LIBRARY STPAN 96 Metropolitan Borough of Saint Pancras. REPORT OK THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938. MAITLAND RADFORD, M.D., B.S., D.P.H. Printed by F. P. Lewingdon's Exors., 216 & 218, Eversholt Street, N.W.1. Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938. MAITLAND RADFORD, M.D., B.S., D.P.H. IV. CONTENTS. Introductory i—xiii Section I.—-Statistics, Social Conditions and General Information relating to the Area 1—16 „ II.—Population, Marriages, Births and Deaths 17—26 „ 111.—Sanitary Circumstances of the Area 27—36 „ IV.—Factories 37—42 „ V.—Housing 43—52 „ VI.—Inspection and Supervision of Food 53—64 „ VII.—Prevalence of, and Control over, Infectious Diseases 65—80 ,, VIII.—Tuberculosis 81—94 „ IX.—Maternity and Child Welfare 95—128 INDEX. page Advice cards 109 Aged persons, removal of 34 Agriculture Produce (Grading & Marking) Act, 1928 and 1931 56 Akers, R. C. xiii Altitude of Borough 2 Ambulance facilities 8 Ampthill Square Centre 10, 11, 100 Analysis of food 60 Analyst's notes 63 Ancillary services 116 Animal tests of milk 55 Ante-natal care 123 Ante-natal services 97 Area of Borough 2 Area of playing fields 2 Area of public open spaces 2 Area undeveloped 2 Artificial Cream Act, 1929 56 Artificial Light clinics 9 Artificial Light treatment—staff, statistics 103 Artificial pneumothorax 88 Attendances, visits, etc., at Centres 96, 99 Avalon 119 Bacteriological examination of milk 55 Bacteriological work 78,79 Bakehouses and Restaurant Kitchens 57 Barnes House Clinic 101 Baths and Washhouses 35 Bed Bugs 77 Beds and bedding for Tuberculous patients 92 Berry, L. G. xiii page Birth notifications 18,96,109 Birth rate 2,4 Births and Deaths Registration Act, 1926 19 Births— and Deaths Registration Act, 1926 19 and rates per Ward 5,18 In public institutions 18 Legitimate and illegitimate 2, 18 Registered 2,4,17 Still 2,19 Blair. Miss M. L. xiii Block grants 106, 121 Boarding out children from Tuberculous homes 92 Bodies received at Mortuary 26 Brookfield Estate 50 Buck Street Nursery School 121 Byelaws enforced by Borough Council 12 Camden Park Road site 50 Camden Town Centre 9,10,11,101 Canal Boats Act 34 Cancer deaths 3,23 Catarrhal Jaundice 75 Centres—Borough Council contributions 106 Centres—Maternity and Child Welfare 9, 96, 100 Cerebro-spinal meningtis 71 Child Welfare 109 Classes for Mothers 100—103 Cleansing and Disinfecting station 11,76 Cleansing of persons 78 Clearance Orders 48 V. Clinic for Sick Mothers and Young page Children 11 Clinics— Ante-natal 9 Artificial Light 9 Child Welfare 9 Dental 10,100,101,105 Massage 11,101,103 Schick Testing 11 School 10 Treatment centres, etc. 9 Venereal Disease 10 Cobden House, Arlington Road 50 Cod liver oil and milk supplied to mothers and children 116—118 Committee, Members of x Common Lodging Houses 33 Compulsory Purchase Orders 48 Condemned food 58 Confinement—subsidies and facilities 124 Consultations and attendances at Centres 99 Consultations, times of 98 Contributions of Borough Council to Centres 106 Convalescent home treatment 119 Convalescent Homes for Children 11 Coroner's Court 26 County of London (Measles and Whooping Cough) Regulations, 1938 14 Cowsheds 53 Dairies and Milkshops 54 Dairies and Milkshops, registration 54 Day Nurseries and Nursery Schools 9, 10, 120, 121 Death rate— (Adjusted) 2,20 (Adjusting factor) 20 Infantile 3,4,5,25,113 Maternal 2,22 (Unadjusted) 2 Deaths- Aged persons 23 Cancer 3,21,23,24 Causes (by ages, Wards and sex) 21 Diarrhoea and enteritis 3,21 Homeless persons 23 Illegitimate infants 3,25 Infantile by causes, age, Wards 113 Infantile by causes for last ten years 114 Infantile—legitimate and illegitimate 3,5,25 In public institutions in and outside the Borough 22 Maternal 2,122 Measles 3,21,74,75 Persons of unknown address 23 Rates by Wards 5,23 Registered 2,4,19 Transferable 4 Tuberculosis 3,5,21,81,82,85 Whooping cough 3,21,75 Deed, Miss M. xiii Defects remedied without notice 44 Dental clinics— page Ampthill Square 10,100 Camden Town Centre 10, 101 Eastman 10,105 St. Pancras Dispensary 10 Dentures for necessitous mothers 100, 101, 102 Dentures for tuberculous patients 91 Diarrhoea and enteritis—deaths 3 Dinners for Mothers and children 100, 101 Diphtheria 69 Diphtheria anti-toxin 70 Diphtheria immunisation scheme 11,70 Disinfecting and cleansing station 76 Disinfecting for institutions 77 Domiciliary midwifery service 123 Drainage 35 Dwelling-house inspection 44 Dwellings controlled by Estates Committee 49 Dysentery 72 Eastman Dental Clinic 10, 105 Economic conditions 7 Encephalitis Lethargica . 71 Engledow, C. A. xiii Enteric fever 71 Eradication of Bed Bugs 77 Erysipelas 71 Estates Committee—work of 49 Estates controlled by Borough Council 49 Factories Act, 1937 13,37 Factories and workplaces 40 Factories, etc., inspections 38,41 Factory inspections—defects found 39 Families (1931 Census) 2 Fegan, Miss J. xiii, 89 Fever, Scarlet 69 Finsen Light Treatment 89 Food analysis 60 Food and Drugs (Adulteration) Act, 1928 60 Food inspections 53 Food poisoning 72 Food summonses 62 Food surrenders 58 Food, unsound, condemned 58 Foster-mothers and children 116 Fried fish shops 57 German Measles and Measles 14,72 Grants to Welfare Centres 106 Haines, Dr. J. Finch xiii Hampshire Street area 48,51 Health propaganda 15 Health visiting 96 Health Visitors— (Students) 108, 127 Summary of year's work 108 Visits to children 108 Visits to expectant mothers 108 VI. page Home Helps 125 Home Nursing 11 Home Work and Outworkers 39 Hospital accommodation 16 Houses and flats erected 43 Houses let in lodgings 33 Housing— Conditions 46 Inspector 47 Act, 1936,—overcrowding 45 Act, 1936,—proceedings under 44,45 Schemes in the Borough 43 Ice Cream and Preserved Food 56 Illegitimate births 2, 18 Infant Life Protection 116 Infantile deaths per Ward 5, 113 Infantile mortality 5,25,112,113,114 Infants, Death Rates 3 Infectious diseases 65,66,67 Infectious disease, deaths 66,67 Infirm persons—removal of 34 Inhabited houses 2 Inquests 25,26 Inspection and supervision of food 53 Institute of Ray Therapy 9,103 Institutional midwifery 123 Institutional provision for unmarried mothers 11 Insulin, Provision of 11 Invalid Children's Aid Association 120 Itinerant milk vendors 54 Jaundice, Catarrhal 75 Kenbrook House, Leighton Road 49 Kentish Town Centre 9,95,102 Kirby, Mr. E. F. xiii Knowlson, Dr. M. E. xiii Lake, R. B. xiii Legal proceedings 29 Legislation 12 Lighting of staircases — tenement buildings 33 Local Acts—Byelaws 12 Lodging-houses 33 Lodgings, Houses let in 33 London County Council (General Powers) Act, 1938 15 Malaria 72 Map of Borough ii, iii Margarine—wholesale dealers 62 Marriages 17 Massage 11,101,103 Massage Clinics 11,101 Maternal Care 122 Maternal Mortality 2,122 page Maternity and Child Welfare— Advisory Sub-Committee 95 General Administration 95 Special activities 100—105 Maternity and Child Welfare Centres— Addresses, hours 9,98 Attendances, visits 97 Royal Free Hospital 9,97 University College Hospital 9,97 Work carried out 108 Maternity and Child Welfare Officer— Report 127 Maternity Outfits, sterilised 125 Mayoress of St. Pancras Home for Sick Poor Children 119 Measles— and German Measles 14,72 Death rate 75 Deaths 3,74 Incidence rate 75 Notifications 74 Nursing 73 Meat and other foods 56 Medical examination of school children 110,111 Medical Officer of Health—remarks ix Merchandise Marks Act, 1926 56 Meterological table 1 Midwifery— Cases 124 Grants to hospitals 124 Institutional 123 Service (Domiciliary) 123 Midwives Act, 1936 123 Milk Act, 1934 55 Milk— And cod liver oil grants 116—118 Bacteriological examinations 55 In sealed containers 54 Sampling 54 Shops and daries registration 54 (Special Designations) Order, 1936 55 Supplied to mothers and children 116—118 Supply 53 To school children 55 Tubercle tests 55 Vendors—itinerant 54 Mortuary 26 North St. Pancras School for Mothers 9,102 Notices served—intimation and statutory 27 Notifiable diseases 65,66,67 Notification of— Births 18, 109 Births Acts (1907, 1915) 18,109 Infectious disease 65,66,67 and deaths from infectious disease 66,67 Outworkers 39 VII. PAGE Nurseries, Day 9,133 Nursery Schools and Day Nurseries 9,10, 120 Nursing Associations 11, 121 Observation Day Nursery 100 Occupations 6 Offensive trades 32 Officers xi, xii Open air schools 11 Open spaces—area 2 Ophthalmia Neonatorum 71,115 Outdoor relief 7 Outworkers and home work 39 Overcrowding 45 Permitted numbers 46 Persons per acre 2 Persons per acre (1931 Census) 2 Playing fields—area 2 Pneumonia 72 Pneumothorax treatment 88 Poliomyelitis and Polioencephalitis 71 Population— 1931 Census 2, 17 Estimated 2,4,17 Of Wards 17 (Statistics) Act, 1938 14 Post-mortem examinations 26 Pritchard, Dr. P. V.—Report 127 Professional nursing 11,121 Prosecutions, food 62 Prosecutions—general santiary work 29 Provis, Dr. F. L. xiii Public Assistance Department 8 Public Baths and Washhouses 35 Public Health— Acts—proceedings under 44 Committee x Legislation 12 (London) Act, 1936 116 (Meat) Regulations, 1924 56 Officers xi, xii (Preservatives in Food) Regulations, 1925-1927 63 (Prevention of Tuberculosis Regulations, 1925 86 Prevention of Tuberculosis Regulations, 1930 83 Public open spaces—area 2 Public Vaccinators 69 Puerperal Maternal Mortality 2,122 Puerperal Pyrexia and Fever 71, 125,126, 127 Queen's Crescent Centre 9, 102 Queen's Crescent site 50 Rag and Bone dealers 32 Rag Flock 32 Rainfall 1 page Rat Week 36 Rate—sum produced by 2 Rateable value 2 Rats and Mice (Destruction) Act, 1919 35 Refuse collection and disposal 36 Rehousing facilities 47 Relief granted 7 Relief stations 8 Rent Restrictions Acts, 1920-1938 34 Rent Scales Revision 50 Restaurant Kitchens and Bakehouses 57 Royal Free Hospital Welfare Centre 9.97,99,108 St. Margaret's Home 11 St. Pancras Dispensary 10, 11, 119 St. Pancras School for Mothers 9,11,100 Samples of food analysed 60 Sanitary Inspection of the area 27 Sanitary Inspectors' visits 28 Sanocrysin treatment 89 Scarlet Fever 69 Schick Testing Clinic 11 School children—cleansing 78 School children, medical examination 110,111 School clinics 10 Schools, nursery 10 Schools, open air 11 Shops Act, 1934 33 Sick mothers and young children, Clinic 11 Slaughterhouses 59 Slaughtermen, licensing 60 Slaughter of Animals Act, 1933 59 Small Pox 68 Smith, Mrs. M. Ashwood xiii Smoke abatement 31 Soil and situation of Borough 2 Somers Town Centre 9,11,103 South Highgate Centre 9, 103 Staff xi, xii Staff changes during year xiii Staircases, tenement buildings 33 Statistical summary 2 Statistics, comparative 3 Statistics, Vital, for last 10 years 5 Statutory notices 27 Statutory powers—action under 44 Sterilised maternity outfits 125 Stillbirths 19 Student Health Visitors 108,127 Summonses—Food and Drugs (Adulteration) Act, 1928 62 Summonses—General sanitary work 29 Tenement buildings—lighting of staircases 33 Transfer of Powers (London) Order, 1933 59 Treatment of Pre-school child 112 viii. page Tubercle tests of milk 55 Tuberculosis— Beds and bedding 92 Boarding out of children 92 Care Committee 89 Death rates by Wards 5,84 Deaths 3,81,85 Deaths by ages 81 Deaths by ages, Wards and sex 85 Dental treatment 91 Disinfection of rooms 89 Dispensaries 10 Dispensary sessions 86 Employment of Patients 92 Handicrafts Class 92 Health Visitors' visits 89 Housing 91 Institutional treatment 88 Interval from notification to death 82 New cases 81,88 Notification register 86 Officer's Report 88 Prevalence and fatality 84 Primary notifications 81 Provision of clothing 91 Public Assistance 90 Receipts and Payments Account 94 Residential treatment 90 Shelter 92 Special death reports and transfers 83 Staff 89 Summary of work 87 page Tuberculosis, continued— X-ray work 89 Tuberculous patients—beds and bedding 92 Typhoid Fever 71 Underground rooms 47 Undeveloped area 2 Unemployed 7 University College Hospital Welfare Centre 9,10,97,99,104 Unmarried mothers 11 Unsound food 58 Vaccination 68 Venereal disease clinics 10 Visiting of homes 108 Ward births and deaths 5 Washhouses and Baths 35 Water certificates 34 Water cut off 34 Water supply 34 Well water 34 Westripp, H. E. xiii White, Dr. Burt xiii Whooping cough 14,75 Whooping cough deaths 3,75 Winchester, E. W. xiii Woolvin, J. T. xiii Workplaces 38,41 X-ray work 89 IX Public Health Department, Town Hall, Euston Road, N.W.1. June, 1939. To the Mayor, Aldermen and Councillors of the Metropolitan Borough ok St. Pancras. Sir, Ladies and Gentlemen, This Report upon the sanitary circumstances and the vital statistics of the Borough is the 83rd Annual Report that has been submitted and the fifth that I have had the honour to prepare. A summary of the principal statistics for the year 1938 is given on pages 2, 3 and 4. The Registrar General's mid-year estimate of the population again shows a fall, the decrease being 2,500 or 1.37 per cent. It is a matter of interest that the birth rate for the Borough has risen and is higher than for the last five years. In this respect the Borough reflects the slight upward tendency apparent in the rate for the Country as a whole. Graphs illustrating the birth rate, death rate and infantile mortality rate during recent years will be found facing page 4. Matters extraneous to the usual work of the Public Health Department made 1938 a difficult year for all concerned, and for this reason I wish to lay special emphasise upon my thanks to members of the Borough Council generally, to the Chairman and Members of the Public Health Committee, to the staff of the Public Health Department and to my colleagues in other Departments for their assistance and co-operation throughout the year. I am, Sir, Ladies and Gentlemen, Your obedient Servant, MAITLAND RADFORD, Medical Officer of Health. Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 1937, to October, 1938. CHAIRMAN. Councillor C. H. Denyer, M.A. 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, J.P. Spry, William Palmer. COUNCILLORS. Ward 2 Bell, Mrs. Florence Nightingale Harrison, J.P. 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 Gertrude. 3 Jackson, Miss Stella, B.A. 6 Kemp, Sydney Alfred. 2 Melvin, Frederick 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. November, 1938, to October, 1939. CHAIRMAN. Councillor C. H. Denyer, M.A. DEPUTY-CHAIRMAN. Councillor Mrs. E. Davies. EX-OFFICIO. The Right Worshipful the Mayor (Councillor George Albert Watts, J.P.). ALDERMEN. Crosby, Miss Ada, M.B.E. Evans, Evan. Gregg, Dr. Edward Andrew, J.P. Spry, William Palmer. COUNCILLORS. Ward 2 Bell, Mrs. Florence Nightingale Harrison, J.P. 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 Gertrude. 3 Jackson, Miss Stella, B.A. 1 Joshua, Miss Lucy Henrietta. 3 Melvin, Frederick George. 6 Needham, Mrs. May. 4 Pym, Mrs. Diana, B.A. 5 Rolles, Harry. 8 Seear, Ernest George. 7 Swift, Mansell James, F.R.M.S, 3 Tibbles, Mrs. Gladys. XI. STAFF OF THE PUBLIC HEALTH DEPARTMENT at end of the year 1938. MEDICAL OFFICER OF HEALTH. ADMINISTRATIVE MATERNITY AND CHILI 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. (a) 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. Adkins. ¶‡S. W. Capel. Inspectors of Factories. ‡||†**Miss J. A. J. Camman. ‡§B. H. Thompson. Homing Inspector. *‡§¶A. H. Walker. Assistant Housing Inspector. ‡¶xE. W. Winchester. District Inspectors. ‡§W. L. Brown. ‡§R. E. James. ‡M. Jaffa. xT.H.Hague. xW.C.Mansfield. ¶x+R. Warren. xW. B. Dykes. x¶R.N. Thomas. x¶J.A.Hoark. x¶J. F. Woolvin, xE. F. Kirby. x H. E. Westripp. TUBERCULOSIS DISPENSARY, BARNES HOUSE, CAMDEN ROAD. N.W.1. 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, †abcMrs. E. Bevan. Clerical, etc., Assistant, Miss J. Fegan. Dentist (art time), Mr. A. J. Maurice, L.D.S. CLERICAL STAFF. A. Carpenter, Chief Clerk. G. N. Cove. V. R. Meurice. G. F. Peeling, (g) C. W. Smith. C. A. Exgledow. L. G. Berry. R. B. M. Lake. (g) W. Shackcloth. J. Murphy. G. A. Mitchell. P. S. Thomas. F. E. Barker, (g) Miss A. Andrews, (g) Miss V. Clark. * Cert. Municipal and County Engineers. § San. Insp. Cert. Royal San. Inst. || Health Visitor's Certificate, † S.C.M. a state Registered Nurse. b Registered Fever Nurse. c Tuberculosis Training. X Cert. San. Insp. Examination Board. ^ Cert. Meat and other Foods. + Smoke Abatement Cert. (L.C.C.). ** Certificate, Qaeen Charlotte's Hospital. X Cert. Royal San. Inst. and San. Insp. Exams. Joint Board. (g) Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. XII. BOROUGH COUNCIL 8TAFF AT THE CENTRES AND CLINICS. (g) Medical Officers. No. of Consultations per month. Dr. Ol.ga Alcock 4 Dr. Chas. H. Alderton 4 Dr. Phyllis Dixon 5 Dr. Cyril Elgood 8 Dr. Helen Gillespie 5 Dr. Janie Lorimer Hawthorne 7 Dr. T. Ivor Hughes 5 Dr. M. E. Knowlson 4 Dr. Nora Leesmith 12 Dr. Caroline Meade 8 Dr. J. Balfour Neill 8 Dr. K. H. Odling-Smee 4 Dr. Audrey E. Russell 8 Dr. John W. Wigg 4 Dr. C. Kitcat 4 Dr. H. Burt White 4 (g) Dental Clinic (Camden Town). R. M. Underwood, L.D.S., Dentist 6 Dr. Jas. Maughan, Anœthetist 2 (g) Artificial Light Clinic. Dr. P. Y. Pritchard 8 (The above are part-time officers.) (g) Superintendents of Maternity and Child Welfare Centres. ¶||†Miss M. L. Blair. ||†MRs. E. Crockart. †||Miss G. R. Bristow. **||†Miss M. Manger. ll†Mrs. S. C. Chapman. ||†Miss E. M. Robinson. (g) Health Visitors at Maternity and Child Welfare Centres. ¶†**Miss E. B. Bagnall. ¶||Miss A. M. U. Harrop. ‡||Miss V. K. Blaxland. †Mrs. E. Lurie. ||†Mrs. E. E. Bruce. †||‡Mrs. J. Lynn. ||†Miss B. M. Harris. (N.B.—In addition there are four temporary Health Visitors at the Centres.) 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. Prudamks( Do. ). (The above are full-time officers.) ‡ Cert. San. Insp. Examination Board. || Health Visitor's Certificate. § San. Insp. Cert. Royal San. Inst. † S.C.M. ¶ State Registered Nurse. ** Midwifery Certificate, Queen Charlotte's Hospital, (g) Officers to whose salary contribution is made under the Public Health Actsor by Exchequer Grant, Xlll. CHANGES IN STAFF DURING 1938. (a) Sanitary Inspectors and Clerical Staff. Mr. R. C. Akehs, Sanitary Inspector, retired from the service on 31st March, his duties being taken over by Mr. J. F. Woolvin. Mr. C. A. Engledow, Grade "A" Clerk in the Department, was promoted to the Grade " B" clerkship in place of Mr. Woolvin. Mk. E. W.Winchester, Sanitary Inspector, was appointed Assistant Housing Inspector (a new post authorised by the Council 011 25th May) as from 1st November. Mr. E. F. Kirby (Grade "B" Clerk in the Department) was appointed to the post vacated by Mr. Winchester, and his duties taken over by Mr. R. B. M. Lake. Mr. II. E. Westripp (Grade "B" Clerk in the Department) was appointed Sanitary Inspector (a new post authorised by the Council on 25th May) as from 1st November, and his duties were taken over by Mr. L. G. Behry. Three Junior Clerks, Messrs. Mitchell, Thomas and Barker commenced duty in November. (b) Health Visitors. Mrs. M. Ashwoop Smith, Health Visitor attached to the Camden Town Centre, retired on 31st January. Miss M L. Bair was promoted to the position of Superintendent at the new Kentish Town Welfare Centre, Raglan Street, in February. (c) Tuberculosis Dispensary Staff. Miss M. Deed retired in September from her position as Clerical Assistant at the Tuberculosis Dispensary, and Miss J. Fegan was appointed in her place. (d) Medical Officers at Centres. It is regretted that Dr. J. Finch Haines and Dr. F. L. Provis both passed away during the year. Dr. Burt White and Dr. M. E. Knowlson were appointed during the year to the Staff of Medical Officers, to take Clinics at St. Pancras Dispensary and Camden Town Centre respectively. Section I. Statistics, Social Conditions and General Information relating to the Area. 1 Meteorological Table for Saint Pancras, 1938. (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.) 29.9 30.3 30.3 30.3 30.0 30.1 30.0 300 30.0 29.9 29.9 29.9 Air Temper ature— Mean of— A. Maximum 47.8 46.6 60.1 56.2 61.9 71.3 71.4 73.8 68.5 57.8 55.2 45.0 B. Minimum 39.0 36.6 41.8 39.2 45.9 63.9 55.1 56.2 53.1 46.0 46.1 36.2 Mean of A and B 43.4 41.6 60.9 47.7 53.9 62.6 63.3 65.0 60.8 51.9 50.7 40.6 Difference from Average +3.1 +1.1 + 7.2 —0.6 —2.5 + 1.6 -1.0 + 1.3 + 1.8 0.0 +6.6 -0.9 Humidity—Morning 86 84 78 66 68 63 71 81 82 83 87 91 Earth Temperature at 4 ft. depth 44.8 44.3 44.4 47.1 49.4 53.7 57.0 59.8 57.9 55.1 51.3 48.1 Bright Sunshine— Total Observed (daily mean) Hrs. 0.92 2.01 4.17 4.11 4.37 6.37 4.95 4.55 3.86 3.08 1.68 1.27 Per cent. of total possible 11 20 35 30 28 39 31 31 31 29 19 16 Percentage of average Hrs. 99 125 147 98 70 97 so 81 91 119 130 159 Rain and other forms of precipitation— Number of Days 21 9 4 4 11 5 13 10 15 18 15 21 Total Fall Ins. 2.78 0.48 0.34 0.10 1.43 0.34 1.17 1.80 2.38 2.72 2.98 3.55 Percentage of average (1881-1915) „ 149 29 19 6 81 17 49 81 131 103 126 149 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, 20.07 inches. 2 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, 530 acres. Playing fields (private), 7 acres. Undeveloped area, 50 acres. Soil and Situation.—Practically the whole of the Borough is situated on London clay. There are a few superficial deposits of gravel in the south, and lower Bagshot sands in the extreme north. The altitude varies from 48 feet above ordnance datum, the lowest point, which is situated in the south of the Borough in the neighbourhood of Ampton Street, King's Cross Road, to 427 feet above ordnance datum, the highest point, which is in Pond Square in the extreme north of the Borough. The Borough is about four miles long, extending from near Oxford Street in the south to Highgate in the north, and averages about a mile in width. Rainfall during the year recorded at Camden Square, 20.07 inches. Population (1931 Census), 198,133. Population (Registrar-General's mid-year estimate), 179,400. Number of persons per acre, 66. Number of inhabited houses at end of 1938 (according to Rate Books), 28,638. Rateable Value, £2,279,863. Sum produced by a penny rate, about £9,100. Number of families or separate occupiers (1931 Census), 56,929. Number of persons per acre (Census year 1931), 74. Live Births Legitimate Total. M. F. 2151 1083 1068 Birth rate per 1,000 of the estimated resident population, 135. Illegitimate 282 148 134 2433 1231 1202 Stillbirths 83 54 29 Rate per 1,000 total (live and still) births, 32.98. Excess of births over deaths, 370. Deaths 2063 1106 957 Death rate per 1,000 of the estimated resident population, 11.5. Adjusted Death rate 11.7 per 1,000 of the estimated population (see page 20). Deaths from puerperal causes (Headings 29 and 30 of the Registrar General's Short List) : — Deaths. Kate per 1,000 total (live and still) births. No. 29 Puerperal sepsis — — No. 30 Other puerperal causes 2 0.8 Total 2 0.8 3 Death rate of Infants under one year of age:— All infants per 1,000 live births, 64. Legitimate infants per 1,000 legitimate live births, 60. Illegitimate infants per 1,000 illegitimate live births, 95. Deaths from Cancer (all ages), 344. „ Measles (all ages), 12. „ Whooping Cough (all ages), 3. „ Diarrhoea (under 2 years of age), 42. „ Tuberculosis (all ages)—133. Pulmonary, 121. Death rate per l,000 of the estimated resident population, 0.67 Other forms, 12. „ „ „ 0.06 Comparative Statistics. Rate per 1000 of Population. Rate per 1000 Births. Birth rate Death rate. Infant Mortality. St. Pancras 13.5 *11.5 64 England and Wales 15.1 11.6 53 126 County Boroughs and Great Towns, including London 15.0 11.7 57 County of London 13.4 11.4 57 *Unadjusted. 4 VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1938 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000. Number. Rate per l,000 Nett Births. Number. Rate. 1928 206000 205600 3980 3274 15.9* 3053 14.8† 985 550 261 80 2618 12.7† 1929 204400 203900 4231 3170 15.5* 3505 17.2† 1005 626 262 83 3126 15.3† 1930 204400 203900 4660 3208 15.4* 2928 14.1† 999 549 194 60 2478 11.9† 1931 195600 195200 4483 2955 15.1* 2979 15.3† 933 555 200 68 2601 13.3† 1932 194000 — 4224 2684 13.8 2832 14.6 937 650 186 69 254.5 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 1938 179400 — 3841 2433 13.5 2501 13.9 1067 629 156 64 2063 11.5 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. 5 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. 1 485 14.9 369 11.3 25 51 17 0.5 2 275 15.4 212 11.9 23 83 15 0.8 3 477 15.9 365 12.1 26 54 31 1.0 4 307 14.1 269 12.4 23 75 16 0.7 5 343 13.2 279 10.7 13 38 18 0.7 6 208 12.7 153 9.4 13 62 10 0.6 7 113 9.6 117 9.9 17 150 6 0.5 8 225 9.6 261 11.2 13 58 15 0.6 Homeless — — 38 — 3 — 5 — Borough 2433 13.5 2063 11.5 156 64 133 0.7 * Per 1000 live births. 6 PRINCIPAL OCCUPATIONS OF THE INHABITANTS OF THE BOROUGH. There are no particular industries carried on in the Borough which to any extent affect the public health prejudicially. It is of interest to note that a large number of residents are engaged in work upon the railways. This necessitates residence in the neighbourhood and is an important factor in the local housing situation. The following table gives for eaoh sex the principal occupations as ascertained at the 1931 Census. The numbers and percentages engaged in the various occupations mentioned are also given:— Total Population (over 14 years of age): Males, 75,794 ; Females, 85,493. Males. Occupation. Number. Percentage. Transport Workers (Railways, &c.) 12,705 17 % Commercial and Financial (Shop Assistants, &c.) 8,771 11 „ Personal Service (Waiters, Hairdressers, &c.) 7,378 10 „ Metal Workers 4,565 6 „ Clerks and Typists 5,241 7 „ Wood and Furniture AVorkers 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 % 7 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 are of interest. They have been kindly provided by Mr. B. Chapman, Local Public Assistance Officer, and the Statistics Branch of the Ministry of Labour. Half-year ending Average weekly No. of persons receiving out-relief. Average weeklycost of relief. £ March 1936 3986 1649 September 1936 3524 1365 March 1937 3536 1499 September 1937 3086 1270 March 1938 3102 1424 September 1938 3113 1410 Number of unemployed:— Men. Women. Juveniles. Total. At January, 1936 5198 1255 137 6590 At January, 1937 4482 1169 143 5794 At January, 1938 5453 1404 -* 6857 At January, 1939 6283 1808 -* 8091 * The number of juveniles is not now published separately. 8 GENERAL INFORMATION. Public Assistance Department. Area IV.