/#■ •(\V. i? LIBRARY % g26 NAY 1^70 H WES 36 City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR • - • . 1926 ANDREW J. SHINNIE, M.D., D.P.H. (Lond.), Medical Officer of Health and, Administrative Tuberculosis Officer. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD., PRINTERS IN ORDINARY TO HIS MAJESTY. ST. MARTIN'S LANE, W.O.2. iii CONTENTS. PAGE Introductory remarks v Census Statistics viii Population 1 Births 2 Deaths 6-12 Infantile Mortality 12 Common Lodging-Houses 19 Tables 6-9 Communicable Diseases 21 Smallpox 21 Vaccination 24 Scarlet Fever 24 Diphtheria 24 Schick Test 24 Anti-toxin 28 Bacteriological Diagnosis 23 Typhoid Fever 28 Measles 29 Influenza 29 Diarrhoea and Enteritis 30 Deaths from 30 Whooping-Cough 30 Cerebro-spinal Fever 32 Poliomyelitis 32, 33 Encephalitis Lethargica 32 Chickenpox 32 Mumps 32 Plague 32 Anthrax 32 Puerperal Fever 32 Ophthalmia Neonatorum 34 Bacteriological Laboratory 35 Tuberculosis 35 New cases (notified) 36 ,, ,, ,, Tables 36-40 Deaths and non-notified deaths, 40 Tuberculosis Dispensary 41 Dental Treatment 43 Returns (Ministry of Health table) 44 (6026)o iv PAGE Housing 46 New Schemes 46 Conditions generally 48 Obstructive buildings 51 Register of Houses let in lodgings 51 Underground Bedrooms 51 Table II (Required by Ministry) 52 General Sanitary Conditions 53 ,, „ „ (Statistical table) 54 Removal of Refuse 55 Removal of offensive refuse 55 Nuisances— Intimation and Statutory Notices 55 Rat repression 56 Water Supply 57 Artesian Wells 57 New Sanitary Construction 57 Smoke prevention 58 Draft Revised Drainage By-laws Under Sec. 202 Met. Management Act, 1855 59 Under Sec. 39 P. H. London Act, 1891 59 Underground Kitchens 59 Local By-laws and Regulations 60 Workshops 61-62 Outworkers List 63-64 Disinfection 64 Mortuaries 65 Maternity and Child-Welfare 66 New Centres 66 Ante-natal Work 69 Maternity and Mothercraft 70-71 Infancy and Early Childhood 72 Nursing 75 Dental Treatment 76 Inspection and Supervision of Food 78 Milk and Dairies Order, 1926 79 Registration of Dairymen 81 Milk and Dairies Amendment Act, 1922 82 Public Health (Milk and Cream Regulations), 1912 and 1917 82 Public Health (Preservatives in Food) Regulations, 1925 and 1926 85 Sale of Food and Drugs Acts 87 Samples taken 87 Meat Regulations, 1924 88 Food premises 89 Food condemned 90 Spirit Samples 91 Staff 92 V Annual Report on the Health and Sanitary Condition of the City of Westminster. 1928. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for 1926. This report is, in accordance with the instructions of the Ministry of Health, submitted as an Ordinary Report. That of last year was a Survey Report, which dealt in a somewhat fuller manner with the sanitary conditions of the City and the various matters concerning the public health which had occurred during the previous five years. The health of the City continued to be satisfactory during 1926. Although a large number of cases of Measles were recorded, the outbreak, on the whole, was of a mild character. There were markedly fewer cases of Diphtheria and Scarlet Fever, particularly in the Victoria and St. John Wards. There was a noteworthy decrease in the death rate, and an increase in the birth rate. The City Council were the second authority in London to adopt the Schick method for the prevention of Diphtheria. This work was instituted in Holborn five years ago, and is still proceeding in that Borough. It has since been introduced in Camberwell and Deptford. It is a measure which is likely to have a far-reaching influence in the control of this dangerous and infectious disease. Since the month of September this vi work has been carried out at the Council's Maternity and Child Welfare Centres and at the Centre of the Westminster Health Society in Page Street. Definite progress has been made in Housing. Two schemes, to which somewhat full reference is made, are proceeding in St. John Ward. Considerable attention has been paid to houses where insanitary conditions were found to exist, and measures were taken towards remedying those defects. The work of Registration of Houses let in Lodgings under the new London County Council By-laws was begun afresh, the old Register having been discarded for the reasons subsequently mentioned. Supervision of drainage work in new and existing buildings continues to engage the Sanitary Inspectors to a still greater extent. The number of drainage plans submitted during 1926 exceeds all previous records. In Maternity and Child Welfare, the work of the Department has increased, owing to the fact that the Council in July took over the conduct of this work in the Northern Wards of the City from the Westminster Health Society. The Council established a new Centre in temporary premises at 9, Frith Street, Soho Square. While the Society, being free to concentrate on St. Margaret and St. John Wards, opened a model Welfare Centre for that area in September. In the section dealing with Food, it will be noted that samples found to be adulterated continue to decrease in number. Staff.— The Council lost an able officer by the sudden death of Mr. Arthur Ware, in February. He was a man of strong convictions and high ideals, and carried out his duties as Sanitary Inspector with marked efficiency during his 23 years' service. Mr. Mark Canton, Sanitary Inspector under the Fulham Borough Council, was appointed in June to the vacancy caused by the death of Mr. Ware. Miss F. Rigg and Miss H. Blick were appointed Health Visitors in July to undertake duties in connection with the greatly increased area over which the Council are now responsible for Maternity and Child Welfare. F. Bridger, who had been in the Council's service for 20 years as drain tester, unfortunately broke down permanently in health in July and was pensioned. vii The clerical staff was increased by the appointment of Mr. S. Bennett as junior clerk and shorthand typist. I have again to thank the Chairman and Members of the Public Health Committee for the courtesy and kindness which I have received from them, and to record my appreciation of the able assistance which has been so freely given by the Staff of the Department. I have the honour to be, Your obedient Servant, Andrew J. Shinnie. April, 1927. viii SUMMARY OF PARTICULARS REQUIRED BY THE MINISTRY OF HEALTH. 1.— General Statistics. Area (acres)— 2,502.7. Population (Census 1921)— 141,578. Population, June, 1926 (Registrar-General's Estimate)— 141,800. „ „ „ Civilian— 138,400. Number of Inhabited Houses (1921)— 25,321. Number of Families or Separate Occupiers (1921)— 33,946. Rateable value— £9,216,000 (March, 1927). Sum represented by a penny rate— £36,480. 2.—Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth Rate. Legitimate 723 726 1,449 11.3 Illegitimate 74 83 157 Totals 797 809 1,606 Death s— 1,608. Death-rate— 11.6. Number of women dying in, or in consequence of, childbirth:— Puerperal fever, 2. From other causes, 4. Number of deaths of infants under one year of age per 1,000 births— 59.7. Legitimate rate, 52.4; Illegitimate rate, 127.3. Number of deaths from measles (all ages)— 24. „ „ diphtheria— 9. „ ,, whooping cough (all ages)— 2. „ „ scarlet fever— 0. „ ,, diarrhoea (under 2 years of age)— 15. „ „ typhoid fever— 2. 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. STATISTICAL, INCLUDING REMARKS ON THE NATURAL AND SOCIAL CONDITIONS. A summary of particulars required by the Ministry of Health is set forth on the preceding page and further reference to certain points mentioned will be found in other parts of the report. The estimated population of the City of Westminster for the year 1926 is given by the Registrar-General as 141,800 (the population as enumerated at the 1921 Census was 141,578). The civilian population, which excludes those belonging to the military forces in barracks and hospitals, numbered 138,400, and for the purpose of calculating the death-rate this number is taken. Both gross and net totals show a decrease on the corresponding figures for 1925, which were 142,600 and 139,600 respectively. In spite of increased unemployment which followed the general strike, and which continued during the coal stoppage, it does not appear that distress has been severely felt in the City. The Guardians have kindly supplied the figures relating to outdoor relief and they show that the total expended during 1926 amounted to £8,222 3s. 8d., compared with £9,849 16s. in 1925. There is no doubt that a good deal of individual hardship was experienced during those anxious days in May. The weather was then somewhat severe for the time of year, but there is no evidence to show that an abnormal amount of fatal illness resulted from the 'rigorous conditions which were imposed upon the community. Under the emergency regulations the Food Inspectors made daily reports as to the current prices of food in the retail shops and as to stocks in hand. The emergency organisation of the Government for the distribution of food to shops proved so efficient that no scarcity was complained of, nor did prices rise unduly. The Medical Officer of Health and Sanitary Inspectors were also engaged in supervising the sanitary accommodation at the various barracks and drill halls where the reserve of special constables were billeted. Arrangements for some 8,000 men had to be improvised in the drill halls of the London Scottish, Buckingham Gate; City of London Regt., Tufton Street,; Westminster Dragoons, Elverton Street; and the Queen Victoria's Rifles, Davies Street; and the old hospital of the Grenadier Guards in Rochester Row. 2 Meteorological.— The month of January was the coldest, the temperature being somewhat below the average for this month. The minimum shade temperature was 20 degrees Fahr., and the maximum 53 degrees Fahr. The highest temperature of the year was reached on 19th September, a shade reading of 90 degrees Fahr. being recorded. The maximum shade temperatures for June, July and August were 79, 89, and 84 degrees Fahr. respectively. November was the wettest month, rain having fallen on 25 days with a total depth of 4.37 inches. December had most dry days; rain fell only on five days with a total depth of 0.29 inch. The barometric readings varied from 29.65 inches in November to 30.21 inches in December. The mean for the whole year was 29.9. August was the brightest month, having 203.46 hours of sunshine on 30 days. January had fewest bright days— only 12 with 21.30 hours of sunshine. There were 178 wet days in the year with a total rainfall of 27.27 inches. Sunshine lasting 1,153.37 hours occurred on 265 days during the year. Births. The births registered in Westminster during 1926 numbered 1,535, but of these the homes of 500 were in other districts and have therefore to be deducted from the total. There were, however, 571 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,606, which is 71 more than the similar figure for 1925. The increase in births registered which was noted last year has still been maintained, but a greater deduction has to be made for infants born in the City although not belonging to it. The net result shows a slight rise in the births in Westminster, and indicates also a greater use of the maternity beds available in the City by women from other districts. As compared with 1925, there was a rise from 497 to 571 in the number of children belonging to Westminster parents born in other districts. Much has been written in previous reports regarding children born in Westminster to women whose home address is outside the City. The number of such cases has been steadily increasing during the last five years, until it has risen from 78 in 1921 to 500 in 1926. On the other hand, the number of Westminster women who were confined in homes and hospitals outside the City rose from 497 in 1925 to 571 in 1926. A fair portion of these births could have taken place in institutions in the City had the parents desired to avail themselves of the facilities of which others, non-residents in Westminster, took advantage. The birth-rate throughout the country generally and in the County of London shows a continued decline, the figures being 17.8 and 17.1 per 3 1,000 respectively. These are the lowest rates yet recorded with the exception of 1918, when the corresponding rates were 17.7 and 15.8 per 1,000. In Westminster the rate has risen from 10.7 to 11.3, which, however, is lower than the average birth-rate of the quinquennium 1921-25. The increase in the number of births has occurred only in the northern area of the City. In the other districts into which the City is divided for the purposes of Maternity and Child Welfare, the number of births remains the same as last year. Various theories have been put forward as to the causes of the falling birth-rate. The fact that the birth-rate 30 years ago was almost 30 per 1,000 and has now declined to 17.8 per 1,000 has given rise to speculation as to the causes. It would appear that the rate of decline is becoming more rapid and the fact has been noted that after nine years of peace the nation is no more fertile than in the last year (1918) of war exhaustion. The most serious contribution to the solution of the problem postulates an ebb and flow theory to human fertility. It is recollected that on the continent a flow began about the end of the eighteenth century, probably not unconnected with the national upheavals which culminated in the French Revolution and the Napoleonic Wars. The flowing tide in this country went with the rise of industrialism. A rising birth-rate seems to presage an ebullition of human energy in every sphere of activity and achievement. Increasing prosperity and a rising birthrate go hand in hand. Although it has frequently been stated that the falling birth-rate is a sign of the present diminished prosperity of the middle classes, the fact that the decline in this country was first observed among the rural dwellers in Wales rather tends to confound this theory. It may well be, as so ably argued in a recent Times leader, that European peoples are passing through a period of quiescence following one of exuberant vitality. Other theories which require mention are two which are at mutual variance— that hardship and lean years encourage fertility; and, on the other hand, that a copious food supply and ease increase it. Some students of the problem see in the falling rate a sign of race weariness, a shrinking away from the responsibility of bringing large families into the world to join in the stress of present-day economics. Dr. Menzies, the County Medical Officer, has advanced a theory which, in its common-sense view, must have a wide appeal. He feels that the result of educating a generation and supplying the means of social amelioration has largely supplanted the need for large families. In days when old age pensions were non-existent and national insurance unheard of, those of the labouring class, if they lived long enough, could look forward only to the workhouse in their declining years unless they had reared a family 4 numerous enough to support them. He suggests that a large family was almost an insurance against destitution in old age. Education has evolved a higher social conscience in individuals, and parents are less imbued with that primitive and selfish motive of self-preservation. They endeavour to have a small family so that the coming generation may get the best possible start in life and thus improve on the conditions in which the parents began. Table I. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 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 1924 1,447 344 521 1,624 1,250 1,214 36 1925 1,519 481 497 1,535 1,435 1,385 50 1926 1,635 500 571 1,606 1,402 1,355 47 The legitimate and illegitimate births are distributed as follows:— Table II. Legitimate. Males 741-238+220=723 Females 699-202+229=726 1440-440+449=1449 Illegitimate. Males 38-27+63=74 Females 57-33+59=83 95-60+122 =157 The legitimate births show an increase of 31 and the illegitimate 40 on the figures of 1925. 5 As shown in Table I, 1,402 notifications of births were received by the Department for 1926 as compared with 1,435 in 1925. Of the total of notifications, 778 were sent by midwives, of whom 45 were practising in the City during 1926. The following Table shows the number of male and female children born since 1914 ,and those who did not survive the first year of life, with the number of the surviving children at the end of the first year of life Table III. Number Born. Number of Deaths under 1 year. Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 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 1924 847 780 58 38 789 742 1925 783 752 57 49 726 703 1926 797 809 48 48 749 761 For each 1,000 girls born, there were in— 1913 1,006 boys. 1920 972 boys. 1914 1,080 boys. 1921 1,067 boys. 1915 1,033 boys. 1922 987 boys. 1916 965 boys. 1923 1,082 boys. 1917 914 boys. 1924 1,086 boys. 1918 1,177 boys. 1925 1,041 boys. 1919 965 boys. 1926 985 boys. Still-births. 47 still-born children were notified during the year, 26 of this number being born to non-residents of Westminster. The corresponding figure for 1925 was 50. Inquiries into the causes of these still-births have not brought definite information in all cases. It would appear, however, that in 2 cases there was a history of a fall or accident with a certain aniount of shock and fright. Placenta Pra3via accounted for 2 cases, while breech presentations occurred in 4. Kidney disease, diabetes and heart disease were predisposing causes in 3 instances. 6 MALES. Table IV.— Causes of and Ages at, Death during the year 1926. Causes of Death. corrected deaths in tub 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 Kniglitsbridge. Kniglitsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. | Regent. Charing Cross. Covent Garden. Strand. Homeless. Small-pox - - - - - - - - - - - - - - - - - - - - - - - - Measles 12 2 5 4 1 - - - - - - - - 8 - 3 - - - - - 1 - - Scarlet fever — — — — — — - — — — — - — — - — - — - - - - — - 10 3 4 3 - 2 - — 1 - 2 1 — 2 - - - 1 1 Whooping-eough 2 1 — 1 - - - - - - - - 1 1 - - - - - - - - - - Diphtheria, Memb. croup 5 — — 1 4 - - - - - - - - 4 - 1 - - - - - - - - Cerebro-spinal meningitis - - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 1 - - - - - - ] - - - - - - - - - - - - - - - Diarrhœa, enteritis 8 4 2 — — — — — 2 — — - — 6 - — 1 1 — - - - Erysipelas 3 — — — 1 — — 1 1 — — - — 1 - 1 - — — - - 1 Other septic diseases 11 1 — — — 1 — 3 6 — — 2 — 1 1 2 1 1 — 2 - - - 1 Syphilis, &c. 1 — 1 — — — — — — — — — — — - 1 — Diabetes 10 — — — — — 3 1 6 — 2 — — 2 1 1 - - 1 1 - 2 Rheumatic fever 5 — — — 1 — — 2 2 — - - - 3 - - - - 1 1 Tuberculosis of lungs 77 — — — — 6 26 31 14 — 3 2 2 21 2 27 3 1 1 . 3 9 3 Other forms of tuberoulosis 6 1 2 1 2 - - 1 - - 1 - - 2 - - - - - 2 - Malignant growths 96 - — — - — 4 69 33 — 3 8 25 5 22 3 3 2 2 4 6 10 3 Congenital debility, malformation, and premature birth 30 30 - - - - - - - - 1 - - 15 1 8 1 - - 1 - 1 2 - Old age 7 — — — — — 7 1 - 3 - 2, - - - 1 - - - Meningitis and convulsions 5 3 - - - - 1 1 - - 1 - 2 1 - - - - - - - 1 — — 7 MALES.—Table IV. (continued). Causes or Death. Cobbbotbd Deaths in the City at subjoinbd Ages. Deaths in Wabds (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5'. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general pnralysis 13 - - - - - 4 8 1 - - - 1 5 - 3 - 1 _ 1 1 1 - Other diseases of nervous system 14 _ __ 1 2 2 4 5 2 1 2 1 2 — 2 - - — 2 2 Valvular diseases of heart 10 - - 1 — — 2 5 8 - 1 1 1 3 2 2 2 — — - - 4 - — Other circulatory diseases 179 1 - - 1 1 9 66 101 - 24 1 17 37 17 33 9 6 4 9 2 5 12 3 Bronchitis 90 2 - - — — 1 25 62 - 1 - 6 28 4 33 3 2 1 1 - 3 6 2 Broncho-pneumonia 16 — 4 2 — — 1 2 7 - 1 - 3 5 1 3 — 1 — - — 1 1 — Pneumonia, other forms 44 — — — — — 9 18 17 - 3 - 2 14 2 9 1 1 3 1 2 1 3 2 Other respiratory diseases 13 — — — — 1 3 4 5 - 2 - — 4 1 3 — — — 1 — - 2 — Alcoholism 3 - - - - - 1 1 1 - — - 1 — — — 1 — 1 - — - — — Cirrhosis of liver 8 — — — — — 1 5 2 - — - — — 1 2 1 — 1 1 — 1 1 — Appendicitis and typhlitis 8 — — — — — 2 6 — - 3 - — 2 1 1 - - - 1 - - - - Other digestive diseases 34 - - - - - 4 16 14 - 2 1 3 8 5 10 1 — 1 1 — 2 — — Bright's disease, &c. 32 — — — 1 1 2 10 18 - — 1 1 7 3 13 2 1 — 1 — i 1 1 Cystitis, &c. 28 — — — — — — 6 22 - 1 2 2 7 2 7 3 — — 1 — 1 — 2 Deaths by accident or negligence 38 2 1 1 3 6 7 7 11 - 4 - 4 12 - 6 2 3 2 - 1 3 1 1 Deaths by suicide and murder 18 1 - - - 1 8 8 - - 2 - 1 3 1 6 1 - 1 - 1 1 1 — Other defined diseases 12 — 2 — — — 4 4 2 - — 1 1 6 — 2 — — — - 1 1 — — Diseases, ill defined or unknown - - - - - - - - - - - - - - - - - - - - - - - - All causes 855 48 15 11 14 19 98 300 350 — 60 11 58 236 51 204 38 20 22 2o 13 39 56 22 8 FEMALES. Table IV. (continued)—Causes of, and Ages at, Death during the year 1926. Causes or 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 12 2 8 1 1 - - - - - - - - - - - - - - - - - - - Scarlet fovor - — — - - - - - - - - — - - - - - - - — - - — - Influenza 9 1 — - - 1 - 4 3 — 2 - - 2 2 2 - - - 1 - - — - Whooping-cough - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria, Momb. croup 4 — — 2 2 - - - - - 3 - - 1 - - - - - - - - - - Ccrobro-spinal meningitis - - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis 1 - - - - 1 - - - - - - - 1 - - - - - - - - - - Enteric fever 1 — - - - 1 - - - 1 — - - - - - - - — - — - - Diarrhoea, enteritis 12 9 — 1 — - - 1 1 - 1 - - 5 1 2 1 - - - - - - 2 Erysipelas 1 — — - - - — 1 - - - - - 1 - - - - - - - - - - Puerperal fever 2 — - - - 1 1 - - - - - 1 - 1 - - - - - - - - Other septio diseases 14 - - - - - 6 3 5 - 1 - 4 3 — 3 2 - - - - - - - Syphilis, &c. — — — — — — — — - - — - — — — — — - — — - — — — Diabetes 8 — - — - - - 6 2 - - - - 4 - 1 - 1 — 1 - 1 - - Rheumatic fever 5 — — — - - - 1 4 —. - 2 1 1 - - - - - - 1 - Tuberculosis of lungs 42 - - - 1 10 14 14 3 - 1 2 2 16 - 14 2 — - 1 - 2 1 1 Other forms of tuberculosis 8 2 - 1 1 2 1 1 - - - - 1 3 - 3 - - - 1 - - - - Malignant growths 111 - — — — 4 25 53 29 1 16 6 8 39 2 17 5 1 2 3 3 6 1 2 Congenital debility, malformation, and premature birth 17 17 - - - - - - - 1 1 - - 4 1 2 5 - 1 - 1 - - 1 Old age 39 - - - - - - - 39 - 3 1 3 12 2 7 2 1 - 2 2 - - 4 Meningitis and convulsions 2 - - - 2 - - - - - - - - - - - - - - - - 1 - - 9 FEMALES.—Table IV. (continued). Causes or Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 1 - - - - - - 1 - - - - - - - - 1 - - - - - - - Other diseases of nervous system 12 - - - 1 1 2 4 4 - - 2 1 5 - 1 1 1 - - - 1 - - Valvular diseases of heart 13 — - - - - - 6 7 - 1 - 2 8 - 1 - - - - - 1 - - Other circulatory diseases 160 - - - 1 7 8 37 113 2 17 5 22 44 13 30 6 4 2 1 - 13 3 4 Bronchitis 75 2 1 - 1 — 1 13 57 - 5 1 4 22 3 27 3 - - 3 - 7 — - Broncho-pneumonia 45 11 4 3 - 1 - 6 20 - 3 1 5 18 3 13 - 2 - - - - - - Pneumonia, other forms 32 1 - - - - 2 14 15 - 3 - 6 14 1 7 - - - 1 - - - - Other respiratory diseases 3 - — — - — - 1 2 - - 1 - 1 — — 1 — — — - — — - Alcoholism 4 — — — - — 1 3 —r — — 1 1 1 — 1 — - - - - - - - Cirrhosis of liver 1 — — — - — 1 — — — — 1 — — — — — — — — - — — — Appendicitis and typhlitis 5 - - - - - 2 1 2 1 1 - - - - - - - - - - - - - Other digestive diseases 23 - - - - - 4 10 9 - 1 - 5 11 1 3 - - - 2 - - - - Bright's disease, &c. 24 — — — - — 4 7 13 — - - 1 6 3 6 2 1 1 — - 4 — — Cystitis, &c. 8 - - - - - 4 4 1 - 1 4 1 1 - - - - - - - - Accidents and diseases of parturition 4 - - - - - 3 1 - - 1 - - 1 - 1 - 1 - - - - - - Deaths by accident or negligence 24 1 1 - 2 5 6 9 - - 2 2 9 2 6 1 1 1 - - - - Deaths by suicide and murder 13 2 - - - - 5 4 2 - - - - 4 - 3 1 - - - - 3 - 2 Other defined diseases 12 - - - 1 1 7 3 1 1 2 1 2 - 1 1 — - 1 - 2 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 753 48 13 0 10 31 87 209 346 5 64 23 69 252 37 162 32 14 8 18 6 39 6 18 (6026)Q 10 Deaths, 1,752 deaths were registered in the City in the 52 weeks of 1926. After deducting 1,009 deaths of non-citizens in public institutions, etc., in the City, and adding those of 865 citizens who died in other districts, the corrected total is 1,608, as compared with 1,728 in 1925, and is equivalent to an annual rate of 11.6 per 1,000 persons (civilian population). The London death-rate for 1926 was 11.6 (civilians only), for England and Wales 11.6. These rates are a little lower than in 1925 as regards England and Wales and Westminster. The figure is constant for London. