Ac 4355 STPAN 92 Metropolitan Borough of Saints Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934. ( For the purpose of this Report, the year consists of the 52 weeks ended 29th December, 1934.) MAITLAND RADFORD, M.D., B.S., D.P.H. 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 1934. (For the purpose of this Report, the year consists of the 52 weeks ended 29th December, 1934.) MAITLAND RADFORD, M.D., B.S., D.P.H. 2 Public Health Department, Town Hall, Pancras Road, N.W. 1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough ok St. Pancras. Sir, Ladies and Gentlemen, This Report upon the sanitary circumstances and administration and the vital statistics of the Borough during the year 1934 is the 79th Report that has been submitted and is the first that I have had the honour to prepare. The summary of the principal statistics for the year is given on pages 12 to 16 and does not reveal any matter calling for special comment. It is satisfactory to be able to record that the number of cases of puerperal fever and of puerperal pyrexia notified were both lower than for several years past and that the maternal mortality rate is not high as compared with that of similar areas. These facts justify the hope that the efforts being made to attain still better results in the future will be crowned with success. As will be seen in the section of this Report dealing with staff, the office of Medical Officer of Health was filled during the first six months of the year by my predecessor, Dr. Sowden, while I have had that honour during the last six months. At their meeting in June the Council placed on record their appreciation of the distinguished services rendered to St. Pancras by Dr. Sowden during his tenure of the post of Medical Officer of Health. I take this opportunity to express the great pleasure it has afforded me to take up my duties in this Borough, and my thanks to the members of the Council, especially those who are members of the Health Committee, and my colleagues on the staff for the help and encouragement that has been extended to me in my new work. I am, Sir, Ladies and Gentlemen, Your obedient Servant, MAITLAND RADFORD, Medical Officer of Health. 4 Meteorological Table for Saint Pancras, 1934. (Deduced from observations at Camden Square, N.W. 1.) January. February. Maroh. April. May. June. July. August. September. October. November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 30.147 30.448 29.722 29.766 30.108 30.061 30.035 29.905 30.070 29.985 30.040 29.623 Air TemperatureMean of— A. Maximum 44.8 44.5 49.3 56.8 65.5 72.2 78.6 71.8 70.7 59.0 48.3 50.9 B. Minimum 35.4 32.8 36.6 42.3 46.9 531 57.9 54.7 53.5 47.8 40.6 45.2 Mean of A and B 40.1 38.7 42.9 49.5 56.2 62.7 68.3 63.3 62.1 53.4 44.5 48.1 Difference from Average 0.0 —1.8 -0.8 +1.2 —0.1 +2.0 +4.0 +0.1 +3.3 +1.7 +0.8 +7.0 Humidity—Morning 87.6 88.6 83.8 79.0 67.3 67.6 64.7 75.0 77.4 83.5 91.4 90.2 Earth Temperature at 4 ft. depth 43.8 42.1 42.1 44.7 49.4 55.0 60.0 60.8 59.1 56.4 51.3 49.6 Bright Sunshine— Total Observed (daily mean) Hrs. 0.87 2.21 2.83 3.44 6.42 6.52 8.62 5.94 5.82 2.54 0.95 0.23 Per cent, of total possible 10 22 24 25 41 40 54 41 46 24 11 3 Difference from average Hrs. —0.10 +0.60 +0.19 —0.70 +0.22 +0.06 +2.03 +0.14 +1.85 —0.01 —0.28 —0.50 Rain and other forms of precipitation. Number of Days 18 4 16 12 7 8 6 13 10 13 11 23 Total Fall Ins. 1.35 0.20 1.96 2.24 0.46 1.13 0.91 1.94 2.78 1.09 1.85 4.80 Difference from average ,, —0.51 —1.46 +0.12 +0.71 —1.30 —0.87 —1.46 —0.28 +0.98 —1.54 —0.51 +2.40 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. 5 CONTENTS page Introduction 2 Map of Borough, showing statistics by Wards 3 Public Health Committee 8 Staff of Public Health Department 9 & 10 Changes in Staff during 1934 11 Statistical Summary 12&13 Section I.—Statistics and Social Conditions of the Area Meteorological Table 4 Vital Statistics for 1934 and 10 previous years 14 Table of Births, Deaths, Infantile Deaths and Tuberculosis Deaths, by Wards 15 Table of Birth rates, Death rates and Infantile Mortality rates of London and the Metropolitan Boroughs 16 Population and General Statistics 17 Principal occupations of the inhabitants of the Borough 18-21 Economic Conditions 21 Marriages 22 Births 22 Illegitimacy 23 Notification of Births 23 Still Births 23 Deaths 24 Method of adjusting rate 24 Causes (short list) 25-28 Aged Persons 28 In each Ward 29 Persons of unknown address 29 Inquests, Table of 30 Infantile Mortality 30 Table of Deaths from stated causes at various ages under 1 year 31 Table of Deaths from stated causes under 1 year for 1934 and 10 preceding years 32 Section II—General Provision of Health Services Hospital Accommodation 33 Hospitals in the Borough 33 paok Institutional Provision Unmarried Mothers 34 Ambulance Facilities 34 Clinics, Treatment Centres, &c 34-36 Maternity and Child Welfare 37 Block Grants 37 Ante-natal 38 At Confinement 38 Infants and Young Children 39 Advice cards 39 Home Visiting 39 Table of Visits paid by Health Visitors 40 Summary of Visiting Work by each Centre 41 Maternity and Child Welfare Centres 41 Attendancesat Consultations, etc 42-44 Artificial Light Treatment 44 Dental Clinic 45 Day Nurseries 47 Nursery Schools 47 Clinic f or Ailing Mothers and Children 48 Convalescent Home Treatment 48 Home for Sick Poor Children 48 Infant Life Protection 49 Supply of Milk to Mothers and Children 49 Professional Nursing 51 Home Helps 52 Midwives and Midwifery 52 Maternal Mortality 54 Table of Maternal Deaths 55 Medical examination in elementary schools 56 & 57 Provision of Insulin 58 Public Health Officers of the Local Authority 58 Local Legislation 58 Public Health Legislation 59 Local Acts, By-laws and Regulations in force in the Borough 58 London County Council By-laws 59 London County Council (General Powers) Act, 1934 59 Milk Act, 1934 60 Shops Act, 1934 61 Merchandise Marks Act, 1926 62 Health Propaganda 62 6 CONTENTS—-continued page Section III—Sanitary Ciroumstanoes of the Area Water Supply 63 Public Baths and Washhouses 63 Drainage 63 Rata and Mice 64 Rat Week 64 Refuse Collection and Disposal 64 Mortuary and Coroner's Court 65 Sanitary Inspections 66 Table of Workcarricdoutby District Inspectors 67 Table of Work done by Food Inspectors 68 Inspections made by Factory and Workshop Inspectors 69 & 72 Notices served in regard to Nuisances and Breaches—Legal Proceedings 69-71 Smoke Abatement 71 Factory and Workshop Acts 71 Factory Inspections Defects found 72 Outworkers and Home Work 72 Principal Industries concerned 73 Factories, Workshops and Workplaces on Register 74 Other matters 74 Premises and Occupations controlled by bye-laws or regulations 74 Offensive Trades 74 Rag and Bone Dealers 74 Rag Flock Acts, 1911-1928 75 Houses Let in Lodgings 75 Lighting of Staircases 75 Common Lodging Houses 75 Canal Boats Acts 76 Rent and Mortgage Interest Restrictions Acts, 1920-1933 76 Removal of Aged, Diseased or Infirm Persons 76 Section IY—Housing Statistics 77 Housing Conditions 78 Facilities for re-housing 79 Underground Rooms 79 Work of the Estates Committee 79 Ferdinand Place Clearance Order 80 Kennistoun House 81 Housing Site, Highgate Road , 81 page London County Council Estates 81 Housing Schemes in the Borough 81 Housing Act, 1930—Clearance Areas 82 Section V—Inspection and Supervision of Food (a) Milk Supply 82 Cowsheds, Dairies and Milkshops 82 Milk in Sealed Containers 83 Sampling out of Office Hours 83 Milk (Special Designations) Order, 1923 83 Licences to sell milk for 1934 84 Artificial Cream Act, 1929 87 (b) Meat and Other Foods 87 Unsound or diseased food condemned and destroyed 87 Slaughter of Animals Act, 1933 87 Licensing of Slaughtermen 89 Registration, &c, of Slaughterhouses 89 Fried Fish and Fish Curing Premises 89 Ice Cream Premises 89 Bakehouses and Restaurant Kitchens 89 Underground Bakehouses 89 (c) Food and Drugs (Adulteration) Act, 1928— Samples taken 90 Preservation of 93 Prosecutions— (a) Food and Drugs (Adulteration) Act, 1928 92 (b) Public Health atives, &c, in Food) Regulations, 1925-1927 92 Wholesale Dealers in Margarine 92 Work of the Public Analyst 93 Section YI—Prevalence of, and control over, Infectious Diseases Notifiable Diseases 95 Notifications by ages and Deaths from notifiable diseases 96 Do by Wards 97 Small Pox 98 Vaccination 98 7 CONTENTS—continued page Scarlet Fever 99 Diphtheria 99 Enteric (Typhoid) Fever 100 Puerperal Fever and Pyrexia 100 Erysipelas 102 Cerebro-spinal Meningitis 102 Anterior Poliomyelitis and Polioencephalitis 102 Ophthalmia Neonatorum 103 Encephalitis Lethargica 104 Pneumonia 104 Malaria 104 Dysentery 104 Food Poisoning 104 Measles and German Measles 105 Deaths in previous years 107 Incidence rate and Mortality rate in previous years 108 Tuberculosis— New Cases and Deaths 109 Notifications 110 Prevalence and fatality for 10 years 111 Notifications and Deaths by Wards 111 PAGE Tuberculosis —continued Public Health (Tuberculosis) Regulations, 1930 112 Public Health (Preventionof Tuberculosis) Regulations, 1925 112 Boarding out of Children 112 Provision of beds and bedding for Necessitous Tuberculous Patients 112 Disinfection of Rooms 113 Home Visits and Enquiries 113 Care Committee 113 Report by Hon Secretary 114 Dispensary 115 Sanocrysin Treatment 115 Artificial Light Treatment 115 Report by Tuberculosis Officer 115 Summary of work carried out 117 Section YII—Other Services Disinfecting and Cleansing Station 118 Work done 118 Disinfection for Institutions, etc 119 Cleansing Station 119 Bacteriological Work 120 8 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 1933, to October, 1934. November, 1934, to October, 1935. CHAIRMAN. CHAIRMAN. Councillor Charles Henry Denyer, M.A. Councillor John Evans. DEPUTY-CHAIRMAN. DEPUTY-CHAIRMAN. Councillor John Evans. Alderman William Palmer Spry. EX-OFF1CIO. EX-OFFICIO. The Right Worshipfcl the Mayok The Right Worshipful the Mayor (Councillor Charles Henry Denyer, M.A., J.P.). (Councillor Frederic Hewson, J.P.). ALDERMEN. ALDERMEN. Crosby, Miss Ada, M.B.E. Davies, David, J.P., L.C.C. Davies, David, J.P. Escott, Arthur, F.I.B.D. Escott, Arthur, F.I.B.D. Morrell, Rev. R. Conyers, M.A. Rolles, Harry. COUNCILLORS. Ward COUNCILLORS Bell, Mrs. Florence Nightingale Ward Harrison, J.P. 8 Allan, Mrs. Isabella Menzies. 8 Blackmore, Claud. 4 Alliston, Mrs. Evelyn. 8 Chambers, Percy Henry. 3 Barry, Mrs. Mary Ann. 6 Cooper Mrs, Julia Susannah. 2 Bell, Mrs. Florence Nightingale 1 Davies Mrs. Edith. Harrison. 4 Davies, Mrs. Lilian. 8 Blackmore, Claud. 8 Debenham, Martin Ridley. 7 Crosby, Miss Ada, M.B.E. 8 Evans, Evan. 8 Evans, Evan, L.C.C. 1 Flint, Mrs. Louisa Elizabeth. 1 Flint, Mrs. Louisa Elizabeth. 6 Gregory, Mrs. Jeanetta. 4 Flynn, William, J.P. 2 Horne, George, J.P. 6 French, Alexander George. 4 Lake, Mrs. Amy Elizabeth. 2 Horne, George, J.P. 3 Melvin, Frederick George. 7 Jenkins, Edwin. 7 Pilbeam, Cecil Gerald. 5 Kemp, Sydnby Alfred. 5 Rolles, Harry. 2 Moore, Thomas Fairless. 8 Seear, Ernest George. 1 Perryman, Walter. 5 Swann-Mason, Rev. Richard Swann, 5 Radford, Mrs. Laura. O.B.E., M.A. 1 Smerdon, Mrs. Edith Maude. 7 Swift Mansell, James, F.R.M.S. 7 Swift, Mansell James, F.R.M.S. 3 Wright, James Albert. 9 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT END OF THE YEAR 1934. MEDICAL OFFICER OF HEALTH, ADMINISTRATIVE MATERNITY AND CHILD WELFARE OFFICER, AND ADMINISTRATIVE TUBERCULOSIS OFFICER. (g) M. Radford, M.D., B.S., D.P.H. DEPUTY MEDICAL OFFICER OF HEALTH, MATERNITY AND CHILD WELFARE OFFICER (as from March 193S, formerly Assistant Medical Officer). (g) P. Y. Pkitchard, 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. Goodciiil!)—Ward 1. Dr. A. E. Tait—Wards 5, 6 and 7. Dr. F. L. Pelly—Ward 2. Dr. C. H. A. Alderton—Ward 8. Dr. J. Wiqg—Wards 3 and 4. VACCINATION OFFICER Mr. A. E. Wolfe. (G)SANITARY INSPECTORS. Inspectors of Food and Food Places. ¶‡G. W. Adktns. ¶‡H. K. Nixon. Inspectors of Workshops and Factories. ‡Miss M. E. BirnsY, B.A. (Lond.). ‡§B. II. Thompson. District Inspectors. ‡§W. L. Brown. *‡§¶A. H. Walker. ‡§R. E. James. ‡R. C. Akers. ‡M. Jaffa. ‡¶S. W. Capel. §H. G. West. ‡¶+E. W. Winchester. xT. H. Hague. xW. C. Mansfield. ¶ x+R. Warren. (G) TUBERCULOSIS DISPENSARY, BARNES HOUSE, CAMDEN ROAD, N.W.I. Tuberculosis Officer, G. A. Back, B.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H. Sanitary Inspectors and Health Visitors (for Tuberculosis), ‡║†**Miss J. A. J. Camman. ‡║Miss A. Holland. Nurse, a ‡†Miss S. A. Long. Clerical, etc., Assistant, Miss M. Deed. Dentists [part time), Mr. A. J. Maurice, L.D.S. Mr. B. R. Vincent, L.D.S. CLERICAL STAFF. W. C. W. Roworth, Chief Clerk. A. Carpenter. J. A. Hoare. (g) G. N. Cove. (g) E. F. Kirby. (g) Miss A. Andrews. R. N. Thomas. F. A. J. Goodchild (attached to J. F. Woolvin. the Estates Dept.). (Junior Clerk—-vacant). W. B. Dykes. * Cert. Municipal and County Engineers. ‡ Cert. San. Insp. Examination Board. § San. Insp. Cert. Royal San. Inst. ¶ Cert. Meat and other loods. || Health Visitor's Certificate. + Smoke Abatement Cert. (L.C.C.). † C.M.B. ** Certificate, Queen Charlotte's Hospital. a State Registered Nurse. 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. 10 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS, (o) Medical Officers. No. of Consultations per month. Dr. Chas. H. A. Alderton 4 Dr. B. Marion Cockerell 10 Dr. Hflen Gillespie 5 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 6 Dr. Nora Leesmith 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. John W. Wigq 4 (g) Dental Clinic. Mrs. W. A. Murch, L.D.S., Dentist 6 Dr. Jas. Maughan, Anmthetist. . 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. (The above are part-time officers.) (o) Superintendents oj 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. ║†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. ff'Miss E. B. Bagnall. ‡§Mrs. A. Hunter. ‡||Miss V. K. Blaxland. †MRs. E. Lurie. ║†Mrs. E. E. Bruce. †║†Mrs. J. Lynn. ║†Miss B. M. Harris. ║†MRS. M. A. Smith. 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. S San. Insp. Cert. Kojal 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. 11 CHANGES IN STAFF DURING 1934. Dr. G. Sownen, Medical Officer of Health, retired after 10 years' service on 30th June. Dr. M. Radford appointed Medical Officer of Health from 1st July. Mr. W. G. Auger, Inspector of Food and Inspector under the Canal Boats Acts, retired after 37 years' service on 30th June. Mr. G. W. Adkins, one of the District Sanitary Inspectors, holding the necessary qualifications, was appointed Inspector of Food as from 1st July in place of Mr. Auger. The Public Health Committee authorised the Medical Officer of Health to arrange for the several District Sanitary Inspectors concerned to carry out the requirements of the Canal Boats Acts in the ordinary course of their duties. Mr. R. Warren, who had been for some years on the clerical staff and possessed the requisite qualifications, was appoiuted District Sanitary Inspector in place of Mr. Adkins as from 1st July. Mr. J. A. Hoare, a Grade "A" clerk in the Department, was promoted to the Grade "B" clerkship vacated by Mr. Warren. Miss M. Tempi.eton, Superintendent, Ampthill Square Maternity and Child Welfare Centre, who had been absent on sick leave since 5th February, resigned (after 14 years' service) as from 30th June. Miss M. A. Clarke, Health Visitor, Somers Town Maternity and Child Welfare Centre, after 12 years' service, resigned as from 31st October. Dr. J. W. Wigg was engaged to conduct a Monday afternoon consultation at the Somers Town Welfare Centre in place of the Tuesday morning consultation previously conducted by Dr. Lydia Leney. 12 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 1934 (according to Rate Books), 27,196. Number of families or separate occupiers (1931 Census), 56,929. Number of persons per acre (Census year 1931), 74. 2.—Principal Statistics fok 1934. Population (Registrar-General's mid-year estimate), 187,540. Number of persons per acre, 69. Births. Males, 1,229; females, 1,220. Total, 2,449. Birth rate, 13.1 per 1000 of population. Legitimate births, 2,210 ; illegitimate births, 239. Excess of births over deaths, 41. Deaths. Males, 1303,; females, 1,105. Total, 2,408. Death rate, 12.84 per 1000 of population. Adjusted death rate, 13.09 per 1000 of population (see page 24). Infantile Mortality. Deaths of infants under one year of age per 1000 births, 65. Legitimate rate, 58; illegitimate rate, 130. 13 Maternal (Puerperal) Mortality. Number of women dying in, or in consequence of, child-birth : From Sepsis, 3; from other causes, 7. Total Puerperal Mortality, 4.0 per 1000 births (live and still). Number of deaths from Measles (all ages), 32. „ „ Whooping Cough (all ages), 9. „ „ Diarrhœa and Enteritis (under 2 years of age), 27. Tuberculosis. Pulmonary. Deaths, 157; death rate per 1000 of population, 0.8. All forms. Deaths, 172; death rate per 1000 of population, 0.9. Rateable value, £2,121,198. Sum produced by a penny rate, £8,320. Rainfall during the year (recorded at Camden Square), 20.7 inches. Comparative Statistics. Rate per 1000 of Population. Rate per 1000 Births. Birth rate Death rate. Infant Mortality. St. Pancras 13.1 12.8 65 England and Wales 14.8 11.8 59 121 Great Towns 14.7 11.8 63 County of London 13.2 11.9 67 14 VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1934 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. 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 1934 187540 — 4092 2449 13.1 2862 15.3 1083 629 160 65 2408 12.8 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. † Baaed on civil population. 15 "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. 1 338 11.4 403 11.9 16 41 29 0.9 2 270 14.5 254 13.6 9 33 23 1.2 3 503 16.0 425 13.5 32 64 28 0.9 4 326 14.4 309 13.6 16 49 20 0.9 5 369 13.6 330 12.1 37 100 23 0.8 6 217 12.7 185 10.9 13 60 13 0.8 7 110 8.9 137 11.1 15 136 16 1.3 8 266 10.9 297 12.2 18 68 17 0.7 Homeless — — 68 — 4 — 3 — Borough 2449 13.1 2408 12.8 160 65 172 0.9 16 Tabic showing the Birth rates, Death rates, and Infantile Mortality rates of London and the Metropolitan Boroughs for 1934. (52 weeks ended 29th December, 1934.) Estimated Population. Mid. 1934. Birth Rate. Death Rate (Crude). Death Rate (Adjusted). Infantile Mortality per 1000 births. County of London 4,230,200 13.2 11.9 - 67 West. Paddington 139,790 13.7 12.4 12.3 95 Eensington 179,080 12.3 13.3 12.5 93 Hammersmith 129,170 13.8 12.9 13.3 77 Fulham 145,400 13.7 12.6 12.7 69 Chelsea 58,160 10.8 13.4 11.4 65 City of Westminster 124,050 9.4 11.8 12.1 66 North. St. Marylebone 92,820 90 12.7 12.6 61 Hampstead 90,000 10.4 11.3 10.6 53 St. Pancras 187,540 131 12.8 13.09 65 Islington 314,200 14.7 11.8 11.9 62 Stoke Newington 50,620 13.7 11.5 11.0 60.6 Hackney 211,120 14.2 11.7 12.2 56 Central. Holborn 36,000 8.58 12.2 — 71 Finsbury 64,970 15.1 13.4 14.6 51 City of London 9,660 6.8 10.5 11.6 121 East. Shoreditch 90,630 16.1 13.1 14.4 84 Bethnal Green 102,060 14.3 11.8 13.3 72.6 Stepney 214,990 15.3 12.3 14.3 87.2 Poplar 146,870 15.5 12.3 13.7 62 South. Southwark 159,980 14.9 13.5 14.4 77 Bermondsey 105,060 14.8 12.4 14.1 64 Lambeth 283,900 14.21 12.78 12.65 63.38 Battersea 150,870 14.3 12.5 12.3 61.3 Wandsworth 345,250 10.98 11.18 10.39 57 Camberwell 238,360 13.22 12.31 12.31 67 Deptford 101,380 15.8 13.1 13.6 68 Greenwich 97,250 13.71 12.23 12.47 87 Lewisham 222,180 12.2 10.0 10.1 43 Woolwich 145,520 13.7 11.3 12.0 63 17 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 figure was 211,36(5. The mid-year (1934) population of the Borough is estimated by the Registrar-General to be 187,540, the corresponding estimate for the previous year (1933) being 190,900. 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 II.51. Forces are now allocated to their area of residence in the same manner as civilian deaths. The following figures shew the number of persons in each of the "Wards in the Borough:— Administrative Area of St. Pancras Metropolitan Borough. Census, 1931. Total (Estimated) 1934. Males. Females. Total. Ward — No. 1 15,867 20,005 35,872 33,955 No. 2 9,621 10,054 19,675 18,626 No. 3 15,615 17,543 33,158 31,389 No. 4 11,965 11,990 23,955 22,673 No. 5 13,737 15,004 28,741 27,205 No. 6 8,861 9,139 18,000 17,036 No. 7 6,155 6,867 13,022 12,302 No. 8 12,562 13,148 25,710 24,354 Total . . 94,383 103,750 198,133 187,540 18 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried on in the Borough which to any extent affect the public health prejudicially. It is of interest to note that a large number of residents are engaged in work upon the railways. This necessitates residence in the neighbourhood and is an important factor in the local housing situation. The following table gives for eaoh sex the principal occupations as ascertained at the 1931 Census. The numbers and percentages engaged in the various occupations mentioned are also given:— Total Population (over 14 years of age): Males, 75,794; Females, 85,493. Males. Occupation. Number. Percentage. Transport Workers (Railways, &c.) 12,705 17% Commercial and Financial (Shop Assistants, &c.) 8,771 11 „ Personal Service (Waiters, Hairdressers, &c.) 7,378 10 „ Metal Workers 4,565 6 „ Clerks and Typists 5,241 7„ Wood and Furniture Workers 2,972 4 „ Public Administration and Defence 1,600 2 „ Unoccupied and Retired 6,360 8 „ All other Occupations 26,202 35 „ Total 75,794 100 % Females. Occupation. Number. Percentage. Personal Service (Domestic, Waitresses, &c.) 15,427 18 % Makers of Textiles 5,607 7 „ Clerks and Typists 5,960 7 „ Commercial and Financial 3,248 4„ Professional Occupations (excluding Tvpists) 2,809 3 „ Unoccupied and Retired 44,219 52 „ All other Occupations 8,223 9 „ Total 85,493 100 % Tables shewing in detail the occupations of males and females, aged 14 years and over, and of juveniles at four age periods are set out overleaf. 19 Occupations of MALES and FEMALES agkd 14 years and over, showing also the total "Operatives" and the total "Out of Work" as ascertained at the 1931 Census. Note.