City of Westnunster. ANNUAL REPORT FOR THE YEAR 1922 by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Ed., Medical Officer of Health. Printed by Order of tlie Council. LONDON: HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJE.STY, ST. MARTIN'S LANE, W.C.2. City of Westminster. ANNUAL, REPORT FOR THE YEAR 1922 bt FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Ed., Medical Officer cf Health. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. City of Westmmster. ANNUAL REPORT FOR THE YEAR 1922 BT FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Ed., Medical Officer cj Health. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. Annual Report on the Health and Sanitary Condition of the City of Westminster. 1922. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1922. It includes Keturns required by the Ministry of Health and Home Office. Details of the various activities of the Public Health Department having been given in the 1921 Report, it is not necessary to do more than record any changes which have taken place in 1922. Additional volumes, relating to the Census of 1921, have been issued, and from these information relating to "Westminster has been abstracted and compared with similar figures ascertained at former Census periods. With the exception of the first quarter of the year, when influenza was somewhat prevalent, the health of the City has been good and, notwithstanding the existence of unemployment and difficulties in housing accommodation, the death-rate of infants was only 51 per 1,000 born, the lowest figure it has ever been and only equalled by one other metropolitan borough. (6809)q a 2 iv The housing problem is slowly solving itself; many residents in Westminster, whose work is in the suburbs, have moved nearer their work as houses have been built, thus relieving the congestion in the inner districts. Westminster is becoming every year more and more of a business centre and less a residential one. The Council, in its early days, recognised this tendency and adopted a policy to provide houses for persons whose work necessitated living in proximity thereto, and although it has not itself built any dwellings recently, yet it has assisted in the provision of houses in other parts of London more suitable for residence. At present the contribution of the City of Westminster towards the cost of Housing Schemes in London amounts to £32,000 per annum. This fact appears to be overlooked by those who allege Westminster is not doing anything to help. The work of the Public Health Department in its various branches has been steadily carried on. As regards repairs and remedying of nuisances, it has been easier during the past year to get work done, doubtless due to reduction in cost. The supervision of the food of the people, and of places where it is sold, has always been regarded by the Council as of great importance; details relating thereto will be found in the Report. It is interesting to note improvement in the quality of milk so far as its chemical ingredients are concerned. Orders come in force in the coming year to promote the sale of milk with a higher standard of bacteriological purity, which means, therefore, a cleaner milk. A Departmental Committee has reported on the pollution of the atmosphere due to the emission of smoke, and has recommended that increased powers should be given to local authorities and that higher penalties should be inflicted. It is suggested that the dealing with smoke nuisances should be controlled by County Councils, which will doubtless be opposed so far as London is concerned. Recommendations are also made for the greater use of gas, electricity and smokeless fuel, especially for domestic and office purposes, and in large buildings the adoption of central heating. This method is being installed in many of the new buildings at present b£ing constructed in AVestminster. I have the honour to be, Your obedient Servant, FRANCIS J. ALLAN, Medical Officer of Health. « vi > SUMMARY OF PARTICULARS REQUIRED BY CIRCULAR 359 OF THE MINISTRY OF HEALTH, DATED 10th JANUARY, 1923. 1.—general Statistics. Area (acres)—2,502*7. Population (Census 1921)—141,578. Population, June, 1922 (Registrar-General's Estimate)—141,800. Number of Inhabited Houses (1922)— Rateable value—£8,131,854 (September, 1922). Sum represented by a penny rate—£32,274. 2.—Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth Rale. Legitimate 842 861 1,703 13.4 Illegitimate 98 94 192 „ unregistered 5 2 7 Totals 945 957 1,902 Deaths—1,796. Death-rate—12.9. Number of women dying in, or in consequence of, childbirth:— J,vrom sepsis, 4. From other causes, 3. Number of deaths of infants under one year of age per 1,000 births—54.6. Legitimate rate, 49.3; Illegitimate rate, 100. Number of deaths from measles (all ages)—11. „ „ whooping cough (all ages)—5. „ „ diarrhoea (under 2 years of age)—8. Other particulars asked for are given in the body of tlie Report. A list of the staff of the Public Health Department is appended to the Report. PART I. A. STATISTICS. Population. Further results of the Census have now been published by the RegistrarGeneral, and I have extracted certain information relating to the City of Westminster. This gives the population of the various wards and civil parishes, the number of dwellings and private families, with details of the number of rooms occupied. Particulars are also given of the number of males and females living at each age with their marital conditions. These have been summarised into five yearly groups in the Tables appended. In my last report I pointed out that the Census returns for Westminster show a lower population than actually existed, as the Census was taken on a Sunday at the end of June, when a number of people might reasonably be expected to be away from home. In Table 10 it appears that 1,815 dwellings were vacant, but this figure includes also those without a tenant. Moreover, in houses occupied by more than one family, only some of the inmates may have been away from home, and certain of the larger houses which were unlet had caretakers in charge, so would not be returned as vacant. Taking dwellings only, of less than five rooms which were vacant, the absent population would be about 4,000, but undoubtedly the total number of absentees must have been much larger. The Census population for 1921 was 41,433 less than it was in 1901, and 18,683 less than it was in 1911. On comparing the numbers living at various age periods, the curious fact emerges that there is an actual increase in the number of persons at ages over 45 years as compared with the year 1901. This applies both to men and women, there being an increase of 1,890 men and 3,237 women, a total of 5,127. As probably about 1,000 persons over 45 were inmates of Poland Street and Sheffield Street poor law institutions in 1901, and as these institutions have been discontinued in the interval, the actual increase in the general population must be about 6,000 at these ages. 2 fensus 1901. Age Periods. Per cent. Total. Males. Females. Under 5 7.0 12,805 6,416 6,389 5 and under 15 1.-5 22,880 11,329 11,551 15 „ 25 23.57 43,188 19,994 23,194 25 „ 35 21.65 39,605 17,291 22,314 35 „ 45 15.06 27,570 12,810 14,760 45 „ 55 10.14 18,570 8,858 9,712 55 „ 65 6.19 11,359 5,303 6,056 65 and over 3.84 7,034 2,962 4,072 100.00 183,011 84,963 98,048 Census 1911. Age periods. Per cent. Total. Males. Females. Under 5 6.01 9,746 4,871 4,875 5-15 10.80 17,332 8,562 8,770 15-25 21.93 35,198 16,233 18,965 25-35 21.82 35,040 15,070 19,970 35-45 16.23 26,030 11,741 14,289 45-55 11.61 18,611 8,768 9,843 55-65 6.79 10,877 5,184 5,693 65 and up 4.64 7,427 3,020 4,407 100.00 160,261 73,449 86,812 Census 1921. Age Periods. Per cent. Total. Males. Females. Under 5 4.31- 6,119- 3,031- 3,088- 5-15 10.05- 14,252- 7,051- 7,201- 15-25 19.48- 27,532- 11,520- 16,012- 25-35 19.31- 27,380- 10,566- 16,814- 35-45 17.09+ 24,205- 10,199- 14,006- 45-55 14.62+ 20,703+ 9,388+ 11,315+ 3 5-65 9.27+ 13,140+ 6,160+ 6,980+ 65+ 5.82+ 8,247+ 3,465+ 4,782 + 100.00 141,578 61,380 80,198 It will be seen in the accompanying Table that there was some indication of this change in 1911 in women between 45 and 55, and in both men and women over 65 years of age. The reduction in population is thus confined to persons under 45 years of age, and all the age periods below 45 are affected in both sexes. The decline in the birth-rate during the last 20 years accounts to some extent for the decrease in the number of persons in the groups up to 25. The effect of the war is seen in the proportionately greater decrease of males in the groups 15-25, 25-35 and 35-45 as compared with the figures for females at the same ages. 3 Compared with the population for London as a whole there are, as in previous enumerations fewer children proportionately in Westminster and but for the inclusion of the births of 1920 when the numbers were high, the proportion of children under 5 would have been still lower. - London. Westminster. Males. Females. Males. Females. Under 5 9.2 7.7 4.9 3.9 5-15 19.4 16.8 11.5 9.0 15-25 17.2 18.5 18.7 19.9 25-35 15.2 16.9 17.3 21.0 35-45 14.1 14.6 16.6 17.5 45-55 12.1 11.6 15.3 14.1 55-65 7.8 7.6 10.0 8.7 Over 65 4.6 6.3 5.6 5.9 100.0 100.0 100.0 100.0 Between the ages of 15 and 35 there has always been an excess due to the importation of domestic servants, waiters and other hotel and restaurant staffs, besides which there are numbers of both sexes employed in business. There is little difference in the proportion of females at this age period between 1911 and 1921, but the percentage of males has fallen from 42.7 in 1911 to 36 in 1921. Census, 1911.—City of Westminster. Wards. Families or Separate Occupiers. Population. tutions, Large Establishments &c„ 1911 (included in/ Columns 2 and 1901. 1911. 4). 1911. Persons. Persons. Males. Females. No. Population. 1 2 3 4 5 6 7 8 The City 35,984 183,011 160,261 73,449 86,544 812 27,987 Charing Cross 733 5,755 4,908 2,489 2,419 32 2,335 Conduit 742 5,876 4,273 1,894 2,379 38 1,623 Covent Garden 1,802 8,917 8,493 4,090 4,403 32 2,097 Great Marlborough 1,026 7,908 5,277 2,588 2,689 14 1,049 Grosvenor 2,684 15,266 14,223 5,525 8,698 84 2,347 Hamlet of Knightsbridge 1,243 7,601 7,692 2,779 4,913 34 1,376 Knightsbridge St. George 2,743 15,657 13,794 4,968 8,826 52 1,595 Pall Mall 663 4,122 3,774 2,071 1,703 49 1,598 Regent 1,586 9,558 7,108 3.560 3,548 33 959 St. Anne 2,143 11,493 9,286 4,913 4,373 34 1,066 St. John 7,602 29,914 28,857 14,490 14,367 33 2,930 St. Margaret 2,417 13,784 11,302 5,187 6,115 52 3,223 Strand 308 7,002 3,458 1,909 1,549 18 2,500 Victoria 10,292 40,158 37,816 16,986 20,830 39 3,289 4 Census, 1921. Wards. Persons. Males. Females. Private Families. Population in private Families. Charing Cross 4,650 2,317 2,333 605 1,162 Conduit ' 3,456 1,281 2,175 622 2,135 Covent Garden 7,064 3,345 3,719 1,498 5,908 Great Marlborough 3,194 1,492 1,702 . 813 2,611 Grosvenor 1,3880 4,934 8,946 2,661 11,730 Hamlet of Knightsbridge 0,687 2,012 4,675 1,382 5,632 Knightsbridge St. George 12,563 4,280 8,283 2,572 11,370 Pall Mall 3,572 1,831 1,741 425 1,812 Regent 6,878 3,131 3,747 1,211 4,132 St. Anne 6,699 3,315 3,384 1,807 5,118 St. John 24,162 11,509 12,653 6,944 21,464 St. Margaret 9,261 4,128 5,133 2,168 7,080 Strand 2,116 1,402 714 178 645 Victoria 37,396 16,403 20,993 11,060 31,697 141,578 61,380 80,198 33,946 112,526 Information is now available relating to the various wards of the City. There is a reduction in the total population in each ward, but the rate varies very considerably, thus in Victoria Ward it is only 1 * 1 per cent., while in Great Marlborough Ward it is 39.4 per cent, of the 1911 population. Percentage reduction in population between 1911 and 1921:— Victoria 1.1 St. John 16.0 Grosvenor 2.4 Covent Garden 16.8 Regent 3.2 St. Margaret 18.0 Charing Cross 5.2 Conduit 19.0 Pall Mall 5.3 St. Anne 27.8 Knightsbridge St. George 8.9 Strand 38.8 Great Marlborough 39.4 Knightsbridge Hamlet 13.0 In Grosvenor, Pall Mall, Regent and Victoria Wards the decreases shown are entirely in the male population, there being an actual increase in the number of females. In Conduit, the Hamlet and Knightsbridge St. George the reduction is chiefly in the male population. The Victoria and Hamlet Wards show an increase in the number of private families. In St. John's Ward the males used to number more than the females, now they are in a minority. In the Strand the reduction in the female population is considerable, 1,549 to 714. Since 1901, Conduit, Great Marlborough, Regent, St. Anne, Strand, and St. Margaret Wards show the greatest proportional diminution in population, due chiefly to the conversion of residential property into business premises. 5 In 14 hospitals and 10 nursing homes there were 1,853 persons, including staff. In 10 barracks and 2 military hospitals, 2,958 persons. In ships, barges and boats (11), 13 persons. Twenty-one persons (11 of whom were women) were found sleeping in the streets, in 1911 there were 93 of this class. In the workhouse and infirmary (in Chelsea Borough) not reckoned in the population for Westminster, there were 1,603 inmates. The area of the City of Westminster is 2,502.7 acres (3.91 square miles). The average number of persons per acre is now 57. In 1901 it was 72 and in 1911, 64. There are about 700 acres of parks and other public open spaces, and if these are deducted the average density of population would be 101 in 1901, 88 in 1911 and 78 in 1921. The average density for the County of London was 60 persons per acre in 1921, 60 4 in 1911. The density of population varies greatly in different parts of the City, the averages for the several Wards being as follows:— Ward. 1911. 1921. Less Open Spaces. 1911. 1921. St. Anne 172 124 174 126 St. John 136 114 148 124 Great Marlborough 138 84 — — Covent Garden 114.7 95 — — Victoria 106 95 — — Regent 97 94 — — Pall Mall 72.5 69 — — Knightsbridge St. George 79 72 — — Conduit 65 52 — — St. Margaret 51 42 59 48 Strand 40 24 41 25 Grosvenor 28 27 77 75 Charing Cross 23 22 37 35 Hamlet 22.4 19 74 64 When the averages are calculated on the acreage less parks, &c., the differences are less accentuated. Marital conditions. Males. Total. Single. Married. Widowed. Divorced. 1911 73,419 45,925 25,088 2,436 _ 100.0 62.5 34.2 3.2 —• 1921 61,380 33,413 25,682 2,098 187 100.0 54.5 41.8 3.4 0.3 6 Females. - Total. Single. Married. Widowed. Divorced. 1911 86,812 54,530 24,340 7,942 100.0 62.8 28.0 9.1 — 1921 80,198 47,085 24,595 8,347 171 100.0 58.7 30.7 10.4 0.2 From the above Table it will be seen that there is a reduction in the number of single persons, and an increase in the number of married of both sexes in actual numbers, as well as in the proportions they bear to the total males and females. The increase in the number of widows reflects the toll exacted by the late war. Births. In order to obtain a more correct estimate of the birth-rate than is shown by calculating it on the total population, it is necessary to ascertain the number of women living at child-bearing ages; extracting the figures from the Returns, I find that the numbers between 15 and 45 years of age were in:— - Unmarried. Married. Widows. 1901 39,029 19,274 1,938 1911 35,602 15,999 1,623 1921* 30,216 14,740 1,771* * And 106 divorced. The legitimate birth-rate in these years calculated on the number of married women between those ages was:— 165 per 1,000 in 1901. 137 „ „ 1911. 117 „ „ 1921. It is often alleged that this reduction is due to deliberate restriction in the size of families, but consideration of the figures leads to the conclusion that there are other influences which play an important part. It is known that age has an important bearing upon fecundity in women, declining gradually from round about the age of 20 when every hundred marriages may result in about 40 children within a year, until between 40 and 45 when only five children might be expected. The age of the fathers has also an influence. According to Dr. Farr he estimated that the fathers and mothers of nearly half the children bom are under 30 7 years of age. Consequently a postponement of marriage to more mature years must lead to a decreased birth-rate. The proportion of married females between the ages of 15 and 45 in the population of Westminster wa3 at the three last Census periods per 1,000 - Under 25. 25-35. 35-45. 