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below :— Table V. (From 1912 to 1926.) Year. Number of Deaths. Westminster Bate. London Rate. 1912 1,984 12.5 13.6 1913 2,030 12.7 14.2 1914 1,946 12.7 14.4 1915 2,138 15.7 16.1 1916 1,827 13.7 14.3 1917 1,896 15.5 15.0 1918 2,062 16.3 18.9 1919 1,819 14.2 13.4 1920 1,600 10.9 12.4 1921 1,623 11.5 12.4 1922 1,796 12 9 13.4 1923 1,493 10.6 11.2 1924 1,695 11.8 12.1 1925 1.728 12.3 11.7 1926 1,608 11 .6 11.6 The deaths of males were 855, females 753. Table VI. This table shows the total deaths distributed among age periods :— 1926. Under 1 year 1 to 2 years 2 to 5 years 5 to 15 years 15 to 25 years 25 to 45 years 45 to 65 years 65 and up. years Total. M. 48 15 11 14 19 98 300 350 855 F. 48 13 9 10 31 87 209 346 753 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 1924 96 32 39 41 46 184 557 700 1,695 1925 106 28 22 25 65 198 496 788 1,728 1926 96 28 20 24 50 185 509 G96 1,608 11 From the above table it will be observed that the decline in the number of deaths is chiefly seen during the first year of life, during early middle age and again in old age. In the first of those groups there are thus surviving a larger number of children who, having weathered the first hazardous year, have a greatly improved chance of growing up. It would appear that in the highest age group fatal illness was much less prevalent among elderly people than during 1925, and survival was more pronounced among males. The causes of death are set out in Table IV. There was an increase among the males of deaths from the following causes: septic diseases, diabetes, rheumatic fever, respiratory and digestive diseases, appendicitis and cystitis. Among the females the causes showing an increase were septic and circulatory diseases, tuberculosis and cystitis. There were, however, fewer deaths from cancer: 96 among males and 111 in females. The corresponding figures in 1925 were 114 and 116. Deaths from tuberculosis were increased by 6. Diseases of the circulatory system still stand at the head of all causes of death, and although they furnished 345 (179 males and 166 females), the number is smaller than shown last year (356, 196 males, 160 females). Under this category are included deaths from apoplectic strokes and by far the most cases occur in the age period above 65 years. Deaths from valvular disease of the heart have fallen this year by half. During the year two valuable official communications on cancer have been issued. The first, a memorandum from the Ministry of Health on cancer of the breast shows, as a result of careful examination of records of the subsequent history of hospital cases, that if operation is performed sufficiently early and completely, the risk of recurrence is very slight. On the other hand, should advice not be sought until the disease has spread to the neighbouring lymphatic glands, then no operation can hold out any prospect of cure. and at best can only alleviate for a few months, while a fatal ending is inevitable. It is hoped that by some measure of co-operation with the general hospitals in the City, the importance of early diagnosis and treatment may become more widely known, as suggested in the circular from the Ministry and on the lines of the British Empire Campaign. The other is a publication issued by the Medical Research Council and deals with the question of diet as a cause of cancer. An elaborate investigation in institutions where rules of dietary have been strictly enforced for many years, namely the homes of various monastic orders, has failed to prove that diet, vegetarian, meat free or otherwise has had any influence on the incidence of cancer. Neither the presence nor the absence of certain constituents of diet appear to be determining factors. 6026)Q B 2 12 The distribution of deaths in the various wards of the City are shown in the following table, and may be compared with the similar figures during the four preceding years:— Table VII. - 1922. 1923. 1924. 1925. 1926. M. F. Total. m. F. Total. m. f. Total. m. f. Total m. f. Total. Conduit 6 18 24 11 12 23 11 11 22 11 4 15 - 5 6 Grosvenor 56 68 124 48 47 95 50 52 102 80 49 129 60 64 124 Hamlet 37 29 66 29 30 59 30 28 58 23 20 43 11 23 34 K. St. George 61 56 120 45 56 101 43 60 103 58 61 119 58 69 127 Victoria 249 283 532 217 261 478 245 282 527 275 305 580 236 252 488 St. Margaret 52 49 101 43 37 80 50 33 83 37 42 79 51 37 88 St. John 240 203 443 170 166 336 245 196 441 221 189 410 204 162 360 St. Anne 35 30 65 39 21 60 41 26 67 37 29 66 38 32 70 Gt. Marlborough 19 17 36 9 15 24 22 12 34 7 20 27 20 14 34 Pall Mall 24 11 35 12 12 24 33 8 41 19 7 26 22 8 30 Regent 27 32 59 21 30 51 35 22 57 27 21 48 25 18 43 Charing Cross 19 7 26 18 9 27 17 9 26 16 9 25 13 6 19 Covent Garden 40 28 68 34 22 56 26 25 51 31 28 59 39 39 78 Strand 49 13 62 42 8 50 40 7 47 60 3 63 56 6 62 Homeless 23 12 35 18 11 29 23 11 34 23 16 39 22 18 40 Infantile Mortality.—The corrected death-rate of infants for Westminster was 59.7 per 1,000 births. The mortality among legitimate infants was 52.4 per 1,000; that of illegitimate 127.3. The infant mortality rate for London was 64. These figures show a considerable improvement on those of 1925, during the early part of which there occurred a severe epidemic of whooping cough. Although this disease was not very prevalent in 1926, there was an almost equally severe outbreak of measles, which, however, was not so far reaching in fatal results. Seven infants under 1 year died of whooping cough in 1925, whilst 4 died of measles in 1926. The latter year was fortunate in that while the number of births had increased from 1,535 to 1,606, the deaths of infants during the first year had fallen from 106 to 96. Table XI shows that more than 50 per cent. of the deaths of infants under one year occurred during the first month of life. Of the total 96 infants who died, 41 were under one week old. Prematurity accounted for 30 of the group under one month. This cause seems to have affected 13 both legitimate and illegitimate infants equally. Of the 76 legitimate infants' deaths, 25 were certified as from prematurity, and of the 20 illegitimate, 6 were from the same cause. Only in 12 cases of death from Prematurity does there appear to be a definite cause attributable in each instance. The reports from the health visitors resulting from visits of inquiry indicate that in— 2 cases Mother suffered from kidney disease. 1 case Shock before confinement. 1 case Too strenuous work before confinement. 1 case Severe fall before confinement. 1 case Placenta Prævia. 1 case Accidental hæmorrhage. 1 case Contracted pelvis—Cæsarean Section. 1 case Pernicious vomiting of pregnancy with albuminuria. 1 case Due to Syphilis. 1 case Excessive mental worry. 1 case Displacement of womb and overwork. Table VIII shows the deaths as they occurred during the four quarters of the last four years:— Table VIII. Total 1926. Total 1925. Total 1924. Total. 1923. lst Quarter 30 35 31 24 2nd „ 24 14 27 20 3rd „ 25 24 16 18 4th „ 17 33 22 21 96 106 96 83 14 Table IX shows the births and deaths of infants, legitimate and illegitimate, since 1902 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table IX. Year. Legitimate. Illegitimate. Total Rate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death -rate per 1,000 Births. 1902 3,275 410 125 186 32 172 127 140 1903 3,035 345 113 150 25 166 116 130 1904 2,920 320 109 134 40 298 118 145 1905 2,971 305 102 149 24 161 105 130 1906 2,744 285 103 187 38 203 110 131 1907 2,764 269 97 163 34 208 103 116 1908 2,739 266 97 174 27 155 100 113 1909 2,548 232 91 203 26 128 93 108 1910 2,399 189 78 193 25 129 82 103 1911 2,195 210 95 166 33 198 103 129 1912 2,194 168 76 155 27 174 83 91 1913 2,057 184 89 176 29 164 95 105 1914 1,995 147 73 162 24 148 79 104 1915 1,798 141 78 181 41 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 48 239 103.6 104 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 1924 1,489 82 55.0 138 14 101.4 59.0 69 1925 1,418 88 62.0 117 18 153.8 69.0 67 1926 1,449 76 52.4 157 20 127.3 59.7 64 Table X shows the causes of death of children who died under one year of age. Figures under the same grouped causes are given from 1920 onwards, showing the proportion per 1,000 births applicable under each heading:— Table X. — 1920. 1921. 1922. 1923. 1924. 1925. 1926. Diphtheria — 1.4 — — — 0.65 — Influenza — — 3.6 — 0.6 0.65 0.62 Measles 2.21 — 1.0 — 5.5 — 2.49 Whooping Cough — 1.5 1.0 1.1 1.9 4.5 0.62 Septic diseases 0.44 1.4 0.5 1.7 1.2 — 0.62 Bronchitis and pneumonia 12.80 11.8 7.3 4.0 10.4 16.2 9.9 Stomach and bowel complaints 9.29 13.4 3.1 1.1 1.9 5.2 8.0 Syphilis 2.64 2.6 2.1 2.8 1.2 1.3 — Congenital malformations 6.19 9.3 4.2 5.1 4.9 3.2 4.34 Prematurity 5.40 15.5 16.2 13.1 14.1 16.9 19.3 Neglect and injury at birth 17.07 7.3 5.7 6.8 3.1 0.65 3.72 Debility from birth and atrophy, rickets, tasis 11.48 11.0 4.2 6.2 5.3 7.1 3.72 Tuberculosis 1.76 1.4 1.5 1.7 1.8 1.9 1.86 Other causes 4.34 3.6 3.6 2.8 6.7 10.4 4.34 73.62 80.2 54.6 40.6 59.0 69.0 59.7 15 Table XI shows nett deaths from various causes at several age periods during the first year of life in the City of Westminster:— Table XI.—Infant Mortality, 1926. CAUSES OF DEATH. Under 1 Week 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 months. Total Deaths under 1 Year. Influenza — — — — — — 1 — — 1 Diphtheria — — — — — — — — — — Measles — — 1 — 1 — — 1 2 4 Whooping Cough — — — — — — — — 1 1 Sepsis — — — 1 1 — — — — 1 Tuberculosis — — — — — — 1 1 1 3 Meningitis 2 — — — 2 — 1 — — 3 Bronchitis — — — — — 1 2 1 — 4 Pneumonia (all forms) — 1 — — 1 5 2 1 3 12 Gastro-enteritis — — — — — 4 6 1 2 13 Injury at birth 1 — — — 1 — — — — 1 Neglect at birth 3 — — — 3 — — — — 3 Murder 3 — — — 3 — — — — 3 Atelectasis 1 — — — 1 — — — — 1 Congenital tions 2 1 1 — 4 2 — — — 6 Premature birth 24 1 3 2 30 1 — — — 31 Malnutrition, mus, debility from birth 3 — — — 3 2 — — — 5 Accidents — — — 1 1 — — — — 1 Other causes 2 — — — 2 — 1 — — 3 Totals 41 3 5 4 53 15 14 5 9 96 Table XII. Nett Births in the year— Males. Females. Total. Legitimate 723 726 1,449 Illegitimate 74 83 157 797 809 1,606 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 42 34 76 Illegitimate infants 6 14 20 48 48 96 The causes of death of the Illegitimate were:—Neglect at birth 2, murder 3, prematurity 6, enteritis 4, tuberculosis 1, inanition 1, br.-pneumonia 2, status lymphaticus 1. 16 Table XIII. Infant Mortality, 1926.—Nett Deaths from stated causes at various ages under One Year of Age in Pimlico Area (Victoria, Knightsbridge, St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Influenza - - - - - - 1 - - 1 Whooping Cough — — — — - - - - 1 1 Measles — — 1 — 1 - - 1 - 2 Tuberculosis — — — - - - - - 1 1 Bronchitis — — — - - - - 1 - 1 Pneumonia (all forms) 1 — — — 1 3 2 1 - 7 Gastro-enteritis — — — - - 3 4 - 1 8 Injury at birth 1 — — - 1 - - - - 1 Atelectasis 1 — — - 1 - - - - l Congenital malformations - - - - - 2 - - - 2 Premature birth 9 — 2 - 11 - - - - 11 Want of attention at birth 1 - - - 1 - - - - 1 Mulnutrition, marasmus and debility from birth - - - - - 2 - - - 2 Accidents — — — 1 1 - - - - 1 Other causes 1 — — - 1 - 1 - - 2 Meningitis 1 — — — 1 — 1 — — 2 Totals 15 — 3 1 19 10 9 3 3 44 Table XIV. Nett Deaths in the year of— Males. Females. Total. Legitimate infants 25 14 39 Illegitimate infants 2 3 5 17 Table XV. Infant Mortality, 1926.—Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and tinder 12 Months. Total Deaths under 1 Year. Measles - - - - - - - - 2 2 Tuberculosis - - - - - - - 1 — 1 Bronchitis - — — — — — 1 — — 1 Pneumonia (all forms) - - - - - 2 1 — 3 6 Gastro-enteritis - - - - - - - 1 1 2 Congenital malformations 2 - - - 2 - - - - 2 Premature birth 6 1 2 — 8 1 — — - 9 Atrophy, marasmus 1 - - - 1 - - — - 1 Want of attention 1 — — — 1 — — — - 1 Totals 9 1 2 — 12 3 2 2 6 25 Table XVI. Nett Deaths in the year of— Males. Females. Total. Legitimate infants 9 12 21 Illegitimate infants 1 3 4 Table XVII. Infant Mortality, 1926. Nett Deaths from staled causes at various ages under One Year of Age in the North District (Grosvenor, Conduit, St. Anne, Pall Mall, Regent, Gt. Marlborough, Strand, Charing Cross and Covent Garden Wards). causes of dhath. Under 1 Week. 1—2 Weeks. 2-3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Tuberculosis - - - - - - 1 - - 1 Pneumonia (all froms) - - - - - 1 - - - 1 Gastro-enteritis - — - — - 1 — — — 1 Congenital malformations 1 1 1 - 3 - - - - 3 Premature birth 10 - - 1 11 — — — — 11 Malnutrition, inanition and debility from birth 1 - - - 1 - - - - 1 Sepsis - - - 1 1 — — — — 1 Meningitis l — — — 1 — — — — 1 Murder l — — — 1 — — — — 1 Other causes 1 — — — 1 — — — — 1 Totals 15 1 1 2 19 2 1 — - 22 18 Table XVIII. Nett Deaths in the year— Males. Females. Total. Legitimate infants 8 8 16 Illegitimate infants 3 3 6 Table XIX. Deaths of infants with no known address, or found in streets, parks, &c.:— CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2-3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Mouths. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Want of attention 1 - - - 1 - - - - 1 Murder 2 — — — 2 — — — — 2 Enteritis - — — — — - 2 — — 2 3 - - - 3 - 2 - - 5 Table XX. Males. Females. Total. Legitimate — — — Illegitimate — 5 5 Table XXa. The following table shows the allocation of the nett births and infant deaths among the various Wards in the City, together with the infantile mortality rate for the Ward. Wards. Population, 1921 Census. Total Births, 1926. Legitimate. Illegitimate. Total Infant Deaths, 1926. Legitimate. Illegitimate. 1926—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total. Conduit 3,456 6 5 1 1 1 - 200.0 - 166.6 Grosvenor 13,880 111 97 14 4 3 1 30.9 71.4 36.0 Pall Mall 3,572 18 13 5 1 1 0 76.9 - 55.5 Regent 6,878 46 41 5 2 1 1 24.3 200.0 43.4 Gt. Marlborough 3,194 25 25 — 2 2 0 80.0 — 80.0 St. Anne 6,699 100 90 10 7 6 1 66.6 100.0 70.0 Covent Garden 7,064 70 65 5 2 2 0 30.7 - 28.5 Charing Cross 4,650 11 6 5 1 - 1 — 200.0 90.9 Strand 2,116 13 4 9 2 - 2 - 222.2 153.8 Victoria 37,396 603 539 64 42 37 5 68.6 78.1 69.6 K. St. George 12,563 134 120 14 2 2 - 16.6 - 14.9 Hamlet 6,687 38 37 1 - - - - - - St. Margaret 9,261 48 43 5 4 4 — 93.0 — 83.3 St. John 24,162 383 364 19 21 17 4 46.7 210.5 54.8 Homeless — — — - 6 - 5 - - — Total 141,578 1,606 1,449 157 96 76 20 52.4 127.3 59.7 19 Common Lodging House Deaths. Reference has been made in former reports to the shifting population which inhabits the four common lodging houses which are licensed in the City. Some of the residents are permanent, but a greater proportion are birds of passage. Deaths among the latter class of people tend to increase the death-rates of the Wards in which those lodging houses are situated; 107 deaths of persons giving addresses in common lodging houses occurred in 1926. They were mostly in institutions:— Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 42 *33, Great Peter Street 1 10, Great Peter Street (Salvation Army) (licensed for 565 men) 27 16, Strutton Ground (licensed for 201 men) 27 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 10 107 * Discontinued many years ago. 20 HOSPITALS IN WESTMINSTER. The following is a list of Hospitals in the City:— All Saints' Hospital, 49, Vauxhall Bridge Road. Genito urinary diseases. Charing Cross Hospital, Agar Street, W.C. Gordon Hospital, 126, Vauxhall Bridge Road. Rectal diseases. Grosvenor Hospital for Women, Vincent Square, S.W. Infants' Hospital, Vincent Square. King Edward VII Hospital for Officers, 17, Grosvenor Crescent. S.W. London Lock Hospital, 91, Dean Street, W. Royal Dental Hospital, 32, Leicester Square, W.C. Royal Ear Hospital, 43, Dean Street, W. St. George's Hospital, Hyde Park Corner, S.W. St. John's Hospital, Leicester Square. Diseases of the Skin. St. Peter's Hospital, Henrietta Street, W.C. Diseases of the bladder, etc. Sheffield Street Hospital, Clare Market (Female). Under the control of the Metropolitan Asylums Board. Westminster Hospital, Broad Sanctuary, S.W. Royal Westminster Ophthalmic Hospital, King William Street, W.C. St. Stephen's Hospital (City of Westminster Infirmary), under the control of the Guardians of the City of Westminster, is situated at 369, Fulham Road, S.W. Dispensaries:—City of Westminster Tuberculosis Dispensary, 1, Pimlico Road. A well-equipped dispensary under the control of the Guardians is held at the Union Offices, Princes Row, S.W. Public Dispensary, 122, Drury Lane, W.C. Western Dispensary, 40, Rochester Row, S.W. Westminster General Dispensary, 9, Gerrard Street, W. 21 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The following table shows the number of cases of infectious disease which came to the notice of the department during the period 1922-1926. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1922 1923 1924 1925 1926 Small-pox - 1 1 - - Diphtheria 285 91 237 286 223 Erysipelas 37 34 29 44 44 Scarlet fever 261 129 226 214 132 Enteric fever 12 18 15 17 11 Continued fever - - — — — Puerperal fever 7 3 10 6 5 Puerperal pyrexia — — — — 7 Cerebro-spinal meningitis 4 1 3 3 1 Encephalitis lethargica 2 2 15 7 5 Polio-myelitis 1 1 1 3 2 Ophthalmia neonatorum 25 32 23 21 16 Measles 591 131 852 117 1,026 German measles 11 42 34 117 14 Pneumonia 48 60 92 58 69 Malaria - — 1 1 — Dysentery — — — 3 — Anthrax 1 — 1 — — Chicken-pox 178 169 89 149 198 Mumps 25 95 147 120 64 Whooping-cough 67 35 97 255 46 Small-pox.—No cases of this disease were notified in Westminster during the year. Information was received from the various Port Sanitary Authorities of 156 contacts. A considerable number of these were students from South Africa visiting this country on holiday—one of whom had succumbed to small-pox in a Continental port. The names of all contacts are circulated by the Port Sanitary Authorities to the various districts to which they intend to proceed, but this only applies to persons remaining on the vessel until it reaches a port in this country. The contacts who leave the ship en route and proceed overland are entirely lost sight of and cannot be traced. Vaccination.—The Vaccination Officer informs me that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 1,306 Secondary 51 These figures do not include vaccinations and re-vaccinations done by private practitioners. No vaccination was done by the Medical Officer of Health under the Public Health (Small-pox Protection Regulations, 1917). 22 Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1926. 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera (C). Plague (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria 190 2 2 8 19 14 71 28 11 28 5 2 — 188 2 9 — - 1 1 1 6 - - - - - - Erysipelas 44 2 — 1 — — — 1 — 3 8 22 7 30 14 4 - - - - - - 1 - - - 2 1 Scarlct fever 118 — 5 6 15 14 48 14 6 6 2 2 — 117 1 - - - - - - - - - - - - - Typhus fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 10 - - - - - - - 2 3 2 3 — 9 1 2 — - — — — — — — 1 — 1 — Relapsing fever (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued fever (C) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 4 — — — — — — — — 2 2 — — 4 — 2 — - — — — — — — 1 1 — — Cerebro-spinal meningitis 1 - - - - - - - 1 - - - - 1 - - - - - - - - - - - - - - Polio-myelitis 2 - - - - - - - - 1 1 — — 2 — 1 — - — — — — — — 1 — — — Encephalitis lethargica 5 - - - - - - 1 - - 2 2 — 3 2 2 - - - - - - - - - 1 1 — Ophthalmia neonatorum 16 16 — — — — — — — — — — — 12 4 - - - - - - - - - - - - - Pneumonia 69 — — — 3 2 5 — 2 12 14 21 10 59 10 76 1 - - - - - - - 5 6 32 32 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - - - - - - - - - - - - - - Trench fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal pyrexia 7 - - - - - - - - 6 1 — — 7 — — — - — — — — — — — — — — Totals 466 20 7 15 37 30 124 44 22 61 37 52 17 432 34 96 1 - 1 1 1 6 1 — 8 8 36 33 Correction has been made for errors in notification or revision of diagnosis in 33 cases. Cases not notified:— Scarlet fever, 6, 5, 6, 5, 5, 6, 6, 8, 9, 12, 13, 24, 35, 38. Diphtheria, f, ft, 2, 2, 2, 3, 3, 3, 4, 4, 5, 6, 6, 6, 6, 6, 8, 9, 9, 11, 12, 12, 14, 14, 15, 16, 16, 18, 18, 19, 22, 28. Typhoid, 30. Puerperal fever, 34. 23 Table XXIV. 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 - - - - - - - - - - - - - - - Cholera (C). Plague (R) - - - - - - - - - - - - - - - Diphtheria — 11 19 90 8 74 2 2 3 2 — 1 — 9 2 Erysipelas — 1 2 12 2 11 — — 2 2 1 1 4 1 5 Scarlet fever 1 6 8 31 2 38 — 1 16 9 3 5 4 7 1 Typhus fever — — — — — — — — — — — — — — — Enteric fever — 1 5 2 1 1 — — 1 — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — — 1 2 — 1 — — — — — — — 1 — Cerebro-spinal meningitis — — 1 — — — — — — — — — — — — Polio-myelitis — — - 1 — — 1 — — — — — — — — Encephalitis lethargica — 1 — - — — 2 — 1 — — — — 1 — — Ophthalmia neonatorum — 1 2 7 — 4 - - - - - 1 — — 1 Pneumonia — 6 6 26 2 16 — 1 2 2 — 2 1 2 4 Malaria — — — — — — — — — — — — — — — Dysentery - - - - - - - - - - - - - - - Trench fever — — — — — — — — — — — — — — — Puerperal pyrexia - — — 2 1 1 1 — — — 1 — — 1* 1 Totals 1 26 44 173 16 148 4 5 24 15 5 10 10 21 14 * Notified to St. Marylebone. 24 Scarlet Fever.—132 cases of this disease occurred in 1926—a decrease of 82 on the figures of 1925. The wards showing a marked decrease are those of St. John and Victoria—the former with 38 and the latter with 21 fewer cases. The disease was contracted mostly by children between the ages of 3 and 15. There were no deaths. The case rate of this disease per 1,000 of the population was 0.92, the rate for England and Wales being 2.10. Of the total cases in Westminster 99 per cent. were moved to hospital. Diphtheria.—223 cases of this disease occurred, showing a decrease of 63 on the figures of 1925. Again the wards showing the decrease are St. John and Victoria—the former with 18 fewer cases and the latter with 37. At no time was there any semblance of an outbreak during the year, the closest co-operation having existed between the Council's staff and that of the London County Council in the following up and swabbing of contacts of cases already sent to hospital, or of children who were sent home from school with sore throats. Most of the cases and deaths occurred in children between the ages of 3 and 15. There were 9 deaths (5 males and 4 females), giving a rate of 40.3 per 1,000 cases. The case rate of this disease for Westminster was 1.57 per 1,000 living, and that of England and Wales 1.31. The death-rate for Westminster was 0.06, and for England and Wales 0.07. Schick Test and Immunization.