—(* Persons "out of work" are included in the occupied (Orders i- xxxi). "Retired" are segregated in Order xxxii. Total Population Under 14 years. Age 14 and over. Males 94,383 18,589 75,794 Females 103,750 18,257 85,493 Occupation. Males. Females. Total. i. Fishermen 3 - 3 ii. Agricultural occupations 388 6 394 iii. Mining and Quarrying occupations 64 - 64 iv. Workers in the treatment of non-metalliferous mine and quarry products 15 8 23 v. Makers of bricks, pottery and glass 212 154 366 vi. Workers in chemical processes ; makers of paints, oils, etc. 108 45 153 vii. Metal workers (not electroplate or precious metals) 4,309 184 4,493 viii. Workers in precious metals and electroplate 256 83 339 ix. Electrical apparatus makers, fitters and electricians 1,221 228 1,449 x. Makers of watches, clocks and scientific instruments 210 19 229 xi. Workers in skins ; leather goods makers 272 207 479 xii. Textile workers 114 112 226 xiii. Makers of textile goods and articles of dress 2,020 5,607 7,627 xiv. Makers of foods, drinks and tobacco 935 366 1,301 xv. Workers in wood and furniture 2,972 583 3,555 xvi. Paper and cardboard workers; Bookbinders 229 693 922 xvii. Printers and Photographers 1,312 430 1,742 xviii. Builders, bricklayers, stone and slate workers; contractors 3,048 9 3,057 xix. Painters and decorators 2,996 135 3,131 xx. Workers in other materials 120 85 205 xxi. Workers in mixed or undefined materials, including makers of musical instruments 979 456 1,435 xxii. Persons employed in transport and communication 12,705 631 13,336 xxiii. Commercial, finance and insurance occupations (excluding clerks) 8,771 3,248 12,019 xxiv. Public administration and defence 1,600 39 1,639 xxv. Professional occupations (excluding clerical staff) 2,129 2,809 4,938 xxvi. Persons professionally engaged ill entertainment and sport 1,034 456 1,490 xxvii. Persons engaged in personal service 7,378 15.427 22,805 xxviii. Clerks and Draughtsmen; Typists 5,241 5,960 11.201 xxix. Warehousemen. Storekeepers and packers 2,256 1,499 3,755 xxx. Stationary engine drivers, dynamo and motor attendants 375 - 375 xxxi. Other and undefined workers 6,162 1,795 7 957 Total occupied 69,434 41,274 110,708 xxxii. Retired or not gainfully occupied 6,360 44,219 50,579 Total occupicd and unoccupied 75,794 85,493 161,287 20 Occupations (Condensed List) of Juveniles at Four Age Periods under Age 2l Years, and showing also the Numiibr "Out of Work" as ascertained at the 1931 Census. ST. PANCKAS METROPOLITAN BOROUGH,, MALES. Age (last Bihthday). Out of work included in previous columns). 14 15 16 & 17 18-20 i. Fishermen - - 1 - - ii. Agricultural occupations — 3 4 9 2 iii. Mining and quarrying occupations — — 1 5 6 iv.&v. Quarry products, bricks, pottery and glass workers 6 10 26 20 - vi. Chemicals, paints, oil workers — 1 3 7 1 vii. Metal workers 42 90 221 451 83 viii.ix.&x. See table on previous page 23 44 102 201 35 xi. Leather and leather goods workers 2 4 22 25 5 xii. Textile workers - 1 5 14 3 xiii. Textile goods workers, etc. 9 12 74 111 7 xiv. Makers of foods, drinks and tobacco 1 4 27 67 5 xv. Workers in wood and furniture 23 45 142 240 61 xvi. Paper and cardboard makers and workers 2 5 9 15 — xvii. Printers and photographers 16 40 88 133 11 xviii. Building occupations 1 7 34 107 26 xix. Painters and decorators 9 21 57 140 40 xx. & xxi. See table on previous page 11 20 65 100 17 xxii. (1) Railway workers 2 4 24 84 11 xxii. (2) Road transport workers 67 103 232 341 50 xxii.(3)(4) Other transport and communication workers ... 330 392 546 427 93 xxiii. Commerce, finance and insurance 57 116 380 659 76 xxiv. (1) Public administration — — — 23 — xxiv. (2) Defence - — 8 118 — xxv. Professional occupations — 3 29 86 5 xxvi. Entertainment and sport workers — 2 13 40 12 xxvii. Personal service 50 61 228 478 76 xxviii. Clerks, draughtsmen and typists 21 93 387 705 58 xxix. Warehousemen, storekeepers, etc. 15 42 129 214 21 xxx. Stationary engine drivers, stokers, etc. — 1 3 9 2 xxxi. Other and undefined occupations 60 77 205 419 281 i.-xxxi. Occupied 747 1,201 3,065 5,248 997 xxxii. Not gainfully occupied 525 283 240 219 - Total Population 1,272 1,484 3,305 5,467 997 FEMALES. i.-vi. See table on previous page 10 18 25 30 1 vii. Metal workers 1 8 16 45 2 viii., ix., x. &xi. See table on previous page 23 24 70 103 16 xii. Textile workers 2 2 9 17 6 xiii. Textile goods workers, etc. 234 227 550 857 50 xiv. (1) Makers of foods 6 6 19 28 2 (2) (3) &(4) Makers of drinks and tobacco 3 3 20 39 3 xv. Workers in wood and furniture 14 24 61 91 5 xvi. Paper and cardboard makers and workers 19 25 86 116 9 Carried forward 312 337 856 1,326 94 21 ST. PAXCRAS METROPOLITAN BOROUGH. FEMALES. Age (last Bibthday). Out of work (included in previous columns). 14 15 16 & 17 18.20 Brought forward 312 337 856 1,326 94 xvii. Printers and photographers 18 28 55 83 4 xviii-xxi. See table on previous page 23 28 58 122 19 xxii. Transport and communication workers 49 45 77 116 7 xxiii. Commerce, finance and insurance 55 87 232 450 47 xxiv. Public administration and defence - — 1 1 — xxv. Professional occupations 1 2 29 162 3 xxvi. Entertainment and sport workers 1 1 17 46 19 xxvii. Personal service 87 129 534 1,194 107 xxviii. Clerks, typists, etc. 57 147 657 1,005 51 xxix. Storekeepers, packers, etc. 42 108 265 327 41 xxx.-xxi. See table on previous page 98 101 287 354 142 i.-xxxi. Occupied 743 1,013 3,018 5,186 534 xxxii. Not gainfully occupied 540 380 457 747 - Total Population 1,283 1,393 3,475 5,933 534 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 for the past three years 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. Half-year ending Average weekly No. of persons receiving out-relief. Average weekly cost of relief. March 1932 4304 1190 September 1932 4765 1222 March 1933 5121 1459 September 1933 4159 1237 March 1934 4017 1293 September 1934 3948 1335 22 Number of unemployed:— Men. Boys (1-4-18). Women. Girls (14-18). Total. At January, 1933 7888 168 1453 113 9622 At January, 1934 6567 149 1298 92 8106 At January, 1935 4538 89 1220 52 5899 MARRIAGES. The number of marriages celebrated during the year was 1,797. This is equal to a rate of 9'6 marriages per 1000 of total population, or a rate of 19 2 persons marrying per 1000 of the population. The average yearly number of marriages during the preceding five years was 1,911, equal to a rate of 95 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 2,449, equal to an annual birth rate of 13*1 per 1000 of population. This is again for the third year in succession the lowest birth rate recorded in the Borough. The rate for the previous year was 136, and the rate for 1932 was 13-8. The actual number of births registered as having taken place in the Borough during the year was 4,092, but this figure has to be corrected by deducting the births of nonresidents, which occurred chiefly in various hospitals and other institutions in the liorough (2,032), and by adding the births belonging to St. Pancras which occurred outside the liorough (389). The corrected figure is therefore as stated above, 2,449. The corresponding figures for previous years and the birth rate for 1934 of the County of London and the Metropolitan Boroughs, are given on page 16. The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1934, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Ward. 1934. 1933. Births. Birth Rate. Births. Birth Rate. 1 388 11.4 435 12.6 2 270 14.5 301 15.9 3 503 16.0 526 16.5 4 326 14.4 318 13.8 5 369 13.6 386 13.9 6 217 12.7 217 12.5 7 110 8.9 113 9.0 8 266 10.9 293 11.8 Borough 2449 13.1 2589 13.6 23 No less than 2,902 births occurred in Publie Institutions in St. Pancras, equal to 71 per cent. of the total births which took place in the Borough. Illegitimacy. Of the 2,449 net St. Pancras births, 239 were recorded as being illegitimate. This equals 9*8 per cent, of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1924 5*9 per cent. 1929 7.8 per cent. 1925 6.3 „ 19.30 8.4 „ 1926 6.3 „ 1931 8.3 „ 1927 6.9 „ 1932 8.0 „ 1928 7.3 „ 1933 8.8 „ In the years before the great War the illegitimate births in the Borough were from 4 to 5 per cent, of the total births registered. During the war years the rate increased to about 9 per cent., and although a decrease then occurred, a steady increase in the number of illegitimate births has taken place during the recent years. Notification of Births. The notifications of births received during the year numbered 4,248: this figure includes 159 still-births and 4,089 live births, and represents 99'9 per cent, of the births registered as having taken place in the Borough. The Notification of Births Acts (1907-1915) require: " 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 Registry Office within forty-two days of the birth. Still Births. The Births and Deaths Registration Act, 1926, which came into force on July 1st, 1927, requires the birth of any still born child to be registered. The definition of still birth for the purpose of the Act is as follows:— Still born or still birth shall apply to any child which has issued forth from its mother after the 28th week of pregnancy, and which did not at any time after being completely expelled from its mother, breathe or show any other sign of life. For the purpose of the Births and Deaths Registration Act, a child which, whatever the period of pregnancy, breathes or shows any other sign of life after complete expulsion from the mother, is a live born child, and if it dies even within a brief period only after birth, both the birth and the death must be registered. The fact of still birth must be certified either by the Medical Practitioner or the Midwife who was in attendance, or who has examined the child, or by declaration in a prescribed form if no Medical Practitioner nor Midwife was present. If, in any of the last mentioned cases, 24 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 referenee 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 Males 106 7 58 55 Illegitimate Females 66 2 46 22 Illegitimate Males 9 - 4 5 Females 6 - 3 3 Inward transfers relate to still births belonging to the Borough, but which took place in some other area. Outward transfers refer to still births of non-residents, but which took place in the Borough. DEATHS. The actual number of deaths registered as having taken place in the Borough during the year was 2,862. This number has to be corrected by the exclusion of 1,083 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 629 deaths of residents which occurred and were registered outside the Borough. The net number of St. Pancras deaths registered during the year was accordingly 2,408 ; equal to an annual death rate of 12*8 per 1000 of population. The corresponding rate for the previous year was 13.7 and the average yearly death rate of the Borough for the previous five years was 13.5 per 1000 of population. Details of the corresponding figures for previous years will be found in the table on page 14. Adjusted Death Rate. The following explanatory passages are quoted from a memorandum issued by the Registrar-General in March, 1935:— "At the end of Table S.D. 24 (on page 26) will be found a factor (labelled C.F. 102) by which the crude death rate of the area should be multiplied in order to make it comparable, from a mortality point of view, with the crude death rate of the country as a whole, or with the mortality of any other local area, the crude death rate of which should be similarly modified with its own factor for the purpose." The necessity for the application of this factor arises from the fact that the populations of all areas are not" similarly coEstituted as regards the proportions of their sex and age group 25 components and their crude death rates fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions The factor may be said to represent the population handicap to be applied to the area." Applied to St. Pancras the death rate of 12 84 per 1000 of population is adjusted by the comparability factor of 1.02 to 13.09 per 1000 of population. Causes of Death. The principal causes of death as furnished by the Registrar—General are set out in the following table. As his figure for total deaths (2422) includes all deaths registered during the period from 1st January to 31st December, it is in excess of the number (2408) compiled locally for the period 52 weeks ending 29th December. The latter figure has been used in this Report for statistical purposes. 26 S.D. 24. REGISTRAR GENERAL'S SHORT LIST OF THE CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF ST. PANCRAS, 1934. CAUSES OF DEATH. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards ALL CAUSES M 1310 89 15 18 25 45 56 84 153 274 317 234 F 1112 72 20 13 20 32 50 54 92 160 265 334 1. Typhoid and Paratyphoid Fevers M — — — — — — — — — — — — F — — — — — — — — — — — — 2. Measles M 21 6 6 8 1 — — — — — — — F 9 2 6 1 — — — — — — — — 3. Scarlet Fever M — — — — — — — — — — — — F 1 — — — — — — — — — — 1 4. Whooping Cough M 3 1 1 1 — — — — — — — — F 6 2 3 1 — — — — — — — — 5. Diphtheria M 8 — 2 1 3 1 — 1 — — — — F 11 1 4 1 4 — — 1 — — — — 6. Influenza M 16 1 — — — — — 1 2 7 4 1 F 14 — — 1 — 1 — 2 1 1 3 6 7. Encephalitis Lethargica M — — — — — — — — — — — — F — — — — — — — — — — — — 8. Cerebro spinal Fever M 1 1 — — — — — — — — — — F 3 2 — — 1 — — — — — — — 9. Tuberculosis of Respiratory System M 114 — — — — 11 18 21 33 19 10 2 F 44 — — — — 10 14 7 6 4 2 1 10. Other Tuberculous Diseases M 6 — — 1 2 1 1 — — 1 — — F 9 — 1 — 2 2 2 — 1 — — 1 11. Syphilis M 9 — — — — — — 3 — 2 2 2 F 2 1 — — — — — — — 1 — — 12. General paralysis of the insane, tabes dorsalis M 16 — — — — — — 5 2 8 1 — F 3 — — — — — — 1 1 1 — — 13. Cancer, Malignant Disease M 168 — — 1 — 1 2 8 25 53 55 23 F 168 — — — — 1 3 10 29 38 49 38 14. Diabetes M 10 — — — — 1 — — 1 4 4 — F 16 — — — — — — — — 6 7 3 IS. Cerebral Hemorrhage, etc. M 44 — — — — — — 2 3 9 20 10 F 49 — — — — — — 1 3 13 18 14 27 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 281 — — — 6 6 3 6 22 52 94 92 F 293 — — — — 3 3 5 17 34 93 138 17. Aneurysm M 10 — — — — — — 1 3 1 3 2 F 4 — — — — — — — 2 — 1 1 18. Other Circulatory Diseases M 55 — — — — — — 2 3 11 22 17 F 44 — — — — — 1 2 1 11 8 21 19. Bronchitis M 45 1 — — — — — 2 7 17 7 11 F 39 2 — — — — — — — 4 12 21 20. Pneumonia (all forms) M 130 17 3 1 — 3 6 11 16 27 29 17 F 82 10 5 5 2 — 3 8 5 10 15 19 21. Other Respiratory Diseases M 20 1 — 1 1 1 — 2 5 6 2 1 F 7 — — — — 1 — — 1 3 1 1 22. Peptic Ulcer M 25 — — — — 1 3 3 6 6 6 — F 6 — — — — — — 1 2 1 2 — 23. Diarrhoea, etc. M 18 11 2 1 1 1 — — — — 1 1 F 22 18 — — — — — — — — 1 3 24 Appendicitis M 12 — — — 1 1 1 2 2 2 — 3 F 8 — — — 1 2 — — — 2 2 1 25. Cirrhosis of Liver M 4 — — — — — — 1 1 — 2 — F 10 — — — — — 1 — 3 3 2 1 26. Other Diseases of Liver, etc. M 2 — — — — — — — — 1 1 — F 11 — — — — — — 1 — 3 4 3 27. Other Digestive Diseases M 22 2 1 — 1 2 1 — 2 6 4 3 F 17 — — — — — 1 2 2 4 3 5 28. Aoute and Chronic Nephritis M 29 — — — 1 1 1 — 3 7 10 6 F 27 — — — — 2 2 1 4 9 4 5 29. Puerperal Sepsis F 3 — — — — — 2 1 — — — — 30. Other Puerperal Causes F 7 — — — — 1 2 4 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 40 44 — — 2 — — — — — — — F 28 27 — — — — — — — 1 — — 28 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 12 — — — — — — — — — 2 10 F 31 — — — — — — — — — 7 24 33. Suicide M 30 — — — — 2 9 6 5 6 2 — F 10 — — — — 1 3 1 3 — 3 — 34. Other violence M 47 — — 1 3 5 4 7 1 8 8 9 F 35 3 — — 4 2 3 1 4 1 6 11 35. Other defined Diseases M 106 4 — 1 3 7 7 — 11 21 28 24 F 92 3 1 4 6 6 10 5 7 10 24 16 36. Causes ill—defined or unknown M — — — — — — — — — — — — F 1 1 — — — — — — — — — — C.F. 102. Deaths under 1 year Legitimate. Illegitimate. M 78 11 F 55 17 For the purpose of comparison, the death rates for the County of London and the Metropolitan Boroughs are given in a table on page 16. Of the total of 2,408 St. Pancras deaths which occurred during the year, no less than 1,645 took place in public institutions; this equals a proportion of 68 per cent, of the total deaths. As compared with the previous year there was an increase in the number of deaths due to Diabetes, Cerebral Haemorrhage and Pneumonia and a decrease in those attributed to Cancer, Nephritis and Heart Diseases. Deaths of Aged Person?. The corrected number of deaths of residents at 65 years of age and upwards, which occurred during the year 1934 was 1,143. Of these 580 were between the ages of 65 and 75 ; 459 were between the ages of 75 and 85, and 104 were 85 years of age and upwards. 29 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. 1934. 1933. Deaths. Death Rate (unadjusted). Deaths. Death Rate. 1 403 11.9 407 11.8 2 254 13.6 239 12.6 o o 425 13.5 462 14.5 4 309 13.6 333 14.4 5 330 12.1 377 13.6 6 185 10.9 233 13.4 7 137 11.1 154 12.3 8 297 12.2 343 13.8 Homeless 68 — 60 — Borough 2408 12.8 2608 13.7 Deaths of Persons of unknown addresses, etc., included in thf. Mortality Statistics. The following deuths have been included in the Mortality Statistics of the Borough, in accordance with the Registrar—General's rules relating to " Transferable Deaths " : — Various Asylums 20 Highgate Hospital 2 St. Pancras Hospital 41 Found dead in Regent's Canal 3 ,, ,, on West. Hill 1 „ ,, „ Parliament Hill Fields 1 Total 68 30 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 — 1 — 7 4 13 Pneumonia 2 1 — — 7 5 15 Cerebral Hemorrhage — — — — 4 2 6 Cancer — — — — 7 8 15 Tuberculosis — 1 — — 4 1 6 Other causes 5 3 3 4 41 16 72 Accidents— Street Vehicles — 6 18 17 34 28 103 Burns and Scalds — 1 1 1 4 7 14 Railway — — — 1 10 — 11 Falls — — 2 2 24 74 102 Other causes 1 7 5 3 29 17 61 Suicides† — — — 10 101 16 127 Murder 1 1 — — 1 — 3 Open Verdict‡. 5 — — 2 11 — 18 Totals 15 29 30 40 283 178 566§ ‡ Includes 65 cases of coal gas poisoning. I Includes 2 cases of coal gas poisoning. § St. Pancras cases 128, ex—St. Pancras 438 (see also page 66). Infantile Mortality. The number of deaths of St. Pancras infants under one year of age occurring during 1934 was 160. This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 65. The corresponding rate for the previous year was 58. The following table gives the deaths and death rates of both legitimate and illegitimate infants for 1934 :— Legitimate. Illegitimate. Total. Number of Births 2,210 239 2,449 Number of Deaths (under one year of age) 129 31 160 Death rate per 1000 births 58 130 65 The Infantile Mortality rates for previous years, the figures for each Ward, and the Infant Mortality rates for the County of London and the Metropolitan Boroughs are given in tables on pages 14, 15 and 16. On the next two pages tables are given which indicate :— 1. The causes of death of all children under one year of age during 1934, classified according to age at death. 31 2. The causes of death of children under one year of age during the terl previous years. In this table the number of births in each year is also given for reference. Next Deaths from stated causes at various Ages under 1 Year of Age for the Year 1934. CAUSE OF DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Measles — — — — — — 2 3 3 8 Whooping Cough — — — — — — 2 1 — 3 Influenza — — — — — — — 1 — 1 Erysipelas — — — — — — — — — 1 Meningitis (not Tuberculous) — — — — — — 1 1 1 3 Bronchitis — — — — — 2 2 — — 4 Broncho—pneumonia 1 — 1 — 2 8 5 7 2 24 Lobar—pneumonia — — — — — — — — — 1 Pneumonia (type not stated) — — — — — — — 1 — 1 Enteritis — — — — — 12 8 4 1 25 Syphilis 1 — — — 1 — — — — 1 Injury at Birth 3 — — — 3 — — — — 3 Atelectasis 6 — 1 — 7 — — — — 7 Congenital Malformations 11 — 1 1 13 1 1 1 1 17 Premature Birth 52 4 2 — 38 4 — — 1 43 Congenital Debility, Sclerema and Icterus — — — 1 1 1 1 1 — 4 Other causes 4 1 — — 5 2 3 4 — 14 Totals 58 5 5 2 70 30 27 24 9 160 Nett Births in the year legitimate 2210 illegitimate 239 Nett Deaths in the year legitimate infants 129 illegitimate infants 31 32 Deaths from Stated Causes under 1 Year of Age for 1934 and 10 preceding Years. CAUSE OF DEATH. 1921 1925 1926 1927 1928 1929 1930 1931 1932 1933 Average for 10 years. 1934 Measles 15 2 25 — 30 — 3 1 6 — 8 8 Scarlet Fever — — — — — — — — — 1 — — Whooping Cough 13 29 11 15 10 32 2 10 11 4 14 3 Diphtheria and Croup — 1 1 — — 3 1 1 1 1 1 — Erysipelas 2 2 — — — — 2 — 3 — 1 1 Influenza 6 2 1 2 — 5 2 1 2 1 2 1 Tuberculous Meningitis 3 2 3 3 — — 1 1 1 1 2 — Other Tuberculous Diseases — 1 1 1 2 — 2 2 1 — 1 — Meningitis (not Tuberculous) 5 4 3 2 1 4 3 8 3 6 4 3 Convulsions 4 4 2 1 1 5 — 1 — 2 2 — Bronchitis 12 19 14 5 9 7 7 4 3 4 8 4 Bronchopneumonia 51 34 36 42 43 43 20 42 27 12 35 24 Lobar-pneumonia 3 4 2 2 3 4 — 3 1 — 2 1 Pneumonia (type not stated) 3 — 1 1 2 1 3 1 2 — 1 1 Diarrhœa 6 9 7 3 8 5 6 6 9 2 6 — Enteritis 46 36 38 24 33 34 36 22 42 27 34 25 Gastritis — 2 — — — 1 — — 1 — — — Syphilis 2 6 1 2 4 1 3 2 2 1 2 1 Rickets — — — — — — 1 — — 2 — — Suffocation (overlying) 1 4 3 1 1 — 1 — — — 1 — Injury at Birth 4 7 3 9 2 9 4 3 6 2 5 3 Atelectasis 7 2 6 10 11 7 3 4 8 7 7 7 Congenital Malformations 23 20 25 15 20 23 12 23 10 14 19 17 Premature Birth 59 57 57 39 50 46 48 43 36 37 47 43 Congenital Debility, Solerema and Icterus 24 17 18 14 16 14 8 7 2 8 13 4 Other causes 14 17 16 14 15 18 26 15 9 19 16 14 Totals 303 280 274 205 261 262 194 200 196 151 231 160 Nett Births 4112 3880 3612 3299 3274 3170 3208 2955 2684 2589 3278 2449 33 Section II.—GENERAL PROVISION OF HEALTH SERVICES. Hospital Accommodation. A. Fercr and Small Pox.—Hospital accommodation is provided by the London County Council, who now control the various institutions previously provided by the Metropolitan Asylums Board. B. Tuberculosis.—For patients suffering from this disease Institutional accommodation is provided through the London County Council. C. General, Children's and other Hospitals.— The under—mentioned are situated within the Borough. The St. Pancras and Highgate Hospitals are extensively used by residents of the Borough. St. Margaret's Hospital admits cases of the kind specified from the whole of the metropolitan area. 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 by St. Pancras residents. Hospital. Number of Beds. London County Council General Hospitals. St. Pancras Hospital, King's Road 380 Highgate Hospital, Dartmouth Park Hill 555 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. General 414 University College Hospital, Gower Street — Obstetric 85 Royal Ear 41 General .. 