WES 38 City of Westminster REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928 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 MA JEST,Y. ST. MARTIN'S LANE, W.C.2, iii CONTENTS. page Introduction v General Statistics 1 General Provision of Health Services for the Area 2 Staff 8 Educational Establishments 11 Population 13 Births 13 Deaths 23 Infantile Mortality 24 Common Lodging-Houses 30 Tables 17-29 Communicable Diseases 31 Small-pox 31 Vaccination 31 Scarlet Fever 34 Diphtheria 34 Schick Test 35 Anti-toxin 37 Bacteriological Diagnosis 37 Enteric Fever 37 Measles 38 Influenza 38 Diarrhoea and Enteritis 39 Deaths from 39 Whooping Cough 39 Cerebro-spinal Fever 39 Poliomyelitis 39 Encephalitis Lethargica 40 Chicken-pox 40 Mumps 40 Plague, etc 40 Anthrax 40 Puerperal Fever 40 Puerperal Pyrexia 40 Ophthalmia Neonatorum 40 Bacteriological Laboratory 41 Tuberculosis 41 New eases (notified) 42 „ „ „ Tables 42-46 Deaths and non-notified deaths 46-48 Tuberculosis Dispensary 48 Dental Treatment 51 Returns (Ministry of Health table) 52, 53 Housing 54 New Schemes 54-56 Conditions generally 58 Basement dwellings 59 Re-occupation of overcrowded or insanitary dwellings 60 Table I (required by the Ministry) 61, 62 Sanitary Circumstances of the Area 63 Local By-laws and Regulations 64 (10285) A 2 iv Sanitary Circumstances of the Area—continued. pade Fouling of Foot ways by Dogs 65 Rag Flock Acts 65 Nuisance from Pigeons 65 Sanitary Inspection of the Area 66 Statistical Table 67 Houses Let in Lodgings 68 Nuisances—Intimation, Statutory Notices, etc 68 Rat Repression 69 Water Supply 69 New Sanitary Construction 70 Smoke Abatement 70 Factories, Workshops and Workplaces 71 Disinfection 74 mortuaries 76 Maternity and Child-Welfare 76 Puerperal Fever, Puerperal Pyrexia, Mortality in Childbirth 77 Maternity Hospital Accommodation 79 Widows' and Orphans' Contributory Pensions Act, 1925 79 Ante-natal Work 79 Maternity and Mothercraft 81 Infancy and Early Childhood 82 Nursing 85 Dental Treatment 86 Convalescent Homes 87 Homes for Unmarried Mothers 87 Day Nursery 87 Supply of Milk 88 Inspection and Supervision of Food 88 Acts and Regulations relating to Food 88 Merchandise Marks Act, 1926, and Agricultural Produce (Grading and Marking) Act, 1928 90 Milk and Dairies Order, 1926 91 Registration of Dairymen 91 Milk and Dairies Amendment Act, 1922 92 Analysis of Milk Samples 93 Condensed Milk Regulations, 1923-1927 95 Dried Milk Regulations, 1923-1927 95 Public Health (Preservatives in Food) Regulations, 1925,1926 and 1927 95 Samples Taken (Tables) 96 Meat Regulations, 1924 97 Food Premises 98 Food Condemned 99 Spirit Samples 99 Appendix— Millbank Improvement Scheme I Ebury Bridge Housing Scheme II Photographs, etc. IV-XII V Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 2 8. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1928. This report is in accordance with the instructions of the Ministry of Health submitted as an ordinary report. The fuller survey reports are required at the end of each quinquennium. The work of the department in connection with the circumstances arising as a result of the Thames Flood in January was commented upon in last year's report. That work continued throughout the year and has called for extra effort from each member of the staff, whilst also entailing the employment of additional assistance. The improvement of the Millbank area which had been previously mentioned was duly formulated in a scheme and submitted to Parliament as an Improvement Bill in the spring of the present year. Royal Assent was given to the measure in May. A report dealing with the sanitary survey of the area and the proof of evidence of the Medical Officer of Health have been submitted to the Ministry of Health as a special report. Certain details relating to it and to the Millbank Housing Scheme are given as part of an appendix to this report, together with a few illustrations. In the appendix there are also set out certain details of the Ebury Bridge Housing Scheme and the proposed new Tuberculosis Dispensary and Maternity and Child Welfare Centre. Reference should also be made to a new Maternity and Child Welfare Centre which the Council proposes to erect for the northern area of the City. The scheme will be fully discussed in next year's report. This new centre will replace the present one at 9, Frith Street, Soho Square, which was taken as a temporary expedient, and consists of shop premises. The new centre will form part of large municipal premises containing public baths and wash-houses, highways department depot, and rate collector's offices, situated in Marshall Street and Dufours Place. The whole building will be completed about the end of 1930. VI The health of the city has remained satisfactory throughout 1928. The birth-rate has risen from 10.0 to 10.3 per 1,000, and although the estimated population has fallen, the actual number of births has scarcely diminished. The infantile death-rate has fallen from 68.6 to 58.39 per 1,000 births ; that for legitimate children showing a decrease of 11.3 on last year's figure. The general death-rate has only decreased 0.8 per 1,000. In view of the considerably fewer deaths, 1,497, as compared with l,682 in 1927, this rate of decrease should be greater, but is neutralised by the reduction in population as estimated by the Registrar-General, 136,500 to 129,700. This reduction is necessarily somewhat conjectural. The incidence and death-rate from tuberculosis has again fallen from 83.5 to 83.2 per 100,000. Unfortunately, as if to emphasize the gravity of the problem which is being generally discussed, the deaths of women in childbed have increased from 5.7 to 12.4 per 1,000 births. As a contribution to preventive effort towards solving this serious problem the City Council has arranged with Westminster Hospital to admit for confinement women recommended from the four Maternity and Child Welfare Centres in the city. This scheme is discussed in detail in this report. With regard to infectious diseases, only two cases of the mild type of Small-pox occurred ; Diphtheria, Scarlet Fever and Measles showed an increase on the figures of last year, whilst Whooping Cough and Pneumonia generally showed an appreciable decrease. In no sense was there any semblance of an outbreak of infectious disease even in the districts which were subjected to the unpleasant after-effects of the flood. Food Administration.—Additional duties were imposed owing to the coming into force of the Merchandise Marks Acts and the Agricultural Produce (Grading and Marking) Act. The proportion of adulterated samples was 1.7 per cent. Housing.—A considerable amount of space is devoted to this aspect of public health work. The numbers of hard cases which the staff of the Medical Olficer of Health has to investigate continue to increase, but it is hoped, that when the comprehensive policy of the Council is fully developed, the majority of those cases living in overcrowded or other insanitary conditions will be relieved. It should be noted that when schemes in hand are completed the Council will have provided almost 1,000 dwellings since the war. A matter which is causing constant anxiety and which may require further consideration is the issue of dangerous structure notices on old dwelling houses. Whilst no one doubts the expert judgment of vii those who issue these notices or the necessity for certifying dangerous structures, yet it would appear that piecemeal demolition is in the case of working-class dwellings frequently resorted to rather than methods of drastic repair and shoring up to render such structures secure. As a result some tenants suffer great hardships, for unless they can obtain other rooms almost immediately their homes are pulled down about their ears. Although they may be protected under the Rent Acts, these tenants are placed in an impossible position, as under the London Building Act a building certified as dangerous must be made secure or demolished. Staff.—There were no changes in the permanent staff. Mr. Sanderson, the Senior Sanitary Inspector, was allocated certain duties of a supervisory nature in order to assist the Medical Officer of Health, and his salary was accordingly increased. The work of the department continues to increase mainly by reason of the measures for the improvement of the public health passed by the Legislature in recent years. Mr. Da vies, one of the three temporary sanitary inspectors engaged after the flood, was retained throughout the year. Every member of the staff deserved praise for the work in connection with the flood, but it may not be inappropriate to mention the individual efforts of Mr. Sanderson and Mr. Manhood in the preparation of the evidence for the Millbank Improvement Scheme. To the Chairman, Vice-Chairman and members of the Public Health Committee, and to the staff of the department, I would offer my sincere appreciation and grateful thanks for their constant support and assistance. I have the honour to be, Your obedient Servant, June, 1929. Andrew J. Shunnie. 1 SUMMARY OF PARTICULARS REQUIRED BY THE MINISTRY OF HEALTH. 1.—General Statistics. Area (acres)—2,502.7. Population (Census 1921)—141,578. Population, June, 1928 (Registrar-General's Estimate)—132,700. „ „ „ Civilian—129,700. Number of Inhabited Houses (1921)—25,321. Number of Families or Separate Occupiers (1921)—33,946. Rateable value—£9,090,000 (March, 1929). Sum represented by a penny rate—£38,760. 2.—Extracts from Vitat. Statistics for the Year. Births— Males. Females. Total. Birth-rate. Legitimate 642 578 1,220 10.3 Illegitimate 80 70 150 Totals 722 648 1,370 Deaths—1,497. Death-rate—11.5. Number of women dying in, or in consequence of, childbirth:— Puerperal fever, 3 From other causes. 14 12.4 per 1,000 births. Number of deaths of infants under one year of age per 1,000 births—58.39. Legitimate rate, 53.2 ; Illegitimate rate, 100.0. Number of deaths from measles (all ages)—5. „ „ diphtheria—13. „ „ whooping cough (all ages)—3. „ „ scarlet fever—1. „ „ diarrhoea (under 2 years of age)—15. „ „ typhoid fever—6. Other particulars asked for are given in the body of the Report. A list of the staff of the Public Health Department is included in the Report. 2 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. The provision of hospital accommodation for the isolation and treatment of patients suffering from Infectious Diseases is organized and maintained for the County of London as a whole by the Metropolitan Asylums Board. The Board's hospitals, 14 in number, are situate in various parts of London and neighbouring districts as follows:— Brook Hospital, Shooters Hill, Woolwich, S.E. Eastern Hospital, Brooksby's Walk, Homerton. Grove Hospital, Tooting Grove, S.W. North Eastern Hospital, St. Ann's Road, N.15. North Western Hospital, Lawn Road, Hampstead. Park Hospital, Hither Green, S.E. South Eastern Hospital, Avonley Road, S.E. South Western Hospital, Landor Road, Stockwell. Western Hospital, Seagrave Road, Fulham, S.W. Joyce Green, Dartford. Northern Hospital, Winchmore Hill, N.21. Southern Hospital, Dartford. Long Reach Hospital, Dartford. Orchard Hospital, Dartford. Since the passing of the National Insurance Act, 1911, and other measures enabling public authorities to provide treatment for diseases other than those scheduled in Sec. 55 (8) of the Public Health (London) Act, 1891, the Board has provided the following hospitals and sanatoria for tuberculosis and beds at certain of its hospitals for certain specified diseases as under:— Tuberculosis— Pulmonary (Adults). King George V Sanatorium, Godalming, Surrey (Males). Pinewood, Wokingham, Berks. (Females). Colindale Hospital, Hcndon (Males). St. George's Home, Chelsea (Females). Grove Park Hospital, Lee (both sexes). Children (both sexes). Millfield, Rustington, Sussex. High Wood Hospital for Children, Brentwood, Essex. 3 Tuberculosis—contd. Non-Pulmonary (Adults). St. Luke's Hospital, Lowestoft (both sexes). Grove Park Hospital, Lee (both sexes). Children (both sexes). Queen Mary's Hospital for Children, Carshalton. Princess Mary's Hospital, Margate. Millfield, Rustington, Sussex. Measles.—All the fever hospitals. Puerperal Fever and Puerperal Pyrexia.—North Western Hospital, Lawn Road, Hampstead. Encephalitis Lethargica.—All the fever hospitals. After treatment: Northern Hospital, Winch more Hill. Zymotic Enteritis.—All the fever hospitals. Marasmus.—St. Margaret's, Leighton Road, N.W. Ophthalmia Neonatorum.—St. Margaret's, N.W. Venereal Diseases.—Sheffield Street Hospital, Kingsway, AV.C. Rheumatism.—High Wood Hospital for Children, Brentwood, Essex. The most notable additions in recent years to its hospital services have been 170 beds (the number of beds available at Carshalton will be increased to 350) for the treatment of rheumatic children whether in a pre-rheumatic state or during acute or chronic illness. There are now available at Winchmore Hill Hospital 56 beds for those cases, admission being secured on the recommendation of the Medical Officer of Health. There is likewise provision for acute and chronic cases of poliomyelitis and encephalitis lethargica in children which has recently been extended to include adult cases, 50 beds having been set aside at the Northern Hospital for this purpose. The Board also deals with cases of non-notifiable infectious diseases such as measles, whooping cough and mumps, as accommodation permits. With regard to measles, on occasions when beds are in great demand the standing arrangement is that cases of measles where home conditions are unsuitable will be admitted in preference to those of scarlet fever of mild type and which can suitably be nursed at home. Accommodation for infectious cases for those who can pay for such isolation and treatment is available at the London Fever Hospital, Liverpool Road, N. All cases of small-pox must be isolated at the Board's hospitals at Joyce Green and the Orchard, near Dart ford, some 2,000 beds being provided for the purpose. 4 Tuberculosis.—The Board provides hospitals as already detailed. Cases of non-pulmonary tuberculosis in their initial stages are usually treated for a time at most of the voluntary hospitals of the City, while pulmonary cases (consumption) occasionally, and for only limited periods may also be treated there. Maternity Hospitals.—While there are no hospitals in the City devoted exclusively to maternity, there are maternity departments and beds in the following general hospitals:— Maternity beds. Westminster Hospital 15 St. George's Hospital 11 Charing Cross Hospital 15 There are also 28 maternity beds at St. Stephen's Hospital (Westminster Guardians) situate in the borough of Chelsea; and 52 beds at Sheffield Street Hospital (for lying-in women suffering from venereal disease). Other hospitals not within the City to which Westminster women are admitted for confinement are St. Thomas' Hospital, The General Lying-in Hospital, York Road, Lambeth (45 beds), The Middlesex Hospital, City of London Lying-in Hospital, City Road (71 beds), Queen Charlotte's Lying-in Hospital (75 beds). Clapham Maternity Home (moderate fees) (50 beds). The City Council as a Maternity and Child Welfare Authority has arrangements with St. George's and Westminster Hospitals for providing maternity beds for Westminster women. Detailed reference to this provision will be found in the Maternity and Child Welfare section of this Report. Children.—In-patient and Out-patient treatment for sick children is provided at the following hospitals :—Westminster, St. George's, Charing Cross, the Infants Hospital, Vincent Square (up to 5 years of age); and at other hospitals in the City established for the treatment of particular conditions or diseases of special organs, such as All Saints' Hospital, Vauxhall Bridge Road (30 beds) and St. Peter's Hospital, Henrietta Street, Covent Garden (32 beds) for Genito Urinary Diseases; St. John's Hospital, Leicester Square, for Diseases of the Skin. (In-patient Department, 262, Uxbridge Road (35 beds)). Blind.—The London Association for the Blind, Rosedale House, 144a, Warwick Street, S.W. (Hostel—67, Belgrave Road, S.W.) for the training and welfare of the blind. Orthopaedic.—Surgical orthopaedic treatment is carried out in special departments of Westminster, St. George's and Charing Cross Hospitals. At Westminster Hospital there is in addition facilities for continuing the 5 after treatment of orthopædic cases by means of massage, electro-therapy and remedial exercises under the care of expert instructors. There is also a large out-patient institution, " The London Clinic," in Ranelagh Road, at which, in addition to light therapy, a complete system of treatment by exercises and massage is carried on. Other hospitals in the City are the following:— HOSPITALS IN WESTMINSTER. All Saints' Hospital, 49, Vauxhall Bridge Road. Genito urinary diseases. Charing Cross Hospital, Agar Street, W.C. Golden Square, Throat, Nose and Ear Hospital. Gordon Hospital, 126, Vauxhall Bridge Road. Rectal diseases. Grosvenor Hospital for Women, Vincent Square, S.W. Hospital for Women, Soho Square, 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. 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. 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. 6 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the Area.—These are as follows:— 63, Sutherland Street. 67, Denbigh Street. St. John the Baptist's Home, 159, Tulse Hill. Two of these three homes for unmarried mothers are in the City, while the third, formerly in the City, was moved to the suburbs a few years ago. Women are admitted on the recommendation of church or rescue workers and are maintained there with their infants for a period before confinement and for some months afterwards, a period in all of some twelve months. The "Westminster Guardians also provide shelter for unmarried mothers, and when necessary, maintain the infants in various homes under their administration. Ambulance Facilities.—(a) Infectious cases are removed by the ambulance service of the Metropolitan Asylums Board. (6) Non-infectious and accident cases are also conveyed by the Metropolitan Asylums Board at a moderate charge. The ambulance services of the L.C.C., the Westminster Guardians, and of the British Red Cross Society are also available. Private firms such as the Daimler Motor Hire Company have a fleet of ambulances for hire. Clinic and Treatment Centres.—Maternity and Child Welfare Centres:— (1) Administered entirely by the Westminster City Council— (a) 1, Pimlico Road—First floor of 5 rooms. (b) 15, Bessborough Street—Self-contained house of 9 rooms. (c) 9, Frith Street—Ground and first floor premises of 5 rooms. (2) Subsidized by the City Council:— The Westminster Health Society, 30, Page Street, a building constructed and designed as a Maternity and Child Welfare Centre. The above are mainly consultation centres, treatment being given only in special circumstances, and on a most limited scale. (3) Maternity and Child Welfare Centres at Hospitals:— (a) *The Infants Hospital, Vincent Square. (b) *Charing Cross Hospital. (c) Westminster Hospital. (d)St. George's Hospital. *Subsidized by Ministry of Health. Treatment is given at the above hospitals. 7 Day Nurseries:— The British Red Cross Society's Day Nursery, Warwick Street. Accommodation for 10 children. School Clinics.—These are organized and administered by the Education Authority, the London County Council. Besides arrangements with hospitals in the City for the treatment of school children, clinics are conducted by officers of the L.C.C. at the following institutions:— Western Dispensary, Rochester Row, S.W. Westminster General Dispensary, Gerrard Street, W. A clinic for minor ailments at 40, Marsham Street is maintained by the British Red Cross Society in co-operation with the London County Council. Orthopaedic clinics have already been mentioned in connection with the work of the general hospitals and Metropolitan Asylums Board. Artificial Light Clinics.—The City Council does not provide artificial light treatment because there are already ample facilities provided on a voluntary basis in the various hospitals and dispensaries in the City. The London Clinic in Ranelagh Road, S.W. 1, requires special mention. It is a large institution founded and maintained by the British Humane Association whose object is the alleviation and cure of certain ailments by means of artificial light, &c. The beneficent work of this body is very largely due to the inspiration, liberality and deep personal interest of the late Campbell Johnston, Esq., who was its first chairman and who died in 1928 while holding that office. From small beginnings in Tufton Street the work increased so quickly that larger premises were required. A large building formerly a furniture depository in Ranelagh Road was taken and converted for the purposes of out-patient treatment by light on a large scale. Besides artificial sunlight other treatments such as electrotherapy, inhalation, and foam baths are administered. Patients attend daily and contribute according to their means for treatment. Cases of hardship are treated free. Tuberculosis Dispensary.—The City Council organized a Tuberculosis Dispensary Scheme in 1916. The dispensary is part of an old building at 1, Pimlico Road, which during the next year or so will give place to a new tuberculosis dispensary designed for the purpose. The scheme is administered solely by the City Council and its officers ; details relating to the work will be found in the Tuberculosis section of the report. Treatment Centres for Venereal Diseases.—These are not within the province of the City Council. They are conducted at the three general 8 hospitals, St. John's Hospital for Diseases of the Skin and at the London Lock Hospital, 91, Dean Street. These voluntary bodies receive substantial financial grants from the Ministry of Health through the London County Council which exercises a certain degree of administrative control over the clinics. The following are the Public Health Officers of the City Council. Those whose services are part time are signified thus : * Those whose salaries are the subject of contribution under the Public Health Acts or Exchequer grants are indicated thus:†— STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Administrative Tuberculosis Officer : †Andrew J. Shinnie M.D., D.P.H., &c. Assistant Medical Officers : † Ian 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) Obstetric Consultant: *A. Goodwin O.B.E., M.D., F.R.C.S. Bacteriologist : *J. A Braxton Hicks M.D., M.R.C.P., D.P.H. Dental Clinic: †*W. H. Turner L.D.S., R.C.S., Eng. †*T. Graham Scott (Anaesthetist) M.R.C.S., L.R.C.P. Public Analysts : *Cecil H. Cribb B.Sc., F.I.C. *P. A. Ellis Richards F.I.C. Clerical Staff : A. Wise S. G. Bennett. A. J. Manhood. †Miss M. MacFarlane (Tuberculosis Dispensary). F. W. Lake. W. Jenkins. Sanitary Inspectors : †J. Sanderson (Senior Sanitary In- R.S.I., San. Sc. Cert., Gold Medallist spector) Carpenters' Company. †M. Canton S.I.E.B., Meat Cert., R.S.I. †W. J. Davies (Temporary 10th Jan., S.I.E.B., Meat & Food Cert. 1928) †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. H. Jackson S.I.E.B. †C. Ratclff S.I.E.B., Meat and Food Cert. 9 Sanitary Inspectors—continued. †F. E. Siddle S.I.E.B., Meat Cert., R.S.I. †W. G. J. Sutton (Sampling Officer) S.I.E.B., Meat and Food Cert. †H. E. White (Sampling Officer) S.I.E.B., R.S.I., Meat and Food Cert., Dipl. Inst, of Hygiene. †Miss C. Hughesdon S.I.E.B., R.S.I., H.V., Certified Midwife, Dipl. Nat. Health Soc, Health Visitors : †Miss A. Sanders H.V. †Miss J. G. Alexander H.V., Certified Midwife, Hosp. Nursing. †Miss D. H. M. Waldino 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. Blick H.V., Certified Midwife, Dipl. Board of Education. †Miss F. Rigg H.V., Certified Midwife, Dipl. Board of Education. Instructors in Mothercraft at Centres. †*Mrs. Coleman Red Cross Cert. 1st el., and gold medal. †*Mns. Steffens Midwife : †Miss A. J. Irving Certified Midwife, Hosp. Nursing. Other Staff : A. Wheal, Superintendent of Disinfection. R. Watling, Keeper of Mortuary and Coroner's Court. A. W. Nicholls, Mortuary Assistant. W. Slattery, Engineer. J. Atkins, Disinfector. S. C. West, Disinfector. P. W. Attwater, Disinfcctor. A. B. Holland, Disinfector. J. R. Doyle, Motor Driver. A. T. Steward, Assistant to Inspectors. W. H. Smith, Messenger. Mrs. Wheal, Attendant, Verminous Children. †Mrs. W. Jenkins, Caretaker, 15, Bessborough Street. †Mrs. Hawthorn, Miss Mates and Miss Barry,† Cleaners. In addition to the above, the following are the stall of the City of Westminster Health Society (subsidized by the City Council):— Medical Officers : *N. Olivier Richards M.D., M.R.C.P., Maternity and Child Welfare. Health Visitors : Miss Callaghan (Supt., Centro) H.V., San. Insp. Cert. Domestic Economy , &c. Miss Pinchen H.V., Dipl. National Health. Miss Reed H.V. and Midwife. Miss Cross Midwife. (With assistants, paid and voluntary, holding H.V. certificates, and nursing experience.) Mrs. Steffens (Mothcrcraft Classes). (10285) B 10 Nursing in the Home.