtheria, the cases being fairly uniformly distributed throughout the year. Measles was somewhat prevalent during March, April and May, after which there was a fall which lasted until December. German measles was unusually prevalent, the total number of cases being 877. This is the highest number hitherto recorded in any year since the disease was made notifiable. One death occurred from this disease. Monthly Numkkk of Certified Deaths from the Dangerous Infectious Diseases during 1925. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter . Total. Jan. Feb. Mar. April. ' May. June. July. Aug. Sept. Oct. Nov. Dec. Scarlet Fever — — — — — — — — — — — — — Diphtheria and Membranous Croup 4 6 3 4 1 2 — 2 2 — 5 5 34 Enteric Fever — — 1 — — 1 — — 1 — — — 3 Puerperal Fever 1 — — — — — — — 1 1 1 — 4 Erysipelas 1 1 1 1 2 1 2 1 — — 1 1 12 Cerebrospinal Meningitis — — — 1 2 — — — — — — 1 4 Dysentery — — — — — — — — 1 — — — 1 Encephalitis Lethargica 1 — — 1 — 3 — — 1 1 1 2 10 Poliomyelitis — — — — — — — — — 1 — — 1 Measles — — — — — — 1 — — — — 2 3 Tuberculosis (Pulmonary) 10 24 18 14 15 17 5 18 11 14 15 19 180 Tuberculosis (Other Forms) 4 4 12 2 4 3 3 4 5 5 2 3 51 Totals—Notifiable Inlectious Diseases 21 35 35 23 24 27 11 25 22 22 25 33 303 Whooping Cough 12 15 9 7 11 7 2 3 2 1 1 1 71 Diarrhoea and Enteritis 4 4 6 2 3 3 8 7 6 4 6 4 37 The total number of deaths from all the notifiable infectious diseases was 303. This compares very favourably with the previous year, when 409 deaths occurred. Not a single death was registered as being due to scarlet fever, although 651 cases of this disease were notified. Deaths from diphtheria and whooping cough showed an increase; those from tuberculosis and measles a considerable decrease as compared w ith the previous year. 48 In the following table the number of notifications are set forth for the past 10 years:— Diseases. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Variola or Small-pox — — — 10 — — 1 — 1 — Scarlatina or Scarlet Fever 448 246 332 558 863 1713 1156 487 759 651 Diphtheria and Membranous Croup 424 45??? 399 348 747 723 725 512 623 704 Typhus Fever — — — — — — — — — — Enteric or Typhoid Fever 38 24 17 7 18 28 14 20 12 16 Fever, Simple or Continued 1 — — — — — — — — — Relapsing Fever — — — — — — — — — — Puerperal Fever 18 9 5 13 18 11 11 20 16 23 Erysipelas 120 12??? 121 134 126 87 118 92 108 117 Cholera — — — — — — — — — — Plague — — — — — — — — — — Anthrax 1 — 1 — — — — — — 1 Glanders — — — — — — — — — — Hydrophobia — — — — — — — — — — Cerebrospinal Meningitis 23 25 13 10 6 4 7 2 3 7 Anterior Poliomyelitis and Polioencephalitis 9 1 1 4 2 4 1 6 5 6 Ophthalmia Neonatorum 38 31 40 39 69 101 59 57 52 37 Encephalitis Lethargica .. .. .. 3 11 8 5 5 45 24 Acute Primary Pneumonia .. .. .. 86 142 242 384 286 293 231 Acute Influenzal Pneumonia .. .. .. 213 108 99 189 40 131 76 Malaria .. .. .. 98 58 18 13 13 1 6 Dysentery .. .. .. 6 4 1 3 3 — 1 Trench Fever .. .. .. 1 — — — — — — Measles 1855 3681 2144 1034 3093 1149 3728 327 4332 1233 German Measles 381 609 311 268 195 81 253 134 270 877 Chicken-pox .. .. 401 .. .. .. .. .. .. — Tuberculosis Pulmonary 735 825 1034 799 684 546 534 440 447 389 Other Forms 138 169 203 206 132 153 148 137 119 103 Totals 4229 6197 5022 3837 6277 4968 7349 2581 7217 4502 49 The notifications of, and deaths from, the notifiable infectious diseases are classified in the following table according to the Wards in which they occurred:— INFECTIOUS DISEASES. Notifications. Deaths. Ward. Whole Borough. Ward. Whole Borough. 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1. Variola or Small-pox — — — — — — — — — — — — — — — — — — 2. Scarlatina or Scarlet Fever 116 101 100 81 85 49 40 79 651 — — — — — — — — — 3. Diphtheria and Membranous Croup 118 77 156 110 99 67 19 58 704 4 4 9 3 6 3 2 3 34 4. Typhus Fever — — — — — — — — — — — — — — — — — — 5. Enteric or Typhoid Fever 3 1 1 2 2 3 3 1 16 — — — — — — — 2 3 6. Fever, Simple and Continued — — — — — — — — — — — — — — — — — — 7. Relapsing Fever — — — — — — — — — — — — — — — — — — 8. Puerperal Fever 4 3 4 5 2 4 1 — 23 — 1 — 2 — 1 — — 4 9. Erysipelas 21 15 20 10 16 18 3 14 117 2 3 3 — 3 — 1 — 12 10. Cholera — — — — — — — — — — — — — — — — — — 11. Plague — — — — — — — — — — — — — — — — — — 12. Anthrax — — — — 1 — — — 1 — — — — — — — — — 13. Glanders — — — — — — — — — — — — — — — — — — 14. Hydrophobia — — — — — — — — — — — — — — — — — — 15. Cerebrospinal Meningitis 2 2 1 2 — — — — 7 2 — — 1 — — — 1 4 16. Anterior Poliomyelitis 1 — 1 — — 1 2 1 6 — — — — — — — 1 1 17. Ophthalmia Neonatorum 2 7 3 1 6 8 5 5 37 — — — — — — — — — 18. Encephalitis Lethargica 8 1 5 2 2 3 — 3 24 3 2 — 1 2 1 — 1 10 19. Acute Primary Pneumonia 26 17 45 29 31 31 8 44 231 — — — — — — — — — 20. Acute Influenzal Pneumonia 13 15 14 9 13 4 1 7 76 — — — — — — — — — 21. Malaria 1 — 1 — 1 2 — 1 6 — — — — — — — — — 22. Dysentery — — — — — — — 1 1 — — — — — — — 1 1 23. Trench Fever — — — — — — — — — — — — — — — — — — 24. Measles 240 74 253 122 177 141 24 202 1233 — — — 1 1 — — 1 3 25. German Measles 130 96 124 116 142 113 19 137 877 — — — — — 1 — — 1 26. *Tuberculosis, Pulmonary 42 35 62 44 63 38 28 71 389† 19 16 30 19 32 17 11 32 801║ „ Other Forms 17 15 15 15 17 9 6 8 103‡ 8 2 10 11 8 6 3 3 51 * Including all primary notifications made under the Public Health (Tuberculosis) Regulations, 1912, on Forms A, B, C, or D, and also cases first coming under notice by means of Special Death Reports or Transfers, † Including 8, the home addresses of which were not known. ‡ „ 1, „ „ ║ „ 4, „ „ 50 SMALL-POX. No case of this disease was notified in the Borough during the year. A number of contacts were kept under observation for various periods. These were usually persons who had arrived from abroad, and Small-pox had occurred on the ship during the voyage. Such contacts are kept under observation during the incubation period, and arc also urged to be vaccinated, unless this has recently been done. VACCINATION. The following table is drawn up from returns, kindly supplied by the Clerk to the Guardians, in respect of children whose births were registered in the Parish of St. Pancras from January 1st to December 31st, 1924:— VACCINATIONS. 1st January to 31st December, 1924. Number. Percentage of Births registered. North. East. West. South. Whole Borough North. East. West. South. Whole Borough Births registered 883 1112 932 1471 4398 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 40 62 53 52 207 4.5 5.6 5.7 3.5 4.7 Successfully vaccinated 443 565 495 751 2254 50.2 50.8 53.1 51.1 51.3 Had smallpox — — — — — — — — — — Insusceptible of vaccination — 2 2 6 10 — 0.2 0.2 0.4 0.2 Received certificate of conscientious objection 360 316 281 357 1314 40.8 28.4 30.2 24.3 29.9 Postponed by medical certificate 3 19 23 20 65 0.3 1.7 2.5 1.4 1.5 Moved to known address in other districts 11 84 14 166 275 1.2 7.6 1.5 11.3 6.3 Lost sight of by removal 21 54 48 109 232 2.4 4.9 5.1 7.4 5.3 Unvaccinated and not accounted for in previous columns 5 10 16 10 . 41 0.6 0.9 1.7 0.7 0.9 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. 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 1924 4398 2254 51.3 1355 30.8 51 SCARLET FEVER. 651 cases were notified during the year; but of this number 100 were subsequently reported by the hospital authorities not to be suffering from this disease. The actual number of cases was therefore 551, equal to an attack rate of 2.6 per 1,000 of population. During the preceding 5 years the average yearly number of cases was 928, the figures, therefore, for the past year show that the disease was very much less prevalent. Of the 100 cases which were incorrectly diagnosed, 53 were notified by Medical Officers of hospitals and other institutions, and 47 by general practitioners. I have also to report the fact that this is the first year in the records of the Borough in which not a single death occurred from this disease. During recent years Scarlet Fever has undoubtedly been of a milder type, but even so, the fact that 551 cases were treated without a single fatality is highly creditable to the hospital authorities. The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years, the figures being corrected for errors in diagnosis:— Year. No. of Cases. Case rate per 1,000 of population. No. of Deaths. Death rate per 1,000 of population. Case Mortality per cent. Percentage of Cases removed to Hospital. 1916 404 2.0 8 0.04 2.0 96 1917 224 1.2 1 0.02 1.8 97 1918 289 1.6 7 0.04 2.4 96 1919 510 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 1925 551 2.6 0 0.00 0.0 98 Of the 651 cases notified, 639, or 98.2 per cent., were removed to hospital. Return Cases.—This term is applied to cases of Scarlet Fever which occur in a house within 28 days of the return from hospital of a previous case. 17 such cases occurred during the year. Four cases were in one house and one in each of thirteen other houses. Special inquiries are made into these cases, with the object of discovering any possible source of infection. DIPHTHERIA. This disease was rather more prevalent than during the previous year and the case mortality was also higher. 704 cases were notified; but of this number 141 (equal to 20.3 per 52 cent.) were subsequently reported by the hospital authorities not to be suffering from this disease. The actual number of cases was, therefore, 563, equal to an attack rate of 2.6 per 1,000 of population. During the preceding 5 years the average yearly number of cases was 570; the figures, therefore, for the past year practically correspond with this average. Of the 141 cases which were incorrectly diagnosed, 69 were notified by Medical Officers of hospitals or other institutions, and 72 by general practitioners. The number of deaths certified during the year as being due to Diphtheria was 34, equal to a death-rate of 0.16 per 1000 of population, and a case mortality of 6.0 per cent. of actual cases. The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years, corrected for errors in diagnosis:— Year. No. of Cases. Case rate per 1,000 of population. No. of Deaths. Death rate per 1,000 of population Case mortality per cent. Percentage of cases removed to hospital. 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 14 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 1925 563 2.6 34 0.16 6.0 98 Of the 704 cases notified, 692 (98.3 per cent.) were removed to hospital. 685 were admitted to Metropolitan Asylums Board Hospitals, and 7 eases to other hospitals. 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. 12 cases of this description occurred during the year. Two eases were in one house and one in each of ten other houses. TYPHOID OR ENTERIC FEVER. Sixteen cases were notified during the year; but, on further investigation, 5 of these were found to have been incorrectly diagnosed. The actual number of cases was, therefore, 11. During the preceding 5 years, the average yearly number of cases was 14.4; the figures, therefore, for the past year arc below the average. 53 Based on bacteriological examination, 6 cases were reported to be suffering from Typhoid and 5 from Paratyphoid fever. Three of the cases proved fatal. With reference to the source of infection, in one case oysters had been eaten, another had been staying at the sea-side, and another touring the Continent, during the incubation period. Two of the cases were hospital nurses, and another had been an in-patient of a hospital for several months prior to the onset of the illness. In the remaining cases no probable source of infection could be discovered. The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years, corrected for errors in diagnosis:— Year. Number of Cases. Number of Deaths. Case Mortality per cent. 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 1 1924 9 2 22 1925 11 3 27 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:— 54 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 4th January, 1925, to the 2nd January, 1926 (inclusive). Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. Total Notifications (i.e., including cases previously notified by other Doctors), Primary Notifications. Total Notifications (i.e., including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10 10 to 15 Total. Pulmonary Males — 1 5 2 11 21 52 50 40 23 2 207 267 — — — — — 77 159 35 131 Females — 2 4 5 16 26 <9 29 21 10 5 147 198 — — — — — 43 109 13 71 Non-pulmonary Males 2 6 6 3 6 5 2 6 2 1 3 42 50 — 1 2 3 4 2 15 2 11 Females 2 6 2 6 6 5 3 4 3 1 1 39 50 — 2 — 2 2 3 12 — 19 Totals 4 15 17 16 39 57 86 89 66 35 11 435 565 — 3 2 5 6 125 295 50 232 Age Periods. Number of Primary Notifications on Form C, included in above. Number of Primary Notifications on Form D, included in above. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males — — — — — — — — — — — — — — — — — — — — — — — — Females — — — — — — — — — — — — — — — — — — — — — — — — Non-pulmonary Males — — — — — — — — — — — — — — — — — — — — — — — — Females — — — — — — — — — — — — — — — — — — — — — — — — Totals — — — — — — — — — — — — — — — — — — — — — — — — 55 It will be seen that the total number of primary notifications was 440. In addition to this, there were 52 other cases which were not notified, but which first came under notice cither by means of special death reports (36), or as transfers from other districts (16). The total number of new cases during the year was therefore 492, equal to a notification rate of 2.28 per 1000 of population. During the preceding 5 years the average yearly number of cases was 688, equal to an average notification rate of 3.09) per 1000 of population. Of the total 492 new cases which came to knowledge during the year, 389 were suffering from pulmonary tuberculosis, and 103 were non-pulmonarv in character, equal to notification rates of 1.8 and 0.48 respectively per 1000 of population. One of the most satisfactory features of the public health of the Borough during recent years has been the steady fall year by year in the number of notifications of eases of this disease. In the following table all the cases occurring during the year are classified for age and Age Periods. Cases not Notified—Information obtained from Special Death Reports and by Transfer from other districts. 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 Malos — 3 — — — 2 6 5 3 3 2 24 Females — 1 — — — — 1 5 2 — 2 11 Non-Pnlmonary Malos 1 5 1 1 1 — — — — — 1 10 Females — 1 1 1 — 1 1 — — 1 1 7 Totals 1 10 2 2 1 3 8 10 5 4 6 52 Total Notifications during 1925. Ages. Pulmonary Tuberculosis. Other forms of Tuberculosis. Total, all Forms. Males. Females. Total. Males. Females. Total. 0—1 — — — 3 2 5 5 1—5 4 3 7 11 7 18 25 5—10 5 4 9 8 5 13 22 10—15 2 5 7 6 7 13 20 15—20 11 16 27 7 6 13 40 20—25 23 26 49 5 6 11 60 25—35 58 30 88 2 4 6 94 35—45 55 34 89 6 4 10 99 15—55 43 23 66 2 3 5 71 55—65 26 10 36 1 2 3 39 65 & upwards 4 7 11 4 2 6 17 Totals 231 158 389 55 48 103 492 56 Deaths from Tuberculosis. The deaths from all forms of tuberculosis during the year numbered 231, equal to n deathrate of 1.07 per 1000 of (civil) population. Of this number of total deaths, 180 were due to pulmonary, and 51 from other forms of tuberculosis, equal to death-rates of 0.83 and 0.24 respectively per 1000 of population. During the preceding 5 years, the average yearly number of deaths from Tuberculosis of all forms was 295, equal to an average death-rate of 1.36 per 1000 of population. In the following table the deaths which occurred during the past year are classified as regards age and sex:— Deaths from Tuberculosis during the Year 1925). Ages. Pulmonary Tuberculosis. Other forms of Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0—1 — — — 1 2 3 3 1—2 1 — 1 1 1 2 3 2—5 — — — 5 3 8 8 5—10 — — — 1 1 2 2 10—15 — 2 2 3 — 3 5 15—20 3 11 14 1 2 3 17 20—25 9 7 16 2 3 5 21 25—35 15 12 27 2 3 5 32 35—45 28 17 45 5 2 7 52 45—55 23 18 41 5 1 6 47 55—65 19 4 23 1 2 3 26 65 & upwards 7 4 11 2 2 4 15 Totals 105 75 180 29 22 51 231 The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years:— 57 Year. Estimated Population. Primary Notifications. Deaths. Notification Rate. Heath Rate Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms All forms. 1916 218387 735 138 873 340 83 423 3.36 0.63 3.99 1.55 0.38 1.93 1917 218387 825 169 994 353 9' 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 540 153 699 250 54 334 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 1.21 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 1925 215900 389 103 492 180 51 231 1.80 0.48 2.28 0.83 0.24 1.07 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 2.27 0.54 2.81 1.03 0.28 1.32 Females 1.38 0.42 1.80 0.66 0.19 0.85 Both Sexes 1.80 0.48 2.28 0.83 0.24 1.07 The table below shows the number of notifications and the number of deaths, together with the corresponding rates per 1,000 of population for each Ward of the Borough:— Tuberculosis (All Forms). Ward. Notifications. Deaths. Number. Hate per 1000 of Population. Number. Rate per 1000 of Population. 1 59 1.6 27 0.7 2 48 2.2 18 0.8 3 77 2.1 40 1.1 4 59 2.2 30 1.1 5 80 2.6 40 1.3 6 47 2.2 23 1.1 7 34 2.2 14 0.9 8 79 2.9 35 1.3 No address 9 — 4 — Totals 492 2.3 231 1.1 58 Tuberculosis Dispensary Service. Dental Treatment. As the existing arrangements for the dental treatment of Dispensary patients suffering from tuberculosis had proved to be unsatisfactory, it was suggested that arrangements should bo made for this work to be carried out by the dentists at the St. Pancras Dispensary—Messrs. Southcomb May, L.D.S. (Eng.), and A. J. Maurice, L.D.S. (Edin.). Details of the proposed scheme were submitted to the Central Authorities, and in July notifications were received from the Minister of Health and the London County Council approving the arrangements proposed by the Borough Council for the dental treatment of cases of tuberculosis for the period ending 31st March, 1926, subject to the total cost not exceeding £100, and on the understanding that the arrangements will be reviewed by the Borough Council before the expiration of this period. During the period the above arrangements have been in force dentures have been provided for 11 patients; in seven instances these were provided free of charge, in four cases the patients made contributions of from 10s. to £2. Treatment or Tuberculosis. X-ray Examinations and Reports. In July, 1924, the Borough Council accepted, subject to the sanction of the Minister of Health, the offer of the Middlesex Hospital to conduct X-ray examinations for a fee of 7s. 6d. per examination, which would include the supply of a print when desired. The Minister of Health and the London County Council were not prepared to approve of this arrangement, and desired the continuation of arrangements with the University College IIospit.il. That Hospital was prepared to resume the examinations for the Council, and, with regard to the question of payment, pointed out that the Ministry of Health had sanctioned the following fees : —(a) cases on which only a report is required, 7s. 6d.; (b) cases on which a report and a plate is required, 15s. The Council, therefore, recommended that arrangements be made with the University College Hospital to resume the X-ray examination of tuberculous patients referred to the Hospital by the Council's Tuberculosis Officer, on payment of the fees sanctioned by the Ministry of Health. The approval of the Ministry of Health and the London County Council were received and reported to the Borough Council in July, 1925. Public Health (Tuberculosis) Regulations. Regulations are already in operation prescribing the treatment of persons affected with tuberculosis, for preventing the spread of the disease, and for the notification of particulars of cases of the disease to the Medical Officer of Health. The new regulations provide, as from the 1st January, 1925, that the Medical Officer of Health is to furnish to the County Medical Officer of Health quarterly statements to be compiled from the existing Register of Notifications. Circular 549 has also been issued by the Minister of Health, urging the necessity for securing a greater measure of uniformity in the procedure of notification of tuberculosis, and a stricter compliance with the requirements of the regulations in each district. Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations, which came into force on 31st July, 1925, provide that "no person "who is aware that he is suffering from tuberculosis of the respiratory tract shall enter upon "any employment or occupation in connection with a dairy which would involve the milking "of cows, the treatment of milk, or the handling of vessels used for containing milk." The Council may require any such person to discontinue his employment or occupation in that capacity. The Boarding-out of Children from Tuberculous Homes. On April 1st, 1925, a scheme was designed by the London County Council for (a) the boarding-out of children living in heavily infected and overcrowded homes, and also (b) for the 59 boarding-out of children who were being discharged from Sanatorium treatment, and whose homes were unsuitable or inimical to maintenance of health. Under this scheme:— Recommendations for children to be sent away are sent by the Medical Officer of Health, accompanied by reports as to the condition of the infected person and as to the home circumstances. Children accepted as suitable are sent away for a period of three to four months, the scheme being worked in co-operation with the Invalid Children's Aid Association. The parents of children sent away are assessed as regards contributions by the Invalid Children's Aid Association. In July, 1925, the scheme was extended to include "weakly" children living under conditions likely to subject them to infection, and also children, in suitable instances, whose parents were under treatment for tuberculosis. The duration of boarding-out was also extended, the children being kept away as long as the conditions in the home were unfavourable. The scheme has proved very useful—it would doubtless be more extensively used in the absence of any assessment. During the year 36 children have been boarded-out. Treatment of Teberculosis—Cessation of Supervision. During the year consideration was given to the fact that while much attention had, for a long period, been given to discovering and treating cases of Tuberculosis, no systematic provision had been made for a cessation of activities in respect of cases which could reasonably be regarded as cured. There was also the additional factor, that the wastage of cases by death and untraced removal is less than the concurrent increase, so that if cases that can reasonably be regarded as cured continue to be supervised and reported upon, the dispensaries and Public Health Departments become overloaded. The following proposals for the cessation of supervision were made after consultation between the County Council and the Ministry of Health:— 1. All cases wrongly diagnosed as tuberculous, and also cases in which the diagnosis after observation is not confirmed, are to be removed from the register. 2. (a) Pulmonary cases should be regarded as "arrested" when, for a period of 2 years, there have been no symptoms of tuberculosis and no signs of active disease, and as "cured" when this condition has been maintained for 5 years, that is for 3 years after the stage of "arrest" has been reached. (6) Non-pulmonary cases may be regarded as "arrested" as soon as there is reason to believe that the disease is unlikely to recur, and as "cured" when 3 years have elapsed without any signs or symptoms of active disease. Cases reaching the stage of "cure" as above defined are to be discharged from dispensary supervision, and their names removed from the dispensary register. The above procedure came into force on January 1st, 1925, and during the year 790 names have been removed from the register. 60 Tuberculosis Dispensaries—Home Visits and Inquiries. In conscquence of a report made by your Medical Officer of Health in 1924, the Council passed the following resolutions:— (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 Dispensary, 39, Oakley Square, N.W.1. (b) That the agreement with University College Hospital for the dispensary treatment of cases of Tuberculosis occurring in Wards 7 and 8 be not renewed after 31st March, 1925. (c) That notice be given for the determination of the agreement as to the occupation by the Council of a part of premises, 132, Maiden Road, used as a branch dispensary. During the year effect was given to the above resolution of the Council, the sanetions of the Ministry of Health and the London County Council having been duly received. Home visits and inquiries, both as regards notified eases and contacts, were carried out by the Women Inspectors of the Town Hall staff, and by the two nurses attached to the dispensaries at Oakley Square and University College Hospital up to March 31st, 1925. Since that date all visits and inquiries have been made by the Town Hall staff as the Nurse at the Oakley Square Dispensary is fully occupied owing to the additional consultations now held there. The visiting work carried out by the above staff during the year in connection with Tuberculosis was as follows:— Visits by Tuberculosis Officer 189 „ Women Inspectors 6,868 ,, Dispensary Nurses (to March 31st only) 325 Attendance of Women Inspectors at dispensaries 535 Number of cases in which disinfection was carried out 150 The table on the opposite page gives a summary of the work carried out at the Tuberculosis Dispensaries during the year:— 61 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 20 36 29 8 93 19 39 7 6 9 8 30 16 6 — — — — — Examined for first time during the year 187 204 163 146 700 224 248 2 12 21 11 46 28 6 17 10 5 2 34 8 20 Total 207 240 192 154 793 243 287 9 13 30 19 76 44 12 17 10 5 2 34 8 20 Found to be suffering from:— Tuberculosis Pulmonary 121 80 1 1 203 5 144 1 4 — 1 6 1 2 12 1 — — 13 — — Non-pulmonary 3 14 38 33 88 3 14 — — — — — — — — 1 — — 1 — — Not suffering from Tuberculosis 44 83 134 107 368 180 65 2 5 20 12 39 24 3 2 6 5 2 15 8 11 Under observation on December 31st pending diagnosis 28 39 5 1 73 31 27 4 6 7 6 23 13 3 3 2 — — 5 — 1 Ceased attendance before completion of diagnosis 11 24 11 12 61 24 37 2 3 3 — 8 6 4 — — — — — — 5  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 489 67 210 Reports received from Insurance Practitioners re insured patients under domiciliary treatment during the year 55 2 8 Total number of attendances during the year— Persons referred to affiliated hospital — — 7 Consultations with medical practitioners at the homes of patients— Insured 1860 77 88 Uninsured 2150 168 102 Insured 7 — — Persons placed under observation for the purpose of diagnosis during the year 339 21 1 Uninsured 3 — — Other visits paid by Tuberculosis Officers to the homes of patients 167 7 5 Cases in which the period of observation exceeded two months 68* 15 — Visits by Dispensary Nurses or Health Visitors to the homes of patients for dispensary purposes 3406 126 115 Insured persons under domiciliary treatment on December 31st 131 6 145 Specimens of sputum examined for dispensary purposes 951 59 39 * 60 due to non-attendance. Figures for Maiden Road and University College Hospital Dispensaries are for 3 months ended 31st March only. 62 The following report on the clinical work carried out at the Dispensaries during the year has been furnished by the Tuberculosis Officer, Dr. Viaey:— Tuberculosis Dispensary Report for 1925. In March, 1925, it was decided to concentrate all the St. Pancras cases of Tuberculosis at the Dispensary at 39, Oakley Square, and, in consequence, those who had previously attended University College Hospital and Maiden Road were transferred to Oakley Square, and the Maiden Road Dispensary was closed. This has been found greatly to have facilitated the work in all ways, and has not proved inconvenient to the patients attending. Nine Clinics are held weekly. Two mornings—011 Mondays and Fridays. Five afternoons—011 Mondays, Tuesdays, Wednesdays, Thursdays and Fridays. Two evenings— on Tuesdays and Thursdays. The average attendance per Clinic being 14. New cases are obtained by various means:— 1. Sent up by local Practitioners. 2. Attend on their own account. 3. Transferred from Hospitals or Dispensaries as being St. Pancras residents. 4. Requested to attend as Contacts by the Tuberculosis Officer or Health Visitors. These cases are kept under close observation until a diagnosis can be made, when, if proved to be tuberculous, they are recommended Institutional Treatment under the London County Council Scheme, and if non-tuberculous, are either discharged or kept under future supervision. When necessary cases arc sent to the University College Hospital for X-ray examination and report. Sputums arc tested at the Dispensary, it being the practice to obtain 3 negative sputums before requiring X-ray in lung cases, the third sputum specimen being tested by some special means as the Antiformin method or the Doppelmethode. Attempts are made to establish the diagnosis within a month of first seeing the patient, but in cases where it is obvious that ground is not being lost by so doing, this period is extended. In suspicious cases, admission can be obtained to Brompton Hospital for diagnosis purposes if desired, and use is made of this assistance in a few instances. The Dispensary being primarily for diagnosis and general supervision purposes, patients are encouraged to go to their private or panel doctor for any treatment required when they are at home; but to attend the Dispensary at regular intervals for examination. In the cases, however, where a patient has no panel doctor, and is not in a position to afford medical fees, treatment is given at the Dispensary, provided they are well enough to attend regularly; but if unable to do so, they are cncouraged to seek assistance from the District (Poor Law) Medical Officer, or to enter the Highgate Hospital. All established cases of Pulmonary Tuberculosis are sent to the Dental Surgeon at 39, Oakley Square to have such dental treatment done as is necessary, previous to their admission to Sanatorium, the arrangements being the Borough Council pays 5s. per patient for scaling, 5s. per tooth for stoppings, 5s. per patient for extractions, with 5s. extra if an anaesthetic is required, and £2 or £4 for single or double dentures. The patients who require artificial teeth are assessed by the Tuberculosis Care Committee and make contributions 63 according to their means. When extractions are required, the usual practicc is to avoid too extensive extractions at each sitting, and to spread the work done over as long a period as possible, aiming at getting the mouth clear of diseased teeth before admission to Sanatorium, the dentures being fitted and supplied on their return. Special treatment.—Artificial Sunlight and Finsen Light Treatment can be obtained at the London Hospital. Artificial Pneumothorax cases are sent to Brompton Hospital. Cases with Tuberculosis of the Larynx are referred to the Specialist who attends at 39, Oakley Square every Saturday morning. Work outside the Dispensary.—All cases on notification are visited by the Health Visitor, and at least once by the Tuberculosis Officer. These visits are invaluable in assisting to control the spread of the disease, and in getting to know the needs ot each patient. Where possible, patients are encouraged to occupy separate rooms, or at least separate beds, and bedding and beds are loaned for this purpose by the Borough Council to necessitous cases. Extra milk and eggs are supplied by the Borough Council on the recommendation of the Tuberculosis Officer, and Invalid Dinners can be supplied to those who are at a convenient distance to the Invalid Kitchen, 20b, Seymour Street. Outside assistance can be obtained for many necessitous patients from the various Charitable Associations. Contact cases are encouraged to attend at the Dispensary for examination, and if the original patient has a positive sputum, they are examined periodically. School children contacts are seen at the Dispensary, and a report sent to the School Medical Officer classifying them:— (1) An unsatisfactory child whether contact or not. (2) An apparently healthy contact. (3) A contact that has not been examined. Children who are contacts of cases who have positive sputums can be boarded out under the London County Council Scheme. This means of prevention of the spread of the disease has been found most helpful, and could be usefully extended to embrace delicate children of parents with Pulmonary Tuberculosis whose sputums are negative. Delicate children can be recommended for Open-air Schools. These schools are found most helpful, and could be increased in number and size. Patients who return from Sanatorium fit for light work are referred to the Local Labour Exchanges for special consideration in accordance with the scheme for Employment of Tuberculous Persons instituted in June, 1925. Sanatorium and Hospital Treatment. All eases recommended for institutional treatment are dealt with by the London County Council, which is the authority for the purpose for the Metropolis. The accommodation for advanced cases, to which attention was directed a year ago, still remains inadequate. Such cases are usually the most dangerous from the point of view of infection, and the position cannot be regarded as satisfactory until institutional accommodation is available for every such patient who is willing to accept it. The following table gives the number of eases of pulmonary tuberculosis notified 64 during each of the past four years, and the number and percentage for whom no institutional accommodation was available:— Year. Total number of cases notified. No accommodation available for : Number. Percentage. 1922 534 18 3 per cent. 1923 440 24 5 „ 1924 447 46 10 „ 1925 389 47 12 „ 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." The following particulars concerning the work of the Committee and cases dealt with during the year have been supplied by the Hon. Secretary, Miss Bibby:— The St. Pancras Tuberculosis Care Committee. Report of the Hon. Secretary for the year 1935. This Committee has accomplished little beyond the routine work of assessment and of reference to the allied charities during the year 1925. The meetings of the full Committee have been few, but the Sub-Committee has met regularly every week except during August. We are especially indebted to Mr. Neal, of the Red Cross, Mrs. Philipson, of the Invalid Children's Aid Association, Miss Hill, of the Charity Organisation Society, Miss Bell, of the School Care Committee, and Mrs. Grair, of the Infant Welfare Centres, for regular attendance at the Sub-Committee, as well as for much assistance in other directions. As in previous years, the work has been hampered by lack of adequate clerical assistance and by lack of money. Mrs. Grair has very kindly given help every week, but even with this valuable assistance the clerical work has not been fully dealt with. Patients, both at home and in Sanatoria, respond amazingly to carefully written letters, which are a valuable adjunct to personal visiting. The need for an emergency fund still exists (in the opinion of the Hon. Secretary), and it is to be regretted that the Ministry of Health and the London County Council discourage the holding of funds by Tuberculosis Care Committees. It should be added that some members of the Tuberculosis Care Committee would not concur with this opinion. 65 The Committee have again had before them many cases in which the need for employment for ex-patients was urgent. Nothing of note is being done in this connection in the London area, except by the Central Fund for the Industrial Welfare of Tuberculous Persons. There are several St. Pancras men in the workshop organised by this Fund, and further work of this kind for the unskilled and for women patients is urgently needed. The St. Pancras Committee considers that, not only workshops, but work centres are required to meet the varying needs of patients. There is great need for a home for women patients who return from Sanatoria sufficiently restored for the moment to resume their old occupations, but still in need of more care than their crowded homes can provide. The provision of medical care in their own homes for those patients who are not eligible for Poor Law assistance, and are too poor to pay medical fees is still among our difficulties. It is understood that further provision for advanced cases is now available; but it is not yet possible to say that every advanced case willing to go into an institution, permanently or temporarily, can be granted a vacancy. The care of the children of families in which there is a patient suffering from tuberculosis is engaging the attention of the Committee in a special degree. The boarding-out scheme of the London County Council was warmly welcomed and utilised as far as possible. Further care might be expended upon these children in their own homes with advantage. Clothing for patients going into institutions, and also for those returning to active life, is greatly needed. A needle-work guild, or a clothing fund for the provision of both new and old clothing, would help very considerably. To Mrs. Philipson, of the Invalid Children's Aid Association, acknowledgment of most valuable help must again be made. Mrs. Philipson's help in every part of the Committee's work is indispensable, and, once more, she has not only helped in the decision as to assessments, but has done the whole of the Committee's work as to the collection of the sums due. To Mr. Neal, Mr. Leyland, and the Red Cross generally, we are grateful for the personal kindness with which their help is given. There is much urgent work remaining for the Committee, and it is greatly to be desired that its activities should be developed. From January 1st, 1925, to 31st December, 1925, the total number of cases considered was 495, and the number assessed 260. Of the 260 cases assessed, 116 were assessed nil; 54 were assessed at from one shilling to ten shillings. Suitable cases were referred to the under-mentioned agencies:— The Charity Organisation Society, The Guardians, The Invalid Children's Aid Association, The British Red Cross, The Labour Exchange, etc. Ten children were referred to open-air schools. Thirty-six children were sent away by the Invalid Children's Aid Association, under the London County Council scheme, the total number of cases referred to the Invalid Children's Aid Association being 49. 