A C4353 STPAN 94 Metropolitan Borough of Saint pancras. REPORT OK THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936. (For the purpose of this Report, the year consists of the 53 weeks ended 2nd January, 1937, except where otherwise stated.) MAITLAND RADFORD, M.D., B.S., D.P.H. Printed by F. P. Lcwingdon 26 & 27, Eversholt Street, Camden Town, N.W.l. Metropolitan Borough of Saint pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936. (For the purpose of this Report, the year consists of the 53 weeks ended 2nd January, 1937, except where otherwise stated.) MAITLAND RADFORD, M.D., B.S., D.P.H. CONTENTS. pages Section I.—Statistics, Social Conditions and General Information relating to the Area 25 ,, II.—Population, Marriages Births and Deaths 27—36 „ III.—Sanitary Circumstances of the Area 37—45 „ IV.—Factory and Workshop Acts 47—50 „ V.—Housing 51—59 „ VI.—Inspection and Supervision of Food 61—72 „ VII.—Prevalence of, and Control over, Infectious Diseases 73—86 „ VIII.—Tuberculosis 87—99 „ IX.—Maternity and Child Welfare 101—135 INDEX page Advice cards 113 Aged persons, removal of 43 Altitude of Borough 12 Ambulance facilities 19 Ampthill Square Centre 20,116 Analysis of food 67 Analyst's notes 70 Ancillary services 121 Animal tests of milk 63 Ante-natal services 130 Area of Borough 12 Area of playing fields 12 Area of public open spaces 12 Area undeveloped 12 Artificial Cream Act, 1929 64 Artificial Light clinics 20 Artificial Light treatment—staff, statistics 109 Artificial pneumothorax 94 Attendances, visits, etc., at Centres 113 Avalon 124 Bacteriological examination of milk 63 Bacteriological work 85,86 Bakehouses and Restaurant Kitchens 66 Barnes House Clinic 107 Baths and Washhouses 44 Bed Bugs 84 Beds and bedding for Tuberculous patients 97 Birth notifications 28 Birth rate 12,14 Birth rate of Metropolitan Boroughs 16 Births and Deaths Registration Act, 1926 29 Births and rates per Ward 15,28 Births, legitimate and illegitimate 12,28 Births in public institutions 28 Births registered 12,14,27 Births, still 12,29 Block grants 110—111 Boarding out children from Tuberculous homes 98 page Bodies received at Mortuary 36 Buck Street Nursery School 126 Byelaws enforced by Borough Council 23 Camden Park Road site 58 Camden Town Centre 107 Canal Boats Acts 43 Cancer deaths 33 Care at confinement 130 Carlow Street Estate 57 Caversham Road Centre 108 Centres—Borough Council contributions 110—111 Centres—Maternity and Child Welfare 20 Cerebro-spinal meningitis 79 Child Welfare 113 Classes for Mothers 106 Cleansing and Disinfecting station 22,85 Cleansing of school children 85 Clearance Orders 55 Clinic for Sick Mothers and Young Children 22 Clinics, School 21 Clinics, treatment centres, etc. 20 Committee, Members of 6 Common Lodging Houses 42 Condemned food 64 Confinement—subsidies and facilities 131 Consultations and attendances at Centres 105 Consultations, times of 104 Contributions of Borough Council to Centres 110—111 Convalescent Homes 22 Convalescent home treatment 124 Coroner's Court 36 Cowsheds 61 Dairies and Milkshops 61 Dairies and Milkshops, registration 62 Day Nurseries and Nursery Schools 20,21,125 Death rate (adjusted) 12,30 Death rate (adjusting factor) 30 Index—continued. pace Death rate, Infantile 13 Death rate, Maternal 127 Death rate (unadjusted) 12 Death rate of Metropolitan Boroughs 16 Deaths 12,14,15,29 Deaths, aged persons 33 Deaths, cancer 13,33,34 Deaths, causes (by ages, Wards and sex) 30 Deaths, diarrhoea and enteritis 13 Deaths, homeless persons 33 Deaths, illegitimate infants 13 Deaths, infantile—legitimate and illegitimate 13,15 Deaths, infantile by causes 118 Deaths, infantile by causes for last 10 years 119 Deaths, in public institutions in and outside the Borough 31,32 Deaths, maternal 12, 127 Deaths, measles 13,81,82 Deaths, persons of unknown address33 Deaths, rates by Wards15,33 Deaths, registered 12,14,29 Deaths, transferable 14 Deaths, tuberculosis 13,15,91 Deaths, whooping cough 13 Defects remedied without notice 51 Dental clinics 21, 107 Dental clinic, Ampthill Square 106 Dental clinic, Camden Town Centre 107 Dental clinic, Eastman 110 Dental clinic, St. Pancras Dispensary 124 Dentures for necessitous mothers 108 Dentures for tuberculous patients 98 Denyer House 57 Diarrhoea and enteritis—deaths 13 Dinners for Mothers and children 106, 107 Diphtheria 77 Diphtheria anti-toxin 77 Diphtheria, immunisation scheme 78 Disinfecting and cleansing station 82 Disinfecting for institutions 83 Drainage 44 Dwelling-house inspection 51 Dwellings controlled by Estates Committee 55 Dysentery 79 Eastman Dental Clinic 110 Economic conditions 18 Encephalitis Lethargica 79 Enteric fever 78 Erysipelas 79 Estates Committee—work of 55 Estates controlled by Borough Council 55 Factories, workshops and workplaces 47,49 Factories, etc., inspections 47—50 Factory and Workshop Acts 47 Factory and Workshop, inspections— defects found 48 page Families (1931 Census) 12 Ferdinand Place Estate 56 Finsen Light Treatment 95 Food analysis 67 Food and Drugs (Adulteration) Act, 1928 67 Food inspections 61 Food poisoning 80 Food summonses 69 Food surrenders 64 Food unsound, condemned 64 Foster-mothers and children 121 Fried Fish shops 66 German Measles and Measles 80 Grants to Welfare Centres 110, 111 Health propaganda 24 Health visiting 102 Health Visitors 112 Health Visitors (students) 134 Health Visitors, summary of year's work 112 Health Visitors, visits to children 112 Health Visitors, visits to expectant mothers 112 Health Week 24 Home Helps 132 Home Work and Outworkers 48 Hospital accommodation 24,25 Houses and flats erected 51 Houses let in lodgings 42 Housing 51 Housing Act, 1930—proceedings under 52 Housing Act, 1935—overcrowding survey 52 Housing conditions 53 Housing Inspector 54 Housing schemes in the Borough 59 Ice cream premises 66 Illegitimate births 28 Infant Life Protection—Children Acts, 1908, 1932 121 Infantile deaths per Ward 15 Infantile mortality 35 Infectious diseases 74,75 Infectious diseases, deaths 75 Inhabited houses 12 Infirm persons—removal of 43 Inquests 35 Inspection and supervision of food 61 Institutional provision for unmarried mothers 18 Insulin 22 Invalid Children's Aid Association 125 Itinerant milk vendors 62 Legal proceedings 39—41 Legislation 23 Leighton Road site 58 Lighting of staircases — tenement buildings 42 Local Acts—Byelaws 23 Index—continued. page Lodging-houses ... ... 42 London County Council housing estates 59 Luxmoore, Miss M. W. J. ... ... 9 Main Memorial Home ... ... 18 Malaria ... ... ... 79 Map of Borough ... ... 2—3 Margarine—wholesale dealers ... 70 Marriages ... ... ... 27 Massage ... ... ... 107 Massage Clinics ... ... 22,107 Maternal Care ... ... 127 Maternal Mortality ... ... 127 Maternity and Child Welfare ... 101 Maternity and Child Welfare (Advisory) Sub-Committee ... ... 101 Maternity and Child Welfare Centres- addresses, hours ... ... 104 Maternity and Child Welfare Centres— attendances, visits ... ... 105 Maternity and Child Welfare Centres— Royal Free Hospital ... ... 103 Maternity and Child Welfare Centres— University College Hospital ... 103 Maternity and Child Welfare Centres— work carried out ... ... 112 Maternity and Child Welfare Centres— general administration ... ... 101 Maternity and Child Welfare Officer— Report ... ... ... 134 Maternity and Child Welfare—Voluntary Committees ... ...101—111 Maternity Outfits, sterilised ... ... 132 Mayoress of St. Pancras Home for Sick Poor Children ... ... 124 Measles and German Measles ... 80 Measles, death rate ... ... 82 Measles, deaths ... ... 81 Measles, incidence rate ... . ... 82 Measles, notifications ... ... 81 Measles, nursing ... ... 80 Meat and other foods ... ... 64 Medical examination of school children 115,117 Medical Officer of Health—remarks ... 5 Meteorological table ... ... 10 Metropolitan Boroughs—birth and death rates ... ... ... 16 Midwifery ... ... ... 130 Midwifery cases ... ... 131 Midwifery grants to hospitals ... 131 Midwives ... ... ... 130 Milk Act, 1934 ... ... 63 Milk—Bacteriological examinations ... 63 Milk grants ... ... ... 123 Milk in sealed containers ... ... 62 Milk sampling ... ... 62 Milk shops and dairies registration ... 62 Milk (Special Designations) Order, 1923 and 1936 ... ... ... 62 Milk supplied to mothers and children... 122 page Milk supply ... ... ... 61 Milk to school children ... ... 63 Milk, Tubercle tests ... ... 63 Milk vendors—itinerant ... ... 62 Ministry of Health circular No. 1550 ... 113 Ministry of Health circular No. 1443 ... 127 Mortuary ... ... ... 36 North St. Pancras School for Mothers ... 108 Notices served—intimation and statutory 37 Notifiable diseases ... ... 73 Notification of births ... ... 28 Notification of births Acts, 1907, 1915 ... 28, 113 Notification of infectious disease ... 73,74 Notification of and deaths from infectious disease ... ... 75 Nursery Schools ... ... 21,125 Nursing Associations ... ... 126 Observation Day Nursery ... ... 106 Occupations ... ... ... 17 Offensive trades ... ... 41 Officers ... ... ... 7—8 Open air schools ... ... 22 Open spaces—area ... ... 12 Ophthalmia Neonatorum ... ... 79, 120 Outdoor relief ... ... 18 Outworkers and home work ... 48 Overcrowding survey ... ... 52 Persons per acre ... ... 12 Persons per acre (1931 Census) ... 12 Pirret, Dr. M. J. ... ... 9 Playing fields—area ... ... 12 Pneumonia ... ... 79 Pneumothorax treatment ... ... 93 Poliomyelitis and Polioencephalitis ... 79 Population (1931 Census) ... . ... 12 Population, estimated ... ... 12,14 Population, marriages, births and deaths 27 Population of Wards ... ... 27 Post-mortem examinations ... ... 36 Pritchard, Dr. P. V.—Report ... 134 Professional nursing ... ... 22,126 Prosecutions—general sanitary work ... 39—41 Prosecutions, food ... ... 69 Public Assistance Department ... 19 Public Baths and Washhouses ... 44 Public Health Acts—proceedings under 52 Public Health Committee ... ... 6 Public Health Legislation ... ... 24, Public Health (London) Act, 1936 ... 24 Public Health (Meat) Regulations, 1923 66 Public Health Officers ... ... 7,8 Public Health (Prevention of Tuberculosis) Regulations, 1925 ... 92 Public Health (Prevention of Tuberculosis) Regulations, 1930 ... 89 Public Health (Preservatives in Food) Regulations, 1925-1927 ... ... 70 Index—continued. page Public open spaces—area 12 Puerperal Maternal Mortality 127 Puerperal Pyrexia and Fever 78,132 Queen's Crescent Centre 108 Queen's Crescent site 58 Rag and Bone dealers 41 Rag Flock Acts, 1911-1928 42 Rainfall 12 Rat Week 45 Rate—sum produced by 12 Rateable value 12 Rats and Mice (Destruction) Act, 1919 45 Refuse collection and disposal 45 Rehousing facilities 54 Relief granted 18 Relief stations 19 Rent Restrictions Acts, 1920-1933 43 Restaurant Kitchens and Bakehouses 66 Royal Free Hospital Welfare Centre 20, 122 St. Margaret's Home 18 St. Pancras School for Mothers 20, 106 St. Pancras Dispensary 22, 124 Samples of food analysed 67 Sanitary Inspection of the area 37 Sanitary Inspectors' visits 38 Sanocrysin treatment 95 Scarlet Fever 77 School children—cleansing 85 School children, medical examination 115, 117 School clinics 21 Shops Act, 1934 43 Slaughterhouses 65 Slaughtermen, licensing 65 Small Pox 76 Smoke abatement 41 Soil and situation of Borough 12 Somers Town Centre 109 Somers Town Estate extension 58 South Highgate Centre 109 Staff 7—8 Staff changes during year 9 Staircases, tenement buildings 42 Statistical summary 12 Statistics, comparative 13 Statistics, Vital, for last 10 years 14 Statutory notices 37 Statutory powers—action under 52 Sterilised maternity outfits 132 Stillbirths 29 Summonses—Food and Drugs (Adulteration) Act, 1928 69 Summonses—General sanitary work 39—41 Student Health Visitors 134 Swimming pools 44 PAGE Tenement buildings—lighting of staircases 42 Tubercle tests of milk 63 Tuberculosis 87 Tuberculosis, beds and bedding 98 Tuberculosis, boarding out of children 99 Tuberculosis Care Committee 96 Tuberculosis death rates by Wards 15, 90 Tuberculosis deaths 87, 91 Tuberculosis deaths by ages 87 Tuberculosis deaths by ages, Wards and sex 91 Tuberculosis dental treatment 98 Tuberculosis, disinfection of rooms 95 Tuberculosis dispensaries 21 Tuberculosis Dispensary sessions 92 Tuberculosis Health Visitors' visits 95 Tuberculosis, housing 98 Tuberculosis, institutional treatment 94 Tuberculosis, interval from notification to death 88 Tuberculosis, new cases 87 Tuberculosis, notification register 92 Tuberculosis Officer's Report 94 Tuberculosis, prevalence and fatality 90 Tuberculosis, primary notifications 87 Tuberculosis, Public Assistance 97 Tuberculosis, residential treatment 97 Tuberculosis, shelter 98 Tuberculosis, special death reports and transfers 89 Tuberculosis, staff 95 Tuberculosis, summary of work 93 Tuberculosis, X-ray work 95 Tuberculous patients—beds and bedding 97 Typhoid Fever 78 Underground rooms 54 Undeveloped area 12 Unemployed 18 Unmarried mothers 18 University College Hospital Welfare Centre 121 Unsound food 64 Vaccination 76 Venereal disease clinics 21 Visiting of homes 112 Ward births and deaths 15 Washhouses and Baths 44 Water certificates 44 Water cut off 44 Water supply 43 Whooping cough deaths 13 Wolfe, A. E., death of 9 Workshops and workplaces 47 49 X-ray work 95 5 Public Health Department, Town Hall, Pancras Road, N.W. 1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Sir, Ladies and Gentlemen, This Report upon the sanitary circumstances and the vital statistics of the Borough is the 81st Annual Report that has been submitted and is the third that I have had the honour to prepare. A summary of the principal statistics for the year 193G is given on pages 12 and 13. It will be noted that a further fall in the population is estimated and that the birth rate is as low as 13.0 per 1000 of the population. This birth rate is the lowest so far recorded for the Borough. The biennial epidemic of Measles occurred during the year and particulars, together with comparative figures for previous years, will be found on pages 80-82. Statistical information relating to London as a whole and for the different Metropolitan Boroughs is given in the table on page 10. I wish to thank the members of the Borough Council, and especially the Chairman and Members of the Public Health Committee for the encouragement and assistance that has been so generously given throughout the year. I wish also to thank my colleagues on the staff for their help and co-operation. I am, Sir, Ladies and Gentlemen, Your obedient Servant, MA1TLAND RADFORD, Medical Officer of Health. 6 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 1995, to October, 1936. CHAIRMAN. Councillor John Evans. DEPUTY-CHAIRMAN. Alderman William Palmer Spry. EX-OFFICIO. The Right Worshipful the Mayor (Alderman Rupert Frederick William Fincham, F.C.A., J.P ) ALDERMEN. Crosby, Miss Ada, M.B.E. Dayies, David, J.P., L.C.O. Escott, Arthur, F.I.B.D. COUNCILLORS. Ward 2 Bell, Mrs. Florence Nightingale Harrison, J.P. 5 Bishop, Mrs. Mary Rebecca. 8 Blackmore, Claud. 6 Cooper, Mrs. Julia Susannah. 1 Davies, Mrs. Edith. 4 Davies, Mrs. Lilian. 3 Debenham, Martin Ridley. 5 Denyer, Charles Henry. 8 Evans, Evan. 1 Flint, Mrs. Louisa Elizabeth. 6 Gregory, Mrs. Jeanetta. 2 Horne, George, J.P. 4 Lake, Mrs. Amy Elizabeth 3 Melvin, Frederick George. 7 Pilbeam, Cecil Gerald. 0 Swann-Mason, Rev. Richard Swann, O.B.E., M.A. 7 Swift, Mansell James, F.R.M.S. 3 Wright, James Albert. November, 1936, to October, 1937. CHAIRMAN. Alderman W. P. Spry. DEPUTY-CHAIRMAN. Councillor Mrs. L. E. Flint. EX=OFFICIO. The Right Worshipful the Mayor (Alderman Rupert Frederick William Fincham, F.C.A., J.P.) ALDERMEN. Crosby, Miss Ada, M.B.E. Davies, David, J.P. Escott, Arthur, F.I.B.D. COUNCILLORS. Ward 2 Bell, Mrs. Florence Nightingale Harrison, J.P. 5 Bishop, Mrs. Mary Rebecca. 8 Chambers, Percy Henry. 6 Cooper, Mrs. Julia Susannah. 1 Davies, Mrs. Edith. 8 Debenham, Martin Ridley. 5 Denyer, Charles Henry, M.A. 8 Evans, Evan. 8 Evans, John. 6 Gregory, Mrs. Jeanetta. 2 Horne, George, J.P. 4 Lake, Mrs. Amy Elizabeth. 3 Melvin, Frederick George. 4 Menon, Venualil Krishnan Krishna. 1 Pearson, Louis, B.A. 7 Pilbeam, Cecil Gerald. 5 Rolles, Harry. 7 Swift, Mansell James, F.R.M.S. 3 Wright, James Albert, 7 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of the year 1936. MEDICAL OFFICER OF HEALTH ADMINISTRATIVE MATERNITY AND CHILE WELFARE OFFICER, VACCINATION 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 (g) P. V. Pritchard, M.D., D.P.H., M.R.C.P., F.R.F.P.&S. PUBLIC ANALYST. J. Kear Colwell, F.I.C. PUBLIC VACCINATORS. Dr. JN. J. Goodchild—Ward 1. Dr. F. L. Pelly—Ward 2. Dr. J. W. Wigg—Wards 3 and 4. Dr. A. E. Tait—Wards 5, 6 and 7. Dr. C. H. Alderton—Ward 8. (G)SANITARY INSPECTORS. Inspectors of Food and Food Places. ¶‡G. W. Adktns. ¶‡H. K.Nixon. Inspectors of Workshops and Factories. ¶†**Miss J. A. J. Camman †§B. H. Thompson. District Inspectors. ‡§W. L. Brown. ‡§R- E. James. ‡R. C. Akers. ‡M. Jaffa. ‡¶S. W. Caphl. §H. G. West. ‡¶+E. W. Winchester. xT. H. Hague. x W. C. Mansfield. ¶x +R. Warren, x W. B. Dykes. Housing Inspector. *‡§¶A. H. Walker. (G) TUBERCULOSIS DISPENSARY, BARNES HOUSE, CAMDEN ROAD. N.W.I. Tuberculosis Officer (g), G.A. B ack, B.A., M.B., B.Ch., M.R.C.S.,L.R.G.P., D.l .H Sanitary Inspectors and Health Visitors (for Tuberculosis), A‡†Miss S. A. Long. ‡||Miss A. Holland. Nurse and Sec. to Tuberculosis Care Committee, †ABcMrs. E. Bevan. 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, (g) V. R. Meurice. (g) Miss A. An drews. G. F. Peeling. C. W. Smith, x J. A. Hoare. E. F. Kirby. ¶ x R. N. Thomas. x J. F. Woolvin. (g) H. E. WliSTRIPP, C. A. Engledow. W. Shackcloth. * Cert. Municipal and County Engineers. § San. Insp. Cert. Royal San. Inst. || Health Visitor's Certificate, † S.C.M. A State Registered Nurse, B Registered Fever Nurse. cTuberculosis Training-. X Cert. San. Insp. Examination Board. ¶11 Cert. Meat ana other Foods. + Smoke Abatement Cert. (L.C.C.), ** Certificate, Queen Charlotte's Hospital. X tCert. Royal San. Inst, and San. Insp. Exams. Joint Board. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. 8 BOROUGH COUNCIL STAFF AT THE CENTRES AND CLINICS. (g) Medical Officers. No, of Consultations per month. Dr. Chas. H. Aldkrton 4 Dr. B. Marion Cockerell 10 Dr. Helen Gillespie 5 Dr. J. Finch Haines 13 Dr. Janie Lorimer Hawthorne 6 Dk. Nora Leesmith 4 Dr. J. Balfour Neill 8 Dr. K. H. Odling-Smee 4 Dr. Martin Oldershaw. 4 Dr. Francis L. Provis 4 Dr. Audrey E. Russell 8 Dr. Abraham I. Silverman 4 Dr. John w. wigg 4 Dr. C. Krrcat 4 (g) Dental Clinic. R. M. Underwood, L.D.S., Dentist 6 Dr. Jas. Maughan, Anaesthetist 2 (g) Artificial Light Clinic. Dr. P. Y. 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.) (g) Superintendents of Maternity and Child Welfare Centres. ‡||Miss G. R Bristow. ||†Miss M. H. Landel Jones. ||†MRs. S. C. Chapman. **||†Miss M. Manger. ||†Mrs. E. Crockart. ||†Miss E. M. Robinson. (g) Health Visitors at Maternity and Child Welfare Centres. ‡§||Miss F. A. Anderson. ¶||Miss A. M. U. Harrop. ¶||**Miss E. B. Bagnall. ‡§Mrs. A. Hunter. ¶||†Miss M. L. Blair. +Mrs. E. Lurie. ‡||Miss V. K. Blaxi.and. †||‡MRs. J. Lynn. ||†Miis. E. E. Bruce. ||†MRS. M. A. Smith. ||†Miss B. M. Harris. DISINFECTING AND CLEANSING STAFF. T. Bartholomew (Foreman). Mrs. E. Mace (Matron). A. E. Godwin (Stoker and Disinfector). Mrs. L. Blaby (Assistant). J. Stanley (Driver and Disinfector). J. Root (Mortuary, etc., Caretaker). II. Prudames( Do. ). (The above are full-time officers.) ‡ Cert. San. Insp. Examination Hoard, §| San. Insp. Cert. Koyal San. Inst, ¶ State Registered Nurse. || Health Visitor's Certificate. † S.C.M. ** Midwifery Certificate, Queen Charlotte's HosDital g Officers to whose salary contribution is made under the Prublic Health Acts or by Exchequer Grant 9 CHANGES IN STAFF DURING 1936. Dr. Maitland Radford was appointed Vaccination Officer in place of Mr. A. E. Wolfe, who died on '24th June. In consequence of the extra work devolving upon the Public Health Department, the Council authorised the appointment of an additional Grade D Clerk, and Mr. V. R. Meurice was promoted to the position. The vacancy thus created was filled by Mr. C. W. Smith Miss M. W. J. Luxmoork, Tuberculosis Nurse, resigned, and Mrs. E. Bevan was appointed in May to take her place. As a matter of interest it may be recorded that a member of the clerical staff, Mr. J. A. Hoare, was successful during the year in obtaining the certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examinations Joint Board. Dr. M. J. Pirret, who conducted consultations at Ampthill Square and Somers Town Centres, resigned during the year, and Drs. K. H. Odling-Smee and Audrey E. Russell respectively were appointed to take charge of these Clinics. 10 Meteoroligical Table for Saint Pancras, 1936. (Deduced from observations at Camden Square, N. W. 1.) January. February. March. April. May. June. July. August. September. October. November. December. Barometer— Mean Pressure at 32° F. at station level (Bar. 112 ft. above V.S.L.) 29.6 29.7 29.8 30.0 30.0 30.0 29.8 30.1 30.0 30.1 29.9 30.1 Air Temperature— Mean of— A. Maximum 45.0 42.4 52.6 52.2 65.7 71.2 69.2 73.1 67.0 57.0 48.7 47.2 B. Minimum 37.4 33.2 40.9 39.3 46.8 54.5 55.9 56.0 54.5 43.6 39.0 37.6 Mean of A and B 41.2 37.8 46.7 45.7 56.3 62.9 62.5 64.5 60.7 50.3 43.9 42.4 Difference from Average + 11 —2.7 +3.0 —2.6 0.0 +2.2 —1.8 + 1.3 + 1.9 —1.4 +0.2 +1.3 Humidity—Morning 88.9 89.2 85.0 70.2 72.5 73.3 70.5 77.5 84.5 80.7 90.0 90.0 Earth Temperature at 4 ft. depth 44.8 42.8 42.9 45.7 49.5 63.8 57.8 58.3 58.7 56.0 50.8 47.1 Bright Sunshine— Total Observed (daily mean) Hrs. 0.60 1.66 1.48 3.89 6.00 6.15 4.11 5.68 2.83 23.3 0.92 1.13 Per cent. of total possible 7 17 13 28 38 37 26 39 22 22 9 14 Difference from average Hrs. —0.37 +0.05 —1.16 —0.25 —0.20 —0.31 —2.48 —0.12 —1.14 —0.20 —0.31 +0.40 Rain and other forms of precipitation— Number of Days 20 14 15 14 6 19 20 6 16 13 18 19 Total Fall Ins. 4.02 1.47 1.11 1.86 0.48 3.82 2.95 0.48 2.99 2.04 3.07 1.87 Difference from average +2.20 —0.20 —0.76 —0.16 —1.32 + 1.84 + 3.04 —1.76 + 1.20 —0.0 +0.72 —0.56 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. Section I. Statistics, Social Conditions and General Information relating to the Area. 12 Section 1.— STATISTICS AND SOCIAL CONDITIONS OF THE AREA. STATISTICAL SUMMARY. 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. Son, 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. Rainfall during the year recorded at Camden Square, 25.69 inches. Population (1931 Census), 198,133. Population (Registrar-General's mid-year estimate), 183,900. Number of persons per acre, 68. Number of inhabited houses at end of 1936 (according to Rate Books), 29,216. Rateable Value, £2,223,345. Sum produced by a penny rate, about £8,700. Number of families or separate occupiers (1931 Census), 56,929. Number of persons per acre (Census year 1931), 74. Total. m. f. Live Births Legitimate 2156 1062 1094 Illegitimate 233 118 115 Birth rate per 1,000 of the estimated resident population. 13.0. 2389 1180 1209 Stillbirths 103 55 48 Rate per 1,000 total (live and still) births, 44.8. Excess of deaths over births, 89. Deaths 2478 1323 1155 Death rate per 1,000 of the estimated resident population, 13.5. Adjusted Death rate 13.8 per 1,000 of the estimated population (see page 30). Deaths from puerperal causes (Headings 29 and 30 of the Registrar General's Short List) : Deaths. Rate per 1.000 total (live and still) births. No. 29 Puerperal sepsis 5 2.0 No. 30 Other puerperal causes 2 0.8 Total 7 2.8 13 Death rate of Infants under one year of age:— All infants per 1,000 live births, 79. Legitimate infants per 1,000 legitimate live births, 77. Illegitimate infants per 1,000 illegitimate live births, 103. Deaths from Cancer (all ages), 361 „ Measles (all ages), 17. ,, Whooping Cough (all ages), 16. „ Diarrhoea (under 2 year's of age), 71. ,, Tuberculosis (all ages)—361. Pulmonary, 150. Death rate per 1,000 of the estimated resident population, 0.8 All forms, 164. ,, „ „ 0.9 Comparative Statistics. Rate per 1000 of Population. Rate per 1000 Births. Birth rate Death rate. Infant Mortality. St. Pancras 13.0 13.5 79 England and Wales 14.8 12.1 59 122 County Boroughs and Great Towns, including London 14.9 12.3 63 County of London 13.6 12.5 66 k—«• VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1936 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000. Number. Rate per l,000Nett Births. Number. Rate. 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 141† 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 1935 185300 — 4020 2466 13.3 2523 13.6 983 679 155 63 2219 11.9 1936 183900 — 3739 2389 13.0 2794 15.1 1014 697 190 79 2478 13.5 Area of district in acres (land and inland water), 2694 ; total population at all ages, 198,133; number of inhabited bouses, 24,980; average number of persons per house, 793; at Census, 1931. * Based on total population. † Based on civil population. 15 Total Births, Total Deaths, Infantile Deaths, and Deaths from Tuberculosis, with corresponding rates per 1000 for each Ward. Births and Deaths.—Outward transfers are excluded. St. Pancras births and deaths in public institutions and inward transfers are classified according to home address in the borough. Wards. Births. Deaths. Deaths under 1 year. Deaths, Tuberculosis (all forms). No. Rate. No. Rate. No. Rate. No. Rate. 1 445 13.4 446 13.4 27 61 26 0.8 2 246 13.5 240 13.2 21 85 8 0.4 3 477 15.5 440 14.3 27 57 44 1.4 4 315 14.2 303 13.6 27 86 18 0.8 5 340 12.7 350 13.1 32 94 27 1.0 6 197 11.8 211 12.6 14 71 13 0.8 7 116 9.6 147 12.2 11 95 15 1.2 8 253 10.6 291 12.2 26 103 13 0.5 Homeless — — 50 — 5 — — — Borough 2389 13.0 2478 13.5 190 79 164 0.9 16 Table showing the Birth rates, Death rates, and Infantile Mortality rates of London and the Metropolitan Boroughs for 1936 (53 weeks ended 2nd January, 1937.) Estimated Population. Mid. 1936. Birth Kate. Death Rate (Crude). Death Rate (Adjusted). Infantile Mortality per 1000 births. County of London 4,141,100 13.6 12.5 - 66 West. Paddington 139,200 13.6 12.98 12.81 72 Kensington 176,100 12.7 12.5 11.7 78 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 18.7 11.6 58 City of Westminster 124,100 8.5 11.1 11.4 65.8 North. St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65.8 St. Pancras 183,900 13.0 13.3 13.8 79 Islington 804,100 15.24 12.44 12.56 61 Stoke Newington 50,350 13.7 11.4 10.9 44.6 Hackney 209,100 14.4 12.0 12.6 62.9 Central. Holborn 34,850 8.29 11.99 12.88 62 Finsbury 60,800 13.8 14.0 15.3 81 City of London 9,100 7.6 11.4 12.65 147 East. Shorediteh 85,400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14.7 12.6 14.7 100.09 Poplar 140,300 15.0 12.5 13.8 72 South. Southwark 152,200 14.8 13.1 — 59 Bermondsey 100,400 15.4 12.8 14.6 60 Lambeth 277,500 13.9 12.5 12.4 59 Battersea 145,500 14.63 13.06 12.98 59.21 Wandsworth 343,000 11.46 11.79 10.96 58 Camberwell 229,300 18.93 12.64 12.64 58.86 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.82 11.36 11.58 49 Lewisham 224,000 13.0 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 17 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 each sex the principal occupations as ascertained at the 1931 Census. The number's 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 Typists) 2,809 3 „ Unoccupied and Retired 44,219 52 „ All other Occupations 8,223 9„ Total 85,493 100 % 18 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 factors which lead to under.nourishment, and are 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 is 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 1934 4017 1293 September 1934 3948 1335 March 1935 4223 1604 September 1935 3946 1507 March 1936 3986 1649 September 1936 3524 1365 Number of unemployed:— Men. Women. Juveniles. Total. At January, 1934 6567 1298 241 8106 At January, 1935 4538 1220 141 5899 At January, 1936 5198 1255 137 6590 At January, 1937 4482 1169 143 5794 GENERAL INFORMATION. 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 (Tel. Euston 1170). 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. 19 PUBLIC ASSISTANCE DEPARTMENT. Are\ IV.—Comprising the Metropolitan Boroughs of Holborn, Sr. Pancras, St. Marylebone and Hampstead. Local Public Assistance Officer. B. Chapman, Northumberland Street, W.l (Tel. Welbeck 6896 and 6897). Chief Relieving Officer. J. H. Webster, 29, Marylebone Road, N.W.I (Tel. Welbeck 2894 and 2895). Relief Stations. Address. Telephone. Relief districts served. 46, Iverson Road, Kilburn, N.W.6 Maida Vale 1009 l New End, Harapstead, N.W.3 Hampstead 0949 29, Marylebone Road, N.W.1. Welbeck 2894-5 2 & 3 Clifton Villas, Camden Square, N.W.1. Gulliver 1230 4 Relief Station, Bower Cottage, Holmes Road, N.W.5 Gulliver 2868 5 Clifton Villas, Camden Square, N.W.1. Gulliver 1230 6 & 7 25, Kentish Town Road, N.W.1. Gulliver 4826 8 21, Medburn Street, N.W.1. Euston 1654 9 128, Albany Street, N.W.1. Euston 2618 10 46 and 17, Clarendon Square, N.W.1. Euston 2392 11 89, Gray's Inn Road, W.C.1. Chancery 8012 12 Relief Offices, 53, Clerkenwell Road, E.C.1 Clerkenwell 5870 13 Ambulance Facilities. London Ambulance Service (Accident and General). Headquarters, The County Hall, S.E.I. Provides the following services: — (1) For removal of infectious, non-infectious and maternity cases. (Tel. Waterloo 3311.) (2) For accident cases. (Tel. Waterloo 6000.) 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 pregnant women to hospitals from 8 a.m. to 11 p.m. (Tel. Sloane 5191.) 