Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928. 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. Lewingaon. and 27. Eversholt Street. London N.W. 1. Metropolitan Borongh of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928. 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. Borough of ST. PANCRAS 3 CONTENTS. page Map of Borough, showing statistics by Wards 2 Public Health Committee 5 Staff of Public Health Department 6 Introduction 8 Statistical Summary 10 Section I.—Statistics, and Social Conditions of the Area. Population and General Statistics 12 Principal occupations of the inhabitants of the Borough 13 Economic Conditions 14 Marriages 14 Births 14 Illegitimacy 15 Notification of Births 15 Still Births 16 Deaths 16 Inquests 18 Infantile Mortality 19 ection II.—General Provision of Health Services. Hospital Accommodation 22 Institutional Provision for Unmarried Mothers 23 Ambulance Facilities 23 Clinics, Treatment Centres, &c. 23 Maternity and Child Welfare 25 Ante-natal 25 At Birth 25 Infants and Young Children 25 Advice Cards 26 Home Visiting 26 Attendances at Consultations, etc. 27 Centres 28 Alterations in Staff and Procedure 30 Artificial Light Treatment 30 Dental Clinic 33 Day Nurseries 35 Clinic for Ailing Mothers and Children 35 Convalescent Home Treatment 36 Home for Sick Poor Children 36 Supply of Milk to Mothers and Children 36 Public Health Officers of the Local Authority37 page Professional Nursing 37 Home Helps 38 Midwives 38 Midwifery 39 Maternity and Nursing Homes 40 Maternal Mortality 40 Legislation in force 42 Health Week 44 National Rat Week 45 Section III.—Sanitary Circumstances of the Area. Water Supply 45 Drainage 46 Refuse Collection and Disposal 46 Mortuary 47 Sanitary Inspections 47 Notices served 47 Nuisances—Legal Proceedings 48 Smoke Abatement 49 Factory and Workshop Acts 49 Inspections 50 Defeats found 50 Hi me Work 51 Factories, Workshops and Workplaces on Register 52 Other matters 52 Premises and Occupations controlled by by-laws or regulations 53 Offensive Trades 53 Rag and Bone Dealers 53 Houses Let in Lodgings 53 Lighting of Staircases 54 Handrails for Staircases 54 Underground Rooms 54 Canal Boats Acts 54 Rent and Mortgage Interest Restrictions Act, 1923 54 Medical Examination of School Children 55 Section IY.—Housing. Statistics 57 Ventilation of Bath-rooms 58 Overcrowding 58 Housing Schemes— Work of the Estates Committee 58 4 CONTENTS—continued. page Section Y.—Inspection and Supervision of Food. (а) Milk Supply 60 Cowsheds, Dairies and Milkshops 60 Bottled Milk 61 Sampling out of Office Hours 61 Milk (Special Designations) Order, 1923 61 (б) Meat and Other Foods 63 Unsound or diseased food condemned and destroyed 63 Food Poisoning and Preservatives 63 Preservative in Butter 66 Slaughter-houses 66 Fried Fish and Fish Curing Premises 66 Ice Cream Premises 66 Bakehouses and Restaurant Kitchens 66 (c) Sale of Food and Drugs Acts— Samples taken 67 Prosecutions— (a) Sale of Food and Drugs Acts 68 (b) Public Health tives, etc., in Food) Regulations, 1925 69 (c) Milk and Dairies Order, 1926 69 Wholesale Dealers in Margarine 69 Section YI.—Prevalence of, and control over, Infectious Diseases. Notifiable Diseases 69 Notifications and Deaths from notifiable diseases by ages 70 Do. by Wards 71 Smallpox 72 Vaccination 72 Scarlet Fever 73 Diphtheria 73 Enteric (Typhoid) Fever 73 Puerperal Fever 73 Puerperal Pyrexia 74 Erysipelas 74 Cerebrospinal Meningitis 75 Anterior Poliomyelitis and Polioencephalitis 75 page Ophthalmia Neonatorum 75 Encephalitis Lethargica 75 Pneumonia 75 Malaria 76 Dysentery 76 Measles and German Measles 76 Hospital Accommodation 76 Tuberculosis— New Cases and Deaths 78 Notifications 79 Prevalence and fatality for 10 years 80 Notifications and Deaths by Wards 80 Public Health (Tuberculosis) Regulations, 1924 81 Public Health (Prevention of Tuberculosis) Regulations, 1925 81 Boarding-out of Children 81 Provision of Beds, etc 82 Disinfection of Rooms 82 Home Visits and Enquiries 82 Care Committee 82 Dispensary 84 Report by Tuberculosis Officer 84 Summary of work carried out 86 Section YII.—Other Services. Disinfecting and Cleansing Station 87 Disinfection for Institutions, etc . 88 Bacteriological Work 89 Appendix. Table No. 1. Vital Statistics for 11 years 92 Do. 2. Registrar - General's Short List of Causes of Death 93 Do. 3. Births and Deaths in Wards 95 Do. 4. Do., in certain large towns and Metropolitan Boroughs 96 Do. 5. Meteorology 97 Do. 6. Work carried out by District Inspectors 98 Do. 7. Do.—Food Inspectors 99 Do. 8. Do.—Factory & Workshop & Women Inspectors 100 5 Metropolitan Borough of Saint Pancras. PUBLIC HEALTH COMMITTEE. November, 1927, to October, 1928. CHAIRMAN. Alderman Alfred Solomon, J.P. DEPUTY-CHAIRMAN. Councillor Evan Evans. EX-OFFICIO. The Right Worshipful The Mayor (Councillor Rev. R. Conyers Morkell M.A.. J.P.). ALDERMEN. Gregg, Dr. Edward Andrew. Rolles, Harry. Swift, Mansell James. F.R.M.S. 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. 1 Davies, John William. 5 Escott, Arthur. 3 Hewson, Frederick. 7 Jenkins, Edwin. 4 Johnson, Job, J.l1. 5 Kemp, Frederick William Isaac. 6 Martin, Arthur Henry. 7 Mathfws, William Lee. 5 Paterson, Mrs. Louisa Sophia. 2 Salmon-Brunsdon, Mrs. Elizabeth. 1 Spry, William Palmer. 5 Williams, Lt.-Col. Charles. November, 1928, to Octobtr, 1929. CHAIRMAN. Councillor Evan Evans. DEPUTY-CHAIRMAN. Councillor Mrs. Evelyn Alliston. EX-OFFICIO. The Right Worshipful The Mayor (Councillor E. J. Saunders, J.P.). ALDERMEN. Davies, David, J.P., L.C.C. Gregg, Dr. Edward Andrew. Rolles, Harry. Swift, Mansfll James, F.K.M.s. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 8 Badge, William. 2 Bell, Mrs. Florence Nightingale Harrison. 8 Blackmore, Claud. 7 Crosby, Miss Ada, M.B.E. 1 Davies, John William. 1 Ellis, Alfred Cave. 5 Escott, Arthur. 4 Flynn, William, J.P. 3 Hewson, Frederick. 2 Horne, George. 7 Jenkins, Edwin. 5 Kemp, Frederick William Isaac. 2 Moore, Thomas Fairless. 3 Perrett, James John. 5 Radford, Mrs. Laura. 1 Smerdon, Mrs. Edith Maude. 4 Woods. Mrs. Iris Marion. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1928. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. (g) G. Sowden, M.D., D.P.H., M.R.C.S., L.R.C.P. TUBERCULOSIS OFFICER. (g) A. Viney, M.R.C.S., L.R.C.P., D.P.H. ASSISTANT MEDICAL OFFICER. (g) G. A. Back, B.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H. PUBLIC ANALYST. J. Kear Colwei.l, F.I.C. (G) SANITARY INSPECTORS AND HEALTH VISITORS. Inspectors of Food and Food Places. §¶W. G. Auger. §¶H. R. Child. Inspector of Workshops and Factories. J§B. II. Thompson. District Inspectors. §G. Rackham. ¶‡G. W. Adkins. *‡§¶ J. I. Lonnon. ‡R. C. Akers. ‡§W. L. Brown. ‡M. Jaffa. §E. M. Dillon. ‡¶S. W. Capel. *‡§¶A. H. Walker. ‡¶H. K. Nixon. ‡§R. E. James. §H. G. West. ‡ ¶E. W. Winchester. Women Sanitary Inspectors and Health Visitors. ‡Miss M. E. Bibby, B.A. ‡||Miss Y. K. Blaxland. (Lond.). (Senior) ‡||†**Miss J. A. J. Camman. ‡§||Miss F. A. Anderson. ‡||Miss A. Holland. ‡§Mrs. A. Hunter. CLERICAL STAFF. A. D. Corrick, Chief Clerk. A. G. Capel. (g) A. Carpenter. G. N. Cove [attached to the Estates Dept.). J. D. Holiday. T. H. Hague. (g) Miss A. Andrews. W. C. Mansfield. (g) H. G. Avril. R. Warren. * Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Inap. Cert. Royal San. Inst. ¶Cert. Meat and other Foods. || Health Visitor's Certificate. †C.M.B. ** Certificate, Queen Charlotte's Hospital. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants, 7 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. (g) Medical Officers. No, of Consultations per month. Dr. Chas. H. A. Alderton 4 Dr. H. Searle Baker 4 Dr. Albert J. Clarke 2 Dr. B. Marion Cockerell 15 Dr. A. Gertrude Grogan 4 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 5 Dr. Ethel F. Iredell 4 Dr. Lydia A. Leney 8 Dr. J. Balfour Neill 8 Dr. Martin Oldershaw 2 Dr. Margaret R. Paterson 4 Dr. Mary J. Pirret 8 Dr. Francis L. Proyis 13 Dr. Helen Trrover 5 (g) Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist 10 Dr. Jas. Maughan, Anœsthetist. 2 (g) Artificial Light Clinic. Dr. William Beaumont 12 (g) Consulting Obstetiic Surgeons. Martin H. Oldershaw, M.D., M.B., B.S., F.R.C.S., L R.C.P. Francis L. Proyis, M.R.C.P., F.R.C.S., M.R.C.S., L.R.C.P. (g) Dentists at Tuberculosis Dispensary. Mr. Southcomb May, L.D.S. Mr. A. J. Maurice, L.D.S. (The above are part-time officers.) (g) Superintendents of Maternity and Child Welfare Centres. Senior. Junior. ‡||Miss G. R. Bristow. ||†Miss M. L. Blair. ||†Mrs. E. Crockart. ||†MRS. S. C. Chapman. ||†Miss M. II. Landel Jones. †Miss M. Manger. **Miss M. Smyth. ||†Miss E. M. Robinson. †Miss M. Templeton. (g) Health Visitors at Maternity and Child Welfare Centres. †**Miss E. B. Bagnali. †MRs. E. Lurie. †Mrs. E. E. Bruce. †||I‡Mrs. J. Lynn. ||‡Miss M. A. Clarke. ||†Mrs. M. A. Smith. ||†Miss B. M. Harris. ||†‡Miss V. B. Woodroff. ||Miss A. M. U. Harrop. (g) Tuberculosis Dispensary. Nurse Visitor, ‡†Miss S. A. Long. Clerical and General Assistant, Miss Margaret Deed. DISINFECTING AND CLEANSING STAFF. Foreman of Disinfecting Station T. Bartholomew. Disinfector A. J. Dibben. Motor Driver and Disinfector J. Stanley. „ ,, C. Browne. 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. Roval San. Inst. ¶ Health visitor's Certificate. † C.M.B. ** Midwifery Certificate, Queen Charlotte's Hospital. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 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, In accordance with the requirements of the Sanitary Officers Order I have the honour to present the Annual Report on the sanitary circumstances and administration, together with the vital statistics of the Borough. The Minister of Health, in the exercise of his powers under the above order has intimated that the Report for 1928 shall be an "ordinary" report, that is, a report less detailed in character than the "Survey" Reports which are periodically required. This is the 73rd Annual Report which has been presented and the sixth which it has been my duty to submit to the Members of the Council. A summary of the principal statistics for the year will be found on page 10. The items to which attention may be directed are the following: — The population, accord in 2 to the estimate of the Registrar-General, shews a decrease of no less than 7,200 as compared with 1927, and of 10,800 as compared with the year 1926. This matter is further considered on page 12, but it should be pointed out that if the population is under-estimated the death and other rates which are based on this estimate are caused to appear unduly high. The birth rate for 1928 was 15.9 per 1000 of estimated population and the death rate 12.7, as compared with rates of 15.5 and 12.3 respectively for the previous year. The actual numbers of both births and deaths were less than during 1927, but owing to the estimated decrease in population the rates are rendered slightly higher. Deaths from Heart disease, Cancer and from Injuries were more numerous than in the previous year, but there was a decrease in those due to Bronchitis, Pneumonia, Influenza and Whooping Cough. The infant mortality rate was 80 per 1000 births, as compared with 62 for the previous year. This very considerable increase was due to the fact that high figures for all the customary principal causes of infant deaths, namely, Respiratory, Enteritic and Congenital causes, coincided with an epidemic of Measles of a severe type. A scheme of co-operation in Ante-natal work as regards University College Hospital 9 and the Council's Centres came into operation on January 1st, 1928, and was continued throughout the year. This co-operation is working smoothly and should prove of value to all concerned. In connection with this it may be mentioned that for the past year the rate of Maternal Mortality, a subject to which considerable attention has recently been given, was only 1.8 per 1000 Births. This is the lowest maternal death rate hitherto recorded in the Borough. A portion of the Housing Scheme in Somers Town initiated by the Borough Council was completed during the year and was formally opened by H.R.H. The Princess Mary on July 25th, 1928. Progress was also made with the housing scheme of the London County Council in the Ossulston Street area, and the first portion, in which the Borough Council have arranged for the provision of a new Maternity and Child Welfare Centre, should be ready for occupation during 1929. There is still, however, a shortage of housing accommodation for the poorer members of the community, those whose employment is irregular and uncertain and those who have very large families. Such persons are unable to pay the rent that is necessary for the amount of accommodation they require, and therefore the housing provision made by the London County Council at Becontree, Downham, etc., is not available for them. A cheaper type of accommodation is urgently required for families of this character, which should ba centrally situated in order to lessen the cost of travelling to and from work. I have once more to express my thanks for the consideration so invariably extended to me by the Chairman and Members of the Public Health Committee, and to record my appreciation of the cordial co-operation accorded by the staff of the Public Health Department. I am, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. 10 STATISTICAL SUMMARY. 1.—General Statistics. Area of Borough, 2,694 acres. I'laying fields (private), 7 acres. Area of various public open spaces, 503 acres. Undeveloped area, 50 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 altitude varies from 48 feet above ordnance datum, the lowest point, which is situated in the south of the Borough in the neighbourhood of Ampton Street, King's Cross Road, to 427 feet above ordnance datum, the highest point, which is in Pond Square in the extreme north of the Borough. 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. Number of inhabited houses (1921 Census), 24,660. Number of families or separate occupiers (1921 Census), 56,653. Number of persons per acre (Census year 1921), 78. 2.—Principal Statistics for 1928. Population (Registrar-General's estimate) Civilian, 205,600. Total, 206,000. Number of persons per acre, 76. Births. Males, 1,682; females, 1,592. Total, 3,274. Birth rate, 15.9 per 1,000 of population. Legitimate births, 3,036 ; illegitimate births, 238. Excess of births over deaths, 656. heaths. Males, 1,416; females, 1,202. Total, 2,618. Death rate, 12.7 per 1,000 of population. Infantile Mortality. Deaths of infants under one year of age per 1,000 births, 80. Legitimate rate, 74; illegitimate rate, 151. 11 Maternal Mortality. Number of women dying in, or in consequence of, child-birth : From Sepsis, 3 ; from other causes, 3. Maternal death rate per 1,000 births, 1.8. Number of deaths from Measles (all ages), 127. „ „ Whooping Cough (all ages), 24. „ „ Diarrhoea and Enteritis (under 2 years of age), 45. Tuberculosis Pulmonary. Deaths, 191 ; death rate per 1,000 of population, 0.93. All forms. Deaths, 216; death rate per 1,000 of population, 1.05. Rateable value, £2,131,839. Sum produced by a penny rate, £8,600. Rainfall during the year (recorded at Camden Square), 26'0 inches. Comparative Statistics. Rate per 1,000 of Population. Rate per 1,000 Births. Birth rate. Death rate. Infant Mortality. St. Pancras 15.9 12.7 80 England and Wales 16.7 11.7 65 107 Great Towns 16.9 11.6 70 County of London 15.9 11.6 67 12 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1928. Fur the purpose of this Report, the year consists of the 52 weeks ended 29th December, 1928. Section 1.-STATISTICS AND SOCIAL CONDITIONS OF THE AREA. POPULATION AND GENERAL STATISTICS. The population of the Borough at the Census of 1921 was 211,366. From that date, according to the estimates of the Registrar-General, it gradually increased year by year until 1926, when the population was estimated to have reached a total of 216,810. A sudden and rather remarkable decrease appears to have occurred during the year 1927, when the Registrar-General estimated the total population to be only 213,200, and an even greater decrease during 1928 for which year the population is estimated to be only 206,000. The estimated decrease during the past two years is therefore greater than the estimated increase which occurred during the preceding five years. Some decrease has doubtless occurred, owing to the demolition of a number of houses in connection with the London County Council Ossulston Street area rebuilding scheme, to the removal of a number of families to Becontree, Downham, llendon, and other places, and also, to some extent, to the use of premises for industrial purposes which previously were residential in character. The reduction due to the above causes has been minimised by the development of the Holly Lodge Estate in the north of the Borough, by the excess of births over deaths, and by the conversion of a number of the larger houses, originally occupied by one family, into flats occupied by a number of families. Exact information will not be available until the next census in 1931, but for the reasons stated above I think the Registrar-General has under-estimated the population of the Borough. Attention may be directed to the fact that population is one of the factors influencing the amount of "Block" grant local authorities are to receive under the New Local Government Act. It is unfortunate, therefore, this decrease in population should have occurred at this particular time. It may also be noted that a similar decrease in population appears to have occurred in practically all the Metropolitan Boroughs. The figures of the Registrar-General have, however, been used throughout this report, the estimate of total population being used for calculating the marriage and birth rates and the estimate of the civilian population for calculating the death rate, 13 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried no in the Borough which to any extent affect the public health prejudicially. The following table gives for each sex the principal occupations as ascertained at the last Census. The number and percentage engaged in the various occupations mentioned are also given: — Total Population (over 12 years of age): Males, 78,036; Females, 90,616. Males. Occupation. Number. Percentage. Transport Workers (Railways, &c.) 13714 18 % Commercial and Financial (Shop Assistants, &c.) 7612 10 „ Personal Service (Waiters, Hairdressers, &c.) 5676 7 ,, Metal Workers 5158 1 ,, Clerks and Typists 4643 6 „ Wood and Furniture Workers 4282 5 „ Public Administration and Defence 3156 4 „ Unoccupied and Retired 9669 12 „ All other Occupations 24126 31 „ Total 78036 100 „ Females. Occupation. Number. Percentage. Personal Service (Domestic, Waitresses, &c.) 13350 15 % Makers of Textiles 5523 6 „ Clerks and Typists 4928 5 „ Commercial and Financial 3003 3 „ Unoccupied and Retired (married) 35263 39 „ ,, (unmarried) 10406 12 „ „ (widowed or divorced) 6424 7 „ All other Occupations 11719 13 „ Total 90616 100 „ 14 Economic Conditions. The amount of out-relief granted during the past 10 years is indicated in the following table (kindly supplied by Mr. Bernard Chapman, Clerk to the St. Pancras Guardians), which gives for half-yearly periods the amount spent on out-door relief, and the number chargeable in this respect in the middle wreek of each half-year:— Half- Year ending Amount spent in the half-year. Numbers chargeable in the middle week of the half-year. Lady day, 1919 £ 3814 754 Michaelmas, 1919 4557 823 Lady day, 1920 6146 899 Michaelmas, 1920 8161 1079 Lady day, 1921 13081 1660 Michaelmas, 1921 21400 3529 Lady day, 1922 40081 6429 Michaelmas, 1922 34591 6325 Lady day, 1923 34193 6425 Michaelmas, 1923 28312 5489 Lady day, 1924 31690 5290 Michaelmas, 1924 26607 4723 Lady day, 1925 26766 4319 Michaelmas, 1925 31290 4267 Lady day, 1926 36061 5427 Michaelmas, 1926 43351 6242 Lady day, 1927 45159 5695 Michaelmas, 1927 37825 4998 Lady day, 1928 39812 5313 Michaelmas, 1928 35301 4610 MARRIAGES. The number of marriages celebrated during the year was 1991. This is equal to a rate of 9.7 per 1000 of total population. The average yearly number of marriages during the preceding five years was 1,894, equal to a rate of 8 7 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 3,274, equal to an annual birth rate of 15-9 per 1000 of population. The rate for the previous year, which was the lowest ever recorded in the Borough, was 15.5. The actual number of births registered as having taken place in the Borough during the year was 3,980, but this figure has to be corrected by deducting the births of nonresidents, which occurred chiefly in various hospitals and other institutions in the Borough— these numbered 1,259, and by adding the births belonging to St. Pancras which occurred outside the Borough—these numbered 553. The corrected figure being therefore as stated above, 3,274. The corresponding figures for previous years are given in Table 1, on page 92. 15 The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1923, and for comparison the figuares for the previous year are also given:— Ward Births and Birth Hates. Ward. 1928. 1927. Births. Birth Rate. Births. Birth Rate. 1 525 14.8 485 13.6 2 341 16.1 337 15.3 3 569 16.5 585 16.3 4 430 17.2 406 15.6 5 507 17.4 535 17.6 6 340 17.0 371 17.9 7 171 11.7 191 12.5 8 391 15.0 389 14.3 Borough 3274 15.9 3299 15.5 No less than 1,809 births occurred in Public Institutions in St. Pancras, equal to 45-5 per cent, of the total births which took place in the Borough. Table 4, on page 96, shows for 1928 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 3,274 net St. Pancras births, 238 were recorded as being illegitimate. This equals 7.3 per cent. of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1918 9.5 per cent. 1923 5.7 per cent. 1919 8.4 „ 1924 5.9 ,, 1920 5.6 „ 1925 6.3 „ 1921 5.5 „ 1926 6.3 „ 1922 5.6 „ 1927 6.9 „ Notification of Births. 3,987 notifications of births were received during the year: this includes 136 stillbirths and 3,851 live births, and represents 95 per cent. of the births registered as having taken place in the Borough. The Notification of Births Act (1907) states: "Information with regard to the event shall be given to the Medical Officer of Health within 36 hours of the 16 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 Register Office within forty-two days of the birth. Still Births. The Births and Deaths Registration Act, 1926, which came into force on July 1st, 1927, requires the birth of any still born child to be registered. The definition of still birth for the purpose of the Act is as follows:— Still born or still birth shall apply to any child which has issued forth from its mother after the 28th week of pregnancy, and which did not at any time after being completely expelled from its mother, breathe or show any other sign of life. For the purpose of the Births and Deaths Registration Act, a child which, whatever the period of pregnancy, breathes or shows any other sign of life after complete expulsion from the mother, is a live born child, and if it dies even within a brief period only after birth, both the birth and the death must be registered. The fact of still birth must be certified either by the Medical Practitioner or Midwife who was in attendance, or who has examined the child, or by declaration in a prescribed form if no Medical Practitioner or Midwife was present. If in any of the last mentioned cases information is given by the Registrar to the Local Authority, the Minister of Health has intimated that the Medical Officer of Health shall arrange for enquiries to be made in order that he may be satisfied that the child was really still born and that there were no suspicious circumstances attaching to the case. DEATHS. The net number of St. Pancras deaths registered during the year was 2,618; this equals an annual death rate of 127 per 1000 of population. The average yearly death rate of the Borough during the previous five years was 12.5 per 1000 of population. The actual number of deaths registered as having taken place in the Borough during the year 1928 was 3,053. This number has to be corrected by the exclusion of 985 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 550 deaths of residents which occurred and were registered outside the Borough. The corrected figure is therefore 2,618 and is used in calculating the death rates in this report. In Table 1, on page 92, will be found details of the corresponding figures for previous years. 