* v A \*\ I \ /f C4355 STPAN 101 Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 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 AND SONS, LTD.. ST. MARTIN'S LANE. LONDON (7090) 65966 Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. CONTENTS. Introductory 4-10 Section 1.—General Information 11-14 Section 2.—Population, Births and Deaths 15-21 Section 3.—Prevalence of, and Control over, Notifiable Diseases 22-32 Section 4.—Sanitary Circumstances of the Area 33-38 Section 5.—Factories 39-40 Section 6.—Inspection and Supervision of Food 41-45 Section 7.—Maternity and Child Welfare 46-51 Section 8.—Tuberculosis 52-62 3 INDEX. PAGES Acute influenzal pneumonia 24 Acute primary pneumonia 24 Ambulance facilities 13 Analyst, Public 10 Anterior poliomyelitis and polioencephalitis 24 Area of borough, wards, open spaces 11 Bacteriological examinations 32 Bakehouses 39 Births— Notification of 15 Rates 15 Registered live 15 Registered still 15 Bodies received at mortuary 37 Cerebro-spinal meningitis 24 Child life protection 50 Children, illegitimate, care of 50 Cleansing and disinfecting station 30 Clerical staff 9 Climatological summary 14 Committees, members of 8 Coroner's Court 37 Daily guardians 50 Day nurseries 50 Deaths— Classification with age distribution 17 Infantile by causes, age and ward distribution 18 Number and rate, all ages 16 Puerperal 21 Rate, infants under 1 year of age 16 From tuberculosis 21, 52 Dental treatment 46 Diphtheria 24 Diphtheria immunisation 24 Disinfection 32 District inspectors 9 District nursing associations 48 Dysentery 25 Encephalitis lethargica 26 Enteric or typhoid fever 26 Erysipelas 26 Factory inspectors, visits by 39 Food inspection and supervision 41 Food inspectors, visits by 41 Food legislation 43 Food poisoning 26 Food sampling 41,42 Food summonses 45 Foreword 4 Health visitors 9 ,, ,, visits by 46 Home helps 49 Home nursing 23 Hospitals in the borough 12 Housing applications 38 (7090) PAGES Ice cream 42 Infantile mortality— Causes, age and ward distribution 18 Rate 12, 16 Causes, since 1939 20 Inspectors, district, food, factory, housing 8, 9 Insulin, provision of 12 Inquests 37 Invalid Children's Aid Association 37 Legal proceedings 34, 35 Malaria 26 Maternal mortality 21 Maternity and Child Welfare: members of Committee 8 Centres 12 Sessions and attendances 47 Maternity cases—provision of beds 49 Measles 26 Meat and other foods, visits made 42 Midwifery grants 48 Milk— Licences granted 42 Purveyors on register 42 Mortuary 37 Notifiable diseases, list of 22 Notifications of births 15 Notifications of infectious diseases 23 Nurseries, day 50 Nursing in the home 48 Ophthalmia neonatorum 27 Population 11, 15 Post-mortem examinations 37 Premature infants, care of 49 Public Analyst 10 Public Health Committee, members of 8 Puerperal fever and pyrexia 27 Rat extermination 37 Sanitary inspectors, visits by 33 Scabies 27 Scarlet fever 28 Smallpox and vaccination 28 Social welfare 13 Staff of Public Health Department 8 Statistics, vital, from 1918 19 Statistics, vital, summary of 12 Still births 15 Tuberculosis— Care Committee 60 Deaths 21, 52, 56 Dispensary staff 9 Notifications 52, 54 Prevalence and fatality 55 Times of sessions 57 Work carried out 58 Typhoid or enteric fever 26 Vaccination 28 Vaccinators, Public 10 Verminous conditions 31 Water supply 38 Welfare centres 12 Whooping cough 30 A 2 4 Town Hall, Euston Road, N.W.1. June, 1947. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Your Worship, Ladies and Gentlemen, In the contents of this report upon the conditions of health and sanitation in the Metropolitan Borough of St. Pancras during the year 1946 will be found statistical tables and detailed information. In these opening remarks, therefore, I propose to summarise some of the matters that have received our special attention, and to give some indication of the lines upon which our work should be conducted in the future. I have no hesitation in directing my first comment towards the environmental conditions under which the residents of the borough are living. In these days of large plans for improved services for the treatment of the sick it is very easy to lose sight of the fact that it is the food which the people eat and the houses in which they live that are of far more immediate importance than the hospitals and social services that will be provided to treat the diseases which can arise if food, housing and environment generally are inadequate or unsatisfactory. Environmental hygiene is of paramount importance in this country, which is still suffering acutely from the ravages of war. Modern warfare no longer means the enrichment of the victor at the expense of the vanquished, nor the procession of cartloads of booty before cheering crowds. To win a war is no longer sufficient, for when this is achieved problems almost as severe and grim have still to be faced if the country is to regain the amenities of pre-war days. Sanitary Defects. The size of the problem with which we have to contend can be measured from the number of complaints of sanitary defects in houses in the borough. This number was 5,689. The number of houses in the borough is approximately 18,000. This means that in 31 per cent. of the houses in the borough there was a sanitary defect for which the residents had to seek the help of the Public Health Department to overcome a nuisance dangerous or injurious to health ; and to deal with these complaints no less than 16,663 inspections were made. In nearly every case the complaint was justified and needed a remedy. Admittedly in some the sanitary defect referred to a small item amounting to inconvenience and was easily remedied, but in many the defects were acute and serious. It is sometimes difficult to appreciate a condition when large numbers are mentioned. It is easier to understand the misery that lies behind one individual complaint than the mass of suffering occasioned by 5,689. An illustration of this is easily found if one considers a frequent complaint from a tenant that his roof is leaking. This often means inability to use one or more of the few rooms available to him and his family—it means damp clothes, damp bedding and an acutely miserable existence. When one multiplies cases of this description to the extent to which they exist in this borough one gets a truer picture of the value of the work of the Sanitary Inspector and the extent to which he can and does help the public. 5 We have received co-operation from the majority of landlords and agents in the borough who have done their best, sometimes under most difficult circumstances, to abate sanitary defects. It would be helpful, however, if all the landlords and agents would realise the necessity of commencing, or at least preparing, to ameliorate a condition injurious to health upon receipt of an intimation notice that a sanitary defect exists. It is unfortunately true that there are cases where no action is taken until a formal notice is served, and sometimes even a summons. This represents a waste of time and money and an unnecessary continuation of miserable living conditions for the tenant. There have been no less than 50 court proceedings in connection with sanitary defects during the year, the largest number since 1927 when there were 62. Even this number will be materially exceeded in the year 1947. I regret this long list of prosecutions, for although it is an earnest of the zeal of your inspectors and a very definite indication of the Council's determination to remedy sanitary defects, it would be more pleasant to record that we were able to secure the abatement of all nuisances without once having to seek the assistance of the Court. It will be noted that in no less than 18 cases proceedings had to be taken before we could secure the remedy of so serious a nuisance as a defective roof. Housing. Housing is still the major problem in the borough and at the time of writing this report the Housing Department had 10,451 applications for re-housing. When one realises that the number of separate occupations is about 52,708 it will be realised that over a fifth of the population is asking for alternative accommodation. During the year my department investigated 1,363 housing applications to see how serious were the conditions under which the persons were living and to secure immediate amelioration if this could be achieved by abatement of sanitary defects. Of the 1,363 investigations the following was the classification:— A (urgent priority) 1,001 B (urgent priority—less serious) 153 C (general waiting list) 131 D (no special consideration) 78 There is no need for me to enlarge on the fact that out of 1,363 investigations, 1,001 were found to need urgent housing priority. These "A" cases include many where large families are living in one or two rooms, sometimes in a basement. Food. Sixteen actions were undertaken in connection with the Sale of Food and Drugs Act. It will be noticed that in two cases heavy fines were imposed. I am not satisfied that there is yet adequate supervision of the food sold, exhibited or prepared for sale in the borough. At the present moment the Council employs only two food inspectors. During the summer months they could spend a large proportion of their time dealing with the manufacture and sale of ice cream alone. When one realises the number of restaurants and premises selling food in this borough, it will be realised that with our present staff we cannot fulfil our task completely, and I hope in due course to present a report to the Committee on this subject. Births and Infantile Mortality. The number of registered live births was 2,494. This is the highest figure recorded since 1933, when the number was 2,589. At that time, however, the population of St. Pancras was 190,900 as compared with 129,410 in 1946. The production of so many births by this reduced (7090) A 3 6 population is due to a birth-rate of 19.3, as compared with 13.6 in 1933 and is, in fact, the highest rate since 1923. I think this is due to the many marriages that have occurred with the return of men and women from the Forces, and also to the fact that many married couples who did not have children during the war period have since determined that it was time to raise a family. For this reason I doubt whether the present birth-rate will be continued over a period of many years. The infantile mortality rate for the year, which is considered as an index of the health of the population, was 38, the lowest ever recorded in St. Pancras, comparing with 44 per thousand births in 1945, which even then was a record. The rate for the country as a whole in 1946 was 43, and for London 41. Ninety-six children died before they reached the age of one year. Of these 15 died of bronchitis and pneumonia, 24 due to premature birth, 12 injury at birth, 13 enteritis, 11 atelectasis, and 8 congenital malformations. These figures of death from individual causes enable us to assess our efforts and determine what further improvements can be obtained. Children should not contract bronchitis, pneumonia or enteritis, and injury at birth should be preventable with expert obstetric care and optimum environment in all cases. Atelectasis is a condition in which the lungs fail to expand at birth. The cause of this and possibly prematurity may be associated with inherited factors. So far we make a dividing line between deaths due to prematurity and children born dead; but it is very possible that the causes are allied and may be associated with blood reactions of the parents. We know that under certain circumstances mating couples may produce children likely to die of haemorrhage soon after birth, and this factor may also be responsible for the birth of a dead child. So far our knowledge is not sufficient to prevent congenital malformations, but there is reason to believe that research may make even this possible as well as the prevention of stillbirths and hæmorrhagic disease of the new born in the near future. An infantile mortality rate, however, of 38 in St. Pancras is good, and is an indication of what can be achieved by determination, even under adverse housing and environmental conditions; for I have already pointed out that a large percentage of our houses have sanitary defects and that at least a fifth of our residents need rehousing, many of them urgently. Much of this low infantile mortality is, in my opinion, due to the constant attention which our health visitors give to the individual children under one year in the borough. It is easy to forget that the primary duty of a health visitor is to visit homes where there