AC 4355 STPAN 89 Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1931. G. SOWDEN, M.D., D.P.H., Barrister-at-Law, Fellow of the Royal Institute of Public Health, Printed by F. P. Lewingdon, 26 & 27, Eversholt Street, Camden Town, N.W.1. Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1931. G. SOWDEN, M.D., D.P.H., 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 10 & 11 Section I.—Statistics, and Social Conditions of the Area. Population and General Statistics 12 Principal occupations of the inhabitants of the Borough 13 Economic Conditions 14 Marriages 14 Births 14 Illegitimacy 15 Notification of Births 15 Still Births 16 Deaths 16 Inquests 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 25 Maternity and Child Welfare 27 Block Grants 27&28 Ante-natal 28 & 32 At Birth 29 Infants and Young Children 29 Advice Cards 29 Home Visiting 29 Attendances at Consultations, etc. 31 Centres 34 Artificial Light Treatment 36 Dental Clinic 37 Day Nurseries 38 Nursery Schools 39 Clinic for Ailing Mothers and Children 39 Convalescent Home Treatment 40 Home for Sick Poor Children 40 Supply of Milk to Mothers and Children 41 page Professional Nursing 43 Home Helps 43 Midwives 44 Midwifery 44 Maternal Mortality 45 Medical examination in elementary schools 47 Provision of Insulin 49 Local Legislation 49 Public Health Legislation 50 London County Council By-laws 50 Tuberculosis Regulations 50 Tenement House By-laws (Decontrolled premises) 50 Smoke Abatement 50 Merchandise Marks Act 50 Health Propaganda 50 Section III.—Sanitary Circumstances of the Area. Water Supply 51 Public Baths and Washhouses 51 Drainage 51 Rats and Mice 52 Pigeons 52 Refuse Collection and Disposal 52 Mortuary and Coroner's Court 53 Sanitary Inspections 53 Notices served 54 Nuisances and Breaches—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 62 Overcrowding 62 Housing Schemes— Work of the Estates Committee 61 Section Y.—Inspection and Supervision of Food. (а) Milk Supply 66 Cowsheds, Dairies and Milkshops 66 Milk in Sealed Containers 66 Sampling out of Office Hours 66 Milk (Special Designations) Order, 1923 67 Artificial Cream Act, 1929 69 (b) Meat and Other Foods 69 Unsound or diseased food condemned and destroyed 70 Slaughter-houses 70 Fried Fish and Fish Curing Premises 70 Ice Cream Premises 70 Bakehouses and Restaurant Kitchens 70 Underground Bakehouses 70 (c) Food and Drugs (Adulteration) Act, 1928— Samples taken 71 Prosecutions— (a) Food and Drugs (Adulteration) Acts 72 (b) Public Health atives &c. in Food) Regulations 1925 72 (c) Milk and Dairies Order, 1926 73 Wholesale Dealers in Margarine 73 Section YI.—Prevalence of, and control over, Infectious Diseases. Notifiable Diseases 73 Notifications and Deaths from notifiable diseases by ages 74 Do. by Wards 75 Small Pox 76 Vaccination 76 Scarlet Fever 77 Diphtheria 77 Enteric (Typhoid) Fever 78 Puerperal Fever and Pyrexia 79 Erysipelas 80 Cerebro-spinul Meningitis 80 page Anterior Poliomyelitis and Polioencephalitis 81 Ophthalmia Neonatorum 81 Encephalitis Lethargica 81 Pneumonia 82 Malaria 82 Dysentery 82 Measles and German Measles 82 Tuberculosis— New Cases and Deaths 85 Notifications 86 Prevalence and fatality for 10 years 87 Notifications and Deaths by Wards 88 Public Health (Tuberculosis) Regulations, 1930 88 Public Health (Preventionof Tuberculosis) Regulations, 1925 88 Boarding out of Children 89 Provision of Beds, etc 89 Disinfection of Rooms 89 Home Visits and Enquiries 89 Care Committee 89 Dispensary 91 Artificial Light Treatment 91 Report by Tuberculosis Officer 91 Summary of work carried out 92 Section YII.—Other Services. Disinfecting and Cleansing Station 93 Disinfection for Institutions, etc 94 Bacteriological Work 95 Appendix. Table No. 1. Vital Statistics for 11 years 98 Do. 2. Registrar-General's Short List of Causes of Death 99 Do. 3. Births and Deaths in Wards 102 Do. 4. Do., in certain large towns and Metropolitan Boroughs 103 Do. 5. Meteorology 104 Do. 6. Work carried out by District Inspectors 105 Do. 7. Do.—Food Inspectors 106 Do. 8. Do.—Factory & Workshop & Women Inspectors 107 Do. 9. Do.—Centre Superintendents, W omen Inspectors and Health Visitors 108 5 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. 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, Hev. 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. 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, Author. 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. November, 1931, to October, 1932. CHAIRMAN. Councillor Mrs. Evelyn Alliston. DEPUTY-CHAIRMAN. Councillor Charles Henry Denyer, M.A. EX-OFFICIO. The Right Worshipful The Mayor (Sir Alfred Davies, C.B.E., J.P., L.C.C.). ALDERMEN. Davies, David, J.P., L.C.C. Escott, Arthur, f.i.b.d. Morp.ell, Rev. R. Conyers, M.A. Rolles, Harry. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzieb. 2 Bell, Mrs. Florence Nightingalb Harrison. 7 Crosby, Miss Ada, M.B.E. 1 Davies, John William. 8 Evans, Evan, L.C.C. 8 Evans, John. 1 Flint, Mrs. Louisa Elizabeth. 4 Flynn, William, J.P. 6 French, Alexander George. 7 Gurney, Frederick Brown, F.A.I, 3 Hewson, Frederick. 2 Horne, George, j.p. 7 Jenkins, Edwin. 5 Kemp, Sydney Alfred. 2 Moore, Thomas Fairless. 1 Seward, William Guy. 1 Smerdon, Mrs. Edith Maude. 7 Swift, Mansell James, F.R.M.S. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT DURING THE YEAR 1931. MEDICAL OFFICER OF HEALTH AND ADMINISTRATIVE TUBERCULOSIS OFFICER. (g) G. Sowden, M.D., D.P.H, M.R.C.S., L.R.C.P. TUBERCULOSIS OFFICER. (g) 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. V. Pritchard, M.D., D.P.H., 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. Pelly—Ward 2. Dr. J. Wigg—Wards 3 and 4. Dr. A. E. Tait—Wards 5, 6 and 7. Dr. C. H. A. Ai.deuton—Ward 8. VACCINATION OFFICER. Mr. A. E. Wolfe. (G)SANITARY INSPECTORS. Inspectoris of Food and Food Places. §¶W. G. Auger. §¶H. R. Child. Inspectors of Workshops and Factories. †Miss M. E. Bibuy, B.A. (Lond.). †§B. H. Thompson. District Inspectors. §G. Rackham. *+§¶J. I. 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. b (G) SANITARY INSPECTORS AND HEALTH VISITORS (FOR TUBERCULOSIS). ‡¶**Miss J. A. J. Camman. ‡¶Miss A. Holland. CLERICAL STAFF. W. C. W. Roworth, Chief Clerk. A. Carpenter. (g) G. N. Cove. xT. H. Hague. xW. C. Mansfield. F. A. J. Goodchild (attached to the Estates Dept.). (g) Miss A. Andrews. If x R. Warren, (g) J. A. Hoare. E. F. Kiruy. *Cert. Municipal and County Engineers. §San. Insp. Cert. Royal San. Inst. || Health Visitor's Certificate. †C.M.B. ‡Cert. San. Insp. Examination Board. Cert. Meat and other Foods. † Smoke Abatement Cert. (L.C.C.). **Certificate, Queen Charlotte's Hospital. X Cert. Royal San. Inst, and San Insp. Exam9. Joint Board. (G) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 7 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. (g) Medical Officers. No. of Consultations per month. Dr. Chas. II. A. Alderton 4 Dr. Albert J. Clarke 2 Dk. B. Marion Cockerell 14 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 5 Dr. Ethel F. Iredell 4 Dr. Lydia A. Lkney 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. Russkll 4 Dr. Abraham I. Silverman 4 Dr. Helen Turoveii 5 (G) Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist 8 Dr. Jas. Maughan, Anw^thetist. 2 (G) Artificial Light Clinic. Dr. William Beaumont 8 (G) Consulting Obstetric Surgeons. Martin II. Oldershaw, M.D., B.S., F.R.C.S. Francis L. Provis, M.R.C.P., F.R.C.S. (G) Dentists at Tuberculosis Dispensaiy. 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 oihcers.) (g) Superintendents oj 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) Heulth Visitors and Inspectors at Maternity and Child Welfare Centres. +§||Miss i. A. Anderson. †*'Miss E. B. Bagnall. ‡¶Miss V. K. Blaxland. ¶†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. ¶† Mrs. 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. Dibbf.n (Disinfector). J. Stanley (Driver and Disinfector). C. Browne (Do.). Mrs. E. 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. Inst. || Health "Visitor's Certificate, †C.M.B. **Midwifery Certificate, Queen Charlotte' s Hospital. (G) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 8 Public Health Department, Town Hall, Pancras Road, N.W. 1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Ladies and Gentlemen, In accordance with the requirements of the Ministry of Health, as indicated in the Sanitary Officers Order, I have the honour to submit the Annual Report, on the sanitary circumstances, the sanitary administration, and the vital statistics of the Metropolitan Borough of St. Pancras for the year 1931. This report contains the information specified in the Circular and Appendix issued by the Ministry, and is set out, as far as possible, in the manner specified therein. This is the 76th Annual Report which has been presented, and the ninth which it has been my duty to submit to the Members of the Council. A summary of the principal statistics for the year is given on pages 10 and 11. The items to which attention may be directed include the following: — Population. According to the preliminary Census reDort, the total population of the Borough on April 1st, 1931, was 198,113. At the previous Census (1921) the total population was 211,366, thus indicating a decrease, during the 10 years, of 13,253 persons. The birth rate was 15.1 per 1000 of population. This shows a slight decrease as compared with 1930, and is the lowest birth rate hitherto recorded in the Borough. The death rate was 13.3 per 1000 of population, as compared with a rate of 11.9 for the previous year. The increase was chiefly due to the prevalence of Influenza, which resulted in a larger number of deaths from this disease and from Pneumonia. The low rate for the year 1930 was doubtless affected by the fact that the population had been estimated at too high a figure by the Registrar-General. The infantile mortality rate was 68 per 1000 births, as compared with a rate of 60 for the previous year. The maternal (Puerperal) death rate was 2 4 per 1000 live births. Notifiable infectious diseases were much less prevalent than during the previous year, with the exception of acute Primary Pneumonia and acute Influenzal Pneumonia, both of which showed a slight increase. Housing. Continued progress has been made with the various housing schemes which are being carried out by the Borough Council, the London County Council, and the St. Pancras House Improvement Association, Ltd, 9 Barnes House, Camden Road, although not quite ready for occupation at the end of the year, was completed and occupied in February, 1932, prior to the compilation of this report. In addition to 22 flats, the building also provides a Tuberculosis Dispensary, a Maternity and Child Welfare Centre and five lock-up shops. Coroner's Court. Extensive improvements were carried out to this building during the year, a new lease was arranged with the London County Council and the terms under which the premises are let were revised. Health legislation coming into force during the year included the following:— The Public Health (Tuberculosis) Regulations, 1930, which came into force on January 1st, 1931, and Amended By-laws with respect to houses divided into separate tenements. The effect of the Amendment is to cause certain Sections which had been held in abeyance to apply to houses of this type which have now become decontrolled. The routine duties of the department have been carried out by the staff with zeal and efficiency, and I have again to express my thanks to the members of the Public Health Committee for the consideration so invariably accorded to me. I am, Ladies and Gentlemen, Your obedient Servant, G. SOWDEN, Medical Officer of Health. 10 STATISTICAL SUMMARY. 1.—General, Statistics. Area of Borough, 2,694 acres. Area of various public open spaces, 503 acres. Playing 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 (1931 Census) (Provisional), 198,113. Number of inhabited houses (according to Rate Books), 27,280. Number of families or separate occupiers (1921 Census), 56,653. Number of persons per acre (Census year 1931), 74. 2.—Principal Statistics for 1931. Population (Registrar-General's mid-year estimate) Civilian, 195,200. Total, 195,600. Number of persons per acre, 73. Births. Males, 1,528; females, 1,427. Total, 2,955. Birth rate, 15.1 per 1,000 of population. Legitimate births, 2,710; illegitimate births, 245. Excess of births over deaths, 354. Deaths. Males, 1,355; females, 1,246. Total, 2,601. Death rate, 13.3 per 1,000 of population. Infantile Mortality. Deaths of infants under one year of age per 1,000 births, 68, Legitimate rate, 64; illegitimate rate, 110. 11 Maternal (Puerperal) Mortality. Number of women dying in, or in consequence of, child-birth : From Sepsis, 2; from other causes, 5. Maternal death rate per 1,000 births, 2.4. Number of deaths from Measles (all ages), 2. „ ,, Whooping Cough (all ages), 14. „ „ Diarrhoea and Enteritis (under 2 years of age), 30. Tuberculosis. Pulmonary. Deaths, 181 ; death rate per 1,000 of population, 0.93. All forms. Deaths, 206 ; death rate per 1,000 of population, 1.06. Rateable value, £2,054,378. Sum produced by a penny rate, £8,373. Rainfall during the year (recorded at Camden Square), 254 inches. Comparative Statistics. Rate per 1,000 of Population. Rate per 1,000 Births Birth rate. Death rate. Infant Mortality. St. Pancras 15.1 13.3 68 England and Wales 15.8 12.3 66 107 Great Towns 16.0 12.3 71 County of London 15.0 12.4 65 12 Metropolitan Borough of St. Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1931. For the purpose of this Report, the year consists of the 52 weeks ended 2nd January, 1932. 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 preliminary report, the total population of the Borough at the Census taken on April 1st, 1931, was 198,113. These figures indicate a decrease of 13,253 persons during the inter-censal period. The mid-year (1931) population of the Borough was estimated by the Registrar-General to be as follows:—Total population 195,600. Civil population 195,200. The very considerable decrease in population in the short interval between the date of the Census (April 1st) and the middle of the year is stated to be due to a preliminary allocation to the usual place of residence of persons, who, at the date of the Census, were residing in hotels, hospitals or other temporary abode. The estimated total population as given by the Registrar-General (195,600) has been used for the purpose of calculating the marriage and birth rates, and the estimated civilian population (195,200) for calculating the death rate for the year 1931. The following figures taken from the Preliminary Census Report for 1931 shew the number of persons of each sex in each of the three Parliamentary Divisions in the Borough. Parliamentary Divisions. Males. Females. Totals. North 31586 36916 68502 South-East 30991 32898 63889 South-West 31869 33853 65722 Totals 94446 103667 198113 13 The total female population exceeds that of the male by 9,221. Further details with reference to the last Census will not be available until the Annual Report for 1932. PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried on 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 1921 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 „ 14 ECONOMIC CONDITIONS. The amount of out-relief granted during the past 10 years is indicated in the following table (kindly supplied by Mr. Bernard Chapman, 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, 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 Lady day, 1931 34084 3968 Michaelmas, 1931 29028 3810 MARRIAGES. The number of marriages celebrated during the year was 1,907. This is equal to a rate of 9.7 marriages per 1000 of total population, or a rate of 19.4 persons marrying per 1000 of the population. The average yearly number of marriages during the preceding five years was 1,984, equal to a rate of 93 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 2,955, equal to an annual birth rate of 15.1 per 1000 of population. This is the lowest birth rate recorded in the Borough. The rate for the previous year was 15.4, and the rate for 1929 was 15'5. The actual number of births registered as having taken place in the Borough during the year was 4,483, 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 1,905, and by adding the births belonging to St. Pancras which occurred outside the Borough—these numbered 377. The corrected figure being therefore as stated above, 2,955. The corresponding figures for previous years are given in Table 1, on page 98. 15 The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1931, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Ward. 1931. 1930. Births. Birth Rate. Births. Birth Rate. 1 530 15.0 481 13.3 2 337 17.4 365 17.1 3 551 16.8 594 17.1 4 356 15.1 422 16.7 5 451 15.9 507 17.2 6 275 15.5 306 15.2 7 137 10.7 163 11.0 8 318 12.5 370 14.0 Borough 2955 15.1 3208 15.4 No less than 2,734 births occurred in Public Institutions in St. Pancras, equal to 61 per cent, of the total births which took place in the Borough. Table 4, on page 103, shows for 1931 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 2,955 net St. Pancras births, 245 were recorded as being illegitimate. This equals 8.3 per cent, of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1921 5.5 per cent. 1926 6.3 per cent. 1922 5.6 „ 1927 6.9 „ 1923 5.7 „ 1928 7.3 „ 1924 5.9 „ 1929 7.8 „ 1925 6.3 „ 1930 8.4 „ 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 16 death of a child would be reported before information bad 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. 4,515 notifications of births were received during the year: this includes 175 stillbirths and 4,340 live births, and represents 96.8 per cent, of the births registered as having taken place in the Borough. The Notification of Births Act (1907) states: "Information with regard to the event shall be given to the Medical Officer of Health within 36 hours of the occurrence of the birth of a child, alive or dead, which has issued forth from its mother after the twenty-eighth week of pregnancy." This notification is in addition to, and not in substitution for, registration of birth, which must be carried out at a 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 at tendance, 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 113 5 58 Females 73 6 35 Illegitimate Males 14 2 7 Females 9 1 6 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 2,601; equal to an annual death rate of 13.3 per 1000 of population. 17 The corresponding rate for the previous year was 11.9 and the average yearly death rate of the Borough for the previous five years was 12.9 per 1000 of population. The actual number of deaths registered as having taken place in the Borough during the year was 2,979. This number has to be corrected by the exclusion of 933 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 555 deaths of residents which occurred and were registered outside the Borough. The corrected figure is therefore 2,601 and is used in calculating the death rate in this report. In Table 1, on page 98, 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. 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 Average for 10 years. 