STPAN 100 LIBRARY Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. Printed by Harrison & Sons, Ltd., 44-47, St. Martin's Lane, London, W.C.2. Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. 2 INDEX. PAGE Adulterations of food 22 Bacteriological examinations 19 Births, birth rate 10 Births, notified 12 Births, registered 10 Births, still 11 Bodies received at mortuary 21 Child life protection 17 Clearance areas, report on 5 Cleansing and Disinfecting station 20 Daily guardians 16 Day nurseries 17 Death, causes of, by age 13 Deaths, death rate 11 Deaths, from puerperal causes 11 Deaths, from T.B. 12 Death rate, infantile 12 Death rate, maternal 11 Dental clinics 14, 15 Diphtheria immunisation 4, 18 Diseases, infectious 5, 19 Disinfection and disinfestation 20 District Nursing Associations 15 Food and Drugs Act, 1938 22 Food inspection and supervision :— Adulterations of 22 Prosecutions 22 Samples taken 22 Foreword 3 Guardians, daily 16 Gynaecological clinic 15 Health Visitors, visits made 15 Home helps 16 Housing 21 Housing schemes, report on 5 Illegitimate children, care of 16 Infantile mortality 12 Infantile mortality graph 12 PAGE Infantile mortality by wards 12 Infectious diseases, notification 5, 19 Inquests 21 Invalid Children's Aid Association 16 Maternal mortality 11 Maternity cases, beds for 16 Maternity and Child Welfare : Committee 8 Superintendents 9 Health Visitors 9 Consultations 14 Attendances 14 Medical Officer of Health 8 Foreword 3 Midwifery grants 16 Meat and other foods, visits and inspections 22 Milk purveyors registered 22 Milk (Special Designations) Regulations, 1936-1943 22 Licences granted 22 Mortuary and Coroner's Court 21 Population 10 Post mortem examinations 21 Premature infants, care of 17 Public Analyst 10 Public Health Committee 8 Public vaccinators 10 Puerperal maternal mortality 11 Rat extermination 21 Sanitary Inspectors, staff visits by 18 Small-pox and vaccination 18 Staff 8 Still births 11 Tuberculosis, Report on 23 Tuberculosis, statistics 24-25 Tuberculosis Care Committee 26 Vaccination, Public vaccinators 10 3 Town Hall, Euston Road, N.W.I. 22nd July, 1946. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Your Worship, Ladies and Gentlemen, I have pleasure in presenting to you my annual report upon the conditions of health in the Metropolitan Borough of St. Pancras for the year 1945. The year in question was marked by the defeat of Germany and Japan, and thus the end of the war. It was a year, therefore, of high hopes, in which one anticipated a resumption of those services conducive to health and comfort, which had been abandoned during the hard period of the war. Few of our vast hopes have been realised. So great has been the interruption in communal activity and family life during the war that in the latter months of the year it was possible to think only of what was required in the near future and to contemplate planning for the years ahead. At the time of writing this report we are still in the stage of planning, and the public generally have been little able to realise the benefits of peace, except insofar as they have been freed from the dangers of war. In every walk of life there has been a feeling of delay and frustration. Shortage of labour and materials have made it impossible to alleviate many acute and serious environmental defects, and it would indeed be surprising if the public did not ask how long it would be before some of their most serious complaints were to be met. Despite the effects of the war, the tiredness of the population, the defects and frustrations which one is bound to meet, there are, however, grounds for satisfaction in some respects. The outstanding feature of the year is the fact that the infantile mortality rate in St. Pancras was the lowest ever recorded. On page 12 I have set out in graph form this rate since 1904. An infantile mortality rate of 44 is usually considered good in any area. In an area such as St. Pancras it is excellent. It is a tribute to the Health Visitors whose primary duty it is to keep children well; to the doctors who have attended at our centres and have advised on slight deviations from normal health, and above all to the general practitioners of the district, to whom has fallen the lot by day and by night of curing children and keeping minor ailments from becoming serious illness. But if the mortality rate of 44 per thousand is low it still leaves us no room for complacency. It is our duty to ask ourselves whether an even lower figure could and should be obtained. During the year there were 1,957 births to St. Pancras mothers, and 86 children died before they attained the age of one year. Could any of these deaths have been prevented by methods known to us today or by improved environmental factors? The answer to this must be in the affirmative—for of the 86 children who died, 12 died from pneumonia and 24 from diarrhœa. Of these it is possible that some deaths could have been prevented by a better parental knowledge, better surroundings, and possibly earlier treatment. I believe as housing improves in the borough, and when time is available to teach parent-craft more widely, that an even lower infantile mortality rate will be achieved. 4 There are other figures which show that health has been well maintained. The death rate was 16.2, which compares with 13.0 in 1939, 20.5 in 1940 and 18.9 in 1944. The birth rate at 17.6 was higher than it has been since 1925, with the one exception of 1944 when it was 18.1. This increased birth rate has entailed another problem, that of maternity accommodation. Owing to enemy action the hospital accommodation for maternity cases in London has been considerably reduced. Furthermore the destruction of homes, the increase in overcrowding and the inability to get help has made hospitalisation necessary where previously confinements could take place at home. Even all the available hospital beds cannot be utilised on account of shortage of midwifery and domestic staff. It has not been possible to provide proper midwifery accommodation for those who needed it, let alone for those who asked for it. Lack of midwives is a very serious problem, as is also lack of midwifery accommodation. It has been argued, and rightly so, that childbirth is a normal function and can take place in normal surroundings, possibly more safely than in the environment of a