are children under five. It is these visits to the homes and concentration on special cases that, in my opinion achieve most in child health. No less than 32,000 visits were made by our health visitors during the year. Infectious Disease. There were 66 notifications of diphtheria during the year, and two deaths. Neither of the two children who died had been immunised, and of the 45 under 15 years of age who contracted the disease we have records that only seven were immunised. Whooping cough accounted for the death of one child out of the 497 cases notified. Intense research is now being carried out to ascertain the effect of immunisation, and the results which have been achieved give at least cause for encouragement. It is not generally considered wise to commence a scheme of mass immunisation against this disease, but comparative experimental work between districts and schools is considered advisable, and in due course the results achieved may indicate the lines on which we should proceed in order to eradicate, or at least mitigate, the effects of this distressing condition. In the body of this report will be found figures concerning the incidence and death rate from measles for the past 20 years. The number of cases have varied considerably. There 7 have been as few as 85 in 1939 and as many as 3,734 in 1926. Of equal interest, however, is the mortality rate per thousand cases, for there has been an almost steady decline from a figure of 17.4 in 1926 to 1.8 in 1946. Measles is a disease which chiefly affects children, and deaths, when they occur, affect earlier rather than later age periods. The disease tends to be most serious in children under 5. The continuous reduction, therefore, in mortality from measles can well be associated with the care which has been given by your health visitors to young sufferers from this disease. Measles is notifiable, and every case in children under 5 is visited and the parents advised by your staff. Conclusion. It is difficult in these days to separate preventive from curative medicine. The work, therefore, of a Medical Officer of Health and, in fact, the Public Health Department, is completed only by the help and active co-operation of the doctors who are practising in the borough, and I wish to take this opportunity of thanking them for their ever present assistance. It is they who first see disease in the home and advise as to the initial methods necessary to prevent its spread, and it is their co-operation and the information which they give to the Public Health Department which sets in motion the machinery we have available to improve health and retard disease. I am deeply indebted to the Council and the Committees which I immediately serve for the courtesy, help and co-operation I have received throughout the year. I would also like once more to refer to the work of my staff. The Health Department of your Council works as a very happy and, I trust, efficient team, the leader of which it has been a pleasure and privilege to be during 1946. I beg to remain, Your Worship, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, Medical Officer of Health. (7090) A 4 8 Metropolitan Borough of St. Pancras. 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. November, 1946, to October, 1947. Councillor Mrs. W. Paul (Chairman) ; Councillor Rev. J. Jones (Vice-Chairman); The Mayor (Councillor F. W. Powe); Aldermen Dr. L. F. Browne and Dr. E. A. Gregg; Councillors Dr. S. G. Dean, Mrs. M. A. Foster, Miss F. L. M. Freeman, Mrs. J. Gregory, C. Haimes, Mrs. L. G. Hume, R. Kane, A. G. Shelley, H. B. Sheridan 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. November, 1946, to October, 1947. Councillor Mrs. D. D. Naftel (Chairman); Councillor Mrs. A. E. Lake (Vice-Chairman); The Mayor (Councillor F. W. Powe); Aldermen Mrs. L. Bartlett and G. Home; Councillors Mrs. L. Bryant, Miss L. M. Chivers, Mrs. K. E. Deacon, Dr. S. G. Dean, Mrs. M. A. Foster, Miss F. L. M. Freeman, Mrs. J. Gregory, Rev. J. Jones, T. B. Moss and T. J. Powney. STAFF OF THE PUBLIC HEALTH DEPARTMENT at the end of the year 1946. 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., F.R.C.P., F.R.F.P. &S., D.P.H. 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. 9 District Inspectors. W. B. Dykes. H. E. Westripp. C. A. Engledow. G. K. Wilby. T. H. Hague. J. H. Willett. E. F. Kirby. I. Williams. W. Shackcloth. J. F. Woolvin. R. N. Thomas. (5 vacancies.) Clerical Staff. A. Carpenter, Chief Clerk. V. R. Meurice. G. A. Mitchell. C. W. Smith. P. S. Thomas. W. C. Mansfield. J. J. Wisdom. G. F. Peeling. D. H. Smith. R. B. M. Lake. Miss B. Pinnock. J. M. Murphy. Miss J. M. White. V. J. Stanton. Clerical Staff (M. & C.W. Section). Miss A. Andrews. Miss E. M. Foster. 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 (for Tuberculosis): Miss M. M. Gilpin, Miss W. E. Webb. Nurse, and Secretary to Tuberculosis Care Committee: Mrs. E. Bevan. Clerical: Miss L. M. Davison, Mrs. S. W. Gardner. MATERNITY AND CHILD WELFARE S. M. Tracy, L.R.C.P., M.R.C.S., D.P.H., Assistant Medical Officer. Superintendents of Centres. Miss M. L. Blair (Kentish Town). Mrs. S. C. Chapman (Queen's Crescent). Miss B. M. Harris (Ampthill Square). Miss M. Manger (Somers Town). Health Visitors. Miss A. M. U. Harrop Miss C. O'Leary (Ampthill Square). Miss E. M. Boyce †Miss H. I. Hurst †Miss M. M. Wilson (Queen's Crescent). Miss H. Smith Miss B. M. L. Boxall Miss H. M. Upton (Camden Town). †iss M. A. Clarke (Somers Town). Miss E. B. Bagnall Mrs. B. L. Owen (Kentish Town). Miss G. E. H. Thomson †Miss B. H. Whiting (South Highgate). †emporary. 10 DAY NURSERIES Superintendent Matron : Miss E. M. Butler. Clerical: Miss B. E. Elsy. 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 5 Ward 6 Ward 7 Dr. A. E. Tait. Ward 3 Ward 4 Dr. J. W. Wigg. Ward 8 Dr. C. H. Alderton. 11 SECTION 1. General Information and Statistical Summary. General Statistics. 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 in the south (in the neighbourhood of Ampton Street, King's Cross Road) to 427 feet above Ordnance datum in the north (Pond Square). The borough is about 4 miles long, extending from Oxford Street in the south to Highgate in the north, and averages about a mile in width. Acres. Area of the borough 2,694 Area of Ward 1 990 Area of Ward 2 162 Area of Ward 3 452 Area of Ward 4 271 Area of Ward 5 342 Area of Ward 6 180 Area of Ward 7 118 Area of Ward 8 179 Area of various public open spaces 530 Regent's Park and Primrose Hill 102 Parliament Hill 184 Kenwood 164 Waterlow Park 29 Disused burial grounds 31 Private square gardens 20 Area of borough highways, excluding footpaths, 28 acres (approx.) Total length of roads, about 90 miles. Population (1931 Census) 198,133 Population (Registrar General's mid-1946 estimate) 129,410 Number of persons per acre (estimated average) 48 Rateable value £2,107,657 Product of a penny rate, about £8,050 12 Summary of Vital Statistics. Net registered live births 2,494 Birth-rate (per 1,000 of estimated population) 19.3 Deaths, all ages 1,717 Death rate (per 1,000 of estimated population) 13.3 Infantile deaths 96 Infantile death rate (per 1,000 live births) 38 Tuberculosis deaths 98 Tuberculosis death rate (per 1,000 of estimated population) 0.75 Maternity and, Child Welfare Centres. Telephone St. Pancras School for Mothers, 1, Ampthill Square, N.W.1. EUSton 2972 Camden Town Welfare Centre, Barnes House, Camden Road, N.W.1. GULliver 1667 Kentish Town Welfare Centre, Raglan Street, N.W.5 GULliver 1389 North St. Pancras School for Mothers, Queen's Crescent, N.W.5 GULliver 2988 Somers Town Welfare Centre, Chamberlain House, Ossulston Street, N.W.1 EUSton 2380 South Highgate Welfare Centre, 1, St. Alban's Road, N.W.5 GULliver 2008 University College Hospital, Maternity and Child Welfare Department, Huntley Street, W.C.1 (for Ward 7—Children) EUSton 5050 Tuberculosis Dispensary, Barnes House, Camden Road, N.W.1. GULliver 2371 Provision of Insulin. Provision of insulin for 17 necessitous patients was made during the year, under powers contained in Section 227 of the Public Health (London) Act, 1936, at a total cost to the Council of £53. Hospitals in the Borough. Telephone British Dental, 146, Camden Road, N.W.1. GUL 1977 British Functional Mental and Nervous Disorders, 72, Camden Road, N.W.1. GUL 2041 Central London Ophthalmic, Judd Street, W.C.1. EUS 2543 Elizabeth Garrett Anderson, 144, Euston Road, N.W.1. EUS 2501 Hampstead General and N.W. London (Out-patients Department), Bayham Street, N.W.1. GUL 1734 Highgate, Dartmouth Park Hill, N.19 ARC 2681 London Foot, 33, Fitzroy Square, W.l. MUS 0602 London Skin, 40, Fitzroy Square, W.l. MUS 1411 Manor House (Ophthalmic), 324, Gray's Inn Road, W.C.1. TER 5121 National Temperance, Hampstead Road, N.W.1. EUS 5206 Royal Ear, Huntley Street, W.C.1. EUS 5050 Royal Free, Gray's Inn Road, W.C.1. TER 4331 Royal National Throat, Nose and Ear, Gray's Inn Road W.C.1. TER 4311 13  T elephone St. Margaret's, Leighton Road, N.W.5 GUL 2483 St. Pancras, Pancras Road, N.W.1. EUS 1617 University College, Gower Street, W.C.1. EUS 5050 West End Hospital for Nervous Diseases.—Owing to war damage of hospital premises at Gloucester Gate, Regent's Park, N.W.1, temporary wards have been available at Princess Louise Hospital, St. Quintin Avenue, N. Kensington, W.10. Ambulance Facilities. London Ambulance Service (Accident and General). Headquarters: The County Hall, S.E.1. For accidents (in the home or elsewhere) or sudden illness (in streets, public places and places of employment) Dial 999 For maternity cases or very urgent illness in the home WATerloo 6000 For other cases—illness, infectious diseases, &c. WATerloo 3311 The following restrictions have had to be placed upon the admission of certain types of infectious disease to the London County Council hospitals, owing to the acute shortage of nursing and domestic staff:— Chickenpox, German Measles and Mumps.—Patients will be admitted at the request of the Borough Medical Officer of Health only. No patient will be accepted for admission except on grounds of clinical severity or where home conditions make it impossible to retain the patient at home. Whooping Cough.—Patients will be accepted direct from medical practitioners and will be admitted up to the limit of the available accommodation for this disease. In the event of beds not being available, preference will be given to younger children and children who cannot be cared for at home. Measles.—No patient will be admitted except at the request of the Borough Medical Officer of Health. In the event of beds not being available, children under 3 years of age will be given preference. Scarlet Fever.—This will be dealt with in the same way as chickenpox, German measles and mumps, except that some preference will be given to children under 5 years of age. Enteritis and Dysentery.—Children under two years of age will be accepted direct from medical practitioners and every effort will be made to admit all such patients. Patients over 2 years of age will be dealt with in the same category as chickenpox, German measles and mumps. Social Welfare. L.C.C. Area III/IV—Comprises the Metropolitan Boroughs of Finsbury, Hampstead, Holborn, Islington, St. Marylebone, St. Pancras and Shoreditch. Local Social Welfare Officer (Area III/IV)— G. E. Oughton. Area Welfare Officer— C. H. Osbourn. Head Office: 53, Clerkenwell Road, E.C.1. Phone: CLE 5871. District Welfare Officers. R. J. O'Connell (GUL 2868) A. F. Whyman (GUL 2737) District Welfare Station, Bower Cottage, Holmes Road, N.W.5. H. Williams, 29, Marylebone Road. (WEL 2894). 14 Climatological Summary, Year 1946. Station, Camden Square, N.W.1—Lat. 51° 33' N. Long. 0° 08' W. January February March April May June July August September October November December Barometer— Mean Pressure at 32° F. at station mbs. level (Bar. 112 ft. above M.S.L.) 1022.1 1016.7 1017.5 1020.3 1014.5 1015.4 1017.3 1012.0 1014.4 1019.6 1008.9 1015.7 Air Temperature— Mean of— A. Maximum °F. 42.5 48.7 49.0 62.2 62.5 66.5 73.5 69.2 65.8 57.7 52.8 43.0 B. Minimum °F. 34.8 39.7 35.8 43.6 45.2 51 .5 56.5 54.5 53.5 47.0 43.9 33.6 Mean of A and B °F. 38.7 44.2 42.4 52.9 53.9 59.0 65.0 61.9 59.7 52.3 48.3 38.3 Difference from average (1906.1935) °F. –1.6 +3.7 –1.3 +4.6 –2.5 –2.0 +0.7 –1.8 +0.7 +0.4 + 4.2 –3.2 Mean relative humidity per cent. 91 86 80 73 78 69 75 74 83 83 88 90 Earth temperature at 4 ft. depth °F. 44.5 44.1 43.0 46.5 50.1 53.2 57.5 58.6 57.1 55.6 51.3 47.3 Bright sunshine— Total observed (daily mean) Hr. 0.98 2.01 2.40 6.08 5.98 5.51 7.30 5.49 3.64 2.33 1 .19 * Percentage of possible 12 20 20 45 39 33 45 38 29 22 13 * Percentage of average 105 126 85 145 96 84 119 98 65 90 92 * Rainfall (rain-gauge level, 110 ft.)