AC 4355 LIBRARY STP AN 103 Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. Metropolitan Borough of Saint Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. CONTENTS. Introductory 4-12 Committees and Officers 13-16 Section 1.—General Information 17-22 Section 2.—Population, Births and Deaths 23-33 Section 3.—Notifiable Diseases 34-46 Section 4.—Sanitary Circumstances of the Area 47-53 Section 5.—Factories, &c. 54-56 Section 6.—Inspection and Supervision of Food 57-61 Section 7.—Maternity and Child Welfare 62-67 Section 8.—Tuberculosis 68-71 3 INDEX. PAGES Acute influenzal pneumonia 67 Acute primary pneumonia 37 Aged persons, care of 4, 49 Ambulance facilities 21 Analyst, Public 15 Anterior poliomyelitis and polio-encephalitis 37 Area of borough, wards, open spaces 17 Bacteriological examinations 43 Bakehouses 12, 54 Bed service—Emergency 22 Births— illegitimate 30 notification of 62 numbers and rates since 1918 29 rates 5, 23, 29 registered live 23, 29 registered still, and rate 23 still—numbers and rates since 1929 30 Blind persons, care of 5, 49 Bodies received at mortuary 52 Burials 52 Cancer, Deaths from 24, 25, 26 Cerebro-spinal meningitis 38 Chief officers of the Council 13 Child guidance 67 Child life protection 66 Children, illegitimate, care of 67 Chiropody clinics 67 Cleansing and disinfecting 44 Clerical staff 15 Climatological summary 18 Committees, members of 13 Complaints 6 Condemned food 61 Coroner's Court 52 Daily guardians 67 Day nurseries 20 Day nurseries, staff 16 Deaths— bronchitis 24, 26 cancer 24, 25, 26 classification, with age distribution 24 heart disease 24, 26 illegitimate children 30 infantile deaths and rates 5, 26, 29 infantile, with causes, age and ward distribution 27 maternal 24, 31 neo-natal 6, 29 number and rate, all ages 23, 29 pneumonia 24, 26 tuberculosis 24, 32, 33 Dental treatment 63 Diphtheria 38 Diphtheria immunisation 38, 39 Disinfection 46 District Nursing Associations 65 Drainage work 48 Dysentery 39 Emergency Bed Service 22 Encephalitis lethargica 39 Enteric or Typhoid Fever 40 Erysipelas 40 Factories and bakehouses 12,54 Factory Inspectors 15 Factory Inspectors, work of 54 Food— condemned 61 hygiene of 9 inspectors 15 inspectors, work of 57 poisoning 40 sampling 58 summonses 60 unsound 61 Foot clinics 67 Foreword by M.O.H. 4 Health visitors 16 Health visitors, visits by 63 Home and domestic helps 66 Home nursing 65 Hospitals in the Borough 20 Houses and flats erected 8, 53 Housing 7, 53 (6594) PAGES Ice cream 10, 59 Illegitimate children, care of 67 Infantile mortality— causes, age and ward distribution 27 causes, since 1939 28 numbers and rates since 1918 29 rates 5, 26, 29 Infectious diseases 6, 36 Inspectors—housing, food, factory and district 15 Invalid Children's Aid Association 66 Legal proceedings 7, 48, 60 Licensed premises 11,50 Malaria 40 Marriages 19 Maternal mortality 24, 31 Maternity and Child Welfare— centres 19 committee members 13 sessions and attendances 64 staff 16 Maternity cases—beds for 66 Measles 40, 41 Meat and other foods—inspections 58 Medical staff 15, 16 Midwifery grants 65 Milk: inspections, samples, etc. 58 Mortality, infantile—see Infantile mortality. Mortuary and Coroner's Court 52 Notices served 47, 54, 57 Notifiable diseases 34 Notifications— births 62 infectious diseases 37 Nurseries, Day 20 Nursing Associations 65 Nursing, Home 65 Ophthalmia neonatorum 41 Outworkers 56 Pharmacy and Poisons 50 Pneumonia 37 Poliomyelitis and polio-encephalitis 37 Population 5, 23, 26, 29 Population, since 1918 29 Post-mortem examinations 52 Premature infants, care of 66 Public Analyst 15 Public Health Annexe—attendance at 44, 45 Public Health Committee members 13 Public Health (Tuberculosis) Regulations, 1930 70 Public houses 11, 50 Puerperal fever and pyrexia 41 Rat extermination 51 Registrars of births, deaths and marriages 14 Rodent control 51 Sanitary circumstances 6, 47 Sanitary inspectors 15 Sanitary inspectors, work of 6, 47, 48 Scabies 42,44 Scarlet fever 42 School treatment centres 21 Smallpox and vaccination 42 Staff 15, 16 Statistics, Vital 5, 19, 23, 29, 30 Stillbirths 23, 30 Summonses—see Legal proceedings. Tuberculosis— Death rate 68 deaths 24, 26, 32, 33, 68, 69 dispensary 19 dispensary, staff 16 new cases 68 notification register 71 notifications 68, 70 prevalence and fatality for past ten years 71 Typhoid or enteric fever 40 Unsound food 61 Vaccination 42 Verminous persons 44 Vital statistics 5, 19, 23, 29, 30 Water 50 Welfare centres 19 Whooping cough 34 A 2 4 Town Hall, Euston Road, N.W.I. July, 1949. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Saint Pancras. Your Worship, Ladies and Gentlemen, Once again it is my privilege to report to you upon conditions of health and sanitation in the Metropolitan Borough of St. Pancras. This report, for the year 1948, is the fifth I have placed before you, and I hope within its pages to indicate some of the improvements which have been achieved. We have passed in this time from war to peace, but recent years have not been easy and the work of reconstruction has been overshadowed by tiredness, shortage of labour and material and the inevitable frustration and disillusion that awaits those who believe that war always confers material benefit upon the victors. On the other hand our achievements are by no means meagre, and it is pleasant to see new housing accommodation arising in St. Pancras which, if as yet inadequate in quantity, is nevertheless commensurate in quality with the ideas we nurtured during the war. In my last report I referred to the fact that the new legislation did not relieve the Council of its responsibility for the health of the inhabitants of the borough and of those who come to work within its boundaries; that there is now a sharp division between the services aimed at providing actual medical inspection and care, and those which, by improvement of environmental conditions, prevent disease; and in this new clarification I trust that we have been enabled to improve those services which are now our direct and sole concern. There is, among others, one problem in particular which causes me grave concern, and that is the care of the aged in the borough. Responsibility rests with various authorities for their proper care. The hospitals must look after them in sickness, the local health authority is responsible for their care when it is only the incapacity of old age which causes them to need institutional treatment. It also provides Home Helps, a most valuable service. The St. Pancras Borough Council must secure that the aged are adequately housed and may help towards their feeding and recreation, as well as in their social activities. At the same time, over six voluntary bodies are helping, either by home visitation, and/or the provision of advice, food, social clubs, occupation, recreation and wireless. It is the unfortunate lot, moreover, of the Borough Council to secure the removal of the aged to an institution when they are incapable of looking after themselves and there is no one to care for them. It is obvious that there exists a strong desire and willingness to help the aged, but it is equally obvious that some definite central co-ordination is required. It is essential that the Borough should know the total number of men and women over the age on which they are entitled to retirement pension, i.e., over 60 for women and 65 for men. The large proportion of these, probably 80 to 90 per cent., will need little, if any, help from any external source. The remainder will need help in various forms. Some can remain happy with a little help in the home, others will need provision of meals, many the provision of housing accommodation in which they retain complete independence because the accommodation is such that it relieves them from those duties and responsibilities and dangers applicable to 5 advancing years. A few will need a short period of hospitalisation until they can be trained and acclimatised to live in comfort and even to work, despite their age ; and there will be in the end what I believe will be a small residue who will need permanent residence in a hospital or institution. I feel the time has come when the Council should foster a central committee which shall be responsible for those aged persons in the Borough who need help. Experience is showing that there are many old people in institutions whose condition of helplessness is in fact due to their entering an institution too soon, or staying there for an unnecessarily long time. I hope that in the year 1949 the Council will give this matter its very careful consideration. Care of Blind Persons in St. Pancras. For the first time last year I reported on the special care which the Health Department was taking of blind persons. During 1948 this special care was continued. It is directed towards seeing that no sanitary defects in the premises which they occupy remain unremedied because such defects are not apparent to the blind persons. Furthermore, we are sometimes able to take steps under the Housing Act to provide for them amenities to which they are entitled and which can make living much easier for them. An example of this would be the right of a family in a tenement dwelling to have a water supply on their own floor. To a blind person such an amenity means a considerable increase in comfort. During 1948 water was in fact supplied in four cases and 26 notices were served on landlords requiring the abatement of sanitary nuisances. A Home Help was offered in 19 cases by the L.C.C. and accepted in 17. There are in fact 75 persons residing in the Borough who are either totally blind or so blind as to be unable to do ordinary work for which sight is required. At least one visit was paid during the year in every case. Statistics. The population of the Borough was 140,200 in the middle of 1948, showing an increase of 3,500. In 1944 the population of the Borough was 105,780, so that there has been an increase of nearly 35,000 in four years. This increase has in the past been occasioned by the return of families who have been evacuated, and later by demobilisation and an increase in the number of births. The present increase would appear to be due to the new families coming to reside in the Borough. The post-war increase in marriages appears to have come to an end, for with a figure of 1,575 there were two less than in 1947. The birth rate has fallen from 20.4 per thousand in 1947 to 17.4 in 1948, and with 2,447 births to residents of the Borough there are 346 less than in the previous year. Four years ago the birth rate was 18.1 and the number of births, 1,914; but the population was then only 105,780. Infantile Mortality. The infantile mortality rate in 1948 was 37 per thousand. This means that there was an increase of three per thousand on the previous year. This figure is unfortunate in that it is the first time since 1943 that the infantile mortality rate has risen, and this despite the fact that the infantile mortality rate for the country as a whole is 34 per thousand, the first time it has ever been below 40. It is, however, pleasing to report that the infantile mortality (6594) a 3 6 rate for illegitimate children has fallen to 42 per thousand, and at last we have got figures for infantile mortality rates for legitimate and illegitimate children which differ by only five per thousand and indicate that the chance of survival for the one is practically as good as that for the other. This is most satisfactory, for it is not so many years since there was considerable divergence between the two figures. In fact twenty years ago the infantile mortality rate for the Borough as a whole was 80 per thousand, but for illegitimate children, 152, whilst in 1944, the figures were respectively 64 and 105. This year they are 37 and 42. Neo-Natal Deaths. The number of children who died under the age of one year was 91 out of a total of 2,447 births. In 1947, 95 children died out of a total of 2,793 births. Of the children who died in 1947, 47 were under one month, but in 1948 the number was 65, and in fact the neo-natal mortality rate, that is, figures relative to the deaths of children under one month, has risen from 17 to 26 per thousand. This is a considerable increase in view of the lessened number of births. It is essential to see if one can ascertain the cause. In this respect it will be noted that out of 91 infantile deaths 20 were due to prematurity, whilst last year, out of 95, 15 were due to this cause; and it is a fact that prematurity is an important factor in infantile mortality. I stress this particular condition because the death rate caused by it is one capable of reduction by methods at present known, appreciated and adopted in parts of this country and elsewhere. Skilled nursing and early care can do much to save the premature child, and one wonders if the time has arrived when prematurity should "not be notified and a scheme adopted for making available all those services which can help and save the premature infant. Infectious Diseases. The notifications of infectious diseases are noteworthy in two respects; namely, infantile paralysis (anterior poliomyelitis) and scabies. During 1947 there were notified 36 cases of infantile paralysis, a serious disease which is liable to cause permanent crippling. For 1948, the number of notifications was seven, and in fact we did not have a return of the epidemic of the previous year. Scabies, which is an infection of the skin, is dropping steadily in St. Pancras, the total number of notifications being 138 in 1948, compared to 300 in 1947 and 699 in 1946. Otherwise infectious disease has not shown any material variation over the previous year. Vital statistics of the Borough indicate that the population is rising, the birth and death rates falling, that there is a slight increase in infantile mortality, better care of the illegitimate baby, and the absence from the borough of serious epidemic and infectious diseases. Sanitary Circumstances of the Area. The basic work of a health department is that performed by the sanitary inspectors in their various spheres of activity, be it in abolishing nuisances which are injurious to health, improving the conditions of housing, bettering the conditions under which persons work, or improving the cleanliness or quality of the food they consume. By and large the value of this work is seldom appreciated, for it is not by any means spectacular. Nor has any sanitarian yet succeeded in conveying to the public its full significance. Yet it is on the work of the public health department in this respect that the health and the comfort of a community depend. No less than 7,136 