hospital where a mother is exposed to germs to which she may be intolerant. This argument is a good one in districts where housing is good and where a mother during child-birth can find a relative or a friend to look after her family. It cannot be considered as advisable in the majority of the homes in St. Pancras, which are definitely unsuitable for the conduct of a confinement. The position at the time of writing this report is even more acute owing to the increased number of births. The demobilised man wishes to resume family life, to marry if he is single, to have children if he is childless, and he looks to the State to provide him with a home and the amenities for having children and rearing a family. The daily post of a Medical Officer of Health contains many letters in no indefinite terms, setting forth the demands of the ex-service man. In many cases these letters have shown that during his absence on service he has not realised the difficulties with which his wife has had to contend: the bad housing, the queueing, the difficulties of providing the right and proper food for children. His return home has added to his wife's domestic difficulties, for there has been one more to house and one more to feed. The letters I have received certainly do not show that the returned soldier is as patient about the conditions as they now exist as his wife was during the dreadful days and the trying experiences she suffered during the war. Perhaps this is best so; for it is not by submission to unsatisfactory conditions that progress is ultimately achieved. Diphtheria Immunisation. During the course of the year the responsibility for securing immunisation against diphtheria was placed upon each individual health visitor insofar as the children in her district were concerned. This responsibility has been well received. There were 2,069 live births notified during 1945, and 1,794 children were immunised during the year. At the time of writing this report there were 9,938 children in the borough under the age of 15 who had been immunised. This figure is not complete, for there are many children returned to the borough who were immunised whilst evacuated and for whom no records have been available. Recent investigations have shown, however, that in all probability 65 89 per cent. of the children under five in the borough are immunised, or 86 08 of those between 1 and 5, as immunisation does not usually begin until a child is one year old. During the course of the year there were notified 104 cases of diphtheria, but in only 69 cases was the diagnosis confirmed. There was not one single death in the borough due to diphtheria. 5 Infectious Diseases- The table on page 19 sets out the diseases, infectious and contagious, that were notified during the course of the year. The cases of dysentery were mostly of a mild nature. There were 1,025 cases of measles, in most cases slight. Whooping cough was considerably less than in 1944. There were 245 cases of scarlet fever. It was not possible to remove all cases of scarlet fever to hospital. Scabies continued to demand continuous supervision and treatment, and the clinic was busy throughout the year. Housing. The most serious menace to public health today is inadequate housing, which is marked to a very serious degree in this borough. During the course of the year I have been asked to investigate no less than 685 housing applications and to advise upon those (i) which needed urgent priority, (ii) of slightly less priority, (iii) who needed rehousing on account of illness or sickness and (iv) where no immediate action was required. This total of 685 represents only a portion of those who applied for Accommodation. There were others concerning whom the conditions were such that no report was required on health grounds, and at the time of writing this report there are no less than 8,630 persons awaiting alternative accommodation in the borough. Of the 685 applications mentioned I was constrained to advise urgent priority rehousing in no less than 486 cases. In the majority of these there was serious overcrowding, lack of separation of the sexes, and factors definitely inimical to health. In 70 cases a lesser priority was granted, and in 127 alternative accommodation was required on account of illness. This latter category is an important one, for it includes people living in upper floors, who are crippled and cannot climb stairs. It includes persons with heart disease who should have ground floor accommodation It includes women with babies, living in rooms on the top floor of a house, who have to fetch all their water from downstairs and carry their children up and down frequently during the day. The housing picture is not a very pleasant one to draw. There is, however, another side to the question. Sites have been, or are being acquired, modern flats planned, consents are being obtained, and in due course we should see good housing arising on open bombed sites and in slum areas. In all big ventures there is little to see, little to demonstrate, in the early stages, but when once housing commences it will gain from its own momentum. Housing is of the utmost priority in all public health measures today, and if it plays second to anything at all it can only be to the provision of sufficient and adequate food. In connection with the Council's housing schemes, I inspected and reported upon the conditions in five areas. In one area I came to the conclusion that a large proportion thereof could be dealt with as a clearance area and accordingly I represented it as such. On the recommendation of the Ministry of Health, however, it was not considered advisable to deal with this area under Part III of the Housing Act, 1936, and a proportion of it will be dealt with under Part V in connection with a housing scheme which is now in progress. The four other areas which I surveyed were not, in my opinion, such that they could be represented as clearance areas. The houses in all these areas numbered 513, and the following table shows their occupation: — Number of houses: Empty 146 Occupied 367* 513 Total number of rooms in occupied houses 2,394† ,, ,, separate lettings 821 *Includes six houses used wholly for commercial purposes. Of this number 230 rooms are unoccupied. 