1901 110 466 424 1911 92 448 460 1921 92 430 478 The proportion under 25 in 1921 would have been less but for the increase in marriages after the war. There are no data applicable to this country upon which exact calculations can be made, but it is evident from the above figures that a reduction in the birth-rate must be expected, as there are more married women at the higher ages. On a rough estimate based on the married women's ages, taking 1901 at 100, the number of births which might be expected in 1911 should equal 79 and in 1921, 69, but those which actually occurred were less, viz., 69 in 1911 and 63 in 1921. Consideration must also be given to the ages of the husbands. It would involve a complicated actuarial operation—if the full facts were available—to determine the precise effect, but generally it may be pointed out that whereas in 1901, 59 per cent, of the husbands were under 45 years of age, in 1921 the percentage had fallen to 49. It appears that in 1901, 8.7 wives under the age of 45 were married to older men and in 1921 the figure had risen to 20. There are other factors bearing on the subject, such as race and religion, in regard to which changes have taken place in Westminster, but data are not available. The above must be taken therefore as merely indications of probable causes in the diminution in the birth-rate so far as it affects the City. The Registrar estimates the population of Westminster for the year 1922 to be 141,800, but for calculating the death rate he deducts the military population, leaving 139,389 as representing the civil population. The number of births registered in Westminster in 1922 was 1,347, of these the home address of 81 was elsewhere, and therefore these haye to be deducted, but 629 children were born to residents of Westminster in institutions in other parts of London; adding thfese the nett number was 1,895, a reduction of 24 on the figure for the year 1921. The fluctuations in past years are showh below. The birth-rate was 13.4 per 1,000 persons; the London birth-rate was 21.4 and for England and Wales 20.6, both showing a decrease on the 1921 rates. 8 Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Nett. Total. Alive. Stillborn. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 2,520 2,365 2,110 2,134 1,992 1,860 1,721 1,643 1,325 1,138 1,210 1,731 1,418 1,347 39 49 60 49 35 15 71 175 159 146 98 89 78 81 270 276 311 264 276 312 329 342 378 458 480 618 579 629 2,751 2.592 2,361 2,349 2,233 2,157 1,979 1,810 1,544 1,459 1,592 2,260 1,919 1,895 1,612 1,674 1,562 1,501 1,462 1,386 1,292 1,330 1,020 911 1,004 1,327 1,049 1,046 1,571 1,621 1,507 1,469 1,424 1,347 1,250 1.288 985 888 977 1.289 1,032 1,020 41 53 55 34 38 39 42 42 35 23 27 38 17 26 Divided into legitimate and illegitimate, the figures for 1922 are:— Legitimate— Males 627- 24 + 239 = 842 Females 635-28 + 254 - 861 Total .. 1,262 - 52 + 493 = 1,703 Illegitimate— Males 44-16 + 70— 98 Females 41-13+ 66= 94 Total 85 —29 + 136 = 192 There is a slight reduction in the net number of births compared with the year 1921, confined to legitimate births. In the Pimlico and North areas there is, however, an increase in the number of births, while in St. Margaret and St. John's area there is a decrease. It will be noted that the number of mothers who go out of Westminster to be confined in institutions has increased considerably in the last three years. To the above figures there should be added 7 foundlings, 5 males and 2 females whose births were not registered. The notifications received numbered 1,046, of these 739 were received from midwives. The number of still-births notified was 26, but information was received of 17 other still-births and miscarriages. 9 Number Born. Number of Deaths under 1 year. Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1,120 1,120 1,006 889 756 789 786 1,117 991 945 1,113 1,037 973 921 788 670 814 1,149 928 957 111 103 103 84 94 84 74 104 91 68 102 68 79 67 64 64 63 63 63 36 1,009 1,017 903 805 662 705 712 1,013 900 877 1,011 969 894 854 724 606 751 1,086 865 921 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. 1922 987 boys. Maternity and (Jhild Welfare. Expectant Mothers.—The names of 795 were sent in by hospitals, voluntarily notified or found by visitors, and to these 2,689 visits were paid at their homes (see Table); 188 attended the Mothercraft Classes. Ante-natal Clinics.—114 women attended for the first time in 1922 (139 in 1920, 155 in 1921). There were 214 attendances altogether of expectant mothers at the two centres. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Pimlico Road 50 50 62 112 67 Bessborough Street 50 64 38 102 71 78 women also attended the Clinic at Bessborough Street after confinement, making 122 attendances. Mothercraft 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. The figures given below show an increase in attendances at Bessborough Street. Mothercraft classes are also carried on at the Greek Street, Rochester Row and Mayfair Centres by the Health Society. 10 Particulars relating to these classes are given below:— Mothercraft Classes. — Pimlico Road. Bessboro' Street. Rochester Row. Greek Street and Mayfair. Total. Number of classes 45 52 87 125 309 Total attendances 498 580 959 939 2,976 Average attendances 11.0 11.1 11.0 7.5 - Number of expectant mothers 16 37 76 59 188 Number of attendances by expectant mothers 109 196 336 243 884 Number of other mothers 32 38 94 118 282 Number of attendances by other mothers 389 384 623 696 2,092 Attendances of children in nurseries during classes 498 451 565 832 2,346 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Pimlico Road were 187; at Bessborough Street, 246. Attendance during Confinement.—The Council's midwife attended necessitous women and emergency cases in the Pimlico area. Number of cases attended— As midwife 108 As emergency 2 With hospital students 5 With private doctor 1 Total 116 Number of— Pre-natal visits 610 Lying-in visits 1,402 Subsequent visits 172 Visits to infants under 1 year other than lying-in visits 172 Total number of visits 2,356 Attendances at ante-natal and other clinics:— 1, Pimlico Road 72 15, Bessborough Street 62 Total 134 In the St. John and St. Margaret's area, the Health Society has two midwives. The Society has during 1922 taken over the out-patient maternity work of Charing Cross Hospital. 11 Number of cases attended— Rochester Row. Greek Street. As midwife 86 — With hospital students 33 47 With private doctors 15 — Visits paid 1,829 689 Midwives also attended at the Rochester Row Centre on 52 afternoons to interview expectant mothers. Puerperal Fever and Mortality in Childbirth.—Six cases of puerperal fever occurred with four deaths. In two the confinement took place in lying-in homes. Of the remaining four 1 was result of extra uterine fcetation and in two the fever was due to influenza. Three other deaths occurred, one due to criminal abortion and two to other causes. 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:— Pimlico. Bcssbo rough Street. Rochester Row. Greek Street. Total Total. Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Pre-natal— First visits _. 177 45 110 2 249 16 184 12 720 75 795 Other visits 192 98 161 19 463 37 286 28 1,102 182 1,284 Children under 1 year of age— First visits 467 79 206 3 455 11 313 84 1,441 177 1,618 Other visits 2,228 1,030 527 151 767 800 695 798 4,217 2,779 6,996 Children over 1 and under 6 years— Visits 2,741 1,248 636 190 968 1,967 929 1,251 5,274 4,656 9,930 5,805 2,500 1,640 365 2,902 2,831 2,407 2,173 12,754 7,869 20,623 8,305 2,005 5,733 4,580 20,623 To the Pimlico and Bessborougli Street figures have to be added visits paid by the midwife, viz., first pre natal 108, subsequent 502; children under 1, 172. The visits paid by the midwives of the Health Society are included under their respective headings. (6809)q B 12 Infant consultations are held at each of the Centres. The following are details of the attendances:— Attendances at Infant Consultations, 1922. 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 100 224 41 1,697 751 1,941 792 2,773 15, Bessborough Street 100 145 46 1,500 1,223 1,645 1,269 2,914 100, Rochester Row 95 283 50 1,478 611 1,761 661 2,422 60, Greek Street 45 143 28 389 171 532 199 731 Mayfair* 8 5 5 21 28 26 33 59 1921 348 318 800 915 170 243 5,085 5,980 2,784 2,665 5,905 6,895 2,954 2,908 8,859 9,803 The average attendances were— 1922. 1921. Pimlico Road 87.3 31.8 Bessborough Street 29.1 40.5 Rochester Row 25.5 27.5 Greek Street 16.2 21.4 • Mayfair 7.3 8.0 In addition to the inspections by the medical officer stated above, 206 attendances for weighing only were made at Rochester Row, 291 at Greek Street, and 11 at the Mayfair ccntro, 52 infants under 1 year and 39 children of 1 to 5 years were transferred from the Infant Consultations at Greek Street to Dr. Lewin's Nasal Hygiene Class. Ante-natal Clinics and Medical 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 473 60, Greek Street 300 15, Bessborough Street 379 Mayfair 100, Rochester Row 599 * The Infant Consultations were given up at the Mayfair centre in April. 13 At the North Centre, 60, Greek Street, 48 classes were held by Dr. Lewin for Nasal Hygiene, especially in connection with cases of adenoids and faulty nasal conditions ; 392 children attended, of whom 182 lived in Westminster. At Charing Cross Hospital:— The number of individual mothers who attended during the year were 154 Number attended ante-natal sessions 84 Number of individual children 617 Total attendances of— Expectant mothers 146 Children 2,379 Pre-natal visits paid 465 Post-natal visits paid 1,546 Number of sessions with Medical Officer 48 Special department clinic 49 These figures include mothers and children resident in other boroughs. Visits were also paid in connection with— Pimlico. Bessborough Street. Rochester Row. Greek Street. Total. Still-births and miscarriages 9 11 7 6 33 Deaths of children 20 20 19 13 72 Infectious disease 208 161 441 269 1,139 Total 297 192 467 288 1,244 Arrangements are made with the three local Nursing Associations for nursing children in their homes; 2,799 visits were paid to 189 sick children. Ophthalmia Neonatorum.—24 cases were notified and 2 others (twins) born in a home in Streatham were notified in that district. There were also two cases of which information was received, who apparently developed the complaint at a later date than the period during which this illness is notifiable, making a total of 28 cases in all. Of these, 8 cases were admitted to St. Margaret's Hospital, 1 to St. George's Hospital and 1 to the Infirmary; with the exception of one over age case who died in St. Margarets, all recovered without any permanent injury to the eyes resulting. Seven of the babies were born in Hospitals or Maternity Homes. One of these was said to be quite well on discharge from hospital, but was found shortly after to be suffering. Another case found by the Health Visitors had been attended by a midwife who failed to call in a doctor or to notify. She was dealt with by the County Council for the former, and was summoned by the City Council for the latter, and was fined £1 and £2 2s. costs. B 2 (6809)Q 14 In addition to the above, 18 infants were found to be suffering from slight inflammation of the eyes, and appropriate treatment secured for them. 114 visits were paid by the Health Visitors, and 719 by the District Nurses, who were called in to assist. Dental Clinic.—The dentist, Mr. W. H. Turner, L.D.S., reports:— "It gives me great pleasure to report that the work of the Dental Clinic has increased considerably during the past year. Applicants for treatment are coming with greater confidence, making it clear that the clinic is established in 'good report' in the City. "Maternity and children numbered 121 patients (59 in 1921). Their treatment required 584 attendances for 942 teeth extractions, 73 filling of teeth and 232 other dental operations. General ansesthetics were administered on 200 occasions by Dr. Graham Scott. Local ansesthetics were used 17 times. Pyorrhoea cases still form a large proportion of the work. Several cases of unusual type received treatment and in two of these cases where X-ray photographs were necessary, I was able to arrange for these to be taken at Guy's Hospital Dental Department with no charge to the patients. In one other case (an early diagnosis of deep seated trouble in the lower jaw), I arranged for the patient to be admitted to hospital, where the necessary operation was performed for the removal of the growth. I am glad to state that the majority of the patients appreciate the fact that the Council place it in their power to receive qualified dental services. Many of the mothers appear to be especially anxious that no unqualified practitioner shall give treatment or dental advice for their children" Patients contributed £10 16s. in small sums according to their means. Dentures were supplied in 5 cases, the cost being met partly by the patients, and partly by assistance from the Council, the Philanthropic Society and other voluntary agencies. Convalescent Homes.—In the Soho area, facilities for convalescent treatment are provided by the St. Henry Fund, of which the Medical Officer of Health is ex-officio a trustee; 8 nursing mothers with their children were sent to Convalescent Homes in 1922. Others were sent away through various charitable agencies. IIo)nes.—A grant of £100 was made to the St. John the Baptist Home, formerly in Westminster, now at Tulse Hill, and Five Guineas to the Home of Compassion. Supply of Milk.—Grants of milk free or at reduced prices were made to 101 expectant and nursing mothers and to children, 47 less than in 1921. Except in a few instances ordinary milk was granted, in the others, dried milk. The amount expended was £142 0s. 61/2d. 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 the Council's Centres at cost and at reduced price was 4,219 lbs. 15 Deaths. 1,763 deaths were registered in the City in the 52 weeks of 1922. After deducting 838 deaths of non-citizens in public institutions in the City, and adding those of 871 citizens who died in other districts, the corrected total is 1,796, as compared with 1,623 in 1921, and is equivalent to an annual rate of 12.9 per 1,000 persons. The London death-rate for 1922 was 13.4 (civilians only), for England and Wales 12.9. All the rates are slightly higher than in 1921. 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 12.5 150 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 1922 1,796 12.9 13.4 The deaths of males were 940 (897 in 1921), females 856 (726 in 1921), giving rates per 1,000—1922, males 15.6, females 10.7; 1921, males 14.6, females 9.0. Divided into various age periods we get:— 1922. 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. 67 17 13 19 30 111 332 351 940 F. 37 9 19 22 32 100 252 385 856 1919 140 24 31 33 80 265 570 676 1,819 1920 167 18 21 27 53 222 517 575 1,600 1921 154 28 32 35 56 204 499 615 1,623 1922 104 26 32 41 62 211 584 736 1,796 which give rates per 1,000 living at these periods as follows:— Under 5. 5-15. 15-25. 25-45. 45-65. 65 & Up. All Ages. 1921 M. 41.0 2.8 24 5.2 18.8 92.0 14.6 1922 M. 34.0 2.7 2.7 5.5 21.1 100.0 15.6 1921 F 28.8 2.0 1.1 3.0 10.6 60.0 9.0 1922 F 22.3 3.1 2.0 3.2 13.5 80.0 10.7 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. 16 Males.—Up to the age of 15, the number of deaths was less than in the previous year, above that age there were slight increases in each period up to 45 ; between 45 and 65 the increase was 37, and above 65 it was 31. Influenza and chest diseases accounted for 58 extra deaths, and diseases of the heart and bloodvessels for 22. Tuberculosis gave 10 extra and locomotor ataxia and general paralysis (both after effects of syphilis), gave 11 extra. These were counterbalanced by decreases in diarrhoea and enteritis 13, cancer and malignant growths 10, old age 15, suicide and murder 7, and other smaller figures. Among females there was a considerable decrease under 2 years of age, with slight increases at each age period up to 45, between 45 and 65 there was an increase of 48 deaths, and above 65 years of 90. The net increase was 130. Here again influenza and respiratory disease accounted for a considerable proportion, viz., 55 extra deaths, cancer for 20, tuberculosis for 34, heart, &c., 15, alcoholism and cirrhosis of the liver 6. Except as regards diarrhoea and enteritis, in which there was a decrease of 8, the deaths from other complaints were about the same as in 1921. The deaths in the first quarter of the year were the heaviest due to the prevalence of influenza and pneumonia. The third quarter was abnormally low owing to the absence of diarrhoea. The deaths were distributed as follows :— - 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. M. 307 221 170 242 F. 307 216 141 192 614 437 311 434 The deaths were distributed in the wards in the years 1919,1920,1921 and 1922 as follows:— - 1919. Total. 1920. 1921. 