WES 39 City of Westiminster. RE PORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1929 ANDREW J. STIINNIE, M.D., D.P.H. (Lond.), Medical Officer of Health, and Administrative Tuberculosis Officer. Printed by Order of the Council. LONDON: harrison and sons, ltd. printers in ordinary to his majesty, st. martin's lane, w.c.2, City of Westiminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1929 ANDREW J. SHINNIE, M.D., D.P.H. (LOND.), Medical Officer of Health and Administrative Tuberculosis Officer. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD. PRINTERS IN ORDINARY TO HIS MAJESTY. ST. MARTIN'S LANE, W.C.2. 72556 iii CONTENTS. PAGE Introductions v General Statistics 1 Statistics and Social Conditions of the Area 2 Meteorological2 Population 2 BIRTHS 4 Deaths 14 Infantile Mortality 17 Common Lodging-Houses 21 Tables 8-20 Health Services for the Area, General Provision of 21 Staff 27 By-laws under the Public Health (London) Act, 189131 Infectious Diseases 31 Small-pox 32 Vaccination 33 Scarlet Fever 36 Diphtheria 36 Schick Test 36 Anti-toxin 38 Bacteriological Diagnosis 38 Enteric Fever 38 Measles 38 Influenza 38 Diarrhoea and Enteritis 39 Deaths from 39 Whooping Cough 39 Cerebro-spinal Fever 40 Poliomyelitis 40 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 cases (notified) 42 „ „ „ Tables 42-46 Deaths and non-notified deaths 46-48 Tuberculosis Dispensary 48 Dental Treatment Returns (Ministry of Health table) 53-56 Cancer 57 Sanitary Circumstances of the Area 57 Water, Artesian Wells 57 Public Swimming Baths 58 Drainage and Sewerage House Drainage ®® New Drainage By-laws New Sanitary Constructions Water Closet Accommodation Scavenging Public Sanitary Conveniences Sanitary Inspection of the Area Statistical Table Restriction of Rent Acts Nuisances—Intimation, Statutory Notices, etc. Rat Repression Water Supply Removal of Offensive Refuse Lighting of Staircases in Tenement Buildings Houses Divided into Separate Tenements (9583) 4 2 IV Page Factories, Workshops and Workplaces 66 kk Abatement 69 Premises and Occupations Controlled by By-Laws and Regulations 76 I Houses Let in Tenements 76 Underground Rooms 76 Rag and Bone Dealers 77 Other Sanitary Conditions Requiring Notice 77 T Fouling of Footways by Dogs 77 Nuisance from Pigeons 77 Noise 78 Sale of Old Clothes 79 Rag Flock Acts, 1911 and 1928 79 Removal of Infirm and Diseased Persons in certain cases 79 I Schools 80 Health Education 80 POB lic Health Conferences, etc. 81 Sheffield Conference of Royal Sanitary Institute 81 I National Association for the Prevention of Infantile Mortality 81 National Association for the Prevention of Tuberculosis 81 I Sanitary Inspectors' Association Conference at Lowestoft 81 Winter School for Health Visitors81 Housing 81 New Schemes, etc. 81-86 Dangerous Structures 81-86 Underground Rooms 86 Re-occupation of overcrowded or insanitary dwellings 88 Families re-housed 88 Table (required by the Ministry of Health) 89-90 [isinfection 91 Mortuariesn 93 Maternity and Child-Welfare 93 Maternity Beds 93 Measles—Staff for Visiting Cases 94 Barlow'8 Gift 95 Maternity Mortality—Puerperal Fever and Puerperal Pyrexia 95 Widows' and Orphans' Contributory Pensions Act, 1925 96 Ante-natal Work 97 Maternity and Mothercraft 98 Infancy and Early Childhood 100 Nursing of Cases of Illness connected with Pregnancy 101 Nursing 103 Dental Treatment 104 Convalescent Homes 105 Homes for Unmarried Mothers 105 Day Nursery 105 Supply of Milk 105 Inspection and Supervision of Food 106 Acts and Regulations relating to Food 106-108 Registration of Dairymen and Premises109 Bottling Milk in the Street 109 Churns and other Milk Vessels 110 Milk and Dairies Amendment Act, 1922 110 Milk and Dairies (Consolidated) Act, 1915 110 Analysis of Milk Samples 112 Bacteriological Examination of Milk 113 Condensed Milk Regulations, 1923-1927 114 Dried Milk Regulations, 1923-1927 114 Public Health (Preservatives in Food) Regulations, 1925, 1926 and 1927 114 Samples Taken (Table) 115 Regulations of Street Trading 117 Meat Regulations, 1924 117 Food Order, 1921 117 Food Premises 118 Food Condemned 119 Spirit Samples 119 V Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 2 9. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1929. The report is prepared in accordance with the requirements contained in Circular 1048 from the Ministry of Health, which are practically identical with those of Circular 939 of the previous year. On this occasion the various sections and sub-headings are set out exactly in the order suggested by the Ministry. In addition, certain matters of importance to the health of the City are discussed at some length. The sphere of work relating to the public health is steadily growing and is, each year, embracing more factors relating to the health of the individual and the state of his environment. As the Annual Report of the Medical Officer of Health is expected to be a faithful account of all circumstances which influence the public health, it is becoming difficult to deal adequately with many matters and still keep the Report within reasonable compass. The work of the Department falls under these sections 1. General Sanitation—abatement of nuisances and other conditions relating to environment, e.g., water supplies, drainage work, smoke abatement, etc. 2. Prevention and control of Infectious Disease and Vital Statistics. 3. Housing. 4. Inspection of Factories, Workshops and Workplaces. 5. Supervision of Food and Food premises. 3. Maternity and Child Welfare. 7. Prevention and treatment of Tuberculosis. 8. Disinfection and Mortuaries. The vital statistics of the City show increases in the death and infantile mortality rates similar to those recorded in most parts of the country : this fact receives more than one comment in the report. vi As regards infectious disease, the City was remarkably free from serious outbreaks. Smallpox, which has been very prevalent in other fcarts of London, was, except for two cases, non-existent among residents. In this connection it may be observed that while Westminster is a relatively well vaccinated area, the districts where smallpox has been rife do not appear to be so well protected. The present outbreak of smallpox in London is costing a very great deal of money which might have been avoided had vaccination been more universal. In Westminster, where a great many contacts are employed, the work of supervising them has idded very greatly to the ordinary duties of the department. Housing continues to be an issue of prime importance. The occurrence of dangerous structures among working class dwellings is a problem of increasing urgency and is discussed at some length. Overcrowding and other insanitary conditions of living still call for remedy, but they do not present the desperate need of those whose homes have become dangerous structures and are being pulled down over their heads. The progress of the new housing schemes of the City Council receives special notice illustrated with photographs. While the Millbank scheme of 604 dwellings develops slowly, being a replacement or improvement scheme, that at Ebury Bridge is near completion and will afford 210 additional dwellings. Both will effect a pronounced improvement in housing conditions in the City. Among general sanitary matters the question of smoke abatement and the anticipation of sulphur fumes from the Battersea Power Station are discussed. Some remarks on the injurious effects of noise are added. As regards the supervision of food, the routine inspection of restaurants and other food premises continues to be a most important duty. No outbreaks of food poisoning were reported. The usual number of food samples were examined by the Public Analysts and a somewhat higher percentage of adulterations were found among the milk samples. The discovery of boric acid in caviare lead to two prosecutions. Boric acid is not permitted in any food nor may any preservative be added to caviare. The orders relating to the marking of agricultural produce continue to increase in number and add considerably to the work of food inspection. Maternal Mortality figured seriously in 1928, but in 1929 it has dropped from 12.4 per 1,000 births to 3.6. This fortunate circumstance is largely due to fewer deaths from abortion—two as compared with five in 1928. The provision of maternity beds in Westminster Hospital has proved a most successful arrangement and of great benefit to mothers attending the Maternity and Child Welfare Centres. vii Staff: The Council having considered reports on the steadily increasing duties which fall to the Department, relieved Mr. John Sanderson, Senior Sanitary Inspector, of his duties as district inspector, and appointed him to assist the Medical Officer of Health in certain special matters and to exercise general supervision over the sanitary conditions in the City. Mr. Davies, a fully qualified Sanitary Inspector holding also the Meat and Food Certificate, was appointed as an additional Sanitary Inspector. Other changes following re-organization of the Department were the appointment of Mr. A. Wise to the position of Chief Clerk .and the promotion of Messrs. A. J. Manhood and W. F. Lake, Second Division clerks carrying out highly responsible duties, to the grade of 1st Division. In order to deal with the increasing clerical work an additional clerk was appointed in the person of Mr. F. E. Norwood, who began his duties as Junior Clerk in October, 1929. I would again, in conclusion, express my gratitude to the Chairman, Vice-Chairman and members of the Public Health Committee for their constant support, and to the staff of the Department my appreciation of the cheerful assistance which they have rendered. I have the honour to be, Your obedient Servant, Andrew J. Shinnie. June, 1930. 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)—130,000. „ „ Civilian—125,800. Number of Inhabited Houses (1921)—25,321. Number of Families or Separate Occupiers (1921)—33,946. Rateable value— £10,052,000 (March, 1930). Sum represented by a penny rate— £40,300. 2.—Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth-rate. Legitimate 606 584 1,190 10.4 Illegitimate 82 85 167 — — — Totals 688 669 1,357 Deaths—1,875. Death-rate—14.8. Number of women dying in, or in consequence of, childbirth :— Puerperal fever, 3 3.6 per 1 000 births. From other causes, 2 Number of deaths of infants under one year of age per 1,000 births—77 .37. Legitimate rate, 69.7 ; Illegitimate rate, 131.7. Number of deaths from measles (all ages)—4. „ ,, diphtheria—8. „ „ whooping cough (all ages)—19. „ „ scarlet fever — —. „ „ diarrhœa (under 2 years of age)—8. „ ,, typhoid fever— —. 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 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Meteorological. The year 1929 deserves to be remembered as one of great rrr 'eorological abnormalities. The early months gave lis a period of intense frost more severe than in any year since 1895. This was followed by six months of pronounced drought of such a degree that many districts in England and Wales were without water, and supplies had to be borrowed from more fortunate districts where means of collection and storage had been planned with the foresight necessary to meet such an emergency. In this remarkable year it would seem that Nature repented of her parsimony and gave us in the last three months a rainfall of unprecedented abundance. November was the wettest month ever known. During the last three months south and south-westerly gales were abnormally violent and frequent. While most rain fell in November—5.54 inches, December had most rainy days, 24. March was the driest with only one wet day. As regards sunshine, every day in July had periods of brightness, while its aggregate number of hours of bright sunshine was highest—248. February had fewest bright days (10) while January had the fewest hours of sunshine. As regards temperature the first three months showed a record well below average. February was the coldest month, when the mean temperature for the whole month was well below freezing point. This prolonged period of intense cold had an undoubted influence in causing an abnormal incidence of respiratory disease among the very old and the very young, and its further consequences may be observed in the remarkably high general death rate and the raised infantile mortality rate for the year. September, with a mean temperature of 62° F., was the warmest month, and also the warmest September ever recorded. On 19 days the maximum shade temperature reached over 70° F., and one day, the hottest of the year, September 4th, it reached 85.2° F. Bright sunshine over the longest period occurred in July between 12th and 25th when the daily average was 11.9 hours. To add one final characteristic to this year of extraordinary weather contrasts it should be recorded that it was remarkably free from fogs. Population. The estimated population of the City of Westminster for the year 1929 is given by the Registrar-General as 130,000 (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 3 125,800, and for the purpose of calculating the death-rate this number is taken. Both gross and net totals show a decrease on the corresponding figures for 1928, which were 132,700 and 129,700 respectively. The number of deaths returned for the first quarter of the year was the highest since the City was formed. The number 799 gave a death rate of 6.3 per 1,000 and was accounted for mainly by the incidence of respiratory disease which has been mentioned in connection with the remarks on weather conditions. Of persons between the ages of 45 and G5, no fewer than 80 died from influenza, an increase over the same period of the previous year of 75. In the middle periods of life similar effects from the prolonged spell of intensely cold weather were not realised so severely, as the deaths from respiratory diseases between the ages of 25 and 45 were 34, compared with 22 of the year before. Among infants, however, the withering effects of the cold were striking. In 1928 the number of infants dying in the first quarter was 21, while in 1929 the corresponding figure was 40. For this period the number dying from respiratory diseases was 14; in 1928 the number was 5. Influenza claimed a considerably larger number of victims as compared with the previous year. So far as cases go it is only influenzal pneumonia which is notifiable and 51 such cases were notified ; in 1928 they numbered 26. Deaths certified as due to influenza or its complications numbered 99, being 81 in excess of that in 1928. Nothing of the nature of an epidemic of infectious disease occurred. While cases of whooping cough, chicken pox and German measles had increased, diphtheria, measles and scarlet fever had decreased. There is no special industry in Westminster which engages a large proportion of the population, and it is therefore impossible to correlate any one occupation with conditions likely to be prejudicial to health. By far the greater proportion of those who work in Westminster live in other districts. Although the area of Westminster is very much greater than the City of London changes are taking place similar to those which have made the City of London almost deserted by night while thronged by day. The resident population of Westminster has fallen according to the Census, from 201,969 in 1891 to 141,578 in 1921, while the day population has been steadily increasing and may now be estimated to be about 450,000. The number of new buildings (and by far the greater proportion are devoted to non-residential purposes with the exception of new hotels), is rapidly increasing. Some indication of this increase is shown in the number of plans submitted in connection with building operations and reported upon by the officers of the Public 4 Health Department. The increase is shown thus : 1921, 383 ; 1922, 468 ; 1923, 551; 1924, 602 ; 1925, 658 ; 1926, 724 ; 1927, 750 1928, 752 ; 1929, 877. The changes in "Westminster are not, as is mostly the case in the City of London, only for commercial purposes. In addition to new banks, insurance and shipping offices, large shops and other business premises; new theatres, cinemas, hotels, restaurants, clubs, and institutions connected with the pursuit of the arts and sciences are being erected. These enterprises afford increasing opportunities for employment and thus it is that the day population is multiplying rapidly. The public health administration of the City is primarily concerned with safeguarding the health of its citizens who reside within its boundaries but year by year supervision of conditions affecting those who do not live in Westminster but work in or otherwise spend most of their waking hours in some pursuit within its borders requires increasing attention. Two points may illustrate this contention. Firstly, the number of restaurants which people away from home patronize has steadily increased and now approaches 1,100. This is probably a larger number than in any district of similar acreage in the country. It is a matter of prime importance that sanitary supervision of everything connected with restaurants should be carefully administered. Secondly, the incidence of infectious disease. Although there were only two cases of smallpox in residents of Westminster in 1929, there were 10 among those who are at work there, and throughout the year 478 non resident contacts who work in Westminster were under almost daily supervision for periods entailing some 4,000 visits by officers of the department. Births. The births registered in Westminster during 1929 numbered 1,577, but of these the homes of 751 were in other districts and 7 were registered under the Legitimacy Act, and have therefore to be deducted from the total. There were, however, 538 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,357, which is 13 less than the similar figure for 1928. Although the Registrar General's estimate of the population of the City is 2,700 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 5 only 98. This figure lias risen to 751 in 1929, and includes not only vtomeu 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 13 fewer than last year; the legitimate births were 30 less, and the illegitimate 17 more. The comparative totals are :— 1927. 192s. 1929. Legitimate. Legitimate. Legitimate. Males 638 642 606 Females 617 578 584 Illegitimate. Illegitimate. Illegitimate. Males 74 80 82 Females 70 70 85 1,399 1,370 1,357 Table I. Births Registered Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 1910 2,365 49 276 2,592 1,674 1,621 53 1911 2,110 60 311 2,361 1,562 1,507 55 1912 2,134 49 264 2,349 1,501 1,469 34 1913 1,992 35 276 2,233 1,462 1,424 38 1914 1,860 15 312 2,157 1,386 1,347 39 1915 1,721 71 329 1,979 1,292 1,250 42 1916 1,643 175 342 1,810 1,330 1,288 42 1917 1,325 159 378 1,544 1,020 985 35 1918 1,138 146 458 1,459 911 888 23 1919 1,210 98 480 1,592 1,004 977 27 1920 1,731 89 618 2,200 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 1,624 1,250 1,214 36 1925 1,519 481 497 1,535 1,435 1,385 50 1926 1,535 600 571 1,606 1,402 1,355 47 1927 1,375 552 (20) 576 1,399 1,205 1,169 36 1928 1,471 643 (23) 542 1,370 1,404 1,362 42 1929 1,577 758 (7) 538 1,357 1,532 1.474 58 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. 6 The legitimate and illegitimate births are distributed as follows:— Table II. Legitimate. Males 766 — 368 + 208 = 606 Females 704 — 318 + 198 = 584 1,470 686 + 406 1,190 Illegitimate. Males 52 — 34 + 64 = 82 Females 55 — 38 + 68 = 85 107 72 + 132 = 167 The legitimate births show a decrease of 30 and the illegitimate an neiviiso of 17 on the figures of 1928. As shown in Table I, 1,532 notifications of births were received by the Department for 1929 as compared with 1,404 in 1928. Of the total of notifications, 960 were sent by midwives, of whom 31 were practising in the City during 1929. The following Table shows the number of male and female children liorn since 1914, and those who did not survive the first year of life, with Uto 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. 1014 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 1920 797 809 48 48 749 761 1927 712 687 52 44 660 643 1928 722 648 47 33 675 615 1929 688 669 57 48 631 621 7 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. 1929 1,028 boys. Still-births.—58 still-born children were notified during the year, 34 of this number being born to non-residents of Westminster. The corresponding figure for 1928 was 42. corresponding figure for 1928 was 42. Under the Births and Deaths Registration Act, 1926, which into came force on 1st July, 1927, all stillbirths must be registered. Still-birtlis Inward Outward Registered. Transfers. Transfers. Total Legitimate and Illegitimate 'Males 40 9 20 Females 24 4 16 Illegitimate (Males 7 4 3 Females 2 — 1 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 1929, 44 cases, or roughly 11.0 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. 8 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. 1,002 57 11 9 13 21 105 356 243 187 F. 869 48 17 7 10 22 65 257 197 246 1, Enteric fever M. - - - - - - - - - - F. - - - - - - - - - - 2. Smallpox M. - - - - - - - - - - F. - - - - - - - - - - 3. Measles M. - - - - - - - - - - F. 1 - 1 - - - - - - - 4. Scarlet fever M. - - - - - - - - - - F. - - - - - - - - - - 5. Whooping-cough M 5 3 1 1 - - - - - - F. 17 9 4 2 2 - - - - - 6. Diphtheria M. 7 1 2 2 1 - - 1 - - F. 1 - - 1 - - - - - - 7. Influenza M. 53 1 1 - 1 1 2 19 18 10 F. 52 - 2 - - 1 6 18 10 15 8. Encephalitis lethargica M. - - - - - - - - - - F. 2 - - - - - 1 - 1 - 9, Meningococcal meningitis M 2 - 1 - - - 1 - - - F. 1 - 1 - - - - - - - 10. Tuberculosis of respiratory system M. 85 - - - - 5 27 47 6 - F. 31 - - - - 9 8 10 4 - 11. Other tuberculous diseases M 4 - - 1 1 1 1 - - - F. 6 1 1 - 1 - 1 2 - - 12. Cancer, malignant disease M. 107 1 - - 2 - 4 55 32 13 F. 114 - - - 1 - 6 56 34 17 13. Rheumatic fever M. 3 - - - 1 1 - 1 - - F. 1 - - - - 1 - - - - 14. Diabetes M 9 - - - - - - 2 5 2 F. 11 - - - - - - 6 3 2 15. Cerebral hæmorrhage, etc. M. 24 - - - - - 2 5 9 8 F. 26 - - - - - 1 6 7 12 16. Heart disease M. 238 - - - 1 - 12 76 69 80 F. 203 - - - 4 1 8 45 58 87 17. Arterio-sclerosis M. 30 - - - - - - 8 13 IS F. 33 - - - - - 1 7 14 11 18. Bronchitis M. 46 1 - - - - - 12 17 16 F. 60 - - - - - 1 9 12 38 19. Pneumonia (all forms) M 93 10 4 3 1 3 13 26 22 11 F. 76 8 6 1 1 2 3 21 17 17 20. Other respiratory diseases M. 13 2 - - 1 1 - 5 1 3 F. 11 - - - - - 1 6 2 2 9 Causes of Death. Sex. All Ages. 0– 1– 2– 5– 15– 25– 45– 65– 75– 21. Ulcer of stomach or duodenum M. 25 – – – – – 4 15 4 2 F. 3 – – – – – – 2 1 – 22. Diarrhœa, etc M 6 3 – – – – – 2 1 – F. 12 8 1 – – – – 1 2 – 23. Appendicitis and typhlitis M. 12 – – – – 2 2 7 1 – F. 6 – – – – – 1 3 1 – 24. Cirrhosis of liver M. 11 – – – – – 2 8 1 – F. 3 – – – – – – 2 1 – 25. Acute and chronic nephritis M. 38 1 – – – 1 3 18 9 6 F. 27 – – – – – 2 13 5 7 26. Puerperal sepsis M. – – – – – – – – – – F. 2 – – – – – 2 – – – 27. Other accidents and diseases of pregnancy and parturition M. – – – – – – – – – – F. 1 – – – – 1 – – – – 28. Congenital debility and malformation, premature birth M. 26 26 – – – – – – – – F. 15 15 – – – – – – – – 29. Suicide M. 15 – – – – – 9 6 – – F. 13 – – – – – 5 5 – 3 30. Other deaths from violence M 34 3 1 1 2 3 9 5 6 4 F. 35 1 1 3 1 3 5 5 8 8 31. Other defined diseases M. 110 5 1 1 2 3 14 38 29 17 F. 105 6 – – – 4 12 40 17 26 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 28th December, 1929:— Westminster, City of, Met. B. Number of Cases of Infectious Diseases Notified (Civilians). Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. 2 213 173 8 12 10 51 (The Case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Smallpox, 0.28; scarlet fever, 3.05; diphtheria, 1.59; enteric fever, 0 07, puerperal pyrexia, 0.14; puerperal fever, 0.06; and erysipelas, 0.45.) (9583) p 10 MALES Table I.— Causes of , and Ages at, Death during the year 1929. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent. Garden. Strand. Homeless. Smallpox – – – – – – – – – – – – – – – – – – – – – – – – Measles – – – – – – – – – – – – – – – – – – – – – – – – Scarlet fever – – – – – – – – – – – – – – – – – – – – – – – – Influenza 51 1 – – – 1 2 20 27 – 4 1 3 17 3 16 2 – 4 1 – – – – Whooping-cough 5 3 1 1 – – – – – – – – – 1 – 3 – – – 1 – – – – Diphtheria, Memb. croup 7 1 2 2 1 – – 1 – – – – – 2 – 4 1 – – – – – – – Cerebro-spinal meningitis 1 – – – – – 1 – – – – – – – – – – – 1 – – – – – Poliomyelitis – – – – – – – – – – – – – – – – – – – – – – – – Enteric fever – – – – – – – – – – – – – – – – – – – – – – – – Diarrhœa, enteritis 3 3 – – – – – – – – – – – 2 – – – – – – 1 – – – Erysipelas 1 – – – – – – 1 – – – 1 – – – – – – – – – – – – Other septic diseases 8 – – – – – 1 2 5 – 1 – – 3 1 1 1 – – – 1 – – – syphilis &c. 1 1 – – – – – – – – – – – – – – – – – – 1 – – Diabetes 6 – – – – – – 1 5 – – – 1 1 – 3 – – – 1 – – – – Rheumatic fever 7 – – – 1 1 – 4 1 – 1 – – 1 – 2 – – 2 – – – – 1 Tuberculosis of lungs 83 – – – – 5 27 45 6 – 5 – 3 26 1 31 6 1 1 – – 3 5 1 Other forms of tuberculosis 4 1 – 2 – 1 – – – – – – – 1 – – – 1 – – – – 2 Malignant growths 106 – – – 1 – 4 55 46 1 9 4 11 23 12 21 2 2 8 3 2 3 5 – Congenital debility, malformation, and premature birth 24 24 – – – – – – – – 2 – 2 11 1 5 – – – – 2 1 – – Old age 13 – – – – – – 1 12 – – – – 4 2 2 1 – – 1 – 1 – 2 Meningitis and convulsions 6 4 1 – – – – 1 – – – – – – – – – – – – – – – 11 MALES—Table I (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightbridge. Knightbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Coveut Garden. Strand. Homeless. Loc. ataxia and general paralysis 9 – – – – – 5 2 2 – 1 – – 2 – 3 1 1 – – – – – 1 Other diseases of nervous system 4 1 – – – – 1 2 – – – 1 – – 1 1 – – – – – – – 1 Valvular diseases of heart 19 – – – 1 – 3 7 8 – 2 – 1 3 1 7 1 – 1 2 – 1 – – Other circulatory diseases 193 – – – 2 – 7 59 125 1 19 5 15 44 8 53 5 1 3 5 10 9 11 4 Bronchitis 134 3 – – – – 1 39 91 1 5 1 6 28 4 53 9 2 – 2 2 6 12 3 Broncho-pneumonia 62 7 6 3 – 1 6 16 23 – 5 l 2 13 1 27 2 3 3 1 – 3 – 1 Pneumonia, other forms 46 1 – – 1 4 9 17 14 – 5 – 1 11 3 10 5 1 3 3 2 2 – – Other respirators diseases 11 1 – – 1 – 1 5 3 – – 1 2 3 1 3 – – – – – 1 – – Alcoholism 7 – – – – – 4 2 1 1 1 – 1 3 – – – – – 1 – – – – Cirrhosis of liver 10 – – – – – 1 9 – – 2 – 1 2 3 2 – – – – – – – – Appendicitis and typhlitis 13 – – – – 2 2 8 1 – 3 – 1 3 2 3 – – – 1 – – – Other digestive diseases 44 – – – – 1 5 24 14 – 7 l 3 8 – 13 1 – 2 1 2 5 1 –_ Bright's disease, &c. 57 1 – – – 1 5 26 24 – 9 1 3 11 3 18 3 1 – 1 1 2 1 3 Cystitis, &c. 17 – – – – – – 5 12 – 2 – 4 3 2 2 1 – 2 – – – – 1 Deaths by accident or negligence 34 3 1 2 2 3 6 6 11 – 4 l 2 11 1 7 – – 3 2 1 1 – 1 Deaths by suicide and murder 17 – – – – – 10 6 1 – – – 4 7 1 1 – – 2 – – – 1 1 Other defined diseases 9 2 – – 1 1 1 1 3 – 1 – – 3 – 3 1 1 – – – – - – Diseases, ill defined or unknown – – – – – – – – – – – – – – – – – – – – – – – – All causes 1,012 57 11 10 11 21 102 365 435 4 83 18 66 249 51 298 42 14 35 26 24 39 36 22 (9583) B 2 12 FEMALES. Table I.— Causes of, and Ages at, Death during the year 1929. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox – – – – – – – – – – – – – – – – – – – – – – – – Measles 4 1 2 – 1 – – – – – – – 1 2 – 1 – – – – – – – – Scarlct fever – – – – – – – – – – – – – – – – – – – – – – – – Influenza 48 – 1 – – 1 6 1 6 24 – 5 3 5 15 1 14 1 – – 1 1 2 – – Whooping-cough 14 8 3 2 1 – – – – – 1 – – 5 – 5 – 1 – 1 – 1 – – Diphtheria, Memb. croup 1 – – 1 – – – – – – – – – 1 – – – – – – – – – – Cerebro-spinal meningitis – – – – – – – – – – – – – – – – – – – – – – – – Poliomyelitis – – – – – – – – – – – – – – – – – – – – – – – – Enteric fever – – – – – – – – – – – – – – – – – – – – – – – – Diarrhœa, enteritis 5 4 1 – – – – – – – – – – 2 – 2 – – – 1 – – – – Erysipelas – – – – – – – – – – – – – – – – – – – – – – – – Puerperal fever 3 – – – – 1 2 – – – – – – 1 – – 1 – – – – – – – Other septic diseases 11 – – – – 1 4 4 2 – 1 1 4 2 1 1 – – – 1 – – – – Syphilis, &c – – – – – – – – – – – – – – – – – – – – – – – – Diabetes 9 – – – – – – 6 3 1 1 – 1 3 – 2 – – – – – – 1 – Rheumatic fever 9 – – – – – 1 6 2 – – – 1 3 1 2 – 1 – – – 1 – – Tuberculosis of lungs 30 – – – – 9 8 10 3 – 1 – 2 11 1 10 – 1 – – – 1 1 2 Other forms of tuberculosis 7 2 1 – – – 1 3 – – – – – 3 – 4 – – – – – – – – Malignant growths 109 – – – 1 – 6 55 47 2 12 3 10 36 12 13 7 2 2 3 1 4 1 1 Congenital debility, malformation, and premature birth 16 16 – – – – – – – – – 1 – 6 – 2 1 2 – 1 – – 1 2 Old age 8 – – – – – – – 8 – 2 – 2 2 – 1 – – – – – – – 1 Meningitis and convulsions 1 – 1 – – – – – – – – – – – – 1 – – – – – – – – 13 FEMALES—Table I (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 5 – – - – 1 – 4 – – – – – 1 – 1 – – – 2 – – – 1 Other diseases of nervous system 9 – – – – – 1 3 5 – 1 – 2 2 1 2 – – – – – 1 – – Valvular diseases of heart 17 – – – 1 1 – 4 11 – 1 – 1 7 – 5 1 – – – – 2 – – Other circulatory diseases 190 1 – – 3 3 6 40 138 – 13 10 20 65 13 42 3 5 1 4 1 11 – 2 Bronchitis 120 – – – – – 4 28 88 – 8 2 8 45 4 40 3 – – 3 1 5 – 1 Broncho-pneumonia 62 9 6 1 – 1 1 9 35 – 1 1 5 25 2 19 5 – – – – 3 – 1 Pneumonia, other forms 35 – 1 – 1 1 3 13 16 – 3 2 5 9 1 7 1 – – 2 1 1 – 3 Other respiratory diseases 6 – – – – – – 3 3 – – – 1 1 1 1 – – – 1 – 1 – – Alcoholism 6 – – – – – 2 3 1 – – 2 – 3 – – – – – – – 1 – – Cirrhosis of liver 4 – – – – – – 3 1 – 1 – – 2 – 1 – – – – – – – – Appendicitis and typhlitis 6 – – – – – 1 3 2 – 1 – 1 1 1 2 – – – – – – – – Other digestive diseases 22 4 – – – – 2 8 8 – 4 2 – 8 1 3 2 1 1 – – – – – Bright's disease, &c. 37 1 – – 1 – 2 19 14 – 4 – 7 14 – 3 2 1 – 2 1 2 – 1 Cystitis, &c. 8 – – – – – – 2 6 – 1 – 1 1 1 – – – 1 1 1 1 – – Accidents and diseases of parturition 2 – – – – – 2 – – – – – – 2 – – – – – – – – – – Deaths by accident or negligence 36 1 1 4 – 3 6 5 16 – 1 2 3 6 – 18 1 – 1 1 – 2 – 1 Deaths by suicide and murder 12 – – – – – 3 6 3 – – 1 – 4 1 2 – 1 – – – 1 1 1 Other defined diseases 11 1 – – – – 5 2 3 – – – – 4 2 3 – – – – – 1 – 1 Diseases, ill defined or unknown – – – – – – – – – – – – – – – – – – – – – – – – All causes 803 48 17 8 9 22 65 255 439 3 63 30 80 292 44 207 20 15 6 24 7 11 5 18 14 Deaths. In the City in the 52 weeks of 1929, 1,799 deaths were registered. After deducting 974 deaths of non-citizens in public institutions, etc., in the City, and adding t???se of 1,050 citizens who died in other districts, the corrected total is 1,875, as compared with 1,497 in 1928, and is equivalent to an annual rate of 14'8 per 1,000 persons (civilian population), compared with 11.5 last year. The London death-rate for 1929 was 13.8 (civilians only), for England and Wales, 13.4. These rates are much higher than in 1928 for Westminster and the country as a whole. Among Westminster residents 799 deaths occurred during the first quarter of the year. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below Table V. (From 1915 to 1929.) Year. Number of Deaths. Westminster Rate. London Rate. 1915 2,138 15.7 16.1 1916 1,827 13.7 14.3 1917 1,896 15.5 15.0 1918 2,062 16.3 18.9 1919 1,819 14.2 13.4 1920 1,600 10.9 12.4 1921 1,623 11.5 12.4 1922 1,796 12.9 13.4 1923 1,493 10.6 11.2 1924 1,695 11.8 12.1 1925 1,728 12.3 11.7 1926 1,608 11.6 11.6 1927 1,682 12.3 11.9 1928 1,497 11.5 11.6 1929 1,875 14.8 13.8 The deaths of males were 1,012, females 863. Table VI. This table shows the total deaths distributed among age periods:— 1929. 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. 57 11 10 11 21 102 365 435 1,012 f. 48 17 8 9 22 65 255 439 863 1920 167 18 21 27 53 222 517 575 1,600 1921 154 28 32 35 56 204 499 615 1,623 1922 104 26 32 41 62 211 584 736 1,796 1923 83 16 13 19 46 171 463 682 1,493 1924 96 32 39 41 46 184 557 700 1,695 1925 106 28 22 25 65 198 496 788 1,728 1926 96 28 20 24 50 185 509 696 1,608 1927 96 13 20 24 42 179 533 775 1.682 1928 80 14 10 31 51 164 466 681 1,497 1929 105 28 18 20 43 167 620 874 1,875 The causes of death are set out in Table IV. There was an increase among males of deaths from the following causes:—Influenza, whooping cough, pulm. tuberculosis, cancer, general paralysis, circulatory, respiratory and digestive diseases, and diseases of the liver and kidneys. 15 Among females the causes showing an increase were measles, influenza, whooping cough, septic diseases, diabetes, alcoholism, circulatory, respiratory and kidney diseases. 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. 1925. 1926. 1927. 1928. 1929. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total Conduit 11 4 15 – 5 5 4 – 4 4 4 8 4 3 7 Grosvenor 80 49 129 60 64 124 58 67 125 59 78 137 88 63 151 Hamlet 23 20 43 11 23 34 25 30 55 16 22 38 18 30 48 K. St. George 58 61 119 58 69 127 74 74 148 54 57 111 66 80 146 Victoria 275 305 580 236 252 488 245 286 531 231 226 457 249 292 541 St. Margaret 37 42 79 51 37 88 42 42 84 29 32 61 51 44 95 St. John 221 189 410 204 162 360 217 138 355 173 163 336 298 207 505 St. Anne 37 29 66 38 32 70 44 33 77 26 23 49 42 28 70 Gt, Marlborough 7 20 27 20 14 34 18 15 33 20 17 37 14 15 29 Pall Mall 19 7 26 22 8 30 21 9 30 31 7 38 35 6 41 Regent 27 21 48 25 18 43 35 20 55 25 12 37 26 24 50 Charing Cross 16 9 25 13 6 19 15 7 22 12 8 20 24 7 31 Covent Garden 31 28 59 39 39 78 29 35 64 35 29 64 39 41 80 Strand 60 3 63 56 6 62 52 5 57 46 10 56 36 5 41 Homeless 23 16 39 22 18 40 29 13 42 26 22 48 22 18 40 Infantile Mortality.— The corrected death-rate of infants for Westminster was 77.37 per 1,000 births. The mortality among legitimate infants was 69.7 per 1,000; that of illegitimate 131.7. The infant mortality rate for London was 70. The number of infants dying under 1 year was 105, an increase of 25 on the figure of last year and as the total number of births shows a decrease of 13, the infantile mortality rate unfortunately has risen. The chief contributory causes of death were pneumonia, prematurity, gastroenteritis and whooping cough. Twenty-four of the 27 premature deaths occurred before the fourth week of life. Gastro-enteritis accounted for 10 deaths, 6 of the infants being over four months old. Six of those occurred during July, August, and September, and might be attributed to what is commonly called "summer diarrhœa." Table VIII shows the deaths as they occurred during the four quarters of the last four years:— Table VIII. Total 1929. Total. 1928. Total. 1927. Total 1926. 1st Quarter 40 21 29 30 2nd „ 29 19 16 24 3rd „ 18 21 26 25 4th „ 18 19 25 17 105 80 96 96 16 Table IX shows the births and deaths of infants, legitimate and illegitimate, since 1902 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table IX. Year. Legitimate. Illegitimate. Total Rate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 1902 3,275 410 125 186 32 172 127 140 1903 3,035 345 113 150 25 166 116 130 1904 2,920 320 109 134 40 298 118 145 1905 2,971 305 102 149 24 161 105 130 1906 2,744 285 103 187 38 203 110 131 1907 2,764 269 97 163 34 208 103 116 1908 2,739 266 97 174 27 155 100 113 1909 2,548 232 91 203 26 128 93 108 1910 2,399 189 78 193 25 129 82 103 1911 2,195 210 95 166 33 198 103 129 1912 2,194 168 76 155 27 174 83 91 1913 2,057 184 89 176 29 164 95 105 1914 1,995 147 73 162 24 148 79 104 1915 1,798 141 78 181 41 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 48 239 103.6 104 1918 1,234 112 86.6 225 36 155 100 108 1919 1,383 99 71.5 217 41 188 87.5 85 1920 2,047 123 60 219 44 200 73.6 76 1921 1,729 117 67.7 190 37 194 80.2 80 1922 1,703 84 49.3 199 20 100 54.6 74 1923 1,582 68 42.9 176 15 85.7 47.2 60 1924 1,489 82 55.0 138 14 101.4 59.0 69 1925 1,418 88 62.0 117 18 153.8 69.0 67 1926 1,419 76 52.4 157 20 127.3 59.7 64 1927 1,255 81 64.5 144 15 104.1 68.6 59 1928 1,220 65 53.2 150 15 100.0 58.39 67 1929 1,190 83 67.7 167 22 131.7 77.37 70 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 1922 onwards, showing the proportion per 1,000 births applicable under each headingTable X. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. Diphtheria – – – 0.65 – 1.4 1.4 0.73 Influenza 3.6 – 0.6 0.65 0.62 0.71 – 0.73 Measles 1.0 – 5.5 – 2.49 – – 0.73 Whooping Cough 1.0 1.1 1.9 4.5 0.62 1.4 2.1 8.1 Septic diseases 0.5 1. 1.2 – 0.62 0.71 – – Bronchitis and pneumonia 7.3 4.0 10.4 16.2 9.9 6.4 13.8 14.7 Stomach and bowel complaints 3.1 1.1 1.9 5.2 8.0 12.1 10.9 7.3 Syphilis 2.1 2.8 1.2 1.3 2.8 0.72 0.73 Congenital malformations 4.2 5.1 4.9 3.2 4.34 7.8 5.1 4.4 Prematurity 16.2 13.1 14.1 16.9 19.3 20.0 9.4 19.8 Neglect and injury at birth 5.7 6.8 3.1 0.65 3.72 4.2 4.3 1.4 Debility from birth and atrophy, rickets, atelectasis 4.2 6.2 5.3 7.1 3.72 4.2 3.6 2.2 Tuberculosis 1.5 1.7 1.8 1.9 1.86 2.1 2.1 2.2 Chicken Pox – – – – – – 0.73 Other causes 3.6 2.8 6-7 10.4 4.34 4.2 2.1 13.2 54.6 46.6 59.0 69.0 59.7 68.6 58.39 77.37 17 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, 1929. CAUSES of death. Under 1 Week 1–2 Weeks. 2–3 Weeks. 3 –4 Weeks. Total under 4 Works. 4 Weeks and under 3 Months. 3 Months and under 6 .Months. 6 Months and under 9 Months. 9 Months and under 12 months. Total Deaths under 1 Year. Influenza – – – – – – 1 – – 1 Diphtheria – – – – – 1 – – – 1 Measles – – – – – – 1 – – 1 Whooping Cough – – – – – – 3 3 5 11 Nephritis – – – – – 2 – – – 2 Tuberculosis – – – – – – 2 1 – 3 Meningitis 1 – – – l – 1 2 – 4 Bronchitis – – – – – 1 2 – – 3 Pneumonia (all forms) 1 1 – – 2 3 3 4 5 17 Gastro-enteritis – – 1 1 2 2 3 2 1 10 Injury at birth – – – – – – – – – – Neglect at birth 2 – – – 2 – – – – 2 Murder – – – – – – – – – – Atelectasis 1 – – – 1 – – – – 1 Congenital malformations 4 – – – 4 1 1 – – 6 Premature birth 19 4 – 1 24 2 1 – – 27 Malnutrition, marasmus, debility from birth 1 – – – 1 1 – – – 2 Accidents 4 – 1 – 5 1 – – 1 7 Other causes 2 – – – 2 – 2 1 – 5 Syphilis – 1 – – 1 – – – – 1 Chicken Pox – – – – – – – 1 – 1 Totals 35 6 2 2 45 14 20 14 12 105 Table XII. Nett Births in the year:— Males. Females. Total. Legitimate 606 584 1,190 Illegitimate 82 85 167 688 669 1,357 Nett Deaths in the year of :— Males. Females. Total. Legitimate infants 44 39 83 Illegitimate infants 13 9 22 57 48 105 The causes of death of the Illegitimate were:—Neglect at birth, 2, prematurity 10, pneumonia 2, syphilis 1, hæmorrhagic disease 2, debility 1, stomach complaints 2, nephritis 1, and bronchitis 1. 18 Table XIII. Infant Mortality, 1929.—Netl Deaths from stated causes at various ages under One Year of Age in Pimlico Area (Victoria, Knightbridge St. George and Hamlet Wards) CAUSES OF DEATH. Under 1 Week. 1–2 Weeks. 2–3 Weeks. 3–4 Week4 Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Diphtheria – – – – – – – – – – Influenza – – – – – – 1 – – 1 Whooping Cough – – – – – – 2 1 – 3 Measles – – – – – – 1 – – 1 Tuberculosis – – – – – – 1 – – 1 Bronchitis 1 – – 1 Pneumonia (all forms) 1 – – – 1 1 2 4 2 10 Gastro-enteritis – – 1 – 1 2 2 – – 5 Injury at birth – – – – – – – – – – Atelectasis – – – – – – – – – – Congenital malformations – – – – – – – – – – Premature birth 10 4 – – 14 2 1 – – 17 Malnutrition,marasmus and debility from birth 1 – – – 1 1 – – – 2 Accidents 1 – – – 1 1 – – 1 3 other causes 1 – – – 1 – 1 – – 2 Meningitis 1 1 – – 1 – 2 Syphilis – – – – – – – – – – Totals 15 4 1 – 20 7 12 6 3 48 Table XIV. Nett Deaths in the above area during the year :— Males. Females. Total Legitimate 18 18 36 Illegitimate 8 4 12 19 Table XV. Infant Mortality; 1029.—Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. causes of death. Under 1 Week. 1–2 Weeks. 2–3 Weeks. 3–4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Chicken Pox – – – – – – – 1 – 1 Meningitis – – – – – – 1 1 – 2 Whooping Cough – – – – – – 1 1 3 5 Measles – – – – – – – – – – Tuberculosis – – – – – – 1 – – 1 Bronchitis – – – – – – 1 – – 1 Pneumonia (all forms) – 1 – – 1 2 1 – 3 7 Gastro-enteritis – – – – – – – 1 1 2 Atelectasis 1 – – – 1 – – – – I Congenital malformations 2 – – – 2 1 – – – 3 Premature birth 3 – – 1 4 – – – – 4 Want of attention – – – – – – – – – – Nephritis – – – – – – 1 – – 1 Diphtheria – – – – – 1 – – – 1 Accidents 1 – 1 – 2 – – – – 2 Other causes – – – – – – – 1 – 1 Totals 7 1 1 1 10 4 6 5 7 32 Table XVI. Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 19 13 32 Illegitimate infants – – – Table XVII. Infant Mortality, 1929. Nett Deaths from stated causes at various ages under One Year of Age in the. North District (Grosvenor, Conduit, St. Anne, Pall Mall, Urgent, Gt. Marlborough, Strand, Charing Cross and Covent Garden Wards). causes of death. Under 1 Week. 1–2 Weeks. 2–3 Weeks. 3–4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 MontHS 3 Months and under 6 Months. 6 Months and under 9 MontHS. 9 Months and under 12 Months. Total Deaths under 1 Year Bronchitis – – – – – 1 – – – 1 Syphilis – 1 – – 1 – – – – 1 Pneumonia (all forms) – – – – – – – – – – Gastro-enteritis – – – 1 1 – 1 1 – 3 Nephritis – – – – – 1 – – – 1 Congenital malformations 2 – – – 2 – 1 – – 3 Premature birth 6 – – – 6 – – – – 6 Malnutrition, inanition and debility from birth – – – – – – – – – – Accidents 1 – – – 1 – – – – 1 Whooping Cough – – – – – – – 1 2 3 Other causes – – – – – – 1 – – 1 Totals 9 1 – 1 11 2 3 2 2 20 20 Table XVIII. Xett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 6 8 14 Illegitimate infants 4 2 6 Table XIX. Deaths of infants with no known address, or found in streets, parks, &c.:— CAUSES OF DEATH. Under 1 Week. 1–2 Weeks. 2–3 Weeks. 3–4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Mont hs and uuder 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Tuberculosis – – – – – – – 1 – 1 Want of attention 2 – – – 2 – – – – 2 Syphilis – – – – – – – – – – Other causes 2 – – – 2 – – – – 2 4 – – – 4 – – 1 – 5 Table XX. Deaths of children unknown :— Males. Females. Total. Legitimate 1 – 1 Illegitimate 1 3 4 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, 1920. Legitimate. Illegitimate. Total Infant Deaths, 1929. Legitimate. Illegitimate. 1929—Infant death rate per 1,000 births. legitimate. Illegitimate. Total. Conduit 3,456 1 1 – – – – – – – Grosvenor 13,880 78 60 18 5 3 2 50.0 111.1 64.1 Pall Mall 3,572 14 10 4 – – – – – – Regent 6,878 39 32 7 3 3 – 93.7 – 76.9 Gt.Marlborough 3,194 16 15 i 3 2 1 133.3 1000.0 187.5 St. Anne 6,699 71 65 6 2 2 – 30.7 – 28.1 Covent Garden 7,064 62 58 4 3 2 1 34.4 250.0 48.3 Charing Cross 4,650 11 9 2 3 2 1 222.2 500.0 272.7 Strand 2,116 3 3 – 1 – 1 – – 333.3 Victoria 37,396 499 425 74 42 32 10 75.2 135.1 84.1 K. St. George 12,563 104 94 10 2 2 – 21.2 – 19.2 Hamlet 6,687 24 19 5 4 2 2 105.2 400.0 166.6 St. Margaret 9,261 47 44 3 1 1 – 22.7 – 21.2 St. John 24,102 387 355 32 31 31 – 87.3 – 80.1 Homeless – 1 – 1 5 1 4 – – – Total 141,578 1,357 1,190 167 105 83 22 69.7 131.7 77.37 21 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 permanent, but a greater proportion are birds of passage. Deaths among the latter class of people tend to increase the death-rates of the wards in which those lodging houses are situated; 138 deaths of persons giving addresses in common lodging houses occurred in 1929. They were mostly in institutions:— Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 28 33, Great Peter Street 2 10, Great Peter Street (Salvation Army) (licensed for 565 men) 42 16, Strutton Ground (licensed for 201 men) 48 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 16 Church Army Home, Greencoat Place 2 138 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. A somewhat full survey, which included a schedule of the hospitals for Fever, Smallpox, Tuberculosis and various other diseases, owned and administered by the Metropolitan Asylum Board, was given in the report for last year. By the time this report is issued the Board will have been absorbed by the London County Council. The latter may have schemes of reorganization in contemplation which may also include the poor law infirmaries now under its control as decreed by the Local Government Act, 1929. In the report for 1930, it may be possible to discuss the provision of hospitals by the public authority in the light of what has been accomplished by the London County Council since 1st April. Apart from those hospitals which have been alluded to in the preceding paragraph, the Health Services actually in operation in the City fall under the following heads:— Provided by (1) the City Council, (2) Voluntary Associations, (3) National Health Insurance Act, (4) City of Westminster Guardians, (5) Private Medical Practitioners, (6) Nursing Associations. The health services provided directly by the City Council are discussed in the appropriate sections of this report 22 Voluntary Associations. Voluntary Hospitals. The following general hospitals are situated in the City. Out-patient departments are established at each and the total number of beds for in-patients is 976:— Westminster.—Broad Sanctuary. St. George's.—Hyde Park Corner. Charing Cross.—Agar Street, Strand. Treatment is free at all of them for those who are unable to contribute to the cost of treatment. It may be remarked parenthetically that Westminster is the hospital area for London. In no other district can be found so many voluntary hospitals or so many dealing with special diseases. Provident Dispensaries. These are 4 in number, situated as follows:— Public Dispensary, 122, Drury Lane, W.C. St. George (Hanover Square), 16, Little Grosvenor Street, W. Western Dispensary, 40, Rochester Row, S.W. Westminster General Dispensary, 9, Gerrard Street, W. They supply not only treatment to out-patients, but also visits by their honorary medical officers to patients' homes. Resident medical officers are attached to two of them for the purpose of undertaking emergency work, either at the dispensary or in the homes of patients. In some instances, special clinics for dental, ;eye, ear, nose and throat work are held, while in one instance a district midwifery service is provided. The excellent services which these provident dispensaries provide cannot be too highly praised. This work is carried on unobstrusively, but none the less efficiently. It is feared that, in these days when publicity is so effective, they have not made the fullest use of this instrument. They are dependent on voluntary subscriptions and on the small fees for membership (say, 1s. per month) which patients pay. There is good reason to believe that National Health Insurance with its medical services has to some extent deprived the dispensaries of much of their opportunities for service, at least so far as insured workers are concerned. But there is still a great need for the benefits of the dispensaries among the dependents of those workers. At the present time they supply the only medical services in the homes of the people for those who are not insured and who cannot afford private medical attendance and are yet not so distressed as to require the services of 23 the poor law medical officer. It is significant that, one of these, the Royal Provident Dispensary, Pimlico, closed down sonic years ago owing to lack of support, and the building has since been demolished. It has often been said that the general medical practitioner is first line of defence in the constant warfare against disease which is being waged in every civilized community. These dispensaries are staffed by general practitioners in the neighbourhood who, in addition to the advantage of having intimate knowledge of the medical histories of the families, have also almost daily contact with the home conditions, a factor which can be appreciated at its true value by those whose duty it is to supervise the public health. In any scheme of co-ordinated health services, the fullest recognition should be paid to the work of these institutions. It is possible that the London County Council may, in accordance with the Local Government Act, 1929, co-ordinate the work of the voluntary hospitals with that of what were formerly the poor law infirmaries. This would give a valuable opportunity of linking up the out-patient work of the hospitals with the medical treatment carried on by the dispensaries in the homes of patients. It might also provide what at the present time is lacking in the teaching schools of the London hospitals, namely, training in diagnosis and treatment in the homes of the people, which is probably the most important work which a general practitioner is called upon to do. National Health Insurance. Under the National Health Insurance scheme there are 90 medical practitioners practising in Westminster who are under contract to treat patients in insured occupations. The City of Westminster Guardians. The City of Westminster Guardians, in addition to providing hospital accommodation to the number of 720 beds at St. Stephen's Hospital and beds in convalescent homes, have a staff of 6 part-time medical officers whose duty it is to attend daily at the Guardians' dispensaries to deal with out-patients and also to undertake treatment at home for cases referred by the Relieving Officer. Until 1st April, 1930, the Guardians are also the authority for administering the Vaccination Acts. The Guardians provide free vaccination and re-vaccination for persons permanently resident in the City. There are five public vaccinators working in different areas. The Vaccination Officer, also on the Guardians' staff, acts as registrar for the purposes of the Vaccination Acts. The City Council is an authority under the Maternity and Child Welfare Act, 1918, and has established a scheme which, in conjunction 24 with voluntary agencies throughout the City, serves the needs of this branch of public health work. Maternity Beds.—Maternity beds are provided at the three general hospitals in the City, viz.: Westminster, 15; St. George's, 11; Charing Cross, 15. (Fuller reference in Maternity and Child Welfare Section.) Hospitals for Children.— A part from the Infants' Hospital, Vincent Square, with 50 beds for children up to five years of age, there are no hospitals devoted exclusively to diseases of children. The three general hospitals have special pediatric departments in charge of specialist physicians. Accommodation for in-patient children is as follows: Westminster, 21 beds; St. George's, 19 beds ; Charing Cross, 22 beds. Orthopaidic:—Orthopedic departments exist at the general hospitals mentioned in the preceding paragraph. Other hospitals of a special character in the City are the following:— All Saints' Hospital, 49, Vauxhall Bridge Road. Genito urinary diseases. 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. King Edward VII Hospital for Officers, 17, Grosvenor Crescent, S.W. London Lock Hospital, 91, Dean Street, W. Queen Alexandra Military Hospital, Millbank. Royal Dental Hospital, 32, Leicester Square, W.C. 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. The City Council does not subscribe to the funds of any of the voluntary hospitals except where contribution is in respect of some direct service, e.g., to Westminster Hospital for maternity cases sent from the Council's Maternity and Child Welfare Centres. Hospitals in areas near to or adjoining the City which are available to Westminster patients as they are to patients from any part of London or beyond include :— The Middlesex Hospital. St. Thomas' Hospital. 25 The General Lying-in, York Road. Queen Charlotte's Hospital. Royal Free Hospital. Royal Westminster Ophthalmic Hospital, Broad Street, Holborn. The Children's Hospital, Great Ormond Street. The Victoria Hospital for Children, Tite Street, Chelsea. Cheyne Hospital for Children, Chelsea. St. Stephen's Hospital (720 beds) is the Westminster Guardians' Hospital, and is situate at 369, Fulham Road, S.W. Institutional provision for unmarried mothers, illegitimate infants and homeless children in the area:— St. Anne's Shelter, 67, Denbigh Street, S.W.1. 9 beds. Home of Compassion, 63, Sutherland Street S.W.l 13 beds. St. John the Baptist's Home, 159, Tulse Hill, S.W.2 15 beds. Ambulance Facilities. (a) For infectious cases.— The ambulance service of the Metropolitan Asylums Board is available at all times free of charge and is extremely efficient. (b) For non-infectious cases, accidents, etc.:— (1) The ambulances of the Metropolitan Asylums Board on a ment for mileage. (2) Ambulances of the London County Council. (3) Ambulances of the Westminster Guardians to remove cases to the Guardians' Hospital, available day and night without charge. (4) Ambulances of the British Red Cross Society on payment. (5) Private ambulances, e.g., Daimler Hire Services, on payment. Clinic and Treatment Centres.—Maternity and Child Welfare Centres:— (1) Administered entirely by the Westminster City Council:— (а) 14, Westbourne Street.—Self-contained premises of 6 rooms (temporary centre). (b) 15, Bessborough Street—Self-contained house of 9 rooms, (c) 9, Fritli 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 AVelfare Centre. The above are mainly consultation centres, treatment being given only in special circumstances, and on a most limited scale. (9583) c 26 (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. Day Nurseries:— The British Red Cross Society's Day Nursery, Warwick Street. Accommodation for 40 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. The Metropolitan Asylums Board also provide in-patient treatment for orthopaedic cases. 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. 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 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. In view of the pending demolition of the dispensary premises at 1, Pimlico Road for the 27 purpose of an improvement of the area, the dispensary was transferred to temporary premises in Monck Street at the end of the year. There are also special tuberculosis departments for out-patients at St. George's and Charing Cross hospitals. Patients suffering, from tuberculosis are, in special instances, retained as in-patients in these hospitals until arrangements can be made for their removal to tuberculosis institutions of the Metropolitan Asylums Board. Treatment Centres for Venereal Diseases.— These are not within the province of the City Council. They are conducted at the three general 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 J ' 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.) †*Thomas M. Ling M.A., M.B., B.Ch., M.R.C.S., L.R.C.P, (Maternity and Child Welfare) Obstetric Consultant: *Aubrey 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 (Anæsthetist) 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. (9583) c 2 28 Clerical Staff: Arthur Wise (Chief Clerk). A. J. Manhood. S. G. Bennett. F. W. Lake K. E. Norwood (Appd. 14/10/29). W. Jenkins. †Miss M. MacFarlane (Tuberculosis pensary). Sanitary Inspectors: †John Sanderson (Senior Sanitary R.S.I., San. Sc. Cert., Gold Medallist Inspector) Carpenters' Company. †M. Canton S.I.E.B., Meat Cert., R.S.I. †W. J. Davies (Sampling Officer) S.I.E.B., Meat and Food Cert. †C. J. Dee S.I.E.B., R.S.I., 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. Ratcliff S.I.E.B., Meat and Food Cert. †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 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., Certificated Midwife, Hosp. Nursing, State Registered Nurse. †Miss D. H. M. Walding S.I.E.B., Dipl. Nat. Health Soc., Nursing, Dipl. Board of Education. †Miss Howell Evans S.I.E.B., Dipl. Nat. Health Soc., Nursing. †Miss M. M. Scott S.I.E.B., H.V., Certified Midwife, Dipl. Board of Education. †Miss H. Blick H.V., Certificated Midwife, Dipl. Board of Education. †Miss F. Rigg (resigned 28/9/29) H.V., Certificated Midwife, Dipl. Board of Education. †Miss E. Turnbull (Temporary H.V., Certificated Midwife, State 10/10/29) tered Nurse, Miss P. L. Luff (Appd. 28/11/29) S.I.E.B., Certificated Midwife, Dipl. Board of Education. †Miss F. Avery (Temporary 16/12/29) H.V:, Certificated Midwife. Instructors in Mothercraft at Centres. †*Mrs. Coleman Red Cross Cert. 1st cl., and gold medal. †*MRs. 