—Comprising the Metropolitan Boroughs of Holborn, St. Pancras, St. Marylebone and Hampstead. Local Public Assistance Officer (Area IV.) B. Chapman, Luxborough Street, W.1 (Tel. We/heck 6896 and 6897). Chief Relieving Officer. J. H. Webster, 29, Marylebone Road, N.W.1 (Tel. Welbeck 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 1 29, Marylebone Road, N.W.1. Welbeck 2894-5 2 & 3 Clifton Villas, Camden Square, N.W.1. Gulliver 1230 4 Relief Station, Bower Cottage, Holmes Road, N.W.5 Gulliver 2868 5 Clifton Villas, Camden Square, N.W.1. Gulliver 1230 6 & 7 25, Kentish Town Road, N.W.1. Gulliver 4826 8 21, Medburn Street, N.W.1. Euston 1654 9 128, Albany Street, N.W.1. Euston 2618 10 Old Town Hall, Pancras Road, N.W.1. Euston 2392 11 89, Gray's Inn Road, W.C.1. Chancery 8012 12 Relief Offices, 53, Clerkenwell Road, E.C.1 Clerkenwell 5870 13 Ambulance Facilities. London Ambulance Service (Accident and General), Headquarters, The County Hall S.E.1 provides the following services:— (1) For removal of infectious, non-infectious and maternity cases. (Tel. Waterloo 3311.) (2) For accident cases. (Tel. Waterloo 6000.) Urgent maternity cases are removed to hospital at any hour of the day or night, free of charge, on application by a qualified medical practitioner or certified midwife, provided that a doctor or midwife accompanies the patient. Other ambulance facilities include:— St. John Ambulance Association, St. John's Gate, Clerkenwell, E.C.1. (Tel. Clerkenwell 6644.) British Red Cross Society, 14, Grosvenor Crescent, S.W.1. (Tel. Sloane 5191.) These convey pregnant women to hospitals from 8 a.m. to 11 p.m. 9 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 High gate. (Tel. Archway 3677.) (Mondays and Thursdays at 10 a.m.) The Borough Council. The Institute of Ray Therapy, 152-154, Camden Road. (Tel. Gulliver 3876.) A Voluntary Committee. A number of the hospitals in the Borough also provide this treatment. B. Maternity and Child Welfare Centres. Kentish Town Centre, Raglan Street, N.W.5. (Tel. Gulliver 1389.1 The Borough Council. St. Pancras School for Mothers, 1, Ampthill Square. (Tel. Euston 2972.) The Borough Council, with assistance 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. Euston 5050.) The Hospital Authorities, with a subsidy from the Borough Council. Royal Free Hospital Centre. (Tel. Terminus * 4331.) The Hospital Authorities. (The hours of attendance at the Council's Centres are given 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, Gospel Oak Grove. (Tel. Gulliver 2906.) The Voluntary Committee, with a subsidy from the Borough Council. Margaret Club and Day Nursery (for fatherless children), 42, Phoenix Road. (Tel. Euston 1822.) „ „ Whitefield Day Nursery, 53, Whitfield Street. (Tel. Museum 5196.) „ „ *Foundling Hospital Day Nursery „ „ [*Closed temporarily from end of October. To be opened in new building now in course of construction.] 10 Situation. By whom provided. D. Nursery Schools. Somers Town Nursery School, 18, Crowndale Road. (Tel. Euston 1958.) A Voluntary Committee. Jellicoe Nursery School, 6a, Rochford Street „ Mary Ward Nursery School, 16, Burton Street „ St. Christopher's Hall, Bridgeway Street The Committee of the St. Pancras House Improvement Society, Ltd Trinity Presbyterian Hall, Buck Street The Church Authorities. E. Denial Clinics. Barnes House, Camden Road (Tel. Gulliver 1667.): For nursing and expectant mothers and children under 5 years of age who attend the Maternity and Child Welfare Centres The Borough Council. Ampthill Square (Tel. Euston 2972): For mothers and children who attend the Centre at 1, Ampthill Square The Voluntary Committee. St. Pancras Dispensary (Tel. Euston 1882): For Tuberculosis cases The Borough Council. „ For ordinary cases The Dispensary Committee. Eastman Dental (Tel. Terminus 4331: For The Committee of the Royal Clinic nursing and expectant mothers and children; also provides in-patient treatment for tonsils and adenoid cases, cleft palate, &c. Free Hospital and Clinic. F. School Clinics. Highgate New Town, Chester Road; St. Pancras Centre, Prince of Wales Road; Clarendon Square Voluntary Committees, working under agreement with the London County Council. G. Tuberculosis Dispensaries. Barnes House, Camden Road. (Tel. Gulliver 2371.) The Borough Council. University College Hospital. (Tel. Euston 5050.) The Hospital Authorities. H. Ventreal 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. 11 Situation. By whom provided. I. Clinic for Sick Mothers and Young Children. St. Pancras Dispensary, 39, Oakley Square. (Tel. Euston 1882.) Medical Officer paid by Borough Council; other expenses paid by Dispensary Committee. J. Convalescent Homes for Sick Poor Children. The Mayoress of St. Pancras Home for Sick Poor Children, "Avalon," 1, St. Alban's Road, N.W. 5. (Tel. Gulliver 2626.) By Voluntary Committee, with grant from Borough Council. Invalid Children's Aid Association (various homes) Subsidy from Borough Council. K. Open Air Schools. Holly Court, Highgate, N. 6 London County Council. Euston Square, N.W. 1 „ L. Cleansing Station. 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, 6 & 7, Canonbury Place, N. 1. (Tel. Canonbury 1955.) By Voluntary Committee, with grant from Borough Council. Hampstead District Nursing Association, 3, Pond Street, Hampstead, N.W.3. (Tel. Hampstead 6406.) „ Metropolitan District Nursing Association, 31, Bedford Place, W.C. 1. (Tel. Museum 0352.) „ 14, Oakley Square, N.W. 1. (Tel. Euston 1358.) „ N. Massage Clinics. St. Pancras School for Mothers, 1, Ampthill Square. (Tel. Euston 2972.) By Voluntary Committee. Somers Town Welfare Centre, Chamberlain House. (Tel. Euston 2380.) „ Camden Town Welfare Centre, Barnes House. (Tel. Gulliver 1667.) „ O. Schick Testing Clinic (in connection with Diphtheria Immunisation Scheme). St. Pancras Dispensary, 39, Oakley Square. (Tel. Euston 1882.) By the Borough Council. P. Institutional Provision for Unmarried Mothers. St. Margaret's House, 218, Camden Road, N.W.1 (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. 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. 12 During the year, and with the sanction of the Ministry of Health, supplies have been provided in 12 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. (c) A quarterly report is to be furnished by the medical practitioner to the Medical Officer of Health giving the following information:— (1) Tbe number of doses of Insulin administered. (2) Particulars concerning any tests made of the urine or of the blood of the patient. (3) The progress of the patient during the period under report. Patients who are insured under the National Health Insurance Act are not eligible under the above scheme, as supplies of Insulin are available for them under the Act. Public Health Officers of the Local Authority. A complete list of the above, including both whole and part time officers, is given on pages xi. and xii. Local Legislation. A.—Local Acts, Bye Laws, and Regulations in force in the Borough:— 1. Bye-laws made by the Borough Council:— (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knacker's 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. (tf) 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. 2. Regulations concerning the use of Post-mortem rooms. 3. Bye-laws and Regulations made by the London County Council, but enforced by the Borough Council:— (a) Drainage bye-laws and deposit of drainage plans. (b) Closing and filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of fsecal and offensive matter by road. (e) Waterclosets, earthclosets and privies. 13 (f) Ashpits and cesspools. (g) Receptacles for dung. (h) Conveyance of carcasses of dead horses through streets. (i) Bye-laws with respect to houses divided into separate tenements, etc. (j) Licensing, inspection and supervision of seamen's lodging houses. (k) Registration, licensing, inspection and regulation of common lodging houses. (l) Licensing of dairymen to use premises as cow-houses. (m) Licensing and inspection of slaughter-houses and knackers' yards. (n) Offensive trades. (o) Rag and bone dealers. (p) Humane slaughtering of animals and poultry. (q) Demolition of buildings. (r) Ice cream vendors and premises. (s) Duties concerned with infant life protection under Part XIII. of the Public Health (London) Act, 1936. (t) Smoke abatement. (u) Fish curers and vendors of fried fish. (v) Dairies, cowsheds and milkshops. (w) Use of underground rooms for habitation. (x) Protection of food. B.—Public Health Legislation either enacted or coming into force during 1938:— Factories Act, 1937. (Came into force 1st July, 1938.) County of London (Measles and Whooping Cough) Regulations, 1938. Population (Statistics) Act, 1938. London County Council (General Powers) Act, 1938, Scction 3 and 4. A summary of the most important provisions contained in this new legislation is set out below:— The Factories Act, 1937. The New Factories Act which came 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 van boys. Under Section 54, basement bakehouses lawfully in use at the 30th July, 1937, must, in the year ending 30th June, 1939, and in every fifth succeeding year thereafter, be examined by the appropriate Metropolitan Borough Councils. If, as a result of the examination, the Council are not satisfied that the bakehouse is suitable for use as regards construction, height, light, ventilation and any hygienic respect, the Borough Council may give notice in writing that the existing certificate of suitability shall cease to have effect after the expiration of a period not less than one month specified in the notice, and the basement bakehouse must cease to be used accordingly. A right of appeal is given to a court of summary jurisdiction. On the other hand, if the Borough Council are satisfied that the bakehouse is suitable they are to give notice in writing that the certificate is to continue to operate in accordance with Section 54 (2) (b) of the Act. 14 County of London (Measles and Whooping Cough) Regulations, 1938. These Regulations came into operation on the 1st October, 1938, and have the effect of making the provisions of Sections 192 and 193 of the Public Health (London) Act, 1936, applicable to Measles and Whooping Cough subject to certain modifications. The present position is as follows:— Every medical practitioner attending on, or called in to visit, the inmate (in this section referred to as "the patient") shall forthwith, on becoming aware that the patient is suffering from measles or whooping cough, as the case may be, send to the district medical officer of health a certificate stating the full name and the age and sex of the patient, the full address of the house, and the disease, whether measles or whooping cough, from which, in the opinion of the medical practitioner, the patient is suffering, and stating also whether the case occurs in the private practice of the practitioner or in his practice as a medical officer of a public body or institution; and where the certificate refers to the inmate of a hospital, it shall specify the place from which, and the date on which, the patient was brought to the hospital, and shall be sent to the district medical officer of health for the district in which the said place is situate : Provided that this section shall not require any certificate— (a) where to the knowledge of the medical practitioner a case of measles or whooping cough as the case may be has occurred in the house and has been notified within the two months immediately preceding the date on which he first became aware of the disease in the case he is attending, (b) where the case is being treated in a hospital for infectious diseases, or (c) in the case of a person suffering from measles or whooping cough as the case may be admitted as a patient into a hospital belonging to the County Council, if at the time of his admission a copy of a certificate under this sub-section to that effect has been sent by a district medical officer of health to the County Council as in hereinafter provided. Under these Regulations the Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920, are repealed. The effect of the new regulations in this Borough is accordingly as follows:— Measles—the position remains unchanged so far as notification by doctors is concerned; parents and guardians are however no longer required to notify. Whooping Cough bccomes notifiable. German Measles is no longer notifiable. Population (Statistics) Act, 1938. This act, which came into operation on the 1st July, 1938, imposes on Registrars of Births and Deaths the duly of obtaining certain further particulars on birth, still-birth and death registration, in addition to those already required for entry in the register. This information is required for the compilation of statistical information with respect to the social and civil conditions of the population of Great Britain. Every person registering information regarding any birth, still-birth, or death is now required to furnish the Registrar with the following particulars if within his knowledge:— (1) On registration of birth or still-birth— (a) the age of the mother; (b) the date of the marriage; 16 (c) the number of children of the mother by her present husband and how many of them are living; (d) the number of children of the mother by any former husband and how many of them are living. (2) On registration of death— (a) if the deceased was a male, whether he had been married, and, if so, whether he was married at the date of death; (b) if the deceased was a woman and had been married— (i) the year in which she was married and the duration of the marriage; (ii) whether she had any children by the husband or any former husband. (c) the age of the surviving spouse, if any, of the deceased. It is provided that the additional information so supplied is not to be entered in the register, but is to be received and treated in the strictest confidence and transmitted to the Registrar-General for statistical purposes only. Any person who discloses such information in contravention of the Act is made liable to prosecution and to the penalties of imprisonment or fine or both. [Extract from Report of Town Clerk.] London Count; Council (General Powers) Act, 1938. Section 3 enacts that a sanitary authority may provide, either free of charge or subject to such payment as they may in any case determine, temporary shelter or house accommodation for any persons who vacate a house or part of a house by reason of any action taken by the sanitary authority in pursuance of section 123 of the Public Health (London) Act, 1936, for the destruction or removal of vermin in or from that house or part of a house or any other house or part of a house in proximity thereto. The sanitary authority may, with the consent of the Minister of Health, borrow for the purpose of the provision of shelter or house accommodation under these powers. Under Section 4, the London County Council may at any time submit to the Secretary of State (after complying with such requirements as to notice as may be prescribed) a draft order determining the places in the count)' for the holding of inquests by coroners appointed by the County Council, and assigning an area for each of such places, and providing that any inquest shall be held at the place appointed for the area in which the death occurred or in which the body was found, unless the coroner in any case deems the circumstances to be of such an exceptional nature as to render it expedient that the inquest should be held at some other place. The Secretary of State after taking into consideration any objections to the draft order made in the prescribed manner and within the prescribed time may make the order either in the terms of the draft submitted to him, or with such modifications as he thinks fit. It shall be the duty of the coroners to comply with the provisions of any order thus made. The Borough Council may be affected by the foregoing section as the St. Pancras Court has been very largely used for the holding of inquests on cases from adjoining Boroughs, although the latter have facilities of their own. It is interesting to record that during the past year, 548 inquests were held in the Coroner's Court, 147 of which were in respect of St. Pancras cases, and 401 from other Boroughs. These figures are typical of the conditions which have existed since 1932. [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 16 exist in the Borough by printing this information on the reverse side of the Monthly Lists and the book covers which are issued to borrowers at the libraries. HOSPITAL ACCOMMODATION. A. Ferer and Small Pox.—Hospital accommodation is provided by the London County Council. B. Tuberculosis.—For patients suffering from this disease Institutional accommodation is provided through the London County Council. C. General, Children's and other Hospitals.— The under-mentioned are situated within the Borough. The St. Pancras and Highgate Hospitals are extensively used by residents of the Borough. St. Margaret's Hospital admits cases of the kind specified from the whole of the metropolitan area. The use of the various general and special voluntary hospitals is by no means confined to residents either of this Borough or of the metropolitan area. On the other hand, hospitals situated outside the Borough are largely used by St. Pancras residents. Hospital. Number of Beds. London County Council General Hospitals. St. Pancras Hospital I, St. Pancras Way (Tel. Euston 1617) 380 St. Pancras Hospital II, „ ,, „ 304 Highgate Hospital, Dartmouth Park Hill (Tel. Archway 2681) 545 London County Council Special Hospital. St. Margaret's Hospital, Leighton Road (for ophthalmia neonatorum and congenital syphilis in children) (Tel. Gulliver 2483) 90 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 256 Obstetric 45 Ear, Nose and Throat 26 National Temperance Hospital, Hampstead Road (Tel. Euston 3755) 158 Elizabeth Garrett Anderson Hospital, Euston Road (Tel. Euston 2501) 105 West End Hospital for Nervous Diseases, Regent's Park (Tel. Welbeck 1260) 76 Hospital for Tropical Diseases, 25, Gordon Street (Tel. Museum 3326) 77 Central London Throat, Nose and 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, 2, Fitzroy Square (Tel. Euston 2696) 22 St. Saviour's Hospital, Osnaburgh Street (Tel. Euston 2770) 21 North-West London Hospital, Bayharn Street (Tel. Gulliver 1734) Outpatients only. St. Pancras 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. Welbeck 1133) Section II. Population, Marriages, Births and Deaths. 17 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 (1938) population of the Borough is estimated by the Registrar-General to be 179,400, the corresponding estimate for the previous year (1937) being 181,900. The following figures shew the estimated number of persons in each of the Wards in the Borough :— Administrative Area of St. Pancras Metropolitan Borough. Census, 1931. Total (Estimated) 1938. Males. Females. Total. Ward — No. 1 15,867 20,005 35,872 32,484 No. 2 9,621 10,054 19,675 17,821 No. 3 15,615 17,543 33,158 30,020 No. 4 11,965 11,990 23,955 21,693 No. 5 13,737 15,004 28,741 26,023 No. 6 8,861 9,139 18,000 16,294 No 7 6,155 6,867 13,022 11,769 No. 8 12,562 13,148 25,710 23,296 Total . . 94,383 103,750 198,133 179,400 MARRIAGES. The following table shews the number of marriages for 1938, and for each of the preceding four years :— Year. Estimated Population. Number of Marriages. Marriages per 1,000 of Population. 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 1938 179,400 2,178 12.1 BIRTHS. The number of births registered during the year belonging to St. Pancras was 2,433, equal to an annual birth rate of 13.5 per 1000 of estimated population. The rate for the previous year was 13.0, and the rate for 1936 was 13.0. The actual number of births registered as having taken place in the Borough during the year was 3,841. This figure is corrected by deducting the births of non residents (1,904), which occurred chiefly in the various hospitals and other institutions in the Borough, and by adding the births belonging to St. Pancras (496) which occurred out»ide the Borough. The corrected figure is 2,433. 18 The corresponding figures for previous years are given on page 4. The following table gives the number of births and the birth rate per 1,000 of estimated population in each Ward of the Borough for the year 1938, and for comparison the figures for the previous year are also given : — Ward Births and Birth Rates. Ward. 1938 1937. Births. Birth Rate. Births. Birth Rate. 1 485 14.9 463 14.1 2 275 15.4 279 15.4 3 477 15.9 512 16.8 4 307 14.1 291 13.2 5 343 13.2 285 10.8 6 208 12.7 172 10.4 7 113 9.6 115 10.0 8 225 9.6 247 10.4 Borough 2433 13.5 2364 13.0 No less than 2,971 births occurred in Public Institutions in St. Pancras, equal to 77*3 per cent, of the total births which took place in the Borough. Illegitimacy. Of the 2,433 net St. Pancras births, 282, or 11.6 per cent., were recorded as being illegitimate. The corresponding figures for the preceding 10 years were as follows:— Year. Rate. Year. Rate. 1928 7.3 per cent. 1933 8.8 per cent. 1929 7.8 „ 1934 9.8 „ 1930 8.4 „ 1935 8.8 „ 1931 8.3 „ 1936 9.7 „ 1932 8.0 „ 1937 9.3 „ 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 Notification of Births Acts (1907-1915) require "information with regard to the event to be given to the Medical Officer of Health within 36 hours of the occurrence of the birth of a child, alive or dead, which has issued forth from its mother after the twenty-eighth week of pregnancy." This notification is in addition to, and not in substitution for, registration of birth, which must be carried out at a Registry Office within forty-two days of the birth. 19 The notifications of births received during the year numbered 3,892; which includes 119 still-births and 3,773 live births. The figure of live births notified represents 98.2 per cent, of the births registered as having taken place in the Borough. This ratio affords an indication as to the efficiency of notification. Still-Births. The Births and Deaths Registration Act, 1926, which came into force on 1st July, 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 twenty-eighth 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. A communication has been received from the Registrar-General to the effect that as the operation of the Population (Statistics) Act, 1938, has necessitated a change in the Birth and Still-bii th tabulation procedure, it is not now practicable to furnish separate records of the inward and outwards transfers of still-births. The following table gives particulars, by sex and legitimacy, with reference to still births actually allocated to the Borough during the year:— Legitimate. Illegitimate. Total. Males 41 10 54 Females 22 7 29 DEATHS. The actual number of deaths registered as having taken place in the Borough during the year was 2,501. This number is to be corrected by the exclusion of 1,067 deaths which occurred in the Borough of persons who were not St. Pancras residents, and by the inclusion of 629 deaths of residents which occurred outside the Borough. The net number of St. Pancras deaths registered during the year was accordingly 2,063 ; equal to an annual death rate of 11.5 per 1000 of estimated population. Details of the corresponding figures for previous years will be found in the table on page 4. 20 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 11.5 per 1000 of population is adjusted by the comparability factor of 1.02 to 11.7 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. 21 THE CAUSE OF DEATH AT ALL AGES, TOGETHER WITH WARD DISTRIBUTION, IS SHOWN IN THE FOLLOWING TABLE:— CAUSES OF DEATH. Ages—Both Sexes. DEATHS IS EACH WARD. SEX- Under 1 yeai. 1 and under 2 years. 2 and under 5 years. 5 and under 10 years. ^ 10 and under 15 years. 15 and under 20 years. 20 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Ward 1. Ward 2 Ward 3. Ward 4, Ward 5. Ward 6 Ward 7. Ward 8. No address. Totals. M F M F M F M F M F M V M F M F M F M F ALL CAUSES 156 12 12 7 12 22 38 76 J 06 188 382 505 413 134 182 187 110 102 186 179 157 112 147 132 84 69 60 57 157 104 23 15 1106 957 1. Typhoid and Paratyphoid Fevers — — — — — — 1 — 1 — — — — — — — — — — — — — — — — 1 — — 1 — — 1 1 2. Measles 5 3 3 1 — — — — — — — — — — 1 3 1 2 1 1 2 1 — — — 6 6 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 1 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 1 5. Diphtheria — 1 3 2 — — 1 1 — — —% — — — — 1 — — 2 1 — 2 — — 1 — 1 — — — — 4 4 6. Influenza 1 — — — — — — — — 1 2 2 — — 1 2 — — 1 — 1 — 1 — — — — — — — — — 4 2 7. Encephalitis Lethargica — — — — — — — 2 — — — — — — — 1 — — 1 — — — — — — — — — — — — — 1 1 8. Cerebro-spinal Fever 3 — — — — — 1 — — 1 — — — — 1 - 1 — 1 1 — — — — 1 — — — — — — — 4 1 9. Tuberculosis of Respiratory System — 1 — — 1 7 12 22 23 26 16 9 4 — 12 4 7 7 14 14 9 4 12 5 5 3 5 1 11 4 2 2 77 44 10. Other Tuberculous Diseases 1 — — — 1 1 1 5 1 — — 1 1 — 1 — 1 3 _ 3 — 1 — 2 — — — — 1 — 5 7 11. Syphilis 4 — — — — — — — 3 6 4 5 2 — 1 1 — — 3 1 2 1 — 1 — 1 5 2 — — — — 17 7 12. General Paralysis of the insane, tabes dorsalis — — — — — — — 1 4 4 1 — — — — — 1 — 2 — — — 2 — 1 — 3 — 1 — — — 10 — 13. Cancer, Malignant Diseases — — — — — 1 2 3 17 40 112 114 47 8 29 31 19 16 35 30 31 16 18 34 15 10 3 8 27 19 3 — 180 164 14. Diabetes — — — — 1 — — — — 3 3 13 3 — 2 4 1 4 2 5 1 1 — — — — 2 1 — — — 8 15 15. Cerebral Hemorrhage, etc. — — — — — — — — 2 9 14 24 23 6 8 5 4 6 3 5 7 6 3 7 3 4 3 2 5 — 1 37 41 16. Heart Disease — — — 1 3 2 3 9 13 18 82 176 182 67 50 70 23 24 49 54 38 30 38 37 21 23 13 13 27 37 4 5 263 293 17. Aneurysm 1 — — — — — — — 1 1 3 5 2 2 1 1 1 — 3 1 1 3 2 1 — — — — 1 — — — 9 6 18. Other Circulatory Diseases — — — — — — — — — 2 18 34 30 10 6 10 3 4 8 — 5 7 8 4 3 2 5 6 7 6 2 1 47 47 19. Bronchitis 3 — — — — — — 1 — 4 17 15 9 3 6 4 7 3 6 4 6 I 3 3 — — — — 7 1 — 1 35 17 20. Pneumonia (all forms) 24 3 — — 1 1 2 4 4 18 31 33 18 12 12 8 11 13 7 18 9 9 7 9 5 3 7 3 19 8 1 2 78 73 21 Other Respiratory Diseases 1 — — — — 1 — 3 1 — 2 2 3 1 1 2 — 1 1 1 1 — 1 — 2 2 — — 1 1 2 — 9 7 22. Peptic Ulcer — — — — — — — 1 4 5 14 9 3 1 3 1 3 — 6 1 5 1 5 2 2 1 1 2 4 — — — 29 8 23. Diarrhoea, etc. 40 2 — — — — — — 1 — 1 3 1 — 4 7 5 6 5 3 2 1 5 2 2 1 — — — — — — 28 20 24 Appendicitis — — — 1 — — 3 — 1 1 1 1 — — 2 1 — — 1 — — — 1 — — 1 2 — — 5 3 25. Cirrhosis of Liver — — — — — — — — 4 — 1 3 1 — — — — — — — — 1 1 3 1 — — 1 2 — — — 4 5 2(5. Other Diseases of Liver, etc. — — — — — 1 — 1 2 — — — — 1 1 — — — — 1 — — — 1 — — — — — 3 1 27. Other Digestive Diseases 2 — — — 1 — 1 2 2 8 6 4 1 2 2 1 1 2 3 2 3 4 2 2 1 — 1 1 — — 15 12 28. Acute and Chronic Nephritis 1 — — — 1 — _ 2 •J 7 10 6 10 3 3 7 2 2 3 2 I 2 4 3 2 4 2 1 2 2 — — 19 23 29. Puerperal Sepsis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 30. Other Fuerperal Causes. — — — — — — — — 2 — — — — — — — — 1 — — — 1 — — — — — — — — — — — 2 31. Congenital Debility, Premature Birth, Malformations, etc. 56 — 1 — — — — — — — — — — — 9 6 4 3 4 6 4 2 1 2 2 3 6 2 1 1 1 34 23 32. Senility — — — — — — — — — — 2 2 20 13 1 4 1 1 5 4 4 2 2 2 — 1 2 2 4 1 l 15 22 33. Suicide — — — — 1 4 5 9 6 4 1 1 1 4 1 2 3 2 1 2 3 1 2 2 5 2 — — 18 13 34. Other violence 5 — 3 — 2 1 1 6 6 7 5 9 18 5 4 6 3 3 5 5 6 4 11 5 4 — 2 1 6 3 3 — 44 27 35. Other defined Diseases ... 