—The following District Nursing Associations, undertake the nursing of the poor in their homes in three areas of the City The Metropolitan Nursing Association, The Westminster Nursing Association, The Pimlico. Belgravia and Chelsea Nursing Association, Their work is carried out in close co-operation with the health services of the Council, particularly in regard to the work of the Maternity and Child Welfare Centres and Tuberculosis Dispensary. The Associations undertake on behalf of the City Council, by agreement, the nursing of children up to the age of 5 years of any ailment which can be nursed at home. This includes cases of measles, whooping cough, mumps, gastro enteritis, ophthalmia neonatorum, primary pneumonia, &c. In 1928 pneumonia and influenzal pnemonia. in adults were included in the agreements and in 1929 women suffering from any condition arising from, or connected with, pregnancy or childbirth. Payment is made by the Council to the Association at the rate of 1s. 6d. for each nursing visit.. Mid wives.—The City Council is not the supervising authority under the Midwives Acts. Under the powers conferred by the Maternity and Child Welfare Act, 1918, the Council employ one midwife, who practises for necessitous cases in the Victoria, Knightsbridge St. George and Hamlet wards of the City. From a return provided by the L.C.C. the number of midwives practising in the City is estimated at 31. Maternity and Nursing Homes.—The Council is not the authority. under the Midwives and Maternity Homes Act, 1920, nor under the Nursing Homes Registration Act, 1927. There are believed to be 5 of such homes in the City. Maternal Sickness and Mortality.—The City Council appointed Dr. Aubrey Goodwin, Assistant Obstetric Surgeon to Westminster Hospital, under the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, and also made arrangements with the three District Nursing Associations for the home nursing of cases. Circular instructions were issued to all medical practitioners practising in the City, informing them that the services of Dr. Goodwin were available on notifying a case under these regulations, also acquainting them of the nursing services which the Council had provided. The special hospital accommodation of the M.A.B. for puerperal cases was also brought to their notice. When cases have occurred, it is found that medical practitioners have been anxious to assist in the investigations and have readily supplied information. 11 As regards maternal deaths, the method of inquiry suggested by the Ministry and the questionnaire issued by the Maternal Mortality Committee set up by the Ministry has been used. In this instance also medical practioners have assisted in every possible way in making investigations as complete as possible. The information relating to maternal deaths is collected and compiled personally by the Medical Officer of Health as the matters under consideration are of a strictly confidential nature. In cases where the circumstances are such as to warrant expert investigation on clinical grounds the Council has retained the services of Dr. Aubrey Goodwin, the obstetrical specialist, to confer with the practitioner concerned and to report his investigations to the Medical Officer of Health. Colleges, Schools, Technical Institutes and other Educational Establishments.—The number of elementary schools either wholly or partly under the control and management of the L.C.C. is 29. There are also 5 secondary schools under the same authority. Adult education or training is undertaken at:— National School of Cookery and Domestic Economy, 72, Buckingham Palace Road. St. Martin's Art School, 107, Charing Cross Road. Westminster Technical Institute, Vincent Square. Polytechnic Annexe, 16, Balderton Street. Westminster Training College, Horseferry Road. King's College, Strand. London College of Music, 47, Gt. Marlborough Street, W. London School of Dental Surgery, 32, Leicester Square. London School of Economics, Houghton Street, W.C.2. Royal Academy of Arts, Burlington House, W. Schools. Burlington School, Boyle Street. Francis Holland School for Girls, 39, Graham Street. French Protestant School, Noel Street. Grey Coat School for Girls, Greycoat Place, S.W.1. Royal College of St. Peter, "Westminster School", Dean's Yard, S.W. Westminster Abbey Choir School, Dean's Yard, S.W. Westminster Cathedral Choir School, Ambrosden Avenue, S.W. Westminster City School, 55, Palace Street, S.W.1. (10285) B 2 12 Elementary and Secondary Schools. Provided. Millbank School. Pulteney School. St. George's Row, and Ranelagh Road Schools. Buckingham Gate Central School. Westminster Day Continuation School, Horseferry Road, S.W. Non-Provided. Abbey, Westminster— St. George's, Westminster— Burdett-Coutts and Towns- Brompton. hend Foundation. St. Anselm's. Christ Church. St. Barnabas'. St. Anne's C.E. St. George's, Hanover Square. St. Clement Danes. St. Michael's. St. James' and St. Peter's. St. Paul's P. St. James-the-Less. St. Peter's C.E. St. Margaret's. St. Gabriel's. St. Martin's-in-the-Fields. St. Martin's-in-the-Fields Parochial. St. Matthew's. St. Mary's C.E. St. Patrick's R.C. St. Vincent's R.C. Westminster Cathedral R.C. Holy Trinity, C.E. Health Education.—A small book was published as last year during Health Week and circulated widely through the agency of the Churches, schools, public libraries and baths, and maternity and child welfare centres. The book contained an account of all the activities of the Health Department during the year, with a series of photographs showing various aspects of maternity and child welfare work, the inoculation against diphtheria being performed, the tuberculosis dispensary, sampling of food, &c. The new housing schemes of the Council were also briefly described and illustrated. Towards the end of the year the Council was considering a proposal to circulate the monthly periodical " Better Health." This magazine is the publication of the Central Council of 13 Health Education, a body set up under the auspices of the Ministry of Health. The members of this body consist of representatives of local authorities and insurance committees throughout the county, together with a number of Medical Officers of Health and officials of the Ministry of Health. The subject matter of this magazine consists of instructive articles on health matters written by experts, the purpose being, in these times when the press is flooded with all sorts of health articles, good, bad and indifferent, to supply those who desire instruction in health with sound and accurate information. It is proposed to enter into an agreement for the supply of 2,000 copies monthly of " Better Health." These will be distributed to the public through the usual channels. The publication will not involve any cost to the Council. STATISTICAL, INCLUDING REMARKS ON THE NATURAL AND SOCIAL CONDITIONS. A summary of particulars required by the Ministry of Health is set forth on a preceding page and further reference to certain points mentioned will be found in other parts of the report. Population. The estimated population of the City of Westminster for the year 1928 is given by the Registrar-General as 132,700 (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 129,700, and for the purpose of calculating the death-rate this number is taken. Both gross and net totals show a large decrease on the corresponding figures for 1927, which were 139,300 and 136,500 respectively. The Guardians have again been good enough to supply figures dealing with outdoor relief, and from them it would appear that unemployment is, fortunately, still decreasing in the City. In 1926 the amount expended in outdoor relief was £8,222 3s. 8d., in 1927 £6,360 13s. 3d., and in 1928 £5,666 1s. 11di. Births. The births registered in Westminster during 1928 numbered 1,471, but of these the homes of 620 were in other districts and 23 were registered under the Legitimacy Act, and have therefore to be deducted from the total. There were, however, 542 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,370, which is 29 less than the similar figure for 1927. 14 Although the Registrar General's estimate of the population of the City is 6,600 below the figure of last year, the decrease in the births is not, fortunately, proportionate. Women whose homes are outside the City continue, in increasing numbers, to avail themselves of the facilities for confinement which the large general hospitals in the City offer. The number in 1919—mostly women whose home address was in easy reach of the hospital, although in some neighbouring borough—was only 98. This figure has risen to 620 in 1928, and includes not only women from the various metropolitan boroughs but also from the counties around London. It will be observed from Tables I and II that the registered births are 29 fewer than last year; the legitimate births were 35 less, and the illegitimate 6 more. The comparative totals are :- 1926. Legitimate. 1927. Legitimate. 1928. Legitimate. Males 723 638 642 Females 726 617 578 Illegitimate. Illegitimate. Illegitimate. Males 74 74 80 Females .. 83 70 70 . 1,606 1,399 1,370 Table I. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Still, born. 1910 2,365 49 276 2,592 1,674 1,621 53 1911 2,110 60 311 2,361 1,502 1,507 55 1912 2,134 49 264 2,349 1,501 1,469 34 1913 1,992 35 276 2,233 1,402 1,424 38 1914 1,800 15 312 2,157 1,386 ,1,347 39 1915 1,721 71 329 1,979 1,292 1,250 42 1910 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 2,200 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 1,024 1,250 1,214 36 1925 1,519 481 497 1,535 1,435 1,385 50 1926 1,535 500 571 1,006 1,402 1,355 47 1927 1,375 552 (20) 576 1,399 1,205 1,109 36 1828 1,471 043 (23) 542 1,370 1,404 1,302 42 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. 15 The legitimate and illegitimate births are distributed as follows Table II. Legitimate. Males 714 - 304 + 232 = 642 Females 640 - 267 + 205 = 578 1,354 -571 + 437 = 1,220 Illegitimate. Males 62 - 41 + 59 = 80 Females 55 - 31 + 46 = 70 117 -72+ 105 = 150 The legitimate births show a decrease of 35 and the illegitimate an increase of 6 on the figures of 1927. As shown in Table I, 1,404 notifications of births were received by the Department for 1928 as compared with 1,205 in 1927. Of the total of notifications, 680 were sent by mid wives, of whom 31 were practising in the City during 1928. 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 1927 712 687 52 44 660 643 1928 722 648 47 33 675 615 16 For each 1,000 girls born, there were in— 1914 1,080 boys. 1922 987 boys. 1915 1,033 boys. 1923 1,082 boys. 1916 965 boys. 1924 1,086 boys. 1917 914 boys. 1925 1,041 boys. 1918 1,177 boys. 1926 985 boys. 1919 965 boys. 1927 1,036 boys. 1920 972 boys. 1928 1,114 boys. 1921 1,067 boys. Still-births.—42 still-born children were notified during the year, 20 of this number being born to non-residents of Westminster. The corresponding figure for 1927 was 36. Under the Births and Deaths Registration Act, 1926 which came into force on 1st July, 1927, all stillbirths must be registered. The Ministry of Health is desirous that certain figures supplied by the Registrar-General, and statistics based thereon, should, for the purpose of comparison, be included in this Report. In making these comparisons one thing must not be forgotten—the difference between notified cases of infectious disease as supplied by the Registrar-General, and upon which figures are based not only the case rates, etc., for Westminster, but for London and the County as a whole ; and the return of cases of infectious diseases as compiled by the Medical Officer of Health. As statistics must, to a certain degree, portray the health of a community, every effort is made in Westminster to confine figures to cases in which the diagnosis has been confirmed. During 1928, 26 cases, or roughly 6-4 per cent, of the diphtheria and scarlet fever cases, were discharged from hospitals as not suffering from these diseases—these figures are not supplied to the Registrar-General. Another important factor is the number of infectious disease cases for which certificates are not submitted, and therefore cannot be forwarded to the Metropolitan Asylums Board, from which source the Registrar-General obtains his figures. Obviously the totals of cases and case rates must be seriously affected if the same conditions prevail among other Metropolitan Boroughs and the various Councils throughout the country. 17 Causes of Death at different Periods of Life in the City of Westminster. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— All Causes M. 799 48 10 7 17 23 88 284 188 134 E. 716 33 3 5 14 27 79 191 175 189 1. Enteric fever M 2 1 1 . F. 3 — — — — 1 1 — 1 — 2. Smallpox M. F. 3. Measles M. 4 3 __ 1 __ F. 1 4. Scarlet fever M. F. 1 1 5. Whooping-cough M. 1 1 F. 2 2 6. Diphtheria M. 10 2 ___ 4 4 F. 3 3 7. Influenza M. 14 3 5 3 3 F. 6 3 1 2 8. Encephalitis lethargica M. F. 1 9. Meningococcal meningitis M. 1 1 F. 10. Tuberculosis of respiratory system M. 63 1 6 27 25 3 1 F. 32 — — — 1 3 8 13 7 — 11. Other tuberculous diseases M. 6 2 — — 1 1 1 1 — — F. 10 1 1 — 2 2 — 2 1 1 12. Cancer, malignant disease M. 104 2 59 32 11 F. 120 13 65 33 19 13. Rheumatic fever M. 1 E. — 14. Diabetes M. 12 2 6 2 2 F. 8 — — — — ■ 1 1 1 4 1 15. Cerebral haemorrhage, etc. M 16 1 7 4 4 F. 42 1 15 10 16 16. Heart disease M. 151 3 6 54 54 34 F. 141 — — 1 — 2 12 26 37 bi 17. Arterio-sclerosis M. 50 16 16 18 F. 39 6 21 12 18. Bronchitis M. 36 1 1 2 8 13 11 F. 30 1 3 3 19. Pneumonia (all forms) Af 47 6 4 7 21 6 3 F. 46 7 — — ] — 3 13 14 8 20. Other respiratory diseases M. 12 1 — — — — 3 6 2 — E. 8 1 3 3 1 18 Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 05— 75— 21. Ulcer of stomach or duodenum M. 11 2 7 1 i F. 5 1 3 1 — 22. Diarrhoea, etc M. 8 8 F. 9 5 — — — 1 1 1 1 — 23. Appendicitis and typhlitis M. 6 1 4 1 F. 3 — — — — 1 1 1 — — 24. Cirrhosis of liver M. 9 1 5 3 _ F. 8 5 2 1 25. Acute and chronic nephritis M. 35 1 1 7 9 11 6 F. 23 — — — — 2 3 8 6 4 26. Puerperal sepsis M. F. 9 — — — — 1 8 — — •— 27. Other accidents and diseases of pregnancy and parturition M. F. 9 — — — — 3 6 — — — 28. Congenital debility and malformation, premature birth M. 15 15 F. 10 9 — 1 29. Suicide M 14 fi 6 2 1 F. 7 — — — — 1 2 3 1 — 30. Other deaths from violence M. 38 1 1 1 5 7 4 9 3 7 e. 36 — — 1 3 5 5 9 6 7 31. Other defined diseases M 133 10 1 2 3 3 15 35 32 32 F. 103 7 1 1 4 3 12 21 23 31 32. Causes ill-defined or unknown M. F. 1 1 A statement showing the number of cases of certain infectious diseases in the above-named area during the 52 weeks ended 29th December, 1928 Westminster, City of, Met. B. Number of Cases of Infpclious Diseases Notified (Civilians). Smallpox. Scarlet fever. Diphtheria. [ Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. 2 213 205 27 21 6 48 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Smallpox, 0.32 ; scarlet fever, 2.61; diphtheria, 1.55 ; enteric fever, 0.09, puerperal pyrexia, 0.14; puerperal fever, 0.06; and erysipelas, 0.42.) 19 MALES. Table IV.—Causes of, and Ayes at, Death during the year 1928. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 15. 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.. j Charing Cross. Covent Garden. Strand. ess. Small-pox — — — — — — — — — — — — — — — — — — — — — — — — Measles 4 3 — 1 1 1 3 Scarlet, fever — Influenza 12 — — 2 4 6 2 — 2 4 2 ! I 1 — — — — — Whooping-cough 1 i " 1 Diphtheria. Memb. croup 10 2 4 — — — — 1 1 — 4 1 3 — — — — — — Cerebro-spinal meningitis — — - - Poliomyelitis Enteric fever 3 | — — — 1 •1 — 1 — — — — 1 1 — — — — — Diarrhœa, enteritis 11 9 1 — — 1 6 1 4 Entric fever Other sentic diseases s — — — 1 1 3 3 2 — 2 2 — ! — 2 — — — — — Syphilis, &c. 4 — 3 I — — — 3 — 1 — — — — — 1 Diabetes 11 — — — 2 — 5 4 — 1 5 — — — 1 2 — — 1 — 1 Rheumatic fever 1 — — — — — 1 — — — — — 1 — — — — — Tuberculosis of lungs 61 — — — 7 26 24 4 S 1 2 19 — 17 3 2 2 2 1 5 3 1 Other forms of tuberculosis 7 2 — 2 1 1 1 — — — S — o 1 1 — — — — Malignant growths !l!) — — 1 1 54 43 8 2 10 27 4 23 i 5 o 4 — 2 5 3 Congenital debility, malformation, and premature birth 17 16 1 _ 1 1 5 6 1 3 Old age 5 — — — — 5 1 ?, ' 1 1 Meningitis and convulsions 4 : 2 i 1 20 MALES—Table IV (continued). Causes of Death. Corrected Deaths in thb 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 2 i 1 _ _ 1 1 — Other diseases of nervous 8 1 4 1 2 1 «__ 3 1 1 1 1 Valvular diseases of heart.. 18 — — 9 9 — 4 — 1 2 — 7 — — — 1 — — 2 1 Other circulatory diseases .. 165 2 1 1 2 6 61 92 1 13 b 11 40 8 37 21 4 5 1 2 8 6 3 12 8 17 1 Bronchitis .. .. • • 83 1 — """" — Broncho-pneumonia .. 21 6 3 — 1 5 6 2 — 2 7 3 1 1 1 Pneumonia, otlier forms .. 3!) 1 l 1 8 17 11 1 1 5 13 8 2 1 1 1 Other respiratory diseases .. 9 4 s 2 1 5 1 1 5 2 3 — 1 1 Cirrhosis of liver 6 — — 1 1 2 2 Appendicitis and typhlitis.. 6 — — — 1 4 1 — — 1 2 1 1 Other digestive diseases .. 30 3 — — 3 12 12 1 2 2 10 1 7 1 2 2 1 Bright's disease, &c. .. 45 — — 1 1 8 12 23 Cystitis, &c... .. •< '29 1 4 24 2 1 2 9 1 5 3 3 1 Deaths by accident or negligence.. •• .. 35 1 6 7 4 7 10 2 — 1 12 1 10 2 1 1 2 1 — — 2 Deaths by suicide and murder .. .. •• 16 1 — — — — 5 8 2 1 - 1 - — 2 4 ] — 3 1 — _ a 1 1 Other defined diseases .. 12 1 — 2 1 2 5 1 Diseases, ill defined or unknown .. .. .. All causes .. 787 47 11 6 18 24 87 278 316 1 4 69 16 54 231 29 . 173 26 J 20 31 25 12 35 46 26 21 females. Table iv- (continued)—Causes of, and Ages at, Death during the year 1928. Causes of Death, < Corrected Deaths in the City at subjoined aoes. Deaths in Waiids (at all Aoes). 09 O to c3 < 1 u <D c i* o r3 c 3 tj a eS rM »d h 0) tj C 3 h <33 cj »o u t3 C 3 c a o lo ci m o ■a- 3 a eS lo lo r* <D C 3 td a aj lo (m *o co It a> 1 3 t3 C oj »o ai tj b gj cu 3 t5 c o3 lO cd *3 a o o U o c o u in O u o o u c tn o 0) C ci w © © to & 'c s tn O .gxa * tH o -*-» o > <u h aS to a -*-> co a -c o ♦-d co o c c <5 co to 3 O h o .o * £ O *c3 'cS Cn ■*» a o t4) ■ O CO m O u 0 bO g -C Cr i c o ra M c5 o *> c 0) > o U *2 5 £ CO tn 03 -2 "o a o a Bmall-pox .... Measles 1 1 .Scarlet fever 1 Influenza 0 3 3 — 1 1 2 1 1 — — — — — — — Whooping-cough 2 2 o Diphtheria, Merab. croup .... 3 Orebro-spinal meningitis .... Poliomyelitis 1 1 1 1 Enteric fever 3 — — — 1 — — — —• 1 — — — — — — — Diarrhoea, enteritis 7 5 — 1 — 1 — 1 —• 1 3 1 — — — 1 — — — — Erysipelas .... - .... 1 1 Puerperal fever 3 — — — 3 — — — — — ' 1 2 — — — — — — — Other septic diseases 3 — — — , 2 1 Syphilis, &c 1 1 1 1 — Diabetes 3 — — 1 — 1 1 —• — — 2 — — — — — 1 1 — Rheumatic fever 2 — 1 — 1 — — — o — — — — — — — — Tuberculosis of lungs 29 — 1 2 8 11 7 — 3 — 9 1 9 1 — — 2 — 2 1 I Other forms of tuberculosis 11 1 1 2 2 — 3 o — — 1 — 6 4 — — — — — — — — Malignant growths .... 117 12 61 r>4 — 10 6 9 42 3 20 5 4 1 4 1 3 1 3 Congenital debility, formation, and premature birth 12 11 1 3 — 4 3 — 1 — — — 1 1 Old age 24 24 1 — 2 1 4 <» — 3 1 — 2 5 Meningitis and convulsions 1 1 -1 -1 i »1 -1 22 FEMALES—Table IV (continued). Causes or Death. Corrected Deaths in thb City at subjoined Ages. Deaths in Wards (at all Aoes). All ages. Under 1. 1 and under 2. 2 and under •>. 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 .... i i 1 Other diseases of nervous system 12 _ 1 1 1 i 4 4 2 4 1 3 1 _ 1 Valvulor diseases of heart 14 2 2 4 6 — 1 — — 7 4 1 1 Other circulatory diseases 171 lu 40 121 3 16 7 17 51 11 31 10 7 2 2 i 7 1 5 Bronchitis .... .... 70 2 — •i 12 54 — 3 — 5 22 4 28 — — — — 2 4 1 1 Broncho-pneumonia 34 8 •— 2 6 18 — 3 — 1 11 4 8 — — — — — 5 2 Pneumonia, other forms .... 2C> 1 1 1 8 15 — C 1 1 9 — 4 1 1 1 Other respiratory diseases 3 — — 1 2 — — 1 — 1 1 — Alcoholism .... 3 — -— _ 1 9 2 _ 1 Cirrhosis of liver 5 — 1 3 1 ' 1 — 1 1 1 1 Appendicitis and typhlitis 3 — 1 1 1 Other digestive diseases 23 — 1 1 — 2 9 10 — 3 — 1 13 1 4 1 Bright's disease, lee. 31 — 2 3 10 it; — 2 2 2 1 1 8 1 1 1 1 1 1 2 Cystitis, &c. 6 1 — 4 — 2 — 1 1 — 1 Accidents and diseases of parturition 14 4 10 1 1 1 1 4 4 1 1 1 Deaths by accident or negligence 40 1 _ 1 4 5 6 11 i 12 6 2 4 7 13 1 1 1 1 1 1 2 Deaths by suicide and murder 7 1 2 3 1 1 1 3 1 1 Other defined diseases lb 1 1 3 5 4 1 4 0 4 3 3 1 1 1 Diseases, ill defined or unknown .... .... — — — — — — — — 1 — — — — — — — — — — — — — All causes ....' 710 33 3 4 13 27 77 188 365 1 4 78 | 22 1 57 226 32 163 23 17 7 12 8 29 !l0 1 1 22 23 Deaths. 1,661 deaths were registered in the City in the 52 weeks of 1928. After deducting 992 deaths of non-citizens in public institutions, etc , in the City, and adding those of 828 citizens who died in other districts, the corrected total is 1,197, as compared with 1,082 in 1927, and is equivalent to an annual rate of 11.5 per 1,000 persons (civilian population), compared with 12*3 last year. The London death-rate for 1928 was 11-6 (civilians only), for England and Wales 11-7. These rates are a little lower than in 1927 for the country as a whole. The number of deaths and the death-rates per 1,000 for the past fifteen years arc shown below :— Table V. (From 1913 to 1927.) Year. Number of Deaths. Westminster Rate. London Rate. 1813 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 15.5 150 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 11.6 116 1927 1,682 12.3 11.9 1928 1,497 11.5 11.6 The deaths of males were 787, females 710. Table VI. This table shows the total deaths distributed among age periods:— 1927. 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. 47 11 6 18 24 87 278 316 787 f. 33 3 4 13 27 77 188 365 710 1920 167 is 21 27 53 222 517 575 1,600 1921 154 2s 32 35 56 204 499 615 1,623 1922 104 26 32 41 02 211 584 736 1,796 1923 83 16 13 19 46 171 403 682 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 50 185 509 696 1,608 1927 96 13 20 24 42 179 633 775 1.CS2 1928 80 14 10 31 51 164 466 681 1.497 The causes of death are set out in Table IV. There was an increase among the males of deaths from the following causes:—Diphtheria, enteric, diabetes, meningitis, pneumonia, respiratory, alcoholism and cystitis. Among the females the causes showing an increase were circulatory 24 diseases, enteric, non-pulm. tuberculosis, old age, br.pneumonia, alcoholism, accidents of parturition, digestive diseases and deaths by accidents and negligence. 