AV 4344 WES 41 City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 3 1 ANDREW J. SHINNIE, M.D., D.P.H. (Lond.), Medical Officer of Health and Administrative Tuberculosis Officer. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD. PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1931 ANDREW J. SHINNIE, M.D., D.P.H. (Lond.), Medical Officer of Health and Administrative Tuberculosis Officer. Printed by Order of the Council. LONDON: HARRISON AND SONS, LTD. PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. 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 22 Distribution of, in Wards 16, 21 Infantile Mortality 16 Stillbirths 10 Meteorological 4 Population 5 Staff of the Public Health Department 2 Statistics, General and Vital 1 Prevalance of, and Control over, Infectious Diseases 23 Anthrax 33 Bacteriological Laboratory 35 Cerebro-spinal Fever 33 Chicken-pox 33 Diarrhoea and Enteritis 32 Diphtheria 30 Anti-toxin 31 Schick Test Immunization 30 Encephalitis Lethargica 33 Enteric Fever 32 Influenza 32 Measles 32 Mumps 33 Notifications 28 Ophthalmia Neonatorum 34, 63 Poliomyelitis 33 Puerperal Fever 34 Puerperal Pyrexia 34 Scarlet Fever 30 Small-pox and Vaccination 24 Tuberculosis 35 Deaths and non-notified deaths 40, 41 Dispensary Report 42 Returns (Ministry of Health) 46 Notifications—primary 37 Tables 35 Whooping Cough 33 General Provision of Health Services in the Area 48 Ambulance facilities 51 Ante-natal cases 57 Ante-natal clinics 57 Ante-natal visiting 57 Barlow's Gift 56 Birth Control 66 Blind Persons Act, 1920 56 Children Act, 1908 56 Clinics and Treatment Centres 51 Convalescence 65 Day Nurseries 65 Dental Treatment 63 Disinfection 67 Health Education 66 Health Visiting 55 (6862) iv page General Provision of Health Services in the Area—(contd.)48 Hospitals 49 Infant Clinics 60 Insulin Treatment 66 Laboratory facilities 49 Maternal Mortality 52 Maternity and Nursing Homes 51 Maternity Beds 54 Midwifery Services 58 Midwives 48 Mothercraft 57 Milk, supply of 66 Mortuaries 68 Nursing in the Home 48, 62 Unmarried Mothers, Homes for 65 Widows and Orphans Contributory Pensions Act, 1925 56 Sanitary Circumstances of the Area 69 Conferences, etc. 84 Dogs, Fouling of Footways by 81 Drainage and Sewerage 70 Ministry of Health Summary 83 Mosquitoes 83 Outworkers 77 Pigeons, Nuisance from 82 Premises and Occupations—Controlled by By-laws, etc. 80 Public Swimming Baths, etc 69 Rat Repression 82 Rent Acts 73 Sanitary Inspection of the Area 72 Factories, Workshops and Workplaces 75 Nuisances—Intimation, Statutory Notices, etc. 73 Scavenging 71 Smoke Abatement 78 Water Supply 69,74 Housing 85 City Council's Schemes 87 Overcrowding 92 Rehousing 88 Statistics required by Ministry of Health 85 Underground Rooms 91 Inspection and Supervision of Food 96 Artificial Cream Act, 1929 97 Condensed Milk Regulations, 1923-1927 100 Dried Milk Regulations, 1923-1927 100 Food and Drugs (Adulteration) Act, 1928 101, 105 Samples, results of analysis, action taken, etc. 101 Food, Inspection and Destruction of 105 Food Order, 1921 103 L.C.C. General Powers Bill, 1932 96 Meat Regulations, 1924 103 Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928 97 Milk and Dairies Amendment Act, 1922 97 Milk and Dairies (Consolidation) Act, 1915 98 Milk and Dairies Order, 1926 98 Milk Samples 99 Nutrition 106 Preservatives in Food Regulations, 1925-1927 100 Restaurants and other Food Premises 103 Spirit Samples 105 Street Trading 102 V Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 3 1. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1931. The report is prepared in accordance with the requirements of Circular 1206 of the Ministry of Health. The report of last year was of the nature of a survey report, the previous five years being viewed in retrospect as regards the needs and developments in health services. The subject of housing was dealt with in a comprehensive manner; the conditions prevailing in the various wards of the City were fully reported, and the new housing schemes of the Council were described in detail and illustrated. On this occasion the report is of a simpler character and, as laid down in the Circular, only extensions or developments of health services which have taken place since my last report receive full comment. Statistics and other data relating to birth and death rates, infectious diseases, the administration of the various statutory powers of the sanitary authority are set out in the customary form. The year 1931 was, meteorologically, not very favourable to health. There was a rise in the general death-rate, infantile mortality and deathrate from tuberculosis, and these features were also common to the County of London and the country as a whole. Weather conditions in the first quarter of the year were mainly responsible for an increase of deaths from respiratory diseases among the elderly and the very young. More than one-third of the total deaths for the year occurred in the first three months. The population enumerated at the 1931 Census was 129,535. In 1921 it was 141,578—a fall of 8.5 per cent.; in 1911, 160,261; and in 1901, 183,011. The rate of fall seems to remain fairly constant. The steady decrease is due to the declining birth-rate and to the movement of the resident population to outer districts. The Registrar-General attributes the 8.5 per cent. fall in population as being due to 7.7 per cent. migration and 0.8 due to births and deaths. The birth-rate has never been so low (10.17). This is partly due to the high proportion of elderly vi people in the population. Only in one borough, Chelsea, is the average age higher for both sexes; males 35.5 years; females 37.0 years. In Westminster: males 35.5 years, females 36.9 years; the County of London: males 32.0 years, females 33.9 years. The density of population is given as 51.8 to the acre. This compares with 56.5 in 1921 and 73.1 in 1911. The density for the whole county is 58.7. Density is greatest in Southwark, 151.7, and least in the City of London, 16.2, with Woolwich next, 17.7. The number of private families in Westminster is 33,056. Only in one borough does the occupation of persons per room show a lower figure, Hampstead .70 per room. In Westminster it is .76; in Shoreditch 1.45. In 1921 in Westminster the figure was .81 per room. These figures, together with the remarkably low density of persons per acre, do definitely reflect the improvement in housing conditions which has been taking place during the past ten years in Westminster. Perhaps one more point may be alluded to; the population included in private families occupying more than 2 persons per room was 7,223 in 1931 or 7.1 per cent. In 1921 the corresponding population was 11,364 or 10.1 per cent. The proportion of population congregated as private families under this density standard of more than 2 per room adopted by the Registrar-General, is highest in Finsbury, 29.4 per cent., and lowest in Hampstead and Lewisham, each 4.1 per cent. Westminster is seventh among the 29 metropolitan sanitary authorities in amplitude of space for private families. A further and more detailed analysis of the Census report, which has only come to hand when this Annual Report is ready for publication, will be given next year. In 1931 the incidence of infectious disease was notably less ; the only deaths were five from diphtheria and two from cerebro-spinal meningitis. There were only two cases of smallpox of the prevalent variola minor type. This disease is still endemic in London, and although the number of patients not living but working in Westminster and their contacts is considerable—it entailed 129 visits to places of work—the residents of Westminster, owing to their well-vaccinated condition, remain free from infection. From the Vaccination Officer's report it will be seen that the average of primary vaccination among infants in Westminster is over 63 per cent. In England and Wales the average is about 40 per cent. Ten maternal deaths again form a melancholy record—the same figure as last year. Details of most are given in the report. As the births are fewer, this number is disquieting; the more so as six of the cases were under expert care before, during, and after confinement. vii In the Housing section the progress of the Grosvenor scheme is noted, while the completion of the Ebury Bridge estate by relieving 210 families from overcrowded and insanitary homes in the City is one of the greatest single and completed measures of sanitary progress accomplished in central London for the past twenty years. Other matters in this section deal with underground rooms and the repair and future use of these and other dwellings from which families have been re-housed. The Kensington proposals as to underground rooms are discussed in detail. The investigation of atmospheric pollution continues, and a full year's records are submitted. It may be remembered that the imminence of the opening of the large riverside power stations stimulated the initiation of these researches. A new departure is the estimation of the sulphur gas content of the air. Mr. Cecil Cribb, one of the Council's public analysts, undertook the necessary chemical investigations and devised a somewhat simpler method of gas absorption. His untimely death only a few days ago is to be greatly regretted. Orders under the Merchandise Marks and similar Acts continue in number and increase the work of food administration. The standard of food, especially as regards freedom from adulteration, is even better than that of previous years. There is a pronounced superiority in the quality of the milk samples taken in the South district as compared with those in the North. This is a matter which ought to be brought to the notice of the producers concerned. The opening of the new Tuberculosis Dispensary and the two new Maternity and Child Welfare Centres has made the year notable. The Day Nursery has passed to the management of a new voluntary Committee and its finances are in a much healthier state. The premises remain inadequate and unsuitable, but if general economic conditions improve it may be possible in the future to acquire premises more suitable for the purpose. The year as a whole has shown a slight slowing down of the building developments which hitherto had been increasing year by year throughout the City. Plans submitted of drainage work fell from 891 in 1930 to 748 in 1931: The work of the public health department, however, does not seem to have shrunken judging from the correspondence passing in and out of the department during the year. The figures are as follows :— Letters received 3,821 Letters sent out 7,852 viii Staff.—Mr. S. G. Bennett, third division clerk, obtained the qualifications of a sanitary inspector, which achievement the Council recognised by granting him promotion. Dr. Braxton Hicks, bacteriologist, part-time, resigned his office at Westminster Hospital, and Dr. R. J. V. Pulvertaft, his successor at the Hospital, became responsible for bacteriological work carried out at the Hospital on behalf of the City Council. Mr. W. H. Turner, part-time dental surgeon, resigned, and Mr. Stewart Tait, L.D.S., who had been acting in the former's absence, was appointed in his place. Dr. F. J. Gordon, anaesthetist at the dental clinic, was likewise appointed to succeed Dr. Scott, who resigned. Mr. Albert Wheal and Mrs. Wheal, superintendent of disinfection and female attendant at the disinfecting station respectively, retired on the 31st December, the former having reached the age limit. Mr. Wheal was a man of remarkable ability, and his experience of everything relating to the practice of disinfection was unrivalled. He had a unique facility in dealing with difficulties and his services will long be remembered with grateful appreciation. Both can look back on a long record of excellent and devoted service. On Mr. Wheal's retirement some re-arrangement of duties at the disinfecting station was initiated. It is intended that a vacancy occurring among the disinfecting staff shall be filled by one who can devote part of his time to duties under the Rats and Mice Destruction Act. Complaints of rat infestation are numerous, and it is felt that skilled advice and assistance by one who can devote a good deal of time to the problem may be welcomed by occupiers. In conclusion, let me offer my sincere thanks to the Mayor and members of the Council, in particular to the Chairmen and Vice-Chairmen and members of committees dealing with health matters for their never-failing courtesy and consideration. Likewise my gratitude is due to the staff of my department for the manner in which they have carried out their duties throughout the year. I have the honour to be, Your obedient Servant, Andrew J. Shinnie. June, 1932. 1 SUMMARY OF PARTICULARS REQUIRED BY THE MINISTRY OF HEALTH. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres)—2,502.7. Population (Census 1931)—129,535. Population, June, 1930 (Registrar General's Estimate)—123,800. —120,500 (Civilian). „ 1931 „ „ „ —119,000. ,, „ „ —115,600 (Civilian). Number of Inhabited Houses (1931)—22,536. Rateable value— £10,850,000 (March, 1932). Sum represented by a penny rate—£43,170. Revised death rate 1930—12.2 Revised birth rate 1930—11.0 Extracts from Vital, Statistics for the Year. Births— Males. Females. Total. Birth-rate. Legitimate 515 548 1,063 10.17 Illegitimate 70 78 148 Totals 585 626 1,211 Stillbirths—44.5 per 1,000 births. Deaths—1,609. Death-rate—13.9. Number of women dying in, or in consequence of, childbirth :— Puerperal fever, 4 From other causes, 6 8.2 per 1,000 births. Number of deaths of infants under one year of age per 1,000 births -75.1. Legitimate rate, 69.6 ; Illegitimate rate, 114.8. Number of deaths from measles (all ages)—Nil. „ ,, diphtheria—5. ,, ,, whooping cough (all ages)—4. „ „ scarlet fever—Nil. ,, „ diarrhoea (under 2 years of age)—16. „ ,, 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 Administrative Tuberculosis Officer : Andrew J. Shinnie M.D., D.P.H., &c. Assistant Medical Officers : Ian S. Thomson M.A., M.D., D.P.H. (Tuberculosis Officer and Asst. Medical Officer of Health.) *Ethel M. Vernon M.D., B.S. (Maternity and Child Welfare.) *A. D. C. Bell M.A., M.B., B.Ch., M.R.C.S., L.R.C.P. (Maternity and Child Welfare.) Obstetric Consultant: *Aubrey Goodwin O.B.E., M.D., F.R.C.S. Westminster Hospital Laboratories. R. J. V. Pulvertaft, M.B., B.Ch. Bacteriologist to the Hospital. (Cantab.), M.R.C.P., &c. § Public Vaccinators : Mayfair District Kenneth R. Hay, M.B., O.B.E., 47, Hill St., Berkeley Square, W.l. Belgrave and Knightsbridge District *Henry W. Doll, M.R.C.S., L.R.C.P., 42, Montpelier Square, S.W.7. Westminster (St. Margaret and St. *Albert E. Cope, M.D., 66, Belgrave Road, John) District. S.W.1. Westminster (St. Anne and St. James) District Strand District *Percy J. Edmunds, M.B., B.Sc., 5, Great Marlborough Street, W.l. Dental Clinic : ♦T. Stewart Tait (Appd. 26.3.31, L.D.S., R.C.S., Edin. Acting since 23.1.30.) ♦F. J. Gordon (Anaesthetist) ...' M.R.C.S., L.R.C.P. Public Analysts : ♦Cecil H. Cribb B.Sn., F.I.C. ♦P. A. Ellis Richards F.I.C. 3 § Vaccination Officer: James 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 Wise (Chief Clerk). A. J. Manhood. S. G. Bennett, S.I.E.B. F. W. Lake. F. E. Norwood. W. 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.E.B., Meat and Food Cert. C. J. Dee S.I.E.B., R.S.I., Meat and Food Cert. W. L. French S.I.E.B., R.S.I., Meat and Food Cert. F. J. Haigh S.I.E.B. H. R. Hardy R.S.I., M.I. San. Eng. T. H. Jackson ' S.I.E.B. C. Ratcliff S.I.E.B., Meat and Food Cert. F. E. Siddle S.I.E.B., Meat Cert., R.S.I. W. G. J. Sutton (Sampling Officer) S.I.E.B., Meat and Food Cert. H. E. White S.I.E.B., R.S.I., Meat and Food Cert. Dipl. Inst, of Hygiene. Miss C. Hughesdon S.I.E.B., R.S.I., Health Visitor's Certificate, Certificated Midwife, Dipl. Nat. Health Soc. Health Visitors : Miss A. Sanders Health Visitor's Certificate. Miss J. G. AlexanderHealth 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 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 medal. *Mrs. Steffens (until November, 1931). Other Staff : A. Wheal, Superintendent of Disinfection (retired 31/12/31). R. Watlino, 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 (retired 31/12/31). Mrs. A. W. Nicholls, Caretaker, 15, Bessborough Street. 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 Certificate, 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 Health Visitor's Certificates, and nursing experience.) Mrs. Steffens (Mothercraft Classes). Meteorological. It has been usual for some years past to add a note as to climatic conditions throughout the year, for these sometimes have an influence on health generally and vital statistics. Deficiency in sunshine was a marked feature and what is more important, sunshine was lacking in the period when it is most expected, April to September, inclusive. This may well have been a factor of importance in increasing the general death rate, infantile mortality rate and the death rate from pulmonary 5 tuberculosis. Lack of sunshine deprives the body of building up resisting powers to respiratory and other catarrhal affections which abound in the winter months. Although rainfall for the year was below average, the six months mentioned showed a rainfall above normal. The holiday months of July, August and September were colder than average. It can well be understood, then, that 1931 deserves to be called a depressing and gloomy year. Population. The population of Westminster, as enumerated by the Census taken on the 26th April, 1931, was 129,535 (56,535 males and 73,000 females). This shows a decrease of 12,043 (8.5 per cent.) on the population of 1921. Males were decreased by 4,845 and females by 7,198. These figures are provisional, as are the figures of the population of wards in Table XXa. Births. The births registered in Westminster during 1931 numbered 1,640, but of these the homes of 921 were in other districts and 21 were registered under the Legitimacy Act, and have therefore to be deducted from the total. There were, however, 513 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,211, which is 157 less than the similar figure for 1930. The Birth Kate of 10.17 is the lowest ever recorded in the City of Westminster. 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 within easy reach of the hospital, although in some neighbouring borough—was only 98. This figure has risen to 921 in 1931, and includes not only women from the various metropolitan boroughs but also from the counties around London. It will be observed from Table I that the total registered births are also less than last year. The comparative net totals are:— 1929. Legitimate. 1930. Legitimate. 1931. Legitimate. Males 606 603 515 Females 584 599 548 Illegitimate Illegitimate. Illegitimate. Males 82 93 70 Females 85 73 78 1,357 1,368 1,211 6 Table I. Births Registered. Births Notified. In Westminster, Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillhorn. 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 1,535 500 571 1,606 1,402 1,355 47 1927 1,376 552 (20) 576 1,399 1,205 1,169 36 1928 1,471 643 (23) 542 1,370 1,404 1,362 42 1929 1,577 758 (7) 538 1,357 1,532 1,474 58 1930 1,689 859 (16) 538 1,368 1,653 1,597 56 1931 1,640 942 (21) 513 1,211 1,589 1,536 53 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 795 — 473 + 193 = 515 Females 763 - 411 + 196 = 548 1,558 - 884 + 389 = 1,063 Illegitimate. Males 46 — 32 + 56 - 70 Females 36 — 26 + 68 = 78 82 — 58 -f 124 = 148 The legitimate births show a decrease of 139 and the illegitimate a decrease of 18 on the figures of 1930. As shown in Table I, 1,589 notifications of births were received by the Department for 1931 as compared with 1,653 in 1930. Of the total of notifications, 998 were sent by midwives, of whom 30 were practising in the City during 1931. 7 The following Table shows the number of male and female children born since 1915, 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. 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 1931 585 626 50 41 535 585 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. 1931 934 boys. 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, 1931. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. 821 48 7 5 12 27 37 49 103 179 211 143 F. 752 41 8 7 4 32 37 38 77 118 185 205 1. Typhoid and paratyphoid fever M. 2 — — — — 1 — — — 1 — — F. — — — — — — — — — — — — 2. Measles M — — — — — — — — — — — — F. — — — — — — — — — — — — 3. Scarlet fever M. — — — — — — — — — — — — F. — — — — — — — — — — — — 4. Whooping-cough M. 2 — 1 1 — — — — — — — — F. 3 1 — 2 — — — — — — — — 5. Diphtheria M. 2 — 1 — 1 — — — — — — — F. 3 — — — 1 1 1 — — — — — 6. Influenza M. 14 — — — — 1 — 1 1 6 4 1 F. 28 — 1 — — 3 1 2 2 4 6 9 7. Encephalitis lethargica M. 1 — — — — — — — 1 — — — F. 1 — — — — 1 — — — — — — 8. Cerebro-spinal fever M. 2 1 — — — — 1 — — — — — F. 1 — — — — — 1 — — — — — 9. Tuberculosis of respiratory system M. 68 — — — 1 6 12 15 18 8 6 2 F. 37 — — — — 10 11 7 6 2 — 1 10. Other tuberculous diseases M. 7 — — — 1 3 1 — 1 1 — F. 8 — — 1 — 4 2 — — 1 — — 11. Syphilis M 5 1 — — — — — — — 1 1 — F. 2 1 — — — 1 — — — — — — 12. General paralysis of the insane, tabes dorsalis M. 5 — — — — 1 — — 1 — 2 1 F. 1 — — — — — — — — 1 — — 13. Cancer, malignant disease M. 113 1 — — — — 2 4 20 33 41 12 F. 101 — — — — — — 8 16 29 30 18 14. Diabetes M. 6 — — — — — 1 — 1 3 — 1 F. 16 — — — 1 1 — — 3 5 5 1 15. Cerebral hæmorrhage, eto. M. 30 — — — — — — — 3 9 15 3 F. 29 — — — — — — 1 3 4 10 11 16. Heart disease M. 196 — — — — 2 1 3 21 42 62 65 F. 176 — — 2 — 2 1 4 13 27 58 69 17. Aneurysm M. 5 — — — — — — — 1 2 2 — F. 2 — — — — — — — 1 — — 1 9 Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35- 45- 55— 65— 75— 18. Other circulatory diseases M. 24 — — — — — — 2 2 9 5 6 F. 25 — — — — — — — — 5 5 15 19. Bronchitis M. 38 3 — — — 1 — 1 3 6 14 10 F. 45 2 1 — — — 1 1 2 3 10 25 20. Pneumonia (all forms) M 72 12 2 2 1 3 4 3 4 18 14 9 F. 61 8 2 — 1 2 5 4 3 8 14 14 21. Other respiratory diseases M. 12 — — — 1 — 1 1 2 4 2 1 F. 7 1 1 — — — 1 — 1 — 2 1 22. Peptic ulcer M. 5 — — — — — 1 2 1 — — 1 F. 3 — — — — — — — — — 3 — 23. Diarrhoea, etc M. 10 9 1 — — — — — — — — — F. 9 6 — — — — — — — — 2 1 24. Appendicitis M 4 — — — — 1 — — 2 1 — — F. 5 — — — — 1 1 — 1 1 1 — 25. Cirrhosis of liver M. 10 — — — — — — — 1 5 4 — F. 4 — — — — — — 1 1 2 — — 26. Other diseases of liver, etc. M. 4 — — — — — — — 1 — 2 1 F. 3 — — — — — — — — — 2 1 27. Other digestive diseases M. 14 — — — — 1 1 2 4 3 3 — F. 25 1 — — — 2 — 1 4 5 5 7 28. Acute and chronic nephritis M 25 — — — 1 — 1 2 1 5 7 8 F. 19 — — — 1 — — — 6 4 7 1 29. Puerperal sepsis F. 4 — — — — 1 1 2 — — — — 30. Other puerperal causes F. 1 — — — — — 1 — — — — — 31. Congenital debility, premature birth, malformations, etc. M. 18 17 1 — — — — — — — — — F. 17 17 — — — — — — — — — — 32. Senility M. 7 — — — — — — — — 1 1 5 F. 14 — — — — — — — — — — 14 33. Suicide M. 13 — — — — 1 3 2 2 3 2 — F. 11 — — — — — 2 2 3 2 2 — 34. Other violence M. 43 2 1 — 2 3 6 4 4 10 5 6 F. 39 2 — 1 — 1 3 1 6 3 13 9 35. Other defined diseases M. 64 2 — 2 4 3 2 7 6 8 19 11 F. 52 2 3 1 — 2 5 4 6 12 10 7 36. Causes ill-defined, or unknown M. — — — — — — — — — — — — F. — — — — — — — — — — — — (6862) B 10 Still-births.