6 Occupants: Adults 1888 Under 10 years 247 2135 Average number of rooms per occupied house 6.35 lettings ,, ,, 2.27 ,, ,, persons ,, ,, 5.91 ,, ,, ,, ,, room 1.01 ,, ,, ,, letting 2.60 General Sanitary Conditions. The basis, however, of good public health is satisfactory environmental hygiene, which necessitates the abatement of sanitary nuisances, improvement in existing houses, the care of food and supervision of factory life: work which is supervised by your sanitary inspectors. We have been considerably short of staff to carry out this work adequately during 1945, and a heavy strain has rested upon them. Generally, the food supplied and its preparation have been reasonably satisfactory, but there is much room for improvement, whilst the same remarks would apply to factory hygiene and premises in which out-workers ply their occupation. Insofar as houses are concerned we have had to restrict ourselves almost entirely to work under the Public Health (London) Act. This means that we have only attempted to secure the abatement of definite sanitary nuisances, and in most cases these have come to our notice as a result of complaints. On the other hand we have been able to secure that, where alteration or new drainage work has been provided, it has complied with the appropriate bylaws insofar as this has been possible. But here again shortage of labour and materials has limited the scope of work that could be carried out. In normal times a health department would not wait for complaint before taking action, but cause a routine survey to be made in order to help occupiers to free themselves from conditions which are a danger or injurious to health. Better still would it be if, instead of dealing with nuisances alone, we were able to make routine inspections of all the working class property in the district, under the Housing Act of 1936; for under this Act we can take action to remedy any defect in the premises which renders the house in any respect unfit for human habitation. Sanitarians are generally agreed that this is the best method of dealing with domiciliary environmental factors dangerous to health. Once again, shortage of labour and material has made is impossible to take proceedings under the Housing Act. Just as one hopes, however, that new housing will in due course proceed apace, so one trusts that there will soon be a free supply of materials and adequate labour for rendering property in all ways fit for human habitation. It is not sufficient to build new houses or flats and to leave insanitary dwellings unimproved. The improvement of existing housing must proceed pari passu with new housing, and the time is eagerly awaited when no landlord can claim that limitation of labour or material renders it impossible for him to carry out work on his property essential to the health of those who dwell thereon. It will be realised that no attempt has been made during the year to secure the demolition of houses unfit for human habitation. In one br two cases, however, action has been taken to close insanitary basements. Here again it is essential that strenuous action shall be taken to close the many basements in the district that are unfit for human habitation. At present this can only be attempted where basements are unoccupied. 7 Conclusion. The general picture of health in the borough is thus an outline of defects which must be overcome; of unsatisfactory housing conditions; and a slow start to build the post-war St. Pancras we all desire to see. To the Medical Officer of Health, however, it has been a year of hope, for he has seen plans conceived which when materialised will vastly improve the health of the borough. It is, moreover, a year of achievement, in that the vital statistics are good and the infantile mortality rate the lowest yet recorded. It is a year that foreshadows a. future better than the past. This report would not be complete were I not to pay a tribute to the staff of the Public Health Department, and to my colleagues whose ever ready help and co-operation I have keenly appreciated. I have also received every help and support from the medical practitioners of the district and from the staffs of the many hospitals in the borough with whom it has been a pleasure to work. No Medical Officer of Health could have received more help or support from the Committees with which he has been associated than I have during 1945, and I would take this opportunity of thanking the Chairman and members of these committees and the Council for their courtesy at all times. I beg to remain, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, Medical Officer of Health. 8 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. November, 1944, to October, 1945. Councillor H. G. May (Chairman)', Councillor Mrs. L. G. Hume (Deputy Chairman)', The Mayor (Alderman J. H. Mitchell), Aldermen Dr. E. A. Gregg and G. Home; Councillors W. Comber, Mrs. J. Gregory, Miss L. H. Joshua, Mrs. A. E. Lake, Mrs. W. Paul, Mrs. D. Pym, T. J. Redman and E. J. Saunders (died 11th August, 1945). PUBLIC HEALTH COMMITTEE. November, 1945, to October, 1946. Councillor Mrs. W. Paul (Chairman)', Councillor Rev. J. Jones (Vice-Chairman), The Mayor (Councillor F. L. Combes); Aldermen Dr. L. F. Browne and Dr. E. A. Gregg; Councillors Dr. S. G. Dean, C. T. E. Fisher, Mrs. M. A. Foster, Miss F. L. M. Freeman, Miss E. M. Haworth, Mrs. L. G. Hume, R. Kane, Mrs. A. E. Lake, Dr. N. Malleson and R. L. Workman. MATERNITY AND CHILD WELFARE COMMITTEE. November, 1945, to October, 1946. Councillor Mrs. D. D. Naftel (Chairman); Councillor Mrs. A. E. Lake (Vice-Chairman)', The Mayor (Councillor F. L. Combes); Aldermen Mrs. L. Bartlett and E. A. Minter; Councillors Mrs. L. Bryant, Miss L. M. Chivers, Mrs. K. E. Deacon, Dr. S. G. Dean, Mrs. M A. Foster, Mrs. J. Gregory, Dr. N. Malleson, A. Morris, T. B. Moss and T. J. Redman. STAFF OF THE PUBLIC HEALTH DEPARTMENT at the end of the year 1945 MEDICAL OFFICER OF HEALTH, ADMINISTRATIVE MATERNITY AND CHILD WELFARE OFFICER, VACCINATION OFFICER, AND ADMINISTRATIVE TUBERCULOSIS OFFICER : Dennis H. Geffen, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H. DEPUTY MEDICAL OFFICER OF HEALTH, MATERNITY AND CHILD WELFARE OFFICER : P. V. Pritchard, M.D., M.R.C.P., F.R.F.P. & S. D.P.H. (Civil Affairs branch, R.A.M.C., since May, 1945), E. A. Utting, M.R.C.S., L.R.C.P.—appointed Temporary Assistant Medical Officer, May, 1945. 