STPAN 95 Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. MAITLAND RADFORD, M.D., B.S., D.P.H. Printed by F. P. Lewindon's Exors., 216 & 218, Eversholt Street, N.W.1. Metropolitan Borough of Saint Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. MAITLAND RADFORD, M.D., B.S., D.P.H. CONTENTS, PAGES Introductory 1—10 Section I.—Statistics, Social Conditions and General Information relating to the Area 11—28 „ II.—Population, Marriages Births and Deaths 29—38 „ III.—Sanitary Circumstances of the Area 39—47 „ IV.—Factory and Workshop Acts 49—52 V.—Housing 53—64 „ VI.—Inspection and Supervision of Food 65—76 „ VII.—Prevalence of, and Control over, Infectious Diseases 77—91 „ VIII.—Tuberculosis 93—105 „ IX.—Maternity and Child Welfare 107—141 INDEX. page Advice cards 122 Aged persons, removal of 45 Agriculture Produce (Grading & Marking) Act, 1928 and 1931 69 Alcock, Dr. Olga 9 Altitude of Borough Ambulance facilities 18 Ampthill Square Centre 20, 112 Analysis of food 72 Analyst's notes 74 Ancillary services 129 Anderson, Miss (Health Visitor) 9 Animal tests of milk 67 Ante-natal services 109 Area of Borough 12 Area of playing fields 12 Area of public open spaces 12 Area undeveloped 12 Artificial Cream Act, 1929 68 Artificial Light clinics 19 Artificial Light treatment—staff, statistics 115 Artificial pneumothorax 100 Attendances, visits, etc., at Centres 111 Avalon 132 Bacteriological examination of milk 67 Bacteriological work 90, 91 Bakehouses and Restaurant Kitchens 71 Barnes House Clinic 113 Baths and Washhouses 45 Bed Bugs 89 Beds and bedding for Tuberculous patients 104 Birth notifications 30 Birth rate 12, 14 Births and Deaths Registration Act, 1926 31 page Births and rates per Ward 15, 30 Births, legitimate and illegitimate 12, 30 Birts in public institutions 30 Births registered 12, 14, 29 Births, still 12, 31 Block grants 118, 119 Boarding out children from Tuberculous homes 104 Bodies received at Mortuary 38 Brookfield Estate: Allocation of land to Electricity undertaking 63 Buck Street Nursery School 134 Byelaws enforced by Borough Council 22 Camden High Street, Nos. 287 & 289 63 Camden Park Road site 62 Camden Town Centre 113 Canal Boats Act 44 Cancer deaths 35 Capel, Mr. S. W. (Food Inspector) 9 Catarrhal Jaundice 87 Care at confinement 136 Carpenter, Mr. A. 9 Caversham Road Centre 107 Centres—Borough Council contributions 118, 119 Centres—Maternity and Child Welfare 19 Cerebro-spinal meningits 83 Child Welfare 122 Clark, Miss V. M. 9 Classes for Mothers 112—115 Cleansing and Disinfecting station 21, 87 Cleansing of school children 90 Clearance Orders 60 Clinic for Sick Mothers and Young Children 21 Clinics, School 20 Index—continued. page Clinics, treatment centres, etc. 19 Cockerell, Dr. Marion 9 Cobden House, Arlington Rd. 62 Committee, Members of 6 Common Lodging Houses 44 Condemned food 68 Confinement—subsidies and facilities 136 Consultations and attendances at Centres 111 Consultations, times of 110 Contributions of Borough Council to Centres 118, 119 Convalescent Homes 21 Convalescent home treatment 132 Coroner's Court 38 Cove, G. N. 9 Cowsheds 66 Dairies and Milkshops 66 Dairies and Milkshops, registration 66 Day Nurseries and Nursery Schools 19, 20, 133 Death rate (adjusted) 12, 32 Death rate (adjusting factor) 32 Death rate, Infantile 13 Death rate, Maternal 135 Death rate (unadjusted) 12 Deaths 12, 14, 15, 31 Deaths, aged persons 35 Deaths, cancer 13, 35, 36 Deaths, causes (by ages, Wards and sex) 33 Deaths, diarrhœa and enteritis 13 Deaths, homeless persons 35 Deaths, illegitimate infants 13 Deaths, infantile—legitimate and illegitimate 13, 15 Deaths, infantile by causes 126 Deaths, infantile by causes for last 10 years 127 Deaths, in public institutions in and outside the Borough 34 Deaths, maternal 12, 135 Deaths, measles 13, 86, 87 Deaths, persons of unknown address 35 Deaths, rates by Wards 15, 35 Deaths, registered 12, 14, 31 Deaths, transferable 14 Deaths, tuberculosis 13, 15, 93, 94, 97 Deaths, whooping cough 13 Defects remedied without notice 54 Dental clinics 20, 112, 113, 116 Dental clinic, Ampthill Square 112 Dental clinic, Camden Town Centre 113 Dental clinic, Eastman 116 Dental clinic, St. Pancras Dispensary 132 Dentures for necessitous mothers 114 Dentures for tuberculous patients 103 Denyer House 63 Diarrhoea and enteritis—deaths 13 Dinners for Mothers and children 112, 113 Diphtheria 81 Diphtheria anti-toxin 81 page Diphtheria, immunisation scheme 21, 82 Disinfecting and cleansing station 87 Distinfecting for institutions 89 Dixon, Dr. Phyllis 9 Drainage 46 Dwelling-house inspection 54 Dwellings controlled by Estates Committee 61 Dysentery 84 Eastman Dental Clinic 116 Economic conditions 17 Elgood, Dr. Cyril 9 Encephalitis Lethargica 83 Enteric fever 82 Erysipelas 83 Estates Committee—work of 61 Estates controlled by Borough Council 61 Factories, workshops and workplaces 49, 51 Factories, etc., inspections 49, 52 Factory and Workshop Acts 23, 49 Factory and Workshop, inspections— defects found 50 Families (1931 Census) 12 Ferdinand Place Estate 62 Finsen Light Treatment 101 Food analysis 72 Food and Drugs (Adulteration) Act, 1928 72 Food inspections 65 Food poisoning 84 Food summonses 74 Food surrenders 68 Food unsound, condemned 68 Foster-mothers and children 129 Fried Fish shops 70 Fumigation Act, 1937 26 German Measles and Measles 85 Grants to Welfare Centres 118, 119 Health propaganda 27 Health visiting 108 Health Visitors 121 Health Visitors (students) 140 Health Visitors, summary of year's work 121 Health Visitors, visits to children 121 Health Visitors, visits to expectant mothers 121 Hoare, J. A. 9 Home Helps 137 Home Work and Outworkers 50 Hospital accommodation 27, 28 Houses and flats erected 53 Houses let in lodgings 44 Housing 53 Housing Act, 1936,—proceedings under 54 Housing Act, 1936,—overcrowding 55 Housing conditions 58 Index—continued. page Housing Inspector 59 Housing schemes in the Borough 64 Hughes, Dr. T. Ivor 9 Hunter, Mrs. (Health Visitor) 9 Hydrogen-Cyanide (Fumigation) Act, 1937 26 Ice Cream and Preserved Food 71 Illegitimate births 30 Infant Life Protection 129 Infantile deaths per Ward 15 Infantile mortality 37, 125, 126, 127 Infectious diseases 78, 79 Infectious diseases, deaths 79 Inhabited houses 12 Infirm persons—removal of 45 Inquests 37 Inspection and supervision of food 65 Institute of Ray Therapy 116 Institutional provision for unmarried mothers 17 Insulin 21 Invalid Children's Aid Association 133 Itinerant milk vendors 66 Jaundice, Catarrhal 87 Kentish Town Centre 107, 114 Kirby, Mr. E. F. 9 Legal proceedings 41, 42 Legislation 23 Leighton Road site 61 Lighting of staircases — tenement buildings 44 Local Acts—Byelaws 22 Lodgings, Houses let in 44 Lodging-houses 44 London County Council housing estates 63 London County Council (General Powers) Act, 1937 23 Malaria 83 Map of Borough 2—3 Margarine—wholesale dealers 74 Marriages 29 Massage 113 Massage Clinics 21, 113 Maternal Care 135 Maternal Mortality 135 Maternity and Child Welfare 107 Advisory Sub-Committee 107 General Administration 107 Special activities 112—118 Maternity and Child Welfare Centres— Addresses, hours 110 Attendances, visits 109 Royal Free Hospital 109 University College Hospital 109 Work carried out 121 page Maternity and Child Welfare Officer— Report 140 Maternity Outfits, sterilsed 137 Mayoress of St. Pancras Home for Sick Poor Children 132 Meade, Dr. Caroline 9 Measles and German Measles 85 Measles, death rate 87 Measles, death 86 Measles, incidence rate 87 Measles, notifications 86 Measles, nursing 85 Meat and other foods 68 Medical examination of school children 122. 123, 124 Medical Officer of Health—remarks 5 Merchandise Marks Act, 1926 69 Meteorological table 10 Midwifery 136 Midwifery cases 136 Midwifery grants to hospitals 137 Midwives 136 Midwives Act, 1936 135 Milk Act, 1934 67 Milk—Bacteriological examinations 67 Milk grants 129 Milk in sealed containers 66 Milk sampling 66 Milk shops and dairies registration 66 Milk (Special Designations) Order, 1936 67 Milk supplied to mothers and children 129 Milk supply 65 Milk to school children 67 Milk, Tubercule tests 67 Milk vendors—itinerant 66 Mortuary 38 National Campaign 27 Nixon, Mr. H. K. (Food Inspector) 9 Noise Nuisances 24 North St. Pancras School for Mothers 114 Notices served—intimation and statutory 39 Notifiable diseases 77 Notification of births 30, 122 Notification of births Acts (1907, 1915) 30, 122 Notification of infectious disease 77, 78 Notification of and deaths from infectious disease 79 Nursery Schools 20,133 Nursing Associations 134 Observation Day Nursery 112 Occupations 16 Offensive trades 43 Officers 7— 8 Oldershaw, Dr. Martin 9 Open air schools 21 Open spaces—area 12 Ophthalmia Neonatorum 83, 128 Outdoor relief 17 Index—continued. page Outworkers and home work50 Overcrowding 55 Overcrowding survey, 1935 56, 57 Persons per acre 12 Persons per acre (1931 Census) 12 Physical Training and Recreation Act 24 Playing fields—area 12 Pneumonia 83 Pneumothorax treatment 100 Poliomyelitis and Polioencephalitis 83 Population (1931 Census) 12 Population, estimated 12, 14 Population, marriages, births and deaths 29 Population of Wards 29 Post-mortem examinations 38 Pritchard, Dr. P. V.—Report 140 Professional nursing 21, 134 Prosecutions—general sanitary work 41, 42 Prosecutions, food 74 Public Assistance Department 18 Public Baths and Washhouses 45 Public Health Acts—proceedings uuder 54 Public Health Committee 6 Public Health Legislation 23 Public Health (London) Act, 1936 129 Public Health (Meat) Regulations, 1924 70 Public Health Officers 7, 8 Public Health (Prevention of Tuberculosis) Regulations, 1925 98 Public Health (.Prevention of Tuberculosis) Regulations, 1930 95 Public Health (Preservatives in Food) Regulations, 1925-1927 74 Public open spaces—area 12 Puerperal Maternal Mortality 135 Puerperal Pyrexia and Fever 82, 137, 138—140 Queen's Crescent Centre 114 Queen's Crescent site 62 Rag and Bone dealers 43 Rag Flock 43 Rainfall 12 Rat Week 46 Rate—sum produced by 12 Rateable value 12 Rats and Mice (Destruction) Act, 1919 46 Refuse collection and disposal 46 Rehousing facilities 58 Relief granted 17 Relief stations 18 Rent Restrictions Acts, 1920-1933 45 Restaurant Kitchens and Bakehouses 71 Roworth, W. C. W. 9 Royal Free Hospital Welfare Centre 19, 110, 129 St. Margaret's Home 17 St. Pancras School for Mothers 19, 21 112 PAGE St. Pancras Dispensary 21, 132 Silverman, Dr. A. I. 9 Samples of food analysed 72 Sanitary Inspection of the area 39 Sanitary Inspectors' visits 40 Sanocrysin treatment 101 Scarlet Fever 81 Schick Testing Clinic 21 School children—cleansing 90 School children, medical examination 122, 123, 124 School clinics 20 Shops Act, 1934 44 Slaughterhouses 69 Slaughtermen, licensing 70 Slaughter of Animals Act, 1933 65 Small Pox 80 Smoke abatement 42 Soil and situation of Borough 12 Somers Town Centre 115 Somers Town Estate extension 63 South Highgate Centre 115 Staff 7—8 Staff changes during year 9 Staircases, tenement buildings 44 Statistical summary 12 Statistics, comparative 13 Statistics, Vital, for last 10 years 14 Statutory notices 39 Statutory powers—action under 54 Sterilised maternity outfits 137 Stillbirths 31 Summonses—Food and Drugs (Adulteration) Act, 1928 74 Summonses—General sanitary work 41, 42 Student Health Visitors 140 Swimming pools 45 Tenement buildings—lighting of staircases 44 Training, Physical and Recreation 24 Thomas, R. N. 9 Tubercle tests of milk 67 Tuberculosis:— Beds and bedding 104 Boarding out of children 104 Care Committee 101 Death rates by Wards 15, 96 Deaths 93, 97 Deaths by ages 93 Deaths by ages, Wards and sex 97 Dental treatment 103 Disinfection of rooms 101 Dispensaries 20 Dispensary sessions 98 Employment of Patients 104 Handicrafts Class 104 Health Visitors' visits 101 Housing 103 Institutional treatment 100 interval from notification to death 94 index—continued. page Tuberculosis, continued— New cases 93, 100 Notification register 98 Officer's Report 100 Prevalence and fatality 90 Primary notifications 93 Public Assistance 102 Receipts and Payments Account 105 Residential treatment 102 Shelter 104 Special death reports and transfers 95 Staff 101 Summary of work 99 X-ray work 101 Tuberculous patients—beds and bedding 104 Typhoid Fever 82 Underground rooms 59 Undeveloped area 12 Unemployed 17 page Unmarried mothers 17 University College Hospital Welfare Centre 116—118 Unsound food 68 Vaccination 80 Venereal disease clinics 20 Visiting of homes 121 Ward births and deaths 15 Washhouses and Baths 45 Water certificates 45 Water cut off 45 Water supply 45 West, H. G. 9 Whooping cough deaths 13 Westripp, H. E. 9 Woolvin, J. F. 9 Workshops and workplaces 49—52 X-ray work 101 5 Public Health Department, Town Hall, Euston Road, N.W.I. 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 8.2nd Annual Report that has been submitted and the fourth that I have had the honour to prepare. A summary of the principal statistics for the year 1937 is given on pages 12 and 13. It will be noted that the Registrar General's mid-year estimate of the population again shows a fall in comparison with the preceding year, the decrease being 2000 or 1.09 per cent., and that the birth rate is the same as for 1936, namely 13.0 per 1000 of the population. This is the lowest birth rate that has so far been recorded. Graphs illustrating the birth rate, death rate and infantile mortality rate during recent years will be found on pages 14 and 15 respectively. Particulars relating to overcrowding in the Borough, as ascertained from the survey carried out under the 1935 Housing Act, will be found on pages 55.57. The move to the New Town Hall was made in July, so that work duriug the latter months of the year was under the greatly improved conditions afforded by our present accommodation. The change is much appreciated by the staff of the department. I wish to thank the members of the Borough Council generally, and especially the Chairman and Members of the Public Health Committee, for their encouragement and assistance throughout the year. My thanks are also due both to the staff of the Public Health Department and to colleagues in other Departments for unfailing help and co-operation. I am, Sir, Ladies and Gentlemen, Your obedient Servant, MAITLAND RADFORD, Medical Officer of Health. 6 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 193b, to October, 1937. CHAIRMAN. Alderman W. P. Spry. DEPUTY-CH AIRMAN. 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. 3 Debbnham, Martin Ridley. 5 Denyer, Charles Henry, M.A. 8 Evans, Evan. 8 Evans, John. 6 Gregory, Mrs. Jbanetta. 2 Horne, George, J.P. 4 Lare, Mrs. Amy Elizabeth. 3 Melvin, Frederick George. 4 Menon, Vengalil 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. November, 1937, to October, 1938. CHAIRMAN. Councillor C. H. Denyer. DEPUTY-CHAIRMAN. Councillor Mrs. E. Davies. EX-OFFICIO. The Right Worshipful the Mayor Councillor John Charles Gerald Sperni, M.I.Struct.E., J.P.). ALDERMEN. Crosby, Miss Ada, M.B.E. Evans, Evan. Gregg, Dr. Edward Andrew. Spry, William Palmer. COUNCILLORS. Ward 2 Bell, Mrs. Florence Nightingale Harrison, J.P. 8 Blackmore, Claud. 8 Chambers, Percy Henry. 4 Day, Dr. Mrs. Mary Tregellis. 3 Debenham, Martin Ridley, B.A. 5 Escott, Arthur, F.I.B.D. 8 Evans, John. 1 French, Frederic Joseph. 6 Gregory, Mrs. Jeanetta. 7 Hume, Mrs. Lydia Gbrtrude. 3" Jackson, Miss Stella, B.A. 2 Melvin, Frbderick George. 6 Needham, Mrs. May. 1 Pearson, Louis, B.A. 4 Pym, Mrs. Diana, B.A. 5 Rolles, Harry. 7 Swift, Mansell James, F.R.M.S. 3 Tibbles, Mrs. Gladys. 7 STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of the yeah 1937. MEDICAL OFFICER OF HEALTH ADMINISTRATIVE MATERNITY AND CHILD 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. N. 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. ADTCTNS. ¶‡JS. W. Capel,. 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. ‡¶+E. W. Winchkster. xT. H.Hague. x W. C. Mansfiei.d. ¶ x+R. Warrkn. xW. B. Dykes. x¶R. N. Thomas. ¶x J. A.Hoare. Housing Inspector. *‡§¶A. H. Walker. (G) TUBERCULOSIS DISPENSARY, BARNES HOUSE, CAMDEN ROAD N.W.I Tuberculosis Officer (g), G. A. Back, B.A., M.B., B.Ch.,M.R.C.S.,L.R.C.P.,D.P.H. Sanitary Inspectors and Health Visitors (for Tuberculosis), A‡†Miss S. A. Long. ‡||Miss A. Holland. Nurse and Sec. to Tuberculosis Care Committee, fABcMrs. E. Bevan, Clerical, etc., Assistant, Miss M. Deed. Dentist (part time), Mr. A. J. Maurice, L.D.S. CLERICAL STAFF. A. Carpenter. Chief Clerk. G. N. Cove. V. R. Meurice. (g) Miss A. Andrews. G. F. Peeling. (g) C. W. Smith. x E. F. Kirby. ¶ x J. F. Woolvin. xH. E. Westripp. (g) C. A. Engledow. W. Shackcloth. J. Murphy, (g) Miss V. Clarke. * Cert. Municipal and County Engineers. § San. Insp. Cert. Royal San. Inst. || Health Visitor's Certificate. † S.C.M. A Mate Registered Nurse. B Registered Fever Nurse. C Tuberculosis Training. ‡ Cert. San. Insp. Examination Board. ¶ Cert. Meat and other Foods. + Smoke Abatement Cert. (L.C.C.). ** Certificate, Queen Charlotte's Hospital. X Cert. Royal San. Inst, and San. Insp. Exams. Joint Board. 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. Olag Alcock 6 Dr. Chas. H. Alderton 4 Dr. Phyllis Dixon4 Dr. Cyril Elgood 4 Dr. Helen Gillespie 5 Dr. J. Finch Haines (deceased March, 1938) 13 Dr. Janie Lorimer Hawthorne6 Dr. T. Ivor Hughes 4 Dr. Nora Leesmith 4 Dr. Caroline Meade 6 Dr. J. Balfour Neill 8 Dr. K. H. Odling-Smee 4 Dr. Francis L. Provis (deceased May, 1938) 4 Dr. Audrey E. Russell 8 Dr. John W. Wigg 4 Dr. C. Kitcat 4 (g) Dental Clinic. R. M. Underwood, L.D.S., Dentist 6 Dr. Jas. Maughan, Anaesthetist. 2 (g) Artificial Light Clinic. Dr. P. V. Pritchard 8 (g) Consulting Obstetric Surgeons. T. Ivor Hughes, M.R.C.S., L.R.C.P., M.C O.G. Francis L. Provis, M.R.C.P., F.R.C.S. (deceased May, 1938) (The above are part-time officers.) (g) Superintendents of Maternity and Child Welfare Centres. ‡||Miss G. R Bristow. **||†Miss M. Manger. ||†Mrs. S. C. Chapman. ||†Miss E. M. Robinson. ||†MRs. E. Crockart. (g) Health Visitors at Maternity and Child Welfare Centres. ‡§||Miss F. A. Anderson. ||†Miss B. M. Harris. ¶†**'Miss E. B. Bagnall. ¶||Miss A. M. U. Harrop. ¶||†Miss M. L. Blair. †MRs. E. Lurie. †||Miss V. K. Blaxland. †||‡MRS. J. Lynn. ||†MRS. E. E. Bruce. ||†MRS. M. A. Smith (resigned 31st January, 1938) (N.B.—Miss Baguall was Acting Superintendent at Kentish Town Centre.) 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). H.Prudames( Do. ). (The above are full-time officers.) ‡ Cert. San. Insp. Examination Board. † San. Insp. Cert. Royal San. Inst. ¶ State Registered Nurse. || Health Visitor's Certificate. †.S.C.M. ** Midwifery Certificate, Queen Charlotte's Hospital. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grant. 9 CHANGES IN STAFF DURING 1937. Consequent upon the separation of the Public Health and Estates Departments as from April 1st, Mr. W. C. W. Roworth became the Administrative Officer of the Estates Department, and Mr. A. Carpenter was appointed Chief Clerk of the Public Health Department. Mr. G. N. Cove was appointed First Clerk on 24th March in place of Mr. Carpenter. Miss Anderson (Health Visitor) retired on 30th June, and Mrs. Hunter (Health Visitor) on 30th November. Mr. II. K. Nixon (Food Inspector) retired on 30th April, Mr. S. W. Capel being appointed in his place. The vacancy for Sanitary Inspector thus created was filled by Mr. R. N. Thomas. Mr. J. F. Woolvin was promoted to Grade B. Mr. II. G. West (Sanitary Inspector) retired on 30th September, and Mr. J. A. Hoare was appointed in his place. Mr. H. E. Westripp was promoted to Grade B. Miss V. M. Clark was appointed to the Staff in June. Dr. Caroline Meade, who conducts consultations at Kentish Town Welfare Centre, was included on the Council's Staff at Centres and Clinics as from 1st April. Dr. A. I. Silverman resigned in May, his consultations at Camden Town Centre being continued by Dk. Cyril. Elgood. Dr. Olga Ai.cock (Older Children and Infants' Clinics) and Dr. Phyllis Dixon (Ante Natal Clinics) were appointed to Kentish Town Centre in June and July respectively, in place of Dr. B. Marion Cockerell, who resigned. Dr. Martin Oi.dershaw, Consulting Obstetric Surgeon and Medical Officer at Camden Town and Somers Town Centres, died in July. His duties for the Counoil were taken over by Dr. T. Ivor Hughes. The following Officers of the Department were successful during the year in obtaining certificates of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board: — Mr. E. F. Kirby Mr. J. A. Hoare Mr. J. F. Woolvin Sanitary Inspector's Certificate. Meat and Other Foods Certificate. 10 Meteorological Table for Saint Pancras, 1937. (Deduced from observations at Camden Square, N.W. 1.) January. February. March. April. May. June. July. August. September. October. November. December. Barometer- Mean Pressure at 32° F. at station level (Bar. 112 ft. above M.S.L.) 29.8 29.6 29.72 29.9 30.0 30.1 30.0 30.1 30.0 30.0 30.1 29.9 Air Temperature— Mean of— A. Maximum 46.7 48.7 46.3 56.9 65.3 70.8 71.6 76.2 67.6 59.9 47.9 42.7 B. Minimum 37.9 39.6 34.8 43.7 49.2 53.3 57.1 57.8 50.9 47.9 37.9 35.5 Mean of A and B 42.3 44.1 40.5 50.3 57.3 62.1 64.3 67.0 59.3 63. 9 42.9 39.1 Difference from Average +2.0 + 3.6 —3.2 + 2.0 +0.9 +1.1 0.0 +3.3 +0.3 +2.0 -1.2 —2.4 Humidity—Morning 90 84 79 81 74 65 68 76 80 87 91 91 Earth Temperature at 4 ft. depth 40.5 44.8 43.6 45.5 49.7 55.3 58.2 60.0 58.8 56.5 51.6 46.3 Bright SunshineTotal Observed (daily mean) Hrs. 0.75 1.65 2.88 2.93 5.40 6.68 4.23 5.95 4.75 2.16 1.39 0.48 Per cent. of total possible 9 17 24 21 35 41 26 41 38 20 16 6 Percentage of average Hrs. 81 103 102 70 87 102 69 106 112 83 108 60 Rain and other forms of precipitation— Number of Days 23 23 20 14 13 12 8 4 14 9 7 18 Total Fall Ins. 3.47 4.33 2.96 2.64 2.89 1.49 0.53 1.34 1.54 2.21 1.26 3.92 Percentage of average (1881-1916) 187 262 160 172 163 74 22 61 85 84 53 164 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. Total rainfall for year, 28.58 inches. 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. Plaving fields (private), 7 acres. Undeveloped area, 50 acres. Soil and Situation.—Practically the whole of the Borough is situated on London clay. There are a few superficial deposits of gravel in the south, and lower Bagshot sands in the extreme north. The altitude varies from 48 feet above ordnance datum, the lowest point, which is situated in the south of the Borough in the neighbourhood of Ampton Street, King's Cross Road, to 427 feet above ordnance datum, the highest point, which is in Pond Square in the extreme north of the Borough. The Borough is about four miles long, extending from near Oxford Street in the south to Highgate in the north, and averages about a mile in width. Rainfall during the year recorded at Camden Square, 28-58 inches. Population (1931 Census), 198,133. Population (Registrar-General's mid-year estimate), 181,900. Number of persons per acre, 67. Number of inhabited houses at end of 1937 (according to Rate Books), 28,758. Rateable Value, £2,255,375. Sum produced by a penny rate, about £8,975. 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 . , Illegitimate . 2143 221 1147 124 996 97 Birth rate per 1,000 of the estimated resident population, 13'0. 2364 1271 1093 Stillbirths 78 48 30 Rate per 1,000 total (live and still) births, 31-9. Excess of births over deaths, 35. Deaths 2329 1241 1088 Death rate per 1,000 of the estimated resident population, 12*8. Adjusted Death rate 130 per 1,000 of the estimated population (sre page 32). Deaths from puerperal causes (Headings 29 and 30 of the Registrar General's Short List) : — Deaths. Rate per 1,000 total (live and still) birtha. No. 29 Puerperal sepsis .. . . 5 2-0 No. 30 Other puerperal causes .. .. 3 1-2 Total .. 8 3-2 BIRTH RATE for the Borough per 1000 population. DEATH RATE FOR THE BOROUGH PER 1000 POPULATION (UNADJUSTED) 13 Death rate of Infants under one year of age :— All infants per 1,000 live births, 65. Legitimate infants per 1,000 legitimate live births, 58. Illegitimate infants per 1,000 illegitimate live births, 127. Deaths from Cancer (all ages), 337. „ Measles (all ages), 1. „ Whooping Cough (all ages), 9. „ Diarrhoea (under 2 years of age), 52. ,, Tuberculosis (all ages)—162. Pulmonary, 148. Death rate per 1,000 of the estimated resident population, 0.8. Other forms, 14. ,, ,, „ 0.08 Comparative Statistics. Rate per 1000 of Population. Rate per 1000 Births. Birth rate Death rate. Infant Mortality. St. Pancras 13.0 *12.8 65 England and Wales 14.9 12.4 58 125 County Boroughs and Great Towns, including London 14.9 12.5 62 County of London 13.3 12.3 60 *Unadjusted. 14 VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1937 AND PREVIOUS YEARS. Year Population estimated to middle of each Year Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Kate. Number. Rate per 1000. 1927 213200 212800 3925 3299 15.5* 3034 14.3† 939 526 205 62 2621 12.3† 1928 206000 205600 3980 3274 15.9* 3053 14.8† 985 550 261 80 2618 12.7† 1929 204400 203900 4231 3170 15.5* 3505 17.2† 1005 626 262 83 3126 15.3† 1930 204400 203900 4660 3208 15.4* 2928 14.1† 999 549 194 60 2478 ll.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 1937 181900 — 3796 2364 13.0 2742 15.0 1035 622 154 65 2329 12.8 Area of district in acres (land and inland water), 2,694; total population at all ages, 198,133; number of inhabited houses, 24,980; average number of persons per house, 7.93 ; at Census, 1931. * Based on total population. † Based on civil population. 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. 1 463 14.0 423 12.8 34 73 27 0.8 2 279 15.4 235 13.0 13 47 12 0.6 3 512 16.8 407 13.2 29 57 33 1.2 4 291 13.2 301 13.5 14 48 27 1.3 5 285 10.8 313 11.9 14 49 18 0.7 6 172 10.4 180 10.8 13 76 15 0.8 7 115 9.6 131 10.8 18 156 13 1.1 8 247 10.4 283 11.8 15 61 14 0.7 Homeless — — 56 — 4 — 3 — Borough 2364 13.0 2329 12.8 154 65 162 0.9 16 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried 011 in the Borough which to any extent affect the public health prejudicially. It is of interest to note that a large number of residents are engaged in work upon the railways. This necessitates residence in the neighbourhood and is an important factor in the local housing situation. The following table gives for eaoh sex the principal occupations as ascertained at the 1931 Census. The numbers and percentages engaged in the various occupations mentioned are also given : — Total Population (over 14 years of age) : Males, 75,794 ; Females, 85,493. Males Occupation. Number. Percentage. Transport Workers (Railways, &c.) 12,705 17 % Commercial and Financial (Shop Assistants, Ac.) 8,771 11 „ Peisonal Service (Waiters, Hairdressers, &.c.) 1,318 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 % 17 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. ChapmaD, 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 1935 4223 £ 1604 September 1935 3946 1607 March 1936 3986 1649 September 1936 3524 1365 March 1937 3536 1499 September 1937 3086 1270 Number of unemployed:— Men. Women. Juveniles. Total. At January, 1935 4538 1220 141 5899 At January, 1936 . . 5198 1255 137 6590 At January, 1937 4482 1169 143 5794 At January, 1938 5453 1404 * 6857 * The number of juveniles is not now published separately. GENERAL INFORMATION. Institutional Provision for Unmarried Mothers. St. Margaret's House, 218, Camden Road, N.W.I (Tel. Gulliver 5250). 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. 18 PUBLIC ASSISTANCE DEPARTMENT. Area IV.—Comprising the Metropolitan Boroughs of Holborn, St. Pancras, St. Marylehonr and Hampstead. Local Public Assistance Officer (Area IV.) B. Chapman, Northumberland Street, W.l (Tel. Welbeck 6896 and 6897). Chief Relievinq Officer. J. H. Webster, 29, Marylebone Road, N.W.I (Tel. We/beck 2894 and 2895). Relief Stations. Address. Telephone. Relief districts served. 