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. 29 W. Slattery, Engineer. J. Atkins, Disinfector. s. C. West, Disinfector. F. W. Attwater, Disinfector. 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. Whittlesea, Miss Mates and Miss Barry,† Cleaners. In addition to the above, the following are the staff 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., Centre) 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 (Mothercraft Classes). Nursing in the Home.— Except as regards midwifery in certain districts of the City, the Council does not provide a nursing service. The need is most adequately undertaken by the following District Nursing Associations:— The Metropolitan Nursing Association, The Westminster Nursing Association, The Pimlico, Belgravia and Chelsea Nursing Association. The first mentioned also carries out a district midwifery service in the northern area of the City in conjunction with the out-door maternity department of Charing Cross Hospital. Midwives.— As previously stated, the Council employs on its staff one whole-time midwife. She undertakes necessitous cases in the wards of Victoria, Knightsbridge St. George and Hamlet of Knightsbridge. The Westminster Health Society employs two midwives for cases in St. Margaret and St. John wards. They are whole-time officers of the society. Midwifery in the remaining areas is undertaken by the Metropolitan Nursing Association, working in conjunction with Charing Cross Hospital. The out-door midwifery department of Middlesex Hospital also operates 30 to a large extent in Soho and in the district lying immediately to the south of Oxford Street. The needs of necessitous cases throughout the City are therefore adequately met. Only 4 private practising midwives reside in the City, but the total number of midwives who practice in the area is estimated to be 31. The London County Council is the local supervising authority underthe Midwives Act. and all payments to medical practitioners and midwives authorized under this Act are made by this body. Maternity and Nursing Homes.—A part from the general sanitary supervision of premises, workplaces, &c., which the City Council exercises, it has no control over the registration and organization of these homes. The London County Council is the authority under the Nursing Homes Registration Act, 1927. From a schedule of maternity and nursing homes in London issued by the County Council it would appear that there are 7 such homes in Westminster. 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 ???assist in the investigations and have readily supplied information. 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 practitioners 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 tne 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. Local By-laws and Regulations.—The following by-laws and regulations made by the City Council are in force in the City and became operative on the dates mentioned:— 31 By-laws under the Public Health (London) Act, 1891– Paving of yards and open spaces in connection with dwellinghouses.–24lh August, 1908. Cleansing of Cisterns. 24th August, 1C08. 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.–11th January, 1916. By-law relating to fouling of footways by dogs.–March. 1928. 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 1925-1929. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1923 1926 1927 1928 1929 Smallpox – – – 2 2 Diphtheria 286 223 185 233 170 Erysipelas 44 44 37 47 54 Scarlet fever 214 132 180 241 227 Enteric fever 17 11 24 28 7 Continued fever – – – – 1 Puerperal fever 6 5 6 6 10 Puerperal pyrexia – 7 26 21 12 Cerebro-spinal meningitis 3 1 1 1 2 Encephalitis lethargica 7 5 1 1 – Poliomyelitis 3 2 1 – 1 Ophthalmia neonatorum 21 16 14 7 11 Measles 117 1,026 71 997 381 German measles 117 14 12 21 179 Pneumonia 58 69 64 26 51 Malaria 1 – 1 2 – Dysentery 3 – – 8 7 Anthrax – – – – – Chicken pox 149 198 206 210 229 Mumps 120 64 153 150 73 Whooping-cough 255 46 128 70 246 32 Smallpox.—Smallpox of the mild type known as "variola minor," hitherto prevalent in the North and Midlands, began to appear in London in 1928, when 285 cases were notified. In 1929, however, the number has increased to 1,116 in the London area. It would appear that the bulk of the cases came from outlying districts, such as the County Borough of West Ham, and boroughs on the eastern side of London, Hackney, Bethnal Green, Poplar and Stepney. There were 6 deaths. The disease appears to have been rife where large masses of the population have neglected to take advantage of the protection afforded by vaccination. Although only two cases occurred among residents in Westminster and 10 in those who worked in Westminster but resided in other districts, the work entailed in keeping non-resident contacts under supervision has become very onerous. Authorities of districts where patients reside rely on those in charge of districts where the contacts of such patients work to keep the said contacts under observation. This has required frequent visits by the Sanitary Inspectors to workplaces. Some 478 contacts were visited 1,400 times. Lists of contacts provided by employers totalling some 1,500 names and addresses have been received in the department, and have been circulated to the districts of residence of contacts of cases of smallpox found at work or known to have been at work in Westminster. The 2 eases of this disease notified during the year in the City were both females, aged 30 and 27 respectively. The latter case, a school teacher, contracted the mild variety of smallpox which is still prevalent throughout the country. The former case was a first-class passenger on board the S.S. Tuscania, from which vessel cases of smallpox had been landed on the way home from India. She took up her residence at a large hotel in Westminster, was subsequently seen by the Medical Officer of Health and removed to hospital as a case of smallpox of the Eastern variety, although greatly modified owing to vaccination. Other cases among passengers and crew of this vessel were notified in various parts of the Country and in London. The disease was mostly of the severe type, "Variola major," and a number died. Fortunately, both Westminster cases were but slightly affected and made speedy recoveries. Information was received from Port Sanitary Authorities of 102 contacts from various ships in which cases of smallpox had occurred. 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 33 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 550 Secondary 351 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 (Smallpox Protection) Regulations, 1917. 34 Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1929. Notifiable Diseases. At all Ages. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Smallpox 2 - - - - - - - - 2 - - - 2 - - - - - - - - - - - - - - Cholera (C). Plague (R) - — — - — — — — — — — — — - — — — — — — — — — — — — — — Diphtheria 148 3 5 8 14 13 48 21 8 20 2 6 - 147 1 8 1 2 3 1 - - - - - - 1 Erysipelas 54 1 - - 1 - 1 1 1 6 6 30 7 41 13 1 - - - - - - - - - - 1 - Scarlet fever 208 l 2 7 21 15 86 25 14 31 3 3 - 204 4 - - - - - - - - - - - - - Typhus fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 7 - 1 3 2 1 - 4 3 - - - - - - - - - - - - - Relapsing fever (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued fever (C) 1 - - - - - - - - 1 - - - - 1 - - - - - - - - - - - - - Puerperal fever 10 - - - - - - - - 10 - - - 8 2 3 - - - - - - - - 3 - - - Cerebro-spinal meningitis 2 - 2 - - - - - - - - - - 2 - 1 - - - - - - - - - 1 - - Poliomyelitis 1 - - - - - 1 - - - - - - 1 - - - - - - - - - - - - - - Encephalitis lethargica - - - - - - - - - - - - - - - 2 - - - - - - - - 1 - - 1 Ophthalmia neonatorum 11 11 - - - - - - - - - - - 4 7 - - - - - - - - - - - - - Pneumonia 51 — — — 1 1 1 3 1 9 8 18 9 26 25 81 1 1 — - - 1 1 — 9 8 30 30 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 7 l 1 1 1 2 1 - - - - - - 7 - - - - - - - - - - - - - - Puerperal pyrexia 12 - - - - - — - 1 10 1 — — 11 1 — — — — — — — — — — — — — Totals 514 17 10 16 38 31 138 50 26 92 22 58 16 457 57 96 2 3 3 1 — 1 1 — 13 9 32 31 Correction has been made for errors in notification or revision of diagnosis in 46 cases. Cases not notified :— Scarlet fever, 1/12 1, 3, 6, 6, 6, 6, 6, 6, 7, 8, 8, 10. 17, 17, 19, 20, 40, 40. Diphtheria, 2, 2½, 3, 3, 3, 3½, 4, 4, 4, 4½. 5, 6, 6, 8, 13, 16, 19, 21, 25, 25, 25, 29, 35 Table XXIV. City of Westminster.—Infectious Diseases, Distributed in each Ward. Notifiable Diseases Condult. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St Anne. Homeless. Smallpox — — — 1 1 — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — Diphtheria 1 5 12 49 4 55 2 5 6 — 1 14 3 12 1 Erysipelas 1 2 5 17 5 17 1 1 — — 1 — — — 4 Scarlet fever 1 14 18 65 6 66 2 2 7 2 5 21 4 14 — Typhus fever — — — — — — — — — — — — — — — Enteric fever — 1 2 1 1 1 — — — — — — 1 — — Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — 1 1 2 — 4 — — — — — — — 2 — Cerebro-spinal meningitis — — — 1 — 1 — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — 1 Encephalitis lethargica — — — — — — — — — — — — — — — Ophthalmia neonatorum — — 1 5 — 4 — — — — — — — 1 — Pneumonia 1 4 10 10 9 10 — 2 1 1 — — — 2 1 Malaria — — — — — — — — — — — — — — — Dysentery — — — 2 — 2 — — — — — — — — 3* Puerperal pyrexia — 1 1 8 — 1 — — — 1 — — — — — Totals 4 28 50 162 26 161 5 10 14 4 7 35 8 31 10 * Non residents 36 Scarlet Fever.—227 cases of this disease occurred in 1929, a decrease of 14 on the figures of 1928. The Covent Garden Ward showed a marked increase, the distribution in the remaining wards being normal. There were no deaths. The case rate of this disease per 1,000 of the population was 1.74 for the City, and for England and Wales 3.05. Of the total cases in Westminster 98.2 per cent. were removed to hospital. Diphtheria.—170 cases of this disease occurred, showing a decrease of 63 on the figures of 1928. The wards showing a marked decrease are St. John, Victoria and Grosvenor. The largest number of cases occurred between the ages of 5.10 and 20.35. There were 8 deaths (7 males and 1 female) and mostly between the ages of 1.5. giving a rate of 47.0 per 1,000 cases. The case rate of this disease for Westminster was 1.30 per 1,000 living, and for England and Wales 1.59. The death rate for Westminster was 0.06. and for England and Wales 0.08. Report ox Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1929. During the year Schick Testing and Immunisation Treatment against Diphtheria was continued at the Council's Maternity and Child Welfare Centres and the Westminster Health Society's Centre in Page Street, one clinic being held each week at each Centre. Two hundred and four new cases came to the clinics in 1929, as compared with 256 in 1928. The numbers show some variation, depending on the presence of diphtheria in the district, the time of year, and possibly on variations in the other work at the Centres, but on the whole, there does not seem to be any marked falling off in the number desiring this treatment. As in previous years, it was noted that a considerable proportion of the patients (about 10 per cent.) had not been vaccinated against smallpox. New cases attended the different Centres as follows:— 1, Pimlico Road 81 15, Bessborough Street 55 30, Page Street 50 9, Frith Street 18 204 The work entailed 312 tests and retests, 506 protective injections and 161 attendances for inspection only, a total of 979 attendances. 37 In the case of very young children, treatment was sometimes given without the preliminary test. Such cases would usually give positive results if the test were performed, and by omitting it one injection is avoided. In many cases the parents prefer to have the test done, however. The results of testing were as follows:— Age. Positive. Negative. No test. Total. Under 5 years 84 9 22 115 Under 10 years 49 24 — 73 Over 10 years 12 4 — 16 145 37 22 204 Four of the nine negative cases under 5 years of age had definitely been in contact with diphtheria, and 3 others belonged to large families who were all negative and who had therefore probably been in contact with infection. Six cases were under treatment at the end of the year, 2 stopped treatment after the test, and 8 others stopped after two injections owing to illness or for family reasons. In some cases, two injections have been found sufficient to give the desired immunity. The protective treatment takes at least three months to have its full effect. It is customary to repeat the Schick test about six months after treatment in order to demonstrate that the patient has obtained the desired protection. Since the treatment was started in Westminster about 60 per cent. of those who required and were due for this retest have received it. During 1929, retests were performed on 127 cases; of these, 112 were negative, having been positive at the initial test before treatment; 11 were still slightly positive or doubtfully negative; 9 of these received two more protective doses each and three of them were negative at a second retest. The others have not yet received the second retest. Two children (brothers) were unable to attend for the reading of the retest. Two young children were retested as the primary result was indefinite. The second tests were positive and the children received treatment. One child who had received treatment followed by a negative retest was notified as suffering from diphtheria and was removed to hospital. The hospital reported that the diagnosis of diphtheria was not confirmed and the child was sent home in a few days. 38 Antitoxin, for use in cases of diphtheria, is provided free of charge for medical practitioners attending patients residing in the City. The supply is available on application at the City Hall, and at the Council's Mortuary in Horseferry Road. It is apparent from the small amount used (12 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 1925, was:— 1925. 1926. 1927. 1928. 1929. 674 679 595 646 607 Enteric Fever.—There were 7 cases of typhoid and paratyphoid which came to the knowledge of the department during 1929. Of these were notified as paratyphoid and 3 as typhoid. There was a history of fish having been consumed in 1 case, watercress 1, ice cream 1, 2 cases came from abroad, and no history was obtainable in 2 cases. There were no deaths. The death rate of this disease for England and Wales was 0.01. The case rate for England and Wales was 0.07 and for westminster 0.05. Measles.—The following table shows the number of cases notified head teachers of schools, the Metropolitan Asylums Board, hospitals and private practitioners during the last five years:— 1925. 1926. 1927. 1928. 1929. 117 1,026 71 997 381 The death-rate for England and Wales per 1,000 population was 0.08, for London 0.04, and for Westminster 0.03. 129 cases were moved to hospital (119 to the hospitals of the Metropolitan Asylums Board and 10 to private hospitals). 59 cases were under 5 years of age, and 4 deaths occurred, all females between the ages of 1 and 5 years. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows:— 39  1925. 1926. 1927. 1928. 1929. Males 13 10 24 12 51 Females 24 9 37 6 48 37 19 61 18 99 The death-rate in 1929 for Westminster was 0.76 per 1,000; for London 0.69, and for England and Wales 0.74. Last year the corresponding rates were 0.13 for Westminster. 0.13 for London, and 0.19 for England and Wales. Diarrhœa and Enteritis.—Deaths from this cause were much lower than in 1928. The total deaths were 8—3 males and 5 females—7 being under 1 year old. The infant death-rate from this cause in Westminster was 5.8. Table XXVI. Deaths from Diarrhœa and Enteritis. Under 1 year. Other ages. Total. 1925 8 5 13 1926 13 7 20 1927 16 — 16 1928 14 4 18 1929 7 1 8 58 17 75 The 7 deaths under 1 year of age occurred during the 2nd and 3rd quarters of the year. Whooping Cough.—246 cases were notified during the year, with 19 deaths—11 being under 1 year. This is a huge increase on the figures of 1928, when 70 cases, with 3 deaths, were recorded. 30 cases were moved to hospital. The death-rate for Westminster was 0.15, for London 0.26, and for England and Wales 0.15. The deaths from whooping cough during the last five years are thus set out:— Table XXVII. Under 1 year. At other ages. Total. 1925 7 10 17 1926 1 1 2 1927 2 5 7 1928 3 — 3 1929 11 8 19 24 24 48 40 Cerebro-spinal Fever.—2 cases only of this disease occurrcd, with 1 death. Poliomyelitis.—1 case occurred. Encephalitis Lethargica.—No cases were notified. Two deaths occurred during the year. Chicken Pox.—229 cases were notified, 5 being moved to hospital. Mumps.—73 cases were recorded. Plague, etc.—Intimation was received of two persons coming into Westminster from places infected with plague. Anthrax.—There were no cases in 1929. Puerperal Fever.—10 cases occurred, with 3 deaths—8 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. 1925 1,535 6 1 1926 1,606 5 2 1927 1,399 6 1 1928 1,370 6 3 1929 1,357 10 3 Puerperal Pyrexia.—12 cases occurred, 10 being notified by hospitals. To the women concerned in the above 12 cases (9 were married and 3 single), 8 children were born; the remaining 4 cases arose from miscarriage. Ophthalmia Neonatorum.—11 cases occurred in 1929—3 males and 8 females. Four were admitted to hospital and 7 treated either at home or as out-patients of hospitals. In addition to these notified cases, 15 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. 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. 41 The following details in tabular form are required by the Ministry of Health of the cases notified in 1929:— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 11 7 4 11 — — — 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 607 Blood in suspected typhoid 9 Sputa for investigation of T.B. 358 Expenditure on first two was £86 7s., and for the third £47 17s. 3d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1929, 259 new cases of pulmonary tuberculosis came to the knowledge of the Department, including 13 cases who had moved into the City, and 32 non-notified deaths. Non-pulmonary forms of tuberculosis gave 42 cases—7 of these being non-notified deaths and 2 transfers. (9583) D 42 Table I. Tuberculosis, 1929. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. Under 1 _ _ 1 2 - - 1 2 1 1 — 2 3 - - 1 1 5 1 1 6 5 - - 1 - 10 1 - - - - - - - 15 10 16 — 3 3 4 - - 20 12 20 2 4 2 5 1 - 25 31 30 1 6 11 5 - 1 35 33 15 1 2 16 3 - - 45 33 19 1 1 26 7 - 2 55 18 5 — 1 19 3 - 1 65 and upwards 8 5 — 1 6 3 — — Totals 148 111 14 28 83 30 4 7 In this table all primary notifications are included, and also other new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the year. The total cases for 1929 show a total increase of 65 on those of 1928. There was an increase of 24 males and 48 females among the pulmonary cases, but as the increase of primary notifications was distributed more or less evenly throughout the four quarters of the year, the rise in the 1929 figures must be attributed to the non-notified deaths; 27 of these occurred during the first two quarters of the year, which, with the increased number of deaths from influenza and other respiratory diseases, was associated with the severe winter of 1928-9. Out of the total cases notified in 1929. 41 died, and the following table shows the period between notification and death of these cases:— Weeks. Months. 1—2 2—3 3—1 1—2 2—3 3—4 4—5 5—6 6—7 7—8 8—9 9—10 l0-11 14 2 4 8 6 4 1 - 1- - - 1 Table II. 1925 1926 1927 1928 1929 New cases notified 282 288 245 213 247 * Number included in above who died during the year 46 (16.3%) 45 (15.6%) 31 (12.6%) 32 (15.0%) 41 (16.5%) Total Tuberculous Deaths 129 133 114 108 124 Death Rates per 100,000 92.4 96.0 83.5 83.2 98.8 43 Table III. Tuberculosis.—Notifications received during the period from 30th December, 1928, to 28th December, 1929. 1920. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males - 1 1 1 9 12 29 27 26 11 5 122 131 Females — — 1 — 15 17 26 12 16 2 3 92 104 Non-pulmonary— Males - 2 5 - - 2 - 1 1 - - 11 12 Females 1 2 4 — 2 4 5 2 — — 1 21 22 Total 1 5 11 1 26 35 60 42 43 13 9 246 269 Number of notifications on Form B. (School medical inspection.) Number on on Form C. Admissions to Primary notifications. Total notifications, including cases previously notified. Poor Law institutions. Sanatoria. Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males - - - - - 11 75 Females — - - - - - 50 Non-pulmonary— Males - - - - - - 17 Females — 1 — 1 1 — 17 Total — 1 — 1 1 11 159 (9583) 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. 1920. Age Periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total. Pulmonary- Males — — — — 1 — 2 6 7 7 3 26 Females — — — — 1 3 4 3 3 3 2 19 Non-pulmonary- Males 1 — 1 — — — 1 — — — — 3 Females 1 1 — — 1 — 1 — 1 1 — 6 Total 2 1 1 — 3 3 8 9 11 11 5 54 C.L.H. General. Non-pulmonary. C.L.H. General. Total. Notified pulmonary 43 171 - 33 247 Not notified in Westminster - 45 - 9 54 Total 43 216 42 301 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. 1929. All Ages. Conduit. Grosvenor. Knightebridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Received Institutional Treatment during 1929. Pulmonary— Males 148 1 7 6 33 5 52 2 3 4 3 3 1 13 7 8 111 Females 111 2 5 10 29 4 25 3 3 3 3 4 7 1 9 3 79 Non-pulmonary Males 14 — — 2 6 — 3 — — — 1 — 1 — - 1 11 Females 28 1 1 1 7 1 13 1 — 1 — — — — 2 — 18 301 4 13 19 75 10 93 6 6 8 7 7 9 14 18 12 219 46 Table VI. Tuberculosis Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all forms. General Population. C.L.H and no Address. Total. Males. Females. Males. Females. Males. Females. Total. 1912 233 154 115 10 512 - - 59 571 1913 203 174 89 8 474 91 86 177 651 1914 186 105 94 4 390 34 38 72 462 1915 155 95 59 8 317 46 26 72 389 1916 183 135 64 9 391 42 39 81 472 1917 209 164 51 7 431 42 34 76 507 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 1929 106 105 42 6 259 14 28 42 301 (Military cases which were excluded during the war were again made notifiable in 1920.) A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the City. Non-notified Deaths.—There were 39 deaths from Tuberculosis (23 males and 16 females) during 1929 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, of inmates of asylums, etc., and the cause of death in some cases was only discovered on post-mortem examination. These 39 non-notified deaths gave a percentage of 31.4 of the total deaths from Tuberculosis for the year. The total number of cases of Tuberculosis on the Register at the end of 1929 was 1,571 as compared with 1,489 at the end of the year 1928. The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths is much higher this year, having risen from 23 to 39; the corresponding percentage proportions are 21.3 per cent. (1928) and 31.4 per cent. (1929). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner, who in the majority of cases was only called in when the patient was in an advanced stage of the disease. In 7 instances the diagnosis was made as a result of post-mortem examination. 47 Public Health (Prevention of 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 1929. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of eases on Register at beginning of year 1929 723 411 163 192 Notified for the first time during year 127 100 12 23 850 511 175 215 Removed from the Register on account of death or removal from Westminster 105 53 14 8 745 458 161 207 Of the 180 cases removed from the Register during the year 1929, 88 were on account of death, and 92 persons suffering from Tuberculosis moved from the City. Of the 88 deaths mentioned above, 1 died from a cause other than Tuberculosis. Deaths from Tuberculosis.—The total number of deaths from Tuberculosis for 1929 (all forms) was 124—Males 87, Females 37. This gives a death-rate for this disease of .98 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. 1925 129 .92 1926 133 .96 1927 114 .83 1928 108 .83 1929 124 .98 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 96.6 1925 ,, 115 82.3 14 10.0 129 92.4 1924 ,, 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 1929 „ 113 81.8 11 8.7 124 98.8 Westminster Tuberculosis Dispensary. Annual Report, 1929. The work of the Tuberculosis Dispensary was carried out during the year without any radical change in the routine described in previous reports. Four hundred and sixty-one new cases were examined during the year, of which 240 were considered to be definitely tuberculous, although not all at an active stage of the disease. The following table shows the sources from which new cases have been referred to the Dispensary during the last three years:— 1927. 1928. 1929. Practitioners 153 149 169 Health Visitors 158 159 162 St. Stephen's Hospital 52 61 65 Ministry of Pensions 9 10 8 School Medical Officer 27 42 33 Hospitals 9 11 11 Friends, Charitable Organizations, etc. 20 20 13 428 452 461 49 It may be noted that there are only minor variations in the numbers referred from different sources. The table shows a regular supply of new cases to the Dispensary from these different sources in fairly constant proportion. The annual totals vary in definite relation to the number of cases of Tuberculosis notified in Westminster. As in previous years, the Dispensary has been in constant touch, by letter, telephone or personal interview, with the practitioners in the district and with the officials of the various hospitals and charitable organizations which deal with Dispensary patients. The months of February and March, 1929, were characterized by extremely severe weather, and the effect of this was definitely noticeable in the work of the Dispensary. A larger proportion than usual of new cases during the year showed definite signs of acute active Tuberculosis, and, with few exceptions, these patients dated the onset of their symptoms from these severe months. Two hundred and forty new cases were considered tuberculous, as compared with 201 in 1928. Many of the patients with disease of longer standing showed some degree of loss of ground during, or soon after, this period. Seventy-one patients on the current Dispensary register died during the year, as compared with 52 in the previous year. These deaths were divided between new cases, with rapidly spreading disease, and old cases, some of over 10 years' standing, who had maintained fair health for a number of years but were apparently unable to stand the strain of an unusually hard winter. There does not seem any ground for believing that the increase of cases with active disease was anything but a temporary increase, or that the general tendency to decrease in Tuberculosis which has been noticeable in recent years will not continue. Although there was an increase during the year of new cases, and especially of cases that were definitely tubercular, there was a decrease in the total attendances at the Dispensary. This figure depends largely on the number of old cases who remain in regular attendance at the Dispensary. As has been pointed out, an unusually large number of these old patients died. The decrease, however, is probably due even more to the number who leave the district. This migration has been particularly noticeable in the last two or three years, and it may be that families with members who are tuberculous are particularly anxious to take advantage of any opportunity to move to the country or to the new housing estates on the outskirts of London. Eight per cent. of the cases who attended the Dispensary for the first time during 1929 had left Westminster before the end of the year, and over 10 per cent. of the old cases on the current Dispensary register were definitely known to have left the district. Xo doubt a corresponding proportion of old 50 cases who had not attended recently but were liable to return also left Westminster. The number of incoming cases is apparently much smaller. The number of cases of Tuberculosis notified annually in Westminster is now less than half the number notified annually ten years ago. It is probable that in the last two or three years the number of new cases each year who can become regular Dispensary patients is considerably less than the number who cease attendance owing to recovery, removal or death. It would seem probable, therefore, that there will be in the future a definite diminution of the work of the Dispensary, but it does not, at present, seem likely that this decline will be great enough in the immediate future to warrant any change in the existing arrangements at the Dispensary. It is possible, of course, that the decline in incidence may not continue uninterrupted. The children born during the War have not yet reached the adolescent years which are so serious for the tuberculous. 