66 PUERPERAL FEVER. Twenty-three cases were notified during the year, but on further investigation two of these were found to have been incorrectly diagnosed. Another case (fatal) which had not been notified came to knowledge by means of the death returns. The actual number of eases was therefore 22. This equals an incidence rate of 5.7 per 1,000 births, and a case mortality of 18.2 per cent. Of the 21 notified cases, 4 were primiparæ (women who had not previously had a child), and 17 were multipara) (women who had previously had one or more children); 5 cases followed the birth of either dead or premature children, and 16 occurred after the birth of live children. In 4 instances some operative procedure or instruments were required at the birth. The following table gives particulars of the cases which have occurred during the past 5 years, and also states by whom the confinements were attended:— Year. Number of Cases. Number of Deaths. Case Mortality per cent. Number of cases occurring in Confinements attended by:— Doctors. Midwives. Students. In Hospital. 1921 *11 4 36.0 4 4 — 2 1922 11 3 27.0 5 3 2 1 1923 20 9 45.0 10 8 2 — 1924 †15 3 20.0 4 6 3 — 1925 ‡22 4 18.2 11 4 6 — Totals 79 23 29.1 34 25 13 3 * 1 unattended at birth. † 1 do. and 1 not notified. ‡ 1 not notified. Additional institutional accommodation for the treatment of cases of this disease was provided during the past year. The following copy of a letter, which was sent to all medical practitioners in the Borough, gives particulars concerning this additional accommodation:— Town Hall, Dear Sir or Madam, Pancras Road, N.W.1. Puerperal Fever. I am directcd by the Minister of Health to state that he has had under consideration the hospital accommodation available in London for cases of Puerperal Fever, and he is satisfied as a result of inquiries that further special facilities both for nursing and medical treatment are required, with a view to reducing the mortality from this disease. Arrangements have accordingly been made by the Metropolitan Asylums Board whereby in future cases of Puerperal Fever will be concentrated, as far as practicable, in three of their institutions, namely, the North-Western Hospital, Hampstead, the Eastern Hospital, Homerton, and the South-Western Hospital, Stockwell. Special wards will be set aside for these cases, and special medical and nursing staffs provided. The Metropolitan Asylums Board, have also, with the Minister's approval, appointed an obstetric consultant at these three institutions. 67 Application for admission should be made to the Medical Officer of Health at the Town Hall, but, if urgent, the Metropolitan Asylums Board will admit the patient on the request of the medical practitioner in attendance. Yours faithfully, G. Sowden, Medical Officer of Health. OPHTHALMIA NEONATORUM. Thirty-seven cases were notified or otherwise came to knowledge during the year. This equals an incidence rate of 9'5 per 1,000 births. Of the 37 cases, 18 were regarded as slight, 14 of moderate severity, and 5 were severe. Thirteen cases were admitted to the special hospital provided for the treatment of cases of this disease—St. Margaret's, Leighton Road, N.W.; 24 cases were treated at home, the help of a visiting nurse being provided in 21 of these cases. In 4 cases the children were illegitimate. Recovery was complete in all the 37 cases. The following table gives particulars of the cases which have occurred during the past 5 years, and also states who was in attendance at the birth:— Year. Number of Cases. Rate per 1,000 births. Number of cases occurring in Births attended by:— Doctors. Institution Midwives. Private Midwives. Students. Hospital In-patient. 1921 101 21.2 15 25 15 20 20 1922 59 12.9 5 15 14 13 12 1923 51 11.7 8 3 15 9 16 1924 52 12.6 7 4 11 16 14 1925 37 9.5 6 7 4 13 7 Total 300 13.0 41 54 59 77 69 CEREBRO-SPINAL MENINGITIS (Cerebro-Spinal Fever). Seven cases were notified, but two of these were subsequently found to have been incorrectly diagnosed. Two other cases, notified to be suffering from Encephalitis Lethargica (sleepy sickness) were discovered at the post-mortem examinations to have died from Cerebrospinal Meningitis. There were therefore 7 actual cases of this disease during the year, and 4 of these proved fatal. The following table gives the number of actual cases, and the case mortality during each of the past 10 years:— Year. Cases. Deaths. Death Rate per cent. Year. Cases. Deaths. Death Rate per cent. 1916 20 12 60 1921 4 3 75 1917 21 16 76 1922 6 6 100 1918 9 8 89 1923 2 2 100 1919 8 7 87 1924 1 1 100 1920 5 3 60 1925 7 4 57 58 acute poliomyelitis and polioencephalitis. Six cases of poliomyelitis were notified during the year. It was subsequently found that two of the cases had been incorrectly diagnosed, and were not suffering from this disease. One patient died. 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 1924 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. From the information obtained, it 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. The following copy of a letter, which was sent to all medical practitioners in the Borough, gives particulars concerning this additional accommodation:— Public Health Department, Town Hall, Pancras Road, N.W. 1. Poliomyelitis. Dear Sir or Madam, The London County Council has recently considered the question of dealing effectively in residential institutions with the later and more chronic stages of this disease, with a view to limiting, as far as possible, permanent crippling and physical deformity. Arrangements have now been made for the treatment of cases either entering upon the second stage of the disease (deemed for this purpose to commence 3 months after onset) or being discharged from a general hospital after undergoing correctional operation. Recommendations for the treatment of these cases must be made on special forms which may be obtained on application. Assessments will be made for each case on the same principles as obtain in respect of tuberculous children. The work of assessment and the collection of the contributions will be undertaken by the Invalid Children's Aid Association. The in-patient treatment is being provided at Queen Mary's Hospital, Carslialton. Yours faithfully, G. Sowden, Medical Officer of Health. encephalitis lethargica. This is commonly termed "Sleepy Sickness;" it should be noted, however, that it is a totally different disease to the tropical malady known as "Sleeping Sickness." The popular term is an unfortunate one, as it tends to confuse the two diseases. Twenty-four cases were notified during the year. Owing to an error in the date, one fatal case should have been included in the notifications for the previous year; the death was included. On further investigation eight cases were found to have been incorrectly diagnosed. Three other cases were discovered which had not been notified. The actual number of cases was therefore 18. Ten deaths were registered during the year as being due to this disease. Five of these relate to cases either not notified or notified in previous years. One was a visitor from abroad who died in hospital. The death cannot be transferred, although he was not a resident and the case had hot been notified here. 69 This disease has been increasingly prevalent during recent years, and its importance is due to the fact that it is not only associated with a high death rate, but that many who recover suffer from physical weakness or mental or moral degeneration, and these after-effects may develop long after apparent recovery. The following table gives particulars concerning the cases notified or otherwise coming to knowledge during the past 5 years, the number of deaths and death rate, and the present condition of those who recovered:— Encephalitis Lethargica, 1921-1925. Cases notified or otherwise discovered. Number of deaths. Death rate per cent. Condition of Survivors. Not traced. Complete recovery. Slightly affected. Seriously affected. 77 29 37.6 16 11 17 4 PNEUMONIA. During the year, 231 cases of acute primary pneumonia, and 76 cases of acute influenzal pneumonia, were notified. All cases are visited, and, if desired by the Medical Attendant, a nurse is supplied to necessitous cases, the cost being defrayed by the Borough Council. During the year, a nurse was provided in 62 instances, 997 nursing visits being paid. Of the total 307 cases notified, 159 were admitted to various institutions and 148 were treated in their own homes. Pneumonia is also a frequent complication of other diseases, but when originating in this way it is not notifiable. The total number of deaths therefore registered each year as being due to Pneumonia include other forms of this disease in addition to the notifiable types. In the early part of the year it was noticed that, in connection with several cases of pneumonia which had been notified, the patients were all men employed at the same factory. On visiting the premises I ascertained that work had only recently started, and that an experimental plant had been laid down to recover tin from scrap metal by a new process. In the course of the work both chlorine gas and phosgene were generated, and although at certain stages the workmen used gas masks, on several occasions accidental and unexpected escapes of these gases had occurred. The following table gives particulars as to the prevalence of the notifiable forms of the disease, and the total deaths and death rates from all forms during the past 5 years:— Year. Notifications. Total deaths all forms. Death rate per 1000 of Population. Acute Primary. Acute Influenzal. 1921 242 99 173 0.81 1922 384 189 265 1.25 1923 286 46 201 0.94 1924 293 131 200 0.92 1925 231 76 204 0.94 70 The matter was reported to the Chief Inspector of Factories at the Home Office and also to the Inspector under the Alkali Acts (Ministry of Health). These departments sent both medical and technical inspectors, and certain improvements were carried out. Numerous complaints had by now been received from occupiers of adjoining premises, as, owing to negligence on the part of workmen, on several occasions fumes had escaped violently and caused a decided nuisance in the neighbourhood. It was therefore suggested it was undesirable that such work should be carried on in a crowded district, and that an isolated site out of London was essential for such a process. This suggestion was finally accepted, and before the end of the year the premises were vacated and the plant removed. MEASLES AND GERMAN MEASLES. These diseases are compulsorily notifiable in St. Pancras under Special Regulations sanctioned in 1920. All eases are notifiable by parents or guardians, but only the first case occurring in a house during an outbreak is notifiable by the medical attendant. An interval of two months since the previous case constitutes a fresh outbreak. From 1916 to 1919 inclusive these diseases were notifiable throughout the whole of England and Wales; but at the end of the year 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 a special local regulation. During recent times measles has tended to be prevalent in alternate years. In 1924 no less than 4,332 cases were notified, with 74 deaths. A diminished prevalence was therefore expected in 1925, and this anticipation proved correct, for only 1,233 cases were notified; the disease was also of a mild type, and only three deaths occurred. For necessitous cases, where considered necessary, a nurse was provided. During the vear 42 cases were nursed, 325 nursing visits being paid. German measles was unusually prevalent, especially during March, April and May; 582 cases were notified in these three months out of a total of 877 cases during the whole year. One death occurred. The cases were notified or reported as follows:— Measles. German Measles. Notified by medical practitioners 1022 781 „ parents or guardians 107 53 Otherwise discovered 104 43 1233 877 The number of cases notified, the deaths, and the case mortality per cent. for the ten years during which measles has been notifiable, will be found in the following table:— Year. Cases Notified. Deaths. Case Mortality per cent. Measles. G.M. Measles. G.M. Measles. G.M. 1916 1885 381 42 — 2.2 — 1917 3681 609 118 1 3.2 0.2 1918 2144 311 75 — 3.5 — 1919 1034 268 15 — 1.5 — 1920 3093 195 65 — 2.1 — 1921 1149 81 23 — 2.0 — 1922 3728 253 107 — 2.9 — 1923 327 134 5 — 1.5 — 1924 4332 270 74 — 1.7 — 1925 1233 877 3 1 0.2 0.1 71 OTHER NOTIFIABLE DISEASES. Malaria.—Six cases were notified. In all cases the disease had been contracted abroad, but they were notified owing to a recurrence of the illness. Another case was notified, but this was one of "induced" malaria, in which the disease was deliberately given as a method of treatment for general paralysis. The effect in this case was beneficial, and the patient has been discharged from the institution and sent home. Dysentery.—The notifiable forms of this disease are Amœbic and Bacillary Dysentery, and the infection in these cases has usually been contracted abroad. One case of the bacillary type occurred during the year and proved fatal—the patient was an Italian subject engaged in a restaurant. Anthrax.—One case was notified. The disease is not common, no previous case having been reported since 1918. It usually occurs in persons who handle imported hair or hides. The case in question occurred in a man engaged in tanning goat skins, which had been imported from India and various parts of Africa. At the tannery in question great care is taken, and the employees have adequate medical supervision. This is well shown by the fact that only four cases have occurred during a period of 12 years, and during this period about eight million skins have been handled. The man made a good recovery and returned to the same work. No cases of typhus, cholera, plague., glanders, or hydrophobia were notified. WHOOPING COUGH. This disease was very prevalent, especially during the months of January and February. The mortality was also great, the number of deaths recorded, 71, being, with one exception, the highest number during any of the past 10 years. 29 of the deaths were of children under 1 year of age. It is a curious fact that whooping cough is the one disease which is more fatal to girls than to boys. Since 1915 the total number of deaths from this cause is 477, and of this number 207 were boys and 270 girls. The following table gives the number of deaths from Whooping Cough during each of the past ten years:— Year. Deaths. Year. Deaths. 1916 39 1921 38 1917 27 1922 29 1918 80 1923 28 1919 7 1924 46 1920 60 1925 71 DIARRHŒA AND ENTERITIS. Fifty-five deaths were recorded during the year from the above causes. Of this number 45 were of children under 1 year of age. Deaths from these causes are most numerous in summer and early autumn, especially if the weather is hot and dry, and flies are very numerous. The principal victims are artificially fed babies, the infection being due to contamination of milk and other food by flies. Breast fed babies suffer very little from these affections. The following table gives particulars concerning the deaths from the above causes, and the total infant mortality rate from all causes during the past 10 years.:— 72 Diarrhœa and Enteritis, Year. Number of Births Registered. Number of Deaths from Diarrhoea and Enteritis. Infantile Mortality— from all Causes— per 1000 Births. At all Ages. Under 5. Under 1. Death-rate under 1 per 1000 Births. 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 1925 3880 55 49 45 12 72 During the past 3 years the infantile death-rate in the Borough from this cause has been unduly high. As stated above, the disease most frequently attacks artificially fed infants: those who are entirely breast fed seldom suffer from this affection. In the early part of the summer the attention of the medical practitioners who conduct the consultations at the Welfare Centres was drawn to this matter, and they were requested to co-operate and for a time concentrate on this work. 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 the disease was not very prevalent, and the number of deaths recorded, 41, was about half the figure of the previous year. The following table gives the number of deaths from Influenza during each of the past eight years:— Year. Deaths. Year. Deaths. 1918 700 1922 142 1919 260 1923 24 1920 46 1924 80 1921 57 1925 41 SYPHILIS. In the following table are given the age and sex distribution of all deaths certified during the year as due to (a) syphilis, (b) locomotor ataxy and general paralysis of the insane, which are late manifestations of the disease, and (c) aortic aneurysm, which is frequently caused by it:— 73 MALES. FEMALES. Total Persons. Under 5 years. 5—15 years. 15 to 65 years. 65 and over. Total Males. Under 5 years. 5—15 years. 15 to 65 years. 65 and over. Total Females. Syphilis 4 — 1 — 5 1 — 3 1 5 10 Locomotor Ataxy — — 3 — 3 — — — — — 3 General Paralysis of the insane — — 8 — 8 — — 3 — 3 11 Aortic Aneurysm — — 12 l 13 — — 2 1 3 16 Totals 4 24 1 29 1 — 8 2 11 10 The following table gives the total number of deaths (male and female) from the syphilitic group of diseases during the past 5 years : — Year. Number of deaths from— Total. Syphilis. Locomotor Ataxy. General Paralysis of the Insane. Aortic Aneurysm. Male. Female. Male. Female. Male. Female. Male. Female. 1921 10 8 5 — 8 2 8 — 41 1922 3 9 6 — 18 5 5 2 48 1923 7 1 6 — 10 2 12 3 41 1924 11 4 2 1 20 2 5 1 46 1925 5 5 3 — 8 3 13 3 40 Totals 36 27 22 1 64 14 43 9 216 CANCER. As a cause of death this disease is steadily increasing. It usually manifests itself during late adult life, and it has been stated that, as the average age at death has increased, and is now higher than it was, more people are living at an age at which Cancer usually developes. During the past year 324 deaths were recorded as being due to this cause; this is equal to a death-rate of 1.5 per 1000 of population. This is the highest number of deaths from this disease hitherto recorded in the Borough during any year. The sex distribution of the deaths and death-rates is shown in the following table:— Sex. No. of Deaths. Death-rates per 1,000 males or females living, based on estimated population. Males 167 1.64 Females 157 1.38 Total 324 1.50 71 The number of deaths and the death-rate from Cancer during tho past 10 years are given in the following table:— Sex. 1916. 1917. 1918. 1919. 1920. 1921, 1922. 1923. 1924. 