—In the foreword to the Annual Report for 1925 allusion was made to a resolution by the Council to provide facilities for carrying out this work on behalf of children coming within the Maternity and Child Welfare Scheme. The test and immunization had been performed in March, 1925, at the Newport Market School. The following extract from a special report made to the Public Health Committee in February, 1926, summarizes the conception regarding the Schick test held at the time with a résumé of the circumstances which led to its adoption. REPORT ON THE PREVENTION OF DIPHTHERIA BY MEANS OF THE SCHICK TEST AND IMMUNIZATION. In the late autumn of last year there was an outbreak of diphtheria in the Victoria Ward, which involved 74 cases and 4 deaths. The occurrence was the subject of a special report to the Public Health Committee on 17th November last, and in that report it was suggested that consideration might be given to the adoption of the newer methods of prevention which are now at our disposal. This outbreak arose from the presence of a diphtheria carrier, a scholar attending St. Gabriel's School. The infection spread among the scholars attending the school; many of those who were susceptible contracted the disease, while some of those who wore naturally immune, frequently carried the germs in their throats and passed the infection on to others. The problem of dealing with diphtheria carriers has always presented 25 difficulty. Carriers are often perfectly healthy to all appearances, and as they cannot be certified as "suffering from" diphtheria, isolation is sometimes difficult to effect, and requires considerable persuasion in order to have it carried out. Diphtheria is highly infectious, and is particularly fatal among children under the age of five years. It is spread among scholars, and in families, through the agency of carriers. No uniform method has yet boon discovered by which carriers can bo rendered harmless, although in certain cases presenting abnormal conditions of the throat and nose, e.g., enlarged septic tonsils, surgical treatment has achieved the desired effect. Individuals may be divided into two classes—those who aro naturally immune to diphtheria infection, and those who are susceptible. It invariably happens in an outbreak of diphtheria that a number of cases occur, some perhaps of a fatal nature, before the infecting agent or carrier can be discovered. We have, however, at our disposal the means by which all susceptible individuals can be protected against infectious carriers. By means of inoculation, somewhat similar in nature to vaccination against small-pox, natural antitoxin can be made to develop in susceptible individuals. This natural antitoxin creates immunity to diphtheria which lasts for many years, and perhaps during lifetime. In order to tell whether an individual is susceptible, and requires this method of immunization, a test is employed. This is called the Schick test, and it is performed on the skin of the forearm, a trace of diphtheria toxin being injected under the skin. If the individual is susceptible, a small circular red wheal arises round the site of injection in the course of a few days. The absence of any such reaction in the skin denotes that the person is naturally immune and, therefore, does not require to be immunized. The test is also used to tell whether the three immunizing injections have proved effective, and a susceptible individual having received three immunizing doses should give a negative result to the Schick test, say, at the end of three months. This would prove that he is immune or protected. If the test proves positive it is evident that three immunizing injections are insufficient to create immunity in the particular case, and it will be necessary to repeat the series of injections. In a few rare instances three and even four series of injections have been necessary before the person developed immunity to diphtheria as ndicated by the Schick test. This re-testing after a course of immunizing injections may be compared to the inspection of vaccinations; unless a vaccination is inspected about the eighth or ninth day, there is no proof that the vaccination has been successful. This method of testing and immunization was put into practice in New York by Park in 1913, and since then some 50,000 school children have been treated in that city. It is noteworthy that 90 per cent, of those have remained immune to diphtheria after seven years. In this country the Ministry of Health have carried out extensive tests, and have introduced this form of immunization into 14 residential schools. The Medical Officers of the Ministry have tested 4,528 children, and have immunized 1,400. Among the former there were 265 cases of diphtheria before immunization, but during the year following this treatment there were only 2 cases. In Edinburgh some 4,000 school children have been treated by the Sanitary Authority, and the method has been widely practised in the Fever Hospitals of Manchester and Birmingham. In the Metropolitan Borough of Holborn, since 1922, immunization work has been carried out for children under school age attending the Maternity and Child Welfare Contre; the number tested was 642, of which 460 were positive, and 172 were negative or immune, 10 did not attend for the test to be inspected. In the latter part of 1924 and beginning of 1925 there was an outbreak of diphtheria at the Newport Market Army Training School. It became evident that the infections which kept breaking out were caused by carriers among the scholars. The Medical Officer of Health arranged for the scholars to be immunized in the manner which has been describod above, and obtained the authority of the Public Health Committee for the necessary expenditure on the testing material, which amounted to £1 12a. 2d. Tho (6026)q _ o 26 material for immunization was supplied free of cost by Messrs. Burroughs, Wellcome & Co. The tests and treatment were carried out on 72 scholars by the Medical Officers of the Ministry of Health in collaboration with the Medical Officer of Health and Medical Officers of the London County Council. It was left to the Modical Attendant of the Home to complete the series of injections and to re-test at the end of throe months. As in the case of vaccination it is not anticipated that treatment of this kind will be universally acceptable to those on whose behalf it is undertaken. A Sanitary Authority, however, which adopts the Schick methods cannot be charged with neglecting to adopt the most modern and complete weapons at its disposal for the prevention of a dangerous and infectious disease. Sir George Newman, the Chief Medical Officer of the Ministry, considers that the time is ripe for making this treatment available for the child population. He suggests that it should be done in connection with the Maternity and Child Welfare Centres, as children under the age of 5 are the most susceptible to diphtheria, and are most likely to die from it. The entire cost of the testing and treatment is estimated not to exceed the cost of 3s. per head. Should the Committee consider it desirable to adopt this scheme of treatment it could be carried out by the existing staff and in existing premises in connection with the Maternity and Child Welfare Scheme of the Council. The Schick work was instituted in the City as a municipal scheme in June, 1926, when the re-testing of those previously immunized and the immunization of new boys at Newport Market School were performed. A special circular letter was sent to all doctors practising in the City, informing them about the Schick work and inviting their co-operation. Leaflets were printed and distributed by the sanitary inspectors and health visitors, particularly in homes where there had been severe cases of diphtheria. The inoculations are entirely voluntary, and whether they are taken advantage of depends very largely on the powers of explanation and persuasion exercised by the health visitors. As a result of their enthusiastic efforts many are anxious to apply for the Schick treatment. Dr. Thomson, the Assistant Medical Officer, submits the following report on the immunization which he has carried out to the end of the year. Before concluding this note on the Schick work it must again be remarked that unless a re-test is performed after immunization there is no means of knowing whether the protection has become effective or not. This point must be constantly brought before the public, as it is one of cardinal importance. REPORT ON THE SCHICK TEST AND DIPHTHERIA IMMUNIZATION TREATMENT IN WESTMINSTER, 1925-26. " Following a small outbreak of Diphtheria in Newport Market Army Training School in March, 1925, the boys of this school were tested for susceptibility to Diphtheria by means of the Schick Test. Tho records show that about 53 boys were tested, of whom 17 were considered to be susceptiblo and received two or three immunizing injections, each injection consisting of 1 c.c. of Toxin-antitoxin mixture. In June, 1926, one boy in the school contracted Diphtheria, and four others were found to be germ carriers. None of these boys had received immunising treatment. They were removed to hospital, where the four carriers were Schick tested, all with negative results. 27 In June and September, 1926, the Schick treatment in the school was brought up to date by touting all the boys who had joined the school since the previous treatment, and re-testing those who had received immunizing treatment, except a few who had left the school in the interval. Forty new boys were tested and 15 were found to ba positive. The latter were given three immunizing doses at intervals of one week. Fourteen cases were re-tested, and five of these still showed a positive result. One boy left the school at this time; the other four were given a second series of three immunizing doses each. It may be noted that of the five cases which gave a positive result after re-testing, three had only very slight reactions and were marked as (?) positive, while a fourth had had a pseudo-positive reaction on the first occasion and had apparently not received the immunizing treatment. Thus, out of fourteen re-tested, only one gave a definite positive reaction after receiving immunization treatment. In March, 1927, all the boys then in the school were re-tested. Out of 11 new entrants who had not had treatment, four gave definite positive results and two others very slight reactions. The boy who had Diphtheria in June, 1926, but had had no previous test or treatment, gave a very marked positive result. Another boy who was positive at the first test and negative at the second showed a well-marked positive result at the third test. With this exception, all the 63 old case3 were negative. Notes. Ages.—The ages of the boys vary between 9 and 14, but the majority are between 10 and 13, so little difference can be expected in different age groups. An analysis of the 31 boys tested in June, 1926, did not show any preponderance of positive results among the younger boys. Ages 9 10 11 12 13 14 Boys tested 4 9 8 7 3 0 Found positive 2 3 1 4 2 0 Length of time in School.—The following table suggests that there is a much higher percentage of positives among boys who have recently come to the school. After six months many may have been exposed to a sufficient number of sub-infective doses to allow natural insusceptibility to develop. New entrants are not necessarily younger boys. Many enter at 12 and 13. Tested. Positive. In school less than 6 months 14 9 ,, from 6 to 12 months 13 3 ,, from 12 to 18 months 7 2 34 14 Reactions.—There were no reactions of any note. One boy complained of chill and feverishness on the day following his second immunizing dose, which may have been due to reaction. Another stated he had a stiff arm some days after the same dose. He had been recently vaccinated and was at the time having a course of Pituitrin injections for nocturnal eneuresis. Diphtheria.—One case occurred in June, 1926, and four positive swabs were obtained from boys without symptoms. One of the carriers was absent when the first tests were done. The others came to the school after the tests, including the one who actually had Diphtheria. (6026) c 2 28 Conclusions.—The question of protecting the community from Diphtheria by Schick treatment is a difficult one, but the work at Newport Market School demonstrated clearly that a small community of this nature could very readily be protected. The work occupied only a few hours in all, and there were no harmful results, nor was there any interruption of the school work. In the 15 months between the two series of tests 31 new boys joined the school, arriving singly at irregular intervals. Thus about one-third of the personnel of the school changes annually. To keep the school protected would need fairly frequent treatment of new boys, but this could readily be done by a school medical officer. If done every four months there would be about 8 or 10 boys each time, and the re-testing of the batch before could be done at the same time. Under such a system there would never be more than a few boys unprotected at one time. Better still would be to treat each boy on arrival, but it is easier to deal with them in batches. At the end of October the work at the Child Welfare Centres was started. It was thought best to begin with one Centre only, and the Bessborough Street Centre was chosen as, owing to the small epidemic of Diphtheria during the previous year, it was felt that the importance of the work would readily be appreciated. Owing to the excellent co-operation of the Health Visitors at the Centre there was no difficulty in finding parents who wished their children treated. Twenty-two cases were tested before the end of the year, of whom 17 were positive and received treatment, and many inquiries were being made by parents desiring treatment for their children in the following year. It was found that the treatment can readily be carried out at a Child Welfare Centre, that it was well tolerated by the children and without unpleasant after-effects. Particularly noteworthy was the interest displayed by many of the mothers, and their eagerness to have any treatment which would mitigate the dangers of Diphtheria." Ian S. Thomson. Antitoxin, for use in cases of diphtheria, is provided free of charge for medical practitioners attending patients residing in the City. The supply is available on application at the City Hall, and at the Council's Mortuary in Horseferry Road. It is apparent, however, from the small amount used (36 bulbs, each containing 8,000 units), that practitioners prefer to send their patients at once into the fever hospitals, where antitoxin is administered on admission to all cases of clinical diphtheria. In times of epidemic, however, when the capacity of the fever hospitals is greatly taxed, there tends to be delay in admitting cases, and it is then that practitioners make full use of the antitoxin supplied by the Council. Bacteriological Diagnosis.— Swabs from suspected cases among those residing in the City can be examined by the Council's bacteriologist free of charge to the practitioners attending. The materials for swabbing are supplied by the Council, and reports are in the first instance telephoned or telegraphed to the doctor concerned, and written reports follow. The number of throat swabs examined by the Council's bacteriologist during each year since 1922 were:— 1922 1923 1924 . 1925 1926 456 281 556 674 679 Enteric Fever.—There were 11 cases of typhoid and paratyphoid which came to the knowledge of the department during 1926. Of these 4 were notified as paratyphoid and 7 were typhoid. Of the 4 paratyphoid 29 cases one was subsequently discharged from hospital as not suffering from this disease. There was a history of fish having been consumed in 2 cases, ice cream in 1 case, 2 cases came from abroad, 2 were nurses attending on cases of typhoid, and in 3 cases there was no history ascertainable. There were 2 deaths. The death-rate of this disease, both for England and Wales and for Westminster, was 0.01. The case rate for England and Wales was 0.07 and for Westminster 0.07. Measles.—The following table shows the number of cases notified by head teachers of schools, the Metropolitan Asylums Board, hospitals and private practitioners during the last five years 1922. 1923. 1924. 1925. 1926. 591 131 852 117 1026 This disease again assumed epidemic form at the beginning of 1926, and 1,026 cases were notified to the department. Of these, 934 cases occurred in the first quarter of the year, with a resulting death-roll for the quarter of 14. The epidemic seems to have ceased its ravages as the year went on—78 cases occurring in the second quarter with 9 deaths, 10 cases in the third quarter with 1 death, and 4 cases in the last quarter with no death. The total deaths for the year were 24— 12 males and 12 females, and 13 out of this total were children under 2 years of age. The death-rate for England and Wales per 1,000 population was 0.09, for London 0.20, and for Westminster 0.17. Of the above 24 deaths, 14 occurred in hospitals and 10 at home. 99 cases were removed to hospital. There is now no reason why children suffering from measles, in whose surroundings there are present any elements which would militate against their recovery, should not be removed to hospital, the Metropolitan Asylums Board having agreed to receive cases of measles into their hospitals in greater numbers than before, even to the extent of giving these cases preference over scarlet fever cases. This fact, coupled with the nursing facilities offered by the Council, should go far towards lowering the mortality from this disease. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows:— 1922 1923 1924 1925 1926 Males 43 9 25 13 10 Females 52 11 31 24 9 95 20 56 37 19 30 The death-rate in 1926 was 0.13 per 1,000, the rate for London being 0.17. Last year the corresponding rates were higher, being 0.26 for Westminster and 0.23 for London. Diarrhœa and Enteritis.—Deaths from this cause were much higher in 1926 than in the previous year. The total deaths were 20—8 males and 12 females—13 being under 1 year old, 2 between the ages of 1 and 2, 1 between 2 and 5, and 4 between 45 and 65. The infant death-rate from this cause in Westminster was 8.0. Table XXVI. Deaths from Diarrhœa and Enteritis. - Under 1 year. Other ages. Total. 1922 8 4 12 1923 2 —. 2 1924 3 3 6 1925 8 5 13 1926 13 7 20 31 19 53 The 13 deaths under 1 year of age were distributed over the quarters of the year:— 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. 2 3 4 4 Whooping Cough.—46 cases only were notified during the year with 2 deaths—one at the age of 9 months and the other at 3 years. This is a remarkable decrease on the figures of 1925, when 255 cases, with 17 deaths, were recorded. Ten cases were moved to hospital. The deaths from whooping cough during the last five years are thus set out:— Table XXVII. Under 1 year. At other ages. Total. 1922 2 3 5 1923 2 3 5 1924 3 1 4 1925 7 10 17 1926 1 1 2 15 18 33 31 The following table is inserted by courtesy of the Medical Officer of Health of Poplar, who collected the data. The comparative vital statistics are interesting. Cities and Boroughs. Estimated population to the middle of year. Births. Annual rate per 1,000 persons living. Zymotic Deaths. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Deaths of Infants under one year to 1,000 births. LONDON 4,605,600 17.1* (?) 11.6* 64* west Districts. Paddington 146,700 15.3 0.8 12.6 86 Kensington 180,000 15.1 0.6 12.8 60 Hammersmith 134,400 16.3 0.6 11.4 66 Fulham 164,300 16.2 0.6 10.8 64 Chelsea 64,820 13.3 0.7 12.5 64 City of Westminster 138,400 11.3 0.44 11.6 59.7 North Districts. St. Marylebone 105,800 12.7 0.5 11.9 81 Hampstead 87,530 12.3 0.23 10.6 60 St. Pancras 216,800 16.7 0.8 12.4 76 Islington 339,200 19.0 0.5 12.0 66 Stoke Newington 53,080 16.0 0.8 10.7 48 Hackney 228,500 17.2 0.46 10.8 59 Central Districts. Holborn 43,200 12.38 0.5 12.1 90 Finsbury 77,550 21.4 0.67 12.9 66 City of London 13,230 7.1 0.07 10.4 66 East Districts. Shoreditch 106,400 23.5 12.2 66 Bethnal Green 119,600 20.9 11.6 70 Stepney 256,100 19.4 0 11.5 65 Poplar 169,000 21.6 0 11.4 70 South Districts. Southwark 188,600 20.2 0.9 12.7 70 Bermondsey 123,100 19.6 0.76 12.1 60 Lambeth 311,000 17.9 0.5 11.5 38.4 Battersea 171,900 17.3 0.7 11.4 61.6 Wandsworth 342,100 14.1 0.6 10.37 64 Camberwell 275,400 16.6 (?) 11.0 70 Deptford 115,700 18.2 0.7 11.3 56 Greenwich 104,300 17.7 0.4 10.8 61 Lewisham 187,800 16.3 0.2 10.0 40 Woolwich 141,900 17.4 0.3 10.2 43 *These provisional figures are taken from a table furnished by the Registrar-General. Other figures supplied by Medical Officers of Health. 32 Cerebro-spinal Fever.—One case only of this disease occurred, with no death. Polio-myelitis.—2 cases occurred, with one death. Encephalitis Lethargica.—5 cases occurred, with 2 deaths, both males, aged 42 and 53. Chicken Pox.—198 cases were notified. Mumps.—64 cases were recorded, 3 being moved to hospital. Plague, etc.—Intimation was received of one person coming into Westminster from a place infected with plague. Anthrax.—There were no cases in 1926. Puerperal Fever.—5 cases occurred, with 2 deaths—both in hospital. The following table shows the number of births for the last five years, together with the number of cases of puerperal fever and deaths:— Year. No. of births. No. of cases. Deaths. 1922 1,895 6 4 1923 1,752 3 - 1924 1,624 10 2 1925 1,535 6 1 1926 1,606 5 2 Puerperal Fever and Puerperal Pyrexia.—Regulations relating to the notification of these conditions came into force on 1st October, 1926. The following extracts from reports to the Public Health Committee indicate the reasons which actuated the Minister in framing these regulations, and the provisions by which it is hoped that considerable improvement will be achieved in lessening morbid conditions which are far too frequently associated with childbirth. Puerperal fever has been compulsorily notifiable since the Infectious Diseases Notification Act, 1889, but it is apparent, from the large numbers of women who die annually in England and Wales from the results of puerperal sepsis that the disease is notified too late for any effective treatment to be carried out. There is, on the other hand, good reason for believing that many cases are not notified at all. Whatever may be the cause which acts as a deterrent to notification, it is important to adopt measures for the early treatment of morbid conditions which may arise during the puerperium. As the term puerperal fever is indefinite, admits of difficulty in diagnosis and tends to deter or delay notification, the Minister has clearly defined the term puerperal pyrexia, and has made this condition 33 also notifiable. It is "any febrile condition (other than puerperal fever) occurring in a woman within 21 days after childbirth, or miscarriage, in which a temperature of 100.4 degrees Fahr., or more, has been sustained during a period of 24 hours, or has recurred during that period." A form of notification is also prescribed for puerperal pyrexia. This term differs from puerperal fever in that it does not imply any cause for the abnormal condition such as is associated with the term puerperal fever. Both conditions, therefore, are notifiable, and the Minister has empowered authorities administering the Maternity and Child Welfare Act to provide assistance in the diagnosis, treatment, and nursing of cases which are notified to the Medical Officer of Health. On the notification forms the medical practitioner can request:— (1) A second opinion on the case. (2) A bacteriological examination of blood or of a discharge. (3) Hospital treatment (admission). (4) A trained nurse. The Council have made provision for meeting the requirements of medical practitioners who may request any of the facilities mentioned. The arrangements were to be of a tentative nature, whilst experience of the working of the Regulations was being gained during a period of six months. Dr. Stanley Dodd, senior obstetric surgeon to Westminster Hospital, was appointed as obstetric consultant during this period. Dr. Braxton Hicks, of Westminster Hospital, the Council's bacteriologist, undertook to examine specimens submitted to him under these Regulations, special apparatus being supplied by the Council. Hospital treatment was already provided by the Metropolitan Asylums Board and at St. Stephen's Hospital, while mild cases could be admitted to general hospitals. Arrangements for nursing at home were made with the three District Nursing Associations, who already provide nursing services in the City under the Council's Maternity and Child Welfare Scheme. A circular letter was addressed to all medical practitioners practising in the City, informing them as to the Regulations and of the facilities which the Council had provided. Polio-myelitis.