STPAN 88 AC4 355 Metropolitan Borough of Saint Pancras. REPORT of thE, MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930. 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. F. P. Lewingdon, 26 & 97, Eversholt Street, N.W. Metropolitan Borough of Saint Pancras. With the Medical Officer of Health's Compliments. Public Health Department, Town Hall, Pancras Road, N.W . I. S. 3. 1000. 10-30. Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930. G. SOWDEN, M.D., D.P.H., M.R.C.S., L.R.C.P., Barrister-at-Law, Fellow of the Royal Institute of Public Health. 3 CONTENTS. page Map of Borough, showing statistics by Wards 2 Public Health Committee 5 Staff of Public Health Department 6 & 7 Introduction 8 Statistical Summary 11 Section I.—Statistics, and Social Conditions of the Area. Population and General Statistics 13 Principal occupations of the inhabitants of the Borough 14 Economic Conditions 15 Marriages 15 Births 15 Illegitimacy 16 Notification of Births 16 Still Births 17 Deaths. 17 Inquests 19 Infantile Mortality 20 Section II.—General Provision of Health Services. Hospital Accommodation 23 Institutional Provision for Unmarried Mothers 24 Ambulance Facilities 24 Clinics, Treatment Centres, &c. 24 Maternity and Child Welfare 26 Block Grants 26&27 Ante-natal 27&31 At Birth 27 Infants and Young Children 28 Advice Cards 28 Home Visiting 28 Attendances at Consultations, etc. 30 Centres 33 Artificial Light Treatment 35 Dental Clinic 36 Day Nurseries 37 Nursery Schools 38 Sun Bathing Play Centre 38 Clinic for Ailing Mothers and Children 40 Convalescent Home Treatment 40 Home for Sick Poor Children 40 Supply of Milk to Mothers and Children 41 Professional Nursing 42 Home Helps 43 page Midwives 43 Midwifery 43 Maternal Mortality 45 Medical examination in elementary schools 46 Provision of Insulin 48 Public Health Officers of the Local Authority 48 Local Legislation 48 Public Health Legislation 49 London County Council By-laws 49 Agricultural Produce (Grading and Marking) Act 49 Merchandise Marks Act 49 Tuberculosis Regulations 50 Qualification of Medical Officers and Health Visitors (Regulations) 50 Local Government Act, 1929 50 Housing Act, 1930 50 Parrots (Import) Regulations 50 Health Propaganda 50 Section III.—Sanitary Circumstances of the Area. Water Supply 51 Public Baths and Washhouses 51 Drainage 51 National Rat Week 52 Pigeons 52 Refuse Collection and Disposal 53 Mortuary 53 Sanitary Inspections 54 Notices served 54 Nuisances—Legal Proceedings 54 Smoke Abatement 55 Factory and Workshop Acts 55 Inspections 55 Defects found 56 Home Work 56 Factories, Workshops and Workplaces on Register 57 Other matters 58 Premises and Occupations controlled by bye-laws or regulations 58 Offensive Trades 58 Rag and Bone Dealers 58 Rag Flock Acts, 1911-1928 59 Houses Let in Lodgings 59 Lighting of Staircases 59 Canal Boats Acts 59 Rent and Mortgage Interest Restrictions Act, 1923 59 4 CONTENTS—continued. page Section IV.—Housing. Statistics 60 Housing Conditions 61 Underground Rooms 65 Housing Schemes— Work of the Estates Committee 67 Section Y.—Inspection and Supervision of Food. (а) Milk Supply 69 Cowsheds, Dairies and Milkshops 69 Bottled Milk 70 Sampling out of Office Hours 70 Milk (Special Designations) Order, 1923 70 Artificial Cream Act, 1929 72 (b) Meat and Other Foods 72 Unsound or diseased food condemned and destroyed 73 Slaughter-houses 73 Fried Fish and Fish Curing Premises 73 Ice Cream Premises 73 Bakehouses and Restaurant Kitchens 73 Underground Bakehouses 73 (c) Sale of Food and Drugs Acts— Samples taken 74 Prosecutions— (a) Sale of Food and Drugs Acts 76 (b) Milk and Dairies Order, 1926 76 (c) Merchandise Marks ported Goods) No. 4 Order, 1929 76 (d) London County Council (General Powers) Act, 1928 77 Wholesale Dealers in Margarine 77 Section VI.—Prevalence of, and control over, Infectious Diseases. Notifiable Diseases 77 Notifications and Deaths from notifiable diseases by ages 78 Do. by Wards 79 Small Pox 80 Vaccination 80 Scarlet Fever 84 Diphtheria 84 Enteric (Typhoid) Fever 84 Puerperal Fever and Pyrexia 85 Erysipelas 86 Cerebro-spinal Meningitis., 87 tagfe Anterior Poliomyelitis and Polioencephalitis 87 Ophthalmia Neonatorum 87 Encephalitis Lethargica 88 Pneumonia 88 Malaria 88 Dysentery , 88 Measles and German Measles 88 Psittacosis 91 Yellow Fever 92 Tuberculosis— New Cases and Deaths 93 Notifications 94 Prevalence and fatality for 10 years 95 Notifications and Deaths by Wards 95 Public Health (Tuberculosis) Regulations, 1924 96 Public Health (Preventionof Tuberculosis) Regulations, 1925 96 Boarding-out of Children 96 Provision of Beds, etc. 96 Disinfection of Rooms 97 Home Visits and Enquiries 97 Care Committee 97 Dispensary 98 Artificial Light Treatment 99 Report by Tuberculosis Officer 99 Summary of work carried out 100 Section YII.—Other Services. Disinfecting and Cleansing Station 101 Disinfection for Institutions, etc. 101 Bacteriological Work 103 Appendix. Table No. 1. Vital Statistics for 11 years 106 Do. 2. Registrar - General's Short List of Causes of Death 107 Do. 3. Births and Deaths in Wards 109 Do. 4. Do., in certain large towns and Metropolitan Boroughs 110 Do. 5. Meteorology 111 Do. 6. Work carried out by District Inspectors 112 Do. 7. Do.—Food Inspectors 113 Do. 8. Do.—Factory & Workshop & Women Inspectors 114 Do. 9. Do.—Centre Superintendents, Women Inspectors and Health Visitors 115 Metropolitan Borough of Saint Pancras, PUBLIC HEALTH COMMITTEE. November, 1929, to October, 1930. CHAIRMAN. Councillor Evan Evans. DEPUTY-CHAIRMAN. Councillor Mrs. Evelyn Alliston. EX-OFFICIO. The Right Worshipful The Mayor (Councillor H. E. Capes, J.P.). ALDERMEN. Gregg, Dr. Edward Andrew. Morrell, Rev. R. Conyers, M.A. Rolles, Harry. Swift, Mansell James, F.R.M.S. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 8 Badge, William. 2 Bell, Mrs. Florence Nightingale Harrison. 3 Bolsom, Sidney. 4 Brieiiley, Charles Henry. 7 Crosby, Miss Ada, M.B.E. Davies, John William. 5 Denyer, Charles Henry, M.A. 1 Ellis, Alfred Cave, F.S.I. 5 Escott, Arthur. 8 Evans, John. 3 Hewson, Frederick. 2 Horne, George. 7 Jenkins, Edwin. 2 Powe, Frederick William (Junior). 5 Radford, Mrs. Laura. 1 Smerdon, Mrs. Edith Maude. 4 Woods, Mrs. Iris Marion. November, 1930, to October, 1931. CHAIRMAN. Councillor Mrs. Evelyn Alliston. DEPUTY-CHAIRMAN. Councillor Charles Henry Denyer, M.A. EX-OFFICIO. The Right Worshipful The Mayor (Councillor Christopher Harvey, J.P.). ALDERMEN. Gregg, Dr. Edward Andrew. Morrell, 1!ev. 11. Conyers, M.A. Rolles, Harry. Swift, Mansell James, F.R.M.S. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 8 Badge, William. 2 Bell, Mrs. Florence Nightingale Harrison. 4 Brierley, Charles Henry. 3 Capes, Henry Edward. 7 Crosby, Miss Ada, M.B.E. 1 Davies, John William. 1 Ellis, Alfred Cave, F.S.I. 5 Escott, Arthur. 8 Evans, Evan. 8 Evans, John. 4 Flynn, William, J.P. 3 Hewson, Frederick. 2 Horne, George. 7 Jenkins, Edwin. 5 Kirby, Frederick George. 1 Smerdon, Mrs. Edith Maude. 4 Woods, Mrs, Iris Marion, M.A. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of 1930. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. (o) G. Sowden, M.D., D.P.H., M.R.C.S., L.R.C.P. TUBERCULOSIS OFFICER. (a) G. A. Back, B.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H. ASSISTANT MEDICAL OFFICER. (g) p. y. Pkitchahd, M.B., Ch.B., d.p.IL, M.r.C.p., f.r.f.p.S. PUBLIC ANALYST. J. Kear Colwell, F.I.C. PUBLIC VACCINATORS. Dr. N. J. Goodchild—Ward 1. Dr. F. L. Pkli.y—Ward 2. Dr. J. Wigg—Wards 8 and 4. Dr. A. E. Tait—Wards 5, 6 and 7. Dr. C. II. A. Ai.derton—Ward 8. VACCINATION OFFICER. Mr. A. E. Wolfe. (G)SANITARY INSPECTORS. Inspectors of Food and Food Places. &1iW. G. Auger. §¶ H. R. Child. Inspectors of Workshops and Factories. ‡Miss M. E. Birby, B.A. (Lond.). ‡§B. II. Thompson. District Inspectors. §G. Rackham. ‡§¶ J. Lonnon. ‡§W. L. Brown. ‡§ ¶ A. H. Walker. ‡§ R. E. James. ¶‡ G. W. Adkins. ‡R. C. Akers. ‡M. Jaffa. ‡¶S. W. Capel. ‡¶H. K. Nixon. § H. G. West. §‡ E. W. Winchester. (G) SANITARY INSPECTORS AND HEALTH VISITORS (FOR TUBERCULOSIS). ‡||†**Miss J. A. J. Camman. ‡||Miss A. Holland. CLERICAL STAFF. W. C. W. Rowoiith. Chief Clerk. A. Carpenter, (g) G. N. Cove. T. H. Hague. W. C. Mansfield. F. A. J. Goodchild (attached to the Estates Dept.). (g) Miss A. Andrews. R. Warren, (g) J. A. Hoarf. E. f. Ivirhy. * Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Royal San. Inst. ¶ Cert. Meat and other Foods. || Health Visitor's Certificate, † C.M.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 Comultations per month. Dr. Chas. H. A. Alderton 4 Dr. Albert J. Clarke 2 Dr. B. Marion Cockerell 14 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 5 Dr. Ethel F. Iredell 4 Dr. Lydia A. Leney 4 Dr. J. Balfour Neill 8 Dr. Martin Oldershaw 2 Dr. Margaret R. Paterson 4 Dr. Mary J. Pirret 8 Dr. Francis L. Provis 13 Dr. Audrey E. Russell 4 Dr. Abraham I. Silverman 4 Dr. Helen Turover 5 (g) Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist 8 Dr. Jas. Maughan, Anmthetist 2 (g) Artificial Light Clinic. Dr. William Beaumont 8 (g) Consulting Obstetric Surgeons. Martin H. Oldershaw, M.D., B.S., F.R.C.S. Francis L. Provis, M.R.C.P., F.R.C.S. (g) Dentists at Tuberculosis Dispensary. Mr. A. J. Maurice, L.D.S. Mr. J. H. Threlfall, L.D.S. Mr. B. R. Vincent, L.D.S. (The above are part-time officers.) (G) Superintendents of Maternity and Child Welfare Centres. senior. ‡||Miss G. R. Bristow. ||‡MRS. E. Crockart. ||‡Miss M. H. Landel Jones. **Miss M. Smyth. †Miss M. Tkmpleton. Junior. ||†Miss M. L. Blair. ||†MRS. S. C. Chapman. **||†Miss M. Manger. ||†Miss E. M. Robinson. (g) Health Visitors and Inspectors at Maternity and Child Welfare Centres. ‡§||Miss F. A. Anderson. †*Miss E. B. Bagnall. ‡||Miss Y. K. Blaxi.and. ||†MRS. E. E. Bruce. ||‡Miss M. A. Clarke. ||†Miss B. M. Harris. ||Miss A. M. U. Harrop. ‡§Mrs. A. Hunter. †Mrs. E. Lurie. †||‡MRs. J. Lynn. ||†Mns. M. A. Smith. (g) Tuberculosis Dispensary. Nurse, |‡†Miss S. A. Long. Clerical, etc.. Assistant, Miss M. Deed. DISINFECTING AND CLEANSING STAFF. T. Bartholomew (Foreman). A. J. Dibben (Disinfector). J. Stanley (Driver and Disinfector). C. Browne ( Do. ). Mrs. Hi. Mace (Matron). Mrs. A. Styles (Assistant). Mrs. L. Blaby ( Do. ). J. Root (Mortuary, etc., Caretaker). (The above are full-time officers.) ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Royal San. Inat. ** Midwifery Certificate, || Health Visitor s Certificate. + C.M.B. Oueen Charlotte's Hospital. (a) Officers to whose salary contribution is made under the Public Health Acts or by Ex chequer Urania 8 Public Health Department, Town Hall., Pancras Road, N.W. 1. To the, Mayor, Aldermen and Councillors of the Metropolitan Borough ok St. Pancras. Ladies and Gentlemen, In accordance with requirements specified in the Sanitary Officers Order, I have the honour to present the Annual Report on the sanitary circumstances, the sanitary administration, and the vital statistics of the Borough for the year 1930. This is the 75th Annual Report which has been presented, and the eighth which it has been my duty to submit to the Members of the Council. The Registrar-General has not provided any figures with reference to the estimated population of the Borough for the year 1930, in view of the fact that the Census is due to be taken shortly and definite figures will therefore be available during the year. The Minister of Health has suggested that, for the purpose of this report, the estimated population of the Borough for the year 1929 shall be taken as representing the population for 1930. This suggestion has been adopted, as it is probable that no material alteration has occurred during the 12 months, and, therefore, the various rates which are calculated on this estimate will not be affected to any serious extent,. A summary of the principal statistics for the year is given on pages 11 and 12. These statistics present several very satisfactory features when compared with the corresponding figures for previous years, and indicate that the public health in St. Pancras was never better. The principal items to which attention may be directed are the following: — The birth rate, 15.4 per 1000 of population, was practically the same as for the previous year when the rate was 15.5. The death rate was the lowest hitherto recorded in the Borough, being only 119 per 1000 of population, as compared with 15.3 for the previous year. The infantile mortality rate was also the lowest hitherto recorded in the Borough, the rate being 60 per 1000 births, as compared with a rate of 83 for the preceding year. The maternal death rate and the death rate from Tuberculosis were also the lowest previously recorded in the Borough. Notifiable infectious diseases showed no undue prevalence, with the exception of Measles and Small-pox. A number of cases of the last mentioned disease were notified late in the previous year, and cases continued to occur during the first six months of 1930. Although the type of illness was in no case severe and the mortality nil, the work of the department was considerably increased, as not only had actual cases of the disease to be dealt with, but much time and labour had to be expended in connection with the tracing and visiting of contacts., 9 The work of the department was also disarranged and rendered difficult owing to the number of changos which took place in the staff. Dr. A. Viney, who had rendered very able service since his appointment in 1925, first as Assistant Medical Officer and later as Tuberculosis Officer, tendered his resignation in July. Mr. A. D. Corrick, Chief Clerk since 1925, and an exceedingly capable and efficient officer, left the department in August on being appointed Deputy Town Clerk. Mr. A. G. Capel, First Clerk, who had been associated with the Public Health Department for 34 years, was appointed Hate Collector. Mr. J. D. Holiday, Clerk since 1925, was appointed a Registrar of Births and Deaths. Mr. H. G. Avril, Junior Clerk since 1925, resigned on obtaining an appointment as Sanitary Inspector under another Authority. Miss Y. B. Woodroff, Health Visitor, resigned her appointment on account of ill- health. Two of the outstanding features of the year were the coming into force of the'Local Government Act and the Housing Act, 1930. The first mentioned abolished the Boards of Guardians, and although the greater part of their work in London was handed over to the County Council, certain matters including Vaccination and functions under the Registration Acts were allocated to the Metropolitan Borough Councils. The work in connection with Vaccination was assigned to the Public Health Department and the Vaccination Officer and Public Vaccinators became officers of the department. The Local Government Act also altered the method of payment of grants in aid to various institutions carrying out duties in connection with the .Maternity and Child Welfare Service. Under powers contained in sec. 101 (6) of the Act a scheme was made by the Minister of Health, under which certain specified grants previously paid by the Ministry were to be paid in future by the Borough Council. The Minister also made an Order under powers contained in sec. 59 of the Local Government Act prescribing the qualifications to be held by Medical Officers and Health Visitors appointed by Local Authorities under the Maternity and Child Welfare Act, 1918, and the Public Health (Tuberculosis) Act, 1921. Homing. During the year further progress was made with the scheme being carried out by the Borough Council in the Wolcot Street area, the London County Council scheme in Ossulston Street, and with the provision of accommodation in Somers Town by the St. Pancras House Improvement Society, Ltd. There is still, however, a large amount of overcrowding, and many of those with large families, whose need is the greatest, are unable to pay the rent for the amount of accommodation required, even if this were available, 10 Although the new Housing Act provides for an increased rate of contribution, in certain cases even np to an amount of seventy shillings per annum, for 40 years, per person rehoused, yet the standard laid down, which requires a house of 3 bedrooms for 5 persons and 4 bedrooms for 7 persons, irrespective of size of room or age or sex of the occupants, is so lavish as to seriously diminish the value of the financial grant. On this scale an unskilled labourer with wages of 40s. to 50s. per week and a family of 9 or 10 children would require a house with at least 6 bedrooms, which, in practice, would be very difficult to provide. A more appropriate standard would be one based on number of cubic feet per person, with separation of the sexes, as regards sleeping accommodation, for persons over 12 years of age. In conclusion, I have again to thank the Chairman and members of the Public Health Committee for the consideration so invariably accordcd to me, and the staff of the department for their loyal and cordial co-operation. Iam, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. 11 STATISTICAL SUMMARY. 1.—General Statistics. Area of Borough, 2,694 acres. Area of various public open spaces, 503 acres. Flaying fields (private), 7 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 1930. Population (Registrar-General's estimate) Civilian, 203,900. Total, 204,400. Number of persons per acre, 76. Births. Males, 1,639 ; females, 1,569. Total, 3,208. Birth rate, 154 per 1,000 of population. Legitimate births, 2,939 ; illegitimate births, 269. Excess of births over deaths, 730. Deaths. Males, 1,378; females, 1,100. Total, 2,478. Death rate, 119 per 1,000 of population. Infantile Mortality. Deaths of infants under one year of age per 1,000 births, 60. Legitimate rate, 57; illegitimate rate, 100. 12 Maternal Mortality. Number of women dying in, or in consequence of, child-birth : From Sepsis, 0 ; from other causes, 5. Maternal death rate per 1,000 births, 1.6. Number of deaths from Measles (all ages), 31. „ „ Whooping Cough (all ages), 4. „ „ Diarrhœea and Enteritis (under 2 years of age), 43. Tuberculosis. Pulmonary. Deaths, 165; death rate per 1,000 of population, 0.79. All forms. Deaths, 189; death rate per 1,000 of population, 0.91. Rateable value, £1,905,159. Sum produced by a penny rate, £7,760. Rainfall during the year (recorded at Camden Square), 28.8 inches. Comparative Statistics. Rate per 1,000 of Population. Rate per 1,000 Births. birth rate. Death rate. Infant Mortality. St. Pancras 15.4 11.9 60 England and Wales 16.3 11.4 60 107 Great Towns 16.6 11.5 64 County of London 15.7 11.4 59 13 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1930. For the purpose of this Report, the year consists of the 53 weeks ended 3rd January, 1931. The annual rates are corrected in order to make them comparable with those for other (,fifty-two weeks) years. 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. According to the annual estimates of the Registrar-General, a steady increase of population occurred from the Census year 1921 up to and including the year 1926, when the estimated population of the Borough was 216,800. Since then, year by year, a somewhat rapid decrease is estimated to have taken place, and for the year 1929 the Registrar-General has estimated the total population of the Borough to be 204,400, and the civilian population 203,900. A certain amount of decrease has doubtless occurred during the past two or three years, owing to the clearance of a number of slum areas and the re-housing of people outside the Metropolis, but it is doubtful if the population of the Borough has decreased to the extent estimated by the Registrar-General. As the Census is being taken this year (1931), although the figures will not be available for some time, the Registrar-General has not provided the usual estimate of the population, and it has been suggested by the Ministry of Health that the figures for the year 1929 should be used for the year 1930. It is probable that little alteration has occurred during this period, and therefore the estimated total population, 204,400, has been taken for the purpose of calculating the marriage and birth rates, and the estimated civilian population, 203,900, for calculating the death rate for the year 1930. 14 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried 011 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 7 „ 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 „ 15 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, Local Public Assistance Officer), which gives for half-yearly periods the amount spent on out-door relief, and the number chargeable in this respect in the middle week of each half-year:— Half-year ending Amount spent in the half-year. Numbers chargeable in the middle week of the half-year. £ 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 Lady day, 1929 38578 4500 Michaelmas, 1929 32744 4192 Lady day, 1930 35016 4578 Michaelmas, 1930 31549 4284 MARRIAGES. The number of marriages celebrated during the year was 2,103. This is equal to a rate of 9.8 per 1000 of total population. The average yearly number of marriages during the preceding five years was 1,944, equal to a rate of 9.2 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 3,208, equal to an annual birth rate of 15.4 per 1000 of population. The rate for the previous year was 15.5. The actual number of births registered as having taken place in the Borough during the year was 4,660, 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 1,851, and by adding the births belonging to St. Pancras which occurred outside the Borough—these numbered 399. The corrected figure being therefore as stated above, 3,208. The corresponding figures for previous years are given in Table 1, on page 106. 16 The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1930, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Ward. 1930. 1929. Births. Birth Rate. Births. Birth Rate. l 481 13.3 487 13.7 2 365 17.1 328 15.7 3 594 17.1 570 16.7 4 422 16.7 430 17.3 5 507 17.2 504 17.4 6 306 15.2 318 16.1 7 163 11.0 174 12.0 8 370 14.0 359 13.9 Borough 3208 15.4 3170 15.5 No less than 2,720 births occurred in Public Institutions in St. Pancras, equal to 58.4 per cent, of the total births which took place in the Borough. Table 4, on page 110, shows for 1930 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 3,208 net St. Pancras births, 269 were recorded as being illegitimate. This equals 8.4 per cent, of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1920 5.6 per cent. 1925 6.3 per cent. 1921 5.5 „ 1926 6.3 „ 1922 5.6 „ 1927 6.9 „ 1923 5.7 „ 1928 7.3 ,, 1924 5.9 „ 1929 7.8 „ In the years before the great War the illegitimate births in the Borough were from 4 to 5 per cent, of the total births registered. During the war years the rate increased to about 9 per cent., and although a decrease then occurred, a steady increase in the number of illegitimate births has taken place during the past 6 or 7 years. To what extent this is due to an alteration of traditional standards, and to what extent it is caused by overcrowding it is difficult to state, but probably both factors are concerned. Notification of Births. The long delay which might and frequently did occur before a birth was registered was found to diminish the value of the work carried out at the Welfare Centres. At times the death of a child would be reported before information had been received with reference to its birth. The Notification of Births Act was therefore passed in order to remedy this defect and to give the Local Authority early information of the occurrence of all births. 4,822 notifications of births were received during the year: this includes 179 stillbirths and 4,643 live births, and represents 99.6 per cent, of the births registered as having 17 taken place in the Borough. The Notification of Births Act (1907) states: " Information with regard to the event shall be given to the Medical Officer of Health within 36 hours of the occurrence of the birth of a child, alive or dead, which has issued forth from its mother after the twenty-eighth week of pregnancy." This notification is in addition to, and not in substitution for, reijistration 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. In accordance with the instructions of the Ministry of Health, the following table is included which gives particulars, by sex and legitimacy, with reference to all still births registered in the Borough during the year:— Still Births Registered. Inward Transfers, Outward Transfers. Total Legitimate and Illegitimate Males 127 11 71 Females 79 6 49 Illegitimate Males 10 3 5 Females 10 1 3 Inward transfers relate to still births belonging to the Borough, but which took place in some other area. Outward transfers refer to still births of non-residents, but which took place in the Borough. DEATHS. The net number of St. Pancras deaths registered during the year was 2,478; equal to an annual death rate of 11.9 per 1000 of population. The corresponding rate for the previous year was 15.3 and the average yearly death rate of the Borough for the previous five years was 13.1 per 1000 of population. The actual number of deaths registered as having taken place in the Borough during the year was 2,928. This number has to be corrected by the exclusion of 999 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 549 deaths of residents which occurred and were registered outside the Borough. The corrected figure is therefore 2,478 and is used in calculating the death rate in this report. The death rate of the Borough for the year 1930 is the lowest hitherto recorded, but it would appear to be unlikely that any further material reduction will take place, or that so 18 low a rate will be maintained, owing to the fact that during receht years the birth rate lias decreased, the expectation of life has increased and there is now a greater proportion of the population living in the later age periods, during which the death rate is higher. In Table 1, on page 106, will be found details of the corresponding figures for previous years. Causes of Death. The principal causes of death during the year are stated in the following table, and, for comparison, the figures and averages for the previous 10 years are also given:— Diseases. 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 Average for to years. 