8 — 2 2 2 4 10 10 10 20 29 27 31 1 21 13 7 3 15 16 13 10 14 5 7 4 2 3 13 6 3 l 95 61 36. Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Special Causes (1ncluded in No. 35 above) Erysipelas — — — — — — — — — — 3 1 1 — — — 1 — 2 1 — — — — — — — — — — — — 4 1 22 THE FOLLOWING TABLE GIVES PARTICULARS OF THE DEATHS IN PUBLIC INSTITUTIONS IN THE BOROUGH, TOGETHER WITH ST. PANCRAS DEATHS IN OTHER HOSPITALS OUTSIDE THE BOROUGH St. Pancras Hospital. Highgate Hospital. St. Margaret's Hospital. University College Hospital. Royal Free Hospital. National Temperance Hospital. Eliz, Garrett Anderson Hospital. West End Hospital. Hospital for Tropical Diseases. Central London Throat, &c., Hospital. Metropolitan Ear &c., Hospital. St. Saviour's Hospital. Royal Ear Hospital. Hampstead General Hospital. Middlesex Hospital. Other London Hospitals. Hospitals outside London. CAUSES OF DEATH. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St: Pancras. Belonging to St. Pancras. Not belonging to St- Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging to St. Pancras. Belonging to St. Pancras. Not belonging 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. ALL CAUSES 441 268 337 41 — 10 76 337 19 195 19 81 1 27 — 31 3 9 — 19 — 1 1 2 2 1 2 — — — 443 — 123 — 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2. Measles — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — 10 — 1 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — — — 5. Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — 5 — 6. Influenza — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — 7. Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — 8. Cerebro-spinal Fever 1 — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — 4 — — — 9. Tuberculosis of Respiratory System 11 5 37 16 — — 6 11 — 8 — 1 — — — 1 — — — — — — — — — — — — — — 40 — 9 — 10. Other Tuberculous Diseases 1 1 3 I — — 3 2 — 2 — 1 — — — — — — — — — — — — — — — — — — 5 — — — 11. Syphilis 10 2 5 — — — 1 1 1 2 — 1 — — — — — — — — — — — — — — — — — — 6 — 1 — 12. General Paralysis of the insane, tabes dorsalis — 2 1 — — — 3 — — — 1 — — — 2 — — — — — — — — — — — — — — — — 9 — 13. Cancer, Malignant Diseases 75 30 65 9 — — 22 112 — 44 4 29 — 8 — 10 1 2 — 1 — — — 1 — 1 — — — — 59 — 14 — 14. Diabetes 3 2 7 — — — — 5 — 3 1 2 — — — — — — — — — — — — — — — — — — 5 — — — 15. Cerebral Haemorrhage, etc. 19 5 16 — — — — 4 1 1 — — — — — — — — — — — — 1 — — — — — — 14 — 2 — 16. Heart Diseas 115 70 79 3 — — 7 23 3 19 1 7 — — — — — 1 — — — — — — — — — — — 108 — 28 — 17. Aneurysm 5 — 1 — — — 1 1 — 1 — — — — — 1 — — — — — — — — — — — — — 2 — — — 18. Other Circulatory Diseases 31 9 13 1 — — 2 8 — 5 1 3 — — — 2 — — — — — — — — — — — — — 14 — 5 — 19. Bronchitis 7 6 12 — — — — 3 — 4 — — — — — — — — — — — — — — — 1 — — — 9 — — — 20. Pneumonia (all forms) 42 39 33 3 — — 3 11 2 9 3 1 — — — 1 — — — 1 — — — — — — — — — — 29 — 10 — 21. Other Kespiratorv Diseases 5 1 1 — — — — 2 — 4 — 1 — — — — 1 — — 7 — — — — — — — — — — 3 — 2 — 22. Peptic Ulcer 12 2 6 1 — — 4 8 2 2 — 3 — — — — — — — — — — — — — — — — — — 8 — 1 — 23. Diarrhoea, &c. 1 1 9 2 — — — 5 1 8 1 1 — — — — — — — — — — — — — — — — — — 29 — 2 — 24. Appendicitis 1 — i 1 — — 2 9 2 1 — 2 — 2 — — — — — — — — — — — — — — — — 2 — — — 26. Cirrhosis of Liver 2 — i — — — 1 1 1 1 — — — — — — — — — — — — — — — — — — — 1 — 1 — 26. Other Diseases of Liver, etc. — — i — — — 2 4 — 2 — 4 — — — | — — 1 — — — — — — — — — — — 1 — — — 2?. Other Digestive Diseases 6 3 4 1 — — 4 12 — 6 2 4 — 3 — — — 1 — — — .— 1 — — — — — — — 6 — — — 28. Acute and Chronic Nephritis 6 7 7 — — — 1 13 1 7 — 4 — — — — — — — — — — — — — — — — — — 8 — 7 — 29. Puerperal Sepsis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 30. Other Puerperal Causes 1 1 — — — — 1 2 — — — — — — — — — — — — — — — — — — — — — — — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 16 5 — — — 5 9 27 1 20 — — — — — — — — — — — — — — — — — — — — 22 — — — 32. Senility 20 28 — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — 1 — 33. Suicide 2 3 2 — — — — 1 1 2 1 — — — — — — — 2 — — — 34. Other violence 13 8 4 1 — — 2 8 — 16 2 3 — — — 1 — — — — — — — — — — — — — — 22 — 6 — 35. Other defined Diseases 36 28 28 — — 4 3 60 3 27 4 13 — — — 9 1 2 — 10 — 1 — — 2 — 1 — — — 35 — 17 — 36. Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Special Causes (included in No. 35 above) Erysipelas 2 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 23 Of the total of 2,063 St. Pancras deaths which occurred during the year, no less than 1,467 took place in public institutions; this equals 71 per cent. of the total deaths. As compared with the previous year there was an increase in the number of deaths due to Syphilis, Measles and Cancer, and a decrease in those attributed to Tuberculosis, Influenza, Pneumonia, Heart disease 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 1938 was 1,05:4, which is 0'58 per cent, of the total estimated population. Of these 505 were between the ages of 65 and 75 ; 413 were between the ages of 75 and 85, and 134 were 85 years of age and upwards. Ward Deaths and Death Rates. The number of deaths and the death rates per 1000 of estimated 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. 1938. 1937. Deaths. Death Rate. (unadjusted.) Deaths. Death Rate. (Unadjusted.) 1 369 11.3 423 12.8 2 212 11.9 235 13.0 3 365 12.1 407 13.3 4 269 12.4 301 13.5 5 279 10.7 313 11.9 6 153 9.4 180 10.8 7 117 9.9 131 10.8 8 261 11.2 283 11.8 Homeless 38 — 56 — Borough 2063 11.5 2329 12.8 Deaths of Persons of unknown addresses, 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 14 St. Pancras Hospital 10 Highgate Hospital 1 University College Hos pital 7 St Margaret's Hospital 1 Hospital for Tropical Diseases 3 North Wood, Kenwood 1 Grand Union Canal 1 Total 38 DEATHS FROM CANCER. The deaths from Cancer in the Borough during the year 1938 numbered 344, as compared with 337 in 1937. Particulars concerning this disease, as regards Age, Sex, Situation of Disease and Wards, are set out in the following Table : — 24 The following table, shows the deaths from Cancer in the Borough during 1938. situation of disease. ages. Totals wards. No Address 1 2 3 4 5 6 7 8 0-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 &, up M f M f m F m f m F m f m F m F m f m f Tongue — — — — — — 4 1 — 1 4 2 — — — 1 1 — — — — 2 — 1 1 — — — — Palate — — — — — 1 1 1 — — 3 — — — — — 1 — 1 — 1 — — — — — — — — — Mouth — — — — — — — 1 — — 1 — — — 1 — — — — — — — — — — — — — — — Jaw — — — — — — — 1 — — — — — 1 — — — — — — — — — — — — — — — — Tonsil — — — — — — 1 1 — — 2 — — — 1 — 1 — — — — — — — — — 1 — — — Pharynx — — — — — — 2 3 — — 5 — — — 1 — 2 — — — 1 — — — — — — — — — Gum — — — — — — — 1 — — 1 — 1 — — — — — — — — — — — — — 3 — — — (Esophagus — — — — — — 3 6 3 — 10 2 1 — 1 — 3 — 1 — 1 2 — — — — — — — — Pylorus — — — — — — 1 2 — — — 3 — 1 — — — 1 — — — — — 1 — — 4 1 1 — Stomach — — — — — 8 18 18 7 3 36 19 11 3 6 3 7 3 4 2 2 5 1 2 — — 1 2 1 — Rectum — — — — 2 1 10 lb 9 — 18 20 2 5 — 2 5 4 6 3 1 2 2 2 — — 2 — — — Liver — — — 1 — 1 3 5 1 — 8 3 1 1 — — 1 — 2 — 1 2 — — — — — — — — Gall Bladder — — — — — — 1 3 1 — 1 4 — — — — — 2 1 — — 1 1 — — 1 2 — — — Pancreas — — — — 2 — 4 5 2 — 6 7 1 1 — 1 1 1 1 2 — — — — — — — — — — Small Intestine — — — — — — 1 — — — — 1 — 1 — — — — — — — — — — — — — — — — Caecum — — — — — — — 1 — — — 1 — — — — 1 — — — 2 3 1 — 1 1 2 — — Colon — — — — — — 5 8 6 — 6 13 1 3 — 1 — 2 — 1 1 — — — — — 1 — — — Splenic Flexure — — — — — — — 1 — — 1 — — — — — — — — — — — — — — — 1 1 — — Sigmoid Flexure — — — — — 1 1 1 1 — 2 2 1 — — — — — — 1 — — — — — — — — — — Intestine, not stated — — — — — — 1 — 1 — 1 1 — 1 — — 1 — — — — — — — — — — — — Omentum — — — — — — — — 1 — 1 — 1 — — — — — — — — — — — — — — — — — Peritoneum — — — — — — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — Larynx — — — — — — 1 1 2 — 4 — — — 1 — 1 — 1 — 1 — — — — — 6 4 — — Lung — — — — 4 13 21 10 2 — 38 12 8 2 5 — 4 1 7 2 5 — 2 — 1 3 — 3 — — Uterus — — — — 2 3 5 6 — 1 — 1/ — — — 1 — 5 — 3 — 2 — 3 — — — — — — Ovary — — — — 2 1 3 1 — — — 7 — 1 — 2 — — — 1 — 2 — — — 1 — 4 — — Breast — — — 1 4 6 13 8 3 2 11 36 — 10 1 3 — 6 — 1 — 11 — — — 1 2 — 1 — Kidney — — — — — 2 2 — — 44 — — — — — — — — — 1 — — — — — — — — Bladder — — — — — — 2 6 — 4 3 — — — 3 2 — 1 — — — 1 — — — 2 — — — Prostate — — — — — — 1 5 4 — 10 — — — 2 — 1 — 1 — 2 — 2 — — — — — — — Penis — — — — — — 1 1 — — 2 — — — — — — — 1 — 1 — — — — — 1 — — — Testicle — — — — 1 — — — — — 1 — — — — — — — — — — — — — — — — 1 — — Skin — — — 1 — — — 1 1 1 3 1 1 — — — 1 1 1 — — — — — — — — 1 — — Brain — — — — — 1 2 1 — — 2 2 — — — — — — 2 — — 1 — — 1 — — — — — Lymphosarcoma — — — — — 1 1 1 — — 1 2 — 1 — — — 1 — — — — — — — — — — — — Bones — 1 — — — — 1 1 — — 2 1 — — — — 1 1 1 — — 2 — — — — — — — — Thyroid — — — — — 1 1 — 1 — — 3 — — — — — — — — — — — 1 — — — — — — Muscles — — 1 — — — — — — — — 1 — — — — — — — — — — — — — — — — — — Soft Tissues, Thigh — — — — — — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — All Sites — 1 2 3 17 40 112 114 47 8 180 164 29 31 19 16 35 30 31 16 18 34 15 10 3 8 27 19 3 — 25 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 5 — — — 7 11 23 Pneumonia 3 — 1 1 10 6 21 Cerebral Hæemorrhage — — — — 3 — 3 Cancer — — — — 7 6 12 Tuberculosis — — — 1 4 1 6 Other causes 15 1 1 2 39 12 70 Accidents— Street Vehicles 4 4 5 20 17 50 Burns and Scalds — 1 4 — 5 8 18 Railway — — — — 5 1 6 Falls — 1 2 1 22 70 96 Other causes* 10 5 6 12 44 28 105 Suicides † — — 1 75 21 97 Murder — 1 — — 2 — 3 Manslaughter — — — — 2 — 2 Open Verdict ‡ 1 — — — 3 — 4 Totals 34 13 18 23 248 180 516§ ‡ Includes 40 cases of coal gas poisoning. * Includes 3 cases of coal gas poisoning. ‡ No case of coal gas poisoning. § St. Pancras cases 113, ex-St. Pancras 403 (see also page 26). Infantile Mortality. The number of deaths of St. Pancras infants under one year of age occurring during 1938 was 156 (of which 27 were of illegitimate children). This gives an Infant Mortality rate (number of deaths under one year of age per 1,000 births) of 64. The corresponding rate for the previous year was 65. Further details will be found in the Maternity and Child Welfare Section (page 95). 26 Mortuary and Coroner's Court. These buildings are situated in Cainley 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 : — 1933. 1934. 1935. 1936. 1937. 1938. Number of inquests held :— St. Pancras cases 151 128 142 125 147 113 Ex-St. Pancras cases 422 438 394 464 401 403 Number of bodies received :— St. Pancras cases 306 288 299 264 287 232 Kx-St. Pancras cases 510 525 501 502 500 521 Number of post-mortem examinations made :— St. Pancras cases 286 277 293 249 285 229 Ex-St. Pancras cases 446 492 454 453 466 506 Section III. Sanitary Circumstances of the Area. 27 Section III.-SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTION OF THE AREA. Changes in the personnel of the Council's Inspectorial Staff are set out on page xiii. The work of the Staff is allocated as follows:—There are twelve District Inspectors, each of whom is responsible in his own district for the duties of which particulars are given in the Table on page 28. There is also one Housing Inspector and one Assistant Housing Inspector, who deal 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 53. Work under the Factories Act 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 37 to 41. Inspections.—62,279 visits and inspections were made in 1938 by the Council's staff of 18 Inspectors. Of these inspections, 46,485 were made by the 12 District Inspectors and two Housing Inspectors, 7,727 by the two Inspectors of Food and Food places, and 8,067 by the two Inspectors of Factories and Workshops. Notices served.—3,465 intimation notices were served by the Inspectors during the year. Of these 3,154 were served by the District Sanitary Inspectors, and 311 by the Factory and Workshop Inspectors. 1,306 Statutory notices were served for non-compliance with certain of the above intimation notices. There were none under the Shops Act. Details of the work performed by the various Inspectors will be found in the following tables. 28 Report of Work carried out by District Inspectors for the year 1938. Complaints received, 3,426. Visits in respect of:— Brown. Walker. James. Jaffa. Winchester† Hague. Mansfield. Warren. Dykes. Thomas. Hoare. woolvin. Kirbv.‡ Westripp.‡ Totals. On Complaint Whole house inspected — — 12 — — 4 9 1 23 14 3 15 1 3 85 Do. Re-inspections — 8 54 — — 10 27 1 100 82 — 98 15 — 395 Part of house inspected 418 20 350 580 313 280 284 366 290 351 367 298 60 44 4021 Do. Re-inspections 1527 — 718 734 668 902 455 645 673 709 701 756 85 142 8715 Infectious Diseases Investigations 171 3 '33 255 103 82 169 136 91 145 114 128 14 28 1572 Inspections.. 75 — 49 69 34 27 7 72 24 27 4 29 4 2 423 Re-inspections 511 2 1384 21 211 126 39 150 74 194 9 206 22 2 1951 Smoke Observations 3 — 1 7 20 1 2 28 9 1 30 13 16 6 4 140 Offensive or Regulated Trades — — — — — 4 1 9 — — 47 — — — 61 Mews and Stable Yards 280 — 355 297 267 388 418 341 134 233 297 244 31 3285 Shops Act First Inspections — — — '4 2 2 — 1 — — — 1 1 21 Subsequent do. — — — — 2 — 2 2 12 — — — 5 — 23 Verminous Persons — — 11 15 4 2 3 — 10 — 4 14 — — 63 Pharmacy and Poisons Act First Inspections — — 2 1 — 2 — 1 — — 1 — — — 7 Subsequent do. — — 1 1 — — 1 3 — 2 2 5 — — 15 Other Inspections 60 — 95 388 262 90 159 412 116 200 382 356 60 94 2674 Housing Acts and Regulations Inspections — 272 2 3 127 14 — 15 5 29 4 50 11 — 532 Re-inspections — 2555 107 13 273 120 8 33 103 39 10 108 7 — 3376 Houses let in Lodgings Inspections — — 3 6 28 — — 29 34 37 52 23 — 1 213 Re-inspections — — 125 22 139 — — 10 175 233 253 128 — — 1085 Underground Rooms 244 — 495 536 990 637 982 340 293 71 3 302 911 36 87 6566 Drainage (a) Under Notice 331 — 347 172 55 578 361 169 173 131 161 50 1 87 2616 (b) Voluntary 368 — 858 504 394 396 666 1044 488 521 829 230 73 13 6384 (c) New Buildings 5 11 65 75 73 59 129 209 340 301 251 254 9 19 1800 Attendances at Police Court — — 8 — 7 6 2 9 7 7 5 2 — — 53 Rent Restrictions Acts 1 — 11 — — — — — — — — — — — 13 Canal Boats Acts — — — — — 1 — — — — — — — — 1 A.R.P. Premises Inspected 16 — 58 19 9 71 47 8 — 53 87 18 — — 386 Other Visits — — — — — 3 — — — 2 3 — — 1 9 Totals 4010 2871 4250 3731 3974 3806 3799 4014 3167 4054 3901 3939 441 528 46485 Notices served;— Intimations 370 — 233 259 375 209 220 293 284 347 186 304 35 39 3154 Rent Restrictions Acts 1 — 3 1 1 — — — — 1 — 1 — — 8 Totals 371 — 236 260 376 209 220 293 284 348 186 305 35 39 3162 * Housing Inspector. † Assistant Housing Inspector. Took over duties on 1st November, ‡ Took over duties on 1st November. '29 Legal Proceedings. The following prosecutions were undertaken during the year in respect of general sanitary work :— Public Health (London) Act, 1036. Situation of Property, Offence. Date of Hearing of Summons. Result of Proceedings. 1937 12, William 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. Jan. 7th Costs .£2. 37, James Street, N.W.1 Do. do. do. Jan. 7th Costs £2. 116, Camden Street Fixing a new angle basin on staircase and a new trap and waste for a proposed new basement sink without giving notice to the Sanitary Authority as required by the drainage bye-laws of the London County Council. Jan. 12th Fine 20s. Costs £2 2s. 116, Camden Street Do., do., in a manner contrary to the drainage bye-laws. Jan. 12th Fine 23s. 21, Percy Street, W.l 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. Jan. 14th Bound over in a sum of 10s. to come up for judgment if called upon within twelve months. 78, Camden Road Main roof and top floor front room ceiling defective. Jan. 18th Summons withdrawn. Work completed. Costs ,£3 3s. paid. 41, Caversham Road Basement back room walls damp Feb. 24th Order made to abate within 2 8 days. Costs £2 2s. 3, Hunter Street Fixing new sink in basement kitchen without giving notice to the Sanitary Authority as required by the drainage bye laws of the London County Council. Mar. 14th Dismissed [under Probation of Offenders Act on payment of 10s. costs by each of the Defendants. 16, Lupton Street Fixing new bath, lavatory basin and wastepipe, etc., without giving notice, etc. Mar. 14th Do. do. 110, Cleveland Street Reconstructing first floor kitchen sink and waste pipe without giving notice, etc. Mar. 18th Fine 1s. Costs £2 2s. Do. do. Reconstructing first floor kitchen sink with a waste pipe discharging into a hopper head contrary to drainage bye-laws of the London County Council. Mar. 18th Work satisfactorily completed. Summons withdrawn. 212, Kentiah Town Road Back area paving in foul state and smelling offensively ; first floor sink discharging into rain water pipe and then into a brick sump in yard about 3 feet away frotu yard gulley ; sump is partly full of offensively smelling water, sides and bottom are extremely foul; yard gulley then discharges over surface of back area paving causing same to be in a foul state and smelling offensively. Mar. 25th Order made to abate within 14 days. Costs £2 2s. 14, Leighton Place Moving into St, Pancraa with [a foster child without giving notice to the Council. April 9th Dismissed under the Probation of Offenders Act on payment of £2 2s. costs. 69, Agar Grove. Failing to cleanse walls and ceilings of ground floor front room and scullery (contrary to London County Council tenement house bye-laws). April 20th Fine 15s. Costs £1 1s. Gt. College Street Being a person carrying on the business of rag and bone dealer did distribute outside the L.C.C. School in Great College Street, toys in exchange for rags (contrary to London County Council bye-laws). April 20th Fine 15s. Do. do Do. do. with receptacle (alternative offence] April 20th Summous not dealt with (see above). 14, North Villas Failing to give notice of reconstruction of water closets (contrary to L.C.C. bye-laws) April 23rd Fine 20s. Costs £1 1s. Do. do. Reconstructing water closets without enclosing such water closets by solid walls, etc. (contrary to Loudon County Council bye-laws) April 23rd Fine 20s. Costs .£1 1s. 30 Public Health (Loudon) Act, 1936— continued. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 14, North Villas Failing to give notice of alteration of positions of sinks (contrary to London County Council drainage bye-laws) 1938. April 23rd Fine 20s. Costs £1 1s. 1, Stratford Place Failing to give notice of fixing sinks bath and waste pipes (contrary to London County Council drainage bye laws) April 23rd . Fine 20s. Costs £'1 1s. Do. do. Improperly connecting waste pipes to an existing rain water pipe and failing to provide proper means for ventilation of the traps of the waste water fitments (contrary to london County Council drainage bye-laws) April 23rd Fine 20s. Costs £1 1s. 131, Fortess Road . Walls and ceilings dirty of ground floor and basement water closets; light iron waste pipe to gulley defective; waste pipe from oath in ground floor water closet stopped; waste pipe from lavatory basin in ground floor water closet defective; ground floor water closet basin stopped May 11th Summons withdrawn. Work completed and costs .£1 1s. paid. Do. do Defective window in basement water closet (contrary to London County Council byelaw) May 11th ... Summons withdrawn. Work completed and costs £1 Is. paid. 15, Swinton Street Failing to give notice of fixing a new bath and waste pipe in ground floor back addition (contrary to L.C.C. drainage byelaws) June 13th ... Summons withdrawn. Work put in order. Cost £2 2s. paid. Do. do. Improperly connecting a new bath in the ground floor back addition to a new waste pipe not constructed of prescribed materials (contrary to L.C.C. drainage bye-laws) " " Princess Road Being a person carrying on the business of rag and bone dealer did distribute outside the L.C.C. Schools in Princess Road toys in exchange for rags (contrary to the L.C.C. bye-laws) „ 29th Cases unable to be proceeded with as defendant had given a false address and it had not therefore been possible to serve the Summonses. Do. do Do. do. do. with receptacle (alternative offence) ,, ,, ,, 20, Hawley Road Dustbin defective Aug, 9th Summons withdrawn. Nuisance abated. Costs £2 2s. paid. 193, Dartmouth Park Hill Flat No. 7 193, Dartmouth Park Hill Roof defective Failing to cleanse walls and ceiling of first floor back room (contrary to L.C.C. tenement house bye-laws) Sept. 29th Summonses withdrawn, work completed. Costs £2 8s. paid. Do. do. Do., do., walls and ceiling of second floor back room and to remedy broken sash cords of the room (contrary to L.C.C. tenement house bye-laws) ,, ,, ,, 54, Maple Street Waste pipe and sink in second floor kitchen defective Oct. 14th Nuisance abated. Fine 2s. 6d. Costs £2 2s. 815, Kentish Town Road Depositing for the purpose of preparation for sale a piece of bacon intended for food, which was unsound „ 20th. Fine .£10. Costs £10 10s. 3, St. Mark's Square ... Failing to give notice of fixing a sink, bath and lavatory basin (contrary to L.C.C. drainage bye-laws) ,, ,, ,, Fine 10s. Costs 10s. Do. Do. Do. do. do. do. ,, ,, ,, Dismissed upon payment of 2s. costs. Do. do. Improperly connecting sink to a waste pipe not discharging in the open air over or into a trapped gully; and fixing a bath and lavatory basin with traps not formed and fixed so as to be capable of maintaining a water seal of at least one-and-a half inches (contrary to L.C.C. bye-laws) ,, ,, ,, Fine 10s. Costs 10s. Do. do. Do. do. do. do. ,, ,, ,, Dismissed upon payment of 2s. costs. 35 Baynes Street Taking a foster-child under the age of nine years for reward without giving notice to the Council Nov. 10th ... Fine 10s. Costs 10s. 6d. 31 Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 35, Baynes Street Moving a foster-child under the age of nine years from one address in St. Pancras to another without giving notice to the Council 1938. Nov. 10th Fine 10s. Costs 10s. 6d. 134, Camden Road An accumulation in basement dangerous to health ,, 16th Nuisance abated. Summons withdrawn. Costs £1 5s. paid. 105 Park Street Failing to give notice of fixing a sink and sink waste pipe in ground floor back addition (contrary to L.C.C. drainage byelaws) „ 17th Summons dismissed. Work Do. do. Improperly connecting a new sink in the ground floor back addition to a new waste pipe not constructed of prescribed materials (contrary to L.C.C. drainage bye-laws) „ „ put in order. Costs £2 6s. paid. 2, Harrington Square Dustbin defective, accumulation in front vault Dec. 8th ... Order made to abate within 14 days. Costs £2 2s. 7, Lulot Street Back addition roof defective „ „ Order made to abate within 21 days. Costs £2 2s. 135, Gloucester Road Failing to give notice of fixing new sink and waste in ground floor back room (contrary to L.C.C. drainage bye-laws) „ 13th Fine 20s. Costs 2s. Holding Act, 1936. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 45, Arlington Road Permitting underground rooms to be used for human habitation after a Closing Order had become operative 19338. Jan. 7th ... Rooms vacated and in course of reconstruction. Fine 40s. Costs £2 2s. (for adjournment on December 16th) and £1 1s. (for Hearing, January 7th). 80, Tavistock Place (late 11, Compton Street) Using the front and back underground rooms for human habitation knowing that a Closing Order on them had become operative June 27th Fined 10s. on the understanding that if the rooms were vacated within seven days the penalty would not be enforced. 21C, Euaton Road Using front basement room for human habitation knowing that a Closing Order on it had become operative Aug. 26th Fine 10s.; Costs 20s. 54, Maple Street Failing to give information required under section 168, Oct. 14th ... Information supplied in Court. Fine 2s. 6d.; Costs £1 1s. SMOKE ABATEMENT. Under Section 147 S.S.4 of the Public Health (London) Act, 1936, it is the duty of the Local Sanitary Authority to enforce the provisions of Part V of the Act, relating to Smoke Consumption. Section 147 S.S.6 defines the expression " Smoke " as including soot, ash, grit and gritty particles. By Section 151, the County Council has power to make by-laws regulating the emission of smoke. The by-law made on February 17th, 1931, and allowed by the Minister of Health, came into force on May 19th, L931, and is still in force. The bye-law states that the emission of black smoke for a period of three minutes, and, after live 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. 32 During the year 140 observations of chimney shafts were made and six intimations were served. One statutory notice was served, and there were no prosecutions. Representatives of the Council attended conferences of the National Smoke Abatement Society during the year. PREMISES AND OCCUPATIONS CONTROLLED BY ACTS, BYE-LAWS OR REGULATIONS. Offensive Trades. There are two licensed premises for such trades in the Borough—a tallow melter's in Tudor Place, which has been in existence since the year 1780, and a soap boiler's in Rochester Place. 61 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 Bonk 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— (ft) 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 was one prosecution 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 ok the Public Hkalth (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 flock 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 m the upholstery trades than formerly. No samples were taken during the year under consideration. 33 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 28. There are some 5,166 houses on the register. New bye-laws under Section 6 of the Housing Act, 1936, were continued by the Minister of Health on the 13th December, 1938, and are to come into operation on the 1st January, 1939. Lighting of Staircases of Tenement Buildings. Adequate means for the artificial lighting of every common staircase is required in accordance with the L.C.C. Bye-laws as to Lodging houses for the working classes. These Bye-laws are made under Section 6 of the Housing Act, 1936. The following bye-law shall not come into operation until six months after the Rent & Mortgage Interest (Restrictions) Acts, 1920 to 1935, or any re-enactment thereof with or without modifications relating to dwelling houses, shall have ceased to be in force :— " Wherever practicable provide every common staircase in the lodging house with adequate means of lighting by natural light, including in the case of a new building constructed for use as a lodging house, a window or windows with a total superficies clear of the sash frames of not less than four square feet on the staircase at each storey above the ground storey opening directly into the external air." 