<jss4 WES 31 City of Westminster. ANNUAL REPORT FOR THE YEAR 1921 by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Bd., Medical Officer of Health. Printed by Order of the Council. LONDON: harrison and sons, ltd., printers in ordinary to his majesty, st. martin's lane, w.o.2. City of Westminster. ANNUAL REPORT FOR THE YEAR 19 21 by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.RJ3. Ed., Medical Officer of Health. Printed by Order of tlie Council. LONDON: harrison and sons, ltd., printers in ordinary to his majesty, st. martin's lane, w.c.2. 72554 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1921. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1921. It includes Returns required by the Ministry of Health and Home Office.' Details of the various activities of the Public Health Department having been given in the 1920 Report, it is not necessary to do more than record any changes which have taken place in 1921. The need for economy in expenditure has, and no doubt will, for some time prevent development on new lines, but it is recognised that it is not a wise policy to curtail existing activities which have for their aim the improvement of health and the prevention of illness. It has been difficult to obtain the abatement of nuisances, and to secure the keeping of houses of the tenement class in a decent state of repair, in consequence of the decline ip the incomes of the owners and the high cost of labour. Owing to the same causes the amount of rebuilding and reconstruction has been much less than the average. The year 1921 was an unusual year as regards the weather—it established a record, in the increased amount of sunshine which began early and continued until late in the year, and in the reduction in rainfall which was only about half the normal. The death rate for AVestminster was slightly higher than in the preceding year, but for the country in general it was the lowest on record. While the weathor conditions were on the whole beneficial to the public health, yet in some directions the reverse was the case, as in the occurrence of diarrhoea and septic throats in the autumn, and possibly in the increased prevalence of scarlet fever and diphtheria. (4573) A 2 iv It is with regret that one has to chronicle the death of Col. Charles E. Cassal, one of the Public Analysts of the City since its inception, and previously for the Parish of St. George's, Hanover Square. He took a keen interest in the prevention of the adulteration and sophistication of food, and his efforts in this direction were much appreciated. I have the honour to be, Mr. Mayor, my Lords, Ladies and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. April, 1922. PART I. A. STATISTICS. Population. The Census, 1921.—A preliminary report has been issued by the Registrar-General relating to the number and sex of the population of England and Wales, and of the various administrative areas. The figures are provisional and subject to confirmation in future reports, which will contain other details. For England and Wales, 18,082,220 males and 19,803,022 females were enumerated, showing an intercensal rate of increase of 5.03 over the 1911 population. This increase is only about half of that in the preceding intercensal period and is accounted for by the lower birth-rate prevailing during the years 1915-18 and by the deaths of non-civilians estimated at 560,000 which occurred between 1914 and 1920 at the various theatres of war. The Administrative County of London shows a decrease of 38,436 persons, equal to 0.9 per cent. This is three times as great as happened between 1901 and 1911. Up to 1901, there had been an increase at each Census. The immediately surrounding areas conveniently designated the Outer Ring which, with the Administrative County, comprise Greater London, show an increase of population of 9.6 per cent., much less than at any previous Census period, e.g., 1871, 50.7 per cent.; 1881, 50 per cent.; 1891, 50.1 per cent.; 1901, 45.5 per cent.; 1911, 33.5 per cent. Combining the two sets of figures, the population of Greater London shows an increase of 3.1 per cent., which is only about 60 per cent. of the rate of increase for the whole country. The rate of increase at 1911 Census was 10.2 per cent. The figures for the City of Westminster are set out below, and I have added the corresponding figures recorded at the two previous Censuses of 1901 and 1911. Similar figures are also given for the two Parliamentary Divisions as now existing. 2 Population as Ascertained in 1901, 1911 and 1921. City of Westminster. Year. Males. Females. Total. Decrease. Total. Males. Females. 1901 84,963 98,048 183,011 _ _ _ 1911 73,449 86,812 160,261 11,514 11,236 22,750 1921 61,283 80,034 141,317 12,166 6,778 18,944 Total decrease, 1901-1921 . 23,680 18,014 41,694 St. George's Division. Year. Males. Females. Total. Decease. Total. Males. Females. 1901 35,720 49,386 85,106 — — — 1911 32,152 45,646 77,798 3,568 3,740 7,308 1921 28,787 44,929 73,716 3,365 717 4,082 Total decrease, 1901-1921 6,933 4,457 11,390 Abbey Division. Year. Males. Females. Total. Decrease. Total. Males. Females. 1901 49,243 48,662 97,905 — — — 1911 41,297 41,166 82,463 7,946 7,496 15,442 1921 32,496 35,105 67,601 8,801 6,061 14,862 Total decrease, 1901-1921 16,747 13,557 30,304 The population of the City, which declined by 22,750 between 1901 and 1911, shows a further reduction this year of 18,944, the decrease being at the rate of 12.4 per cent. during 1901-1911 and 11.8 during 1911-1921. The population is somewhat higher than the Registrar-General had provisionally estimated, viz., 137,709 for 1920. This will cause a reduction in the birth and death rates as given in the last Annual Report. The task of making estimates for intercensal years was necessarily 3 extremely difficult. No record of the internal movement of sanitary areas was available, but it was known that during the war such movement in Westminster was abnormal and extensive, due to the arrival and departure of members of the British Forces, of the Forces of the Dominions, Colonies and Allied Powers, of War Refugees, Munition Workers and Officials in Government Departments. The Registrar-General says that the estimates based on the food rationing records and other sources of information were bound to be crude, and little would be gained by attempting any detailed comparisons between them and the enumerated population of 1921. It has been pointed out on previous occasions that the Census returns for Westminster are probably lower than they ought to be on account of the enumeration taking place on a Sunday when the inhabitants have gone elsewhere for the week end. This year the Census having been taken in June, which was an unusually fine and warm month, a number of people were already away on holiday, but possibly this might be counterbalanced by visitors to Westminster from the country and abroad. The total figures will have to be amended, especially as regards the number of persons at advanced ages, when the number is known of the inmates in the Westminster Workhouse and Infirmary which are in the Borough of Chelsea. In the St. George's Division the decrease was only 4,082, or 5-2 per cent, compared with 7,308, or 8-58 per cent, in 1911. The total reduction in the 20 years was 11,390. u The Abbey Division as might be expected shows a much larger reduction in population, viz., 14,862, or 18 per cent., compared with 15,442, or 15-7 per cent, in 1911. The total decrease in the 20 years was 30,304. This is accounted for by the extensive alterations which have taken place in that period in the Strand and in St. John's districts, by the gradual transformation of dwelling houses into business premises, by the closure of Poland Street and Sheffield Street Workhouses, and by the discontinuance of the living in of employees of many large business firms. Males and Females.—Throughout the whole country the Census figures show that there is an increased proportion of females to males. In 1911, to evory 100 males there were 106-8 females, in 1921 the proportion has risen to 109*5. This is one of the direct legacies of the war. In London the proportion was 112-6 in 1911, 116-3 in 1921. 4 Proportion of males and females. City of Westminster. Year. Males. Females. Males. Females. Per Cent. Per Cent. 1901 46.4 53.6 100 115 1911 45.8 54.2 100 118 1921 43.3 56.7 100 130 St. George's Division. Year. Males. Females. Males. Females. Per Cent. Per Cent. 1901 42.0 58.0 100 138 1911 41.3 58.7 100 142 1921 39.0 61.0 100 156 Abbey Division. Year. Males. Females. Males. Females. Per Cent. Per Cent. 1901 50.3 49.7 100 98.6 1911 50.1 49.9 100 99.6 1921 48.0 52.0 100 108.0 In Westminster the proportion has risen from 118 to 130, in the St." George's Division from 138 to 156, and in the Abbey Division from 98.6 to 108. At the two previous Censuses there were more males than females in the Abbey Division, and it will be noticed that in this Division at the 1911 Census the decrease was about equal in the two sexes, now the decrease of females is only a little more than half the male decrease, but in the St. George's Division, where the decrease in the female population was greater than that of the males, it is only 717, against 3,365 males. Possibly, when the figures for the separate Wards are available, it may be found that the decrease of females has occurred chiefly in the May fair district through fewer domestic servants being kept; there may even be an increase in the Pimlico area. Effect of excess of females on death-rate.—The rate of mortality is considerably less for females than for males, and thus a preponderance of them* in the population produces a lower death-rate. 5 1920. Males. No. Rate per 1,000. Females. No. Rate per 1,000. Total. No. Rate per 1,000. St. George's Division 331 = 11.5 408 = 8.6 739 = 9.7 Abbey Division 500 = 14.6 361 = 9.9 861 = 12.2 The City 831 = 13.0 709 = 9.3 1,600 = 10.9 Taking the deaths in 1920 as an example, the rates for each sex is shown in the accompanying table. In St. George's Division, had males and females been in equal proportion, the death-rate would have been 10.5 instead of 9.7 per 1,000. The rates in the Abbey Division are higher than those in the St. George's Division, and this is partly accounted for by the greater proportion of males, and also by the fact that all the Common Lodging Houses are in that Division. These have a proportionately higher death rate on account of their fluctuating population. In 1920, the number of beds available in these places was 1,529 for males and 57 for women. The deaths of males was 86. If these are deducted, the death-rate for males in the Abbey Division would be 12.8 instead of 14.6, and for males and females 11.3 instead of 12.2. The effect of a similar deduction on the rates for the whole City would be to reduce the male rate from 13 to 12 per 1,000 and the total rate from 10.9 to 10.1. The effect of the large proportion of females in the population is shown also in the incidence of Pulmonary Tuberculosis. In 1920 the new cases among males was equal to 2.7 per 1,000, and of females 1.65. Consequently, an increase in the proportion of females results in a smaller number of cases in the aggregate. Births. The number of births registered in Westminster during 1921 was 1,418, of these the home address of 78 was elsewhere, and therefore these have to be deducted, but 579 children were born to residents of Westminster in institutions in other parts of London; adding these the nett number was 1,919, a reduction of 341 on the figure for the year 1920. The fluctuations in past years are shown below. Calculated on the Census population, a birth-rate of 13.6 per 1,000 persons results; the London birth-rate was 22.3 and for England and Wales 22.4, both showing a decrease on the 1920 rates, but in each case 4 points above the 1919 rates. 6  Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Nett. Total. Alive. Stillborn. 1909 2,620 39 270 2,751 1,612 1,571 41 1910 2,365 49 276 2,592 1,674 1,621 53 1911 2,110 60 311 2,361 1,562 1,507 55 1912 2,134 49 264 2,349 1,501 1,469 31 1913 1,992 35 276 2,233 1,462 1,424 38 1914 1,860 15 312 2,157 1,386 1,347 39 1915 1,721 71 329 1,979 1,292 1,250 42 1916 1,643 175 342 1,810 1,330 1,288 42 1917 1,325 159 378 1,544 1,020 985 35 1918 1,138 146 458 1,459 911 888 23 1919 1,210 98 480 ],592 1,004 977 27 1920 1,731 89 618 2,260 1,327 1,289 38 1921 1,415 78 579 1,919 1,049 1,032 17 Divided into legitimate and illegitimate, the figures for 1921 are:— Legitimate— Males 676—13+241 = 904 Females 654—22+193 = 825 Total 1,330—35+435 = 1,729 Illegitimate— Males 43—24+68= 87 Females 45—19+77= 103 Total 88—43+144 = 190 The notifications received numbered 1,049, in 12 instances twins, and in one instance triplets were mentioned. They represent 1,035 confinements. The number of notifications received from midwives was 787. The number of still-births notified was 17, but information was received of 26 other confinements in which dead children were born: 16 of these occurred in hospitals or infirmary; 1 was illegitimate; 3 sets of twins. Number Born. Number of Deaths under 1 year. Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 1913 1,120 1,113 111 102 1,009 1,011 1914 1,120 1,037 103 68 1,017 969 1915 1,006 973 103 79 903 894 1916 889 921 84 67 805 854 1917 756 788 94 64 662 724 1918 789 670 84 64 705 606 1919 786 814 74 63 712 751 1920 1,117 1,149 104 63 1,013 1,086 1921 991 928 91 63 900 865 7 For each 1,000 girls born, there were in— 1913 1,006 boys. 1918 1,177 boys. 1914 1,080 boys. 1919 965 boys. 1915 1,033 boys. 1920 972 boys. 1916 965 boys. 1921 1,067 boys. 1917 914 boys. Maternity and Child Welfare. The Bessborough Street Centre has fully justified its formation. It has, of course, taken away a number of mothers and children from the Pimlico area, but as shown by the attendances at the pre-natal and children's clinics it is providing care for large numbers who found it too far to attend at 1, Pimlico Road. During the first six months one clinic a week was held at Bessborough Street, but it was found necessary to have two per week to cope with the numbers attending and an assistant health visitor was appointed. In addition to the four Centres already existing, a sub-centre has been opened in North Mayfair by the Health Society. Expectant Mothers.—The names of 943 were sent in by hospitals, voluntarily notified or found by visitors, and to these 3,066 visits were paid at their homes (see Table); 201 attended the Mothercraft Classes. Ante-natal Clinics.—155 women attended for the first time in 1921 (139 in 1920). 22 women also attended the Clinic at Bessborough Street, after confinement. The Medical Research Council has in hand an extensive scheme for the study at many centres of problems of child life; the practical object immediately in view is to secure knowledge, at present greatly lacking, which may be a sound guide to the conservation of healthy life in the child before and after birth. The account given in their Report of these investigations is appropriately divided into two sections—pre-natal and post-natal studies. Two papers have been published from which two conclusions can be drawn: the first is that syphilis is a remarkably frequent cause, not only of stillbirth, but also of early post-natal death; There were 368 attendances altogether (293 in 1920) of expectant mothers at the two centres. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Pimlico Road 49 48 65 113 72 Bessborough Street 51 107 148 255 5 8 and the second that an extraordinary number of stillbirths fall within the hopeful purview of prevention by adequate ante-natal supervision. Attendance during Confinement.—The Council's midwife attended necessitous women and emergency cases in the Pimlico area. Number of cases attended— As midwife 103 On emergency 13 With hospital students 2 With private doctor 1 Total 119 Number of— Pre-natal visits 919 Lying-in visits 880 Subsequent visits 115 Visits to infants under 1 year other than lying in visits.. 158 Total number of visits 2,072 Weekly attendances at ante-natal clinics :— 1, Pimlico Road 83 15, Bessborough Street 105 Total 188 In the St. John and St. Margaret's area, the Health Society has two niidwives. They attended 129 cases, paying 1,508 midwifery visits and 413 nursing visits. Number of cases attended— As midwife 66 With hospital students 39 With private doctors 24 They also attended at the Centre on 52 afternoons to interview expectant mothers. Puerperal Fever and Mortality in Childbirth.—Ten cases of puerperal fever occurred. This term includes a number of conditions varying from slight and temporary rises in temperature to severe cases of septic poisoning. Four of the cases resulted from attempts to cause abortion, two were cases complicated with pre-existing abnormal conditions requiring serious operations, and one proved to be pneumonia. Thirteen women died after childbirth, viz., from criminal abortion, 3; hemorrhage, 1; pneumonia, 2; pulmonary embolism, 2;. prolonged 9 labour, 1; tumour, 2; septicaemia, 2 (one of these being after an early miscarriage); there was also 1 death from ectopic gestation. Convalescent Homes.—Several mothers with their children were sent away through the Council. In the Soho area, similar facilities are provided by the St. Henry Fund, of which the Medical Officer of Health is ex-officio a trustee; 18 mothers with their children were sent to Convalescent Homes in 1921. Others were sent away through various charitable agencies. Motliercraft Classes.—These exist at each Centre and are attended by mothers both before and after confinement. The classes at the Pimlico and Bessborough Centres are under the care of Mrs. Coleman and Mrs. Grice, of the Westminster Branch of the British Red Cross Society, the former superintending the class giving instructions to the mothers and supervising the cutting out and making of garments for the children ; the latter, with the assistance of other ladies, looks after the children who accompany their mothers. Employment of Women after Childbirth.—The Factories and Workshops Act, Section 61, provides that the occupier of a factory or workshop shall not knowingly allow a woman, or girl, to be employed therein within four weeks after she has given birth to a child. This Section is extended to laundries by Section 103. This Section was administered by the Home Office, but has now been transferred to the Ministry of Health and local authorities. The attention of the Health Visitors and the Inspector of Women's Workshops has been drawn to the matter. Its importance has always been recognised. Dental Clinic.—The dentist, Mr. W. H. Turner, reports :—I am pleased to be able to report that the Dental Clinic, established by the Council towards the end of 1920, has been greatly appreciated by the patients who have had access to it, and there are already many signs that the Clinic is meeting an urgent need in the "Health Work" in this district. During the past year 59 patients (35 mothers, 24 children) had treatment—necessitating 235 visits by those patients. Local anaesthetic cases numbered 17, whilst the anaesthetist administered 81 general anaesthetics. 525 teeth were extracted, 72 teeth filled and 188 other dental operations performed. Dentures were supplied in 2 cases. These figures emphasise the fact that the majority of the cases were in a very bad dental condition, and had they been treated in an earlier stage much more conservative treatment could have been done. 10 Homes.—A grant of £100 was made to the St. John the Baptist Home formerly in Westminster, now at Tulse Hill. Supply of Milk.—Grants of milk free or at reduced prices were made to 148 expectant and nursing mothers and to children, 99 less than in 1920. Except in a few instances ordinary milk was granted, in the others, dried milk. The amount expended was £260 16s. 1d. for "fresh" milk, and £19 19s. for dried; total, £280 15s. 1d. Each case is re-considered monthly. The reduction in the number of applications is due not to less destitution but to a greater number of persons having to apply to the Guardians, as in cases in which the applicant is already in receipt of Poor Law Relief, (or is considered ought to be), reference is made to the Guardians, so that one authority only deals with the matter. In cases with little or no income the Guardians are able to assist with other food as well as milk. In addition to the above, dried milk is kept at all the Centres, and is supplied to suitable cases at cost price. The amount sold at cost and at reduced price was 10,200 lbs. Mothercraft classes are also carried on at the two other Centres by the Health Society. Particulars relating to these classes are given below:— Mothercraft Classes. Pimlico Road. Bcssboro' Street. Rochester Row. Greek Street. Total. Number of classes 46 48 84 88 266 Total attendances 425 295 1,706 1,015 3,441 Average attendances 9.2 6.1 20.3 11.5 — Highest number of attendances 15 12 14 7 — Number of expectant mothers 16 27 82 76 201 Number of attendances by expectant mothers 69 111 573 309 1,062 Number of other mothers 32 34 69 90 225 Number of attendances by other mothers 356 184 1,133 706 2,379 Attendances of children in nurseries during classes 360 202 745 486 1,793 Materials are purchased in quantity and sold to the mothers at cost price. Infancy and Early Childhood.—The number of visits paid by the Health Visitors in the four areas into which the City was divided, is shown in the accompanying table:— 11 Pimlico. Bessborough Street. Rochester Row. Greek Street. Total. Total. Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Pre-natal— First visits 169 46 120 31 276 22 156 28 711 127 838 Other visits 192 93 196 54 449 32 211 92 1,048 271 1,319 Children under 1 year of age— First visits 478 95 188 48 504 25 343 58 1,513 226 1,739 Other visits 2,663 575 571 260 895 610 1,105 606 5,234 2,051 7,285 Children over 1 and under 5 years— Visits 2,870 454 571 507 958 1,427 1,231 1,454 5,630 3,842 9,472 Children of school age— Visits 1,740 402 252 308 380 875 1,080 2,333 3,452 3,918 7,370 8,102 1,665 1,898 1,208 3,462 2,991 4,126 4,571 17,588 10,435 28,023 9,767 3,106 6,453 8,697 28,023 To the Pimlico and Bessborough Street figures have to bo added visits paid by the midwife, viz., first pre-natal 105, subsequent 804; children under 1, 158. The visits paid by the midwives of the Health Society are included under their respective headings in the Rochester Row area. Total Infectious disease Deaths of children Still-births See also visits paid by midwives, ante. Visits were paid in connection with— 257 195 48 14 Pimlico. 173 142 21 10 Bessborough Street. 115 76 31 8 Rochester Row. 96 51 37 8 Greek Street. 641 464 137 40 Total. There was a reduction in the visits paid in connection with infectious disease owing to the absence of measles. Arrangements are made with the three local Nursing Associations for nursing children in their homes; 1,462 visits were paid to 130 sick children. 12 Infant consultations are held at each of the Centres. At the Bessborough Street Centre the increase of work necessitated an additional session being held each week. The following are details of the attendances:— Attendances at Infant Consultations, 1921. Centre. Number of Sessions. First Attendances. Subsequent Attendances. Total. Total. Under 1 year. Over 1 year. Under 1 year. Over 1 year, Under 1 year. Over 1 year. 1, Pimlico Road 99 245 68 2,032 803 2,277 871 3,148 15, Bessborough Street 76 194 76 1,736 1,072 1,920 1,148 3,068 100, Rochester Row 92 324 60 1,614 534 1,938 504 2,032 60, Greek Street 48 156 37 595 243 751 280 1,031 Mayfair 3 6 2 3 13 9 15 24 318 915 243 5,980 2,665 6,895 2,908 9,803 The average attendances were— Pimlico Road 31.8 Bessborough Street 40.5 Rochester Row 27.5 Greek Street 21.4 In addition to the inspections by the medical officer stated above, 446 attendances for weighing only were made at Rochester Row, 342 at Greek Street, and 12 at the Mayfair centre. Ante-natal Clinics and Infant Consultations in connection with their Maternity Department are held by Charing Cross, Middlesex, and York Road Lying-in Hospitals. The number of individual children medically inspected were— 1, Pimlico Road 343 60, Greek Street 328 lo, Bessborough Street 260 Mayfair 15 100, Rochester Row 649 13 At the North Centre, 60, Greek Street, 47 classes were held by Dr. Lewin for Nasal Hygiene, especially in connection with cases of adenoids and faulty nasal conditions; 364 children attended 1,148 times. 41 children were under 1 year, 81 between 1 and 5, and the remainder were of school age. Deaths. 1,758 deaths were registered in the City in the 52 weeks of 1921. After deducting 944 deaths of non-citizens in public institutions in the City, and adding those of 809 citizens who died in other districts, the corrected total is 1,623, and is equivalent to an annual rate of 11.5 per 1,000 persons. This is slightly higher than in 1920. The London death-rate for 1921 was 12.4 (civilians only), for England. and Wales 12.1. The death-rate for the country as a whole is the lowest on record. The number of deaths and the death-rates per 1,000 for a series of years are shown below:— Year. Number of Deaths. Death-rate. London Rate. 1911 2,005 12.5 15.0 1912 1,984 12.5 13.6 1913 2,030 12.7 14.2 1914 1,946 12.7 14.4 1915 2,138 15.7 16.1 1916 1,827 13.7 14.3 1917 1,896 15.5 15.0 1918 2,062 16.3 18.9 1919 1,819 14.2 13.4 1920 1,600 10.9 12.4 1921 1,623 11.5 12.4 As previously explained, it is impossible to state the rates for the war years with any degree of accuracy, and in the years 1916-18 especially the population is believed to have been higher than the Registrar-General's estimate. The deaths of males were 897 (831 in 1920), females 726 (769 in 1920), giving rates per 1,000—1920, males 13.0, females 9.3; 1921, males 14.6, females 9.0. The number of deaths attributed to various causes and at various . age periods are set out in the table appended to this section of the Report. (4573)Q B 14 Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and up. Total. M. 91 17 17 20 28 109 295 320 897 F. 63 11 15 15 28 95 204 295 726 1921 154 28 32 35 56 204 499 615 1,623 1920 167 18 21 27 53 222 517 575 1,600 1919 140 24 31 33 80 265 570 676 1,819 Deaths of males show a decrease under 1 and between 25 and 45 and increases at all other age periods. Deaths of females show slight increases between 1 and 2 and 2 and 5, and decreases at all other age periods. The increased mortality at the younger ages being chiefly due to Diarrhoea, Whooping Cough and Diphtheria. At the higher ages, there is an increase in both males and females of deaths from old age, bronchitis and diseases of the heart and bloodvessels. Among males death by accident and negligence show an increase of 11, while females are 5 less. Suicide and murder caused 16 more deaths among males than in 1920. The deaths were distributed in the wards in the years 1919, 1920 and 1921 as follows:— 1919. Total. 