complaints were received in the department during 7 the year. Every one of them was investigated and the proper steps taken to deal with it. These complaints are brought to me by post from residents of the Borough or by personal attendance at the counter of the public health department. Sometimes they come over the telephone, and often they are anonymous. They are brought, not only by the complainant, but by social workers, friends, members of the Borough or County Council and they are forwarded by Government offices—and I have even received one which had been made to H.M. the Queen. I know the Council will need no assurance from me that they receive the same attention, no matter from what source they come, and even if they are anonymous, for if there is existent in the Borough a state of affairs which is injurious to health it must be at least investigated, and if justified every step must be taken, within the limits of present conditions, to abate it. 6,567 intimation notices were served, which is approximately 800 more than in 1947 and 3,858 more than in 1945. Where a nuisance is not abated on an intimation notice a statutory notice is served; and in 1948, 3,498 were served. It would appear from comparison with the previous year that the proportion of work carried out on an intimation notice was greater in 1948 than in 1947, and I would like to express my appreciation of this to the owners of property in the Borough. Prompt attention to defects on intimation notices does relieve the department of unnecessary work. It is a reflection, too, of increased harmony between landlords and sanitary inspectors. Unfortunately we had to take police court proceedings in 212 cases as compared with 133 in 1947 and 57 in 1946. £166 was recovered in fines and £229 in costs, considerably more than the sums of £3 and £86 respectively in 1946. If the number of police court proceedings indicates the determination of the Council fo secure that sanitary defects shall be remedied and recalcitrant landlords forced to carry out their responsibility, it nevertheless represents a considerable waste of both time and money. May I say here and now that on the whole I am receiving the co-operation of the landlord, whose lot in many cases is by no means enviable to-day, but that there appear to be some owners of property who are prepared to delay carrying out essential work until forced to do so by the process of law. Housing. The closest contact exists between the Housing Department and the Public Health Department and I am indebted to Mr. Davey and the Housing Department for the happy daily co-operation which has existed throughout the year. In every case where rehousing is requested on medical grounds or because conditions inimical to health are stated to exist, the Health Department investigates the position and makes the appropriate recommendation to the Housing Department. In many cases this necessitates correspondence between me and the patient's medical attendant, and I am grateful to the general practitioners of St. Pancras for their assistance in this matter. During the year 1948 I investigated 1,235 housing applications, and the recommendations I made were as follows :— Certificate A—Urgent priority 671 Certificate B—Priority less serious 247 Certificate C—General waiting list 214 Certificate D—No special consideration 103 1,235 In every case a visit is made to the home to ascertain the number and ages of the residents, the number and sizes of the rooms they occupy, the floor on which the rooms are (6594) a 4 8 situated, the presence of any sanitary defects and whether any of the rooms are unfit for human habitation and should be closed. When this information is before me I am in a position to consider it together with any medical report and data I may have from various voluntary bodies or hospital departments as to particular circumstances which must be taken into consideration. It must not be anticipated that the effect of this investigation is to increase the number of families awaiting rehousing. On the other hand in many cases it is found that by the provision of an adequate water supply and the amelioration of certain adverse sanitary conditions, the immediate and sometimes the permanent need for rehousing can be obviated. The primary object of the investigation is to secure that such accommodation as does become available is given to those whose needs on all grounds are the most urgent. Of those cases who were recommended priority A on medical grounds, severe rheumatism accounted for some and heart disease, post-operative conditions, tuberculosis, and crippling defects for others. There are at present 8,846 families awaiting rehousing in the Borough of St. Pancras. Last year this number was in the neighbourhood of 12,000. The Housing Department sent out questionnaires to the majority of the families on the waiting list asking them if they still required rehousing by the Council. 3,482 did not reply, whilst 1,073 of the questionnaires were returned through the dead letter office. 382 replied that they did not wish their names to remain on the list. As a result it has been possible to place before you a figure which truly represents families who are now awaiting rehousing. The reduction in the waiting list suggests that many of those persons who had asked the Council to find alternative accommodation for them have in the meanwhile secured rehousing either through another authority or as a result of their own efforts. The housing list is still very large and the Council is now dealing with families who are in urgent need of rehousing and who applied at the end of 1945. On the other hand it is only right to contrast the situation with what has been achieved, and the following Table shows the extent of the Council's tenancies in 1947 and in 1948:— 1947. 1948. On estates 1,204 1,504 In requisitioned houses 1,737 1,858 In temporary houses 214 214 In compulsory purchase houses 51 97 Total 3,206 3,673 It is now estimated that no less than 13,500 or 9.6 per cent. of the population of the Borough are tenants of the Council. At the present moment about 150 applications are being received each month. Last year I was able to refer to the number of Council flats which were actually in course of erection. This year it is pleasing to report not only that in nine of the Council's housing schemes, totaling 681 flats, the buildings are in course of erection, but that during the year 312 were completed and are now in occupation. Large blocks of flats are arising in various parts of the Borough, providing a standard of accommodation for the working classes contemplated in the past but now being achieved in reality. 9 So far the work of the department has been concentrated on dealing with complaints and improving existing conditions. So serious is the housing shortage that little attempt at direct slum clearance has been possible. This is a problem which obviously must be dealt with in the near future, for while houses exist in the Borough which are unfit for human habitation, or slums that ought to be condemned, those houses will be occupied and the slums inhabited to the detriment of the health of the district. In due course housing and slum clearance must take place side by side. In the meanwhile, as basements which are unfit for human habitation or, for that matter, parts of houses in the same condition become vacant, steps are being taken to place closing orders upon them ; and during 1948 closing orders were made concerning 57 rooms. This procedure is absolutely essential, for if these rooms were not closed they would be re-occupied immediately and the persons inhabiting them in due course would demand re-housing by the Borough Council on the plea that they were living in accommodation unfit for human habitation. In every case an opportunity is given to the landlord to carry out work to render the rooms fit for habitation, or if this is not economically sound he may be allowed to use them for such purposes as will not cause injury to health as, for instance, storage. In fact, during the year five basement rooms were re-opened, work having been carried out to make them conform with the appropriate regulations. The total number of visits paid by sanitary inspectors in connection with general complaints, licensed premises, outworkers and underground rooms amounted to no less than 45,209: nearly 8,000 more visits than last year. The Hygiene of Food. During 1948, 7,713 visits were paid in respect of premises where food is prepared or sold, 440 to bakehouses and 1,129 to restaurant kitchens. 1,545 samples of food were taken for analysis. It is, however, not sufficient to pay visits, to serve notices, to condemn food and to take legal proceedings where necessary. These are, indeed, methods of preventing the sale of food unfit for human consumption, but they do not succeed in educating manufacturers of food, food handlers and the public in general as to methods of preventing food contamination; and it is the duty of a public health department to see that by means of understanding and education standards of hygiene are steadily improved. In this respect I believe that 1948 was a year of high achievement, marked by three separate campaigns: the first, to educate the public and the trade generally in ideals of food hygiene, the second to secure an improvement in the conditions of ice cream, and the third a survey of licensed premises in the Borough. May I deal with each of these in turn? In late 1947 the Public Health Committee considered methods of education in food hygiene and later determined on the steps that should be taken in the Borough. A programme was adopted which included the attendance of your sanitary inspectors at a special course of instruction, the calling of a town's meeting of all those interested in food trades in the Borough, and a series of lectures to those responsible for the preparation and handling of food. Your Health Department has had the full and active co-operation of every trade in the Borough concerned with food. The town's meeting was held in June, 1948, when representatives of the following trades and organisations attended:— British Medical Association. St. Pancras Chamber of Commerce. Licensed Victuallers Association. St. Pancras Master Bakers. St. Pancras Butchers' Committee. London District Grocers' and Provisions Committee. 10 Hotels and Restaurants. Milk Distributing Trades. Fish Fryers. Confectioners and Tobacconists. Ice Cream Alliance. L.C.C. Meals Service. Central Council for Health Education. Catering Branch of the Railway Executive. St. Pancras Food Control Committee. The Wellcome Foundation Trust. Hospitals. St. Pancras Publicans. Fortes Milk Bars. Industrial Canteens. J. Lyons & Co., Ltd. Express Dairy Co., Ltd. Aerated Bread Co., Ltd. Farma Cream Products. Coffee Stall Holders. Local Press. National Press, etc. The meeting was welcomed by the Mayor (Councillor Mrs. L. Bryant, J.P.), who presidedShe pointed out that St. Pancras had been a pioneer in many fields of public health, and this new venture was an indication of the Council's continued interest. An outline of the proposed campaign was placed before the meeting. It was determined to hold a series of three lectures for persons in charge of food establishments, to be followed by one lecture to the employees. The first series of lectures was to the managerial and supervisory staff of the Aerated Bread Co., Ltd. whose headquarters are in the Borough of St. Pancras. Further lectures followed to the staffs of tea shops, London Meals Service, industrial canteens, milk bars, hospitals, and coffee stalls. Suitable posters have been prepared and are being used by the lecturers. A record of all persons attending is kept and a certificate of attendance, bearing the owner's name and national registration number, is issued. The lectures are given either at the Town Hall or on the premises of the firm concerned, whichever is the more suitable to the firm. As the Council may know, there are a large number of Cypriots in the Borough who are engaged in food preparation, and for them a special lecture is being arranged and will be delivered in their own language. It is hoped, moreover, to widen the scope of the lectures to include the general public. In particular, lectures will be given to housewives and members of clubs. To be effective this campaign must be continued for some considerable while, but already in some instances 100 per cent. of certain staffs have attended lectures. Few people realise how much damage can be done by the carelessness of one single individual in the handling of food. It is a fact that many outbreaks of food poisoning can be attributed to the carelessness of one person. I am prepared to say that our audiences have been keen, intelligent and enthusiastic; that the campaign is worth while and should continue, and that it will in due course raise the level of food hygiene in the Borough. Ice Cream. It is only a short time since the public have been enabled to buy ice cream again. As soon as its manufacture was allowed there was a rush to buy practically anything which bore 11 the name of ice cream. It was often of poor quality and standard. Immediate and vigorous steps were taken to improve this state of affairs and I believe that we have achieved some considerable success. There are now accepted standards of bacterial purity, and of 180 samples submitted for examination last year 113 were regarded as satisfactory. Where samples are found to be unsatisfactory an immediate visit is made to the premises and your food inspectors examine in detail the method of manufacture. The approach is not one of fault-finding, but rather of help and advice. Your inspectors' visits are welcomed rather than resented and the manufacturers in the Borough are anxious to produce a thoroughly good article. Limitation of ingredients makes it difficult to produce a product that compares in food value, taste and cream content, with the pre-war article, but there is no reason why its standard of cleanliness should not be satisfactory. To this end your department is striving with the co-operation of the manufacturers. Ice cream produced in the Borough is distributed widely for there are at least four firms who are manufacturing on a considerable scale and delivering over a large area. Licensed Premises. During the early part of 1948 various members of the committee raised the question as to whether licensed premises were providing food and drink under hygienic conditions. I do not think that their complaints were limited or confined to St. Pancras in particular. There was criticism of glasses and crockery throughout the country. I had also received complaints as to the inadequacy of sanitary provision in some licensed premises in the Borough. I therefore determined to carry out a survey of the whole Borough in this respect. There are 238 licensed premises in the Borough, and it is pleasing to record that although every public house in the Borough has been inspected and in many cases work involving considerable expense required, I have met with co-operation from owners and licensees. If beer is to be produced and served in a healthy manner, various requisites must be secured. Storage must be adequate and clean. Piping from barrel to bar must be hygienic, capable of being cleaned and kept clean. There must be proper provision for the cleansing of glasses and a satisfactory method of dealing with spillage, for the law requires that a pint of beer shall be served in a glass that contains a pint, no more and no less, and to secure this it is impossible to avoid over-filling. In addition to this, the comfort of the customer must be secured by providing hygienic premises and adequate sanitary conveniences. As a result of a survey it was found that out of 238 public houses, in only 33 were the premises so satisfactory that no faults could be found. Seventy-five defects were found in kitchens, 188 in cellars, 118 in bars and 68 behind counters. The sanitary accommodation for males was inadequate in 33 cases and defective in 103; and for females absent in 46 and unsatisfatory in 61. The attention of owners was called to the above defects, and in a large proportion of the cases the necessary work has already been carried out. In the remainder I have little doubt but that improvements will take place within the next few months. With regard to beer spillings, in 60 cases it is either thrown away or returned to the brewers, but in 178 cases it is resold after passing through either a utiliser or some less satisfactory type of filter. I think this question of spillage needs very careful consideration, and have yet to be persuaded that the public will not accept beer in a glass that contains over a pint, and with a line upon it showing when the correct quantity has been served. 