239 Royal Free Hospital, Gray's Inn Road Dental and Ear, Nose 43 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 76 Hospital for Tropical Diseases, Endsleigli 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 St. Saviour's Hospital, Osnaburgh Street 21 North—West London Hospital, Bayham Street St. Pancras Dispensary, Oakley Square London Skin Hospital, Fitzroy Square Out— Western Skin Hospital, Hampstead Road patients British Dentists' Hospital, Camden Road only. London Foot Hospital. Fitzroy Square British Hospital for Nervous Disorders, Camden Road British Red Cross Society Clinic for Rheumatism, Peto Place 34 Institutional Provision for Unmarried Mothers. The Main Memorial Home, 49, Cartwright Gardens, W.C. 1, provides accommodation for young unmarried women expecting for the first time to become mothers. The Home is maintained by funds obtained from voluntary sources, but a grant is made 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.I. Telephone Hop 0262. Provides the following services: — (1) For removal of infectious cases. (2) For non—infectious and accident cases. (31 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. Other ambulance facilities include :— St. John's Ambulance Association, St. John's Gate, Clerkenwell, E.C.I. Tel. Clerkenwell 6644. British Red Cross and Order of St. John Ambulances, These convey prpgnant women to hospitals from 8 a.m. to 11 p.m. Tel. Sloane 7136. Clinics, Treatment Centres, etc. For the 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, (Maternity and Child Welfare The Borough Council. Centre), South Higligatc 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. 35 Situation. By —whom provided, li. Maternity and Child Welfare Centres. St. Pancras School for Mothers, Amptliill 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, Ravdon Street „ „ Camden Town Centre, Camden Road „ „ Caversham Road Centre „ „ University College Hospital Centre The Hospital Authorities. Royal Free Hospital Centre „ „ C. Day 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. 36 Situation. By whom provided. F. School Clinics. High gate New Town: Chester lload, 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, Gower Street (for male and female patients). A complete list giving the days and times at which the clinics are available can be obtained on application to the Medical Officer of Health. I. Clinic for Sick Mothers anil 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. Albau'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. Cleansing Station. Cambridge Street, N.W. 1 The Borough Council (part of accommodation let to L.C.C. forcleansing of school children). M. Professional Nursing at Home. North London Nursing Association, 6 & 7, By Voluntary Committee, with Canonbury Place, N. 1 grant from Borougli Council. Hampstead Nursing Association, 25, Heath Hurst ,, Road, N.W. 3 Metropolitan Nursing Association, 14, Oakley ,, Square, N.W. 1 N. Massage Clinics. St. Pancras School for Mothers, Ampthill Square By Voluntary Committee. Somers Town Welfare Centre, Chamberlain ,, House Camden Town Welfare Centre, Barnes House ,, 37 MATERNITY AND CHILD WELFARE. At their November meeting the Council considered a report from the Medical Officer of Health, expressing the view that the extensive maternity and child welfare services in the Borough would benefit by detailed supervision. The report was still under consideration at the end of the year, but at the time of writing, Dr. P. Y. Pritchard, whose duties have always been largely concerned with maternity and child welfare work, has been placed (under the Medical Officer of Health) in definite control of these services. During the year the Council received Circular 1433, dated 10th October, 1934, from the Minister of Health referring to Circular 1167 of the 11th December, 1930, and an accompanying Memorandum 156/M.C.W. on the subject of Maternal Mortality. The Memorandum contained various suggestions for improving and developing the maternity services of local authorities, and the Circular urged the importance of each authority doing all .that is reasonably possible to provide a sat isfactory service for its area. The Circular 1433 was particularly directed to those authorities whose districts have unduly high maternal mortality rates, which is not the case in St. Pancras. The Medical Officer of Health presented a report reviewing the maternity and child welfare work in the borough, in the light of the points raised in the Ministry's circular. At the close of the year the report was still under consideration by the Council. 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 them the County Council, and to which the Metropolitan Borough Councils are to contribute. The scheme provided for the payment during the fixed grant period to the various voluntary associations of contributions of the amounts 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 continued in force until 31st March, 1933. An amended scheme was then prepared by the Minister of Health, coming into force on April 1st, 1933, and continuing until March 31st, 1937. The following associations are those to which the St. Pancras Borough Council make contributions, the amounts under the existing scheme being also stated:— Association. Scheme expiring 31st March, 1937. £ St. Pancras School for Mothers 777 Somers Town Welfare Centre 275 North St. Pancras School for Mothers 136 South Highgate Welfare Centre 141 Caver sham Road ,, 421 Camden Town „ 560 St. Pancras Dispensary 146 University College Hospital 890 Whitefield Day Nursery 480 Kentish Town „ 513 Margaret „ 750 Mayoress of St. Pancras Home for Sick Poor Children 700 38 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 may reasonably be required. The work carried out in the Borough in connection with maternity and child welfare may be summarised under the following three headings 1. Ante—natal. Special consultations are held at the Centres maintained bv the Borough Council and also at the General and Women's Hospitals, both in and adjacent to the Borough. Visits by Council's Health Visitors to the Homes. Classes for mothers, held by the Superintendents of the various Centres. Provision of dinners (at some Centres), milk, and also of dental treatment for expectant and nursing mothers. A scheme of co—operation in Ante—natal work between the Borough Council and University College Hospital, in force since January 1st, 1928. During 1933 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 Confinement. A subsidy is paid by the Borough Council to certain hospitals in connection with the admission of necessitous cases to their maternity wards. 39 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 Ilome Helps. 3. Infants and Yuung Children. The dispatch by post of cards of advice to the individual mothers immediately after the receipt of the notification of birth required by law. The visiting of infants and young children by the Council's staff of health visitors. The provision and maintenance of Child Welfare Centres. These Centres are partly maintained on a voluntary basis; but the whole of the professional staff (medical officers and health visitors) are paid and controlled by the Council, who also pay the rent, rates and taxes of the Centre premises. The provision of a clinic for ailing mothers and young children, the expenses being borne partly by municipal and partly by voluntary funds. The provision of a municipal dental clinic. The subsidisation of a Home for ailing young children. The supply of milk, free or at reduced price. The subsidisation of the four voluntary Day Nurseries in the Borough. The payment for the home nursing of sick infants in certain cases. A Centre for Artificial Light treatment. The provision of convalescent home treatment by means of subsidy to voluntary agencies. 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 the University College Hospital, (lie Middlesex Hospital, the Maternity Nursing Association, and other agencies. Home. Visiting. — The Council's Health Visitors at the Welfare Centres are full—time workers (17 in number), who divide their time between the necessary work at the Centres and visitinsr the homes of the mothers and children. The number of visits paid by each officer is shown in the following table:— 40  Bristow. Crockart. Jones. Templeton * Chapman. Manger. Anderson. Blaxland. Hunter. Blair. Robinson. Bagnall. Bruce. Clarke.† Harris. Harrop. Lurie. Lynn. Smith. Totals. Infants. Under 1 [ First Visits 82 6 1 — 5 113 103 230 101 173 123 209 236 70 139 156 115 174 156 2192 1 Subsequent 285 24 5 — 35 424 302 777 290 377 353 1070 705 570 510 629 3811 692 541 7978 „ 1-2 First Visits 4 — — — 2 3 6 6 6 7 8 7 15 — 17 16 8 2 16 123 Subsequent 200 21 — — 16 221 231 414 459 219 232 301 309 389 320 397 332 353 281 4695 „ 2-5 First Visits 1 — — — 1 8 13 2 1 12 17 1 17 — 19 9 6 1 10 118 Subsequent 224 20 — — 19 228 522 519 1046 281 313 331 462 475 366 600 386 579 528 6899 Expectant Mothers First Visits 44 9 — — 6 36 63 121 47 96 80 170 70 56 98 62 56 102 83 1199 Subsequent 55 2 — — 14 79 29 77 35 42 70 291 188 133 55 89 110 86 39 1394 Measles 130 6 — — 4 131 159 272 156 200 96 93 475 249 240 275 278 229 261 3260 German Measles 8 — — — — 2 13 13 7 3 14 1 21 3 7 22 13 16 5 148 Whooping Cough 6 — — — — — 19 1 11 4 5 8 24 — 5 14 9 22 13 141 Ophthalmia Neonatorum — — — — — 1 7 5 10 — 5 4 4 — 2 3 — 4 3 48 Puerperal Fever 1 — — — — — — 1 1 — — — 1 1 2 — — 2 — 9 ,, Pyrexia 1 — — — — 1 2 8 1 4 — 1 3 1 1 — 2 2 — 27 Other diseases 37 — — — 1 4 84 28 198 19 29 38 169 41 73 139 93 63 88 1104 Milk Enquiries 1 — — — 2 — 4 5 6 2 3 7 2 — 8 2 3 4 3 52 Foster Children 44 — 8 — — 6 31 74 3 27 48 124 33 23 36 101 22 100 56 736 Other Visits 138 219 4 14 51 172 525 118 590 501 153 424 90 190 655 161 68 203 490 4771 Totals 1267 307 18 14 156 1429 2113 2671 2968 1967 1549 3080 2824 2201 2553 2675 2639 2639 2573 34894 Consultations and Classes attended 206 266 230 32 248 213 103 183 132 223 147 118 196 150 132 163 120 162 158 3182 * Miss Temple ton, retired as from 30th June. † ,, Clarke resigned „ ,, 31st October. 41 In addition to the Council's Health Visitors at the Welfare Centres there were two part-time trained workers, not paid by the Council, at the Cuversham Road Centre, and one part-time trained voluntary (unpaid) worker at the Somers Town Centre. There were also two trained visitors at the University College Hospital Centre, who worked in neighbouring boroughs as well as in St. Pancras, and whose salaries were paid by the hospital authorities, and not by the Council, and three trained visitors at the Royal Free Hospital. During 1934 the Council's staff at the various Centres made 22,005 visits to 2,433 children, and 2,593 visits to 1,199 expectant mothers; the trained workers not paid by the Council made 6,929 visits to 399 children, and 468 visits to 376 expectant mothers The visiting work for each Centre is set out in detail on the next page, and is summarised so far as the last six years in the following statement:— Year. No. of Expectant Mothers Visited. Total Visits to Expectant Mothers. No. of Children Visited. Total Visits to Children. 1934 1575 3061 2832 28934 1933 1780 3405 2948 33096 1932 1862 3309 3086 29386 1931 1645 3306 3263 34002 1930 1645 3105 3519 37972 1929 1845 3632 3643 41711 Maternity and Child Welfare Centres. These are six in number, excluding the Centres at the University College Hospital and the Royal Free Hospital. Each Centre is managed by a Committee, the members of which not only give valuable help at the various consultations, but in most cases also provide additional funds for the maintenance of many other useful activities associated with the work of each Centre. The Council has representatives on each of the six Committees and each of the eight Committees sends one representative to the Council's Maternity and Child Welfare (Advisory) Sub—Committee. The Centre at the Royal Free Hospital is not subsidised by the Council. The following Table gives statistics concerning the work of all the Centres during the year. It will be seen that 471 ante—natal consultations were held, the number of expectant mothers was 1,431 and their total attendances were 6,250. For the two previous years the total attendances were 5,880 and 6,367. The number of consultations for children was 1,404, the children who attended for the first time numbered 2,649, and the total attendances were 40,784. For the two previous years the total attendances ot children were 43,839 and 45,123. 42 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. 10-2 years. 2-5 years. Total. Under 1 year. 1-2 years. 2-5 years. Total. First visits. Total visits. First visits. Total visits. Per month. Total. Per month. Total. Council Staff. Others. St. Pancras School for Mothers 53 161 219 18 27 264 2828 1044 939 4811 232 418 456 4152 14 170 1 12 3 - Somers Town Centre 66 186 321 27 27 375 4351 1718 1065 7134 210 504 429 4634 16 197 1 11 2 1(a) North St. Pancras i School for Mothers 145 387 336 22 30 388 4066 1495 1153 7314 148 499 471 3917 18 211 2 24 3 — South Highgate Centre — — 75 18 14 107 1129 434 387 1950 75 159 135 1458 8 79(c) - - 1 - Camden Town Centre 184 483 434 87 55 576 6030 1847 1666 9543 327 475 664 4795 20 248 2 23 5 — Caversham Road Centre 138 810 307 37 46 390 3850 1121 1105 6076 189 571 438 6055 12 142 4 48 2 2(b) ‡University College Hospital 668 3470 367 18 35 420 2253 461 395 3109 212 214 132 3476 18 202 18 203 — 2 †Royal Free Hospital 177 753 — — — 129 440 186 221 847 182 221 107 447 12 151 12 150 — 3 Totals 1431 6250 — — — 2649 85547 8306 6931 40784 1575 3061 2832 28934 118 1404 40 471 16 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) 1 part—time trained visitor (honorary) for 28 days. (b) 2 part—time trained visitors, Caversham Road. (c) 1 of the weekly consultations suspended for 6 months. † 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.) 43 Particulars concerning some of the special activities of the individual Centres are given in the following paragraphs : — St. Pancras School for Mothers, 1, Ampthill Square. In addition to the consultations provided by the Council, interviews with parents (apart from those otherwise recorded) numbered 1,532. Other activities of this centre include the following :— Clauses for Mothers. At infant care classes there were 258 attendances; and at needlework, etc., classes, 672 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. 2,018 dinners were supplied to nursing and expectant mothers, and 1,679 to young children. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,789 attendances during the year, of which 585 were made by infants under one year of age, and 1,204 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.o.s. During the year 38 consultations were held, at which 188 treatments were provided for mothers and 178 for children. Details of the work done are given in the following table :— Mothers. Children. Extractions with anaesthetics 47 27 „ without anaesthetics 2 3 Fillings 57 82 Scalings 4 - Impressions and fitting dentures, etc. 45 - Examinations and advice 33 66 Totals 188 178 366 Massage Clinic. Treatments numbering 735 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 1,300 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes during the winter months, at which 237 attendances were recorded, and 26 mothers and 38 children were sent away on holiday for a period of two weeks. 669 massage treatments were given by a trained voluntary masseuse. The clothing stall was kept well equipped by voluntary knitters. 44 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 207 attendances wore recorded. 33 Sewing and Knitting classes were held, at which 457 attendances were made. Three talks to fathers were given, at which the attendances were 52. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 1,693. 48 children attending this Centre were referred for Artificial Light treatment and 27 children for Massage at the Almeric Paget Institute, a Voluntary Society whose premises are at 14, Rochford Street, which is near the Centre. 31 mothers and 44 children were referred to the Council's Dental Clinic for treatment. 20 mothers and 25 children were sent away on holiday or convalescence. Camden Town Centre. 26 mothers and 42 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 2,475. 23 classes for expectant mothers were held simultaneously with the ante—natal clinics. There were 396 attendances. 31 Knitting and Needlework classes and Health Talks were given, the total attendances being 1095. The services of two trained masseuses (not paid by the Borough Council) were available throughout the year, during which time 87 massage clinics were held. There were 698 attendances. Dinners for Mothers and Children.—These were supplied daily at the Centre to 1,031 expectant mothers, 2,845 nursing mothers and 2,415 children, at a charge of 2d. per head. South Highgate Centre. Four mothers and five children were sent away on holiday, either to the country or seaside, for a period of two weeks. One mother partly paid for herself and the other three were paid for from Centre funds. 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 (part—time) were also provided from the same fund. Artificial Light Treatment—South Highc.ate Centre, Raydon Street. 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 October. Consultations were held on Mondays and Wednesdays in each week, the average number of patients at each consultation being 11. 45 Staff', Equipment and Statistics for 1934— The clinic for providing the Artificial Light 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. Staff'.—The Medical Officer carrying out the treatment is the Council's Deputy Medical Officer of Health, Dr. P. V. Pritchard. The Superintendent of the Centre is Miss E. M. Robinson, who is assisted at the consultations by a Health Visitor from another Centre. Lamps, etc.—Three in number : 1 Westminster Single Arc Lamp, and 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:— 1934. 1933. Total number of cases treated 38 40 Total number of new cases 30 35 Total number of attendances 735 604 Number of Consultations held 64 44 Average attendance per Consultation 11 14 Average number of attendances per child 19 15 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 touch with the various Welfare Centres. Consultations are held every Thursday morning for examinations, fillings, etc., and for extractions with gas on alternate Friday mornings. No charge is made for extractions, fillings or scaling, but the patients contribute what they can reasonably afford towards the cost of dentures. 46 The work done during the year is summarised in the following table, the figures io* the previous year also being given for comparison:— Work carried out at the Dental Clinic. 1934. 1933. Number of new cases Mothers 163 169 Children 220 270 Total 383 439 Number of Attendances For extractions under nitrous oxide ( gas) 309 374 ,, ,, local anæsthesia 18 17 ,, fillings and dressings 287 401 „ scaling 14 42 ,, impressions and fitting dentures 213 201 ,, examination and advice 549 646 Total attendances 1390 1618 Total number of clinics held 77 78 Number of clinics with nitrous oxide anaesthesia 23 21 The following table shows the number and cost of the dentures supplied during the year:- Number of Patients supplied with dentures 31. Total cost £106 10s.0d. Amount paid by mothers £46 11s. 6d. Amount paid by Borough Council £29 5s. 0d. Amount paid by Public Assistance £10 0s. 0d. Amount paid by various Societies £20 13s. 6d. Five mothers paid the entire cost of their dentures. The Societies who made contributions towards the cost of dentures were the Metropolitan Hospital Sunday Fund, £12 10s. Od.; and various other societies, £8 3s. (id. Dental treatment is also provided at the voluntary clinic which is held at the St. Pancras School for Mothers, see page 43. 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 f>8 chairs and complete electric units, the Surgical wing contains 32 beds for tonsil and adenoid, cleft palate, hare lip, etc., cases requiring operative treatment. 47 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, 1934, are as follows:— Number of Days Open. Attendances. Average per Day. Whitefield Day Nursery 220 4747 216 Kentish Tn. Day Nursery 221 7584 34.3 Margaret Day Nursery 299 13851 46.3 Foundling Site Day Nursery 256 3826 14.9 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 loo 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 36 Jellicoe Nursery School, Ha, Rochford Street 53 40 Mary Ward Nursery School, 16, Burton Street 25 19 Magdalen Mission Nursery School, 5, Clarendon Street 24 20 St. Christopher's Nursery School, Bridgewater Street 45 30 In addition to the above, a Nursery School is available each day in premises in Buck Street, Kentish Town Road, granted by Trinity Presbyterian Church. The children, many of whom are reccommended by Welfare Centres, have dinner, an hour's sleep, and hot baths occasionally. The average attendance daily is 30 and there is a waiting list of over 30. The Superintendent, who is voluntary, holds the Diploma of the Rachel McMillan Training College, and there is a rota of daily helpers. Two students from the North—Western Polytechnic take their practical training at the school. A doctor visits regularly. A scheme is in hand to increase the numbers and accommodation so as to attain the standard recognised by the Board of Education, and thus secure the continuance of the School. 48 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 iti the following table, the figures for the two previous years also being given for comparison:— 1934 1933. 1932. New Cases: Children under 5 years of age 30 54 78 Ailing Nursing Mothers 26 44 46 Ailing Expectant Mothers 34 53 45 Attendances: Children under 5 years of age 73 134 232 Ailing Nursing Mothers 51 113 87 Ailing Expectant Mothers 70 106 107 Dispensary as a whole (including the above). New Cases: Children under 5 years of age 520 460 484 Ailing Nursing and Expectant .Mothers 60 97 91 Attendances: Children under 5 years of age 1296 1160 1106 Ailing Nursing and Expectant Mothers 121 219 194 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 equally by the Committee of the St. Pancras Dispensary and by the Committee of the Mayoress' Home. During the year the Nurse made 692 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. 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. 49 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. 177 children were admitted during the year, and the average length of stay in the Home was 26 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 37 children were sent away during the year. Infant Life Protection—Children Acts, 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." During the year 4 children on the Register died. The coroner was notified as required by the Acts, but no inquests were held. At the end of the year there were 121 persons on the Register who for reward were receiving 124 children. 