STP AN9 Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1933. G. SOWDEN, M.D., D.P.H., Barrister-at-Law, 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 1933. G. SOWDEN, M.D., D.P.H., Barrister-at-Law. 3 CONTENTS. page Map of Borough, showing statistics by Wards 2 Public Health Committee 6 Staff of Public Health Department 7 & 8 Introduction 9 Statistical Summary 11 & 12 Section I. —Statistics and Social Conditions of the Area. Population and General Statistics 13 Principal occupations of the inhabitants of the Borough 14 Economic Conditions 14 Marriages 15 Births 15 Illegitimacy 16 Notification of Births 16 Still Births 16 Deaths 17 Inquests 20 Infantile Mortality 20 Death Bates of Infants and Young Children 23 Section II.—General Provision of Health Services. Hospital Accommodation 24 Institutional Provision for Unmarried Mothers 25 Ambulance Facilities 25 Clinics, Treatment Centres, &c. 25-27 Maternity and Child Welfare 28 Block Grants 28 Ante-natal 29 At Birth 30 Infants and Young Children 30 Advice cards 30 Home Visiting 31 Attendances at Consultations, etc. 32 Centres 33 Artificial Light Treatment 35 Dental Clinic 36 Day Nurseries 37 Nursery Schools 37 Clinic for Ailing Mothers and Children 38 Convalescent Home Treatment 39 page Home for Sick Poor Children 39 Infant Life Protection 39 Supply of Milk to Mothers and Children 39 Professional Nursing 42 Home Helps 42 Midwives 43 Midwifery 43 Maternal Mortality 44 Medical examination in elementary schools 47 & 48 Provision of Insulin 49 Local Legislation 49 Public Health Legislation 49 London County Council By-laws 50 Transfer of Powers (London) Order, 1933 50 Children and Young Persons Act, 1932 50 Slaughter of Animals Act, 1933 50 Pharmacy and Poisons Act, 1933 50 Housing Financial Provisions Act, 1933 50 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 50 Health Propaganda 51 Section III.—Sanitary Circumstances of the Area. Water Supply 51 Public Baths and Washhouses 51 Drainage 52 Rats and Mice 52 Rat Week 52 Refuse Collection and Disposal 52 Mortuary and Coroner's Court 53 Sanitary Inspections 54 Notices served 54 Nuisances and Breaches—Legal Proceedings 54 Smoke Abatement 55 Factory and Workshop Acts 55 Inspections 56 Defects found 56 Home Work 57 Factories, Workshops and Workplaces on Register 57 Other matters 58 4 CONTENTS—continued. page 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 Common Lodging Houses 59 Canal Boats Acts 60 Rent and Mortgage Interest Restrictions Acts, 1920-1933 60 Section IV.—Housing. Statistics 60 Housing Conditions 62 Underground Rooms 63 Work of the Estates Committee 64 Kennistoun House 64 Bangor Wharf 65 Housing Act, 1930—Schemes 65 Litcham Street Area 65 London County Council Estates 66 Housing Schemes in the Borough 66 Section V.—Inspection and Supervision of Food. (a) Milk Supply 66 Cowsheds, Dairies and Milkshops 66 Milk in Sealed Containers 67 Sampling out of Office Hours 67 Milk (Special Designations) Order, 1923 67 Artificial Cream Act, 1929 70 (b) Meat and Other Foods 70 Unsound or diseased food condemned and destroyed 70 Slaughter-houses 70 Slaughter of Animals Act, 1933 71 Registration, &c., of Slaughterhouses 72 Fried Fish and Fish Curing Premises 72 Ice Cream Premises 72 Bakehouses and Restaurant Kitchens 73 Underground Bakehouses 73 page (c) Food and Drugs (Adulteration) Act, 1928— Samples taken 73 Prosecutions— (a) Food and Drugs (Adulteration) Act, 1928 75 (b) Public Health atives, &c., in Food) Regulations, 1925 75 (c) Milk and Dairies Order, 1926 76 Wholesale Dealers in Margarine 76 Section VI.—Prevalence of, and control over, Infectious Diseases. Notifiable Diseases 76 Notifications by ages and Deaths from notifiable diseases 77 Do. by Wards 78 Small Pox 79 Vaccination 79 Scarlet Fever 80 Diphtheria 80 Enteric (Typhoid) Fever 81 Puerperal Fever and Pyrexia 81 Erysipelas 83 Cerebro-spinal Meningitis 83 Anterior Poliomyelitis and Polioencephalitis 83 Ophthalmia Neonatorum 84 Encephalitis Lethargica 85 Pneumonia 85 Malaria 85 Dysentery 85 Food Poisoning 85 Measles and German Measles 88 Tetanus 91 Tuberculosis— New Cases and Deaths 92 Notifications 93 Prevalence and fatality for 10 years 94 Notifications and Deaths by Wards 91 Public Health (Tuberculosis) Regulations, 1930 95 Public Health (Prevention of Tuberculosis) Regulations, 1925 95 Boarding out of Children 95 5 CONTENTS—continued. page Tuberculosis —continued. Provision of Beds, etc. 95 Disinfection of Rooms 96 Home Visits and Enquiries 96 Care Committee 96 Dispensary 98 Sanocrysin Treatment 99 Artificial Light Treatment 99 Report by Tuberculosis Officer 99 Summary of work carried out 101 Section VII.—Other Services. Disinfecting and Cleansing Station 102 Disinfection for Institutions, etc. 103 Cleansing Station 103 Bacteriological Work 104 Appendix. Table No. 1. Vital Statistics for 11 years 106 page Table No. 2. Registrar - General's Short List of Causes of Death 107 Do. 3. Births and Deaths in Wards 110 Do. 4. Do. in County of London and Metropolitan Boroughs 111 Do. 5. Meteorology 112 Do. 6. Work carried out by District Inspectors 113 Do. 7. Work carried out by Food Inspectors 114 Do. 8. Do.—Factory & Workshop and Women Inspectors 115 Do. 9. Do.—Centre Superintendents, Women Inspectors and Health Visitors ,,116 6 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 1932, to October, 1933. CHAIRMAN. Councillor Charles Henry Denyer, M.A. DEPUTY-CHAIRMAN. Councillor John Evans. EX-OFFICIO. The Right Worshipful the Mayor (Alderman Sidney Bolsom, J.P., F.R.G.S.). ALDERMEN. Davies, David, J.P., L.C.C. Escott, Arthur, F.I.B.D. Morrell, Rev. R. Conyers, M.A. Rolles, Harry. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 3 Barry, Mrs. Mary Ann. 2 Bell, Mrs. Florence Nightingale Harrison. 6 Cooper, William. 7 Crosby, Miss Ada, M.B.E. 1 Davies, John William. 8 Evans, Evan, L.C.C. 1 Flint, Mrs. Louisa Elizabeth. 4 Flynn, William, J.P. 6 French, Alexander George. 3 Hewson, Frederic. 2 Horne, George, J.P. 5 Kemp, Sydney Alfred. 5 Radford, Mrs. Laura. 1 Smerdon, Mrs. Edith Maude. 5 Swann-Mason, Rev. Richard Swann, O.B.E., M.A. 7 Swift, Mansell James, F.R.M.S. November, 1933, to October, 1934. CHAIRMAN. Councillor Charles Henry Denver, M.A. DEPUTY-CHAIRMAN. Councillor John Evans. EX-OFFICIO. The Right Worshipful the Mayor (Councillor Frederic Hewson, J.P.). ALDERMEN. Davies, David, J.P., L.C.C. Escott, Arthur, F.I.B.D. Morrell, Rev. R. Conyers, M.A. Rolles, Harry. COUNCILLORS. Ward 3 Allan, Mrs. Isabella Menzies. 4 Alliston, Mrs. Evelyn. 3 Barry, Mrs. Mary Ann. 2 Bell, Mrs. Florence Nightingale Harrison. 8 Blackmore, Claud. 7 Crosby, Miss Ada, M.B.E. 8 Evans, Evan, L.C.C. 1 Flint, Mrs. Louisa Elizabeth. 4 Flynn, William, J.P. 6 French, Alexander George. 2 Horne, George, J.P. 7 Jenkins, Edwin. 5 Kemp, Sydney Alfred. 2 Moore, Thomas Fairless. 1 Perryman, Walter. 5 Radford, Mrs. Laura. 1 Smerdon, Mrs. Edith Maude. 7 Swift, Mansell James, F.R.M.S. 7 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT END OF THE YEAR 1933, 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. Y. Phitchard, 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. A. E. Tatt—Wards 5, 6 and 7. Dr. F. L. Pelly—Ward 2. Dr. C. H. A. Alderton—Ward 8, Dr. J. Wigg—Wards 3 and 4. vaccination officer. Mr. A. E. Wolfe. (G) sanitary inspectors. Inspectors of Food and Food Places. §¶W. G. Auger. ‡¶H. K. Nixon. Inspectors of Workshops and Factories. ‡Miss M. E. Bibby, B.A. (Lond.). ‡§B. II. Thompson. District Inspectors. ‡§W. L. Brown. ‡¶S. W. Capel *‡§¶A. H. Walker. §H. G. West. ‡§R. E. James. ‡¶+E. W. Winchester. ¶‡G. W. Adkins. xT. H. Hague. ‡R. C. Akers. x W. C. Mansfield. ‡M. Jaffa. (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. ¶ x +R. Warren. (g) G. N. Cove. J. A. Hoare. (g) Miss A. Andrews. (g) E. F. Kirby. F. A. J. Goodchild (attached to R.N. Thomas. the Estates Dept.). J. F. Woolvin. W. B. Dykes. * Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Royal San. Inst. ¶ Cert. Meat and other Foods. || Health Visitor's Certificate, + Smoke Abatement Cert. (L.C.C.). †C.M.B. ** Certificate, Queen Charlotte's Hospital. X Cert. Royal San. Inst. and San. Insp. Exams. Joint Board. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 8 borough council staff at the centres and clinics. (g) Medical Officers. No, of Consultations per month. Dr. Chas. H. A. Alderton 4 Dr. B. Marion Cockerell 10 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 6 Dr. Nora Leesmith 4 Dr. Lydia A. Leney 4 Dr. J. Balfour Neill 8 Dr. Martin Oldershaw 4 Dr. Mary J. Pirret 8 Dr. Francis L. Provis 4 Dr. Audrey E. Russell 4 Dr. Abraham I. Silverman 4 Dr. Hrlen Gillespie 5 (g) Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist ti Dr. Jas. Maughan, Anæsthetist 2 (g) Artificial Light Clinic. Dr. P. V. Pritchard 8 (g) Consulting Obstetric Surgeons. Martin H. Oldershaw, M.D., B.S., F.R.C.S. Francis L. Provis, M.R.C.P., F.R.C.S. (g) Dentists at Tuberculosis Dispensary. Mr, A. J. Maurice, L.D.S. Mr. J. H. Threlfall, L.D.S. Mr. B. R. Vincent. L.D.S. (The above are part-time officers.) (g) Superintendents of Maternity and Child Welfare Centres. Senior. Junior. ‡||Miss G. R. Bristow. ¶||†Miss M. L. Blair. ||†Mrs. E. Crockart. ||†Miss E. M. Robinson. ||†Miss M. H. Landel Jones. ¶†Miss M. Templeton. ||†Mrs. S. C. Chapman. **||†Miss M. Manger. (g) Health Visitors and Inspectors at Maternity and Child Welfare Centres. ‡§||Miss F. A. Anderson. ¶||Miss A. M. U. Harrop. ¶†**Miss E. B. Bagnall. ‡§Mrs. A. Hunter. ‡||Miss v. K. Blaxland. †Mrs. E. Lurie. ||†Mrs. E. E. Bruce. †||‡Mrs. J. Lynn. ||‡Miss M. A. Clarke. ||†Mrs. M. A. Smith. ||†Miss B. M. Harris. (g) Tuberculosis Dispensary. Nurse, ¶†‡Miss S. A. Long. Clerical, etc., Assistant, Miss M. Deed. DISINFECTING AND CLEANSING STAFF. T. Bartholomew (Foreman). Mrs. E. Mace (Matron). A. J. Dibben (Disinfector). Mrs. L. Blaby (Assistant). J. Stanley (Driver and Disinfector). J. Root (Mortuary, etc., Caretaker). C. Browne ( Do. ). (The above are full-time officers.) ‡ Cert. San. Insp. Examination Board. || Health "Visitor's Certificate. § San. Insp. Cert. Royal San. Inst. † C.M.B. ¶ State Registered Nurse. ** Midwifery Certificate, Queen Charlotte's Hospital. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 9 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 my Annual Report 011 the sanitary circumstances, sanitary administration, and the vital statistics of the Borough for the year 1933. This is the 78th Annual Report which has been presented to the Sanitary Authority, and the eleventh 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 11 and 12. During the earl)' months of the year, Influenza, of a somewhat severe type and with Pneumonia as a frequent complication, was very prevalent, and was responsible for a high mortality during January and February. The outbreak was widespread and extended practically throughout London and the country. A brief spell of cold weather in December also tended to cause an increase in the death rate, especially in old people, but the long, dry and exceptionally warm summer had a favourable influence and to a considerable extent counteracted the above-mentioned adverse factors. The birth rate, which has steadily declined for a number of years, was again the lowest on record, and for the first time in the history of the Borough was slightly lower than the death rate. The rate of Infantile Mortality was the lowest ever recorded in the Borough, being only 58 per 1000 births, the corresponding rate for the whole of London being 59. This remarkably low rate, and also the decrease in the number of deaths of children under 5 years of age and the low general death rate, would appear to indicate that the nutrition of the people, and consequent resistance to disease, had been reasonably well maintained, despite public anxiety on the subject of unemployment and its possible effect on nutrition. There was no undue prevalence of notifiable infectious diseases, with the exception of Influenzal Pneumonia during the early part of the year, of German Measles in the second quarter, and some increase in Scarlet Fever, of a very mild type, during the last quarter of the year. Housing conditions continued to receive attention and a number of areas were inspected with reference to the possibility of action being taken under Section 1 of the Housing Act of 1930. Several areas will probably be dealt with during the coming year. 10 Further progress was made with the housing schemes of the London County Council in the Somers Town area, the St. Pancras House Improvement Society, and on the Crown Estate in the Cumberland Market area. The block of 64 flats being erected by the Borough Council in Leighton Road were nearing completion by the end of the year. In accordance with statutory provisions, a very complete survey of the public health services of the Borough was made during the year by Medical Officers of the Ministry of Health. The subsequent report indicated, in the words of the Act, "That a reasonable standard of efficiency and progress is being maintained by the Borough Council in the discharge of their functions relating to public health." Appreciation was also expressed in the report of the support given by the voluntary agencies associated with the work. The following changes occurred in the staff of the department during the year:— Mr. H. R. Child, Inspector of Food, and an exceedingly active and efficient officer, retired owing to ill-health after 33 years' service. Mr. J. I. Lonnon, who had been a district Sanitary Inspector since 1899, retired on superannuation. Mr. H. K. Nixon, one of the district Sanitary Inspectors, and who possessed the necessary qualifications, was appointed Food Inspector in the place of Mr. Child. Mr. T. H. Hague and Mr. W. C. Mansfield, both of whom were qualified Sanitary Inspectors, but who had been for some years on the Clerical Staff of the Public Health Department, were appointed to take the place of Mr. Nixon and Mr. Lonnon respectively. As this is the last Annual Report it will be my privilege to submit, I would like to conclude by expressing to the members of the Council, and particularly to the members of the Public Health Committee, my appreciation of the kindness and consideration they have so invariably accorded to me during the years I have held office. To every member of the staff of the Public Health Department I am indebted for a loyal support and ready co-operation which has never failed and for which it is impossible adequately to express my thanks. I am, Ladies and Gentlemen, Your obedient Servant, G. SOWDEN, Medical Officer of Health. 11 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), 198,133. Number of inhabited houses at end of 1933 (according to Rate Books), 27,118. Number of families or separate occupiers (1931 Census), 56,929. Number of persons per acre (Census year 1931), 74. 2.—Principal Statistics for 1933. Population (Registrar-General's mid-year estimate), 190,900. Number of persons per acre, 71. Births. Males, 1,331; females, 1,258. Total, 2,589. Birth rate, 13.6 per 1000 of population. Legitimate births, 2,362; illegitimate births, 227. Excess of deaths over births, 19. Deaths. Males, 1,424; females, 1,184. Total, 2,608. Death rate, 13 7 per 1000 of population. Infantile Mortality. Deaths of infants under one year of age per 1000 births, 58. Legitimate rate, 54; illegitimate rate, 106. 12 Maternal (Puerperal) Mortality. Number of women dying in, or in consequence of, child-birth : From Sepsis, 5; from other causes, 5. Total Puerperal Mortality, 3 7 per 1000 births (live and still). Number of deaths from Measles (all ages), 4. ,, „ Whooping Cough (all ages), 15. ,, „ Diarrhœa and Enteritis (under 2 years of age), 32. Tuberculosis. Pulmonary. Deaths, 171; death rate per 1000 of population, 0.90. All forms. Deaths, 195; death rate per 1000 of population, 1.02. Rateable value, £2,103,010. Sum produced by a penny rate, £8,230. Rainfall during the year (recorded at Camden Square), 16.8 inches. Comparative Statistics. Rate per 1000 of Population. Rate per 1000 Births. Birth rate. Death rate. Infant Mortality. St. Pancras 13.6 13.7 58 England and Wales 14.4 12.3 64 107 Great Towns 14.4 12.2 67 County of London 13.2 12.2 59 13 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1933. For the purpose of this Report, the year consists of the 52 weeks ended 30th December, 1933. Section 1.-STATISTICS AND SOCIAL CONDITIONS OF THE AREA. POPULATION AND GENERAL STATISTICS. The total population of the Borough at the Census of 1931 was 198,133. The Census figure of 198,133 represents a decrease in the population of the Borough of 6.3 per cent. since the Census of 1921, at which date the population of the Borough was 211,366. The mid-year (1933) population of the Borough is estimated by the Registrar-General to be 190,900. The corresponding estimate for the previous year (1932) being 191,000. Until recently the estimated population has been divided into civil and total, but for the past two years the estimated total population only is given. Deaths of persons serving in H.M. Forces being now allocated to their area of residence in the same manner as civilian deaths. The following figures taken from the Census Report for 1931 shew the number of persons of each sex in each of the Wards in the Borough:— Administrative Area of St. Pancras Metropolitan Borough. Males. Females. Total. Ward — No. 1 15,867 20,005 35,872 No. 2 9,621 10,054 19,675 No. 3 15,615 17,543 33,158 No. 4 11,965 11,990 23,955 No. 5 13,737 15,004 28,741 No. 6 8,861 9,139 18,000 No. 7 6,155 6,867 13,022 No. 8 12,562 13,148 25,710 Total 94,383 103,750 198,133 14 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. The information obtained at the last Census (1931) with reference to the numbers engaged in the principal occupations is not yet available, but will probably be published in time for inclusion in the next Annual Report. There are no particular industries carried on in the Borough which to any extent affect the public health prejudicially. ECONOMIC CONDITIONS. Although many parts of St. Pancras are inhabited by persons who are in good financial circumstances, a large proportion of the Borough is working class in character. Unemployment and irregular employment are therefore factors which may lead to under nourishment, and are also likely to be associated with inadequate housing accommodation and overcrowding, and so affect the public health adversely. In this connection the following particulars with reference to the amount of out-door relief granted by the Public Assistance Authority and the number of persons registered as unemployed may be of interest. They have been provided by Mr. B. Chapman, local Public Assistance Officer, and the Statistics Branch of the Ministry of Labour. For comparison the corresponding figures for the previous year are given:— 26 weeks ended. Average weekly No. of persons receiving out-relief. Average weekly cost of relief. 26 weeks ended. Average weekly No. of persons receiving out-relief. Average weekly cost of relief. £ £ March, 1933 5121 1459 2nd April, 1932 4304 1190 September, 1933 4159 1237 1st October, ,, 4765 1222 Number of unemployed:— Men. Boys (14.18). Women. Girls (14.18). Total. At January 22nd, 1934 6567 149 1298 92 8106 At January 23rd, 1933 7888 168 1453 113 9622 15 MARRIAGES. The number of marriages celebrated during the year was 1,801. This is equal to a rate of 9.4 marriages per 1000 of total population, or a rate of 18.8 persons marrying per 1000 of the population. The average yearly number of marriages during the preceding five years was 1,949, equal to a rate of 9.6 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 2,589, equal to an annual birth rate of 13.6 per 1000 of population. This is the lowest birth rate recorded in the Borough. The rate for the previous year was 13.8, and the rate for 1931 was 15.1. The actual number of births registered as having taken place in the Borough during the year was 4,208, 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 1,969, and by adding the births belonging to St. Pancras which occurred outside the Borough —these numbered 350. The corrected figure being therefore as stated above, 2,589. The corresponding figures for previous years are given in Table 1, on page 106. The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1933, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Ward. 1933. 1932. Births. Birth Rate. Births. Birth Rate. 1 435 12.6 472 13.4 2 301 15.9 310 16.1 3 526 16.5 525 16.2 4 318 13.8 346 148 5 386 13.9 375 13.3 6 217 12.5 257 14.6 7 113 9.0 126 9.9 8 293 11.8 273 10.8 Borough 2589 13.6 2684 13.8 No less than 2,870 births occurred in Public Institutions in St. Pancras, equal to 68 per cent. of the total births which took place in the Borough. Table 4, on page 111, shows for 1933 the birth rate of the County of London and of the Metropolitan Boroughs. The rates for England and Wales and the Great Towns are set out on page 12. 16 Illegitimacy. Of the 2,589 net St. Pancras births, 227 were recorded as being illegitimate. This equals 8.8 per cent. of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1923 5.7 per cent. 1928 7.3 per cent. 1924 5.9 „ 1929 7.8 „ 1925 6.3 ,, 1930 8.4 „ 1926 6.3 „ 1931 8.3 „ 1927 6.9 „ 1932 8.0 „ 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 recent years. Notification of Births. The long delay which might and frequently did occur before a birth was registered was found to diminish the value of the work carried out at the Welfare Centres. At times the death of a child would be reported before information had been received with reference to its birth. The Notification of Births Act was therefore passed in order to remedy this defect and to give the Local Authority early information of the occurrence of all births. 4,246 notifications of births were received during the year: this includes 158 stillbirths and 4,088 live births, and represents 97.1 per cent. of the births registered as having taken place in the Borough. The Notification of Births Acts (1907-1915) requires: "Information with regard to the event to 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. 