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. 1924. 1925. 1926. 1927. 1928. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Conduit 11 11 22 11 4 15 — 5 5 4 — 4 4 4 8 Grosvenor 50 52 102 80 49 129 60 64 124 58 67 125 59 78 137 Hamlet 30 28 58 23 20 43 11 23 34 25 30 55 16 22 38 K. St. George 43 GO 103 58 61 119 58 69 127 74 74 148 54 57 111 Victoria 245 282 527 275 305 580 236 252 488 245 286 531 231 226 457 St. Margaret 50 33 83 37 42 79 51 37 88 42 42 84 29 32 61 St. John 245 196 441 221 189 410 204 162 360 217 138 355 173 163 336 St. Anne 41 2G 67 37 29 66 38 32 70 44 33 77 26 23 49 Gt. Marlborough 22 12 34 7 20 27 20 14 34 18 15 33 20 17 37 Pall Mall 33 8 41 19 7 26 22 8 30 21 9 30 31 7 38 Regent 35 22 57 27 21 48 25 18 43 35 20 55 25 12 37 Charing Cross 17 9 26 16 9 25 13 6 19 15 7 22 12 8 20 Covent Garden 20 25 51 31 28 59 39 39 78 29 35 64 35 29 64 Strand 40 7 47 60 3 63 56 6 62 52 5 57 46 10 56 Homeless 23 11 34 23 16 39 22 18 40 29 13 42 26 22 48 Infantile Mortality.—The corrected death-rate of infants for Westminster was 58-39 per 1,000 births. The mortality among legitimate infants was 53-2 per 1,000; that of illegitimate 100-0. The infant mortality rate for London was 67. The number of infants dying under 1 year was 80, a decrease of 16 on the figure of last year and as the total number of births only shows a decrease of 29, the infantile mortality rate, especially the legitimate rate haB appreciably declined. The chief contributory causes of death were pneumonia, prematurity and gastro-enteritis. Twelve of the 13 premature deaths occurred before the fourth week of life. Gastro-enteritis accounted for 14 deaths, 13 of the infants being over four months old. Eleven of those occurred during July, August, and September, and might be attributed to what is commonly called " summer diarrhoea." Table VIII shows the deaths as they occurred during the four quarters of the last four years :— Table VIII. Total. 1928. Total. 1927. Total 1926. Total 1925. 1st Quarter 21 29 30 35 2nd „ 19 16 24 14 3rd „ 21 26 25 24 4th „ 19 25 17 33 80 96 96 106 25 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 US 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 1927 1,255 81 64.5 144 15 104.1 08. 6 59 1928 1,220 65 53.2 150 15 100.0 58.39 67 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 1921 onward?, showing the proportion per 1,000 births applicable under each heading:— Table X. — 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. Diphtheria 1.4 — — — 0.65 — 1.4 1.4 Influenza — 3.6 0.6 0.65 0.62 0.71 — Measles 10 5.5 2.49 — — Whooping Cough 1' 5 10 11 1.9 4.5 0.62 1.4 2.1 Septio diseases 1.4 0.5 1.7 1.2 — 0.62 0.71 — Bronchitis and monia 11.8 7.3 40 10.4 16.2 9.9 6.4 13.8 Stomach and bowel complain ta 13.4 31 11 1.9 5.2 80 12.1 10.9 Syphilis 2.6 21 QO CI 1.2 1.3 — 2.8 0.72 Congenital 5.1 tions 9.3 4.2 51 4.9 3.2 4.34 7.8 Prematurity 15.5 16.2 131 14.1 16.9 19.3 200 9.4 Neglcct and injury at 4.3 birth 7.3 5.7 6.8 31 0.65 3.72 4.2 Debility from birth and atrophy, 3.6 ets, atelectasis 11.0 4.2 6.2 5.3 7.1 3.72 4.2 Tuberculosis ... 1.4 1.5 1.7 1.8 1.9 1.86 2.1 2.1 Other causes ... 3.6 3.6 2.8 6.7 10.4 4.34 4.2 21 so.2 54.6 46.6 59.0 69.0 59.7 68.6 58.39 (10286) c 26 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, 1928. causes OF DEAT1I. Undrr 1 Week 1—2 Wcck». 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under g Month*. 0 Months and under 9 Months. 9 Month? and under 12 months. Total Deaths | under 1 Year. Influenza Diphtheria — — 1 — i — — 1 — 2 Measles Whooping Cough 1 i — 1 3 Sepsis 1 Tuberculosis 2 — — 3 Meningitis i — — — I — 1 — — 2 Bronchitis — 1 — — i — 2 — — 3 Pneumonia (all forms) — — 1 — i 2 6 4 3 16 Gastro.enteritis i — — — i 4 6 1 2 14 Injury at birth 2 — — — 2 — — — — 2 Neglect at birth 4 — — — 4 — — — — 4 Murder 1 — — — 1 — — — — 1 Atelectasis 1 — — — 1 — — — — 1 Congenital malformations 4 2 6 1 7 Premature birth 8 3 1 — 12 1 — — — 13 Malnutrition, marasmus, debility from birth 1 1 1 3 5 Accidents Other causes 2 — — — 2 — 1 — — 3 Syphilis — — — — — 1 — — — 1 Totals 25 4 5 — 34 11 23 <» 6 80 Table XII. Nett Births in the year— Males. Females. Total. Legitimate 642 578 1,220 Illegitimate 80 70 150 722 648 1,370 Nett Deaths in the year of— Males. Females. Total. Legitimate infants 37 28 65 Illegitimate infants 10 5 15 47 33 80 The causes of death of the Illegitimate were:—Neglect at birth 4, prematurity 2, pneumonia 3, found drowned 1, syphilis 1, murder 1, marasmus 1, mastoiditis 1, and ha?morrhagic disease 1. 27 Table XIII. Infant Mortality, 1928.—Nett Deaths from stated can s at various ages under One Year of Age in Pimlico Area ( Victoria, Knightsbridge St. George and Hamlet Wards) CAUSES of DEATH. M ■ K if a> •c c D . « j: a> CI J, CO % £ 7 * ■»» X. O 0/ eo II - z> H C m « UJZ CO a» - 1 =53 r" w -r "2 « Sfcf 515 O tc a V U3 C, 1 52 ® •x> Li ~ 2 111 2 o Total Deaths under One Year. Diphtheria _ — 1 — 1 — — 1 Influenza Whooping Cough — — l — 1 Measles .. •• 1 Tuberculosis . • • • 2 '— 3 Bronchitis — — — — 1 — 1 Pneumonia (all forms) — — 1 — 1 1 3 1 1 7 Gastro-enteritis 3 5 1 9 Injury at birth •• — — 2 — — — 2 Atelectasis — — — — — — — — Congenital malformations 3 1 4 1 5 Premature birth 5 — — 5 — — — 5 Want of attention at birth Malnutrition,marasmus and debility from birth 2 o Accidents 1 1 Otlier causes .. — — — — — — Meningitis .. •• 1 — — — 1 — — — 1 Syphilis — — — — — — —" — Totals.. 11 — 3 — 14 5 16 1 2 38 Table XIV. Nett Deaths in the year of— Males. Females, Total Legitimate infants .. 19 16 35 Illegitimate infants .. 3 — 3 (10285) c2 28 Table XV. Infant Mortality, 1928.—Nett Deaths from stated causcs at various ayes under One Year of Aye in St. John and St. Margaret Wards. CAUS12S OF DEATH. ■ a. u &< ■c C £ ■ y J, in % 3 •0 ■ I b * « — B5 c -* - ~ - a» "« ^ c H "0 c rt x ^ "3 C S C £ £ =<2 »*■ w •© s • _ k£ -co c w 5 M 2 £ ~ f 1 5 5 » • •x> C j * u*0 111 g§« ?! 2 o> £ 2 8* Q- if o c H a Meningitis Whooping Cough Measles Tuberculosis .. Bronchitis Pneumonia (all forms) Gastro-enteritis Congenital malformations . • • • Premature birth Atrophy, marasmus .. Want of attention .. Other causes Totals 1 1 2 1 1 1 i i _ 1 1 2 3 1 1 1 1 i 1 1 1 2 1 1 2 1 i i l 1 2 2 6 4 2 3 2 1 1 1 6 1 2 — 9 4 6 3 3 25 Table XVI. Nett Deaths in the year of— Males. Females. Total. Legitimate infants 14 6 20 Illegitimate infants 4 1 5 Table XVII. Infant Mortality, 1928. Nett Deaths from stated 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 Covcnt Garden Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. [ 2-3 Weeks. 3—4 Weeks. Total under i 4 Weeks. 4 Weeks and i under 3 Months. i 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Atelectasis .. i i ■ i Diphtheria J uberculosis — — — — — — — — — Pneumonia (all forms) 1 i 1 3 Gastro-enteritis i — 1 Congenital malformations i 1 Premature birth i 3 — 4 i — — — 5 Malnutrition, inanition and debility from birth i 1 1 Murder i 1 1 Want of attention .. i — — — 1 — — — — 1 Totals 5 3 — — 8 2 1 2 1 14 29 Table XVIII. Nett Deaths in the year— Males. Fomales. Total. Legitimate infants 4 .. 6 10 Illegitimate infants 4 .. — .. 4 Table XIX. Deaths of infants with no known address, or found in streets, parks, &c.:— CAUSES OK DEATH. M I » I •c a D 3—2 Weeks. ■ at 5s 7 rt 03 -c 9 1 w u - 3 O "s ^ H c • b — 10 t- 'S |15 CO c eS 10 o §2 «o n •c c rt « fll <© ■c LI S §5£ 2 o» ToUl Deaths under 1 Year. Want of attention Syphilis Other causes 2 1 — — 2 1 _ — — 2 1 3 - - - 3 _ — — 3 Table XX. Males. Females. Total. Legitimate .. .. .. — — — Illegitimate — 3 3 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, 1928. Legitimate. Illegitimate. Total Infant Deaths, 1928. Legitimate. Illegitimate. 1928—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total. 1 Conduit 3,456 2 2 Grosvenor 13,880 88 77 11 4 3 1 38-9 90-9 45-4 Pall Mall 3,572 10 8 2 — — — — Regent 6,878 46 38 8 3 2 1 52-6 125-0 65-2 Gt. Marlborough 3,194 20 16 4 1 — 1 — 250 0 500 St. Anne 6,699 55 48 7 — — — — Covent Garden 7,064 52 46 6 6 5 1 108-2 166-4 115-3 Charing Cross.. 4,650 8 8 — — — — — — Strand . . 2,116 8 4 4 — — _ — — Victoria 37,396 502 435 67 30 27 3 620 44-7 59-7 K. St. George.. 12,563 130 125 5 8 8 — 640 — 61-5 Hamlet 6,687 30 29 1 — — — — — — St. Margaret .... 9,261 31 27 4 2 2 — 74-0 — 64-5 St. John 24,162 385 359 26 23 18 5 50-0 192-3 59-7 Homeless — 3 — 3 3 — 3 — 1000-0 1000-0 Total 141,578 1,370 1,220 150 80 65 15 53-2 100-0 58.39 30 Common Lodging House Deaths. Reference has been made in former reports to the shifting population which inhabits the six common lodging houses which are licensed in the City. Some of the residents are perm^.ent, 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; 84 deaths of persons giving addresses in common lodging houses occurred in 1928. They were mostly in institutions:— Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 37 33, Great Peter Street 4 10, Great Peter Street (Salvation Army) (licensed for 5C5 men) .. .. .. .. 10 16, Strutton Ground (licensed for 201 men) 20 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 12 Church Army Home, Greencoat Place 1 84 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 1924-1928. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1924 1925 1926 1927 1928 Small-pox X — — — 2 Diphtheria 237 286 223 185 233 Erysipelas 29 44 44 37 * 47 Scarlet fever 226 214 132 180 241 Enteric fever 15 17 11 24 28 Continued fever — — — — — Puerperal fever 10 6 5 6 6 Puerperal pyrexia — — 7 26 21 Cerebrospinal meningitis ... 3 3 1 I 1 Encephalitis lethargica 15 7 5 1 1 Poliomyelitis 1 3 2 1 — Ophthalmia neonatorum 23 21 16 14 7 Measles 852 117 1,026 71 997 German measles 34 117 14 12 21 Pneumonia 92 58 69 64 26 Malaria 1 1 — 1 2 Dysentery — 3 — — 8 Anthrax 1 — — — — Chicken-pox .... 89 149 198 206 210 Mumps .... .... 147 120 64 153 150 Whooping-couffh 97 255 46 128 76 31 Small-pox.—Two eases of this disease were notified in Westminster during the year, both males, aged 37 and 15 respectively, residing in industrial dwellings which generally lend themselves to the rapid spread of infection. The latter case was only discovered when the disease was well advanced and the rash fully out. It was then found that he was still being employed as a messenger at a large factory in Westminster. Although there were many contacts, no further case was reported in Westminster, but this lad had infected three other people in the same factory before being moved to hospital. Ihe other case had been treated for blood poisoning in a hospital where a previous case of smallpox was in the same ward. This patient had been discharged from that hospital undiagnosed. Information was received from the various Port Sanitary Authorities of 142 contacts. The names of all contacts are circulated by the Port Sanitary Authorities to the various districts to which they intend to proceed. This only applied, until recently, to persons remaining on the vessel until it reached a port in this country, the contacts who left the ship en route and proceeded overland were entirely lost sight of and could not be traced. Vaccination.—The Vaccination Officer informs me that the following number of persons were vaccinated by the Public Vaccinators during the year Primary 1,291 Secondary .. .. .. .. 182 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). Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1928. Cases Notified. Q Deaths. Notifiabm Diseases. At Ages—Years. ■ > o S-: a o H At Ages- -Years. a> to < "5 < &> •c a D T M 1 fr) CJ t © I 1 © s in CO o N «n I eo 0* ¥ in •o > m o <0 4) ci "5. 2 ^ u ■o "3 H O to < *-> •< <u TJ a D 1 eo • N CO m 1 •«* © I 2 o ci U) eo ci in 2 eo ifl 2 "3 S* 41 > o ia <o Small-pox Cholera (C). Plague (R) Diphtheria Erysipelas.... Scarlet (ever Typhus fever Enteric fever Relapsing fever (R) Continued fever (C) Puerperal fever Cerebro-spinal meningitis Poliomyelitis Enoephaliti6 lethargica.... Ophthalmia neonatorum Pneumonia Malaria Dysentery Puerperal pyrexia 2 107 47 204 25 6 1 1 7 26 2 8 21 7 7 1 5 6 1 15 8 1 18 9 1 2 13 11 1 78 2 73 1 2 1 18 3 32 1 11 1 24 4 1 2 23 8 34 12 4 6 1 1 14 l 4 6 5 4 2 6 5 4 17 2 2 1 7 1 1 1 10 1 4 2 190 36 196 18 5 1 1 4 19 1 8 19 7 11 8 7 1 3 7 1 2 13 1 1 G 3 1 05 2 2 1 1 3 1 5 2 — 2 1 4 1 3 7 2 25 1 1 26 Totals 547 u 12 24 30 25 157 53 44 103 33 35 16 500 47 90 4 1 1 3 1 5 2 — 7 11 27 28 Correction has been made (or errors in notification or revision of diagnosis in 2 cases. Cases not notified :— Typhoid, 2, 21, 72. Scarlet fever, 1, 2f, 3, 3i, 4, 6, 5, 5, 5, 6, 5i, 6, 6, 6, 7, 7, 7, 7, 9J, 10.15, 17, 17, 18, 18, 18, 19, 20, 25, 31, 43, and 5 in-patients of Gen. Hospitals, 1, 3, 13, 23, 26. Diphtheria, ft, A. 1A» 2» 3, 3, 3, 4, 4, 4J, 6, 5, 5, 6, 6, 7, 7, 9, 9, 9i, 10, 10, 11, 12, 13, 17, 18, 21, 21, 23, 30, 30, and 4 in-patients of Gen. Hospitals, ft, 2J, 3, 3*. Table XXIV. City of Westminster.—Infectious Diseases, Distributed in each Ward. Notifiable Diseases. *3 ■o o □ B § ightsbridge St. George. «■ 3 O eS •2> «3 s a J3 O *9 ■ 2 og rtj) 6 a a s c V to x: to s o o -3 9) <n O B O CO c ■ a E •a <8 o *» a V > •a a a *> c c < ~z E 6 o e W > 55 55 w" "5 PH 2 O x: u o O CO 00 o H Smallpox 1 1 Cholera (C). Plague (R) __ . __ — Diphtheria 18 7 76 8 83 3 1 6 2 11 — 9 9 Erysipelas 3 — 3 10 20 1 4 2 — — 3 2 2 Scarlet fever 19 14 66 19 71 2 2 7 6 1 9 1 12 9 Typhus fever . Enteric fever 7 9 3 1 3 ___ 1 1 Relapsing fever (R) __ Continued fever (C) _ __ ___ Puerperal fever 2 2 1 1 Cerebro-spinal meningitis 1 Poliomyelitis .... Encephalitis lethargica ___ 1 — Ophthalmia neonatorum 1 6 1 Pneumonia 2 4 0 __ 4 1 . 2 1 1 2 Malaria . . ... 1 1 Dysentery 1 i 1 • 5* Puerperal pyrexia — 1 14 — 4 — — — — — 2 — — — Totals 3 46 40 184 28 193 9 10 18 9 3 23 6 25 26 • Non residents 34 Scarlet Fever.—241 cases of this disease occurred in 1.928— an increase of 61 on the figures of 1927. The wards showing a slight increase are those of St. John, Victoria, and St. Anne. The disease, which hitherto was contracted mostly by children between the ages of 3 and 15 has, during the past year claimed many cases among those of more advanced years. 146 cases occurred in those between the ages of 3 and 15, and 76 cases between 15 and 45. There was one death. The case rate of this disease per 1,000 of the population was 1.81, the rate for England and Wales being 2.61. The death-rate for Westminster was 0.007 per 1,000, and for England and Wales 0.01. Of the total cases in Westminster 96 per cent, were moved to hospital. I * ! Diphtheria.—233 cases of this disease occurred, showing an increase of 45 on the figures of 1927. The wards showing a marked increase are St. John and Victoria—the former with 21 more cases and the latter with 11. 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, but there was an increase in the number of cases in those of higher ages. There were 13 deaths (10 males and 3 females), giving a rate of 55.7 per 1,000 cases, and of these deaths 7 occurred between the ages of 5 and 10 giving a death rate for that period of 79.5 per 1,000 cases. The case rate of this disease for Westminster was 1.75 per 1,000 living, and that of England and Wales 1.55. The death.rate for Westminster was 0.10, and for England and Wales 0.06. All cases reported to have been excluded from school on account of suspicious bacilli having been found in swabbings from their nose and throat are visited by the Sanitary Inspectors, and the parents advised to consult their doctor. But in cases where the family is numerous and the income too slender to enable them to call in a medical practitioner, they are visited by the Assistant Medical Officer of Health at their homes, or advised to call at 1, Pimlico Koad for swabbing. Thus unsuspected carriers are discovered, often apparently robust in health, but nevertheless a dangerous source of infection to their fellows. Fifty.seven diphtheria contacts in school schildren were swabbed by Dr. Thomson during the year. It is important that virulence tests 35 should always be carried out oil persistent carriers so that tliosc carrying virulent bacilli may be retained for special treatment, while the nonvirulcnt carriers may safely be discharged to their homes. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1928. This treatment has been continued during 1928 on the lines indicated iu the report for 1927. Two hundred and fifty-six cases were dealt with during the year, as compared with 250 in 1927. It is possible that the figure might have been slightly higher but for the fact that very little work was done in January and February as many of the staff were occupied with special duties arising out of the Thames Flood. In any case, the small but steady supply of patients has been easily maintained, and there seems no reason why it should not continue and even increase. There seems to be justification for the belief that the best ultimate results will be achieved by aiming at a gradual diffusion of knowledge and experience of the treatment among parents. Cases were dealt with at the Maternity and Child Welfare Centres as follows:— Pimlico Road 97 Bessborough Street 46 Frith Street 42 Page Street 71 Total 256 The treatment involved 347 tests and retests, 573 doses of the prophylactic mixture and 138 attendances for the reading of results only—a total of 1,058 attendances. Twenty-four cases were in the course of treatment at the end of the year and in 13 other cases treatment was interrupted by intercurrent illness in the patient or because of infectious disease in other members of the family. These cases will probably complete the treatment in due course. Only 3 cases definitely abandoned treatment before completion and this may be taken as an indication of the interest taken by the parents. As last year, a number of cases who accepted the Schick Treatment voluntarily had avoided vaccination. At least 16 out of the 250 had never been vaccinated, none of them very young children. 36 The following table shows the results of testing and the age groups of the patients:— Age. Positive. Negative. Treated without Testing. Under 5 years 139 10 7 Over 6 years 51 28 — Over 10 years 11 10 — 201 48 7 It is of interest that of the 10 cases under 5 who were negative, 7 had definitely been in contact with cases of diphtheria in the family, and may in this way have acquired immunity in resisting small doses of infection. This bears out what has been found elsewhere, that the test is hardly necessary under five years, if there has been no contact with diphtheria. It is proposed in future to increase the number treated without a preliminary test. It has been found, however, that many parents prefer to have susceptibility demonstrated by the test before treatment is started. The table also shows the increase of immunity with age. Between 5 and 10, 64 per cent, only and over 10, about 50 per cent, are positive. In a small percentage of cases only, reactions after treatment were reported, especially among the older children. Most of these cases complained of slight malaise or discomfort and in five or six cases, there were rather more severe general or local reactions. These were invariably transient reactions, being confined to the two or three days following a prophylactic injection. In one or two cases reactions followed each injection, in many others it occurred only after one, usually the first. It must also be recognised that in an occasional case the child or the mother is temperamentally unsuitable for the treatment and that it is probably wise to abandon the treatment in these rare cases. The number of patients attending for retests has been higher than in the previous year and about 60 per cent, of those who have received prophylactic treatment since the scheme started and who were due for retesting, have received retests. Some of the others may still attend, and a number leave the district before the rctest is due. Ninety-eight were retested during 1028, of whom 89 gave a negative result. Nine gave slight positive or doubtful results and eight of these, after the parents had been consulted, received two additional protecting doses. No retest gave a marked positive result. One child was removed to hospital, six months after a negative retest, with definite clinical and bacteriological diphtheria. It appears probable 37 that his immunity was insufficient to withstand a massive infection and that his symptoms were aggravated by an unfortunate delay in his removal to hospital. Two others were removed to hospital -diagnosed as diphtheria. One showed no symptoms and had a negative swab in hospital, the other had a positive swab and slight nasal discharge, which cleared up at once after a small dose of antitoxin. As these last two cases were definitely infected but suffered no ill effects, they should be regarded as satisfactory. The Schick treatment does nothing to prevent a patient from becoming a " carrier " and only aims at protecting him from the consequences of the disease. Parents reported several cases where a protected child was in contact with the disease, but did not develop it. There is, of course, no definite proof that infection occurred. Another child was sent to hospital as diphtheria a few weeks after Schick treatment. The treatment does not have its full effect for several months, so such cases are possible. In this particular case, however, the diagnosis was not confirmed in hospital. 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 Ilorseferry Road. It is apparent 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 may 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 1924, was:— 1924. 1925. 1926. 1927. 1928. 556 674 679 595 646 Enteric Fever.—There were 28 cases of typhoid and paratyphoid which came to the knowledge of the department during 1928. Of these 19 were notified as paratyphoid and 9 as typhoid. There was a history of fish having being consumed in 3 cases, cream 3 cases, ice-cream in 38 1 case, 4 eases came from abroad, 2 had just taken up residence in the City, and in 15 cases there was no history ascertainable. There were 6 deaths. The death-rate of this disease for England and Wales was 0-01, and for Westminster .04. The case rate for England and Wales was 0.09 and for Westminster 0.21. In July and August an outbreak of para-typhoid fever B occurred in Kensington (47 cases), Fulham (25), Wandsworth (^5), Hammersmith (3). There were also 91 cases from outlying districts adjoining the County of London. During this period 11 cases of para-typhoid fever B were notified in the City of Westminster. The cause of the outbreak in the districts mentioned was believed to be due to imported cream but from investigation it appeared very doubtful whether there was any direct association between the causal factors in that outbreak and the sources of infection in the Westminster cases. The death-rate for England and Wales per 1,000 population was 0-11, for London 0-30, and for Westminster 0.03. 179 cases were removed to hospital (157 to the hospitals of the Metropolitan Asylums Board and 22 to private hospitals. 133 cases were under 5 years of age, and 5 deaths occurred, all between the ages of 1 and 2 years. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows :— 1924. 1925. 1926. 1927. 1928. Males 25 13 10 24 12 Females 31 24 9 37 6 56 37 19 61 18 The death-rate in 1928 for Westminster was 0-13 per 1,000; for London, 0-13, and for England and Wales 0-19. Last year the corresponding rates were higher, being 0-14 for Westminster and 0-39 for London. 