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. Pasteurised milk is not stipulated. Where a family is in receipt of relief, the application is 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, in order to avoid overlapping. 50 The following procedure has been agreed upon between the Borough Council and the London County Council regarding the provision of extra nourishment to expectant mothers attending the ante-natal clinics at the London County Council Hospitals:— (a) In receipt of relief.— Women in receipt of relief who attend the County Council'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. (b) Not in receipt of relief.—Expectant mothers attending ante-natal clinics attached to the London County Council's general hospitals, who are not in receipt of relief, but are nevertheless in such financial circumstances as to be unable to bear Ihe cost of such nourishment, are supplied with extra nourishment on the certificates of the County Council's medical officers, provided that these cases come within the category of the Borough Council's scheme. At the end of 1933 there were 219 families actually in receipt of milk under the Borough Council's scheme. During 1934, 348 new families were added to the list of recipients. By the end of that year there were 204 families receiving grants. The total cost of this scheme in 1932 was £937 : in 1933. £1.086: and in 1934. i.992. Month. FREE. HALF-PKICE. COST. Pints. †Lbs. (Dried Milk.) Prints. †Lbs. ( Dried Milk.) £ s. d. January 6300 235 616 15 111 19 10 February 5348 190 224 20 95 0 10 March 4872 155 308 5 74 9 3 *April 5656 185 336 5 89 4 11 May 4564 110 280 10| 67 13 2 June 4592 170 308 10 72 16 2 *July 5236 175 616 30 83 18 10 August 3976 110 504 30 62 9 9 September 4172 95 336 25 62 10 8 *October 5740 170 644 30 103 13 2 November 4592 135 448 10 81 0 5 December 4928 130 616 30 87 10 9 59976 1860 5236 220 £992 7 9 * 5 week months. † 1½ lbs. of (reconstituted) dried milk powder is equivalent to 7 pints of cow's milk. 51 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 income scale, below which a family is eligible for an allowance, is sbown 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 Statements as to income for the purpose of these applications are verified by the Health Visitors attached to the various Centres. Occasionally an enquiry is made of the employer in verification of the statement of wages. 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. Of these Associations, only the Metropolitan District Nursing Association, whose local headquarters are at 14, Oakley Square, undertake the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment for this nursing is included in the block grant. The block grants made by the Council are as follows:— District Nursing Association. Under the Maternity and Child Welfare Scheme. Under the Influenzal Pneumonia Regulations. Total Block Grant. £ £ £ Hampstead 20 10 30 Metropolitan 150 50 200 North London 15 10 25 Totals 185 70 255 52 The following table gives the number of casea and number of visits during the past year:— District Nursing Association. No. of cases. No. of visits. Average No. of visits per case. Metropolitan 124 1892 15.3 Hampstead 93 1622 17.4 North London 11 191 17.4 Total 228 3705 16.3 In addition to the above, the Metropolitan District Nursing Association also undertook the necessary nursing arising in connection with 162 cases, chiefly maternity or tuberculosis, and children's complaints, and to these 1,987 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 rospect of maternity cases only. Two permanent " Helps " were employed throughout the year, and 14 temporary " Helps " for emergency cases. 82 cases were dealt with during the year, 78 being maternity and 4 sickness cases. Midwives. In the Metropolis, the supervising authority for midwives is the London County Council. According to figures supplied by that authority in January, 1935, the number of midwives who, in 1 y;34, had notified their intention to practise in St. Pancras was 45. Only 12 of this number are engaged in private practice, the remainder are on the staff of various hospitals and institutions in the Borough. Private midwives are not subsidised by the Borough Council, but a subsidy is paid for each approved necessitous case attended in the patient's home by midwives on the staff of certain hospitals and by midwives employed by the Maternity Nursing Association, The subsidy is not paid in cases where " Maternity benefit " is payable under the National Health Insurance Act. Midwifery. There are a large number of institutions, situated either within or near the Borough, which provide midwifery attendance, either at the patient's home or by admission as in-patients. There is at present no arrangement under which midwives acting in the capacity of maternity nurses attend cases with students at the patients' homes. 53 In the following table particulars are given for 1934, 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 355 241 19 Royal Free Hospital 83 21 .. Elizabeth Garrett Anderson Hospital 47 .. 54 St. Pancras Hospital 408 .. 3 Middlesex Hospital 128 .. 31 Queen Charlotte's Hospital 91 .. 1 City of London Hospital 23 .. .. Royal Northern Hospital 29 .. .. St. Bartholomew's Hospital 3 .. .. Other hospitals 140 .. 2 Queen Mary's Maternity Home 49 .. Maternity Nursing Association .. .. 211 Totals 1356 262 321 The cases admitted as in.patients represented 53*7 per cent, and those attended at home 23.1 per cent, of the total number of St. Pancras births. A.s 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 — Elizabeth Garrett Anderson Hospital 4 0 0 Queen Charlotte's Hospital 8 0 0 City of London Hospital 7 5 0 Middlesex Hospital 29 0 0 University College Hospital 96 0 0 Maternity Nursing Association 1 10 0 Total £145 15 0 The corresponding grants for the previous three years were: £115 5s. 0d., £174 10s. 0d., and £215 10s. 0d. 54 Maternal Mortality. The following observations and figures have been furnished by Dr. Pritchard, Deputy Medical Officer of Health. 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. 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 meaning 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 1934 there were 10 Puerperal Maternal Deaths, 3 due to Sepsis (including one following abortion, where the circumstances were suspicious of some criminal interference) and 7 due to other causes (including one where the woman was not in labour, but eight months pregnant, one after abortion, two with "stillborn " deliveries, two following toxajmias, and one following " operation shock " when sewing up a vaginal tear). There was one Non.Puerperal Maternal Death due to Acute Broncho.Pneumonia. The coroner returned another death as " injection of scalding fluid into uterus for purposes of procuring abortion, circumstances unknown." This has not been included in any of the forcging figures. The Puerperal Maternal Mortality rate was 4.0 per 1000 births (live and still). 55 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. 19251928 Sepsis 8 10 18 Information not available 0.6 1.3 Other Causes 18 — 18 1.3 1.3 Totals 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 1934 Sepsis 2 1 3 2 1 0.8 1.2 Other causes 6 1 7 4 2 2.4 2.8 Totals 8 2 10 6 3 3.2 4.0 * Previous to 1932, calculations made for live Births only. 56 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, 1934. Defect. Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1223 Cases. * 420 Cases. * 1215 CaseE. * 1537 Cases. • 1212 Cases. * 413 Cases. * 1193 Cases. * 1478 Cases. * Malnutrition 7 3 2 2 5 4 1 — 10 6 2 2 16 9 — — Skin disease 16 13 7 6 12 10 9 6 11 10 4 4 4 2 15 9 Defective teeth — 459 — 115 — 271 — 471 — 460 — 126 — 238 — 373 Enlarged tonsils 214 91 25 10 65 20 44 11 233 87 29 11 81 25 47 19 Adenoids 8 7 2 1 3 1 — — 9 6 1 1 — — 2 2 Enlarged tonsils and adenoids 54 22 8 4 6 3 1 — 58 22 13 5 7 1 3 — Other nose and throat defects 12 6 5 2 11 9 3 2 13 6 6 5 10 3 6 4 Enlarged glands 34 4 5 1 12 — 7 — 21 4 6 — 5 1 6 1 Eye disease 61 38 13 9 16 10 19 9 58 32 11 7 15 8 18 10 Vision defect — — — 35 — 127 — 144 — — — 33 — 140 — 144 Otorrhœa 25 12 5 2 19 15 11 7 31 21 5 5 19 11 13 13 Other ear disease 9 5 4 — 6 1 3 3 13 7 1 1 2 1 1 1 Defective hearing 5 2 1 1 6 2 8 4 4 2 1 — 5 3 5 2 Speech defects 4 1 1 — 2 1 5 1 6 — 1 — — — — — Heart defects 40 — 11 1 22 3 22 4 28 4 7 2 32 3 49 2 Anæmia 20 5 8 4 9 — 10 2 7 3 2 1 11 2 6 3 Lung defects 87 21 16 6 14 4 9 1 70 24 10 4 9 2 7 3 Nervous defects 8 — 3 1 4 1 7 3 7 2 3 2 5 2 6 1 Phthisis 5 — 3 — 8 — 4 — 4 — 2 — 5 1 6 1 Other T.B. disease 2 2 — — — — — — 1 — — — — — — — Rickets 11 3 — — — — 1 — 2 1 1 — 1 — 1 — Spinal deformities 4 2 3 2 13 4 11 6 3 1 2 — 22 13 32 17 Other deformities 7 — 3 — 18 2 17 5 9 3 5 1 26 4 43 21 Other defects 68 31 22 14 45 25 26 10 72 45 23 17 66 39 53 35 Number of children noted for treatment 633 187 451 615 625 189 440 557 Note.—Defects, however alight, are included under " Cases.'' Those severe enough to require treatment are shown under.* 57 Routine Medical Inspection of Elementary School Children in St. Pancras in 1934. 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 1223 729 472 22 233 955 35 — 1188 32 3 1206 17 — 677 335 211 — — — Girls 1212 754 446 12 256 925 31 — 1149 59 4 1195 17 — 695 336 181 — — — Age 8— Boys 420 265 150 5 51 341 28 — 404 15 1 410 10 — 274 106 40 285 77 47 Girls 413 241 169 3 60 342 11 — 372 36 5 403 10 — 248 120 45 285 75 47 Age 12— Boys 1215 876 335 4 210 955 50 — 1170 43 2 1206 9 — 908 267 40 866 171 177 Girls 1193 781. 401 8 302 852 39 — 1076 98 19 1183 10 — 915 251 27 859 156 178 Age 14— Boys 1537 1023 502 12 454 1052 31 — 1516 21 — 1526 11 — 1026 457 54 1142 172 220 Girls 1478 1035 431 12 544 898 36 — 1407 68 3 1466 12 — 1077 375 26 1092 181 203 Totals 8691 5704 2909 78 2110 6320 261 — 8282 372 37 8595 96 — 5820 2247 624 4529 832 872 % St. Pancras 65.6 33.5 0.9 24.3 72.7 3.0 95.3 4.3 0.4 98.9 1.1 — 67.0 25.8 72 72.7 13.3 14.0 % London 53.9 45.5 0.6 20.5 75.3 4.2 96.9 2.8 0.3 98.9 1.1 0.0 68.8 26*5 4.7 65.3 19.2 15.5 58 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 exponse of the Local Authority, and the number °f 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. (f) A quarterly report is to be furnished by the medical practitioner to the Medical Officer of Health giving the following information : — (1) The number of doses of Insulin administered, (2) Particulars concerning any tests made of the urine or of the blood of the patient. (3) The progress of the patient during the period under report. Patients who are insured under the National Health Insurance Act are not eligible under the above scheme, as supplies of Insulin are available for them under the Act. Public Health Officers of the Loc\l 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 Acts, 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 ail}' 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. 59 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. (c) Removal and disposal of house and other refuse. (d) Removal of faecal and offensive matter by road. (e) Waterclosets, earthelosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) live.laws with respect to houses divided into separate tenements, etc. (j) Licensing, inspection and supervision of seamen's lodging houses. (k) Registration, licensing, inspection and regulation of common lodging houses. (l) Licensing of dairymen to use premises as cow.houses. (m) Licensing and inspection of slaughter.houses and knackers' yards. (n) Offensive trades. (o) Rag and bone dealers. (p) Humane slaughtering of animals and poultry. (q) Demolition of buildings. (r) Tee cream vendors and premises. (s) Duties concerned with infant life protection under Part 1 of the Children Act, 1908. 5. London County Council (General Powers) Acts, 1893.1934. 6. Children and Young Persons Act, 1932. 7. Slaughter of Animals Act, 1933. 8. Pharmacy and Poisons Act, 1933. B.—Public Health Legislation either enacted or coming into force during 1934 :— London County Council (General Powers) Act, 193//.. 1.—Under section 27 it is provided (inter alia), that any committee appointed by a borough council for any of the purposes of the Public Health (London) Act, 1891, may (subject to the terms of its appointment) serve and receive notices, take proceedings, and empower any officer of the borough council to make complaints and take proceedings on its behalf and otherwise to execute the Act. Under section 38 (which replaces the corresponding provisions in section 23 (1) of the Municipal Corporations Act, 1882) the borough council may make bye.laws for the good rule and government of the whole or any part of the borough, and for the prevention and suppression of nuisances therein ; provided that any such bye.laws shall not be inconsistent with any bye.laws so made by the London County Council and in fprce in any part of the borough. The confirming authority in relation to bye.laws is the Home Secretary, except that as respects 60 bye laws relating to public health or to any other matter which in the opinion of the Home Secretary and of tlie Minister of Health concerns the functions of the Minister rather than those of the Home Secretary, the confirming authority shall be the Minister. The validity of a bye.law shall not be questioned in any legal proceedings on the ground that the Home Secretary or the Minister is not the confirming authority. Under sections 39 and 40 one code of procedure is laid down for making bye.laws in lieu of section 114of the Public Health (London) Act, 1891, and of the Municipal Corporations Act, 1882, and for obtaining their confirmation. A standard maximum fine of £5 (with a daily penalty of £2 for continuance of the offence) is provided. Notwithstanding anything contained in the Metropolitan Police Courts A.ct, 1839, or in any other Act, every penalty recovered under or in pursuance of any of the aforesaid bye.laws shall be payable to the authority taking the proceedings leading to the recover}' of the penalty. Milk Ad, 1934. 2.—This statute came into operation on the 15th August, 1934, and provides for temporarily securing to producers of milk, by means of payments out of moneys provided by Parliament, a minimum return in respect of milk used in the manufacture of milk products ; for conditionally requiring repayment to the Exchequer of the amount of such payments ; for making, out of moneys so provided, payments for the purposes of improving the quality of the milk supply and increasing the demand for milk ; for regulating the manner in which milk is described for the purposes of advertisement, and sale; for imposing and conferring certain duties and powers on boards administering milk marketing schemes ; and for purposes connected with these matters. The Borough Council will be affected by Section 10, which has been enacted in substitution of section 3 of the Milk and Diaries (Amendment) Act, 1922, which deals with licences to sell milk under special designations. Any order now in force under the 1922 Act continues until revoked. The amending section is as follows :— 3.—(1) The Minister of Health, after consultation with the Minister of Agriculture and Fisheries, may by order— (а) prescribe, in relation to milk of any description, such designation (hereinafter referred to as a " special designation ") as he considers appropriate ; and (b) as respects any special designation, provide for the granting by the Minister of Health or local authorities of licences (hereinafter referred to as " milk licences") authorising the use of that special designation ; and (c) prescribe the periods for which, and the conditions (including conditions as to the payment of fees) subject to which, milk licences in general or milk licences of any particular class are to be granted ; (d) provide for the revocation or suspension of a milk licence in the event of a breach of any condition subject to which the licence was granted ; and (e) provide for entitling any person aggrieved by the refusal, suspension or revocation of a milk licence by a local authority to appeal to the Minister of Health ; and (f) provide for such matters as are necessary for giving effect to, or are incidental to, or consequential on, any provisions contained in the order by virtue of the foregoing provisions of this sub.section." " (2) No person shall, for the purpose of the sale or advertisement Of any milk— (a) use a special designation in any manner calculated to suggest chat it refers to that milk, unless there is in force a milk licence authorising the use of that designation in connection with that milk; or 61 (b) refer to that milk by such description, not being a special designation, as is calculated falsely to suggest either that the cows from which the milk is derived are free from the infection of tuberculosis or of any other disease, or that the milk is tested, approved or graded by any consistent person. " (3) in any proceedings taken by virtue of paragraph (b) of the last foregoing sub.section, it shall lie on the defendant to prove the truth of any suggestion which, in the opinion of the court, his acts or conduct as proved by3the prosecution are or is calculated to convey." Shops Act, 1934. 3. —This statute came into operation on the 30th December, 1934, and regulates the hours of employment of persons under the age of eighteen years who are employed about the business of wholesale or retail shops, or employed elsewhere in connection with wholesale or retail trade or business, and makes provisions as to the arrangements in shops and warehouses for the health and comfort of workers. "Shop" means a shop as defined by the Shops Act, 1912 ("the expression 'shop' includes any premises where any retail trade or business is carried on; and the expression ' retail trade or business ' includes the business of a barber or hairdresser, the sale of refreshments or intoxicating liquors, and retail sales by auction, but does not include the sale of programmes and catalogues and other similar sales at theatres and places of amusement"). " Shop " also means any wholesale shop and includes any warehouse occupied for the purposes of his trade by any person carrying on any retail trade or business or by any wholesale dealer or merchant. Section 10 will be enforceable by the sanitary authority (the borough council) so far as the section relates to ventilation and temperature of shops, and to sanitary conveniences. Sub.section 1 provides that in every part of a shop in which persons are employed about the business of a shop—(a) suitable and sufficient means of ventilation shall be provided and suitable and sufficient ventilation shall be maintained ; and (h) suitable and sufficient means shall be provided to maintain a reasonable temperature and a reasonable temperature shall be maintained. It is provided by section 10 (2) that in every shop, unless exempted, there shall be provided and maintained suitable and sufficient sanitary conveniences available for the use of persons employed in or about the shop. Section 10 (3) enacts that in every part of a shop in which persons are employed about the business of the shop, suitable and sufficient means of lighting shall be provided, and every such part of a shop shall be kept suitably and sufficiently lighted. It is provided by section 10 (4) that in every shop, unless exempted, there shall be provided and maintained suitable and sufficient washing facilities for the use of persons employed in or about the shop. Section 10 (5) provides that where persons employed about the business of a shop take any meals in the shop, there shall be provided and maintained suitable and sufficient facilities for the taking of those meals. It will be observed from the foregoing that there may be exemptions from the provisions of section (10), (2) and (4) as to sanitary conveniences and washing facilities. An exemption would operate if there is in force a certificate (which may be withdrawn) exempting any shop by reason of restricted accommodation or other special circumstances affecting the 62 shop, and that suitable and sufficient sanitary conveniences or washing facilities, as the case may be, are otherwise conveniently available. The occupier of a shop aggrieved by the withdrawal of an exemption certificate may appeal to the County Court. The owner or occupier of a shop failing to comply with a notice served under any provision of section (10) will be liable on summary conviction to a fine not exceeding £20, or in the case of a second or subsequent conviction in respect of the same requirement to a fine not exceeding £50, or £5 for every day since the first conviction in respect of that requirement, whichever is the greater. It will be a defence to prove that there was no contravention of section 10, or that the requirements of a notice were, within a reasonable time after service thereof, complied with in so far as they were necessary to secure compliance with the statute. Any fines obtained are payable to the authority instituting the prosecution. Scction 11 provides that any person, being either the owner or the occupier of a shop, who has incurred or is about to incur any expense for the purpose of securing that the requirements of section 10 are complied with in respect of the shop, who alleges that the whole or any part of the expenses ought to be borne by any other person having an interest in the premises, may apply to the county court, and the court may make such order concerning the expenses or their apportionment as appears just and equitable. It is provided by section 13 (3) that it is the duty of the sanitary authority (the borough council) as part of their duties under the Public Health Acts to enforce the provisions of the new Shops Act relating to ventilation and temperature of shops, and to sanitary conveniences, and any inspector appointed by such an authority shall for the purposes of his powers and duties have in relation to shops all the powers conferred in relation to factories and workshops on inspectors by section 119 of the Factory and Workshop Act, 1901, and that section and section 121 of the same Act shall apply accordingly. This means that the inspector has power to enter, inspect and examine shops, and to inspect certificates, registers, etc., and the shopkeeper must afford the inspector every facility to carry out his duties. It is the duty of inspectors (county council) appointed under the Shops Act, 1912, to take note of and if necessary report to the borough council any contravention of any provision of the new Act which the borough council have to administer. Merchandise Marks Act, 1926. 