1931 Heart Disease 435 461 394 398 381 388 448 465 603 430 440 553 Cancer 290 302 319 298 324 301 292 321 297 357 310 355 Tuberculosis—all forms 304 315 272 271 231 212 217 216 250 189 248 206 Pneumonii 173 265 201 200 204 155 207 181 295 160 204 203 Bronchitis 276 308 223 304 274 259 227 138 255 106 237 143 Injuries 88 127 113 114 118 142 132 145 129 165 127 121 Cerebral Hemorrhage, Embolism, and Apoplexy 126 120 112 118 123 110 92 67 78 99 105 92 Congenital Debility, Malformation and Premature Birth 137 126 119 105 94 100 69 86 88 72 100 76 Nephritis and Bright's Disease 60 67 79 75 75 89 84 83 72 72 76 61 Influenza 57 142 24 80 41 29 83 14 137 14 62 49 Diarrhcea and Enteritis 98 47 61 63 55 63 35 52 48 52 57 33 Diphtheria and Croup 51 44 20 22 31 12 6 12 18 32 25 19 Rheumatic Fever 16 15 8 5 18 10 13 15 7 17 12 18 Whooping Cough 38 29 28 46 71 24 35 24 77 4 38 14 Erysipelas 3 12 4 4 12 8 6 2 4 9 6 8 Pleurisy 7 10 8 8 16 5 3 7 5 6 7 4 Measles 23 107 5 74 3 65 5 127 7 31 45 2 Puerperal Fever 4 4 9 4 4 1 4 3 4 — 4 2 Scarlet Fever 7 20 3 12 — 2 2 1 4 7 6 2 Enteric Fever 3 1 3 2 3 1 2 1 3 1 2 1 18 The Registrar-General's short list of deaths at different age periods is given in Table 2 on page 99, and, for the purpose of comparison, the death rates for England and Wales, the County of London, the Metropolitan Boroughs, and certain of the large towns are given in Table 4 on page 103. It will be noted that 21 Metropolitan Boroughs had a lower and 7 a higher general death rate than St. Pancras, Of the total 2,601 St. Pancras deaths which occurred during the year, no less than 1,570 took place in public institutions; this equals a proportion of 60 per cent, of the total deaths. As compared with the previous year, there was an increase in the number of deaths due to Heart Disease, Tuberculosis, Pneumonia, Bronchitis and Influenza, and a decrease in those attributed to Cancer, Injuries, Cerebral Hasmorrhage, Bright's Disease, Enteritis, Diphtheria and Measles. Of the 553 deaths due to various forms of Heart Disease, 29 were of persons over 85 years of age, 156 were between 75 and 85, and 170 were between 65 and 75 years of age. One death was recorded as having been due to Beri-Beri, a disease which does not usually occur in this Country. The patient was an inmate of the Hospital for Tropical Diseases, and although a foreigner, the death has to be accepted, as the Institution is situated in this Borough. 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 Dreceding vear being also given for comparison:— Ward Deaths and Death Rates. Ward. 1931. 1930. Deaths. Death Rate. Deaths. Death Rate. 1 469 13.2 402 1l.l 2 225 11.6 246 11.5 3 441 13.5 417 12.0 4 350 14.8 304 12.0 5 367 13.1 368 12.7 6 198 11.1 179 8.9 7 161 12.5 167 11.3 8 346 13.6 365 13.8 Homeless 44 — 30 — Borough 2601 13.3 2478 11.9 19 Deaths of Persons of unknown addresses, etc., included in the, Mortality Statistics. The following deaths have been included in the Mortality Statistics of the Borough, in accordance with the Registrar-General's rules relating to " Transferable Deaths":— Various Asylums 12 Highgate Hospital 6 St. Pancras Hospital 18 Hospital for Tropical Diseases 1 Royal Free Hospital 2 Found on Parliament Hill Fields 2 „ in Regent's Canal 2 „ on doorstep, Stanhope Street 1 Total 44 Inquests. In the following table will be found the causes of death, as certified by the Coroner; they are also further classified into age periods:— Causes. Under 1 year. 1-5 years. 5—15 years. 15—25 years. 25-65 years. 65 and over. Totals. Natural— Heart Disease 2 1 — — 6 2 11 Pneumonia — 1 — — — 2 3 Cerebral Haemorrhage — — — — 2 — 2 Cancer — — — — 3 — 3 Tuberculosis — — — 1 1 — 2 Other causes 2 1 5 4 19 6 37 Accidents— Street Vehicles — 4 14 12 24 22 76 Burns and Scalds 1 3 — — 2 8 14 Railway — — — — 4 — 4 Falls 3 1 — — 17 50 71 Other causes* 2 4 8 1 7 7 29 Suicides† — — — 3 76 6 85 Murder — — — 1 2 — 3 Manslaughter — — — 1 1 — 2 Open YerdictX 4 — — 1 10 4 19 Totals 14 15 27 24 174 107 361§ *Includes 5 cases of coal gas poisoning. † „ 31 cases ,, „ ‡Includes 2 cases of coal gas poisoning. §St. Pancras cases 101, ex-St. Pancras 260 (see also page 53). 20 Infantile Mortality. 200 deaths of St. Pancras infants, under one year of age, occurred during 1931. This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 68. The corresponding rate for the previous year was 60, and for the year 1929 it was 83. The principal causes for the slightly higher rate for 1931 as compared with the previous year were an increase in the deaths due to Whooping Cough, Meningitis and Broncho-pneumonia. The following table gives the deaths and death rates of both legitimate and illegitimate iufants for 1931:— Legitimate. Illegitimate. Total. Number of Births 2,710 245 2,955 Number of Deaths (under one year of age) 173 27 200 Death rate per 1000 births 64 110 68 In Table 1, on page 98, the Infantile Mortality rates are given for previous years, and in Table 3, on page 102, the figures will be found for each Ward. Table 4, on page 103, 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 1931, 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 Nett Deaths from stated causes at various Ages under 1 Year of Age for the Year 1931. cause of death. Under 1 week. 1 —2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 week. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Measles — — — — — — 1 — — 1 Whooping Cough — — — — — 1 2 3 4 10 Influenza — — — — — 1 — — — 1 Diphtheria — — — — — — — — 1 1 Tuberculous Meningitis — — — — — — — — 1 1 Other Tuberculous Diseases — — — — — — 1 1 — 2 Meningitis (not Tuberculous) — — — — — — 2 4 2 8 Convulsions — — — — — — — 1 — 1 Bronchitis — — 1 — 1 2 — — 1 4 Bronchopneumonia — — 1 2 3 17 8 9 5 42 Lobar-pneumonia — — — — — 1 1 1 — 3 Pneumonia (type not stated) 1 — — — 1 — — — — 1 Diarrhœa — — 1 — 1 1 4 — — 6 Enteritis — — — 1 1 3 8 8 2 22 Syphilis — — — — — — 1 1 — 2 Suffocation (overlying) — — — — — — — — — — Injury at Birth 3 — — — 3 — — — — 3 Atelectasis 3 — — 1 4 — — — — 4 Congenital Malformations 11 — — — 11 2 6 2 2 23 Premature Birth 29 2 6 2 39 3 1 — — 43 Congenital Debility, Sclerema and Icterus 2 — 1 — 3 2 2 — — 7 Other causes 2 — 2 — 4 3 6 1 1 15 Totals 51 2 12 6 71 33 43 31 19 200 Nett Births in the year legitimate 2710 illegitimate 245 Nett Deaths in the year legitimate infants 173 illegitimate infants 27 22 Deaths from Stated Causes under 1 Year of Age for 1931 and 10 preceding Years. cause of death. 1021 1922 1923 1924 1925 1926 1927 1928 1929 1930 Average for 10 years. 1931 Measles 7 15 1 15 2 25 — 30 — 3 10 1 Scarlet Fever — 3 — — — — — — — — — — Whooping Cough 18 11 8 13 29 11 15 10 32 2 15 10 Diphtheria and Croup 2 — — — 1 1 — — 3 1 1 1 Erysipelas — 1 1 2 2 — — — — 2 1 — Influenza 2 7 — 6 2 1 2 — 5 2 3 1 Tuberculous Meningitis 4 3 4 3 2 3 3 — — 1 2 1 Other Tuberculous Diseases 4 8 3 — 1 1 1 2 — 2 2 2 Meningitis (not Tuberculous) 3 2 3 5 4 3 2 1 4 3 3 8 Convulsions 8 8 5 4 4 2 1 1 5 — 4 1 Bronchitis 13 21 12 12 19 14 5 9 7 7 12 4 Broncho-pneumonia 39 54 34 51 34 36 42 43 43 20 40 42 Lobar-pneumonia 1 3 1 3 4 2 2 3 4 — 2 3 Pneumonia (type not stated) 3 6 1 3 — 1 1 2 1 3 2 1 Diarrhœa 11 4 6 6 9 7 3 8 5 6 7 6 Enteritis 63 27 37 46 36 38 24 33 34 36 37 22 Gastritis 2 — 1 — 2 — — — 1 — 1 — Syphilis 14 8 5 2 5 1 2 4 1 3 5 2 Rickets 1 1 — — — — — — — 1 — — Suffocation (overlying) 2 5 1 1 4 3 1 1 — 1 2 — Injury at Birth 3 3 6 4 7 3 9 2 9 4 5 3 Atelectasis 8 4 9 7 2 6 10 11 7 3 7 4 Congenital Malformations 25 31 27 23 20 25 15 20 23 12 22 23 Premature Birth 75 61 70 59 57 57 39 50 46 48 56 43 Congenital Debility, Sclerema and Icterus 34 28 21 24 17 18 14 16 14 8 19 7 Other causes 18 23 16 14 17 16 14 15 18 26 17 15 Totals 360 337 272 303 280 274 205 261 262 194 275 200 Nett Births 4764 4559 4348 4112 3880 3612 3299 3274 3170 3208 3823 2955 23 Section II.—GENERAL PROVISION OF HEALTH SERVICES. Hospital Accommodation. A. Fever and Small Pox.—Hospital accommodation is provided by the London County Council, who now control the various institutions previously provided by the Metropolitan Asylums Board. B. Tuberculosis.— For patients suffering from this disease Institutional accommodation is provided through the London County Council. C. General, Children's and other Hospitals.— The following are situated within the Borough. The St. Pancras and Ilighgate Hospitals are primarily intended for residents of the Borough, St Margaret's Hospital admits cases of the kind specified from the whole of the metropolitan area, but the use of the various general and special voluntary hospitals is by no means confined to residents either of this Borouoh or of the metroDolitan area. On the other hand, hospitals situated outside the Borough are largely used by St. Pancras residents. Hospitals. Number of Beds. London County Council General Hospitals. St. Pancras Hospital, King's Road 384 Highgate Hospital, Dartmouth Park Hill *554 London County Council Special Hospital. 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 National Temperance Hospital, Hampstead Road 134 Elizabeth Garrett Anderson Hospital, Euston Road 105 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 51 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, Fitzrov Square Western Skin Hospital, Hampstead Road British Dentists' Hospital, Camden Road London Foot Hospital, Fitzroy Square British Hospital for Nervous Disorders, Camden Road *Average of 531 only available, owing to reconstruction. 24 Institutional Provision for Unmarried Mothers. The Main Memorial Home, 49, Cartwright Gardens, W.C. 1, provides accommodation lor 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. London Ambulance Service. Tel. City 7200.—This now includes the ambulance service of the late Metropolitan Asylums Board, the late Boards of Guardians, and the London County Council Accident Service. The two first named have been amalgamated under the title General Ambulance Section, the last continues to function as hitherto under the title of Accident Section. (a) The Accident Ambulanccs provide for the conveyance to hospitals, infirmaries or private residences of :— 1. Persons meeting with accidents or suffering from sudden illnesses in the streets, public places and places of employment. 2. Persons meeting with accidents in their homes. 3. Persons suffering from illnesses in their homes, if a medical practitioner certifies that the case is one of life or death, that no other ambulance is available and that arrangements have been made for the reception of the patient in a hospital. 4. Parturient women, if the case is one of urgency, whether from the home, place of business, or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case. 5. Non-urgent cases of parturition, between the hours of 11 p.m. and 8 a.m., if letters of admission to maternity hospitals are produced, it being sufficient in such cases for a female friend to accompany the patient. No charge is made in respect of the services provided in any of the categories enumerated above. The servicc normally functions within the County of London, but excludes the City of London, within which the Corporation maintains its own ambulance service for the removal of casualties within its area. (b) The General Ambulances deal with the transport of cases, both infectious and noninfectious, in connection with admissions to and discharges and transfers from the hospitals and institutions of the London County Council, within and without the administrative County of London, which includes the City. No charge is made in respect of these services, except in the case of the removal of maternity patients in certain cases under agreements with Metropolitan Borough Councils. General Ambulances are also supplied on payment of prescribed charges for the conveyance of infectious and non-infectious cases between private houses, hospitals (other than those referred to above), nursing homes, etc., and for examination, consultation and treatment by specialists or at special establishments. The charges for work carried out for public authorities and for journeys extending outside the county are, for one or two persons conveyed, 1s. a mile up to 50 miles, and thereafter 10d. a mile; for more than two persons the scale charges are higher. Additional charges are made as follows: — (a) 5s. for the services of a nurse for a period up to two hours, and thereafter at an extra charge of 2s. an hour or part of an hour; and (b) 5s. an hour or part of an hour for keeping an ambulance waiting more than 15 minutes. 25 The charge to private persons is 10s. for the removal of one patient from one place to another within the administrative County of London. This charge includes, if necessary, the services of a male attendant, and one friend is allowed to accompany the patient. Additional charges as above are made for the services of a nurse and for keeping an ambulance waiting. Other additional charges are as follows:—(a) 5s. if two patients are conveyed in one ambulance; (b) 2s. 6d. if the friend accompanying the patient wishes to be conveyed alone for the outward or return journey; (c) 2s. 61. a head each way for each additional person who desires to accompany the patient. Other ambulance facilities include:— St. John's Ambulance Association, St. John's Gate, Clerkenwell, E.C.I. Tel. Clerkenwell 6614. British Red Cross and Order of St. John Ambulances, These con vey pregnant women to hospitals from 8 a.m. to 11 p.m. Tel. Sloane 7136. 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 Climes. Raydon Street, South Highgate The Borough Council. Almeric Faget Clinic, Roehford Street A Voluntary Committee. 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 ,, „ Argyle 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. Bay Nurseries. Kentish Town Day Nursery, Gospel Oak Grove The Voluntary Committee, with a subsidy from the Borough Council. Margaret Day Nursery (for Fatherless children), „ „ 56-59, Clarendon Square Whitfield Street Day Nursery, 53, Whitfield Street „ ,, Day Nursery, Foundling Hospital Site . . „ ,, * Shortly after the end of the year these two Centres were combined and the work transferred to new premises, Barnes House. Camden Road. † This Centre has recently been closed. 26 Situation. By whom provided. D. Nursery Schools. Somers Town Nursery School, 18, Crowndale Road Jellicoe Nursery School, 6a, Rochford Street Mary Ward Nursery School, 16, Burton Street Magdalen Mission Nursery School, 5, Clarendon Street St. Christopher's Hall, Bridge water Street Trinity Presbyterian Hall, Buck Street E. Dental Clinics. *Argyle Square: For nursing and expectant mothers and children who attend the Maternity and Child Welfare Centres Amp thill Square : For mothers and children who attend the Centre at 1, Ampthill Square St. Pancras Dispensary : For Tuberculosis cases ,, For ordinary cases . . Eastman Clinic: For nursing and expectant mothers and children ; also provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. F. School Clinics. Highgate New Town: Chester Road St. Pancras Centre, Prince of Wales Road Clarendon Square G. Tuberculosis Dispensaries. *St. Pancras Dispensary, Oakley Square University College Hospital II. Venereal Disease Clinics. A Voluntary Committee. „ „ The Mission Authorities. The Committee of the St. Pancras House Improvement Society, Ltd. The Church Authorities. The Borough Council. The Voluntary Committee. The Borough Council. The Dispensary Committee. The Committee of the Royal Free Hospital and Clinic. Voluntary Committees, working under agreement with the London County Council. The Borough Council. The Hospital Authorities. 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. * Tie work carried oat at these institutions was transferred early in 1932 to more adequate and centrally situated premises at Barnes House, Camden Road. 27 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. Invalid Children's Aid Association (various homes) K. Open Air Schools. Holly Court, Ilighgate, N. 6 Euston Square, N.W. 1 L. Professional Nursing at Home. North London Nursing Association, 6 & 7, Canonburv Placc, N. 1 Hampstead Nursing Association, 25, Heath Hurst Road, N.W. 3 Metropolitan Nursing Association, 14, Oakley Square, N.W. 1 By Voluntary Committee, with grant from Borough Council. Subsidy from Borough Council. London County Council. By Voluntary Committee, with grant from Borough Council. „ „ MATERNITY AND CHILD WELFARE. For many years considerable attention has been devoted to this work in St. Pancras, not only by 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 beinsr 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 28 £ 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 by the Borough Council and also at the General and Women's Hospitals, both in and adjacent to the Borough. Visits by Council's Health Visitors to the Homes. Classes for mothers, held by the Superintendents of the various Centres. Provision of dinners (at some Centres), milk, and also of dental treatment for expectant and nursing mothers. A scheme of co-operation in xYnte-natal work between the Borough Council and University College Hospital, in force since January 1st, 1928. *The grant allocated by the Ministry of Health to the Margaret Day Nursery was based on the expenditure incurred during the standard year (1929) at the old premises then occupied in Ampthill Square. The Committee of the Nursery had, however, acquired a site in Clarendon Square on which a large and well designed day nursery was erected. The accommodation in the new premises was very much greater, and although the expenses were necessarily higher, no increase in the grant made by the Minister could be obtained until the expiration of the period of three years for which the amount of grant had been fixed. Under these circumstances, the Borough Council very generously decided to make a grant of £390 per annum for a period of two years towards the cost of the new premises. At the end of this time the position could be reviewed, as a new scheme would then be made by the Minister of Health. 29 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 casss attended at home by midwives on the staff of various hospitals and institutions. The provision by the Borough Council of Consultants' services, bacteriological investigation and skilled 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 four voluntary Day Nurseries in the Borough. The payment for the home nursing of sick infants in certain cases. A Centre for Artificial Light treatment. 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 three part-time trained workers, not paid by the Council, at the Caversham Road Centre, and one part-time trained voluntary (unpaid) worker at the Somers Town 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 three trained visitors at the Royal Free Hospital. 