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:— 1924. 1925. 1926. 1927. 1928. 852 117 1,026 71 997 39 Diarrhoea and Enteritis.—Deaths from this cause were slightly higher than in 1927. The total deaths were 18—11 males and 7 females—14 being under 1 year old. The infant death-rate from this cause in Westminster was 10-2. Table XXVI. Deaths from Diarrhcea and Enteritis. Under 1 year. Other ages. Total. 1924 3 3 6 1925 8 5 13 1926 13 7 20 1927 16 16 1928 14 4 18 54 19 i 73 The 14 deaths under 1 year of age were distributed over the quarters of the year:— 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. 119 3 Whooping Cough.— 70 cases were notified during the year with 3 deaths—all being under 1 year. This is a decrease on the figures of 1927, when 128 cases, with 7 deaths, were recorded. 15 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. 1924 3 1 4 1925 7 10 17 1926 1 1 2 1927 2 5 7 1928 3 — 3 16 17 33 Cerebro-spinal Fever.—One case only of this disease occurred. Poliomyelitis.—1 case occurred. 40 Encephalitis Lethargica.—1 case was notified, with 1 death during the year. Chicken Pox.—210 cases were notified, 5 being moved to hospital. Mumps.—150 cases were recorded. Plague, etc.—Intimation was received of five persons coming into Westminster from places infected with plague. Anthrax.—There were no cases in 1928. Puerperal Fever.—6 cases occurred, with three deaths—5 cases were removed to 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. 1924 1,624 10 2 1925 1,535 6 1 1926 1,606 6 2 1927 1,399 6 1 1928 1,370 6 3 Puerperal Pyrexia.—21 cases occurred, all being notified by hospitals. To the women concerned in the above 21 cases (17 were married and 4 single), 16 children only were born; the remaining 5 cases arose from miscarriage. The Public Health (Ophthalmia Neonatorum) Regulations, 1926. These regulations have been in force since October, 1926, and under them midwives are no longer obliged to notify, but they are obliged to call qualified medical assistance to all cases of inflammation of the eyes. If the medical practitioner considers the case one of Ophthalmia Neonatorum, he must notify to the Medical Officer of Health. Ophthalmia Neonatorum.—Seven cases occurred in 1928—6 males and 1 female. Four were admitted to hospital and 3 treated either at home or as out-patients of hospitals. In addition to these notified cases, 10 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. 41 It will be noted that this year the cases of genuine Ophthalmia are 50% less. The following details in tabular form are required by the Ministry of Health of the cases notified in 1928:— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 7 3 4 7 — — — 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 646 Blood in suspected typhoid 21 Sputa for investigation of T.B. 355 Expenditure on first two was £93 2s. 2d., and for the third £48 12.s. 10d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1928, 187 new cases of pulmonary tuberculosis came to the knowledge of the Department, including 9 cases who had moved into the City, and 11 non-notified deaths. Non-pulmonary forms of tuberculosis gave 49 cases—12 of these being non-notified deaths. (10285) d 42 Table I. Tuberculosis, 1928. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. Under 1 _ _ 2 1 _ _ 2 1 1 1 1 1 5 2 5 4 _ 1 2 10 1 2 3 1 _ 1 1 _ 15 8 6 2 5 1 2 1 20 11 14 4 3 6 1 1 1 25 30 18 1 5 11 4 35 45 31 21 6 13 3 2 3 15 14 3 6 1 3 55 16 2 1 _ 10 5 1 _ 65 and upwards 4 2 — 2 4 7 — 2 Totals 124 63 22 27 61 29 7 11 In this Table all primary notifications are included, and also other new cases of tuberculosis coining to the knowledge of the Medical Officer of Health during the year. The total cases for 1928 stow a decrease of 38 on those of 1927. Out of the total cases notified in 1928, 32 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 8—9 9—10 10—11 12 3 3 3 8 1 — — — — 1 — 1 Table II. 1924 1925 1926 1927 1928 New cases notified 347 282 288 245 213 Number included in above who died during the year 66 (19.0%) 46 (16.3%) 45 (15.6%) 31 (12.6%) 32 (15.0%) Total Tuberculous Deaths 138 129 133 114 108 Death Rates per 100,000 96.5 92.4 9.60 83.5 83.2 43 (10285) Table III. Tuberculosis.—Notifications received during the period from 1st January, 1928, to 29th December, 1928. 1928 Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified.[/333] 0 to 1. 1 to5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 36. 36 to 45. 45 to 55. 55 to 65. 65 Total and up. new cases. Pulmonary Males _ 2 1 8 10 27 29 17 13 4 111 118 Females 2 5 11 17 6 13 1 1 56 G3 Non-pulmonary— Total 1 1 8 7 20 27 60 38 31 15 0 204 219 Number of notifications on Form B. (School medical inspection.) Number on Form C. Admissions to Primary notifications. Total notifications, including cases previously notified. Poor Law institutions. Sanatoria. Under 5. 6 to 10. 10 to 15. Total. l Pulmonary— Non-pulmonary— Males — — 6 Females — — — — — 12 Total — — — — — 1 128 D 2 44 Table IV. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1928. Age Periods. 0 to 1. 1 to 5. 6 to 10. 10 to 15. 16 to 20. 20 to 25. 26 to 36. 35 to 45. 46 to 65. 65 to 85. 65 and up. Total. Pulmonary— Males _ — — — — 1 3 2 4 3 13 Females 1 3 1 1 1 7 Non-pulmonary— Males 1 — 1 1 1 _ _ 4 Females 1 1 2 — — — — 1 2 — 1 8 Total 2 1 3 — 1 5 4 4 6 4 2 32 c.l.h. General. Non-pulmonary. C.l.h. General. Total Notified pulmonary 29 138 3 34 204 31 156 49 236 45 Table V. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1927. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Co vent Garden. Strand. St. Anne. Homeless. Kecdvcd Inntltutlonal Treatment during 1027, Pulmonary— Males 124 4 6 29 6 30 2 6 3 4 — 2 11 9 12 97 Females 63 _ 7 2 23 — 20 — — 3 — _ 2 1 3 2 39 Non-pulmonary— Males 22 _ 1 1 10 1 6 1 __ 1 — 1 20 Females 27 — 1 3 10 5 2 1 — 1 — 2 — 2 — 22 236 — 13 12 72 7 61 4 7 6 6 — 6 13 14 15 178 46 Table. VI. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all firms. General Population. C.L.h. and no Address. Total. Males. Fermales. Males. Females. Males. Females. Total. 1912 233 184 115 10 512 _ _ 59 571 1913 203 174 89 8 474 91 86 177 651 1914 186 105 94 4 390 34 38 72 462 1915 155 95 59 8 317 46 26 72 389 1916 183 135 64 9 391 42 39 81 472 1917 209 164 51 7 431 42 34 76 507 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 1922 119 110 42 2 273 24 30 54 327 1923 111 114 42 1 268 24 32 56 324 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 1927 103 67 24 1 195 21 29 50 245 1928 97 61 27 2 187 22 27 49 236 (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-mtified Deaths.-—There were 23 deaths from Tuberculosis (12 males and 11 females) during 1028 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 23 non-notified deaths gave a percentage of 21-3 of the total deaths from Tuberculosis for the year. The total number of cases of Tuberculosis on the Register at the end of 1028 was 1,180 as compared with 1,457 at the end of the year 1027. The Public Health (Tuberculosis) Regulations, 1024. The number of unnotified deaths is slightly lower this year, being down from 20 to 23; the corresponding percentage proportions are 25-4 per cent. (1027) and 21-3 per cent. (1028). Enquiries were made, but in no instance did there appear to be neglect on the part of a medical practitioner to notify a case. In 14 instances the diagnosis was made as a result of post-mortem examination. 47 Public Health (Prevention ok Tuberculosis) Regulations, 1925. The object of these regulations is to prevent anyone who is aware that he is suffering from an infectious form of tuberculosis from engaging in certain departments of the milk trade. There was no occasion for exercising the powers conferred by these regulations during 1928. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on Register at beginning of year 1928 701 407 154 195 Notified for the first time during year 116 60 18 19 817 467 172 214 Removed from the Register on account of death or removal from Westminster ... 94 56 9 22 723 411 163 192 Of the 181 cases removed from the Register during the year 1928, 84 were on account of death, 94 persons suffering from Tuberculosis moved from the City, and the diagnosis was revised in 3 cases. Of the 84 deaths mentioned above, 2 died from causes other than Tuberculosis. Deaths from Tuberculosis.—The total number of deaths from Tuberculosis for 1928 (all forms) was 108—Males 68, Females 40. This gives a death-rate for this disease of -83 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. 1924 138 .96 1925 129 .92 1926 133 .96 1927 114 .83 1928 108 .83 The average five-yearly rate per 1,000 was .90 48 The following table shows Deaths per 100.000 of civilian population since 1917. Table VIII. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1917 annual 194 147 29 22 223 169 1918 186 148 31 24 217 173 1919 134 105 21 16 155 121 1920 139 97 18 12 157 109 1921 120 84.9 15 10.6 135 95.5 1922 144 103.3 21 15 165 118.3 1923 103 73.3 16 11.3 119 84.7 1924 124 86.7 14 9.9 138 96.5 1925 115 82.3 14 10.0 129 92.4 1926 119 85.9 14 10.1 133 96.0 1927 100 73.2 14 10.2 114 83.5 1928 90 69.3. 18 13 8 108 83.2 Westminster Tuberculosis Dispensary. Annual Report, 1928. The work of the Tuberculosis Dispensary has been carried out during the year without any radical change in the routine described in previous reports. Four hundred and fifty-two new cases were examined during the year, of which 201 were considered to be definitely tuberculous, though not necessarily at an active stage of the disease. The following table shows the sources from which new cases were referred to the Dispensary during 1928 and in the two previous years. 1926. 1927. 1928. Practitioners 142 153 149 Health Visitors (contacts, etc.) 161 158 159 St. Stephen's Hospital 54 52 61 Ministry of Pensions 15 9 10 School Medical Officer 33 27 42 Hospitals 12 9 11 Friends, Charitable Organizations, etc. 29 20 20 446 428 452 49 This table indicates that the increase in the total compared with 1927 is due largely to an increase in cases referred by the School Medical Officer and in cases seen in connection with St. Stephen's Hospital. The slight decrease in the number of patients referred by practitioners is explained by the fact that the total number of notifications in Westminster in 1928 was slightly lower than in the previous year. The cases referred by the Ministry of Pensions were for the most part old cases who had moved into Westminster from elsewhere. As pointed out last year, a gradual decrease in the number of pensioners attending is to be expected. Reference has been made in previous reports to the importance of the connection between the Dispensary and St. Stephen's Hospital. These cases are almost all definite cases of tuberculosis, so about a quarter of the new cases of tuberculosis, as distinct from suspects, are obtained through the hospital. Many of these new cases are from Common Lodging Houses and have often been resident in Westminster only a short time. Others, however, are genuine Westminster residents of the type who, from choice or necessity, do not seek treatment until they are too ill to carry on. These are sent straight to St. Stephen's Hospital by medical practitioners, and many of them would never come in touch with the Tuberculosis Officer except through the hospital. It is possible to arrange for suitable cases to be transferred to the London County Council institutions and to get others to attend the Dispensary after discharge from St. Stephen's Hospital. Considerable use is made of the Hospital for Dispensary cases who are awaiting a Sanatorium vacancy, and who cannot be treated at home, and for other more advanced cases where it is desired to see if sufficient improvement is made under hospital conditions before recommendations are made to the County Council. Even more important is the touch which can be maintained with old Dispensary cases. Many advanced cases which would not be considered eligible for treatment under the London County Council's Tuberculosis Scheme, are recommended from the Dispensary to St. Stephen's Hospital. Some of these are patients who have attended the Dispensary for many years and who are more willing to enter the hospital when they know that they will still be seen by the Tuberculosis Officer. In other cases, the Tuberculosis Officer finds cases in the hospital whose Dispensary attendance has lapsed. It would therefore seem that the connection between the Dispensary and the hospital docs much to aid continuity of treatment, which is of prime importance in the treatment of Tuberculosis. It is highly desirable 50 that, in the forthcoming rearrangement of the Tuberculosis Scheme in London, this connection should be maintained and if possible strengthened. The above table gives certain details of the work of the Dispensary in 1928 and in the preceding five years. 1923. 1924. 1925. 1926. 1927. 1921. New Patients 529 613 395 446 428 452 Old Patients attending 800 652 474 519 513 551 Contacts examined 245 271 150 162 131 98 Individuals who attended 1,329 1,255 869 965 941 1,003 Total Attendances 3,133 3,292 2,637 2,697 2,627 2,370 Written Medical Reports to London County Council and Medical Practitioners 1,651 1,884 1,280 1,378 1,270 1,300 Consultations with Medical Practitioners 209 243 90 92 105 98 Other visits paid by Medical Officer 227 178 87 46 149 112 Visits by Health Visitors to Dispensary Cases 4,717 4,907 5,636 4,144 4,875 3,444 Sputum Examinations 360 232 443 223 172 159 X-ray Examinations 5 2 2 5 12 16 The following table shows the number of cases recommended for Hospital and Sanatorium treatment in 1928:— Hospital. Sanatorium. Insured Males 35 38 Insured Females 12 11 Uninsured Males 5 7 Uninsured Females 7 11 Boys 3 4 Girls 2 0 64 71 In addition many children have been recommended for Convalescent treatment through the Invalid Children's Aid Association, the Guardians, the School Authorities, St. Henry's Fund, etc. It is unfortunately less easy to obtain convalescent treatment for tuberculous adults. It seems probable that spells of convalescent treatment at appropriate times might prevent many quiescent cases from losing ground and possibly save them from reactivation of their disease, and from the need for further spells of Sanatorium treatment. The association with the Westminster Hospital has been continued and a number of cases have been referred there during the year for surgical opinions, for orthopedic treatment, or for treatment such as the removal of tonsils and adenoids. 51 Sixteen patients have had X-ray examinations and 159 specimens of sputa have been examined at Westminster Hospital in connection with the work of the Dispensary. Seven cases have had Artificial Pneumothorax treatment at Brompton Hospital and elsewhere. In all, 118 refills have been given at a cost to the Council of 10s. 6d. each. The results in all these cases have been thoroughly satisfactory, and in suitable cases the value of this form of treatment cannot be over estimated. One case of Lupus has attended ten times for Light treatment at the London Hospital. Seven cases have been referred to the Council's Dental Clinic for treatment. The total number of attendances was 54, G6 extractions and 13 fillings were performed. Dentures were supplied to 5 patients, the Council contributing £2 towards the cost in one instance. School children are recommended to the school authorities for dental treatment and also for treatment of conditions of the eye and the nose and throat. The Tuberculosis Care Committee has approved grants for extra diet to 10 persons for varying periods at a total cost to the Council of £60. Cases are recommended by the Tuberculosis Officer purely on medical grounds as an adjuvant to the other treatment provided under the Council's Tuberculosis Scheme. Most of the cases are patients who are awaiting or have recently returned from institutional treatment. Care and After-Care. During 1928 the Tubercidosis Care Committee issued a report, giving details of the various branches of its work, and citing illustrative cases in which the Committee was able to help patients to accept institutional treatment by obtaining relief from some of their responsibilities, or to aid them on their return from Sanatorium. Detailed reference was also made to the aid given by the British Red Cross Society and the United Services Fund to ex-service tuberculous men and their dependents, and to the Open Air Class in St. James's Park which is attended by many children who are Dispensary patients. Handicrafts Class. This class, referred to in last year's report, has been continued very successfully by the voluntary committee. Excellent work is turned out by the patients and they appear to derive considerable physical and mental benefit from the interest and occupation which their work gives them. In many cases they are also able appreciably to augment their incomes. 52 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. Return showing the Work or the Dispensary during the Year 1928. Diagnosis. Pulmonary. Non-pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — (a) Definitely tuberculous 105 54 3 2 5 8 12 7 110 62 15 9 (b) Doubtfully tuberculous __ 1 8 —. (e) Non-tuberculous — — — — — — — — 31 36 31 27 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 _ — 1 3 1 1 3 (b) Doubtfully tuberculous — — — — — — — — 1 I (e) Non-tuberculous — — — — — — — — I 14 35 41 C.—Cases written off the Dispensary Register as— (a) Cured (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) 43 60 78 81 D.—Number of Persons on Dispensary Register on December 31st (a) Diagnosis completed 253 190 12 18 20 16 87 78 273 206 99 96 (b) Diagnosis not completed — — — — — — — — — 1 — — 53 1. Number of persons on Dispensary Register on January 1st 679 *2. Number of patients transferred from other areas and of " lost sight of "cases returned 24 3. Number of patients transferred to other areas and cases " lost sight of " 142 4. Died during the year 52 6. Number of observation cases under A (b) and B (6) above in which period of observation exceeded 2 months 2 6. Number of attendances at the Dispensary (including Contacts) ... 2,370 †7. Numbor of attendances of non-pulmonary cases at Orthopedic Out-stations for treatment or supervision 8. Number of attendances at General Hospitals or other tions approved for the purpose, of patients for— (а) "Light" treatment 10 (b) Other special forms of treatment 118 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 7 10. Number of consultations with medical practitioners— (а) At homes of Applicants 54 (b) Otherwise. 318 11. Number of other visits by Tuberculosis Officers to homes 112 12. Number of visits by Nurses or Health Visitors to homes for pensary purposes3,444 13. Number of— (а) Specimens of sputum, etc., examined 159 (b) X-ray examinations made in connection with Dispensary work 10 14. Number of Insured Persons on Dispensary Register on the 31st December 315 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 182 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 — (b) Form G.P. 36 1 * No cases discharged as " cured " have returned to the Despensary. | A number of Orthopaedic and surgical cases have been referred lo general hospitals. (Signed) Ian S. Thomson, M.D., Tuberculosis Officer.. 23rd February, 1929. 54 HOUSING. The Millbank Improvement Scheme. The overflowing of the Thames on the night of 6th-7th January and the damage which followed focussed attention on the housing conditions in the riverside area, a result always likely to happen where the destructive forces of Nature, he they fire, wind or water, play havoc with the defences which man has devised to protect himself against them. A general outline of the circumstances of the flood and of the measures taken to provide shelter and to make good the losses suffered by those whose homes were flooded was given in the preface to the report of last year. It was mentioned there that an Improvement Scheme was in contemplation, which it was hoped to promote in a private Bill. It was felt that owing to the peculiar circumstances which had arisen, largely owing to the flood, a more expeditious method of dealing with the area would be by the promotion of a late Bill in the parliamentary session of 1928 rather than by proceeding under Part II of the Housing Act, which deals with insanitary areas. In this instance the Council was dealing with an owner who not only had no desire to oppose an improvement scheme but who was most anxious by every means in his power to hasten the work of restoration of the devastated area and, further, to help replace the affected working-class dwellings by new and more roomy dwellings fitted with every convenience likely to increase comfort in the home and to raise the standard of living. The hope that there would be time to promote a late Bill was unfortunately not fulfilled owing to the nature of the negotiations which had to take place between the owner (the Duke of Westminster) and the Council. The scheme, however, was completed in the autumn, and the Bill embodying the scheme was deposited in November, 1928. It was passed through Parliament in the spring and received the Royal Assent this month (May, 1929). Stated briefly, the scheme is as follows: The whole of the Millbank estate is to be rebuilt, while existing working-class dwellings, together with other buildings, will gradually be demolished. The Duke has given to the Council an area of land sufficient to contain 604 working-class dwellings (this figure corresponds to the number of families residing in the area on the night of the flood). In addition to this gift the Duke will contribute a capital sum of £113,650 towards the cost of the new dwellings and, further, will contribute a considerable sum towards the making of certain new streets. The total money value of the Duke's gift, including the estimated value of the land is not far short of £310,000, and the cost of the scheme to the Council will be about £350,000. The capital value of this improvement scheme may therefore be reckoned about £700,000. The enormous cost of building working-class dwellings in Westminster is of sufficient moment to call for remark. If 55 the Council had not received a free gift of the land (a 999 years lease at one shilling per year), and also a gift of a capital sum, the expenditure to be borne by the ratepayers would have amounted to £606,600 for 604 dwellings, or more than an average £1,000 per dwelling. The work of remedying the insanitary conditions resulting from the flood, providing information for the proper distribution of the Mayor's Relief Fund and the surveys necessary for the submission of evidence in the Improvement Bill were a dominant issue in the department throughout the year. The administration of relief for loss or damage to household effets and for damage to houses was closely bound up with the work of surveying insanitary conditions, and the staff of the department, although all were working overtime and sacrificing week-end leisure, had to be temporarily increased to deal with the emergency. Three additional sanitary inspectors and a clerk were engaged for some months. As this work concerned the department so closely a brief account is included as an appendix to this report. The preparation of evidence for the Millbank Improvement Bill also occupied the greater part of the year and extended into 1929. The evidence consists of a Proof of Evidence, being an account of the historical and general characteristics of the Millbank Estate, the condition of premises previous to the flood and the eSects of the flood on premises, particularly dwelling-houses, a discussion as to the best methods of dealing with the area and an outline of the proposals contained in the Bill. Four appendices were submitted: (1) a complete statement of the occupation of all the premises in the area, supplying names of tenants, subtenants, &c., number of rooms occupied, rents, number of families (adults and children), trade or calling of each head of household and a sanitary report on such premises; (2) a plan on ordnance scale showing types of premises differently coloured, e.g., working-class dwellings, shops, &c.; (i) statistical tables relating to persons and premises; and (4) a book of photographs indicating the existing state of premises in various parts of the area. These five documents have been submitted to the Ministry as a special report. The main plea of the Bill was for power to acquire land for new working-class dwellings to replace those which in the course of time had become worn out and had suffered such damage from the flood that they had become either wholly or in part unfit for habitation. A perspective view of the proposed new housing scheme as designed by Sir Edwin Lutyens is shown on page v of the appendix to this report. 