STPAN 104 Borough of Saint pancras REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1949 DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. Borough of Saint pancras REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1949 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 Committees and Officers 13 Section 1.—General Information 16 Section 2.—Population, Births and Deaths 21 Section 3.—Notifiable Diseases 33 Section 4.—Sanitary Administration 45 Section 5.—Factories, &c 55 Section 6.—Inspection and Supervision of Food 58 3 INDEX. PAGES Aged persons, care of 9 Ambulance facilities 20 Analyst, Public 15 Area of borough l6 Bacteriological examinations 41, 60 Bakehouses, Visits to 55 Basement rooms 47 Births— illegitimate 21, 27 numbers and rates since 1918 26 rates 4, 21, 24, 26 registered live, and rate 4, 21 registered still, and rate 21, 27 still—numbers and rates since 1929 27 Blind persons, care of 51 Bodies received at mortuary 53 Burials 52 Cancer, Deaths from 29 Chief officers of the Council 13 Cleansing and disinfecting 42 Clerical staff 15 Climatological summary 17 Closing and demolition orders 47 Committee, members of 13 Complaints 45, 46 Condemned food 62 Coroner's Court 53 Day nurseries 19 Deaths— bronchitis 30 cancer 29, 30 classification, with age distribution 22 heart disease 30 illegitimate children 23, 27 infantile deaths and rates 23, 26 infantile, with causes, age and ward distribution 24 infantile, with causes, since 1939 25 maternal 28 measles 37 neo-natal 26, 27 number and rate, all ages 21, 26 pneumonia 30 tuberculosis 30, 31, 32, 38, 39, 40 Diphtheria and Diphtheria immunisation graph 34 Disinfection 44 Drainage work 46 Factories Act, 1937 56 Factories and bakehouses 55 Factory Inspectors 15 Factory Inspectors, work of 55 Flats erected 948 Food— condemned 62 inspectors 15 inspectors, work of 58 sampling 60 summonses 61 unsound 58, 62 Foreword by M.O.H 4 General information 16 Hospitals in the Borough 19 Houses and flats erected 48 Housing 10, 48 Ice cream 59, 60 Infantile mortality 9, 23 causes, age and ward distribution 24 causes, since 1939 25 numbers and rates since 1918 28 PAGES Infantile mortality—continued. rates 23 Infectious diseases 33 Infectious diseases—notifications 35,36 Inspectors—housing, food, factory and district 15 Legal proceedings 46, 61 Licensed premises 10, 50 Marriages 18 Maternity and Child Welfare centres 18 Measles 37 Meat and other foods—inspections 59 Milk : inspections, samples, etc. 59 Mortality, infantile—see Infantile mortality. Mortuary and Coroner's Court 53 National Assistance Act, 1948 51 Notices served 45, 55, 58 Notifiable diseases 33 Notifications—infectious diseases 35 Nurseries, Day 19 Outworkers 10, 57 Persons per acre (estimated average) 16 Pharmacy and Poisons 47 Poliomyelitis and polio-encephalitis 4 Population 4, 16, 21 Population, since 1918 26 Post-mortem examinations 53 Prevention of Damage by Pests Act, 1949 53 Public Analyst 15 Public Health Annexe—attendance at 42 Public Health Committee members 13 Public Health (Tuberculosis) Regulations, 1930 38 Public houses 10, 50 Rat extermination 53 Rateable value and general rate 16 Registrars of births, deaths and marriages 14 Rodent control 53 Sanitary administration 45 Sanitary inspectors 15 Sanitary inspectors, work of 45 Scabies 42, 43 Scarlet fever 5 School treatment centres 20 Smallpox and vaccination 5 Staff 15 Statistics, Vital 18, 21, 26, 27 Stillbirths 21, 27 Summonses—see Legal proceedings. Tuberculosis— Death rates 32, 40 deaths 30, 31, 39, 40 chest clinic 19 Medical Officer of Health's report 6 new cases 38 notification register 41 notifications 38 prevalence and fatality for past eleven years 40 Underground rooms 47 Unsound food 62 Verminous persons 42, 43 Vital statistics 18, 21, 26, 27 Water 47 Welfare centres 18 Whooping cough 33 4 Town Hall, Euston Road, N.W.1. July, 1950. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Saint Pancras. Your Worship, Ladies and Gentlemen, I have pleasure in presenting to you my annual report for the year 1949, the sixth it has been my privilege to place before you. Since the passing of the National Health Service Act, 1946, attention has been focused on disease rather than health; on the cure of sickness rather than on its prevention, despite the fact that it is better to keep a person well and out of hospital than to give him expert treatment once he enters. These pages therefore refer to preventive medicine, to problems of infectious disease, including poliomyelitis and tuberculosis, to the prevention of smallpox, the care of those who work in their homes, and to details of work concerned with factories, workshops, the preparation of food, and general sanitary problems. I have made a few comments on the serious housing situation in the borough, and to the need for a service to care for the aged—matters which are receiving our urgent attention, but the work that lies before a public health department in a central London borough in improving the health and the happiness of its citizens is limitless in its scope. The population of the borough in the middle of 1949 was 141,330—an increase of 1,130 in one year. The lowest population recorded in recent years in St. Pancras was in 1941 when it was 103,770. Since then there has been an increase of nearly 40,000 individuals living in the borough. Most of this increase, however, has occurred since the end of the war in 1945, and this means that the Council has had to plan the post-war reconstruction of its social services against a steadily increasing population. The number of births in the borough, at 2,290, is 157 less than last year; the birth rate has fallen by 1.2 to a figure of 16.2. Poliomyelitis. The year was marked by an outbreak of infantile paralysis (poliomyelitis). During the course of 1949 there were 66 notifications, in 45 of which the diagnosis was confirmed after admission to hospital, laboratory tests and consultants' opinion. London has suffered from two outbreaks of poliomyelitis in recent years, one in 1947 and the other in 1949. The number of cases that were notified in St. Pancras in 1947, was 36. In 1949 it was 66. This disease is associated with an incubation period of about 10 to 20 days, an acute febrile illness resulting in paralysis in 50 per cent, of the cases. In probably 50 per cent, the paralysis is to some extent permanent. The fact that we have had two epidemics within so short a period has given rise to the fear that in England the disease may be assuming a recurrence similar to that which appertains in the United States of America. During the course of the year my attention was drawn to the fact that two children aged 10 months had developed paralysis within two or three weeks of receiving a combined injection against whooping cough and diphtheria. This caused me to investigate all the cases recently notified 5 in the Borough, as a result of which it appeared that 6 children in all had contracted poliomyelitis within 22 days of immunisation. Telephone conversations to my colleagues, the Medical Officers of Health in other Boroughs in London, showed that similar instances were occurring elsewhere. The combined vaccine was withdrawn during the epidemic. Further investigations were carried out in which I had the help of every Medical Officer of Health in London. At that time there had been 359 cases of poliomyelitis in London, and 182 of the patients were under 5 years of age. 30 had developed poliomyelitis within 4 weeks of being immunised against diphtheria and/or whooping cough, paralysis affecting the limb of injection. In 21 cases a combined vaccine had been used, in 8 cases a vaccine protecting from diphtheria alone. In one case the vaccine was against whooping cough. Since I prepared the report on this subject similar occurrences have been reported from Australia, and an association between inoculation and the paralysis of poliomyelitis has been accepted. There is no suggestion that vaccine causes infantile paralysis. All that can be said is that it can activate paralysis in children carrying the virus of the disease. It must not be thought for one moment that immunisation alone can cause this event. It can result from injections of any description and from minor surgical operations such as the removal of tonsils and adenoids, removal of teeth, and the like. I have had one serious case following upon an operation for appendicitis. It is customary to cease operations for removal of tonsils and adenoids during the period of a poliomyelitis epidemic, and minor operations might well be postponed unless they are of urgent necessity. Should poliomyelitis unfortunately occur again in this country the postponement of immunisation might well be considered in an area where the disease is existing in epidemic form, but such postponement should most definitely be temporary and it would be a tragedy if such temporary postponement led parents to deprive their children of the very definite advantage which can be given to them by protection from diphtheria. In this respect I would call attention to the fact that in the whole of St. Pancras during 1949 there were only two confirmed cases of diphtheria. The public has naturally shown much concern as to the co-relation between injection and paralysis. It must be remembered, however, that the cases that have occurred are few, that the possibility has always been recognised, and that it is not so very long since, in the absence of immunisation against diphtheria 3,000 children were dying from diphtheria every year in England and Wales. In the worst epidemic of poliomyelitis that has occurred in this country, which was in 1947, the total number of persons who died was about 688. That the public should understand the situation is right. Truth is valuable even at high price, possibly at any price, but a sense of proportion is essential and can be expected from a well informed, understanding, public. It is hoped that the co-relation between local stimulus and paralysis as indicated by the work carried out in St. Pancras with the help of the Medical Officers of Health of London may show a line of research into the causation of this disease which may lead in due course to its prevention. All information concerning poliomyelitis, about which so little is yet known, must ultimately be of advantage. Smallpox. Since July 1948 vaccination against smallpox has not been compulsory in this country and I think a time has come when we are entitled to consider the results of this new policy. In the year 1947, when vaccination was compulsory, 68.7 per cent, of the children normally resident in this Borough were vaccinated within a few months of birth. What the figure is for 1949 I do not know, but by and large throughout the country the percentage of vaccinated children has dropped to 18-20 per cent., and I have seen nothing to indicate that the figure is any better in the Borough of St. Pancras. The risk of smallpox, however, is still present. 6 During 1949 there was one case of smallpox in St. Pancras. Fortunately we became aware of it before infection could be spread, but this happy state of affairs cannot always be expected. It must be remembered, moreover, that three main-line stations bring persons into the area of St. Pancras every day in the week and to that extent we resemble a port authority. During the early months of 1950 cases of smallpox occurred in Glasgow, and as a result I was repeatedly asked to give an opinion on doubtful cases arriving in St. Pancras from all over the country,. and also from abroad. As things stand, I can only advise parents to take advantage of the facilities available to them to have their children vaccinated. I have severe doubts as to the widom of making vaccination non-compulsory. Scarlet Fever. It was suggested during the year that scarlet fever, which for many years had taken on a benign character, was once more becoming virulent and, accordingly, towards the end of the year I investigated 80 cases notified to me to see whether this was the position. 42 cases were nursed at home. They were all mild, although one was complicated by chickenpox. 