46, Iverson Road, Kilburn, N.W.6 Maida Vale 1009 1 New End, Hampstead, N.W.3 Hampstead 0949 29, Marylebone Road, N.W.I. Welbeck 2894-5 2 & 3 Clifton Villas, Camden Square, N.W.I. Gulliver 1230 4 Relief Station, Bower Cottage, Holmes Road, N.W.5 Gulliver 2868 5 Clifton Villas, Camden Square, N.W.I. Gulliver 1230 6 & 7 25, Kentish Town Road, N.W.I. Gulliver 4826 8 21, Medburn Street, N.W.I. Euston 1654 9 128, Albany Street, N.W.I. Euston 2618 10 46 and 47, Clarendon Square, N.W.I. Euston 2392 11 89, Gray's Inn Road, W.C.I. Chancery 8012 12 Relief < 'ffices, 53, Clerkenwell Road, E.C.I 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 oases. (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 Ambulance Association, St. John's Gate, Clerkenwell, E.C.I. (Tel. Clerkentcell 6644.) British Red Cross Society, 14, Grosvenor Crescent, S.W.I. (Tel. is'loane 5191.) These convey pregnant women to hospitals from 8 a.m. to 11 p.m. 19 Clinics, Treatment Centres, etc. For the purpose of reference these are given in tabular form; details concerning the work carried out will be found on succeeding pages. Situation. By whom provided. A. Artificial Light Clinics. 43, Raydon Street, (Child Welfare Centre), South The Borough Council. High gate. (Tel. Archway 3677.J (Mondays ana Thursdays at 10 a.m.) The Institute of Ray Therapy, 152-154, Camden A Voluntary Committee. Road. (Tel. Gulliver 3876.) A number of the hospitals in the Borough also provide this treatment. B. Maternity and Child Welfare Centres. Kentish Town Centre, Raglan Street, N.W.5. The Borough Council. (Tel. Gulliver 1389.1 St. Pancras School for Mothers, l,Ampthill Square. The Borough Council, with assisted. Euston 2972.) ance from the Voluntary Committee. Somers Town Centre, Chamberlain House, „ ,, Ossulston Street. (Tel. Euston 2380.) North St. Pancras School for Mothers, 129, Queen's „ „ Crescent. (Tel. Gulliver 2988.) South Highgate Centre, 43, Raydon Street. „ ,, (Tel. Archway 3677.) Camden Town Centre, Barnes House, Camden ,, ,, Road. (Tel. Gulliver 1667.) University College Hospital Centre. (Tel. The Hospital Authorities, with a Euston 5050.) subsidy from the Borough Council. Royal Free Hospital Centre. (Tel. Terminus The Hospital Authorities. ' 4331.) (The hours of attendance at the Council's Centres are yiven in the Maternity and Child Welfare 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, 27,(jrospel Oak Grove. The Voluntary Committee, with a (Tel. Gulliver 2906.) subsidy from the Borough Council. Margaret Club and Bay Nursery (for fatherless „ „ children), 56-59, Clarendon Square. (Tel. Euston 1822.) Whitefield Day Nursery, 53, Whitfield Street. „ ,, (Tel. Museum 5196.) Foundling Hospital Day Nursery, Brunswick „ „ Square. (Tel. Terminus 6640.) 20 Situation. By whom provided. D. Nursery Schools. Soniers Town Nursery School, 18, Crowndale A Voluntary Committee. Road. (Tel. Euston 1958.) Jellicoe Nursery School, 6a, Rochford Street „ Mary Ward Nursery School, 16, Burton Street „ St. Christopher's Hall, Bridgewater Street The Committee of the St. Pancras House Improvement Society, Ltd. Trinity Presbyterian Ilall, Buck Street The Church Authorities. E. Dental Climes. Barnes House, Camden Road (Tel. On/liver 1667.): The Borough Council. For nursing and expectant mothers and children under 5 years of age who attend the Maternity and Child Welfare Centres Ampthill Square (Tel. Euston 2972): For The Voluntary Committee, mothers and children who attend the Centre at 1, Ampthill Square St. Pancras Dispensary (Tel. Euston 1882): For Tuberculosis cases The Borough Council. „ For ordinary cases The Dispensary Committee. Eastman Dental (Tel. Terminus 4331): For The Committee of the Royal Clinic nursing and expectant Free Hospital and Clinic, mothers and children; also provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. F. School Clinics. Highgate New Town, Chester Road ; Voluntary Committees, working St. Pancras Centre, Prince of Wales Road; under agreement with the Clarendon Square London County Council. G. Tuberculosis Dispensaries. Barnes House, Camden Road. (Tel. Gullicer The Borough Council. 2371.) 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, Gray's 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. 21 Situation. By whom provided. I. Clinic for Sick Mothers and Young Children. St. Fancras Dispensary, 39, Oakley Square. (Tel. Medical Officer paid by Borough Etesian 1882.) Council; other expenses paid by Dispensary Committee. J. Convalescent Homes for Sick Poor Children. The Mayoress of St. Pancras Home for Sick By Voluntary Committee, with Poor Children, "Avalon," 1, St. Alban's grant from Borough Council Road, N.W. 5. (Tel. Gulliver 2626.) Invalid Children's Aid Association (various Subsidy from Borough Council, homes) K. Open Air Schools. Holly Court, Highgate, N. 6 London County Council. Euston Square, N.W. 1 „ L. Cleansing Station. Camley Street, N.W. 1. (Tel. Euston 5344.) The Borough Council (part of accommodation let to L.C.C. forcleansing of school children). M. Professional Nursing at Home. North London District Nursing Association, By Voluntary Committee, with 6 & 7, Canonbury Place, N. 1 . (Tel. grant from Borough Council. Canonbury 1955.) Hampstead District Nursing Association, 3, ,, Pond Street, Hampstead, N.W.3. (Tel. Hampstead 6406.) Metropolitan District Nursing Association, 14, , Oakley Square, N.W. 1. (Tel. Euston 1358.) N. Massage Clinics. St. Pancras School for Mothers, I, Ampthill Square. By Voluntary Committee. (Tel. Euston 2972.) Soiners Town Welfare Centre, Chamberlain ,, House. (Tel. Euston 2380.) Camden Town Welfare Centre, Barnes House. ,, (Tel. Gulliver 1667.) 0. Schick Testing Clinic (in connection with Diphtheria Immunisation Scheme). St. Pancras Dispensary, 39, Oakley Square. By the Borough Council. (Tel. Euston 1882.) 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 227 of the Public Health {London) Act, 1936. During the year, and with the sanction of the Ministry of Health, supplies have been provided in 10 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. 22 (c) A quarterly report is to bo 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 arc 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. Bye-laws made by the Borough Council: — (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, otfal, 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:— (а) Drainage bye-laws and deposit of drainage plans. (б) Closing and tilling up of cesspools and privies. (r) Removal and disposal of house and other refuse. (d) Removal of faecal and offensive matter by road. (e) Waterclosets, earthclosets and privies. (J) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc. 23 (j) Licensing, inspection and supervision of seamen's lodging houses. (k) Registration, licensing, inspection and regulation of common lodging houses. (i) 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 XIII. of the Public Health (Loudon) Act, 1936. (t) Smoke abatement. (u) Fish curers and vendors of fried fish. (v) Dairies, cowsheds and inilkshops. (w) Use of underground rooms for habitation. (x) Protection of food. B.—Public Health Legislation either enacted or coming into force during 1937 :— Factories Act, 1037. (Comes into force 1st July, 1938.) L.C.C. (General Powers) Act, 1937. Sections 63, 65, 66, 67, 68. Physical Training and Recreation Act, 1937. Hydrogen Cyanide (Fumigation) Act, 1937. A summary of the most important provisions contained in this new leglation is set out below :— The Factories Act, 1937. The New Factories Act which will come into force on the 1st July, 1938, is designed to secure safe and healthy working conditions in manufacturing and certain other operations. It is a consolidating and amending measure, and will replace the Factory and Workshop Act of 1901 and various later Acts. It follows broadly the lines of the Act of 1901, but contains many new provisions based on modern practice and also embodies a large number of changes, suggested by experience, on points of detail. One of its most important features is that it greatly reduces the permissable working hours laid down in previous Factory Acts both for women and young persons. It also regulates for the first time the working hours of some additional classes of employees under 18 connected with factories, such as errand boys and ran boys. L.C.C. (General Powers) Act, 1937. Accommodation for Storage and Cooking of Food. Section 65 enacts that the proviso to sub-section (1) of section 184 of the Public Health (London) Act, 1936, is repealed, and that the other provisions of that section shall extend and apply to every tenement house within the county whether the tenement house was or was not used or occupied as such before the beginning of August, 1908, or the 16th August, 1909, as the case may be. Under this proviso certain tenement houses had been exempt. The effect now is to extend to every tenement house within the county the provisions with regard to the accommodation for storage and cooking of food in tenement houses, so that if at any time it appears to a sanitary authority that, in any tenement house within their district, sufficient and suitable accommodation for the storage or cooking of food is not provided for the 24 use of each family occupying the house, on the storey, or one of the storeys, in which are situate the rooms or lodgings in the separate occupation of that family, the sanitary authority may, if the provision of such accommodation is practicable, serve on the owner of the house a notice requiring him to provide, within such reasonable time as may be specified in the notice, sufficient and suitable accommodation for the storage or cooking of food, as the case maybe; and if the owner fails to comply with the requirements of the notice, he shall be guilty of an offcnce and liable to a fine not exceeding forty shillings, and to a further fine not exceeding twenty shillings for every day 011 which the offence continues after conviction. [Extract from Report of Town Clerk.] Noise Nuisances. The following byelaw in regard to street cries and noises was made by the Borough Council in 1907 and only applies to Sundays : — Under section 66 it is provided that a noise nuisance shall be a nuisance which may bo dealt with summarily under the Public Health (London) Act, 1936. A noise nuisance is deemed to exist where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health. The section does not apply to a noise occasioned by the exercise of the functions under any Act of the county council or the sanitary authorities or any statutory undertakers; or affect the power of the county council or any borough council to make byelaws for good rule and government and suppression of nuisances under section 38 of the London County Council (General Powers) Act, 1934. It is further provided by section 66 of the new statute that no complaint to a petty sessional court under paragraph 20 of the fifth schedule to the Act of 1936 in respect of a noise nuisance shall be of any effect unless it is made by not less than three persons, being either householders or occupiers of premises within hearing of the noise nuisance which is the subject of the complaint. In any proceedings occasioned in the course of any trade, business or occupation it will be a good defence for the person charged to show that he has used the best practicable means of preventing or mitigating the nuisance having regard to the cost and to other relevant circumstances. [Extract from Report of Town Clerk.] In connection with this matter the following byelaw recently made by the Borough Council as to nuisances caused by wireless loudspeakers, gramophones, etc., came into operation on the 1st August, 1937. "No person shall (a) in any street or public place or in or in connection with any shop, business premises or other place which adjoins any street or public place and to which the public are admitted, or (6) upon any other premises by operating or causing or suffering to be operated any wireless loudspeaker, gramophone, amplifier or similar instrument make or cause or suffer to be made any noise which shall be so loud and so continuous or repeated as to cause a nuisance to occupants or inmates of any premises in the neighbourhood. Provided that no proceedings shall be taken against any person for any offence against this byelaw in respect of premises referred to in paragraph (b) thereof, unless the nuisance be continued after the expiration of a fortnight from the date of the service on such person of a notice alleging a nuisance, signed by not less than three householders residing within the hearing of the instrument as aforesaid. Any person offending against this byelaw shall be liable on summary conviction to a fine not exceeding five pounds." Physical Training and Rkckeaticn Act, 1937. This Act has been passed to provide for the development of facilities for, and the encouragement of, physical training and recreation, and to facilitate the establishment of centres for social activities. 25 Section 1 enacts that there shall continue to be two National Advisor}' Councils for Physical Training and Recreation, the one for England and Wales and the other for Scotland, consisting in each case of such persons as the Prime Minister may from time to time appoint, whose principal duty it shall be to investigate, and advise the Government with regard to, matters relating to the maintenance and improvement of the physical well-being of the people by means of exercise and recreation. A National Council may appoint committees to assist them in the discharge of their functions and may appoint as members of any such committee, or authorise any such committee to co-opt as members thereof, persons who are not members of the National Council. Under section 2 it is provided that the National Council for England and Wales shall, so soon as may be, make, and may from time to time vary, arrangements for the establishment throughout their area of local committees consisting of persons representing local education authorities for higher education, and other local authorities, and voluntary organizations promoting objects which are objects of the Act, and other persons who have special knowledge and experience of matters with which the local committees will be concerned. Any such arrangements shall empower a local committee to delegate or refer matters arising out of their functions to sub-committees, and to appoint as members of a sub-committee, or authorise a sub-committee to co-opt as members thereof, members of local authorites and other persons who are not members of the committee. The functions of a local committee are :—(a) to review the existing facilities for physical training and recreation in the various localities within their area, to direct public interest to the value of such training and recreation and to encourage the promotion of local schemes for the provision of further and better facilities therefor; (b) to examine and consider any proposals which may be put before them for the provision of such facilities as aforesaid, and any application for financial assistance by way of a grant under the Act which may be made to them; and (c) to transmit any such application with their recommendations thereon to a "Grants Committee" to be appointed by the Prime Minister. A local authority may, either free of charge or on such other terms as may be agreed, place at the disposal of a local committee, or of a sub-committee of such committee, any officers or staff belonging to or employed by the authority. Section 3 provides that the Board of Education may, in accordance with recommendations made by the grants committee and in accordance with arrangements approved by the Treasury, make grants :—(a) towards the expenses of a local authority or local voluntary organisations in providing (but not in maintaining except in cases of special hardship or difficulty) whether as a part of wider activities or not, or in aiding the provision of, facilities for physical training and recreation, including the provision and equipment of gymnasiums, playing fields, swimming baths, bathing places, holiday camps and camping sites, and other buildings and premises for physical training and recreation; (b) towards the expenses of a local authority or local voluntary organisation in respect of the training and supply of teachers and leaders; and \c) to the funds of any national voluntary organisation having such objects as aforesaid, either in aid of its work as a whole, or in aid of any specified branch of its work. Under section 4 (I) the powers of a local authority (which includes a metropolitan borough council) are extended. They may acquire, lay out, provide with suitable buildings and otherwise equip, and maintain lands, whether situate within or without their area, for the purpose of gymnasiums, playing fields, holiday camps or camping sites, or for the purpose of centres for the use of clubs, societies or organisations having athletic, social or educational objects, and may manage those lands and buildings themselves, either with or without a charge for the use thereof or admission thereto, or may let them, or any portion thereof, at a nominal or other rent to any person, club, society or organisation for use for any of the purposes aforesaid. The authority may also provide, and, where necessary, arrange for the training of such wardens, teachers and leaders as they deem requisite for securing that effective use is made of the facilities for exercise, recreation and social activities so provided, 26 A local authority may contribute towards expenses incurred by another local authority, whether under this or any other Act, or by a voluntary organisation, in providing or maintaining within the area of the contributing authority, or on a site where it will benefit any of the inhabitants of that area, anything mentioned in Section 4 (1), or a swimming bath or bathing place. Section 5 provides for the compulsory purchase of land for the purposes mentioned in section 4. Expenditure incurred for these purposes is to be defrayed by a metropolitan borough council out of a general rate, and money may be borrowed therefor. Under section 7 the Hoard of Education may provide, maintain and aid a National College of Physical Training for England and Wales, or more than one such College, and may make such provision with respect to the management thereof as they think proper. Section 8 provides that all expenses incurred by the Board of Education for the purposes of the Act, including the amount, of any grant paid or payable, shall be defrayed out of moneys provided by Parliament. The Board are empowered, subject to the approval of the Treasury, to (i) make such payments in respect of the administrative expenses of the National Council, of committees thereof, and of the grants committee, and in respect of allowances to members of the National Council, members of committees thereof and members of the grants committee ; (ii) pay such remuneration to the chairman of the grants committee ; and (iii) after consultation with the grants committee, make such payments in respect of the administrative expenses of, and in respect of allowances to members of, a local committee and any subcommittee thereof. The Minister of Health and the President of the Board of Education have issued a memorandum on the powers of local authorities under the Act. It is stated therein that the National Advisory Council and the Grants Committee were constituted on the 1st March, 1937, and that steps are now being taken to set up the local area committees, which will include among their members representatives of local authorities. .Reference is made inter alia to the extension of the existing power of providing community centres for municipal housing estates so as to enable these centres to be provided in any part of the authority's area. In order to qualify for grant under the new Act facilities must be provided in the centre for physical training and recreation. As regards the provision of swimming baths and pools it is mentioned that certain questions will call for consideration under the new development which may be expected, e.g. :—(a) arrangements for combining other forms of physical training and recreation with covered swimming baths, and (hi the use of swimming baths during the winter months. The memorandum also states that if the wide powers conferred by the Act are to be used to the greatest advantage, close co-operation between different local authorities and voluntary organisations is essential. [Extract from Report of Town Clerk.] Hydrogen Cyanide (Fumigation) Act, 1937. Section 1 provides that, with a view to protecting persons from danger in connection with the fumigation of premises and articles (including any ship, vehicle or aircraft) with hydrogen cyanide, the Secretary of State may make regulations with respect to such fumigation and, without prejudice to the generality of this provision, the regulations may (a) regulate the manner in which the hydrogen cyanide is to be generated and require the admixture therewith of any substance; (h) prohibit the carrying out of any such fumigation except by or under the supervision of persons having such training or experience as may be specified in the regulations and by such numbers of persons as may be so specified; (c) regulate the disposal of the residues of any substances used in the fumigation; and (c/) for the purpose of preventing injurious effects resulting from the fumigation, impose temporary restrictions upon the use of any premises or article, and require such tests as may be specified in the regulations to be carried out after the fumigation. The regulations may distinguish between different classes of fumigation, according to the method or circumstances thereof or 27 otherwise, and may contain special requirements or exemptions in relation to any such class. Regulations shall not apply to the fumigation of rabbit warrens or to fumigation carried out in the open air. Any person contravening any regulation will be liable to a fine not exceeding fifty pounds in respect of each offence. All such regulations made by the Secretary of State must be laid before Parliament as soon as may be after they are made. Under section 2 it is provided that whenever any accident which occasions loss of human life or personal injury occurs as the result of t lie fumigation of any premises, or article, the person by whom, or by whose agent, the fumigation was carried out shall forthwith send or cause to be sent to the Secretary of State notice of the accident and of the loss of human life or personal injury. A penalty not exceeding five pounds is fixed for noncompliance with this provision. The Secretary of State is empowered to make inquiries and investigations into accidents. Section 4 provides that His Majesty may by Order in Council apply the provisions of the Act, or such of those provisions as may be specified in the Order in Council, to fumigation with any substance other than hydrogen cyanide in like manner as they apply to fumigation with hydrogen cyanide, subject to such adaptations, if any, as may be necessary, having regard to the nature of the said substance. A draft of any such order shall not be presented to His Majesty in Council until a copy thereof has lain before each House of Parliament for twenty-eight days on which that House has sat, and, if either House within that period resolves that the draft be not so presented, no further proceedings shall be taken thereon. Any Order in Council may bo varied or revoked by a subsequent Order made in like manner and subject to the like provisions. [Extract from Report of Town Clerk.] 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 Horough by printing this information on the reverse side of the Monthly Lists and the book covers which are issued to borrowers at the libraries. NATIONAL CAMPAIGN. During the six months commencing on the 1st of October, 1937, a campaign known as the National Campaign, to encourage the wider use of the Health Services, was conducted throughout the country. Central administrative arrangements were undertaken by the Central Council for Health Education on behalf of and in close co-operation with the Ministry of Health. The co-operation of Local Authorities was invited, and the sum of twenty-five pounds was spent in posting throughout the borough specially designed posters supplied by the Ministry of Health. The idea behind this campaign, namely that the intelligent co-operation of the persons for whom they are intended is essential to the full realisation of the benefits of the Social Services, is of great importance and it is to be hoped that it will be still further developed. HOSPITAL ACCOMMODATION. A, Fcier and Small Pox.—Hospital accommodation is provided by the London County Council. 28 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 Ilighgate 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, St. Paucras Way (Tel. Button 1617) 380 Higligate Hospital, Dartmouth Park Hill (Tel. Archway 2681) 546 London County Council Special Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum aud congenital syphilis in children) (Tel. Gulliver 2483) 81 General and Special Voluntary Hospitals. University College Hospital, Gower Street (Tel. Euston 5050) Private 77 General 414 Obstetric 85 (Royal Ear 41 Royal Free Hospital, Gray's Inn Road (Tel. Terminus 4331) General 262 Obstetric 42 Ear. Nose and Throat 23 National Temperance Hospital, Hampstead Road (Tel. Euston 3755) 158 Elizabeth Garrett Anderson Hospital, Euston Ro&d (Tel. Buxton 2501) 105 West End Hospital for Nervous Diseases, liegeut's Park (Tel. Welberk 1260) 76 Hospital for Tropical Diseases, Endsleigh Gardens (Tel. Museum 3326) 77 Central London Throat, Nose aud Ear Hospital. Gray's Inn Road (Tel. Terminus 4311) 78 Central London Ophthalmic Hospital, Judd Street (Tel. Euston 2543 51 Metropolitan Ear, Nose and Throat Hospital, Fitzroy Square (Tel. Euston 2696) 22 St. Saviour's Hospital, Osuaburgh Street (Tel. Euston 2770) 21 North-West London Hospital, Bayham Street (Tel. Gulliver 1734) OutV patients j only. St. Paucras Dispensary, Oakley Square (Tel. Euston 1882) London Skin Hospital, Fitzroy Square (Tel. Museum 1411) Western Skin Hospital, Hampstead Road (Tel. Euston 1134) British Dentists' Hospital, Camden Road (Tel. Gulliver 1977) London Foot Hospital, Fitzroy Square (Tel. Museum 0602) British Hospital for Nervous Disorders, Camden Road (Tel. Gulliver 2041) British Red Cross Society Clinic for Rheumatism, Peto Place (Tel. Welbeek 1133) Section II. Population, Marriages, Births and Deaths. 29 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 (1937) population of the Borough is estimated by the Registrar-General to be 181,900, the corresponding estimate for the previous year (1936) being 183,900. The following figures shew the estimated number of persons in each of the Wards in the Borough :— Administrative Area of St. Paneras Metropolitan Borough. Census, 1931. Total (Estimated) 1937. Males. Females. Total. Ward — No. 1 15,867 20,005 35,872 32,936 No. 2 9,621 10,054 19,675 18,069 No. 3 15,615 17,543 33,158 30,443 No. 4 11,965 11,990 23,955 21,994 No. 5 13,737 15,004 28,741 26,384 No. 6 8,861 9,139 18,000 16,521 No 7 6,155 6,867 13,022 11,933 No. 8 12,562 13,148 25,710 23,620 Total 94,383 103,750 198,133 181,900 MARRIAGES. The following table shews the number of marriages for 1937, and for each of the preceding four years :— Year. Estimated Population. Number of Marriages. Marriages per 1,000 of Population. 1933 190,900 1,801 9.4 1934 187,540 1,797 9.6 1935 185,300 2,036 10.9 1936 183,900 2,032 11.0 1937 181,900 2,000 10.9 BIRTHS. The number of births registered during the year belonging to St. Paneras was 2,364, equal to an annual birth rate of 13-0 per 1000 of population. The rate for the previous year was also 13.0, and the rate for 1935 was 13.3. The actual number of births registered as having taken place in the Borough during the year was 3,796. This figure is corrected by deducting the births of non-residents (1,902), which occurred chiefly in various hospitals and other institutions in the Borough, and by adding the births belonging to St. Paneras (470) which occurred outside the Borough. The corrected figure is 2,364. 