12 Unless proper arrangements exist behind counters for the cleansing of glasses customers will receive beer in glasses soiled with lipstick, an obvious evidence of insufficient cleansing. Factories. Your Factory Inspectors paid 5,673 visits in 1948, compared with 3,954 in 1947. These visits included 440 to bakehouses and 307 to outworkers' premises. Towards the end of the year a survey of conditions of out-work commenced, and I hope to give details of the results of this survey in my report for 1949. Particular attention has been paid to bakehouses. In 1945 there were 60 bakehouses in the Borough, of which 33 were underground. Three underground bakehouses have since been closed and it is hoped within a short time that another five will be replaced by modern premises at ground floor level. Generally. It remains for me once again to thank the Council and the Committees for the help and courtesy I have received at all times. The maintenance of the health of the Borough depends, however, not only on the work of the department but on the doctors who practise within its boundaries, and the co-operation of my colleagues whose help I have had at all times. It has been said that the work of a health department is least obvious, and thus less appreciated, when it is working most efficiently. This is true; a health department is often praised for dealing competently with an epidemic, but seldom congratulated for preventing one. The year 1948 shows a steady increase in the volume of work that has been carried out. It also shows a widening of the scope of the work of the department and the happy co-operation with all those communities in St. Pancras with whom it has to work. But St. Pancras is still a Borough where housing is inadequate, where there is much out-moded property and where standards of hygiene have yet to be considerably raised: and there are still many classes of the community as regards age, occupation and environmental condition who need the active help of the Borough Council. The work of 1948 shows only some of the roads that are open and need investigation in the years that are now ahead. I beg to remain, Your Worship, Ladies and Gentlemen, Your obedient Servant, DENNIS H. GEFFEN, Medical Officer of Health. 13 Metropolitan Borough of St. Pancras. PUBLIC HEALTH COMMITTEE. (as at 31 st December, 1948.) Councillor Miss F. L. M. Freeman (Chairman); Councillor Rev. J. Jones (Vice-Chairman); The Mayor (Councillor Mrs. Lilian Bryant) ; Aldermen Dr. L. F. Browne and Dr. E. A. Gregg; Councillors Dr. S. G. Dean, W. Donovan, E. F. Evans, Mrs. M. A. Foster, Mrs. J. Gregory, Mrs. L. G. Hume, Mrs. L. M. Jeger, A. G. Shelley, H. B. Sheridan and R. L. Workman. MATERNITY AND CHILD WELFARE COMMITTEE. (as at 4th July, 1948.) Councillor Mrs. L. M. Jeger (Chairman); Alderman Mrs. L. Bartlett (Vice-Chairman); The Mayor (Councillor Mrs. Lilian Bryant) ; Alderman G. Home; Councillors Dr. S. G. Dean, Mrs. M. A. Foster, Miss F. L. M. Freeman, Mrs. J. Gregory, Miss E. M. Haworth, Mrs. L. G. Hume, Rev. J. Jones, Dr. N. Malleson, T. B. Moss, A. S. Ruffell and Mrs. J. Young. CHIEF OFFICERS OF THE COUNCIL. Town Clerk and Solicitor R. C. E. Austin, LL.M. Deputy Town Clerk W. F. McKeer. Borough Engineer and Surveyor C. S. Bainbridge, M.Inst.C.E., F.R.I.C.S., M.I.Mun.E. Borough Librarian F. P. Sinclair, A.L.A. Borough Treasurer and Accountant P. C. Taylor, F.I.A.C. Borough Valuer W. S. Willis, F.R.I.C.S. (Special Rating Diploma). Housing Manager A. W. Davey, A.I.H. Building Manager A. E. Ullmer. Chief Architect T. Sibthorp, L.R.I.B.A., A.R.I.C.S., A.M.T.P.I. Superintendent Registrar J.M. Lander. 14 REGISTRARS OF BIRTHS AND DEATHS. St. Pancras Town Hall, Euston Road, N.W.l. St. Pancras Sub-District. Registrar. Day and Hour of Fixed Attendance. North Frederick Charles Irvine Daily, 9.30 a.m. to 12.30 p.m. Monday 2 p.m. to 4.30 p.m. Tuesday Wednesday Thursday Friday, 6 p.m. to 8 p.m. South-East Alice Andrews (Miss) Daily, 9.30 a.m. to 12.30 p.m. Monday 2 p.m. to 4.30 p.m. Wednesday Thursday Friday, 6 p.m. to 8 p.m. South-West Stanley Western Kirkup Daily, 9.30 a.m. to 12.30 p.m. Monday 2 p.m. to 4.30 p.m. Wednesday Thursday Friday, 6 p.m. to 8 p.m. REGISTRARS OF MARRIAGES. Frederick Charles Irvine ... ... ...~ Athelstan F. L. Eatenton Alice K. Kimmance (Mrs.) ... ... ..._ St. Pancras Town Hall, Euston Road, N.W.I. Hours of Attendance : Daily, 9.30 a.m. to 4.30 p.m.; Saturdays, 9.30 a.m. to 12.30 p.m. Superintendent Registrar : John M. Lander. Deputy Superintendent Registrar : Henry J. Millichap. 15 STAFF OF THE PUBLIC HEALTH DEPARTMENT at the end of the year 1948. Medical Officer of Health: Dennis H. Geffen, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary and Housing Inspector. E. W. Winchester. Inspectors of Food and Food Places. (3) S. W. Capel (Senior Food Inspector). R. N. Thomas. R. Warren. Inspectors of Factories. (2) J. A. Hoare. I. Williams. Deputy Chief Sanitary and Housing Inspector. W. B. Dykes. District Ins-hectors (15). B. V. Cryer. C. A. Engledow. T. H. Hague. J. E. Jones. A. G. King. E. C. J. Kipping. E. F. Kirby. S. A. C. Lord. J. Marginson. H. P. Price. E. S. Rushton. W. Shackcloth. H. E. Westripp. J. H. Willett. (1 vacancy.) Clerical Staff (12). V. R. Meurice, Chief Clerk. C. W. Smith, First Clerk. G. F. Peeling. R. B. M. Lake. Miss B. Pinnock. D. H. Smith. J. F. S. Dove. A. A. Sleet (S.I. Course). S. Morse. N. L. B. Collier. E. Driscoll. Miss J. M. White. H. Harwood (Temporary, vice Sleet). Public Analyst. C. Harcourt Wordsworth, B.Sc. (Lond.), F.I.C. The Council's Tuberculosis Officer, G. A. Back, B.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H., was transferred to the Regional Hospitals Board as from 5th July, 1948. 16 The following Maternity and Child Welfare and Tuberculosis Dispensary staffs were transferred to the London County Council as from 5th July, 1948:— maternity and child welfare Senior Maternity and Child Welfare Officer. Susan M. Tracy, L.R.C.P., M.R.C.S., D.P.H. Assistant Medical Officers. Margaret Edge, M.B., Ch.B., D.C.H., C.P.H. Agnes V. Smyth, M.R.C.S., L.R.C.P., D.P.H. Mary J. D. Paterson, M.B., B.S., D.P.H. Margaret Randell, B.Sc., M.B., B.Ch., D.Obst., R.C.O.G. Superintendent Health Visitors (2). Miss B. M. Harris (Ampthill Square). Miss M. Manger (Somers Town). Health Visitors (18). Miss C. O'Leary Miss I. Lamb (Ampthill Square). Miss H. Smith Miss B. M. L. Boxall Miss F. E. Overton (Camden Town). Miss E. B. Bagnall Mrs. B. N. Owen Miss M. Tolan (Kentish Town). Miss E. M. Boyce Miss M. M. Wilson Mrs. S. Payne (Queen's Crescent). Miss M. A. Clarke Miss A. E. Silvester (Somers Town). Mrs. J. E. Baghdadi Miss I. T. Farrelly (South Highgate). (There were three vacancies.) Clerical Staff (6). Miss A. Andrews. J. M. Murphy. Miss M. Foster. Mrs. M. E. Rowley. Mrs. E. L. de Piro. Miss P. Taylor. day nurseries Superintendent Matron : Miss E. M. Butler. Clerk : Miss B. E. Elsy. tuberculosis dispensary Health Visitors (2). Miss M. M. Gilpin. Miss W. E. Webb. Nurse and Secretary to Tuberculosis Care Committee. Mrs. E. Bevan. Clerical Staff. Miss L. M. Davison. Mrs. S. W. Gardner. 17 SECTION 1. General Information and Statistical Summary. General. 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 near 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-1948 estimate) 140,200 Number of persons per acre (estimated average) 52 Rateable value £2,107,657 Product of a penny rate, about £8,010 General rate—16/8 in the £ for the year. (6594) b 18 Climatological Summary, Year 1948. Station, Camden Square, N.W.l—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.) 1000.5 1022.4 1029.1 1013.2 1016.2 1014.1 1017.1 1013.8 1018.5 1019.2 1023.4 1019.3 Air Temperature— Mean of— A. Maximum °F. 48.6 47.0 57.1 60.9 65.6 67.5 71.3 70.1 67.7 58.9 51.6 48.9 B. Minimum °F. 39.2 37.0 41.0 43.6 46.6 52.9 55.7 55.4 53.2 45.9 41 .4 41.0 Mean of A and B °F. 43.9 42.0 49.1 52.3 56.1 60.2 63.5 62.7 60.5 52.4 46.5 44.9 Difference from average (1906.1935) °F. +3.6 + 1.5 + 5.4 +4.0 -0.3 -0.8 -0.8 -1.0 + 1.5 +0.5 +2.5 +3.4 Mean relative humidity per cent. 86 79 81 71 69 70 72 77 79 83 91 80 Earth temperature at 4 ft. depth °F. 46.4 45.2 44.4 47.3 52.2 54.9 56.5 59.2 58.0 55.4 51.0 47.9 Bright sunshine— Total observed (daily mean) Hr. 0.70 1.40 3.21 — 6.81 5.80 5.90 4.53 5.14 2.47 1.60 0.85 Percentage of possible 8 14 27 — 44 35 37 31 41 23 18 11 Percentage of average 75 87 113 — 109 88 96 81 121 95 124 106 Rainfall (rain.gauge level, 110 ft.)— Number of days precipitation 22 13 8 12 10 18 8 14 9 10 10 12 Total fall In. 3.61 1.40 0.57 1.68 2.77 2.11 1.06 3.02 1.34 1.96 1.76 2.20 Percentage of average (1881.1915) 194 84 31 109 157 104 45 137 74 75 75 92 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. Not available for April. Total rainfall for year, 23.48 inches. 19 Marriages. The following table shows the number of marriages which have taken place in the Borough since 1939, and the marriage rates for those years. Year. C. of E. R.C. Chapels. Superintendent Registrar's Office. Total Marriages. Estimated Population. Marriage Rate per 1,000 Population. 1939 741 266 76 1,346 2,429 167,300 29.04 1940 815 221 80 1,235 2,351 133,200 35.30 1941 534 185 56 792 1,567 103,770 30.20 1942 529 152 42 687 1,410 105,900 26.62 1943 445 121 33 602 1,201 108,640 22.10 1944 426 130 32 556 1,144 105,780 21.62 1945 589 175 51 695 1,510 111,400 27.10 1946 471 148 25 853 1,497 129,410 23.12 1947 405 179 32 961 1,577 136,700 23.06 1948 452 170 32 921 1,575 140,200 22.46 Summary of Vital Statistics. Net registered live births 2,447 Birth-rate (per 1,000 of estimated population) 17.4 Deaths, all ages 1,596 Death rate (per 1,000 of estimated population) 11.3 Infantile deaths 91 Infantile death rate (per 1,000 live births) 37.2 Tuberculosis deaths 98 Tuberculosis death rate (per 1,000 of estimated population) .70 Maternity and Child Welfare Centres. Telephone St. Pancras School for Mothers, 1, Ampthill Square, N.W.l. EUS 2972 Camden Town Welfare Centre, Barnes House, Camden Road, N.W.l. GUL 1667 Kentish Town Welfare Centre, Raglan Street, N.W.5 GUL 1389 North St. Pancras School for Mothers, Queen's Crescent, N.W.5 GUL 2988 Somers Town Welfare Centre, Chamberlain House, Ossulston Street, N.W.l. EUS 2380 South Highgate Welfare Centre, 1, St. Alban's Road, N.W.5 GUL 2008 University College Hospital, Maternity and Child Welfare Department, Huntley Street, W.C.l (for Ward 7—Children) EUS 5050 Tuberculosis Dispensary. Barnes House, Camden Road, N.W.l. GUL 5567/8 (6594) b 2 20 Day Nurseries. Telephone Caversham Road, N.W.5 GUL 5769 Margaret Day Nursery, 42, Phcenix Road, N.W.I EUS 1822 254-256, Camden Road, N.W.I GUL 2910 Coram Gardens Day Nursery, 41, Brunswick Square, W.C.I TER 6054 108, Hampstead Road, N.W.I EUS 3686 Kentish Town Day Nursery, 27, Gospel Oak Grove, N.W.5 GUL 2906 South Highgate Day Nursery, Chester Road, N.19 ARC 4921 Regents Park Day Nursery, 4, Prince Albert Road, N.W.I GUL 4037 Hospitals in the Borough. (There are no disclaimed hospitals in the Borough.) Name and Address of Hospital. Telephone Number. Authority under which Functioning. Number of Beds. British Hospital for Functional Mental and Nervous Disorders, 72, Camden Road, N.W.I GUL 2041 Paddington Group 21 None. Elizabeth Garrett Anderson, 144, Euston Road, N.W.I EUS 2501 Board of Governors, Royal Free Hospital 142 Hampstead General and N.W. London (Out-Patients' Department), Bayham Street, N.W.I GUL 1734 Board of Governors, Royal Free Hospital None. Highgate, Dartmouth Park Hill, N.19 ARC 2681 Archway Group 19 282 London Foot, 33, Fitzroy Square, W.l MUS 0602 Paddington Group 21 None. London Skin, 40, Fitzroy Square, W.l MUS 1411 Paddington Group 21 None. National Temperance, Hampstead Road, N.W.l EUS 5206 Paddington Group 21 160 Royal Ear, Huntley Street, W.C.l EUS 5050 Department of U.C.H. 53 Royal Free, Gray's Inn Road, W.C.l TER 4331 Teaching Hospital (Own Board of Governors) 229 Royal National Throat, Nose and Ear, Gray's Inn Road, W.C.l TER 4311 Teaching Hospital (Own Board of Governors) 225 St. Pancras, St. Pancras Way, N.W.l EUS 1617 Board of Governors, U.C.H. 308 University College, Gower Street, W.C.l EUS 5050 Teaching Hospital (Own Board of Governors) 632 West End Hospital for Nervous Diseases, 73, Welbeck Street, W.l WEL 1260 Paddington Group 21 60* * Owing to war damage of hospital premises at Gloucester Gate, Regent's Park, N.W.l, temporary wards have been available at St. Charles' Hospital, Ladbroke Grove, North Kensington, W.10. 