—Considerable interest was aroused in the latter part of the year owing to outbreaks in various parts of the country. Those affecting private preparatory schools in Broadstairs and Uppingham School attracted public attention. In both instances the schools were closed and the boys sent home. The homes of six contacts were in Westminster, but none of these developed the disease, nor was there any evidence that they carried the infection to others.. 34 Puerperal Pyrexia.—Seven cases occurred, four of which were in unmarried women and could be attributed to abortion. One unmarried woman died through abortion, with a miscarriage of twins. OPHTHALMIA NEONATORUM. The Public Health (Ophthalmia Neonatorum) Regulations, 1926. The following report to the Public Health Committee in October, 1926, sufficiently explains the objects of these Regulations:— "The following has been sent in the form of a circular letter to all medioal practitioners in the City, as required by Article 4 of the Regulations. It embodies the main provisions, and a copy of the Regulations has also been enclosed to each practitioner concerned. "These Regulations, as mentioned in my covering letter, come into force on the 1st October, 1926. They differ from the Public Health (Ophthalmia Neonatorum) Regulations, 1914, which have now been revoked, in that it is no longer incumbent upon a midwife to notify to the local authority a case of this disease; but, in accordance with the rules of the Central Midwives Board, midwives are still required to summon medical assistance in all cases, however slight, of inflammation of, or discharge from, the eyes of a child, and to send immediate notice to the local supervising authority (the London County Council) that such assistance has been sought. "The duty of notifying a case of ophthalmia neonatorum is now placed solely upon the medical practitioner in attendance upon the case, as it was felt that the previous dual obligation of notification placed upon both midwife and practitioner, often tended towards total absence of notification, with its consequent delay in treatment of the child. It is hoped, therefore, that advantage will be taken of the City Council'* arrangements with the District Nursing Associations for supervision and nursing of mild cases, and the greater facilities for treatment provided by the Metropolitan Asylums Board for serious cases of ophthalmia neonatorum at St. Margaret's Hospital, N.W." " Other provisions deal with enforcement of the Regulations by local authority, the forms of notification required from medical practitioners, transmission of notifications to the Medical Officer of Health, fees payable for notification, information of notification to be sent to County Medical Officer (London County Council), and to the Metropolitan Asylums Board. Notification is not required in certain cases falling under the category of inmates of premises belonging to His Majesty the King. " The aim of the Regulations is to ensure that prompt treatment is provided for cases of ophthalmia neonatorum, and it is suggested that the Medical Officer of Health should get in touch with the practitioner who notifies and should provide nursing assistance if required. In the cases of inflammation of the eyes which are reported to the County Medical Officer by midwives, the Medical Officer of Health of the local authority shall be informed after the visit of the Inspector of Midwives so that he may arrange for supervision of the case by a Health Visitor, should it be neoessary." Sixteen cases were notified during 1926—6 males and 10 females. Twelve were admitted to hospital and four treated either at home or as out-patients of hospitals. In addition to these notified cases, 11 cases of slight inflammation of the eyes came to the knowledge of the Department. Facilities are afforded for the treatment of this disease by the Metropolitan Asylums Board at St. Margaret's Hospital, Kentish Town, N.W. Mothers are also admitted, and, if necessary, receive treatment. 35 The following details in tabular form are required by the Ministry of Health of the cases notified in 1926:— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Notified. Treated. At homo. In hospital. 16 4 12 10 1 — — Five children moved away after notification. No cases were notified by midwives during 1926. Bacteriological Laboratory. The examination of specimens for bacteriological investigation is carried out by Dr. Braxton Hicks at the laboratory of "Westminster Hospital. The facilities provided by the Council apply only to patients who are residents in the City. A charge, however, is made for work done on behalf of individuals whose place of occupation is in Westminster, but who may be attended by Westminster practitioners. The following is the summary of bacteriological work performed:— Swabbings from throats in suspected diphtheria 679 Blood in suspected typhoid 14 Sputa for investigation of T.B. 461 Expenditure on first two was £96 13s. 8d., and for the third £62 0s. 2d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1926, 238 new cases of pulmonary tuberculosis were notified and 2 moved into the City who had been notified elsewhere—a total of 240. Non-pulmonary forms of tuberculosis gave 48 cases—2 of these being removals into Westminster. 36 Table I. Tuberculosis, 1926. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. Under 1 - 1 1 - - - 1 2 1 — — 3 4 — - - 1 5 1 1 1 3 - - 1 1 10 2 4 1 2 - 1 1 - 15 3 14 5 5 1 5 - 1 20 19 14 1 3 5 5 - 1 25 41 27 1 8 15 8 1 1 35 30 19 — 3 11 6 2 - 45 31 7 2 1 20 6 - 1 55 12 4 — 1 11 8 - - 65 and upwards 7 3 2 — 14 3 — — Totals 146 94 18 30 77 42 6 8 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. The primary notifications for 1926 show a slight increase of 6 on those of 1925. Out of the total cases notified in 1926, 45 died, and the following table shows the period between notification and death of these cases. Weeks. Months. 1—2 2—3 3—4 1—2 2—3 3—4 4—5 5—6 6—7 7—8 14 5 6 6 2 4 1 1 1 Table II. 1922 1923 1924 1925 1926 New cases notified 327 324 347 282 288 Number included in above who died during the year 100 44 66 46 45 (30.5%) (13.5%) (19.0%) (16.3%) (15.6%) Total Tuberculous Deaths 165 119 138 129 133 Death Rates per 100.000 118.3 84.7 96.5 92.4 96.0 37 Table III. Tuberculosis.—Notifications received during the period from 3rd January, 1926, to 1st January, 1927. 1925. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. Age periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males — — 1 1 3 19 40 30 30 12 7 143 160 Females 1 — 1 4 14 14 27 19 7 4 3 94 98 Non-pulmonary— Males 1 3 1 1 5 1 1 — 2 1 2 18 19 Females — 4 3 2 5 2 7 3 1 1 — 28 33 Total 2 7 6 8 27 36 75 52 40 18 12 283 310 Number of notifications on Form 13. (School medical inspection.) Number on Form C. Admissions to Primary notifications. Total notifications, including cases previously notified. Poor Law institutions. Sanatoria. Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males — — 1 1 1 30 130 Females — — — — — — 73 Non-pulmonary— Males — — — — — 13 Females — — — — — — 11 Total — — 1 1 1 30 227 38 Table IV. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. (Forms A and B.) 1925. Age Periods. 0tol. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 65. 55 to 65. 65 and up. Total. Pulmonary— Males — — — — — — 1 — 1 — — 2 Females — — — — — — — — — — — — Non-pulmonary— Males — — — — — — — — — — — — Females — — — — — 1 1 — — — — 2 Total — — — — — 1 2 — 1 — — 4 C.L.H. General. Non-pulmonary. C.L.H. General. Total. Notified pulmonary 33 205 2 44 284 Not notified in Westminster — 2 — 2 4 Total 33 207 48 288 39 Table V. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1925. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Received Institutional Treatment during 1926. Pulmonary— Males 146 — 6 8 42 5 45 1 1 5 1 1 8 14 6 3 112 Females 94 — 10 7 32 — 19 1 1 9 1 1 8 — 3 2 69 Non-pulmonary— Males 18 1 1 — 5 1 4 1 — 1 1 — — 2 1 — 16 Females 30 1 4 3 12 — 7 — — 3 — — — — — — 19 288 2 21 18 91 6 75 3 2 18 3 2 16 16 10 5 216 40 Table VI. 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. 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 76 607 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 66 324 1924 140 122 33 1 296 27 24 51 347 1925 108 92 27 1 228 23 31 54 282 1926 117 90 29 4 240 18 30 48 288 (Military cases which were excluded during the war were again made notifiable in 1920.) A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the city. Non-notified Deaths.—There were 32 deaths from Tuberculosis (22 males and 10 females) during 1926 of persons who had not been notified in Westminster. The majority of these had been notified elsewhere, some were sudden deaths of visitors to this country, and the cause of death in some cases was only discovered on post-mortem examination. These 32 non-notified deaths gave a percentage of 24.0 of the total deaths from Tuberculosis for the year. The total number of cases of Tuberculosis on the Register at the end of 1926 was 1,889, as compared with 1,805 at the end of the year 1925. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on Register at beginning of year 1926 811 578 190 226 Notified for the first timo during year 146 94 18 30 957 672 208 256 Removed from the Register on account of death or removal from Westminster 102 79 11 12 855 593 197 244 41 Of the 204 cases removed from the Register during the year 1926, 106 were on account of death, 90 persons suffering from Tuberculosis moved from the City, and the diagnosis was revised in 2 cases. Of the 106 deaths mentioned above, 4 died from causes other than Tuberculosis. Deaths from Tuberculosis.—The total number of deaths from Tuberculosis for 1926 (all forms) was 133—Males 83, Females 50. This gives a death-rate for this disease of .96 per 1,000. The following table shows the number of deaths from Tuberculosis for the last 5 years, together with the death rate. Year. Deaths. Rate per 1,000. 1922 165 1.16 1923 119 .84 1924 138 .98 1925 129 .92 1926 133 .96 The average five-yearly rate per 1,000 was .97. The following table shows Deaths per 100.000 of civilian population since 1917. Table VIII. Westminster—Deaths from Tuberc.ulosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1917 annual 191 147 29 22 223 169 1918 ,, 186 148 31 24 217 173 1919 ,, 134 105 21 16 155 121 1920 ,, 139 97 18 12 167 109 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 1924 ,, 124 86.7 14 9.9 138 96.6 1925 ,, 115 82.3 14 10.0 129 92.4 1926 ,, 119 85.9 14 10.1 133 96.0 WESTMINSTER TUBERCULOSIS DISPENSARY. Report by the Tuberculosis Officer on the AWork of the Dispensary during 1926. The number of new eases examined during the year was 446, as compared with 395 in 1925. The increase is due partly to a small increase in (6026)Q D 42 the number of new notifications, but chiefly to an increase in the number of cases examined as contacts. This number, for reasons stated in last year's report, was somewhat small in 1925. The following table shows the sources from which these new cases were recommended to the Dispensary, and also the corresponding figures for the previous year. The proportion recommended by practitioners is much the same, and, except for the increase in contact examinations, there is no very marked difference in the proportion of cases recommended from different sources. 1926. 1925. Practitioners 142 136 Health Visitors (contacts, etc.) 161 91 St. Stephen's Hospital 54 76 Ministry of Pensions 15 12 School Medical Officer 33 44 Hospitals 12 4 Friends, Charitable Societies, Jewish Board of Guardians, etc 29 32 446 395 The routine of the Dispensary remains unaltered and there has been no radical change in methods or in treatment. 1921. 1922. 1923. 1924. 1925. 1926. New Patients 609 421 529 603 395 446 Old Patients attending 588 825 800 652 474 519 Contacts examined 281 183 245 271 150 162 Individuals who attended 1,197 1,246 1,329 1,255 869 965 Total Attendances 3,695 3,275 3,133 3,292 2,637 2,697 Written Medical Reports to London County Council and Medical Practitioners 1,609 1,554 1,652 1,884 1,280 1,378 Consultations with Medical Practitioners 178 181 209 243 90 92 Other visits paid by Medical Officer 320 315 227 178 87 46 Visits by Health Visitors to Dispensary Cases 4,941 4,995 4,717 4,907 5,636 4,144 Sputum Examinations 308 327 360 232 443 223 X-ray Examinations 28 16 5 2 2 5 During the year the London County Council started a Work Centre for the production of firewood. Suitable cases who are definitely tubercular and who have pensions for Tuberculosis are accepted, and several have been recommended from this Dispensary. One was appointed to the clerical staff at the Centre and has remained there with benefit to his health and his financial circumstances. Others were unable to stand 43 the strain of resuming manual work after long periods without employment and have had to discontinue after varying periods. It is felt, however, that a few suitable cases would derive lasting benefit from schemes of this nature. The following classified table shows the number of cases recommended to the London County Council for institutional treatment in 1926:— Insured patients— Hospitals. Sanatoria. Males 17 47 Females 6 18 Uninsured patients— Males 3 5 Females 10 9 Boys Girls Under 15 years of age 5 2 5 1 46 82 The totals for the previous year were:— Hospitals, 41; and Sanatoria, 75. The Tuberculosis Dispensary is affiliated by official agreement with Westminster Hospital. During the year some 15 cases were referred to the hospital for orthopaedic treatment or for the treatment of some associated condition such as the removal of tonsils and adenoids. In the case of school children the treatment of these nose and throat conditions is undertaken by the school authorities, and Dispensary cases are referred to them. X-ray examinations were made at Westminster Hospital in five cases in connection with the work of the Dispensary. 223 specimens of sputum were examined at the hospital in connection with the work of the Dispensary. Artificial pneumothorax treatment has been carried out in a few suitable cases, all with very satisfactory results. The treatment was carried out in three cases at Brompton Hospital and in two cases at other hospitals. There was a total of 35 refills, at a cost to the Council of 10s. 6d. for each refill. Dental Treatment.—This treatment is undertaken for school children by the Education Authority and for pensioners by the Ministry of Pensions, and cases are referred from the Dispensary to these Authorities. Other cases are treated at the expense of the Council at the Dental Clinic at the Western Dispensary in Rochester Row. Three new cases have received treatment during the year, making 18 attendances. Thirty-eight extractions, 15 fillings, and other operations were performed. Anaesthetics were given in six instances. (6026)Q D 2 Table I. TUBERCULOSIS SCHEME OF THE WESTMINSTER METROPOLITAN BOROUGH COUNCIL. Return showing the Work of the Dispensary (or Dispensaries) during the Year 1926. Diagnosis. Pulmonary. Non-pulmonary. Total. (6) Adults. (6) Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases (7) examined during tho year (excluding contacts):— (a) Definitely tuberculous 87 62 — 1 4 4 3 4 91 56 3 5 — — — 1 — — — — — — — 1 (c) Non-tuberculous 34 42 29 21 — — — — 34 42 29 21 B.—Contacts examined during the year:— (a) Definitely tuberculous 11 16 — — 2 1 3 2 13 17 3 2 (6) Doubtfully tuberculous (8) — — — — — — — — — — — — (c) Non-tuberculous 8 29 40 — — — — — 8 29 40 50 C.—Cases written off the Dispensary Register (9) as— (a) Cured (10) — — — — — — — — — — — — (6) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) 42 71 69 71 — — — — 42 71 69 71 D.—Number of Persons on Dispensary Register (9) on December 31st (a) Diagnosis completed 265 206 20 16 16 10 93 85 281 216 113 101 (b) Diagnosis not completed — — — 1 — — — — — — — 1 44 X. Number of persons on Dispensary Register (9) on January 1st 684 . 2. Number of patients transferred from other areas and of "lost sight of"(11) cases returned 2 3. Number of patients transferred to other areas and cases " lost sight of" 104 4. Died during the year 61 5. Number of observation cases (8) under A (b) and B (b) above in which period of observation exceeded 2 months 1 6. Number of attendances at the Dispensary (including Contacts) 2,697 *7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision — 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for— (a) "Light" treatment — (b) Other special forms of treatment 35 8. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 3 10. Number of consultations with medical praotitioners— (а) At Homes of Applicants 52 (b) Otherwise 262 11. Number of other visits by Tuberculosis Officers to Homes .... 46 12. Number of visits by Nurses or Health Visitors to Homes for pensary purposes 4,144 13. Number of— (а) Specimens of sputum, etc., examined 223 (б) X-ray examinations made 5 in connection with Dispensary work. 14. Number of Insured Persons on Dispensary Register (9) on the 31st December 345 15. Numbor of Insured Persons under Domiciliary Treatment (4) on the 31st December 761 16. Number of reports received during the year in respect of Insured Persons :— (a) Form G.P. 17 — (4) Form G.P. 36 — 45 * Approximately J 5 cases have been referred to General Hospitals for Orthopaedic or surgical treatment. (Signed) Ian S. Thomson, M.D., Chief Tuberculosis Officer. 28iA February, 1927. 46 Extra nourishment was granted on the recommendation of the Tuberculosis Officer to 16 patients at a cost of £63 7s. 3d. Care and After-care.—The work of the Tuberculosis Care Committee has continued as in previous years. During the year the Committee issued for the first time an Annual Report on its work, and printed copies of this Report were sent to various bodies and individuals who are specially interested in the work done by the Committee. The Report started with a survey of the history of the Committee and an account of its composition, and then considered the activities of the Committee under the following headings:— (а) The care of the dependants whilst a breadwinner is in Sanatorium or unable to work. (b) The housing of a tuberculous family living in unhealthy tions. (c) The provision of convalescent treatment for delicate members of a tuberculous family. (d) The provision of suitable clothing for patients in hospital or torium. (e) The provision of extra nourishment. (f) Employment. (g) The assessing of patients' contributions towards the cost of tutional treatment, after consideration of their financial circumstances. The Report also suggested a scheme for the teaching of suitable handicrafts to ex-Sanatorium patients who were unfit to return to their former occupations. Details of this scheme are now under consideration by the Committee. The Report concluded with an account of three typical cases which had been dealt with by the Committee. HOUSING. In the Annual Report for 1925 reference was made to the proposals which were formulated for erecting 83 flats, to house 500 individuals, on the site adjoining the Council's dwellings in Regency Street. The site is bounded on its eastern aspect by Esher Street. The Minister of Health did not see fit to approve the original scheme because of possible obstruction to light and air from buildings six storeys in height as proposed. To meet the Minister's objections, modifications were introduced, and the scheme which was sanctioned by him in April provides for a building which, in its central part, will be four storeys high and rising to a height of six storeys at either end. The accommodation is consequently somewhat reduced; 77 flats (4 two-room, 45 three-room and 28 four-room) will be constructed. The rents to be charged respectively will vary as follows : 6s. 6d. to 7s. 9d.; 47 9s. 6d. to 10s. 6d.; 12s. 6d. to 13s. 9d. exclusive of rates. The flats will be self-contained, each being provided with a bathroom, having a bath and W.C. The contract price of the building is £62,865. The superficial area of the site measures 17,414 square feet and the purchase price was £10,000. At the close of the year preparations were well advanced for the work of clearing the site and beginning building operations, but the problem of dishousing the tenants in certain houses on the site had to be solved. The Council, under Section 128 of the Housing Act, 1925, are absolved of any obligation to find alternative accommodation under the terms of the Rent Restrictions Acts, but in the present state of shortage a drastic exercise of this privilege would cause undoubted distress to existing tenants. There were six occupied houses which stood in the way of the scheme, one in Vincent Street, one in Esher Street and four in Page Street. Some of the tenants have found accommodation elsewhere, while for others rooms have been found in the Council's dwellings in Regency Street. Although notice to vacate had been given there were still some twenty-five persons in the Page Street houses who had failed to find other accommodation. Willow Street Scheme.—The scheme which has been outlined above has been under consideration since 1924, and for the reasons which have been stated, its progress has been impeded at various points. Those reasons do not exist in regard to the scheme now to be described. The Council considered the triangular area of vacant land, 12,360 superficial feet in extent, which has a frontage on Willow Street, is bounded on one side by Greencoat Place and on the other by houses in Rochester Row. A 999 years' lease has been obtained from the Ecclesiastical Commissioners, the owners of the site, at a ground rent of £250 per annum, and it is proposed to erect three blocks of five storeys each. There will be forty-one flats (eleven 2-room; twenty-five 3-room, and five 4-room), providing accommodation for approximately 200 individuals. By the terms of the lease the building must be completed by September, 1927. In these circumstances of urgency the Council decided to forego the formalities contingent on making application to the Ministry for a subsidy under the Housing Acts, and resolved to make the necessary financial provision out of revenue. The scheme is, therefore, not subject to the conditions governing the grant of a subsidy, and baths will not be provided for each flat, although a number of bathrooms will be included. There will be a laundry and drying-room for the use of the tenants. It is estimated that the cost of the building will be £30,500, and at the close of the year the question of inviting tenders was being considered. The accommodation in the Willow Street scheme will be similar to that in the Horseferry Road estate of the Peabody Trust. The additional 48 block on this estate to which reference was made in the Annual Report for 1925 was completed in November, 1926. The scheme of the London County Council for providing suitable homes on their housing estates for those residents in Westminster who are living in insanitary or overcrowded conditions proceeded during 1926. Since the scheme came into operation in January, 1925, 71 families have accepted vacancies on those estates. The year which has closed has seen a still greater increase in building activities throughout the City. The conversion of large houses into flats and the erection of new blocks of residential flats seem to show that there is still an unsatisfied demand from those who wish to live in central London. The difficulty in maintaining household service in the large houses of the older type has had an important influence in developing this modern method of living on one floor. The fact that in many instances complete service including meals can be obtained through the management holds out an added inducement to those whose interests are mainly outside their homes. The conversion of what were formerly the dwellings of coachmen and grooms in mews into small flats and houses is still proceeding chiefly in Mayfair and in Knightsbridge. After necessary alterations and renovations have been effected, premises of this description, although old in structure, form convenient and attractive dwellings. The demand for such houses is very great and large sums have been spent in their purchase and redecoration. If such premises are let the rents which are demanded are surprisingly high. Housing Conditions.