— Number of days precipitation 10 18 6 10 14 21 9 16 19 10 18 15 Total fall In. 1.55 2.80 1 .24 1.51 2.99 3.26 2.20 3.83 3.16 1.53 3.49 1.95 Percentage of average (1881-1915) 83 168 68 98 170 161 92 173 174 58 148 82 Hour of observation, 9 a.m. (G.M.T.). The readings for Bright Sunshine are those taken at Regent's Park—no readings being recorded at Camden Square. Total rainfall for year, 29.51 inches. * No readings available for December. 15 SECTION 2. Births and Deaths. STATISTICS FOR THE YEAR 1946. Population. The civilian population, as estimated by the Registrar-General, mid-1946, was:—129,410 Comparable estimates for preceding years are set out on page 19. Registered Live Births. M. F. Total. Rate per 1,000 of estimated population. Legitimate 1,134 1,063 2,197 Illegitimate 163 134 297 1,297 1,197 2,494 19.3 Comparable figures for preceding years are set out on page 19. Registered Still Births. M. F. Total. Rate per 1,000 Live and Still Births. Legitimate 27 26 53 Illegitimate 7 4 11 34 30 64 25.0 Comparable figures for preceding seven 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 1945 56 27.8 Notification of Births. Under the Notification of Births Acts, 1907 and 1915, a medical practitioner attending a woman in her confinement is required, within 36 hours, to give notice to the Medical Officer of Health of the occurrence of the birth of a child, alive or dead unless he (or she) has reason 16 to believe that the father of the child, or some other person who either was present at the birth or who was in attendance on the mother within six hours afterwards, has already sent the notification. No fee is payable. This notification is in addition to, and not in substitution for, Registration of Birth, which must be made within 42 days of the birth. Births (live and still) notified as having taken place in St. Pancras 3,133 Less non-residents born in the borough 1,813 1,320 Add St. Pancras residents born outside the borough 975 Total St. Pancras births notified 2,295 56 of these were still births, leaving a net figure of 2,239 live births notified in 1946. Note.—The number of notified births in any one year will necessarily differ from the number of registered births in the same year owing to the difference in time allowed for notification and registration. Deaths—All Ages. M. F. Total Rate per 1,000 of estimated population 946 771 1,717 13.3 Comparable figures for preceding years are set out on page 19. Death Rate of Infants under 1 year of age. All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 37 Illegitimate infants per 1,000 illegitimate live births 47 Comparable figures for preceding seven 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 1945 44 40 65 Comparable figures for preceding years are also set out on page 19. 17 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 96 18 8 169 457 969 946 771 1. Typhoid and paratyphoid — — 1 — 1 — 1 1 2. Cerebro-spinal fever 1 1 — 1 — — 2 1 3. Scarlet fever — — — — — — — — 4. Whooping cough — 1 — — — — — 1 5. Diphtheria — — — 2 — — 1 1 6. Tuberculosis of respiratory system — — — 51 30 11 59 33 7. Other forms of tuberculosis 1 — — 4 1 — 5 1 8. Syphilitic diseases — — — 6 7 2 10 5 9. Influenza 1 — — 2 1 7 5 6 10. Measles 1 1 — — — — 1 1 11. Ac. poliomyelitis and polioencephalitis — — — — — — — — 12. Ac. infectious encephalitis — — — 1 1 — 2 — 13. Cancer—buccal cavity and Oesoph (M); Uterus (F) — — — 3 8 16 18 9 14. Cancer—stomach and duodenum — — — 4 17 27 30 18 15. Cancer—breast — — — 4 15 6 — 25 16. Cancer—all other sites — — — 10 72 93 108 67 17. Diabetes — — — 1 6 5 5 7 18. Intracranial vascular lesions — — — 1 34 91 58 68 19. Heart diseases — — 12 80 349 210 231 20. Other circulatory diseases — — — 1 15 41 33 24 21. Bronchitis 8 1 1 6 47 104 108 59 22. Pneumonia 7 5 — 6 31 67 62 54 23. Other respiratory diseases — — — 3 8 6 13 4 24. Ulcer—stomach or duodenum — — — 1 14 6 20 1 25. Diarrhœa (under 2 years) 13 1 — — — — 10 4 26. Appendicitis — — — 3 1 1 3 2 27. Other digestive diseases 1 2 — 3 14 19 21 18 28. Nephritis — — 1 — 11 22 23 11 29. Puerperal and post-abortive sepsis . . — — — 2 — — — 2 30. Other maternal causes — — — 1 — — — 1 31. Premature birth 24 — — — — — 12 12 32. Congenital malformations, birth injury and infant diseases . . 32 2 — 3 3 1 27 14 33. Suicide — — — 8 8 2 10 8 34. Road traffic accidents — 1 4 4 3 6 8 10 35. Other violent causes 3 3 — 8 9 32 27 28 36. All other causes 4 — 1 18 20 55 54 44 18 DEATHS OF INFANTS UNDER 1 YEAR OF AGE Deaths of infants from stated causes with Age and Ward distribution:— Cause of death Age Deaths in each Ward No address Totals Under 1 day 1 day to 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks to 3 months 3-6 months 6-9 months 9-12 months Total 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 Cerebrospinal fever — — — — — — — — 1 — 1 — — — — — 1 — — — — — — — — — — — — — 1 Whooping cough — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pulmonary tuberculosis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculous meningitis — — — — — — — — — 1 1 — — — — — — — — — — — — — — — 1 — — — 1 Influenza — — — — — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — — — 1 Measles — — — — — — — — 1 — 1 — 1 — — — — — — — — — — — — — — — — — 1 Convulsions — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — 3 4 1 — 8 2 — 1 — 1 1 — — — — 1 — — — 2 — — — 7 1 Broncho-pneumonia — — — — — — 5 2 — — 7 — 1 1 1 — 1 — — — — — 1 — — — 1 1 — 2 5 Lobar pneumonia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (not stated) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteritis — — — — — — 4 3 4 2 13 1 1 1 1 3 1 2 — — _ 1 — 1 1 — — — — 9 4 Congenital malformations 1 4 — 1 — 6 2 — — — 8 1 2 1 — 2 — — — — — — — — — — — — — 4 4 Premature birth 10 7 3 — — 20 4 — — — 24 4 4 1 1 4 3 — 1 1 1 — — 1 — 1 2 — — 12 12 Injury at birth 3 6 2 — — 11 1 — — — 12 2 3 — — — 1 1 1 — — — 1 — — 1 — — 6 6 Atelectasis 2 9 — — — 11 — — — — 11 1 1 — — 1 — 2 — 1 2 — — 1 — 2 — — — 8 3 Other diseases peculiar to first year of life — 1 — — — 1 — — — — 1 — — — — — — 1 — — — — — — — — — — — 1 — Lack of care of new-born — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other violence — — — — — — 2 — 1 — 3 — — — — — — — — — — — — — 2 — — 1 2 Other causes 1 — 1 — — 2 1 — 1 1 5 1 1 1 — — — 1 — — — — — — — — — — 1 3 2 Totals 17 27 6 1 — 51 22 10 9 4 96 12 15 6 5 12 8 7 2 4 3 2 1 4 1 5 7 1 1 53 43 1 To face page 18. St. Pancras INFANTILE DEATHS per 1,000 registered live births (children under the age of 12 months). 19 Vital Statistics of Borough of St. Pancras during 1946 and previous Years. Year Population estimated at middle of each year Nett Registered live births belonging to the borough Nett deaths belonging to the borough At all ages Under 1 year of age Number Rate per 1,000 of estimated population Number Rate per 1,000 of estimated population Number Rate per 1,000 nett live births 1918 196,883 3,318 16.8 3,914 22.3 340 102 1919 228,585 3,824 16.7 2,930 13.4 336 88 1920 228,980 5,934 25.4 2,895 12.4 435 73 1921 212,900 4,764 22.4 2,778 13.0 360 76 1922 212,500 4,559 21.5 3,107 14.6 337 74 1923 214,400 4,348 20.3 2,585 12.1 272 63 1924 214,600 4,112 18.8 2,848 13.0 303 74 1925 216,300 3,880 17.9 2,745 12.7 280 72 1926 216,800 3,612 16.7 2,680 12.4 274 76 1927 213,200 3,299 15.5 2,621 12.3 205 62 1928 206,000 3,274 15.9 2,618 12.7 261 80 1929 204,400 3,170 15.5 3,126 15.3 262 83 1930 204,400 3,208 15.4 2,478 11.9 194 60 1931 195,600 2,955 15.1 2,601 13.3 200 68 1932 194,000 2,684 13.8 2,545 13.1 186 69 1933 190,900 2,589 13.6 2,608 13.7 151 58 1934 187,540 2,449 13.1 2,408 12.8 160 65 1935 185,300 2,466 13.3 2,219 11.9 155 63 1936 183,900 2,389 13.0 2,478 13.5 190 79 1937 181,900 2,364 13.0 2,317 12.7 154 65 1938 179,400 2,433 13.5 2,063 11.5 156 64 1939 167,300 2,187 12.3 2,170 13.0 114 52 1940 133,200 1,948 14.6 2,728 20.5 108 56 1941 103,770 1,434 13.8 2,055 19.8 74 51 1942 105,900 1,785 16.9 1,730 16.3 117 66 1943 108,640 1,836 16.9 1,842 17.0 130 71 1944 105,780 1,914 18.1 2,001 18.9 123 64 1945 111,400 1,957 17.6 1,806 16.2 86 44 1946 129,410 2,494 19.3 1,717 13-3 96 38 (7090) B 2 20 Infantile Mortality. 1939 1940 1941 1942 1943 1944 1945 1946 Measles — — 1 — 1 — — 1 Whooping cough 5 — 8 3 1 2 3 — Influenza — — 1 1 1 — — 1 Cerebro-spinal fever — 1 — — — — — 1 Syphilis 1 1 — — 1 1 — — T.B. — — — 1 — — — — Meningitis — 1 — — 3 1 — 1 Convulsions 1 — — 1 — — — — Bronchitis 3 4 1 6 6 3 1 8 Broncho-pneumonia 13 16 — 10 10 20 — 7 Lobar pneumonia 2 1 — 1 1 — — — Pneumonia (not stated) — 1 9 1 2 1 12 — Enteritis and diarrhœa 30 29 9 23 18 20 24 13 Congenital debility, sclerema, icterus 3 — 1 — — — — — Congenital malformations 8 10 7 13 10 13 6 8 Premature birth 30 17 19 27 28 25 7 24 Injury at birth 4 3 2 3 8 7 4 12 Atelectasis 2 5 4 5 8 6 13 11 Haemorrhage from umbilicus 1 — — — — — — — Inattention at birth 1 — — — — — — — Lack of care of new-born — — — 3 — 1 — — Violence — 9 — 3 — 6 4 3 Mikulier's disease — — 1 — — — — — Maternal toxæmia — — 1 — — — — — Melaena neonatorum — — 1 — — — — — Icterus gravis — — 1 — — — — — Septicaemia — — — — — 1 — — Bacillary dysentery — — — — — 1 — — Other diseases peculiar to first year of life — — — 8 — 4 2 1 Other causes 10 10 8 8 32 11 10 5 Totals 114 108 74 117 130 123 86 96 21 Deaths from Puerperal Causes. Rate per 1,000 Live and Still Births. Deaths. Sepsis. Other causes. Total. Puerperal Sepsis 2 0.78 1.56 Other maternal causes 2 0.78 Comparable figures for preceding seven 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 1945 5 2.48 Deaths from Tuberculosis—All ages. Death Rate per 1,000 of estimated population. Pulmonary 92 0.71 Other forms 6 0.04 98 Total 0.75 Comparable figures for preceding seven 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 1 .21 1945 127 114 (7090) B 3 22 SECTION 3. 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 :— Smallpox (Variola). Cholera. Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever (Scarlatina). Typhus Fever. Typhoid Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. 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). Scabies (1943). And the Infectious Diseases (London) Regulations, 1927 for :— Malaria. Acute Primary Pneumonia. Dysentery. 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 Hydrophobia Anthrax " when these occur in man D.—Under Section 17, Food and Drugs Act, 1938 :— Food Poisoning. (For information regarding removal to hospital, see " Ambulances," page 13.) 23 Provision of Home Nursing for Specified Diseases. Where home 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. 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 arranged for and carried out under his instructions on receipt of the card duly signed by him. Details as to the manner in which this work is done under a block grant from the Borough Council, and the diseases covered, are reported in the Maternity and Child Welfare Section, page 48. Infectious Diseases. — Notifications Comparable totals for 1945 Under 1 1 and over Total for 1946 Acute influenzal and primary pneumonia 6 117 123 136 Anterior poliomyelitis and polioencephalitis — 3 3 5 Cerebro-spinal meningitis 1 8 9 8 Diphtheria and membranous croup 4 90 94 104 Dysentery 13 79 92 155 Encephalitis lethargica — — — — Enteric or typhoid fever — 5 5 5 Erysipelas — 53 53 60 Food poisoning — 9 9 8 Malaria — 7 7 4 Measles 74 1,041 1,115 1,025 Ophthalmia neonatorum 33 — 33 10 Puerperal fever — 6 6 19 Puerperal pyrexia — 47 47 34 Scabies 19 680 699 887 Scarlatina or scarlet fever 2 242 244 245 Typhus — — — 2 Whooping cough 65 446 511 183 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 Ce rebro-spinal meningitis — 2 2 Diphtheria and membranous croup 2 26 28 Dysentery 1 7 8 Enteric fever — 1 1 Erysipelas — 3 3 Measles 4 4 8 Puerperal pyrexia — 1 1 Scarlatina or scarlet fever — 14 14 Whooping cough 2 12 14 (7090) B 4 24 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 80 notifications of the former and 43 of the latter, during 1946. Anterior Poliomyelitis and Polioencephalitis. Three cases were notified, of which one case was subsequently not confirmed. 