1930 Heart Disease 442 435 4611 394 398 381 388 448 465 603 442 430 Cancer 299 290 302 319 298 324 301 292 321 297 304 357 Tuberculosis—all forms 312 304 315 272 271 231 212 217 216 250 260 189 Injuries 92 88 127 113 114 118 142 132 145 129 120 165 Pneumonia 197 173 265 201 200 204 155 207 181 295 208 160 Bronchitis 236 276 308 223 304 274 259 227 138 255 250 106 Cerebral Haemorrhage, Embolism, and Apoplexy 98 126 120 112 118 123 110 92 67 78 104 99 Nephritis and Bright's Disease 95 60 67 79 75 75 89 84 83 72 78 72 Congenital Debility, Malformation and Premature Birth 182 137 126 119 105 94 100 69 86 85 111 72 Diarrhoea and Enteritis 54 98 47 61 63 55 63 35 52 48 58 52 Diphtheria and Croup 33 51 44 20 22 34 12 6 12 18 25 32 Measles 65 23 107 5 74 3 65 5 127 7 48 31 Rheumatic Fever 6 16 15 8 5 18 10 13 15 7 11 17 Influenza 46 57 142 24 80 41 29 83 14 137 65 14 Erysipelas 12 3 12 4 4 12 8 6 2 4 7 9 Scarlet Fever 11 7 20 3 12 - 2 2 1 4 6 7 Pleurisy 12 7 10 8 8 16 5 3 7 5 8 6 Whooping Cough 60 38 29 28 46 71 24 35 24 77 43 4 Enteric Fever 1 3 1 3 2 3 1 2 1 3 2 1 Puerperal Fever 8 4 4 9 4 4 1 4 3 4 5 — The Registrar-General's short list of deaths at different age periods is given in Table 2 on page 107, and, for the purpose of comparison, the death rates for England and AVales, the County of London, the Metropolitan Boroughs, and certain of the large towns are given in Table 4 on page 110. It will be noted that 16 Metropolitan Boroughs had a lower and 12 a higher general death rate than St. Pancras, Of the total 2,478 St. Pancras deaths which occurred during the year, no less than 1,555 took place in public institutions; this equals a proportion of 6:3 per cent, of the total deaths. 19 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 given for comparison:— Ward Deaths and Death Rates. Ward. 1930. 1929. Deaths. Death Rate. Deaths. Death Rate. 1 402 11.1 416 12.6 2 246 11.5 318 15.2 3 417 12.0 509 14.9 4 304 12.0 394 15.9 5 368 12.7 493 17.3 6 179 8.9 296 15.0 7 167 11.3 213 14.7 8 365 13.8 409 15.8 Homeless 30 — 48 — Borough 2478 11.9 3126 15.3 Inquests. In the following table will be found the causes of death, as certified by the Coroner ; they are also further classified into age periods:— Causes. Under 1 year. 1—5 year 8. 5—15 years. 15—25 years. 25-65 years. 65 and over. Totals. Natural— Heart Disease 3 7 — — 14 6 24 Pneumonia 3 — — — 1 1 5 Enteritis — l 1 — 1 — 3 Cancer — — — — 2 — 2 Tuberculosis — — — — 2 1 3 Other causes — 6 1 1 10 5 23 Accidents— Street Vehicles — 6 7 8 18 12 51 Burns and Scalds 4 2 1 — 1 — 8 Railway — — — 1 2 1 4 Falls — — 1 2 12 14 29 Other causes* 5 3 5 5 15 6 39 Suicides † — — — 6 56 5 67 Murder 4 — — — — — 4 Manslaughter — — — — — 1 1 Open Verdict 3 1 — 2 3 1 10 Totals 22 20 16 25 137 53 273 * Includes 1 case of coal gas poisoning. † „ 38 eases ,, „ 20 Infantile Mortality. 194 deaths of St. Pancras infants under one year of age occurred during 1930. This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 60, as compared with 262 deaths and a rate of 83 for the previous year. It is gratifying to be able to report that the infant death rate during the year was the lowest ever recorded in the Borough. The decreased infant mortality during 1930 was chiefly due to a diminution in the number of deaths from Measles and Whooping Cough, to a decrease in the neo natal mortality (deaths during the first month of life) and to a reduction in the number of deaths from Pneumonia, Diarrhcea and Enteritis. The following table gives the deaths and death rates of Infants, both legitimate and illegitimate, for 1930:— Legitimate. Illegitimate. Total. Number of Births 2,939 269 3,208 Number of Deaths (under one year of age) 167 27 194 Death rate per 1,000 births 57 100 60 In Table 1, on page 106, the Infantile Mortality rates are given for previous years, and in Table 3, on page 109, the figures will be found for each Ward. Table 4, on page 110, 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 1930, 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. 21 1930. 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 1 under 1 year. Measles — — — — — — — 1 2 3 Whooping Cough — — — — — 1 1 — — 2 Influenza — — — — — — 1 — 1 2 Diphtheria — — — — — — — — 1 1 Erysipelas — — — — — — — 1 1 2 Tuberculous Meningitis — — — — — — — 1 1 1 Other Tuberculous Diseases — — — — — — 1 1 — 2 Meningitis (not Tuberculous) — — — — — 1 1 — 1 3 Bronchitis — — — — — 1 6 — — 7 Broncho-pneumonia — — 1 — 1 3 3 1o 3 20 Lobar-pneumonia — — — — — — — — — — Pneumonia (type not stated) 1 — — — 1 — — — 2 3 Diarrhœa — — — — — 2 2 1 1 6 Enteritis 1 — 2 — 3 8 18 4 3 36 Syphilis — 1 — — 1 1 — — 1 3 Rickets — — — — — — — 1 — 1 Suffocation (overlying) — — — — — 1 — — — 1 Injury at Birth 3 — — — 3 1 — — — 4 Atelectasis 2 — — — 2 1 — — — 3 Congenital Malformations 3 2 1 — 6 2 3 1 — 12 Premature Birth 42 1 1 1 45 2 1 — — 48 Congenital Debility, Sclerema and Icterus 4 — — — 4 2 2 — — 8 Other causes 7 — 2 — 9 3 7 3 4 26 Totals 63 4 7 1 75 29 46 24 20 194 Nett Births in the year legitimate 2939 illegitimate 269 Nett Deaths in the year legitimate infants 167 illegitimate infants 27 22 Deaths from Stated Causes under 1 Year of Age for 1930 and 10 preceding Years. CAUSE OF DEATH. 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 Average for 10 years. 1930 Measles 21 7 15 1 15 2 25 — 30 — 12 3 Scarlet Fever — — 3 — — — - — — — — — Whooping Cough 18 18 11 8 13 29 11 15 10 32 17 2 Diphtheria and Croup 2 2 — - - 1 1 — — 3 1 1 Erysipelas — — 1 1 2 2 — — — — 1 2 Influenza 2 2 7 6 2 1 2 — 5 3 2 Tuberculous Meningitis 6 4 3 4 3 2 3 3 — — 3 1 Other Tuberculous Diseases 2 4 8 3 — 1 1 1 2 — 2 2 Meningitis (not Tuberculous) 7 3 2 3 5 4 3 2 1 4 3 3 Convulsions 7 8 8 5 4 4 2 1 1 5 5 — Bronchitis 27 13 21 12 12 19 14 5 9 7 14 7 Broncho-pneumonia 60 39 54 34 51 34 36 42 43 13 44 20 Lobar-pneumonia 5 1 3 1 3 4 2 2 3 4 3 — Pneumonia (type not stated) 4 3 6 1 3 — 1 1 2 1 2 3 Diarrhœa 11 11 4 6 6 9 7 3 8 5 7 6 Enteritis 26 63 27 37 46 30 38 24 33 34 36 36 Gastritis 2 2 — 1 — 2 — — — 1 1 — Syphilis 15 14 8 5 2 5 1 2 4 1 6 3 Rickets 1 1 1 — — — — — — — — 1 Suffocation (overlying) 2 2 5 1 1 4 3 1 1 — 2 1 Injury at Birth 5 3 3 6 4 7 3 9 2 9 5 4 Atelectasis 10 8 4 9 7 2 6 10 11 7 7 3 Congenital Malformations 33 25 31 27 23 20 25 15 20 23 24 12 Premature Birth 105 75 61 70 59 57 57 39 50 46 62 48 Congenital Debility, Sclerema and Icterus 40 34 28 21 24 17 18 14 16 14 23 8 Other causes 24 18 23 15 14 17 15 14 15 18 17 26 Totals 435 360 337 272 303 280 274 205 261 262 299 194 Nett Births 5934 4764 4559 4348 4112 3880 3612 3299 3274 3170 (095 3208 23 Section II.- GENERAL PROVISION OF HEALTH SERVICES, Hospital Accommodation. A. Fever and Small Pox.—Hospital accommodation is provided by the London County Council. 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 St. Pancras and Highgate Hospitals of the London County Council, the use of these hospitals is by no means confined to residents of the Borough. On the other hand, hospitals situated outside the Borough are largely used by St. Pancras residents. Hospitals. Number of Beds. London Coonty Council Hospitals. St. Pancras Hospital, King's Road 378 Highgate Hospital, Dartmouth Park Hill *554 St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum and marasmus) 60 General and Special Voluntary Hospitals. University College Hospital, Gower Street General 414 Obstetric 85 Royal Ear 41 Royal Free Hospital, Gray's Inn Road 280 London Temperance Hospital, Hampstead Road 136 Elizabeth Garrett Anderson Hospital, Euston Road 107 West End Hospital for Nervous Diseases, Regent's Park 78 Hospital for Tropical Diseases, Endsleigh Gardens 76 Central London Throat, Nose and Ear Hospital, Gray's Inn Road 76 Central London Ophthalmic Hospital. Judd Street 52 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square 22 St. Saviour's Hospital, Osnaburgh Street 21 North-West London Hospital, Bayham Street Outpatients only. St. Pancras Dispensary, Oakley Square London Skin Hospital, Fitzroy Square Western Skin Hospital, Hampstead Road British Dentists' Hospital, Camden Road London Foot Hospital, Fitzroy Square British Hospital for Functional, Mental and Nervous Disorders, Camden Road • Average of 480 only available, owing to reconstruction. 24 Institutional Provision for Unmahried 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 by the Ministry of Health. Ambulance Facilities. For infectious cases ambulances are provided by the London County Council. For non-infectious cases the London County Council 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 County Council is available between the hours of 11 p.m. and 8 a.m. The ambulances of the British Red Cross and Order of St. John convey pregnant women to hospitals from 8 a.m. to 11 p.m. Clinics, Treatment Centres, etc. For purpose of reference these are given in tabular form; details concerning the work carried out will be found on succeeding 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 „ The Institute of Ray Therapy, 152-154, Camden Road „ A number of the hospitals in the Borough also provide this treatment. B. Maternity and Child Welfare Centres. St. Pancras School for Mothers, Ampthill Square and Somers Town Centres The Borough Council, with assistance 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. Dan Nurseries. 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 „ „ 25 Situation. By whom provided. D. Nursery Schools. Somers Town Nursery School, 18, Crowndale Road A Voluntary Committee. Jellicoe Nursery School, 6a, Rochford Street „ Mary Ward Nursery School, 16, Burton Street „ Magdalen Mission Nursery School, 5, Clarendon Street The Mission Authorities. Charrington Hall, Charrington Street The Committee of the St. Pancras House Improvement Society, Ltd Trinity Presbyterian Hall, Buck Street The Church Authorities. E. Dental Clinics. Argyle Square: For nursing and expectant mothers and children who attend the Maternity and Child Welfare Centres The Borough Council. Ampthill Square: For mothers and children who attend the Centre at 1, Ampthill Square The Voluntary Committee. St. Pancras Dispensary : For Tuberculosis cases „ For ordinary cases The Borough Council. The Dispensary Committee. Eastman Clinic: For nursing and expectant mothers and children ; also provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. The Committee of the Royal Free Hospital and Clinic. F. School Clinics. Highgate New Town : Chester Road Voluntary Committees, working under agreement with the London County Council. St. Pancras Centre, Prince of Wales Road Clarendon Square G. Tuberculosis Dispensaries. St. Pancras Dispensary, Oakley Square University College Hospital The Borough Council. The Hospital Authorities. II. 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). A complete list giving the days and times at which clinics are available can be obtained on application to the Medical Officer of Health. 1. 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, 26 Situation. By whom provided. J. Convalescent Homes for Sick Poor Children. The Mayoress of St. Pancras Home, "Avalon," St. Alban's Road, N.W. 5. By Voluntary Committee, with grant from Borough Council. Invalid Children's Aid Association (various homes) Subsidy from Borough Council. K. Open Air Schools. Holly Court, Highgate, N. 6 London County Council. Euston Square, N.W. 1 „ L. Professional Nursing at Home. North London Nursing Association, 6 & 7, Canonbury Place, N. 1 By Voluntary Committee, with grant from Borough Council. Hampstead Nursing Association, 25, Heath Hurst Road, N.W. 3 „ Metropolitan Nursing Association, 14, Oakley Square, N.W.1 „ MATERNITY AND CHILD WELFARE. For many years considerable attention has been devoted to this work in St. Pancras, not only bv the Borough Council and the associated voluntary committees, but also by the general and voluntary hospitals, etc. The Local Government Act, which came into force on April 1st, 1930, authorised the Minister of Health to make a scheme determining, in relation to voluntary associations providing maternity and child welfare services, which of those are to be treated as services in respect of which the County Council are to contribute and which are services in respect of which the Metropolitan Borough Councils are to contribute, and the scheme provided for the payment during the fixed grant period to the various voluntary associations of contributions of such amounts as may be specified in the scheme. Each of the annual contributions were to be paid either in a single sum before the 30th of September in each year, or in equal quarterly or half-yearly instalments. The associations in respect of which the County Council make contributions are principally those providing residential accommodation. The following are those to which the St. Pancras Borough Council make contributions, the amount being also stated:— £ St. Pancras School for Mothers 777 Somers Town Welfare Centre 249 North St. Pancras School for Mothers 136 South Highgate Welfare Centre. 178 Caversham Road „ 421 Grafton Road „ 32 Camden Town „ 197 Argyle Square „ 121 St, Pancras Dispensary 146 University College Hospital 890 27  £ Whitefield Day Nursery 564 Kentish Town „ 432 Margaret ,, 403 Mayoress of St. Pancras Home for Sick Poor Children 758 The payment of the above-mentioned contributions is subject to the following conditions:— 1. That the Borough Council are satisfied as to the efficiency of the maternity and child welfare service provided by the association in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided; 2. That no reduction or alteration of such service is made without the consent of the Borough Council; 3. That such service, and any premises in which it is carried on, are open to inspection at all reasonable times by any officer of the Borough Council duly authorised by the Council, and by any officer of the Ministry of Health appointed for that purpose by the Minister; 4. That the association sends to the Borough Council in each year a copy of the annual report of the association on the maternity and child welfare work of the previous year, together with a statement of the accounts of the association for that year relating to such work and a copy of the auditors' certificate thereon, and furnishes the Borough Council from time to time with such other information relating to the maternity and child welfare services provided by the association and the expenditure thereon as the Borough Council may reasonably require. The above scheme came into operation on April 1st, 1930, and is to continue in force until March 31st, 1933. The work carried out in the Borough in connection with maternity and child welfare may be summarised under the following three headings:— 1. Ante-natal. Special consultations are held at the Centres maintained bv 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 cases attended at home by jnidwives on the staff of various hospitals and institutions, 28 The provision by the Borough Council of Consultants' services, bacteriologicul investigation and skilled nursing 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. 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. A sun bathing play centre was also instituted during the year in conjunction with H.M. Office of Works and the Sunlight League (see page 38). The visiting and supervision of necessitous children under 5 years of age upon discharge from the St. Pancras and Ilighgate 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 (20 in number), 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 Somers Town Centre, and one parttime (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, 29 During 1930 the Council's staff at the various Centres made 26,9-15 visits to 2,853 children, and 2,677 visits to 1,411 expectant mothers; the trained workers not paid by the Council made 11,027 visits to 666 children, and 428 visits to 234 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... 1411 2677 2853 26945 Trained Centre staff, not paid by Council 234 428 666 - 11027 Total of all trained workers 1645 3105 3519 37972 Corresponding totals for 5 previous years — 1929 1845 3632 3643 41711 1928 1574 3192 3463 42141 1927 943 2179 3422 39595 1926 1618 3651 4030 48686 1925 2007 4979 4542 55547 30 Centre. Attendances at Consultations. Visits by Trained Visitors. Consultations. Number of Visitors. Expectant Mothers. Children. Expectant Mothers. Children. Infants, Expectant Mothers. 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 84 263 258 17 22 297 3277 967 826 5070 304 378 558 3076 14 173 2 26 3 — Somers Town 52 170 222 10 15 247 3601 1362 893 5856 153 457 253 4264 12 150 1 12 2 1(f) North St. Pancras School for Mothers 72 155 315 9 7 331 4637 1716 1272 7625 125 349 500 4183 18 215 1 12 3 — South Highgate Centre — — 112 4 14 130 1984 669 470 3123 51 105 145 1723 8 102 — — 1 — Grafton Road Centre 68 173 211 10 19 240 3045 1011 695 4751 129 327 295 3945 14 162 1 12 2 — Camden Town Centre 136 180 324 21 14 359 3776 1242 961 5979 263 391 554 6340(e) 18 214 1 12 3 1(g) Argyle Square Centre 10 18 208 9 14 231 2127 579 374 3080 161 201 336 1772 10 120 — — 1 — Caversham Boad Centre 149 797 296 13 18 327 4358 740 957 6055 233 589 397 5333 12 142 4 49 2 2(h) † University College Hospital 934 3552 — — — 603 — — — 5550 — — 294 6558 18 204 18 200 — 2 † Royal Free Hospital 258 1069 — — — 135 597 197 208 1002 226 308 187 778 12 155 12 154 — 2 Totals 1763 6377 — — — 3100 — — — 48091 1645 (a) 3105 (b) 3519 (c) 37972 (d) 136 1637 40 477 *17 8 * An additional visitor was also attached to the following Centres:— Ampthill Square, South Highgate, Camden Town. Caversham Road, for 3 days a week; North St. Pancras School for Mothers, Grafton Road and Somers Town, for 2 days a week. (а) Exclusive of 44 visits by students (Ampthill Square, 39 ; Camden Town, 5). (b) „ 44 „ „ ( „ 39; „ 5), (c) „ 27 „ ,, (Grafton Road, 22; „ 5). (d) „ 293 „ „ (Ampthill Square, 32; Queen's Crescent, 41; Grafton Road, 108; Argyle Square, 10; Camden Town, 102). (e) Exclusive of 61 visits by untrained part-time visitor. (f) Part-time trained visitor. (g) Part-time untrained visitor. (h) 1 full-time and 1 part-time trained visitor. † Figures refer to St. Pancras cases only. 31 Ante-Natal Activities. A detailed review has just been made for the five years 1926-1930 of the Ante-Natal work carried out at the Council's Centres in the Borough, excluding the CamJen Town Centre, from which a report was not furnished, owing to recent alterations in administration and re-organisation. The results may be taken as representative, because the review covers a period of five years and a group of over 2,000 cases. The value of this Ante-Natal service is clearly demonstrated. The reports have been tabulated and summarised in the following table which has been prepared by Dr. Pritchard, Assistant Medical Officer. Both " patients,"—mother and child,—benefit from the service. The examination is intended to discover if there is any condition present which could interfere with a normal confinement, that is, both a normal labour and a normal child. It is said, on the authority of the Medical Research Council, that more than 25 per cent. " of all dead births are due to the accidents and complications associated with manipulation by a midwife or doctor at birth . . . . They point to more and better ante-natal supervision of expectant mothers . . . ." The greater proportion of that 25 per cent. can be, and is being, saved by the early discovery of abnormalities. It is a well known fact that such conditions as a contracted pelvis or a malpresentation of the foetus, if unheeded, lead to complicated confinements. These lead to manipulations at labour, which is of necessity prolonged. The effect is detrimental to the woman and her child. The endeavour of the Clinic is to make the actual process of delivery as easy and safe as possible for both "patients" by the early discovery and appropriate correction of any possible source of trouble. The figures for St. Pancras are very satisfactory. In the group under review, 8 per cent. of the 2,098 women examined were found to have some signs of possible danger; that is, conditions were discovered which are known to be the cause of abnormal terminations of pregnancy. It is fair to conjecture that, without, the subsequent supervision and treatment which these 171 cases received, many of them would have resulted in death or injury to either "patient." There were no maternal deaths and 80 per cent. of the births were of healthy babies. We cannot measure morbidity in figures, but we can assume that it shares in the general improvement due to the Ante-Natal care, as seen in the improved mortality. It is not the function of the Centre to treat the conditions found. These are reported to the midwife or doctor who has been engaged, otherwise the woman is referred to hospital. Over 80 per cent. of the abnormalities were treated by Institutions, and over 70 per cent, of the confinements took place there. An analysis of the type of labour and the resulting child showed that about 70 per cent. of the women had a normal delivery. There were 11 inductions for cases with abnormal pelvis and these all resulted in healthy viable babies. Six of the eight Cæsarean Sections were performed for the same condition and with the same successful results. Of the 19 cases of malpresentation found at the ante-natal centres, and subsequently treated, only two required surgical aid at labour, and one of these gave birth to a viable but short lived baby. The others were all healthy. Until the early part of last century, it is estimated that about 80 per cent, of all foetuses which were in an abnormal position, or which were associated with a contracted pelvis, were born dead. There were 52 such cases under consideration, and only two of the confinements ended in still-births. A similar table for other areas of activity has not been brought to my notice, therefore comparison is impossible. The figures collected do show, without doubt, that the Ante-Natal service in St. Pancras is doing useful work. Its effect in reducing the Infantile Mortality is recognised, and it is looked upon as the most essential fighting unit in the forthcoming increased activity to reduce the persistently high Maternal Mortality. 32 Ante-Natal Activities. 1926-1930. Ante-Natal Condition. Treated By- Confinement (Place). Labour. Foetus or Child. Totals. Institution. Privately. Institution. At Home. Normal. Miscarriage. Premature. Induction. Cesarean. Other Abnormal. Viahle Healthy. Viable Unhealthy. N on-Viable Foetus. iN on-Viable Still horn. Abnormal Cases. Normal Cases. All Cases. Percentage of Abnormal Cases. Ampthill Square— 34 592 626 5.4 Albuminuiia 9 1 6 4 7 — — — — 3 9* — 1 1 10 Abnormal Pelvis 7 — 7 — — — — 5 2 — 7 — — — 7 Malpresentation 11 1 6 6 10 — — i — 1 12* 1* — — 12 Other Conditions 5 — 5 — 4 1 — — — 4 — 1 — 5 Somers Town— 16 190 206 7.8 Albuminuiia 3 — 2 1 2 — — — — 1 2 — — — 3 Abnoimal Pelvis 8 — 4 4 5 — 1 — 1 1 8 — — — 8 Malprtsentalion 3 — 1 2 3 — — — — — 3 — — — 3 Other Conditions 2 — 1 1 1 — — — 1 — 2 — — — 2 Caversham Road— 76 606 682 11.1 Albuminuria 8 2 9 1 10 — — — — — 9 — — 1 10 Abnormal Pelvis 12 — 12 — 7 — — 4 1 — 12 — — — 12 Malpresentation 4 — 4 — 4 — — — — — 4 — — — 4 Cardiac Disease 11 1 11 1 12 — — — 12 Tuberculosis 3 — 3 — 3 — — — — — 3 — — — 3 Ante-Partum Hæm. 3 4 5 2 4 1 — — — 2 3 1 1 2 7 Other Conditions 26 2 21 7 25 1 1 — — 1 25 — 3* 1 28 Grafton Road— 22 * 287 7*7 Abnormal Pelvis 2 — 2 — — — — i i — 2 — — — 2 Cardiac Disease 2 2 2 2 2 — 2 — — — 4 — — — 4 Threatened Miscariiage 3 — 3 — 2 — i — — — 4* — — — 3 Other Conditions 6† 7 6 6 5 1 1 i 1 3 8 2 2 '3 Queen's Crescent— 23 274 297 /• 7 A bnormal Pelvis 4 — 4 — i — — i i i 2 — — 2 4 Tuberculosis i — i — i — — — — — 1 — — 1 Other Conditions io 8 6 12 IO 6 2 5* 1 6 7 18 TOTALS M3 28 121 49 118 IO 6 '3 8 *5 140 4 14 17 171 1927 2098 8-1 Percentages 83-6 i6'4 71-2 CC oo 69*6 5*9 3'5 7-6 47 8-8 80 2-3 8-o 9.7 8-i 91-9 Total Albuminuria 20 3 '7 6 '9 — — — — 4 20 — 1 3 23 Total Abnormal Pelvis.. 33 — 29 4 '3 — i » 6 2 3' — — 2 33 Total Malpresentation .. 18 i 11 o 17 — ' — 1 '9* t — '9 * Including Twins. t One Fibroid Tumour simulating pregnancy, Removed. Successful confinement later. 33 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 30 gives statistics concerning the work of all the Centres during the 3'ear. It will be seen that 477 ante-natal consultations were held, the number of expectant mothers was 1,763 and their total attendances were 6,377. For the two previous years the total attendances were 5,706 and 6,993. The number of consultations for children was 1,637, the children who attended for the first time numbered 3,100, and the total attendances were 48,091. For the two previous years the total attendances of children were 44,851 and 45,804. 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, 40 ailing mothers were seen by doctors, and interviews with parents (apart from those otherwise recorded) numbered 3,553. Other activities of this centre include the following:— Classes for Mothers. At infant care classes there were 548 attendances; and at needlework, etc., classes, 556 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,445 dinners were supplied to nursing and expectant mothers, and 2,224 to young children. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,776 attendances during the year, of which 835 were made by infants under one year of age, 573 by children from 1 to 2 years of age, and 368 by children from 2 to 5 years of age. Dental Clinic. This is provided out of funds from voluntary sources. The Dental Surgeon is Mr. George Thomson, l.o.s. During the year 44 consultations were held, at which 229 treatments were provided for mothers and 193 for children. Details of the work done are given in the following table :— Mothers, Children. Extractions with anaesthetics .. .. . . 58 51 „ without anaesthetics . . .. .. — 1 Fillings .. .. .. .. 47 65 Scalings . . .. .. 16 — Impressions and fitting dentures, etc. . . 50 3 Examinations and advice .. .. 58 73 Totals .. . . 229 193 422 34 Somers Town Centre, Chamberlain House, Ossulston Street. In addition to the Consultations provided by the Borough Council, the Health Visiting Staff had 2,040 interviews with parents and the Voluntary Committee arranged for knitting, &c., classes, at which 404 attendances were recorded, and 31 mothers and 37 children were sent away on holiday for a period of two weeks. North St. Pancras School for Mothers, Queen's Crescent. During the year 14 voluntary consultations for older children were held by Dr. J. Finch Haines, at which 392 attendances were recorded. Health Talks and Cookery Demonstrations were held, at which 385 attendances were made. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 2,270. 54 children attending this Centre were referred for Artificial Light treatment or for Massage to the Almeric Paget Institute, a Voluntary Society whose premises are at 14, Rochford Street, which is near the Centre. 24 mothers and 35 children were referred to the Council's Dental Clinic for treatment. The Voluntary Committee of this Centre maintains a Holiday Home at St. Margaret's, Heme Bay (4 beds, 2 babies' cots), to which mothers and children attending the Centre are sent for a much needed holiday. During the year holidays were provided for 16 mothers and 30 children. 10 mothers and 10 children were also sent to other Convalescent Homes. Grafton Road Centre. 12 voluntary consultations were held during the year for children from 2 to 5 years of age, the Medical Officer being Dr. Richard II. Wace. 9 mothers and 11 children were sent away for convalescence. 