1920. 1921. M. F. Total. M. F. Total. Conduit 17 9 14 23 8 12 20 Grosvenor 115 47 55 102 57 50 107 Hamlet 82 17 31 48 18 29 47 K. St. George 134 48 54 102 55 55 110 Victoria 483 210 254 464 234 233 467 St. Margaret 75 62 44 106 44 37 81 St. John 388 198 168 3C6 214 162 376 St. Anne 93 53 44 97 47 36 83 Gt. Marlborough 54 19 18 37 16 12 28 Pall Mall 46 26 7 33 20 11 31 Regent 74 43 18 61 35 37 72 Charing Cross 32 15 11 26 28 10 38 Covent Garden 66 31 36 67 38 23 61 Strand 68 42 7 49 57 12 69 Homeless 98 11 8 19 26 7 33 Infantile Mortality.—The corrected death rate of infants for Westminster was 80.2 deaths per 1,000 births, the average of the previous five years having been 87.6. This is the lowest recorded, with the exception of the rate in 1920. Below are given figures for both births and deaths of infants corrected, distinguishing legitimate and illegitimate births, showing the rates for a series of years 15 Year. Legitimate. Illegitimate. Total Rate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 1902 3,275 410 125 186 32 172 127 140 1903 3,035 345 113 150 25 166 116 130 1904 2,920 320 109 134 40 298 118 145 1905 2,971 305 102 149 24 161 105 130 1906 2,744 285 103 187 38 203 110 131 1907 2,764 269 97 163 34 208 103 116 1908 2,739 266 97 174 27 155 100 113 1909 2,548 232 91 203 26 128 93 108 1910 2,399 189 78 193 25 129 82 103 1911 2,195 210 95 166 33 198 103 129 1912 2,194 168 76 155 27 174 83 91 1913 2,057 184 89 176 29 164 95 109 1914 1,995 147 73 162 24 148 79 104 1915 1,798 141 78 181 41 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 48 239 103.6 104 1918 1,234 112 86.6 225 36 155 100 108 1919 1,383 99 71.5 217 41 188 87.5 85 1920 2,047 123 60 219 44 200 73.6 76 1921 1,729 117 67.7 190 37 194 80.2 80 Five-Yearly Averages. 1892-96 — — 159 157 1897-1901 — — 150 159 1902-06 111 200 115 135 1907-11 92 164 96 114 1912-16 75 188 87 100 1917-21 73.8 195 88.8 90 The five-yearly averages show the steady improvement which has taken place in last 25 years in Westminster, and later in London. In the three divisions into which the City is divided under the Maternity and Child Welfare Scheme, the figures (omitting the homeless) were:— Centre. Legitimate. Illegitimate. TotaL 1919. 1920. 1921. 1919. 1920. 1921. 1919. 1920. 1921. Pimlico and Bessboro'— Births 604 930 799 107 99 85 711 1,029 884 Deaths 37 58 58 15 25 11 52 83 69 Death-rate per 1,000 births 61 62.4 72.7 140 252 129 73.1 80.6 78.0 Greek Street— Births 354 526 373 56 74 55 410 600 428 Deaths 29 26 24 5 5 9 34 31 33 Death-rate per 1,000 births 82 49.4 64.3 89 67.5 163 83 51.6 77.1 Rochester Row— Births 420 593 557 44 35 39 464 628 596 Deaths 28 39 35 10 7 6 38 46 41 Death-rate per 1,000 births 66.6 65.7 62.8 227 200 153 83 73.2 68.7 (4573)Q B 2 16 The causes of death of children under 1 year of age are set forth in Tables appended, and a summary showing the proportion of deaths per 1,000 births from various grouped causes in the last seven years is set out below:— 1915. 1916. 1917. 1918. 1919. 1920. 1921. Diphtheria — — — — — — 1-4 Influenza 0.5 — — 6.81 5.62 — — Measles 3.5 0.5 3.9 0.68 1.87 2.21 — Whooping cough 1.5 1.6 1.9 3.4 0.62 — 1.6 Septic diseases 1.5 — 1.9 — — 0.44 1.4 Bronchitis and pneumonia 14.1 15.4 16.8 16.35 10.00 12.80 11.8 Stomach and bowel complaints 15.1 12.7 7.1 10.89 8.75 9.29 13.4 Syphilis 5.0 4.9 8.4 6.13 5.62 2.64 2.6 Congenital malformations 45 6.7 5.8 4.76 3.75 619 9.3 Prematurity 20.7 20.9 27.2 23.3 21.2 5.40 15.5 Neglect and injury at birth 7.7 6.7 6.7 8.17 7.50 17.07 7.3 Debility from birth and atrophy, rickets, atelectasis 10.7 5.5 13.6 8.17 11.80 1.48 11.0 Tuberculosis 3.0 4.4 2.6 613 2.50 11.76 1.4 Other causes 3.0 3.4 7.1 5.45 6.87 4.34 3.6 90.8 82.7 103.0 100.24 86.10 73.62 80.2 It will be noticed that of the infants who died, exactly half succumbed before the end of the first month. It is one of the objects of the ante-natal clinics to reduce this number by ensuring greater safety in child-birth and that the infants shall be born in a healthier condition. 17 Table I.—Causes of, and Ages at, Death during the year 1921. Causes or Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Aqes). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Meases — — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever 4 — — 1 3 — — — — — — 1 — 1 — 2 — — — — — — — — Influenza 16 — — — — — 3 6 7 1 — 1 4 3 3 3 1 — — — — — — — Whooping-cough 5 1 4 — — — — — — — 1 — — 3 — — 1 — — — — — — — Diphtheria, Memb. croup 14 1 — 6 7 — — — — 2 1 — — 4 — 2 1 — 1 3 — — — — Cerobro-spinal meningitis 1 — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhœa, enteritis 15 11 1 — — — 2 — 1 — — — 1 5 — 7 — 1 — 1 — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 2 — — — — — 2 — — — — — — 2 — — — — — — — — — — Other septic diseases 3 1 — — — — 1 1 — — — — — — 1 1 — — — — — 1 — — Syphilis, &c. 2 2 — — — — — — — — — — — 1 — — — — — — — — — 1 Diabetes 5 — — — — 2 — 2 1 — — 1 — 1 — — 2 — — 1 — — — — Rheumatic fever 1 — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of meninges 3 1 1 — 1 — — — — — — 2 — — — 1 — — — — — — — — Tuberculosis of lungs 43 — — — — 7 23 9 4 — 1 — 3 16 2 11 5 — 1 1 — 2 — 1 Tuberculosis of peritoneum 1 — — — 1 — — — — — — — — — — — 1 — — — — — — — Other forms of tuberculosis 4 — — — — 1 — 2 1 — — — — 2 — 1 — — 1 — — — — — Malignant growths 96 — — 1 — — 10 51 33 — 4 8 7 30 8 12 5 — 5 7 1 6 2 — Congenital debility, malformation, and premature birth 29 29 — — — — — — — — 4 — 2 10 2 5 1 2 — — 1 2 — — Old age 66 — — — — — — 1 65 1 1 1 7 21 3 20 2 1 — 3 1 1 3 1 Meningitis and convulsions 4 — 3 — — 1 — — — — 1 1 — 1 — 1 — — — — — — — — 18 FEMALES.—Table I. (continued). Causes of Death. Corrected Deaths in the.City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 3 — — — — — — — — — — — — — — 1 — — — — — 1 — — Other diseases of nervous system 16 — — — — — 6 6 4 1 3 — 1 3 1 1 1 — 1 1 — 1 — 2 Valvular diseases of heart 27 — — — 1 — 5 12 9 1 2 1 2 13 1 5 — 1 — 1 — — — — Other circulatory diseases 133 1 — — 2 1 5 58 66 4 15 7 9 38 6 33 4 2 2 3 3 5 1 1 Bronchitis 87 3 — — — — 1 19 64 1 6 2 6 34 2 15 8 3 — 7 — 1 1 1 Broncho-pneumonia 21 4 — 4 — — 2 4 7 — — 1 1 5 3 8 — 1 — 1 — — 1 — Pneumonia, other forms 27 1 1 — — 3 7 7 8 — 2 — 2 6 1 10 1 1 — — — 2 3 — Other respiratory diseases 7 — — — — — 2 2 3 — — — 1 3 1 1 — — — 1 — — — — Alcoholism — — — — — — — — — — — — — — — — — — — — — — — — Cirrhosis of liver 1 — — — — — — — — — — — — — — — — — — — — — — — Appendicitis and typhlitis 3 — — 1 — 1 — — 1 — — — 1 1 — — — — — — 1 — — — Other digestive diseases 22 4 — 1 — 2 6 5 4 — 4 — 2 4 2 7 1 — — — 2 — — — Bright's disease, &c. 20 — — — — 2 2 8 8 — 2 — 1 7 1 1 — — — 5 1 1 1 — Cystitis, &c. 4 — — — — — 3 1 — — 1 — 1 — — 2 — — — — — — — — Accidents and diseases of parturition 8 — — — — 3 5 — — — — — — — — — — — — 1 — — — — Deaths by accident or negligence 12 3 — 1 — — 2 4 2 — 1 1 1 5 — 3 1 — — — — — — — Deaths by suicide and murder 8 l — — — 1 3 1 2 — 1 — 1 3 — 3 — — — — — — — — Other defined diseases 14 — 1 — — 3 2 4 4 — — 2 2 6 — 2 1 — — 1 — — — — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 726 63 11 15 15 28 95 204 295 12 50 29 65 233 37 162 36 12 11 37 10 23 12 7 19 I MALES. Table I.—Causes of, and Ages at, Death during the year 1921. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 55. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever 1 — — — 1 — — — — — — — — 1 — — — — — — — — — — Influenza 14 — — — — 1 1 6 6 — — 3 — 2 — 6 1 — — — — — 2 — Whooping-cough 4 2 1 1 — — — — — — — — — 3 — 1 — — — — — — — — Diphtheria, Memb. croup 14 1 1 5 7 — — — — — — — — 9 — 5 — — — — — — — — Cerebro-spinal meningitis — — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 1 — — — — — — — 1 — — — — 1 — — — — — — — — — — Diarrhœa, enteritis 18 15 1 1 — — — 1 — 1 1 — 1 6 2 3 1 1 — — 1 — — 1 Erysipelas 1 — — — — — 1 — — — — — — — — — — — — — — — 1 — Other septic diseases 8 — 1 — — — 4 1 2 — 2 — — — 1 2 — 1 — 2 — — — — Syphilis, &c. 3 1 1 — — — — 1 — — — — — — — 2 1 — — — — — — — Diabetes 6 — — — — — 1 5 — — — 1 — 2 — 1 — — 1 — 1 — — — Rheumatic fever 2 — — 1 — — — — 1 — — — — — — 1 — 1 — — — — — — Tuberculosis of meninges 3 — — 2 — 1 — — — — 1 — — 1 — 1 — — — — — — — — Tuberculosis of lungs 77 — — 1 — 10 29 27 10 1 2 — 2 17 3 27 2 — 1 5 1 2 12 2 Tuberculosis of peritoneum — — — — — — — — — — — — — — — — — — — — — — — — Other forms of tubrroulosis 4 1 — 1 — 1 — 1 — — — — — 1 — 3 — — — — — — — — Malignant growths 106 — — — 1 — 5 45 55 1 4 2 7 33 8 21 5 4 2 4 2 3 9 1 Congenital debility, malformation, and premature birth 43 43 — — — — — — — — 3 1 4 15 4 8 1 — 1 2 2 1 1 — Old age 40 — — — — — — — 4.0 — 1 — 3 15 — 10 4 — — — 2 1 1 3 20 MALES.—Table 1. (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 9 — — — — — 4 4 1 — 1 — — 2 — 1 1 — — — — 2 1 1 Other diseases of nervoug system. 11 — — — 1 2 2 3 3 — 1 — 1 2 1 5 — — 1 — — — — — Valvular diseases of heart 31 — — — — 1 4 15 11 — 4 1 2 3 1 9 2 — 1 — 2 3 3 — Other circulatory diseases 144 — — 1 3 1 15 57 67 1 9 6 13 35 7 30 6 1 4 2 7 6 11 6 Bronchitis 95 3 2 2 1 — 1 29 57 1 7 — 7 16 11 34 4 3 — 9 1 4 7 1 Broncho-pneumonia 32 9 5 — — — 2 10 6 1 2 1 2 10 — 6 5 — — — 1 — — 4 Pneumonia, other forms 46 2 2 — — 2 5 26 9 2 5 1 1 13 1 6 1 1 2 2 — 5 4 2 Other respiratory diseases 5 — — — — — — 4 1 — 1 — — 2 — — — — — 1 — 1 — — Alcoholism 6 — — — — — 3 3 — — 1 1 — 2 — — 1 — — 1 — — — — Cirrhosis of liver 8 — — — — 1 — 5 2 — 1 — — 2 1 1 — — 1 1 1 — — — Appendicitis and typhlitis 6 — — — — — 3 2 1 — — — 1 1 — 1 1 — 1 1 — — — — Other digestive disease 28 1 — — 2 — 2 15 8 — 1 1 1 6 3 5 2 1 1 1 1 3 2 — Bright's disease, &c. 28 1 — — — — 5 10 12 — 1 — 3 9 4 5 1 — 1 — — 2 2 — Cystitis, &c. 22 — — — — 1 1 2 18 — 4 — — 5 4 5 — — 1 1 1 1 — — Deaths by accident or negligence 30 5 3 2 2 2 7 5 4 — 1 — 3 7 2 4 3 — — 2 2 2 1 3 Deaths by suicide and murder 27 1 — — — — 10 13 3 — 3 — 1 7 — 3 3 3 — 1 2 2 — 2 Other defined diseases 18 2 — — 2 5 3 4 2 — — — 2 5 1 6 1 — 2 — 1 — — — Diseases, ill defined or unknown 1 1 — — — — — — — — — — — — — 1 — — — — — — — — All causes 897 91 17 17 20 28 109 295 320 8 57 18 55 234 44 214 47 16 20 35 28 38 57 26 21 Table V.—Infant Mortality, 1921. Nett deaths from stated causes at various ages wider One Year of Age in the City of Westminster. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 months. Total Deaths under 1 Year. Diphtheria — — 2 — 2 — — — — 2 Measles — — — — — — — — — — Whooping cough — — — — — 1 1 1 — 3 Erysipelas — — — — — — 1 — — 1 Umbilical sepsis — — — — — 1 — — — 1 Tuberculosis — — — — — — — 1 1 2 Syphilis 1 — — — 1 2 2 — — 6 Meningitis — — — — — 1 — — — 1 Bronchitis 1 — — — 1 2 1 2 — 6 Pneumonia (all forms) — 1 — — 1 3 1 10 2 17 Infective enteritis — — — 1 1 2 6 6 6 21 Enteritis — — — — — 1 — 3 1 5 Gastritis — — — — — — — — — — Injury at birth 7 — — — 7 — — — — 7 Neglect at birth 6 — — — 6 — — — — 6 Murder 2 — — — 2 — — — — 2 Atelectasis 2 2 — — 4 — — — — 4 Congenital Malformations 4 4 — 3 11 5 1 — 1 18 Premature birth 17 6 2 4 29 1 — — — 30 Malnutrition, marasmus — — — 2 2 1 4 — 1 8 Debility from birth 1 1 2 4 8 1 — — — 9 Rickets — — — — — — — — — — Accidents — — — — — 1 — — — 1 Other causes 1 1 — — 2 2 — 1 — 5 Totals 42 15 6 14 77 24 17 24 12 154 Nett Births in the year— Males. Females. Total. Legitimate 904 825 1,729 Illegitimate 87 103 190 • 991 928 1,919 Nett Deaths in the vear of— Males. Females. Total. Legitimate infants 69 48 117 Illegitimate infants 22 15 37 91 63 154 In addition there were 43 stillbirths. The causes of death of the Illegitimate were:—Measles 1, tuberculosis 1, bronchitis 2, pneumonia 4, enteritis 4, syphilis 5, neglect at birth 5, murder 1, atelectasis 1, congenital malformation 1, prematurity 5, marasmus and debility from birth 7, rickets 2. 11 infants had no known address, having been found in various parts of the city. 22 Table V, continued.—Infant Mortality, 1921. Nett deaths from stated causes at various ages under One Year of Age in Pimlico Area ( Victoria, Knightsbridge St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Diphtheria — — 1 — 1 — — — — 1 Whooping cough — — — — — 1 1 1 — 3 Measles — — — — — — — — — — Tuberculosis — — — — — — — 1 1 2 Bronchitis — — — — — — 1 1 — 2 Pneumonia (all forms) — 1 — — 1 3 1 4 2 11 Infective enteritis — — — 1 1 2 3 5 1 12 Gastritis — — — — — — — — — — Syphilis — — — — — 1 — — — 1 Injury at birth 1 — — — 1 — — — — 1 Atelectasis — 1 — — 1 — — — — 1 Congenital malformations 3 1 — — 4 4 — — — 8 Premature birth 7 3 — 3 13 — — — — 13 Umbilical sepsis — — — — — 1 — — — 1 Malnutrition, marasmus and debility from birth — 1 1 3 5 1 4 — — 10 Accident — — — — — 1 — — — 1 Rickets — — — — — — — — — — Other causes 1 — — — 1 — — 1 — 2 Totals 12 7 2 7 28 14 10 13 4 69 Nett Births in the year— Legitimate 799 Illegitimate 85 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 38 20 58 Illegitimate infants 7 4 11 There were also 16 stillbirths. Table V, continued.—Deaths of infants with no known address, or found in streets, parks, &c.:— CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Premature 1 — — — 1 — — — — 1 Syphilis — — — — — — 1 — — 1 Infective enteritis — — — — — — 1 — 1 2 Neglect at birth 6 — — — 6 — — — — 6 Murder 1 — — — 1 — — — — 1 8 — — — 8 — 2 — 1 11 23 Males. Females. Legitimate — — Total. Illegitimate 8 3 11 1 still birth in addition. The two enteritis and the syphilis deaths were of foundlings, inmates of the Infirmary. Table V, continued.