9 Inspectors of Food and Food Places. S. W. Capel. R. Warren. Inspectors of Factories. J. A. Hoare. Miss V. K. Blaxland. Housing Inspector. E. W. Winchester. District Inspectors. W. B. Dykes. A. Trevethick. T. H. Hague. H. E. Westripp. E. F. Kirby. I. Williams. T. Lloyd. J. F. Woolvin. R. N. Thomas. (3 vacancies). Clerical Staff. A. Carpenter, Chief Clerk. C. A. Engledow. V. R. Meurice. W. Shackcloth. *C. W. Smith. *J. Murphy. W. C. Mansfield. G. F. Peeling. *G. A. Mitchell. *R. B. M. Lake. *P. S. Thomas. *L. G. Berry. Miss A. Andrews TUBERCULOSIS DISPENSARY Tuberculosis Officer. G. A. Back, B.A.. M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H. Health Visitors. Miss M. M. Gilpin. Miss W. E. Webb. Nurse, and Secretary to Tuberculosis Care Committee. Mrs. E. Bevan. MATERNITY AND CHILD WELFARE Superintendents of Centres. Miss M. L. Blair. Mrs. S. C. Chapman. Mrs. E. Crockart. Miss M. Manger. Miss B. M. Harris. Health Visitors. Miss A. M. U. Harrop. Miss E M. Boyce. Miss C. O' Leary. Miss I.. Farrelly. Miss H. Smith. Miss G. E. H. Thomson. Miss B. M. L. Boxall. †Miss M. M. Wilson. Miss E. B. Bagnall. †Miss H. I. Hurst. Miss B. L. Morris. †Miss M. A. Clarke. •H.M. Forces. †Temporary. 10 PUBLIC ANALYST C. Harcourt Wordsworth, B.Sc.(Lond.), F.I.C. PUBLIC VACCINATORS : Ward 1 Dr. N. J. Goodchild. Ward 2 Dr F. L. Pelly. Ward 3 Ward 4. Dr. J. W. Wigg. Ward 5 Ward 6 Ward 7 Dr. A. E. Tait. Ward 8 Dr. C. H. Alderton. STATISTICS FOR THE YEAR 1945. Population. The civilian population, as estimated by the Registrar-General, mid-1945 was:—111,400. The following table shows the estimated population during the preceding six years:— 1939 .. 167,300 1942 .. 105,900 1940 .. 133,200 1943 .. 108,640 1941 103,770 1944 .. 105,780 Comparable figures for preceding six years: — Year. 1939 2,187 123 1940 1,948 146 1941 1,434 138 1942 1,785 169 1943 1,836 169 1944 1,914 18 1 Live Births. M. F. Total. Rate per 1,000 of estimated population. Legitimate 845 787 1,632 Illegitimate 160 165 325 1,005 952 1,957 17.6 11 Still Births. M. F. Total. Rate per 1,000 Live and Still Births. Legitimate 25 18 43 Illegitimate 6 7 13 31 25 56 27.8 Comparable figures for preceding six* years Year. 1939 60 26.7 1940 66 32.8 1941 34 23.2 1942 48 26.2 1943 47 25.0 1944 59 29.9 Deaths—All ages. Rate per 1,000 of estimated population M. F. Total. 1,020 786 1,806 162 Comparable figures for preceding six years: — Year. 1939 2,170 13.0 1940 2,728 20.5 1941 2,055 19.8 1942 1,730 16.3 1943 1,842 17.0 1944 2,001 18.9 Deaths from Puerperal Causes. Deaths. Rate per 1,000 Live and Still Births. Sepsis. Other causes. Total Puerperal Sepsis 3 1.49 Other maternal causes 2 0.99 2 48 Comparable figures for preceding six years: — Year 1939 3 1.33 1940 6 2.98 1941 4 2.72 1942 8 4.36 1943 1 0.53 1944 6 3.04 12 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 44 Legitimate infants per 1,000 legitimate live births .. 40 Illegitimate infants per 1,000 illegitimate live births.. 65 Comparable figures for preceding six years: — Year. All Infants. Legitimate. Illegitimate. 1939 52 46 94 1940 56 52 86 1941 51 52 44 1942 66 59 117 1943 71 66 99 1944 64 57 105 Infant Mortality. Deaths from stated causes with Ward distribution: — Cause of death 1 2 3 4 5 6 7 8 No address Totals Whooping cough 1 1 — — — — — 1 — 3 Bronchitis 1 — — — — — — — — 1 Pneumonia (not stated) 2 1 4 2 1 1 1 — — 12 Enteritis 7 2 5 3 1 2 — 4 — 24 Congenital malformation 1 — 1 1 1 — — 2 — 6 Premature birth 2 1 1 2 — — — 1 — 7 Injury at birth — — 1 — 2 — 1 — — 4 Atelectasis 4 2 2 1 4 — — — — 13 Other diseases peculiar to first year of life — — 1 — — — — 1 — 2 Other violence — — — 1 1 — 1 — 1 4 Other causes 3 — 1 3 — 1 — 2 — 10 Totals 21 7 16 13 10 4 3 11 1 86 Deaths from Tuberculosis—All ages. Death Rate per 1,000 of estimated population. Pulmonary 117 1.05 Other forms 10 0.09 127 Total 1.14 Comparable figures for preceding six years: — Year. No. of Deaths. Total. 1939 130 0.77 1940 160 1.20 1941 123 1.18 1942 147 1 39 1943 117 1 08 1944 128 121 Notifications of Births. The number of births notified as having taken place in the Borough during 1945 was 2,489. The number of births of non-residents was 1,014, and information was received in respect of 639 births occurring outside the Borough. Thus there were 2,114 St. Pancras births notified, of which 45 were still births, leaving a net figure of 2,069 live births. 13 CLASSIFICATION OF DEATHS, WITH AGE DISTRIBUTION Ages—Both Sexes Causes of death Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Totals M F All Causes 86 20 10 177 501 1,012 1.020 786 1. Typhoid and paratyphoid — — - - 2. Cerebro-spinal fever — 1 — — 1 3. Scarlet fever — — - 4. Whooping cough 3 — — — — 1 2 5. Diphtheria — — — — — - 6. Tuberculosis of respiratory system — — 1 55 53 8 87 30 7. Other forms of tuberculosis — 1 — 5 2 2 3 7 8. Syphilitic diseases — — — 3 6 2 8 3 9. Influenza — — — 1 3 2 2 4 10. Measles — — 1 - 1 11. Ac. poliomyelitis and polioencephalitis - - - - - - - 12. Ac. infectious encephalitis — — — 1 1 2 2 2 13. Cancer—buccal cavity and Oesoph (M); Uterus (F) - - - 14 22 15 21 14. Cancer—stomach and duodenum — — — 3 20 28 29 22 15. Cancer—breast — — — 3 15 11 1 28 16. Cancer—all other sites 1 — 1 12 87 106 129 78 17. Diabetes — — — 2 1 6 4 5 18. Intracranial vascular lesions 1 — — 2 38 112 81 72 19. Heart diseases — — — 13 82 304 207 192 20. Other circulatory diseases — — — — 12 46 28 30 21. Bronchitis 1 — — 3 31 110 93 52 22. Pneumonia 12 4 1 7 28 61 65 48 23. Other respiratory diseases 1 — — 3 7 8 10 9 24. Ulcer—stomach or duodenum — — — 3 14 8 21 4 25. Diarrhoea (under 2 years) 24 2 — — — 21 5 26. Appendicitis — 1 — — 3 4 6 2 27. Other digestive diseases 2 1 1 2 10 20 19 17 28. Nephritis — — — 6 15 21 22 20 29. Puerperal and post-abortive sepsis — — — 3 — 3 30. Other maternal causes — — — 2 2 31. Premature birth 7 — - 3 4 32. Congenital malformations, birth injurv and infant diseases 25 2 - 2 - 2 21 10 33. Suicide — — 3 13 3 15 4 34. Road traffic accidents — 2 1 5 2 9 12 7 35. Other violent causes 4 4 4 20 15 40 39 48 36. All other causes 5 2 — 18 29 75 75 54 M 1 -x PROVISION OF HEALTH SERVICES IN THE BOROUGH Treatment Centres and Clinics. Centre. St. Pancras School for Mothers (Ampthill Square) Camden Town. Kentish Town. North St. Pancras School for Mothers (Queen's Crescent) Somers Town. South Highgate. University College Hospital. Royal Free Hospital. Totals. 