17 The fact of still birth must be certified either by the Medical Practitioner or Midwife who was in attendance, or who has examined the child, or by declaration in a prescribed form if no Medical Practitioner or Midwife was present. If, in any of the last mentioned cases, information is given by the Registrar to the Local Authority, the Minister of Health has intimated that the Medical Officer of Health shall arrange for enquiries to be made in order that he may be satisfied that the child was really still born and that there were no suspicious circumstances attaching to the case. In accordance with the instructions of the Ministry of Health, the following table is included which gives particulars, by sex and legitimacy, with reference to all still births registered in the Borough during the year:— Still Births Registered. Inward Transfers. Outward Transfers. Still Births Allocated to the Borough. Total Legitimate and Illegitimate Males 87 7 45 49 Females 89 1 51 39 Illegitimate Males 8 1 1 8 Females 11 - 4 7 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 2,608; equal to an annual death rate of 13.7 per 1000 of population. The corresponding rate for the previous year was 13.1 and the average yearly death rate of the Borough for the previous five years was 13.3 per 1000 of population. It should be noted that for the first time in the history of the Borough the death rate was higher than the birth rate. For a number of years a decrease has been taking place in both of these rates, with the result that the population now contains a larger proportion of persons at the later years of life. As the death rate of these older persons is high, it may be anticipated that in future years the death rate will tend to equal or to be consistently higher than the birth rate, and to result, apart from immigration, in a stationary or decreasing population. The actual number of deaths registered as having taken place in the Borough during the year was 3,102. This number has to be corrected by the exclusion of 1,032 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 538 deaths of residents which occurred and were registered outside the Borough. The corrected figure is therefore 2,608 and is used in calculating the death rate in this report. In Table 1, on page 106, will be found details of the corresponding figures for previous years. 18 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. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Average for 10 years. 1933 Heart Disease 394 398 380 388 448 465 603 430 553 590 4G5 656 Cancer 319 298 324 301 292 321 297 357 355 359 322 354 Tuberculosis—all forms 272 271 231 212 217 216 250 189 206 189 225 193 Pneumonia 201 200 204 155 207 181 295 160 203 184 '99 168 Injuries 113 114 118 142 132 145 129 165 121 123 130 158 Influenza 24 80 41 29 83 14 137 14 49 4' 5' 121 Bronchitis 223 304 274 259 227 138 255 106 '43 99 203 100 Congenital Debility, Malformation and Premature Birth 119 105 94 100 69 86 88 72 76 58 86 68 Nephritis and Bright's Disease 79 75 75 89 84 83 72 72 61 55 75 68 Cerebral Hæmorrhage, Embolism, and Apoplexy 112 118 123 110 92 67 78 99 92 63 95 56 Diarrhoea and Enteritis 61 63 55 63 35 52 48 52 33 61 52 36 Rheumatic Fever 8 5 18 10 13 15 7 17 18 16 13 18 Whooping Cough 28 46 71 24 35 24 77 4 14 25 35 15 Diphtheria and Croup 20 22 34 12 6 12 18 32 19 10 19 13 Erysipelas 4 4 12 8 6 2 4 9 8 17 7 9 Puerperal Fever 9 4 4 1 4 3 4 — 2 9 4 5 Measles 5 74 3 65 5 127 7 31 2 27 35 4 Scarlet Fever 3 12 — 2 2 1 4 7 2 5 4 4 Pleurisy 8 8 16 5 3 7 5 6 4 3 7 2 Enteric Fever 3 2 3 1 2 1 3 1 1 2 2 — The Registrar-General's short list of deaths at different age periods is given in Table 2 on page 107, and, for the purpose of comparison, the death rates for the County of London and the Metropolitan Boroughs are given in Table 4 on page 111. The rates for England and Wales and the Great Towns are set out on page 12. It will be noted that 27 Metropolitan Boroughs had a lower and one a higher general death rate than St. Pancras, Of the total 2,608 St. Pancras deaths which occurred during the year, no less than 1,729 took place in public institutions; this equals a proportion of 66 per cent. of the total deaths. 19 As compared with the average of previous years there was an increase in the number of deaths due to Heart Disease, Cancer, Injuries and Influenza; and a decrease in those attributed to Tuberculosis, Pneumonia, Enteritis and Bronchitis. Deaths of Aged Person. The corrected number of deaths of residents at 65 years of age and upwards, which occurred during the year 1933 was 1,204. Of these 614 were between the ages of 65 and 75; 452 were between the ages of 75 and 85, and 138 were 85 years of age and upwards. Ward Deaths and Death Rates. The number of deaths and the death rates per 1000 of population for each of the Wards during the past year were as follows, the figures for the preceding year being also given for comparison:— Ward. 1933. 1932. Deaths. Death Rate. Deaths. Death Rate. 1 407 11.8 424 12.1 2 239 12.6 225 11.7 3 462 14.5 422 13.0 4 333 14.4 359 15.3 5 377 13.6 370 13.1 6 233 13.4 180 10.2 7 154 12.3 168 13.2 8 343 13.8 347 13.8 Homeless 60 — 50 — Borough 2608 13.7 2545 13.1 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 16 High gate Hospital 5 St. Pancras Hospital 31 Various other Hospitals 5 Found dead in High Street, Camden Town 1 Found dead in Regent's Canal 1 Found dead in Telephone Box, Seaton Street 1 Total 60 20 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 — - — 1 6 1 8 Pneumonia 7 — 1 - 13 16 37 Cerebral Hæmorrhage . - — — - 2 2 4 Cancer - — — 10 7 17 Tuberculosis . - — — - 3 — 3 Other causes . 14 9 6 5 47 14 95 Accidents— Street Vehicles — 4 15 8 33 22 82 Burns and Scalds 3 5 3 1 8 8 28 Railway — - — — 6 1 7 Falls 1 3 1 2 30 75 112 Other causes* 3 2 4 3 11 10 33 Suicides † — — 1 9 110 12 132 Murder — - - 2 — — 2 Manslaughter — — - — — — — Open Verdict‡ 1 — - 1 11 — 13 Totals 29 23 31 32 290 168 573§ * Includes 7 cases of coal gas poisoning. ‡ Includes 1 case of coal gas poisoning, † ,, 59 cases ,, ,, § St. Pancras cases 151, ex-St. Pancras 422 (see also page 53). Infantile Mortality. 151 deaths of St. Pancras infants under one year of age occurred during 1933. This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 58. The corresponding rate for the previous year was 69. The following table gives the deaths and death rates of both legitimate and illegitimate infants for 1933:— Legitimate. Illegitimate. Total. Number of Births 2,362 227 2,589 Number of Deaths (under one year of age) 127 21 151 Death rate per 1000 births 54 106 58 In Table 1, oil page 106, the Infantile Mortality rates are given for previous years, and in Table 3, on page 110, the figures will be found for each Ward. Table 4, on page 111, gives the Infant Mortality rates for the County of London and the Metropolitan Boroughs. The rates for England and Wales and the Great Towns are set out on page 12. On the next two pages tables are given which indicate 1. The causes of death of all children under one year of age during 1933, 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 1933. cause of death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Scarlet Fever - - - - - - - 1 — 1 Whooping Cough - - - - - - - 3 1 4 Diphtheria - - — - - - - 1 — 1 Influenza - - - - - - 1 - - 1 Tuberculous Meningitis - - - - - - 1 - - 1 Meningitis (not Tuberculous) - — — 1 1 1 2 — 2 6 Convulsions 2 — - — 2 — — — — 2 Bronchitis - — - 1 1 — — 1 2 4 Broncho-pneumonia 1 — - — 1 4 4 1 2 12 Diarrhœa - - - - - - 1 — 1 2 Enteritis — — 2 1 3 6 13 2 3 27 Syphilis - - - - - - 1 - - 1 Rickets - - - - - - - 1 1 2 Injury at Birth 2 — — — 2 — — — — 2 Atelectasis 6 - - — 6 — 1 — — 7 Congenital Malformations 4 1 2 - 7 3 4 — — 14 Premature Birth 20 6 1 — 36 1 — — — 37 Congenital Debility, Sclerema and Icterus 4 1 1 — 6 1 1 — — 8 Other causes 4 — — — 4 3 7 2 3 19 Totals 52 8 6 3 69 19 36 12 15 151 Nett Births in the year legitimate 2362 Nett Deaths in the year ligitimate infants 127 illegitimate 227 illegitimate infants 24 22 Deaths from Stated Causes under 1 Year of Age for 1933 and 10 preceding Years. CAUSE OF DEATH. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Average for 10 years. 1933 Measles 1 15 2 25 - 30 - 3 1 6 8 — Scarlet Fever — — - - — — — — — — — 1 Whooping Cough 8 13 29 11 15 10 32 2 10 11 14 4 Diphtheria and Croup — - 1 1 — — 3 1 1 1 1 1 Erysipelas 1 2 2 — — - — 2 — 3 1 — Influenza - 6 2 1 2 — 5 2 1 2 2 1 Tuberculous Meningitis 4 3 2 3 3 — — 1 1 1 2 1 Other Tuberculous Diseases 3 - 1 1 1 2 — 2 2 1 1 — Meningitis (not Tuberculous) 3 5 4 3 2 1 4 3 8 3 4 6 Convulsions 5 4 4 2 1 1 5 - 1 — 2 2 Bronchitis 12 12 19 14 5 9 7 7 4 3 9 4 Broncho-pneumonia 34 51 34 36 42 43 43 20 42 27 37 12 Lobar-pneumonia 1 3 4 2 2 3 4 - 3 1 2 — Pneumonia (type not stated) 1 3 — 1 1 2 1 3 1 2 2 — Diarrhœa 6 6 9 7 3 8 5 6 6 9 6 2 Enteritis 37 46 36 28 24 33 34 36 22 42 35 27 Gastritis 1 - 2 — — — 1 - — 1 1 — Syphilis 5 2 5 1 2 4 1 3 2 2 3 1 Rickets - - - - - - - 1 - - — 2 Suffocation (overlying) 1 1 4 3 1 1 - 1 — — 1 — Injury at Birth 6 4 7 3 9 2 9 4 3 6 5 2 Atelectasis 9 7 2 6 10 11 7 3 4 8 7 7 Congenital Malformations 27 23 20 25 15 20 23 12 23 10 20 14 Premature Birth 70 59 57 57 39 50 46 48 43 36 51 37 Congenital Debility, Sclerema and Icterus 21 24 17 18 14 16 14 8 7 2 14 8 Other causes 16 14 17 16 14 15 18 26 15 9 16 19 Totals 272 303 280 274 205 261 262 194 200 136 244 151 Nett Births 4348 4112 3880 3612 3299 3274 3170 3208 2955 2684 3454 2589 23 Death Rates of Infants and Young Children. Although the death rate of children under 5 years of age and the Infantile Mortality rate have been falling for a number of years, there appears to have been little or on decrease in the heavy death rate which occurs during the first month of life. The following table gives the total number of deaths in the Borough at all ages, the number of deaths under 5 years of age, under 1 year of age, and under 1 month for each year during the period 1921-1932. The table also gives the percentage of deaths under 5 years of age to the total deaths at all ages, and the percentage of deaths under 1 month to the total deaths under 1 year for each year during the same period:— Year. Total deaths at all ages. Deaths under 5 years of age. Percentage of total deaths. Average Percentage for the 6 years. Deaths under 1 year of age. Deaths under 1 month. Percentage of deaths under 1 year. Average Percentage for 6 years. 1921 2778 495 17 18 360 135 38 37 1922 3107 618 20 337 117 35 1923 2585 408 16 272 129 47 1924 2848 515 18 303 96 32 1925 2745 434 16 280 95 34 1926 2680 409 15 274 98 36 The average Birth rate for years 1921-1926 was 19.6. 1927 2621 300 11 12 205 85 41 36 1928 2618 423 16 261 82 31 1929 3126 397 13 262 95 36 1930 2478 291 12 194 75 39 1931 2601 255 10 200 71 36 1932 2515 271 11 186 64 34 The average Birth rate for years 1927-1932 was 15.4. It will be noted that during the 6 years, 1927-32, the deaths of children under 5 years of age averaged 12 per cent. of the total deaths, but during the previous 6 years, 1921-6, the average was 18 per cent., a difference of 6 per cent. During the same periods the average birth rate fell from 19.6 during 1921-26 to 15.4 during the years 1927-32, a difference of 4.2. The decrease in the mortality rate of children under 5 years of age therefore more than compensated the fall in the birth rate. These figures are also of interest in relation to the system of Block grants which now replace the percentage grants previously made in connection with Maternity and Child Welfare work. One factor in the formula on which the amount of grant is based is the number of children in the area under 5 years of age. Although the number of such children in St. Pancras is decreasing, it is obvious from the above table that the decrease is due to a falling birth rate and not to any increase in the rate of mortality of the children concerned. The table also shows that during the 6 years, 1927-32, the average percentage of deaths under the age of one month to the total deaths under 1 year of age was 36, and during the previous period of 6 years, 1921-26, the percentage was 37, or practically the same. It would have been anticipated that the amount of Ante-Natal work which has been carried out during recent years would have had a favourable effect on this heavy mortality during the first month of life, and further inquiry into this point appears to be necessary. 24 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 ft and other Hospitals.— The following are situated within the Borough. The St. Pancras and Highgate Hospitals are primarily intended for residents of the Borough. St. Margaret's Hospital admits eases 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 Borough or of the metropolitan area. On the other hand, hospitals situated outside the Borough are largely used bv St. Pancras residents. Hospitals. Number of Beds. London County Council General Hospitals. St. Pancras Hospital, King's Road 384 Highgate Hospital, Dartmouth Park Hill 557 London County Council Special Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum and congenital syphilis in children) 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 General 239 Obstetric 43 Dental and Ear, Nose and Throat 32 National Temperance Hospital, Hampstead Road 152 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 78 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, Fitzroy Square Western Skin Hospital, Hampstead Road British Dentists' Hospital, Camden Road London Foot Hospital, Fitzroy Square British Hospital for Nervous Disorders, Camden Road British Red Cross Society Clinic for Rheumatism, Peto Place 25 Institution at, Provision for Unmarried Mothers. The Main Memorial Home, 49, Cartwright Gardens, W.C. 1, provides accommodation for young unmarried women expecting for the first time to become mothers. The Home is maintained by funds obtained from voluntary sources, but a grant is made by the Ministry of Health. St. Margaret's Home, 13, Burton Street, W.C.I. This Rescue Home, maintained entirely by funds from voluntary sources, provides accommodation for young women and babies requiring care and supervision, and endeavours to find suitable situations for those capable of work. Ambulance Facilities. London Ambulance Service (Accident and General). Headquarters, The County Hall, S.E.1. Telephone Hop 0262. Provides the following services:— (1) For removal of infectious cases. (2) For non-infectious and accident cases. (3) For maternity cases. Urgent maternity cases are removed to hospital at any hour of the day or night, free of charge, on application by a qualified medical practitioner or certified midwife, provided that a doctor or midwife accompanies the patient. Full details with reference to the London Ambulance Service were given in the Annual Report for last year. Other ambulance facilities include:— St. John's Ambulance Association, St. John's Gate, Clerkenwell, E.C.1. Tel. Clerkenwell 6644. British Red Cross and Order of St. John Ambulances, These convey 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 Clinics. Raydon Street, South Highgate The Borough Council. Almeric Paget Clinic, Rochford 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. 26 Situation. By whom provided. B. Maternity and Child Welfare Centres. St. Pancras School for Mothers, Ampthill Square The Borough Council, with assistance from the Voluntary Committee. Somers Town Centre, Chamberlain House „ „ North St. Pancras School for Mothers, Queen's „ „ Crescent South Highgate Centre, Raydon Street „ „ Camden Town Centre, Camden Road ,, „ Caversham Road Centre ,, „ University College Hospital Centre The Hospital Authorities. Royal Free Hospital Centre „ „ 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 Whitefield Day Nursery, 53, Whitfield Street „ ,, Day Nursery, Foundling Hospital Site ,, ,, D. Nursery Schools. Somers Town Nursery School, 18, Crowndale A Voluntary Committee. Road Jellicoe Nursery School, 6a, Rochford Street „ Mary Ward Nursery School, 16, Burton Street ,, Magdalen Mission Nursery School, 5, Clarendon The Mission Authorities. Street St. Christopher's Hall, Bridgewater Street The Committee of the St. Pancras House Improvement Society, Ltd. Trinity Presbyterian Hall, Buck Street The Church Authorities. E. Dental Clinics. Barnes House, Camden Road : For nursing and The Borough Council, expectant mothers and children under 5 years of age who attend the Maternity and Child Welfare Centres Ampthill Square: For mothers and children who The Voluntary Committee, attend the Centre at 1, Ampthill Square St. Pancras Dispensary: For Tuberculosis cases The Borough Council. „ For ordinary cases The Dispensary Committee. Eastman Clinic: For nursing and expectant The Committee of the Royal mothers and children; also Free Hospital and Clinic, provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. 27 Situation, By whom provided, F. School Clinics. Highgate New Town: Chester Road Voluntary Committees, working St. Pancras Centre, Prince of Wales Road under agreement with the Clarendon Square London County Council. G. Tuberculosis Dispensaries. Barnes House, Camden Road The Borough Council. University College Hospital The Hospital Authorities. H. Venereal Disease Clinics. These are provided at various Voluntary Hospitals under agreements made with the London County Council. The undermentioned are situated within the Borough, but many others in the Metropolis are available for St. Pancras residents:— The Royal Free Hospital, Gray's Inn Road (for women and children only). University College Hospital, Grower 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. I. 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. J. Convalescent Homes for Sick Poor Children. The Mayoress of St. Pancras Home, "Avalon,"By Voluntary Committee, with St. Alban's Road, N.W. 5 grant from Borough Council. Invalid Children's Aid Association (various Subsidy from Borough Council, homes) K. Open Air Schools. Holly Court, Highgate, N. 6 ,. London County Council. Euston Square, N.W. 1 ,, L. Professional Nursing ai Home. North London Nursing Association, 6 & 7, By Voluntary Committee, with Canonbury Place, N. 1 grant from Borough Council. Hampstead Nursing Association, 25, Heath Hurst „ Road, N.AV. 3 Metropolitan Nursing Association, 14, Oakley ,, Square, N.W. 1 M. Massage Clinics. St. Pancras School for Mothers, Ampthill Square By Voluntary Committee. Somers Town Welfare Centre, Chamberlain ,, House Camden Town Welfare Centre, Barnes House ,, 28 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 daring 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 scheme came into operation on April 1st, 1930, and coutinued in force until 31st March, 1933. An amended scheme was then prepared by the Minister of Health, coming into force on April 1st, 1933, continuing until March 31st, 1937. The following associations are those to which the St. Pancras Borough Council make contributions, the amounts under the old and amended schemes being also stated:— Scheme expiring 31st March, 1933. Scheme expiring 31st March, 1937. £ £ St. Pancras School for Mothers 777 777 Somers Town Welfare Centre 249 275 North St. Pancras School for Mothers 136 136 South Highgate Welfare Centre 178 141 Caversham Road „ 421 421 Grafton Road „ 32 — Camden Town „ 197 560 Argyle Square ,, 121 — St. Pancras Dispensary 146 146 University College Hospital 890 890 Whitefield Day Nursery 564 480 Kentish Town „ 432 513 Margaret ,, 403 750 Mayoress of St. Pancras Home for Sick Poor Children 758 700 The increase at the Somers Town Centre of £26 was due to the extra cost of cleaning, lighting and heating as a consequence of the transfer of the work of the Argyle Square Centre. The South Highgate Centre and the Whitefield Day Nursery reductions were arrived at after consideration of the Institutions' statements of income and expenditure for the year ended 31st March, 1932. The increase in the grant for the Camden Town Centre (£363) was due to the loan expenditure for the larger premises now occupied at Barnes House and for additional 29 expenses for cleaning, lighting and heating, owing to the inclusion of the Centre formerly held at Grafton Road, and also the dental clinic which had been transferred from Argyle Square. The increased amount for the Kentish Town Day Nursery (£81) was due to the receipt of an application from the Voluntary Committee pointing out that the previous grants had proved to be inadequate. With regard to the Margaret Club and Day Nursery the Borough Council had made a special building grant of £780, paid in four half-yearly instalments, in addition to the block grant, pending the revision of the scheme. The increased amount was due to the fact that the old premises catered for twenty children, whereas the new premises accommodated fifty children, and the expenditure had increased proportionately. With regard to the Mayoress of St. Pancras' Nursing Fund and Home for Sick Poor Children, the Ministry of Health were informed that the financial position of the institution justified the reduction. 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 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. 30 A scheme of co-operation in Ante-natal work between the Borough Council and University College Hospital, in force since January 1st, 19'28. During the preceding year a scheme was brought into operation, in association with the Voluntary Committees, for the provision of sterilised maternity outfits. Arrangements were made by which these could be obtained either at about cost price, or in necessitous cases below cost price, according to individual circumstances. 2. At Birth. A subsidy is paid by the Borough Council to certain hospitals in connection with the admission of necessitous cases to their maternity wards. A subsidy is also paid in connection with certain cases attended at home by 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. •J. Infanta 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) arc 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. Duties concerned with infant life protection under Part I of the Children Acts, 1908-1932. 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. 31 Home Visiting.—The Council's Health Visitors at the Welfare Centres are full-time workers (19 in number), who divide their time between the necessary work at the Centres and visiting the homes of the mothers and children. In addition there was one full-time and one part-time trained worker, not paid by the Council, at the Caversham Road Centre, and one part-time trained voluntary (unpaid) worker (who resigned early in the year) 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. During 1933 the Council's staff at the various Centres made 26,163 visits to 2,453 children, and 2,800 visits to 1,286 expectant mothers; the trained workers not paid by the Council made 6,933 visits to 495 children, and 605 visits to 494 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 1286 2800 2453 26163 Trained Centre staff, not paid by Council 494 605 495 6933 Total of all trained workers 1780 3405 2948 33096 Corresponding totals for 5 previous years— 1932 1862 3309 3086 29386 1931 1645 3306 3263 34002 1930 1645 3105 3519 37972 1929 1845 3632 3643 41711 1928 1574 3192 3463 42141 32 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. Other St. Pancras School for Mothers 37 93 204 5 13 222 3236 1209 1036 5481 258 413 503 7188 14 170 1 12 4 - Somers Town Centre 64 177 188 38 21 247 4642 1868 1091 7601 230 507 433 4555 16 198 1 12 3 1(e) North St. Pancras School for Mothers 100 334 344 13 20 377 4832 1073 1101 7506 193 623 562 4853 18 211 2 24 3 — South Highgate Centre — — 80 5 3 88 1517 573 413 2503 73 146 149 1576 8 102 - — 1 — Camden Town Centre 164 424 383 19 56 458 5998 2145 2105 10248 291 426 599 5129 20 249 2 24 5 — Caversham Road Centre 157 912 295 19 21 335 4618 942 941 6501 241 750 416 5477 13 141 4 48 2 2(f) †University College Hospital 634 3221 385 19 38 442 2236 344 527 3107 279 295 153 3632 18 202 18 203 — 2 †Royal Free Hospital 174 719 - — — 133 461 224 207 892 215 245 133 686 12 153 12 150 — 3 Totals 1330 5880 — — — 2302 27540 8878 7421 43839 1780 (a) 3405 (b) 2948 (c) 33096 (d) 119 1426 40 473 18 8 An additional visitor was also attached to the following Centres:— North St. Pancras School for Mothers, for 2 days a week: Caversham Road, for 3 days a week; South Highgate, for 1 day a week. (a) Exclusive of 3 visits by students (Caversham Road). (b) ,, 33 ,, ,, (Caversham Road 28, Somers Town 5). (c) ,, 5 ,, ,, (Caversham Road). (d) ,, 306 ,, ,, (Caversham Road 218, Somers Town 88). (e) Part-time trained visitor. (Resigned, January, 1934.) (f) 1 full-time and 1 part-time trained visitor. Caversham Road, f Figures refer to St. Pancras cases only. (At University College Hospital there is, in addition to these 2 Health Visitors, 1 Sister with 5 Visiting Maternity Nurses who are detailed to visit special ante-natal cases.) 