1922. M. F. Total. M. F. Total. M. F. Total. Conduit 17 9 14 23 8 12 20 6 18 24 Grosvenor 115 47 55 102 57 50 107 56 68 124 Hamlet 82 17 31 48 18 29 47 37 29 06 K. St. George 134 48 54 102 55 55 110 64 56 120 Vctoria 483 210 254 464 234 233 467 249 283 532 St. Mararet 75 62 44 106 44 37 81 52 49 101 St. John .„ 388 198 168 366 214 162 376 240 203 443 St. Anne 93 53 44 97 47 36 83 35 30 65 Gt. Marlborough 54 19 18 37 16 12 28 19 17 36 Tall Mall 46 26 7 33 20 11 31 24 11 35 Regent 74 43 18 61 35 37 72 27 32 59 Charing Cross 32 15 11 26 28 10 38 19 7 26 Covent Garden 66 31 36 67 38 23 61 40 28 68 Strand ..„ 68 42 7 49 57 12 09 49 13 62 Homeless 98 11 8 19 26 7 33 23 12 35 17 There was an increase in the number of deaths in all the Wards with the exception of St. Anne, Regent, Charing Cross and Strand. Infantile Mortality.—The corrected death-rate of infants for Westminster was 54.6 deaths per 1,000 births, a figure which has never been reached before. Had the mortality been the same now as in the 10 years 1892-1901, the deaths of infants would have been three times as many. The mortality of legitimate infants was only 49'3 per 1,000; in the northern or Greek St. area this rate was still lower viz. 31.9; figures which a few years ago would have been thought incredible. 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:— 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 95 105 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 48 239 103.5 104 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 S0.2 80 1922 1,703 84 49.3 199 20 100 54.6 74 Five-Yearly Averages. 1892-96 - - 159 157 1897-1901 - - 150 159 1902-06 Ill 200 115 135 1907-11 92 164 96 114 1912-16 75 188 87 100 1917-21 73-8 195 88.8 90 In the three division into which the City is divided under the Maternity and Child Welfare Scheme, the figures (omitting the homeless) were:— 18 Centre. Legitimate. Illegitimate. Total 1920. 1921. 1922. 1920. 1921. 1922. 1920. 1921. 1922. Pimlico and borough— Births 930 799 819 99 85 92 1,029 884 911 Deaths 58 58 44 25 11 7 83 69 51 Death-rate per 1,000 births 62.4 72.7 53.7 252 129 76 80.6 78.0 55.9 Greek Street— Births 526 373 372 74 55 59 600 428 431 Deaths 20 24 13 5 9 2 31 33 15 Death-rate per 1,000 births 49.4 64.3 34.9 67.5 163 34 51.6 771 34.5 Rochester Row— Births 593 557 512 35 39 41 628 596 553 Deaths 39 35 27 7 6 4 46 41 31 Death-rate per 1,000 births 65.7 62.8 52.7 200 153 97.5 73.2 68.7 560 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:— — 1916. 1917. 1918. 1919. 1920. 1921. 1922. Diphtheria — — — — — 1.4 — Influenza — — 6-81 5-62 — — 3-6 Measles 0.5 3.9 0.68 1.87 2.21 — 1.0 Whooping cough 1.6 1.9 3.4 0.62 — 1.5 1.0 Septic diseases — 1.9 — — 0.44 1.4 0.5 Bronchitis and pneumonia. 15.4 16.8 16.35 10.60 12.80 11.8 7.3 Stomach and bowel complaint* 12.7 7.1 10.89 8.75 9.29 13.4 3.1 Syphilis 4.9 8.4 613 5.62 2.64 2.6 2.1 Congenital malformations 6.7 5.8 4.76 3.75 6.19 9.3 4.2 Prematurity 20.9 27.2 23.3 21.2 5.40 15.5 16.2 Neglect and injury at birth 6.7 6.7 8.17 7.50 17.07 7.3 5.7 Debility from birth and atrophy, rickets, tasis 5.5 13.6 8.17 11.80 1.48 11.0 4.2 Tuberculosis 4.4 2.6 6.13 2.50 11.76 1.4 1.5 Other causes 3.8 7.4 5.45 6.90 4.34 3.6 3.6 83.4 103.6 100.24 87.5 73.62 80.2 54.6 Of the 101 deaths, 51 occurred in the first quarter of the year. The third quarter is usually a heavy one on account of deaths from acute diarrhoea, but this year there was not one death attributable thereto, and if it had not been for influenza in the first and measles in the second 19 quarter, the death-rate would have been even lower. The deaths in the four quarters occurred as follows:— - Pimlico. St. Margaret and St. John. North. Unknown. Total. 1st Quarter 27 13 9 2 51 2nd „ 8 8 2 2 20 3rd „ 7 5 3 1 16 4th „ 9 5 1 2 17 The final cause of death as stated in the death certificate does not always reveal the conditions which may have led up to it. Thus, of 11 cases of broncho-pneumonia the infants in several cases had been prematurely born or in delicate health from birth, 3 were of the peculiar type known as mongolism, another had rickets, as probably also had some of . those whose deaths were ascribed to dentition or convulsions. Table V.—Infant Mortality, 1922. Nett deaths from stated causes at various ages under One Year of Age in 'lie City of Westminster. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Totnl under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 0 Month* and under 12 months. Total Deaths under 1 Year. Influenza - - 1 - 1 1 3 1 1 7 Diphtheria - - - - - - - - - — Measles - - - - - - - -2 — 2 Whooping cough - - - - - - - 2 — 2 Umbilical sepsis - - - - - - - 1 — 1 Tuberculosis - - - - - - - - 3 3 Syphilis - - - - - - 4 — — 4 Meningitis - - - - - - 1 1 — 2 Bronchitis - — — — — 1 1 1 — 3 Pneumonia (all forms) - - - - - 2 3 2 4 11 Infective enteritis - - — — — — — — — — Gastro-enteritis - - — 1 1 — 2 1 2 6 Injury at birth 2 1 — — 3 — — — — 3 Neglect at birth 4 - - — 4 — — — — 4 Murder 3 _- - - 3 — — — 1 4 Atelectasis . - - - - - - - - - - Congenital 8 tions 4 1 5 2 1 — — Premature birth 23 1 24 5 1 — 1 31 Malnutrition, marasmus debility from birth 2 2 5 7 Rickets - - - - - — 1 — — 1 Accidents - - - - - — — — — — - - - - - tion - 1 — — 1 — — 3 1 5 Totals 38 4 1 1 44 16 17 14 13 101 20 Nett Births in the year— Males. Females. Total. Legitimate 842 861 1,703 Illegitimate 98 94 192 940 955 1,895 There were in addition 5 male and 2 female illegitimate unregistered. Nett Deaths in the year of— Males. Females. Total. Legitimate infants 56 28 84 Illegitimate infants 12 8 20 68 36 104 In addition there were 43 still-births. The causes of death of the Illegitimate were :—Influenza 1, convulsions 1, pneumonia 1, enteritis 2, syphilis 3, neglect at birth 3, murder 3*, congenital malformation 1, prematurity 4, debility from birth 1. The dead bodies of 6 infants were found, and the foundling died in the Infirmary. Table V, continued.- Infant Mortality, 1922. 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. I 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. Influenza — — 1 — 1 1 2 — — 4 Diphtheria — — — — — — — — — — Whooping cough — — — — — — — 1 — 1 Measles — — — — — — — 1 —. 1 tuberculosis — — — — — — — — 2 2 Bronehitis — — — — — 1 1 — — 2 Pneumonia (all forms) — — — — — 1 — 1 1 3 Infective enteritis — — — — — — — — — — Gast-oenteritis — — — — — 1 — 2 — 3 Syphilis — — — — — 3 — — — 3 Injury at birth 2 — — — 2 — — — — 2 Atelectasis — — — — — — — — — — Congenital malformations 3 — — — 3 — 1 — — 4 Premature birth 12 — — — 12 5 — — — 17 Want of attention at birth 1 — — — 11 — — — — 1 Malnutrition marasmus and debility from birth — — — — — 1 2 3 Murder — — — — — — — — i 1 Rickets — — — — — — — — — — Other causes — 1 — — 1 — 2 — 1 4 Totals 18 1 1 0 20 13 8 5 e 51 21 Nett Births in the year— Legitimate 819 Illegitimate 92 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 31 13 44 Illegitimate infants 4 3 7 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. Tolal 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. Influenza — — — — — — 1 — — 1 Neglect at birth 3 — — — 3 — — — — 3 Murder 3 — — — 3 — — — — 3 6 — — — 6 — 1 — — 7 Males. Females. Total. Legitimate - - - Illegitimate 5 2 7 Table V, continued.—Infant Mortality, 1922. 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. Diphtheria — — — — — — — — — — Influenza — — — — — — — 1 — 1 Measles — — — — — — — 1 — 1 Whooping cough — — — — — — — 1 — 1 Umbilical sepsis — — — — — — — 1 — 1 Tuberculosis — — — — — — — — 1 1 Meningitis — — — — — — — 1 — 1 Bronchitis — — — — — — — 1 — 1 Pneumonia (all forms) — — — — — — 3 — 2 5 Acute diarrhoea . — — — — — — — — — — Gastroenteritis — — — 1 1 — 1 1 — 3 Syphilis — — — — — — 1 — — 1 Rickets — — — — — — 1 — — 1 Injury at birth — — — — — — — — — — Congenital malformations 1 1 — — 2 — — — — 2 Premature birth 7 1 — — 8 — 1 — — 9 Atrophy, marasmus — — — — — 1 1 — — 2 Debility from birth .. — — — — — — — — — — Atelectasis Accident — — — — — — — — — — Convulsions; dentition — — — — — — — 1 — 1 Totals 8 2 — 1 11 1 8 8 3 31 22 Nett Births in the year— Legitimate 512 Illegitimate 41 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 14 13 27 Illegitimate infants 1 3 4 Table V, continued.—Infant Mortality, 1922. Nett Deaths from stated causes at various ages under One Year of Age in the North1 District (Grosvenor, Conduit and Strand Borough Wards). 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 G Mont hs. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Influenza — — — — — — — — 1 1 Diphtheria — — — — — — — — — — Measles — — — — — — — — — — Whooping cough — — — — — — — — — — Umbilical sepsis — — — — — — — — — — Tuberculosis — — — — — — — — — — Bronchitis — — — — — — — — — — Pneumonia (all forms) — — — — — 1 — 1 1 3 Infective enteritis — — — — — — — — — — Syphilis — — — — — — — — — — Injury at birth — 1 — — — — — — — 1 Atelectasis — — — — — — — — — — Congenital malformations — — — — — 2 — — — 2 Premature birth 4 — — — 4 — — — 1 6 Malnutrition, inanition and debility from birth 2 — — — 2 — — — — 2 Rickets — — — — — — — — — — Murder — — — — — — — — — — Convulsions; dentition — — — — — — — 1 — 1 Totals 6 1 — — 7 3 — 2 3 15 Nett Births in the year— Legitimate 372 Illegitimate 59 Nett Deaths in the year- Males. Females. Total. Legitimate infants 11 2 13 Illegitimate infants 2 0 2 23 FEMALES. Table I.—Causes of, and Ages at, Death during the year 1922. 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. Small pox — — — — — — — — — — — — — — — — — — — — — — — — Measles 3 1 2 — — — — — — — — — — — — 2 — — — — — — — — Scarlet fever 1 — — — 1 — — — — — — — — — — 1 — — — — — — — — Influenza 52 1 — — — — 9 21 21 1 5 1 1 12 5 16 — 1 2 6 1 1 1 — Whooping cough 4 1 1 2 — — — — — — — — — 2 — 2 — — — — — — — — Diphtheria, Memb, croup 13 1 4 8 — — — — — — — — 6 1 1 1 1 — 3 — — — — Cerebro spinal meningitis 1 1 — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — enteric fever 1 — — — — — 1 — — — — — — 1 — — — — — — — — — — diarrhoea , enteritis 7 4 — — — — 1 — 2 — 1 — — 3 — 3 — — — — — — — — Erysipelas 2 — — — — — — 1 1 — — — — — — 2 — — — — — — — — Puerperal fever — — — — — 1 2 1 — — — — — 3 1 — — — — — — — — — Other septic diseases 6 — — — — — 1 4 1 — — — 1 1 — 3 — — — — 1 — — — syphilis, & c. 3 2 — — — 1 — — — — — — — — — — — — — — — — — 1 Diabetes 12 — — — — 1 1 6 4 — — 1 1 6 1 1 — — — 2 — — — — Rheumatic fever — — 1 — — 1 1 — — 1 — 2 — — — — — — — — — — Tuberculosis of meninges 2 — — 1 1 — — — — — — — — 1 — 1 — — — — — — — — Tuberculosis of lungs 62 — — — 1 11 2ft 20 1 2 3 3 3 18 5 18 7 1 — 2 — — — — Tuberculosis of peritoneum 2 — — — 1 1 — — — — — — — 2 — — — — — — — — — — Other forms of tuberculosis 5 — — 1 1 2 — 1 — 2 — 1 1 — 1 — — — — Malignant growths 129 — — — 1 12 55 61 3 9 3 10 52 5 25 5 4 3 1 3 5 1 — Congenital debility, malformation, and premature 16 16 — — — — — — 1 6 2 2 — — — — — 1 1 Old age 63 63 2 2 3 3 20 1 15 — 3 — 2 — 2 1 — Meningitis and convulsions 3 1 — — 1 1 — ■ — — — — — — 1 — 1 — — — 1 — 24 Causes of Death. Corrected Deaths in the City at subjoined AgES. Deaths in Wards (at all Aoes). 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 MaU. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 6 — — — 1 — 2 2 1 1 1 2 — 2 — — — — — — — — — — Other diseases of nervous svstem 15 1 — — — 1 1 7 5 — — — — 6 1 3 1 1 — 2 1 — — — Valvular diseases of heart 35 — — — — — 5 15 15 — 4 — 2 16 1 11 — — — 1 — — — — Other circulatory diseases 140 — 1 — 1 3 8 45 82 3 20 9 17 30 9 29 3 3 1 4 — 7 2 3 Bronchitis 87 1 1 — 2 — 2 14 67 2 2 — 5 32 2 19 7 2 — 3 — 8 3 2 Broncho-pneumonia 30 6 3 7 — — 1 10 9 — — 1 2 10 2 15 2 — 1 — — 1 — 2 Pneumonia, other forms 32 — — — — 2 1 14 15 1 3 1 — 9 2 10 — — 1 2 — 1 1 1 Other respiratory diseases 8 — — 1 — 1 1 2 3 1 1 — 2 — 2 — 1 1 — — — — — — Alcoholism 2 2 — — — — — 2 — — 1 — — 1 — — — — — — — — — — Cirrhosisof liver 5 — — — 1 — — 3 1 — — 1 — 1 — 1 — — — — — — 2 — Appendicitis and typhlitis 3 — — — — . — 2 1 — — — — 1 — 1 — — — — — 1 — — — Other digestive diseases 287 21 — 2 1 — 3 9 11 — 4 1 — 13 3 6 — — — 1 — 1 — — Bright's disease, &o. 21 — — 1 — 2 3 9 6 — 1 — 3 7 3 2 1 — 2 — — — 1 1 Cvstitis, &c. 2 — — — — — 1 1 — — — — — — — — — — — — — — — — Accidents and diseases of parturition \ 2 — — — — 1 1 — — — 1 — — — — 1 — — — — — — — — Deaths by accident or negligence 18 1 — — — 2 3 2 10 2 4 — 2 — 1 5 1 — — 2 — — — 1 Deaths by suicide and murder 12 — — — — 2 4 5 1 — 1 1 2 3 — 2 — — 1 — — 1 1 — Other defined diseases 11 — — 1 1 — 4 2 3 — 3 — — 4 1 1 1 — 1 — — — — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 856 37 9 19 22 32 100 252 385 18 68 29 66 283 49 203 30 17 11 32 7 28 13 12 25 MALES. Table I.—Causes of, and Ages at, Death during the year 1922. Causes of Death. Corrected Deaths in the Cut 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. Grosyenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall 41 all. Regent. Charing Cross. Coyent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles 8 1 3 3 1 — — — — — 1 — — 2 1 3 — — — — — — — 1 Scarlet fever 2 — 1 — — 1 — — — — — — — 1 — — — — — — — 1 — — Influenza 43 6 1 2 — — 8 15 11 — 1 1 3 I8 1 10 1 1 — 2 1 1 2 I Whooping-cough 1 1 — — — — — — — — — — — 1 — — — — — — — — — — Diphtheria, Memb. croup 11 — 1 4 0 — — — — — — — 1 5 — — — 2 — 3 — — — — Cerebro-spinal meningitis 3 — 1 — — 1 — — 1 — — — — 2 — 1 — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhoea, enteritis 5 4 — — — — — — 1 — — — 1 3 — 1 — — —-— — — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever — — — — — — — — — — — — — — — — — — — — — — — — Other septic diseases 8 — — — — 1 2 3 2 — — 1 — 3 1 1 i — 1 — — — — — Syphilis, &c. 2 1 — — — — — 1 — — — — — 1 — 1 — — — — — — — — Diabetes— 9 — — — — 1 — 5 3 — 3 1 — 1 — — i — — — 1 2 — — Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of meninges 5 1 — — 3 1 — — — — — — — — — 4 — — — — — 1 — — Tuberculosis of lungs 82 1 — — — 7 27 40 7 1 1 1 7 29 2 20 7' — 1 2 — 4 6 1 Tuberculosis of peritoneum — — — — — — — — —. — — -- — — — — — — — — — — — — Other forms of tuberculosis 7 1 — — — 3 2 1 — 2 1 ?, 1 1 — — — Malignant growths 96 — — — — 1 4 45 46 — 9 5 5 28 7 20 2 2 1 3 3 4 6 1 Congenital debility, malformation, and premature birth 39 37 2 — — — — — — 1 2 2 4 15 1 6 3 2 — 1 — 2 1 — Old age 25 — - — — — — 1 24 — 3 1 2 5 1 10 1 — — — — 1 — 1 Meningitis and convulsions 3 — - I — 2 i 1 1 — — — — — — 1 1 — — — 1 — — — — — 26 MALES.—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 20 — — — — — 6 11 3 1 3 1 — 4 1 6 2 1 — — — 1 — — Other diseases of nervous system 10 — — — — 1 3 2 4 — 2 1 1 1 1 2 — — 1 — — — 1 — Valvular diseases of heart 31 — — — — — 7 12 12 — 4 2 2 9 5 5 1 — — — 1 i 1 — Other circulatory diseases 166 1 — — 1 2 13 62 87 1 5 10 14 36 8 40 6 4 5 5 5 8 10 9 Bronchitis 90 2 — — 1 — 1 26 59 1 8 1 5 13 1 36 5 1 3 2 — 3 9 2 Bronclio-pneumonia 26 4 5 — 1 — 3 6 7 — • 2 — 3 7 2 9 — 1 — — — 1 1 — Pneumonia, other forms 69 1 — 1 2 4 10 30 19 — 1 3 2 17 — 20 1 2 2 2 — 3 6 2 Other respiratory diseases 14 — — — — 1 — 7 6 — 1 — — 3 4 4 2 — — — — — — — Alcoholism . 2 — — — — — 1 — 1 — — ■— — 1 1 — — — — — — — — — Cirrhosis of liver 16 — — — — — 2 14 — — — 2 3 4 — 2 — 1 1 — 2 1 — — Appendicitis and typhlitis 5 — — — — 1 2 1 1 — — 2 — 1 — — — — 1 1 — — — — Other digestive diseases 30 — — — — 2 3 16 9 — 1 — 2 9 4 6 1 — — 1 1 1 3 — Bright*8 disease, &c. 23 — — — — — 3 8 11 — 1 1 — 5 4 5 — 1 1 — 3 1 1 — Cystitis, &c. 20 — — — — — — 4 16 — 3 — 3 3 1 3 — — 2 2 1 — 1 1 Accidents and diseases of parturition — — — — — — — — — — — — — — — — — — — — — — — Deaths by accident or negligence.. 34 1 1 — 2 2 6 10 12 — 3 — 3 8 4 7 — — 2 2 1 4 — — Deaths by suicide and murder 20 4 — 1 — — 4 5 6 — — — 2 7 1 2 — 1 2 1 — — 1 3 Other defined diseases ., 17 1 1 2 — — 3 7 3 1 — 1 1 4 — 9 — — — — — — 1 — Diseases, ill defined or unknown 1 — — — — — 1 — — — — — — — — — — — — — — — — 1 All causes .. 940 67 17 13 19 30 111 332 351 6 56 37 64 249 52 240 36 19 24 27 19 40 49 23 27 B.—Communicable Diseases. Details respecting the notifications of infectious disease received are set out 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. 1920. 1921. 1922. 1920. 1921. 1922. Smallpox - - - Ophthalmia neonatorum 28 25 25 Diphtheria 229 248 285 Measles 703 26 591 Erysipelas 70 53 37 German measles 45 9 11 Scarlet fever 395 681 261 Pneumonia 112 62 48 Enteric fever 14 10 12 Malaria 16 1 — Continued fever 1 — — Dysentery 3 — — Puerperal fever 10 10 7 Anthrax — — 1 Cerebro-spinal meningitis 4 — 4 Chickenpox — 119 178 Mumps — 278 25 Encephalitis lethargica 3 — 2 Whooping cough — 133 67 Polio-myelitis — — 1 Smallpox.