—Steady progress has been made with the work of house-to-house inspection, which received a fresh impetus from the coming into force of the Housing Consolidated Regulations, 1925. This system of routine inspection taking streets seriatim has been most actively pursued particularly in the Victoria Ward, which, in addition to being largest in area, also contains by far the greatest proportion of workingclass dwellings. The following streets in the City: Cheval Place, Churton Place, Clarendon Street, Cumberland Street, Douglas Place, Livonia Street, Westmoreland Place, Westmoreland Street, have been systematically inspected, and certain features which emerge are the existence of overcrowding, which is prevalent, but not to the extent which was anticipated, the illegal and sometimes overcrowded condition of basement rooms, the verminous state of many rooms, and the presence of dilapidations, such as dirty and defective walls and ceilings. Dampness was present in basement rooms to a considerable extent, and this is largely due to the absence of damp-proof courses. Appropriate action was taken 49 for remedying these insanitary conditions. In several cases it has been possible to instal water supply on certain upper floors for the convenience of the occupants. In spite of the fact that the properties which have been inspected are very old, and that in many cases the owners have not had resources sufficient to undertake radical structural renovations, none were found to be in a state so dangerous or injurious to health as to be unfit for human habitation. It may be of interest here to compare the conditions as regards density of population, incidence of tuberculosis and case rate of five wards of the City. It has been stated that overcrowding is most serious in Victoria Ward, and that as a result tuberculosis is most prevalent. It is evident from a glance at the succeeding table that this allegation cannot be substantiated. It is true that the Victoria is the largest ward in the City in area, and also that it contains Table I. Ward. Population 1921 Census. Acreage. Density of population per acre. Cases of Tuberculosis. Case rate per 1,000 people. Victoria 37,396 555.4 95 79 2.11 St. John 24,162 234 114 91 3.76 Grosvenor 13,880 491.21 27 19 1.36 St. Anne 6,699 53.4 124 9 1.34 Strand 2,116 86.9 24 17 8.03 a greater population than any other ward, but it does not follow that the population is more densely distributed than in other districts, nor does it follow that there is a higher incidence of tuberculosis in this particular ward. St. Anne's Ward, where there is the greatest density of population shows in regard to tuberculosis the fewest cases and also the lowest case rate per 1,000. The Strand Ward, where the population is most sparse, shows by far the highest case rate for tuberculosis. Grosvenor Ward, with its great open spaces and industrial dwellings of the best type, modern and well kept, shows a density of population almost as low as the Strand, but it shows a higher incidence of tuberculosis than St. Anne's, where the population is almost five times as dense. Sufficient has been said to show the futility of drawing conclusions without taking into consideration density of population and the case rate relative to the number of people. In the course of a general survey throughout the City, 841 houses have been noted as being in a state not reasonably fit in all respects for habitation, and the condition of a few is such that although they have been made reasonably fit owing to action by the sanitary authority, yet in course of time they may lapse into the category of being so 50 dangerous or injurious to health as to be unfit for habitation. In certain of those instances it would no doubt benefit the owners voluntarily to close such houses but it would not improve the plight of the tenants who, in the present state of house shortage, would probably find themselves homeless, and their last state would be worse than their first. It will not be possible to take any drastic action against overcrowding in Westminster until that ideal state has been reached when there will be a surplus of houses in the Greater London area. It might be supposed that by erecting 500 additional houses or flats in Westminster a general easement of overcrowding would ensue and that a spacing out would occur among the overcrowded families. But there exists a constant tide of those who are eager to live in Westminster and who are willing to pay decontrolled rents in order to achieve that object. Thus there is an unabated demand for vacated rooms by people from other districts, and unless the conditions in which those persons have come to live are contrary to the regulations of the sanitary authority or are otherwise unsatisfactory the sanitary authority are powerless. Instances have been noted of individuals working in Poplar and Lambeth coming to live in Westminster and experiencing no great difficulty in finding accommodation. Having settled in Westminster some of these incomers show sufficient enterprise to make application for dwellings which the Council hope to erect for the benefit of Westminster workers. Other instances might help to illustrate the difficulties of the situation. A man with his family were living in unsatisfactory conditions. He was in regular employment at Beacontree on one of the L.C.C. housing estates. Nothing would induce him to leave Westminster for a house on this estate, which was close to his place of employment. In an overcrowded family the two male wage-earners were employed on night work in a South London district. The inconvenience of travelling was preferred to living in the neighbourhood of employment. One concluding case may complete the illustrations. A clerk in good employment, living in two rooms with his wife, desired to get away from the squalid environment. He did not require to be at work before 9 a.m., but they had no desire to have a self-contained house in an L.C.C. estate, and would prefer to live even nearer the heart of the West End. When one is confronted with such varying aspirations and conditions of mind the task of distributing housing accommodation is not easy. While it is very desirable that in a central district provision should be made with a view to preference for the worker who requires to live near his work, no such restriction can be placed on privately-owned houses, and the law of supply and demand is permitted free operation. The case of dwellings built by the local authority, however, raises this very 51 important question. It should be a condition in selecting tenants that the work must be in Westminster, and preference should be given to those who have resided at least two years previously in the City. Reference was made when writing last year as to the conditions at St. George's House, the old casual wards of the workhouse. It is satisfactory to record that by the end of 1926 all the tenants had left. The building is therefore now empty. The owners made generous awards to the remaining tenants, who were thus enabled to obtain other accommodation. Obstructive Buildings in Willow Place—This is a narrow court, approached through a still narrower passage. There were five old houses of the cottage type in the court. The two houses on the right were inhabited and are in fair condition, the drainage having been made modern only a few years ago. The three houses on the left had been empty for years, were utterly dilapidated and quite unfit for habitation. They were reported to the Public Health Committee as obstructive buildings, obstructing light and air from the cottages on the right. On these facts being represented to the owners measures were undertaken to demolish them and to clear the site. This has been done, with lasting benefit to the other two houses. The new bye-laws of the L.C.C. regulating houses let in lodgings came into operation in March, 1926. In 1925 it was recorded that there were 1,103 houses on the register under the old bye-laws of the City Council. The old register was found to contain a number of houses, the ownership of many of which had changed, and a certain number where the character of the lettings had altered so materially that the houses in question could no longer be classified as houses let in lodgings. As the new bye-laws difier in many important respects from the old and moreover cover a much wider field as regards requirements, it was deemed expedient to begin with a fresh register. As suggested in the memorandum from the L.C.C., the progress of registration is being gradually established. At the end of 1926 thirteen houses had been registered. Underground Bedrooms.—The use of underground rooms as sleeping rooms contrary to the regulations made by the Council under the Housing and Town Planning Act, 1909, which have effect as if made under the Housing Act, 1925, was brought to the notice of the Sanitary Authority in 18 instances. In 13, the question arose in connection with the conversion of large houses into flats and the suitability of the basement quarters for the caretaker or servants' was found to be contrary to the terms of the regulations. Objection was raised in similar circumstances in connection with three new houses. In two instances there had been 52 illegal use of underground bedrooms in existing premises and notices have been served on the owners and occupir^s under Section 96 of the Public Health Act, 1891. Restriction of Rent Acts.—No applications were received for certificates under these Acts. The following table required by the Ministry of Health, is set forth in detail:— Table II. Number of new houses erected during the year:— Tenements. (a) Total 0 (b) With State assistance under the Housing Acts— (i) By the Local Authority 0 (ii) By other bodies or persons 0 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,212 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 555 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (unoccupied) (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 841 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 34 3. Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs.. 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 0 (6) By Local Authority in default of owners 0 53 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close B.—Proceedings under Public Health Acts. 0 (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,053 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,018 (b) By Local Authority in default of owners 0 C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 3 (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 dwellinghouses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 (6) Number of dwelling-houses voluntarily demolished 3 General Sanitary Conditions. The table given below shows in considerable detail matters relating to the general sanitary condition of the City. The work of the district sanitary inspectors is performed under several main headings: inspection of nuisances and other insanitary conditions, whether on complaint or otherwise; supervision of all new sanitary fittings and drainage in old and new buildings, which includes reporting on plans of proposed sanitary construction in respect of requirements laid down in the by-laws under the Metropolis Management Acts and the Public Health (London) Act, 1891 ; and other specialised duties. It was pointed out last year that the increasing number of new buildings in the City had added greatly to the duties and responsibilities of members of the department. This 54 statement applies with still greater force on this occasion. In certain large buildings a careful examination of the drainage system frequently involves several whole days being devoted to this purpose by a sanitary inspector. Table III. Inspection of premises:— Stables:— Cleansed 16 Complaints received 995 Dung accumulations removed 24 Total Primary Inspections 3,740 Inspected on Complaint 1,083 Sanitary work supervised:— „ Infectious Disease 417 Drains:— „ Housing Regulations, 1925 555 Constructed 544 Amended and repaired 199 Re-inspections 18,065 Ventilated 208 Houses let in lodgings (visits) 4,837 Interceptor traps fixed 144 Overcrowded (houses) 12 Sealed off from sewer 36 Other infringements 247 Gully traps fixed Defective traps abolished Manholes built 852 51 572 Nuisances and other matters dealt with:— ,, repaired 313 „ covers fixed or repaired 578 Houses, cleansed throughout 234 Tested by smoke 116 „ „ partially 683 ,, chemical 198 Overcrowding (rooms) 59 „ water 887 Light or ventilation improved 265 air 48 Roofs repaired 341 Fresh air inlets fixed or repaired 356 Floors and staircases repaired 292 Underground rooms:— Soil Pipes:— Illegal use 2 Fixed 532 Closed — Ventilated 408 Yards, areas, paved or repaired 276 Repaired 241 Tested by smoke 218 Damp walls remedied 174 ,, chemical 190 Offensive refuse removed 151 „ water 24 Keeping of animals discontinued 17 „ air 413 Water-closets:— Verminous premises cleansed 174 Constructed 2,171 Drains unstopped 180 Repaired 447 Waste-pipes „ 111 Traps ventilated 1,301 Urinals cleansed 58 Flushing cisterns fixed 1,722 Water-closets:— „ „ repaired 411 Cleansed or limewashed 529 Waste Pipes:— Unstopped 127 Constructed 1,365 Ventilation and light improved 293 Repaired 252 Trapped 3,021 Ventilated lobbies provided 25 Ventilated 2,735 Dust-bins provided 279 Disconnected from drain 231 ,, repaired 15 Rainwater Pipes:— Water Supply:— Fixed or repaired 549 Provided 202 Disconnected from drains 77 „ additional in tenement houses 44 Urinals:— Constructed 549 Re-instated 13 Repaired or improved 77 Cisterns fixed 189 Stables:— „ cleansed 196 Drained 2 ,, covered 204 Paved 3 „ abolished 42 Dung receptacles provided 1 Taps off main provided 361 Garages constructed 43 Pipes repaired 254 Petrol interceptors provided 6 55 Removal of Refuse.—This is in chargc of the Highways Department, whose chief officer is the City Cleansing Surveyor, and the following particulars are supplied by his courtesy. A charge is made for the removal of other than house refuse from trade premises, such examples being fruit and vegetables, builders' refuse, etc. There is a daily collection of house refuse, the removal of trade refuse being subject to special arrangements; 98,000 tons of the former were collected during the year and 1,000 tons of the latter. Refuse, after collection, is disposed of in two ways; in one it is sent down the river in barges to be finally deposited on waste land in Essex; in the other it is sorted in a salvage plant at one of the Council's depots. During 1926, 88,000 tons were sent away in barges and 11,000 tons were treated at the salvage plant. Certain authorities dispose of their refuse by burning in destructors either with or without previous separation. Burning of refuse seems, on the whole, to have certain advantages from a sanitary point of view, but as a means of producing heat for raising steam, this method heretofore has not always been found to be a financial success. In view, however, of the possibilities of very large central power-stations being developed under the new Electricity Act, it is conceivable that heat might be efficiently produced if the combustion of refuse were carried out on a scale sufficiently large to bring down the overhead charges. By-laws as to Removal of Offensive Refuse.—Three cases were reported of removal in unsuitable vehicles and in inadequate receptacles. Including those there were 11 instances of removal during prohibited hours. A summons was ordered in each case, the proceedings resulting in fines amounting to £14 5s. Nuisances.—Intimation notices were served in 1,074 instances and 1,802 letters were sent dealing with those notices or kindred matters. Statutory notices authorised by the sanitary authority numbered 43 and related to 39 premises. Police court proceedings were taken in 10 instances in order to enforce compliance with the requirements of statutory notices. The following are the comparative figures since 1922:— — 1922. 1923. 1924. 1925. 1926. Intimation Notices 1,344 1,373 1,098 980 1,074 Letters 1,445 1,141 1,028 1,592 1,802 Statutory Notices 61 38 41 27 43 Legal Proceedings 6 2 2 5 10 56 In the 10 instances of legal proceedings the cases were:— (1) Dirty state of restaurant kitchen. Abatement order 14 days and £1 1s. costs. (2) Dirty and defective state of house. Abatement Order 14 days and £2 2s. costs. (3) Dirty and defective state of house. Summons withdrawn on payment of £2 2s. costs. (4) Damp state of part of house. Summons withdrawn on payment of £2 2s. costs. (5) Dirty and defective state of house. Abatement Order 14 days and 10s. costs. (6) Damp state of part of house. Summons withdrawn on payment of £1 1s. costs. (7) Dirty state of house. Abatement Order 14 dayB. (8) Failure to provide proper separate sanitary accommodation for sexes employed in workshop premises. Fined 20s. and 30s. costs. (9) Dirty state of workshop premises. Summons dismissed. The defendant called witnesses who gave evidence to the effect that the work had been completed before the issue of the summons, and although the evidence of the Sanitary Inspector was in direct opposition to that of the defendant, the Magistrate dismissed the summons. (10) Occupation of a room unfit for human habitation. Closing Order and £2 2s. costs against the occupier, who was subsequently fined £10 10s. and £2 2s costs for failing to comply with the Order. In this case a man was found to be occupying for living and sleeping purposes a room adjoining a fried-fish shop, from which it was separated only by a defective wood and glass partition. The room was in a dirty and damp state and was filled with boxes and baskets containing fruit and vegetables which the occupier sold from a street stall. The room was eventually vacated. Rat Repression.—Thirty-three complaints of rats were received and in each case an inspector investigated as to the cause of the complaint. In 12 instances it was found that they had entered through faulty or defective drains and sewers. Forty-three connections were examined by the City Engineer's staff at the request of the Public Health Department. During rat week, beginning in November, a special circular dealing with the causes of rat invasion and the means of getting rid of rats was distributed to householders and to business firms. During that week 10,000 baits were laid in the Council's sewers. 57 Water Supply.—The Metropolitan Water Board sent eight notices of withdrawal of water supply to premises. The reason for the action of the Board in each case was failure to pay water rate. Water Supply in Tenement Houses.—Power to effect this provision is given under Section 48 of the Public Health (London) Act, 1891, and under Section 78 of the London County Council (General Powers) Act, 1907. The number of cases in which this action was taken since 1922 is as follows:— 1922. 1923. 1924. 1925. 1926. 53 36 27 55 44 Artesian Wells.—No fresh wells have been sunk during 1926. It was mentioned last year that in order to get an adequate supply, the chalk had to be penetrated to a greater and greater depth, and coincidently the shallower wells were drying up. This is noted in the case of the wells which supply the Trafalgar Square fountains. Three wells to supply the fountains were sunk in 1847. They also supplied water to the Houses of Parliament, several Government buildings, and Millbank Prison. By 1913, two of the wells were dry because of the fall of the water level. The third was retained for the exclusive supply of the fountains. Now, with the further fall of the water level, the Metropolitan Water Board has been called upon to provide an additional supply. New Sanitary Construction.—Plans relating to work of this description numbered 724, of which 110 represented sanitary provisions in entirely new buildings. The corresponding figures since 1922 are as follows:— — 1922. 1923. 1924. 1925. 1926. Plans 468 551 602 658 724 Plans of work in new buildings included in above 39 73 80 102 110 In 42 instances the plans related to houses wholly or partially being converted into flats, and in 12 instances to premises in mews being converted into dwellings of a superior class. Of the total of plans submitted, 4 were not approved, as the work proposed did not comply with the by-laws. In 3, the proposals were withdrawn. Combined drainage orders were made in 27 cases. Infringements of the by-laws were reported to the Public Health Committee in 12 instances in respect of failure to give notice of intention to construct or to deposit plans. Nine builders were cautioned and three were summoned in respect of these offences and were convicted, fines and costs amounting to £9. (6026)Q E 58 Smoke Prevention.—The Smoke Abatement Bill, the main provisions of which were discussed in last year's report, became law in December, 1926. The provisions of the Act will come into force on 1st July, 1927. The principal provisions deal with the following matters:—power to take proceedings in respect of a nuisance from smoke which is not black; extension of "smoke" to include soot, ash, grit, and gritty particles; increase of penalties; power to make by-laws prescribing standards as to the emission of smoke; power to make by-laws respecting cooking and heating arrangements in new buildings other than private dwelling-houses; power to the Minister to authorize the County Council to carry out duties with regard to smoke abatement on default of the Sanitary Authority; and power to the Minister to extend the operation of the Alkali Act. It will not be a defence in the case of black smoke to plead that the best practicable means have been used to prevent it. This defence, however, will still be available in cases where the smoke is not black. It will be noted that the smoke nuisance from private houses still remains without interference. During the period when British coal was not available, complaints were lodged almost daily. They referred mostly to particular buildings. In spite of the frequency with which this nuisance was the cause of complaint during that period, there were fewer complaints of smoke throughout the entire year than in 1925. There is no doubt that the foreign coal, which alone was obtainable from the beginning of May almost till the end of November, produced a great deal of unconsumed carbon particles. Even with the most careful stoking performed by trained stokers it was impossible to prevent nuisance. It seemed an occasion rather for advice from the officers of this department than summary proceedings. In 26 instances intimation notices were served. It may be observed that as the law stood it would have been futile to take proceedings during this period of stress having regard to the type of fuel available, and the fact that the best practicable means were being used to counteract the nuisance. The following table shows the extent to which smoke has been a cause of complaint to the sanitary authority during the past five years, and also a summary of the measures taken in mitigation:— Table IV. — 1922. 