City of Westminster. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR . - 1932 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. City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1932 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 r N ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. III CONTENTS. page Introduction vii Statistics and Social Conditions of the Area 1 Births 9 Deaths 12 Causes of, compiled by Medical Officer of Health 15 „ „ „ „ Registrar General 12 Common Lodging-House. 27 Distribution of, in Wards 15, 20 Infantile Mortality 20 Stillbirths 14 Meteorological 5 Population 5 Staff of the Public Health Department 2 Statistics, General and Vital 1 Prevalence of, and Control over, Infectious Diseases 27 Anthrax 36 Bacteriological Laboratory 38 Cancer 37 Cerebro-spinal Fever 36 Chicken-pox 36 Diarrhœa and Enteritis 35 Diphtheria 33 Anti-toxin 34 Schick Test Immunization 33 Encephalitis Lethargica 36 Enteric Fever 34 Influenza 35 Measles 34 Mumps 36 Notifications 31 Ophthalmia Neonatorum 36,61 Poliomyelitis 36 Puerperal Fever 36 Puerperal Pyrexia 36 Scarlet Fever 33 Small-pox and Vaccination 28 Tuberculosis 38 Deaths and non-notified deaths 43, 45 Dispensary Report 46 Returns (Ministry of Health) 49 Notifications—primary 40 Tables 38 Whooping Cough 35 General Provision of Health Services in the Area 51 Ambulance facilities 52 Ante-natal cases 55 Ante-natal clinics 56 Ante-natal visiting 55 a 2 IV page General Provision of Health Services in the Area—(contd.) 51 Barlow's Gift 54 Children Act, 1908 54 Clinics and Treatment Centres 52 Convalescence 62 Day Nursery 63 Dental Treatment 61 Disinfection 64 Health Visiting 54 Hospitals 52 Infant Clinics 58 Insulin Treatment 63 Laboratory facilities 51 Maternal Mortality 53 Maternity and Nursing Homes 52 Maternity Beds 53 Midwifery Services 56 Midwives 51 Mothercraft 56 Milk, supply of 63 Mortuaries 65 Nursing in the Home 51,60 Unmarried Mothers, Homes for 63 Sanitary Circumstances of the Area 66 Dogs, Fouling of Footways by 79 Drainage and Sewerage 66 Local Government Act—Transfer of Powers 80 Ministry of Health Survey 81 Outworkers 74 Pigeons, Nuisance from 80 Premises and Occupations—Controlled by Local Authority 78 Public Swimming Baths, etc 66 Rat Repression 79 Rent Acts 70 Sanitary Inspection of the Area 70 Factories, Workshops and Workplaces 72 Nuisances—Intimation, Statutory Notices, etc. 71 Public Cleansing 67 Smoke Abatement 75 Water Supply 66,71 Housing 82 General Observations 82 Overcrowding 89 Rehousing 85 Statistics required by Ministry of Health 89 Underground Rooms 87 Inspection and Supervision of Food 91 Artificial Cream Act, 1929 93 Condensed Milk Regulations, 1923-1927 96 Dried Milk Regulations, 1923-1927 96 Food and Drugs (Adulteration) Act, 1928 95 Samples, results of analysis, action taken, etc.97 Food, Inspection and Destruction of 100 Food Order, 1921 99 Meat Regulations, 1924 99 V page Inspection and Supervision of Food—(contd.) 91 Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928 93 Milk and Dairies Amendment Act, 1922 94 Milk and Dairies (Consolidation) Act, 1915 95 Milk and Dairies Order, 1926 94 Milk Samples 95 Nutrition 101 Preservatives in Food Regulations, 1925-1927 96 Restaurants and other Food Premises 100 Spirit Samples 98 Street Trading 99 VII Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 3 2. Me. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1932. The report is prepared in accordance with the requirements of Circular 1269 issued to all local authorities by the Minister of Health. On this occasion under certain headings the Minister requires information only where alterations or developments have taken place. It has thus been possible to deal with a number of subjects quite briefly and so pay regard to the Minister's suggestion in his " economy report " that annual reports might be somewhat shorter. The birth-rate is the lowest yet recorded in Westminster and again indicates the high proportion in the population of unmarried persons and those in groups beyond a fertile age. The death-rate is lower than last year chiefly because of a milder spring ; the infantile mortality rate is considerably lower and the death rate from tuberculosis is the lowest for some years. The number of cases notified, both pulmonary and nonpulmonary, however, is somewhat higher. A commentary on certain features arising out of the 1931 census will be found under vital statistics, and also under housing. The incidence of diphtheria was notably less last year. A special report is submitted on the work of the Diphtheria immunisation clinic. Housing is not dealt with in the detailed manner of the 1930 report but the progress of the Council's housing schemes is indicated and the improvement in overcrowding and occupation of underground rooms which has been taking place for some years past is noted. Appropriate extracts from the 1931 census are quoted which confirm these statements. Next year I hope to be in a position to report on the action taken by the Council on the Minister's Circular No. 1331 re slum clearance programmes. VIII In maternity and child welfare, maternal deaths number 5 as contrasted with 10 last year, and the fact that increasing use is being made of the Council's indoor and outdoor midwifery scheme give grounds for gratification. While owing to prevailing unemployment expenditure on milk grants on medical grounds for mothers and infants has increased in 1932, there is good reason to believe that unemployment in the City during the first half of 1933 has fallen considerably. The issue of these grants is governed by a scale of income. In spite of the hardships of many families the general state of nutrition has been maintained and is reflected in the lowered infant death rate, tuberculosis death rate and general death rate. An increase in plans of drainage work, implying as it does more employment, reflects a welcome tendency to a revival of business. Proposed changes in the byelaws of the L.C.C. governing cleansing, storage and removal of refuse receive comment; likewise the suggested byelaw to permit a combined soil and waste pipe in house drainage. New methods of the estimation of sulphur gas in the air were begun last year and figures for a complete year are now submitted. Atmospheric pollution is a matter of widespread importance, but few local authorities take a really active interest in it. The City Council has for some years pursued investigations with all the scientific methods available, and now that the new Battersea Power Station has come into operation certain of the objects of these investigations may be more clearly discernible. The Mortuary at Horseferry Road required to be brought up to date. A sub-cominittee to which the matter was referred has almost completed successfully its entire re-organisation. With its new chapel, preservation chambers and laboratories the mortuary premises are one of the most modern and well equipped in the country. The vacancy which occurred in 1931 by the retirement of Mr. Wheal, Disinfecting Superintendent, was filled by promoting Mr. S. C. West to the post of Disinfecting