4.—Orders in Council were made by the Ministry of Agriculture and Fisheries, requiring an indication of origin to be affixed to imported dead poultry and imported bacon and ham. The Orders came into force on 22nd June, 1934, and 22nd July, 1934, respectively. Of the new legislation the Shops Act throws the greatest amount of work upon the officers of the Borough Council. There are some 4,700 shops in the Borough, and it has been decided to make every effort to complete the initial inspections within one year from the coming into operation of the Act. 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 and the book covers which are issued to borrowers at the libraries. 63 The arrangements made for the issue of the St. Pancras edition of the Monthly. Journal known as " Better Health," discontinued for a time owing to the lack of advertising support, were resumed early in 1934 011 payment of a slightly increased subsidy bv the Borough Council. 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 modical 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, 13 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, 453 certificates were issued under Section 48 (2) of the Public Health (London) Act, to the effect that a proper and sufficient supply of water for sanitary and domestic purposes had been provided. An additional supply of water was furnished to the upper floors of 109 tenement houses under powers contained in Section 78 of the London County Council (General Powers) Act, 1907. PUBLIC BATHS AND WASHIIOUSES. These are provided by the Borough Council at the following situations:—Prince of Wales Road, N.W.5 ; Whitfield Street, W.l ; and King Street, N.W.I. A block of 12 slipper baths, available to the public, adjoins the Council's flats at L'rospect Terrace, N.C.I. The water supply in all cases is obtained from the mains of the Metropolitan AVater Board, but at the Prince of Wales Road Baths an additional supply is available from a deep well 011 the premises. DRAINAGE. The sanitary inspectors have the duty of supervising all work in connection with drains, including construction, reconstruction and repairs. During the year the following 64 work has been carried out; the figures for the previous year are also given for the purpose of comparison :— Inspections. Inspections. Inspections. 1934. 1933. 1932. Drainage work done under notice 2958 2713 2420 Voluntary drainage work 8721 7892 6647 Drains of new buildings 2525 2600 2652 Total 14204 13205 11719 Drainage Register.—The following is ail analysis of the Drainage Register during 1934, the figures for the previous year being given for comparison :— 1934. 1933. Plans deposited—Old Buildings under Notice 73 96 „ „ Old Buildings, Voluntary 268 240 „ „ New Buildings and Additions 70 73 411 409 Applications without Plans 435 349 Total number of Applications and Plans 846 758 Rats and Mick (Destruction) Act, 1919. During the year 98 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 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, 5th 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 lhat 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 ail parts of the Borough with the exception of Wards 2 and 6, in which a collection is made twice weekly during the summer months, and daity collections before 10 a.m. in prescribed main streets. Additional collections are also given to flats, eating houses, etc. 65 The use of Pagefield lorries and containers, first introduced in 192.5, 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:— 1934. 1933. Tons. Tons. Quantity of refuse collected 51142 51310 Quantity of refuse burnt at Destructor 31376 32962 Quantity put on rail 19743 18340 Quantity of clinker residual 12062 12720 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 OHice, 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 canoellcd and a new lease of the Court was granted to the Loudon Count}' 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 Count}' 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 from Islington and Hampstead. The matter still remains under the consideration of the Metropolitan Boroughs' Standing Joint Committee. 66 The following table gives particulars concerning the number of inquests held, number of bodies received and post.mortem examinations made during each of the past six years:— 1929. 1930. 1931. 1932. 1933. 1934. Number of inquests held:— St. Pancras cases 158 155 101 121 151 128 Ex-St. Pancras cases 97 118 260 443 422 438 Number of bodies received:— St. Pancras cases 250 218 222 242 306 288 Ex-St. Pancras cases 26 63 374 571 510 525 Number of post-mortem examinations made:— St. Pancras cases 190 173 175 206 286 277 Ex.St. Pancras cases 16 34 229 415 446 492 Totals 737 761 1361 1998 2121 2148 During the year attention was drawn to effluvia arising at the Mortuary in hot weather. This had become more noticable since the increase in the number of bodies sent to the St. Pancras Mortuary. The chief need is the installation of refrigerating plant, but this question is bound up with the larger one of providing increased accommodation, which would involve considerable capital outlay, and which, as indicated above, is still under consideration. Meanwhile authority was given for periodical deliveries of ice during the hot weather, and this resulted in a mitigation of the nuisance. In December a communication was received from the County Medical Officer of Health, intimating that work 011 a new mortuary for the use of the St. Pancras Hospital had commenced. When this new building is available the existing arrangement, under which the Hospital has the use of the Borough Council's mortuary, will 110 longer be necessary. SANITARY INSPECTION OF THE AREA. Inspections.—62,156 visits and inspections were made in 1934 by the Council's staff of Inspectors. Of these inspections, 45,324 were made by the District Sanitary Inspectors, 9,163 by the Inspectors of Food and Foorl places, and 7,669 by the Inspectors of Factories and Workshops. The visits of Miss Camman and Miss Holland are not included in this total as in previous years, for the reason that the duties of these officers are in connection with the Tuberculosis Dispensary. Their visits are gi\en under that heading elsewhere. Notices served.—3,757 intimation notices were served by the Inspectors during the year. Of these 3,397 were served by the District Sanitary Inspectors, 357 by the Factory and Workshop Inspectors, and three by the Food Inspectors. 1,377 Statutory notices were served for non.compliance with certain of the above intimation notices. I11 October it was decided to discontinue the practice of sending a warning letter after the issue of a Statutory Notice. For six months from the date of this decision a notice of the intention to discontinue accompanied each Statutory Notice issued. Details of tiie work performed by the various Inspectors will be found in the following tables. 67 Report of Work carried out by Dist rict Inspectors for the year 1934. Brown. Walker. James. Adkins.§ Akeks. Jaffa. Capel. West. Winchester Hague. Mansfield. Warren.* Totals. Complaints received, 3,083. Complaints Investigated. Whole house inspected 12 24 14 11 15 12 70 1o 1 17 21 1 208 ,, Re.inspections 15 4 143 214 197 112 527 26 — 83 177 9 1507 ,, Tart of house inspected 343 331 324 156 203 491 100 348 381 259 322 210 3468 „ Re-inspection 1164 1026 738 298 497 980 268 999 1253 1051 559 526 9359 Infectious Diseases Investigations 216 201 203 124 148 277 118 102 205 159 252 140 2145 Inspections 88 32 108 96 69 130 44 27 100 51 58 71 874 Re-inspections 497 50 626 147 246 31 143 102 355 304 405 232 3138 Smoke Observations 11 20 17 30 5 129 47 19 1 50 — 67 396 Offensive or Regulated Trades — — — — — — 1 44 — — — 1 46 Mews and Stable Yards—Number inspected 336 374 370 154 450 276 362 283 411 308 376 144 3844 Verminous Persons — — 4 — 6 12 — — 35 30 3 — 90 Other Inspections and Re-inspections 24 92 79 53 39 296 178 34 150 70 94 101 1210 Housing Acts and Regulations, 1925 and 1930. Number of Houses Inspected Primary Inspections 2 15 37 3 39 52 21 5 11 35 27 — 247 Re-inspections 4 38 261 24 92 149 89 53 35 200 113 35 1093 Houses let in Lodgings (Bye.laws Sec. 6) Number of Houses Inspected Primary Inspections 3 67 4 — 7 105 62 — 50 21 — 4 323 Re.inspections 16 642 60 5 25 259 455 22 501 429 — 3 2417 Underground rooms 31 46 26 11 26 — 12 186 100 55 68 66 627 Drainage. (a) Under Notice, Plans, Supervision, etc. 339 20 286 183 696 121 179 320 98 194 445 77 2958 (b) Voluntary, do. do. 815 1099 897 561 938 271 881 977 503 552 795 432 8721 («) New Buildings, do. do. 77 178 289 98 156 54 571 324 241 323 185 29 2525 Attendances at Police Court, etc. 0 1 5 2 — — 10 22 9 3 — 3 61 Canal Boats Acts — — — — — — — — 2 — — — 2 Rent Restrictions Acts 12 — 7 12 7 10 2 — — — 1 4 65 Totals 4011 4260 4508 2182 3861 3767 4140 3903 4442 4194 3901 2155 45324 Notices served :— Intimations 324 285 265 109 210 368 228 272 509 301 299 227 3397 Rent Restrictions Acts 4 — 7 2 3 1 2 — 2 — 1 4 26 Totals 328 285 272 111 213 369 230 272 511 301 300 231 3423 § See also Table on next page. * Commenced duties as Inspector 2nd July, 1934. 68 Inspections and other work of the Food Inspectors during 1934. Mr. Auger.* Mr. Adkins. † Mr. Nixon. Total. Number of Visits to:— Milkshops 169 140 155 464 Dairies 51 117 167 335 Ice Cream Premises 5 76 45 126 Slaughter Houses 2 25 125 152 Butchers' Shops and Meat Stalls 458 429 2220 3107 Prepared Meat Premises 42 47 58 147 Fishmongers' Shops 1 162 202 365 Fried Fish Shops 69 82 165 316 Fish Curers' Premises 19 13 45 7 7 Other Premises where Food or Drugs are sold 11 156 48 215 Marketing Streets and Places 1019 807 776 2602 Attendances at Police Court 3 6 13 22 Other Visits 76 106 183 365 Re.inspection after Intimation Notices 1 1 1 3 Total 1926 2167 4203 8296 Number o( Samples taken: — Formal 47 132 165 314 Informal 106 124 241 471 Total 153 256 406 815 Unsound Foods. Surrenders:— Meat, &c. 2 8 19 29 Fish 1 9 8 18 Shell Fish — 1 — 1 Fruit — 1 1 2 Vegetables — 1 — 1 Total 3 20 28 51 Seizures:— — — 1 1 ‡Canal Boats Acts 2 — — 2 Notices Served 2 — 1 3 * Mr. Auger retired 30th June. + Mr. Adkins. See also Table on previous page. ‡ Canal Boats. See also Table on previous page. 69 Report of Work carried out by the Factory and Workshop Inspectors during the year 1934. Inspections and Re-Inspections. Thompson. Bibby. Totals. Factories (including factory laundries and bakehouses) 2072 548 2620 Workshops (including workshop laundries and bakehouses) 1295 450 1745 Workplaces (including restaurant kitchens) 642 665 1307 Outworkers' premises - 1861 1861 Other Visits 2 134 136 Totals 4011 3658 7669 Notices served relating to:— Factories 180 12 192 Workshops 64 36 100 Workplaces 50 15 65 Others — — — Totals 294 63 357 The following prosecutions were undertaken during the year in respect of general sanitary work and breaches of the Statute :— 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. Brownlow Mews Conveying offensive trade refuse, viz., fish offal, across the carriageway without using a suitable receptacle properly constructed so as to prevent the escape of the contents thereof 1934 Jan. 16th Dismissed under the Probation of Offenders Act. Brownlow Mews Aiding, abetting and procuring the above 16th Do. do. Costs £15s. 52, Lulot Street Front guttering defective; lower sink foul and defective ; upper and lower sink waste pipes untrapped ; yard water closet walla damp and dilapidated ; upper water closet partially choked (continuously stopping up owing to furred trap) Feb. 5th Order 14 days. Costs £2 2s. 12, Seymour Street Occupying for sleeping purposes an underground room Feb. 15th Fine £1. 124, Cleveland Street Occupying for sleeping purposes underground rooms July 19th Rooms vacated. Summons withdrawn. 41, Cobourg Street Dirty ceilings of ground floor front and back rooms and dirty walls of yard, washhouse and water closet apartment. Staircase sink waste pipe defective July 26th Costs £22s. Summons withdrawn. Work carried out. 37, Islip Street Drain defective Sept. 6th Costs £2 2s. Summons withdrawn Work completed. 70 Situation of Property. Offence. Pate of Hearing of Summons. Result of Proceedings. 2, Retcar Street Roof defective 1934, Sept. 25th Fine 1s. Costs £2 12s. 6d. Compton Street Causing to be removed or carried by road in London certain offensive matter during prohibited hours, namely at 12.5 a.m. Oct. 16th Summons withdrawn. Compton Street Removing or carrying do. do. Oct. l6th Summons withdrawn. 6, Chenies Place Washhouse roof defective ; mica flap to fresh air inlet defective ; copper flue defective; accumulation of rubbish dangerous to health in front basement vaults Nov. 23rd Work carried out Summons withdrawn. Costs £2 2s. „ „ Yard paving defective Nov. 23rd (See above.) 3, St. John's Gardens Water service pipe defective; water closet trap furred ; staircase ceiling defective Dec. 18th Adjourned sine die on promise to ca.rry out work. London County Council Bye.Laivs—Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 2, Retcar Street Failing to cleanse the walls and ceilings of two large first floor front rooms, and to remedy defective window sashes in first floor front (north) room and dilapidated wall plaster of first floor back room, water. closet and upper part of staircase. 1934. Sept. 25th See proceedings under Public Health (London) Act, 1891. 74, Cleveland Street Being a lodging house did cause or knowingly permit the second floor addition room to be overcrowded. Oct. 5th Fine 1s. Coats £1 1s. 74, Cleveland Street Being a lodging house did cause or knowingly permit persons of different sex above the age of 12 years, and not being persons living together as husband and wife, to occupy the same sleeping apartment. Oct. 5th Fine 1s. Costs £1 1s. London County Council (General Powers) Act, 1922. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 2, Retcar Street Failing to sfrrip, purify and cleanse the walls, ceiling and woodwork of the first floor back room. 1934. Sept. 25th See proceedings under Public Health (London) Act, 1891. London County Council Bye.Laws made under the Metropolis Management Acts. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 32, Caversham Road Altering drainage work without depositing in duplicate plans, sections and particulars 1934. Feb. 5th Costs £1 5s. 4, Fitaroy Street Constructing or altering drainage work by fixing a new pedestal water.closet on first floor half landing without depositing or causing to be deposited plans and without giving notice in writing Aug. 3rd Fined £2. Costa £1 ls. 176, Great College Street Before constructing a sink waste pipo did fail to serve upon the sanitary authority at least 24 hours' notice in writing Nov. 8th Fined 2a. 6d. Coats 10s. 6d. 176, Great College Street Constructing a sink waste pipe so as to discharge into a rain.water hopper head contrary to the Bye-laws Nov. 8th Fined 2s. 6d. Costs 10a. 6d. 71 London County Council By-laws—Public Health (London) Act, 1891, and London County Council (General Poicers) Act, 1928. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 4, Fitzroy Street In constructing a new water.closet apartment on the first floor half landing did fail to provide in the external wall a window made to open 1934. Aug. 3rd Fined £3. Costs £1 1s. Housing Act, 1930. Situation of Properly. Offence. Date of Hearing of Summons. Result of Proceedings. 124, Cleveland Street Knowing that a Closing Order had become operative and applicable to the front and back underground rooms, did permit such rooms to be used for sleeping purposes 1934 Sept 28th Fined £2. Costs ,£1 1s. SMOKE ABATEMENT. During the year 396 observations of chimney shafts were made and three notices were served. There were 110 prosecutions. The Public Health (Smoke Abatement) Act, 1926, came into force 011 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, in the Metropolis, is the London County Council, and a bye.law was made under powers contained in Section 2 of the Act 011 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. The work is carried out by one male inspector and one female inspector. 72 1.—Inspections made by Male and Female. Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories 2620 192 — Workshops 1745 100 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1307 60 — Totals 5672 352 — 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 Acta* : — Want of cleanliness 174 168 — — Want of ventilation 10 9 2 — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 109 108 — — Sanitary accommodation— Insufficient 12 12 — — Unsuitable or defective 67 65 — — Not separate for sexes 9 9 — — Other breaches 152 151 — — 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) 67 67 - - Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) - - — — Totals 600 589 2 — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Outworkers and Home Work. In certain industries specified in the Act, if work is given out by Employers or Contractors to be done by workers in their own premises, lists containing the names and 73 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. In the first half of 1934, 656 notifications of outworkers were received from 13 local authorities outside St. Pancras. In the second half of 1934, 725 notifications were received from 16 local authorities outside St. Pancras. From St. Pancras employers in the first half of 1934, 187 notifications were received, of which 65 addresses were in St. Paucras. The remainder were forwarded to the appropriate local authorises. In the second half of 1934, 204 notifications were received, of which 56 addresses were in St. Pancrus. The remainder were forwarded to the appropriate local authorities. 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 41 282 195 518 Bootmaking 2 — 103 105 Embroidery — 3 25 38 Miscellaneous 1 6 37 44 Totals 44 291 370 705 4.—List of Factories, Workshops (Registered, Sec. 131) ano Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 67 81 - 148 Cabinet makers 59 66 - 125 Coach builders 20 15 — 35 Dressmakers 89 119 17 225 Engineers 213 37 — 250 Foundries 14 — - 14 Furniture makers 13 19 - 32 Furriers 8 13 2 23 Laundries 9 5 — 14 Metal workers 35 38 - 73 Milliners 1 15 2 18 Organ builders 7 3 — 10 Pianoforte manufacturers 40 12 1 53 Printing 71 9 — 80 Restaurant kitchens — — 292 292 Tailors 33 223 144 400 Upholsterers 8 38 2 48 Wood carvers 8 17 — 25 Other occupations 548 492 396 1436 Totals 1243 1202 856 3301 74 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 as remediable under the Public Health Acts, but not under the Factorv and Workshop Act (s. 5)— Notified by H.M. Inspector 19 Reports (of action taken) sent to H.M. Inspector 19 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 13 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 64 Bakehouses and restaurant kitchens are also referred to on page 89. 6.—Total Inspections. Premises. Male Inspector. Woman Inspector. Total. Outworkers. Not Outworkers. Factories 2072 203 548 2823 Workshops 1295 859 450 2604 Workplaces 642 799 665 2106 Total 4009 1861 1663 7533 PREMISES AND OCCUPATIONS CONTROLLED BY ACTS, RYE.LAWS OR REGULATIONS. Offensive Trades. There are two licensed premises for such trades in the Borough—a tallow raelter's in Tudor Place, which has been in existence since the year 1780, and a soap boiler's in Rochester Place. 45 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 75 (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 28 premises in the Borough in which the business of a rag and bone dealer is carried on, and these are visited regularly by the Inspectors concerned. Rag Flock Acts, 1911.1928. Rag Flock Premises. The above Acts prohibit the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean tlock 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 bve.laws which had been held in abeyance. Particulars concerning the inspections made will be found in the Table on page 67. Lighting of Staircases of Tenement Buildings. The above provision is required by Section 61 of the London Count}' 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, it' 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. 76 During the year the Committee considered applications for the renewal of the licences of the common lodging houses at 60, King's Road (33 beds for women) and 15 & 16, Litcham Street (45 beds for men). The premises at 60, King's Road were inspected and found to be satisfactory and to comply with the regulations. The licence was therefore renewed for the year ending June, 1935. With regard to 15 & 16, Litcham Street, the licence was renewed for the year ending 30th June, 1935, but on the 7th August, 1934, the premises were sold to the St. Pancras House Improvement Society, who are using the houses for decanting purposes. 32 visits were made during the year to those common lodging houses. 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 was formerly made by Inspector Auger, and upon his retirement (30th June) this duty was transferred to the District Sanitary Inspectors concerned. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920.1933. During the year 20 applications were received from tenants for certificates and in every case 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, six 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 five 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. REMOVAL OF AGED, DISEASED OR INFIRM PERSONS. Section 28 of the London County Council (General Powers) Act, 1928, authorises the removal to a home or institution of certain aged, diseased or infirm persons living under insanitary conditions. During the year three persons were dealt with, two of whom were husband and wife living together. 