1944 1945 1944 1945 1944 1945 1944 1945 1944 1945 1944 1945 1944 1945 1944 1945 1944 1945 Expectant Mothers— Ante Natal— Sessions 24 27 60 61 85 85 76 89 15 20 12 26 203 202 148 150 623 660 Attendances 265 384 935 996 1,008 953 852 1,128 194 314 143 429 2,596 3,416 509 919 6,502 8,539 Post Natal— Sessions — 24 23 - - - - - - - - - - - - 24 23 Attendances — 273 286 - - - - - - - - - - - - 273 286 Infants— Sessions 149 122 250 247 149 145 150 150 128 99 103 99 103 102 97 101 1,129 1,065 Attendances- Age 0-1 2,021 2,110 3,253 4,007 4,128 4,861 3,945 4,727 1,997 2,874 2,610 3,013 382 371 87 12 18,423 21.975 Age 1-5 1,047 1,268 1,624 1,720 1,629 2,028 973 1,238 1,135 1,519 1,353 1,702 241 246 25 38 8,027 9,759 Total 3,068 3,378 4,877 5,727 5,757 6,889 4,918 5,965 3,132 4,393 3,963 4,715 623 617 112 50 26,450 31,734 Dental Clinics 29 32 85 83 - - - - - - - - - - - - 114 115 Attendances— Mothers 225 237 818 833 - - - - - - - - - - - - 1,043 1,070 Children 81 116 151 192 - - - - - - - - - - - - 232 308 Artificial Light (Infants only)— Sessions - - - - - - - - - - 83 57 — - — — 83 57 Attendances— Age 0-1 __ 111 141 111 141 Age 1-5 - - - - - - - - - - 1,554 675 — — — — 1,554 675 Total - - - - - - - - - - 1,665 816 — — — — 1,665 816 15 Dental Treatment. Ampthill Square. Camden Town Sessions 32 83 Attendances—Mothers 237 833 Children 116 192 The Borough Council made a contribution during the year of £78 4s. towards the total cost of £156 8s. for dentures supplied to Nursing and Expectant Mothers. Gynecological Clinic. Sessions are held weekly, and during the year there were 312 women attending, of whom 112 were new cases. Health Visitors. The total number of visits made by Health Visitors was as follows:— - Council's Visitors U.C. Hospital Visitors Total 1944 1945 1944 1945 1944 1945 To Expectant mothers 3,677 3,467 92 179 3,769 3,646 ,, Post natal 801 699 14 54 815 753 ,, Children 18,347 21,051 883 1,112 19,230 22,163 ,, Child life protection 187 2,304 26 98 213 2,402 ,, Infectious diseases, etc. 1,385 1,172 24 43 1,409 1,215 ,, Other visits 2,454 1,299 61 11 2,515 1,310 23,851 29,992 1,100 1,497 24,951 31,489 Nursing in the Home. The following District Nursing Associations undertake the nursing of cases of illness occurring in expectant and nursing mothers and children under 5 years of age. An annual block grant is made to each Association in respect of nursing for certain specified diseases: — Block Grant. Number of Cases. Visits. £ Hampstead 30 54 946 Metropolitan 250 125 1,126 North London 25 26 157 205 2,229 16 Invalid Children's Aid Association. Under this scheme, assistance is rendered towards the cost oi convalescence of St. Pancras children under the age of 5 years, with a maximum of 50 cases. The financial arrangements provide for a payment of 75 per cent. of the amount outstanding after allowing for any payments by parents. During 1945, 13 children were so assisted at a cost to the Council of £104 13s. Id. Home Helps. During the course of the year the Voluntary Committee asked to be relieved of responsibility of maintaining the Home Helps scheme for the borough, and accordingly the Council determined that as from 1st July the provision of home helps should be continued under the direct control of the Public Health Department. Where home helps are supplied to help women who are expectant or nursing, or in connection with the care of children under 5 the cost is borne by the local authority. Home helps may be provided in case of sickness or for the care of elderly persons, and in these cases the full cost is recovered from the Ministry of Health. During the course of the year it was found extremely difficult to obtain women who were prepared to accept employment as home helps, and it was possible to meet the demand in only 29 cases. There were 45 applications. The rate of pay during the year to home helps was Is. 6d. per hour. There has been a subsequent rise in the pay of home helps to Is. 9¾d. per hour, a figure agreed by the Joint Industrial Council, and it is hoped that in the forthcoming year this very necessary service may be increased, not only in respect of expectant and nursing mothers and children under 5, but also for the aged and the sick whose needs in this respect it has been impossible to meet during 1945. Midwifery Grants. By arrangements with Middlesex Hospital and University College Hospital assistance is accorded to the hospital where the St. Pancras mother is accepted for her confinement and is unable to pay the sum of £3 per week. This assistance is a maximum of £1 per patient admitted to the hospital, and is granted only in approved necessitous cases. The total for 1945 was 135 cases. Provision is also made to the University College Hospital by a payment of an agreed sum in respect of the use of an Emergency Obstetric Unit, but there was no case during the year. Provision of Beds for Maternity Cases. The London County Council has made arrangements whereby 8 maternity beds are available for St. Pancras cases at the University College Hospital. These beds are filled by cases referred to the hospital by the Borough Council, and the London County Council pay an agreed sum for their retention. Daily Guardians- At the end of the year there were 8 persons having the care of children under this scheme, and the total number of visits made were 108. Payments to the Guardian for the care of children are made by the Ministry of Labour through the local Labour Exchanges, after the Borough Council has approved such Guardian and supplied the necessary particulars on prescribed Forms to the Labour Exchange. Care of illegitimate children. A block grant of £217 was paid to the Standing Joint Committee in respect of five voluntary societies who make arrangements for the care of the unmarried mother and her 17 child. In no case was the Council asked to make a contribution towards the cost of caring for an illegitimate child placed with a foster mother in the district. Child Life Protection. During the course of the year 12 women notified their intention to accept foster children, and these notifications were in respect of 17 children. All the Council's Health Visitors are also designated as Infant Life Protection Visitors, and in the course of supervision they paid 282 visits. One woman was prosecuted for accepting a foster child without prior notification to this authority, and was fined £1 with £1 Is. costs. Care of premature infants. Doctors and nurses notifying births