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. Cerebro-Spinal Meningitis. (Cerebrospinal Fever, Meningococcal Meningitis, " Spotted Fever.") Nine cases were notified, and in all but two the diagnoses was confirmed. There were three deaths. Diphtheria. The number of cases notified was 94, as compared with 104 during the previous year, but the diagnosis was not confirmed in 28 instances. The actual number of cases was therefore 66 (of whom 45 were under 15 years of age), which gives an attack rate of 0-51 per 1,000 of population. Two deaths occurred, giving a case mortality of 3-0 per cent. Investigation of multiple cases—that is, several cases occurring more or less together in one house—shows that in 5 families there were two cases and in 2 families three cases. St. Margaret's Hospital Nursery had four cases, one subsequently not confirmed. Diphtheria Immunisation. The immunisation of children is carried out at the Council's Welfare Centres and Day Nurseries, by general practitioners, and also by the London County Council Medical Officers at the day schools. The Council's Health Visitors have been in constant touch with parents of children under school age, for the purpose of securing immunisation. During the year 2,478 children were recorded as immunised through the various channels mentioned, and the total number of St. Pancras children known to be immunised since the scheme commenced is 12,416. 25 The following table gives information as regards diphtheria immunisation in the borough, and shows:— (a) Number of registered St. Pancras births each year Column 2. (b) Number of St. Pancras children born in each year who have been immunised in the borough Horizontal totals. (c) Number of children immunised in the borough during each year Diagonal totals. (d) Number of children immunised, by age at time of immunisation Vertical columns. (e) Total children immunised in the borough. (f) Ages at 31st December, 1946. Dysentery. 92 cases were notified during the year, all of which were St. Pancras residents. Bacteriological examinations were made in 5 cases, and all other cases were diagnosed clinically. Eight were subsequently held not to be Dysentery. 26 Encephalitis Lethargica. No cases were notified during the year, and no deaths occurred. Enteric or Typhoid Fever. Five cases of Typhoid were notified during the year, of which one diagnosis was not confirmed. There were two deaths. Erysipelas. 53 cases were notified, three subsequently not confirmed, and no deaths occurred ; as compared with 60 cases and no deaths during the previous year. Food Poisoning. Food Poisoning and suspected Food Poisoning are notifiable by Section 17 of the Food and Drugs Act, 1938. Nine notifications were received during the year. There was no death. Malaria. Seven cases were notified and there were no deaths. All were St. Pancras residents. Measles. Particulars of the cases, deaths and incidence and mortality rates of Measles since 1926 are given in the following table:— Estimated population Year Cases Deaths Under 1 year Over 1 year Total Incidence rate per 1,000 population Under 1 year 1-5 years 5-15 years Adults Total Mortality rate per 1,000 cases 216,800 1926 260 3,474 3,734 17.2 25 38 2 — 65 17.4 213,200 1927 40 377 417 1.9 — 5 — — 5 12.0 206,000 1928 234 3,642 3,876 18.8 30 87 10 — 127 32.7 204,400 1929 28 563 591 3.0 — 4 3 — 7 11.8 204,400 1930 179 3,297 3,476 17.1 3 26 2 — 31 8.9 195,600 1931 31 399 430 2.2 1 1 — — 2 4.7 194,000 1932 135 2,730 2,865 14.8 6 21 — — 27 9.4 190,900 1933 38 399 437 2.2 — 4 — — 4 9.2 187,540 1934 195 3,443 3,638 19.4 8 23 1 — 32 8.8 185,300 1935 23 97 120 0.6 — 1 — — 1 8.3 183,900 1936 180 2,795 2,975 16.2 3 12 2 — 17 5.7 181,900 1937 28 610 638 3.5 — 1 — — 1 1.5 179,400 1938 166 2,171 2,337 13.0 5 6 1 — 12 5.1 167,300 1939 14 71 85 0.5 — — — — — — 133,200 1940 20 265 285 2.1 — 1 — — 1 3.5 103,770 1941 45 571 616 5.9 1 — 1 — 2 3.2 105,900 1942 91 1,401 1,492 14.1 — — — — — — 108,640 1943 89 993 1,082 9.9 1 3 — — 4 3.7 105,780 1944 50 748 798 7.5 — — — — — — 111,400 1945 71 954 1,025 9.2 — — 1 — 1 1.0 129,410 1946 74 1,041 1,115 8.6 1 1 — — 2 1.8 27 MEASLES—Mortality rate per 1,000 cases. Ophthalmia Neonatorum. The number of cases notified was 33, and in addition 62 cases of mild inflammation of the eyes were reported. 24 cases recovered satisfactorily, without impairment of vision, 7 were removed from the district, and 2 were still under treatment at the end of the year. Puerperal Pyrexia and Puerperal Fever. In 1946 there were 47 notifications of Puerperal Pyrexia and six notifications of Puerperal Fever. Scabies. 699 cases were notified and visited, as compared with 887 in 1945, 931 in 1944, and 546 in 1943 (for five months only). 28 Scarlet Fever. The number of cases notified was 244 as compared with 245 cases during the previous year. Fourteen cases were not subsequently confirmed. The actual number of cases was therefore 230. No deaths 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 five 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 17 families there were two such cases, in three families there were three, and in one family there were four. Cases of scarlet fever are not admitted to hospital, except at the request of the Medical Officer of Health on grounds of clinical severity or where home conditions make it impossible to retain the patient at home. Some preference may be given to children under 5 years of age. Smallpox and Vaccination. Smallpox has not been a troublesome question in St. Pancras for some years. Suspected contacts have certainly appeared from time to time, particularly since the end of the war, but prompt supervision and vaccination have prevented what might have become a positive danger to the borough residents. From 1937 to the present time no case of smallpox has been reported, nor has a St. Pancras resident been recorded as contracting the disease outside the borough or dying from this complaint during the same period. The following figures and curves show the number of births dealt with and the vaccinations obtaining in relation to such births. Graph "A" sets out particulars of all births coming within the scope of the Vaccination Officer, for the period 1937 to 1945 (figures for 1946 are not yet available) including children transferred into the borough. Of the total births registered in the borough about 26 per cent, were of children whose parents lived in other areas, full details of which were accordingly given to the vaccination officers concerned who thereafter became responsible for seeing that vaccination was carried out. Graph "B" shows only those children who, although born outside the borough, were transferred to St. Pancras and duly dealt with here under the Vaccination Act. It will be noted that of these we secured vaccination in 80 per cent, of the children. I think it is fair to assume from this that we are securing the same high percentage in the children born in the borough who continue to reside therein. In other words, we are securing the vaccination of 80 per cent, of our children. This is an extremely high figure, and one well worth noting at a time when the law has repealed the Vaccination Acts and vaccination after the appropriate date will no longer be compulsory. It has been argued that throughout the country generally a bigger percentage of children have been immunised against diphtheria by voluntary methods than have been protected by vaccination by compulsion. This does not apply in St. Pancras. In this respect it must be noted that the figure of 55 per cent, (see table on page 30) refers to all the births which occur in St. Pancras, including those of persons who came into the borough to have their children in the many hospitals in the area, and therefore does not represent the St. Pancras children vaccinated. 29 VACCINATION. 30 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, 1945. Figures for 1946 are not yet available. Number Percentage of Births registered North SouthEast Southwest Whole Borough North SouthEast Southwest Whole Borough Births registered 293 1,012 1,231 2,536 100.0 100.0 100.0 100.0 Successfully vaccinated 152 540 717 1,409 51.9 53.3 58.2 55.5 Died, unvaccinated 3 42 46 91 1.0 4.1 3.7 3.6 Had smallpox — — — — — — — — Insusceptible of vaccination — 1 — 1 — 0.1 — 0.0 Received certificate of conscientious objection 92 154 222 468 31.4 15.2 18.0 18.4 Postponed by medical certificate 9 6 20 35 3.1 0.6 1.6 1.4 Moved to known address in other districts 12 211 167 390 4.1 20.8 13.5 15.3 Lost sight of by removal 13 37 42 92 4.4 3.6 3.4 3.6 Unvaccinated and not accounted for in previous columns 12 21 17 50 4.1 2.0 1.3 1.9 Comparable percentages of successful vaccinations for previous years were:— 1940 33.4 1941 43.6 1942 54.7 1943 57.2 1944 55.5 Whooping Cough. 511 cases were notified by medical practitioners, of which 14 were not subsequently confirmed. An additional 48 cases came to the notice of the department and were visited. There was one death, a child between 1 and 5 years of age. CLEANSING AND DISINFECTING STATION. Cleansing. The number of attendances at the Cleansing Station, Camley Street, was as follows:— (1) Scabies. Men Women Children under 5 Schoolchildren Total St. Pancras 507 1,550 598 2,135 4,790 Ex St. Pancras 17 33 12 611 673 No fixed abode 2 2 — — 4 Totals 526 1,585 610 2,746 5,467 31 (2) Verminous Conditions. Men Women Children under 5 Schoolchildren Total Head lice St. Pancras — 60 33 1,773 1,866 Ex St. Pancras — 5 4 622 631 No fixed abode — 5 — — 5 Body lice St. Pancras 889 7 1 — 897 Ex St. Pancras 28 — — — 28 No fixed abode 42 2 — — 44 Totals 959 79 38 2,395 3,471 The majority of the children included in the above table were brought to the cleansing station by school officers of the London County Council under powers conferred upon them by the Education Act, 1944. Payment is made by the London County Council at the rate of two shillings per child in respect of verminous conditions, and one shilling per bath for those suffering from scabies. During the year the Council approved a scheme for the conversion of bomb damaged flats at Prospect Terrace for use as a cleansing and disinfecting station and to provide office accommodation for the rodent control staff. The work of reconstruction commenced in July, but contrary to expectation was not completed by the end of the year. 32 Disinfection. Figures set out below show the number of houses, rooms, etc., dealt with after infectious diseases or following complaints of vermin:— Number of Cases Number of Houses Sprayed and Fumigated Number of Rooms and Contents Rooms only Contents only Cerebro-spinal meningitis 11 11 9 2 Diphtheria 93 93 90 1 2 Dysentery 19 19 18 2 — Enteric fever 3 3 3 — — Erysipelas 32 32 30 2 — Measles 76 76 6 7 66 Malaria 1 1 1 — — Poliomyelitis 3 3 3 — — Puerperal fever 6 6 5 — 1 Scabies 36 36 5 2 29 Scarlet fever 221 223 210 16 8 Tuberculosis 120 120 107 20 13 Vermin 447 447 33 688 58 Other diseases 236 236 15 22 211 Pneumonia 2 2 1 — 1 Whooping cough 1 1 — — 1 Bacteriological Examinations. 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. This work is carried out under contract by the Royal Institute of Public Health and Hygiene, 23, Queen Square W.C.I. Positive Negative Total Diphtheria bacilli 31 479 510 Tubercle bacilli 6 97 103 Dysentery 2 / 75 77 Totals 39 651 690 33 SECTION 4. Sanitary Circumstances of the Area. Summary of Work carried out by District Sanitary Inspectors during 1946. Complaints received, 5,689 Dykes Engledow Hague Kirby Lloyd Shackcloth Thomas Trevethick Williams Winchester Woolvin Wilby Willett Total On complaint— Whole house inspection 2 1 — — — — — — — — — — — 3 Part of house inspection 418 616 588 486 542 699 838 346 481 272 367 48 15 5,716 Part of house reinspection 711 1,254 1,078 743 1,254 1,479 1,552 354 452 420 1,564 26 27 10,944 Infectious diseases— Investigations 58 53 98 52 36 107 168 64 24 26 80 3 7 776 Inspections 2 1 — — 1 — — — 2 2 — — 1 9 Reinspections — — — — 5 16 2 — 3 7 — — — 33 Smoke observations — — 42 — — 5 — — — 7 — 1 — 55 Mews and stable yards 4 — — — — 32 — 1 — — 2 — — 39 Protection of Food By-laws — — — — — — — — — — 2 — — 2 Pharmacy and Poisons Act— First inspections 1 5 6 — 1 5 4 — 4 3 3 — — 32 Subsequent inspections 1 — — 2 — — — — — — 3 — — 6 Verminous persons — — 14 — — 2 4 — — — — — — 20 Housing applications 64 . 