—53 still-born children were notified during the yeai, 34 of this number being born to non-residents of Westminster. The corresponding figure for 1930 was 33. Under the Births and Deaths Registration Act, 1926, which came into force on 1st July, 1927, all stillbirths must be registered. Still-births Registered. Inward Transfers. Outward Transfers. Total Legitimate and Illegitimate Males Females 40 18 25 24 8 11 Illegitimate Males 3 6 1 Females — 1 — A statement showing the number of cases of certain infectious diseases in the above-named area during the 52 weeks ended 2nd January, 1932:— Westminster, City of, Met. B. Number of Cases of Infectious Diseases Notified (Civilians). Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. 2 176 156 10 15 4 44 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Smallpox, 0.14 ; scarlet fever, 2.05 ; diphtheria, 1.27; enteric fever, 0.06; puerperal pyrexia, 0.14; puerperal fever, 0.06 ; and erysipelas, 0.38.) The preceding unnumbered death table and the figures in respect of registered still-births are those supplied by the Registrar General and inserted at the request of the Ministry of Health. Neither the statistics relating to deaths, nor 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. 43 cases of Diphtheria and Scarlet Fever were discharged from hospital owing to incorrect diagnosis during 1931. 11 MALES Table IV.—Causa of, and Ages at, Death during the year 1931. Causes op Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 13 — — — — 1 — 7 5 1 3 1 i 4 1 1 — — 1 — — — — — Whooping-cough 2 — 1 1 — — — — — — — — — 2 — — — — — — — — — — Diphtheria, Memb. croup 2 — — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal meningitis 1 1 — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 2 — — — — 1 — 1 — — — — — 1 — — 1 — — — — — — — Diarrhoea, enteritis 12 8 1 — — — — 1 2 — — — 1 6 — 3 — — — — — 1 — 1 Erysipelas 2 — — — — — — — — — — — — — — — — — — — — — — — Other septic diseases 11 — — — — — 4 4 3 — 1 — 1 3 1 2 2 — — — — 1 — — Syphilis, Ac. 5 1 — — — — — — — — — — — — — — — — — — — 1 — — Diabetes 5 — — — — — 1 2 2 — — — i 2 — 1 — — — — — 1 — — Rheumatic fever 3 — — — 1 1 — — 1 — — — — 1 — 2 — — — — — — — — Tuberculosis of lungs 70 — — — 1 6 27 28 8 — 3 — 3 20 — 25 5 1 — 4 1 2 4 2 Other forms of tuberculosis 6 — — — 1 3 1 1 — — — — 2 — — 2 — — — 1 — — 1 — Malignant growths 113 1 — — 1 1 6 50 54 — 8 2 16 27 8 24 5 2 3 5 3 3 3 4 Congenital debility, malformation, and premature birth 18 18 — — — — — — — — — — 1 10 — 3 2 — — — — 1 — 1 Old age 5 — — — — — — 1 4 1 — — — — 2 — — — — — — — 2 Meningitis and convulsions 3 — 1 — — — 1 — 1 — — — — 1 — 14 — — — — 1 — — — (6862) B 2 12 MALES—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. 46 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 3 — — — — 1 — 1 1 — 1 — — — — 2 — — — — — — — — Other diseases of nervous system 8 — — — — — 3 3 2 — 3 — — 2 1 1 — — — 1 — — — — Valvular diseases of heart 19 — 1 — — — 1 7 10 — 1 1 1 7 1 4 3 — — — — 1 — — Other circulatory diseases 187 — — 1 1 — 9 69 107 2 17 6 11 46 9 47 9 4 5 4 6 10 8 3 Bronchitis 101 3 — — — 1 2 25 70 — 3 ?, 6 — 3 42 3 1 1 2 8 4 5 — Broncho-pneumonia 48 12 3 2 — 1 1 15 14 — 1 1 1 15 — 15 1 — 4 2 2 3 2 1 Pneumonia, other forms 34 — — — 1 2 7 11 13 1 3 1 4 5 2 9 ?, 1 1 1 1 2 — 1 Other respiratory diseases 5 — — — — 1 1 1 2 — — 1 — — — 3 — — — — — 1 — — Alcoholism 5 — — — — — 1 4 — — — — — — — — — — — — — — — — Cirrhosis of liver 11 — — — — — — 5 6 — — 1 1 6 — 1 — — 2 — — — — — Appendicitis and typhlitis 6 — — — — 2 — 4 — — 2 1 — 1 — 1 — — — — — 1 — — Other digestive diseases 18 1 — — — — 5 6 6 1 2 — — 8 — 2 1 — — — — 2 1 1 Bright's disease, &c. 44 — — — 1 — 3 14 26 — 4 — 6 11 — 10 1 1 1 1 1 3 3 2 Cystitis, &c. 11 — — — — 1 — — 10 — 1 1 1 1 1 2 — — 1 2 — — 1 Deaths by accident or negligence 41 3 1 — 2 3 9 10 13 2 1 — 2 10 — 10 2 1 3 — 2 3 — 5 Deaths by suicide and murder 15 — — — — 1 5 6 3 — 3 1 1 5 1 — 1 — 1 — — 2 — — Other defined diseases 14 2 — — 1 2 1 1 7 — — — — — — — — — — — — — 1 1 Diseases, ill defined or — — — — — — — — — — — — — — — — — — — — — — — — All causes 843 50 9 5 11 28 88 282 370 7 64 19 60 234 28 219 38 11 23 23 22 42 28 25 13 FEMALES. Table IV.—Causes of, and Ages at, Death, during the year 1931. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. "i 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. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 24 — — — — 3 3 6 12 — 2 2 2 11 — 5 — — — 2 — — — — Whooping-cough 2 1 1 — — — — — — — — — — — — — — — — — — — — — Diphtheria, Memb. croup 3 — — — 1 1 1 — — — — — — — — — — — — 1 — — — — Cerebro-spinal meningitis 1 — — — — — — — — — — — — — — — — — — — — 1 — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarahœa, enteritis 10 6 1 — — — — 1 2 — 2 — 1 3 — 3 1 — — — — — — — Erysipelas 2 — — — — — 1 1 — — — — — — — — — — — 1 — — — — Puerperal fever 4 — — — — 1 3 — — — — — — — — — — — — — — — — — Other septic diseases 10 — — 1 — 1 1 2 5 — — 1 1 5 — 1 — — — — — 2 — — Syphilis, &c 2 1 — — — — — — — — — — — — — — — — — — — — — — Diabetes 15 — — — 1 1 — 7 6 — 2 1 — 3 2 4 1 1 — — — 1 — —- Rheumatic fever — — — — — 1 — 1 — 1 — — — — 1 — — — — — — — — Tuberculosis of lungs 35 — — — — 9 16 8 2 — 1 — 5 13 2 9 2 — 1 2 — — — — Other forms of tuberculosis 10 — — 1 — 6 2 1 — — 2 1 — 2 1 2 — — 1 — 1 — — Malignant growths 107 — — — — 1 7 49 50 1 5 2 14 35 11 18 3 3 2 3 2 4 1 3 Congenital debility, malformation, and premature birth 17 17 — — — — — — — — 2 — — 8 — 3 4 — — — — — — — Old ago 15 — — — — — — — 15 1 2 — 1 8 — 3 — — — — — — — — Meningitis and convulsions 3 1 1 — 1 — — — — — — — — — — — — — — — — — — — 14 FEMALES—Table IV {continued). Causes or Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Loc. ataxia and general paralysis 1 — — — — — — 1 — — — — — — — 1 — — — — — — — — Other diseases of nervous system 7 — 1 — — 1 1 1 3 1 — — — 1 1 4 — — — — — — — — Valvular diseases of heart 14 — — — — — 2 6 6 — 2 — — 6 1 4 — — — — — 1 — — Other circulatory diseases 167 — — 1 — — 6 41 119 2 7 6 18 55 14 39 4 3 — 9 2 6 — 2 Bronchitis 91 2 — — — 1 3 12 73 — 3 — 8 40 2 30 1 3 — 2 — 2 — — Broncho-pneumonia 49 7 2 1 1 — I 12 25 1 6 3 3 12 3 14 2 — — 3 — 2 — — Pneumonia, other forms 31 2 1 — — 2 8 7 11 1 4 1 5 8 1 8 1 — — — 1 — — 1 Other respiratory diseases 3 1 1 — — — — 1 — — 1 — — 2 — — — — — — — — — — Alcoholism 3 — — — — — 1 2 — — — — — 2 — 1 — — — — — — — — Cirrhosis of liver 3 — — — — — 1 1 1 — 2 1 — — — — — — — — — — — — Appendicitis and typhlitis 5 — — — — 1 1 2 1 — 1 1 — 1 — 1 — — 1 — — — — — Other digestive diseases 25 1 — — — — 2 9 13 1 1 1 2 11 3 2 — — — 1 — 2 — 1 Bright's disease, &c. 30 — — — 1 — 1 11 17 — 3 2 4 1 5 7 4 — — 3 — 1 — — Cystitis, &c. 5 — — — — — 1 3 1 — 1 1 1 1 — 1 — — — — — — — — Accidents and diseases of parturition 6 — — — — 1 5 — — — 1 — — 4 — — — — — — 1 — — — Deaths by accident or negligence 41 2 — 1 1 1 4 8 24 1 2 — 2 13 1 14 1 1 1 — 1 1 3 Deaths by suicide and murder 10 — — — — — 4 4 2 — 1 1 — 5 1 2 — — — — — — — — Other defined diseases 13 — 1 1 — — 1 3 7 — 1 — — 5 1 5 — — 1 — — — — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 766 41 9 6 6 31 78 199 396 9 58 24 67 259 50 187 25 11 6 28 6 24 2 10 15 1,740 deaths were registered in the City during 1931. After deducting 1,006 deaths of non-citizens in public institutions, etc., in the City, and adding those of 875 citizens who died in other districts, the corrected total is 1,609, as compared with 1,478 in 1930, and is equivalent to an annual rate of 13.9 per 1,000 persons (civilian population), compared with 12'2 last year. The London death-rate for 1931 was 12.4 (civilians only), for England and Wales, 12.3. These rates are higher than in 1930 for Westminster and the country as a whole. Among Westminster residents 547 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 1917 to 1931.) Year. Number of Deaths. Westminster Rate. London Rate. 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 10.6 112 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 *12.2 11.4 1931 1,609 13.9 12.4 * Corrected rate. The deaths of males were 843, females 766. Table VI. This table shows the total deaths distributed among age periods :— 1931. 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. 50 9 5 11 28 88 282 370 843 F. 41 9 6 6 31 78 199 396 766 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 1931 91 18 11 17 59 166 481 766 1,609 16 The causes of death are set out in Table IV. There was an increase among males of deaths from the following causes :—Influenza, enteritis, septic diseases, pulm. tuberculosis, cancer, accidents, cirrhosis, bronchitis and other respiratory diseases, the increase in the last-named diseases being especially marked. Among females the causes showing an increase were influenza, enteritis, septic diseases, diabetes, non-pulm. tuberculosis, bronchitis and other diseases of the respiratory system. 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. — 1927. 1928. 1929. 1930. 1931. m. f. Total. m. f. Total. m. f. Total. m. f. Total m. f. Total. Conduit 4 — 4 4 4 8 4 3 7 8 3 11 7 9 16 Grosvenor 58 67 125 59 78 137 88 63 151 70 61 131 64 58 122 Hamlet 25 30 55 16 22 38 18 30 48 20 26 46 19 24 43 K. St. George 74 74 148 54 57 111 66 80 146 62 E6 118 60 67 127 Viotoria 245 286 531 231 226 457 249 292 541 222 212 434 234 259 493 St. Margaret 42 42 SI 29 32 61 51 44 95 30 34 64 28 49 77 St. John 217 138 355 173 163 336 298 207 505 186 179 365 219 187 406 St. Anne 44 33 77 26 23 49 42 28 70 38 18 56 38 25 63 Gt. Marlborough 18 15 33 20 17 37 14 15 29 8 8 16 11 11 22 Pall Mall 21 9 30 31 7 38 35 6 41 20 7 27 23 6 29 Regent 35 20 55 25 12 37 26 24 50 24 24 48 23 28 51 Charing Cross 15 7 22 12 8 20 24 7 31 12 11 23 22 6 28 Covent Garden 29 35 64 35 29 64 39 41 80 26 28 54 42 24 66 Strand 52 5 57 46 10 56 36 5 41 39 3 42 28 2 30 Homeless 29 13 42 26 22 48 22 18 10 28 15 43 25 11 36 Infantile Mortality.—The corrected death-rate of infants for Westminster was 75-1 per 1,000 births. The mortality among legitimate infants was 69-6 per 1,000; that of illegitimate 114-8. The infant mortality rate for London was 65. The number of infants dying under 1 year was 91, an increase of 10 on the figure of last year and as the total number of births shows a decrease of 157, the infantile mortality rate shows an increase of 15-9 on the figures of 1930. The chief contributory causes of death were bronchopneumonia, prematurity and gastro-enteritis. Twenty-four of the 27 premature deaths occurred before the fourth week of life. Stomach and bowel complaints accounted for 16 deaths, 13 of the infants being under six 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 1931. 1st Quarter 28 40 21 29 2nd „ 18 29 19 22 3rd „ 17 18 21 16 4th „ 18 18 19 24 81 105 80 91 Table IX shows the births and deaths of infants, legitimate and illegitimate, since 1904 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table IX. Year. Legitimate. Illegitimate. Total Bate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 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 2,764 209 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 1926 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 1931 1,063 74 69.6 148 17 114.8 75.1 65 Table X shows the causes of death of children who died under one year of age. Figures under the same grouped causes are given from 1924 18 onwards, showing the proportion per 1,000 births applicable under each heading:— Table X. — 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 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 1.9 4.5 0.62 1.4 2.1 81 0.73 0.82 Septio diseases 1.2 — 0.62 0.71 — — — — Bronchitis and pneumonia 10.4 16.2 9.9 6.4 13.8 14.7 14.6 22.3 Stomach and bowel complaints 1.9 5.2 8.0 121 10.9 7.3 5.8 13.2 Syphilis 1.2 1.3 — 2.8 0.72 0.73 21 1.6 Congenital malformations 4.9 3.2 434 7.8 5.1 4.4 4.3 6.6 Prematurity 141 16.9 19.3 20.0 9.4 198 18.2 22.3 Neglect and injury at birth 31 0.65 3.72 4.2 4.3 1.4 1.4 2.4 Debility from birth and atrophy, riok. ets, atelectasis 5.3 7.1 3.72 4.2 3.6 2.2 2.7 3.3 Tuberculosis 1.8 1.9 1.86 2.1 2.1 2' 2 1.4 — Murder 1.4 — Accidents — — — — — — — 1.6 Cancer — — — — — — — 0.82 Cerebro.spinal Meningitis — — — — — — — 0.82 Other oauses 6.7 10.4 4.34 4.2 21 13.2 1.4 1.6 59.0 69.0 59.7 68.6 58.39 77.37 59.21 75.1 Table XI shows nett deaths from various causes at several age period during the first year of life in the City of Westminster:— Table XI.—Infant Mortality, 1931. CAUSHS OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weekc. 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. 1 Total Deaths i under 1 Tsar. Whooping Cough — — — — — — — 1 — 1 Meningitis 1 — — — 1 — — — — 1 Bronchitis and Pneumonia (all forms) — — — — — 8 6 7 6 27 Congenital malformations, etc 5 1 6 1 1 — — 8 Premature birth 19 — 2 3 24 3 — — — 27 Other causes — — — — — 1 — — 1 2 Syphilis — — — — 1 1 — — 2 Accidents and negligence 3 — — — 3 1 — — 1 5 Cancer 1 — 1 Cerebro.spinal Meningitis — — — — — — 1 — — 1 Stomach and bowel — — — — — 4 9 2 1 16 28 1 2 3 34 19 18 11 9 91 19 Table XII. Nett Births in the year :— Males. Females. Total. Legitimate 515 548 1,063 Illegitimate 70 78 148 585 626 1,211 Nett Deaths in the year of :— Males. Females. Total. Legitimate infants 40 34 74 Illegitimate infants 10 7 17 50 41 91 The causes of death of the Illegitimate were:—Neglect at birth 3, prematurity 6, pneumonia 1, syphilis 1, debility 2, digestive disease 3, and otitis media 1. Table XIII. Infant Mortality, 1931.—Nett Deaths from stated causes at various ages under One Year of Age in Pimlico A rea ( Victoria, Knightsbridgt St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 .vie ntlis and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Death, under One Year. Otitis Media — — — — — 1 — — 1 2 Bronchitis and Pneumonia (ail forms) .. — — — — — 4 — 3 1 8 G-astro-enteritis — — — — — 2 5 1 2 10 Accidents and negligence _ — — 1 1 Congenital malformations 2 — — — 2 — — — — 2 Premature birth 11 — 1 — 12 3 — — 15 Malnutrition,marasmus and debility from birtli 1 1 — — 2 — — — — 2 Cerebro-spinal Meningitis 1 — — 1 — — — — 1 Syphilis — — — — — 1 1 Whooping Cough — — — — — — — 1 — 1 Totals 15 1 1 — 17 12 5 5 4 43 Table XIV. Nett Deaths in the above area during the year :— Males. Females. Total Legitimate 19 15 34 Illegitimate 7 2 9 20 Table XV. Infant Mortality, 1931.—Nett Deaths from stated causet 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. 1 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 l Year. Syphilis — — — — — 1 1 Bronchitis and Pneumonia (all forms) .. — — — — — 2 4 3 4 13 Gastro-enteritis — — — — — 1 2 1 — 4 Cancer 1 — 1 Premature birth 3 — I 2 6 — — — — 6 Meningitis — — — — — — 1 — — 1 Accidents and — — — — — — — — gence .. — — — — — — — — 1 1 Totals 3 1 2 6 3 7 6 5 27 Table XVI. Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 15 11 26 Illegitimate infants — 1 1 Table XVII. Infant Mortality, 1931. Nett Deaths from stated causes at various ages under One Year of Age in the North District (Grosvenor Conduit, St. Anne, Pall Mall, Urgent, Gt. Marlborough, Strand, Charing Cross and Covent Garden Wards). causes OF death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Mouths. Total Deaths under 1 Year Bronchitis and Pneumonia (all forms) — — — — — 2 2 1 1 6 Gastro-enteritis — — — — — 1 1 — — 2 Congenital malformations i 1 1 2 Premature birth 5 — — i 6 — — — — 6 Malnutrition, inanition and debility from birth 1 — — — 1 — — — — 1 Totals 7 — — 1 8 3 4 1 1 17 21 Table XVIII. Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 6 8 14 Illegitimate infants 1 2 3 Table XIX. Deaths of infants with no known address, or found in streets, parks, dec.:— CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. I 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 Your. Debility — — — — 1 — — — 1 Want of attention 3 — — — 3 — — — — 3 3 3 1 4 Table XX. Deaths of children unknown :— Males. Females. Total. Legitimate — — — Illegitimate 2 2 4 Table XXa. The following table shows the allocation of the nett births and infant deaths among the various Wards in the City, together with the infantile mortality rate for the Ward. Wards. Population, 1931 Census. Total Births, 1931. Legitimate. Illegitimate. Total Infant Deaths, 1931. Legitimate. Illegitimate. 1931—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total. Conduit 2,086 2 2 — — — Grosvenor 13,318 78 65 13 2 — 2 — 153.8 25.6 Pall Mall 2,872 10 9 1 — — — — — — Regent 4,047 16 16 — 2 2 — 125.0 — 125.0 Gt.Marlborough 3,331 20 18 2 — — — — — — St. Anne 5,405 48 45 3 8 7 1 155.5 333.3 160.6 Covent Garden 6,655 54 50 4 4 4 — 80.0 — 74.0 Charing Cross 3,210 10 8 2 1 1 — 125.0 — 100.0 Strand 2,052 4 — 4 — — — — — — Victoria 36,955 492 424 68 41 32 9 75.4 132.3 83.3 K. St. George. 11,445 85 78 7 2 2 — 26.6 — 23.5 Hamlet 6,461 11 8 3 — — — — — — St. Margaret 8,071 30 25 5 — — — — -— — St. John 23,071 350 317 33 27 26 1 82.0 30.3 77.1 Homeless — 1 — 1 4 — 4 — — — Total 129,579 1,211 1,063 148 91 74 17 69.6 114.8 75.1 22 The following table is inserted by courtesy of the Medical Officer of Health, Poplar, who collected the data. Vital Statistics, 1931. — Population. Birthrate. Deathrate. Infantile Mortality per 1,000 Births. West Districts— l'addington 140,300 14.79 13.05 87 Kensington 174,800 14.2 14.0 76 Hammersmith 135,100 15.3 1 12.2 68 Fulham 151,200 15.08 12.3 67 Chelsea 57,220 12.8 14.1 42 City of Westminster 115,600 10.17 13.9 75.1 North Districts— St. Marylebone 97,620 11.4 12.4 65 Hampstead 87,740 11.2 11.7 60 St. Paneras 196,600 15.1 13.3 68 Islington 324,600 16.3 12.6 64 Stoke Newington 51,380 15.2 12.7 53.9 Hackney 217,000 15.5 11.4 60 Central Districts— Holborn 34,470 10.21 14.27 74 Fingbury 70,120 18.0 14.02 62 City of London 10,808 5.6 12.5 81 East Districts— Shoreditch 98,260 17.1 12.5 74.2 Bethnal Green 109,200 16.8 12.5 87.7 Stepney 225,800 17.5 13.1 78 Poplar 156,300 17.5 12.4 77 South Districts— Southwark 172,900 16.9 14.0 61 Bermondsey 112,400 17.4 12.5 57 Lambeth 295,900 15.28 12.66 60.35 Battersea 159,800 15.5 12.1 57.3 Wandsworth 353,200 12.27 11.30 59 Camberwell 252,100 14.7 11.9 56 Deptford 107,200 16.3 12.0 53 Greenwich 100,640 14.96 11.41 64 Lewisham 220,800 14.1 10.2 49 Woolwich 142,600 15.1 11.6 59 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; 100 deaths of persons giving addresses in common lodging houses occurred in 1931. They were mostly in institutions:— 23 Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 23 33, Great Peter Street (licensed for 80 men) 5 7, St. Ann's Street (Salvation Army) (licensed for 565 men) 23 16, Strutton Ground (licensed for 201 men) 26 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 15 Church Army Home, Greencoat Place (131 women) 8 100 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 1927-1931. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1927 1928 * 1929 1930 1931 Smallpox 2 2 3 2 Diphtheria 185 233 170 256 140 Erysipelas 37 47 54 37 46 Scarlet fever 180 241 227 265 196 Enteric fever 24 28 7 18 7 Continued fever — — 1 — — Puerperal fever 6 6 10 6 4 Puerperal pyrexia 26 21 12 16 15 Cerebro-spinal meningitis 1 1 2 — 8 Encephalitis lethargica 1 1 — 3 1 Poliomyelitis 1 — 1 3 — Ophthalmia neonatorum 14 7 11 16 1 Measles 71 997 381 551 74 German measles 12 21 179 15 23 Pneumonia 64 26 51 25 49 Malaria 1 2 — — 1 Dysentery — 8 7 — 1 Anthrax — — — — — Chicksnpox 206 210 229 173 204 Mumps 153 150 73 166 80 Whooping-cough 128 76 246 14 83 Membranous croup — — — — 1 24 Smallpox.—Two cases of smallpox occurred during the year. These cases were of the mild type, prevalent in other districts of London for some years past. Cases of this disease in a household are generally far-reaching in their effects, both from a pecuniary and social point of view. In some instances an unfortunate contact is excluded from work without pay, or dismissed. From a business aspect, we can understand the position of the employer, and from a purely public health point of view, it is debatable as to whether it is the safer plan to exclude a contact or allow him to continue at work during the incubation period. The mildness of this type of smallpox is lulling the public into a sense of false security by obscuring the character of the severe or major smallpox which has been fortunately absent from this country for some years. Should it reappear it may bring unfortunate results for the unvaccinated. Smallpox Arrangements.—The L.C.C. made arrangements by which cases of suspected smallpox could be admitted to South Wharf Hospital. Such cases have first to be seen by the practitioner attending the case, the Medical Officer of Health and one of the consultant experts of the L.C.C. In the event of a definite diagnosis not being arrived at, patients would then be admitted as observation cases at the request of the M.O.H. concerned. Vaccination.