21 mothers and 41 children were referred for treatment to the Council's Dental Clinic, and 18 children attended the Artificial Light Clinic. Camden Town Centre. In addition to the routine work, 17 mothers and 15 children were sent away on holiday, either to the country or seaside, for a period of two weeks. In consequence of the transfer of the Council's Superintendent to another Centre, the members of the Voluntary Committee tendered their resignation. This was accepted by the Council, and the formation of a new Committee was left in the hands of the Chairman and Deputy Chairman of the Public Health Committee and the Medical Officer of Health. The new Committee was formed and are carrying on the work with great success and efficiency, probably due, to some extent, to the fact that the Centre receives their undivided attention. The members of the late Committee also acted as the Committee of the Maternity Nursing Association, and, in consequence, their interest was necessarily divided. Advantage was taken of the opportunity afforded by the change of Committee to terminate the practice of staffing the Ante-Natal Clinic by Nurses of the Maternity Nursing Association, to the practical exclusion of the Council's staff. The present method is more satisfactory, and is uniform with the practice adopted at other Centres. 35 The present Superintendent, a very capable officer, is also extremely popular, and the ttlothercraft, needlework, and other classes arranged by her are much appreciated and are remarkably well attended. Argyle Square Centre. 10 mothers and 13 children were each sent for two weeks holiday through the Women's Country Holiday Fund. 31 children attending the Centre were referred for Artificial Light treatment at the Roj-al Free Hospital and Cromer Street Clinics; 6 children for massage, etc., at the Almeric Paget Institute, and 4 to the Council's Artificial Light Clinic. A variety of knitted clothes for babies are sold at the Centre, made up by the League of Remembrance and friends of the Centre. South Highgate Centre. 5 mothers and 10 children were sent on holiday, either to the country or seaside, for a period of two weeks. Caversham Road Centre. 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) were also provided from the same fund. Classes have been held in Needlework, Child Study and Mothercraft, at which there were 701 attendances. 89 mothers and 129 children were sent away on holiday. Artificial Light Treatment. The clinic maintained by tbe Borough Council for the provision of this form of treatment was in regular use throughout the year, except for a period during the middle of the summer. Consultations were held on two days in each week, the average number of patients at each consultation being 45, as compared with 30 during the previous year, and 41 per consultation in 1928. Staff, Equipment and Statistics for 1930. 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. Two Consultations, each of two hours duration, are held weekly. Staff.—The Medical Officer carrying out the treatment is Dr. William Beaumont, m.r.c.s., i..r.c.p. The Superintendent of the Centre is Miss G. R. Bristow, who is assisted at the consultations by a Health Visitor from another Centre. Lamps, etc.—Three in number: 1 Westminster Single Arc Lamp, 2 Alpine Suu Four Arc Lamps. The current is direct, and voltage at main 220. Cases treated.—Particulars with reference to the cases treated are given in the following table, the figures for the previous year being also given for comparison:— 36  1930. 1929. Total number of cases treated 147 154 Total number of new cases 85 88 Total number of attendances 2898 2355 Number of Consultations held 65 77 Average attendance per Consultation. . 45 .30 Average number of attendances per child 20 15 Cost. £ s. d. Electric current . . 6 10 7 Cleaning .. .. 6 16 0 Consultation fees . . 7 b Miscellaneous .. . . 15 2 4 £120 16 5 No part of the salary of the Superintendent or Health Visitors is allocated to nor included in the above figures. In addition to the Clinic provided by the Borough Council, Artificial Light Treatment is available at the Cromer Street Centre, the Almeric Paget Clinic, Rochford Street, and also at all the Voluntary General Hospitals in the Borough. The Institute of Ray Therapy, was also opened towards the end of the year at 152-154, Camden Road. 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 were held every Monday and Wednesday in the afternoon, and on alternate Fridays in the morning. 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 for the previous year also being given for comparison :— Work carried out at the Dental Clinic. 1930. 1929. Number of new cases Mothers 138 145 Children 233 267 Total 371 412 Number of Attendances For extractions under nitrous oxide (gas) 279 284 „ „ local anaesthesia 50 33 „ fillings and dressings 282 310 „ scaling 26 37 ,, impressions and fitting dentures 315 253 ,, examination and advice 496 552 Total attendances 1448 1469 Total number of clinics held 94 111 Number of clinics with nitrous oxide anaesthesia 23 22 37 The following table shows the number and cost of the dentures supplied during the year:— Number of Patients supplied with dentures 53. Total cost £199 13s 6d. Amount paid by mothers £83 15s 6d. Amount paid by Borough Council £33 10s Od. Amount paid by various Societies £82 8s. Od. Five mothers paid the entire cost of two dentures each. Two mothers paid the entire cost of one denture each. The Societies who made contributions towards the cost of dentures were the Metropolitan Hospital Sunday and Saturday Funds, £32 11s. 0d.; the Charity Organisation Society, £31 1s. 0d.; and various other societies, £18 16s. 0d. The general supervision of the work, arranging appointments, recording attendances and the collection of contributions, etc., is carried out by Miss E. M. Robinson, the Superintendent of Argyle Square Centre. Dental treatment is also provided at the voluntary clinic, which is held at the St. Pancras School for Mothers, see page 33. The Eastman Dental Clinic attached to the Royal Free Hospital was opened during the year. This lavishly equipped clinic provides dental treatment for children and for nursing and expectant mothers, and operative treatment in connection with enlarged Tonsils and Adenoids in children. The Dental Section is equipped with 68 chairs and complete electric units, the Surgical wing contains 37 beds for tonsil and adenoid, cleft palate, hare lip, etc., cases requiring operative treatment. As regards the Dental service, it would appear to be a matter for regret that such abundant provision should have been made solely for the extraction of teeth. It is doubtful if many of the adult patients concerned will consent to the extraction of teeth when no provision is made for the supply of dentures. The Welfare Centre held in connection with University College Hospital is able to refer cases needing dental treatment to the dental department of that hospital. Day Nurseries. The Council assists three approved day nurseries in the Borough by the payment of block grants as approved by the Ministry of Health. Particulars in regard to the day nurseries for the year ended 31st December, 1930, are as follows :— — No. of Days Open. Attendances. Average per Day. Whitefield Day Nursery 229 6932 30.3 Kentish Tn. Day Nursery 228 7581 33.3 Margaret Day Nursery 274 5857 21.4 38 Nursery Schools. The undermentioned Nursery Schools are situated in the Borough. They provi le care, facilities for play, training in good habits, and some elementary instruction for children who are too young to be admitted to the ordinary schools. They are provided chiefly by voluntary effort, and no grant is made by the Borough Council. The work is valuable and an increase in the amount of accommodation is desirable. Name and Situation. Accommodation. Average daily attendance. Somers Town Nursery School, 18, Crowndale Road 48 40 Jellicoe Nursery School, 6a, Rochford Street 60 53 Mary Ward Nursery School, l6. nurton Street . . 25 21 Magdalene Mission Nurserv School. Clarendon btreet 24 21 In addition to the above, a Nursery School was opened during the year in Charrington Hall, Charrington Street, by the Committee of the St. Pancras House Improvement Society, Ltd. Accommodation is provided for 20 children. A small Nursery School or Play Centre is also available for about two hours daily, in the mornings only, at the Trinity Presbyterian Hall, Buck Street. The numbers are limited according to the amount of help available, but the average daily attendance is about 17. Sun Bathing Play Centre. In June a communication was received from the Sunlight League with reference to a children's Sun Bathing Centre in Regent's Park. H.M. Office of Works had devoted a sum of money, raised by the First Commissioner, for the purpose of erecting a shelter for use in connection with sun bathing, the Sunlight League having advocated such centres in a deputation to the Office of Works. The communication stated that the League found themselves faced with complete responsibility of administration, but did not feel able, by virtue of its constitution, to undertake it. Neither could the First Commissioner of Works carry out the task, as he was not empowered to do so. Under these circumstances, the League expressed the hope that the Borough Council, who they believed instituted the first Infant Welfare Centre, would be the first to administer a Sun Bathing Centre in a London Park. The Public Health Committee recommended and the Council agreed to take over the administration of the Centre, the salary of the supervisor to be defrayed by the Sunlight League and incidental expenses by the Council. The Centre was not completed until the beginning of August, but during that month and until the end of September it was open daily. The following report on the scheme was subsequently submitted to the Council:— 10th October, 1930. To the Chairman and Members of the Public Health Committee. Mr. Chairman, Ladies and Gentlemen, Sun Bathing Play Centre. It was reported in the Council's Minutes of June 25tli (page 435) that a shelter was to be erected in Regent's Park by H.M. Office of Works and a portion of ground enclosed for the purpose of a Sun Bathing Play Centre for children. The scheme was originally suggested by the Sunlight League, but as that Society did not feel able, by virtue of its constitution, to undertake the work of supervision and management, the Borough Council was approached and agreed to be responsible for these duties when the premises were ready. 39 Premises, Supervision, etc. The shelter was completed by August 11th, and was formally oponed by His Worship the Mayor (Councillor H. E. Capes, J.P.) on August 18th, when representatives of the Borough Council, H.M. Office of Works and the Sunlight League were present. The building is of brick, one-storey high, and measures 30 feet in length by 20 feet in depth. It is divided by folding doors, and each half contains sanitary accommodation and a shower bath. A number of lockers are provided and pegs for the children's clothing. The Sunlight League undertook to provide the salary of a competent supervisor from tho date of opening until the end of September, but the various incidental expenses have been defrayed by the Borough Council. Miss M. Garnett was selected for the post of Supervisor, and has carried out her duties with great tact and efficiency. In addition to her nursing qualifications, Miss Garnett has had experience in sunlight treatment in Switzerland and in artificial light treatment in this country. The Centre was open daily from 10 a.m. to 1 p.m. and from 2 p.m. to 6 p.m. The children admitted were between the ages of 2 an,1 5 years. They were not suffering from any definite illness, but were selected from those attending the various welfare ccntrcs in the Borough as being likely to derive benefit from this form of treatment. The parents were required to sign a form accepting all responsibility in connection with the child's attendance and were asked to provide a towel, bathing slip and a sun hat. Miss Garnett subsequently organised a Mothers' Committee, the members of which made suitable bathing slips of cellular cotton material, and these could be purchased for a few pence. The mothers also assisted the Supervisor in taking charge of the children. Method and Attendances. The method adopted was to arrange tho children into groups according to their susceptibility to sunlight—this depends partly on age, partly on ability to pigment, and partly on previous exposure. After a few exposures, the older children do not require so much supervision, and the nurse is able to concentrate on the group containing the youngest and most susceptible. Each child was weighed at the first attendance and subsequently once a week. Tho shower baths had been placed at such a height that the force of water was too great for small children, but a shower bath improvised from a watering can proved to be a popular part of tho proceedings. During the brief heat wave which occurred in the last week of August and the first few days of September, the attendance was very good, but during the remainder of the period when the weather was extremely unsatisfactory, the attendance suffered in consequence. During the extreme heat, difficulty was experienced in securing some protection from the direct rays of the sun. The shelter will only accommodate a small number of children and the trees in the vicinity were inadequate. If the Centre is to be again used for sun bathing, some form of awning, should be provided, either around the building or in the grounds. The total number of children entered on the register during the seven weeks the Centre was open was 148, and the number of attendances each week was as follows:—44, 90, 293, 249, 152, 112, 86, making the total attendances 1,026. The morning session was much less popular than the afternoon, doubtless owing to the mothers' domestic duties. Of the total of 148 children, 24 attended in the morning and 124 in the afternoon. 29 children attended once only, 18 made only two attendances, 20 made three attendances, 9 attended four times; therefore rather more than half the children entered on the register only made 4 or less attendances. On five days, owing to exceptionally bad weather, no children attended, and on several other days the number present varied from 1 to 3. Conclusions and Results. It is difficult to express an opinion as to the effect on the health of the children, owing to the short time the Centre was in use, the extremely unsatisfactory weather during the greater part of the time and consequent irregular attendance, or small number of attendances niade by 40 so many of the children. In 33 children who made 10 or more attendances, there was an increase of weight in 30, varying from ½ lb. to 2¼ lbs. The greatest increase was recorded in the case of two children (brothers), who made the highest number of attendances, namely 29, and whose weight increased 2 lbs. 2 ozs. and 2 lbs. 4 ozs. respectively, a rate of increase much in excess of the average normal rate. In a few cases, children of a nervous, excitable type, who usually slept badly, were stated to be less restless and to be sleeping better. Some improvement in appetite was also recorded. The general conclusion drawn from the experience gained is that it would be difficult and expensive to maintain a Centre exclusively for sun bathing. During bad weather, although the staff would be in attendance, the number of children would be small or even nil. I am of the opinion that it would be more satisfactory to combine a sun bathing centre with a day nursery or nursery school. In these cases the building would be adequate to accommodate the children at all times, and provision could be made for sun bathing whenever the weather was suitable. It should be recorded that great interest was taken in the Regent's Park Sun Bathing Centre. Many persons visited it and a number of kind donors sent toys for the use of the children. I am, Ladies and Gentlemen, Your obedient Servant, G. Sowden, Medical Officer of Health. 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 1930, new cases under five years of age numbered 54, ailing mothers 19, and expectant mothers (new cases) 89. The total attendances at this clinic were :—134 of children under five, 47 of ailing mothers, and 158 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, 432 ; attendances, 1,059 ; ailing mothers and expectant mothers: new cases, 108; attendances, 205. 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 914 visits to the homes of children under five. The Dispensary Resident Medical Officer also made 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. 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 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 the St. Pancras Branch of the Dickens Fellowship. 41 The staff consists of a Matron, Assistant Matron, three Probationers and a domestic staff numbering three. A laundry, equipped with electrically-driven machinery, is also attached to the home. 173 children were admitted during the year, and the average length of stay in the Home was about 4 weeks. (6) 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 Borough Council, during 1930, continued to make grants of milk, either free or at reduced price. 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 during 1930 is shown in the following figures:— Pints of Milk Granted Free. Pints of Milk Granted at Halfprice. Cost to Council. 1930. £ s. d. January 6590 1073 114 16 10 February 6835 1084 116 18 7 March 7332 1394 126 11 3 April 6361 1276 96 7 9 May 5862 1612 92 3 0 June 5308 1317 83 9 0 July 5763 1520 90 13 9 August 5860 1182 89 7 6 September 6482 1469 115 9 0 October 7512 1609 131 7 7 November 7438 1928 132 6 10 December 8539 1890 141 6 6 Totals 79882 17354 £1330 17 7 At the end of 1929 there were 159 families actually in receipt of milk under this scheme. During 1930, 470 new families were added to the list of recipients, and at the end of that year there were 230 families actually receiving grants. As will be seen from the above table, there were supplied in 1930, 79,882 pints of milk free and 17,354 pints of milk at half cost to the applicants, at a gross cost to the Council of £1,330 17s. 7d. The Council passed a resolution in July, 1928, that 7½ per cent, be deducted from the accounts of all dairymen supplying milk under the scheme to the value of £2 or over monthly. The effect of this has been to reduce the total cost by over 2 per cent., and this amount should be deducted from the figures in the table. Enquiries were made by the Health Visitors from the various "Welfare Centres in the Borough wherever any doubt existed as to the circumstances of the family. 42 The scale in use in making the grants is based on weekly income and was originally 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 present revised income scale is shown hereunder:— Number in Family. After Deduction of Rent. Free. Half-price. £ s. d. £ s. d. One 0 12 0 0 13 9 Two 0 18 3 1 3 0 Three 1 2 0 1 7 6 Four 1 5 6 1 11 3 Five 1 10 0 1 16 6 Six 1 13 0 2 1 3 Seven 1 16 6 2 5 9 Eight 2 0 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. Professional Nursing in Necessitous Homes. This is now provided by the staff of the three following District Nursing Associations :— Hampstead, Metropolitan and North London. 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 Metropolitan District Association, whose local headquarters are at 14, Oakley Square, for the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment by a block grant is made by the 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. Metropolitan 205 2239 10.9 Hampstead 40 563 14.1 North London 19 181 9.5 Total 264 2983 11.3 43 In addition to the above, the Metropolitan District Nursing Association also undertook the nursing of various complications arising in connection with 41 maternity cases and 21 cases of tuberculosis, and to these 1,342 visits were paid. 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 nine temporary " Helps " for emergency cases. 93 cases were dealt with during the year, 79 being maternity and 14 sickness cases. The services rendered by the "Home Helps" are very valuable and are much appreciated. The work is also increasing in volume, doubtless due to the supervision exercised by the Hon. Secretary, who is keenly interested, and who is ably assisted by a competent and experienced Visitor. The importance of the work performed by "Home Helps" was mentioned recently in the Memorandum on Maternal Mortality issued by the Ministry of Health, in which it was suggested that Local Authorities should consider the desirability of making this provision in districts where it was not already available. 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 1930, had notified their intention to practise in St. Pancras was 45. Only 12 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. 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. 44 In the following table particulars are given, for 1930, 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 . .. 476 461 25 Royal Free Hospital .. .. .. 96 37 Elizabeth Garrett Anderson Hospital . . 54 *121 St. Pancras Hospital . . . . .. 297 Middlesex Hospital . . . . .. 92 .. 32 Queen Charlotte's Hospital . . . 84 City of London Hospital.. .. . . 35 Royal Northern Hospital. . . . . . 20 St. Bartholomew's Hospital . . .. . . 2 Other hospitals.. . . . . . . 44 Queen Mary's Maternity Home . . .. 84 Maternity Nursing Association . . . . . . . . 307 Totals .. 1282 621 364 * Attended by qualified staff. It 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 40 per cent, and those attended at home 30-7 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 5 0 0 Elizabeth Garrett Anderson Hospital — Queen Charlotte's Hospital 27 0 0 City of London Hospital 16 0 0 Middlesex Hospital 26 0 0 University College Hospital 167 10 0 Maternity Nursing Association 1 15 0 Total £243 5 0 The corresponding grants for the previous three years were: £238, £234 15s. 0d., and £264 5s. 0d, 45 Maternal Mortality. This subject has lately been receiving considerable attention. The situation is, unfortunately, complicated, as the Ministry of Health, the Registrar-General, and the majority of Public Health Officials, taken as a body, do not always agree over definitions and classifications of these deaths. Deaths of women during pregnancy or childbirth are classified into two groups. The first and main division is reserved for those cases where death is directly due to the Puerperal state. Each authority has its own title for this collection, but it is not always used with the same intention. The resulting differences of opinion are sufficiently numerous to render tho annual statistics of doubtful value. Until they are rectified we can placc little value upon local statistics, more especially considering that they are based upon such a small number of cases. Deaths which are only associated with pregnancy or childbirth, not directly due to either, are collected for the second large group. They are all classified primarily to their particular cause of death and then re-grouped as Non-Puerperal Maternal Deaths. In 1930 there were 5 Puerperal and 3 Non-Puerperal Maternal deaths in the Borough. In addition, there was 1 case of self-induced abortion, which was classified to " Suicide." The Puerperal Mortality Pate was 1"6, which compares favourably with 3'5 for 1929, or 2'(> the average for the years 1925-1928. There were no deaths due to Sepsis in 1930, while in the period 1925-1929 there were 22 such cases. Enquiries arc made into all these deaths, whether directly due to or only associated with pregnancy or childbirth. Reports are then made and forwarded to the special Maternal Mortality Committee appointed by the Ministry of Health. This Committee has been using the information with a view to a better understanding of the problem. It issued recently ai " Interim Report" based on the analysis of the first 2000 enquiries. The Report is open to criticism, and some of the statistical sections and the deductions are to be taken with reserve. Its great value, however, lies in the suggestions for an extended service, which should help in the reduction of Maternal Mortality in the future. 46 MEDICAL EXAMINATION OF ELEMENTARY SCHOOL CHILDREN The information in the two following tables has been supplied by the School Medical Officer of the London County Council:— Routine Medical Examination of Elementary School Children in St. Pancras, 1930. Defect. Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1301 1312 981 1072 1340 1215 i 961 962 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * CaBes. * Cases. * Malnutrition 7 6 15 15 4 4 4 3 9 9 11 11 6 6 6 6 Skin disease 14 14 8 7 7 6 6 6 22 18 9 9 10 6 7 4 Defective teeth — 367 - 260 — 168 — 180 — 385 — 253 — 162 — 192 Enlarged tonsils 165 92 82 37 55 18 39 17 174 82 81 52 46 22 45 21 Adenoids 21 10 13 12 6 6 2 2 18 10 16 10 2 2 1 1 Enlarged tonsils and adenoids 113 82 77 39 11 4 3 3 129 79 46 23 28 12 8 4 Other nose and throat defects 20 15 15 10 4 3 4 4 27 24 18 16 10 8 7 6 Enlarged glands 77 12 74 4 28 3 26 1 55 10 55 7 17 3 8 3 Eye disease 32 19 18 10 7 6 1 1 £2 37 27 16 7 3 9 7 Vision defect — — — 137 — 118 — 92 — — — 132 - 105 — 85 Otorrhoea 29 25 19 17 3 2 5 3 25 20 12 11 2 1 5 3 Other ear disease 2 2 3 i 1 — — — 5 1 6 4 4 2 — - Defective hearing 6 4 13 7 4 3 10 7 8 4 9 6 9 7 6 2 Speech defects ... 4 1 1 — 3 2 3 1 2 - 2 — - — 1 1 Heart defects ... 19 3 30 5 19 2 14 3 16 3 26 2 26 6 31 8 Anosmia 9 8 11 4 8 2 6 5 9 7 11 8 7 -- 8 3 Lung defects 46 17 22 7 11 3 5 — 48 30 8 5 12 3 5 2 Nervous defects... 11 3 15 7 6 4 3 3 10 4 9 4 13 2 6 2 Phthisis — — 3 — 3 1 1 — 2 - 1 — 2 — — — Other T.B. disease — — — — — — — — — - _ — — — 1 — Rickets 8 2 1 - 1 — 1 — 6 2 2 1 — — 2 — Spinal deformities 2 1 5 4 6 6 6 2 — — 9 6 12 10 16 10 Other deformities 7 3 8 5 7 5 3 3 3 1 9 4 16 6 13 4 Other defects ... 48 33 48 30 20 14 17 13 60 34 52 30 47 25 41 33 Number of children noted for treatment 580 496 325 308 601 487 340 340 Note.—Defects, however slight, are included under "Cases.'' Those severe enough to require treatment are shown under *. 47 Routine Medical Inspection of Elementary School Children in St. Pancras in 1980. 