City of Westminster. ANNUAL REPORT FOR THE YEAR 1923 by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Ed., Medical Officer of Health Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJESTY, ST, MARTIN'S LANE, W.C.2. City of Westminster. ANNUAL REPORT FOR THE YEAR 1923 by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camb., F.R.S. Ed., Medical Officer of Health Printed by Order of the Council. LONDON: HA R BISON 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. 1923. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1923. It includes Returns required by the Ministry of Health and Home Office. Details of the various activities of the Public Health Department having been given in the 1921 Report, it is not necessary to do more than record any changes which have takeD place in 1923. The year 1923, as measured by the death·rate of 11·6 per 1,000, was the healthiest ever known in this country, the lowest record previously having been 12 • 1 in 1921. Westminster participated in a similar manner. The causes of this low rate of mortality are largely the comparative absence of influenza until December, the consequent smaller number of cases of respiratory diseases such as bronchitis and pneumonia, and the absence until the end of the year of measles. Diphtheria and scarlet fever were much less prevalent than in the previous year, and there was scarcely any summer diarrhoea. In consequence infant mortality reached a lower figure than in any previous year. When the serious nature of the industrial depression prevailing throughout the year is taken into consideration, the vast proportions of unemployment and the relatively high cost of living, the figures, indeed, are extraordinary, but they must not be taken as a gauge of the general good health of the nation. They show that there was an absence of a large amount of sickness from certain· causes, but there may have been ill· health of a non·fatal character, and it is not improbable that the conditions (5416)q A 2 iv mentioned above may have lowered the standard of health. There is some evidence pointing to this in the amounts paid by approved assurance societies for sickness and disablement benefits. Sickness amongst the members has steadily increased since 1920, and even in 1923 there was a slight increase in the amount of benefits paid as compared with the year 1922. On the other hand, it is to be noted that the number of new cases of Pulmonary Tuberculosis which one expects to be affected by conditions tending to a lowering of bodily resistance such as overcrowding, insufficient food, etc., continues to decrease, although perhaps not quite at the same rate as in pre·war years. The housing question is one which continues to give anxious thought throughout the country. Under the legislation passed by Parliament an increasing number of houses have been built, but many more are required. There are three essential factors which must be made effective before any increase in building can be hoped for, viz., money, materials and men. So far there has been no difficulty with the first. It has been stated recently that the County Council in the last three years had voted 22 millions for housing, but has been able to expend only 9| millions. The difficulty, therefore, seems to lie in the other two factors, viz., in the cost and sufficient supply of materials, and in the number of men available and in the amount of work they are prepared to carry out. Unless Parliament has the courage to tackle these two matters firmly it is unlikely that the deficit of houses will be wiped out for many years. The City Council has been urged during the year to build houses in Westminster, and various schemes have been worked out to give effect thereto, only to be turned down on the ground of expense. Through the generosity of the Duke of Westminster, who has given a site, the Council has been able to get one scheme sanctioned by the Ministry and accommodation for some 300 persons who require to live near their work will soon be ready for occupation. Other schemes for providing additional accommodation, such as that of the Peabody Trust, are being held up through the operation of the Rent Restrictions Act. The housing difficulty is not confined to any one class of the community, and the conversion of large houses into flats and of stables into dwelling·houses continues. There appears to be considerable demand for such premises, and the provision of such accommodation must have an effect in releasing a certain number of houses and thus relieving the downward pressure. V It has been the aim of the Council to see that houses are kept in a state of tenantable repair, and to endeavour to deal fairly between landlords and tenants so that essential matters are attended to. Attempts are frequently made to make use of the municipal authority in private disputes, and the sanitary inspectors have had to exercise a considerable amount of tact and discrimination in dealing with such cases. In no instance has any legitimate complaint been made which has not been attended to and the cause thereof remedied to the fullest extent possible. The Report gives particulars of the work carried out in connection with the Maternity and Child Welfare and the Tuberculosis schemes of the Council. In both departments a large amount of valuable work has been carried out, and the increasing demand made upon them is evidence of the appreciation with which they are regarded by those in whose interests they serve. The Report also gives information as to the supervision of food in the City and of the places where it is sold, a matter of considerable importance in a City like Westminster with a resident and working population of close on 400,000 besides many thousands of daily visitors on business or pleasure. 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, 1923 (Registrar·General's Estimate)—142,840. „ „ „ Civilian—140,430. Number of Inhabited Houses (1923)—27,199. Rateable value—£8,278,369 (September, 1923). Sum represented by a penny rate—£32,423. 2.—Extracts from Vital Statistics for the Year. Births Males. Females. Total. Birth Rate Legitimate 827 755 1;582" 12·5 Illegitimate 84 86 170 „ unregistered 3 3 6 Totals 914 844 1,758 Deaths—1,493. Death·rate—10·6. Number of women dying in, or in consequence of, childbirth:— From sepsis, 0. From other causes, 4. Number of deaths of infants under one year of age per 1,000 births—47 ·2. Legitimate rate, 42·3; Illegitimate rate, 85·7. Number of deaths from measles (all ages)—1. „ „ diphtheria—4 „ „ whooping cough (all ages)—5. ,, ,, scarlet fever—0. „ „ diarrhoea (under 2 years of age)—2. „ „ typhoid fever—1. Other particulars asked for are given in the body of the Report. A list of the staff of the Public Health Department is appended to the Report. PART I. A. STATISTICS. Population. From further Reports issued by the Registrar·General, the following information has been extracted and compared with former periods :— Birthplaces of Persons enumerated at the Census.—In London, 92 per cent, of the population were born in England as compared with 91 per cent, in 1911, about 3 per cent, in the remainder of the British Isles, nearly 1 per cent, in various Dominions and rather more than 3 per cent, in foreign countries. Female immigrants from Wales, Scotland and Ireland are in excess of those enumerated in 1911, so that the reduction has been amongst males. The difference is particularly marked in the case of Southern Ireland. Colonial immigrants have increased about 7,000, for while the numbers born in foreign countries have decreased by 28,000, precise comparison of aliens of European origin is rendered difficult on account of the change of frontiers. With the exception of Belgians, the number of nationals of countries participating in the late war have diminished, especially so in the case of enemy countries. Belgians, however, have increased from 2,109 in 1911 to 4,207. Russia still claims the largest proportion of aliens, 29,668, or about 25 per cent, of the total. Poland had nearly as many, viz., 26,923; followed by France (11,104), Italy (10,994), United States of America (6,524), Germany (5,743), Belgium (4,207) and Holland (3,435). Germans numbered 27,290 in 1911. Westminster.—According to country of origin, the population was distributed thus in 1911 and 1921:— 1911. 1921. Males. Females. Total. Males. Females. Total. England 58,623 72,009 130,632 48,769· 65,233· 113,999· Wales 912 1,208 2,120 654— 1,230 + 1,887· Scotland 1,962 2,598 4,560 1,731· 2,710 + 4,441 · Ireland 2,149 2,194 4,343 1,557· 2,659+ 4,216· Isle of Man and Channel Islands 125 159 284 113 — 173+ 286+ British Dominions 1,158 1,407 2,565 1,691 + 1,782 + 3,473+ Naturalised British Subjects 331 132 463 368+ 445+ 813+ Foreign Countries 7,943 5,102 13,043 6,411· 5,829+ 12,240— Born at Sea 1 2 3 25+ 53+ 78+ Birthplace not 731 1.506 2.237 429· 529· 958· 2 Foreigners, including naturalised subjects, were 11,831 in 1901, 13,508 in 1911, and 13,053 in 1921, giving percentages of the total population of 6·5, 9·4 and 9·2 respectively. Among Metropolitan Boroughs, the Borough of Stepney contained the largest number of aliens, over 30 per cent, of the aliens in the County and about 15 per cent, of its population. Westminster is second in respect of numbers, it was fourth on the list in 1911. Of the Metropolitan boroughs, Westminster had the largest number of natives of France, Belgium, Italy, Switzerland, and the United States. Jbrom the figures appended a comparison may be made of the distribution in Westminster of each nationality at each of the last three Censuses:— 1901. 1911. 1921. Europe— Austria 392 532 98 Belgium 323 240 480 Czecho·Slovakia — — 82 Denmark 52 82 110 Finland — — 11 France 2,249 2,510 2,014 Germany 2,031 2,166 434 Greece 21 31 82 Hungary 91 114 43 Italy 2,282 2,624 1,949 Jugo·Slavia — — 13 Netherlands 124 174 222 Norway 28 57 71 Poland 1,015 1,508 1,351 Portugal 10 18 41 Roumania — — 102 Russia 903 739 741 Spain 102 98 182 Sweden 185 171 143 Switzerland 958 937 659 Turkey 35 64 37 Others 26 61 33 Asia— Armenia — — 3 China 1 16 120 Japan 25 40 100 Others 10 6 119 Africa 25 43 34 America— United States 864 1,078 2,507 Argentina 15 70 174 Brazil 8 42 49 Chile 1 13 18 { 82 Mexico 32 Others 18 52 87 Unspecified 25 14 35 As the Census of 1921 was taken in the middle of the year, instead of in spring as previously, there were a number of visitors in Westminster at that time, of these 2,406 were of foreign origin, the majority, 1,421, were from the United States, which accounts for the larger figure given in the above list. It is necessary to include these in the estimated population, as deaths of persons whose home address is other than in England or Waies have to be reckoned as Westminster deaths. Similarly there is 3 always a proportion of infectious disease among such visitors, and also of tuberculosis. Estimated Population for 1923.—The Registrar·General estimates the population to bs 142,840, but for calculating the death rate he deducts the military population in Barracks and Hospitals, leaving 140,430 as representing the civil population. This is an increase of 1,041 over the 1922 estimate. The rates for infectious diseases, &c., are calculated on the larger figure, for births and deaths on the lower one. The proportion of males and females in the Civil population works out at 59,677 and 80,753 respectively. Births. I The number of births which took place in Westminster in 1923 was 1,361, of these the home address of 194 was elsewhere, and therefore these have to be deducted, but 585 children were born to residents of Westminster in institutions in other parts of London; adding these the net number was 1,752, a reduction of 143 on the figure for the year 1922. The fluctuations in past Years are shown below. The birth·rate was 12·5 per 1,000 persons; the London birth·rate was 20·2 and for England and Wales 19·7, both showing a decrease on the 1921 rates. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 1909 2,520 39 270 12,751 1,612 1,571 41 1910 2,365 , 49 276 [2,592 1,674 1,621 53 1911 2,110 60 311 2,361 1,562 1,507 55 1912 2,134 49 264 2,349 1,501 1,469 34 1913 1,992 35 276 2,233 1,462 1,424 38 1914 1,860 15 312 2,157 1,386 1,347 39 1915 1,721 71 329 1,979 1,292 1,250 42 1916 1,643 175 342 1,810 1,330 1,288 42 1917 1,325 159 378 1,544 1,020 985 35 1918 1,138 146 458 1,459 911 888 23 1919 1,210 98 480 1,592 1,004 977 27 1920 1,731 89 618 2,260 1,327 1,289 38 1921 1,418 78 579 1,919 1,049 1,032 17 1922 1,347 81 629 1,895 1,046 1,020 26 1923 1,361 194 585 1,752 1,045 1,016 29 Divided into legitimate and illegitimate, the figures for 1923 are :— Legitimate— Males 666· 90 + 251 = 827 Females 611· 68 + 212 = 755 Total 1,277 · 158 + 463 = 1,582 4 Illegitimate— Males 42·14 + 56 = 84 Females 42·22 + 66 = 86 Total 84 · 36 + 122 = 170 There is a reduction of 170 in the net number of legitimate births compared with the year 1922, and of 22 in the illegitimate births. The decrease affects each of the districts into which the city is divided for maternity and child welfare work. To the above figures there should be added 6 foundlings, 3 males and 3 females, whose births were not registered. The notifications received numbered 1,045, of these 659 were received from midwives. The number of still·births notified was 29, but information was received of 4 other still·births and miscarriages. Number Born. Number of Deaths under 1 year. Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Gills. 1913 1,120 1,113 Ill 102 1,009 1,011 1914 1,120 1,037 103 68 1,017 969 1915 1,006 973 103 79 903 894 1916 889 921 84 67 805 854 1917 756 788 94 64 662 724 1918 789 670 84 64 705 606 1919 786 814 74 63 712 751 1920 1,117 1,149 104 63 1,013 1,086 1921 991 928 91 63 900 865 1922 945 957 68 36 877 921 1923 914 844 44 38 870 806 5 Maternity and Child Welfare. Expectant Mothers.—The names of 802 were sent in by hospitals, voluntarily notified or found by visitors, and to these 3,064 visits were paid at their homes (see Table); 194 attended the Mothercraft Classes. Ante·natal Clinics.—112 women attended for the first time in 1923 (139 in 1920, 155 in 1921). There were 247 attendances altogether of expectant mothers at the two centres. Centre. Session First Subsequent Tota. No. of Attendance. Attendances. Individuals. Pimlico Road 50 51 80 131 57 Bessborough Street 51 51 65 116 55 170 women also attended the Clinic at Bessborough Street after confinement, making 280 attendances (85 first, 195 subsequent). Clinics are also held at Charing Cross and St. George's Hospitals, and will be at Westminster Hospital when it is reopened. Mothercraft Classes.