of children have been requested to inform the Medical Officer of Health of the weight of the child at birth, and in most cases they have cooperated in this respect. Prematurity to-day is not deemed to exist in accordance with date of birth of the child as compared with expected time of confinement. What matters most is not whether a child has been born one month or two months before the expected time; but its weight at birth, and babies are considered to be premature when their birth weight is 5£ lb. or less. From information received it appeared that 49 children weighed under 5½ lb. at birth. Eleven were born at home of whom one died, and 37 in hospital of.whom seven died. Therefore 40 out of the 48 survived. Children who were designated as premature in accordance with the above were visited frequently by the Council's Health Visitors, and monthly reports submitted to the Medical Officer of Health until such time as they weighed 8 lb. Hay Nurseries. There are eight day nurseries in the borough, controlled by the Council. The full cost during 1945 was borne bv the Ministry of Health. The following table sets out the nurseries and the accommodation provided at each: — Nursery. Accommodation. Margaret Day Nursery, 42, Phoenix Road, N.W.1 70 Day Nursery, 254-256, Camden Road, N.W.1 85 Foundling Site Day Nursery, 40, Brunswick Square, W.C.1 54 Day Nursery, 108, Hampstead Road, N.W.1 80 Kentish Town Day Nursery, 27, Gospel Oak Grove, N.W.5 55 Peckwater Street Day Nursery, Kentish Town, N.W.5 70 South Highgate Day Nursery, Chester Road, N.19 45 Regent's Park Day Nursery, 4, Prince Albert Road, N.W.1 52 It is usual to have on the rolls of each nursery 20 per cent, more children than the nursery can actually accommodate, as it is found that attendance of young children in nurseries is low owing to the incidence of minor maladies and infectious conditions and other causes of irregular attendance. There is a big demand for day nursery accommodation in the borough, and in actual fact at the end of the year there were some 333 children awaiting admission to these nurseries. Primarily day nursery provision is intended for the admission of children whose mothers are working; during the war in order to meet labour scarcity on account of military service, and during present peace conditions to meet the need for labour for export and other purposes. Day nursery provision must, therefore, be of such a nature as to provide for the care of children during all those hours when their mothers are at work, and must be distinguished from nursery school provision which is in accord with infant school timetables. It is intended that when the needs of mothers who are working have been met that excess provision may be 18 utilised for the care of children whose mothers are lying-in or sick. In St. Pancras it has not yet been possible to make even adequate provision for the children of mothers who are actually working either on account of personal necessity or to meet the national needs. Diphtheria Immunisation. The immunisation of children is carried out by general practitioners, at the Council's Welfare Centres and Day Nurseries, also by the London County Council Medical Officers at the day schools. During the year 1,794 children were recorded as immunised through the various channels mentioned, and the total number of St. Pancras children immunised since the scheme commenced is 9,938. Small-pox and Vaccination. The number of births dealt with by the Vaccination Officer during 1944 totalled 2,047, of which number 1,137 (55.5 per cent.) were successfully vaccinated. Figures for 1945 are not yet available. Comparable percentages of vaccinations for 1940, 1941, 1942 and 1943 were 33.4 per cent., 43.6 per cent. 54.7 per cent. and 57.2 per cent. respectively. SANITARY CIRCUMSTANCES IN THE BOROUGH Summary of Work Carried Out by Food, Factory and District Sanitary Inspectors during the Year 1945 District Sanitary Inspectors C omplai nts received, 3,832 , Complaints investigated Whole house inspected 2 Part of house inspected 3,817 Part of house re-inspections 6,486 Infectious Disease Investigations 642 Inspections 6 Re-inspections 41 Mews and Stable Yard Inspections 28 Pharmacy and Poisons Act Inspections 5 Other Inspections and Re-inspections 3,787 Inspections under Overcrowding Provisions 2 Underground Rooms (residential) Inspections 25 Drainage Under Notice, Plans, Supervision, etc. 690 Voluntary (for which plans must be submitted and approval obtained) 1,079 New Buildings 263 Attendances at Police Courts 44 Inspections under Rent Restrictions Acts 68 Housing Act Inspections 243 Other Visits 23 Food Inspectors Visits to Milk Premises 573 Visits to Food Premises 3,016 Visits to Meat Depot 256 Other Visits 1,247 Attendances at Police Court 28 War Damage Food Investigations 119 Factory Inspectors Visits to Factories (with mechanical power) 2,504 Visits to Factories (without mechanical power) 538 Visits to Workplaces 398 Visits to Restaurant Kitchens 890 Visits to Outworkers' premises 456 Other Visits 686 Scabies and Verminous cases 1,644 Common Lodging Houses 4 19 Intimation Notices served General 2,658 Factories (with mechanical power) 240 Factories (without mechanical power) 39 Workplaces 31 Rent Restrictions Acts 51 Infectious Diseases. Notifications Comparable totals for 1944 Under 1 1 and over Total Acute influenzal and primary pneumonia 38 98 136 123 Anterior poliomyelitis and polioencephalitis 1 4 5 - Cerebro-spinal meningitis 4 4 8 10 Diphtheria and membranous croup 1 103 104 58 Dysentery 67 88 155 56 Encephalitis lethargica - - — 2 Enteric or typhoid fever — 5 5 1 Erysipelas 3 57 60 56 Food poisoning — 8 8 3 Malaria — 4 4 2 Measles 71 954 1,025 798 Ophthalmia neonatorum 10 - 10 6 Puerperal fever - 19 19 16 Puerperal pyrexia — 34 34 27 Scabies 21 866 887 931 Scarlatina or scarlet fever 1 244 245 184 Typhus _ 2 2 — Whooping cough 32 151 183 575 It was subsequently ascertained that the following notifications which are included in the preceding table, were not regarded as cases of the disease as originally diagnosed:— Under 1 Over 1 Total Anterior poliomyelitis 1 1 Cerebro-spinal meningitis 1 1 2 Diphtheria and membranous croup — 35 35 Dysentery 8 15 23 Erysipelas — 3 3 Measles 2 5 7 Scarlatina or scarlet fever — 12 12 Whooping cough 2 7 9 Bacteriological examinations. Positive. Negative. Total. Diphtheria bacilli 38 