Foreman. In the latter's place Mr. N. Heathcote was appointed. In addition to duties of disinfection he acts as rat officer under the Rats and Mice (Destruction) Act, having been trained in methods of rat disinfestation under the Port of London Sanitary Authority through the kind offices of Dr. C. F. White, the port Medical Officer of Health. IX The percentage of adulterated samples continues to be minimal as compared with, say, a quarter of a century ago. The cleanliness and quality of food is improving but further improvement may be hoped for as a result of the new food legislation which is referred to in this report. Mr. Cecil H. Cribb, who had been a public analyst to the Council since its inception, died suddenly in July 1932. A man of much personal charm he was amongst the foremost in his profession. He possessed a truly scientific mind which, to seek the deeper implications of nature, ranged beyond the confines of his own speciality into the realms of kindred sciences. He had many valuable researches to his credit and his opinion was often sought by departmental committees on questions of food legislation. Mr. T. McLachlan, F.I.C., etc., his associate in analytical work, was appointed temporarily to succeed Mr. Cribb in July and became Public Analyst in December. Dr. P. J. Edmunds, Public Vaccinator of St. Anne and St. James district, resigned in December and his deputy, Dr. H. A. Morton Whitby, was appointed to the part-time post. No other changes in staff occurred throughout the year. In conclusion I wish to thank specially the Chairman, Vice-Chairman and members of the Public Health Committee for their kindness and consideration; also the members of other committees whom it is my honour to serve. I also wish to express my appreciation to the staff for their assistance in the work of the department and especially to my deputy, Dr. Thomson, for his help in preparing this report. It is a little late in publication owing to my time being taken up in the early part of this year in submitting a proof of evidence in connection with the Essex County Bill. Its publication would have been later still had it not been for his valued assistance. I have the honour to be, Your obedient Servant, ANDREW J. SHINNIE. July, 1933. 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. (Corrected figure—129,579.) Population, June, 1932 (Registrar General's Estimate)—126,400 Number of Inhabited Houses (1931)—22,536. Rateable value—£11,020,000 (March, 1933). Sum represented by a penny rate— £43,160. Extracts from Vital Statistics for the Year. Births— Males. Females. T otal. Birth-rate. Legitimate 535 485 1,020 9.1 Illegitimate 70 62 132 Totals 605 547 1,152 Stillbirths—32.7 per 1,000 births. Deaths—1,557. Death-rate—12.3. Number of women dying in, or in consequence of, childbirth:— Puerperal fever, 1 4.3 per 1,000 birth:- From other causes, 4 Number of deaths of infants under one year of age per 1,000 births 65.9. Legitimate rate, 49.0 ; Illegitimate rate, 196.9. Number of deaths from measles (all ages)—3. „ „ diphtheria—3. „ „ whooping cough (all ages)—2. „ „ scarlet fever—2. „ „ diarrhœa (under 2 years of age)—10. „ ,, typhoid fever—Nil. 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.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.1. 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) *Henry A. M. Whitby, M.R.C.S., L.R.C.P., Strand District 5 Great Marlborough Street, W.1. Vaccination Officer: James H. Lowe. 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, 3 Public Analysts : *Cecil H. Cribb (deceased 15/6/32) B.Sc., F.I.C. *P. A. Ellis Richards F.I.C. *T. McLachlan (temporary appointment 21/7/32 made permanent 15/12/32) A.C.G.F.C., F.I.C. 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, Certified Midwife, Dipl. Nat. Health Sec. Health Visitors: Miss A. Sanders Health Visitor's Certificate. Miss J. G Alexander Health Visitor's Certificate, Certified 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, Certified Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Miss H. Blick Health Visitor's Certificate, Certified Midwife, Board of Education Health Visitor's Diploma. Miss P. L. Luff Certified Midwife, Board of Education Health Visitor's Diploma. Miss E. M. Craigie Certified Midwife, Health Visitor's Certificate, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. 4 Clerical Staff : Arthur Wise (Chief Clerk). A. J. Manhood. S. G. Bennett, S.I.E.B., Meat and Food Cert. F. W. Lake. F. E. Norwood. W. Jenkins. Miss M. MacFarlane (Tuberculosis pensary). Instructor in Mothercraft at Centres. *Mrs. Coleman Red Cross Cert. 1st el., and gold medal. Disinfecting Staff. S. C. West, Foreman Disinfector, 1/1/32. W. Slattery, Engineer. J. Atkins, Disinfector. P. W. Attwater, Disinfector. N. Heathcote, Disinfector and Rat Officer (appointed 13/6/32). A. B. Holland, Disinfector. J. R. Doyle, Motor Driver. A. T. Steward, Assistant to Inspectors. W. H. Smith, Messenger. Mrs. Faulkner, Attendant, Verminous Children (appointed 1/1/32). Mortuary Staff. R. Watlino, Keeper of Mortuary and Coroner's Court. A. W. Nicholls, Mortuary Assistant. Caretakers and Cleaners. 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). 5 Meteorological. The weather during 1932 was notable for its marked variations at different times. Early January was comparatively warm and mild, then a spell of cold and windy but very dry weather lasted until the middle of March. Much rain fell in April, and more in May, but low temperatures continued. June was hot and very dry, and there was a further very hot period in August. The last months of the year were fairly normal, except that there was less frost than is usual in November and December. Snow lay on three days only during the year. In spite of two very hot spells, 1932 was, on the whole, deficient in sunshine—even more so than 1931. The average temperature, however, was not particularly low. From the health point of view the year was probably not a very good one. Marked variations are apt to be trying, and a high average of sunlight is more beneficial to health than occasional waves of hot weather. Population. The reports issued by the Registrar-General on the results of the Census of England and Wales which was taken in 1931 show that the City of Westminster had, at the time of the Census, a population of 129,579 persons, of whom 56,496 were males and 73,083 females. This shows a decrease since the Census of 1921 of 11,999 persons, approximately 8.5 per cent, of the population. The total population of England and Wales increased during the intercensal period by over two millions, or about 5.4 per cent. Although this is the highest total yet recorded, the increase was less than in any decennium since 1861, except during the War, and the percentage increase, with the same exception, was less than half as large as on any previous occasion. While this diminishing increase may not seem regrettable in times of depression, there is no doubt that the tendency, if it continues, will mean a waning population in the future. A dwindling birth-rate is by no means unique to this country, but our figures are now the lowest except