AC 4341 City of Westminster REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930 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.0.2. City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1930 ANDREW J. SHINNIE, M.D., D.P.H. (Loud.), 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. iii CONTENTS. PAGE Introduction v Statistics and Social Conditions of the Area 1 Births 5 Deaths 8 Causes of, compiled by Medical Officer of Health 11 „ „ „ „ Registrar General 8 Common Lodging-House 23 Distribution of, in Wards 16 Infantile Mortality 16 Stillbirths 9 Meteorological 4 Population 5 Staff of the Public Health Department 2 Stastistics, General and Vital 1 Prevalance of, and Control over, Infectious Diseases 23 Anthrax 34 Bacteriological Laboratory 36 Cerebro-spinal Fever 34 Chicken-pox 34 Diarrhoea and Enteritis 34 Diphtheria 31 Anti-toxin 32 Bacteriological Diagnosis 33 Schick Test Immunization 31 Encephalitis Lethargica 34 Enteric Fever 33 Influenza 33 Measles 33 Mumps 34 Notifications 23,25, 30 Ophthalmia Neonatorum 35,147 Poliomyelitis 34 Psittacosis 35 Puerperal Fever 34, 61, 138 Puerperal Pyrexia 35,61,138 Scarlet Fever 31 Small-pox and Vaccination 24, 26-29 Tuberculosis 36 Deaths and non-notified deaths 41-43 Dispensary Report 43 Returns (Ministry of Health) 48-53 Notifications—primary 37, 41 Tables 37-41 Whooping Cough 34 General Provision of Health Services in the Area 54 Ambulance Facilities 62 Ante-natal Centres 65 Clinics, School and Orthopaidic 66 Day Nurseries 66, 150 Hospitals 57 Laboratory facilities 56 Local By-laws and Regulations in force 56 Maternal Mortality, Investigation of 61, 138 Maternity and Child Welfare Centres 65 Midwives 55 Nursing in the Home 54 Tuberculosis Dispensaries 65 Venereal Disease, Treatment Centres for 66 Sanitary Circumstances of the Area 67 Conferences, etc. 87 Disinfection 89 Dogs, Fouling of Footways by 85 Drainage and Sewerage 68 Health Education 87 Mortuaries 91 (7070) A 2 iv page Sanitary Circumstances of the Area—(contd.) 67 Pigeons, Nuisance from 86 Premises and Occupations—Controlled by By-laws, etc 82 Public Swimming Baths, etc. 67 Rat Repression 86 Sanitary Inspection of the Area 71 Factories, Workshops and Workplaces 73 Nuisances—Intimation, Statutory Notices, etc. 72 Scavenging 71 Shops, Assistants, Investigations of conditions of 83 Smoke Abatement 77 Battersea Power Station 79 Fulham Power Station 80 Water Supply 67 Housing 92 City Council's Schemes 94 Ebury Bridge 95 Grosvenor Housing—Millbank 96 Hostels 122 Houses, By-laws relating to, etc 121 Fitness of 119 Overcrowding 118 Sufficiency of supply of 118 Working Class—Tabular summary of 123 Statistics required by Ministry of Health 92 Survey of Housing throughout the City 97 Underground Rooms 122 Unhealthy Areas 121 Inspection and Supervision of Food 124 Artificial Cream Act, 1929 125 Condensed Milk Regulations, 1923-1927 128 Dried Milk Regulations, 1923-1927 121 Food and Drugs (Adulteration) Act, 1928 129 Samples, results of analysis, action taken, etc. 129 Food, Inspection and Destruction of 132 Food Order, 1921 131 Meat Regulations, 1924 131 Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928 124 Milk and Dairies Amendment Act, 1922 125 Milk and Dairies (Consolidated) Act, 1915 126 Milk and Dairies Order, 1926 126 Preservatives in Food Regulations, 1925-1927 128 Restaurants and other Food Premises 131 Spirit Samples 133 Street Trading 130 Maternity and Child Welfare 133 Ante-natal Work 139 Confinements in Hospitals 142 Midwives' Cases 141 Mothercraft 140 Barlow's Gift 137 Children under School Age 133 Convalescent Homes 150 Day Nursery 66, 150 Dental Treatment 148 Infancy and Early Childhood 142 Health Visiting 142 Infant Clinics 145 Nursing 147 Maternal Mortality 138 Summary of enquiries 138 Maternity Beds 134 Maternity Cases, Ambulance Services for 135 Midwifery, District Services 136 Milk, Supply of, to necessitous cases 150 Unmarried Mothers, Homes for 62, 150 Venereal Diseases—Death rates of Infants 148 V Annual Report on the Health and Sanitary Condition of the City of Westminster. 1 9 3 O . Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1930. The report is prepared in accordance with the requirements of Circular 1119 from the Ministry of Health. The Circular required that this report should be of the nature of a survey report on simpler lines than that of the survey report of 1925, but paying special regard to housing conditions in the area in view of the new provisions contained in the Housing Act of 1930. The opportunity therefore has been taken of embodying a general review of housing conditions throughout the City. In the housing section, pages 92 to 123, the characteristics of each Ward are described, the types of working-class dwellings are detailed together with any defects or deficiencies which call for comment. The presence of overcrowding, illegal occupation of underground rooms and other insanitary conditions are discussed and recorded. Where it seems practicable, suggestions are offered for remedying conditions. The measures which the City Council has taken during the past five years for improving the housing of the working classes, including, as they do, the completion of more than 200 dwellings as additional accommodation (in contrast to replacement or rehousing operations), are an achievement worthy of remark in so central an area. New homes have been provided for 210 families on the Ebury Bridge Scheme ; four blocks are already occupied, while the remainder containing 130 flats are almost ready. On the Grosvenor Housing Scheme some 154 families from the Millbank area will have been rehoused by July, 1931, at the same rents but in vastly superior conditions to those of their old homes. When this Scheme is finished in 1934, G04 families will have been accommodated. The Council's contribution to housing in the City since the war closely approximates to 1,000 new dwellings built or to be built. Photographs shewing the new flats and the insanitary properties which they are replacing are shewn on pages 107 to 112. vi These two new housing schemes are managed by women property managers trained in Octavia Hill methods and appointed by the Council within the past eighteen months. Great success has attended these appointments which appeared at the time somewhat of an innovation in the City's housing administration. The property managers get in close touch with families before they are rehoused. They learn" their difficulties and encourage and help them to maintain a standard worthy of their new dwellings. The majority of people living in slum houses are the victims of their environment. In those cases where a family occupies a single room it is almost impossible to maintain a clean and orderly home, and it is very gratifying to find that the number who do not react to their new environment and fail in establishing a reign of cleanliness and tidiness is not greater than 1 per cent. I have attempted in this report to set down a faithful narrative of the circumstances and activities concerned with the health of the City during the year. The fact that this report was begun in February and is published in July is an indication of the manner in which the interruptions occasioned by the day to day work of the Council has interfered with its preparation. The work of health administration continues to increase year by year although the depression in economic spheres continues. This increase, partly attributable to Parliamentary legislation, is also a reflexion of the growing interest in the public health exhibited by all classes of society. The comparatively recent and lively discussion in the Press over the Battersea Power Station with the rousing of public opinion in defence of an unpolluted atmosphere is a remarkable example of this movement. The Fulham Power Station public enquiry in December provided a fitting stage for controversy. The circumstances of this enquiry and its findings are of the greatest importance to public health and are somewhat fully discussed. The Council has taken a prominent part in trying to keep the air of our City free from further pollution and is accumulating records, interesting so far, but likely to be of greater value in the future when these great power stations are pouring forth volumes of gases daily from the thousands of tons of coal which they will consume. The graphic record of atmospheric suspended impurities (under Smoke abatement) deserves attention. Judging from the number of plans submitted the building industry in the City has been busier than last year, 891 compared with 877 in 1929. In 1926 plans numbered 724 with a progressive increase each vii year since the war. Some very large buildings, e.g., Dorchester Hotel and Strand Palace Hotel, were completed during the year. Such as these entail a very great deal of study of plans and supervision of sanitary construction while the buildings are in course of erection. The Local Government Act, 1929, has affected the health administration only to the extent of transferring the duties under the Vaccination Acts and Orders. The Minister has also made Orders in connection with the cessation of the percentage, grants formerly received for Tuberculosis and Maternity and Child Welfare services. It is no longer necessary to obtain the Minister's approval for the appointment of certain officers and for developments in these services. In Maternity and Child Welfare, consideration has been given to the Minister's circular dealing with the care of children between infancy and school age. As a first step the Council appointed an additional health visitor in order that the home visiting of those children might be adequately undertaken. For the better organisation of the work a rearrangement of the health visitors districts was made. It is gratifying to note that infantile mortality has fallen from 73-6 in 1920 to 59-21 in 1930. The problem of obtaining day nursery accommodation on a scale to meet the demand for this service still awaits solution. The question of maternal mortality was brought prominently forward in the interim report of the Minister of Health's Departmental Committee. On the resignation of Miss Irving, the Council's midwife, an opportunity was given of reviewing midwifery services and in co-operation with Westminster Hospital the Council instituted at the end of the year a complete midwifery service as part of its Maternity and Child Welfare scheme. The fall in maternal mortality has unfortunately not been maintained. In 1929 it was 3-6 but in 1930 it rose to 7-3 per 1,000 births. A study of the notes on these deaths in the Maternity and Child Welfare section suggests that at least half of them might have been prevented had antenatal care been sought. Illegitimacy is still the sinister factor exacting a growing toll of the lives of mothers and infants. The secrecy and furtiveness which almost always surround these cases prevent the health services from taking eSective action for their care and treatment. The health of the City has been maintained at a satisfactory level. The general death rate has fallen from 14.8 in 1929 to 11.7 in 1930, owing to the absence in the latter year of the severe climatic conditions viii which caused the high death rate in 1929 for respiratory diseases ; to which same cause may be attributed the decline during 1930 in the rate for pulmonary tuberculosis. This fell from .98 in 1929 to .85 in 1930. As regards infectious disease, while there was an increase in the number of cases, there were fewer deaths. Smallpox was prevalent in certain districts of London but Westminster fortunately remained free except for three cases. This freedom, when one considers the enormous daily influx of workers from infected districts, must be due either to the well vaccinated state of Westminster inhabitants or to the high standard of sanitary conditions in this City—according to whichever view is held on the subject of the prevention and incidence of Smallpox. The work of supervising contacts from other districts at work in the City demanded as last year a great deal of time. Dr. Thomson, Assistant Medical Officer of Health, has submitted his report on the work of the diphtheria immunization clinics held at the Welfare Centres. It is included in the section dealing with infectious diseases. There is a small increase in the number of cases treated. This method of prevention is now firmly established and the benefits of protecting children from a dangerous disease are becoming more and more appreciated. The Tuberculosis Regulations 1930 which came into operation in 1931 provide for certain changes in the classification and transmission of notifications, define the responsibility of notification in certain cases and suggest methods in the keeping of records. The Housing Act, 1930. Reports dealing with various provisions in the Act while it was still in the form of a bill before Parliament, were submitted by me to the Housing and Public Health Committees. In the autumn the Council submitted to the London County Council a statement as to housing operations in hand or in contemplation in response to an enquiry by the latter. The London County Council are required under the Housing Act, 1930, to submit proposals to the Minister relating to housing measures and to obtain information from the borough councils. Section 101 (6), Local Government Act, 1929—Grants to voluntary associations carrying out Maternity and Child Welfare duties. The Minister by order fixed the annual grants payable by the City Council to the Westminster Health Society, the Infants' Hospital, Vincent Square, Charing Cross Hospital and the British Red Cross Society Day Nursery. These payments include sums formerly paid direct by the Ministry. Prior ix to the order coming into force the Council had not contributed to the two hospitals in respect of their Maternity and Child Welfare centres. Arrangements having been made for the demolition of the old premises No. 1, Pimlico Road, and rebuilding a new Tuberculosis Dispensary and Maternity and Child Welfare Centre near the old site, the Tuberculosis Dispensary was moved in January, 1930, to temporary premises in vacant rooms over the Highways Depot in Monck Street; while the centre was temporarily accommodated at 14, Westbourne Street in March, 1930, by arrangement with the Grosvenor Estate. Staff—The four medical practitioners acting as public vaccinators (part time) under the late Board of Guardians were transferred to the service of the City Council under the provisions of the Local Government Act, 1929. Their names are included in the list of officers of the Department. The list also includes the name of Mr. J. H. Lowe, whole-time vaccination officer who was also transferred and is now an officer in the public health department. Miss E. M. Craigie, a Health Visitor on the staff of the Poplar Borough Council was appointed in July, 1930. This appointment was made in order that the visiting of the pre-school child might be more adequately undertaken. On the resignation of Mrs. Jenkins, resident caretaker at the Maternity and Child Welfare Centre at 15, Bessborough Street, Mrs. Nicholls, the wife of the Assistant Mortuary Keeper, was appointed to the post. In conclusion I wish to express my sincere thanks to the late Chairman of the Public Health Committee, the Rev. Jocelyn Perkins, the present Chairman, Mrs. F. M. Odone, and to all members of Committees concerned with the health administration of the City for their interest and support. I am also grateful to the staff of my Department for their assistance during a year in which the work has been particularly onerous. I have the honour to be, Your obedient Servant, ANDREW J. SHINNIE. July, 193] 1 SUMMARY OF PARTICULARS REQUIRED BY THE MINISTRY OF HEALTH. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres)—2,502-7. Population (Census 1921)—141,578. Population, June, 1929 (Registrar General's Estimate)—130,000. (See note on population.) „ „ „ Civilian—125,800. Number of Inhabited Houses (1921)—25,321. Number of Families or Separate Occupiers (1921)—33,946. Rateable value— £10,076,000 (March, 1931). Sum represented by a penny rate—£43,140. Extracts from Vitat. Statistics for the Year. Births— Males. Females. Total. Birth-rate. Legitimate 603 599 1,202^ 10-5 Illegitimate 93 73 166/ Totals 696 672 1,368 Deaths—1,478. Death-rate—11-7. Number of women dying in, or in consequence of, childbirth :— Puerperal fever, 4 7.3 per 1,000 births. From other causes, 6 Number of deaths of infants under one year of age per 1,000 births - 59-21. Legitimate rate, 43-2 : Illegitimate rate, 174 6. Number of deaths from measles (all ages)—15. „ ., diphtheria—6. „ „ whooping cough (all ages)—2. „ „ scarlet fever—2. „ „ diarrhoea (under 2 years of age)—8. „ ,, typhoid fever—2. Other particulars asked for are given in the body of the Report. 2 The following are the Public Health Officers of the City Council. Under the Local Government Act, 1929, the Ministry no longer contribute 50 per cent, of salaries of officers engaged in tuberculosis and maternity and child welfare. This discontinued contribution is included in the calculation of the General Exchequer Grant payable to the Council under the Act. The L.C.C., however, still contribute a percentage grant to tuberculosis services. Those whose services are part time are signified thus: * STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Administrates 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 (Resgd. 18.9.30) ... M.A., M.B., B.Ch., M.R.C.S., L.R.C.P. (Maternity and Child Welfare) ♦A. D. C. Bell (Appd. 18.9.30) ... M.A., M.B., B.Ch., M.R.C.S , L.R.C.P. 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. § Public Vaccinators : Mayfair District ♦Kenneth R. Hay, M.B., O.B.E., 47, Hill St., (Population, 17,336) Berkeley Square, W.l. Belgrave and Knightsbridge District... ♦Henry W. Doll, M.R.C.S., L.R.C.P., 42, (Population, 56,646) Montpelier Square, S.W.7. Westminster (St. Margaret and St. *Albert E. Cope, M.D., 66, Belgrave Road, John) District. S.W.I. (Population, 33,423). Westminster (St. Anne and St. James) ~ District (Population, 20,343). ►♦Percy J. Edmunds, M.B., B.Sc., 5, Great Strand District Marlborough Street, W.l. (Population, 13,830). Dental Clinic : ♦T. Stewart Tait (Acting for Mr. L.D.S., R.C.S., Edin. Turner) ♦F. J. Gordon (Anaesthetist) (Appd. M.R.C.S., L.R.C.P. 20.2.30) Public Analysts : ♦Cecil H. Cribb B.Sc., F.I.O. ♦P. A. Ellis Richards F.I.C. 3 § Vaccination Officer: Jambs H. Lowe. § The Vaccination Officer and the Public Vaccinators were transferred from the late Board of Guardians as required by the Local Government Act, 1929, on and from the 1st April, 1930. Clerical Staff : Arthur Wish (Chief Clerk). A. J. Manhood. S. G. Bennett. F. W. Lake. F. E. Norwood. YV. Jenkins. Miss M. MacFarlane (Tuberculosis pensary). Senior Sanitary Inspector : John Sanderson r.S.I., San. Sc. Cert., Gold Medalist, Carpenters' Company. Sanitary Inspectors : M. Canton S.I.E.B., Meat Cert., R.S.I. W. J. Davies (Sampling Officer) ... S.I.B.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.T., 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., Health Visitor's Certificate, Certificated Mid-wife, Dipl. Nat. Health Soc. Health Visitors : Miss A. Sanders Health Visitor's Certificate. Miss J. G. Alexander Health Visitor's Certificate, Certificated Midwife, State Registered Nurse. Miss D. H. M. Walding Board of Education Health Visitor's Diploma, S.I.E.B., National Health Society's Diploma, Nursing. Miss Howell Evans National Health Society's Diploma, Nursing, S.I.E.B. Miss M. M. Scott Health Visitor's Certificate, Certificated Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Miss H. Blick Health Visitor's Certificate, Certificated Midwife, Board of Education Health Visitor's Diploma. Miss P. L. Luff Certificated Midwife, Board of Education Health Visitor's Diploma. Miss E. M. Craigie (Appd. 3/7/30) Certificated Midwife, Health Visitor's Certificate, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. 4 Instructors in Mothercraft at Centres. ♦Mrs. Coleman Red Cross Cert. 1st cl., and gold meda'. *Mrs. Steffens Midwife : Miss A. J. Irving (Resigned 30/9/30) Certificated Midwife, Hosp. Nursing. Other Staff : A. Wheal, Superintendent of Disinfection. R. VV'atling, Keeper of Mortuary and Coroner's Court. A. W. Nicholls, Mortuary Assistant. W. Slattery, Engineer. J. Atkins, Disinfector. S. C. West, Disinfector. P. W. Attwater, 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 (Resigned 8.3.30). Mrs. A. W. Nicholls, Caretaker, 15, Bessborough Street (Appd. 10.3.30). Mrs. Whittlesea, Mrs. Crowley, 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 : ♦The Hon. Mrs. N. Olivier Richards M.D., M.R.C.P., Maternity and Child Welfare. ♦Winifred M. Gray M.D. (Lond.), M.B., B.S. (Ante-natal Clinic). Health Visitors : Miss Callaghan (Supt., Centre) Health Visitor's Certific ite, Cert. Domestic Economy, &c. Miss Pinchen Health Visitor's Certificate, Dipl. National Health. Miss Reed Health Visitor's Certificate and Certificated Midwife. Miss Cross Certificated Midwife. (With assistants, paid and voluntary, holding Hexlth Visitor's Certificates, and nursing experience.) Mrs. Steffens (Mothercraft Classes). Meteorological. During 1930 there were no exceptional features, such as very severe frost, many months of drought and excessive rainfall, which distinguished 1929. It has been described as a year of characteristic British weather. That is to say, it was a thoroughly wet year. Rainfall was in excess of the average except during February, June, October and December. There was a short spell of very warm weather in August, with a shade maximum of 95° F. on the 28th. June had most sunshine, 219 hours 5 in 28 days. December, it may be remembered, was abnormally dark owing to fogs in the upper atmosphere. There were only 7 days on which sunshine could be measured, amounting to only 13 hours. The lowest temperatures were found in March and November. Population. In a Memorandum from the Ministry of Health dated the 28th January, 1931, it is suggested that, in the absence of any computation of the population for the Mid-Year 1930, by the Registrar General, who is desirous of basing this estimate on the Population as ascertained by the 1931 Census, the Report of the Medical Officer of Health should not be delayed on this account, but that the estimated population for MidYear, 1929, might be used. The rates, therefore, concerning Vital Statistics have been calculated upon this old figure. Should, however, the corrected figure be available before this report is put into circulation, the revised figures will accordingly be inserted. Births. The births registered in Westminster during 1930 numbered 1,689, but of these the homes of 843 were in other districts and 16 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 1,368, which is 11 more than the similar figure for 1929. Women whose homes are outside the City continue, in increasing numbers, to avail themselves of the facilities for confinement which the large general hospitals in the City offer. The number in 1919—mostly women whose home address was in easy reach of the hospital, although in some neighbouring borough—was only 98. This figure has risen to 843 in 1930, and includes not only women from the various metropolitan boroughs but also from the counties around London. It will be observed from Tables I and II that the registered births are 11 more than last year. The comparative totals are :— 1928. 1929. 1930. Legitimate. Legitimate. Legitimate. Males 642 606 603 Females 578 584 599 Illegitimate. Illegitimate. Illegitimate. Males 80 82 93 Females 70 85 73 1,370 1,357 1,368 6 Table I. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alire. Stillborn. 1910 2,365 49 276 2,592 1,674 1,621 53 1911 2,110 60 311 2,361 1,562 1,507 55 1912 2,134 49 264 2,349 1,501 1,469 34 1913 1,992 35 276 2,233 1,462 1,424 38 1914 1,860 15 312 2,157 1,386 1,347 39 1915 1,721 71 329 1,979 1 ,292 1,250 42 1916 1,643 175 342 1,810 1,330 1,288 42 1917 1,325 159 378 1,544 1,020 985 35 1918 1,138 146 458 1,459 911 888 23 1919 1,210 98 480 1,592 1,004 977 27 1920 1,731 89 618 2,260 1,327 1,289 38 1921 1,418 78 579 1,919 1,049 1,032 17 1922 1,347 81 629 1,895 1,046 1,020 26 1923 1,361 194 585 1,752 1,045 1,016 29 1924 1,447 344 521 1,624 1,250 1,214 36 1925 1,519 481 497 1,535 1,435 1,385 50 1926 1,535 600 571 1,606 1,402 1,355 47 1927 1,375 5o2 (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 1930 1,689 859 (16) 538 1,368 1,653 1,597 56 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. The legitimate and illegitimate births are distributed as follows Table II. Legitimate. Males 812 404 + 195 = 603 Females 781 390 + 208 = 599 1,593 794 + 403 = 1,202 Illegitimate. Males 55 36 + 74 = 93 Females 41 29 + 61 = 73 96 65 + 135 = 166 The legitimate births show an increase of 12 and the illegitimate a decrease of 1 on the figures of 1929. . As shown in Table I, 1,653 notifications of births were received by the Department for 1930 as compared with 1,532 in 1929. Of the total of notifications, 972 were sent by midwives, of whom 30 were practising in the City during 1930. 7 The following Table shows the number of male and female children born since 1914, and those who did not survive the first year of life, with the number of the surviving children at the end of the first year of life Table III. Number Born. Number of Deaths under 1 year Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 1914 1,120 1,037 103 68 1,017 969 1915 1,006 973 103 79 903 894 1916 889 921 84 67 805 854 1917 756 788 94 64 662 724 1918 789 670 84 64 705 606 1919 786 814 74 63 712 751 1920 1,117 1,149 104 63 1,013 1,086 1921 991 928 91 63 900 865 1922 945 957 68 36 877 921 1923 914 844 44 38 870 806 1924 847 780 58 38 789 742 1925 783 752 57 49 726 703 1926 797 809 48 48 749 761 1927 712 687 52 44 660 643 1928 722 648 47 33 675 615 1929 688 669 57 48 631 621 1930 696 672 48 33 648 639 For each 1,000 girls born, there were in— 1914 1,080 boys 1923 1,082 boys. 1915 1,033 boys 1924 1,086 boys. 1916 965 boys. 1925 1,041 boys. 1917 914 boys. 1926 985 boys. 1918 1,177 boys. 1927 1,036 boys. 1919 965 boys. 1928 1,114 boys. 1920 972 boys. 1929 1,028 boys. 1921 1,067 boys. 1930 1,035 boys. 1922 987 boys. (7070) b 8 Deaths. The following unnumbered tables are supplied by the Registrar General at the request of the Ministry of Health :— Causes of Death at different Periods of Life in the City of Westminster, 1930, Causes of Death. Sex. AU Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— All Causes M 812 49 9 6 10 20 93 286 199 140 F. 689 34 5 6 11 19 82 197 149 186 1. Enteric fever M 2 - - - - 2 - - - - F. - - - - - - - - - - 2. Smallpox M - - - - - - - - - - F. - - - - - - - - - - 3. Measles M 9 2 3 2 2 - - - - - F. 9 3 4 1 1 - - - - - 4. Scarlet fever M. 1 - - 1 - - - - - - F. 1 - - - - - - - - - 5. Whooping-cough M 1 - 1 - - - - - - - F. 1 1 - - - - - - - - 6. Diphtheria M. 4 1 2 1 F. 1 - - - - - - - - - 7. Influenza M. 5 - - - - - - 2 2 1 F. 5 - - - - - - 3 2 - 8. Encephalitis lethargica M. 2 - - - - - 1 1 - F. 3 - - - - - - 2 1 - 9. Meningococcal meningitis M 1 - - - - - - - - - F. 1 - - - - - - - - - 10. Tuberculosis of respiratory system M. 62 5 23 31 3 - F. 35 1 — — 2 4 17 9 1 1 11. Other tuberculous diseases M. 6 2 1 1 2 — F. 4 1 — — — 1 1 — — 1 12. Cancer, malignant disease M 111 7 50 42 12 F. 113 — — — 1 — 10 46 32 24 13. Rheumatic fever M. 2 _ 1 1 F. 1 - - - 1 - - - - - 14. Diabetes M 14 - - - - - 1 5 6 2 F. 6 - - - - - - 4 1 1 15. Cerebral haemorrhage, etc. M. 30 - - - - - 3 12 9 6 F. 46 - - - - - 1 13 16 16 16. Heart disease M. 172 - - - 1 8 57 61 45 F. 162 - - 1 2 4 11 41 35 68 17. Arterio-sclerosis M 29 - - - - - - 7 12 10 F. 24 - - - - - - 2 11 11 18. Bronchitis M. 34 5 - - - 1 3 5 6 14 F. 26 2 - - - - - 2 3 9 9 Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25- 65— 75— 19. Pneumonia (all forms) M. 56 8 2 - - 2 5 22 14 3 F. 50 9 _ - - 1 6 12 13 9 20. Other respiratory diseases M 7 - - - - 1 1 5 - - F. 4 - 1 - - - - - 1 2 21. Ulcer of stomach or duodenum M. 12 - - - - - 5 5 2 F. 10 — — — — — 3 7 — — 22. Diarrhoea, etc M. 10 5 - - - - - 2 1 2 F. 2 - - - - - - - 1 1 23. Appendicitis and typhlitis M. 5 — — 1 1 3 - F. 4 — — 1 — 1 — 2 - — 24. Cirrhosis of liver M. 1 - - - - - - 1 - - F. 5 - - - - - - 4 1 - 25. Acute and chronic nephritis M. 26 _ 2 2 10 4 8 F. 22 - - - - - 1 11 7 3 26. Puerperal sepsis M. _ __ - - - F. 4 — — — — — 4 — — — 27. Other accidents and diseases of pregnancy and parturition M. - - - - - - - - - - F. 6 — — — — 2 4 — — — 28. Congenital debility and malformation, premature birth M. 23 23 - - - - - - - - F. 12 12 - - - - - - - - 29. Suicide M. 27 1 6 8 6 6 F. 9 - - - - - 5 3 1 — 30. Other deaths from violence M. 32 1 1 2 9 10 4 5 F. 24 1 — — — 1 6 6 3 7 31. Other defined diseases M 128 5 1 1 9, 4 14 49 26 26 F. 96 4 - 2 2 3 13 30 19 23 32. Causes ill-defined or unknown M 2 - - - - 1 1 - - - F. 1 - - - - - - - 1 - Still-births.—56 still-born children were notified during the year, 33 of this number being born to non-residents of Westminster. The corresponding figure for 1929 was 34. Under the Births and Deaths Registration Act, 1926, which into came force on 1st July, 1927, all stillbirths must be registered. Still-births Registered. Inward Transfers. Outward Transfers. Total Legitimate and Illegitimate Males 37 19 21 Females 28 5 14 Illegitimate Males 6 3 2 ^Females 3 — 1 (7070) b 2 10 A statement showing the number of cases of certain infectious diseases in the above-named area during the 53 weeks ended 3rd January, 1931:— Westminster, City of, Met. B. Number of Cases of Infectious Diseases Notified (Civilians). Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. 3 256 260 17 16 6 38 (The case rates of these diseases for England and Wales per 1,000 living are respectively asfollows:—Smallpox, 0 • 29 ; scarlet fever, 2-76 ; diphtheria, 1 • 84 ; enteiic fever, 0-07, puerperal pyrexia, 0-14 ; puerperal fever, 0-06 ; and erysipelas, 0-45.) The preceding unnumbered death table and the figures in respect of registered stillbirths are those supplied by the Kegistrar General and inserted at the request of the Ministry of Health. Neither do the statistics relating to deaths, nor to those relating to infectious disease, correspond closely to the figures compiled by the Medical Officer of Health. In the former case a different system of tabulation is employed, while in the latter allowance is made for cases cancelled because of revised diagnosis. 33 cases of Diphtheria and Scarlet Fever were discharged from hospital owing to incorrect diagnosis during 1930. MALES Table IV.—Causes of, and Ages at, Death during the year 1930. Corrected Deaths in thk City at subjoined Ages. Deaths in Wakds (at at.l Ages). Causes of Death. 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. Orosvenor. 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 7 3 1 1 - - - 2 — 2 1 1 - 1 — — — — Scarlet fever 1 — - - - - - - - - - - - - - - - - - - - - - - Influenza 3 — — — — — 1 2 — — 1 1 — — — - 1 — — — — Whooping-cough 1 — 1 - - - - - - - - - - - - - - - - - - - - - Diphtheria, Memb. croup 5 — — 2 2 — 1 — — — — — — 1 — 1 — — - 1 — 1 1 — Oerebro-spinal meningitis - - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - — Enteric Fever - - - - - - - - - - - - - - - - - - - - - - - — Diarrhoea, enteritis 7 6 1 - — — _ 1 2 3 — - — — 1 Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - Other sentic diseases 8 — — - — 1 — 4 3 — 2 - 5 — 1 — — — — — — — Syphilis, Ac. 6 2 — - — — 1 2 1 3 — 2 — — - — — 1 — Diabetes 12 - - - - - - 5 7 — 1 4 2 1 3 — - — — 1 — Rheumatic fever 8 — - - — 1 1 1 1 1 - 1 — Tuberculosis of lungs 63 — — - 4 24 32 3 1 3 1 2 14 1 19 6 2 3 2 1 3 4 1 Other forms of tuberculosis 6 — 2 - 1 — 1 2 1 - 1 1 1 — 1 — — 1 - [Malignant growths 108 — — - — — 8 48 52 8 3 8 30 3 25 9 1 2 2 — 7 6 4 Congenital debility, malformation, ana premature birth 24 23 - 1 - - - - - - - - 2 9 9 4 3 - 2 1 - 1 - - Old age 8 — — - — — — — 8 2 1 1 I 2 — — — — — — — 1 Meningitis and convulsions 3 - - 1 1 - 1 - - — 1 — — 1 - - - - - 1 - - - - 11 MALES—Table IV (continued). Corrected Deaths in the City at subjoined Ages. Deaths in Wabds (at all Ages). Causes of Death. 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 7 - - - - - - 7 - - - - - 3 - 1 1 - - - - - - 2 Other diseases of nervous system 7 - - - - 1 1 2 3 - - - 2 _ 2 _ 1 - - - - 2 _ Valvular diseases of heart 12 - - - - - 1 4 7 — — 1 1 6 — 2 — — 1 — — 1 — Other circulatory diseases 183 1 — 1 1 — 7 69 104 3 20 6 16 48 14 42 3 — 6 7 2 8 5 3 Bronchitis 66 3 — — — — 5 15 43 l 4 — 4 24 — 25 1 1 — 1 — — 5 — Broncho-pneumonia 41 6 1 — 1 1 6 10 16 — 1 1 1 8 1 14 3 1 1 1 1 1 5 2 Pneumonia, other forms 35 1 — — — 2 3 19 10 l 6 1 5 7 1 4 2 — 1 — 2 — 4 1 Other respiratorv diseases 2 — — — — 2 — — — — — — — 1 — 1 — — — — — — — — Alcoholism 2 — — — — — — 2 — — — — 1 — — — — — — — — 1 — — Cirrhosis of liver 3 — — — — — 1 1 1 — - - - - - - - - - - - - - - Appendicitis and typhlitis 5 — 1 — 1 3 — — 2 — — 1 — — — — 1 1 — — — Other digestive diseases 34 2 — - 6 13 13 — 5 2 4 9 1 7 — 1 2 1 1 1 Bright's disease, &e. 41 — — — — 2 4 17 18 l 2 2 3 10 — 12 2 — 1 2 1 2 — 3 Cystitis, &c. 18 — — — — 1 1 4 12 1 4 — 2 6 — 3 1 - - - - - - 1 Deaths by accident or negligence 28 1 - - 1 3 7 8 8 - 3 1 2 8 1 4 1 - 1 2 - 2 3 Deaths by suicide and murder 27 1 - - - 1 6 8 11 - 3 - 3 8 1 6 2 - - 1 1 - 1 2 Other defined diseases 17 — — — 1 1 5 5 5 — 3 1 2 5 1 2 - - - - - - 3 Diseases, ill defined or - - - - - - - - - - - - - - - - - - - - - - - - All causes 793 48 8 7 10 20 91 281 328 8 70 20 62 222 30 186 38 8 20 24 12 26 39 28 12 FEMALES. Table IV.--Causes of, and Ages at, Death during the year 1930. Causes or Death. • coerected deaths in the clty at subjoined Aqes. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 26. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smullpox - __ _ - - - - - - - - - - - - - - - - Measles 8 3 3 — 1 1 - - — 4 3 - 1 - - - - - - Scarlet fever 1 — — 1 — - - - — - - - 1 - - - - - - - - Influenza 3 — — — — - 1 2 - 1 - 1 1 - - - - - - - - - Whooping-cough 1 1 - - - - - - - - - - - - - - - - - - - - - - Diphtheria, Memb. croup 1 — — — 1 _ - - - 1 - - - - - - - - - - Cerebro-spinal meningitis - - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis — — — — - - - - - - - - - - - - - - - - - - Enteric fever 2 — — — — 2 - - 1 - 1 - - - - - - - - - - Diarshcea, enteritis 1 1 - - - - - - - - - - - - - - - - - - - - - - Ervsipelas — — — — — .— - - - - - - - - - - - - - - - Puerperal fever 4 - - - - - 4 - 1 - - - - - - - - - Other septic diseases 5 — — — 1 1 — 3 1 1 1 1 - - - - Syphilis, &c 4 1 - - - - - 2 1 - - - 3 - 1 - - - - - - - - Diabetes 6 — — — — — 4 2 1 - 1 2 - 1 1 - - - - - - - Rheumatic fever 3 — — — 1 — _ 2 - - - - 1 1 1 - - - - - - - - Tuberculosis of lungs 35 1 — — 2 4 18 8 2 1 __ 2 12 2 14 - - - 3 - 1 - - Other forms of tuberculosis 3 1 1 — 1 - - - - - 1 - - 2 - - - - - - - - Malignant growths 109 — — — 1 - 9 44 55 - 10 6 14 32 4 26 2 1 1 - - - - - Congenital debility, malformation, and premature birth 11 11 - - - - - - - - - - - 6 2 3 - - - - - - - - Old age 15 - - - - - - - 15 - 2 1 _ 6 1 2 - - - - - - - 3 Meningitis and convulsions 3 1 - - 1 - 1 - - - - 2 - - - - - 1 - - - - 13 14 FEMALES—Table IV (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 1 — — — — — 1 — — — — — — — — — — — — 1 — — — — Other diseases of nervous system 12 — — — — — 2 6 4 — 1 — 2 3 1 2 1 — — — — 1 1 — Valvular diseases of heart 13 — — — 1 — 5 7 — 1 — 1 3 4 3 — — — — — — — 1 Other circulatory diseases 195 2 — 2 1 2 14 47 127 — 10 5 20 68 6 52 8 1 1 5 1 9 — 4 Bronchitis 54 1 — 1 — 1 — 6 45 — 3 1 1 19 3 21 3 — — 1 — 2 — — Broncho-pneumonia 37 7 1 — — 2 4 6 17 — 2 3 1 9 3 12 — 1 — 1 1 2 — 2 Pneumonia, other forms 25 2 — — — — 2 10 10 — 5 2 3 4 1 6 — — — — 1 i — 1 Other respiratory diseases 6 — — — — — 1 2 3 — 1 — — 2 1 1 — — — — — 1 — — Alcoholism 5 — — — — — 1 3 1 1 — — 1 — — 1 — 1 — — — 1 — — Cirrhosis of liver 6 — 1 1 3 1 — 1 — — — — 4 — — 1 — — — — — Appendicitis and typhlitis 4 — 1 — 1 — 2 — — 1 — — 1 — 1 — — 1 — — — — — Other digestive diseases 18 — — — — — 3 9 6 1 2 2 2 4 — 3 — — 1 1 i 1 — Bright's disease, &c. 29 — — — — — 2 13 14 — 3 1 2 9 2 7 — 2 1 1 — — 1 — Cystitis, &c 10 — — — — — — 4 6 — 3 1 3 2 — — — — — — — — — 1 Accidents and diseases of. parturition 6 — — — — 2 4 — — — — 1 — 4 — — — — — — 1 — — Deaths by accident or negligence 24 — — — — 1 6 6 11 — 6 — — 4 — 6 — 1 — — 2 4 — 2 Deaths by suicide and murder 10 1 — — — — 5 3 1 — 2 — — 2 — 4 — — 1 1 — — — — Other defined diseases 15 — 1 2 1 2 4 5 — — — 2 4 2 2 1 — — 2 1 — — 1 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — All causes 685 33 5 6 11 22 80 193 335 3 61 26 56 212 34 179 18 8 7 24 11 28 3 15 15 1,692 deaths were registered in the City during 1930. After deducting 1,013 deaths of non.citizens in public institutions, etc., in the City, and adding those of 799 citizens who died in other districts, the corrected total is 1,478, as compared with 1,875 in 1929, and is equivalent to an annual rate of 11.7 per 1,000 persons (civilian population), compared with 14'8 last year. The London death.rate for 1930 was 11.4 (civilians only), for England and Wales, 11.4. These rates are much lower than in 1929 for Westminster and the country as a whole. Among Westminster residents 426 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 1916 to 1930.) Year. Number of Deaths. Westminster Rate. London Rate. 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 1930 1,478 11.7 11.4 The deaths of males were 793, females 685. Table VI. This table shows the total deaths distributed among age periods :— 1930. Under 1 year 1 to 2 years 2 to 5 years 5 to 15 years 15 to 25 years 25 to 45 years 45 to 65 years 65 and up. years Total. M. 48 8 7 10 20 91 281 328 793 F. 33 5 6 11 22 80 193 335 685 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 1930 81 13 13 21 42 171 474 663 1,478 16 The causes of death are set out in Table IV. There was an increase among males of deaths from the following causes:—Measles, enteritis, syphilis, diabetes, diseases of nervous system and suicide. Among females the causes showing an increase were measles, syphilis, pulm. tuberculosis, nervous and circulatory diseases and deaths from accidents of parturition. 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. 1926. 1927. 1928. 1929. 1930. m. f. Total. m. f. Total. m. f. Total. m. f. Total m. f. Total. Conduit . — 5 5 4 — 4 4 4 8 4 3 7 8 3 11 Grosvenor 60 64 124 58 67 125 59 78 137 88 63 151 70 61 131 Hamlet 11 23 34 25 30 55 16 22 38 18 30 48 20 26 46 K. St. George 58 69 127 74 74 148 54 57 111 66 80 146 62 56 118 Victoria 236 252 488 245 286 531 231 226 457 249 292 541 222 212 434 St. Margaret 51 37 88 42 42 84 29 32 61 51 44 95 30 3 4 64 St. John 204 162 360 217 138 355 173 163 336 298 207 505 186 179 365 St. Anne 38 32 70 44 33 77 26 23 49 42 28 70 38 18 56 Gt. Marlborough 20 14 34 18 15 33 20 17 37 14 15 29 8 8 16 Pall Mall 22 8 30 21 9 30 31 7 38 35 6 41 20 7 27 Regent 25 18 43 35 20 55 25 12 37 26 24 50 24 24 48 Charing Cross 13 6 19 15 7 22 12 8 20 24 7 31 12 11 23 Covent Garden 39 39 78 29 35 64 35 29 64 39 41 80 26 28 54 Strand 56 6 62 52 5 57 46 10 56 36 5 41 39 3 42 Homeless 22 18 40 29 13 42 26 22 48 22 18 40 28 15 43 Infantile Mortality.—The corrected death-rate of infants for Westminster was 59.21 per 1,000 births. The mortality among legitimate infants was 43.2 per 1,000; that of illegitimate 174.6. The infant mortality rate for London was 59. The rate for legitimate infants has appreciably declined, whilst that for illegitimate infants is abnormally high, due to a large degree to the mothers of these children being temporarily domiciled in Westminster as inmates of rescue homes or for the purpose of domestic employment. The number of infants dying under 1 year was 81, a decrease of 24 on the figure of last year and as the total number of births shows an increase of 11, the infantile mortality rate shows a decrease of 18.16 on the figures of 1929. The chief contributory causes of death were pneumonia, prematurity, gastro-enteritis and measles. Twenty-three of the 25 premature deaths occurred before the fourth week of life. Gastro-enteritis accounted for 8 deaths, 5 of the infants being over four months old. 17 Table VIII shows the deaths as they occurred during the four quarters of the last four years :— Table VIII. Total 1930. Total 1929. Total. 1928. Total. 1927. 1st Quarter 28 40 21 29 2nd „ 18 29 19 16 3rd „ 17 18 21 26 4th „ 18 18 19 25 81 105 80 96 Table IX shows the births and deaths of infants, legitimate and illegitimate, since 1903 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table IX. Year. Legitimate. Illegitimate. Total Kate, Westminster. Total Rate, London. Births. Deaths. Death.rate per 1,000 Births. Births. Deaths. Death.rate per 1,000 Births. 1903 3,035 345 113 150 25 166 116 130 1904 2,920 320 109 134 40 298 118 145 1905 2,971 305 102 149 24 161 105 130 1906 2,744 285 103 187 38 203 110 131 1907 2,764 269 97 163 34 208 103 116 1908 2,739 266 97 174 27 155 100 113 1909 2,548 232 91 203 26 128 93 108 1910 2,399 189 78 193 25 129 82 103 1911 2,195 210 95 166 33 198 103 129 1912 2,194 168 76 155 27 174 83 91 1913 2,057 184 89 176 29 164 95 105 1914 1,995 147 73 162 24 148 79 104 1915 1,798 141 78 181 41 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 48 239 103.6 104 1918 1,234 112 86.6 225 36 155 100 108 1919 1,383 99 71.5 217 41 188 87.5 85 1920 2,047 123 60 219 44 200 73.6 76 1921 1,729 117 67.7 190 37 194 80.2 80 1922 1,703 84 49.3 199 20 100 54.6 74 1923 1,582 68 42.9 176 15 85.7 47.2 60 1924 1,489 82 55.0 138 14 101.4 59.0 69 1925 1,418 88 62.0 117 18 153.8 69.0 67 1926 1,449 76 52.4 157 20 127.3 59.7 64 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 1930 1,202 52 43.2 166 29 174.6 59.21 59 18 onwards, showing the proportion per 1,000 births applicable under each heading:— Table X. — 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. Diphtheria — — 0.65 — 1.4 1.4 0.73 — Influenza — 0.6 0.65 0.62 0.71 — 0.73 — Measles — 5.5 2.49 0.73 3.6 Whooping Cough 1.1 1.9 4.5 0.62 1.4 2.1 8.1 0.73 Septic diseases 1.7 1.2 — 0.62 0.71 — — — Bronchitis and pneumonia 4.0 10.4 16.2 9.9 6.4 13.8 14.7 14.6 Stomach and bowel complaints 1.1 1.9 5.2 8.0 12.1 10.9 7.3 5.8 Syphilis 2.8 1.2 1.3 — 2.8 0.72 0.73 2.1 Congenital malformations 5.1 4.9 3.2 4.34 7.8 5.1 4.4 4.3 Prematurity 13.1 14.1 16.9 19.3 20.0 9.4 19.8 18.2 Neglect and injury at birth 6.8 3.1 0.65 3.72 4.2 4.3 1.4 1.4 Debility from birth and atrophy, rickets, atelectasis 6.2 5.3 7.1 3.72 4.2 3.6 2.2 2.7 Tuberculosis 1.7 1.8 1.9 1.86 2.1 2.1 2.2 1.4 Murder — 1.4 Chicken Pox 0.73 — Mongolism — — — — — — — 0.73 Other causes 2.8 6.7 10.4 4.34 4.2 21 13.2 1.4 46.6 59.0 69.0 59.7 68.6 58.39 77.37 59.21 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, 1930. causks 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. C Mont lis and under 9 .Months. 9 Months and under 12 months. Total Deaths | under 1 Year. Measles — — — — — — — 2 3 5 Whooping Cough — — — — — — — 1 — 1 Tuberculosis — — — — — 1 — 1 — 2 Meningitis — — — — — — — 1 — 1 Bronchitis and Pneumonia (all forms) — 2 — 2 9 2 4 3 20 Gastro-enteritis 2 — 1 — 3 — 3 — 2 8 Injury at birth 1 — — — 1 — — — — 1 Neglect at birth 1 — — — 1 — — — — 1 Murder 1 — — — 1 — — 1 — 2 Congenital malformations 4 1 — — 5 1 — — — 6 Premature birth 23 — — — 23 — i 1 — 25 Malnutrition, marasmus, debility from birth 1 — — — 1 2 1 — — 4 Mongolism 1 — — — 1 — — — — 1 Other causes 1 — — — 1 — — — — 1 Syphilis — — — — — 3 — — — 3 Totals 35 3 1 — 39 16 7 11 8 81 19 Table XII. Nett Birtha in the year :— Males. Females. Total. Legitimate 603 599 1,202 Illegitimate 93 73 166 696 672 1,368 Nett Deaths in the year of :— Males. Females. Tota'. Legitimate infants 27 25 52 Illegitimate infants 21 8 29 48 33 81 The causes of death of the Illegitimate were:—Neglect at birth 1, prematurity 8, pneumonia 10, syphilis 2, debility 2, digestive disease 1, congenital malformation 1, whooping cough 1, murder 2, and meningitis 1. Table XIII. Infant Mortality, 1930.—Nett Deaths from stated causes at various ages under One Year of Age in Pimlico A rea (Victoria, Knightsbridge St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks Total under 4 Weeks. 4 Weeks and under 3 Mom hs. 3Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Dentin under One Year. Measles — — — — — — — — 3 3 Bronchitis and Pneumonia (all forms) — —1 — — 1 5 — 1 3 10 Grastro-enteritis 2 — — — 2 — — — 1 3 Injury at birth 1 — — — 1 — — — — 1 Congenital malformations 1 1 — — 2 1 — — — 3 Premature birth 7 2 1 1 11 — 1 — — 12 Malnutrition,marasmus and debility from birth 1 — — — 1 1 1 — — 3 Meningitis — — — — — — — 1 — 1 Syphilis — — — — — 3 — — — 3 Totals 12 4 1 1 18 10 2 2 7 39 Table XIV. Nett Deaths in the above area during the year :— Males. Females. Total Legitimate 12 12 24 Illegitimate 12 3 15 20 Table XV. Infant Mortality, 1930.—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. Whooping Cougli — — — — — — — 1 — 1 Measles — — — — — — — 1 — i T uberculosis 1 — 1 — 2 Bronchitis and Pneumonia (all forms) 1 — — 1 2 1 1 1 6 Gastro-enteritis — — 1 — 1 — 2 — — 3 Congenital malformations 2 — — — 2 — — — — 2 Premature birth 6 — 1 — 7 — — 1 — 8 Murder — — — — — — — 1 — 1 Other causes 1 — — — 1 — — — — 1 Totals 10 — 2 — 12 3 3 6 1 25 Table XVI. Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 7 11 18 Illegitimate infants 3 4 7 Table XVII. Infant Mortality, 1930. Nett Deaths from stated causes at various ages under One Year of Age in the North District (Grosvenor Conduit, St. Anne, Pall Mall, Regent, Gt. Marlborough, Strand, Charing Cross and 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 Measles — — — — — — — 1 — 1 Bronchitis and Pneumonia (all forms) — — — — — 2 1 1 — 4 Gastro-enteritis — — — — — — — — 1 1 Congenital malformations 1 — — — 1 — — — — 1 Premature birth 4 1 — — 5 — — — — — Malnutrition, inanition and debility from birth — — — — — 1 — — — 1 Mongolism — 1 — — — 1 — — — 1 Totals 5 2 — — 7 3 1 2 1 14 21 Table XVIII. Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 8 2 10 Illegitimate infants 3 1 4 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 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Enteritis — — — — — — 1 — — 1 Want of attention 1 — — — 1 — — — — 1 Murder 1 — — — 1 — — — — 1 2 — — — 2 — 1 — — 3 Table XX. Deaths of children unknown :— Males. Females. Total Legitimate — — — Illegitimate 3 — 3 Table XXa. The following table shows the allocation of the nett births and infant deaths among the various Wards in the City, together with the infantile mortality rate for the Ward. Wards. Population, 1921 Census. Total Births, 1930. Legitimate. Illegitimate. Total Infant Deaths, 1930. Legitimate. Illegitimate. 1930—.Infant death rate per 1,000 births Legitimate. Illegitimate. Total. Conduit 3,456 4 2 2 — — — — — — Grosvenor 13,880 84 75 9 2 1 1 13.3 111.1 23.8 Pall Mall 3,572 6 4 2 2 i 1 250.0 500.0 333.3 Regent 6,878 39 31 8 2 2 — 64.5 — 61.2 Gt.Marlborough 3,194 15 10 5 1 1 — 100.0 — 66.6 St. Anne 6,699 58 49 9 5 5 — 102.0 — 86.2 Covent Garden 7,064 35 31 4 2 — 2 — 500.0 57.1 Charing Cross 4,650 6 1 5 — — — — — — Strand 2,116 3 1 2 — — — — — — Victoria 37,396 561 503 58 33 20 13 39.7 224.1 58.8 K. St. George 12,563 118 107 11 5 3 2 28.0 181.4 42.3 Hamlet 6,687 28 24 4 1 1 — 41.6 35.7 St. Margaret 9,261 38 32 6 2 1 1 31.2 166.0 52.6 St. John 24,162 372 332 40 23 17 6 51.1 150.0 61.8 Homeless — 1 — 1 3 — 3 — — — Total 141,578 1,368 1,202 166 81 52 29 43.2 174.6 59.21 22 Two interesting features may be observed in the above table. Firstly, the very high death rate among illegitimate infants, which raises the Infantile Mortality Rate of the City and prejudices the results of the Maternity and Child Welfare services. As is well known, these unfortunate mothers, owing to circumstances, conceal their condition and tend to avoid all the agencies which are instituted for their help. It is little wonder then that they contribute both to Maternal and to Infantile Mortality to a considerable extent. Secondly, the fallacy of interpreting certain statistics from their face value. The Infant Mortality Rate of Pall Mall Ward is appalling, namely, 333.3. Far from being an unhealthy area, it is one of the best in the City as regards housing and sanitation, but it is utterly lacking in fertility : a population of 3,572 persons produced only 6 infants; two of these were illegitimate and they died. Hence the high rate. The following table is inserted by courtesy of the Medical Officer of Health, Poplar, who collected the data. The comparative figures are interesting. Vital Statistics, 1930. . Population. Birthrate. Death. rate. Infantile Mortality per 1,000 Births. West Districts— Paddington 142,800 15.12 12.64 78 Kensington 176,000 14.6 12.7 69 Hammersmith 136,900 15.9 11.7 64 Fulham 153,700 15.3 10.8 57 Chelsea 62,680 12.7 12.5 40 City of Westminster 125,800 10.5 11.7 59 North Districts— St. Marylebone 102,400 12.1 10.6 62 Hampstead 84,830 11.8 11.5 58 St. Pancras 203,900 15.4 11.9 60 Islington 319,800 17.4 12.1 70 Stoke Newington 50,040 14.6 12.2 54.6 Hackney 214,400 16.4 11.1 49 Central Districts— Holborn 38,380 10.5 12.7 89 Finsbury 66,860 19.4 13.8 63 City of London 10,700 8.3 12.0 89 East Districts— Shoreditch 99,710 20.1 12.2 65 Bethnal Green 110,500 17.7 11.1 60.3 Stepney 241,800 17.4 11.2 76 Poplar 160,000 19.1 10.5 55 South Districts— Southwark 178,500 16.8 12.5 57 Bermondsey 113,800 18.1 13.1 63 Lambeth 294,400 15.76 12.04 56.83 Battersea 161,800 16.4 11.4 54.7 Wandsworth 355,864 13.17 10.59 55 Camberwell 256,900 14.8 10.9 51 Deptford 111,000 15.9 11.3 61 Greenwich 104,430 15.38 9.99 45 Lewisham 207,900 15.1 9.7 42 Woolwich 141,600 15.5 10.9 42 23 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; 98 deaths of persons giving addresses in common lodging houses occurred in 1930. They were mostly in institutions :— Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 34 33, Great Peter Street (licensed for 80 men) 2 7, St. Ann's Street (Salvation Army) (licensed for 565 men) 23 16, Strutton Ground (licensed for 201 men) 25 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 14 Church Army Home, Greencoat Place (131 women) — 98 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 1926-1930. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1926 1027 1928 1929 1930 Smallpox — — 2 2 3 Diphtheria 223 185 233 170 256 Erysipelas 44 37 47 54 37 Scarlet fever 132 180 241 227 265 Enteric fever 11 24 28 7 18 Continued fever — 1 — Puerperal fever 6 6 6 10 6 Puerperal pyrexia 7 26 21 12 16 Cerebro-spinal meningitis 1 1 1 2 — Encephalitis lethargica 5 1 1 — 3 Poliomyelitis 2 1 — 1 3 Ophthalmia neonatorum 16 14 7 11 16 Measles 1,026 71 997 381 551 German measles 14 12 21 179 15 Pneumonia 69 64 26 51 25 Malaria 1 2 Dysentery — — 8 7 — Anthrax — — Chicksnpox 198 206 210 229 173 Mumps 64 153 150 73 166 Whooping-cough 46 128 76 246 14 (7070) c 24 Smallpox.—Three cases of this disease occurred among residents in the City. The first case was in the person of a woman who had been an in-patient of a hospital for 5 weeks; and the other two cases were both members of a family who had been infected by a missed case in the same household. This disease still continues to be of the mild type which has been prevalent in England and Wales for the past 2 or 3 years, and although Westminster may count itself fortunate in having so few cases among its inhabitants, the work in connection with the supervision of contacts of smallpox still continues to demand its share of attention from the staff of the department. The names of 206 passengers who had been in contact with cases of smallpox contracted abroad were received from the Port Sanitary Authorities. The administration of Smallpox in London has figured very prominently in the proceedings of the sanitary authorities throughout the County during the year. Difficulties were experienced in certain boroughs in applying strict methods of prevention owing to the mild nature of the disease. The Ministry issued a special circular suggesting that chickenpox should be made notifiable while these mild smallpox cases were prevalent. Accordingly in Westminster chicken-pox has been notifiable since March, 1930. The vaccination of non-resident contacts was also suggested. This also has been carried out. Considerable discussion has taken place with the L.C.C. (the hospital authority) as to admission to the observation hospital at Rotherhithe of doubtful cases, of mothers suffering from small-pox with suckling infants and infants with smallpox being admitted with their mothers who were not suffering. These and many other problems connected with the control of this mild form of smallpox were happily progressing towards solution at the end of the year. Vaccination.—The Vaccination Officer informs me that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 567 Secondary 161 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. 25 (7070) Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1930. Cases Notified. Caaes removed to Hospital. Treated at Home. At all Ages. Deaths. Notifiable Diseases. At all Ages. At Agee—Years. At Ages—Yean. 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. 2-8. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 85-45. 45-65. 65 and 1 over. Smallpox 3 — — — — — — 1 1 — — 1 — 3 — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — Diphtheria 236 8 11 21 13 18 96 24 14 25 1 3 2 234 2 6 — — 1 1 — 21 1 — — 1 — — Erysipelas 37 — 1 — — — — 1 3 13 16 3 23 14 — — — — — — — — — — — — — Scarlet fever 252 — 9 13 29 23 82 30 22 33 7 3 1 251 1 2 — — 1 — 1 — — — — — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 17 — — —. 2 1 7 3 3 1 11 6 2 — — — — — — — — 1 1 — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 6 — — — — — 5 1 5 1 4 — —. — — — — — — 2 2 — — Cerebrospinal meningitis — — — — — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis 3 — 1 — — — — — — — — — — 3 — — — — — — — — — — — — — — Encephalitis lethargica 3 — — — — — 1 1 — — 1 2 1 4 — — — — — — — — — 1 2 1 Ophthalmia neonatorum 16 16 — — — — — — — — — — — 9 7 — — — — — — — — — — — — — Pneumonia 25 — 1 — — — 1 8 4 6 5 15 10 60 3 — — — — — — — 5 3 29 20 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — —. —. — — — — — — — — — — — — — — — — — — Puerperal pyrexia 16 — — — — — — — 15 1 — — 14 — — — — — — — — — — — — — — *Chicken-pox 95 1 4 2 4 7 42 20 7 7 — — 1 3 92 — — — — — — — — — — — — — Totals 709 25 27 36 46 48 223 76 47 105 30 32 14 573 136 78 3 — 2 i i 2 1 8 8 31 21 c 2 Correction has been made lor errors in notification or revision of diagnosis in 33 cases. Cases not notified :— Scarlet fever, 13. Diphtheria, 20. * Made notifiable March, 1930. 26 The Vaccination Officer now being an officer of the City Council and a member of the Public Health Department, has submitted a report, which is incorporated in the report of the Medical Officer of Health :— Vaccination Officer's Report. Under the provisions of the Local Government Act, 1929, the functions of the Board of Guardians of the City of Westminster Union in respect of Vaccination were transferred to the Westminster City Council on the 1st April, 1930. Under the Vaccination Order, 1929, and embodied in the Vaccination Order, 1930, instructions have been issued to the Public Vaccinators as follow:— (1) In place of the officially advocated four insertions, trial be made of vaccination and re-vaccination in one insertion with a minimum of trauma, and that multiple scarification and (or) cross-hatching be deprecated. (2) Primary vaccination be performed in infancy, between the ages of two and six months as at present, and re-vaccination be offered at the time when a child enters school (5 to 7 years), and again on leaving (14 to 16 years). (3) Vaccination in multiple insertions be available for such persons as desire to obtain the maximum protection against smallpox obtainable at one operation. (4) In public vaccination, parents be informed that if, in consequence of vaccination, a child requires medical attention, it is the duty of the public vaccinator concerned to provide such attention without cost to the parents. From personal enquiries in the course of my visitations, it is interesting to note that parents are more disposed to have their children vaccinated since the new regulations have been in force. It having been reported that three smallpox cases occurred in Westminster and the Strand Districts, the Medical Officer authorised the vaccination or re-vaccination of non-resident smallpox contact cases, although the persons concerned are at their place of business but not residents in the Public Vaccinator's District, and in such cases the Minister of Health has expressed his willingness to sanction the payment of fees under the Local Authorities (Expenses) Act, 1887. 27 Vaccination Return for the Year ended 31st December, 1929. Number of Births returned in the " Birth List Sheets" as registered from 1st January to 31st December, 1929. Number of these Births duly entered by 31st January, 1931, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1931, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1931, neither duly entered in the " Vaccination Register " (cols. 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (cols. 8, 9 and 10 of this Return). Total number of Certificates of Successful Primary Vaccination of children under 14 received during the calendar year 1930. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the children to which they relate, during the calendar year 1930. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to Places unknown,or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had Small-pox. 2 3 4 5 6 7 8 9 10 11 12 13 1,570 993 14 — 307 58 11 116 71 — 1,325 329 28 Summary of Monthly Returns for the Year ended 31st December, 1930. No. of Cases in Birth Lists received. No. of Certificates of V accination received. No. of Certificates of Postponement owing to health of Child. No. of Statutory Declarations under Section 1 of the Vaccination Act, 1907. No. of Certificates of Insusceptibility. No. of Cases. No. of Entries in List sent to Public Vaccinators. Parents Removed out of District. Otherwise not found. 1,683 1,325 64 329 11 47 44 246 29 Statement of Vaccinations carried out by the Public Vaccinators during the year ended 31st december, 1930. Name of Public Vaccinator and District. No. of Successful Primary Vaccinations. No. of Successful Re-vaccinations. Dr. K. R. Hay (Mayfair) 12 11 Dr. H. W. Doll (Belgrave and Knightsbridge) 247 20 Dr. A. E. Cope (Westminster, St. Margaret and St. John) 224 105 Dr. P. J. Edmunds (St. James and St. Anne) 69 14 Dr. P. J. Edmunds (Strand, from 1st April, 1930) 11 11 Dr. J. Bremner (Strand, until 31st March, 1930) 4 — 567 161 30 Table XXIV. City of Westminster.—Infectious Diseases, Distributed in each Ward. Notifiable Diseases. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless and non residents. Smallpox 1 2 — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — Diphtheria — 8 22 79 9 93 3 1 10 — 2 5 3 12 9 Erysipelas — — 4 13 — 12 — 1 — — 2 1 1 2 1 Scarlet fever — 12 11 93 7 110 — 2 3 1 5 8 — 10 3 Typhus fever — — — — — — — — — — — — — — — Enteric fever 1 1 2 3 — 4 2 1 1 — 1 — 1 1 — Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — 1 — 3 — 2 — — — — — — — — — Cerebro-spinal meningitis Poliomyelitis — — 1 — 1 1 — — — — — — — — — Encephalitis lethargica — — — — — — — — — — — — — — — Ophthalmia neonatorum — 1 1 5 — 6 — — — — — —1 — 2 — Pneumonia — — 6 9 2 5 — 1 — — — 1 — 1 — Malaria — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — Puerperal pyrexia — 2 1 6 1 4 — — 1 — — 1 — — — Chicken-pox 25 2 10 24 7 18 — — 1 — 1 3 4 Totals 26 27 58 237 27 239 5 6 16 1 11 20 5 32 13 31 Scarlet Fever.—265 cases of this disease occurred in 1930, an increase of 38 on the figures of 1929. The Victoria and St. John Wards showed a marked increase, the distribution in the remaining wards being normal. There were 2 deaths. The case rate of this disease per 1,000 of the population was 2.38 for the City, and for England and Wales 2.76. The death rate for Westminster was 0.01 per 1,000 and that for London and England and Wales was 0.02 respectively. Of the total cases in Westminster 99.6 per cent, were removed to hospital. Diphtheria.—256 cases of this disease occurred, showing an increase of 86 on the figures of 1929. The wards showing a marked increase are St. John and Victoria. The largest number of cases occurred between the ages of 5.10 and 20.35. There were 6 deaths (5 males and 1 female), giving a rate of 23.4 per 1,000 cases. The case rate of this disease for Westminster was 1.9 per 1,000 living, and for England and Wales 1.84. The death rate for Westminster was 0.04, and for England and Wales 0.09. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1930. This treatment was continued throughout the year at the Council's Maternity and Child Welfare Centres and at the Westminster Health Society's Centre at 30, Page Street, one clinic being held at each Centre weekly. 225 new cases attended during 1930, as compared with 204 the previous year. 960 cases have been dealt with in four and a quarter years, an average of 226 per annum. There seems no reason why this average should not be maintained without undue calls on the time of the staff and without any extensive propaganda. New cases attended the Centres as follows :— 14, Westbourne Street 86 15, Bessborough Street 49 9, Frith Street 26 30, Page Street 64 Total 225 The work entailed 291 tests and retests, 584 protective injections and 135 attendances for inspection only, a total of 1,010 attendances. As in previous years, it was found that a considerable proportion of the patients (about 12 per cent.) had not been vaccinated against smallpox. 32 The following table shows the results of the tests performed :— Age. Positive. Negative. No test. Total. Under 5 years 113 6 31 150 Under 10 years 36 18 2 56 Over 10 years 13 6 0 19 All ages 162 30 33 225 All except the negative cases received protective injections and only a very few failed to complete the treatment. A rather larger number of children were treated without the test than in previous years. Two children, aged respectively 3 months and 4| months were treated and showed no sign of discomfort. Reactions occur in a small proportion of cases, especially among the older children, but these are always transient and have never been serious. Retests are performed in about 60 per cent, of the cases, with the object of determining whether the desired protection has been obtained. In 99 cases out of 105 the result was negative. The remaining 6 were positive and received further treatment. The importance of this further treatment where complete protection has not been obtained was emphasized by two old cases during the year. These had shown slightly positive results on retest but were not, for one reason or another, given further treatment and both had slight attacks of Diphtheria in 1930. Parents are not always willing to continue treatment in the few cases which do not obtain sufficient protection from the first course, but it is very important that they should do so. It must be fully realized that there is a small proportion of cases where immunisation is more difficult to achieve, and these cases require particular attention. 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. 33 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 1926, was :— 1926. 1927. 1928. 1929. 1930. 679 595 646 607 744 Enteric Fever.—There were 18 cases of typhoid and paratyphoid which came to the knowledge of the department during 1930. Of these 6 were notified as paratyphoid and 12 as typhoid. There was a history of fish having been consumed in 2 cases, watercress 1, 7 cases came from abroad, and no history was obtainable in 8 cases. There were 2 deaths. The death rate of this disease for Westminster was 0-01 and for England and Wales 0 01. The case rate for England and Wales was 0 07 and for Westminster 0'13. Measles.—The following table shows the number of cases notified by head teachers of schools, hospitals and private practitioners during the last five years :— 1926. 1927. 1928. 1929. 1930. 1,026 71 997 381 551 The death rate for England and Wales per 1,000 population was 0-10, for London 0-23, and for Westminster 0-11. 137 children between the ages of 1 and 5 were removed to hospital. 15 deaths occurred, 7 males and 8 females between the ages of 1 and 15. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows :— 1926. 1927. 1928. 1929. 1930. Males 10 24 12 51 3 Females 9 37 6 48 3 19 61 18 99 6 The death rate in 1930 for Westminster was 0.04 per 1,000; for London 0-08, and for England and Wales 0.12. Last year the corresponding rates were 0.76 for Westminster, 0.69 for London, and 0.74 for England and Wales. 34 Diarrhoea and Enteritis.—The total deaths were 8—7 males and 1 female—7 being under 1 year old. The infant death rate from this cause in Westminster was 5-1. Table XXVI. Deaths from Diarriicea and Enteritis. Under 1 year. Other ages. Total. 1926 13 7 20 1927 \ 16 16 1928 14 4 18 1929 7 1 8 1930 7 1 8 57 13 70 Whooping Cough.—14 cases were notified during the year, with 2 deaths. This is a huge decrease on the figures of 1929, when 246 cases, with 19 deaths, were recorded. 3 cases were moved to hospital. The death rate for Westminster was 0-01, for London 0-03, and for England and Wales 0-05. The deaths from whooping cough during the last five years are thus set out:— Table XXVII. Under 1 year. At other ages. Total. 1926 1 1 2 1927 o 5 7 1928 3 — 3 1929 11 8 19 1930 1 1 2 18 15 33 Cerebro-spinal Fever.—No case of this disease occurred. Poliomyelitis.—3 cases occurred. Encephalitis Lethargica.—-3 cases were notified. 4 deaths occurred during the year. Chicken Pox.—173 cases were notified, 3 being moved to hospital. Mumps.—166 cases were recorded. Anthrax.—There were no cases in 1930. Puerperal Fever.—6 cases occurred, with 4 deaths—5 cases were removed to hospital. 36 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. 1926 1,606 5 2 1927 1,399 6 1 1928 1,370 6 3 1929 1,357 10 3 1930 1,368 6 4 Puerperal Pyrexia.—16 cases occurred, 14 being removed to hospitals. To the women concerned in the above 16 cases (12 were married and 4 single), 14 children were born; the remaining 2 cases arose from miscarriage. Psittacosis.—Seven members of one household were in the early part of 1930, attacked with symptoms identical with those usually evinced in cases of human psittacosis. Unfortunately the body of the parrot, the presumed cause of the outbreak, had been disposed of before examination could be made, thereby removing the only tangible evidence at the disposal of the authorities. The frequency of the outbreaks in various parts of the country rendered necessary the issuing of an Order prohibiting the importation into this country of certain species of parrots. Ophthalmia Neonatorum.—16 cases occurred in 1930—8 males and 8 females. 9 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 London County Council 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. 36 The following details in tabular form are required by the Ministry of Health of the cases notified in 1930:— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 16 7 9 16 — — — 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 744 Blood in suspected typhoid 13 Sputa for investigation of T.B. 438 Urine 1 Expenditure on first two was £105 12s. 8d., and for the third £59 0s. 5d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1930, 190 new cases of pulmonary tuberculosis came to the knowledge of the Department, including 11 cases who had moved into the City, 15 non-notified deaths, and 1 posthumous notification. Non-pulmonary forms of tuberculosis gave 57 cases—8 of these being posthumous notifications and non-notified deaths, and 4 transfers. 