731 769 Tubercle bacilli 8 89 97 Others 7 16 23 53 836 889 20 Figures set out below show the number of houses, rooms, ctc., dealt with after infectious diseases or following complaints of vermin: — Number of cases Number of houses Number of rooms sprayed or fumigated Cerebro-spinal meningitis 8 8 8 Diphtheria 104 104 106 Dysentery 155 155 155 Enteric fever 5 5 5 Erysipelas 60 60 60 Measles 27 27 27 Malaria 4 4 4 Poliomyelitis 5 5 7 Puerperal fever 19 19 19 Scabies 37 37 37 Scarlet fever 245 245 248 Tuberculosis 135 135 139 Vermin 521 521 648 Other diseases 172 172 172 Cleansing Station. The number of attendances at the Cleansing Station, Camley Street, was as follows:— [1) Scabies. . Men Women Children under 5 Schoolchildren Total St. Pancras 598 1,857 678 2,440 5,573 Ex St. Pancras 18 31 22 653 724 No fixed abode 3 1 — — 4 Totals 619 1,889 700 3,093 6,301 (2) Verminous Conditions. Men Women Children under 5 Schoolchildren Total Mead lice St. Pancras 60 36 1,490 1,586 Ex St. Pancras — 5 4 507 516 No fixed abode — 6 — 6 Body lice St. Pancras 801 4 3 — 808 Ex St. Pancras 25 — — — 25 No fixed abode 32 4 — — 36 Totals 858 79 43 1,997 2,977 9.\ In order to assist with the treatment of scabies cases arrangements were continued with the Middlesex and University College Hospitals, and the number of attendances at each of these clinics was:— Middlesex. University College. Total. 487 205 692 Note.—These clinics were closed as from 31st December, 1945. Rat Extermination. During 1945, the Council continued to make available to the public the services of three Rodent Operators, working under the general direction of a District Sanitary Inspector. The methods of extermination recommended by the Ministry of Food were closely followed, and the many tributes received demonstrate the efficiency of these methods and the skill of the operators. There were 701 complaints of rat infestation during the year. 528 premises were treated; 173 were business premises in respect of which receipts from occupiers amounted to approximately £350, and 355 were private dwellings where the service was free of charge. Mortuary and Coroner's Court. The number of cases dealt with at the Public Mortuary, Camley Street, during the year were:— (1) Bodies received 720 (2) Post mortems held:— (a) St. Pancras cases. (i) Resident and died in St. Pancras 212 (ii) Resident in St. Pancras, died elsewhere 18 (iii) Died in St. Pancras, resident elsewhere 89 319 (b) Ex-St. Pancras cases (both resident elsewhere and died elsewhere) 376 695 (3) Bodies received for viewing only 25 (4) Inquests held 512 During the year considerable improvements were made to the premises despite the difficulties of shortage of essential materials. There was a complete change of staff and a permanent Mortuary Keeper and Assistant Mortuary Keeper were appointed. The cottage was put into a good state of repair and the Mortuary Keeper is now resident. Housing. Work under the Housing Act, 1936, was suspended owing to the War, but a number of re-housing applications were dealt with by having such premises inspected and the prescribed form forwarded to the London County Council. The number of applications referred by the borough to the L.C.C. for information as to overcrowding was 57, and 38 on account of tuberculosis in the family. 22 INSPECTION AND SUPERVISION OF FOOD Milk Supply. Number of purveyors on the Register at the end of the year were:— Dairies 128 Itinerant purveyors 64 For sale of milk in sealed containers only 207 The Inspectors made 573 visits and 291 formal samples were taken and submitted for analysis. Milk (Special Designations) Regulations, 1936 to 1943. The number of licences granted during 1945 were: — Licences. Supplementary. To sell Tuberculin Tested milk 35 4 To sell Pasteurised milk 47 8 To pasteurise milk 1 — Meat and Other Foods. (i) Public Health (Meat) Regulations, 1924. Periodical visits of inspection were made as follows: — Meat Depots 256 Butchers' Shops and Meat Stalls 749 Prepared Meat premises 355 (ii) Inspection of other premises where food is prepared or offered for sale. The Food Inspectors have continued to keep all such premises under regular and frequent observation, 741 inspections being made for this purpose. Adulterations and Prosecutions. A total of 801 samples (405 formal and 396 informal) were sent for analysis, of which 14 formal and 7 informal were found to be adulterated. Prosecutions in 11 cases were undertaken under the Food and Drugs Act, 1938—2 in respect of Milk and 9 for other adulterated foods, resulting as follows:— Fine. Costs. 1 case (Gin) £10 £7 7s. 1 ,, (Gin) £5 £4 4s. 1 ,, (Pork sausages) £5 £2 2s. 2 cases (1 Milk, 1 Vinegar) £2 £2 2s. 1 case (Vinegar) — £7 7s. 1 case (Boracic Ointment) — £5 5s. 3 cases (1 Milk, 1 .Vinegar, 1 Sausages) — £2 2s. 1 case (Sausages) Dismissed owing to the smallness of the deficiency. 23 TUBERCULOSIS The figures relating to the control of tuberculosis in St. Pancras in 1945 do not show many marked changes when compared with those of the previous year and though a comparison with the year immediately preceding the war reveals certain very marked alterations the adverse effect of war conditions—some of which still persist—has certainly been less than might have been expected. The total deaths from tuberculosis in 1945 (127) are slightly less than they were in 1938 (133) and though there was a marked rise to 160 in 1940 and 147 in 1942, these peak years were followed by a fall which in 1943 produced the lowest number of deaths (117) ever recorded in St. Pancras. Although these figures are not strictly comparable owing to changes in the population, they are likely to be more reliable guides than the crude death rates because the tuberculous population did not diminish by evacuation and calling up in the same way as the general population. The notifications of tuberculosis in 1945 (337) also show a slight decrease compared with 1938 (365). During the war the annual figures were all lower than they were in 1938 or 1945 except in 1944 when it rose to 356. This recent rise may be partly the effect of war conditions but may also be due to the increase in the use of X-rays for the detection of early cases especially in the Forces where the tendency is to discharge and notify anyone suspected of being tuberculous though it is by no means certain that the disease is active. Even some of the