30 During 1931 the Council's staff at the various Centres made 25,165 visits to 2,661 children, and 2,804 visits to 1,370 expectant mothers; the trained workers not paid by the Council made 8,837 visits to 602 children, and 502 visits to 275 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 1370 2804 2661 25165 Trained Centre staff, not paid by Council 275 502 602 8837 Total of all trained workers 1645 3306 3263 34002 Corresponding totals for 5 previous years— 1930 1645 3105 3519 37972 1929 1845 3632 3643 41711 1928 1574 3192 3463 42141 1927 943 2179 3422 39595 1926 1618 3651 4030 48686 31 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 72 207 264 21 27 312 3123 9S2 823 4928 277 323 474 2801 14 171 2 26 3 _ Somers Town 65 172 182 10 7 199 3219 1673 867 5759 153 497 221 4526 12 153 1 12 2 1(c) North St. Pancras School for Mothers 82 189 341 19 10 370 4613 1689 1015 7317 137 395 512 4556 18 213 1 12 3 — South Highgate Centre — — 98 8 5 111 1701 828 477 3006 81 171 127 1716 8 104 - 1 — Grafton Road Centre 65 163 201 8 23 232 3198 1200 773 5171 109 263 269 3558 14 163 1 12 2 — Camden Town Centre 114 174 305 26 31 362 4011 1481 1279 6771 260 366 533 3906 17 203 1 11 3 — Argyle Square Centre 9 26 193 17 9 219 2427 624 406 3457 155 220 312 2537 8 101 — — 2 — Caversham Road Centre 177 930 302 12 17 331 4198 690 976 5864 224 751 407 4759 15 144 4 49 2 4 (f) †University College Hospital . 787 3665 — — — 731 — — — 4345 — 180 4878 18 204 18 204 — 2 †Royal Free Hospital 193 862 — — — 134 468 252 219 939 249 320 228 765 12 153 12 150 — 3 Totals 1564 6388 — — — 3001 — — — 47557 1645 (a) 3306 (b) 3263 (c) 34002 (d) 136 1609 40 476 *18 10 * An additional visitor was also attached to the following Centres:— Ampthill Square, South Highgate, Grafton Road, Camden Town, Caversham Road, Argyle Square, Somers Town, for 3 days a week, (a; Exclusive of 43 visits by students (Ampthill Square, 8 ; Camden Town, 35). (b) „ 45 „ ( „ 8; „ 37). (c) „ 57 „ ,, „ 19; „ 38). (d) ,, 354 „ ,,( ,, 103; Queen's Crescent, 71; Camden Town, 180). (e) Part-time trained visitor. (f) 1 full-time and 3 part-time trained visitors Caversham Road, † Figures refer to St. Pancras cases only. 32 Ante-Natal. Activities. A detailed review Was made for the five years 1926-1030 of the Ante-Natal work carried out at the Council's Centres in the Borough, excluding the Camden 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 Caesarean Section* 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. 33 Ante-Natal Activities 1926-1930. AntE-Natal CONDiTION. Treated By. Confinement (Mace). Labour. Foetus or Child. Totals. Institution. Privately. Institution. At Home. Normal. Miscariiage. Premature. Induction. Caesarean. Other Abnormal. Viable Healthy. Viable Unhealthy. Non-Viable Foetus. Non-Viable Still born. Abnormal Cases, Normal Cases, All Cases. Percentage of Abnormal Cases. Ampthill Square — 34 593 626 8.4 Albuminuria 9 1 6 4 7 - - - - 3 9* - 1 1 10 Abnormal Pelvis 7 - 7 - - - - 5 2 - 7 - - - 7 Malpresentation 11 1 6 6 10 — — 1 - 1 12* 1* — — 12 Other Conditions 5 - 5 — 4 1 - - — - 4 - 1 - 5 Somers Town— 16 .90 206 7.8 Albuminuria 3 — 2 1 2 — — — — 1 2 — 1 3 Abnormal Pelvis 8 4 4 5 — 1 — 1 1 8 — — — 8 Malpresentation 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 — — — 1 Ante-Partum Hæm. 3 4 5 2 4 1 — — — 2 3 I 1 2 7 Other Conditions 26 2 21 7 25 1 1 1 25 — 3* 28 Grafton Road-— 22 265 287 7.7 Abnormal Pelvis 2 — 2 — — — — 1 1 — 2 — — — 2 Cardiac Disease 2 2 2 2 2 — 2 — — — 4 — — — 4 Threatened Miscarriage 3 — 3 — 2 — 1 — — — 4* — — — 3 Other Conditions 6† 7 6 6 5 1 1 — 1 3 8 — 2 2 13 Queen's Crescent— 274 297 7.7 Abnormal Pelvis 4 — 4 — 1 — — 1 1 1 2 — — 2 4 Tuberculosis 1 — 1 — 1 — — — — — — 1 — — 1 Other Conditions 10 8 6 12 10 6 — — — 2 5* 1 6 7 18 TOTALS 143 28 12 49 118 10 6 13 8 *5 140 4 14 17 171 1927 2098 8.1 Percentages 83.6 16.4 71.2 28.8 19.6 5.9 3.5 7.6 4.7 8.8 80 2.3 8.0 9.7 8.1 91.9 Total Albuminuria 20 , 3 17 6 19 — — — — 4 20 — 1 3 23 Total Abnormal Pelvis 33 — 29 4 13 — 1 11 6 2 31 —- — 2 33 Total Malpresentation 18 1 11 3 17 — — 1 — 1 19* 1 — — 19 34 Maternity and Child Welfare Centres. These ate 10 in number. Each Centre is managed by a Committee, the members of which not only give valuable help at the various consultations, but in most cases 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 SubCommittee. The Centre at the Royal Free Hospital is not subsidised by the Council. The Table on page 31 gives statistics concerning the work of all the Centres during the year. It will be seen that 476 ante-natal consultations were held, the number of expectant mothers was 1,564 and their total attendances were 6,388. For the two previous years the total attendances were 6,377 and 5,706. The number of consultations for children was 1,609, the children who attended for the first time numbered 3,001, and the total attendances were 47,557. For the two previous years the total attendances of children were 48,091 and 44,851. 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, interviews with parents (apart from those otherwise recorded) numbered 1,467. Other activities of this centre include the following:— Classes for Mothers. At infant care classes there were 310 attendances; and at needlework, etc., classes, 545 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,019 dinners were supplied to nursing and expectant mothers, and 2,165 to young children. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,763 attendances during the year, of which 547 were made by infants under one year of age, and 1,763 by children from 1 to 5 years of age. Dental Clinic. This is provided out of funds from voluntary sources. The Dental Surgeon is Mr. George Thomson, l.d.s. During the year 40 consultations were held, at which 150 treatments were provided for mothers and 154 for children. Details of the work done are given in the following table:— Mothers. Children. Extractions with anaesthetics 42 28 „ without anaesthetics — 4 Fillings 28 71 Scalings 12 — Impressions and fitting dentures, etc. 42 — Examinations and advice 26 51 Totals 150 154 304 35 Somers Town Centre, Chamberlain House, Ossulston Street. In addition to the Consultations provided by the Borough Council, the Health Visiting Staff had 1,985 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes, at which 314 attendances were recorded, and 31 mothers and 35 children were sent away on holiday for a period of two weeks. 79 massage treatments to 14 cases were given by a trained voluntary masseuse. North St. Pancras School for Mothers, Queen's Crescent. During the year 10 voluntary consultations for older children were held by Dr. J. Finch Haines, at which 212 attendances were recorded. Health Talks and Cookery Demonstrations were held, at which 371 attendances were made. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 2,257. 35 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. 20 mothers and 21 children were referred to the Council's Dental Clinic for treatment. The Holiday Home, provided by the Voluntary Committee of this Centre, at St. Margaret's, Heme Bay, has not been so successful as was anticipated, and it has failed to attract an adequate number of mothers. The Committee have, therefore, decided to discontinue it and to dispose of the premises. Grafton Road Centre. In February a communication was received from Dr. Wace intimating that, on account of ill-health, he was unable to continue the Monthly (Voluntary) Consultation he had conducted for some time, for children between the ages of 2 and 5 years. Dr. Alderton very kindly offered to undertake the duties in connection with this Consultation until the end of the year, when the amalgamation with the Camden Road Centre would take place and other arrangements would then be made. 10 mothers and 17 children were sent away for convalescence. 12 mothers and 22 children were referred for treatment to the Council's Dental Clinic, and 22 children attended the Artificial Light Clinic. Camden Town Centre. 28 mothers and 35 children were sent away on holiday, either to the country or seaside. Interviews with parents by the Superintendent, apart from medical consultations, numbered 2,093. 27 knitting and needlework classes were held during the year, at which the total attendances were 702. Argyle Square Centre. Six mothers and their children were each sent for two weeks holiday through the Women's Country Holiday Fund, aided by the Centre; three others had free holidays. 36 A variety of knitted clothes for babies are sold at the Centre, made up by the League of Remembrance and friends of the Centre. Expectant mothers receive advice as to baby clothing, and can get the material cut out and receive instructions for making it up. South Highgate Centre. Two mothers and five children were sent on holiday, either to the country or seaside, for a period of two weeks. In January a communication was received from the Voluntary Committee of the Centre stating that, in their opinion, the amenities of the premises would be improved by the installation of electric heating. The matter was considered by the Public Health Committee and a recommendation that the neccssary work be carried out was approved by the Council. 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 four qualified Health Visitors (one full-time and three part-time) were also provided from the same fund. Classes have been held in Needlework, Child Study and Mothercraft, at which there were 599 attendances. 64 mothers with their children were sent away on holiday. Artificial Light Treatment. The clinic maintained by the Borough Council for the provision of this form of treatment was in regular use throughout the year, except for a period during the middle of the summer. Consultations were held on two days in each week, the average number of patients at each consultation being 39, as compared with 45 during the previous year, and 30 per consultation in 1929. Staff, Equipment and Statistics for 1931. 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 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 are held weekly. Staff.—The Medical Officer carrying out the treatment is Dr. William Beaumont, m.r.c.s., L.r.c.r. 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:— 37 1931. 1930. Total number of cases treated 142 147 Total number of new cases 75 85 Total number of attendances 2506 2898 Number of Consultations held 64 65 Average attendance per Consultation 39 45 Average number of attendances per child 18 20 Cost. £ s. d. Electric current 5 8 11 Cleaning 6 16 0 Consultation fees 96 1 6 Miscellaneous 0 3 9 £108 10 2 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 Almeric Paget Clinic, Rochford Street, the Institute of Bay Therapy, Camden Road, and also at the Voluntary General Hospitals in the Borough. 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. For some time consultations were held every Monday and Wednesday in the afternoon, and on alternate Fridays in the morning. In February, Mrs. Murch, l.d.s., the Dentist in charge of the Clinic, intimated that, owing to the reduction in the numbers attending, a decrease in the number of consultations could be made. It was suggested that every Wednesday afternoon for fillings, etc., and each third Monday for gas (with an extra clinic occasionally) would be adequate. This re-arrangement of sessions was approved and adopted. No charge is made for extractions, fillings or scaling, but the patients contribute what they can reasonably afford towards the cost of dentures. 38 The work done during the year is summarised in the following table, the figures for he previous year also being given for comparison:— ]Work carried out at the Dental Clinic. 1931. 1930.. Number of new cases Mothers 153 138 Children 201 233 Total 354 371 Number of Attendances For extractions under nitrous oxide (gas) 287 279 „ „ local anaesthesia 33 50 „ fillings and dressings 316 282 „ scaling 25 26 „ impressions and fitting dentures 225 315 „ examination and advice 476 496 Total attendances 1362 1448 Total number of clinics held 73 94 Number of clinics with nitrous oxide anaesthesia 19 23 The following table shows the number and cost of the dentures supplied during the year Number of Patients supplied with dentures 37. Total cost £125 1s 0d. Amount paid by mothers £70 12s 6d. Amount paid by Borough Council £22 0s. 0d. Amount paid by various Societies £29 8s. 6d. Four mothers paid the entire cost of two dentures each. Three mothers paid the entire cost of one denture each. The Societies who made contributions towards the cost of dentures were the Metropolitan Hospital Sunday Fund, £10 5s. 0d.; the Metropolitan Hospital Saturday Fund, £4 3s. 6d., the Charity Organisation Society, £6 5s. 0d.; the Public Assistance Office, £4 0s. 0d.; and various other societies, £4 15s. 0d. The Charity Organisation Society, in previous years, made contributions towards the cost of dentures provided under this scheme, but are no longer able to do so owing to shortage of funds. 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 the Argyle Square Centre. Dental treatment is also provided at the voluntary clinic which is held at the St. Pancras School for Mothers, see page 34. The Eastman Dental Clinic, a lavishly equipped institution, attached to the Royal Free Hospital, is also available for patients of similar type, and the Welfare Centre held in connection with the University College Hospital is able to refer cases needing dental treatment to the dental department of that hospital. 39 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, and makes a contribution to the Foundling Site Day Nursery based on one-quarter of the expenditure incurred by the Nursery adjusted to the proportion of St. Pancras children attending. Particulars in regard to the day nurseries for the year ended 31st December, 1931, are as follows:— Number of Days Open. Attendances. Average per Day. Whitefield Day Nursery 233 6593 28.3 Kentish Tn. Day Nursery 230 7875 34.2 Margaret Day Nursery 295 6876 23.3 Foundling Site Day Nursery 253 1980 7.8 Nursery Schools. The undermentioned Nursery Schools are situated in the Borough. They provide 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 43 Jellicoe Nursery School, 6a, Rochford Street 58 48 Mary Ward Nursery School, 16, Burton Street 25 20 Magdalen Mission Nursery School, 5, Clarendon Street 24 20 In addition to the above, a Nursery School was opened during the year at St. Christopher's Flats, Bridgewater Street, by the Committee of the St. Pancras House Improvement Society, Ltd. Accommodation is provided for 40 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. 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. 40 The work carried out during the year is summarised in the following table, the figures for the previous year also being given for comparison:— 1931. 1930. New Cases : Children under 5 years of age 86 54 Ailing Nursing Mothers 29 19 Ailing Expectant Mothers 88 89 Attendances: Children under 5 years of age 215 134 Ailing Nursing Mothers 103 47 Ailing Expectant Mothers 196 158 Dispensary as a whole (including the above). New Cases: Children under 5 years of age 441 432 Ailing Nursing and Expectant Mothers 117 108 Attendances: Children under 5 years of ago 1088 1059 Ailing Nursing and Expectant Mothers 299 205 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 90-5 visits to the homes of children under five. The Dispensary Resident Medical Officer also made numerous 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. 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. 41 156 children were admitted during the year, and the average length of stay in the Home was about 4 weeks. (b) Children requiring a longer period of convalescence, or who require more skilled nursing, are sent to various homes by the Invalid Children's Aid Association, and a contribution towards the cost is made by the Borough Council. Under this scheme 36 children were sent away during the year. Supply of Milk to Mothers and Children. The Borough Council during the year 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. Towards the end of the year it was considered that there might be an appreciable amount of overlapping between the Public Assistance Department of the London County Council through their relief work and the Borough Council's scheme for the supply of milk, and inquiries showed that in a number of cases grants from the Borough scheme were made to cases known to be in receipt of relief. In October, 1931, after careful revision of the situation, the Welfare Centres were reminded of the instructions issued by the Ministry of Health. These stated, inter alia, that "milk should be given only where the Medical Officer of Health (or in certain cases the Medical Officer of the Centre) is satisfied that a supply is essential on the grounds of health . . . and "it is the first principle of administration that overlapping with other bodies concerned in the matter should be absolutely avoided." It appears to be probable that during recent years the question of health as the sole basis for a grant of milk has not been adhered to, and that purely financial reasons have been considered. This financial problem is the province of the Public Assistance Committee and not the Child Welfare Authority. It was, therefore, decided to work the scheme in closer co-operation with the Public Assistance Officers, and to adhere strictly to the instructions issued by the Ministry of Health. The rules are definite. All applications for grants of milk for children and nursing or expectant mothers as defined above must be based upon the necessity on the grounds of health, no matter to which authority, London County Council or Borough Council, the case is referred. Where a family is in receipt of relief, the application should be made by the Medical Officer of the Welfare or Ante-Natal Centre directly to the Public Assistance Committee on the forms provided. Where the family is not in receipt of relief, the application is considered by the Special (Milk) Sub Committee of the Borough Council. Grants are made, either free or at half price, in accordance with an approved scale of income. Information is exchanged between the authorities concerned, and a considerable amount of overlapping has been abolished. At the end of 1930 there were 230 families actually in receipt of milk under the Borough scheme. During 1931, 484 new families were added to the list of recipients. By the end of that vear there were 172 families receiving grants. The total cost of this scheme in 1929 was £1,149; in 1930, £1,330; and in 1931, £1,414. 42 1931. FREE. HALF-PRICE. TOTAL COST. Month. Pints. Fresh Milk. Lbs. Dried Milk. Pints. Fresh Milk. Lbs. Dried Milk. £ s. d. *January 8204 330 1256 90 158 17 6 February 6300 270 1172 60 124 17 6 March 7280 280 1092 25 138 18 0 *April 8064 370 1428 35 141 0 2 May 5628 245 1148 45 97 19 6 June 6524 245 1064 50 110 14 0 *July 9380 285 1064 55 149 12 5 August 7224 215 888 70 116 5 11 September 7616 230 1120 70 123 18 6 *October 6104 255 884 40 104 14 6 November 3864 245 420 30 72 11 10 December 4004 160 392 15 75 5 0 80192 3130 11928 585 .£1414 14 10 * 5 week month. 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. This has reduced the above total by over £50. 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. £ 8. 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. Where any doubt exists as to the true circumstances of the family, enquiries are made by the Health "Visitors attached to the various Welfare Centres, 43 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 90 1992 22.1 Hampstead 24 492 20.5 North London 23 291 12.7 Total 137 2775 20.3 In addition to the above, the Metropolitan District Nursing Association also undertook the necessary nursing arising in connection with 109 cases, chiefly maternity or tuberculosis, and to these 1,071 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 year, and 18 temporary " Helps " for emergency cases. 