21 School Treatment Centres in St. Pancras. (By appointment only. Application in first instance to School Care Committee.) Vision Highgate New Town Clinic, Chester Road, N.19. St. Pancras Clinic, 26, Prince of Wales Road, N.W.5. Dental Highgate New Town Clinic. . St. Pancras Clinic. Somers Town Clinic, Chalton Street, N.W.I. Nutrition Highgate New Town Clinic. Somers Town Clinic. Rheumatism Hampstead General Hospital, Bayham Street, N.W.I Ears Somers Town Clinic. Tonsils and Adenoids Highgate Hospital, Dartmouth Park Hill, N.W.5. Minor Ailments Highgate New Town Clinic. St Pancras Clinic. Somers Town Clinic. Children can attend for treatment any time during working hours and are seen by the doctor on his next attendance. Ambulance Facilities. The London County Council, as local health authority, is responsible under Section 27 of the National Health Service Act, 1946, for the provision of ambulance facilities within the administrative county of London. The Home Service Ambulance Department (Order of St. John of Jerusalem and British Red Cross Society) and the Hospital Car Service, act as agents of the County Council in supplying some of the ambulance and car transport provided under the Act. The Headquarters of the London Ambulance Service are at The County Hall, Westminster Bridge, S.E.I. Ambulances may be summoned as follows:— (1) Accidents Sudden illness in the streets, public places or places of employment. (Note.—For sudden illness in the home a doctor, not an ambulance, should be summoned Dial "999" (or follow the instructions given on the telephone instrument) and ask for "AMBULANCE." (2) Maternity patients (who have booked a bed in a hospital or maternity home) Very urgent illness in the home (provided a medical practitioner certifies that the case is one of life or death and arrangements have been made with a hospital for the patient's admission) Telephone— WATerloo 6000 CENtral 6301 REGent 4000 RELiance 3622 or NEW Cross 2645 (3) Illness, infectious disease, etc.—Normally the hospital to which the patient is to be admitted will summon the ambulance, if one is necessary, by telephoning WATerloo 3311 This applies also to patients being discharged from hospital or attending there as out-patients. (6594) B 3 22 Emergency Bed Service. (King Edward's Hospital Fund for London.) The Emergency Bed Service (MONarch 3000) was founded in 1938 to assist general practitioners in finding beds for acute emergency cases. Since the 5th July, 1948, the service has acted as agent for the four Metropolitan Regional Hospital Boards for the admission of all types of cases except mental and tuberculous, working in close harmony with the ambulance service. 23 SECTION 2. Births and Deaths. STATISTICS FOR THE YEAR 1948. Population. The civilian population, as estimated by the Registrar-General, mid-1948, was :—140,200. Comparable estimates for preceding years are set out on page 29. Registered Live Births. M. F. Total. Rate per 1,000 of estimated population. Legitimate 1,058 1,108 2,166 Illegitimate 144 137 281 1,202 1,245 2,447 17.4 Comparable figures for preceding years are set out on page 29. Registered Still Births. M. F. Total. Rate per 1,000 Live and Still Births. Legitimate 22 18 40 Illegitimate 4 2 6 26 20 46 18.4 Comparable figures for preceding years are set out on page 30. Deaths—All Ages. M. F. Total Rate per 1,000 of estimated population 871 725 1,596 11.3 Comparable figures for preceding years are set out on page 29. (6594) 24 CLASSIFICATION OF DEATHS, WITH AGE DISTRIBUTION—1948 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 91 10 8 135 422 930 871 725 1. Typhoid and paratyphoid fevers — — — — — — — — 2. Cerebro-spinal fever — — — — — — — — 3. Scarlet fever — — — — — — — — 4. Whooping cough 1 — — — — — — 1 5. Diphtheria — — 1 — — — 1 — 6. Tuberculosis of respiratory system — — — 40 35 15 62 28 7. Other forms of tuberculosis — 1 — 3 3 1 5 3 8. Syphilitic diseases — — — — 9 9 15 3 9. Influenza — — — — 1 — 1 — 10. Measles — 1 — — — — 1 — 11. Ac. poliomyelitis and polioencephalitis — — — — — — — — 12. Ac. infectious encephalitis — — — — — — — — 13. Cancer—buccal cavity and Oesoph (M) ; Uterus (F) — — — 2 14 11 13 14 14. Cancer—stomach and duodenum — — — 3 19 27 32 17 15. Cancer—breast — — — 3 17 11 — 31 16. Cancer—all other sites — — — 12 79 123 135 79 17. Diabetes — — — 1 1 5 1 6 18. Intracranial vascular lesions — — — 2 32 126 71 89 19. Heart diseases — — — 21 87 270 184 194 20. Other circulatory diseases — — — 3 19 76 50 48 21. Bronchitis 2 — 1 25 66 63 31 22. Pneumonia 7 — 1 3 21 50 43 39 23. Other respiratory diseases 1 — — 1 6 4 8 4 24. Ulcer—stomach or duodenum — — — 3 7 15 24 1 25. Diarrhoea (under 2 years) 4 2 — — — — 3 3 26. Appendicitis — — 1 5 2 4 27. Other digestive diseases — — — 1 7 17 14 11 28. Nephritis — — — 3 6 12 12 9 29. Puerperal and post-abortive sepsis — — — 3 — — — 3 30. Other maternal causes 31. Premature birth 20 — — — — — 11 9 32. Congenital malformations, birth injury and infant diseases 47 — — 1 2 — 26 24 33. Suicide — — — 7 9 7 18 5 34. Road traffic accidents — — — 3 1 2 4 2 35. Other violent causes 8 4 3 11 3 29 24 34 36. All other causes 1 2 2 8 19 49 48 33 LIVE BIRTH RATE DEATH RATE for the Borough, per 1,000 population. [To face page 24 25 DEATHS FROM CANCER OF ST. PANCRAS RESIDENTS DURING 1948. Situation of Disease. Ages. Totals. Wards. No Address. 1 2 3 4 5 6 7 8 0-15. 15-20. 20-25. 25-35. 35-45. 45-55. 55-68. 65-75. 75-85. 85 and up. M F M F M F M F M F M F M F M F M F M F Tongue — — — — 1 — — 5 — — 5 1 1 — — — 2 1 — — 2 — — — — — — — — — Mouth — — — — — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — — — Tonsil — — — — — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — — — Pharynx — — — — — — 1 1 — — 2 — — — — — 1 — — — — — — — — — 1 — — — Pyriform Fossa — — — — — — — 1 — — 1 — — — — — 1 — — — — — — — — — — — — — Oesophagus — — — — — — 3 2 2 — 3 4 — 1 — — 1 — 1 1 — — — — — — 1 2 — — Pylorus — — — — — — — 1 — — — 1 — — — — — 1 — — — — — — — — — — — — Stomach — — — — 3 2 17 15 11 — 32 16 3 4 6 2 8 4 3 2 9 1 — 3 — — 4 — — — Rectum — — — 1 1 I 6 11 6 1 13 14 1 5 1 1 2 3 1 — — 1 2 1 3 2 3 — — 1 Liver — — — — — 1 1 5 2 — 3 6 1 2 — — — 1 — 1 1 1 1 — — 1 — — — — Gall Bladder — — — — — — — 2 — 1 1 2 — 1 1 — — — — — — — — — — — — — — — Pancreas 1 3 4 4 — 4 8 1 3 — — 1 1 - 1 1 — — 1 1 1 — 1 — — Caecum — — — — — — — 1 2 — 2 2 — — — — — 1 - - 1 — 1 — - — — 1 — — Colon — — — — 2 2 3 8 8 — 9 14 2 6 — 1 1 2 - 3 3 1 — — 1 1 2 — — — Splenic Flexure — — — — — — — — 1 — — 1 — — — — — — — — — — — — — 1 — — — — Sigmoid Flexure — — — — — — — — 1 1 2 — — — — — 1 — — — — — — — — — — — — — Larynx — — — — — — 3 2 1 1 7 — 3 — — — — — 1 — 1 — — — — — 2 — — — Lung — 1 — — 6 13 26 18 4 1 59 10 12 5 6 — 7 3 3 — 7 — 8 — 2 — 13 2 1 — Uterus — — — — 1 5 5 1 2 — — 14 — — — 2 — 2 — 2 — 3 — 2 — 1 — 2 — — Ovary — — — — — — 4 2 2 — — 8 — 1 — — — 2 — 1 — 3 — — — — — 1 — — Breast — — — — 3 7 10 10 1 — — 31 — 7 — 4 — 6 — 2 — 5 — 2 — — — 4 — 1 Kidney — — — — — — 1 3 - — 3 1 — — — 1 2 — — — — — 1 — — — — — — — Bladder — — — — — — 5 8 5 — 15 3 5 — 2 — 4 1 2 — — 1 1 — 1 1 — — — — Prostate — — — — — — 3 5 1 1 10 — 1 — — — 2 — 2 — 1 — 1 — 1 — 2 — — — Testicle — — — — — — 1 — — — 1 — — — — — — — — — — — — — — — 1 — — — Skin — — — — — — — — 1 — — 1 — — — — — — — — — — — 1 — — — — — — Brain — — — 1 — — 1 — — — 1 1 — 1 1 — — — — — — — — — — — — — — — Bone — — — — — — 1 — — — 1 — — — — — — — 1 — — — — — — — — — — — Thyroid — — — — — — — — 2 — 1 1 — — — — — — — — — — — 1 — — 1 — — — Urethra — — — — — — — — — — — 1 — — — — — — — — — 1 — — — — — — — — Parotid — — — — — — 1 — — — 1 — 1 — — — — — — — — — — — — — — — — Eye — — — — — — 1 — — — — 1 — — — — — — — — — 1 — — — — — — — — Multiple — — — — — — — 1 — — 2 — 1 — — — — — — — — — 1 — — — — — — — All Sites — 1 — 2 17 34 96 108 56 7 180 141 34 36 16 11 33 28 14 13 26 19 17 11 9 8 30 13 1 2 26 The following table shows the number of deaths of St. Pancras persons from certain diseases during the years 1918 to 1948— Year. Cancer. Tuberculosis. Heart Disease. Pneumonia. (all forms). Bronchitis. Population. 1918 269 485 378 376 228 196,883 1919 245 341 360 179 301 228,585 1920 299 312 423 197 236 228,980 1921 290 304 411 173 276 212,900 1922 302 315 431 265 308 212,500 1923 319 272 394 201 223 214,400 1924 298 271 398 200 304 214,600 1925 324 231 381 204 274 216,300 1926 301 212 388 155 259 216,800 1927 292 217 448 207 227 213,200 1928 321 216 465 181 138 206,000 1929 297 250 603 295 255 204,400 1930 357 189 430 160 106 204,400 1931 355 206 553 203 143 195,600 1932 359 189 590 184 99 194,000 1933 354 195 656 168 100 190,900 1934 336 173 574 212 84 187,540 1935 326 139 607 156 68 185,300 1936 361 165 582 182 90 183,900 1937 337 162 579 216 81 181,900 1938 344 133 556 151 52 179,400 1939 359 130 581 146 85 167,300 1940 310 160 585 176 226 133,200 1941 260 123 414 153 129 103,770 1942 255 147 398 118 130 105,900 1943 288 117 416 141 168 108,640 1944 294 128 458 137 158 105,780 1945 287 127 399 113 145 111,400 1946 275 98 441 116 167 129,410 1947 342 105 447 149 170 136,700 1948 321 98 378 82 94 140,200 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 37 Legitimate infants per 1,000 legitimate live births 36 Illegitimate infants per 1,000 illegitimate live births 42 Comparable figures for preceding 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 1946 38 37 47 1947 34 30 61 See also tables on pages 29 and 30. 27 DEATHS OF INFANTS UNDER 1 YEAR OF AGE—1948 from stated causes with Age and Weird 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 and under 3 months 3-6 months 6-9 months 9-12 months Total Deaths under 1 year 1 2 3 4 5 6 7 8 M F M F M F M F M F M F M F M F M F M F Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Whooping cough — — — — — — — — 1 — 1 — — — — — — — — — — — 1 — — — — — — — 1 Influenza — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Meningitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — 1 1 — ? — — — — 1 1 — — — — — — — — — — — — 1 1 Broncho-pneumonia — — — — — — 3 1 2 1 7 1 — — — — 1 — — — — — 1 1 — 1 2 — — 3 4 Lobar Pneumonia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (not stated) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteritis — — 1 — — 1 1 — 2 — 4 1 1 — — 1 — — — — 1 — — — — — — — — 2 2 Syphilis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Injury at birth 7 2 — — — 9 — — — — 9 1 — — 2 — 1 1 1 — — 1 2 — — — — — — 3 6 Atelectasis 11 7 2 1 — 21 — — — — 21 4 1 1 1 2 — 3 — 1 2 — — — 1 2 1 — — 13 8 Malformation 2 4 1 — — 7 5 1 — — 13 — — — 2 1 1 1 1 — 2 — — — — — — 7 6 Premature birth 9 7 3 1 — 20 — — — — 20 3 — — — 1 4 2 4 2 1 3 — — — — — — — 11 9 Congenital Debility — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Sclerema, Icterus 1 3 — — — 4 — — — — 4 — 1 — — — — 1 — — 2 — — — — — — — — 1 3 Other causes 3 — — — — 3 2 2 3 — 10 1 — — i — 1 1 — 4 1 — — — — — — — 1 6 4 Totals 33 23 7 2 — 65 11 5 9 1 91 14 5 1 4 7 9 9 6 8 9 4 6 1 1 3 3 — 1 47 44 28 Deaths of Infants under 1 year of age, from, stated causes, since 1939. 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Measles — — 1 — 1 — — 1 — — Whooping cough 5 — 8 3 1 2 3 — 4 1 Influenza — — 1 1 1 — — 1 — — Cerebro-spinal fever — 1 — — — — — 1 — — Syphilis 1 1 — — 1 1 — — 1 — T.B — 1 — — — — 1 — Meningitis — 1 — — 3 1 — 1 1 — Convulsions 1 — — 1 — — — — — — Bronchitis 3 4 1 6 6 3 1 8 2 2 Broncho-pneumonia 13 16 — 10 10 20 — 7 13 7 Lobar pneumonia 2 1 — 1 1 — — — — — Pneumonia (not stated) — 1 9 1 2 1 12 — 1 — Enteritis and diarrhoea 30 29 9 23 18 20 24 13 13 4 Congenital debility, sclerema, icterus 3 — 1 — — — — — — — Congenital malformations 8 10 7 13 10 13 6 8 8 13 Premature birth 30 17 19 27 28 25 7 24 15 20 Injury at birth 4 3 2 3 8 7 4 12 9 9 Atelectasis 2 5 4 5 8 6 13 11 7 21 Haemorrhage from umbilicus 1 — — — — — — — — — Inattention at birth 1 — — — — — — — — — Lack of care of newborn — — — 3 — 1 — — 2 — Violence — 9 — 3 — 6 4 3 7 — Mikulier's disease — — 1 — — — — — — — Maternal toxaemia — — 1 — — — — — — — Melæna neonatorum 1 Icterus gravis — — 1 — — — — — — 4 Septicaemia — — — — — 1 — — 1 — Bacillary dysentery — — — — — 1 — — — — Other diseases peculiar to first year of life — — — 8 — 4 2 1 3 — Other causes 10 10 8 8 32 11 10 5 7 10 Totals 114 108 74 117 130 123 86 96 95 91 LEGITIMATE CHILDREN. INFANTILE DEATH RATE (under the age of 12 months) NEO-NATAL DEATH RATE ( „ „ „ 4 weeks) for the Borough, per 1,000 registered live births. [To face page 28 ILLEGITIMATE CHILDREN. INFANTILE DEATH RATE (under the age of 12 months) NEO-NATAL DEATH RATE ( „ „ „ 4 weeks) for the Borough, per 1,000 illegitimate live births. [To face page 28 29 Vital Statistics of Borough of St. Pancras since 1918. 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 Under 4 weeks. Number Rate per 1,000 of estimated population N umber Rate per 1,000 of estimated population Number Rate per 1,000 nett live births Number Rate per 1,000 nett live births. 1918 196,883 3,318 16.8 3,914 22.3 340 102 98 30 1919 228,585 3,824 16.7 2,930 13.4 336 88 143 37 1920 228,980 5,934 25.4 2,895 12.4 435 73 171 29 1921 212,900 4,764 22.4 2,778 13.0 360 76 135 28 1922 212,500 4,559 21 .5 3,107 14.6 337 74 117 26 1923 214,400 4,348 20.3 2,585 12.1 272 63 129 30 1924 214,600 4,112 18.8 2,848 13.0 303 74 96 23 1925 216,300 3,880 17.9 2,745 12.7 280 72 95 24 1926 216,800 3,612 16.7 2,680 12.4 274 76 98 27 1927 213,200 3,299 15.5 2,621 12.3 205 62 85 26 1928 206,000 3,274 15.9 2,618 12.7 261 80 82 25 1929 204,400 3,170 15.5 3,126 15.3 262 83 95 30 1930 204,400 3,208 15.4 2,478 11.9 194 60 75 23 1931 195,600 2,955 15.1 2,601 13.3 200 68 71 24 1932 194,000 2,684 13.8 2,545 13.1 186 69 64 24 1933 190,900 2,589 13.6 2,608 13.7 151 58 69 27 1934 187,540 2,449 13.1 2,408 12.8 160 65 70 29 1935 185,300 2,466 13.3 2,219 12.0 155 63 60 24 1936 183,900 2,389 13.0 2,478 13.5 190 79 52 22 1937 181,900 2,364 13.0 2,329 12.8 154 65 48 20 1938 179,400 2,433 13.5 2,063 11.5 156 64 57 23 1939 167,300 2,187 12.3 2,170 13.0 114 52 49 22 1940 133,200 1,948 14.6 2,728 20.5 108 56 41 21 1941 103,770 1,434 13.8 2,055 19.8 74 51 39 27 1942 105,900 1,785 16.9 1,730 16.3 117 66 55 31 1943 108,640 1,836 16.9 1,842 17.0 130 71 66 36 1944 105,780 1,914 18.1 2,001 18.9 123 64 52 27 1945 111,400 1,957 17.6 1,806 16.2 86 44 37 19 1946 129,410 2,494 19.3 1,717 13.3 96 38 51 20 1947 136,700 2,793 20.4 1,916 14.0 95 34 47 17 1948 140,200 2,447 17.4 1,596 11.3 91 37 65 26 30 Still Births, Illegitimate Births, and Deaths of Illegitimate Children. Year. Still Births. Illegitimate Births. Deaths of Illegitimate Children. Under 1 year. Under 4 weeks. Number (Illegitimates in brackets.) Rate per 1,000 births (live and still). Number. Rate per cent. of live births. Number. Rate per 1,000 Illegitimate births. Number. Rate per 1,000 Illegitimate births. 