—These exist at each Centre and are attended by mothers both before and after confinement. Notwithstanding the decrease in the number of births, the attendances at the Council's Centres show an increased attendance by the mothers. Mothercraft classes are also carried on at the Greek Street, Rochester Row and Mayfair Centres by the Health Society. These also show an increase in attendances. The total attendances at all the Centres were 4,621, compared with 3,585 in 1922. Particulars relating to these classes are given below :— Mothercraft Classes. 1923. Pimlico Road. Bessboro' Street. Rochester Row. Greek Street and Mayfair. Total. Number of classes 45 49 87 125 306 Total attendances 597 730 1,807 1,487 4,621 Average attendances 13·2 14·9 20·0 11·9 — Number of expectant mothers 22 42 87 43 194 Number of attendances by expectant mothers 88 270 748 279 1,385 Number of other mothers 32 37 55 58 182 Number of attendances by other mothers 509 460 1,059 1,208 3,236 Attendances of children in nurseries during classes 362 690 574 512 2,138 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Pimlico Road were 202; 6 at Bessborough Street, 224; at Rochester Row, 1,320; and at Greek Street and Mayfair, 1,337. In addition to which many renovations were carried out. Attendance during Confinement.—The Council's midwife attended necessitous women and emergency cases in the Pimlico area. Number of cases attended— 1923. 1922. As midwife 95 108 As emergency 7 2 With hospital students 7 5 With private doctor — 1 Total 109 116 Number of— Pre·natal visits 527 610 Lying·in visits 866 1,402 Subsequent visits 358 172 Visits to infants under 1 year other than lying·in visits 215 172 Total number of visits 1,966 2,356 Attendances at ante·natal and other clinics :— 1, Pimlico Road 41 72 15, Bessborough Street 73 62 Total 114 134 In 16 instances booked for attendance and visited, the women were unable to be confined at home on account of abnormalities or unsuitable home conditions, and were admitted to hospital. In the St. John and St. Margaret's area, the Health Society has two midwives who attend the Westminster Hospital out·door cases. The Society also does the out·patient maternity work of Charing Cross Hospital, and has two midwives for this object. Number of cases attended— Rochester Row. Greek Street. As midwife 94 — With hospital students 15 53 With private doctors 12 — 121 53 Midwifery visits 1,671 726 Nursing visits 283 · 1,954 726 7 The midwives at the Rochester Row Centre attend there once a week to interview expectant mothers. The midwives at the Greek Street Centre attend the classes at Charing Cross Hospital. Middlesx Hospital sends a midwife and maternity nurse from the hospital to its out·patient cases. A maternity ward with 11 beds has been opened in St. George's Hospital, in which 41 of the confinements which took place during the year, were Westminster cases. Similar wards are being formed in Charing Cross and Westminster Hospitals with 14 and 4 beds respectively. Other hospitals to which women were chiefly admitted for confinement were Queen Charlotte's, 76; St. Thomas, 57; General Lying·in Hospital, 56; 41, Jeffrey's Road, Stockwell, 46; Middlesex, 26; 21, Endsleigh Street, 12; and the Westminster Infirmary, 134. Puerperal Fever and Mortality in Childbirth.—Three cases of puerperal fever occurred with no death. In one the confinement took place in hospital. Four deaths occurred from complications connected with pregnancy, one due to ectopic gestation, two to nephritis and one to tumour. 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. Bessborough Street. Rochester Row. Greek Street. Total. Total Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Staff. Vol. Pre·natal— First visits 126 71 122 8 244 20 155 6 647 105 752 Other visits 87 211 113 34 398 24 299 18 897 287 1,184 Children under 1 year of age— rirst visits 341 141 281 14 453 14 300 34 1,375 203 1,578 Other visits 1,736 983 800 167 966 518 1,026 437 4,528 2,105 6,633 Children over 1 and under 5 years— Visits 2,111 1,119 1,121 473 1,114 1,329 1,027 870 5,373 3,791 9,164 4,401 2,525 2,437 696 i 3,175 1,905 2,807 1,365 J 12,820 6,491 J 19,311 6,926 3,133 5,080 4,172 19,311 To the Pimlico and Bessborough Street figures have to be added visits paid by the midwife, viz., first pre·natal 358, subsequent 527; children under 1, 215; and in the Greek Street area 243 pre·natal visits. The visits paid by the midwives of the Health Society in the Rochester Row area are included under their respective headings. In addition to the above, 45 visits were paid in cases of still·births and miscarriage and 75 in connection with enquiries regarding the deaths of young children. 8 Ophthalmia Neonatorum. Notified (three by midwives) 30 Not notified 2 Notified, but above age limit 3 35 Treated— At home— By private practitioners 14 As Hospital Out·patients 9 In hospital 12 35 At the end of the year two of the infants were still under treatment. Vision was unimpaired in the remaining 33; two of these died subsequently, one from prematurity and one from syphilis. The confinements were conducted by medical practitioners in 12 cases, by midwives in 15 and eight took place in an institution. In five instances the infants were illegitimate. In addition to these 35 cases, instances of slight inflammation of the eyes were recorded in 25 infants, and appropriate treatment secured for them. 81 visits were paid in these cases by the Health Visitors and 280 by District Nurses called in to assist. Infant Medical Inspection.—Clinics for this purpose are held at each of the Centres and show an increased attendance at Bessborough Street, Rochester Row and Greek Street. At Rochester Row Centre it has been found necessary to devote a third afternoon per week for this work. Details of attendances are given in the accompanying table. Visits were paid by Health Visitors and District Nurses as follows :— 1923. Health Visitors. Nurses. Patients. Nurses. Puerperal fevel — — Ophthalmia neonatorum and conjunctivitis 5 — — Measles 81 16 280 Diarrhcea 133 2 16 Pneumonia — 2 14 Whooping cough — 22 257 Chickenpox 65 — 15 Influenza — 2 Other complaints — 157 1,211 284 201 1,793 9 Attendances at Infant Consultations, 1923. 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 100 225 48 1,620 708 1,845 756 2,601 15, Bessborough Street 102 179 31 1,456 1,307 1,635 1,338 2,973 100, Rochester Row 106 289 58 1,775 956 1,985 1,093 3,078 60, Greek Street 49 126 24 431 223 557 247 804 357 819 161 5,282 3,194 6,022 3,434 9,456 1922 348 800 170 5,085 2,784 5,905 2,954 8,859 The average attendances per session were— 1923. 1922. 1921. Pimlico Road 26·0 27·7 31·8 Bessborough Street 29·1 * 29·1 40·5 Rochester Row 30·9 25·5 27·5 Greek Street 16·4 16·2 21·4 Ante·natal Clinics and Medical Consultations in connection withi 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 448 100, Rochester Row 639 15, Bessborough Street 453 60, Greek Street 297 10 ✓ 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 ; 93 Westminster children attended. Visits were also paid by the Health Visitors in connection with— Pimlico. Bessborough Street. Rochester Row. Greek Street. Total. Still·births and miscarriages 13 12 10 10 45 Deaths of children 27 9 17 22 75 nfectious disease 106 82 54 43 285 Total 146 103 81 75 405 Arrangements are made with the three local Nursing Associations for assistance in nursing sick children in their homes ; 1,793 visits were paid to 309 children. Dental Clinic.—The dentist, Mr. W. H. Turner, L.D.S., reports :— I am glad to report that the Dental Clinic has had another successful and busy year. The following statement gives an indication of the work done under the Maternity and Child Welfare Scheme during the last three years. 1921. 1922. 1923. Number of Sessions 52 58 59 New patients— First attendance 59 121 123 Subsequent attendances 176 463 479 Teeth extractions 525 942 1,056 Teeth filled 72 73 91 Other dental operations 188 232 343 Amesthetics— Local 17 17 20 General 81 200 202 Dentures supplied 2 5 3 "On two occasions, when it was necessary, arrangements were made— as in the previous year—for radiographs to be taken at Guy's Hospital Dental Department. "There has been a slight increase in the number of attendances to the number of patients and as this ratio is fairly high it is evident that many patients still postpone treatment far too long, with the resulting necessity for more drastic treatment when they eventually reach us. This, apparently, indicates that there is room for more dental propaganda work by the Health Visitors and Welfare Centres—with special insistence upon the importance and value of early treatment of dental defects." Of the new patients in 1923, 73 were mothers and 50 were children under 5 years of age. 11 Patients contributed £13 19s. 6d. in small sums according to their means. Dentures were supplied in 3 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; 40 mothers and children were sent to Convalescent Homes in 1923. Others were sent away through various charitable agencies. Homes.—A grant of £100 was made to the St. John the Baptist Home, formerly in Westminster, now at Tulse Hill, and £25 to the Westminster Red Cross Day Nursery. Supply of Milk.—Grants of milk free or at reduced prices were made to 74 expectant and nursing mothers and to children, 27 less than in 1922. Except in a few instances ordinary milk was granted, in the others, dried milk. The amount expended was £78 16s. Id. 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 4,312 lbs. Deaths. 1,597 deaths were registered in the City in the 52 weeks of 1923. After deducting 778 deaths of non·citizens in public institutions in the City, and adding those of 715 citizens who died in other districts, the corrected total is 1,493, as compared with 1,796 in 1922, and is equivalent to an annual rate of 10'6 per 1,000 persons. The London death·rate for 1923 was 11·2 (civilians only), for England and Wales 11·6. All the rates are the lowest on record. The number of deaths ami the death·rates per 1,000 for a series of years are shown below:— Year. Number of Deaths. London Rate. 1911 2,005 12·5 15·0 191 2 1,984 12·5 13*6 1913 2,030 12·7 14*2 1914 1,946 12·7 14'4 191 5 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*9 191 9 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 1923 1,493 10·6 11·2 The deaths of males were 756, females 737, giving rates per 1,000— 1923, males 12'6, females 9'1. These rates show an improvement in (5416)q b 12 both sexes as compared with 1922, but it is more marked among males, and the female rate is higher than in 1921. Divided into various age periods we get:— [####]1923. Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and up. Total.9/###] M. 45 6 4 9 23 86 269 314 756 F. 38 10 9 10 23 85 194 368 737 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 1923 83 16 13 19 46 171 463 682 1,493 which give rates per 1,000 estimated to be 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 2·4 5·2 18·8 92 0 14·6 1922 M 340 2·7 2·7 5·5 21·1 1000 15·6 1923 M 18·2 1·4 20 4·3 17·6 860 12·6 1921 F 28·8 2·0 11 30 10·6 60·0 90 1922 F 22·3 31 2·0 3·2 13·5 80·0 10·7 1923 F 18·0 1·3 1·4 2·7 10·7 76·4 91 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. In almost every class of disease the numbers of deaths recorded were below those recorded in 1922. The exceptions were : Cancer in males (111 against 96), nervous diseases (both sexes), kidney or bladder diseases (both sexes), rheumatic fever (both sexes), accidents (both sexes), syphilis (both sexes), alcoholism (in males). The deaths were distributed in the wards in the years 1920,1921,1922 and 1923 as follows :— {###) 1920. 1921. 1922. 1923. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Conduit 9 14 23 8 12 20 6 18 24 11 12 23 Grosvenor 47 55 102 57 50 107 56 68 124 48 47 95 Hamlet 17 31 48 18 29 47 37 29 66 29 30 59 K. St. George 48 54 102 55 55 110 64 56 120 45 56 101 Victoria 210 254 464 234 233 467 249 283 532 217 261 478 St. Margaret 62 44 106 44 37 81 52 49 101 43 37 80 St. John 198 168 366 214 162 376 240 203 443 170 166 336 St. Anne 53 44 97 47 36 83 35 30 65 39 21 60 Gt. Marlborough 19 18 37 16 12 28 19 17 36 9 15 24 Pall Mall 26 7 33 20 11 31 24 11 35 12 12 24 Regent 43 18 61 35 37 72 27 32 59 21 30 51 Charing Cross 15 11 26 28 10 38 19 7 26 18 9 27 Covent Garden 31 36 67 38 23 61 40 28 68 34 22 56 6trand 42 7 49 57 12 69 49 13 62 42 8 50 Homeless 11 8 19 26 7 33 23 12 35 18 11 29 13 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 47•2 deaths per 1,000 births, the lowest rate which has ever been reached. Had the mortality been the same now as in the 10 years 1892·1901, the deaths of infants would have been more than three times as many. The mortality of legitimate infants was only 42·3 per 1,000; in the Pimlico area this rate was still lower, viz. 36•2 figures which a few years ago would have been thought incredible. In the St. John's and St. Margaret's area it was 49, and in the Northern area 50. The averages for legitimate infant deaths during the preceding three years, 1920·21·22, was : Pimlico, 62*9 ; St. Margaret and St. John, 60·3 ; Northern, 49·5; and for the whole City, 59·0. 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 3,275 414 126 186 32 178 128 140 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 48 239 103·6 104 1918 1,234 112 86·6 225 36 155 100 108 1919 1,383 99 71·5 217 41 188 87·5 85 1920 2,047 123 60 219 44 200 73·6 76 1921 1,729 117 67·7 190 37 194 80·2 80 1922 1,703 84 49·3 199 20 100 54·6 74 1923 1.582 68 42·9 176 15 85·7 47·2 60 Five·Yearly Averages. 1892·961. — 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 (5416)Q B 2 14 In the three divisions into which the City is divided under the Maternity and Child Welfare Scheme, the figures (omitting the homeless) were :— Centre. Legitimate. Illegitimate. Total. 1921. 1922. 1923. 1921. 1922. 1923. 1921. 1922. 1923. Pimlico and Bessborough— Births 799 819 773 85 92 92 884 911 865 Deaths 58 44 28 11 7 5 69 51 33 Death·rate per 1,000 births 72·7 53·7 36·2 129 76 54·3 78·0 55·9 38·0 Greek Street— Births 373 372 340 55 59 54 428 431 394 Deaths 24 13 17 9 2 2 33 15 19 Death·rate per 1,000 births 64·3 34·9 50·0 163 34 37·0 77·1 34·5 48·2 Rochester Row— Births 557 512 469 39 41 23 596 553 492 Deaths 35 27 23 6 4 1 41 31 24 Death·rate per 1,000 births 62·8 52·7 490 153 97·5 43·4 68·7 56·0 48·7 The causes of death of children under 1 year of age are set for;h 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:— 1917. 