37 Table I. Tuberculosis, 1930. New Cases. Deaths. Age.Periods. Pulmonary. Non.pulmonary. Pulmonary. Non.pu monary. M. F. M. F. M. F. M. F. Under 1 — 1 1 1 — 1 — 1 1 — 5 4 — — 2 — 5 1 1 3 o — 1 1 — 10 3 1 2 2 — 1 — — 15 1 9 6 6 3 — — 1 20 13 10 1 7 2 4 — — 25 23 17 3 8 13 6 — — 35 29 16 1 1 11 11 1 — 45 27 9 1 — 15 7 1 — 55 20 4 1 1 16 2 1 1 65 and upwards 3 2 — 1 3 2 — — Totals 120 70 24 33 63 35 6 3 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 1930 show a total decrease of 54 on those of 1929. There was a decrease of 28 males and 41 females among the pulmonary cases. Non.pulmonary showed an increase of 10 males and 5 females. There was also a large decrease in the number of non.notified deaths. Out of the total cases primarily notified in 1930, 23 died, and the following table shows the period between notification and death of these cases:— Weeks. Months. 1—2 2—3 3—4 1—2 2—3 3—4 4—5 5—6 6—7 7—8 8—9 9—10 10—11 10 1— 2 3 2 3 11 — ___ Table II. 1926 1927 1928 1929 1930 New cases notified 288 245 213 247 209 Number included in above who died during the year 45 31 32 41 23 (15.6%) (12.6%) (15.0%) (16.5%) (ii.o%) Total Tuberculous Deaths 133 114 108 124 107 Death Rates per 100,000 96.0 83.5 83.2 98.8 85.0 38 Table III. Tuberculosis.—Notifications received during the period from 29th December, 1929, to 21th December, 1930. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. Oto 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males 1 1 3 1 13 22 22 24 16 3 105 117 Females — — 1 — 9 9 14 15 8 2 1 59 63 Non-pulmonary— Males 1 3 3 1 6 1 2 — — — — 17 19 Females — 3 1 1 4 7 8 1 — — 1 26 28 Total 1 6 6 5 20 30 46 38 32 18 5 207 227 Number of notifications on Form b. (School medical inspection.) Number on Form C. Primary notifications. Total notifications. including cases previously notified. Poor Law institutions. Sanatoria. Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males 17 71 Females — — — 56 Non -pulmonary— Males — — 8 Females 1 1 2 2 — 14 Total — 1 1 2 2 17 149 39 (7070) Table IV. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1930. 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 7 3 4 — 15 Females 1 — — 1 — 1 3 1 1 2 1 11 Non-pulmonary— Males — 2 — 1 — — 1 1 1 1 — 7 Females 1 1 — — 2 — — — — 1 — 0 Total 2 3 — 2 2 1 5 9 5 8 1 38 C.l.h. General. Non-pulmonary. C.L.H. General. Total. Notified pulmonary 17 147 — 45 209 Not notified in Westminster — 26 — 12 38 Total 17 173 57 247 40 Table V. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1930. 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 120 — 2 11 28 5 30 1 2 4 — 1 13 11 10 2 83 Females 70 1 3 12 21 3 16 1 3 2 — 2 3 — 3 — 54 Non-pulmonary— Males 24 — 3 4 7 — 3 1 — 1 1 — 1 1 2 — 22 Females 33 — 5 4 11 2 6 1 — 1 — — 3 — — — 26 247 1 13 31 67 10 55 4 5 8 1 3 20 12 15 2 185 41 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 lis 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 23 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 1930 104 69 16 1 190 24 33 57 247 (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 21 deaths from Tuberculosis (13 males and 8 females) during 1930 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 21 non-notified deaths gave a percentage of 19.6 of the total deaths from Tuberculosis for the year. The total number of cases of Tuberculosis on the Register at the end of 1930 was 1,607 as compared with 1,571 at the end of the year 1929. The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths is much lower this year, having fallen from 39 to 21; the corresponding percentage proportions are 31.4 per cent. (1929) and 19.6 per cent. (1930). Enquiries were made, but (7070) D2 42 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 4 instances the diagnosis was made as a result of post-mortem examination. 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 1930. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on Register at beginning of year 1930 745 458 161 207 Notified for the first time during year 112 64 19 31 857 522 180 238 Removed from the Register on account of death or removal from Westminster 102 66 10 12 755 456 170 226 Of the 190 cases removed from the Register during the year 1930, 84 were on account of death, and 106 persons suffering from Tuberculosis moved from the City. Deaths from, Tuberculosis.—The total number of deaths from Tuberculosis for 1930 (all forms) was 107—Males 69, Females 38. This gives a death-rate for this disease of .85 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. 1926 133 .96 1927 114 .83 1928 108 .83 1929 124 .98 1930 107 .85 The following table shows Deaths per 100,000 of civilian population since 1918. 43 Table VIII. Westminster—Deaths from, Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1918 annual 186 148 31 24 217 173 1919 ,, 134 105 21 16 165 121 1920 ,, 139 97 18 12 157 109 1921 „ 120 84.9 15 10.6 135 95.5 1922 ,, 144 103.3 21 15 165 118.3 1923 ,, 103 73.3 16 11.3 119 84.7 1924 ,, 124 86.7 14 9.9 138 96.5 1925 ,, 115 82.3 14 10.0 129 92.4 1926 ,, 119 85.9 14 10.1 133 96.0 1927 ,, 100 73.2 14 10.2 114 83.5 1928 ,, 90 69.3 18 13.8 108 83.2 1929 ,, 113 81.8 11 8.7 124 98.8 1930 ,, 98 77.9 9 7.1 107 85.0 The following report and tables of statistics required by the Ministry of Health are submitted by Dr. Ian S. Thomson, Tuberculosis Officer and Assistant Medical Officer of Health. Westminster Tuberculosis Dispensary. Annual Report, 1930. At the end of January, 1930, the Tuberculosis Dispensary was transferred to temporary premises in Monck Street, pending the opening of the new Dispensary at Ebury Bridge. The transfer was effected without interruption of the work of the Dispensary and the usual routine has been continued. A number of old patients did not continue attendance after the transfer, but these are for the most part cases whose present condition is fairly good and many of them will probably resume attendance later if their progress becomes unsatisfactory. The number of new patients examined by the Tuberculosis Officer during 1930 was three hundred and forty-one, of whom 251 were considered definitely tuberculous. In the previous year the number of new cases was 461 and the figure for 1930 is indeed the lowest on record. This low figure is primarily due to the small number of cases notified during the year and the resultant fall in the number of available contact cases. It was pointed out in last year's report that an unusually severe winter has a marked effect on the Dispensary work. In 1930 the reverse condition held, for there was less illness than usual and as a result far fewer cases were referred for Dispensary observation and diagnosis by practitioners and School Medical Officers. Although the incidence of Tuberculosis appears to be falling, the rapidity of fall is probably not nearly so great 44 as the figures for 1930 suggest, and this view is supported by the figures in the early months of 1931. The following Table shows the sources from which new cases were referred to the Dispensary during the last three years. It will be seen that the proportion referred from each source is a fairly constant one. 1928. 1929. 1930. Practitioners 149 169 139 Health Visitors 159 162 121 St. Stephen's Hospital 61 65 41 Ministry of Pensions 10 8 6 School Medical Officers 42 33 15 Hospitals 11 11 7 Friends, Charitable Organizations, etc. 20 13 12 452 461 341 A survey of the cases of Tuberculosis notified in Westminster during 1930 shows that 66 per cent, were seen by the Tuberculosis Officer during the year at the Dispensary or in St. Stephen's Hospital. A further 15 per cent, were recommended for treatment from Hospitals which they were attending and a fair proportion of these will probably attend the Dispensary after Sanatorium treatment. 11 per cent, were not available for Dispensary attendance, some because they died very shortly after notification, some because they were above the usual Dispensary standard and obtained private treatment, and a few because they were resident in mental or other institutions outside the City. Only 8 per cent, who might reasonably have attended did not do so, and some of these left the district soon after notification. A very small proportion refuse to attend. These proportions seem to be fairly constant in different years and give a good indication of the work of the Dispensary with regard to definite cases of Tuberculosis. In addition, old cases are supervised, contacts examined, and suspects referred by practitioners or School Medical Officers are kept under observation for a period. It has been pointed out in previous reports that there has been in recent years a large exodus of patients from Westminster, and this continues. 40 per cent, of the new patients found to be tubercular during 1930 were only temporary residents in Westminster, such as domestic servants (14 per cent.), residents in Common Lodging Houses, young foreign waiters and other single men in temporary employment. Many of these leave the City after treatment. In addition, many permanent residents, after the occurrence of a case of Tuberculosis in the family, 45 are inclined to consider the question of obtaining more suitable bousing accommodation, which can often only be done by moving to the outskirts of London. Much time is spent by all members of the Dispensary staff in discussing the patients' housing problems with them. Dispensary Statistics. — 1926. 1927. 1928. 1929. 1930. New Patients 446 428 452 461 341 Old Patients attending 519 513 551 430 507 Contacts examined 162 131 98 111 55 Individuals who attended 965 941 1,003 891 818 Total Attendances 2,697 2,627 2,370 2,312 2,210 Written Reports to London County Council and Medical Practitioners 1,378 1,270 1,300 1,333 1,250 Consultations with Medical Practitioners 92 105 98 143 106 Other visits paid by Tuberculosis Officer 46 149 112 97 82 Visits by Health Visitors to Dispensary Cases 4,144 4,875 3,444 3,257 2,967 Sputum Examinations 223 172 159 154 225 X-ray Examinations 5 12 16 12 29 The above Table gives certain particulars with regard to the work of the Dispensary in 1930 and in the four preceding years. It may be noted that there is a considerable falling off in the number of contact cases examined, although most of the available child contacts and a fair proportion of adults have been examined as in other years. This is primarily due to the smaller number of new cases, but also to the type of case which appears to be becoming increasingly common in Westminster. 60 per cent, of the new tubercular cases in 1930 were unmarried, and, as has been stated, a large proportion were persons who had no permanent home in Westminster. There seems reason to believe that the declining in incidence of active Tuberculosis is more marked in the later age groups than in the young adult groups, and cases among the middle-aged parents of families seem to be less common. Large families are also becoming less usual. The following Table shows the number of patients who have been recommended for treatment in Sanatoria or in hospitals other than St. Stephen's Hospital. Hospitals. Sanatoria. Insured Males 20 40 Insured Females 17 18 Uninsured Males 1 6 Uninsured Females 5 6 Boys 4 3 Girls 1 0 48 73 46 In addition, convalescent treatment lias been recommended for exService men through the United Services Fund, and for many children through the Invalid Children's Aid Association, the Public Assistance Committee, the School Authorities, St. Henry's Fund and other agencies. In April, 1930, St. Stephen's Hospital passed from the control of the Guardians to that of the London County Council. The arrangement whereby the Tuberculosis Officer visits this hospital regularly has been continued, though it has not, so far, been put on a permanent basis. This arrangement is of the greatest value, as it enables the Tuberculosis Officer to come in contact with a number of new cases which he might not see otherwise, and also to keep in touch with many old patients who are under treatment there, often for long periods. The association with Westminster Hospital has been continued and many cases were referred there during the year for surgical opinions, for orthopaedic treatment and for treatment such as the removal of tonsils or adenoids. 29 patients have had X-ray examinations and 225 specimens of sputum were examined in connection with the work of the Dispensary. 6 cases have received Artificial Pneumo-thorax treatment at Brompton Hospital and elsewhere. In all, 94 refills were given at a cost to the Council of 10s. 6d. each refill. A survey was made of cases to whom this treatment has been given during the last six years. One patient who died was probably not a very suitable case from the beginning. The remaining 17 are surviving and 13 of them have been able to work most or all of the time. All remained for a considerable period in fairly good condition and had remarkably few troublesome symptoms. Although these are, to some extent, picked cases, all 17 were definite cases of Tuberculosis, 13 at least having positive sputa and 15 of them were between the ages of 16 and 28 and therefore at a stage where a fairly acute form of the disease is common. Unfortunately, only certain patients are suitable, but there seems to be reason to conclude that these cases have a good chance, as a result of artificial pneumo-thorax treatment, of remaining at least moderately well for many years, with few symptoms and a fairly high average of working capacity. The expenditure on this treatment is therefore thoroughly justifiable. One case of Lupus of the skin has made excellent progress with Light treatment given at the London Hospital. She attended 220 times during the year, at a cost to the Council of Is. each attendance. 6 Dispensary patients attended the Council's Dental Clinic during the year, 3 being new cases and 3 cases who had attended previous to 1930. 47 In all, these patients made 36 attendances, and 2 fillings and 24 extractions were performed. Dentures are provided when required and payment for these is made by the patients, with grants from the patients' Approved Society or from certain charitable organizations. In certain cases the Tuberculosis Care Committee approves applications for a grant from the City Council toward the cost of dentures. The work of the Tuberculosis Care Committee has been continued on the lines indicated in previous reports, and in the special reports on the work made by the Committee from time to time. When a patient is sent to Sanatorium the Committee give careful consideration to the details of his position, partly to ascertain whether and in what proportion he should be asked to contribute towards his treatment, but also to consider the position of his dependents, if any, while he is away. The economic position on return receives similar consideration and the Committee with its excellent representation of organizations which are in a position to assist certain classes of patients, is usually able to arrange for valuable assistance when this is required. The Tuberculosis Care Committee also approve recommendations for the provision of extra diet in cases recommended by the Tuberculosis Officer. The recommendations are made on medical grounds only, and in most cases the patients receiving extra diet from the Council are awaiting or have recently returned from Sanatorium treatment, or are patients who have previously received institutional treatment and are at a stage where domiciliary treatment is the form considered most suitable. Extra diet is not recommended for patients who have not taken full advantage of other treatment offered under the Council's Tuberculosis Scheme. During 1930, 20 persons received extra diet for varying periods, at a total cost to the Council of £113 17s. l0d. The Tuberculosis Care Committee has taken much interest in the work of the Handicrafts Class conducted for Dispensary patients by a voluntary Committee, of which the Mayoress is President. The class has continued its useful work, and the patients attending benefit by the interest and occupation it provides. The Handicraft Class in conjunction with other similar classes took part in a very successful exhibition and sale which was held in the Carpenters' Hall and was opened by the Lord Mayor. This exhibition provided a stimulus for the workers, increased their opportunities for disposing of their work and gave publicity to this useful and interesting undertaking. 48 tuberculosis scheme of the (a) Pulmonary Annual Return showing in Summary Form the Condition of all Patients Arranged According to the Years in Which the Patients First Came as shown Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 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). Alive— Discharged as cured— Adults m. 4 — — — — — — — — — F. 7 — — — — — — — — — Children m. — — — — — — — — — — F. — — — — — — — — — — Disease arrested— Adults m. 13 — 2 — 2 1 — 2 — 2 F. 18 — 2 — 2 5 — — — — Children m. 4 — — — — — — — — — F. 5 — — — — — — — — — Disease not arrested Adults m. 10 — 11 4 15 2 — 1 2 3 F. 6 — 3 3 6 — — 3 1 4 Children M. — — — — — — — — — — F. — — — — — 1 — — — — Condition not ascertained during the year 19 — — — 4 2 — — — 1 Lost Sight of or otherwise Removed from Dispensary Register 1,230 104 Dead— Adults m. 1 — — 366 366 — — — 25 25 F. — — — 185 185 — — — 18 18 Children m. — — — 1 1 — — — — — F. — — — 1 1 — — — 1 1 Totals 1,905 169 49 WESTMINSTER METROPOLITAN CITY COUNCIL. Tuberculosis. Whose Case Records are in the Possession of the Dispensary at the end of 1930, Under Public Medical Treatment for Pulmonary Tuberculosis, and their Classification on Form A. 1927. 1928. 1929. 1930. Class T.B. minug. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Claas 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) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — — 1 1 2 1 2 — 3 — — — — — — — — — — 4 — 3 — 3 10 — 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 7 4 11 2 — 5 6 11 11 2 17 8 27 55 1 38 12 51 1 — 3 2 5 4 — 4 6 10 20 1 19 5 25 36 1 21 10 32 3 — — — — 3 — — — — 5 — — — — 2 — 1 — 1 1 — — — — 1 — — — — 2 — 1 — 1 1 — — — — 2 — — — 2 2 — — — 2 2 — — — 2 — — — — — 29 — — — 57 26 — — — 54 21 — — — 51 9 — 12 3 15 — — — 23 23 — — — 34 34 — — — 26 26 — — — 13 13 — — — 11 11 — — — 18 18 — — — 17 17 — — — 6 6 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — — — — 1 1 43 — — — 113 51 — — — 134 61 — — — 149 103 — — — 119 50 (b) Hon-Pulmonary Annual Return showing in Summary Form the Condition or all Patients arranged according to the years in which the patients first came Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive— • Discharged as Cured— Adults m. — — — — — — — — — — f. — — — — — — — — — — Children m. — 1 — 5 6 — — — — — F. — — — 1 1 — — — — — Disease arrested— Adults m. 1 — — — 1 — — — — — f. — — — 3 3 1 — — — 1 Children m. — 1 — 9 10 — — — 4 4 F. 1 — — 3 4 1 — — 5 6 Disease not arrested— Adults m. — — 1 1 2 — — — — — f. — — 1 — 1 — — — — — Children m. — — — 5 5 — — — 2 2 F. — — — 2 2 — — — — — Transferred to Pulmonary — — — — — — — — 1 1 Condition not ascertained during the Year 1 — — 2 3 — — — 1 1 Lost Sight of or otherwise Removed from Dispensary Register — — — — 251 — — — — 8 Dead— Adults m. — — — — — — — — — — F. — — — — — — — — — — Children m — — — — — — — — — — F. — — — — — — — — — — Totals 289 23 51 Tuberculosis. Whose Case Records are in the possession of the Dispensary at the end of 1930, under Public Medical Treatment, and their Classification as shown on Form A. 1927. 1928. 1929. 1930. 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. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 2 — — — — — 1 — — 2 3 — — — — — — — — — — — — — — — 2 — — 1 3 — — — — — — — — 4 4 1 — 1 2 — — — 6 6 — — — — — — — — — — — — 2 2 — — — 2 2 — — — — — — — — — — 1 — — — 1 — — 1 — 1 3 2 1 1 7 — — — — — — — 1 — 1 4 1 2 1 8 5 4 4 3 16 1 — — — 1 — — — — — 1 — 4 5 5 2 — 3 10 — — — — — — — — 1 1 4 — — 2 6 — 1 1 11 13 — — — — — — — — — — — — — — — — — — — — — 1 — 3 4 3 1 — 3 7 3 1 1 2 7 — — — — — 3 3 — 17 23 3 3 1 18 25 4 5 2 8 19 — 2 — — 2 2 — — — 2 — — — — — — — — — — — — — 1 1 — — — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 7 4 — 25 36 8 5 2 25 40 19 7 6 28 60 13 11 6 19 49 52 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. Return showing the Work of the Dispensary during the Year 1930. 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 123 74 3 1 9 17 8 10 132 91 11 11 (6) Doubtfully tuberculous — — — — — — — — 5 4 — — (c) Non-tuberculous — — — — — — — — 22 24 16 13 B.—Contacts examined during the year :— (a) Definitely tuberculous 1 2 — — — — 2 1 1 2 2 1 (b) Doubtfully tuberculous — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 6 1 12 16 C.—Cases written off the Dispensary Register as— (a) Cured 2 — — — — — 2 1 2 — 2 1 (4) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 32 41 34 30 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 252 209 18 12 20 38 57 42 272 247 75 54 (b) Diagnosis not completed — — — — — — — — 5 4 — — 53 1. Number of persons on Dispensaiy Register on January 1st 643 2. Number of patients transferred from other areas and of " lost sight of" cases returned †20 3. Number of patients transferred to other areas and cases " lost sight of" 178 4. Died during the year 70 5. Number of observation cases Under A (6) and B (6) above in which period of observation exceeded 2 months 6 6. Number of attendances at the Dispensary (including Contacts) 2,272 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision * 8. Number of attendances at General Hospitals or other tions approved for the purpose, of patients for— (а) " Light" treatment 220 (b) Other special forms of treatment 94 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 3 10. Number of consultations with medical practitioners— (a) At homes of Applicants 66 (b) Otherwise 287 11. Number of other visits by Tuberculosis Officers to homes 82 12. Number of visits by Nurses or Health Visitors to homes for pensary purposes 2,967 13. Number of— (а) Specimens of sputum, etc., examined 225 (b) X-ray examinations made in connection with Dispensary work 29 14. Number of Insured Persons on Dispensary Register on the 31st December 373 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 251 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 — (b) Form G.P. 36 — * A number of surgical cases have been referred to the affiliated hospital, Westminster Hospital. † No cases discharged as "cured" have returned to the Dispensary. 54 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority.—A detailed list of the officers of the Public Health Department with their duties and qualifications is set out on pages 2, 3 and 4 at the beginning of the report. The Local Government Act, 1929, created very great extensions of the health services of County Councils and County Boroughs by transferring to them the entire health services, including hospitals, of the Poor Law Guardians. So far as the Metropolitan Sanitary Authorities are concerned the additional duties imposed are confined to the administration of the Vaccination Acts and Orders formerly carried out by the Guardians. The Act, however, provides for the transfer or delegation by arrangement with the London County Council of Health Services now carried out by it to the Metropolitan Borough Councils. The new duties of the County Council, including as they do those of the late Metropolitan Asylums Board and all the Poor Law Unions of London, are of a magnitude far beyond anything conceivable in any other part of the country. It would therefore seem a prudent and expedient policy for some of the duties of the health services, particularly those of a local character formerly performed by the County Council, to be transferred to the local sanitary authority for executive purposes. 2. Nursing in the Home.—(a) General:—The nursing of the sick in their homes is carried out by the three following associations:— (1) The Metropolitan District Nursing Association. Headquarters: 31, Bedford Place, W.C. (2) The Westminster Nursing Committee. Headquarters: 27, Bessborough Gardens, S.W. (3) The Pimlico, Belgravia and Chelsea Nursing Association. quarters: 10, Sydney Street, Chelsea. The associations by mutual arrangement operate in three separate areas of the City—the first in the northern wards, the second in St. Margaret and St. John Wards and the third in Victoria and Knightsbridge Wards. Thus there is adequate and efficient home nursing service throughout the City for all who are in need of it. Application for a district nurse is made by the medical practitioner in attendance. While it is free for those in distress, a charge is made according to means. (b) Infectious Diseases.—So far as the nursing of infectious cases at home is concerned, this is limited mainly to measles and whooping cough. The City Council under its Maternity and Child Welfare Scheme employs the services of the nursing associations for the nursing of children 55 up to 5 years of age suffering from measles, whooping cough, bronchitis, influenza, pneumonia, and for any ailment of childhood. The provision is made through the Maternity and Child Welfare Centres. A fee of 1s. 6d. is paid by the Council for each nursing visit. 2,612 visits were paid during 1930. Further details will be found later in this report. The Council also provides through the nursing associations for the nursing of cases of puerperal fever and puerperal pyrexia and for any illness occurring in connection with pregnancy, confinement or the puerperium. 3. Midwives.—The number of midwives residing and practising in the City is 6, but in addition 24 who live in other districts practise in Westminster. The City Council ceased to employ a whole-time midwife on its staff from 30th September, 1930, but has since entered into an agreement with Westminster Hospital whereby the Hospital employs midwives for district cases in connection with the Council's Maternity and Child Welfare Scheme. This district midwifery service is in operation throughout the whole City, with the exception of the area of the Westminster Health Society which employs its own whole-time midwife. There are also district midwifery services supplied by Middlesex Hospital, Charing Cross Hospital (by arrangement with the Metropolitan Nursing Association) and the General Lying-in Hospital. The Ormond Home in Chelsea also undertakes district cases mostly in the area adjoining Chelsea. 4. National Health Insurance.—The estimated insured population of the City is 49,430 under the care of 90 insurance medical practitioners. There are no points of contact between the administration of National Health Insurance and the Health Services of the City Council except as regards the treatment of those insured persons who are in attendance at the Tuberculosis Dispensary. This takes the form of consultations between the Tuberculosis Officer and the patient's insurance doctor, referred to in the report of the former and interchange of reports between the Tuberculosis Officer and the Regional Medical Officer of the National Health Insurance Section of the Ministry of Health. The advantages of Maternity Benefit are also brought to notice among the cases applying for midwifery services. 5. Poor Law Medical Out-Relief.—This is now the concern of the London County Council but it should be noted that this service has been, and is, very efficient in the City and that there is constant co-operation between it and the Tuberculosis and Maternity and Child Welfare Service of the City Council. (7070) E 56 6. Laboratory Facilities.—Bacteriological work on behalf of the City Council is carried out by Dr. Braxton Hicks, the bacteriologist of Westminster Hospital at the Medical School of the Hospital. Dr. Hicks examines on behalf of the City Council specimens from suspected cases of typhoid fever, diphtheria and tuberculosis, and other special examinations as occasion arises. He also conducts routine examinations of the water from the Council's swimming baths to which reference is made later. Examination of graded milk for the purpose of the Ministry of Health is done by the Chemical Research Association. The chemical analysis of food samples, water, milk, etc., are performed by the two part-time public analysts appointed by the Council, Mr. Cecil Cribb's laboratory is situated at 10a, Featherstone Buildings, High Holborn, while Mr. Richard's is at the Royal Dental Hospital, Leicester Square. Some 1,800 samples of food are examined annually. Mr. Cribb is also engaged in special investigations of atmospheric pollution from the two deposit gauges in the City, at the Mortuary in Horseferry Road and in Mount Street Gardens. The rain collected in these gauges is examined at the end of each month. 7. Local By-laivs and Regulations.—Legislation in force—The following by-laws and regulations made by the City Council are in force in the City and became operative on the dates mentioned:— By-laws under the Public Health (London) Act, 1891— Paving of yards and open spaces in connection with dwellinghouses.—24th August, 1908. Cleansing of cisterns.—24th August, K08. 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, slaughter-house, 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. 57 8. Hospitals.—A list of hospitals in the City is set out below. The City Council being a Metropolitan Sanitary Authority has no hospitals under its Control. The authority for public hospitals in the London area is the London County Council. The only public hospital in the City is the Sheffield Street Hospital, a maternity Hospital for women suffering from venereal disease. Two other hospitals which are neither public nor voluntary are Queen Alexandra Military Hospital, Millbank, for soldiers serving in the Forces, and King Edward VII Hospital for Officers, Grosvenor Crescent. There are, however, 13 voluntary hospitals in the City, a greater concentration than can be found anywhere else in London, or perhaps in the whole country. Nine of these are special hospitals devoted to the treatment of particular conditions. The Ministry ask in what proportion these hospitals are used by patients residing outside the City. These voluntary hospitals are well-known throughout the country, almost all have teaching schools in connection, and they are used by patients coming from beyond the confines of London. It would be a safe computation to estimate that between 80 and 90 per cent, of the patients attending reside outside the City of Westminster. (a) Hospital. Situation. Purpose. No. of beds. Management. Westminster Hospital St. George's Hospital Charing Cross Hospital All Saints' Hospital Gordon Hospital Grosvenor Hospital for Women Hospital for Women Infants' Hospital London Lock Hospital Royal Dental Hospital St. John's Hospital St. Peter's Hospital Sheffield Street Hospital Throat, Nose and Ear Hospital Broad Sanctuary Hyde Park Corner Agar Street, W.C. 49, Vauxhall Bridge Road 126, Vauxhall Bridge Road Vincent Square, S.W. Soho Square Vincent Square 91, Dean Street, Soho 32, Leicester Square Leicester Square Henrietta Street Clare Market Golden Square General General General Genito-urinary disease Rectal disease Diseases peculiar to women Do Diseases peculiar to children Treatment of male patients Diseases of Skin Diseases of bladder, etc. Venereal disease 195 336 305 (out-patient dept. only) 34 45 82 50 38 (out-patients only) 39 52 (women only) 101 Voluntary. Do. Do. Do. Do. Do. Do. Do. Do. Do. Do. Do. L.C.C. Voluntary. (7070) e 2 58 (b) The distribution of beds in the hospitals in the area is asked for under the following heads. Gene ral Medical. General Surgical. Children Maternity. Venereal Disease. Tuberculosis. Chronic Sick. Mental. Mental Deficiency. Orthopaedic. Ear, Nose and Throat. Puerperal Fever and Pyrexia. Ophthalmia Neonatorium. Other. There are no beds for mental or mental deficiency cases in the hospitals in the City. Provision for ophthalmia and for puerperal fever and pyrexia is made by the L.C.C. in their hospitals in other districts. Cases of this sort may be retained occasionally and temporarily in the hospitals in the City. The same applies to tuberculosis and to the chronic sick. There are 38 beds for venereal cases in the Lock Hospital in Dean Street for males only, and for pregnant women with venereal disease there are 52 beds in the L.C.C. Hospital at Sheffield Street, W.C. 2. General Medical Beds. Male. Female. Westminster Hospital 25 33 (There are also 16 beds (medical and surgical) for middle-class paying patients and 14 beds in private wards.) Charing Cross Hospital 43 58 (Also 14 children's beds). St. George's Hospital 49 53 Queen Alexandra Military Hospital Army Hospital. King Edward VII Hospital 22 — General Surgical Beds. Male. Female. Westminster Hospital 45 51 (Including casualty beds.) Charing Cross Hospital 56 71 (Also 2 children's beds.) St. George's Hospital 59 69 Children Westminster Hospital 21 Charing Cross Hospital 20 St. George's Hospital 19 Infants' Hospital, Vincent Square 50 59 Maternity. Westminster Hospital 15 Charing Cross Hospital 19 St. George's Hospital 11 Sheffield Street Hospital 52 Orthopaedic. Male. Female. Westminster Hospital 2 2 Charing Cross Hospital 6 8 St. George's Hospital (Included in Surgical Beds.) Ear, Nose and Throat. Male. Female. Westminster Hospital 3 4 Charing Cross Hospital 6 8 (Also 4 Children's Beds.) St. George's Hospital 5 5 Throat Hospital, Golden Sq. 32 33 (Also 11 Children's Beds and 25 beds for private patients.) Diseases of Women. Hospital for Women, Soho Square 82 Grosvenor Hospital 45 Westminster Hospital Charing Cross Hospital Included in General Beds. St. George's Hospital Diseases of the Skin. St. John's Hospital and at the general hospitals. Diseases of Genito-Urinary System. Male. Female. All Saints' Hospital Out-patient Department only. London Lock Hospital 38 — St. Peter's Hospital 39 — Rectal Diseases. Male. Female. Gordon Hospital (and in general hospitals) 16 12 (And 6 beds apportioned as required.) Dental Hospital. Male. Female. Royal Dental Hospital, Leicester Square 4 6 (Situated at Charing Cross Hospital.) 