1925. Average of past 10 years. Males 125 135 125 114 150 140 157 159 133 167 140 Females 142 146 144 131 149 150 145 160 165 157 149 Total 267 281 269 245 299 290 302 319 298 324 289 Hate per 1000 of population 1.22 1.29 1.23 1.12 1.28 1.36 1.42 1.49 1.36 1.50 1.33 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. Anthrax 1 1 1 1 Scarlet Fever 638 622 655 655 Diphtheria 691 682 718 718 Enteric Fever 17 16 16 2 Erysipelas 72 72 72 1 Puerperal Fever 18 18 18 3 Encephalitis Lethargica 9 9 9 7 Cerebrospinal Meningitis 6 6 6 6 Poliomyelitis 1 1 1 — Tuberculosis 150 150 148 128 Measles 11 11 8 8 Vermin and Scabies 71 71 84 78 Other Diseases (not notifiable) 248 248 250 48 Totals 1933 1907 1980 1655 On the following page is shown the number of articles disinfected or destroyed during the year on account of infectious disease or verminous condition:— 75 — Infectious Disease. Verminous. Destroyed. Disinfected. Destroyed. Disinfected. Beds, mattresses and palliasses 102 1970 20 35 Bolsters and pillows 50 4001 7 57 Sheets, blankets and counterpanes 26 5543 — 81 Rugs, mats, cushions, carpets, covers and curtains 29 864 8 7 Wearing apparel 9 2429 — 9 Books — 157 — — Sundries 32 409 3 2 Totals 248 15373 38 191 The tables above are exclusive of the disinfection of the clothing of persons attending the cleansing station for vermin or scabies. Cleansing Station. The amount of work carried out during the year is shown in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and the clothing is disinfected: — Men. Women. Children under 15. Total. St. Pancras Cases Other Cases Vermin 1028 26 4135 *5189 Scabies 10 5 769 784 Vermin 59 2 827 888 Scabies — — 147 147 Totals 1097 33 5878 7008 * Includes 565 males and 8 females who had no home address. The staff of the Disinfecting and Cleansing Station consists of a Foreman, a Stoker and General Assistant, and 2 Assistant Disinfectors; a Matron of the Cleansing Station and 2 Women Assistants. THE MORTUARY. Considerable and very necessary improvements have been carried out during the year. The old post-mortem room was small; there was no facility for hot water, and the lighting and ventilation were inadequate. The fittings were also of a very old type, insanitary and defective. It was decided to convert the large viewing room into a post-mortem room, and use the smaller adjoining room, which previously had been reserved for infectious cases, as a viewing room. The old and unsatisfactory post-mortem room could then be utilised, when necessary, for infectious cases for which purpose it was adequate. Two new tables of modern type were provided in the post-mortem room, together with hand-basins, sinks and a supply of hot water. The lighting and ventilation were also improved. The building and equipment is now thoroughly satisfactory. 76 INQUESTS AND POST-MORTEMS, Number of inquests held during the year:— Males 196 Females 107 Total 303 Number of bodies received:— — Males 117 Females 84 Total 201 Number of Post-mortems held:— — Males 89 Females 54 Total 143 INQUESTS. 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 1 35 19 58 Pneumonia 8 2 — — 3 3 16 Cerebral Hæmorrhage 2 — — — 7 4 13 Tuberculosis — — — — 6 1 7 Other causes 7 4 4 — 21 7 43 Accidents— Street Vehicles — 4 12 5 18 18 52 Burns and Scalds 3 1 — 2 3 9 Railway — — — — 5 1 6 Fall — 2 1 2 9 7 21 Other causes* 11 2 2 2 8 6 31 Suicides † — — — 1 24 5 30 Murder — — — 1 1 1 3 Manslaughter — — — 1 — — 1 Open Verdict ‡ 1 — — 4 7 1 13 Totals 31 17 21 17 146 71 303 * Includes 1 case of coal gas poisoning. † „ 7 cases ,, ,, ‡ „ 3 „ „ „ Section V.-SANITARY CIRCUMSTANCES OF THE DISTRICT. SANITARY INSPECTION OF THE BOROUGH. Inspections.—Altogether 66,541 inspections were made in 1925 by the staff of Inspectors and Visitors. These consisted of 477 initial inspections and 34,064 re-inspections. Of these inspections, 36,702 were made by the District Sanitary Inspectors, 7,494 by the Sanitary Inspectors of Food and Food places, 3,567 by the Sanitary Inspector of Factories and Workshops, and 18,778 by the Women Sanitary Inspectors and Health Visitors. The inspections made by each individual Inspector and Visitor are shown in Tables 10 and 11, on pages 117 and 118. The work of the various classes of Inspectors and Visitors is set out in Tables 7, 8 and 9, on pages 113, 114 and 116. The inspections dealt with above are exclusive of the visits made by the Council's stall at the Maternity and Child Welfare Centres (see page 27), and by the staff of the Tuberculosis Dispensaries (see page 61); nor do they include the work of the disinfecting staff (see page 74). Notices served and result of serevice.—3,762 intimation notices (comprising 7,876 items) were served by the Sanitary Inspectors during 1925. These were made up as follows:— The following table summarises the work of the Inspectors during each of the past 5 years:— 1921 1922 1923 1924 1925† Total Inspections 40526 40772 40437 38871 36702 *District Inspectors. Intimation Notices served (items) 8928 7798 6595 7941 7255 Total Inspections 6423 6909 7115 7369 7494 Food Inspectors. Intimation Notices served (items) 14 13 4 7 10 Total Inspections 3430 3225 3144 3606 3567 Factory Inspectors. Intimation Notices served (items) 622 512 434 471 611 Women Inspectors.—Total Inspections 19289 19911 15468 18731 18778 * One additional district Inspector since October 21st, 1925. † 2 Inspectors absent on account of illness for 35 weeks. — District Inspectors. Factory and Workshop Inspector. Food Inspectors. Women Inspectors. Total. In respect of Nuisances 5498 1 2 — 5501 In respect of the Tenement House By-laws 398 — — — 398 In respect of Breaches of Statutes in Factories, Workshops and Workplaces — 610 — — 610 In respect of other Breaches of Statutes and By-laws 1359 — 8 — 1367 Totals 7255 611 10 — 7876 These intimations are classified in Tables 12, 13, 14 and 15, on pages 119 and 120. 1,282 Statutory notices (comprising 2,084 items) were served during 1925 and the early part of 1926, following non-compliance with these intimation notices. These are also classified in Tables 12, 13, 14 and 15, on pages 119 and 120. 78 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. 114, Torriano Avenue Roof defective Jan. 28th Costs £1 1s.—Order 28 days. 17, St. George's Square Rooms dirty; water-closet basin and apartment foul; rainwater pipe and sink defective „ 28th Order 28 days 17, „ Water-closet and accessories not maintained in a proper condition of repair „ 28th Fined 10s., costs £1 1s. 1, Wolcot Street Ceilings damp; washhouse and water-closet roofs defective „ 29th Fined 1s., costs £2 2s. 1. „ Failing to provide portable metal dust bin „ 29th Summonses withdrawn. Notices complied with. 1, „ Defective yard paving 29th 2, „ Ceiling damp; roof and guttering defective; ceiling defective Feb. 25th Fined 1s., costs £2 2s. 2 „ Walls and ceilings dirty „ 25th Summonses withdrawn. Notices complied with. 2, „ Failing to pave yard „ 25th 3, „ Roof, guttering and ceiling defective ,, 25th Do. 11, ,, Walls and ceilings dirty and defective; rainwater pipe defective; ground outside water-closet in a foul condition „ 25th Fined 1s., costs ,£1 1s. 11, „ Failing to provide portable metal dust bin „ 25 th Summons withdrawn —notice complied with. 11, „ Failing to repair yard paving „ 25th Fined 1s., costs £1 1s. 12, „ Ceilings damp, defective and dangerous; roof and guttering defective; ground outside water-closet foul „ 25 th Do. 12, „ Failing to provide proper portable metal dust bin „ 26th Withdrawn—notice complied with. 12, „ Failing to repair yard paving „ 25th Do. 154, Seymour Street Rainwater pipe defective „ 25th Fined 1s., costs £1 1s. 24, Barclay Street Drain ventilating pipe defective „ 25th Costs ,£1 1s.—Order 14 days. 10b, Gospel Oak Grove Walls and ceilings dirty and roof defective Mar. 11th Costs £2 2s.—Order 14 days. 35, Queen's Crescent Roofs and skylight defective „ 11th Costs £2 2s.—Order 21 days. 21, Carlton Road Walls and ceilings dirty; roof of lobby and dust bin defective „ 18th Costs £2 2s.—Order 14 days. 55, Fitzroy Road Failing to comply with nuisance order Feb. 11th Fined 1s., costs £3 3s. 13, Drummond Street Defective drain April 27th Costs £1 3s.—Order 28 days. 23, 24, 46, 47 & 18, Barclay Street Failing to comply with nuisance orders „ 27th Adjourned sine die for enquiry as to Bankruptcy proceedings. 17, St. George's Square Do. „ 30th Fined .£1 14s., costs £1 1s. 15, Falkland Place Failing to provide sufficient water-closet accommodation „ 15th Costs £6 6s. Ejectment order obtained by owner. 52, Lulot Street Defective back addition roof Oct. 16th Fined 1s., costs £2 2s. 66, Chalton Street Drain ventilating pipe, fresh air inlet and foul air outlet defective; interceptor without a stopper Nov. 9th Costs ,£2 2s.—Order 28 days. 83, Leverton Street Absence of proper and sufficient supply of water „ 26th Costs £2 2s.—notice complied with. Under the London County Council (General Powers) Act, 1922. Situation of Property Offence. Date of Hearing of Summons. Result of Proceedings. 1, Wolcot Street Room verminous Jan. 29th Summons withdrawn—notice complied with. 2, „ Do. Feb. 25th Do. 3, „ Do. „ 25th Do. 24, Barclay Street Do. „ 25th Do. 79 PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS AND REGULATIONS. Offensive Trade.—There is only one licensed place for such trades in St. Pancras, viz., a tallow-melter's in Tudor Place. Forty-six visits were made to these premises in 1925. Registered Tenement Houses. At the end of 1925 there were 2,365 such houses on the Register. Statistics as to the inspection of these and other houses will be found in Tables Nos. 7 and 13, on pages 113 and 119. 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 280 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 499 4946 Voluntary drainage work 846 3082 Drains of new buildings 112 2286 1457 10314 Drainage Register.—The following is an analysis of the Drainage Register during 1925:— Plans deposited—Old Buildings under Notice 180 ,, „ Old Buildings, Voluntary 184 ,, „ New Buildings and Additions 41 405 Applications without Plans 257 Total number of Applications and Plans 662 80 Water Sera ice. 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 and waste 2 2.—Non-payment of Rates 5 3.—Broken supply pipe 1 56 Certificates were issued by the Medical Officer of Health, under Section 48, Subsection 2, of the Public Health (London) Act, 1891, in respect of new houses, certifying that they have a proper and sufficient supply of water for sanitary and domestic purpose?. Canal Boats Aits. The Canal Boats (Amendment) Regulations, 1925, came into force during the year. The responsibility of maintaining a canal boat in a habitable condition is now placed upon the owner, instead of the master. During the year Inspector Auger examined 3 canal boats, which were registered for the occupation of 6 adults and 7 children, and were actually occupied by 5 adults and 1 child. A weekly inspection of the canal and wharves has also been made. The Rag Flock Act, 1911. No samples of rag flock were taken during the year. Rag and Bonk Dealers. New by-laws made by the London County Council lor regulating the business of the above were sanctioned by the Ministry of Health in September, 1923, but certain portions were not to take effect for a period of 12 months. These portions became operative late in 1924, and special visits were made then and early in the past year to all persons engaged in this business, drawing their attention to the new regulations. A list of the names and addresses of all rag and bone dealers was given in the Report for 1924. RENT AND MORTGAGE INTEREST RESTRICTIONS ACT, 1923. During the year 139 applications were received from tenants for certificates under this Act, and in 134 cases certificates were granted specifying the works required to be executed to put the dwelling houses into a good and tenantable 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, e.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. 81 FACTORY AND WORKSHOP ACTS. The following five tables are those asked for by the Home Secretary:— 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including factory laundries and bakehouses) 1155 265 — Workshops (including workshop laundries and bakehouses) 1874 280 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 505 65 — Total 3534 610 — 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*: — Nil. Nil. Want of cleanliness 168 168 Want of ventilation 3 3 Overcrowding 2 2 Want of drainage of floors — — Other nuisances 118 118 Sanitary accommodation— Insufficient. . 13 13 Unsuitable or defective 89 89 Not separate for sexes 28 28 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) 1 1 Breach of special sanitar y requirements for bakehouses (ss. 97 to 100) 99 99 Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report; 89 89 Total 610 610 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 82 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:—16 in respect of the making, etc., of wearing apparel, comprising the names of 63 outworkers (contractors) and 7.3 outworkers (workmen), and 1 in respect of upholstering, containing the names of 3 outworkers (workmen). 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year. Number. (1) (2) Bakehouses 102 Restaurant kitchens 376 Laundries 23 Domestic workshops — Other workshops where women are employed 482 Other workshops 831 Total number of workshops on Register 1814 5.—Other Matters. Class Number. (1) (2) Mattel's 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 33 Reports (of action taken) sent to H.M. Inspector 33 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 14 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 86 83 The number of factories, workshops and workplaces added to and removed from the register during 1925 was as follows: — — Added to Register. Removed from Register. On Register at end of 1925. Bakehouses— Workshop — 12 102 Factory 11 — 57 Laundries— Workshop — 6 23 Factory — 2 10 Restaurant kitchens 4 20 376 Other workshops where women are employed 46 17 482 Other workshops 37 22 831 Other factories 51 14 774 The number of inspections that were made during 1925 were as follows: — — Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-in spections. Inspections. Re-inspections. Bakehouses 309 224 — — 309 224 Restaurant kitchens 95 185 — — 95 185 Laundries 18 23 — — 18 23 Domestic workshops — — 315 105 315 105 Other workshops 398 1176 — — 398 1176 Other workplaces 83 142 462 83 545 225 Other factories 234 647 — — 234 647 Total 1137 2397 777 188 1914 2585 Bakehouses and restaurant kitchens are also referred to in Section V. (page 93). 84 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. Tho County Medical Officer has kindly furnished me with particulars of medical inspections of school children in St. Pancras during 1925. They are classified in the following Tables:— Medical Routine Examination of Elementary School Children in St. Pancras, 1925. Defect. Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14 Number examined 19 65 1070 1591 1055 2036 1071 1556 1051 Malnutrition Cases. * Cases. * Cases. * Cases. # Cases. * Cases. * Cases. * Cases. * 9 7 18 18 8 6 4 4 11 9 24 23 10 8 2 *2 Skin disease 28 20 9 7 16 11 7 7 31 21 9 8 13 10 17 11 Defective teeth — 523 — 227 — 239 — 190 — 562 1 229 — 207 — 204 Enlarged tonsils 171 51 69 20 49 12 28 9 190 53 68 20 51 17 48 17 Adenoids 132 71 41 27 15 10 6 3 137 72 35 21 8 4 1 — Tonsils & adenoids 146 88 28 22 12 8 — — 149 99 40 28 12 12 — — Other nose and throat 27 15 9 7 17 11 14 11 20 12 8 5 13 10 9 6 Enlarged glands 85 8 47 5 18 — 5 1 76 5 48 4 9 1 5 2 Eye disease 52 39 18 12 10 4 5 4 57 44 11 8 11 12 12 9 Defective vision... — — — 114 — 182 — 98 — — — 121 — 165 — 101 Otorrhœa 33 25 9 6 12 11 10 9 46 84 19 12 20 15 5 4 Other ear disease 8 8 2 1 8 7 3 2 7 1 3 3 2 2 1 1 Defective hearing 18 11 14 8 19 12 17 12 12 5 13 6 13 8 9 4 Speech defects 11 1 1 — 1 — 3 — 1 1 — — 2 2 — — Heart defects 36 5 28 2 26 5 16 2 34 4 23 4 14 14 22 3 Anæmia 58 19 28 17 45 21 9 4 60 28 25 14 51 32 28 12 Lung defects 101 46 29 11 16 1 10 3 104 10 32 17 8 4 4 — Nervous system 3 1 6 2 1 — 4 2 8 1 6 4 6 4 10 5 Phthisis 5 1 10 2 6 1 2 1 3 — 4 1 5 1 1 1 Other T. B. disease — — — — 2 1 — — — — — — — — 1 — Rickets 18 7 8 5 4 — — — 8 3 5 3 1 1 — — Spinal deformities* 6 4 9 7 9 7 4 3 2 2 9 6 28 16 17 15 Other deformities 8 3 3 — 11 5 9 1 6 3 4 2 11 1 9 2 Other defects 63 29 31 17 37 21 9 5 65 36 32 16 37 21 33 13 Number of children noted for treatment 788 128 499 313 848 445 473 358 Note —Defects, however slight, arc included under "Cases." Those severe enough to require treatment are shown under *. 85 Medical Routine Examination of Elementary School Children in St. Pancras in 1925. Age Group. Number examined. Clothing and Hoots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good. Fair. Boor. Good. Average. Below normal. Bad. Clean. Nits. 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 1965 1514 444 7 355 1576 34 — 1893 69 3 1927 38 — 976 685 304 — — — Girls 2036 1508 527 1 380 1610 46 — 1843 175 18 2001 34 1 992 703 341 — — — Age 8— Boys 1070 809 258 3 147 884 30 — 1044 24 2 1057 13 — 587 351 132 510 331 208 Girls 1071 767 301 3 139 893 38 1 929 128 14 1035 35 1 526 434 111 537 321 199 Age 12— Boys 1591 1200 384 7 194 1369 28 — 1549 42 — 1562 28 1 1025 505 61 972 329 286 Girls 1556 1214 339 3 252 1270 34 — 1402 142 12 1518 36 2 1036 487 33 905 342 307 Age 14— Boys 1055 777 277 1 210 822 23 — 1019 31 5 1028 26 1 661 358 30 704 178 168 Girls 1051 776 272 3 275 760 16 — 948 92 11 1036 15 — 610 379 32 700 148 201 Total 11395 8565 2802 28 1952 9184 258 1 10627 703 65 11164 225 6 6443 3902 1050 4328 1649 1369 % St. Pancras 751 246 03 171 80.6 2.3 — 93.2 6.2 0.6 98.0 2.0 — 56.5 34.3 9.2 58.9 22.5 18.6 % London 60.1 38.6 1.3 21.1 72.9 6.0 — 91.0 8.3 0.7 95.3 4.6 0.1 61.8 30.2 8.0 53.9 26.3 19.8 86 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, 1926 :— — Weekly average Number of children fed. Number of meals provided. Cod Liver Oil and Malt. Dinners. Breakfasts. Milk. Ordinary Schools. *(a) Necessitous 269 16118 36967 1147 †(b) Non-necessitous 625 9383 — 109038 4494 Special Schools. *(a) Necessitous 72 12631 — 2285 334 †(b) Non-necessitous 337 57912 — 17151 5 Totals 1303 96044 165391 5980 * Free, or paying part of the full authorised charge. † Paying the full authorised charge. The schools were closed for normal holidays during the following periods:— Easter—9th to 20th April, 1925. Whitsuntide—1st June, 1925. Summer—23rd July to 24th August, 1925, inclusive. Autumn—26th and 27th October, 1925. Christmas—24th December, 1925, to 11th January, 1926, inclusive. Section VI.—FOOD. (a) MILK SUPPLY. Cowsheds, Dairies, and Milkshops. Cowsheds.—There are only two licensed cowsheds in the Borough; these can accommodate 30 cows, hut were occupied during the year by only 16. This small number of cows only contribute a negligible fraction of the milk required in tho Borough, practically the whole supply being brought in from farms in the country, either by rail or motor transport. Dairies and Milkshops.—Thirty applications for registration under the Dairies, Cowsheds and Milkshops Orders were received during the year. Of this number, 19 were granted and 11 refused. Six applications in respect of itinerant vendors were also received: of these, 3 were granted and 3 refused. The following list gives particulars as to the purveyors of milk on the register at the end of 1925:— 87 Number of purveyors of milk from retail milkshops on the register at the end of 1924 211 Deduct number removed from the register during the year 1925 -17 Add number of purveyors registered by resolution of the Council during 1925 + 19 Total number of purveyors of milk from retail milkshops on register at the end of 1925 213 In addition to the above, there were also on the register at the end of 1925 one person in respect of premises where a wholesale milk trade only is done, and 12 itinerant vendors without retail milkshops. The two cowsheds abovo mentioned also have retail milkshops attached to them, and these are included in the total of 213. Dairies, Cowsheds and Milkshops Order, 1885. Legal proceedings were taken in the following cases against vendors carrying on the rade of purveyors of milk without being registered:— Date of Hearing Address where offence oommitted. Offence. Result of Proceedings. 1925. 