1918. 1919. 1920. 1921. 1922. 1923. Diphtheria 1·4 Influenza — 6·81 5·62 — — 3·6 — Measles 3·9 0·68 1·87 2·21 1·0 — Whooping cough 1·9 3·4 0·62 — 1·5 1·0 1·1 Septic diseases 1·9 — — 0·44 1·4 0·5 1·7 Bronchitis and pneumonia 16·8 16·35 10·60 12·80 11·8 7·3 4·0 Stomach and bowel complaints 7·1 10·89 8·75 9·29 13·4 3·1 1·1 Syphilis 8·4 6·13 5·62 2·64 2·6 21 3·8 Congenital malformations 5·8 4·76 3·75 6·19 9·3 4·2 5·1 Prematurity 27·2 23·3 21·2 5·40 15·5 16·2 131 Neglect and injury at birth 6·7 8·17 7·50 17·07 7·3 5·7 6·8 Debility from birth and atrophy, rickets, atelectasis 13·6 8·17 11·80 1·48 110 4·2 6·2 T uberculosis 2·6 6·13 2·50 11·76 1·4 1·5 1·7 Other causes 7·4 5·45 6·90 4·34 3·6 3·6 2·6 103·6 100·24 87·5 73·62 80·2 54·6 ' 47·2 Of the 83 deaths, 24 occurred in the first quarter of the year. The third quarter is usually a heavy one on account of deaths from acute 15 diarrhoea, but this year there was only one death attributable thereto, and that was probably due to syphilis. The absence of influenza and of measles kept down the death·rate in the first half of the year The deaths in the four quarters occurred as follows :— 1923. Kmlico. St. Margaret and St. John. North. Unknown. Total. 1923. Total 1922. 1st Quarter 8 5 7 4 24 51 2nd „ 8 7 4 1 20 20 3rd „ 7 4 5 2 18 16 4th „ 10 8 3 0 21 17 33 24 19 7 83 104 It will be noted in the table below that more than half of the deaths occurred before the infants were a month old, nearly half at or within a few hours after birth. Of the deaths over a month old, a third had not come under observation of the medical officers or health visitors at the various centres, due either to the fact that the parents were in a position to obtain skilled advice, or that the children were born elsewhere and had recently come into Westminster, or illegitimate children born outside Westminster and at once sent to homes not in the City. In the last group it frequently occurs that the child has never lived in Westminster but because the mother had been in service here before going to some institution for her confinement, the death is placed to the debit of the City. Common Lodging House Deaths.—Seventy·six deaths of persons giving addresses in common lodging houses occurred during the year, mostly in institutions :— Bruce House 36 16, Strutton Ground 13 *33, Great Peter Street 2 10, Great Peter Street 21 *Hanover Court 1 40, „ „ (females) 3 * These two lodging houses were discontinued many years ago. Eleven of the deaths were from Tuberculosis. Deaths of persons who had no definite address.—Eighteen males and 11 females died for whom no address could be traced. 16 Table V.—Infant Mortality, 1923. Net deaths from stated causes at various ages under One Year of Age in the City of Westminster. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3-4 Weeks. Totr 1 under 4 Weeks. 4 Weoks 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 — — —— — — — — — — Diphtheria — — — — — — — — — Measles — — — — — — — — Whooping cough — — — — — 1 1 — — 2 Sepsis — — — — — 1 1 — 1 3 Tuberculosis — — — — — — 2 — 1 3 Syphilis — 1 — 1 2 2 1 — — 5 Meningitis — 1 — — 1 — — — 1 2 Bronchitis — — — — — — — 1 — 1 Pneumonia (all forms) — 1 — 1 2 — 1 1 2 6 Infective enteritis — — — — — — —— 1 — 1 Gastro-entcritis — — — — — 1 — — — 1 Injury at birth 5 — — — 5 1 — — — 6 Neglect at birth 3 — — — 3 — — — — 3 Murder 3 — — — 3 — — — — 3 Atelectasis 4 — — — 4 — — — 4 Congenital malformations 2 — — — 2 4 2 — 1 9 Premature birth 21 — 1 2 24 — — — 24 Malnutrition, marasmus debility from birth 1 1 2 4 6 Rickets — — — — — 1 — — 1 Accidents — — — — — — — — — — Other causes — — — — — — 2 — 1 3 Totals 39 3 1 5 48 11 14 3 7 83 Net Births in the year— Males. Females. Total. Legitimate 827 755 1,582 Illegitimate 87 89 176 914 844 1,758 Including 3 male and 3 female illegitimates unregistered. Net Deaths in the year of— Males. Females. Total. Legitimate infants 39 29 68 Illegitimate infants 6 9 15 45 38 83 In addition there were 43 still-births. The causes of death of the Illegi mate were:—Broncho-pneumonia 1, syphilis 3, neglect at birth 2, murder 3, congenital malformation 1, prematurity 4, debility from bir h 1, marasmus 1, whooping cough 1, cerebral effusion 1. 17 Table V, continued.—Infant Mortality, 1923. Net deaths from stated causes at various ages under One Year of Age in Pimlico Area ( Victoria, Kniglitsbridge St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total DeathB under One Year. Influenza — — — — — — — — — — Diphtheria — — — — — — — — — — W hooping cough — — — — — — —— — — Measles — — — — — — — — —— — Tuberculosis — — — — — — — — 1 1 Bronchitis — — — — — — 1 — 1 Pneumonia (all forms) — l — 1 2 — — — — 2 Infective enteritis — — — — — — — — — — G·astro·enteritis — — — — — — — — — — Syphilis — — — — — 2 — — — 2 Sepsis — — — — — 1 — — — 1 Injury at birth 1 — — — 1 1 — — — 2 Atelectasis 1 — — — 1 — — — — I Congenital malformations 1 1 1 — — 2 Premature birth 11 — — 1 12 — — — — 12 Want of attention at birth 1 1 l Malnutrition,marasmus and debility from birth — — — 1 1 — 4 — — 5 Murder — — — — — — — — — — Rickets — — — — — — — — — Other causes — 1 — — 1 — 1 1 3 Totals 15 2 3 20 5 5 1 2 33 Net Births in the year— Legitimate 773 Illegitimate 92 Net Deaths in the year of— Males. Females. Total./###] Legitimate infants 18 10 28 Illegitimate infants 1 4 5 18 Table V, continued.—Infant Mortality, 1923. 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. ♦5 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Diphtheria — — — — — — — — — — Influenza — — — — — — — — —— — Measles — — — — — — — — — Whooping cough — — — — — 1 1 — — 2 Sepsis — — — — — — 1 — — 1 Tuberculosis — — — — — — 1 — — 1 Meningitis — — — — — — — — — — Bronchitis — — — — — —— — — — — Pneumonia (all forms) — — — — — — — 1 — 1 Acute diarrhoea — — — — — — — — — Gastro-enteritis — — — — —• — — — — Syphilis — 1 — 1 2 — — — — 2 Rickets — — — — — — — — — — Iniury at birth 1 — — — 1 — — — — 1 Congenital malformations 1 — — — 1 3 2 _ 1 7 Premature birth 6 — 1 — 7 — — — — 7 Atrophy, marasmus — — — — — — — — — — Debility from birth — — — — — — — — —— — Atelectasis 1 — — — 1 — — — — 1 Accident Intussusception — — — — — — 1 — — 1 Totals 9 1 1 1 12 4 6 1 1 24 Net Births in the year— Legitimate 469 Illegitimate 23 Net Deaths in the year of— Males. Fema'es. Total. Legitimate infants 11 12 23 Illegitimate infants 0 0 11 19 Table V, continued.—Infant Mortality, 1923. Nett Deaths from stated causes at various ages under One Year of Age in the North District (Grosvenor, Conduit and Strand Borough Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and I under 3 Months. 3 Months and under (3 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Influenza — — — — — — — — — — Diphtheria — — — — — — — — — — Measles — — — — — — — — — — Whooping cough — — — — — — — — — — Umbilical sepsis — — — — — — — — — — Tuberculosis — — — — — — 1 — — 1 Bronchitis — — — — — — — — — — Pneumonia (all forms) — — — — — — 1 — 2 3 Infective enteritis — — — — — — — 1 — 1 Syphilis — — — — — — 1 — — 1 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 2 — — — 2 — — — — 2 Congenital malformations — — — — — — — — — — Premature birth 4 — — 1 5 — — — — 5 Malnutrition, inanition and debility from birth 1 — — — 1 1 — — — 2 Rickets — — — — — 1 — — — 1 Murder — — — — — — — — — — Convulsions; dentition — — — — — — — — — — Totals 10 — — 1 11 2 3 1 2 19 Net Births in the year— Legitimate 340 Illegitimate 54 Net Deaths in the year— Males. Females. Total. Legitimate infants 10 7 17 Illegitimate infants 1 1 2 Table V, continued.—Deaths of infants with no known address, or found in streets, parks, &c.:— causes of death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. Weeks and under 3 Months. 3 Months and under 6 Months. 6 Mouths and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Premature 1 — — — 1 — — — — 1 Meningitis — — — — — — — — 1 1 Neglect at birth 2 — — — 2 — — — — 2 Murder 3 — — — 3 — — — — 3 Totals 6 — — — 6 — — — 1 7 Males. Females. Total. Legitimate — — — Illegitimate 4 3 7 20 FEMALES. Table I.—Causes of, and Ages at, Death during the year 1923. Causes of Death. corbected deaths in the clty 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 26. 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 1 — 1 — — — — — — — — — — — — 1 — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 11 — — — — 2 — — 9 — — — 2 6 — 2 — — — 1 — — — — Whooping-cough 3 1 2 — — — — — — — 1 — — 1 — 1 — — — — — — — — Diphtheria, Memb. croup 4 — — 3 1 — — — — — — — — 2 — — — — — — 1 1 — — Cerebrospinal meningitis 1 — — — — — — 1 — — — — — 1 — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 1 — — — 1 — — — — — — — — — — — 1 — — — — — — — Diarrhœa, enteritis 1 1 — — — — — — — — — — — 1 — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever — — — — — — — — — — — — — — — — — — — — — — — — Other septic diseases 6 — — — — — 2 3 1 — 3 — 1 1 — 1 — — — — — — — — Syphilis, &c. 1 1 — — — — — — — — — — — 1 — — — — — — — — — — Diabetes Rheumatic fever 6 5 — — — — — 1 2 4 4 — 1 1 — 3 4 — 1 1 — — — — — — — Tuberculosis of the respiratory system 35 — — 1 2 7 11 12 2 — 1 — — 14 1 12 — 1 1 2 — 1 1 1 Non-pulmonary tuberculosis 12 3 2 2 1 — 4 — — — — 2 1 4 — 4 1 — — — — — — — Malignant growths 126 — — — — — 16 53 57 2 10 7 8 37 8 31 3 3 4 6 3 3 — 1 Congenital debility, malformation, and premature birth 26 26 — — — — — — — — 1 1 6 2 9 — 1 1 9 — 2 — 1 Old age 49 — — — — — — 1 48 1 — 1 6 19 3 14 — — — 3 — — — 2 Meningitis and conrulsions 4 1 1 — 1 — 1 — — — — 1 — 1 — — — — — — 1 1 — — 21 FEMALES.—Table I. (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Co vent Garden. Strand. Homeless. Loc. ataxia and general paralysis 6 — — — — — 2 3 1 — — 1 1 9 — 1 1 — — — — — — — Other diseases of nervous system 17 —— — — — 1 4 7 5 — 1 — 1 8 — 3 1 — 1 1 — — — 1 Valvular diseases of heart 21 — — — — — 2 8 11 — 1 1 — 9 1 6 — 1 1 — — — — 1 Other circulatory diseases 146 — — — 1 — 8 42 95 2 11 4 18 42 9 31 1 3 2 10 2 1 3 — Bronchitis 79 — — — 1 — 1 12 65 3 9 3 6 25 — 23 5 2 1 2 1 5 3 3 Broncho-pneumonia 16 — 1 1 1 1 2 3 7 1 2 — 1 5 1 5 — 1 — — — 3 — — Pneumonia, other forms 23 2 2 — — 2 4 7 6 1 3 1 — 9 — 7 — — 1 — — — — — Other respiratory diseases 10 — — — — — 2 2 6 — 1 2 1 3 1 1 — — — 1 — 1 — — Alcoholism 2 — — — — — 1 1 — — — — — 1 — — — — — — — — — — Cirrhosis of liver 3 — — — — — — 1 2 — — — 2 — 1 — — — — — — 1 — — Appendicitis and typhlitis 3 — — — 1 — 1 1 — — — 1 — 1 — — — — — — 1 — — — Other digestive diseases 18 — — — — — 6 5 7 — 1 — — 8 1 5 1 1 — — — — 1 — Bright's disease, &c. 37 — — — 1 2 0 11 21 — 2 1 4 20 3 2 3 1 — — — 1 — — Cystitis, &c. 7 — — — — — — 3 4 — 1 — — 4 — 1 — — — — — 1 — — Accidents and diseases of parturition 4 — — — — 1 2 1 — — 1 — — 2 — 1 — — — — — — — — Deaths by accident or negligence 23 — — 1 — 4 4 6 8 — 1 — 2 12 1 3 2 1 — 1 — — — — Deaths by suicide and murder 10 1 — — — 1 3 3 2 1 1 1 1 3 1 — — — — — — 1 — 1 Other defined diseases 20 2 — 1 — 2 6 6 3 1 2 2 1 6 4 1 1 — — 1 — 1 — 1 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 737 38 9 9 11 23 85 194 368 12 47 30 56 261 37 166 21 15 12 30 9 22 8 11 22 MALES. Table I.—Causes of, and Ayes at, Death during the year 1923. 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 — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 9 — — — 1 — — 3 5 — 2 — 2 — 2 2 — — — 1 — — — — Whooping-cough 2 1 — 1 — — — — — — — — — — 1 1 — — — — — — — — Diphtheria, Memb. croup — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal meningitis — — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhœa, enteritis 1 1 — — — — — — — — — — — 1 — — — — — — — — — — Erysipelas 1 — — — — — — 1 — — — — — — — 1 — — — — — — — — Other septic diseases 8 1 — — — — — 4 3 — — 1 1 1 — 2 — 1 1 — — — 1 — Syphilis, &c. 5 4 — — — — — 1 — — — — — 1 — 3 — 1 — — — — — — Diabetes 5 — — — — — 1 2 2 — — — — 3 1 — — — — 1 — — — — Rheumatic fever 2 — — — — 1 — — 1 1 — — — — — — — — — — — 1 — — Tuberculosis of the Respiratory System 68 — — — — 8 22 30 8 2 5 1 3 22 — 17 3 — 1 1 — 5 8 — Non-Pulmonary Tuberculosis 4 1 — — 2 — 1 — — — 1 — — — — 1 1 — — 1 — — — — Malignant growths 111 — — — — — 6 58 47 1 9 7 8 31 9 21 7 1 — 2 4 5 6 — Congenital debility, malformation, and premature birth 29 28 1 — — — — — — — 3 — 2 14 2 5 1 — — 1 — 1 — — Old age 25 — — — — — — — 25 — 1 — — 11 1 4 1 — — 2 — 1 4 — Meningitis and convulsions 4 1 — — — 1 — 1 1 — 1 — — 3 — — — — — — — — — — 23 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. G-rosvenor. Hamlet of Knightsbridge. Knightsbridge St. G-eorge. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Kegent. Charing Cross. Covent Garden. Strand. Homeless. Ioc. ataxia and general paralysis 7 — — — — — 2 4 1 — — — — 2 — 3 — — 1 — — — — 1 Other diseases of nervous 14 — — — 1 — 2 6 5 — — — — 4 1 4 — 1 — — 1 3 — — Valvular diseases of heart 17 — — — — 1 1 6 9 — 1 — — 5 2 4 1 — — — 2 1 1 — Other circulatory diseases 148 — — — 1 3 16 51 77 2 8 8 13 33 7 39 6 5 3 4 4 4 9 3 Bronchitis 68 — 1 — — 1 5 12 49 1 5 1 3 22 — 19 4 — — 1 2 3 5 2 Broncho-pneumonia 20 4 2 1 — — 1 5 7 — 1 1 1 9 — 1 1 — 1 2 1 1 1 — Pneumonia, other forms 29 — — — 1 — 3 16 9 — 1 — 3 8 3 8 2 — — 1 — 1 1 1 Other respiratory diseases 4 — 1 — — — — 3 — — — — — 2 — — 1 — — — — 1 — — Alcoholism 4 — — — — — — 3 1 — — — — 3 1 — — — — — — — — — Cirrhosis of liver 8 — — — — — 1 2 5 — 3 — 2 1 — — 1 — — — — 1 — — Appendicitis and typhlitis 5 — — 1 — — — 3 1 — — 1 — 2 — 1 1 — — — — — — — Other digestive diseases 22 — — — — — 7 7 8 — 3 — 1 3 5 4 2 — 1 1 — 1 — 1 Bright's disease, &c. 30 — — — — — 5 12 13 1 — 1 4 10 — 7 3 — — 1 — 1 — 2 Cystitis, &c. 28 — — — — — 1 6 21 — 1 1 — 4 5 8 2 — — — 3 1 2 1 Deaths by accident or negligence 39 — — 1 2 6 5 15 10 2 1 3 1 14 3 8 1 — 2 — 1 1 2 — Deaths by suicide and murder 21 2 — — — 1 6 8 4 1 1 3 1 3 — 3 1 — 2 1 — 1 2 2 Other defined diseases 18 2 1 — 1 2 1 8 3 — 1 1 — 7 — 4 — — — 1 — 1 — 3 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 756 45 6 4 9 24 86 267 315 11 48 29 45 219 43 170 39 9 12 21 18 34 42 16 24 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. 1921. 1922. 1923. 1921. 