17 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. 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 Average for 10 years. 1928 Heart Disease 389 370 442 435 461 394 398 38l 388 448 411 465 Cancer 269 245 299 290 302 319 298 324 301 292 291 821 Bronchitis 228 301 236 276 308 223 304 274 259 227 264 138 Tuberculosis—all form; 485 311 312 304 315 272 271 231 212 217 296 216 Pneumouia 376 179 197 173 265 201 200 204 155 207 216 181 Injuries 119 108 92 88 127 113 114 118 142 132 115 145 Cerebral Haemorrhage, Embolism, and Apoplexy 131 91 98 126 120 112 118 123 110 92 112 67 Congenital Debility, Malformation and Premature Birth 121 147 182 137 126 119 105 94 100 69 120 86 Nephritis and Bright's Disease 98 61 95 60 67 79 75 75 89 84 78 83 Influenza 700 260 46 57 142 24 80 41 29 83 146 14 Diarrhœa and Enteritis 56 68 54 98 47 61 63 55 63 35 60 52 Whooping Cough 80 7 60 38 29 28 46 71 24 35 42 24 Rheumatic Fever 8 7 6 10 15 8 5 18 10 13 11 15 Erysipelas 11 9 12 3 12 4 4 12 8 6 8 2 Diphtheria and Croup 31 21 33 51 44 20 22 31 12 6 27 12 Measles 75 15 65 23 107 5 74 3 65 5 44 127 Puerperal Fever 2 9 8 4 4 9 4 4 1 4 5 3 Pleurisy 14 9 12 7 10 8 8 16 5 3 9 7 Scarlet Fever 7 5 11 7 20 3 12 - 2 2 7 1 Enteric Fever 5 2 1 3 1 3 2 3 1 2 2 1 The Registrar-General's short list of deaths at different age periods is given in Table 2 on page 93, and, for the 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 4 on page 96. It will be noted that 19 Metropolitan Boroughs had a lower and 9 a higher general death rate than St. Pancras, Of the total 2,618 St. Pancras deaths which occurred during the year, no less than 1,677 took place in public institutions; this equals a proportion of 64 per cent. of the total deaths. 18 Ward Deaths and Death Rates. The number of deaths and the death rates per 1000 of population for each of the Wards during the past year were as follows, the figures for the preceding year being also ffiven for comparison:— Ward Deaths and Death Kates. Ward. 1928. 1927. Deaths. Death Rate. Deaths. Death Rate. 1 424 12.0 388 10.9 2 244 11.6 257 11.7 3 428 12.4 421 11.8 4 347 13.9 363 14.0 5 409 14.2 416 13.7 6 252 12.6 267 12.9 7 170 11.6 156 10.2 8 318 12.2 323 11.9 Homeless 26 — 30 — Borough 2618 12.7 2621 12.3 Inquests. In the following table will be found the causes of death, us 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 3 - - - 8 6 17 Pneumonia 3 - — — 2 — 5 Disease of Arteries - — 1 - 2 1 4 Cancer — — — — 2 — 2 Other causes 4 4 1 1 9 4 23 Accidents— Street Vchicles — 3 11 7 29 10 60 Burns and Scalds - 2 — 1 1 4 8 Railway - - - 1 2 — 3 Falls 1 2 1 1 14 25 44 Other causes* 6 3 3 2 17 6 37 Suicides t — - - 2 41 6 49 Murder - — — - 1 — 1 Manslaughter — — — — 1 — 1 Open Verdict 2 - 1 1 5 — 9 Totals 19 14 18 16 134 62 263 * Includes 1 case of coal gas poisoning. † ,, 16 cases ,, „ 19 Infantile Mortality. 261 deaths of St. Pancras infants under one year of age occurred in 1928. This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 80, as compared with a rate of 62 in 1927. The following table gives the deaths and death rates of Infants, both legitimate and illegitimate, for 1928:— Legitimate. Illegitimate. Total. Number of Births 3,036 238 3,274 Number of Deaths (under one year of age) 225 36 261 Death rate per 1,000 births 74 151 80 The causes of the high Infant Mortality in 1928 were an exceptionally heavy death rate from Measles, no less than 30 Infants under one year of age having died from this cause, and associated with this were high death rates from Broncho-Pneumonia, Enteritis, Premature Birth and other Congenital causes. Of the total deaths which occurred of Infants under one year of age during 1928, Measles was responsible for 11.5 per cent., Broncho. Pneumonia for 16*5 per cent., Diarrhoea and Enteritis, 15.7 per cent., and Premature Birth and other Congenital causes, 37.2 per cent. In Table 1, on page 92, the Infantile Mortality rates are given for previous years, and in Table 3, on page 95, the figures will be found for each Ward. Table 4, on page 96, gives the Infant Mortality rates for England and Wales, the County of London, the Metropolitan Boroughs, and certain other large towns. On the next two pages tables are given which indicate:— 1. The causes of death of all children under one year of age during 1928, classified according to age at death. 2. The causes of death of children under one year of age during the ten previous years. In this table the number of births in each year is also given for reference. 20 1928. 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 and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Measles - - — — — 1 2 11 16 30 Whooping Cough — - — 1 1 2 1 3 3 10 Influenza — — — — - — — — — — Tuberculous Meningitis — — — — — — — — — — Other Tuberculous Diseases — — - — — — 1 1 — 2 Meningitis (not Tuberculous) — — — — — — 1 — — 1 Convulsions 1 — — — 1 — — - — 1 Bronchitis — - 1 1 2 4 1 2 — 9 Broncho-pneumonia 2 - - — 2 13 9 10 9 43 Lobar-pneumonia - — — — — 1 1 — 1 3 Pneumonia (type not stated) 1 — — — 1 — — 1 — 2 Diarrhoea — — — 1 1 3 2 2 — 8 Enteritis — 1 1 — 2 10 10 6 5 33 Syphilis — — — — — 2 — 2 — 4 Suffocation (overlying) — — — — — 1 — — — 1 Injury at Birth 2 — — — 2 — — — — 2 Atelectasis 10 1 — — 11 — — — — 11 Congenital Malformations 2 1 1 — 4 10 3 3 - 20 Premature Birth 34 4 4 2 44 5 1 - - 50 Congenital Debility, Sclerema and Icterus 5 — - 2 7 6 3 — — 16 Other causes 2 1 1 — 4 1 5 2 3 15 Totals 59 8 8 7 82 59 40 43 37 261 Nett Births in the year legitimate illegitimate 3036 238 Nett Deaths in the year legitimate infants illegitimate infants 225 36 21 Deaths from Stated Causes under 1 Year of Age for 1928 and 10 preceding Years. CAUSE OF DEATH. 1918 1919 1920 1921 1922 1923 1921 1925 1926 1927 Average for 10 years. 1928 Measles 16 4 21 7 15 1 15 2 25 11 30 Scarlet Fever — 1 — — 3 — — - - - — — Whooping Cough 27 2 18 18 11 8 13 29 11 15 15 10 Diphtheria and Croup 1 — 2 2 — — - 1 1 — 1 — Erysipelas 1 — — — 1 1 2 2 - — 1 — Influenza 18 11 2 2 7 — 6 2 1 2 5 — Tuberculous Meningitis 8 4 6 4 3 4 3 2 3 3 4 - Other Tuberculous Diseases 4 8 2 4 8 3 - 1 1 1 3 2 Meningitis (not Tuberculous) 3 6 7 3 2 3 5 4 3 2 4 1 Convulsions 3 6 7 8 8 5 4 4 2 1 5 1 Laryngitis — — — — — 1 — — 1 - — — Bronchitis 17 23 27 13 21 12 12 19 14 5 16 9 Broncho-pneumonia 29 24 60 39 54 31 51 34 36 42 40 43 Lobar-pneumonia 6 1 5 1 3 1 3 4 2 2 3 3 Pneumonia (type not stated) 9 8 4 3 6 1 3 — 1 1 4 2 Diarrhoea 6 10 11 11 4 6 6 9 7 3 7 8 Enteritis 31 37 26 63 27 37 46 36 38 24 37 33 Gastritis 1 3 2 2 — 1 — 2 — — 1 - Syphilis 13 11 15 14 8 5 2 5 1 2 8 4 Rickets — — 1 1 1 - — — — — - — Suffocation (overlying) 6 1 2 2 5 1 1 4 3 1 3 1 Injury at Birth 2 6 5 3 3 6 4 7 3 9 5 2 Atelectasis 8 7 10 8 4 9 7 2 6 10 7 11 Congenital Malformations 17 31 33 25 31 27 23 20 25 15 25 20 Premature Birth 50 68 105 75 61 70 59 57 57 39 64 50 Congenital Debility, Sclerema nd Icterus 46 45 40 34 28 21 24 17 18 14 29 16 Other causes 18 24 24 18 23 15 14 17 15 14 18 15 Totals 340 336 435 360 337 272 303 280 274 205 314 261 Nett Births 3318 3824 5934 4764 4559 4348 4112 3880 3612 3299 4165 3274 22 Section II.—GENERAL PROVISION OF HEALTH SERVICES. Hospital Accommodation. A. Fever and Smallpox.—Hospital accommodation is provided by the Metropolitan Asylums Board. B. Tuberculosis.— For patients suffering from this disease Institutional accommodation is provided through the London County Council. C. Maternity, Children's and other Hospitals— The following are situated in the Borough, but with the exception of the two hospitals of the St. Pancras Guardians, the use of these hospitals is by no means confined to residents of the Borough. On the other hand, hosnitals situated outside the Borough are largely used bv St. Pancras residents. Hospitals. Number of Beds. St. Pancras Poor Law Hospitals. St. Pancras Hospital, King's Road 378 Highgate Hospital, Dartmouth Park Hill *554 Metropolitan Asylums Board Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum and marasmus) 63 General and Special Voluntary Hospitals. General University College Hospital, Gower Street - Obstetric Royal Ear 415 75 39 Royal Free Hospital, Gray's Inn Road ... 268 London Temperance Hospital, Hampstead Road 186 Elizabeth Garrett Anderson Hospital, Euston Road 75 West End Hospital for Nervous Diseases, Regent's Park 80 Hospital for Tropical Diseases, Endsleigh Gardens 56 Central London Throat, Nose and Ear Hospital, Gray's Inn Road 32 Central London Ophthalmic Hospital, Judd Street 40 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 St. Saviour's Hospital, Osnaburgh Street 21 North-West London, Bayham Street - St. Pancras Dispensary, Oakley Square - London Skin Hospital, Fitzroy Square - Western Skin Hospital, Hampstead Road - British Dentists' Hospital, Camden Road - London Foot Hospital, Charlotte Street - * 410 only available, owing to reconstruction. 23 Institutional Provision for Unmarried Mothers. The Main Memorial Home, 49, Cartwright Gardens, W.C. 1, provides accommodation for young unmarried women expecting for the first time to become mothers. The Home is maintained by funds obtained from voluntary sources, but a grant is made bv the Ministry of Health. Ambulance Facilities. For infectious cases ambulances are provided by the Metropolitan Asylums Board. For non-infectious cases the Metropolitan Asylums Board have special ambulances. For accident cases the London County Council provide ambulances, and those of the St. John's Ambulance Association are also available. For Maternity cases the London Ambulance Service provided by the London Count}' Council is available between the hours of 11 p.m. and 8 a.m. The St. Pancras Guardians also have three motor ambulances, which may be hired when available. Clinics, Treatment Centres, etc. For purpose of reference these are given in tabular form ; details concerning the work carried out will be found on succecding pages. Situation. By whom provided. A. Artificial Light Clinics. Raydon Street, South Highgate The Borough Council. Cromer Sunlight Centre, Cromer Street A Voluntary Committee. Almeric Paget Clinic, Rochford Street ,, A number of the hospitals in the Borough also provide this treatment. J{. Maternity and Child Welfare Centres. St. Pancras School for Mothers, Ampthill Square The Borough Council, with assist- and Chalton Street Centres ance from the Voluntary Committee. North St. Pancras School for Mothers, Queen's „ Crescent South Highgate Centre, Raydon Street „ Grafton Road Centre „ Camden Town Centre, Camden Road „ Arayle Square Centre ,, Caversham Road Centre University College Hospital Centre The Hospital Authorities. † Royal Free Hospital Centre „ „ Cromer Welfare Centre, Cromer Street A Voluntary Committee. C.— Day Aurseries. Kentish Town Day Nursery, Gospel Oak Grove The Voluntary Committee, with a subsidy from the Borough Council. Margaret Day Nursery (for the children of „ Unmarried, Widowed and Deserted Mothers only), 44, Ampthill Square Whitfield Street Day Nursery, 53, Whitfield Street ,, † A grant is made by the Borough Council in respect of the Visitor's Salary. 24 Situation. By whom provided. D. Dental Clinics. Argyle Square: For nursing and expectant The Borough Council. mothers and children who attend the Maternity and Child Welfare Centres Ampthill Square: For mothers and children who The Voluntary Committee. attend the Centre at 1, Ampthill Square St. Pancras Dispensary: For Tuberculosis cases The Borough Council. ,, For ordinary cases The Dispensary Committee. E. School Clinics. Highgate New Town: Chester Road Voluntary Committees working St. Pancras Centre, Prince of Wales Road under agreement with the Lancing Street Centre, Churchway London County Council. F. Tuberculosis Dispensaries. St. Pancras Dispensary, Oakley Square The Borough Council. University College Hospital The Hospital Authorities. G. Venereal Disease Clinics. These are provided at various Voluntary Hospitals under agreements made with the London County Council. The undermentioned are situated within the Borough, but many others in the Metropolis are available for St. Pancras residents:— The Royal Free Hospital, Gray's Inn Road (for women and children only). University College Hospital, Gower Street (for male and female patients). H. Clinic for Sick Mothers and Young Children. St. Pancras Dispensary, 39, Oakley Square . . Medical Officer paid by Borough Council; other expenses paid by Dispensary Committee. I. Convalescent Homes for Sick Poor Children. The Mayoress of St. Pancras Home, "Avalon," By Voluntary Committee, with St. Alban's Road grant from Borough Council. Invalid Children's Aid Association (various Subsidy from Borough Council, homes) J. Open Air Schools. Holly Court, Highgate, N. 6 London County Council. Euston Square, N.W. 1 ,, K. Professional Nursing at Home. Central St. Pancras Nursing Association, By Voluntary Committee with 62, Camden Road, N.W. 1 grant by Borough Council. North LondonNursing Association,413, Holloway ,, Road, N. 7 Hampstead Nursing Association, 25, Heath Hurst ,, Road, N.W. 3 Metropolitan N ursing Association, 23, Bloomsbury ,, Square, W.C. 1 25 MATERNITY AND CHILD WELFARE. For many years considerable attention has been devoted to this work in St. Paneras, not only by the Borough Council and the associated Voluntary Committees, but also by the general hospitals, etc. The work carried out may be summarised under the following three headings:— 1. Ante-natal. Special consultations are held at the Centres maintained by the Borough Council and also at the General and Women's Hospitals, both in and adjacent to the Borough. Visits by Council's Health Visitors to the Homes. Classes for mothers, held by the Superintendents of the various Centres. Provision of dinners, milk, and also of dental treatment for expectant (and nursing) mothers. A scheme of co-operation in Ante-natal work between the Borough Council and University College Hospital, in force since January 1st, 1928. 2. At Birth. A subsidy is paid by the Borough Council to certain hospitals in connection with the admission of necessitous cases to their maternity wards, A subsidy is also paid in connection with certain eases attended at home by midwives on the staff of various hospitals and institutions. The provision by the Borough Council of Consultants' services, bacteriological investigation and skilled nurs ng in connection with cases developing Puerperal Fever or Puerperal Pyrexia. Hospital accommodation is also available for these cases. A subsidy is paid by the Borough Council to a Voluntary Committee for the provision of Home Helps. 3. Infants and Young Children. 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 infants and young children by the Council's staff of health visitors, who work (a) from the Town Hall and (6) from the Centres. The provision and maintenance of 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. The provision of a clinic for (ailing mothers and) young children, the expenses being borne partly by municipal and partly by voluntary funds. The provision of a municipal dental clinic. The subsidisation of a Home for ailing young children. The supply of milk, free or at reduced price. The subsidisation of the three voluntary Day Nurseries in the Borough. The payment for the home nursing of sick infants in certain cases. A Centre for Artificial Light treatment. 26 The visiting and supervision of necessitous children under 5 years of age upon discharge from the Borough Poor Law Hospitals. The provision of convalescent home treatment by means of subsidy to voluntary agencies. The above-mentioned activities are dealt with in detail in the following pages. Advice Cards.—Besides the posting of cards of advice to the mothers of all infants whose births have been notified, cards of advice to expectant mothers have been distributed through University College Hospital, Middlesex Hospital, the Maternity Nursing Association, and other agencies. Home Visiting.—The Council's Health Visitors at the Welfare Centres are full-time workers (18 in number1, 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 and one part-time trained worker, not paid by the Council, at the Caversham Road Centre, one part-time trained voluntary (unpaid) worker at the Chalton Street and Grafton Road Centres, and one part-time (untrained) voluntary worker at the Camden Road Centre. 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, and two trained visitors at the Royal Free Hospital. During 1928 the Council's staff at the various Centres made 30,485 visits to 2,862 children, and 2,743 visits to 1,339 expectant mothers ; the trained workers not paid by the Council made 11,656 visits to 601 children, and 449 visits to 235 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. Centre Staff, paid by Council 1339 2743 2862 30485 Trained Centre staff, not paid by Council 235 449 601 11656 Total of all trained workers 1574 3192 3463 42141 Corresponding totals for 5 previous years— 1927 943 2179 3422 39595 1926 1618 3651 4030 48686 1925 2007 4979 4542 55547 1924 1921 4621 4571 53884 1923 2084 4953 5401 52759 Centre. Attendances at Consultations. Visits by Trained Visitors. Consultations. Expectant Mothers. Children. Expectant Mothers. Children. Infants, Expectant Mothers. Number of Visitors. New cases. Total attendances. New cases. Total attendances. Under 1 year. 1-2 years. 2 - 5 years. Total. Under 1 year. 1 - 2 years. 2-5 years. Total. First visits. Total visits. First visits. Total visits. Per month. Total. Per month. Total. Council Staff. Others. St. Pancras School for Mothers- Ampthill Square 118 344 331 10 29 370 3449 1016 870 5335 280 427 598 5146 14 167 2 25 3 - Chalton Street 46 95 174 10 8 192 2477 1021 913 4411 180 433 283 5074 12 149 1 12 2 1(a) North St. Pancras School for Mothers, Queen's Crescent 68 141 333 12 14 359 5080 1819 1335 8234 95 301 491 4710 18 213 1 12 3 — South Highgate Centre — — 85 7 10 102 1506 673 349 2528 38 77 112 1150 8 101 - — 1 — Grafton Road Centre 49 97 191 13 24 228 2569 1047 792 4408 133 343 310 5465 13 160 1 12 2 1(a) Camden Town Centre, Camden Road 191 222 367 39 2 408 4308 1435 1040 6783 295 422 573 4569(b) 21 247 1 12 3 l(c) Argyle Square Centre 17 31 219 15 22 256 2617 626 541 3784 151 289 360 3993 13 161 — - 2 — Caversham Road Centre 148 782 274 7 5 286 4127 697 638 5462 184 605 356 5873 12 142 4 48 2 2(d) University College Hospital, Gower Street 1048 4030 - - - 774 — — — 3784 — — 223 5526 18 206 18 208 — 2 Royal Free Hospital, Gray's Inn Road 323 1251 — — — 172 566 245 264 1075 218 290 157 635 12 151 12 151 - 2 Totals 2008 6993 — — — 3147 — - - 45804 1574 3192 3463 42141 141 1697 40 480 18 9 (a) Part-time trained visitor, (b) Exclusive of 403 visits by untrained part-time visitors. (c) Part-time untrained visitor. (d) 1 full-time and 1 part-time trained visitor. 28 Maternity and Child Welfare Centres. These are 10 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 one 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 the year. It will be seen that 480 ante-natal consultations were held, the number of expectant mothers was 2,008 and their total attendances were 6,993. For the two previous years the total attendances were 6,685 and 6,822. The number of consultations for children was 1,697, the children who attended for the first time numbered 3,147, and the total attendances were 45,801. For the two previous years the total attendances of children were 44,098 and 47,735. Particulars concerning some of the special activities of the individual Centres are given in the following paragraphs : — St. Pancras School for Mothers, 1, Ampthill Square. In addition to the consultations provided by the Council, other activities of this centre include the following: — Classes for Mothers. At infant care classes there were 600 attendances; ante-natal care, 211 attendances; and at needlework, etc., classes, 527 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,307 dinners were supplied to nursing and expectant mothers, and 2,289 to young children. Observation Bay Nursery. This is for children needing special care. There were 1,685 attendances during the year, of which 933 were made by infants under one year of age, and 752 by children over one year. Interviews with parents (other than already recorded) numbered 5,791. Dental Clinic. This is provided out of funds from voluntary sources. The Dental Surgeon is Mr. George Thomson, L.D.S. During the year 43 consultations were held, at which 287 treatments were provided for mothers and 251 for children. Details of the work done are given in the following table:— Mothers. Children. Extractions with anæsthetics 50 25 „ without anaesthetics — 7 Fillings 48 121 Scalings 17 — Impressions and fitting dentures, etc. 113 — Examinations and advice 59 98 Totals 287 251 538 29 A Post-natal Clinic (voluntary) was initiated during the year, but the attendances were not satisfactory, and for the present it has been discontinued. Chalton Street Centre. The additional activities of this Centre included the provision of knitting and needlework classes at which 312 attendances were recorded. Interviews with parents numbered 3,125: these are in addition to the work recorded in the table on page 27. Norih St. Pancras School for Mothers, Queen's Crescent. During the year 23 voluntary consultations for older children were held by Dr. J. Finch Haines. The new cases at these consultations numbered 15 and the attendances 654. Health Talks and Cookery Demonstrations were held, 283 attendances being recorded. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 3,110. 23 children attending this Centre were referred for Artificial Light treatment, and 10 for Massage to the Almeric Paget Institute, a Voluntary Society whose premises are at 14, Rochford Street, which is near the Centre. Grafton Road Centre. 12 voluntary consultations were held during the year, the Medical Officer being Dr. Richard H. Wace. 63 dinners were supplied to nursing and expectant mothers. 17 mothers and 20 children were sent away for convalescence, Camden Road Centre. 38 mothers and 47 children in need of a change were sent to the country or seaside for a holiday. The Camden Road, and Oakley Square Centres were amalgamated in 1927, and since then the combination has been known as the Camden Town Centre. The Oakley Square Centre was originated by the Committee of the Maternity Nursing Association and its activities were then limited to the children of mothers who were attended in their confinements by the staff of that Association. Since 1918, when the Maternity and Child Welfare Act came into force, the Borough Council has defrayed the cost of the consultation fees of the Medical Officers and the salaries of the Health Visitors, but the staff of the Maternity Nursing Association has continued to assist in the work. Prior to the amalgamation, in fact, the staff of the Association were present at the Ante-natal Consultations to the exclusion of the Council's staff. Since the amalgamation this anomaly no longer exists, neither are the Ante-natal Consultations limited to mothers who are to be attended by the staff of the Association, but any mother living in the area can attend, and also any child residing in the area can attend the Infant Consultations. This Centre is in fact identical with the others, a Borough Conneil Centre working in association with a Voluntary Committee. 