1925. 1926. 1927. 1928. 1929. New Patients 395 446 428 452 461 Old Patients attending 474 519 513 551 430 Contacts examined 150 162 131 98 111 Individuals who attended 869 965 941 1,003 891 Total Attendances 2,637 2,697 2,627 2,370 2,312 Written Medical Reports to London County Council and Medical Practitioners 1,280 1,378 1,270 1,300 1,333 Consultations with Medical Practitioners 90 92 105 98 143 Other visits paid by Medical Officer 87 46 149 112 97 Visits by Health Visitors to Dispensary Cases 5,636 4,144 4,875 3,444 3,257 Sputum Examinations 443 223 172 159 154 X-ray Examinations 2 5 12 16 12 The above table gives certain details of the work of the Dispensary in 1929 and in the preceding four years. The following table shows the number of cases which have been recommended for hospital and sanatorium treatment. It does not include the cases which are recommended for treatment in the Tuberculosis wards of St. Stephen's Hospital Hospitals. Sanatoria. Insured Males 23 44 Insured Females 2 1 Uninsured Males 14 15 Uninsured Females 7 6 Boys 2 2 Girls 0 1 48 69 51 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. 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 orthopædic treatment, or for treatment such as the removal of tonsils and adenoids. Twelve patients have had X-ray examinations, and 154 specimens of sputa have been examined at Westminster Hospital in connection with the work of the Dispensary. Eleven cases have had artificial Pneumothorax treatment at Brompton Hospital and elsewhere. In all, 116 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 7 times for Light Treatment at the London Hospital. Two cases have been referred to the Council's Dental Clinic for treatment. The total number of attendances was 12; 21 extractions and 3 fillings were performed. Dentures were supplied to both patients. 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. Several Pensioners have been recommended to the Ministry of Pensions for dental treatment. The Tuberculosis Care Committee has approved grants for extra diet to 14 persons for varying periods at a total cost to the Council of £75 19s. 9d. 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. The work of the Tuberculosis Care Committee has continued on the lines described in previous reports and much useful work has been done in advising patients who have returned from Sanatorium, or their dependents while the patient is away, as to the means whereby necessary assistance can be gained. There is hardly any necessitous case which cannot be aided by one organization or another, and much useful work is done in putting the patient in touch with the appropriate organization. The Care Committee also consider the financial situation of the patient and their familes and assess the amount of payment to be made for treatment. A large proportion of cases are not required to make any payment. 52 The Handicrafts Class, also described in previous reports, has continued its useful work throughout the year. The attendances and the results have been very satisfactory. A separate report on the work of the City of Westminster Tuberculosis Care Committee has been prepared by the Secretary, Miss A. Sanders. The report deals with the inclusive period 1928-1929, and gives an excellent survey of the aims of the Committee and the work which it has accomplished. As regards contributions towards the cost of sanatorium treatment, it is interesting to find that almost two-thirds of the cases during the past four years have been assessed as "free" by the Committee. Perhaps the most important feature of the report relates to the work of the Handicrafts Committee, which has been fortunate in securing the Mayoress as its President. The Handicrafts Class organized by this Committee, and maintained with difficulty on a purely voluntary basis, is one of the most useful measures that could have been conceived as part of an anti-tuberculosis campaign. 53 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. Return showing the Work of the Dispensary during the Year 1929. 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 90 87 5 2 9 17 14 12 99 104 19 14 (6) Doubtfully tuberculous — — — — — — — — 2 2 0 1 (e) Non-tuberculous — — — — — — — — 29 36 26 18 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 1 — — — — 1 1 1 1 1 (b) Doubtfully tuberculous — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 6 19 38 44 C.—Cases written off the Dispensary Register as— (a) Cured 2 5 — — — — 3 1 2 5 3 1 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — - - — — — — — 38 67 87 77 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 219 207 20 14 23 27 75 53 242 23l 95 67 (b) Diagnosis not completed — — — — — — — — 2 2 0 1 54 1. Number of persons on Dispensary Register on January 1st 675 2. Number of patients transferred from other areas and of " lost sight of " cases returned 30 3. Number of patients transferred to other areas and cases "lost sight of " 172 4. Died during the year 71 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 3 6. Number of attendances at the Dispensary (including Contacts) 2,312 7. Number of attendances of non-pulmonary cases at Orthopœdic Out-stations for treatment or supervision * 8. Number of attendances at General Hospitals or other Institutions approved for the purpose, of patients for— (a) " Light " treatment 7 (b) Other special forms of treatment 116 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 2 10. Number of consultations with medical practitioners— (a) At homes of Applicants 70 (b) Otherwise 321 11. Number of other visits by Tuberculosis Officers to homes 97 12. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,257 13. Number of— (a) Specimens of sputum, etc., examined †154 (b) X-ray examinations made in connection with Dispensary work 12 14. Number of Insured Persons on Dispensary Register on the 31st December 328 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 240 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 2 (b Form G.P. 36 0 * A number of surgical cases have been referred to the affiliated hospital, Westminster Hospital. No cases discharged as " cured " have returned to the Dispensary. † 1 urine. (Signed) Ian S. Thomson, M.D., Tuberculosis Officer. 24th February, 1930. 55 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (a) Pulmonary Tuberculosis. Annual Return showing in Summary Form the Condition of all Patients whose Case Records are in the possession of the Dispensary at the end of 1929, Arranged according to the Years in which the Patients First came under Public Medical Treatment for Pulmonary Tuberculosis, and their Classification as shown in Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. 1929. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive- Discharged as cured— Adults M. 2 - - - - - - - - - - - - - - - - - - - - - - - - F 7 - - - - - - - - - - - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - F. — — — — — — - - - - - - - - - - - - - - - - - - - Disease arrested— Adults M 13 1 10 1 12 1 - 3 - 3 1 - 4 2 6 - - - - - - - - - - F 34 1 2 — 3 5 — l - 1 3 - 1 — 1 - - - - - - - - - - Children M. 4 - — — — 1 - 2 - 2 1 - - - - - - - - - - - - - - F. 5 - - - - 1 - - - - 1 - - - - - - - - - - - - - - Disease not arrested Adults M. 14 - 11 11 22 2 - 2 3 5 2 - 8 5 13 5 3 9 8 20 19 6 25 28 59 F. 8 - 7 4 11 1 - 3 3 6 2 - 3 3 6 13 2 6 9 17 25 3 31 15 49 Children M. - - - - - - - - - - 2 - - - - 2 — — — — 5 — — — — F. 1 - - - - - - - - - 1 - - - - 1 - - - - 2 - 1 — 1 Condition not ascertained during the year 11 - - 4 4 1 — 1 — 1 2 — 2 2 4 10 — 9 5 14 — — — — — Lost Sight of or otherwise Removed from Dispensary Register 1,213 96 28 - - - 54 19 - 31 9 40 10 — 11 5 16 Dead- Adults M. 1 — — 356 356 — — — 25 25 — - - 18 18 — — — 29 29 — — — 14 14 F. — — — 182 182 — — — 16 16 — - - 11 11 — — — 13 13 — — — 10 10 Children M. - - - 1 1 - - - - - - - - - - 1 - - - - - - - - - F. — — — 1 I — — — 1 1 — - — — — — - — 1 1 — — — - — Totals 1,905 169 43 - - - 113 51 5 55 74 134 61 9 68 72 49 56 (b) Non-Pulmonary Tuberculosis. Annual Return showing in Summary Form the Condition of all Patients whose Case Records are in the possession of the Dispensary at the end of 1929, Arranged according to the Years in which the Patients First came under Public Medical Treatment and their Classification as shown in Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. 1929. Bones and joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive— Discharged asCured- Adults M. - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Children M. — - - 3 3 - - - - - - - - - - - - - - - - - - - - F. — — — 1 1 - - - - - - - - - - - - - - - - - - - - Disease arrested— Adults M. 1 - - - 1 - - - - - - 1 - 1 2 1 - - 1 2 1 - - 1 2 F. 1 - - 3 4 - - - - - - - - - - - - - - - - - - 2 2 Children M. — 2 - 16 18 1 1 - 4 6 - - - 4 4 - - - 4 4 - - - 6 6 F. 1 - - 13 14 1 — — 4 5 - - - - - - - - 2 2 - - - 2 2 Disease not arrested— Adults M. 1 - 1 - 2 - - - - - - - - - - 1 1 1 3 3 1 3 1 8 F. — 1 1 - 2 - - - - - - - - - - - - 1 1 2 7 3 3 3 16 Children M. — — - 10 10 — - — 2 2 1 - - 2 3 1 2 - 4 7 3 1 - 6 10 F.. — — - 3 3 - - - 1 1 — 1 - 3 4 1 1 - 4 6 5 2 — 4 11 Transferred to Pulmonary - - - - - - - - 1 1 - - - - - - - - - - - - - - - Condition not ascertained during the Year 1 - - 6 7 1 - — 1 2 2 1 - 2 5 - - - - - - - - - - Lost Sight of or otherwise Removed from Dispensary Register - - - - 224 - - - - 6 2 1 - 13 18 3 1 - 9 13 1 - - 2 3 Dead— Adults M. - - - - - - - - - - 2 - - - 2 - - - - - - - - - - F. - - - - - - - - - - - - - - - 1 - - - - 1 - - - - Children M. - - - - - - - - - - - - - - - - - - - - - - - - - F. — — - - — — - — — — — — - - - - - - - - - - - - - Totals 289 23 7 4 25 36 8 5 2 25 40 20 7 6 27 60 57 Cancer.—This subject continues to engage the most serious study. Deaths certified to be due to cancer numbered 215. The age period most affected was 45-65 (203 cases). The rate for males as compared with females was 1.9 to 1.5 per 1,000, and the region most frequently involved appeared to be the stomach. Cancer cases now take up a considerable proportion of surgical beds in general hospitals, and in Westminster there are not only three large general hospitals dealing with this type of case but a considerable proportion of the special hospitals also, as for example, St. Peter's Hospital for genito-urinary diseases and the two hospitals devoted to diseases of women. The vast amount of research and clinical work on the radium treatment of cancer at Westminster Hospital requires special mention. The staff of this hospital have been for some years in the forefront of clinical cancer workers in this country. Recognition of the excellence of the work done led the Radium Commission to choose this hospital for the grant of a radium bomb for a preliminary period of three years. Extreme pressure on the beds of the hospital induced the Governing Body to open and equip a special hospital or annexe for the radium treatment of cancer cases. This annexe, equipped with the "bomb" for practising radium treatment, and other apparatus for the treatment of cancer by deep X Rays, is situated in Fitzjohn's Avenue, Hampstead. There are 22 beds. The Staff comprises the Honorary Physicians and Surgeons of Westminster Hospital, and a whole-time Physicist, Pathologist and Radium Officer are engaged in order that research into all forms of cancer treatment may be strongly pursued in close proximity to the bedside. The nursing staff is supplied by the parent hospital. There does not appear to be in Westminster any call for a municipal cancer clinic, but it is worthy of discussion whether there might not be great benefit if the hospital authorities were to institute special clinics. There are quite a number of ways in which the local authority could co-operate and assist in such a project. SANITARY CIRCUMSTANCES OF THE AREA. Water.—The Ministry of Health does not require any information as regards water supply in the case of Metropolitan boroughs for the reason that the main supply for the metropolis is provided by one public authority, the Metropolitan Water Board. In Westminster, however, the custom of obtaining private water supplies in the case of large new buildings is growing. These supplies are obtained from deep or artesian wells, the borings into the chalk of the London basin reaching a depth (9583) f. 58 of 300 to 600 feet before a sufficient supply can be obtained. As these borings increase in number, a greater and greater depth has to be reached as the more superficial layers of underground water at 300 to 400 feet become exhausted by the withdrawals from existing borings. In certain cases it is a condition that an alternative supply from the Board's mains is available if required. In 1921, the then Medical Officer of Health reported the existence of 15 such wells in Westminster of varying depth between 300 and 500 feet. Since then deep wells have been or are now being sunk in connection with the following buildings:— Aldwych House; Bush House (2); Messrs. Cook's, Berkeley Street; 28, Brook Street; Sun Life Office, Cockspur Street; Imperial Chemical Industries, Grosvenor Road ; 112/114, New Bond Street (2); 87/91, New Bond Street and 333, Oxford Street; Grand Buildings, Northumberland Avenue; Grosvenor House, Park Lane (3 borings, 300 to 400 feet unsuccessful); Dorchester House, Park Lane; Messrs. Gamages, Marble Arch; Devonshire House, Piccadilly; Nos. 14 and 137, Regent Street; New Cinema, Wilton Road. The most recent to obtain a supply is the London Electric Railway Building, over St. James's Park Station. The depth of the two wells is 500 feet and they provide a supply which is stored in tanks of a capacity of over 127,000 gallons. The analysis shows the water to be of a high degree of organic and bacterial purity, and suitable for drinking and domestic purposes. The Officers of the Department are at the present time engaged in investigations with regard to these wells. Public Swimming Baths.—The question of the possibilities of infection from public baths and the methods of purifying the water received much public attention in the autumn. This resulted from a report issued by the Ministry of Health. The report under the joint authorship of Messrs. E. A. Sandford Fawcett, H. T. Calvert and J. Alison Glover, investigated the methods of purification at present in use and made certain recommendations chiefly in regard to the prevention of contamination of the water by the persons and clothing of bathers. For some years, the City Council's Swimming Baths have been provided with mechanical filtration plants. The whole of the water is "turned over" or passed through the filters twice a day. The process of filtration is continuous. By this means, all dirt and germs are removed from the water. In addition, a certain amount of chlorine is added to the water in order to keep it free from germs. The processes, filtration, heating 59 the water, chlorination and aeration (blowing in air to impart a fresh sparkling quality to the water) are carried out by mechanical means in sequence. So far as the Council's baths are concerned, the public need have no fear of infection. Frequent samples have been taken for bacteriological examination, and have shown a most satisfactory state of purity. At the present time, new baths are being constructed to replace those at Marshall Street in the Soho district. It is intended that these baths shall embody the most modern arrangements for preventing contamination of the water. At the request of the Chairman of the Baths Committee, the Medical Officer of Health took part in the deliberations of the Committee and with the Chairman, Baths Superintendent, City Engineer and Architect visited other districts where filtration plants had recently been installed. One of these visits was to Stretford, near Manchester, where much valuable information was obtained. In this instance, a periodic bacteriological scrutiny is carried out by the Medical Officer of Health and this particular filtration plant has satisfied the tests. Public Baths and Washhouses form an important provision as regards the public health. There are three separate establishments in the City, at Great Smith Street, Buckingham Palace Road and Marshall Street, the latter being in course of reconstruction. In this central London area, it is natural that the majority of those who use the swimming baths are not residents in the City. In warm weather, particularly, the baths are patronised to their utmost capacity and it is therefore of very great importance that every safeguard should be taken to keep the water pure. The numbers using the swimming baths during 1929 were as follows:— Great Smith Street: 120,572 men; 43,597 women. Buckingham Palace Road: 76,420 men; 43,608 women. Those using the washhouses during the year were:—Great Smith Street, 25,753; Buckingham Palace Road, 36,042. Drainage and Sewerage.—The Ministry does not require any information under this head as the London County Council is the Authority for main sewers and sewage disposal. Local sewers however, are built, maintained and controlled by the Works Department of the City Council. Many complaints were received, particularly during the intensely dry summer and autumn, of foul emanations from the sewer gratings in the streets. This was due to an order of the County Council which entailed the opening of sewer ventilators which had formerly been closed or (9583) E 2 60 screened. This policy was a natural outcome of the investigation of the causes of the serious explosion which occurred in the underground conduits in Holborn at the end of 1928. As a result of many representations the County Council closed a number of these ventilators and this, with the setting in of a particularly wet season, removed the cause of complaints which while it lasted may not have been actually injurious to health, but was certainly nauseating and not conducive to good health. House Drainage.—This is the concern of the Public Health Department to the extent that the drainage on the house side of the intercepting traps of all buildings, except those owned by the Government, Royal Palaces, and Embassies is subject to its supervision. Where new buildings are being constructed, or alterations are being made which involve additions to or modification of existing sanitary arrangements, plans must be submitted to the Medical Officer of Health in order that he may report to the Council as to whether the work to be done complies with requirements laid down in the By-laws made under the Metropolis Management Acts, and those under the Public Health (London) Act, 1891. Examination of these plans involves in many cases, lengthy consultations with architects and builders at the City Hall and also on the site of new works. The sanitary inspectors concerned pay repeated visits to watch the progress of construction and finally to test the apparatus and drainage when completed. The work of the department connected with drainage is increasing steadily as the table given below shows. The importance of this supervision as a public health measure is becoming realised more and more as public attention is turning not only to the conditions in which people dwell but also to those in which they are employed. Visits to premises concerning schemes of proposed works open up opportunities for inspecting other conditions and much improvement has resulted from consultations between the officers of this department and those responsible for the construction and maintenance of premises. Perhaps an example may make this clear. It is a common custom in Westminster to take advantage of the space afforded by excavation, often necessary in order to obtain sound foundations, to construct rooms below ground level. Questions as to the intended use of such rooms and as to whether they comply with existing sanitary ordinances may entail considerable alterations. Such alterations, as the law now stands, can be insisted upon only after the rooms have come into occupation. This may entail considerable subsequent expense and it will therefore be apparent that a frank exchange of ideas when discussing 61 the plans between the architect or builder and the sanitary inspectors may save cost and much future inconvenience. New drainage By-laws made by the London County Council under the Metropolitan Management Act, 1855 (Sec. 202).—It is satisfactory to note that in the final draft of these by-laws now to be sent to the Ministry of Health for approval, due consideration has been given to the views expressed by the City Council, and that with slight exceptions, all of the suggested amendments and variations have been adopted by the County Council. New Sanitary Construction.—Plans relating to work of this description numbered 877, of which 91 represented sanitary provisions in entirely new buildings. The corresponding figures since 1925 are as follows 1925. 1926. 1927. 1928. 1929. Plans Plans of work in new buildings included in above 658 102 724 110 750 93 752 81 877 91 Combined drainage orders were made in 20 cases. Infringements of the By-laws were reported by the Sanitary Inspectors in 16 instances in respect of failure to give notice of intention to construct, or to deposit plans. Ten builders were cautioned and two were summoned in respect of these oSences and were convicted, fines and costs amounting to £5. Closet Accommodation.—The water carriage system is in existence throughout the City. Scavenging.—This is not under the control of the Public Health Department, but is carried out by a separate department of the City Council under the City Cleansing Surveyor. There is a daily collection of house refuse throughout the City. The figures relating to collection and disposal of refuse during 1929 are as follows:— Tons. House refuse collected 98,003 Trade refuse collected 1,245 99,248 Refuse barged away 87,206 Refuse dealt with in Salvage Plant 12,042 62 • In the early part of the year, the Ministry of Health published a report by Mr. J. C. Dawes, Inspector of Cleansing, etc., to the Ministry, upon his investigation of the public cleansing services in London and the methods of disposal of refuse by municipal authorities. This report was of such a character that a Departmental Committee was appointed to consider as to certain recommendations which it might be deemed desirable to adopt. The outcome of these deliberations is awaited with interest. It is certain that some of the methods of refuse collection and disposal in vogue in the County call for reform. It would appear to be among the first principles in public health that refuse should be promptly removed in a manner the least likely to cause public nuisance and that the final disposal should ensure that the mass should be organically inert, free from the possibilities of fermentation or combustion. Briefly, that dust should return to dust. During the past year, the Council has experimented with various types of refuse-collecting vehicles with a view to the provision of a system of refuse-collection which shall, as far as possible, be dustless in operation. A final decision as to the system to be adopted cannot, however, be reached until the recommendations of the Departmental Committee have been published; but in the meantime these experiments are being continued. Public Sanitary Conveniences.—These are under the control of the City Engineer. There are 33 underground conveniences in the City, 18 for men and 15 for women. In addition, there are 36 public urinals for men. The underground conveniences were inspected in the early part of the year at the request of the Works Committee, and as a result certain improvements in the ventilation have since been carried out in 22 of them. It is the intention of the Council to reconstruct certain of the underground conveniences which are old and out-of-date and insufficient in accommodation. 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, duties connected with housing and infectious disease, and others relating to the sanitary condition of the City. 63 Table 1. Inspection of premises:— Sanitary work supervised :— Dwelling-houses— Drains— Primary Inspections— Constructed 1,742 (a) On complaint 1,548 Repaired and amended 378 (6) Infections disease 1,104 Ventilated 761 (c) Housing Regulations, 1925 515 Interceptor traps fixed 289 Sealed off from sewer 48 (d) Housing applications 377 Gully traps fixed 1,571 (e) Other reasons 1,639 Defective traps abolished 123 Re-inspections 10,346 Manholes built 1,352 Other Premises— ,, repaired 313 Primary Inspections— ,, covers fixed or repaired 380 (a) On complaint 473 (6) Other reasons 1,495 Fresh air inlets fixed or repaired 278 Re-inspections 3,683 Petrol interceptors provided 23 Sanitary Works— Tested by smoke 480 Total Inspections— ,, chemical 836 (a) Under notice 1,917 ,, water 1,719 (6) Voluntary works 13,438 air 756 Soil Pipes- Fixed 852 Nuisances and other matters dealt with:— Ventilated 357 Repaired 318 Water-closets— Public Health Acts— Constructed 2,134 Dirty conditions 1,437 Repaired 541 Damp conditions 1,282 Traps ventilated 254 Verminous conditions 292 Flushing cisterns fixed 2,239 Defective drainage, wate closets, &c. 752 „ „ repaired 181 Waste Pipes— „ roofs 491 Constructed 1,921 ,, walls and ceilings 1,106 Repaired 343 „ floors, staircases, & 426 Trapped 213 „ paving of yards, &c. 783 Ventilated 285 Water-closets— Disconnected from drain 58 Insufficiently lighted or ventilated 93 Rainwater Pipes— Fixed or repaired 987 Directly approached from rooms 35 Disconnected from drain 32 Urinals— Insufficient 36 Constructed 256 Keeping of animals 3 Repaired or improved 43 Other nuisances 854 Water Supply— Overcrowding (families) 49 Provided 144 ,, abated 13 Taps off main provided 283 Underground rooms— Cisterns fixed 143 Illegal occupation 10 Pipes repaired 229 Occupation discontinued 5 Housing Act, 1925— Underground bedrooms— Contrary to Regulations 40 Use discontinued 17 L.C.C. (General Powers) Act, 1907 - Absence of water supply to upper floors of tenemen houses 5 Restriction of Rent Acts.