1922 1923. Small-pox — — 1 Ophthalmia neonatorum 25 25 52 Diphtheria 248 285 91 Measles 26 591 131 Erysipelas 53 37 34 German measles 9 11 42 Scarlet fever 681 261 129 Pneumonia 62 48 60 Enteric fever 10 12 18 Malaria 1 — — Continued fever — — — Dysentery — — — Puerperal fever 10 7 3 Anthrax — 1 — Cerebro-spinal meningitis — 4 1 Chicken-pox 119 178 169 Mumps 278 25 95 Encephalitis lethargica — 2 2 Whooping cough 133 67 35 Polio-myelitis — 1 1 Small-pox.—This disease, which caused a considerable amount of anxiety in 1922, continued to increase in amount in 1923 in various parts of England. The number of cases in each of the last 7 years is given as:— 1917 7 1920 280 1918 63 1921 336 1919 311 1922 973 1923 2,500 The counties chiefly involved were Gloucester, Derby, Nottingham and the West Riding of Yorkshire. The disease as it appeared in those districts was of a very mild type and it is probable that a number of cases were not recorded. So far this type has not yet invaded London, but as not much attempt is being made to prevent its continuance, it is not improbable that it will spread to other localities. So long as people prefer to pay the heavy cost of interference with business, of the provision of hospital accommodation and maintenance and of various other outlays involved, instead of availing themselves of vaccination, the disease will continue until the supply of unprotected persons is exhausted. London has, however, been invaded on two occasions by a more virulent form of small-pox, imported from Spain. On one of these occasions a lady arrived at a hotel in Westminster and shortly after became ill, but refused to see a doctor. At the end of a week she left to stay with friends in the suburbs ; three relatives developed small-pox and one died. After she had left the hotel a resident employee fell ill with it, and a chambermaid who had left the hotel in the interval, a non-resident porter and a clerk at business premises near by also developed the disease. Not knowing that the lady's illness was of an infectious character, the proprietor of the hotel did not have the room disinfected before allowing other persons to occupy it, with the result that a gentleman who was the next occupant took ill with small-pox soon after his return to his home in the country. In all, only 12 cases appear to have supervened. 25 City of Westminster.—Cases of Infectious Disease Notified during the Year 1923. Notifiable Diseases. At all Ages. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Small-pox 1 — — — — — — — — 1 — — — 1 — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 80 1 7 6 12 6 12 6 7 18 5 — — 78 2 4 — — 1 2 — 1 — — — — — — Erysipelas 34 — — — — — 1 2 1 4 8 11 7 11 23 1 — — — — — — — — — — — 1 Scarlet fever 121 — 4 4 11 13 35 15 16 20 1 2 — 117 4 — — — — — — — — — — — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 18 — — — — — 3 — 2 10 — 2 1 16 2 1 — — — — — 1 — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 3 — — — — — — — — 2 1 — — 3 — — — — — — — — —- — — — — — Cerebro-spinal meningitis — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — Polio-myelitis 1 — — — — — — — 1 — — — — 1 — — — — — — — — — — — — — — Encephalitis lethargica 2 — — — — — — — — 1 — 1 — 2 — 2 — — — — — — — — 1 — 1 — Ophthalmia neonatorum 30 30 — — — — — — — — — — — 12 18 — — — — — — — — — — — — — Pneumonia 60 1 3 — — — 6 4 3 13 5 19 6 52 8 52 2 2 — — — — 1 — 6 2 24 15 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — —— — — — — — — — — — — — — — — — — — — — — — Trench fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 350 32 14 10 23 19 57 27 30 69 20 35 14 293 57 61 2 2 1 2 — 2 1 — 7 2 26 10 Correction has been made for errors in notification or revision of diagnosis in 32 cases. Cases not notified :— Ophthalmia neonatornm, 2 cases. Diphtheria, 11 cases, ages 1 2, 4, 5, 6, 6, 9, 20, 27, 40, 50. Scarlet fever, 8 cases, ages 2½,4, 5, 6, 8, 15, 19, 19. Cerebro-spinal, 1 case, age 54. 26 City of Westminster.—Infectious Diseases, Distributed in each Ward Notifiable Diseases. 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. Small-pox — — — — — — — — — — — — 1 — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — Diphtheria 3 7 6 23 1 20 1 3 6 2 1 10 — 7 1 Erysipelas — 3 4 9 — 13 2 — 2 — — — — 1 — Scarlet fever 3 1 16 36 6 29 4 1 7 6 3 4 — 12 — Typhus fever — — — — — — — — — — — — 1 — — Enteric fever — 5 — 5 1 2 — 1 1 — 1 — — 1 1 Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — — — 1 — 1 — — — — — 1 — — — Cerebro-spinal meningitis — — 1 — — — — — — — — — — — Polio-myelitis — — 1 — — — — — — —— — — — — — Encephalitis Lethargica — 1 — 1 — — — — — —— — — — — — Ophthalmia neonatorum — — 1 14 — 10 — 1 2 1 — — — — — Pnoumonia 1 2 7 21 1 20 1 — — 1 1 1 — 1 — Malaria — — — — — — — — — — 1 1 2 2 — Dysentery — — —— — — — — — — — — — — — — Trench fever — — — — — — — — — — — — — — — Totals 7 19 35 111 9 95 8 6 18 10 7 17 4 24 2 27 The close co-operation which exists between the Medical Officers of the Metropolis, and surrounding districts, of the County Council and the Ministry of Health leads to a rapid discovery and the keeping under observation of persons who have been in contact with small-pox, and it is due to the prompt measures which are undertaken by these various Officers that such an outbreak was kept within such small limits. Information was received of 174 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:— Primary vaccinations 1,409 Re-vaccinations 314 These figures do not include private vaccinations. Unvaccinated infants in 1920 and 1921 were 21 per cent. In 1922, primary vaccinations exceeded the possible by 50, about 3 per cent. In 1923, about 17 per cent, were unvaccinated. One child died some weeks after being vaccinated from septic infection of the wound. Vaccination was not done by the Medical Officer of Health under the Public Health (Small-pox Protection Regulations, 1917). Scarlet fever.—This disease was less prevalent than in 1922. No deaths resulted. Diphtheria was much less prevalent than in the three preceding years and caused 4 deaths. Antitoxin was supplied free to medical men in 62 cases, at a cost of £35 5s. 0d., and 281 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. Typhoid Fever.—Twenty-one cases of this disease were notified, but 2 cases eventually proved not to be typhoid, and 7 were cases of paratyphoid fever. One person not notified in Westminster was an inmate of an asylum and died there. Eight patients (7 typhoid and 1 paratyphoid) contracted the disease before coming to Westminster. There was a history of shellfish having (5416)Q c 28 been consumed in 5 cases and 1 case of paratyphoid was ascribed to handling cultures in a bacteriological laboratory. One death occurred. Examination of the blood was made in 6 suspected cases. Influenza.—This was certified as the cause of 20 deaths (against 95 in 1922), 9 males and 11 females, 3 in persons aged between 45 and 65 and 14 over 65 years of age. Cerebrospinal Fever.—One case occurred and was fatal. Poliomyelitis.—One case occurred. Encephalitis Lethargica.—Two cases occurred, both females, aged 23 and 56. Both proved fatal. Measles.—Every second year measles assumes epidemic form. In 1921 only 26 cases were known, in 1922 591 cases were noted, in 1923 there were 131 cases with only 1 death. The cases were distributed 38 in the first quarter, 52 in the second, 13 in the third, and 28 in the fourth. An increase in the last quarter is unusual and suggests that it is an early beginning of the 1924 outbreak, which in the ordinary course will be more extensive than that of 1923. Of the 131 cases, 29 were admitted to hospital (13 in M.A.B. Hospitals, 16, mostly adults, in the London Fever Hospital). 133 visits were paid by Health Visitors, and in 2 cases District Nurses were called in and paid 16 visits. There were also 42 cases of Kubella (rose rash or German measles), 3 of whom were treated in hospital. Diarrhoea and Enteritis.—Two 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. Both of the above deaths were infants, one due to inability to digest anything, the other to improper feeding and want of attention, the mother refused assistance from the Health Visitors. Whooping Cough.—Only 40 cases were recorded, but 5 deaths occurred. Four cases were treated in hospital (3 M.A.B., 1 Infirmary). 29 Chicken-pox was prevalent during the year, 169 cases being notified chiefly from schools. Two were treated in hospital. Mumps.—Ninety-five cases were recorded. Two were treated in hospital. Puerperal Fever and Ophthalmia Neonatorum.—See above, under Maternity and Child Welfare. Plague and Cholera.—Intimation was received of 14 persons coming into Westminster from places where plague had occurred and one from a cholera-infected port. (5416)q c 2 30 Tuberculosis. In 1923, 254 new cases of pulmonary disease were notified and 14 persons died who had not been notified in Westminster, a total of 268. Non-pulmonary forms of tuberculosis gave 56 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 1923 111 114 42 1 268 24 32 56 324 [Military ciaes which were ex-luded during the war were again mide 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 5.2 per cent, of the total, non-pulmonary 14.2 per cent. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922 1923. Pulmonary 46 40 31 35 41 27 33 20 26 14 Non-pulmonary 13 24 21 10 14 8 7 7 12 8 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 shortness of the illness and difficulty of diagnosis. Included are 3 deaths from ordinary or generalised tuberculosis, one of which had been notified as typhoid fever. One medical practitioner was cautioned for failing to notify. 31 Tuberculosis, 1923. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. 0 — — 2 4 — — 1 3 1 — 1 2 6 — 1 — 4 5 1 5 8 5 — 1 2 — 10 2 2 — 5 — 1 — 1 15 7 5 — 4 4 3 — — 20 18 18 4 2 4 4 — — 25 29 44 2 5 6 5 1 4 35 42 15 4 — 16 6 — — 45 33 8 2 — 16 6 — — 55 13 14 — 1 14 6 — — 65 and upwards 8 3 — — 8 2 — — Totals 153 115 24 32 68 35 4 12 In this Table all primary notifications are included, and also other new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the year. In addition to the deaths mentioned in the above table, six males died who had been notified in the past as suffering from tuberculosis : the cause of death was certified to be cancer of lung (age 54), aneurism (age 58), syphilis of lung (age 52), bronchiectasis (age 17) (in none of the above was tubercle found post-mortem), broncho-pneumonia (age 44), and acute pneumonia (age 53). One female notified in 1904, in whom the disease had been arrested for many years, died from angina pectoris. Of the males, 28 of the deaths in the above table, and of the females 16, were new cases in 1923. The remaining deaths, 40 males and 19 females, had been notified in previous years :— 1908, 1909 and 1911, 1 each; 1915 and 1917, 2 each, all males; 1918, 4 males, 1 female ; 1919, 8 males, 1 female ; 1920, 3 males, 2 females ; 1921, 6 males, 2 females ; 1922, 12 males, 9 females. Two persons (1 male age 31 and 1 female age 20), notified in 1923, died after leaving Westminster. Nationality of Patients.—As usual, many nationalities were represented among those notified in 1923 ; 280 were born in England, 15 in Ireland, 2 in Scotland, 2 in Wales and 3 in British Dominions ; 22 were of foreign origin:—Italian 4, French 3, Russian 3, Polish 3, Swiss 2, Portuguese, Austrian, German, Spanish, Belgian, Roumanian and Chinese, 1 each, 32 Tuberculosis Dispensary.—The Tuberculosis Medical Officer (Dr. Shinnie), in his annual report, states : " There has been a considerable increase in the number of new patients examined. This is partly accounted for by new patients being found in the wards of the Infirmary. There was a total increase of 108 over the previous year. The Infirmary accounts for 60, some of whom would have been examined in the ordinary course on discharge from that institution. Another source of increase seems to lie in the number of contacts. In 1922 183 were examined, and in 1923 the number increased to 245, a difference of 62. The total of old patients attending was slightly less—800 as compared with 825 in 1922. This is due to school children having been transferred to the School Medical Officer during 1922 ; formerly they were under supervision at the Dispensary. Under the L.C.C. scheme of 1922, school children who no longer exhibited signs of active tuberculosis ceased attendance at the Tuberculosis Dispensary, and came under the care of the School Medical Officer. The total number of individuals (old and new) attending during the year was the largest since the Dispensary was established, namely, 1,329. Total attendances were less—3,133—which means that on the average patients were attending at less frequent intervals. This is suggestive of a higher state of health generally. Administrative and clerical duties figure largely in the routine of tuberculosis work. Reports to Public Authorities and to Medical Practitioners increased from 1,554 to 1,652. Consultations with medical practitioners in regard to the diagnosis and progress of cases occur more frequently as years go on. They increased from 181 to 209. This is an indication that the Dispensary has achieved one of the chief purposes for which it was established, namely, to be of assistance to the general practitioner in dealing with cases of tuberculosis. The total number of new cases notified in the city during 1923 numbered 324, and the Dispensary dealt directly with 197 of those. The figure 324 includes 70 cases who died within the year 1923. Some of them were not notified, the cause of death being certified as tuberculosis. Others died within one month of notification. Others died within one month of notification. The following table indicates in detail the proportion dealt with by the Dispensary (set out in brackets):— Pulmonary Tuberculosis. Other Forms. Common Lodging-house. 225 (157). 56 (12). 