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. The only common lodging house in the borough, at 60, King's Road (33 beds for women), was vacated on the 14th March. Eight visits had been made up to this date, and the premises found to be satisfactory and to comply with the regulations. Shops Act, 1934. The number of shops inspected during the year was 24, and the total number inspected since the coming into force of the Act is 3,535. No notices were served and no certificates of exemption were granted. 34 Canal Boats Acts. tinder 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. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920-1938. During the year seven applications were received from tenants for certificates and in every case a certificate was granted, specifying the work required to be executed in order to put the house into a good and tenantable state of repair. In accordance with Section 5 of the Act of 1923, three 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. Requests for action under this section were received in respect of several aged persons. With the single exception referred to it was possible either to bring about an improvement with the co-operation of the persons concerned and of relatives or to persuade the individuals to enter an institution voluntarily. 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, twelve 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, 202 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 90 tenement houses under powers contained in Section 95 of the Public Health (London) Act, 1936. At its meeting in January, 1938, the Public Health Committee authorised an offer of assistance being made to the owners of wells in the borough by the Public Health Department with a view to securing the purity of water obtained from this source. 35 The owners of wells were most willing to co-operate and the water and circumstances generally of eight wells were examined in collaboration with Mr. Kear Colwell, m.a., f.c.s., the Analyst of the borough. At the time of writing, a report upon wells has been asked for by the Ministry of Health and information obtained in the course of the investigation just referred to has been included in this report. PUBLIC BATHS AND WASIIHOUSES. These are provided by the Borough Council at the following situations:—Prince of Wales Road, N.W.5; Whitfield Street, W. 1 ; 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. 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. 1938. 1937. 1936. Drainage work done under notice 2616 2631 2898 Voluntary drainage work 6384 7771 7466 Drains of new buildings 1800 2786 3190 Total 10800 13188 13554 Drainage Register.—The following is an analysis of the Drainage Register during 1937, the figures for the previous year being given for comparison :— 1938. 1937. Plans deposited—Old Buildings under Notice 72 74 ,, ,, Old Buildings, Voluntary 212 263 „ „ New Buildings and Additions 68 87 352 424 Applications without Plans 413 436 Total number of Applications and Plans 765 860 RATS AND MICE (DESTRUCTION) ACT, 1919. During the year 180 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. 36 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. I have to thank Mr. C. S. Bainbridge, the Borough Engineer and Surveyor, for the following information : — " It may be interesting for you to know that it is now reported to me that poison was laid down during Rat Week in 127 places throughout the sewers in this Borough, and from observations made, the whole of the poison was taken from 85 places, part from 29 places, and in 13 places the poison bait was not touched. I have details of the actual points at which the bait was put down, if they are required." REFUSE COLLECTION AND DISPOSAL. A.—A weekly collection is made in ad parts of the Borough with the exception of Wards 2 and 6, in which a collection is made twice weekly during the summer months, and daily collections before 10 a.m. in prescribed main streets. Additional collections are also given to flats, eating houses, etc. The use of Pagefield lorries and containers, first introduced in 1925, has very much facilitated this work. B.—The methods of refuse disposal are :— (а) 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, the Borough Engineer and Surveyor. For the purpose of comparison the figures for the previous year are also given :— 1988. 1937. Tons. Tons. Quantity of refuse collected 54925 55622 Quantity of refuse burnt at Destructor 28415 31288 Quantity put on rail 26510 24334 Quantity of clinker residual 10078 10391 Section IV. Factories. 37 SECTION IV.—FACTORIES. Work reported upon in this Section is now carried out under the Factories Act, 1937, which came into force on 1st July, 1938. The following brief report upon this Act was submitted to the Public Health Committee on 9th December. Factories Act, 1937. 1. In accordance with your instructious I beg to report briefly upon the provisions of this Act, which came into force on the 1st July last. 2. The general effect of the Act will be to increase the power of Metropolitan Borough Councils in regard to certain matters to be referred to below, but the Act will not materially affect the number of premises on our Register. 3. The Act is a consolidating and amending measure which replaces the Factory and Workshops Act of 1901, and certain other enactments. It is to be noted that the old distinction between a factory and a workshop is abolished and that the expression " workshop" is discontinued. The only term now used is " factory" ; for certain purposes a distinction is drawn between factories where mechanical power is used and factories where this is not used. 4. The arrangement that obtained under the 1901 Act, by which certain provisions of the Public Health Acts were applied to workshops and defaults were treated as nuisances, is now abandoned. The operative provisions for factories, whether or not using mechanical power, are now contained in the Factories Act itself and non-observance renders the person responsible liable to a fine on summary conviction. 5. Under Section 151 of the Act, power is given to deal with premises in which the following are carried out—(a) sorting of articles, (b) filling of bottles or containers, (c) production of cinematograph films, and (d) making of articles for use in the building trade. Certain factories, such as foundries, letter press printing works, etc., previously excluded under the definition of " factory," are now to be dealt with by Local Authorities under the Act, providing that no mechanical power is used. 6. Under Section 1 a higher standard of cleanliness can be required than was formerly possible. 7. A new requirement is introduced in regard to a workroom in which a substantial proportion of the work is done sitting and does not involve serious physical effort, namely that a temperature of less than 608F shall not be deemed, after the first hour, to be a reasonable temperature while work is going on. 8. In Section 2 a new standard of overcrowding is introduced, namely, 400 instead of 250 cubic feet per employee. This standard may result in the discovery of legal overcrowding and require action by the Local Authority. 9. Consideration of the Act and consequential rules and orders does not indicate that any change in this Council's administrative arrangements are called for. The matter will be kept under observation and the Committee will be informed regarding any points of interest that may arise in the course of administration. Inspections are carried out by one male inspector and one female inspector. The arrangement is that the female inspector is responsible for inspecting factories and restaurants in which women are employed and for all visits to outworkers. 38 The male inspector is responsible for factories, bakehouses and restaurants in which men are employed. Roth inspectors visit factories in which men and women are employed. Report of Work curried out by the Factory Inspectors during the year 1938. Inspections and Re-Inspections. Thompson. Miss Camman. Totals. Factories (with mechanical power) 2011 801 2812 Factories (without mechanical power) 1200 453 1653 Workplaces (including restaurant kitchens) 485 1107 1592 Outworkers' premises — 995 995 Shops Act 187 790 977 Other Visits 29 9 38 Totals 3912 4155 8067 Notices served relating to:— Factories (with mechanical power) 144 15 159 Factories (without mechanical power) 58 32 90 Workplaces 24 13 37 Others 5 20 25 Totals 231 80 311 Information concerning the work carried out under the above Act is given in the following tables in the form required by the Home Secretary. 1. — Inspfctions made by Male and Female Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (with mechanical power) 2970 159 — Factories (without mechanical power) 1758 90 — Workplaces (other than inspections of Outworkers' premises which are included in Part 6 of this Report) 2264 37 — Totals 6992 286 — 39 2.—Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to h.m. Inspectors. (1) (2) (3) (4) (5) Want of cleanliness (s. 1) 169 159 — — Inadequate ventilation (s. 4) 4 4 — — Overcrowding (s. 2) — — — — Ineffective drainage of floors (s. 6) — — — — Other nuisances 112 109 — — Sanitary conveniences (s. 7)— Insufficient 10 10 — — Unsuitable or defective 63 59 — — Not separate for sexes 6 6 — — Other breaches 51 49 — — Illegal occupation of underground bakehouses (s. 54) — — — — Breach of special sanitary requirements for bakehouses (Part 1 of 3rd Schedule) 56 53 — — Other offences (excluding offences relating to outwork; — — — — Totals 471 449 — — 3.—Outworkers and Home Work. In certain industries specified in the Act, if work is given out by Employers or Contractors to be done by workers in their own premises, lists containing the names and 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. Notifications of Outworkers were received as follows : — From Local Authorities outside St. Pancras. From St. Pancras Employers. Notifications. Authorities Notifying. Total Notifications. Notifications where addresses were in St, Pancras. In the first half of year 655 17 186 57 In the second half of year 605 15 200 65 Totals 1260 32 386 *122 * The remainder were forwarded to the appropriate local authorities, 40 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 with Mechanical Power. Factories without Mechanical Power. Workplaces. Wearing apparel 104 146 127 377 Bootmaking 1 2 60 63 Embroidery 6 4 32 42 Miscellaneous 5 2 82 89 Totals 116 154 301 571 4.—List of Factories and Workplaces. Nature of Work. Factories with Mechanical Power. Factories without Mechanical Power. Workplaces (including Outworkers). Total. Bakehouses 69 78 — 147 Cabinet makers 56 55 — 111 Coach builders 19 15 l 35 Dressmakers 127 82 16 225 Engineers 223 35 — 258 Foundries 13 — — 13 Furniture makers 14 20 — 34 Furriers 10 12 2 24 Laundries 14 — 60 74 Metal workers 42 34 — 76 Milliners 4 9 — 13 Organ builders 8 3 — 11 Pianoforte manufacturers 40 8 1 49 Printing 84 6 — 90 Restaurant kitchens — — 304 304 Tailors 59 231 109 399 Upholsterers 15 32 — 47 Wood carvers 9 9 — 18 Other occupations 617 472 329 1418 Totals 1423 1101 822 3346 41 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factories Act (s. 114) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factories Act (s. 9)— Notified by H.M. Inspector 10 Reports (of action taken) sent to H.M. Inspector 10 In regard to factories where protected persons have been found to be employed (Public Health (London) Act, 1986, section 131) 1 Underground bakehouses (s. 54) :— Certificates granted during the year — In use at the end of the year 54 Bakehouses and restaurant kitchens are also referred to on page 57. 6.—Total Inspections of Factories and Workplaces. Premises. Male Inspector. Female Inspector. Total. Outworkers. Not Outworkers. Factories (with mechanical power) 2153 117 817 3087 Factories (without ,, ,, ) 1233 298 520 2056 Workplaces (including restaurant kitchens 492 622 1772 2886 Total 3883 1037 3109 8029 Section V. Housing. 43 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) 329 flats (h) With State assistance under the Housing Acts : — (i) By the Local Authority 153 (ii) By other bodies or persons 35 The 329 flats mentioned above as having been erected during the year comprised the following : - By the Crown Estate (Tintern House, Cumberland Market) 22 flats By the St. Pancras House Improvement Society, Ltd. : — Stephenson House, York Rise 18 flats Trevithick House „ 21 „ Brunei House „ 18 ,, Newcomen House „ 26 „ Faraday House „ 36 ,, 119 flats By the London County Council (Chalton House) 35 flats By the St. Pancras Borough Council:— Cobden House, Arlington Road 55 flats Kenbrook House, Leighton Road 98 „ 153 flats Total 329 flats In addition there were in course of erection at the end of the year : — By the Crown Estate Nil. By the St. Pancras House Improvement Society, Ltd., Werrington Street 57 flats By the London County Council Nil. By the St. Pancras Borough Council :— Camelot House, Camden Park Road 95 flats Montague Tibbies House, Queen's Crescent 139 ,, 234 flats Total 291 flats 44 1. Inspection of dwelling-houses. Inspection— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1253 (b) Number of inspections made for the purpose 8060 (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 745 (b) Number of inspections made for the purpose 5206 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (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 789 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 2550 3. Action under Statutory Powers. (а)—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 208 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 170 (b) By Local Authority in default of owners Nil. (б)—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices (Statutory) were served requiring defects to be remedied 796 (2) Number of dwelling-houses in which defects were remedied after service of formal (Statutory) notice : — (a) By owners 515 (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 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 45 ((/)—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 370 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 75 HOUSING ACT, 1936-PART IV. OVERCROWDING. (a) (i) Number of dwellings overcrowded at the end of the year 2965 (ii) „ families dwelling therein 2965 (iii) ,, persons „ „ 13876 (b) Number of new cases of overcrowding reported during the year 144 (c) (i) „ cases of overcrowding relieved during the year *1674 (ii) „ persons concerned in such cases 7597 (d) Particulars of any cases in which dwelling houses have again become overcrowded after Local Authority have taken steps for (he abatement of overcrowding 2 * 62 by London County Council; 40 by Borough Council; and 1,58 J by own efforts as revealed by 1937 Survey. One overcrowded family obtained other accommodation after service of informal notice by the Borough Council. The vacated premises again became overcrowded,* and notices were served upon the landlord, the landlord's agent and the occupier requiring the abatement of the offence. These notices were subsequently complied with. * Owing to the premises being re-let by the caretaker, knowledge of which was disclaimed by the agent. (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. A routine inspection of some 600-700 dwellings a mouth is being carried out in this borough with a view to ascertaining (a) the extent to which overcrowding existing at the time of the survey has been abated, and (6) the extent to which overcrowding has become established in dwellings not overcrowded at the time of the survey. It is too soon to draw definite conclusions, but the general indication is that the number of families living under conditions of overcrowding as defined in the Housing Act, 1936, is diminishing. Satisfaction at this tendency is tempered by the knowledge that it is extremely difficult for alternative accommodation to be obtained for large families with small incomes. Many families of this type are known to the Public Health Department to be living under conditions of gross overcrowding. They are, however, unable to afford the rents for accommodation sufficient to meet the requirements of the Housing Act. The provisions of the Act under which overcrowding established anew after the " appointed day" constitutes an offeace makes it impossible unless a special certificate is given for such families to move into accommodation in which they would be less overcrowded if the new tenancy does not comply with the legal standards. In this matter a position has been established in which best may be the enemy of good. During the year under consideration 13 cases of overcrowding established since the "appointed day" and in contravention of Section 59 of the Housing Act, 1936, came to the notice of the Public Health Department. An informal notice requiring the abatement of overcrowding was sent in twelve cases. In the remaining instance a notice in the form required by the Act was issued. At the end of the year eight cases had been abated and the remainder were still engaging the attention of the Department. There were no prosecutions. 46 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 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 arc 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. HOUSING CONDITIONS. One of the chief problems 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 conditious. These powers are given under the following : — (a) The overcrowding provisions of the Housing Act, 1936. (b) The Rye-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). 47 Facilities for 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 the vacancy from the County Council As from 31st December, 1938, the payments to the County Council under this arrangement have been increased to £4 10s. Od. per flat per annum. The following table shows the number of families accommodated under this arrangement:— 1934 1 1935 13 1936 8 1937 13 1938 15 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 370 No. of rooms the use of which has been discontinued for human habitation 404 No. of families accommodated elsewhere as a result of these notices by:— London County Council 15 St. Pancras Borough Council 51 No. of rooms vacated by own efforts or not used for human habitation by re-arrangement 188 No. of underground rooms rendered fit for human habitation (without Closing Orders) 82 No. of underground rooms rendered fit for human habitation (after Closing Orders) 75 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 progress in the working of Section 9 of the Housing Act, 1936. A summarised table is given below. Mr. Winchester was appointed Assistant Housing Inspector in July, but, owing to the crisis and departmental difficulties, he was unable to put in full time till late in the year. The work under Section 9 has generally been carried out satisfactorily, but in a few cases the lack of any definite standard is still a disadvantage, and has on occasion failed to secure work of a lasting character. 48 The application of this Section to unfit houses is still having a good effect ON the owners of adjoining properties, and I am pleased to be able to report that many houses have been reconditioned without the service of notice by the Council; and so more work has been accomplished than is actually shown in the accompanying table. In consequence, there has been an increase in the number of voluntary specifications submitted under Section 51, and I am pleased to report these have generally been carried out satisfactorily. Considerable time has been given to advising house owners and builders upon making their houses to comply with the Housing Act. Summary of Work. 1937. 1938. Notices under Section 157. (Notices to Inspect) 585 539 Surveys under Housing Acts 541 272 Clearance Areas—Demolition and Closing Orders 244 267 Specifications under Section 9 .. 172 208 Agreed Specifications 35 54 Re-inspections of above 2157 2555 PROCEEDINGS UNDER PART III, HOUSING ACT, 1936. The following shews the position as regards Clearance and Compulsory Purchase Orders :— Date. Order. Site. Position at the end of the Year. Those made during the j/ear: 5th December Compulsory Purchase Hampshire Street, Area 1 Submitted to Minister of Health for confirmation. do. do. do. Area 2 do. Those made previously: 4th Nov., 1937 Clearance Order Stibbington Street Order operative. do. do. Stucley Place do. do. * do. Whitfield Place do. 49 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, Grav'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 (IS flats), Johnson House (30 flats), Gladwin House (IS Hats), 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, Highgate Road (44 flats). (j) Ferdinand Place Estate (111 Hats), consisting of Harmood House (62 flats), Ferdinand House (31 flats), and Powlett House (18 flats). (k) Cobden House, Arlington Road (55 flats). (l) Kenbrook House, Leighton Road (98 flats). (m) 13 and 15, Bayham Place. (n) 15, Willes Road (flat over filtration plant of Prince of Wales Road Baths). (o) 24, Grafton Road. (p) 41 and 47, Stanhope Street. (q) 145, 147, 149, 151, 153, 155, 157, 159 and 161, Great College Street. (r) 9, Georgiana Street. (s) 67, 69 and 71, Pratt Street. (t) 3, James Street. (u) 207, Arlington Road. (v) Oak House and Wellington House, East Finchley. (w) 287 and 289, Camden High Street. The waiting list for accommodation on the Council's Estates is restricted to persons living in the Borough in overcrowded conditions or in unfit property upon which Closing or Demolition Orders have been made by the Borough Council. During the past year there have been 66 changes of tenancies in the Council's properties. Kenbrook House, Leighton Road. This estate of 98 flats was completed during the year and has been occupied by families who were displaced from clearance areas, unfit property upon which Closing or Demolition Orders had been made by the Borough Council or who were overcrowded under the provisions of the Housing Act, 1936. 50 The weekly rentals fixed by the Council are as follows:— Nett. Inclusive. s. d. s. d. 1-room flats.. 4 10 7 6 2 ,, ,, 9 0 12 5 3 ,, ,, 12 0 16 1 4,, ,, 13 0 17 10 5 ,, ,, 14 0 19 7 Cobden House, Arlington Road. This estate was completed early in the year. It consists of 55 flats erected on the site of the Carlow Street area and was officially opened by His Worship the Mayor (Councillor John Sperni, j.p.) on the 1st April, 1938. The families rehoused were displaced from clearance areas, individual unfit houses upon which Closing or Demolition Orders had been made by the Borough Council, or who were overcrowded under the provisions of the Housing Act, 1936. Queen’s Crescent Schkme. Considerable progress was made with this scheme, which provides for the erection of 139 flats on the site of the Journeyman Tailors’ Benevolent Institution. The rents to be charged on this estate will be the same as those at Kenbrook House, Leighton Road. The accommodation will be utilised for rehousing persons displaced from insanitary property by the Council's Orders, or for relieving overcrowding in the Borough. Camden Park Road Scheme. This scheme provides for the erection of 95 flats, and at the end of the year satisfactory progress had been made. It has been decided to charge the same rents on this estate as at Kenbrook House, Leighton Road. The accommodation will be utilised for re-housing persons displaced from insanitary property upon which Orders have been made by the Council, or for relieving overcrowding in the Borough. Brookfield Estate. The existing hot water system, which had been in use since the estate was occupied in 1922, has been replaced by the installation of " Ideal" boilers in the flats and maisonettes. Revision of Rent Scales. The rent scales in force at certain of the Council's estates were modified as from 4th April, 1938. 51 The rents at the pre-war estates (Goldington Buildings, Flaxman Terrace and Prospect Terrace) were adjusted with the object of ultimately standardising the gross rents by charging the same rent for similar accommodation, irrespective of situation. The following adjustments were made to the rentals on post-war estates:— Estate. Type of accommodation. Weekly reduction s. d. Somers Town All flats 0 6 Barnes House 3 room flats 0 6 „ „ 4 „ „ 1 0 „ „ 6 „ „ 2 9 Una House 4 „ „ 1 0 Kennistoun House 2&3 „ „ 0 6 „ „ 4 „ „ 1 0 Hampshire Street Area. Compulsory Purchase Orders have been made in respect of two areas in Hampshire Street and Torriano Avenue, under Part III of the Housing Act, 1936. If the Orders are confirmed by the Minister of Health, it is anticipated that approximately 108 Hats could be erected on one of the sites. The number of persons who would be displaced from the two areas is 315. Section VI. Inspection and Supervision of Food. 53 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. Particulars of the inspections and other duties carried out bv these officers during the year are given in the following table:— wards 4, 5, 7, 8, Mr. Adkins. wards 1, 2, 3, 6, Mr. Capel, Total. Number of Visits to:— Milkshops 303 313 616 Dairies 285 368 653 Ice Cream Premises 210 203 413 Slaughter Houses 10 161 171 Butchers' Shops and Meat Stalls 231 1023 1254 Prepared Meat Premises 156 212 368 Fishmongers' Shops 74 65 139 Fried Fish Shops 140 240 380 Fish Curers' Premises 19 82 101 Other Premises where Food or Drugs are sold 170 53 223 Marketing Streets and Places 2132 697 2829 Attendances at Police Court — 23 23 Other Visits 248 309 557 total † These visits do not include visits made for the purpose of taking samples. †3978 †3749 †7727 Number of Samples taken;— Formal 200 208 408 200 192 392 Bacteriological 30 71 101 total 430 471 901 unsound foods. Surrenders:— Meat, &c. 1 42 43 Fruit 1 1 2 Fish 3 2 5 Bacon 2 13 15 Ham 1 1 2 Vegetables 2 3 5 Groceries 2 6 8 total 12 68 80 Seizures:— — 1 1 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) Orders, 1936 and 1938, and the Milk Act, 1934. Cowsheds. There are no licensed cowsheds in the Borough. 54 Dairies and Milkshops. The Milk and Dairies Order, 1926, requires the Sanitary Authority to register all persona 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 according!}' 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. Eleven applications for registration under the Milk and Dairies Order, 1926, were granted during the year. Nine applications in respect of itinerant vendors were also granted. The following list gives particulars as to registrations and de-registrations during the year. Dairies. Purveyors of Milk (Itinerant). Milk in Sealed Containers. Number on register at end of 1937 191 59 238 Number removed from register during 1938 13 2 46 Number added to register during 1938 11 9 43 Number on register at end of 1938 189 66 235 In addition to the above, six persons (firms) were also on the register at the end of 1938 in respect of premises at which retail trade in cream is conducted. 