1918 — — 310 9.5 75 237 18 57 1919 — — 302 8.4 69 216 17 53 1920 — — 332 5.6 68 212 15 46 1921 — — 264 5.5 46 178 15 58 1922 — - 254 5.6 40 157 7 28 1923 — — 247 5.7 44 177 15 60 1924 - - 242 5.9 36 147 8 33 1925 — — 243 6.3 31 129 10 42 1926 — — 226 6.3 31 135 10 43 1927 — — 228 6.9 33 142 15 65 1928 — — 238 7.3 37 152 17 70 1929 114 (17) 34.7 246 7.8 31 123 8 32 1930 103 (16) 31 1 269 8.4 29 105 12 43 1931 104 (13) 33.9 245 8.3 29 114 12 47 1932 78 (13) 28.2 214 8.0 27 121 10 45 1933 88 (15) 32.8 227 8.8 23 99 17 73 1934 77 (8) 30.4 239 9.8 28 114 14 57 1935 94 (11) 36.7 218 8.8 21 95 11 50 1936 103 (9) 41 .3 233 9.7 28 120 12 52 1937 78 (14) 31.9 221 9.3 28 121 10 43 1938 83 (17) 32.9 282 11.6 27 94 9 31 1939 60(6) 26.7 265 11 .7 26 94 Records suspended. 1940 66 (10) 32.8 197 9.8 17 86 1941 34 (6) 23.2 159 10.8 7 44 1942 48 (8) 26.2 188 10.2 22 117 1943 47 (11) 25.0 274 14.5 27 99 1944 59 (13) 29.9 287 14.5 30 105 1945 56 (13) 27.8 325 16.1 21 65 1946 64 (11) 25.0 297 11.6 14 47 1947 70 (8) 24.4 313 11.2 19 61 1948 46 (6) 18 4 281 11.5 12 42 The still birth rate is the number of children born dead, out of every thousand live and still births. The still birth rate for 1948 was 18.4. This is the lowest figure that has ever been recorded in the Borough of St. Pancras. It is impossible to consider the still birthrate separately from the rate of children who die within a few hours or days of birth, for the causation is much the same in many cases. A premature child may fail to breath and be regarded as a still birth, or may live a few days and be regarded as a neo-natal death. Again, a foetal abnormality may result in still birth or survival for a few hours. It will, therefore, be seen that often the causes of the one are the causes of the other. I do not think there is any doubt but that as the health of a population improves, so does the still birth rate fall. Better surroundings, adequate nutrition and care during the ante-natal period are factors of prime importance. Thus the steady decline in the still birth rate in St. Pancras, which has fallen from the high figure of 41.3 in 1936 to 18.4 in 1948, may be considered as a reflection 31 of the improved health of the expectant mothers of the district and the care that is being taken of them. The number of illegitimate births has fallen from 313 in 1947 to 281 in 1948. It is, however, 11.5 per cent. of live births, a figure which has been practically constant since 1946 ; was exceeded during the later years of the war ; but is higher than any figure recorded from 1918 until 1937. On the other hand the death rate amongst illegitimate children is 42 per thousand, and this is the lowest infantile mortality rate for illegitimate infants that has ever been recorded in the borough. It compares with the infantile death rate of 37 per thousand for all children, legitimate and illegitimate. A survey of previous years shows that the death rate for illegitimate babies under one year of age has been as high as 237 per thousand in 1918. It has always been approximately twice as high as that for legitimate children. This approximation of the figures shows that there is a keener appreciation of the need of care for the illegitimate baby and the unmarried mother. In many cases the unmarried mother lives in the home of her parents, is treated as a member of the family, and normal channels are used for ante-natal care and confinement. In other cases this position does not occur, and the unmarried mother, sometimes quite a young girl, is left to make her own arrangements with little help from her family. In these cases the help of voluntary agencies is forthcoming, with the resultant reduced mortality figures which it is now possible to show. Maternal Mortality in Borough of St. Pancras in 1948. Ages. Conditions. Wards. 15-20. 20-25. 25-30. 30-35. 35—40. 40-15. 45 and up. Married. Single. Widowed. 1 2 3 4 5 6 7 8 No Address. Post Abortive Sepsis - - - 1 - - - 1 - - - - - - - - - - - Puerperal Sepsis - - 1 1 - - - 2 - - - - - 1 1 - - - - Associated with childbirth but not classed thereto— Mitral Stenosis - - 1 - - - - 1 - - 1 - - - - - - - - Attempted Miscarriage - - - 1 - - - 1 - - - - - 1 - - - - - Deaths from Puerperal Causes in 1948. Rate per 1,000 Live and Still Births. Deaths. Sepsis. Other causes. Total. Puerperal Sepsis 3 1-20 Other maternal causes - - 1.20 Comparable figures for preceding years:— Rate per 1,000 Live and Still Births. Year. Sepsis. Other Causes. Total. Sepsis. Other Causes. Total. 1939 1 2 3 0.44 0.89 1..33 1940 3 3 6 1.49 1.49 2.98 1941 1 3 4 0.68 2.04 2.72 1942 5 3 8 2.73 1.63 4.36 1943 — 1 1 - 0.53 0.53 1944 2 4 6 1.01 2 03 3.04 1945 3 2 5 1.49 0.99 2.48 1946 2 2 4 0.78 0.78 1 .56 1947 1 — 1 0.35 — 0.35 32 Deaths from Tuberculosis of St. Pancras Residents during 1948. 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 and upwards Wards No address Total 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 M F M F M F M F M F M M F M F M F M F M F M F M F All Forms - - - - - 1 - - - - 3 5 2 2 9 6 8 8 14 3 18 3 8 2 5 1 10 4 3 2 14 7 15 1 4 7 8 9 5 - 8 1 - - 67 31 Respiratory System - - - - - - - - - - 2 5 2 2 8 5 8 8 12 3 17 3 8 1 5 1 9 3 3 2 13 6 15 1 4 7 6 8 5 - 7 1 - - 62 28 Central Nervous System - - - - - 1 - - - - 1 - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - 1 1 Intestines and Peritoneum - - - - - - - - - - - - - - - - - 2 - 1 - - - - - - - - - - - - - - - - - - - 1 - - - 3 - Vertebral Column - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 1 - - - - - - - 1 Bones and Joints - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lymphatic System - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Genito Urinary System - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 1 Tuberculous Pericarditis - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - Disseminated Acute - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - „ not distinguished - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 33 Deaths from Tuberculosis—All ages. Death Rate per 1,000 of estimated population. Pulmonary 90 0.64 Other forms 8 0.06 98 0.70 Comparable figures for preceding years Year. No. of Deaths. Rate. 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 1.14 1946 98 0.75 1947 105 0.77 34 SECTION 3. Prevalence of, and Control over, Notifiable Diseases. The undermentioned diseases are compulsorily notifiable in St. Pancras :— A. Under the Public Health (London) Act, 1936 (Section 304)— Cholera. Continued Fever. Diphtheria. Enteric Fever. Erysipelas. Membranous Croup. Relapsing Fever. Scarlatina or Scarlet Fever. Smallpox (Variola). Typhoid Typhus Fever. B. Under Regulations made by the Minister of Health under powers contained in the Public Health Acts— Acute Encephalitis Lethargica (Regulation No. 2048, 1919). Acute Influenzal Pneumonia (Regulation No. 1207, 1927). Acute Primary Pneumonia (Regulation No. 1207, 1927). Dysentery (Regulation No. 1207, 1927). Malaria (Regulation No. 1207, 1927). Measles (Regulations 1100, 9th September, 1938 and No. 205, 9th February, 1940). Whooping Cough (Regulations No. 1100, 9th September, 1938 and No. 205, 9th February, 1940). C. Under London County Council Order—Public Health (London) Acts. Acute Polioencephalitis (1912). Acute Poliomyelitis (1912). Anthrax (1909). Cerebro-spinal Fever (1912). Glanders (1909). Hydrophobia (1909). Ophthalmia Neonatorum (1910).* * Also Minister of Health Regulations No. 971, 31st July, 1926; No. 419, 25th May, 1928; No. 35, 21st January, 1937. 35 D. Under Food and Drugs Act, 1938 (Section 17) (as amended by National Health Service Act, 1946, Tenth Schedule)— Food Poisoning. E. Under Public Health Act, 1936 (Section 143)— Plague (Regulations of Local Government Board, 1900). F. Under Public Health (London) Act, 1936, as amended by the London County Council (General Powers) Act, 1948— Puerperal Pyrexia. G. County of London (Scabies) Regulations, 1943. Scabies. H. Public Health (Tuberculosis) Regulations, 1931— Tuberculosis. (For information regarding removal to hospital, see " Ambulances," page 21.) (6594) 9C Notification of Infectious Diseases. Population 196,883 228,585 228,980 212,900 212,500 214,400 214,600 216,300 216,800 213,200 206,000 204,400 204,400 195,600 194,000 190,900 187,540 185,300 183,900 181,900 179,400 167,300 133,200 103,770 105,900 108,640 105,780 111,400 129,410 136,700 140,200 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Smallpox - 10 - - 1 - - - 1 - 3 87 175 4 5 - - - - - - - - - - - - - - - - 2. Scarlatina or Scarlet Fever 332 558 863 1713 1156 487 759 651 432 527 618 668 659 435 517 653 705 354 434 364 333 253 100 136 173 408 184 245 244 124 132 3. Diphtheria or Membranous Croup 399 348 747 723 725 512 623 704 523 390 407 374 568 334 301 363 456 440 487 614 374 157 84 118 101 99 58 104 94 41 37 4. Enteric or Typhoid Fever 17 7 18 28 14 20 12 16 15 21 21 16 7 13 8 5 6 7 11 10 7 6 7 12 3 2 1 5 5 2 1 5. Puerperal Fever 5 13 18 11 11 20 16 23 14 22 19 23 19 24 30 20 14 24 9 14 V 6 5 8 8 6 16 19 6 5 6 6. Puerperal Pyrexia - - - - - - - (g) 13 47 40 71 52 38 46 45 27 19 23 30 37 34 28 23 29 32 27 34 47 35 34 7. Erysipelas 121 134 126 87 118 92 108 117 80 98 97 110 120 96 117 121 156 92 81 64 86 51 50 43 56 72 56 60 53 38 46 8. Cerebro-spinal Meningitis 13 10 6 4 7 2 3 7 3 3 3 4 7 12 13 8 4 5 2 6 13 12 37 29 14 5 10 8 9 7 6 9. Anterior Poliomyelitis and Polioencephalitis 1 4 2 4 1 6 5 6 2 3 2 2 1 1 4 7 2 4 2 8 5 2 1 3 2 3 — 5 3 36 7 10. Ophthalmia Neonatorum 40 39 69 101 59 61 52 37 43 38 32 36 32 45 74 42 33 23 31 26 22 23 16 19 21 12 6 10 33 23 19 11. Encephalitis Lethargica (a) 3 11 8 5 5 45 24 11 9 8 4 6 2 — — 1 — — — — — — — — — 2 — — — — 12. Acute Influenza and Influenzal Pneumonia (b) 213 108 99 189 40 131 76 60 121 65 208 24 79 68 111 66 44 46 79 39 31 20 38 26 44 34 136 123 97 87 13. Acute Primary Pneumonia (b) 86 142 242 384 286 293 231 218 178 282 250 170 193 178 211 300 151 182 150 166 168 86 103 89 79 89 14. Malaria (e) 98 58 18 13 13 1 6 2 2 2 1 2 1 1 3 29 61 22 16 6 1 — — — 1 2 4 7 1 — 15. Dysentery 6 4 1 3 3 — 1 2 1 5 3 1 1 4 1 30 51 57 84 63 10 2 19 54 31 56 155 92 24 70 16. Measles 2144 1034 3093 1149 3728 327 4332 1233 3734 417 3876 591 3476 430 286o 437 3638 120 2975 H38 2337 85 285 616 1492 1082 798 1025 1115 902 1361 17. German Measles 311 268 195 81 253 134 270 877 143 60 83 1074 116 68 65 486 191 145 78 120 355 (d) - - - - - - - - - 18. Food Poisoning - - - - - - - - - - - - - (f) 16 28 22 10 22 65 8 4 1 7 2 15 3 8 9 7 2 19. Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20. Whooping Cough - - - - - - - - - - - - - - - - - - - (d) 113 626 46 342 480 439 575 183 511 484 363 21. Scabies - - - - - - - - - - - - - - - - - - - - - - - - (e) 546 931 887 699 300 138 22. Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 23. Anthrax 1 - - - - - - 1 1 1 - - - - - - - - - - - - - - - - - - - - - 24. Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Notes.—(a) Encephalitis lethargica compulsorily notifiable from 1st January, 1919 (S.R. and O. No. 1741, 1918). (b) Acute Primary and Acute Influenzal Pneumonia compulsorily notifiable from March, 1919 (P.H. (Pneumonia, Malaria, Dysentery, etc.) Reglns, 1919. (c) Malaria and Dysentery compulsorily notifiable from 1st March, 1919 (P.H. (Pneumonia, Malaria, Dysentery, etc.) Reglns, 1919). (d) Whooping Cough compulsorily notifiable and German Measles ceased to be notifiable from 1st October, 1938. (e) Scabies compulsorily notifiable from 1st August, 1943. (/) Food Poisoning notifiable 12th July, 1932 (L.C.C. (General Powers) Act, 1932). (g) Puerperal Pyrexia notifiable 1st October, 1926. 37 Cases Notified. Disease. Notifications Comparable totals for 1947 Under 1 1 and over Total for 1948 Acute influenzal and primary pneumonia 4 83 87 97 Anterior poliomyelitis and polioencephalitis 7 7 36 Cerebro spinal meningitis 2 4 6 7 Diphtheria and membranous croup 3 34 37 41 Dysentery 6 64 70 24 Enteric or typhoid fever — 1 1 2 Erysipelas 1 45 46 38 Food poisoning — 2 2 7 Malaria — — — 1 Measles 69 1,292 1,361 902 Ophthalmia neonatorum 19 — 19 23 Puerperal fever — 6 6 5 Puerperal pyrexia — 34 34 35 Scabies 3 135 138 300 Scarlatina or scarlet fever 1 131 132 124 Whooping cough 36 327 363 484 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:— Disease. Under 1 Over 1 Total Anterior poliomyelitis — 2 2 Cerebro-spinal meningitis — 1 1 Diphtheria and membranous croup 3 17 20 Dysentery — 2 2 Erysipelas — 2 2 Measles 3 6 9 Scarlatina or scarlet fever — 10 10 Whooping cough 3 2 5 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. There were 68 notifications of the former and 19 of the latter during 1948 (as compared with 62 and 35 respectively for 1947). Anterior Poliomyelitis and Polioencephalitis There were 15 actual cases of anterior poliomyelitis in St. Pancras during 1947, the year when England had one of its most serious outbreaks of this disease. During 1948 seven cases were notified, but in two cases the diagnosis was not confirmed. (6594) c 3 38 Cerebro-Spinal Meningitis. (Cerebro-Spinal Fever, Meningococcal Meningitis, " Spotted Fever.") Six cases were notified, and in all but one the diagnoses were confirmed. There was no death. Diphtheria and Diphtheria Immunisation. It will be noted that of the 37 cases of diphtheria notified 20 were unconfirmed. Therefore, the total number of cases of diphtheria which occurred in the Borough during the year was 17, compared with 21 in the previous year. The number of persons suffering from diphtheria in the Borough is small compared with previous years before immunisation had been accepted by the public. The immunisation of children is carried out at Welfare Centres and Day Nurseries, by general practitioners, and also by the London County Council Medical Officers at the day schools. Health Visitors have been in constant touch with parents of children under school age, for the purpose of securing immunisation. During the year, 2,126 children were recorded as immunised through the various channels mentioned, representing 86 per cent, of the births recorded, and the total number of St. Pancras children known to be immunised since the scheme commenced in 1936 is 16,824. The following graph shows the incidence of diphtheria over a period of 28 years and the number of immunisations since 1936:— DIPHTHERIA. CASES NOTIFIED NUMBERS IMMUNISED [To face page 38 39 The following table shows:— (a) The number of children born each year since 1923 (Column 2). (b) The number of those children who have been immunised (Column 3). (c) The ages of those children at 31st December, 1948 (Column 4). (d) The ages of those children at time of immunisation (Column 5). (e) The year of immunisation and totals immunised each year (Diagonal Columns). (/) The total immunised and the age distribution (Bottom line). 