56 Ebury Bridge Schcme. The financial provisions, lay-out and general design of another new housing scheme have been approved by the Council and the work is now proceeding. This is the Ebury Bridge Housing Scheme, on land shortly to be designated surplus owing to the policy of the Council pursued in recent years of centralizing the work of certain departments. In brief, as it affects this area the policy will include the filling in of part of the Grosvenor canal, the demolition of certain old workshops and stores, making a clearance of approximately two acres. The dangerous corner of Ebury Bridge Road, where the Tuberculosis Dispensary and Maternity and Child Welfare Centre now stand will be cut off, thus bringing this road into direct line with Buckingham Palace Road. These two institutions will be rebuilt in more up-to-date and commodious buildings, and will be more or less homogeneous with the new housing scheme. A perspective view of the proposed scheme and plans of the Maternity and Child Welfare Centre and Tuberculosis Dispensary are shown on pages x, xi and xii of the appendix to this report. It will be noted that in addition to eight blocks of flats there will be two floors of flats over the Dispensary and Welfare Centre. It is the intention to house in them certain officers of the Council who are required to live near their work. When these two schemes are completed the Council will have provided a total of approximately 1,000 dwellings since the war. The working class accommodation owned by the Council previous to the war was 396. In addition there are throughout the City no fewer than 72 blocks of industrial dwellings containing 6,209 separate flats. It has already been pointed out that there is a larger number of industrial dwellings in Westminster than in any other district of London. In other words suitable working-class accommodation exists in higher proportion than in the other Metropolitan Boroughs. If the comparative figures of resident and day population are borne in mind the difficulty of providing housing for all who work in Westminster will become apparent:—138,000 residents and almost 400,000 who come to Westminster daily to work. In order to make room for houses for the majority of Westminster workers it would be necessary probably to demolish some of the shops and offices in which they work, which is a reductio ad absurdum., The proposal might likewise be put forward that those who work in the City of London should be housed there. It would again be a question of housing half a million persons where only 13,000 are now dwelling. This could only be accomplished by erecting industrial dwellings of enormous height on the cleared sites of say banks, insurance offices and warehouses. 57 Two Completed Schemes.- The two housing schemes, which were nearing completion at the end of 1927, were opened for occupation in May and June, 1928. Details of each, Admiral House, Willow Street, and Schomberg House, Esher Street, were described last year. In considering applications for the 118 flats in both houses the Housing Committee gave preference to cases which had come under the notice of the Medical Officer of Health and were recommended by him. In this way 79 families found relief from overcrowding and other insanitary conditions. With regard to a proportion of the flats in Schomberg House the Housing Committee had to alter the allocations for the following reasons. In the Millbank Scheme it was agreed by the contracting parties to proceed at once with the houses on the South side of Vincent Street. That is to say, whether the Bill passed or not the Duke had agreed to give this section of land for the purpose of new working-class dwellings. Consequently, in order to expedite demolition and re-construction, the tenants of this side of Vincent Street were housed in Schomberg House, soon after it was opened. These old houses were soon razed to the ground and the site cleared for rebuilding. The Housing Committee has in consequence a considerable list of urgent cases which would have been housed in Schomberg House had it not been necessary to house the Vincent Street tenants and thus accomplish the clearance of the south side of this street. Wonnholt Estate, Hammersmith.—In the report for last year details were given of an agreement entered into with the London County Council under the provisions of Section 14 of the Housing (Financial Provisions) Act, 1924, under which the London County Council allocated to the City Council 50 houses on the Wormholt Estate at Hammersmith, for the housing of Westminster families to be nominated by the City Council. By January, 1928, 42 of these 50 houses had been let to the City Council's nominees and in that month the agreement was extended to cover a further 50 houses, making a total of 100 in all. As a result of the conditions arising out of the flood, the letting of these houses proceeded rapidly and was completed in the early part of the year. Other London County Council Estates.—Under the arrangement made by the London County Council by which a certain percentage of new accommodation on that Council's outlying estates is allotted to the various Borough Councils for families living in overcrowded or other insanitary conditions, 52 Westminster families were re-housed, principally on the Downham and Watling Estates. (10285) E 58 The existing estates of the County Council, other than that at Becontree in Essex, have now been practically completed and occupied. Nomination of tenants by the Borough Councils has therefore ceased, except in the case of the latter estate, which, however, has no attraction for Westminster workers owing to its distance from the City and its inaccessibility. Housing Applications.—It is the practice of the Public Health Department to examine all applications received by the Council for housing accommodation and in cases where overcrowding or other insanitary conditions appear to exist, to inspect and report to the Town Clerk for the information of the Housing Committee. During the year, 344 such inspections were made and of the urgent cases discovered 137 were re-housed in dwellings of the City Council or of the London County Council. The City of Westminster year bv year is developing as the City of London developed in the past—becoming a centre for merchandise, banking, and other spheres of commerce. In addition its traditional characteristic as the home of the Arts and Sciences is continually extending. If these features are to be preserved and this natural scheme of evolution is to proceed there cannot also be a very large development as a workingclass district. So far as the Council is concerned in providing dwellings, certain guiding principles will have to be set up. Who actually requires to live in Westminster to be near his or her place of work ? It should be a condition that a tenant holds his tenancy only so long as his work remains of such a nature that it demands his living near at hand. There is no other way of settling a problem which is likely to become more and more difficult as years go on. It is well known that tenants from other districts are most eager to live in Westminster irrespective of where their work may be. Having obtained a room or rooms these families increase and grow older. Soon, as "old Westminster" residents they lodge applications for the Council's dwellings on the grounds of overcrowding, &c. If they succeed in obtaining larger accommodation it is more than likely that their old rooms will be taken by a family from an outside district. So it goes on. From a close study of the housing problem extending almost over five years one is becoming convinced that there is generally in Westminster sufficient working-class accommodation for all to whom it is vitally important to live near their work. It will be remembered that a large proportion of it is occupied by those who work in other districts—18,900 in 1921 census. The cost of travelling or occupations entailing abnormal hours are of course very pressing questions for Westminster workers. The Council's activities should therefore clearly 59 be restricted to replacing the working-class dwellings in the City where these are worn out and lacking in conveniences and also to making such provision for certain classified workers as will put an end to overcrowding and others forms of illegal occupation. Basement dwellings.—The question of living in basements is one which came into great prominence in connection with the flooding of riverside districts of London. It will be remembered that there are two governing principles here involved. The Public Health London Act, 1891, Section 96, requires that no basements shall be occupied as separate dwellings unless they comply with certain structural standards. If, however, the occupier has a room on an upper floor the force of this section ceases to have effect. The Housing Act, 1909, and Regulations re-enacted in the Act of 1925 lay down more far-reaching requirements if basements are to be used as sleeping rooms. It is under the latter that it is possible to take the most satisfactory action. A room which does not comply may be closed for sleeping purposes by order of the Sanitary Authority. The danger to which occupants of basement sleeping rooms are exposed in districts liable to river flooding need not be emphasised. The risk is increased where those rooms do not comply either in respect of greater depth below the footway or deficiency of access of windows or doors. So far as Westminster is concerned only one fatality occurred in an underground room illegally occupied; the others who were drowned were living in underground rooms where the conditions were in accordance with statutes and regulations. With regard to the question of basements generally the whole matter cannot be decided so simply as many imagine. In several instances basements have been found which according to measurements were illegally occupied and yet were brighter and more airy than many others which complied with the regulations or for that matter some ground floor rooms in certain districts. Other factors play an important part—width of street, height and elevation of neighbouring buildings, aspect in relation to sunlight. There are, however, many basement rooms which are undoubtedly depressing to health when the occupants have to live, sleep and eat in the same rooms. Ventilation in these is often inadequate, dampness in varying degrees owing to defects in the original construction may be present and is sometimes incurable. The atmosphere of the interiors is dim and murky. If housing accommodation increased to such J O an extent would it ever be expedient to ask for powers to close all underground rooms for living purposes? In those cases where underground rooms have become disused whether by reason of action by the sanitary authority or otherwise they become dumps for rubbish. Dirt and dust (10285) E 2 60 accumulate to an extraordinary degree, rats find an attractive home. and dampness becomes aggravated. Such a state of deterioration goes on that the structure of the whole house is threatened and an atmosphere of nuisance is created. If disused basement rooms are not sealed by having doorways and windows bricked up then they had far better be occupied. Used for purposes other than sleeping, say as kitchens or for having meals in, and submitted regularly to broom and bucket these underground rooms help to ventilate the whole house. During the year 32 cases of illegal occupation of underground rooms were discovered; in 18 of these the tenants obtained alternative accommodation, all except two being rehoused in dwellings of the City Council or of the London County Council. The cases which remain to be dealt with have been recommended for preferential consideration when suitable accommodation becomes available. Reoccupation of overcrowded or insanitary dwellings. It has been the practice in this department for some years to communicate with the owner of houses or rooms from which tenants previously living in overcrowded or other insanitary conditions have moved to other dwellings. It is pointed out to the owner that it is his duty to see that in re-letting, such conditions do not recur. Re-inspections of such houses have been made at regular intervals and only in two instances was it found necessary to issue fresh notices. In one case accommodation was found for a family illegally occupying two underground rooms. In spite of warnings the owner re-let those rooms under the same conditions. He was proceeded against and was convicted. Collayc Place and Willow Place.—In October a request was made to the Medical Officer of Health by the Westminster Housing Association and four local government electors, that an inspection be made of the houses in these two streets, in accordance with Sections 35 and 30 of the Housing Act, 1925. It was suggested that the Medical Officer of Health might make an official representation to the Council with a view to a small Improvement Scheme being undertaken in connection with these properties. A detailed inspection was accordingly made of the houses in question and certain defects requiring remedy under the nuisance sections of the Public Health Act were found to exist, but the general condition of the premises was not such that they could be described as "unfit for habitation "or" dangerous or injurious to the health of the inhabitants" as specified in Section 35 (a) and (b) of the Housing Act. A report in these terms was subsequently made to the Council as required by Section 36 (2) of the Act. Cottage Place, a cul-de-sac on the North side of Romney Street, consists of 11 houses of the cottage type, varying in size from two to four rooms. 61 Each of them was occupied by one family only, except one of the fourroomed cottages, which contained two families. The houses are old and nearing the end of their useful life, but they are fairly well situated so far as access to light and air is concerned. They have been the subject of house-to-house inspections under the Housing Consolidated Regulations from time to time and appropriate action has been taken where necessary to secure that they shall be kept in a reasonable state of repair. Willow Place is a small court opening out of Willow Street, and consists of two cottages, one of which contains eight rooms and the other four. There were three families in the former and one in the latter. The site was formerly occupied by six small cottages, which were reconstructed and converted into two some thirty years ago. Prior to 1926 there were three unoccupied and dilapidated cottages on the opposite side of the court which obstructed light and air from the other two, As stated in the report for that year, the Council took steps to obtain the demolition of those three cottages, with considerable benefit to the remaining two, the structural condition of which is fairly good. The following table, required by the Ministry of Health, is set forth in detail:— Table I. Number of new houses erected during the year:— Tenements. (a) Total 118 (b) With State assistance under the Housing Acts— (i) By the Local Authority 77 (ii) By other bodies or persons 0 1. Unfit duelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,458* (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 382 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 40† (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,209** *Includes 722 houses affected by the Thames Hood of January 6-7th. **Includes 711 houses „ „ „ „ †Houses rendered wholly or in part unlit by reason of the Flood. 62 2. Remedy of dejects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 95 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:— (а) By owners 0 (b) By Local Authority in default of owners .. 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,489 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,485 (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 0 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the 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 ance of Demolition Orders 0 63 SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation.—The water-carriage system is in existence throughout the City. Scavenging.—This is in charge of the Highways Department, whose chief officer is the City Cleansing Surveyor, and the following particulars are supplied by his courtesy. There is a daily collection of house refuse throughout the City, the removal of trade refuse being subject to special arrangements; 104,866 tons of the former were collected during the year and 741 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 1928, 84,766 tons were sent away in barges and 11,728 tons were treated at the salvage plant. The remainder was carted away by various contractors. The subject of the ultimate disposal of refuse from the Metropolitan area is one which has received considerable attention during the past year. A considerable proportion of Metropolitan refuse is dumped in Essex and other outlying districts. Residents and others in the vicinity of the dumps have complained of the nuisance caused by rats, and by the smoke from fires which are the result of spontaneous combustion. Various methods of treating the refuse with a view to preventing the heaps from taking fire have been tried, but apparently without success. Some of these dumps have assumed gigantic proportions and there is no doubt ample justification for the complaints which have been made. The Ministry of Health is conducting an investigation into the whole question of the methods of disposal of refuse from the London area and it is hoped that as a result some more satisfactory means will be found of dealing with the problem. The City Council's refuse disposal depot at Ebury Bridge has been undergoing reconstruction and the work is expected to be completed in July, 1929. The canal and lock have been widened and modernised and this will enable the barging of refuse to be carried on with the minimum of delay. 64 Local By-laws ami 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.—24th August, 1908. Regulations as to underground sleeping places under Section 17 (7), Housing, Town Planning, etc., Act, 1909.—11<A January, 1916. By-law relating to fouling of footways by dogs:—March, 1928. Premises and Occupations which can be controlled by Bye-laws and Regulations— (1) Houses let in tenements. (2) Underground rooms. (3) Butchers shops and stalls. (4) Dairies and milk shops. (5) Ice-cream premises. (G) Bakehouses. (7) Workshops and workplaces. (8) Rag and bone dealers. (9) Fried fish shops and fish curers. (10) Street traders dealing in foodstuffs (storage). 65 Fouling of Footways by Dogs.—The temporary by-law made by the Council to which reference was made in the previous report came into force in March, 1928. Up to June, 1929, five offences against the by-law had been reported to the Council by the Police. Prosecutions were ordered in four cases, in three of which the defendants were fined 10s., 5s., and 5s. respectively; in the remaining case the payment of 2s. costs was ordered. Complaints have been made from time to time that the streets in certain parts of the City were particularly subject to this nuisance and it has been suggested that the Council has not been sufficiently energetic in administering the by-law. It should, however, be pointed out that folding of the footway is an offence only if the dog is on a lead, and that doubtless nuisances are caused mostly by dogs which are allowed to run loose. The by-law has been brought to the notice of all ratepayers, a copy being enclosed with rate demands, and copies have been posted on lamp posts, sand bins and elsewhere in prominent positions, so that no doubt the majority of residents are aware of its existence. There has been a marked improvement in the condition of the streets in the City since the by-law came into force, and steps should be taken to secure its continuance from the date of expiry of the temporary period of two years during which it has effect. Rag Flock Acts, 1911 and 1928.—There are no premises in the City which come within the provisions of these Acts. Nuisance from Pigeons.—The London County Council (General Powers) Act, 1927, gave powers to metropolitan sanitary authorities to adopt measures for dealing with this nuisance. The appropriate section No. 52 (1), is as follows:— " For the purpose of abating or mitigating any nuisance annoyance or damage caused by the congregation at any place in the county of house doves or pigeons having or believed by the local authority to have no owner or of preventing or minimising any such nuisance annoyance or damage which might in the opinion of the local authority bo so caused the local authority may notwithstanding anything in the Larceny Act 1861 or in any other Act seize and destroy or sell or otherwise dispose of or cause to be seized and destroyed or sold or otherw ise disposed of any such house doves or pigeons in excess of such number as the local authority may consider reasonable and take such other steps as they may deem necessary for any such purpose. Provided that a local authority shall not in the exercise of the powers conferred by this section— (a) enter upon any building or and (other than a public highway) without the consent of the occupier or the authority body or person having the exclusive control and management of such building or land ; or 66 (b) execute or do any work or thing affecting the structure of Buch building or the use of such land without the consent of the authority body or person in whom such building or land is vested ; or (c) knowingly destroy sell or otherwise dispose of or cause to be destroyed old or otherwise disposed of any house dove or pigeon belonging to any person." For many years past complaints have been received concerning nuisance and damage to property caused by pigeons. As soon as statutory power to deal with the nuisance had been conferred complaints became more frequent and insistent. The City Council therefore appointed Mr. Anthony of Wood Green to deal with the nuisance by trapping pigeons in the regions where they were most complained of. This plan of working is in accordance with the scheme described in last years report. The actual work of trapping the pigeons commenced on the 25th June and is still in operation. At first difficulties were experienced ; some people attempted to frighten the birds or to lure them away from the traps by placing abundance of food not far away. This sometimes happens now but much less frequently. The total number of birds caught up to the end of the year amounted to 2,072, and the eggs taken 287. The cost of carrying out this work during the period mentioned was £88 9s. 3d. The object of the Act is to abate or mitigate any nuisance, annoyance or damage caused by pigeons, and certainly not to exterminate them as many lovers of the birds appear to think. On the other hand many persons, not so sympathetically inclined, are desirous that they should be ruthlessly wiped out. Sanitary Inspection of the Area. The following table 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. 