those of Sweden. Variation in the population of any area is governed by the excess or otherwise of births over deaths, and by the balance of emigration from and immigration into the area. In England and Wales, as a whole, the birth-rate is still in excess of the death-rate, and its decline is to some extent mitigated by a decline in the death-rate—a decline which is of importance as it indicates a definite advance in the national vitality. All the large divisions of England, therefore, still show an increase in population, with the exception of South Wales. There are, however, 6 certain definite migrational trends which affect the distribution of the population. At the end of last century there was a general depopulation of rural areas, with a corresponding increase of all urban populations. Between 1901 and 1921 a balance appeared to have been established, and urban increases were simply the result of the natural increase of population in the towns themselves. In the last decennium, however, a new trend has become apparent. There is an increasing migration of population from the North and the Midlands to the South, and to the South-East and London in particular. This trend is distinct from certain marked local migrations from particularly distressed areas, and seems to indicate a new localisation of industrial centres. The result is a great increase in the population and the extent of Greater London. The tendencies mentioned must of course have an effect on the situation in Westminster, but the fact that the population of the City is falling shows that there are other more local factors which have an even greater effect. Of these, the fact that the birth-rate has fallen below the death-rate is certainly one, but this is not so far the primary factor, for of the percentage decrease of 8.5 of the population only 0.8 is due to excess of deaths over births, and the remaining 7.7 is attributable to migration. This migration is due to the process of decentralisation which is inevitable in all expanding towns, drawing workers to new non-central workplaces, and also to the continued invasion of residential quarters by commercial and administrative undertakings. This increases the economic importance of the City, but has also had the effect of raising property values, and so causing an increasing number of the poorer classes, especially those with large families, to seek places of residence in outlying localities. The recent influx of population into London is well shown in the Census figures for certain of the outlying Metropolitan Boroughs and for practically the whole of the " Outer Ring " of Greater London, but it has done little to stem the outward migration from Westminster and certain other Central London boroughs —although the percentage decrease (8.5) in the City of Westminster is certainly a little lower than the corresponding figure (11.7) for the previous decennium. This decentralisation of population is by no means new, and can be seen in the following population figures for the last sixty years :— 1871 247,593 1901 183,011 1881 229,573 1911 160,261 1891 198,966 1921 141,578 Greater London as a whole shows a percentage increase in population of 9.7, three times as great as the increase in the last decennium, and 7 twice as great as the increase for the country as a whole. This may be only a transient increase, but suggests the relative prosperity of the London area. This is confirmed by the comparatively low unemployment ratio, and should have resultant good effects on the health of the people. The following table shows the decrease of the population as it has affected the various wards of the City. Wards. Census 1911. Census, 1921. Census, 1931. Decrease on 1921 Census. Percentage Reduction on 1921 Census. Conduit 4,273 3,456 2,086 1,370 39.6 Grosvenor 14,223 13,880 13,318 562 4.0 Pall Mall 3,774 3,572 2,872 700 19.6 Regent 7,108 6,878 4,047 2,831 41.2 Great Marlborough 5,277 3,194 3,331 137* 4.3* St. Anne 9,280 6,699 5,405 1,294 19.3 Covent Garden 8,493 7,064 6,655 409 5.6 Charing Cross 4,908 4,650 3,210 1,440 31.0 Strand 3,458 2,116 2,052 64 3.0 Victoria 37,816 37,396 36,955 441 1.2 Knightsbridge St. George 13,794 12,563 11,445 1,118 8.9 Hamlet 7,692 6,687 6,461 226 3.4 St. Margaret 11,302 9,261 8,671 590 6.4 St. John 28,857 24,162 23,071 1,091 4.5 * Increase. It may be noted that the wards which show the greatest decrease in proportion to population are those, such as Regent, Conduit and Charing Cross, which have long since ceased to be primarily residential quarters Great Marlborough ward shows a small increase, and Strand a very smal decrease. As the population of these two wards, like one or two others has fallen by over 50 per cent, since the beginning of the century, it is possible that the full effect of decentralisation has already been felt ir these wards, and that a balance has been established. The following table throws some light on the age distribution of the population of the City of Westminster, as compared with that of the Administrative County of London as a whole. The succeeding table gives a similar comparison with regard to marital condition. Age Distribution per 1,000 of each sex. (Age last birthday.) Age. City of Westminster. Administrative County of of London. Male. Female. Male. Female. 0-4 44 33 73 63 5-19 180 157 254 225 20-39 372 394 331 340 40- 404 416 342 372 b 8 Marital Condition distribution -per 1,000 of each sex. City of Westminster. Administrative County of London. Male. Female. Male. Female. Single 534 574 524 517 Married 426 312 438 384 Widowed or divorced 40 110 38 99 These tables give a good indication of certain of the special features of the population of the City. It is essentially an older population, the average age being 35.5 years for males and 36.9 for females, as compared with the averages for the whole County of 32.0 and 33.9 The preponderance of females over males is above the average for the County, and the proportion of single persons, especially females, is high. The last facts, and the greater number of married women who are over childbearing age in an older population, account largely for a low birth-rate. The relatively very low proportion of children in the population is due to this low birth-rate, and to the fact that the larger families are particularly apt to move away from Central London. The City offiers much employment to single persons in resident posts as hotel, club or domestic servants, and to married couples without children as caretakers. 