1 YEAR 2 BIRTHS 3 NUMBER IMMUNISED 4 AGE AT 31st DEC. 1947 5 AGE AT TIME OF IMMUNISATION TOTALS IMMUNISED YEAR 1936[] 0/1 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/10 10/11 11/12 12/13 13/14 14/15 233 193/###] - 617 1938 1923 4348 1 25-26 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 - 302 1939 1924 4112 5 24 - 25 .. .. .. .. .. .. .. .. .. .. .. .. 2 3 - 158 1940 1925 3800 9 23-24 .. .. .. .. .. .. .. .. .. .. .. 2 6 1 - 78 1941 1926 3612 12 22-23 .. .. .. .. .. .. .. .. .. .. 3 6 3 - - 590 1942 1927 3299 14 21-22 .. .. .. .. .. .. .. .. .. 1 8 3 2 - - 2694 1943 1928 3274 18 20-21 .. .. .. .. .. .. .. .. 5 4 4 2 1 2 - 2300 1944 1929 3170 59 19-20 .. .. .. .. .. .. .. 13 14 2 2 1 6 9 12 1172 1945 1930 3208 173 18-19 .. .. .. .. .. .. .. 35 7 1 1 6 27 75 10 1794 1946 1931 2955 223 17-18 .. .. .. .. .. 23 31 17 4 1 8 27 90 20 2 2478 1947 1932 2664 261 16-17 .. .. .. .. 31 56 15 9 2 4 36 79 21 3 5 2282 1948 1933 2589 329 15-16 .. .. .. 35 32 27 8 4 14 18 99 20 3 19 - 2126 .. 1934 2449 479 14-15 .. .. 60 93 40 14 4 33 63 118 18 5 28 2 1 .. .. 1935 2466 650 13-14 .. 43 158 46 21 7 29 153 108 27 4 48 3 3 .. .. .. 1936 2389 682 12-13 3 113 78 24 10 53 135 150 32 8 60 11 5 .. .. .. .. 1937 2364 784 11-12 8 55 40 12 79 242 171 64 10 72 21 10 .. .. .. .. .. 1938 2433 865 10-11 4 29 20 89 359 149 65 24 100 20 6 .. .. .. .. .. .. 1939 2187 967 9-10 2 14 151 404 174 61 28 101 21 11 .. .. .. .. .. .. .. 1940 1948 1247 8-9 1 108 691 183 64 66 97 28 10 .. .. .. .. .. .. .. .. 1941 1434 1233 7-8 8 494 430 79 73 92 38 19 .. .. .. .. .. .. .. .. .. 1942 1785 1154 6-7 36 442 332 189 93 42 20 .. .. .. .. .. .. .. .. .. .. 1943 1836 1122 5-6 20 349 514 151 61 27 .. .. .. .. .. .. .. .. .. .. .. 1944 1914 1143 4-5 10 836 191 66 40 .. .. .. .. .. .. .. .. .. .. .. .. 1945 1957 1382 3-4 30 1216 105 31 .. .. .. .. .. .. .. .. .. .. .. .. .. I946 2494 1364 2-3 205 1067 92 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1947 2793 1479 1-2 797 682 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1948 2447 1169 0-1 1169 TOTALS 16824 — 2293 5448 2862 1402 1127 858 652 650 390 287 210 220 197 138 30 Dysentery. 70 cases were notified during the year, all of which were St. Pancras residents, as compared with 24 for 1947. Bacteriological examinations were made in 54 cases, and all other cases were diagnosed clinically. The greatly increased number of cases was due to two outbreaks, one at a Day Nursery (12 cases in May) and the other at an institution in the Borough (10 cases in December). Encephalitis Lethargica. No cases were notified during the year, and no deaths occurred. (6594) c 4 40 Enteric or Typhoid Fever. There were no deaths. One case of paratyphoid was notified during the year. Erysipelas. 46 cases were notified, two were subsequently not confirmed, and no deaths occurred 1 as compared with 38 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. Two notifications were received during the year. There was no death. Malaria. No cases were notified and there was no death. 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 1 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. 129,410 1946 74 1,041 1,115 8.6 1 1 — — 2 1.8 136,700 1947 56 846 902 6.6 — 2 — — 2 2.2 140,200 1948 69 1,292 1,361 9.7 — l — — 1 0.7 41 Ophthalmia Neonatorum. The number of cases notified was 19, of which 16 were St. Pancras residents. All these cases recovered satisfactorily. The remaining three cases were ex-St. Pancras residents but were in-patients of St. Pancras hospitals when the disease occurred. Puerperal Pyrexia and Puerperal Fever. In 1948 there were 34 notifications of Puerperal Pyrexia and six notifications of Puerperal Fever. As from October, 1948, Section 50 of the London County Council (General Powers) Act, 1948, repeals Section 304 of the Public Health (London) Act, 1936, which included Puerperal Fever as a notifiable disease. Puerperal pyrexia is defined as— " any febrile condition occurring in a woman within twenty-one days after childbirth or miscarriage in which a temperature of 100-4 deg. Fahrenheit (38 deg. Centigrade) or more has been sustained during a period of twenty-four hours or has recurred during that period." Puerperal fever is defined as infection and fever resulting from pregnancy. It must be noted that in the case of puerperal pyrexia the disease is notifiable no matter what the cause of the raised temperature. Thus a woman developing a temperature of 102 deg. 42 as a result of influenza during the lying-in period would rightly be notified as a case of puerperal pyrexia, even although the influenza was not in any way resulting from the confinement. On the other hand, puerperal fever is the definite infection associated in some ways with parturition. Throughout the country there has been notification of puerperal pyrexia only and this latest regulation brings London into line with England as a whole. It will be realised that puerperal pyrexia includes puerperal fever. Scabies. It is pleasing to note that the incidence of scabies has lessened within the last few years. 138 cases were notified during the year 1948, as compared with— 300 in 1947. 699 in 1946. 887 in 1945. 931 in 1944. Scarlet Fever. The number of cases notified was 132 as compared with 124 during the previous year. Ten cases were not subsequently confirmed. The actual number of cases was therefore 122. No death occurred. Return Cases.—This term is applied to cases of Scarlet Fever which occur in a house within 28 days of the return from hospital of a previous case. There were only two 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 five families there were two such cases, and in one institution there were three cases. Smallpox and Vaccination. There was no case of smallpox in the Borough during the year 1948. 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, 1947. Number Percentage of Births registered North SouthEast Southwest Whole Borough North SouthEast Southwest Whole Borough Births registered 528 1,390 1,450 3,368 100.0 100.0 100.0 100.0 Successfully vaccinated 329 839 944 2,112 62.3 60.3 65.1 62.7 Died, unvaccinated 12 32 35 79 2.3 2.3 2.4 2.3 Had smallpox — — — — — — — — Insusceptible of vaccination 1 2 6 9 0.1 0.1 0.4 0.3 Received certificate of conscientious objection 121 189 217 527 22.9 13.7 15.0 15.6 Postponed by medical certificate 31 31 27 89 5.9 2.2 1.8 2.6 Moved to known address in other districts 21 260 173 454 4.0 18.7 12.0 13.5 Lost sight of by removal 4 14 31 49 0.8 1.0 2.1 1.5 Unvaccinated and not accounted for above 9 23 17 49 1.7 1.7 1.2 1.5 GRAPH A. All Births, including Inward Transferred Births. GRAPH B. [To face page 42 Inward Transferred Births only. This graph and the figures relate to vaccinations of inward transfers only, i.e., children born in hospitals in other boroughs, but resilient in St. Pancras. It will be noted that 71 per cent, were vaccinated. 43 The following are comparable percentages of successful vaccinations:— 1940 33.4 1941 43.6 1942 54.7 1943 57.2 1944 55.5 1945 55.5 1946 61.1 1947 62.7 It will be seen that the total number of children born in the Borough during 1947 was 3,368, a figure which includes not only births to St. Pancras residents, but to persons living in other boroughs who entered hospitals in the Borough for their confinement. Of these, 2,112 were vaccinated, a percentage of 62.7. The number of St. Pancras children born was 2,793, of which 1,919 were vaccinated, a percentage of 68.7. Whooping Cough, 363 cases were notified by medical practitioners, as compared with 484 for 1947 and 511 for 1946, and five were not subsequently confirmed. An additional 47 cases came to the notice Of the department and were visited. There was one death. 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 2 343 345 Tubercle bacilli 3 93 96 Faeces (Dysentery) 39 166 205 Faeces (Food Poisoning) — 15 15 Haemolytic Streptococci 1 1 2 Gram, negative diplococci and Trichomonas vaginalis 2 1 3 Pathogenic organisms — 8 8 Urethral smears — 3 3 Meat pie (Food Poisoning) — 1 1 Totals 47 631 678 44 CLEANSING, AND DISINFECTING. Cleansing. The number of attendances at the Council's Public Health Annexe during the year was as follows:— (1) Scabies. Men Women Children under 5 Schoolchildren Total 1948 Total 1947 St. Pancras 347 391 217 626 1,581 2,100 Ex St. Pancras 27 10 1 — 38 323 No fixed abode — 2 — — 2 — Totals 374 403 218 626 1,621 2,423 (2) Verminous Conditions. Men Women Children under 5 Schoolchildren Total 1948 Total 1947 Head lice St. Pancras 2 40 44 1,835 1,921 1,740 Ex St. Pancras — 3 5 — 8 536 No fixed abode — — — — — — Body lice St. Pancras 502 9 3 514 435 Ex St. Pancras 17 1 — — 18 23 No fixed abode 9 — — — 9 33 Totals 530 53 52 1,835 2,470 2,767 The majority of the children included in the above tables were brought 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. 45 Attendances at Public Health Annexe. 46 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 Sprayed and Fumigated Number of Rooms and Contents Rooms only Contents only Cerebro-spinal meningitis 6 6 — 2 Diphtheria 46 43 3 2 Dysentery 39 51 18 6 Enteric fever 2 1 2 — Erysipelas 34 5 2 34 Measles 48 3 4 41 Other diseases 458 21 8 434 Pneumonia 1 — — 1 Poliomyelitis 7 5 3 — Puerperal fever 3 3 — — Scabies 28 1 — 27 Scarlet fever 123 88 31 15 Tuberculosis 129 108 38 14 Vermin 673 18 1,329 57 Whooping cough 5 — — 5 Totals 1,602 353 1,438 638 47 SECTION 4. Sanitary Circumstances of the Area. Visits by District Sanitary Inspectors. Complaints received 7,136 On complaint— Whole house inspections 204 Part of house inspection 7,304 Part of house re-inspection 20,411 Infectious Diseases— Investigations 569 Inspections 25 Re-inspections 27 Smoke observations 31 Mews and Stable Yards 62 Shops Act inspections 209 Protection of food by-laws 5 Pharmacy and Poisons Act— First inspections 134 Subsequent inspections 35 Verminous persons 15 Blind persons 42 Housing Act and Regulations 5 Houses let in lodgings 1 Overcrowding Regulations 4 Underground rooms 324 Drainage— Under notice 1,726 Voluntary 3,474 New buildings 909 Licensed premises 263 Boiler plants 104 Outworkers 384 Housing applications 1,983 Other inspections 2,178 Ineffective visits 4,539 Rent Restrictions Acts 51 Police Courts 201 Total 45,209 Intimation Notices served— Rent Acts 20 Others 6,541 Statutory Notices served— General 3,431 Yard paving 30 Vermin 37 48 The following table gives a summary of this branch of the work of the department during the past four years:— 1945. 1946. 1947. 1948. Number of complaints received 3,832 5,689 7,550 7,136 Number of visits 17,251 29,578 37,375 45,209 Intimation notices served 2,709 4,487 5,760 6,567 Statutory notices served 1,388 2,580 3,912 3,498 Number of Police Court proceedings 17 57 133 212 Costs and /or fines 13 55 120 162 Amount of fines 1s. £3 £40 £166 Amount of costs £31 £86 £171 £229 The above police court proceedings were taken under the following statutes or regulations:— Public Health (London) Act, 1936 16 41 81 158 Housing Act, 1936 (L.C.C. Lodging House By-laws) 1 15 28 40 L.C.C. Water Closet By-laws — 1 11 5 Metropolis Management Acts (L.C.C. Drainage By-laws) — — 10 5 Public Health (London) Act, 1891 (Vestry By-laws) — — 1 3 Defence (General) Regulations', 1939, Scabies Order, 1941 — — 1 — Public Health (London) Act, 1891 (Rag Flock Regulations, 1912) — — 1 — L.C.C. Rag and Bone Regulations — — — 1 Drainage. The Sanitary Inspectors have the duty of supervising all work in connection with drains, including construction, reconstruction and repairs. During the year the following work has been carried out, and the figures for the previous three years are also given for the purpose of comparison:— Inspections. 1948. Inspections. 1947. Inspections. 1946. Inspections. 1945. Drainage work done under notice 1,726 1,858 1,135 690 Voluntary drainage work 3,474 3,378 3,538 1,079 Drains of new buildings 909 334 373 263 Total 6,109 5,570 5,046 2,032 49 Aged Persons. Section 47 of the National Assistance Act, 1948, came into operation on the 5th July, superseding Section 224 of the Public Health (London) Act, 1936, and makes provision for the purpose of securing the necessary care and attention for persons who— (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions ; and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. During the six months ended 31st December, 1948, no cases were dealt with by the department under this Section. Blind Persons. Number of Blind Persons on register in 1948 75 Removed to hospital during year (one after having had a home help for a time) 2 73 Living with relatives 41 Living alone 32 — 73 Totally blind 18 Partially blind 55 — 73 Conditions satisfactory (apart from housing) 58 Fair 13 Unsatisfactory 2 — 73 Notices were served on the landlord in 26 cases requiring work to be carried out, including in two cases a water supply, and in two other cases water was provided in the blind person's room by arrangement with the owner. All the blind persons were visited once during the year. The ages of the blind persons were as follows:— 80-89 14 70-79 22 60-69 14 50-59 9 40-49 6 30-39 3 20-29 2 19 1 5 1 Not known 1 73 A Home Help was provided in three cases. (6594) 50 Water. The Metropolitan Water Board supplies the bulk of the water in the Borough and it has been satisfactory in quality and quantity. In addition to the well which is available, if necessary, to augment the water supply to the Council's swimming baths at Prince of Wales' Road, there are four factories in the Borough drawing water from wells situated on their own premises. Records are required to be kept by these firms by the Water Abstraction Regulations, 1947, made under the Water Act, 1945, which makes provision for the conservation and proper use of water resources and supplies. Samples have been taken from these wells for chemical and bacteriological examination and also from water pumped from wells situated outside the Borough to various points on the railway system centred on Euston Station. These examinations have been carried out by the Public Analyst. Samples of water have also been taken regularly from the Council's swimming bath at Prince of Wales' Road and also from the open-air ponds at Ken Wood and Parliament Hill Fields and appropriate action taken where necessary. Pharmacy and Poisons Act, 1933. The following applications were received during 1948 for retention or entry in the Council's list of persons entitled to sell poisons included in Part II of the Poisons List:— Retentions 119 New entries 36 Total 155 169 inspections were made by the Council's sanitary inspectors during the year. Public Houses. During 1948 an attempt was made to improve the conditions under which the public obtain and consume their liquid refreshment. There are 238 public houses in this Borough, and during the course of their initial survey it was found that many of them were badly in need of improvement, both from an aesthetic and a hygienic point of view. In 33 instances only, the premises were extremely well conducted, and no faults could be found. 