137 applications were received and 116 cases were dealt with during the year, 93 being maternity and 23 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. 44 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 1931, had notified their intention to practise in St. Pancras was 46. Only 17 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. In the following table particulars are given, for 1931, 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 352 376 .. Royal Free Hospital 104 19 .. Elizabeth Garrett Anderson Hospital 52 •79 .. St. Pancras Hospital 323 .. .. Middlesex Hospital 116 .. 49 Queen Charlotte's Hospital 84 .. .. City of London Hosspital 51 .. .. Royal Northern Hospital 25 .. .. St. Bartholomew's Hospital .. 5 .. Other hospitals. . *39 .. .. Queen Mary's Maternity Home 76 .. .. Maternity Nursing Association .. .. 300 Totals 1222 479 349 * 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 41.4 per cent, and those attended at home 28.0 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. 45 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 3 0 0 Elizabeth Garrett Anderson Hospital 8 0 0 Queen Charlotte's Hospital 25 0 0 City of London Hospital 22 0 0 Middlesex Hospital 32 0 0 University College Hospital 125 10 0 Maternity Nursing Association — Total £215 10 0 The corresponding grants for the previous three years were: £2.38, £243 5s. 0d., and £234 15s. 0d. 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 the annual statistics of doubtful value. Until they are rectified we can place 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. These do not include any cases following criminal interference. In 1931 there were 7 Puerperal and 5 Non-Puerperal Maternal deaths in the Borough. In addition, there were 3 deaths following abortions, 2 criminal and I violence with an open verdict, which are not included in the returns for Maternal deaths. Of the 7 Puerperal Maternal deaths, 2 were due to Sepsis, 1 to Hyperemesis Gravidarum following an abortion, 1 to Inversion of Uterus, 1 to accidental Haemorrhage, 1 to Placenta Praavia leading to Haemorrhage, 1 to Post Partum Haemorrhage. The 5 Non-Puerperal Maternal deaths were attributed, 1 each, to Pulmonary Tuberculosis, Broncho-Pneumonia, Atrophy of Liver,Valvular Disease of the Heart and Influenza. 46 Period. Puerperal Maternal Deaths. Full-time Confinements. Abortions, etc. Total Puerperal Maternal Deaths. Post Mortems. Inquests. Puerperal Mortality Rate (Puerperal Maternal Deaths per 1000 live births). Excluding Abortions. Total. 1925 1928 Sepsis 8 10 18 Other Causes 18 — 18 Totals 26 10 36 Information not available 0.6 1.3 1.3 1.3 1.8 2.6 1929 Sepsis 3 1 4 3 2 0.9 1.3 Other Causes 6 1 7 3 — 1.9 2.2 Totals 9 2 11 6 2 2.8 3.5 1930 Other Causes 2 3 5 2 1 0.6 1.6 Totals 2 3 5 2 1 0.6 1.6 1931 Sepsis 2 — 2 1 1 0.7 0.7 Other Causes 4 1 5 4 — 1.4 1.7 Totals 6 1 7 5 1 21 2.4 Enquiries are 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 an " 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. 47 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, 1931. Defect Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1470 1271 1282 771 1323 1224 1243 746 Malnutrition Cases 16 * 16 Cases 21 * 20 Cases 8 * 8 Cases. 5 • 4 Cases 15 . • 13 Case 20 a. * 18 Cases 8 1. * 7 Case 4 8. • 4 Skin disease 10 7 13 12 3 2 8 6 16 12 7 5 8 8 4 3 Defective teeth — 421 — 215 - 215 — 1 59 — 357 — 239 — 174 — 127 Enlarged tonsils 173 94 97 46 48 33 25 10 181 90 90 52 59 34 24 10 Adenoids 29 19 9 6 1 1 1 1 15 10 11 7 5 5 3 2 Enlarged tonsils and adenoids 151 125 19 25 19 9 1 1 119 78 58 34 18 11 7 5 Other nose and throat defects 31 28 20 14 15 14 6 4 26 19 12 8 13 13 5 3 Enlarged glands 26 9 10 4 10 5 1 — 12 — 9 1 5 2 3 — Eye disease 49 30 22 12 20 13 4 2 48 33 29 22 14 8 8 6 Vision defect — — — 108 — 135 — 68 — — — 127 — 133 — 80 Otorrhœa 23 13 12 8 8 4 2 2 23 12 11 5 11 8 3 2 Other ear disease 1 — 3 2 3 2 — — 4 2 2 — 2 1 — - Defective hearing 2 1 9 4 6 4 2 1 3 1 6 2 2 1 2 — Speech defects 5 1 1 - - - - - 5 1 1 — 1 — 1 — Heart defects 30 4 19 2 22 1 10 1 18 2 28 5 35 8 25 5 Anaemia 11 6 21 13 6 — 5 3 4 3 13 5 9 8 6 4 Lung defects 52 27 23 10 7 1 5 2 60 26 22 10 11 5 1 1 Nervous defects. 17 5 13 4 6 2 1 — 7 — 11 4 8 3 2 1 Phthisis 1 — 10 — 3 — 1 — 3 — 3 — 3 - 3 - Other T.B. disease 2 1 — — — — — — — — — — — — 1 1 Rickets 11 5 2 — 1 — 2 — 9 4 3 1 1 — — — Spinal deformities 1 1 11 6 7 3 3 1 2 2 10 5 14 9 10 8 Other deformities 10 — 9 3 5 2 4 1 12 2 6 1 5 3 6 2 Other defects 67 37 56 30 30 18 11 5 67 42 50 36 64 38 23 13 Number of children noted for treatment 694 464 416 243 669 490 401 211 Note.—Defects, however slight, are included under "Cases." Those severe enough to require treatment are shown under. * 48 Routine Medical Inspection of Elementary School Children in St. Pancras in 1931. 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. Lens 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. 1470 1013 422 35 157 1278 35 1411 54 5 1425 42 3 888 378 204 — — Girls 1323 952 352 19 155 1142 26 —- 1234 80 9 1295 27 1 799 359 165 — — — Age 8— Boys 1271 900 349 22 137 1095 38 1 1222 46 3 1244 27 — 916 284 71 797 309 147 Girls 1224 841 370 13 179 1021 24 — 1099 114 11 1200 24 — 862 289 73 748 232 173 Age 12— Boys 1282 915 351 16 160 1092 30 — 1241 40 1 1262 18 2 S80 379 23 859 221 191 Girls 1243 914 323 6 116 1106 21 — 1149 91 3 1220 23 — 879 335 29 800 231 209 Age 14— Boys 771 562 202 7 145 611 15 — 753 18 — 764 7 — 556 204 11 529 120 120 Girls 746 550 189 7 126 611 9 — 700 43 3 734 11 1 578 148 20 481 131 131 Totals 9330 6647 2558 125 1175 7956 198 1 8809 486 35 9144 179 7 6358 2376 596 4214 1304 971 % St. Pancras 71.3 27.4 1.3 12.6 85.3 2.1 94.4 5.2 0.4 98.0 1.9 0.1 68.1 25.5 6 4 64.9 20.1 15.0 % London 60.8 38.5 0.7 20.6 74.9 4.5 95.5 4.0 0.5 97.3 2.6 0.1 66.2 27.4 6-4 58.5 23.5 18.0' 49 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 : — (a) 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. Local Legislation. A.—Local Acts, Bye Laws, and Regulations in force in the Borough:— 1. St. Pancras (Measles and German Measles) Regulations, 1920. 2. Bve-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. 50 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 filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of faecal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc. (j) Offensive trades. (k) Rag and bone dealers. (l) Humane slaughtering of animals and poultry. (m) Demolition of buildings. (n) Ice cream vendors and premises. 6. London County Council (General Powers) Acts, 1893-1928. B—Public Health Legislation either enacted or coming into force during 1931:— The Public Health (Tuberculosis) Regulations (1930). Came into force on January 1, 1931. Public Health (Smoke Abatement) Act, 1926. By-laws made by the London County Council under Section 2 of the above Act came into force May 19, 1931. London County Council (Tenement House) Bye-laws. As regards decontrolled premises came into force June 8, 1931. Merchandise Marks Act, 1926. An Order in Council made by the Ministry of Agriculture and Fisheries regarding Imported Frozen and Chilled Salmon and Sea Trout came into force on 29th December, 1931. 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 the St. Pancras edition of the Monthly Journal known as " Better Health " to be continued. 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. A copy is also sent to each member of the Council and to all medical practitioners in the Borough who place it on the table of their waiting rooms. 51 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, 19 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 dwellings, 109 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 120 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.I. A block of 12 slipper baths, available to the public, adjoins the Council's flats at Prospect Terrace, W.C.I. 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. Inspections. Drainage work done under notice Voluntary drainage work Drains of new buildings 1931. 2842 6552 2733 1930. 3380 6814 1528 Total 12127 11722 Drainage Register.—The following is an analysis of the Drainage Register during 1931:— Plans deposited—Old Buildings under Notice 97 ,, ,, Old Buildings, Voluntary 208 ,, „ New Buildings and Additions 72 377 Applications without Plans 304 Total number of Applications and Plans 681 52 Rats and Mice (Destruction) Act, 1919. During the year 120 complaints were received 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 is caused by the blocking of rain water and other pipes by their nests. The birds also pick out mortar from between the bricks and so tend to cause dampness to penetrate through the walls. Although 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, in practice the section is of little value. The prevalence of the birds is encouraged by the practice of feeding them adopted by so many kind-hearted but misguided persons, and for the same reason the use of traps has proved a failure, the birds, being so well fed, will not enter the traps to obtain the food which is placed inside. In a number ot' cases the traps have either been removed or interfered with by these misguided persons, who, doubtless owing to ignorance, object to the destruction of these birds. As poisoning might prove to be dangerous, the only available method would appear to be shooting. 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, and daity collections before 10 a.m. in prescribed main streets. Additional collections are also given to flats, eating houses, etc. 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. The following figures for the past year, kindly supplied by Mr. E. W. Swinstead, m.i m. & cy.e., the Rorough 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 :— Refuse Collection and Disposal. 1931. 1930. Quantity of refuse collected Quantity of refuse burnt at Destructor Quantity put on rail Quantity of clinker residual Tons. 58086 36339 21832 12366 Tons. 59099 36118 22864 12911 53 MORTUARY AND CORONER'S COURT. These buildings are situated in Cambridge Street, at the rear of St. Pancras Gardens Extensive improvements have been made in connection with the Mortuary during recent years, and it is now a satisfactory and well equipped building. During the year 1931, a number of improvements were carried out to the Coroner's Court. The work included the provision of a separate entrance to the Coroner's Office, the installation of electric heating and provision of additional sanitary accommodation. A room for the Coroner's Officers and a separate room for female witnesses were also provided. Improvements were also made in connection with the lighting, heating and seating arrangements of the Court. In view of the expenditure incurred, the existing lease was cancelled and a new lease of the Court was granted to the London County Council at an increased rental. It is now provided that the use of the Court is not to be restricted solely to the investigation of deaths occurring within the Borough of St. Pancras. This proviso was doubtless desired on account of the recent re-arrangement of Coroners' districts by the London County Council. Permission to make an increased use of the Mortuary and Post-mortem room in connection with cases occurring outside the Borough was not included. There has, however, been a growing tendency to make use of this accommodation for ex-St. Pancras cases, and, if not curtailed, this matter will require consideration. The following table, which gives particulars concerning the number of inquests held, number of bodies received and post-mortem examinations made during each of the past five vears, shows the increase which has occurred owing to the re-arrangement of Coroners' districts above mentioned : — 1927. 1928. 1929. 1930. 1931. Number of inquests held St. Pancras Cases 156 165 158 155 101 Ex-St. Pancras Cases 91 98 97 118 260 Number of bodies received St. Pancras Cases 182 215 250 218 222 Ex-St. Pancras Cases 38 28 26 63 374 Number of post-mortem examinations made St. Pancras Cases 135 178 190 173 175 Ex-St. Pancras Cases 23 19 16 34 229 Totals 625 703 737 761 1361 SANITARY INSPECTION OF THE AREA. Inspections.—75,525 visits and inspections were made in 1931 by the Council's staff of Inspectors and Health Visitors. Of these inspections, 52,127 were made by the District Sanitary Inspectors, 9,431 by the Inspectors of Food and Food places, 6,903 by the Inspectors of Factories and Workshops, and 7,064 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 54 and Child Welfare Centres (see pages 31 and 108), and by the staff of the Tuberculosis Dispensaries (see page 92) ; nor do they include the work of the disinfecting staff, particulars of whose work are given on pages 93 and 94. Notices served.—4,199 intimation notices were served by the Inspectors during the year. Of these 3,797 were served by the District Sanitary Inspectors, 399 by the Factory and Workshop Inspectors, and 3 by the Food Inspectors. 1,536 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 105—108. 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. 67, Chalton Street Yard paving defective 1931 Jan. 7th Fined £2. Costs £4 4s. 58, Haverstock Hill Roofs and rain-water pipe defective, 1st floor back room damp „ 29th Adjourned sine die. Costs £3 3h. 67, Stibbington Street Failing to comply with Nuisance Order Feb. 19 th Fined £5. Costs £8 3s. 25, Retcar Street Overcrowding Mar. 17th Order 21 days. 67, Stibbington Street Roof, &c., defective April 2nd Order 14 days. Costs £2 2s. 13, Chamberlain Street Roof defective 23rd Order 14 days. Costs £2 2s. 80, Gloucester Road ,, May 21st Order 14 days. Costs £2 2s. 51, Carlton Road Failing to maintain in a proper state of repair the water closet and accessories thereof „ 21st Withdrawn, work done. Costs £2 2s. 67, Stibbington Street Roof, &c., defective Nov. 19th Order 28 days. Costs £1 5s. 7, Houghton Placc Water closet dirty, basement back room damp ,, 19th Adjourned sine die. Costs £1 5s. 4, Fitzroy Street Workshop dirty Dec. 1st Withdrawn, work done. Costs £1 l1s. 6d. 23, ,, ,, „ 1st Withdrawn, work in hand. Costs £1 11s 6d. 50, Werrington Street Defective flooring „ 23rd Withdrawn, work done. Five summonses were taken under the London County Council By-laws dealing with the removal of offensive matter by road. Fines were inflicted amounting to .£5 0s. 6d., with costs £3 3s. London County Council Bye-Laws—Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 67, Stibbington Street 13, Chamberlain Street Failing to remedy defective plaster to staircase walls Failing to carry out cleansing work and to provide and maintain efficient means for carrying off waste water from tap 1931. April 2nd ,, 23rd Dismissed. Work done. Fined £1. 50, Werrington Street Failing to carry out cleansing work Dec. 23rd Dismissed. Work done. Costs £2 2s. 55 London County Council Bye-Laws made under the Metropolis Management Acts. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 269, Pentonville Road Partially reconstructing drainage work without giving notice and contrary to Bye-Law 13 1931. May 7th Fined £'1. 19, Lewisham Road Fixing a new sink without giving notice and contrary to Bye-Law 13 July 2nd Fined £1. Costs £1 2s. 304, Gray's Inn Road Fixing a new water-closet pan and trap without giving notice „ 2nd Summons withdrawn. Costs £3 3s. 10, North Court, Chitty Street Renewing waste pipe without giving notice and contrary to Bye-Law 13 ,, 3rd Fined £2. Costs £1. 45, Brecknock Road Fixing four lavatory basins with waste pipes without giving notice „ 14th Fined £1. Costs £2 2s. 232b, Gt. College Street 12, Jeffreys Street Fixing two new basins without giving notice... Fixing two new sinks without giving notice and contrary to Bye-Law 13 Dec. 9th „ 9th. Fined £1. Costs £1 Is. Fined £1. Costs £1 Is. SMOKE ABATEMENT. 540 observations of chimney shafts were made during the year and seven 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 bye-laws regulating the emission of smoke. The Authority for this purpose, for the Metropolis, is the London County Council, and a bye-law was made under powers contained in Section 2 of the Act on February 17th, 1931, and was allowed by the Minister of Health and came into force on May 19th, 1931. The bye-law states that the emission of black smoke for a period of three minutes, and, after five years from the date of confirmation of this bye-law, for a period of two minutes, in the aggregate within any continuous period of thirty minutes from any one chimney of a building, other than a private dwelling house, shall, until the contrary be proved, be presumed to be a nuisance liable to be dealt with summarily under the Public Health (London) Act, 1891. 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 Mai,f, and Femai.e Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories 2343 228 — Workshops 1890 131 2 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 962 40 — Totals 5195 399 2 56 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts* : — Nil. Want of cleanliness 186 186 2 Want of ventilation 7 7 — Overcrowding — — — Want of drainage of floors — — — Other nuisances 154 154 — Sanitary accommodation— Insufficient. 10 10 — Unsuitable or defective 100 99 — Not separate for sexes 10 10 — Other breaches 50 49 Offences under the Factory and Worlshop — Act:— Illegal occupation of underground bakehouses (s. 101) — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 65 65 — Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) — — — Totals 582 580 2 * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acta. 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 40 in respect of the making, etc., of wearing apparel, comprising the names of 97 outworkers (contractors) and 90 outworkers (workmen), 1 in respect, of upholstering, comprising the name of 1 outworker (workman), 1 in respect of the making or filling of Christmas crackers, etc., comprising the names of 4 outworkers (workmen). 2 in respect of embroidery, comprising the names of 43 outworkers (workmen), 2 in respect of making, etc., of coat hangers, comprising the names of 21 outworkers (workmen), and 1 in respect of general furnishers, comprising the names of 19 outworkers (contractors) and 5 outworkers (workmen). 57 The following table gives 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 26 273 200 499 Bootmaking 2 — 106 108 Embroidery — 3 32 35 Miscellaneous 1 8 27 36 Totals 29 284 365 678 4.—List of Factories, Workshops (Registered, Sec. 131) and Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 64 89 — 153 Cabinet makers 54 67 — 121 Coach builders 22 17 — 39 Dressmakers 65 116 23 204 Engineers 208 34 — 242 Foundries 15 — — 15 Furniture makers 11 20 — 31 Furriers 6 13 1 20 Laundries 10 6 — 16 Metal workers 33 35 — 68 Milliners — 15 2 17 Organ builders 7 3 — 10 Pianoforte manufacturers 41 19 1 61 Printing 71 11 — 82 Restaurant kitchens — — 289 289 Tailors 13 227 142 382 Upholsterers 4 37 2 43 Wood carvers 3 18 — 21 Other occupations 505 511 371 1387 Totals 1132 1238 831 3201 58 5.—Other Matteks. Class. Number. (1) (2) Natters 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 101 Reports (of action taken) sent to H.M. Inspector 101 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 13 Underground bakehouses (s. 101) :— Certificates granted during the vear In use at the end of the year 84 Bakehouses and restaurant kitchens are also referred to on page "ft. 6.