141 65 — 147 149 101 — 35 49 — 1 — 752 Other inspections 100 341 193 445 398 318 264 586 786 83 357 — 11 3,882 Housing Acts and Regulations— Inspections — — — — — — — 7 — — — — — 7 Re-inspections — 1 — — — — — — — — — — — 1 Houses let in lodgings Inspections — — — — — — — — — — — — — — Re-inspections — — — — — — — 1 — — — — — 1 Overcrowding Regulations— Inspections — 3 — — — — — 13 — — 3 — — 19 Re-inspections — — — — — — — — — — — — — — Underground rooms 1 31 10 8 3 1 1 1 — 1 9 — — 66 Drainage— 1,135 Under notice 47 40 181 51 74 30 68 24 505 6 109 — — Voluntary 190 387 563 611 474 146 184 54 275 109 545 — — 3,538 New Buildings 92 20 2 22 28 38 53 95 16 — 7 — — 373 Police Court attendances 22 5 3 7 — 7 5 1 7 — — 57 Rent Restrictions Acts 48 — 6 3 — 7 20 2 11 — — 97 Ineffective visits 180 162 — — 135 245 171 — 81 — — 17 10 1,001 Special Social Survey — — 174 136 212 — 110 113 169 — 100 — — 1,014 Totals 1,941 3,061 3,023 2,566 3,310 3,286 3,545 1,662 2,833 985 3,169 96 101 29,578 Notices served— Rent Acts 35 1 — — — 2 8 2 — 2 1 1 — 52 Others 402 593 481 331 440 516 702 267 186 224 258 25 10 4,435 * Housing Inspector. Engledow Shackcloth commenced 1st March. Trevethick resigned 31st July. Lloyd resigned 7th December. Wilby Willett commenced 9th December. (7090) C 34 Legal Proceedings. The following prosecutions were undertaken during 1946 in respect of general sanitary work:- Public Health (London) Act, 1936. Date of Hearing Address Offence Result of Proceedings, Court and Magistrate 23.1.46 1, Wesleyan Place Main roof leaking Work in progress. Adjourned sine die. Costs £2 2s. Mr. Ronald Powell, Marylebone. 4.3.46 56, Birkenhead Street Defective grate Work completed. Costs £3 3s. Mr. Bertram Reece, Clerkenwell.* 4.3.46 19, Drummond Street Ceiling damp in second floor back room. Guttering defective over second floor back room. Defective wall plaster in first floor back room. Defective window frame in third floor back room Adjourned sine die for work to be completed. Costs, £3 3s. Mr. Bertram Reece, Clerkenwell.* 30.4.46 25, Healey Street Defective plaster to walls of attic room. An occupied house without a proper and sufficient supply of water to the tenants of first and second floors Work completed. Summons withdrawn. Costs £3 3s. Mr. Ronald Powell, Marylebone.* 28.5.46 14, William Road Basement front room and passage damp; waste pipe of sink at rear defective and improperly discharging over yard Adjourned sine die. Work now completed and £1 2s. costs received. Mr. Ronald Powell, Clerkenwell. 4.6.46 13, Lancing Street Ground floor and first floor walls and ceilings dirty. Main roof defective. Staircase ceiling plaster defective. Doors defective Nuisances abated. Summonses withdrawn. Costs £5 5s. Mr. Bertram Reece, Clerkenwell. 4.6.46 14, Lancing Street Ground floor walls and ceilings dirty 20.6.46 121, Albert Street Main roof defective Nuisance abated. Summons withdrawn. Costs £2 2s. Mr. Ivan Snell, Marylebone. 25.6.46 50, Lulot Street Back addition roof defective Cases adjourned sine die for work to be completed. Costs £2 2s. Mr. Daniel Hopkins, Clerkenwell.* 25.6.46 50, Lulot Street Ceiling plaster loose and defective, first floor back room 2.7.46 12, Lancing Street Roof defective and rain leaking into first floor rooms and down staircase Case adjourned sine die for work to be completed. Costs £3 3s. Mr. Frank Powell, Clerkenwell. 6.8.46 27, Oakford Road Main drain stopped Adjourned without date, owner agreeing to execute necessary work. Costs £2 2s. Mr. Bertram Reece, Clerkenwell. 21.8.46 21, Prince of Wales Road Walls and ceilings of front and back rooms damp. Rain water pipe defective to W.C. apartment Work completed. Summons withdrawn. Costs £2 2s. Mr. Ronald Powell, Marylebone. 8.8.46 9, Dunollie Place Water supply in improper position in W.C. apartment on first floor Work in progress Summonses adjourned without date. Costs £3 3s. Mr. Bertram Reece, J Clerkenwell.* 8.8.46 10, Dunollie Place A tenement house without a proper and sufficient supply of water to top storey 26.8.46 68, Lulot Street Walls damp. Roofs leaking. Yard W.C. basin foul, and fitting leaking. Window frame defective. Wallpaper loose and hanging. Flooring defective Work in progress. Adjourned without date. Costs £4s. Mr. Bertram Reece, Clerkenwell † * See also under Housing Act, 1936. † See also under Housing Act, 1936, and L.C.C. (General Powers) Act, 1928. 35 Public Health (London) Act, 1936—continued. Date of Hearing Address Offence Result of Proceedings, Court and Magistrate 16.9.46 16, Frideswide Place Main roof defective Order made to abate nuisance within 28 days. Costs £6 6s. Mr. Bertram Reece, Clerkenwell. 16.9.46 18, Bramshill Gardens Main roof defective Work in progress. Summons adjourned without date. Costs £2. Mr. Bertram Reece, Clerkenwell. 16.9.46 108, Chetwynd Road Roof defective over basement W.C. apartment. Ceiling and frieze paper hanging in basement back room. Ceiling plaster defective in basement W.C. apartment Nuisances abated. Summons withdrawn. Costs £3 3s. Mr. Bertram Reece, Clerkenwell.* 18.9.46 43, Mornington Terrace Basement W.C. choked Nuisance abated. Summons withdrawn. Costs £3 3s. Mr. Ronald Powell, Marylebone.* 18.9.46 31, Highgate Road Walls damp in ground floor back addition. Back addition roof defective Nuisance abated. Summons withdrawn. Costs £2 2s. Mr. Ronald Powell, Marylebone. 18.9.46 3, St. Leonard's Square Main roof defective Repairs carried out. Summons adjourned without date. Costs £3 3s. Mr. Ronald Powell, Marylebone. 18.9.46 86, Belmont Street Main roof and guttering defective Work in hand. Summons adjourned without date. Costs £ 1 1s. Mr. Ronald Powell, Marylebone. 24.9.46 43, Arlington Road Dampness to walls of first floor back room Order made to abate nuisance within 28 days. Mr. Ivan Snell, Marvlebone. 15.10.46 2, Barclay Street Roof defective; window displaced from wall and requires re-setting; flooring defective top floor back room; ceiling plaster defective, top floor front room 15.10.46 19, Barclay Street Roof defective; wall and ceiling plaster defective, top floor front room 15.10.46 22, Barclay Street Rainwater pipe at rear defective Work in hand. Summonses adjourned sine die. Costs £8 8s. Mr. Frank Powell, Clerkenwell.* 15.10.46 40, Barclay Street Dampness in ground floor passage; roof defective; ceiling and wall plaster defective, ground floor front room; window box parting beading and sash cord defective, ground floor back room 15.10.46 46, Barclay Street Failing to cleanse from vermin the ground floor front and back rooms Work completed. Summonses adjourned sine die. Costs £2 2s. each case. Mr. Bertram Reece, Clerkenwell. 11.11.46 6, Frideswide Place Main roof defective 11.11 46 20, Frideswide Place Main roof defective 12.11.46 61, Doynton Street Main roof defective Order made to abate nuisance within 7 days. Costs £1 1s. Mr. Bertram Reece, Clerkenwell. * See also under Housing Act, 1936. (7090) C 2 36 Public Health (London) Act, 1936—continued. Date of Hearing Address Offence Result of Proceedings, Court and Magistrate 12.11.46 62, Doynton Street Walls damp both ground floor front rooms; main, back addition, washhouse and first floor half-landing roofs defective; front eaves gutter to main roof defective; ground floor back room flooring defective; ground floor front (R) room ceiling plaster fallen Order made to abate nuisances within 21 days. Costs £2 2s. Mr. Bertram Reece, Clerkenwell. 17.12.46 1, Bertram Street Main roof defective; flush joint to first floor W.C. fitting leaking Work completed. Summons withdrawn. Costs £2 2s. Mr. Bertram Reece, Clerkenwell. Public Health (London) Act, 1936—Section 257. 7.5.46 26, St. Anthony's Flats Undertaking for reward, the care of a foster child, without giving notice to the Local Authority Fined £1. Costs £1 1s. Mr. Bertram Reece, Clerkenwell. Public Health (London) Act, 1936, and L.C.C. (General Powers) Act, 1928. L.C.C. Water Closet Bye-laws. 26.8.46 68, Lulot Street Defective yard W.C. door † Housing Act, 1936—L.C.C. Lodging-house Bye-laws. 4.3.46 56, Birkenhead Street Failing to cleanse walls and ceilings of various rooms † 4.3.46 19, Drummond Street Failing to cleanse first floor back, second floor back and third floor back rooms † 30.4.46 25, Healey Street Failing to cleanse walls and ceilings of top attic room † 30.4.46 25, Healey Street Failing to provide and maintain efficient means for carrying off waste water from drip sink on half-landing 25.6.46 50, Lulot Street Failure to cleanse walls and ceilings of various rooms and to remedy defective wall plaster † 6.8.46 29, Lady Somerset Road Failing to keep clean the second floor front and back rooms, of which she was the occupier Fined 10s. Mr. Bertram Reece, Clerkenwell. 8.8.46 10, Dunollie Place Failing to provide and maintain means for carrying off waste water from tap on first floor landing † 26.8.46 68, Lulot Street Failing to cleanse walls and ceilings of various rooms and passages † 16.9.46 108, Chetwynd Road Failing to cleanse walls and ceilings of basement back room and scullery, and to remedy defective wall plaster in scullery † 18.9.46 43, Mornington Terrace Failing to cleanse walls and ceilings of staircase † 24.9.46 43, Arlington Road Failing to cleanse walls and ceilings of passage and staircase Fined 40s. Costs 40s. Mr. Ivan Snell, Marylebone. 15.10.46 2, Barclay Street Failing to cleanse walls and ceilings of top floor front and back rooms, passage and staircase † † For result of proceedings see Public Health (London) Act, 1936. 37 Housing Act, 1936—L.C.C. Lodging-house Bye-laws—continued. Date of Hearing Address Offence Result of Proceedings, Court and Magistrate 15.10.46 2, Barclay Street Failing to remedy defective inner and parting beading to window of top floor back room, defective innerbeading of right window and defective sashcords and glazing of one pane of left window to top floor front room † 15.10.46 63, Barclay Street Failing to cleanse walls and ceiling of second floor back room 28.11.46 114, Prince of Wales Road Failing to cleanse walls and ceilings to top floor front and back rooms and to remedy defective ceiling plaster Nuisance abated. Summons withdrawn. Costs £2 2s. Mr. Paul Bennett, V.C., Marylebone. † For result of proceedings see Public Health (London) Act, 1936. Rat Extermination. An important advance in rodent control was made during the year 1946 when the Ministry of Food agreed to increase the Government grant provided the Council undertook the systematic treatment of the Borough area by area. The preparation of the scheme and the training of staff was completed in December. A full report on the efficacy of the scheme will not be available, therefore, until 1947. Although the Ministry of Food is the Government department responsible for the central administration of rodent control, so far as St. Pancras is concerned the extermination of rats is important not only for the preservation of food supplies but in the interests of public health. Rats can carry disease, such as the organism responsible for salmonella food poisoning, typhoid fever and dysentery, and their presence in dwelling houses causes loss of sleep and has a dangerous effect upon the nervous system, especially of women and children. There were 834 complaints of rat infestation during the year. . 660 premises were treated ; 181 were business premises in respect of which receipts from occupiers amounted to approximately £375, and 479 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 858 (2) Post-mortems held :— (a) St. Pancras cases. (i) Resident and died in St. Pancras 175 (ii) Resident in St. Pancras, died elsewhere 56 (iii) Died in St. Pancras, resident elsewhere 77 308 (b) Ex-St. Pancras cases (both resident elsewhere and died elsewhere) 518 826 (3) Bodies received for viewing only 32 (4) Inquests held 570 (7090) C 3 38 Housing. 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 London County Council for |i information as to overcrowding was 245, and 84 on account of tuberculosis in the family. Water Supply. The bulk of the water supply in the borough is provided by the Metropolitan Water Board, and this has been satisfactory both in quality and quantity. Eight wells are in use in the borough, from which samples were taken during the year, the results of analyses being communicated to the owners. Various departments of the L.M.S. Railway are supplied from a private well situated at the L.M.S. Colne Valley pumping station at Watford. Two representative samples were taken from :— L.M.S. Clearing House, Drummond Street. 64, Cardington Street. 39 SECTION 5. Factories and Bakehouses. Factories. Inspections are carried out by one male and one female inspector, the arrangement being that the latter is responsible for inspection of factories, restaurants, etc., in which women only are employed. Both inspectors visit buildings where men and women are employed. Particulars of inspections and other work carried out by these officers during 1946 are given in the following table:— Mr. Hoare Miss Blaxland Totals Number of visits to— Factories (with mechanical power) 2,064 621 2,685 Factories (without mechanical power) 402 333 735 Workplaces 224 281 505 Outworkers' premises — 22 22 Restaurant kitchens ... 