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 Sepember 1st, 1925, provides for this duty, and Section 8 (4) of the Act states: " The Authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, the amount whereof shall, in default of agreement, be settled by the Local Government Board [Ministry of Health]." It is the practice of this Council to chargc a fee of 10s. 6d. each in respcct 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 one, for which purpose one visit was made. The fee was handed to the inspector concerned in accordance with a resolution of t he Council. 55 Milk (Special Designations) 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 1938 are contained in the following table: — Sample Grade for which licence was issued. No. of licences 31st Dec., 1938. No. complying with standard. No. below standard. Total samples. Tuberculin Tested 40 6 l 7 Accredited 5 1 — 1 Pasteurised 119 68 4 72 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 8 samples of milk were tested for the presence of Tubercle Bacilli. All were found to be satisfactory. Upon the coming into force of the Milk Act, 1934 (in August 1935), the Milk Marketing Board made an arrangement in consultation with the London County Council for the supply of milk to the children of the County Council's schools at the reduced price of Is. a gallon. This cheap price 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. 5.—Any head teacher having a point to raise as to the quality of the milk supplied is asked to communicate with the School Medical Officer. (G.P.H.l.) 6.—Head teachers are asked to ensure that the straws supplied for consuming the milk are not taken from the sealed wrapping until immediately before use and that they are destroyed at once after use. 56 Samples of milk numbering 58 were taken from schools in the Borough and submitted to bacteriological examination, the result in 57 cases being satisfactory. In the remaining instance the licensee's attention was drawn to the matter, and he subsequently gave up bottling the milk himself and obtained supplies already bottled by the wholesaler. Artificial Cream Act, 1929. The above Act, which came into force on 1st June, 1929, requires the registration of all premises in which Artificial Cream is manufactured, sold, or exposed for sale for human consumption. This requirement does not apply to premises where Artificial Cream is not supplied otherwise than in the properly closed and unopened receptacles in which it is delivered to those premises, nor to its manufacture solely for domestic purposes, nor to its manufacture on any premises for use in the preparation on those premises of some other article of focd. The number of premises on the register at the end of the year was three. Artificial Cream is defined in the Act as an article of food resembling Cream and containing no ingredient which is not derived from milk, except water. In actual practice it is manufactured from dried milk, butter and water in suitable proportions, and the term Re-constituted Cream would appear to be more appropriate than the word Artificial. MEAT AND OTHER FOODS. The two special Food Inspectors have kept under regular observation food exposed or deposited for sale in slaughter-houses, butchers' shops, cooked meat shops, fishmongers' premises, stalls, market places, etc., and particulars of the number of visits appear on page 53. 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 53. No prosecutions were undertaken during the year in question. 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, rasins, eggs in shell, dried eggs, oat products, raw tomatoes, fiozen 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 must 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. 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 57 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 387. Bakehouses and Restaurant Kitchens. At the end of 1938 there were 147 bakehouses on the register, as compared with 150 at the end of 1937. These bakehouses are classified in the following table:— Bakehouse with mechanical power Bakehouse without mechanical power Not in Use. Total. Above ground 28 l 13 42 Under ground 48 6 51 105 147 As a result of 628 inspections which were made during the year, 56 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 1,164 inspections were made, and 25 notices served. Bakehouses and restaurant kitchens are supervised by the Factory Inspectors. Further particulars will be found on pages 37 to 41. Fried Fish and Fish Curing Premises. In 1938 there were 73 fried fish vendors' premises in the Borough, at 6 of which fish curing was also carried on. There were 21 fish curers' premises, including the 6 above mentioned. Visits made by the Food Inspectors to these premises during the year totalled 481. 58 UNSOUND FOOD CONDEMNED AND DESTROYED. The undermentioned unsound or diseased food was surrendered by the owners or seized for destruction or to be dealt with as trade refuse. Surrendered. Article Reason for Surrender or seizure. Remarks. Meat. 6 prs. Sheep’s lungs Parasitic Inspection after slaughter. 1 Pig’s carcase Swine Fever ,, ,, ,, 3 „ lungs Pneumonia ,, ,, ,, 5 „ „ Pleurisy ,, ,, ,, 1 „ lung Congested ,, ,, ,, 1 „ heart Pneumonia ,, ,, ,, 3 „ hearts Pleurisy 16 „ mesenteries Tubercular ,, ,, ,, 1 ,, ,, Parasitic ,, ,, ,, 1 „ liver Tubercular ,, ,, ,, 19 „ heads ,, 1 ,, head Abscess ,, ,, ,, ½ ,, ,, Bruised Surrendered. 1 Bullock's liver Tubercular Inspection after slaughter. 7 1b. „ „ Flukes ,, ,, ,, 1 Bovine head Tubercular Surrendered. 9¼ lbs. Lamb Abscess ,, 38 lbs. Sausages Decomposed ,, 60 „ Cornod beef ,, ,, 48 „ Pressed pork Tins defective ,, 25 ,, Ham Decomposed ,, 378 „ Bacon ,, ,, 8¼ ,, ,, Maggotts Seized. Fish. 1 box Haddocks Decomposed Surrendered. 1 stone Cod Fillets ,, ,, 31 „ Kippers ,, ,, 4 „ Various ,, ,, 33 jars Fish paste Blown ,, Vegetables. 97 cwt. Potatoes Chemical contamination ,, 149 „ ,, Decomposed ,, 56 lbs. Onions ,, ,, Fruit. 1392 lbs. Greengage plums ,, ,, 36 Oranges ,, ,, 18 tins Mixed Fruit . Blown ,, 11½ cwt. Cheeses Decomposed ,, 59 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 hitter premises. Particulars regarding these slaughter-houses and their inspection, for the purpose of which 171 visits were made, are contained in the following table, as required by the Ministry of Health:— Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 17 .. .. 236 291 Number inspected 17 .. .. 236 291 All diseases except Tuberculosis. Whole carcases condemned .. .. .. .. 1 Carcases of which some part or organ was condemned 1 .. .. 6 10 Percentage of the number inspected affected with disease other than tuberculosis 5.9 .. .. 2.5 3.4 Tuberculosis only. Whole carcases condemned .. .. .. .. .. Carcases of which some part or organ was condemned 1 .. .. .. 26 Percentage of the number inspected affected with tuberculosis 5.9 .. .. .. 8.9 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 60 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 cach 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 or Slaughtermen. Applications for licences for slaughtermen under the provisions of the Slaughter of Animals Act, 1933, were received from five persons in respect of the three slaughter-houses. The Council's Inspector reported in each case that, in his opinion and from personal observation of the applicant's work, he was a fit and proper person to act as a slaughterman and the licences were granted for one year ending 31st October, 1938. FOOD AND DRUGS (ADULTERATION) ACT, 1928. Analyses of 800 samples have been made under this Act, of which 108 were formal and 392 informal. Of the formal, 398 proved to be genuine, and 10, or 24 per cent., adulterated; and of the informal, 384 were genuine and 8, or 2.0 per cent., adulterated. Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Acid (tartaric) — 3 — 3 — — Apples — 2 — 2 — — Apricots (dried) — 1 — 1 — — Aspirin — 1 — 1 — — Beef (corned) — 1 — 1 — — ,, (minced) 1 2 — 1 1 1 Black pudding — 1 — 1 — — Brandy — 1 — 1 — — Bread — 2 — 2 — Breast of lamb 1 — 1 — Butter 78 — 78 — Camphor, Spirits of — 3 — 3 — — Cascara Sagrada — 1 1 — — Cheese 1 9 1 9 — Cherries (glace) — 1 1 — Chocolate (marslimallows) — 1 — 1 — — ,, Roll — 1 — 1 — — Cocoa — 8 — 8 — Coffee — 8 — 8 — Cornflour — i — 1 — Crab, dressed (canned) — 1 — 1 Cream (artificial) — 1 — 1 — Cream — 9 — 9 — ,, (canned) — 4 — 4 — ,, (bottled) — 1 — 1 — — ,, (salad) — 1 — 1 — — Crystals, Grape fruit — 1 — 1 — — Currants — 3 3 Dates — 1 — 1 — Dripping — 4 — 4 — — Carried forward 2 152 1 | 151 1 1 61 Articles of food of which samples have been taken Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 2 152 1 151 1 1 Flour (pea) — 1 — 1 — — ,, (self-raising) — 3 — 3 — — Food, Parish's — 1 — 1 — — Friar's Balsam — 1 — 1 — — Fruit (mixed) — 3 — 3 1 — — ,, Salad (canned) — 1 — 2 — — Ginger (ground) — 2 — 3 — — Glycerine — 3 — 1 — — „ and Borax — 1 — 1 — — „ Lemon and Honey — 1 — 1 — — Honey — 1 — 1 — — Jam — 5 — 5 — — Jelly, Red Currant — 2 — 2 — — ,, Crystals — 1 — 1 — — Table — 1 — 1 — — Lard — 12 —— 12 — — Lemon Cordial — 1 — 1 — — Lemonade Powder — 1 — 1 — — Magnesium Carbonate — l — 1 — — Margarine — 10 — 10 — — Marmite — i — 1 — — Meat Pie — 2 — 2 — — Milk 397 21 394 23 3 1 „ Dried, F.C. — 1 — 1 — — ,, Condensed, S.S. — 4 — 4 — — Mincemeat — 1 — 1 — — Minced meat — 6 —— 6 — — Mustard — 3 — 3 — — Oitmeal — 1 — 1 — Oats, Rolled — 1 — 1 — — Oil, Camphorated — 3 — 3 — — „ Cod Liver — 3 — 3 — — ,, Cod Liver and Malt Extract — 1 — 1 — — ,, Olive — 3 — 3 — — ,, of Almonds — 1 — 1 — — ,, of Cloves — I — 1 — — Ointment, Zinc — 9 — 2 — — ,, Carbolic — 1 — 1 — — „ Mercury Comp. — 1 — 1 — — ,, V/hite precipitate — 1 — 1 — — Olives, stuffed — 1 — 1 —• — Paste, Fish 2 9 2 9 — — ,. ,, (canned) — 1 — 1 — — ,, Crab and Lobster — 1 — 1 — — ,, Chicken and Ham 1 — — — — — Peas (canned) — 1 — 1 — — Peel Candied — 1 — 1 — — Pepper — 8 — 8 — — Pickles, Mustard — 1 — 1 — — Pie, Meat .. — 2 — 2 — — Pineapple (canned) — 1 — 1 — — Powder, Lemonade — 1 — 1 — — „ Seidlitz — 3 — 3 — — „ Bismuth — 1 — 1 — — ,, Boracic — 1 — 1 — — Puree, Apple (canned) — 1 — 1 — — Quinine, Ammon. tinct. — 1 — 1 — — Carried forward 402 299 397 •287 5 2 62 Articles of food of which samples have been taken. Total number of samples. Genuine. Adulterated. Formal Informal Formal Informal Formal Informal Brought forward 402 299 397 297 5 2 Quinine, Tincture of — 2 — 2 — — Roll, Meat (canned) — 1 — 1 — — Rolls and butter — 3 — 3 — ,, Sausage — 2 — 2 — — Salmon (canned) — 3 — 3 — — Salts, Epsom — 3 — 3 — — Sal Volatile — 1 — 1 Sardines 1 6 — 5 1 1 Sauce — 1 — 1 ,, Mint — 1 — 1 Sausages 2 16 1 15 1 1 ,, Beef — 1 — 1 „ Breakfast — 1 1 „ Pork — 1 1 — ,, Smoked — 1 1 — Soda, Bicarbonate of — 1 — 1 — — Spratts (canned) — 1 — 1 — — Suet — 1 — 1 — — Sugar — 15 — 15 — — Sultanas — 4 — 4 — Tapioca — 1 — 1 — — Tea — 4 — 4 — — Vinegar — 7 — 7 — — ,, Malt 2 3 — 1 2 2 ,, Non Brewed 1 9 — 8 1 1 Whisky — 1 — 1 — — Wine, Ipecacuanha — 3 — 3 — — Totals 408 392 398 384 10 8 Summonses. Prosecutions were undertaken in respect of two samples, which were reported as being adulterated. The results of the proceedings are stated in the following table:— Article. Offence. Food and Drugs (Adulteration) Act, 1928. Date of Hearing. Result of Proceedings. Penalty. Costs. 1938. £ s. d. Vinegar Selling as Malt Vinegar, Vinegar 100 per cent. other than Malt Vinegar 23rd April 1 1 0 Milk Selling milk adulterated to the extent of 3.0 per cent. of added water Jrd June Dismissed under the Probation of Offenders Act 2 15 0 Wholesale Dealers in Margarine. No certificates of registration under the provisions of the Food and Drugs (Adulteration) Act were issued during the year 63 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 had been taken formally and the Committee decided to send a cautionary letter to the vendor in three cases. The fourth was subsequently prosecuted (1939). REPORT OF THE BOROUGH ANALYST. 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:— During the year 1938, 800 samples were submitted for analysis in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, 408 having been purchased with the required formalities and 392 obtained informally. Of this total, 18 (2.25 per cent.) proved to be adulterated, 10 being samples submitted formally and 8 informally. Last year 19 (2.4 per cent.) were so certified, 10 being submitted formally and 9 informally. The adulterated articles consisted of Milk, Meat Paste, Minced Meat, Sardines, Sausages and Vinegar. Milk.—Four hundred and twenty-one samples of milk were examined and only four (0.95 per cent.) fell below the limits required by the Moard of Agriculture Regulations—3.0 per cent. of fat and 8.50 per cent. of non-fatty solids—and were certified to be adulterated. Three of the adulterated samples were deficient in fat, the amount in each case being at least 2.0, 3.0 and 8.9 per cent. respectively, and to the one remaining adulterated sample, water had been added to the extent of at least 3.0 per cent. In the table given below, prepared by the Publie Health Department, the results of 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 of Qhnuink Milk during the Years 1936, 1937 and 1938. Month. Number of Samples Examined. Genuine. Fat per cent. Average. Non-fatty Solids per cent. Average. 1936 1937. 1938. 1936. 1937. 1938. 1930. 1937. 1938. January 14 10 33 3.6 3.6 3.6 9.10 9.02 8.91 February March 32 14 44 3.6 3.6 3.5 9.10 8.92 8.98 44 29 46 3.5 3.5 3.4 9.00 8.88 9.02 April 23 49 34 3.5 3.4 3.3 8.93 8.89 8.81 May 24 32 38 3.5 3.3 3.3 9.02 8.82 8.94 June 15 62 50 3.3 3.3 3.4 9.01 8.84 8.97 July 48 20 32 3.4 3.4 3.3 8.93 8.83 8.95 August 36 35 21 3.4 3.4 3.4 8.95 8.89 8.99 September 31 34 35 3.7 3.7 3.5 9.03 9.06 9.02 October 30 25 17 3.7 3.6 3.6 9.11 9.05 9.03 November 16 48 31 3.8 3.8 3.6 9.06 9.04 9.05 December 6 23 36 3.8 3.6 3.7 9.07 8.86 8.93 Whole Year 319 381 417 3.6 3.5 3.4 9.03 8.93 8.96 64 Although the quality of the Milk supply may be said to have been maintained, attention must be drawn to the fact that during the three years shown above, there has been a gradual fall in the average fat content. It is still well above the limit specified by the Board of Agriculture, but it must be remembered that that limit is to be regarded as the lowest amount of fat contained in genuine milk of the poorest quality and it was certainly never intended that producers should endeavour to produce milk with only 3'0 per cent, of fat. When it is considered what an important article of food milk is, especially for infants and invalids, it is necessary to emphasise the importance of a supply of good milk, such as can he obtained from properly treated and selected cows. Meat Paste. One sample of chicken and ham paste contained sulphite preservative equal to 41 parts per million of sulphur dioxide. The Preservative Regulations do not permit its use in meat pastes. Minced Beef. Two samples of minced beef had been preserved with 82 and 222 parts per million of sulphite preservative respectively. The use of preservative is prohibited in minced beef. Sardines. Two samples of sardines were certified to contain seven and eight parts per million of lead respectively. The presence of this poisonous metal in sardines is still occupying the attention of Food Authorities, with the result that it is only in more or less isolated cases that an excessive quantity is found. Sausages. Three samples of sausages sold without notice that preservatives had been added were found to contain 178, 206 and 220 parts per million of sulphite preservative and were certified accordingly. As the Preservative Regulations have been in force for a number of years there can be little excuse for the sale of sausages without notice being given of the presence of preservative, especially as reputable makers label all pounds in the proper manner and many issue additional labels to be used when the original pounds are broken up and sold in smaller quantities. Malt Vinegar. In a recent decision it was held that the word Vinegar must be used to apply to Malt Vinegar only, and that any other vinegar must be properly described as "non-brewed," etc., at the time of sale. In three cases certificates were given that the samples contained 100 per cent of vinegar other than malt vinegar. A non-brewed vinegar was found to be deficient in Ascetic acid—the essential acid of vinegar—to the extent of at least 10.0 per cent. Vinegar should contain at least 4.0 per cent. of Ascetic acid. Legislation. The new Act to amend the Food and Drugs and other Acts mentioned in my last Report has now been passed by the Legislature and will come into force on the 1st October, 1939. Section VII. Prevalence of, and Control over, Infectious Diseases. 65 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); Measles and Whooping Cough (1938). and the Infectious Diseases (London) Regulations, 1937, for Malaria Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia. and wherein Enteric Fever is defined to include the Paratyphoid group of Fevers. C. Under a Special Order of the London County Council in 1909 Glanders Anthrax Hydrophobia "when these occur in man." D. Under the London County Council (General Powers) Act, 1932, and the Public Health (London) Act, 1936 Food Poisoning. 66 The following table gives the number of cases notified, the number of deaths which occurred, and the number of patients admitted to hospital during 19:58. 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. 1 and under 2. 2 ana under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and upwards. I. Small-pox — — — — — — — — — — — — — — — 2. Scarlatina or Scarlet Fever 6 10 21 25 43 130 46 13 22 3 5 — 333 319 — 3. Diphtheria and Membranous Croup 10 20 28 26 28 147 39 26 40 6 1 3 374 374 8 4. Erysipelas 2 1 2 — — 3 2 5 15 8 28 20 86 66 5 5. Enteric or Typhoid Fever — — — —— — — 1 1 2 2 1 — 7 7 2 6. Puerperal Fever — — — — — — — 6 1 — — 7 7 — 7. Puerperal Pyrexia — — — — — — — 2 31 2 — — 37 36 — 8. Cerebro-spinal Meningitis 3 — — — — 1 — 2 5 — 2 — 13 12 5 9. Anterior Poliomyelitis and Polioencephalitis — — — 2 — — 1 — 2 — — — 5 5 — 10, Ophthalmia Neonatorum 21 — — — — — — — — — — — 22 12 — 11. Encephalitis Lethargica — — — — — — — — — — — — — — 2 12. Acute Influenza and Influenzal Pneumonia 1 3 — 1 2 5 — 3 6 2 12 4 39 21 6 13. Acute Primary Pneumonia 11 12 5 10 4 IS 4 10 33 16 35 11 166 128 5 14. Malaria — — — — — — — — 3 — 2 — 5 4 1 15. Dysentery 12 4 10 4 3 9 — 3 9 3 4 2 63 58 2 16. Measles 166 242 296 324 333 847 66 14 42 7 — - 2337 675 12 17. German Measles† 8 28 32 28 33 148 46 9 19 4 — — 355 72 — 18. Food Poisoning.. — — _ _ — 2 1 — 2 1 2 — 8 1 — 19. Whooping Cough† 17 17 10 18 '4 36 1 — — — — — 113 68 3 20. Continued Fever — — — — — — — — — — — — — — — For Pneumonia Deaths, see Tables on pages 21 and 22. † Whooping Cough was notifiable as from 1st October, and German Measles ceased to be notifiable as from that date. 67 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. 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1. Small-pox — — — — — — — — — — — — — — — — — _ 2. Scarlatina or Scarlet Fever 65 86 40 38 33 25 9 37 — 333 — — — — — — — — 3. Diphtheria and Membranous Croup 40 60 88 47 47 45 22 25 — 374 — 1 2 1 2 1 1 — 8 4. Erysipelas 19 8 18 9 11 8 2 11 — 86 — 1 3 — — — — 1 5 5. Enteric or Typhoid Fever — 1 2 — 1 — 2 1 — 7 — — — — — — 1 1 2 6. Puerperal Fever — 2 — 2 1 1 _ 1 — 7 — — — — — — — — — — 7- .. Pyrexia 5 4 9 4 4 5 4 2 — 37 — — — — — — — — — — 8. Cerebro-spinal Meningitis 1 2 4 — 1 1 2 2 — 13 1 1 2 — — 1 — — 5 9. Anterior Poliomyelitis and Polioencephalitis — — 1 2 1 — 1 — — 5 — — — — — — — — — — 10. Ophthalmia Neonatorum 3 2 7 3 1 5 — 1 — 22 — — — — — — — — — — 11. Encephalitis Lethargica — — — — — — — — — — 1 — 1 — — — — — — 2 11. Acutc Influenza and Influenzal Pneumonia 9 6 12 2 5 — 3 2 — 39 3 — i 1 1 — — — — 6 13. Acute Primary Pneumonia 38 29 26 21 16 10 6 26 — 166 3 — — 1 — — — 1 — 5 14. Malaria — — — 2 — — 3 — — 5 — — — — — — — — — 1 15. Dysentery 15 8 10 5 7 3 6 3 — 63 — — 1 — — _ — 1 — 2 16. Measles 357 415 43 402 311 164 70 187 — 2337 1 — 3 3 1 3 1 — — 12 17. German Measles† 34 61 85 52 43 51 17 12 — 355 — — — — — — — — — — 18, Food Poisoning — - 1 — 1 5 1 — — 8 — — — — — — — — — 19, WhoopingCough† 25 30 18 15 9 9 2 5 — 113 — — 1 1 — — — 1 — 3 20. Continued Fever — — — — — — — — — — — — — — — — — — — — Totals 611 714 75* 004 492 332 150 >°9 — 39/0 9 3 '4 7 4 | 5 4 5 F 5' For Pneumonia deaths, see Tables on pages 21 and 22. † Whooping Cough was notifiable as from 1st October, and German Measles ceased to be notifiable as from that date. 68 SMALL.POX. There were 110 cases notified in St. Pancras during 1938. 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, 1937. Vaccinations. 1st January to 31st December, 1937. Number. Percentage of Births registered. North. SouthEast. SouthWest. Whole Borough North. SouthEast. SouthWest. Whole Borough Births registered 367 2053 1404 3824 100.0 100.0 100.0 100.0 Died, unvaccinated 8 89 45 142 2.2 4.3 3.2 3.7 Successfully vaccinated 159 965 598 1722 43.3 47.0 42.6 45.0 Had smallpox — — — — — — — — Insusceptible of vaccination 1 5 3 9 0.3 0.2 0.2 0.2 Received certificate of conscientious objection 157 597 412 1166 42.8 29.0 29.3 30.5 Postponed by medical certificate 17 27 28 72 4'6 1.3 1.9 1.8 Moved to known address in other districts 2 229 243 474 0.5 11.1 17.3 12.4 Lost sight of by removal 16 118 59 193 4.4 5.7 4.2 5.0 Unvaccinated and not accounted for in previous columns 7 23 16 46 1.9 1.0 1.1 1.2 The corresponding figures for the past ten years are as follows:— Year. Births. Successfully Vaccinated. Per cent. Conscientious Objections, and Children otherwise escaping Vaccination. Per cent.. 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 1937 3824 1722 45.0 1166 30.5 69 Return showing the number of persons successfully vaccinated and re-vaccinated at the cost of the rates bv the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1938:— 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 Vaccina tion 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 179 10 189 9 „ 2 „ F. L. Pellv 112 16 128 3 Wards 3 and 4 , J. W. Wigg 295 15 310 7 ,, 5, 6, and 7 „ A. E. Tait 224 18 242 3 Ward 8 „ C. H. Alderton 78 12 90 16 St. Pancras Hospital ,, W. Feldman 2 — 2 — Highgate Hospital ,, C. Thackeray 3 2 5 2 Totals 893 73 966 40 SCARLET FEVER. The number of cases notified was 333, as compared with 364 cases during the previous year. It was subsequently ascertained that 23 cases were not regarded as cases of this disease. The actual number of cases was therefore 310. No death occurred. 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 three 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 nine families there were two such cases, in three families there were three, and in one family there were four. It is recommended to the friends of patients discharged from hospital after suffering from scarlet fever:— 1. That, if practicable, for three weeks after leaving hospital, the patient should not sleep in the same bed as children who have not had scarlet fever. '2. That during this period articles used by the patient (such as cup, plate, spoon, handkerchief, towels, and toys) should be kept distinct from those used by other children. 3. That the patient should not attend school for two weeks. The above precautions are especially important in the case of those patients who have a discharge from either nose or ears. DIPHTHERIA. The number of cases notified was 374, as compared with 614 cases during the previous year. It was subsequently reported by the hospital authorities that 67 cases were not regarded as cases of this disease. The actual number of cases was therefore 307. This equals an attack rate of 1.7 per 1,000 of population. Eight deaths occurred, giving a case mortality of 2.6 per cent. 70 Investigation of multiple cases—that is, several cases occurring more or less together in one house —shows that in 12 families there were two such cases, in seven families three such cases, in one family four such cases, and in one family six 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 98 thousand units were provided. If, in the course of the next few weeks after leaving hospital, any alteration of voice, defect in the sight, difficulty in swallowing, or loss of power in limbs or tendency to faintness should be observed in a patient who has had diphtheria, a doctor should be consulted at once. It is recommended to the friends of patients discharged from hospital after suffering from diphtheria:— 1. That, if practicable, for three weeks after leaving hospital, the patient should not sleep in the same bed as children who have not had diphtheria. 2. That during this period articles used by the patient (such as cup, plate, spoon, handkerchiefs, towels and toys) should be kept distinct from those used by other children. That the patient should not attend school for two weeks. The above precautions are specially important in the case of those patients who have a discharge from either nose or ears. Immunization Scheme. The following report is submitted by Dr. P. V. Pritchard, the Deputy Medical Officer of Health:— The scheme for immunizing children against Diphtheria was put into operation in October, 1936. Certain alterations to the original 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. 71 There are 82 Medical Practitioners on the approved panel. At the end of the year 1,474 children were reported to have received or to be in the process of receiving immunization under the scheme. During 1938 there were 795 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. Five cases of Typhoid and two cases of Para 13. Typhoid were notified during the year. One diagnosis of Typhoid was not confirmed. There were two deaths. PUERPERAL PYREXIA AND PUERPERAL FEVER. In 1938 there were 37 notifications of Puerperal Pyrexia and seven notifications of Puerperal Fever. Further details of these diseases are given on page 125 of the Maternity and Child Welfare Section. ERYSIPELAS. 