—Considerable anxiety was occasioned by the occurrence of cases in various parts of London, by the prevalence of the disease in Derbyshire, Nottingham and adjoining counties and finally by a serious outbreak in Poplar. In two cases firms in Westminster were sending tailoring work to workshops in Stepney which were in contact with the disease, and several persons living in infected houses were employed in Westminster. The disease as manifested in the north was of a very mild type and still continues, but in Poplar it was of a virulent character. No cases occurred in Westminster, but on one occasion it was only by a few days that we escaped. A woman, who was employed as a temporary cook in a good class flat in Westminster, went down to Dartford with her daughter to see her sister, who was said to be suffering from blood poisoning. On her arrival, she was informed that the illness was smallpox, and that there were two other cases in the house. It was not for some days that we learned' of her visit, and when seen, she did not disclose the fact that she had taken her daughter with her. Her employer, on being acquainted with the matter, sent her back to Dartford, but on the way to the station the woman instructed the taxidriver to take her to Fulham, where shortly afterwards both she and her daughter developed the disease. The spread of this fatal type of small-pox in London was checked by recource to vaccination and re-vaccination, by the prompt method of dealing with contacts, and by the system of inter-communication between Medical Officers of Health, in which the officers of the County Council co-operated, in particular by placing at the service of practitioners, experts who were readv at any hour to visit suspected cases. c (CS09)q 28 City .of Westminster.— Cases of Infectious Disease Notified, during the year 1922. Notifiable Diseases. Casks Notified in the city of 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. 15 to 65. 65 and up wards. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Cholera (c). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 285 4 71 148 39 19 4 — 1 11 17 79 11 36 9 3 38 48 6 1 3 j9 3 278 Erysipelas 37 2 — 4 2 11 12 6 — 1 4 11 2 !) 1 — 3 — — 1 2 3 — 8 Scarlet fever 261 5 42 140 41 24 3 1 15 36 62 19 47 10 1 14 11 5 27 2 21 — 247 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — Knteric fever 10 — — 1 4 4 1 — 1 3 — — — 1 1 — 1 — — — — — — 8 Relapsing fever — — — — — — — — — — — — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 5 — — — — 1 2 — — 1 — 2 — 3 — — — — — — — — — 2 Cerebro-spinal meningitis 4 1 1 1 1 — — — — 4 — 2 — 1 — — — — — — — — — 4 Polio-myelitis 1 — — — — — 1 — — — — 1 — — — — — — — — — — — I Encephalitis lethargica 1 — — 1 — — — — — — — — — 1 — — — — — — — — — — Ophthalmia neonatorum 24 ?4 — — — — — — — — — 2 14 — 3 —— — —• — 3 — 1 — 8 Pneumonia 48 1 4 4 5 13 17 4 11 5 8 3 15 3 1 2 — 5 1 1 27 Malaria — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — — — — — — Trench fever — — — — — — — — — — — — — — — — — — — — — — — -Anthrax 1 — — — — 1 — — — — — 1 — — — ~~~ — — ~~~ — — — — 1 Totals 675 35 118 305 94 73 40 1o 3 36 64 173 35 114 24 5 56 61 11 37 8 45 3 584 Correction has been made for errors in notification or revision of diagnosis. Cases not notified: Enterio2; Ophthalmia neonatorum 12; Encephalitis Lethargica 1; Puerperal Fever 1, 29 Information was received of 34 persons coming to Westminster who had been in contact with cases or coming from infected ports. These were kept under observation. The Public Vaccinators have forwarded the following particulars for the year:— Ordinary vaccinations 1,851 Re-vaccinations 9,437 These figures do not include private vaccinations; a large number of the re-vaccinated were non-residents. As the number of primary vaccinations exceeds the number of infants less deaths under 3 months of age, it is evident that a number of older children who had been vaccinated in infancy were vaccinated in 1922. The proportion of unvaccinated infants in 1920 and 1921 was 21 per cent. None were performed by the Medical Officer of Health under the Public Health (Small-pox Protection Regulations, 1917). Scarlet fever.—This disease was less prevalent than in 1921. Three deaths resulted. Diphtheria was more prevalent than in the two preceding years and caused 24 deaths. Antitoxin was supplied free to medical men in 51 cases, and 456 swabbings from the throats of suspected cases were examined. Notwithstanding the facilities afforded, there is still regrettable delay from time to time in recognising cases of this serious disease. Diagnosis is not always easy, and the existence of carriers of the organism in an active condition cannot with existing methods be detected readily. If this disease is to be tackled effectively, improvements such as I have referred to in previous reports will have to be adopted. Typhoid Fever.—Twelve cases of this disease were notified, but 2 cases eventually proved not to be typhoid, and 2 were cases of paratyphoid fever. One person not notified in Westminster was an inmate of an asylum and died there. In another case, the cause of death was attributed to typhoid fever contracted in India 20 years previously, but other ailments were specified to which apparently death was more likely attributable. Influenza.—This was certified as the cause of 95 deaths, 43 males and 52 females, 10 under 5 years of age, 17 between 25 and 45, 36 between 45 and 65 and 32 over 65 years of age. Cerebrospinal fever,—Four cases occurred, 3 of which died. (6809)Q c2 30 Encephalitis lethargica.—Two cases occurred, both females aged 9 and 27. The latter died, the former recovered, but has since seemed mentally dull. Measles.—Every second year measles assumes epidemic form. In 1921 only 26 cases were known, in 1922 591 cases were noted. The bulk of these occurred in the second quarter of the year. Of these 33 were admitted to hospital. Eleven deaths resulted, 1 in Grosvenor "Ward, 3 in Victoria, 1 in St. Margaret, 5 in St. John, and 1 homeless, in the Infirmary. Ten of these were under 5 years of age, the most dangerous period. There were also 11 cases of Rubella (rose rash or German measles), mostly in children. Diarrhwa and Enteritis.—Twelve deaths are recorded under this heading, which includes a variety of illness in which diarrhoea is a prominent or final symptom. Infective or summer diarrhoea which produces an acute illness was practically absent, chiefly on account of weather conditions. Eight of the deaths were of children under 1 year, 3 of elderly people, and one between 25 and 45 years. Chickenpox was prevalent in the second quarter of the year, 178 cases being notified from schools. Mumps.—Only 25 cases were recorded compared with 278 in 1921. Puerperal Fever and Ophthalmia Neonatorum.—See ante under maternity and child welfare. Plague.—Intimation was received of one person coming into Westminster from a place where plague had occurred. Anthrax.—One case occurred, having been infected while at work in another borough. Visits were paid by Health Visitors and Nurses as follows:— Health Visitors. Nurses. Puerperal fever 5 - Ophthalmia neonatorum and conjunctivitis 114 719 Measles 900 90 Diarrhoea - 14 Pneumonia - 671 Whooping cough 120 2 Chickenpox - 4 Influenza - 42 Other complaints - 1,257 1,139 2,799 31 Tuberculosis.—Notifications received during Year 1922. 1922. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including oases previously notified. Age periods. 0 to 1. 1 to 5. 5 to 10. 10 to 18. 15 to 20. 20 to 26. 25 to 36. 35 to 45. 45 to 66. 55 to 66. 65 and up. Total new cases. Pulmonary— Casuals— Males — — — — — 3 9 12 11 4 2 41 45 Females — — — — 1 — — — — — 1 2 2 Males — — 6 2 3 15 18 26 20 11 7 108 151 Females — — 2 4 12 16 24 24 7 6 1 96 120 N on. pulmonary— Males 1 2 3 4 1 1 3 1 1 1 — 18 19 Females — 2 3 4 6 4 3 — — 1 — 23 24 Total 1 4 14 14 23 39 57 63 39 23 11 288 361 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. Poor Law institutions. Sanatoria. Poor Law institutions. Sanatoria Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males — — — — — 44 72 11 57 Females — — — — — 5 47 — 28 Non-pulmonary— Males _ — — — — 7 4 Females — 1 — 1 2 1 6 4 Total — 1 — 1 2 50 131 11 93 Pulmonary—38 deaths unnotified. C. L. H. 1, M., age 51; F. — General, 11. M„ ages 20, 22, 23, 32, 35, 36, 38, 45, 38, 64, 72 , 14, F., ages 17, 30, 31, 32, 33, 40, 45, 49, 51, 52, 54, 54, 59, 70. Non-pulmonary 6, M., ages 11/12, 8, 10, 17, 29, 69 , 6, F., ages 5, 5, 12, 19, 21, 32. 32 Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of persons who have been treated in Institutions. 1922. 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. Received Institutional Treatment. Pulmonary— Common Lodging-houses, Males 42 — — — — — 26 — — — — — — 13 1 2 34 Females 2 — — — — — 1 — — — — — — — — 1 2 General Males 119 — 6 9 39 5 24 4 2 0 " _ 4 12 1 6 1 52 Females 110 2 10 5 32 7 26 3 1 8 4 2 3 — 7 — 46 Non-pulmonary— Males 24 — — 3 10 — 6 — — — — — 1 2 1 1 13 Females 30 — 1 3 11 5 7 — — — — — 2 — 1 — 14 Insured. Military. Ex-Army. Police. Hospital Nurses. Asylurn. 111 previously. Pulmonary— Males 55 7 29 1 — 5 49 Females 43 — 1 — 2 11 33 Non-pulmonary— Males 2 — 2 — — 1 3 Females 6 — — — — 1 6 33 Tuberculosis. In 1922, 247 new cases of pulmonary disease were notified and 26 persons died who had not been notified in Westminster, a total of 273. Non-pulmonary forms of tuberculosis gave 54 new cases. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all forms. General Population. c.l.h. and no Address. Total. Males. Females. Males. Females. Males. Females. Total. 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 1922 119 110 42 2 273 24 30 54 327 (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. Non-notified cases.—Pulmonary cases not notified in Westminster were 9.5 per cent, of the total, non-pulmonary 22.2 per cent. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. Pulmonary 46 40 31 35 41 27 33 20 26 Non-pulmonary 13 24 21 10 14 8 7 7 12 Enquiry is made in each case as to the reason for non-notification; the majority of the pulmonary cases had been notified elsewhere, several of them came to London for treatment, some were sudden deaths, the cause being only discovered on post-mortem examination, and some were deaths in asylums. Among the non-pulmonary failure to notify was chiefly due to the rapidity of the illness and difficulty of diagnosis. In a larger proportion than usual the illness in a number of pulmonary cases was in an acute form and ran a rapid course. Attention was drawn in the Annual Report for 1920 to the fact that the greater proportion of females in the population was a cause of fewer 34 cases, as there is a lower incidence of the disease in females than in males, but until the number of persons living at various age periods was known, it would not be possible to say if the reduction was solely due to this cause. These figures are now available, and I have calculated out the rates per 1,000 in each group for the years 1913.14 and 1920.21, not including therein common lodging house and homeless cases. – Males. Females. 1913.14. 1920.21. 1913.14. 1920.21. Under 5 0.2 0.8. 0.2 0.4 5-15 0.7 1.4 1.4 0.9 15-25 1.5 2 1 1 1 1.5 25-35 3.4 2.9 1.7 2 1 35-45 _3 1 2.6 2 0 2 0 45-55 3.8 1.7 2 0 1.5 55-65 2.8 2 0 1.6 0.9 65 and upwards 1.8 1.3 1.2 0.6 All ages 2.9 2 0 1.6 1.5 These rates show an increase in the proportion of cases at the younger ages in both sexes which is, I consider, due to the more thorough examination of contacts and improved diagnosis, in the latter years compared with the conditions which obtained in 1913-14 before the Tuberculosis Dispensary was started. From the age of 25 among males there has been a distinct improvement in each age group, except between 15 and 25, but among females it is not until the age of 45 that reduction appears; indeed, between the ages of 15 and 35 there is an increase. Why this should be so is not clear. One reason may be that the earlier part of this period covers the time when young women come up to London to be servants, clerks, shop assistants, and that in 1913-14 these were sent back to the country when the nature of the illness was discovered, and notification was not made in Westminster. Another possible reason may be that it is the result of the home conditions and lessened food, due to lo;s of work from trade depression. Both these factors would tell more heavily upon the younger than the older adult females, and in 1922 there is again an increase to 1.7 between 15 and 25 years, while there is a decrease at other age periods. It does not apply to males at the same age, for in 1922 tha rates are lower up to 45, above which there is an increase, but the figures are rather small for reliable conclusions to be drawn. In both sexes the improvement is doubtless greater than is shown, as notification is better now than it was in 1913-14, although still diagnosis might be made at an earlier stage than is sometimes the case. Tuberculosis Dispensary.—From the following table, taken from the Report of the Medical Officer, it will be seen that the number of 35 new patients seen at the Dispensary was less than in the previous year, but the attendance of old patients was larger, as was the total number of individuals who attended. The total attendances, however, are lower:— Dispensary Statistics. 1922. 1921 1920. 1919. New patients 421 609 592 607 Old patients attending 825 588 561 490 Individuals who attended 1,246 1,197 1,153 1,097 Contacts examined 183 281 221 139 Total attendances 3,275 3,695 5,267 4,882 Written medical reports to L.C.C., W.P.C., &c 1,154 1,169 1,284 1,439 Do. To medical practitioners, &c. 400 440 410 302 Consultations with medical practitioners 181 178 92 79 Visits paid by medical officer 315 320 165 96 Visits by health visitors to dispensary cases 4,995 4,941 4,767 4,159 Sputum examinations 327 308 239 255 X.Ray „ 16 28 30 12 The number of persons under supervision excluding domiciliary patients was 433. The number of insured persons under domiciliary treatment at December 31 was 739. References to affiliated hospital in the year were 37. The consultations with medical practitioners show an increase. These have increased each year, and it is a gratifying testimony to the cooperation which exists between practitioners and the Tuberculosis Medical Officer, whose assistance they have learned to appreciate. The Tuberculosis Officer reports that: "Fewer new cases were sent by the Ministry of Pensions. The numbers of new claimants for tuberculosis pensions on the grounds of attributability to war service is likley to become a steadily diminishing quantity as time goes on. In 1921 those cases numbered 74, while in 1922 there were 35, more than a 50 per cent, reduction. The work undertaken on behalf of the Ministry of Pensions seems, however, to increase rather than to diminish." " It has been suggested that closer co.operation with the Guardians with regard to the treatment of tuberculous patients in the Infirmary might be adopted. I believe that greater use of the facilities for treatment, which the Guardians possess, would lead to a definite reduction in 36 the incidence of tuberculosis in the City. It might he well to enumerate the various spheres in which such action would operate:— (1) The immediate treatment of acute or emergency cases. (2) The prolonged treatment of uninsured patients who are unable to meet the expense of private medical attendance, many of those are in a category midway between acute and advanced or bedridden cases. They have usually had a period of Sanatorium treatment, but have been discharged without regaining working capacity. (3) The advanced, bedridden and infectious cases. "It is extremely important to isolate cases of this sort in institutions. By so doing a great deal of infection can be prevented. Much has already been done by the Guardians in this respect, but a much larger degree of isolation is possible. Of the total deaths from tuberculosis in Westminster in 1922, 65 per cent, died in hospitals or in the Infirmary. This is probably a higher proportion than is generally found in London. There is no doubt that the last six months in the life of a consumptive is the period in which he is at least likely to take precautions against spreading infection. If this period can be spent in an institution, the risk of massive doses of infection to members of his household is very considerably diminished." "There is still, unfortunately, a very larg' proportion of cases of tuberculosis where the diagnosis is made too late for treatment to be of any avail. The Medical Officer of Health has already dealt with this in the section of his report devoted to the Notification of Tuberculosis. The fault largely lies with patients, who postpone seeking medical advice until their symptoms are sufficiently severe to prevent their working. By this time the disease is well advanced and the outlook is hopeless. Much less frequently does the fault lie with the medical practitioner attending. The standard of medical practice in Westminster is high, although exceptionally there may be failure in diagnosis and consequently in notification. The matter of early diagnosis is particularly urgent in young women between the ages of 15 and 25 years. In them the disease frequently shows characteristics of acute and rapidly progressive tendencies, and it is possible that some lives might be saved if the Council's provisions were again brought to the notice of medical practitioners." "327 cases of tuberculosis were recorded by the Medical Officer of Health in 1922. The Dispensary dealt directly with 148, or 45 per cent, of this gross total. For practical purposes one must deduct cases occurring in asylums, 18 in number; 46 who died within 5 days of notification, and some 40 cases occurring in common lodging houses where no information concerning their previous state of health was obtainable until they entered the Infirmary. The percentage thus calculated as cases dealt with through the Dispensary works out at 69. When one considers that 37 a fairly large propor^um of the cases in Westminster occur in domestic and hotel servants, and in single individuals living in hostels or lodgings, the proportion is not insignificant. This percentage and the afore men tioned special circumstances have a special relationship to the number of contacts available for examination." "The total number of persons attending for the first time was 421. Of those 183 were contacts. 