17.2 per cent, of the population recorded in the Census were resident in hotels, boarding houses and lodging houses, as compared with 3.6 over the whole County. The following tables give details of the population with regard to habitation. The table in respect of the 1921 Census is inserted for comparison. Habitation. Persons. Percentage. Dwellings occupied by private families 101,442 78.4 Hotels, Boarding Houses and Lodging Houses 22,300 17.2 Schools and Educational Institutions 522 0.4 Civilian Hospitals and Nursing Homes 1,957 1.5 Institutions for Physically Defectives 23 0.0 Prisons 45 0.0 Naval, Military and Air Force Premises 2,986 2.3 Civilian Ships, Boats and Barges 31 0.0 All others (including Vagrants) 273 0.2 TotaL 129,579 100.0 9 Census, 1921. Wards. Persons. Males. Females. Private Families. Population in private Families. Charing Cross 4,650 2,317 2,333 605 1,162 Conduit 3,456 1,281 2,175 622 2,135 Covent Garden 7,064 3,345 3,719 1,498 5,908 Great Marlborough 3,194 1,492 1,702 813 2,611 Grosvenor 13,880 4,934 8,946 2,661 11,730. Hamlet of Knightsbridge 6,687 2,012 4,675 1,382 5,632 Knightsbridge St. George 12,563 4,280 8,283 2,572 11,370 Pall Mall 3,572 1,831 1,741 425 1,812 Regent 6,878 3,131 3,747 1,211 4,132 St. Anne 6,699 3,315 3,384 1,807 5,118 St. John 24,162 11,509 12,653 6,944 21,464 St. Margaret 9,261 4,128 5,133 2,168 7,080 Strand 2,116 1,402 714 178 645 Victoria 37,396 16,403 20,993 11,060 31,697 141,578 61,380 80,198 33,946 112,496 Census, 1931. Wards. Persons. Males. Females. Private Families. Population in private Families. Charing Cross 3,210 1,567 1,643 558 1,599 Conduit 2,086 787 1,299 414 1,170 Covent Garden 6.655 3,158 3,497 1,380 4,232 Great Marlborough 3,331 1,569 1,762 988 3,228 Grosvenor 13,318 4,978 8,340 2,801 10,146 Hamlet of Knightsbridge 6,461 2,073 4,388 1,299 5,418 Knightsbridge St. George 11,445 3,898 7,547 2,554 10,277 Pall Mall 2,872 1,462 1,410 476 1,339 Regent 4,047 1,881 2,166 582 1,623 St. Anne 5,405 2,645 2,760 1,474 4,366 St. John 23,071 11,146 11,925 6,625 20,291 St. Margaret 8,671 3,469 5,202 1,929 5,897 Strand 2,052 1,411 641 155 445 Victoria 36,955 16,452 20,503 11,821 31,411 129,579 56,496 73,083 33,056 101,442 Births. The births registered in Westminster during 1932 numbered 1,608, but of these the homes of 942 were in other districts and 12 were registered under the Legitimacy Act, and have therefore to be deducted from the total. There were, however, 498 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,152, which is 59 less than the similar figure for 1931. The Birth Rate of 9.1 is the lowest ever recorded in the City of Westminster. B 2 10 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 942 in 1932, 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 art also less than last year. The comparative net totals are:— 1930. Legitimate. 1931. Legitimate. 1932. Legitimate. Males 603 515 535 Females 599 548 485 Illegitimate. Illegitimate. Illegitimate. Males 93 70 70 Females 73 78 62 1,368 1,211 1,152 Table I. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 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 1,375 552 (20) 576 1,399 1,205 1,169 36 1928 1,471 643 (23) 542 1,370 1,404 1,362 42 1929 1,577 758 (7) 538 1,357 1,532 1,474 58 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 1932 1,608 954 (12) 498 1,152 1,594 1,538 56 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. 11 The legitimate and illegitimate births are distributed as follows:— Table II. Legitimate. Males 764 - 436 + 207 = 535 Females 738 - 431 + 178 = 485 1,502 — 867 + 385 = 1,020 Illegitimate. Males 60 — 49 + 59 = 70 Females 46 - 38 + 54 = 62 106 — 87 + 113 = 132 The legitimate births show a decrease of 43 and the illegitimate a decrease of 16 on the figures of 1931. As shown in Table I, 1,594 notifications of births were received by the Department for 1932 as compared with 1,589 in 1931. Of the total of notifications, 692 were sent by midwives, of whom 30 were practising in the City during 1932. The following Table shows the number of male and female children born since 1916, 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. 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 1932 605 547 41 35 564 512 For each 1,000 girls born, there were in— 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. 1923 1,082 boys. 1932 1,106 boys. 12 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 Metropolitan Borough of Westminster, 1932. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45- 55- 65— 75— All Causes M. 830 43 8 5 9 33 30 55 108 148 227 164 F. 746 36 5 7 9 21 39 55 87 116 166 205 1. Typhoid and paratyphoid fevers M. - - - - - - - - - - - - F. - - - - - - - - - - - - 2. Measles M. - - - - - - - - - - - - F. 3 1 1 — 1 - - - - - - - 3. Scarlet fever M. 1 - - - - - 1 - - - - - F. 1 - - - 1 - - - - - - - 4. Whooping-cough m. 1 - - 1 - - - - - - - - F. 1 1 - - - - - - - - - - 5. Diphtheria M. 2 - - - 2 - - - - - - - F. 1 - - - - - - - - - - - 6. Influenza M. 23 - - - - 1 1 - 3 1 8 9 F. 39 — — — — 1 1 — 5 11 7 14 7. Encephalitis lethargica M. - - - - - - - - - - - - F. - - - - - - - - - - - - 8. Cerebro-spinal fever M. 5 1 - 1 — 2 1 - — — - - F. - - - - - - - - - - - - 9. Tuberculosis of respiratory system M. 67 1 - - 1 11 7 17 13 10 6 1 F. 28 — — — — 7 9 6 3 1 1 1 10. Other tuberculous diseases M. 8 - 2 - 1 3 1 1 - - - - F. 7 — 1 1 — 2 2 1 — — — — 11. Syphilis M. 4 2 - - - - - - 2 - - - F. 5 — — — — — 1 2 1 — 1 — 12. General paralysis of the insane, tabes dorsalis M. 10 - - - - - - 3 3 2 2 — F. 2 - - - - - - 1 1 — — — 13. Cancer, malignant disease M. 95 - - - - - 1 5 10 28 40 11 F. 94 - — — — 1 6 20 24 26 17 14. Diabetes M. 6 - - - - - - - - 1 2, 3 F. 11 - - - - - - - - 5 3 3 15. Cerebral haemorrhage, etc. M. 25 - - - - - - - 3 8 7 7 F. 40 - - - - - 1 2 4 7 16 10 16. Heart disease M. 213 — 2 1 1 2 18 39 80 70 F. 166 — — — — 1 3 5 12 26 45 74 17. Aneurysm M. 8 - - - - - - 1 4 1 2 - F. 7 - - - - - 1 2 1 1 1 1 13 Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 18. Other circulatory diseases M. 27 - - - - - - - 3 5 6 13 F. 33 - - - - - - - 2 3 12 16 19. Bronchitis M. 34 2 - - - - - 4 3 5 9 11 F. 26 1 - - - - - - - 5 8 12 20. Pneumonia (all forms) M. 54 4 1 — - 4 1 4 9 11 16 4 F. 60 6 — 3 4 — 3 2 5 6 14 17 21. Other respiratory diseases M. 10 - - 1 - — - 2 2 4 1 — F. 6 - - - - - 1 2 1 — 1 1 22. Peptic ulcer M 16 - - - - - 3 3 4 1 4 1 F. 1 - - - - - - - 1 - - - 23. Diarrhœa, etc M 6 3 2 - - - - - - - 1 - F. 7 5 - — — — — 1 1 — - — 24. Appendicitis M 5 - - - - - - 2 - 1 1 1 F. 11 — — — — 2 1 1 2 1 3 1 25. Cirrhosis of liver M 8 - - - - - - - 3 2 3 - F. 6 - - - - - 1 1 2 1 1 — 26. Other diseases of liver, etc. M. 4 — — — — — — 1 3 — — — F. 1 - - - - - - - - 1 - - 27. Other digestive diseases M. 18 — — — — 1 2 2 4 3 4 2 F. 11 — — 1 — — — 1 3 2 3 1 28. Acute and chronic nephritis M 18 - - - - - - - 5 4 7 2 F. 21 — — — — 1 1 2 5 4 4 4 29. Puerperal sepsis F. 2 - - - - - - - - - - - 30. Other puerperal causes F. 4 — — — — 1 — 3 — — — — 31. Congenital debility, premature birth, malformations, etc. M. 17 17 - - - - - - - - - - F. 19 18 - - - - 1 - - - - - 32. Senility M 5 - - - - - - - - - - 5 F. 16 - - - - - - - - - 2 14 33. Suicide M 24 - - - - 2 4 4 5 4 4 1 F. 18 — — — — 1 2 7 4 2 2 — 34. Other violence M. 46 9 - 1 1 5 3 4 4 7 7 5 F. 33 2 2 1 2 1 5 2 3 5 5 5 35. Other defined diseases M. 69 4 3 1 2 3 4 - 7 11 16 18 F. 65 2 1 — 1 3 4 7 11 11 11 14 36. Causes ill-defined, or unknown M. 1 - - - - - - - - - 1 — F. 1 - - - - - - 1 - - - - 14 Still.births.