17th Deo, G, Mornington Street, N.W.1 Carrying on the trade or business of a purveyor of milk without being registered Dismissed with £l 1s. costs against Council. Do. 8, Mornington Street, N.W.1 Do. do. Withdrawn. <K With reference to the registration of purveyors of milk, it has always been the policy of the St. Pancras Borough Council to require registration, whether tho milk was sold in sealed bottles or otherwise. In some boroughs this practice has not been followed, and sterilised milk in sealed (paper seal) stoppered bottles is allowed to be sold in any shop without registration. In addition to this, certain wholesale distributors of sterilised bottled milk have informed the proprietors of general shops that this milk can be sold by them without it being necessary to register as purveyors of milk. Several prosecutions have taken place with reference to this in various parts of the country, and Magistrates have differed in their decisions. On December 17th, 1925, proceedings were taken by the St. Pancras Borough Council against the proprietor of a general shop for selling sterilised milk in bottles without being registered. The case was dismissed with costs against the Council. The report of the Public Health Committee on this case is given below, as it clearly states the present position, and also states the views of the Council as to the amendment of the law they consider necessary:— Bottled Milk.—Prosecution of Unregistered Vendor. We have considered the report from the Council's Solicitors as to a summons they conducted against a general shopkeeper for carrying on the business of a purveyor of milk without being registered, when the Magistrate dismissed the summons with one guinea costs against the Council. The milk sold was described as sterilised milk, and the Magistrate held that the defendant was a purveyor cf milk, but that, hating regard to the 88 special treatment to which the milk had been submitted, it was not milk as contemplated by the Dairies, Cowsheds and Milkshops Order, 1885. Having regard to the decision in this case, a summons against another person for a similar offence was withdrawn. In two similar prosecutions by the Council, taken some time ago, the Magistrate held that milk sold in sealed bottles came within the terms of the Order, and a similar decision was given in a Manchester case. In a ease considered at Paddington the Magistrate held that the seller of bottled milk need not be registered as a purveyor of milk, and in a Wolverhampton case a decision was given in 1919, by a Stipendiary, that sterilised milk was a milk preparation, and did not come within a Milk Trices Order. The Council's policy has been to require the occupiers of general shops to be registered as purveyors of milk, whether sold in bottles or otherwise. If the shop is clean and the occupier undertakes not to keep, store or sell paraffin or other oil, loose pickles and vinegar, coal, coke, or any articles which are likely to cause dust, or by their odour to pollute milk, he is registered, but otherwise registration is refused. There is always the possibility of a shop-keeper opening the bottles and selling the milk in small quantities, with the attendant risk of contamination. We understand that many local authorities do not require registration when bottled milk is the only kind of milk sold. Under the Milk and Dairies Act, 1915 (which came into force in September, 1925), the expression " milk" includes cream, skimmed milk and separated milk. We are of opinion that an amendment of this definition, so as to include all liquid milk sold in bottles, whether sterilised or otherwise, would be advisable. We recommend— That a full statement of the Council's position in regard to the registration of purveyors of bottled milk be forwarded to the Minister of Health, and that he be asked to issue a regulation, or if necessary obtain an amendment of the law, to require that purveyors of liquid milk sold in bottles, whether it be sterilised or treated in any other manner, must be registered. In the case mentioned above, the Magistrate's decision that, because the milk had been sterilised, that is, heated to or above boiling point, it was no longer milk as contemplated by the Order, and therefore the vendor need not be registered, gives rise to a remarkable situation. Vendors of Pasteurised milk, that is, milk heated to a temperature of 145-150 degrees, must not only be registered, but must pay a special fee for permission to sell such milk. According to the Magistrates's decision recorded above, a vendor has only to heat the milk to a higher temperature, for instance, boiling point, and then it is no longer milk as contemplated by the Order, and registration is not necessary. 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. 89 The following licences for the Sale of Graded Milk were granted in respect of 1925:— 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. Dec. 19 th, 1924 Welfords & Premier Dairies, Ltd., 233, Seven Sisters Road, N. 4 "Certified" Supplementary licence to sell in St. Pancras. Do. Belgravia Dairy Co., Ltd., 4-6, Exhibition Road, S.W. 7 Do. Do. Do. Do. "Pasteurised" Do. Do. J. R. Mills & Sons, 23, Francis Street, W.C. 1 "Grade A" 23, Francis Street. Do. Manor Farm Dairy Co., Ltd., 39, High Road, East Finchley, N. 2 "Certified" Supplementary licence to sell in St. Pancras. Do. Do. "Pasteurised" 26, High Street, Highgate. Do. Do. Do. Swain's Lane. Do. Marshall's Dairies, Ltd., 19, Tudor Place. W. 1 "Grade A Tuberculin tested'' 19, Tudor Place. Do. Vicarage Farm Dairy Co., Ltd., 277 & 279, Kentish Town Road, N. W. 5 "Grade A" 277/9, Kentish Town Road. Do Do. "Certified" Do. Do. Do. "Pasteurised" Do. 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. Lord Rayleigh's Dairies, Ltd., 16, Caroline Street, W.C.1 "Certified" Supplementary licence to sell in St. Pancras. Do. Do. "Grade A Tuberculin tested'' Do. Do. Welford & Sons, Ltd., Elgin Avenue, W.9 "Certified" 63, Park Street. Do. Do. "Pasteurised" Do. Do. Do. "Certified" 69, Albany Street. Do. Do. " Pasteurised " Do. Jan. 23rd, 1925 J. Evans, 35, Southampton Street "Grade A" 35, Southampton Street. Do. J. Richards, Ltd., 41, Englands Lane, N.W. 3 " Pasteurised " 126, Regent's Park Road. Feb. 19th, 1925 John Davies, 78, Judd Street, W.C. 1 " Grade A " 78, Judd Street. Do. Evan Jones, 137, King's Cross Road, W.C. 1 " Certified " 137, King's Cross Road. Do. T. Jones, 23, Haverstock Road Do. 23, Haverstock Road. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. Report for Year ended 31st December, 1925. 1. Milk, and Cream not sold as Preserved Cream. — (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 370 1 Cream 9 3 Nature of preservative in each case in column (b), and action taken under Regulations in regard to it:— C. 2. Milk. At least 15.3 per cent. of added water and 1.76 per cent. of sodium carbonate. Informal Sample. 90 C. 186. Cream. 0.165 per cent. of boron trioxide, equal to 0.292 per cent, of boric acid, Proceedings taken under the Sale of Pood and Drugs Acts for selling to the prejudice of the purchaser. Fined 20s.; costs, 42s. A. 189. Cream. 0.145 per cent, of boron trioxide, equal to 0.257 per cent. of borio acid, A, 190. Cream. 0.111 per cent. of boron trioxide, equal to 0.196 per cent. of boric acid. In the last two 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. (a) Instances in which samples have boon submitted for analysis to ascertain if tho statements on the labels as to Preservatives were correot — (i) Correct statements made 21 (ii) Statements incorrect — Total 21 (iii) Percentage of preservative found in each sample: Boric acid, 0.296, 0.211, 0.179, 0.221, 0.223, 0.248, 0.322, 0.285, 0.270, 0.273, 0.094, 0.198, 0.119, 0.082, 0.159, 0.068, 0.186, 0.287, 0.198,0.142, and trace only. Percentage stated on statutory label: 0.4. (b) Determinations made of milk fat in cream sold as preserved cream : — (i) Above 35 per cent. 21 (ii) Below 35 per cent. — Total 21 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed : None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken : None. 3. Thickening Substances.—Any evidence of their addition to cream or to preserved cream. Action taken where found : None. Milk and Dairies (Consolidation) Act, 1915. The above-mentioned Act, the operation of which had been deferred owing to the War, came into force on the 1st September, 1925. The Act repeals and re-enacts a number of provisions contained in the Contagious Diseases (Animals) Acts and the Sale of Food and Drugs Acts with regard to Milk and Dairies. It also reproduces a number of amendments and new provisions which wore contained in the Milk and Dairies Act, 1914, the operation of which was deferred. Public Health (Prevention of Tuberculosis) Regulations, 1925. These important regulations came into force on 31st July, 1925. They constitute a definite legislative step towards the prevention of tuberculous infection being spread by milk. They provide that " no person who is aware that he is suffering from tuberculosis of the " respiratory tract shall enter upon any employment or occupation in connection with a " dairy which would involve the milking of cows, the treatment of milk, or the handling of " vessels used for containing milk." Tho Council may require any such person to discontinue his employment or occupation in that capacity. 91 Public Health (Meat) Regulations, 1924. Tho above Regulations, which came into force on April 1st, 1925, are based on the recommendations of the Departmental Committee on Moat Inspection. They are designed to secure more adequate inspection of animals slaughtered in this country, and improvements in the handling, transport and distribution of meat. The Borough Council have to enforce and execute these Regulations and, by resolution, have authorised the Medical Officer of Health and the Food Inspectors to act for the Council. "With regard to slaughter-houses, the Regulations require that due notice shall be given to the Local Authority concerning the time when slaughtering is to take place, that notice must be given when any carcase appears to be diseased or unsound, and forbids certain processes to be carried on in any slaughter-house. With regard to shops, stores, stalls, etc., the Regulations specify certain precautions which are to be taken with the object of preventing contamination, and for securing cleanliness of premises, implements, etc. A person suffering from infectious disease is also prohibited from slaughtering animals or handling meat. A copy of the Regulations was delivered by the Food Inspectors to every person in the Borough who deals in "meat." This is defined in the Regulations as meaning the flesh of cattle, sheep or goats (including bacon, ham, edible offal and fat) sold or intended for sale for human consumption. A number of prosecutions have been undertaken in connection with breaches of the above Regulations. Particulars concerning these will be found on page 95. In actual practice the above Regulations have been disappointing, and their value has been diminished owing to their ambiguity. The Union of London Retail Meat Traders stated that, as there existed an impression that there can be read into the Regulations a direction for the compulsory introduction of glass windows to all butchers' shops, a letter was forwarded to the Minister of Health asking for a ruling on this point. In his reply, the Minister stated that he had no jurisdiction to give an authoritative interpretation of the Meat Regulations, that they would be administered by Local Authorities, and in any case of dispute as to their meaning it would be for the Courts to decide. Such a position is thoroughly unsatisfactory to the public, to the traders and to the officers of Local Authorities. It should not be necessary to have to undertake prosecutions in order to define the meaning of a Regulation. Every Act, by-law, regulation or order should be made as definite and as clear as possible, so that the interpretation cannot be influenced by the bias of the party affected, or the ideal of the official concerned. Bye-laws—Slaughter Houses—Humane Killing. The by-laws made in 1923 requiring the use of mechanically-operated instruments in connection with the slaughter of animals, permitted, under certain conditions, the Jewish method of slaughter. During the past year the question arose as to whether similar permission should be allowed in respect of slaughter of animals for the food of Moslems. This appeared to be desirable, and an amending by-law was made by the London County Council in March; this was approved by the Minister of Health and came into operation on the 31st July, 1925. 92 Meat Inspection—Tuberculosis Order, 1925. No. 2. This order, made by the Minister of Agriculture and Fisheries, under authority contained in the Diseases of Animal Acts, 1894-1925, relates to the slaughter of animals affected with certain specified forms of Tuberculosis. It provides that notice of intention to slaughter shall be given to the Sanitary Authority in cases where it is intended that the carcase or any part thereof should be disposed of for human consumption, and that no part of the carcase shall be removed from the premises for thai purpose except with the permission, in writing, of the Medical Officer of Health or other competent officer. The order came into force on 1st September, 1925. (b) OTHER FOODS. The Food Inspectors have kept under regular observation 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. Apricots, 67 crates Margarine, 1 box Beef, 34 lbs. Oranges, 18 boxes and 35 cases Cabbages, 1½ trucks Pears, 96 barrels Cherries, 5 baskets Plaice, 1 box Dabs, 1 trunk Plums, 98 baskets Dogfish, 1 basket Rabbits, 27 Elongatas, 1 box Raspberries, 2 tubs Fillets, 10 boxes Roe, 3 boxes Fowls, 20 Sprouts, 6½ bags Green Peas, 110 bags Strawberries, 137 tubs Haddocks, 6 stone. Tomatoes, 68 boxes Liver (Ox), 5 White Pollock, 1 box Lung (Ox), 1 Seized. Bacon, 162 lbs. With reference to the seizure mentioned above, this occurred in the course of a housing inspection by the Medical Officer of Health, accompanied by Mr. James, Sanitary Inspector. 21 pieces of Bacon, weighing 112 lbs., were found on the premises, 32, Chalton Street, and 8 pieces, weighing 50 lbs., belonging to the same owner, were found on a stall in Chalton Street. The whole of this meat was unsound and unfit for food. Proceedings were instituted and a penalty of £10, or in default 31 days' imprisonment, was inflicted. The Magistrate stated that the penalty in this case was small, as the defendant was in humble circumstances. Details in regard to the work of the Food Inspectors are shown in Table No. 8, on pages 114 and 115. Slaughter-houses. At the end of 1925 there were 5 licensed slaughter-houses (private) in the Borough. .Structurally lhey do not confoim to a high standard .of execllcncc. These are kept under 93 periodical inspection by the Food Inspectors, who made 149 inspections in this connection in 1925. Fried Fish and Fish Cumng Premises. In 1925, there were 81 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 19 fish eurers' premises, including these 4. 391 visits were made by the Food Inspectors to the premises during the year. Ice-Cream Premises. In 1925, 328 ice-cream premises were known to the department; 394 visits were paid to them by the Food Inspectors during the year. Bakehouses and Restaurant Kitchens. At the end of 1925 there were 159 bakehouses on the register, including 57 factory bakehouses. Thirty-nine of these bakehouses were not in use. 117 of the 159 were underground bakehouses, of which 50 were factory bakehouses, and 31 not in use. At the end of the year 376 restaurant kitchens were on the register. Bakehouses and restaurant kitchens are visited by the Factory and Workshop Inspector and further particulars in regard to the work will be found on pages 81 to 83. Public Health (Preservatives, Etc., in Food) Regulations, 1925. The Minister of Health has forwarded a copy of these Regulations, which are based on the recommendations of the receut Departmental Committee on the use of preservatives and colouring matter in food. As the Regulations do not come into force until January 1st, 1927, they have doubtless been issued to enable the various traders concerned to dispose of existing stocks which contain preservatives, and also to give time in which to introduce improved methods in order to render the use of preservatives unnecessary. 94 (c)— SALE OF FOOD AND DRUGS ACTS. 750 samples have been taken under these Acts, and 724 of these proved to be genuine and 26, or 3.5 per cent., adulterated. The details are given in the following table : — Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Arrowroot 4 4 — Brawn 1 1 — Butter 114 114 — Celery 1 1 — Cocoa 16 16 — Coffee 18 18 — Cream 9 6 3 Do. (Preserved) 21 21 — Dripping 1 1 — Flour (Self-Raising) 40 40 — Lard 20 20 — Margarine 35 35 — Milk 370 352 18 Mustard 15 14 1 Olive Oil 6 6 — Oysters 1 1 — Pepper 14 14 — Pork Pie 1 1 — Prescriptions 12 12 — Rice 10 10 — Salad Oil 2 2 — Sausages 23 20 3 Sugar 6 6 — Vinegar 8 7 1 Vinegar (Malt) 2 2 — Total 750 724 26 Note. The 750 include four informal samples of milk, one of celery and one of oysters. Prosecutions were undertaken as regards 12 of the above 26 samples which were reported as being adulterated. The results of the proceedings are stated in the following table:— Summonses. (a) Under the Sale of Food and Drugs Acts. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. £ s. d. £ s. d. A. 20 Milk Deficient in milk fat, 13'3 per cent. Mar. 10th Dismissed. Warranty proved. C. 146 „ 10'3 „ July 9th 2 0 0 2 2 0 A. 157 Sausages Boron trioxide, 0.148 per cent. . „ 23rd Dismissed. 2 2 0 A. 158 „ ,, 0.938 „ „ „ 1 0 0 2 2 0 C. 199 Milk Added water, 13.0 per cent Sept. 3rd 5 0 0 3 3 0 C. 200 „ 13.5 „ „ „ 5 0 0 3 3 0 C. 186 Cream Boric acid, 0.292 per cent. „ „ 1 0 0 2 2 0 A. 225 Milk Deficient in milk fat, 5.0 per cent. Oct. 1st 2 0 0 1 12 6 C. 276 Vinegar Deficient in acetic acid, 35 per cent. Nov. 3rd 0 2 6 0 10 6 A. 349 Milk Added water, 5.9 per cent. Jan. 21st Dismissed. 5 5 0 A. 350 „ Deficient in milk fat, 18 per cent. „ A. 348 „ „ 3 „ „ 95 The prosecution in connection with the sample of Sausages, No. A 158, is of importance, owing to the enormous amount of preservative present. According to the Analyst's certificate, no less than 116 grains of Boric Acid was found per pound of sausage. Although there is no definite standard, about 17 grains of this preservative per pound of sausage, etc., has hitherto been considered permissible. The amount present in the case in question, 116 grains per pound, is an alarming and distinctly undesirable quantity. The Public Health (Preservatives, etc., in Food) Regulations, which come into force in January, 1927, prohibit the use of Boric Acid entirely. Summonses—continued, (b) Under the Margarine Act, 1887. Address, Offence. Date of Hearing of Summons. Result of Proceedings. 10. Wellington Street Exposing for sale by retail Margarine without being labelled Jan. 29th Fined £2. 10, ,, Selling by retail Margarine in plain wrapper ,, 29th Do. 6, Mornington Street Do. do. Apl. 2nd Fined £3, costs £1 1s. 6, ,, Exposing for sale by retail Margarine without being labelled ,, 2nd Withdrawn. (c) Under the Meat Regulations, 1924. Address. Offence. Date of Hearing of Summons. Result of Proceedings. Queen's Crescent Exposing meat from a stall which was not suitably covered over and screened May 28th Fined £1, costs £l 1s. Do. Do. do. „ 28th Do. Do. Do. do. July 9th Fined ,£3, costs £3 3s. Do. Do. do. ,, 9th Fined £3, costs £2 2s. Do. Do. do. ,, 9th Do. Do. Do. do. „ 9th Do. Do. Do. do. „ 9th Do. Chalton Street Do. do. Dec. 30th Fined 10s., costs 10s. 6d. Do. Do. do. „ 30th Do. Do. Do. do. „ 30th Do. Do. Do. do. " 30th Do. Section VII.