38 cases were removed to hospital. Of these, two were severe, one was complicated by convulsions, one by enlarged tonsils and one by a weak heart. The complicated cases were removed to hospital on account of complication, but the two severe cases were removed owing to home conditions, as were the other 33 cases. From this small survey I came to the conclusion that scarlet fever had not shown any increased virulence in the Borough of St. Pancras. Tuberculosis. The number of persons suffering from tuberculosis at the beginning of the year was 1,305. This had increased by 51 to a total of 1,356 by the end of the year. I do not think this indicates a real increase in the number of tuberculous persons in the Borough, but better and, I trust, earlier diagnosis. The number of cases notified to me during the year was 352. This included not only cases notified for the first time but persons already suffering from tuberculosis who moved into the Borough during the year. Tuberculosis remains one of the endemic diseases of this country, and it would appear that, in the Borough of St. Pancras, nearly one per cent, of the population' has already been notified as suffering from the disease. I therefore thought it wise during the year to review the Council's duties in connection with tuberculosis and to investigate the conditions under which persons notified during the year were living and to see what steps might be taken to improve their environment. A survey was conducted in the compilation of which I had the help of two of your Sanitary Inspectors, Mr. Cryer and Mr. Engledow. In view of the importance of drawing attention to the powers of a Borough Council in preventing tuberculosis and in order that I may give you some indication of what has been achieved, I am setting out in full in this foreword the report which we presented to the Public Health Committee. It is as follows:— Review of Council's duties. Before the passing of the National Health Service Act of 1946 local authorities had authority under Section 173 of the Public Health Act, or section 219 of the Public Health (London) Act, to make arrangements for the treatment of tuberculosis. In that these two sections have been repealed by the National Health Service Act there has been some impression that all duties in connection with persons suffering from tuberculosis live been transferred to the regional hospital boards, and that the after care of the tuberculous person rests 7 entirely with the county or county borough council as local health authority, deriving its powers from section 28 of the National Health Service Act (Prevention of illness, care and after care). This impression is incorrect, for certain and definite duties rest on local authorities and medical officers of health in accordance with the Public Health (Tuberculosis) Regulations of 1930. These duties may be summarised as follows : The Medical Officer of Health of a local authority must keep a register of persons suffering from tuberculosis who are resident in the area for which he is responsible, and must pass relevant information to the County Medical Officer of Health and to the Medical Officers of Health of other local authorities. On receipt of a notification he must make " such enquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection The local authority may, on the advice of their Medical Officer of Health "supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of tuberculosis, for preventing the spread of infection and for removing conditions favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary ". The local authority may also provide and publish or distribute information concerning tuberculosis and precautions to be taken against the spread of infection. These requirements of the Public Health (Tuberculosis) Regulations give Metropolitan Boroughs and District Councils considerable opportunity for controlling and preventing tuberculosis. It must be remembered that this disease is associated largely with two factors : (1) The provision of an adequate and satisfactory supply of food ; and (2) The environment under which a population is living. National policy is determining the question of food. Improvement of environmental conditions rests largely with the Metropolitan Boroughs and District Councils. Procedure. Following upon the receipt of notification, information is passed to Dr. G. A. Back, Tuberculosis Officer and Chest Physician in the Borough of St. Pancras. As soon as a visit has been made by the Tuberculosis Health Visitor the Public Health Department is informed in order that the environmental conditions may be investigated by the District Sanitary Inspector. It has been found advisable that the first approach to the patient should be made by the Tuberculosis Health Visitor for it sometimes happens that the patient is not aware that a diagnosis of tuberculosis has been made in his case. By the time of the visit of the Sanitary Inspector, the patient is aware of the diagnosis, has some general idea of the steps which must be taken to secure adequate treatment, and is prepared to discuss environmental factors with the Inspector. Object of Visit. The investigations of the Inspector are aimed primarily at the prevention of the spread of infection and towards removal of conditions favourable to infection. This entails inspection with relation, principally, to overcrowding, general hygiene, including lighting and ventilation, and sanitation. In consultation with the Tuberculosis Officer, recommendations are made for re-housing and are forwarded to the relevant housing authorities, calling attention to the particular priority needed in each case. Sanitary defects, and where possible the lack of certain amenities, such as separate water supply and food storage accommodation, are dealt with by the service of notice upon owners under the Public Health (London) Act, 1936, or the Housing Act, 1936. The table at the end of this report summarises some of the conditions that were found. The Survey. We investigated 242 cases. An investigation of certain premises was not made because the conditions were already known, the case was first notified on death, or for other specific reasons. There are in the Borough of St. Pancras two hostels for the working classes. One contains residential accommodation for 1,087 and the other for 958 men. In these two hostels were notified during the year, 36 cases of persons suffering from Pulmonary Tuberculosis. All these 36 persons were not resident in the hostels throughout the year. Three were admitted to hospital shortly after we received the notification and others have left and moved elsewhere. There are, of course, other persons notified as tuberculous in these hostels who were notified during earlier years, and at the end of 1949 the number of tuberculous persons resident in the two hostels was 59. These premises accommodate only males, and it is a fact that many of the cases are elderly persons with no relatives, limited means and suffering from open tuberculosis. They tend to wander from district to district, between the hostel and the hospital. On the other hand the hostels are under supervision, provide dining and recreation rooms, meals at a reasonable price, and each patient has a separate cubicle bedroom. Whilst the conditions are not ideal fcr a person suffering from tuberculosis, neither from his own point of view nor that of those with whom he is resident, the patient is at least segregated from children and young persons, and to that extent better placed than if he were in a private dwelling sharing his accommodation with a family of young children. In 19 cases of pulmonary tuberculosis the premises were statutorily overcrowded. At first sight this may seem a small number. It must be remembered, however, that the standard of statutory overcrowding 8 is very low indeed, living rooms counting in the same way as bedrooms, a child under 10 counting as a half a unit and children under one year not being counted at all. In these circumstances two rooms measuring over 110 sq. ft. each would not be statutorily overcrowded if they contained three adults, or, alternatively, one adult, four children under 10 and twin babies under one year. Furthermore, consideration must be given to the fact that 128 tuberculous persons did not sleep in separate rooms. We feel, therefore, that we are justified in maintaining that overcrowding exists in a large proportion of cases. We would hold that where the circumstances are such that there is insufficient accommodation for a person suffering from tuberculosis to have at least a sleeping room to himself, there is overcrowding which is dangerous and injurious to health—not so much to the patient himself, but to those with whom he shares the room. The worst case of overcrowding was that of a husband and wife and five children who occupied two rooms. Three members of this family, father and two children, were notified cases of pulmonary tuberculosis. Furthermore, the rooms they occupied were underground rooms within the meaning of the Housing Act, 1936, and did not comply with the regulations thereof as to fitness for human habitation. This family had recently applied to be re-housed, and a recommendation for urgent priority was made. 42 patients had accommodation which included basement rooms, but the number of cases where accommodation consisted entirely of basement rooms was 15. Lighting and ventilation was inadequate in 15 cases. A menities. In 193 out of the 242 dwellings visited a separate water supply was available. 110 families had the use of their own water closet ; 61 the use of a separate bath. In 52 cases the family had the use of a bath together with other persons. In 129 dwellings there was no bath provided. It will be seen, therefore, that in 49 families where there was a case of tuberculosis, water supply was shared with another family, and in 132 cases there was also sharing of a water closet. It is not suggested that tuberculosis is spread by the sharing of a water supply, a water closet or a bath with another family. The point is that the cure of tuberculosis and the prevention of spread of the disease is best secured where the patient is provided with every modern convenience of hygiene and sanitation. Housing. Whilst the above facts give some indication of the conditions which we have found in the homes of those suffering from tuberculosis, it gives little idea of what the Public Health Department has achieved to improve these conditions. The fact that a recommendation has been made for re-housing does not mean the conditions can be ameliorated immediately, for there are approximately 10,000 families awaiting re-housing in St. Pancras, many in urgent need of priority, and the total building allocation for the whole Borough for the year 1950 is approximately 250 housing units. Service of Sanitary Notices. Seventy-nine sanitary notices were served during the year in connection with the above 242 dwellings. These notices dealt with absence of a proper food cupboard, dampness from whatsoever cause, inadequacy of water supply, defective plaster, need for redecoration, and the like. Improvements. What has been achieved as a result of the visits of the sanitary inspectors during the year 1949 ? It would give us great pleasure if we could report that adequate housing accommodation and proper environmental conditions had been provided in every case. Unfortunately this is far from being so, and we can only express the hope that the time may not be far distant when this ideal may be attained. In the meanwhile the Public Health Department has achieved much to improve the conditions under which those we have visited are living, and possibly have succeeded in part in preventing some spread of infeccion. Positive achievements which we car record include the removal of the cause, and remedy of dampness in 25 cases, in some of which it was necessary to repair the roof. Furthermore, in 41 cases we secured general repair and redecoration of the premises. The drainage system was repaired in seven cases, the water closet apartment in nine, an additional water supply was made available in seven premises, and ventilated food cupboards provided in nine. Thirty-three general sanitary defects were also remedied. The above does not take into consideration the conditions improved as a result of simple advice and measures which the patient himself could take, as, for instance, the opening of windows which we found fixed, the cleansing of rooms and removal of conditions likely to favour the spread of infection, for which no notice was necessary. It is easy to under-estimate the good effect of such advice resulting quite often from friendly conversation between the inspector and the patient and his family. Very often a separate bedroom for the patient is achieved and furniture so re-arranged or removed that the conditions under which the patient can be treated prior to admission to hospital or sanatorium are entirely different from those met with at the first visit of the Inspector. We would add that the combination of the visit of the Tuberculosis Health Visitor and the Sanitary Inspector, working in harmony, one directed primarily towards treatment and nursing and the other to the removal of adverse environmental factors, constitutes no small contribution to the prevention of the spread of infection and the recovery of the patient. 