—56 still.born children were notified during the year, 40 of this number being born to non.residents of Westminster. The corresponding figure for 1931 was 53. Under the Births and Deaths Registration Act, 1926, which came into force on 1st July, 1927, all stillbirths must be registered. Still.births Inward Outward Registered. Transfers. Transfers. Total Legitimate and Males 44 9 29 Illegitimate Females 19 10 14 Males 3 3 3 Illegitimate Females 3 1 3 A statement showing the number of cases of certain infectious diseases in the City during the 52 weeks ended 31st December, 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. 3 213 84 7 7 8 49 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Smallpox, 0.05 ; scarlet fever, 2.12 ; diphtheria, 1.08 ; enteiic fever, 0.06; puerperal pyrexia, 0.14 ; puerperal fever, 0.05 ; and erysipelas, 0.36.) 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. 26 cases of Diphtheria and Scarlet Fever were discharged from hospital owing to incorrect diagnosis during 1932. 15 MALES Table IV.—Causes of, and Ages at, Death during the year 1932. Corrected Deaths in tub City at subjoined Ages. Deaths in Wakes (at all Ages). Causes of Death. All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. | Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox. — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever 1 — — — — — 1 — — — — — — — 1 — — — — — — — — — Influenza 21 — — — 1 — 4 16 — 4 — 4 4 1 2 — 2 1 1 2 — Whooping.cough 1 — — — — — — — — — — — — — 1 — — — — — — — — Diphtheria, Memb. croup 2 — — — — — — — — — — — — — 1 — — 1 — — — — — — Cerebrospinal meningitis 5 1 — 1 — 2 1 — — — — — 1 1 — 2 1 — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — —— — — — — — — — — — — — — — — — Diarrhœa, enteritis 5 3 1 — — — — — 1 — 1 — — 1 — 2 1 — — — — — — Erysipelas 3 1 — — — — — 1 1 1 — — — 1 — 1 — — — — — — Other septic diseases 8 — — 1 — — 1 2 4 — — 1 — 2 — 3 — — 1 1 — — — — Syphilis, &c. 5 2 — — — — 1 1 1 — — — — 1 — 1 — — — — — — 1 2 Diabetes 5 — — — — — — 1 4 — — — — — 1 — 1 — — 1 1 1 — — Rheumatic fever 2 — — — — 1 1 — — — — — 2 — — — — — — — — — — Tuberculosis of lungs 66 — — — 1 11 24 23 7 — 4 1 2 19 1 27 2 1 — 2 — 3 4 — Other forms of tuberculosis 10 1 2 — 1 3 3 — — — 1 — — 1 — 3 1 1 1 — — — 1 1 Malignant growths 90 — — — — — 4 37 49 — 6 1 5 22 7 25 5 — 4 3 — 7 2 Congenital debility, malformation, ana premature birth 19 19 — — — — — — — — 1 — 2 6 — 3 — — — 1 — 1 — 5 Old age 6 — — — — — — — 6 — — — 1 2 — 1 2 — — . — — — — Meningitis and convulsions 4 — 1 — 1 1 — 1 — — — — — 1 — 3 — — — — — — — — 16 MALES—Table IV (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wabds (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Kniehtsbridge. 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 8 — — — — — 2 5 1 — — — — 4 — 2 — — — — — — 1 1 Other diseases of nervous system 7 — — — — — 2 1 4 — — 1 3 — 2 — — — — — — 1 — Valvular diseases of heart.. 8 — — — 1 — — 6 1 — 1 — 1 3 — 1 — — 1 — — 1 — — Other circulatory diseases 194 — — — — 2 2 62 128 1 14 4 23 52 13 44 7 2 3 6 5 5 14 4 Bronchitis 84 2 — 1 — — 4 19 58 — 1 2 5 19 2 35 3 2 2 2t — 5 4 2 Broncho.pneumponia 46 3 2 — — 2 4 15 20 — 5 1 1 15 4 9 — — — 2 1 5 3 — Pneumonia, other forms 32 1 — — 1 3 5 13 9 — 2 1 3 8 1 8 3 1 ? 21, — — 1 — Other respiratory diseases 7 1 — — — — 1 3 2 — 1 — — 1 1 3 1 — — — — — — — Alcoholism 3 — — — — — — 2 1 1 — — — 1 — 1 — — — — — — — — Cirrhosis of liver 9 — — — — — — 6 3 — 8 — 1 2 — 2 — — — — — — — 1 Appendicitis and typhlitis 5 — — — — — 3 1 1 — — — — — — — — — — — — — — — Other digestive diseases 30 1 1 — — — 8 12 8 — — 1 3 6 — 10 2 3 — 1 — — 1 1 Bright's disease, &c. 28 — — — — — — 16 12 — 1 2 4 6 1 5 — — 2 — 1 — — — Cystitis, &c. 32 — — — — 1 1 4 26 — 3 — 3 6 2 11 1 — 1 1 2 2 — — Deaths by accident or negligence.. 42 4 — 1 1 4 8 11 13 — 6 2 2 12 1 10 1 — 2 2 — 2 — 1 Deaths by suicide and murder 24 — — — — 2 8 10 4 — — 1 1 8 — 5 1 — 1 2 — 2 — 3 Other defined diseases 12 2 1 — — 1 3 2 3 — 1 — 2 5 1 1 — — 1 — — 2 — 1 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 824 41 8 5 8 33 87 259 383 3 55 17 67 214 38 226 32 12 23 30 11 36 36 24 17 FEMALES. Table IV.—Causes of, and Ages at, Death during the year 1932. Causes of Death Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles 3 1 1 — 1 — — — — — — — — 2 — 1 — — — — — — — — Scarlet fever 1 — — — 1 — — — — — 1 — — — — — — — — — — — — — Influenza 37 — — — — 1 1 15 20 — — 2 4 15 3 11 1 — — — — — — 1 Whooping.cough 1 1 — — — — — — — — — — — — — 1 — — — — — — — — Diphtheria, Memb. croup 1 — — 1 — — — — — — — — — — — 1 — — — — — — — — Crrebro.spinal meningitis — — — — — — — — — — — — — — — 1 — — — — — — — — Poliomyelitis 1 — — — 1 — — — — — — — — — — 1 — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — Diarthœa, enteritis 6 5 1 — — — — — — — — — — 3 — 3 — — — — — — — — Erysipelas 3 — — — — — — 1 2 — 1 — — 1 — 1 — — — — — — — — Puerperal fever 1 — — — — — 1 — — — — — — — — 1 — — — — — — — Other septic diseases 15 1 — — — 1 4 6 3 — 1 2 1 5 1 5 — — — — — — — — Syphilis, &c 5 — — — — — 3 1 1 — — — 1 2 — 2 — — — — — — — — Diabetes 12 — — — — — — 5 7 1 2 — — 3 — 4 1 — — 1 — — — — Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of lungs 24 — — — — 6 13 3 2 — 2 — — 5 — 11 2 — — 1 — 2 — 1 Other forms of tuberculosis 6 — — 1 — 2 2 1 — — 1 — — 3 — 2 — — — — — — — — Malignant growths 92 — — — — 2 7 40 43 — 7 3 9 30 15 19 1 1 — 2 1 2 — 2 Congenital debility, malformation, and premature birth 18 17 1 — — — — — — — 1 — 1 11 1 2 — — 1 — — — — 1 Old age 10 — — — — — — — 16 — 2 — 1 5 3 3 — ] — — — — — 1 Meningitis and convulsions 4 — 1 — — 1 1 1 — — — — 1 — — — — — — — — — — — 18 FEMALES—Table IV (continued). Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. j 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. 1 Homeless. Loc. ataxia and general paralysis 2 — — — — — 1 1 — — — — — — — 2 — — — — — — — — Other diseases of nervous system 8 — — — — — 1 2 5 1 1 — — 2 2 1 — — — 1 — — — — Valvular diseases of heart 16 — — — — — — 4 12 — 1 1 2 5 — 5 1 — — — — 1 — — Other circulatory diseases 198 — — — — — 17 44 137 1 22 8 23 68 10 43 5 4 2 5 — 4 — 3 Bronchitis 55 2 — — — 12 41 — 4 — 1 19 2 18 3 — — 2 — 5 — 1 Broncho.pneumonia 53 6 — 3 4 — 1 10 29 — 2 1 10 21 1 12 2 — — 1 — 3 — — Pneumonia, other forms 19 — — — — — 4 3 12 — 1 — 1 3 5 4 1 1 — 2 1 — — — Other respiratory diseases 7 — — — — — 4 2 1 — — — — 2 2 3 — — — — — — — — Alcoholism 4 — — — — — 3 1 — 1 — — — 2 — — — — 1 — — — — — Cirrhosis of liver 3 — — — — — — 2 1 — — 1 — 1 — — — — 1 — — — — — Appendicitis and typhlitis 14 — — 1 — 2 3 4 4 — — — 7 4 — 2 1 — — — — — — — Other digestive diseases 12 — — — — — 1 5 6 — 1 — 3 4 — 4 — — — — — — — — Bright's disease, &c. 22 — — — — 1 4 6 11 — 5 1 1 6 3 2 — — 2 1 — 1 — — Cystitis, &c. 6 — — — — — 1 2 3 — 1 — 1 1 1 — — — — — — 1 — 1 Accidents and diseases of parturition 4 — — — — 1 3 — — — — — — — — 2 — 2 — — — — — — Deaths by accident or negligence 29 — 2 1 1 1 6 6 12 — 4 — 1 10 — 5 2 — 1 — 1 3 — 2 Deaths by suicide and murder 22 1 — — — 1 11 7 2 — 3 — 2 6 1 3 — — 2 2 — 1 — 2 Other defined diseases 13 1 — — — 1 2 4 5 — — 1 — 5 — 3 1 — — 1 — 2 — — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 733 35 6 7 8 20 94 188 375 4 63 20 70 244 50 179 21 9 10 19 3 26 — 15 19 1,654 deaths were registered in the City during 1932. After deducting 943 deaths of non.citizens in public institutions, etc., in the City, and adding those of 846 citizens who died in other districts, the corrected total is 1,557, as compared with 1,740 in 1931, and is equivalent to an annual rate of 12.3 per 1,000 persons compared with 13'9 last year. The London death.rate for 1932 was 12.3 and for England and Wales, 12.0. The number of deaths and the death.rates per 1,000 for the past fifteen years are shown below :— Table V. (From 1918 to 1932.) Year. Number of Deaths. Westminster Rate. London Rate. 1918 2,062 16.3 18.9 1919 1,819 14.2 13.4 1920 1,600 10.9 12.4 1921 1,623 11.5 12.4 1922 1,796 12.9 13.4 1923 1,493 10.6 11.2 1924 1,695 11.8 12.1 1925 1,728 12.3 11.7 1926 1,608 11.6 11.6 1927 1,682 12.3 11.9 1928 1,497 11.5 11.6 1929 1,875 14.8 13.8 1930 1,478 *12.2 11.4 1931 1,609 13.9 12.4 1932 1,557 12.3 12.3 * Corrected rate. The deaths of males were 824, females 733. Table VI. This table shows the total deaths distributed among age periods:— 1932. 