—Total Inspections. Premises. Male Inspector. Women Inspector. Total. Factories 1937 406 2343 Workshops 1436 454 1890 Workplaces (including Outworkers' premises) 518 2015 2533 Total 3891 2875 6766 PREMISES AND OCCUPATIONS CONTROLLED BY ACTS, BYE-LAWS OR REGULATIONS. Offensive Trades. There are two licensed premises for such trades in the Borough—a tallow melter's in Tudor Place, which has been in existence since the year 1780, and a soap boiler's in Rochester Place. 25 visits were made to these premises during the year. Rag and Bone Dealers. Additional bye-laws were made in 1928 by the London County Council, under powers given by Section 9 of the London Couuty 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 rag.-!, 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 the 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, 1925, came into force on March 5th, 1926. On the 8th June, 1931, the Minister of Health allowed the application to decontrolled houses of certain of the bye-laws which had been held in abeyance. Particulars concerning the inspections made will be found in Table 6 on page 105. 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 2 canal boats, which were registered for the occupation of 4 adults and 6 children, and were actually occupied by 3 adults and 1 child. A weekly inspection of the canal and wharves has also been made. RENT AND MORTGAGE INTEREST RESTRICTIONS ACT, 1923. During the year 40 applications were received from tenants for certificates under this Act, and in 38 cases 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 each case 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, door furniture, 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 iu 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)) 99 flats (b) With State assistance under the Housing Acts : — (i) By the Local Authority __ (ii) By other bodies or persons 99 1. Inspection of duelling-houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2810 (A) Number of inspections made for the purpose 11627 (2) (a) Numberof dwelling-houses which were inspectedand recorded under the Housing Consolidated Regulations, 1925 1171 (b) Number of inspections made for the purpose 6421 (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 1457 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 .. . . . . .. 2645 3. Action under Statutory Powers. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 39 (2) Numberof dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 36 (b) By Local Authority in default of owners — 61 B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 1069 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice : — (a) By owners 1045 (b) By Local Authority in default of owners Nil. C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (previously made) 2 D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made . 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. E.—Proceedings under Section 3 of the Housing Act, 1925 (now repealed) :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. F.—Proceedings under Sections 11, 11 and 15 of the Housing Act, 1925 : — (1) Number of dwelling-houses in respect of which Closing Orders were made Nil. (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. Particulars concerning Inspection of Tenement Houses are given in Table 6 on page 105. The 99 flats mentioned at the beginning of this Section as having been erected during the year comprised, the following : — 69 flats erected by the London County Council on their Ossulston Estate; and 30 flats built by the St. Pancras House Improvement Society, Ltd. (St. Christopher's Flats in Bridgewater Street). 62 HOUSING CONDITIONS. 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. Overcrowding. As a result of the attention of the Public Health Committee having been called to the difficulty of accommodation being found for persons displaced through the operation of Closing Orders, the Estates Committee were asked if they would assist in the matter. Their reply stated that there is a very large number of persons who are waiting for accommodation at the present time, and that, generally speaking, families displaced by a Closing Order are unable to afford the rentals charged for the Council's flats, but that they are prepared to consider sympathetically cases of exceptional hardship who are likely to prove suitable tenants. In connection with this subject, the Public Health Committee requested me to report with respect to overcrowding amongst the poorer members of the community, who cannot afford the present rents of municipally provided houses, and the following report was presented:— To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, In accordance with the resolution of the Committee, I beg to submit the following report concerning housing conditions, with reference to the poorer section of the community. It is amongst this class that overcrowding is most prevalent and also most difficult to remedy, for it appears to be an unfortunate fact that as we descend in the social scale the birth rate increases, with the result that large families and low wages tend to be associated. There are large numbers of unskilled labourers and other workers in the Borough, usually with numerous children, who are earning wages of about fifty shillings per week. In order to avoid overcrowding and to secure separation of the sexes in sleeping apartments, these families require flats with at least three bedrooms. The rent of such flats in a central area is about 18s. 6d. per week, an amount it is quite impossible to pay out of such an income. The accommodation provided by the London County Council on the outskirts of London is also not available for these families, as the Authority in question will only accept tenants who are in a position to pay, not only the rent for the accommodation considered to be necessary, but also the expense which must be incurred in travelling to and from work. It is frequently stated that when the better paid workers move to more adequate accommodation outside London, the rooms they vacate become available for these poorer families. This is not always the case, because the rooms vacated become decontrolled as the Rent and Mortgage Interest Restriction Acts cease to apply, and the rents are usually increased to a price beyond the means of the persons concerned. It is in consequence of these circumstances that overcrowding is prevalent, because inadequate accommodation is less of a hardship than either cold or hunger, and therefore, when money is very limited, food, warmth and clothing will always come before rent. The following examples illustrate the type of family concerned, and the records of the department contain numerous similar cases:— B. Man, wife and six children, ages 11, 9, 6, 4, 3 and 1, in one room. Rent 6s. 9d. per week. Labourer, maximum wages £3 2s. per week. T. Man, wife and eight children, ages 14, 12, 10, 9, 7, 4, 3, and 1, in two rooms. Rent 7s. 6d. per week. Railway employee, wages £2 8s. per week. L. Man, wife and six children, ages 10, 8,6, 5, 3 and 2, in one room (furnished). Rent 15s. per week. Wages £3 per week. 63 It has been publicly stated by a well-known housing authority that " those who have benefitted by the national expenditure and by the large subsidies which have been granted have been the fairly well off, not the poorest classes, who need most help, especially not those members of the poorest class who have large families. Even municipal authorities, when they come to let houses, tend, like any other landlord, to let to the most eligible tenant, that is the applicant with the most money and the fewest children." If this statement can be accepted it would follow that if overcrowding is to be abated the first consideration in the allocation of accommodation should be housing need rather than ability to pay rent, and if this policy were adopted, the present loss in municipal enterprise would be largely increased. In this connection the building of two-bedroom flats out of public funds has been criticised. It is pointed out that such flats are only suitable for persons with very small families, and these can more easily house themselves. The alternative would be to let them to families for whom three bedrooms are necessary, but, on both sanitary and moral grounds, such a policy would be indefensible. It must be appreciated that the private landlord is averse to letting rooms to persons with large families, as children are apt to be destructive, and therefore the upkeep of the premises is heavy. It would, therefore, appear that, as regards housing such families, the solution lies with the local authorities. To provide adequate accommodation for these poorer families at rents they can afford to pay is a most difficult problem. At the present time there is no vacant land available in the Borough on which to build dwellings to house persons who would be displaced if any large clearance scheme could be formulated, and although the new Housing Act, 1930, provides for a larger subsidy, which would enable a corresponding reduction to be made in the rents, the site difficulty still presents itself. Apart from the provision of flats, consideration might be given to the policy of reconditioning existing houses. These could probably be let at lower rents than newly erected houses. Here again a difficulty presents itself in St. Pancras, owing to the scarcity of suitable houses at the present time. In conclusion, it might be advisable to define the position with reference to the interpretation of the word overcrowding " :— (a) Tenement houses. In rooms used exclusively as sleeping apartments, the Tenement House Bye-laws require 300 cubic feet of free air space for every person of 10 years of age or over and 150 cubic feet for each child under 10 years occupying such room. In rooms not used exclusively as sleeping apartments, the requirements are 400 and 200 cubic feet respectively. When the Rent and Mortgage Interest Restriction Acts cease to be in force, the requirements will be 400 cubic feet per person, with no reduction for children. (b) In houses which are not Tenement houses no standard is provided, any necessary action with reference to overcrowding must be taken under the Public Health (London) Act, 1891, and it would be necessary to prove injury or danger to health, but in such instances the Magistrate would probably apply the standards laid down with reference to Tenement houses. (c) A standard of two persons per room is frequently assumed to be a useful criterion. This has been adopted by the Registrar-General for statistical purposes, but is of little value in practice, as it takes no account of the size of the room nor the sex of the occupants ; it also has no validity in law. In many cases, with a family of young children, more than two persons can quite justifiably occupy one room. On the other hand, a man and wife, with a grown-up son and daughter, would require three bedrooms, which is a standard of less than two persons per room. (d) In connection with the accommodation to be provided under the Housing Act, 1930, Section 37 regards a house containing two bedrooms as providing accommodation for four persons, a house containing three bedrooms as providing accommodation for five persons, and a house containing four bedrooms as providing accommodalion for seven persons. This standard is distinctly unreasonable and most also prove to be very expensive in practice. No reference is made to the size of the room or to the age or sex of the occupants, and if strictly enforced would even exclude an infant from the room occupied by the parents. I am, etc., G. Sowden, Medioal Officer of Health. 64 HOUSING SCHEMES. WORK OF THE ESTATES COMMITTEE OF THE BOROUGH COUNCIL. The following account of the principal matters dealt with during the year has been furnished by Mr. 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 and Caretaker's Lodge). (c) Prospect Terrace Dwellings, Gray's Inn Road (71 flats). (d) Una House, Prince of Wales Road (64 flats). (e) The Brookfield Estate, Highgate (113 flats, 90 maisonettes and 2 houses). (f) Aldenham House, Aldenham Street, Somers Town (26 flats). (g) Wolcot House, Aldenham Street, Somers Town (18 flats). (h) 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) Barnes House, Camden Road (22 flats). (l) 110 and 112, Leighton Road, Kentish Town. (m) 40, Argvle 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). (n) 13 and 15, Bayham Place, Camden Town. (o) 15, Willes Road, Kentish Town. (p) 24, Grafton Road, Kentish Town. (q) 20 and 22, High Street and 3 and 5, Little King Street, Camden Town, (r) 5, Camden Road (the lower part is used as Electricity Showrooms, and the upper part let in rooms). (s) 41 and 47, Stanhope Street, Regent's Park. (t) 143, 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street, Camden Town. (u) 9, 10, 11, 12, 13, 14 and 15, Georgiana Street, Camden Town. (v) 3, James Street, Camden Town. (w) 207, Arlington Road. (x) 43, 45, 47, 49, 51, 53 and 55, Leighton Road, and 2 and 2a, Lady Margaret Road, Kentish Town. 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 are extremely bad, and in all cases persons with families receive first consideration. Daring the past year there have been 67 changes of tenancies in the Council's properties. 65 Camden Road Housing Scheme. This scheme, which was developed on the site previously occupied by the offices of the Gas Light & Coke Company at 7 & 9, Camden Road, was practically completed during the year under review. It provides 22 working-class dwellings, consisting of one six-room flat, seven four-room flats, and fourteen three-room flats, and includes a Tuberculosis Dispensary and Maternity and Child Welfare Centre, together with five shops on the ground floor frontage in Camden Road. The tenancies were allocated to families who were found to be living under very unsatisfactory conditions. Somers Town Housing Scheme—Wolcot Street Area. The Council decided to utilise a portion of the main courtyard at the Somers Town Estate, which had an area of about 23,520 sq. ft., for the erection of a sixth block of dwellings, which will comprise eighteen flats. The consent of the sanctioning authorities was obtained, and in November, 1931, the Council accepted the tender of Messrs. John Greenwood, Ltd., to carry out the work for the sum of £7,785. It is anticipated that the flats will be ready for occupation in August, 1932. Kentish Town Housing Scheme. The Council have acquired a site in Leighton Road and Lady Margaret Road, comprising an area of approximately 25,000 sq. ft., for housing purposes. A scheme has been prepared by the Council's Architect (Mr. A. J. Thomas, f.r.i.b.a.), and is now under the consideration of the sanctioning authorities. Una House, Prince of Wales Road. Further consideraton has been given to the proposal to provide an additional floor, to consist of sixteen additional flats at Una House, and the Architects for the original scheme were consulted. They expressed the opinion that the proposal was practicable, but, having regard to building difficulties, the Architects estimated the cost at £10,000. This estimate was largely in excess of the expenditure originally contemplated, and the Council therefore decided not to proceed with the scheme at the present time. Goldington Buildings. It has been found possible to provide bathroom accommodation at a number of flats at Goldington Buildings, and it was found that the majority of the tenants were prepared to pay a small increase in their rentals for this facility. In most cases a separate bathroom was provided bv enclosing and converting an existing balcony, and in a small number of cases the scullery was found to be large enough for a bath to be installed. London County Council Housing Estates. The Borough Council continue to avail themselves of the preferential treatment which is given to bad cases of overcrowding and special hardship when recommended to the London County Council. Since the initiation of this scheme in January, 1925, the number of St. Pancras families who have been housed under this arrangement up to December, 1931, is 782. It will, of course, be appreciated that in addition a number of St. Pancras families make direct application to the County Council, and in many cases accommodation is obtained by this method. The demand for housing accommodation in the central districts by working-class families still continues. It has been found that many persons are unable to accept accommodation in the outlying estates, as it is essential for the wage-earners to live within easy access of their employment, and, at the present time, the extra travelling expenses involved by living further away are a serious consideration, which prevents other applicants from moving to the cottage estates on the outskirts. 66 Additional Housing Schemes in the Borough. During the past year the St. Pancras House Improvement Society, Ltd., have further developed their schemes in the Somers Town area. An additional block of dwellings has been opened and another is in course of development. The London County Council are also making progress with their schemes in the Ossulston Street area. In the west of the Borough the Crown Estate are developing an area in the neighbourhood of Cumberland Market. Two blocks of dwellings are nearly ready for occupation and others are well advanced. When the scheme is fully developed it is anticipated that 800 working-class flats will be provided. Section V.—INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. Cowsheds.—There are now no licensed cowsheds in the Borough. Dairies and Milkshops.—Twenty-six applications for registration under the Milk and Dairies Order, 1926, were received and granted during the year. Eighteen applications in respect of itinerant vendors were also received and granted. The following list gives particulars as to the purveyors of milk on the register at the end of 1931 :— Number of purveyors of milk from retail milkshops on the register at the end of 1930 211 Deduct number removed from the register during the year 1931 -34 Add number of purveyors registered by resolution of the Council during 1931 + 26 Total number of purveyors of milk from retail milkshops on register at the end of 1931 203 In addition to the above, the following were also on the register at the end of 1931 : — 5 persons (firms) in respect of premises where a wholesale trade in milk is done. 2 „ (firms) „ „ „ cream „ 4 „ „ retail „ „ „ and 24 itinerant vendors without retail milkshops. Milk, in Sealed Containers. Daring the year 45 persons were registered to sell milk in sealed containers, and 17 were removed from the register. At the end of the year there were 135 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 duty, and Section 8 (4) of the Act states: " The Authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, the amount whereof shall, in default of agreement, be settled by the Local Government Board [Ministry of Health]." 