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 or both eyes. Entrants— Boys 1301 961 321 19 147 1137 16 1 1253 43 5 1271 26 4 794 306 201 Girls 1340 1016 313 11 155 1163 22 — 1264 63 13 1318 21 1 801 330 209 — — — Age 8— Boys 1312 949 343 20 115 1148 48 1 1275 34 3 1280 29 3 894 283 135 802 302 199 Girls 1215 907 299 e 140 1040 35 — 1128 73 14 1193 21 1 804 322 89 752 279 174 Age 12— Boys 00 758 212 n 78 877 26 946 32 3 967 14 — 716 240 25 660 152 166 Girls 961 751 206 4 112 824 24 1 881 72 8 952 8 1 731 197 33 626 181 153 Age 14— Boys 1072 819 236 17 130 927 15 1043 29 — 1062 10 — 757 287 28 713 179 174 Girls 962 718 238 6 157 787 17 1 903 56 3 947 15 — 720 206 36 648 136 172 Totals 9144 6879 2168 97 1034 7903 203 4 8693 402 49 8990 144 10 6217 2171 756 4201 1229 1038 % St. Pancras 752 237 11 11-8 864 23 95-1 4-4 0-5 983 1-6 01 68-0 237 83 650 190 160 % London 597 395 08 20-5 750 45 949 4'5 06 97-4 2-5 01 652 27-7 71 56-6 249 18'5 4$ Provision of Insulin. Owing to the cost of this recently discovered and valuable remedy for the treatment of Diabetes, several applications have been received from Voluntary Hospitals for a supply to be provided, for necessitous patients, at the expense of the Local Authority. With the sanction of the Ministry of Health, this provision can be made under powers contained in Section 77 of the Public Health (London) Act, 1891. During the year, and with the sanction of the Ministry of Health, supplies have been provided, subject to the following conditions : — («) The Insulin is to be issued by the Medical Officer of Health to the medical practitioner undertaking the treatment of the patient. (b) The name and address, age and sex of each patient to be stated. (c) A quarterly report is to be furnished by the medical practitioner to the Medical Officer of Health giving the following information : — (1) The number of doses of Insulin administered, (2) Particulars concerning any tests made of the urine or of the blood of the patient. (3) The progress of the patient during the period under report. Patients who are insured under the National Health Insurance Act are not eligible under the above scheme, as supplies of Insulin are available for them under the Act. 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, and changes in the staff are referred to on page 9. Local Legislation. A.—Local Acta, Bye Laws, and Regulations in force in the Borough: — 1. St. Pancras (Measles and German Measles) Regulations, 1920. 2. Bye-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 water-closets supplied with sufficient water for their effective action. (g) Mortuaries. 3. Regulations concerning the use of Post-mortem rooms. 49 4. Bye-laws and Regulations made by the London County Council, but enforced by the Borough Council:— (a) Drainage bye-laws and deposit of drainage plans. (b) Closing and tilling 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. Public Health Legislation either enacted or coming into force during 1930:— New Bye-laws with respect to Water Closets, Urinals, &c. 21st August, 1930. New Drainage Bye-laws 4th September, 1930. Agricultural Produce (Grading and Marking) Act, 1928. The following Regulations made by the Minister of Agriculture and Fisheries, under powers contained in the above-mentioned Act, came into force on the dates stated: — Regulations with reference to the Grading and Marking of— Eggs 10th March, 1930. Tomatoes and Cucumbers (Glass house grown) 14th April, 1930. Strawberries 19th May, 1930. Dressed Poultry 2nd June, 1930. Canned Fruits 4th June, 1930. Canned Peas and Beans 4th June, 1930. Cherries 18th June, 1930. Cider 10th November, 1930. The Agricultural Produce (Grading and Marking) (Tomatoes and Cucumbers) Regulations, 1929, are revoked. The Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1928, are revoked. Merchandise Marks Act, 1926. The following Orders in Council, made by the Minister of Agriculture and Fisheries under powers contained in the above-mentioned Act, came into force on the dates stated:— Imported Raw Tomatoes Order 17th March, 1930. Malt Products Order 26th September, 1930. 50 The Council's Food Inspectors are authorised to supervise the carrying out of the requirements of the various Orders and Regulations which have been made under the Acts referred to. In order that retailers should not be able to plead ignorance of the law, a printed summary, giving particulars of the requirements contained in the various Orders and Regulations, was distributed to the shopkeepers and stallholders concerned. Proceedings were instituted against a retailer for a flagrant breach of the Imported Raw Tomatoes Order (see page 76). The Public Health (Tuberculosis) Regulations, July 28, 1930. These Regulations came into force on January 1st, 1931, and amend the requirements with reference to Notification. The County of London (Tuberculosis) Regulations. Came in'o force on April 1st, 1930, and give power to maintain or arrange for the maintenance, otherwise than in their homes, of children living in houses where, owing to overcrowding or otherwise, they are in danger of being infected with tuberculosis, or whose parent or parents are receiving residential treatment for tuberculosis, and for whose care arrangements cannot otherwise be made. The Regulations are administered through the London County Council, but cases considered to be suitable are recommended by the staff of the Borough Council. Local Government (Qualifications of Medical Officers and Health Visitors) Regulations, 1930. On and after April 1st, 1930, the approval of the Minister of Health is not required in connection with the appointment of the above-mentioned officers. The Local Government Act. This very important and comprehensive Act came into force on April 1st, 1930. The Housing Act, 1930. This Act makes further provision with respect to the clearance or improvement of unhealthy areas, the repair or demolition of insanitary houses, and the housing of persons of the working classes. It came into force on 16th August, 1930. Parrots (Prohibition of Import) Regulations. Came into force on May 20th, 1930 (see page 91). HEALTH PROPAGANDA. In addition to the numerous leaflets which are distributed from the various Welfare Centres, Tuberculosis Dispensary, etc., an arrangement was made during the year, in conjunction with the Education and Public Libraries Committee, to make known the Health Facilities which exist in the Borough by printing this information on the reverse side of the Monthly Lists which are issued to borrowers at the libraries. Arrangements were also made for the issue of a St. Pancras edition of the Monthly Journal known as "Better Health." Two thousand copies are issued each month and are distributed through the following agencies:— Infant Welfare Centres. Tuberculosis Dispensary. Public Libraries. L.C.C. Schools in the Borough. 51 A copy is also sent to each member of the Council and to all medical practitioners in the Borough, who have kindly promised to place it on the table of their waiting room. From numerous letters which have been received the periodical appears to be greatly appreciated. Section III.—SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. This is provided and controlled by the Metropolitan Water Board. Several industrial undertakings in the Borough have provided a private supply of good quality by means of deep wells. The Borough Council also obtains, by means of a deep well, a considerable supply for use at the Public Baths, Prince of Wales Road. Under Section 49 of the Public Health (London) Act, 14 notices were received and the necessary action was taken with reference to premises in which the water supply had been cut off. In connection with new houses, 110 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 118 tenement houses under powers contained in Section 78 of the London County Council (General Powers) Act, 1907. PUBLIC BATHS AND WASHHOUSES. These are provided by the Borough Council at the following situations:—Prince of Wales Road, N.W.5; Whitfield Street, W.1; and King Street, N.W.1. A block of 12 slipper baths, available to the public, adjoins the Council's flats at Prospect Terrace, W.C.1. The water supply in all cases is obtained from the mains of the Metropolitan Water Board, but at the Prince of Wales Road Baths an additional supply is available from a deep well on the premises. DRAINAGE. The sanitary inspectors have the duty of supervising all work in connection with drains, including construction, reconstruction and repairs. During the year the following work has been carried out; the figures for the previous year are also given for the purpose of comparison:— Inspections. 1930. Inspections. 1929. Drainage work done under notice 3380 3181 Voluntary drainage work 6814 7163 Drains of new buildings 1528 1972 Total 11722 12316 52 Dramage Register.—The following is an analysis of the Drainage Register during 1930:— Plans deposited—Old Buildings under Notice 126 „ „ Old Buildings, Voluntary 201 „ „ New Buildings and Additions 60 387 Applications without Plans 256 Total number of Applications and Plans 643 National Rat Week. Rats and Mice (Destruction) Act, 1919. A circular was issued to all Local Authorities by the Minister of Agriculture and Fisheries, suggesting that during the week commencing 3rd November special efforts should be made to secure concerted action with a view to the destruction of rats and mice. The matter was considered by the Public Health Committee and the following procedure adopted:— A circular was forwarded to the occupiers of premises particularly likely to be infested owing to the nature of the business carried on therein—such as railway sheds and sidings, goods yards, wharves, slaughter-houses, corn chandlers, etc. Attention was also called to the necessity of abolishing refuse and rubbish heaps which might serve as breeding grounds. Chemists and hardware dealers in the Borough were asked to stock, exhibit or advertise suitable raticides, traps, etc., during the week in question. With the co-operation of the Borough Engineer a quantity of bait was also laid in the Council's sewers. A communication was subsequently received from the Minister of Agriculture expressing appreciation of the action taken by the Borough Council. In addition to the above-mentioned special procedure 102 complaints were received during the year with reference to nuisances caused by premises being infested by rats. Steps were taken by the service of notices on owners or occupiers, by the testing of drains, and other necessary measures in order to abate the nuisance. Nuisance Caused by Pigeons. During the year complaints were received on several occasions regarding a nuisance arising from the presence of large numbers of these birds. In addition to the fouling of gutters, window ledges, areas, etc., by accumulation of excreta, nuisance may also be caused by the blocking of pipes by their nests, and by the birds picking out mortar between the bricks and so tending to cause dampness within the houses. Section 52 of the London County Council (General Powers) Act, 1927, authorises local authorities in London to seize, destroy, sell, or otherwise dispose of pigeons in excess of such numbers as the local authority consider reasonable. Arrangements were made for the capture and humane destruction of a number of these birds, but the work is difficult to carry out in densely populated areas, and the prevalence of the birds is unfortunately encouraged by the practice of feeding them, which is adopted by many kind-hearted, but misguided persons. 53 Refuse Collection and Disposal, A.—A weekly collection is made in all 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. & cy.e., the Borough Engineer, give some idea of the enormous amount of refuse to be dealt with. For the purpose of comparison the figures for the previous year are also given:— Quantity of refuse collected 59099 18 58993 12 Quantity of refuse burnt at Destructor 36118 4 34381 0 Quantity put on rail 22864 14 24509 3 Quantity of clinker residual 12911 18 12527 17 MORTUARY. This is situated in Cambridge Street, at the rear of St. Pancras Gardens. The following table gives particulars concerning the number of inquests held, number of bodies received and post-mortem examinations made during the year. Male. Female. . Number of inquests held 179 94 273 ,, bodies received 173 108 281 ,, post-mortem examinations 125 82 207 Extensive improvements have been made in connection with the Mortuary during the past two years, and it is now a well-equipped and satisfactory building. During the year under review the artificial lighting was further improved, and the following work, suggested by the Sub-Committee, was carried out:— Mortuary approach road.—Remove defective corrugated iron coal shed; remove earth banks to widen the road and concrete the surface; build a new brickwork coal shed, with concrete flat roof and concrete floor, against the wall in the corner of yard to approximately the same area as the existing coal shed. Mortuary yard.—Fill up and cover over existing disused pit near gas-meter cupboard, 1930. 1929. Tons. Cwts. Tons. Cwts. 54 SANITARY INSPECTION OF THE AREA. Inspections.—74,231 visits and inspections were made in 1930 by the Council's staff of Inspectors and Health Visitors. Of these inspections, 50,820 were made by the District Sanitary Inspectors, 9,544 by the Inspectors of Food and Food places, 7,600 by the Inspectors of Factories and Workshops, and 6,267 by the Women Sanitary Inspectors and Health Visitors (for Tuberculosis). The inspections dealt with above are exclusive of the visits in connection with the health of expectant mothers and young children made by the Council's staff at the Maternity and Child Welfare Centres (see pages 30 and 115), and by the staff of the Tuberculosis Dispensaries (see page 100); nor do they include the work of the disinfecting staff, particulars of whose work are given on pages 101 and 102. Notices sewed.—4,178 intimation notices were served by the Inspectors during the year. Of these 3,720 were served by the District Sanitary Inspectors, 452 by the Factory and Workshop Inspectors, and 6 by the Food Inspectors. 1,338 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, 8 and 9 on pages 112—115. The following prosecutions were undertaken during the year in respect of general sanitary work:— Summonses. Under the Public Health (London) Act, 1891 (except in respect of Food). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 30, Rhyl Street Failing to comply with the provisions of a Nuisance Order 1930 Jan. 16th Withdrawn Notice, complied with. 1, St. Silas Street Back addition roof defective „ 16th. Work carried out—Costs £2 2s. „ Yard paving defective „ l6th Work carried out—Costs 10s. 6d. 23, Islip Street Drain, roof, and skylight defective 30th Order 21 days—Costs £2 2s. 158, Seymour Street Manhole cover, fresh air inlet, connection of water closet to soil pipe, staircase ceiling, passage floor boards and front area paving defective Feb. 24th Order 28 days—Costs £2 2s. 158, „ Yard paving defective „ 24th Fined £2. Costs £l 1s. 158, „ ,, ,, ,, 24th Fined £2. Costs £1 1s. 75, Harmood Street Dustbin defective April 3rd Notice complied with— Costs £1 3s. 77, „ „ „ ,, 3rd Notice complied with — Costs £1 3s. 81, „ Failing to provide portable metal dustbin 3rd Notice complied with— Costs £1 3s. 87, „ Forecourt undrained ,, 3rd Order 14 days—Costs £1 5s, 91, „ „ „ ,, 3rd Order 14 days—Costs £1 5s. 25, Hawley Crescent An occupied house without a proper and sufficient supply of water (to upper floors) June 26th Notice complied with— Costs £2 2s. 1a, Rhyl Street Overcrowding July Slat Order 28 days. Costs £1 5s. 81, Marsden Street Insufficient water closet accommodation „ 31st Notice complied with— Costs £1 5s. 17, Litcham Street An occupied house without a proper and sufficient supply of water (to upper floors) Aug 1st Order 28 days. 18, „ Roof defective ,, 1st Fined £2. 67, Stibbington Street Washhouse roof, guttering and paving defective Nov. 6th Order 14 days. Costs £1 5s. 55 London County Council Bye-Lawa—Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 158, Seymour Street Failing to cleanse walls and ceiling of watercloset and remedy defective treads, etc., to staircase 1930. Feb. 24th Fined £1. Costs £1 1s. 3, Rhyl Street Back basement room overcrowded July 31st Adjourned sine die to enable owner to take proceedings for possession. 9, Litcham Street Failing to carry out cleansing work Aug. 1 Fined £5. 10, „ „ „ „ „1 Fined £4 17, „ „ „ „ „ 1 Fined £4. 18, „ „ „ „ „ 1 Fined £2. 19, „ „ „ „ „ 1 Fined £2. Costs £2 2s. London County Council Bye-Laws—Metropolis Management Acts. Queen Alexandra Mansions, Judd Street Altering a drain without giving notice 1929. Dec. 31st Costs £1 1s. SMOKE ABATEMENT. 371 observations of chimney shafts were made during the year and four notices were served. There were no prosecutions. The Public Health (Smoke Abatement) Act, 1926, 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, and a Conference, known as the Greater London Joint Smoke Abatement Conference, on which the London, other County and Borough Councils and representatives of various Industries were present, met during the year and considered the question of bye-laws, especially with reference to the maximum period during which black smoke could be emitted from industrial undertakings, but bye-laws under the Act have not yet been made. Draft bye-laws have been considered, and will probably be issued at an early date. 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:— 1.— Inspections made by Male and Female Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories 2023 143 — Workshops 3737 246 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 784 23 — Totals 6544 412 — 58 2.—Defects Found. Particulars. (1) Number of Defects Number of Found. (2) Remedied. (3) Referred to h.m. Inspectors. (4) Prosecutions. ##] Nuisances under the Public Health Acts*: — Nil. Nil. Want of cleanliness 200 194 Want of ventilation 5 5 Overcrowding 1 1 Want of drainage of floors — — Other nuisances 133 132 Sanitary accommodation— Insufficient 5 5 Unsuitable or defective 117 113 Not separate for sexes 24 24 Other breaches 49 48 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) 56 56 Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) — — Totals 590 578 * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Home Work. 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 carried out in premises which are insanitary, or in which infectious disease is present. The following lists were received during the year:—37 in respect of the making, etc., of wearing apparel, comprising the names of 60 outworkers (contractors) and 114 outworkers (workmen), 1 in respect of upholstering, comprising the name of 1 outworker (workman), 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 8 outworkers (workmen), 3 in respect of embroidery, comprising the names of 50 outworkers (workmen), 1 in respect of making, etc., of coat hangers, comprising the names of 10 outworkers (workmen), and 1 in respect of general furnishers, comprising the names of 17 outworkers (contractors) and 5 outworkers (workmen). 57 The following table give9 the number and type of outworkers' premises in the Borough and the principal industries concerned:— Nature of Work. Nature of Premises. Total. Factories. Workshops. Workplaces. Wearing apparel 20 273 297 590 Card boxes — — 4 4 Artificial flowers — — 2 2 Miscellaneous — 7 42 49 Totals. . 20 280 345 645 4.—List of Factories, Workshops (Registered, Sec. 131) and Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 65 89 — 154 Cabinet makers 54 63 — 117 Coach builders 21 18 — 39 Dressmakers 65 118 26 209 Engineers 187 34 — 221 Foundries 15 — — 15 Furniture makers 10 19 — 29 Furriers 6 14 1 21 Laundries 9 7 — 16 Metal workers 32 33 — 65 Milliners — 18 3 21 Organ builders 8 2 — 10 Pianoforte manufacturers 43 23 — 66 Printing 73 11 — 84 Restaurant kitchens — — 280 280 Tailors 12 239 146 397 Upholsterers 4 34 2 40 Wood carvers 3 18 — 21 Other occupations 475 534 342 1351 Totals 1082 1274 800 3156 58 5.—Other Matters. Class. (1) Number. ##] Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 140 Reports (of action taken) sent to H.M. Inspector 140 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 36 Underground bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 85 Bakehouses and restaurant kitchens are also referred to on page 73. 6.—Total Inspections. Premises. Male Inspector. Women Inspector. Total. Factories 1498 525 2023 Workshops 2330 1407 3737 Workplaces (including Outworkers' premises) 412 1329 1741 Total 4240 3261 7501 PREMISES AND OCCUPATIONS CONTROLLED BY ACTS, BYE-LAWS OR 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. 39 visits were made to these premises during the year. No complaints have been received, and the business is well conducted. Rag and Bonk Dealers. Additional bye-laws were made in 1928 by the London County Council, under powers given by Section 9 of the London County Council (General Powers) Act, 1908. The bye-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 59 (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 bye-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 (he full amount of the penalty imposed by this bye-law. There are 29 premises in the Borough in which the business of a rag and bone dealer is carried on, and these are visited regularly by the Inspectors concerned. Rag Flock Acts, 1911-1928. Rag Flock Premises. The above Acts prohibit the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. The expression "flock manufactured from rags" is defined in the 1928 Act as flock which has been produced wholly or partly by tearing up woven, or knitted, or felted materials, whether old or new, but does not include flock obtained wholly in the processes of the scouring and finishing of newly woven or newly knitted or newly felted fabrics. Houses Let in Lodgings. Bye-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 112. Lighting of Staircases of Tenement Buildings. The above provision is required by Section 61 of the London County Council (General Powers) Act, 1927, which came into force on August 1st, 1928. Tenement buildings are regularly inspected in order to ensure that compliance with the Act is maintained. 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 3 canal boats, which were registered for the occupation of 7 adults and 5 children, and were actually occupied by 7 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 58 applications were received from tenants for certificates under this Act, and in 54 eases certificates were granted, specifying the work required to be executed in order to put the houses into a good and tenantable state of repair, 60 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, Bye-laws, etc. Section IV.—HOUSING. The following particulars concerning the number of new houses and flats erected during the year, and details of the work carried out with reference to existing houses (under the Housing Act and Public Health Acts), are given in the following form in accordance with the requirements of the Ministry of Health:— Number of new houses erected during the year :— (a) Total (including number given separately under (b)) 155 flats (b) With State assistance under the Housing Acts:— (i) By the Local Authority 39 (ii) By other bodies or persons 116 1. Unfit duelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4062 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 880 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 1353 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action (intimation only) by the Local Authority or their Officers 2782 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 270 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 202 (b) By Local Authority in default of owners 1 61 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. 13.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 852 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice:— (a) By owners 794 (b) By Local Authority in default of owners Nil. C.—Proceedings under Sections 11,14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders 5 (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. Particulars concerning Inspection of Tenement Houses are given in Table 6 on page 112. The 155 flats mentioned at the beginning of this Section as having been erected during the year comprised the following:— 39 flats built by the Borough Council (36 in Clarendon Street, Somers Town, and 3 built on vacant land in Chester Road on the Brookfield Estate); 66 flats erected by the London County Council on their Ossulston Estate; and 50 flats built by the St. Pancras House Improvement Society, Ltd. (30 in Bridgewater Street, and 20 in Little Drummond Street). HOUSING CONDITIONS. 1.—General Observations. With the exception of a relatively small number of blocks of self-contained flats, the greater part of the working-class accommodation in the Borough consists of tenement houses, and the drawbacks associated with this form of housing are well known. Most of these houses are old, and, owing to age and the rough usage associated with numerous tenants, frequent inspections and the service of many notices are required to keep them in anything like suitable condition. Although the majority of the tenement houses have been occupied as such for many years, the number is steadily increasing, as year by year there are streets in which the houses, previously occupied by one family, are now being let to a number of families. The factors mainly responsible being the age of the houses in question, the cost of upkeep, the inconvenience of so many stairs, the migration of many of those able to afford it to the outlying suburbs, and the increasing popularity of the modern up-to-date flat. The type of tenement house usually found in the Borough is a single-fronted terrace house, generally of about three storeys, but also having a more or less underground basement. Each floor usually has two rooms, one in front, the other at the back, and although there are 62 many single-room tenements, as a rule each floor is occupied by one family ; but there are also tenements of three or four rooms, but in these cases the rooms are necessarily spread over more than one floor. The principal drawbacks associated with tenement houses of this type are the following:—Insufficiency in the number of rooms; most working-class families require four rooms—a living room, and a bedroom each for the parents, boys, and girls respectively. Absence or shortage of such essentials as facilities for storing and cooking food, scullery accommodation, bath, adequate supply of water, and means of getting rid of waste water. As regards w.c. accommodation, there is usually only one to each house, generally situated either in the basement or in the yard. No adequate provision exists for storing coals, which usually have to be kept in one of the room, and no separate facilities for storing refuse, as this can only be kept in a bin, which is placed in the yard, a situation very inconvenient for tenants on the upper floors, who, in consequence, either store it for a time in the room until it is convenient to take it down to the yard, or the rubbish is thrown out of the window on to the yard. Tenement houses are particularly unsuitable for children, owing to the inadequate amount of sleep they can obtain, as these houses are invariably noisy and overcrowded. Adults and children must share the same room or rooms, and sleep is practically impossible until everyone retires, usually late at night. A frequent source of nuisance arises from the neglect to keep clean parts of the premises which are used in common by all the tenants, such as staircase, passages, yard, w.c., washhouse, etc. The letting of tenement houses is usually done in one of two ways: either there is a non-resident landlord who collects the rents from each individual tenant, or there is a resident tenant, usually protected by the Rent and Mortgage Interest Restrictions Acts, who rents the whole house, retaining one or two rooms for personal use and subletting the remainder. 