26 were suffering from pulmonary tuberculosis. 8 were suffering from non.pulmonary tuberculosis. 140 were not tuberculous." The estimated net expenditure on the Dispensary Service for the 12 months ending March, 1923 is £1,786. For the two preceding years the actual net expenditure was 1920.21, £2,122; 1921.22, £1,794. An offer was received from Charing Cross Hospital to take over the Dispensary Service. The advantages and disadvantages of the scheme were very carefully considered in conference with the Ministry and the County Council; eventually it was decided to continue the present system which has worked so satisfactorily in the past. The total number of cases of tuberculous disease on the Register at the end of 1922 was 1,589 as compared with 1,513 at the end of the year 1921. Pulmonary. Non. pulmonary. Total. General. Casuals. December, 1921 1,120 73 350 1,543 New cases, 1922 229 44 54 327 Old cases returned to Westminster 13 – o 15 Total cases on Register during 1922 1,362 117 400 1,885 Died during 1922 128 16 25 179 Moved 84 – 33 117 Remaining at end of 1922 1,140 101 348 1,589 Home Visiting.—The Tuberculosis Medical Officer paid 315 visits during the year to patients at their homes. The number of visits paid in previous years was:— 1916 257 1919 96 1917 197 1920 165 1918 237 1921 320 The Health Visitors paid 5,278 visits, 4,995 of these being to persons attending the Dispensary (in 1921, 6,648 aud 4,941 respectively); 2,245 visits were paid to insured persons and 387 to ex.service men. 36 Extra Nourishment.—Nine 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. The cost of the extra nourishment was £55 1s. 1½d. Institutional treatment.—Of the new cases in 1922 with pulmonary disease, institutional treatment was afforded to 36 of the Common Lodging House cases, to 52 males and 46 females in the general population, and to 27 of the non.pulmonary. Of old pulmonary cases 7 casuals, 36 males and 23 females of the general section and 14 non.pulmonary cases received institutional treatment, making a total of 200 pulmonary and 41 non.pulmonary. Dental treatment.—10 patients received dental treatment at the Council's expense, necessitating 47 attendances, at which 81 teeth were extracted, 11 teeth filled and 16 other dental operations performed. General anaesthetics were administered on 17 occasions. Eight dentures were provided and fitted. The Council contributed £4 6s. 6d. towards the cost. Special Treatment.—Three patients had 14 pneumo.thorax refills at a cost of £7 7s. and one patient had X.ray treatment at a cost of 15s. Bacteriological Diagnosis.—Sputum was examined in 456 instances, 327 being specimens sent from the Dispensary and 129 from private practitioners. The cost was £67 18s. 6d. Deaths.—The net number registered as dying from tuberculosis were— Pulmonary: Males, 82; females, 62; Non.pulmonary: Males, 12; females, 9. Total, 165, but in addition 14 persons who had been notified were certified as dying from other complaints. The causes of death of the pulmonary cases were stated as Bronchiectasis, perforated gastric ulcer (2); penumonia (2); influenza, chronic bronchitis, cardiac disease (2); cancer, 7 males and 3 females. Of the non.pulmonary, death was ascribed to chronic bronchitis, influenza, drowning and sarcoma, this last was not really a case of tuberculosis, although at first it was so diagnosed, the others were 2 males and 1 female. In several of these cases the tuberculosis was cured or at least quiescent. 84 deaths occurred of the 1922 pulmonary cases, and 70 among those notified in previous years. The duration of illness from the appearance of the first symptoms, so far as could be ascertained in 117 cases was under 6 months in 16 cases, and between 6 months and 1 year in 20, between 1 year and 3 years in 30, between 3 and 6 years in 23, between 6 and 10 years 11, between 10 and 15 years 6, between 15 and 20 years 2, and between 20 and 30 years 9. 39 30 of the 70 deaths were notified in 1921, and 12 in 1920, and the remaining 28 extended over the years 1908-1919. Of the non-pulmonary deaths 16 were 1922 cases. They included 4 deaths from miliary or generalised tuberculosis, 4 from meningitis and 1 pericarditis. The death-rates for 1920, 1921, and 1922 calculated were per 100,000 population Males. Females. 1920. 1921. 1922. 1920. 1921. 1922. Pulmonary 131 125.6 136.6 76.3 53.8 78.1 Non-pulmonary 9.6 11.4 19.9 14.5 9.9 11.3 Total 140.6 137.0 156.5 90.8 63.7 89.4 Westminster—Deaths from Tuberculosis. . Pulmonary. Non-pulmonary. Total Deaths. Rates. Deaths. Bates. 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 1922 „ 144 103.3 21 15 165 118 .3 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 For London the rates for 1922 were 108 and 21 respectively. Total, 129. Bacteriological Laboratory. Examinations were made as follows :— Swabbings from throats in suspected diphtheria 456 Blood in suspected typhoid 3 Blood in suspected malaria 1 Sputum for tuberculosis 489 The expenditure on the first three was £615s, 8., and for tuberculosis £67 18s. 6d 40 Disinfection. The number of articles treated was 1917. 1918. 1919. 1920. 1921. 1922. Rooms 814 722 941 1,196 1,502 1,179 Articles disinfected 281,895 153,048 50,496 49,542 31,654 28,709 Articles washed 8,015 6,551 5,759 7,185 6,766 7,355 Articles destroyed 5,097 3,048 543 70 38 105 Books disinfected 12 4 77 42 212 173 Vehicles 1 1 2 6 1 8 The motor van during 1922 ran 3,814 miles and carried 3,257 cwt. of goods, the highest amount in any one day being 34 cwt. Cleansing of Persons.—The number of Westminster children suffering from head and body lice treated at the cleansing station was 636, again an increase over the preceding year. There is, however, a satisfactory decrease in cases of scabies. Head lice. Body lice. Scabies. Total. Children 619 17 36 672 Adults 4 207 34 245 623 224 70 917 Many of the adults also suffered from head lice. All the lice cases were dealt with at the station, but 21 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 286 for head lice, 11 for body lice, and 6 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 887 children suffering from head lice had treatment on 1,184 occasions, the 28 with body lice had 60 treatments, and 42 with scabies had 143 baths. In dealing with the Westminster cases, 1,512 visits were paid to the houses, three times as many as were paid in 1921. 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 on ! account of infectious disease. 41 Inquests were held at Ilorseferry Road, where the Coroner's Court is situated, in 217 cases, and there were 9 adjourned inquests. Post.mortem examinations were made in 128 instances. The number of dead bodies taken to the mortuaries for purposes of inquest, and to await burial during the last 20 years were:— Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1903 396 341 55 1913 328 286 42 1904 381 322 59 1914 323 295 28 1905 368 307 61 1915 376 349 27 1906 344 283 61 1916 281 252 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 289 269 20 1911 383 334 49 1921 273 238 35 1912 324 284 40 1922 269 247 22 There are resting places for the dead at Drury Lane, Ebury Bridge, or Dufours Place, but no use was made of them during the year. 42 PART II. C.—Housing, House Inspection, etc. The Census figures now published give a number of details as to the manner in which the population of Westminster is housed. The tables appended are constructed on different lines from those in former years, consequently comparison is somewhat difficult. Variations which occur may be due in some measure to differences in classification. The total buildings in the city appear to be 19,718, of which 15,014 contained dwellings. In 1911 there were 17,540 buildings containing dwellings, so there is a reduction of 2,526. Undivided private dwelling houses have fallen from 11,522 to 8,830, while blocks of flats, tenements and structurally divided houses have increased from 1,146 to 1,265. Shops with dwellings attached have fallen from 2,603 to 2,222, but similar offices, warehouses and workshops, also other buildings, including institutions, etc., have increased from 2,151 to 2,577. As the Registrar.General points out, these figures must be taken as approximate, but they indicate the change from a residential to a business area which has been taking place in parts of the City for some years. Omitting 616 dwellings occupied by non.private families, there were 27,136 dwellings containing 151,379 rooms, but 1,815 of these, with 8,673 rooms, were vacant on Census night. These dwellings contained 33,946 separate lettings. Of private dwellings 42.6 per cent, consisted of from 1 to 3 rooms, 17.8 per cent, of 4 to 5 rooms, 17.9 per cent, of 6 to 8 rooms, and 21.7 per cent, contained 9 or more. There has been a marked increase in the number of tenements containing from 1 to 4 rooms with a corresponding decrease in dwellings containing from 5 rooms and upwards, but apparently the number of 'persons occupying tenements of from 1 to 4 rooms has decreased from 74,617 to 70,432, while those in the larger dwellings decreased from 54,201 to 42,094. 43 Table II.—Private Families, Classified by Size of Family, Rooms Occupied, and Density of Occupation. (From Table II, Census Report.) The following table contains an analysis of the private families according to— (a) The number of persons in the family. (b) The number of rooms occupied by the family. Where more than one family is enumerated within a structurally separate dwelling, each is classified according to the rooms it severally occupies and not to the total number of rooms in the dwelling. If, as occasionally happens, one of the rooms is shared by two families (the allotment to each family being, say, 4½and 3½ in an 8.roomed dwelling), the families are classified to the next higher integral number of rooms (5 and 4 respectively), but in arriving at the totals (column (m), etc.) the actual figures (4½ and 3½) have been used. For definitions of "Private family," "Structurally separate dwelling" and "Rooms," see note at heading of Table III, p. 50. (GS09)v n 44 Number of Persons in Family. Number of Private Families occupying the following Number of Rooms. Total Private Families. Population in Private Families. Rooms occupied Density of Occupation. Average Number of Rooms per Person. Population at following densities of occupation (rooms per person). 1. 2. 3. 4. 5. 6–7. 8–9. 10 and over. No. Per cent. under .3. .3 and under .5. .5 and under .7. .7 and under .0. Cols. a b c d e f g h i j k 1 m n o P q r Westminster, City op, Met. B.— l 4,373 1,894 712 347 122 130 60 55 7,603 22.8 7,693 14,358 1.86 –. – 19 – 2 1,393 3,098 1,829 787 283 361 161 235 8,147 241 17,294 24,852 1.53 8 – 2,778 2 3 353 1,857 1,768 828 314 437 252 248 6,057 17.8 18,171 22,757 1.25 3 1,056 5,571 – 4 100 993 1,209 729 270 434 283 281 4,200 12.7 17,196 18,997 1.10 400 – 3,972 4,836 5 25 477 765 510 224 288 181 280 2,750 8.1 13,795 13,647 0.99 125 2,385 3,825 2,550 6 12 237 417 303 174 202 131 313 1,780 5.3 10,734 10,522 0.98 72 1,422 4,320 1,044 7 1 103 235 194 105 124 85 307 1,154 3.4 8,078 8,257 1.02 728 1,645 1,358 1,365 8 1 37 129 83 68 80 68 262 718 2.1 5,744 6,115 1.07 304 1,302 1,208 640 9 – 11 53 54 38 50 20 213 448 1.3 4,032 4,556 1'13 99 963 639 324 10 – 3 20 33 29 43 23 168 310 0.9 3,190 3,637 1'14 30 530 610 340 11 – 1 2 14 6 19 8 126 176 0.5 1,936 2,637 1.34 33 220 209 154 1 2 – – 3 3 4 7 2 08 117 0.3 1,404 1,081 1.41 36 84 96 06 13 – – – 3 2 5 3 59 72 0.2 936 1,330 1'40 – 130 39 – 14 – – – – 2 – 1 47 50 0.1 700 1,019 1.46 – 28 14 56 15 and over – – – – 1 1 2 144 148 0.4 2,623 4,015 153 – 31 74 154 Total Private Families 0,258 8,711 7,142 3,888 1,642 2,181 1,270 2,845 33,046 100.0 – – – – – – – Population in Private Families 8,830 22,507 24,240 14,756 8,068 0,313 5,708 20,105 — — 112,526 — — 1,838 9,526 24,732 11,561 Rooms Occupied 6,246 17,421 21,426 15,552 ,210 13,048 10.633 45,244 — — — 138,680 123 — — — — 18.4 25.7 21.0 ll.5 4.8 6.4 3 8 8.4 100 0 1021. Percentage of families living in various units of occupation. 17.8 25.2 19.4 10.1 5.1 7.3 4.6 10.5 100. 0 101.1. „ „ „ „ „ „ „ ■15 Table X.—Buddings, Dwellings, Rooms and Families. Note.—The following table contains analyses of (1) the buildings and (2) the structurally separate dwellings of each area. In the upper part of each section the several classes (Groups I.V) are analysed both in the left.hand columns (a.c), in respect of their characteristics as buildings, and in the right.hand columns (f.p) in respect of the dwellings which they comprise. In the lower part of each table the subjects of analysis on the left and right respectively are different; on the left the "buildings" analysis is continued in respect of an expanded classification of one of the five groups; while on the right the analysis according to dwellings is continued in respect of certain selected classes of private family occupations. Buildings (left.hand columns (a.c)).—In the enumeration of buildings, a building has generally been regarded as a structure wholly detached' or separated from another by a vertical party wall. A block of flats would be one building though there might be one or more separate flats on each floor. The allocation of buildings among the several dosses shown in column (e) is based on the descriptions furnished by the local enumerators. The varieties of type encountered in the buildings enumerated have, however, inevitably given rise to some difference of practice on the part of enumerators in describing borderline bases ; and the number of buildings assigned to the several classes in column (e) should therefore be regarded as approximate. The classification differs from that adopted in 1911 in the following respects:— (a) Structurally divided private houses are separately shown for the first time, with a view to affording an indication of the extent to which houses originally built for the occupation of single families have been structurally divided to provide separate and independent accommodation for two or more families. There is evidence, in the returns, that it has not always been possible for enumerators to distinguish between buildings originally erected to comprise, e.g., maisonettes and those subsequently converted for the purpose. (b) Inns and public houses in which the business of the establishment is primarily that of retailing liquors are classed with Shops (Group IV) instead of with Hotels (Group V), which are thus limited in the table to those of a residential character. (6809)q D 2 46 Structurally Separate Dwellings (right.hand columns (f.p)).—Above the " total" line dwellings are classified according to the type of building in which they occur, while below the "total" line the same premises are classified according to the number of families enumerated within them. Dwellings "Vacant on Census Night" include those unoccupied through the temporary absence of the usual occupier as well as those without a tenant. The total rooms in dwellings occupied by private families as shown in the following table is usually slightly in excess of the total rooms occupied (Tables III and XI) owing to the fact that, in certain dwellings inhabited by two or more families, part of the dwelling was unoccupied on Census night. Definitions.