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. 41 8 5 8 33 87 259 383 824 F. 35 6 7 8 20 94 188 375 733 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 1932 76 14 12 16 53 181 447 758 1,557 20 The causes of death are set out in Table IV. There was an increase among males of deaths from the following causes :—Influenza, cerebrospinal meningitis, non.pulmonary, tuberculosis, general paralysis, cystitis, suicide, and circulatory and digestive diseases. Among females the causes showing an increase were influenza, measles, septic diseases, syphilis, appendicitis, suicide and diseases of the circulatory and respiratory systems. There was a marked increase in deaths from suicide among both males and females. 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. . 1928. 1929. 1930. 1931. 1932. m. f. Total. m. f. Total. m. f. Total. m. f. Total m. f. Total Conduit 4 4 8 4 3 7 8 3 11 7 9 16 3 4 7 Grosvenor 59 78 137 88 63 151 70 61 131 64 58 122 55 63 118 Hamlet 16 22 38 18 30 48 20 26 46 19 24 43 17 20 37 K. St. George 54 57 111 66 80 146 62 £6 118 60 67 127 67 70 137 Victoria 231 226 457 249 292 541 222 212 434 234 259 493 214 244 458 St. Margaret 29 32 61 51 44 95 30 34 64 28 49 77 38 50 88 St. John 173 163 336 298 207 505 186 179 365 219 187 406 226 179 405 St. Anne 26 23 49 42 28 70 38 18 56 38 25 63 32 21 53 Gt. Marlborough 20 17 37 14 15 29 8 8 16 11 11 22 12 9 21 Pall Mall 31 7 38 35 6 41 20 7 27 23 6 29 23 10 33 Regent 25 12 37 26 24 50 24 24 48 23 28 51 30 19 49 Charing Cross 12 8 20 24 7 31 12 11 23 22 6 28 11 3 14 Covent Garden 35 29 64 39 41 80 26 28 54 42 24 66 36 26 62 Strand 46 10 56 36 5 41 39 3 42 28 2 30 36 . 36 Homeless 26 22 48 22 18 40 28 15 43 25 11 36 24 15 39 Infantile Mortality.—The corrected death.rate of infants for Westminster was 65.9 per 1,000 births. The mortality among legitimate infants was 49.0 per 1,000; that of illegitimate 196.9. The infant mortality rate for London was 66. The number of infants dying under 1 year was 76, a decrease of 15 on the figure of last year. The chief contributory causes of death were broncho.pneumonia, prematurity, gastro.enteritis and neglect at birth. 21 Table VIII shows the deaths as they occurred during the four quarters of the last four years:— Table VIII. Total 1929. Total 1928. Total 1931. . Total 1932. 1st Quarter 40 21 29 21 2nd „ 29 19 22 17 3rd „ 18 21 16 22 4th „ 18 19 24 16 105 80 91 76 Table IX shows the births and deaths of infants, legitimate and illegitimate, since 1905 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table IX. Year. Legitimate. Illegitimate. Total Rate, Westminster. Total Rate, London. Births. Deaths. Death.rate per 1,000 Births. Births. Deaths. Death.rate per 1,000 Births. 1905 2,971 305 102 149 24 161 105 130 1906 2,744 285 103 187 38 203 110 131 1907 2,764 269 97 163 34 208 103 116 1908 2,739 266 97 174 27 155 100 113 1909 2,548 2:52 91 203 26 128 93 108 1910 2,399 189 78 193 25 129 82 103 1911 2,195 210 95 166 33 198 103 129 1912 2,194 168 76 155 27 174 83 91 1913 2,057 184 89 176 29 164 95 105 1914 1,995 147 73 162 24 148 79 104 1915 1,798 141 78 181 41 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 48 239 103.6 104 1918 1,234 112 86.6 225 36 155 100 108 1919 1,383 99 71.5 217 41 188 87.5 85 1920 2,047 123 60 219 44 200 73.6 76 1921 1,729 117 67.7 190 37 194 80.2 80 1922 1,703 84 49.3 199 20 100 54.6 74 1923 1,582 68 42. 9 176 15 85.7 47.2 60 1924 1,489 82 55.0 138 14 101. 4 59. 0 69 1925 1,418 88 62.0 117 18 153.8 69.0 67 1926 1,449 76 52.4 157 20 127.3 59.7 64 1927 1,255 81 64.5 144 15 104.1 68. 6 59 1928 1,220 65 53.2 150 15 100.0 58.39 67 1929 1,190 83 67.7 167 22 131.7 77.37 70 1930 1,202 52 43.2 166 29 174.6 59.21 59 1931 1,063 74 69.6 148 17 114.8 75.1 65 1932 1,020 50 49.0 132 26 196.9 65.9 66 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 1925 22 onwards, showing the proportion per 1,000 births applicable under each heading:— Table X. — 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. Diphtheria 0.65 — 1.4 1.4 0.73 — — — Influenza 0.65 0.62 0.71 — 0.73 —_ — — Measles — 2.49 — — 0.73 3.6 — 0.86 Whooping Cough 4.5 0.62 1.4 21 8.1 0.73 0.82 0.86 Septic diseases — 0.62 0.71 — — — — 0.86 Bronchitis and pneumonia 16.2 9.9 6.4 13.8 14.7 14.6 22.3 12.1 Stomach and bowel complaints 5.2 80 12.1 10.9 7.3 5.8 13.2 8.6 Syphilis 1.3 — 2.8 0.72 0.73 2.1 1.6 1.7 Congenital malformations 3.2 4.34 7.8 5.1 4.4 4.3 6.6. — Prematurity 16.9 19.3 20.0 9.4 19.8 18.2 22.3 19.9 Neglect and injury at birth 0.65 3.72 4.2 4.3 1.4 1.4 2.4 7.8 Debility from birth and atrophy, rickets, atelectasis 7.1 3.72 4.2 3.6 2.2 2.7 3.3 5.2 Tuberculosis 1.9 1.86 2.1 2.1 2.2 1.4 — 0.86 Murder — — — — — 1.4 — 0.86 Accidents — — — — — — 1.6 0.86 Cancer — — — — — — 0.82 — Cerebro.spinal ingitis — — — — — — 0.82 0.86 Erysipelas — — — — — — — 0.86 Other causes 10.4 4.34 4.2 2.1 13.2 1.4 1.6 3.4 69 0 59.7 68.6 58.39 77.37 59.21 75.1 65.9 Table XI shows nett deaths from various causes at several age periods during the first year of life in the City of Westminster:— Table XI.—Infant Mortality, 1932. Causes of death. Under 1 Week 1—2 Week 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 0 Months and under 9 .Months. 9 Months and under 12 months. Total Deaths under 1 Year. Measles — — — — — — — — 1 1 Whooping Cough —. — — — — — — — 1 1 Septic Diseases — — — — — 1 — — — 1 Bronchitis and Pneumonia (all forms) 1 — — 1 2 3 2 4 3 14 Premature birth 17 2 1 1 21 2 — — — 23 Other causes 1 — — — 1 1 1 — 1 4 Syphilis — — 1 — 1 — 1 — — 2 Neglect at birth 9 — — — 9 — — — — 9 Debility 3 1 — — 4 2 — — — 6 Cerebro.spinal Meningitis — — — — — — — — 1 1 Stomach and bowel — 1 1 — 2 2 1 4 1 10 Tuberculosis — — — — — — — 1 —. 1 Murder 1 — — — 1 — — — — 1 Accidents — — — — — — 1 — — 1 Erysipelas — — — — — — — — 1 1 32 4 3 2 41 11 6 9 9 76 23 Table XII. Nett Births in the year:— Males. Females. Total. Legitimate 535 485 1,020 Illegitimate 70 62 132 605 547 1,152 Nett Deaths in the year of:— Males. Females. Total. Legitimate infants 28 22 50 Illegitimate infants 13 13 26 41 35 76 The causes of death of the Illegitimate were:—Neglect at birth 8, prematurity 5, pneumonia 3, syphilis 2, digestive disease 5, otitis media 1, murder 1, and septic disease 1. Table XIII. Infant Mortality, 1932.