349 246 595 Scabies and verminous cases — 1,169 1,169 Other visits 344 299 643 Special survey 36 36 Totals 3,419 2,971 6,390 Notices served relating to— Factories (with mechanical power) 180 76 256 Factories (without mechanical power) 36 40 76 Workplaces 15 8 23 Rent Restrictions Acts 2 2 4 Others 24 37 61 Totals 257 163 420 Bakehouses. There are now 58 bakehouses registered in the Borough, of which some 35 are underground. During the past year six bakehouses were closed down for business reasons, and the tendency appears to be for the large bakery combines to buy the smaller type of bakehouse in order to use the shop for the retail side of the business, supplying it directly from factory bakehouses situated outside the borough. The Factories Act requires the examination every five years of all basement bakehouses in respect of which a certificate of suitability has been issued, in order to ensure the continuance (7090) c 4 40 of satisfactory conditions as regards construction, height, light and ventilation. Owing to the great difficulty in securing structural alterations which would involve the use of materials now in very short supply it has not been considered desirable to carry out this examination. After prolonged negotiations with the Ministry of Works, the occupiers of two basement bakehouses, with the support of the Borough Council, secured licences to rebuild or adapt their premises, and work on new premises, above ground, complying in all respects with modern ideas for bakehouses, is in progress. It is to be hoped that, as conditions improve, other occupiers of basement bakehouses will be encouraged to take similar action. The Factories Act also requires the inspection of bakehouses twice yearly, in addition to the above-mentioned provision, to secure the limewashing, painting and washing down of the internal surfaces of the bakehouse. Even here great difficulty is experienced in getting the necessary work done, as the bulk of materials used for redecoration is primarily reserved for housing work. As with many other concerns labour difficulty is experienced by the bakers in this borough, the shortage of skilled labour involving them in difficulties associated not only with the business itself but also with the local authority as regards the regular cleansing of the bakehouse. The provision of proper and adequate clothing also presents great difficulty, as the issue of industrial coupons only suffices for about one set of apron, trousers and cap, whereas it was the usual practice to use two, or even three, sets a week. Hot water is available for ablution purposes at all times in the bakehouses in the borough, but the soap and towel rations are inadequate. Despite all these difficulties conditions have improved in the past two years, although there is still much to be achieved before the ideals envisaged in the Factories Act, 1937, and the Food and Drugs Act, 1938, are obtained in everv bakehouse in the borough. 41 SECTION 6. 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 work carried out by these officers during 1946 are given in the following table :— Capel Warren Totals Number of visits to— Milkshops 54 66 120 Dairies 273 227 500 Ice cream premises 387 263 650 Slaughterhouses 2 1 3 Butchers' shops and meat stalls 321 447 768 Prepared meat premises 269 95 364 Fishmongers' shops 83 24 107 Fried fish shops 49 36 85 Fish curers' premises 13 9 22 Other premises where food and drugs are sold 347 385 732 Market streets and places 401 473 874 Meat depots 39 25 64 Railway goods yards, warehouses, etc 55 178 233 Attendances at Police Court 20 17 37 Reinspections after Intimation Notices 1 5 6 Other visits 338 399 737 Totals 2,652 2,650 5,302 Number of samples taken— Formal 204 200 404 Informal 195 200 395 Bacteriological 67 72 139 Totals 466 472 938 Unsound Foods. Surrenders 218 225 443 Seizures - 1 1 42 Milk Supply. Number of purveyors on the Register at the end of the year were:— Dairies 134 Itinerant purveyors 69 For sale of milk in sealed containers only 187 For sale of cream and artificial cream 9 The Inspectors made 620 visits and 306 formal samples were taken and submitted for analysis. Milk (Special Designations) Regulations, 1936 to 1943. The number of licences granted during 1946 were :— Licences. Supplementary. To sell Tuberculin Tested milk 42 5 To sell Pasteurised milk 53 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 64 Butchers' Shops and Meat Stalls 768 Prepared Meat premises 364 (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, the following inspections being made for this purpose :— Ice cream 650 Fishmongers 107 Fried fish 85 Others 732 Food Sampling. A total of 799 samples (404 formal and 395 informal) were sent for analysis, of which 9 formal and 15 informal were found to be adulterated. Ice Cream. There are 153 premises in the borough registered for the sale of ice cream. This number includes most of the manufacturers, who also sell by retail. The majority of the registered premises were in use during the year, only a few not carrying out business owing to the difficulty of obtaining supplies. 43 There are 65 premises registered in the borough for the manufacture of ice cream, of which only 35 are at present being used for this purpose. All these premises have been inspected by the Council's two Food Inspectors and found satisfactory. The above figures do not include any premises used exclusively as a hotel, restaurant, etc., which sell or manufacture ice cream, as such premises are exempted from registration by Section 14 (7) of the Food and Drugs Act, 1938. There would be very many more applications for registration to make ice cream if it were not for the difficulty in obtaining a Food Ministry licence for the allocation of ingredients, for such licence is not granted unless it can be proved that ice cream was manufactured during the period July, 1938, to July, 1939. In the case of caterers, however, part of the catering allocation may be used for the manufacture of ice cream. The type of premises used for manufacture varies from the small shops selling sweets or other commodities, to factories with machinery to the value of thousands of pounds. Considerable improvements have been made during the year in the general condition of premises used for making ice cream in spite of the handicap from the difficulty in obtaining the necessary building licences. Where there were any serious defects in the premises, notices were served and the work carried out, but much more remains to be done in this respect when circumstances permit. Fifty-six bacteriological samples of ice cream were taken during the year and 22 of these, mostly from the early samples, were reported as poor or unsatisfactory. After such premises had been visited, the adverse report discussed and advice given, marked improvement resulted and further samples have tended to prove that the fault has been discovered and rectified. It has been our experience that bad samples of ice cream, insofar as bacteriological analysis is concerned, result in most cases from faulty routine on the part of the manufacturer. This is markedly so in the case of the maker of small quantities of ice cream for sale in the small shop. Proper precautions as to personal hygiene, and in particular hand washing, the sterilisation and proper cleansing of the utensils used and of the mix which has been made, will nearly always result in a very satisfactory improvement. The lifting of the ban on the manufacture and sale of ice cream has brought about a tremendous public demand for this article of food, and this has attracted, especially during the summer months, a number of doubtful itinerant vendors, many of whom sell inferior quality of ice cream at a high price. The absence from the streets of the well-known and reliable firms who sold ice cream before the war created favourable conditions for the poor type of vendor. It should be remembered that the peak of ice cream consumption coincides with the time of the year when there is a general increase in the demands on the services of the two food inspectors. For these reasons it is impossible to devote as much time and work to the supervision of ice cream as is necessary, and in particular the sources from which itinerant vendors obtain their supplies and the conditions under which their barrows and utensils are kept must remain largely unchecked. During the year eight prosecutions were instituted regarding ice cream offences. In these, fines were imposed in five cases, and in the other three the defendants (itinerant vendors) did not appear and the cases were not dealt with. Some Recent Food Legislation. The legislative control of food is by Acts of Parliament, the Defence (General)Regulations, 1939, the Defence (Sale of Food) Regulations, 1943, and the various Orders made thereunder. 44 The Food and Drugs Act, 1938, is the main Act, consisting of over 100 sections, and is a consolidating measure incorporating a number of Acts of Parliament which formerly dealt with the public health side of food control. The orders and regulations have been numerous, and some of them have already been revoked or amended. They contain much technical detail which necessitates prolonged study by those who have to administer them. The following are three of the more important of these regulations and orders :— (i) The Defence (Sale of Food) Regulations, 1943. These regulations give the Minister of Food power to control the composition of foods and to restrict claims or suggestions made in advertisement of the presence of vitamins or minerals. It is an offence to give or display with any food exposed for sale, or to publish, or to be party to the publication of an advertisement, which falsely describes any food, or is otherwise calculated to mislead as to its nature, substance or quality or, in particular, as to its nutritional or dietary value. (ii) The Labelling of Food Order, 1946. Under this Order the following requirements must be met:— (a) Pre-packed articles of foods must contain the business name and address of the packer or labeller ; (b) A statement as to the ingredients, which must be specified in the order, and the proportion in which they are used ; (c) The ingredients forming the greatest part of the food by weight must be noted first, and so on ; (d) The net weight of the food must be given. (iii) The Food Standards (General Provisions) Order, 1944. This order lays down the general provisions which will be applicable in relation to food standards, and already the following foods have been made subject to such standards: jam, marmalade, mincemeat, etc., self-raising flour, mustard, baking powder, golden raising flour, shredded suet, liquid coffee essences and salad cream and mayonnaise. The above legislation is in some ways an epoch-making event and constitutes a very real step forward in the much desired improvement of our hitherto inadequate food laws. The discerning housewife is now able to see what she is getting when purchasing prepacked articles of food, and to appreciate the value of food in spite of imaginative and skilfully drawn up advertisements, packings and labels. To make these orders fully efficacious it is essential that the public should be educated in the knowledge of food values, including such adjuncts as vitamin and mineral content. The war made it necessary to secure that the public should be guided in this respect on account of food shortages, and it is to be hoped that the work that started during the war will be continued in peace, not only in times of restricted diet, but even when food of all kinds is freely available.; for even then knowledge and discrimination are essential to the maintenance of health. It will be realised that many of the orders are at present temporary. It is to be hoped that in due course they will be permanent and more comprehensive, and brought within the terms of one Act of Parliament which should preferably be the Food and Drugs Act of 1938. This would make for ease of administration. 45 Legal Proceedings. The following prosecutions were undertaken during 1946 in respect of food and drugs:— Food and Drugs Act, 1938. Date of Hearing Offence Result of Proceedings, Court and Magistrate 6.3.46 Selling " Coffee " which contained 38 per cent, chicory Dismissed under P. of O. Act_ Costs 20s. Mr. Raphael, Clerkenwell. 30.4.46 Selling milk from which 6 per cent, of fat had been abstracted Dismissed under P. of O. Act. Costs £2 2s. Mr. Ronald Powell, Marylebone. 9.5.46 Selling from 2, Fortess Road mustard which did not comply with the Food Standards (Mustard) (No. 2) Order, 1944, No. 275 Dismissed under P. of O. Act. Costs £3 3s. Mr. Frank Powell, Clerkenwell. 