—Infant Mortality, 1921. Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Erysipelas — — — — — — 1 — — 1 Diphtheria — — — — — — — — — — Influenza — — — — — — — — — — Measles — — — — — — — — — — Whooping cough — — — — — — — — — — Umbilical sepsis — — — — — — — — — — Tuberculosis — — — — — — — — — — Meningitis — — — — — — — — — — Bronchitis 1 — — — 1 — — — — 1 Pneumonia (all forms) — — — — — — — 5 — 5 Acute Diarrhœa — — — — — — 1 — 3 4 Chronic Enteritis — — — — — 1 — 3 1 5 Gastritis — — — — — — — — — — Syphilis 1 — — — 1 — 1 — — 2 Rickets — — — — — — — — — — Injury at birth 2 — — — 2 — — — — 2 Congenital malformations — 2 — 3 5 — — — 1 6 Premature birth 3 2 1 — 6 1 — — — 7 Atrophy, marasmus — — — — — — — — 1 1 Atelectasis 1 — — — 1 — — — — 1 Debility from birth 1 — 1 1 3 — — — — 3 Accident — — — — — — — — — — Other causes — 1 — — 1 2 — — — 3 Totals 9 5 2 4 20 4 3 8 6 41 Nett Births in the year— Legitimate 557 Illegitimate 39 Still births in addition 11 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 19 16 35 Illegitimate infants 2 4 6 24 The death from Erysipelas was due to dirt getting into wound after vaccination. Two of the Acute Diarrhœa deaths were of children who never lived in Westminster, being boarded out, after birth in outlying institutions; 1 death was a child who had been in the Infirmary for three months before death. Of the Chronic Enteritis deaths, 2 were of children who came into Westminster a few weeks before. The cause of the death recorded as Marasmus was possibly Tuberculosis. Two deaths were members of a set of triplets; 1 child died out of each of 4 sets of twins. Table V, continued.—Infant Mortality, 1921. Nett Deaths from stated causes at various ages under One Year of Age in the North District. CAUSE of DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Mont hs and under 9 Mont hs. 9 Months and under 12 Months. Total Deaths under 1 Year. Diphtheria — — 1 — 1 — — — — 1 Measles — — — — — — — — — — Whooping cough — — — — — — — — — — Umbilical sepsis — — — — — — — — — — Tuberculosis — — — — — — — — — — Bronchitis — — — — — 2 — 1 — 3 Pneumonia (all forms) — — — — — — — 1 — 1 Infective enteritis — — — — — — 1 1 1 3 Syphilis — — — — — 1 — — — 1 Injury at birth 4 — — — 4 — — — — 4 Atelectasis 1 1 — — 2 — — — — 2 Congenital malformations 1 1 — — 2 1 1 — — 4 Premature birth 6 1 1 1 9 — — — — 9 Malnutrition — — — 2 2 — — — — 2 Inanition and debility from birth — — — — — 1 — — — 1 Rickets — — — — — — — — — — Murder 1 — — — 1 — — — — 1 Meningitis — — — — — 1 — — — 1 Totals 13 3 2 3 21 6 2 3 1 33 Nett Births in the year— Legitimate 373 Illegitimate 55 Nett Deaths in the year— Males. Females. Total. Legitimate infants 12 12 24 Illegitimate infants 5 4 9 25 There were also 13 still births. The infant certified as dying from Diphtheria at 16 days had snu???es from birth, and probably was syphilitic, but the Diphtheria bacillus was reported to have been isolated. Two deaths (1 prematurity and 1 debility) were said to have been due to the state of the health of the mothers through having worked in munition factories. Four infants never lived in Westminster, having been born elsewhere or boarded out with foster mothers; in 3 instances it was alleged that the infants had not been properly looked after. Two of the children who died from Infective Enteritis had been in the Infirmary from birth. 26 B.—Communicable Diseases. The details respecting the notifications of infectious disease received are set out in the form required by the Ministry and on the adjoining page. The following summary shows the number of cases which came to the notice of the Department in the last three years. 1919. 1920. 1921. 1919. 1920 1921. Smallpox 1 — — Ophthalmia neonatorum 25 28 25 Diphtheria 133 229 248 Measles 516 703 26 Erysipelas 75 70 53 German measles 159 45 9 Scarlet fever 239 395 681 Pneumonia 187 112 62 Enteric fever 9 14 10 Malaria 33 16 I Continued fever — 1 — Dysentery — 3 — Puerperal fever 5 10 10 Anthrax 2 — — Cerebro-spinal meningitis 4 4 — Chickenpox — — 119 Mumps — — 278 Encephalitis lethargica 4 3 — Whooping cough 133 Smallpox.—No cases were notified, but 1 case occurred in a person who had an office in Westminster. Information was received of 342 persons coming to Westminster who had been in contact with cases or coming from infected ports. These were kept under observation. The Public Vaccinators and Vaccination Officers have forwarded the following particulars for the year of vaccinations performed:— Primary vaccinations 1,471 Re-vaccinations 79 None were performed by the Medical Officer of Health under the Public Health (Smallpox Protection Regulations, 1917). Scarlet fever.—This disease was extremely prevalent, and the number of cases notified by no means represents the total number of persons who were attacked, for, on account of the slight nature of the illness in many cases, the disease was not diagnosed. In the autumn the pressure on the accommodation in the fever hospitals was so great that it became necessary to restrict admission to the more serious cases, and to those living in tenement houses where there were other children. The question has been raised from time to time as to the usefulness of removing all cases to hospital. Now that the disease occurs in a much 27 milder form than it used to do, the time seems opportune for an enquiry to be made. It is admitted that isolation in hospital has not controlled the disease in large towns, and there is always a risk of cross-infection. The experiment recently made of only admitting serious and complicated cases should afford some evidence which may be helpful in deciding whether the practice should be continued as a regular procedure, and if so, it might be possible to economise in the amount of hospital accommodation. Greater use might be made of the treatment at home recommended by Dr. Milne, viz., the application of eucalyptus oil to the body and carbolic oil to the mucous membranes of the mouth and throat, whereby it is claimed that persons suffering from scarlet fever need not be isolated even in their own homes for more than a couple of days. In several cases this method has been adopted in Westminster, and no secondary cases have occurred in the families. Five deaths occurred, 1 between the ages of 2 and 5, 4 between 5 and 15. Diphtheria also increased, and 248 cases were notified. No restriction was placed upon the admission into hospital of cases of this disease, but occasionally on account of want of room some delay occurred, in such cases medical men were supplied with antitoxin free for all cases of diphtheria. 55 bulbs were so supplied. 28 persons died from diphtheria; 11.2 per cent. of the cases notified. Swabbings from 431 patients were submitted for bacteriological examination. This is essentially a disease which is spread by personal contact, and if its spread is to be checked it is essential that as many persons as possible who may have been in contact with known cases should be examined and swabbings taken from their throats for bacteriological examination. This is done in schools by the officers of the education authority, but it ought also to be done in the houses. In a number of instances the medical man attending has had the rest of the family examined, but in the majority of cases it is not carried out. In the first place the medical practitioner can hardly be expected to do it as he receives no remuneration, and in the second place it is often impracticable for him to do so, as the patient may be seen at his surgery or at a hospital. Then in a tenement house he cannot be expected to examine all the inmates. There is no one on the staff of the public health department who could undertake this work systematically.* The local authority might pay medical practitioners to do this and in times of epidemic might retain a medical man specially. Were the school medical officers attached to the local authorities as assistant medical officers of health they would be able to follow up suspected cases discovered in the schools and a greater check would be 28 City of Westminster.— Cases of Infectious Disease Notified during the year ended 31st December, 1921. Notifiable Diseases. Cases Notified in the City or Westminster. Total Cases Notified in each Ward. Cases removed to Hospital. At all Ages. At Ages—Years. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 248 4 56 117 32 33 5 1 — 13 18 84 17 61 4 1 14 11 2 4 7 11 1 232 Erysipelas 53 1 — 7 4 17 15 9 — 1 1 20 — 12 — — 3 2 1 4 5 1 3 25 Scarlet fever 681 1 92 470 87 29 2 — 4 26 45 192 18 227 14 4 45 23 7 12 14 49 1 646 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 9 — — — 1 5 3 — — — 21 — 2 2 2 — 1 — — — 1 2 — 6 Relapsing fever — — — — — — — — — — — — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 9 — — — 2 7 — — — — — 8 — 1 — — — — — — — — — 8 Cerebro-spinal meningitis 2 — — — 1 1 — — — 1 — — — 1 — — — — — — — — — — Polio-myelitis — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis lethargica 2 — — 1 — — 1 — — — — 1 — 1 — — — — — — — — — 1 Ophthalmia neonatorum 21 21 — — — — — — — — 3 9 — 1 — — 3 3 — 1 — — 1 13 Pneumonia 62 — 5 6 7 24 15 5 — 2 5 15 3 19 1 — 3 6 1 1 4 2 — 34 Malaria 1 — — — — 1 — — — — — 1 — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — — — — — — Trench fever — — — — — — — — — — — — — — — — — — — — — — — — Totals 1,089 27 153 601 134 117 41 15 4 43 73 330 40 325 21 5 69 45 11 22 31 63 6 960 Correction has been made for errors in notification or revision of diagnosis. Cases not notified: 1 Enteric (age 79, in Asylum); 1 Puerperal (age 19); 1 Encephalitis; 4 Ophthalmia. 29 obtained in the dissemination of infection than we at present possess. By the use of antitoxin passive immunity can be conferred on other members of a family for 3 to 5 weeks during an outbreak. It is now possible to ascertain whether a person is susceptible or not to diphtheria by the Schick method. Inmates of institutions, schools, hospital and other staffs can be tested, and those who are susceptible can be immunised, so that such institutions can be protected from outbreak of diphtheria. Typhoid fever.—The cases of this disease were 10 ; 3 being cases of Paratyphoid B. Four of the persons affected were infected elsewhere before coming to Westminster. One person was not resident in the City, being an inmate of an asylum, and died there. This was the only death. The services of the Council's Bacteriologist were utilised to report on the blood of seven persons ill from suspected Typhoid. Influenza.—This complaint was certified as the cause of 30 deaths— 14 males and 16 females, all adults, 13 being over 65 years of age. Cerebro-spinal Fever.—Two cases occurred, one of whom died. Encephalitis Lethargica.—Three cases occurred, one male (age 63) and two females. The females recovered without any subsequent bad results; the man died. Whooping Cough.—133 cases came to the knowledge of the Department, 9 deaths occurred, 8 of children under 2 years of age, 1 between 2 and 5. Measles.—Following on the heavy epidemics of the two previous years there was a great decline in this disease in 1921. Notices were received from schools of 37 children suffering or suspected to be suffering from Measles. Of these, 12 were found to be ill from other complaints. The total number of known cases was only 26, one infant was removed to hospital. No deaths occurred. A conference of the County Council and Local Authorities was held to discuss improvements in the method of dealing with measles and as to further co-ordinating with the Borough medical officers. A scheme has been adopted by the Education Authority with the intention of expediting notification by which when a school is specially affected with measles, a nurse will be detailed to visit the school daily to examine the children. There were also 9 cases of Rubella (rose rash or German measles), mostly in children. (4573)q • c 30 Diarrhœa and Enteritis.—Acute or infective Diarrhœa is usually associated with hot weather but notwithstanding the prolonged warm and dry weather which prevailed it was not until the middle of July that any increase occurred in the number of deaths, and this increase tallied with the observations of the late Dr. Ballard, that the rise in mortality from infective diarrhoea does not commence until the temperature of the earth, as recorded by the 4 ft. earth thermometer, has reached 56 deg. Fahr., no matter how high the atmospheric temperature may be. In 1921 it was not until the week ending July 9th that the mean temperature of the earth at a depth of 4 ft. at Greenwich was 55.9 deg., the next week the deaths in London rose from 12 to 30, and gradually rose higher in subsequent weeks. Why this should be so is not known, but as this complaint is almost entirely confined to young children who are artificially fed, it suggests that their food is more liable to be contaminated at that time, through infected dust being blown on to it or being conveyed to it through the agency of flies. Diarrhœa occurs as a cause of death at other seasons of the year and is then due to the effects of chill or more often to defects in the digestive functions from debility or improper feeding. Of the 33 deaths ascribed to diarrhœa, 28 were of infants under 2 years of age and of these 5 were not of the infective variety, 1 death was of a child between 2 and 5, and the remaining 4 were adults. The rate of deaths under 2 years of age was 14.5 per 1,000 births in Westminster, 21*3 for all London. It was expected that the death rate would have been higher, as in 1911 when the proportion of deaths under 2 years of age per 1,000 births was 47.5. It is not improbable that the extensive use of dried milk has had an influence, and possibly also the altered conditions of traffic now existing as compared with the year 1911. Chichenpox and Mumps were prevalent throughout the year, 119 cases of the former and 278 of the latter being notified from schools. Ophthalmia Neonatorum.