30 The corresponding figures for previous years are given on page 14. The following table gives the number of births and the birth rate in each Ward of the Borough for the year 1937, and for comparison the figures for the previous year are also given:— Ward Births and Birth Rates. Word 1937. 1936. Births. Birth Rate. Birtlis. Birth Rate. 1 463 14.1 445 13.4 2 279 15.4 246 13.5 3 512 16.8 477 15.5 4 291 13.2 315 14.2 5 285 10.8 340 12.7 6 172 10.4 197 11.8 7 115 10.0 116 9.6 8 247 10.4 253 10.6 Borough 2364 13.0 2389 13.0 No less than 2,871 births occurred in Public Institutions in St. Pancraa, equal to 7o-6 per cent, of the total births which took place in the Borough. Illegitimacy. Of the 2,364 net St. Pancras births, 221 were recorded as being illegitimate. This equals 9.3 per cent, of the total births registered. The corresponding figures for the preceding 10 years were as follows :— Year. Rate Year. Rate. 1927 69 per cent. 1932 8.0 per cent. 1928 7.3 „ 1933 8.8 „ 1929 7.8 „ 1934 9.8 „ 1930 8.4 „ 1935 8.8 „ 1931 8.l3 „ 1936 9.7 „ 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, an upward tendency in the number of illegitimate births has been apparent during recent years. Notification of Births. The notifications of births received during the year numbered 3,929; which includes 131 still-births and 3,798 live births. The figure of live births notified represents 100 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 31 Medical Officer of Health within 36 hours of the occurrence of the birth of a child, alive or dead, which has issued forth from its mother after the twenty-eighth week of pregnancy." This notification is in addition to, and not in substitution for, registration of birth, which must be carried out at a Registry Office within forty-two days of the birth. Stll. Births. The Births and Deaths Registration Act, 1926, which came into force on July 1st, 1927, requires the birth of any still born child to be registered. The definition of still birth for the purpose of the Act is as follows : — Still born or still birth shall apply to any child which has issued forth from its mother after the 28th week of pregnancy, and which did not at any time after being completely expelled from its mother, breathe or show any other sign of life. For the purpose of the Births and Deaths Registration Act, a child which, whatever the period of pregnancy, breathes or shows any other sign of life after complete expulsion from the mother, is a live born child, and if it dies even within a brief period only after birth, both the birth and the death must be registered. The fact of still birth must be certified either by the Medical Practitioner or the Midwife who was in attendance, or who has examined the child, or by declaration in a prescribed form if no Medical Practitioner or Midwife was present. If, in any of the last mentioned cases, information is given by the Registrar to the Local Authority, the Minister of Health has intimated that the Medical Officer of Health shall arrange for enquiries to be made in order that he may be satisfied that the child was really still born and that 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 81 13 46 48 Illegitimate Females 66 8 44 30 Illegitimate J Males 5 2 1 6 Females 9 2 3 8 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 2,742. This number is to be corrected by the exclusion of 1,035 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 622 deaths of residents which occurred outside the Borough. The net number of St. Pancras deaths registered during the year was accordingly 2,329; equal to an annual death rate of 12.8 per 1000 of population. Details of the corresponding figures for previous years will be found in the table on page 14. Adjusted Death Rate. The following explanatory passages are quoted from a memorandum issued by the Registrar-General in March, 1935: — "At the end of Table S.D. 24 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 12 8 per 1000 of population is adjusted by the comparability factor of 1.02 to 13.0 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. 33 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, 1937.) CAUSES OF DEATH. Ages—Both Sexes. DEATHS IN EACH WARD. SEX- Under 1 year. i 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 ; 1 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 1 M F 1 M F M F ALL CAUSES ... 154 21 23 19 13 22 31 95 J 25 254 438 557 460 127 195 228 122 113 212 195 176 125 162 151 97 SS 75 56 167 116 35 21 1241 1088 1. Typhoid and Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - 2. Measles - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 3. Scarlet Fever 1 - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - — 1 2 4. Whooping Cough - 6 3 - - - - - - - - - - - - 1 - 2 - 2 - - — 1 — 2 - — 1 — — — 9 5. Diphtheria 1 - 5 7 2 - - - - - - - - - - - 1 2 1 1 2 — — 2 1 2 — — 1 2 — — 6 9 6. Influenza 2 1 5 4 6 11 17 12 2 2 5 6 o 7 7 3 3 4 5 3 2 ] 4 2 1 1 2 29 31 7.Encephalitis Lethargica - _ _ - - - - 1 - 1 - - - - 1 - - - 1 - - - - - - - — — — — — 2 — 8. Cerebro-spinal Fever 2 - - - - - - - - - - - - - - - 1 - - - - - - 1 - - - - - — — — 1 1 9. Tubereulosie of Respiratory System - - - - - 11 15 27 21 27 30 16 1 - 12 12 8 4 19 13 19 7 14 2 8 5 8 3 8 4 1 1 97 51 10. Other Iuberculous 1 - 2 1 1 1 2 1 - 1 4 - - - 2 1 - - 1 - - 1 1 1 1 1 2 — 1 1 - 1 8 6 11. Syphilis - - - 1 - - - - 2 4 3 4 — 3 - - - 1 - 3 - 3 1 — — — 1 1 1 — 13 1 12. General Paralysis of the insane, tabes dorsalis - - - - - - - - 1 3 2 3 - - - - - 1 1 - 1 2 1 1 - 1 1 - - 7 2 13.Cancer, Malignant Diseases - - ~~ - 1 7 24 55 88 108 52 2 21 39 20 9 29 33 24 13 27 21 17 11 6 10 32 17 4 4 180 157 14.Diabetes - - - - - - - 2 - 1 9 10 5 2 3 3 - 1 3 8 1 3 - 2 1 - - 1 1 2 — — 9 20 15.Cerebral Hæmorrhage, etc. - - - - - - - - 2 6 22 2 6 22 3 9 4 7 4 6 5 5 7 4 9 2 1 3 1 7 4 2 1 45 36 16.Heart Disease - - 1 3 2 2 - 4 13 42 100 162 190 60 56 72 31 38 60 45 37 42 35 28 18 18 17 4 39 23 12 4 305 274 17. Aneurysm - - - - - - 1 1 3 2 7 5 2 - 1 3 1 - 5 1 1 3 2 _ 1 — 2 1 — 1 — 13 8 18. Other Circulatory Diseases - - - - - - - - 4 11 19 31 36 15 6 10 1 4 5 12 2 6 10 16 5 8 2 5 8 12 2 2 41 75 19. Bronchitis - - - - - - -~ 1 6 10 13 16 23 9 4 4 5 3 8 9 3 9 3 4 4 2 2 7 4 2 1 50 31 20. Pneumonia (all forms) 2 1 - - - - 4 12 19 38 53 32 9 15 12 16 13 11 14 29 7 12 20 7 12 8 4 16 17 2 1 116 100 21. Other Respiratory Diseases 32 7 6 - 2 - - 2 2 2 3 1 5 1 1 2 1 1 2 1 1 1 2 1 _ — — — — 3 — — 7 9 22. Peptie Uleer - 1 4 8 6 3 2 1 4 3 1 2 2 2 2 4 2 — — 2 1 — — 17 8 23. Diarrhoea, etc. 51 1 1 - - - - 1 - 1 3 - 1 - 8 5 1 6 9 2 4 2 3 3 3 2 3 3 3 2 — — 34 25 24 Appendicitis - - - - - - - 3 2 2 3 4 2 2 1 - 1 - - 2 — 1 1 1 — 1 — 1 5 — — 8 8 25. Cirrhosis of Live - - - - - - - - - 4 5 3 - 1 - - - 2 1 — 3 — 1 — — — ' 4 — — — 9 3 26. Other Diseases of Liver, etc. - - - - - - - - - 1 2 3 1 - - 1 - 1 - 1 - 2 — — — — — 1 1 — — 1 6 27. Other Digestive Diseases 1 - 1 - - - 1 5 5 5 14 7 2 1 5 2 3 1 3 3 2 — 5 1 1 2 2 7 2 1 — IS 23 28. Acute and Chronic Nephritis - - - - - 1 3 3 7 13 15 11 2 4 6 2 3 6 5 5 5 1 3 2 3 — 1 4 6 — 24 32 29. Puerperal Sepsis - - - - - - 1 1 - - - - - - - - - - - - 1 — — — — 1 — — — — — 2 30. Other Puerperal Causes - - - - - - 1 1 1 — — — — — — 2 — — — — — — 1 — — — — — 3 31. Congenital Debility, Premature Birth, Malformations, etc. 50 - - - - - - - - - - - - - 7 5 - - 7 8 - 2 2 3 1 — 1 7 3 3 1 — 22 28 32. Senility - - - - - - - - - - - 3 13 8 2 7 1 2 3 1 3 2 — 1 2 — — — — 9 15 33. Suicide - - - - - - - 10 3 9 8 4 2 1 4 2 — 1 6 4 3 — 5 4 2 — 4 1 4 —' — 1 28 13 34. Other violence - - 2 2 9 - 6 5 5 - 19 20 5 7 6 5 5 7 5 9 6 5 6 7 1 3 1 2 2 3 1 18 33 35. Other defined Diseases 4 6 6 1 5 4 3 2 11 8 22 27 36 20 5 20 18 13 8 12 9 11 7 9 6 7 8 4 9 1 2 - 91 i 65 36. Causes ill-defined or unknown 1 - - - - - - — — — - 1 — — — — - — - — - 1 - - - - - - - - 1 - 1 1 Special Causes (included til No. 35 above) Erysipelas - — — - — 1 — — — — — — - — — — - 1 - i - 34 34 THE FOLLOWING TABLE GIVES PARTICULARS OF THE DEATHS IN PUBLIC INSTITUTIONS IN THE BOROIGII, TOGETHER WITH SI. 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, 193<.) 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, Ac., Hospital. Metropolitan Ear, Ac., Hospital. St. Saviour a Hospital. Royal Ear Hospital. Hampstead General Hospital. Middlesex Hospital. Other London 1 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. j Not belonging! to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras- Belonging to St. Pancras Not belonging^ to St. Panoras. Belonging to St. Pancras. Not belonging to St. Pancras. | Belouging to St. Pancras. Not belonging to St. Pancras Belonging to St. Pancras. Not belonging to St. Pancras. 1 Belongingto St. Pancras. Not belonging to St. Pancras. Belonging , to St. Pancras. Not belonging to St. Panoras. Belouging j to St. Pancras. Not belonging to Belonging to St. Pancras. Not belonging to Belonging to Not belonging to St Pancras ALL CAUSES 492 225 460 51 1 8 69 313 27 185 27 82 2 33 2 33 3 6 — 17 — 2 3 — 1 4 2 — — 440 — 110 — 1. Typhoid ana Paratyphoid Fevers 1 —— — — — — — — — — — — — — — — — — — — — — — — — — —- — — — — 1 2. Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 3. Scarlet Fever — — — 0— — — — — — — — — — — — — — — — — — — — — — — — — 6 —2 — 4. Whooping Cough — — — — — — — 1 1 — — — — — _ — — — — — — — . — — — — — — 6 — 3 — 5. Diphtheria — — 4 2 — — — — 1 2 — 2 — — — — — — — — — — — — — — — 3 — 6 — 6. Influenza 10 3 13 — — — — — — — — — — — — — — — — — — | — — — — — — — 2 — 7. Encephalitis Lethargica — 2 — — _ _ — — — — — — — — — — — — — — — — — — — 1 — — — 8. Cerebro-spinal Fever — — 44 —— — — — — — — — — — — — — — — — — — — — — — — — — — 47 — 14 — 9 Tuberculosis of Respiratory System 9 7 5 29 — — 2 5 1 2 — 2 — 2 — 3 1 — — 1 — — — — — — — — — — — 1 — 10. Other Tuberculous Diseases 3 1 3 1 — — — 7 1 — — — — — — 1 — — — — — — — — — — 1 — — 3 — 1 — 11. Syphilis 3 1 3 — — — — — — — — — — — — — — — — — — — 2 — 5 — 12. General Paralysis of the insane, tabes dorsalis 1 — — — — — — - — 24 — 4 — 1 I 4 — 3 — — — 1 — 1 — — — 71 — 8 — 13. Cancer, Malignant Diseases 74 28 77 5 — 12 87 32 7 9 — 1 — — — — — — — — — — — — — 6 — — — 14. Diabetes 6 4 6 — — 1 5 l 1 — — 1 — — — — — — — — — — — — — 15 — 3 — 15. Cerebral Haemorrhage, etc. 19 6 23 — — 3 2 4 1 4 — 1 — 1 — — — — — — 1 — — 91 — 21 — 16. Heart Disease... 89 51 110 4 — 8 26 4 8 2 4 — — — — — — — — — — — — — — — — — 3 1 — 17. Aneurysm 1 1 5 — — 5 1 £ — ] — 2 — — — — — — — — — — — — — 12 — 8 — 18. Other Circulatory Diseases 56 21 7 — — — 3 11 9 1 5 i I i o 2 — — — — — — — — — — — — — — 1 — — 9 — 1 — 19. Bronchitis 24 9 11 — — 3 1 j. I 9 1 I — 1 — — — 2 — — — — — — — — — 27 — 7 — 20. Pneumonia (all forms) 67 27 53 3 — 6 21 2 4 2 2 — 1 — 1 — — — 3 — 1 — — — — — — 3 — — — 21. Other Respiratory Diseases 5 2 3 I 7 1 9 2 — — — 1 — — — — — — — — — — — — — 6 — 1 — 22. Peptic Ulcer ... 11 4 3 Q i .1 4 9 5 1 3 — — — — — — — — — — — — — — — 3 — 1 — 23. Diarrhoea, &c. 1 — 10 O O 4 i 5 — — — — — — — — — — — — — — — — — 37 — — — 24. Appendicitis ... 3 4 1 £ o A 9 — 1 — — — — — — — — — — — — — — — 3 — — — 25. Cirrhosis of Liver 3 — 1 — , — — — — — — — — — — — — — — — — 2 — — — 26. Other Diseases of Liver, etc. — — 4 — — — 2 6 2 i n J A — 4 — — — — — 2 — — — 1 — — — — — 12 — 1 — 27. Other Digestive Diseases 5 4 11 — — — 3 6 1 10 1 J? — 9 — — — — — — — — — —1 — — 1 — — 5 — 2 — 28. Acute and Chronic Nephritis 9 6 14 1 — — 3 14 1 6 1 4 — £ — — — — — — — — — — — — — — — 1 — — — 29. Puerperal Sepsis — — — — — — 1 — — — — — 9 — — — — — — — — — — — — — — — 1 — — — 30. Other Puerperal Causes 1 — — — — — — — — 6 — £ — — — — — — — — — — — — — 19 — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 17 3 3 — i 5 4 21 1 18 — — —- 5 — 2 — — — — — — — — — — — — — 2 — 1 — 32. Senility 12 16 — — — — — 1 1 — — — — — — — — — — — — — — — — — 3 18 — 3 — 33. Suicide 4 2 1 1 1 i l l 99 A c 9 — — — — — — — — — — — — — 1 — 29 — 3 — 34. Other violence 25 6 5 3 — — 1 9 1 O u — — — — — — — — 1 — — — — 13 — 35. Other defined Diseases 32 21 38 1 — 2 9 61 1 23 2 15 — 3 1 14 1 2 — 5 — 1 — 1 — — — — — — — — — — 36. Causes ill-defined or unknown 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Special Causes (included in No. 35 above) Erysipelas 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 35 Of the total of 2,329 St. Pancras deaths which occurred during the year, no less than 1,637 took place in public institutions ; this equals 70 per cent, of the total deaths. As compared with the previous year there was an increase in the number of deaths due to Influenza and Pneumonia, and a decrease in those attributed to Tuberculosis, Syphilis, Measles, Cancer, Heart Diseases and digestive diseases. Deaths of Aged Persons. The corrected number of deaths of residents at 65 years of age and upwards, which occurred during the year 1937 was 1,144, which is 0"6 per cent, of the total population. Of these 557 were between the ages of 65 and 75; 460 were between the ages of 75 and 85, and 127 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. 1937. 1936. Deaths. Death Rate. (UNADJDSTKD.) Deaths. Death Rate. (Unadjusted.) l 423 12.8 446 13.4 2 235 13.0 240 13.2 3 407 13.3 440 14.3 4 301 13.5 303 13.6 5 313 11.9 350 13.1 6 180 10.8 211 12.6 7 131 10.8 147 12.2 8 283 11.8 291 12.2 Homeless 56 — 50 — Borough 2329 12.8 2478 13.5 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 15 St. Pancras Hospital 25 High gate Hospital 3 Royal Free Hospital 1 University College Hospital 4 St Margaret's Hospital 1 Hainpstead General Hospital, Bayham Street 1 Hospital for Tropical Diseases 2 14, Fitzroy Square 1 Found dead, L.M.S. Station, Euston 1 „ „ No. 1 Pond, Highgate 1 Total 55 DEATHS FROM CANCER. The deaths from Cancer in the Borough during the year 1937 numbered 337, as compared with 361 in 1936. Particulars concerning this disease, as regards Age, Sex, Situation of Disease and Wards, are set out in the following Table :— 36 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, 1937. 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 46 55 55-66 65-75 75-85 85 & up M F M F M F M F M F M F 1 M F 1 M F M F M F Total—all situations 1 — 7 24 05 88 108 52 2 180 157 21 39 20 9 29 38 24 13 27 21 17 11 6 10 32 17 4 4 Tongue — — — — — 1 3 2 3 — 8 1 3 — — — — — 1 — 2 — — 1 — — 2 — — — Othar Buccal Cavity — 1 — 3 4 — — 7 1 — 1 3 — — 1 — — — 2 — 1 — — — — Pharynx — — — 2 3 1 — — — — — — — — — — — — — — — — — — — — — Esophagus — — 2 1 3 4 — 9 1 — — 1 — 1 1 2 — 1 — 2 — — — 2 — — Stomach — 2 9 20 17 5 — 36 17 5 3 3 2 7 2 5 3 4 4 5 2 — — 6 1 1 Liver — 1 1 1 1 •z — 1 5 — 1 — 1 — 1 1 — —- — 1 1 — — Gall Bladder 1 4 1 — 1 5 2 1 2 — — — — — — 1 — Intestines 1 2 — 6 20 4 — 10 23 1 6 — 1 2 2 — 2 2 5 1 3 1 — 3 4 — Rectum — — 1 3 8 6 4 — 14 8 3 2 3 — 2 3 2 — 1 2 — — — — 3 1 — Others — — 1 3 — — — — 4 — 2 — — — — — — — 1 — — — 1 — — Uterus — 2 6 3 6 2 — — 19 — 5 — 3 — 3 — 1 — 2 — 1 — 1 1 — 2 Ovary and Fallopian Tu be — — — 1 1 4 1 1 4 — — 12 — 2 — 1 — 3 — 1 — 1 — — — 1 — 2 — 1 Vigina, Vulva — — — — — — — — — — — — — — — — — — — —1— — — — — — — — — — — Breast 1 2 6 3 U 7 2 — 32 — 8 — — — 8 — — 3 — 4 — 4 — 3 — 1 Skin — — 1 2 1 — 2 2 — 2 — Larynx — — — 1 5 1 — 6 1 — .1 — — 1 — — — 2 — 1 — — — 2 — — — Lung and Pleura — — 2 4 10 15 5 — — 31 5 1 — 3 — 8 3 3 1 9 — 4 — 1 — j 2 1 — — Mediastinum — — — 1 — 1 — 1 1 — 1 1 — — — — — — — — — — — — — — Pancreas — 1 6 4 6 — 10 10 1 4 1 — 3 — 1 — 1 2 _ — 1 1 2 3 — — Bladder — — — .— 2 1 — 2 I 1 — — — 1 1 — — — | — — — — — — Prostate — - 2 4 5 2 — 13 — 2 — 1 — 2 — 1 — 1 __ | — — 1 5 — — Others — 1 — 2 7 7 7 5 3 — 23 9 4 3 3 1 3 3 4 1 2 — 2 — 1 1 3 — 1 — 37 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 9 9 19 Pneumonia 6 — — — 9 16 31 Cerebral Haamorrliage 1 — — — 3 3 7 Cancer — — — — 5 5 10 Tuberculosis — — — 2 5 — 7 Other causes •27 0 2 8 76 16 131 Accidents— Street Vehicles 1 6 5 IS 18 48 Burns and Scalds — 3 1 — 4 9 17 Railway — — — — 4 — 4 Falls — 1 3 1 16 64 85 Other causes* 5 2 4 5 23 19 58 Suicidet† — — — 9 81 21 111 Murder 1 — — — 2 — 3 Open Verdict ‡ 2 — — 3 10 2 17 Totals 42 9 16 34 265 182 548§ f Includes 48 cases of coal gas poisoning. * Includes 5 cases of coal gas poisoning. J Includes I case of coal gas poisoning. § St. Pancras cases 147, ex-St. Pancras 401 (see also page 38). Infantile Mortality. The number of deaths of St. Pancras infants under one year of age occurring during 1937 was 154 (of which 28 were of illegitimate children). This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 65. The corresponding rate for the previous year was 79. Further details will be found in the Maternity and Child Welfare Section (page 107). 38 Mortuary and Coroner's Court. These buildings are situated in Camley 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 : — 1932. 1933. 1934. 1935. 1936. 1937. Number of inquests held :— St. Pancras cases 121 151 128 142 125 147 Ex-St. Pancras cases 443 422 438 394 464 401 Number of bodies received :— St. Pancras cases 242 306 288 299 264 287 Ex-St. Pancras cases 571 510 525 501 502 500 Number of post-mortem examinations made :— St. Pancras cases 206 286 277 293 249 285 Ex-St. Pancras cases 415 446 492 454 453 466 Totals 1998 2121 2148 2083 2057 2086 Section III. Sanitary Circumstances of the Area. 39 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 40, 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 65. Work under the Factory 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 49-52. Inspections.—59,818 visits and inspections were made in 1937 by the Council's staS of 16 Inspectors. Of these inspections, 44,740 were made by the 11 District Inspectors and one Housing Inspector, 6,967 by the two Inspectors of Food and Food places, and 8,111 by the two Inspectors of Factories and Workshops. Notices served.—3,442 intimation notices were served by the Inspectors during the year. Of these 3,086 were served by the District Sanitary Inspectors, and 356 by the Factory and Workshop Inspectors. 1,239 Statutory notices, four 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. 40 Report of Work carried out by District Inspectors for the year 1937. Complaints received, 3,428. Visits in respect of:— Brown. Walker.* jaues. Akers. Capel.‡ Jaffa. Thomas. west.† Hoare. Winchester Hague. Mansfield. Warren. Dykes. Totals. On Complaint Whole house inspected 1 — 19 25 2 — 2 2 — 1 3 9 4 40 108 Do. Re-inspections 23 — 65 84 3 — 19 1 30 — 47 11 4 75 362 Part of house inspected 443 — 285 232 83 603 314 248 47 400 297 256 380 284 3872 Do. Re-inspections 1610 — 852 391 175 1021 574 773 449 1075 800 411 661 682 9474 Infectious Diseases Investigations 158 — 123 77 52 271 116 89 11 165 194 227 174 111 1768 Inspections.. 70 — 69 25 5 87 31 26 1 82 54 15 101 21 587 Re-inspections 427 — 333 177 39 26 163 119 4 236 239 56 145 63 2027 Smoke Observations 4 — 11 32 5 14 40 32 8 3 6 53 16 38 262 Offensive or Regulated Trades — — — — 6 — 6 37 16 — — — 10 — 75 Mews and Stable Yards 287 — 419 406 57 267 160 183 102 346 282 403 371 184 3467 Shops Act First Inspections — — — — — — 1 103 1 11 — — — — 116 Subsequent do. — — 127 — — — 5 211 49 8 1 4 — — 406 Verminous Persons — — — 12 — 31 12 — — — 20 — — — 75 Pharmacy and Poisons Act First Inspections — — — 1 — 3 1 1 — — — — — — 6 Subsequent do. — — 5 — — — 2 — — — — — 1 2 10 Other Inspections 74 — 73 57 43 248 249 19 64 345 136 90 290 68 1756 Housing Acts and Regulations Inspections — 341 106 — — — 14 1 14 1 — 2 25 12 516 Re-inspections 2 2175 264 — 9 4 76 6 1 1 23 9 23 70 2663 Houses let in Lodgings Inspections — — 81 — 4 15 28 — — 26 — — 23 31 208 Re-inspections 4 — 372 — 22 21 115 — — 68 10 13 28 179 832 Underground Rooms 106 — 72 258 51 172 233 36 3 592 411 433 198 51 2616 Drainage (a) Under Notice 184 — 354 438 25 181 130 93 — 63 392 299 327 145 2631 (b) Voluntary 548 — 998 817 106 430 533 838 232 465 421 906 906 571 7771 (c) New Buildings 15 — — 517 129 215 221 80 7 260 449 326 252 515 2786 Attendances at Police Court — — 6 — 1 — 2 — 1 — 2 — 7 10 30 Rent Restrictions Acts 13 — 10 6 — 2 — — — — 2 — 2 — 35 Food and Food Places — — — — 101 — — — — 79 — — 101 — 281 Canal Boats Acts — — — — — — — — — — — — _ — — Totals 3970 2516 4644 3356 918 3611 3047 2898 1040 4227 3789 3523 4049 3152 44740 Notices served:— Intimations 391 — 277 132 63 318 274 196 53 425 193 190 302 272 3086 Rent Restrictions Acts 2 — — 1 — — — — — 2 — — 1 — 6 Totals 393 - 277 - 63 318 274 196 53 427 193 190 303 272 3092 * Housing Inspector. t Retired 30th September. Duties taken over by Mr. Hoare. J Appointed Food Inspector in April. Duties as District Inspector taken over by Mr. Thomas. 41 Legal Proceedings. The following prosecutions were undertaken during the year in respect of general sanitary work:— Public Health. (London) Act, 1936. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 49. Wicklow Street Walls of washhouse and back yard dirty: absence of waste pipe to sink on landing. 1937 Agreement reached as to work to be carried out, and summonses adjourned sine die to enable this to done. 51, Wicklow Street Walls and ceiling of ground floor back room, ceilings of ground floor front and first floor front rooms, walls of water closet apartment, washhouse and back yard dirty. Rainwater pipe defective. Jan. 25th 53. Wicklow Street Defective condition of washhouse paving 10, St. Augustines Road Main roof defective Feb. 9th Summonses withdrawn. Work carried out and £2 2s. cost paid. 43, Peckwater Street Main roof defective April 1st Summons dismissed. 24, Highgate Road Main roof defective April 28th Work done and summons withdrawn. Costs £2 2s. 4, Oakley Square Undertaking for reward the maintenance of a child under the age of nine years apart from the parents and failing to give notice thereof to the local authority. May 14th Penalty £2. Costs £2 2s. 19, Shirlock Road do. do. May 21st Penalty £1. 12, Langbourne Avenue Reconstructing waste pipe in a manner contrary to the drainage bye-laws of the London County Council. June 21st Summons dismissed. Work completed, 12, Langbourne Avenue Reconstructing waste pipe without giving notice to the Sanitary Authority as required by the drainage bye laws of the London County Council. June 21st Dismissed under Probation of Offenders Act. Costs £2 2s. 82, Cbalton Street An occupied house without a proper and sufficient supply of water upstairs: addition roof defective, firegrate of first floor back room defective. July 26th Penalty £2. Costs £2 2s. Order for 21 days not served. Defendant owing General Rates. Fresh notices served on new owner, 35, Leighton Grove Sink on staircase untrapped and improperly constructed and discharging into rain water pipe and hopper head under window. Julv 29th Costs £2 2s. Summons withdrawn. Work done. Costs paid. 52, Raydon Street Back addition roof over water closet apartment and washhouse defective. Aug. 27th Summons withdrawn. Nuisance abated. 44, Lulot Street Back addition roof defective Oct. 5th Costs £2 2s. Order for 28 days. 46, Lulot Street Back addition roof defective Oct. 5th Costs £2 2s. Order for 28 days. 52, Lulot Street Back addition roof defective Oct. 5th Costs £2 2s. Order for 28 days. 7, Busby Place Fixing a new sink and waste pipe without giving notice to the Sanitary Autnority as required by the drainage bye-laws of the London County Council. Oct. 15th Penalty £l. Costs £1 1s. Kentish Town Road Causing to be removed or carried offensive matter by road through London without using a suitable carriage or vessel properly constructed and furnished with a sufficient covering so as to prevent the escape of any such matter or liquid therefrom and so as to prevent any nuisance arising therefrom contrary to bye-laws made by the London County Council under Section 16 (2) of the Public Health (London) Act, 1891. Nov. 19th Penalty £5. Costs £5 5s. Kentish Town Road Removing or carrying do. do. Nov. 11th Penalty £1. 46, Howland Street Undertaking for reward the maintenance of a child under the age of nine years apart from the parents and failing to give notice thereof to the Local Authority. Nov. 22nd Penalty £2. Costs £2. 42 London County Council Drainage Bye-lawn (Metropolis Management Act, 1855, and Metropolis Management Acts (Amendment) Bye-laws Act, 1899). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 70, Leighton Road Constructing new water closet apartment with new soil pipe and water closet, new gully and short soil branch and manhole, without depositing plan. 1937 April 1st Plans supplied. Summons withdrawn. Costs £2 2s, London County Council Bye-Laws—Public Health (London) Act, 1891, and Sec. 6 Housing Act, 1925. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 1937. 11, Ley bourne Road Being a lodging house, did cause or knowingly permit the ground floor back room to be overcrowded. Feb. 8th Children admitted to a London County Council Institution. Summons withdrawn. 10, St. Augustine's Road Failing to cleanse the hall floor, scullery and water closet apartment and the walls and ceilings of the top landing and upper staircase. Feb. 9th See proceedings under Public Health (London) Act, 1936. 82, Chalton Street Failing to cleanse walls and ceiling of ground floor addition room and ceiling of first floor front room and to remedy defective window cords of second floor back room. July 26th Penalty £1. 81, St. Paul s Road Failing to cleanse and free from vermin the ground floor front room and to cleanse the walls and ceilings of the basement front, ground floor back and first floor front rooms. Oct. 15th Costs £2 4s. Od. Summons withdrawn. Work completed. Ventry Byelaws. Situation of Properly. Offence. Date of Hearing of Summons. Result of Proceedings. 1937. 49, Wicklow Street Yard paving defective Jan. 25th Agreement readied as to work to be carried out, and summonses adjourned sine die to enable this to be done. 51, „ „ „ „ „ „ „ SMOKE ABATEMENT. During the year 262 observations of chimney shafts were made and five intimations were served. Two 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 were increased, and power was given to local authorities to make bye-laws regulating the emission of smoke. The Authority for this purpose, in the Metropolis, is the London County Council, and a bye-law was made under powers contained in Section 2 of the Act on February 17th, 1931, aud was allowed by the Minister of Health and came into force on May 19th, 1931. 43 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, 1936. 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 inciter's in Tudor Place, which has been in existence since the year 1780, and a soap boiler's in Rochester Place. 75 visits were made to these premises during the year, These trades are not subject to annual licensing, but they cannot be established anew or extended without the sanction of the Local Authority. Rag and Bone Dealers. Additional bye-laws were made in 1928 by the London County Council, under powers given by Section 9 of the London County Council (General Powers) Act, 1908. The bye-laws provide as follows:— 1—A person carrying on the business of a rag and bone dealer shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy— (a) in or from any part of the premises used for or in connection with his business, or (b) in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags, bones, fat, rabbit skins, or other like articles, or (c) in any other way connected with his business. 2—A person carrying on the business of a rag and bone dealer who shall offend against the foregoing bye-law shall be liable for every such offence to a penalty of Five Pounds. Provided nevertheless that the Court before whom any information may be laid or any proceedings may be taken in respect of any such offence may if the Court think tit adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this bye-law. There were no prosecutions in respect of this bye-law during the year. There are 21 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. Section 136 of the Public Health (London) Act, 1936. Rag Flock Premises. The above section prohibits the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean dock manufactured from rags. The expression "flock manufactured from rags" is defined in sub-section (6) of the 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 process of scouring and finishing 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. 