43 (28). =69.7 per cent. = 21.4 per cent. = 65 per cent. 33 Of the total 324 cases 60.8 per cent, were examined by the Council's Tuberculosis Officer. Last year the corresponding percentage was 45. It will thus be seen that there has been a very pronounced tendency for the Dispensary to extend its activities in getting in touch with all cases of tuberculosis notified for the first time in the city. If one may deduct the cases which died within four weeks of notification, together with the few asylum and military hospital cases, numbering in all about 50, the Dispensary is found to have dealt with more than 70 per.cent. of the total of new cases of tuberculosis in the city. It is extremely important that the Tuberculosis Officer, although not necessarily responsible for the treatment of individual cases, should have direct personal knowledge of them. His duty should be to see that adequate treatment is being given to all cases, whether by panel or private medical practitioners, or at hospitals. It is therefore most satisfactory to record such an increased proportion of the total new cases being examined by him. A type of case which is difficult to follow up is found among the inmates of common lodging-houses. Many of those seek treatment in the Infirmary when in an advanced stage of the disease. Since May a very large proportion of those cases has been examined in the Infirmary. A good deal of information has been obtained concerning them, and in a few instances sanatorium treatment has been arranged. In those few cases the possibility of cure from sanatorium treatment has raised fresh hopes when the prospect seemed to envisage a cycle of common lodging houses and casual wards. In the report of 1922 a suggestion for closer co-operation with the Guardians was alluded to. The Council, acting on the suggestion of the Ministry of Health, made arrangements with the Guardians by which the Tuberculosis Officer should act as consulting physician to the tuberculosis wards of the Infirmary. He has visited the Infirmary once a week since the beginning of May, and in consultation with Dr. Sandiland, the Medical Superintendent, has examined cases there. This may be considered to be the most important departure in the Council's Tuberculosis scheme since it was established in 1916. Cases requiring urgent hospital treatment are now admitted to the Infirmary without delay. Formerly, matters would have had to take their course at home whilst patients were awaiting accommodation under the County Council. The County Council now arrange to transfer patients direct to sanatorium from the Infirmary if their physical condition shows sufficient improvement. By courtesy of the Medical Superintendent, the Tuberculosis Officer has also been able to keep certain patients under personal observation in the Infirmary pending diagnosis. Thus the period of waiting for a sanatorium bed, which, is so trying for a consumptive, is largely eliminated. It is found that patients are less unwilling to enter the Infirmary than heretofore. Cases of advanced disease, with whom the 34 Tuberculosis Officer is in touch, are becoming much more amenable in regard to admission. It is extremely important that those cases should not remain at home on account of the lack of nursing and the possibilities of spreading infection. The tuberculosis wards are extremely well ventilated, bright and airy, and it is satisfactory to record that several patients who were admitted in a grave stage of the disease were discharged after several manths' treatment, fit to resume their occupations. In the Infirmary during the autumn an extended trial was given to a vaccine, prepared on similar lines to that introduced by Professor Dreyer. The results obtained were comparable to those given by the older preparations of tuberculin. In no case could it be declared that a cure had been effected, although in patients who had already acquired a measure of resistance there was an increased sense of well-being. Greater success in treatment would certainly be achieved if sheltered balconies or verandahs were available at the Infirmary. During six months of the year continuous rest in the open air does more to combat the poisoning of the system by tuberculosis than any drug. Sixty new patients were examined in the Infirmary during the six months following the appointment of the Tuberculosis Officer. 12 were recommended to the L.C.C. for transfer to sanatorium : 8 of those availed themselves of sanatorium treatment. 24 patients were admitted to the tuberculosis wards on the recommendation of the Tuberculosis Officer; 4 patients were admitted for observation. The Tuberculosis Officer paid 28 visits to the Infirmary, and saw or examined 456 patients. During the year 529 new patients were examined at the instance of:— — Insured. Non-Insured. Total. Males. Females. Males. Females. Boys. Girls. Medical Practitioners 69 53 3 26 16 9 176 Health Visitors 13 11 2 37 34 43 140 Infirmary 35 11 1 10 0 3 60 Ministry of Pensions 19 0 9 0 0 0 28 School Medical Officers 0 0 0 0 7 2 9 Hospitals 3 1 0 2 0 2 8 Westminster Health Society 0 0 0 2 5 2 9 Invalid Childrens' Aid. Association 0 3 0 0 1 0 4 British Red Cross Society 2 0 1 0 0 0 3 Jewish Organisations 1 0 2 2 1 1 7 Other sources: parents, friends, etc. 12 6 4 16 30 17 85 Totals 154 85 22 95 94 79 529 35 Recommendations for institutional treatment to the L.C.C.:— Insured— Hospitals. Sanatoriums. Males 53 23 Females 15 9 Uninsured— Males 3 2 Females 10 8 Boys 0 5 Girls 3 0 84 47 Dispensary Statistics. 1923. 1922. 1921 . 1920. 1919. Persons attending for 1st time 529 421 609 592 607 Old patients attending 800 825 588 561 490 Individuals who attended 1,329 1,246 1,197 1,153 1,097 Contacts examined 245 183 281 221 139 Total attendances 3,133 3,275 3,695 5,267 4,882 Written medical reports to public authorities 1,300 1,154 1,169 1,284 1,439 Do. To medical practitioners, &c. 352 400 440 410 302 Consultations with medical practitioners at houses of patients.. 209 181 178 92 79 Other visits paid by medical officer 227 315 320 165 96 Visits by health visitors to dispensary cases 4,717 4,995 4,941 4,767 4,159 Sputum examinations 360 327 308 239 255 X-Ray 5 16 28 30 12 The number of persons under Dispensary supervision excluding domiciliary patients at 31st December was 425. The number of insured persons under domiciliary treatment at 31st December was 720. References to affiliated hospital in the year were 32." 36 Tuberculosis.—Notifications received during the period from 31st December, 1922, to 29th December, 1923. 1923. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Casuals— Males — — — — 1 4 8 15 9 2 2 41 42 Females — — — — — — — — — — — — 0 General— Males — — 1 2 6 13 21 25 22 9 4 103 129 Females — 1 5 2 5 18 44 15 8 11 1 110 133 Non-pulmonary— Males 2 2 7 — — 4 1 4 2 — — 22 25 Females 2 3 5 5 4 2 4 — — 1 — 26 26 Total 4 6 18 9 16 41 78 59 41 23 7 302 355 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 — — — — 1 22 127 3 65 Females — — — — — 2 76 — 24 Non-pulmonary— Males — — — — — — 11 — 7 Females — — — — — — 12 — 8 Total — — — — 1 24 226 3 104 37 Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1923. Age Periods. Number of notifications on Form A. Primary notifications. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total. Pulmonary— Casuals— Males — — — — — — — 1 — — 1 Females — — — — — — — — — — 1 1 General— Males — — — — — 1 — 2 1 2 2 8 Females — — — — — — — — — 3 1 4 Non-pulmonary— Males — — 1 — — — 1 — — — — 2 Females 2 3 — — — — 1 — — — — 6 Total 2 3 1 — — 1 2 2 2 5 4 22 C.L.H. General. Non-pulmonary. Total. Notified pulmonary 41 213 4 8 302 Not notified in Westminster 2 12 8 22 Total 43 225 56 324 38 Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1923. All Ages. Conduit. Grosvenor. Knights- bridge 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 during , 1923. Pulmonary— Common Lodging-houses, ' &c.— Males 43 — — — — 3 17 — — — — — — 19 — 4 37 Females 1 — — — — — — — — — — — — — — 1 1 General— 111 2 12 7 43 3 33 1 — 4 3 1 1 — 1 — 79 Males Females 113 — 4 4 43 2 32 3 1 4 4 2 2 2 10 — 71 Non-pulmonary— 24 — 2 1 9 — 8 — — 1 — — — — 3 — 23 Males Females 32 — 1 4 11 — 9 2 — — 1 — 1 — 3 — 24 324 2 19 16 106 8 99 6 1 9 8 3 4 21 17 5 235 Insured. Ex-Service. Army. Police. Hospital Nurses. Asylum. 111 previously. Pulmonary— Males 83 60 2 — — 3 46 Females 50 — 1 — 1 1 35 Non-pulmonary— Males 5 1 — — — 1 3 Females 2 — — — 1 — 5 140 61 3 — 2 5 89 39 The estimated net expenditure on the Dispensary Service for the 12 months ending March, 1924 is £1,778. For the three preceding years the actual net expenditure was 1920-21, £2,122 ; 1921-22, £1,794 ; 1922-23, £1,385 17s. 10d. The total number of cases of tuberculous disease on the Register at the end of 1923 was 1,682 as compared with 1,589 at the end of the year 1922. Pulmonary. Nonpulmonary. Total. General. Casuals. December, 1922 1,140 101 348 1,589 New eases, 1923 225 43 50 324 Old cases returned to Westminster 3 — — 3 Total cases on Register during 1923 1,368 144 404 1,916 Died during 1923 99 11 16 126 Moved 91 — 17 108 Remaining at end of 1923 1,178 133 371 1,682 In addition to those who moved out of the City, 59 changed their addresses in the City during the year, casuals not being included. Home Visiting.—The Tuberculosis Medical Officer paid 436 visits during the year to patients at their homes. The number of visits paid in previous years was :— 1919 175 1921 498 1920 257 1922 496 The Health Visitors paid 5,412 visits, 4,717 of these being to persons attending the Dispensary (in 1922, 5,278 and 4,995 respectively); 596 visits were paid to ex-service men. Extra Nourishment.—Fifteen 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 £49 7s. 5d. Dental Treatment— Eleven patients received dental treatment at the Council's expense, necessitating 62 attendances, at which 103 teeth were extracted, 5 teeth filled and 60 other dental operations performed. General anaesthetics were administered on 15 occasions. Two dentures were provided and fitted. The Council contributed £3 towards the cost. Special Treatment.—Five patients had 54 pneumo-thorax refills at a cost of £28 7s. and one patient had X-ray treatment at a cost of £1 5s. 40 X-Bay Examinations.—Plates were taken by this method in five instances at the Council's expense. A number of other cases were examined in this way at various hospitals. Bacteriological Diagnosis.—Sputum was examined in 578 instances, 300 being specimens sent from the Dispensary and 218 from private practitioners. The cost was £79 10s. 5d. Sale of Milk by persons suffering from Tuberculosis.—There is no legal power by which a person who is in an infective tubercular condition can be prevented from selling milk, either in a shop or on a round, whereby milk may readily be infected. The Medical Officer of Health is prohibited from informing a milk dealer that a person in his employ is in such a condition. The only course open is to persuade the employee to change his occupation. The question has been under the consideration of the various Metropolitan Borough Councils and the Minister of Health has been asked to issue an Order empowering Local Authorities responsible for administering the Tuberculosis Regulations to prevent infectious tuberculous persons from engaging in any occupation connected with the milk trade that would be likely to result in the milk becoming infected. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1916 annual 164 124 37 27 201 151 1917 „ 194 147 29 22 223 169 1918 „ 186 148 31 24 217 173 1919 „ 134 105 21 16 155 121 1920 „ 139 97 18 12 157 109 1921 „ 120 84.9 15 10.6 135 95.5 1922 „ 144 103.3 21 15 165 118.3 1923 „ 103 73.3 16 11.3 119 84.7 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 were 97.1 and 18.7 respectively, giving a total rate of deaths from Tuberculosis of 115'8. The death-rates for males and females in Westminster for 1920, 1921, 1922, and 1923 calculated were per 100,000 population:— 41 Males. Females. 1920. 1921. 1922. 1923. 1920. 1921. 1922. 1923. Pulmonary 131 125.6 136.6 113.4 76.3 53.8 78.1 43.4 Non-pulmonary 9.6 11-.4 19.9 6.6 14.5 9.9 11.3 14.8 Total 140.6 137.0 156.5 120.0 90.8 63.7 89.4 58.2 Bacteriological Laboratory. Examinations were made as follows:— Swabbings from throats in suspected diphtheria 281 Blood in suspected typhoid 6 Sputum for tuberculosis 578 The expenditure on the first two was £40 3s. 5d., and for tuberculosis £79 10s. 5d., including cost of outfits, postage, and telegrams in both instances. Disinfection. The number of articles treated was:— 1918. 1919. 1920. 1921. 1922. 1923. Rooms 722 941 1,196 1,502 1,179 742 Articles disinfected 153,048 50,496 49,542 31,654 28,709 21,933 Articles washed 6,551 5,759 7,185 6,766 7,355 8,679 Articles destroyed 3,048 543 70 38 105 173 Books disinfected 4 77 42 212 173 215 Vehicles 1 2 5 1 8 3 The motor van during 1923 ran 3,415 miles and carried 3,293 cwt. of goods, the highest amount in any one day being 36 cwt. The petrol consumption was 382 gallons, equal to nearly 9 miles per gallon. Cleansing of Persons.—The number of Westminster persons suffering from head and body lice treated at the cleansing station was 690, again an increase over the preceding year. 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 218 for head lice, 14 for body lice, and 5 for scabies, and are included in the following summary:— Head lice. Body lice. Scabies. Total. Children 864 26 48 938 Adults 13 69 21 103 877 95 69 1,041 42 All the lice cases were dealt with at the station, but 29 of the scabies cases were treated at home. Each case implies a number of attendances far 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; these amounted to 3,654 articles. The 864 children suffering from head lice had treatment on 1,126 occasions, the 26 with body lice had 72 treatments, and 40 with scabies had 182 baths at the station. In dealing with the Westminster cases, 1,641 visits were paid to the houses by the Disinfecting Superintendent, an increase over 1922. Verminous Houses.—8 rooms were disinfected, and from 35 houses 752 articles were removed for disinfection and 117 for destruction. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 336; in 1 instance on account of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 318 cases, and there were 7 adjourned inquests. Post-mortem examinations were made in 173 instances. Seventeen bodies were received in the mortuary chapel to await burial. 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 1923 336 318 17 There are resting places for the dead at Drury Lane, Ebury Bridge, and Dufours Place, but no use was made of them during the year. The increase in the number of inquest cases appears to be due in large measure to traffic accidents. 43 PART II. C.