33 Maternity and Child Welfare Centres. These are 8 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 011 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 32 gives statistics concerning the work of all the Centres during the year. It will be seen that 473 ante-natal consultations were held, the number of expectant mothers was 1,330 and their total attendances were 5,880. For the two previous years the total attendances were 6,367 and 6,388. The number of consultations for children was 1,426, the children who attended for the first time numbered 2,302, and the total attendances were 43,839. For the two previous years the total attendances of children were 45,123 and 47,557. 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 2,090. Other activities of this centre include the following:— Classes for Mothers. At infant care classes there were 405 attendances; and at needlework, etc., classes, 735 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,953 dinners were supplied to nursing and expectant mothers, and 2,340 to young children. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,801 attendances during the year, of which 502 were made by infants under one year of age, and 1,299 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 41 consultations were held, at which 226 treatments were provided for mothers and 166 for children. Details of the work done are given in the following table:— Mothers. Children. Extractions with anaesthetics 46 26 „ without anaesthetics 1 4 Fillings 63 71 Scalings 14 — Impressions and fitting dentures, etc. 57 — Examinations and advice 45 65 Totals 226 166 392 34 Massage Clinic. 697 treatments were given by trained masseuses, the cost of whose services was not paid by the Borough Council. Somers Town Centre, Chamberlain House, Ossulston Street. In addition to the Consultations provided by the Borough Council, the Health Visiting Staff had 1,246 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes, at which 418 attendances were recorded, and 42 mothers and 57 children were sent away on holiday for a period of two weeks. 844 massage treatments were given by a trained voluntary masseuse. The clothing stall was kept well equipped by voluntary knitters. 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 264 attendances were recorded. Health Talks and Cookery Demonstrations were held, at which 86 attendances were made. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 1,913. 54 children and 1 mother attending this Centre were referred for Artificial Light treatment and 15 children for Massage at the Alineric Paget Institute, a Voluntary Society whose premises are at 14, Rochford Street, which is near the Centre. 44 mothers and 54 children were referred to the Council's Dental Clinic for treatment. 24 mothers and 25 children were sent away on holiday or convalescence. Camden Town Centre. 24 mothers and 28 children were sent away on holiday, for a period of two weeks, either to the country or seaside. Interviews with parents by the Superintendent, apart from medical consultations, numbered 2,670. 20 classes for expectant mothers were held simultaneously with the ante-natal clinics. There were 362 attendances. The services of two trained masseuses (not paid by the Borough Council) were available throughout the year, during which time two massage clinics were held weekly and a third was instituted at the beginning of September. There were 865 attendances. On the recommendation of the Public Health Committee, the Council gave authority for the erection of a Perambulator Shed for the use of mothers attending this Centre, at an approximate cost of £83. South Highgate Centre. Five mothers and five children were sent on holiday, either to the country or seaside, for a period of two weeks. Caversham Road Centre. In addition to the consultations provided by the Council, a number of others have been held, the cost of which has been defrayed out of funds from voluntary sources. The services of two qualified Health Visitors (one full-time and one part-time) were also provided from the same fund. 35 Classes have been held in Needlework, Child Study and Mothercraft, at which there were 585 attendances. 44 mothers and 65 children were sent away on holiday for two weeks to the seaside or country. 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 the period July to November. Consultations were held on two days in each week, the average number of patients at each consultation being 14, as compared with 35 during the previous year, and 39 per consultation in 1931. Staff', Equipment and Statistics for 1933. 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 the Council's Assistant Medical Officer, Dr. P. V. Pritchard. 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 Sun 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:— 1933. Total number of cases treated 40 Total number of new cases 35 Total number of attendances 604 Number of Consultations held 44 Average attendance per Consultation 14 Average number of attendances per child 15 Cost. £ s. d. Electric current 3 8 11 Cleaning 5 14 0 Miscellaneous 0 10 0 £9 12 11 No part of the salary of the Superintendent or Health Visitors is allocated to nor included in the above figures. 36 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 Ray Therapy, Camden Road, and also at the Voluntary General Hospitals in the Borough. The Borough Council's Dental Clinic, Barnes House, Camden Road. At this clinic dental treatment is provided, under the Maternity and Child "Welfare Scheme, for nursing or expectant mothers and children under five years of age who are in attendance at the various Welfare Centres. Consultations are held every Thursday morning for fillings, etc., and each third Friday morning for gas (with an extra clinic occasionally). No charge is made for extractions, fillings or scaling, but the patients contribute what they can reasonably afford towards the cost of dentures. The work done during the year is summarised in the following table, the figures for the previous year also being given for comparison:— Work carried out at the Dental Clinic. 1933. 1932. Number of new cases Mothers 169 161 Children 270 230 Total 439 391 For extractions under nitrous oxide (eras) 374 309 Number of Attendances „ „ local anæsthesia 17 39 ,, fillings and dressings 401 406 ,, scaling 42 36 ,, impressions and fitting dentures 201 239 ,, examination and advice 646 501 Total attendances 1618 1530 Total number of clinics held 78 76 Number of clinics with nitrous oxide anæsthesia 21 21 The following table shows the number and cost of the dentures supplied during the year:- Number of Patients supplied with dentures 32. Total cost £104 0s. 0d. Amount paid by mothers £42 16s. 0d. Amount paid by Borough Council £33 17s. 6d. Amount paid by Public Assistance £8 0s. 0d. Amount paid by various Societies £19 6s. 6d. Five mothers paid the entire cost of their dentures. 37 The Societies who made contributions towards the cost of dentures were the Metropolitan Hospital Sunday Fund, £9 15s. 6d.; and various other societies, £9 1ls. 0d. Dental treatment is also provided at the voluntary clinic which is held at the St. Pancras School for Mothers, see page 33. The Eastman Dental Clinic attached to the Royal Free Hospital is a lavishly-equipped clinic which provides dental treatment for children and for nursing and expectant mothers, and operative treatment in connection with enlarged tonsils and adenoids in children. The Dental Section is equipped with 68 chairs and complete electric units, the Surgical wing contains 32 beds for tonsil and adenoid, cleft palate, hare lip, etc , cases requiring operative treatment. 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. 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 also 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, 1933, are as follows:— Number of Days Open. Attendances. Average per Day. White field Day Nursery 228 5814 25.5 Kentish Tn. Day Nursery 229 6900 30.1 Margaret Day Nursery 303 13879 45.8 Foundling Site Day Nursery 253 4873 19.3 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 use of this accommodation is desirable. Name and Situation. Accommodation. Average daily attendance. Somers Town Nursery School, 18, Crowndale Road 48 39 Jellicoe Nursery School, 6a, Rochford Street 54 43 Mary "Ward Nursery School, 16, Burton Street 25 19 Magdalen Mission Nursery School, 5, Clarendon Street 25 20 St. Christopher's Nursery School, Bridgewater Street 40 31 38 In addition to the above, a nursery school is available each day in premises in Buck Street, granted by the Trinity Presbyterian Church. The children have dinner, 1½ hours sleep, and hot baths occasionally, the average attendance being about 28. The school is affiliated to the Nursery School Association and two students from the North Western Polytechnic take their practical training at the school. A trained social worker, whose salary is paid from voluntary sources, is in charge, and assistance is given by a daily rota of voluntary helpers. A doctor visits regularly, and a small business committee supervises equipment. 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. Patients are referred from the Town Hall, from the Welfare Centres, by the Health Visitors, etc., to this clinic. The work carried out during the year is summarised in the following table, the figures for the previous year also being given for comparison:- 1933. 1932. New Cases: Children under 5 years of age 54 78 Ailing Nursing Mothers 44 46 Ailing Expectant Mothers 53 45 Attendances: Children under 5 years of age 134 232 Ailing Nursing Mothers 113 87 Ailing Expectant Mothers 106 107 Dispensary as a whole (including the above). New Cases: Children under 5 years of age 460 484 Ailing Nursing and Expectant Mothers 97 91 Attendances: Children under 5 years of age 1160 1106 Ailing Nursing and Expectant Mothers 219 194 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 service 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 966 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 a block grant made by the Borough Council in accordance with the scheme of the Ministry of Health. 89 Convalescent Home Treatment. (a) The Mayoress of St. Panchas 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. 162 children were admitted during the year, and the average length of stay in the Home was 27 days. (b) Children requiring a longer period of convalescence, or who require more skilled nursing, are sent to various homes by the Invalid Children's Aid Association, and a contribution towards the cost is made by the Borough Council. Under this scheme 36 children were sent away during the year. Infant Life Protection—Children Acis, 1908—1932. The duties under the above Acts were transferred to the Borough Council on April 1st, 1933. The following statement as to the duties and the recommendations of the Public Health Committee in connection with carrying out the work were approved by the Council:— "The duties comprise the supervision of the health and well-being of all children who are under the care of foster mothers until such children reach the age of nine years. A register of foster mothers must be kept with a list of children under their care, .and the Local Authority may fix a maximum number of nurse-infants who may be kept in any dwelling. Records must also be kept with regard to removals, deaths, offences against the Act, etc. When premises are registered for the first time, a report should be obtained as regards suitability and sanitary condition. We consider it advisable that the District Sanitary Inspectors shall inspect and report on the condition of the homes for registration purposes, for the clerical staff of the Public Health Department to keep the necessary records, and for the Health Visitors at the various Welfare Centres to carry out the duties of inspecting and supervising the homes, the health and well-being of the children, to give any necessary advice, and report contraventions of the Act. "Arrangements can be made for the extra work involved by the operation of the Order to be carried out without addition to the staff of the Public Health Department." 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. 40 Towards the end of 1931 it was considered that there might he 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 appeared to be probable that during recent years the question of health as the sole basis for a grant of milk had not been adhered to, and that purely financial reasons had been considered. This financial problem is the province of the Public Assistance Committee and not the Child AVelfare 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. Further consideration was given to this subject during the year as regards the provision of extra nourishment to expectant mothers attending the Ante-Natal Clinics of the London County Council Hospitals. The following procedure was suggested by the County Council and agreed to by the Borough Council:— Women in receipt of relief who attend the County Conncil's ante-natal clinics for examination and advice prior to confinement in the County Council's Hospitals should normally come under the sole supervision of the County Council during the ante-natal period, and, except in any particular case in which special arrangements have been made with the local maternity and child welfare centre, should not be required to attend the Borough Council's welfare centres for the purpose of obtaining extra nourishment, as such attendance would involve divided clinical responsibility. It is accordingly proposed that in these cases any extra nourishment required during the ante-natal period shall be supplied as relief in kind from the County Council's clinic. After confinement the nursing mothers will be referred to the Borough Council's welfare centres, with a view to any extra nourishment required being supplied through such centres. Recommendations from the welfare centres in respect of the supply of extra nourishment to nursing mothers (whether or not the mother has previously attended one of the County Council's clinics) will be dealt with in the same way as similar recommendations in respect of expectant mothers. 41 At the end of 1932 there were 225 families actually in receipt of milk under the Borough scheme. During 1933, 49.5 new families were added to the list of recipients. By the end of that year there were 219 families receiving grants. The total cost of this scheme in 1931 was £ 1,4.14; in 1932, £937; and in 1933, £1,086. FREE HALF-PRICE. COST. Month. Tints. Lbs. Pints. Lbs. £ s. d. * January 6020 360 560 45 112 8 6 February 5796 255 392 20 103 14 6 March 5936 260 364 35 92 13 11 *April 7168 300 216 30 111 12 6 May 4900 205 140 40 76 0 0 June 4088 220 112 25 66 2 9 *July 5908 255 224 15 91 8 9 August 4760 200 140 50 74 5 0 September 4480 180 196 25 69 1 11 *October 5852 265 J 224 5 103 9 5 November 5152 285 308 10 92 3 7 December 5320 210 308 15 93 4 10 65380 2995 3184 315 £1086 5 8 * 5 week months. 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 about £29. The scale in use in making the grants is based on weekly income and was originally drawn up by the Council in 1922. It was discontinued in April, 1928, and a new scale brought into use in consequence of a recommendation by the Minister of Health that the scale should be brought into accord with the fall in the index figure of the cost of living. The present revised income scale is shown hereunder:— Number in Family. After Deduction of Rent. Free. Half-price. £ s. d. £ s. d. One 0 12 0 0 13 9 Two 0 18 3 1 3 0 Three 1 2 0 1 7 6 Four 1 5 6 1 11 3 Five 1 10 0 1 16 6 Six 1 13 0 2 1 3 Seven 1 16 6 2 5 9 Eight 2 0 0 2 10 3 42 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. 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 Nursing Association, whose local headquarters are at 14, Oakley Square, for the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment bv 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 56 1311 23.4 Hampstead 17 523 30.8 North London 4 95 23.8 Total 77 1929 25.1 In addition to the above, the Metropolitan District Nursing Association also undertook the necessary nursing arising in connection with 123 cases, chiefly maternity or tuberculosis, and children's complaints, and to these 1,475 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 9 temporary "Helps" for emergency cases. 78 applications were received and 71 cases were dealt with during the year, 66 being maternity and 5 sickness cases. 43 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 1933, had notified their intention to practise in St. Pancras was 44. Only 12 of this number are engaged in private practice, the remainder are on the staff of various hospitals and institutions in the Borough. Private midwives are not subsidised by the Borough Council, but a subsidy is paid for each approved necessitous case attended in the patient's home by midwives on the staff of certain hospitals and by midwives employed by the Maternity Nursing Association. The subsidy is not paid in cases where "Maternity benefit" is payable under the National Health Insurance Act. Midwifery. There are a large number of institutions, situated either within or near the Borough, which provide midwifery attendance, either at the patient's home or by admission as in-patients. In the following table particulars are given, for 1933, 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 331 273 8 Royal Free Hospital 80 17 .. Elizabeth Garrett Anderson Hospital 49 .68 .. St. Pancras Hospital 411 .. .. Middlesex Hospital 109 .. 27 Queen Charlotte's Hospital 74 .. .. City of London Hospital 37 .. .. Royal Northern Hospital 24 .. .. St. Bartholomew's Hospital 1 .. .. Other hospitals 94 .. .. Queen Mary's Maternity Home 52 .. .. Maternity Nursing Association .. .. 224 Totals 1262 358 259 * Attended by qualified staff. It will be seen from the above table that full use is made of the institutional facilities which are available. 44 The oases admitted as in-patients represented 48.7 per cent. and those attended at home 23.8 per cent. of the total number of St. Pancras births. As compared with the previous year, there was a decrease in the number of cases attended at home and an increase in the number of those admitted as in-patients. The Borough Council pays a subsidy to certain hospitals for the admission of cases to their maternity wards, and also pays a subsidy for cases attended at home by midwives on the staff of certain institutions. No subsidy is paid for cases attended by medical students. The following table gives the names of the hospitals, etc., and the amount paid during the past year:— £ s. d. Royal Free Hospital 1 0 0 Elizabeth Garrett Anderson Hospital 5 0 0 Queen Charlotte's Hospital 13 0 0 City of London Hospital 4 0 0 Middlesex Hospital 17 5 0 University College Hospital 67 15 0 Maternity Nursing Association 7 5 0 Total £115 5 0 The corresponding grants for the previous three years were: £174 10s 0d., £215 10s. 0d., and £238. Maternal Mortality. The following observations and figures have been furnished by Dr. Pritchard, Assistant Medical Officer. This subject has recently received considerable publicity and attention. Unfortunately the term Maternal Mortality has never been definitely defined. Various authorities—the Registrar-General, the Ministry of Health and the local Public Health Authorities—use it to mean markedly different groups of deaths. This is an unfortunate state of affairs, because the use of the term without a definition can be very misleading. An example will explain the position:—A woman died and the death certificate given was—"Acute Pulmonary (Edema, Asthma, Recent Puerperium." This death counts as a Maternal Death and so increases the figure of Maternal Mortality. This figure, therefore, includes deaths which are merely associated with pregnancy, cases which one cannot include with the figure, which should represent the common risk run by the average woman who becomes pregnant. There would be no difficulty if Maternal Mortality always meant this wide group of deaths. Some authorities, however, use it to mean only those deaths directly due to pregnancy. When a figure is quoted without a definition it is impossible to know whether the small, select, true group or the large indefinite group is indicated. Some authorities use the same term to indicate either the one or the other, and this occurs in the Departmental Report on Maternal Mortality and Morbidity issued by the Ministry of Health, 45 The clearest classification divides all these deaths into two groups.—Those deaths occurring during pregnancy or childbirth, where the death is directly due to the puerperal state are grouped as Puerperal Maternal Mortality. This group is sub-divided into the deaths which have been due to Puerperal Sepsis and those due to Non-Septic Puerperal causes. Such a group would indicate the average risk of pregnancy very accurately if we could eliminate those cases of abortion which have been artificially induced, but leave insufficient evidence to return a verdict of criminal interference. The second group is reserved for those deaths which are only associated with pregnancy or childbirth, such as the case of Asthma already quoted. They are all classified primarily to their particular cause of death, and then re-grouped as Non-Puerperal Maternal Deaths. They do not include cases following criminal abortion. The Puerperal and Non-Puerperal groups are added together to form the total Maternal Mortality. The qualification, Puerperal or Non-Puerperal, is the important indication to the true moaning of any given term when discussing this subject. Enquiries are made into all these deaths. Reports are made and forwarded to the Special Maternal Mortality Committee appointed by the Ministry of Health. In 1933 there were 10 Puerperal Maternal Deaths, 5 due to Sepsis and 5 to other causes. The 5 Septic Puerperal Maternal Deaths include 2 cases of abortion where the circumstances were very suspicious of criminal interference, but which were returned by the coroner as "Open Verdicts." There were 4 Non-Puerperal Maternal Deaths due respectively to Influenza, Infective Endocarditis, Acute Hepatitis and Peritonitis following an operation for Hysterectomy. There was one death after an abortion which the coroner returned as "Fefo de se." The Puerperal Maternal Mortality rate was 3 7 per 1000 births (live and still). 