— SANITARY ADMINISTRATION. The Staff. The names of the staff of the Public Health Department at the end of 1925 will be found on pages 6 and 7. The following changes occurred during the year Dr. N. M. Donnelly, Tuberculosis Officer, resigned September, 1925. Dr. A. Viney, appointed Assistant Medical Officer for Maternity and Child Welfare, and Assistant Tuberculosis Officer in February, 1925. In September, 1925, Dr. Viney was appointed Tuberculosis Officer, owing to the resignation of Dr. Donnelly. Dr. Gr. A Back, appointed Assistant Medical Officer for Maternity and Child Welfare, and Assistant Tuberculosis Officer. To commence duty in January, 1926. 96 Mr. A. Powell Coke, Chief Clerk of the Public Health Department, and Clerk of the Estates Department, terminated his duties in these positions in August, 1925, owing to being appointed Deputy Town Clerk. Mr. Coke had been associated with the work of the Public Health Department since 1904, and his intimate knowledge of the work, together with his outstanding ability, caused the loss of his services to be keenly felt by the department. Mr. A. D. Corrick appointed Chief Clerk. Mr. S. W. Barker, Junior Clerk, resigned. Mr. H. G. Avril appointed Junior Clerk. Mr. F. A. J. Goodchild appointed Junior Clerk. Mr. L. Higgins and Mr. J. B. Richards, Temporary Clerks, appointments terminated. Staff at Maternity and Child Welfare Centres. Dr. Martin Oldershaw appointed Medical Officer for Ante-Natal Clinics at Argyle Square Centre. Dr. Kathleen F. Lander appointed Medical Officer for Ante-Natal Clinics at Camden Town Centre. Dr. P. Ruth Elliott appointed Medical Officer for Ante-Natal Clinics at Grafton Road Centre. Dr. A. R. Roche resigned his consultations at Grafton Road Centre. Dr. H. S. Baker appointed Medical Officer at Grafton Road Centre. Dr. W. Beaumont appointed Medical Officer at Sunlight Clinic at South Highgate Centre. Miss M. E. Jacobs appointed Health Visitor in place of Miss J. M. Anderson, resigned. Miss M. F. Brooks and Miss A. E. Thurman held temporary appointments as Health Visitors. Summary of the Principal Changes in the Public Health Services during the past 5 Years. 1921. Measles and German Measles made compulsorily notifiable diseases by means of special regulations. Additional Consultations provided at the Ampthill Square and Queen's Crescent Centres. Massage Clinics also provided at these Centres and at the Chalton Street and Camden Road Centres. The Day Nursery at Cartwright Gardens closed. 1922. An additional Health Visitor and a third weekly Consultation provided at the Grafton Road Centre. A new Welfare Centre opened at Caversham Road to take the place of the Centres at Falkland Road and Oseney Crescent, which were closed. Additional powers provided with reference to the disinfection of verminous articles. 1923. Resignation of the Medical Officer of Health, Dr. T. S. Higgins, and appointment of the present Medical Officer of Health, Dr. G. Sowden. New Dental Clinic in connection with the Maternity and Child Welfare Scheme provided in the premises of the Argyle Square Centre. The Tuberculosis Care Committee formed in accordance with the recommendations contained in the circular of the Ministry of Health. Arrangement with the Lister Institute for bacteriological examinations terminated and Professor A. G. R. Foulerton appointed to do the work. 97 1924. Re-organisation of the districts and duties of the Sanitary Inspectors and Health Visitors. Re-arrangement of Ante-Natal Consultations and Midwifery grants. Berkeley Road Welfare Centre closed and work transferred to Camden Road. Appointment of Dr. S. Churchill as Assistant Medical Officer terminated. Council decided that the dispensary treatment of tuberculous persons, for the whole of the Borough, should be carried out at the Dispensary in Oakley Square. Provision of beds and/or bedding for necessitous persons suffering from Tuberculosis. Arrangement with Professor A. G. R. Foulerton for bacteriological examinations terminated. Professor F. H. Teale appointed in his stead. 1925. Clinic for Artificial Light treatment opened at the South Highgate Centre. Maiden Road Branch Tuberculosis Dispensary closed. Agreement respecting Joint Tuberculosis Dispensary at University College Hospital terminated. Improved arrangements for dental treatment of Tuberculous patients. Improvements to Mortuary and new equipment provided for Post Mortem room. Mr. West appointed an additional Sanitary Inspector (Temporary). CHEMICAL AND BACTERIOLOGICAL WORK. The Borough Council has an arrangement with the Bacteriologist of University College Hospital for the examination, at the expense of the Council, of material sent by medical practitioners in connection with suspected cases of diphtheria, typhoid fever and tuberculosis. The following specimens were examined during the year : — Nature of Specimen. Positive. Negative. Total. Swabs for Diphtherias Bacilli 257 1030 1287 Blood, re Typhoid Fever 3 3 6 Sputum for Tubercle Bacilli 59 409 468 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 cerebro-spinal fluid in suspected cases of cerebro-spinal fever, encephalitis lethargica, &c., are available to the Medical Officer of Health through the London County Council, 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.I.C.) in connection with the Sale of Food and Drugs Acts is given on page 94. Section VIII.—HOUSING. During the year ended December 31st, 1925, 62 houses and 88 flats were erected in the Borough, on the Holly Lodge Estate in Ward 1. One flat over business premises was also erected in Ward 6. In connection with overcrowding, the London County Council gives special consideration, with regard to vacancies in any of the dwellings under their control, to cases recommended by your Medical Officer of Health. Such cases are selected from the worst cases of over- 98 Crowding which arc discovered. During the year 18 families comprising 97 persons who wree living in 24 rooms have been found accommodation in County Council dwellings. In connection with all these cases, the owner of the premises where the overcrowding had occurred is communicated with—drawing his attention to the fact that the overcrowding had been abated, and requesting his co-operation in preventing any recurrence of this condition. The shortage of houses still constitutes the most serious public health problem in St. Pancras. During the year the efforts of the Council's staff have been concentrated in keeping existing houses in as satisfactory a condition as possible. In this connection a number of inspections have been made and notices served under the new Housing Act, 1925, which came into force on 1st July, 1925. It is a matter for regret that progress in the provision of working-class houses is so slow. Overcrowding is very prevalent, and this not only facilitates the spread of infectious disease and constitutes a menace to health, but it is also deleterious for other obvious reasons not associated with public health. It is significant that the illegitimate birth rate is gradually rising, a slight but steady increase having occurred during each of the past 5 years. HOUSING ACT, 1925. Housing Consolidated Regulations, 1925. The above Act, which came into force on July 1st, 1925, consolidates previous enactments relating to the Housing of the Working Classes. Provision is made for securing the repair, maintenance and sanitary condition of houses, including power of Local Authorities to do any necessary work if the owner defaults, and the cost of such work can be made a charge on the premises. Power is provided by Section 6 to make by-laws for tenement houses, the Authority for this purpose in London being the London County Council. By-laws under this Section have been made and will come into force on 5th March, 1926. The Housing Consolidated Regulations, 1925, made by the Minister of Health in pursuance of powers conferred on him by the Housing Act, 1925, came into force on 1st September, 1925. These require the Local Authority to determine the procedure to be adopted to give effect to the requirements of Section 8 of the Act in regard to the inspection of their district. In this connection Mr. H. G. West, a fully-qualified sanitary inspector, who was previously in the service of the Council in this capacity, was appointed temporarily. Mr. West had been employed as milk inquiry officer, but this duty is now being performed by the women sanitary inspectors. By appointing an additional district sanitary inspector (making the number 12 instead of 11), the Borough is now divided into slightly smaller areas, and each inspector in his own area is carrying out the inspections required by the Act. Records of the inspections have to be kept, and the Medical Officer of Health must include in his Annual Report information and particulars in regard to the houses inspected. The following table gives the Housing statistics for the year ended 31st December, 1925 :— Number of new houses erected during the year:— (a) Total (including number given separately under (b)) 62 houses and 89 flats (b) With State assistance under the Housing Acts: — (i) By the Local Authority Nil. (ii) By other bodies or persons Nil. 99 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2525 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 438 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1570 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 rowers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 52 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 52 (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 3331 (2) Number of dwelling-houses in which defects were remedied after service of formal notice : — (а) By owners 3313 (b) By Local Authority in default of owners Nil. C.— Proceedings under Sections 11,14 and 15 of the Housing Act, 1925:— (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. 100 HOUSING SCHEMES, Wolcot Street Area. The proposals of the Borough Council for improving the unhealthy conditions in this area were initiated in 1919, when a scheme was prepared under Part II. of the Housing of the Working Classes Act, 1890. During the past seven years endless negotiations, interviews and discussions have taken place with the Ministry of Health and the London County Council. In April, 1925, an alternative lay-out to that originally proposed was made by the Ministry, and an agreement was at last reached and the scheme was finally approved, subject to certain conditions and modifications, by an Order dated May 2nd, 1925. It is stated that nothing in the 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. The entire cost will, therefore, have to be defrayed by the Borough. Somers Town Housing Scheme—Ossulston Street Area. On January 1, 1925, this area was inspected by your Medical Officer of Health, together with certain officers of the London County Council. On January 14th the following representation was made under Part I. of the Housing of the Working Classes Acts, 1890 (now Part II. of the Housing Act, 1925), to the London County Council, who are the responsible authority for dealing with schemes under this part of the Act :— Sir, I beg to represent, pursuant to the provisions of the Housing Acts, 1890—1923, that within the area in Somers Town, in the Metropolitan Borough of St. Pancras, bounded by Hampden Street on the North, Ossulston Street on the East, Chalton Street on the West, and Huston Road on the South, which area is shown outlined in red on the plan annexed hereto—houses, courts or alleys are unfit for human habitation, and/or the narrowness, closeness and bad arrangement; or the bad condition of the streets and houses, or groups of houses within such area; or the want of light, air, ventilation ; or proper convenience or any other Sanitary defect; or one or more of such causes are dangerous or injurious to the health of the inhabitants, either of the buildings in the said area, or of the neighbouring buildings, and that the most satisfactory method of dealing with the evils connected with such houses, courts or alleys, and the sanitary defects in such area is an improvement scheme for the re-arrangement and reconstruction of the streets and houses within such area, or of some of such streets or houses. I am, etc., G. Sowden, Medical Officer of Health for the Metropolitan To the Clerk to the London Borough of St Pancras. County Council. In February, 1925, the London County Council decided to make a scheme under Part I. of the Housing of the Working Classes Act, 1890. The scheme was duly submitted to the Minister of Health for confirmation, and a local inquiry was held by Mr. H. A. Chapman on 11th and 12th August, 1925. The confirmation of the seheme by the Minister, with certain modifications, was made whilst this report was being written, by an order dated 27th April, 1926. 101 This scheme is one of considerable magnitude, and the site is a valuable and important one, being situated close to three great railway termini. The area comprises about eight acres, and the execution of the scheme will involve the displacement of about 2,700 persons. It is proposed that accommodation for re-housing no fewer than that number shall be provided within the area. Conversion of Vacant Houses. This is probably, at present, the most readily available, and the least expensive method of providing improved housing accommodation in the Borough. Although less expensive than the erection of new houses, it is still a costly process owing to high values and the cost of labour. The question was considered by the Estates (Housing Scheme) Sub-Committee, and at their request a report was submitted on this matter, as follows:— To the Chairman and Members of the Estate# (Homing Scheme) Sub-Committee. " In pursuance of the resolution of the Sub-Committee, I beg to report on the question of conversion of suitable vacant houses into working class dwellings. The only vacant houses in the Borough suitable for the purpose are a number in Drummond Crescent, a larger number on an island site between Euston Road and Argyle Square, and a few 011 the north side of Johnson Street. If any of these could be secured and adapted, then other property, although occupied, might be obtained, as accommodation for displaced tenants would then be available. The greatest need at present in St. Pancras is for dwellings comprising one living room and three bedrooms. These are required for persons with small incomes and large families. The ordinary landlord cannot supply this need, as such persons cannot pay an economic rent. It is, therefore, for this particular class that State Aided Dwellings are necessary. If these could be provided, sub-letting should be expressly forbidden, otherwise overcrowding would occur. Persons without children or with only a small family can more easily find accommodation than those above-mentioned, as they can pay an economic rent, and landlords very naturally prefer and provide for tenants without many children. A large proportion of the houses in St. Pancras contain only two rooms on each floor. In order to secure the accommodation above described, it is necessary to take two adjoining houses, provide the necessary doorways in the party walls and thus secure a four roomed flat on each floor. The cost of this work would average about £100 per floor. The St. Pancras House Improvement Society are proceeding somewhat on these lines. In April, 1925, I informed this Society that several adjoining houses in Somers Town could be purchased, including two empty houses. These two are now being adapted as described above, and when finished the families in the other houses can be accommodated in order to adapt the remainder. In reply to a further enquiry from this Society, I recently suggested to them the Drummond Crescent houses above mentioned, and I believe some, if not all, of these may have been purchased. If still available these are very suitable for the purpose mentioned in your Resolution. As building is now so expensive, it is probable that alterations to existing houses on the lines indicated would be more economical, and would help more speedily to remedy the existing shortage and consequent overcrowding." I am, etc., G. Sowden, Medical Officer of Health. 102 The Report was considered by the Sub-Committee and the following opinion was reported to the parent Committee :— It is important for the Committee to realise that there is no Government financial assistance available for the conversion of empty houses, and if any scheme of this sort was contemplated, the loss sustained would fall entirely on the rates. For this reason, and in view of the fact that the St. Pancras House Improvement Society, who have raised funds for the purpose, are carrying out the conversion of derelict houses into flats for the accommodation of the working classes, we are not prepared to recommend that any action should be taken at the present time. 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. D. Corrick, Clerk to the Committee, who succeeded Mr. A. Powell Coke in that position in October, in 1925, upon Mr. Coke's promotion to the office of Deputy Town Clerk. The Estates Committee, whose Chairman is Councillor W. C. Wood, control nearly five hundred dwellings in different parts of the Borough. A great deal of the time of the Committee is taken up with questions concerning the administration of these properties, which are situate at (a) The Brookfield Estate, Highgate ; (b) Una House, Prince of Wales Road ; (c) Goldington Buildings, Great College Street; (d) Flaxman Terrace, Euston Road ; and (e) Prospect Terrace, Gray's Inn Road. In practice it is found that very few vacancies occur in the Council's dwellings, and for these there is a long waiting list of admittedly hard cases of bad housing accommodation. Material assistance has been given by the London County Council in relieving eases of overcrowding in St. Pancras. They have accommodated many families in their various estates in other parts of London, especially in the new estates at Becontree in Essex, and Downham, near Catford. Headway is being made with the development of the County Council's new Watling Estate at Hendon, which will further relieve the housing situation. Somers Town Housing. Wolcot Street Area.—The new housing scheme initiated by the Borough Council for the improvement of the unhealthy conditions existing in this area is making progress. Terms for the purchase of the interests in the land have been settled, and tenders for the erection of seventy working-class flats are now before the Council. The Minister of Health would not make any grant towards the annual loss on the scheme, and in order that this greatly needed improvement should be no longer delayed, the Council decided to proceed and to bear the whole loss, estimated at £2,000 per annum Staff. The administrative work in connection with the Estates Committee (Chairman: Councillor W. C. Wood, Deputy-Chairman : Councillor R. J. Smerdon) is carried out by Mr. A. D. Corrick, the Clerk to the Committee, who is assisted by Mr. G. N. Cove and the Housing Superintendent, Mr. L. Barnard. The resident caretakers at the several blocks of buildings are as follow:—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. 