20 Clinic8, 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, (Child Welfare Centre), South High gate. (Tel. Archway 3677.) (Mondays ana Thursdays at 10 a.m.) The Borough Council. The Institute of Ray Therapy, 152-154, Camden Road. (Tel. Gulliver 3876.) A Voluntary Committee. A number of the hospitals in the Borough also provide this treatment. B. Maternity and Child Welfare Centres. St. Pancras School for Mothers, Ampthill Square. (Tel. Euston 2972.) The Borough Council, with assistance from the Voluntary Committee. Somers Town Centre, Chamberlain House. (Tel. Euston 2380.) ,, ,, North St. Pancras School for Mothers, Queen's Crescent. (Tel. Gulliver 2988.) ,, ,, South Highgate Centre, Raydon Street. (Tel. Archway 3677.) ,, ,, Camden Town Centre, Barnes House, Camden Road. (Tel. Gulliver 1667.) ,, ,, Caversham Road Centre. (Tel. Gulliver 4628.) ,, ,, University College Hospital Centre. (Tel. Euston 5050.) The Hospital Authorities Royal Free Hospital Centre. (Tel. Terminus 4331.) ,, ,, (The hours of attendance at the Council's Centres are given in the Maternity and Child We/fare Section.) Ante-Natal Clinics are held at all the above Centres with the exception of the South Highgate Centre C. Day Nurseries. Kentish Town Day Nursery, Gospel Oak Grove. (Tel. Gulliver 2906.) The Voluntary Committee, with a subsidy from the Borough Council. Margaret Club and Day Nursery (for fatherless „ „ children), 56-59, Clarendon Square. (Tel. Euston 1822.) Whitefield Day Nursery, 53, Whitfield Street. (Tel. Museum 5196.) „ „ Foundling Site Day Nursery, Terminus 6640.) „ „ 21 Situation. By whom provided. D. Nursery Schools. Somers Town Nursery School, 18, Crowndale Road. (Tel. Euston 1958.) A Voluntary Committee. Jellicoe Nursery School, 6a, Rochford Street „ Mary Ward Nursery School, 16, Burton Street „ Magdalen Mission Nursery School, 5, Clarendon Street The Mission Authorities. 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 (Tel. Gulliver 1667.): For nursing and expectant mothers and children under 5 years of age who attend the Maternity and Child Welfare Centres The Borough Council. Ampthill Square (Tel. Euston 2972): For mothers and children who attend the Centre at 1, Ampthill Square The Voluntary Committee. St. Pancras Dispensary (Tel. Euston 1882): For Tuberculosis cases „ For ordinary cases The Borough Council. The Dispensary Committee. Eastman Dental (Tel. Terminus 4331) : For Clinic nursing and expectant mothers and children ; also provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. The Committee of the Royal Free Hospital and Clinic. F. School Clinics. Highgate New Town : Chester Road St. Pancras Centre, Prince of Wales Road Clarendon Square Voluntary Committees, working under agreement with the London County Council. G. Tuberculosis Dispensaries. Barnes House, Camden Road. (Tel. Gulliver 1667.) The Borough Council. University College Hospital. (Tel. Euston 5050.) 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, Graves Inn Road (Tel. Terminus 4331) (for women and children only). University College Hospital, Gower Street (Tel. Euston 5050) (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. 22 Situation. By whom provided. 1. Clinic for Sick Mothers and Young Children. St. Pancras Dispensary, 39, Oakley Square. (Tel. Euston 1882.) 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," 1, St. Alban's Road, N.W. 5. (Tel. Gulliver 2626.) By Voluntary Committee, with grant from Borough Council. Invalid Children's Aid Association (various homes) Subsidy from Borough Council. K. Open Air Schools. Holly Court, Highgate, N. 6 London County Council. Euston Square, N.W. 1 ,, L. Cleansing Station. Cambridge Street, N.W. 1. (Tel. Euston 2132.) The Borough Council (part of accommodation let to L C.C. for cleansing of school children). M. Professional Nursing at Home. North London Nursing Association, 6 & 7, Canonburv Placc, N. 1. (Tel. Canonbury 1955.) By Voluntary Committee, with grant from Borough Council. Hampstead Nursing Association, 25, Heath Hurst Road, N.W. 3. (Tel. Hampstead 6406 ) ,, Metropolitan Nursing Association, 14, Oakley Square, N.W. 1. (Tel. Euston 1358.) ,, N. Massage Clinics. St. Pancras School for Mothers, Ampthill Square. (Tel. Euston 2972.) By Voluntary Committee. Somers Town Welfare Centre, Chamberlain House. (Tel. Euston 2380.) ,, Camden Town Welfare Centre, Barnes House. (Tel. Gulliver 1667.) ,, Provision of Insulin. With the sanction of the Ministry of Health, provision of insulin for necessitous patients 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 in 8 instances, 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. 23 (c) A quarterly report is to be furnished by the medical practitioner to the Medical Officer of Health giving the following information: — (1) The number of doses of Insulin administered, (2) Particulars concerning any tests made of the urine or of the blood of the patient. (3) The progress of the patient during the period under report. Patients who are insured under the National Health Insurance Act are not eligible under the above scheme, as supplies of Insulin are available for them under the Act. Public Health Officers of the Local Authority. A complete list of the above, including both whole and part time officers, is given on pages 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. Bve-laws made by the Borough Council:— (а) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. (c) For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. ((d) As to the paving of yards and open spaces in connection with a dwelling house. (e) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (f) With respect to the keeping of water-closets supplied with sufficient water for their effective action. (g) Mortuaries. 3. Regulations concerning the use of Post-mortem rooms. 4. Bye-laws and Regulations made by the London County Council, but enforced by the Borough Council:— (a) Drainage bye-laws and deposit of drainage plans. (b) Closing and filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of faecal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenments, etc. 24 (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) Ice cream vendors and premises. (s) Duties concerned with infant life protection under Part 1 of the Children Act, 1908. (t) Smoke abatement. (u) Fish curers and vendors of fried fish. (v) Dairies, cowsheds and milkshops. (w) Use of underground rooms for habitation. (x) Protection of food. B.—Public Health Legislation either enacted or coming into force during 1936:— (Public Health (London) Act, 1936. An Act to consolidate certain enactments relating to public health in London. Came into force 1st October, 1936.) 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. Health Week. The first Health Week for many years was held for one week during May. It was inaugurated by a letter from the Mayor, Alderman R. F. W. Fincham, addressed to all parents and prospective parents in the Borough. A full programme was arranged at each Welfare Centre of lectures, exhibitions, demonstrations, informal talks, films and competitions covering a wide field of subjects such as cooking for families of limited means, sewing, laundry, food values with special reference to buying and housekeeping, simple psychology, dental care and general maternal and infant welfare. The attendances recorded were between 6,000 and 7,000 adults, a very gratifying response to the efforts of the organisers which has proved to have been followed by an increased interest in the maternity and child welfare work in the Borough. Hospital Accommodation. A. Fever and Small Pox.—Hospital accommodation is provided by the London County Council. 25 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 (Tel. Euston 1617) 380 Highgate Hospital, Dartmouth Park Hill (Tel. Archway 2681) 546 London County Council Special Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum aud cougenital syphilis in children) (Tel. Gulliver 2483) 85 General and Special Voluntary Hospitals. Private 77 University College Hospital, Gower Street General 414 (Tel. Euston 5050) Obstetric 85 Royal Ear 41 General 256 Royal Free Hospital. Gray's Inn Road Obstetric 45 (Tel. Terminus 4331) Ear, Nose and Throat 21 National Temperance Hospital, Hampstead Road (Tel. Museum 5206) 153 Elizabeth Garrett Anderson Hospital, Euston Road (Tel. Euston 2501) 105 West End Hospital for Nervous Diseases, Regent's Park (Tel. Welbeck 1260) 76 Hospital for Tropical Diseases, Endsleigh Gardens (Tel. Museum 3326) 76 Central London Throat, Nose and Ear Hospital, Gray's Inn Road (Tel. Terminus 4311) 78 Central London Ophthalmic Hospital, Judd Street (Tel. Euston 25431 51 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square (Tel. Museum 6188) 22 St. Saviour's Hospital, Osnaburgh Street (Tel. Museum 2770) 21 North-West London Hospital, Bayham Street (Tel. Gulliver 1734) St. Pancras Dispensary, Oakley Square (Tel. Euston 1882) London Skin Hospital, Fitzroy Square (Tel. Museum 1411) Out- Western Skin Hospital, Hampstead Road (Tel. Museum 1464) patients British Dentists' Hospital, Camden Road (Tel. Gulliver 1977) only. London Foot Hospital, Fitzroy Square (Tel. Museum 0091) British Hospital for Nervous Disorders, Camden Road (Tel. Gulliver 2041) British Red Cross Society Clinic for Rheumatism, Peto Place (Tel. Welbeck 1133) Section II Population, Marriages, Births and Deaths. 27 Section II.-POPULATION, MARRIAGES, BIRTHS AND DEATHS. POPULATION. 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 211,366. The mid-year (1936) population of the Borough is estimated by the Registrar-General to be 183,900, the corresponding estimate for the previous year (1935) being 185,300. The following figures shew the estimated number of persons in each of the Wards in the Borough:— Administrative Area of St. Pancras Metropolitan Borough. Census, 1931. Total (Estimated) 1936. Males. Females. Total. Ward— No. 1 15,867 20,005 35,872 33,295 No. 2 9,621 10,054 19,675 18,265 No. 3 15,615 17,543 33,158 30,780 No. 4 11,965 11,990 23,955 22,233 No. 5 13,737 15,004 28,741 26,677 No. 6 8,861 9,139 18,000 16,706 No 7 6,155 6,867 13,022 12,063 No. 8 12,562 13,148 25,710 23,881 Total 94,383 103,750 198,133 183,900 MARRIAGES. The number of marriages celebrated during the year was 2,032. This is equal to a rate of 11.0 marriages per 1000 of total population, or a rate of 22.0 persons marrying per 1000 of the population. The average yearly number of marriages during the preceding five years was 1,988, equal to a rate of 10'4 per 1000 of population. BIRTHS. The number of births registered during the year belonging to St. Pancras was 2,389, equal to an annual birth rate of 130 per 1000 of population. This is a decrease of 0'3 births per 1000 under last year's figures. The rate for the previous year was 13 3, and the rate for 1934 was 13*1. The actual number of births registered as having taken place in the Borough during the year was 3,739. This figure is corrected by deducting the births of non residents (1,857), which occurred chiefly in various hospitals and other institutions in the Borough, and by adding the births belonging to St. Pancras (507) which occurred outside the Borough. The corrected figure is 2,389. 28 The corresponding figures for previous years, and the birtli rate for 1936 of the County of London and the Metropolitan Boroughs, are given on pages 14 and 16 respectively. The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1936, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Ward. 1936. 1935. Births. Birth Rate. Births. Birth Rate. 1 445 13.4 425 12.6 2 246 13.5 271 14.7 3 477 15.5 491 15.8 4 315 14.2 347 15.5 5 340 12.7 353 13.1 6 197 11.8 229 13.6 7 116 9.6 107 8.8 8 253 10.6 243 10.1 Borough 2389 13.0 2466 13.3 No less than 2,729 births occurred in Public Institutions in St. Pancras, equal to 72.9 per cent, of the total births which took place in the Borough. Illegitimacy. Of the 2,389 net St. Pancras births, 233 were recorded as being illegitimate. This equals 9.7 per cent, of the total births registered. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1926 6.3 per cent. 1931 8.3 per cent. 1927 6.9 „ 1932 8.0 „ 1928 7.3 „ 1933 8.8 „ 1929 7.8 „ 1934 9.8 „ 1930 8.4 „ 1935 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 3,879: this figure includes 144 still-births and 3,735 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 29 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 his 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, 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 no suspicious circumstances attach to the case. In accordance with the instructions of the Ministry of Health, the following table is included which gives particulars, by sex and legitimacy, with reference to all still births registered in the Borough during the year:— Still Births Registered. Inward Transfers. Outward Transfers. Still Births Allocated to the Borough. Total Legitimate and Males 90 17 52 55 Illegitimate Females 66 11 29 48 Illegitimate Males 8 1 1 8 Females 5 - 4 1 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 2,794. This number is to be corrected by the exclusion of 1,014 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 698 deaths of residents which occurred outside the Borough. The net number of St. Pancras deaths registered during the year was accordingly 2,478 ; equal to an annual death rate of 13.5 per 1000 of population. 30 The corresponding rate for the previous year was 12.0 and the average yearly death rate of the Borough for the previous five years was 13.0 per 1000 of population. Details of the corresponding: figures for previous years will be found in the table on page 14, and of the rates of other Metropolitan Boroughs on page 16. 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 will be found a factor (labelled C.F. 1.02) 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 constituted as regards the proportions of their sex and age group 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 13.5 per 1000 of population is adjusted by the comparability factor of 1.02 to 13.8 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 (2,416) includes all deaths registered during the period from 1st January to 31st December, it is less than the number (2,478) compiled locally for the period 53 weeks ending 2nd January. The latter figure has been used in this Report for statistical purposes. 31 THE CAUSE OF DEATH AT ALL AGES, TOGETHER WITH WARD DISTRIBUTION, IS SHOWN IN THE FOLLOWING TABLE:— (This Table, which is compiled by the Registrar—General, relates to the period 1st January to 31st December, 1936.) CAUSES OF DEATH. Ages—Both Sexes. DEATHS IN EACH WARD. SEX— Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 10 years. 10 and under 15 year.?. 15 and under 20 years. 20 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 and under 85 years. 85 years and upwards. Ward 1. Ward 2 Ward 3. Ward 4, Ward 5. Ward 6. Ward 7. Ward 8. No address. Totals. M F M F M F M F M F M F M F M F M F M F ALL CAUSES 184 31 30 21 8 24 55 89 119 254 426 575 478 122 206 233 124 108 229 200 179 117 160 180 114 93 92 53 157 123 26 22 1287 1129 1. Typhoid and Paratyphoid Fevers 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 2. Measles 3 6 7 2 — — — — — — — — — — 2 1 2 2 2 — 2 1 1 2 — 2 1 — — — — — 10 8 3. Scarlet Fever — — 2 2 — 1 1 1 — — — — — — — — — — — 1 1 — 1 1 — — 1 1 — 1 — — 3 4 4. Whooping Cough 8 7 — — — — — — — — — — — — 1 — — 3 1 — 1 1 — — — 2 3 — — 6 9 5. Diohtheria — 2 2 3 1 — — — — — — — — — 1 — 1 1 1 — 1 — — — 1 1 — — — 1 — — 6 2 6. Influenza 2 1 1 — 1 1 — 1 3 — 4 5 4 3 5 3 4 3 2 1 3 — — — 2 1 — — 1 2 — — 15 2 7. Encephalitis Lethargica — — — — — — — — — — — — 1 — — — — — — — — — — 2 — — — — 1 — — — 1 11 8. Cerebro spinal Fever 1 — — — — 1 — — — — — — — — — — — — — — 1 1 — — — — — — — — — 1 — 9. Tuberculosis of Respiratory System 2 1 1 — — 5 23 31 24 31 23 7 3 1 11 11 3 4 25 14 14 3 16 9 10 2 13 — 12 2 — — 104 1 10. Other Tuberculous Diseases 2 — 1 1 2 1 1 2 — 1 2 — — — 1 1 — 1 2 2 — 1 1 2 — 1 — 2 — 1 — 1 4 48 11. Syphilis 1 — — — — — 1 2 3 2 3 3 — — 2 — 1 1 1 1 — 1 1 1 2 1 — 1 1 — — 6 9 12. General Paralysis of the insane, tabes dorsalis — — — — — — 1 7 4 5 1 — — 1 — — 3 2 1 1 2 1 1 1 — 1 4 — — — 11 9 13. Cancer, Malignant Diseases — — — — — 4 1 6 23 58 87 123 56 6 38 33 15 12 33 29 27 20 25 30 17 11 9 9 21 29 — — 190 7 14. Diabetes — — — 1 — — 1 1 1 2 8 8 6 — 1 6 1 2 1 2 2 2 1 3 — 1 — — 3 1 5 4 9 171 15. Cerebral Haemorrhage, etc. — —— — — — — — — — 6 15 21 26 1 3 8 2 6 4 8 6 6 2 3 3 2 1 2 4 9 — 2 25 19 16. Heart Disease — — — 1 1 1 3 8 10 41 99 176 183 59 52 70 37 33 64 49 45 27 25 67 21 24 11 8 26 27 — — 290 44 17. Aneurysm — — — — — — 1 — 2 2 2 6 — — — — — — 1 3 2 1 2 — — — — 2 1 — 9 7 7 292 18. Other Circulatory Diseases — — — — — — — 2 9 18 39 38 11 8 18 1 9 10 11 7 9 4 7 6 8 4 4 4 5 1 — 46 6 19. Bronchitis 4 — — — — — 1 1 — 13 16 21 25 9 6 10 7 2 8 7 6 3 8 8 6 1 2 2 5 6 2 2 49 71 20. Pneumonia (all forms) 17 10 3 — — 2 — 5 7 19 37 41 36 5 11 9 11 7 13 15 19 7 11 18 14 9 9 3 15 10 2 — 104 41 21 Other Respiratory Diseases — — — — 1 2 — 2 2 3 1 4 3 — 3 1 — — 2 — 1 2 3 1 1 — 1 — 1 2 1 — 12 78 22. Peptic Ulcer — — — — — — — — 1 8 12 5 6 1 9 1 6 1 7 — 3 1 5 1 1 — 1 — 4 — — — 29 6 23. Diarrhoea, etc. 58 2 2 — — — — 1 — — 1 1 1 — 5 4 5 1 2 2 6 9 6 5 3 1 5 1 5 6 — — 37 4 24 Appendicitis — — — 1 — — 3 — — 2 3 2 — — — 1 2 — 1 — — — 2 1 — — 1 — 2 1 — — 8 29 25. Cirrhosis of Liver — — — 1 — — — — — 7 7 3 1 — 1 1 — 2 2 1 — — 5 1 1 — 1 1 2 1 — — 12 3 26. Other Diseases of Liver, etc. — — — — — — — 1 — — 1 5 2 2 3 1 1 — 1 1 — 1 — — — 1 — — 1 1 — — 6 5 27. Other Digestive Diseases 2 — 3 1 — — 1 3 7 4 10 15 8 1 6 8 3 — 2 9 — 3 4 2 3 1 2 4 4 4 — — 24 31 28. Acute and Chronic Nephritis — — — — 1 1 2 1 3 5 13 20 13 2 5 5 3 6 7 5 3 1 3 3 2 5 5 — 6 1 1 1 — 35 26 29. Puerperal Sepsis — — — — — — 2 2 1 — — — — — — — — — — 1 — — — 1 — 1 — — — — — 1 — 5 30. Other Puerperal Causes — — — — — — 1 1 — — — — — — — — — — — 1 — 1 — — — — — — — 2 — — — 2 31. Congenital Debility, Premature Birth, Malformations, etc. 62 — 1 — — — — — — — — — — 5 5 2 5 10 3 3 2 3 8 4 3 2 1 4 1 — 1 33 30 32. Senility — — — — — — — — — — — 4 13 8 1 1 2 1 5 3 1 — 2 4 2 1 — 1 — 1 — — 13 12 33. Suicide — — — — — — 3 4 6 7 10 4 — — 3 1 3 — 4 — 1 1 2 3 1 1 5 2 3 2 2 — 24 10 34. Other violence 5 — 2 4 1 4 4 5 9 4 12 10 11 7 9 4 3 3 5 9 3 3 4 5 6 3 5 1 8 4 — 3 43 35 35. Other defined Diseases 16 2 5 4 — 4 7 12 15 22 39 46 38 6 24 27 9 6 11 17 20 11 19 10 9 7 12 — 15 8 3 1 122 94 36. Causes ill—defined or unknown — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — 1 — — — 1 — Special Causes {included in No. 35 above) Erysipelas 1 — — — — — — — 1 1 — 2 1 — — — — — 1 1 1 1 — — — 1 — — 1 — — — 3 3 32 THE FOLLOWING TABLE GIVES PARTICULARS OF THE DEATHS IN PUBLIC INSTITUTIONS IN THE BOROUGH, TOGETHER WITH ST. PANCRAS DEATHS IN OTHER HOSPITALS OUTSIDE THE BOROUGH (This Table, which is compiled by the Registrar-General, relates to the period 1st January to 31st December, 1936.) CAUSES OF DEATH. St. Pancras Hospital. Highgate Hospital. St. Margaret's Hospital. University College Hospital. Royal Free Hospital. National Temperance Hospital. Eliz, Garrett Anderson Hospital. West End Hospital Hospital for Tropical Diseases. Central London Throat, &c., Hospital. Metropolitan Ear, &c., Hospital. St. Saviour's Hospital. Royal Ear Hospital. Hamp stead General Hospital. Middlesex Hospital. Other London Hospitals. Hospitals outside London. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St- Pancras. Belonging to | St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras Belonging to St. Pancras. Not belonging t0 St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St, Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St Pancras. ALL CAUSES 481 176 134 37 2 8 91 308 26 196 28 68 3 43 1 33 5 12 1 27 — 3 — 3 1 3 2 — 1 — 497 — 117 — 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 2. Measles — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — 11 — 5 — 3. Scarlet Fever — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 — 3 — 4. Whooping Cough — — — — — — — — — — — — — — — — — — — — . — — — — — — — — — 11 — 1 — 5. Diphteria — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 5 — 2 — 6. Influenza 2 1 4 — — — — 1 — — — — — — — — — 1 — — — — — 1 — — — — — — — — — — 7. Encephalitis Lethargica — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 8. Cerebro-spinal Fever 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — 9. Tuberculosis of Respiratory System 12 7 34 17 — — 3 9 1 3 — 1 — — — — — — — — — — — — — — — — — — 46 — 18 — 10. Other Tuberculous Diseases 2 3 2 — — — 4 9 1 1 — 4 — — — 1 — — — — — — — — — — — — — — 2 — — — 11. Syphilis 7 2 2 — — — — 1 — 1 — — — — — — — — — — — — — — — — — — — — 4 — — — 12. General Paralysis of the insane, tabes dorsalis 6 — — — — — 1 — — — — — — — 2 — — — — — — — — — — — — — — 2 — 9 — 13. Cancer, Malignant Diseases 74 23 86 5 — — 13 86 1 31 3 18 1 7 — 8 1 4 — 1 — — — 1 — 1 — — — — 79 — 9 — 14. Diabetes 3 1 3 — — — 2 10 1 — 1 2 — 1 — — — — — — — — — — — — — — — — 7 — 3 — 15. Cerebral Hæmorrhage, etc. 18 9 17 1 — — — 4 1 2 — — — — — — — — — — — — — — — — — — — — 6 — 2 — 16. Heart Disease. 101 37 108 3 — — 8 24 2 19 4 5 — 5 — 2 — — — — — — — — — 1 — — — — 103 — 20 — 17. Aneurysm — — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 18 Other Circulatory Diseases 38 8 17 — — — 5 2 1 4 — 3 — 1 — — — — — 1 — — — — — — — — — — 8 — 4 — 19. Bronchitis 20 4 11 — — — 2 1 2 3 1 — — — — — — — — — — — — — — — — — — — 13 — 1 — 20. Pneumonis (all forms) 58 20 37 3 — — 6 15 3 11 2 2 — 2 — — 1 1 — — — — — — — — — — — 27 — 8 — 21. Other Respiratory Diseases 6 1 1 1 — — — 3 — 1 1 1 — — — 1 — — 1 5 — 1 — — — — — — — — 3 — — — 22. Peptic Ulcer 4 3 9 — — — 1 10 2 5 2 1 — 3 — — — — — — — — — — — — — — — — 6 — — — 23. Diarrhæa, &c. 1 — 11 4 — 1 3 7 — 11 2 4 1 — — — — — — — — — — — — — — — — — 40 — — — 24. Appendicitis 3 — 2 — — — — 4 2 4 — 4 — 4 — — — — — — — — — — — — — — — — 2 — — — 25. Cirrhosis of Liver 4 — 1 — — — 4 3 1 — — — — — — — — — — — — — — — — — — — — — 2 — 1 — 26. Other Diseases of Liver, etc. — — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — — — 27. Other Digestive Diseases 9 3 16 1 — — 4 15 — 9 2 3 — 2 — 1 — — — — — 1 — — — — — — — — 21 — 2 — 28. Acute and Chronic Nephritis 11 6 10 — — — 1 4 — 2 — 2 — 4 — — 1 — — — — — — — — — — — 1 — 12 — 6 — 29. Puerperal Sepsis 2 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — — — 30. Other Puerperal Causes — — — — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — 1 — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 13 7 2 — 2 3 6 21 3 28 1 — — — — — — — — — — — — — — — — — — — 17 — 1 — 32. Senility 11 9 — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — 4 — 33. Suicide 1 4 1 — — — — 2 1 5 — — — — — 1 1 — — — — — — — — — — — — — — 1 — 34. Other violence 20 8 10 1 — — 7 7 — 24 3 2 — — — 1 — — — — — — — — — — 1 — — — 9 — 5 — 35. Other defined Diseases 54 18 44 1 — 4 18 65 4 32 5 16 1 7 1 16 1 5 — 17 — 1 — 1 1 1 — — — — 47 — 11 — 36. Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Special Causes (included in No. 35 above) Erysipelas 1 — 3 1 — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — —- Legitimate. Illegitimate. , j | ( M 84 13 Deaths under 1 year ) F 72 15 33 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 2,478 St. Pancras deaths which occurred during the year, no less than 1,759 took place in public institutions; this equals a proportion of 71 per cent. of the total deaths. As compared with the previous year there was an increase in the number of deaths due to Measles, Influenza, Pneumonia, Tuberculosis, Cancer, Heart Diseases and digestive diseases, and a decrease in those attributed to Syphilis. Deaths of Aged Persons. The corrected number of deaths of residents at 65 years of age and upwards, which occurred during the year 1936 was 1,203, which is 0'6 per cent, of the total population. Of these 591 were between the ages of 65 and 75; 486 were between the ages of 75 and 85, and 126 were 85 years of age and upwards. Ward Deaths and Death Rates. The number of deaths and the death rates per 1000 of population for each of the Wards during the past year were as follows, the figures for the preceding year being also given for comparison:— Ward. 1936. 1935. Deaths. Death Rate. (unadjusted) . Deaths. Death Rate. (Unadjusted.) 1 446 13.4 352 10.5 2 240 13.2 231 12.5 3 440 14.3 395 12.7 4 303 13.6 287 12.8 5 350 13.1 308 11.4 6 211 12.6 187 11.2 7 147 12.2 141 11.6 8 291 12.2 266 11.0 Homeless 50 — 52 — Borough 2478 13.5 2219 12.0 Deaths of Persons of unknown addresses, etc., included in the Mortality Statistics. The following deaths have been included in the Mortality Statistics of the Borough, in accordance with the Registrar-General's rules relating to " Transferable Deaths ":— Various Asylums 11 St. Pancras Hospital 26 Highgate Hospital 3 Royal Free Hospital 2 University College Hospital 2 Found dead, Parliament Hill Fields 2 ,, ,, Kenwood 1 „ „ Primrose Hill 1 „ ,, 14, Bernard Street 1 „ „ 22, Aldenham Street 1 Total 50 DEATHS FROM CANCER. The deaths from Cancer in the Borough during the year 1936 numbered 361, as compared with 326 in 1935. Particulars concerning this disease, as regards Age, Sex, Situation of Disease and Wards, are sex out in the following Table:— 34 The following table, which is compiled by the Registrar—General shows the deaths from Cancer in the Borough of St. Pancras from 1st January to 31st December, 1936. SITUATION OF DISEASE. AGES. SEX. CANCER DEATHS IN EACH WARD. No Address. 1 2 3 4 5 6 7 8 0—15 15—20 20—25 25—35 35—45 45—55 55—65 65—75 75—85 85& up] M F M F M F M F M F M F M F M F M F M F Total—all situations — 1 1 6 23 58 87 123 56 6 190 171 38 33 15 12 33 29 27 20 25 30 17 14 9 9 21 20 5 4 Lip — — — — — — — — 1 — — 1 — — — — — — — — — — — 1 — — — — — — Tongue — — — — 1 1 2 2 — — 6 — 3 — — — 1 — 1 — — — —— — 1 — — — — — Cheek (internal) — — — — — — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — Palate — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — — — Mouth — — — — — — — 4 — 1 5 — 1 — — — — — 2 — — — 1 — — — 1 — — — Jaw — — — — — — — 1 — — — 1 — — — — — — — — — — — — — 1 — — — — Tonsil — — — — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — Pharynx — — — — — — 3 1 — 4 — 1 — — — 1 — — — 1 — — — — — 1 — — — (Esophagus — — — — — 2 6 9 5 — 19 3 2 — — — 2 1 2 — 6 1 3 — 2 — 1 — 1 1 Stomach — — — 2 3 10 8 16 11 — 29 21 5 5 2 3 5 2 8 3 3 3 — 3 2 — 4 1 — 1 Rectum — — 1 — 1 3 9 11 4 — 14 15 2 4 1 1 1 — 1 2 2 3 2 — 1 3 3 2 1 — Liver — — — — — 3 4 1 2 — 7 3 2 2 2 — 1 — 1 — — — 1 — — 1 — — — — Gall Bladder — — — — — 2 — 1 — — 1 2 1 1 — — — 1 — — — — — — — — — — — — Pancreas — — — — 1 — 8 5 — — 8 6 3 1 2 — — 2 1 — 1 1 — — 1 1 — — — 1 Caecum — — — — — — 2 3 — — — 5 — 2 — — — 1 — — — 1 — — — — — 1 — — Hepatic Flexure — — — — — 1 — — 1 — — 2 — — — — — — — 1 — — — — — — — — — 1 Sigmoid — — — — — 2 1 4 — — 4 3 1 — 1 2 — 1 — — — — — — — — 1 — 1 — Colon — — — — — 2 6 9 2 — 12 7 3 — — — 3 1 1 — 3 3 1 — 1 2 1 — — Peritoneum — — — — — 1 1 — — — 1 1 1 — — 1 — — — — — — — — — — — — — — Intestine (not described) — — — — — — — 1 1 — 1 1 — — — — — 1 — — — — — — — — — — — — Larynx — — — — 1 2 1 2 3 — 7 1 1 — — — — — 2 — — 1 I — 1 — 2 1 — — Lung — — — 1 4 8 12 13 4 — 36 2 5 — 4 1 13 — 3 — 5 2 5 — — — 1 — — — Mediastinum — — — — — — — — 1 — 1 6 1 5 — — — — — — — — — — — — — — — Uterus — — — — 2 — 7 2 5 — — — — 4 — 1 — 5 — 3 — — — 1 — 1 — 3 — — Ovary — — — — 3 6 1 3 1 — — 22 — 1 — — — 3 — 3 — — — 1 — — — — — — Vulva — — — — — 3 — 2 — — — 11 — 1 — — — — — 1 — — — — — — — 1 — — Breast — — — — 3 1 6 13 6 3 — 3 — 4 — 2 — 8 — 1 — 9 — 3 — 1 — 8 — —— Kidney — — — 1 2 8 5 2 — — 6 39 — — 2 — 1 — — — 9 3 — 1 1 — — — — Bladder — — — — — — 2 7 2 1 7 4 2 2 1 — 1 1 1 1 1 — — — — — — 1 1 — Prostate — — — — — — 2 5 3 — 10 5 3 — — — 1 — 1 — 2 — — — — — — — — — Penis — — — — — 1 — — 1 — 2 — — — — — 1 — — — — — — — — — — — — — Testes — — — — 1 — — — — — 1 — — — — — — — — — 1 — — — — — — — — — Skin — — — 1 — — 1 2 1 — 1 4 — 1 — — — 1 — — — — — — — — — 1 1 — Brain — — — — — 1 — — — — — 1 — — — — — — — 1 — — — — — — — — — — Bones — 1 — — — — 1 1 — — 1 2 — 1 — — — — — 1 — — — — — — 1 — — — Others — — — 1 1 1 — 1 — 1 4 1 1 — — — 1 1 2 — — — — — — — — — — — 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 17 9 27 Pneumonia 2 — 2 — 12 8 24 Cerebral Hemorrhage . — — — — 7 3 10 Cancer — — 1 — 7 4 12 Tuberculosis 1 — — — 1 1 3 Other causes 10 — 4 7 54 24 99 Accidents— Street Vehicles 1 1 9 18 32 24 85 Burns and Scalds 2 4 3 1 5 9 24 Railway — — — 6 1 7 Falls — 2 — 3 28 72 105 Other causes* 7 1 5 7 36 12 68 Suicides† — — — 7 80 21 108 Manslaughter — — — 1 — — 1 Open Verdict ‡ 7 — — 1 9 — 16 Totals 30 8 24 46 293 188 589 § ‡ Includes 48 cases of coal gas poisoning. * Includes 1 case of coal gas poisoning. ‡Includes I case of coal gas poisoning. § St. Pancras cases 125, ex-St. Pancras 464 (see also page 36). Infantile Mortality. The number of deaths of St. Pancras infants under one year of age occurring during 1936 was 190 (of which 24 were of illegitimate children). This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 79. The corresponding rate for the previous year was 63. Further details will be found in the Maternity and Child Welfare Section. 35 36 Mortuary and Coroner's Court. These buildings are situated in Cambridge Street, at the rear of St. Pancras Gardens. The following table gives particulars concerning the number of inquests held, the number of bodies received and the post-mortem examinations made during each of the past six years:— 1931. 1932. 1933. 1934. 1935. 1936. Number of inquests held:— St. Pancras cases 101 121 151 128 142 125 Ex-St. Pancras cases 260 443 422 438 394 464 Number of bodies received:— St. Pancras cases 222 242 306 288 299 264 Ex-St. Pancras cases 374 571 510 525 501 502 Number of post-mortem examinations made:— St. Pancras cases 175 206 286 277 293 249 Ex-St. Pancras cases 229 415 446 492 454 453 Totals 1361 1998 2121 2148 2083 2057 Section III. Sanitary Circumstances of the Area. 37 Section III.-SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTION OF THE AREA. The work of the Council's Inspectorial Staff is allocated as follows There are eleven District Inspectors, each of whom is responsible in his own district for the duties of which particulars are given in the Table on page 38, and one Housing Inspector, who deals with the borough as a whole, under the Housing Acts. Two Food Inspectors divide the Borough for the purposes of the duties detailed on page 61. Work under the Factor}' and Workshops Acts is carried out by one male and one female inspector, and information as to the work carried out under these Acts will be found in the Tables on pages 47-50. Inspections.—62,869 visits and inspections were made in 1936 by the Council's staff of 16 Inspectors. Of these inspections, 47,309 were made by the 12 District Sanitary Inspectors (including the Housing Inspector), 7,508 by the two Inspectors of Food and Food places, and 8,052 by the two Inspectors of Factories and Workshops. Notices served.—3,586 intimation notices were served by the Inspectors during the year. Of these 3,305 were served by the District Sanitary Inspectors, and 281 by the Factory and Workshop Inspectors. 1,389 Statutory notices, 35 being under the Shops Act, were served for non-compliance with certain of the above intimation notices. Details of the work performed by the various Inspectors will be found in the following tables. 38 Report of Work carried out by District Inspectors for the year 1936. Complaints received, 3,538. Brown. Walker.§ James. akkrs. Jaffa. Capel. West.* Winchester Hague. Mansfield. Warren. Dykes. Thomas. Totals. On Complaint Whole house inspected 5 — 23 47 — 14 6 4 2 2 9 27 4 143 Do. Re-inspections 23 — 37 82 — 62 41 — 45 18 10 18 35 371 Part of house inspected 463 — 305 200 566 290 253 405 229 315 405 246 78 3755 Do. Re-inspections 1620 — 994 420 906 862 711 1152 956 555 893 591 188 9848 Infectious Diseases Investigations 123 — 149 82 160 167 77 204 118 239 157 106 10 1592 Inspections 57 — 64 27 63 75 26 S4 37 16 65 32 6 522 Re-inspections 381 — 347 191 31 386 52 227 222 35 133 56 29 2090 Smoke Observations 19 — 7 5 50 78 17 2 32 84 94 29 1 418 Offensive or Regulated Trades — — — 2 — — 40 — — 4 2 — — 48 Mews and Stable Yards 293 — 377 499 237 216 205 376 282 422 400 271 35 3693 Shops Act First Inspections 104 — 14 — 4 11 220 19 101 76 71 — — 620 Subsequent do 6 — 16 — — 11 171 15 78 18 16 — 3 334 Verminous Persons — — 6 3 6 — — 5 17 10 — — — 47 Pharmacy and Poisons Act First Inspections 23 — 23 2 24 26 22 38 10 23 19 23 1 234 Subsequent do. 2 — 16 '3 2 4 11 2 6 6 1 5 — 68 Other Inspections 49 — 73 105 299 267 35 302 192 214 288 128 44 1995 Housing Acts and Regulations Inspections 8 353 79 23 47 7 1 14 21 5 36 18 — 612 Re-inspections 31 2577 446 50 66 30 22 60 126 22 54 72 — 3556 Houses let in Lodgings Inspections 8 — 77 31 l03 27 1 60 12 4 51 42 — 410 Re-inspections 75 — 307 81 189 197 — 468 157 61 260 222 — 2017 Underground Rooms 59 — 40 143 35 136 66 233 57 250 112 62 15 1208 Drainage (a) Under Notice 460 — 4'5 426 197 114 176 96 469 336 139 65 5 2898 (b) Voluntary 305 — 610 931 300 829 759 450 361 1108 831 792 190 7466 (c) New Buildings 1 — 12 577 393 339 292 244 362 137 300 473 60 3190 Attendances at Police Court — — 10 17 — 14 7 6 7 — 7 1 — 69 Rent Restrictions Acts 20 — 31 4 6 — 6 6 — 11 — — 84 Canal Boats Acts — — — — — — — — — — — — — Food and Food Places — — — — — 11 — — — — — — — 11 Number of samples taken (Formal) — — — — — — — 3 — — — — — 3 Totals 4135 2930 4478 3961 3684 4253 3217 4445 3899 3960 4364 3279 704 47309 Notices served:— Intimations 432 279 203 351 286 225 479 249 243 295 205 58 3305 Pent Restrictions Acts 4 — — 2 2 — — 1 — — 5 — — 14 Totals 436 — 279 205 353 206 225 480 240 213 300 205 58 3319 § Housing Inspector. * Absent 11 weeks on account of illness. †Temporary Assistant Inspector. 39 Legal Proceedings. The following prosecutions were undertaken during the year in respect of general sanitary work:— Public Health (London) Act, 1801. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 33, Cobourg Street Main roof defective 1936. Jan. 15th Costs £2 2s. Order to abate nuisance within 14 days. 48, Cobourg Street Back addition roof defective Jan. 29th Costs £2 2s. Summons withdrawn. Work done. 4. Barnby Street Main roof defective Jan.29th Costs £2 2s. Summons withdrawn. Work done. 54, Acton Street Occupied house without proper and sufficient supply of water upstairs Feb. 5th Costs £2 2s. Work done. 58, Burton Street Sink waste from upstairs Sink discharging in such a manner as to cause a nuisance Feb. 27th Costs £2 2s. Summons withdrawn. Work done. 121, Drummond Street Wall of ground floor addition room damp, roof defective. Defective flue to fireplace of ground floor addition room Mar. 26th Costs £2 2s. Work carried out. Summons withdrawn. 100, Marquis Road Basement back room flooring and wall defective: basement scullery walls and front room wall defective Oct. 2nd Fine 10s. Costs £3 3s. 37, Cobourg Street Main roof defective Oct. 23rd Fine 5s. Costs £1 ls. 39, Cobourg Street Washhouse roof defective Oct. 23rd Fined 5s. Costs £1 1s. 26, Egbert Place Defective drain Dec. 7th Costs £2 4s. Adjourned sine die. Work in progress. Public Health (London) Act, 1936. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 30, Georgiana Street Failing to strip, purify and cleanse walls and ceiling of top floor front room 1936. Dec. 14th See Proceedings under L.C.C. Bye - laws (Public Health (London) Act, 1891. and Sec. 6 of Housing Act, 1925). London County Council Drainage Bye-lawn (Metropolis Management Act, 1855, and Metropolis Management Acts (Amendment) Bye-laus Act, 1899). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 173, Camden Road Fixing new lavatory basin and bath waste pipe discharging into a rain-water head, without uotice 1936. Aug. 19th Fine £1, Costs £2 2s. 8, Rochester Road Fixing two new sinks and waste pipe, without notice Nov. 13th Fine £1. 285, High Street Fixing a new water closet pan and trap without notice Nov. 18th Dismissed under the Probation of Offenders Act. 40 London County Council Bye-Laws—Public Health (London) Act, 1801, and Sec. ti Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 1, Barnby Street Failing to strip and cleanse walls and ceiling of top floor back room 1936. Jan. 15th Fine 5s. Costs £2 2s. 3, Swinton Street Failing to cleanse walls and ceilings of passage and staircase Feb. 27th Costs £2 2s. Summons withdrawn. Work done. 265, Gray's Inn Road Failing to cleanse walls and ceilings of passage and staircase and to remedy defective window cords of first floor back room Mar. 26th Costs £2 2s. Summons with. drawn. Work nearly completed. do. Failing to cleanse ceiling of second floor front room Mar. 26th do. Dust bin defective—two new bins required— plaster to walls and ceilings of passage and staircase defective: firegrate of first floor back room defective Mar. 26th do. Roof defective: plaster to ceilings second floor front and back rooms defective Mar. 26th 100, Marquis Road Failing to cleanse the walls and ceilings of the basement back room and basement passage Oct. 2nd Fine 10s. 33, Gobourg Street Failing to cleanse walls and ceilings of first and second floor back rooms and the staircase between the first and second floors, and to remedy defective condition of stair treads Oct. 9th Fine £5. 174, Cam len Street Failing to cleanse walls and ceilings of top floor front and back rooms and to remedy defective wall plastering thereof Dec. 14th . Costs .£1 3s. Summons withdrawn. Work done and costs paid. 30, Georgiana Street Failing to cleanse walls and ceilings of staircase, washhouse and water closet apartment and remedy defective staircase baluster Dec. 14th ... Costs £1 5s. Summons withdrawn. Work done and costs paid. London County Council Bye-laws — Public Health (London) Act, 1891. Situation of Properly. Offence. Date of Hearing of Summons. Result of Proceedings. Chalton Street Causing offensive matter to be removed without using a properly covered vehicle 1936. May 11th Fine £2. Costs £3 3s. Causing offensive matter to be removed during prohibited hours May 11th Fine £2. Removing offensive matter without using a properly covered vehicle May 11th Fine £2. Removing offensive matter during prohibited hours May 11th Dismissed under the Probation of Offenders Act. Clarendon Square Causing offensive matter to be removed without using a properly covered vehicle June 16th Fine £5. Causing offensive matter to be removed during prohibited hours June 16th Costs £2 2s. Removing offensive matter without using a properly covered vehicle Removing offensive matter during prohibited hours June 16th June 16th Adjourned sine die. Public Health (Preservatives, etc., in Food) Regulations. Defendant. Offence. Date of Hearing of Summons. Result of Proceedings. Erich Friedrich Selling sausages which contained an added preservative, such article not being labelled 1936. Nov. 18th Fine £1. Costs £2 2s. 41 Housing Act, 1930. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 5, College Mews Failing to comply with notice to vacate premises, ordered to be demolished under terms of the (College Mews) Clearance 1936. Oct. 2nd Order made to vacate within 29 days. 2 & 3, College Mews Failing to comply with notice to vacate premises, ordered to be demolished under terms of the (College Mews) Clearance Order Oct. 2nd Order made to vacate within 14 days. SMOKE ABATEMENT. During the year 418 observations of chimney shafts were made and 9 intimations were served. No statutory notices were served, and there were no prosecutions. The Public Health (Smoke Abatement) Act, 1926, came into force on July 1st, 1927. The term "smoke" was 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 Count}' Council, and a bye-law was made under powers contained in Section 2 of the Act on February 17th, 1931, and was allowed by the Minister of Health and came into force on May 19th, 1931. The bye-law states that the emission of black smoke for a period of three minutes, and, after five years from the date of confirmation of this bye-law, for a period of two minutes, in the aggregate within any continuous period of thirty minutes from any one chimney of a building, other than a private dwelling house, shall, until the contrary be proved, be presumed to be a nuisance liable to be dealt with summarily under the Public Health (London) Act, 1891. PREMISES AND OCCUPATIONS CONTROLLED BY ACTS, BYE-LAWS OR REGULATIONS. Offensive Trades. There are two licensed premises for such trades in the Borough—a tallow melter's in Tudor Place, which has been in existence since the year 1780, and a soap boiler's in Rochester Place. 48 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 anv balloon or toy— (a) in or from any part of the premises used for or in connection with his business, or 42 (b) in the course of his business while carried on from any cart, harrow 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 25 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 (Re-enacted under Section 136 of the Public Health (London) Act, 1936.) Rag Flock Premises. The above Acts prohibit the sale or use, for the purpose of making anv article of upholstery, cushions or bedding, of unclean dock 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. In recent years rag flock has been very much less used in the upholstery trades than formerly. No samples were taken during the year under consideration. Houses Let in Lodgings. Bye-laws dealing with these houses, made under power given by Section 6 of the Housing Act, 1925, came into force on March 5th, 1926. On the 8th June, 1931, the Minister of Health allowed the application to decontrolled houses of certain of the bye-laws which had been held in abeyance. Particulars concerning the inspections made will be found in the Table on page 38. These inspections relate to some 4,685 houses. Lighting of Staircases of Tenement Buildings. The above provision is required by Section 61 of the London County Council (General Powers) Act, 1927, which came into force on August 1st, 1928. Tenement buildings are regularly inspected in order to ensure that compliance with the Act is maintained. Common Lodging Houses. By the Transfer of Powers (London) Order, 1933, the registration, licensing, and inspection of common lodging houses were transferred to the Borough Council. The licences in respect of common lodging houses expire on the 30th June. Applications for the renewal of licences have to be made by the holder 21 days prior to the licensing meeting, and notification of the date of the meeting, and of the necessity for making application, if renewal is desired, has to be sent to each holder. Any objection to the granting or the renewal of a licence is required to be made in writing at least 7 days before the date of the licensing meeting. The Borough Council decided that the Public Health Committee should act on their behalf as the Licensing Authority at the Committee meeting to be held in June, and that the necessary notices giving the day and time of the meeting should be served on the persons concerned. 43 During the year the Committee Considered an application for the renewal of the licence of the common lodging house at 60, King's Road (33 beds for women). The premises were inspected and found to be satisfactory and to comply with the regulations. The licence was therefore renewed for the year ending June, 1937. 8 visits were made during the year to this common lodging house. Shops Act, 1934. The number of shops inspected during the year was 640, and the total number inspected since the coming into force of the Act is 3,369. Additional sanitary accommodation and/or improved arrangements in regard to ventilation and heating were provided in 49 shops as a result of these inspections. Certificates of exemption were granted in respect of twelve shops. , 1925, the responsibility for maintaining a canal boat in a habitable condition is now placed upon the owner, instead of the master.Canal Boats Acts. Under the Canal Boats (Amendment) Regulations Inspections of the canal and wharves are the duty of the District Sanitary Inspectors concerned. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920-1933. During the year 14 applications were received from tenants for certificates and in every case a certificate was granted, specifying the work required to be executed in order to put the house into a good and tenantable state of repair. In accordance with Section 5 of the Act of 1923, 12 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, and in 10 cases the "release" certificate was granted. In the remaining two cases the work had not been carried out to the satisfaction of the inspector. 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 224 of the Public Health (London) Act, 1936, authorises the removal to a home or institution of certain aged, diseased or infirm persons living under insanitary conditions. During the year two persons were so dealt with. 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. 44 Under Section 98 of the Public Health (London) Act, 1936, nine 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, 965 certificates were issued under Section 95 (2) of the Public Health (London) Act, 1936, 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 103 tenement houses under powers contained in Section 78 of the London County Council (General Powers) Act, 1907. PUBLIC BATHS AND WASHHOUSES. These are provided by the Borough Council at the following situations:—Prince of Wales Road, N.W.5; Whitfield Street, W.l; and King Street, N.W.1 A block of 12 slipper baths, available to the public, adjoins the Council's flats at Prospect Terrace, W.C.1 The water supply in all cases is obtained from the mains of the Metropolitan Water Board, but at the Prince of Wales Road Baths an additional supply is available from a deep well on the premises. For reasons of economy and hygiene the Council decided to instal a water purification plant to serve the four swimming pools at these baths, and the work was completed during the year. Discussion has taken place with Officers of the London County Council with a view to effecting certain improvements in the Highgate Swimming Pools, which lie within the area of the Borough. DRAINAGE. The sanitary inspectors have the duty of supervising all work in connection with drains, including construction, reconstruction and repairs. During the year the following work has been carried out; the figures for the previous two years are also given for the purpose of comparison :— Inspections. Inspections. Inspections. 1936. 1935. 1934. Drainage work done under notice 2898 2934 2958 Voluntary drainage work 7466 7478 8721 Drains of new buildings 3190 2651 2525 Total 13554 13063 14204 Drainage Register.—The following is an analysis of the Drainage Register daring 1936, the figures for the previous year being given for comparison :— 1936. 1935. Plans deposited—Old Buildings under Notice 70 86 „ ,, Old Buildings, Voluntary 218 238 „ „ New Buildings and Additions 58 58 346 382 Applications without Plans 472 464 Total number of Applications and Plans 818 846 45 Rats and Mice (Destruction) Act, 1919. During the year 129 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. The Ministry of Agriculture and Fisheries issued a Circular stating that this year's " Rat Week " would commence on Monday, 2nd November, and urging upon all local authorities responsible for the execution and enforcement of the Rats and Mice (Destruction) Act, 1919, the desirability of making a special effort during that week to secure concerted action with a view to the destruction of rats and mice. As in previous years, printed circulars on the subject and recipes for suitable poisons were sent to the occupiers of premises peculiarly liable, owing to the nature of the business carried on therein, to infestation by rats, and chemists' shops and stores were requested to stock, exhibit or advertise suitable rat poisons, traps, etc. 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 daily collections before 10 a.m. in prescribed main streets. Additional collections are also given to flats, eating houses, etc. The use of Pagefield lorries and containers, first introduced in 1925, has very much facilitated this work. B.—The methods of refuse disposal are :— (a) By combustion in the Destructor. (b) Removal to the country by rail. Rat Week. Refuse Collection and Disposal. The following figures for the past year are kindly supplied by Mr. C. S. Bainbridge, a m.inst.c.e., p.a.s.i., the Borough Engineer. For the purpose of comparison the figures for the previous year are also given:— 1936, 1935. Quantity of refuse collected Tons. 56169 Tons. 53780 Quantity of refuse burnt at Destructor 32867 32938 Quantity put on rail 23300 20856 Quantity of clinker residual 11150 12941 Section IV, Factory and Workshop Acts. 47 SECTION IV.—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. The arrangement is that the female inspector is responsible for inspecting workshops in which women are employed and for all visits to outworkers and to domestic workshops. The male inspector is responsible for workshops in which men are employed, including bakehouses and restaurants. Both inspectors visit workshops in which men and women are employed. Report of Work carried out by the Factory and Workshop Inspectors during the year 1936. Inspections and Re-Inspections. Thompson. Miss Camman. Totals. Factories (including factory laundries and bakehouses) 1876 798 2674 Workshops (including workshop laundries and bakehouses)... 1446 807 2253 Workplaces (including restaurant kitchens) 770 624 1394 Outworkers' premises - 1182 1182 Shops Act 372 36 408 Other Visits 4 137 141 Totals 4468 3584 8052 Notices served relating to:— Factories 141 24 165 Workshops 61 14 75 Workplaces 10 2 12 Others 24 6 30 Totals 236 46 282 48 1.—Inspections made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 2891 165 Workshops 2594 75 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1567 12 Totals 7052 252 — 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*: — Want of cleanliness 103 102 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 115 115 — — Sanitary accommodation— Insufficient. . 4 4 — — Unsuitable or defective 71 66 — — Not separate for sexes 5 5 — — Other breaches 35 35 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) 1 1 — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 59 59 — — Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) — — — Totals 393 387 — — * 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 tbeir own premises, lists containing the names and 49 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 1936, 257 notifications of outworkers were received from 19 local authorities outside St. Pancras. In the second half of 1936, 581 notifications were received from 20 local authorities outside St. Pancras. From St. Pancras employers in the first half of 1936, 278 notifications were received, of which 72 addresses were in St. Pancras. The remainder were forwarded to the appropriate local authorities. In the second half of 1936, 249 notifications were received, of which 70 addresses were in St. Pancras. The remainder were forwarded to the appropriate local authorities. The following table gives tbe number and type of outworkers' premises in the Horough and the principal industries concerned :— Nature of Work. Nature of Premises. Total. Factories. Workshops. Workplaces. Wearing apparel 59 163 156 378 Bootmaking — — 65 65 Embroidery — 2 33 35 Miscellaneous 1 — 52 53 Totals 60 165 306 531 4.—List of Factories, Workshops (Registered, Sec. 131) and Workplaces. Nature of Work. Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 69 79 — 148 Cabinet makers 61 62 123 Coach builders 21 14 35 Dressmakers 123 87 18 228 Engineers 219 36 255 Foundries 14 — 14 Furniture makers 15 19 34 Furriers 8 12 1 21 Laundries 12 3 15 Metal workers 37 35 72 Milliners 6 13 2 21 Organ builders 7 3 10 Pianoforte manufacturers 41 9 1 51 Printing 83 7 90 Restaurant kitchens — — 286 286 Tailors 51 233 114 398 Upholsterers 14 42 1 57 Wood carvers 9 10 19 Other occupations 618 477 417 1512 Totals . . 1408 1141 840 3389 50 5.—Other Matters. Class. Number. (1) (2) Matters notified to H. M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (b. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 21 Reports (of action taken) sent to H.M. Inspector 21 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1891, section 27) 14 Underground bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year. . 63 Bakehouses and restaurant kitchens are also referred to on page 47. 6.—Total Inspections of Factories, Workshops and Workplaces. Premises. Male Inspector. Woman Inspector. Total. Outworkers. Not Outworkers. Factories 2042 51 798 2891 Workshops 1515 272 807 2594 Workplaces <J07 859 660 2426 Total 4464 1182 2265 7911 Section V Housing. 3 51 Section V.-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 accordance with the requirements of the Ministry of Health :— Number of new houses and flats erected during the year :— («) Total (including number given separately under (b)) 363 flats and houses (6) With State assistance under the Housing Acts : — (i) By the Local Authority 106 (ii) By other bodies or persons 82 The 363 houses and flats mentioned above as having been erected during the year comprised the following : — 82 flats by the St. Pancras House Improvement Society, Ltd. (St. Jo-eph's House, Drummond Crescent, 36; St. Michael's House, Aldenham Street, 26; Pentland House, Wilkin Street, 20) ; 106 flats by the St. Pancras Borough Council (Denver House, Higligate Road, 44 ; Harmood House, Harmood Street, 62); 36 flats at Warren Court, Tottenham Court Road (London Transport); 20 flats at 32-35, Tottenham Court Road (Viscount Gort Estate); 119 flats at Paramount Court, Tottenham Court Road (Paramount Court, Ltd.). In addition, there were in course of erection at the end of the year 128 flats by the Crown Estate, 101 flats by the St. Pancras House Improvement Society, Ltd., 108 flats bv the London County Council, and 18 by the East End Dwellings Co., Ltd., in Cromer Street. 1. Inspection of dwelling-houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1693 (6) Number of inspections made for the purpose 9727 (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 1028 (b) Number of inspections made for the purpose 5513 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 1050 2. Remedy of defects without Service oj formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 3474 52 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 225 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 143 (b) By Local Authority in default of owners. . — (b)—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 837 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice : — (at) By owners 669 (6) 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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 (d)—Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made .. .. .. 188 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 (3) Number of underground rooms made tit as a result of preliminary notice only under section 20 (without Closing Orders) 20 (4) (a) (i) Number of dwellings overcrowded at the end of the year 4520 (ii) „ families dwelling therein 4520 (iii) ,, persons „ „ 31225½ (b) Number of new cases of overcrowding reported during the year 56 (c) (i) ,, cases of overcrowding relieved during the year 58 (ii) „ persons concerned in such cases 282 (d) Particulars of any cases in which dwelling houses have again become overcrowded after Local Authority have taken steps for the abatement of overcrowding Nil. Overcrowding. The preliminary survey required under the Housing Act, 1935, for the ascertainment of overcrowded houses was reported upon last year. A dwelling house is deemed to be overcrowded if the " permitted number " as determined in accordance with one or other of the following tables, whichever is the less, is exceeded :— 53 (a) Where a house consists of : — (i) One room 2 persons (Who must be of same sex unless under 10 years of age, or husband or wife). (ii) Two rooms 3 persons. (iii) Three rooms 5 persons. (iv) Four rooms 7^ persons. (v) Five rooms or over 10 persons "With an additional two persons in respect of each room in excess of five ; or (6) The aggregate number obtained by reckoning for each room a number of persons as follows : — (i) 110 sq. ft. or more 2 persons. (ii) 90 sq. ft. but less than 110 sq. ft. 1½ persons. (iii) 70 „ „ „ „ 90 1 person. (iv) 50 „ „ „ „ 70 ½ person. (v) Less than 50 sq. ft. Nil. In making these reckonings 110 account is to be taken of a child under one year of age, while children between the ages of one and ten are reckoned as half units. Overcrowding thus ascertained is not liable to be dealt with under the provisions of the Act until the "appointed day" is fixed by the Minister, and in fixing this day regard will be had to the special circumstances of each area. At the time of writing the appointed day has not been fixed for St. Pancras. HOUSING CONDITIONS. As stated in last year's report, 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." Slum conditions readily establish themselves in houses of this type and every effort should be made to prevent an increase of such conditions in St. Pancras as a result of gravitation from other parts of London as extensive demolition of slum property takes place. The Local Authority possesses powers not only to prevent slumming but to improve existing housing conditions. These powers are given under the following :— (a) The overcrowding provisions of the Housing Act, 1935. (b) The Bye-laws relating to Houses let in Lodgings, especially in regard to decontrolled houses. (c) Powers in relation to closure of underground rooms and parts of houses that are unfit for human habitation. (<d) Reconditioning of houses not fit for human habitation when this can be done at reasonable cost (Section 17, Housing Act, 1930). (e) Demolition of such houses when reconditioning cannot be done at reasonable cost (Section 19, Housing Act, 1930). hi 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. UNDERGROUND ROOMS. The following are the particulars of action taken during the yrear in respect of underground rooms : — No. of Closing Orders on separate rooms or tenements for human habitation .. .. .. .. ..170 No. of rooms the use of which has been discontinued for human habitation 143 No. of families accommodated elsewhere as a result of these notices by:— London County Council .. . . .. .. 3 St. Pancras Borough Council . . . . . . .. 29 No. of rooms vacated by own efforts or not used for human habitation by re-arrangement . . . . .. . . 68 HOUSING INSPECTOR. The following report upon the work he has carried out during the year is submitted by Mr. Walker, who was transferred from the post of District Sanitary Inspector to that of Housing Inspector in April, 1935 :— " I have to report that the working of Section 17 of the Housing Act, 1930, has again gone quite smoothly. From the attached summary of the work accomplished during 1936, it will be seen that I was able to inspect 303 houses as against 160 during the last eight months of the previous year. This increase is largely the outcome of the simplified system commenced last year. The number of houses reconditioned by voluntary specifications after a joint inspection by the owners' surveyors and myself is double last year's total at 69. All these specifications have received the approval of the l'ublic Health Committee. No inspections were made during 1936 for Clearance Areas, but the Ministry's Enquiry and consequent re-inspections of the Clearance Areas—Efskine Mews, Roberts Mews, Everton Buildings and Crown Place—occupied a considerable time. Some trouble has again been experienced in respect of the quality of work, but the majority of owners have carried out the work in a satisfactory manner. It is to be hoped that in any new Housing Act some attempt will be made to fix a standard in respect of work carried out upon working class dwellings. It has not been possible to devote as much time as I should have wished to the re-inspection of work in progress during the year, owing to the large number of houses awaiting inspection on my book. I have come to the conclusion that more time should be devoted to this most important part of the reconditioning." ho Summary of Work for 1936. 