67 Table II. Inspection of premises:— Sanitary work supervised:— Dwell i no-housei— Drains— Primary Inspections— Constructed 1,425 (a) On complaint 1,760 Repaired and amended 423 (b) Infectious disease 697 Ventilated 871 (c) Housing Regulations, 1925 382 Interceptor traps fixed 338 Sealed off from sewer 63 (d) Other reasons 2,619 Gully traps fixed 1,459 Re-inspections 9,165 Defective traps abolished 198 Other Premises— Manholes built 1,126 Primary Inspections— „ repaired 254 (a) On complaint 384 ,, covers fixed or (b) Other reasons 1,637 repaired 491 Re-inspections 3,279 Fresh air inlets fixed or repairec 353 Sanitary Works— Petrol interceptors provided . 15 Total Inspections- Tested by smoke 227 (a) Under notice 2,201 „ chemical 412 (b) Voluntary works 11,482 „ water 1,647 ,, air 37 Soil Pipes— Nuisances and other matters Fixed 717 dealt with:— Ventilated 342 Repaired 272 Public Health Acts— Tested by smoke 253 Dirty conditions 1,742 ,, chemical 424 Damp conditions 1,459 „ air 719 Verminous conditions 368 „ water 72 Defective drainage, water- Water-closets— closets, &c. 849 Constructed 2,384 ,, roofs 573 Repaired 425 ,, walls and ceilings 1,409 Traps ventilated 223 ,, floors, staircases, &c. 487 Flushing cisterns fixed 2,473 „ paving of yards, &c. 977 ,, „ repaired 221 W ater-closets— Waste Pipes— Insufficiently lighted or Constructed 1,849 ventilated 134 Repaired 352 Directly approached from Trapped 279 rooms 43 Ventilated 316 Insufficient 21 Disconnected from drain 372 Keeping of animals 12 Rainwater Pipes— Other nuisances 1,013 Fixed or repaired 1,024 Overcrowding (families) 56 Disconnected from drain 283 „ abated 41 Urinals— Underground rooms— Constructed 279 Illegal occupation 14 Repaired or improved 56 Occupation discontinued 7 Water Supply— Housing Act, 1925— Provided 163 Underground bedrooms— Taps off main provided 417 Contrary to Regulations 18 Cisterns fixed 172 Use discontinued 11 Pipes repaired 241 L.C.C. (General Powers) Act, 1907— Absence of water supply to upper floors of tenement houses 6 68 Houses Let in Lodgings.—The number of houses on the register at the end of the year was 255. The Sanitary Inspectors paid 713 visits of inspection to these houses and infringements of the by-laws were reported in a number of instances. Those infringements were principally failure to keep rooms in a cleanly condition and free from vermin ; there were also several cases of overcrowding and lack of proper separation of sexes in sleeping apartments. Appropriate action was taken in each to obtain compliance with the requirements of the by-laws. The further registration of houses of this class was postponed for a considerable period pending the result of an appeal from a decision of the magistrate at Marlborough Street Police Court. In this case the Council issued a summons against an owner or " tenant" for failing to make the return of particulars required for the purpose of registration, and a conviction was obtained. The owner appealed to the High Court on the ground that the house in question, being let to several different families each of whom occupied a separate floor, was not a " house let in lodgings " as defined in the by-laws. At the hearing of the appeal, however, no decision was come to on this point, the case being sent back to the magistrate who, in his statement of case had omitted to say whether he had as a fact found that the house was occupied by members of the working classes. The magistrate heard the case a second time, and after hearing further evidence decided that the house was not so occupied and dismissed the case. It should, however, be noted that the conditions had changed since the original hearing. It is unfortunate that no decision was obtained in the High Court on the question raised in the appeal, as the point at issue was one of considerable importance to local authorities generally. Restriction of Rent Acts.—Two applications were received for certificates under these Acts, and both were granted. Nuisances.—Intimation notices'were served in 1,778 instances, the number of premises concerned being 1,75G. Statutory notices authorised by the sanitary authority numbered 45 and related to 43 premises. Police court proceedings were taken in 4 instances in order to enforce compliance with the requirements of statutory notices. A conviction was obtained in one instance, the defendant being fined £1. In this case two rooms which were " underground rooms " within the meaning of section 96 of the Public Health (London) Act, 1891, had been vacated by a family who had been rehoused by the City Council, and the defendant, in spite of a warning from the Council, had relet them. The other three cases, which were in respect of dirty and defective conditions, were withdrawn on 69 payment of costs, £2 2s., £1 1s. and £1 respectively, the notices having been complied with. The following are the comparative figures since 1924 - 1924. 1925. 1926. 1927. 1928. Intimation Notices 1,098 980 1,074 1,450 1,778 Statutory Notices 41 27 43 49 45 Legal Proceedings 2 5 10 5 4 Rat Repression.—Forty-four complaints of rats were received and in each case an inspector investigated as to the cause of the complaint. In a number of instances it was found that they had entered through faulty or defective drains and sewers. Thirty-four 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 baits were laid in the Council's sewers, as in former years. Water Supply.—The Metropolitan Water Board sent nine notices of withdrawal of water supply to premises. In eight cases the reason for the action of the Board was failure to pay water rate, and in the remaining one defects in the water fittings, causing waste of water. 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 1924 is as follows :— 1924. 1925. 1926. 1927. 1928. 27 55 44 22 6 By-laws as to Removal of Offensive Refuse.—Two cases were reported of removal in unsuitable vehicles and in inadequate receptacles. A summons was ordered in each case, one defendant being fined fl and £1 costs; the other case was dismissed owing to lack of sufficient evidence. 70 New Sanitary Construction.—Plans relating to work of this description numbered 752, of which 81 represented sanitary provisions in entirely new buildings. The corresponding figures since 1924 are as follows:— - 1924. 1925. 1926. 1927. 1928. Plans 602 658 724 750 752 Plans of work in new buildings included in above 80 102 110 93 81 Combined drainage orders were made in 32 cases. Infringements of the by-laws were reported by the Sanitary Inspectors in 21 instances in respect of failure to give notice of intention to construct or to deposit plans. Twelve builders were cautioned and three were summoned in respect of these offences and were convicted, fines and costs amounting £5. Smoke Abatement.—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 III. - 1924 1925. 1926. 1927. 1928. Complaints received 40 80 62 79 36 Observations taken 2,309 1,999 2,490 2,057 640* Notices issued— Preliminary 42 23 26 29 21 Statutory — — — 1 1 Summons — — — — — * Fewer observations because of other work on Millbank Improvement Scheme. Your medical officer has continued to attend the meetings of the Smoke Abatement Committee for Greater London as a representative of the Metropolitan Standing Joint Committee. The meetings have been held at the Ministry of Health and much useful work has been accomplished. It is hoped to issue a report in the autumn of 1929 dealing with suggested By-laws, Standards of smoke emission, and general methods for carrying out the requirements of the Smoke Abatement Act 1926. The two smoke inspectors attended the special course organized by the Royal Sanitary Institute as resolved by the Council. The practical knowledge gained has been of great advantage to them when called upon to advise engineers and stokers as to difficulties experienced in smoke prevention. 71 Factories, Workshops and Workplaces. 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 1928, the number of inspections made, and the results of such inspections :— Table IV. Work Premise. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,273 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset, makers, furriers, etc. 1,152 Leather workers, boot and shoe makers, harness makers, etc. 56 Carpentry, upholstery, carvers, gilders, etc. . 43 Surgical and dental instrument makers 9 Tobacco manufacturers 13 Wig makers and hair workers 36 Printing, bookbinding, lithographers, envelopo making, stationers, relief stamping, etc. .. 50 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 50 Metalworkers . 19 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial 37 Florists 15 Laundries 24 Bakehouses 72 Photographers 37 Jewel case makers 7 Cinema film workplaces 33 Total 2,926 The use of 221 workshops was discontinued, and 20G additions were made to the register during the year. Table X.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including factory laundries) 229 10 — Workshops (including workshop laundries) 2,534 220 1 Workplaces (other than Outworkers' premises) 2,491 108 — Total 5,254 338 1 72 Table VI.—Defects found. Number of Dcfects. Number of offences. in respect to which Prosecutions wore instituted. (5) Particulars. (1) Found. (2) Remedied. (3) Referred to II. M. Inspector. (4) Nuisances under the Public Health Acts :— Want of cleanliness 313 313 Want of ventilation 36 36 — — Overcrowding 50 50 — — Want of drainage of floors 11 11 — C — Other nuisances 141 141 — — Sanitary accommodation— Insufficient 40 40 Unsuitable or defective 191 191 — 1 Not separate for sexes 25 25 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (8. 101) Other offences — — — — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) -- Total 807 807 — 1 Table VII.—Other Matters. Class. Number. Visits to Outworkers' premises other than workshops ##] Matters notified to II.M. Inspector of Fac tories: — Failure to affix Abstract of the Factory and Workshop Act 231 Absence of means of worming — Matters referred by H.M. Inspectors 108 Workrooms measured 340 Visits of Enquiry re Employment of Women 141 ,, Outworkers 107 Underground bakehouses in use at the end of the year 47 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 110 is appended. 73 (10285) Table VIII. 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. I Workmen. Wearing apparel 1,102 1,780 8,823 27 39 92 414 6,146 98 - - - - - 12 - - Linens, etc. 4 24 53 — - —- 6 67 1 - - - - — — — - Cutlery, electroplate, etc. - - - - - - - - - - - - - - - Furriers 12 26 37 - - - 13 32 3 - - - - - - - - Umbrellas, toys, artificial flowers, etc 4 88 109 - - - - 114 - - - - - - - - - Engraving, metal work, etc. _ 2 _ - Hairwork - - - - - - 2 - - - - - - - - - - Total 1,122 1,924 9,022 27 39 92 439 6,359 102 - - - - - 12 — — 74 Outworkers.—The total number of lists received during the year amounted to 1,149. Notices in respect of failure to send lists were sent to 102 firms. No legal proceedings were necessary in respect of this offence. The lists contained 11,077 names and addresses of which 6,359 were in other districts, 5,547 being within the Metropolitan area and 622 in the London Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,698, of whom 1,415 were registered as occupying workshops. The number of houses in which outwork was being carried on was 812. Disinfection. Compulsory Cleansing : The difficulties which have been experienced from time to time in the past as regards the cleansing of verminous persons who refused to be cleansed by the Sanitary Authority have largely been removed by the compulsory powers conferred in Sec. 26 (f the London County Council (General Powers Act, 1928). There is now authority to compel any such person to be cleansed and also his clothing. Application must be made to a petty sessional court, and the Court, if satisfied, will make an order for the person's removal to a cleansing station for the cleansing of himself and his clothing, and for detention therein for such period and subject to such conditions as may be specified in the order. No charge shall be made for the work carried out or for maintenance in the cleansing station, and such cleansing, removal, and maintenance shall not be considered to be parochial relief or charitable allowance to the person involved or to the parent of such person, nor shall the person or parent by reason thereof be deprived of any right or privilege or be subject to any disqualification or disability. 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 88 houses, and 5,957 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 354 men and 16 women, and 1 child 75 under school age, were given medicated baths at the Disinfecting Station, which necessitated their making 397 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 297, and the Disinfecting Superintendent and the Sanitary Inspectors paid 512 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, Fulham, and the City of London. There were among Westminster children, 611 cases of head lice treated, 35 of scabies, but no cases of body lice. In all these cases the clothing was disinfected together with the bedding from their homes, amounting in all to 937 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows : 364 for head lice, 4 for body lice and 17 for scabies. The number of attendances of these children for baths at the station was 1,237. The following table shows the total number of individuals treated at the station for verminous conditions Table IX. 1928. Head lice. Body lice. Scabies. Total. Children 1,005 4 52* 1,061 Adults 7 343 20 370 1,012 347 72 1.431 * One was under school age. All the lice and scabies cases were dealt with at the station. Table X. General disinfection of premises, articles. &c.:— 1924. 1925. 1926. 1927. 1928. Rooms 984 1,081 932 890 891 Articles disinfected 23,382 22,833 21,775 12,201 20,628 Articles washed 4,862 5,142 5,550 4,841 5,062 Articles destroyed 198 265 372 152 1,169 Books disinfected * 425 454 166 48 59 Vehicles,, 3 8 4 7 6 Offices and business premises — 21 25 9 10 * School books, 10; library books, 30; private books, 13. The motor van during 1928 ran 3,901 miles and carried 2,275 cwt. of goods, the highest amount in any one day being 35 cwt. The petrol consumption was 457 gallons, equal to 8.5 miles per gallon. (10285) r 2 76 Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 348—in four instances on account of infectious disease. Inquests were held at the Coroner's Court, Horseferry Road, in 341 cases, and there were 34 adjourned inquests. Post-mortem examinations were made in 195 instances. Seven bodies were received in the mortuary chapel to await burial. The number of dead bodies taken to the mortuaries for purposes of inquest, and to await burial, during the last 26 years is set out as follows:— Table XI. Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1903 396 341 55 1916 281 252 29 1904 381 322 59 1917 278 265 13 1905 368 307 61 1918 285 242 43 1906 344 283 61 1919 308 269 39 1907 358 281 77 1920 289 269 20 1908 364 298 66 1921 273 238 35 1909 291 258 33 1922 269 247 22 1910 333 281 52 1923 336 318 17 1911 383 334 49 1924 340 328 12 1912 324 284 40 1925 334 317 17 1913 328 286 42 1926 343 323 20 1914 323 295 28 1927 357 341 16 1915 376 349 27 1928 348 341 7 There is a resting place for the dead at Drury Lane. MATERNITY AND CHILD WELFARE. The problem of maternal mortality was discussed in the report for 1927, and it was then mentioned that the Ministry of Health was taking steps to deal with the matter. The first step is naturally to measure the extent of the problem and to make a comprehensive inquiry into causation, prevalence and contributory factors. With this object in view the Minister set up on the 4th June, 1928, a committee designated the Maternal Mortality Committee. He appointed Sir George Newman the Chief Medical Officer of the Ministry to be Chairman. The members include Medical Officers of Health, Obstetric Surgeons, representatives of the Central Midwives Board and others. One of the 77 first acts of the Committee was to send out a form of inquiry relating to maternal deaths to all local authorities. The Medical Officer of Health of the local authority was requested to undertake the prescribed inquiry into each maternal death occurring in his district. Deaths of this description occurring in the practice of a medical practitioner are of deep concern to him as well as to the bereaved relatives. It is therefore important to obtain the cordial co-operation of the practitioner concerned. The British Medical Association was consulted by the Minister as to the procedure to be adopted. The Association expressed approval of the objects and mode of the inquiry and circularised all divisions and branches in the country recommending the fullest co-operation with the Medical Officers of Health in making investigations. Where midwives only were concerned it was recommended that the Local Supervising Authorities should inquire into the question as regards the work of the midwives and should consult and exchange reports with the Medical Officers of Health of the local sanitary authority. It was further recommended that in certain cases it might be desirable to obtain the services of an obstetric specialist where the features of the case required particular experience. The City Council in approving the principles and objects of these inquiries appointed the Medical Officer of Health to carry out investigations and to consult with medical practitioners concerned. The Council further appointed Dr. Aubrey Goodwin the Council's Obstetric Consultant under the Puerperal Fever and Puerperal Pyrexia Regulations to make special inquiries at the request of the Medical Officer of Health where necessary. The form of inquiry embraces environmental as well as personal or medical aspects, and factors such as home conditions, previous medical history are generally already known to the Medical Officer of Health through the health visitors. The remaining points as to the clinical circumstances of the case are to be obtained from the practitioner in attendance. Where the patient has died in hospital it may be possible to obtain the results of bacteriological and other investigations. Since these forms of inquiry were issued in October, one death occurred and was inquired into. The report was made personally by the Medical Officer of Health and sent to Dame Janet Campbell at the Ministry. It is hoped that by examining reports sent in from all over the country to draw conclusions and to establish certain principles which may lead to constructive action in endeavouring to diminish a serious and apparently preventable cause of death. Puerperal Fever, Puerperal Pyrexia and Mortality in Childbirth.— The year 1928 furnishes a melancholy record of deaths in childbed. The number 17 is the highest recorded in the City. 78 The following is a summary of the results of inquiries :— Aged 36. "Widow." Died in Infirmary. Puerperal fever—presumed abortion. Aged 47. Died in Infirmary. Long and difficult confinement—puerperal fever. Aged 36. Died in hospital. Puerperal fever. Aged 33. Died in nursing home. Toxaemia of pregnancy. Aged 21. Died in hospital. Chorea gravidarum. Aged 31. Died at home. First child. Haemorrhage following labour and disease of pituitary gland. Aged 31. Died in infirmary. Eclampsia. Had stillborn child in 1926 with Eclampsia, was warned against future pregnancies. Again pregnant 1928 and delayed seeking advice. Aged 26. Died in infirmary. Post partem haemorrhage; normal pregnancy, placenta could not be expressed, baby post mature and desquamating. Aged 42. Died at home. Post partum haemorrhage, normal delivery. Placenta wholly expressed, fibroid of uterus present. Aged 40. Died at home. Embolism of pulmonary artery at 13th day of puerperium. Aged 32. Single. Died in infirmary. Miscarriage. Aged 43. Incomplete abortion. Doctors stated that woman was not pregnant. Died in infirmary after curetting and transfusion. Aged 29. Single. Died in infirmary, parturition—previously notified as puerperal pyrexia. Aged 35. Single. Died in infirmary. Parturition, previously notified as puerperal pyrexia. Aged 23. Single. Died in hospital. Eclampsia. Aged 23. Single. Died in infirmary. Septic infection of uterus after miscarriage. Aged 42. Died in nursing home. Abortion. It will be noted that 5 of these cases were the results of miscarriage or abortion. Puerperal Fever.—There were 3 non-fatal cases, the chief points relating to these are set out below. Aged 26. Delivered by midwife, fever soon subsided. Treated at home. Aged 29. Doctor delivered. Fever started at 8th day of confinement, piece of retained placenta expelled at 3rd day. Aged 32. Confined in hospital. Fever started 2nd day after birth of stillborn child. Puerperal Pyrexia.—21 cases were notified, 19 recovered from this milder condition uneventfully whilst 2 developed the more serious condition of puerperal fever. 79 Maternity Hospital Accommodation.—Reference was made last year to the difficulty sometimes experienced by Westminster women who desired to have their confinements in hospital. So great is the demand for beds in Westminster by women from other districts that the accommodation left for those who live permanently in the city has become extremely limited. The Public Health and Maternity and Child Welfare Committee considered the various aspccts of this question together with particular instances and decided that it was desirable to make further provision. Negotiations were begun with the Westminster Guardians in regard to setting apart a portion of their maternity ward to receive cases recommended by the Council. Whilst the financial proposals were not unacceptable to either party it was not found practicable to split up the maternity ward and to make the necessary structural alterations as required by the Ministry of Health. The committee then discussed proposals with the Governors of Westminster Hospital who had recently increased their maternity beds from 4 to 15. It was finally decided to enter into an agreement with the hospital whereby accommodation will be provided for a number of women not exceeding 100 per annum. The cases to be admitted are limited to those recommended from the Maternity and Child Welfare Centres of the Council and the Westminster Health Society. While those patients who could afford would contribute to the cost of their treatment and maintenance in the hospital, the Council will provide a fixed contribution at the rate of £150 for cases up to 100 in number for a yearly period. The Maternity and Child Welfare Sub-Committee of the Council is to consider each case and will assess the contribution which each patient may be expected to pay to the hospital. The almoners would collect such sums direct from patients. The scheme does not provide for any beds to be specially reserved, but it goes a long way to securing accommodation if the patients attend the hospital and book for in-patient treatment at a reasonably early date. These are the main points of the Council agreement which received the formal sanction of the Ministry of Health and will operate as from 1st January, 1929. The scheme will be provisional for a preliminary period of six months. The Widows' and Orphans' Contributory Pensions Act, 1925.