103 APPENDIX. 104 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1925 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 per 1,000 Nett Births. Number. Rate. Number Rate. Number. Rate. 1915 218387 200322 4458 4754 21.8* 3523 176† 672 692 497 105 3543 17.7† 1916 214135 196813 4310 4530 21.2* 2991 15.2† 565 619 385 85 3045 15.5† 1917 208006 186600 3635 3796 18.2* 3099 16.6† 608 718 402 106 3142 16.8† 1918 196883 175716 3339 3318 16.8* 3789 21.5† 626 751 340 102 3914 22.3† 1919 228585 219434 3804 3824 16.7* 3104 14.1† 670 496 336 88 2930 13.4† 1920 228980 228178 6191 5934 25.4* 3007 12.9† 713 601 435 73 2895 12.4† 1921 212900 — 5099 4764 22.4 2836 13.3 651 593 360 76 2778 13.0 1922 212500 — 4865 4559 21.5 3219 15.1 715 603 337 74 3107 14.6 1923 214400 — 4654 4348 20.3 2735 12.8 634 484 272 63 2585 12.1 1924 214600 214300 4447 4112 18.8* 2937 13.4† 640 551 303 74 2848 13.0† 1925 216300 215900 4111 3880 17.9* 2864 13.31† 680 561 280 72 2745 12.7† Area of district in acres (land and inland water), 2694.4 ; total population at all ages, 211,366 ; number of inhabited bouses, 24,660 average number of persons per house, 8.57 ; at Census, 1921. * Based on total population. † Based on civil population. 105 Table No. 2. Deaths Registered from all Causes for the Year 1925. Note. The Deaths of Non-Residents occurring in Public Institutions situated in the Borough are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the Borough are included. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. Totals. M. F. M. F. M. F. M. F. M. F. M F. M F. M. F. m. F. M. F. m. F. M. F. M. F. M F. M. F. PERSONS 1.—General Diseases. 1. Enteric Fever — — — — — — — — — — — — — — — — 1 1 — — — — — — — — — — 2 1 3 2. Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3. Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Small Pox- (a) Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Doubtful — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Measles l —- 1 — 1 — 3 — — — — — — — — — — — — — — — — — — — — — 3 — 3 7. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 8. Whooping Cough 15 14 10 8 9 10 34 32 2 3 — — — — — — — — — — — — — — — — — — 36 35 71 9, (a) Diphtheria 1 — 3 1 10 9 14 10 2 7 — — — — — — — — — — — — — — — — — — 17 17 34 (b) Croup — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Influenza — 2 — — — — — 2 — 1 — — 2 — 3 3 — 4 2 2 3 3 3 6 2 4 1 — 16 25 41 11. Miliary Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cholera Nostras — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 14. Dysentery — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 1 15. Plague — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 16. Yellow Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 17. Leprosy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 18. Erysipelas 1 1 — — — — 1 1 — — — — — — — — — 2 2 — 1 — — 4 1 — — — 5 7 12 19. (a) Mumps — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 (b) German Measles 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 (c) Varicella — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Other Epidemic Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 20. (a) Pyæmia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Septicæmia — — — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — 2 2 (c) Vaccinia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 21. Glauders — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 22. Anthrax (Splenic Fever) —. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 23. Rabies — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 24. Tetanus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 25. Mycoses — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 26. Pellagra — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 27. Beri-beri — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 28. (a) Pulmonary Tuberculosis — — 1 — — — 1 — — — — 1 11 16 14 12 27 16 20 16 17 4 6 4 1 — — — 96 69 165 (b) Phthisis (not defined as tuberculous) — — — — — — — — — — — 1 1 2 1 — 1 1 3 2 2 — 1 — — — — — 9 6 15 29. (a) Acute Phthisis — — — — — 1 — 1 — — — — 1 2 1 1 2 1 2 1 — — — — — — — — 6 6 12 (6) Acute Miliary Tuberculosis — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 30. Tuberculous Meningitis 1 1 1 — 5 1 7 2 l 1 2 — 1 — — 2 1 — — — — — — 1 — — — — 12 6 18 31. (a) Tabes Mesenterica — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 (b) Other peritoneal & intestinal tubercle — — — — — — — — — — — — — 2 — — — 1 2 — — — — — — — — — 2 3 5 32. Tuberculosis of Spinal Column — — — — — — — — — — — — — 1 1 — — — — — 1 — 1 — — — — — 3 1 4 33. Tuberculosis of Joints — — — — — — — — — — 1 — — — — — 1 — 1 — — — — — — — — — 3 — 3 34. (a) Lupus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Tuberculosis of other Organs — 1 — — — — — 1 — — — — — — — — — — — — — 2 — — — 1 — — — 4 4 35 Disseminated Tuberculosis — — — — — 1 — 1 — — — — — — — — 1 — — — — — — — — — — — 2 1 3 36. Rickets, Softening of Bones — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 37. Syphilis 4 1 — — — — 4 1 — — — — — — — — 1 1 — 2 — — — 1 — — — — 5 6 10 38. Other Venereal Diseases — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 39. Cancer of the Buccal Cavity — — — — — — — — — — — — — — — — 2 — 6 — 4 — 6 1 2 1 — — 20 2 22 40. „ Stomach, Liver, &c. — — — — — — — — — — — — — — — — 3 3 12 9 25 12 23 15 2 3 — — 65 42 107 41. „ Peritoneum, Intestines, and Rectum — — — — — — — — — — — — — — — — 2 — 1 2 7 8 21 6 3 4 2 1 36 21 57 42. „ Female Genital Organs — — — 1 — — 1 — — — — — — — 3 — 4 — 7 — 9 — 11 — 2 — — — 37 37 43. ,, Breast — — — — — — — — — — — — — — — 1 — — — 6 — 9 1 4 — 9 — 1 1 32 33 44. ,, Skin — — — — — — — — — — — — — — — — — — — 1 — — 1 — — — — — 1 1 2 45. Cancer of other or unspecified Organs — — — — — — — — — — — — — — — 1 — — 2 5 15 4 14 8 8 4 1 — 44 22 66 46. Other Tumours (situation undefined) — — — — — — — — — — — — — — — — — — 3 1 — — — 1 — — — — 3 2 5 47. Rheumatic Fever — — — — — — — — — 1 — 2 1 1 — — — 1 — 1 — 4 — 2 — 5 — — 1 17 18 48. (a) Chronic Rheumatism — — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — 2 2 (b) Osteo-Arthritis — — — — — — — — — — — — — — 1 — — — — 1 — 1 1 — 1 2 — — 3 4 7 (c) Gout — — — — — — — — — — — — — — — — — — — — — — 2 — — 1 — — 2 1 3 49. Scurvy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 106 Deaths Registered from All Causes for the Year 1925—continued. Cause of Death. AGES. 0 to i 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. PER- S0NS 1. General Diseases—con. 50. Diabetes - - - - - - - - - - - - - - 2 1 - 1 - 1 2 1 3 5 1 - 1 - 9 9 18 51. Exophthalmic Goitre - - - - - - - - - - - - - - - - - 3 - 3 - 2 - - 1 - - - 1 8 9 52. Addison's Disease - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 1 53. Leucocythæmia Lymphadenoma - - - - - - - - 1 - - - - - - - - - - - - - - 1 - 1 - - 1 2 3 54-. Anæmia, Chlorosis - - - - - - - - - 1 - - - - - - 1 2 1 1 - 1 1 - - - - - 3 5 8 55. (a) Diabetes insipidus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Purpura - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 - 1 (c) Haemophilia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (d) Other General Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 2 56. Alcoholism (acute or chronic - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 57. (a) Occupational Lead Poisoning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Non-occupational Lead Poisoning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 58. Other Chronic Occupational Poisonings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 59. Other Chronic Poisonings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. (a) Encephalitis Lethargica - - - - - - - - - - 1 - 2 - - 1 1 1 2 1 1 - - - - - - - 7 3 10 (6) Encephalitis, other forms - - - - - - - - - - - - - 1 1 1 - - - - - 2 - - - - - - 2 1 6 61. (a) Cerebrospinal Fever - - - - - - - - 1 1 - - - 1 - - - - - - - - - - - - - - 2 2 4 (b) Posterior Basal Meningitis - - - - - - - - - - - - 2 - - - - - - - - - - - - - - - 2 - 2 (c) Meningitis, other forms 2 2 3 - 1 - 6 2 1 - - 1 - - 1 1 - 1 - - - - - - - - - - 8 5 13 62. Locomotor AStaxy - - - - - - - - - - - - - - - - 1 - - - 2 - - - - - - - 3 - 3 63. (a) Anterior Poliomyelitis - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 - 1 (b) Other Diseases of the Spinal Cord - - - - - - - - - - - - 1 - 1 - 1 5 1 9 2 2 2 - 3 1 1 - 12 10 22 64. Cerebral Haemorrhage, Apoplexy - - - - - - - - - - - 1 - - 2 - 2 1 7 8 16 8 14 16 3 15 - - 44 49 93 65. Softening of Brain - - - - - - - - - - - - - - - - 1 1 - - - 1 1 1 - 1 - - 2 4 6 66. Paralysis without specified cause - - - - - - - - - - - - - - - - - - 1 1 1 2 - 2 1 1 - - 3 6 9 67. General Paralysis of the Insane - - - - - - - - - - - - - - - - 1 1 2 2 5 - - - - - - - 8 3 11 68. Other forms of Mental Alienation - - - - - - - - - - - - - - 1 - 1 - 1 - - - 1 - - - - - 4 - 4 69. Epilepsy - - - - - - - - - - 1 - 1 - - 2 - - 1 2 1 3 - 2 - - - - 4 9 13 70. Convulsions (Non-puerperal; 5 years and over) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 71. Infantile Convulsions (under 5 years) 4 - - - - - 1 4 1 - - - - - - - - - - - - - - - - - - - 4 1 5 72. Chorea - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 73. Hysteria, Neuralgia, Neuritis - - - - - - - - - - - - - 1 - - - - - - - 1 - - - - - - 1 1 2 74. Other Diseases of the Nervous System - - - - - - - - - 1 - - - 2 1 1 - 1 1 1 1 3 1 - - - - - 7 6 13 75. Diseases of the Eyes and Annexa - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 76. (a) Mastoid Disease - 1 - - - - - 1 - - - - 1 1 - - - 1 - - - - - - - - - - 2 2 4 (b) Other Diseases of the Ears - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 3. Diseases of the Circulatory System. 77. Pericarditis - - 1 1 - - 1 1 - - - - 1 - - - - - 1 - 2 - - - - - - - 5 2 7 78. Acute Myocarditis and Endocarditis 1 - - - - - 1 1 1 - - - 1 - 2 2 1 1 2 - - 1 1 1 - - - - 7 11 18 79. (a) Valvular Disease - - - - - - - - 1 - - 1 3 3 2 1 3 6 8 7 13 14 21 12 9 17 - - 60 61 121 (b) Fatty Degeneration of the Heart - - - - - - - - - - - - - - 1 - 1 - 2 6 2 2 3 3 4 3 - - 13 14 27 (c) Other Organic Disease of the Heart - - - - - - - - - - - 1 1 1 2 2 4 10 13 5 26 17 29 37 22 33 2 10 99 116 215 80. Angina Pectoris - - - - - - - - - - - - - - - - - - - - 1 1 2 - - - - - 3 1 4 81. (a) Aneurysm - - - - - - - - - - - - - - - - - 1 5 1 7 - 1 1 - - - - 13 3 16 (b) Arterial Sclerosis - - - - - - - - - - - - - - - - 3 - 4 1 7 8 15 3 13 15 1 1 43 28 71 (c) Other Diseases of Arteries - - - - - - - - - - - - - - - 1 - - - - - 1 - - - 1 - - - 3 3 82. (a) Cerebral Embolism and Thrombosis - - - - - - - - - - - - - - - - - - - 1 - 4 7 6 4 4 1 3 12 18 30 (b) Other Embolism and Thrombosis - - - - - - - - - - - - - - - - - - 2 - - 1 - - - - - - 2 1 3 83. Diseases of the Veins (Varices, Hæmorrholds, Phlebitis, etc.) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 84. (a) Status Lymphaticus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 (b) Other Diseases of the Lymphatic System - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 85. Haemorrhage; other Diseases of the Circulatory System - - - - - - - - - - - - - - - 1 - - - - - 2 - - - - - - 3 - 3 1. Diseases of the Respiratory System. | 86. Diseases of the Nasal Fossae - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 87. Diseases of the Larynx 2 - - - - 1 - 3 - - - - - - - - - - - - - - - - - - - - 3 - 3 88. Diseases of the Thyroid Body 1 1 - - - - 1 1 - - - - - - - - - - - - 1 - - 1 - 1 - - 1 4 5 89 & 90. Bronchitis 13 6 4 2 1 - 18 8 1 - - - 1 1 1 1 3 2 19 5 22 21 38 42 27 41 8 15 138 136 274 91. Broncho-Pneumonia 22 12 8 14 4 5 34 31 1 1 - - - - - 2 1 1 3 9 3 3 5 4 3 6 4 - 1 60 51 111 92. (a) Lobar Pneumonia 2 2 1 - 3 - 6 2 - - 1 - - 2 - 1 5 3 6 7 10 7 6 2 3 1 1 38 26 64 (b) Pneumonia (typo not stated) - - - - 1 - 1 - - 1 - - 1 - - - 1 4 1 3 1 2 3 4 1 1 4 1 16 13 29 93. Pleurisy - - 1 - - 2 1 2 _ 1 - - - - - 1 - - 4 1 4 - 1 1 - - - - 10 6 16 107 Deaths Registered from all Causes for the Year 1925—continued. Cause of Death. ages. 0 to 1 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. PERSONS 4. Diseases of the Inspiratory System—con. 94. Pulmonary Congestion,Pulmonary Apoplexy 1 — — — — — 1 — — — — — — — — — — — — — — 1 1 2 1 — — 1 3 4 7 95. Gangrene of the Lung — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 96. Asthma — — — — — — — — — — — — — 1 — 1 2 — 4 3 3 1 4 2 2 5 — — 15 13 28 97- Pulmonary Emphysema — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — — 1 1 2 98. (a) Fibroid Disease of the Lung — — —. — — — — — — — — — — — — — 1 1 — — — — — — - 1 1 2 (b) Other Diseases of the Respiratory System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Other Diseases of the Mouth and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 100. Diseases of Pharynx, Tonsillitis — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 1 101. Diseases of Œsophagus — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — 102. Perforating Ulcer of Stomach — — — — — 1 — 1 — — — — — — 1 — 3 — 2 1 3 1 1 1 — — — — 10 4 14 103. (a) Inflammation of Stomach 2 — 1 — — — 3 — — — — — — — — — — — 1 — 1 — — — — 1 — — 5 1 6 (b) Other Diseases of Stomach — 1 — — — — — 1 — — — — — — — — — — — — 1 — — — — — — — 1 1 2 104 & 105. (a) Infective Enteritis 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 (b) Diarrhoea (not returned as infective) 6 3 1 — — — 7 3 — — — — — — — — — — — — — — — — — — — — 7 3 10 (c) Enteritis (not returned as infective) 4 4 — 1 — — 4 5 — — — — — — — — — 1 1 — 1 — — 1 — 1 — — 6 8 14 (d) Gastro-Enteritis (not returned as infective) 16 11 1 — 1 — 18 11 — — — — — — — 1 — — — — — — — — — — — — 18 12 30 (e) Dyspepsia (under 2 years of age) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Colic — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 1 (g) Ulceration of Intestines — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 (h) Duodenal Ulcer — — — — — — — — — — — — — — — — 1 — — — — — — 1 — — — — 1 1 2 106. Ankylostomiasis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 107. Other Intestinal Parasites — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 108. Appendicitis — — — — 1 — 1 — — — — — — 2 1 — 2 1 2 1 2 — 1 — — — — — 9 4 13 109. (a) Hernia — — — — — — — — — — — — — — — — 1 — — — 1 3 2 1 — 1 — — 4 5 9 (b) Intestinal Obstruction 1 — — — 1 — 2 — — — — 1 — — — — 1 — 2 — 1 — — 1 1 2 — 1 7 5 12 110. Other Diseases of the Intestines — — — — — — — — — — — — — — — — — 2 1 2 — 1 1 — — — — — 2 5 7 111. Acute Yellow Atrophy of Liver — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 112. Hydatid of Liver — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 113. (a) Cirrhosis of the Liver (not returned as alcoholic) — — — — — — — — — — — — — — — — 2 3 5 1 1 2 1 1 1 — — — 10 7 17 (b) Cirrhosis of the Liver (returned as alcoholic) — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 (c) Diseases formerly classed to " Other Diseases of Liver and Gall Bladder" — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 114. Biliary Calculi — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — 1 — — — 4 4 115. Other Diseases of the Liver — 1 — — — — — 1 — — — — — — — — 1 — 1 1 1 — 1 — 1 — — 1 5 3 8 116. Diseases of the Spleen — — — — — — — — — — — — — — — — — — — — — — — — —: — — — — — — 117. Peritonitis (cause unstated) — — — 1 1 — 1 1 1 — — — 1 — — — — — — — — 1 1 — — 1 — — 4 3 7 118. Other Diseases of the Digestive System — — — — — — — — — — — — — — — — — 1 — — — 1 1 1 — — — — 1 3 4 6. Non- Venereal Diseases of the Genito -Urinary System and Annexa. 119. Acute Nephritis — — — — 1 — 1 — — — — — 1 1 — — 2 — 1 2 1 1 — — — — — — 6 4 10 120. Bright's Disease 1 — — 1 — — 1 1 — — — — — — 2 3 7 1 6 6 6 4 8 9 6 3 1 1 37 28 65 121. Chyluria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 122. Other Diseases of the Kidney and Annexa 1 — — — — — 1 — — — — — — — — — — 2 — — — — 1 1 — — — — 2 3 5 123. Calculi of the Urinary Passages — — — — — — — — — — — — — — — — — 1 — — —— — — — — — — — — 1 1 124. Diseases of the Bladder — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — 2 — — — 4 — 4 125. Diseases of the Urethra, Urinary Abscess, &c. — — — — — — — — — — — — — — — — 1 — 1 — 1 — — — — — — — 3 — 3 126. Diseases of the Prostate — — — — — — — — — — — — — — — — — — 1 — 5 — 5 — 3 — 1 — 15 — 15 127. Non-Venereal Diseases of Male Genital Organs — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 128. Uterine Hemorrhage (Non-puerperal) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 129. Uterine Tumour (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 130. Other Diseases of the Uterus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 131. Ovarian Cyst, Tumour (Non-cancerous) — — — — — — — — — — — — — — — — — — — 1 — 1 — — — 1 — — — 3 3 132. Other Diseases of the Female Genital Organs — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — 1 1 133. Non-puerperal Diseases of the Breast (Non-cancerous) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 108 Deaths Registered from all Causes for the Year 1920—continued. Cause of Death. AGES. 0 to 1 1 to 2 2 to 5 Tota under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. persons 7. The Puerperal State. 134. Accidents of Pregnancy — — — — — — — — — — — — — — — 3 — 1 — 1 — — — — — — — — — 5 5 135. Puerperal Hæmorrhage — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 136. Other Accidents of Childbirth — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 1 137. Puerperal Fever — — — — — — — — — — — — — 2 — 1 — 1 — — — — — — — — — — — 4 4 138. ,, Albuminuria and Convulsions — — — — — — — — — — — — — — — — — —— — — — — — — — — — — — 1 1 139. ,, 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 — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — 2 — 2 (b) Gangrene (other types) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 143. Carbuncle, Boil — 1 — — — — — 1 — — — — — — — — — 1 — — — — 4 1 — — — — 4 3 7 144. Phlegmon, Acute Abscess — — — — — 1 — ] — — — — — — — — — — — — — — — 1 1 1 — — 1 3 4 145. 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 — — — 5 1 6 147. Diseases of the Joints — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 148. Amputations — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 149. Other Diseases of Locomotor System — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Malformations. 150. Congenital Malformations 12 8 — — 1 — 13 8 — — — — — — — — — — — — — — — — — — — — 13 8 21 11. Diseases of Early Infancy. 151. (a) Premature Birth 37 20 — — — — 37 20 — — — — — — — — — — — — — — — — — — — — 37 20 57 (b) Infantile Debility, Icterus, and Sclerema 8 8 — — — — 8 8 — — — — — — — — — — — — — — — — — — — — 8 8 16 152. Other Diseases peculiar to early Infancy 6 5 — — — — 6 5 — — — — — — — — — — — — — — — — — — — — 6 5 11 153. Lack of Care — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Old Age. 154. (a) Senile Dementia — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 — 1 2 2 4 (b) Senile Decay — — — — — — — — — — — — — — — — — — — — 2 2 20 17 22 27 9 16 53 62 115 13. Affections Produced by External Causes. 