1936. 1935. Notices of Intention to survey, issued under Section 127 of the Housing Act, 1925, and served upon owners and occupiers 692 332 Surveys made under the Housing Acts 353 242 Specifications or Schedules prepared for the purposes of Statutory Notices under Section 17 of the Housing Act, 1930 234 130 Specifications agreed upon between the Council and owners without service of notices 69 30 Re-inspections of above 2573 1157 CLEARANCE ORDERS. The following Clearance Orders were made during the year:— Date. Site. Position at the End of the Year. 13th Feb., 1936 Crown Place Demolished. do. Erskine Mews Partly vacated. do. Everton Buildings Vacant, not demolished. do. j Roberts Mews, No. 1 Partly demolished. No. 4 occupied. 1 _ », >, No. 2 Demolished. 23rd April, 1936 Fitzroy Mews Partly vacated. do. Hargrave Place Vacant except one house. do. Hawley Mews Partly vacated. 26th Aug., 1935 College Mews Being demolished. NOTE —No. 18, Everton Buildings was represented to tbe Ministry, but the Order was not confirmed. WORK OF THE ESTATES COMMITTEE OF TIIE BOROUGH COUNCIL. The following account of the principal matters dealt with during the year has been furnished by Mr. W. C. W. Roworth, Administrative Officer: — 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 pf 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 :— (а) Goldington Buildings, Great College Street (56 flats). (б) Flaxman Terrace Dwellings, Euston Road (84 flats and Caretaker's Lodge). (c) Prospect Terrace Dwellings, Gray's Inn Road (71 flats). 56 (d) Una House, Prince of Wales Road (64 flats). (e) The Brookfield Estate, Highgate (113 flats, 90 maisonettes and 2 houses), (/) 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 I toad (22 flats). (h) Kennistoun House, Leighton Road (64 flats). (i) Denyer House (44 flats). {j) Ferdinand Place Estate (111 flats), consisting of Harmood House (62 flats), Ferdinand House (31 Hats), and Powlett House (18 flats), not yet completed. (k) 84 to 110 (even, inclusive), Leighton Road. (l) 13 and 15, Bayham Place. (m) 15, Willes Road (flat over filtration plant of Prince of Wales Road Baths). (n) 24, Grafton Road. (o) 41 and 47, Stanhope Street. (p) 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street. (q) 9, Georgiana Street. (r) 67, 69 and 71, Pratt Street. (s) 3, James Street. (t) 207, Arlington Road. (w) Oak House and Wellington House, East Finchley. Preference is given to persons residing in the Borough when vacancies occur on the Council's estates, and preferential consideration is given to families displaced from insanitary property or those living under overcrowded conditions. During the past year there have been 76 changes of tenancies in the Council's properties. Ferdinand Place Estate. The property on the site upon which this Estate is being developed was the subject of a Compulsory Purchase Order made by the Borough Council on the 21st February, 1934, which was confirmed by the Ministry of Health. The Order atfected 45 houses, a factory and a dance hall. There were bl families residing in the area with a population of 242 persons, for whom rehousing accommodation was provided. The site comprises 1| acres. The housing scheme was carried out by the Council's Ai-chitect, Mr. Albert J. Thomas, f.r.i.b.a., and consists of five 2-room, fifty-one 3-room, forty-seven 4-room and eight 5-room flats, a total of 111 dwellings, comprising 391 rooms, exclusive of kitchens. Under the provisions of the Housing Act, 1930, three blocks of flats will be erected on the estate when completed, named Harmood House (62 flats), Ferdinand House (31 flats), and Powlett House (18 flats). The first block of flats completed, viz., Harmood House, was opened by His Worship the Mayor (Alderman R. F. W. Fincham, f.c.a., j.v.) on the 5th May, 1936. Ferdinand House was completed in January, 1937. The population of Harmood House and Ferdinand House is 457 persons, of whom 102 are children under 10 years of age. Powlett House is in course of erection. The accommodation has been utilised to rehouse families from slum clearance areas and other insanitary property. The acquisition costs for the site were approximately £14,597 and the building 57 costs will be approximately £58,000. The builders are Tarran Industries, Ltd. The accommodation is subsidised by the Exchequer and also from the rates. The weekly rentals fixed by the Council are as follows: — Nefct. Inclusive. s. d. s. d. 2 rooms ., ., 7 0 10 3 3 rooms 8 3 12 2 4 rooms 9 6 14 2 5 rooms 10 0 15 4 In addition to the perambulator sheds on the estate, provision has been made for a number of sheds for the storage of barrows, etc. Denyer House, Highgate Road. The Council entered into negotiations with the London, Midland & Scottish Railway Co. for a site of approximately three acres upon which to provide working class accommodation. The land was situated at. the rear of Twisden Road, extending from Highgate Road to York Rise. The Railway Company, however, decided to retain this land in view of their commitments to rehouse families who would be displaced owing to the reconstruction of Euston Station. Subsequently the London County Council acquired a portion of this site, approximately j acre, 011 Highgate Road frontage. The County Council agreed to transfer their interests in this piece of land to the Borough Council, so that it could be developed under the provisions of the Housing Act, 1930, for working class accommodation. The scheme was carried out by the Council's Architect, Mr. A. J. Thomas, f.r.i.b.a., and consists of 44 flats, comprising 22 3-room, 18 4-room and 4 5-room dwellings, a total 158 rooms, exclusive of kitchens, bathrooms, etc. Each flat is provided with a separate bathroom, with hand basin, and a separate w.c. The contractors are Tarran Industries, Ltd. The cost of the site, exclusive of legal fees, etc., was £3,000, and the building contract is in t he sum of £26,193 9s. 8d. The estate was named after Councillor C. H. Denver, m.a., a former Mayor of the Borough, in view of his great interest in the provision of accommodation for the working classes. The tenancies were allocated to families displaced by the Council's Orders from slum clearance areas and other insanitary property. The building was opened by His Worship the Mayor (Alderman R. F. W. Finchain, f.c.a., j.p.) on the 22nd October, 1936. The accommodation is subsidised by the Exchequer and also from the rates. The weekly rentals fixed by the Council are as follows: — Nett. Gross. s. d. S. d. 3-room flats 9 3 13 2 4 „ „ 10 6 15 2 5 ,, ,, 11 0 16 5 The population consists of 241 persons, of whom 38 are '.children under 10 years of age. Carlow Street Estate. The site on which this estate is being developed formerly comprised Nos. 1-8 (consecutive, inclusive), Carlow Street, 1-7 (consecutive inclusive), Nelson Street, and 12-26 (even, inclusive), Arlington Road, which premises were the subject of a compulsory purchase 58 order made by the Borough Council and confirmed by the Minister of Health on the Tth August, 1935. The scheme submitted by the Council's Architect, Mr. A. J. Thomas, f.ii.i.h.a., and approved by the London County Council, consists of 4 two-room, 2 three-room, 43 four-room and 6 five-room tenements, a total of 55 dwellings, consisting of 216 rooms. A contract has been entered into with Messrs. M. J. Gleeson, Ltd., to carry out the work in the sum of £35,364. The total cost of the acquisition of the site was approximately £9,891. The development of the site involved the making of a Closing Order in respect of a portion of the footway in Nelson Street, which will be included in the estate. The Council have also taken over the private roadway in Nelson Street, which will be maintained as a public thoroughfare and will form an approach road to the estate. The building is in course of construction and will afford accommodation under the Housing Acts for families displaced by the Council's Orders from insanitary property. Somers Town Extension. The Council decided to make a small extension of their Somers Town estate at the north-western corner, which involved the demolition of Nos. 32, 33 and 33a, Johnson Street, the property of the Council, consisting of a fried fish shop, with living accommodation above, and storage accommodation for the estate. In order to complete tbe scheme, however, it was necessary to acquire No. 186, Seymour Street. The extension will provide accommodation for a fried fish shop on the ground floor, a five-room flat on each of the first and second floors, and one four-room and one three-room maisonette on the upper floors. Improved storage facilities will also be available for the purposes of the estate. The Council have placed a contract w ith Messrs. C. & F. Bryen to carry out the work for the sum of £6,417 9s. 6d. Leighton Road Site. Plans for the development of the site acquired by the Council in Leighton Road for the provision of working class accommodation are before the London County Council, so that it is not possible to indicate the amount of accommodation which will be provided on this estate. The area of the site is approximately acres and the site was purchased at a cost of £11,000, exclusive ol legal fees, etc. Queen's Crescent Site. The Council have acquired the site at present occupied by the Journeyman Tailors' Benevolent Institution, which covers an area of approximately two acres at the junction of Queen's Crescent and Prince of Wales Road, for the sum of £18,000, and have approved a tentative lay-out for the development of the site for working class accommodation. The plans, which embody a number of one-room flats to accommodate aged persons, are now before the London County Council for approval. It is proposed to use the accommodation, when available, for the purpose of abating overcrowding in the Borough. *■' Housing Site in Camden Park Road. The Borough Council have decided to acquire a site, formerly used as a reservoir, in Camden Park Road. The site is approximately 11 acres in area and a tentative lay-out has been approved. It is proposed to use the accommodation, when available, for the purpose of abating overcrowding in the Borough. 59 London County Council Housing Estates. The London County Council give preferential consideration to families who are living in overcrowded conditions and in cases where a member of the family is suffering from tuberculosis. The number of St. Pancras cases rehoused by the County Council under this arrangement between January, 1925, and Tccember, 1936, is 988. In addition, a number of families living in the Borough are rehoused by the London County Council as a result of direct application. Housing Schemes in the Bokough. The Borough Council have now developed ten housing estates in the Borough, with a totnl of 845 flats, comprising 2,768 rooms, exclusive of kitchens, etc. The Ferdinand Place estate will be completed shortly, and the Carlow Street estate and the Somers Town extension are in course of development. The Leightoti Road, Queen's Crescent and Camden Park Road schemes will be proceeded with so soon as the necessary sanctions have been obtained. The London County Council have placed contracts for the erection of a block of 101 flats to complete their Ossulston Estate. The Commissioners of Crown Lands are extending their housing scheme in the Cumberland Market area by the erection of a block of 128 flats in Redhill Street. During the year the St. Pancras House Improvement Society, Ltd., have erected 36 flats in Drummond Crescent, 26 flats in Aldenham Street and 20 flats in Wilkin Street, known as St. Joseph's Flats, St. Michael's Flats and Pentland House respectively. At the end of the year a further 101 flats were in course of erection. Section VI. Inspection and Supervision of Food. 61 Section VI.—INSPECTION AND SUPERVISION OF FOOD. The work of food inspection is carried out by two inspectors, who devote the whole of their time to these duties. Mr. Nixon inspects in Wards I, II, III and VI, and Mr. Adkins in Wards IV, V, VII and VIII. Particulars of the inspections and other duties carried out by these officers during the year are given in the following table:— Mr. Adkins. Mr. Nixon,* Total. Number of Visits to:— Milkshops 129 22 151 Dairies 243 231 474 IceCream Premises 2°3 63 208 Slaughter Houses 19 105 124 Butchers' Shops and Meat Stalls 504 '556 2060 Prepared Meat Premises 59 42 101 Fishmongers' Shops 99 187 286 Fried Fish Shops 17S 206 384 Fish Curers' Premises 19 41 60 Other Premises where Food or Drugs are sold 204 48 252 Marketing Streets and Places 2172 612 2784 Attendances at Police Court 6 9 15 Other Visits 304 245 549 Total 4'39 33^9 7508 Number of Samples taken : — Formal 203 144 347 Informal 197 256 453 Bacteriological 51 50 101 Total 451 450 901 Unsounij Foods. Surrenders:— Meat. &c 12 19 31 Fruit 3 2 5 Fish 7 10 17 Pickles 1 — 1 Cheese 2 — 2 Vegetables .. .. .. .. .. .. — 1 i Sweets .. .. ., — 1 i Total 25 33 58 Seizures:— — — — * Owing to sickness Mr. Nixon was absent from duty for 11 weeks. During this time assistance was rendered by Messrs. Winchester and Capel, and figures of the work done by these Inspectors may be seen on page 38. MILK SUPPLY. Cotctheds.—There are no licensed cowsheds in the Borough. Dairies and Milks/iops.—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, 62 The term " dairy " does not include a shop from which milk is sold only in the properly closed and unopened receptacles in which it is delivered to the shop. Premises in which milk is sold only in sealed rec3ptacles accordingly do not require to be registered. Persons selling milk in such sealed receptacles must, however, be registered as purveyors 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. Twenty-five applications for registration under the Milk and Dairies Order, 1926, were granted during the year. Eleven applications in respect of itinerant vendors were also granted. The following list gives particulars as to registrations and de-registrations during the year. Milkshops. Purveyors of Milk. Number on register at end of 1935 187 59 Number removed from register during 1936 25 8 Number added to register during 1936 26 11 Number on register at end of 1936 187 62 In addition to the above, six persons (firms) were also on the register at the end of 1936 in respect of premises at which retail trade in cream is conducted. Milk in Sealed Containers. During the year 22 persons were registered to sell milk in sealed containers, and 13 were removed from the register. At the end of the year there were 232 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]." It is the practice of this Council to charge a fee of 10s. 6d. each in respect of samples taken under this section. The samples have to be taken very early in the morning, usually between 3 and 4 a.m. The number of samples taken under this arrangement during this year was fifteen, for which purpose three visits were made. The fees were handed to the inspectors concerned in accordance with a resolution of the Council. Milk (Special Designations) Orders, 1923 and 1936. On 1st June of the year covered by this report the Milk (Special Designations) Order, 1936, came into force, and introduced certain changes in regard to the titles of and standards of purity of designated milk. 63 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 (see pai/e 62), the Milk (Special Designations) Orders, 1923 and 1936, and the Milk Act, 1934. The Special Designations [1923 Order] comprised the following: — " Certified," " Grade A (tuberculin tested)," " Grade A," " Grade A (pasteurised)," and " Pasteurised." The Special Designations [1936 Order] comprised the following:— " Tuberculin Tested : "Accredited "; and "Pasteurised." Particulars as to the number of licences and the samples taken for bacteriological examination under this Order during 1936 are contained in the following table: — Grade for which licence was issued. No. of licences 31st Dec., 1935. Samples. No. complying with standard. No. below standard. Total samples. Under 1923 Order— Certified Milk 18 — — — Grade A (Tuberculin Tested).. 33 11 l 12 Grade A 16 3 l 4 Pasteurised 57 33 — 33 Under 1936 Order— Tuberculin Tested 1 10 8 18 Accredited 2 3 — 3 Pasteurised 5 27 2 29 Unremitting care on the part of all engaged in its production and distribution is essential if the standards of purity of designated milk arc to be maintained. The licensee was communicated with regarding every sample found to be unsatisfactory, and assurances were received in every instance that appropriate steps would be taken to secure that milk sold under this Order would in future comply with the required standards. During the year 14 samples of milk were tested for the presence of Tubercle Bacilli, all of which were found satisfactory. Upon the coming into force of the Milk Act, 1934 (in August 1935), 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 Is. 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. 64 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.I.) 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. Samples of milk numbering 50 were taken from schools in the Borough and submitted to bacteriological examination, the result in 48 cases being satisfactory. In the remaining Iwo instances the licensees' attention was drawn to the matter, and assurances were received that in future every precaution would be taken to ensure that the graded milk sold by them complied with the provisions of the Order. 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. Artificial Cream is defined in the Act as an article of food resembling Cream and containing no ingredient which is not derived from milk, except water. In actual practice it is manufactured from dried milk, butter and water in suitable proportions, and the term Re-constituted Cream would appear to be more appropriate than the word Artificial. 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., and particulars of the number of visits appear on page 61. The undermentioned unsound or diseased food was surrendered by the owners for destruction or to be dealt with as trade refuse. On no occasion was a seizure of unsound food made. Unsound Food Condemned and Destroyed. Surrendered. Corned Beef, 30 lbs. and 2 tins. Haddocks, 16 stones. Pigs' Heads, 9. Ham, 45J lbs., I tin and 1 ham. Greens, 6 sacks. Peaches, 8 boxes. Nectarines, 132 boxes. Apples, 21 boxes. Beef, 11 stones. Bacon, 264J lbs. Sardines, 200 tins. Kippers, 11 boxes. Fish, 12 stones. Strawberries, 168 lbs. Pickles, 1 gallon. Cherries, 44 boxes. Herrings, 1 cwt. Hogs Meat, fore quarter. Cheese, 1076 lbs. Skate, 190 lbs. Cod, 3 stones. Pieces, 5 lbs. Cocoanut ice sweet, 5 lbs, Sprats, 50 lbs. 65 SLAUGHTER-HOUSES. This Council having passed a resolution as provided in the Slaughter of Animals Act, 1933, extending the provisions of the Act relating to humane slaughter so as to include sheep, ewes, wethers, rams and lambs, the requirements of the Act as to humane killing apply to all animals killed in slaughter-houses in the Borough. These provisions apply also to Knackers' Yards, but there are none of these in St. Pancras. There are three slaughter-houses in the Borough for which licences have been obtained, viz.:—12, Pond Square (rear of 61, High Street, Highgate), 166, Great College Street and 65, Osnaburgh Street. No slaughtering takes place at the latter premises. Particulars regarding these slaughter-houses and their inspection, for the purpose of which 124 visits were made, are contained in the following table, as required bv the Ministry of Health Animals. Post Mortem Inspections. Condemnations. No. of killings. Carcases. Organs. T.B. Other diseases. T.B. Other diseases. Sheep 150 __ — — 150 Lambs 110 — — — — 110 Pigs 350 — — 9 — 350 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 bo 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, and the necessary notices giving the day and time of the meeting will be served on the persons concerned. Licensing of Slaughtermen. Applications for licences for slaughtermen under the provisions of the Slaughter of Animals Act, 1933, were received from fiveipersons 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, he was a fit and proper person to act as a slaughterman and the licences were granted for one year ending 31st October, 1937. f>6 PUBLIC HEALTH (MEAT) REGULATIONS, 1024. A periodical inspection of butchers' shops and meat stalls is carried out under these regulations, and the number of visits paid will be found in the table on page 61. No prosecutions were undertaken during the year in question. Fried Fish and Fish Curing Premises. In 1936 there were 81 fried fish vendors' premises in the Borough, at 8 of which fish curing was also carried on. There were 18 fish curers' premises, including the 8 above mentioned. Visits made by the Food Inspectors to these premises during the year totalled 444. 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 anv 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 344. Bakehouses and Restaurant Kitchens. At the end of 1936 there were 148 bakehouses on the register, as compared with 147 at the end of 1935. These bakehouses are classified in the following table:— Factory Bakehouse. Workshop Bakehouse Not in Use. Total. Above ground 17 15 9 41 Under ground 52 11 44 107 148 At the end of the year 286 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 47 to 50. 67 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Analyses of 800 samples have been made under this Act, of which 347 were formal and 453 informal. Of the formal, 332 proved to be genuine, and 15, or 4.3 per cent., adulterated; and of the informal, 437 were genuine and 16, or 3.5 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Almonds (ground) — 4 — 4 — — Anchovies (bottled) — 1 — 1 — — ,, (canned) — 1 — 1 — — Apricots (dried) — 3 — 3 — — Arrowroot — 1 — 1 — — Aspirins — 1 — 1 — — Bacon — 2 — 2 — — Beans, Baked (canned) — 3 — 3 — — Beef — 1 — 1 — — Bisto — 1 — 1 — — Brawn — 6 — 6 — — ,, (canned) — 1 — 1 — — Bread (brown) — 1 — 1 — — ,, (white) — 1 — 1 — — Butter — 50 — 50 — — Cake, sponge — 2 — 2 — — Carrots (canned) — 1 — 1 — — Cheese — 6 — 6 — — Chocolate — 1 — 1 — — Cocoa — 4 — 4 — — Cocoanut, dessicated — 3 — 3 — — Coffee — 2 — 2 — — Cookeen — 1 — 1 — — Cornflour — 2 — 2 — — Crab (canned) 1 — 1 — — Cream 3 5 3 5 — — ,, (canned) — 2 — 2 — — Cube, black currant — 1 — 1 — — „ orangeade — 1 — 1 — — Cucumber, pickled — 1 — 1 — — Currants — 10 — 10 — — Doughnut — 1 — 1 — — Dripping — 2 — 2 — — Essence (lemon) — 1 — 1 — — Faggott — 1 — 1 — — Figs (canned) — 1 — 1 — — Flour, bun — 2 — 2 — — ,, cake — 2 — 2 — — ,, (self-raising) — 1 — 1 — — Fruit (dried) — 2 — 2 — — „ mixed (dried) — 2 — 2 — — Ginger (ground) — 4 — 4 — — Glycerine, Lemon aud Ipecacuanha — 1 — 1 — — Grape Fruit (canned) — 2 — 2 — — Haricot Babbit (canned) — 1 — 1 — — Herrings (canned) — 4 — 4 — — Honey — 2 — 2 — — Jam 4 — 4 — — ,, (canned) — 1 — 1 — — Jelly — 2 — 2 — — „ Mint — 1 — 1 — — Carried forward 3 157 3 157 — — 68 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 8 157 3 157 Jelly, Table — 1 — 1 — — Juice, Tomato (canned) — 1 — 1 — — Kidney, Pig's, and Sweetbread — 1 — 1 — — Lard — 10 — 10 — — Lobster (canned) — 1 — 1 — — Lozenges — 1 — 1 — — Macaroni — 1 — 1 — — Margarine — 2 — 1 — — Meat (minced) 2 12 2 10 — 2 Milk 327 6 314 5 13 1 ,, (condensed, full cream) — 2 — 2 — — ,, (condensed.sweetened,skimmed' — 2 — 2 — — ,, (evaporated) — 1 — 1 — — Mincemeat — 1 — 1 — — Mixture, sponge — 1 — 1 — — Mustard — 1 — 1 — — ,, Compound — 2 — 2 — — Oil, camphorated — 1 — 1 — — ,, castor — 2 — 2 — — Ointment, Basilicon — 1 — 1 — — ,, Zinc — 2 — 2 — — Olive Oil — 5 — 5 — — Onions, pickled — 1 — 1 — — Oranges (canned) — 2 — 2 — — Paste, fish — 4 — 4 — — ,, meat. 3 — 3 — — Pastry, Coloured — 1 — 1 — — Peas (canned) — 5 — 5 — — „ (dried) — 1 — 1 — — „ (split) — 1 — 1 — — Pepper — 12 — 12 — — Pickles — 1 — 1 — — „ (sweet) — 1 — 1 — — Pie. fruit — 2 — 2 — — „ meat — 14 — 14 — — Pilchards, Tomato sauce (canned) — 1 — 1 — — Pills. Liver — 1 — 1 — — Plums (bottled) — 1 — 1 — — Powder, custard — 3 — 3 — — ,, lemonade — 1 — 1 — — ,, pudding — 1 — 1 — — Prawns (canned) — 1 — 1 — — Pudding, meat — 1 — 1 — — Raisins — 10 — 10 — — Raspberries (canned) — 1 — 1 — — Rice — 5 — 5 — — Roes, soft (canned) — 1 — 1 — — Roll and Meat — 4 — 4 — — Salad, Fruit (canned) — 3 — 3 — — Salmon (canned) — 5 — 5 — — Salt, gravy — 1 — 1 — — Salts, Epsom — 4 — 4 — — Sardines 1 23 — 22 1 1 Sauce — 4 — 4 — — ,, Mint — 1 — 1 — — Sausage 11 30 10 30 1 9 „ cooked — 8 — 8 — — Carried forward 344 381 329 368 | 15 13 69 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informa Formal Informal Formal Informal Brought forward 344 381 329 368 15 13 Sausage, Frankfurter (canned) — 1 — 1 — — ,, liver 3 3 3 — — 3 Sherbet — 1 — 1 — — Sild (canned) — 11 — 11 — — Soap (coal tar) — 1 — 1 — — Soup (canned) — 4 — 4 — — Spread Cheese and Tomato — 1 — 1 — — Suet — 1 — 1 — — Sugar — 14 — 14 — — Sultanas — 8 — 8 — — Sweets — 1 — 1 — — Swiss Roll — 1 — 1 — — Syrup of Figs — 1 — 1 — — „ Golden — 1 — 1 — — „ Lung — 1 — 1 — — Tablets, Ammoniated Quinine — 1 — 1 — — Tea — 1 — 1 — — Tincture of Iodine — 1 — 1 — — Tomatoes (canned) — 12 — 12 — — Tongue (canned) — 1 — 1 — — ,, (cooked) — 1 — 1 — — Tripe — 3 — 3 — — V inegar — 2 — 2 — — Totals 347 453 332 437 15 16 Summonses. Prosecutions were undertaken in respect of 13 samples, which were reported as being adulterated. The results of the proceedings are stated in the following table:— Article. Result of Analysis Food and Drugs (Adulteration) Act, 1928. Date of Hearing. Result of Proceedings. Penalty. Costs. Milk Deficient in milk-fat 27 per cent. 1936. 17th Jan. Dismissed under Probation of Offenders Act £ s. d. 5 5 0 „ „ „ „ 6.6 „ 26th Feb. Fined 40/-on each Summons with £3 3s. Od. Costs. Time to pay was refused. Committed for 1 month. „ „ „ „ 6.0 „ „ „ „ „ 6.0 „ 17th Dec. „ „ „ „ 6.0 „ Fined 40/- and 10 gns. Costs on one Summons and 40/- on each of the other nine Summonses. „ „ „ „ 8.0 „ „ „ „ „ 6.6 „ „ „ „ „ 7.0 „ „ „ „ „8.6 „ „ „ „ „ 54 „ „ „ „ „ 40 0 „ „ „ „ „ 5.6 „ „ „ „ „ 33.0 „ 70 A prosecution was also undertaken under the Public Health (Preservatives &c. in Pood) Regulations, in respect of a sample of Sausages, which contained an added preservative and were not labelled in accordance with the Regulations. A penalty of 20s. was imposed and costs of £2 2s. Od. allowed. Wholesale Dealers in Margarine.—No certificates of registration under the provisions of the Food and Drugs (Adulteration) Act were issued during the year. PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS 1925-1927. All samples were examined for any contravention of these Regulations and two were found to contain proportions of preservatives contrary to the standards. These samples (one sardines and one sausages) had been taken formally and the Committee decided to send a cautionary letter to the vendor in the first case. In the case of the sausages a prosecution was instituted and a fine of £1 with £2 2s. Od. costs was imposed. I have to thank Mr. .T. Kear Colwell, f.i.c., the Borough Analyst, for the following notes upon the work he has carried out during the year. Report of the Borough Analyst. During the year 1936, 800 samples were submitted for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 347 having been purchased with the required formalities and 453 obtained informally. Of this total, 30 (3.8 per cent.) proved to be adulterated, 14 being samples submitted formally and 16 informally. Last year 26 (3.25 per cent.) were so certified, 18 being submitted formally and 8 informally. The adulterated articles consisted of Milk, Minced Meat, Sardines, Liver Sausage and Sausages. Milk.—Three hundred and nineteen samples of milk were examined and fourteen (4 4 per cent.) fell below the limits required by the board of Agriculture Regulations— 3.0 per cent. for fat and 8.50 per cent. for non-fatty solids—and were certified to be adulterated. Thirteen of the adulterated samples were deficient in fat, the amount varying from at least 2.9 per cent. to at least 40.0 per cent., and to the remaining adulterated sample water had been added to the extent of at least 2.9 per cent. It must be pointed out that the Board of Agriculture limits are not to be regarded as the average for milk of good quality, but are to be taken as the limits for genuine milk of the poorest quality, and if the sophistication in the samples mentioned in the previous paragraph were compared with the average milk supply of St. Pancras the adulteration certified would be much greater. In the table given below I have set out the results of the analyses of the genuine milks month by month, prepared by the Public Health Department, and have compared them with a similar table introduced in the last Annual Report. 71 Monthly Variation of Chemical Composition of Genuine Milk during the Years 1934, 1935 and 1936. Month. Number of Samples Examined. Genuine. Fat per cent. Average. Non-fatty Solids per cent. Average. 1934. 1935 1936. 1934. 1935. 1936. 1934. 1935. 1936. January 39 44 14 3.6 3.5 36 8.94 8.97 9.10 February 37 32 32 3.8 3.5 3.6 9.00 8.74 9.10 March 19 51 44 3.5 3.3 3.5 8.96 8.81 9.00 April 17 29 23 3.8 33 3.5 8.89 8.75 8.93 Mav 15 29 24 3.5 3.7 3.5 8.97 8.84 9.02 June 30 34 15 3.4 3.5 3.3 9.03 8.88 9.01 July 60 19 48 3.4 3.4 3.4 9.00 8.96 8.93 August 35 14 36 3.5 3.4 3.4 8.89 8.77 8.95 September 43 30 31 3.5 3.6 3.7 9.08 8.87 9.03 October 37 46 30 3.7 3.7 3.7 9.02 8.93 9.11 November 30 31 16 3.8 3.6 3.8 9.01 9.02 9.06 December 16 19 6 3.5 3.6 3.8 9.00 9.06 9.07 Whole Year 378 378 319 3.6 3.5 3.6 8.98 8.89 9.03 It will be observed that the average for both fat and non-fatty solids varies very little from year to year, the actual average for the three years being 3 57 and 8.97, so that the general milk supply of the Borough must be regarded as not unsatisfactory. Minced Meat—Two of the samples of minced meat contained sulphite preservative, the amount found being 123 and 82 parts per million of sulphur di-oxide respectively. No preservative is permitted to be used in minced meat and they were therefore certified to be adulterated. Sardines.