77 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) 483 flats and houses (b) With State assistance under the Housing Acts: — (i) By the Local Authority 64 (ii) By other bodies or persons 88 The 483 houses and flats mentioned above as having been erected during the year comprised the following: — 64 flats built by the St. Pancras Borough Council (Kennistoun House, Leighton Road); 63 flats by the London County Council (Levita House, Ossulston Street); 25 flats by the St. Pancras House Improvement Society, Ltd. (Athlone House, Litcham Street); 98 flats by the Commissioners of Crown Lands (Windsor House, Cumberland Market) ; 179 flats, Endsleigh Court, Upper Woburn Place; 32 flats, Marlborough House, 12-20, Osnaburgh Street; 16 flats (Brook House and Cranleigh House) by Mr. G. Burgoyne in Johnson Street; 5 houses, Chetwynd Road; 1 house in Fitzroy Park. 1. Inspection of dwelling-houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1652 (b) Number of inspections made for the purpose 9807 (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 570 (b) Number of inspections made for the purpose 4080 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1026 2. Remedy of defects without Service of formal Notice*. Number of defective dwelling-houses rendered fit in consequence of informal action (intimation only) by the Local Authority or their Officers 2305 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 12 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 50 (b) By Local Authority in default of owners — 78 B.—Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices (Statutory) wore served requiring defects to be remedied 871 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice: — (a) By owners 613 (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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (previously made) Nil. 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 43 (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. (3) Number of underground rooms made tit as a result of preliminary notice only under section 20 (without Closing Orders) 2 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 23 (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. HOUSING CONDITIONS. It is estimated that the number of dwelling houses in St. Pancras occupied by members of the working classes is about 18,000. With the exception of flats erected since the War, the majority of these houses are some 80 to 100 or 120 years old, but differ from much of the property of similar age in other parts of London in that they were originally well designed and built having regard to the standards then obtaining. There are, of course, exceptions to this generalisation, and scattered throughout the Borough are a number of houses, the best treatment for which would be demolition. Since the War many such houses have been demolished and replaced by flats as a result of the activities of the Borough Council, the County Council, the St. Pancras House Improvement Society, and the Commissioners of Crown Lands. The major problem presented by present-day housing conditions in the Borough is the overhaul and reconditioning in the light of modern standards of the many houses that are unsuitable for demolition but do not conform, largely as a result of neglect and hard wear, and partly as a result of the manner in which they are now let, to what is regarded as "fitness for occupation." 79 Tower to carry out this essential work is contained in the Housing Acts and the Bye-laws relating to Houses let in Lodgings. Of special interest in connection with these Bye-laws are the powers conferred to improve these houses as and when they become decontrolled. Facilities for rehousing. The London County Council have arranged to provide facilities for rehousing accommodation upon their estates for families displaced by Metropolitan Borough Councils under the provisions of the Housing Act, 1930. This arrangement provides that Borough Councils who wish to avail themselves of the facility shall pay £1 17s. 6d, per flat per annum for 40 years for each displaced family so accommodated. In the event of the family who are rehoused vacating the accommodation, the Borough Council would still be liable to continue payments for the remainder of the 40 years, but would have the right to nominate another tenant from the Borough, provided this was done within seven days of receipt of notification of vacancy from the County Council. In July the Borough Council requested the County Council to provide rehousing accommodation for '25 families under this arrangement in order to make it possible to deal with illegally occupied rooms and other accommodation which is unfit for human habitation. The chief difficulty that arises is the provision of housing accommodation in the vicinity at a rental which the person displaced can afford, and the inability of the occupier of the worst accommodation to afford increased rental for the accommodation which he should have. Should it be found that alternative accommodation is not available under this scheme for those living in the worst underground rooms, but only for those occupying underground rooms under conditions of technical illegality, this scheme will require to be reconsidered. Closed, underground rooms—Prevention of subsequent use. At the same meeting the Council approved a recommendation to the effect that the Metropolitan Boroughs' Standing Joint Committee should be asked to consider a recommendation that legislation should be introduced empowering Local Authorities to fix an inscribed metal plate or other permanent notification in underground rooms which had bean closed for sleeping purposes. This recommendation was made to meet the very real difficulty of securing the permanent closure of rooms for sleeping purposes. Experience shows that change of tenancy is a frequent cause of a room once closed being again used for sleeping purposes, and it is often extremely difficult to establish the fact that the tenant knows that such occupation is illegal. 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). 80 (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) 41 and 47, Stanhope Street. (o) 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street. (p) 9, 10, 11, 12, 13, 14 and 15, Georgiana Street. (q) 67, 69 and 71, Pratt Street. (r) 3, James Street. (s) 207, Arlington Road. (t) 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 91 changes of tenancies in the Council's properties. Ferdinand Place Clearance Order. The Council on the 21st February made a Compulsory Purchase Order in respect of Nos. 26 to 30 and 32 to 36 even (inclusive) and Nos. 42 to 60 even (inclusive) Ferdinand Place ; Nos. 5 to 11 consecutive (inclusive) and Augusta Cottage, Harmood Place; and Nos. 2 to 10 even (inclusive) and Nos. 5 to 19 odd (inclusive) Powlett Place, upon the representation of the late Medical Officer of Health, Dr. G. Sowden. It was considered that the site could be developed for housing purposes provided that adjoining properties were compulsorily purchased under Section 3 of the Housing Act, 1930, in order to provide for the satisfactory development of the cleared area. Nos. 43 to 57 odd (inclusive) Harmood Street and factory at the rear of Nos. 45 and 47, known as 2a, Harmood Place; Nos. 30a (hall used for dances and club purposes) and the vacant sites of Nos. 38 and 40, Ferdinand Place, were therefore included in the Order, which was confirmed by the Ministry on the 23rd July. The total area is approximately 1| acres. The number of families residing in the area who will be displaced is 61. The development of the site by the Council's Architect, Mr. Albert J. Thomas, F.R.I.B.A., provides for an estate of 111 flats, consisting of 392 rooms, exclusive of kitchens. The approval of the sanctioning authorities has been obtained to the scheme. The accommodation to be provided will be required to rehouse at moderate rentals families displaced from other clearance areas, illegally occupied underground rooms, and other 81 accommodation unfit for human habitation, in respect of which action will be taken by the Council under the Housing Acts. Tenders have been invited for the erection of the first block of dwellings on the site which will consist of 62 flats. Kennistoun House, Leighton Road. This Estate was completed in the early part of the year and was opened by His Worship the Mayor (Councillor Frederick Hewson, J.P.), on 2nd February. It is the eighth estate developed by the Borough Council and comprises 64 flats with a total of 210 rooms. The site on which the building is erected is approximately half an acre. There were originally 9 houses on the site, and 24 families were displaced. The Estate has provided an opportunity to rehouse 64 families, comprising 200 adults and 146 children under 15 years, a total of 346 persons, in flats of the latest type, with facilities for electric cooking, heating and lighting, and provided with labour saving devices. The total cost of the scheme was approximately £37,314. The Estate was designed by the Council's Architect, Mr. Albert J. Thomas, F.R.I.B.A., under whose supervision it was erected by Messrs. Gee, Walker and Slater, Ltd. Housing Site, Highgate Road. In April the Council were in negotiation for the acquisition of a site situated between Highgate Road and York Rise, at the rear of Twisden Road, with an area of approximately three acres, with frontages to both Highgate Road and York Rise. An offer was made to the London, Midland and Scottish Railway Co., who were the freeholders, which it was understood would receive favourable consideration. The provision of working class accommodation on this site would have enabled the Council to deal with many of their housing problems. The Company, however, ultimately decided that they were not prepared to dispose of their interests. It is, however, expected that the Council will acquire about three-quarters of an acre of this site, with a frontage on Highgate Road, for housing purposes. London County Council Housing Estates. The Borough Council continue to avail themselves of the preferential treatment which is given to bad cases of overcrowding and special hardship when recommended to the London County Council. Since the initiation of this scheme in January, 1925, the number of St. Pancras families who have been housed under this arrangement up to December, 1934, is 929. 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 control eight estates in the Borough, with a total of 709 flats comprising 2,295 rooms. During the year the London County Council completed the South section of Levita House on the Ossulston Street Estate, which consists of 63 flats (189 rooms). The dwellings erected on this Estate now number 310, with a total number of 983 rooms. The third section of Levita House, consisting of 61 flats, is now in course of preparation. 82 The Commissioners of Crown Lands arc erecting a further block of dwellings in the Cumberland Market area, which will be known as "Bagshott House", and it is understood that the Commissioners contemplate a considerable extension of their housing scheme in this area in the near future. The St. Pancras House Improvement Society have erected another 25 flats in Liteham Street and have now completed Athlone House, which consists of 35 flats. A further block of 36 flats is in course of erection on this estate in addition to a block of flats in Ferdinand Street. The Society have practically completed St. Anne's House, consisting of 30 flats, on their Somers Town Estate, which will make 240 dwellings on this Estate. Further extensions are contemplated in the Drummond Crescent area. Housing Act, 1930 — Clearance areas in St. Pancras. Resolutions declaring the following to be clearance areas under Section 1 of the Housing Act, 1930, were passed by the London County Council during the year:— Melton Slews (Nos. 1 and 2) areas, Lucas Place area, Speedy Place area, Seymour Row (Nos. 1 and 2) areas and the Stanhope Buildings area. The Ministry of Health Inquiry was not held until after the end of the year covered by this report. 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-seven applications for registration under the Milk and Dairies Order, 1926, were received and granted during the year. Nineteen applications in respect of itinerant vendors were also received and granted. The following list gives particulars as to the 201 purveyors of milk in respect of 197 retail milkshops on the register at the end of 1934:— Number of retail milkshops on the register at the end of 1933 203 Deduct number removed from the register during the year 1934 - 43 Add number registered by resolution of the Council during 1934 +37 Total number of retail milkshops on register at the end of 1934 197 83 In addition to the above, the following were also on the register at the end of 1934: — 2 persons (firms) in respect of premises where a wholesale trade in milk is done. 4 11 ,, retail ,, ,, ,, and 24 itinerant vendors without retail milkshops. Milk in Sealed Containers. During the year 43 persons were registered to soil milk in sealed containers, and 34 were removed from the register. At the end of the year there were 190 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, the Milk (Special Designations) Order, 1923, and the Milk Act, 1934. (See pa yes 82 & 86.) 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. 84 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 1934:— 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 he sold. Dec. 21st, 1933 City of London Dailies, 116120, Goswell Koad, E.C.1 "Pasteurised" To sell in St. Pancras. Do. D. Davies, Woburu Dairies, 10-11, Dukes Road, W.C.1 "Grade A Tuberculin tested" (Bottling) 10-11, Dukes Road. Do. D. D. Davies, 98, Camden Road, N.W.1 "Grade A Tuberculin tested " 98, Camden Road. Do. J. Evans, 35, Southampton Street, W.l "Grade A Tuberculin tested 35, Southampton Street. Do. Express Dairy Co., Ltd., 26.30, Tavistock Place, W.C.l "Pasteurised " 12, South Grove. Do. Do. "Grade A Tuberculin tested " Do. Do. Do. "Certified " Do. Do. Do. "Pasteurised ' 1, Guilford Street. Do. Do. "Grade A Tuberculin tested " 5, Stibbington Street. Do. Do. "Certified Do. Do. Do. " Pasteurised " Do. Do. Do. Do. 46, Mornington Crescent. Do. Do. Do. 68, Mansfield Road. Do. Do. "Certified Do. Do. Do. "Grade A Tuberculin tested " Do. Do. Do. "Pasteurised 151, Highgate Road. Do. Do. Do. 26, Tavistock Place. Do. Do. "Certified " Do. Do. Do. "Grade A Tuberculin tested " Do. Do. T. Jones, 23, Haverstock Road, N.W.5 Do. 23, Haverstock Road. Do. London Co-operative Society, Ltd., 54, Maryland Street, E.15 Do. 135, Hampstead Road. Do. Do. "Pasteurised " Do. Do. Do. "Grade A Tuberculin tested " 32, Oak Village. Do. Do. "Pasteurised " Do. Do. London Wholesale Dairies, Ltd., Vauxhall, S.E.ll "Grade A Tuberculin tested To sell in St. Pancras. Do. Marshall's Dairies, Ltd., 19, Tudor Place, W.l "Grade A Tuberculin tested " 19, Tudor Place. Do. A. Meredith, 118, Chalton Street, N.W.1 "Pasteurised" (Plant) 118, Chalton Street. Do. Do. "Certified" Do. Do. Do. "Grade A Tuberculin tested " Do. Do. Do. Do. Ill, Park Street. Do. Do. "Pasteurised " Do. Do. Do. "Certified " Do. Do. Meadowland Milk, Ltd., 166, Kensal Road, W.10 "Pasteurised " To sell in St. Pancras. Do. Nestlé & Anglo-Swiss Condensed Milk Co., 6-8, Eastcheap, E.C.3 Do. Do. Do. B. Rees, Ltd., 2 & 3, Carthusian Street, E.C.1 Do. Do. [Continued on next page. 83 Date of Licence. Name and Address of Licensee. Grades of milk in respect of which Licence is granted. St. Pancras Address at which graded milk will be sold. Dec. 21st, 1933 W. L. Davies & Sons, 41, King Street, N.W.1 "Grade A Tuberculin tested" 41, King Street. Do. Wallen's Dairies, Ltd., 79a, Albert Road. N.W.6 "Pasteurised" To sell in St. Pancras. Jan. 25th, 1934 J. R. James. 155, Hampstead Road, N.W 1 Do. 155, Hampstead Road. Do. Do. "Grade A Tuberculin tested" Do. Do. J. D. Jones, 37, Kentish Town Road. n.W.1 "Grade A " 97, Kentish Town Road. Do. Griffiths Bros., 51, St. George's Road N.W.1 "Grade A" (Bottling) 51, St. George's Road. Do. D. Williams. 57, Leighton Road, N.W.5 "Grade A Tuberculin tested " 57, Leighton Road. Do. T. J. Jones, 6, Hastings Street, W.C.1 Do. 6, Hastings Street. Do. E. A. Lewis, 18a, Highgate Road, N.W.5 Do. 18a, Highgate Road. Do. J. Adams, 15, Crowndale Road N.W.1 "Grade A Tuberculin tested" 15, Crowndale Road. Mar. 1st, 1934 J. Jones, 6, Hastings Street, W.C.1 Do. 6, Hastings Street. Apl. 10th, 1934 United Dairies (London), Ltd., Western Avenue, Acton, 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. Do. 25, Swain's Lane. Do. Do. Do. 51, South Grove. Po. Do. "Certified" "Grade A Tuber- culin tested" "Grade A Pasteurised" To sell in St. Pancras (from 58, Acacia Road, N.W.8, 30, Coptic Street, W.C.1, and 62,Archway Road, N. 19). Apl. 26th, 1934 R. A. Evans. 77, Torriano Avenue, N.W.5 "Grade A" 77, Torriano Avenue. Do. Do. "Pasteurised" Do. Do. G. T. Enoch, 15, Crowndale Road. N.W.1 'Grade A Tuberculin tested" 15, Crowndale Road. May 31st, 1934 W. Jones & Sons. 63, Harmood Street, N.W.1 "Pasteurised" 63, Harmood Street. June 28th, 1934 D. H. Richards, 43, Charlotte Street, W.1 "Grade A Tuberculin Tested.'' 39, Goodge Street. Sept. 27th, 1934 G. T. Enoch, 15, Crowndale Road, N.W.1 "Pasteurised" 15, Crowndale Road. Do. Vicarage Farm Dairy, Ltd., 277-279, Kentish Town Road, N.W.5 Do. 277-279, Kentish Town Road. Do. Do. Do. 1a, Woodsome Road. Do. David E. Jones, 3, Churchway, N.W.1 Do. 3, Churchway. Do. Samuel Williams, 41, King Street, N.W.1 Do. 41, King Street. Do. Do. "Grade A Tuberculin tested" Do. Oct. 25th, 1934 Thomas Jones, 23, Haverstock Road, N.W.5 "Pasteurised" 23, Haverstock Road. Do. D. Thomas, S, Dartmouth Park Hill, N.W.5 Do. To sell in St. Pancras. Do. John J. Davies, 101, Dartmouth Park Hill. N.19 Do. 101, Dartmouth Park Hill. Do. United Dairies (London), Ltd., Western Avenue, W.3 Do. To sell in St. Pancras (from 58, Acacia Road, N.W.8). Do. E. M. Davies, 6, Buck Street, N.W.1 Do. 6, Buck Street. Do. F. Higgs & Son, 94, Park Street, N.W.1 "Certified" 94, Park Street. [Continued on next page. 86 Date of Licence. Name and Address of Licensee. Grades of milk in respect of which License is granted. St. Pancras Address at which graded milk will be sold. Oct. 25th, 1934 Arthur Roberts, 78, Judd Street, W.C.1 ''Grade A Tuberculin tested" 78 Judd Street. Do. Express Dairy Co., Ltd., 26-30, Tavistock Place, W.C,1 "Certified" To sell in St. Pancras from 42, Englands Lane, 244, Upper Street, 17, Jacob's Well Mews, 31, Ashbrook Road. Do. Do. "Grade A Tuberculin tested" Do. Do. Do. "Pasteurised" Do. Nov. 29th, 1934 A. M. Dunn, 68, Great College Street, N.W.1 "Pasteurised" 68, Great College Street. Do. Chas. Leister, 84, Great College Street, N.W.1 Do. 84, Great College Street. Dec. 20th, 1934 F. Higgs & Son, 94, Park Street, N.W.1 "Grade A" 94, Park Street. 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. 20 such samples were taken during the year and in 19 eases the result of the examination was satisfactory. In the remaining instance the result of the examination showed that the sample did not comply with the prescribed conditions. The licensees' attention was drawn to the matter and an assurance was received that in future every precaution would be taken at all stages to ensure that the graded milk sold by them complied with the provisions of the Order. As regards "Certified" Milk and "Grade A (Tuberculin tested)" Milk, in those cases in which the latter milk is bottled at the farm, a scheme has been devised by the Ministry of Health, under which the work of sampling is divided between the Local Authorities in whose area the milk is sold. Upon the coming into force of the Milk Act, 1934 (in August), the Milk Marketing Board made an arrangement in consultation with the London County Council for the supply of milk to the children of the County Council's schools at the reduced price of 1s. a gallon. This cheap price only applies to milk actually drunk as a beverage by children in the schools. The particulars relating to this Scheme were given in the London County Council Gazette of the 24th September, 1934, as follows:— 1.— Milk must be " pasteurised " milk, labelled as such. 2.—The borough medical officers of health will supply, on request, a list of registered sellers of pasteurised milk in their areas. 3.—Head teachers are asked in return to notify the borough medical officer of health of the name of the vendor whom they have chosen. 4.—Samples of the milk supplied will be taken from time to time by borough medical officers of health. 5.—Any head teacher having a point to raise as to the quality of the milk supplied is asked to communicate with the School Medical Officer. (G.P.H.l.) 6.—Head teachers are asked to ensure that the straws supplied for consuming the milk are not taken from the sealed wrapping until immediately before use and that they are destroyed at once after use. 87 Four samples from L.C.C. Schools in the Borough were taken and submitted to bacteriological examination, the result in each case being satisfactory. Artificial Cream Act, 1929. The above Act, which came into force on June 1st, 1929, requires the registration of all premises in which Artificial Cream is manufactured, sold, or exposed for sale for human consumption. This requirement does not apply to premises where Artificial Cream is not supplied otherwise than in the properly closed and unopened receptacles in which it is delivered to those premises, nor to its manufacture solely for domestic purposes, nor to its manufacture on any premises for use in the preparation on those premises of some other article of focd. The number of premises on the register at the end of the year was 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-const,ituted Cream would appear to be more appropriate than the word Artificial. (6) MEAT AND OTHER FOODS. The two special Food Inspectors have kept under regular observation food exposed or deposited for sale in slaughter-houses, butchers' shops, cooked meat shops, fishmongers' premises, stalls, market places, etc. The undermentioned unsound or diseased food was surrendered by the owners for destruction or to be dealt with as trade refuse. On one occasion a seizure of unsound food was made. Unsound Food Condemned and Destroyed. Surrendered. Apples, 40 20-lb. boxes Kidneys, Pigs', 13 lb3. Bacon, 236¾ lbs. Kippers, 7 boxes Beef - Corned, 6 6-lb. tins Misenteries, Pigs', 2 Cod, 64 lbs. Pears, 20 boxes Dabs, 2 boxes and 70 lbs. Periwinkles, 2 bushels Dogfish, 2 stone Pork, 11 lbs. Fowls, 63 Potatoes, 12 stone. Haddock, 1 box and 14 lb. Roe, Cod's, 1 box. Haddock and Rock Salmon, 70 lbs. Skate, 2 boxes and 20¼ stone Ham, 1 Tongue, Ox (tinned), 1 Ham, Boneless, 15½ lbs. Turkeys, 13 Ham, Tinned, 70½ lbs. Whiting, 2 boxes Head, Pigs', 16 Seized. Head, Pig's, 1 (Tuberculous). Slaughter of Animals Acr, 1933. This Act was passed to provide for the humane and scientific slaughter of animals and came into operation on 1st January, 1934. No animal is to be killed in a slaughterhouse 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 88 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 rescindment 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 .'laughterhouses 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. The Council have passed 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. 