—The Vaccination Officer states that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 563 Secondary 29 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. The report of the Vaccination Officer is given below in the form of tables prescribed by the Ministry of Health in the Vaccination Order. 25 Vaccination Return for the Year ended 31st December, 1930. Number of Births returned in the " Birth List Sheets " as regis, tered from 1st January to 31st December, 1930. Number of these Births duly entered by 31st January, 1932, in Columns 1, 11, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1932, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1932, 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 1931. 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 1931. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Un vaccinated. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to Places1 unknown,or which cannot be reached; and Cases not having been found. Insus1 ceptible of Vaccination. Had Smallpox. 2 3 4 5 6 7 8 9 10 11 12 13 1,683 1,072 9 322 81 6 112 81 — 1,253 302 (6862) 26 Summary of Monthly Returns for the Year ended 31st December, 1931. No. of Cases in Birth Lists received. No. of Certificates of Vaccination 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. 1,599 1,253 66 302 9 48 48 254 27 Statement of Vaccinations carried out by the Public Vaccinators during the year ended 31ST december, 1931. Name of Public Vaccinator and District. No. of Successful Primary Vaccinations. No. of Successful Re-vaccinations. Dr. K. R. Hay (Mayfair) 14 1 Dr. H. W. Doll (Belgrave and Knightsbridge) 253 7 Dr. A. E. Cope (Westminster, St. Margaret and St. John) 210 19 Dr. P. J. Edmunds (St. James and St. Anne) 58 1 Dr. P. J. Edmunds (Strand) 28 1 563 29 (6802) c 2 28 Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1931. Notifiable Diseases. At all Ages. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. 1 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. ! 45-65. 65 and over. Smallpox 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 132 4 7 4 13 11 34 17 14 24 3 1 — 131 1 5 — 1 — — — 1 1 1 1 — — — Erysipelas 46 1 — — — — 1 1 — 13 5 22 3 39 7 4 — — 1 — — — — — — 1 1 1 Scarlet fever 179 — 8 11 19 16 61 18 12 30 3 1 — 177 2 — — — — — — — — — — — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 7 — — — — — 1 1 1 2 1 — 1 b 2 2 — — — — — — — — i — 1 — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fover (C) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 4 — — — — — — — 1 3 — — — 4 — 4 — — — — — — — — 2 2 — — Cerebro-spinal meningitis 8 1 — 1 — — 3 — 2 1 — — — 7 1 2 1 — — — — — — — 1 — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis lethargica. 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum 7 7 — — — — — — — — — — — 4 3 — — — — — — — — — — — — — Pneumonia 49 2 — — — 1 5 1 3 15 7 10 5 36 13 66 2 1 — — — — 1 — 12 7 18 24 Malaria 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal pyrexia 15 — — — — — — — — 11 4 — — 14 1 — — — — — — — — — — — — — •Chicken-pox 105 1 4 5 5 12 60 14 3 8 2 1 — 6 99 — — — — — — — — — —— — — — Membranous Croup 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 558 16 19 22 37 40 56 52 38 108 25 36 91 428 130 84 3 2 1 — — 1 2 1 18 10 21 25 Correction has been made for errors in notification or revision of diagnosis in 46 cases. Diph. 29, Scarlet lever 14, Enteric 3. Cases not notified :— Scarlet fever, 17. Diphtheria, 8. * Made notifiable March, 1930. 29 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. Itegent. Great Marlborough. Charing Cross. J Covent Garden, j Strand. St. Anne. Homeless and non residents. Smallpox — — — — — — — — 1 — — 1 _ Cholera (C). Plague (R) — — — — — — — — — Diphtheria 3 9 19 31 6 42 1 1 11 1 — 7 2 4 3 Erysipelas 3 6 15 2 10 — — — — — 2 3 3 Scarlet fever — — 14 52 15 06 1 8 3 — 8 2 10 4 Typhus fever — — — — — — — — — — — — — — — Enteric fever 1 2 — 1 — 2 — — — 1 — — Relapsing fever (R) — — — — — — Continued fever (C) — — — — — — — — — — — — — — Puerperal fever 1 2 — — 1 — — — — — — Cerebro-spinal meningitis — — 1 3 3 1 — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — Encephalitis lethargica — 1 — — — — — — — — — — — — — Ophthalmia neonatorum 2 4 — — — — — — 1 — — Pneumonia 5 6 13 1 16 — 2 — — — 3 1 2 — Malaria — 1 — — — — — — — — — — — — Dysentery 1 — — — — — — — — — — Puerperal pyrexia 1 1 8 5 — — — — — — — — — Chicken-pox — 3 3 10 3 46 — — 2 9 4 14 — 11 — Membranous Croup — — — — — — — — 1 — — — — — — Totals 3 37 50 138 30 192 2 4 26 13 4 35 10 29 10 30 Scarlet Fever.—196 cases of this disease occurred in 1931, a decrease of 69 on the figures of 1930. The Victoria and St. John Wards showed a marked decrease, the distribution in the remaining wards being normal. There were no deaths. The case rate of this disease per 1,000 of the population was 1.6 for the City, and for England and Wales 2.05. The death rate for London was 0.02 per 1,000 and that for England and Wales was 0.01. Of the total cases in Westminster 989 per cent, were removed to hospital. Diphtheria.—140 cases of this disease occurred, showing a decrease of 116 on the figures of 1930. The wards showing a marked decrease are St. John and Victoria. The largest number of cases occurred between the ages of 5.15 and 2035. There were 5 deaths (2 males and 3 females), giving a rate of 35.7 per 1,000 cases. The case rate of this disease for AVestminster was 1.1 per 1,000 living, and for England and Wales 12.7. The death rate for Westminster was 0.04, England and Wales 0.07, and for London 0-06. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1931. This treatment was continued throughout the year at the Council's Maternity and Child Welfare Centres and at the Westminster Health Society's Centre, one clinic being held at each Centre weekly. 161 new cases attended during the year, as compared with 225 in 1930 and 204 in 1929. The low incidence of Diphtheria in 1931 may, to some extent, account for the lower figure in that year. New cases attended the Centres as follows :— Westbourne Street 62 Bessborough Street 46 Marshall Street 6 Page Street 47 161 The work entailed 205 tests and re-tests, 448 protective injections and 110 attendances for reading only, a total of 763 attendances. As in previous years, it was found that a considerable proportion of patients (17 per cent.) had not been vaccinated against smallpox, although coming voluntarily for treatment against diphtheria. 31 The following Table shows the results of tests where they were performed :— Age. Positive. Negative. No Test. Total. Under 5 years 57 2 57 116 5 to 10 years 21 7 8 36 10 to 15 years 8 1 0 9 86 10 65 161 All, except negative cases, received prophylactic treatment. In some cases postponement of this occurs for unavoidable reasons, but almost every case eventually received the full course of treatment. No case failed to complete the course without good reason. No serious reactions occurred after treatment. Results of previous years have confirmed the findings elsewhere that most young children give positive results and require treatment. An increasing number of the younger children are therefore given treatment without previous testing, unless there is a history of direct contact with Diphtheria. This method may have the result that one or two children receive harmless but not very necessary treatment, but on the other hand, each child so treated is saved one injection, thus shortening the course. Re-tests were performed, as in previous years, on about 60 per cent, of the cases previously treated, and those cases which did not appear to have attained sufficient protection received, on an average, two further injections. Treatment can never be considered as complete unless a negative re-test has been obtained. Ian S. Thomson. Antitoxin, for use in cases of diphtheria, is provided free of charge for medical practitioners attending patients residing in the City. The supply is available on application at the City Hall and at the Council's Mortuary in Horseferry Road. It is apparent 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. 32 Enteric Fever.—There were 7 cases of typhoid and paratyphoid which came to the knowledge of the department during 1931. Of these 4 were notified as paratyphoid and 3 as typhoid. There was a history of fish having been consumed in 1 case, watercress 1, ice cream 1, 1 case came from abroad, and no history was obtainable in 3 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 06 and for Westminster 0'05. Measles.—The following table shows the number of cases notified by head teachers of schools, hospitals and private practitioners during the last five years :— 1927. 1928. 1929. 1930. 1931. 71 997 381 551 74 The death rate for England and Wales per 1,000 population was 0*08, for London 0-03, and for Westminster nil. 34 children were removed to hospital, 14 being between the ages of 1 and 5. No deaths occurred. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows :— 1927. 1928. 1929. 1930. 1931. Males 24 12 51 3 13 Females 37 6 48 3 24 61 18 99 6 37 The death rate in 1931 for Westminster was 0.32 per 1,000; for London 0.03, and for England and Wales 0.36. Last year the corresponding rates were 0.04 for Westminster, 0.08 for London, and 0.12 for England and Wales. Diarrhoea and Enteritis.—The total deaths were 22—12 males and 10 females—16 being under 1 year old. The infant death rate from this cause in Westminster was 13.2. 33 Table XXVI. Deaths from Diarrhoea and Enteritis. Under 1 year. Other ages. Total. 1927 16 16 1928 14 4 18 1929 7 1 8 1930 7 1 8 1931 16 6 22 60 12 72 Whooping Cough.—83 cases were notified during the year, with 4 deaths. This is an increase on the figures of 1930, when 14 cases, with 2 deaths, were recorded. 53 cases were moved to hospital, 45 being between the ages of 1 and 5. The death rate for Westminster was 0.03, for London 0.07, and for England and Wales 0.06. The deaths from whooping cough during the last five years are thus set out:— Table XXVII. Under 1 year. At other ages. Total. 1927 2 5 7 1928 3 — 3 1929 11 8 19 1930 1 1 2 1931 1 3 4 18 17 35 Cerebro-spinal Fever.—8 cases of this disease occurred with 2 deaths. Poliomyelitis.—No cases occurred. Encephalitis Lethargica.—1 case was notified. 2 deaths occurred during the year. Chicken Pox.—204 cases occurred, 31 being moved to hospital. This disease was made notifiable in March, 1930, owing to the prevalence of smallpox in the vicinity of the City. As the cases of smallpox were so few and experience over a period of 18 months failed to show that, in Westminster at any rate, there was any measure of confusion between the two diseases, notification ceased in October, 1931. Mumps.—80 cases were recorded, 15 cases being moved to hospital. Anthrax.—There were no cases in 1931. 34 Puerperal Fever.—4 cases were notified and 4 deaths occurred. All cases were removed to hospital—2 of these cases were spinsters and 1 was a widow. 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. 1927 1,399 6 1 1928 1,370 6 3 1929 1,357 10 3 1930 1,368 6 4 1931 1,211 4 4 Puerperal Pyrexia.—15 cases occurred, 14 being removed to hospitals. To the women concerned in the above 15 cases (9 were married, 1 widow, and 5 single), 13 children were born; 3 cases arose from miscarriage. Ophthalmia Neonatorum.—7 cases occurred in 1931—2 males and 5 females. 4 were admitted to hospital and 3 treated either at home or as out-patients of hospitals. In addition to these notified cases, 13 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. The following details in tabular form are required by the Ministry of Health of the cases notified in 1931:— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 7 3 4 7 — — — 35 Bacteriological Laboratory. The examination of specimens for bacteriological investigation is carried out 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 materials for swabbing, etc., are supplied by the Council. The following is the summary of bacteriological work performed :— Swabbings from throats in suspected diphtheria 477 Blood in suspected typhoid 18 Sputa for investigation of T.B. 409 Expenditure on first two was £75 Is. Id., and for the third £56 9s. 8d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1931, 212 new cases of pulmonary tuberculosis came to the knowledge of the Department, including 9 cases who had moved into the City, 19 non-notified deaths, and 1 posthumous notification. Non-pulmonary forms of tuberculosis gave 43 cases—7 of these being posthumous notifications and non-notified deaths, and 3 transfers. Table i. Tuberculosis, 1931. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. P. M. F. M. F. Under 1 _ — — — — — — — 1 — — — 2 — — — 1 5 2 — 4 4 1 1 10 1 1 4 1 — 15 2 9 1 4 1 4 4 20 20 16 4 4 6 5 3 1 25 25 31 2 4 11 13 1 2 35 32 17 2 1 15 3 1 45 21 7 2 2 19 6 55 16 2 — — 9 2 1 1 65 and upwards 6 4 1 1 8 2 — — Totals 125 87 20 23 70 35 6 10 36 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 1931 show a total increase of 8 on those of 1930. There was an increase of 5 males and 17 females among the pulmonary cases. Non-pulmonary showed a decrease of 4 males and 10 females. There was also a slight increase in the number of non-notified deaths. Out of the total cases primarily notified in 1931, 36 died, and the following table shows the period between notification and death of these cases:— Weeks. Months. 1—2 2—3 3—1 1—2 2—3 3—4 4—5 5—6 6—7 7—8 8—9 9—10 10—11 171352221—11—1 Table II. 1927 1928 1929 1930 1931 New cases notified 245 213 247 209 201 Number included in above who died during the year 31 32 41 23 36 (12.6%) (15.0%) (16.5%) (11.0%) (17.9%) Total Tuberculous Deaths 114 108 124 107 121 Death Rates per 100,000 83.5 83.2 98.8 85.0 104.6 37 Table III. Tuberculosis.—Notifications received during the period from 28th December, 1930, to 2nd January, 1932. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to 1. 1 to 5. 5 to 10. 10 to 16. 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 — 2 17 22 28 18 13 5 106 115 Females — — — 1 9 13 24 11 5 2 1 66 70 Non-pulmonary— Males 1 3 1 2 2 1 2 1 13 13 Females — — 4 — 3 4 1 — 2 — 1 16 17 Total — — 6 4 15 36 49 40 27 15 8 201 215 38 Table IV. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1931. 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 1 — 3 3 4 3 3 1 19 Females — — — — — 3 7 6 2 — 3 21 Non-pulmonary— Males — — 3 1 — 2 — 1 — — — 7 Females — 1 1 1 — 3 1 — — — 7 Total — 1 4 3 1 8 13 12 5 3 4 54 C.L.H. General. Non-pulmonary C.L.H. General, Total. Notified pulmonary 18 154 1 28 201 Not notified in Westminster — 40 — 14 54 Total 18 194 43 255 39 Table V. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions, 1931 All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St Anne. Homeless. I Received Institutional ment during 1931. Pulmonary— Males 125 — 10 8 35 3 35 2 2 3 2 2 5 13 4 1 95 Females 87 1 8 8 20 5 21 2 1 5 2 2 2 — 4 — 55 Non-pulmonary— Males 20 — 3 2 8 — 6 — — 1 — — — — — — 15 Females 23 — — 2 0 1 7 2 — 3 — — 2 — — — 15 255 1 21 20 75 9 09 6 3 12 4 4 9 13 8 1 180 40 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. 1913 203 174 89 8 474 91 86 177 651 1914 186 105 94 4 390 34 38 72 462 1915 155 95 59 8 317 46 26 72 389 1916 183 135 64 9 391 42 39 81 472 1917 209 164 51 7 431 42 34 76 507 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 1922 119 110 42 2 273 24 30 54 327 1923 111 114 42 1 268 24 32 56 324 1924 140 122 33 1 296 27 24 51 347 1925 108 92 27 1 228 23 31 54 282 1926 117 90 29 4 240 18 30 48 288 1927 103 67 24 1 195 21 29 50 245 1928 97 61 27 2 187 22 27 49 236 1929 106 105 42 6 259 14 28 42 301 1930 104 69 16 1 190 24 33 57 247 1931 108 86 17 1 212 20 23 43 255 (Military cases which were excluded during the war were again ma.de 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 25 deaths from Tuberculosis (19 males and 6 females) during 1931 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 25 non-notified deaths gave a percentage of 20.6 of the total deaths from Tuberculosis for the year. The total number of cases of Tuberculosis on the Register at the end of 1931 was 1,631 as compared with 1,607 at the end of the year 1930. 41 The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths is slightly higher this year, having risen from 21 to 25 ; the corresponding percentage proportions are 19.6 per cent. (1930) and 20.6 per cent. (1931). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner, who in the majority of cases was only called in when the patient was in an advanced stage of the disease. In 2 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 1931. The Public Health (Tuberculosis) Regulations, 1930. These Regulations came into force on 1st January, 1931. They rescind certain of the previous Tuberculosis Regulations, and deal with the responsibility for, and mode of transmission of, notification. Certain suggestions are also made regarding diagnosis and co-operation between the Local Authority and general practitioners. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on Register at beginning of year 1931 755 456 170 226 Notified for the first time daring year 113 79 17 19 Removed from the Register on account of death or removal from Westminster 868 103 535 70 187 11 245 20 765 465 176 225 Of the 204 cases removed from the Register during the year 1931, 96 were on account of death, and 106 persons suffering from Tuberculosis moved from the City, and notification was withdrawn in 2 cases. Deaths from Tuberculosis.—The total number of deaths from Tuberculosis for 1931 (all forms) was 121—Males 76, Females 45. This gives a death-rate for this disease of 1-04 per 1,000. The following table shows (6862) d 42 the number of deaths from Tuberculosis for the last 5 years, together with the death-rate. Year. Deaths. Rate per 1,000. 1927 114 •83 1928 108 •83 1929 124 •98 1930 107 •85 1931 121 1.04 The following table shows Deaths per 100,000 of civilian population since 1918. Table VIII. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Kates. Deaths. . Rates. 1918 annual 186 148 31 24 217 173 1919 134 105 21 16 155 121 1920 139 97 18 12 157 109 1921 120 84.9 15 10.6 135 95.5 1922 144 103.3 21 15 165 118.3 1923 103 73.3 16 11.3 119 84.7 1924 124 86.7 14 9.9 138 96.5 1925 115 82.3 14 10.0 129 92.4 1926 119 85.9 14 10.1 133 96.0 1927 100 73.2 14 10.2 114 83.5 1928 90 69.3 18 13.8 108 83.2 1929 113 81.8 11 8.7 124 98.8 1930 98 77.9 9 7.1 107 85.0 1931 105 90.8 16 13.8 121 104.6 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. CITY OF WESTMINSTER TUBERCULOSIS DISPENSARY. Annual Report, 1931. In December, 1931, the temporary premises in Monck Street were vacated and the Dispensary was transferred to the ground floor of a new building on the site of the original Dispensary at Ebury Bridge. The new Dispensary consists of a large and a small office, waiting room, weighing room, dressing rooms, consulting room and medical officer's room, and a room for the handicraft class, as well as suitable cloakrooms and lavatories. 43 The accommodation is ample and excellent and the rooms are arranged to promote easy and efficient management of the clinics. The fact that the Dispensary is now permanently established under the best conditions, and on the old site, should be to the benefit of the work, which was naturally affected in certain respects by the transfers in 1930 and 1931. 400 new cases were seen by the Tuberculosis Officer during 1931, as compared with 341 in 1930. 243 of these new cases were considered to be tubercular, although many were not at an active stage of the disease. The proportion of notified cases seen annually shows no great variation, and new cases are obtained from the sources named in the following table in fairly constant proportion each year:— 1929. 1930. 1931. Practitioners 169 139 152 Health Visitors 162 121 134 St. Stephen's Hospital 65 41 76 Ministry of Pensions 8 6 5 School Medical Officer 33 15 18 Hospitals 11 7 7 Referred by Friends, Charitable Organisations, etc. 13 12 8 461 341 400 The cases referred by the Ministry of Pensions are usually pensioners who have moved into Westminster from other districts. There are still a number of pensioners among the old cases who attend the Dispensary, but this branch of the work is naturally one which decreases each year. The cases classed as referred from St. Stephen's Hospital are, for the most part, cases seen by the Tuberculosis Officer in the first instance during his visits to the hospital. The value of these visits has been referred to in previous reports. Contact is established not only with the new cases mentioned, but also with many old patients who are receiving treatment in the hospital. Suitable cases are selected by the Tuberculosis Officer in consultation with the medical officers of the hospital and recommendation for Sanatorium treatment is made. The willing co-operation of the Medical Superintendent and other officers of the hospital has been of great value in the working of the Council's Tuberculosis Scheme. (6862) D 2 44 The following table gives certain details of the work of the Dispensary luring 1931 and preceding years:— — 1927. 1928. 1929. 1930. 1931. New Patients 428 452 461 341 400 Old Patients 513 551 430 507 427 New Contacts Examined 131 98 111 55 85 Individual Attendances 941 1,003 891 848 827 Total Attendances 2,627 2,370 2,312 2,210 2,314 Written Reports to L.C.C. and Practitioners 1,270 1,300 1,333 1,250 1,187 Consultations with Practitioners 105 98 143 106 157 Other Visits 149 112 97 82 72 Visits by Health Visitors to Dispensary Cases 4,875 3,444 3,257 2,967 3,469 Sputum Examinations 172 159 154 225 192 X-ray Examinations 12 16 12 29 42 The number of contact cases examined shows an increase on the low figure in 1930, but is still considerably lower than in earlier years. As was pointed out in the report for 1930, there appears to be in recent years a smaller number of contacts available for examination. This is due, in the first place, to the decrease in the number of new cases of Tuberculosis, but even more to the fact that an increasing proportion of these cases appear to be young, unmarried persons, who are living-in at their place of employment, or are living in temporary lodgings, hostels or common lodging houses. The family contacts of such cases are not available for examination in Westminster. Care is being taken that available contacts are examined as far as possible. The figures given only apply to the first examination of contact cases. 