2.— Sufficiency of Supply of Houses. During the year further progress was made with the scheme being carried out by the Borough Council in the Wolcot Street area, the London County County Council's scheme in Ossulston Street, and with the provision of accommodation in Somers Town by the St. Pancras House Improvement Society, Ltd. A scheme has also been initiated recently for the provision of a block of wor king class flats 011 a portion of the Crown Estate situated to the North of Cumberland Market, previously used for industrial purposes. When completed they are to be used to accommodate tenants at present living in old houses on adjoining portions of the Crown Estate. These houses can then be demolished and similar blocks of dwellings be erected on the cleared site. This scheme constitutes a very valuable contribution to the housing needs of the Borough, for, although on additional accommodation will be available for some time, it is estimated that the total housing accommodation to be provided will ultimately be considerably in excess of the amount demolished. There is still, however, a shortage of houses, chiefly due to the difficulty of obtaining sites on which to build them. For the same reason, it would be extremely difficult to provide accommodation in which to house tenants who must be displaced before any clearance or improvement scheme can be carried out. 63 In the South of the Borough especially, ground values appear to be increasing, and this part is being more used for industrial purposes. In a number of instances working class houses have either been demolished for the erection of business premises or have been converted to this use. 3.—Overcrotvding. (a) Extent. This continues to be very prevalent, but it is difficult to give definite statistics concerning its prevalence owing to the absence of any satisfactory and reliable standard. The Tenement House bye-laws at present require 300 cubic feet of free air space for every person over 10 years of age, and 150 cubic feet for each child under 10 years occupying a room used exclusively for sleeping purposes. In rooms not used exclusively as sleeping apartments the requirements are 400 and 200 cubic feet respectively. It is stated in the byelaws that when the Rent and Mortgage Interest (Restrictions) Acts cease to be in force, the requirement is to be 400 cubic feet per person, with no reduction for children. A new bye law is, however, now contemplated by the London County Council in this connection and is shortly to be submitted to the Minister of Health for approval. This will require 400 cubic feet of air space for each person of 10 years of age or over, and 300 cubic feet of free air space for each child under 10 years of age with reference to any room wholly or partly used as a sleeping apartment. In houses which are not tenement houses no standard is provided; any necessary action with reference to overcrowding would be taken under the Public Heath (London) Act, and it would be necessary to prove injury or danger to health. In connection with accommodation provided under the new Housing Act (1930), Sec. 37 of that Act regards a house containing two bedrooms as providing accommodation for four persons, a house containing three bedrooms as providing accommodation for 5 persons, and a house containing four bedrooms as providing accommodation for 7 persons. This standard is definitely unreasonable, and must also prove to be unnecessarily expensive in practice. No reference is made to the size of the rooms or to the age or sex of the occupants, and, if strictly enforced, would exclude an infant from the room occupied by the parents. The introduction of a definite and uniform standard appears to be desirable for all working class houses, preferably based on cubic feet of free air space, with separation of the sexes in sleeping apartments for persons over 12 years of age. Based on the routine inspection of 4,217 working class houses carried out by the district Sanitary Inspectors under the Public Health and Housing Acts, it has been ascertained that 6,989 persons are living at a density of three or more persons per room. This is irrespective of size of room or the age or sex of the occupants. (b) Causes. The causes of overcrowding are many and varied, and include the following:— 1. Inability to pay for adequate accommodation owing to low wages and large number of dependent children. The following are typical cases:— b. Man (labourer), wife and 12 children, eldest age 17. Family income from 50s. to 70s. per week. Two rooms, rent 8s. 9d. h. Man, wife, 8 children, eldest age 16 (has heart disease). Two rooms, rent 8s. 2d. The man sells ice cream during the summer, is unemployed the remainder of the year. In arrears with rent, and has parish relief. Cases such as the above have usually lived in the same rooms for many years; in a number of instances the rooms were taken when the parents married, and the children have 64 been born and have grown up there. Although the accommodation has gradually become increasingly inadequate, the tenants are disinclined to leave as they arc protected by the Rent and Mortgage Interest Restrictions Acts, and would lose the privileges conferred by that Act if other rooms were taken. Apart from this, it is almost impossible for them to move, as no landlord would accept tenants with such large families, and who would obviously be unable to pay the rent for more accommodation. If overcrowding is to be abated in cases of this type, it would appear they must be housed by the Local Authority and the inevitable loss fall on the rates. 2. Able to pay for adequate accommodation, but this is not available in the Borough, and the nature of the occupation does not permit living at a distance. 3. Able to pay for better accommodation, but prefer to have more money for other purposes rather than expend it on rent. b. Man, wife, 5 children. 1 room. Rent 8s. 3d. The man is a first class decorator working for a West End firm. Wages about £6 weekly, a large part being spent on drink. n. Man, wife, 8 children. Living in 2 rooms. Ages of children: males, 26, 21, 17, 14, and 4 years; females, 19, 8, and 2. The man has a pension of 19s. Wages £3 15s. The five elder children contribute a further £3 15s. to household expenses, the total wages being, of course, much more. In this case the owner applied to the Court for possession on account of the overcrowding and arrears of rent. The application was refused and an Order made to pay 3s. per week off the arrears. A most inequitable decision. In a number of instances, such as the above, the grown-up sons and daughters, although in receipt of good wages, do not make an adequate contribution to the family exchequer ; they are parasites upon the parents. In some cases where the family income is adequate, all desire for better accommodation appears to have been lost, apparently owing to long residence under conditions of gross overcrowding and even indecency. The following is a typical case:— n. Man, wife, 2 daughters aged 19 and 15, and a son aged 17, all living and sleeping in one basement room. 5. Chronic illness or defect in the parents, such as Epilepsy, Tuberculosis, etc., with resulting poverty. h. Man (unemployed, epileptic), wife, 11 children. 2 rooms. Rent 10s. Family income £2 6s. 6d. Have parish relief. Apart from the question of transmission of the defect or disease, such persons are obviously quite incapable of providing adequately for their children, although this fact does not in the least act as a deterrent. It would appear that in such cases sterilisation is the proper remedy. (c) Action taken during the year to deal with Overcrowding. The London County Council allocate a certain percentage of the accommodation on their large housing estates, chiefly at Becontree, to suitable families who are recommended by the Metropolitan Borough Councils. Persons can also make direct application to the London County Council. The Valuer of that Authority has kindly given me the following particulars 65 with reference to the number of St. Pancras families provided with accommodation by the London County Council during the year:— (a) On recommendation of the Borough Council 49 (b) Other cases of special hardship 22 (c) From the London County Council General List 243 The above mentioned comprised families who could afford the necessary rent, plus travelling expenses, and whose work permitted them to live at a distance. Efforts were made in these cases to obtain the accommodation vacated in order to relieve overcrowding in other families living in the house or in adjoining premises, and in a number of instances the owners co-operated in the manner desired. The Estates Committee, in allocating accommodation in new flats provided during the year by the Borough Council, also exercised due discretion in selecting families whose need was great by reason of living under overcrowded conditions. In several instances Closing Orders were made with reference to families living under conditions of serious overcrowding in underground rooms which were defective or insanitary. Legal proceedings were also taken in one very flagrant case of quite unnecessary overcrowding. The family income was ample, but, owing either to apathy or demoralisation, no effort was made to procure more suitable accommodation. The family consisted of man, wife, and 13 children, comprising sons of 25, 23, 21, 17, 15, and 10, and daughters of 19, 13, 8, 7, 5, 2, and 1 years of age. Rent 13s. 6d. per week for three rooms, one of which, quite small, was used for living purposes only, and in the other two rooms the parents and 13 children slept. A family income of more than £10 per week was admitted, but it was estimated that the actual earnings were about £14. An order to vacate the premises within 28 days was made, and within that period suitable and satisfactory accommodatiou was secured. Underground Rooms. Housing Act, 1025, Section 18, as amended by the Housing Act, 1030. In consequence 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, prohibiting their use for sleeping purposes:— 1, Grange Road (one room). 196, High Street, Camden Town (two rooms). 75, Maiden Road (one room). 93, Maiden Road (one room). In order to ascertain the extent to which underground rooms were at present being used, the undermentioned Inspectors have recently made a special survey in all areas where such rooms were likely to be used for sleeping purposes. Definite information was desired, not only for statistical purposes but in order that preference could be given to persons living in unsatisfactory basement rooms whenever any alternative accommodation became known to the department. 66 The following table gives particulars regarding the use of underground rooms concerning which information was obtained:— Inspector. Number of Underground Rooms. Empty. Used as Washhouse or for Trade purposes. Used for Living only. Living and/or Sleeping. Used for sleeping but do not comply with the Regulations Number of Rooms. Number of occupants. Adkins 883 39 164 443 237 237 484 Akers 717 33 34 488 162 121 232 Brown 321 6 12 152 151 98 204 Capel 562 48 85 284 145 21 39 Jaffa 873 44 88 432 309 38 85 James 1803 71 234 1060 438 170 366 Lonnon 965 158 204 341 262 249 439 Nixon 648 58 40 318 232 137 271 Rackhain 157 2 94 61 61 120 Thompson 750 98 196 194 262 121 243 Walker 464 77 52 186 149 9 18 West 781 52 394 196 139 70 105 Winchester 1240 137 408 421 274 161 339 Totals 10164 823 1911 4609 2821 1493 ' 2945 It will be noted that, out of a total of 10,164 underground rooms, no less than 2,821 were found to be used for sleeping purposes. Many of these are quite satisfactory and comply with the Regulations. 1,493 rooms occupied by 2,945 persons did not comply with all the Statutory requirements for underground rooms used for sleeping purposes, and were therefore illegally occupied. Many of these were fairly satisfactory rooms and only infringed the requirements in certain particulars, others were definitely unsatisfactory. It is, however, impossible to take proceedings in all these cases as suitable alternative accommodation is not available, and even an undesirable basement dwelling is better than no accommodation. It would also appear that the good intentions of the housing reformer are not always appreciated, and that in a number of cases this type of home appears to be preferred. During the course of this survey the following somewhat amusing, but rather pathetic, anonymous communication was received:— "Dear Sir, Please don't get us out of our basements, where our babies have all the freedom and keep well and strong. Ours never get fevers and things, because we never go to the clinics where they are caught. Us mothers were all born in basements, and are quite strong. Please leave us alone. From 20 Mothers." 67 HOUSING SCHEMES. WORK OP THE ESTATES COMMITTEE OF THE BOROUGH COUNCIL. The following account of the principal matters dealt with during the year has been furnished by Mr. W. C. W. Roworth, 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 "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 (56 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, Ahlenham Street, Somers Town (26 flats). (g) Wolcot House, Aldenham Street, Somers Town (18 flats). (h) Johnson House, Johnson Street, Somers Town (26 flats). (i) Gladwin House, Johnson Street, Somers Town (18 flats). (j) Clarendon House, Clarendon Street, Somers Town (36 flats). (k) 110 and 112, Leighton Road, Kentish Town. (l) 40, Argyle Square (the main part of the premises is used as a Maternity and Child Welfare Centre and Dental Clinic, but four rooms in the house are let). (m) 13 and 15, Bayham Place, Camden Town. (n) 15, Willes Road, Kentish Town. (o) 24, Grafton Road, Kentish Town. (p) 20 and 22, High Street and 3 and 5, Little King Street, Camden Town. (q) 5, Camden Road (the lower part is used as Electricity Showrooms, and the upper part let in rooms). (r) 41 and 47, Stanhope Street, Regent's Park. (s) 143, 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street, Camden Town. (t) 9, 10, 11, 12, 13, 14 and 15, Georgiana Street, Camden Town. (u) 3, James Street, Camden Town. (v) 207, Arlington Road. Preference is given to persons residing in the Borough when vacancies occur in the Council's dwellings, and applications are dealt with in priority, but priority is given in some cases where the housing conditions arc extremely bad, and in all cases persons with families receive first consideration. During the past year there have been 43 changes of tenancies in the Council's properties, and the opening of the final block of d wellings in the Somers Town Housing Scheme (Wolcot Street Area) has found accommodation for another 36 families. 68 Somers Town Housing Scheme (Wolcot Street Area). The fifth and final block of dwellings of the Borough Council's housing scheme in the Somers Town area was completed in December, 1930, and was named "Clarendon House," after the thoroughfare in which it is situated. This block comprises 36 dwellings, so that a total of 124 separate tenements have now been provided by the Borough Council in this area. It will be remembered that the Council bear the whole financial liability, without any contribution from the State, as regards the first four blocks of dwellings, but that the block just completed is eligible for State and County Grants under the Housing Act, 1924. It might be mentioned that accommodation has been found for all families who were displaced by reason of the operation of the clearance scheme. Camden Road Housing Scheme. This property, situated on a site at Nos. 7 and 9, Camden Road, will be developed for the crection of 22 self-contained working-class dwellings, in respect of which the State and County Subsidy will be available under the Housing Act of 1924, and will also house a Tuberculosis Dispensary and Maternity and Child Welfare Centre. Shops or offices are to be erected on the ground floor frontage in Camden Road. The Council accepted the tender of the Canonbury Construction Company, Ltd., to carry out the work for the sum of £21,464 in July, 1930, but some delay arose in obtaining the consent of the sanctioning authorities for the provision of the Maternity and Child Welfare Centre, and it was not until the end of December, 1930, that the work could be commenced. It is, however, now proceeding satisfactorily, and is expected to be completed by the end of the year. London County Council Housing Estates. The London County Council continue to house a number of St. Pancras families in their various estates, and so relieve bad cases of overcrowding and special hardship, to which preferential treatment is given upon the recommendation of the Borough Council. This scheme was initiated in January, 1925, and the number of St. Pancras families benefited to the end of 1930 is 686. There are, in addition, a large number of St. Pancras families accommodated in the County Council's dwellings who make application direct. The London County Council have also rendered valuable assistance in providing suitable accommodation for persons displaced by the clearance of the Wolcot Street Area. There is, however, considerable difficulty in arranging for families living in this Borough to accept housing accommodation in the outlying Estates, even if they are able to afford the fares for travelling to their work. This is due to the fact that many of the applicants are railway employees and other transport workers, who, by reason of their being called upon to work at night, must of necessity live within reasonable distance. This factor, of course, applies to many other trades and may be considered to be one of the causes of housing congestion in the Borough. Una House, Prince of Wales Road, Kentish Town. The Borough Council have approved a proposal for the provision of an additional floor, which would provide for 16 additional flats, thus making a total of 80 flats at these dwellings. The proposal has not yet been carried into effect, because of the negotiations that have been taking place between the Council and the Ministry of Health, with a view to an agreement being arrived at for a fixed annual grant to be paid in respect of the Council's Housing Assisted Schemes, instead of the present annual payment of the actual deficiency in excess of the produce of a penny rate. It will be remembered that Una House comes within the category of "Assisted Housing" schemes, and, in the event of an agreement being arrived at, 69 the Borough Council would have sole jurisdiction, and the Ministry would not have to scrutinise the financial details, so that the Council would be enabled to go forward with the proposal, which would provide accommodation for 16 additional families. Housing Act, 1930. The London County Council are required, under Section 31 of the Housing Act, 1930, to review housing conditions in the Administrative County of London, and submit proposals ever five years for the provision of new housing, after consultation with the Councils of the Metropolitan Boroughs. The first statement was required during the year now under review. The Borough Council were asked to supply certain information as to their proposals for the provision of new housing accommodation, and found some difficulty in formulating definite proposals in view of the fact that the provisional programme of the London County Council did not include any additional housing accommodation in this Borough, so that it was doubtful if any action could be taken in connection with clearance or improvement areas, as the Act requires the provision of suitable accommodation for persons who are likely to be displaced before any demolition work is carried out. It is the intention of the Borough Council to extend Una House, as already outlined, and for 22 flats to be erected at Camden Road. Further, the housing scheme in the Wolcot Street Area has only just been completed. The congested conditions in the Borough are such that there are no vacant sites available on which to provide accommodation for persons who would be displaced by schemes involving demolition of property. The Somers Town Area is, however, being transformed. In addition to the Borough Council's scheme, the London County Council arc engaged in extensive housing schemis in the Ossulston Street Area, and the St. Pancras House Improvement Society are continuing their scheme for the erection of working class dwellings in this area. H.M. Office of Works are also developing a comprehensive housing scheme in the Regent's Park Area. There is a need for the provision of housing accommodation, when dealing with slum areas, for re-housitig the one-room tenant. It has been found that this class of tenant is quite numerous, and the fact that no provision is made for it in re-housing schemes presents serious difficulties. The attention of the London County Council has been drawn to the matter, and we understand that it is likely to receive consideration. The Estates Committee continue to investigate the suitability of sites which come to their notice for housing purposes. Section V.- INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. Cousheds. — There are now no licensed cowsheds in the Borough. Laities and Milkshops.—Twenty-nine applications for registration under the Milk and Dairies Order, 1926, were received during the year. Of this number 28 were granted, and one refused. Twelve applications in respect of itinerant vendors were also received, 10 being granted and two refused. The following list gives particulars as to the purveyors of milk on the register at the end of 1930:— Number of purveyors of milk from retail milkshops on the register at the end of 1929 208 Deduct number removed from the register during the year 1929 —25 Add number of purveyors registered by resolution of the Council during 1930 +28 Total number of purveyors of milk from retail milkshops on register at the end of 1930 211 70 In addition to the above, the following were also on the register at the end of 1930:— 3 persons (firms) in respect of premises where a wholesale trade in milk is done. 2 „ (firms) „ „ „ cream „ 2 ,, ,, retail ,, ,, „ and 24 itinerant vendors without retail milkshops. Bottled Milk. During the year 25 persons were registered to sell milk in sealed bottles, and 13 were removed from the register. At the end of the year there were 107 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, which came into force on September 1st, 1925, provides for this fluty, 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 had 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 Milk and Dairies (Consolidation) 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 production, distribution and standards of purity of the various grades of milk sold under special designations are governed by powers contained in the Milk and Dairies (Amendment) Act, 1922 and the Milk (Special Designations) Order, 1923. The special designations comprise the following:— " Certified," "Grade A (tuberculin tested)," "Grade A," and "Pasteurised." Licences to producers of "Certified" and "Grade A (tuberculin tested)" Milk are granted by the Minister of Health, subject to compliance with conditions which are specified in the Order. Licences to sell Milk under the various special designations and for the production of Pasteurised Milk are authorised to be granted by the Borough Council. Any such licence is valid for not more than one year and expires on December 31gt in each year. 71 The following licences were granted in respect of the year 1930:— 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. Deo. 18th, 1929 Lincolnshire Dairies, Ltd., 31, Oak Village, N.W. 5 " Pasteurised " (Plant) 31, Oak Village. Do. Marshall's Dairies, Ltd., 19, Tudor Place, W. 1 " Grade A Tuberculin tested " 19, Tudor Place. Do. T. James, 16, Kenton Street, W.C. 1 Do. 16, Kenton Street. Do. United Dairies (London), Ltd., 233, Seven Sisters Road, N. 4 " Grade A " To sell in St. Pancras. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. Do. United Dairies (London), Ltd., 39, High Road, N. 2 Do. 25, Swain's Lane. Do. Do. " Certified " To sell in St. Pancras. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. " Grade A Pasteurised " Do. Do. Do. " Pasteurised " 51, South Grove. Do. United Dairies (London), Ltd., 31, St. Petersburgh Place, W. 2 Do. 69, Albany Street, Do. Do. Do. 48, Marchmont Street. Do. Do. Do. 63, Park Street. Do. Do. Do. 126, Regent's Park Road. Do. Do. " Certified " To sell in St. Pancras. Do. Do. " Grade A Tuberculin tested " Do. Do. J. R. Mills & Son, 23, Francis Street, W.C. 1 " Grade A " 23, Francis Street. Do. Express Dairy Co., Ltd., 26, Tavistock Place, W.C, 1 "Pasteurised " 50, Gower Place. Do. Do. Do. 26, Tavistock Place. Do. Do. " Certified " Do. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. Do. 1, Guilford Street. Do. Do. " Certified " Do. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. " Pasteurised " 12, South Grove. Do. Do. " Certified " Do. Do. Do. "Grade A Tuberculin tested " Do. Do. Do. " Grade A Tuberculin tested " 5, Stibbington Street. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. Do. Do. Do. 138, Ossulston Street. Do. Do. Do. 46, Mornington Crescent. Do. John Evans, 35, Southampton Street, W. 1 " Grade A Tuberculin tested " 35, Southampton Street. Do. T. J. Jones, 6, Hastings Street, W.C.1 " Certified " 6, Hastings Street. Do. Do. " Grade A Tuberculin tested " Do. Do. H. J.Jenkins. 97, Kemish Town Road, N.W. 1 "Grade A " 97, Kentish Town Road. Do. D. Davies, 10-11, Dukes Road, W.C. 1 " Grade A Tuberculin tested" 10-11, Dukes Road. Do. Do. Do. (Bottling) Do. Jan. 30th, 1930 D. Williams, 57, Leighton Road, N.W. 5 " Grade a Tuberculin tested" 57, Leighton Road. Do. J. R. James, 155, Hampstead Road, N.W 1 Do. 155, Hampstead Road. Do. Lord Rayleigh's Dairies (1929), Ltd., 16, Caroline Street, W.C.1 " Certified " To Bell in St. Pancras. Do. Do. " Grade A Tuberculin tested " Do. [Continued on next page. 72 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. Feb. 27th, 1930 E. A. Lewis, 18a Highgate Road, N.W. 5 "Grade A Tuberculin tested ' 18a, Highgate Road. June 26th, 1930 Farmers & Cleveland Dairies Co., Ltd., 13, East Street, N. 1 Do. 18, Holmes Road. Do. United Dairies (London), Ltd., 39, High Road, N. 2 "Pasteurised " To sell in St. Pancras. July 31st, 1930 D. M. Richards, 161, Whitfield Street, W. 1 "Grade A Tuberculin tested " 161, Whitfield Street. Nov. 27th, 1930 H. J. Jenkins, 97, Kentish Town Road, N.W.1 " Pasteurised " 97, Kentish Town Road. Dec. 18th, 1930 London Co-operative Society, Ltd., Oakthorpe Dairy, Palmers Green, N. 13 Do. Hampstead Road Depot. Do. Do. "Grade A Tuberculin tested " Do. Samples of milk sold under special designations are taken at intervals, and are submitted to bacteriological examination, in order to ascertain if they comply with the standard specified in the Order. As regards "Certified" Milk, and "Grade A.