— The Local Authority may, in cases of desertion of a child or in the case of an orphan, administer the payment on behalf of the child. No cases have so far been reported to the Council. 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 80 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 conditio, for confinements. Table I.—Ante-natal Cases. Name of Hospital. City Council's Centres. Westminster Health Society. Totals. No. 1, Pimlico Road. No. 15, Bessborough Street. No. 9, Frith Street. No. 30, Page Street. General Lying-in 16 26 2 34 78 St. George's 24 17 4 2 47 Westminster 13 16 38 67 St. Thomas' 2 4 1 7 14 Charing Cross 3 4 — 1 8 Middlesex 1 3 27 — 31 Woolwich — — — 6 6 St. Stephen's — — — 17 17 Queen Charlotte's — 2 — — 2 St. Mary's — — 1 — 1 Clapham Maternity — — — 2 2 Royal Free — — — — — Royal Northern 1 — — — 1 King's College 1 1 — — 2 Found by Health Visitors 73 94 56 (id 288 By Private Doctors and Midwives 45 45 Reported to Centre voluntarily 108 77 21 43 249 Totals 242 244 112 260 858 Ante-natal Visiting.-—To the 858 expectant mothers who became known to the Centre, 744 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,350. 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 75 66 141 103 Bessborough Street 51 118 166 284 167 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. 81 ftlothercrafi.—Classes in motlicrcraft arc 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. 1928. Pimlico Road. Ressboro' Street. Frith Street. Page Street. Total. Number of classes 47 58 46 89 240 Total attendances 368 1,186 732 3,366 5,652 Average attendances 7.8 20.4 15.9 37.8 23.5 Number of expectant mothers 6 91 28 59 184 Number of attendances by 30 352 114 581 1,077 expectant mothers Number of other mothers 50 178 107 125 460 Number of attendances by other mothers 338 834 618 2,785 4,575 Attendances of children in nurseries during classes 152 1,047 522 2,741 4,462 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Pimlico Road were 173 ; at Bessborough Street, 566 ; at Frith Street, 635 ; and at Page Street, 2,037. In addition to those, many renovations were carried out. The class at Frith Street, under the charge of Mrs. Steffens, is held every Tuesday afternoon at 2.30 ; at Bessborough Street, on Wednesdays at 2.30, and at Pimlico Road on Mondays at 2.30, under the charge of Mrs. Colman. Midwifery Services.—The work performed by the Council's midwife is summarised below, and comparative figures since 1923 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. Table IV. 1923. 1924. 1925. 1926. 1927. 1928. Number of cases attended— As midwife 108 75 73 80 65 77 As emergency 2 — — — — — With hospital students 5 — — — — — With private doctor 1 — — — — — Total 116 75 73 80 65 77 Number of— Pre-natal visits 610 570 779 860 678 599 Lying-in visits 1,402 920 939 1,005 812 1,149 Subsequent visits Visits to infants under 1 172 315 335 351 415 442 year, other than lying-in visits 172 266 234 262 376 433 Total number of visits 2,356 2,071 2,287 2,478 2,281 2,623 82 Table V. Attendances by midwife at ante-natal and other clinics :— 1923 1924 1925 1926 1927 1928 , Pimlico Road 72 40 54 43 39 40 5, Bessborough Street 62 83 75 87 82 86 Total 134 123 129 130 121 126 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. As midwife 44 With hospital students 7 With private doctors 3 54 Midwifery visits 849 Nursing visits 46 886 There is a 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, 15 ; St. Stephen's, 28. 620 women from other districts were confined in Westminster and 364 women belonging to the City were delivered in the hospitals mentioned —the number in St. Stephen's alone being 202. The number of children born to Westminster parents in institutions outside the City numbered 542. The following table shows the number of confinements in the hospitals mentioned :— Table VII. • Charing Cross Hospital: 278, of which 45 were Westminster cases. St. George's Hospital: 252, of which 60 were Westminster cases. Westminster Hospital: 119, of which 57 were Westminster cases. St. Stephen's Hospital: 202. Sheffield St. Hospital: 51. Infancy and, Early Childhood.—At the centres in the City weekly clinics are held for the purpose of giving medical advice. 83 The following figures give an approximate number of the births in the four areas divided for the purposes of maternity and child welfare:— 1, Pimlico Road. 15, Bessborough St. 30, Page St. 9, Frith St. 377 381 314 298 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:— Table VIII. - Pimlico Road. Bessborough Street. Frith Street. Page Street. Total. Pre-natal— First visits 242 210 128 164 744 Other visits 537 272 201 340 1.350 Children under 1 year of age— First visits 401 385 316 265 1,367 Other visits 1,806 1,367 1,373 1,143 5,089 Children over 1 and under 5 years— Visits 2,859 1,846 2,921 2,439 10,065 Death enquiries, still-births, &c 40 44 33 20 137 Infectious diseases 594 348 206 224 1,372 The Council's midwife paid 599 visits before, and 433 after, confinements which are not included in the above Table. 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 2 p.m. Tuesday (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 continues satisfactorily, as shown by the average attendance per session. The comparative totals since 1923 are also shown:— 8 i Table IX. Attendances at Infant Consultations, 1928. Centre. Number of Sessions. First Attendances Subsequent Attendances. Total. Total. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Under 1 year. Over 1 year. 1, Pimlico Road 100 212 52 2,211 1,519 2,423 1,571 3,994 15, Bessborough Street 101 219 57 2,614 1,645 2,833 1,702 4,535 9, Frith Street 50 82 30 736 511 818 541 1,359 30, Page Street 99 204 71 1,849 1,538 2,053 1,609 3,602 1928 350 717 210 7,410 5,213 8,127 5,423 13,550 1927 353 736 280 7,477 5 269 8,213 5,549 13,702 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 10,027 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 The average attendances per session were— 1928. 1927 1926. 1925. 1924. 1923. Pimlico Road 39.9 37 .1 42.4 32.2 29.7 26.0 Bessborough Street 44.9 44.7 38.5 33.6 31.0 291 Frith Street 27.1 29.2 23.1 — — — Page Street 36.9 40.1 36.3 — — — The number of individual children medically inspected were— 1, Pimlico Road 567 15, Bessborough Street 557 9, Frith Street 235 30, Page Street 620 85 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. 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, and for certain conditions in adults. A flat rate of Is. 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 2 72 Puerperal pyrexia 1 17 Influenza 1 10 Pneumonia 19 198 Bronchitis 10 105 Measles 32 388 Whooping cough 1 4 Other complaints 108 1,025 Total 174 1,819 Ophthalmia neonatorum has been notifiable since 1911. The percentage of mild (non-purulent) and notified (purulent) cases in relation to births from the year 1921 is as follows :— Table XI. Rate per 100 births Cases (notified). 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 1927 14 1.9 1928 7 1.2 86 With regard to the incidence of venereal disease the following table shows the death-rates of infants per 1,000 births, certified to have died from syphilis:— 1901-5 2.8 1921-25 1.7 1906-10 3.2 1926 0.62 1911-15 2.4 1927 2.8 1916-20 4.95 1928 0.72 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. Seven cases were notified during the year, 4 of those being treated in hospital. There were also 10 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 2 cases, 72 visits being-paid. Dental Trcatment.—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 Section of the Report. Expectant and nursing mothers, and children under five years of age, are eligible for treatment. Mr. W. H. Turner, the Dental Surgeon, submits the following report:— I beg to forward myreport on the treatment carried out at the Dental Clinic during the past year, 1928. Whilst there has been a slight diminution in the number of new patients, the treatment they required has necessitated a greater number of subsequent attendances than in any previous year. This appears to be due to the higher percentage of patients presenting themselves sufficiently early to have more detailed conservative work done, and a smaller number of the cases requiring drastic extensive extractions. This constantly increasing recognition of the importance of early treatment for dental defects is a very good sign. During the year the dental department at the Western Dispensary has been extended by the addition of a well equipped " Gas Recovery Room " adjacent to the surgery, and this has 87 proved a great Loon, both with regard to the patients' comfort and for the more convenient arranging of the gas sessions. I append a detailed summary of the cases :— Maternity and Chiild Welfare. Now patients— First attendances 172 Subsequent attendances 807 Teeth extractions 930 Teeth filled 208 Other dental operations 038 Anaesthetics administered— Local 28 General 182 Dentures supplied 14 (Signed) W. H. Turner, L.D.S., It.C.S.Eng. Table XII. 1923. 1924. 1925. 1926. 1927. 1928. Number of Sessions 70 79 92 92 90 88 New patients— First attendance 123 179 205 209 204 172 Subsequent attendances 479 522 613 629 802 807 Teeth extractions 1,056 1,349 1,278 1,668 1,198 930 Teeth filled 91 154 167 189 218 208 Other dental operations 433 478 616 699 777 638 Ansthctics administered— Local 20 25 38 31 17 28 Genera) 202 240 255 295 263 182 Dentures supplied 3 4 6 2 6 14 Fatients contributed £14 Os. 6d. in small sums according to their means. 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. Ilenry 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 makes 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. The two other homes in the City which exist for a similar purpose were mentioned previously in this report. 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 88 greatest. The Council make an annual grant of £50 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 mcdical 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 does 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, 3,837 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 £78 13s. 6d. INSPECTION AND SUPERVISION OF FOOD. The provision of food for an island population which depends more and more on supplies from overseas, has become a highly organised and very complicated undertaking. The varieties of foodstuffs increase in number as also do the methods of compounding them. The task of supervising food in its original state and the preparations and compounds which are devised in various forms requires increasing vigilance so that the public may be safeguarded from articles which may be unsound, adulterated or otherwise injurious to health. To render the administrative control of food less complicated, Parliament has passed a consolidating statute, The Food and Drugs (Adulteration) Act, 1928. This Act includes the essential and most useful provisions of statutes dealing with food and drugs from the Sale of Food and Drugs Act, 1875, onwards. The following are the repeals set out in the schedule to this Act which came into force on 1st January, 1929. Act. Portions Repealed. The Sale of Foods and Drugs Act, 1875 The whole Act, except sees. 30, 31 and 36. The Sale of Food and Drugs Act Amendment The whole Act. Act, 1879 The Margarine Act of 1887 The whole Act. The Burgh Police (Scotland) Act, 1892 In sec. 432 the words " under the Sale of Food and Drugs Act, 1875, and also The Sale of Food and Drugs Act, 1899 The whole Act. The Butter and Margarine Act, 1907 The whole Act. The Milk and Dairies (Scotland) Act, 1914 Sec. 27. The Milk and Dairies (Consolidation) Act, 1915 Sec. 9 and 3rd Schedule. The Finance Act, 1921 Sec. 23. The Licensing Act, 1921 Sec. 10. The Sale of Food and Drugs Act, 1927 The whole Act. 89 The legal powers of the Local Authorities as regards the control of food supplies may be summarized thus :— Law relating to Food and Drugs :—- (1) Food and Drugs (Adulteration) Act, 1928. (2) Sec. (4) Milk and Dairies (Amendment) Act, 1922. (3) Food and Drugs Act, 1875—sees. 30, 31 and 30 (dealing with tea). Orders and Regulations made under repealed Acts and continued in force by the Food and Drugs (Adulteration) Act:— (1) Order as to Registration of Margarine Factories, &c., 1900. (2) Order as to Registration of Butter Factories, &., 1907. (3) Regulation as to competency of Analysts, 1900. (4) Sale of Milk Regulations, 1901 and 1912. (5) Sale of Butter Regulations, 1902. Regulations made under the Public Health (Regulations as to Food) Act, 1907, and effective for certain purposes of the Food and Drugs (Adulteration) Act:—- (1) Public Health (Condensed Milk) Regulations, 1923 and 1927. (2) Public Health (Dried Milk) Regulations, 1923 and 1927. (3) Public Health (Preservatives, &c., in Food) Regulations, 1925 to 1927. List of Legal Provisions relating to Food and Food Supply. Public Health (London) Act, 1891. Sale of Horseflesh, &c., Regulations Act, 1889. London County Council (General Powers) Act, 1902. (Ice Cream Manufacture and Sale.) London County Council (General Powers) Act, 1907. (Milk Supply Tuberculosis.) London County Council (General Powers) Act, 1908. (Storage of Food in Shops.) Power to make Bye-laws relating to :— Fried Fish Shops. Fish Curers. Rag and Bone Shops. London County Council (General Powers) Act, 1909. (Storage of Food in tenement houses.) London County Council (General Powers) Act, 1927. (Street Trading.) London County Council (General Powers) Act, 1928. (Registration of Ice Cream Premises.) Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Acts, 1922. Milk and Dairies (Special Designations) Order, 1923. Milk and Dairies Order, 1926. Sale of Food (Marking of Imported Meat) Order, 1921. Public Health (Shellfish) Regulations, 1915. Public Health (Imported Food) Regulations, 1925. Public Health (Imported Milk) Regulations, 1926. Public Health (Meat) Regulations, 1924. Public Health (Prevention of Tuberculosis) Regulations, 1925. Merchandise Marks Act, 1926. Merchandise Marks Act, No. 3 Order. Merchandise Marks Act, No. 5 Order. Agricultural Produce (Grading and Marking) Act, 1928. Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1928. (10285) G 90 As foreshadowed in last year's report there is now in the L.C.C. General Powers Act, 1928. Section 29, provision requiring the registration of ice cream premises. The main points are :— (1) Premises used for the sale or manufacture or storage of ice cream must be registered with the local authority. (2) Factories and premises used as a hotel restaurant or club are exempt from registration. (3) This section came into force in August, 1928, and public notice was given in the press. (4) Penalty 40s. and a daily penalty of not exceeding 20s. Merchandise Marks Act, 1926, and Agricultural Produce (Grading and Marking) Act, 1928. The object of these statutes is to encourage the marketing of Home and Empire farm produce by requiring that certain articles shall be clearly marked to indicate their place of origin. In certain instances, notably eggs, a standard of quality has been set up by Regulation, the Agricultural Produce (Grading and Marking) (Eggs) Regulation, 1928. Up to the end of 1928 the following Orders in Council, made under the Merchandise Marks Act, had been issued :—Merchandise Marks (Imported Goods), No. 3 Order, 1928, dealing with honey and apples, and the Merchandise Marks (Imported Goods) No. 5 Order, 1928, dealing with currants, sultanas and raisins, eggs in shell, dried eggs and oat products. The provisions of these statutes and orders have very little, if anything to do with the Public .Health, but the duty of administering them has nevertheless been imposed on sanitary authorities. The Council has therefore by resolution designated the Medical Officer of Health and the Food Inspectors as the officers responsible for the administration. It should be noted that the Government Department concerned is not the Ministry of Health but that of Agriculture and Fisheries. The latter has sponsored these Acts through Parliament, and it is from this Government department that orders dealing with various articles of produce continue to be issued. So far the following have been made the subject of special orders :— Imported Goods.—Honey, apples, currants, sultanas, raisins, eggs in shell, dried eggs and oat products. (1928.) Home Produce.—Broccoli, tomatoes, cucumbers, apples and pears. (1929.) It was at first thought that the duties to be carried out by the Food Inspectors would not be considerable. With the steadily increasing number of articles, however, which have been brought under order it is found that the inspectors have to spend more and more time examining 91 produce in shops and on stalls to (See whether " marking " is being properly carried out. Should those duties continue to increase, detailed supervision cannot be undertaken to the same extent as the work of the inspectors which is more directly concerned wit' the Public Health must be their principal consideration. Milk and Dairies Order, 1926. Registration of Dairymen and Dairy Premises.- At the end of the year there were 330 names of persons and premises on the register. They included dairy shops, milk stores and those itinerant vendors who sell milk from street barrows. Some of the latter sell milk in Westminster but store their milk vessels, &c., in premises in other districts. They require to be registered in both districts. Eleven new applications from milk sellers were received and registered. Eight of these concerned new premises, the remaining three were transfers of business from one proprietor to another as were also their premises. In 86 instances registration of premises was cancelled as sale of milk was discontinued. One person was prosecuted for selling milk without being registered and was fined 10s. Other provisions of the Milk and Dairies Order.- Contraventions of the Order numbered 7, including :— (1) Lack of cleanliness of dairy. (2) Keeping of animals in a dairy. (3) Insufficient lighting and ventilation. (4) Damp condition of dairy premises. (5) Defective milk vessels. In three instances there was an offence under Section 8 of the L.C.C. General Powers Act, 1908, as regards the sanitary requirements of premises used for the storage of food. In none of the above cases was it found necessary to take legal proceedings. The conditions were remedied at once after verbal or written notice. Bottling Milk in the Street.—The Order has now been in force two years, and although dairymen in the City have been made fully aware of its provisions, offences under Article 31 are still being perpetrated. The object of this article is to ensure that milk shall be bottled and sealed in registered premises and shall be delivered to the consumer in that state. Either through ignorance or wilful carelessness there is still a tendency to tamper with those sealed bottles by removing the discs and when empty, by refilling dirty and unwashed bottles and putting the discs on in the street. Two dairymen and 15 roundsmen were prosecuted for this offence—last year there were 10 cases. Fines varying (10285) G2 92 from 10s. to £3 were inflicted. Unless penalties are made more severe it is likely that these offences will continue and may increase. The practice of using scaled bottles was introduced by the large milk distributors at considerable cost with the sole object of improving the cleanliness of milk as supplied to households. Householders should therefore cooperate by seeing that they are not being deprived of the advantages which have been provided. Churns and other Milk Vessels.—The Order provides that churns and other vessels shall be provided with a lid without openings so as effectively to prevent the access to the milk of dirt, dust or rain water or the return to the interior of the receptacle of any milk which may have been splashed above the lid. This article came into force in October, 1928, and it was found necessary to notify two of the larger wholesale dairymen of contraventions of this section of the Order. The use of cartons instead of glass bottles has aroused interest among British dairy companies and there is a possibility of several London firms delivering milk in cartons in the near future should experiments, which are being made, prove satisfactory. In New York 50,000 families are having their milk delivered in cartons. World's Dairy Congress, 1928. This Congress to which your Medical Officer was appointed a delegate, was held in July. It was of an international character and included representatives from all who are interested in dairy produce. Members of sanitary authorities and their officers, farmers, distributors and those interested in the administrative, bacteriological, chemical and veterinary aspects of the industry. Your delegate was unfortunately owing to official duties able to attend only on one day, but the discussions which he attended on the chemical and bacteriological standards for milk and the visit to Shinfield farm, near Reading, proved highly instructive. It was amply demonstrated that it is possible to produce a milk bacteriologically pure according to the standards set for certified milk and of excellent quality as regards chemical analysis with plant of an inexpensive and perhaps primitive nature so long as the methods of production are maintained with scrupulous cleanliness and attention to detail. Milk and Dairies Amendment Act, 1922. Under the Milk (Special Designation) Order, 1923, made under this Act the Council issued licences for the sale of:— Certified milk .. .. .. .. .. .. 17 Grade A (Tuberculin tested) milk .. .. ..16 Grade A milk .. .. .. .. .. .. 1 Pasteurized milk .. .. .. .. ..14 13 samples were taken for bacteriological analysis. 93 These samples for bacteriological examination are taken by the Council's inspectors by arrangement with the Ministry, and the reports are sent to the Council as well as to the Ministry. All the samples except oue were found to comply with the bacteriological standards of the order. It was found to contain B. coli in 1 c.c. but not in 1 /10th c.c. Pasteurization of milk is not undertaken at any premises in the City. During the year 60 milk sellers took advantage of the provision contained in 3rd Schedule of the Milk and Dairies Act. 1915, to request the Local Authority to take samples from the consignors at the place of delivery. The form of written request is prescribed in the Schedule, and although 32 of the requests were in proper legal form, 28 were quite inadmissible in that they specified neither time nor place where the samples could be taken nor did they express a request for such samples to be taken. It is important to note that there is no obligation on the Local Authority to take the extra samples from the consignor unless the request is submitted in due legal form and lodged with the authority within 60 hours of the taking of the original sample. Unless the precise requirements of the schedule are observed a warranty cannot be pleaded. It proved necessary to take samples from consignors only in 1 case, in response to the requests from 60 vendors, as 59 of the original samples from the vendors proved genuine. The analysis of the sample from the vendor which was not genuine is summarised below, together with the result of the corresponding sample taken subsequently from the consignors :— Vendor's Sample. Action taken and Result. Consignor's Sample, number taken. Result of Analysis. Action taken and Result. Contained 3 per cent, added water. Vendor cautioned .... 