9 Our experience during the past year has convinced us that a borough council as public health and housing authority stands foremost in the fight against tuberculosis. It is with no sense of complacency that we present this report—it is but an indication of what is needed, and an inspiration for future work. SUMMARY OF INVESTIGATION. Pulmonary Non-Pulmonary Total Home conditions investigated 208 34 242 Males 121 12 133 Females 87 22 109 Ages : 0-10 years 19 7 26 10-20 32 9 41 20-30 68 9 77 30-40 43 4 47 Over 40 years 46 5 51 Social condition: 1. Poor 18 3 21 2. Moderate working class 163 31 194 3. Superior 27 — 27 Self-contained dwellings 60 11 71 Not self-contained dwellings 148 23 171 Overcrowded, Housing Act, 1936 19 1 20 Separate room for patient 80 15 95 Separate bed for patient 115 21 136 Patient in bed 26 1 27 Patient in hospital 68 14 82 Room used for other purposes 71 7 78 Accommodation which includes basement rooms 36 6 42 Separate water supply 165 28 193 Separate water-closet 92 18 110 Shared water-closet 116 16 132 Ventilated food cupboard 69 8 77 Separate bath 54 7 61 Shared bath 44 8 52 No bath 110 19 129 Infantile Mortality. The outstanding figure of the year is the infantile death rate which is 30.6—the lowest ever recorded in this Borough. The number of children who died under the age of one year is 70. I am still not satisfied that this is the lowest figure obtainable. Better housing and continued improvement in food, purer atmosphere, the prevention of prematurity and the control of infection and even foetal abnormality are all capable of reducing this number to considerably less than the present figure, despite the fact that it represents the best so far attained. It is interesting to note that the infantile death rate in illegitimate children was less than that for legitimate children. The figure is small, the total number of illegitimate children who died being 7, but when one remembers that it is not so long since the death rate of illegitimate was double that for legitimate children there is reason for at least some satisfaction. Care of the aged. This problem has been consistently before your Public Health Department and it is seldom a week passes but that we have considered the plight of some aged person who needs our help in some form or another. Towards the end of the year a scheme was developed which it is hoped to see in operation during 1950. It is anticipated that this will be a combination of 10 voluntary and Council effort and that it will be adequate in its scope to bring, in due course to every aged person in the borough the help he needs to secure for him an active, healthy old age in surroundings of his own choice. Public Houses. The survey of licenced premises which commenced in 1948 was continued throughout 1949. Some publicity was given to my report on this subject last year and I would like to dispel any erroneous impressions that may have been created. By and large the public houses of this Borough are as good as elsewhere in so far as it is within my power to judge. I can however, and I do state that they are capable of improvement and I would like to emphasise that in attempting to secure such improvement I have had the complete and loyal support and co-operation of the owners of licenced premises. They have been prepared to discuss improvements on every occasion, and it has been only lack of. labour and materials and the difficulty in obtaining licences that has prevented them from going even further than the requirements I could ask for on sanitary grounds. Your Sanitary Inspectors paid 317 visits during the year. Page 50 of the report sets out in detail the improvements that were effected, those that are in progress and those promised. The programme is a long term programme and I have been in contact with officials of the Ministry of Works with a view to securing that the work be carried out even if it be spread over a period of time. The work indicated on page 50 represents in some cases, major reconstruction work and it has been willingly undertaken. I am satisfied that the improvements will continue and that the work that unfortunately could not be done during the war years is not only being made good, but a healthy and up-to-date outlook is being adopted by those who are responsible. Housing. No report on the health of the Borough can ignore the present housing situation. The last report of the Housing Manager is to the effect that 9,991 families are on the Council's waiting list. There are about 40,000 families in the borough, and therefore a quarter of them have requested to be re-housed. Still more unfortunate is the fact that of the families that have applied, 1,811 have been marked as urgent priority "A" cases. We are concerned that the total number of family units we are to be allowed to erect during 1950 is approximately 250. Regularly every morning my post brings me letters setting out pathetic circumstances under which many of the residents of your Borough are living, and I know, too, that the mail bag of every Councillor contains similar appeals to my own. I have had referred to me during the year 1,056 housing applications in order that I might advise as to priority. In 605 cases I had to recommend that the family was in immediate need of re-housing on grounds of health. In only 114 cases was I reasonably satisfied that attention to sanitary defects would render the applicants' present accommodation satisfactory. In the pages of this report I have set out in more detail some of the reasons which supported the applicants' request to be re-housed. Outworkers. Early in the year I reported to the Public Health Committee that I was concerned as to the conditions under which outwork was being carried out in the Borough, and I was authorised to carry out a survey of the situation in conjunction with the London School of Hygiene and Tropical Medicine. 11 I would like to acknowledge here the excellent co-operation which existed between the School and my Department. Approximately 40 per cent, of the investigations were carried out by the School and 60 per cent, by your officers. We had in mind that there was a possibility that outwork could be carried out under very adverse conditions, that rates of pay might be inadequate, and that children might be employed to the prejudice of their health. In the past there have been recommendations from various bodies that outwork should cease. The survey showed that by and large the outworkers in the borough were female, and in not a single case was it found that outwork was being done by a home worker under 23 years of age. In most cases women were doing home work in order to augment the family income, working at such hours as suited themselves and looking after their homes without undue interference with the daily routine. In that the home work was carried out in the living room it did to this extent interfere somewhat with comfort. In many cases women were carrying out work which they had performed as either full-time or part-time workers in a factory before marriage. Home work was generally regular throughout the year, apart from the making of Christmas crackers which lasted from Whitsun until the Christmas season. The time spent on home work varied considerably, from two hours a day upwards. The rates of pay were in accordance with those paid in the trade concerned, and complaints about remuneration were unusual, earnings ranging from 10s. to over £3 per week. In some cases much larger sums were being earned. Sweated labour does not appear to be occurring. The reasons for choosing home work appeared to be the need for the care of children and the reluctance or inability to leave them in day nurseries or with daily guardians. It is possible, however, that the fact that there were children encouraged the housewife and mother to undertake home work in order-to augment her husband's wages. Again, elderly and partially disabled persons found outwork a congenial method of increasing their income and keeping themselves occupied. There were some persons who preferred home work because of the liberty it gave them. It is a fact that in St. Pancras some very highly skilled embroidery and tailoring work is being carried out by expert craftsmen in their own homes. In the report prepared by the Seminar of the London School of Hygiene and Tropical Medicine a reference is made to the fact that some of the workers in the boot and shoe trade were keen individualists and enjoyed freedom to work when and how they liked and to stop work entirely for a period if they so wished. Again, in the tailoring trade it is stated that the incentive to work at home seemed to be the good wages that could be earned whilst retaining some independence. A survey of this description is undertaken in the belief that a set of circumstances exists and requires investigation. The investigation, however, must be entirely objective and the decisions reached must not be prejudiced by preconceived ideas. In this survey I think it can be claimed that the impressions we have formed are free and unprejudiced for it is a fact that in some ways I have come to the conclusion that the conditions which we feared do not in fact exist. By and large, outwork is carried out under satisfactory conditions. Children are not employed. There is little interference with the comfort of the home, the family income is raised, leisure is well filled and the old and cripplied are provided with remunerative occupation and young mothers are enabled to work and yet look after their children. 12 I think a very good case could be made out for carrying out home work under a complete system of supervision. A few points occur to me immediately:— (1) There is a considerable shortage of factory space in the country. Home work carried out under suitable conditions could relieve much of this shortage. (2) There is in the Borough of St. Pancras a shortage of day nursery accommodation. The cost of a day nursery is between £2 10s. Od. and £3 per child per week, to which the parents contribute about 5s. a week. The woman who goes out to work and places her child in a nursery is subsidised therefore by approximately £2 10s. Od. a week. It has yet to be proved that medically it is wise to congregate together a large number of young children, for they tend to contract infections which otherwise they might avoid or which might be delayed until a time when these infections were associated with less risk, as for instance, measles and whooping cough. There is much to be said for the young mother staying at home and looking after her baby and carrying out home work rather than placing her child in a nursery and going out to work. (3) I have been much impressed by some of the skilled work and the independence of some outworkers in the Borough. In the case of the aged and crippled, outwork can be a blessing, both because it occupies hours otherwise empty and because it grants independence and increases the individual's income. The actual figures relating to outwork will be found within the pages of this report. Medical Examinations. During the course of the year I carried out 86 medical examinations, 65 being in respect of new entrants and 21 of existing staff. Conclusion. This survey of the activities of the Public Health Department indicates the huge amount of work clamouring for accomplishment, each sphere of activity vying with the others in urgency. The efforts of the public health services in the past have resulted in lowering the incidence of infantile and maternal mortality as well as infectious diseases, some of which are now rendered almost non-existent. These advances are noted. Environmental conditions in the Borough, however, are not yet satisfactory, as indicated in particular by the conditions in which many of your citizens still live and work. Whilst infectious disease remains in our midst, whilst children die from disease that can be prevented and one per cent, of the population is notified as suffering from tuberculosis, and cases of food poisoning are still occurring, no Medical Officer of Health can remain complacent. May I take this opportunity once again of thanking the members of the Council for their encouragement and courtesy at all times, and my colleagues in my own and other departments for their continued co-operation and help. 