—Nett Deaths from stated causes at various ages under One Year of Age in Pimlico Area (Victoria, Knightsbridge St. George and Hamlet Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Week 8. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 .Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Measles — — — — — — — — 1 1 Bronchitis and Pneumonia (all forms) — — — — — — — 4 1 5 Grastro.enteritis — 1 1 — 2 1 — 1 — 4 Neglect at birth 1 — — — 1 — — — 1 Premature birth 10 3 i — 14 2 — — 16 Malnutrition,marasmus and debility from birth — 2 — — 2 — — — — 2 Other causes — — — — — — 1 — 1 — Accident — — — — — — 1 — — 1 Totals 11 6 2 — 19 3 2 5 3 32 Table XIV. Nett Deaths in the above area during the year :— Males. Females. Total, Legitimate 11 11 22 Illegitimate 3 7 10 c 24 Table XV. Infant Mortality, 1932.—Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. causes of death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Monhss and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Whooping Cough — — — — — — — — 1 1 Bronchitis and Pneumonia (all forms) — — — — — 1 — 2 1 4 Stomach complaints — — — — — 1 1 2 1 5 Tuberculosis — — — — — — — 1 — 1 Premature birth 3 — — 1 4 — — — — 4 Debility 1 — — — 1 1 — — — 2 Septic Diseases — — — — — 1 — — — 1 Other causes 1 — — — 1 1 — — — 2 Cerebro.Spinal Meningitis — — — — — — — — 1 1 Totals 5 — — 1 6 5 1 5 4 21 Table XVI. Nett deaths in the above area during the year Males. Females. Total. Legitimate infants 12 6 18 Illegitimate infants — 3 3 Table XVII. Infant Mortality, 1932. Nett Deaths from stated causes at various ages under One Year of Age in the North District (Grosvenor Conduit, St. Anne, Pall Mall, Regent, Gt. Marlborough, Strand, Charing Cross and Covent Garden Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and | under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year Pneumonia 1 — — 1 2 1 — — 1 4 Stomach complaints — — — — — — 1 — — 1 Premature birth 3 — — — 3 — — — — 3 Neglect at birth 1 — — — 1 — — — — 1 Debility 1 — — — 1 — i — — 2 Erysipelas — — — — — — — — 1 1 Totals £ — — 1 7 .1 2 — 2 12 25 Table XVIII. Nett deatha in the above area during the year :— Males. Females. Total. Legitimate infants 5 5 10 Illegitimate infanta 2 — 2 Table XIX. Deaths of infants with no known address, or found in streets, parks, &c.: CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Pneumonia — — — — — 1 — — — 1 Neglect at birth 7 — — — 7 — — — — 7 Syphilis — — 1 — 1 — 1 — — 2 Murder 1 — — — 1 — — — — 1 Total 8 — 1 — 9 1 1 — — 11 Table XX. Deaths of children unknown :— Males. Females. Total. Legitimate — — — Illegitimate 8 3 11 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, 1932. Legitimate. Illegitimate. Total Infant Deaths, 1932. Legitimate. Illegitimate. 1932—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total. Conduit 2,086 5 4 1 1 1 — 250.0 200.0 Groavenor 13,318 66 55 11 2 2 — 36.3 — 30.3 Pall Mall 2,872 6 4 2 1 1 — 250.0 — 166.6 Regent 4,047 36 30 6 1 1 — 33. 3 — 27.7 Gt. Marlborough 3,331 10 9 1 — — — — — — St. Anne 5,405 30 25 5 5 3 2 120.0 400.0 166.6 Covent Garden 6,655 48 43 5 2 2 — 46.5 — 41.6 Charing Cross 3,210 11 10 1 — — — — — — Strand 2,052 4 4 — — — — — — — Victoria 36,955 463 408 55 28 19 9 46.4 163.6 60.4 K. St. George 11,445 90 79 11 3 2 1 25. 3 90.9 33.3 Hamlet 6,461 30 27 3 1 1 — 37.0 — 33.3 St. Margaret 8,671 32 30 2 1 1 — 33.3 — 31.2 St. John 23,071 318 292 26 20 17 3 58.2 115.3 62.8 Homeless — 3 — 3 11 — 11 — — — Total 129,579 1,152 1,020 132 76 50 26 49.0 196.9 65.9 C 2 26 It is not usual for medical officers of health to set out a table such as the above but certain features in it are so interesting that it has been included in each report for the past few years. It clearly indicates the danger of relying upon mortality rates without taking into account other factors. Take Pall Mall and Regent wards—very similar in residential characteristics. The Infant Mortality Rate in Pall Mall would appear to indicate conditions disastrous to infant life, while Regent has an infant mortality rate probably better than any in the country. The explanation is that although there is a population of 2,872 in Pall Mall only 6 children were born during the whole year and one of these died. In Regent with almost double the population 36 births took place and again one died. The only measurable gauge lies in the wards of large populations, Grosvenor, Victoria and St. John's. By plotting an average of these respective rates, 30.3 ; 60.4 ; 62.8 a general indication can be obtained of the survivorship of infants in the city. The following table is inserted by courtesy of the Medical Officer of Health, Poplar, by whom the figures were compiled. Statistics foe 1932. City or Borough. Population. (R..G's. estimate) Birthrate. Death. rate. Infant Mortality Rate. West Districts— Paddington 143,600 13.76 13.26 107 Kensington 183,500 12.9 13.6 98 Hammersmith 133,700 14.5 12.8 66 Fulham 149,600 14.28 12.35 58 Chelsea 59,430 11.9 12.9 52 City of Westminster 126,400 9.1 12.3 65.9 North Districts— St. Marylebone 96,430 10.97 12.4 87.2 Hampstead 90,130 10.9 11.6 54 St. Paneras 194,000 13.8 13.1 69 Islington 324,600 15.25 12.36 68 Stoke Newington 61,680 15.0 12.9 53 Hackney 214,200 14.5 11.5 53.9 Central Districts— Holborn 36,440 9.57 14.19 71.63 Finsbury 69,030 16.0 13.4 81 City of London Not yet available. East Districts— Shoreditch 95,800 17.5 12.3 80 Bethnal Green 106,300 15.4 12.0 69 Stepney 223,000 16.7 12.3 61.6 Poplar 152,400 17.2 12.1 63 South Districts— Southwark 168,900 16.2 13.1 72 Bermondsey 110,100 16.6 12.0 56 Lambeth 292,300 14.7 12.5 56 Battersea 157,000 14.8 121 57.8 Wandsworth 353,300 11.86 11.56 62 Camberwell 248,000 14.6 12.0 65 Deptford 105,100 15.9 12.2 65 Greenwich 99,590 14.7 11.8 80 Lewisham 221,500 12.7 10.2 54 Woolwich 146,900 14.0 11.1 60 27 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; 107 deaths of persons giving addresses in common lodging houses occurred in 1932. They were mostly in institutions :— Table XXI. Deaths. Bruce House (L.C.C.) (licensed for 715 men) 30 33, Great Peter Street (licensed for 80 men) 6 7, St. Ann's Street (Salvation Army) (licensed for 565 men) 33 16, Strutton Ground (licensed for 201 men) 20 40, Great Peter Street (Church Army) (licensed for 57 women and 2 children) 8 Church Army Home, Greencoat Place (131 women) 10 1 107 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 1928.1932. Details respecting the notifications of infectious disease received are set out on the adjoining page. Table XXII. 1928 1929 1930 1931 1932 Smallpox 2 2 3 2 3 Diphtheria 233 170 256 140 80 Erysipelas 47 54 37 46 50 Scarlet fever 241 227 265 196 211 Enteric fever 28 7 18 7 7 Continued fever — 1 — — — Puerperal fever 6 10 6 4 7 Puerperal pyrexia 21 12 16 15 8 Cerebrospinal meningitis 1 2 — 8 6 Encephalitis lethargica 1 — 3 1 2 Poliomyelitis — 1 3 — 1 Ophthalmia neonatorum 7 11 16 7 13 Measles 997 381 551 74 810 German measles 21 179 15 23 18 Pneumonia 26 51 25 49 51 Malaria 2 — — 1 1 Dysentery 8 7 — 1 2 Anthrax — — — — — Chicksnpox 210 229 173 204 201 Mumps 150 73 166 80 92 Whooping.cough 76 246 14 83 138 Membranous croup — — — 1 —. 28 Smallpox.