—21 cases were notified, but 4 others came to the knowledge of the Department through the Health Visitors. There were also 10 cases of slight inflammation without discharge. No permanent injury resulted, except in one case in which there was a slight scar. Ten of the infants were born in Institutions, 5 were illegitimate, and 4 eventually died, 2 from broncho-pneumonia at 2 months and 6 months, and 2 from syphilis at 1 month and 3 months. Thirteen children were treated in Hospital. Plague.—Intimation was received of 38 persons coming into Westminster from places or ships where plague had occurred. 31 Visits were paid by Health Visitors and Nurses as follows:— Health Visitors. Nurses. Puerperal fever 18 — Ophthalmia neonatorum 168 256 Measles 91 — Diarrhœa — 5 Pneumonia — 276 Whooping cough 187 36 Bronchitis — 153 Other complaints — 736 464 1,462 The visits paid by nurses to children suffering from the illnesses specified above were only 726 as compared with 1,640 in 1920, but there is a considerable increase, 736 (109 in 1920) in attendance for discharging ears, bums and other accidents, and various minor ailments. Tuberculosis. In 1921, 251 new cases of pulmonary disease were notified and 20 persons died who had not been notified in Westminster, a total of 271. Non-pulmonary forms of tuberculosis gave 41 new cases. The figures for a series of years are shown below:— Pulmonary. General Population. C.L.H. and no Address. Non-Pulmonary. Males. Females. Males. Females. Total. Males. Females. Total. Total of all forms. 1911 193 119 109 3 424 — — 77 501 1912 233 154 115 10 512 — — 59 571 1913 203 174 89 8 474 91 86 177 651 1914 186 105 94 4 390 34 38 72 462 1915 155 95 59 8 317 46 26 72 389 1916 183 135 64 9 391 42 39 81 472 1917 209 164 51 7 431 42 34 76 507 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 Military cases which were excluded during the war were again made notifiable in 1920. A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the city. (4573)Q C 2 32 The number of deaths of cases unnotified in Westminster was 27. Enquiry was made into each case and it was ascertained that most of them had been notified elsewhere. Some were of persons who were in London on a visit. Another group consists of inmates of Asylums. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. Pulmonary 32 46 40 31 35 41 27 33 20 Non-pulmonary 25 13 24 21 10 14 8 7 7 33 Tuberculosis.—Notifications received during 1921. 1921. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, Including cues previously notified. Ago 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 up. Total new cases. Pulmonary— Casuals— Males — — — — — 4 8 6 8 6 3 34 36 Females — — — — — 2 — — — — — 2 2 General— Males — — 3 4 8 13 30 22 16 7 6 109 134 Females — — — 3 9 14 33 29 11 4 3 106 124 Non-pulmonary— Males 1 1 4 3 2 1 — 2 1 — — 15 18 Females — 3 1 3 5 2 1 2 1 — — 18 26 Total 1 4 8 13 24 36 72 60 37 " 12 284 340  Number of notifications on Form B. (School medical Inspection.) Number on Form C. Admissions to. Number on Form D. Discharges from. Primary notifications. Total notifications, including cases previously notified. Under 6. 6 to 10. 10 to 16. Total. Poor Law institutions. Sanatoria. Poor Law institutions. Sanatoria. Pulmonary— Males — — — — 22 94 4 68 Females — — — — — 2 63 — 32 Non-pulmonary— Males — — — — — — 6 — 5 Females — — 1 1 1 — 9 — 6 Total — — 1 1 1 24 172 4 111 Deaths registered but not notified:—Pulmonary Casuals—Males 3, ages 42, 55, 65. General—Males 9, ages 2, 21, 22, 24, 32, 34,39, 57, 73; females 8, ages 18, 25, 34, 41, 51, 53, 66, 70. • Non-pulmonary—Males 4, ages 10/12, 2, 8, 4; females 8, ages 13/12, 6, 77. 34 Tuberculosis.—Table shouting distribution in Wards of notified and unnotified rases, 1921. 1921. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Pulmouary— Common Lodging-houses, &c.— Males 37 — — — 3 2 17 — — — — — — 13 — 2 Females 2 — — — — — — — — — — — — — — — General— Males 118 1 6 6 41 10 32 1 3 6 1 1 8 1 6 1 Females 114 1 10 6 35 5 22 4 2 3 3 1 2 — 13 1 Non-pulmonary— Males 19 — 2 — 5 6 3 — — 1 — 1 1 — — — Females 22 — 1 2 4 — 5 4 1 2 1 — — — 2 — 312 2 19 14 88 23 81 9 6 12 5 3 11 14 21 4  Insured Persons. Military Cases. Ex-Soldiers and Sailors. Police. Hospital Nurses. Asylum Cases. Ill previous to Residence in City. Pulmonary— Males 77 5 37 4 — 6 39 Females 37 — — — 4 7 32 Non-pulmonary— Males 1 — 1 — — 1 1 Females 6 — — — 1 1 8 121 5 38 4 5 15 80 35 Statistics for England and Wales show that with the exception of the war period there has been a steady and substantial decline in deaths from Phthisis since 1847, so that at the present time the death rate among males is half what it was at the former period, while the death rate among females has been reduced by two-thirds. Sir George Newman, in his Report to the Ministry of Health, ascribes this to five great influences:— (1) The progress of sanitary reform since Sir Robert Peel's mission in 1843; the increased attention paid to child life and diseases predisposing to tuberculosis, and the treatment of cases in poor law and other hospitals. (2) Advance in social well-being and communal health from 1851 onwards. (3) The spread of a knowledge of the contagiousness of the disease, particularly since 1881. (4) Special measures of prevention and treatment of tuberculosis in recent years. (5) An increase in the resistance of the population due to better wages, cheaper food, better hours and a more sanitary environment, reform in the factory system and shorter hours of work under improved conditions and possibly an increase in immunity in those living in large towns. Tuberculosis still levies a heavy toll of life, and if the reduction shown in past years is to continue, not only must the measures be continued which have proved successful in the past, but these must be strengthened and improved. When the number of persons living at various age periods is known, it will be possible to ascertain whether the improvement has taken place at each period and what effect has been produced by alteration in the number living in the various age groups, as compared with similar figures at the previous Census. For example, it is obvious from the declining birth rate which obtained for so many years that there must be fewer persons under 20 years of age, consequently the number of young persons liable to be infected is less. From the figures supplied me by the Peabody Trustees it appears that the number of children under five in their buildings in Westminster is half what it was in 1911. In view of housing difficulties and depression in trade, the reduction is remarkable. In a number of instances a consumptive patient in an infective condition has had to live with his family in a couple of rooms through inability to obtain better accommodation. This danger has been counterbalanced to some extent by the larger number of persons who have been admitted to institutions. Still, it is not improbable that the trying 36 financial year we have just gone through may tell in the next few years, for in a disease like tuberculosis the effects do not show themselves immediately. I have already referred to the effect upon the death rate produced by the increased number of females in the population. With regard to tuberculosis, this factor also has to be taken into account as part of the explanation in the reduction of cases of Pulmonary Tuberculosis, as males suffer to a greater extent than females. Consequently, an increase of females in the population results in a smaller number of cases in the aggregate. Thus in 1920 the new cases among males in Westminster was 2.7 per 1,000 (2.3 without Common Lodging House cases) and of females 1.65. This is shown more particularly in St. George's Division, where females are in greater excess. There the male cases in 1920 were 2.07, the females 1.11 per 1,000, making a rate of 1.60 for the total population. Had the males and females been equal in numbers the rate would have been 1.9. The Abbey Division, where the proportions are more nearly equal, had 2.88 cases per 1,000 males and 1.80 per 1,000 females, equal to 2.30 for the Division. Deducting Common Lodging House and homeless cases the rates stand at 2.35 for males, 1.70 for females and 2.00 for the Division. In 1921, the incidence for the City was 2.5 per 1,000 for all males (1.9 without Common Lodging House and homeless cases) and 1.4 for all females. Comparison with the pre-war year 1913 shows that there has been a reduction in the incidence of the disease in both males and females in Westminster in the general population:— Males. Females. 1913 2.9 2.6 1920 2.3 1.6 1921 1.9 1.4 Infection of children is derived from two sources, directly from a human source, indirectly from a bovine source, through milk containing the bacillus. Though infection from human sources is much the more common form, yet the danger from tuberculous milk cannot be disregarded. In children, the infection, in a proportion of instances, is rapidly fatal, but in the greater number the tubercle bacilli are disseminated to various parts of the system where they may remain latent until some period of lowered health, with perhaps local injury, occurs, when they may be stimulated to activity. 37 Non-pulmonary Tuberculosis.—The parts of the body affected were : M. F. Spine 1 2 Bones and joints 7 4 Cervical glands 3 6 Meninges of brain 1 3 Reproductive organs 0 1 M. F. Kidney and bladder 0 1 Mediastinal glands 2 1 Mesentery and bowels 5 4 In the second Table details are given of ex-soldiers or sailors, asylum cases and of persons ill before coming to Westminster. The nationality of the persons notified is as usual varied, representative of the cosmopolitan nature of the population of Westminster. Those not of English birth were:— M. F. Irish 7 0 Scots4 1 Welsh0 1 Belgian1 1 Danish1 0 Dutch0 1 French2 1 M. F. German01 Italian33 Polish and Russian 3 3 Roumanian 1 0 Swedish0 1 Swiss 2 0 Seven of the above were Jewish. The total number of cases of Tuberculous disease on the Register at the end of 1921 was 1,543 as compared with 1,648 at the end of the year 1920. Pulmonary. Nonpulmonary. Total. General. Casuals. December, 1920 1,189 100 359 1,648 New cases, 1921 231 39 41 311 Old cases returned to Westminster 5 — — 5 Total cases on Register during 1921 1,425 139 400 1,964 Died during 1921 94 26 15 135 Moved 211 40 35 286 Remaining at end of 1921 1,120 73 350 1,543 Through the courtesy of the Clerk to the Guardians, we have been able to revise our register from their index of persons dealt with by them and have eliminated a number of old standing cases. In addition, 1,327 contacts and "suspects" remain under supervision. 38 Home Visiting.—The Tuberculosis Medical Officer paid 320 visits during the year to patients at their homes. The number of visits paid in previous years was:— 1916 257 1917 197 1918 237 1919 96 1920 165 The Health Visitors paid 6,648 visits, 4,941 of these being to persons attending the Dispensary; 2,628 visits were paid to insured persons, 621 of these being to discharged soldiers and sailors. During the summer one of the Tuberculosis Visitors resigned her position, and the Council in view of the reduction in the number of tuberculous cases, decided not to appoint a successor. The areas in the City were therefore rearranged and the work divided between three remaining Visitors, an arrangement which has proved satisfactory. Institutional treatment.—Of the 271 persons recorded in 1921 with pulmonary disease, institutional treatment was afforded to all the Common Lodging House cases, to 90 males and 67 females in the general population, and to 30 of the 41 non-pulmonary. The reduction generally of tuberculosis in London enables provision for institutional treatment to be offered to a larger number of persons. Bacleriologiml Diagnosis.—Sputum was examined in 474 instances, 308 being specimens sent from the Dispensary and 166 from private practitioners. The cost was £64 16s. 7d. Extra Nourishment.—In the Spring of 1921, the Insurance Committee gave up the provision of extra nourishment to consumptives and the duty fell upon local authorities. Six persons have been in receipt of milk and eggs at the Council's expense on the recommendation of the Tuberculosis Medical Officer. The applications were duly considered by the After Care Committee. Denial treatment.—12 patients received dental treatment at the Council's expense. Dentures were provided in 5 cases. X-Ray Treatment.—By an arrangement with certain hospitals, the Council is authorised to pay for X-ray treatment for persons suffering from tuberculosis of the skin. One patient has been so treated at St. Thomas Hospital. Tuberculosis Dispensary.