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, 1949.) Councillor Evan Evans (Chairman); Councillor Dr. C. L. Mason (Vice-Chairman); The Mayor (Councillor J. W. Kingsley Maile, J.P.); Aldermen Mrs. L. Bartlett and N. Shand Kydd; Councillors Mrs. L. A. Arabin, Dr. K. W. Aylwin-Gibson, T. Barker, N. A. Burton, Mrs. M. Carruthers, Mrs. M. A. Foster, Mrs. L. M. Jeger, Mrs. E. C. May, R. W. Smith and R. C. W. Trill. 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. 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.1. 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 Wednesday 2p.m to 4.30 p.m 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 Wednesday 2 p.m. to 4.30 p.m. 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 Wednesday 2 p.m. to 4.30 p.m. Thursday Friday, 6 p.m. to 8 p.m. REGISTRARS OF MARRIAGES. Frederick Charles Irvine Athelstan F. L. Eatenton St. Pancras Town Hall, Euston Road, N.W.1. Alice K. Kimmance (Mrs.) 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 1949. 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. (3) J. A. Hoare. I. Williams. Miss D. M. Richardson. Deputy Chief Sanitary and Housing Inspector. W. B. Dykes. District Inspectors (15). J. W. C. Armstrong. J. Marginson. F. R. Bray. H. P. Price. B. V. Cryer. E. S. Rushton. C. A. Engledow. A. A. Sleet. T. H. Hague. H. E. Westripp. J. E. Jones. J. H. Willett. K. A. Lock. (1 vacancy.) S. A. C. Lord. Clerical Staff (12). V. R. Meurice, Chief Clerk. C. W. Smith, First Clerk. S. Morse. G. F. Peeling. N. L. B. Collier. R. B. M. Lake. E. Driscoll. Miss B. Pinnock. Miss J. M. White. D. H. Smith. H. Harwood (Temporary). J. F. S. Dove. Public Analyst. C. Harcourt Wordsworth, B.Sc. (Lond.), F.I.C. 16 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 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-1949 estimate 141,330 Number of persons per acre (estimated average) 52 Rateable value £2,054,863 Product of a penny rate, about £8,200 General rate—17/- in the £ for the year. 17 Climatological Summary, Year 1949. Station, Camden Square, N.W.1—Lat. 51° 33' N. Long. 0° 08' W. January February March April May June July August September October November December Barometer— Mean Pressure at 32° F. at station mbs. level (Bar. 112 ft. above M.S.L.) 1023.1 1028.1 1022.7 1018.9 1015.8 1020.9 1020.4 1020.7 1018.2 1016.6 1008.8 1013.4 Air Temperature— Mean of— A. Maximum °F. 48.1 50.9 49.5 62.8 64.4 72.7 78.3 76.4 74.6 63.8 50.6 49.2 B. Minimum °F. 38.3 36.8 36.5 45.3 46.2 53.5 58.3 57.5 58.5 49.6 39.6 40.0 Mean of A and B °F. 43.2 43.9 43.0 54.1 55.3 63.1 68.3 66.9 66.5 56.7 45.1 44.6 Difference from average (1906-1935) °F. + 2.9 + 3.4 - 0.7 + 5.8 - 1.1 + 2.1 + 4.0 + 3.2 + 7.5 + 4.8 + 1.0 + 31 Mean relative humidity per cent. 85 87 81 67 74 76 64 75 81 86 90 86 Earth temperature at 4 ft. depth °F. 45.4 43.4 43.9 47.1 51.3 54.7 59.8 61.3 60.5 58.8 51.7 48.3 Bright sunshine— Total observed (daily mean) Hr. 1.26 2.87 3.17 6.86 6.59 7.93 7.90 7.50 5.17 3.37 1.87 1.25 Percentage of possible 15 29 27 50 43 48 49 52 41 31 21 16 Percentage of average 136 179 112 163 106 120 129 133 121 130 145 156 Rainfall (rain-gauge level, 110 ft.)— Number of days precipitation 10 7 5 10 12 4 8 7 7 14 14 13 Total fall In. .75 .93 .84 1.65 1.91 .71 .84 1.25 .36 4.83 2.14 1.40 Percentage of average (1881-1915) 40 56 46 107 109 35 35 57 20 184 91 59 Hour of observation, 9 a.m. (G.M.T.). The readings for Bright Sunshine are those taken at Regent's Park—no readings being recorded at Camden Square. Total rainfall for year, 17.61 inches. IS Summary of Vital Statistics. Net registered live births 2,290 Birth-rate (per 1,000 of estimated population) 16.2 Deaths, all ages 1,774 Crude death rate (per 1,000 of estimated population) 12.5 Adjusted death rate (per 1,000 of estimated population) 12.6 Infantile deaths 70 Infantile death rate (per 1,000 live births) 30.6 Tuberculosis deaths 105 Tuberculosis death rate (per 1,000 of estimated population) .74 * The crude death rate of the area is multiplied by the factor 1.01 in order to make it comparable, from a mortality point of view, with the crude death rate of the country as a whole, or with the mortality of any other local area, the crude death rate of which should be similarly modified with its own factor for the purpose. The necessity for the application of this factor arises from the fact that the populations of all areas are not similarly constituted as regards the proportions of their sex and age group components. Crude death rates fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions. The factor may be said to represent the population handicap to be applied to the area. Applied to St. Pancras, the death rate of 12.5 per 1,000 of population is adjusted by the comparability factor of 1.01 to 12.6 per 1,000 of population. 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 1949 389 221 23 934 1,567 141,330 22.17 Maternity and Child Welfare Centres. Telephone St. Pancras School for Mothers, 1, Ampthill Square, N.W.1 EUS 2972 Camden Town Welfare Centre, Barnes House, Camden Road, N.W.1 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.1 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.1 EUS 5050 26, Margaret Street, W.l Tuberculosis Chest Clinic. Telephone LAN 4112/3/4 Day Nurseries. Telephone Caversham Road, N.W.5 GUL 5769 Margaret Day Nursery, 42, Phoenix Road, N.W.1 EUS 1822 254-256, Camden Road, N.W.1 GUL 2910 Coram Gardens Day Nursery, 41, Brunswick Square, W.C.1 TER 6054 1, Ampthill Square, N.W.1 EUS 2972 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.1 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.1 GUL 2041 Paddington Group 21 None. Elizabeth Garrett Anderson, 144, Euston Road, N.W.1 EUS 2501 Board of Governors, Royal Free Hospital 142 Hampstead General and N.W. London (Out-Patients' Department), Bayham Street, N.W.1 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.1 EUS 5206 Paddington Group 21 160 Royal Ear, Huntley Street, W.C.1 EUS 5050 Department of U.C.H 53 Royal Free, Gray's Inn Road, W.C.1 TER 4331 Teaching Hospital (Own Board of Governors) 229 Royal National Throat, Nose and Ear, Gray's Inn Road, W.C. 1 TER 4311 Teaching Hospital (Own Board of Governors) 225 St. Pancras, St. Pancras Way, N.W.1 EUS 1617 Board of Governors, U.C.H. 308 University College, Gower Street, W.C.1 EUS 5050 Teaching Hospital (Own Board of Governors) 632 19 20 School Treatment Centres in St. Pancras. (By appointment only. Application in first instance to Divisional Treatment Organiser.) Vision Highgate New Town Clinic, Chester Road, N.19. St. Pancras Clinic, 26, Prince of Wales Road, N.W.5. Somers Town Treatment Centre, Chalton Street, N.W.1. Dental Highgate New Town Clinic. St. Pancras Clinic. Somers Town Treatment Centre. Nutrition Highgate New Town Clinic. Somers Town Treatment Centre. Rheumatism Hampstead General Hospital, Bayham Street, N.W.1. Ears Royal National Throat, Nose, and Ear Hospital, Gray's Inn Road, W.C.1. Tonsils and Adenoids Highgate Hospital, Dartmouth Park Hill,N.W.5. * Minor Ailments Highgate New Town Clinic. St Pancras Clinic. Somers Town Treatment Centre. * 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.—Telephone, the Emergency Bed Service MONarch 3000. This applies also to patients being discharged from hospital or attending there as out-patients. 21 SECTION 2. Births and Deaths. STATISTICS FOR THE YEAR 1949. Population. The civilian population, as estimated by the Registrar-General, mid-1949, was :—141,330. Comparable estimates for preceding years are set out on page 26. Registered Live Births. M. F. Total. Rate per 1,000 of estimated population Legitimate 1,062 994 2,056 Illegitimate 120 114 234 1,182 1,108 2,290 16.2 Comparable figures for preceding years are set out on page 26. Registered Still Births. M. F. Total. Rate per 1,000 Live and Still Births. Legitimate ... ... 26 17 43 Illegitimate ... ... 2 1 3 28 18 46 19.7 Comparable figures for preceding years are set out on page 27. Deaths—All Ages. M. F. Total Crude death rate per 1,000 of estimated population Adjusted death rate per 1,000 of estimated population 960 814 1,774 12.5 12.6 Comparable figures for preceding years are set out on page 26. 22 CLASSIFICATION OF DEATHS, WITH AGE DISTRIBUTION—1949 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 70 8 16 134 488 1,058 960 814 1. Typhoid and paratyphoid fevers — — — — — — — — 2. Cerebro-spinal fever — — — — — — — — 3. Scarlet fever — — — — — — — — 4. Whooping cough — 1 — — — — — 1 5. Diphtheria — — — — — — — — 6. Tuberculosis of respiratory system — 1 1 31 43 23 67 32 7. Other forms of tuberculosis 1 1 — 4 — — 2 4 8. Syphilitic diseases — — — 1 6 2 6 3 9. Influenza 1 — — — 2 7 5 5 10. Measles 1 — — — — — — 1 11. Ac. poliomyelitis and polioencephalitis — — 2 3 — — 4 1 12. Ac. infectious encephalitis — — — — — — — — 13. Cancer—buccal cavity and Oesoph (M); Uterus (F) — — — 2 15 19 16 20 14. Cancer—stomach and duodenum — — — 2 16 35 33 20 15. Cancer—breast — — — 3 15 18 1 35 16. Cancer—all other sites — — 1 16 86 117 119 101 17. Diabetes — — 1 — 1 8 4 6 18. Intracranial vascular lesions — — — 3 36 123 73 89 19. Heart diseases — — — 15 98 340 237 216 20. Other circulatory diseases — — — — 23 70 41 52 21. Bronchitis 4 1 — 2 36 84 83 44 22. Pneumonia 8 — 2 5 26 77 60 58 23. Other respiratory diseases — — — 2 8 10 16 4 24. Ulcer—stomach or duodenum — — — 2 15 11 22 6 *25. Diarrhoea (under 2 years) 2 — — — — — 2 — 26. Appendicitis — — — 1 — 3 3 i 27. Other digestive diseases — — — 1 9 19 16 13 28. Nephritis — — — 3 4 18 18 7 29. Puerperal and post-abortive sepsis — — — 4 — — — 4 30. Other maternal causes — — — 1 — — — 1 31. Premature birth 12 — — — — — 6 6 32. Congenital malformations, birth injurv and infant diseases 32 — — 3 — — 19 16 33. Suicide — — — 7 14 4 17 8 34. Road traffic accidents — — 2 2 2 4 9 1 35. Other violent causes 2 — 3 12 7 21 27 18 36. All other causes 7 4 4 9 26 45 54 41 * Diarrhoea at ages 2 years and over is included under No. 27. [To face page 22 —LIVE BIRTH RATE for the Borough, per 1,000 population DEATH RATE 23 Death Rate of Infants under 1 year of age, 1949. All infants per 1,000 live births 31 Legitimate infants per 1,000 legitimate live births 31 Illegitimate infants per 1,000 illegitimate live births 30 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 1948 37 36 42 See also tables on pages 26 and 27. Infantile death rates comparison. 1949 1948 1947 1946 1945 1944 1943 1942 1941 St. Pancras 30-6 37 34 38 44 64 71 66 51 England and Wales 32 34 41 43 46 45 49 51 60 London Administrative County 29 31 37 41 53 61 58 60 68 24 DEATHS OF INFANTS UNDER 1 YEAR OF AGE—1949 from stated causes with Age and Ward distribution. Cause of death Age Deaths in each Ward No address Totals Under 1 day 1 day to 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks 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 Disseminated Tuberculosis _ _ _ _ _ _ 1 - _ _ 1 _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ 1 Influenza - - - - - - - 1 - _ 1 _ _ 1 - _ _ _- _ _- __ _- _- _ _- _- _ _ _ 1 _ Measles - - - - - - - 1 - 1 _ _ - _ _ _ _ _ _ 1 _ _ _ _- _ - _- _ — 1 Meningitis - - - - - - - 2 _- - 2 1 _ _- _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ 1 1 Bronchitis - - - - - - 1 3 - - 4 1 - 1 2 _ _ _ _ _ _ 2 2 - - 1 1 - 2 3 1 - 1 7 2 _ - _ 4 _ . _ _ _ _ _ _ _ 1 _ _ 6 1 Pneumonia (not stated) 1 - - - 1 - - - - - - - _ - - - - - - - - - - - - - - - 1 - Enteritis - - - - - - 1 - - 1 2 - - 1 - - - - - 1- - - - - - - - - - 2 - Congenital Malformations __ 3 - - - 3 1 - 1 - 5 _ _ _ _ - 1 1 1 - - - - - - 1 1 - - 2 3 Premature Birth 4 7 - - - 11 1 - - - 12 2 1 1 - - 2 - 1 1 1 - 1 - - 2 - - - 6 6 Injury at Birth 4 9 - - - 13 - - - - 13 3 _ _ _ - 1 2 1 2 1 1 - - 2 - - - - 8 5 Atelectasis .. .. ... 