1923. 1924. 1925. 1926. Complaints received 31 12 40 80 62 Observations taken 1,795 600 2,309 1,999 2,490 Notices issued— Preliminary 80 8 42 23 26 Statutory 2 2 — — — Summons 1 — — — 59 Draft Revised Drainage By-laws.—'These draft by-laws made by the London County Council under Section 202 of the Metropolis Management Act, 1855, were forwarded to the City Council for their observation. The Public Health Committee considered the draft by-laws together with a report by the Medical Officer of Health, and made a presentment which has been embodied in the report of the Council. A communication was addressed to the L.C.C. requesting that the by-laws be amended in accordance with the views expressed in the report. The draft by-laws are in some respects an improvement on those now in force in that the requirements are set out in simpler form; certain modifications are introduced with the object of bringing those requirements into line with modern practice. Among the innovations to which the Council took exception were: (1) permission to dispense with the intercepting trap under certain conditions; (2) the inclusion of bidets as slop sinks, so that the wastes from them shall discharge into soil pipes and not into waste pipes, as at present. There are also certain points of detail concerning sanitary construction, some of which are desirable, while there are others to which exception has been taken. Draft Revised Drainage By-laws made by the L.C.C. under Section 39 of the Public Health London Act, 1891.—These were forwarded in the last week of the year for the observations of the Council. They involve striking changes in the construction and methods of ventilation of W.C.'s. They will be considered and reported on in due course. Underground Kitchens.—This subject was under discussion during the year and the following report was presented by the Public Health Committee as representing their views. The hope was expressed that the Council might consider it advisable to request the County Council to introduce into a General Powers Act provisions consistent with the opinions expressed in this report. The Construction of Underground Kitchens in Newly-Erected Hotel and Restaurant Premises. "Proposals have been recently brought forward in connection with the submission of plans of new buildings of the hotel restaurant type, whereby it is intended to use the sub-basement floors as kitchens and as places for the preparation of food. It is realised that where site values are high, it is necessary to make the utmost use of the available space. Unless, however, there is an open area or other means of access to light and air, the premises are dependent solely on mechanical methods of ventilation and are without daylight. The depth beneath ground level may be as much as 27 feet, and work may (6026)Q E 2 60 be carried on for long hours in an atmosphere where the temperature is usually abnormally high. The law with regard to the use of underground bakehouses is quite definite and binding. Under the Factory and Workship Act, 1901, no such bakehouse shall be used after the passing of this Act, unless it was in use previously and certified to be suitable for the purpose. The processes carried on in the kitchens of large hotels and restaurants are in many respects similar to those in bakehouses and the objection to the use of the latter would appear to hold good in regard to kitchens, particularly where the proposed situation is in a sub-basement. It has been found practicable in the case of many modern hotels, hospitals, etc., to place kitchens on the top floor of the building, and this custom is one which has all the advantages from a public health point of view. The importance of the influences of fresh air and sunlight as factors tending to diminish industrial fatigue is appreciated by those who are interested in studying conditions of work and production. There is no doubt that work performed for long hours in artificial light has a depressing influence on health and this is also true, though perhaps to a less extent, where there is no direct access to the fresh outside air. It would, therefore, appear that any proposal to use sub-basement premises as kitchens, or for the preparation of food, is of the nature of a retrograde step—a return to conditions which are inconsistent with sanitary progress." Local By-laws and Regulations—The following by-laws and regulations made by the City Council are in force in the City and became operative on the dates mentioned By-laws under the Public Health (London) Act, 1891— Paving of yards and open spaces in connection with dwelling-houses.— 24th August, 1908. Cleansing of Cisterns.—24th August, 1908. Water-closets—water supply to.—24th August, 1908. For the prevention of nuisances arising from— (1) Snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (2) Any offensive matter running out of any manufactory, brewery, slaughterhouse, knacker's yard, butcher's or fishmonger's shop or any dunghill, into any uncovered space, whether or not surrounded by a wall or fence. (3) Keeping of animals in such place or manner as to be injurious or dangerous to health.—2ith August, 1908. Regulations as to underground sleeping places under Section 17 (7), Housing, Town Planning, etc., Act, 1909.—1 \th January, 1916. 61 Occupations and Workshops—In the following tables are shown in detail the number and variety of work premises on the register at the end of 1926; the number of inspections made, and the results of such inspections:— Table V. Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,390 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 1,155 Leather workers, boot and shoe makers, harness makers, &c. 65 Carpentry, upholsterv, carvers, gilders, &c. 59 Surgical and dental instrument makers 11 Tobacco manufacturers 13 Wig makers and hair workers 47 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, &c. 59 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 61 Metal workers 25 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 43 Florists 21 Laundries 27 Bakehouses 70 Photosraphers 33 Jewel case makers 11 Cinema film workplaces 57 Total 3147 The use of 315 workshops was discontinued, and 261 additions were made to the register during the year. Table VI.—Inspection. Premises. Number of Inspections. ReInspections. Defects Found. Intimation Notices. Statutory Notices. Prosecutions. Factories 153 96 14 2 — — Workshops 1,589 2,132 664 316 8 2 Workplaces 1,373 2,110 677 167 5 — Total 3,115 4,338 1,255 485 13 2 62 Table VII.—Defects found. Particulars. Number of Defects. Number of Prosecutions. Found. Nuisances under the Public Health Acts:— Lack of cleanliness 425 1 Insufficient ventilation 63 — Unventilated gas stoves 59 — Overcrowding 35 — Floors without means of drainage 19 — Sanitary accommodation— Insufficient 59 — Unsuitable 108 — Defective 165 — Not separate for sexes 41 1 Other defects 281 — Total 1,265 2 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses — — Breach of special sanitary requirements for bakehouses (included above) — — Other offences — — Table VIII.—Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 190 Matters notified to H.M. Inspector of Factories:— Failure to affiix Abstract of the Factory and Workshop Act 173 Absence of means of warming — Matters referred by H.M. Inspectors 144 Workrooms measured 326 Visits of Enquiry re Employment of Women 151 „ „ Outworkers 300 Underground bakehouses in use at the end of the year 48 A copy of a table relating to outworkers required by the Home Office under the Factory and Workshop Act, 1901, and giving information under the headings of Sections 107, 108, 109 and 1J 0 is appended. Table IX. Outworkers' Lists, Section 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 & 110. Trade. Lists received from employers. Addresses of Outworkers. Notices served on occupiers as to keeping or sending of lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Received from other Councils. Sent to other Councils. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing apparel 1,096 1,813 8,916 44 37 111 470 6,209 112 — 1 — — — 12 — — Curtains, etc — — — — — — 2 — — — — — — — — — — Linens, etc. 4 20 63 — — — 4 73 1 — — — — — — — — Cutlery, electroplate, etc. — — — — — — 2 — — — — — — — — — — Furriers 11 21 27 2 1 4 14 44 4 — — — — — — — — Umbrellas, toys, artificial flowers, etc 4 84 105 — — — 1 176 1 — — — — — — — — Engraving, metal work, etc. — — — — — — 2 — — — — — — — — — — Hairwork — — — — — — 4 — — — — — — — — — — Total 1,114 1,944 9,111 46 38 115 499 6,602 118 — 1 — — — 12 — — 64 Outworkers.—The total number of lists received during the year amounted to 1,160. Notices in respect of failure to send lists were sent to 118 firms. In one case a prosecution was ordered and the firm concerned was fined 40s. The lists contained 11,208 names and addresses of which 6,502 were in other districts, 5,598 being within the Metropolitan area and 682 in the London Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,745, of whom 1,482 were registered as occupying workshops. The number of houses in which outwork was being carried on was 856. Disinfection. Disinfection of rooms from which patients suffering from notifiable infectious disease have been removed is carried out by means of the formaldehyde spray. For other non-notifiable infectious conditions disinfection is carried out on request, and a charge is made according to the circumstances of the case. Bedding and wearing apparel are removed to the Disinfecting Station, and are there submitted to steam disinfection. Books are treated with formalin. The cleansing of persons and of premises in a verminous state has been carried out by the Disinfecting Staff. Visits were paid to 60 houses, and 3,169 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 213 men and 20 women, and 4 children under school age, were given medicated baths at the Disinfecting Station, which necessitated their making 249 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 362, and the Disinfecting Superintendent and the Sanitary Inspectors paid 501 visits of investigation to their homes. By agreement with the London County Council, arrangements are in force for the treatment at the Westminster Disinfecting Station of school children from the boroughs of Battersea, Chelsea, Holborn, Kensington, Lambeth, Paddington, St. Pancras, St. Marylebone, and the City of London. There were among Westminster children, 528 cases of head lice treated, 13 of body lice and 28 of scabies. In all these cases the clothing was disinfected together with the bedding from their homes, amounting in all to 1,649 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 337 for head lice, 0 for body lice and 10 for scabies. The number of attendances of these children for baths at the station was 1,444. 65 The following table shows the total number of individuals treated at the station for verminous conditions:— Table X. 1926. Head lice. Body lice. Scabies. Total. Children 868 13 39 920 Adults 4 223 6 233 871 236 46 1,163 All the lice and scabies cases were dealt with at the station. Table XI. 1922. 1923. 1924. 1925. 1926. Rooms 1,179 742 984 1,081 932 Articles disinfected 28,709 21,933 23,382 22,833 21,775 Articles washed 7,355 8,679 4,862 5,142 5,550 Articles destroyed 105 173 198 265 372 Books disinfected * 173 215 425 454 166 Vehicles ,, 8 3 3 8 4 Offices and business premises — — — 21 25 * School books, 134; library books, 32; private books, 0. The motor van during 1926 ran 4,120 miles and carried 4,073 cwt. of goods, the highest amount in any one day being 39 cwt. The petrol consumption was 408 gallons, equal to 10 miles per gallon. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 343—in one instance on account of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 323 cases, and there were 3 adjourned inquests. Postmortem examinations were made in 151 instances. Twenty bodies were received in the mortuary chapel to await burial. 66 The number of dead bodies taken to the mortuaries for purposes of inquest, and to await burial, during the last 24 years were:— Table XII. Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1903 396 341 55 1915 376 349 27 1904 381 322 59 1916 281 252 29 1905 368 307 61 1917 278 265 13 1906 344 283 61 1918 285 242 43 1907 358 281 77 1919 308 269 39 1908 364 298 66 1920 289 269 20 1909 291 258 33 1921 273 238 35 1910 333 281 52 1922 269 247 22 1911 383 334 49 1923 336 318 17 1912 324 284 40 1924 340 328 12 1913 328 286 42 1925 334 317 17 1914 323 295 28 1926 343 323 20 There are resting places for the dead at Ebury Bridge, Dufours Place and Drury Lane. MATERNITY AND CHILD WELFARE. Two events of outstanding importance occurred during the year, namely, the opening of two new centres, one by the Council and the other by the Westminster Health Society. The Westminster Health Society had conducted the work of Maternity and Child Welfare on behalf of the City Council at 60, Greek Street, for many years, but they decided to give up that work in the northern area as from the end of June, 1926. It then became incumbent on the Council to continue the work, and they passed a resolution to this effect on 21st January, 1926. Steps were taken to acquire the whole building, of which the Westminster Health Society occupied one floor, but the offer of £9,250 for the freehold made by the Council was not accepted. In order that there should be no loss of continuity in the work, premises for a centre had to be found at once. Premises which had been used as a shop at 9, Frith Street, were found to be vacant, and fortunately they offered suitable temporary accommodation for the purpose of a maternity and child welfare centre. They were taken for a period of three years at a rental of £300, terminable at the end of that time on six months' notice. Until the premises were ready for occupation temporary arrangements were made to hold one infant clinic per week at the Westminster Dispensary, Gerrard Street. At Frith Street certain alterations, involving the moving and erection of partitions, were made in order to provide separate rooms, but otherwise 67 no change affecting the general structure proved necessary. The Council went into occupation in July, 1926, and the work of Maternity and Child Welfare in that area has been carried on there successfully ever since. These premises, although obviously a converted shop, have served the purpose for the time being extremely well. The situation and general lay-out are very convenient, and although not designed as a model centre, certain necessary facilities are provided which are lacking at the Council's other centres, namely, a ground floor level with the pavement, in which there is an office and large space for perambulators. On the first floor a spacious airy waiting-room communicates with two other rooms, which open out of each other, but have separate exits. The entire premises give an impression of ample space. Since work was begun at Frith Street considerable experience has been gained as to the requirements for a permanent centre in this area. The best situation would appear to be in Frith Street, Dean Street, or Greek Street. These are parallel open streets easily reached from working-class dwellings at either extremity of the district, such as those in Wild Street, Covent Garden, and in the Grosvenor Ward. As regards lay-out and floor space, the following points should receive consideration:— (1) It should be approached directly from the street, the ground floor being almost level with the pavement. (2) The street frontage on the ground floor should be inviting in appearance and with suitable windows. (3) The ground floor should have an area of, say, 751 feet, which allows for a vestibule, an office, and general space for perambulators, cupboard room and lavatory. (4) The first floor, 1,102 feet, should allow for stairs, landing, passage and three rooms, one 29 feet by 14 feet, a second, 24 feet by 14 feet, a third, 15 feet by 12 feet, and lavatory. (Total floor space, 1,856 square feet.) (5) If another floor were to be provided, there should be quarters for a resident caretaker. If the building be enclosed between party walls, there should be ample through ventilation by windows on each floor at front and back, with an area or courtyard behind measuring at least all the width of the building, and not less than 15 feet across. Windows on three sides of the building are of great advantage, but these ideal conditions are difficult to obtain in this neighbourhood. These suggestions provide for the minimum accommodation which is desirable for a centre in this district, the object being to economise space 68 and to render the whole lay-out as simple as possible. The temporary premises at 9, Frith Street, go a long way to fulfil those requirements. The centre was opened in August and Dr. Duncan Leys, B.A., M.B., Ch.B. (Oxon), M.R.C.P., was appointed to conduct one infant clinic per week. This is held on Wednesdays. By arrangement with the Westminster Health Society the services of Mrs. Steffens, who had previously taught mothercraft for the Society in this area, were retained. Two fully qualified health visitors, replacing two officials of the Westminster Health Society, were appointed by the Council for the work in this northern area as from 1st July, 1926. The Westminster Health Sociei * relieved of their work in tfr their efforts in St. Margaret inadequate premises in Rochester Row had Hampered them m this area for some time, and it now became possible to proceed with the scheme for a new and model centre. On a site in Page Street generously given by the Duke of Westminster a new centre has been built, which replaces the one in Rochester Row. The building was C( 1 1 v September and was- formally opened by the wife of the Prime '-cription of it will be found in the annual report J, ; carried on t1 to develop and have an important relationship .of the Council a few words concerning the structure are here added. It is a two-storey building with a frontage of 56 feet in Page Street. There s ample space on three of its sides, only one wall being a party wall. The large flat roof affords space for a playground and solarium. On the ground floor there is a broad hall-way, large waiting-room, three smaller rooms, and two rooms for the resident caretaker. Central heating, supplied from a boiler in the basement, runs throughout the building. There are on the first floor a large room which can be divided by movable partitions, and four smaller rooms, which serve as doctor's room, weighing room, etc. Windows on three sides give all the rooms and passages a generous supply of light and air. The general scheme of the centre, which may be regarded as a model, was designed by experts of long experience in maternity and child welfare, and it has attracted the interest of many who are concerned with this work in various quarters of the globe. The cost of the building amounted approximately to £5,530. Consequent upon the decrease in the area over which the Society worked it was found necessary to draw up a fresh agreement with that body. By its terms the Society undertake to perform certain maternity and child welfare duties on behalf of the Council in the wards of St. Margaret and St. John, for which services the Council pay an annual grant of £350. 69 The eastern boundary of the area is, as in the former agreement, taken to be a line down the centre of Vauxhall Bridge Road. Ante-natal Work.—The supervision of expectant mothers is recognised to be of increasing importance, and for this purpose it is extremely desirable that they should avail themselves of the expert advice obtainable at the centres and at the hospitals. The following table shows the number of cases which were dealt with through the various centres and how they became known to the health visitors. The co-operation of the hospitals with the welfare centres continues to develop, and there is interchange of much useful information between those bodies which should result in greatly improved conditions for confinements. Table I.—Ante-natal Cases. Name of Hospital. City Council's Centres. Westminster Health Society. Totals. No. 1, Pimlico Road. No. 15 Bossborough Street. 3 months 100, Rochoster Row and 30, Page Street. 6 months No. 9, Frith Street. No. 60, Greek Street. General Lying-in 22 13 2 22 2 61 St. George's 47 12 5 6 7 77 Westminster 13 24 1 17 — 55 St. Thomas's 7 3 — 7 — 17 Charing Cross — 3 1 1 41 46 Middlesex 1 — 8 1 8 18 Woolwich — — — 1 — 1 St. Stephen's — — — 8 9 17 Queen Charlotte — — — 2 5 7 St. Bartholomew's — — — — 1 1 Clapham Maternity — — — 4 — 4 Royal Free — — — — 2 2 Found by Health Visitors 63 96 18 — — 177 By Private Doctors and Midwives — — — 78 23 101 Reported to Centre Voluntarily 93 48 4 — — 145 Totals 246 199 39 147 98 729 Six hundred and twenty-eight visits were paid by the health visitors to the 729 expectant mothers who became known to them, and 973 subsequent visits were also paid. 70 The attendances by those mothers at the clinics held by Dr. Vernon are detailed below:— Table II.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Pimlico Road 51 84 71 155 118 Bessborough Street 51 99 80 179 118 Ante-natal clinics are also held at Charing Cross, St. George's, Westminster and Middlesex Hospitals for mothers who have made arrangements for their confinements with these hospitals. Mothercraft.—Classes in mothercraft are held at the various centres, and health talks have been given each week throughout the year in connection with those classes. Table III.—Mothercraft Classes, 1926. Pimlieo Road. Bessboro' Street. 4 months. Frith Street. Page Street and Rochester Row. 6 months. Greek Street. Total. Number of classes 46 49 16 86 66 263 Total attendances 595 866 168 1,678 597 3,904 Average attendances 12.7 17.5 10.5 19.5 9.0 14.8 Number of expectant mothers 13 49 5 64 9 140 Number of attendances by expectant mothers 62 174 13 437 39 725 Number of other mothers 94 135 40 99 30 398 Number of attendances by other mothers 533 692 155 1,241 558 3,179 Attendances of children in nurseries during classes 222 1,030 114 939 231 2,536 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Pimlico Road were 223; at Bessborough Street, 252; at Frith Street, 172; at Rochester Row and Page Street, 1,035; and at Greek Street and Mayfair, 393. In addition to those, many renovations were carried out. The class at Frith Street was begun in September under the charge of Mrs. SteSens, and is held every Tuesday afternoon. Midwifery Services.—The work performed by the Council's midwife is summarised below, and comparative figures since 1922 are given. Her area, which was formerly contained in Victoria Ward, now takes in that part of St. John's Ward bounded on the east by Vauxhall Bridge Road. 71 Table IV. Number of cases attended— 1922. 1923. 1924. 1925. 