—Of the 312 new cases in 1921 the Dispensary dealt with 154, but as in 62 instances (such as persons in asylums and other institutions, soldiers, police and persons whose 39 illness was not known in Westminster until death) it was not practicable for such persons to have been seen by the Tuberculosis Medical Officer. The possible number therefore was 250, of which 154 represents 61.6 per cent. In 1920 the proportion was 62'7. The following figures give some idea of the work done. Dispensary Statistics. 1921. 1920. 1919. New patients 609 592 607 Old patients attending 588 561 490 Individuals who attended 1,197 1,153 1,097 Contacts examined 281 221 139 Total attendances 3,695 5,267 4,882 Written medical reports to L.C.C., L.I.C., W.P.C., &c. 1,169 1,284 1,439 To medical practitioners, &c. 440 410 302 Consultations with medical practitioners 178 92 79 Visits paid by medical officer 320 165 96 Visits by health visitors to dispensary cases 4,941 4,767 4,159 Sputum examinations 308 239 255 Patients were examined at the instance of the following sources:— Ins. Unins. 1921. 1920. 1921. 1920. Medical practitioners 104 97 54 53 Ministry of Pensions 36 1 13 2 War Pensions Committee 23 27 2 ] Insurance Committee 7 37 — 3 London County Council 2 — 5 5 Friends, &c. 7 17 72 84 Westminster Health Society 2 1 10 20 Health visitors 29 26 186 151 Jewish Board of Guardians 1 2 3 12 Schools (School Med. Officers) — — 17 24 Other sources (Guardians, I.C.A.A., etc. 6 9 30 20 Of the 281 contacts examined— 51 were found to be suffering from tuberculosis. 40 were doubtful cases. 195 were free from the disease. 40 Insured Patients. 105 patients were recommended for admission to sanatorium or hospital, 55 were admitted for treatment, and 16 were admitted to hospital for observation, in 7 of whom a diagnosis of tuberculosis was eventually made. Uninsured Patients. 36 recommended for institutional treatment and 29 were admitted. Diagnosis made at first attendance, subject to revision later. 1921. 1920. Pulmonary tuberculosis 158 150 Not-pulmonary tuberculosis 25 31 Non-tuberculous 367 281 Doubtful 59 124 Discharged Soldiers. Ex-service men seen for the first time 109 102 Old Patients 127 — Admitted to sanatorium or hospital 76 35 Deaths.—130 persons (81 males and 49 females) who had suffered at some time from pulmonary tuberculosis died during the year, but 10 of these died from other complaints. Of the new cases of pulmonary disease recorded in 1921, death occurred in 44 males (14 casuals and 30 general population) and in 27 females. The remainder were of persons notified in previous years, 26 (16 males 10 females) being 1920 cases ; 12 (7 males 5 females), 1919 cases; the rest (12 males 7 females) being spread over each of the years 1909-1918, while 2 were of male persons notified so far back as 1905. Of the non-pulmonary 16 died (1 from Bright's disease) 12 were 1921 cases, 1 of 1920, 1 of 1918, and 2 of 1913. The net number registered as dying from tuberculosis were—Pulmonary: Males, 77; Females, 43— Non-pulmonary : Males, 7; Females, 8. The death-rates for 1920 and 1921 calculated on the Census population were per:— Males. Females. Total. 1920. 1921. 1920. 1921. 1920. 1921. Pulmonary 131 125.6 76 53.6 97 84.9 Non-pulmonary 9.6 11.4 14.5 99 12 10.6 Total 1406 137.0 90.8 63.7 109 95.5 For London the rates were 105 and 20 respectively. Total 125. 41 Westminster—Deaths from Tuberculosis. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1916 annual 164 124 37 27 201 151 1917 „ 194 147 29 22 223 169 1918 „ 186 148 31 24 217 173 1919 „ 134 105 21 16 155 121 1920 „ 139 97 18 12 157 109 1921 „ 120 84.9 15 10.6 135 95.5 1881-90 average — 208 — 89 — 297 1891-95 „ — 184 — 80 — 264 1896-1900 „ — 174 — 70 — 244 1901-05 „ 302 169 70 40 372 209 1906-10 „ 218 132 58 34 276 166 1911-15 „ 195 128 37 25 232 153 1916-20 „ 163 124 27 19 190 143 Bacteriological Laboratory. Examinations were made as follows:— Swabbings from throats in suspected Diphtheria 431 Blood in suspected Typhoid 7 Sputum for Tuberculosis 474 (308 of these specimens were sent from the Tuberculosis Dispensary). The expenditure on the first two was £61 5s. 6d., and for Tuberculosis £64 16s. 7d. Disinfection. The number of articles treated was 1916. 1917. 1918. 1919. 1920. 1921. Rooms 1,324 814 722 941 1,196 1,502 Articles disinfected 119,303 281,895 153,048 50,496 49,542 31,654 Articles washed 5,377 8,015 6,551 5,759 7,185 6,766 Articles destroyed 5,214 5,097 3,048 543 70 38 Books disinfected 1,593 12 4 77 42 212 Vehicles 1 1 1 2 5 1 The motor van during 1921 ran 3,978 miles on 308 days and carried 2,805 cwt. of goods, the highest amount in any one day. being 31 cwt. The consumption of petrol was 431 gallons. The prevalence of scarlet fever and diphtheria led to an increase in the number of rooms disinfected, but the number of articles treated was fewer as disinfection for the military authorities has practically ceased. 42 Cleansing of Persons.—The number of Westminster children suffering from head and body lice treated at the cleansing station was 566, an increase over the number in 1920. This is probably partly due to the greater activity of the school nurses in sending cases to the Station at the first signs of infestation, and to more stringent action where parents persistently send their children to school in an unsatisfactory condition. There is, however, a satisfactory decrease in cases of scabies. Westminster. Head lice. Body lice. Scabies. Total. Children 549 17 52 618 Adults 4 98 12 114 553 115 64 732 All the lice cases were dealt with at the Station, but 19 of the scabies cases were treated at home. By arrangement with the County Council school children from Battersea, Chelsea, Holborn, Kensington, Lambeth, St. Pancras and St. Marylebone were sent to the Station for cleansing, these numbered 595 for head lice, 41 for body lice, and 40 for scabies. Each case implies a number of attendances for treatment, and the disinfection of the clothing, besides which in the Westminster cases the bedding is removed for disinfection at the same time that the persons affected are being treated. The 1,148 persons suffering from head lice had treatment on 1,455 occasions, the 156 with body lice had 192 treatments and 85 affected with scabies had 369, a total of 2,016 treatments at the station. In dealing with the Westminster cases, 513 visits were paid to the houses. A conference was convened by the County Council to discuss the steps which might be taken to deal more effectively with verminous conditions. A Bill has since been drafted to strengthen sections 19 and 20 of Part IV of the L.C.C. (General Powers) Act, 1904 to repeal the various sections of Acts dealing with such conditions and re-enact them afresh with the necessary amendments. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 274; in 1 instance death was the result of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 238 cases, and there were 7 adjourned inquests. Post-mortem examinations were made in 113 instances. 43 The number of dead bodies taken to the mortuaries for purposes of inquest and to await burial during the last 18 years are:— Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1903 393 341 55 1913 328 286 42 1904 388 322 59 1914 323 295 28 1905 370 307 61 1915 376 349 27 1906 345 283 61 1916 309 252 29 1907 358 281 77 1917 278 265 13 1908 364 298 66 1918 285 242 43 1909 291 258 33 1919 308 269 39 1910 333 281 52 1920 296 269 20 1911 373 334 49 1921 274 238 35 1912 324 284 40 There are resting places for the dead at Drury Lane, Ebury Bridge, or Dufours Place, but the public make very little use of them. Two bodies were admitted to Drury Lane; none at the other two. 44 , PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions. In many cases some of the work specified was in premises, parts of which were occupied as workshops:— 1921. 1921. Complaints received and dealt with 920 Sanitary Work completed:— Drains:— Premises inspected on complaint, &c. 1,670 Manholes built 474 House to house inspection 3,655 „ repaired and cleansed 298 Subsequent visits 21,046 Premises (registered), visits to 1,784 ,, covers fixed or repaired 569 Overcrowding found - Tested by smoke 38 Other infringements 304 ,, chemical 197 Sanitary Work completed:— ,, water 403 Houses:— „ air 20 Cleansed throughout 282 „ partially 979 Fresh air inlets fixed or repaired 195 Overcrowding—rooms 3 Soil Pipes:— Light or ventilation improved 446 Fixed 280 Roofs repaired 549 Ventilated 256 Floors and staircases repaired 735 Repaired 262 Tested by smoke 108 Underground rooms:— „ chemical. 190 Illegal use 19 „ water 42 Closed 1 „ air 172 Yards, areas, paved or repaired 447 Water-closets:— Constructed 1,288 Damp walls remedied 265 Repaired 635 Offensive refuse removed 293 Ventilated and light improved 467 Keeping of animals discontinued 42 Cleansed or limewashed 1,228 Verminous premises cleansed 323 Ventilated lobbies provided 336 Filthy or unwholesome bedding, &c. 6 Unstopped 101 Drains:— Traps ventilated 890 Constructed 195 Flushing cisterns fixed 1,282 Amended and repaired 270 „ „ repaired 379 Ventilated 173 Waste Pipes:— Unstopped and cleansed 139 Constructed 1,537 Interceptor traps fixed 143 Repaired 274 Cleansed and scaled off from sewer 48 Unstopped 66 Trapped 2,192 Gully traps fixed 867 Ventilated 1,739 Defective traps abolished 218 Disconnected from drain 854 45  1921. 1921. Sanitary Work completed:— Sanitary Work completed:— Rainwater Pipes:— Water Supply:— Fixed or repaired 571 Cisterns defective, abolished 17 Disconnected from drains .. 107 Taps off main provided 489 Urinals:— Pipes repaired 204 Constucted 281 Dust Bins:— Repaired or improved 42 Movable, provided 271 Cleansed 99 „ repaired 4 Water Supply:— Fixed, abolished 7 Provided 155 Stables:— „ additional in tenement houses 44 Drained 6 Paved 9 Certificates granted 3 Cleansed 6 Cut off 14 Dung receptacles provided 5 Reinstated 33 Dung accumulations removed 42 Cisterns fixed 111 „ cleansed 202 Garages constructed 16 „ covered 182 Petrol interceptors provided 8 1,780 intimations of nuisances (exclusive of smoke nuisances), &c., and 113 statutory notices were issued ; 1,305 letters were written. Police Court proceedings had to be resorted to in respect of 9 properties. Closing orders were made in two instances—the necessary work has since been carried out. Plans.—383 sets of plans were examined during 1921. Of these 22 were plans of new buildings. The corresponding figures for 1920 were 602 and 53. Failure to give notice occurred in 29 instances, and to send in plans 34 instances. Prosecution occurred in three instances and penalties were inflicted: £3, £8 and £1. Removal of Offensive Refuse.—Two firms were summoned (one twice) for removing such refuse during prohibited hours, and for not having proper receptacles for the purpose. One firm was fined £4, the other £4 on the first offence and £5 with £2 2s. costs on the second. Revenue Act.—No applications were received. Water Supply.—29 notices of withdrawal of water supply were received from the Metropolitan Water Board. It was reinstated on notice. The reasons given for cutting off the supply were: waste of water, 3; non-payment of rates, 26. Additional water supply to tenement houses was provided in 44 instances. Owing to the prolonged drought the rainfall during the year being only half the normal amount, considerable anxiety was experienced as (4573)q D 46 to the water supply of London. The Ministry of Health issued a letter asking that sanitary authorities should, as far as possible, restrict the use of water for such purposes as the watering of streets or recreation grounds and the flushing of sewers. The need for economising water was also impressed on the public. On account of the want of rain, causing a diminished flow in the sewers and the prolonged high temperature, flushing was more required than usual as offensive smells were given off through the street ventilators of many of the main sewers, and a number of people were reported as suffering from 6eptic throats in consequence. The Water Board draws its water from three sources : the Thames Valley (59 per cent, of the total supply), the Lea Valley (23 per cent.), and from a number of wells (18 per cent.). In addition to the Water Board's supply water is also obtained from many private wells which have been sunk to a depth of 300 to 500 ft. or more through the London clay into the chalk bed so as to tap the great reservoir of water which exists there, and which is fed largely by the rainfall in Hertfordshire. There are 15 of such wells in Westminster, and inquiry at the end of the year disclosed that the water in two had diminished, so that their use had to be given up, while in the others the head of water had sunk about 25 ft., but the amount being raised was up to the average, analysis of the various wells showed that the purity of the water had been in no way affected. Many years ago it was sufficient to sink wells of this kind to a depth of 200 ft., but as more and more wells have been sunk it has been necessary to go to a greater depth in order to reach the lower level to which the water has fallen. Even if the rainfall in 1922 is above the normal it is improbable that the level of the water in these wells will rise to its usual height, as much of the rain which would in the ordinary way filter through to this underground lake will be absorbed by the earth which has become very dry to a considerable depth. Utilisation of Waste Water during the Shortage.