—During the year considerable attention has been paid to the question of sardines as a number of samples from different parts of the kingdom were found to contain an excessive quantity of lead. In some cases the amount of this metal found was as much as 40 parts per million, and most of these were sardines imported from Portugal. As this is a dangerous quantity, owing to the fact that lead is a cumulative poison, enquiries were set on foot to ascertain the cause of the presence of lead and to find whether its distribution was general throughout the industry, or confined to sardines imported from particular countries. As is well known sardines and similar fish packed in cans under the name of sardines are submitted to a process of cooking before the actual canning takes place. The process of cooking consists of grilling the fish for a short time over a fire, and it was found that in some cases the grill on which the fish were laid was composed of an alloy containing a large proportion of lead and that in the process to which they were submitted, the fish were liable to absorb considerable quantities of this metal. This was particularly the case with fish prepared and canned in Portugal, and steps were taken either to destroy all the consignments in which the excess was found, or return them to the country of origin. 72 Of twenty-four samples examined in St. Pancras, two were found to contain 25 and 33 parts per million of lead respectively, and were therefore certified as adulterated. It is of the utmost importance to maintain such a popular delicacy as the sardine in the highest condition of purity, and fish containing such a large amount of toxic metal as lead cannot be dealt with too drastically. Sausages.— In all, fifty-three samples of sausages were examined and nine were found to have been preserved with a sulphite preservative without due notice having been given to the purchaser, and were certified accordingly. The quantity of sulphite found varied from 27 to 480 parts per million of sulphur di-oxide. When notice is given to the purchaser, sausages are allowed to contain as much as 450 parts per million, but, in one case where the sausages were not marked "Preserved" there was such an amount of preservative present that clearly indicated that the preservative had been thrown in to the sausage contents in a very haphazard fashion, which is just the proceeding that the Preservatives Regulations were intended to stop. A further instance of this carelessness was found in a sample sold as "Preserved Sausages" where the sulphite present was 520 parts per million, an excess of 70 parts per million above the permissible quantity. It has been shown that when preservative is added to sausage meat there is a very rapid disappearance of the preservative at first, so that it may be assumed that when it comes into the Analyst's hands he finds very much less than that originally added and probably much less than some of the purchasers may have already consumed. I need hardly say how exceedingly reprehensible the reckless addition is, and how extremely injurious to health it may be to persons who react somewhat easily to the particular compound used. In addition, two samples of liver sausage contained 123 and 215 parts per million of sulphur di-oxide respectively. I make no apology for again referring to the urgent necessity for the appointment of a small Official Committee, which should be empowered to fix and revise Standards for Food. It is only necessary to instance such things as vinegar, cream, cheese, and other articles of daily consumption, for which, at present, there is no Official Standard. Although the honest vendor does his best to provide his customers with the genuine article, properly described, there are unscrupulous persons who continue to hoodwink the public and yet are able to remain under the cover of the law, as it stands at present. Section VII. Prevalence of, and Control over, Infectious Diseases. 73 Section VII. - PREVALENCE OF, AND CONTROL OVER, NOTIFIABLE DISEASES. The undermentioned diseases are eompulsorily notifiable in St. Pancras:— A. Under the Public Health (London) Acts, 1891 and 1936:— Small-pox (Variola) Typhus Fever Cholera Typhoid „ Diphtheria and Membranous Croup Entcric ,, Erysipelas Relapsing ,, Scarlet Fever (Scarlatina) Continued „ Puerperal „ B. Under Special Regulations made by the Ministry of Health granted under powers contained in the Public Health Acts:— Plague (1900) Cerebro-spinal Fever and Acute Poliomyelitis (1912) Acute Encephalitis Lethargica and Acute Polio-encephalitis (1919) Puerperal Fever and Puerperal Pyrexia (1926, 1928) Ophthalmia Neonatorum (1926, 1928) Tuberculosis (1930); and the Infectious Diseases (London) Regulations, 1937, 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, and the Public Health (London) Act, 1936 Food Poisoning. 74 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1936. 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 vear. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. S 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. I. Small-pox _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. Scarlatina or Scarlet Fever 4 26 28 33 43 57 50 25 60 3 4 1 434 424 6 3. Diphtheria and Membranous Croup 10 22 37 52 34 186 71 17 40 12 5 1 487 483 8 4 Enteric or Typhoid Fever 2 _ _ 1 _ 1 1 3 2 1 _ _ 11 11 1 5. Puerperal Fever _ _ _ _ _ _ _ _ 5 4 _ _ 9 8 1 6. Puerperal Pyrexia _ _ _ _ _ _ _ 1 21 1 _ _ 23 18 _ 7. Erysipelas 6 _ 1 _ 1 2 3 2 12 13 30 11 81 64 7 8. Certbro-spinal Meningitis _ 1 _ _ _ _ 1 _ _ _ _ _ 2 2 2 9. Anterior Poliomyelitis and Polioencephalitis _ _ _ _ 1 _ _ _ _ _ _ _ 2 2 1 10, Ophthalmia Neonatorum 31 _ _ _ _ _ _ _ _ _ _ _ †31 16 _ 11. Encephalitis Lethargica _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 12. Acute Influenza and Influenzal Pneumonia 1 _ 1 3 1 1 _ 2 14 6 11 6 46 25 25* 13. Acute Primary Pneumonia 7 8 7 5 4 9 10 11 29 17 53 22 182 147 9* 14. Malaria _ _ _ _ _ _ _ _ 12 5 5 _ 22 22 1 15. Dysentery 4 13 4 5 1 3 5 1 8 3 10 _ 57 57 3 16. Measles 180 314 362 391 462 1155 51 17 37 6 _ _ 2975 785 17 17. German Measles 10 7 4 6 6 16 8 1 17 2 _ 1 78 20 _ 18. Food Poisoning _ _ _ _ _ _ _ _ 11 6 4 1 22 _ _ * For Pneumonia Deaths, see Table on pages 31 and 32. † Excluding one case which came to notice after death. 75 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. NO Address. Whole Borough. ward. NO Address. Whole brough. 1 2 3 4 5 6 7 8 1 2 3 4 5 6 1 8 1. Small-pox - - - - - - - - - - |- - - - - - - - - - 2. Scarlatina or Scarlet Fever 58 44 80 36 96 30 30 8 1 434 - - 1 1 1 - 1 2 - 6 3. Diphtheria and Membranous Croup 50 49 101 45 82 63 28 69 - 487 1 1 1 1 - 3 - 1 - 3 4. Enteric or Typhoid Fever 3 1 2 - 1 1 1 2 - 11 - - - - - - - 1 - 1 5 Puerperal Fever - 2 3 3 1 - - - - 9 - - - - - 1 - - - 1 6. „ Pyrexia 6 4 1 3 3 1 1 4 - 23 - - - - - - - - - - 7. Erysipelas 15 13 14 9 14 3 5 8 - 81 - - 2 2 - 1 - 1 1 7 8. Cerebro-spinal Meningitis - - 1 - 1 - - - - 2 - - 1 1 - - - - 2 0. Anterior Poliomyelitis and Polioencephalitis - - 1 - - 1 - - - 2 - - - - - 1 - - - 1 10. Ophthalmia Neonatorum 9 1 8 4 2 1 3 3 - †31 - - - - - - - - - - 11. Encephalitis Lethargica - - - - - - - - - - - - - - - - - 1 - 1 12. Acute Influenza and Influenzal Pneumonia 9 10 8 6 5 5 1 2 - 46 - 1 1 1 - - - 1 - †25 [3. Acute Primary Pneumonia 39 11 26 21 26 22 13 23 1 182 2 1 1 4 1 - - - - †9 14. Malaria - - - - 1 - 17 4 - 22 - - - - - - 1 - - 1 15. Dysentery 6 6 10 2 3 11 16 3 - 57 - - 1 1 - - - 1 - 3 16. Measles 536 406 567 296 450 315 64 341 - 2975 2 4 2 3 2 2 1 1 - 17 17. German Measles 6 6 14 3 12 6 5 26 - 78 - - - - - - - - - - 18. Food Poisoning - - - - - 1 17 4 - 22 - - - - - - - - - - Totals 737 553 836 428 697 460 201 548 2 4462 5 7 9 '4 5 8 3 9 1 82 For Pneumonia deaths, see Table on pages 31 and 32. t Excluding one case which came to notice after death. 76 Vaccinations. 1st January to 31st December, 1935. Number. Percentage of Births registered. North. SouthEast. Southwest. Whole Borough North. SouthEast. Southwest. Whole Borough Births registered 418 1684 1943 4045 1000 1000 1000 1000 Died, unvaccinated 19 75 80 174 4.5 4.4 4.1 4.3 Successfully vaccinated 177 648 807 1632 42.3 38.1 41.7 40.5 Had smallpox - - - - - - - - Insusceptible of vaccination 2 3 1 6 0.5 0.2 0.05 0.1 Received certificate of conscientious objection 171 521 546 1238 4.1 31.0 28.0 32.8 Postponed by medical certificate 4 16 24 44 0.9 0.9 1.21 1.1 Moved to known address in other districts 5 336 311 652 1.2 19.8 16.1 16.1 Lost sight of by removal 26 72 141 239 6.2 4.2 7.2 5.9 Unvaccinated and not accounted for in previous columns 14 13 33 60 3.3 0.7 1.7 1.5 SMALL.POX. There were no cases notified in St. Pancras during 1930. VACCINATION. Mr. A. E.Wolfe, the Council's Vaccination Officer died on 23nd May. 1936. On 24th June, Dr. Maitland Radford, the Medical Officer of Health, was appointed Vaccination Officer by the Borough Council, and this appointment was subsequently confirmed on 23rd September by the Ministry of Health for a period of 12 months, after which the question is to be reviewed. 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, 1935. 77 Return showing the number of persons successfully vaccinated and re-vaccinated at the cost of the rates by the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1936:— 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 159 16 175 3 „ 2 „ F. L. Pelly 124 25 149 6 Wards 3 and 4 „ J. W. Wigg 307 36 343 10 „ 5, 6, and 7 „ A. E. Tait 251 36 287 13 Ward 8 „ C. H. Alderton 104 21 125 8 St. Pancras Hospital „ W. Feldman 7 - 7 - Totals 952 134 1086 40 SCARLET FEVER. The number of cases notified was 434, as compared with 354 cases during the previous year. It was subsequently ascertained that 40 cases were not regarded as cases of this disease. The actual number of cases was therefore 394. Six deaths occurred; this equals a case mortality of 1.5 per hundred cases. Return Cases.—This term is applied to cases of Scarlet Fever which occur in a house within 28 days of the return from hospital of a previous case. There were 11 such cases during the year. Multiple cases in one house—that is, several cases occurring more or less together—are not as frequent as one might expect. In 22 families there were two such cases, in three families three, and in one family there were four multiple cases, in each home. DIPHTHERIA. The number of cases notified was 487, as compared with 440 cases during the previous year. It was subsequently reported by the hospital authorities that 101 cases were not regarded as cases of this disease. The actual number of cases was therefore 386. This equals an attack rate of 2.1 per 1,000 of population. Eight deaths occurred, giving a case mortality of 2.1 per cent. 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 two families three such cases in each home. Antitoxin for the treatment of necessitous cases of this disease is supplied to medical practitioners free of charge by the Council. During the year 142 thousand units were provided, 78 Immunization Scheme. The following report is submitted by Dr. P. V. Pritchard, the Deputy Medical Officer of Health:— The scheme for immunizing children against Diphtheria was put into operation in October, 1936. Certain alterations to the original description as given in last year's Report were found necessary and these have been made. Immunization is provided for children between 1 and 13 years of age whose parents are not earning more than £250 a year. The Borough Council pays the family doctor for giving the immunizing injections a fee of 7s. 6d. per case and provides him with the necessary material. After careful investigation it was decided to use toxoid-antitoxin floccules because of its reputation for a low incidence of unwanted or unspecific reactions. This T.A.F. is given in three injections at fortnightly intervals. The Council pays 4s. per set of the three doses. The Schick test is a method of finding out whether a person is immune to Diphtheria. It may be performed in the first place to see whether the course of immunizing injections is necessary. As children between 1 and 5 are so very liable to the infection, it is recommended that they should all be immunized, and no preliminary Schick test is necessary. After 5 years of age the incidence of the disease becomes lower and many children develop an immunity in a natural way. The preliminary test is therefore valuable to distinguish these protected children from those who have not developed the protection and who therefore require the artificial method of immunization. Schick testing three months after the last of the three injections of T.A.F. is very necessary, as a small percentage of children fail to develop a complete protection with one course of three injections. The post immunization Schick test detects these children, who are directed to have a further course of T.A.F., and who would otherwise have been thought to be protected when such was not the case. For this reason it is most important that parents should have this post Shick examination performed. All Schick testing is done at special clinics and at suitable institutions by the Deputy Medical Officer of Health in his capacity as Diphtheria Immunization Officer. This officer is also responsible for the general administration of the scheme. Although the scheme was started only in October, by the end of the year there were 480 children on the register as " having received, or in process of receiving, treatment under the scheme." Diphtheria immunization is nearly 100 per cent. successful in preventing the disease in individuals. A scheme such as the one in St. Pancras aims at protecting the community. In order to reduce the liability of the community to Diphtheria infection it will be necessary for a high proportion of all susceptible children to be immunized at the earliest possible date, and for this "saturated" state to be maintained by immunizing all children directly after infancy. ENTERIC OR TYPHOID FEVER. Two cases of Typhoid and nine cases of Para B. Typhoid were notified during the year. One diagnosis of Typhoid was not confirmed. There was one death. 79 ERYSIPELAS. 81 cases were notified and 7 deaths occurred, as compared with 92 cases and 9 deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever, Meningococcal Meningitis, "Spotted Fever.") Two cases were notified and both died. ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Two cases were notified, of which one moved away and one died. This disease, the popular name for which is infantile paralysis, causes paralysis of certain muscles with resulting serious deformity. A very great deal can be done for children who have had this disease if they are placed under expert care, and if this is continued for many years after the initial illness. Every effort is made to follow up these cases. OPHTHALMIA NEONATORUM. The number of cases notified was 31, excluding one case which came to notice after death, and in addition 30 cases of mild inflammation of the eyes were reported. One case moved out of the Borough and was lost sight of. Twenty-six cases all recovered satisfactorily, without impairment of vision, but one case was left with severe scarring. Further particulars are given on page 120 of Maternity and Child Welfare Section. ENCEPHALITIS LETHARGICA. No cases were notified during the year, but the death was reported of a previously notified case. 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 182 notifications of the former and 46 of the latter, including Influenza, during 1936 (as compared with 151 and 44 respectively for 1935). There were 13 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 1936, 34 cases were nursed under this arrangement and 630 nursing visits were paid. MALARIA. 22 cases were notified and there was one death. They were all old cases in which the disease had been contracted abroad. Cases of Malaria diagnosed in the borough are notified to this Authority. Of the cases notified 20 were in-patients of the hospital for Tropical Diseases, Endsleigh Gardens. The remaining two cases were induced Malaria for therapeutic purposes. In two instances the home address was in St. Pancras. DYSENTERY. 57 cases were notified during the year, of which three died, and on investigation it was shown that 8 of them did not really belong to St. Pancras. The same rule for the notification of Malaria (as described above) applies to Dysentery. Eight of the cases were in-pitients of the Hospital for Tropical Diseases, none of whom was a St. Pancras resident. 80 There were 49 St. Pancras cases in the 57 notifications, 47 of whom contracted the Sonne type of Dysentery, and the others the B. Flexner type. They all recovered. FOOD POISONING. Food Poisoning and suspected 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. Twenty-two notifications were received during the year, but there were no deaths. The following report, dated 18th November. 1936, was prepared by the Medical Officer of Health:— "I have to report that on the 6th instant I received a letter from Dr. T. V. Good, the Senior Medical Officer to the General Post Office, informing me that there had been seventeen cases of food poisoning amongst the staff of the Euston Telephone Exchange. I visited the Exchange the same day and found that all cases had returned to duty. Suspicion appeared to rest upon steak and kidney pudding eaten at the midday meal on the 4th. Unfortunately there were no remains of this for the purpose of analysis. A bacteriological examination was made in respect of the cook, but with entirely negative results. The indisposition was slight, and although there can be little doubt that it originated from food eaten at the Stuff Canteen on the 4th instant, it is not possible to draw any more precise conclusion as to its cause." MEASLES AND GERMAN MEASLES. Notification of these diseases in St. Pancras is 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. Every case of Measles or German Measles which comes to the notice of this Department is visited by a Health Visitor who gives the mother advice and help as regards the patient. Where actual nursing is necessary for the case, this is arranged for by the Health Visitor and carried out by the staffs of the several nursing associations Details us to the manner in which this work is done under a Block Grant from the Borough Council is reported on page 110. 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. During 1936 the Borough experienced its bi-ennial epidemic of measles. From the table on page 74 it will be seen that out of a notified total of 3,053 of these diseases (measles and German measles) 805 were removed to hospital. Home nursing was provided in 117 cases. German Measles is generally a mild disease. There were 78 cases during the year 1936, as compared with 145 cases during 1935. There were no deaths. Particulars of the cases, deaths and incidence and mortality rates of Measles are given in the following tables:— 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 1936 715 2117 132 11 2975 180 1529 1206 60 4 12 1 — 17 3 12 2 1935 18 30 39 33 120 23 51 36 10 — — — 1 1 — 1 — — 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 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 — 81 82 Table II MEASLES. Year. Incidence Rate per 1000 Population. Mortality Rate per 1000 Oases. Quarters of Year. Total. Quarters of Year. Total. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1936 3.9 115 .7 1 16.2 5.6 5.7 76 — 5.7 1935 .1 .2 .2 .2 .6 — — — 30.3 83 1934 9.9 8.4 1.0 .1 19.4 5.4 12.7 10.4 — 8.8 1933 .4 .9 .7 .2 2.2 25.9 — 14.5 9.2 1932 39 9.8 .8 .3 14.8 10.7 8.4 18.5 — 9.4 1931 .7 .9 .3 .3 22 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 — 139 204 7.0 12.0 DISINFECTING AND CLEANSING STATION. These buildings are situated in Cambridge Street, at the rear of St. Pancras Gardens. 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. 83 The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of caaea. No. of houaes. No. of rooms contents disinfected or destroyed. No. of rooms sprayed and fumigated. Scarlet Fever 464 441 437 425 Diphtheria 458 452 445 470 Enteric Fever 9 9 9 2 Puerperal Fever 4 4 4 — „ Pyrexia 1 1 — 1 Erysipelas 69 69 68 7 Cerebro-spinal Meningitis 9 9 8 6 Measles 47 46 39 37 Pneumonia 2 2 2 — Dysentery 3 3 3 — Scabies 175 168 172 12 Tuberculosis 114 113 44 106 Vermin 280 268 267 223 Other Diseases (not notifiable) 398 3S2 370 58 Totals 2033 1967 1868 1347 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 89 1760 3 522 Bolsters and pillows 45 3802 5 786 Sheets, blankets and counterpanes 21 5626 5 2425 Rugs, mats, cushions, carpets, covers and curtains 24 1300 1 378 Wearing apparel 104 3784 5 205 Books 1 235 — — Sundries 85 1731 — 152 Totals 269 18238 19 4548 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 Institution, 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. 84 The fees received for this work during the year ended .'51st March, 1937, amounted to £118 13s. Od. In November a communication was considered from the Metropolitan Boroughs' Standing Joint Committee asking for the Council's views on the need for legislation to empower Borough Councils to provide temporary accommodation for persons removed from their dwellings while the premises undergo disinfestation for vermin. Such accommodation is provided under Statute in cases of infectious disease, but not at present for vermin, and the Council were of opinion that legislation should be introduced for the latter purpose also. Eradication of Bed Bugs. The following information is given in the form required by the Ministry of Health:— 1. The number of houses infested was 268, and the number of rooms sprayed and fumigated was 223. No Council property was involved. In a number of cases the contents only were disinfested. 2. The methods employed for disinfestation were : (a) spraying by Formalin ; (b) burning of Sulphur Candles. 3. In cases where tenants from slum clearance areas were rehoused in the Council's flats, the beds, bedding, etc., were disinfested by steam at the Council's Disinfecting Station, and a contractor was employed to disinfest the furniture by Hydrogen Cyanide. 4. Disinfestation was carried out by the Local Authority except in circumstances explained in (3) above. In cases where the London County Council rehouse tenants living in verminous premises, the Borough Council undertake to disinfest the bedding and rooms. The powers of the Local Authority for dealing with infested houses are strengthened by Section 123 of the Public Health (London) Act, 1936. Valuable information regarding the prevalence of bug infestation in the Borough has been obtained in the course of a general survey that is being carried by the St. Pancras House Improvement Society, Ltd. Mr. McKenny Hughes, who is a well known authority, has undertaken to investigate the facts regarding infestation, and I have to thank him for permission to quote the following preliminary conclusions. Representative houses of different types and situated in various parts of the Borough have been inspected. There are few streets containing working-class dwellings which can be pronounced free from infestation, and in a considerable number of streets 100 per cent. of the bouses are infested. The result of Mr. McKenny Hughes' inspection is to confirm the impression of the ubiquity of the bug in working-class houses. It would be true to say that 50 per cent. of the working-class houses in the Borough are infested. While a good deal can be done and is done both by the tenants themselves and by the Public Health Department to mitigate this evil, present methods cannot be considered to be sufficiently thorough. The subject is a difficult one and it is hoped that experiments now being carried out will make possible the introduction of more effective methods of disinfestation in the near future. 85 Cleansing Station. The amount of work carried out during the year is shown in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and the clothing is disinfected. Men. Women. Children under 15. Total. Vermin 1743 44 4106 5893 Scabies 217 191 2789 3197 Totals 1960 235 6895 *9090 • Includes 205 males and 8 females who had no home address. The staff of the Disinfecting and Cleansing Station consists of a Foreman, a StokerDisinfector and two Motor Drivers and Disinfectors ; a Matron of the Cleansing Station and one Woman Assistant. The majority of the children included in the above table have been brought to the cleansing station from the public elementary schools by officers of the London County Council. 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. Clerical duties and general supervision are undertaken by London County Council School Nurses. Payment is made by the L.C.C. 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 bv 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. 86 The undermentioned examinations were made during the year:— Nature of Specimen. Positive. Negative. Total. Swabs for Diphtheria Bacilli 180 1932 2112 Sputum for Tubercle Bacilli 19 391 410 Stools for Dysentery 3 23 26 „ „ Food Poisoning — 3 3 „ „ Typhoid — 1 1 Blood ,, ,, 2 1 3 „ film for Malaria — 1 1 Urine for Tubercle Bacilli 1 — 1 Remains of 1 jar of Fish Paste for suspected Food Poisoning — 1 1 Remains of 1 Hake for suspected Food Poisoning — 1 1 Sandwiches and Pressed Beef do. — 1 1 205 2355 2560 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. Section VIII. Tuberculosis. 87 Section VIII.-TUBERCULOSIS. TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1936 are given in the following table in the form required by the Ministry of Health:— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 1 1 — 2 1 1 — 2 1—5 — 1 4 2 — 1 1 1 5—10 3 6 a 3 — — — 1 10—15 3 4 8 2 — — 2 — 15—20 5 18 5 7 2 3 1 — 20—25 37 28 3 7 10 15 — 1 25—35 36 33 4 10 22 9 — 2 35—45 26 17 4 2 15 9 — — 45—55 36 14 1 1 27 5 1 — 55—65 26 2 — 2 16 4 — 2 65 & upwards 13 1 — — 9 1 — — Totals 186 125 31 38 102 48 5 9 The total number of Primary notifications was 288 ; in addition to these, 31 cases, which had not been notified, came to knowledge by means of special death reports, and 61 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 380, equal to a notification rate of 2.06 per 1,000 of population. The total number of new cases during the previous year was 322. The deaths from all forms of Tuberculosis during the year numbered 164, equal to a death rate of 0'9 per 1,000 of population. The total number of deaths in the previous year was 138. It will be noted that, out of a total of 164 deaths from Tuberculosis, 31 were of cases which either died un-notified or were notified only at death. Death from tuberculosis before notification maybe due to:—(1) Sudden death of a person who has not consulted a doctor since tuberculosis has developed. (2) Sudden death of 88 a person who has been notified elsewhere but has not consulted a doctor since arrival in the borough. (3) Difficulty in diagnosis before death. (4) The doctor being under an erroneous impression that the case has been notified in the borough previously. When necessary a communication is sent to the certifying practitioner asking for an explanation of the circumstances under which formal notification was not made. No case occurred in which it appeared to be desirable to institute proceedings for deliberate or wilful neglect to comply with the regulations. The interval elapsing between notification and death is an indication of the efficiency of notification. In the following table the deaths from tuberculosis (from January 1st to December 31st) are classified according to this interval:— TUBERCULOSIS DEATHS—1936. Time of Notification. PULMONARY. NON-PULMONARY. Total. Percentage. Male. Female. Male. Female. 1936 Discovered on Death 19 2 2 8 31 19.8 Six months or less before Death 26 8 1 2 37 23.5 Remainder 3 — — — 3 1.9 1936 Total 48 10 3 10 71 45.2 1935 17 12 29 18.5 1934 8 4 — — 12 7.7 1933 10 5 — — 15 9.6 1932 3 2 1 — 6 3.8 1931-1927 12 7 1 — 20 12.7 Before 1927 3 1 — — 4 2.5 Total 101 41 5 10 157 100 89 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 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 :— Summary of Notifications during the. period from 1st January, 1936, to the 31st December, 1936 (inclusive). Age Periods. Number of Notifications on Form A. Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors), 0 to 1 l to 5 5 to 10 10 to '5 '5 to 20 20 2- 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males 1 - l 3 5 31 29 18 24 17 10 139 152 Females — 1 4 3 16 22 25 15 12 2 1 101 113 Non-pulmonary Males 3 1 7 3 2 2 4 1 — — 23 25 Females — - 3 2 6 5 7 - 1 — - 25 28 Totals i 4 9 15 30 60 63 38 38 19 11 288 *318 *Excluaire of 27 " 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 - - 2 - - 6 7 8 12 9 3 47 Females 1 — 2 1 2 6 8 2 2 — — 24 Non -pulmonary Males — 1 1 1 2 1 2 — — — — 8 Females 2 2 — — 1 2 3 1 — 2 — 13 Totals 3 3 5 2 5 15 20 11 14 11 3 92 90 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 per 1000 population. Death Kate per 1000 population. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. 