(Tuberculin tested)" Milk in those cases in which the latter milk is bottled at the farm, a scheme has been devised by the Ministry of Health, under which the work of sampling is divided between the Local Authorities in whose area the milk is sold. Samples of the grades above mentioned are to be taken on receipt of instructions from the Ministry, and no samples of these Grades were required to be taken in this Borough during the year. Artificial Cream Act, 1929. The above Act, which came into force on June 1st, 1929, requires the registration of all premises in which Artificial Cream is manufactured, sold, or exposed for sale for human consumption. This requirement does not apply to premises where Artificial Cream is not supplied otherwise than in the properly closed and unopened receptacles in which it is delivered to those premises, nor to its manufacture solely for domestic purposes, nor to its manufacture on any premises for use in the preparation on those premises of some other article of focd. The number of premises registered during the year, in accordance with the requirements of the Act, was one (retail). Artificial Cream is defined in the Act as an article of food resembling Cream and containing no ingredient which is not derived from milk, except water. In actual practice it is manufactured from Dried Milk, Butter and Water in suitable proportions, and the term He-constituted Cream would appear to be more appropriate than the word Artificial. A reference to legal proceedings is made on page 76. (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, 73 The undermentioned unsound or diseased food was surrendered by the owners for destruction or to be dealt with as trade refuse:— Unsound Food Condemned and Destroyed. Surrendered. Apples, 21 boxes Oranges, 43 boxes Beef, 40 stone Peas, 2 tins, and 1 waggon load Cabbages, 68 bags (1 ton 8] cwt.) Haddocks, 5 boxes Plucks, Pigs', 2 Heads, Pigs', 2 Plums, 4 baskets, 103 2-lb. tins, 4 1 -gull. Horse Radish, 27 casks tins Kippers, 12 boxes Potatoes, 14 bags Livers, Bullocks', 7 Raspberries, 1 ton, 12 2-lb. tins „ Sheep's, 1 Skate, 2 cwt. 2i stones Lungs, Bullock's, 1 pair Tangerines, 20 " boats " Lungs and Heart (Sheep's), 1 pair Tomatoes, 92 boxes Mackerel, 1 box Slaughter-houses. At the end of 1930 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 180 inspections during the year. Fried Fish and Fish Curing Premisfs. In 1930 there were 75 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 21 fish curers' premises, including the 4 above mentioned. 430 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, 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 section above mentioned does not apply to any premises used as a Hotel, Restaurant or Club. The total number of premises on the register of the department at the end of the year was 231. Bakehouses and Restaurant Kitchens. At the end of 1930 there were 154 bakehouses on the register, including 65 factory bakehouses. 38 of these bakehouses were not in use. 112 of the 151 were underground bakehouses, of which 55 were factory bakehouses, and 27 not in use. At the end of the year 280 restaurant kitchens were on the register. Bakehouses and restaurant kitchens are supervised by the Factory and Workshop Inspectors, and further particulars in regard to them will be found on pages 55 to 58. Underground Bakehouses. The question of dealing with disused underground bakehouses was considered by the Public Health Committee in 1929, when attention was also called to the absence of any Act or Regulation requiring notice to be given to the Local Authority when alterations were to be made to underground bakehouses. 74 The report was considered by the Council, and it was decided to refer the matter to the Metropolitan Boroughs' Standing Joint Committee, with an expression of opinion that legislation should be sought giving the powers considered to be necessary. Early in 1930 the subject was considered by the Metropolitan Boroughs' Standing Joint Committee, who decided to obtain the co-operation of the District Surveyors. A SubCommittee was appointed, which included Councillor Evan Evans (Chairman of the Public Health Committee), to meet representatives of the District Surveyors. The following proposals were ultimately made: — (1) Each Borough Council to be asked to supply the Secretary of the District Surveyors' Association with a list of the premises included in each Council's register of underground bakehouses. (2) The District Surveyors will then notify the Borough Councils concerned when any structural alterations are proposed. (3) That a communication be addressed to the London County Council urging that a clause he included in their next General Powers Bill providing that any certificate granted pursuant to Section 101 of the Factory and Workshop Act, 1901, shall lapse if and when the premises to which such certificate refers become disused as an underground bakehouse, and that the premises shall not again be so used until a new certificate has been granted. These proposals were approved and adopted by the Metropolitan Boroughs' Standing Joint Committee, as they considered that an endeavour should be made to amend the existing unsatisfactory position. The thanks of the Joint Committee were extended to the District Surveyors' Association, Councillor Evan Evans, and the other members for their assistance in the matter. (c)—SALE OF FOOD AND DRUGS ACTS. 800 samples have been taken under these Acts, of which 504 were formal and 296 informal. Of the formal, 487 proved to be genuine, and 17, or 3.4 per cent., adulterated; and of the informal, 273 were genuine and 23, or 7.7 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informa Almonds (ground) — 1 — 1 — — Apricots (dried) — 1 — 1 — — Bacon — 4 — 4 — — Beef (minced) 2 5 2 3 — 2 „ (spiced) — 1 — 1 — — ,, steak — 1 — 1 — — Brawn — 4 — 4 — — Butter 129 1 129 1 — — Cakes (fruit) — 2 — 2 — — Camphor Ice — 1 — 1 — — Carbolic Ointment 1 14 — 13 1 1 Cheese 3 15 3 15 — — Cherries (canned) — 2 — 2 — — Cinnamon (ground) — 7 — 7 — — Cocoa 5 2 5 2 — — Coffee 5 — 5 — — — Coffee and Chicory (extract) — 4 — 4 — — Cream — 25 — 25 — — ,, Bun 1 1 1 1 — — ,, (canned) — 1 — 1 — — „ Cornet 8 6 2 2 1 4 „ Doughnut 0 10 — 1 6 9 Carried forward 155 108 147 92 8 16 75 Artiolea of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 155 108 147 92 8 16 Cream Frame 1 — 1 — — — ,, Horn 2 4 1 2 1 2 ,, Pastry 2 — 1 — 1 — Shell 1 — 1 — — — Currants — 2 — 2 — — Dripping 5 — 5 — — — Fish paste — 2 — 2 — — Flour (Self-raising) 15 — 15 — — — Fruit (mixed) — 1 — 1 — — Ginger (ground) — 2 — 2 — — ,, Wine — 1 — 1 — — Green Soap — 2 — 2 — — Gregory's Powder — 5 — 5 — — Ham (cooked) — 1 — 1 — — Honey — 2 — 2 — — Indian Cerate — 1 — 1 — — Jam — 6 — 6 — — Jelly (table) — 1 — 1 — — Lamb (meat) — 2 — 2 — — Lard 12 — 12 — — — Lemon Cheese — 2 — 2 — — „ Curd — 1 — 1 — — Liniment of Turpentine — 14 — 14 — — Margarine 5 6 5 6 — — Marmalade — 1 — 1 — — Meat Paste — 1 — 1 — — „ Pie — 2 — 2 — — Milk 280 4 274 4 6 — „ (condensed) — 7 — 7 — — Mincemeat — 1 — 1 — — Mustard 6 — 5 — — — Olive Oil — 2 — 2 — — Orange Wine — 1 — 1 — — Peas (canned) — 4 — 4 — — Peel (candied) — 2 — 2 — — Pepper 5 1 5 1 — — „ (compound) — 1 — 1 — — Peroxide of Hydrogen — 1 — 1 — — Plums (canned) — 1 — 1 — — Port Wine — 1 — 1 — — Pork Pie — 1 — 1 — — Prescription — 2 — 2 — — Princess Cake (cream-filled) 1 — — — 1 — Raisins — 4 — 4 — — Raisin Wine — 2 — 2 — — Sago — 1 — 1 — — Sauce — 1 — 1 — — Sausages 3 52 3 47 — 5 ,, (cooked) — 4 — 4 — — Spice (mixed) — 1 — 1 — — Suet (shredded) — 4 — 4 — — Sugar — 1 — 1 — — Sulphur Ointment — 1 — 1 — — Sultanas — 4 — 4 — — Sweets — 6 — 6 — — Swiss Roll — 1 — 1 — — Tea — 7 — 7 — — Vinegar 9 — 9 — — — ,, (malt) 3 1 3 1 — — Zinc Ointment — 10 — 10 — — Totals 504 296 487 273 17 23 76 Prosecutions were undertaken as regards 14 samples, which were reported as being adulterated. The results of the proceedings are stated in the following tables:— (SUMMONSES. {a) Sale of Food and Drugs Acts. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. 1930. £ s. d. £ s. d. A. 35 Milk Deficient in milk fat, 15.3 per cent Mar. 18th Dismissed under Probation of Offenders Act. 2 0 0 C. 145 „ „ 200 „ July 30th — — — 2 2 0 C. 154 „ „ 30.0 „ „ „ — — — 2 2 0 *C. 214 Cream cornets The fatty portion of the "cream" contained 80 per cent, of fat other than milk fat. Nov. 18th — — — *C. 215 „ pastries „ „ Summonses adjourned sine die pending result of appeal Lyons v. Wiltshire C.C. *C. 217 „ horns „ „ *. 218 „ doughnuts „ „ *A. 151 „ „ „ 27th *A. 152 Princess cake (cream filled). „ „ „ „ „ „ „ *A. 157 Cream doughnuts „ „ *A. 158 „ „ „ „ *C. 220 „ „ „ „ *C. 221 „ „ 1931. A. 169 Carbolic ointment Deficient in phenol or carbolic acid and adulterated by the addition of 216 per cent. of zinc ointment, 20 per cent. starch and 6 8 per cent. of sulphur. Jan. 1st — — — 2 0 0 * Summonses were also served under the Artificial Cream Act, 1929, for selling for human consumption under a description or designation including the word " cream," a substance purporting to be cream which was net cream as defined by the Artificial Cream Act, 1929, contrary to Section 1 of that Act. (b) Milk and Dames Order, 1936. [###Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 1929. College Place Delivering milk in bottles which were not filled and closed on registered premises Dec. 27th Fined £1, Costs 10s. 1930. Litcham Street „ „ Jan. 2nd Fined £1, Costs £1 1s. „ „ „ „ „ Fined £1. Holmes Road Carrying on the trade of a dairyman without being registered „ Fined £1, Costs £1 1s. 85, Whitfield Street „ „ Mar. 18th Fined £2. (c) Under the Merchandise Marks (Imported Goods) No. 4 Order, 1929. Address. Offence. Date of Hearing of Summons. Result of Proceedings. 1930. Seaton Street Exposing for sale imported raw tomatoes, which were not marked by means of a show ticket bearing the indication of origin Aug. 29th Fined £5, Costs £2 2s. 77 (d) London County Council (General Powers) Act, 1928. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 1930. 303, Kentish Town Road Using premises for the sale of ice cream without the premises being registered Sept. 12th Fined £2, Costs £2 2s. 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 compulsory notifiable in St. Pancras:— A, Under the Public Health (London) Act, 1891 Small-pox (Variola) Typhus Fever Cholera Typhoid „ Diphtheria and Membranous Croup Enteric „ Erysipelas Relapsing ,, Scarlet Fever (Scarlatina) Continued „ Puerperal „ B. Under Special Regulations made by the Ministry of Health granted under powers contained in the Public Health Acts:— Plague (1900) Cerebrospinal Fever and Acute Poliomyelitis (1912) Acute Encephalitis Lethargica and Acute Polio-encephalitis (1919) Puerperal Fever and Puerperal Pyrexia (1926, 1928) Ophthalmia Neonatorum (1926, 1928) Tuberculosis (1930); and the Infectious Diseases (London) Regulations, 1927, for Malaria Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia ; and wherein Enteric Fever is defined to include the Paratyphoid group of Fevers C. Under a Special Local Order of the Ministry of Health in 1920 Measles German Measles D. Under a Special Order of the London County Council in 1909 Glanders Anthrax Hydrophobia " when these occur in man." As compared with the previous year there was an increase in the number of cases of Diphtheria and a decrease in the number of cases of Scarlet Fever, Puerperal Fever, Puerperal Pyrexia, Enteric Fever and Pneumonia ; other notifiable diseases shewed no undue prevalence, with the exception of Small-pox, an outbreak of which continued during the early part of the year, and Measles, an epidemic of which occurred during the first two quarters of the year. 78 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1930. The notifications have not been corrected for any subsequent revision of diagnosis:— Notifiable Diseases (other than Tuberculosis). [##3]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. 1. Small-pox — 5 31 36 40 56 7 175 — — — — — — — — 175 2. Scarlatina or Scarlet Fever 2 143 287 95 80 51 1 659 — 2 3 1 — 1 — 7 569 3. Diphtheria and Membranous Croup 6 164 236 60 52 49 1 568 1 17 9 2 1 2 — 32 545 4. Enteric or Typhoid Fever — — 1 1 3 2 — 7 — — — — — 1 — 1 6 5. Puerperal Fever — — — — 9 10 — 19 — — — — — — — — 9 6. Puerperal Pyrexia — — — — 18 34 — 52 — — — — — — — — 7 7. Erysipelas 3 6 2 4 7 73 25 120 2 1 — — — 4 2 9 72 8. Cerebrospinal Meningitis 1 — — 1 4 1 — 7 1 1 — — 1 2 — 5 7 9. Anterior Poliomyelitis and Polioencephalitis — — 1 — — — — 1 — — — — — — — — 1 10, Ophthalmia Neonatorum 32 — — — — — — 32 — — — — — — — — 6 11. Encephalitis Lethargic — 1 1 — — 2 1 5 — 2 1 — — — 2 5 3 12. Acute Primary Pneumonia 9 21 11 7 21 82 19 170 — — — — — _ — — *118 13. Acute Influenzal Pneumonia — 1 2 2 06 11 2 21 — — — — — — — — 8 14. Malaria — — — — — 2 — 2 — — — — — — — — 1 15. Dysentery — — — — — 1 — 1 — — — — — — — — 1 16. Measles 179 1857 1344 51 34 11 3476 3 26 2 — — — — 31 360 17. German Measles 9 45 45 10 5 2 — 116 — — — — — — — — 5 * For Pneumonia Deaths, see Table 2 on page 108. 79 The notifications of, and deaths from, the notifiable infectious diseases other than Tuberculosis ate 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 1 6 7 8 I. Small-pox 7 40 10 27 16 29 1 45 175 — — — — — — — — — 2. Scarlatina or Scarlet Fever 159 69 81 48 99 50 31 122 659 3 — 2 — — — — 2 7 3. Diphtheriaand Membranous Croup 81 71 109 56 134 38 25 54 568 3 3 3 — 12 5 1 5 32 4. Entericor Typhoid Fever 4 2 — — — — 1 — 7 1 — — — — — — — 1 5. Puerperal Fever 3 — 3 2 6 2 1 2 19 — — — — — — — — — 6. ,, Pyrexia 8 5 10 7 11 2 4 5 52 — — — — — — — — — 7. Erysipelas 16 12 24 16 14 10 10 16 † 120 1 — — 2 1 2 2 1 9 8. Cerebrospinal Meningitis 1 2 — 1 2 — — 1 7 1 1 — — 1 1 — 1 5 9. Anterior Poliomyelitis and Polioencephalitis — — — — 1 — — — 1 — — — — — — — — — 10. Ophthalmia Neonatorum 3 4 3 4 4 4 1 9 32 — — — — — — — — — 11. Encephalitis Lethargica 1 — 2 — 1 — — 1 5 1 1 1 1 — — — 1 5 12. Acute Primary Pneumonia 30 15 36 24 22 10 10 23 170 — — — — — — — — — 13. Acute Influenzal Pneumonia 5 4 6 1 4 — 1 3 24 — — — — — — — — — 14. Malaria 1 — — — — 1 — — 2 — — — — — — — — — 15. Dysentery — — — 1 — — — — 1 — — — — — — — — — 16. Measles 457 364 567 129 658 373 183 445 3476 — 3 1 3 3 3 8 10 31 17. German Measles 12 6 35 10 20 12 10 11 116 — — — — — — — — — Totals 788 594 886 626 992 531 273 737 †5434 10 8 1 6 17 11 11 20 90 * For Pneumonia deaths, see Table 2 page 108. † Including 2 cases—"homeless." 80 SMALL-POX. 175 cases of this disease were notified in the Borough during the year, as Compared with 87 cases during the previous year. Small-pox became somewhat prevalent in the Metropolis in 1929, and cases continued to occur during 1930. In St. Pancras the prevalence was limited to the first six months of the year, the cases were invariably mild in character, and no deaths occurred. Although the type of the disease was extremely mild, the efforts made to prevent the spread of infection, including the tracing and supervision of the large number of contacts, involved the staff of the Public Health Department in a considerable amount of extra work. VACCINATION. As from April 1st, 1930, the functions previously carried out by the Board of Guardians in respect of Vaccination were transferred to the Borough Council. In connection with the taking over of these duties, the following report was submitted to the Public Health Committee, and the undermentioned recommendations were adopted by the Council. To the Chairman and Members of the Public Health Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit the following Report with reference to the subject of Vaccination. Local Government Act, 1929. Public Vaccination. Under Section 18 (g) of the Local Government Act, the functions of the Board of Guardians in respect of vaccination, and the officers employed in connection with those functions, will, as from the 1st April, 1930, be transferred to the Borough Council. Section 2 of the Act provides that the functions relating to Vaccination shall be discharged by the Council as functions relating to public health. The Local Government Act does not alter the existing law relating to vaccination in any material respect, and it will be the duty of the Borough Council to make provision for public vaccination to be continued on the lines laid down by the Vaccination Acts, 1867 to 1907, and the various Orders which have been made from time to time under those Acts. These Orders have now been consolidated and amended, and a new Order, the Vaccination Order, 1930, will come into operation on the 1st April next. The following appear to be the principal matters requiring consideration in order to ensure the smooth transfer of the vaccination functions on the appointed day — The Council are required to divide their area into vaccination districts, and to enter into a contract with a duly registered medical practitioner to act as public vaccinator for each district. The scheme of division of the area into districts and any alteration to it, as also the public vaccinator's contract, are subject to the approval of the Minister of Health. Under Section 113 of the Local Government Act, the liabilities of the Guardians in relation to their contracts with existing public vaccinators will be transferred to the Borough Council on the 1st April next. The present public vaccinators and the districts for which they act are as follows ■ District 1 Dr. N. J. Goodcliild. District 2 Dr. F. L. Pelly. Districts 3 & 4 Dr. J. Wigg. Districts 5, 6 & 7 Dr. A. E. Tait. District 8 Dr. C. H. A. Alderton. 81 The Ministry of Health suggests that, until the Council have gained experience of the administration of public vaccination, they may find it convenient to maintain the present districts and to make contracts with the same public vaccinators, and on the same conditions as to remuneration, etc., as are provided for in the contracts determined by the Guardians. At a later date it will be open to the Council to review the arrangements, and to submit for the Minister's approval such re adjustments, if any, as may seem to be necessary. The fees at present paid to public vaccinators are as follows:— 1. A sum of 1s. in respect of every child whose birth has been registered in his district or who is resident in his district and whose birth has been registered in some other district, or has not been registered at all, except in the case of a child who has died or has been removed from the district before attaining the age of four months, or who has been duly certified to be successfully vaccinated otherwise than by the public vaccinator, or to be insusceptible of vaccination, or to have had smallpox, before reaching that age, or with regard to whom a statutory declaration under Section 1 of the Vaccination Act, 1907, has been made. 2. A sum of 4s. in respect of each case of successful vaccination performed by the public vaccinator at his surgery or elsewhere than at the home of the person vaccinated where the case is that of—a l>erson other than a child, or a child whose age exceeds twelve months and in whose case the parent or person having the custody of the child has requested that the child may be vaccinated elsewhere than at the home of the child. 3. A sum of 4s. for every successful re-vaccination by the public vaccinator at his surgery or elsewhere than at the home of the person vaccinated. 4. A payment in respect of each case of successful vaccination or of successful re-vaccination performed by the public vaccinator at the home of the person vaccinated or re-vaccinated of a sum of 5s. or 4s. respectively. Nothing in the paragraphs numbered (2), (3) and (4) shall apply in any case in which during a period of twenty-four consecutive hours successful vaccination or successful re-vaccination has been performed by the public vaccinator upon two or more persons at one and the same house, or on any premises (other than the surgery of the public vaccinator) whereon those persons were together present at any time during the aforesaid period. In every such case the amount to be paid to the public vaccinator shall be, in respect of the first person vaccinated or re-vaccinated, a sum of 5s. or 4s., and in respect of every other person vaccinated or re-vaccinated a sum of 2s. 6d. Public Vaccinators are not full time officers of the Council, their conditions of service are governed by contract determinable by notice (1 month), and they are not subject to the provisions of the Poor Law Officers Superannuation Act. Institutional Public Vaccinators. The Institutions of the Guardians are also constituted Vaccination Districts, and the medical officer of each institution acts as public vaccinator. These officers are under the same obligations as the public vaccinators of ordinary vaccination districts. Their services are governed by contract, which can be terminated in the same manner as that of an ordinary public vaccinator, although the form of contract which is laid down in the new Order differs somewhat from the ordinary form. The payments have been regarded as emoluments of the office, and therefore subject to deduction under the Poor Law Officers Superannuation Act. Vaccination Officers. These are officers of the Poor Law Authority and on the appointed day, April 1st, will bo automatically transferred to the Borough Council. Their appointment can only be determined with the Minister's consent, and their transfer is governed by the provisions of the Act relating to the transfer, superannuation and compensation of Poor Law Officers. The Council are required to appoint such number of suitable persons to act as Vaccination Officers as the Minister shall consider sufficient. The Council may, from time to time, appoint such assistants to Vaccination Officers, and employ such temporary substitutes for Vaccination Officers absent from duty on account of sickness or other reason, as the Council may consider necessary. No alteration in the district of a Vaccination Officer shall be made by the Council without the prior approval in writing of the Minister. 82 Except as otherwise provided by the Vaccination Order, 1930, every Vaccination Officer may be appointed on such terms and conditions of service as the Council may think proper. The name and remuneration of every Vaccination Officer, together with particulars of the district assigned to him, shall on his appointment be reported to the Minister of Health. At the present time there are two Vaccination Officers:—Mr. S. A. Broomhead for North and East St. Pancras (Wards 1, 2, 3, and 6) and Mr. A. E. Wolfe for South and West St. Pancras (Wards 4, 5, 7, and 8). Each Vaccination Officer has been required to have an Office in the district, where he may be found on one day in each week. Mr. Broomhead has intimated to the Guardians that he proposes to retire and take his superannuation on the 31st March next. The question therefore arises of providing for the discharge of the duties in the North and East divisions, either by the appointment of another officer, or by appointing one Vaccination Officer for the whole of the Borough. Owing to the continued decrease in the number of births and to the large number of conscientious objectors to vaccination, the duties could doubtless easily be carried out by one officer. At present about 3,800 births are registered during the year, deaths of children under one year of age, removals, etc., reduce this number by about 600, and conscientious objectors by a further 1,250. Of the remaining 2,000 children, a very large percentage are vaccinated either by a general practitioner or by the public vaccinator without any trouble on the part of the Vaccination Officer. The actual number of cases requiring visits, supervision, etc., is therefore not great. Expenditure in connection with Vaccination. This information has very kindly been supplied by Mr, B. Chapman, Clerk to the Guardians:— For the year ended 30th September, 1927 £1,149 „ „ „ „ „ „ 1928 £1,144 „ „ „ „ „ „ 1929 £1,212 Details of Cost of Vaccination for the Year ended 30th September, 1929. Salaries of Vaccination Officers: — £ s. d. £ s. d. Mr. Broomhead 280 0 0 Mr. Wolfe 305 0 0 585 0 0 Office Accommodation Allowance (£E20 each) 40 0 0 Fees to Public Vaccinators 478 0 0 „ Institutional Vaccinators 22 0 0 Registrars of Births and Deaths 53 0 0 Printing, Stationery, Postage 34 0 0 £1,212 0 0 Owing to the prevalence of Small-pox, the fees payable to the Public Vaccinators at the present time are probably somewhat above the average, and during the coming year there will doubtless be an increase in connection with printing and stationery, as new forms may have to be provided. If one Vaccination Officer is appointed for the whole of the Borough in the place of two as formerly, an economy should be effected. Allowing for the above factors, the total cost for the year commencing 1st April next should not exceed £1,100. I am, etc., G. Sowden, Medical Officer of Health. January 16th, 1930. We recommend— (a) That the functions of the St. Pancras Board of Guardians in respect of vaccination, transferred to the Council by Section 18 (g) of the Local Government Act, 1929, be exercised by the Public Health Committee, as from lst April, 1930. 83 (b) That, subject to the adoption of the foregoing recommendation, the duties of the Public Health Committee shall include the following:— " To carry out the powers and duties of the Borough Council with regard to vaccination under the Vaccination Acts and the Orders made thereunder." (c) That the services of the Public Vaccinators and Institutional Public Vaccinators be retained on the same conditions as regards districts, remuneration, &c., as obtain at present, (d) That Mr. A. E. Wolfe be appointed as Vaccination Officer for the whole of the Borough, at an inclusive salary of £400 per annum, including the provision of office accommodation, as from the 1st April, 1930. The following table gives particulars as regards vaccination in respect of children whose births were registered in the Parish of St. Pancras from 1st January to 31st December, 1929. VACCINATIONS. 