28.5.46 Selling butter adulterated by the addition of 20 per cent, of foreign fat (margarine) Summons withdrawn on advice of Council's Solicitors in view of Warranty. £10 10s. costs paid to Council by Warrantors. Mr. Ronald Powell, Marylebone. 13.6.46 Selling Vinegar deficient in acetic acid by 10 per cent. Dismissed under P. of O. Act. Mr. Ivan Snell, Marylebone. 24.7.46 Re 204a, Gower Street. Using unregistered premises for the storage of ice-cream intended for sale Fined 40s. Costs £2 2s. Mr. Bertram Reece, Clerkenwell. 24.7.46 Re 41 —43, King's Cross Road. Using unregistered premises for the storage of ice-cream intended for sale Fined 40s. Costs £\ Is. Mr. Bertram Reece, Clerkenwell. 21.8.46 Re 18, Chester Terrace Mews. Using unregistered premises for the storage of ice-cream intended for sale Fined £4 Costs £1 Is. Mr. Ronald Powell, Marylebone. 21.8.46 Exposing ice-cream for sale from a vehicle which did not bear the name and address of the dealer Fined £1. Mr. Ronald Powell, Marylebone. 18.9.46 Exposing ice-cream for sale from a vehicle which did not bear the name and address of the dealer. (Two summonses) Summonses dismissed, the Magistrate being not satisfied that defendant was the dealer. Mr. Ronald Powell, Marylebone. 25.9.46 Selling a cake unfit for human consumption Fined £30. Costs £15 15s. Mr. Bertram Reece, Clerkenwell. 25.9.46 Selling a cake unfit for human consumption Case not proceeded with. 2.10.46 Giving with a drug (OPTABS eye lotion tablets) sold by defendants, a label which falsely described the drug in that the formula included in the label incorrectly described the constituent parts of such drug Fined £10. Costs £15 15s. Mr. j. R. Sandbach, K.C., Clerkenwell. 2 10.46 Giving with the above-mentioned drug sold by defendants a label which was calculated to mislead the purchaser as to its nature, substance or quality No separate penalty. 20.11.46 Selling bread unfit for human consumption Fined £2. Costs £3 3s. Mr. J. R. Sandbach, K.C., Marylebone. Public Health (London) Act, 1936—L.C.C. Bye-laws for the Protection of Food. 21.8.46 Failing to keep an ice-cream wafer-holder in a clean state Fined £5. Costs £2 2s. Mr. Ronald Powell, Marylebone. 46 SECTION 7. Maternity and Child Welfare. Health Visitors. The number of Health Visitors employed at the end of the year— (a) by the Council, 17. (b) by the University College Hospital, 2 (equivalent to half of the whole time service of one Health Visitor). The following table gives the total number of visits made by the above mentioned Health Visitors during 1945 and 1946:— Council's Visitors University College Hospital Visitors Total 1945 1946 1945 1946 1945 1946 To Expectant mothers 3,467 3,685 179 159 3,646 3,844 To Post natal 699 834 54 96 753 930 To Children 21,051 22,935 1,112 1,345 22,163 24,280 To Child life protection 304 345 98 73 402 418 To Infectious diseases, etc. 1,-172 1,739 43 41 1,215 1,780 To Other visits 3,299 1,447 11 14 3,310 1,461 Totals 29,992 30,985 1,497 1,728 31,489 32,713 Dental Treatment. Ampthill Square Camden Town Sessions 37 91 Attendances— Mothers 337 1,304 Children 102 213 The Borough Council made a contribution during the year of £123 19s. 9d. towards the total cost of £247 19s. 6d. for dentures supplied to Nursing and Expectant Mothers. Maternity and Child Welfare Centres—Sessions and Attendances. Centres St. Pancras School for Mothers (Ampthill Square) Camden Town Kentish Town North St. Pancras School for Mothers (Queen's Crescent) Somers Town South Highgate Totals for Council's Centres University College Hospital Grand Totals 1945 1946 1945 1946 1945 1946 1945 1946 1945 1946 1945 1946 1945 1946 1945 1946 1945 1946 Ante-natal sessions 27 45 61 78 85 91 89 90 20 43 26 50 308 397 202 203 510 600 First attendances 125 216 243 390 215 401 310 466 108 207 112 189 1,113 1,869 459 506 1,572 2,375 Subsequent attendances 259 774 753 1,410 738 1,397 818 1,389 206 572 317 694 3,091 6,236 2,957 3,670 6,048 9,906 Post-natal sessions 23 24 - 23 24 23 24 Attendances — — 286 333 — — — — — — — — 286 333 — — 286 333 Infants sessions 122 99 247 241 145 151 150 153 99 102 99 102 862 848 102 103 964 951 *First attendances, age 0-1 169 193 338 396 340 367 342 398 213 287 182 204 1,584 1,845 42 79 1,626 1,924 Subsequent attendances, age 0-1 1,941 2,254 3,669 4,640 4,521 5,180 4,385 4,317 2,661 3,523 2,831 3,214 20,008 23,128 329 651 20,337 23,779 *First attendances, age 1-5 12 35 75 83 44 47 27 37 33 45 25 35 216 282 8 20 224 302 Subsequent attendances, age 1-5 1,256 1,330 1,645 1,886 1,984 1,840 1,211 1,205 1,486 1,438 1,677 1,752 9,259 9,451 238 331 9,497 9,782 Total attendances 3,378 3,812 5,727 7,005 6,889 7,434 5,965 5,957 4,393 5,293 4,715 5,205 31,067 34,706 617 1,081 31,684 35,787 Dental Clinic sessions 32 37 83 91 — — — — — — — — 115 128 — — 115 128 Attendances— Mothers 237 337 833 1,304 — — — — — — — — 1,070 1,641 — — 1,070 1,641 Children 116 102 192 213 — — — — — — — — 308 315 — — 308 315 Massage sessions 91 92 100 102 89 85 55 99 95 93 89 94 519 565 519 565 Massage attendances 389 458 953 811 374 416 362 657 735 630 545 670 3,358 3,642 — — 3,358 3,642 Gynaecological clinics— First attendances — — — — 112 164 — — — — — — 112 164 — — 112 164 Subsequent attendances — — — — 312 436 — — — — — — 312 436 — — 312 436 Dinners— Mothers 2,204 2,809 — — — — — — — — — — 2,204 2,809 — — 2,204 2,809 Children 2,376 2,467 — — — — — — — — — — 2,376 2,467 — — 2,376 2,467 «£- * Excluding transfers from other centres. 48 Professional Nursing in Necessitous Homes. This is provided by the staff of the following three District Nursing Associations:— Hampstead District Nursing Association, 3, Pond Street, N.W.3. Metropolitan District Nursing Association, 31, Bedford Place, Bloomsbury Square, W.C.I. North London (Islington) Nursing Association, 6 and 7, Canonbury Place, N.l. The Borough Council has an arrangement with these 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, 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 £ s. £ s. £ Hampstead 20 0 10 0 30 Metropolitan 187 10 62 10 250 North London 15 0 10 0 25 Totals 222 10 82 10 305 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 Hampstead 98 1,040 Metropolitan 122 1,120 North London 38 251 Totals 258 2,411 Midwifery Grants. By arrangement 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 1946 was 51 cases. An agreed sum is also paid to the University College Hospital in respect of the use of an Emergency Obstetric Unit, but there was no case during the year. 49 Provision of Beds for Maternity Cases. The London County Council has made arrangements whereby eight 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. Invalid Children's Aid Association. Under this scheme assistance is rendered towards the cost of convalescence of St. Pancras children under the age of 5 years, with a maximum of 70 cases per annum. The financial arrangements provide for a payment of 75 per cent. of the amount outstanding after allowing for any payments by parents. During 1946, 48 children were so assisted at a cost to the Council of £569 5s. Id. Home Helps. Maintenance of the Home Helps scheme for the borough is under the direct control of the Public Health Department. Where home helps are supplied to assist 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 help6 may also be provided in case of sickness or for the care of elderly persons, when the full cost is recovered from the Ministry of Health. Extreme difficulty is still experienced in obtaining women who are prepared to accept employment as home helps, and during the past year it was possible to meet the demand in only 32 cases. There were 91 applications. The rate of pay of home helps is Is. 11d. per hour, a figure agreed by the Joint Industrial Council. 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 the date of birth of the child as compared with expected time of confinement. What matters more 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 5½ lb. or less. Children who were designated as premature in accordance with the above were visited frequently by the Council's Health Visitors, who submitted monthly reports to the Medical Officer of Health until such time as the infant weighed 8 lb. The following table gives particulars in respect of 1946:— Where born Number Born Died in 24 hours Died between 24 hours and 1 month Survived At home 34 3 4 27 In hospital 112 3 10 99 Totals 146 6 14 126 D (7090) 50 Child Life Protection. This is governed by Part XIII of the Public Health (London) Act, 1936. 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. The District Sanitary Inspectors inspect and report on the condition of the homes for registration purposes, the clerical staff of the Public Health Department keep the necessary records, and the Health Visitors at the various Welfare Centres carry out the duties of inspecting and supervising the homes, the health and well-being of the children, giving any necessary advice, and reporting contraventions of the Acts. During the course of the year 15 women notified their intention to accept foster children, and these notifications were in respect of 26 children under 9 years of age received during the year, the number at the end of the year being 19. All the Council's Health Visitors are also designated Infant Life Protection Visitors, and in the course of supervision they paid 418 visits. One woman was prosecuted under Section 257 of the Public Health (London) Act, 1936, for accepting a foster child without prior notification to this authority, and was fined £1 with £1 Is. costs. 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 by the Council's Health Visitors during the year was 64. 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 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. Day Nurseries. There are eight day nurseries in the borough, controlled by the Council. The full cost during 1946 was borne by the Ministry of Health. The following table sets out the nurseries and the accommodation provided at each:— Day Nursery Accommodation Margaret Day Nursery, 42, Phoenix Road, N.W.I 70 254-256, Camden Road, N.W.I 85 Foundling Site Day Nursery, 40, Brunswick Square, W.C.I 54 108, Hampstead Road, N.W.I 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.I 52 51 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, 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 490 children awaiting admission. 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 urgent need for labour. Day nursery accommodation must, therefore, be of such a nature as to provide for the care of children during those hours when their mothers are at work, and must be distinguished from nursery school provision which is in accord with infant school timetables. When the needs of mothers who are working have been met, excess provision may be utilised for the care of children whose mothers are lying-in or sick. D 2 (7090) 52 SECTION 8. Tuberculosis. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1946 are given in the following table in the form required by the Ministry of Health :— New Cases Deaths Age Periods Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0-1 year 1 1 ¯ ¯ ¯ ¯ ¯ 1 1-5 years 3 2 1 5 — ¯ — — 5-15 years 6 8 — 4 — ¯ — — 15-25 years 27 26 3 6 3 5 1 — 25-35 years 35 29 8 2 10 15 2 — 35-45 years 23 7 2 2 14 4 1 — 45-55 years 22 5 — 1 5 3 — — 55-65 years 19 5 — — 19 3 1 — 65 and upwards 1 2 1 — 8 3 — — Totals 137 85 15 20 59 33 5 1 The total number of Primary notifications was 257 ; in addition to these, 7 cases, which had not been notified, came to knowledge by means of special death reports, and 91 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 355, equal to a notification rate of 2.74 per 1,000 of population, compared with 337 new cases during the previous year. The deaths from all forms of Tuberculosis during the year numbered 98, equal to a death rate of 0.75 per 1,000 of population, whereas the total number of deaths in the previous year was 127. It will be noted that, out of a total of 98 deaths from Tuberculosis, 5 (being 5 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 a person who has been notified elsewhere but has not consulted a doctor since arrival in the 53 Borough. (3) Difficulty in diagnosis before death. (4) The doctor being under an erroneous impression that the case has been notified in the Borough previously. When necessary a communication is sent to the certifying practitioner asking for an explanation of the circumstances under which formal notification was not made. No case occurred in which it appeared to be desirable to institute proceedings for deliberate or wilful neglect to comply with the regulations. The interval elapsing between notification and death is an indication of the efficiency of notification. In the following table the deaths from tuberculosis (from 1st January to 31st December) are classified according to this interval:— Tuberculosis Deaths, 1946.