44 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 40. These inspections relate to some 4,985 houses. Fresh bye-laws under the Housing Act, 1936, are in course of preparation, and await confirmation by the Ministry of Health. 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. Under Sections 156-166 of the Public Health (London) Act, 1936, the registration, licensing, and inspection of common lodging houses are the concern of 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 seven 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. 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, 1938. Six visits were made during the year to this common lodging house. Shops Act, 1934. The number of shops inspected during the year was 142, and the total number inspected since the coining into force of the Act is 3,511. Additional sanitary accommodation and/or improved arrangements in regard to ventilation and heating were provided in four shops as a result of these inspections. No certificates of exemption were granted. Canal Boats Acts. Under the Canal Boats (Amendment) Regulations, 1925, the responsibility for maintaining a canal boat in a habitable condition is now placed upon the owner, instead of the master. Inspections of the canal and wharves are the duty of the District Sanitary Inspectors concerned, 45 RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920-1933. During the year 8 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. Tn accordance with Section 5 of the Act of 1923, two 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 each case the "release" certificate was granted. In the majority of cases where an examination of premises for the purpose of issuing a certificate under the Act was made by an inspector, opportunity was also taken of serving, where applicable, Intimation Notices on the owners for the abatement of nuisances or for remedying breaches under the Public Health (London) Act, the London County Council (General Powers) Acts, Bye-laws, etc. REMOVAL OF AGED, DISEASED OR INFIRM PERSONS. Section 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 one person was 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. Under Section 98 of the Public Health (London) Act, 1936, eight 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, 450 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 68 tenement houses under powers contained in Section 95 of the Public Health (London) Act, 1936. 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 Plender 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 installed a water purification plant to serve the four swimming pools at these baths. Certain improvements were in course of [progress in the Highgate Swimming Pools, which lie within the area of the Borough. Excavation was commenced during the latter part of the year in connection with the new London County Council lido at Parliament Hill Fields. 46 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 1937. 1936. 1935. Drainage work done under notice 2631 2898 2934 Voluntary drainage work 7771 7466 7478 Drains of new buildings 2786 3190 2651 Total 13188 13554 13063 Drainage Register.—The following is an analysis of the Drainage Register during 1937, the figures for the previous year being given for comparison:— 1937. 1936. Plans deposited—Old Buildings under Notice 74 70 ,, „ Old Buildings, Voluntary 263 218 „ „ New Buildings and Additions 87 58 424 346 Applications without Plans 436 472 Total number of Applications and Plans 860 818 Rats and Mick (Destruction) Act, 1919. During the year 142 complaints were received with reference to nuisances caused by premises being infested by rats. Steps were taken by the service of notices on owners or occupiers, by the testing of drains, and other necessary measures to abate the nuisance. Rat Week. The Ministry of Agriculture and Fisheries issued a Circular stating that this year's "Rat Week" would commence on Monday, 1st 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 to infestation by rats, owing to the nature of the business carried on therein, and chemists' shops and stores were requested to stock, exhibit or advertise suitable rat poisons, traps, etc. Refuse Collection and Disposal. A. —A weekly collcction 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. 47 The use of Pagefield lorries and containers, first introduced in 1925, has very much facilitated this work. B.—The methods of refuse disposal are:— (a) By combustion in the Destructor. (b) Removal to the country by rail. The following figures for the past year are kindly supplied by Mr. C. S. Bainbridge, a.m.inst.c.e., p.a.s.i., m.i.m. & cy.e., the Borough Engineer. For the purpose of comparison the figures for the previous year are also given:— 1937. 1936. Tons. Tons. Quantity of refuse collected 55622 56169 Quantity of refuse burnt at Destructor 31288 32867 Quantity put on rail 24334 23300 Quantity of clinker residual 10391 11150 Section IV. Factory and Workshop Acts. 49 SECTION IV.—FACTORY AND WORKSHOP ACTS. Inspections are 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 1937. Inspections and lie-Inspections. Thompson. Miss Camman. Totals. Factories (including factory laundries and bakehouses) 2101 898 2999 Workshops (including workshop laundries and bakehouses) 1126 631 1740 Workplaces (including restaurant kitchens) 452 1050 1502 Outworkers' premises - 1169 1169 Shops Act 193 470 663 Other Visits 22 16 38 Totals 3894 4217 8111 Notices served relating to:— Factories 190 32 222 Workshops 52 25 77 Workplaces 26 5 31 Others 5 21 26 Totals 273 83 356 50 Information concerning the work carried out under the above Acts is given in the following' tables in the form required by the Home Secretary. 1.— Inspections made by Male and Femai.k Sanitary Inspectors. Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories 3106 222 — Workshops 1799 77 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1968 31 — Totals 6873 330 — 2.—Defects Found. Particulars. Number of Defects Number of Prosecution*. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 164 153 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 138 127 — — Sanitary accommodation— Insufficient 6 6 — — Unsuitable or defective 116 107 — — Not separate for sexes 25 25 — — Other breaches 80 73 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 64 64 — — Other offences (excluding offences relating to outwork, which are included in Part 3 of this Report) — — — — Totals 594 556 — — # Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Outwokkers and Home Work. In certain industries specified in the Act, if work is given out by Employers or Contractors to be done by workers in their own premises, lists containing the names and 5i 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 1937, 656 notifications of outworkers were received from 16 local authorities outside St. Pancras. In the second half of 1937, 552 notifications were received from 11 local authorities outside St. Pancras. From St. Pancras employers in the first half of 1937, 146 notifications were received, of which 54 addresses were in St. Pancras. The remainder were forwarded to the appropriate local authorities. In the second half of 1937, 149 notifications were received, of which 50 addresses were in St. Pancras. The remainder were forwarded to the appropriate local authorities. The following table gives the number and type of outworkers' premises in the Borough and the principal industries concerned:— Nature of Work. Nature of Premises. Total. Factories. Workshops. Workplaces. Wearing apparel 94 169 159 422 Bootmaking 4 — 62 66 Embroidery . . 2 3 36 41 Miscellaneous 3 — 69 72 Totals. . 103 172 326 601 4.—List of Factories, Workshops (Registered, Sec. 131) and Workplaces. Nature of Work, Factories. Workshops. Workplaces (including Outworkers). Total. Bakehouses 82 68 - 150 Cabinet makers 55 60 — 115 Coach builders 18 15 — 33 Dressmakers 129 92 28 249 Engineers 221 36 — 257 Foundries 14 — — 14 Furniture makers 14 20 — 34 Furriers 8 13 1 22 Laundries 12 1 46 59 Metal workers 41 33 — 74 Milliners 4 5 - 9 Organ builders 8 3 - 11 Pianoforte manufacturers 41 8 1 50 Printing 83 6 — 89 Restaurant kitchens — 304 304 Tailors 54 223 126 403 Upholsterers 16 35 1 52 Wood carvers 9 10 — 19 Other occupations 612 482 415 1509 Totals 1421 1110 922 3453 52 5.—Other Matters. Class. Number. (1) (2) Matters notified to U. M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 19 Reports (of action taken) sent to H.M. Inspector 19 In regard to workshops where protected persons have been found to be employed (Public Health (London) Act, 1936, section 131) 13 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 60 Bakehouses and restaurant kitchens are also referred to on page 71. 6.—Total Inspections of Factories, Workshops and Workplaces. Premises. Male Inspector. Woman Inspector. Total. Outworkers. Not Outworkers. Factories 2197 97 909 3110 Workshops 1156 409 643 1808 Workplaces 519 694 1449 3155 Total 3872 1200 3001 8073 Section V. Housing. 53 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:— (a) Total (including number given separately under (b) 470 flats (b) With State assistance under the Housing Acts:— (i) By the Local Authority 53 (ii) By other bodies or persons 235 The 470 flats mentioned above as having been erected during the year comprised the following:— By the Crown Estate (Camberley House, Cumberland Market) 128 flats By the St. Pancras House Improvement Society, Ltd.:— St. Michael's House, Aldenham Street 33 flats St. Anthony's House, Stibbington Street 45 „ Priestley House and Leonard Day House, Athlone Street 49 ,, 127 flats By the London Count}- Council (Walker House) 108 flats By the St. Pancras Borough Council:— Powlett House, Powlett Place 18 flats Ferdinand House, Ferdinand Place 31 ,, Somers Town Extension, Cranleigh Street 4 „ 53 flats By the East End Dwelling Co. Moatlands House, Cromer Street 18 flats Whiteheather House, ,, 18 ,, Edward Bond House, „ 18 „ 54 flats Total 470 flats In addition there were in course of erection at the end of the year:— By the Crown Estate (Tintern House, Cumberland Market) 22 flats By the L. M. S. Railway Co. (to re-house tenants displaced in the Euitou Area), to be leased to the St. Pancras House Improvement Society, Ltd., on completion (York Rise Housing Scheme) 120 flats By the London County Council (Charlton House) 35 flats By the St. Pancras Borough Council:— Cobden House, Arlington Road 55 flats Leighton Road site 98 „ Camden Park Road site 95 „ Queen's Crescent site 189 ,, 387 flats Total 564 flats 54 1. Inspection of dwelling-house*. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1419 (b) Number of inspections made for the purpose 7303 (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 724 (b) Number of inspections made for the purpose 4219 (3) Number of dwelling-houses found to be in a state so dangerous . or injurious to health as to be unfit for human habitation 9 (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 1071 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2592 3. Action under Statutory Powers. (a)—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 144 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 208 (b) By Local Authority in default of owners Nil. (b)—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 856 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice:— (a) By owners 650 (b) By Local Authority in default of owners Nil. (c)—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 55 (d)—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 141 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 17 4. Housing Act, 1936—Part IV.-Overcrowding (a) (i) Number of dwellings overcrowded at the end of the year 4497 (ii) „ families dwelling therein 4497 (iii) ,, persons „ „ 21469 (b) Number of new cases of overcrowding reported during the year 154 (c) (i) ,, cases of overcrowding relieved during the year 121 (ii) „ persons concerned in such cases 608 (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. 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:— (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 and wife). (ii) Two rooms 3 persons. (iii) Three rooms 5 persons. (iv) Four rooms 7½ persons. (v) Five rooms or over 10 persons With an additional two persons in respect of each room in excess of five; or (b) 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 no 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. The "appointed day" after which the provisions of the Act relating to overcrowding were in force was fixed by the Minister of Health for 1st January, 1938. As from that date the effect of the Act is to make overcrowding as defined above illegal in the Borough under the following circumstances:— (a) If a house or part of a house having become empty, is let so as to be overcrowded ; (b) If overcrowding continues after suitable alternative accommodation has been offered. 56 HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. Metropolitan Borough of ST. PANCRAS. Size of family ("equivalent number" of persons). Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Totals of Families. . *0 *½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over. Overcrowded. Not Overcrowded. Total. 1 - - 235 4,244 2,180 1,743 664 2 642 19 103 - 219 3 6 5 42 - - 28 - - 17 - 1 - 6 - 10,168 10,168 1½ - - 35 10 49 50 34 - 15 - 4 - 4 - - - 2 - - - - - - - - - - 35 168 203 2 - - 31 102 †1,342 4,377 2,186 1 3,027 121 725 4 1,212 17 25 86 263 8 5 123 8 - 45 1 3 - 34 1172 13,574 13,746 2 ½ - - 2 101 149 34 1,590 1 830 57 317 4 223 2 8 21 55 1 - 24 1 - 1 - - - 10 252 3,179 3,431 3 - - 1 52 121 48 2,228 2 2,065 121 822 11 1,358 46 77 189 401 9 6 220 18 - 61 - 2 1 54 222 7,691 7,913 3½ - - - 19 16 368 364 4 480 27 220 3 272 8 13 41 75 - 4 34 1 - 16 - - - 4 767 1,202 1,969 4 - - 1 12 12 483 452 5 55 131 877 7 1,005 55 108 222 426 13 17 227 17 2 69 3 4 - 47 965 3,285 4,250 4½ - - - 1 9 133 130 3 14 18 206 5 174 9 25 44 61 3 8 37 3 - 6 - - 1 4 290 604 894 5 - - - 4 - 153 163 3 23 55 445 14 603 28 64 145 299 13 6 190 15 1 59 2 6 - 36 401 1,926 2,327 5½ - - - 3 3 53 49 - 106 9 71 2 136 15 14 35 49 5 2 31 8 - 10 - 2 - 8 294 317 611 6 - - - - 1 43 48 - 152 13 119 4 23 43 63 139 184 15 12 150 18 2 48 5 6 - 39 380 747 1,127 6½ - - - - 1 33 16 - 49 2 44 1 9 13 19 44 35 4 4 27 5 - 11 1 - - 3 155 166 321 7 - - - 1 - 18 13 1 39 4 37 9 22 17 34 65 87 8 9 62 9 3 47 1 3 1 31 161 360 521 7½ - - - 1 1 7 4 - 28 6 18 1 5 3 15 25 16 2 1 11 5 - 10 - 1 - 4 89 75 164 8 - - - - - 2 2 - 25 4 17 - 52 1 15 15 5 6 6 53 8 4 20 - 5 1 41 133 149 282 8½ - - - - - 5 - - 3 - 5 - 19 - 4 5 3 2 2 10 3 1 5 - 2 - 4 44 29 73 9 - - - - - 1 1 - 7 - 4 - 13 3 4 8 2 1 3 16 6 1 11 3 4 - 9 44 53 97 9½ - - - - - - - - 3 - - - 5 - - 3 - 1 2 1 1 2 6 1 1 - 4 14 16 30 10 - - - - - - - - 2 - 1 - 7 - 2 1 - - 2 2 4 - 8 - - - 7 17 19 36 10½ - - - - - - - - 2 - - - 3 1 - - 4 - - - - - 3 1 - 1 - 10 5 15 11 - - - - - 1 - - - - 1 - 3 - - 1 2 - - - - - 1 - - - 3 8 4 12 11½ - - - - - - - - - - - - 1 - - - 2 1 - - - - - 1 - 1 1 4 3 7 12 - - - - - - - - 2 - - - - - - - 1 - - - - - - - - - 6 3 6 9 12½ - - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - 2 - 2 13 & over - - - - - - - - - - - 1 - - - - - - - - - - 1 - - - - 2 - 2 TOTAL OF OWELLINGS OVEROROWDED - - 70 296 †352 1,348 1,242 12 455 93 317 16 139 25 40 33 15 3 4 3 - - 1 - - - - †4,464 NOT OVER CROWDED - - 235 4,254 3,541 6,204 6,702 10 7,114 494 3,719 50 5,229 239 456 1,061 2,000 89 85 1,244 130 16 454 19 40 6 355 43,746 TOTAL - - 305 4,550 3,893 7,552 7,944 22 7,569 587 4,036 66 5,368 264 496 1,094 2,015 92 89 1,247 130 16 455 19 40 6 355 48,210 *0 = a dwelling of 1 room under 50 square feet ½ = a dwelling of 1 room between 50 and 70 square feet. † Including 39 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. Note:—The families recorded on the left of the thick diagonal line are all overcrowded, and the worst cases of overcrowding are those furthest from the line. The families recorded on the right of the line are those not overcrowded. Persona dwelling in overcrowded dwellings. 20,712. 57 The following table shows the number of families in each Ward ascertained in the course of the Housing Survey, 1935, to be overcrowded and not overcrowded. Ward. Area. Families and Dwellings. Total. Overcrowded. Not Overcrowded. 1 (8) Brookfield 504 (5.79 %) 8220 8724 2 (3) Grafton, Maitland 549 (11.1%.) 4396 4945 3 (7) Bartholomew, Camden and College 663 (6.94 %) 8893 9556 4 (6) Chalk Farm, Hawley and Castle 550 (8.82 %) 5685 6235 5 (5) Mornington, Euston, Regent's Park 669 (9.7%) 6231 6900 6 (1) Oakley, Ossulston 627 (16 %) 3301 3928 7 (2) Endsleigh, Whitfield 240 (12.28 %) 1715 1955 8 (4) Argyle, Burton, Mecklenburgh 623 (10.44%) 5344 5967 4425 (9.18%) 43785 48210 +39* -39* 4464 (9.26 %) 43746 Notes—(1 Percentage of overcrowing to Total is in italics, (2) In certain Wards a, number of streets have been specially excluded. Insufficient accommodation to secure proper sex separation, and for that reason overcrowded. 58 HOUSING CONDITIONS. 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, largely as a result of neglect and hard wear, and partly as a result of the manner in which they are now let, conform to modern standards. 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, 1936. (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 9, Housing Act, 1936). (e) Demolition of such houses when reconditioning cannot be done at reasonable cost (Section 12, Housing Act, 1936). Facilities tor rehousing. The London County Council provide facilities for rehousing accommodation upon their estates for families displaced by Metropolitan Borough Councils under the provisions of the Housing Act, 1936. 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. The following table shows the number of families accommodated under this arrangement:— 1934 1 1935 13 1936 8 1937 13 59 UNDERGROUND ROOMS. The following are the particulars of action taken during the year in respect of underground rooms:— No. of Closing Orders on separate rooms or tenements for human habitation 278 No. of rooms the use of which has been discontinued for human habitation 141 No. of families accommodated elsewhere as a result of these notices by:— London County Council 11 St. Pancras Borough Council 29 No. of rooms vacated by own efforts or not used for human habitation by re-arrangement 88 No. of underground rooms rendered fit for human habitation 60 I have to thank the Medical Officer of Health concerned for information regarding a decision in the West London County Court that has an important bearing upon the Underground Room Regulations, which was obtained by the Hammersmith Borough Council. Briefly, the decision was as follows:— An appeal had been lodged against a Closing Order placed upon a back basement room, the appellant holding that, as the floor of this room was only 1 ft. 3 in. below the level of the garden adjoining, the room was not an underground room within the meaning of the Act. After hearing Counsel the Judge ruled that to take a room out of Section 12 Sub-section 2 it must not fall within either of the provisions, i.e., the floor must not be more than 3 ft. below the street and must not be more than 3 ft. below the surface of any ground within 9 ft. The effect of this ruling is that where the byelaws are applicable to front basement rooms they are also applicable to the back basement room in the same house. HOUSING INSPECTOR. The following report upon the work he has carried out during the year is submitted by Mr. Walker, Housing Inspector. I am pleased to report the progress on the working of Section 9, of the Housing Act, 1936. A summarised table is given below. It will be seen that the number of Notices served during 1937 was slightly lower than in 1936. Two factors account for this. In the first place the Public Health Committee ordered a complete survey of the Borough for housing purposes. This I undertook in conjunction with my other duties, and it took a considerable amount of my time. 60 Futhermore, clearance area work was rather prominent during this year, and the following areas were surveyed:—Cobourg Street, Whitfield Place, Stucley Place and Stibbington Street. With the exception of the Cobourg Street area, the Ministry confirmed the orders. In the case of the Cobourg Street area, after the work on this area had been completed, the London County Council decided to take action themselves and it is still awaiting action on their part. In the work under Section 9, the notices have generally been carried out satisfactorily. An attempt was made during the year to better the living conditions of the existing stable dwellings in the borough. Most mews were inspected and through ventilation is being secured mostly on a voluntary basis and many meetings between owners have taken place with the view of helping them to improve this class of dwelling. Summary of Work for 1937. 1937. 1936. Notices of Intention to survey, issued under Section 157 of the Housing Act, 1936, and served upon owners and occupiers 585 692 Surveys made under the Housing Acts 341 353 Specifications or Schedules prepared for the purposes of Statutory Notices under Section 9 of the Housing Act, 1936 172 234 Specifications agreed upon between the Council and owners without service of notices 35 69 Re-inspections of above 2175 2573 CLEARANCE ORDERS. The following shews the position as regards Clearance Orders:— Date. Site. Position at the End of the Year. Those made during the year: 4th November Stibbington Street Submitted to Minister of Health for confirmation. do. Stucley Place do. do. Whitfield Place do. NOTE —Cobourg Street area was represented to the Ministry, but is being dealt with by the London County Council. Those made previously: 26th Aug., 1935 College Mews Demolished. 13th Feb., 1936 Erskine Mews ,, do. Roberts Mews, No. 1 ,, do. Fitzroy Mews ,, do. Hargrave Place ,, do. Hawley Mews ,, 61 WORK OF THE ESTATES COMMITTEE OF THE BOROUGH COUNCIL. The following account of the principal matters dealt with during the year has been furnished by Mr. W. C. W. Roworth, 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 of houses for the working classes; and to deal with such other "matters as may be referred to the Committee by the Council." The dwellings controlled by the Committee comprise:— (a) Goldington Buildings, Great College Street (56 flats). (b) Flaxman Terrace Dwellings, Euston Road (84 flats and Caretaker's Lodge). (c) Prospect Terrace Dwellings, Gray's Inn Road (71 flats). (d) Una House, Prince of Wales Road (64 flats). (e) The Brookfield Estate, Highgate (113 flats, 90 maisonettes and 2 houses). (f) Somers Town Estate (146 flats), consisting of Aldenham House (26 flats), Wolcot House (18 flats), Johnson House (30 flats), Gladwin House (18 flats), Clarendon House (36 flats), and Morland House (18 flats). (g) Barnes House, Camden Road (22 flats). (h) Kennistoun House, Leighton Road (64 flats). (i) 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) Cobden House, Arlington Road (55) flats. (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. (u) Oak House and Wellington House, East Finchley. (v) 287 and 289, Camden High Street. 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 87 changes of tenancies in the Council's properties. Leighton Road Site. The scheme submitted by the Council's Architect, Mr. A. J. Thomas, f.r.i.b.a., and approved by the London County Council, provides for the erection of 6 one-room, 2 two-room, 16 three-room, 68 four-room and 6 five-room tenements, a total of 98 flats, consisting of 360 62 rooms. A contract to carry out the work has been entered into with Messrs. M. J. Gleeson, Ltd., in the sum of £71,489 14s. 7d. The total cost of the acquisition of the site was £11, 179 19s. 6d. Provision has been made for a transformer sub-station to be constructed for the purpose of affording supplies of electricity to the estate and the immediate neighbourhood. The Hats are in course of construction and will afford accommodation for persons displaced from unfit property by the Council's Orders. Queen's Crescent Site. This site of approximately two acres was acquired from the Journeyman Tailors' Benevolent Institution. A faculty authorising the demolition of the chapel was granted by the London Consistory Court on condition that the chapel site should never be built upon and that it should be delineated and a suitably inscribed tablet placed upon it. The scheme submitted by the Council's Architect, and approved by the London County Council, provides for the erection of 8 one-room, 1 two-room, 99 four-room and 31 five-room tenements, a total of 139 flats comprising 561 rooms. A contract to carry out the work has been entered into with the Parker Construction Co., Ltd., in the sum of £100,191. The cost of the acquisition of the site was £18,000, excluding legal charges. Provision has been made for the erection of a transformer sub-station for the purpose of affording supplies of electricity to the estate and the immediate neighbourhood. The site was vacated in October, 1937. The building is in course of construction and will afford accommodation for the relief of overcrowding in the Borough. The Minister of Health has approved the dwellings for this purpose and the appropriate Exchequer contribution will be made. Camden Park Road Site. The scheme submitted by the Council's Architect, and approved by the London County Council, provides for the erection of 3 two-room, 10 three-room, 67 four-room and 15 fiveroom flats, a total of 95 tenements comprising 379 rooms. A contract to carry out the work has been entered into with Messrs. A. P. C. Wray, Ltd., in the sum of £66,221 15s. 11d. The cost of the acquisition of the site was £10,250, excluding legal charges. Provision has been made for the erection of an electricity transformer sub-station to serve the estate and the immediate neighbourhood. The flats are in course of construction and the accommodation will be utilised either for rehousing persons displaced from insanitary property by the Council's Orders, or for relieving overcrowding in the Borough. Ferdinand Place Estate. Powlett House, a block of 18 flats, was occupied in July, 1937, and completes this estate of 111 dwellings. The amenities of the estate have been improved by the development as a garden space of the piece of land lying between Harmood House and the London Passenger Transport Board garage in Harmood Street. Flowering shrubs and trees have been planted with paved surrounds, Cobden House, Arlington Road. The estate erected on the site of Nos. 1-8 (consecutive inclusive), Carlow Street, 1-7 (consecutive inclusive), Nelson Street and 12-26 (even inclusive), Arlington Road, which was 63 the subject of a compulsory purchase order made by the Council, has been named "Cobden House." It will comprise 4 two-room, 2 three-room, 43 four-room and 6 five-room tenements, a total of 55 dwellings and will be ready for occupation shortly. It will be utilised to rehouse families displaced by the Council's Orders from unfit property. The following scale of weekly rentals has been adopted: Nett. Inclusive. s. d. s. d. 2-roorn flats 8 0 11 3 3 „ „ 9 3 13 2 4 „ „ 10 6 15 1 5 „ „ 11 0 16 4 Denyer House. Proposals submitted by the Borough Engineer and Surveyor in consultation with the Architect for the widening of the existing; footway on the south side to provide an improved vehicular road to the estate direct from Highgate Road are being carried into effect. The piece of land fronting the estate has been handed over to the Works Department, who will lay it out as an open space. Somers Town Extension. The small extension of the Somers Town Estate on the site of Nos. 32, 33 and 33a, Johnson Street was completed in September, 1937. The rentals of the three and four-room flats were fixed on the same basis as those obtaining on the Somers Town estate generally, and the weekly rental of the five-room flats was fixed at 13s. net (18s. 3d. inclusive). The Minister of Health has approved the four flats for the purpose of providing accommodation for the abatement of overcrowding. The Exchequer contribution will be £19 per flat per annum for 40 years, and the rate contribution £9 10s. per flat per annum for 40 years, of which the London County Council have agreed to contribute one-half. The fried fish shop included in the extension scheme has been let on a seven years' lease to the tenant of the fish shop which formerly stood on the site. BrookField Estate. Part of the land at the rear of the block of flats at 74, St. Alban's Road has been allocated, with the consent of the Minister of Health, to the Electricity Undertaking as a site for an electricity transformer sub-station. 