51 The following table gives some indication of the chief defects which were found to exist in the remainder:— Defects. Kitchen— (a) Dirty or defective walls or ceilings 47 (6) Defective flooring 6 (c) Larder unventilated or dirty, or inadequate storage space 22 Cellar— (a) Dirty or defective walls or ceilings 92 (b) Defective flooring 64 (c) Defective drainage, faulty sinks, etc. 32 Bars— (a) Dirty or defective walls or ceilings 85 (b) Defective flooring 13 (c) Other defects, e.g., glazing, ventilation, etc. 20 Behind Counters— (a) Absence or insufficiency of hot water supply 37 (b) Defective or untrapped sinks 31 Female Sanitary Accommodation— (a) Absence or insufficiency of W.Cs. or washbasins 46 (b) Dirty or defective 61 Male Sanitary Accommodation— (a) Absence or insufficiency of urinals or W.Cs. 33 (b) Dirty, insanitary, unscreened or unventilated 103 With regard to the disposal of beer spillings, in 60 cases the spillings were either thrown away or returned to the brewers, but in 64 instances they were re-sold after passing through a utilizer, and in the remainder the spillings were returned to the barrel after filtering by various methods, and then re-sold—an arrangement which cannot be looked upon favourably During the year 263 visits have been paid by the Sanitary Inspectors, and correspondence has ensued with the several brewers in order to overcome the various shortcomings. Rodent Control. In conjunction with the Ministry of Agriculture and Fisheries, rodent control was continued energetically throughout the year. It can be said that the heavy infestations which were apparent in 1945 have been eradicated and the long-term control of the persistent infestations by the investigation and repairing of defective drains constitutes the most important work of this service. Eight operatives and one Rodent Officer, working under the part-time supervision of a Sanitary Inspector were employed on rodent control. 1,981 premises were treated and 9,038 investigated. 12,418 visits were made for laying and checking prebaits and poison baits. With the co-operation of the Borough Engineer's Department, two sewer campaigns were undertaken, one of which was a double treatment, i.e., a complete treatment was carried out with one type of prebait and poison, immediately followed by a further treatment with a different prebait and poison. It is estimated that this work resulted in the destruction of approximately 13,500 rats. (6594) d 2 52 Burials. Section 50 of the National Assistance Act, 1948, placed upon the Borough Council, as from 5th July, 1948, the duty of causing "to be buried or cremated the body of any person who has died or been found dead in their area, in any case where it appears to the authority that no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority." During the period from that date to the end of the year 37 cases were dealt with, having come to the notice of the Public Health Department from the following sources:— Cases. Royal Free Hospital 6 St. Pancras Hospital 7 Highgate Hospital 6 National Temperance Hospital 1 Coroner's officers 13 Private persons 4 Mortuary and Coroner's Court. The St. Pancras Mortuary continues to be one of the busiest in London. The following table shows the routine work undertaken with, in brackets, the corresponding figures for 1947:— Post-Mortem Examinations. Received for Viewing only. Total. Resident and died in St. Pancras 206 (268) 1 (4) 207 (272) Died in St. Pancras, resident elsewhere 144 (175) 5 (9) 149 (184) Resident in St. Pancras, died elsewhere 41 (52) 2 (1) 43 (53) Resident and died elsewhere 488 (525) 40 (29) 528 (554) 879 (1,020) 48 (43) 927 (1,063) Accommodated for St. Pancras Hospital during rebuilding of Hospital Mortuary 37 (-) Total Number of bodies received 964 (1,063) 53 Houses and Flats Erected in the Metropolitan Borough of St. Pancras since 1919. Year. By St. Pancras Borough Council. By London County Council. By Commissioners of Crown Lands. By Private Enterprise. Annual Total. 1919 — — — — — 1920 — — — — — 1921 12 — — — 12 1922 254 — — — 254 1923 — — — 12 12 1924 — — — 108 108 1925 — — — 151 151 1926 — — — 50 50 1927 — — — 295 295 1928 44 — — 254 298 1929 44 60 — 258 362 1930 39 66 — 50 155 1931 — 69 — 30 99 1932 40 52 166 60 318 1933 — — 80 167 247 1934 64 63 98 258 483 1935 — 61 83 341 485 1936 106 — — 257 363 1937 53 108 128 181 470 1938 153 35 22 119 329 1939 234 — — 57 291 Totals erected between the wars 1,043 514 577 2,648 4,782 1948 134 — — 11 145 Housing. Requests were received from the London County Council for confirmation of statutory overcrowding in respect of 573 applications for re-housing. Inspections were made by the Council's Sanitary Inspectors and the prescribed forms forwarded to the London County Council in respect of these cases. (•594) d a 54 SECTION 5. Factories and Bakehouses. Particulars of inspections and other work carried out by the two Factory Inspectors during 1948 are given in the following table— Number of visits to— Factories (with mechanical power) 2,270 Factories (without mechanical power) 869 Workplaces 308 Bakehouses 440 Restaurants 1,129 Power laundries 17 Laundry receiving offices 79 Outworkers' premises 307 Scabies and vermin cases 3 Food control enquiries 23 Water sampling 19 Police Court 4 Other visits 205 Total 5,673 Intimation Notices served relating to Statutes under which served. Factories Act, 1937. Public Health (London) Act, 1936. Food and Drugs Act, 1938. Factories (with mechanical power) 125 93 8 Factories (without mechanical power) 31 22 1 Workplaces 19 26 1 Bakehouses 1 1 53 Restaurants and Canteens 2 8 118 Outworkers — — 1 Totals 178 150 182 Statutory notices served :— 74 were served under the Public Health (London) Act, 1936. 8 were served under the Factories Act, 1937. 14 were served under the Food and Drugs Act, 1938. 55 Factories Act, 1937. The following particulars are furnished in accordance with Section 128(3) of the above Act, with respect to matters under Part I and Part VIII:— Part I of the Act. 1. Inspections, etc. Premises Number on Register. Number of Inspections. Written Notices. Occupiers Prosecuted. (i) Non.power factories, in which Sections 1, 2, 3, 4 and 6 are enforced by Local Authorities 404 869 31 Nil. (ii) Power factories in which Section 7 only is enforced by the Local Authority 1,322 2,287 125 Nil. (iii) Other Premises, excluding out.workers' premises 519 387 19 Nil. Totals †2.245 3,543 175* Nil. * Not including 141 notices served under Public Health (London) Act, 1936, and 10 under Food and Drugs Act, 1938. † Does NOT include about 300 unoccupied premises formerly used for commercial purposes. 2. Cases in which defects were found. Particulars. Found. Remedied. Referred. Number of prosecutions. To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 121 121 1 4 – Overcrowding (S.2) – – – – – Unreasonable temperature (S.3) – – – – – Inadequate ventilation (S.4) 1 1 1 – – Ineffective drainage of floors (S.6) 3 3 – – – Sanitary Conveniences (S.7)— (a) Insufficient 12 12 – 3 – (b) Unsuitable or defective 83 83 – 11 – (c) Not separate for sexes – – – 2 – Other offences against the Act (not including offences relating to Outwork) – – 13 – – Totals 220 220 15 20 – (6594) D 4 56 Part VIII of the Act. Outworkers. In certain industries specified in the Act, if work is given out by employers or contractors to be done by workers in their own homes, lists containing the names and addresses of such workers must be forwarded to the Local Authority, with the object of preventing work being carried out in premises which are insanitary or in which infectious disease is present. The following table gives the number and type of such premises in the borough, and the nature of the work carried out:— Wearing apparel– Making, etc. 401 Household linen 24 Curtains and furniture hangings 2 Furniture and upholstery 13 Electro.plate 15 Fur pulling 11 Umbrellas, etc 1 Artificial flowers 8 Nets, other than wire nets 2 Paper bags 3 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 Brush making 7 Carding, etc., of buttons, etc 4 Stuffed toys 2 Chocolates and sweetmeats 1 Cosaques, Christmas crackers, Christmas stockings, etc. 10 Lampshades 1 Total 509 There were no instances of default in sending lists to the Council, nor was legal action taken in any case. 57 SECTION 6. Inspection and Supervision of Food. Particulars of the inspections and other work carried out by the Council's three Food Inspectors during 1948 are given in the following table:— Number of visits to— Milkshops 144 Dairies 466 Ice cream premises 935 Slaughterhouses 6 Butchers' shops and meat stalls 834 Prepared meat premises 519 Fishmongers' shops 206 Fried fish shops 140 Fish curers' premises 54 Other premises where food and drugs are sold 1,564 Market streets and places 1,413 Railway goods yards, warehouses 100 Attendances at Police Court 58 Re.inspection after Intimation Notices 302 Other visits 972 Total 7,713* Those visits do not include visits made for the purpose of taking samples. Number of samples taken— Formal 515 Informal 685 Bacteriological 345 Total 1,545 Unsound Foods:— Surrenders 460 Seizures 3 Intimation Notices served 111 Statutory Notices served 15 58 Milk Supply. The Number of purveyors on the Register at the end of the year were Dairies u2 Itinerant purveyors qq For sale of milk in sealed containers only ... ... ... 197 For sale of cream and artificial cream 9 59 Bacteriological Samples—Milk, 1948. T.T. (Past) . Past. Ster. H.T. Totals Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory L.C.C. Schools and Institutions – – 58 4 – – 4 – 62 4 Day Nurseries 1 – 8 – – – 11 2 20 2 Dairies 11 – 46 1 4 – 2 – 63 1 Totals 12 – 112 5 4 – 17 2 145 7 2. Ice Cream. 180 samples of ice cream were submitted for examiuation, the result being that 113 were regarded as satisfactory and 67 unsatisfactory. There is still no legal standard in regard to ice cream, but this bacteriological examination is an indication of the degree of purity. Where samples are consistently unsatisfactory action is taken to remedy defects in manufacture or handling, or to improve the cleansing and sterilisation of utensils used in the production of the ice cream. Almost invariably a higher grade product is the result. The importance of taking samples of ice cream for examination lies in the fact that it keeps manufacturers alive to their responsibilities. Generally speaking, they show a keen interest in the result of the examinations of their samples and have a genuine desire to aim at and to maintain a high standard. Where unsatisfactory samples of ice cream were manufactured outside the Borough I communicated with the Medical Officer of Health of the appropriate area to enable him to investigate the conditions under which the commodity was produced. The following table shows the detailed results of the examinations of ice cream samples during the years 1947 and 1948, and indicates that the improvement anticipated in my last report was achieved during the latter period:— 1947 1948 Samples % Samples % Satisfactory Grade I 17 22.3 75 41.7 Grade II 14 18.4 38 21.1 Unsatisfactory Grade III 23 30.3 31 17.2 Grade IV 22 29.0 36 20.0 Totals 76 100.0 180 100.0 60 There were also thirteen samples of synthetic bakery filling cream, taken from a very large manufacturer of this product in the Borough, which were reported to be very satisfactory from a bacteriological point of view. Legal Proceedings. The following 19 prosecutions were undertaken during 1948 in respect of food and drugs Food and Drugs Act, 1938. Court and Date of Hearing. Offence. Result of Proceedings. Marylebone 23.1.48 Marmalade intended for but unfit for human consumption Dismissed under Probation of Offenders Act. Costs refused. Marlborough Street 22.3.48 Lime juice cordial deficient in sugar and containing excess saccharin Summons withdrawn. Costs £2 2s. Clerkenwell 24.3.48 Milk adulterated by addition of 4.8 per cent. water Dismissed under Probation of Offenders Act. Costs £3 3s. Marylebone 31 3.48 Bread intended for but unfit for human consumption Dismissed under Probation of Offenders Act. Costs £10 10s. Clerkenwell 12.4.48 Milk adulterated by addition of 6.8 per cent. water Fine £2. Costs £2 2s. (Third Party proceedings.) Marylebone 26.4.48 Beef sausages containing only 24 per cent. of meat Fine £5. Costs £1 1s. Marlborough Street 3.6.48 Milk deficient in fat to extent of at least 11 per cent. Dismissed under Probation of Offenders Act. Costs £7 7s. Marylebone 9.6.48 Milk deficient in fat to extent of at least 9 per cent. Adjourned sine die. Costs £5 5s. Marylebone 29.7.48 Selling as malt vinegar a type which was otherwise Fine £2. Costs £3 3s. Do. Failure to cause ice cream wafer holder to be kept in a clean state Fine £5. Costs £2 2s. Do. Milk from which fat abstracted by at least 14 per cent. Dismissed under Probation of Offenders Act Costs £3 3s. Marylebone 14.9.48 Contaminated broken biscuits Dismissed under Probation of Offenders Act. Costs £2 2s. Clerkenwell 5.10.48 Selling as malt vinegar a type which was otherwise Case discharged under Probation of Offenders Act on payment to Council of £10 10s. costs. Clerkenwell 12.10.48 Dirty bakehouse Plea of guilty. Fine £10. Costs £3 3s. Clerkenwell 12.11.48 Cake unfit for human consumption Pleaded guilty. Dismissed under Probation of Offenders Act. Costs £2. Marylebone 17.11.48 Bread roll unfit for human consumption (glass) Plea of guilty. Fine £2. Costs £1 1s. Marlborough Street 25.11.48 Defective and dirty condition of food store Plea of guilty. Local Authority congratulated on taking action. Fine £15. Costs £15. Clerkenwell 22.12.48 Defective floor, window ceiling of food store Summons withdrawn. Work done. Costs £2 2s Marlborough Street 31.12.48 Ice cream wafer holder not in clean state Plea of guilty. Fine £4. Costs £3 3s. 61 Unsound Food Condemned and Destroyed. During the year 1948, the undermentioned unsound or diseased food was surrendered by the owners and dealt with by the Food Inspectors. Wherever possible the food was used for cattle feeding. Articles. Quantity. Articles. Quantity. Apples 163 lbs. Marmalade 8 lbs. Apricots (dried) 8 lbs. Meat pies 14 lbs.