60 Hospital accommodation in the City of Westminster is ample for the needs of its citizens. It must be remembered, however, that these voluntary hospitals serve a vastly greater population than that of Westminster and it may, and does happen, that Westminster people have to go further afield to seek treatment. This may be due to predilection on the part of the doctor attending or the wishes of the patient. Generations of some families have always been treated, say, at St. Thomas' Hospital, and the tradition is continued. There was a real difficulty concerning maternity hospital accommodation for Westminster women which has been solved, It frequently happened that they had, owing to the beds being filled by women from other districts, to trudge round hospitals in other areas seeking admission. This need has been adequately met by the arrangement for maternity beds which the Council has made with Westminster Hospital and is referred to later in this report. Co-operation between the voluntary hospitals and the Health Services of the Council is satisfactory in every respect. The sphere of such cooperation is concerned mainly with the Tuberculosis and Maternity and Child Welfare Services to which reference is made later. The L.C.C. Hospital, St. Stephen's, in Fulham Road (369 beds) fulfils adequately the functions of asylum for the chronic sick and also an overflow reservoir of beds for acute cases living in the City but who cannot be accommodated in the voluntary hospitals. While nothing but praise can be offered as to medical, surgical and nursing skill practised at this hospital, the building itself offers suggestions for improvement. It is too far away for the resident population to reap the fullest advantage in dealing with acute cases. The internal structure of the building with its lofty blocks, each provided with a steep staircase, is not conducive to easy administration and must cause waste of energy and time. It would appear that in view of the greatly increasing number of acute and major surgical cases being admitted in recent years, the resident medical staff requires to be reinforced. It is also doubtful whether the laboratory and radiological facilities are now adequate according to modern standards. If anaesthetics are still administered by the resident staff then it must be obvious that in a hospital of 369 beds, four resident doctors, apart from the Medical Superintendent, whose time is necessarily much taken up with administration, must be hard put to it to overtake so great a mass of clinical work. (The City Council has no concern with the hospital provision of the L.C.C. and this comment is made in accordance with the request expressed in paragraph 9 of Appendix I of the Ministry of Health Circular 1119.) 61 9. Maternity and Nursing Homes.—Registration, etc.—The City Council has no concern with the registration and supervision of these Homes in Westminster. That is the work of the L.C.C. The City Council's officers have, however, power of entry as regards matters of sanitation, infectious disease such as ophthalmia neonatorium, puerperal fever, etc. Last year 3 visits were paid to Nursing and Maternity Homes. It is not known how often officers of the L.C.C. also visited. In the booklet published by the L.C.C. it is stated that there are seven Nursing Homes, six of which have been approved for the reception of maternity patients. 10. Maternal Mortality.—The arrangements for the investigation of maternal deaths are as follows. In accordance with the suggestions contained in Circulars 888 and 934 of 1928, the Medical Officer was appointed to investigate in consultation with the practitioner concerned each case where expert experience appeared to be necessary, the Council's obstetric consultant under the Puerperal Fever and Pyrexia Regulations, Dr. Aubrey Goodwin, Hon. Obstetrician to Westminster Hospital was appointed as expert for such inquiries. During the year 1930, ten maternal deaths were certified. All took place after admission to hospital (except one, who died in the ambulance), and reports have been furnished to the Maternal Mortality Committee of the Ministry. In no case was it necessary to call upon the services of Dr. Goodwin, as full information was supplied by each institution concerned. The home and social conditions were reported upon by the Health Visitors. Puerperal Fever and Puerperal Pyrexia.—Under the Regulations the City Council in 1927 made the following arrangements:— (1) Provision of a consultant on request of a medical practitioner. Dr. Goodwin, Hon. Assistant Obstetrician to Westminster Hospital, was appointed by the Council and his services are available for any case of puerperal fever or puerperal pyrexia where the doctor attending desires a second opinion or diagnosis or treatment. He was not called upon during 1930. (2) Bacteriological examinations of blood or discharge are carried out by Dr. Braxton Hicks, Bacteriologist to Westminster Hospital, and appointed by the City Council under these Regulations. No examinations were requested in 1930. (3) Hospital treatment is provided by the L.C.C. in special tions at the request and on notification by medical practitioners. 19 cases were removed to hospital in 1930. (4) Nursing in the home is provided by the Council through the three District Nursing Associations. A medical practitioner may 62 appeal direct to the Nursing Association or may obtain a nurse through the Public Health Department. 217 cases were nursed in 1930. 11. Institutions for Unmarried Mothers, Illegitimate infants and homeless children.—The City Council has no institutions of this nature under its control, but its public health services work in co-operation with three voluntary institutions two of which are within the City, while the third and largest, formerly in the City, was transferred in 1921 to Tulse Hill, Lambeth. These institutions are in effect rescue homes. Unmarried mothers are admitted, usually some months before the birth of their children, and do domestic work in the institutions or are trained in some special work. The confinements take place there or in lying-in hospitals, in which latter case the mothers return to the rescue homes and remain as a rule, during the nursing period—some months. The L.C.C. now make annual grants under the Discontinued Grants (Apportionment) (London) Order, 1930, and in the case of St. John the Baptist Home, Tulse Hill, the City Council contributes an annual sum of £100. The L.C.C., in addition to their former duties under the Children Act, 1908, as regards boarded-out children, is now, under the Local Government Act, 1929, obliged to exercise all the functions of the Guardians as regards the provision of homes for illegitimate and homeless children. There are no such institutions in Westminster. 12. Institutional Provision, if any, for the Care of Mental Defectives.— The City Council has no powers under the Mental Deficiency Act. Provision for such cases is made by the L.C.C. for the whole of London in its various institutions. 13. Ambulance Facilities.—As from 31st March, 1930, the L.C.C. took over the Ambulance Services of the Metropolitan Asylums Board and also those of the various Boards of Guardians. The service has now been fully co-ordinated and particulars regarding it have been furnished to local authorities, medical practitioners, nursing associations and midwives. The following is a summary of the circular in question 1.—Ambulances Supplied Without Payment. The Council provides ambulances, free of cost, for the conveyance to— A.—Hospitals or private residences of :— (i) Persons meeting with accidents or suffering from sudden illnesses in the streets, public places, places of employment, etc.; (ii) Persons meeting with accidents in their homes ; (iii) Persons suffering from illnesses in their homes if a medical practitioner certifies that the case is one of life or death, that no other ambulance 63 is available and that arrangements have been made for the reception of the patient in a hospital; (iv) Parturient women, if the case is one of urgency, whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case; and (v) Non-urgent cases of parturition, between the hours of 11 p.m. and 8 a.m., if letters of admission to maternity hospitals are produced, it being sufficient in such cases for a female friend to accompany the patient. II.—Ambulances Supplied on Payment. Ambulances and ambulance omnibuses are also provided by the Council on payment of prescribed charges for the conveyance of infectious and non-infectious cases between private houses, hospitals (other than the Council's hospitals, etc.), nursing homes and country and seaside resorts, and for examinations, consultations and treatment by specialists or at special establishments. Particulars are as follows:— D.—Infectious cases:— Arrangements for the reception of the patient must be made by or on behalf of the patient before application for an ambulance is sent to the Council, and a medical certificate as to the nature of the disease must be handed to the ambulance driver before the patient is removed. The charges are as follow:— (а) Within the Administrative County of London (private cases), 10s. for the removal of one patient from one place to another within the administrative county of London. This charge includes, if necessary, the services of a male attendant, and one friend is allowed to accompany the patient. Additional charges are made as follows:— (i) 5s. if two patients are conveyed in one ambulance; (ii) 2s. 6d. if the friend accompanying the patient wishes to be conveyed alone for the outward or return journey; (iii) 2s. 6d. a head each way for each additional person who desires to accompany the patient; (iv) 5s. for the services of a nurse for a period up to two hours, and thereafter at an extra charge of 2s. an hour or part of an hour; (v) 5s. an hour or part of an hour for keeping an ambulance waiting more than 15 minutes. (b) For journeys extending outside the county and for work carried out for public authorities within and without the county. For 1 or 2 persons, in addition to the Council's staff, 1s. a mile up to 50 miles, and thereafter l0d. a mile. For 3 or 4 persons, in addition to the Council's staff, 1s. 3d. a mile up to 50 miles, and thereafter 1s. a mile. For 5 to 8 persons, in addition to the Council's staff, 1s. 6d. a mile up to 50 miles, and thereafter 1s. 3d. a mile. For over 8 persons, in addition to the Council's staff, particulars of charges may be obtained on application to the Medical Officer of Health at the address given below. 64 The highest number of persons at one time on the journey will be charged for on the total mileage reckoned to and from the ambulance station. For a journey occupying over 8 hours a small additional charge will be made to cover driver's expenses, and where the journey extends to a second day, it will be necessary for the person ordering the vehicle to arrange for garaging and also for lodging and subsistence for the staff. Additional charges are made as under (as) (iv) and (v). E.—Non-infectious cases :— Particulars are as under " D " above for infectious cases, except that in the Administrative County of London the additional charge for a journey back to the first address or on to further addresses is 5s. plus the prescribed waiting fee for each address. How to Obtain an Ambulance or Ambulance Omnibus. The vehicles are available at any hour of the day or night including Sundays and public holidays. To call an ambulance by telephone, in cases of accident or sudden illness in the street, place the telephone receiver to the ear (and dial " 0 " if connected to an automatic exchange). When the operator answers, ask for " ambulance " and wait for the reply " ambulance " ; then give particulars. In cases other than accident, etc., the following telephone number should be used:— CITy 7200. Ambulances are also provided by the British Red Cross Society and certain private firms. Certain of the hospitals, such as Westminster, possess ambulances of their own. 14. Clinics and Treatment Centres.—Out-patient departments, in some cases on a considerable scale, are conducted at all of the 13 voluntary hospitals in the City. Maternity and Child Welfare Centres.—(a) Provided by the City Council— (1) 14, Westbourne Street, S.W.I, self-contained premises of 6 rooms (temporary centre pending rebuilding at Ebury Bridge). (2) 15, Bessborough Street, S.W.I, self-contained house of 9 rooms. (3) 9, Frith Street, W.l, ground floor and first floor premises of 5 rooms (temporary centre to be given up March, 1931). New centre is part of new Public Baths, Marshall Street, W., to be opened April, 1931. This is the first building designed and built by the City Council for the purposes of Maternity and Child Welfare. It consists of two floors with offices, pram, store, doctor's room, weighing and waiting rooms and balcony, etc. 65 (b) Provided by voluntary associations assisted by grants from the City Council— (1) The City of Westminster Health Society, 30, Page Street, a building of two floors constructed as a centre. It contains some ten rooms with a flat roof which provides a nursery and sun shelter. (2) Infants' Hospital, Vincent Square. The premises are the usual rooms of the out-patient department. (3) Charing Cross Hospital. The out-patient department of the hospital. The two hospital centres last named do not confine their activities to consultative work but are also treatment centres. They formerly received grants from the Ministry of Health, but none from the Council. Those grants are now provided by the City Council. Other centres not recognised as such by the Ministry of Health exist at Westminster and St. George's Hospitals. Ante-natal Centres.—These provide for medical advice for expectant mothers and so far as the local authority is concerned are conducted in close connection with, or as part of, the organization of its Maternity and Child Welfare Centres. (1) Provided by the City Council at the centres— 14, Westbourne Street. 15, Bessborough Street. One session is held per week at each. (2) Provided by voluntary associations—- (a) Westminster Health Society, 30, Page Street. One session per fortnight. (b) Westminster Hospital . . ' _ , TT . , In connection with out-patient (c) ot. George s Hospital V .. , , midwifery department. (a) Charing Cross Hospital J Tuberculosis Dispensaries.—(1) Provided for the whole area of the City by the Council at Monck Street (temporary premises), Horseferry Road. The dispensary consists of ground floor and first floor premises containing six rooms. (2) Provided by voluntary associations— (a) St. George's Hospital. (b) Charing Cross Hospital. These hospital dispensaries form part of the general out-patient activities of the hospitals. 66 Treatment Centres for Venereal Diseases.—These are provided at Westminster, St. George's, Charing Cross and St. John's Hospitals, and London Lock Hospital. The City Council has no powers as regards these centres, the authority under the Venereal Diseases Acts being the London County Council. These centres are conducted at the three general hospitals in the City and also at certain of the special hospitals, such as St. John's Hospital for Skin Diseases. Those having agreements with the London County Council receive considerable grants from this authority, who exercise a certain degree of supervision over their administration. School Clinics.—They are outside the purview of the City Council and are organised by the L.C.C., the education authority. Much of the treatment of school children is, as in the case of the general population, carried out independently at the various hospitals in the City. There are, however, school treatment clinics, provided by the L.C.C. for eye testing, ear, nose and throat conditions at the— Western Dispensary, Rochester Row, S.W.; Westminster General Dispensary, Gerrard Street, W. By arrangement with the British Red Cross Society, a clinic for the treatment of minor ailments is carried on at 40, Marsham Street. Orthopaedic Clinics.—None conducted by the local or Education authority, but again the general hospitals have each special orthopaedic departments ; in the case of Westminster Hospital a specially appointed orthopaedic surgeon is in charge and there is attached a school of massage and department for remedial exercises. A great deal of orthopaedic in-patient work is done at certain of the hospitals of the L.C.C. (old M.A.B.). Among other clinics of a voluntary character may be mentioned the London Clinic in Ranelagh Road, S.W.I. This is a large institution which provides for all classes of treatment of a special character, such as artificial sunlight, medicinal baths for cases of rheumatism, heart disease, electro-therapy in all its forms, etc., etc. The clinic is under the management of the British Humane Association, a registered charity. Day Nurseries.—There is only one such institution in the City; the Westminster Red Cross Day Nursery, Warwick Street, S.W.I. It is exceedingly well conducted, but as there is accommodation for only 40 children it is woefully inadequate for the needs of the population and ig in constant financial difficulties, 67 15. Local Government Act, 1929.—The Act has imposed changes in the public health administration of the City only in one respect. The general public health provisions of the Act are administered by the London County Council. Duties under the Vaccination Acts and Orders formerly under the administration of the Westminster Guardians, as from 1st April, 1930, are carried out by the City Council under the Medical Officer of Health. Under the Guardians' administration there were five part-time public vaccinators, general medical practitioners in various districts of the City, and one whole-time vaccination officer. They were regarded as transferred officers under the Act and were appointed in the Public Health Department under conditions similar to those of their appointments under the Guardians. Further reference to vaccination is made under the section relating to Infectious Diseases. SANITARY CIRCUMSTANCES OF THE AREA. Water.—The Medical Officer of Health is asked not to report on water supplies because it is assumed that all London is uniformly supplied by the Metropolitan AVater Board. In previous reports it has been pointed out that some very large and important premises in Westminster are independent of the Board's supply because they rely on their own borings into the chalk under the London clay. In last year's report some 16 buildings, recently erected or in course of construction, were reported as having water from one to three wells each. During the year three additional premises obtained water from artesian wells, and as a result of further inquiry it is found that a total of 81 buildings are supplied with water from private wells; 32 of these buildings are also connected with the Metropolitan Water Board's mains for fire protection and other purposes, in addition to the supplies from wells. As each new boring is undertaken, a greater depth has to be reached before a sufficient supply becomes available. This is largely due to the exhaustion of the more superficial collections of water. The water from these deep wells is pure, but slightly hard. Public Swimming Baths, Washhouses, &c.—The City is well supplied with these institutions, which are truly measures which serve the public health. Besides those at Buckingham Palace Road and Great Smith Street, the newly-constructed baths at Marshall Street were almost completed before the end of the year, the opening being arranged for 17th April, 1931. The system for purifying the water is the Kennicott. embodying the most modern apparatus for filtering, chlorinating, warming and aerating the water. The design, construction and equipment of these 68 indoor baths are of such a character that it would be difficult to find any in the country to surpass them. During the year samples were taken from the older swimming pools at times of greatest pressure ; these were found to be bacteriologically satisfactory. The tests have proved useful in indicating the efficiency of the filtration plants, and improvements have been made in order to meet the very highest possible standards of purity :— The numbers using the swimming baths in 1930 were :— Great Smith Street: 190,949 men ; 74,581 women. Buckingham Palace Road : 139,341 men ; 86,964 women. The numbers relating to users of the public washhouses were :— Great Smith Street, 36,266 ; Buckingham Palace Road, 35,935. Drainage and Sewerage.—Last year complaints of foul odours from open sewer ventilators were frequent in the summer. The L.C.C., on representations, closed a number of these and thus removed the source of nuisance. House Drainage.—The increasing work of the department in connection with drainage plans and works of old and new buildings was fully remarked last year. It continues to grow. No fewer than 891 plans were examined and approved. But the work is not confined to examining plans and discussing amendments and improvements with architects; the actual construction of the drainage and sanitary fitments must be inspected while in progress, and on completion must be tested. For example, super visionof the drainage work at Dorchester Hotel included 275 bathrooms, each fitted with w.c., bath, lavatory and bidet, over 100 sinks, lavatories, &c., w.cs. for staff and, in addition, Turkish baths, shower baths, hairdressing saloons, &c., with some 20 miles of pipes to serve them. New Drainage By-laws made by the London County Council under the Metropolis Management Act, 1855 (Sec. 202.)—These By-laws were approved by the Minister of Health on the 4th March, 1930, with slight reservations and came into operation six months after that date. Although the by-laws have only been in force a few months, it is already realised that they are a considerable advance upon the old code. Up to the present no difficulty has been experienced in their administration and with intelligent interpretation and application they should meet the requirements of the present day. New By laws of the L.C.C. under Sec. 39, Public Health (London) Act, 1891, as to Water Closets, TJrinals, &c.—These were confirmed by the Minister, and came into force on the 21st August. It may be recollected 69 that when the By-laws were submitted in draft to the Council in 1927, certain amendments were submitted by the Council, and some were accepted by the County Council. The proposal to permit w.cs. and urinals to be constructed without natural ventilation or light was objected to as a retrograde step, as also was the approach to a water closet or urinal through an intervening entrance lobby without a minimum size of the lobby being laid down. The By-laws were, however, made by the London County Council on the 20th May, and approved by the Minister as above, without conceding these further suggestions of the City Council, and they also contained a provision, which had not appeared before, to the effect that a water closet or urinal might be entered directly from a bedroom or dressing room if used exclusively in connection with such room. The City Council, being aware of a fairly widespread demand that private bathrooms, with all conveniences, should be allowed to be approached directly from bedrooms, suggested that a minimum superficial area for such an apartment should be specified, with a window or lantern light, according to the floor space. Correspondence took place between the Ministry and the Council as to these objections, the Ministry taking the view that the Council's objections were calculated to impede what the Ministry deemed progress and development in sanitary construction. The results of inquiry as to By-laws in force of 15 great towns of England and Wales appeared to support the view of the City Council with regard to mechanical ventilation and artificial lighting ; in no instance were these provincial By-laws relaxed or amended so as to permit internal w.cs. relying solely on mechanical ventilation and artificial light. New Sanitary Construction.—Plans relating lo work of this descriptioL numbered 891, of which 96 represented sanitary provisions in entirely new buildings. The corresponding figures since 1926 are as follows :— — 1926. 1927. 1928. 1929 1930. I'ians 724 750 752 877 891 Plans of work in new buildings included in above 110 93 81 91 96 Combined drainage orders were made in 15 cases. Infringements of the By-laws were reported by the Sanitary Inspectors in 12 instances in respect of failure to give notice of intention to construct, or to deposit plans. Nine builders were cautioned and three were sum- 70 inoned in respect of these offences and were convicted, fines and costs amounting to £6 lis. 0d. Closet Accommodation.—The water carriage system is in existence throughout the City. 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. As reported last year, measures have been taken to improve the ventilation of the older conveniences and otherwise to bring them up to date. The demand for public conveniences increases as the residential character of the central district of the City gives way to that of public buildings, theatres and other places of amusement. In consequence, the streets tend to become more thronged with people in the later hours of the day. The number annually using public conveniences has reached the surprising total of over 20 millions. Further, to meet public requirements, the Council arranged that at least two (in Leicester Square and Piccadilly) shall remain open all night. New conveniences are also being constructed in certain areas. 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 1930 are as follows:— Tons. House refuse collected 98,178 Trade refuse collected 1,475 99,653 Refuse barged away 88,675 Refuse dealt with in Salvage Plant 10,978 The Medical Officer of Health is indebted to Captain Cable, the City Cleansing Surveyor, for the figures quoted above, and for the following note. He writes :— " House Refuse Collection.—The present system of refuse collection by open vans is very unsatisfactory. Extensive tests have been carried out and particular attention has been given to the two latest methods, one being the Interchange of Bins system, by which a sterilised bin is left and the full bin taken away, and the other system providing for the bins to be shot in a dustless manner into a totally enclosed collecting vehicle in the 71 street. The former is the most hygienic system known at the present time, but the question of cost naturally arises, and if it should be found prohibitive from a financial point of view, it will be necessary to investigate the cost of other systems which may approximate to this more or less perfect system, in order that the City Council may adopt the best system having regard to cost. " Disposal.—Although the Government Departmental Committee recommended that a central authority should be established for the disposal of refuse, it is not anticipated that any legislation can or will be brought forward for the next year or two to enable this recommendation to be put into operation, but in the meantime steps are being taken to cover every six feet of deposited refuse with about nine inches of earth in order to prevent fires being caused by spontaneous combustion. This method of dealing with the situation, although not perfect and possibly costly, ameliorates the condition of fires and reasonably preserves the amenities of the districts concerned if properly carried out." Sanitary Inspection of the Area. The following table shows in considerable detail matters relating to the general sanitary condition of the City. The work of the district sanitary inspectors is performed under several main headings ; inspection of nuisances and other insanitary conditions, whether on complaint or otherwise ; supervision of all new sanitary fittings and drainage in old and new buildings, which includes reporting on plans of proposed sanitary construction in respect of requirements laid down in the By-laws under the Metropolis Management Acts and the Public Health (London) Act, 1891, duties connected with housing and infectious disease, and others relating to the sanitary condition of the City. (7070) F 72 Table I. Inspection of premises :— Dwelling-houses— Primary Inspections— (a) On complaint 1,164 Directly approached from rooms 29 lb) Infectious disease 1,081 (cj Housing Regulations, 1925 853 Accommodation insufficient 32 Water Supply— (d) Housing applications 514 Cisterns dirty and uncovered 131 (e) Other reasons 1,955* Absence of—in upper floors of tenement houses 21 Total 5,567 Dustbins— Absence of 86 Re-inspections 12,583 Insufficient 62 Other Premises—- Defective 212 Primary inspections— Animals kept so as to be a nuisance 9 (a) On complaint 524 (6) Other reasons 1,574 Other nuisances 782 Dangerous structures noted 31 Total 2,098 Sanitary works supervised :—- Re-inspections 5,908 Sanitary Works— Total Inspections— Drains (including soil, waste, rainwater pipes, etc.)— (a) Under notice 1,734 (6) Voluntary works 14,357 Constructed 5,502 Altered, repaired, etc 1,467 Nuisances, etc.:— Intercepting traps fixed 243 Petrol interceptors provided 35 Defective or dirty conditions of internal structure 3,254 Tested by smoke 513 „ chemical 924 Verminous conditions 237 „ water 2,031 Damp conditions 1,023 ,, air 853 Defective drainage, waterclosets, etc. 616 W ater-closets— Constructed 2,419 „ roofs 292 Repaired and reconditioned . 344 ,, paving of areas, etc. 472 Urinals- Water-closets— Constructed 321 Insufficiently ventilated or lighted 51 Repaired and reconditioned 57 * This figure includes 801 visits of enquiry in respect of smallpox contacts. Restriction of Rent Acts.—Two applications were received for certificates under these Acts, but in neither case was the application acceded to. Nuisances.—Intimation notices were served in 1,239 instances, the number of premises concerned being 1,197. Statutory notices served by the sanitary authority numbered 72 and related to 70 premises. Police court proceedings were taken in 5 instances in order to enforce compliance with the requirements of statutory notices, which related to dirty and defective conditions in dwelling-houses, including in one instance, failure to provide water supply to an upper floor. In 3 cases the summonses were withdrawn; £2 2s. costs being awarded in each of two cases; in the third, the magistrate refused to make any order as to 73 costs. In the two other cases, orders were made requiring the necessary work to be carried out within 21 days, costs in one instance being 6s. and in the other 2s. The following are the comparative figures since 1926 :— — 1926. 1927. 1928 1929. 1930. Intimation Notices 1,074 1,450 1,778 1,158 1,239 Statutory Notices 43 49 45 59 72 Legal Proceedings 10 5 4 7 0 Water Supply.—The Metropolitan Water Board sent three notices of withdra wal of water supply to premises. In each case the reason for the action of the Board was failure to pay water rate. Water Supply in Tenement Houses.—Power to eSect 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. 1907. The number of cases in which this action was taken since 1926 is as follows :— 1926. 1927. 1928. 1929. 1930. 44 22 6 5 21 By-laws as to Removal of Offensive Refuse.—Three cases were reported during the year. A summons was issued in each instance ; two of the defendants were fined 40s. and the other 30s., including costs. 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. During the year, the Sanitary Inspectors reported two 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. 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 (7070) f2 74 of 1930, 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 1,355 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc 1,275 Leather workers, boot and shoe makers, harness makers, etc. 52 Carpentry, upholstery, carvers, gilders, etc 48 Surgical and dental instrument makers 11 Tobacco manufacturers 10 Wig makers and hair workers 41 Printing, bookbinding, lithographers, envelopo making, stationers, relief stamping, etc. 56 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 29 Metal workers 23 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 23 Florists 29 Laundries 22 Bakehouses 62 Photographers 35 Jewel case makers 8 Cinema film workplaces 30 Total .. 3,109 The use of 165 workshops was discontinued, and 323 additions were made to the register during the year. Table III.—Inspection. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4)[/### Factories (including factory laundries) 253 5 — Workshops (including workshop laundries) 2,915 273 — Workplaces (other than Outworkers' premises) 2,231 86 — Total 5,399 364 — 75 Table IV.—Dejects found. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to h.m. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 312 312 — — Want of ventilation 34 34 — — Overcrowding 40 40 — — Want of drainage of floors — — — — Other nuisances 43 43 — — Sanitary accommodation Insufficient 15 15 — — Unsuitable or defective 123 123 — — Not separate for sexes 29 29 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) — — — — Total 596 596 — — Table V.