5 5 - 1 - 11 - - - - 11 1 2 1 1 - 1 1 1 - - - - - - 2 - 1 - 6 5 Other Diseases peculiar to the first year of life 1 2 - - - 3 - - - - - - - - 1 - - - - - - - - - - 1 - - - 2 1 Lack of care of Newborn 1 - - - - 1 - - - - 1 - - - - - - - - _ _ _ _ _ _ _- _ _ 1 _ 1 Other Violence - - - - - - - 1 - 1 _ - - - - - - - _ _ _ _ _ _ _ 1 _ _ _ 1 Other causes - - - - - - 2 — 1 2 5 - - 1 - 1 - 1 1 1 - - - - - - - - - 4 1 Totals 15 27 1 2 — 45 10 7 4 4 70 10 3 6 4 5 5 7 6 5 3 1 1 - 2 6 4 1 1 41 29 25 Deaths of Infants under 1 year of age, from stated causes, since 1939. 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Measles — — 1 — 1 — — 1 — — 1 Whooping cough 5 — 8 3 1 2 3 — 4 1 — Influenza — — 1 1 1 — — 1 — — 1 Cerebro-spinal fever — 1 — — — — — 1 — — — Syphilis 1 1 — — 1 1 — — 1 — — T.B. — — — 1 — — — — 1 — 1 Meningitis — 1 — — 3 1 — 1 1 — 2 Convulsions 1 — — 1 — — — — — — — Bronchitis 3 4 1 6 6 3 1 8 2 2 4 Broncho-pneumonia 13 16 — . 10 10 20 — 7 13 7 7 Lobar pneumonia 2 1 — 1 1 — — — — — — Pneumonia (not stated) — 1 9 1 2 1 12 — 1 — 1 Enteritis and diarrhoea 30 29 9 23 18 20 24 13 13 4 2 Congenital debility, — — — — — — — — — — — ma, icterus 3 — 1 — — — — — — Congenital malformations 8 10 7 13 10 13 6 8 8 13 5 Premature birth 30 17 19 27 28 25 7 24 15 20 12 Injury at birth 4 3 2 3 8 7 4 12 9 9 13 Atelectasis 2 5 4 5 8 6 13 11 7 21 11 Haemorrhage from umbilicus 1 — — — — — — —— — — — Inattention at birth 1 — — — — — — — — — — Lack of care of newborn — — — 3 — 1 — — 2 — 1 Violence — 9 — 3 — 6 4 3 7 — 1 Mikulier's disease — — 1 — — — — — — — — Maternal toxaemia — — 1 — — — — — — — — Melaena 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 — 3 Other causes 10 10 8 8 32 11 10 5 7 10 5 Totals 114 108 74 117 130 123 86 96 95 91 70 26 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 Number 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 2,170 130 114 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 1949 141,330 2,290 16.2 1,774 12.5 70 31 45 20 To fact page 27] LEGITIMATE CHILDREN. -INFANTILE DEATH RATE (under the age of 12 months) FOR THE Borough, per 1,000 registered live births. -NEO.NATAL DEATH RATE ( „ „ „ 4 weeks) To face page 27] ILLEGITIMATE CHILDREN. -INFANIILE DEATH RATE (under the age of 12 months) fOR THE Borough, per 1,000 illegitimate live births. -NEO-NATAL DEATH RATE („ „ „ 4 weeks) 27 Still Births, Illegitimate Births, and Deaths of Illegitimate Children. Still Births. Illegitimate Births. Deaths of Illegitimate Children. Under 1 year. Under 4 weeks. Year. 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 Rec ords suspe nded. 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 1949 46 (3) 19 7 234 10 2 7 30 28 Maternal Mortality in Borough of St. Pancras in 1949. Ages. Conditions. Wards. 15.20. 20-25. 25-30. 30-35. 35—40. 40-45. 45 and up. Married. Single. Widowed. 1 2 3 4 5 6 7 8 No Address. Post Abortive Sepsis Abortion without mention of septic conditions - 2 1 1 - - - 2 2 - 2 - - 1 - - - 1 - Associated with childbirth but not classed thereto— - - - - - - - - - - - -- - - - - - - - Deaths from Puerperal Causes in 1949. Deaths. Rate per 1,000 Live and Still Births. Total. Puerperal Sepsis 4 1.71 2.14 Other maternal causes 1 0.43 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 6 101 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 1948 3 — 3 1.20 — 1.20 29 DEATHS FROM CANCER OF ST. PANCRAS RESIDENTS DURING 1949. Situation of Disease. Ages. Totals Wards. No Address. 1 2 3 4 5 6 7 8 0-15. 15-20. 20-25. 25-35. 35—45. 45-55. 55-65. 65-75. 75-85. 85 and up. M F M F M F M F M F M F M F M F M F M F - - - - - - 2 2 2 - 5 1 - 1 2 - - - 2 - - - - - - - 1 - - - Palate - - - - - - - - 1 - - 1 - - - - - - - - 1 - - - - - - Jaw - - - - - - - 1 - - - 1 - 1 - - - - - - - - - - - - - - - - Tonsil - - - - - - - 1 - - 1 1 - - - - - - - - - - - - - - - - - Oesophagus - - - - - 2 9 4 3 _ 10 2 3 _ _ 1 2 _ 2 _ _ _ _ 1 _ _ 2 _ 1 - Stomach - - - _ 2 7 8 23 11 1 3? 20 2 2 2 2 9 6 6 3 6 4 2 1 1 4 1 1 - Caecum - - - 1 - 1 1 4 1 - 5 3 3 2 - - 1 1 1 - - - - - - - - - - Colon - - - - - 2 6 2 10 5 8 17 1 4 2 2 2 3 1 3 1 1 1 3 - 1 - - - - Splenic Flexure - - - - - - - 1 - - 1 — - - - - 1 - - - - - - - - - - - - - Sigmoid Flexure - - - - - 2 3 3 1 - 2 7 - - - 1 1 3 1 1 - 1 - 1 - - - - - - Intestine—not stated - - - - 1 - 1 - - - - 2 - 1 - 1 - - - - - - - - - - - - - - Intestinal Glands - - - - - - - 1 - - 1 - - - - - - - - - 1 - - - - - - - - - Rectum - - 1 - 3 2 7 8 5 1 12 15 1 1 - 4 1 3 3 2 2 3 2 1 1 - 2 1 - - Liver - - - - - - - 2 6 - 5 3 _ 1 1 - 1 1 - - - - - - 1 - 2 1 - - Gall Bladder - - - - - - - 2 2 - 2 2 - - - - 1 - - 1 - - - - - 1 - - 1 - Bile Duct - - - - - - - 3 - - 1 2 1 - - - - - - _ _ — - 1 - - - 1 _ - Pancreas - - - - - 1 2 10 3 1 8 9 1 2 - 2 2 2 - - 1 2 - - 2 - 2 1 - - Larynx - - - - - - 3 1 - - 4 - - - - — 1 - - - 1 - - - - - 2 - - - Lung - - - -- - 5 12 2 ] 1 20 ] 1 _ 1 _ 2 - 5 _ - - 3 - 2 _ 3 _ - - Bronchus - - -- - 1 4 14 11 6 - 32 4 5 4 5 _ 6 - 4 _ 2 - 1 - _ _ 8 _ 1 - Pleura - - - - 1 - - - - - - 1 - - - _ 1 _ _ _ - _ - _ _ _ - Uterus - - - - 2 4 5 6 3 - - 20 - 2 2 _ 4 _ 4 - 2 _ 1 _ 2 _ 3 _ - Breast - - - - 9 6 9 8 8 2 1 35 - 6 1 4 _ 6 _ 6 - 2 _ 6 _ 3 _ 2 _ - Ovary - - - - 3 5 1 3 - - 12 - 1 - 1 — 3 - 3 - 1 - - - 1 — 1 _ 1 Prostate - - - - - - 2 3 1 - 6 - 2 - - - 1 - 1 - 1 - - - - - 1 - - - Penis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Testicle - - - - - - - - - - -- - - - - - 1 - - - - - - - - - - - - - Bladder 4 1 I 2 5 3 - 1 - 2 1 — 3 - - - 1 - - - - - - - Skin — — — — 1 1 — — 2 — — 4 - 1 - - — 2 _ - - - - - - - - 1 - - Brain 1 — — 1 1 2 — — — — 3 2 - 1 - 1 — — — - 1 - 1 - - - 1 - - - Spinal Cord — — — — — — — — — — — — — — — — — — — — — — — - - - - - - - Bones — — — 1 — 1 — 2 — — 2 2 — — — — — — — 1 1 — 1 - - - - - - - Thyroid Gland — — — — — — — — — — — — — — — — — — — — — — — - - - - - - - Lymph Gland — — — — — — — — — — — — — — — — — — — — — — — - - - - - - - Abdomen — — — — — — — — — — — — — — — — — — — — — — - - - - - - - Multiple Myelomatosis — — — — — 1 — 1 — — — 2 — 1 — 1 — — — — — — — - - - - - - - All Sites 1 — 1 3 19 :48 83 107 69 13 168 176 22 34 14 24 33 37 29 23 17 18 14 18 7 9 28 12 4 1 30 The following table shows the number of deaths of St. Pancras persons from certain diseases during the years 1918 to 1949— 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 1949 345 105 453 118 127 141,330 31 Deaths from Tuberculosis of St. Pancras Residents during 1949. 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 t 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 F M F M F IV IF M F All Forms -_ 1_ _- _ _- 2 _ 1 _ _ 2 2 2 6 7 5 5 6 1 4 8 18 3 12 1 9 1 6 7 5 2 17 12 14 6 4 2 4 2 3 3 1 - - 6^ 36 Respiratory System _ _ _ _ 1 _ 1 _ _ 2 1 2 5 6 5 4 6 14 8 18 3 12 1 9 1 6 7 5 2 15 12 14 2 4 2 4 2 3 3 1 - _ _ 67 32 Central Nervous System _ _ _ _ _ _ _ _ _ _ _ 1 -_ 1 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ 2 _ _ _ _ _ _ _ _ _ _ 2 2 Lymphatic System _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _- 1 Disseminated not d i s tinguished -_ 1 -_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ 1 32 Deaths from Tuberculosis—All ages. Death Rate per 1,000 of estimated population. Pulmonary 99 0.70 Other forms 6 0.04 105 0.74 Comparable figures for preceding years:— Year. No. of Deaths. Rate. 1939 130 0.77 1940 160 1.20 1941 123 11.8 1942 147 1.39 1943 117 1.08 1944 128 1.21 1945 127 1.14 1946 98 0.75 1947 105 0.77 1948 98 0.70 33 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 (including typhoid and paratyphoid). Erysipelas. Membranous Croup. Relapsing Fever. Scarlatina or Scarlet Fever. Smallpox (Variola). Typhus Fever. B. Under Regulations made by the Minister of Health under powers contained in the Public Health Acts— Acute Encephalitis (Regulation No. 2259, 1949). Acute Influenzal Pneumonia (Regulation No. 1207, 1927). Acute Poliomyelitis (Regulation No. 2259, 1949). Acute Primary Pneumonia (Regulation No. 1207, 1927). Dysentery (Regulation No. 1207, 1927). Malaria (Regulation No. 1207, 1927). Measles (Regulations No. 1100, 1938 and No. 205, 1940). Meningococcal Infection (Regulation No. 2259, 1949). Ophthalmia Neonatorum (Regulations No. 971, 1926 ; No. 419, 1928; No. 35, 1937). Whooping Cough (Regulations No. 1100, 1938, and No. 205, 1940). C. Under London County Council Order—Public Health (London) Acts— Anthrax (1909). Glanders (1909). Hydrophobia (1909). D. Under Food and Drugs Act, 1938 (Section 17) (as amended by National Health Service Act, 1946, Tenth Schedule)— Food Poisoning. c (6763) 34 E. Under Public Health Act, 1936 (Section 143)— (Regulations of Local Government Board, 1900). Plague. 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, 1930— Tuberculosis. * A case is not notifiable where to the knowledge of the medical practitioner a case of scabies has occurred in the house and has been notified within the 28 days immediately preceding the date on which he first became aware of the disease in the case he is attending Cases of Scabies and Vermin may be treated free of charge at St. Pancras Public Health Annexe, Prospect Terrace, Gray's Inn Road, W.C.I, (opposite Royal Free Hospital) '(Telephone TERminus 8567) between the hours of 9 a.m. to 4 p.m. and on Saturdays 9 a.m. to 12 noon. Removal to Hospital. Removal to hospital of cases of Chickenpox, German Measles, Measles, Mumps and Scarlet Fever may be effected by telephoning to the Public Health Department (TERminus 7070). In the case of other infectious diseases applications should be made direct to the Emergency Bed Service (MONarch 3000). [To face page 34 DIPHTHERIA. . CASES NOTIFIED- NUMBERS IMMUNISED- 35 NOTIFICATIONS OF INFECTIOUS DISEASES, 1949 (with 1948 comparison). Showing number of revised diagnosis. " Disease Notifications Diagnosis subsequently revised Under 1 1 and over Totals 1949 1948 1949 1948 1949 1948 1949 1948 Acute Influenzal and Acute Primary Pneumonia 1 4 111 83 112 87 1 — Anterior Poliomyelitis and Polioencaphalitis 8 — 58 7 66 7 21 2 Cerebro-spinal meningitis 2 2 4 4 6 6 1 1 Diphtheria and membranous croup 2 3 9 34 11 37 9 20 Dysentery 6 3 60 58 66 61 1 2 Enteric or Typhoid Fever — — — 1 — 1 — — Erysipelas — 1 37 45 37 46 1 2 Food poisoning 1 — 11 2 12 2 — — Malaria — —— 1 — 1 — Measles 65 69 1,081 1,292 1,146 1,361 5 9 Ophthalmia neonatorum 19 19 — — 19 19 — — * Puerperal Fever — — — 6 — 6 — — Puerperal Pyrexia — — 15 34 15 34 — — Scabies — 3 65 135 65 138 — — Scarlatina or Scarlet Fever 2 1 179 131 181 132 9 10 Smallpox — — 1 — 1 — — — Whooping Cough 45 36 275 327 320 363 4 5 * Ceased to be notifiable as from October, 1948. 36 Notifications of Infectious Diseases since 1918. Population 196,883 228,585 228,980 212,900 212,500 214,400 214,600 216,300 216,800 213,200 206,000 204,400 204,400 195,600 194,000 190,900 187,540 185,300 183,900 181,900 179,400 167,300 133,200 103,770 105,900 108,640 105,780 111,400 129,410 136,700 140,200 141,330 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 1945 1947 1948 1949 1. Acute Influenza and Influenzal Pneumonia (b) 213 108 99 189 40 131 76 60 121 65 208 24 79 68 111 55 44 46 79 39 31 20 38 26 44 34 136 123 97 87 112 2. 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 3. 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 3 2 3 5 3 36 7 66 4. Anthrax 1 — — — ——— —~ — 1 1 1 — — — — — — — — — — — — — — — — — — — — — — 5. 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 . 6 6. Continued Fever — — — — — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — — 7. 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 11 8. Dysentery {c) 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 61 66 9. Encephalitis Lethargica (a) 3 11 8 6 5 45 24 1 1 9 8 4 5 2 — — 1 — — — — — — — — — 2 — — — — — 10. 