—F definitions of "Private Family," "Structurally Separate Dwelling" and " Rooms," see note at the head of Table III, p. 50. 47 Buildings. Population 1921. City of Westminster. Dwellings occupied by non.private families (excluded from cols. g.P). Structurally Separato Dwellings occupied by Privato Families or Vacant. Total Rooms. In course of Erection. Completed Vacant on Census night. Occupied by Caretaker. 1.3 Rooms. 4.5 Rooms. 6.8 Rooms. 9 or more Rooms. Total Dwellings. Not containing Dwellings. Containing Dwellings. (included in Cols, a b c d e f g h k 1 m n 0 P 20 – 8,830 65,953 I. Undivided Private Houses .. 246 308 92 524 1,044 2,250 4,766 8,584 88,920 „ – 152 1,051 II. Structurally divided Private Houses – 30 1 364 91 26 6 477 1,250 6 – 1,113 31,643 III. Blocks of Flats, Tenements, ctc. 11 1,137 10 8,276 1,918 1,208 298 11,700 38,920 19 2,606 2,222 11,013 IV. Shops 48 83 23 475 645 766 288 2,174 12,260 26 2,098 2,697 31,918 V. Others 311 257 107 1,148 826 305 107 2,386 10,029 71 4,704 16,014 141,578 Total 616 1,815 233 10,077 4,524 4,555 5,465 25,321 151,379 Principal Buildings In Group V (Others) abovo:— Vacant on Census night 904 432 276 204 1,816 8,673 Dwellings occupied by— 16 1,460 897 3,183 Oillces, Factories, 1 privato family 9,782 3,587 2,740 3,307 19,416 107,800 Warehouses, 2 private families .. .. 72 327 517 296 1,212 8,411 Workshops Hotels 3 or more private families 19 178 1,023 1,658 2,878 26,495 2 — 120 10,865 — 1 45 2,895 Institutions Total Dwellings occupied by private families " No. per cent. 9,873 4,092 4,280 6,261 23,506 142,706 — 66 8 41 Places of Worship 43 17 18 22 100 – 44 6 11 Places of Amusement Total privato families therein 9,983 4,810 7,730 11,414 33,946 – 48 it has been assumed for the purpose of comparison that overcrowding exists if there are more than two persons per room, but obviously this is not a very reliable test as no regard is paid to the size of a room. The census figures show that there has been a reduction in Westminster in the number of persons so living as tested by this method. Tenement. No. of Tenements. Persons 1921. 1901. 1911. 1921. Number. Average per Tenement. 1 room 1,599 869 492 1,671 3.4 2 rooms 1,846 1,262 869 3,964 4.5 3 rooms 729 575 442 3,412 7.7 4 rooms 172 154 107 1,045 9.7 Total 4,346 2,860 1,910 10,092 — The number of persons living more than two in a room in such tenements was:— Year. Population in 1.4 rooms. Persons living more than 2 per room. Percentage. 1891 104,787 38,834 371 1901 83,624 23,856 28.5 1911 74,617 16,207 21.7 1921 70,432 10,092 15.5 Each decade has shown a marked improvement in the amount of overcrowding. Since 1891 the reduction in the number of 1.4 roomed tenements is about 33 per cent., and the reduction in "overcrowding" 74 per cent. Including dwellings of more than 4 rooms, the population living more than 2 in a room was 11,364 in 1921, compared with 16,596 in 1911, 10.1 as compared with 12.9 per cent, of the total private family population. The proportion of persons more than 2 in a room in dwellings over 4 rooms is evidently larger than it was in 1911. These results are partly due to the reduction in the average size of families, for as the Registrar.General points out the re.grouping of the population into smaller family units has been accompanied by a reallocation of the available rooms. In other words, a large proportion of the population have become qualified for the housing .advantages enjoyed by small families, and have thus absorbed out of the available pool of rooms a larger share than previously fell to the lot of families of the same size, the share making a reduction of 16,292 since 1911, as the reduction in the total population was 18,683, the difference of 2,391 indicates the reduction in persons in non.private families. Hospitals and nursing homes show an increase from 1,745 to 1,853, but^there is a loss of 424 by the closing of Poland Street Workhouse and of 406 in military barracks and hospitals; 10,865 persons, including staffs, were living in 120 hotels, compared with 10,216 in 1911, but this latter figure included also persons living in Inns and public.houses, which are now classed as shops, so that the increase in the hotel population is greater than that shown. Had the 5,000 persons occupying the smaller dwellings who were absent on census night been at home, instead of a decrease there would have been an increase in their population; the decrease in the larger dwellings also would not have been so great. At the foot of Table II it is shown that the number of families occupying dwellings of less than 5 rooms was 76.6 per cent, of the total compared with 72.5 in 1911, while there is a decrease in the number of families in the larger houses from 27.5 to 23.4, which indicates that the larger houses are being given up or have been converted into flats and their stables and garages into dwellings. Probably this has had some effect in reducing the average number of occupants per room, as shown in this comparative statement:— Tenements. 1891. 1901. 1911. 1921. 1 room 2.9 1.8 1.6 1.4 2 rooms 1.6 1.5 1.4 1.3 3 rooms 1.3 1.3 1.2 1.1 4 rooms 1.1 1.1 1.0 0.9 He has worked out a number of interesting statistics for each metropolitan borough from which the following are abstracted:— Percentage of structurally separate Dwellings. Westminster. London. Range of variation in London boroughs. Maximum. Minimum. Undivided private houses 34 68 89 10 Maisonettes, flats, tenements, etc. 48 21 61 4 Attached to shops, etc 18 11 67 7 Rooms per dwelling 6.09 5.85 7.96 3.7 Families per dwelling 1.44 1.60 2.30 1.09 Persons per family, 1921 3.31 3.79 4.26 3.12 Persons per family, 1911 3.71 4.15 4.66 3.56 Rooms per person, all private families 1.23 0.96 1.41 0.65 Increase or decrease in dwellings, 1911-21 – 2,903 + 27,738 – – Per cent. – 10.7 + 4.1 +21.8 –14.6 Increase or decrease in private families – 795 + 96,946 –— – Per cent. – 2.3 + 9.5 +27.9 –15.7 Surplus or deficiency of rooms in 1921— On basis of County of London standard 1911 – 1,525 – 58,441 Percentage – 1.6 – 1.6 +30.6 –27.6 50 t The deficiency of rooms on tliis standard is greatest in Finsbury, Shoreditch and other East End boroughs, whereas there is an excess in Lewisham, Wandsworth and Hampstead. Disregarding differences in type of accommodation and size of rooms, the population in Westminster and in London as a whole is, on a general average of rooms per person, less densely housed than in 1911. While the amount of overcrowding has decreased there is in Westminster also an improvement in its intensity. In 1901 this may be taken as 108, in 1911 although less in amount the intensity had risen to 112, now it has fallen to 102. The rise in 1911 was the result of clearances of insanitary property, chiefly in St. John's Ward, which led to many of the displaced persons crowding into adjoining parts of the city. Table III.—Families and Dwellings. Definitions. Private Family.—Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) institutions, or (ii) business establishments or boarding.houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings.—A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, haviDg separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit; a private house which has not been structurally subdivided is similarly a single unit whether occupied by one family or by several families. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non.domestic purposes consists of at least 3 rooms and is more than one quarter of the whole. The dwellings shown in this table are those occupied by private families only. Rooms.—For the purpose of the Census the rooms enumerated are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop room3. 51 City of Westminster. Private Families and Dwellings. Private Families. Population in Private Families. Structurally Separate Dwellings occupied. Rooms occupied. Rooms per Person. Cols, a b c d e f Westminster, City of, Met. B. Wards and Civil Parishes 33,946 112,526 23,506 138,680 1.23 Charing Cross— St. Martin's in the Fields (Pt. of) 605 1,162 545 2,890 2.49 Conduit— St. George, Hanover Square (pt. of) 622 2,135 618 3,545 1.06 Covent Garden 1,498 5,908 1,397 4,373 0.74 St. Martin's in the Fields (Pt. of) 1,317 5,255 1,220 3,614 0.69 St. Paul, Covent Garden 181 653 177 759. 1.16 Great Marlborough St. James, Westminster (Pt. of) 813 3,611 464 2,317 0.89 Grosvenor— St. George, Hanover Square (pt. of) 2,661 11,730 2471 21,915 1.87 Hamlet of Knightsbridge— St. Margaret and St. John (pt. of) 1,382 5,632 1,136 10,149 1.80 Knightsbridge, St. George's St. George, Hanover Square (pt. of) 2,572 11,370 2,467 19,905 1.75 Pall Mall— St. James, Westminster (Pt. of) 425 1,812 404 2,221 1.23 Regent— St. James, Westminster (Pt. of) 1,211 4,162 938 3,717 0.89 St. Anne— St. Anne 1,807 5,118 1,355 4,980 0.97 St. John— St. Margaret and St. John (pt. of) 6,944 21,464 4,462 18,923 0.88 St. Margaret 2,168 7,080 2,042 10,047 1.42 Close of the Collegiate Church of St. Peter 26 194 23 164 0.85 St. Margaret and St. John (pt. of) 2,142 6,886 2,019 9,883 1.44 Strand 178 645 176 699 1.08 Liberty of the Rolls 27 93 28 92 0.99 Precinct of the Savoy 9 33 10 39 1.18 St. Clement Danes 127 434 124 517 1.19 St. Mary le Strand 15 85 14 51 0.60 Victoria— 11,060 31,697 5,031 32,999 1.04 St. George, Hanover Square (pt. of) 11,060 31,697 5,031 32,999 1.04 St. Martin in the Fields (Pt. of) – – – – – Entire Civil Parishes— St. Martin in the Fields 1,922 6,417 1,765 6,504 1.01 St. George, Hanover Sq 16,915 56,932 10,587 78,304 1.38 St. Jaines, Westminster 2,449 8,558 1,806 8,255 0.96 St. Margaret and St. John 10,468 33,982 7,617 38,955 1.15 52 While the average number of rooms per person in private families is 1.23 for the whole of the city, there are considerable variations in the various wards as shown in Table III of the Census Report; thus in Charing Cross each person has 2.49 rooms and in Grosvenor 1.87, Hamlet 1.80, and Knightsbridge 1.75, while in five wards each person has less than one room, viz., Covent Garden, 0.74; St. John's, 0.88; Great Marlborough and Regent, 0.89; St. Anne, 0.97. The remaining wards are: Conduit, 1.66; St. Margaret's, 1.42 Pall Mall, 1.23; Strand, 1.08; and Victoria, 1.04. An amount of legal overcrowding still exists, but it has been reduced during the last year. Some of it was due to tenants taking in relatives during the war, or who have been dis.housed in other boroughs, in other cases it was due to the family growing up. The Peabody Trust, when they opened their new buildings in Horseferry Road, were able to remedy any overcrowding due to this last cause in their own buildings by rearranging the tenants from their various groups of dwellings. From the applications received at the City Hall, it is evident that there are many who desire to live in Westminster on account of convenience for their work, but on the other hand there is a considerable number of persons now living in Westminster whose work is elsewhere and who would be glad to move nearer to it if they could get dwellings. If an interchange could be effected much of the difficulty would be solved. The County Council has undertaken to provide within a period of five years from January, 1920, not fewer than 29,000 new dwellings exclusive of those to be erected on the cleared sites of insanitary areas, and the Westminster City Council contributes some £32,000 a year towards the cost of this and other building schemes in the Metropolis. Already the County Council has provided 6,800 cottages and tenements in block dwellings providing accommodation for 52,000 persons. The Rents Restriction Acts, while of benefit in some directions, have restricted the removal of insanitary worn.out houses and the reconstruction of congested areas. One such scheme which would provide work to the extent of about £150,000, in one of the most closely populated parts of Westminster, is being held up chiefly on this account. So far as the lower.rented houses are concerned, the repeal of these Acts would probably not affect their rents. Any attempt on the part of landlords to raise the weekly rent would be met by the inability of the tenant to pay. Under present economic conditions many landlords are not getting their full rents. The manager of one large estate informs me that they have not put up their rents to the full extent allowed by the Acts, as in their opinion the tenants could not pay the full amount; the result is they have no arrears. 53 The persons who would be hardly hit by the repeal of the Acts are those paying rents at the other end of the scale, and withdrawal of protection would force many of such persons to seek for lower rented premises and would thereby cause greater pressure on those inhabiting less highly rented premises. If the Acts are repealed or if protection is withdrawn from any class provision should be made whereby machinery may be set up whereby fair rents may be settled, which would remove the object which landlords have in view in many cases where they might desire to evict the existing tenant. New Peabody Buildings.—Nine blocks of these new buildings in Great Peter Street were completed and opened during the year. They afford accommodation for 95 families. Most of these were transferred from the Peabody Buildings in Buckingham Gate, the remainder being former residents in other of the Peabody Buildings in Westminster who were in need of additional accommodation. The building of other blocks is held up as the Trustees are unable to obtain possession of the site. The Buckingham Gate dwellings have been sold, and it is from the proceeds of this sale that the Peabody Trust has been able to erect the new dwellings. Those in Buckingham Gate were reported on by me as far back as November, 1911, when I pointed out that many of the rooms were unsatisfactory and very dark and without means of through ventilation. The death.rate for the previous ten years was five points above the average of other Peabody dwellings in "Westminster. Some reconstruction was possible and was carried out as a temporary measure, but the Trustees agreed with my suggestion that it was desirable to dispose of these buildings with a view to the erection of better designed ones elsewhere. It was only after prolonged negotiations that the site in Great Peter Street became available and, unfortunately, it came at a time when it was most difficult to deal with the matter. When completed it will have effected a great improvement not only as regards the buildings themselves but also in the removal of a black spot from the city. The City Council's scheme for the erection of new dwellings, which I mentioned last year, has not yet been started, various complications having occurred, but it is hoped that they will be put in hand at an early date. During the year the cost of building has fallen so that it will be possible to provide an additional number of tenements to that originally proposed without additional cost. A form required by the Ministry is appended. Special inspections were made during the year of houses in the following streets : Ross Street and Place, Union Street, Medway Street, Hudson's Terrace, Richard's Cottages, Westminster Buildings, Ponsonby Place, Page Street, Percy Cottages, Phillip's Terrace, Kinnerton Street and 54 Yard, Frederic Mews, Shepherd's Place, Cottage Place, Kinnen on Place South—199 houses. No. 15, Grosvenor Cottages and adjoining houses in Whittaker Street having reverted to the ground landlord, a small reconstruction scheme recommended in 1920 was carried out. The first.named had no yard and the w.c. was approached from the kitchen. A portion of the gardens of the Whittaker Street houses was cut off and allocated to No. 15, and the w.c. removed to it. The houses were put in good condition and re.drained. Restriction of Rents Acts.—Applications for certificates were asked for and granted in five instances. It does not appear, however, that proceedings were thereafter carried to the county court, the applicants apparently being satisfied with the required repairs having been carried out. Houses let in Lodgings.—At the end of 1921 there were 1,150 houses on the register, during 1922 this number was still the same. 3,000 visits were paid to such houses and notices were served with reference to 413 defects. Statutory notices were served in 24 instances, followed by police court proceedings in three instances. As has been pointed out previously, many of the?" houses arc partly used as work places, and consequently more visits than those stated have been paid to the premises. The 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, and also on account of a legal difficulty with regard to existing by.laws made under another Act. The first part contains some useful powers, particularly one whereby the tenant is made responsible for the cleanliness of beds and bedding, floors and walls. If the by.laws as a whole cannot be put in force, sanction might at least be given for this part, once the legal difficulty is got over. Housing Conditions. (Return required by the Ministry.) Statistics. Year ended 31st December, 1922. 