—Other Matters. Classes Number. Visits to Outworkers' premises other than workshops 199 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 234 Absence of means of warming — Matters referred by H.M. Inspectors 113 Workrooms measured 339 Visits of Enquiry re Employment of Women 100 „ ,, Outworkers 113 Underground bakehouses in u?e at the end of the year 45 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. 76 Table VI. Outworkers' Lista, 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. Xoticcs 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 1,055 1,618 8,575 20 8 94 423 6,436 88 — — — — — 22 — — Linens, etc 6 34 74 — — — 9 68 — — — — — — — — — Furriers 10 36 32 — — — 17 36 — — — — — — — — — Umbrellas, toys, artificial flowers, etc 3 93 116 — — — — — — — — — — — — — — Total 1,074 1,781 8,797 20 8 94 449 6,638 88 — — — — — 22 — — 77 Outworkers.—The total number of lists received during the year amounted to 1,091. Notices in respect of failure to send lists were sent to 88 firms. No legal proceedings were necessary in respect of this offence. The lists contained 10,680 names and addresses, of which 6,638 were in other districts, 5,623 being within the Metropolitan area and 684 in the London Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,802, of whom 1,592 were registered as occupying workshops. The number of houses in which outwork was being carried on was 776. Smoke Abatement.—The following table shows the extent to which smoke has been a cause of complaint to the sanitary authority during the past five years, and also a summary of the measures taken in mitigation:— Table VII. — 1923. 1927. 1928. 1929 1930. Complaints received 02 79 3G 52 31 Observations taken 2,490 2,057 640 854 755 Notices issued— Preliminarv 26 29 21 12 16 Statutorv — 1 1 — 2 Legal Proceedings — — — — 2 Legal Proceedings.—During the year it was found necessary to issue summonses against two firms for permitting chimneys to emit smoke in such quantity as to cause a nuisance. One case was dealt with under the provisions of the Public Health (Smoke) Abatement Act, 1926. An abatement order was made by the magistrate and the defendants were ordered to pay £2 2s. costs. The other case was taken under Section 24 of the Public Health (London) Act, 1891. Nine summonses were issued against this firm for nuisances which occurred after the service of the Statutory notice. The magistrate decided to deal with two of the summonses only, the other seven being adjourned sine die. An abatement order was made, and the defendants were ordered to pay 20 guineas costs. Greater London Joint Smoke Abatement Committee.—This Committee, set up by the Guildhall Conference of Local Authorities continued its meetings during the year. Your Medical Officer of Health, as a representative from the Metropolitan Standing Joint Committee, attended on most occasions. Among matters referred to the Committee was the 78 problem of smoke from railway locomotives. Practical methods of co-operation between observers of local authorities and officials at railway stations were agreed and recommended to local authorities. The by-law dealing with the permissible issue of black smoke was also freely discussed. In framing their by-law for London the L.C.C. had compromised with the Federation of British Industries and had conceded a period of 3 minutes in the aggregate in a continuous period of 30 minutes instead of a 2-minute standard advocated by the Committee. This concession was, however, to remain for 5 years, after which the original period of 2 minutes would become operative. It is a matter for congratulation that in these times of trade depression a by-law acceptable to all parties should have been made. Previously there had been no legal standard, and this by-law, which awaits confirmation by the Minister, is at least one benefit conferred by the Smoke Abatement Act, 1926. As regards by-laws requiring the provision in new buildings, other than private dwelling houses, of such arrangements for heating or cooking as are calculated to prevent or reduce the emission of smoke, the Committee were unable at this stage to suggest a by-law capable of practical application. Atmospheric Pollution.—During 1929 the Council was apprehensive of the possible danger to public health by the pollution of the atmosphere likely to arise from the emission of flue gases from the large power stations that were proposed to be erected in somewhat close proximity to the south-western boundaries of the City—namely, in Battersea and Fulham. The Medical Officer of Health was instructed to obtain information as to the methods in vogue for measuring atmospheric pollution. This was done, and the necessary instruments were subsequently purchased and installed. Two types of apparatus are used for this purpose. One of these is known as the Automatic Air Filter, and measures the amount of suspended impurity in a measured volume of air. One of these instruments was installed at the City Hall, and daily readings have been taken since the 1st August, 1930. The diagram on the opposite page indicates in graphic form the varying amounts of suspended dirt from month to month estimated as the average pollution for the whole month shown at each hourly interval of the twenty-four hour cycle. It will be noted that the maximum amount of pollution occurs each day between the hours of 9 a.m. and 11 a.m., and a lesser peak is evident in the evening between 7 p.m. and 9 p.m. As the year advances the morning rise increases greatly and tends to be maintained at a high ATMOSPHERIC POLLUTION.—AUTOMATIC AIR FILTER. Average Monthly-Hourly Readings. Taken at the City Hall. Degrees of Pollution are calculatedjfrom a standard scale of shade values. One degree corresponds to -54 lbs. of dirt per 1 million cubic yards of air. Average degrees of suspended matters (mostly dirt) estimated for each month and indicated to show the variations at each hour in the 24 hours. The means are so calculated on this graph to show in convenient form the sum of pollution throughout the whole month interpreted in terms of a single period of 24 hours. To face page 78. 79 level throughout the rest of the day. The lateness in the rise to the maximum (9-11 a.m.) would appear to indicate that in the neighbourhood of the City Hall, at any rate, factory chimneys are almost negligible as a contributory factor. The pollution is no doubt to be attributed to the fireplaces of restaurants, offices, and dwelling houses. The other instrument is known as a Deposit Gauge, and is used for the collection of particles of dirt, etc., contained in the atmosphere. Rain water, together with the impurities which it collects during its passage to earth, is collected in this gauge, and by chemical analysis it is possible to ascertain the degree of atmospheric pollution. Two of these gauges have been installed ; one was placed in the Gardens in Mount Street, Mayfair, and the other at the Mortuary Premises, Horseferry Road. The gauges were installed in July, and the results of the monthly analyses in tons per square mile are shown below Table VIII. 1930. Figures in English tons per sq. mile. Horseferry Road. Mount Street. Wandsworth Common. Total Solids Sulphur. Total Solids. Sulphur. Total Solids. Sulphur. August 33.99 1.69 14.9 1.20 10.79 2.04 September 37.65 3.64 37.26 3.56 17.95 3.16 October 31.87 2.80 25.88 2.82 10.12 1.35 November 42.04 4.80 35.12 5.62 19.13 2.37 December 37.78 4.41 32.59 5.11 15.61 1.57 The figures in the third columns are taken for comparison and control. Battersea Power Station.—Opposition to the erection of the first section of this super.power station was offered by a deputation representing the authorities of Westminster, Chelsea and Kensington, and the Dean and Chapter of Westminster Abbey, who waited upon the Ministers of Health and Transport in the autumn of 1929 and received certain assurances by which it was hoped to allay the apprehensions which they had voiced on the problem of sulphur and grit elimination. As the first sectk i had already been authorised it was felt then that no further steps could be taken in opposition to the erection of the station as a whole, pending the further investigations of the Government Chemist. 80 Fiilham Power Station.—In November, 1930, the Government Chemist's final report was published, and about the same time notice was given of the intention of the Fulham Borough Council to apply for the consent of the Electricity Commissioners, to the erection of a large extension to their power station at Townmead Road, Fulham. Under the provisions of the Electricity Supply Act, 1919, before such a scheme receives the sanction of the Electricity Commissioners, a public inquiry may be held at which objections can be heard. The local authorities mentioned above, fortified by the decision of the Manchester Corporation v. Farnworth case given by the House of Lords, decided to lodge objections and to appear at any inquiry to be held. On this occasion they were fortunate in being associated with the London County Council, who were also raising opposition. The principle involved was based on apprehensions as to dangers likely to arise from the working of the proposed station at Fulham; and there was also the larger issue, the settlement once and for all of measures to be taken at all new and large power stations to prevent nuisance and dangers from sulphur fumes and other deleterious effluents. There had been much public discussion on these matters, and although the Manchester case drew attention to the effects, no judicial body had ever expressed an opinion on the prevention of these dangers. There was thus crystallised at this public inquiry a great volume of public opinion, supported by scientific evidence to the effect that, unless efficient preventive measures were taken, the Fulham Power Station would be a source of danger to the health of the neighbouring districts and, further, would definitely cause material damage to buildings. The objecting authorities submitted that consent should not be given to the scheme unless the Commissioners were satisfied as to the adequacy of the means for preventing nuisance and dangerous fumes from the station when in operation ; alternatively, that a station should be erected near the estuary of the Thames where the effects of such nuisance would be minimised. The inquiry was held in December, 1930. The L.C.C., who bore half the expenses of the objecting authorities, were supported by the City of Westminster, the Royal Borough of Kensington, and Chelsea. Among the expert witnesses on their side were Prof. J. S. Haldane, Dr. J. S. Owens, Sir Frank Baines, F.R.T.B.A. (who offered convincing evidence supported by photographs of the actual damage to ancient buildings caused by the sulphur gases in the air of industrial towns), Mr. J. A. Robertson, consulting engineer, Dr. Daly, a medical officer of the L.C.C., and your Medical Officer of Health. Much of the medical evidence turned upon increased liability 81 to fog owing to a large volume of sulphur particles from the effluent of the chimneys being distributed in the atmosphere. The increased deathrate from respiratory diseases in industrial as compared with rural areas was submitted as one of the evil results of smoke-polluted air, also the fact that in cold periods the incidence of fog was closely correlated with a greatly increased death-rate from those diseases among the elderly and the very young. Prof. Haldane and Dr. Owens pointed out that no provision had been made for re-heating the flue gases after they had been cooled in the process of sulphur elimination, and they warned the Commissioners of the dangers likely to arise from those gases charged with sulphuric acid, carbon dioxide and carbon monoxide being emitted in a cold state, descending and displacing the warm air usually found over thickly populated regions. They envisaged dangers such as had actually occurred in Belgium shortly before, when a number of deaths occurred in an industrial area during foggy weather. A great deal of evidence relating to electrical, engineering, and financial questions was also given on both sides. The upshot was that the Commissioners gave their sanction to the erection of the Fulham Power Station subject to the following conditions or safeguards which had been suggested in the submissions of the opposing authorities :— The extension of the Fulham Power Station to be carried out in sections. The first section to be erected under clearly defined conditions ; further sections to be erected as the Commissioners may prescribe. To prevent the possibility of any nuisance arising steps must be taken:— (a) To eliminate smoke and grit; (b) To prevent the discharge of sulphur compounds into the air ; (c) To avoid noise and vibration. The Electricity Commissioners, Commissioner of Works and the Minister of Health shall have powers to supervise, to decide as to the methods for preventing nuisance and to inspect the apparatus for measuring sulphur emission and the records made. They may also test the methods in use. Finally, the chimneys must be at least 300 feet high. Prof. Haldane and Dr. Owens considered the conditions imposed by the Commissioners and deemed it necessary to issue a further warning as to the dangers likely to follow from the emission of flue gases in a cooled state. Representations were accordingly made to the Commissioners who, subsequently, stated that any plans for the Fulham station which did 82 not include provision for the re-heating of the flue gases would not receive their approval. The reason why special mention of this inquiry is made in this report is to emphasize that this was the very first occasion in an inquiry of this sort where a case was made out in the interests of public health and the protection of ancient buildings. Recent electricity legislation has had in view the supply of cheap electricity to be provided throughout the land. The schemes include the building on specially chosen sites of large power stations and linking these up with existing stations. And although these projects were universally welcomed, the possibilities of dangers arising were lost sight of until the Battersea Station had been sanctioned. Controversy and discussion followed and grew in volume till public opinion was fully awakened. The Fulham inquiry gave an appropriate opportunity for ventilating these apprehensions and of supporting them by evidence, and it is to be hoped that the safeguards obtained will be permanently adopted at all new power stations. It is a matter for the greatest satisfaction to report that the conditions submitted by the Councils concerned at the inquiry have been substantially met by the Commissioners in the conditions which the latter have attached to their consent to the Fulham scheme. Premises and Occupations which can be Controlled by By-laws and Regulations. (1) Common Lodging Houses.—Six in number, detailed on page 23. They are controlled and supervised by the L.C.C. The City Council's officers have power of entry and general powers relating to nuisances, drainage work, and infectious disease. (2) Slaughter Houses.—By L.C.C. as above. There are none in the City. (3) Offensive Trades.—There are none such registered in the City. (4) Cowsheds.—By L.C.C.: none in the City. (5) Houses Let in Tenements.- -The number of houses on the register at the end of the year was 386. The Sanitary Inspectors paid 1,463 visits of inspection to these houses and infringements of the By-laws were reported in a number of instances. Appropriate action was taken where possible to obtain compliance with the requirements of the By-laws. (6) Underground Rooms. (7) Butchers' Shops and Stalls. 83 (8) Dairies and Milk shops. (9) Ice-cream Premises. (10) Bakehouses. (11) Workshops and Workplaces. (12) Ray-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. (13) Fried-fish Shops and Fish Curers. (14) Street Traders Dealing in Foodstuffs. Particulars relating to premises and occupations included in the foregoing list, other than Nos. 5 and 12, may be found under the appropriate headings elsewhere in this report. Other Sanitary Conditions requiring Notice. Advertising signs obstructing light and air from occupied rooms.—The growing custom of erecting large electric signs on the front of buildings, particularly in the Strand and Piccadilly areas, entails, in some cases, the obstruction or occlusion of windows. An investigation into these conditions has been made at 47 premises, and while no instance has been found of dwelling rooms being affected, there were 7 office or workrooms where artificial light had to be used all day. Ventilation was possible only by mechanical means or by having the doors permanently open ; the windows were entirely out of action. In the instances where conditions were not satisfactory from a hygienic point of view, fresh arrangements were insisted upon to ensure adequate ventilation. Investigation of Conditions of Shop Assistants.—A special inquiry was made in the autumn at the request of the Home Office, through the medium of the Metropolitan Boroughs' Standing Joint Committee. Seven boroughs, the Cities of London and "Westminster, Kensington, Hammersmith, Islington, Lambeth and Stepney were selected for these inquiries and approached for their consent. The City Council acceded to the request, and instructed the Medical Officer of Health to proceed in co-operation with the Society of Medical Officers of Health. The Medical Officer of each borough instructed his sanitary inspectors to visit 180 shops and to report under 19 separate headings, e.g., lighting, heating, sanitary accommodation, mess and rest-rooms, provision for 84 personal washing, drying clothes, &c., &c. Ten shops of each of the following 18 groups were visited :— Bakers and Pastrycooks. Boot Shops. Butchers Chemists. Confectioners. Cooked Meats and Tripe Shops. Dairies. Departmental Stores Fancy Goods. Fishmongers and Poulterers. Greengrocers, Fruiterers, &c. Grocers and Provision Dealers. Hairdressers and Barbers. Ironmongers, &c. News vendors. Tobacconists. Drapery (Soft Furnishing &c.). Wholesale Establishments. In almost every instance the inspectors were received with courtesy, every facility being granted for obtaining the information. The reports were recorded on special cards under the various headings, and a digest of the data was prepared by each of the Medical Officers. These digests were further condensed and summarised in one report for the whole of the seven districts. This report was sent to the Home Office. The preparation of the report entailed several conferences of the Medical Officers concerned, and necessarily took up a great deal of time, but as may be supposed, the largest proportion of time was spent by the staff in inspecting and in compiling information obtained. The main features which emerged as far as the City of Westminster is concerned are summarized as follows :— The report in detail is still in the hands of the Government Department concerned, and must for the present be regarded as a confidential document. The types of shops were classified as to (a) size, and (6) class of business. Size.—34 large, 51 medium, 95 small; total, 180. Class.—24 high, 59 middle, 35 artizan and labouring class trade. The remainder, 62, including 10 wholesale shops could not be definitely grouped as to class of trade. Hours of sale : Were longest in food shops. In some cases assistants attend on a rota or it is a case of personal attendance by the proprietor. Sunday opening existed in 23 • 3 per cent, of shops. Premises varied greatly. In no case insanitary, but a few were of poor standard. Ventilation: Was satisfactory. In a few draughty. Very good in dairies. Only in one case " stuffy." Overcrowding : Pound only in one case; but at " Sale " times in large shops where crowds are attracted by cheapness there is a tendency. Heating : Provided in 64 per cent, and was sufficient and satisfactory except in 6. No heating in a large proportion of butchers, fish and cooked meat shops. Means of heating should be more generally adopted. — - Natural lighting satisfactory in 75 per cent. Poor in certain small shops Artificial lighting satisfactory in all but 7. 85 Basements for sale purhses inclined to be overcrowded at "Sale" periods. Sanitary arrangements : Sufficient and suitable in 75 per cent. In remainder the common use by both sexes, accessibility, or cleanliness, were points for criticism. Messrooms : Found in 50 per cent. and these varied greatly in character and suitability. It is desirable, at least, in Central London where most assistants are far from their homes that more adequate mess-room accommodation should receive attention. Cloak Rooms, &c.: Adequate in 71 per cent. This might be improved. Retiring rooms for female assistants : Provided in 26 per cent. Where several females are employed it is almost a necessity. Facilities for personal washing : Provided in 95 per cent. In some rather primitive. Should be a compulsory provision where food is handled. Seats : Adequate in 73 per cent. In som? it appeared that assistants were not encouraged to sit down. General Welfare arrangements and supervision: Exist in the very large shops and stores. First Aid provision: Found in 53 per cent.; specially necessary where knives are used. Living-in arrangements : An uncommon condition, only found in 7 and was unsatisfactory in 1. As will be noted from the above summary conditions of employment in Westminster shops are generally good. There is room for improvement in some cases as regards hours, heating, sanitary accommodation, cloak rooms and, where possible, mess and retiring rooms. Rag Flock Acts, 1911 and 1928.—There are no premises in the City which come within the provisions of these Acts. Fouling of Footways by Dogs—-By-law.—Seven cases of infringement of the By-law were reported to the Council by the Commissioner of Police. Summonses were issued against six of the offenders, one of whom was ordered to pay the maximum penalty of 40s., the others being fined 10s. 6d., 7s. 6d., 5s. (2), and 2s. costs, respectively. In the remaining case it was decided to take no action, the person concerned being a child of fourteen years. The Sanitary Inspectors kept observation in certain parts of the City from which complaints had been received of offences against the By-law being committed, but it was found impossible to obtain any evidence. Schools.—In addition to the list of schools and other educational establishments given in the report of the Medical Officer of Health of 1928, there are many professional, technical and other institutes and educational establishments in the City, such as the Institutes of 86 Engineering, Medical Colleges, City and Guilds of London Institution, Imperial Institute and Colleges of Music, Estate Management, Science and Technology, Needlework, &c. Most of them are old-established and well-managed institutions of great traditions and renown, and the sanitary arrangements generally are of the best class. Of the 47 referred to in the report of 1928 some 29 are elementary or continuation schools either wholly or partly under the control of the London County Council, and though some are old buildings the sanitary arrangements are quite satisfactory. Improvements or alterations in the sanitary arrangements have been carried out during the past year at 9 schools. Rat Repression.—Forty-seven 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 rats had entered through faulty or defective drains and sewers. Thirty outlets to sewers were examined by the City Engineer's staff at the request of the Public Health Department. Special measures were taken to deal with two areas in Kensington Place and Douglas Place. The clearance of old properties in the neighbourhood had disturbed the burrows and in consequence rats became a nuisance and almost a menace to the residents of those areas. A rat catcher was engaged by the City Council, and by using dogs, ferrets, poisoned baits and gas, he succeeded in clearing the premises. 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. The clearance of rat-infested areas is being realised as a measure of great importance to the public health, and the City Council has voted a sum for increased expenditure towards this purpose. 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 the Report of 1928. Nine complaints were received and trapping took place in three different areas. The same difficulties were experienced as last year owing to the partisan feelings of the community. Some are pro-pigeons, while others are anti-pigeons. It is also extremely difficult to deal with the nuisance affecting ledges and cornices of high buildings. If wiring 87 in is done in one case, the pigeons make some other building their home. It is hoped to adopt further methods for dealing with this problem. During the year 81 birds and eggs were trapped and taken. 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. It has proved a successful means of health propaganda, and is now in its second year of issue. The agreement with the printer provides for an issue of 2,000 copies per month. No cost falls on the Council and the magazine 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, and by Medical Officers of other districts, on subjects such as " Health Week," " War on Rats," "Measles," " Diphtheria," " The Common Cold," " Burn Rubbish," " Handicraft Class," " Care of Mouth and Teeth," " Danger from Flies," '' Summer Diarrhoea," " Sunlight and Health," " Why we should take Exercise," " Influenza," etc. 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 with illustrations. These articles are written by experts and prove exceedingly instructive to those who are interested in the public health. 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 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. Royal Institute of Public Health.—Congress held at Portsmouth in June, 1930. A Report by the Medical Officer of Health, the appointed delegate of the City Council, was presented to the Public Health Committee. (7070) G 88 Women Health Officers' Association—Study tour in Germany.— A corresponding interchange to that of the German women health officers to this country in 1929 was arranged with the assistance and approval of the Ministry of Health. One of the Council's health visitors, Miss Walding, was nominated among those selected for the tour. The City Council granted her the necessary 14 days' leave without expenses. She presented a report to the Committee, dealing with the methods and institutions, particularly those relating to Housing, Maternity and Child Welfare and Tuberculosis, seen during the visit to most of the chief towns of Germany. Sanitary Inspectors' Association—Conference at Ilfracombe.—Held in June, 1930. The City Council appointed Mr. White, one of the Sanitary Inspectors, as its delegate, and he made a report on the work of the Conference which was submitted to the Public Health Committee. Royal Sanitary Institute.—Congress held at Margate in June, 1930. The Chairman of the Public Health Committee and the Medical Officer of Health were appointed delegates by the City Council. The Chairman was, unfortunately, unable to attend. A Report dealing with the proceedings was submitted by the Medical Officer of Health to the Public Health Committee. National Association, for the Prevention of Tuberculosis.—Held in London in July, 1930. Dr. Thomson, the Tuberculosis Officer and Assistant Medical Officer of Health, attended as a delegate and reported on the proceedings. National Veterinary Medical Association of Great Britain and Ireland.— A conference was held in London on the 2nd August, 1930, on the question of the grading of milk under the Milk (Special Designations) Order, 1923. One of the Food Inspectors attended the Conference. Joint Tuberculosis Council—Study tour to Canada and the United States of America.—Dr. Thomson, as Tuberculosis Officer, was one of those selected by the Sun Life Assurance Company' of Canada for the grant of a travel scholarship of £100. He visited the various tuberculosis institutions in Canada and U.S.A., some 26 in all. For the purpose of this visit, the City Council granted one extra week's leave of absence to be added to his summer holidays, and in accordance with the action of the L.C.C. and other corporations, voted £30 towards his expenses. Dr. Thomson submitted a report which was presented to the Public Health Committee. 89 Public Health Congress and Exhibition.-—Held in London in November, 1930. Councillor Dr.H.W.J. Steen and the Medical Officer of Health were appointed delegates. Royal Sanitary Institute—-Conference on the Pollution of Rivers and Streams.—Held in London in November, 1930. Councillor Miss Hilda A Dutch was appointed to represent the Council. 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 29th, 1930, to January 9th, 1931. The fee for the course, two guineas, to Members of the Women Public Health Officers' Association, was paid by the Council, together with reasonable expenses. 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. London County Council (General Powers) Act, 1928, Section 28. Removal of Infirm and Diseased Persons in certain cases.—Only in one case did it prove necessary for the Council to exercise, through the Medical Officer of Health, its powers for compulsory removal. All the necessary notices had been served and other legal formalities carefully observed when the patient, who had resolutely refused admission to hospital, changed his mind and was admitted voluntarily. He was aged, very infirm, dirty and quite incapable of attending to himself or of keeping his premises in a sanitary condition. London County Council (General Powers) Act, 1928, Section 26. Compulsory removal to a cleansing station for the cleansing and detention of verminous persons, etc.—In no instance was it necessary to use these compulsory powers in 1930. Disinfection.—Disinfection of rooms from which patients suffering from notifiable infectious disease have been removed is carried out by means of the formaldehyde spray. For other non-notifiable infectious conditions disinfection is carried out on request, and a charge is made according to the circumstances of the case. Bedding and wearing apparel are removed to the Disinfecting Station, and are there submitted to steam disinfection. Books are treated with formalin. The cleansing of persons and of premises in a verminous state is carried out by the Disinfecting Staff. Visits were paid to 71 houses, (7070) G 2 90 and 7,866 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 484 men and 36 women, and 8 children under school age, were given medicated baths at the Disinfecting Station, making 528 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 130. The Disinfecting Superintendent and the Sanitary Inspectors paid 398 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. Among Westminster school children there were treated 355 cases of head lice, 15 of scabies, and 2 cases of body lice. In all these cases, the clothing was disinfected, together with the bedding from their homes, amounting in all to 551 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows : 193 for head lice, 2 for body lice and 2 for scabies. The number of attendances of these children for baths at the station was 965. The following table shows the total number of individuals treated at the station for verminous conditions:— Table IX. 1930. Head lice. Body lice. Scabies. | Total. Children (including those under 550 4 23 577 school age). Adults 3 477 40 | 520 553 481 63 [ 1,097 Table X. General disinfection of premises, articles, etc.:— 1926. 1927. 1928. 1929. 1930. ' Rooms 932 890 891 946 992 Articles disinfected 21,775 12,201 20,628 20,291 23,853 Articles washed .... .... .... 5,550 4,841 5,002 4.994 5,304 Articles destroyed.... .... ... 372 152 1,169 337 190 Books disinfected * .... ... 166 48 5,J 96 179 Vehicles ,, .... .... .... 4 7 6 18 8 Offices and business premises ... 25 9 10 8 39 * School books, 31 ; library books, 48; private books, 100. The following table shows the total number of individuals treated at the station for verminous conditions:— Table IX. 1930. Head lice. Body lice. ScabieB. Total. Children (including those under 550 4 23 577 school age). Adults 3 477 4O 520 553 481 63 1,097 Table X. General disinfection of premises, articles, etc.:— 1926. 1927. 1928. 1929. 1930. Rooms 932 890 891 946 992 Articles disinfected 21,775 12,201 20,628 20,291 23,853 Articles washed 5,550 4,841 5,062 4,994 5,304 Articles destroyed 372 152 1,169 337 190 Books disinfected * 166 48 5!) 96 179 Vehicles ,, 4 7 6 18 8 Offices and business premises 25 9 10 8 39 * School books, 31 ; library books, 48; private books, 100. 91 Molor Disinfecting Van.