—Three applications were received for certificates under these Acts, and all were granted. Nuisances.—Intimation notices were served in 1,158 instances, the number of premises concerned being 1,134. Statutory notices served 64 by the sanitary authority numbered 59 and related to 58 premises. Police court proceedings were taken in 7 instances in order to enforce compliance with the requirements of statutory notices. In 5 cases the summonses were withdrawn on payment of costs, amounting in all to £5 4s. In the other two cases, the defendants were fined £3 and £4 respectively, including costs, the first mentioned being in respect of absence of water supply to premises, and the second, illegal letting of underground rooms as separate dwellings (Public Health Act, Section 96). The following are the comparative figures since 1925:— — 1925. 1926. 1927. 1928. 1929. Intimation Notices 980 1,074 1,450 1,778 1,158 Statutory Notices 27 43 49 45 59 Legal Proceedings 5 10 6 4 7 Rat Repression.—Fifty-two 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. Forty-three outlets to sewers 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 large additions were made to the baits usually laid in the Council's sewers and at the Council's depots. Water Supply.—The Metropolitan Water Board sent six notices of withdrawal of water supply to premises. In four cases the reason for I the action of the Board was failure to pay water rate, and in two, defects in I the water fittings, causing waste of water. Water Supply in Teneinent 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 1925 is as follows:— 1925. 1926. 1927. 1928. 1929. 55 44 22 6 5 By-laws as to Removal of Offensive Refuse.—No cases were reported during the year. 65 Lighting of staircases in tenement buildings.—The L.C.C. (General Powers) Act, 1927 (Sec. 61), provides that every tenement building shall, wherever practicable, be provided with adequate means of natural and artificial lighting, and those constructed after the commencement of the Act with windows to the external air at each storey. At a meeting of the Metropolitan Boroughs Standing Joint Committee some doubt was expressed as to whether the definition of tenement buildings included buildings other than blocks of industrial dwellings, but the County Council pointed out that the definition included buildings constructed or reconstructed so as to comprise two or more separate or selfcontained flats or tenements intended or used for occupation by the working classes. An arrangement was suggested by the Standing Joint Committee and approved by the County Council whereby the District Surveyors will notify the Borough Councils of new buildings coming within the provisions of this section. The Borough Councils in return will notify the District Surveyors of any works involving structural alterations to existing buildings, which under the section Borough Councils may call upon the owners to carry out. During the year, the Sanitary Inspectors reported four cases of inadequate artificial lighting of staircases in tenement buildings. The owners of the premises were notified of the requirements of the Act, and the necessary means of lighting was duly provided in each case. Houses divided into separate tenements.—At the request of the London County Council, the Metropolitan Boroughs Standing Joint Committee considered the question as to whether the suspensory provisions of the by-laws relating to houses of this class should cease to have effect as regards houses which become decontrolled under the provisions of the Rent Restriction Acts, and the Committee invited the observations of the City Council. The Public Health Committee considered a report of the Medical Officer of Health on the subject, and expressed the view that the time was not opportune for bringing into operation by-laws 8, 13, and 17, but that it would be desirable if steps were taken to bring into operation in the case of decontrolled houses the provisions of by-laws 18, 20 and 25. The first-mentioned by-laws relate to increased amount of air space in rooms used for sleeping purposes, ventilation of passages and staircases, watercloset accommodation, and accommodation for washing of clothes and for storage, preparation and cooking of food. Those which it was suggested should be brought into operation relate to adequate lighting of common staircases, the securing of adequate stability of the structure a nd the paving of courts and courtyards of lodging-houses. 66 The City Council adopted the report of the Public Health Committee and directed that the Standing Joint Committee be informed accordingly. 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 1929, the number of inspections made, and the results of such inspections:— Table II. Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,258 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dveing, corset makers, furriers, etc. 1,158 Leather workers, boot and shoe makers, harness makers, etc. 51 Carpentry, upholstery, carvers, gilders, etc. 59 Surgical and dental instrument makers 5 Tobacco manufactures 9 Wig makers and hair workers 47 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 67 Jewellers, silversmiths and burnishers, diamond cutters and 54 Metalworkers 16 Miscellaneous—Basket making, fancv work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 45 Florists 24 Laundries 26 Bakehouses 66 Photographers 35 Jewel case makers 7 Cinema film workplaces 31 Total 2.948 The use of 266 workshops was discontinued, and 288 additions were made to the register during the year. Table III.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including factory laundries) 269 7 — Workshops (including workshop laundries) 2,744 236 1 Workplaces (other than Outworkers' premises) 1,795 100 1 Total 4,808 343 2 67 Table IV.—Defects found. Particulars. (1) Nurnber of Defects. Number of offences in respect to which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to h.m. Inspector. (4) Nuisances under the Public Health Acts:— Want of cleanliness 286 286 — — Want of ventilation 20 20 — — Overcrowding 53 53 — — Want of drainage of floors 13 13 — — Other nuisances 60 59 — 1 Sanitary accommodation- Insufficient 20 20 — — Unsuitable or defective 105 104 — 1 Not separate for sexes 35 35 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 1 1 — — 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 593 591 — 2 Table V.—Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 119 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 159 Absence of means of warming — Matters referred by H.M. Inspectors 92 348 Visits of Enquiry re 60 Employment of Women „ ,, Outworkers 97 Underground bakehouses in use at the end of the year 48 A copy of a table relating to outworkers required by the Home Office under the Factory and Workshop Act, 1901, and giving information under the headings of Sections 107, 108, 109 and 110 is appended. 68 Table VI Outworkers' Lists, Section 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 & 110. Trade Lists received from employers. Addresses of Outworkers. Notices served on occupiers as to keeping or sending of lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Received from other Councils. Sent to other Councils. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing apparel 1,070 1,659 8,635 3 6 15 392 5,928 103 — — — — — 16 — — Linens, etc. 5 31 62 — — — 8 53 — — — — — — — — — Furriers 10 22 34 — — — 11 25 1 — — — — — — — — Umbrellas, toys, artificial flowers, etc 4 97 118 — — — — — — — — — — — — — — Engraving, metal work, etc. — — — — — — — — — — — — — — — — — Total 1,089 1,809 8,849 3 6 15 412 6,108 104 — — — — — 16 — — 69 Outworkers.—The total number of lists received during the year amounted to 1,092. Notices in respect of failure to send lists were sent to 104 firms. No legal proceedings were necessary in respect of this offence. The lists contained 10,679 names and addresses, of which 6,108 were in other districts, 5,476 being within the Metropolitan area and 578 in the London Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,629, of whom 1,398 were registered as occupying workshops. The number of houses in which outwork was being carried on was 797. Smoke Abatement. The Smoke Abatement Committee for Greater London appointed by the Conference of Local Authorities, held at the Guildhall in 1927, continued to hold meetings at the Ministry of Health during 1929. Your Medical Officer of Health was one of three Medical Officers appointed as representatives on the Committee. At an early stage of the proceedings, the Committee issued an inquiry of a very comprehensive nature to 119 local authorities requesting information of the technical and administrative aspects of the smoke problem. In reply, 69 authorities supplied full information to the 24 separate questions in the inquiry. It may be of interest to quote the information returned by the City Council. Public Health (Smoke Abatement) Act, 1926. THE GREATER LONDON JOINT SMOKE ABATEMENT COMMITTEE. Questionnaire. 1. Name of Local Authority ?—Westminster City Council. (а) Acreage ?—2.502.7. (b) Population ?—139,300. 2. Please state what trades and/or works using furnaces for steam-raising or other plants are represented in the district ? Chiefly hotels, clubs, restaurants and theatres and small factories. 3. Please supply the following information:— (a) Total number of— (i) steam-raising plants ? 300 (approx.). Public buildings, theatres, clubs, hotels, etc. (ii) furnaces connected therewith ? Do. (iii) nature of fuel used ? Coal and oil. (b) Number of chimneys connected with factories ? Very few. 70 (c) Number of chimneys connected with metallurgical or pottery works ? {d) Number of other industrial chimneys Restaurants'and hotels ... 709 (including hotels, clubs and res- Clubs taurants) ? 126 835 4. Are systematic observations made of these chimneys in order to cover them all in a given period ? If so, state period ? Every week for periods of half an hour to one hour. 5. How, in practice, is " black" smoke distinguished from other smoke ? What is the line of demarcation ? Coal Smoke Abatement Chart. 6. What is the aggregate permissible period of emission of " black" smoke per hour or half-hour ? Under 2 minutes in any continuous period of 30 minutes. 7. By how much must the permissible period of emission of " black" smoke be exceeded before action is taken:— (а) Informally ?—Anything over 2 minutes in any continuous period of 30 minutes. (b) By service of statutory notices ?—Subsequent offence, (c) By Prosecution ?—Subsequent offence. 8. Does the permissible allowance vary with the number of boilers t No. 9. Is it the practice of the Council's Inspectors to add up the total amount of smoke emitted in separate bursts during each period of observation ? Are short bursts excluded, and what period constitutes a short burst ? Yes. No. Short bursts are anything under 2 minutes. 10. Does the Council confine its efforts to preventing the issue of " black" smoke, or does it proceed under the alternative provisions of the Public Health Acts T Principally to preventing the issue of " black " smoke. 11. What steps are taken by the Local Authority to deal with the emission of smoke (other than " black " smoke), soot, ash, grit or gritty particles ? Informal action only up to date. 12. Are any smoke scales, shades or charts used for the purpose of determining the colour of smoke ? If so, what ? That used by the Coal Smoke Abatement Society. 13. In ascertaining the cause of smoke emissions, arc the premises inspected, and how, in practice, is it decided when a furnace is constructed to consume its own smoke ? Premises are inspected and Engineer consulted as to smoke consumption boxes, etc. 14. Can you say whether the smoke nuisance is increasing or decreasing in your area ? If the latter, to what is the improvement attributed ? Decreasing. Greater care in stoking and better fuel. 71 15. Can you give a synopsis of any action taken, whether co-operative or otherwise, during the years 11125, 1926 and 1927, and the result thereof ? Informal Notices—78. Statutory Orders—2. No summary proceedings found to be necessary. 16. What steps, if any, are taken in your district to deal with smoke nuisances from business premises, offices, shops, hotels, clubs, restaurants, smithies, fishfrying shops, etc. ? Observations constantly kept on chimneys of these premises and necessary verbal or written instructioas given to responsible persons when infringements of Public Health Acts occur. 17. What steps, if any, have been taken to give effect to the provisions of Scction 5 of the Public Health (Smoke Abatement) Act, 1926 ? (Matter concerns the London County Council.) 18. What officers are employed for smoke inspection work ? How many are there, and what are their technical and other qualifications ? Two Sanitary Inspectors carry out combined duties of food inspection, sampling and smoke inspection. Qualified Sanitary Inspectors. 19. Has your Council undertaken any anti-smoke educational work ? If so, does the Council give a grant for the purpose ? No. 20. Are there any local or other classes, or other facilities for training stokers and firemen ? If so, are certificates of efficiency awarded ? No. 21. Do smoke nuisances arise in your district from— (a) Railway engines ?—Yea. (h) Road vehicles ?—Yes. If so, how are they dealt with ? By London County Council and Local Authority. 22. Do manufacturers in your district show a special interest in smoke abatement, and have attempts to secure their co-operation in this matter met with success ? If so, please give details. Interest has been shown by Engineers of various large establishments and greater supervision appears to be exercised by them over the stokers and furnacemen. 23. Are any soot gauges installed in your district T Meteorological Office. 24. Further information or remarks. The majority of nuisances caused by smoke in Westminster arise from restaurant kitchens and boiler houses, due to a very large extent from careless stoking preceding the preparation of meals and the use of poor quality fuel. The above causes are now receiving greater attention from the Engineers in charge with the consequence that smoke emission is decreasing. The following extract from a report by the Medical Officer of Health to the Public Health Committee indicates the scope of the work of the Smoke Abatement Committee and the results of its deliberations:— 72 "The Smoke Abatement Committee in discharging their references from the Conference made the following recommendations which were discussed at the second meeting of the Conference held at the Guildhall in October, 1929, and adopted:— (а) That all Local Authorities should especially instruct their appropriate inspectors to keep observation on all chimneys (not being the chimney of a private dwelling-house) when inspecting their districts, and special observation on complaint or as occasion warrants. (b) Local Authorities should proceed under the Public Health (Smoke ment) Act, 1926, and the acts incorporated therewith, either with regard to 'black ' smoke as such, or with reference to smoke, other than 'black' smoke, which is emitted in such quantities as to be a nuisance. —For the grading of the varying shades of smoke, we recommend the Local Authorities to use, for the time being, the chart referred to in (e). (c) That the emission of ' black ' smoke for a period of t wo minutes in the aggregate within any continuous period of 30 minutes from any one chimney in a building other than a private dwelling-house shall, until the contrary is proved, be presumed to be a nuisance. Note.—It will be a matter for the Local Authorities concerned to consider, after conferring with the Ministry of Health, whether or no exemption is called for with regard to special industries in their particular localities. It is also suggested that Local Authorities should facilitate arrangements whereby, in the case of a breakdown, which may result in the emission of smoke for a longer period than that permitted, the Local Authority can be at once notified, and that due regard by the Authority concerned should be had to such breakdown. (d) That Local Authorities be recommended not to permit any additional allowance by reason of the number of boilers. (e) Pending further investigations, and with a view to obtaining unanimity amongst Local Authorities, the Coal Smoke Abatement Society's Chart is recommended as being the best obtainable at the moment. (/) That Local Authorities be advised to arrange for those officials whose duty it is to deal with smoke nuisances to receive adequate instruction, both theoretical and practical, in the subject. (y) That Local Authorities be urged, through their Education Authorities, to establish classes at the technical colleges, or other recognised educational establishments, for the proper training of stokers in their duties. "It must be mentioned that a reservation was put in by the industrial representatives when the recommendations were framed and that this reservation became the subject of amendments moved at the Conference. The amendments were negatived by large majorities. 73 "These amendments may briefly be noted as regards resolutions (6) and (c):— (6) It was objected that the chart issued by the Coal Smoke Abatement Society was of questionable accuracy and should not be used for the purpose of definition in legal proceedings. Note.—It is admitted that until more exact standards are obtainable these charts fulfil the purposes of comparison better than anything so far devised. They have been accepted by magistrates throughout the country for many years. (c) It was objected that the two-minute period of 'black' smoke continuously or in the aggregate during 30 minutes, as constituting a nuisance, wag too short. It was pleaded that in order to obtain fullest efficiency from steam-raising plant, nuisance should be regarded only if the ' black ' smoke lasted 3 minutes. Note.—The Smoke Abatement Committee had ample opportunity of observing the possibilities of keeping within the two-minute period of the issue of 'black' smoke at H.M. Fuel Research Station at Greenwich. There they saw different types of boiler furnaces fired singly and in series without contravening the period of the proposed by-law. The Minister of Health, in issuing a circular to Local Authorities, recommended the two-minute period in the aggregate over a continuous period of 30 minutes as a reasonable standard for a by-law. The London County Council, in a letter dated 9th June, 1927, referring to making a by-law, suggested precisely the same tiling. This letter was addressed to the Metropolitan Boroughs Standing Joint Committee, and referred by them to the -Metropolitan Borough Councils. The City Council, in replying to the Metropolitan Boroughs Standing Joint Committee, approved of the suggested by-law embodying the two-minute standard. "Resolutions affecting recommendations (a), (d), (e), (/), (g), were carried unanimously. As regards (a), it has always been the practice of the City Council's Inspectors to keep observations on all chimneys other than those of private dwellings, and to make special observations as occasion warrants. "(d) No allowance has ever been given in Westminster for number of boilers, (e) The chart in use has already been referred to. (/) The City Council did arrange for special courses of instruction for its Smoke Inspectors. This has proved a most satisfactory provision, (g) This should be left to the Education Authority. "The London County Council should be urged to embody in their by-laws a provision requiring builders to notify the Local Authority as to the character of the heating plant about to be installed in new buildings, other than private dwelling-houses, as suggested in section 5 of the Smoke Abatement Act of 1926." (9583) F 74 As a result of the adoption by the Conference of the proposed by-law representations were made to the London County Council by the Metropolitan Boroughs' Standing Joint Committee, and by the majority of local authorities in London, requesting the County Council to make a by-law for the emission of black smoke in terms already quoted. In connection with the subject of special training in smoke abatement it should be mentioned that three of the Council's Sanitary Inspectors have taken a further technical course at their own cost and in their own time, and have passed an examination entitling them to hold certificates as persons specially qualified to deal with the question of smoke prevention. As regards the objection raised by industrial representatives that two minutes is too short a period for permissible black smoke, it should be pointed out that in Westminster, at any rate, the best results in smoke abatement have been achieved by consultation between the Council's Inspectors and those responsible for smoke nuisance. The absence of legal proceedings for many years past shows that practical advice, given by specially trained officers has been effective. Smoke nuisance in most cases is the result of careless or ignorant stoking, and it is only in instances where advice has been persistently flouted that legal enforcement is required. 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 VII. - 1925. 1926. 1927. 1928. 1929.[/### ] Complaints received 80 62 79 36 52 Observations taken 1,999 2,490 2,057 640 854 Notices issued— Preliminary 23 26 29 21 12 Statutory — — 1 1 — Summons — — — — — Bailersea Power Station.—The possibility of pollution of the atmosphere from sulphur fumes likely to emanate from the large power station now in course of erection near the river at Battersea has created grave apprehensions in the mind of the City Council. Throughout the year, public interest, stimulated by representations from local authorities likely to be affected and by letters from experts to the "Times," developed into a protest against what appeared to be a project which would add potentially to the pollution already experienced. 75 It was accepted that in the furnaces to be erected combustion would be so complete that little, if any, smoke would be sent out. It was the problem of grit and sulphur gases which required solution. It had been proved to the satisfaction of the Court of Appeal that sulphur fumes from a large power station had definitely deleterious effects on vegetation, crops, and live stock (Farnworth v. Manchester Corporation) and theie was therefore ample justification for the volume of protest which grew around the Battersea project. In the case of Westminster grave fears were entertained that ancient buildings such as Westminster Abbey might suffer seriously. The stone work of the Houses of Parliament, a building not a century old, has crumbled to such an extent because of the acid quality of the polluted atmosphere, that restoration will cost many thousands of pounds. During the past 150 years, much wealth has been spent in periodic restoration of the Abbey from similar causes. Considerations as to the probable effects on the public health were also reasons which induced a deputation to approach the Minister of Health and the Minister of Transport to ask for some guarantee that all fumes would be rendered harmless or alternatively, that the power station should be built in some other district where less harm would result. The Ministers pointed out that one-third of the new station was already in course of erection and special apparatus and measures were to be employed to wash sulphur fumes out of the . flue gases. They thought it would be well to await the results of the working of this section of the power station and the effects of the new methods of sulphur elimination without prejudging the issue. The Government Chemist has issued an interim report on the methods of sulphur elimination to be employed at Battersea. The interim report is to some degree favourable to the methods of elimination, but it is obvious that further and more comprehensive experiments are required before he is fully satisfied that complete disappearance, particularly of sulphurous acid, is possible. The methods which he has so far had submitted to him are those of gas scrubbing—sprays of heated Thames water meeting the gases in the flues. The water naturally somewhat alkaline absorbs the acid flue gases. The whole matter will again be considered when the final report by the Government Chemist is issued. Towards the end of the year, the Council came to the conclusion that it might serve a useful purpose to measure the degree and nature of atmospheric pollution as experienced in the City from day to day, and to contrast the data obtained with those to be obtained after the power (9583) c2 76 station is in operation. The Medical Officer of Health was instructed to make inquiries as to methods of measuring air pollution and to obtain estimates for apparatus. Premises and Occupations which can be Controlled by By-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. (6) Bakehouses. (7) Workshops and places. (8) Rag-and-bone dealers. (9) Fried-fish shops and fish curers. (10) Street traders dealing in foodstuffs. (1) Houses Let in Tenements.—The number of houses on the register at the end of the year was 336. The Sanitary Inspectors paid 1,153 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 where possible to obtain compliance with the requirements of the by-laws. (2) Underground Rooms.—During the year, the Sanitary Inspectors reported 50 cases of illegal occupation of underground rooms. In 40, the rooms were being used as sleeping places and did not comply with the Regulations of the Council under the Housing Acts. In the remaining ten, the rooms were occupied as separate dwellings contrary to the provisions of section 96 of the Public Health Act. Of the 40 rooms illegally used as sleeping places, 15 had been vacated by the end of year, the occupants having obtained alternative sleeping quarters; in two other cases, the owners of the premises carried out works necessary to make the rooms comply with the Council's Regulations. In these two cases, the rooms in question were occupied by servants employed in one instance at a club and in the other at an hotel. Notices were served in respect of the ten rooms illegally occupied as separate dwellings and as a result five of them were vacated by the end of the year. Proceedings were taken against an owner in respect of premises in which two basement rooms had each been let as a separate dwelling to different families, and the Magistrate inflicted a fine of £2 and £2 costs. This owner had in 1928 been prosecuted and fined in respect of the reletting of vacant underground rooms at other premises in the same street 77 (Dufour's Place), after having been informed by the Medical Officer of Health that the rooms were not fit for use as a separate dwelling. (8) Rag-and bone Dealers.—There are 13 premises in the City in which this business is carried on. These have been kept under observation by the Sanitary Inspectors, but no matters requiring attention by the Department have been reported during the year. Particulars relating to the other premises and occupations included in the foregoing list may be found under the appropriate headings in other sections of this report. Other Sanitary Conditions requiring Notice. Fouling of Footways by Dogs.