67 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," " Grade A (pasteurised)," 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 31st in each vear. The following licences were granted in respect of the year 1931 :— Date of Licence. Name and Address of Licensee. Grades of milk in respect of which Licence is granted. St. Pancras Address at which graded milk will Be sold. Dec. 18th, 1930 United Dairies (London), Ltd., 31, St. Petersburgh Place, W. 2 " Pasteurised " 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. United Dairies (London), Ltd., 39, High Road, N. 2 "Pasteurised " Do. Do. Do. " Grade A Pasteurised " Do. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. " Certified " Do. Do. Do. " Pasteurised " 25, Swain's Lane. Do. Do. Do. 51, South GroTe. Do. Marshall's Dairies, Ltd., 19, Tudor Place, W. 1 " Grade A Tuberculin tested " 19, Tudor Place. [Continued on next page. 68 Date of Licence. Name and Address of Licensee. Grades of milk in respect of which Licence is granted. St. Pancras Address at which graded milk will be sold. Dec. 18th, 1930 Express Dairy Co., Ltd., 26, Tavistock Place, VV.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. " Pasteurised " 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 \ 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. London Co-operative Society, Ltd., Oakthorpe Dairy, Palmers Green, N. 13 Do. Hampstead Road Depot. Do. Do. " Grade A Tuberculin tested" Do. Jan.29th, 1931 Farmers <4 Cleveland Dairies Co., Ltd., 13, East Street, N. 1 Do. 18, Holmes Road. 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, Kentish Town lload, N.W.I " Grade A " 97, Kentish Town Road. Do. Do. "Pasteurised " Do. Do. Lincolnshire Dairies, Ltd., 31, Oak Village, N.W. 5 " Pasteurised " (Plant) 31, Oak Village. Do. D. M. T. Richards, 161, Whitfield Street, W. 1 " Grade A Tuberculin tested " 161, Whitfield Street. Do. 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. Do. '• Pasteurised " Do. Do. J. R. Mills, 23, Francis Street, W.C. 1 " Grade A Tuberculin tested " 23, Francis Street. Do. T. James, 16, Kenton Street, W.C. 1 Do. 16, Kenton Street. Feb. 26th, 1931 D. Davies, 10-11 Dukes Road, W.C. 1 "Grade A Tuberculin tested " 10-11, Dukes Road. Do. Do. Do. (Bottling) Do. Do. Express Dairy Co., Ltd., 2G, Tavistock Place W.C.I "Grade A Tuberculin tested " 18, Holmes Road. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. April 28th, 1931 W. J. Evans, 16, Kenton Street, W.C.I "Grade A Tuberculin tested " 16, Kenton Street. May 21st, 1931 A. Meredith, 118, Chalton Street, N.W.I " Pasteurised " (Plant) 118, Chalton Street. Do. Do. " Grade A Tuberculin tested " Do. Do. Do. " Certified " Do. Do. Do. Do. Ill, Park Street. Do. Do. "Grade A Tuberculin tested " Do. Do. Do. " Pasteurised " Do. [Continued on next page. 69 Date of Licence. Name and Address of Licencee. Grades of milk in respect of which Licence is granted. St. Pancras Address at which graded milk will be sold. May 21st, 1931 Griffiths Bros., 51, St. George's Road, N.W. 1 " Pasteurised " (Plant) 51, St. George's Road. June 29th, 1931 B. Kees, Ltd., 2 ct3, Carthusian Street, E.C. 1 " Pasteurised " To sell in St. Pancras. July 29th, 1931 Express Dairy Co., Ltd., 26, Tavistock Place, W.C. 1 " Grade A Tuberculin tested " 68, Mansfield Road. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. Do. Do. " Grade A Tuberculin tested " 151, Highgate Road. Do. Do. " Certified " Do. Do. Do. " Pasteurised " Do. Sept. 21th, 1931 London Wholesale Dairies, Ltd., Vauxhall, S.E. 11 " Grade A Tuberculin tested " To sell in St. Pancras. Oct. 22nd, 1931 T. J. Evans, 95, St. Paul's Road, N.W.I Do. 95, St. Paul's Road. Nov. 26th, 1931 E. E. Hodges it Co., Easton Dairies, nr. Wells, Somerset "Pasteurised " To sell in St. Pancras. Samples of milk sold under special designations are taken at intervals, and are submitted to bacteriological examination, in order to ascertain if tliey 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 food. The numberof 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 Re-constituted Cream would appear to be more appropriate than the word Artificial. (6) 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. 70 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. Cauliflowers, 12 crates Cod, Fillet, 1 stone Fruit Salad (dry), 14 lbs. Grapes, 20 " boats " Heads, Pigs', 2 Lemons, 5 boxes Li vers, Bullocks', 10 ,, Pig's, 1 „ Sheep's, 1 Lungs, Bullocks', 2 Lungs, Pigs', 7 Peas, 86 bags Pears, 1,206 boxes Pluck, Pig's, 1 Prawns, 442 tins (each 2⅕lbs.) Savoy Greens, 2 wagons Skate, 18 lbs. Spleen, Pig's, 1 Strawberries, 43 crates Veal, 2 (6-lb.) tins Seized. 14 Chickens. Slaughter-houses. At the end of 1931 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 173 inspections during the year. Fried Fish and Fish Curing Premises. In 1931 there were 71 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 22 fish curers' premises, including the 4 above mentioned. 434 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 233. Bakehouses and Restaurant Kitchens. At the end of 1931 there were 153 bakehouses on the register, including 64 factory bakehouses. 38 of these bakehouses were not in use. Ill of the 153 were underground bakehouses, of which 54 were factory bakehouses, and 27 not in use. At the end of the year 289 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, 71 (c)—FOOD AND DRUGS (ADULTERATION) ACT, 1928. 800 samples have been taken under this Act, of which 466 were formal and 334 informal. Of the formal, 452 proved to be genuine, and 14, or 3.0 per cent., adulterated; and of the informal, 309 were genuine and 25, or 7.5 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Arrowrcot — 1 — 1 — — Bacon 10 10 — Beans (baked) 1 1 (canned) — 1 1 Beef (minced) — 6 6 Brawn 2 2 Bread and Butter 1 1 Brimstone and Treacle 1 _ 1 — Bristling (canned) — 1 1 Butter 107 4 107 3 1 Cascara Extract 1 1 ,, Tablets 1 1 _ Cheese 7 7 Cod Liver Oil 1 1 Coffee 5 3 5 3 Crab (canned) 2 2 — Cream 19 19 „ (bottle 1) — 1 — 1 — — ,, (canned) — 8 — 8 — — ,, Horn 1 1 Dripping 3 3 Fish Paste 6 6 ,, (canned) — 1 — 1 Flour (self raising) 10 4 10 4 — Fruit (bottled) — 1 — 1 „ (canned) — 2 — 2 „ (preserved) — 2 — 2 Ginger (ground) 1 13 — 11 1 2 Gregory's Powder — 1 — 1 — — Herrings in Tomatoes (canned) — 1 — 1 — — Honey — 2 — 2 — — Jam 4 30 3 21 1 9 Jelly Cream 1 — 1 Lard 8 2 8 2 — Lemonade Powder 2 — 2 — Lemon Cheese 1 — 1 „ Curd 1 — 1 — ,, Juice — 1 — 1 — — Licquorice Powder comp. — 1 — 1 — Margarine 2 3 2 3 — — Marmalade _ 2 — 1 — 1 Meat Paste 1 — 1 — — „ Pie — 3 — 3 — Milk 320 9 310 8 10 1 „ (condensed) — 22 — 22 — — „ (dried) — 1 — 1 — — Minced Meat 1 — 1 — Mustard — 2 — 2 — — Orange Curd — 1 — 1 — — Peas (bottled) — 1 — 1 — — „ (oanned) 1 13 1 12 — 1 „ (dried) — 2 — 2 — — Peel (mixed) — 1 — 1 — — Carried forward 458 209 446 194 12 15 72 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Inform a' Brought forward 458 209 446 194 12 15 Pepper — 16 — 16 — — Peroxide of Hydrogen — 1 — 1 — Pickles 0 2 — Prawns (canned) — 1 — 1 — — Raisins 1 _ 1 — — Rice 5 — 5 — (ground) — 1 — 1 — — Roll and Butter 1 8 1 7 — 1 Salad Oil — 1 1 — Salmon (canned) — 1 — 1 — — Sardellen Butter — I — 1 — — Sardines (canned) — 3 — 3 — — Sauce — 11 — 11 — — Sausage (cooked) ,. — 6 — 6 — — Sausage Roll — 4 — 4 — — Sausages 4 30 3 26 1 4 Soup (canned) — 1 — 1 — — ,, (Tomato Puree) 3 9 2 4 1 5 Suet (shredded) — 1 — 1 — — Sugar — 3 — 3 — — Sweets — 11 — 11 Tea — 2 — 2 — Tincture of Iodine — 2 — 2 — Tomatoes (canned) — 2 — 2 — — Tripe — 2 — 2 — — Totals 466 334 452 309 14 25 Prosecutions were undertaken as regards five samples, which were reported as being adulterated. The results of the proceedings are stated in the following tables:— Summonses. (a) Food and Drugs (Adulteration) Act, 1928. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. 1931. £ 8. d. £ s. d. A. 33 Milk Deficient in milk fat, 8 0 per cent. April 9th 1 0 0 2 2 0 A. 34 ,, 60 „ ,, ,, "Not dealt with " A. 44 ,, 15-3 „ ,, 16th . — 2 2 0 c. 139 Jam Adulterated by the admixture of sulphur dioxide, 0 008 per cent. Sept. 15th Withdrawn, evidence incon elusive C. 216 Milk Deficient in milk fat, 37 3 per cent. Oct. 29th 2 0 0 — (b) Public Health (Preservatives, etc., in Food) Regulations, 1925. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 58, Churchway Selling jam containing an added preservative exceeding the proportion specified 1931. Sept. 15th Withdrawn, evidence inconclusive 73 Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 1931. 48, Wellesley Road Using premises as a dairy without being registered April 15th Fined 10s. 28, Haverstock Road Do. do. Fined 10s. — Despatching milk by rail in a churn not fitted with effective lid, etc. Nov. 12th Fined £1, Costs 10s. 6d, — Aiding and abetting the above.. ,, Fined £1, Costs 10s. Gd. — Despatching milk by rail in a churn not fitted with effective lid, etc. ,, Fined £1, Costs 10s. 6d. — Aiding and abetting the above ,, Fined £1, Costs 10s. 6d. — Despatching milk by rail in two churns not fitted with effective lids, etc. ,, Fined £1, Costs 10s. 6d. — Aiding and abetting the above.. ,, Fined £1, Costs 10s. Od. — Failing to properly cleanse milk churns before despatch ,, Summons dismissed under Probation of Offenders' Act, Costs £1 5s. 24, Woburn Square.. Delivering milk in bottles which were not filled and closed on registered premises Dec. 9th Fined £1 Costs £1 Is. 3, Churchway ., Do. do. Fined 10s., Costs 10s. Gd. Wholesale Dealers in Margarine.—One certificate of registration under the provisions of the Food and Drugs (Adulteration) Act was issued during the year. Section VI.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. NOTIFIABLE INFECTIOUS DISEASES. The undermentioned diseases are compulsorily notifiable in St. Pancras : — 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) Cerebro-spinal 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 74 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." Taking a general view of all the Notifiable Diseases, St. Pancras has maintained a high and satisfactory standard. As compared with 1930 there has been a marked drop in the incidence of Scarlet Fever, Measles and Diphtheria. Unfortunately the case Mortality of Diphtheria is steadily rising. The department is paying particular attention to this. Cerebrospinal Fever and Enteric Fever showed both higher incidence and greater mortality. There was also a sharp rise in the number of cases of Acute Influenzal Pneumonia during an epidemic which spread over England. The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1931. The notifications have not been corrected for any subsequent revision of diagnosis:— Notifiable Diseases (other than Tuberculosis). DISEASES. NOTIFICATIONS. Total all Ages, DEATHS. Total all Ages. Number of Cases admitted to Hospital. At Ages—Years. At Ages—Years. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 25. 25 to 65. 65 upwards. Under 1. 1 to 5. 5 to 15 to to 15. 15 to 25. 25 to 65. 65 upwards. 1. Small-pox — — — — 2 2 — 4 — — — — — — — — 4 2. Scarlatina or Scarlet Fever 6 110 166 82 39 32 — 435 — — 2 — — — — 2 425 3. Diphtheria and Membranous Croup 17 104 104 38 41 30 — 334 1 11 5 1 1 — — 19 424 4. Enteric or Typhoid Fever — 1 1 1 1 9 — 13 — — — — 1 — — 1 11 5. Puerperal Fever — — — — 7 17 — 24 — — — — 2 — 2 24 6. Puerperal Pyrexia — — — — 22 16 — 38 — — — — — 1 — 1† 38 7. Erysipelas 2 8 1 — 7 54 24 96 — 2 — — 1 2 3 8 79 8. Cerebro-spinal Meningitis 5 — 2 — — 5 — 12 5 — 1 1 — 4 — 11 11 9. Anterior Poliomyelitis and Polioencephalitis 1 — — — — — — 1 1 — — — — — — 1 1 10. Ophthalmia Neonatorum 45 — — — — — — 45 — — — — — — — — 37 11. Encephalitis Lethargica — — — — — 1 1 2 — — — — 1 2 — 3 1 12. Acute Primary Pneumonia 6 25 24 10 27 75 26 193 — — — — — — — — *135 13. Acute Influenzal Pneumonia 2 10 3 1 12 43 8 79 — — — — — — — — 23 14. malaria. — — — — — 1 — 1 — — — — — — — — — 15. Dysentery — 1 — — — — — 1 — — — — — — — — 1 16. Measles 31 239 129 14 13 4 — 430 1 1 — — — — — 2 115 17. German Measles 2 17 23 10 8 8 v 68 — — — — — — — — 8 * For Pneumonia Deaths, see Table 2 on page 100. t Cause of Death classified by Registrar General to " Influenza." 75 The notifications of, and deaths from, the notifiable infectious diseases other than Tuberculosis are classified in the following table according to the Wards in which they occurred:- INFECTIOUS DISEASES. Notifications. Deaths. Ward. Whole Borough. Ward. Whole Borough 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1. Small-pox — 2 — — — — — 2 4 — — — — — — — — — 2. Scarlatina or Scarlet Fever 76 43 75 27 78 34 24 78 435 — — 1 — 1 — — — 2 3. Diphtheria and Membranous Croup 57 34 44 37 42 31 15 73 †334 4 4 2 2 2 — — 5 19 4. Enteric or Typhoid Fever 1 — 2 1 5 2 — 2 13 — — 1 — — — — — 1 5. Puerperal Fever 2 5 7 2 5 1 2 — 24 — 1 — — 1 — — — 2 6. ,, Pyrexia 6 3 4 3 11 4 — 7 38 — — — 1 — — — — ‡1 7. Erysipelas 16 12 8 15 12 11 6 16 96 — — — 4 1 1 — 2 8 8. Ccrebro-spinal Meningitis 2 1 2 3 3 — — 1 13 2 1 1 3 3 — — 1 11 9. Anterior Poliomyelitis and Polioencephalitis — — — — — — 1 1 — — — — — — — 1 1 10. Ophthalmia Neonatorum 3 2 11 8 6 6 3 6 45 — — — — — — — — — 11. Encephalitis Lethargica — — 1 1 — — — — 2 — 1 1 1 — — — — 3 12. Acute Primary Pneumonia 32 22 24 27 29 26 4 28 †193 — — — — — — — — — 13. Acutc Influenzal Pneumonia 11 8 21 11 16 4 2 6 79 — — — — — — — — — 14. Malaria — — — — — — — 1 1 — — — — — — — — — 15. Dysentery — 1 — — — — — — 1 — — — — — — — — — 16. Measles 76 69 96 37 73 19 14 45 †430 — 1 — — — — 1 — 2 17. German Measles 4 8 6 4 19 3 9 15 68 — — — — — — — — — Totals 286 210 301 176 259 141 79 281 1776 6 8 6 11 8 1 1 9 50 * For Pneumonia deaths, see Table 2 page ico. † Including 3 cases—"homeless." (1 each of Diphtheria, Acute Primary Pneumonia, and Measles.) ‡ Cause of Death classified by Registrar-General to " Influenza." 76 SMALL-POX. Four cases of this disease were notified in the Borough during the year, as compared with 175 cases during the previous year. The cases were mild in character, and no deaths occurred. 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, who decided that these powers and duties should be exercised by the Public Health Committeo. The following table gives particulars as regards vaccination in respect of children whose births were registered in the Borough of St. Pancras from 1st January to 31st December, 1930. VACCINATIONS. 1st January to 31st December, 1930. Number. Percentage of Births registered. North. ' SouthEast. Southwest. Whole Borough North. SouthEast. Southwest. Whole Borough Births registered 649 1999 1950 4598 100.0 100.0 100.0 100.0 Dead, unvaccinated 24 101 87 212 3.7 5.0 4.4 4.6 Successfully vaccinated 294 952 950 2196 45.3 47.6 48.7 47.8 Had smallpox — — 1 1 — — 0.1 — Insusceptible of vaccination 4 11 7 22 0.6 0.5 0.4 0.5 Received certificate of conscientious objection 285 581 596 1462 44.0 29.1 30.6 31.8 Postponed by medical certificate 4 9 9 22 0.6 0.4 0.5 0.5 Moved to known address in other districts 4 151 120 275 0.6 7.6 6.1 6.0 Lost sight of by removal 24 163 160 347 3.7 8.2 8.2 7.5 Unvaccinated and not accounted for in previous columns 10 31 20 61 1.5 1.6 1.0 1.8 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. 1921 5102 2085 40.9 1934 37.9 1922 4881 2260 46.3 1775 36.4 1923 4682 2491 53.2 1444 30.8 1924 4398 2254 51.3 1355 30.8 1925 4121 1988 48.2 1529 37.2 1926 4141 2084 50.3 1420 34.3 1927 3947 1980 50.2 1285 32.6 1928 4019 1937 48.2 1326 33.0 1929 4223 1936 45.8 1373 32.5 1930 4598 2196 47.8 1523 33.1 77 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, 1931 :— 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.. 153 22 175 5 „ 2 „ F. L. Pelly 143 23 166 4 Wards 3 and 4 „ J. Wigg 354 35 389 8 „ 5, 6, and 7 „ A. E. Tait 338 56 394 14 Ward 8 „ C. H. A. Alderton 150 10 160 10 Highgate Hospital ,, C. Thackray — —. — 5 St. Pancras Hospital ,, W. Feldman 4 — 4 9 Totals 1142 146 1288 55 SCARLET FEVER. The number of cases notified was 435, as compared with 659 cases during the previous year. It was subsequently ascertained that 35 cases had been incorrectly diagnosed. The actual number of cases was therefore 400. Two deaths occurred; this equals a case mortality of 0.5 per hundred cases. 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. There were 15 such cases during the year. Of these three were probably infected from one source, two from another, and the remaining ten each from single cases still carrying the infection after the termination of their treatment in hospital. In tracing the clinical histories it was found that in five houses the original case had definitely developed a nasal discharge shortly after leaving hospital. Such discharges are known to be highly infectious. Several other primary cases were reported to have had colds. In four cases there were no illness of any kind in the persons who were just back from hospital, but as the second cases fell within the above definition they are included. Multiple cases in one house—that is, several cases occurring more or less together—are not as frequent as one might expect. In twenty families there were two such cases and in six families three multiple cases in each home. DIPHTHERIA. The number of cases notified was 334, as compared with 568 cases during the previous year. It was subsequently reported by the hospital authorities that 56 cases had been incorrectly diagnosed, the actual number of cases was therefore 278. This equals an attack rate of 1.4 per 1,000 of population. Nineteen deaths occurred, giving a case mortality of 6.8 per cent. Investigation of multiple cases—that is, several cases occurring more or less together in one house —shows that in 14 families there were two such cases and in eight families three multiple cases in each home. In addition, there were two small epidemic outbreaks, one of six cases and the other of five. The latter was found to be due to the persistent carelessness of the mother of the family and there was one death. 78 The term "Return Cases" is not generally applied in Diphtheria. There were four notifications which could definitely be traced, each to four patients recently returned from hospital after treatment for Diphtheria. Antitoxin for the treatment of cases of this disease is supplied to medical practitioners free of charge by the Council. During the year 136 thousand units were provided. ENTERIC OR TYPHOID FEVER. Thirteen cases were notified during the year. On further investigation three of them were found to have been incorrectly diagnosed, seven were true Typhoid and three were cases of Para B. Typhoid Fever. There was one death from a case of true Enteric. The incidence rate was .05 per 1000 people, which compares favourably with .06 for England and Wales. The case mortality is 10 per cent., which is very high. Such exceptional figures are inevitable when dealing with small numbers. 