—The motor van during 1930 completed 4,408 miles, carrying 3,192 cwts. of goods. The petrol consumed was 422 gallons, equal to 10.4 miles per gallon. Mortuaries. The number of bodies removed to the Council's mortuary under order of the Coroner, or to await burial, was 289. Inquests were held at the Coroner's Court, Horseferry Road, in 282 cases, and there were 19 adjourned inquests. Post-mortem examinations were made in 190 instances. Seven bodies were received in the mortuary chapel to await burial. For some time past complaints had been made as to the inadequacy of the heating arrangements of the Coroner's Court. The system had not been altered from the time it was installed when the premises were built some 40 years ago. As the system was out of date, inefficient and wasteful of fuel, an entirely new system is to be put in at a cost of £160. The number of dead bodies taken to the mortuary for purposes of inquest, and to await burial, during the last 27 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 273 233 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 1930 289 282 7 There is a resting place for the dead at Drury Lane. 92 HOUSING. The circular addressed by the Ministry of Health to Local Authorities regarding the Annual Reports of Medical Officers of Health for 1930, lays particular emphasis on Housing. At the time the circular was issued, the Housing Bill, which has become the Housing Act, 1930, was before Parliament. It was, therefore, desired that Medical Officers in their reports for 1930 should direct early attention to housing defects in their areas, and be in a position to compile accurate records regarding the housing position generally, and should deal more extensively than heretofore with this subject. This section of the report for 1930 is divided into sections (a) and (b). Section (a) is purely statistical, and supplies information in the form laid down by the Ministry. Section (a). Number of new houses erected during the year :— Tenements. (a) Total 160* (i) By the Local Authority 160* (ii) By other bodies or persons 0 (iii) In course of construction 298 (b) With State assistance under the Housing Acts— (i) By the Local Authority— (а) For the purpose of Part II of the Act of 1925 0 (б) For the purpose of Part III of the Act of 1925 0 (c) For other purposes 0 (ii) By other bodies or persons 0 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,567 Number of inspections made 18,150 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 853 Number of inspections made 3,316 * Includes 10 flats built for employees of the City Council. 93 Tenements. (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6* (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 618 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 Ofiicers 166 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 6 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 5 (б) 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 .. .. .. .. .. .. 1 Note :—Three houses of the 5 reported last year, on which repair notices were served under Sec. 3, were demolished in 1930, the tenants having been rehoused. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 887 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 871 (b) By Local Authority in default of owners 0 * These 6 houses were the subject of dangerous structure notices. The tenants obtained alternative accommodation, and the houses were subsequently emolished. Sixteen notices being served at the end of the year, results will be included in next year's figures. 94 Tenements. 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 0 (2) (a) Number of dwelling-houses in respect of which Closing Orders were made 0 (6) Number of underground rooms in respect of which Closing Orders were made 0 (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 ance of Demolition Orders 0 4. Number of houses owned by Local Authority. Total number of completed working-class flats, at 31st December, 1930 671 Total number built in the last two years and held under— (1) Part III of the Housing Act, 1925 .. .. 80 (2) Part II of the Housing Act, 1925 .. .. .. 0 (3) Other powers 80 Section (b). Housing Conditions. (1.) General Observations as to Housing Conditions. (i) City Council's Schemes. Very considerable progress has been made towards completion of the new housing schemes which the City Council has had in hand during the past two years, and to which very full reference was made in the reports of 1928 and 1929. The Ebury Bridge scheme is complete in all but two blocks of 30 flats each, which will be finished in September, 1931. The first sections consisting of 80 flats were occupied in the autumn of 95 1930, while a further section of 70 flats will be ready in the early part of 1931. There are thus provided on this site additional dwellings numbering 210. # The Grosvenor Housing Scheme. The Grosvenor Housing Scheme on the Millbank Estate is being completed in stages as accommodation becomes available for those whose houses are being demolished. It must be remembered that this is an Improvement Scheme, and consequently involves demolition and clearance before new dwellings can be built. Even so, the first two blocks, comprising 70 flats, in Vincent Street, were completed in May, 1930, and occupied in June, 1930. The tenants are strictly confined to those resident on the Millbank area. The 70 families were moved into the flats after a formal opening ceremony had been performed by H.R.H. Princess Mary, Countess of Harewood. Each of the tenants was presented with a bronze key of beautiful design as a memento of the ceremony. Since then very substantial progress has been made with the rest of the scheme: two large blocks, providing each 84 flats, are in course of construction, and one has reached the third storey and will be ready for occupation by August, 1931. [See photographs.) In another part of the area the ground has been cleared, and preparation for the erection of a further block of 141 dwellings is well advanced. Ebury Bridge Scheme. The Ebury Bridge estate, as is well-known, was built on surplus land and therefore makes a substantial contribution to the working-class housing of the City. The tenants selected for these dwellings were those living in overcrowded or otherwise unsatisfactory conditions in Westminster. Preference has always been given to those whose work lies in the City of Westminster, or whose work requires them to live close at hand. The applications received for these flats were naturally very greatly in excess of the available accommodation and it has been rumoured by disappointed applicants that the flats were being filled by people from other Metropolitan areas. It is well that this rumour should be definitely dispelled ; 107 of the families to be rehoused through the additional accommodation provided, were cases investigated by the Medical Officer of Health, and recommended by him on grounds of overcrowding and other unsatisfactory conditions. In two instances only was this plan departed from ; both were night workers employed by the City Council, one had moved away temporarily, because his house in Westminster was demolished as a dangerous structure, while the 96 other was living in very overcrowded conditions in an adjoining district. These were the two exceptions, eminently justified by the special circumstances, which have given rise to those exaggerated rumours to which reference has been made. The Council, in its rehousing operations, took the wise course in a number of instances of allocating a quota of the new flats to certain of its tenants in the older dwellings at Regency Street. Those were tenants who required more rooms for their growing families and who had proved themselves suitable and trustworthy. Their transference to Ebury Bridge thus rendered vacant a number of flats at Regency Street dwellings which were then available for new applicants. Allocation of Flats. By reason, then, of the additional accommodation provided by the Council in 1930, and of vacancies occurring in the Council's dwellings during the year, there have been relieved.:— (1) 87 cases of overcrowding (as legally understood). (2) 26 cases of social overcrowding (lack of proper separation of sexes, or more than two persons to a room). (3) 11 cases of families living illegally in underground rooms. (4) 13 cases from other insanitary conditions. (5) 26 cases, not all overcrowded, were rehoused by the L.C.C. When the Ebury Bridge Estate is finally complete it is anticipated that probably 130 more cases of overcrowding, &c., will be relieved. Following the usual procedure, warning letters have been addressed to the owners as to their obligations in reletting premises from which these families have been rehoused, so that a recurrence of these unsatisfactory conditions may be avoided. These premises were kept under special observation and it is satisfactory to report that due heed has been paid to these warnings. It may, however, be said that owners are usually anxious to avoid the recurrence of overcrowding. In most of the cases where previously overcrowded rooms have been relet, they have been taken either by families without children or by other tenants of the same premises, who were in need of increased accommodation. (ii) Contrasts created by the New Flats. In last year's report, attention was drawn to the very great advantages which the tenants of flats in the Council's new dwellings possess as compared with their less fortunate fellow citizens remaining in tenement houses. The latter, in the rents they pay which include rates, are contributing to the wonderful amenities which those rehoused in the Council's dwellings enjoy. The basement dweller, formerly 97 perhaps an object for commiseration by the tenants of the upper floors, is now envied in his new flat, with his own bath, kitchen, washing and sanitary conveniences. He generally pays a lower rent than many inhabitants of rooms in private tenements and those rooms have none of the amenities provided in the Council's flats. The rents of rooms, particularly in some tenements in the Victoria district, are grossly exorbitant. It is not uncommon to find 15s. charged for an unfurnished room, and as much as 35s. for two unfurnished rooms. It is not as a rule the owner of the house who derives this rich harvest from exploitation of the occupiers or lodgers ; it is the tenant, very often a person in the same walk of life as the lodger. The tenant rents from the owner so many rooms, and sublets these rooms or, perhaps, the whole house, at extortionate rents. The owner, however, who may be deriving some £50 or £60 per annum from his house, less income tax, is obliged to undertake all structural repairs and renewals. While the Rent (Restriction) Acts continue, he sees his tenant enjoying a rent income from subletting of perhaps £200 or more per annum. It is well that this matter should be ventilated, as undoubtedly it is a factor of great aggravation in the housing difficulties in Westminster. Two classes of individuals are oppressed—the owner who is not getting a fair return on his capital and the lodger who by the law of supply and demand, is forced to pay an excessive rent. The middleman or tenant waxes prosperous at the expense of both while the owner may be subjected to unfair criticism by those unacquainted with the true facts of the caseThus do the seeds of discontent grow and bear fruit. (iii) Special Survey. In July of last year, on receipt of the Circular 1,119 from the Ministry, suggesting that special attention be paid to Housing, the Medical Officer of Health directed each district sanitary inspector to survey and to report on the housing conditions in his area. Special points, such as the character of the district, main industries, chief non-residential buildings, &c., are also included in the following summary of this special survey of the whole City. The City of Westminster comprises 2,502 acres, including such open spaces as Hyde Park, Kensington Gardens, St. James's and the Green Parks, and the gardens in 38 squares, the largest being in Vincent Square, of 9 acres, while Eaton, Belgrave and Grosvenor, each approximately measures 4 to 6 acres. The City is situate mainly in what is socially termed, the "West-End" the postal areas included are E.C.4, W.C.2, W.l, S.W.I, S.W.3 and S.W.7. On the north the boundaries 98 are Oxford Street and Bayswater Road, the boroughs adjoining being Paddington and St. Marylebone; the Thames on the south; on the east, Chancery Lane, Charing Cross Road and the Temple separate the City of London, and the Borough of Holborn ; while on the west, Queen's Gate and the Broad Walk, Kensington Gardens bound the Boroughs of Kensington and Chelsea. For the purpose of sanitary inspection and inspection of housing under the Inspection of District (Housing) Regulations, the City is divided into 9 areas. These areas may be generally and briefly designated as follows (refer to map):— (1) The Strand area, which includes Covent Garden, extends eastwards beyond the Law Courts and across one part of Chancery Lane. On the south, its boundary is the river as far as the Temple. In the north, the south side of Lincoln's Inn Fields is within it, while other streets near the margin are Drury Lane and Long Acre, and thence back to Charing Cross Road. (2) St. James's and part of Soho, on the north bounded by Oxford Street, on the west Wardour Street and including the south side of Piccadilly, Jermyn Street, Carlton House Terrace, &c., to Charing Cross. (3) Regent Street area, bounded by Oxford Street, Old Bond Street, north side Piccadilly, returning to Wardour Street as eastern boundary. (4) Mayfair. West of area No. 3, bounded on the north by Oxford Street, on the west by Park Lane, and on the south by Piccadilly. (5) Knightsbridge area is that to the west of St. George's Hospital, including Belgrave Square, part of Eaton and Lowndes Squares. It is bounded on the west by the Boroughs of Kensington and Chelsea. Part of this area extends as far west as the Broad Walk, Kensington Gardens and Queen's Gate. (6) Victoria Street and Buckingham Palace Road area, extending from the Horse Guards along Whitehall, the north side of Victoria Street and Buckingham Palace Road, as far as Chelsea Bridge. It ends not far from Sloane Square station, with Eaton Square and St. James's Park as the northwestern boundary. (7) St. John's, &c., extending from Horse Guards Avenue along the river bank to Vauxhall Bridge with Vauxhall Bridge Road and Victoria Street as its other boundaries. (8) and (9) Pimlico area, divided into two, on the east, bounded by Vauxhall Bridge Road to Victoria Station, the western boundary being the railway and the southern the river. CITY OF WESTMINSTER MAPTM 99 Housing Conditions in these Areas in Detail. (1) Strand area.—This area abuts on the City of London, which it closely resembles in the number of business premises. A typical example is Bush House, composed of office suites, containing more than 2,000 rooms, a magnificent modern structure with spacious lay-out. It also contains historic public buildings, such as Somerset House, Royal Courts of Justice, Royal College of Surgeons, and many Government offices. Education is represented by King's College, commerce by Covent Garden Market and many large printing and publishing establishments. Social life is catered for by at least 20 theatres and cinemas and many large hotels and restaurants. There is a total of 243 restaurants and other places where food is prepared and sold to the public in this district. Some thousands come into Westminster every day to the railway terminus at Charing Cross. It is worthy of note that there is a progressive tendency, particularly in this area for the large hotels to be replaced by business premises, a notable example being the Hotel Cecil. This immense hotel has been demolished and its site cleared for the erection of large offices. Industrial Dwellings. It will be gathered from the preceding paragraph that working-class dwellings do not predominate in the Strand area. They are confined roughly to an area within a radius of a quarter of a mile of Covent Garden Market and comprise industrial dwellings, a common lodging house and some tenements over shops. The Industrial Dwellings are the Peabody Estates, Wild Street and Bedfordbury, L.C.C. dwellings, Sheridan, Fletcher, Beaumont, Siddons and Stirling Buildings, Sandringham Buildings in Charing Cross Road, and Mercer Chambers ; housing a total of 904 families in separate flats, with a population estimated at 2,860. These industrial dwellings require very little attention from a sanitary inspector as regards structure and fittings. Visits mainly concern cases of overcrowding, infectious disease and cleansing. As regards overcrowding, 7 cases have come under notice during 1930. As in the first place, families are allocated flats according to the number of persons, it follows that those few cases have occurred as the number in family increased. Houses let in Tenements. There are only 12 houses let in tenements or lodgings. They house 44 families, numbering 132 persons. In addition to these, there are 87 tenements in connection with or over shops or business premises. In these tenements there may be estimated 394 persons. Five cases of over 100 crowding have been noted. These houses are old, and while both internal and external conditions have generally not called for notice by the Sanitary Authority, yet they are lacking in amenities as regards water supply and w.cs. on separate floors, baths and food stores. When vacated they are seldom re-let as dwellings, but almost always for business purposes. In view of this tendency, there does not appear to be any call for action beyond the relief of overcrowding and the necessary repairs and reconditioning which can be achieved under the Public Health Act. The only common lodging-house in this district, Bruce House (L.C.C.), accommodates 716 men, many of whom are employed in Co vent Garden Market or in connection with the printing and publishing houses. Two particular features. One narrow street of 8 small houses calls for remark. It is Goodwin's Court, running between St. Martin's Lane and Bedfordbury. These are basement houses with two storeys above, each house containing 3 or 4 rooms. The basements do not comply with legal requirements for sleeping rooms and are not used as such. There is no overcrowding, but the houses are fully 150 years old; rooms are very small, the stairways dark and steep and there is general absence of indoor sanitation and conveniences. This small area will in time disappear in the course of commercial development. At present these 18th century dwellings house 8 families (one family in each house). A few rooms are let furnished. In view of all the circumstances the houses cannot be regarded as unfit for habitation, but might properly be the subject of improvement, either on a private basis or as part of a statutory local improvement. There are also the peculiarities of the Adelphi area to be noted. This area lies between the Strand and the river, and was constructed for the most part under the direction of the brothers Adam in the 18th century. It includes such streets as Adelphi Terrace, Robert Street, Adam Street, John Street, &c. The buildings are mainly club and business premises built over Adelphi arches. Some of them contain basements, and even sub-basements if the datum line of the adjoining street is taken, but where these rooms look out on the Embankment it is found that they are some 20 ft. above ground level. This is due to the steep slope down from the Strand to the river. Certain of these low-level rooms are occupied by caretakers and their families, and in 20 instances are illegally occupied. The buildings are let to their full capacity as business premises and there is no other accommodation available for caretakers' quarters. The livelihood of these caretakers depends on their residing on the premises. If turned out of their rooms they would only swell the ranks of the unemployed. It is likely that the 101 whole of this area will, in due course, be demolished and replanned with large modern buildings. In the meantime as there is no tendency to dampness, further action with regard to the illegally occupied rooms is not being taken other than that of arranging for improved sleeping apartments. Overcrowding. In this area, as noted above, 12 cases of overcrowding are recorded. (2) St. James's District and part of Soho.—This district comprises two distinct and widely different areas : (i) The St. James's area, known as clubland, within and about which are many state and public buildings, such as St. James's Palace, York House, Marlborough House, the Admiralty, National Gallery, National Portrait Gallery, London Museum, St. John's Hospital for Skin Diseases, the Royal Dental Hospital. There are 9 large hotels, 6 theatres, and 3 cinemas. A number of fine residences are situated in Carlton House Terrace, St. James's Square, &c. ; some of these are gradually being converted into clubs and business premises. With the exception of a few chauffeurs, caretakers and the employees at clubs and hotels, there are no working-class people resident in the area. Stores, large shops and mixed business premises are found in St. James's Street, Haymarket, the south side of Piccadilly, Jermyn Street, &c. (ii) The northern portion of this district includes Leicester Square, the west side of Charing Cross Road up to Oxford Street and part of Soho. It is essentially a business district containing large and small business premises and shops, with 4 large hotels. This is part of theatreland ; 9 theatres and 7 cinemas bring business to many restaurants in the immediate vicinity. The names of the larger of these, close to Piccadilly, are household words, but among the total of 257 in this district will be found many cafes continental in character and cuisine. In some cases the restaurateur lives over his cafe, while in others the rooms in the upper floors of the four-storey buildings are let out as domestic workshops, where tailors, mostly of Jewish nationality, are engaged as outworkers, tailoring for large firms in the neighbourhood. Some of these tailoring premises are used solely as workshops by the more prosperous, who may reside in the suburbs, while in other cases the workshop forms part of a tenement dwelling. Industrial Dwellings. There are 385 industrial tenements in this district, 89 of which are in Sandringham Buildings on the west side of Charing Cross Road, while the larger number constitute Newport Dwellings, between Shaftesbury Avenue and Leicester Square. The former are occupied by skilled artizans, 102 policemen, postmen, &c., rents being at the rate of 5s. upwards per room. The latter are tenanted by persons more of the labouring class, but the rents are somewhat higher, about 7s. Id. per room. In these blocks there are not a few domestic workshops. The basement flats in Newport Dwellings are somewhat gloomy. Houses let in Tenements. There are no cottage properties in this area, but 43 houses of three or four storeys are let in separate tenements, housing about 249 families. Rents average 6s. 6d. per room. These tenements possess no amenities in the way of food storage, separate water supplies, &c., and the tenants share a common W.c. in the tiny back areas. In spite of frequent repairs, the houses constantly show serious evidence of dilapidation, and viewed from modern standards cannot be regarded as satisfactory. These features are pronounced in Bateman's buildings, a passage way leading out of Soho Square, where rough usage by the tenants soon obliterate the results of reconditioning. Combined Premises. Some 122 business premises have in connection with them about 200 tenements, let at rents of from 5s. a room to as much as 25s. for 2 rooms. These tenements vary in condition. Some are occupied by workers in the tailoring trade and others with fairly substantial earnings, whilst the remainder are tenanted by such people as restaurant and hotel employees. Overcrowding. Sixteen cases of overcrowding came to the knowledge of the Department during the year, but only 5 of this number could be considered illegal. (3) Regent Street area.—This comprises the remaining part of Soho (Great Marlborough Ward) and part of Regent Ward. It is somewhat small, but is an intensively business area. The district contains the Royal Academy, the buildings of the Civil Service Commission, 8 theatres, several high-class and popular hotels and one hospital, the Ear, Nose and Throat, in Golden Square. Shops and business premises vary from the highest class of shops in Bond Street and Regent Street to small shops in Soho and the open market in Berwick Street. Wholesale textile firms and high-class tailoring establishments are found in the neighbourhood of Savile Row and tailoring workshops in the Soho portion, including the workshop proper and the domestic workshop. Residential Contrasts. The residential property varies from aristocratic and old-fashioned Albany to a confined block of four cottages in a court off Berwick Street. 103 These four houses are, perhaps, the least desirable residences in Westminster, and with others in the City, are the subject of a report by the Medical Officer ; they contain from 4 to 6 rooms, are approached from a narrow court between Berwick Street and Wardour Street, and are occupied by 9 families, 5 being of foreign nationality (4 Chinese and 1 Italian), who are engaged as cooks, &c., at local restaurants ; the other occupants are porters, carmen and an old-age pensioner. The rents vary from 9s. 6d. for one room to £1 7 s. 6d. for the whole house. Tenements and Combined Premises. Nineteen tenement houses and some 342 combined business and tenement premises, contain approximately 965 tenements at rents varying from an average of 7s. 6d. per room up to as much as 20s. a room where not rent restricted- The general remarks with regard to tenement houses in the preceding district (No. 2) apply also to these houses. Industrial Dwellings. Six blocks of industrial dwellings in this district house 261 families and vary considerably from the City Council's well-built dwellings in Marshall Street to an old block of 8 dwellings in Hopkins Street, which until recently had the description " Healthy Homes " inscribed on the front of the building. Rents are from 5s. per room in the City Council's dwellings to 8s. a room or more, and with a tendency to increase in the others. The inhabitants of the Soho parts of this and of district No. 2, who live in the industrial buildings and in the various tenements, are of a mixed class and comprise many foreigners. They are engaged mostly in the tailoring trade, or at the various hotels, restaurants and places of amusement in the vicinity. Though generally these habitations may be classified as working-class dwellings, there are many occupants whose incomes lift them above the legal definition of members of the working classes. Overcrowding. Seventeen cases of overcrowding were discovered during the year, but only 4 infringed the legal standard. Restaurants, &c. Places where food is prepared and served to the public number 231, and it will be readily understood that in a district such as this, where the catering trade is so pronounced a feature, frequent changes take place. Cafes close down, new ones are opened, entailing many new visits in addition to periodical inspections. (7070) H 104 (4) Mayfair district.—Mayfair is the heart of fashionable London, and contains a large number of mansions and high-class private residences, family and service flats, hotels, clubs, &c. From the point of view of the housing of the working classes and the purpose of the housing survey, it need only be briefly dealt with. Industrial Dwellings. There are but few working-class dwellings in this district other than those in the large blocks of industrial dwellings south of Oxford Street belonging to the Improved Industrial Dwellings Co., and others in different parts of Mayfair. The 15 estates in all comprise 639 tenements of from 1 to 5 rooms each. They are occupied by the families of domestic servants, policemen, postmen, commissionaires, club and hotel servants and shop assistants. Rents average 5s. per room. Dwellings in Mews. In the mews and similar byways behind large private houses, about 309 families of chauffeurs and others employed in private households live in rooms above garages and business premises. Many of these dwellings have of recent years been improved and converted into small high-class residences, thus lessening the number of working-class dwellings in this area. Special Characteristics. Business premises, hotels and blocks of expensive flats are fast displacing the large mansions of Mayfair, notably in Park Lane to the west, Piccadilly in the south along Berkeley Street to Berkeley Square, and the encroachment of business is also taking place in the streets leading out of Bond Street in the east. The working-class dwellings in this area call for little attention from the Public Health Department; they are mostly well kept and the sanitary visits paid are mostly in connection with notifications of infectious diseases. In this district the inspector is kept fully occupied supervising sanitary alterations and advising generally with regard to sanitary fittings, drainage ventilation, &c. Occasionally notices have to be served under the City Council's Regulations with regard to basement bedrooms. Usually these cases occur in hotels and boarding houses when servants are provided with sleeping rooms in the basement. In new buildings where alterations are made to existing premises, basements receive particular attention, and the advice of the inspector is frequently sought, usually accepted, and acted upon without question. There are 117 cafes, restaurants, and other catering establishments in this district. 105 Overcrowding. Only in two instances was overcrowding noted during the year, and in neither were conditions serious. (5) Knightsbridge.—The predominant types of buildings here are large high-class residences and mansion flats with, in many cases, mews at the rear in which are the garages and stables ; these have rooms above for chauffeurs and stablemen and their families. Several Embassies are in this district, and also the Royal Albert Hall, Imperial Institute, the Indian Section of the Victoria and Albert Museum, Royal College of Music, Royal Geographical Society, Imperial College of Science and Technology (Royal School of Mines), City and Guilds of London Institution, School of Needlework, Hyde Park Barracks, and St. George's Hospital. Other premises include clubs, hotels, restaurants, large public garages, large and small shops and some offices. Working-class dwellings. The working-class population in the Knightsbridge area is relatively small and is tending gradually to decrease. As houses occupied by working-class people become vacant they are either demolished or reconditioned and improved and sold or let as better-class residences or for business purposes. But for the protection afforded by the Rent (Restriction) Acts, many more would, ere this, have disappeared. There are no blocks of industrial dwellings. Some 147 houses are let in tenements, 69 being also business premises ; these are let at an average rent of 4s. 6d. a room. Small houses of the cottage type and dwellings above garages and stables together number 542; these are also let at an average rent of 4s. 6d. a room. The tenement houses and those of the cottage type are old properties, lacking modern conveniences and will, in course of time, give way to improvements. Overcrowding. Ten cases of overcrowding have been dealt with ; 5 only were serious, and in each case arrangements were made for better accommodation. There are 48 restaurants and cafes in this district. (6) Victoria Street and Buckingham Palace Road area.—This district includes a widely differing class of property, from Government buildings in the east to small working-class houses in the west adjoining the Borough of Chelsea. It contains Buckingham Palace, Ministerial Departments adjoining St. James's Park, Whitehall and Parliament Street, Wellington and Chelsea Barracks, the Middlesex Guildhall, Westminster Hospital, &c. (7070) H 2 106 There are six hotels, many large office buildings, theatres and cinemas, and shops of varying size in this area. Since the war, 4 of the large hotels have been converted into premises for business purposes. Two large public garages are in course of construction in Buckingham Palace Road ; one is for use as a station for long-distance motor coaches. High-class residences and mansion flats are found in Eaton Square and in the neighbourhood of Buckingham Palace Road. Some of the streets formerly entirely occupied by members of the working classes are now gradually but surely changing to cater for more affluent tenants. Here again, but for the protection afforded by the Rent (Restriction) Acts many more of the working-class houses in this locality would by now have ceased to be occupied as such. The majority of the working-class houses in the district belong to one of the large ground landlords, and any arrangement that would envisage an orderly development, together with the preservation of sufficient working-class houses, would be an ideal conferring practical benefits. Such an ideal is rapidly becoming an accomplished fact in the development of the Grosvenor housing scheme at Millbank. Working-class dwellings. Quite a large number of blocks of industrial dwellings are situated in this area; there are 11 estates with 1,124 tenements, including those already erected and occupied on the City Council's estate by Ebury Bridge. On one of these estates of 104 tenements, owned by a private Company, the working classes have been replaced by lower middle-class tenants and increased rents are accordingly charged. Tenement houses number 261 ; there are 207 of the cottage type and 187 dwellings over garages, &c. Of the tenement houses, 55 are also partly occupied for business purposes. Almost all these premises are old, and 64 of them, situated in four small areas, have been specially reported upon by the Medical Officer of Health. One of these areas comprises 22 old and dilapidated cottages in a narrow court, and the owners are endeavouring to transfer the occupants to more suitable habitations and so release the site for building purposes. Overcrowding. Fifty-nine cases of overcrowding were noticed : 45 were overcrowding in the social sense, but 14 were below the legal standard and have either been relieved or will be dealt with as opportunities occur. Restaurants, hotels, cafes and licensed houses number 99. 107 Millbank Improvement Scheme. (Block A containing 84 fiats erected on site, see page 95.) 