1.—General. (1) Estimated population For births 141,800 deaths 139,389 (2) General death.rate 12.9 (3) Death.rate from tuberculosis 1.18 (4) Infantile mortality 54.6 (5) Number of dwelling.houses of all classes, 27,136 (Tenements) 33,946 (6) Number of working.class dwelling.houses (7) Number of new working.class houses erected (Tenements) 95 55 2.—Unfit Dwelling.Houses. I.—Inspection. (1) Total number of dwelling.houses inspected for housing defects (under Public Health or Housing Aots) (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 0 (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 1,420 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 120 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, dkc., Act, 1919. (1) Number of dwelling.house3 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 1,300 (2) Number of dwelling.houses in which defects were remedied— (a) By owners All (b) 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) Numbor of dwelling.houses in respect of which Demolition Orders were made 0 (5) Number of dwelling.houses demolished in pursuance of Demolition Orders 0 56 3.—Unhealthy Area Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I, or (b), 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 woman Inspector. 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. The woman inspector visits houses let in lodgings. Revenue Act.—Three applications were received and certificates granted. 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:— 1922. 1922. Complaints received and dealt with Premises inspected on complaint, &c. House to bouse inspection Subsequent visits Premises (registered), visits to Overcrowding found Other infringements Sanitary Work completed:— Houses:— Cleansed throughout „ partially Overcrowding Light or ventilation proved Roofs repaired Floors and staircases re paired Underground rooms:— Illegal use Closed Yards, areas, paved or paired Damp walls remedied Offensive refuse removed Keeping of animals continued Verminous premises cleansed Filthy or unwholesome bedding, &c. Drains:— Constructed Amended and repaired Ventilated Unstopped and cleansed Interceptor traps fixed Cleansed and sealed off from sewer Gully traps fixed Defective traps abolished 879 1,404 2,918 24,245 3,000 - - 239 1,104 70 386 527 641 4 4 447 263 255 39 351 11 218 282 207 119 158 39 908 172 Sanitary Work completed:— Drains:— Manholes built „ repaired and cleansed „ covers fixed or repaired Tested by smoke „ chemical „ water „ air Fresh air inlets fixed or repaired Soil Pipes:— Fixed Ventilated Repaired Tested by smoke „ chemical „ water air Water-closets:— Constructed Repaired Ventilated and light improved Cleansed or limewashed Ventilated lobbies provided Unstopped Traps ventilated Flushing cisterns fixed „ „ repaired Waste Pipes:— Constructed Repaired Unstopped Trapped Ventilated Disconnected from drain 528 282 586 33 248 448 50 245 323 289 198 87 251 71 169 1,439 555 235 1,155 369 87 1,192 1,008 359 1,767 234 89 2,307 1,979 1,050 57 1922. 1922. Sanitary Work completed: — Rainwater Pipes:— Fixed or repaired Disconnected from drains Urinals:— Constructed Repaired or improved Cleansed Water Supply:— Provided „ additional in tenement houses Certificates granted Cut off Reinstated Cisterns fixed „ cleansed „ covered 664 209 196 58 103 227 51 3 36 38 88 147 183 Sanitary Work completed:— Water Supply:— Cisterns defective, abolished Taps off main provided Pipes repaired Dust Bins:— Movable, provided „ repaired Fixed, abolished Stables:— Drained Paved Cleansed Dung receptacles provided Dung accumulations removed Garages constructed Petrol interceptors provided 21 788 179 309 6 8 5 7 8 - 40 12 9 1,344 intimations of nuisances (exclusive of smoke nuisances), &c., and 61 statutory notices were issued; 1,445 letters were written. Police Court proceedings had to be. resorted to in respect of 6 properties. In one case in which a magistrate's order had not been obeyed a penalty of £5 was inflicted. One order to abate nuisance was made, and in three cases the summonses were withdrawn on payment of costs, the work having been completed before the hearing. In one case proceedings were taken under the bye-laws for failing to keep a w.c. in a proper state of repair and a penalty of £3 was inflicted. Plans.—468 sets of plans were examined during 1922. Of these, 39 were plans of new buildings. The corresponding figures for 1921 were 383 and 22. Failure to give notice occurred in 36 instances, and to send in plans 47 instances, and a number of builders were cautioned. One builder was summoned for improper construction of soil and waste pipes and fined 20s. and 21s. costs. Water Supply.—36 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, 1; non-payment of rates, 35. Additional water supply to tenement houses was provided in 53 instances. Removal of Offensive Refuse.—Several contractors were cautioned. Owing to the deficiency of rainfall in 1921 (11.6 inches below the average) it was apprehended that there might be some shortage of water in 1922. Fortunately no difficulty was experienced, but notwithstanding that 30.5 inches of rain fell in 1922 (2.35 inches above the average) it is 58 doubtful if at the end of the year the great underground supplies had recovered their normal level. 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. During the twelve months 294 dead eyes in the sewers were bricked off at a cost of £200. In addition, 79 defective house drain connections were renewed. It is important in pulling down premises that old drains should be taken up or properly filled in. In the week commencing 1st November a united attack was again made throughout the country. During the week 16,080 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 93. Probably the dead bodies were carried away in the sewers. Smoke Prevention. The following is a summary of the work done in connection with smoke prevention:— 1921. 1922. Complaints received 30 31 Observations taken 1,838 1,795 Notices issued— Preliminary 52 80 Statutory 1 2 Summonses - - There was considerable improvement in nuisances from smoke, but we are reminded every winter by the occurrence of fogs that there is room for still further improvement if London is to be protected from the evil effects of the pollution of the atmosphere by smoke. If the public generally appreciated that it is a direct cause of illness and death, that it lowers industrial output besides throwing an additional charge for artificial illumination and that it could be prevented, steps would be taken to have the law made more stringent. In many of the new buildings being erected in Regent Street and elsewhere the ordinary fire-place is being replaced by central heating in accordance with the recommendations of a recent Commission. 59 D.—Occupations, Workshops, etc. The Census Report gives in considerable detail the occupations of residents in Westminster aged 12 years and upwards. This does not represent the number of persons who are engaged in various occupations in Westminster who come from outside, nor does it indicate how many of the residents are working in Westminster. The total occupied residents are as follows :— Males. Females. Employers 2,366 529 Employees 39,639 38,419 Working on own account 2,858 1,548 Total 44,863 40,496 Unoccupied include - Males. Females. Students (over 18) 178 260 Visitors from abroad 2,141 826 Retired from previous gainful occupations 964 234 Ex-naval or military 764 — Other persons (not retired and not gainfully occupied) 4,680 30,512 The principal occupations in which the above are engaged are per 1,000 persons employed Personal service 176 649 Transport (railway, roads, &c.) 115 12 Commercial, finance and insurance 89 51 Defence 67 — Public administration 54 17 Clerks (not Civil Service or municipal) 49 94 Professional 47 52 General labourers, watchmen, &c. 41 1 Metal workers 41 1 Textile trades (dress) 31 82 Builders, painters, &c. 26 — Compared with the figures at the Census of 1901, there is a considerable reduction in the number of occupied persons resident in the city, viz., from 63,198 to 44,863 males, 46,384 to 40,496 females. There is an increase in males engaged in commercial and engineering pursuits and in females engaged in clerical work. Tailors are only 1,000 compared with 2,586, and 897 tailoresses compared with 2,390 in 1901, showing that persons engaged in this occupation, which was an important one in Soho, have migrated elsewhere, as has been indicated by the out-workers' lists. Milliners, dressmakers and other (6809)Q E 60 workers in dress have also decreased considerably. Workers in precious metals and jewels have decreased as residents from 1,283 to 296. Males engaged in personal service have decreased but there is an increase in females principally as waitresses, for female domestic servants have decreased from 24,977 to 20,511. Work Premises.—The following shows the state of the register of work premises at the end of 1922:— Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,543 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 857 Leather workers, boot and shoe makers, harness makers, &c. 54 Carpentry, upholstery, carvers, gilders, &c. 55 Surgical and dental instrument makers 3 Tobacco manufacturers 30 Wig makers and hair workers 42 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, &c. 57 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 41 Metal workers 10 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 52 Florists 26 Laundries 54 Bakehouses 82 Photographers 17 Jewel case makers 9 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 338 workshops was discontinued, and 161 additions were made to the register during the year. In 1920 there was a net increase of 128, but during 1921 there was a reduction of 158 workshops in net numbers, and during 1922 a further reduction of 177. Inspection. Premises. Number of Inspections. ReInspections. Intimation Notices. Statutory Notices. Prosecutions. Factories 170 186 77 — — Workshops 2,580 3,148 510 11 — Workplaces (Excluding restaurant kitchens, &c.) 648 717 63 5 1 Total 3,398 4,051 650 16 1 61 Defects found.—1922. Particulars. Number of Defects. Number of Prosecutions. Found. Nuisances under the Public Health Acts:— - Want of cleanliness 730 - Want of ventilation 49 - Want of ventilation of gas stoves 71 - Overcrowding 37 - Want of drainage of floors 14 - Sanitary accommodation— Insufficient 55 - Unsuitable 86 - Defective 313 1 Not separate for sexes 54 - Other defects 472 - Total 1,881 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses - - Breach of special sanitary requirements for bakehouses (included above) - - Other offences - Other Matters. Class. Number. Visits to Out-workers' premises 1,420 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 127 Absence of means of warming 4 Matters referred by H.M. Inspectors 182 Workrooms measured 220 Visits of Enquiry re Employment of Women 27 „ „ Outworkers 73 Underground bakehouses in use at the end of the year 61 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 employers who neglected to send in returns, and those who failed to reply were visited by an Inspector. No further proceedings had 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. (6S09)Q E 2 62 City of Westminister. Outworkers. 1992. Trade. FEBRUARY LISTS. AUGUST LISTS. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Boot making 363 — 342 21 373 6 347 32 Carpet repairing 2 — — 2 2 — — 2 Corset making 1 — 1 — 1 — 1 — Cutlery repairing — 1 — 1 — 1 — 1 Dress making 315 49 283 81 303 52 277 78 Dyeing and Cleaning 7 — 5 2 8 — 6 2 Embroidery 38 5 35 8 42 — 33 9 Engraving — 1 — i — 1 — 1 Furriers 44 6 39 11 41 11 37 15 Hat making — 2 — 2 — 2 — 2 Lace curtains — 1 — 1 — — — — Lamp shades. &c. 42 — 38 4 51 — 48 3 Laundries 10 3 3 10 10 3 3 10 Lingerie, &c. 155 9 151 13 143 13 131 25 Paper Bags — 1 — 1 — l — 1 Shirt making, Hosiery, &c. 107 4 72 39 135 1 98 38 Tailoring 3,296 140 1,667 1,769 3,493 163 1,708 1,948 Theatrical costumes 7 — 7 — 5 — 5 — Toy making 2 — 2 — 2 — 2 — Umbrella making 14 — 14 — 15 — 15 — Waterproofing 1 — 1 — 1 1 1 1 Totals 4,404 222 2,660 1,966 4,625 255 2,712 2,168 Number of lists received during the year, 824—(February, 409; August, 415). 63 After adjusting the lists, it appears that the actual number of outworkers resident in Westminster is 1,311 (in 1921 the number was 1,249); this is less than the apparent number shown on the accompanying table, as more than one employer may send work to the same person. The number of houses in which out-work is carried on was 725. 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 (Sees. 109, 110). By-laws for Regulating Business of Rag and Bone Dealer. The Council, at their meeting on the 8th May, 1913, directed that representations be made to the Local Government Board, the Home Secretary and the London County Council, pointing out that section 6 of the proposed By-laws, if adopted, would permit of a bedroom opening directly out of a room used for the storage and manipulation of rags, bones, fat, rabbit skins and other like articles, and suggesting that the words of sub-section (1) (d) of section 8 of the London County Council (General Powers) Act, 1908, should, as far as practicable, be substituted for this proposed By-law. By-law 6 of the proposed By-laws reads as follows:— "A person carrying on the business of a rag and bone dealer shall not cause or suffer any rags, bones, fat, rabbit skins or other like articles to be stored or manipulated in any room or place upon his premises used as a sleeping room or place. He shall not cause or suffer any rags, bones, fat, rabbit skins or other like articles to be stored or manipulated in any room or place upon his premises which communicates directly, otherwise than by means of a close-fitting and self-closing door, with any sleeping apartment or with any stair, case or passage leading to any sleeping apartment." The sub-section of the London County Council (General Powers) Act, 1908, which the City Council suggested should, as far as practicable, be substituted for the above, provides as follows:— "No such room shop or other part of a building shall be used as sleeping place and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space." 64 The views of the Council have not been met in the By-laws as finally adopted, so that it will necessitate the Council taking action under the Public Health Act should bedrooms be found opening directly out of a rag and bone store. The Council also expressed the opinion that it is very desirable that it should be made obligatory on a person desiring to establish the business of a rag and bone dealer to notify the Sanitary Authority of his intention to do so, and to first obtain from them a certificate that the premises on which it is proposed to carry on the business are suitable for the purpose. E.—Food Supply. During 1922, 1,868 visits have been paid to the various classes of business 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. 195 notices were served in respect of defects found. Restaurants.—The kitchens of hotels and restaurants are inspected regularly. Ice-cream, Premises.—There were during the year 150 places where this commodity was made or sold, and these were kept under supervision; 200 visits were paid. Bakehouses.—At the end of 1921 there wete 21 above-ground and 61 underground in use. Daring 1922 there was no change. All the bakehouses were inspected, and cleansing carried out twice a year. Milkshops.—At the end of 1922, 478 names of persons selling milk were upon the register. These include 5 persons selling milk on rounds, who had no shop or store. Three applications for registration were refused on the ground that the premises were unfit for storing milk. 211 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 2 itinerant persons selling milk without having been registered for the purpose in Westminster. One was fined £1 and the other ordered to pay 2s. costs. Cowhouse.—There is only one remaining, licensed for 6 cows, but none have been kept. There are no slaughter-houses in Westminster. 