89 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, if 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, nnd the necessary notices giving the day and time of the meeting will be served on the persons concerned. At the end of 1934, there were three licensed slaughter-houses (private) in the Borough, viz.: 12, Pond Square (rear of 61, High Street, Highgate,) 166, Great College Street, and 65, Osnaburgh Street. They are kept under periodical inspection by the Food Inspectors, who made 152 inspections during the year. Licensing of Slaughtermen. Applications for licences for slaughtermen under the provisions of the Slaughter of Animals Act, 1933, were received from five persons in respect of the three slaughter-houses. The Council's Inspector reported in each case that, in his opinion and from personal observation of the applicant's work, ho was a fit and proper person to act as a slaughterman and the licences were granted for one year ending 31st October, 1935. Fried Fish and Fish Curing Premises. In 1934 there were 81 fried fish vendors' premises in the Borough, at 7 of which fish curing was also carried on. There were 22 fish curers' premises, including the 7 above mentioned. 393 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. This registration is for the purpose of information and to facilitate inspection by officers of the Borough Council. The Council is not empowered to refuse registration. The total number of premises on the register of the department at the end of the year was 296. Bakehouses and Restaurant Kitchens. At the end of 1934 there were 148 bakehouses on the register, including 67 factory bakehouses. 54 of these bakehouses were not in use. 109 of the 148 were underground 90 bakehouses, of which 52 were factory bakehouses, 12 were workshop bakehouses, and 45 not in use. At the end of the year 292 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 72 to 74. (c)—FOOD AND DRUGS (ADULTERATION) ACT, 1928. 815 samples have been taken under this Act, of which 344 were formal and 471 informal. Of the formal, 328 proved to be genuine, and 16, or 4.7 per cent., adulterated; and of the informal, 449 were genuine and 22, or 4.7 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 - - Apple Pie - 1 - 1 - - Apple Puff - 1 - 1 - - Apricots (dried) 1 5 - 4 1 1 Asparagus (canned) - 3 - 3 - - Bacon - 1 - 1 - - Barley (pearl) - 5 - 5 - - Beef (salt) - 1 - 1 - - ,, (corned) - 1 - 1 - - „ (spiced) - 1 - 1 - - Beans (canned) - 4 - 4 - - Blackberries (canned) - 1 - 1 - - Brawn - 3 - 3 - - Bread - 1 - 1 - - Butter 2 46 2 44 - 2 Cabbage (pickled) - 1 - 1 - - Cake - 1 - 1 - - Cheese - 5 - 5 - - Cheese and Celery - 1 - 1 - - Cherries (canned) - 1 - 1 - - Chicken and Ham - 1 - 1 - - Chutney - 2 - 2 - - Cocoa - 8 - 8 - - Coffee - 7 - 7 - - „ (cubes) - 1 - 1 - - Cream - 3 - 3 - - „ (bottled) - 1 - 1 - - ,, (canned) - 8 - 8 - - Cream Doughnut - 1 - 1 - - Currants - 1 - 1 - - Curry Powder - 1 - 1 - - Custard Powder - 4 - 4 - - Dripping - 3 - 3 - - Faggot - 1 - 1 - - Figs - 2 - 2 - - Fish Paste - 7 - 7 - - Flour (self-raising) - 5 - 5 - - Fruit (canned) - 1 - 1 - - „ (dried) - 2 - 2 - - „ Salad (dried) - 5 - 5 - - Carried forward 3 148 2 145 1 3 91 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 3 148 2 145 1 3 Ginger (preserved) - 1 - 1 - - Gooseberries (canned) - 1 - 1 - - Grape Fruit (canned) - 3 - 3 - - Ham - 1 - 1 - - Herring in Tomato Sauce - 1 - 1 - - Honey - 1 - 1 - - Jam - 14 - 14 - - „ Puff - 1 - 1 - - Lard - 7 - 7 - - Lemonade Powder - 1 - 1 - - Lemon Squash - 2 - 2 - - ,, Tablets - 1 - 1 - - Lime Juice Cordial - 1 - 1 - - Loganberries (canned) - 2 - 2 - - Margarine - 4 - 4 - - Marmalade - 2 - 2 - - Meat (Minced) - 5 - 5 - - „ Pie - 2 - 2 - - ,, Roll - 2 - 2 - - Milk 334 69 321 53 13 11 ,, (condensed,sweetened,full cream) - 3 - 3 - - „ (condensed,sweetened,skimmed) - 2 - 2 - - Mincemeat - 7 - 7 - - Mint (dried) - 3 - 3 - - ,, Sauce - 2 - 2 - - Mustard - 5 - 5 - - Oatmeal - 1 - 1 - - Olive Oil - 2 - 2 - - Olives - 1 - 1 - - Pastry (chocolate) - 1 - 1 - - „ (real cream) - 1 - 1 - - Peaches (canned) - 1 - 1 - - Pearl Barley - 1 - 1 - - Peas (canned) - 18 - 18 - - „ (dry) - 1 - 1 - - ,, (canned) - 1 - 1 - - Peel (candied) - 1 - 1 - - Pepper 1 20 - 19 1 1 Pickles - 6 - 6 - - Pilchards (canned) - 1 - 1 - - Pineapple (canned) - 4 - 4 - - Plums (canned) - 2 - 2 - - Prunes - 2 - 2 - - Puree (Tomato canned) - 2 - 2 - - Relish - 1 - 1 - - Rice - 5 - 5 - - Roll and Butter - 5 - 5 - - Sage (dried) - 1 - 1 - - Salad Cream - 1 - 1 - - Salmon (canned) - 7 - 7 - - Sardines - 7 - 7 - - Sausages 3 36 3 33 - 3 ,, (veal) - 1 - - - 1 Sausage (cooked) - 2 - 2 - - Sausage Roll 1 2 1 1 - 1 Sild (canned) - 1 - 1 - - „ (Norwegian) - 1 - 1 - - Carried forward 342 427 327 407 15 20 92 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 342 427 327 407 15 20 Soup (canned) - 3 - 3 - - „ (Tomato dried) - 2 - 2 - - Spaghetti - 1 - 1 - - Stout - 3 - 3 - - Suet (shredded) - 7 - 7 - - Sulphur Tablets - 1 - 1 - - Sultanas - 2 - 2 - - Sweets 1 10 1 9 - 1 Swiss Roll - 1 - 1 - - Tart (Black Currant) - 1 - 1 - - Tea - 3 - 3 - - Tincture of Quinine with Cinnamon - 1 - 1 - - Tomatoes (canned) - 5 - 4 - 1 Tripe - 2 - 2 - - Vegetable Salad (canned) - 1 - 1 - - Vinegar (malt) 1 1 - 1 1 - Totals 344 471 328 449 16 22 Summonses. Food and Drugs (Adulteration) Act, 1928. Prosecutions were undertaken in respect of ten samples, wihch were reported as being adulterated. The results of the proceedings are stated in the following table:— No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. ,, ,, ,, 1934. £ 8. d. £ s. d. N. 27 Milk Added water, 7 per cent. April 4th 3 0 0 3 3 0 Name ordered to be removed from Register for a period of 12 months ,, ,, ,, ,, ,, ,, 3 0 0 - N. 28 ,, Added water, 3 per cent. ,, 3 0 0 - ,, " ,, ,, ,, ,, ,, 3 0 0 - N.39 ,, Deficient in milk-fat, 4 per cent. April 24th 0 10 0 2 2 0 N. 40 ,, ,, ,, ,, ,, 6 ,, ,, 0 10 0 2 2 0 N. 68 ,, „ ,, ,, „ 8 „ July 16th - 2 2 0 N. 85 ,, ,, ,, „ „ 10.3 ,, Aug. 22nd 0 1 0 2 2 0 A. 92 ,, ,, ,, ,, ,, 26.3 ,, Sept. 6th . - 2 2 0 A. 90 ,, ,, ,, ,, ,, 5.6 „ Sept. 12th 0 10 0 2 2 0 A. 162 ,, Added water 14.1 per cent. Dec. 12th 1935. 3 0 0 2 2 0 N. 164 ,, Deficient in milk-fat, 12.6 per cent. Jan. 31st 2 0 0 1 1 0 Wholesale Dealers in Margarine.—One certificate of registration under the provisions of the Food and Drugs (Adulteration) Act was issued during the year. PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS 1925-1927. All samples were examined for any contravention of these Regulations and 12 were found to contain proportions of preservatives contrary to the standards. Two of these samples (one Pepper and one Apricot) had been taken formally and the Committee decided to send a cautionary letter to the Vendor in each case. The remaining ten were samples which had been taken informally. The subject of preservatives is dealt with in the notes of the Public Analyst. 93 Preservation of samples taken. Attention was called to the desirability of providing a refrigerator for preserving, especially during the week-end, samples of food and drugs taken by the Council's officers for analysis. This has now been provided and is particularly useful during the hot weather, WORK OF THE PUBLIC ANALYST. The following Notes have been supplied by the Council's Analyst, Mr. J. Kear Colwell, f.i.c. During the year 1934, 815 samples were submitted for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 344 having been purchased with the required formalities and 471 obtained informally. Of this total 38 (or 4,66 per cent.) proved to be adulterated, 16 being samples submitted formally and 22 informally. The adulterated articles consisted of Apricots, Butter, Milk, Pepper, Sausage Roll, Sausages, Sausages (Veal), Sweets, Tomato Puree, and Vinegar (Malt). Milk.—402 samples of Milk were analysed and 24 of these (5 97 per cent.) fell below the limits required by the Hoard of Agriculture Regulations—3.0 per cent, for fat and 8.50 per cent, for non-fatty solids—and were certified to be adulterated accordingly. From 11 of these 24 samples, fat had been abstracted, the amount of the deficiency varying from at least 3.0 per cent. to at least 31.0 per cent.; and to 13 others additions of water had been made, the quantity added varying from at least 3.5 to 14.1 per cent. In this connection it may be interesting to note that practically certain evidence is now obtainable for the determination of the addition of water to milk, by means of the freezing point. Milk as given by the cow has a freezing point, which is almost constant, of 0.55°C., and if the sample freezes at a higher point it affords undoubted indication that water has been added to the milk after "it comes from the cow." In practice a limit of 0.530°C. has been generally adopted as a standard for calculation of the amount of extraneous water. So far, this valuable test as to the genuineness or otherwise of milk is only applicable to fresh milk or milk which has not been allowed to become too acid, as it naturally does on keeping, but the experience of a large number of analysts with many thousands of samples clearly shows that the results obtained from it are practically infallible. It may be interesting to add a table prepared by the Public Health Department from the returns of the Borough Analyst showing the composition of the genuine samples of milk, month by month, during the j'ear 1934. Composition of Genuine Milk Samples during the Year 1934. Month. Number analysed. Average Fat. Average non-fatty Solids. January 39 3 6 per cent. 8.94 per cent. February 37 3.8 „ 9.00 ,, March 19 3.5 „ 8.96 ,, April 17 3.8 „ 8. 89 „ May 15 3.5 „ 8.97 ,, June 30 3.4 „ 9. 03 ,, July 60 3.4 „ 9 .00 ,, August 35 3.5 „ 8 .89 ,, September 43 3.5 „ 9 .08 ,, October 37 3.7 „ 9.02 ,, November 30 3.8 „ 9.01 ,, December 16 3.5 „ 9.00 ,, Year 378 3.6 „ 8.98 ,, 94 It will be observed that the greater portion of the milk supplied to the Borough is of good quality and that there is little variation in the composition throughout the year. The necessity of a good and proper supply of milk cannot be too strongly emphasised, as it forms the main portion of the diet of young children and many invalids. Apricots.—The two samples of dried Apricots certified to be adulterated each contained too large a proportion of sulphite preservative—the quantity allowed by the Preservative Regulations is 2,000 parts per million of sulphite in terms of sulphur di-oxide. In these two cases the amount found was 2,610 and 2,580 parts per million respectively. Butter.—One of the samples of butter contained 1.0 per cent. of water in excess of the Board of Agriculture Standard (16.0 per cent.), and one 4.34 grains per pound of Boric acid. Boric acid is not allowed to be used as a preservative in any article of food. The quantity found in the sample referred to was small, and may have been due to some process of blending, but it certainly ought not to have been there. The excess of water noted appears to be trifling, but when it is remembered what very large quantities of butter are sold per week or month, even by comparatively small vendors, it becomes evident that the sale of a few pounds of water at the price of butter adds a considerable sum to the profits. Pepper.—Both the samples of pepper certified to be adulterated were found to contain sulphite preservative equal, in terms of sulphur di-oxide, to 27 and 55 parts per million respectively. There is no need to add preservative to pepper, and the sulphite in these cases was undoubtedly not used with that object, but for the purpose of bleaching the pepper and giving an inferior article the appearance of one of better value. Sausages. —Sulphite preservative may be used in sausages to the extent of 450 parts per million, in terms of sulphur di-oxide, but due notice of the addition must be given to the purchaser, and even then the quantity of sulphur di-oxide present must not exceed the prescribed 450 parts per million. Without such notice sausages must be free from preservative. In the four samples certified to be adulterated sulphur di-oxide was found, the quantity present being 55, 150, 230 and 370 parts per million respectively, no notice having been given to the purchaser at the time they were sold. Sausage Roll.—This sample contained sulphite preservative (27 parts per million) probably derived from the sausages with which it was made. Cooked foods of this description should not contain preservative. Streets.—Again a sample of sweets contained 130 parts per million of sulphite preservative in excess of the quantity prescribed by the Preservative Regulations (70 parts per million). Tomato Puree.—One of the samples of Tomato Puree contained 5.5 grains per pound of tin, evidently due to the attack of the acid of the Tomato on the metal of the can (tinned iron) in which the Purée was packed. This question continues to demand considerable attention, as the pathological effects of dissolved metals are not yet too clearly understood. Vinegar (Malt).— In this case a wood vinegar had been sold instead of malt vinegar and was certified to be one hundred per cent. of vinegar other than malt vinegar. 95 In concluding these notes, reference may be made to the desirability of the appointment, by the Ministry of Health, of a small, more or less permanent Committee which should have power to fix or vary standards and, if need be, approve methods of analysis, so that greater protection might be afforded to the purchasing public against the substitution of inferior and adulterated articles. As instances, some kind of official Standard is required for the quantity of fat in Cream, and some more precise definition for the fat contained in "Cream" Pastries, one maker using real cream, while another deems any fat made up to look like cream to be sufficient. Also a standard for Cheese, and especially " Cream " Cheese, is urgently needed. Other articles could be mentioned, but these will be enough to indicate the advantages to be gained by the appointment of such a body as is suggested. 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 Infections Diseases (London) Regulations, 1027, 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. 96 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1934. 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 and 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 11 25 59 65 65 270 108 28 51 15 6 2 703 653 1 3. Diphtheria and Membranous Croup 10 26 37 35 50 152 57 30 46 9 3 1 456 453 17 4. Enteric or Typhoid Fever - - - - 1 3 - - 1 - - 1 6 6 - 5. Puerperal Fever - - - - - - - - 12 2 - - 14 12 3 6. Puerperal Pyrexia - — — — — — — 1 19 5 — — 27 27 — 7. Erysipelas 3 4 3 2 1 6 6 8 24 17 61 21 156 122 13 8. Cerebro-spinal Meningitis 2 — — — 1 — — — 1 — — — 4 4 4 9. Anterior Poliomyelitis and Polioencephalitis 1 — — 1 — — — — — — — — 2 2 1 10. Ophthalmia Neonatorum 33 - - - - - - - - - - - 33 15 1 11. Encephalitis Lethargica - - - - - - - - - - - - 1 1 — 12. Acute Influenzal monia — 2 - 1 — 1 — 3 14 6 23 5 55 22 -* 13. Acute Primary Pneumonia 8 14 11 16 10 31 25 16 49 41 56 23 300 52 -* 14. Malaria - - - - 1 - - 1 18 3 6 - 29 29 1 15. Dysentery 1 - - 1 - 1 - - 11 11 5 - 30 30 - 16. Measles 195 405 486 555 587 1214 93 37 54 8 3 1 3638 984 32 17. German Measles 13 10 18 2 1 19 59 22 7 20 2 — — 191 28 — 18. Food Poisoning — — — - — - — — 12 4 5 1 22 12 -† * For Pneumonia Deaths, see Table on page 27. † One Case of Food Poisoning died—death allocated to Cholelithiasis. 97 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 106 93 143 97 87 60 29 90 705 - - - - - - - 1 1 3 Diphtheria and Membranous Croup 63 57 90 82 58 45 16 45 456 6 3 4 - 3 1 - - 17 4. Entericor Typhoid Fever 4 - - 1 - - 1 - 6 - - - - - - - - - 5. Puerperal Fever 1 - 1 4 4 3 1 - 14 - - 2 - - 1 - - 3 6. ,, Pyrexia 4 1 8 4 3 - 1 6 27 - - - - - - - - - 7. Erysipelas 24 17 30 23 15 15 7 22 156 1 2 3 1 2 - 2 1 *13 8. Cerebro-spinal Meningitis - - - 1 2 1 - - 4 - - - - 1 2 1 - 4 9. Anterior Poliomyelitis and Polioencephalitis - - - - 1 1 - - 2 - - 1 - - - - - 1 10. Ophthalmia Neonatorum 3 3 6 5 6 2 4 4 33 - - - - 1 - - - 1 11. Encephalitis Lethargica - 1 - - - - - - 1 - - - - - - - - - 12. Acute Influenzal Pneumonia 8 8 8 5 9 9 3 5 55 - - - - - - - - - ‡ 13. Acute Primary Pneumonia 35 38 37 37 34 48 20 50 †304 - - - - - - - - - 14. Malaria - - 1 - 1 22 - 5 29 - - 1 - - - - - 1 15. Dysentery - - 1 - - - 27 2 30 - - - - - - - - - 16. Measles 608 467 697 472 556 439 98 301 3638 2 4 7 1 4 5 4 5 32 17. German Measles 35 9 33 19 43 13 15 24 191 - - - - - - - - - 18. Food Poisoning - 3 8 2 1 5 1 2 22 - - - - - - - - ||- Totals 891 697 1063 752 820 663 223 556 5669 9 9 18 2 11 9 7 7 73 ‡For Pneumonia deaths, see Table on page 27. || 1 case of Food Poisoning died—Death allocated to Cholelithiasis. †4 cases—"Homeless" (3 Erysipelas, i Primary Pneumonia) * 1 death—"Homeless." 98 SMALL-POX. There were 110 cases notified in St. Pancras during 1034. 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, 1933. Vaccinations. 1st January to 31st December, 1933. Number. Percentage of Births registered. North. SouthEast. SouthWest. Whole Borough North. SouthEast. SouthWest. Whole Borough Births registered 488 1967 1747 4202 100. 0 100.0 100.0 100.0 Died, unvaccinated 16 98 63 177 3.3 5.0 3.6 4.2 Successfully vaccinated 218 892 855 1965 44.7 45.3 48.9 46.8 Had smallpox - - - - - - - - Insusceptible of vaccination 2 4 5 11 0.4 0.2 0.3 0.3 Received certificate of conscientious objection 207 563 489 1259 42.4 28.6 28.0 30.0 Postponed by medical certificate 7 23 23 53 1.4 1.2 1.3 1.3 Moved to known address in other districts 2 142 138 282 0.4 7.2 7.9 6.7 Lost sight of by removal 30 222 150 402 6.2 11.3 8.6 9.5 Unvaccinated and not accounted for in previous columns 6 23 24 53 1.2 1.2 1.4 1.2 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. 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 1933 4202 1965 46.8 1312 31.2 99 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, 1934:— 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 126 7 133 2 ,, 2 ,, F. L. Pelly 141 35 176 5 Wards 3 and 4 ,, J. Wigg 303 34 337 8 ,, 5, 6, and 7 „ A. E. Tait 249 34 283 7 Ward 8 „ C. H. A. Alderton 143 10 153 1 Highgate Hospital ,, C. Thackray - - - 2 St. Pancras Hospital „ W. Feldman 4 - 4 - Totals 966 120 1086 25 SCARLET FEVER. The number of cases notified was 705, as compared with 653 cases during the previous year. It was subsequently ascertained that 43 cases were not regarded as cases of this disease. The actual number of cases was therefore 662. One death occurred; this equals a case mortality of 0'2 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 24 such cases during the year. In tracing the clinical histories it was found that in five 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 these 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 21 families there were two such cases, in four families three multiple cases in each home. There was one epidemic in an orphanage and fifteen cases were reported. There were also two epidemics in other institutions, one with seven cases, and one with eight cases. DIPHTHERIA. The number of cases notified was 456, as compared with 363 cases during the previous year. It was subsequently reported by the hospital authorities that 67 cases were not regarded as cases of this disease. The actual number of cases was therefore 389. This equals an attack rate of 2.1 per 1,000 of population. Seventeen deaths occurred, giving a case mortality of 4.4 per cent. 100 Investigation of multiple cases—that is, several cases occurring more or less together in one house—shows that in 25 families there were two such cases, and in eight families three such cases in each home. There were also two small epidemics in institutions, one with six cases, and one with four cases. Antitoxin for the treatment of cases of this disease is supplied to medical practitioners free of charge by the Council. During the year 104 thousand units were provided. ENTERIC OR TYPHOID FEVER. Two cases of true Enteric and four cases of Para B. Typhoid were notified during the year. There were no deaths reported. PUERPERAL PYREXIA AND PUERPERAL FEVER. In 1934 there were 27 notifications of Puerperal Pyrexia and 14 notifications of Puerperal Fever. One further case of Puerperal Fever was brought to notice only after death. After the usual investigations had been made, some of these cases were re-allocated, and the figures finally accepted were:— Puerperal Pyrexia Cases 24 Deaths 0. Puerperal Fever Cases 18 Deaths 3. 101 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 *3 - - - - - - 3 - - - 33 - Influenza 2 — 1 1 - 2 - - - - 1 32 - Inflammation of Breasts 6 6 - - - 6 - - 6 2 2 23 - Pneumonia 2 2 - - - 2 - - - - 1 39 1 Pyelitis 3 2 - 1 - 3 - - 3 1 2 23 - Cystitis 2 2 - - - 2 - - 2 - 1 31 - Delayed Labour 1 1 - - - 1 - - - - 1 26 - Femoral Thrombosis 1 1 - - - 1 - - 1 - 1 17 - Retained Products 1 1 - - - 1 - - 1 1 - 20 - Sore Throat 1 - - - 1 1 - - - — 1 34 - No cause found 2 1 1 - - 2 - - 1 — 1 26 - Puerperal Pyrexia. Totals 24 16 2 2 1 21 - 3 13 4 11 28 1 9.5 9.5 4.8 Percentages 100 76.2 23.8 87.5 - 12.5 54 17 46 - 4 Puerperal Fever. Associated with Abortion *3 - - - - - - 3 1 1 - 30 1 Other cases 15 8 4 1 2 13 2 - 8 2 10 30 2 Totals 18 8 4 1 2 13 2 3 9 3 10 30 3 26.7 6.7 13.3 Percentages 100 53.3 46.7 72.2 11.1 16.6 50 16.6 56 - 16.6 * All oases sent ill to Hospital for treatment after abortion. 102  1934. 1933. 1932. 1931. 1930. 1929. 1928. Puerperal Fever. Cases 18 31 42 25 33 43 33 Deaths 3 6 8 3 Nil. 5 3 Incidence 7.1 11.6 15.2 8.5 10.3 13.6 10.1 per 1,000 births. Mortality Rate 16.7 19.4 19.0 12.0 Nil. 11.6 9.1 per 100 cases. Death Rate 1.2 2.2 29 1.0 Nil. 1.6 0.9 per 1,000 births. Puerperal Pyrexia. Cases 24 37 34 37 37 53 41 Incidence 9.5 13.8 12.3 12.5 11.6 16.7 12.5 per 1,000 births. ERYSIPELAS. 