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 13 55 Insured Females 7 19 Uninsured Males 2 2 Uninsured Females 4 4 Boys 3 4 Girls 2 0 31 84 In addition, convalescent treatment has been recommended for exservice men through the United Services Fund, and for many children 45 through the Invalid Children's Aid Association, the Public Assistance Committee, the School authorities, St. Henry's Fund and other agencies. The association with Westminster Hospital has been continued and many cases were referred there during the year, for surgical opinions, for orthopaedic treatment or for such treatment as the removal of tonsils and adenoids. Forty-two cases have had X-ray examinations during the year and 192 sputum examinations were made in connection with the work of the Dispensary. Five cases have received artificial pneumothorax treatment at Brompton Hospital and elsewhere. The excellent results of this treatment in suitable cases amply justify the expenditure involved ; 69 refills were given at a cost to the Council of 10s. 6d. each. Light treatment at General Hospitals at the Council's expense has been recommended for one patient. Six new dispensary patients had treatment at the Council's Dental Clinic, and 50 extractions were performed. The work of the Tuberculosis Care Committee has been continued on the lines previously indicated. The Committee assesses the amount to be paid by patients undergoing institutional treatment. The economic position of the patient and his dependents receives careful consideration before and after treatment and the Committee can arrange such aid as is necessary in almost every case. The Committee recommended extra diet allowances on medical grounds to 15 persons for varying periods at a total cost to the Council of £73 3s. id. The work of the Handicraft Class which is run for Dispensary patients by a voluntary Committee, has been continued. The class owed its inception and its progress largely to the energy and enthusiasm of Miss Sanders, Secretary of the Tuberculosis Care Committee. To the regret of everyone concerned with the Class, Miss Sanders does not feel in a position to continue her valuable work as Secretary to the Handicraft Committee. Miss McFarlane has now consented to act as Secretary, and it is hoped that it may be possible to continue the work successfully. The Class is still fortunate in having the help of Miss Willatts as teacher, and has an excellent room in the new premises, and a reasonably sound financial position. Unfortunately, only a limited supply of patients is available for the class and the number is liable to depletion by the requirements of treatment. The particular type of work does not naturally appeal to every patient and many are not available for economic or health reasons. There is no doubt, however, that the occupation and interest provided by the class is of real value to those who are in a position to take advantage of its opportunities. Ian S. Thomson. 46 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. Return showing the Work of the Dispensary Dubing the Year 1S31. Diagnosis. Pulmonary. n on-pulmonary. Total. Grand 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 114 100 9 2 11 10 8 10 125 110 17 12 264 *(b) Diagnosis not completed — — — — — — — — 1 6 1 — 8 (c) Non-tuberculous — — — — — — — — 22 35 11 9 77 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 3 2 4 1 — 1 1 2 3 3 5 13 *(6) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous 7 14 27 24 72 C.—Cases written off the Dispensary Register as— (a) Recovered 1 — — — — — 1 2 1 — 1 2 4 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 38 58 40 36 172 D.—Number of Cases on Dispensary Register on December 31st:— 234 218 31 18 24 24 57 43 258 242 88 61 649 (6) Diagnosis not completed — — — — — — — — — 2 — — 2 47 1. Number of cases on Dispensaiy Register on January 1st 657 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 148 2. fjumber of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 19 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,469 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 219 10. Number of— (a) Specimens of sputum, etc., examined 192 4. Cases written off during the year as Dead (all causes) 64 (6) X-ray examinations made in connection with Dispensary work 42 5. Number of attendances at the Dispensary (including Contacts) 2,314 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 215 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 7. Number of consultations with medical practitioners— 12. Number of " T.B. plus" cases on Dispensary Register on December 31st 211 (a) Personal 76 (6) Other 345 * i.e., remaining undiagnosed on 31st December. 48 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. It is suggested in Circular 1206 of the Ministry of Health that where detailed information regarding the Health Services of the Area was given in the report for 1930, it will be sufficient for the purposes of this report to indicate any alteration or development which has taken place during 1931. Accordingly, as these services were somewhat fully dealt with last year, the report for 1930 being a full or survey report, they are on this occasion discussed briefly. 1. Nursing in the Home.—The nursing of general illness in the home is undertaken by the three District Nursing Associations which operate in the City. The service is free for those without means ; from others, contributions are invited according to circumstances. The City Council, as Maternity and Child Welfare Authority, pays these associations for nursing services in connection with puerperal fever and pyrexia and other illnesses arising before, during, or after confinement; also for ailments in children up to 5 years of age, including measles and whooping cough. The nursing of primary pneumonia and influenzal pneumonia is also provided for by the Council through the agency of the associations. These services are most efficiently and satisfactorily carried out. Under the City Council arrangements, Is. 6d. is paid to the association for each nursing visit; 2,429 visits were paid in 1931 at a cost of £182 3s. 6d. 2. Midwives.—Thirty were practising in the area in 1931. This number includes the qualified midwives of the outdoor departments of Westminster, Charing Cross and Middlesex Hospitals, also the staff of the Ormond Home, Chelsea. Confinements at home attended by the midwives from these Institutions are as follows:— Westminster 50 Charing Cross 15 Middlesex 2 Ormond Home 2 Private Midwives 227 A complete midwifery service, indoor and outdoor, is provided by Westminster Hospital under agreement with the City Council for the inhabitants of the City. This scheme includes general and special antenatal clinics ; the following up of cases and the services of obstetric consultants. 49 3. Laboratory Facilities.—Arrangements with Westminster Hospital for the bacteriological examination of material from suspected cases of tuberculosis, diphtheria, etc., continue. Special examinations of water, milk or other food are made as occasion arises. The Chemical Research Association carry out the bacteriological examinations of graded milk under the Special Designations Order. The chemical analysis of food and drugs is performed by the Council's two public analysts, one of whom, Mr. Cribb, also undertakes the investigation of atmospheric pollution. 4. Legislation in Force.—No additions have been made to existing local legislation during the year. 5. Hospitals.—This subject was fully discussed in last year's report, details of the various hospitals in the City and the purposes for which beds were allocated were furnished. As regards municipal hospitals, these are under the control of the London County Council. One such hospital is situated in the City, the Sheffield Street Hospital for pregnant women suffering from venereal disease (52 beds), St. Stephens Hospital (750 beds), formerly reserved for Westminster inhabitants, now receives patients from a much wider area. As regards tuberculosis and infectious diseases generally, Westminster patients, like those from other metropolitan districts, are treated in one or other of the many hospitals of the London County Council, some of which are in the County, while others are in the neighbouring counties. As has often been remarked, Westminster, with its 13 voluntary hospitals, is the hospital centre of London. Beds number 1,225, and with a population of only 129,535 (1931 census), it follows that voluntary hospital accommodation is more than adequate for Westminster people. It must be remembered, however, that into these hospitals are admitted patients from all over London, and, in fact, from even remote parts of the country. Two recent features might be noticed. They are the extensive developments and new building in progress at the Infants' Hospital, Vincent Square. In view of the financial stringency prevalent at the present time it was thought prudent to defer somewhat the original scheme, but when finished, this hospital will afford a unique example in this country, in that its purpose will not be confined to the treatment of disease. With its ante-natal wards, maternity beds and beds for nursing mothers and infants, it will mark a great departure in preventive medicine—the care of mothers and infants during the most precarious period of the latter's existence. To borrow an analogy from 50 the sea, the hospital will be the pilot to guide them past the shoals which abound in the first few weeks of life and only leave them when fairly and healthily set on their voyage. Two other advances in health services are the institution of private wards at St. Peter's Hospital, male, 1 ward (7 beds) and 2 private rooms (2 beds), female (2 beds), and a new system of contributory beds in Westminster Hospital. There have been private wards at the latter hospital since 1924, but the contributory scheme is designed still further to meet the needs of those who, while they are not eligible for ordinary hospital beds, are unable to afford the cost of treatment in the private department of the hospital. The scheme is a notable advance in the provision of treatment for a large class of the population which, by reason of its uncomplaining submission to the stresses and hardships of present economic conditions, has been sadly neglected and ignored. Wealthy patients are well catered for in private nursing homes and can command the best treatment that money can buy. The poor, owing largely to the philanthropic traditions which inspire our great voluntary hospitals have likewise at their disposal expert nursing and treatment. But heretofore the hapless indigent middle class have been denied these special services which modern medicine can provide. These contributory wards in Westminster Hospital make good that deficiency. The patient must pay a standard fee of five guineas per week for hospital maintenance and also an arranged fee, which will be an inclusive one, to cover all necessary medical or surgical treatment during the patient's stay in hospital which, in the case of a private bed, is limited to a period of not more than eight consecutive weeks. Mention has been made in previous reports of the excellent work, particularly in the way of domiciliary treatment, carried on by the provident dispensaries, of which there are four in the City. Since the operation of National Health Insurance their sphere of work has been somewhat curtailed, but still greater opportunities await them if it were possible to link up their work with that of the out-patient departments of the great voluntary hospitals. They would be the outposts of a complete hospital service, clearing stations dealing with all cases not sufficiently serious to warrant hospital treatment or investigation, while they would continue the following up and treatment at home of cases discharged from hospital. The possibilities for co-ordinating and completing the work done in the hospitals are obvious, while the advantage of instruction and training of medical students in home visiting and treatment are equally cogent. Such proposals could be rendered practicable without additional cost and require only some reorganisation and initiative. Ebury Bridge. New Tuberculosis Dispensary {ground floor) and Maternity and Child Welfare Centre (1st floor), with staff flats 2nd and 3rd floors. Opened by the Mayor and Mayoress, Capt. J. F. C. Bennett and Mrs. Bennett, on Nov. 3rd, 1931, at the same time as the adjoining Ebury Bridge Housing Estate. To face paje 51. 51 6. Maternity and Nursing Homes.—There are no such homes under the control of the City Council. 7. There are no changes to report in the institutional provision for unmarried mothers, illegitimate infants and homeless children. 8. Ambulance Facilities.—The various services were fully detailed in the report for 1930 and, so far as is known, no changes or extensions have been effected. 9. Clinics and Treatment Centres.—While there have been no additions to the number of centres, the year has been made noteworthy by the opening of a new tuberculosis dispensary and three new maternity and child welfare centres, one of these being the centre of the Westminster Health Society. These four new institutions replace four which have been given up or demolished and are situated as follows:—- 1. Tuberculosis Dispensary and Maternity and Child Welfare Centre, Ebury Bridge, Buckingham Palace Road, S.W.I. 2. Maternity and Child Welfare Centre, Marshall Street, Golden Square, W.l. 3. Westminster Health Society, 121, Marsham Street, S.W.I. (1) It will be recollected that since 1916 the Council's tuberculosis dispensary and a maternity and child welfare centre were housed in the old building at Ebury Bridge. In 1930, on the adjoining land, the Ebury Bridge Housing Scheme was developed and the old building was cleared away to permit of a much needed street widening. Very near to the old site a new building of four storeys has been erected. The ground floor, consisting of seven rooms, constitutes the tuberculosis dispensary. There is a wide entrance hall which opens out into a larger irregular space in the centre of the building. The various rooms approached from this central space are a main office with smaller office communicating ; waiting-room, weighing-room, dressing-room, consulting-room and medical officers' rooms. There is also a large room where handicrafts can be carried on by ex-sanatorium patients. These rooms communicate with each other and are planned to meet the needs of a modern tuberculosis dispensary. The first floor is designed as a maternity and child welfare centre and the layout is somewhat similar to that of the ground floor with the addition of a sun flat where the children can enjoy the open air while their mothers are attending mothercraft classes. On the two upper floors are provided flats, five in number, for certain of the City Council's officers. This new building, together with 52 the Ebury Bridge Housing Estate, was opened by their Worships the Mayor and Mayoress, Captain and Mrs. J. F. C. Bennett, in November, 1931. The temporary premises at Monck Street and Westbourne Street, which had served as a tuberculosis dispensary and maternity and child welfare centre respectively, were vacated before the end of the year. (2) Maternity and Child Welfare Centre at Marshall Street. This new centre, which, though self-contained, is part of the new large baths building at Marshall Street, replaces the temporary centre at 9, Frith Street. Soho Square. The building, which, in addition to the departments mentioned, contains wash-houses, private baths, rates offices and highways depots, was opened by the Mayor in April, 1931. The centre was described in the report of last year, with photographs of the principal rooms. (3) The new centre of the Westminster Health Society at 121, Marsham Street, replaces the centre at 30, Page Street, which, though in existence only since 1926, had to be demolished as the site was required for the City Council's Grosvenor Housing Estate. This new centre, which was almost complete at the end of the year, embodies the most modern conception of what a welfare centre should be. It is considerably larger than the previous centre in Page Street and its layout and equipment pay tribute to the knowledge and experience of the Society, which has devoted itself to the work of maternity and child welfare in the City for close on thirty years. The centre consists of three floors, with accommodation for resident caretaker. Distinctive features include open-air nurseries and sun flats for the children. Maternal Mortality.—Arrangements for the investigation of maternal deaths and cases of puerperal fever and puerperal pyrexia were set up by the City Council in 1927 and remain in force. These provisions were fully reported upon in the reports for 1929 and 1930. Neither the obstetric consultant nor the pathologist was called upon to act during the year. The reason for this is that women suffering from puerperal con" ditions do not remain at home for treatment, but are immediately admitted to hospital on notification. There were ten maternal deaths, the same as in 1930, and again similarly all the ten died in institutions. A summary of results of inquiry are given below:— A.D. (43).—Married. First pregnancy, previously suffered from pulmonary tuberculosis. Developed acute bronchitis immediately before labour. After delivery broncho-pneumonia supervened and death 53 resulted from cerebral embolism. She had attended hospital ante-natally and was an in-patient for confinement. H.S. (26).—Married. Attended ante-natal clinic at hospital and was delivered in hospital. Had had acute bronchitis five days before admission. Delivery was easy and normal; bronchitis, which had subsided before confinement, became again acute after delivery. Patient became cyanosed and dyspnceic and died from heart failure. This fatal result was not connected with pregnancy. M.P. (23).—Unmarried. First pregnancy, which had been concealed. Pregnancy discovered in hospital when undergoing treatment for ruptured varicose veins. She was therefore under hospital ante-natal treatment. She discharged herself from hospital and had been walking the streets for 24 hours prior to onset of labour. Premature birth of twins. Sepsis became evident on eighth day and in spite of treatment, she died from broncho-pneumonia, infective endocarditis and sapraemia following parturition. There was nothing in the treatment to which exception could be taken. She was under hospital care except for the 24 hours immediately preceding labour. It is not known whether anything occurred during those 24 hours which might have affected the subsequent course of the pregnancy. R.B. (32).—Unmarried. First pregnancy. Confinement in a nursing home in an outlying district. She was removed to L.C.C. fever hospital suffering from puerperal fever (Septicaemia) following full time labour. E.H. (39).—Unmarried. Third pregnancy. Twins. Had attended hospital ante-natal clinic for some weeks previously and had been advised to become in-patient. She refused. Had had varicose veins. Post-partum haemorrhage. Sepsis arose from inflamed varicose veins, and death from malignant endocarditis. E.B. (36).—Married. Second pregnancy. Under private medical care ante-natally. Difficult labour at home due to malposition. Considerable injury to soft parts, resulting in infection of peritoneal cavity. Removed to hospital on third day after delivery. Death from streptococcal septicaemia. E.M. (33).—Married. Second pregnancy. Had attended hospital ante-natal clinic regularly. Admitted to hospital in labour and with bad cough. Delivery normal. Pneumonia developed independently of puerperium and was cause of death. 54 M.B. (37).—Married. Second pregnancy. Admitted to hospital as case of acute abdomen. Denied pregnancy. Immediate operation disclosed ruptured tubal pregnancy. Acute vomiting and collapse throughout. Death same day. Replies to inquiries have not been received in two of the maternal deaths. In the eight summarized above, it is noteworthy that all had been under ante-natal supervision except M.B., who did not consider herself pregnant and was admitted as an acute surgical abdominal case. Three died from acute conditions of the lungs existing prior to confinement and are not directly attributable to labour. There remain the four deaths from puerperal sepsis, three of them being unmarried women. Two of those unmarried women had been receiving regular ante-natal care at hospitals. The married woman had been under private medical supervision before confinement which took place at home, two doctors being in attendance. From the information supplied by the hospitals concerned, and on reviewing the circumstances of each case in the light of such information, it is difficult to see how these unfortunate results could have been prevented. Circulars 1167 and Memorandum 156/M.C.W., issued by the Ministry of Health contained suggestions by the Minister for the improvement of midwifery services by the provision of consultant services, assistance from the local authority in providing and paying for the services of midwives and doctors, particularly as regards ante-natal supervision. Other facilities mentioned in the circular were similarly suggested as measures to ensure the best possible care of the pregnant woman, before, during, and after confinement. It has been pointed out on previous occasions that the City Council had reviewed its maternity services and had provided such extensions or improvements before the issue of the circular in question. Through the agency of the Maternity and Child Welfare Centres for ante-natal and post-natal care and the arrangements made with Westminster Hospital for home midwifery, confinements in hospital, services of medical practitioners, consultants, laboratory facilities, etc., a complete midwifery service is provided throughout the City. This service is available for any woman who for any reason is not in a position to make private arrangements. 