1927 212800 378 92 470 197 20 217 1.78 0.43 2.2I 0.93 0.09 1.02 1928 205(00 353 102 455 191 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.l6 1.23 1930 203900 321 76 397 165 24 189 1.54 0.36 1.91 0.79 0.12 0.91 1931 195200 329 75 404 181 25 206 1.68 0.38 2.07 0.93 0.13 1.06 1932 194000 324 85 409 164 25 189 1.67 0.44 2.11 0.84 0.13 0.97 1933 190900 297 79 376 171 24 195 1.56 0.41 1.97 0.90 0.12 1.02 1934 187540 296 49 345 157 15 172 1.58 0.26 1.84 0.84 0.08 0.92 1935 185300 275 47 322 123 15 138 1.48 0.25 1.73 0.66 0.08 0.74 1936 183900 311 69 380 150 14 164 1.69 0.37 2.06 0.81 0.07 0.88 The table below shows the number of new cases and the number of deaths, together with the corresponding rates per 1,000 of population, for each Ward of the Borough during 1930:— TUBRRCULOSIS (All, Forms). Ward. New Cases. Deaths. Number. Kate per 1000 of Population. Number. Rate per 1000 of Population. 1 48 1.4 26 0.8 2 25 1.4 8 0.4 3 72 2.3 44 1.4 4 58 2.3 18 0.8 5 55 2.1 27 1.0 6 36 2.2 13 0.8 7 33 2.7 15 1.2 8 47 2.0 13 0.5 Homeless 6 - — - Totals 380 21 164 0.9 In the following table are given the deaths from Tuberculosis of St. Pancras residents during 1936, the deaths in each Ward and those occurring in the Hospitals of the Borough and elsewhere. (This table is prepared by the Registrar-General, and relates to the period 1st January to 31st December, 1936.) Under 1 year. 1—2 years. 2 — 5 years. 5—10 years. 10—15 years. 15—20 years. 1 20—25 years. 25—35 years. 35—45 years. 45—55 years. 55—65 years. 65—75 years 75 yrs. and up. Wards. No address. To tal Not in Institutions. St. Pancras Hospitals. Other London Hospitals. Hospitals outside London St. Pancras Persons. Ex St. Pancras Persons. I II III IV V VI VII VIII M F M F M F M F M F M F M F M F M F M F All Forms 4 1 2 1 2 6 24 33 24 132 25 7 4 12 12 3 5 27 16 14 4 17 11 10 3 13 2 12 3 ... 1 108 57 40 59 65 48 18 Respiratory System 2 1 1 ... ... 5 23 31 24 31 23 7 4 11 11 3 4 25 14 14 3 16 9 10 2 13 2 12 2 ... 1 104 48 38 50 37 46 18 Central Nervous System 2 ... 1 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... 1 4 1 3 11 1 ... Intestine and Peritoneum ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... Vertebral Column ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Other Bones and Joints ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Skin and Sub-cutaneous Tissue ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Genito Urinary System ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... Adrenals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Other sites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disseminated—Acute ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 4 ... ... „ Chronic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ,, Not distinguishe as acute or chronk ... ... ... ... ... 1 ... ... 2 ... l ... ... ... ... 1 ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 2 4 1 ... ... '92 NOTIFICATION REGISTER. This is kept at the Dispensary. The following table gives the information for the veaf ended December 31st, 1936, in the prescribed form : — Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1936 868 287 1155 Number of new cases during the year 331 76 407 1199 363 1562 Number of cases removed from the Register during the year (from death or other causes) 386 126 512 Number of cases remaining on the Register at the end of the year 813 237 1050 Public Health (Prevkntion of Tuberculosis) Regulations, 1925. No formal action was necessary during the year. These regulations make it possible to require that an individual suffering from tuberculosis shall discontinue employment in the milk trade. TUBERCULOSIS DISPENSARY. The following are the times of the sessions at the Dispensary : — Monday 11 a.m. Dr. Back Tuesday 2 p.m. Dr. Back 7 p.m. Dr. Pritchard Wednesday 11 a.m. Dr. Back Thursday 2 p.m. Dr. Back 7 p.m. Dr. Back Friday 2 p.m. Dr. Pritchard Saturday 11 a.m. (School children only) Dr. Back )' 93 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 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. if. F. A.—New Cases examined during the year (excluding contacts) :— (a) Definitely tuberculous 111 77 3 10 11 19 12 3 122 96 15 13 216 (b) Diagnosis not completed - - - - - - - - 15 15 1 2 33 (c) Non-tuberculous - - - - - - - - 79 98 33 26 236 B.—Contacts examined during the year:— (a) Definitely tuberculous - 1 1 - - - - - - 1 1 - 2 (b) Diagnosis not completed - - - - - - - - 1 3 1 — 5 (c) Non-tuberculous - - - - - - - - 60 68 59 65 252 C.—Cases written off the Dispensary Register as— (a) Recovered 9 20 3 2 2 7 7 4 11 27 10 6 54 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuoerculous) - - - - - - - - 142 168 92 95 497 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 361 225 20 15 45 39 30 19 406 264 50 34 754 (b) Diagnosis not completed - - — — — - — — 19 20 1 2 42 I. Number of cases on Dispensary Register on January 1st 725 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 112 (a) Personal 8 (b) Other 238 8. Number of visits by Tuberculos's Officers to homes (including personal consultations) 104 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 172 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes ... 4382 4. Cases written off during the year as L ead (all causes) 92 10. Number of— 529 5. Number of attendances at the Dispensary (including Contacts) 3181 (b) X-ray examinations made in connection with Dispensary work 243 6. Number of Insured persons under Domiciliary Treatment on the 31st December 317 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 417 94 The following is a summary, for purposes of comparison, of certain sections of the foregoing tables. Deaths from Tuberculosis Jan. let-Dec. 31st Ratio of cases on dispensary register to capes on notification register Number per 1,000 deaths from tuberculosis in the Borough Total attendances per case on register Tuberculosis Officer's visits per case on register Total consultations per case on register Nurses' visits per case on register X-ray examinations Actual Per 1,000 inhabitants Definitely tuberculous persons on dispensary register T.B. -f- cases on dispensary register Examinations per 100 new cases 2nd contacts per 100 new cases New cases Contacts Adults Children 157 •85 •76 480 267 328 84 80 4 •13 •3 5.5 30.1 47.1 Report on this Work carried out at the Tuberculosis Dispensary. The following report on the work carried out by the Dispensary has been prepared by Dr. Q. A. Back, the Tuberculosis Officer: — New Patients and Contacts. The total number of new patients dealt with at the Dispensary shows an increase of 16 per cent, from the previous year and is higher than any similar number since 1927. This increase may be attributed partly to an increase in notifications and partly to an increase in the number of patients sent for diagnosis due to the circularisation of medical practitioners when the Dispensary time-table was changed in the early part of the year. The total number of contacts attending has fallen from 274 to 259 in spite of an increase in the available oontacts due to the increase in notification. Of these contacts 42.9) per cent. attended, but it must be noted that last year in St. Pancras 100 notified cases produced less than 150 contacts whereas in London as a whole they are estimated to produce twice as many. Institutional Treatment. This is provided by the London County Council in sanatoria, special hospitals and in the tuberculosis wards of their general hospitals. Application for admission is made as a rule on the appropriate form by the Tuberculosis Officer or the resident staff of the voluntary hospitals, but in emergency patients may be admitted by application to the Medical Superintendent of Highgate Hospital. Altogether 399 applications were accepted, showing an increase of 37 over the previous year. Of these 191 were admissions to General Hospitals, 62 to Brompton Hospital or St. George's Home for investigation of their subsequent treatment, 116 to sanatoria and 30 to various hospitals for observation for diagnosis. The majority (121) of the admissions to the General Hospitals were admissions of destitute patients or those suffering from advanced disease and the recommendations were made by District Medical Officers, General Practitioners and Voluntary Hospitals; the remainder (70) were made by the Dispensary. Of the admissions to sanatoria and special hospitals 121 were recommended by the Dispensary and 87 from other sources. Artificial Pneumothorax Treatment. This work is carried out at various voluntary and London County Council hospitals for patients who have been discharged from hospitals and sanatoria, at a cost to the Borough Council of 10s. 6d. per refill. During the year an arrangement was made whereby refills could be given, at a cost of 5s, each, by the Tuberculosis Officer when he visits Highgate Hospital, 95 The number of refills, which for the past three years had averaged 390, showed a marked increase to 573 during 1936. Of these, 275 were carried out at Brompton Hospital, 83 at University College Hospital, 107 at other voluntary hospitals, 61 at Colindale Hospital, 28 at Grove Park Hospital and 19 at Highgate Hospital. Light Treatment. Finsen Light Treatment for lupus is provided usually at the London Hospital at a cost to the Borough Council of 5s. per attendance, and during the year a similar arrangement was made with University College Hospital. Twenty-one attendances were made at the London Hospital, 36 at University College Hospital and 12 (for radium treatment) at Lambeth Hospital. Sanocrysin Treatment. This may be provided, at a cost of 3s. per injection, at Brompton Hospital or the City of London Hospital, Victoria Park, to patients who are receiving refills with the concurrence of the Tuberculosis Officer. No applications for this treatment were made during the year. X-ray examinations. These are carried out daily at University College Hospital and once a week at Highgate Hospital. During the year University College Hospital reduced their charge to the Borough Council from 10s. to 7s. 6d. per film, screening and report. The same charge is made at Highgate Hospital if the work is carried out by the visiting radiologist, but it may now be carried out at a cost of 2s. 6d. by the Tuberculosis Officer when he visits the hospital. Of the 243 examinations made during the year 42 were made at Highgate Hospital, and of these 22 were made by the Tuberculosis Officer. Disinfection of Rooms. This is always advised on the admission of an infectious case to hospital or sanitorium, on change of residence and after the death of a patient. It is carried out by the Council's staff, free of charge, and during the year 106 premises were disinfected. Home Visits by Tuberculosis Visitors. These visits are made in order to (i) verify notifications ; (ii) investigate the home conditions and report on overcrowding, sanitary defects, need for financial assistance, etc. ; and (iii) give instruction in the prevention of tuberculosis and to invite contacts and patients to attend the Dispensary. The particulars of these visits are as follows : — Number of visits under P h. (Tub.) regulations. Number of visits for Dispenary purposes. Total Visits Miss Holland 139 2702 2841 Miss Long 120 1680 1750 4591 Staff. At the beginning of the year Miss Camman left the Dispensary in order to take up her duties as Inspector of Workshops and Factories at the Town Hall. Her district for visiting was taken over by Miss Long who nevertheless continued to take charge of the two evening clinics. The remainder of the clinics were taken over by Miss Luxmoore, who was appointed to the new post of Dispensary Nurse and Secretary to the Care Committee. At the end of May Miss Luxmoore resigned and Mrs. Bevan took over her duties on June 24th. The arrangement whereby the Tuberculosis Officer visits Highgate Hospital on one afternoon a week was continued during 1936. G. A. Back, Tuberculosis Officer. 96 St. Pancras Tubkkculosis Cake Committee. Lift of Members. 1. Councillors. Alderman A. Escott, f.i.b.d., Chairman. W. C. Wood. Councillor F. L. Combes. „ Mrs. W. Cooper. ,, M. R. Debenbam. „ John Evans. ,, Mrs. Gregory. „ Mrs. A. E. Lake. „ Rev. R. S. Swann Mason, o.b.e., m.a. ,, J. A. Wright. „ A. J. Trott, j.p., representing Public Assistance. 2. Representatives of other bodies interested in the Welfare of Tuberculous Patients. Miss Ball, L.C.C. Schools Care Committee. Dr. Hogarth, L.C.C. (School) Divisional M.O. Mrs. Tibbies, St. Pancras Trades Union. Mrs. D. Gair, Federation of M. & C. W. Centres. Dr. J. W. Clarke, St. Pancras Medical Practitioners. Miss Emly, Metropolitan District Nursing Association. Miss Quartermain, St. Pancras District Nursing Association. Mr. H. E. J. Chollwill, Manager Labour Exchange. Miss Piper, North London Nursing Association. Mr, Congdon, London Insurance Committee. Dr. C. L. Mason, London Panel Committee. Almoners of the following Hospitals :— Royal Free Hospital. Middlesex Hospital. Elizabeth Garrett Anderson Hospital. National Temperance Hospital. Hampstead General Hospital. University College Hospital. 3. Ex-Efficio Members. Dr. M. Radford. Dr. G. A. Back. Dr. P. Y. Pritchard. Mrs. E. Bevan, Secretary. Tuberculosis Care Committees have been established in the majority of, if not in all, Metropolitan Boroughs, in accordance with the suggestions contained in circulars issued from time to time by the London County Council. In June, 1936, a circular dealing with the question of social service in connection with Tuberculosis again urged the importance of this work, and explained that it was the duty of a care committee to focus its activity upon the personal and family circumstances of tuberculous persons. 97 It is a matter for ray great satisfaction that the St. Pancras Tuberculosis Care Committee has extended its work considerably during the last year or two. There is no doubt whatever that the statistical information included in the following report represents in human terms much help, comfort and mitigation of suffering for patients and their families. It is to be hoped that the excellent and essential work that this Committee is doing will be still further extended in the years ahead. The following report on the work carried out during 1936 has been prepared by the Secretary of the Committee:— The Care Committee held 11 meetings during the year, and the work carried out by or reported to them is indicated in the following summary. Residential Treatment. The financial positions of all patients accepted for institutional treatment are investigated by the Tuberculosis Visitors and classified according to whether or not financial difficulty is anticipated. The results, after approval by the Care Committee, are forwarded to the London County Council. During the year the number of investigations reported was:— (a) Financial difficulty anticipated 137 (b) Financial difficulty not anticipated 135 272 Public Assistance. All patients and their families who appear to be eligible are referred to the Public Assistance Department. In January the London London County Council asked that, for an experimental period, all such patients and suitable contacts who appeared to be in need of extra nourishment in addition to or in substitution for their ordinary diet, should be recommended for it by the Tuberculosis Officer. The recommendations have been renewed monthly and are reported to the Care Committee for approval. During the year 121 recommendations were made in respect of 54 patients. As a rule, a pint of milk and an egg were allowed to each patient daily. Extra Nourishment provided by the Borough Council. The Council may provide a pint of milk and an egg daily to necessitous patients who are not in receipt of public assistance, if the recommendations of the Tuberculosis Officer are approved by the Milk Committee. The recommendations are reported to the Care Committee and during the year amounted to: — Number of patients recommended 209 £ s. d. Total cost 125 0 9 Provision of Clothing. This may be provided by the Care Committee for patients awaiting admission to Sanatoria, and by the Care Committee or the London County Council (if it cannot be obtained 98 from other sources) for patients already in a sanatorium or hospital. During the year the following numbers were supplied:- By the Care Committee. (a) Number of Patients 55 (b) Articles of clothing 241 By the London County Council. Number of Patients 33 Dental Treatment. Financial assistance for obtaining dental treatment may be provided by the Council for suitable patients recommended by the Tuberculosis Officer and approved by the Care Committee. The figures for 1936 are: — Number of Patients 9 £ s. d. Total cost of treatment 36 3 6 Amount paid by Borough Council 20 6 8 Housing. When necessary recommendations for better housing accommodation on the Borough Council and London County Council Instates are made to the Kstates Department by the Tuberculosis Officer and are reported to the Care Committee. The figures for 1936 are : - Number of families recommended 47 ,, ,, rehoused:— (a) By Borough Council 4 (6) By London County Council 7 Employment. Patients requiring work after return from Sanatoria are given special recommendations to the Employment Exchange. The number of such patients reported to the Care Committee during the year was 19. Provision of Beds and Bedding. Since 1924 the Council has provided beds and bedding which are lent to tuberculous patients who would be liable otherwise to spread infection by sharing a bed with another person or persons. The Tuberculosis Visitors report periodically on the condition of the beds. The figures for 1936 are:— Number of Families provided with beds and bedding during the year 4 Number of families using beds or bedding on December 31st, 1936 6 Provision of Garden Shelter. There is not much scope for the use of shelters for tuberculous patients. One Shelter provided by the Council at the request of the Care Committee in 1935 is still in use, 99 Bearding out of Contacts. Since 1925 the London County Council has made arrangements to board out for varying periods the following types of children : — (а) Children living in heavily infected and overcrowded homes. (b) Children about to be discharged from institutions where they have had treatment for tuberculosis, in cases where their homes are unsuitable. (c) "Weakly" children living under conditions likely to subject them to infection. (d) Children whose mothers are having institutional treatment for tuberculosis. The arrangements are made by the Invalid Children's Aid Association on behalf of the London County Council, and the number accepted and reported to the Care Committee during 1936 was 12. Miscellaneous. At the request of the Committee, National Health Insurance grants were obtained for patients undergoing Institutional treatment, in order that they could have a little pocket money, to enable them to settle down more quickly. Pocket money amounting to £.8 11s. Od. was granted to seven patients by the Care Committee while they were in sanatoria. With the co-operation of the North St. Pancras School for Mothers a holiday was arranged for the wife and child of a patient who had never had a holiday before. Twenty-one names were submitted to the St. Puncras Needy Fund at Christmas, and generous gifts were received in all cases. Seal Sales. The Care Committee again partook in this scheme for raising funds, organised by the National Association for the Prevention of Tuberculosis. The proceeds up to December, 1936, are shown in the following Statement:— 100 Receipts and Payments for the Year ended 31st December, 1936. Receipts. Payments. 1936. £ s. d.  £ s. d. Jan. 1 To Balance in Bank 72 2 4 Jan. 16 By G.W.R. Fare for Mrs. Wilson 1 8 9 Feb. 1 „ Grant from Miss Pearce for Miss Huckle 5 0 0 Jan. 16 „ Miss Huckle (Miss Pearce's grant) 5 0 0 Feb. 29 ,, Eleanor Palmer Charity 10 10 0 Dec. 19 „ Eleanor Palmer Charity 10 10 0 Apl. 1 Marshall Roberts, Clothing 11 7 9 Dec. 31 „ Sale of Seals 58 5 5 „ Thompson & Co., Clothing 8 6 6 June 12 ,, Marshall Roberts, Clothing 2 17 0 ,, W. IT. Bailey & Son, Hot Water Bottle, Air Rings, etc. 1 5 6 „ L.M.S., Mr. Chew's removal 12 8 0 July 9 ,, Cheque Book 0 4 2 Sept. 3 ,, N. St. Pancras School for Mothers, Holiday for Mrs. McCormac 1 7 0 Dec. 6 „ Messrs. Braby, Tin foil box 2 5 0 „ Petty Cash for year 6 0 0 „ Pocket money for year:— Muiulay 1 15 0 Green 2 0 0 Williams 0 6 0 Kellett 2 10 0 Kielv 1 0 0 Speller 0 10 0 Hunt 0 10 0 ,, Discrepancy last year 0 0 1 „ Balance carried forward 95 7 0 £156 7 9 £156 7 9 Acknowledgment of Donations. The Care Committee are very grateful to the Borough Council for their grant of £25 (received on 7th January, 1937, to the Eleanor Palmer Charity for their two grants of £10 10s., to Queen Mary's London Needlework Guild for their parcel of clothing, the St. Pancras Philanthropic Society for their financial assistance, and to the many friends who have bought Christmas Seals and assisted in other directions, Section IX. Maternity and Child Welfare. 101 SECTION IX.-MATERNITY AND CHILD WELFARE. GENERAL ADMINISTRATIVE ARRANGEMENTS. The Medical Officer of Health is the Administrative Maternity and Child Welfare Officer, and the immediate supervision of the work is undertaken by the Deputy Medical Officer of Health. For the purposes of this work the Borough is divided into six districts. Each district is a distinct unit having its own centre, superintendent, health visitors and voluntary committee. The Council has representatives oil each voluntary committee. The superintendents and health visitors (the latter with a few exceptions) are salaried officers of the Borough Council and, while working in close co-operation with the voluntary committees, are under administrative supervision from the Town Hall. The voluntary committees mentioned in the second paragraph of this section derive directly from those committees to whose magnificent pioneer work the Maternity and Child Welfare movement of to-day owns its existence. St. Pancras can claim a special distinction in that The St. Pancras School for Mothers, now in its 30th year, was the first welfare centre in its modern conception to be established in this country. Since the end of the year covered by this report the voluntary committee of the Caversham Road centre has ceased to function. At the time of writing arrangements are being made for carrying on the work of this centre directly by the Council. The Council placed on record its appreciation of the fine work done by this Committee for many years. In addition to these six Welfare Centres there are a number of other associations that render valuable ancillary services in connection {with the Council's Maternity and Child Welfare scheme. Co-operation between the Voluntary Committees and the Council is maintained by the Maternity and Child Welfare (Advisory) Sub-Committee. Representatives of the six voluntary committees and of the Public Health Committee of the Council serve on this advisory sub-committee, and to it are referred for consideration and report matters affecting maternity and child welfare work in the Borough as a whole. Detailed information as to the work carried out at the different centres, ancillary services rendered by other associations, and as to the financial contributions made by the Borough Council will be given later in this section, and refers only to those services to which the Council make a contribution. Table I. Statistical information is given below in the form required by the Ministry of Health, † 1.—Population of the area served by the Council, Registrar General's estimate for Midsummer, 1936 — 183,900. 2.—Number of births notified in that area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications :— (a) Live Births—2,358. (b) Still births—91. (c) Total*—2,449. (d) By midwives*—2,073. (e) By doctors and parents*—376. *The total of the figures given under (d) and (f) should agree with the figure under (e). † The following Centres in the Borough are not included in the table for the reason that grant is qot [aid by the Borough Council f—Royal Free Hospital and Elizabeth Garrett Anderson Hospital. 102 3.—Health Visiting. (a) Number of officers employed for health visiting at the end of the year. (i) By the Council—17. (ii) By Voluntary Associations — 4. (b) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at infant welfare centres) : — (i) In the case of Health Visitors employed by the Council—17. (ii) In the case of Health Visitors employed by Voluntary Associations 4. (c) Number of visits paid during the year by all Health Visitors :— (i) To expectant mothers :— First visitsf—1,580. Total visits —3,303. (ii) To children under 1 year of age :— First visitsf—2,245. Total visits —14,950. (iii) To children between the ages of 1 and 5 years:— Total visits —14,749. 4.—Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, with some assistance from Voluntary Committees—6. (h) Number of Centres provided and maintained by Voluntary Associations—1 (University College Hospital). (c) Total number of attendances at all Centres during the year :— (i) By children under 1 year of age—24,243. (ii) By children between the ages of 1 and 5 years—14,909. (ft) Total number of children who first attended at the Centres during the year and who, on the dale of their first attendance, were : — (i) Under 1 year of age*—1,771. (ii) Between the ages of 1 and 5 years —308. (e) Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the year, were: — (i) Under 1 year of age—1,597. (ii) Over 1 year of age—3,112. (/) Percentage of notified live births represented by the number in (d) (i) 75-1. 5.—Ante-natal Services. (a) Ante-natal Clinics (whether held at Infant Welfare Centres or at other premises):— (i) Number of Clinics‡ provided and maintained by the Council with assistance from \oluntary committees — 5. * Excluding Children who are known to have previously attended a Centre in another District, † Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. ‡ Including Ante-natal Clinics at institutions transferrel to the Council under Part I of the Local Government Act, 1929. 103 (ii) Number of Clinics provided and maintained by Voluntary Associations—1. (iii) Totid number of attendances at all Clinics during the year—4,533. (iv) Total number of women who attended at the Clinics during the year—1,045. (b) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv)—42*6. The following Tables II and III, show the time table at the different centres and give statistical information as to the work for which each centre was responsible during the year. It will be seen (Table III), that 493 ante-natal consultations were held, the number of expectant mothers was 1,144 and their total attendances were 4,985. For the two previous years the total attendances were 5,697 and 6,250. The number of consultations for children was 1,446, the children who attended for the first time numbered 2,404, and the total attendances were 39,993. For the two previous years the total attendances of children were 41,475 and 40,784. The Centres at University College Hospital and at the Royal Free Hospital, figures in respect of which are included in Table III, are in a different category from the other six centres. The Borough Council is responsible for the payment of grant in respect of the University College Hospital Centre and figures of the work done at this centre are included in the statistical returns made to the Ministry of Health (Table I). At the time of writing Ward 7 has been allocated to the University College Hospital Welfare Department as its own definite area. The Department will be responsible for maintaining the complete Welfare Service, both for clinics and home visiting, for children in that area. In addition the Hospital will provide Consultative and Treatment facilities for cases referred from the other Welfare Centres in the Borough. It will continue to hold Welfare Clinics for ex-St. Pancras children. Under this new arrangement the Hospital's Welfare Centre will function and be supervised in the same manner as the other centres in the Borough's Maternity and Child Welfare Scheme. The Royal Free Hospital receives a grant for its Welfare Department directly from the London County Council. The service given for this grant includes Welfare Clinics and home visiting by three Health Visitors. The Centre is run mainly for the babies born in the hospital or under the care of the hospital's staff or students. The work of the Centre is reported to the Town Hall weekly. It has not been allocated a definite Welfare area and it does not come within the Borough's Maternity and Child Welfare Scheme. Particulars of the work carried out by this Centre are given in Table III on page 105. These figures are not included in the returns made to the Ministry. 104 Tablk II. The following table shows the location of the Council's various Maternity and Child Welfare Centres, together with the days and hours of consultations, and the doctors attending :— Name of Centre. Expectant Mothers. Infants. Children 2—5. St. Pancras School for Mothers, 1, Ampthill Square, N.W.I The 3rd Wednesday in each month at 10 a.m. (Dr. Oldershaw) Mondays, Tuesdays, and Wednesdays at 2 p.m. (Dr«. l'ritchard, Gillespie, and Odling-Smee) The 1st and 2nd Mondays in the month at 10 a.m. Drs. Gillespie and Haines) Camden Town Maternity and Child Welfare Centre, Barnes House, Camden Road, N.W.I The 2nd and 4th Tuesdays in the month at 10 a.m. (Dr. Oldershaw) Mondays. Tuesdays. Thursdays and Fridays at 3 p.m. (Drs. Russell, Silverman, Pritchaid and Alderton) Wednesdays at lo a.m. (Dr. Hainesj Caversbam Road Maternity and Child Welfare Center. 14. Caversham Road, N.W.5 Tuesdays, at 10 a.m. (Dr. Cockerell) Tuesdays and Wednesdays at 2 p.m. (Drs. Cockerell and Meade) Mondays at 2 p.m. (Drs. Cockerell ana Meade) North St. Pancras School for Mothers, 129.Queen's Crescent, N.W.5 The 1st, 2nd and 3rd Thursdays in the month at 10.30 a.m. (Dr. Hawthorne) Tuesdays, Wednesdays, Thursdays and Fridays at 2 p.m. (Drs. Neill, Haines, and Hawthorne) Somers Town Maternity and Child Welfare Centre, Chamberlain House, Ossulston Street,N.W.I The last Wednesday in the month at 10 a.m. (Dr. Oldershaw) Mondays, Tuesdays. Wednesdays and Thursdays at 2 p.m. (Drs. Wigg, Kitcat, Leesmith and Russell) South Highgate Infant Welfare Centre. 