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 — 11. Erysipelas 121 134 126 87 118 92 108 11/ 80 98 9/ 110 120 96 117 121 156 92 81 64 86 51 50 43 56 72 56 60 53 38 46 37 12. Food poisoning — — — — — — — — — — — — — («) 16 28 22 10 22 6a 8 4 1 7 2 15 3 8 9 7 2 12 13. German Measles 311 268 195 81 253 134 270 877 143 60 83 1074 116 68 65 486 191 143 78 120 355 (/) — — — — — — — — — — 14. Malaria (c) 98 58 18 13 13 1 6 2 2 J 2 1 1 3 29 51 22 16 5 1 1 2 4 7 1 — 15. Measles 2144 1034 3093 1 149 3728 327 4332 1233 3734 417 3876 591 3476 430 2865 437 3638 120 2975 638 2337 85 285 616 1492 1082 798 1025 1115 902 1361 1146 16. Ophthalmia Neonatorum 40 39 69 101 59 51 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 19 17. Puerperal Fever 5 13 18 1 1 11 20 16 23 14 22 19 23 19 24 30 20 14 24 9 14 7 6 5 8 8 6 16 19 6 5 6 (h) 18. Puerperal Pyrexia — — — — — — — (d) 13 47 40 71 52 38 46 45 27 19 23 30 37 34 28 23 29 32 27 34 47 35 34 15 19. Relapsing Fever — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 20. Scabies — — — — — — — — — — — — — — — — — — — — — — — — (S) 546 931 887 699 300 138 65 Fever 332 558 863 1713 1156 487 759 651 432 527 618 668 659 435 517 653 705 354 434 364 333 253 100 136 173 408 184 245 244 124 132 181 22. Smallpox — 10 — — 1 — I — 1 — 3 87 175 4 5 — — — — — — — — — — — — — — — — 1 23. Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — — — — 24. Whooping Cough — — — — — — — — — — — — — — — — — — — (U) 113 526 45 342 480 439 575 183 511 484 363 320 Notes—(a) Encephalitis lethargica notifiable from 1st January, 1919. (b) Acute primary and acute influenzal pneumonia notifiable from March, 1919. (c) Malaria and dysentery notifiable from 1st March, 1919. (d) Puerperal pyrexia notifiable from 1st October, 1926. (f) Food poisoning notifiable from 12th July, 1932. (g) Whooping cofigh notifiable and German measles ceased to be notifiable from 1st October, 1938. (h) Scabies notifiable from 1st August, 1943. (i) Puerperal fever ceased to be notifiable from October, 1948. 37 Measles. Particulars of the cases, deaths and incidence and mortality rates of Measles since 1926 are given in the following table:— Estimated population Year Cases Deaths Under 1 year Over 1 year Total Incidence rate per 1,000 population Under 1 year 1-5 years 5-15 years Adults Total Mortality rate per 1,000 cases 216,800 1926 260 3,474 3,734 17.2 25 38 2 — 65 17.4 213,200 1927 40 377 417 1 .9 — 5 — — 5 12.0 206,000 1928 234 3,642 3,876 18.8 30 87 10 — 127 32.7 204,400 1929 28 563 591 3.0 — 4 3 — 7 11.8 204,400 1930 179 3,297 3,476 17.1 3 26 2 — 31 8.9 195,600 1931 31 399 430 2.2 1 1 — — 2 4.7 194,000 1932 135 2,730 2,865 14.8 6 21 — — 27 9.4 190,900 1933 38 399 437 2.2 — 4 — — 4 9.2 187,540 1934 195 3,443 3,638 19.4 8 23 1 — 32 8.8 185,300 1935 23 97 120 0.6 — 1 — — 1 8.3 183,900 1936 180 2,795 2,975 16.2 3 12 2 — 17 5.7 181,900 1937 28 610 638 3.5 — 1 — — 1 1.5 179,400 1938 166 2,171 2,337 13.0 5 6 1 — 12 5.1 167,300 1939 14 71 85 0.5 — — — — — —- 133,200 1940 20 265 285 2.1 — 1 — — 1 3.5 103,770 1941 45 571 616 5.9 1 — 1 — 2 3.2 105,900 1942 91 1,401 1,492 14.1 - 108,640 1943 89 993 1,082 9.9 1 3 — — 4 3.7 105,780 1944 50 748 798 7.5 - 111,400 1945 71 954 1,025 9.2 — — 1 — 1 1.0 129,410 1946 74 1,041 1,115 8.6 1 1 — — 2 1.8 136,700 1947 56 846 902 6.6 — 2 — — 2 2.2 140,200 1948 69 1,292 1,361 9.7 — 1 — — 1 0.7 141,330 1949 65 1,081 1,146 8.1 1 — — — 1 0.8 MEASLES—Mortality rate per 1,000 cases. 38 Tuberculosis. Public Health (Tuberculosis) Regulations, 1930. The total number of primary notifications during the year was 264, in addition to which 10 cases not previously notified came to knowledge by means of special death reports, and 78 cases by transfer from other districts. The total number of new cases from all sources was therefore 352, equal to a notification rate of 2.49 per 1,000 of population, compared with 363 new cases during the previous year, with a notification rate of 2.59 per 1,000 population. The deaths from all forms of tuberculosis during the year numbered 105, equal to a death rate of 0.74 per 1,000 of population, whereas the total number of deaths in the previous year was 98 with a death rate of 0.70 per 1,000 population. It will be noted that, out of a total of 105 deaths from tuberculosis, 10 (being 9-5 per cent.) were of cases which were notified only at death. Death from tuberculosis without prior notification of the disease may be due to— (a) sudden death of a person who has not consulted a doctor since tuberculosis has developed; (b) sudden death of a person who has been notified elsewhere but has not consulted a doctor since arrival in the Borough; (c) difficulty in diagnosis before death; (d) the doctor being under an erroneous impression that the case had been notified in the Borough previously. The number of primary notifications of Tuberculosis and those which came to knowledge by means of death reports and transfers, from other districts as well as deaths during the year, are given in the following three tables :— Number of Primary Notifications . Age periods 0 to 1 I 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 Totals Pulmonary— Males 6 2 2 13 14 30 20 24 16 7 134 Females 1 5 3 4 11 24 18 16 7 5 4 98 N on-pulmonary— Males 1 1 1 2 2 1 1 1 1 11 Females — 2 4 4 2 1 4 1 2 — 1 21 Totals 1 14 10 28 39 54 38 34 22 13 264 39 Information obtained from Special Death Reports and by Transfer from other districts Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Totals Pulmonary— Males 1 1 — — 1 7 19 6 10 6 4 55 Females — 1 1 — 4 5 9 3 1 — 3 27 Non-pulmonary— Males — — — — — — 1 — — — — 1 Females — 1 — — — 2 2 — — — — 5 Totals 1 3 1 — 5 14 31 9 11 6 7 88* * 10 of these cases came to knowledge by means of special death reports, and 78 by transfer from other districts. Number of deaths of Tuberculosis patients. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 I 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up Totals Pulmonary— Males — — — — 2 2 6 4 14 18 21 67 Females — 1 1 — 1 5 5 6 8 3 2 32 Non-Pulmonary— Males — — — — — — 1 1 — — — 2 Females 1 1 — — 1 1 — — — — — 4 Totals 1 2 1 — 4 8 12 11 22 21 23 105 40 The interval elapsing between notification and death is some indication of the efficiency of notification, and in the following table the deaths from Tuberculosis are classified according to this interval:— Tuberculosis Deaths Recorded in 1949. Year of Notification. Total. Percentage. 1949— Discovered on death 10 10.2 Six months or less before death 28 28.6 Between six and twelve months before death 1 1.0 1948 9 9.2 1947 11 11.2 1946 7 7.1 1945 5 5.1 1940-1944 15 15.3 Before 1940 12 12.3 Total 98* 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. The following table gives particulars of the prevalence and fatality of this disease during the past 11 years:— Year Estimated Population Notifications Notification Rate per 1,000 population Deaths Death Rate per 1,000 population Pulmonary Other forms All forms Pulmonary Other forms All forms Pulmonary Other forms All forms Pulmonary Other forms All forms 1939 167,300 310 44 354 1 .87 0.26 213 118 12 130 0.70 0 07 0.77 1940 133,200 292 45 337 219 0.33 2.52 144 16 160 1 .08 012 1.20 1941 103,770 283 40 323 2.72 0.38 3.10 113 10 123 1 08 0.09 1.17 1942 105,900 274 42 316 2.58 0.39 2.97 134 13 147 1 .26 0.12 1 .38 1943 108,640 273 44 317 2.51 0.40 2.91 111 6 117 1.02 0.05 1.07 1944 105,780 320 38 358 3 02 0.35 3.37 115 13 128 1.08 0.09 1.17 1945 111,400 298 39 337 2.67 0.35 3.02 117 10 127 1.05 0 08 1.13 1946 129,410 308 47 355 2.45 0.36 2.81 92 6 98 0.71 0.04 0.75 1947 136,700 320 41 361 2.34 0.30 2.64 96 9 105 0.70 0 07 0.77 1948 140,200 318 45 363 2.27 0.32 2.59 90 8 98 0.64 0.06 0.70 1949 141,330 314 38 352 2'22 0.27 2.49 99 6 105 0.70 0.04 0.74 41 Notification Register. • The following table gives the information for the year ended 31st December, 1949, in the prescribed form:— Pulmonary Non-Pulmonary Total Number of cases on the Register at the commencement of the year 1949 1,128 177 1,305 Number of new cases during the year 341 39 380 1,469 216 1,685 Number of cases removed from the Register during the year (by death or other causes) 289 40 329 Number of cases remaining on the Register at the end of the year 1,180 176 1,356 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 cither by the Royal Institute of Public Health and Hygiene, 23, Queen Square W.C.I, or the Central Public Health Laboratory, Colindale. Positive Negative Total Diphtheria bacilli — 271 271 Tubercle bacilli 3 55 58 Faeces (Dysentery) 1 2 3 Faeces (Food Poisoning) — 2 2 Haemolytic Streptococci 20 33 53 Gram, negative diplococci and Trichomonas vaginalis — 1 1 Pathogenic organisms 1 29 30 Malaria — 1 1 Whooping cough — 2 2 Tape Worm Ova — 1 1 Totals 25 397 422 42 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 1949 Total 1948 St. Pancras 168 186 58 323 735 1,581 Ex St. Pancras 4 2 — — 6 38 No fixed abode — — — — — 2 Totals 172 188 58 323 741 1,621 (2) Verminous Conditions. Men Women Children under 5 Schoolchildren Total 1949 Total 1948 Head lice St. Pancras 2 27 32 1,886 1,947 1,921 Ex St. Pancras — 9 2 — 11 8 No fixed abode — — — — — — Body lice St. Pancras 466 6 — — 472 514 Ex St. Pancras 10 — — — 10 18 No fixed abode 13 — — — 13 9 Totals 491 42 34 1,886 2,453 2,470 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. 43 Attendances at Public Health Annexe. Year. Scabies. Vermin. Totals. 1932 1,706 5,576 7,282 1933 1,731 5,037 6,768 1934 2,256 5,908 8,164 1935 2,051 5.944 7,995 1936 3,197 5,893 9,090 1937 2,427 5,693 8,120 1938 3,924 5,290 9,214 1939 2,081 3,879 5,960 1940 1,591 3,002 4,593 1941 2,049 4,091 6,140 1942 7,089 2,870 9,959 1943 9,152 3,033 12,185 1944 6,171 3,416 9,587 1945 6,301 2,977 9,278 1946 5,467 3,471 8,938 1947 2,423 2,767 5,190 1948 1,621 2,470 4,091 1949 74 1 2,453 3,194 44 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 onlv Cerebro-spinal meningitis 9 6 2 1 Diphtheria 22 21 2 — Dysentery 8 7 1 — Enteric fever 1 1 — — Erysipelas 22 7 1 14 Malaria 1 1 — — Measles 36 2 4 33 Other diseases 301 12 9 283 Poliomyelitis 69 58 12 2 Puerperal fever 4 2 1 1 Relapsing fever 1 1 — — Scabies 4 1 — 3 Scarlet fever 155 102 50 6 Smallpox 3 1 — 2 Tuberculosis 135 120 16 8 Vermin 887 29 1,588 69 Totals 1,658 371 1,686 422 45 SECTION 4. Sanitary Administration. Visits by District Sanitary Inspectors. Complaints received 6,981 On complaint— Whole house inspections 78 Part of house inspections 7,121 Part of house re-inspections 17,055 Infectious Diseases— Investigations 939 Inspections 71 Re-inspections 48 Smallpox visits 101 Smoke observations 121 Mews and Stable Yards 41 Shops Act inspections 227 Subsequent inspections 118 Pharmacy and Poisons Act— First inspections 98 Subsequent inspections 69 Verminous persons 31 Blind persons 56 Overcrowding Regulations 65 Underground rooms 595 Drainage— Under notice 2,361 Voluntary 3,199 New buildings 836 Licensed premises 317 Outworkers Survey 148 'Special survey 320 Housing applications 2,060 Other inspections 2,356 Ineffective visits 5,140 Rent Restrictions Acts 12 Police Courts 148 Total 43,731 Intimation Notices served 5,486 Statutory Notices served 2,848 46 The following table gives a summary of this branch of the work of the department during the past five years:— 1945. 1946. 1947. 1948. 1949.[/##] Number of complaints received 3,832 5,689 7,550 7,136 6,981 Number of visits 17,251 29,578 37,375 45,209 43,731 Intimation notices served 2,709 4,487 5,760 6,567 5,486 Statutory notices served 1,388 2,580 3,912 3,498 2,848 Number of Police Court proceedings 17 57 133 212 139 Costs and/or fines 13 55 120 162 116 Amount of fines 1s. £3 £40 £166 £148 Amount of costs £31 £86 £171 £229 £205 The above police court proceedings were taken under the following statutes or regulations:— Public Health (London) Act, 1936 16 41 81 158 126 Housing Act, 1936 (L.C.C. Lodging House By-laws) 1 15 28 40 5 L.C.C. Water Closet By-laws — 1 11 5 1 Metropolis Management Acts (L.C.C. Drainage By-laws) — — 10 5 2 Public Health (London) Act, 1891 (Vestry By-laws) — — 1 3 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 — Housing Act, 1936 (Sec. 168) — — — — 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 four years are also given for the purpose of comparison:— Inspections. 1945. Inspections. 1946; Inspections. 