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 and still births).* Excluding Abortions. Total. 1925. 1928 Sepsis 8 10 18 Information not available 0.6 1.3 Other Causes 18 — 18 1.3 1.3 Tolals 26 10 36 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 Sepsis - - - - - - - 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 2.1 2.4 1932 Sepsis 6 3 9 8 4 2.2 3.3 Other Causes 4 1 5 4 1 1.4 1.8 Totals 10 4 14 12 5 3.6 5.1 1933 Sepsis 3 2 5 3 2 1.12 1.86 Other Causes 2 3 5 3 — .74 1.86 Totals 5 5 10 6 2 1.86 3.72 * Previous to 1932, calculations made for live Births only. 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, 1933. Defect Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1350 968 1327 1268 1173 955 1253 1227 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Case. * Malnutrition 6 5 24 10 3 1 1 — 4 1 2 1 3 1 — — Skin disease 12 12 6 4 9 6 3 2 15 9 7 7 14 10 8 5 Defective teeth — 170 — 236 - 322 — 329 — 462 — 222 — 305 — 296 Enlarged tonsils 241 104 70 19 67 19 34 14 197 81 90 42 65 20 26 9 Adenoids 18 10 5 3 3 1 — — 4 3 5 1 1 - — — Enlarged tonsils and adenoids 70 37 15 5 17 4 3 1 48 25 22 9 11 2 3 - Other nose and throat defects 18 10 6 2 5 1 8 3 16 3 10 2 7 2 2 2 Enlarged glands 38 10 12 3 14 — 4 2 30 10 7 2 6 — 7 2 Eye disease 65 40 22 12 13 8 14 8 35 21 20 8 18 13 17 14 Vision defect — — - 79 — 159 — 111 — - - 98 — 135 — 129 Otorrhœa 24 16 7 4 3 2 6 5 31 18 15 9 8 6 10 8 Other ear disease 8 5 - — 3 2 2 1 4 1 1 — 1 1 — — Defective hearing 6 2 6 4 11 8 4 2 9 3 2 1 6 2 5 3 Speech defects 3 — 3 1 5 — 2 2 1 - 2 — 1 — — — Heart defects 37 1 24 1 22 1 14 3 30 3 21 2 38 2 36 4 Angelina 15 2 5 1 7 - 5 2 7 2 9 2 11 5 5 1 Lung defects 84 32 22 6 27 7 4 1 52 17 18 7 10 5 6 2 Nervous defects 10 4 10 1 6 — — — 5 1 8 2 6 4 5 3 Phthisis 3 — 6 — 8 — 3 1 7 1 6 - 5 - 3 - Other T.B. disease - — — — 1 1 1 - - - - - - - 1 1 Rickets 8 - 2 - 2 — 3 — 7 1 1 — 1 — — — Spinal deformities 4 3 8 5 9 6 4 3 1 - 6 3 29 16 13 7 Other deformities 14 1 12 4 10 3 11 4 11 2 16 8 19 6 16 4 Other defects 69 31 44 21 54 22 20 12 64 31 69 27 56 18 50 28 Number of children noted for treatment 675 356 499 466 596 380 489 449 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 1933. Age Group. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 1350 812 513 25 318 999 31 2 1289 58 3 1324 25 1 809 351 190 - - - Girls 1173 745 412 16 374 768 31 — 1077 82 14 1145 28 - 647 376 150 — — — Age 8— Boys 968 609 345 14 221 702 44 1 932 31 5 952 14 2 688 237 43 682 168 111 Girls 955 599 349 7 254 676 24 1 870 72 13 939 16 — 672 221 62 668 146 132 Age 12— Boys 1327 894 422 11 355 943 29 — 1291 31 5 1308 19 — 981 324 22 943 153 229 Girls 1253 853 393 7 383 827 43 — 1152 88 13 1239 14 — 936 291 26 913 163 177 Age 14— Boys 1268 860 395 13 455 788 25 — 1238 28 2 1251 17 — 926 317 25 936 146 184 Girls 1227 848 366 13 543 656 28 — 1142 79 6 1203 23 1 900 292 35 833 200 192 Totals 9521 6220 3195 106 2903 6359 255 4 8991 469 61 9361 156 4 6559 2409 553 4975 976 1025 % St. Pancras 65.3 33.6 1.1 30.5 66.8 2.7 94.5 4.9 0.6 98.3 1.7 0.0 68.9 25.3 5.8 71.3 14.0 14.7 % London 54.5 44.8 0.7 20.8 74.9 4.3 96.4 3.2 0.4 98.2 1.7 0.1 69.4 26.0 4.6 63.2 20.3 16.5 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, and the number of applications is steadily increasing. 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 arc 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 7 and 8. Local Legislation. A.—Local Acta, Bye-Laws, and Regulations in force in the Borough:— 1. St. Pancras (Measles and German Measles) Regulations, 1920. 2. Bye-laws made by the Borough Council:— (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. (c) For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. (d) As to the paving of yards and open spaces in connection with a dwelling house. (e) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (f) With respect to the keeping of water-closets supplied with sufficient water for their effective action. (g) Mortuaries. 50 3. Regulations concerning the use of Post-mortem rooms. 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. (f) Removal and disposal of house and other refuse. (d) Removal of fæcal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc (j) Offensive trades. (k) Rag and bone dealers. (l) Humane slaughtering of animals and poultry. (m) Demolition of buildings. (n) Ice cream vendors and premises. 5. London County Council (General Powers) Acts, 1893-1932. B.—Public Health Legislation either enacted or coming into force during 1933:— Transfer of Powers (London) Order, 1933. The Minister of Health issued the above-mentioned Order under Section 64 of the Local Government Act, 1929. The Order came into force on the 1st April, 1933, and provided that the following powers should be transferred from the London County Council to the Metropolitan Borough Councils:— (1) Public Health Services. (a) Licensing, inspection and supervision of seamen's lodging houses. (b) Registration, licensing, inspection and regulation of common lodging houses. (c) Licensing of dairymen to use premises as cow-houses. (d) Licensing and inspection of slaughter-houses and knackers' yards. (e) Sanctioning of establishment or enlargement of premises used for offensive trades. (2) Maternity and Child Welfare Services. Duties concerned with infant life protection under Part 1 of the Children Act, 1908. Children and Young Persons Act, 1932. Came into force on January 1, 1933. Slaughter of Animals Act, 1933. Pharmacy and Poisons Act, 1933. Housing Financial Provisions Act, 1933. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. 51 HEALTH PROPAGANDA. In addition to the numerous leaflets which are distributed from the various Welfare Centres, Tuberculosis Dispensary, etc., an arrangement is in force, 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. The arrangements made for the issue of the St. Pancras edition of the Monthly Journal known as "Better Health" were discontinued for a time owing to the lack of advertising support, but on payment of a slightly increased subsidy by the Borough Council publication is to be resumed early in 1934. Two thousand copies are issued each month and are distributed through the following agencies:— Infant Welfare Centres, Tuberculosis Dispensary, Electricity Department and 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. 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, 8 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, 112 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. A11 additional supply of water was furnished to the upper doors of 157 tenement houses under powers contained in Section 78 of the London County Council (General Powers) Act, 1907. PUBLIC BATHS AND WASHHOUSES. These are provided by the Borough Council at the following situations:—Prince of Wales Road, N.W.5 ; Whitfield Street, W.1; and King Street, N.W.1. A block of 12 slipper baths, available to the public, adjoins the Council's flats at Prospect Terrace, W.C.1. The water supply in all cases is obtained from the mains of the Metropolitan Water Board, but at the Prince of Wales Road Baths an additional supply is available from a deep well on the premises. 52 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:— Drainage work done under notice Voluntary drainage work Drains of new buildings Total Inspections. Inspections. 1933. 2713 7892 2600 13205 1932. 2420 6647 2652 11719 Drainage Register.—The following is an analysis of the Drainage Register during 1933:— Plans deposited—Old Buildings under Notice 96 „ ,, Old Buildings, Voluntary 240 ,, „ New Buildings and Additions 73 409 Applications without Plans 349 Total number of Applications and Plans 758 Rats and Mice (Destruction) Act, 1919. During the year 109 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. Rat Week. The Ministry of Agriculture and Fisheries issued a Circular stating that this year's "Rat Week" would commence on Monday, 6th November, and urging upon all local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, the desirability of making a special effort during that week to secure concerted action with a view to the destruction of rats and mice. As in previous years, printed circulars on the subject and recipes for suitable poisons were sent to the occupiers of premises peculiarly liable, owing to the nature of the business carried on therein, to infestation by rats, and chemists' shops and stores were requested to stock, exhibit or advertise suitable rat poisons, traps, etc. Refuse Collection and Disposal. A.—A weekly collection is made in all parts of the Borough with the exception of Wards 2 and 6, in which a collection is made twice weekly during the summer months, and daily collections before 10 a.m. in prescribed main streets. Additional collections are also given to flats, eating houses, etc. 53 The use of Pagefield lorries and containers, 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 Borough Engineer, give some idea of the enormous amount of refuse to be dealt with. For the purpose of comparison the figures for the previous year are also given:— Quantity of refuse collected Quantity of refuse burnt at Destructor Quantity put on rail Quantity of clinker residual 1933. 1932. Tons. 51310 32962 18340 12720 Tons. 53646 34799 18841 12548 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, but there has been a growing tendency to make use of this accommodation for ex-St. Pancras cases. The attention of the London County Council has been directed to the matter and the subject is still under consideration. The following table gives particulars concerning the number of inquests held, number of bodies received and post-mortem examinations made during the year:— Number of inquests held Number of bodies received Number of post-mortem examinations made St. Pancras cases 151 Ex-St. Pancras cases 422 St. Pancras cases 306 Ex-St. Pancras cases 510 St. Pancras cases 286 Ex-St, Pancras cases 446 54 SANITARY INSPECTION OF THE AREA. Inspections.—67,898 visits and inspections were made in 1933 by the Council's staff of Inspectors and Health Visitors. Of these inspections, 44,316 were made by the District Sanitary Inspectors, 9,488 by the Inspectors of Food and Food places, 7,066 by the Inspectors of Factories and Workshops, and 7,028 by the Women Sanitary Inspectors and Health Visitors (for Tuberculosis). The inspections dealt with above are exclusive of the visits in connection with the health of expectant mothers and young children made by the Council's staff at the Maternity and Child Welfare Centres (see pages 32 and 116), and by the staff of the Tuberculosis Dispensary (see page 101); nor do they include the work of the disinfecting staff, particulars of whose work are given on pages 102 and 103. Notices served.—3,994 intimation notices were served by the Inspectors during the year. Of these 3,689 were served by the District Sanitary Inspectors, 303 by the Factory and Workshop Inspectors, and 2 by the Food Inspectors. 1,414 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 113-116. 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. 1933 213, Seymour Street Yard paving defective Sept. 13th Fined £1. 257, Gray's Inn Road Roof defective over restaurant kitchen Dec. 1st Order to abate nuisance within 28 days. Costs £2 2s. 76, Whitfield Street Water-closet basins foul, fresh-air inlet pipe defective, an offensive accumulation Dec. 6th Do. do. Costs £2 2s. London County Council Bye-Laws—Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 1933. 88, Weedington Road Overcrowding and sleeping accommodation not separate for the sexes Aug. 18th Rooms vacated. Summons withdrawn. 76, Whitfield Street Failing to carry out cleansing work and to remedy defective sash cords, stair treads, walls, ceilings and grate. Dec. 6th Fined £5. 55 Metropolis Management Act, 1855, and Metropolis Management (Amendment) Act, 1862. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 1933. 34, William Street Failing to repair drain Nov. 16th Costs £2 2s. Adjourned sine die on promise to carry out the work. London County Council Bye-Laws made under the Metropolis Management Acts. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 1933. 22, Ley bourne Road Fixing a new sink without giving notice in writing, and further failing to carry out such work so as to comply with Bye-law 13 July 21st Fined £1. Costs £1 3s. 175, Camden Road Fixing a new water-closet pan and trap without giving notice in writing Aug. 11th Dismissed under the Probation of Offenders Act. Costs .£1 1s. 13, Jeffreys Street Do. do. Sept 13th Costs £1 1s. 15, „ Do do. ,, 13th. Costs £1 1s. 19, „ Do. do. „ 13th Summons withdrawn. Doubtful whether defendants had committed the offence. 25, „ Do. do. „ 13th Costs £1 1s. 57, James Street Constructing two new water-closets without depositing plans or giving notice in writing ,, 22nd Dismissed under the Probation of Offenders Act. Costs £2 2s. 20, Howland Street Altering drainage work without depositing plans, &c., of such alterations „ 28th Fined £2. Costs £2 2s. 2a, Anglers Lane Do. do. Oct. 19th Fined £2. Costs £2 2s. 18, Dunollie Road Altering drainage work without giving notice in writing „ 20th Fined 10s. Costs £1 3s. 277, Gray's Inn Road Do. do. Nov. 8th Fined £1. Costs £2 2s. SMOKE ABATEMENT. 307 observations of chimney shafts were made during the year and eight 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:— 56 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories 2201 148 — Workshops 2027 117 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1129 30 1 Totals 5357 295 1 2.—Defects Found. Particulars. (1) Number of Defects Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspectors. (4) Nuisances under the Public Health Acts*:— Want of cleanliness 121 120 — — Want of ventilation 10 9 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 107 106 — 1 Sanitary accommodation— Insufficient 4 3 — — Unsuitable or defective 73 72 — — Not separate for sexes 15 15 — — Other breaches 32 31 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 63 63 — — Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) — — 1 — Totals 425 419 1 1 *Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 57 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:—29 in respect of the making, etc., of wearing apparel, comprising the names of 82 outworkers (contractors) and 55 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 3 outworkers (workmen). 1 in respect of embroidery, comprising the names of 35 outworkers (workmen), and 1 in respect of general furnishers, comprising the names of 13 outworkers (contractors) and 3 outworkers (workmen). 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 30 280 197 507 Bootmaking 2 - 102 104 Embroidery - 3 33 36 Miscellaneous 1 7 33 41 Totals 33 290 365 688 4.—List of Factories, Workshops (Registered, Sec. 131) and Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 65 83 - 148 Cabinet makers 59 69 — 128 Coach builders 20 15 — 35 Dressmakers 75 119 20 214 Engineers 209 34 — 243 Foundries 14 — — 14 Furniture makers 13 19 — 32 Furriers 8 13 2 23 Laundries 9 5 — 14 Metal workers 35 37 — 72 Milliners 1 20 2 23 Organ builders 7 3 — 10 Pianoforte manufacturers 39 19 1 59 Printing 69 9 — 78 Restaurant kitchens — — 291 291 Tailors 31 229 143 403 Upholsterers 8 36 2 46 Wood carvers 8 17 — 25 Other occupations 530 495 382 1407 Totals 1200 1222 843 3265 58 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - Action taken in matters referred by H.M. Inspector us remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 39 Reports (of action taken) sent to H.M. Inspector 39 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 9 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 84 Bakehouses and restaurant kitchens are also referred to on page 73. 6.—Total Inspections. Premises. Male Inspector. Woman Inspector. | Total. Factories 1695 506 2201 Workshops 1697 330 2027 Workplaces (including Outworkers' premises) 632 2113 2745 Total 4024 2949 6973 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. 54 visits were made to these premises during the year. These trades are not subject to annual licensing, but they cannot be established anew or extended without the sanction of the Local Authority. 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 County Council (General Powers) Act, 1908. The bye-laws provide as follows:— 1—A person carrying on the business of a rag and bone dealer shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy— (a) in or from any part of the premises used for or in connection with his business, or 59 (b) in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags, bones, fat, rabbit skins, or other like articles, or (c) in any other way connected with his business. 2—A person carrying on the business of a rag and bone dealer who shall offend against the foregoing bye-law shall be liable for every such offence to a penalty of Five Pounds. Provided nevertheless that the Court before whom any information may be laid or any proceedings may be taken in respect of any such offence may if the Court think fit adjudge the payment as a penalty of any sum less than 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 Premites. 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 113. 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. Common Lodging Houses. By the Transfer of Powers (London) Order, 1933, the registration, licensing, and inspection of common lodging houses were transferred to the Borough Council. The licences in respect of common lodging houses expire on the 30th June. Applications for the renewal of licences have to be made by the holder 21 days prior to the licensing meeting, and notification of the date of the meeting, and of the necessity for making application, if renewal is desired, has to be sent to each holder. Any objection to the granting or the renewal of a licence is required to be made in writing at least 7 days before the date of the licensing meeting. The Borough Council decided that the Public Health Committee should act on their behalf as the Licensing Authority at the Committee meeting to be held in June, and the necessary notices giving the day and time of the meeting should be served on the persons concerned. 60 During the year the Committee considered applications for the renewal of the licences of the common lodging houses at 60, King's Road and 15 & 16, Litcham Street. The premises at 60, King's Road were inspected and found to he satisfactory and to comply with the regulations. The licence was therefore renewed for the year ending June, 1934. With regard to 15 & 16, Litcham Street, notices were served to carry out certain work which had not been fully complied with. The licencee was interviewed and upon the required work being satisfactorily carried out the licence was renewed for the year ending 30th June, 1934. 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. A weekly inspection of the canal and wharves has been made by Inspector Auger. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920-1933. During the year 23 applications were received from tenants for certificates and in 21 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. In accordance with Section 5 of the Act of 1923, 8 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 seven cases the "release" certificate was granted. In the majority of cases where an examination of premises for the purpose of issuing a certificate under the Act was made by an inspector, opportunity was also taken of serving, where applicable, Intimation Notices on the owners for the abatement of nuisances or for remedying breaches under the Public Health (London) Act, the London County Council (General Powers) Acts, Bye-laws, etc. Section IV.—HOUSING. The following particulars concerning the number of new houses and flats erected during the year, and details of the work carried out with reference to existing houses (under the Housing Act and Public Health Acts), are given in the following form in accordance with the requirements of the Ministry of Health:— Number of new houses erected during the year:— (a) Total (including number given separately under (b)) 247 flats (b) With State assistance under the Housing Acts: — (i) By the Local Authority - (ii) By other bodies or persons 57 1. Inspection of dwelling-housrs. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2383 (b) Number of inspections made for the purpose 12026 (2) (a) Number of dwelling-houses included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1119 (b) Number of inspections made for the purpose 6527 61 (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 (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 1433 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 2573 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 59 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 25 (b) By Local Authority in default of owners — B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 927 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice:— (a) By owners 752 (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 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (previously made) 4 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 12 (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. In accordance with paragraph 4 of the Housing Consolidated Amendment Regulations 1932, the following additional information is given:— (i) Number of representations made to the Local Authority with a view to (a) the serving of notices requiring the execution of works ; or (b) the making of Demolition or Closing Orders 29 (ii) Number of houses in respect of which an undertaking was accepted under sub-section (2) of section 19 of the Housing Act, 1930 Nil. 62 Particulars concerning Inspection of Tenement Houses are given in Table 6 on page 113. The 247 houses and flats mentioned at the beginning of this Section as having been erected during the year comprised the following:— 57 flats built by the St. Pancras House Improvement Society, Ltd., Athlone House (10) in Wilkin Street, and St. Nicholas Flats (47) in Clarendon Street; 80 flats by the Commissioners of Crown Lands (Swinley House in Redhill Street); 38 flats, West Hill Court, Highgate; 5 flats, The Old Well House, The Grove, Highgate; 27 flats by Mr. G. Burgoyne in Johnson Street; 34 flats (Regency House), 22/6, Osnaburgh Street; and 6 flats on the site of 4-8, Grange Road. HOUSING CONDITIONS. Considerable attention was given to the above subject during the year by the appropriate Committees. The Circular 1331 issued by the Ministry of Health expressed the opinion that the present rate at which the slums were being dealt with was too slow, and that concerted effort between the central government and the local authorities concerned to ensure a speedier end was desirable. In connection with the above a conference was held between representatives of the Borough Council and the London County Council at which housing conditions in the Borough were considered. In the course of the proceedings it appeared to be generally accepted that no serious slum conditions existed in St. Pancras, but that the Borough presented possibilities for dealing with Improvement Areas by reconditioning at a future date. A number of areas were mentioned by the representatives of the Borough Council, which, it was suggested, were suitable to be dealt with either as Clearance Areas or by Clearance Orders. It was intimated that in due course the London County Council might deal with two of the areas, but the others should be dealt with by the Borough Council, and the necessary steps are now being taken. A printed report on housing conditions, with special reference to Ward 2 was issued and widely circulated during the year by the North St. Pancras Group of the St. Pancras House Improvement Society, Ltd. As the description given in the report was considered to be exaggerated, and in some respects inaccurate, the following report was submitted to the Council and is reprinted here for reference:— To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, Housing Conditions in Ward 2. A report has recently been published which purports to describe housing conditions in Ward 2, but this report cannot be regarded as an accurate representation of existing conditions. In compiling the report it may have been considered permissible, for propaganda purposes, and in order to enlist sympathy, interest, and financial help, to emphasize the worst aspects of the area, but a report on these lines may, perhaps, be regarded as somewhat ill-advised. 63 In areas in which housing conditions are extremely bad, it is usual to find that the death rates and infantile mortality rates are definitely high. It is important, therefore, to note that in the area in question these rates are particularly low, in fact lower than those of the Borough as a whole. The statistics therefore give considerable support to the contention that the pictnre portrayed in the report is not a correct one. A number of the premises described in detail in the report have recently been visited, but the conditions found differ so materially from the description given in the report as to justify the statement that the representation is not a fair nor an accurate one. The report also suggests that the houses in a number of areas, some of them of considerable extent, should be demolished. In making this suggestion, due care does not appear to have been taken to differentiate between evils arising from defects in the houses, those due to poverty and overcrowding, and those due to neglect, carelessness, or bad habits of the tenants. Demolition is not a universal remedy to be applied in every case irrespective of the cause. With few exceptions, the houses in question are not in such a condition, neither is there in their arrangement such a deficiency of light and air as would justify condemnation. Many of the bad conditions described are really financial in origin, the tenants being unable to afford the rent for the amount of accommodation that is really necessary. An unskilled labourer, at times out of work, and handicapped by a large number of young children, is, at present, practically compelled to live in a state of overcrowding. Very often such families live in basement rooms, as these are cheaper, and the combination of poverty, underground rooms, and overcrowding usually leads to dirty, verminous, and unwholesome conditions. Condemnation and demolition of houses will not remedy such defects while the causes producing them remain. Such families can only obtain adequate housing accommodation by some form of rent assistance, and the Housing Act of 1930 permits this rent relief to those who need it and for so long as they need it. In a certain number of cases mentioned in the report the bad conditions are definitely due to the faults and habits of the tenants. Neither sympathy nor help should be extended to families living under conditions of gross overcrowding, with grown-up boys and girls sharing the same room, although the family income is such that they can well afford to pay for adequate accommodation. The service of a notice is the proper remedy in these cases. It would also appear to be necessary to draw attention to the fact that dirty, destructive, and undesirable tenants do exist, and that the slum maker is quite as difficult a problem as the slum. It is far too frequently assumed that all tenants are satisfactory, and all landlords are neglectful and rapacious; this is not so. I am, Ladies and Gentlemen, Your obedient servant, G. Sowden Medical Officer of Health. Underground rooms. A number of those which were illegally occupied were closed during the year. At present it is only possible to deal with the worst cases as alternative accommodation (and within the means of the occupants) is difficult to obtain. In some cases, where two basement rooms are occupied by a family, it is possible to secure compliance with statutory requirements by using the back room for sleeping purposes instead of the front or vice versa. From a health point of view it is doubtful if any material benefit is derived, as a room which is considered to be unfit for sleeping purposes would appear also to be unfit for living purposes, but at present the Underground Room Regulations only apply to rooms used for sleeping purposes. 64 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) Somers Town Estate (142 flats), consisting of Aldenham House (26 flats), Wolcot House (18 flats), Johnson House (26 flats), Gladwin House (18 flats), Clarendon House (36 flats), and Morland House (18 flats). (g) Barnes House, Camden Road (22 flats). (h) Kennistoun House, Leighton Road (64 flats). (i) 32 and 33, Johnson Street. (j) 110, Leighton Road. (k) 13 and 15, Bayham Place. (l) 15, Willes Road. (m) 24, Grafton Road. (n) 20 and 22, High Street and 3 and 5, Little King Street. (o) 41 and 47, Stanhope Street. (p) 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street. (q) 9, 10, 11, 12, 13, 14 and 15, Georgiana Street. (r) 67, 69 and 71, Pratt Street. (s) 3, James Street. (t) 207, Arlington Road. (u) Oak House and Wellington House, East Finchley. Preference is given to persons residing in the Borough when vacancies occur in the Council's dwellings, and preferential consideration is given to applications where the housing conditions are extremely bad, and in all cases persons with families receive first consideration. During the past year there have been 77 changes of tenancies in the Council's properties. Kennistoun House, Leighton Road. This estate was practically completed by the end of the year and arrangements were made for it to be opened officially by His Worship the Mayor (Councillor Frederic Hewson, j.p.) early in the new year. The accommodation comprises 30 four-room, 28 three- 65 room and 6 two-room flats at weekly inclusive rentals of 18s. 2d., 16s. 1d. and 13s. 4d. respectively. The Council decided to name the estate "Kennistoun House" to commemorate the ancient historical name for Kentish Town. The tenants were selected from the waiting list of applicants, each case being visited and specially reported upon, and tenancies were allocated to applicants with the largest families who were living under unsatisfactory conditions. Proposer Housing Scheme at Bangor Wharf. The Council contemplated developing a site, formerly occupied as a depot, at Bangor Wharf, Greorgiana Street, for housing purposes under the provisions of the Housing Act, 1930. The site has an area of about one-third of an acre, and it was considered that it would be possible to provide 35 tenements, with a total of 122 rooms, with facilities for the storage of costers' barrows, etc. It was anticipated that the accommodation to be provided could be let at cheap rentals. The scheme was submitted to the sanctioning authorities for approval, but the County Council, after giving it their careful consideration, expressed the opinion that the site was unsuitable for residential purposes, having regard to its conditions and situation in a district intensively devoted to industrial purposes. Housing Act, 1930. The Council's representatives conferred with representatives of the London County Council on the preparation of schemes for slum clearance and improvement as part of a general programme for the County of London in accordance with Circular No. 1331 of the Minister of Health. A survey of the Borough was made and certain areas were considered suitable for operations under the provisions of the Housing Act, 1930. After consultations with one of the County Medical Officers, it was agreed that three areas might be represented. Two other sites, to which the Medical Officer of Health called attention, were already under the consideration of the County Council. It is understood that the County Council, with the exception of a possible development of their scheme in the Ossulston Street area, do not intend to undertake further extensive housing schemes in the Borough, as their activities are directed to other boroughs where needs are more pressing. The opinion was formed that the County Council do not consider that any serious slum conditions exist in St. Pancras, but rather that the Borough presents possibilities for dealing with improvement areas by way of re-conditioning at a future date. The three areas upon which the Borough Council contemplate taking action were submitted to the County Council in accordance with the provisions of the Act, who intimated that they did not intend to deal with them. After consultation with the authorities concerned as to the general procedure, the Borough Council have decided that, instead of dealing with the areas simultaneously, it would be advantageous to represent them in stages so as to provide housing accommodation on the largest site, for decanting purposes, before the remaining areas are represented. The necessary steps are being taken with regard to the first area. Litcham Street Area. The London County Council notified that an area in Litcham Street had been declared to be a clearance area under the provisions of Section 1 of the Housing Act, 1930, with a view to its re-development for housing purposes by the St. Pancras House Improvement Society, Ltd. The Society have already erected 10 flats in this area and, at the moment, there are 25 more in course of erection. It is contemplated that their scheme, when completed, will consist of 225 flats. In addition, they propose to erect 20 flats in reinforced concrete upon a site in the vicinity. 66 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. Sincc the initiation of this scheme in January, 1925, the number of St. Pancras families who have been housed under this arrangement up to December, 1933, is 887. 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. Housing Schemes in the Borough. The Borough Council now control eight estates in the Borough, with a total of 709 flats comprising 2,295 rooms. The London County Council are proceeding with their scheme in Ossulston Street, and, during the course of the year, Levita House has been practically completed. It is understood that the estate, when completed, will comprise 481 tenements, and there are already 310 flats in occupation. The Commissioners of Crown Lands have completed an additional block of 98 flats in Cumberland Market, known as Windsor House, and up to the present 344 flats have been erected, consisting of 1,017 rooms. It is understood that further blocks of tenements will be erected almost immediately. The St. Pancras House Improvement Society have completed a further block of 47 tenements in Bridgewater Street, known as St. Nicholas' Flats, and contemplate providing a further block of 25 flats in Drummond Street almost immediately. Section V.-INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. Cowsheds.— There are now no licensed cowsheds in the Borough. Dairies and Milkshops.—The Milk and Dairies Order, 1926, requires the Sanitary Authority to register all persons in their district carrying on the trade of cowkeeper or dairyman, and also all premises which are used as dairies. The term "dairy" does not include a shop from which milk is not supplied otherwise than in properly closed and unopened receptacles in which it was delivered to the shop, and therefore such premises do not require to be registered, but any person selling milk in sealed bottles or other receptacles must be registered as a purveyor of milk. Section 2 of the Milk and Dairies (Amendment) Act, 1922, gives the Local Authority power to refuse registration or to remove from the register any retail purveyor of milk, if they are satisfied that the public health is likely to be endangered by any act or default of such person. Thirty-eight applications for registration under the Milk and Dairies Order, 1926, were received and granted during the year (37 retail and 1 wholesale). Thirty applications in respect of itinerant vendors were also received and granted. 67 The following list gives particulars as to the purveyors of milk on the register at the end of 1933:— Number of purveyors of milk from retail milkshops on the register at the end of 1932 208 Deduct number removed from the register during the year 1933 —42 Add number of purveyors registered by resolution of the Council during 1933 +37 Total number of purveyors of milk from retail milkshops on register at the end of 1933 203 In addition to the above, the following were also on the register at the end of 1933:— 3 persons (firms) in respect of premises where a wholesale trade in milk is done. 2 „ (firms) „ „ „ cream „ 4 „ „ retail „ „ „ and 30 itinerant vendors without retail milkshops. Milk in Sealed Containers. During the year 37 persons were registered to sell milk in sealed containers, and 14 were removed from the register. At the end of the year there were 181 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]." The Council decided in February, 1902, that any firm or person requesting a sample of milk to be procured in course of consignment should be required to pay a fee of 10s. 6d., but no charge had 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. 68 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 year. The following licences were granted in respect of the year 1933:— 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. Jan.26th, 1933 Express Dairy Co., Ltd., 26, Tavistock Place, W.C.1 "Grade A Tuberculin tested " 26, Tavistock Place. Do. Do. "Certified" Do. Do. Do. "Pasteurised" Do. Do. Do. Do. 1, Guilford Street. Do. Do. "Grade A Tuberculin tested" 12, South Grove. Do. Do. "Certified" Do. Do. Do. "Pasteurised" Do. Do. Meadowland Milk, Ltd., 166, Kensal Road, W.10 Do. To sell in St. Pancras. Do. R. A. Evans, 77, Torriano Avenue, N.W.5 "Grade A Tuberculin tested" 77, Torriano Avenue. Do. Do. "Pasteurised" Do. Do. D. Williams. 57, Leighton Road, N.W.5 "Grade A Tuberculin tested" 57, Leighton Road. Do. J. R. Mills & Sons, 23, Francis Street, W.C.1 Do. 23, Francis Street. Do. J. R. James, 155, Hampstead Road, N.W.1 Do. 155, Hampstead Road. Do. Do. "Pasteurised" Do. Do. E. A. Lewis, 18a, Highgate Road, N.W.5 "Grade A Tuberculin tested" 18a, Highgate Road. Do. J, Adams, 15, Crowndale Road, N.W.1 "Grade A" 15, Crowndale Road. Do. T. J. Jones, 6, Hastings Street, W.C.1 "Grade A Tuberculin tested" 6, Hastings Street. Do. Do. "Certified" Do. Do. A. Meredith, 118, Chalton Street, N.W.1 "Pasteurised" (Plant) 118, Chalton Street. Do. Do. "Pasteurised" 111, Park Street. Do. Do. "Certified" 118, Chalton Street. Do. Do. Do. 111, Park Street. Do. Do. "Grade A Tuberculin tested'' 118, Chalton Street. Do. Do. Do. 111, Park Street. Feb. 23rd, 1933 Griffiths Bros., 51, St. George's Road, N.W.1 "Grade A Bottling" 51, St. George's Road. Do. H. J. Jenkins. 97, Kentish Town Road, N.W.1 "Pasteurised" 97, Kentish Town Road. Do. Do. "Grade A Tuberculin tested" Do. Mar. 25th, 1933 Nestle Anglo-Swiss Milk Co., 6-8, Eastcheap, E.C.3 "Pasteurised" St. Margaret's Hospital, Leighton Road. June 29th, 1933 | J. D. Jones, 97, Kentish Town Road, n.W.1 "Grade A" 97, Kentish Town Road. [Continued on next page. 63 Data 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. Sept.28th, 1933 Daniel D. Davies, 98, Camden Road, N.W.1 "Grade A Tuberculin tested" 98, Camden Road. Dec. 7th, 1933 Thomas Jones, 23, Haverstock Road, N.W.5 Do. 23, Haverstock Road. Dec. 22nd, 1932 United Dairies (London), Ltd., Western Avenue, W.3 "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 (from St. Marylebone and Holborn addresses). Do. Do. "Grade A Tuberculin tested" Do. Do. Do. Do. "Pasteurised" Do. Do. Do. "Pasteurised" 25, Swain's Lane. Do. Do. Do. 51, South Grove. Do. Do. "Grade A Tuberculin tested" To sell in St. Pancras (from an Islington address). Do. Do. "Certified" Do. Do. Do. "Grade A Pasteurised" Do. Do. Do. "Pasteurised" Do. Do. Marshall's Dairies, Ltd., 19, Tudor Place, W. 1 "Grade A Tuberculin tested" 19, Tudor Place. Do. B. Rees, Ltd., 2 & 3, Carthusian Street, E.C. 1 "Pasteurised" To sell in St. Pancras. Do. London Co operative Society, Ltd., 54, Maryland Street, E.15 Do. 135, Hampstead Road. Do. Do. "Grade A Tuberculin tested" Do. Do. Do. Do. 32, Oak Village. Do. Do. "Pasteurised" Do. Do. London Wholesale Dairies, Ltd., Vauxhall, S.E. 11 "Grade A Tuberculin tested" To sell in St. Pancras. Do. City of London Dairies. 116120, Goswell Road, E.C.1 "Pasteurised" Do. Do. D. Davies, 10-11, Dukes Road, W.C.1 "Grade A Tuberculin tested" 10-11, Dukes Road. Do. W. L. Davies, 41, King Street, N.W.1 (Bottling) "Grade a Tuberculin tested" 41, King Street. Do. John Evans, 35, Southampton Street, W. 1 Do. 35, Southampton Street. Jan. 26th, 1933 Express Dairy Co., Ltd., 26, Tavistock Place, W.C.1 Do. 151, Highgate Road. Do. Do. "Certified" Do. Do. Do. "Pasteurised" Do. Do. Do. "Grade A Tuberculin tested" "Certified" 68, Mansfield Road. Do. Do. Do. Do. Do. "Pasteurised" Do. Do. Do. Do. 138, Ossulston Street. Do. Do. Do. 46, Mornington Crescent. Do. Do. "Grade A Tuberculin tested" 5, Stibbington Street. Do. Do. "Certified" Do. Do. Do. "Pasteurised" Do. Samples of milk sold under special designations are taken at intervals, and are submitted to bacteriological examination, in order to ascertain if they comply with the standard specified in the Order. Ten such samples were taken during the year and in each case the result of the examination was satisfactory. 70 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 camc 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 number of premises on the register at the end of the year was one (wholesale) and three (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 lie-constituted Cream would appear to be more appropriate than the word Artificial. (b) MEAT AND OTHER FOODS. The two special Food Inspectors have kept under regular observation food exposed or deposited for sale in slaughter-houses, butchers' shops, cooked meat shops, fishmongers' premises, stalls, market places, etc. The undermentioned unsound or diseased food was surrendered by the owners for destruction or to be dealt with as trade refuse. Unsound Food Condemned and Destroyed. Surrendered. Bananas, 35 crates Livers, Pigs', 6 Cauliflowers, 8 mats Mackerel, 1 box Chicken, 1 in tin Pears, 48 4-lb. boxes Cod, filleted, 2 boxes Plaice, 1 box Hams, cooked, 2 in tins Plucks, Pigs', 15 stone 4 lbs. Heads, Pigs', 7 Potatoes, 1 ton Herrings, 1 box Skate, l6½ stone Kidneys, Pigs', 35 lbs. Tomatoes, 4 boxes Kippers, 2 boxes Tongue, Ox, 1 6-lb. tin Livers, Mullocks', 2 Veal, 23 6-lb. tins. Slaughter-houses. At the end of 1933 there were 3 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 156 inspections during the year. 71 Slaughter of Animals Act, 1933. This Act has been passed to provide for the humane and scientific slaughter of animals, and comes into operation on 1st January, 1934. No animal is to be killed in a slaughter-house or knacker's yard except it be instantaneously slaughtered, or shall by stunning be instantaneously rendered insensible to pain until death supervenes, and such slaughtering or stunning must be effected by means of a mechanically-operated instrument in proper repair. "Animal" is defined as meaning any horse, mare, gelding, pony, foal, colt, filly, stallion, ass, donkey, mule, bull, cow, bullock, heifer, calf, steer, ox, sheep, ewe, wether, ram, lamb, pig, boar, hog, sow, goat or kid. No person will be liable for any contravention of this provision in respect of the slaughter of any pig, boar, hog or sow in a slaughter-house or knacker's yard in which there is not available a supply of electrical energy, unless it is proved that such a supply could reasonably have been made available; or to the slaughter of any animal without the infliction of unnecessary suffering by the Jewish or Mohammedan methods for the food of Jews or Mohammedans respectively. Every local authority shall within twelve months after the passing of the Act consider the question whether they will pass a resolution applying the Act to all or any of the following animals:— sheep, ewes, wethers, rams and lambs; and if such resolution is passed, the provision as to slaughtering and stunning is to apply to such animals, but where no such resolution is in force the said animals are exempt from such provision. The Council may resolve to exempt either goats or kids or both such animals from the application of the Act. Twenty-eight days' notice of the Council's intention to propose a resolution must be given to every member of the Council, and notice inserted in the local press. A resolution after being passed must be advertised in the local press, and may also be published otherwise in such manner as the Council think sufficient for giving notice thereof to all persons interested. The Minister of Health must also be notified. Similar provisions apply to the rescindinent or variation of any such resolutions. All slaughtermen, including Jewish and Mohammedan, are to be licensed by the Borough Council excepting an officer of or any person employed by the Minister of Agriculture. No licence is to be granted except to a person of the age of 18 years or upwards who is, in the opinion of the Council, a fit and proper person to hold such a licence. The licence is to be in force for a period not exceeding three years, and may be renewed or suspended. The licence will operate in the district of any other authority. Any person aggrieved is allowed to appeal to a court of summary jurisdiction. A fee, not exceeding 2s., may be charged by the Council for each licence issued, and not exceeding 1s. for every renewal thereof. Conditions are laid down as regards the proper conduct and inspection of slaughterhouses and knackers' yards. These places are now under the jurisdiction of the Borough Council as regards licensing since the passing of the recent Transfer of Powers Order, 1933. Penalties are provided for contravening the provisions of the Act, but a person is not liable if he proves that by reason of an accident or other emergency the contravention was necessary for preventing physical injury or suffering to any person or animal. Any local authority who have provided or established a slaughter-house may, if they think fit, employ persons to slaughter or stun animals, and may make such charges as they consider reasonable for the services of the persons so employed. 