156 cases were notified and 13 deaths occurred, as compared with 121 cases and 9 deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal, Fever, Meningococcal Meningitis, "Spotted Fever.") Four cases were notified and two others were brought to notice after death. Of the four notified cases, only two have recovered completely and the diagnosis was doubtful throughout the course of one of them. Two of the notified cases died; the diagnosis in both cases was confirmed. There were therefore six cases, one being very doubtful, and four 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. Two cases were notified, and one came to notice only after death. One of the notified cases was reported to have shown very little progress. An offer to arrange for special treatment at Queen Mary's Hospital was refused. The other notified case is receiving this special treatment. Both these cases are young children. The third case was that of a young man, whose death was allocated to this disease by the Registrar-General, owing to its inclusion on the death certificate. He suffered from active Pulmonary Tuberculosis, which disease contributed to his death. 103 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. 1934 33 17 16 31 — — 2g 13.5 14 15 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 l — 1* 11.4 11 12 1928 32 24 8 32 - — — 9.8 12 6 1927 38 27 11 37 1 — 1* 11.5 11 5 * Due to other causcs. † Several cases removed to unknown addresses. ‡ Excluding one case, information unobtamable. || Died from Prematurity, Congenital Heart Disease and Gonorrhœal Ophthalmia. § One moved away to unknown address. ¶ (1) Died—Prematurity. Ophthalmia Neonatorum. (2) Died—Castro Enteritis. Ophthalmia Neonatorum, Mongolism, Imbecility, G (1) D ied—Acute Bronchitis (before eyes had recovered). (2) Died—Prematurity. Ophthalmia Neonatorum. Gonococcal infection. In addition to the above, there were 42 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 thoroughness with which notification is observed. It is certainly better to err on this side. Out of the 33 notifications this year, only three were considered "grave." There were 9 of "moderate " severity, and 21 were returned as " slight." The true condition is still a prolific cause of blindness. This is definitely seen in those countries where Ophthalmia Neonatorum is not regarded with due consideration. In the past seven years, out of 371 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 16 cases the mother was giving birth to her first baby, and seven of these were illegitimate babies. In 14 cases the confinement took place at home, and of these 12 were attended by midwives, one by a doctor and one by a medical student. Nineteen of the babies were born in Hospitals or Maternity Homes. Twenty-six mothers received ante-natal care. 104 ENCEPHALITIS LETHARGICA. One case was notified during the year. In 1933 there were 16 old St. Pancras cases receiving special Institutional treatment. Two of these were discharged, but moved to addresses outside the Borough. One returned to St. Pancras and is reported to be maintaining a good recovery. The other 13, and the new case, are now under treatment, mainly at Winchmore 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 300 notifications of the former and 55 of the latter during 1934 (as compared with 211 and 111 respectively for 1933). There were 212 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 1934, 41 cases were nursed under this arrangement and 1,105 nursing visits were paid. MALARIA. 29 cases were notified. They were all old cases in which the disease had been contracted abroad. Only three of the cases really belonged to St. Pancras. Under the regulations issued by the Ministry of Health, cases of Malaria diagnosed in the Borough, no matter where the home address of the patient, are notified to this Authority. In this way the number of notifications for this disease depends largely upon the number of malaria patients diagnosed at the Hospital for Tropical Diseases, Endsleigh Gardens. DYSENTERY. 30 cases were notified during the year, and on investigation it was shown that 27 of them did not really belong to St. Pancras. The same rule for the notification of Malaria (as described above) applies to Dysentery. There were three St. Pancras cases, all young children, who contracted the Sonne type of Dysentery. They all recovered. 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. 22 notifications were received during the year. 105 Included in these notifications was that of a woman aged 71 years, who died the day after notification. There was at first some doubt about the diagnosis, which was not completed until death had been otherwise certified. Bacillus Newport was the causative organism. A kind of meat cake called "Faggots" and made from pig's organs, was the article of food suspected, but no definite evidence on this score was forthcoming. 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, Deputy Medical Officer of Health, and demonstrate several important and interesting facts about Measles. Table I. gives the gross figures as regards incidence and deaths. These may be misleading, and they have therefore been worked out in Table II. as Incidence and Mortality Rates. On Table III. these calculations are expressed by two graphs. The tendency for the disease to be prevalent in alternate years is very evident, especially when followed graphically. The third and fourth quarters of the year are 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 now to be a more serious disease 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 106 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 increase in the incidence of Measles occurred in 1934. The following tables and graph give the details. 3,638 cases came to notice by notifications or through visiting. 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 37. 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 191 cases during the year 1934, as compared with 486 cases during 1933. There were no deaths. It was a very mild illness with a rapid recovery. 107 Table I. MEASLES. YEAR. CASES. 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 1934 1864 1567 191 16 3638 195 2033 1307 103 10 20 2 - 32 8 23 1 - 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 - - 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 - 108 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 1934 9.9 8.4 1.0 0.1 19.4 5.1 12.7 10.4 — 8.8 1933 .4 .9 .7 .2 2.2 25.9 . 14.5 — 9.2 1932 3.9 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 2.0 - 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 MEASLES. TABLE III. Incidence Rate per 1000 population (See Table II) Mortality Rate per 1000 cases. page 108. 109 TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1934 are given in the following table in the form required by the Ministry of Health:— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 - - - - - - - - 1—5 1 3 3 2 — - 1 1 5-10 3 5 6 4 — - 1 1 10-15 2 3 6 2 — - 1 1 15—20 10 13 1 3 4 4 — 1 20—25 20 29 1 5 7 5 1 1 25—35 34 29 4 5 18 14 1 2 35-45 35 9 2 — 21 7 — — 45—55 41 9 1 3 33 6 — 1 55—65 24 6 — — 19 4 1 — 65 & upwards 19 2 — 1 12 3 — 1 Totals 189 107 24 25 114 43 6 9 The total number of Primary notifications was 276; in addition to these, 33 cases, which had not been notified, came to knowledge by means of special death reports, and 36 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 345, equal to a notification rate of 1.81 per 1,000 of population. The total number of new cases during the previous year was 376. The deaths from all forms of Tuberculosis during the year numbered 172, equal to a death rate of 0.9 per 1,000 of population. The total number of deaths in the previous year was 195. It will be noted that, out of a total of 172 deaths from Tuberculosis, 33 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. 110 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, 1934, to the 31st December, 1934 (inc/usive). 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 1 9 18 31 26 36 17 15 156 18 5 Females — 3 5 3 11 26 23 7 8 1 1 88 112 Non-pulmonary Males — 2 3 5 1 1 3 2 1 — — 18 19 Females — — 3 1 l 3 3 — 2 — 1 14 15 Totals — 5 14 10 22 48 60 35 47 18 1 7 276 *331 * Exclusive of 12 "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 - 1 — 1 1 2 3 9 5 7 4 33 Females — — — — 1 3 6 2 1 5 1 19 Non-pulmonary Males — 1 3 1 - - 1 - — — — 6 Fernales — 2 1 1 2 2 2 - 1 — — 11 Totals — 4 4 3 4 7 12 11 7 12 5 69 111 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 'orms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 1925 215900 389 103 492 180 51 231 1.8o 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 0.06 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 1934 187540 296 49 345 157 15 172 1.58 0.26 1.84 0.84 0.08 0.-92 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 1934:— Tuberculosis (All Forms). Ward. New Cases. Deaths. Number. Rate per 1000 of Population. Number. Rate per 1000 of Population. 1 61 1.8 29 0.9 2 29 1.6 23 1.2 3 56 1.8 28 0.9 4 42 1.9 20 0.9 5 50 1.8 23 0.8 6 28 1.6 13 0.8 7 34 2.8 16 1.3 8 37 1.5 17 0.7 Homeless 8 — 3 - Totals 345 1.8 172 0.9 112 Public Health (Tuberculosis) Regulations, 1930. These Regulations placed various additional duties upon local Authorities, and continued the requirement of 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, 1934:— Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1934 1242 387 1629 Number of new cases during the year 305 52 357 1547 439 1986 Number of cases removed from the Register during the year (from death or other causes) 391 105 496 Number of cases remaining on the Register at the end of the year 1156 334 1490 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 11 children have been boarded out under the scheme. Provision of Beds and Bedding for Necessitous Tuberculous Patients.—This valuable step was initiated by the Borough Council in 1924. Beds and bedding are lent to tuberculous patients who would otherwise be compelled to share a bed with a person or persons. They are much appreciated by those to whom they are lent and their use should help to limit the spread of infection. 113 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 Room*.—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 3776 „ Holland 3503 Total 7279 In connection with Tuberculosis, the housing conditions of the family are important. Any defects discovered on inspection are reported, and, if any degree of overcrowding exists, special efforts are made to secure more adequate accommodation. 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 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 011 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 organisatio" The Borough Council at their meeting in July were informed that the London County Council had agreed that no contribution towards the cost of the residential treatment of tuberculosis (except in respect of dentures provided by the County Council during treatment) or towards the cost of the boarding out of children under the powers conferred by the County of London (Tuberculosis) Regulations, 1930, be asked for from patients or persons legally responsible for them. This made considerable alteration in the work of the Care Committee and the future method of procedure was still under consideration at the end of the year covered by this report. 114 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 Miss Whelon:— Tuberculosis Care Committee. Report for year 1934 For the year under review, the work of the Care Committee is really only concerned with the first seven months of the year. In July last, the London County Council new arrangements came into effect, and after the usual August recess the Committee held no further meetings, owing to uncertainty as to the future scope of the work. During this period 192 cases were considered by the Committee:—of these, 146 were assessed as free cases. 29 were assessed at sums varying from 1s. to £1. 17 were reviewed for various reasons. Dental Cases. Three cases were assessed to make a contribution towards the cost of their dentures, one was assessed as a free case, while three others received treatment at Sanatoria, in these cases the matter being dealt with as part of the cost of treatment. It may be of interest to give one or two brief examples of work done by the Committee:— Mrs. M. A patient in an advanced stage was granted the services of a Home Help for three months, she then went away to try to recuperate, but had to return home on account of her condition and passed away soon after. L.D. This was a case of a friendless lad who had been abandoned by his parents in infancy. Shortly after he started work he decided to tramp to London in an effort to find his parents. He became ill owing to exposure and hardship and was sent to a Sanatorium where he remained for a considerable time. He had no money, and was dependent upon the kindness of his fellow patients for anything be might want. His Approved Society was approached and agreed to pay him a small weekly sum as pocket money from his accrued benefit. An outfit of clothing was also obtained for him, and he is now at Papworth, from where he writes very happily. Enquiries about insurance matters are of frequent occurrence, and while often the absence of benefit is the result of insufficient stamps, it is usually possible to obtain sympathetic consideration from the Societies. A never-ending side of the work, too, is the provision of clothing for necessitous patients and many calls were made on the Honorary Secretary's cupboard. She would like to express the gratitude of the Care Committee to The Eleanor Palmer Charity for a grant of money for the purchase of clothing and also to Queen Mary's London Needlework Guild for a parcel of clothing sent at Christmas. In conclusion, it should perhaps be mentioned that during the period August to December, 81 cases were reported direct to the London County Council. Hklen M. Whelon, Hon. Secretary. 115 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. 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 in 1933, it was decided by the Borough Council, with the concurrence of the London County Council, that financial responsibility should be accepted for the treatment by Sanocrysin of patients attending the hospital for artificial pneumothorax refills. The cases are to be approved by the Medical Officer of Health and the Tuberculosis Officer, and the Council's liability is limited to a sum of three shillings for each injection. Artificial Light Treatment. Provision as part of Tuberculosis Dispensary Service. There is an arrangement for the treatment of lupus by Finsen lamp at the London Hospital on the basis of 5s. an attendance. Report on the Work carried out at the Tuberculosis Dispensary. The following report on the work of the Dispensary has been furnished by the Tuberculosis Officer, Dr. Back:— The total number of new patients dealt with at the Dispensary during 1934 shows an increase from the previous year of about 34 per cent. This increase is almost entirely due to the larger number of contacts who attended, the figure being nearly 50 per cent. greater than any previously recorded at this Dispensary, although since 1926, when the records were begun, the number of notifications—and consequently the number of available contacts—has fallen by 25 per cent. No contacts were found to be suffering from tuberculosis, but it is satisfactory to know that approximately 44 per cent. of the contacts of all cases of tuberculosis discovered during the year have been examined and have been given advice which should enable them to obtain early treatment if it becomes necessary later. It is also encouraging to find that the contact cards and letters, mentioned in last year's report, and the efforts of the Health Visitors have had such a marked effect on the attendances. 116 Altogether 390 applications for institutional treatment were accepted by the London County Council under the Tuberculosis Scheme during the year. Of these, 174 were admissions to the General Hospitals which are now included under the Scheme, 67 were admissions to Brompton Hospital or St. George's Home for investigation with regard to their subsequent treatment, 123 to sanatoria and 26 to various hospitals for observation for diagnosis. The majority (104) of the admissions to the General Hospitals were emergency admissions of destitute patients or those suffering from advanced disease, and the recommendations were made by District Medical Officers, Relieving: Officers or General Practitioners, the remainder being recommended by the Dispensary (62) or other hospitals (8). Of the admissions to special hospitals for tuberculosis and sanatoria, 123 were recommended from the Dispensary and 93 from other sources. The number of artificial pneumothorax refills for which the Borough Council accepted financial responsibility showed a slight decrease from 403 to 378. Of these 166 were carried out at Brompton Hospital, 97 at University College Hospital, 68 at Colindale Hospital and the remainder (47) at other hospitals. The number of attendances for Finsen Light Treatment at the London Hospital was 17. During the year 150 necessitous patients requiring extra nourishment, either before or after a period of institutional treatment, were granted milk and eggs at a total cost of £83 5s. 9d. The amount allowed to each patient being a pint of milk and one egg daily, the average duration of the allowances was therefore about four weeks. On January 15th information was received from the County Medical Officer of Health that the Tuberculosis Officer had been allocated to Highgate Hospital in the capacity of consultant for tuberculosis, and since that date a weekly visit has been paid to" the hospital on Friday afternoon. I have to thank the Medical Superintendent for his co-operation in making this arrangement and to report that I have found it to be of great value. G. A. Back, Tuberculosis Officer. 117 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 128 71 3 9 10 6 9 7 138 77 12 16 243 (b Diagnosis not completed - - - - - - - - 11 11 1 - 23 (c) Non-tuberculous - - - - - - - - 62 71 21 17 171 B.—Contacts examined during the year:- (a) Definitely tuberculous - - - - - - - - - - - - - (b) Diagnosis not completed - - - - - - - - - 6 1 3 10 (c) Non-tuberculous — — — — — — — 48 88 75 81 292 C.—Cases written off the Dispensary Register as— (a) Recovered 4 5 - 9 - - 11 4 4 5 11 6 26 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 116 163 96 99 474 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 337 207 12 16 40 27 29 36 377 234 41 52 704 (b) Diagnosis not completed — — — — — — — — 14 21 4 3 42 1. Number of cases on Dispensary Register on January 1st 765 7. Number of consultations with medical practitioners:— 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 78 (a) Personal 5 (b) Other 201 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 80 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 207 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4469 4. Cases written off during the year as Dead (all causes) 129 10. Number of— (a) Specimens of sputum, &c., examined 557 5. Number of attendances at the Dispensary (including Contacts) 3364 (b) X-ray examinations made in connection with Dispensary work 121 6. Number of Insured persons under Domiciliary Treatment on the 31st December 347 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above - 12. Number of "T.B. plus cases on Dispensary Register on 31st December 406 118 Section VII—OTHER SERVICES. DISINFECTING AND CLEANSING STATION. These buildings are situated in Cambridge Street, at the rear of St. Pancras Gardens. Extensive internal alterations authorised by the Council were carried out during 1929 and resulted in a gratifying improvement in the facilities and amenities connected with these buildings. Disinfection. In connection with cases of infectious disease, bedding, clothing, etc., are disinfected by steam under pressure at the Council's Disinfecting Station, Cambridge Street. No charge is made. Library books and articles which would be injured by steam are disinfected by formaldehyde generated in a small chamber. Separate motor vans are used for the collection of infected and delivery of disinfected articles. The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of cases. No. of houses. No. of rooms contents disinfected or destroyed. No. of rooms sprayed and fumigated. Small-pox (suspected) 1 1 1 2 Scarlet Fever 643 620 622 569 Diphtheria 424 403 396 420 Enteric Fever 7 7 7 3 Erysipelas 180 130 122 17 Puerperal Fever nnd Pyrexia 10 10 10 4 Encephalitis Lethargica 2 2 1 1 Polio-myelitis 2 2 2 1 Cerebro-spinal Meningitis 8 8 8 5 Pneumonia 4 4 4 1 Tuberculosis 108 108 44 113 Measles 63 61 28 60 Vermin and Scabies 413 373 228 378 Other Diseases 356 351 332 67 Totals 2171 2080 1805 1636 119 The following table gives the number of articles disinfected or destroyed during the year on account of infectious disease or verminous conditions:— Infectious Disease. Verminous. Destroyed. Disinfected. Destroyed. Disinfected. Beds, mattresses and palliasses 61 1912 82 301 Bolsters and pillows 51 4811 17 454 Sheets, blankets and counterpanes 42 6778 12 568 Rugs, mats, cushions, carpets, covers and curtains 56 1861 9 121 Wearing apparel 92 8186 6 101 Books - 95 - - Sundries 33 1470 8 58 Totals 835 20113 84 1603 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, 1935, amounted to £146 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. Total. Vermin 1813 32 4061 *5906 Scabies 157 152 1947 2256 Infectious Disease Contacts - 2 - 2 Totals 1970 186 6008 8164 * Includes 573 males and 3 females who had no home address. The staff of the Disinfecting and Cleansing Station consists of a Foreman, a Disinfector and two Motor Drivers and Disinfectors; a Matron of the Cleansing Station and one Woman Assistant. 126 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. 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 cases, the Borough Council provides bacteriological diagnosis, free of charge, in connection with certain diseases. In addition to the above, the preparation and supply of vaccines is undertaken, if desired by the medical attendant, for use in connection with cases of Puerperal Fever. This work is performed by Professor F. II. Teale, m.d., of University College Hospital, under an arrangement made with the Council. The undermentioned examinations were made during the year:— Nature of Specimen. Positive. Negative. Total. Swabs for Diphtheria Bacilli 166 1706 1872 Blood „ Typhoid Fever 1 — 1 Faeces „ „ - 1 1 Cooked meat for suspected food poisoning - 1 1 Stools for suspected Dysentery - 4 4 Urine „ Tubercle Bacilli - - - Sputum „ ,, 27 322 349 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.