86 cases were notified and five deaths occurred, as compared with 64 cases and two deaths during the previous year. CEREBRO-SPINAL MENINGITIS. (Cerebro-Spinal Fever, Meningococcal Meningitis, "Spotted Fever.") Thirteen cases were notified and five died. In all cases the diagnoses was confirmed. ACUTE POLIOMYELITIS AND POLIOENCEPHALITIS. Five 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 be done for children who have had this disease if they are placed under expert care, and if this is continued for many years after the initial illness. Every effort is made to follow up these cases. OPHTHALMIA NEONATORUM. The number of cases notified was 22, and in addition 37 cases of mild inflammation of the eyes were reported. All the cases recovered satisfactorily, without impairment of vision. Further particulars are given on page 115 of Maternity aud Child Welfare Section. ENCEPHALITIS LETHARGICA. No cases were notified during the year, but two deaths occurred. 72 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 166 notifications of the former and 39 of the latter, during 1938 (as compared with 150 and 79 respectively for 1937). There were 11 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 1938, 32 cases were nursed under this arrangement and 642 nursing visits were paid. MALARIA. Cases of Malaria diagnosed in the Borough are notified to this Authority. Five cases were notified and there was one death. Of the cases notified two were in-patients of the hospital for Tropical Diseases, Endsleigh Gardens, and one was an in-patient of the St. Luke's Hostel, Fitzroy Square. These were ex-St. Pancras rnsidents. Of the other two, both St. Pancras residents, one was an in-patient of Horton Hospital. DYSENTERY. The same rule for the notification of Malaria (as described above) applies to Dysentery. 63 cases were notified during the year, of which two died. 58 of the cases were St. Pancras residents, and of the remaining five, four were in-patients of the Hospital for Tropical Diseases and one of the Royal Free Hospital. Bacteriological examinations were made in 44 cases iu which the types were:—Sonne, 37; Amoebic, 5, and 2 Acute Bacillary. Fourteen cases were diagnosed clinically, and five 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. Eight notifications were received during the year. There was no death. MEASLES AND GERMAN MEASLES. Notification of these diseases in St. Pancras was compulsory until 30th September under the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920. Under these Regulations all cases were notifiable by parents and guardians, but only the first case occurring in an outbreak in a household or institution was notifiable by medical practitioners, an interval of two months since the last case constituting a new outbreak. 73 Since the coming into operation of the County of London (Measles and Whooping Cough) Regulations on the 1st October, the Metropolitan Boroughs of Lambeth and St. Pancras (Measles and German Measles) Regulations, 1920, are repealed, and German Measles has ceased to be notifiable. Every case of Measles or German Measles which comes to the notice of this Department is visited by a Health Visitor who gives the mother advice and help as regards the patient. Where actual nursing is necessary for the case, this is arranged for by the Health Visitor and carried out by the staffs of the several nursing associations. Details as to the manner in which this work is done under a Block Grant from the Borough Council is reported on page 121. 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 66 it will be seen that out of a notified total of 2,692 of these diseases (measles and German measles) 747 were removed to hospital. Home nursing was provided in 116 cases. German Measles is generally a mild disease. There were 355 cases during the year 1938, as compared with 120 cases during 1937. There were no deaths. Particulars of the cases, deaths and incidence and mortality rates of Measles are given in the following tables:— 74 Table I. MEASLES. YEAR. CASES. DEATHS. Quarter of the Tear. Total. Under 1 year. 1—5 years. 5-15 years. Adults. Quarter of the Year. Total. Under 1 year. 1—5 years. 5—15 years. Adults. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1938 1553 672 98 14 2337 166 1195 913 63 5 5 2 — 12 5 6 l — 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 1 — 17 3 12 2 — 1935 18 30 39 33 120 23 51 36 10 — — — 1 1 — 1 — 1934 1864 1567 191 16 3638 195 2033 1307 103 10 20 2 — 32 8 23 1 — 1933 77 180 138 42 437 38 218 158 23 2 — 2 — 4 — 4 — — 1932 749 1901 162 53 2865 135 1592 1090 48 8 hi 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 — — MEASLES. TABLE III 75 Table II. MEASLES. Year. Incidence Rate per 1000 Population. Mortality Rate per 1000 Cases. Quarters of Year. Total. Quarters of Year. Total. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1938 8.6 3.7 .5 .1 13.0 3.2 7.4 20.4 — 5.1 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 54 12.7 10.4 — 8.8 1933 .4 .9 .7 .2 2.2 25.9 — 14.5 — 9.2 1932 3.9 9.8 .8 .3 14.8 10.7 8.4 18.5 — 9.4 1931 .7 .9 .3 .3 2.2 7.4 5.4 — — 4.7 1930 6.5 9.5 .9 .2 17.1 9.7 7.8 17 5 — 8.9 1929 1.3 1.2 .3 .2 3.0 19.4 8.3 — — 11.8 1928 11.0 7.1 .5 .1 18.8 20.7 52.8 19.6 — 32.7 WHOOPING COUGH. Since the coming into operation of the County of London (Measles and Whooping Cough) Regulations on the 1st October, Whooping Cough has been notifiable. Particulars of the Regulations are set out on page 14. Between 1st October and 31st December, 113 cases were notified and three died. 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 measures adopted proved effective, and a general spread of infection throughout these institutions was prevented. 76 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. Library books and articles which would be injured by steam are disinfected by formaldehyde generated in a small chamber. Separate motor vans are used for the collection of infected and delivery of disinfected articles. The work done during the year by the disinfecting staff is shown in the following table:— Disease. No. of cases. No. of houses. No. of rooniB contents disinfected or destroyed. No. of rooms sprayed and fumigated. Smallpox* 1 2 1 2 Scarlet Fever 306 285 297 263 Diphtheria 857 358 848 352 Enteric Fever 8 8 8 2 Puerperal Fever 6 6 6 3 „ Pyrexia 1 1 1 — Erysipelas 75 75 75 6 Cerebro-spinal Meningitis 8 8 8 7 Measles 45 45 36 32 Pneumonia 1 1 1 Dysentery 80 29 29 2 Scabies 301 261 265 Tuberculosis 129 129 33 142 Vermin 364 362 212 295 Polio myelitis 4 4 4 2 Encephalitis lethargica 1 1 1 — Other Diseases (not fiable) 487 487 482 36 Totals 2124 2057 1807 1144 * This was a suspected case of Small pox subsequently diagnosed as Erythema Multiformi. 77 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 114 2908 29 1000 Bolsters and pillows 49 5885 13 1294 Sheets, blankets and counterpanes 29 7478 - 1818 Rugs, mats, cushions, carpets, covers and curtains 27 1967 - 1106 Wearing apparel 52 3864 9 1255 Books 12 723 - 4 Sundries 28 2142 8 446 Totals 311 S4967 59 6918 The tables above are exclusive of the disinfection of the clothing of persons who attended the cleansing station on account of being infested by vermin or suffering from scabies. Disinfection for Institutions, etc. In addition to the disinfecting work carried out free of charge in connection with infectious disease, disinfections for other conditions are frequently performed for hospitals or private residents. A small charge is made in these cases to cover the cost. The fees received for this work during the year ended 31st March, 1939, amounted to £127 10s. 0d. 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 362, and the number of rooms sprayed and fumigated was 295. In a number of cases the contents only were disinfested. Council property is dealt with by the Estates Department. 2. The methods employed for disinfestation by the Public Health Department 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. 78 4. Disinfestation was carried out by the Local Authority except in circumstances explained in (3) above. In cases where the London County Council rehouse tenants living in verminous premises, the Borough Council undertake to disinfest the bedding and rooms. The powers of the Local Authority for dealing with infested houses are strengthened by Section 123 of the Public Health (London) Act, 1936. Cleansing. 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 1431 35 3824 5290 Scabies 360 321 3243 3924 Totals 1791 356 7067 *9214 * Includes 211 males and 1 female who had no home address. The majority of the children included in the above table have been brought to the cleansing station from the public elementary schools by officers of the London County Council. As the Education Authority, powers were conferred upon them by the London County Council (General Powers) Act, 1907, and the Children Act, 1908, authorising the cleansing of children whose bodies or clothing were infested with vermin, or who were in a foul or filthy condition. The necessary cleansing work is carried out by the staff of the Borough Council on behalf of the County Council. Clerical duties and general supervision are undertaken by London County Council School Nurses. Payment is made by the L.C.C. at the rate of two shillings per child in respect of verminous conditions, and one shilling per bath for those suffering from scabies. In connection with children whose bodies or clothing are very verminous, arrangements are made for the homes to be visited by the Sanitary Inspector, as the rooms and bedding may also need disinfesting. It would obviously be useless to deal with the child and neglect the home. BACTERIOLOGICAL WORK. To aid in diagnosis and to detect contact or carrier cases, the Borough Council provides bacteriological diagnosis, free of charge, in connection with certain diseases. In addition to the aboye, 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. 79 The undermentioned examinations were made during the year:— Nature of Specimen. Positive. Negative. Total. Swabs for Diphtheria Bacilli 142 2232 2374 „ „ Hemolytic Streptococci 8 4 12 ,, „ Cerebrospinal Meningitis — 2 2 „ „ Anthrax — 1 1 Sputum for Tubercle Bacilli 18 293 311 Stools for Dysentery 8 31 39 „ „ Food Poisoning 4 7 11 „ „ Typhoid — 4 4 Blood „ „ 2 11 13 Urine for Tubercle Bacilli -- 1 1 Smoked Salmon for suspected Food Poisoning — 1 1 Tinned Peas „ „ „ — 2 2 182 2589 2771 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. 81 Section VIII.—TUBERCULOSIS. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1938 are given in the following table in the form required by the Ministry of Health :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 1 — — 1 — — — 1 1—5 1 4 1 1 — 1 — — 5—16 5 3 12 3 — 1 — 1 15—25 43 36 8 10 10 9 1 1 25—35 38 40 9 5 12 10 3 2 35—45 31 16 2 4 12 11 — 1 45—55 34 11 2 3 20 6 — — 55—65 20 4 — — 13 3 — — 65 & upwards 11 3 — 3 10 3 1 1 Totals 184 117 34 30 77 44 5 7 The total number of Primary notifications was 283 ; in addition to these, 20 cases which had not been notified, came to knowledge by means of special death reports, and 62 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 365, equal to a notification rate of 2.03 per 1,000 of population, compared with 391 new cases during the previous year. The deaths from all forms of Tuberculosis during the year numbered 133, equal to a death rate of 0.74 per 1,000 of population, whereas the total number of deaths in the previous year was 162. It will be noted that, out of a total of 133 deaths from Tuberculosis, 20 (being 15 per cent.) were of cases which were notified only at death. Death from tuberculosis before notification may be due to:—(1) Sudden death of a person who has not consulted a doctor since tuberculosis has developed. (2) Sudden death of 82 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 beiug 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—1938. Time of Notification. PULMONARY. NON-PULMONARY. Total. Percentage. Male. Female. Male. Female. 1938 Discovered on Death 10 4 2 5 21 15.8 Six months or less before Death 28 8 — — 36 27.1 Remainder 4 1 — — 5 3.7 1938 Total 42 13 2 5 62 46.6 1937 14 11 — 25 18.8 1936 6 8 — 1 15 11.3 1935 4 — — — 4 3.0 1934 3 3 — — 6 4.5 1933-1929 7 7 — — 15 11.3 Before 1929 4 1 1 1 6 4.5 Total 80 43 3 7 133 100 83 public health (tuberculosis regulations, 1930. The number of cases of Tuberculosis notified and those which came to knowledge by means of Death Reports and transfers from other Districts are given in the following tables:— Age Periods. Number of Notifications on Form A. Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors). 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males 1 1 2 2 16 22 32 21 22 16 9 144 161 Females — 4 2 1 17 15 29 12 7 2 1 90 110 Non-pulmonary Males .. — 1 4 5 3 5 6 1 2 — — 27 27 Females — 1 — 2 5 4 2 3 3 — 2 22 23 Totals 1 7 8 10 41 46 69 37 34 18 12 283 *321 * Exclusive of 22 " Lost sight of " cases returned. Age Periods. Information obtained from Special Death Reports, by Transfer from other districts, and by Posthumous Notifications. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary Males , , 4 6 10 12 4 2 40 Females ... — — — — 1 3 11 4 4 2 2 27 N011- pulmonary Males — — 3 — — — 3 1 — — — 7 Females ... 1 — 1 1 — 3 1 — — 1 8 Totals 1 — 3 2 3 7 23 16 16 6 5 82 84 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 Rate per 1000 population. Pulmonary. Other forms. All forms. Pulmonary. Other forms. All forms. Pulmonary. Other forms All forms. Pulmonary. Other forms. All forms. 1929 203900 376 93 469 218 32 250 1.84 0.46 2.29 0.07 0.16 0.23 1930 203900 321 76 397 165 24 189 0.54 0.36 1.91 0.79 0.12 0.91 1931 195200 329 75 404 181 25 206 1.68 0.38 2-07 0.93 0.13 1.06 1932 194000 324 85 409 164 25 189 1.67 0.44 2.11 0.84 0.13 0.97 1933 190900 297 79 376 171 24 195 1.56 0.41 1.97 0.90 0.12 1.02 1934 187540 296 49 345 157 15 172 1.58 0.26 1.84 0.84 0.08 0.92 1935 185300 275 47 322 123 15 138 1.48 0.25 1.73 0.66 0.08 0.74 I936 183900 311 69 380 150 14 I64 1.69 0.37 2.06 1.81 0.07 0.88 1937 181900 343 48 391 148 14 162 1.88 0.26 2.15 0.81 0.08 0.89 1938 179400 301 64 365 121 12 133 1.67 0.35 2.03 0.67 0.06 0.74 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 cach Ward of the Borough during 1938 :— Tuberculosis (All Forms). Ward. New Cases. Deaths. Number. Rate per 1000 of Ward Population. Number. Rate per 1000 of Ward Population. 1 49 1.5 17 0.5 2 32 1.8 15 0.8 3 61 2.0 31 1.0 4 50 2.3 16 0.7 5 44 1.7 18 0.7 6 34 2.1 10 0.6 7 32 2.7 6 0.5 8 54 2.3 15 0.6 Homeless 9 - 5 — Totals 365 2.03 133 0.7 85 In the following table are given the deaths from Tuberculosis of St. Pancras residents during 1938, the deaths in each Ward and those occurring in the Hospitals of the Borough and elsewhere. (This table is prepared by the Registrar-General.) Under 1 year. 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. 65—75 years. 75 yrs. upwards. Wards. No address. Total Not in Institutions. St. Pancras Hospitals. Other London Hospitals. Hospitals outside London. I II III IV V VI VII VIII Resident. NonResident. M F M F M F M F M F M F M F M F M F M F M F All Forms 1 1 ... ... 2 8 13 27 24 26 16 10 5 13 7 8 17 14 9 7 12 6 5 5 5 1 11 4 3 2 82 51 10 8 61 49 45 9 Respiratory System ... 1 ... ... ... 7 12 22 23 26 16 9 4 12 4 7 7 14 14 9 4 12 5 5 3 5 1 11 4 2 2 77 44 10 8 54 42 40 9 Central Nervous System 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... 2 2 1 ... Intestines and Peritoneum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Vertebral Column ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... 1 1 1 ... Genito Urinary System ... ... ... ... 1 ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... Adrenals ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ..... ... 1 ... 1 ... Disseminated, Acute ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ,, Not distinguished ... ... ... ... ... ... l 1 ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 2 ... ... 2 ... 1 ... 86 NOTIFICATION REGISTER. This is kept at the Dispensary. The following table gives the information for the ye ended December 31st, 1938, in the prescribed form : — Pulmonary. Non-Pulmonary. Total. Number of cases on the Register at the commencement of the year 1938 790 190 980 Number of new cases during the year 319 68 387 1109 258 1367 Number of cases removed from the Register during the year (from death or other causes) 325 78 403 Number of cases remaining on the Register at the end of the year 784 180 964 Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations make it possible to require that an individual suffering from tuberculosis shall discontinue employment in the milk trade. No formal action was necessary during the year. TUBERCULOSIS DISPENSARY. Tuberculosis Officer, Dr. G. A. Back. Address aud telephone number of Dispensary: — Barnes House, Camden Road, N.W.I. Gulliver 2371. The following are the times of the sessions at the Dispensary : — Monday 11 a.m. Dr. Back .. .. Tuesday .. 2 p.m. Dr. Back 7 p.m. Dr. Pritchard Wednesday 11 a.m. Dr. Back .. .. Thursday .. 2 p.m. Dr. Back 7 p.m. Dr. Back Friday .. 2 p.m. Dr. Pritchard .. Saturday 11 a.m. (School children only) Dr. Back .. .. 8 7 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 122 73 5 8 14 13 8 3 136 86 13 11 246 (b) Diagnosis not completed — — — — — — — — 6 6 — — 12 (c) Non-tuberculous — — — — — — — — 95 108 21 21 245 13.—Contacts examined during the year:— (a) Definitely tuberculous — — 1 — — — — — — — 1 — 1 (b) Diagnosis not completed — — — — — — — — — — 1 — 1 (c) Non-tuberculous — — — — — — — — 69 89 63 64 285 C.—Cases written off the Dispensary Register as— (a) Recovered 11 6 4 6 1 6 3 17 6 10 3 36 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 170 203 81 85 542 D.—Number of Cases on Dispensary Register on Decernber 31st:— (a) Definitely tuberculous 369 225 28 30 45 41 33 23 414 206 61 63 794 (b) Diagnosis not completed — — — — — — — — 7 11 1 19 I. Number of cases on Dispensary Register on January 1st 797 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 90 (a) Personal 7 (b) Other 8. Number of visits by Tuberculosis Officers to 267 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 186 homes (including personal consultations) 71 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3623 4. Cases written off during the year as Dead (all causes) 100 10. Number of— (a) Specimens of sputum, &c., examined 432 5. Number of attendances at the Dispensary (in- i cluding Contacts) 3523 (6) X-ray examinations made in connection with Dispensary work* 377 6. Number of Insured persons under Domiciliary Treatment on the 31st December 328 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 428 "NOT including those made for A.P. refills. 88 The following is a summary, for purposes of comparison, of certain sections of the foregoing tables. Deaths from Tuberculosis Jan. 1st-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 133 .94 .84 597 321 378 118 97 4.3 .08 .33 4.4 47.7 74.9 Report on this Work carried out at the Tuberculosis Dispensary. The following report on the work carried out by the Dispensary has been prepared by Dr. G. A. Hack, 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 decreased from 307 to 287. The total number of contacts of the 365 cases notified during the year was 537 and of these 50 per cent. had been examined at the Dispensary and 7.0 per cent. elsewhere by the end of March, 1939. Institutional Treatment. This is provided by the London County Council in sanatoria, special hospitals and in the tuberculosis wards of their general hospitals. Application for admission is made as a rule on the appropriate form by the Tuberculosis Officer or the resident staff of the voluntary hospitals, but in emergency patients may be admitted by application to the Medical Superintendent of Highgate Hospital. Altogether 399 applications were accepted, showing a decrease of 13 over the previous year. Of these 214 were admissions to General Hospitals, 63 to Brompton Hospital or St. George's Home for investigation of their subsequent treatment, 105 to sanatoria and 17 to various hospitals for observation for diagnosis. The majority (137) 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 (55) were made by the Dispensary. Of the admissions to sanatoria and special hospitals 102 were recommended by the Dispensary and 83 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 583, showed an increase from 800 during 1937, to 989 during 1938. Of these, 249 were carried out at Brompton Hospital, 394 at University College Hospital, 32 at other voluntary hospitals, 99 at Colindale Hospital, 44 at Grove Park Hospital and 171 at Highgate Hospital, of which 151 were carried out by the Tuberculosis Officer. 89 Light Treatment. Finsen Light Treatment for lupus is provided usually at the London Hospital and at University College Hospital at a cost to the Borough Council of 5s. per attendance. Seven attendances were made at the London Hospital and none at University College Hospital during the year. Sanocrysin Treatment. This may be provided, at a cost of 3s. per injection, at Brompton Hospital or the City of London Hospital, Victoria Park, to patients who are receiving refills with the concurrence of the Tuberculosis Officer. No applications for this treatment were made during the year. X-ray examinations. These are carried out daily at University College Hospital and on four days a week at Highgate Hospital. University College Hospital charge the Borough Council ?s. 6d. per film, screening and report. The charge is 2s. 6d. at Highgate Hospital and the work is carried out by the visiting Radiologist or by the Tuberculosis Officer when he visits the hospital. Of the 377 examinations made during the year 158 wore 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 142 rooms were disinfected. Home Visits by Tuberculosis Visitors. These visits were made in order to (1) verify notifications ; (ii) investigate the home conditions and report on overcrowding, sanitary defects, need for financial assistance, etc.; and (iii) give instructions in the prevention of tuberculosis and to invite contacts and patients to attend the Dispensary. The particulars of these visits are as follows:— Number of visits under p.h. (Tub.) regulations. Number of visits for Dispensary purposes. Total Visits. Miss Holland 177 2192 2369 Miss Long 136 1431 1567 3936 Staff.—Miss Deed, who had held the post of Clerical and General Assistant at the Dispensary since 1921, retired in September, and Miss Fegan was appointed to undertake her clerical duties. Her work in the laboratory was taken over by Mrs. Bevan. The arrangement whereby the Tuberculosis Officer visits Highgate Hospital on one afternoon a week was continued during 1938. G. A. Back, Tuberculosis Officer. St. Pancras Tuberculosis Care Committee. List of Members. 1. ~ Representatives of the Borough Council. Alderman W. P. Spry. Councillor A. E. Davies. „ Dr. Mrs. M. T. Day. „ A. Escott, f.i.b.d., Chairman. „ John Evans. „ F. J. French. „ Mrs. J. Gregory. „ Mrs. M. Needham. „ Mrs. D. Pym, b.a. „ J. A. Wright. 90 2. Representatives of other bodies interested in the Welfare of Tuberculous Patients. Miss Ball, L.C.C. Schools Care Committee. Dr. Hogarth, L.C.C. (School) Divisional M.O. Mrs. 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. FT. E. J. Chollwill, 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. V. Pritchard. Mrs. E. Bevan, Secretary. The following report on work carried out during 1938 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 Treatment. The financial positions of all patients accepted for institutional treatment are investigated by the Tuberculosis Visitors and classified according to whether or not financial difficulty is anticipated. The results, after approval by the Care Committee, are forwarded to the London County Council. During the year the number of investigations reported was :— (a) Financial difficulty anticipated 149 (b) Financial difficulty not anticipated 138 287 Public Assistance. All patients and their families who appear to be eligible are referred to the Public Assistance Department. In January, 1936, the 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 91 and reported to the Care Committee for approval. During the year 450 monthly recommendations were made in respect of 82 patients. As a rule, 1½ ints of milk and 2 eggs were allowed to each patient daily and \ lb. of butter weekly. 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 76 monthly recommendations were made in respect of 23 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 89 ,, ,, monthly recommendations 341 Total cost £262 13s. 3d. 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 Count}' 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 15 (b) Articles of clothing 71 By the London County Council. (a) Number of Patients 15 (b) Articles of Clothing 79 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 1938 are : — Number of Patients 15 £ s. d. Total cost of treatment 46 13 6 Amount paid by Borough Council 32 9 2 Housing. When necessary recommendations for better housing accommodation on the Borough Council and Loudon County Council Estates are made to the Estates Department by the Tuberculosis Officer and are reported to the Care Committee. The figures for 1938 are : — Number of families recommended 36 „ „ rehoused:— (а) By Borough Council 4 (b) By London County Council 6 (c) Found accommodation not on Council's Estates 9 92 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 23. Provision of Beds and Bedding. Since 1924 the Council has provided beds and bedding which are lent to tuberculous patients who would bo liable otherwise to spread infection by sharing a bed with another person or persons. The Tuberculosis Visitors report periodically on the condition of the bods. The figures for 1938 are:— Number of families provided with beds and bedding during the year 5 Number of families using beds or bedding on December 31st, 1938 5 In addition the Public Assistance Committee have been asked to provide and have provided bed and bedding 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, and another was purchased during the year and is now 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 : — (а) Children living in heavily infected and overcrowded homes. (b) Children about to be discharged from institutions where they have had treatment for tuberculosis, in cases where their homes are unsuitable. (c) "Weakly" children living under conditions likely to subject them to infection. (d) Children whose mothers are having institutional treatment for tuberculosis. The arrangements are made by the Invalid Children's Aid Association on behalf of the London County Council, and the number accepted and reported to the Care Committee during 1938 was 15. Handicrafts Class. The Handicrafts Class which was formed in 1937, in conjunction with the Hampstead Tuberculosis Care Committee, was continued successfully dnring 1938. At the Exhibition held at the Kensington Town Hall on 23rd March, 1938, our stall attracted considerable attention, and many orders were received in consequence. Queen Mary attended the Exhibition and made a purchase at the stall. Voluntary work of great value litis been given by Mrs. Dixon, a Member of the Hampstead Tuberculosis Care Committee. Unfortunately Mr. Stephen Smith was prevented by ill-health from continuing his valuable assistance, and Mrs. Ollard was also unable to give her services after the beginning of the year. We have been fortunate in retaining the services of Mrs. Bridgman, the teacher provided by the London Count)' Council. The success of the class is due largely to her untiring efforts and enthusiasm. 