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 55 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 the report of last year. The total number of women admitted and confined in the hospital was 61. Of these, 23 were from the centre at Ebury Bridge and Westbourne Street, 11 from Bessborough Street, 11 from Frith Street and Marshall Street, and 16 from Page Street and Marsham Street (Westminster Health Society). Health Visiting.—The importance of visiting children between the ages of one and five years was emphasised by the Minister of Health in circular 1054, issued in 1929. Other points to which he drew the attention of local authorities were extension of day nurseries and further facilities for the medical examination of children of this age period. The ultimate object of these proposals was to ensure that children reaching school age should be free from those defects and diseases which retard and interfere with the benefits of education as well as entailing expense to the Education Authorities who have to provide treatment. The City Council, realising that with the then existing staff of health visitors (some of whom, besides their child welfare duties, are also engaged in tuberculosis visiting) the visiting of children other than infants could not be adequately undertaken, appointed an additional health visitor in 1930. The work and the areas of the health visitors was then reorganised, and from the figures set out below it will be observed that a large proportion of the children visited are between the ages of one and five years:— The following table shows the number of visits paid in connection with the four centres:— Table I. - Westbourne Street and Ebury Bridge. Bessborough Street Frith Street and Marshall Street. Page Street and Marsham Street. Total. Pre-natal— First visits 234 224 111 165 734 Other visits 610 477 173 356 1.616 Children under 1 year of age- First visits 323 286 252 228 1,089 Other visits 1,921 1,743 1,482 1,093 6,239 Children over 1 and under 5 years— Visits 3,173 3,209 1,879 3,297 11,558 Death enquiries, still-births, &c 44 46 34 20 144 Infectious diseases 148 82 60 71 361 56 Children Act, 1908.—Duties imposed under Part I of this Act relating to the foster mothers and boarded-out children are carried out by the London County Council. Barlow's Gift.—The income from this trust, amounting to £33, was by resolution of the Barlow's Gift Committee divided equally between Maternity and Child Welfare and the Tuberculosis Handicrafts Committee. The money has been most usefully expended in providing such necessaries as cannot be bought by money raised from the rates, e.g., rubber bandages and materials for handicrafts. The vouchers are duly presented for the pin-poses of audit. Blind Persons Act, 1920.—With further reference to the Scheme of the London County Council re Care of Blind Children, it is desired by that Council that there should be co-operation between the City Council and itself as regards the welfare and after-care of blind children under 5 years of age. It is requested that any such children in the County should be notified to the Metropolitan Society for the Blind, 296, Yauxhall Bridge Road, S.W.I. 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. 57 Table II.—Ante-natal Cases. Citv Council's Centres. Westminster Health Society. Name of Hospital. No. 14, Westbourne Street and Ebury Bridge. No. 15, Bessborough Street. No. 9, Frith Street and Marshall Street. No. 30, Page Street and Marsham Street. Totals. General Lying-in 17 21 2 24 64 St. George's 22 18 3 3 46 Westminster 11 31 1 46 89 St. Thomas' 9 7 2 2 20 Charing Cross — 2 18 5 25 Middlesex — 1 16 — 17 Elizabeth Garrett Anderson 1 — — — 1 St. Stephen's — 6 — 15 21 Queen Charlotte's — 1 — — 1 St. Mary's 1 1 — — 2 Clapham Maternity — — — — — Royal Free — — 1 — 1 Woolwich — — — 3 3 Found by Health Visitors 68 56 31 71 226 By Private Doctors and Midwives — — — 1 1 Reported to Centre voluntarily 104 82 24 34 244 Totals 233 226 98 204 761 Ante-natal Visiting.—To the 761 expectant mothers who became known to the centres, primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,616. The attendances by those mothers at the clinics are detailed below:— Table III.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Ebury Bridge and Westbourne Street Bessborough Street Westminster Health Society. 51 49 12 114 131 56 231 189 261 345 329 317 177 193 56 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. (6862) E 58 Table IY.—Mothercraft Classes. 1931. Westbourne Street and Ebury Bridge. Bessboro' Street. Frith Street and Marshall Street. Page Street and Marsham Street. Total. Number of classes 56 57 47 88 242 Total attendances 610 1,152 508 2,996 5,266 Average attendances 10-8 22-5 10.8 34-1 21-7 Number of expectant mothers Number of attendances by expectant mothers 30 117 28 40 215 136 394 230 448 1,208 Number of other mothers 68 151 70 93 382 Number of attendances by other mothers 474 758 278 2,548 4,058 Attendances of children in nurseries during classes 385 859 335 2,928 4,507 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Westbourne Street and Ebury Bridge were 188; at Bessborough Street, 698; at Frith Street and Marshall Street, 380 ; and at Page Street and Marsham Street, 1,330. In addition to those, many renovations were carried out. Midwifery Services.—The work performed by the midwives provided by the Westminster Hospital under the City Council's scheme which came into operation on the 1st January, 1931, is summarised below, and comparative figures since 1926 are given. The area in which the midwives' services are performed is the City of Westminster, excluding for the time being those parts of the Parishes of St. Margaret and St. John in which midwifery services are already provided for by the City of Westminster Health Society. Table V. 1926. 1927. 1928. 1929. 1930. 1931. Number of cases attended— As midwife 80 65 77 72 62 62 As emergency — — — — — — With hospital students — — — — — — With private doctor — — — — — -- Total 80 65 77 72 62 62 Number of— Pre-natal visits 860 678 599 579 576 240 Lying-in visits 1,005 812 1,149 1,003 909 794 Subsequent visits 351 415 442 437 420 62 Visits to infants under 1 year, other than lying-in visits 262 376 433 361 292 — Total number of visits 2,478 2,281 2,623 2,380 2,197 1,096 59 Table VI. Attendances by midwife at ante-natal and other clinics:— 1926 1927 1928 1929 1930 1931 Westbourne St. and Ebury Bge. 43 39 40 43 36 51 15, Bessborough Street 87 82 86 97 93 49 Total 130 121 126 140 129 100 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 VII. Number of cases attended— St. Margaret and St. John Wards. As midwife 36 With hospital students 8 With private doctors 5 49 Midwifery visits 907 Nursing visits 99 1,006 There is a tendency for women from other districts to come into Westminster institutions for their confinements. The hospital beds available are as follows :—Charing Cross, 15 ; St. George's, 11 ; Westminster, 15; St. Stephen's, 28. 921 women from other districts were confined in Westminster and 425 women belonging to the City were delivered in the hospitals mentioned—the number in St. Stephen's alone being 221. The number of children born to Westminster parents in institutions outside the City numbered 513. (6862) e 2 60 The following table shows the number of confinements in the hospitals mentioned:— Table VIII. Charing Cross Hospital: 436, of which 51 were Westminster cases. St. George's Hospital: 279, of which 34 were Westminster cases. Westminster Hospital: 363, of which 119 were Westminster cases. Sheifield St. Hospital: 50. St. Stephen's Hospital: 221. Infant Clinics.—These are held at the following centres at the times mentioned:— Council's Centres— Ebury Bridge—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). Marshall Street—2 p.m. Wednesday. Westminster Health Society— Marsham Street—2 p.m. Tuesday. 2 p.m. Friday. Toddlers' Clinic—1st Wednesday each month at 2.30 p.m. 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 1927 are also shown on page 61. 61 Table IX. Attendances at Infant Consultations, 1931. 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 and Ebury Bridge 102 228 115 2,338 1,168 2,566 1,283 3,849 15, Bessborough Street 102 222 54 2,687 2,172 2,909 2,226 5,135 9, Frith Street and Marshall Street 52 98 30 1,315 815 1,413 845 2,258 30, Page Street and Marsham Street 107 208 66 2,257 1,762 2,465 1,828 4,293 1931 363 756 265 8,597 5,917 9,353 6,182 15,535 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 The average attendances per session were— 1931. 1930. 1929. 1928. 1927. Westbourne Street and Ebury Bridge 37.7 43.5 36.5 39.9 37.1 Bessborough Street 56.3 49.5 48.8 44.9 . 44.7 Frith Street and Marshall Street 43.4 40.9 33.1 27.1 29.2 Page Street and Marsham Street 40.1 43.1 38.1 36.9 40.1 The number of individual children medically inspected were— 14, Westbourne Street and Ebury Bridge 573 15, Bessborough Street 628 9, Frith Street and Marshall Street 273 30, Page Street and 121, Marsham Street 544 62 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 which nursing visits were paid :— Table X. Patients. Visits. Ophthalmia neonatorum and conjunctivitis 1 3 Puerperal pyrexia 12 255 Influenza 1 2 Pneumonia 27 430 Bronchitis 11 152 Measles — — Whooping cough — — Other complaints 123 1,587 Total 175 2,429 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 1931 7 1.6 63 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 1906-10 3.2 1911-15 2.4 1916-20 4.95 1921-25 1.7 1926 0.62 1927 2.8 1928 0.72 1929 0.73 1930 2.1 1931 1.6 Ophthalmia neonatorum.— There are a number of cases in which inflammation develops in the eyes of recently-born infants, and if the discharge remains watery in nature and pus does not form the condition need not be classified as ophthalmia. The infection, nevertheless, may be gonococcal in origin. Those are necessarily mild cases, but it is important that they should be recognised and treated at an early stage, because if neglected genuine purulent ophthalmia might ensue. Seven cases were notified during the year, 4 of those being treated in hospital. There were also 13 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 1 case, 3 visits being paid. It is satisfactory to note that the incidence of ophthalmia neonatorum has decreased, and 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. Stewart Tait, Dental Surgeon, submits the following report:— "The annexed tabular statement shows that the increase reported in my last Report has been maintained, the total number of operations of various kinds being much the same as in the previous year. "The work has proceeded on much the same lines as before, but while there has been a marked decrease in the number of extractions 64 there has been a corresponding increase in the amount of conservative work which would seem to point to the fact that mothers now are realising more and more fully the advantage of this latter method of dental treatment. That there is a gratifying appreciation on the part of the parents attending the centre of benefits to health through careful attention to the state of the teeth, and to the necessity of having cases of decay treated as early as possible, is also evidenced by the increasing attendance of patients for subsequent attention after the first operation, there being an increase of nearly 300 under this head. "The additional number of sessions granted by the Council for next year will also enable me to give more detailed attention to individual cases, and I feel certain that these extra sessions will be fully justified by the better results obtained by the treatment. "I would again express my appreciation of the able assistance given me in my work by the other members of the staff associated with me in this work." New Cases 257 Subsequent attendances 1,414 Teeth extracted 1,107 Teeth filled 222 Other dental operations 1,174 Anaesthetics administered:— Local 25 General 255 Dentures supplied 15 Number of sessions 95 Table XII. Comparative statement of work of Dental Clinic (M. & C.W. section) since 1925:— 1925. 1926. 1927. 1928. 1929. 1930. 1931. Number of Sessions 92 92 90 88 89 78 95 New patients 205 209 204 172 153 257 257 Subsequent attendances 613 629 802 807 793 1,129 1,414 Teeth extractions 1,278 1,668 1,198 930 1,172 1,305 1,107 Teeth filled 167 189 248 208 148 201 222 Other dental operations 616 699 777 638 663 1,225 1,174 Anæsthetics administered— Local 38 31 17 28 33 23 25 General 255 295 263 182 194 253 255 Dentures supplied 6 2 6 14 18 22 15 Patients contributed £19 17s. 6d. in small sums according to their means. 65 Convalescence.— The Council has again provided in the estimates for assistance in obtaining convalescent treatment. 12 Westminster children patients at the Infants' Hospital, Vincent Square, were sent to a convalescent home for periods varying from 2 weeks to 3 months. After inquiry a grant was made in each case to make up the deficiency after the parents had contributed. One Mother with her infant was likewise assisted in convalescence. The total amount expended in the year amounted to £26 15s. Day Nursery at 147, Warwick Street.— The Committee maintaining this nursery under the auspices of the British Red Cross Society found itself in grave financial difficulty towards the end of the summer, largely owing to falling off of voluntary subscriptions. In spite of increased grants from the City Council, the outlook became so serious that the Committee intimated that it had no alternative but to close down. In order to prevent a breakdown in so important a branch of maternity and child welfare, the City Council made itself responsible for the administration and maintenance of the nursery from September to the end of the year. It was hoped that during that period a new voluntary committee would be formed with sufficient resources to continue the nursery with similar assistance from the Council. The Mayoress, Mrs. J. F. C. Bennett, who had previously shown a very warm interest in the nursery and had organised charitable efforts on its behalf, gathered together a number of friends who set to work enthusiastically to reconstitute the nursery on a voluntary basis. A committee was formed in December with the Hon. Mrs. Douglas Vickers as Chairman of Executive, Mrs. S. Gluckstein, Chairman of House Committee, and Mrs. Bennett as Honorary Secretary. The Committee had completed its plans for taking over the lease of the nursery premises and had organised schemes for raising funds to maintain the nursery after the 31st December, when the Council's temporary tenure comes to an end. Day Nurseries and Nursery Schools.—Further consideration of the joint circular issued by the Ministers of Health and Education in 1930 took place on a representation from the Metropolitan Standing Joint Committee. It was pointed out that the Council had taken action as regards ensuring more adequate supervision of pre-school age children by appointing a health visitor in the previous year. The question of further facilities for medical examination was deferred in the meantime, while day nursery accommodation was a matter receiving urgent attention. Homes for Unmarried Mothers, etc.—The Council made a grant of £100 to the Home of St. John the Baptist at Tulse Hill. This 66 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 in previous reports. 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, 4,524 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 £147 7s. 11d. This is considerably greater than that spent last year and reflects the increasing degree of unemployment prevailing. Cases in receipt of Public Assistance are not eligible for the Council's extra nourishment Scheme. Birth Control.— Memo. 153/M. & C.W. No action by the City Council was called for on this memorandum. The question of Birth Control advice by officers of local authorities is still acutely controversial. At the Council's M. & C.W. centres any woman desiring advice on birth control is referred to one of the voluntary birth control clinics in London. Insulin Treatment.—The City Council, by virtue of its powers under Section 77 of the Public Health (London) Act, and after receiving the approval of the Ministry of Health, paid for insulin treatment in the case of a necessitous woman out-patient at St. Thomas Hospital. The cost was at the rate of 5s. per week, and on 31st December, £6 1s. had been expended. It is satisfactory to note that the freedom from financial anxiety has been of great benefit to the patient, who has made excellent progress. Health Education.— "Better Health," the monthly magazine of the Central Council of Health Education, published and distributed in the City by the Medical Officer of Health, continued to be an excellent source of information on health matters and was enjoying an increasing circulation. Most unfortunately, its issue in Westminster ceased in October because the printers could not obtain in Westminster a sufficient flow of local advertisements to justify the continuation of 2,000 free copies per month. The magazine is still widely circulated in other parts of the County. 67 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 disinfection of clothing, etc., in a verminous state are carried out by the Disinfecting Staff. Visits were paid to 85 houses, and 6,318 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 374 men and 25 women, and 9 children under school age, were given medicated baths at the Disinfecting Station, making 408 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 53. The Disinfecting Superintendent and the Sanitary Inspectors paid 159 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 379 cases of head lice, and 40 of scabies. In all these cases, the clothing was disinfected, together with the bedding from their homes, amounting in all to 1,334 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 124 for head lice, 3 for body lice and 31 for scabies. The number of attendances of these children for baths at the station was 1,246. The following table shows the total number of individuals treated at the station for verminous conditions:— Table XIII. 1931. Head lice. Body lice. Scabies. Total. Children (including those under school age). 503 3 80 586 Adults — 368 31 399 503 371 111 985 68 Table XIV. General disinfection of premises, articles, etc.:— 1927. 1928. 1929. 1930. 1931. Rooms 890 891 946 992 613 Articles disinfected 12,201 20,628 20,291 23,853 22,004 Articles washed 4,841 5,062 4,994 5,304 3,576 Articles destroyed 152 1,169 337 190 424 Books disinfected * 48 59 96 179 62 Vehicles ,, 7 6 18 8 7 Offices and business premises 9 10 8 39 15 * Library books, 43; private books, 19. Motor Disinfecting Van.— The motor van during 1931 completed 4,409 miles, carrying 3,308 cwts. of goods. The petrol consumed was 421 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 331. Inquests were held at the Coroner's Court, Horseferry Road, in 328 cases, and there were 8 adjourned inquests. Post-mortem examinations were made in 189 instances. Three bodies were received in the mortuary chapel to await burial. London County Council and Inquest Accommodation.— The number of coroners have been reduced and the boundaries of their districts altered in consequence. Correspondence and interviews with officers of the London County Council have taken place with regard to proposals that inquests should be held at the Westminster Coroner's Court on persons dying in other districts. It is felt that this question should be considered in relation to the convenience of those who have to attend the inquests, to economy in matters of transport and to saving the Coroner's time. The City Council reported that generally inquests should be held in the courts nearest to the place where the death took place. As regards Westminster, the possibility of increased use of the premises on account of outside cases might later raise the question of additional expenses on account of heating, lighting and cleansing. These views were put to the London County Council. 69 The number of dead bodies taken to the mortuary for purposes of inquest, and to await burial, during the last 28 years is set out as follows:— Table XV. Year Total. For Inquest. To await Burial. Year. Total. For Inquest. To await Burial. 1903 396 341 55 1918 285 242 43 1904 381 322 59 1919 308 269 39 1905 368 307 61 1920 289 269 20 1906 344 283 61 1921 273 238 35 1907 358 281 77 1922 269 247 22 1908 364 298 66 1923 336 318 17 1909 291 258 33 1924 340 328 12 1910 333 281 52 1925 334 317 17 1911 383 334 49 1926 343 323 20 1912 324 284 40 1927 357 341 16 1913 328 286 42 1928 348 341 7 1914 323 295 28 1929 291 288 3 1915 376 349 27 1930 289 282 7 1916 281 252 29 1931 331 328 3 1917 278 265 13 It may be of interest to note that of the 331 bodies brought to the mortuary, 9 were cases of drowning, 9 of street accidents, 73 of other accidents, 3 of murder, 63 of suicide, 167 of sudden death, natural causes and misadventure, and 7 other causes. There is a resting place for the dead at Drury Lane. SANITARY CIRCUMSTANCES OF THE AREA. Water.—With the exception of those premises which are supplied with water from deep wells, the whole of Westminster takes its supply of water from the Metropolitan Water Board. A deep well is being sunk in connection with a large building now in course of erection on the site of the old London County Council Education Offices on Victoria Embankment. At Shell Mex House, built on the site of the Hotel Cecil, the deep well which supplied part of the needs of the hotel has been filled in. Public Swimming Baths, Washhouses, &c.