* Time of Notification Pulmonary Non-Pulmonary Total Percentage Male Female Male Female 1946— Discovered on death 3 — 2 — 5 5.0 Six months or less before death 9 7 ¯¯ ¯ 16 16.2 Remainder — — — — — — 1946 Total 12 7 2 — 21 21.2 1945 16 11 1 28 28.3 1944 7 7 1 — 15 15.1 1943 5 2 1 — 8 8.1 1942 6 — — — 6 6.1 1941-1937 11 6 1 — 18 18.2 Before 1937 2 1 — — 3 3.0 Total 59 34 5 1 99 100.0 *Note.—This table is compiled from all deaths from tuberculosis known to have occurred in St. Pancras during the year under review, but the total does not as a rule correspond exactly with the total obtained from the Registrar-General and shown in the preceding table because a few deaths may be allocated by him to the previous or subsequent year. D 3 (7090) 54 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 3 5 1 14 13 35 23 22 19 1 137 156 Females 1 2 5 3 13 13 29 7 5 5 2 85 92 N on-pulmonary— Males — 1 — — 1 2 8 2 — — 1 15 17 Females — 5 2 2 3 3 2 2 1 — — 20 20 Totals 2 11 12 6 31 31 74 34 28 24 4 247 285* * Exclusive of 33 " 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 1 65 and | upwards  Pulmonary— Males 2 1 1 9 23 9 10 4 2 61 Females — — 1 2 3 3 10 2 3 — 1 25 Non-pulmonary— Males — 1 1 — 3 — 2 — 1 1 — 9 Females ¯ ¯ ¯ ¯ ¯ 1 1 1 ¯ ¯ ¯ 3 Totals — 3 2 3 7 13 36 12 14 5 3 98 55 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 1,000 population Death Rate per 1,000 population Pulmonary Other forms All forms Pulmonary Other forms All forms Pulmonary Other forms All forms Pulmonary Other forms All forms 1937 181,900 343 48 391 148 14 162 1 .88 0.26 2.14 0.81 0.08 0.89 1938 179,400 301 64 365 121 12 133 1 .67 0.35 2.02 0.67 0.06 0.74 1939 167,300 310 44 354 118 12 130 1 .87 0.26 213 0.70 0.07 0.77 1940 133,200 292 45 337 144 16 160 219 0.33 2.52 1 .08 0.12 1 .20 1941 103,770 283 40 323 113 10 123 2.72 0.38 310 1 .08 0.09 117 1942 105,900 274 42 316 134 13 147 2.58 0.39 2.97 1 .26 0.12 1 .38 1943 108,640 273 44 317 111 6 117 2.51 0.40 2.91 1 .02 0.05 1 .07 1944 105,780 320 38 358 115 13 128 3 02 0.35 3.37 1 .08 0.09 1.17 1945 111,400 298 39 337 117 10 127 2.67 0.35 3.02 1.05 0.08 1.13 1946 129,410 308 47 355 92 6 98 2.45 0.36 2.81 0.71 0.04 0.75 (7090). D 4 56 In the following table are given the deaths from Tuberculosis of St. Pancras residents during 1946, 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 years 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 ¯ ¯ ¯ ¯ 2 7 27 19 8 23 10 1 10 9 7 2 9 10 9 5 7 3 7 2 3 ¯ 11 3 1 ¯ 64 34 12 10 21 65 40 15 Respiratory System ¯ ¯ ¯ ¯ ¯ 1 7 25 18 8 22 10 1 8 9 7 2 8 10 8 5 7 3 7 2 3 ¯ 10 2 1 ¯ 59 33 12 10 19 50 37 14 Central Nervous System 1 ¯ ¯ ¯ 1 — ¯ ¯ ¯ ¯ ¯ ¯ — ¯ ¯ ¯ _ _ _ 1 _ _ ¯ ¯ ¯ _ _ _ ¯ _ 1 1 _ ¯ ¯ ¯ ¯ Intestines and Peritoneum ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 2 ¯ ¯ Vertebral Column ¯ ¯ ¯ ¯ ¯ ¯ ¯ 2 ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ 2 ¯ ¯ 1 ¯ Genito Urinary System ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ 1 1 ¯ Adrenals ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ ¯ ¯ ¯ 1 1 Disseminated, Acute ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ Disseminated, not distinguished ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ Other Bones ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯¯ ¯ ¯ ¯ ¯ ¯ 1 ¯ ¯ Skin ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ — 1 — — 57 Notification Register. This is kept at the Dispensary. The following table gives the information for the year ended 31st December, 1946, in the prescribed form :— Pulmonary Non-Pulmonary  Number of cases on the Register at the commencement of the year 1946 964 155 1,119 Number of new cases during the year 339 49 388 1,303 204 1,507 Number of cases removed from the Register during the year (from death or other causes) 291 45 336 Number of cases remaining on the Register at the end of the year 1,012 159 1,171 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 and 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. — — Tuesday — 2 p.m. — Wednesday 11 a.m. — — Thursday — 2 p.m. 7 p.m. (Patients at work only) Friday — 2 p.m. — Saturday 11 a.m. (School children only) — — 58 The following table gives a summary of the work carried out at the Tuberculosis Dispensary during the year:— Diagnosis Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children Grand Total M. F. M. F. M. F. M. F. M. F. M. F. A.—New cases examined during the year (excluding contacts)- (a) Definitely tuberculous 121 61 5 7 9 12 1 8 130 73 6 15 224 (6) Diagnosis not completed ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 29 30 2 2 63 (c) Non-tuberculous ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 191 216 25 22 454 B.—Contacts examined during the year— (a) Definitely tuberculous — 1 1 ¯ ¯ ¯ ¯ ¯ ¯ 1 1 ¯ 2 (b) Diagnosis not completed ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 1 3 6 1 11 (c) Non-tuberculous ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 46 89 45 40 220 C.—Cases written off the Dispensary Register as— (a) Recovered 18 17 1 — 4 4 2 1 22 21 3 1 47 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 243 307 71 60 681 D.—Number of Cases on Dispensary Register on 31st December- (a) Definitely tuberculous 441 249 45 30 38 31 30 14 479 280 75 44 878 (b) Diagnosis not completed ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 38 50 9 3 100 1. Number of cases on Dispensary Register on 1st January 878 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 81 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 154 4. Cases written off during the year as Dead (all causes) 73 5. Number of attendances at the Dispensary (including Contacts) 4,514 6. Number of consultations with medical practitioners— (a) Personal 2 (b) Other 566 7. Number of visits by Tuberculosis Officers to homes (including personal consultations) 13 8. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,778 9. Number of— (a) Specimens of sputum, etc., examined 580 (b) X-ray examinations made in connection with Dispensary work* 1,237 10. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (6) above — 11. Number of " T.B. plus " cases on Dispensary Register on 31st December 397 * NOT including those made for A.P. refills. 59 Report on the Work carried out at the Tuberculosis Dispensary. New Patients and Contacts. There has been a slight increase in the number of notifications since last year and the number of new cases dealt with at the Dispensary shows a definite increase due to the larger number of patients sent for diagnosis. The number of new contacts attending has increased from 222 to 233. The total number of contacts of the 355 cases notified during the year was 631 and of these 36 per cent. had been examined at the Dispensary and 16 per cent. elsewhere by the end of March, 1947. 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 329 applications were accepted. Of these 164 were admissions to General Hospitals, 144 to sanatoria, and 21 to various hospitals for observation for diagnosis. 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 and by the Tuberculosis Officer when he visits Highgate Hospital, without charge to the Borough Council. The total number of refills given during the year was 2,444 and of these 338 were carried out at Brompton Hospital, 1,426 at University College Hospital, 533 at Highgate Hospital, and 147 at other hospitals. 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. No attendances were made at the London Hospital and none at University College Hospital during the year. X-Ray Examinations. These are carried out at the Archway Hospital and at Highgate Hospital. The charge is 2s. 6d. per film and the work is carried out by the visiting Radiologist or by the Tuberculosis Officer when he visits the hospital. Of the 1,237 examinations made during the year 906 were made at Highgate Hospital by the Tuberculosis Officer. The total number of films made was 1,478. Home Visits by Tuberculosis Visitors. These visits were made in order to (i) verify notifications ; (ii) investigate the home conditions and report on overcrowding, sanitary defects, need for financial assistance, etc. ; and (iii) give instructions in the prevention of tuberculosis and to invite contacts and patients to attend the Dispensary. 60 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 Gilpin 151 1,374 1,525 Miss Webb 157 1,404 1,561 3,086 G. A. Back, Tuberculosis Officer. St. Pancras Tuberculosis Care Committee. List of Members. 1.—Representatives of the Borough Council. Councillor Mrs. L. Bryant. Councillor Mrs. K. E. Deacon. Councillor Miss F. L. M. Freeman. Councillor Mrs. J. Gregory. Councillor Miss E. M. Haworth. Councillor Mrs. G. L. Hume. Councillor J. H. Gore. Councillor Dr. N. Malleson. Councillor A. Morris. Councillor W. M. Perkins. 2.—Representatives of other bodies interested in the Welfare of Tuberculosis Patients. Miss Ball, L.C.C. Schools Care Committee. Dr. Polhill, L.C.C. (School) Divisional M.O. The Superintendent, Metropolitan District Nursing Association. The Superintendent, North London Nursing Association. Dr. C. L. Mason, London Panel Committee. Councillor A. J. Trott, j.p., Social Welfare. Almoners of the following Hospitals :— Royal Free Hospital. Middlesex Hospital. Elizabeth Garrett Anderson Hospital. National Temperance Hospital. Hampstead General Hospital. University College Hospital. 61 3.—Ex-officio Members. Dr. D. H. Geffen. Dr. G. A. Back. Dr. P. V. Pritchard. Mrs. E. Bevan, Secretary. The Care Committee held nine meetings during the year, and the work carried out by or reported to them is indicated in the following summary. Social Welfare. All patients and their families who appear to be eligible are referred to the Social Welfare 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 quarterly and reported to the Care Committee for approval. During the year 83 quarterly recommendations were made in respect of 42 patients. As a rule, 7s. 6d. per week is allowed above the usual scale. 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 23 quarterly recommendations were made in respect of 10 patients. Extra Nourishment provided by the Borough Council. The Council may provide an allowance of 6s. per week for extra nourishment to necessitous patients who are not in receipt of social welfare on the recommendations of the Tuberculosis Officer. The recommendations are reported to the Care Committee and during the year amounted to:— Number of patients recommended 112 Total cost £500 0s. 3d. 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 1946 were :— Number of patients 5 Amount paid by Borough Council£16 16s. 3d. Housing. When necessary recommendations for better housing accommodation on the Borough Council and London County Council Estates are made to the Housing Department by the Tuberculosis Officer and are reported to the Care Committee. The figures for 1946 were :— Number of families recommended128 Number of families rehoused- (a) By Borough Council 7 (b) By London County Council 4 (c) Found accommodation not on Council's Estates 8 62 Maintenance Allowance. 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 1st January to 31st December, 1946:— 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 80 29 — — 18 — 10 *137 Comparable figures for 1945 :— 78 15 1 — 18 — — 10 124 * In addition 1,130 re-assessments of these and previous cases have been made. Boarding Out of Contacts. Since 1925 the London County Council has made arrangements to board out for varying periods the following types of children :— (a) Children living in heavily infected and overcrowded homes. (b)Children about to be discharged from institutions where they have had treatment for tuberculosis, in cases where their homes are unsuitable. (c) " Weakly " children living under conditions likely to subject them to infection. (d) Children whose mothers are having institutional treatment for tuberculosis. The arrangements are made by the Invalid Children's Aid Association on behalf of the London County Council, and the number accepted and reported to the Care Committee during 1946 was 12. Miscellaneous. During the year the Care Committee incurred an expenditure of £227 13s. 3d. on clothing, coal, removals, furniture and pocket money for patients. Seal Sales. The Care Committee again took part in this scheme for raising funds and from this and other sources obtained an income of £421 7s. 0d.