79 PUERPERAL PYREXIA AND PUERPERAL FEVER. Last year this department made a special investigation into this subject. The information was reported in the 1930 Annual Report. It showed that 40 per cent. of all confinements in the Borough took place in institutions. Over 50 per cent. of the cases of Puerperal Pyrexia and Fever were in patients who were confined in these institutions. In 1931 there were 38 notifications of Puerperal Pyrexia. Subsequently one case was found to be Puerperal Fever and transferred to that list. There were 24 cases of Puerperal Fever notified, and one transferred from Puerperal Pyrexia, making a total of 25. Cause of Pyrexia. Total cases notified. Confinement. Infant. Mother. In Institution. At Home. Living. Dead Viable. Non-Viable. Primipara. Unmarried. Average Age. Deaths. Doctor. Midwife. Student. Pyelitis 9 8 1 — — *11 1 — 7 3 27 — Other Urinary Defects 2 2 — — — 2 — — 2 2 21 — Inflammation of Breast 9 7 2 — — 9 — — 8 4 21 — Engorged Breasts 1 1 — — — 1 — — 1 1 19 — Pneumonia 5 4 1 — — †5 1 — 2 1 28 — Influenza 3 1 2 — — 3 — — 3 1 28 1 Bronchitis 1 1 — — — 1 — — 1 — 23 — Retained Products 2 — 1 1 — 2 — — — — 33 — Miscarriage 1 — 1 — — — — 1 — — 28 — Constipation 1 — — — 1 1 — — — — 25 — No obvious cause 3 2 1 — — 3 — — 3 1 22 — Puerperal Pyrexia. Totals 37 26 9 1 1 38 2 1 27 13 28 1 24.3 2.7 2.7 Percentages 100 70.3 29.7 92.7 4.9 2.4 73 35.1 2.7 Puerperal Fever. Associated with Abortion 19 3 3 1 — — — ||9 3 4 29 §2 Other cases 16 9 4 3 — ¶18 — 8 2 27 1 Totals 25 12 7 4 — 18 — 9 11 6 28 3 30.4 17.4 — Percentages 100 52.2 47.8 66.6 33.3 44 24 — 12 * Including 3 sets of twins. + Including 1 set of twins, X Two cases had no medical attention. || Average length of gestation 14 weeks. § Including 1 death which was not allocated to this Borough, although the notification of Puerperal Fever was made to and accepted by St. Pancras. % Including 2 sets of twins. 80  1931. 1930. 1929. 1928. 1927. Puerperal Fever. Cases 25 33 43 33 36 Deaths *3 Nil. 5 3 4 Incidence 8.5 10.3 13.6 10.1 10.9 per 1,000 births. Mortality Rate 12.0 Nil. 11.6 9.1 11.1 per 100 cases. Death Rate 1.0 Nil. 1.6 0.9 1.2 per 1,000 births. Puerperal Pyrexia. Cases 37 37 53 41 33 Incidence 12.5 11.6 16.7 12.5 10.0 per 1,000 births. * See text. 25 cases of Puerperal Fever occurred in the Borough. Three of these cases died as indicated in the above table. The Registrar General, however, has allocated one of these deaths to another Borough. Strictly speaking, we should, therefore, only report 2 deaths and consequently a mortality rate of 8 instead of 12 per 1,000, and a death rate of .7 instead of 1.0. Without doubt the above table reflects the true result of the infection for it relates the end result of the 25 cases. About 8 per cent. of all confinements in the Borough were of unmarried women. Thirty-five per cent. of the confinements which resulted in Puerperal Pyrexia and 24 per cent. of those which ended with Puerperal Fever were among unmarried women. This points to the higher risks of illegitimate pregnancies. They result in a greater incidence of such morbid, and sometimes fatal, conditions as the "Pyrexia" and "Fever" under discussion and also of Ophthalmia Neonatorum. Nearly three-quarters of all the cases of Puerperal Pyrexia were among primiparæ, that is women in their first confinement. Among the Puerperal Fever cases 44 per cent. were primiparae. Abortion plays an important part. Its share cannot be expressed in figures. The reason is obvious. Even in accidental abortions the cause of the Pyrexia is often missed. In many cases the incident is missed or even deliberately concealed. It has been suggested by many authorities that the harmful effects often manifest themselves only at subsequent pregnancies and confinements, with serious results. A distinction between these two conditions is sometimes difficult and often a matter of opinion. Puerperal Fever is more particularly the result of inflammation, acute or chronic, of the female organs of reproduction. Puerperal Pyrexia is a rise of temperature due to inflammation or disease elsewhere. ERYSIPELAS. 96 cases were notified and 8 deaths occurred, as compared with 120 cases and 9 deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever, Meningococcal Meningitis, "Spotted Fever.") There were 12 notifications of this disease during the year. Nine of these cases died and two additional cases were brought to notice on special death reports. There were, therefore, 14 cases and 11 deaths. 81 ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. One case was notified, and subsequently reported to have died from this disease. 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. 1931 45 26 19 43† — — — 15.2 18 14 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 1 — 1* 11.5 11 5 1926 40 24 16 34† — — 2* 11.0 9 7 • Due to other causcs. † Several cases removed to unknown addresses. ‡ Excluding one case, information unobtainable. In addition to the above, there were 29 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 1930 was the lowest for a considerable period. The disease does not seem to be as severe 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. It is certainly better to err on this side. Out of the 45 notifications this year, only four were considered "grave." There were 15 of " moderate " severity, and the rest were returned as "slight." The true condition is still a prolific cause of blindness. This is definitely seen in those countries where Ophthalmia Neonatorum is not regarded with due consideration. In the past five years, out of 182 cases, including all the doubtful ones, we have had two cases where the vision was permanently impaired. Without our present protective routine, it is probable that the incidence would become higher still, that there would be a greater proportion of true and "grave" cases, and that "Impaired Vision" and "Blindness" would result more commonly. There is a marked difference between the Incidence Rate of 144 per 1000 legitimate births and 24.5 per 1000 illegitimate births. In 20 cases the mother was giving birth to her first baby. In 26 cases the confinement took place at home. ENCEPHALITIS LETHARGICA. During the year a special investigation was undertaken with reference to the after effects of this disease. Most of the cases which have been notified in the last 10 years were visited. Twelve of these old cases were found to require attention, and they were offered institutional treatment through the London County Council. Seven accepted and were sent, mostly to Winchmore Hill Hospital, where the special treatment for the after effects of this disease is undertaken. One old case was found to be mentally deficient, and she has been sent to an appropriate home. 82 Two new cases were notified. There was an element of doubt in both diagnoses. One was an old lady of 80, who recovered completely after a short illness without removal to hospital. The other, a man of 64, was probably suffering from Senile Dementia. He also recovered after hospital treatment. Two cases suffering from symptoms of post Encephalitis were brought to notice and added to our register through their removal to hospital for treatment. Two acute cases were brought to notice through the Registrar of Deaths, the diagnoses in these cases having been made after death. There was one death of a patient aged 22, who was notified to this department in 1924. He had previously had institutional treatment on several occasions, but failed to respond. We have, therefore, had four cases of acute and two cases of post Encephalitis Lethargica notified during the year, and there have been three deaths. PNEUMONIA. This disease is a frequent complication of other diseases, such as Measles. When it occurs in that manner it is not notifiable. The notifiable forms of Pneumonia are Acute Primary and Acute Influenzal Pneumonia. There were 193 notifications of the former and 79 of the latter during 1931 (as compared with 170 and 24 respectively for 1930). There were 202 deaths from all forms of Pneumonia during the year. If requested by the medical attendant, a visiting nurse is supplied in necessitous cases at the cost of the liorough Council. In 1931, 71 cases were nursed under this arrangement and 1,137 nursing visits were paid. MALARIA. One case was notified. This patient contracted Malaria originally in 1928, while on Service in India. He had one recurrence in 1930 before returning to this country. DYSENTERY. Two cases were notified. The first was said to have been associated with a small epidemic, the other persons affected resided outside the Borough. There was considerable controversy over the diagnosis, which was not confirmed by any of the several hospitals to which the cases were sent for treatment. The second case on investigation was shown to be one of food poisoning and the doctor concerned agreed to withdraw the notification. MEASLES AND GERMAN MEASLES. These diseases were made compulsorily notifiable throughout the country in 1916 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. Y. 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. 83 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 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, wrhen there is a heavy demand for beds, cases of Scarlet Fever 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, treatment is better 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 expected fall in incidence occurred. Only 430 cases and two deaths were notified in 1931. The Borough, therefore, experienced the lowest recorded Mortality Rate, 4.7, with the one exception of 2.4 in 1925. Expressed in other terms these deaths from Measles were in 1931 equivalent to an Annual Death Rate of 0 01 in St. Pancras. This compares very favourably with 0.08 for the whole of England and Wales, or 0.1 for 107 of the County Boroughs and great Towns, or 0.07 for a group of 159 smaller Towns, or even the 0.03 for London. St. Pancras is one of the very few Local Authorities which have made Measles a Notifiable Disease, and in that way maintained a strict supervision over the great majority of cases. This probably accounts for these highly satisfactory results. Every case which comes to the notice of this Department in the various ways indicated above, or through the School Authorities, is visited by a Health Visitor. Her visit has a double value. It gives her an introduction into many new families and enables her to spread the teaching of the rules of good health. She also is able to give the mother advice and help as regards the patient. Where actual nursing seems necessary for the case, this is arranged for by the Health Visitor and carried out by the staffs of the several nursing associations. Details of how this work is done under a Block Grant from the Borough Council is reported on page 43. Where a medical practitioner is in attendance a card is left for him, suggesting that, if he agrees that the circumstances show the desirability of a visiting nurse, this will be carried out under his instructions on receipt of the card duly signed. It is surprising how frequently doctors omit to take advantage of this very useful service. German Measles is not common, and generally is a mild disease. There were 68 eases during the year 1931, as compared with 116 cases during 1930. There were no deaths. 00 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 4 th 1st 2nd 3rd 1 4th 1931 136 184 55 55 430 31 239 143 17 1 1 — — 2 1 1 — — 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 — 85 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 1931 .7 .9 .3 .3 2.2 7.4 5.4 — — 4.7 1930 6.5 9.5 .9 .2 17.1 9.7 7.8 17.5 — 8.9 1929 1.3 1.2 .3 .2 3.0 19.4 8.3 — — 11.8 1928 11.0 7.1 .5 1 18.8 20.7 52.8 19.6 — 32.7 1927 .2 .7 .5 .7 2.0 — 13.9 204 7.0 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 TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 931 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 — - 2 1 1—5 1 1 7 3 — — 4 — 5—10 4 1 7 7 — 1 — — 10—15 3 4 — 4 1 1 2 1 15—20 16 19 4 2 8 10 1 — 20—25 18 23 5 6 9 10 2 2 25—35 46 31 4 6 17 13 — 2 35-45 40 15 — 3 19 14 — 1 45—55 40 14 1 1 29 16 1 — 55—65 29 6 2 2 17 2 2 2 65 & upwards 13 5 2 1 10 4 1 1 Totals 210 119 39 36 110 71 15 10 86 The total number of Primary notifications was 322; in addition to these, 39 cases, which had not been notified, came to knowledge by means of special death reports, 42 cases by transfer from other districts, and one case by posthumous notification. The total number of new cases during the year from all sources was therefore 404, equal to a notification rate of 2.07 per 1,000 of population. The total number of new cases during the previous year was 397. The deaths from all forms of Tuberculosis during the year numbered 206, equal to a death rate of 1.06 per 1,000 of population. The total number of deaths in the previous year was 189. It will be noted that, out of a total of 206 deaths from Tuberculosis, 40 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:— Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from 4th January, 1931, to the 2nd January, 1932 (inclusive). Number of Notifications on Form A. Primary Notifications. Total Notifications (i.e., including cases previously notified by other Doctors). Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males — 1 4 2 13 16 36 30 37 24 10 173 254 Females — 1 — 4 '7 19 21 12 12 6 4 96 133 Non-pulmonary Males — 3 5 4 — 3 2 — 1 — 2 23 28 Females 1 3 6 4 2 3 5 3 1 1 1 30 32 Totals 1 8 15 14 35 41 64 45 51 31 17 322 *447 * Exclusive of 14 " Lost sight of " cases returned. 87 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 3 2 10 10 3 5 3 37 Females — — 1 — 2 4 10 3 2 — 1 23 Non-pulmonary Males 1 4 2 2 1 2 2 — — 2 — 16 Females — — 1 — — 3 1 — — 1 — 6 Totals 1 4 4 3 6 11 23 13 5 8 4 82 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. j Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 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 1931 195200 329 75 404 181 25 206 1.68 0.38 2.07 0.93 0.13 0.06 88 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 Tuberculosis (All Forms). Ward. New Cases. Deaths. Number. Kate per 1000 of Population. Number. Rate per 1000 of Population. 1 65 1.8 37 1.0 2 32 1.6 16 0.8 3 78 2.4 43 1.3 4 44 1.9 29 1.2 5 56 2.0 27 1.0 6 33 1.9 16 0.9 7 23 1.8 8 0.6 8 71 2.8 28 1.1 Homeless 2 - 2 - Totals 404 2.1 206 1.1 Public Health (Tuberculosis) Regulations, 1930. 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, 1931:— Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1931 1328 414 1742 Number of new cases during the year 347 75 422 Number of cases removed from the Register during the year (from death or other causes) 1675 381 489 96 2164 477 Number of cases remaining on the Register at the end of the year 1294 393 1687 Public Health (Prevention of Tuberculosis) Regulations, 1925. No formal action was necessary during the year under the above regulations. 89 Boarding out of Children from Tuberculous Homes. This scheme was initiated in 1925, and provided for:— (а) The boarding out of children living in heavily infected and overcrowded homes, and for (b) The boarding out of children who were being discharged from Institutions, if the homes were unsuitable and inimical to the maintenance of health. At a later date the scheme was further extended to include : — (c) "Weakly" children, living under conditions likely to subject them to infection, and children, in suitable instances, whose parents were under treatment for tuberculosis. Originally the children were sent away for a limited period. When the scheme was extended it was decided that the children, in all categories, might be kept away as long as the home conditions were unfavourable. The arrangements are made by the Invalid Children's Aid Association, on behalf of the London County Council. During the year 10 children have been boarded out under the scheme. Provision of Beds and Bedding for Necessitous Tuberculous Patients.—This valuable step was initiated by the Borough Council in 1924. Beds and bedding are lent to tuberculous patients who would otherwise be compelled to share a bed with another or other persons. They are much appreciated by those to whom they are lent and their use should help to limit the spread of infection. The Health Visitors 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 139 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 3663 „ Holland 3401 Total 7064 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. Pancras Tuberculosis Care Committee. The Care Committee was constituted in February, 1923, as a voluntary committee in accordance with the wishes of the Ministry of Health, and consists of representatives of various Social Organisations, the Public Assistance Committee, and ten members of the Borough Council, working in connection with the Tuberculosis Dispensary Scheme. 90 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 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: — Tuberculosis Care Committee. Report for year 1931. " The work of the Committee has proceeded on the usual lines throughout the year. In February the Committee suffered a serious loss in the resignation of its Chairman, Mr. Neal, who had acted in that capacity since 1923. The Committee would like to take this opportunity of placing on record its appreciation of his keen interest and unfailing help in its work. In March Councillor Mrs. Alliston consented to be nominated as his successor and was unanimously elected to the position of Chairman. To meet her convenience it was arranged to hold Committee meetings fortnightly instead of weekly as heretofore. Total number of cases considered by the Tuberculosis Care Committee . . 192 37 cases were assessed at sums varying from £1 to 1s. 111 cases were assessed as free from contribution. In addition to this, it has been necessary in 44 cases to keep in touch with families ; to review the circumstances and assist with advice and help when possible. Cases considered for Dentures. The total number considered was eight cases of which 5 were assessed free. 1 case was assessed at £3. 1 case was assessed at £2 5s. 10d. 1 case was assessed at £1 1s. 8d. 91 The Committee is grateful for the continued co-operation and assistance of the Charity Organisation Society, Invalid Children's Aid Association, United Services Fund, and other societies. The kindly work done by Mr. Wakeford and some members of the local branch of "Toe H" in visiting patients in Highgate Hospital still continues, and many patients are cheered by entertainments arranged on their behalf. Queen Mary's Needlework Guild sent a parcel of clothing at Christmas which was most welcome, and the Hon. Secretary has also to thank the St. Pancras Rotarians for their kind gift of £1 towards her clothing cupboard. Her working party has met regularly throughout the year and many articles of clothing have been contributed. During the year 63 patients have been helped with gifts of clothing. H. M. Whelon." TUBERCULOSIS DISPENSARY. Nine consultations are held in each week—two in the morning, five in the afternoon, and two in the evening. During the year the work was carried out at 39, Oakley Square, part of the premises of the St. Pancras General Dispensary. Early in February, 1932, the Tuberculosis Dispensary was transferred to new premises at Barnes House, Camden Road. 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 number of new cases dealt with at the Dispensary during 1931 was approximately the same as it was in 1930, but the total number on the dispensary register fell from 851 to 809. This decrease is due mainly to patients transferring to other areas, or, for other reasons, failing to attend the dispensary, the number included in this category being 223 as compared with 185 in the previous year. Altogether 276 recommendations for institutional treatment were made. Only five of these were subsequently withdrawn by patients, and of the 56 cases not accepted by the London County Council under their tuberculosis scheme, 33 were given sanatorium treatment under the scheme for public assistance. The total number of patients who received sanatorium treatment was therefore 248, or 17 more than the number given similar treatment in 1930. The proportion of contacts who attend for examination is still not more than 16 per cent. The number of attendances for artificial pneumothorax refills shows a reduction from 130 to 112. This figure fluctuates considerably from year to year, because the number of patients treated is small compared with the number of times each patient may attend for treatment. The average annual attendance during the last five years is 101. 