—Besides those at Buckingham Palace Road and Great Smith Street, there are the newlyconstructed baths at Marshall Street, which were opened in April, 1931. The system for purifying the water is the Kennicott, embodying the 70 most modern apparatus for filtering, chlorinating, warming and aerating the water. Bacteriological tests of the water in the six swimming pools at the three establishments are required by the Baths Committee. These tests are made at the periods of maximum pressure and are carried out three times a year at each pool and more frequently if occasion demands. Reports show that the average chlorine content is never in excess of .5 parts per million and seldom under .4. This is in accordance with Ministry of Health Standards. As regards bacteria no bacilli coli or streptococci have been found in a series of examinations, thus indicating an absence of contamination from human sources. These results show that the filtration plants at the three establishments are efficient and are being worked to the best advantage. The numbers using the swimming baths in 1931 were:— Great Smith Street: 151,703 men; 73,771 women. Buckingham Palace Road : 131,736 men ; 84,670 women. Marshall Street: 110,233 men; 76,101 women. The numbers relating to users of the public washhouses were:— Great Smith Street, 34,104; Buckingham Palace Road, 35,937; Marshall Street, 8,887. Drainage and Sewerage.—Complaints of foul odours from open sewer ventilators were less frequent than in the previous year owing, no doubt, to the abnormally wet weather which prevailed during almost the whole of the summer. House Drainage.—The number of plans, 748, of drainage and other sanitary works examined and approved during the year in connection with existing and new buildings is considerably less than those dealt with last year, when the number was 891. It is, however, 24 in excess of those received in 1926 and includes such buildings as Shell Mex House and another large one on Victoria Embankment, Brettenham House, Lancaster Place, the large block of business premises on the triangular site at Trafalgar Square end of the Strand, the Motor Coach Station, Buckingham Palace Road, and Aldford House, Park Lane. In addition, a number of small alterations have been carried out during the year, which have not been of such a character as to require the deposit of plans. 71 New Sanitary Construction.— Of the 748 plans relating to drainage and other sanitary works, 71 represented sanitary provisions in entirely new buildings. The corresponding figures since 1927 are as follows :— 1927. 1928. 1929. 1930. 1931. Plans 750 752 877 891 748 Plans of work in new buildings included in above 93 81 91 96 71 Combined drainage orders were made in 7 cases. Infringements of the By-laws were reported by the Sanitary Inspectors in 28 instances in respect of failure to give notice of intention to construct, or to deposit plans. Eight builders were cautioned, and two were summoned in respect of these offences and were convicted, fines and costs amounting to £4. In the remaining cases, the works in question were of a minor character and the builders concerned having remedied the omissions on being notified by the Department, no further action was considered necessary. 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 35 underground conveniences in the City, 19 for men and 16 for women. In addition, there are 33 public urinals for men. 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 1931 are as follows:— Tons. House refuse collected 97,254 Trade refuse collected 1,380 98,634 Refuse barged away 87,990 Refuse dealt with in Salvage Plant 10,644 72 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 :— "During the early part of the year, various systems of refuse collection were further considered, but in June, 1931, the Highways Committee decided that the financial situation rendered it quite impracticable for the Council to undertake the expenditure of a substantial sum for improving the cleansing service of the City, and as the adoption of any of the systems would involve a heavy cost, the Council could not be recommended to proceed with them at the time. The Committee therefore decided to investigate in order to see what steps could be taken to improve the present cleansing service without heavy expenditure. It was considered advisable, however, to endeavour to come to some definite conclusion as to which of the systems tried out would be most suitable for Westminster, in order that all necessary preparations could be made for the introduction of the system decided upon as soon as the financial situation made this possible. "In October, 1931, the Council considered the report of the Highways Committee on various systems, and approved the adoption of a dustlessloading system of refuse collection involving the use of prescribed ashbins as soon as the financial position permits, but decided to defer selection of the precise make of dustless loading vehicle to be used until the replacement of the existing vehicles could be proceeded with. "With regard to disposal, schemes are being considered for the eventual disposal of the whole of the refuse from Grosvenor Dock and it was decided to dismantle the Refuse Salvage Plant as soon as practicable, as the considerable decrease in revenue from the sale of salved materials no longer justified its retention." Incinerator at a Block of Flats.—Observations kept during the year failed to discover any nuisance from the combined refuse shoot and incinerator. If well maintained, there is no doubt that this method disposes effectively of a considerable amount of domestic refuse and is in itself an entirely sanitary method. Sanitary Inspection of the Area. The following table shows in 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 73 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. Table I. Inspection of premises :— Dwelling-houses— Primary Inspections— Water-Closets— (a) On complaint 852 Directly approached from rooms 22 (6j Infectious disease 410 (c) Housing Regulations, 1925 1,032 Accommodation insufficient 24 Water Supply- (d) Housing applications 179 Cisterns dirty and uncovered 135 (e) Other reasons 2,134* Absence of—in upper floors of tenement houses 19 Total 4,607 Dustbins— Absence of 104 Re-inspections 11,595 Insufficient 42 Other Premises— Defective 90 Primary inspections— Animals kept so as to be a nuisance 26 (a) On complaint 449 (6) Other reasons 1,909 Other nuisances 285 Total 2,358 Dangerous structures noted 37 Re-inspections 5,004 Sanitary works supervised:— Sanitary Works— Total Inspections— Drains (including soil, waste, rainwater pipes, etc.)— (a) Under notice 1,468 (6) Voluntary works 11,825 Constructed 3,341 Nuisances, etc.:— Altered, repaired, etc 1,094 Intercepting traps fixed 167 Defective or dirty conditions Petrol interceptors provided 18 Tested by smoke 284 of internal structure 1,005 ,, chemical 372 Verminous conditions 148 „ water 2,867 Damp conditions 290 ,, air 611 Defective drainage, waterclosets, etc. 359 Water-closets—■ Constructed 1,563 ,, roofs 247 Repaired and reconditioned 524 „ paving of areas, etc. 113 Urinals— Water-closets— Constructed 249 Insufficiently ventilated or lighted 54 Repaired and reconditioned 68 * This figure includes 129 visits of enquiry in respect of smallpox contacts. Restriction of Rent Acts.— Nine applications were received for certificates under these Acts, but in only three cases were the applications granted. Nuisances.— Intimation notices were served in 1,244 instances, the number of premises concerned being 1,182. Statutory notices authorised by the sanitary authority numbered 62 and related to 59 premises. Police court proceedings as detailed below were taken in 5 instances in order to enforce compliance with the requirements of statutory notices. (6862) 74 Details of Nuisance. Result of Proceedings. (1) Obstructed state of drain, etc. Summons dismissed. (This was a tenement house in which a drain from a water-closet had been frequently obstructed by the careless or wilful acts of one or other of the tenants. The Magistrate held that as the owners had done all they possibly could to keep the drain clear, he was not justified in making an order against them.) (2) Rooms in a dwelling house kept in a filthy state. (3) Foul state of a room used for storage purposes. (4) Illegal occupation of two ground rooms. (5) Accumulation of rubbish in empty premises. Prohibition Order against the occupier and 6s. costs. Abatement Order (14 days) and 3s. costs. Occupier fined 10s. and owner 20s. in respect of each room. Summons dismissed. (The defendant contended that there was no nuisance or smell arising from the rubbish. The Magistrate stated that he was not satisfied that a nuisance existed.) The following are the comparative figures since 1927 :— — 1927. 1928. 1929. 1930. 1931. Intimation Notices 1,450 1,778 1,158 1,239 1,244 Statutory Notices 49 45 59 72 62 Legal Proceedings 5 4 7 5 5 Water Supply.— The Metropolitan Water Board sent nine notices of withdrawal of water supply to premises. In each case the reason for the action of the Board was failure to pay the water rate. Water Supply in Tenement Houses.— Power to effect this provision is given under Section 48 of the Public Health (London) Act, 1891, and under Section 78 of the London County Council (General Powers) Act, 1907. The number of cases in which this action was taken since 1927 is as follows :— 1927. 1928. 1929. 1930. 1931. 22 6 5 21 19 By-laws as to Removal of Offensive Refuse.—No cases were reported during the year. 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. No infringements of the Act were reported during the year. 75 Factories, Workshops and Workplaces, Occupations and Workshops.— In the following tables are shown in detail the number and variety of work premises on the register at the end of 1931, 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 1,241 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc. 1,270 Leather workers, boot and shoe makers, harness makers, etc. 57 Carpentry, upholstery, carvers, gilders, etc. 66 Surgical and dental instrument makers 7 Tobacco manufacturers 10 44 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 53 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 59 Metal workers 48 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 40 Florists 22 Laundries 17 60 Photographers 45 Jewel case makers 8 Cinema film workplaces 28 Total 3,075 The use of 360 workshops was discontinued, and 326 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) 332 19 — Workshops (including workshop laundries) 2,949 237 — Workplaces (other than Outworkers' premises) 2,174 122 — Total 5,455 378 — (6862) F 2 76 Table IV.— Defects 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 261 261 Want of ventilation 37 37 — — Overcrowding 36 36 — — Want of drainage of floors 8 8 — Other nuisances 77 77 — — Sanitary accommodation— • Insufficient 6 6 — — Unsuitable or defective 133 133 — — Not separate for sexes 28 28 — — 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 586 586 — — Table V.— Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 138 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 262 Absence of means of warming — Matters referred by H.M. Inspectors 62 Workrooms measured .. 240 Visits of Enquiry re Employment of Women 119 „ „ Outworkers 143 Underground bakehouses in use 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. 77 Table VI. Outworkers' Lists, Section 107. Outwork in unwholesome premises. Section 108. Outwork in infected premises, Sections 109 & 110. Trade Lists received from employers. Addresses of Outworkers. Notices served on occupiers as to keeping or sending of lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Received from other Councils. Sent to other Councils. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing apparel 1,038 1,371 8,157 10 5 62 466 5,846 76 — — 16 Linens, etc. 5 30 68 — — — 10 66 — — — — — — — — — Furriers 10 32 29 — — — 19 36 — — — — — — — — — Umbrellas, toys, artificial flowers, etc. 3 84 104 — — — — 94 — — — — — — — — — Total 1,056 1,517 8,358 10 5 62 495 6,042 76 — — — — — 16 — — 78 Outworkers.— The total number of lists received during the year amounted to 1,056. Notices in respect of failure to send lists were sent to 76 firms. No legal proceedings were necessary in respect of this offence. The lists contained 9,942 names and addresses, of which 6,042 were in other districts, 5,109 being within the Metropolitan area and 602 in the London Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,613, of whom 1,506 were registered as occupying workshops. The number of premises in which outwork was being carried on was 757. 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. — 1927. 1928. 1929. 1930.  Complaints received 79 36 52 31 49 Observations taken 2,057 640 854 755 854 Notices issued— Preliminary 29 21 12 16 10 Statutory 1 1 — 2 2 Legal Proceedings 2 Smoke Abatement By-law.— The By-law to which reference was made last year was submitted in draft to all local authorities in London by the London County Council and having been confirmed by the Minister of Health came into force on 19th May, 1931. Black smoke issuing from any one chimney of a building other than a private dwelling house for a period of 3 minutes in the aggregate, within any continuous period of 30 minutes, shall be presumed to be a nuisance, unless the contrary is proved, liable to be dealt with summarily under the Public Health (London) Act, 1891. After a period of 5 years has elapsed it is hoped that the conditions in industry will have assumed a more prosperous aspect and that firms will be able so to improve plant that the period of two minutes which was originally intended can be equitably imposed. Greater London Joint Smoke Abatement Committee.—This Committee continued its meetings throughout the year. Your Medical Officer of Health, as a representative of the Metropolitan Boroughs' Standing Joint Committee, attended on most occasions. 79 Investigation of Atmospheric Pollution—Department of Scientific and Industrial Research.— In view of the work undertaken by the City Council in relation to the investigation of atmospheric pollution, the Department mentioned invited the Council to appoint members to the Standing Conference of Co-operating bodies. This body consists of representatives of Local Authorities, industrial undertakings, scientific societies, etc., actively interested in such investigations. The Council appointed your .Medical Officer of Health and Mr. C. H. Cribb, one of the City's Public Analysts, as their representatives. They attended the bi-annual meeting in October when matters relating to administration of smoke legislation and research were discussed. Sulphur gas—measurement of .—The deleterious effects of sulphurous and sulphuric acids in the air on the health of the community and on buildings is now fully recognised. A method has been devised by the Department of Scientific and Industrial Research for the determination of the amount of this pollution present in the atmosphere. A measured volume of air is bubbled through a solution of hyperol, the acidity of which can be easily measured. All the sulphur compounds in the air passed through the apparatus are absorbed by this solution, and can be identified and measured by chemical analysis. Mr. Cribb, who has been carrying out laboratory investigations of atmospheric pollution on behalf of the Council, was authorised to proceed with this new line of investigation. Apparatus of the type recommended by the Department but modified by Mr. Cribb in such a manner as to enable a larger volume of air to be examined with increased accuracy was installed at the City Hall at the end of the year. The results obtained by experiment are appended herewith as a matter of interest:— Date Volume of air examined. Time of Experiment. Sulphur dioxide in parts per million. Volumetric analysis. Gravimetric analysis. 12 December, 1931 75 cubic feet 8 hours 0.37 0.48 The diagram on the opposite page indicates in graphic form the varying amounts of suspended dirt as recorded by the automatic air filter installed at the City Hall. Readings are taken hourly throughout the 24 hours and the average pollution for the month is shown, worked out as an average day during that month from these readings. 80 The following table shows the results of the monthly analyses of the amount of dirt collected in the deposit gauges. Two of these gauges were installed in 1930; one at Mount Street Gardens, Mayfair, and the other at the Mortuary premises, Horseferry Road. Table VIII. 1931. Figures in English Tons per Square Mile. Horseferry Road. Mount Street. Wandsworth Common. (For comparison.) Total Solids. Sulphur. Total Solids. Sulphur. Total Solids. ur. January 31.95 3.62 23.21 2.67 15.92 2.21 February 41.26 4.27 33.42 3.70 15.86 1.76 March 32.03 2.73 35.83 4.07 6.53 0.87 April 41.44 4.00 47.08 5.72 25.09 3.03 May 30.58 2.96 33.07 3.56 14.41 2.47 June 26.07 1.83 24.53 2.01 12.16 1.53 July 38.77 5.54 24.30 2.64 14.08 2.35 August 24.02 2.76 21.48 3.21 15.91 0.84 September 22.46 2.11 18.60 2.00 12.27 2.07 October 28.46 3.03 21.44 2.07 10.89 1.89 November 34.70 3.38 26.90 2.91 20.5 2.76 December 40.29 5.83 21.87 3.57 11.45 1.73 Premises and Occupations which can be Controlled by By-laws and Regulations. (].) 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 393. The Sanitary Inspectors paid 1,683 visits of inspection to these houses and infringements of the By-laws were reported in a number of instances. Appropriate action was taken with regard to the infringements. In no case was it necessary to take legal action under the bye-laws. 81 In June last, the Minister of Health approved certain amendments of the bye-laws with regard to houses let in tenements which were made by the County Council in February. These particularly applied to decontrolled houses and allowed clauses which in the principal bye-laws were suspended whilst the Rent Restrictions Acts were in force and had reference to:— Repair, lighting and the ventilation of staircases. Ventilation of passages. Provision of W.C. accommodation. Accommodation for washing clothes. Accommodation for the storage, preparation and cooking of food. Paving of yards. Increased air-space in sleeping rooms. A suspended bye-law dealing with the stability of tenement houses and which is enforced by the County Council was also put into force. (6) Underground Sleeping Places. (7) Butchers' Shops and Stalls. (8) Dairies and Milkshops. (9) Ice-cream Premises. (10) Bakehouses. (11) Workshops and Workplaces. (12) Rag-and-Bone Dealers.— There are 13 premises in the City in which this business is carried on. No matters requiring attention by the Department have arisen 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. Rag Flock Acts, 1911 and 1921.— There are no premises in the City which come within the provisions of these Acts. Fouling of Footways by Dogs— By-law.—Five cases of infringement of the By-law were reported to the Council by the Commissioner of Police. Summonses were issued against all of the offenders and two of them were ordered to pay the maximum penalty of 40s., one of the others was fined 30s. and the remaining two 10s. each. 82 The fact that it is possible only to summons those owners whose dogs are on leads while committing a nuisance, lead to a proposal for an amendment to include dogs not on leads whose owners make no endeavour to stop them committing nuisance. The Town Clerk and Medical Officer of Health had an interview at the Home Office on this proposal with the result that it was not considered practicable to adopt the proposed amendment in a By-law. Rat Repression.—Complaints of infestation by rats numbering 44 were received, and as the result of these complaints some 130 premises were examined. Examinations were made in the sewers in 25 instances and each examination covered the sewers and house drainage connections near the properties affected. Nineteen defective house drainage outlets to the sewers were discovered and dealt with. Five defects other than of private drains were made good. Five areas were specially treated by gas and otherwise, four by the Sanitary Authority and one area by the owners. Three large buildings were also specially treated by the Sanitary Authority. During "Rat Week" in November, the usual steps were taken to deal with the menace. A special Circular dealing with the causes of rat invasion and the means of getting rid of them was distributed. Large additions were made to the baits usually laid throughout the year in the sewers and at the Council's house refuse depots and other places. The Officers of the Council co-operated in the work with the Officials of adjoining boroughs during the " Rat Week." A suggestion by the Medical Officer of Health to arrange for the training of one of the disinfectors in rat catching was approved by the Council. It has been the practice to employ a firm for this work, but it is considered that a properly trained man on the Council's staff will be more satisfactory. 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 in former years owing to the partisan feelings of the community. 83 The complaints related mostly to fouling of cornices and flat copings of buildings, while in a few instances it was alleged that residents could not sleep because of cooing. The agents whom the Council has appointed to deal with pigeons paid several visits and gave some very helpful advice. Mosquitoes.—In August and September complaints were received from a number of occupiers of buildings in the vicinity of the Embankment by Charing Cross Railway Bridge that their premises were infested with mosquitoes. The Sanitary Inspector made a general inspection of the premises in the neighbourhood with a view to discovering whether there were any receptacles containing stagnant water which were acting as breeding grounds. He was accompanied on one occasion by an official of the Ministry of Health. The inspection disclosed the fact that there were in existence many disused water tanks, most of which on examination were found to contain the larvse of mosquitoes. The owners or occupiers responsible were requested to clean out or to remove the tanks and to take steps to ensure that in future water should not be allowed to collect and become stagnant. Enquiries made later proved that the action taken had been effective in mitigating the nuisance. Subsequent investigations were carried out by the Ministry of Health on the question as to whether the insects were carriers of the malaria protozoon. It is understood that the findings were negative. Ministry of Health Survey.