93 Miscellaneous, Holidays were provided, in co-operation with the St. Pancras School for Mothers and the Charity Organisation Society, for four families of Tuberculosis patients. Fares were paid in several cases to enable relatives to visit patients undergoing residential treatment. Pocket money grants were made to fourteen patients without means while they were in Sanatorium. During the cold weather at Christmas, coal was sent to eighty-three needy patients. The Secretary of the St. Pancras Needy Fund again asked for the names of patients in poor circumstances. Twenty names were submitted, and each person received a generous parcel at Christmas. Furniture was provided for two families to enable them to obtain more suitable accommodation, and a bed was purchased for a patient discharged from Sanatorium to enable her to sleep alone. Hire purchase payments were made in two cases where the family income was temporarily reduced, and two grants were made towards the purchase of spectacles. Senl Sites. The Care Committee again took part in this scheme for raising funds, organised bv the National Association for the Prevention of Tuberculosis. The proceeds np to December, i 9-58, are shown in the following statement : — 94 Receipts and Payments Account for the Year ended 31st December, 1938. Receipts. Payments. Cr. Dr. £ s. d. Bv Grants: £ s. d. £ s. d. To Balance brought forward 126 18 2 Mr. Manton (towards stock foi stall) „ Victor Stevens, silver paper 0 9 10 3 3 0 „ National Deposit Friendly Society Grant 3 3 0 ,, Winters (Furniture) 5 0 0 Mrs. Talbot (Lino) 3 8 0 ,, Borough Council Grant 25 0 0 Miss Fleming (Holiday) 1 10 0 „ Eleanor Palmer Charity Grant 21 0 0 Mrs. Grogan ( „ ) 1 0 0 ,, Donation from Mr. Back 1 0 0 Francis Family ( „ ) 3 15 0 „ brant from Borough Council for Handicrafts 10 0 0 Mrs. Thurlow ( ,, ) 1 0 0 Mr. Newman (Removals) 1 15 0 ,, Return of pocket money (Willoughby) 0 10 0 ,, Kennedy (Hire Purchase) 1 8 0 ,, Roberts („ ) 2 0 0 „ Egan's National Health Insurance 2 5 0 '7 \ 7 7 / Miss Long for Miss Rosenwick's bed 1 0 0 ,, Refund from Mr. Lindsay 1 3 5 Miss Read (Glasses) 1 9 6 „ Seal Sales 34 4 10 Mr. Roberts( „ ) 0 12 0 Handicrafts 10 0 0 „ Pocket money : Mr. Talbot 0 10 0 „ Kiely 1 0 0 Miss Brown 0 10 0 Mr. MacAuley 1 0 0 ,, Stenning 0 10 0 „ Willoughby 0 10 0 ,, Munday 1 10 0 „ Michael 1 10 0 ,, Bullock 1 0 0 ,, Kellett 1 0 0 ,, Supple 0 10 0 „ Mead 0 10 0 „ Groves 0 10 0 „ Curtiss 0 10 0 „ Fares 4 7 8 „ Haines, Repairs to surgical Boot 0 6 9 „ National Health Insurance stamps 0 19 8 „ Rents in advance 1 18 6 „ Lindsay Loan 1 3 5 „ Egan, National Health Insurance payments 2 10 0 Sundries 1 10 2 „ Clothing 2 17 0 „ Seal Sale Account 4 14 8 „ Lewingdon, printing 3 12 6 ,, Repair to Wireless and licence 2 0 0 „ Facers, Coal 10 0 7 „ Lindsay, Painting of Shelter 4 10 0 „ Balance at Bank 132 17 10 „ „ in Hand 4 5 0 137 2 10 £225 14 3 £225 14 3 Section IX. Maternity and Child Welfare. 95 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. The Borough is divided into seven Welfare Districts. One of these, Ward 7, has been allocated to the University College Hospital Welfare Department. This Centre is staffed by Hospital Officers and supervised by the Council's Maternity and Child Welfare Officer as part of the Borough's scheme. Kentish Town district has a new Centre in Raglan Street. This is in place of the one formerly housed in Caversham Road. It has no Voluntary Committee and is managed directly by the Council's officers. This Centre has its own Superintendent and Health Visitors. The other five districts 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 an}' 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 32nd 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 at the Centres other than the one at the Hospital are salaried officers of the Borough Council and, while working in close co-operation with the voluntary committees (where they exist), 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. 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:—Royal Free Hospital and Elizabeth Garrett Anderson Hospital. 1.—Population of the area served by the Council, Registrar General's estimate for Midsummer, 1938—179,400. 96 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—2,395. (b) Still births—66. (c) Total*—2,461. (d) By midwives*—2,141. (e) By doctors and parents'—320. *The total of the figures given under (d) and (e) should agree with the figure uuder (e). 3.—Health Visiting. (a) Number of officers employed for health visiting at the end of the year. (i) By the Council—17 (four of which are temporary). (ii) By Voluntary Associations—2 (at University College Hospital Centre). (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 visitsf—1,522. Total visits —3,628. (ii) To children under 1 year of age :— First visitst—2,386. Total visits —12,886. (iii) To children between the ages of 1 and 5 years: — Total visits —13,180. 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—24,626. (ii) By children between the ages of 1 and 5 years—15,722. (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*—1,592. (ii) Between the ages of 1 and 5 years—250. * Exeluding Children who are known to have previously attended a Centre in another Distrist. † Excluding cases which are known to have previously been visited in anothner district and cases visited during the previous year. 97 (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—1,411. (ii) Over 1 year of age—2,668. (g) Percentage of notified live births represented by the number in (d) (i) 66-47 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 —3,979. (v) Total number of women who attended at the Clinics during the year—955. (b) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv)—38.80. J 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 98 and III on page 99,— 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 487 ante-natal consultations were held, the number of expectant mothers was 1,066 and their total attendances were 5,080. For the two previous years the total attendances were 4,985 and 5,189. For the two previous years the total attendances of children were 39,993 and 39,757. 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 Ward 7. Infants attending at 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 95). 98 The Royal Free Hospital receives a grant for its Welfare Department directly front 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 99. These figures are not included in the returns made to the Ministry. 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.1 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 Monday in the month at 10 a.m. (Dr. Gillespie) Camden Town Maternity and Child Welfare Centre, Barnes House, Camden Road, N.W.I The 1st, '2nd and 4th Tuesdays in the month at 10 a.m. (Dr. T. Ivor Hughes) Mondays. Tuesdays, Thursdays and Fridays at 2 p.m. (Drs. Russell, Elgood, Pritchard and Alderton) Wednesdays at 10 a.m. (Dr. Knowlson) – Kentisli Town Maternity and Child Welfare Centre, N.W.5 Tuesdays, at 10 a.m. First Friday, at 2.30 p.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 and 3rd Thursdays in the month at 10.30 a.m. (Dr. Hawthorne) Tuesdays, Wednesdays, Thursdays and Fridays at 2 p.m. (Drs. Neill, Elgood, Hawthorne and Leesmith) – Somers Town Maternity and Child Welfare Centre, Chamberlain House, Oesulston Street, N.W.1 The last Wednesday in the month at 10 a.m. (Dr. T Ivor Hughes) Mondays, Tuesday, Wednesdays and Thursdays at 2 p.m. (Drs. Wigg, Kitcat, Leesmith and Russell) – South Highgate Infant Welfare Centre, 43, Raydon Street, N.19 – Wednesdays and Thursdays at 2 p.m. (Drs. Pritchard and Neill) – Table III. Return of Attendances, Visits and Consultations at the various Welfare Centres in the Borough during 1938. Centre Consultations Attendances at Consultations. Visits by Trained Visitors. Children. Expectant Mothers. Expectant Mothers. Children. Expectant Mothers. Children. Number of Visitors. No. of Birth Notifications allocated to centre. New cases. Total attendances. New cases. Total attendances. Per month. Total. Per month. Total. Under 1 year. 1 - 2 years. 2 - 5 years. Total. Under 1 year. 1 - 2 years. 2 - 5 years. Total. First visits. Total visits. First visits. Total visits. Council Staff. Others. St. Pancras School for Mothers 14 161 1 12 385 33 97 248 22 22 292 3276 1245 777 5298 247 818 416 5624 3 – Camden Town Centre 21 249 2 27 518 140 435 414 58 58 530 5072 1805 1981 8858 338 639 547 5003 4 – Kentish Town Centre 13 162 4 52 414 131 819 334 30 48 412 4791 1214 1109 7114 261 649 439 4834 3 North St. Pancras School for Mothers, Queen's Crescent 17 202 3 35 521 126 429 378 26 34 438 5465 1364 1069 7898 295 843 559 4731 3 – Somers Town Centre 16 199 1 11 372 47 176 235 37 30 302 3496 1515 1221 6232 231 424 404 3569 2 South Highgate Centre 9 103 – – 141 – – 102 20 19 141 1905 1113 1038 4056 62 161 149 1450 1 Royal Free Hospital 13 152 12 160 – 111 624 42 27 4 73 393 192 186 771 176 206 63 360 – 3 University College Hospital 8 102 17 200 108 478 2500 51 14 65 621 158 113 892 88 104 91 855 – 2 Totals 111 1330 40 487 2459 1066 5080 1804 234 215 2253 25019 8606 7494 41119 1698 3834 2668 26426 16 5 (In addition to the above, visits were made by Student visitors attached to Centres, as follows:—Camden Town 1,355; and Kentish Town 784.) 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 ‡ See explanatory remarks regarding these two centres on page 97, 98 and 104. •Figures in respect ot children are in respect of Ward 7 only, as per scheme described on page 104. Figures in respect of mothers are iu respect of the whole of the borough. * † Figures refer to St. Pancras cases only. OP 100 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 1,372. Other activities of this centre include the following :— Classes for Mothers. At Health Talk classes there were 490 attendances; and at needlework, etc., classes, 763 attendances. Dinners for Mothers and Children. These are supplied at a very small charge for necessitous cases. Nursing and expectant mothers were supplied with 2,848 dinners and young children with 944. Observation Day Nursery. This is for children attending the Centre who need special care. There were 1,578 attendances during the year, of which 392 were made by infants under one year of age, 863 by children from 1 to 2 years of age, and 323 by children from 2 to 5 years of age. Dental Clinic. The Dental Surgeon is Mr. George ihomson, L.D.S. During the year 46 consultations were held, at which 137 treatments were provided for mothers and 158 for children. Details of the work done are given in the following table :— Extractions with anaesthetics Mothers. Children. 23 13 „ without anaesthetics — 7 Fillings 56 81 Scalings 20 — Impressions and fitting dentures, etc 32 — Examinations and advice 13 58 Totals 144 159 303 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. 101 Massage Clinic. Treatments numbering 568 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. 28 mothers and 34 children were sent away on holiday, for a period of two weeks, either to the country or seaside. Interviews with parents by the Superintendent, apart from medical consultations, numbered 2,711. Classes for expectant mothers numbering 19 were held simultaneously with the antenatal clinics. There were 324 attendances, the average being 17 per class. Knitting and Needlework classes and Health Talks were given, the total attendances being 960. The services of two trained masseuses (not paid by the Borough Council) were available throughout the year, during which time 67 massage clinics were held. There were 671 attendances. Dinners for Mothers and Children were supplied daily at the Centre to 7,402 expectant and nursing mothers and 4,838 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. 102 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. 1938. 1937. Number of new cases Mothers 169 142 Children 154 160 Total 323 302 Number of Attendances For extractions under nitrous oxide (gas) 325 295 „ local anaesthesia 19 15 „ fillings and dressings 161 139 „ scaling 18 14 „ impressions and fitting dentures 120 182 ,, examination and advice 543 490 Total attendances 1186 1135 Total number of clinics held 75 68 Number of clinics with nitrous oxide anæsthesia 24 28 The following table shows the number and cost of the dentures supplied during the year:— 1937. 1938. Number of Patients supplied with dentures 22 16 Total cost. . £ s. d. £ s. d. 66 15 0 45 15 0 Amount paid by mothers 24 0 0 15 17 6 Amount paid by Borough Council 27 18 6 21 19 6 Amount paid by Hospital Sunday Fund 7 16 6 5 16 6 Amount paid by other sources 7 0 0 2 1 6 Kentish Town Welfare Centre. In addition to the consultations provided by the Borough Council, 32 classes for needlework were held, at which 612 attendances were made. North St. Pancras School for Mothers, 129, Queen's Crescent, N.W.5. Attendances at the Sewing and Knitting classes numbered 454. Interviews with parents by the Superintendent, other than at classes or clinics, numbered 1,735. Two mothers and 68 children attending this Centre were referred for Artificial Light treatment, and 37 mothers and 46 children were referred to the Council's Dental Clinic for treatment. 15 mothers and 37 children were sent away on holiday or convalescence. 103 Somers Town Centre, Chamberlain House, Ossulston Street, N.W.I. In addition to the consultations provided by the Borough Council, the Health Visiting Staff had 685 interviews with parents, and the Voluntary Committee arranged for knitting, &c., classes during the winter months, at which 149 attendances were recorded. 38 mothers and 46 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. " 709 massage treatments were given at 92 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. 361 attendances of mothers were recorded at needlework classes. 23 mothers and 24 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 25th June to 17th October. The consultations, which were held on Mondays and Thursdays in each week, numbered 70, the average number of attendances at each consultation being 17. 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 voltaare at main 220. Cases treated.—Particulars with reference to the cases treated during 1938 are given in the following table :— 1938. 1937. Total number of cases treated 62 44 Total number of new cases 41 46 Total number of attendances 1171 1095 Number of Consultations held 70 69 Average attendance per Consultation 17 16 Average number of attendances per child 18.88 24.9 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. 104 University College Hospital Centre. This Centre is responsible for maintaining the complete Welfare Service, both for clinics and home visiting, for children in Ward 7. 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 undertakes the complete service of a Welfare Centre area for Ward 7. It provides, 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 serves Ward 7 only. It carries 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 are from time to time found necessary and possible. The ante-natal clinics are held by the Maternity Department and are not included in the Scheme. 2. —University College Centre for Mothers and Children living in Boroughs other than St. Pancras. The Hospital provides a similar but separate Service as described under item 1 in respect of the neighbouring Boroughs. The home visiting, however, is not 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 provides 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. 4.— University College Hospital Welfare Centre. Special Clinic Jor St. Pancras Babies born in the Hospital or under the care of Hospital Officers. St. Pancras babies born in University College Hospital or in 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 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. 105 Visiting in the Borough outside of Ward 7 is carried out only at the express wish of the Medical Officer in charge of the Hospital's Welfare Centre. Children visited in this respect are only those attending the Hospital under items 3 and occasionally 4. This results in some overlapping by the Hospital and local Welfare Centres' respective Health Visitors which requires 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. (A) Exchange of Information. Children referred under item 3 are given a letter from the Medical Officer to the Consultant and the Consultant would report back any important notes on the case. In the case of children coming under item 4, the Hospital reports all first attendances indicating whether the baby is considered normal or abnormal. In the case of an abnormal baby clinical notes are appreciated. When the abnormal baby becomes fit for transfer the Hospital notifies the local Centre of this discharge. When required, diaries of Health Visitors, Children's Case Papers, reports on home visiting and other relevant records are sent to the Maternity and Child Welfare Officer at the Town Hall. When a child is transferred to another Centre, the case papers are 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 are 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 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. The Eastman Dental Clinic. This Clinic is attached to the Royal Free Hospital and 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, 106 The Welfare Centre held in connection with the University College Hospital is able to refer cases needing dental treatment to the dental department of that hospital. BOROUGH COUNCIL CONTRIBUTIONS. The Local Government Act, 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. Ihe associations included, particulars of the work of which have alreadv been given are those to which the St. Pancras Borough Council make contributions and the amount 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 3lst 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 Club and Day Nursery . . 11000 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. Grant increased from £760 to £1,000 in May, 1938 107 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 j'ear a copy of the annual report of the association on the maternity and child welfare work of the previous j'ear, together with a statement of the accounts of the association for that year relating to such work and a copy of the auditors' certificate thereon, and furnishes the Borough Council from time to time with such other information relating to the maternity and child welfare services provided by the association and the expenditure thereon as may reasonably be required. WORK CARRIED OUT BY SUPERINTENDENTS AND HEALTH VISITORS. Maternity and Child Welfare work is to be considered under the two main headings of CHILD WELFARE and MATERNAL CARE. In regard to each of these the duties of Superintendents and Health Visitors are divided between home visiting and supervising or rendering assistance in connection with the various activities of the centre to which they are attached. Particulars of the work of these officers are given in the following table : — 1 3 4 6 7 8 9 10 12 108 Table IV. 108 Ampthill Square. Camden Town. Kentish Town. Queen's Crescent. Somers Town. South Highgate. University College Hospital, (j) TOTALS. Bristow.(a) Harrop. Lynn. Crockart.(a) Blair. Smith, (c) Harris, (d) Cross.(b) 0'Leary.(b)(d) Sainsbury.(b) Carr.(b) Taylor.(b) Blair.(a) Bagnall. Harris.(d) Wilson. b) Just.(b)(b) O'Leary.(b)(d) Chapman.(a) Harris.(d) Bruce. Lurie. Just.(b)(d) O'Leary (b)(d) Manger. (a) Blaxland. Robinson.(a) Harris. (d) Just.(6)(d) O'Leary. (b)(d) Brooke. (e) Warren. (e) Barnes. (e) Maternity and Child Welfare : under 1 year (a) First Visits following Birth Notifications 28 185 132 12 17 15 82 162 15 33 90 5 23 143 — 159 0 37 65 223 197 133 192 100 1 6 9 10 59 4 2139 (b) Other First Visits 1 19 20 1 5 3 9 22 8 5 10 — 1 14 — 21 1 3 5 17 9 1 13 20 28 — 2 1 1 7 — 217 (c) Subsequent Visits 376 829 1068 76 94 41 363 636 102 57 211 33 45 762 — 996 21 327 247 12 960 737 11 76 546 871 312 20 22 150 130 252 14 1050O 1 — 2 years :— 10 (a) First Visits — 6 2 1 — 1 1 1 — 4 — — 1 — 13 — 1 — — 5 9 1 — 11 12 — — — 1 1 3 1 88 (b) Subsequent Visits 273 136 470 52 48 24 161 350 80 111 186 5 31 367 17 574 24 115 41 11 468 333 10 96 377 466 180 7 27 87 32 113 5 5607 2—5 years:— (a) First Visits — 9 6 20 1 — 6 4 — — 9 — — 3 — 8 7 2 1 — 7 18 1 — 15 8 — — 1 — 2 3 — 131 (b) Subsequent Visits 257 751 748 82 72 39 291 553 104 164 392 29 37 442 76 339 20 172 80 26 413 380 47 224 862 540 317 16 16 147 67 115 6 7354 Expectant Mothers:— (a) First Visits 31 113 103 30 18 12 52 114 20 27 62 3 11 118 — 111 — 21 10 2 97 91 12 83 80 151 32 1 2 27 19 61 8 1522 (b) Subsequent Visits 89 290 192 18 9 3 61 108 12 27 60 — 11 161 — 153 4 56 81 2 221 185 2 54 92 101 57 — 7 25 5 9 2 2106 Post Natal — 6 2 61 — 1 1 — — 6 45 — — 18 — 74 — 3 1 — 9 — — — 1 2 21 — — 1 3 — — 255 Infectious Diseases:— Ophthalmia Neonatorum 1 — 5 — — — 2 19 — — 20 1 — 1 — 4 — 2 1 — 1 2 — — 1 — — — — — — 1 — 61 Puerperal Pyrexia 1 3 5 — 2 — — 4 1 — 2 — — 2 — 1 — — — — — 3 — — 3 2 — — — — — — — 29 Puerperal Fever — 1 1 — — — — 1 — — 1 — — — — — — — 2 — — 1 — — — 4 — — — — — — 11 Measles Under 1 year 4 24 11 — — — — 8 5 4 — — — 4 — 8 1 4 3 — 24 12 4 10 12 6 — 1 1 2 3 — 151 1—5 years 14 72 89 2 11 11 45 84 26 34 9 — 8 25 — 80 8 23 18 3 184 101 22 7 48 96 31 2 6 17 8 16 _ 1100 Over 5 years 9 82 53 — 11 5 31 52 14 22 10 — 8 23 3 65 11 18 9 4 186 68 21 10 12 78 32 3 3 4 13 41 2 903 German Measles Under 1 year — 3 — — — — — 1 — 3 1 — — 1 — — — — — 1 1 — — — — — — — _ — — — 11 1—5 years 5 10 12 2 — 4 2 8 3 6 8 1 1 4 — 7 6 1 3 — 17 11 — 1 18 7 2 — — 2 2 2 — 145 Over 5 years 4 15 10 — — 1 4 30 5 11 25 1 1 3 — 5 7 2 6 — 23 9 1 8 9 8 4 — — 1 — 7 2 205 Whooping Cough Under 1 year 1 2 — — — — 5 1 — — 4 — — — — — — 3 — 2 2 8 — 2 — 1 3 — — — 34 1—5 years 6 6 9 — — — 4 11 1 6 7 6 — 6 — 9 — 11 — — 20 46 — 7 9 24 9 — — 1 2 4 — 204 Over 5 years — 5 4 — 2 — — 3 — — 3 2 1 18 — 7 6 7 1 — 10 12 1 3 3 3 2 — — 3 — — — 96 Other Diseases Under 1 year — — — — — — 2 6 1 4 2 _ — — — 1 — — 1 — 8 14 — — 2 5 1 — — — 2 1 — 50 1—5 years 18 33 5 — — 6 4 12 12 10 13 — 4 2 — 15 — 2 9 —_ 62 98 — 3 45 87 16 — 1 4 2 4 1 471 Over 5 years 4 67 50 — 11 2 17 35 29 39 46 — 2 21 — 43 — 10 6 8 75 100 1 31 10 22 23 — 3 15 1 3 4 678 Children and Young Persons Act, &c.— Initial Visits to Foster Mothers 2 1 4 — — — 1 — 1 1 — — 1 2 — — — — — — 2 3 — — — 3 3 — — — 2 — 26 Subsequent Visits to Foster Mothers re children : (a) Under 1 year 4 16 1 — 4 — 1 6 4 2 5 — — 26 2 — — — — — 3 — — — — 1 5 — — — — — 80 (b) 1—5 years 13 47 14 — — 3 8 16 14 9 14 1 — 37 3 2 — 1 4 — 19 13 — 1 — 14 33 — — — 1 — 270 (c) Over 5 years 8 43 28 — 1 — 10 24 2 4 29 4 — 7 — — — — 1 — 5 4 — — — 26 25 — — 6 — 207 Other Visits 2 — 15 2 — 4 2 15 9 1 — — 3 7 — 21 1 9 4 — 10 7 — 2 8 23 16 2 2 1 5 15 2 188 Milk Enquiries (a) Expectant Mothers — — 1 — — — — — — — 1 — — — — — 3 — — — 1 — — — — — — — — — — — — 6 (b) Under 1 year 1 — 9 — — — — 2 2 1 1 — — — — 7 — 1 3 — — — — — — 3 4 — — — — — — 34 (c) 1—3 years — — — — — — 1 — 1 3 2 — — — — 2 — 1 1 — 1 — 2 — — 1 2 — — 1 — — — 18 Visits re Deaths of Children (a) Under 1 year — — — — 1 — 1 3 2 2 1 1 — 5 — 8 — 3 1 — 1 1 — — 1 6 — — — — 3 2 1 43 (b) 1—2 years — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5 (c) 2—5 years — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other Visits 14 35 — 76 2 — 13 80 9 16 19 1 23 32 — 53 — 36 48 — 12 8 — 56 5 5 4 — — 26 1 3 — 577 Total Visits 1166 3113 30731436 310 174 1183 2374 483 609 1392 96 216 2258 101 2786 122 902 655 70 3087 2481 140 664 1814 2778 1268 52 99 524 313 761 52 35552 Consultations attended 194 129 131 239 19 17 157 108 14 24 70 4 151 138 — 120 1 17 224 3 170 151 1 8 193 160 166 21 29 99 95 94 8 2985 Classes attended 59 2 — 23 1 1 4 21 — — — 1 26 10 — — _ 35 — 32 34 — — — 4 31 — — — 45 41 2 375 Special Interviews at Centre 1372 — — 2197 — — 512 — 2 — — — 1017 362 24 48 — 3 1576 — 37 122 — — 536 149 635 1 — 31 228 22 — 8874 Ineffective Visits 130 183 318 63 136 16 377 1495 150 263 629 37 39 568 — 526 18 271 172 35 512 770 43 252 291 197 160 8 16 153 268 252 33 8642 In addition to the above, visits were made by Student Health Visitors attached to Centres as follows : Camden Town, 1,355; Kentish Town, 784. Notes :—(a) Superintendent. (Miss Blair appointed Superintendent in February and took over duties on 7th March ; previously at Camden Town. ) (b) Temporary full-time workers paid by Borough Council. (i) Mrs. Just appointed 14th February; resigned 23rd April. (ii) Miss Sainsbury appointed 2nd May—resigned 16th July. (iii) Miss Carr appointed 23rd May—resigned 10th December. (iv) Miss Taylor appointed 15th December. (c) Mrs. Ashwood Smith retired on 31st January. (d) The following Health Visitors were employed at Kentish Town, Queen's Crescent and South Highgate Centres: — Miss Harris during January. Transferred to Camden Town on 7th February in place of Mrs. Ashwood Smith. Mrs. Just from 14th February until 23rd April. Miss O'Leary from 25th April until end of year. Previously transferred from Kentish Town to Camden Town on 7th March (e) Employed and paid by University College Hospital. 1 2 3 6 7 13 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 27 28 29 30 31 32 33 34 35 109 NOTIFICATIONS OF BIRTHS ACT, 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 3,773 and of still births 119. There were 282 illegitimate births. The number of registered live births was 3,841, which shows that notification is obtained in practically every case.* Karly 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 :— Visits to 1934 1935 1936 1937 1938 Children 0-1 First 2454 2365 2334 2364 2386 '' 0-1 Total 14094 16340 13434 14395 12886 '' 1-5 Total 14293 16399 14341 15887 13180 Attendances by Children 0-1 25107 24678 24668 24103 24626 „ 1-5 14830 15818 15325 15654 15722 [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 are 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 110 life. Thus 35 per cent, of school entrants in St. Pancras in 1938 were found to have this condition, while 26 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 100, 101 and 105. Table V. Examination of Elementary School Children in St. Pancras in 1938. 