30 Argyle Square Centre. Sewing classes were held at which the attendances numbered 232. A special Consultation for Toddlers is held monthly, the total attendances being 235. Caversham Road Center. In addition to the consultations provided by the Council, a number of others have been held, the cost of which has been defrayed out of funds from voluntary sources. The services of two qualified Health Visitors (one full-time and one part-time) was also provided from the same fund. Two temporary qualified Health Visitors were also employed for a period of three weeks. Classes were held in a number of subjects, the attendances being as follows:—Needlework 644, Child Study 183, Hygiene 106, Mothercraft 280. Holidays of two weeks duration were provided for 32 families during the year. Alterations in Staff and Procedure during the Year. (a) Dr. Albert Clarke was appointed as Medical Officer in charge of the Ante-natal Clinic at the St. Pancras School for Mothers, Ampthill Square, in the place of Dr. M. J. Pirret, who resigned this appointment. (b) In order that the situation of the Centres should be better known to the public, a circular was issued during the year by the Minister of Health, stating that instructions had been issued to the Postmasters of Crown Post Offices authorising the exhibition on the Official Notice Boards of lists giving the names and addresses of the Ante-natal and Child Welfare Centres. Printed lists giving the necessary information were therefore prepared and and distributed to the Head, Branch and Sub-Offices in the Borougb. (c) The Council also approved a resolution passed by the Maternity and Child Welfare Sub-Committee for the provision of overalls and caps to be worn by the Health Visitors when on duty at the Centres. (b) Certain changes were made with reference to the grants of milk which are made to mothers and children. At the request of the Minister of Health, the scale of income on which grants are based was altered slightly in accordance with the fall in the index figure of the cost of living. The Council also decided that, as from the 1st August, 1928, milk retailers supplying milk in connection with the Council's maternity and child welfare service be required to allow a discount of 7½ per cent. off the prevailing retail prices where the monthly accounts are in excess of £2, and that only those retailers agreeing to this arrangement should be given orders to supply milk. A communication was received from the Minister of Health, stating that the decision of the Council in this matter has been noted with satisfaction (see also page 36). Artificial Light Treatment. The clinic maintained by the Borough Council for the provision of this form of treatment was in regular use throughout the year, except for a period of about two months during the middle of the summer. Consultations were held on three days in each week, the average number of patients at each consultation being 41, as compared with 19 during the previous year. 31 The consultations were in abeyance during July and August as the treatment rooms become very hot at this period, and also because the more valuable natural sunlight is available at this time and can be utilised and enjoyed in the various open spaces in the Borough, combined with the beneficial effects of fresh air. During recent years the subject of treatment by Artificial Light has received much attention, both from the public and the press, but, unfortunately, very exaggerated claims have been made on its behalf. The value of "light" treatment in suitable cases is not questioned, but the expenditure of large sums of money on the indiscriminate multiplication of "light" clinics for the merely palliative treatment of certain diseased or defective conditions should not be regarded as a substitute for the more important duty of removing the causes of those conditions. The tendency to adopt this incorrect attitude appears to be particularly marked in connection with artificial light. This form of treatment has a tonic effect on persons, especially children, who are suffering from the effects of overcrowding, lack of fresh air, unsuitable or insufficient food, etc. The treatment is popular and appeals to the imagination, but the appropriate procedure in these cases would be, not to give mere temporary beuefit by light treatment, but to utilise the money for dealing with the conditions which are responsible for the ill effects. Staff, Equipment and Statistics for 1928. The clinic for providing this treatment was opened in February, 1925. The patients are selected by the Medical Officers of the various Welfare Centres from the children who are in attendance under their care. Medical practitioners can also recommend suitable St. Pancras cases. The treatment is free, the cost being defrayed by the Borough Council. Three Consultations, each of two hours duration, are held weekly. Staff.—The Medical Officer carrying out the treatment is Dr. William Beaumont, m.k.c.s., i.-R.c.p. The Superintendent of the Centre is Miss G. R Bristow, who is assisted at the consultations by two Health Visitors from other Centres. Lamps, etc.—Three in number: 1 Westminster Single Arc Lamp, 2 Alpine Sun Four Arc Lamps. The current is direct, and voltage at main 220. Cases treated.—The total number of cases treated during the year was 187. The number of new patients was 115. The total number of attendances was 4,765. The number of Consultations held, 117. Average attendance per Consultation, 41. Average number of attendances per child, 26. Cost. £ s. d. Electric current 7 11 7 Cleaning 8 8 0 Consultation fees 181 2 6 Miscellaneous 13 15 6 £210 17 7 No part of the salary of the Superintendent or Health Visitors is allocated to nor included in the above figures. 32 As compared with the previous year the number of new patients shows a decrease of 39, and the total attendances a decrease of 1,096. In addition to the clinic provided by the Borough Councd, Artificial light treatment is available at the Cromer Street Centre, the Almeric Paget Clinic, Rochford Street, and also at all the General Hospitals in the Borough. Medical Report on the Work of the Artifirial Light Clinic. The following report on the cases treated has been supplied by Dr. Beaumont, the Medical Officer in charge, who is responsible for the opinions expressed :— Sr. Pancras Artificial Sunlight Clinic, Raydon Street, 1928. After the fourth year of treatment, we can confidently say that the light Clinic amply justifies itself and, as an adjunct of the routine treatment, greatly increases the value of Infant Welfare work, especiallv in those cases which make little or no response to ordinary methods. Total number of attendances, 4,765. Number of cases treated, 187. Number of new cases, 115. Number of clinics, 117. Average number of attendances per child, 26. Average number of attendances at each clinic, 41. The following types have been treated:— Rickets, 82. Condition improved, results in some cases slow. Bronchial affections, 36. Marked improvement. Incipient Tuberculosis, 3. Improvement in 2 cases, 1 lost weight and was discharged. Delayed development, 14. Most marked improvement in several cases. Debility and underweight, 30. Results good. Nervous Instability, 10. Improvement in some cases. Depends on the type of mother. Wasting, 2. 1 lapsed and 1 did well. Notes on the cases treated:— Rickets.—(a) Late bony. It is impossible to give any opinion as regards late bony rickets, except to say that cases of marked Genu Valgum or Varium do not show improvement in the condition of the legs. (b) Delayed closing of the anterior fontanelle, i.e., children over 18/12 ; the rapidity with which this closes greatly impresses the mothers. (c) Fat fiabby children with prominent abdomen require extended treatment. While no photographs or measurements are taken, the mothers themselves comment on the better condition of the children. (d) Delayed dentition. There are several cases now attending who had been given vitamins in all its varied forms with no result, who in less than 12 treatments began to cut teeth with marked rapidity. Bronchial affections. (a) Bronchitis associated with teething. It has been repeatedly noticed that after a few treatments the children have cut teeth without Bronchitis. 33 (b) Bronchitis where there is a history of parents suffering from chronic bronchitis. These cases require long treatment and while under treatment are free, but relapse the next winter unless treated. (c) Asthma. Breathing markedly better and attacks less severe. Belayed development. Where cause is unknown, but where there is no evidence of mental deficiency. Seven of these cases did very well, the remainder did indifferently. Underweight. Of the 30 children who were sent up and were underweight on admission, it was found that those children improved in weight if they attended regularly. All had had Cod Liver Oil and Malt, Vitmar and Virol, and had failed to reach the normal weight until Sunlight treatment was given. This improvement in weight, which has been carefully checked, is one of the most outstanding features of the treatment when it is correctly given. One interesting point is that the older children (above two years) gain more in proportion than the younger. Nervous Instability. Children of this type improve probably because of the improvement in sleeping, one of the universal features of the treatment. Children who have attended regularly have almost without exception benefitted considerably; several cases have changed almost beyond recognition. The unsuccessful cases are those whose mothers have tired after two or three weeks and have attended irregularly; in most of these cases it is found that the children have attended the Welfare Centres irregularly and have been in other ways unsatisfactory— unfortunately, in these cases, too often the treatment has been blamed for slow improvement. During the year there has been a decrease in attendance on the previous year, although the attendance numbers equal 1926, but certain factors must be taken into consideration. (a) Measles epidemic of Spring 1928. (b) The fine Summer of 1928 resulted in healthier children in the Autumn and early W inter. (c) During the Summer months when the Clinic is closed the Centres send their children to other Clinics now available. (d) 1928 is the first year where the numbers were limited by the Ministry of Health. It is the considered opinion of the Staff, from constant observations and intimacy with the mothers, that Sunlight is an invaluable addition to ordinary forms of treatment and there is at present no form of treatment to take its place. The Borough Council's Dental Clinic, 40, Argyle Square. At this clinic dental treatment is provided, under the Maternity and Child Welfare Scheme, for nursing or expectant mothers and children under five years of age who are in attendance at the various Welfare Centres. Consultations are held every Monday and Wednesday in the afternoon, and on alternate Fridays in the morning. 34 No charge is made for extractions, fillings or scaling, but the patients 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 lor the previous year also being given for comparison:— Work carried out at the Dental Clinic. 1928. 1927. Number of new cases Mothers Children 212 251 240 178 Total 463 418 For extractions under nitrous oxide (gas) 315 347 Number ,, ,, local anæsthesia 61 140 of ,, fillings and dressings 377 318 ,, scaling 38 42 Attendances ,, impressions and fittiug dentures 469 465 ,, examination and advice 540 610 Total attendances 1800 1922 Total number of clinics held 111 114 Number of clinics with nitrous oxide anæsthesia 23 25 The following table shows the number and cost of the dentures supplied during the year:— Number of Patients supplied with dentures 83. Total cost £270 0s. 0d. Amount paid by mothers £165 19s. 6d. Amount paid by Borough Council £26 5s. 0d. Amount paid by various Societies £77 15s. 6d. 16 mothers paid the entire cost of two dentures each. 19 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, £28 0s. Od.; the Metropolitan Hospital Saturday Fund, £7 14s. Od.; the Charity Organisation Society, £34 4s. 6d.; and various other societies, £7 17s. 0d. The general supervision of the work, arranging appointments, recording attendances and the collection of contributions, etc., is carried out by Miss M. E. Bibby, 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. 35 Day Nurseries. The Council assists 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. Particulars in regard to the day nurseries for the year ended 31st March, 1929, are as follows:— Grant paid by Borough Council. No. of Days Open. Attendances. Average per Day. £ s. d. Whitefield Day Nursery 142 8 6 225 6387 28.4 Kentish Tn. Day Nursery 144 0 8 227 7430 32.7 Margaret Day Nursery 133 10 5 237 4555 19.2 With the approval of the Minister of Health, the Council also made a contribution of £500 to the building fund of the Margaret Day Nursery. The work carried out by the Committee of this Nursery is so successful and so much appreciated that there is urgent need for more convenient and larger premises. Clinic for Ailing 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 1928, new cases under five years of age numbered 113, ailing mothers 39, and expectant mothers (new cases) 72. The total attendances at this clinic were 402 of children under five, 90 of ailing mothers, and 153 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, 691; attendances, 1,741; ailing mothers and expectant mothers: new cases, 49; attendances, 112. The Medical Officer of this Special Clinic is paid by the Borough Council. He is assisted by a Nurse (part-time), the cost of whose services is defrayed as to one-half by the Committee of the St. Pancras Dispensary and the other half by the Committee of the Mayoress' Home. During the year the Nurse made 932 visits to the homes of children under five. The Dispensary Resident Medical Officer also made 1,119 home visits to sick children under five years of age. The cost of the other work of the Dispensary amongst women and children is defrayed out of funds from voluntary sources, and is also subsidised by the Ministry of Health. 36 Convalescent Home Treatment. (a) The Mayoress of St. Pancras Home for Sick Poor Children.—This is situated at "Avalon," 1, St. Alban's Road, and accommodates 18 children and the necessary staff. The Borough Council makes an annual grant of £350. The age limit for admission is from 18 months to 5 years. The children are either convalescent after illness, or are weak, badly nourished, etc., and require good food, fresh air, and special care. A large garden is attached to the home and an outdoor playroom has been provided by St. Pancras Branch of the Dickens Fellowship. The staff consists of a Matron, Assistant Matron, 3 Probationers and a domestic staff numbering 3. A laundry, equipped with electrically-driven machinery, is also attached to the home. Six children were in residence at the beginning of the year and 165 were admitted during the year. The average length of stay in the Home was 28 days. (b) Children requiring a longer period of convalescence, or who require more skilled nursing are sent to various homes by the Invalid Children's Aid Association,and a contribution towards the cost is made by the Borough Council. Under this scheme 36 children were sent away during the year. Supply of Milk to Mothers and Children. The Council during 1928 continued to make grants of milk, either free or at halfprice. As a rule, in the case of expectant mothers, the grants were restricted to the last three months of pregnancy, and in the case of children to those who were under three years of age. The extent of the distribution of milk in 1928 is shown in the following figures:— Pints of Milk Granted Free. Pints of Milk Granted Half-price. Cost to Council. 1928. £ s. d. January 7620 799 125 11 10 February 8261 762 134 3 4 March 8430 847 137 19 2 April 6582 740 93 18 3 May 5715 1124 85 11 9 June 4897 1111 73 18 0 July 5684 1241 86 7 9 August 5264 1340 81 13 3 September 5194 1007 77 0 0 October 5356 1164 92 10 0 November 5529 1117 94 5 0 December 6212 915 103 5 0 Totals 74744 12167 1186 3 4 37 At the end of 1927 there were 203 families in receipt of milk through the Council's scheme. 233 new families were added to the list of recipients during 1928, and at the end of 1928 there were 156 actually in receipt of milk. As will be seen from the table above, there were supplied in 1928, 74,744 pints of milk free and 12,167 pints at half-price, at a cost (o the Council of £1,186 3s. 4d., half of which sum is repayable by the Ministry of Health. This figure does not include the cost of administration. The Council passed a resolution in July that 7½ per cent. be deducted from the accounts of all dairymen supplying milk under the Scheme if of the value of £2 or over monthly. The effect of this has been to reduce the cost of milk during the last four months of the year by about 2 per cent. The net figures for these months appear in the above table. Inquiries were made by the Women Sanitary Inspectors and Health Visitors, if there was any doubt as to the circumstances of the family. The scale in use in making the grants is based on weekly income and was drawn up by the Council in 1922. It was discontinued in April, 1928, and a new scale brought into use in consequence of a recommendation by the Minister of Health that the scale should be brought into accord with the fall in the index figure of the cost of living. The previous and the revised income scales are shown hereunder:— Number in Family. After Deduction of Rent. Free. Half-Price. Previous scale. New scale. Previous scale. New scale. £ s. d. £ s. d. £ s. d. £ s. d. One 0 13 0 0 12 0 0 15 0 0 13 9 Two 1 0 0 0 18 3 1 5 0 1 3 0 Three 1 4 0 1 2 0 1 10 0 1 7 6 Four 1 8 0 1 5 6 1 14 0 1 11 3 Five 1 12 6 1 10 0 2 0 0 1 16 6 Six 1 16 0 1 13 0 2 5 0 2 1 3 Seven 2 0 0 1 16 6 2 10 0 2 5 9 Eight 2 4 0 2 0 0 2 15 0 2 10 3 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. Public Health Officers of the Local Authority. A complete list of the above, including both whole and part time officers, is given on pages 6 and 7. The undermentioned changes in the staff occurred during the year:—Dr. M. J. Pirret resigned her appointment as Medical Officer in charge of the Ante-natal Clinic at Ampthill Square Centre. Dr. Albert J. Clarke appointed to the above position. Mr. E. W inchester was appointed Sanitary Inspector on May 25th. Professional Nursing in Necessitous Homes. This is provided by the Staff of the following District Nursing Associations : Central St. Pancras, Hampstead, Metropolitan, and North London. 38 The whole of the area undertaken by the Central St. Pancras Association is included within the Borough, and large portions of the areas of the other three Associations. The Borough Council has an arrangement with all the above Associations for the Home Nursing, at the request of the medical practitioner in attendance, of cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Pemphigus Neonatorum, Infective Enteritis, Acute Primary and Acute Influenzal Pneumonia. Arrangements are also in force with the Central St. Pancras and Metropolitan District Associations for the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. A uniform fee of Is. 6d. per visit is paid by the Borough Council. The following table gives the number of cases and number of visits during the past year:— District Nursing Association. No. of cases. No. of visits. Average No. of visits per case. Central St. Pancras 64 811 12.7 Metropolitan 59 655 11.1 Hamps'ead 21 301 14.3 North London 20 313 15.9 Total 164 20?5 12.7 Home Helps. This term is used to describe women who have received a certain amount of training in domestic work, including the care of young children. They are provided for necessitous families where the mother is incapacitated on account of sickness or child-birth. The management is in the hands of a Voluntary Committee, on which the Council is represented by two members. An annual grant of £150 is made by the Borough Council for use in respect of maternity cases only. Two permanent "Helps" were employed throughout the greater part of the year, and eight temporary "Helps" for emergency cases. Fifty cases were dealt with during the year, 43 being maternity and 7 sickness cases. The services rendered by the "Home Helps" are very valuable, and the work of the Committee very efficient. Midwives. In the Metropolis, the supervising authority for midwives is the London County Council. According to figures supplied by that authority, the number of midwives who, in 1928, had notified their intention to practise in St. Pancras was 32. Only 8 of this number are engaged in private practice, the remainder are on the staff of various hospitals and institutions in the Borough. Private midwives are not subsidised by the Borough Council, but a subsidy is paid for each approved necessitous case attended in the patient's home by midwives on the staff of certain hospitals and by midwives employed by the Maternity Nursing Association. The subsidy is not paid in cases where "Maternity benefit" is payable under the National Health Insurance Act. 39 Midwifery. There are a large number of institutions, situated either within or near the Borough, which provide midwifery attendance either at the patient's home or by admission as in-patients. In the following table particulars are given, for 1928, with reference to all St. Pancras women who were attended in their confinements by the staff of the various institutions :— Institution. Admitted as In-patients. Attended at Home. By Students. By Midwives. University College Hospital 358 459 135 Royal Free Hospital 118 15 14 Elizabeth Garrett Anderson Hospital 9 *126 .. St. Pancras Hospital 209 „ 1 Middlesex Hospital 87 „ 37 Queen Charlotte's Hospital 157 „ .. City of London Hospital 53 „ .. Royal Northern Hospital 26 .. .. St. Bartholomew's Hospital . . 5 .. Other hospitals 106 .. .. Queen Mary's Maternity Home 54 . . .. Maternity Nursing Association .. .. 