1926. As midwife 95 108 75 73 80 As emergency 7 2 — — — With hospital students 7 5 — — — With private doctor — 1 —- — — Total 109 116 75 73 80 Number of— Pre-natal visits 527 610 570 779 860 Lying-in visits 866 1,402 920 939 1,005 Subsequent visits 358 172 315 335 351 Visits to infants under 1 year other than lying-in visits 215 172 266 234 262 Total number of visits 1,966 2,356 2,071 2,287 2,478 Table V. Attendances by midwife at ante-natal and other clinics 1922 1923 1924 1925 1926 1, Pimlico Road 41 72 40 54 43 15, Bessborough Street 73 62 83 75 87 Total 114 134 123 129 130 The Westminster Health Society provide midwifery services in St. Margaret and St. John Wards, the western boundary being Vauxhall Bridge Road. The following table gives figures relating to the work performed in this area during the year:— Table VI. Number of cases attended— St. Margaret and St. John Wards (Rochester Row and Page Street). As midwife 54 With hospital students 15 With private doctors 1 70 Midwifery visits 811 Nursing visits 29 840 72 As mentioned earlier in the report, there is a greatly increasing tendency for women from other districts to come into Westminster institutions for their confinements. The hospital beds available are as follows:—Charing Cross, 15; St. George's, 11; Westminster, 4; St. Stephens, 28. Five hundred women from other districts were confined in Westminster and 428 women belonging to the City were delivered in the hospitals mentioned— the number in St. Stephens alone being 209. The number of confinements taking place in the latter hospital are increasing year by year (122 in 1925), which sufficiently indicates the excellence of the organisation of this particular department of the hospital. The number of children born to Westminster parents in institutions outside the City numbered 571. The following table shows the number of confinements in the hospitals mentioned:— Table VII. Charing Cross Hospital: 250, of which 139 were Westminster cases. St. George's Hospital: 234, of which 104 were Westminster cases. Westminster Hospital: 144, of which 76 were Westminster cases. St. Stephen's Hospital: 209. Sheffield St. Hospital: 36. Infancy and Early Childhood.—At the centres in the City weekly clinics are held for the purpose of giving medical advice. The following figures give an approximate number of the births in the four areas divided for the purposes of maternity and child welfare. Owing to the readjustments of the boundary line between the areas served by the centres at Page Street and Bessborough Street, respectively, which took place during the last quarter of 1926, the numbers for each of those districts cannot be taken as an accurate allocation:— 1, Pimlico Road. 15, Bessborough St. 30, Page St. 9, Frith St. 499 365 348 394 The health visitors attached to those centres visit the homes for the purpose of supplementing the instructions of the medical officers, and of advising as to how those instructions should be carried out. Home visiting is of prime importance in maternity and child welfare, and its place cannot be taken by teaching groups of mothers at the centre. In the home the visitor, by seeing the actual conditions, can appreciate any difficulties with which the mother may be contending, and much can be cleared up in the course of a quiet talk. Visits of inquiry are necessary in cases of ophthalmia, measles, and other infectious diseases. The following table shows the number of visits paid in connection with the four centres:— 73 Table VIII. - Pimlico Road. Bessborough Street. Frith Street. (6 mos.) Rochester Row and Pago Street. Greek Street. (6 mos.) Total. Pre-natal— First visits 239 143 55 191 79 707 Other visits 366 158 107 342 75 1.048 Children under 1 year of age— First visits 450 266 156 336 172 1,380 Other visits Children over 1 and under 6 1,257 842 910 977 1,045 5,031 years— Visits 2,134 1,749 920 1,326 1,053 7,182 Death enquiries, still-births, &c 45 33 24 25 12 139 Infectious diseases 209 197 36 94 76 612 The Council's midwife paid 860 visits before, and 262 after, confinements which are not included in the Table VII. Infant Clinics.—These are held at the following centres at the times mentioned:— Council's Centres— 1, Pimlico Road—2 p.m. Wednesday. 2 p.m. Friday. 15, Bessborough Street—2 p.m. Thursday and 10 a.m. Friday (combined with ante-natal clinic). 9, Frith Street—2 p.m., Wednesday. Westminster Health Society— 30, Page Street—2 p.m. Tuesday. 2 p.m. Friday. It will be noted from the following table of attendances that the work at the centres is steadily increasing, and that a greater number of new infants are being brought to the centres. The average attendance per session has increased, as also have the total attendances. The comparative totals since 1921 are also shown:— (6026)i) 74 Table IX. Attendances at Infant Consultations. 1926. 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 101 277 79 2,339 1,565 2,616 1,644 4,260 15, Bessborough Street 102 210 73 1,860 1,785 2,070 1,858 3,928 9, Fritli Street (6 months) 26 66 35 338 163 404 198 602 60, Greek Street (6 months) 24 46 6 171 168 217 174 391 100, Rochester Row and 30, Page Street 101 264 79 2,139 1,190 2,403 1,269 3,672 1926 354 863 272 6,847 4,871 7,710 5,143 12,853 1925 347 754 210 5,711 3,952 6,465 4,162 10,627 1924 374 719 196 5,249 3,646 5,968 3,842 9,810 1923 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 1921 318 900 243 5,980 2,665 6,895 2,908 9,803 The average attendances per session were— 1926. 1925. 1924. 1923. 1922.[/##] Pimlico Road 42.4 32.2 29.7 26.0 27.7 Bessborough Street 38.5 33.6 31.0 29.1 29.1 Frith Street (6 months) 23.1 — — — — Greok Street (6 months) — 19.0 13.3 16.4 16.2 Rochester Row — 30.7 24.3 30.9 25.5 Pago Street and Rochester Row 30.3 — — — — In addition to the inspections by the medical officer stated above, 102 attendances for weighing only were made at Rochester Row and 79 at Greek Street. The number of individual children medically inspected were— 1, Pimlico Road 672 100, Rochester Row, and 30, Page Street 635 15, Bessborough Street 545 60, Greek Street (6 months) 117 9, Frith Street (6 months) 209 The Westminster Health Society relinquished the use of 100, Rochester Row in September. 75 Infant clinics in connection with the maternity departments of Charing Cross, Westminster, St. George's, Middlesex, and the General Lying-in Hospitals are held weekly in those institutions, but they do not come within the maternity and child welfare scheme of the Council, nor do the clinics at the Infants' Hospital, Vincent Square. The Council's arrangement with St. George's Hospital for the admission of cases recommended by the Council's officers remains in force. It is in operation over the area served by the centres at Pimlico Road and Bessborough Street. Two cases were admitted under this arrangement in 1926. Puerperal Fever, Puerperal Pyrexia, and Mortality in Childbirth.—Five cases of puerperal fever and seven cases of puerperal pyrexia came to the knowledge of the department during 1926. Two women died from puerperal fever, and the deaths of four other women were attributable to accidents of parturition, i.e., pregnancy with meningitis, eclampsia, eclampsia gravidarum, and prolonged labour. The woman dying from eclampsia gravidarum was 45 years of age, and this was her eleventh confinement. Nursing.—Under the Maternity and Child Welfare Scheme of the Council arrangements are in force with the three District Nursing Associations, the Pimlico, Belgravia and Chelsea, the Westminster, and the Metropolitan Associations, for the nursing of children under five years of age suffering from various ailments. A flat rate of 1s. 6d. is paid for each visit made by the Association concerned. The following table shows the nature of certain conditions for which nursing visits were paid:— Table X. Patients. Visits. Ophthalmia neonatorum and conjunctivitis 9 267 Influenza 1 6 Pneumonia 13 299 Bronchitis 8 133 Measles 24 344 Whooping cough 0 0 Other complaints 129 1,757 Total 184 2,806 Ophthalmia neonatorum has been notifiable since 1911, and the decline which was noted last year has been maintained. The percentage of mild (6026)Q f 2 76 (non-purulent) and notified (purulent) cases in relation to births from the year 1921 is as follows:— Table XI. Cases (notified). Rate per 100 births for both classes of cases. 1921 21 1.8 1922 24 2.4 1923 30 3.4 1924 23 2.4 1925 21 2.0 1926 16 1.6 With regard to the incidence of venereal disease the following table showing the death rates of infants per 1,000 births, certified to have died from syphilis, is reproduced with the inclusion of the year 1926. 1901-5 2.8 1906-10 3.2 1911-15 2.4 1916-20 4.95 1921-25 1.7 1926 0.62 It will be seen that there is a notable decline in infant deaths from this cause during this period. During the war period the high death-rate among infants would appear to indicate that infectious venereal disease was unduly prevalent, and the fall in the quinquennium 1921-25 has continued. There are a number of cases in which inflammation develops in the eyes of recently born infants, and if the discharge remains watery in nature and pus does not form the condition need not be classified as ophthalmia. The infection, nevertheless, may be gonococcal in origin. Those are necessarily mild cases, but it is important that they should be recognised and treated at an early stage, because if neglected genuine purulent ophthalmia might ensue. Sixteen cases were notified during the year, 12 of those being treated in hospital. There were also 11 instances of watery discharge from the eyes which were brought to the notice of the health visitors. All cases of ophthalmia neonatorum are visited as soon as possible after notification in order to see that adequate treatment is being provided. Treatment by the district nurses was carried out in 9 cases, 267 visits being paid. Detilal Treatment.—The Council's scheme provides for the treatment of cases both under the Maternity and Child Welfare and Tuberculosis Schemes. Figures relating to the latter will be found in the Tuberculosis 77 Section of the Report. Expectant and nursing mothers and children under five years of age are eligible for treatment. Mr. W. H. Turner submits the following report:— "I append a table of statistics, setting out the details of the work carried out at the Dental Clinic, and am glad to report that we have had another good year, with a steady increase in the work. "This increase has been most marked in the number of patients who have had extractions under general anaesthetics; and this has necessitated an occasional additional 'anaesthetic session,' which additional session has taken the place of one of the fortnightly sessions allocated for extension of' conservation' work. This procedure has, in turn, shortened the time available for the latter—the most necessary part of the dental treatment. There are indications that if the work of the clinic continues to expand it will be necessary before long to consider the advisability of converting the extra fortnightly session into a regular weekly one, and preferably having it on a separate day from the weekly morning session, thus giving patients with a lengthy course of treatment the opportunity of two visits weekly. This would enable us to keep a closer watch on acute conditions or on cases of troublesome haemorrhage or inflammation after extractions. "We still have a small minority of patients who have the more urgent work done, and are thus relieved from pain or acute septic conditions, but who fail to attend their re-appointments for completing the treatment necessary. I beg to suggest that, if these cases were scheduled and health visitors notified to call upon them, emphasising again the advantages of a healthy mouth, and. pointing out that, apart from acute and painful conditions, other dental disease can perpetuate ill-health, we should get a still higher percentage of completed cases and thus raise still further the standard of dental health. "Of the new patients in 1926, 133 were mothers and 76 were young children." Table XII. 1922. 1923. 1924. 1925. 1926. Number of Sessions 69 70 79 92 92 New patients— First attendance 121 123 179 205 209 Subsequent attendances. 463 479 522 613 629 Teeth extractions 942 1,056 1,349 1,278 1,668 Teeth filled 73 91 154 167 189 Other dental operations. 232 433 478 616 699 An.esthetics administered— Local 17 20 25 38 31 General 200 202 240 255 295 Dentures supplied 5 3 4 6 2 Patients contributed £17 11s. 6d. in small sums according to their means. 78 Convalescent Homes.—There are many charitable agencies throughout the City which are always ready to answer the call for convalescent treatment for mothers and children. Among them may be mentioned the Friends of the Poor and the St. Henry Fund. The Medical Officer of Health is ex officio a trustee of the latter, the benefits of which are available only to residents of the parish of St. Anne's, Soho. Homes for Unmarried Mothers, etc.—The Council make an annual grant of £100 to the Home of St. John the Baptist at Tulse Hill. This home was formerly in the City, and cases from Westminster are eligible for admission. There are two other homes in the City which exist for a similar purpose. Day Nursery.—There are two nurseries in which mothers who work away from home may place their young children during working hours. The homes are situated in the districts where the need for them is greatest. The Council make an annual grant of £25 towards the expenses of the nursery organised by the British Red Cross Society. Supply of Milk.—Fresh and dried milk is supplied to certain cases recommended by the medical officer of the maternity and child welfare centre. Before the grants are made a standard of income laid down by the Ministry must be proved. In some instances the weekly income docs not justify an award of free milk, but those cases may come within the scale for milk at half price. The applications are considered by a meeting of the ladies of the Maternity and Child Welfare Sub-Committee, which takes place once a month at each centre. Grants are made for a period of one month and are reconsidered for continuation at each meeting. Preparations of dried milk are sold at cost price in connection with the centres, 2,122 pounds being disposed of during the year. The amount expended by the Council for fresh milk as extra nourishment for mothers and infants amounted to £94 2s. 9d. INSPECTION AND SUPERVISION OF FOOD. The following legal provisions which deal with the administrative control of food supplies were made during the year: (1) The Milk and Dairies Order, 1926; (2) The Public Health (Imported Milk) Regulations, 1926; and the Preservatives in Food (Amendment) Order, 1926. Our present knowledge concerning the importance of milk as a food and our views as to the standards of cleanliness to be required in its preparation, were clearly demonstrated at the National Milk Conference held in London in November, at which your Medical Officer of Health had the (honour of being a delegate. Among the many points of interest 79 which were discussed were the results of Dr. Corry Mann's researches, conducted at the request of the Medical Research Council. Dr. Mann found as a result of investigations into schoolboys diet extending over three years, that the addition of a pint of milk per day definitely caused an addition to weight and height which was not observed in the boys who had not received the milk. The importance, therefore, of milk in the diet of growing school children is amply demonstrated. Dr. Harriette Chick, in an extremely able paper, showed how cow's milk was a perfect food, and that it contained a high proportion of lime salts which are so necessary for human nutrition. In regard to vitamins, it was shown that the amount of vitamins A and D (anti-rachitic) would be reduced in the milk of a cow which had been stall fed for a considerable time. In order that the milk may be rich in those vitamins the cow must be exposed to plenty of sunlight. With regard to tuberculosis it was stated that about 40 per cent. of dairy cows in the country would probably be found to react to the tuberculin test. Of milk samples examined for tubercle bacilli the proportion showing T.B. present varied greatly throughout the country; in London, 5 per cent., Birmingham 8.1 per cent., Liverpool 10 per cent., Plymouth as high as 18 per cent. showed T.B., while Cardiff had T.B. in only 1.9 per cent. The average over all shows that 6.6 per cent. of our total milk supply is tainted with tubercle. * On the question of milk as an infective agent in causing tuberculosis, it was reported that the most recent researches showed that 38 per cent. of non-pulmonary cases of tuberculosis in children under five years were caused by tubercle of bovine origin. There is therefore still need for fresh efforts to attain tubercle-free milk by encouraging the public to purchase the various grades of milk which are now produced under the certificate of the Ministry of Health, certified, Grade A (tuberculin tested). It seemed that at the present time, when milk certified to be free from tubercle was not within the reach of all, we should pin our faith to milk which had been carefully pasteurized. Pasteurisation destroys all micro-organisms which may be present, but leaves the qualities of the milk unimpaired. Milk and Dairies Order 1926. This Order is made by the Minister of Health under Section 1 of the Milk and Dairies Act, 1915, which came into force on 1st September, 1925. The issue of the Order was foreshadowed in a report on the Act which was 80 presented to the Public Health Committee in October 1925. It came into force on the 1st October, 1926. It revokes the Dairies and Milkshops Orders of 1885, 1886 and 1889, and all Regulations made thereunder by Local Authorities. The new provisions replace those contained in the above-mentioned Orders and amplify many of them in accordance with modern knowledge and standards of hygiene. It is required that greater attention shall be paid to the health and cleanliness of individuals engaged in the milk industry. There are also similar provisions dealing with the health of cattle and the conditions in which they are to be kept. The latter provisions will be entrusted to County Councils and County Borough Authorities. The City Council as a Metropolitan Sanitary Authority are concerned with those articles of the Order which refer to:— Registration (the person or the premises must be registered). Sanitary condition of dairies as regards free access to air and daylight. Water supply to such premises and means of artificial lighting. Cleaning of milk vessels and those for containing water. Rooms in which milk may not be deposited except for purposes of butter, cheese and cream manufacture, e.g. kitchens, living or sleeping rooms &c. Safeguards against contamination or infection from w.cs, drains, &c. More extended powers to the Medical Officer of Health in the investigation of sources of infectious disease and obligations on the occupier of milk premises to notify the Medical Officer of Health as to the existence of infection among those handling milk or in their households. There are important provisions as to the stoppage of milk supplies from infected premises. The Medical Officer of Health has power to give notice for this purpose, but must report the matter to his Sanitary Authority. "Where the Medical Officer of Health suspects infection among those employed at registered premises, he has power, on giving notice, to examine all suspected persons and to exclude for a specified period those considered as likely to spread infection. Milkshops and all fittings and furniture shall be washed at least once every day. There are further provisions for ensuring the use of churns which can be cleansed readily and for the compulsory cleansing of " empties " before return. This is important. The Minister has given consideration to the representations which have been made to him on the need for the sealing of milk churns. All 81 churns must be marked with name and address of owner. The lids must effect a close seal. No person, except under official authority, shall open any churn, vessel or other receptacle containing milk, or transfer milk from one vessel to another, in any railway van or on any railway station, but the article does not prohibit the purchaser, or his agent, from opening any churn, &c., or transferring the milk to any other vessel when found necessary for the purpose of checking and sampling the milk. Every person delivering milk in bottles shall cause such bottles to be filled and closed on registered premises, and no person must remove or tamper with the disc or other device used for closing a bottle after it has left such premises and before delivery to the customer. A circular setting out in brief form the requirements of the Order was distributed to all persons selling milk to the public. As a result of the intelligent interest displayed by the public in milk, dairying is now coming to be regarded as a scientific avocation, and there has now come into existence the National Institute for Research in Dairying, situated at Shinfield, Reading. The Ministry of Agriculture have urged all local authorities to take advantage of the facilities offered, and to permit their sanitary inspectors to join the courses of instruction at the Institute. The chief subjects for study are those concerned with the preparation of graded milk (certified, &c.). The Council have instructed one of their Food Inspectors to attend a course of the lectures and instruction. The Milk and Dairies Order 1926, and Dairies, Cowsheds and Milkshops Orders, 1885 to 1899. Registration of Dairymen, etc.—At the end of the year the register contained the names of 496 persons who were engaged in the selling of milk, either in or from shops, and including those itinerant vendors who have neither shops nor stores, but sell milk from street barrows. Eleven new applications to be registered during the year were received. Of those, six concerned the transfer of business to another proprietor, while the premises continued to be used for the same purpose. Two applications by itinerant vendors were refused, as the reports concerning them were unsatisfactory. One name was removed from the register by request. The sanitary inspectors paid 851 visits to premises in which milk is sold, but no defects were found which requited the service of a notice. 82 Milk and Dairies Amendment Act, 1922. Under the Milk (Special Designation) Order made under this Act the Council issued licenses for the sale of:— Certified milk 18 Grade A (Tuberculin tested) milk 12 Grade A milk 2 Pasteurized milk 15 11 samples were taken tor Bacteriological analysis. None were found to contain B Coli. The quality of the milk samples taken under this Order was found to be good and the bacteriological standard satisfactory. Pasteurization of milk is not undertaken at any premises in the City. Public Health (Milk and Cream) Regulations, 1912 and 1917. The following table shows the results of work done under these regulations. With regard to cream only three samples were found to contain Preservative. In the 56 samples of Preserved Cream there were none which showed an excess of preservative over the amount permitted (28 grs. per lb.); 5 showed no preservative at all, and the remainder of the total contained amounts below the allowed standard. Table I. The Public Health (Milk and Cream) Regulations, 1912 and 1917. Samples analysed during the Year 1926. Article. Number of samples examined for preservative. Number containing preservative and percentage of preservative found in each sample. Milk 910 No preservative found. Separated milk 3 No preservative found. Sterilized Milk 3 No preservative found. Cream 56 Three contained preservative (2.5, 16.1 and 23.1 grains of boric acid respectively). Satisfactory letters of explanation were received in rcspect of each sample. 