155 to 163. Suicides — — — — — — — — — — — — — l — 3 — 6 — 3 2 4 1 2 — — — — 19 3 22 164. Poisoning by Food — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 165. Other Acute Poisonings — — — — — — — — — — — — — — — — — 1 — 1 — — — — — 1 — — 3 — 3 166. Conflagration — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 1 167. Burns (Conflagration excepted) — 1 2 — — — 2 1 — — — — — — — — — — — — — — 1 1 1 — — — 3 3 6 168. Absorption of Deleterious Gases (Conflagration excepted) 4 1 1 — — — 5 1 — — — — 1 — — — — 1 1 — 1 — — — 1 — — — 9 2 11 169. Accidental Drowning — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 170 to 176. Injuries — — — 1 2 1 2 2 5 — 4 — 5 1 2 4 2 1 6 2 10 4 6 4 2 4 1 2 45 24 69 177. Starvation — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 178. Excessive Cold — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 179. Effects of Heat — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 180. Lightning — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 181. Electricity (Lightning excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 182 to 184, Homicide — — — — — — — — — — — — — 1 — 1 — — — — — — — 1 — — — — — 3 3 185. Fractures (cause not specified) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 186. Other Violence — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — — — — — 2 2 14. Ill-defined Causes. 1 187. 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) — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Teething — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (d) Pyrexia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (e) Other ill-defined Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (f) Cause not specified — — — — — —: — — — — — — — — — — 1 — — — — — — — — — — — 1 — 1 601 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 44 27 47 118 20 8 51 47 87 121 137 156 60 7 812 Diseases of the Nervous System and of the Organs of Special Sense 9 4 3 16 4 6 12 13 20 34 51 40 25 1 222 Diseases of the Circulatory System 1 2 1 4 1 4 10 18 30 58 109 142 125 18 519 Diseases of the Respiratory System 62 30 17 109 4 1 6 9 24 68 85 112 96 28 542 Diseases of the Digestive System 50 5 5 60 1 1 4 5 20 22 23 17 11 2 166 Non-Venereal Diseases of the Genito-Urinary System and Annexa 2 1 2 5 – – 3 5 14 18 19 25 15 8 107 The Puerperal State — — — – — – 2 5 2 2 — — — – 11 Diseases of the Skin and of the Cellular Tissue 2 – 1 3 – – – – 1 1 1 7 3 – 16 Diseases of the Bones and of the Organs of Locomotion — — — — — 1 1 1 — — 1 1 1 — 6 Malformations 20 1 21 — — — — — — — — — — 21 Diseases of Early Infancy 84 — — 84 — — — — — — — — — — 84 Old Age — — — — — — — — — — 4 38 51 26 119 Affections produced by External Causes 6 4 4 14 6 4 9 10 11 15 21 16 9 3 118 Ill-defined Causes — — — — — — — — 1 — — — — — 2 Totals 280 78 81 434 36 25 98 113 210 339 451 555 396 88 2745 110 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. 1 597 16.5 435 12.0 38 64 27 0.7 2 444 19.9 258 11.6 29 65 18 0.8 3 671 18.4 443 12.2 40 60 40 1.1 4 480 18.2 341 12.9 26 54 30 l.1 5 591 19.2 434 14.1 55 93 40 1.3 6 467 22.2 292 13.9 44 94 23 1.1 7 164 10.6 181 11.7 19 116 14 0.9 8 466 16.9 333 12.0 26 56 35 1.3 No Address — — 28 — 3 — 4 — Total 3880 17.9 2745 12.7 280 72 231 1.1 111 the large Towns, and of London and the Metropolitan Boroughs for 1925. (52 weeks ended 2nd January, 1926.) Estimated Population, Mid. 1924. Birth Rate. Death Rate. Infantile Mortality. Estimated Population, Mid. 1924. Birth Rate. Death Rate (Crude), Infantile Mortality. England and Wales †38.890,000 18.3 12.2 75 County of London 4,576 505 18.0 11.7 67 Birmingham 946,980 19.2 11.5 75 West. Liverpool 951,800 22.9 13.7 98 Paddington 146,400 16.0 11.8 73 Manchester 755.000 19.4 14.1 92 Kensington 178,550 15.9 12.9 80 Sheffield 525,000 18.0 11.5 83 Hammersmith 134,200 17.5 11.9 65 Leeds 471,600 18.1 12.5 87 Fulham 163,100 17.2 10.6 75 Bristol 386,200 17.9 13.2 76 Chelsea 64,580 14.5 13.3 66 West Ham 317,400 24.7 10.6 58 City of Westminster 139,900 10.7 12.1 69 Hull 296,800 20.3 13.0 100 North. Bradford 290,200 16.7 13.7 95 St. Marylebone 105,300 14.2 11.7 60 Newcastle-on-Tyne 285,900 24.5 13.3 79 Hampstead 87,600 12.2 10.1 55 Stoke-on-Trent 278,000 23.1 13.5 105 St. Pancras 214,300 18.1 12.6 71 Nottingham 270,300 19.1 13.4 94 Islington 337,400 19.4 12.2 63 Salford 243,700 18.6 13.3 103 Stoke Newington 52,920 15.5 11.6 63 Leicester 241,800 17.9 12.7 86 Hackney 226,900 18.0 11.4 64 Portsmouth 232,000 19.4 12.1 61 Central. Cardiff 226,200 21.4 12.5 88 Holborn 43,250 12.2 12.3 65 Croydon 196,000 17.9 10.9 52 Finsbury 77,180 22.6 13.6 59 Plymouth 192,900 19.0 12.3 64 City of London 13,330 7.5 11.1 60 Bolton 181,100 16.1 13.3 86 East. Willesden 169,100 15.1 9.8 67 Shoreditch 106,500 24.7 13.3 88 Rhondda 167,900 21.7 11.6 96 Bethnal Green 119,200 22.1 12.0 80 Southampton 167,300 19.4 11.6 58 Stepney 253,740 21.0 12.1 75 Sunderland 165,100 25.2 15.2 116 Poplar 167,300 22.9 11.6 75 Swansea 162,700 20.5 11.2 68 South. Birkenhead 154,100 20.7 11.5 9U Southwark 187,714 21.4 13.1 77 Tottenham 153,100 14.9 10.2 62 Bermondsey 122,100 22.7 12.6 75 Oldham 147,300 15.3 14.6 100 Lambeth 309,300 17.9 12.2 62 East Ham 146,900 14.6 9.9 61 Battersea 171,000 18.6 10.4 58 Brighton 137,500 16.8 12.8 54 Wandsworth 338,200 14.4 10.4 53 Middlesbrough 136,300 25.7 14.4 98 Camberwell 273,700 17.8 11.0 64 Derby 133,700 18.7 11.7 74 Deptford 115,200 18.9 11.9 62 Leyton 133,500 12.5 9.9 68 Greenwich 102,470 18.8 11.2 69 Walthamstow 131,100 l6.4 9.9 57 Lewisham 184,900 15.7 10.2 56 Coventry 129,100 17.5 10.8 75 Woolwich 139,980 17.9 10.7 54 Gateshead 128,700 22.3 13.7 116 Blackburn 127,600 15.3 13.6 92 South Shields 126,600 23.6 13.5 113 Stockport 126,600 16.4 13.5 91 † Estimated population to middle of 1925. 211 Table No. 6.—Meteorological Table for Saint Pancras, 1925. (Deduced from observations at Camden Square, N.W. 1.) January. February. March. April. May. June. July. j August. September. October. November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 30.257 29.684 30.175 29866 29.807 30.136 29.926 29.982 29.992 29.944 29.944 29.781 Air temperature— Mean of— Maximum A 46.5 47.2 47.8 55.5 64.8 72.7 74.2 69.7 62.3 59.7 456 42.5 Minimum B 37.8 37.9 36.1 40.6 48.1 52.0 56.6 55.0 47.5 46.1 36.8 34.5 Mean of A and B 42.1 42.5 41.9 48.1 56.5 62.3 65.4 62.3 54.9 52.9 41.2 38.5 Difference from Average +3.3 +2.5 —1.0 —0.3 + 1.4 +1.3 +1.1 —0.9 —3.7 +2.2 —3.1 —2.0 Humidity—Morning 91 87 83 75 73 68 75 80 82 90 88 91 Earth Temperature at 4 ft. depth 45.4 44.5 43.3 44.7 48.8 55.3 58.6 59.2 57.1 54.1 50.2 44.0 Bright Sunshine— Total Observed (daily mean) Hrs. 1.04 1.78 2.47 3.26 6.43 8.85 5.79 4.09 3.29 2.63 2.04 0.86 Percent of total possible 12 18 21 24 41 54 36 28 26 25 23 11 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of Days 11 16 13 15 19 2 15 15 20 15 14 17 Total Fall Ins. 2.01 2.86 0.68 1.63 1.66 0.11 3.58 2.71 2.25 3.09 1.54 2.79 Difference from average ,, +0.16 + 1.22 —1.18 +0.08 —0.12 —1.89 + 1.18 +0.51 +0.43 +0.47 —0.83 +0.39 Hour of observation, 9 a.m. (Greenwich time). The readings for Bright Sunshine are those taken at Regents Rark—no readings being recorded at Camden Square. 118 Table No. 7. Inspections and Re-inspections made by District Inspectors and by the Factory and Workshop Inspector during the year 1925. DUTIES AND PREMISES. Rackham. Lonnon. Brown.* Dillon. Walker. James. ADKINS.t Akers. Jaffa. Capel. Nixon. wEST ‡ Thompson. Totals. inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-mspections. Inspections. Re-inspections. Inspec- | tions. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspec-| tions. Inspections. Re-inspections. District Inspectors. Inspection of Dwelling Homes— After Infectious Disease 67 — 126 208 151 254 85 2S 190 513 61 66 1 58 285 71 95 126 366 135 231 16 42 — — 1381 2118 Upon Complaint (whole house inspected) 3 — 38 22 7 81 331 117 111 43 15 87 137 38 264 51 91 16 32 105 651 116 337 11 2 — — 706 2194 Registered tenement houses (as such) 13 205 — — — — — — 35 76 — — — — — — 59 46 1 — 62 261 — — — — 170 588 Other inscribed dwellings (as such) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Housing Act, 1909: 17 (1) — — — — — — — — 72 468 59 113 — — — — — — 2 1 — 3 — — — — 133 585 Housing Act, 1925 — — — — — — 9 8 — 12 — — — — 18 6 — — 13 22 — — 19 25 — — 70 73 Other house to house inspections — — — — — — — — — 20 — — — — — — — — 55 170 — 25 — — — — 60 215 Complaints (not involving the complete inspection of a dwelling house) 109 570 452 561 277 532 215 632 299 1109 299 746 77 165 364 580 266 333 85 185 304 560 79 260 — — 2826 6233 Drainage— Under notice. Plans, supervision, &c. 7 178 47 248 52 451 241 1350 4 237 47 605 8 95 — 312 10 73 35 597 38 561 9 137 1 2 499 4846 Voluntary. Do. do. 17 235 124 444 41 197 14 50 17 154 35 118 17 376 384 1 132 1057 33 167 13 179 14 86 5 18 846 3082 New Buildings. Do. do. 1 1427 39 180 — — 8 340 2 219 8 19 — 3 36 1 — — 18 97 — — — — — — 112 2286 Yards of Mews and Stables.. 290 — 494 — 339 4 245 1 584 — 57 — 110 — 594 — 860 — 485 6 440 13 37 — — — 4533 24 Smoke Shafts observed — — — — 4 2 7 1 46 2 5 — 19 2 5 — 129 — 44 — 14 — — — — — 273 7 Regulated Trades— Offensive trades — — — — — — — — — — — — — — — — 46 — — — — — — — — — 46 — Rag and bone dealers — — 10 — 3 2 1 — — — 2 — 3 — 5 — 6 — 4 1 4 — — — — — 38 3 Other effluvia businesses — — — — — — — — — — — — — — — — — — — — — — — — — — — — Inspection of Market Streets — — 48 — — — — — — — — — — — — — — — — — — — — — — — 48 — Visits to closed underground rooms — — — — — — — — — — — — — — — — — — — — — — — — — — — — Infectious Diseases. Inquiry, removal, disinfection, &c, 113 — 222 9 225 24 196 14 219 21 169 13 83 11 244 1 120 — 193 — 145 25 30 8 — — 1959 126 Bakehouses— Workshop — — — — — — — — — — — — — — — — — — — — — — — — 173 107 173 107 Factory — — — — — — — — — — — — — — — — — — — — — — — — 136 117 136 117 Restaurant Kitchens — — — — — — — — — — — — — — — — — — — — — — — — 95 185 95 185 Laundries— Workshop — — — — — — — — — — — — — — — — — — — — — — — — 15 5 15 5 Factory — — — — — — — — — — — — — — — — — — — — — — — — 3 18 3 18 Other Factories — — — — — — — — — — — — — — — — — — — — — — — — 134 647 234 647 Other Workshops — — — — — — — — — — — — — — — — — — — — — — — — — 1176 398 1176 Other Workplaces — — — — — — — — — — — — — — — — — — — — — — — — 83 142 83 142 Other Duties 11 — 123 — 27 — 7 — 1 86 1 63 — 34 — 22 34 93 — 71 51 24 — 6 1 508 87 Totals 631 615 1723 187 1200 1797 1253 2540 1418 2358 1044 2265 481 982 1898 1277 1737 11670 1292 2263 1345 2246 239 560 1149 2418 15405 24864 * Absent ill 9 weeks. † Absent ill 20 weeks. ‡ Part year only. 114 Table No. 8.—Inspections and Re-inspections and other work of the Food Inspectors during 1923 DUTIES AND PREMISES. Visits and Inspections. Re-inspections after Intimation Notices, Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals, Milkshops 234 392 626 — — — Dairies 172 17 l89 — — — Cowsheds 15 24 39 — — — Other Premises of Milk Purveyors 3 14 17 — — — Margarine Factories 1 — 1 — — — Butter Factories 2 — 2 — — — Ice Cream Premises 148 245 393 1 — 1 Slaughter Houses 65 84 149 — — — Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 70 309 379 — — _ Butchers' Shops 47 179 226 i — 1 Fried Fish Shops and Fish Curer's premises 145 243 388 3 — 3 Marketing Places 2001 1714 37'5 — — — Other Premises where Food or Drugs are sold 96 6 102 — — — Other Visits 143 335 478 — — — Total 3142 3562 6704 5 — 5 SAMPLES, &c., TAKEN. Formal Samples Informal Samples No, of Milk samples 178 188 366 — 4 4 ” Cream samples 10 20 30 — — — ” Butter and Margarine samples 59 90 149 — — — ” Other samples (specified below)— Arrowroot 1 3 4 — — — Brawn 1 — — — Celery — — — — 1 1 Cocoa 12 4 l6 — — — Coffee 14 4 18 — — — Dripping i — — — Flour 25 15 40 — — — Lard 9 11 20 — — — Mustard 9 6 15 — — — Olive Oil 6 — 6 — — — Oysters — — — 1 — 1 Pepper 11 3 14 — — — Pork Pie — 1 1 — — — Prescriptions 12 — 12 — — — Rice 5 5 10 — — — Salad Oil 2 2 — — — Sausages 14 9 23 — — — Sugar 6 — 6 — — — Vinegar — 10 10 — Total 374 370 744 1 5 6 115 Table No. 8 (row.).—Inspection and Re-inspect ions and other work the Food Inspectors during 1925. UNSOUND FOOD. Mr. Auger. Mr. Child. i Totals. Mr. Auger. Mr. Child. Totals. No. of surrenders and seizures :— Surrendered. seized. Meat, Ac. 5 3 8 — — — Fish 2 4 6 — — — Shellfish Other Foods (specified below):— Margarine — » ( — — — Fruit 7 6 >3 — — — Vegetables 2 2 — — — Total 14 16 30 — — — Inspections of Registered Canal Boats 5 — 5 — — — 116 Table No. 9. Visits, etc., made by Women Inspectors during 1925. First Visits. Subsequent Visits. Call made, but admission not obtained. Miss Bibby. Miss Smith. Miss Anderson. Mrs. Hunter. Miss Blaxland. Miss Camman. Miss Holland. Total. Miss Bibby. Miss Smith. Miss Anderson. Mrs. Hunter. Miss Blaxland. Miss Camman. Miss Holland. Total. Miss Bibby. Miss Smith. Miss Anderson. Mrs. Hunter. Miss Blaxland. Miss Camman. Miss Holland. Total. Grand Total. Infants — 40 8 83 5 — — 131 — 39 237 509 18 — — 803 — 42 40 178 6 — — 266 1200 Expectant Mothers — 30 3 67 5 4 4 113 — 7 2 34 8 — — 51 — 33 1 52 2 2 — 90 254 Ophthalmia Neonatorum — 5 2 6 11 14 11 49 — 11 13 12 30 23 25 114 — 8 — 1 7 9 1 26 189 Puerperal Fever — 2 2 6 8 3 8 29 — 4 5 6 2 4 3 24 — — 5 — 6 — — 11 61 Tuberculosis—Discharged Soldiers & Sailors — 14> 14 10 16 10 17 79 — 52 80 45 372 170 117 836 — 2 — 6 52 6 — 66 981 Do. Others 1 71 34 91 110 66 88 461 — 578 241 459 1134 1157 921 4490 — 287 64 110 241 132 102 936 5887 Measles and German Measles — 325 344 281 450 608 527 2535 — 29 37 11 33 92 21 223 — 37 32 6 49 37 26 187 2945 Whopping Cough — 64 70 34 25 98 199 490 — 28 27 16 2 28 4 105 — 12 25 2 4 6 5 54 649 Scabies — 1 — 18 30 11 8 68 — 1 — 7 7 2 — 17 — 1 — 3 5 2 — 11 96 Other Cases of Illness — 168 310 198 77 479 696 1858 — 60 227 44 98 23 1 383 — 55 96 8 12 6 3 180 2421 Verminous Persons — 3 4 25 13 25 17 87 — 1 2 10 1 1 3 18 — 1 4 5 3 1 16 121 To Hospitals and other Voluntrary Institutions 100 606 122 99 283 194 172 1576 — — — — — — 3 — 3 — — 2 — 3 — — 5 1584 Domestic Workshops — — 32 204 36 42 1 315 — — — 1 2 12 — 15 — — 10 31 19 30 — 90 420 Home Workplaces — 35 23 253 13 15 123 462 — 5 — — — 3 — 8 — 17 9 24 3 — 22 75 545 Laundries-Factory — — — — — — — — — — — — — — — — — — — — — — — — — Workshop — — — — — — — — — — — — — — — — — — — — — — — — — Restaurant Kitchens — — — — — — — — — — — — — — — — — — — — — — — — — Other Eactories — — — — — — — — — — — — — — — — — — — — — — — — — ” Workshops — — — — — — — — — — — — — — — — — — — — — — — — — ” Workpalces — — — — — — — — — — — — — — — — — — — — — — — — Milk Enquiries — 12 2 7 12 27 35 95 — 1 4 — 1 1 2 9 — 1 — 2 5 — 3 11 115 Attendances at Clinics — 112 88 15 80 3 21 321 — — — — — — — — — — — — — — — — 321 Attendances at mittees, &c 165 91 — — — — 8 264 — — — — — — — — — — — — — — — — 264 Other Visits and In Spections 3 24 2 92 98 68 369 656 — 1 2 3 37 1 — 44 — 8 1 1 7 5 — 22 722 Totals 269 1601 1055 1489 1272 1669 2234 9589 — 817 877 1157 1675 1520 1097 7143 — 504 287 428 426 238 163 2046 18778 117 Table no. 10.—Total Number of Inspection* and Re-inspections made by individual Inspector* and Visitors during the year 1925 Inspector. Inspections. lie-inspections. Call made, but admission not obtained. Total. 1. Mr. Rackham 631 2615 — 3246 2. ” Lonnon 1723 1873 — 3596 3. ” Brown * 1200 1797 — 2997 4. ” Dillon 1253 2540 — 3793 5. ” Walker 1418 2358 — 3776 6. ” James 1044 2265 — 3309 7. ” Adkins 481 982 — 1463 8. ” Akers 1893 1277 — 3170 9. ” Jaffa 1737 1670 — 3407 10. ” Capel 1292 2263 — 3555 11. ” Nixon 1345 2246 — 3591 12. ” West (Temporary)‡ 239 560 — 799 13. ” Thompson (Factories and Workshops) 1149 2418 — 3567 14. ” Auger (Food and Food premises) 3535 6 — 3541 15. ,, Child 3948 5 — 3953 16. Miss Bibby 269 — — 269 17. ” Smith 1601 817 504 2922 18. ” Anderson 1055 877 287 2219 19. Mrs. Hunter 1489 1157 428 3074 20. Miss Blaxland 1272 1675 426 3373 21. ” Camman 1669 1020 238 3427 22. ” Holland 2234 1097 163 3494 Totals 32477 32018 2046 66541 * Absent ill, 9 weeks. † Absent ill, 26 weeks. || Absent ill 7 weeks. ‡ Part year only. 118 Table 11. The following tabic gives the number of inspections made by individual Inspectors during cach of the past 5 years:— TOTAL INSPECTIONS. INSPECTOR. 1921 1922 1923 1924 1925 Mr. Rackham 3157 3369 2985 2886 3246 ” Lonnon 3241 3085 3179 3103 3596 ” Brown 3563 3545 3554 3581 29971 ” Dillon 3262 3024 3614 3348 3793 ” Walker 4112 3898 3743 3823 3776 ” James 3781 4131 3833 3532 3309 ” Adkins 3386 3656 3665 3035 14632 ” Akers 3500 3490 37c0 3711 3170 ” Jaffa 4300 3765 3532 3503 3407 ” Capel 3642 3780 3871 3781 3555 ” Nixon 4479 4866 4539 4487 3591 ” West (Temporary) — — — — 7993 Mr. Thompson (Factories and Workshops) 3533 3388 3366 3687 3567 ” Auger (Food Inspector) .. 3270 3239 3430 5593 3541 ” Child (” ”) 3147 3670 3685 3776 3953 Miss Bibby4 506 474 486 409 269 ” Smith 1799 1943 1812 2247 2922 ” Anderson 1900 1866 1509 15795 221996 Mrs. Hunter 1680 1718 1541 2626 3074 Miss Blaxland 2421 2982 2745 3303 3373 ” Camman 2002 2610 2303 3399 3427 ” Holland 13863 2846 2373 3428 3494 119 Table .No. 12.—Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1925, and the resulting Statutory Notices in 1925 and the early part of 1926. Schedule of Nuisances. Intimations. Statutory Notices. 1 Part of the house in a dirty condition ... 1204 336 2 ” ” damp ” 245 76 3 Roof defective 856 275 4 Guttering defective 196 73 5 Water fittings defective 191 51 6 Water-closet apartment with absence of external ventilation 45 9 7 ”” so foul as to be a nuisance or dangerous to health 14 1 8 Water-closet basin foul 83 21 ”” defective 145 13 10 ”” choked 104 16 11 Urinal in a foul condition 3 — 12 Privy in a foul condition — — 13 Soil pipe defective 44 13 14 ” unventilated 34 15 15 ” improperly ventilated 19 8 16 Absence of waste pipe to sink, lavatory or bath 1 1 17 Waste pipe of sink, lavatory, or bath connected with drain 13 2 18 ” ” ” defective 81 18 19 ””” foul 31 6 20 Inlet of drain improperly trapped 23 282 10 21 Drain defective ... 104 22 ” stopped 135 17 23 ” ventilating pipe defective 125 41 24 Rain-water pipe in direct communication with drain 24 6 25 ”” defective 145 39 26 Unpaved condition of roadway 3 — 27 Undrained ”” 1 — 28 Area or part unpaved 1 1 29 ” undrained 3 — 30 Yard or space unpaved 1 — 31 ” undrained 3 1 32 Defective condition of washhouse paving 70 29 33 Dust-bin defective 402 80 34 ”in an improper position 5 1 35 Accumulation of stagnant water which is a nuisance dangerous to health 15 1 36 Accumulation or deposit which is a nuisance dangerous to health 100 15 37 Animals kept in such a manner as to be a nuisance dangerous to health 25 — 38 Part of the house so overcrowded as to be dangerous to health 24 4 39 Space below floor in basement or ground floor insufficiently ventilated 41 10 40 Issuing of black smoke in such a quantity as to be a nuisance 1 — 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 8 1 42 Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates 3 43 Other nuisances 746 191 Total 5501 1518 120 Table no. 14 Factories, Workshops and Work Places—Breaches of Statutes. Intimations. Statutory Notices. 1 Want of cleanliness 168 29 2 Want of ventilation 3 — 3 Want of air space, overcrowding 2 2 4 Sanitary accommodation, absent or insufficient 13 2 5 ”” unsuitable or defective 89 21 6 ”” not separate for sexes 28 1 7 Want of drainage of floors — — 8 Other nuisances 118 19 9 Illegal occupation of underground bakehouse... 1 1 10 Breach of special sanitary requirements for bakehouses 99 — 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 89 11 Total 610 86