287 and 289, Camden High Street. The Council have acquired these premises, together with the garage at the rear, in connection with the proposal to erect a new refuse destructor. Since the property, in which there are various weekly and monthly tenancies, will not be required for demolition in the immediate future, it is being managed by the Estates Committee until such time as it is required for redevelopment. 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 64 arrangement between January, 1925, and December, 1937, is 1,099. 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 Borough. The Borough Council have now developed ten housing estates in the Borough, with a total of 867 flats, comprising 2,857 rooms, exclusive of kitchens, etc. The Carlow Street Estate will be ready for occupation early in 1938. Leighton Road, Queen's Crescent and Camden Park Road schemes are in course of development. The London County Council have erected 108 flats on their Ossulston Estate, and have 35 flats in course of erection in Chalton Street. The Commissioners of Crown Lands have completed 128 tenements during the year in the Cumberland Market area and have a further 22 flats in course of erection. During the year the St. Pancras House Improvement Society, Ltd., have erected 78 flats in Somers Town (St. Michael's Flats and St. Anthony's Flats) and 49 flats in Kentish Town (Priestley House and Leonard Day House). At the end of the year 120 flats were being built at York Rise by the London, Midland and Scottish Railway Co., to be leased to the Society on completion. Three blocks of working-class dwellings (54 flats in all) were erected in Cromer Street by the East End Dwellings Co., Ltd, Section VI. 65 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. Capel 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. Capel.* Total. †Number of Visits to:— Milkshops 252 360 612 Dairies 275 359 634 IceCream Premises 274 283 557 Slaughter Houses 14 130 144 Butchers' Shops and Meat Stalls 331 482 813 Prepared Meat Premises 128 135 263 Fishmongers' Shops 107 43 150 Fried Fish Shops 174 214 388 Fish Curers' Premises 27 58 85 Other Premises where Food or Drugs are sold 117 83 200 Marketing Streets and Places 1901 520 2421 Attendances at Police Court 1 10 11 Other Visits 338 351 689 Total 3939 3028 6967 Number of Samples taken: — Formal 200 200 400 Informal 200 200 400 Bacteriological 40 46 86 Total 440 446 886 Unsound Foods. Surrenders:— Meat. &c. 11 36 47 Fruit 4 — 4 Fish 11 4 15 Bacon 3 11 14 Chicken 2 2 4 Vegetables 1 2 3 Nutter — 1 1 Groceries 3 1 4 Total 35 57 92 Seizures:— — — — *Owing to sickness Mr. Nixon was absent from duty for 11 weeks. During this time assistance was rendered by Messrs. Winchester and Warren, and figures of the work done by these Inspectors may be seen on page 40. Mr. ???apel commenced duties as food Inspector in March. †These visits do not include visits made for the purpose of taking samples. MILK SUPPLY. The production, distribution and standards of purity of the various grades of milk sold under special designations are governed by powers contained in the Milk and Dairies (Amendment) Act, 1922, the Milk (Special Designations) Order, 1936, and the Milk Act, 1934. 66 Cowsheds. There are no licensed cowsheds in the Borough. Dairies and Milkshops. The Milk and Dairies Order, 1926, requires the Sanitary Authority to register all persons in their district carrying on the trade of cowkeeper or dairyman, and also all premises which are used as dairies. The term "dairy" does not include a shop from which milk is 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 receptacles 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. Sixteen applications for registration under the Milk and Dairies Order, 1926, were granted during the year. Four 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 (Itinerant). Number on register at end of 1936 187 62 Number removed from register during 1937 12 7 Number added to register during 1937 16 4 Number on register at end of 1937 191 59 In addition to the above, six persons (firms) were also on the register at the end of 1937 in respect of premises at which retail trade in cream is conducted. Milk in Sealed Containers. During the year 63 persons were registered to sell milk in sealed containers, and 57 were removed from the register. At the end of the year there were 238 persons on this register. Milk Sampling out of Office Hours. Requests are received from time to time from other Metropolitan Boroughs for early morning samples of milk to be taken by the Food Inspectors at railway stations within St. Pancras. The Milk and Dairies (Consolidation) Act, which came into force on September 1st, 1925, provides for this duty, and Section 8 (4) of the Act states: "The Authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, the amount whereof shall, in default of agreement, be settled by the Local Government Board [Ministry of Health]." 67 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 three, for which purpose one visit was made. The fees were handed to the inspectors concerned in accordance with a resolution of the Council. Milk (Speciai, Dksignations) Order, 1936. The Milk (Special Designations) Order, 1936, came into force on 1st June, 1936, and introduced certain changes in regard to the titles of and standards of purity of designated milk. This Order comprises the following:— "Tuberculin Tested"; "Accredited"; "Pasteurised" Milk. Particulars as to the number of licences and the samples taken for bacteriological examination under this Order during' 1937 are contained in the following table:- Samples. Grade for which licence was issued. No. of licences 31st Dec., 1937. No. complying with standard. No. below standard. Total samples. Tuberculin Tested 36 4 — 15 Accredited 6 — — 3 Pasteurised 111 38 4 69 Unremitting care on the part of all engaged in its production and distribution is essential if the standards of purity of designated milk are 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 12 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 1s. a gallon. This cheap price applies only to milk actually drunk as a beverage by children in the schools. The particulars relating to this Scheme were given in the London County Council Gazette of the 24th September, 1934, as follows:— 1.—Milk must be "pasteurised" milk, labelled as such. 2.—The borough medical officers of health will supply, on request, a list of registered sellers of pasteurised milk in their areas. 3.—Head teachers are asked in return to notify the borough medical officer of health of the name of the vendor whom they have chosen. 4.— Samples of the milk supplied will be taken from time to time by borough medical officers of health. 68 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 58 were taken from schools in the Borough and submitted to bacteriological examination, the result in 56 cases being satisfactory. In the remaining two instances the li???nsees' 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 food. 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 He-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 65. 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. Fish. Cockles, 5 gallons. Cod, 5 stones. Cod, filleted, 7 stones 8½ lbs. Dabs, 3 stones. Eels, 8 stones. Haddocks, 12 stones. Herrings, 33 stones. Kippers, 14 stones. Mackerel, 10 stones. Plaice, 8 stones. Rock Salmon, 10 stones 2 lbs. Salmon Trout, 3. Sardines, 100 tine. Skate, 1 stone. Wet, various, 40 lbs. Fish paste, 2 bottles. Shrimps, canned peeled, 135 lbs. Meat. Beef, 3½ lbs. „ filleted, 2 loins. „ corned, 12 lbs. ,, rumps, 2 lbs. Lamb, best end, 5½ pairs. ,, stewed, 1 tray. Mutton, ½ loin and 1 leg. Pigs' Heads, 18. ,, Livers, 3 7. Sheep's Livers, 4 69 Meat—coutinued. Sheep's. Lungs, 4 8 pairs. pigs ,, 4 Pigs' Mesenteries, 18. Pork, 9 lbs. ,, Canned German, 218 lbs. Steak, filleted, 1 tray. Meat Pies, 13. Veal and Ham Pie, ½. Sweetbreads (lamb), 10 lbs. Sausages, canned, 12 cwts. 40 lbs. and 18 tins. Fruit. Apples, 25 boxes. Pears, (3 boxes) 294 lbs. Raspberries (50 barrels), 1¾ tons. Fruit Salad, canned, 2 tins. Goods, bottled and canned, 6 cases and 2,800. Dried Goods, 4¼ cwts. Vegetables. Asparagus, 6 bundles. Beetroots, 230 bags. Cucumbers, 12 tins. Spinach, 1 box. Butter, 1 lb. Bacon, 217¾ lbs. Ham, 14 lbs. Chickens, 7. Merchandise Marks Act, 1926. Under Section 2 certain imported goods may not be exposed for sale unless they bear an indication of origin. Orders in Council have been made under this Act in regard to honey, fresh apples, currants, sultanas, raisins, eggs in shell, dried eggs, oat products, raw tomatoes, frozen and chilled salmon and trout, butter, bacon, ham, dead poultry, maize starch, and all imported meats and offals. Such of the requirements of these Orders as are enforceable by the Borough Council were observed by the Food Inspectors in the ordinary course of their duties. Agricultural Produce (Grading and Marking) Acts, 1928 and 1931. The Minister of Agriculture and Fisheries has made Orders under this Act prescribing grade designations of certain agricultural produce of England and Wales to indicate the quality of the articles. Goods marked mast conform to the standards laid down by the regulations. The Food Inspectors supervise in the ordinary course of their duties such of the requirements of these Regulations as are enforceable by the Borough Council. 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, Highgate High Street), 166, Great College Street and 65, Osnaburgh Street. No slaughtering takes place at the latter premises. 70 Particulars regarding these slaughter-houses and their inspection, for the purpose of which 144 visits were made, are contained in the following table, as required by the Ministry of Health:— Animals. Post Mortem Inspections. Condemnations. No. of killings. Carcases. Organs. T.B. Other diseases. T.B. Other diseases. Sheep and Lambs 189 — — — 8 189 Pigs 315 17 (heads) 1 (head) 21 4 315 Registration, etc., of Slaughter-houses. By the Transfer of Powers (London) Order, 1933, the registration, licensing, and inspection of slaughter-houses were transferred to the Borough Council. The licences expire on the 31st October in each year. Applications for the renewal of licences should be made by the holder 14 days prior to the licensing meeting, and notification of the date of the meeting, and of the necessity for making application, if renewal is desired, should be sent to each holder. Any objection to the granting or the renewal of a licence should be made in writing at least 7 days before the date of the licensing meeting. A fee of 5s. is payable in respect of a slaughter-house licence. The Public Health Committee have been authorised to act on behalf of the Borough Council as the Licensing Authority at the Committee meetings to be held in October, and the necessary notices giving the day and time of the meeting will be served on the persons concerned. Licensing of Si.aughtermen. Applications for licences for slaughtermen under the provisions of the Slaughter of Animals Act, 1933, were received from five persons in respect of the three slaughter-houses. The Council's Inspector reported in each case that, in his opinion and from personal observation of the applicant's work, he was a fit and proper person to act as a slaughterman and the licences were granted for one year ending 31st October, 1938. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. 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 65. No prosecutions were undertaken during the year in question. Fried Fish and Fish Curing Premises. In 1937 there were 74 fried fish vendors' premises in the Borough, at 7 of which fish curing was also carried on. There were 23 fish curers' premises, including the 7 above mentioned. Visits made by the Food Inspectors to these premises during the year totalled 473. 71 Registration of Premises for Sale, etc., of Ice Cream and Preserved Food. Section 187 of the Public Health (London) Act, 1936, states that "any premises used or proposed to be used for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale shall be registered by the owner or occupier thereof with the Sanitary Authority." Any person offending is liable to a penalty. The section above mentioned does not apply to any premises used as a Hotel, Restaurant or Club. This registration is for the purpose of information and to facilitate inspection by officers of the Borough Council. The Sanitary Authority may refuse to register any premises, or may remove from the register any premises which they consider unsuitable, but notice of such intention must be served upon the person concerned, who will have the right to appear before the authority. A right of appeal to a court of summary jurisdiction against the decision of the Sanitary Authority is provided for, with a further appeal to quarter sessions by either party. The total number of premises on the register of the department at the end of the year was 354. Bakehouses and Restaurant Kitchens. At the end of 1937 there were 150 bakehouses on the register, as compared with 148 at the end of 1936. These bakehouses are classified in the following table:— Factory Bakehouse. Workshop Bakehouse Not in Use. Total. Above ground 30 2 11 43 Under ground 52 8 47 107 150 As a result of 732 inspections which were made during the year, 74 notices were served for the cleansing of walls and ceilings. At the end of the year 304 restaurant kitchens were on the register, in respect of which 1078 inspections were made, and 26 notices served. Bakehouses and restaurant kitchens are supervised by the Factory and Workshop Inspectors. Further particulars will be found on pages 49 to 52. 72 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Analyses of 800 samples have been made under this Act, of which 399 were formal and 401 informal. Of the formal, 389 proved to be genuine, and 10, or 2.5 per cent., adulterated; and of the informal, 392 were genuine and 9, or 2.2 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Almonds (ground) — 1 — 1 — — Ammon Tinct. Quinine — 1 — 1 — — Apples (canned) — 1 — 1 — — Arrowroot — 1 — 1 — — Aspirins — 1 — 1 — — Bacon — 1 — 1 — — Barley — 1 — 1 — _ Beef — 1 — 1 — — ,, (corned) — 1 — 1 — — Brawn — 1 — 1 — — Butter — 69 — 69 — — Cake (fish) — 1 — 1 — — Cheese — 2 — 2 — — Cherries (canned) — 1 — 1 — — Chocolate (Brazil Milk) — 1 — 1 — — Cocoa — 9 — 9 — — Coffee — 2 — 2 — — Coffee and Chicory — 2 — 2 — — Cornflour — 1 — 1 — — Crab (canned) — 1 — 1 — — Cream (horseradish) — 1 — 1 — — Cream — 7 — 7 — — ,, (canned) — 6 — 6 — — ,, (salad) — 1 — 1 — — Currants — 5 — 5 — — Damsons (canned) — 1 — 1 — — Dripping — 4 — 4 — — Essence (almond flavouring) — 1 — 1 — — Figs (Compound Syrup of) — 1 — 1 — — Flour (self-raising) — 3 — 3 — — Fruit Cake — 1 — 1 — — Ginger — 8 — 8 — — Ginger (ground) — 2 — 2 — — Glycerine — 5 — 5 — — Herrings (canned) — 1 — 1 — — Honey — 3 — 3 — — Horse Radish (evaporated) — 1 — 1 — — Iodine, tincture — 2 — 2 — — Jam — 4 — 4 — — Jelly — 1 — 1 — — Kipper Snacks (canned) — 2 — 2 — — Lard — 10 — 10 — — „ substitute — 1 — 1 — — Lemonade Crystals — 4 — 4 — — Lemon Cheese — 1 — 1 — — Magnesia 1 3 1 2 — 1 Margarine — 3 — 3 — — Meat (minced) 2 12 — 10 2 2 Meat, Sausage — 1 — 1 — — Milk 385 1 380 1 5 — ,, Condensed, S.S. — 5 — 5 — — Carried forward 388 200 381 197 7 3 73 Articles of food of which samples have been taken Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 388 200 381 197 7 3 Milk, Condensed S.F.C. — 1 — 1 — — ,, Evaporated F.C. — 2 2 — — Milket — 1 1 — — Mincemeat 2 8 — 6 2 2 Mint, dried — 1 — 1 — — Mustard — 3 — 3 — — , , (Compound) — 1 — 1 — — Oatmeal — 1 — 1 — — Oil, Camphorated — 5 — 5 — — „ Castor .. — 8 — 8 — — ,, Olive .. — 2 — 2 — — „ Cod Liver — 1 — 1 — — Ointment, Zinc — 1 — 1 — — Oranges, Canned — 3 — 3 — — Paste, Fish — 6 — 6 — — ,, Meat — 2 — 2 — — Peaches, Canned — 1 — 1 — — Pears (Dried) — 1 — 1 — — „ (Canned) — 1 — 1 — — Peas ( ,, ) — 5 — 5 — — Peel Candied — 1 — l — — Pepper — 19 — 19 — — Pickles — 2 2 — — Pie, Meat 2 2 — — „ Veal and ham — 1 — 1 — — Pilchards, Tomato Sauce 1 — 1 — — Pineapple (Canned) — 4 — 4 — — Plums, Canned — 1 — 1 — — Powder, Baking — 1 — 1 — — „ Custard — 1 — 1 — — ,, Boracic — 1 — 1 — — ,, Gregory's — 1 — 1 — — ,, Seidlitz — 1 — 1 — — Prawns, Bottled — 1 — 1 3 — — Rice — 3 — — — Roll, Sausage — 1 — 1 — — Sago — 1 — 1 — — Salad, Fruit (Canned) — 1 — 1 — — Salmon (Canned) — 4 — 4 — — Salts, Epsom — 7 — 7 — — Sardines — 16 — 16 — — Sauce — 6 — 6 — — „ (Tomato) — 1 — 1 — — ,, Mint Sausage, Cooked — 1 — 1 — — — 1 — 1 — — Sausages 2 28 2 27 — 1 „ (Preserved) — 1 — — — 1 ,, Beef — 2 1 — 1 Savaloy — 2 2 — — Sild — 3 — 3 — — Soft Roes (Canned) — 1 — 1 — — Spice, Mixed — 2 — 2 — — Suet — 1 — 1 — — Sugar — 12 — 12 — — Sulphur, Flowers of — 1 — 1 — — Sultanas — 1 — 1 — — Sweet Corn (Canned) — 1 — 1 — — Carried forward 392 388 383 380 9 8 74 Articles of food of which samples have been taken. ■ Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward Sweets 392 388 383 380 9 8 Tapioca — 1 — 1 — — Vegetables (Canned) — 1 — 1 — — Vinegar 1 1 — — 1 1 Malt 1 5 1 5 — — Non Brewed 5 1 5 1 — — Water, Lemon Barley — 1 — 1 — — Totals 399 401 389 392 10 9 Summonses. Prosecutions wore undertaken in respect of four samples, which were reported as being adulterated. The results ot the proceedings are stated in the following table:— Article. Result of Analysis Date of Hearing. Result of Proceedings. Food and Drugs (Adulteration) Act, 1928. Penalty. Costa. Milk Deficient in milk-fat 18 per cent. 1937. £ s. d. 28th April Dismissed under Probation of Offenders Act 2 2 0 ,, ,, ,, „ 166 „ 21st June ,, — ,, Containing at least 3 4 per cent of added water 11th Aug. Fined £3-3-0 — Vinegar Deficient in Acetic Acid 26.5 per cent 17th June Fined 30/- 0 10 0 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 four were found to contain proportions of preservatives contrary to the standards. These samples (all minced beef) had been taken formally and the Committee decided to send a cautionary letter to the vendor in each case. There were no prosecutions. I have to thank Mr. J. 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 1937, 800 samples were submitted for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 400 having been purchased with the required formalities and 400 obtained informally. 76 Of this total, 19 (2.4 per cent.) proved to be adulterated, 10 being samples submitted formally and 9 informally. Last year 30 (3.8 per cent.) were so certified, 14 being submitted formally and 16 informally. The adulterated articles consisted of Magnesia, Milk, Minced Meat, Sausages, and Vinegar. Milk.—Three hundred and eighty-one samples of milk were examined and five (1.3 per cent.) fell below the limits required by the lioard of Agriculture Regulations— 3.0 per cent. of fat and 8.50 per cent. of non-fatty solids—and were certified to bo adulterated. Three of the adulterated samples were deficient in fat, the amount in each case being at least 5.0, 16.6 and 18.0 per cent. respectively, and to the two remaining adulterated samples, water had been added to the extent of at least 2.1 and 3.4 per cent. respectively. Although the number of samples of milk examined was considerably more than last year, those which fell below the modest requirements of the Board of Agriculture limits were only five—less than half the number so certified last year. In the table given below, prepared by the Publie Health Department, the results oi the genuine milks are set out month by month and compared with the two previous years taken from a similar table introduced in the last Annual Report. Monthly Variation of Chemical Composition or Genuine Milk during the Years 1935, 1936 and 1937. Month. Number of Samples Examined. Genuine. Fat per cent. Average. Non-fatty Solids per cent. Average. 1935 1936. 1937. 1935. 1936. 1937. 1935. 1936. 1937. January 44 14 10 3.5 3.6 3.6 8.97 9.10 9.02 February 32 32 14 3.5 3.6 3.6 8.74 9.10 8.92 March 51 44 29 3.3 3.5 3.5 8.81 9.00 8.88 April 29 23 49 3.3 3.5 3.4 8.75 8.93 8.89 May 29 24 32 3.7 3.5 3.3 8.84 9.02 8.82 June 34 15 62 3.5 3.3 3.3 8.88 9.01 8.84 July 19 48 20 3.4 3.4 3.4 8.96 8.93 8.83 August 14 36 35 3.4 3.4 3.4 8.77 8.95 8.89 September 30 31 34 3.6 3.7 3.7 8.87 9.03 9.06 October 46 30 25 3.7 3.7 3.6 8.93 9.11 9.05 November 31 16 48 3.6 3.8 3.8 9.02 9.06 9.04 December 19 6 23 3.6 3.8 3.6 9.06 9.07 8.86 Whole Year 378 319 381 3.5 3.6 3.5 8.89 9.03 8.93 It will be noted that the average composition of the milk supply was well maintained. Magnesia.—The sample of magnesia certified to be adulterated consisted entirely of magnesium carbonate and not of the oxide which was desired. 76 Minced Meat—Twenty-two samples of minced meat were submitted, and of these no less than eight (36.3 per cent.) were found to contain sulphite preservative. In four of these, informal samples were first purchased and when the preservative was found, a formal sample was subsequently obtained. In each case the sulphite was again found, rather indicating that the vendors were in the habit of adding this preservative to their meat contrary to the Regulations. In these days when effective refrigerators are available it is very desirable that the indiscriminate use of preservative should be stopped. Sausages.—Three samples of sausages were found to contain sulphite preservative and although one of them was sold as "Preserved Sausages" it contained no less than 604 parts per million of sulphur di-oxide, or 154 parts per million in excess of the limit laid down by the Preservatives Regulations for "Preserved Sausages," and when proper notice is given to the purchaser. Another instance of the haphazard methods of using preservatives. Vinegar.—Both the samples of vinegar certified to be adulterated were deficient in acetic acid In the case of one sample, obtained informally, the deficiency was 25.0 per cent. and on purchasing a formal sample from the same vendor some days afterwards, the deficiency was 26.5 per cent. Vinegar should contain at least 4.0 per cent. of acetic acid. It is interesting to note that the term ''vinegar" has been held to mean "malt vinegar" unless it is properly described in some other manner. Sardinet.—In the last report attention was drawn to the presence of large quantities of lead in certain samples of sardines. It is satisfactory to be able to report that none has been certified during the year under review. Until recently the limit of lead allowed was 20 parts per million, but the Port Authorities have now decided to reduce this quantity to five parts per million, and soon propose to return to the country of origin all samples which contain more than mere traces of this metal. Canned Foods.—All the samples of canned foods examined were free from tin or lead, or only contained small traces of these metals. Drugs.—The few samples of drugs examined were all within the limits prescribed and mostly of good quality. Proposed new Legislation.—A Bill has recently been prepared by a Committee to consolidate with amendments, certain enactments relating to Food, Drugs, Markets, Slaughterhouses and Knackers' Yard, a draft of which was presented to Parliament by the Ministry of Health in December, 1937, and is still under consideration. Section VII. Prevalence of, and Control over, Infectious Diseases. 17 Section VII.-PREVALENCE OF, AND CONTROL OVER, NOTIFIABLE DISEASES. The undermentioned diseases are compulsorily 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 Enteric ,, Erysipelas Relapsing „ Scarlet Fever (Scarlatina) Continued „ Puerperal ,, B. Under Special Regulations made by the Ministry of Health granted under powers contained in the Public Health Acts Plague (1900) Cerebro-spinal Fever and Acute Poliomyelitis (1912) Acute Encephalitis Lethargica and Acute Polio-encephalitis (1919) Puerperal Fever and Puerperal Pyrexia (1926, 1928) Ophthalmia Neonatorum (1926, 1928) Tuberculosis (1930); and the Infectious Diseases (London) Regulations, 1927, for Malaria Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia. and wherein Enteric Fever is defined to include the Paratyphoid group of Fevers. C. Under a Special Local Order of the Ministry of Health in 1920 Measles German Measles D. Under a Special Order of the London County Council in 1909 Glanders Anthrax Hydrophobia "when these occur in man." E. Under the London County Council (General Powers) Act, 1932, and the Public Health (London) Act, 1936 Food Poisoning. 78 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 1937. The notifications have not been corrected for any subsequent revision of diagnosis:— DISEASES. NOTIFICATIONS. Total all Ages. Cases admitted to Hospital. Total Deaths. At Ages—Years. Under 1 year. I and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 4 5 and under 65. 65 and upwards. 1. Small-pox — — — — — — — — — — — — — — — 2. Scarlatina or Scarlet Fever 4 16 32 32 40 134 43 19 41 2 1 — 364 348 3 3. Diphtheria and Membranous Croup 9 29 34 40 52 286 76 27 53 4 4 1 614 614 15 4. Erysipelas 2 — 1 1 — — 1 4 10 13 21 11 64 41 2 5. Puerperal Fever — — — — — — 1 11 1 1 — 14 10 — 6. Puerperal Pyrexia — — — — — — — — 28 2 — — 30 21 — 7. Enteric or Typhoid Fever 10 — — — — 4 1 — 2 1 1 1 10 9 1 8. Cerebro-spinal Meningitis 1 1 — 1 — 1 — 2 — — — — 6 6 2 9. Anterior Poliomyelitis and Polioencephalitis — — 1 1 1 1 2 — 2 — — — 8 6 — 10, Ophthalmia Neonatorum 27 — — — — — — — — — — — 27 11 — 11. Encephalitis Lethargica — — — — — — — — — — — — — — 2 12. Acute Influenza and Influenzal Pneumonia 2 1 4 1 3 2 1 5 16 6 23 15 79 59 55 13. Acute Primary Pneumonia 5 5 8 1 3 22 4 11 30 17 31 13 150 123 3 14. Malaria 1 — — — — 1 — — 5 4 5 — 16 16 — 15. Dysentery 1 3 7 3 2 10 4 3 15 15 16 5 84 77 1 16. Measles 28 59 87 80 105 248 14 3 14 — — — 638 200 1 17. German Measles 6 6 10 5 7 35 15 8 26 — 1 1 120 50 — 18. Food Poisoning 1 1 — 1 — 3 3 15 17 10 10 4 65 12 1 10. Continued Fever — — — — — — — 1 — — — — 1 — — *For Pneumonia Deaths, see Tables on pages 33 and 34. 79 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 Borough. I 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1. Small-pox — — — — — — — — — — — — — — — — — — — — 2. Scarlatina or Scarlet Fever 56 34 94 41 52 32 27 28 — 364 — — — 1 — — 1 1 — 3 3. Diphtheria and Membranous Croup 60 100 95 65 99 85 28 82 — 614 — 3 2 2 2 3 — 3 — 15 4. Entericor Typhoid Fever 1 2 — 4 1 — — 1 — 10 — — — — 1 — — — — 1 5. Puerperal Fever 1 2 2 3 2 1 1 2 — 14 — — — — — — — — — — 6. ,, Pyrexia 6 — 6 3 6 5 2 2 — 30 — — — — — — — — — — 7. Erysipelas 10 3 14 7 9 9 3 9 — 64 — 1 — — 1 1 — — — 2 8. Cerebro-spinal Meningitis 1 1 — 1 2 1 — — — 6 — 1 — — 1 — — — — 2 9. Anterior Poliomyelitis and Polioencephalitis 1 1 1 1 3 1 — — 8 — — — — — — — — — — 10. Ophthalmia Neonatorum 4 1 6 6 — 3 2 4 26 — — — — — — — — — 11. Encephalitis Lethargica — — — — — — — — — — 1 — 1 — — — — — — 2 12. Acute Influenza and Influenzal Pneumonia 14 9 10 9 7 10 6 14 — 79 7 7 12 6 8 4 5 3 3 ‡55 13. Acute Primary Pneumonia 26 16 25 14 24 7 10 28 — 150 — — — 1 2 — — — — 3 14. Malaria — — — — — — 16 — — 16 — — — — — — — — — — 15. Dysentery 7 9 8 5 10 5 36 4 — 84 — — — — — — 1 — — 1 16. Measles 80 40 133 96 40 129 50 68 2 638 — — — 1 — — — — — 1 17. German Measles 12 3 14 11 13 34 27 6 — 120 — — — — — — — — — — 18. Food Poisoning 1 — — — 2 — 11 — — 65 — — — — — — — 1 — 1 19. Continued Fever 1 — — — — — — — — 1 — — — — — — — — — — Totals 281 221 408 267 270 321 220 299 2 2289 8 11 15 11 15 8 7 8 3 86 ‡For Pneumonia deaths, see Tables on pages 33 and 34. 