—Housing, House Inspection, etc. Both the Housing and the Public Health Committees interviewed representatives from the Westminster City Labour Party on the subject of housing. The former Committee also received a deputation from the City of Westminster Ratepayers' and Leaseholders' Association on the same subject. Both Committees discussed very fully the difficulties which confronted them in dealing with the housing problem in its various aspects. The views of both deputations, as well as of others who have written or spoken on the subject, appear to be that the City of Westminster, which was already contributing a very large sum of money annually to the housing of London as a whole, was not getting the advantage it should from this contribution and that more houses should be built in Westminster. The Council has always held the opinion that provision should be made in the City for persons whose work necessitated living near their work, especially those who had to be at work late at night or early in the morning, but they have been confronted with many difficulties, particularly with respect to obtaining suitable and available sites, the cost of land, &c., and of securing, in the circumstances, the sanction of the Minister of Health to schemes which have been proposed. The question of housing is, however, a much wider one and cannot be dealt with locally by Borough Councils. It involves many considerations with which Parliament itself has difficulty in dealing. The City Council has been able, after prolonged negotiations, to get a scheme passed for building new dwellings on a corner site with frontages to Pimlico Road, Avery Farm Road and Ebury Square, and the work of erection is well in hand, and it is hoped that they will be ready for occupation early in 1924. The site has been leased to the Council for this purpose for a term of 99 years by His Grace the Duke of Westminster at the nominal rent of £1 per annum. The building, which has been designed by Messrs. Joseph, is five storeys in height, and comprises 15 three-room flats, 20 four-room (5416)q d 44 flats and 5 five-room flats, a total of 40 flats, containing 150 rooms, capable of housing approximately 300 persons. All the flats are absolutely self-contained, i.e., each has a separate scullery, bath and W.C. Each flat is entered from a lobby so as to give absolute privacy to the respective tenants, and from this lobby access is obtained to the scullery and bathroom and also to the open balconette and W.C. Each lobby is provided with shelves and hat and coat hooks. The windows are fitted with Venetian blinds, and each living room is supplied with a "Worker" range with a small oven, and when the oven is not required an ordinary open fire may be used. A cupboard is provided between each scullery and living room with access from both sides. The scullery has a suitable gas stove, sink, and a properly ventilated larder. The bathroom has a good-sized green enamel bath, and hot water is to be supplied from a copper which may also be used for boiling clothes. A coal bunk is provided on the open balconette adjoining the scullery. Every bedroom is fitted with a mantel, register stove and supplied with a good-sized cupboard with hooks for hanging clothes. Every flat is lighted by gas on the slot system. The entrance doorways are finished with glazed facing bricks to avoid damage, and the staircase walls are lined throughout with tiles to ensure an absolutely smooth and clean surface requiring no annual expense for distempering. The floors and roofs throughout are of fireproof construction, and the pavings and landings, sculleries and bathrooms are finished with granolithic. The sculleries and W.C.s and the bathrooms are all tiled to a height of five feet with white glazed tiles finished with a band of red tiles. A drying room to enable tenants to dry their clothes has been provided. There are 20 perambulator sheds for each of which a small weekly rental is charged. The rents to be charged are: for a 5-room flat, 17s. 6d. per week, for a 4-room flat, 14s. per week, and for a 3-room flat, 10s. 6d. per week; rates are additional in each case. There have been a large number of applications for the flats from all parts of London and also from outside. The Housing Committee, in making a selection, have given special consideration to families living at present under unsatisfactory conditions, and to meet the expressed wish of the donor of the site only those persons with children living with them have been accepted as tenants. The approximate cost of these dwellings is estimated to be £26,000. New Peabody Buildings.—The Trustees ha've been unable to proceed with the remaining block of their dwellings in Horseferry Road, being held up by the Rent Restriction Act, 45 Restriction of Rents Acts.—Eleven applications for certificates were asked for and were granted in 10 instances. Houses let in Lodgings.—At the end of 1923 there were 1,144 houses on the register, 2,849 visits were paid to such houses, and notices were served with reference to 346 defects. Statutory notices were served in 20 instances. No police court proceedings had to be taken to enforce them. As has been pointed out previously, many of these houses are 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 come into force on account of legal difficulties. Occupied Basements.—The County Council asked to be supplied with information as to the number of houses in Westminster in which basements were made use of for dwelling purposes, whether let separately or as part of the rest of a house. The reply sent to the four questions asked is appended:— (a) Number of basements used for dwelling purposes 6,914 (b) Number of basement dwellings with ceilings at or below the street level 2,620 (c) Number of basement dwellings in which the width of area in street does not exceed 3 ft. 625 (d) Number of basement dwellings in which the width of area in street does not exceed 4 ft. 636 Nearly half of the number under (a) are in the Victoria Ward and a third are in Mayfair and Knightsbridge districts. In a return made to the Ministry of Health in connection with the London (Equalisation of Kates) Act, 1894, the number of "separately numbered assessments of hereditaments wholly or partially used as dwellings" was stated as being 27,199. At the Census in June, 1921, the total number of dwellings was found to be 27,136, but 1,815 were vacant on census night; that is to say, in the majority of cases the occupants were away; but this figure also included some unoccupied premises. So far as comparison can be made between the two sets of figures, it would appear that the actual number of dwellings has increased. It will be noticed below, under heading "Plans," that 24 houses have been converted into flats and 10 stables into dwelling-houses during the year. Revenue Act.—One application was received and a certificate was granted. Below is a list of details of the work done in connection with insanitary (5416)Q D 2 46 conditions. In many cases some of the work specified was in premises parts of which were occupied as workshops:— 1923. 1923. Complaints received and dealt with 871 Premises inspected on complaint, &c. 1180 House to house inspection 3,548 Subsequent visits 21,027 Premises (registered), visits to 4,912 Overcrowding found 5 Other infringements 374 Sanitary Work completed:— Houses:— Cleansed throughout 271 „ partially 736 Overcrowding 13 Light or ventilation improved 144 Roofs repaired 347 Floors and staircases repaired 408 Underground rooms:— Illegal use 3 Closed 1 Yards, areas, paved or repaired 264 Damp walls remedied 263 Offensive refuse removed 215 Keeping of animals discontinued 22 Verminous premises cleansed 156 Filthy or unwholesome bedding, &c. .. Articles 173 Drains :— Constructed 271 Amended and repaired 144 Ventilated 193 Unstopped and cleansed 119 Interceptor traps fixed 129 Cleansed and sealed off from sewer 109 Gully traps fixed 835 Defective traps abolished 87 Manholes built 562 „ repaired and cleansed 269 „ covers fixed or repaired 531 Tested by smoke 55 „ chemical 246 „ water 630 air 21 Fresh air inlets fixed or repaired 238 Soil Pipes:— Fixed 414 Ventilated 265 Repaired 200 Tested by smoke 107 Sanitary Work completed:— Soil Pipes:— Tested by chemical 274 „ water 66 „ air 213 Water-closets:— Constructed 1,436 Repaired 383 Ventilated and light improved 257 Cleansed or limewashed 798 Ventilated lobbies provided 267 Unstopped 92 Traps ventilated 928 Flushing cisterns fixed 1,155 „ „ repaired 274 Waste Pipes:— Constructed 1,668 Repaired 220 Unstopped 72 Trapped 2,372 Ventilated 1,952 Disconnected from drain 175 Rainwater Pipes:— Fixed or repaired 554 Disconnected from drains 118 Urinals:— Constructed 130 Repaired or improved 24 Cleansed 43 Water Supply:— Provided 892 „ additional in tenement bouses 36 Certificates granted — Cutoff 25 Reinstated 14 Cisterns fixed 149 „ cleansed 135 „ covered 170 Cisterns defective, abolished 14 Taps off main provided 298 Pipes repaired 199 Dust Bins:— Movable, provided 203 „ repaired 4 Fixed, abolished 8 Stables:— Drained — Paved 3 Cleansed 3 Dung receptacles provided 1 Dung accumulations removed 18 Garages constructed 45 Petrol interceptors provided 10 1,373 intimations of nuisances (exclusive of smoke nuisances), &c., and 38 statutory notices were issued; 1,141 letters were written. 47 Police Court proceedings had to be resorted to in respect of 2 properties. In each case the summonses were withdrawn on payment of costs, the work having been completed before the hearing. Plans.—551 sets of plans were examined during 1923. Of these, 73 were plans of new buildings. The corresponding figures for 1921 were 383 and 22, and for 1922, 468 and 39. Three plans were disapproved, and four others were withdrawn or not proceeded with. Orders for "Combined Drainage" were made in 16 cases. In 24 instances the plans related to houses wholly or partially being converted into flats, and in 10 instances to stables being converted into dwellings. Failure to give notice occurred in 29 instances, and to send in plans 24 instances, and a number of builders were cautioned. Three builders were summoned for this, having been previously cautioned, and were fined 10s., £3 and £5, one of them was summoned for improper construction of W.C., and fined 10s. Water Supply.—25 notices of withdrawal of water supply were received from the Metropolitan Water Board. The reasons given for cutting off the supply were: Defects, 3; non-payment of rates, 22. Additional water supply to tenement houses was provided in 36 instances. Removal of Offensive Refuse.—Four contractors were summoned for removing refuse in improper vehicles or receptacles, and one of them for removing it in prohibited hours. Fines were inflicted in each case, amounting in all to £6, with 10s. 6d. costs. Ventilation of London Theatres.-—New regulations have been issued by the London County Council for ventilating theatres, kinemas, and places of public resort for entertainment or dancing. They are to apply to premises for which new licences are sought and to premises which may be reconstructed, and are to guide the Council in its requirements with regard to existing places when it considers that an improvement in their ventilation is necessary. Before the erection or alteration of the premises is started the approval of the Council must be obtained to the proposed ventilating and heating arrangements, which must be capable of giving a supply of outdoor air at the rate of 1,000 cubic feet per person per hour. It is considered, however, that satisfactory results cannot be obtained in large premises unless the plant is capable of giving a supply of warmed air delivered by fans. It must be capable of maintaining a minimum temperature of 55° F. with full air supply in the building when the outdoor temperature is 30° F., that it does not contaminate the air, that it is not in conflict with the regulations for protection against fire, and that no 48 surface used for warming the air is of a higher temperature than 250° F. The condition of the air is not to be regarded as satisfactory if the amount of carbon dioxide in occupied portions of the premises, taken at a level of 3 ft. 6 in. above the floor, exceeds 10 parts in 10,000. Independent means of extraction from lavatories and sanitary conveniences must be provided, so arranged that the air movement does not carry from these places into the public parts. Bat 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; 23 examinations of sewer connections were made and 33 disused connections were bricked off and other defects in sewers were found and remedied, in others the rats were brought from the docks in packages of fruit and vegetables. In the week commencing 1st November a united attack was again made throughout the country. During the week 16,995 baits were laid in 247 of the Council's sewers and at the four wharves used as dust shoots. All of the baits were taken freely, but the actual number of dead rats seen in the sewers was only 43. Probably the dead bodies were carried away by the flow of water. Smoke Prevention. The following is a summary of the work done in connection with smoke prevention:— 1921. 1922. 1923. Complaints received 30 31 12 Observations taken 1,838 1,795 600 Notices issued— Preliminary 1 80 8 Statutory 52 2 2 Summons — — 1 The records of the Advisory Committee on Atmospheric Pollution show that there has undoubtedly been considerable improvement in the purity of the air of London traceable to the increased use of smokeless heating and cooking devices, and to improved appliances and methods of combustion in the case of industrial furnaces. Thus in the years 18811885, during the winter months, Westminster had only 17 per cent. of the sunshine enjoyed by Oxford, Cambridge, Marlborough and Geldeston. This percentage has gradually improved year by year: in 1901-5 it had 49 reached 32 per cent., and in 1916-20 45 per cent. It should be noted, however, that what was actually measured was heat and not light. The long heat waves are able to penetrate through smoke or fog, while the short light waves which contain the rays which are of chemical and physiological importance fail to reach us. 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. It has been estimated that domestic fires in London caused about 2¼ times as much pollution as factory and furnace fires. The remedy is to burn smokeless fuel. Housing Conditions. (Return required by the Ministry.) Statistics. Year ended 31st December, 1923. 1.—General. (1) Estimated population Total Civilian 142,840 140,430 (2) General death-rate 10.6 (3) Death-rate from tuberculosis 0.84 (4) Infantile mortality per 1,000 births 47.2 (5) Number of dwelling-houses of all classes 27,199 (6) Number of working-class dwelling-houses (7) Number of new working-class houses erected 0 2.