—In September, 1931, the Minister intimated that in accordance with powers vested in him under Section 104, Local Government Act, 1929, he had requested Dr. F. R. Seymour to undertake a survey and report to him on the sanitary services of the City of Westminster. Dr. Seymour visited the City Hall on 28th September, and was introduced to the Mayor and Town Clerk. He made a thorough survey of the various branches of the Public Health Department—investigation of infectious diseases, disinfection, mortuaries, office administration and statistics ; sanitary inspection and housing records ; food and drugs administration, factories and workshops inspection, tuberculosis dispensary, the maternity and child welfare centres, and vaccination work. His visits were somewhat interrupted by urgent work at the Ministry and his survey had not concluded by the end of the year. He personally interviewed every member of the staff and accompanied the sanitary inspectors in their work in the district. Dr. Seymour expressed satisfaction with the facilities extended to him for investigating the work of the department and will report in due course to the Minister of Health. 84 Review of Expenditure awl Economies.—During the Autumn, Circular No. 1222 from the Ministry of Health relating to the national financial situation and local public expenditure was considered. The Minister pointed out that expenditure should be viewed in relation to what was urgently necessary for the public health. The Public Health Committee in common with other committees reviewed its estimates for the year 1931-32 and was able to effect certain economies by re-arrangements and by curtailing some proposed extensions of its services until a more propitious occasion. Congresses Attended.—Frankfurt, Whitsuntide, 19.31. Royal Institute of Public Health Annual Congress. Delegates were Councillor H. S. E. Vanderpant and the Medical Officer of Health. Much useful information was brought back on Housing, Day Nurseries, etc., which was embodied in reports to the appropriate committees. Snwke Abatement Conference.—Liverpool, September, 1931. Councillor Mrs. Alderson Home attended as the City Council's delegate, but at her own expense. She reported fully to the Committee on the proceedings. Glasgow, July, 1931.—Royal Sanitary Institute Annual Congress. This was attended by the Medical Officer of Health as delegate and duly reported on by him. Bridlington Conference.—Sanitary Inspectors' Association, September, 1931. Mr. T. H. Jackson, sanitary inspector selected by the Medical Officer of Health, attended and prepared a report for the committee. Winter School for Health Visitors, held in closing days of 1930 and beginning of 1931. Miss Sanders, a senior health visitor, attended this course, her reasonable expenses being provided by the City Council. This is a study course held every year and for some years past the Council has sent one of the health visitors. Great educational benefit has always been derived from these refresher courses. Women Health Officers' Association.—Study tour in Holland. The City Council granted leave without expenses to Miss Walding, a senior health visitor, for a similar study tour in Germany in 1930. On this occasion Miss Walding made a shortened study tour in Holland at her own expense and in time taken from her annual leave. 85 HOUSING. This section of the report for 1931 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). 1. Inspection of Dwelling Houses. (1)—(a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,607 (6) Number of inspections made for the purpose 16,202 (2)—(a) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations 1,032 (6) Number of inspections made for the purpose 4,153 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation ,. 0 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habita- 566 2. Remedy of defects during the'year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 234 3. Action wider Statutory Powers during the year. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 0 (b) By Local Authority in default of owners 0 86 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 774 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 770* (b) By Local Authority in default of owners 0 C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which Demolition Orders were made 0 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 D.-—Proceedings under Section 20 of the Housing Act, 1930. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 E.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 0 (6) By Local Authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 2 * Four dwelling houses were the subject of legal proceedings for non-com pliance with the requirements of Statutory Notices. One Section of the Ebury Bridge Housing Estate. The completed Scheme (210 flats) was formally opened by the Mayor and Mayoress, Capt. J. F. C. Bennett and Mrs. Bennett, on Nov. 3rd, 1931. To face page 87. 87 F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which Closing Orders were made 0 (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit 0 (3) Number of dwelling-houses in respect of which Demolition Orders were made 0 (4) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 Section (b). Housing Conditions. General Observations as to Housing Conditions. City Council's Schemes. The Grosvenor Housing Scheme in the Millbank area is rapidly proceeding towards completion, three blocks, comprising 154 flats, being already occupied. The most recent of these three on the north side of Page Street was completed by the end of June, when 84 families took possession of the same number of separate self-contained flats. Two other blocks of 84 and 141 flats respectively are in course of construction, the smaller of which will be ready for occupation about March, 1932, and the larger before the end of the same year. The Ebury Bridge Scheme of eight blocks containing 210 flats, has now been completed and is fully occupied, the last two blocks of 30 flats each being finished in September, 1931. Full reference was made to these schemes in the reports of 1928, 1929 and 1930. Included in the Ebury Bridge Scheme and in addition to the numbers given above, 15 flats were constructed for City Council's employees. As the site on which the Estate is built was surplus land belonging to the City Council, this estate provides a considerable addition to the working-class accommodation in the City. No working-class houses were demolished or cleared to make room for it, neither were any workingclass families displaced. To such a degree has the land in Westminster been built upon that, with the exception of the Pulford Street site (now in the hands of a Voluntary Housing Trust for possible development), there is no suitable vacant site on which to build working-class houses. It will not be possible, therefore, in the future to build any more such dwellings unless existing houses or commercial buildings can be cleared 88 to provide a site. This somewhat obvious fact requires reiteration, in view of the frequently repeated demands to build more houses for Westminster workers. This must also be borne in mind in connection with clearance schemes under the Housing Act, 1930. Housing accommodation must be provided or available for the tenements from any area scheduled to be dealt with as a clearance area. The Ebury Bridge Estate has been used for the purpose of providing fit and proper dwellings for those who were living in overcrowded or other unsanitary conditions. In many cases the Council transferred their old tenants from Regency Street Dwellings to the new estate, and offered the vacated flats to those applicants whose housing conditions were undoubtedly unsatisfactory. Thus, by means of the new estate, 149 families were relieved of overcrowding and 10 were removed from illegally occupied underground rooms. Similarly, during the year, the London County Council provided, either in their London Estates or in those in the outer suburbs, accommodation for families previously unsatisfactorily housed. The County Council differentiate between those who apply for rehousing on the grounds of insanitary conditions or health reasons and those who wish a suburban dwelling because of improved amenities or other reasons. The former class of applications require an endorsement by the Medical Officer of Health of the borough concerned. There were thus housed by the London County Council 22 families from insanitary conditions and 10 others. During the year 69 Westminster families have been rehoused in the older dwellings of the City Council. Re-housing Operations.—During the year 294 families were rehoused by the City Council and 96 by the London County Council, making a total of 390 families. The estates on which they were accommodated were as follows :— City Council's Estates. Families. Ebury Bridge 141 Grosvenor Housing Scheme 84 Regency Street 61 Schomberg House 2 Admiral House 1 Walden House 2 Marshall Street 2 St. James' Dwellings 1 Total 294 89 London County Council Estates. Families. St. Helier, Morden 34 Becontree, Essex 24 Wormholt, Hammersmith 9 Downham, Bromley 3 Bellingham, Catford 2 Roehampton, S.W. 1 Watling, Edgware 1 Millbank, L.C.C. 5 Streatham Hill, S.W. 5 Loughborough Road, Stockwell 4 Bourne Estate, Clerkenwell 3 China Walk, Lambeth 1 Clapham Park, S.W. 1 East Hill, Wandsworth 1 Glebe Estate, Camberwell 1 Herbrand Street, Holborn 1 Total 96 In the course of the special survey of Housing conditions given in the report for 1930, several small areas, consisting mostly of decaying workingclass cottages were noted. They were referred to as coming under the description of clearance areas. The City Council, by arrangement with the owners, will rehouse the tenants from the houses in one of those areas, Horseshoe Alley. Another of these areas, Cottage Place, is being dealt with similarly, but in this instance, the re-housing so far has been effected by the owners. Another somewhat larger area, referred to last year, is Douglas Place, and adjoining properties. This was represented to the Housing Committee as one which should be dealt with as soon as other accommodation became available, and in due course, this area of old and defective dwellings will be cleared. It will be appreciated that the intentions of the City Council, as regards the clearance of the several groups which have been reported upon, have of necessity had to be modified in view of the present financial situation. Reconditioning and repair to keep those houses reasonably fit must be substituted for more drastic measures until re-housing becomes possible. The number of dwellings owned and managed by the City Council is almost four times greater than it was ten years ago and is steadily increasing, and as the (6862) G 90 turn-over of tenancies, " the come and go " becomes proportionately greater, there is thus provided a better likelihood of vacancies occurring for those who are living in those houses which are ripe for demolition. Ross Street.—The 27 small cottage dwellings in this street, including those belonging to the City Council, were under review during the year. As the time was not propitious for the development of a clearance scheme, steps were taken to ensure such repairs being carried out in all the houses as would make them reasonably habitable for a further period. Douglas Place, etc.—A request was made in April by four local government electors of the City that an official representation under the Housing Act, 1930, be made by the Medical Officer of Health to the City Council in respect of 3, Arneway Street, 39, Chadwick Street, Douglas Place and Richards Cottages. The Medical Officer of Health accordingly inspected the houses referred to and reported to the Council with regard to 3, Arneway Street and 39, Chadwick Street that in his opinion the two houses were not unfit for habitation. With regard to Douglas Place and Richards Cottages, the Medical Officer of Health reported as follows :— " This area was included in the schedule of insanitary areas reported to the Committee in the special reports of May and October, 1930. A further report on the area was submitted in March of this year, recommending that it should be dealt with as a clearance area so soon as rehousing operations could render this course practicable. Conditions during the past two months have not materially altered as regards the area as a whole, but it should be noted that repairs have been carried out to the main walls of certain of the houses following notices by the District Surveyor. A defective drain in No. 1, Douglas Place has also been relaid as a result of an intimation notice served by the Public Health Department. The internal conditions, bad arrangement of the houses, restricted accommodation and lack of amenities remain as before." The matter was referred by the Council to the Housing Committee. The area itself was considered to be too small and otherwise unsuitable for a rehousing scheme, but it was decided to rehouse the occupants of the area as and when suitable accommodation became available. The Council has since rehoused one of the families in Douglas Place. Horse Shoe Alley.—The officers of the department were closely watching the small working-class houses in Horse Shoe Alley and also those adjoining at each end of Horse Shoe Alley in Petty France and 91 Vandon Street. The Medical Officer of Health on the 27th November received a request signed by four ratepayers to " make an official representation to the City Council in respect of Horse Shoe Alley in accordance with sub-section 2 of section 51 of the 1930 Housing Act." These houses were referred to in reports made by the Medical Officer of Health to the Public Health and Housing Committees in May and October, 1930, with regard to small areas of working-class houses occupying valuable sites and which, though not slum areas, were nearing the end of their useful existence. Since those reports were made, some of the houses in and adjoining Horse Shoe Alley became dangerous and were the subject of dangerous structure notices by the District Surveyor. These houses were vacated and partly demolished. This partial demolition seriously affected the remaining houses, and the Medical Officer of Health accordingly made representation to the City Council on the 7th December that the houses in Horse Shoe Alley and those houses adjoining each end of Horse Shoe Alley in Vandon Street and Petty France (21 in all) were by reason of disrepair or sanitary defects unfit for human habitation and that the area should be dealt with as a " clearance area," as provided by the Housing Act, 1930. (Negotiations are taking place between the owners and the City Council whereby some arrangement may be made for the rehousing of the occupants (19 families) and the subsequent demolition of all the houses.) Underground, Rooms.—It was reported last year that some 221 basements were separately occupied as dwellings. Of this number 36 were occupied contrary to the provisions of section 96 of the Public Health (London) Act, 1891. Special attention has been paid during the year to underground dwellings separately occupied as such and to sleeping rooms in basements. Other illegally occupied underground dwellings were discovered numbering 22 and 47 sleeping rooms which did not meet the requirements of the Council's regulations as to sleeping places were recorded. Of these numbers, eight families have been rehoused by the City Council, one on a London County Council Estate, and arrangements were made by the officers of the Department whereby four families were provided with accommodation on other housing estates. Underground rooms at 33 houses, in addition, have ceased to be illegally occupied ; 14 as separate dwellings and 19 as illegal underground sleeping rooms. (6862) G 2 92 The total now found to be still occupied illegally is 59, including 34 separately occupied as dwellings and 25 illegal sleeping places. Three owners who were communicated with gave written undertakings under section 19 of the Housing Act, 1930, not to relet rooms in the basements as bedrooms which do not comply with the requirements of the Act in regard to underground sleeping places. Summonses were taken out against the owner and the occupier of an underground dwelling occupied contrary to the provisions of section 96 of the Public Health (London) Act. These underground rooms were definitely illegal and every consideration was given the occupier. An appointment was made to discuss transferring the occupants to one of the City Council's dwellings, but the appointment was not kept, and as it appeared that they were quite able to pay rent for suitable accommodation the Council instructed proceedings to be taken. The Magistrate fined both the owner and the occupier. The rooms soon afterwards ceased to be occupied as a dwelling and are now used for other purposes. Overcrowding.—During the year 12 new cases of illegal overcrowding were discovered and 29 cases which were overcrowded in the social sense. In a number of instances the families concerned were found to have come from other districts and had been resident in Westminster for a comparatively short period. Some of them had come from the provinces either because the bread-winners had found work in London, or because the prospect of obtaining such appeared to be less remote than in their own districts. The published figures of unemployment show that this problem is much less acute in the South of England than in the industrial areas and this fact is no doubt an inducement to some families to migrate from their home towns. In each of two cases of illegal overcrowding, a family of ten persons was found to be occupying two rooms in a basement, from which the City Council had rehoused the former occupants on the ground of overcrowding. In both instances the owner had received a warning letter from the Council, but no blame could apparently be attached to the owner in either case, because the prospective tenants had obtained the rooms by misrepresenting the facts regarding the number of persons in the family. Notice to abate the overcrowding was served upon the occupier in each case. During the year 40 cases of illegal overcrowding and 68 cases of " social " overcrowding were relieved, principally by the housing schemes of the City Council. 93 Owners of houses or rooms in which tenants lived in overcrowded or other insanitary conditions were written to in 124 instances, after the occupiers moved to other dwellings, emphasizing the need of preventing the recurrence of such conditions. Schools.—In addition to the large number of academic institutions in Westminster there are 29 elementary and 5 secondary schools either wholly or partly under the control and management of the London County Council. The sanitary condition of these calls for no special comment ; alterations or improvements of sanitary arrangements are carried out from time to time, when plans of proposed work are submitted to this Department. Kensington Proposals with regard to Underground Rooms. The Metropolitan Boroughs' Standing Joint Committee asked for the observations of the City Council on certain proposals submitted by the Kensington Borough Council to the London County Council on the subject of underground rooms, namely : — (а) The Borough Councils to survey all underground rooms. (б) To schedule those rooms unfit for living or sleeping purposes. (c) To inform owners concerned in (6) accordingly. (d) Owner to have 21 days to appeal to the Minister on Council's decision under (6). (e) If no appeal made or if appeal dismissed by Minister, the underground room in question to be closed for living or sleeping purposes when the tenant of the said room ceases to occupy it. (f) Penalty for re-letting or re-occupying a scheduled underground room. (g) " Tenant" defined as person who occupies the basement room or rooms in a scheduled house. (h) Borough Councils to be given power to require concreting of the floors of basement rooms liable to flooding in heavy storms where nuisance may arise on account of wooden floors. Previous Proposals.—The whole question of the use of underground rooms was fully reported upon by the Medical Officer of Health in December, 1929, as a result of a communication from the London County Council in November, 1929, when the City Council passed a resolution stating that whilst it was in sympathy with the proposal to prevent the occupation for all habitable purposes of all unsatisfactory underground rooms it was not prepared, having regard to the existing housing difficulties, to support the proposal of the London County Council at that time. 94 The difficulty of enforcing existing legal requirements for underground rooms owing to housing shortage was also emphasised and the City Council was reminded that only the worst cases had been dealt with. It was pointed out that the requirement of the Regulations as regards the angle of light was too theoretical and should be modified ; also that as accommodation became available basement rooms should be required to be let always in conjunction with a room or rooms on upper floors to form a separate dwelling. The proposals put forward by the Kensington Borough Council have essentially the same object in view as those of the London County Council in 1929. The Medical Officer of Health submitted a report on the Kensington Borough Council's proposals, upon which the Public Health Committee expressed the following views:— It is acknowledged that basement dwellings generally are not the most satisfactory, inasmuch that they do not permit the maximum of daylight or of free ventilation, and many are prone to dampness. In modern dwellings of all types, basements are very seldom planned, if they exist at all, as living rooms. They are usually storerooms or boiler rooms, &c. Proposal (a).