342 Totals 1177 605 529 * Attended by qualified staff. Tt will be seen from the above table that full use is made of the institutional facilities which are available. The cases admitted as in-patients represented 35 per cent. and those attended at home 36 per cent. of the total number of St. Pancras births. As compared with the previous year there was a decrease in the number of cases attended at home and an increase in the number of those admitted as in-patients. The Borough Council pays a subsidy to certain hospitals for the admission of cases to their maternity wards, and also pays a subsidy for cases attended at home by midwives on the staff of certain institutions. No subsidy is paid for cases attended by medical students. The following table gives the names of the hospitals, etc., and the amount paid during the past year:— £ s. d. Royal Free Hospital 8 0 0 Elizabeth Garrett Anderson Hospital 2 5 0 Queen Charlotte's Hospital 51 0 0 City of London Hospital 25 0 0 Middlesex Hospital 20 15 0 University College Hospital 124 15 0 Maternity Nursing Association 3 0 0 Total £234 15 0 The corresponding grants for the previous three years were: £264 5s. Od., £216 5s. Od. and £275 10s. 0d. 40 Maternity and Nursing Homes. The Nursing Homes Registration Act, 1927, came into force on 1st July, 1928. Although, as regards the County of London, the London County Council was made the local supervising authority, power was given to delegate all or any of the duties to the Metropolitan Boroughs, other than the power to make by-laws. Representations were made to the London County Council, stating that on grounds of efficiency, economy, and the avoidance of overlapping, the Metropolitan Boroughs should have delegated to them all the powers under the Act, other than the power to make by-laws. The London County Council did not accede to the representation. Maternal Mortality. Six deaths occurred during the year either "in or in consequence of" childbirth, giving a Maternal death rate of 1.8 per 1000 live births. Considerable attention was given to this subject during the year, not only by the Ministry of Health, Maternity and Child Welfare Authorities, Medical Practitioners, etc., but also by the general public. In June a circular was issued by the Minister of Health to all Maternity and Child Welfare Authorities, stating that it was desirable that there should be an investigation in every area by a competent and experienced Medical Officer of all Maternal deaths and of all cases of Puerperal Fever, with a view to ascertaining more exactly the actual causes which lead to Maternal Mortality, in order to provide further means of prevention. The Minister also set up a representative Maternal Mortality Committee, whose duties included the consideration of the scope of the investigations to be made, and the collation and classification of the information obtained. A form of inquiry was subsequently drawn up by the Committee to serve as a guide in making investigations. Normally these inquiries, which are somewhat detailed, are undertaken by the Medical Officer of Health or by the Assistant Medical Officer, but in cases where it is considered desirable investigations can be referred to either of the two consulting Obstetric Surgeons who have been appointed by the Borough Council. The popular interpretation of the meaning of the term "Maternal Mortality in Childbirth,'' is the risk incidental to an average full time confinement, and this meaning is emphasized by the fact that the rate is always expressed as so many deaths per 1000 live births. Attention should be directed to the fact that official statistics with reference to Maternal deaths include, not only the deaths incidental to full time pregnancies, but also the deaths resulting from Abortions, Ectopic pregnancies, and other affections and accidents incidental to pregnancy in its early stages. As the rate is expressed as so many deaths per 1,000 live births, the inclusion of deaths arising in consequence of abortions, etc., unduly swells the maternal mortality rate. It should also be pointed out that many cases of Sepsis and other fatalities associated with abortion, etc., are not normal risks of pregnancy, as they are frequently induced by deliberate interference, due to a desire to terminate an unwanted pregnancy, and as a result of this many of these cases are the subjects of Coroner's Inquests or Post-mortem investigation. It would appear to be desirable that, in order to obtain satisfactory statistics with reference to maternal mortality in childbirth, the cases mentioned above should be excluded, as they cannot be regarded as part of the ordinary risk associated with childbirth. It would 41 be necessary to keep a separate record of deaths following abortion, a practice which is to some extent adopted in Germany, where cases of Post-parturn Sepsis and Post-abortum Sepsis are separately recorded. The following table which gives details concerning Maternal deaths in St. Pancras during the past four years, illustrates the points to which attention has beeu directed. 1925. Full time Confinements. Abortions, etc. Totals. No. of Inquests or Postmortem investigations. Mortality Rate. Total. Excluding Abortions, etc. Deaths from— Sepsis 2 4 6 3 2.8 1.8 Other causes 5 — 5 2 Totals 7 4 11 5 1926. Sepsis 1 2 3 3 2.8 2.2 Other causes 7 - 7 1 Totals 8 2 10 4 1927. Sepsis 4 2 6 4 2.7 2.1 Other causes . . 3 — 3 — Totals 7 2 9 4 1928. Sepsis 1 2 3 3 1.8 1.2 Other causes 3 — 3 2 Totals 4 2 6 5 A minor source of uncertainty with reference to these statistics arises from the fact that the term "Maternal Mortality" is not recognised as a technical definition by the RegistrarGeneral. That official classifies each death according to the information contained in the medical certificate, and, where this gives contributory or alternative causes, rules of selection based on international usage are followed. It is possible that in the interpretation of these rules some difference of opinion may occur, and therefore statistics compiled by a local authority with reference to their area may not a''ree entirely with those compiled in the office of the Registrar-General, but variations due to this cause are probably slight. This subject is also considered under the heading "Puerperal Fever," page 73. 42 Legislation in Force. A. —Local Acta, By Laws, and Regulations in force in the Borough: — 1. St. Pancras (Measles and German Meas'ea) Regulations, 1920. 2. By-laws made by the Borough Council: — (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or tilth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. (c) For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. (d) As to the paving of yards and open spaces in connection with a dwelling house. (e) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (f) With respect to the keeping of waterclosets supplied with sufficient water for their effective action. (g) Mortuaries. 3. Regulations concerning the use of Post-mortem rooms. 4. By-laws and Regulations made by the London County Council, but enforced by the Borough Council:— (a) Drainage by-laws and deposit of drainage plans. (b) Closing and filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of faecal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc. ( j) Offensive trades. (k) Rag and bone dealers. (l) Humane slaughtering of animals and poultry. (m) Demolition of buildings. (n) Ice cream vendors and premises. 5. London County Council (General Powers) Acts, 1893-1928. 43 B.—Public Health Legislation either enacted or coming into force during 1928:— Public Health (Condensed Milk) Amendment Regulations. Public Health (Dried Milk) Amendment Regulations. The above-mentioned regulations arc primarily designed to secure that in the labelling of condensed and dried skimmed milks greater prominence shall be given to the words " Unfit for Babies," and that those words shall also be printed on the outside of any paper or other wrapper in which tins of such milk may be enclosed. Infectious Diseases (London) Regulations, 1927. These came into force on 1st January, 1928, and deal with malaria, dysentery, acute primary pneumonia, acutc influenzal pneumonia, typhus fever, relapsing fever and enteric fever. London County Council (General Powers) Act, 1928. The above Act, which received the Royal assent on 3rd August, contains a number of sections dealing with Public Health. Sections 19 to 23 deal with disused drains, and require Owners or Occupiers of premises to give notice in writing to the Local Authority of the existence of such drains. Section 25 provides that a person having charge or control of premises in which is lying the body of a person who has died from any notifiable infectious disease shall take such steps as may be reasonably practicable to prevent persons coming into contact with the body unnecessarily under a penalty. Section 28 enables the Sanitary Authority, on a report from the Medical Officer of Health, to apply to a Petty Sessional Court for an order for the removal of a verminous person to a cleansing station. Section 27 empowers the Medical Officer to apply for a warrant to enter any common lodging house within the district, in which he believes there is a person who is suffering or has recently suffered Irom a notifiable infectious disease, for the purpose of examining the inmates. Section 28 authorises the removal to a home or institution of certain aged, diseased or infirm persons living under insanitary conditions. A formal resolution by the Council is required authorising the Medical Officer of Health to take the necessary action in such cases as may be found desirable. The powers given by the above section are useful, and proceedings were taken during the year with reference to an infirm and physically incapacitated woman, 84 years of age, who was living alone in a room which was insanitary owing to her neglect. The Medical Officer of Health attended the Court with the Inspector and the Relieving Officer, and gave evidence. The Order was granted, and the woman was removed to the St. Pancras Hospital. This was the first case to be taken, in the Metropolis, under this Act. Section 29 provides for the registration of premises used or proposed to be used for the purpose of the sale, manufacture or storage of ice cream or other similar commodity with the Sanitary Authority, and that no premises shall be used for these purposes unless registered. Penalties are laid down for offences against the provisions of this section. The section will not affect premises used as an hotel, restaurant or club, nor a factory or workshop where notice is require 1 by sub-section (1) of Section 127 of the Factory and Workshop Act, 1901. 42 Legislation in Force. A.—Local Acta, By Laws, and Regulations in force in the Borough: — 1. St. Pancras (Measles and German Meas'es) Regulations, 1920. 2. By-laws made by the Borough Council: — (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. (c) For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. (d) As to the paving of yards and open spaces in connection with a dwelling house. (e) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (f) With respect to the keeping of waterclosets supplied with sufficient water for their effective action. (g) Mortuaries. 3. Regulations concerning the use of Post-mortem rooms. 4. By-laws and Regulations made by the London County Council, but enforced by the Borough Council:— (a) Drainage by-laws and deposit of drainage plans. (b) Closing and filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of fæcal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc. (j) Offensive trades. (k) Rag and bone dealers. (l) Humane slaughtering of animals and poultry. (m) Demolition of buildings. (n) Ice cream vendors and premises. 5. London County Council (General Powers) Acts, 1893-1928. 13 B.—Public Health Legislation either enacted or coming into force during 1928:— Public Health (Condensed Milk) Amendment Regulations. Public Health (Dried Mi:k) Amendment. Regulations. The above-mentioned regulations are primarily designed to secure that in the labelling of condensed and dried skimmed milks greater prominence shall be given to the words " Unfit for Babies," and that those words shall also be printed on the outside of any paper or other wrapper in which tins of such milk may be enclosed. Infectious Diseases (London) Regulations, 1927. These came into force on 1st January, 1928, and deal with malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, typhus fever, relapsing fever and enteric fever. London County Council (General Powers) Act, 1928. The above Act, which received the Royal assent on 3rd August, contains a number of sections dealing with Public Health. Sections 19 to 23 deal with disused drains, and require Owners or Occupiers of premises to give notice in writing to the Local Authority of the existence of such drains. Section 25 provides that a person having charge or control of premises in which is lying the body of a person who has died from any notifiable infectious disease shall take such steps as may be reasonably practicable to prevent persons coming into contact with the body unnecessarily under a penalty. Section 26 enables the Sanitary Authority, on a report from the Medical Officer of Health, to apply to a Petty Sessional Court for an order for the removal of a verminous person to a cleansing station. Section 27 empowers the Medical Officer to apply for a warrant to enter any common lodging house within the district, in which he believes there is a person who is suffering or has recently suffered trom a notifiable infectious disease, for the purpose of examining the inmates. Section 28 authorises the removal to a home or institution of certain aged, diseased or infirm persons living under insanitary conditions. A formal resolution by the Council is required authorising the Medical Officer of Health to take the necessary action in such cases as may be found desirable. The powers given by the above section are useful, and proceedings were taken during the year with reference to an infirm and physically incapacitated woman, 81 years of age, who was living alone in a room which was insanitary owing to her neglect. The Medical Officer of Health attended the Court with the Inspector and the Relieving Officer, and gave evidence. The Order was granted, and the woman was removed to the St. Pancras Hospital. This was the first case to be taken, in the Metropolis, under this Act. Section 29 provides for the registration of premises used or proposed to be used for the purpose of the sale, manufacture or storage of ice cream or other similar commodity with the Sanitary Authority, and that no premises shall be used for these purposes unless registered. Penalties are laid down for offences against the provisions of this section. The section will not affect premises used as an hotel, restaurant or club, nor a factory or workshop where notice is require 1 by sub-section (I) of Section 127 of the Factory and Workshop Act, 1901. 40 In connection with new houses, 25 certificates were issued under Section 48 (2) of the Public Health (London) Act, to the effect that a proper and sufficient supply of water for sanitary and domestic purposes had been provided. An additional supply of water was furnished to the upper floors of 220 tenement houses under powers contained in Section 78 of the London County Council (General Powers) Act, 1907. DRAINAGE. 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 carried out:— Inspections. Drainage work done under notice 3352 Voluntary drainage work 5752 Drains of new buildings 2146 Total 11250 Drainage Register.—The following is an analysis of the Drainage Register during 1928:— Plans deposited—Old Buildings under Notice 108 ,, „ Old Buildings, Voluntary 273 ,, „ New Buildings and Additions 35 416 Applications without Plans 302 Total number of Applications and Plans 718 Refuse Collection and Disposal. A.—A weekly collection is made in ail parts of the Borough with the exception of Wards 2 and 6, in which a collection is made twice weekly during the summer months. The use of Pagefield trucks, first introduced in 1925, has very much facilitated this work. B. — The methods of refuse disposal are:— (a) By combustion in the Destructor. (b) Removal to the country by rail or barge. The following figures for the past year, kindly supplied by Mr. E. W. Swinstead, m.I.m. & Y. f., the Borough Engineer, give some idea of the enormous amount of refuse to be dealt with :— Tons. Cwts. Quantity of refuse collected 56800 3 Quantity of refuse burnt at Destructor 33535 13 Quantity put on rail 23539 9 Quantity of clinker residual 12497 10 47 The quantity of refuse to be disposed of has increased during recent years, and is still increasing, owing to the more extended use of gas and electric cookers. When kitchen ranges were more generally used it was possible to burn a considerable amount of refuse. MORTUARY. This is situated in Cambridge Street, N.W. 1. As a result of the improvements which have been carried out, this is now a satisfactory and well-equipped building. The following table gives particidars concerning the number of inquests held, number of bodies received and post-mortem examinations made during the year. Male. Female. Total. Number of inquests held 158 105 263 „ bodies received 145 98 243 ,, post-mortem examinations 105 73 178 SANITARY INSPECTION OF THE AREA. Inspections.—77,545 visits and inspections were made in 1928 by the Council's stall of Inspectors and Health Visitors. Of these inspections, 44,675 were made by the District Sanitary Inspectors, 10,034 by the Inspectors of Food and Food places, 3,722 by the Inspector of Factories and Workshops, and 19,114 by the Women Sanitary Inspectors and Health Visitors. The inspections dealt with above are exclusive of the visits made by the Council's staff at the Maternity and Child Welfare Centres (see page 27), and by the staff of the Tuberculosis Dispensaries (see page 86) ; nor do they include the work of the disinfecting staff, particulars of whose work are given on pages 87 and 88. Notices served.—4,167 intimation notices were served by the Inspectors during the year. Of t,hes3 3,888 were served by the District Sanitary Inspectors, 241 by the Factory and Workshop Inspector, 27 by the Food Inspectors, and 11 by the Women Sanitary Inspectors. 1,906 Statutory notices were served for non-compliance with certain of the above intimation notices. Details of the work performed by the various Inspectors and Health Visitors will be found in Tables 6, 7 and 8 on pages 98-100. The following prosecutions were undertaken during the year in respect of general sanitary work :— 48 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 38, Litcham Street Insufficient water-closet accommodation Jau. 19th Withdrawn-notice complied with. Costa £3 3s. 43, Carlton Street Occupied house without a proper and sufficient supply of water Feb. 16th ,, ,, Costs £4 6s. 63, Chalion Street Insufficient water-closet accommodation Ceilings top room and staircase damp and roof and guttering defective „ 16th... „ 27th.. ,, ,, Costs £1 3s. Order 14 days—costs £2 10s. 9, Litcham Street Absence of a proper portable metal dustbin May 1st Fined £2. ,, Insufficient water-closet accommodation ,, 1st Fined £2. 10, Litcham Street ,, ,, ,, 1st Fined £2. 17, ,, Absence of a proper portable metal dustbin „ 1st Fined £2. ,, Insufficient water-closet accommodation 1st Fined £2 ,, Roof defective ,, 1st Order 14 days. 19, Litcham Street ,, ,, 1st ,, ,, Absence of a proper portable metal dustbin ,, 1st Fined £2. 77, Chalton Street Occupied house without a proper and sufficient supply of water upstairs 23rd Order 14 days—Coats £1 3s. 8, Leighton Grove Space below floor unventilated and flooring defective June 12th Costs £1 1s. 60, Marquis Road 114, Seymour Street Drain defective Offensive accumulation in yard „ 13th „ 13th Order 28 days—Costs £1 3s. Order 10 days—Costs £1 3s. 62, Arlington Road Basement room damp ,, 21st Order 21 days. 78, Caversham Road Walls and ceiling of room dirty and guttering defective ,, 26th Withdrawn—work carried out, Costs £1 5s. 239, Arlington Road Insufficient water closet accommodation „ 21st Adjourned sine-die. 12, Wellesley Road Room dirty and roof of house and water-closet defective July 19th Order 21 days. 45, ,, Roof, fresh air inlet and rain water pipe defective—also offensive accumulation in back addition room „ 19th Order 14 days. 8, Leighton Grove Failing to comply with provisions of a nuisance order 31st Fined £1. Costs £2 2s. 6, Chaston Street Defective roof and seat of water-closet „ 19th Fined £2. Costs £1 1s. 8, Leighton Grove Failing to comply with the provisions of a nuisance order Sept. 12th Fined £14. 72, Lulot Street Premises damp, guttering and rain water pipe defective Nov. 12th Fined £1. Costs £2 2s. 311, Gray's Inn Road Failing to provide separate water - closet accommodation for persons of each sex „ 28th Undertaking to carry out work forthwith—Costs £2 2s. 4, Leighton Grove Defective roof Dec. 5 th Order 14 days—Costs £2 6s, In four cases proceedings were taken under the London County Council By-laws for carrying or causing to be carried offensive matters during prohibited hours. Fines were inflicted amounting to £2. London County Council Byelaws—Housing Act, 1025. Situation of Property. Offence.* Date of Hearing of Snmmons. Result of Proceedings. 43, Carlton Street Walls and ceiling of staircase dirty Feb. 16th Withdrawn — notice complied witn. Costs £1 3s. 25. Delancey Street Failing to cleanse walls and ceilings Mar. 22nd Fined £5. Costs £4. 8, Leighton Grove Defective stair tread June 12 th Fined £3. 11, Seymour Street Failing to cleanse walls and ceilings and to repair defective window cords and fittings „ 13th Fined £2. 62, Arlington Road Walls and ceilings of staircase dirty and dilapidated ,, 21st Fined 1s.. Co3ts £3 3s. 12, Wellesley Road Failing to provide efficient means for carrying off waste water July 19th Fined £2. Costs £1 1s. 45, ,, ,, ,, and to cleanse rooms „ 19th Fined £1. Costs £1 1s. 49 Unter the London County Council (General Powers) Act, 1922. Situation of Property Offence. Date of Hearing of Summons. Result of Proceedings. 43, Carlton Stieet Rooms verminous Feb. 10th Withdrawn — notice complied with. Costs £1 3s. 9, Litcham Street ,, May 1st Fined £2. 17, ,, ,, ,, 1st Fined £2. Under the London County Council By-laws made under the Metropolis Management Act. Situation of Property. Offence. Date of Hearing Summons. Result of Proceedings. 52, Fitzroy Road Constructing new water-closet without depositing plans June 12th Plans deposited—summons withdrawn. Costs £2 4s. 10, Bisham Gardens Carrying out sanitary work without giving notice or depositing plans July 12th Fined 10s. Costs £2 2s. 10, ,, Failing to cause a newly-constructed sink waste to discharge in the open air over a properly trapped gulley ,, 12th Withdrawn — by-laws complied with. 46, Wrotham Road Reconstructing a ventilating pipe to a drain without giving notice or depositing plans Dec. 11th Dismissed on payment of costs, £2 2s. SMOKE ABATEMENT. 242 observations of chimney shafts were made during the year and 6 notices were served. There were no prosecutions. The Public Health (Smoke Abatement) Act, 1920, came into force on July 1st, 1927. The term "smoke" is now extended to include soot, ash, grit and gritty particles; the penalties for non-compliance with the Act are increased, and power is given to local authorities to make by-laws regulating the emission of smoke. The Authority for this purpose, for the Metropolis, is the London County Council, but by-laws under this Act have not yet been made. In connection with the above subject, a number of complaints were received during the year with reference to the quantity of dust which was discharged from the works of a firm manufacturing materials for road construction. In consequcncc of representations which were made, the manufacture of the materials concerned has now been transferred to other works in a more isolated situation outside the Borough. FACTORY AND WORKSHOP ACTS. Information concerning the work carried out under the above Acts is given in the following tables in the form required by the Home Secretary:— 50 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Writteu Notices. Prosecutions. (1) (2) (3) (4) Factories • • • • • • 1783 121 — W orkshops .. .. .. 2383 104 — Workplaces premises Report) (other than Outworkers' included in Part 3 of this 980 27 1 Totals 5146 252 1 2.—Defects Found. Number of Defects Number of Prosecutions. Particulars. Pound. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 106 100 — — Want of ventilation 3 3 — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 63 59 — — Sanitary accommodation— Insufficient 6 4 — — Unsuitable or defective 47 43 — — Not separate for sexes 26 16 — 1 Other breaches 29 27 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 78 74 - - Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) - - - - 359 327 - 1 * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 51 3.—Home Work. In certain industries specified in the Act, if work is given out by Employers or Contractors to be done by workers at home, lists containing the names and addresses of such workers must be forwarded to the Local Authority. The object of this is to prevent work being done in premises which are insanitary, or in which infectious disease is present. The following lists were received during the year:—16 in respect of the making, etc., of wearing apparel, comprising the names of 51 outworkers (contractors) and 63 outworkers (workmen), 1 in respect of "upholstering, containing the names of 2 outworkers (workmen), 1 in respect of the making of cardboard boxes, comprising the name of 1 outworker (workman), 1 in respect of the making or filling of Christmas crackers, etc., comprising the names of 14 outworkers (workmen), and 1 in respect of hand embroidery, comprising the names of 28 outworkers (workmen). The following table gives the number and type of outworkers' premises in the Borough and the principal industries concerned:— Nature of Work. Natnre of Premises. Total. Factories. Workshops. Workplaces. Wearing apparel 10 225 241 476 Card boxes — — 5 5 Artificial flowers — — 1 1 Miscellaneous — 7 41 48 Totals 10 232 288 530 52 4.