43, Raydon Street, N.19 Wednesdays and Thursdays at 2 p.m. (Drs. Pritchard and Neill) 105 Tahi.f, III. Return of Attendances, Visits and Consultations at the various Welfare Centres in the Borough during 1936. Centre. Attendances at Consultations. Visits by Trainid Visitors. Consultations N umber of Visitor*. Expectant Mothers. Children. Expectant Mothers. Children. Children. Expectant Mothers. No. of Birtii Notifications allocated to centre. New cases. Total attendances. New cages. Total attendances. Under 1 year. 1 -2 years. 2 - 5 years. Total. Under 1 ■year. 1-2 years. 2 - 5 years. Total. First visits. Total visits. First visits. Total visits. Per month. Total. Per month. Total. Council Staff. Others. St. Pftiicras School for Mothers 118 38 89 196 12 30 238 2627 1077 767 4471 214 685 446 6120 14 172 1 12 3 Camden Town Centre 630 165 395 422 48 48 518 5381 1831 1810 9022 340 495 574 4671 20 255 2 25 4 — Cftvershain Road Centre 353 138 647 292 33 48 373 4035 917 1157 6109 388 662 396 5193 12 146 4 49 2 2* North St. Pancras School for Mothers 488 118 359 352 28 54 434 5031 1355 1100 7486 243 658 596 5179 16 205 3 36 3 — Somers Town Centre 408 47 175 264 29 27 320 3583 1397 977 5957 216 474 413 5005 16 203 1 13 s — South Highgate Centre 148 — 80 15 10 105 1722 750 578 3050 77 122 143 1607 8 105 — — 1 — JfRoyal Free Hospital — 99 452 34 6 21 61 425 177 239 841 153 185 72 236 12 157 3 155 — 3 UniversityCollege Hospital — 539 2868 292 21 42 355 1864 402 791 3057 202 307 94 1924 18 203 18 203 — 2 Totals 2450 1144 4985 1898 186 259 2401 24668 7906 7419 39993 1733 3488 2734 29935 116 1446 32 493 16 7 * Two Part-time trained Visitors. On the 29th December the Superintendent died, and a part-time temporary Visitor was appointed. An additional visitor was also attached to the following Centres North St. Pancras School for Mothers, 2 days a week ; Caversham Road, 3 days a week ; and South Highgate, for 1 day a week, † Figures refer to St. Pancras cases only. (In addition to the above visits were made by Student visitors attacked to Centres, as follows :—Ampthill Square 60 ; Camden Town 1013 ; and Caversham Hoad 551.) ‡ See explanatory remarks regarding these two centres on page 103. 106 CENTRES. Particulars concerning some of the special activities of those individual Centres referred to in the above table to which a definite area is assigned 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 958. Other activities of this centre include the following:— Classes for Mothers. At Health Talk classes there were 511 attendances; and at needlework, etc., classes, 813 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. Nursing and expectant mothers were supplied with 2,225 dinners and young children with 770. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,696 attendances during the year, of which 505 were made by infants under one year of age, and 1,191 by children from 1 to 5 years of age. Dental Clinic. The Dental Surgeon is Mr. George Thomson, L.d.s. During the year 49 consultations were held, at which 204 treatments were provided for mothers and 160 for children. Details of the work done are given in the following table :— Mothers. Children. Extractions with anaesthetics 40 13 „ without anaesthetics 5 2 Fillings 74 72 Scalings 8 1 Impressions and fitting dentures, etc. 60 — Examinations and advice 17 72 Totals 204 160 364 This clinic is provided out of funds obtained from voluntary sources, except for a contribution towards fees of the Dental Surgeon made by the Borough Council. The Dental Surgeon submits the following observations:— The prevention of dental caries is possible if children of 2, 3 and 4 years are regularly inspected. The molar teeth may thus be preserved till 10 or 11 years, when they are shed to be replaced by permanent teeth. Mothers are usually willing to accept advice as to the preservation of the temporary teeth. 107 The decay of the incisor teeth is usually caused by the use of a dummy, but is not so serious as the decay of the molars. From three years children attend nursery schools, but it is better for them to attend a Maternity dental clinic until five years with their mothers. Manage Clink. Treatments numbering 672 were given at 90 clinics by trained masseuses, the cost of whose services was not paid by the Borough Council. Camden Town Centre, Barnes House, Camden Road. 22 mothers and 34 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 1,821. Classes for expectant mothers numbering 8 were held simultaneously with the antenatal clinics. There were 165 attendances, the average being 20 per class. Knitting and Needlework classes and Health Talks were given, the total attendances being 687. The services of two trained masseuses (not paid by the Borough Council) were available throughout the year, during which time 78 massage clinics were held. There were 854 attendances. Dinners for Mothers and Children.—These were supplied daily at the Centre to 3,551 expectant and nursing mothers and 1,868 children, at a charge of 2d. per head. The Borough Council's Dental Clinic. 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. Mr. R. M. Underwood, L.D.S., is the Dental Surgeon. 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 toward the cost of dentures. 1()8 The work done during the year is summarised in the following table, the figures for the previous year also being given for comparison:— Work carried out at the Dental Clinic. 1936. 1935. Number of new cases Mothers 179 169 Children 199 261 Total 378 430 For extractions under nitrous oxide (gas) 326 357 Number of Attendances ,, „ local anaesthesia 15 30 „ fillings and dressings 185 296 „ scaling 24 20 ,, impressions and fitting dentures . . 195 169 ,, examination and advice 594 654 Total attendances 1339 1526 Total number of clinics held 78 74 Number of clinics with nitrous oxide anaesthesia 24 23 The following table shows the number and cost of the dentures supplied during the year Number of Patients supplied with dentures 34. Total cost £ 89 13s. 6d. Amount paid by mothers £47 19s. Ud. Amount paid by Borough Council £24 7s. Od. Amount paid by Hospital Sunday Fund £7 9s. 6d. Amount paid by other sources £9 18s. Od. Twelve mothers paid the entire cost of their dentures, two of which were complete sets. Caversham Road Centre, 14, Caversham Road, N.W.5. 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. 36 classes for needlework were held at which 517 attendances were made ; 43 mothers attended five cookery classes, and 101 mothers attended 18 classes in mothercraft. During the year 74 mothers and 145 children were sent away for a fortnight's holiday. North St. Pancras School for Mothers, 129, Queen's Crescent, N.W.5. Attendances at the Sewing and Knitting classes numbered 515. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 1,494. There were two cookery demonstrations, at which 39 mothers attended. 109 62 children attending this Centre were referred for Artificial Light treatment, and 40 mothers and 37 children were referred to the Council's Dental Clinic for treatment. 16 mothers and 37 children were sent away on holiday or convalescence. Somers Town Centre, Chamberlain House, Ossulston Street, N.W.I. In addition to the consultations provided by the Borough Council, the Health Visiting Staff had 1,098 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes during the winter months, at which 195 attendances were recorded. 36 mothers and 42 children were sent away on holiday for a period of two or more weeks, and in addition many children benefitted by convalescent treatment at " Avalon." 703 massage treatments were given at 91 clinics by a trained voluntary masseuse. Many children are sent to the Council's Dental Clinic at Barnes House, which has proved very helpful. The clothing stall was kept well equipped by voluntary knitters. The usual stock of woollen garments was maintained, and served as a valuable educational agent, as well as being a great convenience to the mothers. South Highgate Centre, 43, Raydon Street, N.19. 73 mothers attended needlework classes. 14 mothers and 18 children were sent away on holiday, either to the country or seaside, for a period of two weeks. Artificial Light Treatment. The clinic maintained by the Borough Council at this Centre for the provision of this form of treatment was in regular use throughout the year, except for the period 30th Mav to 10th October. The consultations which were held on Mondays and Thursdays in each week numbered 65, the average number of attendances at each consultation being 12. This clinic 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 K. 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 during 1936 are given in the following table:— 1936. 1935. Total number of cases treated 40 47 Total number of new cases 30 38 Total number of attendances 769 642 Number of Consultations held 65 54 Average attendance per Consultation 12 12 Average number of attendances per child 19 25 13.5 ] 10 In addition to the Clinic provided by the Borough Council, Artificial Light Treatment is available at the Institute of Ray Therapy, Camden Road, and also at the Voluntary General Hospitals in the Borough. Dental. Treatment. Dental treatment is also provided at the clinic which is held at the St. Pancras School for Mothers, see page 106. The Eastman Dental Clinic attached to the Royal Free Hospital is a lavishly-equipped clinic which provides dental treatment for children and for nursing and expectant mothers, and operative treatment in connection with enlarged tonsils and adenoids in children. The Dental Section is equipped with 68 chairs and complete electric units, the Surgical wing contains 32 beds for tonsil and adenoid, cleft palate, hare lip, etc., cases requiring operative treatment. The Welfare Centre held in connection with the University College Hospital is able to refer cases needing dental treatment to the dental department of that hospital. BOROUGH COUNCIL CONTRIBUTIONS. 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, to 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 was 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 Royal Free Hospital receives grant from the L.C.C. and for this reason it has not been the practice to include figures relating to the Welfare Centre at this Hospital in the return which the Borough Council makes to the Ministry. 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. A new scheme in respect of the period terminating March, 1942, was in course of preparation before the end of the year, covered by this report. The associations included, particulars of the work of which have already been given, are those to which the St. Pancras Borough Council make contributions and the amounts of the Council's contributions under the old and the new schemes are given in the following table:— Ill These centres carry out routine M. & C. W. work in defined areas and are staffed by officers of Borough Council. Association. Scheme expiring 31st March, 1937. Scheme commencing 1st April, 1937. £ £ St. Pnncras School for Mothers 777 777 Somers Town Welfare Centre 275* 275 North St. Pancras School for Mothers 136 220 South Highgate Welfare Centre 141* 160 Caversham Road ,, 421 —† Camden Town „ 560* 670 These associations render various ancillary services. St. Pancras Dispensary 146 200 University College Hospital 890 1150 Whitefield Day Nurserv 480 480 Kentish Town ,, 513 513 Margaret ,, 750 760 Mayoress of St. Pancras Home for Sick Poor Children 700 750 Home Helps Committee 150 250 * The Borough Council provides the building in these cases and the following amounts included in the figures given here are allocations in respect of the use of building :—Camden Town, £330 , Somers Town, £191; and South Highgate, .£123. † Grant discontinued owing to resignation of Voluntary Committee. 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. WORK CARRIED OUT BY SUPERINTENDENTS AND HEALTH VISITORS. Maternity and Child Welfare work is to be considered under the two main headings of CHILD WELFARE and MATERNAL CARE. In regard to each of these the duties of Superintendents and health visitors are divided between home visiting and supervising or rendering assistance in connection with the various activities of the centre to which they are attached. Particulars of the work of these officers are given in the following table:— 112 Table IV. 112 Ampthill Squark. Camden Town. Landel- Jones.¶ § Bagnall. Hunter.* Cavehbham Road. George.† Jlist.† O'Leary.‡ Chapman,¶ Queen's Ckkscent. Luiie. somers Town. Brown, a South highgate. totals. Bristow.¶ Harrop. Lynn. Crockart.¶ Blair. Harris.* Hunter.* Smith. Harris.* Reid. † Herbert. || Hunter.* Harris * Bruce. Manger.¶ Anderson. Blaxland. Robinson. Hunter.* Harris.* Maternity and Child Welfare : under 1 year :— (a) First Visits following Birth Notifications 64 155 157 29 161 77 61 148 — 165 1 — 131 43 3 — 2 63 — 11 213 180 132 56 181 - 101 3 17 2157 (b) Other First Visits 13 12 12 5 13 9 1 18 — 3 — — 2 6 — — - 6 — — 34 11 3 2 5 - 21 1 — 177 (c) Subsequent Visits 297 987 1017 140 463 243 271 698 6 1000 30 31 720 381 11 8 5 332 30 51 970 749 604 500 863 22 396 53 114 11122 1—2 years :— (a) First Visits — 2 24 2 7 3 8 — — 1 - — 2 9 2 — 1 1 1 1 17 12 2 5 6 — 4 — 110 (b) Subsequent Visits 233 578 558 68 216 103 148 308 5 246 40 54 159 450 47 4 — 81 42 79 464 358 324 362 400 6 225 35 63 5659 2— 5 years:— (a) First Visits — 8 9 9 — 5 16 2 — 1 2 — — 21 1 — - 5 — 3 25 13 4 13 1 - - 3 3 144 (b) Subsequent Visits 240 926 698 158 426 144 203 508 3 275 105 Ill 111! .92 171 1 — 154 150 189 421 502 305 787 447 13 339 87 142 8447 Expectant Mothers:— (a) First Visits 39 63 112 60 108 46 53 73 — 266 2 1 3 5 1 10 — 19 4 11 118 91 45 56 115 - 61 3 13 1378 (b) Subsequent Visits 46 188 137 18 52 16 19 50 3 315 2 10 5 33 6 - — 55 18 14 214 111 75 63 115 3 40 - 5 1621 Post Natal — 16 — 40 1 9 — 6 2 75 — — 10 6 — - — 2 — 1 — — — 10 6 - 38 2 2 226 Infectious Diseases:— Ophthalmia Neonatorum 7 1 3 3 1 — 2 — 8 1 — 2 — 2 — — - — — 1 — 1 1 3 - 2 — 1 42 Puerperal Pyrexia — 3 — 2 1 5 — — — — - 4 1 — - — - — — 2 1 — — 3 - 4 — — 26 Puerperal Fever — — 2 1 2 — 4 — — 2 — — 1 — — — — — - — 1 — - — — - 1 — — 14 Measles Under 1 year 8 9 18 2 2 3 1 22 1 12 1 1 11 — — — — 6 2 — 18 23 12 6 15 - 9 4 2 188 1—5 years 31 112 122 11 81 92 7 124 — 42 27 1 65 79 — — - 26 33 2 163 111 57 98 184 - 57 13 5 1546 Over 5 years 38 66 89 10 64 52 2 52 3 56 27 1 54 82 — — - 17 13 2 87 76 28 32 138 63 11 10 1073 Under 1 year 1 4 — — — — — 2 — 5 - — -- — — — - - 3 — 4 — — — 1 - — — 1 21 German Measles 1—5 years 1 1 1 — 1 3 1 — — 3 — — — 2 - — - - 3 — 4 — — 2 1 - - — — 26 Over 5 years — 1 4 1 1 — — — — 1 — — — 2 1 — - - 1 1 — — 5 9 - 3 — — 30 Under 1 year - 1 1 — — — — 1 — 1 — — j 1 — — 1 - — 1 3 — 1 5 3 — — 21 Whooping Cough I—5 years 1 10 12 — 3 3 7 21 — — — — 4 5 2 — — 2 13 2 16 24 1 2 29 — 5 2 1 170 Over 5 years — 6 8 — 10 2 — 7 — 1 — — 4 6 — — - 1 1 3 8 14 1 8 3 - 1 — 1 85 Other Diseases Under 1 year — — 1 — - — 4 I — - o — — — — — - 2 - — 8 5 4 14 11 - 5 — — 57 1—5 years 9 30 24 — 11 17 22 24 1 24 12 — 4 10 4 — 8 30 1 82 43 6 100 105 - 13 8 — 588 Over 5 years 9 79 46 3 8 33 12 57 2 84 -3 2 47 63 17 — 5 43 5 111 88 8 60 49 - 58 11 5 928 Children and Young Persons Act, Ac.— Initial Visits to Foster Mothers 2 2 I — 2 5 3 18 — 9 - 1 - - - - - - - - 3 1 — 1 3 — 1 — — 52 Subsequent Visits to Foster Mothers re children:— (a) Under 1 year 1 33 8 — — — 4 2 3 21 2 1 — — - — — — — — — 3 — - 42 — 9 — - 136 (b) 1—5 years 10 42 45 7 7 7 7 30 — 36 — 10 — — — — — 6 — — 28 1 1 26 11 — 40 — 1 325 (e) Over 5 years 2 15 9 — 10 4 6 6 1 11 1 4 — — — — — 4 — — 1 5 1 13 16 — 20 — 1 130 Other Visits 10 1 16 32 2 - 3 43 12 10 - 2 — — — — — 3 — — 5 4 6 12 18 — 11 — 1 191 Milk Enquiries (a) Expectant Mothers - - — — — — — 7 — 1 — — — — — — — - — — — — — — 1 — — — - 9 (b) Under 1 year — 4 11 — — 1 — 1 — 6 — — — — — — — — — — — — — — 5 — 1 2 — 31 (c) 1—3 years 1 — 2 — 2 — — — — 2 — 1 — — 1 — — 1 — — — — — — 1 — 2 - — 13 Visits re Deaths of Children (a) Under 1 year 1 — 4 — 3 1 — 2 — 3 — — 5 — — — 3 — — — — — 3 9 — 1 — - 35 (b) 1—2 years — — — — 1 - — — — — - - - — — — — 1 — — 1 — — — 2 — — — - 5 (c) 2—5 years - - - - - - - - — - - - - 1 - - - 1 - - - - - - - - - - - 2 Other Visits 12 1 — 60 12 10 36 4 3 1 7 1 — 8 3 — - 73 3 2 1 1 39 3 — 22 9 17 328 Total Visits 1176 3356 3181 656 1674 895 904 2214 45 2666 285 262 1342 2011 272 23 8 880 397 378 3023 2436 1662 2243 2842 44 1552 251 405 37113 Consultations attended 220 131 125 193 220 32 47 133 172 117 2 9 29 9 6 7 1 2 221 10 6 171 136 201 77 172 — 166 81 60 2837 Classes attended 63 4 3 58 6 - 5 17 63 4 - - - 2 — — — 37 — 2 37 30 — — — — 6 — — 337 Special Interviews at Centre 958 — — 1821 416 — 8 27 1445 125 — — 13 27 — — — 1376 — — 23 95 879 1 218 — 990 23 53 8498 Ineffective Visits 253 305 552 61 920 36 •279 225 2 671 66 83 207 268 61 4 6 163 90 173 576 702 219 715 564 9 186 23 119 7538 In addition to the above, visits were made by Student Health Visitors attached to Centres as follows: Ampthill Square, 60 ; Camden Town, 1,013; Caversham Road, 551. Notes:—Superintendent. * Miss Harris and Mrs. Hunter changed duties in June. § Miss Landel-Jones died on 29th December, 1936. † Kail lime workers not paid directij by Borough Council, commenced 26th October, 1936. || Miss Herbert resigned, 30th December, and Miss Just took her place on 31st December, 1936. ‡ Temporary part-time worker paid by Council, commenced 31st December, 1936. a Voluntarv worker. 113 Notification of Births Acts, 1907, 1915. Under the provisions of the above Acts all births must be notified to the Medical Officer of Health within 36 hours of the event. This applies to the birth of a child, alive or dead, which has issued forth from its mother after the 28th week of pregnancy. This notification is in addition to, and not in substitution for the registration of birth. The number of live births notified during the year was 3,735 and of still births 144. There were '233 illegitimate births. The number of registered live births was 3,739, which shows that notification is obtained in practically every case. early notification is necessary for an efficient Maternity and Child Welfare service. on receipt of this information the whole machinery is set in motion and a Health Visitor calls on or about the fourteenth day. Where necessary, both the mother and baby are offered the various available facilities. Cards of advice are dispatched by post to the individual mothers immediately after the receipt of the notification of birth. Ministry of Health Circular 1550. In July the above-mentioned Circular was considered, dealing with the arrangements for the supervision of the health of children under school age. The Minister of Health is satisfied that the arrangements made with regard to children up to eighteen months or two years are adequate, but he is of opinion that in many areas insufficient attention is being given to the health of young children from that age to five years. A comprehensive report on the subject was presented by the Medical Officer of Health, which contained the following recommendations, which were subsequently approved by the Borough Council:— (a) Every effort should be made to organise the work at the welfare centres so as to increase the time available for visiting children between the ages of one and live years. (b) Facilities for treatment would be improved if an arrangement were made to enable pre school children to obtain treatment at the school treatment centres in the Borough. (c) It is suggested that the Eastman Dental Clinic and the London County Council be approached jointly with a view to its being made possible for young children to be referred from the Welfare Centres to this clinic for treatment. (d) The introduction of a system of sending birthday cards inviting children to attend the centres is advised. CHILD WKLFAKE. The two essentials upon which all other child welfare activities depend are home visiting and attendance at centres. Both are indispensable, but it should be borne in mind that while good routine home visiting reaches all and has the effect of filling the centres, reliance upon attendance at centres to the neglect of home visiting will do little or nothing for those children whose mothers do not yet recognise the importance of periodic inspection. Particulars of Home Visits to and attendance at Centres of children aged 0-5 are given in the following table :— Visit* to 1932 1933 1934 1935 1936 Children 0-1 First 2694 2587 2454 2365 2334 0-1 Total 14132 15450 14094 16340 13434 1-5 Total 14756 17011 14293 16399 14341 Attendances by Children 0-1 27522 27079 25107 24678 24668 „ 1-5 16625 15868 14830 15818 15325 [See Table IV for details of work at each Centre.] 114 A statistical guide to the success of this work is provided by consideration of (a) the infantile mortality rate and (b) the results of the medical examination of school entrants. Comparative figures showing the infantile mortality rate in St. Pancras for recent years and in the different London Boroughs for 1936 will be found on pages 14 and 16 respectively. Particulars regarding the medical examination of school children in St. Pancras are contained in the following tables kindly supplied by the School Me lical Officer to the London County Council:— In Table V the frequency of the commoner defects found in children at various ages is given and in Table VI the children are classified in relation to clothing, nutrition, cleanliness, teeth and vision. Table V shows that defective teeth are by far the most frequent defect from which children suffer when they enter school and that it remains the most frequent throughout school life. Thus 35 per cent. of school entrants in St. Pancras in 1936 were found to have this condition, while 21 per cent. of children examined in school at 11 years of age had delective teeth. Particulars of the facilities for dental treatment provided in connection with the St. Pancras Maternity and Child Welfare scheme are given on pages 106, 107 and 110. 115 Table V. Examination of Elementary School Children in St. Pancras in 1936. Information supplied by the School Medical Officer of the L.C.C. Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. Number examined 989 657 937 1051 960 588 881 1078 Malnutrition Cases.* Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * 12 10 11 9 7 6 2 1 9 7 4 2 5 5 3 3 Skin disease 11 7 4 4 8 6 8 7 9 7 4 3 7 4 13 11 Defective teeth — 335 — 152 — 208 — 259 358 — 141 — 154 — 250 Enlarged tonsils 132 54 44 19 19 7 16 6 129 55 50 22 29 7 11 6 Adenoids 11 4 5 4 1 1 3 2 12 8 5 4 2 — 1 1 Enlarged tonsils and adenoids 78 29 24 7 18 1 21 - 107 36 26 8 25 3 8 2 Other nose and throat defects 9 3 8 5 5 2 1 — 4 2 6 3 1 1 4 3 Enlarged glands 55 12 14 3 11 1 10 — 57 16 20 4 16 2 1 1 Eye disease 50 28 14 9 15 7 8 5 44 25 22 13 8 4 10 7 Vision defects — — — 41 113 — 131 — — — 29 — 96 — 147 Otorrhoea 25 15 9 7 6 6 2 2 28 17 7 4 4 3 4 4 Other ear disease 1 1 1 — — — 2 2 5 4 1 — 2 1 — — Defective hearing 4 — 1 — 2 1 2 2 2 1 — — — — 2 1 Speech defects 2 — 1 — 3 2 2 1 2 — — — — — 2 2 Heart defects 31 1 19 — 27 — 11 — 24 2 14 — 17 3 30 2 Amentia 6 X 7 5 — — 4 1 7 1 2 1 2 1 1 — Lung defects 55 16 13 7 10 2 2 1 43 17 14 3 10 3 5 2 Nervous defects 6 2 — — 7 3 1 1 4 — 6 1 3 1 1 1 Phthisis 2 — 1 — 2 — 2 — 1 — 7 1 1 — 4 1 Other T.B. disease 1 1 — — — — — — — — — — — — — — Rickets 10 2 2 — 2 — 1 — 3 1 1 — — — 1 — Spinal deformities 2 — 1 1 4 3 5 3 4 1 — — 8 5 21 13 Other deformities 12 8 2 2 5 5 4 1 6 1 8 2 10 7 15 7 Other defects 43 34 24 17 26 15 9 6 39 25 31 23 26 15 26 14 Number of children noted for treatment 476 238 335 385 487 229 289 108 * Defects, however slight, are included under 44 Cases." Those severe enough to require treatment are shown Under.* The following table gives the deaths and death rates of both legitimate and illegitimate infants for 1936 :— Legitimate. Illegitimate. Total. Number of Births 2,156 233 2,389 Number of Deaths (under one year of age) 166 24 190 Death rate per 1000 births 77 103 79 116 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 and 16 respectively. On pages 118 and 119 tables are given which indicate:— 1. The causes of death of all children under one year of age during 1936, classified according to age at death, cause, wards and sex. 2. The causes of death of children under one year of age during the ten previous years. In this table the number of births in each year is also given for reference. 117 TABLE VI Routine Medical Inspection of Elementary School Children in St. Pancras in 1936. Information supplied by the School Medical Officer of the L.C.C. 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. N its. Pediculi. Clean. Dirty. Pediculi. All sound. Lens than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 989 626 354 9 124 828 37 — 953 33 3 977 12 — 608 256 126 — — — Girls 960 671 280 9 157 772 31 — 926 28 6 950 10 — 550 278 132 — — — Age 7— Hoys 657 400 251 6 72 549 36 — 640 17 — 651 6 — 471 154 32 493 109 51 Girls 588 371 215 2 80 475 33 — 555 28 5 582 6 — 406 151 31 451 91 38 Age 11— Boys . 937 614 317 6 124 776 37 — 917 20 — 931 6 — 688 236. 13 672 126 137 Girls 881 595 281 5 159 696 25 1 819 56 6 877 4 — 699 171 11 632 114 133 Age 14— Boys 1051 733 313 5 182 848 21 — 1033 18 — 1048 3 — 779 251 21 765 119 166 Girls 1078 781 294 3 291 770 17 — 1023 49 6 1072 6 — 823 226 29 763 143 169 Total 7141 4791 2305 45 1189 5714 237 1 6866 249 26 7088 53 — 5024 1723 394 3776 702 694 Percentage 671 323 0.6 16.7 800 3.3 961 3.5 0.4 99.3 0.7 — 70.4 24. 1 5.5 73.0 13.6 13.4 London 564 432 04 16.6 77.4 60 97 5 2.2 0.3 99.2 0.7 0.1 70 .0 26.1 3.4 66.2 19.3 14.5 118 (1) Deaths under One Year of Age in the Borough of St. Pancras during 1936. (This table is prepared by the Registrar-General and relates to the period 1st January to 31st December, 1936.) CAUSE OF DEATH. AGE*. DEATHS IN EACH WARD. No Address. Totals. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3—6 months. 6—9 months. 9—12 months. Total Deaths under 1 year. i. 2. 3. 4. 5. 6. 7. 8. M F M F M F M F M F M F M F M F M F m F Measles _ _ _ _ _ _ _ 1 2 3 _ _ _ 2 _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ 3 Whooping Cough _ _ _ _ _ 1 2 5 _ 8 _ _ 1 _ _ 1 1 _ 1 _ 1 _ _ _ 1 2 _ 5 3 Influenza _ _ _ _ _ _ _ 1 1 2 _ _ _ 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 Erysipelas _ _ _ _ _ _ 1 _ _ 1 _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ 1 Meningitis (not Tuber- _ _ _ _ _ 1 _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 Bronchitis _ _ _ _ _ 2 1 1 _ 4 _ 1 1 _ _ _ _ 1 1 _ _ _ _ _ _ _ _ _ 2 2 Broncho-pneumonia. _ _ _ _ _ 9 2 3 3 17 1 1 3 _ 3 1 _ 2 1 1 _ _ 1 1 1 1 _ _ 10 7 Lobar-pneumonia _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Pneumonia (type not atated) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Enteritis 1 _ _ _ 2 14 21 17 4 58 5 4 5 1 2 1 5 8 6 3 2 _ 4 1 5 6 _ _ 34 24 Syphilis _ _ _ _ _ _ 1 _ _ 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 Injury at Birth 4 _ 1 _ 5 _ _ _ _ 5 _ _ 1 _ 1 _ _ _ _ _ 1 _ _ _ 1 _ _ 1 4 1 Atelectasis 1 _ _ _ 1 _ _ _ _ 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 Congenital Malformations 2 1 _ _ 3 7 3 1 _ 11 2 1 1 2 2 1 _ _ 1 _ _ 1 1 1 _ 1 _ _ 7 7 Premature Birth 30 3 1 1 35 2 — _ _ 37 3 3 _ 1 7 2 3 2 1 7 3 1 _ _ 3 1 _ _ 20 17 Congenital Debility, 2 _ _ _ 2 2 1 _ _ 5 _ _ _ 1 _ _ _ _ 1 1 _ 1 1 _ _ _ _ _ 2 3 Other causes 3 1 _ _ 4 8 4 4 7 27 1 3 _ _ 1 3 2 2 5 2 1 _ 1 _ 2 1 _ 3 13 14 Totals 43 5 0 2 52 46 36 13 17 184 12 15 12 9 16 10 11 15 17 14 8 5 8 3 13 12 _ 4 97 87 Deaths of infants not belonging to St. Pancras occurring within the Borough, are excluded. , ,, belonging ,, ,, outside ,, ,, included. Nett Births in the year legitimate 2156 Nett Deaths in the year legitimate infants 166 illegitimate 233 illegitimate infants 24 119 [2) Deaths from Stated Causes under 1 Year or Age for 1936 and 10 preceding Years cause of death. 1926 1927 1928 1929 1930 1931 1932 1933 1931 1935 Average for 10 years. 1936 Measles 25 — 30 — 3 1 6 — 8 — 7 2 Scarlet Fever — — _ — — — — 1 — — — — Whooping Cough 11 15 10 32 2 10 11 4 3 9 11 8 Diphtheria and Croup 1 — — 3 1 1 1 1 — — 1 — Erysipelas — — — — 2 — 3 — 1 1 1 1 Influenza 1 2 — 5 2 1 2 1 1 — 2 2 Tuberculous Meningitis 3 3 — — 1 1 I 1 — — 1 3 Other Tuberculous Diseases 1 1 2 — 2 2 1 — — — 1 1 Meningitis (not Tuberculous) 3 2 1 4 3 8 3 6 3 — 4 6 Convulsions 2 1 1 6 ' — 1 - 2 — — 1 — Bronchitis 14 5 9 7 7 4 3 4 4 4 6 2 Broncho-pneumonia 36 42 43 43 20 42 27 12 24 31 33 15 Lobar-pneumonia 2 2 3 4 — 3 1 — 1 2 2 — Pneumonia (type not stated) 1 1 2 1 3 1 2 — 1 1 1 — Diarrhoea 7 3 8 5 6 6 9 2 — — 5 8 Enteritis 88 24 33 34 36 22 42 27 25 28 35 45 Gastritis — — — 1 — — 1 — — — — 12 Syphilis l 2 4 1 3 2 2 1 1 2 2 1 Rickets — — — — 1 — — 2 — — — — Suffocation (overlying) 3 1 1 — 1 — — — — — 1 — Injury at Birth 3 9 2 9 4 3 6 2 3 5 5 5 Atelectasis 6 10 11 7 3 4 8 7 7 2 7 2 Congenital Malformations 25 15 20 23 12 23 10 14 17 12 18 12 Premature Birth 57 39 50 46 48 43 36 37 43 42 48 37 Congenital Debility, Sclerema and Icterus 18 14 16 14 8 7 2 8 4 3 10 2 Other causes 16 14 15 26 15 9 19 14 13 18 26 Totals 274 205 261 262 194 200 186 151 160 155 224 190 Nett Births 3612 3299 3274 3170 3208 2955 2684 2589 2449 2466 3278 2389 120 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. Form as Desired bv 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. Treated Notified. At Home. In Hospital. 