active cases discovered by this means might otherwise have escaped notification altogether since it is well known that tuberculosis may in some circumstances heal itself without special treatment and without the patient being aware of any illness. The numbers of tuberculous persons on both the notification and on the dispensary register have shown a steady rise in numbers during the war years, the respective figures in 1938 being 964 and 813 and in 1945, 1,119 and 845. The notification register includes every person known to be suffering from tuberculosis in the Borough; the dispensary register includes only those who have actually attended the dispensary or had institutional treatment during the past two years. The numbers have increased mainly because of a tendency during the war not to discharge patients as cured. Usually this is done in the case of lung disease at the end of five years and of disease in other parts of the body at the end of three years provided that during these periods there has been no sign of activity; but war conditions seemed to justify prolonging this supervision especially as it includes the provision of priority milk and other advantages which might make all the difference in preventing a relapse. Prolongation of supervision has led to an increase in the annual number of attendances which fell to 2,825 in 1941 and has risen in the year of this report to 3,843, a figure which has not been exceeded since 1928. Other causes have, however, contributed to the increase. One of them is the need to obtain a certificate for priority milk which is undoubtedly responsible for the more regular attendance of some patients. Another is the considerable increase in the patients sent to the dispensary for diagnosis either by General Practitioners, Medical Boards for National Service, or the Mass Radiography Units. This is shown by a comparison of the number not diagnosed tuberculous in 1938 (257) with the number not diagnosed tuberculous in 1945 (428). The number diagnosed tuberculous has on the contrary shown a decrease from 247 in 1938 to 216 in 1945 and it is to be hoped the increased tendency to refer suspected cases to the dispensary has led not only to an increase in the work carried out there but also to the diagnosis of the disease in an earlier stage when it is more amenable to treatment. Associated with the preceding developments there has been a very marked increase in the use of X-rays and of artificial pneumothorax treatment in recent years. X-ray examinations have risen from 377 in 1938 to 982 in 1945 and artificial pneumothorax refills have risen from 24 989 in 1938 to 2,326 in 1945. All the X-ray films were made at Highgate Hospital and reported on by the Tuberculosis Officer and rather more than a quarter of the refills were given by the Tuberculosis Officer also at Highgate Hospital. Rather more than half the refills were given at University College Hospital by the Hospital staff and the remainder were given at Brompton or other Hospitals. The work at the Tuberculosis Dispensary has also been increased to a marked extent by the introduction of maintenance allowances for certain tuberculous persons in July, 1943. Owing to the exclusion of all persons suffering from non-pulmonary tuberculosis, of all persons suffering from pulmonary disease who are not likely to recover sufficiently to return to work, of persons not regarded as householders and of course of persons who are able to work only a small proportion of those on the notification register benefit under the Scheme. In 1945, this proportion amounted to 124 out of 1,119 and it has never been very much higher. Nevertheless, the work entailed is considerable and the figures for 1945 show that well over 1,000 assessments and re-assessments had to be made all of which may need much detailed enquiry. It became necessary to employ an additional clerk at the dispensary to assist in this work but even so the Tuberculosis Visitors find that it takes up time which could be devoted to other duties. There is no doubt, however, that the Scheme has been of great value and its continuation and expansion is greatly to be desired. The Tuberculosis Care Committee continued to carry on its functions throughout the war and the current figures show that its activities are increasing. Tuberculosis Dispensary. The number of definite cases of tuberculosis on the Dispensary Register at the end of the year was: — Pulmonary Non-Pulmonary Totals Adults Children Adults Children Adults Children M F M F M F M F M F M F 414 251 46 21 41 28 33 11 455 279 79 32 Total attendances 3,843 Visits by Tuberculosis Visitors 2,442 X-Ray Examinations 982 Sputum Examinations 479 A.P. Refills 2,326 Admissions to Institutions 319 25  New Cases Deaths — Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Primary Notifications 143 78 15 12 - - - - Death Reports 20 2 1 2 — — — — Transfers 36 19 6 3 — — — — Other sources - - - - - - - - Ages 0- 1 _ 1 - _ 1 1- 5 7 2 2 - - - - - 5-15 5 7 2 3 - 1 — — 15-25 35 37 4 5 8 7 — 3 25-35 51 23 6 3 14 6 1 — 35-45 30 19 6 1 13 7 1 — 45-55 30 5 — 1 16 3 — — 55-65 29 5 1 1 29 5 1 1 65 and upwards 12 1 — 3 7 1 — 2 Totals 199 99 22 17 87 30 3 7 Comparable figures for 1944 192 128 19 19 76 39 6 7 Notification Register on 31st December, 1945 :— Pulmonary 964 Non-Pulmonary 155 Comparable figures for 1944 Pulmonary 913 Non-Pulmonary 154 maintenance Allowance. These allowances were introduced in rulv, 1943. These allowances were introduced in July, 1943. The following table shows the number of new patients assessed and the type of allowance (if any) granted from January 1st to December 31st, 1944:— Standard Allowance only Standard and Discretionary Standard and Special Standard and Discretionary and Special Special Allowance only Discretionary and Special only Discretionary only Refused Allowance Total 78 15 1 18 — — 10 *124 Comparable figures for 1944 :— 82 24 2 — 20 — — 22 150 * In addition 1,143 re-assessments of these and previous cases have been made. 26 Tuberculosis Care Committee. Income from Seal Sales and other sources—£221 1s. 2d.; expenditure on clothing, coal, removals, pocket money, etc., for patients—£226 18s. 0d.; Extra Nourishment (provided by the Borough Council) cost £489 19s. 3d. The number of patients—97. Dental treatment (provided by the Council) cost £17 12s. 6d., the number of patients so provided being four.