72 After further consideration of the procedure in regard to the application of the abovementioned Act, the Council decided to pass a resolution, as laid down by Section 2, applying Section 1 of the Act to sheep, ewes, wethers, rams and lambs, in order to avoid the confusion of having certain animals dealt with under the Act and others under bye-laws, and also to obviate the possibility of risk of conflict between the requirements of the Act and the bye-laws. Registration, etc., of Slaughter-houses. By the Transfer of Powers (London) Order, 1933, the registration, licensing, and inspection of slaughter-houses were transferred to the Borough Council. The licences expire on the 31st October in each year. Applications for the renewal of licences should be made by the holder 14 days prior to the licensing meeting, and notification of the date of the meeting, and of the necessity for making application, it renewal is desired, should be sent to each holder. Any objection to the granting or the renewal of a licence should be made in writing at least 7 days before the date of the licensing meeting. A fee of 5s. is payable in respect of a slaughter-house licence. The Public Health Committee have been authorised to act on behalf of the Borough Council as the Licensing Authority at the Committee meetings to be held in October, and the necessary notices giving the day and time of the meeting will be served on the persons concerned. This procedure is in accordance with that previously adopted by the London County Council, and will be continued. Fried Fish and Fish Curing Premises. In 1933 there were 78 fried fish vendors' premises in the Borough, at 4 of which fish curing was also carried on. There were 23 fish curers' premises, including the 4 above mentioned. 394 visits were made by the Food Inspectors to these premises during the year. Ice Cream Premises. Section 5 of the London County Council (General Powers) Act, 1932, 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 or the storage of ice cream or other similar commodity intended for sale 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 271. During the year a number of samples of ice cream were submitted to bacteriological examination, and in one instance, taken during the very hot weather of July, the report of the bacteriologist on this sample was as follows:— At 37° c. over 10 million bacteria per cc. At 22° c. bacteria present too numerous to count. Bac. Sporogenes and Welchii present in 1 cc. Bac. Coli. present in 0'000001 cc. As this report indicated an extremely heavy and gross pollution, an immediate investigation was made. The materials and the methods adopted were carefully studied and samples of the materials used, and of the ice cream at various stages during the process of manufacture, were taken for bacteriological examination. Possibilities of infection existed owing to the construction of the floor and the method of handling the containers. The procedure adopted for cleansing the plant was also inadequate. 73 The firm in question co-operated in every possible way, adopted all the suggestions made for eliminating possible sources of infection, and incurred considerable expense in providing means for sterilising the containers and plant, etc. A sample of the finished product taken subsequently, when the various alterations and improvements were in force, was submitted for bacteriological examination, and the report was as follows:— Number of Bacteria per cc., 22,500 B. Coli absent in 1 cc. This report can be regarded as extremely satisfactory, and indicates a very clean product with remarkably low bacterial content. Bakehouses and Restaurant Kitchens. At the end of 1933 there were 148 bakehouses on the register, including 65 factory bakehouses. 32 of these bakehouses wore not in use. 108 of the 148 were underground bakehouses, of which 54 were factory bakehouses, 33 were workshop bakehouses, and 24 not in use. At the end of the year 291 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 56 to 58. (c)—FOOD AND DRUGS (ADULTERATION) ACT, 1928. 800 samples have been taken under this Act, of which 318 were formal and 482 informal. Of the formal, 306 proved to be genuine, and 12, or 3.8 per cent., adulterated; and of the informal, 467 were genuine and 15, or 3.1 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Almonds (ground) — 1 — 1 — — Arrowroot — 2 — 2 — — Bacon — 6 — 6 — — ,, (cooked) — 1 — 1 — — Beans (baked, canned) — 1 — 1 — — Beef (minced) 1 12 1 11 — 1 „ (pressed) — 1 — 1 — — Biscuits — 1 — 1 — — Brawn — 3 — 3 — — Bun — 1 — 1 — — ,, Flour — 1 — 1 — — Butter 23 33 23 33 — — Cake (lunch) — 1 — 1 — — Cheese — 13 — 13 — — Cherries (canned) — 1 — 1 — — Chocolate — 1 — 1 — — „ Spread — 1 — 1 — — Cocoa — 5 — 5 — — Cocoanut (desiccated) — 1 — 1 — — Coffee — 8 — 8 — — Cornflour — 4 — 4 — — Crab (canned) — 2 — 2 — — Cream 1 13 1 12 — 1 „ (canned) — 12 — 12 — — Currants — 2 — 2 — — Custard Powder — 4 — 4 — — Cutlet, chicken — 1 — 1 — — Dripping — 2 — 2 — — Carried forward 25 134 25 132 — 2 74 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 25 134 25 132 - 2 Figs - 1 - 1 — — Fish Paste - 16 - 16 - - Flour - 1 - 1 - - „ (self-raising) - 10 - 10 - — Fruit (crystallised) — 1 — 1 - — „ (dried) - 1 - 1 - — ,, Salad (canned) - 2 - 2 - - Ginger Beer Powder - 1 - 1 - — Grape Fruit (canned) — 4 — 4 - — ,, Squash — 1 — 1 - — Ham and Veal Cutlet - 1 — 1 - — Herrings in Tomato Sauce (canned) — 2 — 2 - — Honey - 2 - 2 - — Horse Radish Cream - 1 - 1 - — Jam 6 21 3 14 3 7 „ Roll 1 1 1 - - 1 Jelly - 3 - 3 — — Lard - 10 - 10 - — Lemon Crystals - 1 - 1 — — „ Curd - 2 - 2 — — „ Squash - 5 - 5 — — Lemonade Powder - 5 - 5 — — Margarine - 7 - 7 — — Marmalade - 1 - 1 — — Meat Paste - 4 - 4 — — Pie - 6 - 6 - — ,, Roll (canned) - 1 — 1 — — Milk 283 61 276 59 7 2 ,, (condensed, full cream) — 2 — 2 — — ,, (condensed, sweetened, skimmed) — 3 — 3 — — ,, (dried) — 6 — 6 — — ,, (residue) — 1 — 1 — — Mincemeat - 3 - 3 — — Mint (dried) 1 5 — 4 1 1 Mustard 1 8 - 7 1 1 „ Mixture - 1 - 1 — — Nutmeg (ground) — 1 — 1 — — Oatmeal - 2 - 2 — — Oil (yellow) — 3 — 3 — — Olive Oil 4 — 4 — — Orangeade Powder — 1 — 1 — — Oranges (canned) — 1 — 1 — — Pears (canned) — 1 — 1 — — Peas (canned) — 10 — 10 — — Peel (mixed) — 1 — 1 — — Pepper — 14 — 14 — — Pickles — 2 — 2 — — Pilchards in Tomato Sauce (canned) — 3 — 3 — — Pineapple (canned) — 6 — 6 — — Plums (canned) — 2 — 2 — — Pudding Mixture — 1 — 1 — — Raisins — 1 — 1 — — Rice - 6 — 6 — — „ (ground) — 1 — 1 — — Salad (potato) — 1 — 1 — — Salmon (canned) — 4 — 4 — — Salt (Salodine) — 1 — 1 — — Sardines — 3 — 3 — — Sauce — 6 — 6 — — Sausages 1 13 1 12 — 1 Sausage (cooked) — 9 — 9 — — Carried forward 318 432 306 417 12 15 75 Articles of food of which samples have been made. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 318 432 306 417 12 15 Sausage Roll — 4 — 4 — — Scone — 1 — 1 — — ,, (cream) — 1 — 1 — — Soup (canned) — 1 — 1 — — Sponge cake — 1 — 1 — — Strawberries (canned) — 1 — 1 — — Suet (shredded) — 2 — 2 — — Sugar — 1 — 1 — — ,, (Demerara) — 2 — 2 — — Sultanas — 3 — 3 — — Sweet Decorations — 1 — 1 — — Sweets — 16 — 16 — — Syrup (Strawberry) — 1 — 1 — — Tapioca — 1 — 1 — — Tea — 1 — 1 — — Tomatoes (canned) — 4 — 4 — — Tomato Puree (canned) — 2 — 2 — — Tripe — 4 — 4 — — Vinegar (malt) — 1 — 1 — — Vitacream — 1 - 1 — — Wheat (prepared) - 1 - 1 — — Totals 318 482 306 467 12 15 Prosecutions wore 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. 1933. £ s. d £ s. d. N. 9 Milk Added water, 10 per cent. Mar. 14th — 2 2 0 N. 79 „ Deficient in milk fat, 13 per cent. June 9th — 2 2 0 N. 131 ,, Added water 18.5 per cent. Oct. 18th - 3 3 0 N. 125 Jam Adulterated by the admixture of sulphur dioxide, 0.010 per cent. Oct. 11th - 2 12 6 (b) Public Health (Preservatives, etc., in Food) Regulations, 1925. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 131, Fortess Road Selling jam which contained an added preservative contrary to Statute 1933. Oct. 11th Not proceeded with.* *See also proceedings under Food and Drugs (Adulteration) Act—Sample N. 125. 76 (c) Milk and Dairies Order, 1926. Address where offence committed. Offence. Date of Hearing of Summons. Result of Proceedings. 1933. Elm Road Delivering milk in bottles which were not filled or closed on registered premises Aug. 4th Fined £1. Hadley Street Carrying on trade of a dairyman without being registered Nov. 29th Dismissed on payment of costs, £2 2s. Wholesale Dealers in Margarine.—No certificates of registration under the provisions of the Food and Drugs (Adulteration) Act were issued during the year. Section VI.—PREVALENCE OF, AND CONTROL OVER, NOTIFIABLE 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 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." E. Under the London County Council (General Powers) Act, 1932:- Food Poisoning. 77 the following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1933. The notifications have not been corrected for any subsequent revision of diagnosis:— DISEASES. NOTIFICATIONS. Total all Ages. Cases admitted to Hospital. Total Deaths. At Ages—Years. Under 1 year. I and under 2. 2 ana under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and upwards. 1. Small-pox — — — — — — — — — — — — — — — 2. Scarlatina or Scarlet Fever 6 22 46 59 56 263 118 24 48 9 2 — 653 632 4 3. Diphtheria and Membranous Croup 3 17 23 34 36 139 49 16 37 6 3 — 363 362 13 4. Enteric or Typhoid Fever — — — — — 2 — 1 1 — 1 — 5 4 — 5. Puerperal Fever — — — — — — — 1 15 4 — — 20 20 5 6. Puerperal Pyrexia — — — — — — — 7 32 6 — — 45 39 — 7. Erysipelas 2 1 2 1 — 3 7 2 20 20 42 21 121 94 9 8. Cerebro-spinal Meningitis 2 3 — — — — 1 — 1 — — — 8 8 6 9. Anterior Poliomyelitis and Polioencephalitis 1 1 — — — 3 — — 2 — — — 7 7 2 10. Ophthalmia Neonatorum 42 — — — — — — — — — — — 42 19 2 11. Encephalitis Lethargica — — — — — — — — — — — — — — 6 12. Acute Influenzal Pneumonia 3 — 2 2 — 5 3 7 15 20 43 11 111 67 * 13. Acute Primary Pneumonia 4 10 10 4 9 28 8 10 37 26 42 23 211 172 * 14. Malaria — — — — — — — — 1 — 2 — 3 3 — 15. Dysentery — — — — — — — — 1 — — — 1 1 1† 16. Measles 38 57 50 56 55 134 24 7 14 1 1 — 437 121 4 17. German Measles 13 24 31 44 42 232 3 20 30 6 3 — 486 81 — 18. Food Poisoning — — — — — 1 3 3 13 4 4 — 28 6 —† *For Pneumonia Deaths, see Table 2 on page 107. † 1 Case of Food Poisoning died—death allocated to Acute Dysentery. 78 The notifications of, and deaths from, the notifiable diseases other than Tuberculosis are classified in the following table according to the Wards in which they occurred:— 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. Scarlatina or Scarlet Fever 100 80 171 85 77 63 25 52 653 — — 2 — 1 — — 1 4 3. Diphtheria and Membranous Croup 39 53 83 45 49 31 22 41 363 2 — — 1 4 1 — 4 ||13 4. Entericor Typhoid Fever 2 1 1 1 — — — — 5 — — — — — — — — — 5. Puerperal Fever 2 1 5 1 3 2 1 5 20 — 1 2 — 1 1 — — 5 6. ,, Pyrexia 9 4 12 3 7 4 2 3 †45 — — — — — — — — — 7. Erysipelas 23 11 21 18 12 16 4 14 † 121 2 — 1 — 2 1 1 1 ||9 8. Cerebro-spinal Meningitis — 1 1 4 1 1 — — 8 1 — 2 1 2 — — — 6 9. Anterior Poliomyelitis and Polioencephalitis 3 2 — 1 — 1 — — 7 1 1 — — — — — — 2 10. Ophthalmia Neonatorum 5 6 11 3 7 4 2 4 42 — — 1 — — — 1 — 2 11. Encephalitis Lethargica — — — — — — — — — 1 — — 3 — — — — ¶6 12. Acutc Influenzal Pneumonia 21 7 26 13 20 12 2 8 †111 — — — — — — — — — 13. Acute Primary Pneumonia 39 18 24 22 26 38 10 34 211 — — — — — — — — — 14. Malaria 1 — — — — — 1 1 3 — — — — — — — — — 15. Dysentery — — — 1 — — — — 1 — — — — — — — 1 ‡1 16. Measles 89 35 75 22 44 80 15 77 437 — — 1 — — — 3 — 4 17. German Measles 49 10 70 24 53 126 18 136 485 — — — — — — — — — 18. Food Poisoning — 1 2 1 5 1 3 15 28 — — — — — — — — ‡— Totals 382 230 502 244 304 379 105 390 †2541 7 2 9 5 10 3 5 7 || ¶52 *for pneumonia deaths, see Table 2, page 107. †Including 5 cases—"homeless" (1 of Puerperal Pyrexia, 2 each of Erysipelas and Acute Influenzal Pneumonia). ‡1 case of Food Poisoning died—Death allocated to Acute Dysentery. || Including two cases not notified to this Borough as the deaths occurred outside London (one each of Diphtheria and Erysipelas). ¶Including 2 deaths—"homeless." 79 SMALL-POX. There were no cases notified in St. Pancras during 1933. 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 Committee. 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, 1932. Vaccinations. 1st January to 31st December, 1932. — Number. Percentage of Births registered. North. SouthEast. SouthWest. Whole Borough North. SouthEast. SouthWest. Whole Borough Births registered 554 1881 1828 4263 100.0 100.0 100.0 100.0 Died, unvaccinated 18 94 79 191 3.2 5.0 4.3 4.5 Successfully vaccinated 256 874 876 2006 46.2 46.5 47.9 47.1 Had smallpox — — — — — — — — Insusceptible of vaccination 2 4 2 8 0.4 0.2 0.1 0.2 Received certificate of conscientious objection 221 516 525 1262 39.9 27.4 28.7 29.6 Postponed by medical certificate 10 31 24 65 1.8 1.6 1.3 1.5 Moved to known address in other districts 9 152 137 298 1.6 8.1 7.5 7.0 Lost sight of by removal 30 177 162 369 5.4 9.4 8.9 8.7 Unvaccinated and not accounted for in previous columns 8 33 23 64 1.4 1.8 1.3 1.5 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. 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 1931 4499 2210 49.1 1464 32.5 1932 4263 2006 47.1 1326 31.1 80 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, 1933:— 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. 156 10 166 2 „ 2 „ F. L. Pelly 136 31 167 4 Wards 3 and 4 „ J. Wigg 290 10 300 4 ,, 5, 6, and 7 „ A. E. Tait 315 35 350 5 Ward 8 ,, C. H. A. Alderton 141 6 147 5 Highgate Hospital ,, C. Thackray 1 1 2 - St. Pancras Hospital „ W. Feldman 8 — 8 - Totals 1047 93 1140 20 SCARLET FEVER. The number of cases notified was 653, as compared with 517 cases during the previous year. It was subsequently ascertained that 33 cases had been incorrectly diagnosed. The actual number of cases was therefore 620. Four deaths occurred; this equals a case mortality of 0.6 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 20 such cases during the year. In tracing the clinical histories it was found that in four houses the original case had definitely developed a nasal or ear discharge shortly after leaving hospital. Such discharges are known to be highly infectious. Several other primary cases were reported to have had colds. In 7 cases there was 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 26 families there were two such cases, in 10 families three multiple cases in each home, and in three families four cases in each house. There was one epidemic in an orphanage and five cases were reported. DIPHTHERIA. The number of cases notified was 363, as compared with 301 cases during the previous year. It was subsequently reported by the hospital authorities that 64 cases had been incorrectly diagnosed, the actual number of cases was therefore 299. This equals an attack rate of 1.6 per 1,000 of population. Thirteen deaths occurred, giving a case mortality of 4.3 per cent. 81 Investigation of multiple cases—that is, several cases occurring more or less together in one house — shows that in 19 families there were two such cases, and in five families three such cases in each home. In addition, there were two small epidemic outbreaks of four cases each. Antitoxin for the treatment of cases of this disease is supplied to medical practitioners free of charge by the Council. During the year 56 thousand units were provided. ENTERIC TYPHOID OR FEVER. Five cases of Para B. Typhoid were notified during the year. One case on further investigation was shown to have been incorrectly diagnosed. There were no deaths reported. PUERPERAL PYREXIA AND PUERPERAL FEVER. In 1933 there were 45 notifications of Puerperal Pyrexia and 20 notifications of Puerperal Fever. Three further cases of Puerperal Fever were brought to notice only after death. After the usual investigations had been made, some of these cases were found to have been incorrectly allocated, and the figures finally accepted were:— Puerperal Pyrexia Cases 37 Deaths Nil. Puerperal Fever Cases 31 Deaths 6*. *Including one returned as "Felo de se." 82 The following tables have been prepared by Dr. Pritchard to bring out some interesting details concerning these cases : — Cause of Pyrexia. Total cases notified. Confinement. Infant. Mother. In Institution. At Home. Living. Dead Viable. Non-Viable. Primipara. Unmarried. Ante-natal attention. Average Age. Deaths. Doctor. Midwife. Student. Abortion with no evidence of infection of Organs of Reproduction 5 1 4 — — — — 5 1 4 1 28 - Bronchitis 3 1 - 2 - 2 — 1 2 1 3 30 — Broncho-Pneumonia 1 1 - - - 1 — - — - 1 23 — Influenzal-Pneumonia 4 4 — — — 3 1 — 4 2 3 22 — Influenza 1 — 1 — — 1 — — 1 — 1 25 — Inflammation of Breasts 6 5 — — 1 6 — — 4 3 6 24 — Pyelitis 4 4 — — — 3 1 — 2 — 3 30 — Retained Products 3 1 2 — — 3 — — 1 1 3 28 — Prolonged Labour 2 1 1 — — 2 — — 1 1 2 28 — Phlebitis 2 1 - 1 — 1 1 — — — 2 40 — Jaundice 1 1 - - - - 1 - — - 1 32 — Necrotic Ovum 1 1 - - - — — 1 1 — 1 23 — Sore Throat, no evidence of infection of Organs of Reproduction 1 1 - - - 1 - - 1 - 1 27 - Gonorrhœa 2 2 - - — 2 - — 2 2 — 22 — Syphilis 1 1 — — — 1 — — — 1 — 21 — Puerperal Pyrexia. Totals 37 25 8 3 1 26 4 7 20 15 28 27 Percentages 100 67.6 21.6 8.1 27 70.3 10.8 18.9 54 40.5 76 — — 32.4 Puerperal Fever. Associated with Abortion *7 1 2 - — — — 7 2 1 — 34 3 Other cases 24 12 3 6 3 23 1 — 12 9 20 28 3 Totals 31 13 5 6 3 23 1 7 14 10 20 29 6 Percentages 100 48.1 18.5 22.2 11.1 74.2 3.2 22.6 45.1 31.9 65 - 19.4 51.8 *All cases sent in to Hospital for treatment after abortion. Note (1) None of these cases received any ante-natal advice. (2) The high average age. 83  1933. 1932 1931. 1930. 1929. 1928. 1927. Puerperal Fever. Cases 31 42 25 33 43 33 36 Deaths 6 8 3 Nil. 5 3 4 Incidence 11.6 15.2 8.5 10.3 13.6 10.1 10.9 per 1,000 births. Mortality Rate 19.4 19.0 12.0 Nil. 11.6 9.1 11.1 per 100 cases. Death Rate 2.2 2.9 1.0 Nil. 1.6 0.9 1.2 per 1,000 births. Puerperal Pyrexia. Cases 37 34 37 37 53 41 33 Incidence 13.8 12.3 12.5 11.6 16.7 12.5 10.0 per 1,000 births. ERYSIPELAS. 121 cases were notified and 9 deaths occurred, as compared with 117 cases and 17 deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever, Meningococcal Meningitis, "Spotted Fever.") Nine cases were notified and three others were brought to notice after death. Of the nine notified cases, only four have recovered completely and the diagnosis was doubtful throughout the course of one of them. Five of the notified cases died; the diagnosis was confirmed for three of these, one was proved at the post mortem to have died from Tetanus and the notification was withdrawn by the medical practitioner concerned, and the other from Encephalitis Lethargica. There were therefore nine definite cases and one indefinite case and six deaths during the year. The case mortality is very high. The disease has a sudden onset and fatal cases usually die in the early stages. A survey of the mode of treatment is being made, the effect of different brands of serum is being carefully recorded, and these reports are sent to the Ministry of Health. It is hoped that the collection of these data from the whole country will supply the necessary information on the value of Serum Treatment. ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Seven cases were notified, two of which died. Of the remaining five, one is under treatment at the Treloar Hospital, Alton; two are at Queen Mary's Hospital, Carshalton, and two are attending Hospitals in London. All these cases occurred in July, August and September. 84 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. 1933 42 23 19 40§ — — 2¶ 16.2 14 19 1932 74 56 18 73 — — 1|| 27.6 30 15 1931 45 26 19 43† — — - 15.2 18 14 1930 31‡ 23 8 30 — - 1* 9.1 17 6 1929 36 21 15 34 1 — 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 causes. †Several cases removed to unknown addresses. ‡ Excluding one case, information unobtainable. || Died from Prematurity, Congenital Heart Disease and Gonorrhœal Ophthalmia. § One moved away to unknown address. (1) Died—Prematurity. Ophthalmia Neonatorum. (2) Died—Gastro Enteritis. Ophthalmia Neonatorum, Mongolism, Imbecility. In addition to the above, there were 49 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 remained the approximate figure for several years. 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 42 notifications this year, only four were considered "grave." There were 12 of "moderate" severity, and 26 were returned as "slight," The true condition is still a prolific cause of blindness. This is definitely seen in those counrties where Ophthalmia Neonatorum is not regarded with due consideration. In the past seven years, out of 298 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. In 17 cases the mother was giving birth to her first baby, and four of these were illegitimate babies. In 22 cases the confinement took place at home, and of these 12 were attended by midwives, five by doctors and five by medical students. Twenty of the babies were born in Hospitals or Maternity Homes. Thirty-six mothers received ante-natal care. The two deaths were among the six babies born where the mother had failed to seek ante-natal advice. 85 ENCEPHALITIS LETHARGICA. No cases were notified during the year. Six cases were brought to notice after death. Sixteen old St. Pancras cases are under treatment at various Institutions, mainly at Winehmore Hill. The majority are reported to be progressing very slowly. 