92 During February the Council made provision for the Tuberculosis Officer to attend a post-graduate course held at Victoria Park Hospital for Diseases of the Chest. The course, which continued for six days, included lectures and practical demonstrations on many important developments in the treatment and diagnosis of tuberculosis, and was of very great interest and value. Gr. A. BACK, M.B., B.Ch., D.P.H." The following table gives a summary of the work carried out at the Tuberculosis Dispensary during the year :— Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 96 55 6 5 6 11 10 14 102 66 16 19 203 (b) Diagnosis not completed — — — — — — — — 14 14 1 3 32 (c) Non-tuberculous — — — — — — — — 75 81 43 35 231 B.—Contacts examined during the year:— (a) Definitely tuberculous — 4 — — — — — — — 4 — — 4 (b) Diagnosis not completed — — — — — — — — 3 4 3 1 11 (c) Non-tuberculous -— — — — — — — — 22 27 30 55 131 C.—Cases written off the Dispensary Register as— (a) Recovered 7 9 4 2 — 2 5 2 7 11 9 4 31 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 100 112 76 91 379 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 342 218 19 18 31 32 40 44 373 250 59 62 744 (b) Diagnosis not completed — — — — — ~~ — — 25 31 5 4 65 1. Number of cases on Dispensary Register on January 1st 851 7. Number of consultations with medical practitioners :— 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 67 (a) Personal 10 (b) Other 145 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 223 151 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4129 4. Cases written off during the year as Dead (all causes) 94 10. Number of— (a) Specimens of sputum, &c., examined 175 5. Number of attendances at the Dispensary (including Contacts) 3264 (b) X-ray examinations made in connection with Dispensary work 65 6. Number of Insured persons under Domiciliary Treatment on the 31st December 242 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 368 93 Section VII. OTHER SERVICES. DISINFECTING AND CLEANSING STATION. These 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. 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 4 4 9 9 Scarlet Fever 421 421 426 430 Diphtheria 804 301 319 321 Enteric Fever 10 10 10 10 Erysipelas 71 71 61 69 Puerperal Fever and Pyrexia 1 1 1 1 Encephalitis Lethargica 1 1 1 1 Polio-myelitis — — — — Cerebro-spinal Meningitis 14 14 9 14 Pneumonia 12 12 9 18 Tuberculosis 139 139 77 121 Measles 18 18 19 25 Vermin aud Scabies 181 181 155 143 Other Diseases 326 326 259 312 Totals 1502 1499 1355 1474 94 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 68 1296 24 160 Bolsters and pillows 41 3014 15 183 Sheets, blankets and counterpanes 32 5258 13 232 Huge, mats, cushions, carpets, covers and curtains 16 917 4 60 Wearing apparel 28 2303 15 52 Books 2 75 — — Sundries 9 318 15 24 Totals 196 13181 86 711 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, 1932, amounted to £74 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. Men. Women. Children under 15. Total. Vermin 1070 20 4942 *6032 Scabies 76 27 1352 1455 Infectious Disease Contacts. 10 11 — 21 Totals 1156 58 6294 7508 • Includes 580 males and 3 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. 95 As the Education Authority, powers were conferred upon them by the London County Council (General Powers) Act, 1907, and the Children Act, 1908, authorising the cleansing of children whose bodies or clothing were infested with vermin, or who were in a foul or filthy condition. The necessary cleansing work is carried out by the staff of the Borough Council on behalf of the County Council. Payment is made by the latter at the rate of two shillings per child in respect of verminous conditions, and one shilling per bath for those suffering from scabies. In connection with children whose bodies or clothing are very verminous, arrangements are made for the homes to be visited by the Sanitary Inspector, as the rooms and bedding may also need disinfecting. It would obviously 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 117 1179 1296 Blood for Typhoid Fever — 7 7 ,, Dysentery 2 — 2 Fasces for Typhoid Fever 2 20 22 ,, Dysentery — 21 21 Urine for Typhoid Fever — 22 22 ,, Dysentery — 21 21 Sputum for Tubercle Bacilli 47 424 471 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. 98 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1931 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District; Under 1 Year of Age. At all Ages. Number. Rate. Number. Bate. Number. Rate per 1,000 Nett Births. Number. Rate. 1921 212900 — 5099 4764 22.4 2836 13.3 651 593 360 76 2778 13.0 1922 212500 — 4865 4559 21.5 3219 15.1 715 603 337 74 3107 14.6 1923 214400 — 4654 4348 20.3 2735 12.8 634 484 272 63 2585 12.1 1924 214600 214300 4447 4112 18.8* 2937 13.4† 640 551 303 74 2848 13.0† 1925 216300 215900 4111 3880 17.9* 2864 13.3† 680 561 280 72 2745 12.7† 1926 216800 216400 4129 3612 16.7* 2992 13.8† 855 543 274 76 2680 12.4† 1927 213200 212800 3925 3299 15.5* 3034 14.3† 939 526 205 62 2621 12.3† 1928 206000 205600 3980 3274 15.9* 3053 14.8† 985 550 261 80 2618 12.7† 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 14.1† 999 549 194 60 2478 11.9+ 1931 195600 195200 4483 2955 15.1* 2979 15.3† 933 555 200 68 2601 13.3† 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. (Details of 1931 Census not available.) * Based on total population. † Based on civil population. 99 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, 1931. 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 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years 65 and under 75 years. 75 years and upwards. ALL CAUSES M 1362 113 21 16 29 45 41 76 168 267 323 263 F 1250 87 12 8 24 48 59 73 149 172 279 339 1. Typhoid and Paratyphoid Fevers M 1 — — — — 1 — — — — — — F — — — — — — — — — — — — 2. Measles M 2 1 1 — — — — — — — — — F — — — — — — — — — — — — 3. Scarlet Fever M — — — — — — — — — — — — F 2 — — — — — — — — — — — 4. Whooping Cough M 8 4 — 1 — — — — — — — — F 6 6 — — — — — — — — — — 5. Diphtheria M 9 1 — 7 1 — — — — — — — F 10 — 1 3 5 1 — — — — — — 6. Influenza M 17 — 1 — — — — 2 — 2 6 6 F 31 1 1 — — 2 2 3 6 3 7 6 7. Encephalitis Lethargica M 2 — — — — 1 — — — 1 — — F — — — — — — — — — — — — 8. Cerebro-spinal Ferer M 4 2 — — — — 1 — 1 — — — F 7 3 — — 2 — 2 — — — — — 9. Tuberoulosig of Respiratory System M 112 1 — — 1 17 17 19 29 18 8 2 F 72 — — — 2 20 13 14 16 3 4 — 10. Other Tuberculous Diseases M 13 1 — 4 2 3 — — — 2 1 — F 11 1 — — 1 2 2 1 1 2 — X 11. Syphilis M 14 1 — — — — — — 5 6 3 — F 5 1 — — — — — 2 — 2 — — 12. General paralysis of the insane, tabes dorsalis M 20 — — — — — 1 4 4 4 5 2 F 3 — — — — — — 2 1 — — — 13. Cancer, Malignant Disease M 173 — — — 1 1 4 5 28 43 60 31 F 189 — — — — — 8 14 40 41 55 31 14. Diabetes M 9 — — — — — — — 1 6 2 — F 15 — — — — — — 1 1 3 6 4 15. Cerebral Haemorrhage, etc. M 43 — — — — — — 1 5 11 19 7 F 54 — — — — — — 1 2 8 16 27 100 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 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 16. Heart Disease M 277 — — — 1 2 3 6 24 65 93 83 F 283 — — — 1 5 11 11 21 48 81 102 17. Aneurysm M 9 — — — — — — — 2 3 3 1 F 6 — — — — — — — 2 2 2 — 18. Other Circulatory Diseases M 61 — — — — — — 1 3 10 23 24 F 41 — — — — — — 1 2 4 16 18 19. Bronchitis M 80 4 — — — — — 2 10 10 17 37 F 62 1 — — — — — 2 4 7 15 33 20. Pneumonia (all forms) M 116 30 8 i 8 1 2 7 14 16 20 14 F 86 18 4 3 — 4 2 3 9 10 14 19 21. Other Respiratory Diseases. M 15 — 1 — — 1 — 2 3 2 4 2 F 14 — — — — — 1 — 2 — 7 4 22. Peptic Ulcer M 22 — — — — 1 1 3 6 6 3 2 F 11 — — — — — — — 2 3 3 3 23. Diarrhœa, etc. M 17 15 1 — i — — — — — — — F 17 13 1 — — — — 1 1 — 1 — 24. Appendicitis M 9 — — — 2 1 1 — 2 1 1 F 9 — — — 2 — 2 — 2 — 2 1 25. Cirrhosis of Liver M 8 — — — — — — 1 2 1 2 2 F 5 — — — — — — 1 2 2 — — 26. Other Diseases of Liver, etc. M 5 — — — — — — — — 1 3 1 F 11 — — — 1 1 1 — 1 4 1 2 27. Other Digestive Diseases M 34 2 2 — 1 — 2 3 4 10 8 2 F 20 — — 1 — — 1 — 2 6 4 6 28. Acute and Chronic Nephritis M 38 — — — — 1 1 — 6 16 11 3 F 30 — — — — 1 4 — 2 9 9 5 29. Puerperal Sepsis F 2 — — — — — 2 _ 30. Other Puerperal Causes F 5 — — — — 1 3 1 31. Congenital Debility, Premature Birth, Malformations, etc. M 40 40 — — — — — — — — — — F 37 37 — — — — — — — — — — 101 Table No. 2—continued. CAUSES OF DEATH. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 year 8. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years- 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 32. Senility M 21 — — — — — — — — 1 5 15 F 62 — — — — — — — — — 6 56 33. Suicide M 24 — — — — — 1 5 5 10 2 1 F 12 — — — — 2 1 3 4 1 1 — 34. Other violence M 53 4 2 1 8 7 4 7 7 8 3 2 F 35 3 — — 4 2 1 5 — 3 11 6 35. Other defined Diseases M 105 7 2 2 8 8 3 7 9 13 21 25 F 97 3 5 1 4 7 3 7 23 11 18 15 36. Causes ill-defined or unknown M 1 — — — — — — — — — — — F — — — — — — — — — — — — Legitimate. Illegitimate. M 95 18 Deaths under 1 year F 76 H 102 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. 1 530 15.0 469 13.2 23 43 37 1.0 2 337 17.4 225 11.6 14 42 16 0.8 3 551 16.8 441 13.5 29 53 43 1.3 4 356 15.1 350 14.8 29 81 29 1.2 5 451 15.9 367 13.1 31 69 27 1.0 6 275 15.5 198 11.1 20 73 16 0.9 7 137 10.7 161 12. 5 19 139 8 0.6 8 318 12.5 346 13.6 29 91 28 1.1 Homeless — — 44 — 6 — 2 — Borough 2955 151 2601 13.3 200 68 206 1.1 103 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 1931. (52 weeks ended 2nd January, 1932.) Estimated Population, Mid. 1931. Birth Rate. Death Rate. Infantile Mortality, Estimated Population, Mid. 1931. Birth Bate. Death Rate. tile Mortality. England and Wales 39,988,000 15.8 12.3 66 County of London 4,374,300 15.0 12-4 65 Birmingham 1,012,700 17.1 11.6 70 West. Liverpool 862,900 21.6 14.2 94 Paddington 140,300 14.8 13.1 87 Manchester 773,900 16.0 13.8 85 Kensington 174,800 14.2 14.1 76 Sheffield 517,800 15.0 11.8 69 Hammersmith 135,100 15.3 12.2 68 Leeds 486,400 14.8 18.4 77 Fulham 151,200 15.1 12.3 68 Bristol 399,900 15.1 11.9 50 Chelsea 57,220 12.8 14.1 42 Kingston.upon Hull 315,200 19.2 13.2 81 City of Westminster 119,000 10.1 13.6 74 Bradford 300,900 18.6 14.3 71 North. West Ham '296,700 17.7 11.4 63 St. Marylebone 93,460 11.4 13.1 66 Newcastle.on.Tyne 284,400 17.8 18.4 92 Hampstead 87,740 11.2 11.7 61 Stoke.on.Trent 279,900 18.6 18.0 100 St. Pancras 195,600 15.2 134 67 Nottingham 270,900 17.2 13.6 82 Islington 324,600 16.7 12.7 63 Portsmouth 248,400 17.5 12.9 55 Stoke Newington 51,880 15.2 12.7 54 Leicester 241,300 15.8 12.4 64 Hackney 217,000 15.5 11.5 60 Croydon 233,800 14.5 11.4 57 Central. Salford 225,900 16.0 14.2 97 Holborn 84,470 10.2 14.8 74 Cardiff 223,800 16.8 12.8 77 Finsbury 70,120 17.1 14.0 66 Plymouth 207,500 16.5 14.8 67 City of London 9,880 6.5 14.4 82 Sunderland 187,600 21.8 14.4 99 East. Willesden 185,630 15.9 10.4 58 Shoreditch 98,260 17.1 12.5 75 Bolton 179,200 18.7 13.5 80 Bethnal Green 109,200 16.b 12.5 88 Southampton 175,600 17.8 11.4 47 Stepney 226,500 17.5 18.1 78 Coventry 168,900 14.7 10.0 59 Poplar 156,300 17.5 12.4 77 Swansea 165,500 16.8 11.6 70 South. Tottenham 159,300 14.7 10.2 58 Southwark 172,900 16.9 140 61 Birkenhead 148,500 18.4 18.4 86 Bermondsey 112,400 17.4 12.6 57 Brighton 145,000 18.5 14.0 54 Lambeth 295,900 15.8 12.7 60 Derby 143,600 16.2 11.4 63 Battersea 159,800 15.5 12.1 57 East Ham 142,800 14.8 10.7 59 Wandsworth 353,200 12.8 11.4 62 Rhondda 142,280 17.1 18.4 81 Camberwell 252,100 14.7 11.9 56 Oldham 141,900 18.6 14.8 106 Deptford 107,200 16.3 12.0 58 Middlesbrough 138,900 21.4 14.1 100 Greenwich 100,640 14.8 11.4 65 Walthmnstow 184,420 14.5 10.4 56 Lewisham 220,800 14.1 10.2 50 Wolverhampton 184,400 17.1 12.0 69 Woolwich 147,400 14.6 11.6 59 Ilford 132,150 15.0 9.0 56 Leyton 128,600 14.1 10.6 89 Norwich 126,800 15.4 12.1 55 Stockport 126,600 18.6 18.9 79 104 Table No. 5.—Meteorological Table for Saint Pancras, 1931. (Deduced from observations at Camden Square, N. W. 1.) January. February. March. April. ' May. June. July. August. September. October. I November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above m.s.l.) Air Temperature— Mean of 29.922 29.872 29-951 29.878 29.880 30.046 29.814 29.902 30.187 30.174 29.837 30.316 A. Maximum 42.8 44.7 48.7 54.4 62.5 70.0 697 67.8 61.5 56.9 51.6 46.2 B. Minimum 34.5 34.7 35.0 41.8 48.0 54.1 55.6 53.9 48.9 44.3 43.0 39.0 Mean of A and B 38.7 39.7 41.9 48.1 55.3 62.1 627 60.9 552 50.6 47.3 42.6 Difference from Average —01 —0.3 —10 —0.3 +0.2 +1.1 —1.6 —2.3 —3.4 —01 +30 +2.1 Humidity—Morning 90 89 80 77 72 74 76 81 86 87 90 88 Earth Temperature at 4 ft. depth 44.7 43.1 42.1 44.5 47.9 53.1 56.7 57.7 55.8 53.8 49.5 47.1 Bright Sunshine— Total Observed (daily mean) Hrs. 1.80 1.92 3.90 3.56 5.03 6.14 4.72 4.57 3.94 3.46 1.81 0.93 Per cent, of total possible 22 19 33 26 32 37 29 32 31 32 20 12 Difference from average Hrs. — — — — — — — — — — — — Rain and other forms of precipitation— Number of Days 20 18 6 17 14 10 18 18 14 6 13 11 Total Fall Ins. 1.34 1.83 0.23 371 2.67 1.41 3.00 5.03 2.70 0.66 1.99 0.82 Difference from average ,, —051 +016 —1.61 +2.17 +0.91 —0.55 +0.55 + 2.84 +0.91 —1.97 —0.35 —1.58 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. 105 Table No. 6. —Report of Work carried out by District Inspectors for the year 1931. Rackham. Lonnon. Brown. Walker. James. Adkins. Akess. Jaffa. Capel. Nixon. West. Winchesterj Thompson.* Totals. Complaints received, 3,426. Complaints Investigated. Whole house inspected — 5 56 27 12 86 49 23 90 26 19 — — 393 „ Part of house inspected 99 401 313 398 235 223 165 343 212 215 330 485 — 3419 ,, Re-inspections 1082 620 1660 1175 878 736 574 820 1274 1012 13 19 1716 — 12866 Infectious Diseases Investigations and inspections 238 351 '99 231 191 239 148 174 206 208 149 158 — 2492 Re-inspections 1 521 334 7 215 138 138 6 227 50 119 37 — 1793 Smoke Observations — 18 — 96 7 87 12 148 105 27 17 23 — 540 Offensive or Regulated Trades — 5 — — — 5 — 6 3 — 31 — — 50 Mews and Stable Yards—Number inspected 317 416 275 386 309 287 483 282 346 472 277 345 — 4195 Verminous Persons 2 3 — — — — 1 1 — — 4 18 — 29 Other Inspections and Re-inspections 131 21 24 27 31 84 20 168 148 12 20 274 — 960 housing Acts and Regulations, 1925 and 1930. Number of Houses Inspected Primary Inspections — — 63 26 140 29 — 161 57 15 16 89 — 596 Re-inspections — — 337 78 273 93 3 677 250 33 22 68 — 1834 Underground rooms 44 945 304 375 857 748 661 288 393 622 287 630 474 6628 Houses let in Lodgings (Bye-laws, See. 6). Number of Tenements Inspected Primary Inspections — 1 30 107 208 3 — 71 40 61 2 52 — 575 Re-inspections Drainage. — 1 173 325 1613 5 — 374 191 329 9 396 — 3416 (a) Under Notice, Plans, Supervision, etc. 147 279 353 17 131 214 401 no 406 170 264 35° — 2842 (b) Voluntary, do. do. 1069 C92 205 845 106 1092 1152 150 387 244 594 116 — 6552 (c) New Buildings, do. do. 99 173 51 397 39 233 457 32 44 673 415 120 — 2733 Attendances at Police Court, etc. 5 — — — 2 2 7 — 3 4 9 10 — 42 Rent Restrictions Acts 13 7 16 — 38 37 11 31 16 — 3 — — 172 Totals 3247 43594393 45 7 5285 4341 4282 3865 4398 4173 3906 4887 474 52127 Notices served:— Intimations 182 221 393 280 442 247 166 379 346 283 314 544 — 3797 R.R.A. 5 1 1 — 3 6 1 8 11 — 2 — — 38 Totals 187 222 394 280 445 253 167 587 357 283 316 544 — 3835 *See also Table No. 8 on page 107. 106 Table No. 7.—Inspections and other trork of the Food Inspectors during 1931. Mr. Auger, Mr. Child. Total. Number of Visits to :— Milkshops .. .. 333 324 6S7 Dairies ioj 66 169 Cowsheds .. — — — Ice Cream Premises 76 '56 232 Slaughter Houses 65 108 '73 Butchers' Shops and Meat Stalls 1091 '331 2425 Prepared Meat Premises 28 429 457 Fishmongers' Shops 24 35 59 Fried Fish Shops 183 170 353 Fish Curers'premises .. .. .. 26 52 78 Other Premises where Food or Drugs are sold 40 77 "7 Marketing Streets and Places .. 2c94 • 37i 3465 Attendances at Police Court .» 4 '9 23 Other Visits .. 241 144 to oc ro Re-inspection after Intimation Notices 1 7 8 Total 4309 4292 8601 •Number of Samples taken ; — Formal 184 282 466 Informal .. 216 118 334 Total 400 400 800 Unsound Foods. Surrenders :— Meat, &c. 6 9 15 Fish i — 1 Shell Fish i — 1 Fruit 3 3 6 Vegetables 1 3 4 Eggs — — — Total 12 IS 27 Seizures:— — 1 Canal Boats inspected.. .. .. ., 2 — 2 Notices Served i 2 3 l07 Table No. 8. Report of Work carried out by the Factory and Workshop Inspectors during the year 1931. Inspections and Re-Inspections. Thompson.* Bibby. Totals. Factories (including factory laundries and bakehouses) Workshops (including workshop laundries and bakehouses) 1937 1436 406 454 2343 1890 Workplaces (including restaurant kitchens) 518 444 962 Outworkers' premises — 1571 1571 Other Visits — 137 137 Totals 3891 3012 6903 Notices served relating to:— Factories 214 14 228 Workshops 96 35 131 Workplaces 34 6 40 Others — — — Totals 344 55 399 * See also Table No. 6 on page 105. 108 Table No. 9. Report of Work carried out by Centre Superintendents, Women Inspectors and Health Visitors during the year 1931. Bristow. Crockart. LiandelJones. Smyth. Templeton. Anderson. Blaxland. Camman. Holland. Hunter. Blair. Chapman. Manger. Robinson. Bagnall. Bruce. Clarke. Harris. Harrop. Lurie. Lynn. Smith. *Woodroff. Totals. Infants. Under 1 First Visits 53 10 5 — — 117 199 — — 115 208 75 98 130 164 233 100 168 228 245 220 137 14 2519 Subsequent 361 42 12 — — 349 697 — — 457 675 305 544 487 936 1037 679 544 429 848 570 844 16 9832 „ 1-2 First Visits 1 4 2 — — 13 13 — — 3 8 4 — 6 12 9 1 8 9 11 3 4 — 111 Subsequent 282 19 2 — — 272 450 — — 345 313 124 310 254 375 514 519 279 191 376 276 434 10 5345 2-5 First Visits — 2 1 — — 16 23 — — 11 4 2 1 3 5 3 1 5 6 6 3 18 — 110 Subsequent 304 13 — — — 527 645 — — 544 358 216 169 308 297 557 420 393 391 615 422 783 5 6967 Expectant Mothers First Visits 52 25 — — — 50 156 — — 44 9s 57 47 60 181 57 42 102 133 71 143 55 12 1385 Subsequent 56 14 — — — 8 106 — — 65 47 152 123 27 382 134 101 34 31 117 22 4 - 1423 Measles 4 — — 4 19 16 — — 43 20 10 5 28 49 24 3 13 58 30 12 45 1 386 German Measles — — — — — 2 4 — — 6 4 1 1 10 — 3 — 2 15 3 9 3 — 63 Whooping Congh 37 — — — 1 25 37 — — 35 18 11 4 26 11 13 3 11 46 14 20 47 9 368 Ophthalmia Neonatorum 2 5 — — 1 8 — — 3 5 1 2 5 — 2 3 11 3 — 9 5 3 72 Puerperal Fever 2 1 — — — 3 — — — 1 3 1 1 — 2 — — 3 3 3 — — 23 ,, Pyrexia 1 1 — — — 1 — — — 3 3 — 4 1 2 3 — 3 1 — 4 2 — 29 Tuberculosis. Dispensary Cases — —- — — — — — 1877 2252 — — — — — — — — — — — — — — 4129 „ Others — — — — — — 1786 1149 — — — — — — — — — — — — — 2935 Other diseases 78 2 2 — 3 79 108 — 1 114 40 41 15 74 31 60 9 22 179 50 103 82 23 1119 Milk Enquiries 5 4 — — — 1 44 — — — — 3 3 12 — — — 9 9 — 18 7 — 123 Consultations and Classes attended 162 251 234 254 224 117 161 _ _ 154 152 164 177 151 145 165 170 166 227 155 215 161 16 3601 Other Visits 145 446 16 — 48 533 140 4 13 773 255 236 188 109 463 30 279 348 463 5 392 174 15 5075 Totals 1545 841 274 254 281 2140 2803 3667 3415 2698 2215 1406 l692 1691 1 3055 2844 2332 2121 2422 2546 2444 2805 124 45615 *Temporary service—4 weeks.