1936 32a 15 16 2 6 B l — 3c 13.4 7 11 1935 23* 11 12 21¶ — — — 9.3 7 10 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 1 — 1* 11.4 11 12 1928 32 24 8 32 — — — 9.8 12 6 •Due to other causos. I Several cases removed to unknown addresses. X Excluding one case, information unobtainable. || Died from Prematurity, Congenital Heart Disease and Gonorrhœal Ophthalmia. § One moved away to unknown address. (1) Died—Prematurity. Ophthalmia Neonatorum. (2) Died—Gastro Enteritis. Ophthalmia N eona to rum, Mongolism, Imbecility. g (T Died—Acute Bronchitis (before eyes had recovered), (2) Died—Prematurity. Ophthalmia Neonatorum. Gonococcal infection. * Excluding one case brought to notice other than by notification. Three cases who moved and were not traced before complete recovery are not included. a Including one case which came to notice after death. b One moved—unable to trace c One Prematurity, Gonorrhoea ; one prematurity ; one prematurity, Gonorrhoea, Ophthalmia Neonatorum, Jaundice of the Newborn. In addition to the above, there were 30 cases of Mild Inflammation not notifiable as Ophthalmia Neonatorum. Out of the 32 notifications this year, five were considered " grave" ten were of " moderate " severity, and seventeen were returned as " slight." A purulent discharge from the eyes of an infant occurring within the specified period given above is required to be notified irrespective of the cause of this condition. Ophthalmia Neonatorum therefore is not necessarily due to a Gonococcal infection. The purpose of this regulation is to prevent the possibility of delay in the treatment of gonorrheal conjunctivitis. This most serious condition is responsible for a high proportion of cases of blindness and is due to infection from the mother. Amongst the preventive measures to be taken ante-natal examination and treatment of the mother should be included. This attention was given in all but two cases. Post-natal [care should be continued in these cases until the mother is free from infection. For particulars of visits paid in respect of this condition see Table IV. 121 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 Acts." " 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 two 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 151 persons on the Register, of whom 89 for reward were receiving 110 children. Particulars of visits paid will be found in Table IV. Ancillary Services. The services here described are of value in that they complement the routine work of home visiting and the conduct of consultations carried on at the six Welfare Centres to which definite areas have been assigned. University College Hospital Welfare Centre. This Centre is not confined to St. Pancras residents and the grant paid by the Borough Council, inasmuch as it consists of the discontinued Ministry of Health grant that used to be paid directly to the hospital, is not to be regarded as being solely in respect of services rendered in St. Pancras. Considered as part of the St. Pancras Maternity and Child Welfare scheme this Centre consists of (ft) a welfare centre attended by babies born either in the hospital or under the auspices of the hospital domiciliary midwifery scheme ; (b) a consultative centre to which babies can be referred for specialist advice ; (c) a treatment centre. Two Health Visitors are employed and these visit cases attending the centre. Statistical information regarding this centre will be found in Table III on page 105. As mentioned on page 103 the University College Hospital Welfare Centre has assumed responsibility for routine Maternity and Child Welfare work in Ward VII, and particulars of this arrangement appear therein. 122 Royal Free Hospital Welfare Centre. This Centre receives a grant from the London County Council. Welfare work in regard to babies born under arrangeiuenls for which the hospital is responsible is carried on by means of a welfare centre and by home visiting undertaken by three Health Visitors. Particulars of the work of this centre are given in Table III on page 105. Supply of Miik 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. 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. 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 the 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 1935 there were 211 families actually in receipt of milk under the Borough Council's scheme. During 1936, 330 new families were added to the list of recipients. By the end of that year there were 187 families receiving grants. The total cost of this scheme in 1934, was £992 ; in 1935, £1,067; and in 1936, ill,028. 123 Particulars of the allowances made in each month of the year are given in the following table : — FREE. HALF-PRICE. COST. Month. Pints. +Lbs. (Dried Milk.) Pints. +Lbs. (Dried Milk.) £ s. d. *January 5600 195 840 30 103 19 6 February 5320 160 392 35 94 2 6 March 5124 120 448 25 88 4 0 *April 5432 185 476 10 97 6 8 May 4116 160 308 15 66 5 8 June 4452 155 308 25 70 9 9 *July 5068 215 504 15 83 12 11 August 3808 140 588 20 62 16 8 September 4340 150 560 25 79 18 0 +October 5180 185 952 35 98 1 9 November 4200 150 784 25 79 9 10 December 5684 190 868 30 104 0 4 58324 2005 7028 290 £1028 7 7 5 week months making a year of 53 weeks. + 1¾ lbs. of (reconstituted) dried milk powder is equivalent to 7 pints of cow's milk. In addition to the above, emergency grants, limited to a period of fourteen days, were made in 264 cases, at a cost of £37 8s. 0d. 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 £31. 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 shown hereunder Number in Family. After Deduction of Rent. Free. Half-price. £ s. d. £ s. d. One 0 12 0 0 13 9 Two 0 18 3 1 3 0 Three 1 2 0 1 7 6 Four 1 5 6 1 11 3 Five 1 10 0 1 16 6 Six 1 13 0 2 1 3 Seven 1 16 6 2 5 9 Eight 2 0 0 2 10 3 Nine 2 3 6 2 15 0 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. 124 ST. PANCRAS DISPENSARY. 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 (Tel. Huston 1882). Patients are referred from the Town Hall, from the Welfare Centres, and by the Health Visitors, etc., to this clinic. The work carried out during the year is summarised in the following table, the figures for the two previous years also being given for comparison : - 1936. 1935. 1934. New Casks : Children under 5 years of age 28 34 30 Ailing Nursing Mothers 5 16 26 Ailing Expectant Mothers 29 25 34 Attendances : Children under 5 years of age 50 130 73 Ailing Nursing Mothers 14 63 51 Ailing Expectant Mothers 49 66 70 Dispensary as a whole (including the above). New Cases : Children under 5 years of age 534 525 520 Ailing Nursing and Expectant Mothers 34 41 60 Attendances: Children under 5 years of age 1688 1525 1296 Ailing Nursing and Expectant Mothers 63 129 121 The Medical Officer of this Special Clinic is paid by the Borough Council. He is assisted by a Nurse (part-time), the cost of whose services is defrayed equally by the Committee of the St. Pancras Dispensary and by the Committee of the Mayoress' Home. During the year the Nurse made 589 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. Panckas Home for Sick Poor Children.—This is situated at " Avalon," 1, St. Alban's Road, and accommodates 22 children and the necessary staff. Dr. Pritchard is the Medical Administrator. The age limit for admission is from 18 months to 5 years. 125 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. Close co-operation with the Council's Welfare Centres is essential if full use is to be taken of the facilities offered at this Home, and this is secured by the appointment of the Deputy Medical Officer of Health as Administrative Medical Officer to the Home. 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. The number of children admitted during the year was 146, the average length of stay in the Home being 33 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 of £1 for each approved case up to a total of £36 per annum towards the cost is made by the Borough Council. Under this scheme 33 children were sent away during the year under review. 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, 1936 are as follows :— Number of Days Open. Attendances. Average per Day. No. of places for children under 5. Whitefield Day Nursery 229 5635 24.6 40 Kentish Tn. Day Nursery 229 7311 31.9 45 Margaret Day Nursery 252 14556 56.9 60 Foundling Site Day Nursery 252 3947 30.0 30-40 Nursery Schools. The undermentioned Nursery Schools are situated in the Borough. They provide care, facilities for play, training in good habits, and some elementary instruction for children who are too young to be admitted to the ordinary schools. 126 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 44 39 Jellicoe Nursery School, Ha, Rochford Street 52 45 Mary Ward Nursery School, 16, Burton Street 30 20 Magdalen Mission Nursery School, 5, Clarendon Street 25 20 St. Christopher's Nursery School, Bridgewater Street 45 31 Buck Street Nursery School 40 35 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. Pavment 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 Loudon 15 10 25 Totals 185 70 255 The following table gives the number of cases and number of visits during the past year :— District Nursing Association. No. of cases. No. of visits. Average No. of visits per case. Metropolitan 367 5445 14.8 Hainpstead 886 1346 3.4 North London 25 162 6.5 Totals 778 6953 8.9 127 MATERNAL CARE. Maternal care comprises ante-natal care, care at the confinement and post-natal care. It is generally agreed that early systematic and thorough ante-natal care is the most important of all means to be taken towards the redaction of maternal mortality. It will be seen from the following Table VII., supplied by the Registrar-General, that 7 deaths were primarily classified as due to childbirth, and that 4 deaths were classified as being associated with pregnancy but not attributable thereto. The puerperal maternal mortality rate (deaths primarily classified to childbirth per 1000 births live and still) for 1936 was accordingly 2'8. Table VII. Maternal Mortality in Borough of St. Pancras in 1936. AGES. CONDITIONS. WAKDS 15-20 years. 20-25 years. 25-30 years. 30-35 years. 35-40 years. 40-45 years. 45 years. Married. Single. Widowed. I. II. III. IV. V. VI. VII. VIII. No Address Post abortive sepsis — 1 — — 1 — — 1 1 — — — 1 — — — — 1 Puerperal septicaemia — 1 — 2 — — — 1 2 — — — — 1 1 — 1 — Other accidents of childbirth — 1 1 — — — — 2 — — — — 1 1 — — — — — Associated with pregnancy and child-bearing but not classed thereto— Carcinoma of uterus — — — — 1 — — — — — — — 1 — — — — — —— Myoma of uterus — — — — — — — 1 — —- — — — — — — 1 — — Abnormality of blood pressure — — — — — 1 — 1 — — — — — — — 1 — — — Acute intestinal obstruction — — — 1 — — — 1 — — 1 — — — — — — — — Ministry of Health Circular No. 1433. On receipt of this circular in 1935 it was decided that the large number of Hospitals in and around the Borough undertaking midwifery work made it necessary to ascertain what was actually taking place in regard to ante-natal care before definite proposals were formulated as required in this circular. With this object an inquiry into some 1900 cases was undertaken. This was completed during the year here considered, and the following report was presented:— 16th March, 1936. To the Chairman and Members of the Public Health Committee. Sir, Ladies and Gentlemen, Maternal Mortality—Ministry of Health Circular 1433. This circular, which is dated 10th October, 1934, contains a request to L,ocal Authorities to review their schemes for maternal care in the light of the suggestions contained in the Ministry of Health Memorandum 156/M.C.W. issued in December, 1930. In St. Pancras consideration of this question is complicated by the fact that a large proportion of confinements take place in public institutions, many of which make arrangements of their own for ante-natal examinations. 128 To meet this difficulty it was thought wise before submitting any report to endeavour to ascertain what is in fact happening in the Borough. With this object particulars have been collected of the ante-natal arrangements obtaining in 1907 consecutive cases. From a mass of detailed information the following general conclusions emerge :— (1) Of these confinements 42 per cent. took place in the home and 58 per cent. in various public institutions. The confinements in the home were conducted as follows (percentages are of total 1907 cases) :— By midwives 13 per cent., medical students 9.5 per cent.; midwives attached to the nursing associations 7 per cent.; doctors in private practice 5.5 per cent.; midwives attached to hospitals 4 per cent.; doctors attached to hospitals 1 per cent.; doctors called in in emergency 1 per cent.; pupil midwife 1 per cent. The following is the order of frequency with which confinements were conducted in various institutions (percentages as above):—St. Pancras Hospital 22 per cent.; University College Hospital 13 per cent.; Middlesex Hospital 4.5 per cent.; Queen Charlotte's 2.5 per cent.; Royal Free Hospital 2 per cent.; ten others (in all) 14 per cent. (2) In this enquiry ante-natal care has been considered from two points of view :—(a) date of commencement—anything later than seventh month being classed as unsatisfactory; (i>) ante natal care subsequent to the first ante-natal examination. (a) In 16 per cent. of all cases arrangements for confinements (booking) were not made until after the seventh month, and in 36 per cent. of all cases the primary ante-natal examination was not made until after the seventh month. It will be seen that 20 per cent. of all cases, although booked before the seventh month, did not for one reason or another receive a primary ante-natal examination until after the seventh month. Twenty-five cases did not book (1.3 per cent.). In 119 cases or 6 per cent. no ante-natal examination was made. (b) In 105 cases the ante-natal care subsequent to the primary ante-natal examination was unsatisfactory. The number of cases in which the ante-natal supervision reached a reasonable standard under both headings (a) and (b) was 1149 or 60 per cent. (3) The foregoing figures suggest the need in St. Pancras of a scheme designed to secure co-operation between all those responsible for ante-natal care. The Borough is fortunate in being able to draw upon abundance of good will and medical skill, but without co-ordination effort in one direction is likely to defeat effort in another. (4) In the Ministry of Health Memorandum 156/M.C.W. the importance of early and regular ante-natal supervision receives special mention. Ante-natal supervision should be undertaken by a doctor having special experience in this branch of medicine and ancillary thereto; facilities such as milk and meals, sewing classes, maternity dressings, and home helps should be available. The primary ante-natal examination was made at the Borough Council's ante-natal clinics in 379 instances, that is, in 21 per cent. of all cases in the series receiving ante-natal supervision. This proportion suggests that it is neither practicable nor desirable that the Borough Council should itself try to undertake ante-natal supervision in every case. (5) With a view to assisting co-ordination (section 3 above) it is suggested that an effort should be made to induce every institution and every individual booking a confinement to obtain the consent of the woman to recommendation being sent to the Maternity and Child Welfare Department of the Council as to the proposed ante-natal supervision and as to any assistance from the ancillary services of the Council that may be required. The Council's Health Visitors would then be able to follow up such cases with a view to securing continuity of ante-natal supervision and to rendering assistance in the various difficulties that may arise. Any case referred to the Borough Council under such conditions as the Borough Council may from time to time approve should, it is suggested, be eligible under the Council's antenatal scheme upon exactly the same terms as women attending the Council's own ante-natal clinics. 129 Note.—St. Pancras Hospital, London County Council, at present give information regarding women attending the hospital ante-natal clinic, provided the woman agrees. (6) If this scheme were adopted (section 5) and proved a success the number of women making use of the various ancillary services would be considerably greater than it is at present. Among these services, dinners constitute a special problem in that they are nowonly available for women living in the districts served by Ampthill Square and Barnes House Centres. Having regard to the great importance of nutrition, it is suggested that the Voluntary Committees of the four other centres be asked to consider the question of the provision of dinners. The Council has power, under Ministry of Health Circular 185, itself to provide meals for expectant mothers. (7) At the present time a Bill is in course of preparation for the establishment of a whole-time salaried service of midwives. One of the benefits to be expected from such a service would be improved ante-natal supervision of midwives' cases. This point is mentioned for the reason that this report would otherwise include a suggestion that co-operation with midwives should be encouraged by the introduction of a scheme, similar to that in being in other Boroughs, whereby a midwife is compensated if a case referred by her to one of the Council's ante-natal clinics is transferred to hospital. (8) Having regard to the special conditions obtaining in St. Pancras and to the importance of establishing and maintaining co-operative effort, it is suggested that representatives of doctors on hospital staffs, of doctors in private practice, of doctors taking Borough Council ante-natal clinics and of midwives practising in the Borough should be invited to serve on a special advisory maternal care committee for the purpose of keping under review and advising upon the working of the scheme outlined in section (5) of this report and upon other kindred matters. (9) Circular 156/M.C.W., referred to above, directed attention to certain services. In St. Pancras those services thus specially referred to are supplied as follows :— (a) Ante-natal Seri'ice.—This is supplied throughout the Borough by means of Hospitals and five Municipal Clinics. There is no Municipal Ante-Natal Clinic attached to the Highgate Centre. Mothers from that area are sent either to Barnes House or Caversham Road. (b) Supply of Midwives.—Midwives to act as midwives are available through the Maternity Nursing Association and privately. There are no Municipal Midwives in St. Pancras. A grant is made by the Borough Council to the Maternity Nursing Association for certain "necessitous cases." This applies to very few cases, and for practical purposes the Council does not subsidise a midwifery service. There is no scheme for supplying "Maternity Nurses." There is a "Home Helps" Scheme which receives a grant from the Council. The scheme is run by a Voluntary Committee in close cooperation with the Public Health Department. The Deputy Medical Officer of Health acts as " liaison officer." This scheme supplies the present demand. (c) Consultants.—This service is provided by the Council but very little use is made of it. (d) Hospital Beds.—St. Pancras is richly supplied in this respect. Grants are made for " necessitous cases." (e) Provision of ancillaries.— (i) Sterilised Maternity Outfits. Available but not used frequently. (ii) Home Helps. See note under (b) above. (iii) Provision of Milk for Expectant and Nursing Mothers. This is provided. (iv) Provision of laboratory facilities (pathological specimens). The Council has no provision for the examination of pathological specimens. The demand for such a service is slight and can be easily arranged for from time to time. (/) Education.—This is receiving special attention. A Health Week is due in May, and each Welfare Centre will help. 130 10.—For the information of the Committee, the Maternal Mortality rate in St. Pancras for the last five years has ben as follows :— 1931; 1932; 1933; 1934; 1935. 2.4 5.1 3.7 40 4.7 Average 3.9. Average for London for 1931/1934, 3.2. Average for England and Wales for 1931/1934, 4 18. (N.B.—The above maternal mortality rates are per 1,000 live and still births.) Maiti.and Radford, Mcdical Officer of Health. Ante-natal Care. As the friends of many families in the Borough, the health visitors are the natural confidants when a babv is expected. This results in a kind of informal notification of pregnancy so far as the clientele of the Welfare Centres is concerned. Reference to Table IV. on page 112 will show that during the year 2,996 visits were paid to 1,378 expectant mothers. From Table III., page 105, it will be seen that 1,144 expectant mothers made 4,985 attendances to the ante-natal clinics at the various centres included in the Council's scheme. The total number of births during the year was 2,389. In addition to consultations held at the Centres maintained by the Borough Council are those at the General and Women's Hospitals, both in and adjacent to the Borough. Classes in Mothercraft are held at the various Centres, and also massage treatment for expectant mothers. Provision of dinners (at some Centres), milk, and also of dental treatment for expectant and nursing mothers is another facility. For particulars of this scheme see pages 106-7, and 122. A scheme of co-operation in Ante-natal work between the Borough Council and University College Hospital has been in force since January 1st, 1928, and this is being extended to bring the Hospitals' Maternity Section under the administration of the Medical Officer of Health. Care at confinement. Midwives. In the Metropolis, the supervising authority for midwives is the London County Council. According to figures supplied by that authority in January, 1937, the number of midwives who, in 1936, had notified their intention to practise in St. Pancras was 89. Only 22 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. 131 A subsidy is paid by the Borough Council to certain hospitals in connection with the admission of necessitous cases to their maternity wards and also in connection with certain cases attended at home by midwives on the staffs of various hospitals and institutions. In the following table particulars are given for 1936 with reference to all St. Pancras women who were attended in their confinements by the staffs of the various institutions :— Institution. Admitted as In-patients. Attended at Home. By Students. By Midwives. University College Hospital 288 171 13 Royal Free Hospital 61 14 .. Elizabeth Garrett Anderson Hospital 33 62 .. St. Pancras Hospital 650 .. 7 Middlesex Hospital 102 .. 41 Queen Charlotte's Hospital 94 .. .. City of London Hospital 45 .. .. Royal Northern Hospital 19 .. .. St. Bartholomew's Hospital 2 1 .. Other hospitals 199 .. .. Queen Mary's Maternity Home 36 .. .. Maternity Nursing Association .. .. 161 Totals 1529 248 222 The cases admitted as in-patients represented 62.4 per cent. and those attended at home 19.2 per cent. of the total number of St. Pancras births. As compared with the previous year, there was a decrease in the number of cases attended at home and an increase in the number of those admitted as in-patients. The Borough Council pays a subsidy to certain hospitals for the admission of cases to their maternity wards, and also pays a subsidy for cases attended at home by midwives on the staffs 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 2 0 0 Elizabeth Garrett Anderson Hospital 1 0 0 Queen Charlotte's Hospital 5 0 0 City of London Hospital 11 0 0 Middlesex Hospital 23 5 0 University College Hospital 77 0 0 Maternity Nursing Association 5 0 0 Total £124 5 0 The corresponding grants for the previous three years were: £215 10s. 0d., £145 15s. Od. and £123. 132 Sterilised Maternity Outfits. 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. Home Helps. A subsidy is paid by the Borough Council to a Voluntary Committee for the provision of 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. Dr. Pritchard attends Committee meetings as Liaison Officer. An annual grant of £250 is made by the Borough Council for use in respect of maternity cases only. Three permanent " Helps " were employed throughout the year, and five temporary " Helps " for emergency cases. 85 cases were dealt with during the year, 79 being maternity and sickness cases. Puerperal Fever and Pyrexia. The Borough Council provides 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. Post-natal care. There are no clinics devoted specially to this work. Post-natal cases are seen on occasion at the ante-natal clinics, but the time at these is generally fully occupied. The question of further provision for post-natal care merits attention. PUERPERAL PYREXIA AND PUERPERAL FEVER. Puerperal Pyrexia is defined as any febrile condition other than a condition which is required to be notified as Puerperal Fever, occurring in a woman within 21 days after childbirth or miscarriage, in which a temperature of 100.4° F., or more, has been sustained during a period of 24 hours or has recurred during that period. Puerperal Fever has not been defined in the same definite manner. In 1936 there were 23 notifications of Puerperal Pyrexia and 9 notifications of Puerperal Fever. After the usual investigations had been made, some of these cases were re-allocated, and the figures finally accepted were Puerperal Pyrexia Cases 17 — Puerperal Fever Cases 15 Deaths 3, 133 The following tables have been prepared by Dr. Pritchard to bring out some interesting details concerning these cases :— Cause of Pyrexia. Total no. 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. Abortions with Retained Products of Conception *2 — — — — — — 2 1 2 24 — Ac. Follicular Tonsi litis 1 1 — — — 1 — — 1 — 1 22 — Cystitis 2 1 1 — — 2 — — 2 — 1 25 — Inflammation of Breasts 4 3 1 — — 4 — — 3 2 3 22 — Influenza 1 — 1 — — — 1 — — 1 30 — Pyelitis 1 1 — — — 1 — — — — 1 25 — Pneumonia 2 2 — — — 1 1 1 2 — 2 27 — No known Lesion 4 2 2 — — 3 — 1 1 — 3 31 — Puerperal Pyrexia. Totals 17 10 5 — — 12 1 4 10 4 12 26 — Percentages — 58.8 29.4 70.6 5.9 23.5 59 24 71 — — Puerperal Fever. Associated with Abortion •4 — — — — — — 4 — 2 — 33 2 Other cases 11 8 — 2 1 8 3 — 8 4 6 29 1 Totals 15 8 _ 2 1 8 3 4 8 6 6 30 3 Percentages — 53.3 1 13.3 | 6.6 53.3 20.0 26.7 53.3 39.8 39.8 — 20.0 19 .9 Total 32 18 5 2 1 20 4 8 18 10 18 28 3 Percentages 56.2 15.7 6.2 3.1 62.5 12.5 25.0 56.2 31.4 56.2 — 9.4 25'0 * Six patients treated in Hospitals after abortion. 134 Comparative Figures for Recent Years ark as follows : — 1936. 1935. 1934. 1933. 1932. 1931. 1930. 1929. 1928. Puerperal Fever. Cases 15 26 18 31 42 25 33 43 33 Deaths 3 2 3 6 8 3 Nil. 5 3 Per Incidence Mortality 6.0 10.4 7.1 11.6 15.2 8.5 10.3 13.6 10.1 1,000 births. Rate 2.0 7.7 16.7 194 19.0 12.0 Nil. 11.6 9.1 100 cases. Death Rate 1.2 •8 1.2 22 2.9 1.0 Nil. 1.6 0.9 1,000 births. Puerperal Pyrexia. Cases 17 17 24 37 34 37 37 53 41 Incidence 6.8 6.0 9.5 13.8 12. 3 12.5 11.6 16.7 12.5 1,000 births. Students. The National Health Society send four or six Student Health Visitors for periods of about three months at a time. They study and work at a centre on two days a week. Various special demonstrations are arranged to help them to gain a practical insight into every branch of the work. The following report is submitted by Dr. P. V, Pritchard, the Maternity and Child Welfare Officer: — I would like to express my appreciation for the manner in which the various Voluntary Committees representing the Welfare Centres and Ancillary Services under the Maternity and Child Welfare Scheme of the Borough have co-operated with me in my endeavour to carry out the wishes of the Council in bringing the Service up to date and making it uniform for the whole Borough. I appreciate the value of my position as liaison officer between these Committees and the Council, as it is this close association with the work and wishes of both sides which enables me to guide the Service in the required direction. It has been impossible to attend to the problem of the care of foster children in the manner and to the extent which I think is necessary. Owing to the wording of the Public Health (London) Act, 1936, there is no such procedure as "Registering" a foster mother. In my opinion ' Registration " should be the fundamental principle, and it should be on the same lines as the Registration of a Nursing Home, for example. In this way a woman would have to prove her ability and the suitability of her home before she could obtain a certificate permitting her to care for a certain and fixed number of foster children. The law at present allows practically any woman to undertake this serious duty so long as she notifies the Borough Council of her intention to do so. The foster child can then be received by the woman, and it is not until the child has actually been so received that the Council can apply to a magistrate for removal. Very good reasons for this request would have to be supplied. This is surely a cumbersome method of preventing children from being cared for by unsuitable foster mothers. The present legal position makes the supervision of these children a difficult problem. It is necessary to have a standard for the whole Borough, and this cannot be obtained by the method of using all the Health Visitors as Infant Life Protection or Foster Children 135 Visitors. Visits to the doubtful and bad cases must be made more frequently, and where possible these cases should be prevented from continuing the work. Greater use of the Welfare Centres should be made by the foster mothers for the children in their care. I should like, and force if necessary, every foster child under five to attend a Centre just as he should do if living in the care of his own parents. During the year the Council sent Mrs. Crockart and Miss Harris to the Sixteenth Winter School for Health Visitors. This "refresher course" was most valuable to the chosen persons and to their fellow workers. It brought them into contact with what is being done elsewhere and the methods and ideas which are being advocated by the leading workers in the Maternity and Child Welfare Movement. Percival V. Pritchard, Deputy Medical Officer of Health.