1st January to 31 st December, 1929. Number. Percentage of Births registered. North. East. West. South. Whole Borough North. East. West. South. Whole Borough Births registered 658 995 1367 1213 4223 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 29 56 77 63 225 4.4 5.6 5.6 52 5.3 Successfully vaccinated 266 408 703 559 1936 40.4 41.0 514 46.1 45.8 Had smallpox — — — — — — — — — — Insusceptible of vaccination 3 6 11 3 23 0.5 06 0.8 0.2 0.5 Received certificate of conscientious objection 324 292 384 346 1346 49.2 29.4 28.1 28.5 31.8 Postponed by medical certificate 2 11 12 — 25 0.3 1.1 0.9 — 0.6 Moved to known address in other districts 12 64 83 146 305 1.8 6.4 6.1 12.0 7.2 Lost sight of by removal 19 151 88 88 346 2.9 15.2 6.4 7.3 8.2 Unvaccinated and not accounted for in previous columns 3 7 9 8 27 0.5 0.7 0.7 0.7 0.6 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. 1920 6086 2693 44.3 2118 34.8 1921 5102 2085 40.9 1934 37.9 1922 4881 2260 46.3 1775 364 1923 4682 2491 53.2 1444 308 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 1928 4019 1937 48.2 1326 33.0 1929 4223 1936 45.8 1373 32.5 84 Return showing the number of Persons successfully vaccinated and re-vaccinated at the cost of the rates by the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1930:— Name of Institution or Vaccination District. Name of the Medical Officer or Public Vaccinator. Nos. of Successful Primary Vaccinations of Persons. No. of Successful Re-vaccinations, i.e., Successful Vaccination of Persons who had been Successfully Vaccinated at some previous time. Under one year of age. One year and upwards. Total. Ward 1 Dr. N. J. Goodchild 165 85 250 167 „ 2 „ F. L. Pelly 113 248 361 114 Wards 3 and 4 „ J. Wigg 334 184 518 110 „ 5, 6, and 7 „ A. E. Tait 377 232 609 189 Ward 8 „ C. H. A. Alderton 134 42 176 40 Highgate Hospital „ C. Thackray 4 17 21 93 St. Pancras Hospital „ W. Feldman 8 77 85 881 Totals 1135 885 2020 1594 SCARLET FEVER. The number of cases notified was 659, as compared with 668 cases during the previous year. It was subsequently ascertained that 24 cases had been incorrectly diagnosed. The actual number of cases was therefore 635. Seven deaths occurred ; this equals a case mortality of 1.1 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. 32 such cases occurred during the year. In analysing the suspected causes of these infections, it was found that four of them gave rise to two "return cases" each, the rest being single infections. Five of them were reported to have had nasal discharge when discharged from hospital. The remainder showed no obvious signs of being infectious. DIPHTHERIA. The number of cases notified was 568, as compared with 374 cases during the previous year. It was subsequently reported by the hospital authorities that 48 cases had been incorrectly diagnosed, the actual number of cases was therefore 520. This equals an attack rate of 2.5 per 1,000 of population. Thirty-two deaths occurred, giving a case mortality of 6.2 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 192 thousand units were provided. ENTERIC OR TYPHOID FEVER. Seven cases were notified during the year. On further investigation two of them were found to have been incorrectly diagnosed, two were true Typhoid and three were cases of Para B. Typhoid Fever. There were no deaths among this group of notified cases. A case was brought to my notice of a person who had contracted Enteric and died from it outside the Borough, but who normally lived here and whose death therefore was allocated back to St. Pancras. 85 These figures give an incidence rate of .02 per 1,000 people, and compare favourably with previous years and with the rate of .07 for the country as a whole. PUERPERAL PYREXIA AND PUERPERAL FEVER. Elsewhere in this report it is shown that about 40 per cent. of all confinements in the Borough took place in institutions. The tables on Puerperal Pyrexia and Puerperal Fever show that about 60 per cent. of the former and 50 per cent. of the latter cases were confined in institutions. This higher percentage is a complicated problem and difficult to explain. It points clearly, however, to the fact that the environmental influences on these diseases are low in comparison with the personal condition of the pregnant woman. Abortion plays an important part, but its share cannot be expressed in figures. The reason is obvious. Even in accidental abortions the cause of the Pyrexia is often missed, and in many cases the incident is concealed. It has been suggested by many authorities that the harmful effects often manifest themselves only at subsequent pregnancies and childbirth. About 8 per cent. of all confinements in the Borough were of unmarried women, but 16 per cent. of the confinements which resulted in Puerperal Pyrexia were among a similar class of women. This points to the higher risk of illegitimate pregnancies, which result in a greater incidence of such morbid or fatal conditions as the Pyrexia under discussion and also of Ophthalmia Neonatorum. Nearly half of the women who developed Puerperal Pyrexia were primiparæ, and all but one of the unmarried women were in this group. In the Puerperal Fever cases only a third were primparous, and of the cases associated with abortion none were either primiparous or unmarried. It is interesting to note that the average age of the " Pyrexia " cases was 26, but among those who developed "Fever," not associated with abortion, the average age was 36. Puerperal Fever is more particularly a result of inflammation, acute or chronic, of the female organs of reproduction, while Puerperal Pyrexia is a rise of temperature due to inflammation or disease elsewhere. 1930. 1929. 1928. 1927. Puerperal Fever. Cases 33 43 33 36 Deaths Nil. 5 3 4 Incidence 10.3 13.6 10.1 10.9 per 1,000 births. Mortality Rate Nil. 11.6 9.1 11.1 per 100 cases. Death Rate Nil. 1.6 0.9 1.2 per 1,000 births. Puerperal Pyrexia. Cases 37 53 41 33 Incidence 11.6 16.7 12.5 10.0 per 1,000 births. 86 There were of* notifications of Puerperal Pyrexia during the year. On further investigation 14 of these were attributed to Puerperal Fever which, together with 19 original notifications, make 33 cases of Fever and 37 cases of Pyrexia. Details of 37 Cases of Puerperal Pyrexia. Cause of Pyrexia. Total. Confinement. Child. Woman. In Institution. At Home. Living. Dead Viable. Non-Viable. Primipara. Unmarried. Average Age. Died. Doctor. Midwife. Student. Inflammation of the Breast 10 8 2 — — 10 — — 7 2 26 — Pyelitis 4 1 1 1 1 3 1 — — 1 27 — Retained Products 4 1 2 — 1 4 — — 2 — 26 — Pneumonia 3 3 — — — 2 1 — 2 — 29 — Tuberculosis 2 1 — — 1 2 — — — — 25 2 Influenza 2 1 1 — — 1 — 1 1 — 23 — Urinary Defects 2 — 1 — 1 1 — 1 1 1 29 — Bronchitis 1 1 — — — 1 — — 1 1 21 — Parotitis 1 1 — — — — 1 — 1 1 28 — Tonsillitis 1 1 — — — — — 1 — — 30 — Phlebitis 1 1 — — — 1 — — 1 — 24 — Rheumatic Carditis 1 — 1 — — 1 — — 1 — 20 — Miscarriage 1 — 1 — — — — 1 — — 30 — Perineal Trauma 1 — 1 — — 1 — — — — 36 — Engorged Breasts 1 1 — — — 1 — — — — 19 — No obvious causes 2 2 — — — 2 — — 1 — 24 — Cases of Pyrexia 37 22 10 27.0 1 2.7 4 10.8 30 3 4 18 6 26 2 Percentages 100 595 40.5 91.0 8.1 10.8 48 16 — 54 Details of 33 Cases of Puerperal Fever. Associated with Abortion 7 1 6 — — — — 7 — — 27 — Otherwise 26 13 6 2 2 23 3 — 12 2 36 — Cases of Fever 33 17 12 36.4 2 6.0 2 6.0 23 3 7 12 2 28 — Percentages 100 51.5 48.4 69.7 90 21.2 36 6 — — * 52 received. Details unavailable for one. ERYSIPELAS. 120 cases were notified and 9 deaths occurred, as compared with 110 cases and 4 deaths during the previous year. 87 CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever, Meningococcal Meningitis, "Spotted Fever.") There were seven notifications, but the diagnosis of one was not confirmed. Two cases died directly from the Fever, and one a few months later from Internal Hydrocephalus, as a result of the Meningitis. One child has had a prolonged and unsatisfactory convalescence, another a complete recovery, and a third case has removed to an unknown address. In addition to these " notified " cases, two additional cases were brought to notice on special death reports. There were, therefore, eight cases altogether, and four of these died directly and one indirectly from the infection. ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Only one case was notified, and this was reported subsequently to be of a very mild character. OPHTHALMIA NEONATORUM. Form as Desired by Ministry of Health. Additional Information. Cases Vision not Impaired. Vision Impaired. Total Blindness. Deaths. Incidence Rate per 1,000 Births. District Nurse in Attendance provided by Borough Council. Cases treated in Special Hospital provided by L.C.C. Notified. Treated At Home. In Hospital. 1930 31‡ 23 8 30 — — 1* 9.1 17 6 1929 36 21 15 34 l — 1* 11.4 11 12 1928 32 24 8 32 — — — 9.8 12 6 1927 38 27 11 37 l — 1* 11.5 11 5 1926 40 24 16 34† — — 2* 11.0 9 7 * Due to other causes. † Several cases removed. ‡ Excluding one case, information unobtainable. In addition to the above, there were four cases of Mild Inflammation not notifiable as Ophthalmia Neonatorum. This disease is an inflammation of the eyes of newly born infants, resulting in a purulent discharge within 21 days of birth. It has been compulsorily notifiable in London since 1911. During the first few years the incidence averaged about 5 cases per 1,000 births in St. Pancras Borough, by 1920 the incidence had reached 11, and this has remained the approximate figure ever since. The rate for 193 is the lowest for a considerable period. The disease does not appear to be as serious now as formerly. The high incidence can only be explained by the alertness of midwives and doctors, who probably err on the side of safety by notifying all suspicious cases. Out of the 31 notifications this year, 19 were " slight" and only 1 was notified as being " grave." It is certainly better to err on this side. The true condition is still a prolific cause of blindness. This is definitely seen in those countries where Ophthalmia Neonatorum is not regarded seriously. In the past 5 years, out of 177 notified cases, we have had 2 cases where the vision was permanently impaired. "Without our 88 present protective routine, it is probable that the incidence would be higher still, that there would be a greater proportion of true or " grave " cases, and that " Impaired Vision " and " Blindness " would result more commonly. The rate of incidence of Ophthalmia Neonatorum was twice as high among illegitimate as among legitimately born babies in the Borough in 1930. ENCEPHALITIS LETHARGIC A. Five cases were notified, but on further investigation two were found to have been incorrectly diagnosed. Three additional cases, not previously notified in this Borough, were brought to notice during the year by means of death certificates. There were, therefore, six genuine cases and five deaths. 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. 170 cases of the former and 24 of the latter were notified during the year (as compared with 250 and 208 cases respectively during the previous 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 48 cases were nursed under this arrangement, 688 nursing visits being paid. MALARIA. Two cases were notified. On further investigation the diagnosis of one was not confirmed. The other case was that of a soldier who had probably contracted the disease abroad. DYSENTERY. One case was notified. It was of the amoebic type, and had been contracted abroad. MEASLES AND GERMAN MEASLES. These diseases were made compulsorily notifiable throughout the country in 191G under the Public Health (Measles and German Measles) Regulations, 1915, but were revoked by the Ministry of Health in 1919. The St. Pancras Borough Council were satisfied as to the value of notification, and intimated to the Ministry the desire to continue the practice. This was granted, and notification became compulsory under the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920. Under these Regulations all cases are notifiable by parents and guardians, but only the first case occurring in an outbreak in a household or institution is notifiable by medical practitioners, an interval of two months since the last case constituting a new outbreak. The following details, tables and chart have been prepared by Dr. P. V. Pritchard, Assistant Medical Officer, and demonstrate several important and interesting facts about measles. Table I. gives the gross figures as regards incidence and deaths. These may be misleading, and they have therefore been worked out in Table II. as Incidence and Mortality Rates. On Table III. these calculations are expressed by two graphs. The tendency for the disease to be prevalent in alternate years is very evident, especially when followed graphically. The third and fourth quarters of the year are always comparatively free, but frequently a rise commences in December and is continued in the first, and generally, but to a less extent, in the second quarter. The wave in December is frequently seen just prior to an "epidemic year." The value of this knowledge is obvious. On the warning signs of a rise, the machinery to combat an epidemic is put to work in a more particular manner, Leaflets explaining the diagnosis, prevention and treatment of the disease 89 are distributed through all schools, welfare centres, and similar institutions. Much of the time and energy of the staff is especially diverted to combat the spread, and the facilities for nursing the cases at home are increased. In 1927 the Fever Hospitals adopted the practice of admitting cases of Measles. Previously Scarlet Fever had the preference, almost to the complete exclusion of Measles. During epidemic times, when there is a heavy demand for beds, cases are only admitted on the recommendation of the Medical Officer of Health. Measles is considered to be a more serious disease now than Scarlet Fever. It has a higher Mortality Rate, and its complications are more numerous and often very serious and crippling. The Mortality Rate swings irregularly, but with a tendency to follow the curve of incidence and not coincide with it. In the 1928 Annual Report an investigation was made into the result of treatment at home and in institutions, and the mortality of cases treated at home was shown to be markedly less than that for cases removed either to Highgate or one of the Fever Hospitals. There are many factors to consider in this brief statement, but it is evident that, unless home conditions are bad, treatremit is batter there. Therefore, during epidemics cases are selected for institutional treatment rather on account of home conditions than the gravity of the attack of illness. An analysis of the age distribution demonstrates that Measles is most common between one and five years. It is not frequent in infancy and comparatively uncommon in adult life. In epidemic years the mortality rate is very high in infancy. The epidemic in 1930 was milder than usual. It lasted for a longer period, and was more marked in the second than the first quarter of the year, which is unusual. Of the 3,476 cases which were notified, 360 were removed to hospitals, and there were 31 deaths registered in the Borough as having been due to Measles. The services of a nurse were provided in all cases where this was desired. This service is provided for under a block grant to the several Nursing Associations, the details of which are given elsewhere in this Report. The routine is for the Health Visitors to visit each notified case. Where the circumstances suggest the desirability of a visiting nurse, a card is delivered to the medical attendant. If he agrees and signs the card, the necessary visiting commences immediately. This is a very useful service, but it is surprising how frequently doctors omit to take advantage of it. German Measles is not common, and generally is a mild disease, and has therefore not been analysed. There were 116 cases during the year, 5 were admitted to Hospitals, and there were no deaths. 90 Table I. MEASLES. year. INCIDENCE. DEATHS. Quarter of the Year. Total. Under 1 year. 1-5 years. 5-15 years. Adults. Quarter of the Year. Total. Under 1 year. 1—5 years. 5—15 years. Adults. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1930 1333 1933 172 38 3476 179 1857 1395 45 13 15 3 — 31 3 26 2 — 1929 257 241 58 35 591 28 198 284 81 5 2 — — 7 — 4 3 — 1928 2271 1474 102 29 3876 234 2143 1425 74 47 78 2 — 127 30 87 10 — 1927 32 143 98 144 417 40 230 131 16 — 2 2 1 5 — 5 — — 1926 2674 973 67 20 3734 260 2008 1421 45 33 30 1 1 65 25 38 2 — 1925 328 341 164 400 1233 61 454 643 75 — — 1 2 3 2 1 — — 1924 2363 1582 239 148 4332 256 2620 1375 81 35 31 7 1 74 15 54 3 2 1923 78 122 56 71 327 33 160 111 23 2 3 — — 5 1 4 — — 1922 2448 999 208 73 3728 287 1953 1425 63 75 29 2 1 107 15 81 10 1 1921 63 59 63 964 1149 86 496 544 23 — 1 3 19 23 7 15 1 — 1920 1580 1322 136 55 3093 177 1445 1387 84 31 30 3 1 65 21 38 5 1 1919 59 356 477 142 1034 53 487 453 41 — 4 9 2 15 4 8 3 — MEASLES. TABLE III. 91 Table II. MEASLES. Year. Incidence Rate per 1000 Population. Mortality Rate per 1000 Cases. Quarters of Year. Total. Quarters of Year. Total 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1930 6.5 9.5 .9 .2 17.1 9.7 7.8 17.5 — 8.9 1929 1.3 1.2 .3 .2 3. 19.4 8.3 — — 11.8 1928 . . 11.0 7.1 .5 .1 18. 20.7 52.8 19.6 — 32.7 1927 . . .2 .7 .5 .7 2.1 — 13.9 20.4 70 12.0 1926 .. 12.3 4.5 .3 .1 17.1 12.3 30.8 14.9 50.0 17.4 1925 .. 1.5 1.6 .8 1.8 5.7 — — 6.1 5.0 2.4 PSITTACOSIS. In the early part of the year, and in various parts of the country, a number of cases occurred of acute illness due to an infection conveyed by parrots, and in a number of instances the illness proved fatal. A memorandum on the subject was issued by the Ministry of Health, pointing out the chief features connected with the disease, and indicating the precautions which should be taken. The symptoms of the disease in human beings are usually a combination of those associated with Typhoid Fever and Pneumonia, and in investigating cases of these two diseases inquiries were made as to any possible contact of the patient with a sick parrot. Although no cases of the disease were discovered in the Borough, in several instances parrots which had been purchased from dealers in St. Pancras were considered to have been the source of infection. Recently imported birds, especially those from South America, were considered to be those most likely to carry infection, and, in addition to parrots, allied species, including Parrakeets, Budgerigars (Love Birds), Cockatoos, Lories, etc., may also be infected. In consequence of the occurrence of cases of fatal illness due to infection from this source, the Minister of Health, in the exercise of powers conferred upon him, made a Regulation prohibiting the importation of Parrots into England and Wales. The Regulation, known as the Parrots (Prohibition of Import) Regulation, 1930, came into force on May 20th, 1930. The enforcement of the Regulation was entrusted to the Customs and Excise Officers at the various ports, but, in defiance of the Regulation, certain dealers on the Continent succeeded in smuggling Parrots, etc., into the country. 92 In August one such consignment reached a dealer in St. Pancras, although the attention of the sender had been drawn to the Regulation, and he had been given definite instructions not to dispatch them. The birds (Blue Budgerigars) were packed in a shallow space between two layers of about 500 Canaries. The space in which the Budgerigars were packed was so small that, of the 35 birds sent, 15 were dead on arrival, owing to overcrowding. After considerable negotiation and much correspondence, in which the Ministry of Health took part, the dealer handed over the remainder of the birds for destruction. YELLOW FEVER. A death from this disease took place in the Borough during the year, and, as such an occurrence is so unusual in this country, inquiries were made as to the mode and source of infection. The disease is endemic on the West Coast of Africa, and it has been generally assumed that it was transmitted only by the bite of the Yellow Fever mosquito, Ædes Ægypti (Stegomyia fasciata), but it is now known that other species of mosquito can carry the disease. The case in question did not, however, originate in this manner; the deceased was a laboratory worker in a research institute in which an investigation concerning Yellow Fever had been going on for some time. The virus was kept alive in monkeys (Macacus rhesus) which till recently were the only animals known to be susceptible to infection. Early in the investigation one of the medical staff and his laboratory assistant contracted the disease in a mild form and both recovered. Some time later another laboratory worker who assisted at a post-mortem examination on a monkey was infected; this was a very severe case, but he also recovered. About 10 days later another of the laboratory staff was taken ill. IIow he contracted the infection was not traced, but it is supposed that he handled some contaminated apparatus. This patient was admitted to the Hospital for Tropical Diseases, Endsleigh Gardens ; the case was moderately severe, but recovery ensued. During his stay in hospital, an examination of his blood was made by a member of the hospital staff, and this person also contracted Yellow Fever, but recovered. A blood examination of the last mentioned case was also made, and the person conducting the examination contracted the infection, and this case proved fatal in five days, although convalescent serum was used on the first day. These cases appear to shew that the infection of Yellow Fever can penetrate through the unbroken skin, and that experimental work and the handling of instruments and apparatus contaminated with infected blood is extremely dangerous. I am indebted for particulars of the above cases to Dr. N. Hamilton Fairley, o.b.e., Director of Pathology and Assistant Physician to the Hospital for Tropical Diseases, and Dr. C. M. Wenyon, c.m.g., c.h.e., Director-in-Chief of the Research Institute concerned. After the occurrence of the last of the above-mentioned cases, it was decided to stop the investigation, the animal house, laboratory, etc., were thoroughly cleansed, and Dr. Wenyon stated work was no longer being done, and they were glad to be rid of the infection. 93 TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1930 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 1 — — 1 1 1-5 3 1 11 4 1 1 3 1 5-10 3 1 9 9 — 1 2 2 10-15 1 1 1 1 — — 1 1 15-20 10 13 3 5 6 5 — 2 20-25 24 22 4 5 10 14 — 1 25-35 44 44 6 6 18 16 1 1 35-45 46 21 1 4 22 9 — 2 45-55 33 8 2 2 26 8 — 1 55-65 20 7 — 1 12 8 1 — 65 & upwards 11 3 — — 7 1 3 — Totals 200 121 38 38 102 63 12 12 The total number of Primary notifications was 343 ; in addition to these, 24 eases, which had not been notified, came to knowledge by means of special death reports, 28 cases by transfer from other districts, and 2 cases by posthumous notification. The total number of new cases during the year from all sources was therefore 397, equal to a notification rate of 1.91 per 1,000 of population. The total number of new cases during the previous year was 469. The deaths from all forms of Tuberculosis during the year numbered 189, equal to a death rate of 0.91 per 1,000 of population. The total number of deaths in the previous year was 250. It will be noted that, out of a total of 189 deaths from Tuberculosis, 26 were of cases which either died un-notified or were notified 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:— 94 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from 29th December, 1929, to the 3rd January, 1931 (inclusive). Age Periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. Total Notifications (i.e., including cases previously notified by other Doctors), Primary Notifications. Total Notifications (i.e,, including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. oria. 0 to 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 5 5 to 10 10 to 15 Total, Pulmonary Males — 2 3 1 8 23 35 37 37 19 10 175 253 — — — — 1 27 123 23 103 Females — — 1 1 11 21 41 14 7 5 3 104 151 — — — — — 11 79 8 83 Non-pulmonary Males — 8 8 — 3 4 4 1 2 — — 30 34 — — — — 1 — 15 4 12 Females — 4 9 1 5 5 5 3 1 1 — 34 39 — — — — — 1 22 3 16 Totals — 14 21 3 27 53 85 55 47 25 13 343 477 — — — — 2 39 239 38 214 Age Periods. Information obtained from Special Death Reports, by Transfer from other districts, and by Posthumous Notifications. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males — 1 — — 2 1 9 9 1 1 1 25 Females — 1 — — 2 1 3 7 1 2 — 17 Non- pulmonary Males 1 3 1 1 — — 2 — — — — 8 Females 1 — — — — — 1 1 1 — — 4 Totals 2 5 1 1 4 2 15 17 3 3 1 54 95 The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years :— Year. Estimated Population. Notifications. Deaths. Notification Rate. Death Rate. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 1921 212903 546 153 699 250 54 394 2.56 0.72 3.28 1.17 0.25 1.43 1922 212500 534 148 682 257 58 315 2.51 0.70 3.21 1.21 0.27 1.48 1923 214400 440 137 577 211 61 272 2.05 0.64 2.69 0.98 0.28 1.27 1924 214300 447 119 566 227 44 271 2 .05 0.54 2.59 1.04 0.20 1.24 1925 215900 389 103 492 180 51 231 1.80 0.48 2.28 0.83 0.24 1.07 1926 216400 354 112 46b 175 37 212 1.64 0.52 2.15 0.81 0.17 0.98 1927 212800 378 92 470 197 20 217 1.78 0.43 2.21 0.93 0.09 1.02 1928 205600 353 102 455 191 25 216 1.72 0.50 2.21 0.93 0.12 1.05 1929 203900 376 93 469 218 32 250 1.84 0.46 2.29 1.07 0.16 1.23 1930 203900 321 76 397 165 24 189 1.54 0.36 1.91 0.79 0.12 0.91 The table below shows the number of new cases and the number of deaths, together with the corresponding rates per 1,000 of population, for each Ward of the Borough during 1930:- Tuberculosis (All Forms). Ward. New Cases. Deaths. Number. Rate per 1000 of Population. Number. Rate per 1000 of Population. 1 54 1.5 19 05 2 50 2.3 24 1.1 3 66 1.9 29 0.8 4 52 2.1 19 0.8 5 51 1.7 33 1.1 6 33 1.6 19 0.9 7 28 1.9 12 0.8 8 59 2.2 33 1.3 Homeless 4 — 1 — Totals 397 1.9 189 0.9+- 96 Public Health (Tuberculosis) Regulations, 1924. these 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 the Borough. The following table gives this information for the year ended December 31st, 1930:— Pulmonary. Non-Pulrronary. Total. Number of cases on the Register at the commencement of the year 1930 1346 435 1781 Number of new cases during the year 324 76 400 1670 511 2181 Number of cases removed from the Register during the year (from death or other causes) 342 97 439 Number of cases remaining on the Register at the end of the year 1328 414 1742 Public Health (Prevention of Tuberculosis) Regulations, 1925. No formal action was necessary during the 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 (A) 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 12 children have been boarded out under the scheme. 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. 