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 965 721 769 904 959 737 734 865 Malnutrition Cases 16 * 13 Cases 6 * 6 Cases 10 * 10 Cases. 3 * 3 Cases 4 * 2 Cases 4 * 3 Cases 4 * 4 Cases 3 * 3 Skin disease 7 6 6 5 6 4 9 7 9 8 4 4 5 4 9 7 Defective teeth — 336 — 223 — 185 234 343 — 226 — 172 231 Enlarged tonsils 158 70 62 29 24 9 11 2 149 74 75 35 22 6 14 7 Adenoids 8 6 1 1 — — — — 4 1 2 1 — — 1 1 Enlarged tonsils and adenoids 54 19 18 6 14 — 8 1 44 13 20 4 13 2 6 3 Other nose and throat defects 7 4 7 7 1 1 — — 4 2 2 2 1 1 5 2 Enlarged glands 20 5 18 5 8 1 6 — 24 3 6 — 8 — 1 1 Eye disease 25 16 9 5 9 6 1 1 42 25 13 8 7 5 3 2 Vision defects — — — 36 — 93 — 90 — — — 57 — 70 — 129 Otorrhœa 10 8 5 4 8 6 2 — 15 6 9 7 4 4 3 2 Other ear disease 3 2 1 1 — — — — 3 3 2 1 — — 1 1 Defective hearing — — 1 1 4 1 1 1 2 1 2 1 6 1 2 — Speech defects 4 1 3 2 — — — — — — 1 1 — — — — Heart defects 15 1 12 — 12 1 19 1 14 — 19 — 10 1 28 — Anæmia 2 2 3 3 1 1 2 1 2 2 — — — — — Lung defects 36 11 13 4 9 2 3 — 28 13 15 2 6 — 3 — Nervous defects 4 2 4 2 3 — 4 2 2 — 5 4 2 1 3 — Phthisis 1 — 4 — 2 — 1 — 2 — 1 — 3 — 4 — Other T.B. disease — — — — — — — — — — — — — — 1 1 Rickets 6 — — — 1 — — — 2 — 1 — — — — — Spinal deformities 1 1 4 3 6 5 4 4 1 1 4 3 3 2 7 3 Other deformities 7 4 2 — 7 1 1 1 3 1 3 3 7 1 7 5 Other defects 13 7 16 11 13 11 9 7 22 20 12 11 16 12 16 12 Number of children noted for treatment — 445 — 297 292 — 324 — 47 — 321 — 259 — 357 Defects, however slight, are included under "Cases." Those severe enough to require treatment are shown under. Table VI. Routine Medical Inspection of Elementary School Children in Sr. Panckas in 1938. 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. 1 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.. 965 692 267 6 132 792 41 — 951 14 959 6 — 604 248 113 — — — Girls 959 658 295 6 124 806 29 — 930 22 7 948 11 — 596 247 116 — — — Age 7— Boys 721 492 224 5 51 646 24 — 706 14 1 716 5 — 487 163 71 513 140 60 Girls 737 511 222 4 100 619 18 — 705 27 5 731 6 — 502 176 59 519 138 69 Age 11— Boys 769 470 294 5 99 640 30 — 752 17 — 759 10 574 172 23 590 77 101 Girls 734 466 266 2 128 593 13 — 686 43 5 729 5 — 557 162 15 559 92 72 Age 14— Boys 904 599 296 9 181 698 25 — 890 14 — 893 11 669 220 15 678 118 107 Girls 865 592 273 — 181 670 13 1 825 34 6 859 6 — 630 219 16 619 115 131 Total 6654 4480 2137 37 996 5464 193 1 6445 185 24 6594 60 — 4619 1607 428 3478 680 540 Percentage 67.3 32.1 0.6 15.0 82.1 2.9 96.8 2.8 0.4 99.1 0.9 — 69.4 24.2 6.4 74.0 14.5 11.5 London 54.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 26.3 3.5 67.8 19.0 13.2 111 112 TREATMENT OF THE PRE-SCHOOL CHILD. During the year this Authority made arrangements with the London County Council for the treatment of the pie-school child. These children can now be referred from the Welfare Centres for attention at the School Treatment Centres. There is a Schedule of charges which varies slightly from time to time, but at the end of the 1938 was as follows: — Operative treatment of enlarged tonsils and adenoids 17s. 1d. Minor ailment treatment 7s. 9d. Dental treatment 7s. 4d. X-ray treatment of ringworm 23s. 8d. Vision treatment (refraction and squint) 7s. 0d. This list of charges cover the attention required and any subsequent treatment for the same complaint during a period of six months from the date of the first attendance. The list also indicates the type of cases dealt with under the Scheme. INFANTILE MORTALITY. The infantile mortality rates for previous years, and the figures for each Ward, are given in tables on pages 4 and 5 respectively. On pages 113 and 114 tables are given which indicate :— 1. The causes of death of all children under one year of age during 1938, 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. Pancras during 1938. CAUSE OF DEATH. AGE. DEATH 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 Measles — — _ 3 2 5 — — _ — 2 — — — — — 1 1 — 1 — — — — 3 2 Whooping Cough — — — — — — — 1 — — 1 — — — — 1 — — — — — — — — — — — — — 1 _ Influenza — — — — — — 1 — — — 1 — — — — — — 1 — — _ — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Meningitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — 1 — — 1 1 1 — — 3 1 — 1 — — — — — — — — — 1 3 — Broncho pneumonia — — 1 — 1 2 6 7 6 1 22 3 1 1 2 — 3 2 2 — 1 1 2 — 3 1 12 10 Lobar Pneumonia — — — — — — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — 1 Pneumonia (not stated) — — — — — — 1 — — — 1 — — — — — — — — — — — 1 — — — — — — — 1 Enteritis — — — — 1 1 9 20 5 5 40 3 4 6 3 5 2 2 1 5 2 2 1 — — 5 — 27 13 Syphilis — 1 — — 1 2 1 — — 1 4 — — — — — — — — 2 2 2 2 Injury at Birth — 6 — — — 6 — — — — 6 2 — 1 — 1 1 — — — 1 — — 5 1 Atelectasis — 4 — — — 4 — — — — 4 — — 1 — 1 — — — — — — — — 1 — 1 — — 2 2 Malformation — 4 — 2 — 6 3 — 2 — 11 2 — — 1 — 1 2 — — 1 2 1 1 6 5 Premature Birth — 25 1 — 2 28 3 — — — 31 4 — 4 3 1 2 5 2 1 1 — 2 2 2 1 — 1 18 13 Congenital Debility, Sclerema, Icterus — — 3 — — 3 1 — — — 4 1 — — — — — — — 1 — — — 1 1 — — — — 3 1 Other causes — 3 1 — — 4 4 8 1 5 22 2 2 — 1 3 3 2 3 2 — 2 — 1 — — — 1 — 13 9 Totals — 43 7 2 5 67 31 37 17 14 156 18 7 13 10 14 12 13 10 9 4 8 5 8 9 11 2 2 1 96 60 113 Death of infante not belonging to St. Pancras occurring within the Borough, are excluded. „ „ belonging ,, ,, outside ,, ,, included. Nett Birth in the year legitimate infantimate 60 illegitimate 282 Nett Deaths in the year legitimate infants 129 illegitimate infants27 Death rate per 1000 births legitimate infants 60 illegitimate 95 legitimate and illegitimate 64 114 (2) Deaths from Stated Causes under 1 Year of Age for 1938 and 10 preceding Years. CAUSE OF DEATH. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Average for 10 years. 1938 Measles 30 – 3 1 6 – 8 – 2 – 5 5 Scarlet Fever – – – – – 1 – – – 1 — — Whooping Cough 10 32 2 10 11 4 3 9 8 – 9 1 Diphtheria and Croup — 3 1 1 1 1 – — – 1 1 — Erysipelas — – 2 — 3 — 1 1 1 — 1 — Influenza — 5 2 1 2 1 1 — 2 2 2 1 Tuberculous Meningitis — — 1 1 1 1 — — 3 — 1 — Other Tuberculous Diseases 2 — 2 2 1 — – – 1 1 1 — Meningitis {not Tuberculous) 1 4 3 8 3 6 3 — 6 2 3 – Convulsions 1 5 – 1 – 2 — — — 1 1 — Bronchitis 9 7 7 4 3 4 4 4 2 2 5 3 Broncho-pneumonia 43 43 20 42 27 12 24 31 15 32 29 22 Lobar-pneumonia 3 4 – 3 1 — 1 2 — — 1 1 Pneumonia (type not stated) 2 1 3 1 2 — 1 1 — — 1 1 Diarrhœa 8 5 6 6 9 2 – — 8 51 39 40 Enteritis 33 34 36 22 42 27 25 28 45 Gastritis — 1 – — 1 – — — 12 — 1 — Syphilis 4 1 3 2 2 1 1 2 1 — 2 4 Rickets — — 1 — — 2 — — – — — — Suffocation (overlying) 1 – 1 — — — — — – — — — Injury at Birth 2 9 4 3 6 2 3 5 5 3 4 6 Atelectasis 11 7 3 4 8 7 7 2 2 4 5 4 Congenital Malformations 20 23 12 23 10 14 17 12 12 11 15 11 Premature Birth 50 46 48 43 36 37 43 42 37 29 41 31 Congenital Debility, Sclerema and Icterus 16 14 8 7 2 8 4 3 2 – 6 4 Other causes 15 18 26 15 9 19 14 13 26 14 17 22 Totals 261 262 194 200 186 151 160 155 190 154 191 156 Nett Births 3274 3170 3208 2955 2684 2589 2449 2466 2389 2364 2754 2433 115 OPHTHALMIA NEONATORUM. This disease is an inflammation of the eyes of newly born infants, resulting in a purulent discharge within 21 days of birth. It has been compulsorily notifiable in London since 1911. During the first few years the incidence averaged about 5 cases per 1,000 births in St. Pancras Borough. By 1920 the incidence had reached 11, and this remained the approximate figure for several years. Form as Desired by Ministry of Health. Additional Information. Cases Vision not Impaired. Vision Impaired. Total Blindness. Deaths. Incidence Rate per 1,000 Births. District Nurse in Attendance provided by Borough Council. Cases treated in Special Hospital provided by L.C.C. Notified. Treated At Home. In Hospital. 1938 22 10 12 22 – – – 9. 9 11 1937 27d 16 11 23 – 1 1e 11. 11 9 1936 32a 15 16 26 b 1 – 3c 13. 7 11 1935 23* 11 12 211¶ – – – 9. 7 10 1934 33 17 16 31 – – 2g 13. 14 15 1933 42 23 19 40§ – – 2¶ 16. 14 19 1932 74 56 18 73 – – 1¶ 27. 30 15 1931 45 26 19 43+ – – – 15. 18 14 1930 31‡ 23 8 30 – – 1* 9. 17 6 1929 36 21 15 34 1 – 1* 11.4. 11 12 * Due to other causes. † Several cases removed to unknown addresses. ‡ Excluding one case, information unobtainable. || Died from Prematurity, Congenital Heart Disease and Gonorrhœal Ophthalmia. § One moved away to unknown address. ¶ (1) Died—Prematurity. Ophthalmia Neonatorum. (2) Died—Gastro Enteritis. Ophthalmia Neonatorum, Mongolism, Imbecility 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, Gonorrhœa; 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 37 cases of Mild Inflammation not notifiable as Ophthalmia Neonatorum. Out of the 22 notifications this year, nine were of "moderate" severity, and thirteen 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. 116 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 108). INFANT LIFE PROTECTION — PUBLIC HEALTH (LONDON) ACT, 1936, PART XIII. The duties under the above Acts were transferred to the Borough Council on 1st April, 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 164 persons on the Register, of whom 108 were receiving 109 children for reward. Particulars of visits paid will be found in Table IV (page 108). 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. Supply of Milk and Cod Liver Oil to Mothers and Children. The Borough Council during the year continued to make grants of milk (1 pint fresh milk daily, or 1½ lb. dried milk weekly, renewable every four weeks by a doctor's certificate), either free or at reduced prices. With the approval of the Borough Council (29th June, 1938) grants of cod liver oil or cod liver oil emulsion were made on the recommendations of the Medical Officers of the Welfare Centres. Grants were restricted to expectant or nursing mothers, children under three years of age, and, in exceptional cases, to children between three and five years of age, regard being had to the scale of income adopted by the Council. 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. Information is exchanged between the authorities concerned, in order to avoid overlapping. 117 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 1937 there were 232 families actually in receipt of milk under the Borough Council's scheme. During 1938, 580 new families were added to the list of recipients. By the end of that year there were 357 families receiving grants. Comparative Figures. The following table shows the comparative cost of grants made under the Council's Scheme during the last six years. 1933 1934 1935 1936 1987 1938 £ £ £ £ £ £ Milk 1086 992 1067 1028 1183 1700 Emergency – – 14 37 43 61 Cod Liver Oil – – – – – 10 During the year 1938, 3,728 applications for milk were considered and grants were made in 3,590 cases. 2,542 of the applications were from unemployed as against 1,563 during the 118 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 8344 246 1484 90 164 8 0 February 7700 282 1652 78 157 19 3 March 6860 270 1624 48 134 10 11 April 6216 260 1568 50 124 0 0½ *May 8356 300 2072 126 146 12 7 June 6216 192 1120 48 101 7 0 *July 7756 288 1904 102 153 2 5½ August 6356 204 980 30 116 14 2½ September 6020 204 896 72 112 16 6 *October 9156 366 952 6 168 18 0½ November 8652 318 1288 30 161 4 8½ December 8328 246 2160 54 158 4 10½ Total 89960 3176 17700 734 .£1699 18 7 * 5 week months. † l¼ 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 377 cases, at a cost during the year of £60 14s. Od. 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 £66 6s. 3d., which should be deducted from the above figures. Grants of cod liver oil or cod liver oil emulsion were made in 212 3ases at an approximate cost of £9 14s. Od. The scale in use in making the grants is based on weekly income and was originally drawn up by the Council in 1922. It was discontinued in April, 1928, and a new scale brought into use in consequence of a recommendation by the Minister of Health that the scale should be brought into accord with the fall in the index figure of the cost of living. The income scales, after deduction of rent (a) as at the end of 1938, and (b) in force after January, 1939, below which a family is eligible for an allowance, are shown hereunder:— Number in Family. (a) At end of 1938 (now superseded). (b) Scale now in force. Free. Half-price. Free. Half-price. £ s. d. £ s. d. £ s. d. £ s. d. One 0 12 0 0 13 9 0 13 6 0 15 6 Two 0 18 3 1 3 0 0 19 6 1 5 0 Three 1 2 0 1 7 6 1 5 0 1 10 0 Four 1 5 6 I 11 3 1 10 0 1 15 0 Five 1 10 0 1 16 6 1 15 0 2 0 0 Six 1 13 0 2 1 3 2 0 0 2 5 0 Seven 1 16 6 2 5 9 2 5 0 2 10 0 Fight 2 0 0 2 10 3 2 10 0 2 15 0 Nine 2 3 6 2 15 0 2 15 0 3 0 0 119 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. Pancras Dispensary, 39, Oakley Square (Tel. Euston 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:— 1938. 1937. 1936. New Casks: Children under 5 years of age 13 19 28 Ailing Nursing Mothers 8 12 5 Ailing Expectant Mothers 15 28 29 Attendances: Children under 5 years of age 22 33 50 Ailing Nursing Mothers 12 34 14 Ailing Expectant Mothers 43 60 49 Dispensary as a whole (including the above). New Cases: Children under 5 years of age 453 440 534 Ailing Nursing and Expectant Mothers 23 40 34 Attendances: Children under 5 years of age 1638 1669 1688 Ailing Nursing and Expectant Mothers 55 94 63 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 430 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. 120 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 151, the average length of stay in the Home being 32 days. (b) Children requiring a longer period of convalescence, or who require more skilled nursing, are sent to various homes by the Invalid Children's Aid Association, and a contribution of £1 for each approved case up to a total of £50* per annum towards the cost is made by the Borough Council. Under this scheme 40 children were sent away during the year under review. * Increased from £36 per annum to £50 per annum, vide Council Minutes dated 21st December, 1938, and a maximum of 40 was allowed for the financial year ending 31st March, 1939. 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, 1938, are as follows:— Number of Days Open. Attendances. Average per Day. No. of places for children under 5. Whitefield Day Nursery 230 6525 28.4 40 Kentish Town Day Nursery 231 8401 36.3 45 Margaret Club and Day Nursery 270 20784 77.0 100† Foundling Hospital Day Nursery 185* 4930 26.3 35 * Nursery closed temporarily at end of September. † Increased from 60 as from 28th March. Nursery Schools. The undermentioned Nursery Schools are situated in the Borough They provide care, facilities for play, training in good habits, and some elementary instruction for children who are too young to be admitted to the ordinary schools. 121 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 46 34 Jellicoe Nursery School, 6a, Rochford Street 53 45 Mary Ward Nursery School, 16, Burton Street 30 22 St. Christopher's Nursery School, Bridgeway Street 45 32 Buck Street Nursery School 40 31 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 see page 11.) The Borough Council has an arrangement with all the above Associations for the Home Nursing, at the request of the medical practitioner in attendance, of cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Pemphigus Neonatorum, Infective Enteritis, Acute Primary and Acute Influenzal Pneumonia. Arrangements are also in force with the Metropolitan District Nursing Association, whose headquarters are at 31, Bedford Place, W.C.1, for the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment for this nursing is included in the following block grants made by the Council: — District Nursing Association. Under the Maternity and Child Welfare Scheme. Under the Influenzal Pneumonia Regulations. Total Block Grant. £ £ £ 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. Hampstead 45 826 18.3 Metropolitan 120 1925 16.2 North London 3 85 28.3 Totals 168 2836 16.8 122 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 two deaths were primarily classified as due to childbirth, and that two 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 1938 was accordingly 0.8. Table VII. Maternal Mortality in Borough of St. Pancras in 1938. AGES. conditions. WARDS 15-20 years. 20-25 years. 25-30 years. 30-35 years. 35-40 years. 40-45 years. 45 years and over. Married. Single. Widowed. I. II. III. IV. V. VI. VII. VIII. No Address. Puerperal haemorrhage – – – – – 1 – 1 – – – 1 – – – – – – – "Other accidents of childbirth" – – – – – 1 – 1 – – – – – 1 – – – – – Associated with childbirth but not classed thereto: Chronic malaria – – – 1 – – – 1 – – – – – – – – 1 – – Empyema 1 – – – – – – – 1 – 1 – – – – – – – – 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 108 will show that during the year 3,628 visits were paid to 1,522 expectant mothers. From Table III., page 99, it will be seen that 1,066 expectant mothers made 5,080 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 2,433. 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. 123 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 100-102 and 116-119. Domiciliary Midwifery Service. In the Metropolis, the supervising authority for midwives is the London County Council. Under the Midwives Act, 1936, the London County Council have set up a Domiciliary Midwifery Service. For this purpose London has been divided into areas, each area comprising a group of Metropolitan Boroughs. Area B consists of the City of London, Finsbury, Holborn, Islington and St. Pancras. The London County Council have allocated four Midwives to serve this area. In addition, Domiciliary Midwifery Service is supplied in the Borough by the Maternity Nursing Association, and other Voluntary Hospituls. These institutions are in receipt of L.C.C. grants for the work of their midwives. This arrangement enables every woman living in Area B, who wishes to have her confinement at home, to have the services of a L.C.C. State Certified Midwife or a fully quali6ed Maternity Nurse if a Doctor has been engaged. The fee asked is £1 10s. to £2, but this amount is adjusted by the L.C.C., not the midwife or maternity nurse, to meet the special circumstances of the woman. This Scheme does not preclude Midwives, other than those referred to above, from undertaking normal private practice. During 1938 about nine Midwives practised in this manner in the Borough. Institutional 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. 124 In the following table particulars are given for 1938 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 282 112 39 Royal Free Hospital 66 17 .. Elizabeth Garrett Anderson Hospital 37 47 .. St. Pancras Hospital 799 .. 6 Middlesex Hospital 81 .. 29 Queen Charlotte's Hospital 70 .. .. City of London Hospital 28 .. .. Royal Northern Hospital 29 .. .. St. Bartholomew's Hospital 13 .. .. Other hospitals 205 .. 12 Queen Mary's Maternity Home 42 .. .. Maternity Nursing Association .. .. 221 Totals 1652 176 307 The cases admitted as in-patients as recorded in the above table represented 67.1 per cent. of the total number of St. Pancras notified births (live and still). As compared with the previous year, there was a slight increase in the number of those admitted as in-patients. The Borough Council pays a subsidy to certain hospitals for the admission of cases to their maternity wards, and also pays a subsidy for cases attended at home by midwives on the staffs of certain institutions. No subsidy is paid for cases attended by medical students. The following table gives the names of the hospitals, etc., and the amount paid during the past year:— £ s. d. Elizabeth Garrett Anderson Hospital 2 0 0 Queen Charlotte's Hospital 8 0 0 City of London Hospital 6 0 0 Middlesex Hospital 23 5 0 University College Hospital 99 15 0 *Maternity Nursing Association 0 10 0 Total £139 10 0 The corresponding grants for the previous three years were: £123, £124 5s. Od. and £118 10s. Od. * Grants discontinued as from 31st March, 125 Sterilised Maternity Outfits. In 1933 a scheme was inaugurated in the Borough by which the Welfare Centres, in co-operation with their Voluntary Committees, could supply Sterilised Maternity Outfits to expectant mothers at reduced charges. This scheme has now been extended and the Borough Council, through the Centres, supplies these outfits to necessitous women at cost price, half this price or free of charge according to the family circumstances. During 1938 fifty-eight outfits were supplied through this Scheme and fifty-four of these were given free of charge. Home Helps. A subsidy is paid by the Borough Council to a Voluntary Committee for the provision of Home Helps in necessitous families. The term Home Helps is used to describe women who render domestic assistance in the homes of women who are unable to undertake their own household duties for reasons of sickness or child-birth. The usual period of this attention is two weeks. 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. Four permanent "Helps" were employed throughout the year, and ten temporary " Helps " for emergency cases. 103 cases were dealt with during the year, 97 being maternity and six sickness cases. Puerperal Fever and Pyrexia. The Borough Council provides Consultants' services, bacteriological investigation and skilled nursing in connection with cases developing Puerperal Fever or Puerperal Pyrexia. Hospital accommodation is also available for these cases. Post-natal care. There are no clinics devoted specially to this work. Post-natal cases are seen on occasion at the ante-natal clinics, but the time at these is generally fully occupied. The question of further provision for post-natal care merits attention. PUERPERAL PYREXIA AND PUERPERAL FEVER. Puerperal Pyrexia is defined as any febrile condition other than a condition which is required to be notified as Puerperal Fever, occurring in a woman within 21 days after childbirth or miscarriage, in which a temperature of 100.4° F., or more, has been sustained during a period of 24 hours or has recurred during that period. Puerperal Fever has not been defined in the same definite manner. In 1938 there were 37 notifications of Puerperal Pyrexia and seven 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 31 cases Puerperal Fever 13 cases 126 The following tables have been prepared by Dr. Pritchard to bring out some interesting details concerning these cases:— Cause of Pyrexia. Total no. cases notified. Confinement. Infant. Mother. In Institution. At Home. Living. Dead Viable. Non-Viable. Primipara. Unmarried. Ante-natal attention. Average Age. Deaths. Doctor. Midwife. Student. Ac. Primary Pneum. 1 – – 1 – 1 – – 1 1 – 15 – Cystitis 4 3 – 1 – 2 2 – 3 – 4 28 – Dental abscess 1 1 – – – 1 – – 1 – 1 25 – Engorged Breast 1 1 – – – 1 – – 1 – 1 30 – Incomplete Abortion 5* – – – – – – 5 – – – 29 – Influenza 1 – – 1 – 1 – – 1 – 1 22 – Mastitis 8 7 – 1 – 8 – – 7 3 6 25 – Pleurisy 1 1 – – – 1 – – – – 1 30 – Pyelitis 5 4 – – 1 5 – – 3 3 5 26 – Retained Chorion 1 1 – – – 1 – – 1 – 1 33 – No apparent cause 3 3 – – – 3 – – 2 1 3 24 – Puerperal Pyrexia. Totals 31 21 – 4 1 24 2 5 20 8 24 26 – Percentages – 80.8 19.2 77.4 6.5 16.1 64.5 25.8 92.3 – – Puerperal Fever. Associated with Abortion 3* – – – – – – 3 – – – 29 – Other cases 10 7 – 3 – 9 1 – 4 3 8 28 – Totals 13 7 – 3 – 9 1 3 4 3 8 28 – Percentages – 70 – 30 – 69.2 7.7 23.1 30.7 23.1 61.5 – – Total 44* 28 – 7 1 33 3 8 24 11 32 27 – Percentages – 77.8 22.2 75 6.8 18.2 54.5 25 88.9 27 – * Please Note.—Cases of abortion are not considered in the calculations for "Confinement" or " Ante natal attention in the above table. These cases were all treated in Hospital after the abortion. 127 Comparative Figures for Recent Years are as follows:— 1938. 1937. 1936. 1935 1934. 1933. 1932. 1931. 1930. 1929. Per Puerperal Fever. Cases 13 13 15 26 18 31 42 25 33 43 Deaths Nil 1 3 2 3 6 8 3 Nil. 5 Incidence 5.2 5.3 6.0 10.4 7.1 11.6 15.2 8.5 10.3 13.6 1,000 births. Mortality Rate Nil 7.7 20.0 7.7 16.7 19.4 19.0 12.0 Nil. 11.6 100 cases Death Rate Nil .4 1.2 .8 1.2 2.2 2.9 1.0 Nil. 1.6 1,000 births. Puerperal Pyrexia. Cases 31 31 17 17 24 37 34 37 37 53 Incidence 12.3 12.7 6.8 6.0 9.5 13.8 12.3 12.5 11.6 16.7 1,000 births. 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 maintaining and improving the high standard of our Service and in making it uniform for the whole Borough. I appreciate my position as liaison officer between these Committees and the Council, as it is this close association with the work and wishes of both parties which help 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, continues to be of great assistance to this department and I wish to record how much I value their co-operation. The difficulty of the satisfactory control of foster mothers is still an unsolved problem. The Public Health (London) Act, 1936, allows any woman, with few exceptions, to take care of foster children. There is no preliminary "Registration" of the woman or her home. She complies completely with the requirements of the Act if she gives this Authority notice of her intention to take the child or children. This fact is not sufficiently well known and it leads to much confusion and incorrect ideas about the so-called "Registered Foster Mother." The words "register" or "registered " do not appear in the relevant legislation. We have continued our policy of training fifteen student Health Visitors a year. Generally they attend twice a week, with an occasional whole week's training. They are divided among Camden Town and Kentish Town Welfare Centres. In addition to their practical work at our Centres and at the Tuberculosis Dispensary under Dr. Back's guidance, I arrange for them to receive experience in other branches of Maternity and Child Welfare activities. The benefit is mutual, the students are taught their profession and those of us who have to train them have to keep abreast of our subjects. From the records it is noted that our students have had marked success in their examinations and their subsequent appointments. 128 The St. Pancras Fathers' Council has been in existence for several years. I have the honour to be the President. The objects of this movement are to encourage fathers to take a more active interest in family welfare from a Public Health point of view. This encouragement is made through meetings which take place mostly at the Queen's Crescent Welfare Centre on several evenings each month. Lectures are given on a variety of subjects and discussions are invited. The membership in St. Pancras grows but at a very slow rate. The movement deserves encouragement and support. During the year the Council sent Miss Bagnall and Miss Harrop to the Eighteenth 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.