108 Millbank Improvement Scheme. (Another view of Block A (84 flats) showing inner lay-out. Aspect is southerly and with balconies for each flat provides for maximum of light and air.) 109 Millbank Improvement Scheme. (Blocks F and G shown in course of construction in Report for 1929. 70 flats in occupation since July, 1930. Formal opening by H.B.H. Princess Mary, July 9th, 1930.) 110 City Council's Ebury Bridge Housing Scheme, begun 1929. (210 flats built on surplus land and almost completed. Provides additional accommodation for families from overcrowded dwellings.) 111 Millbank Improvement Scheme. (Old insanitary dwellings and stables, 55 a, Horseferry Road—1929. Site now occupied by Block A, Grosvenor Housing Scheme of the City Council, see photographs on pages 107 and 108.) 112 Millbank Improvement Scheme. (Old insanitary stables and workshops, 46, Page Street—1929. Note contrast on same site, pages 107 and 108, 1930-31.) 113 (7) St. John's, including Millbank.—It was in this district that the disastrous flooding took place when the embankment walls of the River Thames gave way in January, 1928. It is largely an administrative district, and contains the Houses of Parliament, the Ministries of Air, Labour, Pensions, Transport and the Board of Trade ; Westminster Abbey, Westminster Cathedral; Great Scotland Yard, Police Headquarters and Instructional Institution; five hospitals, including the Queen Alexandra Hospital and the Royal Army Medical College. Other educational establishments are Westminster School, Westminster Abbey and Westminster Cathedral Choir Schools, the Westminster Training College for Teachers, the School of Retail Distribution, the Vincent Square Technical Institute, and the Greycoat School for Girls. Exhibitions include the Tate Gallery, United Services Museum, the Home Office Industrial Museum, and the two halls of the Horticultural Society. There is a large resident population consisting of such as are engaged in administrative work and others who occupy high-class flats, in Ashley Gardens and neighbourhood, and also the private houses not far from Westminster Abbey. Hostels. Ten hostels in the locality provide accommodation for 906 persons, such as business women and girls, male theological students, and boys. One of them is a police hostel for unmarried constables. Working-class dwellings—industrial blocks. Many of the working classes live in this district to be near their work, and most of them occupy the large blocks of industrial dwellings to be found here. Within this area is the Grosvenor Housing Estate of the City Council previously referred to, which adjoins three large blocks of industrial dwellings known as the Regency Street Estate, erected by the City Council about the year 1903. These, together with two more recent blocks, Schomberg and Admiral houses, provide 460 tenements, entirely exclusive of the new Grosvenor Housing Estate of the Council. The Millbank Estate of the London County Council has a total of 895 tenements; on the Peabody Estates there are several blocks with 991 tenements; the Ecclesiastical Commissioners own 139 flats, and there are 6 other smaller estates with a total of '283 tenements. In addition, the Army married quarters, Queen Mary's Buildings, off Frances Street, and the Police married quarters in Cannon Row, Regency 114 Street and Rochester Row, provide accommodation for 182 and 75 families respectively. There is, therefore, in this district a total of 3,025 families and an estimated population of 9,618 housed in the various industrial and block dwellings. Some of the smaller blocks are old and lack the amenities provided in the modern buildings, but generally the industrial dwellings are well kept. Cases of overcrowding occur from time to time and require visits, as also do cases of infectious disease. Tenement Houses. There are 344 houses let in tenements accommodating approximately 1,030 families; they have from 6 to 11 rooms each, and generally appear to be, so far as the main structure is concerned, in fairly good condition, though nearly all have basements. The basements are usually let with rooms on the upper floors, but, owing to the nature of the subsoil and the fact that they are built upon low-lying land, there is a tendency to dampness in these basements while their stairways are dark. The houses vary in internal condition, and whilst some are very well kept, others, particularly those occupied by several families, require considerable attention by the officers of the Department. Most were intended for occupation by one family, but nearly all are now sublet. Neither baths nor proper food stores are provided. W.C.'s are used in common. The only sculleries, in which are coppers, are usually in the basement. The back yards are small, and while the rooms opening on to them are at ground level, the corresponding rooms at the front of the houses are basement rooms. This is because the street surfaces are 8 to 9 feet higher than the yards. Cottages. About 57 cottages of from 2 to 5 rooms are scattered in different parts of the area. They are very old. One row of 11 at the rear of Marsham Street has received a great deal of attention from the officers of the Department: 3 cases of overcrowding here have been dealt with and 2 families were rehoused by the City Council. It is the desire of the owners of this block of property that these old cottages should be demolished to allow development of a larger piece of land. The owners have provided other accommodation for 3 families, and 4 of the houses are now unoccupied. As soon as all the occupants are re-housed these old cottages will be demolished. In this instance improvement is being 115 effected by private enterprise but is somewhat hampered because of the Rent Restriction Acts. Another area, off Vauxhall Bridge Road, containing 17 cottages, was included in a special report by the Medical Officer. Combined Premises. At 174 premises there are tenements over shops and other business premises. The number of tenements is estimated at 320, and the total occupants at over 1,000. The general remarks with regard to this class of dwelling previously made in reference to other districts also apply here. In addition, there are a number of dwellings for caretakers in the various office and mansion blocks which call for no special comment. There are 5 common lodging-houses in this district, 2 for women and 1 for men managed by the Church Army, a large one for men by the Salvation Army, and one for men by a private owner. A total of 1,226 beds is provided in the five. Overcrowding. Cases recorded number 93 in this district. Some 70 cases do not fall below the legal limit, but are deemed to be socially overcrowded inasmuch as, in most instances, the children are reaching adolescence, and the time is arriving when additional accommodation will be necessary. Twenty-three cases were more serious, and could be described as illegal; some have already been provided for, and the remainder will be dealt with as soon as possible. Restaurants. Cafes and licensed houses number 109. (8 and 9) Pimlico District.—This district is divided into two for the purpose of inspection, and as the two parts are so much alike, it is proposed to deal with both at the same time and to treat " Pimlico " as a whole district. It is almost entirely residential, and contains many large residences in Eccleston, St. George's and Warwick Squares and in St. George's Road and Belgrave Road, but the predominant types are 3 or 4-storied basement houses let in tenements. When the district was laid out for building nearly a century ago, it was planned in an orderly disposition with straight roads, intersected by others, with the result that the area consists of square or rectangular blocks of houses, closely built up on all sides in terrace fashion. There is 116 no doubt that most of the houses were built as single-family residences, but few are now occupied entirely by one family. Many of the large houses in the squares and main roads have been converted into flats and single rooms, let to the professional and semi-professional classes. But the large majority of the houses in this area are now tenement houses and occupied almost entirely by members of the working classes. The houses generally are substantially built, with a fair amount of light and air above the basement, and many have large rooms. Two or more water-closets are provided in most of them, usually one outside and the others inside. Water supply and washing accommodation are, in almost all cases, in the basement, but nearly all have taps and sinks in the upper parts. Cooking is provided for by coal ranges or gas cookers, but the provision for the storage of food is generally inadequate. Few baths are provided. There are many separately occupied basement dwellings, and dampness in the basements prevails in varying degrees. A number of the basements are dark, and although the large majority cannot be considered to be illegal, they are unsuitable for separate occupation as dwellings. Overcrowding. Pimlico is an intensively occupied area, and though there is considerable overcrowding, both illegal and social, it is a matter for wonder that it is not of more serious extent considering the urgent demand by those outside the district for accommodation so easily accessible to the west end of London. It is difficult to prevent overcrowding as vacancies occur so seldom. As soon as it is known that rooms are to be vacated many applications are made for them, with the result that rents increase and profiteering takes place. When families increase in number, or the children grow up, accommodation often ceases to be adequate, and it is most difficult, even when the extra rent can be afforded, to find the additional accommodation in the locality. There have been known to the Department during the past two or three years 99 cases of illegal overcrowding and 274 of social overcrowding. Houses let in tenements. Tenement houses number 2,728, with approximately 9,660 tenements, and are estimated to house 28,153 persons. Many of these houses are registrable under the bye-laws, and 289 have already been compiled. Rents vary considerably, from 6s. to as much as 20s. per room unfurnished ; furnished rooms are let at from 10s. to 30s. a room. Owing to the close concentration of families in these houses many notices have to be served with regard to cleansing and verminous 117 ditions, &c., and in some instances for overcrowding. Dampness also calls for frequent attention. It is in this area in which moat of the families rehoused by the City Council and County Council dwelt, and where rehousing is in constant progress. A tendency towards change in character and occupation is also noted here. The large private houses are being taken as offices or converted to better-class flats, and it is calculated that in course of time the whole district will be encroached upon by business interests. Industrial Dwellings. There are two estates of Industrial Dwellings : the Peabody Avenue Estate, near Ebury Bridge, containing 526 tenements, and Cambridge Buildings, owned by the Ecclesiastical Commissioners, with 69 tenements. These dwellings are of the old type, with common conveniences and without baths, but otherwise are satisfactory. When overcrowding occurs in these buildings it is remedied by the owners as soon as vacancies allow. Rents are low, from 3s. 5d. to 5s. a room. Cottages and various. Dwellings of the cottage type, and including those in the mews over garages, workshops and stores, number 239. These vary considerably. Some 93 are owned by the Ecclesiastical Commissioners, 44 being welldesigned modem dwellings, and 49 nearly a century old. These properties belonging to the Commissioners, including the 69 dwellings, (Cambridge Buildings previously referred to), a number of tenement houses and some modern dwellings of the cottage and maisonette types in St. John's District, are well managed by a trained woman property manager on the Octavia Hill system, and require little attention by the Council's officers. The rents are remarkably low and average 3s. 6d. a room. Rents charged for cottages other than those owned by the Ecclesiastical Commissioners vary from 5s. to 10s. 6(2. a room. An area off Wilton Road, comprising about 80 cottages, of 2, 3 and 4 rooms each, and another of 17 dwellings over garages, workshops, &c., in a mews off Bessborough Place, have been included in a special report by the Medical Officer of Health. There are 312 dwellings over, or in connection with, business premises. Usually the basements under shops are entirely under the street level and are unfit for separate occupation as dwellings. Some of the business premises have very small yards, or none at all, and the entrances are, as a rule, by a narrow passage at side of the shops. These premises are generally less desirable as residences than the average tenement house. Rents are from 5s. to 15s. 6d. a room. 118 The total working-class population in this Pimlico district is estimated to be about 32,000. Restaurants, cafes, licensed houses, &c., number 49. (2) Sufficiency of Supply of Houses.—The extent of the shortage of houses available in the City at reasonable rents was considered by the Medical Officer of Health in a report submitted to the Public Health and Housing Committees in May last. It may be stated that approximately 700 dwellings are necessary to alleviate overcrowding and to replace certain old worn-out dwellings on valuable sites. It was stated in the report which is still under consideration that while there were no slum areas in the City, certain houses, singly and in groups, merited demolition by reason of the fact that they could not be adequately reconditioned except by embarking upon an expenditure exceeding the actual value of the houses. Attention was drawn to the fact that schemes of development were being delayed or arrested by reason of the great difficulty of providing suitable alternative accommodation for the occupants of these houses. As there are no suitable vacant sites in Westminster where workingclass houses can be erected, it is a difficult and necessarily slow process to meet the demands for new houses. It will be remembered that the City Council has on its two housing areas now being developed 824 flats in course of construction. On the Grosvenor housing area there will be a surplus of flats after all those on the improvement area have been accommodated. Many of the most urgent cases referred to in this report have already been rehoused at Ebury Bridge. It is inevitable that as time goes on and further developments take place in the City, working-class dwellings will become more scarce and difficult to obtain. A policy, therefore, which provides for the future should warrant careful consideration. If dwellings are to be provided in Westminster, they must necessarily take the form of lofty industrial tenements. (3) Overcrowding.—During the five years to the end of 1930, a total of 1,118 cases of overcrowding of varying intensity came to the knowledge of the officers of the Public Health Department. While 265 of these were illegal according to the standard in the by-laws as to houses let in tenements, the remainder were not overcrowded in the legal sense, but were socially so inasmuch as they consisted of families occupying one or two rooms only. 119 Of the total, 291 families have been allocated houses on the L.C.C. Estates, while 467 were housed in the City Council's dwellings. Some cases of overcrowding were otherwise abated by private arrangements. There are still about 500 cases of overcrowding existing. This total is obviously not constant and varies from month to month as cases are relieved and others are discovered. Overcrowding is most prevalent in Pimlico and the adjoining district of St. John (Millbank), and is due partly to the inability of those affected to pay the high rents demanded when vacancies occur and to the undoubted shortage of working-class accommodation in Westminster, which is aggravated by the influx of people from outside the City who are willing to pay the high rents demanded to be near their work. Other factors which contribute to overcrowding are the demolition of working-class houses and those families who earn good wages but prefer to spend money on indulgences rather than the improvement of their housing conditions. The circumstances of cases of overcrowding are, therefore, somewhat varied, and while the Department strives hard to help those who cannot help themselves, it cannot shoulder the responsibility of those who by intent or by ignorance fail to remedy conditions well within their power to alter. (4) Fitness of Houses- (a) The repair and reconditioning of old working-class dwellings is constantly in progress and its proper supervision demands much of the time of the sanitary inspectors. The majority of owners are alive to the advantages of keeping their properties in good repair, and a great deal of work is done voluntarily. Defects may be discovered in the course of routine house-to-house inspections or by visiting on complaint. Thus, of the 1,059 defective houses reported, 332 were the subject of complaint. In no case was any failure experienced in obtaining remedy for these conditions by administering the nuisance sections of the Public Health Act. Of the 887 intimation notices, only 58 were ineffective, thus requiring the service of statutory notices by the sanitary authority. Only in 5 instances had recourse to be taken to court proceedings to enforce those statutory notices. This is sufficient evidence to prove the simplicity and effectiveness of the procedure under the Public Health Act. Section 3 of the Housing Act, as the similar section in the 1919 Act, had remained practically a dead letter in Westminster because no instance had arisen which could not be dealt with effectively by the Public Health Act. In 1930, however, and in the previous year, a few cases arose in which the fate of generally dilapidated houses was acutely precipitated 120 by their being certified as dangerous structures by the District Surveyor. It seemed practicable by using Section 3, to supplement and to support the action of the District Surveyor in the hope that the occupiers' homes could be preserved. The receipt of counter notices from the owners, declaring their intention of closing, and the subsequent demolition of the houses (an alternative method of complying with the District Surveyor's order), showed that in Westminster the value of a cleared site is vastly greater than that of any old working-class house on it. It may be most welcome to the owner to take advantage of the counter notice provided in Section 3. Generally speaking, it has not been found that the operation of Section 3 has been very successful in endeavouring to repair and preserve working-class dwellings. During the past two years, 11 notices have been served under Section 3, requiring repairs to be carried out; counter notices were served with regard to 3 houses and closing orders became operative. Two of the houses have been demolished and the other will be pulled down as soon as arrangements to rebuild for business purposes are completed. In one case the Council resisted a counter notice and the necessary repairs were carried out. Three other houses with regard to which Section 3 notices were served were vacated and have since been demolished. (b) As already mentioned, reconditioning of old properties is constantly in progress under the provisions of the Public Health Act. Most of the large tenement houses being of sound structure can be dealt with satisfactorily by these means. Certain details may appropriately be dealt with under the L.C.C. by-laws which apply to this type of house, obligations as to cleansing, etc., being the duties of tenants and lodgers. Certain of these by-laws relating to the provision of food stores, separate w.c's, water supplies, etc., are suspended during the life of the Rent Restriction Acts. It is important to note that when these suspended provisions come into force the houses in question will no longer remain working-class houses. Rents of rooms in many cases are already very high, and if the owners are compelled to provide these amenities the houses will pass out of the category of working-class houses in order to fulfil the demand for small middle class flats—a demand far in excess of the supply in such a central district. The type of old decaying house chiefly found among the cottage properties already referred to as entirely uneconomic to recondition adequately admits of one method only. That is, clearance and rehousing of the occupants. This important question is under consideration by committees of the City Council. 121 (c) Internal Water Supply.—Only certain of the industrial dwellings and those cottages containing single families have separate water supplies for each letting. All cottages housing more than one family and most of the tenement houses have common supplies. In the cottage properties water supply is from a yard tap, while in the tenement houses, in addition to a yard pipe or tap in basement scullery, there are water taps and angle sinks on one or more landings. The number of separate lettings without private water supplies may be estimated at 15,000. (d) Separate W.C's. -Here also the only separate lettings with private w.c's are some of the industrial dwellings and the old cottages occupied by single families. The number without separate conveniences is higher than that in the preceding paragraph as many tenements are provided with sinks and water supply, but are without separate w.c's. There is no instance, however, both as regards water supplies and w.c's, where the statutes and by-laws requiring these provisions are not adequately fulfilled. (5) Unhealthy Areas.—A review of the housing conditions in the various wards of the City, together with a study of the vital statistics of the past twenty years, fails to reveal any area which could be characterised as " unhealthy." The death-rate has declined steadily since 1910, with occasional intermissions due to such causes as the influenza pandemic of 1918-19. Infantile mortality has also declined from an average of 85 in 1910-15 to 60 in 1925-30 while the death rate from tuberculosis has fallen from 1.43 in 1910 to .85 in 1930. These improvements in the vital statistics are general throughout the City. It has been previously noted that there are no slum areas or districts where housing generally is of a peculiarly low or unhealthy character. There are, however, houses or small groups of houses which fall far short of modern sanitary standards. The types of defect have been mentioned in the preceding paragraphs dealing with the sanitary districts. These defects are inherent characteristics of old working-class houses in any town or city and can only be dealt with as opportunities arise for clearance and improvement. These opportunities, it is almost unnecessary to add, depend on other housing accommodation being available for the tenants to be displaced. (6) By-laws.—The by-laws in force in the City relating to dwellinghouses are those made by the City Council under the Public Health Act with regard to the paving of yards, cleansing of cisterns, water supply to w.c's, and for the prevention of certain nuisances, and are adequate for the purposes intended. The by-laws made by the London County Council with respect to houses divided into separate tenements have been elsewhere dealt with in this report. 122 No by-laws with regard to tents, vans, sheds, etc., are in force in this district. Underground Rooms.—It is estimated that 6,500 basements are in occupation for dwelling purposes. Of that number about 221 are separately occupied as dwellings. During the past five years, 162 underground rooms have been found to be occupied contrary to Section 96 of the Public Health (London) Act or to the Council's Regulations relating to underground sleeping places made under the Housing, Town Planning, etc., Act, 1909. In 126 cases the occupants have been rehoused and the illegal occupation has ceased. The remainder are still in occupation owing to the difficulty in finding other accommodation. In certain of these cases conditions, though technically breaking the law, are not so serious as to demand radical measures. The figures in the preceding paragraph apply to working-class dwellings, except in a few cases where the Regulations with regard to sleeping apartments were not complied with in such premises as clubs, etc. The City Council's regulations made under Section 17 (7) of the Housing, Town Planning, etc., Act, 1909, with respect to underground sleeping places have proved useful, but are somewhat cumbersome in operation. No penalty is provided for a contravention of the regulations until after a closing order has been made under the Housing Acts with respect to a sleeping place used as such contrary to the regulations. Hostels.—Eighteen Hostels provide accommodation for 1,247 persons, 696 males and 551 females, including business women, students, single policemen, boys and girls. The table which follows is an attempt to convey in statistical form the salient points outlined in the preceding summary of housing conditions of the working classes throughout the various wards of the City. Those who are competent to express opinions on housing must realize the enormous difficulties of dealing with the problem within the boundaries of the City. Site values in this heart of the Empire are necessarily very high. Vacant land, for housing purposes, in an area so circumscribed is practically non-existent, while demands for housing in this central district are naturally insistent. This report attempts to record the continuous work which the City Council has accomplished during the past five years in rehousing and providing additional accommodation, thus successfully relieving overcrowding and other insanitary conditions to an extent perhaps quite unknown to the average citizen. 123 Summary of the Detailed Information given with regard to Working-Class Houses. District. Working Class Population (estimated) Industrial Dwellings. Houses let in Tenements. Cottages and Dwellings over Combined Business Premises and Tenements. Separate Dwellings Underground. Estates. Tenements. Houses. Tenements. Garages, &c. Premises. Tenements. Legal. Illegal. No. 1—Strand, etc 3,430 6 904 12 44 8 47 87 21 20 „ 2—St. James's, etc. 2,453 2 385 43 249 — 122 200 55 — „ 3—Regent Street, etc 3,870 6 261 19 137 6 342 828 14 3 „ 4—Mayfair 2,419 15 639 — — 264 33 45 — — „ 5—Knightsbridge 2,594 — — 78 258 542 69 138 5 — „ 6—Victoria, etc 8,234 11 1,124 206 615 394 55 120 7 2 „ 7—St. John's 13,923 15 3,025 344 1,030 57 174 320 27 5 „8 Pimlico 17,759 1 69 1,478 5,460 93 112 190 31 3 „9 14,543 1 526 1,250 4,200 146 200 376 25 3 69,225 57 6,933 3,430 11,993 1,510 1,154 2,304 185 36 (Excluding those on the Grosvenor Improvement Area.) There are many club and hotel servants, caretakers, etc., not included in the above totals. 124 INSPECTION AND SUPERVISION OF FOOD. The supervision of food in a district with so many restaurants and food shops, and containing the largest and most important wholesale fruit market and clearance depot in the world, entails a great deal more work than can appropriately be recorded in this report. It should be noted that at Covent Garden Market about 600 wholesale merchants deal with 1,000,000 tons of fruit and vegetables annually, a large proportion of which comes from foreign countries. Imported fruit requires careful supervision, and although, in the first place, it must pass the officers of H.M. Customs and Port Sanitary Authority, yet these latter rely on the officers of the Westminster Sanitary Authority to check and to verify consignments concerning which provisional certificates have been given. No cases of food poisoning were reported during the year, nor were there instances of seizure of unsound food exposed, etc., for sale for the food of man. Merchandise Marks Act, 1926, and The Agricultural Produce (Grading and Marking) Act, 1928. The administration of the above orders still demands a great amount of time of the Food Inspectors and during the year the requirements of the numerous orders and regulations have been carried out by the traders concerned in a fairly satisfactory manner. 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. The following order under the Merchandise Marks Act came into force during the year :— No. 4 Order Raw Tomatoes. Tomatoes, when exposed for sale, either wholesale or retail, if 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) (Broccoli) Regulations, 1930. „ „ „ „ „ (Strawberries) Regulations, 1930. „ „ „ „ „ (Canned Fruits, Peas and Beans) Regulations, 1930. „ „ „ „ „ (Dressed Poultry) Regulations, 1930. „ „ „ „ ,, (Cider) Regulations, 1930. „ „ „ „ „ (Cherry) Regulations, 1930. 125 The Agricultural Produce (Grading and Marking) (Egg) Regulations, 1928, were revoked and have been superseded by the Agricultural Produce (Grading and Marking) (Egg) Regulations, 1930. The latter introduced certain slight changes relating to Grades (naming and standards of size). The Artificial Cream Act, 1929. 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 which are exempt from registration because of the provisions of Section 2 (1). 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 10. Grade A (Tuberculin tested) milk 12 Grade A milk 4 Pasteurized milk 14 6 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. Removal of the name of a Milk Vendor from Register of Purveyors of Milk. (Milk and Dairies (Amendment) Act, 1922.) An itinerant milk vendor registered in the City had been guilty of many offences; four samples of milk taken within a period of eighteen months were found to be adulterated, one having 26 per cent. of its fat abstracted. In addition, he was observed bottling milk in the street on two occasions. He had been prosecuted, and convictions had been obtained for each of these offences. The vendor was summoned to attend before the Public Health Committee and made a statement, which, however, was not considered satisfactory, and his name was accordingly removed from the Register of Purveyors of Milk. The vendor if he felt aggrieved at the decision had the right to appeal, but he did not do so. (7070) I 126 Milk and Dairies Order, 1926. Registration of Dairymen and Dairy Premises.—The following table shows the number of persons and premises registered with the Council for the sale of milk during the year. Premises. Persons. Registered to 31st December, 1929 177 137 Registered during the year 4 19 Removed from the register (ceased or transferred business) 6 8 Registered to 31st December, 1930 175 148 The inspectors paid 314 visits to milk shops and dairies during the year and it was found necessary to serve 2 notices with reference to insufficient water-closet accommodation. It was not found necessary to take legal proceedings as the required work was remedied on receipt of notice. Bottling Milk in the street.—Article 31 of the Milk and Dairies Order, 1926, is to ensure that milk shall be bottled and sealed on registered premises and shall be delivered to the consumer in that state. During the year three roundsmen were prosecuted for offences against the Order. Fines varying from 5s. to £3 were inflicted. It is satisfactory to report that there is a further decrease in the number of these cases, but observations require to be no less vigilant as offences may be more prevalent than they appear to be. A roundsmen was observed filling bottles with milk outside his employer's shop contrary to the regulations. Empty bottles and caps were found on the pavement outside the shop and the employer, who was responsible for the actions of the roundsman, was spoken to by the Inspector. A summons was taken out against the employer for not taking effective precautions to prevent contamination of the milk and owing to the explanation given to the magistrate, which was accepted, the summons was dismissed on the payment of 2s. costs. Milk and Dairies (Consolidation) Act, 1915. During the year 54 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 40 of the requests were in proper legal form, 14 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 127 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. All the 54 samples were found on analysis to be " genuine." Three samples of milk were taken in the " course of delivery " on a request by a retailer who had reason to doubt the quality of the milk supplied to him, but all the samples on analysis proved to be genuine. 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. Grades of quality for milk have been set up by the analysts according to the percentage of milk fat. They are:— Good quality : Over 3.8 per cent. of fat. Fair quality : Between 3.3 per cent. and 3.8 per cent. Poor quality : Between 3 per cent. and 3.3 per cent. Adulterated: Below 3 per cent. fat or 8.5 per cent. non-fatty solids. The results of the samples taken in each of the two districts of the City during 1930 are given in the following table:— Table II. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Per cent. No. Per cent North 456 138 30.2 271 59.4 36 7.8 11 2.4 South 454 258 56.8 160 35.2 26 5.7 10 2.1 1930 910 396 43.5 431 47.3 62 6.8 21 2.3 1929 867 323 37.2 422 48.6 79 91 53 6.1 1928 904 410 45.3 373 41.2 101 11.1 20 2.2 1927 944 511 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 1.9 1923 997 158 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 (7070) I 2 128 The quality of the milk sampled has improved this year in comparison with that of last year. Of the total 910 samples of milk taken during the year, 48 were obtained on Sundays. One of the latter proved to be adulterated, 21 per cent of the fat being abstracted. The vendor was prosecuted and a fine of £5 inflicted. Legal Proceedings for Adulteration.