—The by-law made by the City Council in March, 1928, the operation of which was confined to a period of two years, has now been sanctioned by the Home Office as a permanent measure. Two cases of infringement of the by-law were reported to the Council by the Commissioner of Police and a prosecution was ordered in both instances, the defendants being fined 10s. and 7s. 6d. respectively. During the year, complaints were received from time to time as to the insanitary state of the pavements in certain streets, particularly in the neighbourhood of several large blocks of flats in which many dogs appear to be kept. Special observation was kept by the Sanitary Inspectors in one or two instances, but no offences were observed. The City Cleansing Surveyor was requested to pay particular attention to the cleansing of the footways in those streets which were the subject of complaint. From the fact that only two cases of infringement of the by-law were reported during the year, it may be inferred that the by-law has proved effective in preventing the committal of nuisances coming within its scope. Fouling of the footways by dogs which are allowed to run loose exists, however, to a considerable extent, and cleanliness of the streets must in the main depend upon regular attention being paid by the responsible Department to the cleansing of the streets in which nuisances are most in evidence. It has been suggested that the by-law should be made applicable to nuisances committed by all dogs, whether on a lead or not, but it should be pointed out that the by-law now in force in Westminster and in other districts is as sanctioned by the Home Office, to whom it was necessary to submit the draft by-law for approval. Nuisance from Pigeons.—Section 52 (1) of the London County Council (General Powers) Act, 1927. The administration of this section is a duty of the City Council and details of the arrangements made were given in last year's report. 78 During the year, some 378 pigeons were trapped and 146 eggs were taken. The same difficulties previously mentioned were experienced in a still greater degree. There are two opposing bodies of opinion—those who complain of nuisance from pigeons and wish them exterminated, whilst others feel equally strongly that it is cruel to interfere with the liberty of these birds in any way. Thus it is that as soon as the trapper's cage appears in any public garden or space letters of protest are received while others appear in the press. Those who oppose the trapping endeavour to attract the pigeons away from the cages by distributing large quantities of food at some distance. The other school of thought complains that sufficient is not done to deal with the nuisance. Perhaps the mean might be struck if both parties met and argued the matter to a conclusion. In cases where nuisance is confined to the copings and ornamental cornices of lofty buildings, the suggestion that these roosting places might be wired in with coverings of fine wire-netting has been adopted in many cases with satisfactory results. Noise.—The "mechanization of living in modern conditions (if the word may be borrowed from its military context), particularly in large centres of population, has resulted in the perpetuation of noise to such an extent that many see in it a menace to the public health. It is perhaps one of the drawbacks of the progress of civilization. It is certain that noise of particular pitch or repetitive character can cause nervous exhaustion and perhaps nervous disease of functional nature. Loss of sleep, interference with concentration and other contributions to loss of human efficiency may in some cases be justifiably attributed to noise. * The Corporation of Edinburgh has taken the matter up in the interests of public health, but so far has been unable to persuade Parliament to grant powers of suppression. The difficulty seems to lie in defining unreasonable or unnecessary noise, preventable noise, noise capable of mitigation and noise dangerous to health. Should action be confined to noise arising from any trade, occupation or business ? That would leave untouched the roysterers who make night hideous. Street drilling by day or by night is harrowing, but it is "necessary " noise and would also be immune from legislation. Private individuals in "Westminster have been successful in obtaining injunctions at common law for disturbance caused by the music of powerful organs in cinemas in the neighbourhood of their dwellings. * Since the above was written, Edinburgh has obtained powers from Parliament in an Act which contains a section devoted to the prohibition of noise as a nuisance. It is hoped that similar powers may be requested and granted for London. 79 The Public Health Committee considered the question of noise on a reference from the Metropolitan Boroughs' Standing Joint Committee. The former was reminded that noise had been recognized for some years as something which should be controlled by law inasmuch that the City Council and the London County Council had made by-laws in instances such as music near hospitals, street shouting, &c., &c., &c. Complaints are received in the department from time to time as to noise arising from machinery in buildings near dwellings, collection and delivery of milk churns and many other causes. Usually the only remedy available for the complainant is to move for an injunction. At the present time the local authority has no powers to deal with noise other than that regulated by particular by-law. The trend of opinion is, however, moving towards some measures for the control or prohibition of noise, and the time may not be far distant when the legislature may give effect to what appears to be a growing public desire. Sale of Old Clothes. Proposed legislation.—Upon a reference from the Metropolitan Boroughs' Standing Joint Committee, the City Council on the 7th November resolved to agree in principle with a proposal that the London County Council be asked to include a clause in their next General Powers Bill empowering the Borough Councils to regulate the sale of old clothes from shops or stalls. Rag Flock Acts, 1911 and 1928.—There are no premises in the City which come within the provisions of these Acts. Removal of infirm and diseased persons in certain cases.—The London County Council (General Powers) Act, 1928, Section 28, provides similar powers to those contained in the Bradford Corporation Act, as regards aged and infirm or physically incapacitated persons residing in premises rendered insanitary owing to their neglect, or under insanitary conditions; also persons suffering from any grave chronic disease. The Act provides for the compulsory removal of such person and for his detention in a hospital or infirmary for a period of three months. The procedure entails application to a petty sessional court for a removal order, submission of medical evidence, rights of appeal by the person affected, etc. There has been no occasion to enforce these legal powers. The mere fact that these powers exist has in all instances succeeded where ordinary persuasion seemed likely to fail in obtaining the removal of helpless old people. In many cases they live alone, are too ill to look after themselves and cannot keep either themselves or their surroundings clean. 80 Schools.—-A complete list of schools and other educational institutions was included in last year's report. It is omitted on this occasion in order to save space, but will be reproduced when the fuller or survey report, which deals generally with the preceding five-year period, is made at the end of 1930. The London County Council, being the Education Authority, has jurisdiction over institutions for elementary and secondary education, with the exception of certain private schools and those presided over by governing bodies on which the Education Authority is not represented. During the year, there was no occasion for the Sanitary Authority (the City Council) to exercise its powers as regards general sanitary conditions in schools. No outbreak of notifiable infectious disease beyond the small groups of cases which crop up from time to time was observed in connection with schools in the City. Co-operation between the medical services of the City Council and those of the Education Authority can never be complete so long as the officers concerned are responsible to different authorities, but this year in connection with the prevention of measles, a greater measure of contact has been achieved than previously existed. This is referred to in the Maternity and Child Welfare Section. Health Education.—" Better Health," the monthly magazine of the Central Council of Health Education, is published and distributed in the City by the Medical Officer of Health. The agreement with the printer provides for an issue of 2,000 copies per month. No cost falls on the Council and the mazagine is distributed gratis. Space is reserved for news and matters of local interest, and articles have been regularly contributed by the Medical Officer of Health and his staff on subjects such as "How to deal with the Common Cold," "The Rat Problem," "Care of the Teeth," and a variety of others. There is also set out information relating to the work of the Council's Tuberculosis Dispensary, Maternity and Child Welfare Centres, Dental Clinics, etc. The subject matter in the main part of the periodical consists of signed articles and illustrations. These articles are written by experts and prove exceedingly interesting. The matters dealt with include Infectious Diseases, the work of Port Sanitary Authorities, values of Food, lighting and ventilation of workshops and similar subjects. Distribution to the public is effected through the Council's Health Centres, Public Libraries and Baths. Many are circulated in the large blocks of industrial dwellings, such as the Peabody Estates. From all reports it would seem that the magazine is widely read and greatly appreciated. Health Talks at the Maternity and Child Welfare Centres have been a prominent feature for some years past. Associations, such as the Health 81 and Cleanliness Council, the British Social Hygiene Council and others have very kindly supplied lecturers, and in some instances have arranged for films to be shown illustrative of the lectures. Talks of a more informal nature on infant feeding, suitable. clothing, diet and other matters connected with the teaching of mothercraft are given by the health visitors. These lectures and demonstrations are well attended. Public Health Conferences, Etc. Sheffield Congress of the Royal Sanitary Institute.—The Chairman of the Public Health Committee and the Medical Officer of Health were appointed delegates by the Council. The Congress was held in July, 1929. A Report dealing with the proceedings was presented by the Medical Officer of Health to the Pubilc Health Committee. National Association for the Prevention of Infantile Mortality.—Fifth English-speaking Conference was held in London in July. Councillor Miss Dutch was appointed delegate by the Council. National Association for the Prevention of Tuberculosis.—Held in Newcastle-on-Tyne in October, 1929. The Assistant .Medical Officer of Health attended as delegate on behalf of the Council and presented a report of the proceedings to the Public Health Committee. Sanitary Inspectors' Association Conference at Lowestoft.—Held in September, 1929. The Council appointed Mr. Dee, one of the Sanitary Inspectors, as its delegate, and he duly presented a report on the work of the conference which was submitted to the Public Health Committee. Winter School for Health Visitors.—The Council, following a custom of some years, permitted one of the health visitors to attend this study course which lasted from December 27th to January 7th. The fee for the course, three guineas, was paid by the Council. There is great value in these study courses. They stimulate and refresh by bringing new methods and ideas to those who ordinarily have no time in the course of their official work to spend on post graduate study. HOUSING. In the report of last year, the Council's two housing schemes were described in detail and it is now possible to give some idea of the financial aspects, which shew that the Council is committed to a total expenditure in connection with the two schemes of between five and six hundred thousand pounds, for the sake of improving the housing of the working classes in the City. It will be remembered that in both the Millbank and Ebury Bridge Schemes, there is no cost of land; in the former case a lease of 999 years has been given by the Duke of Westminster, while in the latter, the land is the freehold of the Council. Even so, the average cost of each one of the 814 flats will exceed £640. 82 In the case of Ebury Bridge, the progress of construction has been so rapid that although the whole scheme was approved by the Council only in October, 1928, by the time this report is in circulation, most of the blocks will be nearing completion, and some will be ready for occupation about September, 1930. In the Millbank area, the buildings in Vincent Street will also be ready to receive tenants about July, 1930. As regards the larger and remaining sections of the Millbank Housing Scheme, demolition and clearance of the area between Page Street and Horseferry Road at the western end opposite Jessel and Schomberg Houses, will be well advanced by March, 1930. The purpose of the Ebury Bridge scheme is to provide improved housing for those whose work lies in Westminster and who are living in overcrowded or otherwise unsatisfactory conditions in the City; that of the Millbank scheme is to rehouse tenants on the Millbank Estate, whose dwellings, already unsatisfactory, were rendered permanently unfit by the Thames flood of 1928. Photographs of the actual progress of the two schemes are shown on the following pages. In the report of last year, the illustrations shown were photographs of the schemes in contemplation. It is now possible to illustrate the actual buildings so far as completed. It may be useful to recapitulate details of the accommodation soon to be ready for occupation. At Ebury Bridge there are to be 8 blocks of flats. They will consist of 18 one-room, 56 two-room, 88 three-room and 48 four-room flats. The rents to be charged will be consistent with those ruling at the Council's existing dwellings, namely, one room, 6s. 6d.; two rooms, 10s. 2d; three rooms, 13s. 3d.; four rooms, 17s. 2d.; weekly, inclusive of rates. It is perhaps worth while for a moment to contemplate the very great advantages to be conferred on those who, mainly by reason of their large families are fortunate in possessing a prior claim to be housed in the Council's dwellings. For the inclusive sum of 17s. 2d. per week may be had a four-roomed flat and in addition, a kitchen, fitted with a gas cooker, sink, gas copper and bath. Separate w.c. for each flat and fuel stores are provided. Others whose applications cannot be accepted on the grounds that they are neither overcrowded nor otherwise living in insanitary conditions, may be. paying double that rent for smaller accommodation without any of the modern conveniences mentioned. One particularly flagrant case was noted recently—37s. 6d. per week for two unfurnished rooms in a working-class house in Pimlico. Progress with the major part of the Millbank scheme is necessarily slower because of the varying periods of tenancy of the occupiers and the settlement of business claims where commercial premises have to be acquired to make space for the housing scheme. The 70 flats on the 1 II ) . Ill IV v . . ■ . ■ 83 South side of Vincent Street, however, are almost completed. The two blocks contain 2 four-room, 24 three-room, 22 two-room and 22 single-room dwellings, but it should be remarked that even single-room flats each contain a kitchen, which is virtually an additional room, with bath and all conveniences and a separate w.c. for each tenant. The rent for a single room flat will be from 4s. 5d. to 5s. 7d., inclusive of rates, and is based on the rent charged for similar accommodation in the Council's existing dwellings, as provided in the Millbank Improvement Act. It is very doubtful if similar accommodation could be secured at such a low rent anywhere else in central London or even in the County of London. An immense amount of information relating to housing conditions has been obtained through the investigations of applications for dwellings in the Council's new schemes. It was mentioned last year that these investigations were undertaken on behalf of the Housing Committee, the purpose being that the grounds on which the applicant urged his claim, whether it was overcrowding or other unsatisfactory conditions, should be investigated by trained observers. The sanitary inspectors thus visit the houses of the applicants and report in each case as to urgency or necessities. To the 31st December, 1929, 728 applications had been investigated, and of these overcrowding of varying intensity was found in 129. Other insanitary conditions such as the illegal occupation of basement rooms occurred in 28. The applications have been graded as to priority on sanitary considerations, and the Housing Committee in due course will examine these applications, paying regard to the number of rooms required, desirability of tenants, and ability to pay rent for improved accommodation. The average number of housing applications dealt with by the public health department amounts roughly to 18 per week. Within the last month or two, one has been struck with the high proportion of applications from people who have been resident in the City only one or two years. These amount almost to 40 per cent. of the later applications. It is curious after hearing so much of house shortage in Westminster to find that people from other districts were able to obtain rooms in the City, and after residing a year or two were sufficiently established to lodge their applications as "old Westminster residents." Another interesting feature is that the applications examined during the past 3 or 4 months show a great falling off in the proportion of badly overcrowded cases or those otherwise urgently requiring better accommodation. At an earlier period, almost 90 per cent. of the applications received indicated overcrowding or other definitely insanitary conditions of occupation. A much more urgent problem has presented itself during the year concerning the occupation of working-class dwellings certified to be dangerous structures by the District Surveyor. In various parts of the 84 City there are small groups of houses which have been alluded to in the past as approaching the end of their useful life. Those properties in the first instance, perhaps a hundred years ago, were constructed cheaply and without much regard to enduring stability and are now showing serious defects in structure. There is no doubt that the increase in the volume and weight of traffic on the unyielding surface of modern roads causes almost continuous vibration, and this has been the main factor in affecting the fabric of these old dwellings. They were built in an era of slow-moving horse vehicles; the advent of a heavy traction-engine in those days was a rare occurrence and one which excited the interest of both young and old. The road surfaces then were composed superficially of hard core and sand and were to some extent compressible and absorbed impact. Nowadays, the shock of impact travels laterally from the incompressible road surface in waves of vibration which are communicated to the foundations of buildings, particularly when streets are somewhat narrow. Thus in an area like Westminster, signs of settlement in old buildings may prove a greater problem in the future than it is at present. Some of the dwellings which have been affected are of the cottage type. The brick work, when exposed, shows little evidence of being built in proper bond, the bricks are of poor substance and appear insufficiently fired, and the mortar is of doubtful composition. Apart from traffic vibration, it is evident that it was never intended that these structures should be of an enduring character. In the natural course of development and rebuilding of a district they would have been swept away long ago, but these changes have been arrested by the operation of the Rent Restrictions Acts. Unless "suitable" alternative accommodation can be found for the tenants, these old dwelling-houses will continue as anachronisms in the Westminster of the present day. During the year some 19 working-class dwellings were certified as dangerous structures. The certificate may not in the first instance imply that the building must be demolished. It is only in default of "repairing" or "securing" that demolition is resorted to. There are, however, certain cases where the structure may be so unstable that demolition is the one and only safe course to adopt. Some owners of old house property do not consider it economically sound to incur considerable and perhaps unprofitable costs in making old properties secure. If, then, the District Surveyor's notice is not complied with, he takes legal proceedings to enforce it. In nearly all cases this means the gradual demolition of the property by the official contractors, the cost of demolition being chargeable to the owners. Thus it is that in some areas where development and improvement have been delayed by reason of the Rent Restrictions Acts, the protection afforded to tenants by these Acts vanishes when the buildings become certified as dangerous structures, 85 and the unfortunate occupiers have speedily to find other quarters. The Sanitary Authority has no control over the executive functions of a District Surveyor, nor has it any right to interfere with his decisions. Much good can, however, be achieved by active co-operation between the District Surveyor and the officers of the Sanitary Authority. There are numbers of cases of overcrowding in the City and others equally deserving of rehousing, but none present the desperate urgency of those tenants whose roofs are taken from over their heads in dwellings being demolished as dangerous structures. In certain cases where the certificate of the District Surveyor is not too comprehensive, that is to say, where it is a question of dangerous chimney-stacks or where the work required by him does not necessarily mean that the houses must be vacated while the structure is being secured, the powers of the Sanitary Authority under Section 3 of the Housing Act, 1925, have proved useful. In cases where the owners themselves have taken no steps to secure the dangerous structures in the hope that by their default the District Surveyor will proceed with demolition, it has been possible, by serving notices under Section 3, to make owners realise their obligations under this Section. Working-class accommodation which otherwise would have been pulled down has thus been preserved, at least for a time. In other instances, owners, realising the tenants' difficulties, have provided other suitable accommodation for them. It has been pointed out to tenants that they have a remedy at law in the statutory implications of Section 1 of the Housing Act, but the institution of legal proceedings to enforce the provisions of Section 1 does not appeal to people who have not the necessary means. As a point of legal interest it may be observed that in Section 3 lies the only remedy available to the Sanitary Authority in attempting to deal with this problem. The nuisance sections of the Public Health Act provide for the decision of a magistrate if work required is not done. Evidence that a dwelling had been certified as a dangerous structure would in all probability result in a closing order being made and not an abatement order. Closure is the aim of the owners, who naturally desire to reap the benefits of enhanced site value, while the Sanitary Authority is striving to have houses maintained fit for habitation. In these circumstances it is obvious also that the closing and demolition powers of the Housing Act would be equally inapplicable. The problem of working-class dwellings becoming uninhabitable owing to instability of structure is becoming acute and is likely to remain so. The London County Council as the "demolishing authority" has in almost every case endeavoured to provide housing for displaced tenants; 86 the City Council, with much more limited resources, has done likewise. It is surely, however, an obligation on owners to do their part by adequately securing these dwellings or by providing other accommodation. In concluding these remarks it may be well to mention that dwelling houses which fall into the category of dangerous structures are not necessarily insanitary. It is true that many old houses require frequent inspections in order that defects may be remedied before they have assumed a serious character, and this work forms one of the most important duties of the department. Most of the reconditioning of working-class dwellings which is constantly proceeding is done either voluntarily in consultation with the sanitary inspectors or as a consequence of intimations served under the Public Health Act. The older a house, the more prone to defects does it become. But it is not necessarily the house with the most apparent sanitary defects, such as a leaky roof or choked drain, that reveals itself as a dangerous structure. Some houses recently scheduled for demolition as dangerous structures were among the cleanest and best maintained in the district; on the other hand, settlement in the walls may be an outward indication of a graver state of dilapidation inside. Underground Rooms.