—List of Factories, Workshops [Registered, Sec. 131) and Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 62 91 - 153 Cabinet makers 41 66 — 107 Coach builders 19 20 — 39 Dressmakers 33 121 34 188 Engineers 169 37 - 206 Foundries 13 3 - 16 Furniture makers 8 22 - 30 Furriers 6 19 2 27 Laundries 17 9 3 29 Metal workers 28 37 - 65 Milliners 2 15 2 19 Organ builders Pianoforte manufacturers 7 2 — 9 44 23 — 67 Printing 76 12 — 88 Restaurant kitchens — — 381 381 Tailors 13 348 161 522 Upholsterers 5 42 - 47 Wood carvers 1 19 - 20 Other occupations 503 582 301 1386 Totals 1047 1468 884 3399 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.N. 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 42 Reports (of action taken) sent to H.M. Inspector 42 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 15 Underground bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 86 Bakehouses and restaurant kitchens are also referred to on page 66. 53 6 —Total Inspections. Premses. Male Inspectors. Women Inspectors. Total. Factories 1576 207 1783 Workshops 1682 701 2383 Workplaces (including Outworkers' premises) 464 658 1122 Total 3722 1566 5288 PREMISES AND OCCUPATIONS CONTROLLED BY BY-LAWS OB REGULATIONS. Offensive Trades. One only is carried on in the Borough—a tallow melter. This particular business has been in existence since the year 1780. 37 visits were made to these premises during the year. No complaints have been received, and the business is well conducted. Rag and Bone Dealers. Additional by-laws were made during the year by the London County Council, under powors given by Section 9 of the London County Council (General Powers) Act, 1908. The by-laws provide as follows:— 1—A person carrying on the business of a rag and bone dealer shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy— (a) in or from any part of the premises used for or in connection with his business or (b) in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags, bones, fat, rabbit skins, or other like articles, or (c) in any other way connected with his business. 2—A person carrying on the business of a rag and bone dealer who shall offend against the foregoing by-law shall be liable for every such offence to a penalty of Five Pounds. Provided nevertheless that the Court before whom any information may be laid or any proceedings may be taken in respect of any such offence may if the Court think fit adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by-law. There are 32 premises in the Borough in which the business of a rag and bone dealer is carried on, and special visits were made in order to acquaint the owners with the requirements of the new by-laws. Houses Let in Lodgings. By-laws dealing with these houses, made under power given by Section 6 of the Housing Act, came into force on March 5th, 1926. Particulars concerning the inspections made will be found in Table 6 on page 98. 54 Lighting of Staircases or Tenement Buildings, Tte above provision is required by Section 61 of the London County Council (Gcncral Powers) Act, 1927, which came into force on August 1st, 1928. An inspection was made of all tenement buildings, and in a number of cases either the natural lighting by day or the artificial lighting by night was found to be unsatisfactory. Communications were sent to the owners, and the necessary work has been carried out in all cases. Handrails for Staircases in Model Dwellings. In consequence of inspections it was found that in the case of a certain block of dwellings in the Borough there were short flights of steps without handrails. The attention of the owner was called to the matter, and instructions wore at once given for the fixing of the necessary handrails. Underground Rooms (Housing Act, 1925, Section 18 (1) ). Inconsequence of the shortage of housing accommodation, it was considered inadvisable to take action in connection with The above except in serious cases of overcrowding in rooms which were very bad structurally. Closing Orders were made by the Council in the following cases, either prohibiting the use of the rooms entirely, or prohibiting their use for sleeping purposes:— 30, Chalk Farm Road (2 rooms). 31, Maiden Road (2 rooms). A closing order was also made on the entire premises, 19 Leighton Road, consisting of seven rooms on three floors, under Section 11 of the Housing Act, 1925. See also page 58. Canal Boats Acts. Under the Canal Boats (Amendment) Regulations, 1925, the responsibility for maintaining a canal boat in a habitable condition is now placed upon the owner, instead of the master. During the year Inspector Auger examined 4 canal boats, which were registered for the occupation of 7 adults and 1 child, and were actually occupied by 4 adults and 2 children. A weekly inspection of the canal and wharves has also been made. RENT AND MORTGAGE INTEREST RESTRICTIONS ACT, 1923. During the year 38 applications were received from tenants for certificates under this Act, and in 35 cases certificates were granted, specifying the work required to bo executed to put the houses into a good and tenantable state of repair. In accordance with Section 5 of the Act, 18 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. In 17 cases the "release" certificate was granted. 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 for the purpose of issuing a certificate under the Act was made by an inspector, 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. 55 SCHOOLS. The medical inspection of children in Elementary Schools in St. Pancras is carried out by the London County Council, independently of the Borough Council. The County Medical Officer has kindly furnished me with particulars of medical inspections of schojl children in St. Pancras during 1928. They are classified in the following Tables : — Routine Medical Examination of Elementary School Children in Sr. Pancras, 1928. Defect . Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1546 1613 1278 128 1406 1653 1201 1288 Cases * Cases. * Cases * Cases * Cases * Cases * Cases. * Cases . * Malnutrition 17 17 19 16 10 10 10 10 14 13 19 17 6 6 5 5 Skin disease 20 15 19 11 4 3 3 2 15 8 14 11 7 6 8 8 Defective teeth — 409 — 347 — 191 — 198 — 431 — 359 — 206 — 217 Enlarged tonsils 110 39 92 33 51 13 54 13 127 49 128 38 68 23 46 17 Adenoids 57 32 20 11 5 4 — — 31 13 23 16 3 1 3 3 Tonsils & adenoids 208 125 64 37 14 12 12 10 163 93 60 35 28 12 12 9 Other nose and throat 30 19 15 7 13 8 6 6 20 17 10 9 6 6 5 5 Enlarged glands 144 3 102 4 60 — 33 — 110 2 71 2 39 2 18 — Eye.disease 48 33 28 21 12 6 6 4 37 21 24 15 12 4 5 4 Defective vision. — - - 177 — 150 — 129 — — — 189 — 153 — 138 Otorrhœa 16 8 15 12 4 4 8 7 11 7 13 12 4 4 1 4 Other ear discharge 12 7 5 2 3 2 2 1 1 1 6 4 7 6 2 2 Defective hearing 8 8 17 8 7 4 15 7 3 1 8 6 13 7 5 2 Speech defects 7 - 7 2 3 1 2 2 8 2 2 - 3 1 1 1 Heart defects 23 2 34 1 16 1 15 4 15 1 34 6 39 5 22 2 Anæmia 29 13 40 19 23 15 19 11 23 14 40 27 29 13 29 17 Lung defects 64 29 33 12 8 2 6 1 44 15 28 12 12 2 10 3 Nervous system 11 2 20 4 3 1 1 1 10 1 15 7 12 3 5 1 Phthisis 1 — 3 1 2 — — — — — 2 1 2 - — — Other T.B. disease — — 1 — 1 — — — - — — — — — 1 — Rickets 13 5 4 1 - — — — 15 5 2 - - - - - Spinal deformities 2 1 3 2 7 4 1 - 4 2 5 5 4 3 4 3 Other deformities 7 1 29 17 21 11 21 9 6 1 11 8 30 19 23 17 Other defects 41 27 39 24 16 8 13 6 49 30 60 34 34 19 29 14 Number of children noted for treatment 689 643 389 365 613 662 432 403 Note.—Defects, however slight, are included under "Cases." Those severe enough to require treatment are shown under*, 56 Routine Medical Examination of Elementary School Children in St. Pancras in 1928. Age Group. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. 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 1516 1201 329 16 171 1338 37 — 1508 37 1 1530 15 1 887 446 213 — - — Girls 1406 1071 321 14 155 1217 34 - 1321 77 5 1393 12 1 773 459 174 — — — Age 8— Boys 1618 1226 379 8 122 1436 55 — 1566 43 4 1592 21 - 931 495 127 956 363 218 Girls 1653 1191 456 6 172 1434 47 — 1521 120 9 1636 16 1 1017 511 125 947 408 275 Age 12— Boys 1278 986 276 16 132 1118 28 — 1255 23 — 1263 15 — 864 391 23 829 203 241 Girls 1201 906 295 — 119 1064 18 — 1099 98 4 1197 4 — 861 315 25 778 208 215 Age 14— Boys 1218 876 338 4 147 1048 23 — 1190 27 1 1211 7 - 867 320 31 822 158 231 Girls 1288 946 338 4 211 1059 17 1 1218 63 7 1281 6 1 931 332 25 811 228 247 Totals 11203 8403 2732 68 1229 9714 259 1 10684 488 31 11103 96 4 7191 3269 743 5143 1568 1463 % St. Pancras 75.0 244 0.6 11.0 86.7 23 - 95.3 44 0.3 99.1 0.9 0.0 64.2 29.2 66 62.9 19.2 17.9 % London 58.5 40.5 10 20.0 75.2 4.8 - 94.2 5.3 0.5 97.0 2.9 0.1 61.4 28.3 7.3 56.1 25-4 18-5 57 Section IV.—HOUSING* The following particulars concerning the number of new houses erected during the year, and details of the work carried out with referenoe to existing houses (under the Housing Act and Public Health Acts), are given in the following form in accordance with the require* ments of the Ministry of Health :— Number of new houses erected during the year:— (a) Total (including number given separately under (b)) 18 houses 280 flats (b) With State assistance under tbe Housing Acts:— (i) By the Local Authority Nil. (ii) By other bodies or persons Nil. 1. Unfit dwelling-houses*. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3058 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 385 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1646 2. Remedy of defects without Service oj formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action (intimation only) by tbe Local Authority or their Officers 2575 3. Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 272 (2) Number of dwelling-houses which were rendered fit afterservice of formal notices:— (a) By owners 255 {It) 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 (Statutory) were served requiring defects to be remedied 1265 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice:— (a) By owners 1126 (b) Bv Local Authority in default of owners Nil, 58 C,—Proceedings under Sections 11,14 and 15 of tlie Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (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. Particulars concerning Inspection of Tenement Houses are given in Table 6 on page 98. VENTILATION OF BATHROOMS. Attention was directed to this subject during the year owing to the growing practice of converting large houses into a number of separate flats. In the cases in question it is customary to partition off a small space between the front and back rooms, on each floor, in order to make a bathroom. When, as is often the case, the house is situated in a terrace the provision of ventilation to the external air for such a room is almost impossible. There is no legislation at present in force which gives power to prohibit so undesirable an arrangement, and the matter was referred by the Council to the Metropolitan Boroughs' Standing Joint Committee for consideration. The mere absence of external ventilation in a bathroom is in itself objectionable, bu* the danger incidental to the use of a gas geyser in such a room is an additional reason for the provision of regulations on this matter. OVERCROWDING. Unfortunately this is still prevalent, especially amongst unskilled or casual workers, with large families. In such cases the incomes are insufficient to pay for the amount of accommodation that is necessary. In a number of other cases overcrowding exists in families who can afford to pay for adequate accommodation which is available on the outskirts of London, but the nature of the employment does not permit them to live at such a distance. The London County Council allocate to each Metropolitan Borough a certain amount of accommodation in their various housing estates. This accommodation is used to relieve the most serious cases of overcrowding which are discovered. During the year 221 families, comprising 1,250 persons, who were living in 434 rooms, were recommended for and obtained housing accommodation under the above scheme. HOUSING SCHEMES. WORK OF THE ESTATES COMMITTEE OF THE BOROUGH COUNCIL. The following account of the principal matters dealt with during the year has been furnished by Mr. A. D. Corrick, Clerk to the Estates Committee:— The Estates Committee is appointed by the Council to "take over, control and manage "all houses and other properties of the Council, except such as are used by any department of "the Council for its own purposes; to see that such houses and properties are kept in "tenantable condition and let at reasonable rents; to prepare schemes under the Housing of 59 "the Working Classes Acts for the improvement or reconstruction of insanitary areas, and to "supervise the erection of houses for the working classes; and to deal with such other "matters as may be referred to the Committee by the Council," The dwellings controlled by the Committee comprise:— (a) Goldington Buildings, Great College Street (57 flats). (b) Flaxman Terrace Dwellings, Euston Road (84 flats). (c) Prospect Terrace Dwellings, Gray's Inn Road (71 flats). (d) Una House, Prince of Wales Road (65 flats). (e) The Brookfield Estate, Highgate (110 flats, 90 maisonettes and 2 houses). (f) Aldenham House, Aldenham Street, Somers Town (26 flats). (g) Wolcot House, Aldenham Street, Somers Town (18 flats). (h) 110 and 112, Leighton Road, Kentish Town. (i) 40, Argyle Square (the main part of the premises are used as a Maternity and Child Welfare Centre and Dental Clinic, but rooms in the upper part of the house are let). (j) 13 and 15, Bayham Place, Camden Town. (k) 15, Willes Road, Kentish Town. (i) 24, Grafton Road, Kentish Town. (m) 20 and 22, High Street and 3 and 5, Little King Street, Camden Town. (n) 5, Camden Road (the lower part is used as Electricity Showrooms, and the upper part let in rooms). (o) 63, Pratt Street, Camden Town. (p) 41 and 47, Stanhope Street, Regent's Park. (q) 155, 157, 159 and 161, Great College Street, Camden Town. (r) 9, 10, 11, 12, 13, 14 and 15, Georgiana Street, Camden Town. The vacancies occurring in the Council's dwellings are filled from a waiting list of applicants, which is an extensive one, and preference is given to St. Tancras families. It is worth remarking that during the year under review (1928), 55 changes of tenancies occurred in the above-mentioned premises, and the housing conditions of that number of families were accordingly improved. Somers Town Housing Scheme (Wolcot Street Area). On the 25th July, 1928, the first stage of the Borough Council's housing scheme in Somers Town was celebrated by H.R.H. The Princess Mary Viscountess Lascelles opening Aldenham House and Wolcot House, which comprise 44 tenements. Two further blocks of dwellings, comprising another 44 flats, are now under construction and expected to be ready for occupation during the summer of 1929. The Minister of Health was again requested to contribute a Government subsidy towards the annual financial loss, but he informed the Council that he could not see any sufficient ground for departing from the decision conveyed to the Council in 1923, that no financial assistance from the State would be granted in respect of the scheme. The entire cost therefore devolves upon the Council and the annual loss falls upon the local rates. A fifth block, comprising 36 dwellings, is proposed to be built later on the abutting site in Clarendon Street, in respect of which application will be made for the State subsidy. The weekly rents, inclusive of current rates (March, 1929) and water charges, are:—13s. 7d. for two-room; It's. 5d. for three-room ; and 18s. 8d. for four-room tenements. Each tenement also includes a kitchen containing a gas cooker, copper, bath, sink, larder and dresser. 60 Una House—Dampneas. Una House, Prince of Wales Road, Kentish Town, is a building comprising 65 flats and comes within the category of Assisted Housing Schemes, under the provisions of the Housing Act, 1919, which provide for the levying of a penny rate every year for housing purposes. The annual loss in excess of the produce of the penny rate is borne by the Government. As serious damage had been caused to the red brickwork and window frames, as well as to the interior decorations of the upper floors, due to moisture penetrating the brickwork immediately under the coping, the Council decided that it was necessary to provide a projecting course of artificial stone and to fit lead aprons over the windows on the top floor, at an estimated cost of £352. The Minister of Health approved the proposed remedial measures, but suggested that, in order to reduce the cost, a portion of the coping facing the interior courtyard should be omitted, and that for the present the more exposed walls on the outer side of the building only should be dealt with. This was accordingly done and the actual cost was £252. As the Repairs Fund is unable to bear this expenditure, the Council have asked that the amount may be allowed as a special charge on the rent income. This work is in the nature of an improvement rather than an ordinary repair, as no projecting cornices were provided in the original building. Playground Appliances. The experiment of fixing swings at Goldington Buildings, Great College Street, for the use of the younger children having proved very successful, swings were also provided in the courtyard of Flaxman Terrace dwellings. The Council were prepared to supply swings for Una House, but a majority of the tenants petitioned against the proposal. London County Council Housing Estates. The London County Council have placed at the disposal of the Metropolitan Borough Councils a quota of the new housing accommodation being provided at their Becontree, Downliam and Watling Estates, to be utilised for bad cases of overcrowding and cases of special hardship. This scheme was initiated in January, 1925, and the number of St. Pancras families benefited to the end of 1928 is 538. There would be, in addition, a large number of St. Pancras families accommodated in County Council's dwellings from the L.C.C. ordinary waiting list. The work involved in connection with this matter, the amount of correspondence, enquiries, interviews, etc., is considerable, but the results amply compensate for the amount of time occupied and trouble caused. Staff. The administrative work in connection with the Estates Committee (Chairman: Councillor II. E. Capes; Deputy-Chairman: Councillor A. Squire, F.A.I.) 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 follows:—Prospect Terrace, Mr. H. A. Reid; Brookfield Estate, Mr. H. J. Ambrose; Flaxman Terrace, Mr. C. Hanson; Una House, Mr. J. F. Clegg; Goldington Buildings, Mr. G. S. Tunbridge ; Somers Town Estate, Mr. T. J. Hall (nonresident at present). Section V.-INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. Cowsheds.—There are now no licensed cowsheds in the Borough. Laities and Milkshops.—Twenty-one applications for registration under the Dairies, Cowsheds and Milkshops Orders were received during the year. Of this number, 20 were granted and 1 refused. 61 Two applications in respect of itinerant vendors were also received and granted. The following list gives particulars as to the purveyors of milk on the register at the end of 1928:— Number of purveyors of milk from retail milkshops on the register at the end of 1927 209 Deduct number removed from the register during the year 1928 —19 Add number of purveyors registered by resolution of the Council during 1928 +20 Total number of purveyors of milk from retail milkshops on register at the end of 1928 210 In addition to the above, there were also on the register at the end of 1928 two persons in respect of premises where a wholesale trade in cream only is done, and 14 itinerant vendors without retail milkshops. Bottled Milk. During the year 18 persons were registered to sell milk in sealed bottles, and six were removed from the register. At the end of the year there were 77 persons on this register. Milk Sampling out of Office Hours. Requests are received from time to time from other Metropolitan Boroughs for samples of milk to be taken by the Food Inspectors at railway stations within St. Pancras early in the morning. The Milk and Dairies (Consolidation) Act provides for this duty, and Section 8 (4) of the Act states: "The Authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, the amount whereof shall, in default of agreement, be settled by the Local Government Board [Ministry of Health]." The Council decided in February, 1902, that any firm or person requesting a sample of milk to be procured in course of consignment should be required to pay a fee of 10s. 6d., but no charge has been agreed with other Borough Councils requesting our Inspectors to take samples on their behalf. The samples have to be taken very early in the morning, usually between 3 and 4 a.m. After consideration by the Public Health Committee, it was decided that the fee fixed by the Council in 1902 should be adopted in respect of samples taken under the new Milk and Dairies Act, and the following recommendation was approved by the Council:— That any Local Authority requesting the Food Inspectors of this Authority to take a sample of milk in course of consignment from a consignor to a consignee be required to pay at the time of making the request a fee of 10s. 6d. for a sample or samples from any one source, and that the fee be handed over to the Inspector undertaking the sampling. Milk (Special Designations) Order, 1923. The special designations under which milk may be sold comprise the following:— "Certiled," "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. 62 The following licences for the Sale of Graded Milk were granted in respect of 1928:— 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. 30th, 1927 Marshall's Dailies, Ltd., 19, Tudor Dace, W. 1 "Grade A Tuberculin tested" 19, Tudor Place. Do. Welfords & Premier Dairies, Ltd., 233, Seven Sisters Road, N. 4 "Certified" To sell in St. Pancras. Do. Do. "Pasteurised" 51, South Grove. Do. Do. "Certified" Do. Do. Manor Farm Daily, Ltd., 39, High Road, N. 2 Do. 25, Swain's Lane. Do. Do. "Pasteurised" Do. Do. United Dairies (London), Ltd., 31, St. Petersburgh Place. W. 2 "Grade A Tuberculin tested" To sell in St. Pancras. Do. Do. "Certified Do. Do. Do. Do. Do. Do. Do. "Grade A Tuberculin tested Do. Do. Do. "Pasteurised" 69, Albany Street, Do. Do. Do, 177, Albany Street. Do. Do. Do. 48, Marchmont Street. Do. Do. Do. 63, Park Street. Do. Do. Do. 126, Regent's Park Road. Do. J. R. Mills & Son, 23, Francis Street, W.C. 1 "Grade A 23, Francis Street. Do. Express Dairy Co., Ltd.. 26-30, Tavistock Place. W.C. 1 "Certified" 26, Tavistock Place. Do. Do. "Grade A Tuberculin tested" Do. Do. Do. Do. 12, South Grove. Do. Do. "Certified" Do. Do, Lord Rayleigh's Dairies, Ltd., 16, Caroline Street, W.C. 1 Do. To sell in St. Pancras. Do. Do. "Grade A Tuberculin tested ""Pasteurised" (Plant) Do. Do. Lincolnshire Dairies Ltd.. 31, Oak Village. N.W. 5. 31, Oak Village. Do. G. S. Daunton, 1, Guilford Street, W.C. 1 "Grade A Tuberculin tested" 1, Guilford Street. Jan.26th,1928 D. Davies, 10-11, Dukes Road, W.C. 1 Do. 10-11, Dukes Road. Do. Do. Do. (Bottling) "Certified" Do. Do. Do. Do. Do. J. Evans, 35. Southampton Street, W. 1 Do. 35, Southampton Street. Do. H.J. Jenkins, 97. Kentish Town Road, N.W. 1 "Grade A" 97, Kentish Town Road. Feb. 23rd, 1928 E. Jones. 