—It has been the practice in Westminster for some years past to make a schedule of all underground rooms decreed to be illegally occupied. House to house inspections have been in progress for the past five or six years and details are recorded as required by the Housing Consolidated Regulations of 1925. Many of the houses recorded possess underground rooms, but so long as no nuisance requiring action by the Sanitary Authority exists and there is no infringement of the law regulating the use of such rooms there does not appear to be any advantage in compiling separate records apart from the records of the houses already in existence. The records so far made refer to houses of the working classes. The proposal requires a survey of all underground rooms. This is a very wide reference and would, in Westminster, imply a very extensive investigation requiring some years for completion, and is in our opinion unnecessary. The survey should be limited to underground rooms in houses to which the Housing Acts apply. Proposal (b).—Considerations implying that a basement room is unfit for living as well as for sleeping in should be laid down specifically as a basis on which a Sanitary Authority might deem it desirable or necessary to proceed to formal action. Proposal (c).—If suitable criteria are laid down, there is no objection to the owner being informed of the Sanitary Authority's decision as to the use of such underground rooms and to his right to appeal to the Minister of Health against such decision. Proposals (d), (e) and (/).—If no appeal to the Minister is made or such appeal is dismissed, there is no objection to the provision for a closing order prohibiting sleeping and living in such room or rooms being made after the tenant has ceased to occupy it. In Westminster it has been the custom for many years past to warn those who let underground rooms for sleeping purposes that legal action will be taken by the City Council against anyone who re-lets an illegal room after the occupant has left or been rehoused. Only in one instance has this warning been disregarded ; legal proceedings followed and a penalty was imposed. 95 It should be made clear whether the rooms may be used for any purposes other than those of habitation, because it is believed that if left empty they will become markedly damp, not only from the floors but from rising dampness in the walls which may extend to the upper parts of the house. The air in those rooms will stagnate and become foul, rubbish may accumulate and a state of nuisance may thus be engendered. It is the ultimate fate of such rooms if closed for all living purposes which causes concern. If they must be closed, certain structural alterations would appear necessary; all openings should be bricked up, leaving only ventilation spaces, while damp-proofing, horizontal and vertical, should be undertaken in some cases. Proposal (g).—The suggested definition of the word " tenant" is different from that in the by-laws for houses let in tenements. This may give rise to confusion. It would seem simpler to define the person who occupies basement rooms in a scheduled house as " occupier." Proposal (h).—It is stated by the Kensington Borough Council that hundreds of basements in their district are still liable to floods in heavy storms and that in consequence a very unhealthy state arises from time to time. It is asked that power may be given to require concreting of these basements. These conditions must be due either to deficient depth in the sewer levels or lack of capacity in the main sewers. Apart from the Thames flood of 1928 and a few isolated instances in certain areas of the City these conditions have not been experienced in Westminster. Concreting was required by the Medical Officer of Health in the case of a number of flooded basements after the flood of 1928 because it appeared then to be the most practicable means of eradicating the nuisance and the extensive dampness caused by the flood, particularly in those cases where no underfloor ventilation previously existed. A concrete floor is necessarily cold, and may have other disadvantages. It is now three years since the basements affected by the flood were concreted, but dampness can still be detected in them and is, in fact, as prevalent as in those where wooden floors were replaced and underfloor ventilation established. This is therefore a matter which should not be made a requirement in these terms, but should be expressed rather as an obligation to undertake the best practicable means of rendering these basement floors free from dampness. The following recommendations of the Public Health Committee were submitted to and adopted by the City Council:—- (i) That the proposal of the Kensington Borough Council be approved as a serious attempt to deal with what has hitherto been a problem of the utmost difficulty. (ii) That the survey referred to be confined to houses coming within the purview of the Housing Acts, there being no obligation to keep records separate to those already being compiled under the Housing Regulations, 1925. (iii) That standards be laid down on which to make declarations of unfitness of underground rooms. (iv) That provision be made for deciding the ultimate user of underground rooms closed for all living purposes. (v) That concreting be an alternative to other methods for dealing with basement floors. (vi) That copies of this report be forwarded to the Metropolitan Boroughs' Standing Joint Committee and to the Kensington Borough Council. 96 INSPECTION AND SUPERVISION OF FOOD. The promotion by the London County Council, at the request of the Metropolitan Borough Councils, of a Bill embodying proposals relating to food legislation, was the most important feature in this branch of public health administration during the year. A summary of these proposals is given below. It should be noted that most of these proposals for London were already enacted for certain provincial cities some years ago. Those which deal with registration have the object of bringing certain other food premises within similar standards to those which have been applied to dairies and milkshops for many years. In certain districts of London, premises for the sale of ice cream, potted and preserved meats were observed to be conducted in a manner likely to encourage contamination of food both in regard to premises as well as to methods. It was therefore considered that requirements incidental to registration would prevent those who do not make any attempt to conduct their businesses in a clean and wholesome manner from causing danger to the public health. To the vast majority of traders registration is automatic. They need have no apprehensions. The main provisions of the Bill may thus be summarized:— L.C.C. General Powers Bill, 1932—Part III. During the autumn a great deal of work was done in preparing reports and evidence in connection with the public health part of this Bill. Powers are sought in the Bill to :— (1) Refuse Registration or remove from the Register Ice Cream premises. Certain premises to be exempted while factories will be included. (2) Register premises where cooked and potted meats and fish and other preserved food is sold. Likewise to refuse registration or remove such premises from the register. Certain premises are exempt. (3) Require notification of cases of food poisoning or suspected cases of food poisoning. (4) Make By-laws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for sale of any article intended to be sold for food. (5) Apply Section 47 of the Public Health (London) Act, 1891, to food exhibited or given away as prizes at public gatherings. At the present time unsound food can be seized only if it is prepared or stored for sale or exposed for sale, etc. 97 (6) Amend Section 16 of the Housing Act, 1930. This would enable the L.C.C. to deal with clearance areas of less than eleven dwelling houses which it is not empowered to do at present. Merchandise .Marks Act, 1926, and The Agricultural Produce (Grading and Marking) Act, 1928. The administration of the orders made under the abovementioned Acts still demands a great amount of the time of the Food Inspectors. During the year 785 inspections were made for the purposes of these Acts. The requirements of the numerous orders and regulations have been carried out by the traders concerned in a satisfactory manner and in no case was it found necessary to resort to legal action. Verbal warnings were given in 54 cases where failure to mark properly arose from careless oversights. The Artificial Cream Act, 1929. At the beginning of the year there was only one place in the City registered for the manufacture of " artificial " cream, but during the year the firm moved their factory to larger premises outside the City and the address was therefore removed from the Register. The two other places where it is made 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 17 1 sample was taken for bacteriological analysis. 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. Five samples of Certified milk from the same producer were requested to be examined bacteriologically by the Ministry of Health. Only one retailer in the City obtained this grade of milk from the producer in question and he was unable to obtain from the producer more than one sample, but it should be pointed out that this producer's milk is sampled in other districts. The sample was found to comply with the bacteriological standards of the order. Pasteurization of milk is not undertaken at any premises in the City. (6862) G 3 98 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, 1930 175 148 Registered during the year 5 35 Removed from the register 3 16 (ceased or transferred business) Registered to 31st December, 1931 177 167 The inspectors paid 272 visits to milk shops and dairies during the year and it was not found necessary to serve any notices. During the year delivery of milk put in cartons of papier mache at the farm was introduced by a dairy firm. This method involves a minimum of handling and the possibilities of filling milk into unwashed bottles and other insanitary customs cannot occur. The containers are delivered to the consumer sealed up as they left the farm and when empty can be immediately destroyed. Grocers and provision dealers have taken up the marketing of this product; their premises do not require to be registered as dairies, but they themselves must be registered as dairymen. In 1931, 9 were thus registered and 4 samples of this milk proved genuine on analysis. Milk and Dairies (Consolidation) Act, 1915. During the year 66 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 50 of the requests were in proper legal form, 16 were quite inadmissible in that they specified neither time nor place where the samples could be taken nor did they express a request for such samples to be taken. It is important to note that there is no obligation on the Local Authority to take the extra samples from the consignor unless the. request is submitted in due legal form and lodged with the authority within 60 hours of the taking of the original sample. Unless the precise requirements of the schedule are observed a warranty cannot be pleaded. All the 66 samples were found on analysis to be " genuine." 99 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 1931 are given in the following table :— Table I. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Percent. No. Per cent. North 466 187 40.2 245 52.6 32 6.8 2 0.4 South 444 395 89.0 40 9.0 7 1.6 2 0.4 1931 910 582 63.9 285 31.3 39 4.2 4 0.4 1930 910 396 43.5 431 47.3 62 6.8 21 2.3 1929 867 323 37.2 422 48.6 79 9.1 53 6.1 1928 904 410 45.3 373 41.2 101 11.1 20 2.2 1927 914 511 54.1 345 36.5 71 7.5 17 1.8 1926 910 502 55.1 298 32.7 100 10.9 10 1.0 1925 970 489 50.4 368 37.9 98 10.1 15 1.6 1924 994 507 51.0 363 36.5 105 10.5 19 1.9 1923 997 458 45. 9 368 36.9 149 14.9 22 2.2 1922 998 493 49.4 338 33.8 138 13.8 29 2.9 1921 977 449 45.9 362 37.0 131 13.4 35 3.5 1920 987 321 32.5 400 40.5 236 23.9 30 3.0 The quality of the milk sampled has improved this year in comparison with that of last year. The percentage of adidterated samples being only 0.4. Of the total 910 samples of milk taken during the year, 28 were obtained on Sundays. These latter all proved genuine on analysis. 100 Legal Proceedings for Adulteration.—Of the 4 adulterated samples, 3 were considered sufficiently serious to warrant prosecution. Details of the offences and results of proceedings are set out below. Milk— Fine. Costs. 6 per cent, of fat abstracted £2 0s. 14.s. 6d. 8 per cent, of added water £3 0s. — 35 per cent, of fat abstracted Summons dismissed £5 5s. (Probation of Offenders Act) Notices were served in two instances for not having any name or address on the Vendors' barrows. The infringements were remedied without any legal actions being taken. Condensed Milk Regulations, 1923-1927. Fifty-one samples were taken, and were found to be properly labelled and genuine, except one, which was an " informal" sample and deficient in fat to the extent of 1*9 per cent. Formal sample genuine. Dried Milk Regulations, 1923-1927. Seven samples were taken, two of which were reported adulterated. These 2 samples were proprietary articles sold as "humanised milk." The analyst reported the samples to be " adulterated " owing to the fact that the percentage of fat was less than the amount normally found in " humanised milk " formulae. The manufacturers were communicated with and stated in their reply that the low fat content of the product was compensated by the addition of Vitamin D., and also by reason of the fact that the constitution of the product is specially designed for treating cases of fat intolerance in infants. The matter was not further pursued. 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, 101 pickles and sauces made from fruit or vegetables. Four infringements of these regulations were found as the result of analyses of samples. Table II. Food and Drugs (Adulteration) Act, 1928. Samples purchased under the Food and Drugs (Adulteration) Act, showing results of Analysis and subsequent Proceedings for year 1931. r. Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. , £ s. d. £ 8. d. i Apples 2 2 — — — — — — 2 Baking Powder 6 6 — — — — — — 3 Brandy 19 19 — — — — — — 4 Butter 143 143 — — — — — 5 Caviare 8 8 — — — — — — 6 Cheese 2 2 — — — — — — 7 Cocoa 25 25 — — — — — 8 Coffee 25 25 — — — — — 9 Confectionery 2 2 — — — — — — 10 Cream 74 74 — — — — — — 11 Drugs 23 21 2 — — — — — 12 Fish Preparations 43 43 — — — — — — 13 Flavouring Essences 3 3 — — — — — — 14 Fruit Cordials 16 16 — — — — — — 15 Gin 21 19 2 i — 1 — 3 3 0 16 Grapes 1 1 — — — — — 17 Ice Cream 11 11 — — — — — — 18 Jams and Preserves 37 36 1 — — — — 19 Margarine 37 37 — — — — — — 20 Meat Preparations 72 72 — — — — — — 21 Milk 910 906 4 3 2 1 5 0 0 5 19 6 22 Do. Condensed 51 50 1 — — — — — 23 Do. Dried 7 5 2 — — — — — 24 Olive Oil 1 1 — — — — — — 25 Pickles and Sauces 9 9 — — — — — 26 Preserved Fruits 36 36 — — — — — 27 Preserved V egeta bles 23 23 — — — — — 28 Rum 11 11 — — — — — 29 Sausages 78 75 3 3 2 1 2 0 0 2 0 0 30 Spices 23 23 - — — — — — 31 Sugar 1 1 — — — — — 32 Tea 37 37 — — -— — — 33 Whisky 42 39 3 2 2 — 13 13 0 34 Wine 13 13 — — — — — — 1,812 1,794 18 9 4 5 7 0 0 24 15 6 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. 102 The foregoing table 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. Jams and Preserves.—Thirty-seven samples of various kinds were purchased and one (informal), namely, green fig and ginger marmalade, contained 75 parts of sulphur dioxide (35 parts in excess of what is allowed). An official sample taken subsequently was analysed and found to be genuine. Sausages.—Seventy-eight samples were taken, and in three instances the presence of preservatives was not declared by means of labels as required by the Regulations. The quantity of sulphur dioxide present was found to be well within the prescribed limit. Two of the vendors were fined £1 each, one having to pay £2 costs. In the remaining case the magistrate came to the conclusion that there was some doubt in the matter, and dismissed the summons. Drugs.—Twenty-three samples were taken. One sample of light oxide of magnesia was found to lose on ignition 6-94 per cent, instead of not more than 1 per cent.; it also contained an appreciable quantity of carbon dioxide. One sample of light magnesia consisted entirely of light carbonate of magnesia. Both these adulterated samples were unofficial. Subsequent official samples obtained were on analysis found to be genuine. ' aiiie-J Caviare.—The question of preservatives in caviare was discussed during the year. The federation of caviare importers reported that they were still experimenting with methods such as cold storage to obviate the illegal practice of adding boric acid as a preservative. A prosecution had taken place in 1930 in respect to caviare containing boric acid. Samples of caviare taken in 1931 contained no preservative. Regulation of Steeet Trading. The London County Council (General Powers) Act, 1927, provides for the regulation of street trading by the issue of licences which must be renewed annually. Special observation is kept by the Food Inspectors on all stalls where food is exposed for sale and also the premises where it is stored. Where stall-holders have their food stores in other districts the addresses are forwarded for the attention of the sanitary authorities concerned. 103 The number of stalls registered in the City on which food is exposed for sale is about 250, 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 1931 was 136. The inspectors paid 174 visits to these premises. In one case it was found that the walls of the cutting room were in a very defective condition and on the service of a notice the matter was remedied. In another case a stall was found to be without any side curtains ; this was immediately remedied on the attention of the owner being called to it. 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 2,703, 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 106 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 104 and 1,212 restaurants have already been indexed. During the year 1,318 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 61 instances, and in each case the work was satisfactorily carried out. Suspected Food Poisoning.—Information was received from the proprietor of a high-class restaurant in the City concerning a mysterious malady which affected about 10 of the staff, over a period of 14 days. The symptoms were similar in every case, sickness followed in some instances by cramp in the stomach. Suspicion pointed to a male member of the kitchen staff who frequently visited the lavatory and was not very clean in his personal habits, and tests were made of his blood and faeces as well as of 3 samples of milk taken in the cafe. Bacteriological examinations were carried out with regard to these samples with negative results. The man did not return to work at this restaurant and no further cases were reported. Fish Shops and Fried Fish Shops were periodically inspected. There are 31 of these shops in the City to which the Food Inspectors paid 26 visits. Six of these are classified as restaurants, and inspections to them are returned as restaurant inspections. 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 42 visits to premises where ice cream is manufactured, etc. The conditions in all cases were satisfactory. Bakehouses—At the end of 1931 there were 60 bakehouses in the City, of which 45 were underground. During the year, two above-ground bakehouses were discontinued as such. 189 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 105 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 22 8 — — Mandarins — — 1 2 Asparagus — — 3 10 Melons 3 6 2 — Aubuergines — — 3 — Oranges 4 12 — — Bananas 8 10 — — Peaches — 3 1 7 Beans — 5 — 26 Pears 41 16 — — Black currants — 1 2 12 Pineapples — 2 2 — Carrots 3 — — — Plums 1 17 2 — Cauliflower — 4 3 — Potatoes 4 8 — — Celery — — — 14 Prawns — — — 14 EDdive — — — 7 Radish — — 2 9 Fish — 5 2 14 Raspberries — 4 — — Gooseberries — 1 3 24 Spinach 1 15 3 9 Grapefruit 6 14 — — Strawberries — 7 1 2 Bam — 2 2 8 Tomatoes — 12 2 — Lemons 4 5 — — Turnips — 1 — — Lettuce 2 17 — 7 No seizures of unsound food were made during the year. Certification of Food for Export.—Certificates enabling the export of certain articles of food were granted in five instances—four to Canada and one to Italy. Table III. Food and Drugs (Adulteration) Act, 1928. Spirit Samples, 1931. Ninety-three Samples of whisky, brandy, rum and gin were taken during the year. In five 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. Degrees U.P. Action taken and Result. 160N. Gin 53.7° Dismissed under Probation of Offenders Act on payment of £3 3.s. costs. 332N. Gin 36.6° Caution. 497N. Whisky 46.66° Dismissed under Probation of Offenders Act on payment of £10 10s. costs. 499N. Whisky 38.55° Dismissed under Probation of Offenders Act on payment of £3 3s. costs. 571N. Whisky 37.43° Caution. 106 Nutrition—Dissemination of knowledge.—There is a note in the Ministry circular under the Inspection and Supervision of Food section and it is implied that the dissemination of knowledge concerning nutrition should be specially reported upon. Education in the selection of proper dietaries and foodstuffs has always been an important activity of the maternity and child welfare centres. It is believed that it also forms an important item in the syllabus of the elementary and secondary schools being included in the teaching of hygiene and also, as regards girls, in the cooking classes. It is certain that a knowledge of nutrition is a factor of great importance to the public health. Each year brings fresh discoveries of the influence of food on health and disease and it is not improbable that in some future time it may be found that many chronic bacterial invasions, and perhaps some acute infections owe their striking power in the first place to some error or deficiency of diet.