97 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 are instructed to make periodical visits and to report on their condition and the manner in which they are used. Disinfection of Rooms. —This procedure is always advised on the admission of a case to Hospital or Sanatorium, on 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 118 cases. Home Visits and Inquiries. This work is performed by two special officers, and the number of visits paid by each during the year is shewn in the following table:— Miss Camman 3861 „ Holland 3406 Total 7267 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. St. Panoras 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 functions of this Committee were indicated in a circular issued by the Ministry of Health to be as follows:—"The primary duty of the Committee should be to consider the economic position of the family of every patient suffering from tuberculosis as soon as he comes within the purview of the dispensary scheme, and to render such advice and assistance as the circumstances of the case dictate, with a view to enabling the family to adjust their circumstances to the new conditions, to maintain their economic independence, and to derive the fullest possible advantage from the medical treatment prescribed. Certain kinds of assistance may be needed in particular cases, viz., additional food, change of air, clothing, better home conditions, more suitable occupation ; the provision of financial or other assistance, when necessary, for the family of a patient who is under treatment in a residential institution, or temporarily for a patient and his family on his return home from such an institution. Where the necessity for financial assistance arises, it can be better provided through the agency of existing charitable or public organisations than from a fund administered by the Care Committee, and in such cases it should be the function of the Care Committee to bring the family into touch with the appropriate organisation. A subsidiary but important function is to undertake, on behalf of the London County Council, the assessment of charges made in respect of residential treatment afforded to children and to adults whose income exceeds a certain figure. It is important, however, to secure that the activities of Care Committees are not absorbed by the routine work falling under this head, to the detriment of the main functions which are mentioned above." The Care Committee were fortunate in 1928 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 98 helped with clothing and other requisites in order to enable them to accept institutional treatment, and also to assist them when discharged from various institutions. The following particulars concerning the work of the Committee and the cases dealt with have been supplied by the Hon. Secretary—Miss Whelon: — Report of the Tuberculosis Care Committee for the year 1930. " The Committee continued to meet weekly throughout the year. Total number of cases considered 209 51 cases were assessed at sums varying from 12s. 6d. to 1s. 6d. 112 cases were assessed as free from contribution. In addition to these, it has been necessary in 46 cases to keep in touch with families; to review the circumstances and assist with advice and help when possible. Cases considered for Dentures. Total number of cases considered for dentures, 13 ; of these 9 were free cases. 1 case was assessed at 30s. 2 cases were assessed at 10s. 1 case was assessed at 5s. The Committee is grateful for the co-operation and assistance of the Charity Organisation Society, Invalid Children's Aid Association, United Services Fund, and other societies. It would also like to express its warm appreciation of the continued work of Mr. Wakeford and members of the Kentish Town Branch of Toc H. Many visits have been paid to lonely patients in Highgate Hospital, and entertainments have been arranged for their enjoyment. The Committee has gratefully to acknowledge a donation from the Eleanor Palmer Charities, and this much appreciated help has considerably lightened the Hon. Secretary's task in providing garments for patients. Queen Mary's London Needlework Guild sent a parcel of clothing at Christmas, which was most welcome. The Hon. Secretary's working party continues to meet each week, and contributes much valuable help in the making and repairing of garments for necessitous patients. During the year 65 cases have been helped with gifts of clothing, a total number of 212 garments having been distributed. In July last the Committee received, with much regret, the resignation of Dr. Viney as Tuberculosis Officer for St. Pancras. It extended a welcome to his successor, Dr. Back, who has joined the Committee. H. M. Whelon." 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, dressing room, laboratory, office, and the necessary sanitary accommodation. Nine consultations are held in each week— 2 in the morning, 5 in the afternoon, and 2 in the evening. 99 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 new Tuberculosis Dispensary in the Camden Road is now in course of erection. Artificial Light Treatment. Provision as part of Tuberculosis Dispensary Service. The experimental arrangements which had been made by the London County Council for the provision of the above-mentioned form of treatment as part of the Tuberculosis Dispensary Service at certain approved hospitals and other centres in London expired on March 31st, 1929. It was decided that the arrangements should not be renewed, but the County Council state that they have decided to continue the existing arrangements for the treatment of lupus at the London Hospital on the basis of 5s. an attendance for the treatment by Finsen lamp, and 1s. an attendance for general ultra violet light treatment, and at the St. Thomas's Hospital on the basis of payment of 1s. an attendance for treatment by Kromeyer lamp, and to extend these arrangements to include any hospital providing the requisite facilities and approved for the purpose. Particulars of such hospitals will be communicated in due course. Report on the Work carried out at the Tuberculosis Dispensary. The following report on the work of the Dispensary has been furnished by the Tuberculosis Officer, Dr. Back:— " The annual returns show that the Dispensary dealt with fewer patients during 1930 than during the previous year. Nineteen less new cases and 52 less contacts were examined 200 less attendances were made and 18 less cases remained on the register at the end of the year. These reductions, which, excepting the contacts, amount only to 5 per cent. or less of the previous year's totals, must be regarded as being due mainly to a reduction in the number of cases of tuberculosis occurring in the Borough. The number of living cases notified during 1930 shows a fall of 52 (12 per cent. of the number recorded in 1929), and the number of cases recommended for sanatorium treatment, either from the Dispensary or from hospitals, shows a corresponding fall. Altogether 299 recommendations were made. Fifteen of these were subsequently withdrawn on account of death, leaving the district or personal reasons, and 53, a rather larger proportion than usual, were not accepted for treatment under the London County Council scheme for tuberculosis. Four out of the 53 rejected cases were given sanatorium treatment under the scheme for public assistance, and the remainder, for the most part cases which could not be looked after adequately at home, but were not likely to improve at a sanatorium, were offered admission to the L.C.C.'s General Hospitals through the local Relieving Officer. This procedure is not attractive to many patients and such offers are frequently refused. The number of contacts who attend for examination still shows room for improvement. During 1929 only 20 per cent., and during 1930 only 16 per cent. attended. The Health Visitors increased their number of visits by 400, and leaflets and other propaganda have been distributed at the Dispensary and in patients' homes, but it is obvious that further efforts must be made. The number of attendances for the Finsen light treatment at the London Hospital, for which the Council make provision, shows a considerable reduction, owing to the fact that several patients who had attended regularly for long periods were discharged as cured at the end of 1929, and no new cases requiring this treatment have come to the Dispensary since. For similar reasons the number of attendances for artificial pneumothorax refills also show a slight reduction. In spite of the fall in the number of cases of tuberculosis notified, the number of patients sent to the Dispensary by medical practitioners for investigation or treatment shows 100 a slight increase, which indicates that this valuable form of co-operation has continued to be satisfactory. During the year the administration of the Dispensary sustained a loss owing to the resignation of Dr. Vine}7. While he was Tuberculous Officer he introduced many improvements in organisation at the Dispensary, and his departure is regretted very much, both by the patients and the staff. G. A. BACK, M.B., B.CH., D.P.H., Tuberculosis Officer." 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 91 6*2 5 2 10 8 15 14 101 70 20 16 (b) Doubtfully tuberculous — — — — — — — — 24 35 7 6 (c) Non-tuberculous — — — — — — — — 58 66 34 38 B.—Contacts examined during the year (a) Definitely tuberculous 7 7 — — — — 2 — 7 7 2 — (b) Doubtfully tuberculous — — — — — — — — 5 7 — — (c) Non-tuberculous — — — — — — — — 14 33 36 43 C.—Cases written off the Dispensary Register as— (a) Cured — 8 — 4 1 2 3 4 1 10 3 8 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 92 127 86 90 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 369 252 15 9 34 34 35 36 403 286 50 45 (6) Diagnosis not completed — — — — — — — — 24 36 5 2 Number of persons on Dispensary Register on January 1st 869 Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 13 Number of patients transferred from other areas and of " lost sight of " cases returned 58 Number of consultations with medical practitioners:— Number of patients transferred to other areas and cases "lost sight of" 185 (а) At homes of applicants (б) Otherwise 5 224 Died during the year Number of observation cases under A (6) and B (b) 103 Number of other visits by Tuberculosis Officers to homes 57 above in which period of observation exceeded 2 months 55 Number of visits by Nurses or Health Visitors to homes for Dispensary purposes Number of— 4388 Number of attendances at the Dispensary (including Contacts) 3624 (a) Specimens of sputum, &c., examined 653 Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision (b) X-ray examinations made in connection with Dispensary work 65 Number of Insured persons on Dispensary Register on 31st December 509 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 355 (a) "Light treatment 4 Number of Reports received during the year in respect of Insured persons :— (b) Other special forms of treatment 138 (a) Form G.P. 17 4 (b) Form G.P. 36 13 101 Section VII.--OTHER SERVICES. DISINFECTING AND CLEANSING STATION. Those buildings are situated in Cambridge Street, at the rear of St. Pancras Gardens. Extensive internal alterations authorised by the Council were carried out during 1929 and resulted in a gratifying improvement in the facilities and amenities connected with these buildings. During the year under review the following work suggested by the Sub-Committee was carried out: — Disinfecting Station. Repair defects in roof; limewhite walls and repaint ceilings. Courtyard by Garage. Remove wood barrier and build new coal bunker in brickwork to hold about four tons, in the corner by the existing coal store. Coroner's Courtyard. Remove shrubs and soil to extent necessary and lay new tarmac paving to increase the area of waiting space for persons attending the Court. Defective branch drains all round the Court and the Lodge to be traced and properly connected up. Generally at whole of buildings. Rake out all defective pointing and repoint walls. Disinfection. In connection with cases of Infectious disease, Bedding, Clothing, etc., are disinfected by steam under pressure 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 181 172 201 220 Scarlet Fever 640 615 642 644 Diphtheria 552 542 565 572 Enteric Fever 8 8 8 8 Erysipelas 100 108 89 83 Puerperal Fever and 12 12 12 9 Pyrexia Encephalitis Letliargica 3 3 3 3 Polio-myelitis 1 1 1 1 Cerebrospinal Meningitis 4 4 4 4 Pneumonia 18 18 16 15 Tuberculosis 118 117 81 123 Measles 58 58 46 54 Vermin and Scabies 168 167 125 201 Other Diseases 273 268 224 233 Totals 2136 2088 2017 2170 102 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 46 1911 29 172 Bolsters and pillows 25 4127 25 273 Sheets, blankets and counterpanes 16 6955 6 482 Rugs, mats, cushions, carpets, covers and curtains 6 960 9 84 Wearing apparel 20 3554 33 179 Books 121 — — Sundries 38 477 11 36 Totals 151 18105 113 1226 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, 1931, amounted to £76 12s. 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. Vermin Men. Women. Children under 15. Total. 1021 19 4589 *5629 Scabies 37 45 1275 1357 Totals 1058 64 5864 6986 • Includes 628 males and 2 females who had no home address. The staff of the Disinfecting and Cleansing Station consists of a Foreman, a Disinfector and two Motor Drivers and Disinfectors; a Matron of the Cleansing Station and two 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, 103 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 bv the Sanitary Inspector, as the rooms and bedding may also need disinfecting. It would obviously be 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.d., 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 246 1651 1897 Blood re Typhoid Fever 1 17 18 Sputum for Tubercle Bacilli 48 376 424 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. 106 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1930 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000Nett Births. Number. Rate. Number. Rate. Number. Rate. 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 13.6† 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 12.7å 1929 204400 203900 4231 3170 15.5* 3505 17.2† 1005 626 262 83 3126 15.3† 1930 204400 203900 4660 3208 15.4* 2928 14.l† 999 549 194 60 2478 11.9† Area of district in acres (land and inland water), 2694.4 ; total population at all ages, 211,366 ; number of inhabited houses, 24,660; average number of persons per house, 8.57 ; at Census, 1921. * Based on total population. † Based on civil population. 107 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, 1930. 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. ALL CAUSES M 1353 114 22 22 27 58 149 427 296 238 F 1075 80 26 25 31 45 107 295 198 269 1. Enteric Fever M — — — — — — — — — — F 1 — — — — — 1 - — 2. Small Pox M — — — — — — — — — — F — — — — — — — — — — 3. Measles M 16 2 9 4 1 — — — — — F 14 i 10 2 1 — — — — — 4. Scarlet. Fever M 1 — 1 — — — — — — — F 6 — — 1 4 — 1 — — — 5. Whooping Cough M 2 2 — — — — — — — — F 3 2 1 — — — — — — 6. Diphtheria M 16 1 — 7 6 — 2 — — — F 15 — 1 9 4 1 — — — — 7. Influenza m 9 2 — — — — 1 1 4 1 F 4 — — — — — — 3 1 — 8. Encephalitis Lethargica M 1 — — 1 — — — — — — F 4 — 1 — 1 — — — 1 1 9. Meningococcal Meningitis M 3 — — — — 1 1 1 — — F 3 2 — 1 — — — — — — 10. Tuberculosis of Respiratory System M 102 — 1 — — 16 41 38 5 1 F 63 — 1 — 1 19 25 16 1 — 11. Other Tuberculous Diseases M 11 1 2 1 3 — — 1 2 1 F 13 1 — 1 3 3 4 1 — — 12. Cancer, Malignant Disease M 198 — 1 — 1 — 10 92 61 33 F 161 — — — — 1 19 73 37 31 13. Rheumatic Fever M 2 — — — — 2 — — — — F 5 — — 1 3 1 — — — — 14. Diabetes M 15 — — — — — 2 6 6 1 F 12 — — — — — 1 5 3 3 15. Cerebral Hemorrhage, etc. M 41 — — — — 1 1 16 14 9 F 58 — — — — — 1 20 14 93 108 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 256 — — 1 1 5 15 81 79 74 F 202 — — - - 3 16 50 60 72 17. Arterio-sclerosis M 48 — — — — — — 11 18 19 F 33 — — — — — — 5 8 20 18. Bronchitis M 64 3 — — — — 5 17 17 22 F 40 4 — — 1 1 9 10 15 19. Pneumonia (all forms) M 94 19 5 3 2 4 9 24 15 13 F 67 14 3 2 1 1 13 10 16 20. Other Respiratory Diseases M 16 1 — — — 1 5 5 3 1 F 13 — — — — 1 4 4 4 21. Ulcer of Stomach or Duodenum M 29 — — — — 1 10 15 3 — F 8 — — . — — — 1 5 2 — 22. Diarrhœ, etc. M 23 20 — 1 — — — 1 — 1 F 31 24 1 1 2 1 — 1 —' 1 26. Appendicitis and Typhlitis M 7 — — 1 — 3 — 3 — — F 10 — — 2 — 2 — 2 3 1 24. Cirrhosis of Liver M 8 — — — — — — 2 5 1 F 6 — — — — — — 5 1 — 25. Acute and Chronic Nephritis M 35 — — — — 1 3 1g 9 6 F 29 — — — — 3 9 9 8 26. Puerperal Sepsis M — — — — — — — — — — F — — — — — — — — — — 27. Other Accidents and Diseases of Pregnancy and Parturition M — — — — — — — — — — F 4 — — — — — 4 — — 28. Congenital Debility and Malformation. Premature Birth M 45 44 — — — — 1 — — — F 25 24 — — — 1 — — — — 29. Suicide M 32 — — — — 2 13 13 2 2 F 20 — — — — 3 6 10 — 1 30. Other Deaths from violence M 66 5 2 3 6 14 1 14 7 5 F 41 — 1 3 4 4 2 12 4 11 31. Other defined Diseases M 211 14 1 — 7 6 20 70 45 48 F 184 10 5 1 7 4 15 51 30 61 32. Causes ill-defined or unknown M 2 — — — — 1 — — \ — f — — — — — — — — — — Deaths under I year .„ Legitimate, Illegitimate, M 98 16 F 67 13 109 Table No. 3. 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. 1 481 13.3 402 1l.l 29 60 19 0.5 2 365 17.1 246 11.5 13 36 24 1.1 3 594 17.1 417 12.0 30 51 29 0.8 4 422 16.7 304 12.0 20 47 19 0.8 5 507 17.2 368 12.7 43 85 33 1.1 6 306 15.2 179 8.9 13 42 19 0.9 7 163 11.0 167 11.3 15 92 12 0.8 8 370 14.0 365 13.8 30 81 33 1.3 Homeless — — 30 — 1 — 1 — Borough 3208 15.4 2478 11.9 194 60 189 0.9 110 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 1930. (53 weeks ended 3rd January, 1931.) — Estimated Population, Mid. 1929. Birth Rate. Death Rate. Infantile Mortality. — Estimated Population, Mid. 1929. Birth Rate. Death Rate. Infantile Mortality. England and Wales 139,806,000 16.3 11.4 60 County of London 4,417,900 15.7 11.4 59 Birmingham 963,500 17.8 10.8 62 West. Liverpool 869,500 21.7 12.7 81 Paddington 142,800 15.1 12.4 79 Manchester 746,500 17.2 12.8 78 Kensington 175,800 14.7 12.3 69 Sheffield 518,000 15.1 10.6 66 Hammersmith 136,900 15.9 11.6 65 Leeds 478,500 15.8 12.2 66 Fulham 153,700 15.4 10.7 56 Bristol 391,145 15.7 11.2 59 Chelsea 62,680 12.7 11.9 41 West Ham 307,600 18.2 10.8 65 City of Westminster 125,800 10.5 11.5 60 Hull 307,500 20.6 12.4 71 North. Bradford 294,605 15.1 13.4 73 St. Marylebone 102,400 12.2 11.1 62 Newcastleon-Tyne 283,400 18.4 12.1 71 Hampstead 84,830 11.8 11.3 58 Stoke-on-Trent 279,190 19.8 11.7 71 St. Pancras 203,900 15.5 11.8 60 Nottingham 266,800 17.0 12.7 76 Islington 319,800 17.8 12.0 69 Leicester 245,200 15.8 11.0 55 Stoke Newington 50,040 14.6 11.9 52 Portsmouth 242,000 16.3 11.5 57 Hackney 214,400 16.4 11.0 49 Salford 235,600 16.5 12.3 75 Central. Cardiff 224,000 16.9 11.2 72 Holborn 38,380 10.6 12.6 90 Croydon 222,300 15.8 10.3 48 Finsbury 70,980 18.2 13.0 63 Plymouth 199,000 16.0 12.5 61 City of London 10,700 8.3 12.0 44 Sunderland 184,000 23.1 13.4 79 East. Bolton 181,500 13.8 12.0 67 Shoreditch 99,710 19.9 12.2 66 Willesden 172,500 17.5 9.9 58 Bethnal Green 110,500 17.7 11.1 63 Southampton 172,800 18.5 11.8 59 Stepney 241,800 17.4 11.2 76 Swansea 162,700 18.2 11.4 65 Poplar 160,000 19.1 10.5 56 Coventry 162,100 15.2 10.2 67 South. Birkenhead 157,600 17.8 11.1 85 Southwark 178,500 16.8 12.5 58 Tottenham 155,000 16.2 9.9 52 Bermondsey 113,800 18.1 13.0 64 Rhondda 153,100 16.1 10.7 84 Lambeth 294,400 16.1 11.9 58 East Ham 147,600 15.3 9.6 52 Battersea 161,800 16.4 11.3 55 Brighton 146,800 13.3 12.1 51 Wandsworth 346,700 13.5 10.8 55 Oldham 142,500 13.3 13.3 67 Camberwell 256,900 14.8 10.7 53 Derby 140,500 17.1 11.2 71 Deptford 111,000 15.9 11.2 60 Wolverhampton 134,300 18.1 10.6 64 Greenwich 99,900 15.8 10.3 46 Middlesbrough 133,100 21.8 12.9 80 Lewisbam 207,900 15.1 9.7 43 Leyton 128,300 13.7 9.5 45 Woolwich 141,600 14.9 10.7 41 Stockport 127,800 13.8 11.4 53 Preston 126,100 15.7 11.8 68 Blackburn 125,300 12.7 12.7 84 † Estimated population to middle of 1930. 1ll Table No. 5.—Meteorological Table for Saint Pancras, 1930. (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.) 29.799 30.082 29.862 29.788 29.961 30.004 29.845 29.891 29.935 29.382 29.885 29.918 Air Temperature— Mean of— A. Maximum 48.1 42.2 50.5 55.1 62.0 721 70.1 72.6 65.6 59.6 50.4 44.6 B. Minimum 39.7 34.9 36.1 42.7 47.3 540 55.7 55.9 53.1 47.1 39.8 36.9 Mean of A and B 43.9 38.5 43.3 48.9 54.7 631 62.9 64.3 59.3 53.3 45.1 40.7 Difference from Average +5.1 —1.5 +0.4 +0.5 —0.4 +2.1 –1.4 + 1.1 + 0.7 +2.6 +0.8 + 0.2 Humidity—Morning 9.0 88 85 83 77 74 71 84 85 85 88 93 Earth Temperature at 4 ft. depth 45.8 441 43.1 45.2 48.8 53.6 57.3 57.4 578 55.2 51.4 47.9 Bright Sunshine— Total Observed (daily mean) Hrs. 1.17 1.99 3.98 3.54 523 7.36 5.28 6.59 3.81 3.69 1.98 0.63 Per cent. of total possible 14 20 34 26 34 45 33 45 30 35 22 8 Difference from average Hrs. – – — — – — — — — – — — Rain and other forms of precipitation— Number of Days 17 9 8 15 20 8 14 16 18 17 19 15 Total Fall Ins. 2.51 1.01 1.60 1.86 2.67 3.18 2.00 2.94 3.58 1.27 4.27 1.95 Difference from average +0.67 —0.63 —0.24 +0-32 +0.91 + 1.18 —0.39 +0.75 +1.77 —1.38 + 1.93 -0.47 Hour of observation, 9 a.m. (Greenwich time). The readings for Bright Sunshine are those taken at Hampstead—no readings being recorded at Camden Square. 112 Table No. 6. —Report of Work carried out by District Inspectors for the year 1930. Rackhau. Lonnon. Brown. Walkkr. James. Adkins. Akers. Jaffa. Capel. Nixon. West. Winchester Thompson.* Totals. Complaints received, 3,155. Complaints Investigated. Whole house inspected 6 1 27 25 12 80 64 1 74 9 25 3 — 327 „ Part of house inspected 205 379 288 417 264 217 152 543 182 223 3'4 357 — 3541 ,, Use-inspections 1129 647 1544 950 1163 697 660 781 1134 922 1687 1200 — 12514 Infectious Diseases Investigations and inspections . 373 765 137 409 401 547 702 695 447 337 351 247 — 5711 Re-inspections 3 596 503 236 778 309 159 33 698 369 417 723 — 4821 Smoke Observations 8 21 _ 49 5 37 15 155 58 22 — 1 — 37' Offensive or Regulated Trades — — — — — — — 39 — — —. — — 39 Mews and Stable Yards—Number inspected 281 515 262 336 329 200 496 455 332 455 195 265 — 4211 Verminous Persons .. .. — — — _ — 1 — 10 1 — — 26 — 38 Other Inspections and Re-inspections 43 22 3 7 17 99 17 63 94 44 20 206 — 635 Housing Acts and Regulations, 1925. Number of Houses Inspected Primary Inspections — — 15 102 166 22 — 18 49 '5 22 45 — 454 Re-inspections — 60 428 331 535 34 15 21 112 8 40 13 — 1397 Underground rooms 145 168 46 62 90 84 70 281 77 124 216 75 63 1501 Houses let in Lodgings (Bye-laws, Sec. 6). Number of Tenements Inspected Primary Inspections — – — 71 193 15 — — 47 31 20 49 — 426 Re-inspections — – — 375 1123 3 — 5 226 578 191 431 — 2932 Drainage. (a) Under Notice, Plans, Supervision, etc. 70 327 259 51 91 363 374 187 208 384 449 597 — 3380 (b) Voluntary, do. do. 673 672 306 641 242 1162 996 950 427 232 262 251 — 6814 (c) New Buildings, do. do. 62 34 4 182 56 27 353 — 86 405 97 222 — 1528 Attendances at Police Court, etc. – 1 — 2 10 1 2 – 4 1 7 8 — 36 Rent Restrictions Acts 8 3 15 1 34 8 15 7 10 - 40 3 — 144 Totals 3006 4211 4137 4247 5309 4016 4090 4244 42666 4159 4353 4719 63 50820 Notices served;— Intimations 194 149 385 302 482 244 168 332 362 234 329 439 — 3720 R.R.A. 2 3 6 — — 4 5 — 6 3 — — 29 Totals 196 252 391 302 482 248 173 532 368 234 332 439 — 3749 * Set also Table No, 8 on page 114. 113 Table No. 7.—Inspections and other work of the Food Inspectors during 1930. Mr. Auger. Mr. Child. Total. Number of Visits to:— Milkshops 357 378 735 Dairies to 53 113 Cowsheds — — — Ice Cream Premises 87 170 257 Slaughter Houses 87 93 180 Butchers' Shops and Meat Stalls 1277 1477 2754 Prepared Meat Premises 28 296 324 Fishmongers' Shops 9 25 34 Fried Fish Shops 151 194 345 Fish Curers' premises 20 65 85 Other Premises where Food or Drugs are so'd 37 147 184 Marketing Streets and Places 2175 1111 3286 Attendances at Police Court 10 12 22 Other Visits 292 101 393 He-inspection after Intimation Notices 1 1 2 Total 4591 4123 8714 *Number of Samples taken ; — Formal 194 310 504 Informal 206 90 296 Total 400 400 800 Unsound Foods. Surrenders:— Meat, &c. .. 5 4 9 Fish 6 1 7 Shell Fish — — — Fruit 2 4 6 Vegetables 1 4 5 Eggs — — — Total 14 13 27 Seizures:— — — — Canal Boats inspected 3 3 Notices Served 4 2 6 * See page 74. 114 Table No. 8. Report oj Work carried out by the Factory and Workshop Inspectors during the year 1930. Inspections and Re-Inspections. Thompson.* Bibby. Totals. Factories (including factory laundries and bakehouses) 1498 477 1975 Workshops (including workshop laundries and bakehouses)... 2330 917 3247 Workplaces (including Restaurant kitchens) 412 372 784 Outworkers' premises – 1495 1495 Other Visits — 99 99 Totals 4240 3360 7600 Notices served relating to:— Factories 128 15 143 Workshops 179 67 246 Workplaces 16 19 35 Others 25 3 29 Totals 348 101 452 * See also Table No. 6 on page 112. 115 Table No. 9. Report of Work carried out by Centre Superintendents, Women Inspectors and Health Visitors during the year 1930. Bristow. Crockart. LandelJones. Smyth. Templeton. Anderson. Blaxland. Camman. Holland. Hunter. Blair. Chapman. Manger. Robinson. Bagnall. Bruce. Clarke. Harris. Harrop. Lurie. Lynn. Smith. *Woodroff. Totals. Infants. Under First Visits 38 4 2 — 4 176 133 — — 138 228 72 120 230 161 256 125 183 249 234 220 157 54 2784 Subsequent 379 5 6 7 — 337 464 — — 516 720 397 565 443 820 951 809 793 475 802 484 894 101 9968 ,, 1-2 First Visits 2 — — — – 11 1 — — 7 5 — 1 5 3 3 1 6 20 2 3 5 — 75 Subsequent 278 10 1 — 12 206 256 — — 276 401 212 282 203 295 395 128 317 289 447 221 507 49 5085 ,, 2-5 First Visits — — — — — 14 — — — 14 7 5 1 4 1 3 — 4 2 1 5 5 — 66 Subsequent 335 12 — — 18 468 422 — 442 350 372 227 184 229 519 452 430 649 533 314 801 75 6832 Expectant Mothers First Visits 23 35 – — — 80 108 — — 44 119 80 45 126 218 63 53 92 100 54 95 22 23 1380 Subsequent 38 2 — — — 36 51 — — 58 26 173 87 25 282 142 159 75 51 63 30 14 8 1320 Measles 69 89 1 — 3 273 60 _ — 294 288 95 140 50 155 292 115 273 435 193 432 198 36 3491 German Measles 4 — — — — 9 — — — 10 6 1 3 6 6 5 3 5 9 5 18 3 3 96 Whooping Cough — – — — — 4 8 — 5 2 10 1 10 8 20 — 5 29 13 2 25 2 144 Ophthalmia Neonatorum 2 1 — — — — 2 — — 6 2 1 2 8 — 3 1 11 6 2 5 1 — 52 Puerperal Fever 1 – — — — — 1 — — 2 2 — — 2 1 — 3 1 1 8 — — 22 ,, Pyrexia — — – — 1 1 4 — – 2 3 2 2 3 2 5 — — 3 2 4 2 3 39 Tuberculosis. Dispensary Cases — — — — — — — 2012 2.346 — — — — — — — — — — — — — — 4388 „ Others — — — — — — — 1819 1060 — — — — — — — — — — — — — — 2879 Other diseases 46 3 — 1 5 116 41 — — 135 96 42 9 90 55 115 16 91 227 109 181 102 58 1538 Milk Enquiries 8 2 — — 2 14 6 — — 9 3 4 5 26 1 — 4 4 12 1 12 5 2 120. Consultations and Classes attended 163 267 211 241 224 158 89 — — 152 183 166 177 214 148 163 169 171 174 167 145 162 13 3553 Other Visits 171 268 6 — 165 332 74 15 37 665 141 236 215 270 .320 122 224 227 360 120 415 130 54 4571 Totals 1557 698 227 249 434 2235 1720 3376 3443 2774 2582 1868 1882 1899 2705 3057 2559 2690 3091 2749 2594 3033 481 48403 * Part of year only.