137, King's Cross Road, W.C. 1 Do. 137, King's Cross Road. Do. Do. "Certified" Do. Apl. 26th, 1928 J. R. James. 155, Hampstead Road, N,W 1 "Glade A 155. Hampstead Road. Do. Express Dairy Co.. Ltd., 26-30 Tavistock Place, W.C, 1 "Pasteurised 26, Tavistock Place. Do. Do. Do. 12, South Grove. Do. Do. Do. 50. Gower Place. May 23rd, 1928 R. J. Lewis, 67 Chalk Farm Road, N.W. 1 "Grade A" 67, Chalk Farm Road. Sept 20 th,1928 T. J. Jones, 6, Hastings Street, W.C. 1 "Grade A. Tuberculin tested "Do. 6, Hastings Street. Do. T . James 16, Kenton Street, W.C, 1 16. Kenton Street. 63 (b) MEAT AND OTHER FOODS. The two special Food Inspectors have kept under regular observation food exposed or deposited for sale in slaughter-houses, butchers' shops, cooked meat shops, fishmongers' premises, stalls, market places, etc. The undermentioned unsound or diseased food was either seized or surrendered by the owners for destruction or to be dealt with as trade refuse:— Unsound Food Condemned .and Destroyed. Surrendered. Apples, 13 boxes and 5 bags Bananas, 4 crates Black Currants, 48 boxes Carcass, Pig's, 1 Cauliflowers, 28 Cod, 1 box Crabs, 100 Dogfish, 1 trunk Fowls, 8 Haddocks, 1 box Halibut, 2 boxes Heads, Pigs', 3 Livers, Bullocks', 7 „ Pigs', 2 Margarine, 56 lbs. Mutton, Shoulder of Pears, 24 boxes Plaice, 12 stones Pork, 49 lbs. Salmon, smoked, 42 lbs. Skate, 1 trunk and 18 stones Strawberries, 31 tubs Tomatoes, 2 bundles Walnuts, 93 bags. Seized. Grape Fruit, 140. Food Poisoning and Preservatives. Owing to the supervision which is now exercised in connection with food and the premises in which it is prepared and dealt with, outbreaks of food poisoning are rare. In the past year, especially during the hot summer, a few outbreaks occurred, and as new Regulations prohibiting the use of Preservatives in certain foods had recently come into force, the erroneous conclusion was drawn that the events were connected. The presence of the amount of preservative previously permitted in certain foods would not affect the growth of the bacteria usually responsible for attacks of food poisoning. The chief purpose served by preservatives was in retarding decomposition, and to some extent, their use would minimise the effect of lack of cleanliness in food handling and preparation. The use of chemical preservatives is undesirable and is now practically unnecessary, as electric and other methods of refrigeration or cold storage are now available. They arc infinitely better and the use of such methods should be greatly extended. A somewhat extensive outbreak of Food poisoning occurred in the Borough during the year, and although the actual germ was isolated, the manner in which the food became contaminated by it could not be ascertained. The following report on the subject was presented to the Council:— Report on an Outbreak of Food Poisoning. In accordance with the requirements of Section 14 (5) of the Sanitary Officers (London) Order, I beg to submit the following report:— 64 On Friday, September 7th, I was informed by a medical practitioner (Dr. Bolt) that on the previous afternoon and evening, Thursday, September 6th, he had been called to attend a number of persons residing at the Green Cross Club, and that some form of food poisoning was suspected. The premises in question are used as a residential club for business women, and, including staff, from 50 to 60 persons are usually in residence. It was ascertained that between 2 p.m. and 10 p.m. on Thursday, September 6th, 22 persons had been attacked, and the following were the principal features of the illuess:— diarrhoea, vomiting, pain in the back and limbs and more or less collapse. The temperature in different case3 varied from 99° to 102° Fahr., and the pulse rate from 120 to 130. In the majority of the cases the acute symptoms subsided within about 48 hours, but in a few instances the symptoms were more severe and the illness of longer duration. All the patients recovered. I was informed that on Thursday morning, the day on which the attack occurred, breakfast consisted of porridge, bacon, tomatoes, tea and coffee. Dinner, on the preceding evening (Wednesday), comprised soup, veal, mutton cutlets, stewed (fresh) fruit, junket and cornffour. The only article of food eaten in common by all the sufferers was the junket, but unfortunately none of this was available for analysis. A certain quantity had been left over from dinner, but one of the maids received permission to eat it. She was the only member of the kitchen staff who had junket, and she was the only one of this staff who suffered from the illness in question. Samples of such of the foods as were available were collected by Mr. Auger (Food Inspector) and were forwarded to the Pathological Laboratory of the Ministry of Health for analysis, but the report stated that no suspicious organisms were discovered. Samples of faeces from several of the patients were also forwarded for examination and these were found to contain Gaertner Bacilli, a well known organism of food poisoning. A sample of blood from the maid, previously mentioned, was also found to agglutinate Gaertner Bacilli in a dilution of 1-320, which is proof of a recent infection with this Bacillus. One patient who had a rather severe attack was removed to a Nursing Home. A sample of her faeces was examined by another Pathologist, who reported an abundant growth of Gaertner Bacilli. The blood of this case also possessed strong agglutination properties as regards the Bacilli in question. Although the junket is considered to have been the cause of the outbreak, it has not been possible to discover how the junket became infected with the Gaertner Bacillus. This germ is frequently found in the lower animals, including rats and mice; it is also possible for flies to act as agencies for the transmission of bactcrial infection. A few mice and a large number of beetles are stated to have been seen at times in the kitchen, and at that time of the year flies were prevalent. Owing to the method of preparation, certain foods are more likely to become infected than others, and junket is one of these. In the present case the milk was warmed soon after delivery, about 11 a.m. the rennet was added, and it was then left exposed until required for dinner in the evening. Any organisms which obtained access, would, therefore, find themselves for some hours under ideal conditions, both as regards food and temperature, for rapid growth and development. The warm weather prevailing at this time was also extremely favourable for bacterial multiplication. 65 In the early stages of the investigation, certain circumstances indicated that another food might, possibly have been the indirect cause of the outbreak, and it is advisable this should be mentioned In the week preceding the outbreak, several of the kitchen staff had been unwell after eating some cold beef This beef was cooked on Sunday, August 26th, and allowed to get cold. It was eaten by the residents on Sunday evening without any ill effect. The remainder was eaten by several members of the kitchten staff on the following Tuesday, and on the next day (Wednesday) these persons suffered from diarrhoea, vomiting, and more or less malaise. The beef was stated to have had a rather unpleasant taste on the Tuesday, and in consequence one or two of the kitchen staff declined it. These persons remained in good health. It is conceivable that the beef might have become contaminated with Gaertner Bacilli, and the infected members of the kitchen staff, acting as carriers for a few days, could have conveyed the infection by unwashed hands to the junket. The evidence, however, obtained by the agglutination test is opposed to this view. Although the blood of one of the maids who was unwell after eating the beef agglutinated Gaertner Bacilli, this maid had also eaten junket, and sufficient time had elapsed for the reaction to have, developed from the later infection. Additional evidence on this point is, however, available. Another member of the staff who had some of the cold beef on Tuesday, August 28th, and was somewhat indisposed on the following day, was absent on Thursday, September 6th, and therefore did not partake of the dinner at which the junket was served. If the beef had been infected with Gaertner Bacilli, the blood of this person should have possessed agglutination properties, but a sample was taken and examined and found to be quite negative. In addition to the above, the statement that the beef had an unpleasant taste would rather indicate it was undergoing change owing to the presence of putrefactive organisms, as food poisoning germs of the Gaertner type do not cause any obvious change or unpleasant taste in the food. I am therefore of the opinion that it was the junket, and not the beef, which by some means became infected and was the cause of the outbreak. An occurrence of this kind emphasises the necessity for scrupulous cleanliness in the handling of food and the importance of keeping it covered in order to avoid the risk of contamination by rats, mice, flies, etc. Although it may not be a factor in this instance, I think it. desirable to draw attention to the fact that some years ago the premises where the outbreak occurred were badly infested with rats, and a large quantity of "Virus" was used to exterminate these pests. There are several varieties of "Virus" on the market, but all are stated to consist either of Gaertner or other closely related organisms. In rats and mice these germs cause an infectious and fatal disease. The accidental contamination of human food by these germs is a not infrequent cause of outbreaks of poisoning. It would therefore appear to be inadvisable to permit the manufacture and indiscriminate sale of preparations which may become so widely distributed, and which possess such dangerous properties, when other and safer means of getting rid of vermin are available. October 4th, 1928. G. Sowden, Medical Officer of Health. 66 Preservative in Butter. Under the Public Health (Preservatives, etc., in Food) Regulations, boric acid preservative is not allowed in butter. In the undermentioned case the percentage of boric acid was so small that proceedings were not taken, but, in view of the observations made by the wholesale dealers, the matter was reported to the Minister of Health with a view to such action being taken as he may deem desirable. The analyst reported that the sample of butter contained boron preservative equivalent to 0 083 per cent, of boric acid. The attention of the wholesalers was drawn to the matter, and they replied stating that they were very much surprised to receive an intimation that the butter contained preservative, as no preservative of any kind was used or added to the various classes of butter with which they dealt. The firm stated that the preservative content was very slight indeed, far too slight to act in any serious way as a preserving agent, and it may be fairly assumed that preservative has not been deliberately added. They stated that practically all butter was made from cream collected from farmers, and as in the majority of cases the cream is paid for according to grade, certain farmers, in order to obtain the highest grade, have apparently been putting preservative in their cans of cream. The factory proprietors, not suspecting that this would happen, have tipped these cans of cream with many others into the large vats for butter making, thereby impregnating the whole of the vat with a very small percentage of boron preservative. The firm state that this is only theory, but it is the only explanation they can give of the fact that preservative should have been found in the sample of butter analysed by the Council, and in other samples of which they cite instances. Slaughter-houses. At the end of 1928 there were 4 licensed slaughter-houses (private) in the Borough. Structurally they do not conform to a high standard of excellence. They are kept under periodical inspection by the Food Inspectors, who made 159 inspections during the year. Fried Fish and Fish Curing Premises. In 1928 there were 82 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 20 fish curers' premises, including the 4 ab ;ve mentioned. 474 visits were made by the Food Inspectors to these premises during the year. Ice Cream Premises. Section 29 of the London County Council (General Powers) Act, 1928, which came into force on August 3rd, states that "any premises used or proposed to be used for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity shall be registered by the owner or occupier thereof with the Sanitary Authority. Any person offending is liable to a penalty." The requirements of this section have been brought to the notice of the persons concerned. The number of premises on the register of the department at the end of the year was 319. Bakehouses and Restaurant Kitchens. At the end of 1928 there were 153 bakehouses on the register, including 62 factory 67 bakehouses. 35 of these bakehouses were not in use. 114 of the 153 were underground bakehouses, of which 55 were factory bakehouses, and 28 not in use. At the end of the year 381 restaurant kitchens were on the register. Bakehouses and restaurant kitchens are supervised by the Factory and Workshop Inspector, and further particulars in regard to them will be found on pages 50 ard 52. (c)—SALE OF FOOD AND DRUGS ACTS. 800 samples have been taken under these Acts, of which 578 were formal and 222 informal. Of the formal, 552 proved to be genuine, and 26, or 4-5 per cent., adulterated, anc of the informal, 204 were genuine and 18, or 8*1 per cent, adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Apples 4 1 4 1 - - Bacon — 3 — 3 — — Barley — 3 — 3 — — Beef (roast) — 1 — 1 — — Beef (spiced) — 1 — 1 — — Borax — 1 — 1 — — Brawn — 4 — 4 — — Butter 133 1 128 — 5 1 Cake — 7 — 7 — — Cherries (glacé) — 2 — 2 — — Chocolate — 1 — 1 — — Cocoa 5 — 5 — — — Coffee 11 3 11 3 — — Cream 1 25 — 23 1 2 Cream (canned) — 2 — 2 — — Currants — 1 — 1 — — Custard powder 4 — 4 — — — Dripping 7 — 7 — — — Fillet (smoked) — 1 — 1 — — Fish paste — 6 — 6 — — Flour 10 4 10 4 — — Ham (cooked) — 1 — 1 — — Honey — 2 — 2 — — Jam — 5 — 5 — — Jam roll — 3 — 3 — — Jelly crystals — 1 — 1 — — Lard 19 — 19 — — — Lemonade crystals — 2 — 2 — — Lemon cheese — 1 — 1 — — Liver sausage — 1 — 1 — — Lobster (canned) — 1 — 1 — — Margarine — 1 — 1 — — Marmalade — 1 — 1 — — Meat (minced) 1 6 — 5 1 1 ,, paste — 2 — 2 — — ,, pies — 4 — 4 — — Milk 324 2 314 2 10 — ,, (condensed) — 4 — 4 — — Mineral water 1 1 1 — — 1 Mushrooms (canned) — 1 — 1 — — Mustard 11 — 11 — — — Pastry — 1 — 1 — — Carried forward 531 107 514 102 17 5 68 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 531 107 514 102 17 5 Pears (canned) - 1 - 1 — — „ (dried) - 1 - 1 — — Peas (dried) - 1 - 1 — — Peel (mixed) - 3 — 3 — — Pepper 11 — 11 — — — Pickles - 6 - 6 — — Pork and beans (canned) - 1 - 1 — — Prawns (canned) - 1 - 1 — — Prunes - 1 - 1 — — Raisins - 1 - 1 — — Rissole (meat) 1 1 1 — — 1 Sardines - 1 - 1 — — Sauce - 3 - 3 — — Sausages 11 64 5 2 6 12 Saveloy - 1 — 1 — — Sponge cake - 5 - 5 — — Sultanas - 1 - 1 — — Sugar - 1 — 1 - — Sweets - 9 — 9 — — Swiss roll - 4 — 4 — — Tripe - 8 — 8 — — Vinegar 16 — 15 — 1 — „ (malt) 8 — 6 — 2 — Whiskey - 1 — 1 - — Totals 578 222 552 204 26 18 Prosecutions were undertaken as regards 11 samples, which were reported as being adulterated. The results of the proceedings are stated in the following tables:— 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. 1928. £ s. d. £ s. d. C. 84 Milk Deficient in milk fat, 16*0 per cent. May 10th 2 0 0 2 2 0 C.87 „ „ 10.0 „ „ „ 1 0 0 2 2 0 C.88 „ „ 6.0 ,, ,, ,, - 2 2 0 C. 199 „ „ 6.6 „ Oct. 10th - 2 2 0 C. 208 Beef Sausages Sulphur Dioxide, 0 015 per cent. ,, 18th Dismissed C. 210 „ 0.0054 „ „ „ Adjourned sine die. C. 212 „ „ 0.0055 „ „ „ „ C. 262 Minced Beef „ 0.0206 „ Dec. 6th Dismissed under Probation of Offenders Act. 3 3 0 A. 241 Milk Deficient in milk fat, 26'0 per cent. Jan. 22nd 1 0 0 1 1 0 C. 315 „ Added water, 5*4 per cent. Feb. 21st Withdrawn. 2 2 0 69 (b) Public Health (Preservatives, etc., in Food) Regulations, 1925. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 263, Great College Street Selling Cream with which had been mixed Boric Acid 1928. Oct. 18th ,. Fined £5, costs £2 2s. (c) Milk and Dairies Order, 1926. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. Cromer Street Delivering milk in bottles which were not filled and closed on registered premises 1928 Dec 11th Dismissed on payment of costs, £2 2s. Do. Do. do. „ Fined £2 (second conviction) Wholesale Dealers in Margarine.—One certificate of registration under the provisions of the Sale of Food and Drugs Acts was issued during the year. Section VI.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. NOTIFIABLE INFECTIOUS DISEASES. The undermentioned diseases are compulsorily notifiable in St. Pancras : — Small Pox (Variola) Scarlet Fever (Scarlatina) Diphtheria and Membr. Croup Cholera Erysipelas Puerperal Fever Puerperal Pyrexia Acute Polioencephalitis Encephalitis Lethargica Ophthalmia Neonatorum Measles German Measles Plague Typhus Fever Enteric or Typhoid Fever Continued Fever Relapsing Fever Glanders Anthrax Hydrophobia Tuberculosis (all forms) Cerebrospinal Meningitis (Cerebrospinal Fever) Acute Anterior Poliomyelitis Acute primary pneumonia Acute influenzal pneumonia Malaria Dysentery As compared with the previous year there was a slight increase in the number of cases of Scarlet Fever and Diphtheria; other notifiable diseases shewed no undue prevalence, with the exception of Measles, a severe outbreak of which occurred in the first quarter of the year. 70 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1928. The notifications have not been corrected for any subsequent revision of diagnosis:— Notifiable Diseases (other than Tuberculosis). Diseases. Notifications. Total all Ages. deaths. Total all Ages. Number of Cases admitted to Hospital. At Ages—Years. At Ages—Years. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 25. 25 to 65. 65 | upwards Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 25. 25 to 65. 65 upwards. I. Small Pox - - - - - 2 1 3 - - - - - - - - 3 2. Scarlatina or Scarlet Fever 3 164 262 96 62 31 — 618 — 1 - - - - - 1 599 3. Diphtheria and Membranous Croup 10 136 151 45 40 25 — 407 - 8 3 - — 1 — - 401 4. Enteric or Typhoid Fever 1 4 2 3 2 9 — 21 - - - - - 1 - 2 20 5. Puerperal Fever — — — — 7 12 — 19 — — - - 2 1 — 3 16 6. Puerperal Pyrexia — — — — 8 32 — 40 — — — _ — — — — 27 7. Erysipelas 4 2 6 5 13 54 13 97 - - - - - - 1 2 61 8. Cerebrospinal Meningitis — — 1 — 2 — — 3 - - — 1 1 — — 2 3 9. Anterior Poliomyelitis and Polioencephalitis — 2 - - - - - 2 - - - - - - - - 2 10. Ophthalmia Neonatorum 32 - - - - - - 32 - - - - - - - - 9 11. Encephalitis Lethargica — - — — 3 4 1 8 - - - - - - - - 6 12. A cute Primary Pneumonia 13 61 33 14 32 110 19 282 - - - - - - - - 167 13. Acute Influenzal Pneumonia 2 2 — — 8 49 4 65 — — — - — — — _ 32 14. Malaria - - - - 1 1 — 2 - - - - - 2 1 3 — 15. Dysentery — 1 2 - — 2 — 5 — — — — — — — — 5 16. Measles 231 2143 1371 54 12 32 — 38/6 30 87 10 — — — — 127 703 17. German Measles 6 25 42 8 5 2 — 83 - - - - - - - — 1 * For Pneumonia deaths, see Table 2 on page 94. 71 The notifications of, and deaths from, the notifiable infectious diseases other than Tuberculosis 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. Small Pox — — — 2 — — 1 — 3 — — — — — — — — — 2. Scarlatina or Scarlet Fever 83 85 130 69 115 33 23 79 618† — — 1 — — — — — 1 3. Diphtheria and Membranous Croup 55 31 89 32 84 50 20 46 407 1 2 3 1 — 2 1 2 12 4. Enteric or Typhoid Fever 3 3 — 8 1 1 3 2 21 1 — — 1 — — — — 2 5. Puerperal Fever 4 1 5 2 3 2 — 2 19 1 — — — — — — 2 3 6. ,, Pyrexia 6 3 5 10 4 2 2 8 40 — — — — — — — — — 7 Erysipelas 17 10 16 11 19 11 3 10 97 — — — 2 — — — — 2 8. Cerebrospinal Meningitis — — — — 1 1 — 1 3 — — — — — — — — 2 9. Anterior Poliomyelitis and Polioencephalitis — 1 1 — — — — — 2 — — — — — — — — — 10. Ophthalmia Neonatorum 4 4 7 4 6 1 — 6 32 — — — — — — — — — 11. Encephalitis Lethargica 1 — 3 1 — 3 — — 8 — — — — — — — — — 13. Acute Primary Pneumonia 44 30 57 52 35 19 9 36 282 — — — — — — — — — 13. Acute Influenzal Pneumonia 11 5 20 5 12 5 2 5 65 — — — — — — — — — 14. Malaria 1 — — 1 — — — — 2 — — — — — 1 2 — 3 15. Dysentery 1 — — — 4 — — — 5 — — — — — — — — — 16. Measles 595 354 678 424 582 559 110 574 3876 13 15 19 8 14 39 4 14 127† 17. German Measles 12 4 19 17 3 4 2 27 88 — — — — — — — — — Totals 837 531 1030 638 869 691 175 796 5568 16 17 24 12 '5 42 7 18 152 * For Pneumoira deaths, see Table 2 page 94. † Including 1 case—home address not known. 72 SMALL-POX. Three cases of this disease were notified in the Borough during the year, and one case residing in another Borough was discovered while attending a hospital in St. Pancras. Two of the notified cases occurred in one house. The source of the infection of the first case could not be traced. There were a large number of contacts, and of these three, all of whom had refused re-vaccination, developed the disease. A number of persons were reported from time to time to have been in contact with cases of small-pox, and where possible, such persons were vaccinated and kept under observation during the incubation period. VACCINATION. The following table is prepared from information kindly supplied by Mr. Chapman, the Clerk to the Guardians, itr respect of children whose births were registered in the Parish of St. Pancras from 1st January to 31st December, 1927. VACCINATIONS. l.st January to 31st December, 1927. — Number. Percentage of Births registered. North. East. West. South. Whole Borough North. East. West. South. Whole Borough Births registered 637 951 674 1685 3947 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 27 43 25 77 172 4.2 4.6 3.8 4.6 4.4 Successfully vaccinated 299 437 369 875 1980 47.0 46.0 54.6 52.0 50.2 Had smallpox — - - - - - - - - - Insusceptible of vaccination 2 5 1 4 12 0.3 0.5 0.2 0.2 0.3 Received certificate of conscientious objection 263 320 228 432 1242 41.3 33.6 33.8 25.6 31.5 Postponed by medical certificate 6 2 7 6 21 1.0 0.2 1.0 0.3 0.5 Moved to known address in other districts 14 53 7 148 222 2.2 5.5 1.0 8.8 5.6 Lost sight of by removal 18 86 31 119 254 2.8 9.1 4.6 7.1 6.4 Unvaccinated and not accounted for in previous columns 8 5 6 24 43 1.2 0.5 10 1.4 1.1 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. 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 1925 4121 1988 48.2 1529 37.2 1926 4141 2084 50.3 1420 34.3 1927 3947 1980 50.2 1285 32.6 73 SCARLET FEVER. The number of cases notified was 618, as compared with 527 cases during the previous year. It was subsequently ascertained that 45 cases had been incorrectly diagnosed. The actual number of cases was therefore 573. One death occurred ; this equals a case mortality of 0.2 per cent. 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. 