80 SMALL-POX. There were no cases notified in St. Pancras during 1937. VACCINATION. 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, 1936. V ACCINATIONS. 1st January to 31st December, 1936. Number. Percentage of Births registered. North. SouthEast. Southwest. Whole Borough North. SouthEast. Southwest. Whole Borough Births registered 380 1963 1335 3678 100.0 100.0 100.0 100.0 Died, unvaccinated 22 106 65 193 5.8 5.4 4.9 5.2 Successfully vaccinated 193 894 592 1679 50.8 45.5 44.3 45.6 Had smallpox — — — — — — — — Insusceptible of vaccination — 8 2 10 — 0.4 0.1 0.3 Received certificate of conscientious objection 151 603 383 1137 39.7 30.7 28.7 30.9 Postponed by medical certificate 1 12 11 24 0.3 0.6 0.8 0.6 Moved to known address in other districts 1 197 123 321 0.3 10.0 9.2 8.7 Lost sight of by removal 8 128 150 286 2.1 6.5 11.2 7.8 Unvaccinated and not accounted for in previous columns 4 15 9 28 1.1 0.7 0.7 0.8 The corresponding figures for the past ten years are as follows:— Year. Births. Successfully Vaccinated. Per cent. Conscientious Objections, and Children otherwise escaping Vaccination. Per cent. 1927 3947 1980 50.2 1285 32.6 1928 4019 1937 48.2 1326 33.0 1929 4223 1936 45.8 1373 32.5 1930 4598 2196 47.8 1523 33.1 1931 4499 2210 49.1 1464 32.5 1932 4263 2006 47.1 1326 31.1 1933 4202 1965 46.8 1312 31.2 1934 4101 1939 47.3 1251 30.5 1935 4045 1632 40.3 1298 32.1 1936 3678 1679 45.6 1165 31.6 81 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, 1937 :— 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 201 18 219 9 „ 2 „ F. L. Pelly 128 12 140 2 Wards 3 and 4 , J. W. Wigg 335 24 359 13 ,, 5, 6, and 7 „ A. E. Tait 301 26 327 6 Ward 8 ,, C. H. Alderton . 123 16 139 13 St. Pancras Hospital ,, W. Feldman 11 _ 11 _ Totals 1099 96 1195 43 SCARLET FEVER. The number of cases notified was 364, as compared with 434 cases during the previous year. It was subsequently ascertained that -31 cases were not regarded as cases of this disease. The actual number of cases was therefore 333. Three deaths occurred; this equals a case mortality of 0-9 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 6 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 eight families there were two such cases, and in one family there were three. DIPHTHERIA. The number of cases notified was 614, as compared with 487 cases during the previous year. It was subsequently reported by the hospital authorities that 114 cases were not regarded as cases of this disease. The actual number of cases was therefore 500. This equals an attack rate of 2-7 per 1,000 of population. 15 deaths occurred, giving a case mortality of 3'0 per cent. Investigation of multiple cases—that is, several cases occurring more or less together in one house — shows that in 26 families there were two such cases, in nine families three such cases and in three families four 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 112 thousand units were provided. 82 Immunization Scheme. The following report is submitted by Dr. P. Y. 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 arrangements 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 £400 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 for this age group. 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 then 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 Schick 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. There are 78 Medical Practitioners on the approved panel. At the end of the year 731 children were reported to have received or to be in the process of receiving immunization under the scheme. During 1937 there were 1073 attendances at the Schick Testing Clinics. 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 eight cases of Para B. Typhoid were notified during the year. Two diagnoses of Typhoid were not confirmed. There was one death. PUERPERAL PYREXIA AND PUERPERAL FEVER. In 1937 there were 30 notifications of Puerperal Pyrexia and 14 notifications of Puerperal Fever. Further details of these diseases are given on page 138 of the Maternity and Child Welfare Section. 83 ERYSIPELAS. 64 cases were notified and 2 deaths occurred, as compared with 81 cases and 7 deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinai. Fever, Meningococcal Meningitis, "Spotted Fever.") Six cases were notified and two died. In one case the diagnosis was not confirmed, and in another case it was revised to Poliomyelitis. ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Eight cases were notified. There were no deaths. This disease, the popular name for which is infantile paralysis, causes paralysis of certain muscles with resulting serious deformity. A very great deal can bo 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 27, and in addition 25 cases of mild inflammation of the eyes were reported. Two cases moved out of the Borough and were lost sight of. Twentv-three cases all recovered satisfactorily, without impairment of vision, but one case resulted in total blindness. Further particulars are given on page 128 of Maternity and Child Welfare Section. ENCEPHALITIS LETHARGICA. No cases were notified during the year. 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 150 notifications of the former and 79 of the latter, during 1937 (as compared with 182 and 46 respectively for 1936). There were 26 deaths from these 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 1937, 35 cases were nursed under this arrangement and 670 nursing visits were paid. MALARIA. 16 cases were notified and there was no 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 15 were in-patients of the hospital for Tropical Diseases, Endsleigh Gardens, and the remaining one was an in-patient of the Middlesex Hospital. The home address of the latter only was in St. Pancras, 84 DYSENTERY. The same rule for the notification of Malaria (as described above) applies to Dysentery. 84 cases were notified during the year, of which one died. 58 of the cases were St. Pancras residents, and the remaining 26 were all in-patients of the Hospital for Tropical Diseases. Bacteriological examinations were made in 72 cases in which the types were : — Sonne, 44 ; Flexner, 2 ; Amoebic, 26 Nine cases were diognosed clinically, one not bacteriologically confirmed, the remaining three were subsequently held not to be Dysentery. 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. Sixty-five notifications were received during the year, and there was one death. Hie following reports were submitted by the Medical Officer of Health :— (a)— " I have to inform you that I have received a report dated 1st September, 1937, from the Deputy Medical Officer of Health concerning a number of cases of food poisoning that occurred in the Borough during August while I was on leave. The first case was reported on Monday, August 23rd, and during the next few days some fifty cases were under observation by the Public Health Department. The cause of the outbreak was food purchased at a shop in the neighbouring Borough of Finsbury, and the Medical Officer of Health of that Borough is preparing a detailed report on the whole matter. There were in all three deaths, of which one was that of a St. Pancras resident. At the inquest upon these cases on the 2nd September, the Coroner said that he was satisfied that the authorities concerned had taken all necessary action to prevent the spread of the outbreak. It will be appreciated that a great deal of work was thrown upon the Department in dealing with an extensive outbreak of this kind during the holiday season, and the Deputy Medical Officer of Health draws attention to the splendid manner in which he was assisted by the staff in the investigation and control of the outbreak. (b)- I have to report the occurrence of thirteen cases of food poisoning amongst those who partook of the midda\f meal provided on the 9th July at an institution in the Borough. The institution in question was not the one referred to in Report (c) below. All cases have now made a satisfactory recovery. No definite pathological organisms were isolated as a result of the full bacteriological examinations made, but it appears probable that the symptoms were due to toxic substances developing in ham that had been contaminated with micro-organisms. Steps were taken which should minimise the risk of a further occurrence of this kind. (c)- The Deputy Medical Officer of Health has reported the occurrence of ten cases of food poisoning among the staff of an Institution in the Borough on the 22nd August. 85 Those affected all partook of grilled chops and gravy on the day before they became ill. The symptoms were severe diarrhoea and vomiting. Bacteriological examination of the remains of the suspected food did not give conclusive results, and all patients mnde a good recovery. 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 bv 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 Herman 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 as to the manner in which this work is done under a Block Grant from the Borough Council is reported 011 page 134. 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. From the table on page 78 it will be seen that out of a notified total of 758 of these diseases (measles and German measles) 250 were removed to hospital. Home nursing was provided in 35 cases. German Measles is generally a mild disease. There were 120 cases during the vear 1937, as compared with 78 cases during 1936. There were no deaths. Particulars of the cases, deaths and incidence and mortality rates of Measles are given in the following tables :— 86 TABLE I. MEASLES. CASES. DEATHS. YEAR. 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. 1 5—15 years. Adults. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1937 26 166 171 275 638 28 331 262 17 _ — — 1 1 _ 1 — — 1936 715 2117 132 11 2975 180 1529 1206 60 4 12 l — 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 7 7 180 138 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 87 Table II. MEASLES. Year. Incidence Rate per 1000 Population. Mortality Rate per 1000 Cases. Quarters of Year. Total. Quarters of Year. Total. 1st 2nd 3rd | 4th 1st 2nd 3rd 4tli 1937 .1 .9 .9 1.5 3.5 — — — 3.6 1.5 1936 3.9 11.5 .7 .1 16.2 5.6 5.7 7.6 — 5.7 1935 .1 .2 .2 .2 .6 — — _ 30.3 8.3 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 — 145 _ 9.2 1932 3.9 9.8 .8 .3 14.8 10.7 8.4 18.5 _ 9.4 1931 .7 .9 .3 .3 2-2 7.4 5-4 — — 4.7 1930 6.0 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 71 .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 EPIDEMIC CATARRHAL JAUNDICE. * Two outbreaks of this disease occurred during July, one at University College Hospital and the other at the Elizabeth Garrett Anderson Hospital. Owing to the insidious nature of the onset these epidemics are difficult to control. The greatest vigilance and care was exercised by the staffs of the Hospitals concerned, the advice of the officers of the Ministry of Health was readily available and arrangements were made with the London County Council whereby cases showing suspicious symptoms were at once removed to an isolation hospital without waiting for the complete clinical picture. The measure adopted proved effective, and a general spread of infection throughout these institutions was prevented. DISINFECTING AND CLEANSING STATION. These buildings are situated in Camley 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, Camley Street. No charge is made. 88 Library books and articles which would be injured by steam are disinfected by formaldehyde generated in a small chamber. Separate motor vans are used for the collection of infected and delivery of disinfected articles. The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of cases. No. of bouses. No. of rooms contents disinfected or destroyed. No. of rooms sprayed and fumigated. Scarlet Fever 819 805 318 305 Diphtheria 596 575 590 608 Enteric Fever 10 10 10 9 Puerperal Fever 1 1 1 1 „ Pyrexia — — — — Erysipelas 48 48 48 9 Cerebro-spinal Meningitis 5 5 5 4 Measles 19 10 8 9 German Measles 1 1 1 Pneumonia 4 4 4 Dysentery 26 26 22 5 Scabies 189 152 164 5 Tuberculosis 110 110 44 105 Vermin 213 212 109 242 Polio-myelitis 2 2 2 2 Malaria 1 1 1 Continued Fever 1 1 1 1 Other Diseases (not notifiable) 387 337 338 33 Totals 1873 1800 1654 1340 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 38 1888 10 505 Bolsters and pillows ... 4 4505 8 801 Sheets, blankets and counterpanes 2 6551 6 1112 Rugs, mats, cushions, carpets, 4 1553 1 289 covers and curtains Wearing apparel 7 2783 21 871 Books ... _ 504 — 24 Sundries 1 1680 — 286 Totals 51 19464 41 3872 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. 89 Disinfection for Institutions, etc.—In addition to the disinfecting work carried out free of charge in connection with infectious disease, disinfections for other conditions are frequently performed for hospitals or private residents. A small charge is made in these cases to cover the cost. The fees received for this work during the year ended 31st March, 1938, amounted to £127 2s. 6d. In November, 1936, 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 212, and the number of rooms sprayed and fumigated was 242. In a number of cases the contents only were disinfested. Council property is dealt with by the Estates Department, and I have to thank the Administrative Officer for the following particulars : - 26 tenements were found to be infested and, to remedy this condition, 49 rooms were fumigated. 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 (Loudon) Act, 1936. 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 1592 74 4027 5693 Scabies 305 226 1896 2427 Totals 1897 300 5923 8120 * Includes 279 males and females who had no home address. 90 The staff of the Disinfecting and Cleansing Station consists of a Foreman, a StokerDisinfector and two Motor Drivers anrl 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 bv the Sanitary Inspector, as the rooms and bedding may also need disinfesting. It would obviously be useless to deal with the child and neglect the home. BACTERIOLOGICAL WORK. To aid in diagnosis and to detect contact or carrier cases, the Borough Council provides bacteriological diagnosis, free of charge, in connection with certain diseases. In addition to the above, the preparation and supply of vaccines is undertaken, if desired by the medical attendant, for use in connection with cases of Puerperal Fever. This work is performed by Professor F. H. Teale, m.d., of University College Hospital, under an arrangement made with the Council. 91 The undermentioned examinations were made during the year:— Nature of Specimen. Positive. Negative. Total. Swabs for Diphtheria Bacilli 220 2280 2500 „ ,, Haemolytic Streptococci 1 2 3 „ „ Cerebrospinal Meningitis — 3 3 Sputum for Tubercle Bacilli 19 339 358 Stools for Dysentery 12 34 46 „ „ Food Poisoning _ 13 13 „ „ Tuberculosis — 1 1 „ „ Typhoid 1 15 16 Blood „ „ 4 10 14 „ „ Dysentery 1 — 1 Urine —Brouha modification of the pregnancy test _ 1 1 „ for Tubercle Bacilli _ 1 1 Duck Eggs for suspected Food Poisoning _ 4 4 Ham „ ,, ,, ,, — 1 1 Butter „ „ „ „ — 1 1 258 2705 2963 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. 93 Section VIII.-TUBERCULOSIS. TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1937 are given in the following table in the form required by the Ministry of Health :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonarv. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 1 _ — _ — — 1 _ 1—5 2 — 4 2 _ — 1 1 5—10 4 3 1 3 — — — 1 10—15 2 5 3 6 — — — 1 15—20 7 13 3 3 1 10 1 — 20—25 35 31 S 7 6 9 — 2 25—35 44 37 3 4 14 13 1 _ 35—45 33 17 1 _ 14 7 _ _ 45—55 37 8 2 — 24 3 1 _ 55—65 42 4 1 — 27 3 3 1 65 & upwards 11 7 2 1 11 6 — — Totals 218 125 22 26 97 51 8 6 The total number of Primary notifications was 281 ; in addition to these, 32 cases, which had not been notified, came to knowledge by means of special death reports, and 78 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 391, equal to a notification rate of 215 per 1,000 of population. The total number of new cases during the previous year was 380. The deaths from all forms of Tuberculosis during the year numbered 162, equal to a death rate of 0'9 per 1,000 of population. The total number of deaths in the previous year was 164. It will be noted that, out of a total of 162 deaths from Tuberculosis, 32 were of cases which 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 94 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—1937. Time of Notification. PULMONARY. NON-PULMONARY. Male. Female. Male. Female Total. Percentage. 1937 Discovered on Death 21 5 3 3 32 18.6 Six months or less before Death 28 13 2 2 45 26.1 Remainder 1 4 — — 5 2.9 1937 Total 50 22 5 5 82 47.6 1935 17 11 _ _ 28 16.3 1934 6 7 — — 13 7.5 1933 6 2 1 — 9 5.3 1932 6 2 1 — 9 5.3 1931-1927 12 6 2 — 20 11.6 Before 1927 5 5 — 1 11 6.4 Total 102 55 9 6 172* 100 •This total does not agree with that shown by the Registrar General for the reason that there is delay in the receipt of information regarding certain inward transferable deaths. 95 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The number of eases 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 Is/ January, 1937, to the 31s< December, 1937 (inclusive). Age Periods. Number of Notifications on Form A. Primary Notifications. Total .Notifications (i.e.,including cases previously notified by other Doctors). 0 to i 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. Males Pulmonary Females — 1 4 i 7 24 28 21 28 30 6 150 169 — _ 2 3 10 25 23 3 8 3 6 93 102 Males Non-pulmonary Females — 4 1 3 3 1 2 1 1 — 2 18 19 — 2 3 6 1 4 3 — — — 1 20 24 Totals - 7 10 13 21 54 56 35 37 33 15 281 *314 * Exclusive of 15 " Lost sight of " cases returned. Information obtained from Special Death Reports, by Transfer from other districts, and by Posthumous Notifications. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. ' Total. Males Pulmonary Females 1 1 — 1 — 11 16 12 9 12 5 68 — — 1 2 3 6 14 4 — 1 1 32 Males Non- pulmonary Females _ _ _ _ _ _ 2 _ 1 1 — 4 — — — — 2 3 1 — — — — 6 Totals 1 1 1 3 5 20 33 16 10 14 6 110 96. 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 Bate per 1000 population. ce c 0 g "3 * Other forms. All forms. Pulmonery Other rorms. All forms. Pulmonery Other forms. All forms. Pulmonery>> Other forms. All forms. 1928 205600 353 102 455 191 25 216 1.72 0.50 2.21 0.93 0.12 1.05 1929 203900 37<> 93 469 218 32 230 1.84 0.46 2.29 1-07 0.16 1.23 1930 203900 321 76 397 165 24 189 1.54 0.36 1-91 0.79 0.12 0.91 1931 195200 329 75 404 181 25 20(1 i-68 0.38 2 07 0.93 0.13 1.06 1932 194000 324 85 409 164 25 189 1-67 0.44 211 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 '57 15 172 '58 0.26 1.84 0.84 0.08 0.92 1935 185300 275 47 322 '23 15 138 1.48 0.25 1.73 0.66 0.08 0.74 1936 '83900 311 69 380 150 14 I64 1.69 0.37 2.06 0.81 0.07 0.88 1937 181900 343 48 39' 148 14 162 1.88 0.26 2.15 0.81 0.08 0.89 The table below shows the number of new cases and the number of deaths, together with the corresponding rates per 1,000 of population, for each Ward of the Borough during Tuberculosis (ALL, FORMS). Ward. New Cases. Deaths. Number. Rate per 1000 of Ward Population. Number. Rate per 1000 of Ward Population. 1 54 1.6 27 0.8 2 34 1.9 12 0.6 3 66 2.2 33 1.1 4 48 2.2 27 1.2 5 51 1.9 18 0.7 6 43 2.6 15 0.9 7 39 3.2 13 1.1 8 52 2.2 14 0.6 Homeless 4 _ 3 — Totals 391 2.15 162 0.9 97 In the following table are given the deaths from Tuberculosis of St. Pancras residents during 1937, 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, l!>-37.) Wards. CO cc a o tjli X dllUI fto Hospitals. cc f-i o <x> 5 rg -4-3 CO CO Under 1 yea 1—2 years. 2 — 5 years. 5—10 years 10—15 years 15—20 years 20—25 years 25—35 years 35—45 years 45—55 years 55—65 years r. cd ■ £ £ 1 p. i II 2 £ i o M F >1 K D c- III \I F IV \I V VI \IF M F VII M F rai M F c3 MF M F Total CO a hh a •+3 © * St. Pancra Persons. Ex St. Panci Persons. All Forms ... ... ... ... 1 ••• 2 1 1112 17 28 2128 34 16 1 14 13 .. 11 15 27 21 27 30 16 1 12 12 8 4 201319 8 4 191319 815 7 14 3 9 2 8 6 10 5 8 3 3 9 8 5 4 1 1 2 105 57 1 97 51 162 148 33 30 66 57 60 46 Central Nervous System 2 ... • 111 1 ... 1 1 ... 1 1 1 1 3 3 6 1 5 4 1 ... ... 2 1 ... 1 2 ... 2 1 3 1 1 1 1 1 1 1 1 1 Other Organs— 1 1 1 ... 1 1 I Disseminated Tuberculosis— 1 ... 1 1 1 2 2 2 „ Not distinguished 1 M •• 1 1 ... 1 1 2 i i i i i 98 NOTIFICATION REGISTER. This is kept at the Dispensary. The following table gives the information for the year ended December 31st, 1937, in the prescribed form : — Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1937 813 237 1050 Number of new cases during the year 353 53 406 Number of cases removed from the Register during the year (from death or other causes) 1166 380 290 96 1456 476 Number of cases remaining on the Register at the end of the year 'Figures adjusted to: 786* 790 194* 190 980 980 Public Health (Prevention 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 onlv) Dr. Back .. .. 99 The premises provided by the Borough Council for use as a Tuberculosis Dispensary were opened in February, 19.'52. 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. M. F. A.—New Cases examined during the year (excluding contacts) (a) Definitely tuberculous 137 69 5 5 7 9 9 11 144 78 14 16 252 (b) Diagnosis not completed - - - - - - - - 3 8 — — 11 (c) Non-tuberculous - - - - - - - - 89 112 21 25 247 B.—Contacts examined during (a) Definitely tuberculous - 2 1 1 - - - - - 2 1 1 4 (b) Diagnosis not completed - - - - - - - - 1 1 — — 2 (r) Non-tuberculous - - - - - - - - 60 114 53 74 301 C.—Cases written off the Dispen- (a) Recovered 8 16 2 1 6 4 5 5 14 20 7 6 47 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 164 238 76 101 579 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 374 228 22 22 39 40 29 25 413 268 51 47 779 (b) Diagnosis uot completed - — — — - — — 8 10 — 18 I. Number of cases on Dispensary Register on January 1st 796 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 111 (a) Personal 6 (b) Other 277 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 118 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 180 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4083 10. Number of— 4. Cases written off during the year as Lead (all causes) 121 (a) Specimens of sputum, &c., examined 564 (b) X-ray examinations made in connection with Dispensary work* 363 5. Number of attendances at the Dispensary (including Contacts) 3641 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 6. Number of Insured persons under Domiciliary Treatment on the 31st December ... 344 i 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 438 *NOT including those made for A.P. refills. 100 The following is a summary, for purposes of comparison, of certain sections of the foregoing tables. Deaths from Tuberculosis Jan. lst-Dec. 31st Ratio of cases on dispensary register to cases 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 172 .94 .79 452 248 290 104 75 4.5 .14 .35 51 44.4 73.1 Report on the Work carried out at the Tuberculosis Dispensary. The following report on the work carried out by the Dispensary has been prepared by Dr. G. A. Back, the Tuberculosis Officer: — New Patients and Contacts. There has been no significant change since last year either in the number of notifications or in the number of new cases dealt with at the Dispensary. The number of new contacts attending has increased from 259 to 307, a figure higher than any recorded previously. The total number of contacts of the 391 cases notified during the year was 548 and of these 47-6 per cent, had been examined at the Dispensary and 8*2 per cent, elsewhere by the end of March, 1938. 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 412 applications were accepted, showing an increase of 13 over the previous year. Of these 214 were admissions to General Hospitals, 48 to Brompton Hospital or St. George's Home for investigation of their subsequent treatment, 128 to sanatoria and 22 to various hospitals for observation for diagnosis. The majority (156) 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 (58) were made by the Dispensary. Of the admissions to sanatoria and special hospitals 123 were recommended by the Dispensary and 75 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 by the Tuberculosis Officer when he visits Highgate Hospital, without charge to the Borough Council. The number of refills, which for the past three years had averaged 442, showed a marked increase from 573 during 193b, to 800 during 1937. Of these, 323 were carried out at Brompton Hospital, 151 at University College Hospital, 111 at other voluntary hospitals, 75 at Colindale Hospital, 29 at Grove Bark Hospital and 140 at Highgate Hospital, of which 135 were carried out by the Tuberculosis Officer. 101 Light Treatment. Finsen Light Treatment for lupus is provided usually at tlie 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-two attendances were made at the London Hospital and 44 at University College 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 arc carried out daily at University College Hospital and once a week at Highgate Hospital. University College Hospital charge the Borough Council 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 be carried out at a cost of 2s. 6d. by the Tuberculosis Officer when he visits the hospital. Of the 363 examinations made during the year 122 were made at Highgate Hospital 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 105 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 Number of visits under P. h. (Tub.) for Dispenary Total Visits regulations. purposes. Miss Holland 162 2512 2674 Miss Long 115 1571 1686 4360 Staff. No change in Staff was made during the year. The arrangement whereby the Tuberculosis Officer visits Highgate Hospital on one afternoon a week was continued during 1937. G. A. Back, Tuberculosis Officer. St. Pancras Tuberculosis Care Committee. List of Members. 1. Councillors. Alderman A. Escott, f.i.b.d., Chairman. W. P. Spry. Councillor A. E. Davies. ,, Dr. Mrs. M. T. Day. „ John Evans. ,, F. J. French. ,, Mrs. J. Gregory. „ Mrs. M. Needham. „ Mrs. IX Pym, B.A. ,, J. A. Wright. 102 2. Representatives of other bodies interested in the Welfare of Tuberculous Patienti. Miss Ball, L.C.C. Schools Care Committee. I)r. Hogarth, L.C.C. (School) Divisional M.O. Mrs. Councillor G. 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. Ohollwill, Manager, Labour Exchange. Miss Piper, North London Nursing Association. Mr, Congdon, London Insurance Committee. Dr. C. L. Mason, London Panel Committee. Councillor A. J. Trott, j.p., Public Assistance. 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-Officio Members. Dr. M. Radford. Dr. G. A. Back. Dr. P. Y. Pritchard. Mrs. E. Bevan, Secretary. The following report on the work carried out during 1937 has been prepared by the Secretary of the Committee:— The Care Committee held 10 meetings during the year, and the work carried out by or reported to them is indicated in the following summary. Residential Jreaiment. 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. 