1947. Inspections. 1948. Inspections. 1949 Drainage work done under notice 690 1,135 1,858 1,726 2,361 Voluntary drainage work 1,079 3,538 3,378 3,474 3,199 Drains of new buildings 263 373 334 909 836 Total 2,032 5,046 5,570 6,109 6,396 47 Water. The bulk of the water in the Borough is supplied by the Metropolitan Water Board and has been satisfactory in quality and quantity. There are, however, four factories in whose premises wells are situated and used, and a well is also available, if required, to augment the water supply to the Council's swimming baths at Prince of Wales Road. In addition, wells situated outside the Borough are a source of supply to various points on the railway system centred on Euston Station. Samples of this water have been taken and subjected to chemical and bacteriological examination by the Public Analyst, and in the case of one firm a chlorination plant was installed at the suggestion of the Medical Officer of Health. Ken Wood and Parliament Hill Fields open air ponds, the Council's swimming baths at Prince of Wales Road, and a private swimming bath have all received periodic visits of the Council's Inspectors and samples of water have been taken for examination during the year. Pharmacy and Poisons Act, 1933. The following applications were received during 1949 for retention or entry in the Council's list of persons entitled to sell poisons included in Part II of the Poisons List:— Retentions 147 New entries 8 Total 155 167 inspections were made by the Council's sanitary inspectors during the year. Closing and Demolition Orders. Closing orders were made during the year in regard to 114 basement rooms and 4 other rooms which were unfit for human habitation. Eight closing orders were determined. Demolition orders were made regarding 6 premises. 48 Housing. 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 257 — — — 257 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 58 66 — 50 174 1931 — 69 — 30 99 1932 22 52 166 60 300 1933 — — 80 167 247 1934 64 63 98 258 483 1935 — 61 83 341 485 1936 44 — — 257 301 1937 111 108 128 181 528 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 20 15 169 1949 372 55 — 18 445 Requests were received from the London County Council during 1949 for confirmation of statutory overcrowding in respect of 848 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. The following shows the categorical placings of the 9,991 families on the Borough Council's housing waiting list:— Urgent priority "A" cases 1,811 Priority " B " cases 353 Priority "C" cases 223 Others 7,604 During the year the Housing Department referred for my assessment and recommendation 1,056 cases where the applicants' need for re-housing was supported by some medical condition, be it sickness necessitating re-housing, or associated with bad housing or overcrowding. An investigation was made in each case and the medical reason for re-housing carefully assessed, 49 my recommendation being based on this and on a knowledge of the health of the members of the family, the number and size of the rooms occupied, amenities and general background. My recommendations were as follows:— Certificate "A" 605 " "B" 134 " "C" 203 " "D" 114 In most cases your Health Department was able to improve the conditions in which the families were living prior to re-housing, by the provision of certain amenities. Dealing with priorities "A" and "B", Bthe following were the reasons for the recommendations:— Environmental. Serious overcrowding 512 cases. Living in underground rooms which did not comply with regulations 57 „ Conditions such that it was impossible to separate adults of opposite sexes for sleeping purposes 5 „ Family living in one room for sleeping, living, cooking and all domestic purposes 20 „ Members of same family living at separate addresses owing to lack of accommodation 6 „ Other urgent reasons 32 „ Medical. Tuberculosis, it being impossible to provide a separate room for the patient 37 „ Heart disease so severe as to need special accommodation at ground floor level 18 „ Bronchitis, paralysis, rheumatism, crippling, high blood pressure and cance 52 „ 739 cases. 50 Public Houses. The following table shows the number of improvements made, in progress and promised during the year 1949:— Situation Improvements made Improvements in progress Improvements promised Kitchen. (a) Floor 13 1 1 (b) Walls and ceiling 41 2 7 (c) Storage 19 1 3 (d) Generally 23 1 10 Cellar. (a) Floor 59 2 12 (b) Walls and ceiling 67 3 14 (c) Drainage 34 2 6 (d) Generally 32 3 9 Bars. (a) Floor 18 — 4 (b) Walls and ceiling 66 3 17 (c) Generally 41 3 15 Behind Counters. (a) Floor 7 — 3 (b) Shelves 7 — 6 (c) Sinks 21 — 5 id) Hot and cold water 23 — 11 Washing Glasses 7 1 2 Sanitary Accommodation— Female. (a) No. of W.C.'s 26 5 27 lb) No. of washbasins 4 1 6 (cj General condition 51 3 16 Male. (a) No. of urinals 20 5 17 (b) No. of W.C.'s 18 5 19 (cj No. of washbasins 1 2 3 (d) General condition 66 3 23 Spillage Arrangements 6 — 1 Pipe Lines. (a) Cleanliness 3 — — (b) Frequency of cleansing 2 — — Totals 675 46 237 51 Blind Persons. We have continued our visits to blind persons during the year in order to satisfy ourselves that no nuisance existed, of which, owing to their disability, the blind persons may not have been aware. There are on the register of blind persons 101 individuals, of whom 31 are totally blind and the remainder partially blind. The age groups are as follows:— 2 years 1 6 „ 1 20/29 inc 4 30/39 " 4 40/49 „ 4 50/59 " 13 60/69 „ 20 70/79 " 33 80/89 " 16 Information not available 5 101 Of the 101 registered blind individuals:— 39 were living alone. 52 were living with relatives or friends. 9 were in hospital or institution. 1 (the child of 2) was in the Sunshine Home, Abbotskerswell. The conditions were satisfactory or fair in 89 of the homes visited and unsatisfactory in two cases. Insofar as possible Home Helps have been supplied through the L.C.C. Service, and at the time of writing this report 60 blind persons were receiving the help of this Service. The visits of the Inspectors have been welcomed on all occasions. National Assistance Act, 1948. Section 47. Section 47 of the National Assistance Act, 1948, came into operation on the 5th July, 1948, 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 incapacited, are living in insanitary conditions ; and (b) are unable to devote to themselves, and are not receiving from any other persons, proper care and attention. (6763) D2 52 The Department was concerned with six such cases during the year, three of which were still in hand at the end of the year. No Court Order was necessary in any of the three concluded cases, which were as follows:— Case 1 Woman 70-75 years of age suffering from a grave chronic disease (rheumatoid arthritis). She refused all assistance but finally became so ill that removal to hospital was inevitable. She died shortly after admission. Case 2 Woman 70-76 years of age refused at first to enter an Institution, but finally consented. Case 3 Woman 76 years of age. Application was made for an Order for her removal, but was withdrawn when she agreed to be admitted to hospital. Burials. Section 50 of the National Assistance Act, 1948, placed upon the Borough Council, as from the 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". It will be realised that the cases brought for the attention of the Department are of persons who die in poor circumstances. Moreover it must be emphasised that a large proportion of them have no known relatives. During the year 55 cases were dealt with at a total cost of £456 4s. 6d., of which £287 8s. Od. was recovered by the Department, leaving a net cost to the Council of £168 16s. 6d. It was not until the 5th July, 1949, that the provisions of the National Health Service Act, 1946, regarding payment of death grants, came into operation, and the opportunity for recovery of burial expenses prior to that date was limited to such sources as insurance policies, pensions or National assistance payments remaining unclaimed at the time of death, or such small sums of money as were found "on the body". Goods and chattels in most cases were of little or no value. The rooms of many of the deceased persons when visited by the staff of the Department were in a filthy state and it was pathetic that the late occupants had regarded the contents as "furniture" In a number of instances the rooms were disinfested and the contents cleared and destroyed. Death grants are now payable, subject to certain conditions, in respect of persons who were under 65 (men) or 60 (women) on the 5th July, 1948. The grant was successfully claimed in respect of four cases, the amount received being £29 19s. Od. 53 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 1948:— Post-Mortem Examinations. Received for Viewing only. Total. Resident and died in St. Pancras 227 (206) — (1) 227 (207) Died in St. Pancras, resident elsewhere 148 (144) 1 (5) 149 (149) Resident in St. Pancras, died elsewhere 52 (41) 2 (2) 54 (43) Resident and died elsewhere 574 (488) 18 (40) 592 (528) 1,001 (879) 21 (48) 1,022 (927) Accommodated for St. Pancras Hospital during rebuilding of Hospital Mortuary 18 (37) Total Number of bodies received 1,040 (964) Inquests held at Coroner's Court 459 Rodent Control. Seven operatives and one Rodent Officer, working under the part-time supervision of a Sanitary Inspector, were employed on rodent control. 1,631 premises were treated and 8,918 investigated. 12,203 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. Despite the thorough baiting which has been given regularly twice yearly for several years and the large number of rats killed, the takes of both poison and prebait on each treatment indicated no substantial decrease in the number of rats using the sewers. It should be emphasized that a large number of rats feeding in the sewer does not necessarily mean that the sewers are in bad condition. Usually rats live in the earth surrounding sewere and drains, to which they gain access by way of defective private drain outlets. As the Council are aware, the Sanitary Inspectors, in conjunction with the rodent control staff, are dealing with increasing numbers of defective drains and drain outlets. Sewer baiting is preventing an increase of sewer rats and thereby reducing the number of surface infestations. Should the underground infestations become large enough to cause overcrowding of the burrows the rats would work their way to ground level. It is considered that the treatments would be more effective if there were additional baiting points. During 1950 special consideration is to be given to sewer baiting in St. Pancras, and the Ministry of Agriculture and Fisheries will co-operate. Prevention of Damage by Pests Act, 1949. Important changes are made in the law relating to rodents by the passing of the above Statute which comes into force on the 1st April, 1950. 54 A local authority must secure that its district is kept free from rats and mice, and to do this such inspections as may be necessary must be carried out. The local authority must enforce the duties of owners and occupiers. Occupiers must inform the local authority when their premises are infested with rats or mice. The local authority may serve a notice on the owner and/or occupier requiring him to take steps to destroy rats and mice, and in the notice may specify the form of treatment and such structural repairs as may be necessary. There is a right of appeal to a Court of Summary Jurisdiction. If a person on whom a notice has been served fails to take the appropriate steps, the local authority may take such steps themselves and recover the cost thereof. Where groups of houses are concerned, the local authority, after appropriate notice, may carry out the necessary work and recover the costs from the several owners. The Minister of Agriculture and Fisheries will pay half of the costs so far as not recovered. I am of the opinion that an attempt should be made to carry out the provisions of the Act in its initial stages with the staff at present employed by the Council. 