—Unfit Dwelling-Houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,548 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 174 (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 722 11.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of i formal action by the Local Authority or their officers 95 50 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dweling-houses which were rendered fit— (a) By owners 0 (6) 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 722 (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) Number of dwelling-houses in respect of which Demolition Orders were made 0 (6) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 3.—Unhealthy Areas. 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 8 permanent Sanitary Inspectors and 1 woman Inspector. 9 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. 51 D.— Occupations and Workshops. At the 1921 Census, occupied persons were asked for the first time to give particulars of their place of work and a summary of the returns has now been issued. Such figures have an important bearing upon the problems of traffic, transport and housing. The resident population of any locality is no longer the sole matter of concern to that locality. During the day it may be peopled by a body of workers numerically far exceeding and even very differently composed from its so-called permanent population. Occupation has a close connection with the health, mortality and other personal aspects of the individual, and full half of the active life of the worker is often spent in an entirely different environment than that in which he resides. The healthiness or otherwise of the conditions under which he works cannot fail to leave its mark on him. These remarks of the Registrar-General have a particular interest in connection with the City of Westminster, which, next to the City of London, presents the greatest amount of difference between its day and night population. The night population as recorded at the Census was 141,578, the day population is more than 2½ times this, viz., 374,102, and this takes no account of the large miscellaneous movements represented by visitors shopping, attending places of amusement, and places of business or of the pedestrian traffic passing continuously through the City. The following table shows the figures relating to Westminster:— Males. Females. Totals. Total resident population enumerated Occupied persons enumerated 61,380 80,198 141,578 45,041 40,756 85,797 Do. do. with workplace in City 23,717 33,142 56,859 Do. do. with no fixed workplace 5,698 1,240 6,938 Do. do. workplace not stated 2,189 895 3,084 Do. do. with workplace outside City 13,437 5,479 18,916 Occupied persons working in the City but living elsewhere 170,414 81,026 251,440 Total occupied persons in City during day 207,018 116,303 318,321 52 Of the 18,916 persons enumerated in Westminster but working elsewhere, 13,976 work in other parts of London, every Borough being represented, the largest numbers being in the City of London 3,956, St. Marylebone 1,664, Holborn 1,296, Chelsea 1,232, and Kensington 1,052; 147 work in Essex, 36 in Hertfordshire, 127 in Kent, 491 in Middlesex, 250 in Surrey, 1,362 in other parts of England and Wales, and 2,527 elsewhere. Of the 251,441 enumerated in London or the Home Counties who come to Westminster to work, Essex sends 13,977, Hertfordshire 2,306, Kent 6,937, Middlesex 34,142, and Surrey 20,637, while 173,406 live in other Metropolitan Boroughs. Of these Lambeth contributes 23,891, Wandsworth 19,226, St. Pancras 12,702, Battersea 12,670, and Islington 10,858. The following shows the state of the register of work premises at the end of 1923:— Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,647 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 945 Leather workers, boot and shoe makers, harness makers, &c. 56 Carpentry, upholstery, carvers, gilders, &c. 58 Surgical and dental instrument makers 4 Tobacco manufacturers 28 Wig makers and hair workers 45 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, &c. 55 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &e. 40 Metal workers 6 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 53 Florists 27 Laundries 52 Bakehouses 82 Photographers 18 Jewel case makers 10 Cinema film workplaces 60 New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 175 workshops was discontinued, and 363 additions were made to the register during the year. The diminution of the number of workshops which took place in 1921 and 1922 seems to have stopped. 53 inspection.—1923. Premises. Number of Inspections. Reinspections. Defects Found. Intimation Notices. Statutory Notices. Prosecutions. Factorirs 104 72 36 11 1 — Workshops 2,069 2,821 810 385 14 1 Workplaces (Excluding restaurant kitchens, &c.) 1,101 1,628 482 181 1 — Total 3,274 4,521 1,328 577 16 1 Defects found. Particulars. Number of Defects. Found. Number of Prosecutions. Nuisances under the Public Health Acts:— Want of cleanliness 486 — Want of ventilation 37 — Want of ventilation of gas stores 48 — Overcrowding 30 — Want of drainage of floors 17 — Sanitary accommodation— Insufficient 37 — Unsuitable 58 — Defective 237 1 Not separate for sexes 37 — Other defects 311 — Total 1,328 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 1,604 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 174 Absence of means of warming 4 Matters referred by H.M. Inspectors 182 Workrooms measured 272 Visits of Enquiry re Employment of Women 12 „ ,, Outworkers 158 Underground bakehouses in use at the end of the year 61 54 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. Details are given in the Table on the page opposite. After adjusting the lists, it appears that the actual number of outworkers resident in Westminster is 1,278 (in 1922 the number was 1,311); 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 743. 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 (Secs. 109, 110). 55 City of Westminster. Outworkers—1923. 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. Bootmaking 389 2 358 33 394 4 361 37 Corset-making 1 — 1 — 1 1 — Cutlery repairing — 1 — 1 — 1 — 1 Dressmaking 274 78 257 95 345 58 292 111 Embroidery 34 2 25 11 26 2 19 9 Engraving — 1 — 1 — 1 — 1 Furriers 40 13 34 19 33 6 29 10 Hatmaking — 3 — 3 — 1 — 1 Lingerie, &c. 134 11 126 19 194 14 180 28 Shirtmaking, Hosiery, &c. 98 3 66 35 123 6 92 37 Tailoring 3,541 121 1,829 1,833 3,330 129 1,655 1,804 Theatrical costumes 9 9 6 6 — Toys, fancy goods, &c. 107 2 92 17 124 20 115 29 Waterproofing 1 3 1 3 1 4 1 4 Totals 4,628 240 2,798 2,070 4,577 246 2,751 2,072 Number of lists received during the year, 801—(February, 404; August, 397). 56 E.—Food Supply. During 1923, 5,079 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. 197 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 148 places where this commodity was made or sold, and these were kept under supervision; 240 visits were paid. Bakehouses.—At the end of 1922 there were 21 above-ground and 61 underground in use. Daring 1923 two underground were reported to be not at present used. All the bakehouses were inspected, and cleansing carried out twice a year. Milkshops.—At the end of 1923, 490 names of persons selling milk were upon the register. These include 8 persons selling milk on rounds, who had no shop or store. One application was refused on the ground that the premises were unfit for storing milk. The demolition of one building took place during the year. 1,522 visits were paid during the year 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 10s. and the other ordered to pay £3 3s. costs. Cowhouse.—There is only one remaining, licensed for 6 cows, but none have been kept during the past year. There are no slaughter-houses in Westminster. Poultry slaughtering.—Byelaws have been made by the County Council and sanctioned by the Ministry on 22nd December, 1923, for regulating the conduct of the business of a slaughterer of poultry and the structure of the premises in which such business is carried on. Inspection of Food.—The food exposed for sale in shops and on stalls in the street markets has been regularly inspected every day (including Sundays). The following list shows the quantity of food condemned and destroyed during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your officers:— 57 Articles of Food Submitted. Tons. Cwts. Lbs. Tons. Cwts. Lbs. Apples 6 19 36 Mangoes 7 16 0 Apricots 1 1 60 Melons 1 14 0 Bananas 18 15 56 Onions 1 10 0 Carrots 1 10 0 Oranges 2 19 0 Celery 4 0 0 Pears 16 16 0 Cherries 0 1 0 Pineapples 0 3 0 Currants (Black) 2 10 56 Plums 2 17 80 Gooseberries 0 15 0 Potatoes 0 1 10 Grapes 0 4 0 Tomatoes 5 6 0 Grape Fruit 0 5 0 Fish (various) 0 12 0 Greengages 0 2 0 Mutton 5 2 0 Horseradish 0 0 56 41 cases Sauce, 53 lbs. Evaporated Milk, 1 sack Mussels, 604 tins of Meat, 0 Ducks. Articles of Food Seized and Condemned. 19 lbs. Red Currants—Vendor prosecuted and fined £4 and £1 1s. costs. Sale of Food Order.—For exposing for sale imported meat not labelled as such a butcher was prosecuted and fined £3 and two guineas costs. Certificates to enable articles of food to be exported to the United States and Canada were granted in 10 instances. Serving Drinks in Public Bars in glasses not properly cleansed.—The Public Health Committee considered a complaint that barmaids, especially during rush hours, did not cleanse glasses which had been used before serving another customer, the practice being to dip the glass into a bowl of water without wiping or cleansing it. It would be a better arrangement if there were an apparatus giving a jet of water which would cleanse the glass inside and out without loss of time. The Committee found they had no legal power to deal with the matter, but directed that the attention of the Licensed Victuallers' Association be drawn to the complaint. The Association expressed their desire to co-operate and sent a copy of the communication to each of their members. The Wrapping of Bread.—We have in former Reports drawn attention to the risk of contamination to which bread is exposed while being delivered. During the last year attention has been again called to the subject and the Public Health Committee passed a resolution that bread should be properly wrapped before leaving the bakehouse. They were informed that this is already the practice in more than 30 districts in the North of England and that it has been found to be a paying proposition. It is claimed that apart from the advantage to the public of being supplied with a clean article of food, there is less loss of evaporation when a loaf is placed in a wax paper cover, the bread keeps longer, and there is practically no stale or unsaleable bread. It would get rid of the objectionable practice of exchanging stale loaves for fresh ones, and a further result is claimed that where wrapping is employed there is little need for baking during the night. 58 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings for year 1923. r. Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ t. d. 1 Milk 997 905 (70) 22 11 2 9 6 10 0 7 7 0 2 Do. separated 6 4 2 2 2 — 2 0 0 2 2 0 3 Cream 51 49 2 — — — — — 4 Do. preserved 66 49 17 — — — — — 5 Do. cheese 1 1 — — — — — — 6 Butter 139 136 (2) 1 — — — — — 7 Buttered rolls 12 8 4 3 3 — 6 0 0 — 8 Coffee 33 33 — — — — — — 9 Cocoa 10 9 (1) — — — — — — 10 Cake 2 2 — — — — — — 11 Sweets 1 1 — — — — — — 12 Meat pies (various) 41 28 13 2 — 2 — 1 1 0 13 Sausages 104 79 25 1 1 — 4 0 0 — 14 Meat and Fish Paste (various) 68 64 4 — — — — — 15 Rabbit 1 1 — — — — — — 16 Brawn l 1 — — — — — — 17 Gelatine 1 1 — — — — — 18 Caviare 1 — 1 — — — — — 19 Peas 48 27 21 8 5 3 14 0 0 10 10 0 20 Beans 14 7 7 2 2 — 7 0 0 — 21 Spinach 8 5 3 2 1 1 4 0 0 — 22 Fruit (tinned) 46 39 7 1 — 1 — 1 1 0 23 Beer 10 10 — — — — — — 24 Ginger Beer 2 1 1 — — — — — 25 Lemonade 3 3 — — — — — — 26 Kaola 2 2 — — — — — — 27 Cream Soda 1 — 1 — — — — — 28 Olive oil 21 21 — — — '— — — 29 Lime water 11 11 — — — — — 30 Borax 20 18 2 2 1 1 2 0 0 31 Camphorated oil 34 33 1 1 1 — 1 0 0 2 2 0 32 Prescriptions 45 44 1 1 1 — 10 0 0 1 1 0 Totals 1,800 1,592 (73) 135 36 19 17 56 10 0 25 4 0 Summary proceedings were ordered to be taken in 31 instances, 13 cautions were issued, and the attention of the vendors was called to the report of the analyst in 17 instances. There were 10 non-official samples taken during the year. 59 Milk.—997 samples of ordinary milk were taken during the year. The analysts have graded the samples submitted to them into four groups:—Good quality, in which the fat was over 3.8 per cent.; fair quality, in which the fat was between 3.3 and 3.8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent. (the official standard) and 3.3 per cent., or in which the non-fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adulterated are those below the official standard of 3 per cent. for fat and 8.5 for solids not fat. District. Total. Good Quality. No. Percent. Fair Quality. No. Percent. Poor Quality. No. Per cent. Adulterated. No. Per cent. North 513 234 45.6 196 ! 38.2 72 14.0 11 2.1 South 484 224 46.2 172 | 35.5 77 15.9 11 2.2 1923 997 458 45.9 368 36.9 149 14.9 22 2.2 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 33.0 102 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 quality of the milk has not deteriorated during the year; in fact, there is a still further improvement. Eleven prosecutions were taken with regard to adulteration—6 for fat abstracted (19, 8, 9, 11, 14 and 26 per cent.) and 5 for added water (3, 4, 4, 7, and 6 per cent.). Warranties were successfully proved in six instances. For selling, on two different occasions, separated milk which had been coloured with annatto, the vendor was fined £2 and £2 2s. costs. In one sample of milk it was discovered that dried milk had been used, and after explanation by the vendor had been received he was cautioned against a repetition of the offence. Sunday Samples.—47 of the samples of milk were taken on Sundays during the year, one of which was reported adulterated, 19 per cent. fat abstracted, and the vendor prosecuted and fined 30s. (5416)Q E 60 Samples taken in course of Delivery— On Delivery at Shops, &c.