—Of the 21 adulterated samples, 10 were considered sufficiently serious to warrant prosecution. Details of the offences and results of proceedings are set out below. Milk— Fine. Costs. 11 per cent. of fat abstracted £2 0s. — 2.7 per cent. of fat abstracted £2 0s. — (Both taken at the same time from same vendor.) 8 per cent. of fat abstracted £3 0s. — 9 per cent. of fat abstracted £2 0s. — 13 per cent. of fat abstracted Summons dismissed £5 5s. (The defendants stated that owing to a breakdown of their pasteurizing plant the milk was not kept properly stirred. 8 per cent. of fat abstracted £2 0s. — 10 per cent. of fat abstracted Summons dismissed (Probation of Offenders Act) 21 per cent. of fat abstracted £5 0s. — 5 per cent. of fat abstracted and 1 per cent. of added water £1 1s. £1 1s. 8 per cent. of added water 10s. £2 2s. Condensed Milk Regulations, 1923-1927. Fifty 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. Only the following articles may contain preservative which must be either sulphur dioxide or benzoic acid as specified in the regulations. Sausage and sausage meat, fruit and fruit pulp not dried, dried fruit, unfermented grape juice and non-alcoholic wines, cordials and fruit juices, jam, candied peel, sugar, corn, syrup, gelatine, beer, cider, alcoholic wines, sweetened mineral waters, brewed ginger beer, coffee extract, 129 pickles and sauces made from fruit or vegetables. Four infringements of these regulations were found as the result of analyses of samples. Table III. Food and Drugs (Adulteration) Act, 1928. Samples purchased under the Food and Drugs (Adulteration) Act, showing resulti of Analysis and subsequent Proceedings for year 1930. Number. Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s. d. 1 Apples 3 3 — — — — — — 2 Aspirin 1 1 — — — — — — 3 Brandy 24 24 — — — — — — 4 Butter 146 146 — — — — — — 5 Caviare 1 — 1 — — — — 6 Camphorated Oil 6 6 — — — — — — 7 Cocoa 20 20 — — — — — — 8 Coffee 18 18 — — — — — 9 Cream 67 6a 1 1 1 — 2 0 0 — 10 Dripping 1 1 — — — — — 11 Fruit Cordials 25 25 — — — — — 12 Gin 25 24 1 1 — 1 — 5 5 0 13 Ice Cream 12 12 — — — — — 14 Jams, &c. 37 37 — — — — — 15 Lime Water 6 6 — — — — — 16 Margarine 37 37 — — — — — 17 Meat Pies, &c 87 87 — — — — — 18 Milk 910 889 21 10 8 2 17 11 0 12 12 0 19 Do. Condensed 50 50 — — — — — 20 Do. Dried 1 1 — — — — — 21 Do. Skimmed i 1 — — — — — 22 Mustard 4 4 — — — — — 23 Olive Oil 8 8 — — — — — 24 Preserved Fruits 39 37 2 1 — 1 — 25 Preserved Vegetables 37 37 — — — — — 26 Rum 22 22 — — — — — 27 Sausages 59 59 — — — — — 28 Spices 18 18 — — — — — 29 Sultanas and Raisins 15 15 — — — — — 30 Sweets 2 2 — — — — — 31 Syrup of Figs 6 6 — — — — — 32 Tea 36 36 — — — — — 33 Tinned Fish 46 46 — — — — — 34 Turtle Soup 1 1 — — — — — 35 Vinegar 13 13 — — — — — 36 Whisky 22 21 1 1 — 1 — 3 3 0 37 Wine 9 9 — — — — — 1,815 1,788 27 14 9 5 19 11 0 21 0 0 The Council had given authority for 1,800 samples of food to be purchased during the year; authority was also given for an additional 25 samples of foods other than milk to be taken if necessary. 130 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:— Cream.—67 samples were purchased. One of these was found to contain 21.8 grains of boric acid per pound. The vendor was prosecuted and a penalty of £2 was imposed. Preserved Fruits.—39 samples of various kinds were purchased, and two of these, namely, crystallised apricots, contained sulphur di-oxide in excess of the amount allowed under the Public Health (Preservative) Regulations. One sample—informal —contained 235 parts of S02 per million. A formal sample was then taken and was found to contain 410 parts of S02 per million. Proceedings were taken, the vendor pleaded his warranty and the case was dismissed. Owing to the warranty being given more than six months previously, it was not possible to take any action against the warrantors. The amount of preservative (SO,), allowed in these fruits is 100 parts per million. Caviare.—One informal sample was taken, It was found to contain 22.4 grains of boric acid per lb. For some time the Food Manufacturers' Federation have been endeavouring to find a method of keeping caviare fresh without the use of boric acid. It appears that owing to difficulties in bringing sturgeon in a fresh state to this country, it has not been possible to make complete scientific investigations on this side, although certain useful experiments have been conducted. In the interests of the whole industry, the matter is one, both as regards the preparation of this article of food, and its condition when imported into this country, that should form the subject of investigation by the Ministry of Health. Sausages.—A number of samples of sausages taken from various vendors throughout the City have shown small amounts of sulphur dioxide. The amounts present were certainly under the amounts permitted by the Regulations, but in each case the half-pound of sausages as bought by the Inspector was not labelled. The whole packet from which the half-pound was taken was probably labelled correctly. But if the purchaser asks for a half-pound of sausages, and he receives sausages which are not labelled to the effect that they contain preservatives, he is entitled to presume that they are not preserved. He is therefore prejudiced if he finds those sausages are preserved. The matter was brought to the notice of the Sausage Manufacturers' Association with a view to some uniform action being taken to comply with the Regulations, and we have been informed that reminders have been issued to members of the Association that they are under an obligation to carry out the law (or regulation) as it exists. 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 131 the addresses are forwarded for the attention of the sanitary authorities concerned. The number of stalls registered in the City on which food is exposed for sale is about 224, 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 1930 was 136. The inspectors paid 394 visits to these premises. In one case the paving of the yard was in a defective condition and there was not sufficient dust-bin accommodation. These matters were rectified without the service of a notice. Food Order, 1921. No cases came to the notice of the Inspectors of absence of labels on ''imported" meat. Other Food Premises. The total number of inspections to food premises was 2,854, 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 25 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 kept and 1,153 restaurants have already been indexed. During the year 1,142 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 127 instances, and in each case the work was satisfactorily carried out. 132 Fish Shops and Fried Fish Shops were periodically inspected. There are 27 of these shops in the City to which the Food Inspectors paid 28 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. A register has now been prepared in accordance with the provisions of the London County Council (General Powers) Act, 1928, and 76 premises used for the sale, manufacture, etc., of icecream have been recorded. The inspectors paid 41 visits to premises where ice cream is manufactured, etc. The conditions in all cases were satisfactory. Bakehouses.—At the end of 1930 there were 62 bakehouses in the City, of which 45 were underground. During the year, three underground and two above-ground bakehouses were discontinued as such. 175 visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out. Inspection of Food.—Food exposed for sale has received regular inspection by the food inspectors, who have carried out this work daily including Sundays. including Sundays. The following table shows the nature and amount of food voluntarily surrendered or submitted for destruction:— Article. Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Apples 2 2 2 16 Melons - 17 2 12 Apricots — 7 2 — Nectarines ... — 3 — — Apricot pulp — 3 — — Onions ... — 1 — — Bacon — — — 18 Oranges 5 19 1 4 Bananas 1 15 — — Pears 34 3 3 Broad Beans — 11 3 9 Peas — 15 1 12 Black currants 1 1 — — Pickled herrings ... — 3 — Carrots — 6 — — Pineapples ... — 10 2 — Cauliflower — 9 1 — Plums ... — 4 3 8 Chestnuts 3 10 — — Potatoes 4 6 1 10 French beans 1 16 — — Prunes 1 1 7 Figs — 5 3 — Radish ... — 3 — Gooseberries 1 1 1 — Red currants ... — 4 1 10 Grapes — 19 1 — Strawberries ... — 1 2 — Ham — — — 5 Sweet potatoes 2 5 2 — Horseradish — 11 1 — Tomatoes 45 — — — Lettuce 3 1 — — Walnuts ... — 9 — 12 Loganberries — 5 3 — Fish — 1 2 — Certification of Food for Export.—Certificates enabling the export of certain articles of food were granted in eleven instances—seven to Canada and one to Australia, two to United States of America and one to South America. The Canadian authorities have by letter to the Ministry of Health, dated 20th September, 1930, acquainted the Certifying Officer that the 133 importation into Canada of meat food products from animals slaughtered in the United Kingdom will no longer be permitted under the scheme of certification hitherto in force except poultry products certified as having been given veterinary post-mortem inspection. Table IV. Food and Drugs (Adulteration) Act, 1928. Spirit Samples, 1930. 93 Samples of whisky, brandy, rum and gin were taken during the year. In 2 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:— No. Article. Result of Analysis. Action taken and Result. Degrees U.P. 125S. Whisky 41° Dismissed under Probation of Offenders Act on payment of £3 3s. costs. 647S. Gin 38.5° Dismissed under Probation of Offenders Act on payment of £5 5s. costs. MATERNITY AND CHILD WELFARE. The welfare of children under school age and the prevention of maternal mortality were the questions of chief importance affecting this section of public health work during the year. The first had become prominent in view of Circulars 1054 and 1405 from the Ministers of Health and Education respectively. The Ministers pointed out the contrast between the care devoted to babies up to 2 years of age and the lack of it as regards children between these ages and 5 years, when they come under the Education Authorities. It appeared that much of the money spent on the treatment and care of defects and diseases in school children could be saved if adequate attention were given at the early stage of child life. The Ministers' suggestions may be summarized briefly: An extension of services in regard to (1) The systematic health visiting of children before they enter school. 134 (2) Further facilities for their medical examination either by their parents' doctor or at the centres. (3) Increase or extension of day nurseries where circumstances seem to require it. (4) Education authorities were also asked to consider the provision of nursery schools. The City Council, after consideration of these circulars, resolved that early attention should be given to extending its health visiting services on behalf of children under school age. An additional health visitor was appointed and the work and areas of the Centres so reorganised as to allow more time for home visits to these children. The question of further facilities for these medical examinations was deferred pending further information to be obtained from extended health visiting. The Council has also given most careful consideration to the question of day nurseries. The present accommodation is provided by a voluntary society, and although the nursery is extremely well conducted it is entirely inadequate. The finding of larger premises, having regard to the costliness of sites in the City, still remains a problem of great anxiety to all who are interested in this subject. Suggestions as to the inclusion of day nurseries in housing estates, such as exist abroad, have been discussed, together with other alternatives. To meet the difficult financial situation of the existing day nursery, the Council decided to increase its grant. The L.C.C., as Education Authority, approached the City Council as to measures of co-operation. It was decided to transfer information from the City Council's centres to the school authorities relating to the health and welfare of children known to the centres and entering schools, whether at the age of 5 or earlier. A form of record agreed between the two authorities has been drawn up and the transfer of information is proceeding satisfactorily. The L.C.C. also drew attention to the use which might be made of their school treatment centres for the benefit of pre-school children. Maternity Beds.—The agreement with the Westminster Hospital for the provision of maternity beds continues to work very satisfactorily. As mentioned on a previous occasion the scheme has provided a long-felt want and is a notable contribution to the solution of the problem of maternal mortality. The cases admitted are those recommended from the Council's three Maternity and Child Welfare Centres and that of the Westminster Health Society. The grounds on which hospital accommodation is sought are those laid down in Circular M. & C.W. 4, detailed in 135 the report of last year. The total number of women admitted and confined in the hospital was 49. Of these 16 were from the Centre at Westbourne Street, 15 from Bessborough Street, 11 from Frith Street, and 7 from Page Street (Westminster Health Society). The confinements were normal except in two instances. A patient admitted in emergency in a late stage of labour had Caesarean section performed for obstructed labour ; although the child was saved the mother died from exhaustion. The other case had also Caesarean section and both mother and child recovered satisfactorily. The average stay in hospital for all cases was 12 days, and universal satisfaction has been expressed for the care and treatment received. Ambulance Service for Maternity Cases. Consideration was given to a communication from the London County Council on the subject of their Ambulance Service, inviting the views of the City Council, as the Maternity and Child Welfare Authority, as to the need in the City for extended facilities for maternity cases. The extended facilities referred to the conveyance of non-urgent cases between 8 a.m. and 11 p.m., and also the conveyance of expectant mothers to and from ante-natal clinics. It was suggested that the City Council should enter into an agreement for the payment of costs in conveying these non-urgent cases in the day time. The need for ambulances for such non-urgent cases has not so far been experienced in the City, and the Council therefore deferred entering into any such agreement, expressing at the same time the view that ambulances should be free for all maternity cases and that the service should be on similar lines to those provided for infectious cases. The London County Council now controls the ambulances of the old Metropolitan Asylums Board and also those of the Guardians, in addition to its own services. It provides ambulances, free of cost, for the conveyance to hospitals of:— Parturient women, if the case is one of urgency, whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case; and Non-urgent cases of parturition, between the hours of 11 p.m. and 8 a.m. if letters of admission to maternity hospitals are produced, it being sufficient in such cases for a female friend to accompany the patient. 136 District Midwifery Services. The publication of the Interim Report of the Departmental Committee on Maternal Mortality was received in the late autumn, and in view of its recommendations the City Council reviewed its maternity services as outlined below. Consequent upon the resignation of the Council's midwife on the 1st October, the Public Health Committee sanctioned temporary arrangements with Miss Rossi, a private midwife who normally acted as deputy for some years, for the continuation of its district midwifery services. The Committee had under consideration the interim report of the Departmental Committee of the Minister of Health on Maternal Mortality and paid particular attention to the recommendations of that report as regards what are termed "essential services" of a maternity scheme. The Committee when considering the permanent organisation of its midwifery services also had in view the possibilities of embracing certain of the recommendations, already referred to above, in order to render its services complete. It is desirable that so far as is possible there should be available in the City for any necessitous woman who wishes to take advantage of such assistance, a fully efficient service before, during, and after her confinement. The "essential services" referred to above may be summed up as follows:— (1) The provision in every case of the services of a qualified midwife to act either as midwife or as maternity nurse. (2) The provision of a doctor to carry out ante-natal and post-natal examination in every case, and to attend during pregnancy, labour and the puerperium, as may prove necessary, all cases showing any abnormality. (3) The provision of a consultant, when desired by the doctor in attendance, during pregnancy, labour and the puerperium. (4) The provision of hospital beds for such cases as need institutional care. (5) The provision of certain ancillary services (e.g., transport, sterilised equipment, laboratory facilities). The authorities of Westminster Hospital were therefore invited to co-operate in framing a district midwifery scheme which would supplement and complete the indoor maternity service which they had been carrying out on behalf of the City Council for almost two years. The ease and readiness with which the negotiations with the hospital were 137 carried through are in themselves a tribute to the organisation of the institution and to the goodwill of all concerned. An agreement was drawn up to the effect that in return for a fixed annual payment the hospital would undertake district midwifery cases on behalf of the City Council throughout the City except in the area of the Westminster Health Society. The cases are those coming within the ambit of the Council's Maternity and Child Welfare scheme. Briefly, the main points are: The hospital appoints a district midwife and a deputy midwife, who reside at the hospital. These midwifes attend at the Council's Centres and keep in touch with the ante-natal clinics and with the health visitors generally. Fees for midwifery service are assessed by the Council's Sub-Committee as heretofore, but the moneys are paid to the hospital. The services of the hospital's resident and honorary staff are available. for these cases, as are also its bacteriological and laboratory services. The ancillary services mentioned are also provided by the hospital. The scheme, which will operate as from 1st January, 1931, offers a complete midwifery service for any woman who cares to avail herself of the Council's Maternity and Child Welfare scheme by applying either at the centres or at the hospital. It is, perhaps, unique, at any rate in London, as an instance of a complete midwifery unit organised by a voluntary hospital in co-operation with and on behalf of a municipal body, and, moreover, the scheme was complete and ready for service before the Minister issued his circular calling upon local authorities to improve the organisation of their maternity services. 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 December, ] 929, to dedicate half the income for a period ending 31st March, 1931, 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, spectacles, material for children's overalls, etc. The total sum of £16 9s. 11d. has been expended. 138 Maternal Mortality: Puerperal Fever ami Puerperal Pyrexia.—In 1930, 10 deaths occurred in pregnant women, giving a rate of 7.3 per 1,000 births. This was an increase on the figure of 1929, when 5 deaths only were recorded. 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 20. Spinster. Died in Infirmary of puerperal eclampsia. Admitted in comatose state after delivery of stillborn child at home. Urine loaded with albumen. Aged 23. Died in Infirmary. Ante-partum haemorrhage, admitted as "accidental haemorrhage "in a bloodless and grave condition. Caesarean section performed, but patient sank and died on day of admission. Aged 26. Spinster. Died in Infirmary of pyothorax inflammation of womb following abortion. Inquest. Aged 42. Died in hospital of septicaemia. Confinement complicated by prolapsus uteri and asthenia; had severe haemorrhage prior to admission ; child died following normal delivery; placenta pviæa, placenta manually expressed ; severe post-partum hæmorrhage. Aged 35. Died in nursing home of puerperal toxaemia. Patient had suffered for many years from non-diabetic glycosuria. Normal confinement, but placenta manually expressed. Aged 41. Widow. Died on way to hospital, puerperal eclampsia. Inquest. Aged 30. Died in hospital of secondary haemorrhage. Cæsarean section for disproportion hydramnios. Aged 34. Died in hospital of puerperal fever. Child born before arrival at hospital. No midwife in attendance. Aged 31. Died in Infirmary. Placenta prævia and rupture of uterus. Child stillborn at home. Patient was admitted in a moribund condition and unfit for any operative interference. Aged 29. Died in hospital of puerperal fever. Pulmonary embolism and pelvic thrombosis and peritonitis. Normal first pregnancy. Puerperal Fever.—There were 6 cases, of which 4 ended fatally. The four deaths occurred in hospitals, at which institutions the confinements had taken place. 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. 139 Whilst the condition may not indicate puerperal sepsis, notification furnishes an opportunity of dealing with the case at an early stage. There were 16 cases (last year 12) 14 of which were removed to hospital while 2 remained at home. All with two exceptions recovered. The exceptions developed the graver condition of puerperal fever and are included among the ten 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. 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. No. 14, Westbourne Street. No. 15, Bessborough Street. No. 9, Frith Street. No. 30, Page Street. Totals. General Lying-in 12 15 2 14 43 St. George's 39 22 3 1 65 Westminster 14 24 4 34 76 St. Thomas' 10 6 1 2 19 Charing Cross 4 3 6 1 14 Middlesex 4 4 42 — 50 Woolwich — — — — St. Stephen's — 4 —. 2 6 Queen Charlotte's — — — — St. Mary's 2 — — 1 3 Clapham Maternity — — — — — Royal Free — — — — — Royal Northern — — — — King's College — 1 — — 1 University College — — 1 — 1 Found by Health Visitors 65 92 32 79 268 By Private Doctors and Midwives — — — — — Reported to Centre voluntarily 95 63 20 46 224 Totals 245 234 111 180 770 140 Ante-natal Visiting.—To the 770 expectant mothers who became known to the Centre, primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,385. The attendances by those mothers at the clinics held by Dr. Vernon are detailed below:— Table II.—-Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Westbourne Street 49 78 116 194 109 Bessborough Street 49 120 165 285 162 Westminster Health Society. 12 - - 157 - 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. 1930. Pimlico Road. Bessboro' Street. Frith Street. Page Street. Total. Number of classes 44 48 46 93 231 Total attendances 250 1,069 633 3,269 5,221 Average attendances 5.6 22.2 13.7 35.1 22.6 Number of expectant mothers 12 85 24 45 166 Number of attendances by expectant mothers 35 331 107 471 944 373 Number of other mothers 32 137 80 124 Number of attendances by other mothers 215 732 526 2,798 4,271 Attendances of children in nurseries during classes 109 659 505 3,253 4,526 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Westbourne Street were 106; at Bessborough Street, 630; at Frith Street, 481; and at Page Street, 1,888. 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 Westbourne Street on Mondays at 2.30, under the charge of Mrs. Colman. 141 Midwifery Services.—The work performed by the Council's midwife is summarised below, and comparative figures since 1925 are given. Her area, which was formerly contained in Victoria Ward, took in that part of St. John's Ward bounded on the east by Vauxhall Bridge Road. Table IV. 1925. 1926. 1927. 1928. 1929. 1930. Number of cases attended— As midwife 73 80 65 77 72 62 As emergency — — — — — — With hospital students — — — — — — With private doctor — — — — — — Total 73 80 65 77 72 62 Number of— Pre-natal visits 779 860 678 599 579 576 Lying-in visits 939 1,005 812 1,149 1,003 909 Subsequent visits 335 351 415 442 437 420 Visits to infants under 1 year, other than lying-in visits 234 262 376 433 361 292 Total number of visits 2,287 2,478 2,281 2,623 2,380 2,197 Table V. Attendances by midwife at ante-natal and other clinics:— 1925 1926 1927 1928 1929 1930 Westbourne Street 54 43 39 40 43 36 15, Bessborough Street 75 87 82 86 97 93 Total 129 130 121 126 140 129 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 43 With hospital students 7 With private doctors 3 53 Midwifery visits 846 Nursing visits 71 917 (7070) 142 There s 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. 843 women from other districts were confined in Westminster and 476 women belonging to the City were delivered in the hospitals mentioned—the number in St. Stephen's alone being 237. 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: 410, of which 54 were Westminster cases. St. George's Hospital: 244, of which 31 were Westminster cases. Westminster Hospital: 340, of which 148 were Westminster cases. Sheffield St. Hospital: 60, of which 3 were Westminster cases. St. Stephen's Hospital: 237. 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:— 14, Westbourne St. 15, Bessborough St. 30, Page St. 9, Frith St. 430 410 281 238 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 143 New Maternity and Child Welfare Centre at Marshall Street, Soho. Doctor's Room. Weighing Room. 144 New Maternity and Child Welfare Centre at Marshall Street, Soho. Mothercraft Room. (The Centre is included in the building containing Public Baths and Washhouses, &c., Highways and Rates Departments opened by the Mayor of Westminster, Captain J. F. C. Bennett, J.P., April 17th, 1931.) 145 following table shows the number of visits paid in connection with the four centres:— Table VIII. _ Westbourne Street. Bessborough Street. Frith Street. Page Street. Total. Pre-natal— First visits 245 236 125 181 787 Other visits 439 406 164 376 1.385 Children under 1 year of age— First visits 369 380 239 265 1,253 Other visits 1,714 1,476 1,016 1,191 5,397 Children over 1 and under 6 years— Visits 2,758 2,253 2,018 2,639 9,668 Death enquiries, still-births, &c 44 37 35 20 136 Infectious diseases 379 634 396 210 1,619 The Council's midwife paid 576 visits before, and 292 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— 14, Westbourne Street—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 shown on page 146. 146 Table IX. Attendances at Infant Consultations, 1930. 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. 14, Westbourne Street 102 248 81 2,748 1,365 2,996 1,446 4,442 15, Bessborough Street 101 232 51 2,690 2,034 2,922 2,085 5,007 9, Frith Street 53 90 21 1,208 850 1,298 871 2,169 30, Page Street 101 212 78 2,265 1,771 2,477 1,849 4,326 1930 357 782 231 8,911 6,020 9,693 6,251 15,944 1929 353 789 202 7,664 5,496 8,453 5,698 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— 1930. 1929. 1928. 1927. 1926. Westbourne Street ... 43.5 36.5 39.9 37.1 42.4 Bessborough Street 49.5 48.8 44.9 44.7 38.5 Frith Street 40.9 33.1 27.1 29.2 23.1 Page Street 43.1 38.1 36.9 40.1 36.3 The number of individual children medically inspected were— 14, Westbourne Street 593 9, Frith Street 243 15, Bessborough Street 610 30, Page Street 630 147 Infant clinics in connection with the maternity departments of 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. Since the Discontinued Grants (Apportionment) (London) Order, 1930, made by the Minister of Health, the infant welfare clinics at Charing Cross and the Infants' Hospital, Vincent Square, receive annual grants from the City Council, and are accordingly subject to a certain degree of supervision by the latter. 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 wich nursing visits were paid:— Table X. Patients. Visits.[/##] Ophthalmia neonatorum and conjunctivitis .. 2 26 Puerperal pyrexia 2 9 Influenza — — Pneumonia 10 168 Bronchitis 2 15 Measles 65 713 Whooping cough - — Other complaints 136 1,681 Total 217 2,612 Ophthalmia neonatorum has been notifiable since 1911. The percentage of mild (non-purulent) and notified (purulent) cases in relation to births from the year 1922 is as follows:— Table XI. Cases (notified). Rate per 100 births for both classes of cases.[/##] 1922 24 2.4 1923 30 3.4 1924 23 2.4 1925 21 2.0 1926 16 1.0 1927 14 1.9 1928 7 1.2 1929 11 1.9 1930 16 2.2 148 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 1926 0.62 1906-10 3.2 1927 2.8 1911-15 2.4 1928 0.72 1916-20 4.95 1929 0.73 1921-25 1.7 1930 2.1 I here are a number of cases in winch inflammation develops in the eyes of recently-born infants, and if the discharge remains watery in nature and pus does not form the condition need not be classified as ophthalmia. The infection, nevertheless, may be gonococcal in origin. Those are necessarily mild cases but it is important that they should be recognised and treated at an early stage, because if neglected genuine purulent ophthalmia might ensue. Sixteen cases were notified during the year, 9 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 2 cases, 26 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 provides for the treatment of cases both under the Maternity and Child Welfare and Tuberculosis Schemes. Figures relating to the latter will be found in the Tuberculosis Section of the Report. Expectant and nursing mothers, and children under five years of age, are eligible for treatment. Mr. W. H. Turner, the Dental Surgeon, owing to ill-health, found it necessary to apply for long leave of absence, and the Council approved the appointment of Mr. Stewart Tait, L.D.S., as his locum tenens at the Dental Clinic during the former's absence. The Dental Surgeon submits the following report:— I have much pleasure in submitting my report for the above Clinic for the paBt year. There has been a considerable increase in the number of new cases seen at the Clinic, which is very gratifying as it points to a more general 149 interest being taken in the care of the teeth by the mothers attending the Centres and realisation of their importance in matters of health. As a result of this increase in new cases the other branches of the work have shown a corresponding increase. Take, for instance, the number of fillings done during that period as compared with the previous year. This work entails considerably more time than the other work done and I find an increasing number of patients more anxious to have their own teeth conserved rather than extracted, and I think that this should be encouraged where possible. It has therefore been necessary to divide up the sessions for (a) Fillings and other operations; (6) Gas extractions; (c) Denture work. This has enabled me to cover the ground better, but it still entails considerable pressure, and it may be necessary for me to ask you at some future date to consider if you wil 1 bo prepared to grant an extra session per week in order to cope with the increasing work. New cases 257 Subsequent attendances 1,129 Teeth extracted 1,305 Teeth filled 201 Other dental operations 1,225 Anaesthetics administered:— Local 23 General 253 Dentures supplied 22 Number of Sessions 78 T. STEWART TAIT, L.D.S., Dental Surgeon. Table XII. Comparative statement of work of Dental Clinic (M. & C.W. section) since 1924:— 1924. 1925. 1926. 1927. 1928. 1929. 1930. Number of Sessions 79 92 92 90 88 89 78 New patients 179 205 209 204 172 153 257 Subsequent attendances 522 613 629 802 807 793 1,129 Teeth extractions 1,349 1,278 1,668 1,198 930 1,172 1,305 Teeth filled 154 167 189 248 208 148 201 Other dental operations 478 616 699 777 638 663 1,225 Anaesthetics administered— Local 25 38 31 17 28 33 23 Genera] 240 255 295 263 182 194 253 Dentures supplied 4 6 2 6 14 18 22 Patients contributed £20 8s. 6d. in small sums according to their means. Dr. Graham Scott, Anaesthetist at the Dental Clinic for some years, found it necessary to resign owing to pressure of work. Dr. F. J. Gordon, who had been acting as locum tenens, was appointed in his stead. 150 Coywalescent 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.—Careful consideration has been given to a Circular issued jointly by the Minister of Health and the President of the Board of Education on the subject of the health of children under school age. The Circular suggests, inter alia, that in some areas the Maternity and Child Welfare Authorities may decide to supplement their arrangements for the treatment of children under school age by the provision of day nurseries for children whose mothers go out to work, or whose home conditions are such that the children's health would benefit by the daily supervision which can be secured in this way. The day nursery accommodation in Westminster is not sufficient to meet all needs and the whole question is being carefully considered with a view to submitting a recommendation which will meet with approval by the City Council. In the meantime it was decided to increase the Council's grant to the Westminster Red Cross Day Nursery, 147, Warwick Street, in the current financial year from £50 to £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 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, 5,040 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 £99 1s. 7d.