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 211 notifications of the former and 111 of the latter during 1933 (as compared with 178 and 68 respectively for 1932). There were 173 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 Borough Council. In 1933, 31 cases were nursed under this arrangement and 815 nursing visits were paid. MALARIA. Three cases were notified. They were all old cases and the disease had been contracted abroad. DYSENTERY. Only one case was notified during the year, and on investigation it was shown that this patient had contracted the disease in India. One of the fatal cases from the Food Poisoning Epidemic, which is reported below, was recorded by the Coroner as having died from "Acute Dysentery." FOOD POISONING. Cases of Food Poisoning were made notifiable by Section 7 of the London County Council (General Powers) Act, 1932, which came into force on July 12th of that year. No exact definition of food poisoning was given in the Act and some difficulty may be experienced in framing a satisfactory definition. In a number of the patients notified it would appear from the information obtained that the cases should really have been regarded as suffering from Acute Indigestion, etc., and not from actual food poisoning. One definite outbreak of food poisoning did, however, occur during the year affecting 13 persons, two of whom died. The following report which was submitted to the Council gives particulars of the outbreak and is reprinted here for reference. Ladies and Gentlemen, On Sunday afternoon, October 8th, 1933, six patients were admitted to Highgate Hospital suspected to be suffering from food poisoning, and it was stated that food purchased at certain premises in St. Pancras was thought to be responsible. Another patient was shortly afterwards admitted to University College Hospital, and on Monday notifications were received of six other cases, 86 Of the total thirteen cases, five were adults, and eight were children; eleven resided in St. Pancras, and two in Holborn. It was ascertained quite early in the investigation that the food responsible for the outbreak was pease pudding. This had been made on Saturday, the 7th October, the procedure being as follows:—About 4.30 p.m. four pounds of dried split peas in a canvas bag were placed in an enamelled iron saucepan, containing boiling water, to which a little bicarbonate of soda had been added. After coming to the boil they were allowed to "simmer" for three hours, were then emptied into a glazed earthenware vessel, some salt was added, and they were then beaten up with a wooden spatula, about a pint of the water in which the peas had been cooked being added. The process was completed about 7.30 p.m., the finished product weighing about seven or eight pounds. The earthenware vessel containing the pease pudding was kept near a gas stove in a room behind the shop, and at intervals, during the evening, a little boiling water was added to keep the pudding warm and moist. The conditions were therefore ideal for bacterial multiplication. Portions of about five ounces were sold for a penny, each portion being placed in a piece of greaseproof paper and then wrapped in newspaper. It was thought that about eighteen to twenty customers were served with the pudding during Saturday evening as, approximately, two pounds remained unsold. In the thirteen notified cases the pudding was stated to have been purchased or eaten between 7.45 and 10 p.m.. and in practically all the cases the onset of symptoms occurred in the early hours of Sunday morning. The clinical signs and symptoms, which were more or less marked according to the severity of the attack, included vomiting, abdominal pain, diarrhœa, with passing of blood and mucous, rapid pulse, rise of temperature and cyanosis of lips and extremities. The two fatal cases were boys of 11 and 13 years of age, one died at 7 p.m., the other at 9 p.m. on Sunday, that is, within a period of twenty-four hours of having eaten the pudding. In each of these cases only one pennyworth had been purchased, and each boy had given a portion of this to another child, both of whom were subsequently ill. An indication of the severity of the infection may also be gained from the fact that one case, a woman of fifty-four years of age, who had eaten only three tcaspoonfuls of the pudding, and thinking it tasted "musty," threw the remainder in the fire, was taken acutely ill on Sunday morning, and obtained medical advice. The onset of the symptoms was sufficiently rapid to suggest the possibility of chemical (inorganic) poisoning, although the rise of temperature pointed to a bacterial infection. Both chemical and bacteriological investigations were therefore made. The report of the Analyst stated that uo chemical poison could be found either in the dried peas, pease pudding, salt or soda, nor in the vessels in which the pudding had been prepared or stored. The report of the bacteriologist was as follows:— (1) Dried Peas. B. Coli, Streptococci, B. Welcliii, and a few colonies B. Fæcalis Alkaligenes. (2) Pease Pudding. An abundant growth of B. Coli, Streptococci, B. Welchii, a marked growth of B. Fæcalis Alkaligenes and gram negative bacilli which had the reactions of B. Dysenterise. This organism agglutinated well with an Anti-Sonne dysentery serum. From material obtained from the two fatal cases and also from the patient admitted to University College Hospital, dysentery bacilli of the Sonne type were isolated. As dysentery bacilli were not found in the sample of dried peas, but were present in the pease pudding, it appeared to be probable that the infection had been conveyed to the pudding after it was made. It was, however, feasible, owing to the number and character of the organisms present in the dried peas, that dysentery bacilli might also be present, although they had not been isolated from 87 the particular sample examined. To exclude this possibility a number of samples of dried peas from the same consignment were examined and the report received from the Ministry of Health laboratory was as follows :— Nine samples of dried split peas from various sources (same consignment) sent by the Medical Officer of Health, St. Pancras. No organisms of dysentery or enteric group found. B. Coli, non-lactose fermenting coliform bacilli (B. fiscal is alkaligenes type) and B. proteus present in over 50 per cent. of the samples. B. Welchii, aerobic sporing bacilli (B. subtilis type), non-hæmolytic streptococci and staphylococci present in 100 per cent. of the samples. Seven samples of dried split peas belonging to the same consignment, received from Medical Officers of Health, and one sample bought locally over the counter. All gave growth of similar types of organism. This report appeared definitely to exclude the dried peas as the source of infection and to confirm the suspicion that the pudding was infected after having been made. The fact that the consignment of dried peas in question (which had been imported from Poland and milled in Holland) consisted of a thousand 1 cwt. bags, that 700 bags had been distributed throughout London and the country, and a large quantity of the peas consumed, without ill effect, was also an important factor in excluding the peas from suspicion. The staff at the shop, which was a lock-up shop, was stated to consist of the proprietor and his wife. Samples of their blood, urine and fieces were examined, but were found to be negative. This excluded the above persons as "carriers." No rats or mice had been noticed on the premises, and although these animals may be carriers of pathogenic organisms of the Aertrycke-Gærtner group, they are not known to carry dysentery organisms. As a result of further inquiries, it was ascertained that a little girl, age nine years, and two adults, although residing elsewhere, occasionally came to the premises, and sat, either in the shop or in the room behind the shop. Samples of their blood, urine, and feces were examined. The results as regards the two women were negative, but the child's faeces contained large numbers of dysentery bacilli of the Sonne type, and her blood re-acted in a dilution of 1-125. It is unfortunate that nine days had elapsed before the above information was obtained, and the blood, etc., examinations were made, as it was now discovered that the child had been in the room behind the shop in which the pease pudding was kept on Saturday, the 7th October, between 7.30 and 8 p.m., and on being questioned admitted having eaten some of the pease pudding, taking it out of the vessel with her fingers. The point that now arose for consideration was whether the child was the cause or a victim of the outbreak. If the blood examination could have been made at an earlier date this problem would not have arisen. In the opinion of the bacteriologist, it was unlikely that the blood would have re-acted so strongly if the child had only been infected nine days before. It is also important to note that after eating some of the pudding on Saturday evening no symptoms of illness followed. The child was quite well on Saturday night, the whole of Sunday and on Monday until about 4.30 p.m., when she came home complaining of some abdominal pain and a feeling of sickness. She had a holiday from school on Monday and went to Hyde Park for the day with the maid. For her mid-day meal she had some fried fish with much vinegar, then had some ice-cream, and previously had eaten a banana. This very injudicious combination was doubtless responsible for the abdominal discomfort, as a dose of castor oil promptly effected a cure. In outbreaks of food poisoning it is notoriously difficult to trace the exact source of infection, and in a large percentage of cases this is not ascertained. In the present instance, on reviewing all the evidence, it would appear to have been definitely established that:— (1) The child was a "carrier" of dysentery organisms. (2) She infected the pudding on Saturday, the 7th October, when taking a portion out of the receptacle with her fingers. (3) This act was responsible for the outbreak. 88 This was the verdict of the jury after careful inquiry into the cause of death of the two fatal oases. With reference to the presence of bacteria in dried peas, it does not appear to be generally known that such organisms as B. Coli, Streptococci, B. Welchii. Fæcalis alkaligenes, etc., are usually present in peas, oats, wheat and other cereals. That does not necessarily indicate fæcal pollution, but is due to contamination by dust, handling, contact with sacks, containers, etc. The same organisms are also usually present on fruit and vegetables, and is due to contamination by dust, etc. Some tomatoes exposed for sale on a stall were recently examined and an abundant growth of B. Coli was obtained. Although practically all the bacteria mentioned would be destroyed in the ordinary process of cooking, the above facts emphasize the necessity for extreme cleanliness in culinary operations and the desirability of washing cereals before cooking. With reference to the destruction of bacteria in the ordinary process of cooking, some experiments were made in the Ministry of Health Laboratory. When a mass consisting of four pounds of dried peas, in a saucepan of water, was brought to the boil, and then allowed to simmer (the method adopted in making the pease pudding), it was found that the temperature of the water was 96 degrees Centigrade, and the temperature in the interior of the mass of peas was 94 degrees Centigrade. In a control experiment dysentery bacilli (Sonne) were killed at a temperature of 58 degrees Centigrade in twenty minutes. This again indicates that if the preparation of the pudding was carried out as stated, infection could only have occurred subsequently. I am, Ladies and Gentlemen, Your obedient Servant, G. Sowden, Medical Officer of Health. A copy of the report was forwarded to the Minister of Health in accordance with the requirements of Section 14 (5) of the Sanitary Officers (London) Order. There were 28 notifications of Food Poisoning including those due to the pease pudding epidemic which is fully recorded in the above Special Report. Eight of the other cases were definitely shown to be cases of "Indigestion" rather than "Food Poisoning," several of the remaining cases were indefinite and a great variety of foods were stated to have been responsible for the illnesses. In one instance only, apart from the above-mentioned Epidemic, was food considered to be definitely responsible for the illness. 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. V. Pritchard, Assistant Medical Officer, and demonstrate several important and interesting facts about Measles, Table I. gives the gross figures as regards incidence and deaths. These may be misleading, and they have therefore been worked out in Table II. as Incidence and Mortality Rates. On Table III. these calculations are expressed by two graphs. 89 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 usually 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, when 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 decrease in the incidence of Measles occurred in 1933. The following tables and graph give the details. There were 437 notified cases. St. Pancras is one of the few Local Authorities which have made Measles and German Measles notifiable. Because of these measures and the routine "following up" we are able to maintain a strict supervision over the great majority of cases in the Borough. 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 42. 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 486 cases during the year 1933, as compared with 65 cases during 1932. There were no deaths. This is the largest epidemic which has been recorded for many years. It was a very mild illness with a rapid recovery. 90 Table I. MEASLES. YEAR. INCIDENCE. DEATHS. Quarter of the Year. Total. Under 1 year. 1—5 years. 5-15 years. Adults. Quarter of the Year. Total. Under 1 year. 1—5 years. 5—15 years. Adults. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1933 77 180 138 42 437 38 218 158 23 2 — 2 - 4 — 4 — - 1932 749 1901 162 53 2865 135 1592 1090 48 8 16 3 - 27 6 21 - - 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 - 91 Table II. MEASLES. Year. Incidence Rate per 1000 Population. Mortality Rate per 1000 Cases. Quarters of Year. Total. Quarters of Year. Total. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1933 .4 .9 .7 .2 2.2 25.9 - 14.5 — 9.2 1932 39 9.8 .8 .3 14.8 10.7 8.4 18.5 — 9.4 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 20 — 13.9 20.4 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 TETANUS. Although this is not a "Notifiable Disease," it is of interest to note that one case occurred in the Borough. A boy, aged 9, developed symptoms which resembled those of Cerebro Spinal Meningitis. He was sent into a Special Hospital at once, but died within a few hours of admission. A Post Mortem examination proved the case to have been one of Tetanus and the infection had followed an extraction for dental caries. 93 TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1933 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 - - 2 — — — 1 — 1-5 3 2 5 7 — — 4 3 5-10 6 — 9 4 1 — 2 1 10—15 1 5 2 5 1 1 1 3 15—20 10 15 4 4 2 3 — — 20-25 23 24 5 5 12 9 - 1 25—35 38 27 7 2 23 10 — 2 35-45 29 12 1 5 25 3 — 1 45—55 38 11 3 3 26 6 — 3 55—65 26 10 2 1 25 5 — 1 65 & upwards 13 4 1 2 13 6 — 1 Totals 187 110 41 38 128 43 8 16 The total number of Primary notifications was 300; in addition to these, 33 cases, which had not been notified, came to knowledge by means of special death reports, 41 cases by transfer from other districts, and two cases by posthumous notification. The total number of new cases during the year from all sources was therefore 376, equal to a notification rate of 1.97 per 1,000 of population. The total number of new cases during the previous year was 409. The deaths from all forms of Tuberculosis during the year numbered 195, equal to a death rate of 1.02 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 195 deaths from Tuberculosis, 35 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, 93 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 1st January, 1933, to the 31st December, 1933 (inclusive). Age Periods. Number of Notifications on Form A., Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors). 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 3 3 1 10 22 31 25 32 20 8 155 211 Females — 2 — 4 14 19 22 10 9 8 2 90 123 Non-pulmonary Males 1 3 7 1 4 2 7 1 3 2 - 31 31 Females — 4 4 3 2 4 1 4 — - 2 24 26 Totals 1 12 14 9 30 47 61 40 44 30 12 300 *391 *Exclusive of 18 "Lost sight of " cases returned. 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 - - 3 - - 1 7 4 6 6 5 32 Females. - — — 1 1 5 5 2 2 2 2 20 Non-pulmonary Males 1 2 2 1 — 3 — 1 10 Females — 3 — 2 2 1 1 1 3 1 — 14 Totals 1 5 5 4 3 10 13 7 11 9 8 76 64 The following table gives particulars as to the prevalence and fatality of this disease during the past 10 years:— Year. Estimated Population. Notifications. Deaths. Notification Rate. Death Rate. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 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 354 112 466 175 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 1.06 1932 194000 324 85 409 164 25 189 1.67 0.44 2.11 0.84 0.13 0.97 1933 190900 297 79 376 171 24 195 1.56 0.41 1.97 0.90 0.12 1.02 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 1933:- Tuberculosis (All Forms). Ward. New Cases. Deaths. Number. Rate per 1000 of Population. Number. Rate per 1000 of Population. 1 55 1.6 25 0.7 2 40 2.1 23 1.2 3 70 2.2 43 1.3 4 54 2.3 32 1.4 5 52 1.9 23 0.8 6 40 2.3 17 1.0 7 24 1.9 12 1.0 8 38 1.5 18 0.7 Homeless 3 - 2 - Totals 376 2.0 195 1.0 95 Public Health (Tuberculosis) Regulations, 1930. Those Regulations placed various additional duties upon local Authorities, and included the compilation of a register of cases of Tuberculosis of all kinds who are residents of the Borough. The following table gives this information for the year ended December 31st, 1933:— Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1933 1286 396 1682 Number of new cases during the year 312 82 394 1598 478 2076 Number of cases removed from the Register during the year (from death or other causes) 356 91 447 Number of cases remaining on the Register at the end of the year 1242 387 1629 Public Health (Prevention of Tuberculosis) Regulations, 1925. No formal action was necessary during the year under the above regulations. Boarding out of Children from Tuberculous Homes. This scheme was initiated in 1925, and provided for:— (a) The boarding out of children living in heavily infected and overcrowded homes, and for (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 14 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 arc 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. 96 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 108 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 3737 ,, Holland 3296 Total 7033 In connection with Tuberculosis, the housing conditions of the family arc 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. 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." In addition to the above duties, certain alterations were made during the year by the London County Council, with the concurrence of the Borough Council, with reference to the assessment and collection of contributions towards the cost of residential treatment of patients suffering from tuberculosis. 97 These alterations, some of which add to the duties of the Cave Committee, are as follows:—(a) The review of assessments of contributions towards the cost of treatment for tuberculosis under the Council's scheme, approved by the Minister of Health, for the treatment of tuberculosis in London should be undertaken by the Public Assistance Committee or a duly authorised sub-committee of that committee; and that the Minister be asked to approve the substitution of "Public Assistance Committee" for "Public Health Committee" in paragraph 58 (mode of assessment of contributions) of the scheme. (b) That the metropolitan borough councils be asked to arrange for the tuberculosis care committees appointed by them to undertake, as from a date to be arranged (and in addition to their existing assessment and collection functions in respect of tuberculous patients treated under the Council's tuberculosis scheme), the assessment and collection of the amounts which all other tuberculous patients receiving residential treatment under arrangements made by the Council should be required to pay, subject to review as prescribed for assessments under the scheme. (c) That, in reviewing the assessments referred to in the foregoing resolutions (a) and (b), regard do continue to be paid to the importance 011 medical grounds of maintaining the standard of living of the family. 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 1933. "The Committee has continued to meet fortnightly during the year. During the year Miss Hill was obliged to resign from the Committee owing to pressure of work. Her place was very kindly taken by Miss Davidson. Total number of cases considered during the year 318 51 cases were assessed at sums varying from £2 to 2s., and 217 cases were assessed as being free from contribution. In several cases relatives of patients, in making their payments at the Town Hall, disclosed the fact that owing to unemployment, sickness or various causes, difficulty was being experienced in maintaining the payment of the assessment. These cases were brought before the Care Committee where sympathetic consideration was given, and a recommendation submitted to the London County Council for the case either to be free from contribution or a reduction made, and in all cases so submitted concurrence was received. Finally, in the course of the year the sum of £235 18s. 6d. was sent to the London County Council as payments towards the cost of treatment. During the year under review much time has been given to care work, and the following examples give some idea of the variety and scope of the work. 98 A man has been refitted with a spinal jacket. This necessitated much correspondence, and finally through the co-operation of the man's employer and the Charity Organisation Society the instrument was procured and the man enabled to continue in his employment. Another man, who had previously lost a leg through tuberculosis, found it difficult to continue with his work owing to the shrinkage of his "stump," which necessitated his being supplied with a new leg. On application to the Care Committee for help, efforts were made to get in touch with various agencies, and finally, through the courtesy of the Secretary of Queen Mary's Hospital, Roahampton, the man was allowed to attend there for the necessary fitment, the cost of which he was able to meet himself. The mother of a tuberculous patient after being in Hospital for some time was badly in need of convalescent treatment. Through the kindness of Mr. Sidney Bolsoin, ex-Mayor of St. Pancras, a letter was obtained for admission to the Samuel Lewis Home, Walton-on-Naze. The patient was asked to contribute 7s. 6d. towards the cost, and on her being unable to meet this expense Mr. Bolsom most kindly paid it himself. The mother duly returned home greatly benefited by the change. A mother was left with a family of ten children owing to the death of her husband from tuberculosis. She found it very hard to carry on pending the receipt of her pension ; so in the meantime, arrangements were made for five of the children to have school meals, and thus help the mother over a critical time. In another case sympathetic consideration was given in the re-housing of a family, consisting of father, mother (both tuberculous) and three children. The Borough Council recommended this case to the London County Council for preferential treatment, with the result that accommodation has been found for them at Morden. The Care Committee is grateful for the continued co-operation and help of the Charity Organisation Society, Invalid Children's Aid Association, United Services Fund, and other Societies. The Hon. Secretary acknowledges with gratitude a grant from the Eleanor Palmer Charity, which has enabled her to re-stock a somewhat depleted cupboard with men's clothing—always a very pressing need. In addition a parcel of clothing was received from Princess Mary's Needlework Guild containing many useful garments. H. M. Whelon, Hon. Secretary." TUBERCULOSIS DISPENSARY. Nine consultations are held in each week—two in the morning, five in the afternoon, and two in the evening. The premises provided by the Borough Council for use as a Tuberculosis Dispensary were opened in February, 1932. They are situated on the entrance floor of Barnes House, 9-15, Camden Road, and comprise a waiting room, two consulting rooms, laboratory, rooms for the nurse, health visitors, and clerical assistant, dressing rooms for the patients, and the necessary sanitary accommodation. 