11 such cases occurred during the year. Two cases occurred in one house, and were due to the same source of infection. One of the suspected sources of infection was suffering, when discharged from hospital, from nasal discharge. The remainder showed no obvious signs of being infectious. DIPHTHERIA. The number of cases notified was 407, as compared with 390 cases during the previous year. It was subsequently reported by the hospital authorities that 57 cases had been incorrectly diagnosed, the actual number of cases was therefore 350. This equals an attack rate of 1.7 per 1,000 of population. Twelve deaths occurred, giving a case mortality of 3.4 per cent. Antitoxin for the treatment of cases of this disease is supplied to medical practitioners free of charge by the Council. During the year 200 thousand units were provided. ENTERIC (TYPHOID) FEVER. Twenty-one cases were notified and one case was discovered after death. On further investigation four cases were found to have been incorrectly diagnosed. The actual number of cases was therefore 18. Based on bacteriological examination, 11 cases were reported to be suffering from Typhoid and 5 from Para-typhoid fever. In the remaining cases no definite bacteriological information was available. Two deaths occurred, one from Typhoid and the other from Para-typhoid. During the summer months an epidemic of Para-typhoid, caused by infected cream, occurred in London and surrounding districts, but no cases occurring in St. Pancras were traced to this source. In November, a slight epidemic of Typhoid commenced. It was limited to a small area in the Borough, and was found to be due to the consumption of infected winkles. Altogether 12 persons were affected, the last 2 cases being notified in January, 1929. A sample of winkles was obtained and submitted for bacteriological investigation to Professor Teale, of University College Hospital, who reported the winkles to be highly contaminated with sewage germs and to be a potential source of danger, although no typhoid bacilli were found. The wholesale merchant from whom the winkles were bought was traced, and it was found that his supplies were obtained from a very large number of different places, English and Foreign. The retailer was instructed to boil the winkles for a longer period in order to remove the risk of infection, and the matter was reported to the Ministry of Health and the Board of Agriculture and Fisheries. PUERPERAL FEVER, 19 cases were notified. On further investigation the diagnosis of one case was not confirmed. In addition to the notified cases it was found that 12 cases of Puerperal Pyrexia should have been notified as Puerperal Fever, and three other cases were brought to notice on special death reports. Thus the total number of cases which occurred during the year was 33, producing an incidence rate of 10.1 per 1000 births. Four deaths occurred, but of these one was found to be due to illegal interference with pregnancy, and is consequently not allocated to puerperal fever but to violence. The case mortality rate was 9.1 per cent, and the death rate 0.9 per 1000 births. 74 Of the 33 cases, 15 occurred in hospital practice, 15 in the practice of private practitioners, and 3 in the practice of midwives. 11 cases were removed to the M.A.B. hospitals and 4 to the hospitals of the St. Pancras Guardians. There had been instrumental delivery in 6 cases. In estimating the significance of the incidence and death rates for puerperal fever, due allowance should be made for the fact that the termination of pregnancy before the 7th month, though it is not recorded as a birth, is attended by the same, if not a greater risk, of puerperal fever. Of the 33 cases of puerperal fever recorded during 1928, only 22, and of the 5 deaths, only 2 followed the birth of a viable child. The remaining 11 cases and 3 deaths followed the occurrence of miscarriages, the total number of which is an unknown quantity. Although puerperal sepsis following miscarriage forms such a large proportion of the total notifications and deaths due to puerperal fever, yet puerperal fever is commonly spoken of as though it were principally a risk of childbirth and might be altogether prevented be proper ante-natal care and improved technique at confinements. Such measures may, no doubt, prevent those cases of difficult labour and excessive manipulation of which puerperahisepsis is often the sequel, but puerperal sepsis following miscarriage is scarcely affected. In some of these cases there is definite evidence that illegal interference caused the miscarriage, and subsequent sepsis and such cases are excluded from the puerperal mortality figures by the Registrar-General. But in many other cases, it is probable that interference occurs, though definite evidence of this is lacking. Owing to the statistical methods adopted, such cases swell the annual list of obstetrical fatalities, though it is difficult to see by what obstetrical measures they could be prevented. PUERPERAL PYREXIA. Forty cases were notified, and one case notified as Puerperal Fever was afterwards found to be Puerperal Pyrexia. The actual number of cases was therefore 41. One death occurred. On investigation the causes of this condition were ascertained to be as follows:— 1. Infection of Genital passages (12). Puerperal Fever 2 cases Sapræmia 6 cases* Pelvic peritonitis 3 „ Uterine sepsis 1 case * 1 case died. 2. Conditions associated with Childbirth (15). Perineal laceration 1 case Retained Membranes 1 case Cracked Nipples 1 „ Mastitis 7 cases Breast Abscess 1 ,, Pyelitis 3 ,, Superficial Sepsis of Caesarean incision 1 case 3. Intercurrent disease (14). Bronchitis 3 cases Cystitis 1 case Influenza 1 case Abscess of leg 2 cases Constipation 1 „ Empyema 1 case Scarlet Fever 1 „ Coryza 1 „ Serum reaction 1 „ No cause discovered 2 cases Twenty-four of these cases were notified by Medical Officers of Institutions, the remainder by private practitioners. ERYSIPELAS. Ninety-seven cases were notified and 2 deaths occurred, as compared with 98 cases and 6 deaths during the previous year. 75 CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever.) Three cases were notified, but on further investigation the diagnosis in one case was not confirmed. Two deaths were recorded from this disease, and of these one was notified only at death. Three cases, therefore, occurred altogether, with two deaths. ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS. Two cases were notified. Both were admitted to Highgate Hospital. No deaths occurred. OPHTHALMIA NEONATORUM. Thirty-two cases were notified, which equals an incidence rate of 9'8 per 1,000 births. The services of a district nurse were provided in twelve instances. Six cases were admitted to the special hospital provided for the treatment of this disease. The following table gives details concerning the cases in the form desired by the Ministry of Health:— Cases. Vision not Impaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 32 24 8 32† — — — Includes 3 cases removed from the Borough before complete recovery. In addition to the above cases, 19 cases of mild inflammation of the eye in the newlyborn, not notifiable as Ophthalmia Neonatorum, were brought to notice by the London County Council Inspector of Midwives or by Welfare Centres. ENCEPHALITIS LETHARGICA. Eight cases were notified, but on further investigation two cases were found to have been incorrectly diagnosed. Nine unnotified cases were brought to notice during the year, but of these only one was of recent origin. There were therefore seven genuine new cases during the year. No deaths occurred. PNEUMONIA. This disease is a frequent complication of other diseases, but when occurring in that manner is not notifiable. The notifiable forms of Pneumonia are Acute Primary and Acute Influenzal Pneumonia. 282 cases of the former and 65 of the latter were notified during the year. If requested by the medical attendant, a visiting nurse is supplied in necessitous cases at the cost of the Borough Council. During the year 50 cases were nursed under this arrangement, 880 nursing visits being paid. 76 MALARIA. Two cases were notified. Three deaths were registered as having been due to Malaria, but none of these cases had been notified. In every case the disease had been contracted abroad. DYSENTERY. Five cases were notified. The cause of the disease proved to be Flexner's Bacillus in three cases, all of which occurred in one house. In the other two cases the diagnosis of dysentery was not confirmed. No deaths were reported. MEASLES AND GERMAN MEASLES. These diseases are compulsorily notifiable in St. Pancras under Special Regulations sanctioned in 1920. All cases 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 another 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. Hospital Accommodation. During 1927 a decision to abandon the previous practice of always admitting cases of scarlet fever to hospital in preference to measles was adopted. Under the new arrangement, when the incidence of infectious disease is such that the supply of beds is sufficient for all case3, medical practitioners will be able, as in the past, to secure the removal of a patient by direct application to the Metropolitan Asylums Board. During epidemic periods, however, cases of either disease will only be admitted on the recommendation of the Medical Officer of Health. At such periods the selection of cases for hospital will depend on wheiher the home conditions are suitable for treating an infectious patient, and it is designed to take into account the fact that measles has now a higher mortality rate than scarlet fever. The epidemic of Measles which commenced in December, 1927, became very severe in the early part of 1928 and the scheme for hospital treatment outlined above was put into operation. The results obtained, which are discussed below, are discouraging, but information from other boroughs and statistics on a larger scale are necessary before any definite opinions can be expressed. During'the year 3876 cases of Measles and 88 of German Measles were notified. 704 cases were admitted to hospitals. The services of a nurse were provided, in all cases where this was desired by the medical attendant, in connection with cases kept at home. 127 deaths occurred. Measles in a very serious disease and particularly dangerous to young children. The following statistics of the 1927-8 outbreak have therefore been extracted with reference to all cases and for each year of age in those under 5. In table I, below, all notified cases of Measles in children under 5 years of age are arranged in groups according to their age in years. The table shows also the number of such children, arranged in the same manner, who were removed to M.A.B. hospitals, Highgate Hospital, and nursed at home respectively. The deaths and death rates are treated in a similar way. When children in the same age group are compared, there is revealed a very striking contrast between the mortality rates in hospital and those at home, which appears to be very much in favour of the latter. 77 It is possible that there was a selection of severe cases for admission to hospital which might account to some extent for this contrast, but since instructions were given to select cases on account of home conditions rather than the gravity of the illness, it may be doubted if selection of severe cases was wholly responsible. Table II shows the mortality rate during the 1927-8 epidemic compared with those of previous epidemics in this Borough, before special efforts were made to admit cases to hospital. Here again, the comparison does not appear favourable to hospital treatment. It would be interesting to know if these results find any parallel in other Metropolitan boroughs: if so, it would seem to suggest that the disturbance to young children suffering from this disease or its complications, caused by removal to hospital, might be in itself a factor of importance in producing the relatively high mortality rates which were recorded there. With reference to the difference between the mortality rates at the M.A.B. hospitals and Highgate Hospital a word of explanation is necessary. The Medical Superintendent of High gate Hospital thinks that the most important cause was the overcrowding of the wards. He states that little pressure had been expected in view of the special preparations for the epidemic made in the M.A.B. hospitals, also, that two of his wards were out of use owing to building operations. In February, when the M.A.B. hospitals were full and declined to receive any more patients, he was obliged to admit cases, whether he had proper accommodation or not. He mentions also that about 50 cases (not counted as being nursed at Highgate) were sent on, almost immediately after admission, to the M.A.B., and were those best able to travel, the more serious cases being retained. Further investigation into this question is necessary, but at present it would appear that home isolation, with the provision of the services of a nurse, is the most suitable treatment. As a preventive measure, especially in very young or delicate children, the method of protection by the injection of convalescent serum may prove to be of value. This method has been used for some time both in America and on the Continent, and the results are reported to be extremely satisfactory. In this country little use has so far been made of this mode of protection. MEASLES. Table I. AGES. Total No. of Cases. Removed to M.A.B. Hospitals. Removed to Highgate Hospital. Nursed at Home. No. Died. Death rate per cent. No. Died. Death rate per cent. No. Died. Death rate per cent. No. Died. Death rate per cent. Under 1 199 30 15.08 46 6 13.04 24 17 70.83 129 5 3.88 1 and under 2 454 51 11.23 84 11 13.10 68 29 42.65 302 10 3.31 2 and under 3 485 17 3.50 82 7 8.54 37 8 21.62 366 2 0.55 3 and under 4 495 9 1.82 71 4 5.63 37 3 8.11 387 2 0.52 4 and under 5 553 2 0.36 45 1 2.22 26 — — 482 — — 5 and over 1412 10 0.07 98 4 4.08 50 1 2.0 1264 5 0.40 Totals 3598 119 3.3 426 33 7.7 242 58 23.9 2930 24 0.8 78 Table 11. Cases. Deaths. Mortality Rates. 1922 3728 107 2.9 1924 4332 74 1.7 1926 3734 65 1.7 1927-8 3598 119 3.3 TUBERCULOSIS. Particulars of all now cases of Tuberculosis and of all deaths from this disease during 1928 are given in the following table in the form required by the Ministry of Health:— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 1 — — 2 1 — — 1 1-5 2 1 8 8 1 — 2 3 5-10 1 2 15 8 — — 4 1 10-15 - 7 - 13 — 2 - - 15-20 12 21 3 4 6 6 — 1 20-25 18 20 3 5 9 14 1 2 25-35 37 41 3 6 24 15 — 1 35-45 41 28 2 4 23 17 1 2 45-55 48 17 3 1 21 13 1 - 55-65 30 12 5 3 24 8 2 — 65 & upwards 11 — 2 — 6 1 1 — Totals 204 149 43 54 115 76 13 12 The total number of Primary notifications was 400 ; in addition to these, 37 cases, which had not been notified, came to knowledge by means of special death reports, and 18 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 455, equal to a notification rate of 2 21 per 1,000 of population. The total number of new cases during the previous year was 470. The deaths from all forms of Tuberculosis during the year numbered 216, equal to a death rate of l-05 per 1,000 of population. The total number of deaths in the previous year was 217. It will be noted that, out of a total of 216 deaths from Tuberculosis, 37 were of cases which either died un-notified or were notified only at death. The proportion of un-notified cases has decreased considerably during recent years, but it is still unsatisfactory that so large a number of cases should come to knowledge only at death. In a certain number of cases some misunderstanding had existed, and the medical attendant was under the impression that the case had been notified previously. In all cases of failure to notify, a communication is sent to the certifying practitioner asking for an explanation of the circumstances under which formal notification was not made. No case occurred in which it appeared to be desirable to institute proceedings for deliberate or wilful neglect to comply with the regulations. The number of cases of Tuberculosis notified and those which came to knowledge by means of Death Reports and transfers from other Districts are given in the following tables:— 79 Public Health (Tuberculosis) .Regulations, 1912. Summary of Notifications during the period from 1 st January, 1928, to the 29th December, 1928 (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 previou by 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 — 2 1 3 11 17 32 37 43 25 9 180 242 - - - - - 29 151 21 111 Females - 1 2 7 19 18 38 25 15 9 - 134 179 - - - - 26 85 14 76 Non-pulmonary Males - 6 11 4 3 3 3 1 2 4 2 39 44 - 1 - 1 1 2 26 - 13 Females 1 6 6 13 4 4 6 1 1 3 - 45 51 - 1 - 1 2 - 25 - 12 Totals 1 15 20 27 37 42 79 64 61 41 11 398 516 — 2 — 2 3 57 287 35 212 Age Periods. Cases not Notified—Information obtained from Special Death Reports and by Transfer from other districts. 0 1 5 10 15 20 25 35 45 55 65 and upwards to to to to to to to to to to Total. 1 5 10 15 20 25 35 45 55 65 Males 1 — — — 1 15 4 5 5 2 24 Pulmonary Females — — — — 2 2 3 3 2 3 — 15 Males — 2 3 — — — — 1 1 1 — 8 Non- pulmonary Females 1 2 1 — — 1 — 3 — — — 8 Totals 2 4 4 — 3 4 8 11 8 9 2 55 80 The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years:— Year. Estimated Population. Primary Notifications. Deaths. Notification Bate. Death Rate. Pulmonary Other forms. All forms. Pulmonary. Other forms. All forma. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 1919 218387 799 206 1005 268 73 341 3.66 0.94 4.60 1.23 0.33 1.56 1920 218387 184 132 816 249 63 312 3.07 0.59 3.67 1.12 0 z8 1.40 1921 212900 546 153 699 250 54 304 2.56 0.72 3.28 1.17 0-25 1.43 1922 212500 534 148 682 257 58 315 2.51 0.70 3.21 1.2.1 0-27 1.48 1923 214400 440 137 577 211 61 272 2.05 0.64 2.69 0.98 C*28 1.27 1924 214300 447 119 566 227 44 271 2.05 0.54 2.59 1.04 O 20 1.24 1925 215900 389 103 492 l8o 51 231 1.80 0.48 2.28 0.83 0'24 1.07 1926 2l6400 354 112 466 175 37 212 1.64 0.52 2.15 0.81 0-17 0.98 1927 212800 378 92 4 70 I97 20 217 1.78 0.43 2.21 0.93 o-C9 1.02 1928 205600 353 102 455 191 25 216 1.72 0.50 2.21 0-93 0.12 1.05 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. Rate per 1000 of Population. Number. Rate per 1000 of Population. 1 77 2.2 40 1.1 2 39 1.8 26 1.2 3 80 2.3 27 0.8 4 48 1.9 21 0.8 5 74 2.6 37 1.3 6 37 1.9 17 0.9 7 30 2.0 14 1.0 8 65 2.5 31 1.2 Homeless 5 - 3 - Totals 455 2.2 216 1.1 81 Public Health (Tuberculosis) Reoulations, 1924. Those Regulations placed various additional duties upon local Authorities, and included the compilation of a register of cases of Tuberculosis of all kinds who are residents of tha Borough. The following table gives this information for the year ended December 31st, 1928:— Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1928 1299 465 1764 Number of new cases during the year 358 102 460 1657 567 2224 Number of cases removed from the Register during the year (from death or other causes) 313 104 417 Number of cases remaining on the Register at the end of the year 1344 463 1807 Public Health (Prevention of Tuberculosis) Regulations, 1925. No formal action was necessary during tho year under the above regulations. Boarding out of Children from Tuberculous Homes. This scheme was initiated in 1925, and provided for:— (a) The boarding out of children living in heavily infected and overcrowded homes, and for (b) The boarding out of children who were being discharged from Institutions, if the homes were unsuitable and inimical to the maintenance of health. At a later date the scheme was further extended to include : — (c) "Weakly" children, living under conditions likely to subject them to infection, and children, in suitable instances, whose parents were under treatment for tuberculosis. Originally the children were sent away for a limited period. When the scheme was extended it was decided that the children, in all categories, might be kept away as long as the home conditions were unfavourable. The arrangements are made by the Invalid Children's Aid Association, on behalf of the London County Council. During the year 10 children have been boarded out under the scheme. Si Provision of Beds and Bedding for Necessitous Tuberculous Patients.—This valuable step was initiated by the Borough Council in 1924. Beds and bedding are lent to tuberculous patients who would otherwise be compelled to share a bed with another or other persons. They are much appreciated by those to whom they are lent and their use should help to limit the spread of infection. The Health Visitors arc instructed to make periodical visits and to report on their condition and the manner in which they are used. Disinfection of Booms.—This procedure is always advised on the admission of a case to Hospital or Sanatorium, 011 change of residence and after the death of a patient. It is carried out by the Council's staff free of charge. During the past year disinfection was carried out in 153 cases. Home Visits and Inquiries. These are made by the six women Sanitary Inspectors and Health Visitors. The number of visits paid by each during the year is shewn in the following table:— Miss Bibby 363 Mrs. Hunter 1015 Miss Anderson 799 „ Blaxland 1304 ,, Camman 1774 „ Holland 1607 Total 6862 In connection with Tuberculosis, the housing conditions of the family are important. Any defects discovered on inspection are reported, and special efforts are made to secure more adequate accommodation if any degree of overcrowding exists. Sr. Pancras Tuberculosis Care Committee. The Care Committee was constituted in February, 1923, as a voluntary committee in accordance with the wishes of the Ministry of Health, and consists of representatives of various Social Organisations and ten members of the Borough Council, working in connection with the Tuberculosis Dispensary Scheme. The Council approved at that time an arrangement for Miss M, E. Bibby, one of the Council's Women Sanitary Inspectors, to be the Hon, Secretary of the Committee, and for Mrs. E. M. Pliilipson to undertake the duties specially referring to children's cases. The Council in January, 1928, arranged a re-distribution of the duties of the Women Sanitary Inspectors and Health Visitors, and it was decided that Miss Bibby should in future devote the whole of her time to the Council's work and discontinue the secretarial services which she had carried out in connection with the Tuberculosis Care Committee. The Committee temporarily arranged with Dr. A. Viney, the Tuberculosis Officer, to act as Hon. Secretary, with the assistance of Miss A. Andrews, Clerk in the Public Health Department. 83 111 July, Miss H. M. Whelon, of 76, Makepeace Mansions, Highgate, was good enough to place her voluntary services at the disposal of the Care Committee as Hon. Secretary, and they have appointed her to that position. Miss Whelon is experienced in this work, and is a member of the Care Committee of St. Anne's School, Brookfield. The Committee also recommended that Miss Andrews, who has performed clerical work for the Care Committee in addition to her ordinary duties in the Public Health Department since 1st February last, should continue to do so and be paid for these extra services (outside the ordinary office hours) at the rate of £20 per annum. The Borough Council are empowered to defray reasonable expenses of the Care Committee, and the Ministry of Health and the London County Council contribute one-half and one-fourth respectively of the cost. The Borough Couucil approved the above recommendations, and subsequently communications were received from the Ministry of Health and the London County Council approving the appointment of Miss H. M. "Whelon as Hon. Secretary of the St. Pancras Tuberculosis Care Committee, and a payment at the rate of £20 per annum to Miss A. Andrews for clerical duties performed outside office hours for the Care Committee. The Exchequer tuberculosis grant will be available in aid of the Borough Council's contribution in respect of this expenditure. Tuberculosis Cake 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 mcdical 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 res idential 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 arc mentioned above." The Care Committee have been fortunate in securing the services of Miss Whelon as Hon. Secretary. Since her appointment, not only is the routine work ably and actively carried out, but, thanks to her energy and initiative, a large number of necessitous patients have been helped with clothing, and at Christmas with gifts of provisions. The following particulars concerning the work of the Committee and the cases dealt with have been supplied by the Hon. Secretary—Miss Whelon:— 84 The St. Pancras Tuberculosis Care Committee. Report of the Hon. Secretary for the year 192$. The Committee has met regularly every week. The Chairman is Mr. S. N. Neal. During the period Jan. 1—Dec. 31, the total number of cases considered was 206. Of this number 156 were assessed as "free," the remaining 50 being assessed at various amounts, from one shilling and sixpence to two pounds, fifteen shillings. The following table gives the number of cases referred to various social agencies:— The Charity Organisation Society12 cases The United Services Fund2 ,, The British Red Cross4 ,, The Invalid Children's Aid Association 4 „ Other Agencies 10 „ Cases considered for Dentures. Fifteen cases were considered for dentures, of which 9 were "free." The others were assessed at various amounts from ten shillings to two pounds. During the last six months of the year 19 patients were helped by gifts of clothing. At Christmas 30 patients were given parcels of groceries. TUBERCULOSIS DISPENSARY. This is situated at 39, Oakley Square, and forms part of the premises of the St. Pancras General Dispensary. The portion used for Tuberculosis work comprises the whole of the first floor, and consists of a waiting room, consulting room, nurses' room, office and the necessary sanitary accommodation. Two dressing rooms are obtained by partitioning off a portion of the waiting room. Nine consultations are held in each week—2 in the morning, 5 in the afternoon, and 2 in the evening. The premises in which the work is carried out are not very satisfactory, the accommodation is inadequate in extent, and the noise caused by traffic adds to the difficulties of the work. The provision of new premises is at present under consideration. The following report on the work of the Dispensary has been furnished by the Tuberculosis Officer, Dr. Viney:— The number of new cases which attended the dispensary in the year 1928 appears in the report to have fallen considerably when compared with 1927. This fall is only apparent, as the non-tuberculous cases which had attended in previous years, and re-attended last year, have not been taken on the register as new cases merely to be discharged again as nontuberculous. 