65 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:— Articles of Food Submitted. Tons Cwts. Lbs. Tons. Cwts. ###] Apples 14 5 19 Onions 1 6 0 Apricots 0 10 0 Oranges 1 2 0 Bananas 12 19 0 Passion Fruit 0 10 0 Beans 0 16 68 Peaches 0 14 0 Cabbage 0 2 0 Pears 13 3 20 Carrots 0 16 4 Peas 4 6 0 Cherries 0 0 96 do. (Tinned) 0 3 0 Chestnuts 0 1 6 Pineapples 3 13 0 Cranberries 0 3 64 Plums 0 8 78 Currants (Red) 0 3 64 Potatoes 0 15 0 do. (Black) 0 6 78 Rhubarb 2 8 0 Grapes 0 1 50 Tomatoes 0 5 0 Greengages 0 3 0 Turnips 4 9 0 Damsons 0 0 49 Turnip Tops 0 1 0 Fruit (Dried) 0 4 0 Walnuts 0 0 21 do. (Tinned) 0 1 32 Fish (various) 0 4 19 Horseradish 0 4 0 Mutton (Tinned) 0 2 88 Lemons 1 3 0 Turkeys 0 1 58 Melons 21 13 0 Pork Pies 0 0 1 Nectarines 0 1 3 Condensed Milk, 96 tins; Pears (Tinned), 16 tins. Articles of Food Seized and Condemned. Pears, 12 lbs. Vendor cautioned. Pork pies Fined £5. Shrimps (4 packets) „ £5. Certificates to enable articles of food to be exported to the United States and Canada were granted in 25 instances. Unsound Food.—At a conference of representatives of a number of metropolitan borough councils held at Islington, a resolution was passed calling the attention of the Minister of Health to the necessity of the law relating to the sale of unsound food being amended so that food should be examined in bulk before being sold by auction or sample to retailers. The City Council was asked to support this proposal, but being of opinion that it is not practicable declined to do so. If such an amendment of the law were effected it would necessitate the provision of larger warehouses, the employment of a larger staff, skilled and unskilled, and it would lead to considerable delay before fruit 66 and vegetables could be sold. The result would be that there would be a considerable amount of food wasted and there would be an increase in price which would chiefly affect the poorer classes of the community. 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 1922. 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 998 912 (57) 29 21 17 4 50 5 0 19 1 0 2 do. separated 6 5 1 3 Cream, ice 9 9 4 Cream 59 47 12 5 do. preserved 37 24 13 6 do. cheese 2 1 1 7 Butter 150 150 8 do. and roll 1 1 9 Margarine 10 10 10 Coffee 18 18 11 Chocolate 4 4 12 Honey 43 43 13 Jam 29 29 14 Meat pies (various) 57 44 13 1 1 — — 5 5 0 15 Sausage roll 1 1 16 Sausages (various) 103 85 18 4 3 1 6 0 0 1 1 0 17 Brawn 5 5 18 Meat and fish paste 74 58 16 4 3 1 7 0 0 15 15 0 19 Beans 9 1 8 2 2 — 3 0 0 2 12 6 20 Peas 49 7 42 15 13 2 36 1 0 10 14 0 21 Spinach 5 1 4 3 3 — 10 0 0 2 2 0 22 Garlic 1 1 23 Asparagus 2 2 24 Fruit (tinned) 9 8 1 25 Lime juice 7 3 4 26 „ cordial 3 1 2 27 Lemon squash 8 — 8 1 — 1 — 5 5 0 28 Olive oil 51 51 29 Salad oil 3 3 30 Vinegar 1 1 31 Mustard 9 8 (1) 32 Borax 10 8 2 2 1 1 — 3 3 0 33 Cream of tartar 10 9 1 1 1 — 3 0 0 — 34 Camphorated oil 17 16 (1) Totals 1,800 1,566 (59) 175 54 44 10 115 6 0 64 18 6 Summary proceedings were ordered to be taken in 44 instances, 36 cautions were issued, the attention of the vendors was called to the report of the Analyst in 11 instances, and no action was taken with regard to 75 samples which deviated slightly from the standard or were test purchases not taken officially. 67 There were 4 non-official samples purchased during the year. Milk.—998 samples of ordinary milk were taken during the far. The Analysts have graded the samples submitted to them into four groups:—(rood 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. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Percent. No. Percent. North 557 270 48.4 182 32.6 84 150 21 3.7 South 441 223 50.5 156 35.3 54 122 8 1.8 1922 998 493 49.4 338 33.8 138 13.8 29 2.9 1921 987 321 32.5 400 40.5 236 23.9 30 3.0 1920 977 449 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 1916 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 The general quality of the milk during the year has markedly improved. Sunday Samples.—20 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.—14 samples of milk were taken as it was being delivered by wholesale firms to retail customers, including shops, hotels and hospitals. Of these samples, 8 were good, 5 fair, and 1 poor. These samples were taken in consequence of previous samples having been found below the limit (including cases where a warranty defence was set up). Proceedings were taken with regard to 21 samples of milk; in two of the cases the roundsman was summoned as well as the firm. Two retailers were summoned twice, and one three times, so that there were only 17 offenders. Warranties were successfully proved in five eases and in another case the defendant might have got off on a warranty had notice been given 68 in proper time. One summons was withdrawn on payment of costs, the defendant having only taken over a "round" with a stock of milk a few hours before the sample was taken. Eleven of the samples were taken from milk sellers on their rounds, one sample had 4 per cent. added water, the others had deficiency in fat equal to 5, 6, 6, 7, 15, 27, 28, 34, 65 and 70 per cent. The. remaining 10 samples were purchased half in places of refreshment and half in ordinary milk dealers' premises. The offences were 3 per cent. added water, and deficiency of fat of 6, 7, 9, 12, 19, 19, 24, 24 and 52 per cent. In the case of the firm summoned for three offences it was eventually discovered that the farmer was supplying adulterated milk, and proceedings against him were taken elsewhere. On an average every retailer is sampled at least four times a year, while those having multiple shops or a number of roundsmen are sampled a greater number of times. The Public Health (Milk and Cream) Regulations, 1912 and 1917. Samples Analysed during the Year 1922. Article. Number of samples examined for preservative. Number containing preservative and Percentage of preservative found in each sample. Milk 998 No preservative found. „ separated 6 „ „ „ Cream 59 12 contained preservative:— 0.2, 3.9, 8.4, 10.5, 12.6, 14.7, 18.9, 18.9, 19.6, 21, 26.6 boric acid; and one contained a small amount of hydrogen peroxide. 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. 37 2 35* Nil. 37 Nil * Samples contained respectively 27.3, 26.5, 25.9, 25.2, 24.5, 23.8, 23.8, 23.8 23.8, 23.8, 23.1, 21.7, 21.0, 19.6, 18.2, 17.5, 17.5, 17.5, 17.5, 17.0, 16.8, 18.1, 14.1, 14.0, 14.0, 13.3, 13.3, 12.6, 12.0, 11.2, 11.0, 11.0, 10.0, 8.4. Action Taken—Nil. Infringements under Article 5 (1)—Nil. Infringements under Article 5 (2)—Five cases—Receptacles not labelled; prosecuted and fined £4, £4, £2 and £2 2s. and 10s. respectively with costs. Thickening substances—None found. 69 Oilier Infringements.—Proceedings were taken against one retailer for having no name or address on milk can—fined £2; and against two retailers for selling milk without being registered—fined 20s. and 2s. costs. Tinned Vegetables.—63 samples of peas, beans and spinach were taken, 9 of these had no colouring matter added to them, 54 contained sulphate of copper. In peas it varied from under 1 up to 3.04, in beans it was under 2 grains, in spinach there was found 2 grains, 5.25 and 10.43 grains. The practice of the Council for many years has been to prosecute in all cases where the amount was over 2 grains under Section 3 of the Act and the magistrates have always supported the action of the Council. This year, however, two cases in which the amount was 2.21 and 2.92 were dismissed by a magistrate who was acting temporarily in one of the Westminster Courts and who evidently had not had to deal before with this particular class of case. In 12 other cases penalties were inflicted. No proceedings are taken when the amount of copper sulphate is under 2 grains if disclosure is made that it is present. The usual amount is about 1.4 grains. The majority of the peas that failed to indicate the presence of copper, or in which there was an excess were of Italian origin. Fifteen years ago I met representatives of the French packers, and as a result the amount of copper has been restricted so that it has become unusual to find that the abovementioned limit is exceeded. Last year I communicated with the Italian Chamber of Commerce and they called a meeting of Italian packers with whom I discussed the subject. This business has been taken up in Italy since the war and many of the packers were new to it and had no exact information. As a result of the conference the Chamber issued a letter which I drafted to Italian packers and also prepared a special report for the Ministry of Commerce. This will not affect vegetables which have been packed in 1922, but it is hoped that in subsequent years it will be found that the Italian packers have come into line with those in France. One would expect that a matter of this kind should be dealt with by the Minister of Health, but as the successive Ministries have not availed themselves of the powers given by the Public Health (Food Regulations) Act of 1907, there may be some hesitation on the part of the Ministry to enter into such negotiations. It would materially assist both local authorities and manufacturers if such regulations were issued, but before these could be issued an enquiry into the whole subject should be instituted. More than 20. years ago a Committee made an extensive report on the subject with a number of recommendations which have been taken as a guide by local authorities, but no action has been taken thereon by the Ministry. Since then the use of preservatives and colouring matters in foods has become more extensive, and further information is required as to their 70 effect on the foods themselves, especially as regards their vitamin contents, as well as on consumers. Tinned Fruit.—Nine samples were examined. One (pears) contained 2.1 grains of tin. The tins were apparently several years old and the owner destroyed the rest of his stock. Sausages, Brawn and Meat Pies.—104 sausages of various kinds were examined, 86 contained no preservative. In 14 the amount was slight; proceedings were taken in 4 cases, pork sausages 23.8 grains boric acid —dismissed on warranty, breakfast or luncheon sausages 17.5 grains, 21 grains, 22.4 grains—£1 1s. costs, £3 and £3 fines respectively. The five samples of brawn contained no preservative. Of meat pies of various kinds 57 samples were taken, and 44 found free from preservative. Proceedings were taken in one instance as it contained 21 grains boric acid. The vendor was not fined but ordered to pay £5 5s. costs. Meat and Fish Pastes.—Of 72 samples, 56 contained no preservative. Proceedings were taken in three instances. In the case of a chicken and ham paste containing 18.2 grains of boric acid, the summons was withdrawn on the promise of the manufacturers to discontinue its use or to put a proper notice on the tins and on payment of £5 5s. costs. A summons for having 13.3 grains in a salmon and shrimp paste was withdrawn as analysis of the third portion did not reveal any boric acid. A summons was issued in respect of bloater paste which contained only 4.2 grains, because there was a statement on the label that it was guaranteed free from preservatives. A representative of the manufacturers stated that their bloater paste was made from bloaters, anchovies, American bacon, margarine and cereals and that no boric acid was added as no preservative was necessary. It is probable that the boric acid found was contained in the bacon used. The case was settled on payment of £10 10s. costs. Potted Shrimps.—Two samples contained 31.3 and 93.8 grains per 1b. The vendors were fined £2 and £5 respectively. Caviare.—Information was received that Russian caviare containing formalin was being imported into this country, chiefly from one firm in Paris, who sent it direct in many instances to hotels and restaurants. An unofficial sample was obtained and was certified to contain 21 grains of boric acid per lb. and 7.5 parts of formaldehyde per 100,000. The attention of the Ministry was drawn to the matter and samples were obtained at Dover and Folkestone. All contained formalin in a high 71 proportion—125 to 100 parts per million. Two consignments were seized at these ports. A circular letter was sent to all dealers in caviare, hotels and restaurants in Westminster warning them against purchasing caviare so treated. Lime Juice and Lemon Squash.—18 samples were examined. Four of the 10 lime juice samples contained no preservative. All the eight lemon squash samples contained some. Proceedings were taken in one instance in which the sample was said to have been made from fresh lemons. It contained 30.6 grains of phosphoric acid. It was stated that the sample was from the surplus of a consignment made specially for the use of the troops in Mesopotamia, and its contents did not necessarily represent the usual composition. The manufacturers agreed to alter the label on their bottles in future, and on payment of £5 5s. costs, the summons was withdrawn. Drugs.—Samples of borax, cream of tartar and camphorated oil were purchased. Borax is sold for commercial purposes by grocers, oil and colourmen and ironmongers and for medicinal purposes by chemists. The latter is a more purified article and a standard for it is laid down in the British Pharmacopoeia as to the maximum amount of arsenic, lead and other impurities which must not be exceeded. Samples were taken from both chemists and general shops. Of 2 from chemists, one complied with the requirements, the other contained 46 parts of arsenious oxide instead of 5 parts per million. Of 8 from general shops, 7 consisted of the purer article and one had 40 parts of arsenic. Summonses were issued in both cases—the chemist was fined £3 3s.; in the other case the magistrate held that the purchaser was not prejudiced in being supplied with commercial borax. One sample purchased as cream of tartar from a chemist proved to be tartaric acid, for which he was fined £3. The camphorated oil samples were all genuine. Preservatives and Colouring Matters in Food.—The City Council has expressed the view that a Committee should be appointed by the Ministry of Health to go into the whole question anew. 72 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Administrative Tuberculosis Officer : Qualifications. Francis J. Allan M.D., D.P.H., etc. Assistant Medical Officers: Andrew J. Shinnie M.D., D.P.H. (Tuberculosis and Maternity and Child Welfare.) *Ethel M. Vernon M.D., B.S. (Maternity and Child Welfare.) Bacteriologist: *J. A. Braxton Hicks M.D., M.R.C.P., D.P.H. Dental Clinic: *W. H. Turner L.D.S. *T. Graham Scott (Anaesthetist) M.R.C.S., L.R.C.P. Public Analysts: *Cecil H. Cribb B.Sc., F.I.C. *P. A. Ellis Richards F.I.C. Clerical Staff: A. Wise. F. W. Lake. A. J. Manhood. W. Jenkins. Miss M. MacFarlane (Tuberculosis Dispensary). Sanitary Inspectors: F. A. Aris R.S.I. C. J. Dee S.I.E.B., R.S.I., and Meat and Food Cert. F. J. Haigh S.I.E.B. H. R. Hardy R.S.I., M.I. San. Eng. A. McNair (resigned July, 1922) R.S.I, and Meat Cert. E. J. Martinson R.S.I. J. Sanderson R.S.I., San. Sc. Cert., Gold Medallist Carpenters' Company. A. Taylor R.S.I. A. L. Ware S.I.E.B. and R.S.I., R.P.C. J. W. Whipp R.S.I. C. Ratcliff (Food & Drugs, &c.) S.I.E.B., Meat Cert. (Appointed, July, 1922.) Miss C. Hughesden S.I.E.B., R.S.I., H.V., C.M.B. 73 Midwife: Qualifications. Miss A. J. Irving Hosp. Nursing. Health Visitors: Miss A. Sanders (Supt. Centre) H.V. Miss J. G. Alexander (Supt. H.V., C.M.B., Hosp. Nursing. Centre). Mrs. M. Watkinson C.M.B., Nursing. Miss D. H. M. Walding (Tuberculosis). S.I.E.B., Dipl. Nat. Health Soc., Nursing. Miss E. I. Tarbolton (resigned H.V., Dipl. Nat. Health Soc., Nov., 1922). V.A.D. Miss Howell Evans S.I.E.B., Dipl. Nat. Health Soc., Nursing, V.A.D. *Mrs. Coleman (Mothercraft Classes) Red Cross Cert., '1st cl., and gold medal. Other Staff: A. E. Birch, Keeper of Mortuary and Coroner's Court. R. Watling, Mortuary Assistant. A. Wheal, Superintendent of Disinfection. W. Slattery, Engineer. J. Atkins, Disinfector. E. C. Powell, Disinfector. S. C. West, Disinfector. E. Bridger, Drain Tester. P. W. Attwater, Motor Driver. A. T. Steward, Drain Tester. P. C. Neck, Messenger. Mrs. Wheal, Attendant, Verminous Children. Mrs. W. Jenkins, Caretaker, 15, Bessborough Street. Mrs. Ash and Mrs. Flanagan, Cleaners. In addition to the above, there are the following employed by the City of Westminster Health Society (subsidised by the City Council):— Medical Officers: *Octavta Lewin M.B., B.S., Maternity and Child Welfare. *N. Olivier Richards M.D., M.R.C.P., Maternity and Child Welfare. * Part Time Officers. 74 Medical Officers—continued. Qualifications. Miss Cove, Supt. Centre Nat. Health Dipl. Miss Callaghan, Supt. Centre H.V. Miss Miller (Midwife) C.M.B., H.V. Miss Reed, H.V. C.M B., H.V. Miss Purchase, H.V. Nat. Health Dipl. Miss Lock (Midwife) C.M.B., S.I.E.B. Miss G. Cross (Midwife) C.M.B. Mrs. Shanks Supt., Mothercraft; Registered Teacher. Mrs. Steffens Assist. Supt., Mothercraft. And 12 Honorary Visitors and Workers.