+220 Apricot Pulp 25 gallons + 15 cwt. Meal rusk 14 lbs. Bacon 31½ lbs. Mutton 3 lbs. Barley 7 lbs. Oatmeal 20 lbs. Beef 580 lbs. Oranges 164 Biscuits 158 pkts. Ox kidneys 11 lbs. Black Pudding 118 lbs. Ox.tongue 16½ lbs. Butter beans 54 lbs. Pears 4,450 lbs. Cake extender 2 cwts. Peas 15 lbs. Cake flour 48 doz. pkts. Pepper 6 doz. pkts. Canned food 3,841 tins. Pickles 139 jars. Cereals 10 doz. pkts. Pigs lungs (lites) 2 sacks. Cheese 1½ lbs. + 12 cartons. Pork 21½ lbs. Chicken 273 lbs. + 1 case. Pork (canned) 62 lbs. Chocolate 1½ cwts. Potatoes 1¾ cwts. Compound fat 112 lbs. Poultry 1 hamper Confectionery 92 lbs. Prawns 67 lbs. Corned beef 712 lbs. Prunes 175 lbs. Corn flakes 2 lbs. Rabbits 1,080 lbs. Corned mutton 24 lbs. Rice substitute 20 lbs. Crabs 1 crate. Rolls 118 Crows 7 sacks. Salt 2 cwts. + 6 doz. Crumpets 2,400 lbs. pkts. Dates 41 lbs. + 24 pkts. Sausages 186 lbs. Ducks 10 lbs. Sausage meat 50 lbs. Egg powder 36 pkts. Short paste 11 cwts. Eggs 700. Soup cubes 1,416 tins Fish 555 stone. Spaghetti 2 cwts. Fishcakes 72 Spring cabbages 1 ton 13 cwts. 1 qtr. Flour 157 lbs. Sugar 303 lbs. Galantine 12 lbs. Tart bases 11,400 Geese 47 lbs. Tarts 7,000 Gravy browning 4 pints + 15 pkts. Tea 106 lbs. Gravy powder 7 lbs. Tomatoes 2,860 Hares 1 cwt. Tomato juice 322 galls. Ice cream powder 98 lbs. Tomato ketchup 6 botts. Jam 75 lbs. Tomato puree 500 lbs. Kippers 32 stones. Turkey 4 lbs. Macaroni 8 lbs. Veal 16 lbs. Margarine 265 lbs. Yeast 9¾ lbs. 62 SECTION 7. Maternity and Child Welfare. The Maternity and Child Welfare services and staffs passed to the control of the London County Council as from 5th July, 1948, when the National Health Service Act came into force, and the statistics and particulars given in this Section, so far as 1948 is concerned, refer to the period 1st January to 4th July only, except where otherwise stated. Notification of Births. Under the Public Health (London) Act, 1936, a medical practitioner attending a woman in her confinement is required, within 36 hours, to give notice to the Medical Officer of the local Health Authority of the occurrence of the birth of a child, alive or dead . . . unless he (or she) has reason 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 to the local Registrar of Births and Deaths within 42 days of the birth. Prior to 4th July, 1948, such notifications were required to be made to the district Medical Officer of Health, and the number notified for the six months of the year to that date was as follows:— Births (live and still) notified as having taken place in St. Pancras 1,638 Less non.residents born in the borough 918 720 Add St. Pancras residents bom outside the borough 696 Total St. Pancras births notified 1,389 Six of these were still births, leaving a net figure of 1,383 live births notified during the six months to 4th July, 1948. 63 Health Visitors. The number of Health Visitors employed at the 4th July, 1948, was— (a) by the Council, 20. (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 1947 (whole year) and 1948 (six months only):— Council's Visitors University College Hospital Visitors Total 1947 1948 1947 1948 1947 1948 To Expectant mothers 2,431 1,681 180 92 2,611 1,773 To Post natal 736 380 78 49 814 429 To Children 19,507 12,128 1,222 746 20,729 12,874 To Child life protection 367 151 53 24 420 175 To Infectious diseases, etc. 1,491 1,292 48 23 1,539 1,315 To Other visits 1,247 893 22 1 1,269 894 Totals 25,779 16,525 1,603 935 27,382 17,460 Dental Treatment. Ampthill Square Camden Town Sessions 22 73 Attendances— Mothers 130 767 Children 110 183 The Borough Council made a contribution during the period of £116 8s. towards the cost of dentures supplied to. Nursing and Expectant Mothers. 64 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 1948 1947 1948 1947 1948 1947 1948 1947 1948 1947 1948 1947 1948 1947 1948 1947 1948 1947 Ante.natal sessions 54 60 79 107 52 94 48 101 25 50 27 51 285 463 104 203 389 666 First attendances 102 243 192 398 120 314 140 394 116 625 60 109 730 2,083 196 397 926 2,480 Subsequent attendances 545 908 1,040 1,887 804 1,597 871 1,926 361 706 303 618 3,924 7,642 1,447 3,682 5,371 11,324 Post.natal sessions – 1 – 21 – – – – – – – – – 22 – – – 22 First attendances – 8 – 273 – 4 – 12 – – – – – 297 – – – 297 Subsequent attendances – 1 – 16 – – – 1 – – – – – 18 – – – 18 Infant Sessions 51 99 105 203 100 151 77 153 78 129 52 100 463 835 53 102 516 937 *First attendances, age 0.1 135 255 291 534 196 470 231 471 189 332 77 203 1,119 2,265 45 89 1,164 2,354 Subsequent attendances, age 0.1 1,444 2,964 3 791 6,578 3,139 6,325 2,454 5,526 2,534 4,754 1,520 3,249 14,882 29,396 557 802 15,439 30,198 *First attendances, age 1.5 12 31 38 61 21 32 18 2.1 10 31 4 12 103 191 21 19 124 210 Subsequent attendances, age 1.5 558 972 1,205 1,863 1,490 1,765 598 1,003 859 1,685 921 1,545 5,631 8,833 322 382 5,953 9,215 Total attendances 2,149 4,222 5,325 9,036 4,846 8,592 3,301 7,024 3,592 6,802 2,522 5,009 21,735 40,685 945 1,292 22,680 41,977 Dental Clinic sessions 22 36 73 93 – – – – – – – – 95 129 – – 95 129 Attendances— Mothers 130 220 767 1,226 – – – – – – – – 897 1,446 – – 897 1,446 Children 110 140 183 231 – – – – – – – – 293 371 – – 293 371 Massage sessions 50 91 53 102 32 91 47 97 43 92 40 92 265 565 – – 265 565 Massage attendances 254 296 317 795 212 418 282 650 237 587 256 616 1,558 3,362 – – 1,558 3,362 Gynæcoloeical clinics— First attendance – – – – 112 159 – – 63 – – – 175 159 – – 175 159 Subsequent attendances – – – – 204 296 – – 76 – – – 280 296 – – 280 296 Dinner Mothers 705 2,347 – – – – – – – – – – 705 2,347 – – 705 2,347 Children 562 2,464 – – – – – – – – – – 562 2,464 – – 562 2,464 • Excluding transfers from other centres. 1948 figures are for six months only. 65 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.1. North London (Islington) Nursing Association, 6 and 7, Canonbury Place, N.l. The Borough Council had 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. An additional arrangement with the Metropolitan District Nursing Association covered the home nursing of cases of Puerperal Fever and Puerperal Pyrexia. Payment for this nursing was included in block grants made by the Council, which for the six months ended 4th July, 1948, were as follows:— District Nursing Association Under the Maternity and Child Welfare Scheme Under the Influenzal Pneumonia Regulations Total Block Grant £ s. £ s. £ s. Hampstead 10 0 5 0 15 0 Metropolitan 93 15 31 5 125 0 North London 7 10 5 0 12 10 Totals 111 5 41 5 152 10 The following table gives the number of cases and the number of visits during the same half.year:— District Nursing Association No. of Cases No. of Visits Hampstead 46 449 Metropolitan 71 596 North London 23 202 Totals 140 1,247 Midwifery Grants. Assistance was accorded to the University College Hospital where a St. Pancras mother was accepted for her confinement and was unable to pay the sum of £3 per week. This assistance, to a maximum of £1 per patient admitted to the hospital, was granted only in approved necessitous cases. Between 1st January and 4th July, 1948, there were 37 cases, at a cost to the Borough Council of £34 16s. An agreed sum of £7 7s. per call was also paid to this hospital in respect of the use of an Emergency Obstetric Unit which was called upon on four occasions during the half year. (6594) E 66 Provision of Beds for Maternity Cases. By arrangement with the London County Council eight maternity beds were available for St. Pancras cases at the University College Hospital. These beds were filled by cases referred to the hospital by the Borough Council, and the London County Council paid an agreed sum for their retention. 95 cases were accommodated between 1st January and 4th July, 1948. Invalid Children's Aid Association. Under this scheme assistance was rendered towards the cost of convalescence of St. Pancras children under the age of five years, with a maximum of 70 cases per annum. The financial arrangements provided for a payment of 75 per cent. of the amount outstanding after allowing for any payments by parents. During the period ended 4th July, 1948, 20 children were so assisted at a cost to the Council of £196 1s. 5d. Home and Domestic Helps. The Council had in its employ 37 full.time home helps and 17 part.time, and 252 cases (157 sickness, old age, etc., 95 maternity) were cared for during the six months ended 4th July, as compared with 158 during the year 1947. Care of Premature Infants. Prematurity today is deemed to exist when the birth weight of a baby is 5½ lb. or less, and is not now reckoned in accordance with the date of birth as compared with the expected time of confinement. During the six months ended 4th July, 1948, doctors and nurses notifying births of children continued to co.operate by informing the Medical Officer of Health of the weight of children at birth, and those designated as premature were visited frequently by the Council's Health Visitors, who submitted monthly reports until such time as the infant weighted 8 lb. The following table gives particulars in respect of the half year:— Where born. Number Born. Died in 24 hours. Died between 24 hours and 1 month. Survived. Removed to other Boroughs. At home 2 – – 2 – In hospital 87 3 4 69 11 Totals 89 3 4 71 11 Child Life Protection. During the course of the half year 15 women notified their intention to accept foster children, and these notifications were in respect of 25 children under nine years of age receive during the year, the number at the end of the year being 20. Health Visitors paid 175 supervisory visits in their capacity as Infant Life Protection Visitors. 67 Daily Guardians. At the 4th July, 1948, there were 15 persons having the care of 16 children under this scheme, and the total number of visits made by the Council's Health Visitors during the half year to that date was 96. Care of Illegitimate Children. A block grant of £217 was paid to the Metropolitan Boroughs' Standing Joint Committee in respect of the following five voluntary societies who make arrangements for the care of the unmarried mother and her child:— London Diocesan Council for Moral Welfare Work. Southwark Diocesan Council for Moral Welfare. Westminster Catholic Social Welfare Committee. Diocese of Southwark Moral Welfare Committee. Jewish Association for the Protection of Girls, Women and Children. In no case was the Council asked to make a contribution towards the cost of caring for an illegitimate child placed with a foster mother in the district. Child Guidance. An arrangement continued with the Great Ormond Street Hospital, for children recommended by the Council to receive treatment at the hospital's child guidance clinic. Foot Clinics. Clinics for chiropody treatment were provided at Somers Town and South Highgate Welfare Centres. This service, previously limited to children and expectant and nursing mothers, was , during the month, extended to all female residents of the Borough. 68 SECTION 8. Tuberculosis. Particulars of all new cases of Tuberculosis and of all deaths from this disease during 1948 are given in the following table in the form required by the Ministry of Health:— Age Periods New Cases Deaths Pulmonary Non.Pulmonary Pulmonary Non.Pulmonary M. F. M. F. M. F. M. F. 0.1 year 1 – – – – – – – 1.5 years 2 5 – – – – – 1 5.15 years 8 6 6 7 – – – – 15.25 years 29 24 2 3 4 7 1 – 25.35 years 39 23 5 3 8 5 1 1 35.45 years 23 7 3 1 8 8 – – 45.55 years 28 5 1 2 12 3 2 – 55.65 years 15 7 – 1 17 3 1 – 65 and upwards 13 3 2 – 13 2 – 1 Totals 158 80 19 17 62 28 5 3 The total number of Primary notifications was 274; in addition to these, 14 cases, which had not been notified, came to knowledge by means of special death reports, and 75 cases by transfer from other districts. The total number of new cases during the year from all sources was therefore 363, equal to a notification rate of 2.58 per 1,000 of population, compared with 361 new cases during the previous year, with a notification rate of 2.64 per 1,000 population. The deaths from all forms of Tuberculosis during the year numbered 98, equal to a death rate of 0.69 per 1,000 of population, whereas the total number of deaths in the previous year was 105, with a death rate of 0.77 per 1,000 population. It will be noted that, out of a total of 98 deaths from Tuberculosis, 14 (being 14 per cent.) were of cases which were notified only at death. 69 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 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. The interval elapsing between notification and death is some 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, 1948.* Year of Notification. Total. Percentage. 1948— Discovered on death 14 13.9 Six months or less before death 37 36.7 Between six and twelve months before death 1 1.0 1947 9 8.9 1946 9 8.9 1945 8 7.9 1944 9 8.9 1943.1939 7 6.9 Before 1939 7 6.9 Total 101* 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. 70 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 0 1 5 10 15 20 25 35 45 55 65 and upwards Total to to to to to to to to to to 1 5 10 15 20 25 35 45 55 65 Pulmonary— Males 1 2 3 5 7 22 39 23 28 15 13 158 Females – 5 4 2 9 15 23 7 5 7 3 80 Non.pulmonary— Males – – 2 4 1 1 5 3 1 – 2 19 Females – – 4 3 2 1 3 1 2 1 – 17 Totals 1 7 13 14 19 39 70 34 36 23 18 274 Age Periods Information obtained from Special Death Reports, by Transfer from other districts, and by Posthumous Notifications 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Pulmonary— Males – – – – 1 5 10 14 9 2 4 45 Females 1 – – – 3 10 13 2 2 1 1 33 Non.pulmonary— Males – – 1 1 – 2 – 2 – – – 6 Females – 1 – – 1 – 1 – – – – 3 Totals 1 1 1 1 5 17 24 18 11 3 5 87 71 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 j Pulmonary Other forms All forms Pulmonary Other forms All forms Pulmonary Other forms All forms 1939 167,300 310 44 354 118 12 130 1.87 0.26 2.13 0.70 0 .07 0.77 1940 133,200 292 45 337 144 16 160 2.19 0.33 2.52 1.08 0.12 1.20 1941 103,770 283 40 323 113 10 123 2.72 0.38 3.10 1 .08 0.09 1.17 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 1947 136,700 320 41 361 96 9 105 2.34 0.30 2.64 0.70 0.07 0.77 1948 140,200 318 45 363 97 4 101 2.27 0.32 2.59 0.69 0.03 0.72 Notification Register. The following table gives the information for the year ended 31st December, 1948, in the prescribed form:— Pulmonary Non-Pulmonary Total Number of cases on the Register at the commencement of the year 1948 1,069 156 1,225 Number of new cases during the year 338 53 391 1,407 209 1 616 Number of cases removed from the Register during the year (by death or other causes) 279 32 311 Number of cases remaining on the Register at the end of the year 1,128 177 1,305 PRINTED BY HARRISON AND SONS, LTD., ST. MARTIN'S LANE, LONDON (6594/49)