85 The actual number of new cases is about the same as during the previous year. The year ended with 849 on the Register, as compared with 885 in 1927. The number of attendances was 4,398, as compared with 5,094. There was, however, an increase of 18 in the number of cases sent up by general practitioners. Staff.—The staff of the Tuberculosis Dispensary consists of one whole-time tuberculosis officer, a part-time assistant tuberculosis officer, a whole-time nurse, a whole-time clerk, and the part-time services of six women health visitors, whose services practically equal two whole-time health visitors. In addition the services of a part-time dispenser are available. The work of the Dispensary includes diagnosis of new cases; recommendation of notified cases for Sanatoria or other institutional treatment, the examination and supervision of contacts, home inspections, examinations of sputa, etc. X-ray examinations, when required, are carried out under arrangements made with University College Hospital, and treatment by Fmsen light, for cases of Lupus, at the London Hospital. Dental treatment is carried out at the Dental department of the St. Pancras Dispensary. Artificial Pneumothorax treatment is done chiefly at the Brompton Hospital, and a few cases at University College Hospital. Considerable use is made of the Charity Organisation Department, the British Red Cross Association and various other charitable associations. Close touch is kept with the Tuberculosis Care Committee, the sub-committee meetings of which are attended each week by the Tuberculosis Officer. Some of the great needs of the work of the dispensary are 1. The means of offering suitable employment for those who return from Sanatoria fit for light work. 2. Means to alleviate excessive overcrowding in certain cases. 3. Increased use of the facilities for boarding out contact children, or at least giving unsatisfactory contact children country convalescence. In November permission was granted for the Tuberculosis Officer to attend a week's post-graduate instruction at the Victoria Park Hospital for diseases of the chest. The course was of great interest and has proved to be of intense value in the work of the dispensary. By its means a unique opportunity was given of observing and learning all the modern methods of diagnosis and treatment. A. VINEY, M.R.C.S., L.R.C.P., D.P.H." 86 The following table gives a summary of the work carried out at the Tuberculosis Dispensary during the year:— Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 94 65 1 4 3 1 3 6 97 66 4 10 (6) Doubtfully tuberculous — — — — — — — 28 46 8 9 (c) Non-tuberculous - - - - - - - - 48 70 49 40 B.—Contacts examined during the year:— (a) Definitely tuberculous 3 3 — — — — — — 3 3 — — (b) Doubtfully tuberculous - - - - - - - - 2 6 — 1 (c) Non-tuberculous - - - - - - - - 9 23 44 39 C.—Cases written off the Dispensary Register as— - (a) Cured — 1 — 3 — — 1 3 - 1 1 6 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 75 104 95 81 D.—Number of Persons on Dispensary Register on December 31st (a)Diagnosis completed 345 211 15 23 21 14 35 31 366 255 50 54 (b)Diagnosis not completed - - - - - - - - 37 58 13 16 Number of persons on Dispensary Register on January 1st 885 Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 19 Number of patients transferred from other areas and of "lost sight of" cases returned 46 Number of consultations with medical practitioners:— Number of patients transferred to other areas and cases "lost sight of" 234 (a) At homes of applicants 18 (b) Otherwise 225 Died during the year 90 Number of other visits by Tuberculosis Officers to homes 175 Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 69 Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3875 Number of attendances at the Dispensary (including Contacts) 4398 Number of— (a) Specimens of sputum. &c. examined 882 Number of attendances of non-pulmonary cases at Orthopædic Out-stations for treatment or supervision - (b) X-ray examinations made in connection with Dispensary work 50 Number of Insured persons on Dispensary Register on 31st December 479 Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for— Number of Insured persons under Domiciliary Treatment on the 31st December 316 (a) "Light" treatment 67 Number of Reports received during the year in respect of Insured persons:— (6) Other special forms of treatment 115 (a) Form G.P. 17 4 (b) Form G.P. 36 46 87 Section VII.—OTHER SERVICES. DISINFECTING AND CLEANSING STATION. Disinfection. In connection with cases of Infectious disease, Bedding, Clothing, etc., are disinfected by steam, under a pressure of 20 lbs., at the Council's Disinfecting Station, Cambridge Street. No charge is made. Library books and articles which would be injured by steam are disinfected by formaldehyde generated in a small chamber. Separate Motor Vans are used for the collection of infected and delivery of disinfected articles. The work done during the year by the disinfecting staff is shown in the following table: — Disease. No. of Cases. No. of Houses. No. of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Small Pox 3 4 14 14 Scarlet Fever 591 583 616 614 Diphtheria 874 368 894 393 Enteric Fever 14 14 17 8 Erysipelas 82 82 82 4 Puerperal Fever and Pyrexia 20 20 20 7 Encephalitis Lethargica 1 1 — 1 Cerebrospinal Meningitis 2 2 2 1 Tuberculosis 153 158 81 152 Measles 44 44 27 86 Vermin and Scabies 154 154 159 295 Other Diseases 326 327 312 53 Totals 1767 1752 1724 1578 88 The following table gives the number of articles disinfected or destroyed during the year on account of infectious disease or verminous condition:— Infectious Disease. Verminous. Destroyed. Disinfected. Destroyed. Disinfected. Beds, mattresses and palliasses 86 1667 15 88 Bolsters and pillows 43 8456 4 51 Sheets, blankets and counterpanes 31 5183 10 54 Rugs, mats, cushions, carpets, covers and curtains 25 697 4 8 Wearing apparel 35 1996 10 26 Books 1 138 - - Sundries 30 239 - - Totals 251 13376 43 177 The tables above are exclusive of the disinfection of the clothing of persons who attended the cleansing station on account of being infested by vermin or suffering from scabies. Disinfection for Institutions, etc.—In addition to the disinfecting work carried out free of charge in connection with infectious disease, disinfections for other conditions are frequently performed for hospitals or private residents. A small charge is made in these cases to cover the cost. The fees received for this work during the year ended 31st March, 1929, amounted to £86 7s. 6d. 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. Vermin 1064 31 4226 *5321 Scabies 26 38 685 749 Totals 1090 69 4911 6070 * Includes 628 uiales and 1 female who had no home address. The staff of the Disinfecting and Cleansing Station consists of a Foreman, a Disinfector and 2 Motor Drivers and Disinfectors ; a Matron of the Cleansing Station and 2 Women Assistants. The majority of the children included in the above table have been brought to the cleansing station from the public elementary schools by officers of the London County Council. 89 As the Education Authority, powers were conferred upon them by the London County Council (General Powers) Act, 1907, and the Children Act, 1908, authorising the cleansing of children whose bodies or clothing were infested with vermin, or who were in a foul or filthy condition. The necessary cleansing work is carried out by the staff of the Borough Council on behalf of the County Council. Payment is made by the latter at the rate of two shillings per child in respect of verminous conditions and one shilling per bath for those suffering from scabies. In connection with children whose bodies or clothing are very verminous, arrangements are made for the homes to be visited by the Sanitary Inspector as the rooms and bedding may also need disinfecting. It would obviously bo useless to deal with the child and neglect the home. BACTERIOLOGICAL WORK. To aid in diagnosis and to detect contact or carrier cases the Borough Council provides bacteriological diagnosis, free of charge, in connection with certain diseases. In addition to the above, the preparation and supply of vaccines is undertaken, if desired by the medical attendant, for use in connection with cases of Puerperal Fever. This work is performed by Professor F. II. Teale, M.n., of University College Hospital, under an arrangement made with the Council. The undermentioned examinations were made during the year:— Nature of Specimen. Positive. Negative. Total. Swabs for Diphtheria Bacilli 161 1428 1589 Blood re Typhoid Fever 1 15 10 Sputum for Tubercle Bacilli 53 431 484 Facilities for the examination of Cerebro-spinal fluid in suspected cases of Poliomyelitis, Encephalitis Lethargica and Cerebro-spinal Fever are available through the London County Council's laboratory, and for the examination of blood in cases of suspected Malaria through the Ministry of Health. APPENDIX. 92 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1928 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. Nett of Nonresidents registered in the District. of Residents not registered in the District: Under 1 Year of Age. At all Ages. corrected Number. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1918 196883 175716 3339 3318 16.8* 3789 21.0† 626 751 340 102 3914 22.3† 1919 228585 219434 3804 3824 16.7* 3104 14.1† 670 496 336 88 2930 134† 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 13.3† 680 561 280 72 2745 12.7† 1926 216800 216400 4129 3612 16.7* 2992 13.8† 855 543 274 76 2680 12.4† 1927 213200 212800 3925 3299 15'5* 3034 14.3† 939 526 205 62 2621 12.3† 1928 206000 205600 3980 3274 15.9* 3053 14.8† 985 550 261 80 2618 12.7† Area of district in acres (land and inland water), 26944; total population at all ages, 211,366; number of inhabited houses, 24,660; average number of persons per house, 8'57; at Census, 1921. * Based on total population. † Based on civil population. 93 Table No. 2. REGISTRAR-GENERAL'S SHORT LIST OF THE CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF ST. PANCRAS, 1928. CAUSES OF DEATH. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 5 years and upwards. ALL CAUSES M 1426 144 50 37 36 47 160 455 287 210 F 1217 118 40 39 21 48 137 293 241 280 1. Enteric Fever M 2 - - 1 - — 1 - — - F - - - - - - - - - - 2. Small Pox M - - - - - - - - - - F - - - - - - - - - - 3.Measles M 74 20 32 16 6 - - - - - F 54 12 21 17 4 - - - - - 4. Scarlet Fever M 1 - - 1 - - - - - - F - - - - - - - - - - 5. Whooping Cough M 11 3 6 2 - - - - - - F 14 5 6 3 - - - - - - 6. Diphtheria M 8 - 1 3 3 - 1 - - - F 4 - 1 3 - - - - - 7. Influenza M 4 - - - - - - 2 2 F 10 - - - - - 2 2 2 4 8. Encephalitis Lethargica M - - - - - - - - - - F - - - - - - - - - - 9. Meningococcal Meningitis M 1 - - - 1 - - - - - F 1 - - - - 1 - - - 10. Tuberculosis of Respiratory System M 117 1 - 1 - 15 46 48 6 - F 78 - - - 2 20 34 21 - 1 11. Other Tuberculous Diseases M 13 - 2 - 1 1 4 - 1 F 14 1 1 3 4 3 - - - 12. Cancer, Malignant Disease M 166 - - 1 - 3 10 84 43 25 F 162 - - - - 1 22 65 52 22 13. Rheumatic Fever M 4 - - - 2 2 - - - - F 5 - - - 2 2 1 - - - 14. Diabetes M 11 - - - - - - 3 7 - F 10 - - - - - 1 5 4 - 15. Cerebral Haemorrhage, etc. M 36 - - - - - 3 14 11 8 F 14 - - - - - 1 12 20 11 94 TABLE No. 2—continued. CAUSES OF DEATH. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 years and upwards. 16. Heart Disease M 244 1 - - 1 5 13 79 71 74 F 215 - - 1 1 3 18 59 62 71 17. Arterio-sclerosis M 66 - - - - - 17 27 22 F 71 - - - - - - 14 15 42 18. Bronchitis M 77 4 2 - - - 6 3G 14 15 F 68 7 - - - 1 9 13 33 19. Pneumonia (all forms) M 122 24 5 5 2 7 11 45 19 4 F 91 22 4 10 2 1 8 13 18 13 20 Other Respiratory Diseases M 14 - - - - - 2 4 6 2 F 10 - - - - - 1 3 2 4 21. Ulcer of Stomach or Duodenum M 25 - - - - 1 3 17 3 1 F 6 - - - - - - 2 4 - 22. Diarrhœa, etc. M 28 23 2 - 1 - - - 2 - F 23 18 1 - - 1 1 1 1 - 28. Appendicitis and Typhlitis M 10 - - - 1 1 6 1 - 1 F 7 - - - 1 - 2 3 - 1 24. Cirrhosis of Liver M 7 - - - - - - 6 1 - F 7 - - - - - 1 1 2 3 25. Acute and Chronic Nephritis M 39 - - - 1 1 10 14 8 5 F 39 - - - - 2 4 17 10 6 26. Puerperal Sepsis M - - - - - - - - - F 4 - - - - 2 2 - - 27. Other Accidents and Diseases of . Pregnancy and Parturition M - - - - - - - - - - F 3 - - - 2 1 - - - 28. Congenital Debility and Malformation, Premature Birth M 42 42 - - - - - - - - F 43 43 - - - - - - - - 29. Suicide M 23 - - - - 1 9 11 1 1 F 14 - - - - - 8 5 1 - 30. Other Deaths from violence M 69 2 - 4 7 7 17 19 6 7 F 53 2 - 1 4 5 5 11 12 13 31. Other defined Diseases M 212 24 - 3 7 3 21 51 62 41 F 172 8 - 1 3 4 21 50 23 56 32. Causes ill-defined or unknown M - - - - - - - - - - F - - - - - - - - - - Legit, Illegit. M 1 23 Deaths uuder 1 year F 104 14 95 Total Births, Total Deaths, Infantile Deaths, and Deaths from Tuberculosis, with corresponding rates for each ward. Births and Deaths.—Outward transfers are excluded, and then births and 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. 1 525 14.8 424 12.0 32 61 40 1.1 2 341 16.1 244 11.6 24 70 26 1.2 3 569 16.5 428 12.4 45 79 27 0.8 4 430 17.2 347 13.9 34 79 21 0.8 5 507 17.4 409 14.2 50 99 37 1.3 6 340 17.0 252 12.6 33 97 17 0.9 7 171 11.7 170 11.6 12 70 14 1.0 8 391 15.0 318 12.2 29 74 31 1.2 Homeless — — 26 — 2 . 3 — Borough 3274 15.9 2618 12.7 261 80 216 1.1 96 Table No. 4.—Showing the Birth rates, Death rates, and Infantile Mortality rates of England and Wales and certain of the large Towns, and of London and the Metropolitan Boroughs for 1928. (52 weeks ended 29th December, 1928.) Estimated Population, Mid. 1927. Birth Rate. Death Rate. Infantile Mortality. Estimated Population, Mid. 1927. Birth R»te. Death Rate. Infantile Mortality. England and Wales †39,482,000 16.7 11. 7 65 County of London 4,541,000 15.9 11.6 67 Birmingham 952,800 18.1 10.9 65 West. Liverpool 872,900 21.9 12.8 92 Paddington 142,700 15.3 12.8 84 Manchester 751,900 17.2 12.9 90 Kensington 176,500 14.5 12.7 86 Sheffield 524,900 16.1 11.3 73 Hammersmith 132,800 17.0 11.4 67 Leeds 482,600 15.9 12.4 77 Fulham 161,900 14 7 10.8 77 Bristol 385,700 16.5 11.5 61 Chelsea 163,690 12.6 13.2 48 West Ham 315,400 18.7 10.5 64 City of Westminster 186,500 9.9 10.7 57 Hull 296,600 20.6 12.6 80 North. Bradford 293,200 15.1 12.9 68 St. Marylebone 103,500 12 7 11.6 77 Newcastle-on.Tyne 288,500 18.8 12.4 82 Hampstead 86,160 11.6 11.8 54 Stoke-on-Trent 276,900 19.9 11.6 86 St. Pancras 212,800 15.5 12.1 79 Nottingham 265,700 17.7 12.5 85 Islington 334,300 17.4 12.3 64 Salford 247,600 16.8 12.3 96 Stoke Newington 52,130 14.9 11.8 59 Leicester 245,000 16.3 10.9 70 Hackney 224,700 15.5 11.2 68 Portsmouth 232,100 18.0 11.5 54 Central. Cardiff 225,600 18.1 116 77 Holborn 42, 209 11.2 12.3 55 Croydon 212,400 15.9 10.7 58 Finsbury 75,500 19.5 14.1 83 Sunderland 187,800 23.2 131 87 City of London 18,010 6.8 10.6 73 Plymouth 187,600 17.2 13.2 70 East. Bolton 178,300 14.7 12.7 64 Shoreditch 105,700 19.8 12.8 76 Southampton 169,800 18.0 11.7 49 Bethnal Green 117,900 18.1 11.0 73 Willesden 165,320 16.4 10.3 56 Stepney 250,880 18.0 11.4 72 Swansea 162,700 18.4 11.2 61 Poplar 167,000 19.3 11.8 71 Birkenhead 162,000 18.1 11.8 78 South. Rhondda 159,270 170 11.0 77 Southwark 184,250 18.9 12.5 70 Coventry 152,400 160 10.4 65 Bermondsey 121,0(10 18.8 12.4 78 Tottenham 150,210 16.5 10.1 53 Lambeth 307,700 16.3 11.7 61 Brighton 147,600 13.9 12 4 49 Battersea 169,000 16.2 11.3 62 East Ham 146,900 15.1 9.7 49 Wandsworth 34.2,700 185 10.8 50 Oldham 141,400 14.5 14.0 88 Camberwell 271,100 15.3 11.2 61 Derby 137,700 17.6 10 8 64 Deptford 113,800 161 11.7 76 Wolverhampton 135,200 19.6 10.3 61 Greenwich 101,920 16.7 11.0 54 Middlesbrough 133,600 241 12.8 88 Lewisbam 188,600 16.1 10.3 52 Leyton 128,920 14.4 10.1 48 Woolwich 140,770 15.7 10.7 50 Gateshead 127,400 21.6 12.5 85 I Preston 127,100 151 12 4 86 Stockport 125,200 14.6 12.4 76 Estimated population to middle of 1928 97 Table. No. 5.—Meteokoi.ogicai. Table for Saint Pancras, 1928. (Deduced from observations at Camden Square, N. W. 1.) January. February. March. April. May. June. July. August. September. October November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 29.20 30.111 29.816 29.800 29925 29.939 30.101 29.952 30147 29.858 29.798 30.050 Air temperature— Mean of— A. Maximum 47.4 50.1 50.9 56.2 630 67.6 77.6 71.1 68.9 58.8 52.0 43.9 B. Minimum 36.8 37.7 39.3 41.7 45.8 50.6 56.2 54.8 490 46.1 42.2 34.8 Mean of A and B 42.1 43.9 45.1 48.9 54.4 591 66.9 62.9 58.9 52.5 47.1 39.3 Difference from Average +3.3 +39 + 2.2 +0.5 +0.7 —1.9 +2.6 —0.3 +0.3 + 1.8 +2.8 —1.2 Humidity—Morning 91 83 86 75 74 70 64 77 87 88 93 Earth Temperature at 4 ft. depth 43.4 43.3 43.3 45.4 49.0 52.9 57.1 58.9 57.5 54.0 61.1 47.3 Bright Sunshine Total Observed (daily mean) Hrs 1.42 2.21 2.16 3.65 5.53 7.02 9.35 5.87 5.77 2.78 1.44 0.81 Per cent, of total possible 17 18 26 34 43 58 40 46 26 16 11 Difference from average Hrs. — — - — — ~ . — — — . — Rain and other forms of precipitation- Number of Days 21 11 19 17 11 13 7 19 20 16 16 Total Fall Hrs. 3.60 1.66 1.39 1.3.2 1.81 2.59 2.12 2.60 0.69 3.41 2.15 2.66 Difference from average +1.73 0.0 -0.47 -0.24 + 0 04 ' +0 59 —0.28 +0.39 —114 +0.79 —0.20 +0.28 Hour of observation, 9 a.m. (Greenwich time). The readings for Bright Sunshine are those taken at Regent's Park—no readings being recorded at Camden Square. 98 Table No. 6.—Report of Work carried out by District 1 nspectors for the year 1928 Rackham. Lonnon. Brown. Walker. James. Adkins. Akers. Jaffa. Capel. Nixon. West. Winchester Totals. Complaints received, 3,025 Complaints Investigated. Whole house inspected 2 3 54 14 20 88 61 14 71 44 37 24 432 „ Part of house inspected 195 381 308 292 204 202 172 376 177 26.8 385 241 3201 ,, Re-inspections 829 663 1655 814 658 892 523 769 100 1061 1685 581 11230 Infectious Diseases Investigations and inspections 142 445 23» 253 306 432 214 202 257 208 217 70 2977 Re-inspections 6 401 431 26 160 386 350 23 495 163 223 106 2870 Smoke Observations 3 8 — 90 29 22 4 64 8 14 — — 242 Offensive or Regulated Trades — 5 1 — — — 2 37 3 — 8 — 56 Mews and Stable Yards—Number Inspected 308 516 239 376 315 267 463 400 356 375 238 214 4067 Other Inspections and Re-inspections 89 23 11 18 27 97 19 19 80 70 47 188 688 Housing Acts and Regulations, 1925. Number of Houses Inspected Primary Inspections — 31 46 27 — 14 28 53 89 21 45 31 385 Re-inspections — 34 308 208 — 18 4 118 463 45 248 59 1505 Underground rooms illegally occupied Inspections - - - - - - - - 1 1 — — 2 Re-inspections — — — — — — 6 — 5 — 3 — 14 Houses let in Lodgings (Bye-laws Sec. 6). Number of Tenements Inspected Primary Inspections — — 28 77 402 2 63 — 21 67 26 67 753 Re-inspections — — 266 937 1978 — 623 — 78 294 218 451 4842 Drainage. (a) Under Notice, Plans, Supervision, etc. 94 318 287 190 194 338 262 22 8 296 421 367 557 3352 (3) Voluntary, do. do. 533 575 172 399 186 1003 827 835 349 318 240 315 5752 (c) New Buildings do. do. 987 228 2 167 1 — 196 26 148 362 — 29 2146 (d) Tested after Infectious Disease, 553. Attendances at Police Court, etc. 4 3 5 2 14 3 8 — 14 2 1 — 56 Rent and Mortgage Interest Restrictions Acts. Inspections 1 5 4 1 5 4 2 1 6 2 4 — 35 Re-inspections 4 3 15 — 5 26 8 2 2 1 4 — 70 Totals 3197 3642 4063 3891 4604 3794 3832 3167 4019 3737 3996 2733 44675 Notices served:— Intimations 178 184 352 269 488 326 306 212 364 362 458 389 3888 R.R. A.(Tenants) — 5 4 1 5 3 2 1 6 2 6 — 35 Do. Release (Owners) — 2 2 — 2 1 2 1 2 1 4 — 17 Totals 178 191 358 270 495 330 310 214 372 365 468 389 3940 Note.—Inspector Winchester commenced duties 1st June, 1928. 99 Table No. 7.—Inspections and other work of the Food Inspectors daring 1928. Mr. Auger. Mr. Child. Total. Number of Visits to:— Milkshops 365 334 699 Dairies 85 26 111 Cowsheds — — —" Ice Cream Premises 87 153 210 Slaughter Houses 77 82 159 Butchers' Shops and Meat Stalls 1271 1950 3221 Prepared Meat Premises 22 282 304 Fishmongers' Shops 4 58 62 Fried Fish Shops 176 197 373 Fish Curers' premises 26 75 101 Other Premises where Food or Drugs are sold 65 47 112 Marketing Streets and Places 2098 1110 3208 Attendances at Police Court 2 14 15 Other Visits 259 20 459 Re-inspection after Intimation Notices 5 120 125 Total 4542 4648 9190 *Number of Samples taken: — Formal 259 319 578 Informal 141 81 222 Total 400 400 800 Unsound Surrenders:- Meat, &c. 9 8 17 Fish 7 2 9 Shell Fish — 1 1 Fruit 4 4 8 Vegetables 1 — 1 Margarine 1 — 1 Total 22 15 37 Seizure:- Grape Fruit — 1 1 Canal Boats inspected 6 6 Notices Served 3 24 27 * See page 67. 100 Table No. 8. Report of Work carried out by the Factory and Workshop and Women Inspectors during the year 1928. Inspections and Re-Inspections. Thompson. Bibby. Hunter. Anderson. Blaxland. Camman. Holland. Totals. Factories (including factory laundries and bake houses) 1576 88 31 33 7 30 13 1783 Workshops (including workshop laundries and bakehouses) 1682 471 68 42 8 56 56 2383 Workplaces (including Restaurant kitchens) 164 173 20 55 67 128 83 980 Outworkers' premises — 2 123 10 — 7 — 142 Measles — 93 606 869 835 926 896 4225 German Measles — 6 25 34 3 22 5 95 Whooping Cough — 1 74 138 26 18 102 359 Ophthalmia Neonatorum — — 21 28 37 31 25 142 Puerperal Fever — 1 6 1 5 10 4 26 ,, Pyrexia " — 4 12 9 5 4 11 45 Tuberculosis 363 1015 799 1304 1774 1607 6862 Other diseases — 56 334 682 53 167 177 1469 Infectious Disease (after care) - 79 203 600 57 375 411 1725 Milk Enquiries — 49 68 40 19 42 79 287 Assisting at Centres — 79 7 — 39 30 — 155 Attendance at Tuberculosis Dispensary — 3 118 131 141 204 173 770 Hospitals or other Institutions - 29 5 7 12 5 15 73 Verminous Persons - 8 28 46 3 6 14 105 Other Visits — 175 124 41 382 211 247 1210 Totals 3722 1680 2877 3570 2993 4076 3918 22836 Notices served relating to:— Factories 19 2 - - - - - 121 Workshops 95 6 1 — — — - 104 Workplaces 27 - - - - - - 27 Others - - - - - - - - Totals 211 10 1 - — — 252