—24 samples of milk were taken as it was being delivered by wholesale firms to retail customers, including shops, hotels and hospitals. Of these samples, 16 were good, 7 fair, and 1 adulterated—vendor prosecuted and ordered to pay three guineas costs. These samples were taken in consequence of previous samples having been found below the limit (including cases where a warranty defence was set up). For using a dirty and defective can for delivering milk to a customer the proprietor was cautioned after having submitted a letter of explanation. The Public Health (Condensed Milk) Regulations, 1923.—These Regulations prescribe the labelling and composition of condensed milk. They came into operation on the 1st November and apply to imported condensed milk, as well as to that manufactured in this country. A useful provision is that condensed skimmed milk must be clearly marked "Unfit for Babies." Milk (Special Designation) Order.—Under the provisions of the Milk and Dairies Amendment Act of 1922 Orders have been made which came into force in 1923. These Orders have the effect of regulating the production and sale of milk sold under special designations. A number of varieties are specified, but at present they apply to— (1) Certified Milk; (2) Grade A Tuberculin tested; and (3) Grade A Milk. The dairymen producing milk of these three classes must satisfy the Ministry that the milk is produced under proper hygienic conditions, and that the persons employed in its production are trained in the exact technique necessary to ensure compliance with the standards of cleanliness, etc., laid down. Certified milk is the highest grade of milk. The producer must produce a veterinary surgeon's certificate showing the result of an examination of the herd, and that the cows are free from tuberculosis, as shown by tuberculin tests. It must be bottled and sealed at the farm, and sold by the retailer without breaking the seal. It should therefore be clean raw milk, untreated by heat. Grade A (Tuberculin-tested) is the next grade of milk. It is produced under the same conditions as Certified, but instead of being bottled immediately at the farm it may be sent out in bulk in sterilised sealed cans, and transferred into sterilised bottles at the distributing centre. Grade A, the third quality, is produced under similar conditions as the former two, except that the cows from which it is obtained are not tuberculin-tested. They must, however, be examined at least once in every 61 three months, and any animals showing evidence of any disease which may injuriously affect the milk must be immediately removed from the herd, and reported to the Licensing Authority. When bottled, the cap must bear the name of the bottler and the date of production. Such milk may be treated by heat, and if so it must be in accordance with certain conditions, and it must then be labelled "Grade A Milk (Pasteurised)." Standards of bacteriological purity are laid down for the various grades. Certified milk must not contain any Bacillus coli in ll/10th c.c., and not more than 30,000 bacteria per c.c. Grade A (Tuberculin-tested).—Grade A milk shall not contain any time before delivery to the consumer more than 200,000 bacteria per c.c., and there must be no coliform bacillus in l/100th c.c. If such milk is pasteurised it must not contain more than 30,000 bacteria per c.c., and no coliform bacillus in 1 /10th c.c. The Order with regard to pasteurised milk does not come into force until 1924. Such milk must not be otherwise treated than by the method specified, i.e. it must be retained at a temperature of not less than 145° F., and not more than 150° F., for at least 30 minutes, and must then be immediately cooled to a temperature of not more than 55° F. It must not contain more than 30,000 bacteria per c.c., and no Bacillus coli in 1 /10th c.c. It must not be treated with heat more than once. Producers are licensed by the Ministry and distributors by the local authorities. The Council issued licences for the sale of— Certified Milk 27 Grade A (Tuberculin-tested) 6 Grade A 3 Pasteurised 1 Supplementary licences—Certified 2 Arrangements were made under the sanction of the Ministry with the Clinical Research Association to make the necessary bacteriological examination of such samples of the above required by the Ministry to be taken. During the year the Ministry ordered 10 samples to be submitted for examination. One of the samples of "Certified Milk" contained Bacillus coli, and the remainder were satisfactory from a bacteriological standpoint. A sample of "Certified Milk" was also taken in the ordinary way under the Sale of Food and Drugs Act for chemical examination, and was reported to be of "poor quality"—that is to say, just above the official chemical standard. 62 To comply with the requirements for the production of Certified and Grade A milk, it necessarily follows that a higher price must be charged for such milk, and it is contended by some that it is unfair to people who cannot afford to pay the extra price, and in consequence may have to consume milk of ordinary quality. They therefore urge that there should be no division into grades, but that it should be a punishable offence to sell milk below a minimum of both chemical and bacteriological quality. This is undoubtedly a desirable ideal, but to insist upon the provision of a pure raw milk at the present time would lead to a substantial increase in the selling price, which would re-act in a diminished consumption of milk. If the demand for this high-class milk increases, more farmers will undertake its production, with the result that there will be an improvement all round in the conditions under which milk is produced. Many people order ordinary milk to be delivered at their houses in bottles, paying an extra penny for it under the impression that it is specially bottled by the retailer, and will not be tampered with or exposed to contamination during delivery. It is, however, not unknown that such bottles are sometimes filled by the roundsman from his churn in the street. It would therefore be much better for customers desiring their milk to be supplied in bottles to order Certified Milk than to pay extra for ordinary milk. It has been found, moreover, that the better keeping property of such milk makes it worth while for the householder to buy it. As it is impracticable to guarantee that all raw milk is bacteriologically pure, for those who cannot buy Certified Milk the use of milk which has been pasteurised or scalded is an alternative. It is understood that much of the milk now sent up to London has been subjected to some such treatment, doubtless with beneficial results to the consumer; but it appears desirable that if milk has been so treated disclosure of the fact should be made, as purchasers may again subject it to heat, and thereby materially lower its food value. The Astor Committee recommended that pasteurised milk should be sold as such, and not as fresh milk, but the Order does not require such disclosure to be made. The Public Health (Dried Milk) Regulations, 1923.—In view of the large use now made of dried milk, and the advantage which the best kinds have in regard to bacteriological purity, Regulations have been issued to come into force in 1924, dealing only, however, with its chemical composition, and how it is to be labelled. They do not lay down any instructions as to the method of drying. There are two methods in use, one by passing the milk over hot rollers, the other by converting into a spray. Claims are made by the users of each process that their product is the better article. Possibly one form may be better suited for children, and the other for general use. 63 The Public Health (Milk and Cream) Regulations, 1912 and 1917. The Milk and Dairies (Amendment) Act, 1922. Samples Analysed during the Year 1923. Article. Number of samples examined for preservative. Number containing preservative and percentage of preservative found in each sample. Milk 997 No preservative found. In one sample Dried Milk had been used. Explanation received, and vendor cautioned. Separated Milk 6 No preservative found. Two samples were coloured with annatto. Vendor prosecuted, and fined £1 and £1 1s. costs in respect of each sample. Cream 51 Two contained preservative—20 and 23.1 grains of boric acid per lb. Satisfactory explanations received, and the vendors cautioned. 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. 66 3 61* 2 66 Nil. *Samples contained respectively 31.0, 30.8, 25, 24.7, 24.5, 24.5, 24, 23.8, 23.1, 23.1, 23.1, 22.4, 22.4, 22.4, 21, 21, 21, 21, 21, 21, 20.8, 19.6, 19.6, 19.6, 19, 19, 18.2, 18.2, 18, 18, 18, 18, 17.5, 17, 17, 17, 17, 16.8, 16.8, 16.1, 16.1, 16.1, 16, 16, 15.4, 15.4, 15.4, 15, 15, 14, 14, 13.3, 13, 12, 11.9, 11.9, 11.9, 8, 8, 2.8, 2, 2, 2, grains of boric acid per lb. Action Taken. Summary proceedings being taken in respect of sample containing 31 grains. A letter of explanation was received in respect of the 30.8 sample, and no action with regard to the remaining samples. Infringements under Article 5 (1)—Nil. Infringements under Article 5 (2)—Nil. Thickening substances—None found. Sausages, Meat Pies, Fish and Meat Paste— Samples were taken as follows:— 104 Sausages—79 genuine; 25 contained boric acid. (One prosecution. Fine of £4; sample contained 29.4 grains of boric acid per lb.) (5416)Q E 2 64 41 Meat Pies—28 genuine; 13 contained boric acid. (Two prosecutions. One case vendor ordered to pay £1 1s. costs—23 grains per lb; the other summons withdrawn on warranty being proved—29.4 grains per lb.) 68 Fish and Meat Pastes—64 genuine; 4 contained boric acid in small quantities. (No prosecutions.) Tinned Vegetables.—There is a decided improvement in the number of samples of peas containing no colouring matter, and those that did contain sulphate of copper (21 samples out of 48) varied in amounts from 0.8 to 3.9 grains per lb. In 8 cases summary proceedings were taken, copper was found in the following quantities:—1.69, 2, 2.1, 2.49, 2.69, 2.6, 3.16, and 3.9 grains per lb. In the samples of beans 7 cases were found to contain copper in amounts varying from 0.46 to 2.8 grains per lb. (2 cases prosecuted—2.8 and 1.5). In the 3 spinach cases the amounts were 0.67, 2 and 5.5 grains per lb. The two latter were prosecuted, one case convicted and one dismissed by the magistrate on the evidence of the defendants that they were wholesale dealers only and that the tin with which the inspector was served, after he had insisted on being served, was a sample tin kept there for window dressing and was not intended for sale. Proceedings are not taken if the amount of copper is under 2 grains, and proper disclosure of its presence is given. Refusal to sell.—Two vendors, one in respect of a sample of beans and the other for peas, were prosecuted for refusing to sell to the inspector for the purpose of analysis—the first was fined £3 and £1 costs and the latter fined £3. Tinned Fruits.—Out of 46 samples of various fruit, 7 were reported adulterated and contained tin in the following quantities:—3, 1.79, 1.65, 0.82, 0.82, 0.55 and 0.41. Summary proceedings were taken against the vendor of the first sample, and after hearing the evidence the magistrate ordered £1 1s. costs to be paid. Prescriptions.—45 prescriptions were submitted to various pharmaceutical chemists. The medicines as made up were, with one exception, accurately dispensed. This sample was deficient in ammonium chloride to the extent of 40 per cent. The vendor was prosecuted and fined £10 and £1 1s. costs. Food Preservatives.—In response to a public demand, the Minister of Health has appointed a committee to enquire into the use of preservatives and colouring matters in food and to report— 65 (1) Whether the use of such materials or any of them for the tion and colouring of food is injurious to health; and, if so, in what quantities does their use become injurious. (2) Whether it should be required that the presence of such materials and the quantities present in food offered or exposed for sale should be declared. The terms of the reference are somewhat restricted, and one could have wished that the Committee had been given the means to conduct independent investigations. It is well known that the standard of purity of food and the methods of distribution do not compare favourably with those in other countries, notably the United States of America and in Australia. The Committee invited me to give evidence before them, which I did, and supplied figures taken from the City Analyst's reports over a period of 20 years, which showed the beneficial effect of the steady action which the Council had pursued during that period. I also drew attention to the experiments which had been carried out, which showed that the addition of so-called preservatives did not lead to any improvement in the purity of our food or to better methods of keeping and distributing it. These chemicals are not strong enough to kill the really harmful bacteria, so that contaminated food appears fresh and wholesome. Greater use could be made of "cold" for the preserving of food than is at present the case, and it would probably prevent a considerable amount of wastage which now takes place. 66 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. E. J. Martinson R.S.I. J. Sanderson R.S.I., San. Sc. Cert., Gold Medallist Carpenters' Company. A. Taylor (retired January, 1923) 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. F. E. Siddle (Food & Drugs, &c.) S.I.E.B., Meat Cert., R.S.I. (Appointed, February, 1923.) Miss C. Hughesden S.I.E.B., R.S.I., H.V., C.M.B. 67 Midwife: Qualifications. Miss A. J. Irving C.M.B., 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 (Tubercu- S.I.E.B., Dipl. Nat. Health Soc., losis). Nursing. 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, Assistant to Inspectors. 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: *Octavia 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, 68 Medical Officers—continued. Qualifications. Miss Cove, Supt. Centre Nat. Health Dipl. Miss Callaghan, Supt. Centre H.Y. Miss Miller (Midwife) C.M.B., H.V. (Resigned September, 1923.) Miss Reed, H.Y C.M.B., H.V. (Resigned September, 1923.) Miss Purchase, H.V Nat. Health Dipl. Miss Lock (Midwife) C.M.B., S.I.E.B. (Resigned October, 1923.) Miss G. Cross (Midwife) C.M.B. Miss Dodd C.M.B. (Midwife, September, 1923) Miss Taylor C.M.B., S.I.E.B. (H.V., October, 1923) Miss Marwick C.M.B., Nat. Health Dipl. (Midwife, November, 1923.) Mrs. Shanks Supt., Mothercraft; Registered Teacher. Mrs. Steffens Assist. Supt., Mothercraft. And 12 Honorary Visitors and Workers. HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJFSTY, ST. MARTIN'S, W.C.