1 he 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 140 (b) Financial difficulty not anticipated 170 310 Public Assistance. All patients and their families who appear to be eligible are referred to the Public Assistance Department. In January, 1936, 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 293 recommendations were made in respect of 92 patients. As a rule, 1½ pints of milk and 2 eggs were allowed to each patient daily and ½ lb. of butter weekly, 103 Unemployment Assistance Board. When a patient or the person on whom a patient is dependent is in receipt of unemployment assistance benefit the Unemployment Assistance Board is asked to supply extra nourishment. During the year 79 recommendations were made in respect of 22 patients. 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 51 „ „ renewals 143 £ s. d. Total oost 145 18 1 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 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 20 (b) Articles of clothing 57 By the London County Council. (a) Number of Patients 9 (b) Articles of Clothing 37 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 1937 are:— Number of Patients 16 £ s. d. Total cost of treatment 86 19 0 Amount paid by Borough Council 65 0 9 Housing. When necessary recommendations for better housing accommodation on the Borough Council and London County Council Estates are made to the Instates Department by the Tuberculosis Officer and are reported to the Care Committee. The figures for 1937 are:— Number of families recommended 49 ,, ,, rehoused (a) By Horough Council 3 (b) By London County Council 4 104 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 15. 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 1937 are:— Number of Families provided with beds and bedding during the year 3 Number of families using beds or bedding on December 31st, 1937 4 In addition the Public Assistance Committee have been asked to provide and have provided bed and belding in three cases. 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. Boarding out of Contacts. Since 1925 the London County Council has made arrangements to board out for varying periods the following types of children:— (a) 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 1937 was 9. Handicrafts Class. During the year, in conjunction with the Hampstead Tuberculosis Care Committee, a Handicrafts Class has been formed and up to date has proved very successful. A grant of £10 was made by the National Association for the Prevention of Tuberculosis and £10 from each Borough Council through their Care Committees. The London County Council provides the teacher free of charge, if an average of 14 attendances can be maintained. So far this has been maintained or exceeded. We have been fortunate in obtaining the services of Mrs. W. Bridgeman as teacher. Her previous experience of this work, and her popularity with the members of the class have been of the greatest value. Voluntary help of great value has been provided by a St. Pancras patient, Mr. S. Smith, who helps with the Clerical work, and the purchasing of materials for class work by Mrs. Dixon, a member of the Hampstead Tuberculosis Care Committee, and by Mrs. Ollard, who has helped to serve the teas during the classes. The class is held at the St. Pancras Tuberculosis Dispensary every Monday afternoon. Miscellaneous. Holidays were provided in co-operation with the Invalid Children's Aid Association for two patients. Fares were paid twice monthly for two patients relatives to visit them in Sanatorium, throughout the year. In several other cases fares were paid to enable relatives to 105 visit patients once. A suit of clothes was redeemed from pawn to enable a patient to go away for Sanatorium treatment. Accommodation was provided at the Young Women's Christian Association for a patient who was discharged from Sanatorium and had 110 home, until she was able to find other suitable accommodation. Insurance stamps were provided in two cases of arrears, to enable the patients to obtain their National Health Insurance benefit and the first week's rent which had to be paid in advance in cases of re-housing was provided 111 two cases. Pocket money was sent to eight patients while they were away in Sanatorium. Twenty-five names were submitted to the St. Pancras Needy Fund at Christmas, at the request of the Secretary, and generous gifts were received in all cases. In co-operation with the Charity Organisation Society one patient was set up in business again, after his discharge from Sanatorium. Seal Salts. The Care Committee again took part in this scheme for raising funds, organised by the National Association for the Prevention of Tuberculosis. The proceeds up to December, 1937, are shown in the following statement:— Receipts and Payments Account for the Year knded 31st December, 1937. Receipts. Payments. Cr. Dr. £ s. d. £ s. d. £ s. d. To Balance carried forward 95 7 1 By Grants: Mr. Remfrey 3 0 0 „ R. Pheney (holiday) 1 10 0 „ Donation to Dr. Back for Mr. Remfrey 3 0 0 „ S. Hearn (holiday) 4 4 0 ,, King's Cross Philanthropic Society 2 0 0 „ Pocket money: Mr. Kiely 2 0 0 ,, Eleanor Palmer Charity 21 0 0 ,, Teachers' Provident Society 2 2 0 „ Green 0 10 0 ,, Seal Sales 46 1 2 ,, Randall 0 10 0 ,, St. Pancras Borough Council 25 0 0 „ Richards 0 10 0 Miss Wilcox 0 10 0 Mr. Hunt 0 10 0 ,, Monday 1 10 0 „ Pilis 1 0 0 „ G. Haines, boots 3 10 0 „ Mr. Manton, suit from pawn 1 3 0 „ „ Wright, rent 0 14 6 ,, Miss Wilcox, board and rent 1 12 6 ,, Fares 5 9 9 „ Invalid kitchen 0 18 0 „ Shaftesbury Society 1 0 0 ,, Handicrafts Class 5 0 0 35 1 9 ,, Purchase of clothing 18 17 1 „ N.A.P.T. Subscription 0 10 0 ,, Wireless set and licence 6 16 0 ,, Seal Sale Account N.A.P.T. 5 1 3 „ Sundries 1 6 0 £ s. d. ,, Balance at Bank 126 17 2 ,, „ in Hand 0 1 0 126 18 2 £194 10 3 £194 10 3 Section IX Maternity and Child Welfare. 107 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. During the year under review several major changes were made. The Borough was divided into seven "Welfare Districts" each served by its own Centre. One such district, Ward 7, was placed in the charge of the University College Hospital Welfare Department. A special report on this scheme will be found on page 116. The committee of the Caversham Road Centre decided to bring to a close its long period of work in the Borough as from the end of March and the Centre was accordingly transferred to temporary quarters in Torriano Avenue. In order to give this centre a permanent home the Council obtained a site in Raglan Street upon which to build. This building known as the Kentish Town Centre was completed in February, 1938. The newcentre is the first to be controlled entirely by the Borough Council. This occasion is taken to place on record appreciation of the many years of most excellent work undertaken by the Committee of the Caversham Road Centre. Those who know something of the inner working of this committee will recognise that it is fitting that special mention should be made of the large share of this work borne by Miss de Pass. Miss de Pass was the originator and benefactress of this Centre and she was an untiring voluntary worker. She was a pioneer in Maternity and Child Welfare work whose name will be remembered by a wide circle. The remaining five districts have had their boundaries re-allocated, otherwise they continue to function as before each with its own Centre, Superintendent, Health Visitors, Voluntary Workers and Voluntary Committee. The welfare movement of to-day owes its existence in a great measure to good work of these committees. They started the Centres in the pioneering days when neither the Borough Council nor the Ministry gave any financial support. They have carried on the work to its present advanced state. St. Pancras can claim a special distinction in that the St. Pancras School for Mothers, now in its 31st year, was the first Welfare Centre in its modern conception to be established in this country. This Centre is still attended by students of the movement from all over the world. 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. Co-operation between the Voluntary Committees and the Council is maintained by the Maternity and Child Welfare (Advisory) Sub-Committee. Representatives of the 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. In addition to these seven 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. 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, 108 Table I. Statistical information is given below in the form required by the Ministry of Health. [The following Centres in the Borough are not included in the table for the reason that grant is not paid by the Borough Council:—lioyal Free Hospital and Elizabeth Garrett Anderson Hospital.] 1.—Population of the area served by the Council, Registrar General's estimate for Midsummer, 1937—181,900. 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—2,306. (b) Still births—62. (c) Total*—2,368. (d) By midwives*—2,008. (e) By doctors and parents*—360. •The total of the figures given under (d) and (e) should agree with the figure under (e). 3.—Health Visiting. (a) Number of officers employed for health visiting at the end of the year. (i) By the Council—17 (three of which are temporary). (ii) By Voluntary Associations—2. (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 ciations—1. (c) Number of visits paid during the year by all Health Visitors:— (i) To expectant mothers:— First visits†—1,623. Total visits—3,946. (ii) To children under 1 year of age:— First visits†—2,364. Total visits—14,395. (iii) To children between the ages of 1 and 5 years:— Total visits—15,387. 4.—Infant Welfare Centres. (а) Number of Centres provided and maintained by the Council—1. (b) Number of Centres provided and maintained by the Council, with some assistance from Voluntary Committees—5. (c) Number of Centres provided and maintained by Voluntary Associations—1 (University College Hospital). (d) Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—24,103. (ii) By children between the ages of 1 and 5 years—15,654. (e) Total number of children who first attended at the Centres during the year and who, on the date of their first attendance, were:— (i) Under 1 year of age*—1,872. (ii) Between the ages of 1 and 5 years—252. 109 (f) 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—1,777. (ii) Over 1 year of age—3,225. (g) Percentage of notified live births represented by the number in (d) (i) 81.18 per cent. 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 voluntary committees—4. (ii) Number of Clinics provided and maintained by the Council, without the assistance from a voluntary committee—1. (iii) Number of Clinics provided and maintained by Voluntary Associations—1. (iv) Total number of attendances at all Clinics during the year—4,676. (v) Total number of women who attended at the Clinics during the year—1,021. (b) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv)—43.1. * 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 transferred to the Council under Part I of the Local Government Act, 1929. The following Tables,—II on page 110 and III on page 111, 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 386 ante-natal consultations were held, the number of expectant mothers was 1,129 and their total attendances were 5,189. For the two previous years the total attendances were 6,250 and 4,985. For the two previous years the total attendances of children were 40,784 and 39,993. 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 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), (See page 108.) 110 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 111. These figures are not included in the returns made to the Ministry. *At the time of writing however this matter is engaging the attention of the Public Health Committee. Table 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. T. Ivor Hughes) Mondays, Tuesdays and Wednesdays at 2 p.m. (Drs. Pritchard, Gillespie and Odling-Smee) The 1st and 2nd Mondays in the month at 10 a.m. (Drs. Gillespie and Haine) Camden Town Maternity and Child Welfare Centre, Barnes House, Camden Road, N.W.1 The 2nd and 4th Tuesdays in the month at 10 a.m. (Dr. T. Ivor Hughes) Mondays. Tuesdays, Thursdays and Fridays at 1 p.m. (Drs. Russell. Elgood, Pritchard and Alderton) Wednesdays at 10 a.m. (Dr. Haines, — Kentish Town Maternity and Child Welfare Centre, N.W.5 Tuesdays, at 10 a.m. (Dr. Phyllis Dixon) Tuesdays and Wednesdays at 2 p.m. (Drs. Alcock and Meade) Mondays at 2 p.m. (Drs. Alcock and Meade) North St. Pancras School for Mothers, 129, Queen's Crescent, N.W.5 The 1st, 2nd aud 3rd Thursdays in the month at 10.30 a.m. (Dr. Hawthorne) Tuesdays, Wednesdays, Thursdays aud Fridays at 2 p.m. (Drs. Neill, Haines, and Hawthorne) — Somers Town Maternity and Child Welfare Centre, Chamberlain House, Ossulston Street, N.W.1 The last Wednesday in the month at 10 a.m. (Dr. T Ivor Hughes) Mondays, Tuesdays, Wednesdays and Thursdays at 2 pan. (Drs. Wigg, Kitcat, Leesmith and Russell) — South Highgate Infant Welfare Centre, 43, Raydon Street, N.19 — Wednesdays and Thursday's at 2 p.m. (Drs. Pritchard and Neill) — (Dr. Haines died early in 1938. His consultations are being conducted by temporary officers). 111 Table III. Return of Attendances, Visits and Consultations at the various Welfare Centres in the Borough during 1937. Centre. Attendances at Consultations. Visits at Trained Visitors. Consultations Number of Visitors Expectant Mothers. Children. Expectant Mothers. Children. Children. Expectant Mothers. No. of Birth Notification® allocated to centre. New cases. Total attendances. New cases. Total attendances. Under 1 year. 1-2 years. 2- years. Total. Under 1 year. 1-2 years. 2-5 years. Total. First visits. Total visits. First visits. Total visits. Per month. Total. Per month. Total. Council Staff. Others. St. Pancras School for Mothers 358 47 98 234 39 52 325 2798 1077 1066 4941 229 773 393 6076 14 170 1 12 3 — Camden Town Centre 526 142 372 429 45 64 538 5226 1831 1837 8894 364 640 718 6089 21 249 2 24 4 — Kentish Town Centre 425 129 651 314 25 47 386 4575 960 1078 6613 276 861 460 5823 12 144 4 48 4 — North St. Pancras School for Mothers, Queen's Crescent 476 135 424 367 34 37 438 4621 1576 1032 7229 280 741 610 5188 16 201 3 36 3 Somers Town Centre 345 38 145 276 22 36 334 3641 1436 1085 6162 220 469 414 4284 16 198 1 12 2 — South Highgate Centre 172 — — 97 10 18 125 1789 1058 919 3766 76 150 116 1431 8 104 — — 1 — ‡†Royal Free Hospital . — 108 513 42 7 26 75 465 164 243 872 146 164 63 296 13 154 12 151 — 3 ‡†University College Hospital — 530 2986 — — — — — — — — 178 312 — — — — 8 103 — 2 Totals 2367 1129 5189 1759 182 280 2221 23115 8102 7260 38477 1769 4110 2774 29187 102 1220 31 386 17 5 *University College Hospital 65 — — 39 12 1 52 322 69 25 416 — — 85 562 8 69 — — — — * As from 1st May, 1937. and in respect of Ward 7 only, as per scheme described on page 116. An additional visitor was also attached to the following Centres:— North St. Pancras school for Mothers, 2 days a week; Kentish Town, 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 attached to Centres, us follows:—Camden Town 1037; and Kentish Town 445.) ‡ See explanatory remarks regarding these two centres on pages 109, 110 and 116. 112 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 1194. Other activities of this centre include the following:— Classes for Mothers. At Health Talk classes there were 509 attendances; and at needlework, etc., classes, 771 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. Nursing and expectant mothers were supplied with 2,670 dinners and young children with 1,306. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,682 attendances during the year, of which 411 were made by infants under one year of age, 729 by children from 1 to 2 years of age, and 542 by children from 2 to 5 years of age. Dental Clinic. The Dental Surgeon is Mr. George Thomson, l.d.s. During the year 46 consultations were held, at which 133 treatments were provided for mothers and 163 for children. Details of the work done are given in the following table:— Mothers. Children. Extractions with anaesthetics 30 16 „ without anaesthetics 1 6 Fillings 65 68 Scalings 7 2 Impressions and fitting dentures, etc. 23 — Examinations and advice 7 71 Totals 133 163 296 This clinic is provided out of funds obtained from voluntary sources, except in so far as allowance is made in the Council's annual grant. 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. 113 Manage Clinic. Treatments numbering 575 were given at 88 clinics by trained masseuses, the cost of whose services was not paid by the Borough Council. Camden Town Centre, Barnes House, Camden Road. 26 mothers and 43 children were sent away on holiday, for a period of two weeks, either to the country or seaside. Interviews with parents by the Superintendent, apart from medical consultations, numbered 2,160. Classes for expectant mothers numbering 16 were held simultaneously with the antenatal clinics. There were 248 attendances, the average being 15 per class. Knitting and Needlework classes and Health Talks were given, the total attendances being 870. The services of two trained masseuses (not paid by the Borough Council) were available throughout the year, during which time 71 massage clinics were held. There were 874 attendances. Dinners for Mothers and Children.—These were supplied daily at the Centre to 5,033 expectant and nursing mothers and 3,382 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. 114 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. 1937. 1936. Number of new cases Mothers 142 179 Children 160 199 Total 302 378 Number of Attendances For extractions under nitrous oxide (gas) 295 326 „ „ local anaesthesia 15 15 „ fillings and dressings 139 185 „ scaling 14 24 „ impressions and fitting dentures 182 195 „ examination and advice 490 594 Total attendances 1135 1339 Total number of clinics held 68 78 Number of clinics with nitrous oxide anaesthesia 28 24 The following table shows the number and cost of the dentures supplied during the year:— Number of Patients supplied with dentures 22. Total cost £66 15s. 0d. Amount paid by mothers £24 0s. 0d. Amount paid by Borough Council £27 18s. 6d. Amount paid by Hospital Sunday Fund £7 16s. 6d. Amount paid by other sources £7 0s. 0d. Kentish Town Welfare Centre. In addition to the consultations provided by the Borough Council, 33 classes for needlework were held, at which 496 attendances were made. North St. Pancras School for Mothers, 129, Queen's Crescent, N.W.5. Attendances at the Sewing and Knitting,classes numbered 496. Interviews with parents by the Superintendent, other than at classes or clinics numbered 1,548. Two mothers and 38 children attending this Centre were referred for Artificial Light treatment, and 39 mothers and 50 children were referred to the Council's Dental Clinic for treatment. 22 mothers and 35 children were sent away on holiday or convalescence. 115 Somers Town Centre, Chamberlain House, Ossulston Street, N.W.1. In addition to the consultations provided by the Borough Council, the Health Visiting Staff had 830 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes during the winter months, at which 318 attendances were recorded. 28 mothers and 36 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." 630 massage treatments were given at 79 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. 375 attendances of mothers were recorded at needlework classes. 10 mothers and 20 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 28th June to 16th October. The consultations which were held on Mondays and Thursdays in each week numbered 69, the average number of attendances at each consultation being 16. 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 E. M. Robinson, who is assisted at the consultations by a Health Visitor from another Centre. Lamps, etc.—Three in number: 1 Westminster Single Arc Lamp, and 2 Alpine Sun Four Arc Lamps. The current is direct, and voltage at main 220. Cases treated.—Particulars with reference to the cases treated during 1937 are given in he following table:— 1937. 1936. Total number of cases treated 44 40 Total number of new cases 46 30 Total number of attendances 1095 769 Number of Consultations held 69 65 Average attendance per Consultation 16 12 Average number of attendances per child 24.9 19.25 116 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 112. 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. University College Hospital Centre. As from 1st May, 1937, the University College Hospital Welfare Deportment has been allocated Ward 7 as its own definite Welfare area. The Department is now responsible for maintaining the complete Welfare Service, both for clinics and home visiting, for children in that area. In addition the Hospital provides Consultative and Treatment facilities for cases referred from the other Welfare Centres in the Borough. Welfare Clinics are held for ex-St. Pancras children. Under this arrangement the Hospital's Welfare Centre functions and is supervised in the same manner as the other centres in the Borough's Maternity and Child Welfare Scheme. The Details of this Scheme are as follows:— The University College Hospital will undertake the complete service of a Welfare Centre area for Ward 7. It will provide in addition service for the Borough as described hereunder and for the neighbouring Boroughs. All of these services are associated with the grant from the Borough Council under the Maternity and Child Welfare Scheme. 1. —University College Hospital Welfare Centre for St. Pancras Mothers and Children. This Centre will serve Ward 7 only. It will carry out the usual duties of a Welfare Centre such as the holding of Welfare Clinics for children under five, the necessary home visiting as prescribed by the Medical Officer of Health or his Deputy and such auxiliary services as classes in mothercraft, massage, etc., as may from time to time be found necessary and possible. The ante-natal clinics will be held by the Maternity Department and will not be included in the Scheme. 2.—University College Centre for Mothers and Children living in Boroughs other than St. Pancras. The Hospital will continue to provide a similar but separate Service as described under item 1 in respect of the neighbouring Boroughs. The home visiting, however, will not be subject to any supervision by St. Pancras officials. The Clinics are subject to the general definition of a "Satisfactory Service" as referred to herewith. 3.—University College Hospital Welfare Centre Consultative and Treatment Clinic for St. Pancras Children. The Hospital will provide a consultative service to which children attending any Welfare Centre in the Borough can be referred for special examination and advice if necessary, which may be followed up by in-or out-patient treatment at the discretion of the Consultant. 117 4.—University College Hospital Welfare Centre. Special Clinic for St. Pancras Babies born in the Hospital or under the care of Hospital Officers. St. Pancras babies born in University College Hospital or on the district under the care of Hospital Officers are examined when three weeks old. This is in accordance with an agreement between the Welfare and Maternity Department of the Hospital. If normal the babies are immediately discharged by the Welfare Centre for the area in which they are resident. If abnormal they are expected to continue under the care of this Clinic until normal. "Abnormal" indicates a condition which should not be dealt with at a Welfare Centre. The following notes describe certain specific arrangements for the Administration of the Maternity and Child Welfare Scheme in St. Pancras, so far as the University College Hospital is concerned. (a) Home Visiting in St. Pancras. The Hospital's Health Visitors will undertake all the usual home visiting in Ward 7, the Hospital's own Welfare Centre area. Visiting outside the Borough is not controlled by St. Pancras officials. Visiting in the Borough outside of Ward 7 is only carried out at the express wish of the Medical Officer in charge of the Hospital's Welfare Centre. Children visited in this respect would only be those attending the Hospital under items III and occasionally IV. This will result in some overlapping by the Hospital and local Welfare Centres respective Health Visitors which will require co-operation and exchange of information between the Centres. Therefore, unless otherwise indicated, the local Welfare Centres are responsible for visiting all babies after the 14th day. (b) Exchange of Information. Children referred under item III will be given a letter from the Medical Officer to the Consultant. It would be of great value if the Consultant would report back any important notes on the case. In the case of children coining under item IV, the Hospital should report all first attendances indicating whether the baby is considered normal or abnormal. In the case of an abnormal baby clinical notes would be appreciated. When the abnormal baby becomes fit for transfer the Hospital should notify the local Centre of this discharge. When required diaries of Health Visitors, Children's Case Papers, reports on home visiting and other relevant records should be sent to the Maternity and Child Welfare Officer at the Town Hall. When a child is transferred to another Centre, the case papers should be sent to the Town Hall in order that they may be forwarded to the Centre serving the area into which the child has moved. This transfer may result from knowledge coming in the first place to the staff in Ward 7, in which case the papers and information should be sent to the Town Hall as a routine measure without waiting for a request. The grant made under the Maternity and Child Welfare Contributions (London) Scheme, 1937, by the Borough Council to University College Hospital for the Service outlined above is £1,150 per annum. The payment of this contribution 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 contribution 118 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 an 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 auditor's 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. BOROUGH COUNCIL CONTRIBUTIONS. The Local Government Act, 1929, 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, came into operation on 1st April, 1937. 119 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:— These centres carry out routine M. & C. W. work in defined areas and are staffed by officers of Borough Council. Association. Scheme commencing 1st April, 1937, and expiring 31st March, 1942. Scheme expiring 31st March, 1937. £ £ St. Pancras School for Mothers 777 777 Somers Town Welfare Centre 275* 275* North St. Pancras School for Mothers 220 136 South Highgate Welfare Centre 160* 141* Camden Town „ 670* 560* These associations render various ancillary services. St. Pancras Dispensary 200 146 University College Hospital 1150 890 Whitefield Day Nursery 480 480 Kentish Town „ 513 513 Margaret „ 760 750 Mayoress of St. Pancras Home for Sick Poor Children 750 700 Home Helps Committee 250 150 * 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. 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. diseases and defects discovered at the consultations. There may be one or more Centres in the district in accordance with its size and population. Treatment may be arranged at minor ailment or specialist clinics, at the school clinics, or at local hospitals. 120 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:— 121 Table IV. Ampthill Square. Camden Town. Kentish Town. Queen's Crescent. Somers Town. South Highgate TOTALS. University College Hospital (j) Bristow.(a) Harrop. Lynn. Crockart.(a) Blair. Hunter. (h) Smith. Phillips.(f) Edwards. (f) Lunn.(f) Slader.(f) Cross. (f) Bagnall.(b) Harris.(i) George. (c) Wilson. (d) O'Leary.(e) Whitmrrsh. (f) Just.(c) Chapman.(a) Harris. (i) Bruce. Lurie. Manger. (a) Anderson. (g) Blaxland. Slader. Robinson.