—The following extracts from a report by the Medical Officer of Health indicate the principal points in an exchange of views which took place during the year between the London County Council, the Metropolitan Boroughs' Standing Joint Committee and the City Council. After a recital of the existing legal provisions governing the use of underground rooms, the report continued as follows "The question of the use of basement rooms for dwelling purposes was first raised by the Committee appointed by the Conference of Public Authorities on Thames Floods. This Committee had presented their views to the London County Council to the effect that, where basement rooms in low-lying areas liable to floods did not comply with existing statutory requirements, steps should be taken at the earliest practicable time to secure that they were no longer used as dwellings. "The County Council then considered the matter in relation to suggestions for amending the law dealing with underground rooms. The law, as it stands, is almost exclusively concerned with the regulation of those rooms as sleeping places. Appreciation of the present housing shortage in London and the possible results likely to ensue from further legal restrictions in regard to underground rooms, led the County Council to ask for the views of the Metropolitan Boroughs' Standing Joint Committee on the subject (23rd July, 1928). "The Standing Joint Committee, before expressing any opinion to the County Council, requested the fifteen riverside Boroughs individually to state their views (October 1st, 1928). "Accordingly, as Westminster is a riverside authority, the matter was brought before the Public Health Committee on 20th November, 1928, but consideration 87 was deferred until the Conference set up under the auspices of the London County Council for the purposes of investigating the Thames floods and measures for preventing them had completed its deliberations. "The question then remained in abeyance until November, 1929, when the London County Council again communicated with the Standing Joint Committee. On this occasion, the London County Council raise a further issue. It is not only the question of basement rooms in low-lying areas liable to floods, but the general use of basement rooms as dwellings. The London County Council take the view that in many cases the use of basement rooms not only as sleeping rooms but also as living rooms is injurious to health, and they consider that the whole matter should be reviewed in its broader public health aspect. The proposal before the London County Council is to amend or extend Part I of the Housing Act, 1925 (so far as London is concerned), so that all unsatisfactory basement rooms used as living rooms shall be deemed to be so dangerous or injurious to health as to be unfit for human habitation. Such rooms would then come within the provisions of the Act relating to Closing Orders. "The proposal would not prevent the rooms, even though a Closing Order were made, being used for other than dwelling purposes. "Nor would it prevent other parts of the house being used for dwelling purposes. "Nor it is contemplated that closure of a large number of existing dwellings should be effected. "The powers, if obtained, would be exercised only as and when circumstances permitted. "The London County Council also have in mind the obligations w hich would fall to them as the chief housing authority if rehousing on a large scale had to be undertaken. In consequence of Closing Orders, embarrassment to their housing operations would undoubtedly occur. "The question before the Public Health Committee may be put briefly". Is it desirable or expedient on the grounds of public health to apply the existing statutory powers, which deal with basement rooms used for sleeping quarters, to their use for living purposes as well ? "The London County Council propose that, if such unsatisfactory basement rooms were closed for living in, they might be used for other purposes. This may imply that they might be used as larders, wash-houses or domestic storerooms or, alternatively, as offices, stores or other non-domestic purposes. As already pointed out, such rooms, if they be in working-class dwellings and free from human occupation, become repositories of dampness and rubbish and tend to create nuisance. If these rooms are permitted to be occupied most of the day by persons engaged in commercial or other pursuits, the reasons urged for closure seem equally cogent as in the case of their use as dwellings. And if the matter be pursued to its logical conclusion, why not include all unsatisfactory basement rooms where persons are engaged in any trade, occupation or calling ? "At the present time, apart from the power given by the Public Health (London) Act, 1891, to deal with any premises in a state of nuisance or in such a condition as to be dangerous or injurious to health (e.g., a basement dwelling without a window or other means of ventilation), there is no statutory prohibition regulating the use of basement rooms for other purposes than as sleeping quarters. "Owing to the shortage of housing, it has not been found practicable in Westminster to exercise in any degree approaching completeness the existing 88 statutory powers and regulations prohibiting the occupation of underground rooms as sleeping rooms. Only the worst cases have been dealt with and the term "worst" includes those which offend most from a structural point of view and others where overcrowding is pronounced. When underground dwellings are vacated, owners are warned in writing against re-letting them in a manner likely to constitute illegal occupation. These warnings have proved effective, and the number of illegally occupied underground rooms is stsadily diminishing. List year 32 cases were discovered, and in 18 of them removal to better accommodation solved the difficulty. The Council has resorted to Closing Orders only in the most aggravated cases. "The proposal to widen restrictive powers to include unsatisfactory underground rooms used for the ordinary purposes of human habitation in the interests of the public health is one which should receive every sympathy. As, however, it has not so far proved practicable to exercise fully the powers already conferred without causing undue hardship owing to the extreme difficulty in obtaining better accommodation, it would appear precipitate and inadvisable to ask for further powers which are still less likely to be properly exercised in the present circumstances. "As an ultimate principle in public health, it would be worthy of consideration as to whether it would not be most desirable to ensure that no basement room or rooms were let separately as dwellings. That is to say, a condition of occupation would require the tenancy also of a room or rooms on an upper floor." Re-occupation 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 during the year, but in no instance has it been found necessary to issue fresh notices. Families re-housed.—48 families living in overcrowded or other insanitary conditions have been re-housed during the year, 33 by the City Council and 15 by the London County Council. London County Council Estates.—Building operations have been in progress during the year on the St. Helier estate at Morden, and it is anticipated that a portion of the estate will be ready for occupation in the early part of 1930. It is understood that a certain proportion of the accommodation will be allocated to families recommended by the Borough Councils for preferential treatment on account of overcrowding or other insanitary conditions, as in the case of certain other estates belonging to the County Council. The following table, required by the Ministry of Health, is set forth in detail:— 89 Table VIII. Number of new houses erected during the year Tenements. (a) Total 0 (b) With State assistance under the Housing Acts— (i) By the Local Authority 0 (ii) By other bodies or persons 0 (iii) In course of construction 230 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,183 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 515 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3* (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 746 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 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.. 8 * These 3 houses were the subject of dangerous structure notices. The tenants obtained alternative accommodation, and the houses were subsequently demolished. (9583) 8 90  Tenements. (2) Number of dwelling-bouses which were rendered fit after service of formal notices:— (a) By owners 0 (6) By Local Authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 2 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 934 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 929 (b) By Local Authority in default of owners 0 C.—Proceedings under Sections 11, 14, 15 and 18 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders:— (a) Dwelling houses 0 (b) Underground rooms 2 (2) (a) Number of dwelling-houses in respect of which Closing Orders were made 0 (b) Number of underground rooms in respect of which Closing Orders were made 2 (3) (a) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit 0 (b) Number of underground rooms in respect of which Closing Orders were determined, the rooms having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 91 Disinfection. Compulsory Cleansitig: 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 of 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. So far no occasion has arisen for putting these legal powers into force. The fact that such powers exist supplies the necessary lever where ordinary persuasion seems likely to fail. Disinfection.—Disinfection of rooms from which patients suffering from notifiable infectious disease have been removed is carried out by means of the formaldehyde spray. For other non-notifiable infectious conditione 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 96 houses, and 8,014 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 295 men and 37 women, and 7 children under school age, were given medicated baths at the Disinfecting Station, which necessitated their making 339 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 125, and the Disinfecting Superintendent and the Sanitary Inspectors paid 379 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 413 cases of head lice treated. 35 of scabies, and 7 cases of body lice. In all these cases, the clothing was (9583) g 2 92 disinfected together with the bedding from their homes, amounting in all to 1,433 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 215 for head lice, nil for body lice and for scabies. The number of attendances of these children for baths at the station was 1,294. The following table shows the total number of individuals treated at the station for verminous conditions:— Table IX. 1929. Head lice. Body lice. Scabies. Total. Children 629 7* 65* 701 Adults 5 284 43 332 634 291 108 1,033 * Seven were under school age. Table X. General disinfection of premises, articles, &c.:— 1925. 1926. 1927. 1928. 1929. Rooms 1,081 932. 890 891 946 Articles disinfected 22,833 21,775 12,201 20,628 20,291 Articles unshed 5,142 5,550 4,841 6,062 4,994 Articles destroyed 265 372 152 1,169 337 Books disinfected * 454 166 48 50 96 Vehicles ,, 8 4 7 6 18 Offices and business premises 21 25 9 10 8 * School books, 36; library books, 36; private books, 24. Motor Disinfecting Van.—It was found necessary to purchase a new motor van in place of the old Thornycroft, which had been in continuous service since 1914. After considering various types of vehicles a "Morris Commercial Super 25-cwt. Chassis 15.9 h.p. was selected. It is fitted with a special zinc-lined body designed for use as a disinfecting van in accordance with specification. The price was £325 1s. 8d. inclusive of delivery charges, &c. The new van was put in service in July, 1929, and to the end of the year completed 1,805 miles, carrying 1,420 cwts. of goods. The petrol consumed was 203 gallons, equal to 8'8 miles per gallon. The old van, until replaced, ran 2,345 miles and carried 1,704 cwts. of goods. The petrol consumed was 286 gallons, equal to 8.2 miles per gallon. 93 Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 291—in one instance on account of infectious disease. Inquests were held at the Coroner's Court, Horseferry Road, in 288 cases, and there were 13 adjourned inquests. Post-mortem examinations were made in 159 instances. Three 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. Year Total. For Inquest. To await Burial. Year. Total. For Inquest. To await Burial. 1903 396 341 55 1917 278 265 13 1904 381 322 59 1918 285 242 43 1905 368 307 61 1919 308 269 39 1906 344 283 61 1920 289 269 20 1907 358 281 77 1921 273 238 35 1908 364 298 66 1922 269 247 22 1909 291 258 33 1923 336 318 17 1910 333 281 52 1924 340 328 12 1911 383 334 49 1925 334 317 17 1912 324 284 40 1926 343 323 20 1913 328 286 42 1927 357 341 16 1914 323 295 28 1928 348 341 7 1915 376 349 27 1929 291 288 3 1916 281 252 29 There is a resting place for the dead at Drury Lane. MATERNITY AND CHILD WELFARE. (1) Maternity Beds.—Three new features connected with the Council's scheme call for comment. Last year reference was made to a proposal to enter into an agreement with Westminster Hospital for the provision of maternity beds. The cases to be provided for are those referred by the Maternity and Child Welfare Centres and rhe Westminster Health Society The agreement, in the first instance, was for a temporary period of six months, but proved so successful and so satisfactory to all concerned, that it was confirmed and continued on an annual basis. In contrast to the experience of previous years, there has been no complaint of any woman having been sent to hospital and failing to obtain a bed for her confinement. 94 This provision at Westminster Hospital has therefore satisfied a longfelt want and is a notable contribution to the solution of the problem of maternal mortality. The cases referred to the hospital are those coming within the category of complications arising after parturition, cases in which a woman to be confined suffers from illness or deformity, cases which in the opinion of the Medical Officer of Health or Medical Officer of the Centre cannot with safety be confined in their homes, and those cases of necessitous women where in the opinion of the above-mentioned Medical Officers it is necessary to secure proper conditions for the confinement. Thirty-eight cases were referred to the hospital, and only three of those by reason of precipitate and premature confinement at home could not avail themselves of the facilities provided. All those treated in the hospital speak of the comfort and kindness which they received. There was no instance of any illness or complication resulting in those confinements. (2) Measles.—Additional staff for the visiting of cases in time of epidemic. This suggestion was embodied in a memorandum, dealing with epidemics of measles in London issued by the London County Council. It was proposed that preventive work could be made much more effective by closer co-operation between the Education Authority and the local sanitary authority by making use of the information in the hands of those concerned with the school medical services. Measles is commonly spread by school contact; this applies particularly to the junior classes and frequently a child infected at school carries the infection to younger members of the family at home. The school nurses are always on the look-out for early symptoms of measles among scholars and receive immediate notice of all absentees. The school nurses, by meeting the health visitors daily and giving information as to children suspected to be suffering from measles and others absent from school from the same possible cause, could assist in establishing early contact with cases. This system seemed to have considerable advantages over notification, for two reasons: (1) that many parents still consider measles to be a trivial disease and do not call in a doctor; in consequence there is no notification; (2) cases notified are generally those of a severe nature where a doctor has been called in after the disease is well recognised and established, and where the most infectious period (before the rash) is well past and the infection has already spread. The Council having in mind that a considerable outbreak might be expected towards the end of 1929 and in the spring, 1930, appointed a temporary health visitor for work in connection with measles. The appointment was for a preliminary period of three months and her duties were to visit particularly those cases where nursing or hospital treatment was required and to make appropriate 95 arrangements at the earliest possible moment. The temporary health visitor began her duties in December, when over 30 cases were being reported each week. Barlow's Gift.—A sum of money was bequeathed by Jonathan Barlow in 1881 to the vestry of St. George and adjoining vestries for the maintenance of public conveniences. The City Council, since its formation, has administered the fund, the income of which amounts to £33 per annum. According to a proviso in the will, the Council may apply the money to any other benevolent or useful purpose in the said parishes. It was decided, therefore, in May, 1929, to dedicate the income for a period ending 31st March, 1930, to purposes of Maternity and Child Welfare for which expenditure out of the rates could not properly be applied. There are many needs directly affecting health among those who attend the Welfare Centres, and the assistance from this fund has proved a very great boon. Articles such as the following have been bought and lent, or contributions made towards their purchase: rubber bandages, hernia belts, steam kettles, breast pumps, bedding, etc. The total sum of £31 2s. 6d. has been expended. Maternal Mortality: Puerperal Fever and Puerperal Pyrexia.—It may be remembered that last year a regrettably heavy mortality was recorded. In 1929, however, only 5 deaths occurred in pregnant women compared with 17 in 1928. In accordance with the request of the Ministry of Health, Maternal Mortality Committee reports on the circumstances of these cases were forwarded to the Ministry. The following is a summary of the results of inquiries:— Aged 32. Died in infirmary from results of self-procured miscarriage—inquest. Aged 28. Died in isolation hospital. Confinement took place in a maternity hospital. Confinement was 2 weeks overdue, child being abnormally large. Considerable laceration followed instrumental delivery. General infection supervened ending in general septicaemia and broncho-pneumonia. Aged 24. Died in infirmary. Persistent vomiting of pregnancy for which she had attended regularly at the ante-natal clinic of a large maternity hospital. Condition on admission warranted artificial delivery. Infant died after five days. Patient developed puerperal mania and hypostatic pneumonia. Aged 25. Died in infirmary. Septic infection followed miscarriage. Aged 26. Died in hospital. Normal first pregnancy, no instrumental interference. Infected possibly from other case in same ward. Puerperal septicaemia. 96 It is difficult to say after the event how any of these deaths could have been prevented. Three of the cases were under the care of experts before confinement and the deliveries occurred in hospital. The remaining two were the direct result of abortion. While it is a source of satisfaction to note the considerably fewer deaths little emerges to show in what manner the scheme of the local authority has exercised any influence in the reduction or what steps it could have taken to prevent the five deaths of this year. As regards the incidence of abortion, education at the Welfare Centres has, no doubt, an influence in pointing out the evil and tremendous risks of such a procedure. In regard to the general question of puerperal sepsis, in the past it has often been customary to cast the blame on those who attend the patient. More careful study is, however, revealing the fact that the source of infection is sometimes lying dormant in the patient herself and the disturbance to the constitution caused by a confinement may be like the spark which causes the blaze. Puerperal Fever.—There were 7 non-fatal cases which contrasts with 3 last year. Three of them had their confinements in hospital; the remaining four appear to have had fairly normal confinements except that stillborn children were delivered in two. All seven cases made good recoveries. Although the Council provides the services of an obstetric consultant, bacteriologist and nursing facilities for puerperal conditions, these services were not requisitioned as the cases in question were promptly removed to hospital. Puerperal Pyrexia.—A notifiable condition which includes any case of temperature in the lying-in period reaching 100.4°F., which has remained during a period of 24 hours or has recurred during that period. Whilst the condition may not indicate puerperal sepsis, notification furnishes an opportunity of dealing with the case at an early stage. There were 12 cases (last year 21) 11 of which were removed to hospital while one remained at home. All with one exception recovered. That exception developed the graver condition of puerperal fever and is included among the five deaths already reported. 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. 97 Ante-natal Work.—The supervision of expectant mothers is recognised to be of increasing importance, and for this purpose it is extremely desirable that they should avail themselves of the expert advice obtainable at the centres and at the hospitals. The following table shows the number of cases which were dealt with through the various centres and how they became known to the health visitors. The co-operation of the hospitals with the welfare centres continues to develop, and there is interchange of much useful information between those bodies which should result in greatly improved conditions for confinements. Table I.—Ante-natal Cases. Name of Hospital. City Council's Centres. Westminster Health Society. Totals. No. 1, Pimlico Road. No. 15, Bessborough Street. No. 9, Frith Street. No. 30, Page Street. General Lying-in 13 24 2 16 55 St. George's 22 11 2 2 37 Westminster 13 33 3 41 90 St. Thomas' 9 5 — — 14 Charing Cross — 1 2 4 7 Middlesex 1 1 17 — 19 Woolwich — — — — — St. Stephen's — — — — — Queen Charlotte's — — — — — St. Mary's — — 2 — 2 Clapham Maternity — — — — — Royal Free — — — — — Royal Northern — — — — — King's College — ' — — — — Elizabeth Garrett Anderson — — 2 — 2 University College — 1 — 1 Found by Health Visitors 62 96 42 84 284 By Private Doctors and Midwives — — — — _ Reported to Centre voluntarily 90 70 23 44 227 Totals 210 241 96 191 738 Ante-natal Visiting.—To the 738 expectant mothers who became known to the Centre, 715 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,297. The attendances by those mothers at the clinics held by Dr. Vernon are detailed below:— 98 Table II.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. 50 73 90 163 109 Bessborough Street 51 106 163 269 153 Ante-natal clinics are also held at Charing Cross, St. George's, Westminster and Middlesex Hospitals for mothers who have made arrangements for their confinements with these hospitals. Mothercraft.—Classes in mothercraft are held at the various centres, and health talks have been given each week throughout the year in connection with those classes. Table III.—Mothercraft Classes. 1929. Pimlico Road. Bessboro Street. Frith Street. Page Street. Total. Number of classes 48 48 47 89 232 Total attendances 317 1,281 677 3,153 5,428 Average attendances 6.6 26.6 14.4 35.4 23.3 Number of expectant mothers 5 70 20 51 146 Number of attendances by expectant mothers 16 296 101 524 937 Number of other mothers 39 176 94 123 432 Number of attendances by other mothers 301 985 576 2,629 4,491 Attendances of children in nurseries during classes 134 1,076 494 2,787 4,491 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Pimlico Road were 115; at Bessborough Street, 532; at Frith Street, 527; and at Page Street, 2,012. 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 1924 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. 99 Table IV. 1924. 1925. 1926. 1927. 1928. 1929. Number of cases attended— As midwife 75 73 80 65 77 72 As emergency — — — — — — With hospital students — — — — — — With private doctor — — — — — — Total 75 73 80 65 77 72 Number of— Pre-natal visits 570 779 860 678 599 579 Lving-in visits 920 939 1,005 812 1,149 1,003 Subsequent visits 315 335 351 415 442 437 Visits to infants under 1 year, other than lying-in visit* 266 234 262 376 433 361 Total number of visits 2,071 2,287 2,478 2,281 2,623 2,380 Table V. Attendances by midwife at ante-natal and other clinics:— 1924 1925 1926 1927 1928 1929 1, Pimlico Road 40 54 43 39 40 43 15, Bessborough Street 83 75 87 82 86 97 Total 123 129 130 121 126 140 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 31 With hospital student* 6 With private doctors 5 42 Midwifery visits 640 Nursing visit* 138 778 100 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. 751 women from other districts were confined in Westminster and 414 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 538. The following table shows the number of confinements in the hospitals mentioned:— Table VII. Charing Cross Hospital: 310, of which 62 were Westminster cases. St. George's Hospital: 257, of which 33 were Westminster cases. Westminster Hospital: 300, of which 117 were Westminster cases. St. Stephen's Hospital: 202. Sheffield St. Hospital: 53. Infancy and Early Childhood.—At the centres in the City weekly clinics are held for the purpose of giving medical advice. The following figures give an approximate number of the births in the four areas divided for the purposes of maternity and child welfare:— 1, Pimlico Road. 15, Bessborough St. 30, Page St. 9, Frith St. 380 339 342 295 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:— 101 Table VIII. - Pimlico Road. Bessborough Street. Frith Street. Page Street. Total. Pre-natal— First visits 210 222 102 181 715 Other visits 535 241 171 350 1.287 Children under 1 year of age First visits 346 344 284 296 1,270 Other visits 1,628 963 1,202 1,310 5,103 Children over 1 and under 6 years— Visits 2,788 1,746 2,469 2,627 9,630 Death enquiries, still-births, &c 49 41 41 25 156 Infectious diseases 351 201 54 208 814 The Council's midwife paid 579 visits before, and 361 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 1926 are also shewn on page 102. Nursing of Cases of Illness connected with Pregnancy.—An important and very necessary extension of nursing services was effected by the Council in the early part of the year. Formerly, although nursing facilities had been provided for all cases of illness in children under five years of age and also for lying-in women suffering from peurperal fever and puerperal pyrexia, there were none for women suffering from other complications consequent upon confinement or for illness connected with pregnancy. Cases of this nature may not necessarily be serious,but a great many, as, for example, cases of breast abscess, require skilled nursing. Arrangements which were approved by the Ministry of Health were made with the three nursing associations for the" nursing of these cases. 102 Table IX. Attendances at Infant Consultations, 1929. Centre. Number of Sessions. First Attendances. Subsequent Attendances. Total. Total. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Under 1 year. Over 1 year. 1, Pimlico Road 99 220 44 2,072 1,290 2.292 1,334 3,626 15, Bessborough Street 102 222 56 2,548 2.157 2,770 2,213 4,983 9, Frith Street 51 101 27 954 609 1,055 636 1,091 30, Page Street 101 246 75 2,090 1,440 2,336 1,516 3,851 1923 353 789 202 7,664 5,496 8,453 6.698 14.151 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 13.762 1926 354 863 272 6,847 4,871 7,710 5,143 12,853 The average attendances per session were— 1921 1928. 1927. 1926. Pimlico Rood 311.6 39.9 37.1 12.4 Bossborough Street 18.8 44.9 44.7 38.5 Frith Street 33.1 27.1 29.2 23.1 Pago Street 38.1 36.9 40.1 36.3 The number of individual children medically inspected were— 1, Pimlico Road 597 9, Frith Street 231 15, Hessborough Street 464 30, Page. Street 611 103 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 1s. 6d. is paid for each visit made by the Association concerned. The following table shows the nature of certain conditions for which nursing visits were paid:— Table X. Patients. Visits. Ophthalmia neonatorum and conjunctivitis 4 170 Puerperal pyrexia 2 15 Influenza — — Pnoumonia 10 147 Bronchitis 8 90 Measles 9 120 Whooping Cough 4 43 Other complaints 134 1,768 Total 171 2,353 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. Cases (notified). Rate per 100 births for both classes of cases. 1921 21 1.8 1922 24 2.4 1923 30 3.4 1924 23 2.4 1925 21 2.0 1926 16 1.6 1927 14 1.9 1928 7 1.2 1929 11 1.9 104 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 1929 0.73 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. Eleven cases were notified during the year, 4 of those being treated in hospital. There were also 15 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 4 cases, 170 visits being paid. It is satisfactory to note that although the incidence of ophthalmia neonatorum has somewhat increased, investigations show that the infections are much milder in character. At the end of the year, it is reported that no case of impaired vision had resulted among the cases notified throughout the year. Dental Treatment.