55 SECTION 5. Factories and Bakehouses. Particulars of inspections and other work carried out by the Factory Inspectors during 1949 are given in the following table:— Number of visits to— Factories (with mechanical power) 2,640 Factories (without mechanical power) 611 Workplaces 668 Bakehouses 525 Restaurants 973 Power laundries 16 Laundry receiving offices 155 Outworkers' premises 1,595 Scabies and vermin cases 287 Food control enquiries 11 Water sampling 75 Police Court 3 Public Health Annexe 126 Other visits 520 Total 8,205 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) 119 67 — Factories (without mechanical power) 10 29 — Workplaces 18 7 — Bakehouses — — 51 Restaurants and Canteens — 9 94 Outworkefs 1 — — Totals 148 112 145 Statutory notices served 11 31 10 56 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. Occupier Prosecuted. (i) Non-power factories, in which Sections 1, 2, 3, 4 and 6 are enforced by Local Authorities 438 611 10 Nil. (ii) Power factories in which Section 7 only is enforced by the Local Authority 1,468 2,005 119 Nil. (iii) Other Premises, excluding out-workers' premises 524 823 18 Nil. Totals 2,379 3,439 147* Nil. * Not including 103 notices served under Public Health (London) Act, 1936. 2. Cases in which defects were found. Particulars. Found. Remedied. Referred. Number ef prosecutions. To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 116 116 1 — — Overcrowding (S.2) 2 2 1 — — Unreasonable temperature (S.3) 6 6 — — — Inadequate ventilation (S.4) 9 9 — — — Ineffective drainage of floors (S.6) 2 2 — — — Sanitary Conveniences (S.7)— (a) Insufficient 13 13 — 2 — (6) Unsuitable or defective 148 148 — 18 — (e) Not separate for sexes 2 2 — — — Other offences against the Act (not including offences relating to Outwork) 7 7 9 2 — Totals 305 305 11 22 — 57 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. 507 Household linen 18 Lace, Lace curtains and nets 5 Curtains and furniture hangings 4 Furniture and upholstery 6 Brass and brass articles 18 Fur pulling 3 Artificial flowers 6 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 27 Brush making 6 Feather sorting 9 Carding, etc., of buttons, etc 6 Stuffed toys 8 Basket making 1 Cosaques, Christmas crackers, Christmas stockings, etc. 18 Lampshades 12 Total 654 There was one instance of default in sending lists to the Council, and legal action was taken. A fine of £2 was imposed upon the defaulter and £5 5s. costs awarded to the Borough Council. Letters were sent in each of seven cases (stuffed toys), where work was found to be carried on in unwholesome premises, and the outwork ceased. 58 SECTION 6. Inspection and Supervision of Food. Particulars of the inspections and other work carried out by the Council's three Food Inspectors during 1949 are given in the following table:— Number of visits to— Milkshops 229 Dairies 585 Ice cream premises 1,028 Slaughterhouses 2 Butchers'shops and meat stalls 728 Prepared meat premises 528 Fishmongers' shops 201 Fried fish shops 182 Fish curers' premises 88 Other premises where food and drugs are sold 1,448 Market streets and places 855 Railway goods yards, warehouses 177 Attendances at Police Court 25 Re-inspection after Intimation Notices 124 Other visits 939 Total 7,139* •These visits do not include visits made for the purpose of taking samples. Number of samples taken— Formal 460 Informal 695 Bacteriological 349 Total 1,504 Unsound Foods:— Surrenders 696 Seizures — Intimation Notices served 56 Statutory Notices served 11 59 Milk Supply. The Number of purveyors on the Register at the end of the year were:— Dairies 1ll Itinerant purveyors 71 For sale of milk in sealed containers only 207 For sale of cream and artificial cream 9 The Inspectors made 814 visits, and 335 formal samples were taken and submitted for analysis. Milk (Special Designations) Regulations 1936 to 1948. The number of licences granted during 1949 were:— Main Licences Supplementary Licences To sell Pasteurised milk 69 7 To sell Tuberculin Tested milk 56 7 To pasteurise milk 1 — The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949. These Regulations re-enact with amendments the provisions of the Milk (Special Designations) Regulations, 1936 to 1948 (above) and became operative on the 1st October, 1949. They require, inter alia, the licensing of traders selling Sterilised Milk in addition to those selling Pasteurised and Tuberculin Tested Milks. The number of licences (additional to those above-mentioned) issued as from the 1st October, 1949, were:— Main Licences Supplementary Licences To sell Pasteurised milk 42 8 To sell Tuberculin Tested milk 23 8 To sell Sterilised milk 146 13 Meat and Other Foods. (i) Public Health (Meat) Regulations, 1924. Periodical visits of inspection were made as follows:— Butchers' Shops and Meat Stalls 728 Prepared Meat premises 528 (ii) Inspection of other premises where food is prepared or offered for sale. The Food Inspectors have continued to keep all such premises under regular and frequent observation, the following inspections being made for this purpose:— Ice cream 1,028 Fishmongers 201 Fried fish 182 Others 1,448 60 Food Sampling. 1,155 samples (460 formal and 695 informal) were sent for analysis, of which 12 formal and 13 informal were found to be adulterated. Bacteriological Examination of Samples of Milk and Ice Cream. In addition to the samples of food submitted to the Public Analyst for chemical examination, a total of 349 samples were submitted either to the Royal Institute of Public Health and Hygiene, or the Central Public Health Laboratory, Colindale, for bacteriological examination. (a) Milk. 134 samples of milk were taken from dairies and from the London County Council schools and institutions and day nurseries in the Borough to ascertain whether they complied with the appropriate regulations relating to specially designated milks. The samples were subjected to the phosphatase test (which indicates the efficiency of the method of heat treatment) and the methylene blue test indicating the keeping quality of the milk. All the samples complied with the phosphatase test, and 131 of the 134 samples proved satisfactory in regard to the methylene blue test. Appropriate action was taken in the remaining three cases, and the follow-up samples were satisfactory. All the samples taken from the one pasteurisation plant in the Borough were satisfactory. Bacteriological Samples—Milk, 1949. T.T. (Past) Past. Ster. H.T. Totals Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory L.C.C. Schools and Institutions — — 54 1 2 56 1 Day Nurseries 4 — 10 — — — 8 — 22 — Dairies 16 — 31 2 6 — — — 53 2 Totals 20 — 95 3 6 — 10 — 131 3 (b) Ice Cream. 180 samples of ice cream were submitted for bacteriological examination, of which 111 reached grades 1 or 2 when subjected to the methylene blue reduction test. The improvement secured during the previous year has been maintained in a season with an appreciably higher mean temperature, whilst a considerably smaller proportion of samples fell within grade 4. 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. 61 The following table shows the detailed results of the bacteriological examination of ice cream samples during the years 1947, 1948 and 1949. 1947 1948 1949 Samples % Samples 0/ /o Samples % Satisfactory Grade I 17 22.3 75 41.7 59 32.4 Grade II 14 18.4 38 21.1 52 29.0 Grade III 23 30.3 31 17.2 44 24.6 Unsatisfactory Grade IV 22 29.0 36 20.0 25 14.0 Totals 76 100.0 180 100.0 180 100.0 There is still no legal standard for fat content, the Ministry of Food considering it impracticable at the present time to fix a definite standard for the chemical contents of ice cream owing to the shortage of important ingredients. There is, however, an arrangement whereby a manufacturer who undertakes to make an ice cream with a minimum fat content of 2.5 per cent, is allocated a somewhat higher proportion of certain ingredients by the Ministry of Food. In co-operation with that Ministry, this Department has, during the year, taken 89 samples of ice cream for chemical analysis, the results showing a fat content varying between 0-57% and 18-3%. The following summarises the results in three broad divisions. Below 2-5%. 2-5%—5%. Over 5%. 6 31 52 (c) Other commodities. There were also 27 samples of synthetic bakery filling cream, 22 of which were reported to be satisfactory from a bacteriological point of view. Eight samples of other commodities were satisfactory except in one instance. Legal Proceedings. The following 12 prosecutions were undertaken during 1949 in respect of food and drugs :— Food and Drugs Act, 1938. Court and Date of Hearing. Oflence. Result of Proceedings. Marylebone 4.1.49 Hovis loaf containing rats' excreta Plea of guilty. Dismissed under Probation of Offenders Act. Costs £1 Is. Clerkenwell 7.1.49 Bottle of milk containing dirt Summons dismissed. Costs £5 5s. against Borough Council in favour of defendant. Marylebone 9.2.49 Nail in cake Case against wholesalers dismissed. Plea of guilty. Fine £1. Costs £1 1s. Marylebone 8.3.49 Sausage meat (beef) containing only 30 per cent meat Plea of guilty. Fine 40s. Costs £6 6s. 62 Court and Date of Hearing Offence Result of Proceedings Clerkenwell 6.4.49 Added water to milk Plea of guilty. Dismissed under Probation of Offenders Act. Costs £2 10s. Do. Adulterated beef sausage Plea of guilty. Fine £8. Costs £3 3s. Marylebone 11.4.49 Sterilized milk containing glass. Dismissed under Probation of Offenders Act. Costs £2 2s. Marylebone 21.7.49 Milk with fat abstracted Fine £4. Costs £2 2s. Marylebone 3.10.49 Beef sausages containing only 30 per cent meat Fine £3. Costs £2 2s. Marylebone 2.12.49 Selling a cake unfit for human consumption Fine £4. Costs £2 2s. Clerkenwell 5.12.49 Malt vinegar deficient in acetic acid Fine £2. Costs £3 3s. Defence (Sale of Food) Regulations, 1943. Marylebone 2.8.49 Salad cream deficient in edible vegetable oil Dismissed under Probation of Offenders Act. Costs £10 10s. Unsound Food Condemned and Destroyed. During the year 1949, 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. Apricot pulp 500 lbs. Cocoa 35 lbs. Bacon 18½ lbs. Cod 44 stone. Barley flakes 18 lbs. Cod fillets 61 stone. Beef 982¾ lbs. Cod roes 7 stone. Biscuits 112½ lbs. Confectionery 142½ lbs. Black pudding 27 lbs. Conger 7¼ stone. Brawn 604 lbs. Corned beef 1,098¾ lbs. Bream fillets 5 stone. Corned mutton 108 lbs. Brisket 8 lbs. Cowheel 50 lbs. Buns 4 lbs. Cream, synthetic 5 gallons. Butter 65½ lbs. Crumpets 300 Cabbages 3 tons. Currants 50 lbs. Cake 476 lbs. Dabs 15½ stone. Canned foods 5,597 tins. Date paste 192 lbs. Carrots 162 sacks. Dog fish 133½ stone. Catfish 2 stone. Duck 4 lbs. Cauliflowers 1 sack. Eels 20 lbs. Cheese 41 lbs. + 159 cartons. Egg—frozen 308 lbs. Cherries, bottled 5 lbs. Egg—liquid 12 gallons. Chickens 1,408 lbs. Eggs 51 Chili con carne 39 lbs. Farina 2 cwts. Chocolate 4¾ lbs. Figs 128 lbs. Chocolate spread 16 packets. Fish cakes 648 63 Articles. Quantity. Articles. ity. Fish fillets 50 lbs. Oatmeal 13 lbs. Flour 1¼wts. Oatmeal cakes 36 packets. Flour—soya 112 lbs. Oats 50 lbs. Fruit—bottled 20 lbs. Oranges 540 lbs. + 9 crates. Game 168 lbs. Ox Tongue 12 lbs. Geese 51 lbs. Pears 33 crates—9 cwts. 50 lbs. Golden cutlets 1½stone. Gurnard 4½stone. Piccalilli 44 jars. Haddock 125 stone. Pickles 746 jars. Hake 46 stone. Pigeons 4 Halibut 30 stone 3 lbs. Pigs' offal 65 lbs. Ham 15 lbs. Pigs' Trotters 274 lbs. Hares 30 lbs. Plaice 60 stone. Hens 80 lbs. Plums 3 gallons. Herrings 22 stone. Pork 134 lbs. Horseflesh 112 lbs. Pork pies 60 lbs. Ice lollies 89 Prawns 65 lbs. Intestines 3 churns. Rabbits 1 crate—534 lbs. Jam 31 lbs. Raisins 180 lbs. Jam tarts 50 Rice 30 lbs. Jelly fruit cups 25 Sago 144 lbs. Kippers 9 stone 10 lbs. Salad dressing 228 jars. Lamb 64½bs. Salmon 47 lbs. Lites—Pigs 300 sets. Sausage 826 lbs. Livers and kidneys 53 lbs. Semolina 2 lbs. Lobsters 63 lbs. + 1 box. Skate 361½stone—36 lbs. Mackerel 29 stone. Skate wings 35½ stone. Margarine 24 lbs. Suet—shredded 9 lbs. Maws—Jellied 12 lbs. Sultanas 28 lbs. Meat 59 lbs. Tomato juice 564 gallons. Meat loaf 45 lbs. Tomato ketchup 16 bottles. Meat—Luncheon 37 lbs. Tripe 10 cwts. 4 lbs. Meat pies 189 lbs. + 90. Turkey 68 lbs. Meat—U nidentified 1 carton. Veal 5 lbs. Megrim fillets 58½stone. Veal—jellied 16 lbs. Monkfish 1 stone. Vinegar 324 bottles. Mushrooms 29 lbs. Watercress 62 chips. Mutton 45 lbs. Whiting 35 stone. PRINTED BY HARRISON AND SONS, LTD., ST. MARTIN'S LANE, LONDON (6763)