(a) Harris. (i) Brooke. (k) Warren. (k) Barnes. (k) TOTALS. (U.C.H. only) Maternity and Child Welfare: under 1 year:— (a) First Visits following Birth Notifications 33 139 146 9 142 27 115 59 9 38 27 3 1 5 38 172 162 — 2 62 19 221 192 108 35 183 1 88 18 2044 15 23 12 50 (b) Other First Visits 1 31 15 2 16 1 21 6 5 7 1 — — 4 — 29 6 — 1 6 2 17 14 9 11 23 — 4 3 235 5 4 11 20 (c) Subsequent Visits 375 834 968 89 652 120 679 181 25 314 128 4 129 85 183 1205 1178 37 36 231 97 1021 791 456 303 979 3 325 138 11566 88 146 50 234 1—2 years:— (a) First Visits 3 7 6 7 9 2 7 48 1 4 2 — — 1 — 6 4 — — 2 1 22 14 6 3 3 — — 1 159 1 2 2 5 (b) Subsequent Visits 276 584 565 63 282 60 361 82 13 212 69 — 39 181 110 434 328 14 4 61 98 469 458 331 202 437 3 202 99 6037 25 67 18 110 2—5 years:— (a) First Visits — 5 7 18 3 1 11 110 — 6 1 — — 15 1 7 5 — 1 6 2 25 15 15 14 3 — 1 1 273 5 5 — 10 (b) Subsequent Visits 304 865 912 96 419 62 762 104 17 422 151 4 38 238 126 351 386 260 1 106 319 485 442 280 380 491 5 328 223 8577 25 93 15 138 Expectant Mothers:— (a) First Visits 30 71 125 39 91 22 102 49 3 49 9 — 43 7 18 74 124 7 3 9 40 113 118 45 30 145 — 57 19 1445 10 49 6 65 (b) Subsequent Visits 76 255 213 33 70 22 69 25 2 47 8 — 28 4 55 142 344 4 8 46 17 238 160 73 30 146 — 55 19 2189 4 22 4 30 Post Natal 1 16 3 44 1 1 5 8 — 1 — — 4 — 2 67 6 — — 4 — — — — 1 9 — 32 205 0 — 1 3 Infectious Diseases:— Ophthalmia Neonatorum 1 — 9 3 2 1 4 2 1 — — — 1 — 2 1 1 — — — — 2 — 2 — 3 — — 1 36 — — — — Puerperal Pyrexia 3 4 2 1 6 — 1 — — 2 — — 1 — — — 3 — — 1 — 1 2 2 — 4 — 1 — 34 1 1 1 3 Puerperal Fever — — 1 — — — — — — 1 — — — — — — — — — — — 2 — — — 2 — 1 — 7 — — — — Measles Under 1 year 7 3 5 — 1 — 4 6 — 2 — — 2 — — 1 1 — — — — 2 1 2 — 1 — 1 — 38 4 2 — 6 1—5 years 11 6 19 1 15 — 26 1 — 7 12 7 — 4 — 16 18 — — 1 — 24 13 45 7 51 1 9 3 297 10 19 — 29 Over 5 years 3 3 6 1 19 — 24 2 2 6 4 9 1 4 — 14 14 — — 1 1 8 8 21 1 44 — 16 3 215 3 32 — 35 German Measles Under 1 year — — — — — — — — 1 — — — — — — — 1 — — — — — — — — 1 — — — 3 — — — — 1—5 years 3 3 3 — 2 1 2 7 1 — — — — — — — — — — 1 — 1 1 6 1 6 — — — 40 — — — — Over 5 years 1 3 4 — 3 — 1 3 — 2 1 — — 2 — — 4 — — 1 — 2 2 4 4 4 — 1 1 43 — — — — Whooping Cough Under 1 year — 2 2 — — — 1 — — — — — — 1 4 — — — — — 1 — — — 1 6 — 6 1 25 — — — — 1—5 years 6 20 7 — 4 13 45 13 2 — 1 — — 1 3 8 4 — — 1 — 19 18 — 9 15 — 13 3 205 — 2 1 3 Over 5 years 4 11 9 — 3 5 9 6 — — — — — 4 1 8 3 — — — 1 6 11 2 10 1 — 1 3 98 — — — — Other Diseases Under 1 year 1 — — — — 1 — — — — — 2 — — — 2 — — — 1 — 10 7 — 8 12 — 5 1 50 — 3 — 3 1—5 years 4 16 11 — 6 4 16 4 — 3 2 1 — 1 8 40 12 1 — 8 1 34 44 23 23 57 — 5 3 327 1 10 — 11 Over 5 years 6 49 13 1 40 8 59 33 2 4 12 1 — 4 26 33 29 — — 1 8 41 41 6 23 32 — 4 5 481 2 22 4 23 Children and Young Persons Act, &c.— Initial Visits to Foster Mothers 1 4 2 — 4 — — — — — — — 3 4 — — — — — — — 1 2 — — 1 — 2 — 24 — — — — Subsequent Visits to Foster Mothers re children: (a) Under 1 year — 14 — — 2 — 1 — — — — — 5 5 — — — — — — — 2 2 — — 3 — 12 — 46 1 — — 1 (b)1—5 years 12 34 44 — 1 2 32 2 — 8 — — 4 29 — 1 — — — 2 — 24 12 — 2 26 — 47 — 282 — — — — (c) Over 5 years 4 35 26 — 10 3 10 4 — 11 1 — — 1 — — — — — 3 — 11 11 — 6 11 — 20 — 167 — 1 — 1 Other Visits 13 — 6 7 6 7 50 49 — 3 6 — 7 7 6 20 25 6 — 5 — 5 3 1 24 19 — 24 3 302 1 1 — 2 Milk Enquiries (a) Expectant Mothers — — 1 1 — — — — — — — — — — — 3 1 — — — — — — — — 1 — 2 — 9 — 1 — 1 (b) Under 1 year 1 — 7 — 1 2 — 3 — 2 — — — 2 2 7 7 — — 1 — — 2 — — 6 — 5 — 48 5 — — 5 (c) 1—3 years 2 — 2 — — — 1 2 — 1 — — — — — 7 2 — — — — — — — — 2 — 5 1 25 — — — — Visits re Deaths of Children (a) Under 1 year 1 — 3 — 3 — 1 3 — 2 — — — — 2 8 3 — — 2 — 1 1 — — 10 — 2 — 42 2 1 1 4 (b) 1—2 years — — — — 1 — — — — — — — — — — 1 1 — — — — — — — — — — — 1 4 — — — — (c) 2—5 years — — — — 2 1 — — — — — — — — — — — — — — — — — — — — — — — 3 — — — — Other visits 6 — 2 115 13 6 13 7 — 6 2 — 48 — — 2 24 — — 48 — — 2 30 — 2 — 15 9 350 3 1 — 4 Total Visits 1189 3017 3144 530 1829 372 2432 818 84 1160 437 31 354 609 587 2661 2696 329 56 600 607 2807 2387 1467 1128 2739 13 1289 559 35931 163 507 126 796 Consultations attended 210 127 119 257 158 15 158 46 3 55 12 2 170 25 16 105 68 6 1 196 15 166 145 191 54 156 1 149 121 2747 57 55 16 128 Classes attended 54 4 — 63 9 1 1 1 — 6 2 — 34 5 — — 1 — — 31 — 32 29 2 — — — 33 — 308 18 19 4 41 Special Interviews at Centre 1194 — — 2502 105 — — 3 — 2 — — 1216 126 2 15 36 — — 1336 — 37 175 656 — 174 — 573 24 8176 113 58 7 178 Ineffective Visits 167 348 453 40 1062 115 215 334 61 644 285 13 114 162 150 516 784 117 16 132 287 593 804 220 341 521 3 180 158 8835 100 146 55 301 In addition to the above, visits were made by Student Health Visitors attached to Centres as follows : Camden Town, 1,037; Kentish Town, 445. Notes:—(a) Superintendent. (b) Acting Superintendent. (c) Temporary full-time workers not paid directly by Borough Council—Miss George resigned in March. Mrs. Just resigned in January. (d) Temporary part-time worker, not paid directly by Borough Council. Temporary full-time and paid by Borough Council as from 1st April. (e) Temporary part-time worker paid by Borough Council. Temporary full-time as. from 1st April, (f) Temporary full-time workers paid by Borough Council. (i) Miss Phillips, March till 19th June. (ii) Mrs. Edwards appointed and resigned in July. (iii) Miss Lunn appointed 26th July—resigned '25th December. (iv) Miss Slader appointed 29th June—resigned 28th August. (v) Miss Whitmarsh, appointed 2nd November—resigned 4th December. (vi) Miss Cross appointed 27th December. (g) Miss Anderson retired on 30th June. (h) Mrs. Hunter retired on 30th November. (i) Miss Harris was employed at Kentish Town, Queen's Crescent and South Highgate Centres. (j) As from 1st May only. (k) Employed and paid by University College Hospital. 122 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 3,798 and of still births 131. There were 221 illegitimate births. The number of registered live births was 3,796, 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. •The apparent discrepancy being accounted for by the difference between the time allowed for notification and that allowed for registration. CHILD WELFARE. 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 1933 1934 1935 1936 1937 Children 0-1 First 2587 2454 2365 2334 2364 ,, 0-1 Total 15450 14094 16340 13434 14395 ,, 1-5 Total 17011 14293 16399 14341 15387 Attendances by Children 0-1 27079 25107 24678 24668 24103 ,, 1-5 15868 14830 15818 15325 15654 [See Table IV for details of work at each Centre.] 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. Particulars regarding the medical examination of school children in St. Pancras arc contained in the following tables kindly supplied by the School Medical 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 38 per cent. of school entrants in St. Pancras in 1937 were found to have this condition, while 25 per cent. of children examined in school at 14 years of age had defective teeth. Particulars of the facilities for dental treatment provided in connection with the St. Pancras Maternity and Child Welfare scheme are given on pages 112, 113 and 116. 123 Table V. Examination of Elementary School Children in St. Pancras in 1937. 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 1005 786 778 1142 993 803 790 1044 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. # Malnutrition 11 7 6 5 9 8 — — 2 — 3 1 1 1 6 3 Skin disease 5 2 8 8 5 4 13 9 14 13 4 3 4 2 12 8 Defective teeth — 371 — 219 — 191 — 306 — 380 — 195 — 155 — 233 Enlarged tonsils 156 73 60 26 23 4 20 6 161 77 58 20 32 12 22 10 Adenoids 9 7 3 3 — — 1 1 8 7 5 3 1 1 1 — Enlarged tonsils and adenoids 75 22 37 11 21 5 23 1 71 26 31 8 30 9 15 2 Other nose and throat defects 10 4 9 8 4 4 2 2 5 — 2 2 2 1 3 2 Enlarged glands 49 10 45 8 16 2 20 1 58 12 40 7 14 4 6 — Eye disease 30 18 10 6 8 7 7 5 36 24 19 10 9 6 11 9 Vision defects — — — 54 — 80 — 100 — — — 75 — 84 — 113 Otorrhœa 16 12 9 8 5 4 6 6 29 17 7 4 6 6 4 4 Other ear disease 1 — 1 1 2 2 2 2 2 2 1 — — — 2 1 Defective hearing 3 1 4 1 3 1 2 — — — 2 1 3 1 1 1 Speech defects 2 — 1 — — — 2 2 — — 3 1 — — — — Heart defects 16 — 15 — 17 — 14 — 20 2 11 — 17 3 21 2 Anæmia 3 1 3 — 6 1 2 — 3 2 1 — — — 3 — Lung defects 40 11 22 4 9 1 3 1 39 6 23 5 6 3 3 — Nervous defects 2 1 — — 4 1 1 — 3 — 4 — 3 — 1 1 Phthisis 5 — 6 1 2 — — — 7 — 1 — 7 1 1 — Other T.B. disease — — — — — — — — — — — — — — — — Rickets 7 — 8 — — — — — — — — — — — — — Spinal deformities 1 1 6 5 5 4 2 1 2 1 2 1 11 6 12 8 Other deformities 11 3 3 1 5 — 4 2 2 — 7 2 8 2 11 7 Other defects 32 22 14 9 13 10 6 3 26 18 26 19 22 15 25 18 Number of children noted for treatment — 491 — 319 — 286 — 392 — 497 — 297 — 275 — 380 * Defects, however slight, are included under "Cases." Those severe enough to require treatment are shown under * 124 Table VI. Routine Medical Inspection of Elementary School Children in St. Pancras in 1937. 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. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than four decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 1005 651 340 14 131 831 43 — 981 20 4 987 16 2 591 272 142 — — — Girls 993 636 350 7 143 820 30 — 945 41 7 975 18 — 573 268 157 — — — Age 7— Boys 786 443 330 13 90 660 36 — 760 25 1 771 14 1 538 196 52 547 152 78 Girls 803 465 331 7 113 651 38 1 737 60 6 789 14 — 584 160 59 585 125 81 Age 11— Boys 778 449 323 6 118 625 35 — 742 29 7 761 16 1 572 186 20 593 79 104 Girls 790 500 286 4 149 624 16 1 724 50 16 784 6 — 619 154 17 573 101 113 Age 14— Boys 1142 675 463 4 196 933 12 1 1117 24 1 1132 10 — 837 278 27 877 110 124 Girls 1044 671 365 8 280 745 17 2 959 76 9 1041 2 1 797 223 24 787 126 130 Total 7341 4490 2788 63 1220 5889 227 5 6965 325 51 7240 96 6 5111 1732 498 3962 693 631 Percentage 61.1 38.0 0.9 16.6 80.2 3.2 94.9 4.4 0.7 98.6 1.8 0.1 69.6 23.6 6.8 75.0 13.1 11.9 London 55.6 44.1 0.3 16.5 77.4 6.1 97.6 2.1 0.3 99.1 0.9 0.0 70.2 26.3 3.5 67.6 19.0 13.4 125 The INFANTILE MORTALITY rates for previous years, and the figures for each Ward, are given in tables on pages 14 and 15 respectively. On pages 126 and 127 tables are given which indicate:— 1. The causes of death of all children under one year of age during 1937, 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. (1) Deaths under One Year of Age in the Borough of St. Panckas dumng 1937. (This table is prepared by the Registrar-General and relates to the period 1st January to 31st December, 1937.) CAUSE OF DEATH. AGE. deaths in each ward. No Address. Totals. Under 1 day. 1 day to 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. 1. 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 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 Diphtheria — — — — — — — — — 1 1 — — — — — — — — — — — — — — — 1 — — — 1 Influenza — — — — — — 1 — — 1 2 — — — — 1 1 — — — — — — — — — — — — 1 1 Meningococcal Meningitis — — — — — — — 1 1 — 2 — — — — — — — — — 1 — — — — — — — — 1 1 Other Tuberculosis diseases — — — — — — — 1 — — 1 1 — — — — — — — — — — — — — — — — — 1 — Bronchitis — — — — — — 1 1 — — 2 — — 1 — — — — — — — — 1 — — — — — — 1 1 Pneumonia (all forms) — 2 1 1 — 4 7 10 6 5 32 7 — 1 4 1 1 5 1 2 — 2 2 2 — 1 3 — — 21 11 Convulsions — 1 — — — 1 — — — — 1 1 — — — — — — — — — — — — — — — — — 1 — Diarrhœa and Enteritis — — — — — — 8 18 18 7 51 7 4 1 5 7 2 3 2 3 2 3 2 3 3 2 2 — — 29 22 Congenital Malformation 2 1 1 — — 4 5 2 — — 11 2 3 — — 3 — — 1 — 1 — — — 1 — — — — 5 6 Premature Birth 7 14 1 2 — 24 5 — — — 29 4 2 — — 2 4 — — 2 2 1 — 1 6 1 3 1 — 12 17 Injury at Birth 1 2 — — — 3 — — — — 3 — — — — 2 — — 1 — — — — — — — — — — 2 1 Atelectasis 1 3 — — — 4 — — — — 4 — — — — — 2 — — — — — — — — 2 — — — 2 2 Other defined diseases — 1 1 1 1 4 2 2 1 — 9 2 1 — — 1 2 — — — 1 — 1 1 — — — — — 4 5 Causes ill-defined or unknown 1 — — — — 1 — — — — 1 — — — — — — — — — — — — — — — — 1 — 1 — Other violence 3 — — — — 3 — — — 1 4 — — — — — — 1 — — — — 1 — — — — 1 1 2 2 Totals 16 24 4 4 1 48 29 35 26 16 154 24 10 4 9 17 12 9 5 7 7 6 7 7 11 6 9 3 1 83 71 Deaths of infants not belonging to St. Pancraa occurring within the Borough, are excluded. ,, ,,belonging ,, ,, outside ,, ,, included. 9SI Nett Births in the year legitimate 2143 illegitimate 221 Nett Deaths in the year legitimate infants 126 illegitimate infants 28 Death rate per 1000 births legitimate infanta 58 illegitimate 127 legitimate and illegitimate 65 St. Pancras INFANTILE DEATHS per 1000 registered births. (children under the age of 12 months.) 127 (2) Deaths from Stated Causes under 1 Year or Age tor 1937 and 10 preceding Years. CAUSE OF DEATH. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1986 Aver age for 10 years 1937 Measles — 30 — 3 1 6 — 8 — 2 7 — Scarlet Fever — — — — — — 1 — — — — 1 Whooping Cough 15 10 32 2 10 11 4 3 9 8 11 — Diphtheria and Croup — — 3 1 1 1 1 — — — 1 1 Erysipelas — — — 2 — 3 — 1 1 1 1 — Influenza 2 — 5 2 1 2 1 1 — 2 2 2 Tuberculous Meningitis 3 — — 1 1 1 1 — — 3 1 — Other Tuberculous Diseases 1 2 — 2 2 1 — — — 1 1 1 Meningitis (not Tuberculous) 2 1 4 3 8 3 6 3 — 6 4 2 Convulsions 1 1 6 — 1 — 2 — — — 1 1 Bronchitis 5 9 7 7 4 3 4 4 4 2 6 2 Broncho-pneumonia 42 43 43 20 42 27 12 24 31 15 33 — Lobar-pneumonia 2 3 4 — 3 1 — 1 2 — 2 — Pneumonia (type not stated) 1 2 1 3 1 2 — 1 1 — 1 32 Diarrhœa 3 8 5 6 6 9 2 — — 8 5 51 Enteritis 24 33 34 36 22 42 27 25 28 45 35 Gastritis — — 1 — — 1 — — — 12 — — Syphilis 2 4 1 3 2 2 1 1 2 1 2 — Rickets — — — 1 — — 2 — — — — — Suffocation (overlying) 1 1 — 1 — — — — — — 1 — Injury at Birth 9 2 9 4 3 6 2 3 5 5 5 3 Atelectasis 10 11 7 3 4 8 7 7 2 2 7 4 Congenital Malformations 15 20 23 12 23 10 14 17 12 12 18 11 Premature Birth 39 50 46 48 43 36 37 43 42 37 48 29 Congenital Debility, Solerema and Icterus 14 16 14 8 7 2 8 4 3 2 10 — Other causes 14 15 18 26 15 9 19 14 13 26 18 14 Totals 205 261 262 194 200 186 151 160 155 190 224 154 Nett Births 3299 3274 3170 3208 2955 2684 2589 2449 2466 23S9 3278 2364 188 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 Desirid by Ministry of Health. Additional Information. Cases Notified Treated At Home. In Hospital. 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. 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 271d 32a 23* 33 42 74 45 31‡ 36 32 16 15 11 17 23 56 26 23 21 24 11 16 12 16 19 18 19 8 15 8 23 26b 21¶ 31 40§ 73 43† 30 34 32 — 1 — — — — — — 1 — 1 — — — — — — — — — 1e 3c — 2g 2¶ 1 1* 1* — 11.4 13.4 9.3 13.5 16.2 27.6 15.2 9.1 11.4 9.8 11 7 7 14 14 30 18 17 11 12 9 11 10 15 19 15 14 6 12 6 Due to other causes. + Several cases removed to unknown addresses. ‡ Excluding one case, information unobtainable. || Died from Prematurity, Congenital Heart Disease and Gonorrhœal Ophthalmia. § One moved away to unknown addrese. ¶ (1) Died—Prematurity. Ophthalmia Neonatorum. (2) Died—Gastro Enteritis. Ophthalmia Neonatorum, Mongolism, Imbecility. g (1) 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. d Including two cases which moved to unknown address before recovery. e Prematurity, Ophthalmia Neonatorum (Gonorrhoea). In addition to the above, there were 25 cases of Mild Inflammation not notifiable as Ophthalmia Neonatorum. Out of the 27 notifications this year, three were considered "grave", twelve were of "moderate" severity, and twelve 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 one case. 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 (page 121), 129 Infant Life Protection—Public Health (London) Act, 1936, Part XIII. 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." At the end of the year there were 157 persons on the Register, of whom 100 were receiving 116 children for reward. Particulars of visits paid will be found in Table IV (page 121.) 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. Royal Free Hospital Welfare Centre. This Centre receives a grant from the London County Council. Welfare work in regard to babies born under arrangements 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 111. Supply of Milk to Mothers and Children. The Borough Council during the year continued to make grants of milk, either free or at reduced price. As a rule, in the case of expectant mothers, the grants were restricted to the last three months of pregnancy, and in the case of children to those who were under three years of age. 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. 130 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 1936 there were 187 families actually in receipt of milk under the Borough Council's scheme. During 1937, 429 new families were added to the list of recipients. By the end of that year there were 232 families receiving grants. The total cost of this scheme in 1934, was £992; in 1935, £1,067 ; in 1936, £1,028 ; and in 1937, £1,183. With the approval of the Public Health Committee, the grants of dried milk were increased from to lbs. weekly, as from Sunday, 28th November, 1937. 131 During the year 1937, 2,736 applications were considered and grants were made in 2,612 cases. 1,563 of the applications were from unemployed as against 1,394 during the previous year. The distribution of pints of fresh milk and pounds of dried milk for the year is shown in the following figures. FREE. HALF-PRICE COST. Month. Pints. †Lbs. (Dried Milk.) Pints. †Lbs. (Dried Milk.) £ s. d. January February March April *May June July * August September *October November December 6636 5656 5012 5180 5740 4732 4620 4928 4312 7000 6188 5572 215 195 135 115 120 125 165 150 165 200 170 180 490 518 462 336 434 322 322 378 364 518 504 672 20 27 30 25 33 30 27 53 35 30 40 33 122 0 8 107 3 9 92 10 11 91 4 7 88 18 6 75 2 5 76 12 3 81 18 9 83 12 2 128 13 9 121 5 0 113 19 7 Total 65576 1935 5320 383 £1183 2 4 * 5 week months making a year of 52 weeks. † 1¼ 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 292 cases, at a cost during the year of £42 19s. 1d. A deduction of 7½ per cent, is made from all accounts of dairymen supplying milk under the scheme to the value of £2 or over monthly. This has reduced the total cost by about £35, which should be deducted from the above figures. The scale in use in making the grunts 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 0 132 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. ST. PANCRAS DISPENSARY. Clinic for Ailing Mothers, and Children under School Age. A weekly clinic is held at the St. Paneras Dispensary, 39, Oakley Square (Tel. Evston 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: — 1937. 1936. 1935. New Cases: Children under 5 years of age 19 28 34 Ailing Nursing Mothers 12 5 16 Ailing Expectant Mothers 28 29 25 Attendances: Children under 5 years of age 33 50 130 Ailing Nursing Mothers 34 14 63 Ailing Expectant Mothers 60 49 66 Dispensary as a whole (including the above). New Cases: Children under 5 years of age 440 534 525 Ailing Nursing and Expectant Mothers 40 34 41 Attendances: Children under 5 vears of age 1669 1688 1525 Ailing Nursing and Expectant Mothers 94 63 129 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 404 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. Pancras Home for Sick Poor Children.—This is situated at "Avalon," 1, St. Alban's Road, and accommodates 22 children and the necessary staff. 133 Dr. Pritchard is the Medical Administrator. The age limit for admission is from 18 months to 5 years. The children are either convalescent after illness, or are weak, badly nourished, etc., and require good food, fresh air, and special care. A large garden is attached to the home and an outdoor playroom has been provided. 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 149, the average length of stay in the Home being 33 days. (6) Children requiring a longer period of convalescence, or who require more skilled nursing, are sent to various homes by the INVALID CHILDREN'S AID ASSOCIATION, and a contribution 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 34 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, 1937 are as follows:— Number of Days Open. Attendances. Average per Day. No. of places for children under 5. Whitefield Day Nursery 234 6484 28.0 40 Kentish Tn. Day Nursery 229 8843 38.6 45 Margaret Day Nursery 275 15,678 57.0 60 Foundling Site Day Nursery 253 4724 18.74 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 loo young to be admitted to the ordinary schools. 134 They are provided chiefly by voluntary effort, and no grant is made by the Borough Council The work is valuable and an increase in the use of this accommodation is desirable. Name and Situation. Accommodation. Average daily attendance. Somers Town Nursery School, 18, Crowndale Road 48 35 Jellicoe Nursery School, 6a, Rochford Street 52 46 Mary Ward Nursery School, 16, Burton Street 30 19 St. Christopher's Nursery School, Bridgewater Street 45 23 Buck Street Nursery School 40 34 It is regretted that it was found necessary to close the Magdalen Mission Nursery School, 5, Clarendon Street, after ten years' service to the community. Professional Nursing in Necessitous Homes. This is now provided by the staff of the three following District Nursing Associations:— Hampstead, Metropolitan and North London. (For addresses tee page 22.) The Borough Council has an arrangement with all the above Associations for the Home Nursing, at the request of the medical practitioner in attendance, of cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Pemphigus Neonatorum, Infective Enteritis, Acute Primary and Acute Influenzal Pneumonia. Of these Associations, only the Metropolitan District Nursing Association, whose local headquarters are at 14, Oakley Square, undertake the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment for this nursing is included in the block grant. The block grants made by the Council are as follows:— District Nursing Association. Under the Maternity and Child Welfare Scheme. Under the Influenzal Pneumonia Regulations. Total Block Graut. £ £ £ Hampstead 20 10 30 Metropolitan 187 10s. 62 10s. 250 North London 15 10 25 Totals 222 10s. 82 10s. 305 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 110 1660 15.1 Hampstead 123 2087 16.9 North London 50 337 6.7 Totals 283 4084 14.4 135 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 reduction of maternal mortality. It will be seen from the following Table VII., supplied by the Registrar-General, that 8 deaths were primarily classified as due to childbirth, and that 3 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 1937 was accordingly 3.2. Table VII. Maternal Mortality in Borough of St. Pancras in 1937. AGES. CONDI TIONS. WARDS 15-20 years. 20-25 years. 25-30 years. 30-35 years. 86-40 years. 40-45 years. 45 years and over. Married. Single. Widowed. I. II. III. IV. V. VI. VII. VIII. No Address.  Post abortive sepsis — 1 — — — — — — 1 — — — — — — — 1 — — Ectopic gestation — — — 1 — — — 1 — — — — — — — — 1 — — Puerperal sepsis — — — 1 — — — 1 — — — — — 1 — — — — — Other toxaemias of pregnancy — — — — — 1 — 1 — — — — 1 — — — — — — Other accidents of childbirth — 1 — — — — — 1 — — — — 1 — — — — — — Associated with pregnancy and childbearing but not classed thereto — 1 1 1 — — — 3 — — 1 1 — — — — 1 — — Midwives Act, 1936. The London County Council are the employing Authority. The scheme set up under the Act has been worked out in close co-operation with the Borough Councils, which are grouped for the purpose into five areas, A, B, C, D and E. St. Pancras is in area B with Holborn, Finsbury, Islington and the City of London. The Act conies into force on 1st January, 1938, and a report will be included in next year's Annual Report. Ante-natal Care. As the friends of many families in the Borough, the health visitors are the natural confidants when a baby 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 121 will show that during the year 3,634 visits were paid to 1,445 expectant mothers. From Table III., page 111, it will be seen that 1,129 expectant mothers made 5,189 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 2,364. 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. 136 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 112-114 and 129-132. 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, 1938, the number of midwives who, in 1937, had notified their intention to practise in St. Pancras was 104. 42 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 is 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. 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 1937 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 278 124 30 Royal Free Hospital 60 18 .. Elizabeth Garrett Anderson Hospital 44 53 .. St. Pancras Hospital 721 .. 13 Middlesex Hospital 114 .. 30 Queen Charlotte's Hospital 55 .. .. City of London Hospital 32 .. .. Royal Northern Hospital 20 .. .. St. Bartholomew's Hospital 7 .. .. Other hospitals 173 .. .. Queen Mary's Maternity Home 33 .. .. Maternity Nursing Association .. .. 159 Totals 1537 195 232 The cases admitted as in-patients as recorded in the above table represented 64 9 per cent, of the total number of St. Pancras births. As compared with the previous year, there was a slight increase in the number of those admitted as in-patients, 37 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 5 0 0 Elizabeth Garrett Anderson Hospital 3 0 0 Queen Charlotte's Hospital 6 0 0 City of London Hospital 13 0 0 Middlesex Hospital 26 0 0 University College Hospital 64 10 0 Maternity Nursing Association 1 0 0 Total £118 10 0 The corresponding grants for the previous three years were: £145 15s. 0d., £123, and £124 5s. Od. 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. 96 cases were dealt with during the year, 90 being maternity and 6 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. 138 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 1937 there were 30 notifications of Puerperah Pyrexia and 14 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 31 — Puerperal Fever Cases 13 Deaths 1. 139 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. conpinembnt. Infant. Mother. At Home. Living. Dead Viable. Non-Viable. Primipara. Unmarried. Ante-natal attention. Average Age. Deaths. In Institution. Doctor. Midwife. Student. Bronchitis 3 2 1 — 1 3 — — 2 — 3 31 — Broucho Pneumonia 2 1 1 — — 2 — — — 1 2 28 — "Chill" 1 1 — — — 1 — — — — 1 28 — External abscess 1 — — — — 1 — — — — 1 28 — Incomplete Abortions 3 — — — — — — 3 — — — 27 — Haematoma of wound after Caesarian Section 1 1 — — — 1 — — — — 1 27 — Maslitis 8 6 2 — — 8 — — 4 2 8 23 — Breast Abscess 3 3 — — — 3 — — 2 — 3 28 — Pyelitis 3 3 — — — 3 — — 1 1 8 28 — Retained Membranes 1 — 1 — — 1 — — — — 1 20 — Shock 1 1 — — — 1 — — 1 — 1 28 — No known Lesion 4 4 — — — 4 — — 2 — 4 26 — Puerperal Pyrexia. Totals 31 22 5 — 1 28 — 3 12 4 28 26 — Percentages — 70.9 19.3 90.3 — 9.7 38.7 12.9 90.3 — — Puerperal Fever. Associated with Abortion 4* — — — — — — 4 3 4 — 24 1 Other cases 9 9 — — — 8 1 — 5 1 9 26 — Totals 13 9 — — — 8 1 4 8 5 9 26 1 Percentages — 69.2 — — — 61.5 7.7 30.7 61.5 38.4 69.2 — 7.7 Total 44 31 5 — 1 36 1 7 20 9 37 26 1 Percentages — 70.6 11.5 — 2.3 81.8 2.3 15.9 45.5 20.5 84.1 26 2.3 * Seven patients were treated in Hospitals after abortion. 140 Comparative Figures for Recent Years ark as follows:— Puerperal Fever. 1937. 1936. 1935. 1934. 1933. 1932. 1931. 1930. 1929. 1928. Cases 13 15 26 18 31 42 25 33 43 33 Per 1,000 births. 100 cases. 1,000 births. Deaths 1 3 2 3 6 8 3 Nil. 5 3 Incidence 5.3 6.0 10.4 7.1 11.6 15.2 8.5 10.3 13.6 10.1 Mortality Rate 7.7 20.0 7.7 16.7 19.4 19.0 12.0 Nil. 11.6 9.1 Death Rate .4 1.2 •8 1.2 2.2 2.9 1.0 Nil. 1.6 0.9 Puerperal Pyrexia. Cases 31 17 17 24 37 34 37 37 53 41 1,000 births. Incidence 12.7 6.8 6.0 9.5 13.8 12.3 12.5 11.6 16.7 12.5 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. The work of the N. S. P. C. C.'s Inspectors, Mr. Ayling and Mr. LeCore, is of great assistance to this department and I wish to record how much I value this co-operation. 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. Th e 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. 141 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 Vistors as Infant Life Protection or Foster Children 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 necesairy, 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 Miss Blair and Miss Bristow to the Seventeenth 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.