1 Genuine No action. Analysis of 31illc Samples.—Percentage of adulterated samples since 1910 is given on page 94. The legal minimum standards for milk fat and non-fatty solids as laid down in the Sale of Milk Regulations, 1901, are 3 per cent, and 8.5 per cent, respectively. Samples which do not show higher percentages than these are regarded by the analysts as of poor quality. Therefore it may be taken that the legal standards do not indicate any degree of 94 excellence but rather milk which has barely escaped the stigma of adulteration. The grades of quality as set up by the analysts are as follows:— Good quality: Over 3•8 per cent, of fat. Fair quality: Between 3-3 per cent, and under 3-8 per cent. Poor quality: Between 3 per cent, and 3.3 per cent. Adulterated: Below 3 per cent, fat and 8•5 per cent, non-fatty solids. The results of the samples taken in each of the two districts of the City during 1928 are given in the following table:— Table I. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. NO. Percent. No. Per cent. No. Per cant. North 404 212 45.6 186 400 60 12 9 6 12 South 440 198 45.0 187 42.5 41 9.3 14 32 904 410 45 3 373 41 2 101 11.1 20 2.2 1927 914 511 54.1 345 36-5 71 7.5 17 1.8 1926 910 502 55.1 1 298 32.7 100 10-9 10 1.0 1925 970 489 50.4 3118 379 98 101 15 1.6 1924 994 507 51.0 363 36 5 105 10.5 19 1.90 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 34.9 428 398 201 18.7 69 6.4 1918 919 320 34.8 302 32.8 194 212 103 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 94 250 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 35.0 328 346 179 189 108 11-40 The quality of the milk supplied to the City still maintains a high standard. Legal Proceedings for Adulteration.—Of the 20 cases, 5 were considered sufficiently serious to warrant prosecution. Details pf the offences and results of proceedings are set out below. Milk— Fine. Cost*. 3 per cent, added water Summons dismissed. -— 5 per cent, fat abstracted Summons dismissed £2 2$. (Probation of Offenders Act) 14 per cent, fat abstracted .... £2. — 10 per cent, fat abstracted .... £2. —. 29 per cent, fat abstracted .... lOg. £2 2s. Of the total 901 samples of milk taken during the year, 12 were obtained on Sundays. All of the latter proved to be genuine. 95 Samples taken in coursc of delivery.—Seven samples were taken as the milk was being delivered by consignors to hospitals, etc. On analysis all were found to be genuine and of "good" quality. Condensed Milk Regulations, 1923-1927. Thirty-three samples were taken and all proved to be genuine. On one of the tins the label was not worded in accordance with the provisions of the Regulations. The Vendor who was approached on the matter gave a satisfactory explanation and also an undertaking to prevent any infringement of the Regulations in future. Dried Milk Regulations, 1923-1927. Three samples were taken and all proved to be genuine and properly labelled. Public Health (Preservatives in Food) Regulations, 1925, and Public Health (Preservatives in Food) Amendment Regulations, 1926 and 1927. These Regulations have now been printed in a consolidated form in accordance with the promise of the Ministry of Health in 1920 and 1927. As already pointed out in my previous Report there has been a gradual enforcement of the prohibition of the use of certain preservatives and the date for the final prohibition took effect on 1st July 1928. Only the following articles may contain preservative which must be either sulphur dioxide or benzoic acid as specified in the regulations. Sausage and sausage meat, fruit and fruit pulp not dried, dried fruit, unfermented grape juice and non-alcoholic wines, cordials and fruit juices, jam, candied peel, sugar, corn syrup, gelatine, beer, cider, alcoholic wines, sweetened mineral waters, brewed ginger beer, coffee extract, pickles and sauces made from fruit or vegetables. Eight infringements of these regulations were found as the result of analyses of samples. When purchasing sausages which contain preservatives the sampling officer is invariably given the portion of his purchase without a label owing to the fact that the pound only is labelled but not the half a pound asked for. The Regulations provide for the article purchased being labelled as containing preservative, and I am getting into communication with the Sausage Manufacturers Society with a view to seeing that provision is made for every sample of sausages being properly labelled similar to margarine— the smallest purchase of which must be marked. A detailed list of samples is set out below with notes as to analysis and action taken. 96 Table II. Sale of Food and Drugs Acts. Samples purchased under the Sale of Food and Drugs Acts, showing results of Analysis and subsequent Proceedings for year 1928. r. Article of Food. Number of samples purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ 8. d. £ 8 d. •1 Milk 904 884 20 5 3 2 4 10 0 4 4 0 2 Do. Separated 3 3 __ - - - - 3 Do. Dried 3 3 - - 4 Do. Condensed 33 33 - - - - - 5 Cream 75 75 - - 6 Do. Tinned 12 12 - - - 7 Do. Ice 9 9 - - 8 Butter 152 151 1 - - 9 Margarine 65 65 - - - 10 Cocoa 13 13 - - - 11 Coffee. 11 11 - - - 12 Coffee and Chicory 2 2 ' - - 13 Mincemeat 3 3 - - 14 Jams and Preserve. 7 7 - - - 15 Cake 11 11 - - 16 Pearl Barley 4 4 17 Honey 2 2 __ - - 18 Baking Powder 1 1 - - - 19 Custard do. 1 1 20 Semolina 1 1 - - - - - 21 Sauce (Various) 5 5 - - 22 Soup (tinned and bottled) 4 3 1 - - - - - 23 Pickles 3 3 - - 24 Mayonaise 4 4 25 Vinegar 1 1 - - 26 Cheese 3 3 - - 27 Meat and Fish Paste 74 74 ___ - - - 28 Fish (tinned and potted) 8 8 - - - - - - 29 Olive Oil 18 18 ___ - - 30 Pepper 2 2 - - - 31 Mustard 2 2 - - - 32 Suet (shredded) 1 _ 1 - - 33 Meat Pies (various) 24 22 2 1 1 - 2 2 0 34 Sausages (various) 95 90 5 - - - 35 Brawn 2 2 - - 30 (Meat (pressed) 4 4 - - 37 Bacon 1 1 - - 38 Ham 1 1 - - 39 Tongue 2 2 - - 40 Vegetables (tinned) 14 14 - - 41 Fruit (tinned) 34 34 - - 42 Cordials (fruit) 18 18 ___ - - 43 Lcmondade Powder 3 3 - - - 44 Sweets 3 3 - - - 45 Jelly 2 2 - - - - 46 Colouring (culinary) 2 2 - 47 Whiskey 48 44 (3) 1 - - 48 Gin 21 21 __ - - 49 Rum 23 22 1 1 1 - 5 5 0 50 Brandy 22 22 - - - 51 Wine 1 1 - - - 52 Sulphur, Flowers of 2 9 - - - 53 Do., Milk of 14 14 ____ - - 54 Camphorated Oil 27 27 — — — — — — 1,800 1,765(3) 32 7 3 4 4 10 0 11 11 0 97 The following list shows in detail the results of analysis of individual samples other than milk and spirits, which were adulterated and the decision taken in each, with the result of any legal proceedings ordered by the Council:— Butter.—152 samples were taken and one was found to contain 2 grains of boric acid per lb. The vendor was cautioned by letter. Soup.—4 samples of tinned and bottled soup were taken, and one was found to contain 4.5 grains of tin per pound. This being an informal sample an official sample was obtained and was found to contain 0 7 grains of tin per lb.; the amount being so small no action was taken. Suet, shredded.—1 sample was taken and found to contain 18 percent, of riee starch. As the packet was labelled to this effect there was no infringement of the Act. Meat Pies.—24 samples were taken and 2 were found to contain boric acid. The sample with 8.4 grains per lb. of boric acid was unofficial and the subsequent official sample contained 7 grains per lb. of boric acid, the vendor of which was prosceutcd and ordered to pay two guineas costs. Sausages.—95 samples of various kinds were taken, 21 contained preservatives, 16 of these were sold in accordance with the provisions of the P.H. (Preservatives in Food) Regulations, the remaining 5 contained sulphur dioxide in amounts varying from 60 to 150 parts per million, but were not labelled in accordance with the Regulations. In each ease the vendor was cautioned by letter. The amount of sulphur dioxide permitted is 450 parts per million, provided the article is labelled preserved. Regulation of Street Trading. The London County Council (General Powers) Act, 1927, provides for the regulation of street trading by the issue of licences which must be renewed annually. Special observation is kept by the Food Inspectors of all stalls where food is exposed for sale and the premises where the food is stored. Where stall-holders have their food stores in other districts the addresses are forwarded for the attention of the sanitary authority concerned. In two cases communications from a neighbouring borough were received requesting to be informed if the conditions for the storage of food were satisfactory. The necessary enquiries and inspections were made and found quite satisfactory in one case but in the remaining case food was being stored in the sleeping apartment. Steps were immediately taken to stop the practice and after a time the street trader obtained a store elsewhere thus ending the infringement of the above Act. Meat Regulations, 1924. There are no slaughterhouses in the City and the duties imposed are confined to the supervision of meat shops, stalls and stores. In addition to routine and spccial inspection, visits are paid to all meat premises in the City at certain periods in the year for the purpose of a general inspection of the requirements in t he Regulations. A register is kept of all meat vendors and the number at the end of 1928 was 142. The inspectors paid 273 visits to these premises. 98 The conditions on the whole are satisfactory, the traders carrying out the requirements of the Regulations remarkably well. Only three cases of infringement were reported, these were cases where the storage conditions did not come up to the standard laid down. Verbal and written notice was given to the persons responsible and the necessary alterations were carried out without delay. Other Food Premises. The total number of inspections to food premises was 4,376, and these include visits to milk shops and butchers' shops which have already been detailed. Other premises where food is prepared for sale, deposited for sale or sold, include bakers' shops, greengrocery and fruit shops, ice-cream shops, fish shops, fried fish shops, eating places, tea shops and restaurants. As a result of these inspections 101 notices requiring sanitary defects to be remedied were issued. Restaurants.—The keeping of restaurants is one of the most important trades in Westminster. A permanent day population almost four times as large as the resident population, together with the enormous daily influx of people who come for shopping, theatres or other social reasons, require to be catered for. A register of all restaurants is being compiled but the survey is not yet completed. 700 restaurants have already been indexed, and during the year 8G2 visits were paid. Kitchens, pantries, messroom arrangements for staff, systems for washing up, and general sanitary arrangements were specially observed. Defects requiring notices were found in 78 instances, and in each case the work was satisfactorily carried out. Fish Shops and Fried Fish Shops were periodically examined. There are 29 of these shops in the City to which the Food Inspectors paid 56 visits. Ice-Cream Premises.—The inspectors paid 58 visits for the purpose of supervision to premises where ice-cream is prepared or sold. It is particularly necessary that there should be a high standard of cleanliness in the 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. (Vide ante note on London County Council General Powers Act 1928, sec. 29.) Bakehouses.—At the end of 1928 there were 72 bakehouses in the City, of which 52 were underground. During the year 280 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 for destruction. 99 Table III. Articles of food submitted. Tons. cwts. lbs. Tons. cwts. lbs. Apples 8 7 110 Onions 1 — - Apricots — 1 — Ox Tongues — — 33 Bananas 12 0 — Oranges 2 6 — Beans — 8 39 Passion Fruit — 10 — Black Currants — 11 88 Peaches 10 36 Butter Beans — — 28 Pearl Barley — 1 — Carrots — 18 56 Pears 40 4 24 Cauliflowers — 14 56 Pineapples — 3 28 Confectionery 2 6 56 Potatoes 1 2 — Garlic 2 8 — Rice — 4 — Grapes 2 — — Salmon (Tinned) — 5 86 Greengages — 6 48 Sugar — 3 — Kippers — — 48 Tea — 1 0 Lemons 1 15 — Tomatoes 5 13 40 Mandarins — 7 96 Tomato Consume (Tinned) 1 _ Melons 3 6 28 Mc fliers 1 5 — Turnips 1 — — Walnuts 1 Certification of Food for Export.—Certificates enabling the export of certain articles of food were granted in seventeen instances—thirteen to Canada and four to Australia. Table IV. Sale of Food and Drugs Act. Spirit Samples, 1928. 114 Samples of whiskey, brandy, rum and gin were taken during the year. In 4 cases it was found that the spirits were diluted below the standard strength of 35 degrees U.P., and in one a trace of iron was discovered. 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. Action taken and Result. 41N. Whiskey Contained Minimum of proof spirit No action. 153N. „ tt No action. 715N. „ Contained a trace of iron. No action. 499S. „ 360 Vendor cautioned. 779S. Rum 37.5 Proceedings—£5 5s. costs. The improvement in the number of defective samples this year is very marked, a drop of from 44 (20-1 per cent.) in 1925 to 5 (4.3 per cent.) in 1928. I APPENDIX; Concerning certain details relating to the flooding of tho Millbank Area on January 0.7, 1928 and the formation of the Millbank Improvement Scheme. The conditions connected with the occurrence of the flood and its after effects were generally referred to .11 the preface to the report of last year. It now remains to amplify this reference with certain details which have been reported to the Council from time to time. Certain of tho principal considerations embodied in the Improvement Scheme are also mentioned here and copies of that part of the scheme which was prepared by the Medical Officer of Health and his staif have been submitted to the Ministry of Health and the London County Council. The area adjoins the Thames and its boundaries are set out in the rough sketchplan on page IV. The buildings 011 it consist firstly of working-class dwellings of three main types (1) large, old houses, formerly family mansions on the river front, (2) houses of three or four storeys and (3) cottages. At least four streets consist entirely of the cottage type. There are also 76 premises of commercial nature including some 20 garages, 13 shops and 5 public-houses. All the buildings were built about a century ago with the exception of the London Ice Club and the Centre of the Westminster Health Society. As regards the levels of the buildings which were subjected to the flood it was estimated that 131 buildings were dangerously below flood-level and 319 were below flood-level. These figures relate not only to the Millbank area but to adjoining districts. All basements whether of dwelling houses or other premises were completely inundated. It was ascertained that in dwelling houses some 12 were illegally occupied as separate dwellings. It is worthy of note to remark again that of the ten fatalities only one occurred in an illegally occupied basement. On the night of the flood the papulation of the Millbank area is estimated to have been 1,955, consisting of 037 families. Of these 004 were deemed to be workingclass families comprising 1,892 persons. As to the measures adopted for the relief of the victims of the flood it was mentioned last year that damaged furniture and household effects were removed from 619 houses. These articles were carefully checked by the Sanitary Inspectors as taken from each house and recorded in order to meet claims likely to be submitted to the Mayor's Fund. An intensive sanitary survey of the entire flooded area was meantime being carried out, and owners were required to make good the damage to structure wrought by the flood. In those cases where the owners required financial assistance, builders' estimates and specifications were carefully examined before recommendations were passed to the sub-committee specially set up by the Mayor to deal with this aspect of relief. The following figures indicate the extent of the operation of the Mayor's Fund:— Number of flooded houses, 722; number of premises outside the Millbank area where owners were assisted in making good structural damage, 137; amount so expended from Mayor's Fund, £3,331; number of cases relieved for damage to furniture, household and other effects, 1,100; amount so expended from Mayor's Fund, £19,403. The damage caused by the flood fell most heavily on the Millbank Estate proper. Here in almost every instance the houses were owned by a large firm in terms of a lease from the Grosvenor Estate. It had been the intention in due course to develop the whole estate when the working-class dwellings were no longer fulfilling this purpose. The Rent Restrictions Acts and the scarcity of working-class accommodation were governing factors in delaying this project. These working-class II. dwellings had been tho subject of repeated surveys by the officers of tho Public Health Department and were kept in a reasonably fit state of habitation only by frequent repairs. The rents were low and in no case were there the conveniences and amenities usually accepted as necessary adjuncts in modern working-class dwellings. Age and decay had set their seal on the structure? and nothing short of closing orders and reconstruction would have given a satisfactory answer to a growing problem. Even this answer would have caused intense hardship by depriving the sitting tenants of their homes without replacing them. The flood had further aggravated the progress of dilapidation and had made some 40 dwellings entirely unfit for habitation although in a number of instances the occupiers remained because there was nowhere else for them to go, while others obtained temporary refuge with relatives or friends in the locality or elsewhere. It was within a few days of the flood that the Mayor, Mr. Jacques Abady, who had seen with his own eyes the pitiful plight of many of the tenants in the Millbank area was inspired with the possibilities of an improvement scheme. He saw the area replanned and reconstructed with as many working-class dwellings as existed on the night of the flood. But they would be modern dwellings, each with its own cooking, washing and sanitary arrangements and let at rents consistent with those of the old dwellings, except in cases where additional rooms were required to relieve overcrowding. The Mayor lost no time in broaching his scheme to the Trustees of the Grosvenor Estate and found them as gravely concerned with the living conditions in the Millbank Estate as he was himself. They had already given a very handsome contribution to the relief fund and they fell in whole-heartedly with the Mayor's proposals. The extent to which the Grosvenor Estate has assistad in transforming these ideals into a concrete improvement Scheme has already been mentioned in this report. The spirit which prompted such munificence in gifts of land and money for the welfare and happiness of his tenants belongs to the Duke of Westminster himself. The Scheme, in addition to the provision of new working-class dwellings to replace the old, has for its objective the improvement and development of the whole area by sweeping away old and derelict commercial premises and other buildings. New streets will be formed while some of those existing will disappear. Large buildings such as offices and workshops will be erected which besides furnishing opportunities for the employment of the local population will greatly increase the rate income of the City. Possibly also there may be numbers of residential flats so that the schcme when completed will offer an example of town planning as applied to one of the most important districts of central London. The illustrations attached show (1) Sketch-plan of the Millbank Estate, (2) Perspective view of proposed new working-class dwellings designed by Sir Edward Lutyens, (3) Certain photographs indicating the types of old dwellings which it is intended to demolish and replace. Ebury Bridge Housing Scheme. Three illustrations are included on pages x, XI and xII. The first gives a perspective view of the Housing Schcme which was initiated at the suggestion of Capt. J. C. Dalton, the chairman of a special committee of the Council whose reference is a survey of all freehold and leasehold properties belonging to the Council. The Housing Scheme designed by the firm of Ashley and Newman, F.F.R.I.B.A., who have completed so successfully other housing schemes of the Council will provide 210 working-class flats and 16 shops. The rents of the flats will be on a similar scale to those obtaining III at other Council Dwellings, hut it should hp remarked that the rooms in this schcme will he considerably larger than those at Regency Street Dwellings. A great advantage in this instance i.s that there are practically no tenants to be displaced. The dwellings will be built over the site of old workshops no longer in use and vacant yards. The other two illustrations show plans of the new Tuberculosis Dispensary and Maternity and Child Welfare Centre. It should be noted that these institutions will form the ground floor and first floors of the same building as they do in the present premises at 1, Pimlico Road. The accommodation, however, will be considerably greater and will allow for the proper development of the work which hitherto has been seriously hampered owing to the cramped space and inconvenient arrangement of the old building. A special feature of the new Tuberculosis Dispensary w ill be a large room for the handicraft class for tuberculosis patients. This class which is conducted entirely on a voluntary basis has existed for over two and a half years. By its means patients who return from sanatorium unfit for their old employment or for other reasons unable to re-enter it are trained in some branch of handicraft. Their enforced leisure is thus usefully occupied and their minds are diverted from dwelling on their ailments. In the new Maternity and Child Welfare Centre the Sun rooms and open air balconies deserve notice; also the large waiting room which can be used for lectures. There is also an additional waiting room for expectant mothers opening off the doctor's room. The two schemes have been designed by the architects of the Ebury Bridge Scheme and form part of the general lay-out. IV SKETCH PLAN OF MILLBANK ESTATE. V MILLBANK IMPROVEMENT SCHEME. Perspective View of Proposed New Working Class Dwellings. VI MILLBANK IMPROVEMENT SCHEME. Rear of Nos. 32-38, Pack Street. (Xotc part of new City of Westminster Dwelling?f Schomberg House, in background.) VII MILLBANK IMPROVEMENT SCHEME. Rear of Vincent Street, South Side (now demolished). VIII MILLBANK IMPROVEMENT SCHEME. Esher Street and Vincent Street, North Sipe. IX MILLBANK IMPROVEMENT SCHEME. Rear of Esher Street and Kensington Place. X EBURY BRIDGE SCHEME. (Building containing proposed Maternity and Child Welfare Centre and Tuberculosis Dispensary indicated by +.) XI Proposed Tuberculosis Dispensary, Ebusy Bridge. XII Proposed Maternity and Child Welfare Centre, Ebury Bridge.