83 Preserved Cream. Number examined. Without preservative. Preservative under amount stated on label (0.4 percent.). Preservative over amount stated on label. Milk fat in preserved cream. Above 35 per cent. Below 35 per cent. 56 6 51* Nil. 56 Nil. * Samples contained respectively 27.3, 26.5, 25.9, 25.9, 24.5, 24.5, 24.5, 23.1, 23.1, 22.6, 22.4, 22.26, 21.7, 21.7, 21.7, 21.7, 2.1, 20.8, 20.3, 20.3, 19.6, 19.6, 19.6, 19.6, 19.5, 19.1, 19, 18.9, 18.9, 18.9, 18.2, 18, 17.3, 17.2, 16.5, 16.5, 16.5, 16.5,16.1, 16.1, 16.1, 15.2, 14, 13, 9.8, 8.6, 8, 7.7, 4.3, 4, 2.5, grains of boric acid per lb. Actios Taken—nil. Infringements under Article 5 (1)—Nil. Infringements under Article 5 (2)—Nil. During the year 63 milksellers, having had samples of milk taken by the inspectors under the Sale of Food Drugs Acts, made written requests for samples to be taken from their consignors at the place of delivery. All those 63 samples proved to be genuine. Milk.—During the year 910 samples of milk were taken for analysis. The analysts have graded samples in four standards of quality as stated below. The legal standards below which milk is regarded as adulterated are for fat, 3 per cent., and for non-fatty solids, 8.5 per cent:— Good quality, over 3.8 per cent. of fat. Fair quality, between 3.3 per cent. and 3.8 per cent. of fat. Poor quality, between 3 per cent. and 3.3 per cent. Adulterated, below 3 per cent. of fat and 8.5 per cent. non-fatty solids. The following table shows the total number of samples taken since 1910 and their classification into the grades as defined with the percentage proportion of the total which each grade represented. In the year 1926 the samples taken in each of the two districts of the City are given. 84 Table II. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Per cent. No. Per cent. Per cent. No. Percent. North 460 281 61.0 132 28.7 42 8.9 5 1.0 South 450 221 491 166 36.8 58 12.7 5 1.1 1926 910 502 55.1 298 32.7 100 10.9 10 1.0 1925 970 489 50.4 368 37.9 98 10.1 15 1.5 1924 994 507 51.0 363 36.5 105 lO.0 19 1.00 1923 997 468 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 977 449 45.9 362 37.0 131 13.4 35 3.5 1920 987 321 32.5 400 40.5 236 23.9 30 3.0 1919 1,073 375 34.9 428 39.8 201 18.7 69 6.4 1918 919 320 34.8 302 32.8 194 21.2 103 11.2 1917 920 329 35.7 304 33.0 162 17.6 125 13.6 1916 919 235 25.5 360 39.1 221 22.8 103 11.2 1915 937 303 32.3 327 34.8 225 24.0 82 8.70 1914 894 250 27.9 364 40.7 217 24.2 63 7.04 1913 910 . 255 28.0 343 37.6 233 25.6 79 8.60 1912 873 251 28.7 297 34.0 252 28.8 73 8.30 1911 911 305 33.3 311 34.1 218 23.9 77 8.40 1910 947 332 35.0 328 34.6 179 18.9 108 11.40 Table No. II deserves a moment's study. Seventeen years' history of the analyses of the milk supply of the City are shown in these columns. Although these figures deal only with the chemical composition of samples, yet the standard of general excellence indicates that milk is not tampered with to the extent customary in 1910. It will be noted that the improvement in the quality of the milk supplied in the City is well maintained. More than half of the total samples were well above the legal standard and were ranked as of good quality. Only 10.9 per cent. were as low as the legal standard or slightly above it in fat content, and the proportion of adulterated samples was only 1.0 per cent. of the total. This represents a smaller proportion of adulteration than has yet been recorded, and is significant of the progress in the methods of production and distribution of milk which has been made in recent years. Legal Proceedings for Adulteration.—Five prosecutions were undertaken against vendors for the following offences:—28, 14, 8 and 6 per cent. of fat abstraction, and 8 per cent. of added water. The fines and costs imposed as a result of proceedings were as follows Milk— Fine. Costs. 28 per cent. fat abstraction £5 5s. £2 2s. 14 per cent. fat abstraction — £3 3s. 8 per cent. fat abstraction — £2 2s. 6 per cent. fat abstraction — £2 2s. 8 per cent. added water £2 85 Of the total of 910 samples of milk taken during the year, 30 were obtained on Sundays. One of the latter showed 28 per cent. of fat abstracted. Vendor fined £5 5s. and £2 2s. costs. Samples taken in course of Delivery.—Ten samples were taken as the milk was being delivered by consignors to retail purveyors at shops. Six of the samples were of good quality, and four were of "fair" quality. Public Health (Preservatives in Food) Regulations, 1925. These Regulations, to which reference was made in the Report of 1925, are not due to come into operation until 1st January, 1927. Certain provisions relating to particular articles of food such as butter, cream, bacon, ham, etc., etc., are to be deferred in coming into force until a later date in order to allow a sufficient period for methods to be devised for the preparation of those articles without the addition of preservatives. After the Regulations come into force it will no longer be permissible to manufacture for sale or sell any article of food which contains any added preservative or any of the colouring matters specified in the Regulations. In certain foods, however, specified preservatives are to be permitted, but the maximum amount of such preservative in parts per million is clearly defined. Those preservatives are Sulphur Dioxide and Benzoic Acid, and the articles in which they may be put include sausages, fruit (dried and pulp), alcoholic and non-alcoholic wines, jam, mineral waters, and a few others, of which the examples given may be taken as types. As remarked last year, the Minister was unable to accept the recommendation of the Departmental Committee to introduce legislation which would make the prohibitions and limitations imposed by the Regulations binding in proceedings taken in Courts under the Sale of Food and Drugs Acts. (Since this report was in the press a private bill which gives effect to the recommendations expressed above has been passed into law. By its provisions the presence of preservatives or other ingrcdients which contravene the Regulations is declared to be injurious to health.) The Minister considers that it would be well for Local Authorities during the early period of operation of the Regulations to give the person concerned an opportunity of furnishing an explanation before they decide upon legal proceedings. Although the Minister has been asked by the trade to introduce the right to plead a warranty and has expressed sympathy with this request, yet, in view of the statutory powers under which the Regulations were 86 made, he found it impossible to comply with it. He points out, however, that a Local Authority may proceed against a manufacturer or wholesaler, particularly in cases where an article is sold in a sealed container bearing the name and address of either the former or the latter. Public Health (Preservatives, &c., in Food) Amendment Regulations, 1926. Since the Regulations just described were issued, a further series of amending Regulations have been circulated. Their object is to postpone the operation of the 1925 Regulations in respect of certain foods and to introduce certain minor alterations in those Regulations. These alterations chiefly refer to matters of labelling and, where this is not required, to suitable notices; also to the amounts of Sulphur Dioxide to be permitted in certain fruit and fruit pulps. The dates on which the principal Regulations will come into operation are as follows:— (1) All foods except those specified below, 1st January, 1927. (2) Bacon, ham, egg yolk, and articles of food containing preservative necessarily introduced by the use in their preparation of preserved margarine, 1st July, 1927. (3) Butter, cream, and articles of food containing preservative necessarily introduced by the use in their preparation of preserved bacon, preserved ham, preserved egg yolk or preserved cream, 1st January, 1928. (4) Articles of food containing preservative necessarily introduced by the use in their preparation of preserved butter, 1st July, 1928. The Ministry of Health state that a number of communications have been received from various trade interests, representing that, owing to the exceptional industrial conditions or other causes, it has not been possible for retailers completely to clear their old stocks before the date on which the Regulations operate. In view of the time which has elapsed since the original Regulations were made and the desirability of avoiding further elaboration in regard to the dates of their application to particular commodities, the Minister has not felt justified in acceding to the requests for further postponement. He remarks, however, that Local Authorities will probably consider it desirable to refrain from instituting legal proceedings during the next few months where they are satisfied that reasonable efforts have been made to clear old stocks, and that further consignments will conform with the Regulations. 87 Table III. Sale of Food and Drugs Acts. Samples purchased under the Sale Food and Drugs Acts, showing results of Analysis and subsequent Proceedings for year 1926. Number. Article of Food. Number of samples purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. coasts, £ s. d. £. s. d. 1 Milk 910 855 (45) 10 5 2 3 7 6 0 9 9 0 2 Do. separated 3 3 — — — — — — 3 Do. Sterilized 3 3 — — — — — — 4 Do. Condensed 21 21 — — — — — — 5 Cream 66 53 3 — — — — — 6 Do. (preserved) 56 56 — — — — — — 7 Do. cheese 1 1 — — — — — — 8 Ice Cream 5 5 — — — — — — 9 Butter 147 147 — — — — — — 10 Buttered rolls 2 2 — — — — — — 11 Cakes 10 3 7 — — — 12 Arrowroot 7 7 — — — — — 13 Beef, roast 1 1 — — — — — 14 Bacon 1 1 — — — — — — 15 Pork and Beans. 1 1 — — — — — — 16 Heat pies (various) 46 38 8 — — — — — 17 Sausages 57 44 13 — — — — — 18 Meat & Fish Paste 68 68 — — — — — — 19 Asparagus 2 2 — — — — — — 20 Olives 1 1 — — — — — — 21 Olive Oil 20 20 — — — — — — 22 Peas 20 11 9 1 1 — 5 0 0 23 Beans 5 2 3 — — — — — 24 Vegetable Mayonnaise 3 — 3 — — — — — 25 Spinach 6 1 5 2 2 — 12 0 0 — 26 Apples 12 4 8 — — — — — 27 Lemon squash 1 1 — — — — — — 28 Lime juice 3 3 — — — — 29 Fruit, tinned 1 1 — — — — — — 30 Port Wine 2 2 — — — — — — 31 Whisky 169 136 33 8 3 5 8 0 0 28 7 0 32 Brandy 42 42 — — — — — — 33 Rum 39 33 6 2 1 1 2 0 0 3 3 0 34 Gin 33 28 5 2 1 1 2 0 0 7 2 0 35 Lime-water 7 6 1 1 — 1 — 1 1 0 36 Aspirin 10 10 — — — — — — 37 Camphorated Oil 20 20 — — — — — — 38 Ammoniated ture of Quinine 9 9 — — — — — — Totals 1,800 1,638 (45) 117 21 10 11 36 5 0 49 2 0 The following list shows in detail the results of analysis of individual samples other than milk, cream and spirits, which were adulterated and the decision taken in each, with the result of any legal proceedings ordered by the Council:— Apples.—12 samples were taken and 8 were found to contain arsenic in the following quantities: 1/16 1/35. 1/56, 1/65 2/80, 1/509, and 1/100 grain per 1b. 88 The first seven were samples taken unofficially, and the vendors were informed that before any sale could be permitted steps must be taken to have the apples well brushed. This was done under the supervision of the Food Inspector. An official sample was taken from the vendor of the sample containing 1/16 grain of arsenic per lb., and the result of analysis showed about of a grain per lb. The Analyst, when asked by the Committee, stated that the arsenic on the apples was very unevenly distributed, and it was very difficult to get a correct result, but that the apples taken as a whole really showed a very small quantity of arsenic indeed. Cakes.—10 samples were taken and 7 contained preservative—14, 13, 10, 9.3, 8, 8 and 8 grains of boric acid per lb. in the "cream," respectively. The samples consisted of chocolate cream buns and cream sandwich. The analysis of the samples as a whole showed that the quantity of preservative varied from 7 grains to .8 grain. It was pointed out that there was no standard for this kind of "cream," and as the amount was not serious no action was taken. Meat Pies.—46 samples were taken and 8 contained boric acid (6.5, 6.3, 6, 5.6, 2.8, 2.6, 2.5 and 2 grains per lb. respectively). The vendors attention was called to the result of the analysis in respect of the first four samples, and no action was taken with regard to the remainder. Sausages.—57 samples of various kinds were taken. 13 contained preservative in small quantities, varying from 3 grains to 19.6 grains per lb. In the majority of the cases notice was displayed on the container that the sample contained boric acid. The vendors' attention was called to the result of the analysis. Meat and Fish Paste.—68 samples were taken and all were found to be free of any preservative. Peas.—20 samples were taken and 9 were found to contain crystallized copper sulphate in quantities varying from .1 to 2 grains per lb. Summary proceedings were taken in a case where no notice was given and the quantity amounted to 1.26 grains—fined £5. In the remaining cases notice was given that the samples contained copper sulphate, and cautionary letters were sent to the vendors. Beans.—5 samples were taken and 3 were found to contain crystallized copper sulphate (1.7, 1.7 and 1.4 grains per lb.). Notice was given in each case and no action taken. Spinach.—6 samples were taken and 5 contained preservative (3, crystallized copper sulphate—3.47 (fined £7), 1.97 (fined £5) and 1.9 (notice given and vendor's attention called to result of analysis); 1, 2 grains tin per lb. (no action—unofficial sample); 1, 1.2 grains zinc per lb. (no action—unofficial sample). Vegetable Mayonnaise.—3 samples were taken and all contained preservative.55, .27 and .21 grains crystallized copper sulphate per lb. respectively. The vendors of the first two samples were cautioned—the remaining sample was unofiical. Lime Juice.—3 samples were taken and all contained preservative. (265, 214 parts of sulphur dioxide per million and 14.3 grains sulphur dioxide per gallon. No action taken, as the amount was well undor that permitted by the Now Regulations. Meat Regulations, 1924. The requirements of the Regulations have, on the whole, been reasonably complied with by the shopkeepers and stall-holders in the City. 89 One prosecution was ordered for failing to have the name and address inscribed on the stall on which meat was exposed for sale. Two shillings costs were inflicted. The same person was also prosecuted under Section 47 of the Public Health (London) Act, 1891, for depositing for purpose of sale in a front basement area, meat that was unsound, and a fine of £3 and £2 costs was inflicted. In order to focus attention on the ways in which the Meat Regulations were being carried out, the sanitary inspectors were given instructions to make special observations during two separate periods of one week each No infringements were reported. Food Premises. During 1926, 4,489 visits were paid by the sanitary inspectors to premises where food is prepared for sale, deposited for sale, or sold. These premises include milkshops, bakers' shops, butchers' shops, greengrocery and fruit shops, eating places, cafes and restaurants. Street markets and the large wholesale fruit market of Covent Garden were regularly visited. Notices referring to defects in sanitary conditions in food premises were served in 61 instances. Restaurants.—The number of restaurants in the City, which includes hotels, restaurants, and tea shops, is 444. Licensed premises where no meals are served are not included. There were 826 visits paid to restaurants and hotels, the kitchens and arrangements for washing dishes and utensils receiving particular attention. Intimation notices numbering 54 were served and complied with. Fish Shops and Fried Fish Shops were periodically examined. Certain defects, such as dirty walls and ceilings, defective flooring, temporary otstruction of light and air, were reported in a few instances, and seven notices were served. In most cases the conditions were remedied by the occupiers on verbal instructions from the inspectors. Ice Cream Premises.—During 1926, there were 141 premises where ice cream was prepared or sold. The inspectors paid 102 visits for the purpose of supervision. It is particularly necessary that there should be a high standard of cleanliness in the methods of preparation of this article and in the premises where it is made. Ice cream has been known to convey germs of Typhoid Fever and is stated also to have contained the bacillus of Tuberculosis. (6026)Q G 90 Bakehouses.—At the end of 1926, there were 70 bakehouses in the City, of which 48 were underground. During the year 157 visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out: Inspection of Food.—Food exposed for sale has received regular inspection by the food inspectors, who have carried out this work daily including Sundays. The following table shows the nature and amount of food voluntarily surrendered or submitted. Table IV. Articles of Food submitted. Tons. cwts. lbs. Tons. cwts. 1bs Almonds — — 52 Horseradish 2 10 14 Apples 19 14 33 Lemons 1 18 0 Artichokes — 2 16 Mandarins 1 11 76 Bananas 19 7 52 Mangoes — 8 4 Beans — 1 68 Melons — — 80 Black Currants — 19 89 Onions 4 18 84 Cheddar Cheese — — 56 Oranges 6 17 4 Cherries 1 10 82 Pears 22 13 80 Cranberries 4 9 26 Peas — 1 52 Damsons — 2 64 Pineapples — 6 90 Dates — — 68 Plums — 7 40 Garlic — 2 26 Potatoes 12 7 10 Gooseberries — 2 56 Red Currants 4 2 7 Grapes — 15 30 Tomatoes — 1 0 Greengages 1 4 12 Tomato Puree 4 9 12 Beef, 7 lbs., Bacon, lbs., Ducks, 5, Scallops, 1 cwt. 64 lbs., Fish (various), 2 cwt. 78 lbs. Certificates enabling the export of certain articles of food to Canada were granted in nine instances. Condensed Milk.—A quantity of unlabelled tins of machine-skimmed condensed milk were seized by one of the Food Inspectors, who visited at the request of the vendor. The vendor had reported that he had certain tins in his possession which appeared to be unsound. These were surrendered to the Inspector, who found a large number of tins on which small portions of the original labels were adhering, which led one to suppose that the consignment originally came from Holland. Meanwhile the vendor had been busily labelling others with labels of which he had a large stock, which purported that the milk came from Denmark. The Danish Consul took the matter up with a view to taking proceedings under the Merchandise Marks Act. It was also discovered that about 20,000 tins of the same kind of milk were deposited at premises in Stepney. Samples of this machine-skimmed milk proved genuine on analysis. 91 Table V. Sale of Food and Drugs Act. Spirit Samples, 1926. 283 Samples of whiskey, brandy, rum and give were taken during the year. In 44 cases it was found that the spirits were diluted below the standard strength of 35 degrees U.P. The following table shows details concerning the samples of spirits which proved to be adulterated, and the results where legal action was taken:— No. Article. Result of Analysis. Degrees U.P. Notice or No Notice. Action taken and Result. 1223 Whiskey. 35.8 N.N. No Action. 137n „ 35.7 N.N. No Action. 187n „ 40 N.N. Proceedings, £10 10s. costs. 117s „ 42.4 N. No Action. 209n „ 38.4 N.N. Proceedings. £7 7s. costs. 2463 „ 37.7 N.N. Caution. 281n „ 37.8 N.N. Caution. 2733 „ 35.6 N. No Action. 318n „ 50.4 N.N. Proceedings £3 3s. costs. 276n „ 36.5 N.N. Caution. 280n „ 36.5 N.N. Caution. 323n „ 36.3 N.N. Caution. 298s „ 36 N.N. Caution. 299s „ 35.6 N.N. Call attention of Vendor to result. Notices of prices only in bar. 332s „ 35.5 N.N. Caution. 413N „ 35.5 N.N. No Action. 452n „ 38.5 N.N. Call attention of Vendor to result. 534s „ 36.1 N.N. Caution. 538s „ 37.3 N.N. Caution. 605s „ 47.1 N.N. Proceedings, £2 2s. costs. 666n „ 42 N.N. Proceedings, £3 fine. Previous case, 45.6 degrees U.P., dismissed under under Offenders Act with £4 4s. costs. 642s „ 45 — Proceedings, £2 fine. Notice in Bar:—" All spirits guaranteed quality and full strength." 682s „ 36.4 N. Caution. 683s „ 35.8 N.N. Caution. 685s „ 35.9 N.N. Caution. 686s „ 36 N.N. Caution. 814s „ 35.9 N. Call attention of Vendor to result. Notice :—All spirits sold in this establishment are 35 under proof. 815s „ 36 N.N. Call attention of Vendor to result. 765s „ 35.6 N.N. Call attention of Vendor to result. 889n „ 38.1 N.N. Proceedings £3 fine. 891n „ 35.4 N.N. Call attention of Vendor to result. 863n „ 36.9 N.N. Caution. 684s „ 38.7 N.N. Proceedings, £5 5s. costs. 25N Run. 35.84 N. Caution. (Notice unsatisfactory.) 59s „ 36.4 N.N. Caution. 303s „ 44.5 N.N. Proceedings, £3 3s. costs. 610s „ 36.3 N.N. Caution. 644n „ 40 N.N. Proceedings, £2 fine (previous conviction). Previous conviction. 702n „ 36.3 N.N. Caution. 60s Gin. 35.9 N.N. Caution. 425s „ 38.1 N.N. Proceedings, £2 fine, £5 costs. 426s „ 37.1 N.N. Caution. 611s „ 38.8 N.N. Proceedings, £2 2s. costs. 740u „ 36.3 N.N. Caution. 92 STAFF of the PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Administrative Tuberculosis Officer : †ANDREW J. Shinnib M.D., D.P.H., etc. Assistant Medical Officers : †flan S. Thomson M.A., M.D., D.P.H. (Tuberculosis Officer and Asst. Medical Officer of Health.) †*Ethel M. Vernon M.D., B.S. (Maternity and Child Welfare.) †* Duncan Leys M.B., B.Ch., M.R.C.P. (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 : *ecil H. Cribb B.Sc., F.I.C. *. A. Ellis Richards R.I.C. Clerical Staff : A. Wise S. G. Bennett (Temp, appt., 15th Feb.; A. J. Manhood. Perm, appt., 15th May, 1926). F. W. Lake. "(Miss M. MacFarlane (Tuberculosis Dis- W. Jenkins. pensary). Sanitary Inspectors : †F. A. Aris R.S.I. †C. J. Dee S.I.E.B., R.S.I., and Meat and Food Cert. †W. L. French S.I.E.B., R.S.I., Meat and Food Cert. †F. J. Haigh S.I.E.B. †H. R. Hardy R.S.I., M.I. San. Eng. †T. II. Jackson (Food & Drugs, &c.) S.I.E.B. (Now District Inspector). †E. J. Martinson R.S.L †C. Ratcliff S.I.E.B., Meat and Food Cert. †J. Sanderson R.S.I., San. Sc. Cert., Gold Medallist Carpenters' Company. †A. L. Ware (deceased, 20th February, S.I.E.B. and R.S.I., R.P.C. 1926). †M. Canton (Food & DrugB, &c.) S.I.E.B., Meat Cert., R.S.I. (appointed 1st June, 1926). †F. E. Siddle (Food & Drugs, &c.) S.I.E.B., Meat Cert., R.S.L †Miss C. Hughesden S.I.E.B., R.S.I., H.V., Certified Midwife. * Part time Officers. † The Council receives Exchequer grant towards the salaries of these officers. 93 Health Visitors : †Miss A. Sanders H.V. †Miss J. G. Alexander H.V., Certified Midwife, Hosp. Nursing. †Miss D. H. M. Walding S.I.E.B., Dipl. Nat. Health Soc., Nursing, Dipl. Board of Education. †Miss Howell Evans S.I.E.B., Dipl. Nat. Health Soc., Nursing. †Miss M. M. Scott S.I.E.B., H.V., Certified Midwife, Dipl. Board of Education. †Miss H. Buck (appointed 29th July) H.V., Certified Midwife, Dipl. Board of Education. †Miss F. Rigg (appointed 29th July) H.V., Certified Midwife, Dpl. Board of Education. †*MRS. Coleman (Mothercraft Classes) Red Cross Cert. 1st cl., and gold medal, † *Mrs. Steffens Midwife: †Miss A. J. Irving Certified Midwife, Hosp. Nursing. Other Staff: A. E. Blrch, 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. A. B. Holland, Disinfector. (Temp. appt., 9th Aug.; Perm, appt., 16th Dec., 1926). E. Bridger, Drain Tester. (Pensioned, 29th July, 1926). P. W. Attwater, Motor Driver. A. T. Steward, Assistant to Inspectors. W. H. Smith (Messenger). Mrs. Wheal, Attendant, Verminous Children. †Mss. W. Jenkins, Caretaker, 15, Bessborough Street. †Mns. Hawthorn, Miss Mates and Miss Barry,† Cleaners. In addition to the above, the following are the staff of the City of Westminster Health Society (subsidised by the City Council) Medical Officers: *N. Olivier Richards M.D., M.R.C.P., Maternity and Child Welfare. Health Visitors: Miss Callaghan (Supt., Centre) H.V., San. Insp. Cert. Domestic Economy, &.C. (With assistants, paid and voluntary, holding H.V. certificates, and nursing experience.) Two Midwives. Mrs. Steffens (Mothercraft Classes). * Part time Officers. † The Council receives Exchequer grant towards the salaries of these officers.