—The City Cleansing Surveyor utilised the waste water from the swimming baths for flushing the streets and sewers. The quantity of water available was:-Buckingham Palace Road, 121,000 gallons; Great Smith Street, 203,000 gallons; Marshall Street, 103,000 gallons. During the hot weather owing to the large number of bathers, the water in each bath was changed almost every day, but in the ordinary way each bath is emptied on an average four times a week. There was, therefore, a considerable quantity of water available, 47 Rat Repression.—The campaign against rats was continued throughout the year ; 31 specific complaints were investigated and steps taken to destroy the vermin and to remove the source from which they came. In the majority of instances the invasion of houses was due to defects in the drains or sewers, in others the rats were brought from the docks in packages of fruit and vegetables. In the week commencing 1st November a united attack was again made throughout the country. During the week 18,882 baits were laid in 262 of the Council's sewers and at the four wharves used as dust shoots. All of the baits were taken, but the actual number of dead rats seen was only 125. Probably the dead bodies were carried away in the sewers. Mosquitoes and Flies.—In the late autumn there was an unusual number of these insects in the neighbourhood of the Grosvenor Canal and the County Council's Sewage Pumping Station adjoining. The mosquitoes were breeding in two ponds in the grounds of the pumping station and afterwards found shelter in the bushes and undergrowth near by. The ponds were treated with paraffin and the undergrowth was also sprayed with good effect. The source of the flies was traced to deposits of refuse and decaying vegetation in gardens in the vicinity. Smoke Prevention. The following is a summary of the work done in connection with smoke prevention. 1921. 1920. Complaints received 30 29 Observations taken 1,838 2,123 Notices issued— Preliminary 1 87 Statutory 52 1 Summonses — — There was considerable improvement in nuisances from smoke. Houses let in Lodgings.—At the end of 1920 there were 1,164 houses on the register, during 1921 this number has been reduced to 1,150. 1,784 visits were paid to such houses and notices were served with reference to 304 defects. Statutory notices were served in 12 instances. As has been pointed out previously, many of these houses are partly used as (4573)Q d2 48 work places, and consequently more visits than those stated have been paid to the premises. The new by-laws drawn up by the County Council under the Housing and Town Planning Act have not yet been sanctioned by the Ministry, probably on the grounds that they would entail considerable structural alterations which in present circumstances would be very expensive. Housing (Additional Powers) Act, 1919.—Under this Act no person might demolish or convert premises used as dwellings to other uses without the consent of the County Council. That body asked for the observations of the City Council in instances, viz., 2, Carlisle Street, 7 to 12, Wardour Street; 63-65a, Greek Street; Vernon Mansions; 50, 52, 54 and 58, Broadway ; Shaw's Flats, Broad Court; 62 and 64, Brook Street; 48, 50 and 52, Chadwick Street; 65 and 67, Great Peter Street. This useful control terminated at the end of the year. Rent Restriction Act.—Only four applications for certificates were received. Housing.—Special inspections were made of the premises in Ross Street, Willow Street and Place, Kinnerton Street, Douglas Place, Ann's Place, Esher Street, Middle Street, Rutland Street and Commercial Place. The leases of many houses in St. John's and Victoria Wards have fallen in during the year, and have been surveyed for dilapidations by the freeholder's surveyor. In many cases the houses are being put in good order by the freeholder, especially in Page Street, Hinchliffe Street, Vincent Street, Kensington Place and Esher Street. With regard to the remedying of defects found on inspection, notices were served under the Public Health (London) Act, and not under the Housing Act. No action was taken under Sections 17, 18 or 28 of that Act. The figures as to defects found are given in the table above, but the Ministry require a separate form to be filled up which is appended. A shortage of houses still exists though not to such a marked extent as in previous years. In a number of cases married sons are living with their parents, and overcrowding has not been able to be abated in a few cases. In 18 instances the use of underground rooms has had to be permitted as the occupants were unable to find more suitable premises. There has been during the year a considerable improvement, and a large number of people have been able to change houses during the year. - Progress has been made in the erection of two of the three blocks of dwellings being erected by the Peabody Trustees in Great Peter Street, and they will be available for letting in 1922, 49 The Council entered into an agreement with the Board of Guardians for the utilisation of the disused workhouse at Wallis's Yard for the rehousing of persons dishoused from Chadwick Street and Great Peter Street, but the agreement was terminated by the Guardians last autumn, but most of the 70 inmates are still in residence. The Council had for some time endeavoured to find a suitable site for the erection of a block of buildings, and eventually accepted an offer by the Duke of Westminster to lease a vacant site situated at the northeast corner of Pimlico Road with a frontage to that road of 92 feet, a frontage to Ebury Square of 85 feet, and a frontage to Avery Farm Row of 103 feet, and contains approximately 15,000 feet super. The St. Michael's National Schools and blocks of working class dwellings are in the immediate vicinity. It is proposed to erect a block of buildings comprising 32 tenements, containing four 5-room, sixteen 4-room and twelve 3-room tenements, making in all 120 rooms exclusive of sculleries and bathrooms, capable of housing approximately 300 persons. The scheme is now waiting the sanction of the Ministry of Health. Housing Conditions. Statistics. Year ended 31st December, 1921. 1.—General. (1) Estimated population 141,317 (2) General death-rate 11.5 (3) Death-rate from tuberculosis 1.4 (4) Infantile mortality 80.2 (5) Number of dwelling-houses of all classes (Census figures not yet available). (6) Number of working-class dwelling-houses (7) Number of new working-class houses erected 0 2.—Unfit Dwelling-houses. i.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,655 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 197 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects, reasonably fit for human habitation 1,730 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 90 50 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit— (a) by owners 0 (b) By Local Authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B. Proceedings under Public Health, Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,640 (2) Number of dwelling-houses in which defects were remedied— (a) By owners All (6) By Local Authority in default of owners 0 C. Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 0 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 3.—Unhealthy Akeas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I, or (6), Part II, of the Act of 1890 0 (4) Number of houses not complying with the building by-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, &c., Act, 1919 0 (5) Staff engaged on housing work with, briefly, the duties of each officer 9 8 permanent Sanitary Inspectors and 1 temporary assistant (for 3 months). Duties—The general duties of a sanitary inspector in charge of a district: inspection of houses, investigation of complaints, supervision of new drainage and sanitary fittings, &c.) 51 D. WORKSHOPS, &c. The following shows the state of the register of work premises at the end of 1921:— Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,561 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 936 Leather workers, boot and shoe makers, harness makers, &c. 58 Carpentry, upholstery, carvers, gilders, &c. . 59 Surgical and dental instrument makers 4 Tobacco manufacturers 33 Wig makers and hair workers 45 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, &c. 58 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &e. 41 Metal workers 13 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 59 Florists 36 Laundries 58 Bakehouses 84 Photographers 22 Jewel case makers 10 Cinema film workplaces 54 New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 303 workshops was discontinued, and 145 additions were made to the register during the year. In 1920 there was a net increase of 128, but during 1921 the figures were reversed and there was a reduction of 158 workshops in net numbers. Inspection. Premises. Number of Inspections. Intimation Notices. Statutory Notices. Prosecutions. Factories 252 14 1 — Workshops 5,826 563 18 — Workplaces (Including restaurant kitchens, &e.) 1,086 374 2 5 Total 7,764 951 26 1 52 Defects found.—1921. Particulars. Number of Defects. Number of Prosecutions. Found. Nuisances under the Public Health Acts:— Want of cleanliness 868 — Want of ventilation 67 — Want of ventilation of gas stoves 43 — Overcrowding 14 — Want of drainage of floors 17 — Sanitarv accommodation— Insufficient 29 — Unsuitable or defective 507 1 Not separate for sexes 98 — Other defects / 573 — Total 2,216 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses — — Broach of special sanitary requirements for bakehouses (included above) — — — — Other Matters. Class. Number. Visits to Out-workers' premises 1,207 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 72 Absence of means of warming 2 Matters referred by H.M. Inspectors 182 Workrooms measured 238 Underground bakehouses in use at the end of the year 61 Ventilation of Gas Stoves.—Some apprehension by the users of gas has been felt through reports that the quantity of carbon monoxide therein had been increased, and that the gas was therefore more dangerous than heretofore. It is satisfactory, therefore, to learn from the Chairman of the Gas Light and Coke Company that the gas supplied in Westminster contains no more of this dangerous ingredient than it did before the war. During the war, and especially during the recent coal strike, the quantity of carbon monoxide was greater than it now is. So long as combustion is complete and there are no leakages, no danger need arise. If, however, combustion is incomplete and stoves and gas burners are not properly ventilated unconsumed gas may escape into rooms and have a deleterious ■ 53 effect oil persons breathing it. It is, therefore important that all stoves, geysers, &c., consuming gas should be provided with effective means of ventilation even though the stoves should be claimed to be self-consuming, and that care should be exercised to see that no leakages occur from faulty pipes and connections. The Board of Trade proposes to issue an Order to prohibit the supply of any gas containing carbon monoxide unless it has a distinctive pungent smell. Outworkers.—Employers in certain trades, particularly those engaged in the manufacture of articles of clothing, who give out work to be done in the people's homes, are required twice a year to send in lists of the names and addresses of such persons so that the places where the work is carried on may be inspected, and steps may be taken in case of infectious disease to prevent infected articles being given out from or returned to the shops if in course of manufacture. Notices were sent to 53 employers who neglected to send in returns, and those who failed to reply were visited by an Inspector. In 3 instances the employers were found to have given up business : the others sent in their returns without proceedings having to be taken. The handling of these lists requires a considerable amount of clerical work, as the names and addresses of persons living out of Westminster but receiving work from employers in Westminster have to be sent to the M.O.H. of the district in which they live. They in their turn send names of persons living in Westminster receiving work from employers in their districts. All the Metropolitan districts, except Greenwich, are represented, in the following proportions:— Battersea 65 Bermondsey 10 Bethnal Green16 Camberwell 33 Chelsea18 City of London 35 Deptford 6 Finsbury 23 Fulham 42 Greenwich - Hackney 37 Hammersmith 64 Hampstead 19 Holborn 126 Islington 115 Kensington 86 Lambeth 102 Lewisham 18 Paddington 99 Poplar 9 St. Marylebone 574 St. Pancras 456 Shoreditch 13 Stepney 233 Southwark 48 Stoke Newington 11 Wandsworth . 63 Woolwich 4 The districts around London had 283 names, Willesden taking 104 of these. (4573)q D 3 54 City of Westminster. Outworkers. 1921. Trade. FEBRUARY LISTS. AUGUST LISTS. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in Westminster. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in Westminster. Boot making 403 1 381 23 382 — 354 28 Brace and tie making 8 — 8 — 8 — 8 — Carpets, &c 2 — — 2 2 — — 2 Corset making 1 — 1 — 1 — 1 — Cutlery repairing — 1 — 1 — 1 — 1 Dress making 264 42 239 67 328 65 299 84 Dyeing, &c 3 — 3 — 7 — 5 2 Embroidery 64 2 51 6 41 5 38 8 Engraving '3 1 — 4 — 1 ~~~ I Furriers 25 5 25 5 28 8 25 11 Glove making 2 — 2 — 2 — 2 ~~ Hat making — 1 — 1 — 2 — 2 Lara curtain making — 1 — 1 — — — — Lamp shades, &c 65 1 59 7 38 — 34 4 Laundries 10 2 3 9 10 — 3 7 Lingerie, &c. 99 5 95 9 78 11 76 13 Shirt making 109 2 75 36 100 2 64 38 Tailoring 3,189 106 1,675 1 ,620 3,370 138 1,712 1,796 Theatrical costumes 12 — 11 1 9 — 7 2 Toy making 1 — 1 — — — — — Umbrella making 16 — 16 — 16 — 16 — Waterproofing 1 — 1 — 1 ~~ 1 — Totals 4,267 170 2,646 1,791 4,421 223 2,645 1,999 Number of lists received, 781 (February, 387; August, 394). 55 After adjusting the lists, it appears that the actual number of outworkers resident in Westminster is 1,249 (in 1920 the number was 1,325); this is less than the apparent number shown on the accompanying table, as more than one employer may send work to the same person. 908 are persons having workshops. The number of houses in which out-work is carried on was 779. These premises have been visited specially by the woman sanitary inspector, and also by the male inspectors in the course of their ordinary work. Defects relating to cleansing of walls or defective or insufficient W.C. accommodation, unventilated gas heaters, dirty floors, presence of bugs, &c., were found and amended in a number of instances. No prosecutions were taken for doing outwork in unwholesome premises (Sec. 108) or in infected premises (Sec. 109, 110). 56 E. FOOD SUPPLY. During 1921 2,065 visits have been paid to the various classes of business, and 268 intimations were served in respect of defects found, followed by 5 statutory notices by the District Inspectors, beside which there was the regular inspection of street markets, Covent Garden Market, and other places selling food by the Food Inspectors. Restaurants.—The kitchens of hotels and restaurants are inspected at least once a quarter. Ice-cream Premises.—There were during the year 150 places where this commodity was made or sold, and these were kept under supervision ; 210 visits were paid. Bakehouses.—At the end of 1920 there were 21 above-ground and 63 underground in use. During 1921 the number in use was 21 above and 61 below ground. All the bakehouses were inspected, and cleansing carried out twice a year. Milkshops.—At the end of 1921, 477 names of persons selling milk were upon the register. These include persons selling milk on rounds, who had no shop or store. Four applications for registration were refused on the ground that the premises were unfit for storing milk. 642 visits were paid during the year, besides those paid by the two inspectors taking samples under the Food, and Drugs Acts, to premises in which milk is sold. Proceedings were taken against 3 itinerant persons selling milk without having been registered for the pin-pose in Westminster. Fines were inflicted of £3, £1, 10s. and 10s. costs. Cowhouse.—There is only one remaining, licensed for 6 cows, but none have been kept recently. There are no slaughter-houses in Westminster. Inspection of Food.—The food exposed for sale in shops and on stalls in the street markets has been regularly inspected every day (including Sundays). The following list shows the quantity of food condemned and destroyed during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your officers:— / 57 Articles of Food Submitted. Tons Cwts. Lbs. Tons Cwts. Lbs. Asparagus 0 2 56 Oranges 8 7 2 Apples 17 13 0 Pears 10 10 56 Apricots 0 14 0 Peas 1 18 12 Bananas 1 15 0 Pineapples 1 2 0 Brussels sprouts 0 13 0 Plums 0 5 0 Carrots 0 4 0 Potatoes 2 17 28 Cherries 0 17 56 Savoys 2 10 0 Chestnuts 3 0 0 Strawberries 1 2 56 Figs 0 4 0 Tomatoes 5 16 5 Gooseberries 2 8 56 Turnips 1 13 28 Grapes 0 0 14 Walnuts 0 0 84 Greengages 0 0 56 Beef (Corned) 6 0 12 Lettuoe 0 6 0 Pork 0 0 5 Mandarins 2 12 0 Bacon 0 2 0 Melons 0 12 0 Beef 0 4 0 Nectarines 0 2 0 Fish (various) 3 0 51 Condensed Milk, 23 tins ; Turkeys, 10 ; Chickens, 111; Winkles, 2 bushels; Salmon, 3 tins; 1 tin anchovies. Articles of Food Seized and Condemned. Shrimp Paste Fined £3 and £2 2s. costs. 55 oranges ,, £5 and £5 5s, costs. Pork, 4 lb. 7 oz. Cautioned. 58 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings for year 1921. Number. Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 1 Milk 987 92s (29) 30 19 5 14 19 5 0 2 2 0 2 do. separated 12 12 3 do. machine skimmed 2 2 4 4 Cream 46 41 5 5 do. preserved 40 21 19 6 Butter 157 141 (15) 1 1 1 - - 3 3 0 7 Margarine 53 51 (2) 8 do. and butter 1 1 9 Dripping 20 19 1 1 1 - 4 0 0 10 Meat fat 1 1 11 Chocolate 10 10 12 Cocoa 4 4 13 Coffee 16 16 14 Sugar 2 2 15 Jam 54 53 1 16 Meat pies (various) 50 37 13 1 1 - - 3 3 0 17 Sausage rolls 8 4 4 18 Sausages (various) 100 88 12 3 3 8 0 0 19 Brawn 12 12 20 21 22 Meats, potted (various) 20 17 3 Fish, potted (various) 36 31 5 Beans 1 1 23 Peas 39 9 30 5 5 - 15 12 0 2 0 0 24 Spinach 4 1 3 2 2 - 25 0 0 3 3 0 25 Lime juice cordial 3 - 3 26 Lemon squash 3 - 3 27 Olive oil 66 60 (3) 3 2 2 - 10 0 o 2 2 0 28 Salad oil 7 7 29 Lucca oil 2 2 30 Vinegar 1 (1) • 31 Whisky 1 - 1 32 Aspirin tablets 9 9 33 Camphorated oil 24 19 (1) 4 1 1 - 5 0 0 34 Calomel ointment 4 3 1 1 1 - 2 10 0 36 Mercury ointment 5 4 1 1 1 - 2 0 0 Selling margarine in plain wrapper - - - 2 2 0 10 0 1 5 0 Selling preserved cream not labelled as such - - - 2 2 2 10 0 2 11 0 Selling milk without being registered - - - 2 2 - 4 10 0 0 10 0 Totals 1,800 1,003 (51) 146 43 29 14 98 17 0 19 19 0 Summary proceedings were ordered to be taken in 43 instances, 26 cautions were issued, the attention of the vendors was called to the report 59 of the Analyst in G instances, and no action was taken with regard to 68 samples which deviated slightly from the standard or were test purchases not taken officially. There were 21 non-official samples purchased during the year. Milk.—987 samples of ordinary milk were taken during the year. The Analysts have graded the samples submitted to them into four groups:—Good quality, in which the fat was over 3.8 per cent.; fair quality, in which the fat was between 3.3 and 3.8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent, (the official standard) and 3.3 per cent., or in which the non-fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adulterated are those below the official standard of 3 per cent, for fat and 8.5 for solids not fat. District. Total. Good Quality. No. Per cent. Fair Quality. No. Percent. Poor Quality. No. Percent. Adulterated. No. Percent. South 475 120 25.2 224 47.1 126 26.5 5 1.0 North 512 201 39.2 176 34.3 110 21.5 25 4.8 1921 987 321 32.5 400 40.5 236 23.9 30 3.0 1920 977 419 45.9 362 37.0 131 13.4 35 3.5 1919 1,073 375 34.9 428 39.8 201 18.7 69 6.4 1918 919 320 34.8 302 32.8 194 21.2 103 11.2 1917 920 329 35.7 304 33.0 162 17.6 125 13.6 3916 919 235 25.5 360 39.1 221 22.8 103 11.2 1915 937 303 32.3 327 34.8 225 24.0 82 8.70 1914 894 250 27.9 364 40.7 217 24.2 63 7.04 1913 910 255 28.0 343 37.6 233 25.6 79 8.60 1912 873 251 28.7 297 34.0 252 28.8 73 8.30 1911 911 305 33.3 311 34.1 218 23.9 77 8.40 1910 947 332 35.0 328 34.6 179 18.9 108 11.40 It is satisfactory to note that cases of actual adulteration are even lower than those of last year; the quality of the milk generally however has deteriorated. Sunday Samples.—10 of the samples of milk were taken on Sundays during the year, one of which was reported adulterated and the vendor prosecuted. Samples taken in course of Delivery— On Delivery at Shops, &c.—8 samples of milk were taken as it was being delivered by wholesale firms to retail customers, including shops, hotels and hospitals. Of these samples, 2 were good, and 6 fair. These samples were taken in consequence of previous samples having been found below the limit (including cases where a warranty defence was set up). 60 The Public Health (Milk and Cream) Regulations, 1912 and 1917. Samples Analysed during the Year 1921. Article. Number of samples examined for preservative. Number containing preservative and Percentage of preservative found in each sample. Milk 987 No preservative found. Cream 46 5 contained preservative:— (2 — 18-71 and 12-76 grains of boric acid per lb. respectively. Vendors prosecuted and fined). (3 — 18 0; 14-12 and 6-19 grains of boric acid per lb. respectively. Explanatory letter received and cautionary letter sent to each vendor). Preserved Cream. Number examined. Without preservative. Preservative under amount stated on label. (0.4 per cent.) Preservative over amount stated on label. Milk fat in preserved cream. Above 35 per cent. Below 35 per cent. 40 1 39* Nil. 40 Nil. * Samples contained respectively 29.0, 27.2, 26, 25.4, 25, 25, 24.1, 23.8, 21.7, 20.4, 19.6, 19.6, 19.6, 18.9, 18.2, 17.9, 17.5, 17.4, 17.3, 17.3, 16.6, 16.4, 16.2, 14.9, 14.7, 14.7,14.7, 14.5, 14.3, 14, 14, 13.3, 12.6, 12.6, 11.2, 11.9, 10.5, 4.7 and a trace. Action Taken—Nil. Infringements under Article 5 (1)—Nil. Infringements under Article 5 (2)—Two cases—Receptacles not labelled; both prosecuted and fined £2 and 10s. respectively with costs. Thickening substances—None found. Nineteen prosecutions were taken with regard to adulteration:-9 for fat abstracted, 9 for added water, and 1 for both fat abstracted and water added. Eleven sellers of milk where the quality was slightly below the standard were cautioned. Warranties were set up as a defence in 14 instances and were successful. A conference of representatives of metropolitan local authorities agreed that the provisions of the Sale of Food and Drugs Acts with regard to warranty defences in the case of milk operate to the prejudice of the purchaser and the public health, and that they should be repealed. Further, a cowkeeper whose milk is below the standard but proves that it is as given by the cow should not be allowed to sell such milk, as it means that either the cow is inferior or being improperly fed. 61 Certified Milk.—Orders have been issued setting forth the conditions under which a superior quality of milk as regards purity and cleanliness may be sold. The dairy farmer must conduct his business on hygienic lines which must satisfy the Ministry of Health. The herd from which the milk is obtained must contain no cow or heifer which has not passed specified tests as to freedom from tuberculosis. The business must be carried out in a cleanly manner and the milk sent out in sealed bottles with date of bottling. Several milk dealers in Westminster have been authorised to sell such milk for which there is a growing demand. The Board of Trade issued a Food Control Order amending the Milk (England and Wales) Order, 1921. It provides that on and after the 30th June, 1921, the following clause shall be substituted for Clause 5 of the Milk (England and Wales) Order, 1921:— "For the purposes of this Order the expression ' milk' shall include skimmed, separated and butter milk, and any milk which has been submitted to any one or more of the following processes, viz., sterilization, pasteurization, homogenization, or any other like process, but shall not include condensed milk." Sale of Food Order, 1921, and the Local Authorities (Food) Order, 1921.— The Ministry of Health issued Orders (August, 1921) by which functions recently exercised by the Food Controller and the Board of Trade are transferred to local authorities. Under the Sale of Food Order, 1921, local authorities for the purposes of the Sale of Food and Drugs Acts are invested with the powrer of enforcing the requirements of the Order as to the labelling of imported produce, the composition of jam and marmalade, and the composition of dripping, margarine, and other edible fats. The Minister of Health is aware that in the past local authorities have occasionally experienced difficulties in dealing with cases of excessive water in dripping, lard substitutes, &c., and it is hoped that the present Order, by specifying a definite maximum percentage, will assist in the removal of these difficulties. Similarly the provisions of the Order prescribing a standard of composition for jam and marmalade will be found useful. In regard to jam, the watersoluble extract must not be less than 65 per cent, of the jam and not more than 10 per cent, must consist of added fruit juice; marmalade must be made of citrous fruits and fruit juices unless the other varieties of fruits or vegetables used are mentioned in the description. Any imported meat, bacon, ham or lard must, when exposed for sale, bear a label with the word " imported " or words disclosing the country of origin; eggs 62 which have been imported into the United Kingdom must not be sold as "fresh" or "new laid," unless the description similarly includes the word "imported" or words disclosing the country of origin. The enforcement of the provisions hitherto in force with regard to the weight of bread and tea is now entrusted to the local authorities for the purposes of the Weights and Measures Acts. Proceedings were taken in respect of a sample of dripping containing 4.7 per cent, of water and a penalty of £4 inflicted. Copper in Vegetables.—Many years ago when the use of copper to give a fictitious colour to preserved peas and other vegetables was excessive, a conference with representatives of the French packers resulted in a marked improvement being effected. Since the war such vegetables are also being imported from Italy and Spain, and in samples of these goods either the amount of copper exceeded 2 grains to the pound, or no disclosure was made of the presence of copper, and prosecutions resulted. HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.