99 The X-ray work which is necessary in connection with patients suffering or suspected to be suffering from Tuberculosis is carried out at the University College Hospital. Tuberculosis. It was decided during the year that the Tuberculosis Officer of the Borough Council should act as Honorary Consultant for Tuberculosis at the General hospitals of the London County Council in the Borough—the matter to be subject to revision at the end of the year. Sanocrysin Treatment. Arising out of a communication from the Secretary of Brompton Hospital, it was decided bv the Borough Council, with the concurrence of the London County Council, that financial responsibility would be accepted for the treatment by Sanocrysin of certain patients suffer ins: from Tuberculosis. The eases were to be approved by the Medical Officer of Health and the Tuberculosis Officer, and the Council's liability to be limited to a sum of three shillings for each injection. Artificial Light Treatment. Provision as part of Ttdterculosis 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 treatment by Finsen lamp, and Is. an attendance for general ultra violet light treatment; and at the St. Thomas's Hospital on the basis of payment of Is. 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. Hack:— "The number of new tuberculous patients dealt with at the Dispensary during 1933 shows little change from the previous year. Though the number of living patients notified has decreased by thirty-one, there has been no corresponding decrease at the Dispensary owing to the inclusion under the Tuberculosis Scheme, since April 1st, of all tuberculous patients admitted to the L.C.C. General Hospitals. The number of nontuberculous patients shows a slight increase and there is a marked decrease in the number of patients undiagnosed at the end of the year. Owing to this decrease and to an increased number of deaths, the total on the Dispensary Register on December 31st has fallen by forty-nine. The number of contacts who attended, though slightly increased, is still low, and efforts are being made to improve the figure during 1934 by distributing special contact cards and sending out letters when contacts have not attended after a reasonable period. Altogether 404 applications for admission to institutions were made during the year, 345 for treatment and 59 for investigation. Of the former 197 were recommended for sanatorium treatment, 113 from the Dispensary and 84 from Hospitals; the remainder 100 being considered unsuitable for sanatorium were recommended for hospital treatment either as emergency cases (105) or otherwise (43). Of the patients recommended for investigation, 34 were for diagnosis and 25 for decision as to suitability for sanatorium. Ten applications were withdrawn by patients and one patient was refused treatment under the Tuberculosis Scheme and accepted by the Ministry of Pensions. The number of artificial pneumothorax refills given to St. Pancras patients shows a further increase from 348 to 403. The results of this treatment are still under investigation by the London County Council. On February 14th certain proposals for the co-operation of the Tuberculosis Dispensary with the Public Assistance Department were circulated to the Metropolitan Boroughs. These proposals were included in a joint report by the Central Public Health and Public Assistance Committees, which was accepted by the L.C.C. on February 7th, and they were designed to provide suitable tuberculous patients with extra nourishment through the local Public Assistance Committees. The District Medical Officers were consulted on the matter, and it was agreed that they should refer all tuberculous patients seen by them to the Tuberculosis Officer, and that, to save delay, they should recommend suitable patients for extra nourishment first if they thought it necessary. The Tuberculosis Officer, on the other hand, would recommend, direct to the Relieving Officer, all suitable patients already attending the Dispensary. The scale of relief is such that it has been found necessary to recommend in this manner every patient known to be in receipt or in need of Public Assistance and, as a rule, when recommendations have been made the Committees have allowed means to obtain a pint of milk and an egg daily for each patient in addition to the ordinary diet. These arrangements for the distribution of extra nourishment appear to work smoothly, but the allowance itself is by no means adequate, especially when it is considered that proper nutrition is not more important to the patient than to other members of a tuberculous family. G. A. Back, M.B., B.Ch., D.P.H." 101 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 123 64 5 7 11 6 9 9 134 70 14 16 234 (b) Diagnosis not completed — — — - - — - — 6 5 1 — 12 (c) Non-tuberculous - - - - - - - - 57 82 32 24 195 B.—Contacts examined during the year:— (a) Definitely tuberculous - - - - - - - - - - - - - (b) Diagnosis not completed - - - - - - - - 1 1 - - 2 (c) Non-tuberculous — — — — — — — — 9 23 35 41 108 C.—Cases written off the Dispen- sary Register as- (a) Recovered 6 11 1 - — 2 1 4 6 13 2 4 25 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 72 114 70 66 322 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 348 209 9 8 40 35 32 38 388 244 41 46 719 (b) Diagnosis not completed — — — — — — — — 13 22 6 5 46 1. Number of cases on Dispensary Register on January 1st 814 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 86 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" . 211 4. Cases written off during the year as Dead (all causes) 128 5. Number of attendances at the Dispensary cluding Contacts) 3024 6. Number of Insured persons under Domiciliary Treatment on the 31st December 362 7. Number of consultations with medical tioners :— (a) Personal 12 (b) Other 223 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 81 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4287 10. Number of— (a) Specimens of sputum, &c., examined 561 (b) X-ray examinations made in connection with Dispensary work 85 11. Number of 44 Recovered" cases restored to Dispensary Register, and included in A (a) and A. (b) above . 2 12. Number of "T.B. plus cases on Dispensary Register on 31st December 410 152 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 eases 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 — - — — Scarlet Fever 630 620 622 651 Diphtheria 355 349 347 369 Enteric Fever 8 8 8 3 Erysipelas 107 107 106 13 Puerperal Fever and Pyrexia 9 9 14 14 Encephalitis Lethargica — — — — Polio-myelitis 5 5 5 4 Cerebro-spinal Meningitis 10 10 9 10 Pneumonia 4 4 4 2 Tuberculosis 108 108 51 107 Measles 24 23 17 30 Vermin and Scabies 341 336 187 345 Other Diseases 318 318 303 131 Totals 1919 1897 1673 1679 103 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 65 1607 17 308 Bolsters and pillows 28 3908 22 443 Sheets, blaukets and panes 24 5853 2 508 Rugs, mats, cushions, carpets, covers aud curtaius 17 1342 4 146 Wearing apparel 104 2745 9 160 Books - 184 - - Sundries 10 970 - 54 Totals 248 16609 54 1619 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, 1934, amounted to £153 17s. 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 1205 26 3800 *5031 Scabies 100 173 1458 1731 Infectious Disease Contacts 1 5 — 6 Totals 1306 204 5258 6768 * Includes 515 males and 6 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 one Woman Assistant. 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. 104 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 disinfesting. 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 case*, 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. Tcale, 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 135 1328 1463 Blood ,, Typhoid Fever 1 4 5 Faeces ,, „ — 1 1 Urine ,, Tubercle Bacilli — 1 1 Sputum ,, „ 44 366 410 This table does not include the examinations made in connection with the epidemic of food poisoning reported on page 85, and the subsequent investigations of the child who was found to be a carrier of Dysentery and responsible for the outbreak. Facilities for the examination of Cerebro-spinal fluid in suspected cases of Poliomyelitis, Encephalitis Lethargica and Cerebro-spinal Fever are available through the London County Council's laboratory, and for the examination of blood in cases of suspected Malaria through the Ministry of Health. APPENDIX. 106 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1933 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 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† 1932 194000 — 4224 2684 13.8 2832 14.6 937 650 186 69 2545 13.1 1933 190900 — 4208 2589 13.6 3102 16.2 1032 538 151 58 2608 13.7 Area of district in acres (land and inland water), 2694; total population at all ages, 198,133; number of inhabited houses, 24,980; average number of persons per house, 7.93; at Census, 1931. * Based on total population. †Based on civil population. 107 TABI.E NO. 2. REGISTRAR-GENERAL'S SHORT LIST OF THE CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF ST. PANCRAS, 1933. CAUSES OF DEATH. Sex. All agee. 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. 05 and under 75 years. 75 years and upwards. ALL CAUSES M 1425 90 19 21 33 40 63 97 183 297 330 252 F 1183 61 17 9 26 31 41 63 117 189 287 339 1. Typhoid and Paratyphoid Fevers M - - - - - - - - - - - - F - - - - - - - - - - - - 2. Measles M 1 - - 1 - - - - - - - - F 3 — 2 1 - - - - - - - - 3. Scarlet Fever M 3 1 — 1 — 1 — - - - - - F 1 - - - - - - - - - - - 4. Whooping Cough M 8 2 5 1 - - - - - - - - F 7 2 4 — 1 - - - - - - - 5. Diphtheria M 6 1 1 2 2 - - - - - - — F 7 - — 2 5 - - - - - - - 6. Influenza M 64 1 — 1 1 2 4 11 14 14 12 4 F 67 - 1 - — 2 2 4 8 11 11 18 7. Encephalitis Lethargica M 2 — — — — 1 — — — 1 — — F 4 — — — - - — — 1 3 — — 8. Cerebro spinal Fever M 4 3 1 - - - - - - - - - F 2 — — — 1 — — — 1 — — — 9. Tuberculosis of Respiratory System M 128 — — — 2 13 23 25 27 25 12 1 F 44 — — — 1 12 10 3 6 6 4 2 10. Other Tuberculous Diseases M 8 1 — 4 3 — — - — - — — F 15 — 1 2 4 1 2 1 2 1 1 - 11. Syphilis M 7 1 — - — 1 — 1 1 3 - - F - - - - - - - - - - - - 12. General paralysis of the insane, tabes dorsalis M 12 — — — — 1 — 1 4 5 1 — F 4 - - - - - - 1 2 1 — — 13. Cancer, Malignant Disease M 184 — — — — 1 3 6 20 60 61 33 F 182 — — — — 2 5 13 32 46 53 31 14. Diabetes M 9 - - - - - - 1 4 1 2 1 F 11 - - - - - - - 1 1 7 2 15. Cerebral Hæmorrhage, etc. M 29 - - - - - - 1 3 5 13 7 F 25 - - - - - - - 2 4 7 12 108 Table No. 2—continued. CAUSES OF DEATH. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 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 308 - 1 — 5 1 7 6 30 61 95 102 F 332 — — — — 4 5 8 20 41 100 154 17. Aneurysm M 8 — - — — — 1 1 1 2 1 2 F 8 - - - - - - - 1 3 4 — 18. Other Circulatory Diseases M 68 — — — — - — 1 7 6 24 30 F 76 - - - - - - - 4 15 20 37 19. Bronchitis M 47 3 — — — - — 2 8 10 13 11 F 36 3 1 - 1 - — 2 — 4 10 15 20. Pneumonia (all forma) M 111 10 7 4 2 2 4 9 12 29 19 13 F 62 5 5 — 2 3 1 2 8 10 12 14 21. Other Respiratory Diseases M 18 1 1 — — — 1 2 6 3 2 2 F 7 — — — — — — 1 1 1 2 2 22. Peptic Ulcer M 26 — — — 1 — 2 4 8 7 2 2 F 9 - - - - - - 1 2 1 4 1 23. Diarrhœa, etc. M 18 14 1 — — — - - — 1 1 — F 19 14 1 — 1 — — 1 1 — 1 - 24 Appendicitis M 5 — — — 1 1 - 1 1 1 - — F 7 — — 1 — — 1 — 2 1 2 — 25. Cirrhosis of Liver M 8 — — — — — — 1 1 4 2 — F 6 - — - - — — 1 2 2 - 1 26. Other Diseases of Liver, etc. M 2 - - - - - - - - - 1 1 F 4 — - — — — 1 — — 1 1 1 27. Other Digestive Diseases M 30 3 — 1 2 2 1 1 4 6 8 1 F 26 1 — - 1 — — 3 1 7 6 7 28. Acute and Chronic Nephritis M 40 — — — — 2 2 3 7 9 10 7 F 35 — _ — 1 1 — 2 6 7 10 8 29. Puerperal Sepsis F 5 — — — — — 3 2 — — - — 30. Other Puerperal Causes F 5 - - - - - 3 2 — — — - 31. Congenital Debility, Premature Birth, Malformations, etc. M 39 37 — 1 1 — - — — — — F 27 26 - - 1 - - - - - - - 109 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. 32. Senility M 15 - - - - - - - - 1 3 11 F 15 - - - - - - - - - 4 11 33. Suicide M 47 — — — — 3 6 7 10 13 8 1 F 14 — — — - — 4 2 3 3 2 — 34. Other violence M 61 3 — 2 7 4 4 6 4 7 15 9 F 39 3 — 2 2 1 1 2 3 8 8 9 35. Other defined Diseases M 109 9 2 3 6 5 5 6 11 23 25 14 F 89 7 2 1 5 5 6 12 7 12 18 14 36. Causes ill-defined or unknown M - - - - - - - - - - - - F - - - - - - - - - - - - Legitimate. Illegitimate. M 80 10 Deaths under 1 year F 48 13 110 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. 1 435 12.6 407 11.8 19 44 25 0.7 2 301 15.9 239 12.6 10 33 23 1.2 3 526 16.5 462 14.5 29 55 43 1.3 4 318 13.8 333 14.4 15 47 32 1.4 5 386 13.9 377 13.6 27 70 23 0.8 6 217 12 5 233 13.4 14 65 17 10 7 113 9.0 154 12.3 14 124 12 1.0 8 293 11.8 343 13.8 21 72 18 0.7 Homeless — - 60 — 2 — 2 — Borough 2589 13.6 2608 13.7 151 58 195 1.0 111 Table No. 4.—Showing the Birth rates, Death rates, and Infantile Mortality rates of London and the Metropolitan Boroughs for 1933. (52 weeks ended 30th December, 1933.) Estimated Population, Mid. 1933. Birth Bate, Death Rate. Infantile Mortality. County of London 4,298,600 13.2 12.2 59 West. Paddington 141,900 13.4 13.4 85 Kensington 181,100 12.0 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.1 13.0 65 Cheltea 56,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North. St. Marylebone 94,080 9.7 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Pancras 190,900 13.6 13.7 58 Islington 314,200 14.3 12.4 63 Stoke Newington 51,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 51 Central. Holborn 36,050 9.5 13.5 70 Finsbury 66,640 15.1 12.8 50 City of London 9,830 7.7 10.9 65 East Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65 Poplar 149,300 15.4 12.4 54 South. Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 13.6 13.1 63 Battersea 154,000 14.7 12.5 49 Wandsworth 350,200 10.9 11.5 50 Camberwell 243,700 13.3 12.3 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.2 62 112 Table No 5.—Meteorological Table for Saint Pancras, 1933. (Deduced from observations at Camden Square, N.W. 1.) January. February. March. April. May. June. July. August. September. October. November. Deoember. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 30.159 29.988 29.967 30.141 29.982 29.887 30.066 30.075 30.063 29.929 29.944 30.183 Air Temperature— Mean of— A. Maximum 41.6 46.5 55.7 59.5 66.2 72.7 77.6 78.5 71.7 58.4 47.6 38.6 B. Minimum 34.0 36.0 39.1 42.8 48.5 53.1 58.9 57.7 54.4 46.5 40.0 31.7 Mean of A and B 37.8 41.3 47.4 51.1 57.3 62.9 68.3 68.1 63.1 52.5 43.8 35.1 Difference from Average —1.0 +1.3 +4.5 +2.7 +2.2 + 1.9 +4.0 +4.9 +4.5 + 1.8 —0.5 —5.4 Humidity—Morning 90.8 84.9 79.8 70.7 69.5 64.1 67.9 68.3 78.3 85.0 88.1 84.6 Earth Temperature at 4 ft. depth 45.3 43.0 43.4 46.1 50.1 55.3 58.8 61.3 60.3 56.8 51.4 46.1 Bright Sunshine— Total Observed (daily mean) Hrs 0.78 2.16 5.09 4.68 5.12 8.27 7.34 7.85 6.06 2.87 1.17 0.58 Per cent. of total possible 9 22 43 34 33 50 46 54 48 27 13 7 Difference from average Hrs. — — — — - — — — — - - - Rain and other forms of precipitation— Number of Days 14 15 15 7 17 13 13 6 12 17 14 7 Total Fall Ins. 1.34 1.46 2.27 0.83 1.69 1.85 0.92 0.58 301 1.58 0.88 0.36 Difference from average ,, -0.51 —0.20 +0.43 —0.71 —0.08 —016 —1.50 —161 +1.22 —1.06 —1.50 —2.05 Hour of observation, 9 a.m. (Greenwich time). The readings for Bright Sunshine are those taken at Regent's Park—no readings being recorded at Camden Square. 113 Table. No. 6.—Report of Work carried oat by District Inspectors for the year 1933. Lonnon.* Brown. Walker. James. Adkins. Akeks. Jaffa. Capel. Nixon.§ West. Winchester Hague.† Mansfiilu‡ Totals. Complaints received, 3,105. Complaints Investigated. Whole house inspected 10 20 24 27 62 41 16 67 - 31 1 12 24 335 ,, Re-inspections 9 289 17 231 412 231 90 617 - 131 14 4 228 2273 „ Part of house inspected 214 339 202 292 224 176 434 130 12 316 414 234 230 3217 ,, Re-inspections 415 1112 906 496 363 376 790 408 57 1107 1080 909 431 8450 Infectious Diseases Investigations 109 177 105 250 228 151 224 92 7 139 168 140 131 1921 Inspections 55 95 22 183 134 50 134 38 8 46 67 48 49 929 Re-inspections 303 307 11 387 129 196 12 176 6 123 73 27 212 1962 Smoke Observations — — 18 19 10 2 155 6 2 27 2 33 33 307 Offensive or Regulated Trades - - - - 1 - - - - 53 - - - 54 Mews and Stable Yards—Number inspected 222 325 241 323 239 511 276 300 26 322 349 256 219 3609 Verminous Persons ,, — — — 9 1 3 9 — — - 11 10 1 44 Other Inspections and Re-inspections 33 23 29 68 92 21 316 78 — 53 314 99 78 1204 Housing Acts and Regulations, 1925 and 1930. Number of Houses Inspected Primary Inspections 22 16 10 72 20 30 189 30 1 12 21 21 9 453 Re-inspections 28 102 90 352 31 130 181 154 24 59 84 105 90 1430 Houses let in Lodgings (Bye-laws, Sec. 6). Number of f Houses Inspected Primary Inspections — 91 57 87 7 67 141 29 7 2 72 79 27 666 Re-inspections — 468 272 373 19 476 401 195 19 41 678 863 173 3978 Underground rooms — - — 8 36 3 — 3 - 12 32 69 — 164 Drainage. (a) Un ler Notice, Plans, Supervision, etc. 124 255 83 583 258 248 189 93 19 245 269 210 137 2713 (b) Voluntary, do. do. 292 638 580 583 1373 1152 276 663 32 995 316 429 513 7892 (c) New Buildings, do. do. 144 66 55 261 244 148 86 522 20 391 375 179 109 2600 Attendances at Police Court, etc. — 1 — 6 2 4 5 3 1 9 4 2 2 39 Rent Restrictions Acts — 15 — 30 14 2 8 2 — 3 — 2 — 76 Totals 1980 1390 2722 4640 3899 4018 3932 3606 241 4117 4344 3731 2696 44316 Notices served;— Intimations 123 382 203 385 268 223 438 240 20 268 525 359 255 3689 Rent Restrictions Acts — 3 — 8 6 2 3 2 — 1 — — — 25 Totals 123 385 203 393 274 225 441 242 20 269 525 359 255 3714 * Retired 30th June, 1933. † Commenced duties as Inspector 30th January, 1933* ‡ „ „15th April, 1933. §See also Table 7, next page. 114 Table No. 7.—Inspections and other work of the Food Inspectors during 1933. Mr. Auger. Mr. Nixon.† Total. Number of Visits to:— Milkshops 324 171 495 Dairies 150 208 358 Ice Cream Premises 138 119 257 Slaughter Houses 19 137 156 Butchers' Shops and Meat Stalls 1163 2072 3235 Prepared Meat Premises 52 17 69 Fishmongers' Shops 29 24 53 Fried Fish Shops 122 179 301 Fish Curers' premises 38 55 93 Other Premises where Food or Drugs are sold 54 150 204 Marketing Streets and Places 2024 1003 3027 Attendances at Police Court 3 11 14 Other Visits 198 180 378 Re-inspection after Intimation Notices 13 1 14 Total 4327 4327 8654 *Nunber of Sample taken:- Formal 164 154 318 Informal 136 246 482 Total 400 400 800 Unsound Foods. Surrenders :— Meat, &c. 6 12 18 Fish 4 4 8 Shell Fish - — — Fruit 2 3 5 Vegetables 2 1 3 Total 14 20 34 Seizures:— — — — Canal Boats inspected. - — — Notices Served 1 1 2 * See page 73. † See also Table 6 on previous page. 115 Table No. 8 Report of Work carried out by the Factory and Workshop Inspectors during the year 1933. Inspections and Re-Inspections. Thompson. Bibby. Totals. Factories (including factory laundries and bakehouses) 1695 506 2201 Workshops (including workshop laundries and bakehouses) 1697 330 2027 Workplaces (including restaurant kitchens) 632 497 1129 Outworkers' premises - 1616 1616 Other Visits - 93 93 Totals 4024 3042 7066 Notices served relating to:— Factories 133 15 148 Workshops 80 37 117 Workplaces 30 8 38 Others — — — Totals 243 60 303 116 Table No. 9. Report of Work carried, out by Centre Superintendents, Women Inspectors and Health Visitors during the year 1933. Briatow. Crockart. LandelJones. Templeton Chapman. Manger. Anderson. Blaxland. Camman. Holland. Hunter. Blair. Robinson, Bagnall. Bruce. Clarke. Harris. Harrop. Lurie. Lynn. Smith. Totals. Infants. Under 1 First Visits 99 — 2 — — 93 117 204 — — 122 174 131 175 231 105 117 157 193 165 119 2204 Subsequent 385 3 — 3 15 424 317 722 — - 397 413 591 865 785 619 374 802 552 799 529 8595 „ 1-2 First Visits 1 2 — — 1 2 5 11 — — 10 5 12 3 16 3 12 7 7 5 8 110 Subsequent 361 2 — — 5 291 233 343 — — 509 285 312 298 369 411 249 422 372 415 318 5225 „ 2-5 First Visits 3 3 — — - 2 12 3 — — 11 5 7 4 18 3 8 23 12 2 23 139 Subsequent 410 4 — 2 10 194 581 475 — 970 318 560 243 577 507 289 694 523 464 579 7400 Expectant Mother First Visits 58 5 — 1 6 29 99 102 — — 56 76 87 197 77 102 74 76 74 96 71 1286 Subsequent 89 1 — — 21 60 41 107 — — 51 40 55 348 231 97 40 70 150 81 32 1514 Measles 77 1 — 1 — 29 34 38 - — 28 12 15 18 30 47 20 15 11 18 22 416 Gorman Measles 29 — — — — 37 47 129 — — 17 9 17 2 13 82 19 19 15 30 6 471 Whooping Cough 93 - — — - 5 28 6 — - 149 9 6 13 55 4 13 7 72 16 70 546 Ophthalmia Neonatorum 15 — — 7 — 3 9 4 - - 6 2 3 5 7 — — 3 2 2 1 69 Puerperal Fever 1 — — — — 1 1 4 — - 2 3 — — — — — 2 3 2 1 20 ,, Pyrexia 6 — - — — 3 3 3 — — 7 3 1 1 2 3 — 2 1 1 — 36 Tuberculosis. Dispensary Cases - - - - - - - - 1906 2381 - - - - - - - - - - - 4287 „ Others - - - - - - - - 1831 910 - - - - - - - - - - - 2741 Other diseases 104 8 — 3 — 4 101 21 — - 245 11 18 42 106 13 22 20 72 37 30 857 Milk Enquiries 3 — — — 1 2 — 7 — - 12 1 1 8 1 1 3 4 6 6 — 56 Consultations and Classes attended 136 291 216 252 215 223 112 177 — — 159 217 148 146 184 179 126 134 152 141 204 3412 Foster Children 17 6 3 4 1 13 29 23 - - 23 39 51 40 27 31 71 96 32 88 61 655 Other Visits 160 279 6 185 35 228 638 183 — 5 479 409 269 384 64 217 406 467 58 410 300 5182 Totals 2047 605 227 458 310 1643 2407 2562 3737 3296 3253 2031 2284 2792 2793 2454 1843 3020 2307 2778 2374 45221