—The Council's scheme provides for the treatment of ca6es 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 figures relating to dental cases:— Marernity and Child Welfare. New patients 153 Subsequent attendances 793 Teeth extractions 1,172 Teeth filled 148 Other dental operations 663 Anaesthetics administered— Local 23 General 194 Dentures supplied 18 Number of Sessions 89 105 Comparative statement of work of Dental Clinic (M. & C.W. section) since 1924:— 1924. 1925. 1926. 1927. 1928. 1929. Number of Sessions 79 92 92 90 88 89 Now patients 179 205 209 204 172 153 Subsequent attendances 522 613 629 802 807 793 Teeth extractions 1,349 1,278 1,668 1,198 930 1,172 Teeth filled 154 167 189 248 208 148 Other dental operations 478 616 699 777 638 663 Anaesthetics administered— Local 25 38 31 17 28 33 General 240 255 295 263 182 194 Dentures supplied 4 6 2 6 14 18 Patients contributed £13 12s. 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. Henry Fund. The Medical Officer of Health is ex officio a trustee of the latter, the benefits of which are available only to residents of the parish of St. Anne's, Soho. Homes for Unmarried Mothers, etc.—The Council 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, one of them being in the City of Westminster. The Council makes an annual grant of £50 towards the expenses of this nursery, which is organised by the British Red Cross Society. The lack of adequate day nursery accommodation in the City is a matter to which the Council is giving its earnest attention. The Red Cross Dav Nursery is extremely well conducted, but the premises are somewhat small even for the limited number of children taken. There is accommodation for only 40, whereas there is a permanent demand for a day nursery which could house more than 100. Supply of Milk.—Fresh and dried milk is supplied to certain cases recommended by the medical officer of the maternity and child welfare centre. Before the grants are made a standard of income laid down by the Ministry must be proved. In some instances the weekly income (9583) H 106 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, 1,980 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 £75 8s. 6d. INSPECTION AND SUPERVISION OF FOOD. When one considers that in Westminster there is a restaurant for approximately every 120 of the resident population, it will be appreciated that supervision relating to the supply, storage, preparation and handling of food is second to none in importance among the duties of the Public Health department. In addition to restaurants, there are a very large number of shops and stalls where food is stored or sold or prepared for sale. Some of these are subject to special laws and regulations, e.g., meat shops, milk shops, fried fish shops, while all come within Section 8 of the L.C.C. General Powers Act, 1908. The registration of Ice Cream premises under the L.C.C. General Powers Act, 1928, Section 29, has been proceeding dining the year. It should be noted that there is no power to refuse registration on application being made to the Sanitary Authority by an ice cream vendor or maker, and the purpose of registration merely brings the premises to the notice of the Sanitary Authority. They can then be regularly visited and sanitary conditions as required under the General Powers Act, 1908, can be insisted upon. The operation of the Food and Drugs (Adulteration) Act, 1928, should be noted. Further important provisions are as follows:— Being a consolidating measure it does not alter the law relating to the sale of Food and Drugs. but incorporates into one enactment the whole of the Statute Law consisting of some eleven separate Acts of Parliament relating to the subject. Although all based upon the parent Act of 1875, the subsequent amendments and additions had become very numerous and they were over complicated by reason of their various references to one another. The earlier Acts have all been repealed and the new Act ileitis with the various branches of the food laws in five separate parts. Part 1. Incorporates the general provisions of the old Acts relating to the Sale'of Foodstuffs as a whole and includes the prohibition against mixing food and drugs with other ingredients so as to render them injurious to health. Section 10 of the Licensing Act, 1921, appertaining to the sampling of spirits is repealed, but is now dealt with by this Act in this part. 107 Part 2.—Incorporates the provisions of the Margarine Act and deals in a composite form with marking the articles, and the registration of the premises from which they are sold by wholesale. Part 3.—Relates to the appointment of Analysts and the powers of Inspectors as to sampling, etc. The Food Inspector is now to be termed "Sampling Officer." Part 4.—Deals with the legal proceedings, and it is in Section 29 that the important provisions relating to the defence of warranty are contained. Part 5.—Relates to definitions, repeals, title and date of operation of Act. The Public Health (Preservatives in Food, &c.) Regulations, 1925 to 1927, are now given the power of statute law. In Section 1, sub-section 4 of the Food and Drugs (Adulteration) Act; the addition of a preservative in contravention of the regulations shall be deemed to render the article injurious to health. Section 21 lays down a definite standard of proof spirit in whisky, brandy, rum and gin, namely, they shall not contain a greater dilution than 35 degrees under proof. It is further laid down that the purchaser, in demanding an article included in the regulations, is prejudiced as regards its nature or substance or quality if the article supplied does not comply with the regulations as regards the presence or amount of any constituent ingredient or material specified in the regulations. Under the Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928, a rapid succession of orders were made during the year. Hardly a month passes but fresh articles of produce come within the ambit of new orders. As pointed out in last year's report, the administration of these orders has no direct bearing on public health except in so far as some slight difference in quality may be found in Home produce as contrasted with similar produce imported from abroad. The orders emanate from the Ministry of Agriculture and Fisheries, and as the number of articles scheduled continues to increase, the administration of these orders demands a still greater share of the time of the Food Inspectors. The system adopted is that all imported articles are dealt with under the Merchandise Marks Act, 1926, and Home produce under the Agricultural Produce (Grading and Marking) Act, 1926. Two orders uncler the Merchandise Marks Act were in force during the year dealing with the following foods:— No. 3 Order Honey. Fresh Apples. No. 5 Order Currants, Sultanas and Raisins. Eggs in Shell. Dried Eggs. Oat Products. (9583) H 2 108 All the above foods when exposed for Sale, either wholesale or retail, if they were imported into this country from any place outside the United Kingdom must bear an indication of origin. The following regulations have been made under the Agricultural Produce (Grading and Marking) Act, 1928, dealing with Home Produce:— Agricultural Produce (Grading and Marking) (General) Regulations, 1928. „ „ „ „ „ (Eggs) Regulations, 1928. „ „ „ „ „ (Apples and Pears) Regulations, 1929. „ „ „ „ „ (Tomatoes and Cueumbers) Regulations, 1929. „ „ „ „ ,, (Wheat Flour) Regulations, 1929. „ „ „ „ „ (Beef) Regulations, 1929. „ „ „ „ „ (Malt Flour and Malt Extract) Regulations, 1929. „ „ „ „ „ (Potatoes) Regulations, 1929. Under these regulations grades have been made, and goods of these standards can be marked with a recognised Mark approved by the Ministry of Agriculture and Fisheries. This mark is to assist consumers to obtain Home produce of a definite grade and quality. The Artificial Cream Act, 1929. This Act came into force on 1st June, 1929. The title of the "Reconstituted "Cream Bill was altered in the House of Lords so that when it received Royal Assent it became the Artificial Cream Act. The object of the Act is to distinguish clearly between natural cream, which is the fat from fresh milk, and "artificial" cream, which is made from dried separated milk powder, unsalted butter and water. These ingredients, after mixing, are passed through an emulsifying machine. The Act regulates the conditions of manufacture and sale of this commodity. Registration of premises is required except— (1) where it is manufactured by any person solely for his domestic purposes; (2) where it is manufactured for use in the preparation of other articles of food on the same premises; (3) where it is sold in properly closed and unopened receptacles as received. There are strict requirements for labelling all receptacles, &c., "Artificial" Cream. Powers of entry to inspect registered premises 109 are given, also search, warrants may be granted by a Justice where it is suspected that "artificial" cream is being manufactured on unregistered premises. Powers of seizure, penalties for obstruction and use of unregistered premises are included. At present there is only one place in the City registered for the manufacture of "artificial" cream, but there are two other places where it is made but are exempt from registration because of the provisions of Section 2 (1). Milk and Dairies Order, 1926. Registration of Dairymen and Dairy Premises.—At the end of the year there were 312 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. Ten new applications from milk sellers were received and registered. Eight of these concerned new premises, the remaining two were transfers of business and premises from one proprietor to another. In 26 instances registration of premises was cancelled as sale of milk was discontinued. The inspectors paid 366 visits to milk shops and dairies during the year and it was found necessary to serve 6 notices with reference to:— (1) Lack of cleanliness. (2) Accumulation of refuse. (3) Water closet accommodation. (4) Defective flooring. (5) Inadequate water supply. In none of these cases was it found necessary to take legal proceedings, as conditions were remedied on receipt of notice. Bottling Milk in the Street.—The Order has now been in force 3 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 sealing them in the street. Five roundsmen were prosecuted for this offence—last year there were 15 cases. Fines varying from 5s. to £2 were inflicted. It will 110 be noticed that there is a decided decrease in the number of these offences, but observations are being continued. The practice of using sealed 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 co-operate 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 lids 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 receptacles of any milk which may have been splashed over. This Order came into force in October, 1928, and it was found necessary during the year to notify eleven wholesale dairymen of contraventions of this section of the Order. In ten cases matters were rectified as soon as attention was drawn to the offence: one dairyman was summoned because of the state of a churn. The case was dismissed because the magistrate found it difficult to identify the owner. 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 12 Grade A (Tuberculin tested) milk 14 Grade A milk 5 Pasteurized milk 17 5 samples were taken for bacteriological analysis. These samples for bacteriological examination are taken by the Council's inspectors by arrangement with the Ministry of Health, and the reports are sent to the Council as well as to the Ministry. All the samples were found to comply with the bacteriological standards of the order. Pasteurization of milk is not undertaken at any premises in the City. Milk and Dairies (Consolidated) Act, 1915. Under Section 6 it is necessary for the purveyor selling milk in a public street or place from a vehicle or can or other receptacle to have his name and address conspicuously inscribed on the vehicle or receptacle. On two occasions it was found necessary to draw the vendors' attention to the requirements of the section mentioned above. No legal proceedings were necessary. 1ll During the year 48 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 28 of the requests were in proper legal form, 20 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 6 cases in response to the requests from 48 vendors, as 42 of the original samples from the vendors proved genuine. The analyses of the samples from the vendors which were not genuine is summarised below, together with the results of the corresponding samples taken subsequently from the consignors:— Table I. Vendor's Sample. Action taken and Result. Consignor's Sample, number taken. Result of Analysis. Action taken and Result. Contained 4 per cent. of added water. Warranty proved. Summons dismissed 5 Genuine No action. Contained 1 per cent. of added water. 4 per cent. fat abstracted Warranty proved. Summons dismissed 4 Genuine No action. Contained 3 per cent. of added water Summons dismissed under Probation of Offenders Act on payment of 10s. costs 1 Genuine No action. Contained 2 per cent. of added water. Contained 1 per cent. of added water Vendor cautioned 2 Genuine No action. No action. Contained 6 per cent. of added water Dismissed under Probation of Offenders Act 7 Genuine Contained 10 per cent. of added water. Contained 8 per cent. of added water £2 0s. 0d. fine, £2 0s. 0d. costs 1 Genuine No action 112 Analysis of Milk Samples.—Percentage of adulterated samples since 1920 is given in Table II. 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 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 1929 are given in the following table:— Table II. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Per cent. No. Per cent. No. Per cent. No. Per cent. North 423 155 36.6 201 47.5 42 9.9 25 5.9 South 444 168 37.8 221 49.7 37 8.3 28 6.3 1929 867 323 37.2 422 48.6 79 9.1 53 6.1 1928 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 55.1 298 32.7 100 10.9 10 1.0 1925 970 489 50.4 368 37.9 98 10.1 15 1.5 1924 994 507 51.0 363 36.5 105 10.5 19 1.90 1923 997 458 45.9 368 36.9 149 14.9 22 2.2 1922 998 493 49.4 338 33.8 138 13.8 29 2.9 1921 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 The quality of the samples has not been so well maintained this year, but the greater proportion of adulterations were of a slight degree not sufficient to merit legal action. The abnormal climatic conditions throughout the year no doubt had some influence in determining the quality of the milk. 113 Bacteriological examination of milk.—The question was raised as to whether milk obtained from automatic machines was liable to contamination in a greater degree as compared with that sold over the counter or delivered in the ordinary way. Samples from four such machines in different districts were submitted to the City bacteriologist. He reported as follows:— Organisms present. B Coli. (1) Sample good quality—very little dirt 101600 per c.c. Nil in.01 c.c. (2) Fair average sample—moderately 185000 per c.c. Present in -01 c.c. clean „ .001 c.c. Nil in .0001 c.c. (3) Sample of good quality—very little 212000 per c.c Nil in .1 c.c. dirt (4) Sample of good quality—very little 156000 per c.c. Nil in. .1 c.c. dirt There was no evidence suggestive of abnormal contamination and the samples were considered satisfactory. Legal Proceedings for Adulteration.—Of the 53 cases, 14 were considered sufficiently serious to warrant prosecution. Details of the offences and results of proceedings are set out below. Milk— Fine. Costs. 3 per cent, of added water Summons dismissed (Probation of Offenders Act) 10s. 3.5 per cent, of added water Summons dismissed £1 1s. 3.5 per cent, of added water Summons dismissed £1 1s. 4 per cent, of added water Summons dismissed — 6 per cent, of added water Summons dismissed (Probation of Offenders Act) - 7 per cent, of added water Summons dismissed £1 1s. 4 per cent, of fat abstracted 1 per cent, of added water Summonses dismissed (Warranty proved) — 10 per cent, of added water 8 per cent, of added water £2 0s. £2 0s. 14.4 per cent, of fat abstracted and 1.5 per cent, of added water Summons dismissed (Warranty proved) - 26 per cent, of fat abstracted £5 0s. - 12 per cent, of fat abstracted Summons dismissed £3 0s. 8 per cent, of fat abstracted £10 0s. - * Taken <it the same time from one Vendor. 114 Of the total 867 samples of milk taken during the year, 72 were obtained on Sundays. Three of the latter proved to be adulterated to a small extent, each containing one per cent, of added water. The vendors' attention was called to the result of the analyses in each case. Condensed Milk Regulations, 1923-1927. Forty-three samples were taken and all proved to be genuine and properly labelled. Dried Milk Regulations, 1923-1927. One sample was taken and 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 1926 and 1927. 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, alcholic wines, sweetened mineral waters, brewed ginger beer, coffee extract, pickles and sauces made from fruit or vegetables. 20 infringements of these regulations were found as the result of analyses of samples. A detailed list of samples is set out below with notes as to analysis and action taken. 115 Table III. Food and Drugs (Adulteration) Act. Samples purchased under the Food and Drugs (Adulteration) Act, showing results of Analysis and subsequent Proceedings for year 1929. Number Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s. d. 1 Milk 867 814 53 14 3 11 17 0 0 8 16 0 o Do. Separated 3 3 — — - — — - 3 Do. Condensed 43 43 — — - — — 4 Do. Dried 1 1 — - 5 Cream 56 56 — — — - _ 6 Do. Tinned 3 3 — — — 7 Butter 160 155 5 — — — — 8 Margarine 38 38 — — — — — — 9 Olive Oil 5 5 — — — — — — 10 Cocoa 11 11 — 11 Coffee 27 27 — — — — 12 Custard Powder 2 2 — — — —. 13 Rum 21 21 — — — 14 Gin 25 23 2 - — — — 15 Brandy 21 21 - - — — — — 16 Whiskey 29 25 4 1 — 1 — 3 3 0 17 Sausages 75 64 11 — - - - — 18 Meat Pies 18 18 — — - - — — 19 Meat Paste 13 13 — 20 Fish Paste 57 57 — - - — — — 21 Cooked Meats 10 10 — - — — — 22 Preserved Fruits 49 48 1 - — — — — 23 Preserved Vegetables 22 22 - - — — — — 24 Sultanas 28 27 1 1 — 1 — 2 2 0 25 Raisins 21 20 1 — — — — — 26 Currants 4 4 — — — — — 27 Pickles and Sauces 34 34 — — — — — — 28 Vinegar 8 8 — - — — — — 29 Boric Ointment 8 8 - — — — — — 30 Camphorated Oil 11 11 — — — — — — 31 Cheese 1 1 — — — — — — 32 Dripping 3 3 — — — — — — 33 Cider 11 11 — - — — — — 34 Ale 2 2 — — — — — 35 Tinned Fish 16 16 — — — — — • — 30 Jams and Preserves 26 26 — — — — — — 37 Caviare 9 5 4 3 — 3 — 13 13 38 Ice Cream 10 10 — — — — — — 39 Pepper 1 1 — — — — — — 40 Sweets 5 5 — — — — — — 41 Lime Water 6 6 — — — — — — 42 Ammoniated Tincture of Quinine 2 2 - - _ _ _ 43 Syrup of Figs 13 10 3 — — — — — 44 Ground Almonds 1 1 — — — — — — 45 Fruit Cordials 24 22 2 — — — — — 1,800 1,713 87 19 3 16 17 0 0 27 14 0 116 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 case, with the result of any legal proceedings ordered by the Council:— Butter. 160 samples were taken. Three contained a slight excess of moisture and two contained a small percentage of Boric Acid. The vendors were cautioned by letter in each case. Sausages. 75 samples of various kinds were purchased. 11 wore found to contain sulphur di-oxide in amounts varying from 60 to 335 parts per million, and were not labelled in accordance with the Public Health (Preservatives in Food) Regulations. In each case the vendors were cautioned by letter. The amount of sulphur di-oxide permitted is 450 parts per million, provided the article is labelled. Preserved Fruits. 49 samples of various kinds were purchased, and one, dried apricots, was found to contain 2,750 parts of sulphur di-oxide per million. Th& vendor was cautioned by letter. The amount of sulphur di-oxide permitted in these fruits is 2,000 parts per million. Sultanas. 28 samples were purchased. One was found to contain 1140 partsof sulphur di-oxide per million. The vendor of this sample was prosecuted and ordered to pay £2 2s. Od. costs. Raisins. 21 samples were purchased and one was found to contain 880 parts of sulphur di-oxide per million, This was an informal sample. A formal sample was taken and found to be genuine. The amount of sulphur di-oxide permitted in these fruits is 750 parts per million. Syrup of Figs. 13 samples were taken. 3 were found to contain Benzoic Acid as follows: 1,700, 1,700 and 2,200 parts per million. One of these was an informal sample. As regards the 2 formal samples the makers agreed in future to state the amount of Benzoic Acid on the label. Fruit Cordials. 24 samples were taken. 1 contained a preparation of Salicylic Acid equivalent to 1,250 parts of Salicylic Acid per lb., and another contained 650 parts of Benzoic Acid per lb. Both of these were informal samples. Formal samples were taken and found to be genuine. Caviare. 9 samples were taken. 4 were found to contain Boric Acid in amounts varying from 3.5 to 19.6 grains per lb. Three vendors were prosecuted, but the summonses were dismissed under the Probation of Offenders Act on payment of costs amounting to a total of £13 13s. Od. The other vendor was cautioned by letter. Caviare : Preservatives in.—There is no record of this food substance ever having been examined previously for the presence of preservatives. It may be noted that under the regulations, caviare is not included in the schedule of substances to which certain preservatives may be added. In any case boric acid is not permitted under these regulations to be added to any foad. Of the nine samples analysed. 4 were found to contain preservative, and that, boric acid, in the amounts stated. It is contended that boric 117 acid is added not for the purpose of preserving any tendency towards unwholosomeness, but to preserve the original flavour of the article which is said to be somewhat evanescent and likely to be lost in the course of packing and transit from the Black Sea ports. On the other hand, the samples without preservative other than salt indicate that certain importers arc observing the spirit and letter of the regulations although they submit that the unpreserved article is not so acceptable to their customers because of the loss or alteration in flavour. The upshot of the legal proceedings taken in boric acid cases was that the cases were dismissed with costs as first offences. The defendants stated that researches in the meantime were proceeding towards finding some alternative method in place of adding boric acid. It was hoped to reach some successful solution of the problem before the importations of the next season's caviare. 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 on all stalls where food is exposed for sale and also the premises where it is stored. Where stall-holders have their food stores in other districts the addresses are forwarded for the attention of the sanitary authority concerned. The number of stalls registered in the City on which food is exposed for sale is about 200, but this number is continually changing. As a result of constant supervision only a few minor infringements of the by-laws have occurred. These were promptly rectified when pointed out by the inspectors. Otherwise conditions have been satisfactory. 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 special 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 the regulations. A register is kept of all meat vendors and the number at the end of 1929 was 136. The inspectors paid 231 visits to these premises. The conditions were found to be satisfactory. Food Order, 1921. It was found necessary to caution 3 meat vendors respecting the necessity of labelling "imported" meat. A large number of butchers 118 are selling "marked" beef, and find a good demand for it. This beef is graded under the Agricultural Produce (Grading and Marking) Act, 1926. Other Food Premises. The total number of inspections to food premises was 3,122, 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 73 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. About 1,100 restaurants have already been indexed, and during the year 680 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 105 instances, and in each case the work wa6 satisfactorily carried out. Fish Shops and, Fried Fish Shops were periodically inspected. There are 27 of these shops in the City to which the Food Inspectors paid 47 visits. Ice-Cream Premises.—It is particularly necessary that there should be a high standard of cleanliness in the preparation of ice cream 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. A register has now been prepared in accordance with the provisions of the London County Council (General Powers) Act, 1928, and 54 premises used for the manufacture, etc., of ice-cream have been recorded. The inspectors paid 143 visits for the purpose of supervision of the above premises and in three instances Notices had to be served to remedy certain dirty conditions, which were at once complied with. Bakehouses.—At the end of 1929 there were 66 bakehouses in the City, of which 48 were underground. During the year, two underground and four above-ground bakehouses were discontinued being used as such. 176 visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out. 119 It was found that underground rooms at 50/52, Churton Street had been fitted as a bakery contrary to the provisions of the Factory and Workshops Act, 1901, Section 101. Application was made by the occupier for permission to use the rooms temporarily until arrangements could be made to comply with the Act. As the occupier had acted in ignorance of the law and had incurred considerable'expense in adapting the premises he was informed that proceedings would be taken if the use of the bakehouse was not discontinued within a period of two months. Under the circumstances the occupier decided to vacate the premises. 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:— Tons. cwts. qrs. lbs. Tons. cwts. qrs. lbs. Apples 9 3 — 24 Nectarines — 9 2 16 Asparagus — 8 — 4 Oranges 2 10 - — Bananas 50 11 — — Peaches 3 3 — 16 Beans — 8 2 8 Pears 33 6 2 — Blackberries 3 — — Peas — 2 — 16 Cabbages 2 19 — — Persimmons — 6 — 18 Carrots — 7 — 16 Pineapples 2 13 — — Cherries — 8 2 8 Plums — 1 3 4 Celery 1 18 — — Potatoes 8 9 — — Chestnuts 12 10 — — Sprouts 1 13 — — Garlic 4 9 1 4 Strawberries — 3 — — Grape Fruit 5 13 — — Tangerines 42 6 — — Grenadilla — 1 — — Tiger Melons — — 1 13 Horseradish 2 5 1 12 Tomatoes — 2 2 — Leeks 13 1 16 Walnuts 17 12 2 20 Lettuce 3 19 2 16 Fish (Various) 27 Stone Mandarines — 5 1 12 Lobster 2 Barrels. Melons 14 3 1 20 Chicken 2 Hampers. Certification of Food for Export.—Certificates enabling the export of certain articles of food were granted in twenty-one instances—eighteen to Canada and three to Australia. Table IV. Food and Drugs (Adulteration) Act, 1928. Spirit Samples, 1929. 96 Samples of whiskey, brandy, rum and gin were taken during the year. In 6 cases if was found that the spirits were diluted below the standard strength of 35 degrees U.P. The following table shows details concerning the samples of spirits which proved to be adulterated, and the results where legal action was taken:— 120 No. Article. Result of Analysis. Action taken and Result. Degrees U.P. 18S. Whisky 43° Dismissed under Probation of Offenders Act on payment of £3 3s. costs. 76N. „ 35.3° Vendor's attention called. 81N. Gin 36° Vendor cautioned. 268N . Whisky 36.3° Vendor cautioned. 203N. Gin 35.5" Vendor's attention called. 591S. Whisky 36.2° Vendor cautioned. The improvement in the number of defective samples this year is very marked, a drop of from 11 (20.1 per cent.) in 1925 to 6 (6.2 per cent.) in 1929.