—Three cases of this disease were notified during the year Two of these were in tenement houses, while the third occurred in the dwelling quarters of large business premises. Some 130 contacts of cases occurring outside the City were visited during 1932. Many employers controlling large staffs deem it wise to exclude contacts during the incubation period, and in many instances this has proved to be a justifiable procedure, as some of these have in due course developed this disease The prevalent type of smallpox being a mild infection causes but slight illness and the sufferer is inconvenienced only by his removal to hospital and exclusion from work. It entails, however, considerable work for the staffs of public health departments, and much expenditure for hospital fsolation. On these grounds, therefore, measures such as the exclusion of contacts by reducing the possibilities of the spread of the infectior have a decided economic value. Vaccination.—The Vaccination Officer states that the following number of persons were vaccinated by the Public Vaccinators during the yeaPrimary 512 Secondary 31 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. Much is being said as to the falling off of infant vaccination throughout the country, owing chiefly to the facilities for making declarations of conscientious objection. It is often quoted that less than 40% of infants born are vaccinated. In Westminster at any rate there should be good grounds for satisfaction. An intelligent population provides at least 61% of infant vaccinations and the City continues to be remarkably free from smallpox. 29 Vaccination Return for the Year ended 31st December, 1931. Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st December, 1931. Number of these Births duly entered by 31st January, 1932, in Columns I, 11, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1933, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1933, 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 1932. r 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 1932. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Unvaecinated. Postponement by Medical Certificate. Removal to Dis., tricts the Vaccination Officer of which has been duly apprised. Removal to Places unknown,or which cannot be reached; land Cases not hav. | ing been found. Insusceptible of Vaccination. Had Smallpox. 2 3 4 5 6 7 8 9 10 11 12 13 1,599 993 10 — 296 80 7 114 99 — 1,247 310 Summary of Monthly Returns for the Year ended 31st December, 1932. No. of Cases in Birth Lists received. No. of Certificates of Vaccination reoeived. 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. 1,604 1,247 38 310 12 55 55 287 30 Statement of Vaccinations carried out by the Public Vaccinators during the Year ended 31st December, 1932. Name of Public Vaccinator and District. No. of Successful Primary Vaccinations. No. of Successful Re.vaccinations. Dr. K. R. Hay (Mayfair) 11 1 Dr. H. W. Doll (Belgrave and Knightsbridge) 228 7 Dr. A. E. Cope (Westminster, St. Margaret and St. John) 200 17 Dr. P. J. Edmunds (St. James and St. Anne) 43 6 Dr. P. J. Edmunds (Strand) 30 — 512 31 31 Table XXIII. City of Westminster.—Cases of Infectious Disease Notified during the Year 1932. notifiable Diseases. At all Ages. Cases Notified. Cases removed to Hospital. Treated at Home. Deaths. At Ages—Years. At all Ages. At Ages—Years. Under 1. 1.2. 2.3. 3.4. 4.5. 5.10. 10.15. 15.20. 20.35. 35.45. 45.65. 65 and over. Under 1. | 1.2. 2.3. 3.4. 4.5. 5.10. 10.15. 15.20. 20.35. 35.45. 45.65. 65 and over. Smallpox 3 — — — — — — 1 1 1 — — — 3 — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 72 2 4 6 3 2 16 6 8 17 6 2 — 71 1 3 — — — — 1 1 1 — — — — — Erysipelas 50 — — — — — 2 1 5 7 8 20 7 38 12 6 1 — — — — — — — — — 2 3 Scarlet fever 201 1 6 6 16 13 67 37 20 29 3 3 — 194 7 2 — — — — — — 1 — 1 — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 7 — — — — — — — — 4 2 1 — 7 — — — — — — — — — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — — — — — — — — — —— — — — Puerperal fever 7 — — — — — — — — 5 2 — — 7 — 1 — — — — — — — — 1 — — — Cerebro.spinal meningitis 6 1 — — — 1 1 — — 3 — — — 6 — 5 1 — — — 1 — — — 3 — — — Poliomyelitis 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis lethargica 2 — — — 1 — — — 1 — — — — 2 — — — — — — — — — — — — — — Ophthalmia neonatorum 13 13 — — — — —— — — — — — 9 4 — — — — — — — — — — — — — Pneumonia 51 1 — 2 2 — 3 2 4 5 8 15 9 45 6 51 1 — — — — 1 — 1 6 5 16 21 Malaria 1 — — — — — — — — — — — — 1 — — — — — — — — — — — — — Dysentery 2 — 1 — — — — — — — — — — 2 — — — — — — — — — — — — — — Puerperal pyrexia 8 — — — — — — — 7 1 — — 7 1 — — — — — — — — — — — — — Totals 424 18 11 14 22 17 89 47 39 79 31 41 16 393 31 69 3 — — — 2 3 2 1 11 5 18 24 Correction has been made for errors in notification or revision of diagnosis in 28 cases. Diph. 13, Searlet Fever 13. C. Spinal Fever 1. Smallpox 1. Cases not notified:— Scarlet fever, 10. Diphtheria, 8. 32 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. Fall Mali. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless and non residents, Smallpox — — — 1 — — — — — — — — — 2 _ Cholera (C). Plague (r) — — — — — — — — — — — — — — — Diphtheria — 7 8 28 4 16 — — 4 1 — 3 — 4 5 Erysipelas — 3 2 19 2 16 1 1 1 — — 2 2 1 — Scarlet fever — 11 7 54 10 71 1 3 10 10 1 7 2 18 6 Typhus fever —. — — — — — — — — — — — — — — Enteric fever — 3 — 1 1 — — — 1 — — — 1 — — Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — — — 1 1 3 — — — 1 — — — 1 — Cerebro.spinal meningitis — — — 2 — 3 — — — — — — — 1 — Poliomyelitis — — — — — 1 — — — — — — — — — Encephalitis lethargica — — — 1 — — — — 1 — — — — — — Ophthalmia neonatorum — — — 5 — 4 — — — — — 1 2 1 — Pneumonia — 4 4 22 2 13 1 — — 1 1 2 — 1 — Malaria — — — — — — — — — — 1 — — — — Dysentery — — — 1 — — 1 — — — — — — — — Puerperal pyrexia — — 2 2 — 2 — — — — — 1 — 1 — Membranous Croup — — — — — — — — — — — — — — — Totals — 28 23 137 20 129 4 4 17 13 3 16 7 30 11 33 Scarlet Fever.—211 cases of this disease occurred in 1932, a increase of 15 on the figures of 1931. There were 2 deaths. The case rate of this disease per 1,000 of the population was 1.6 for the City, and for England and Wales 2.12. 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 96.5 per cent, were removed to hospital. Diphtheria.—80 cases of this disease occurred, showing a decrease of 60 on the figures of 1931. St. John's Ward show a marked decrease. The largest number of cases occurred between the ages of 5.15 and 20.35. There were 3 deaths (2 males and 1 female), giving a rate of 37.5 per 1,000 cases. The case rate of this disease for Westminster was 0.63 per 1,000 living, and for England and Wales 1.08. The death rate for Westminster was 0.02, England and Wales 0.06, and for London 0.07. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1932. This treatment was continued throughout the year at the Council's Maternity and Child Welfare Centres, and at the Westminster Health Society's Centre in Marsham Street. One clinic was held at each Centre weekly. In the Report on the work in 1931, it was mentioned that an increasing number of cases were being given protective injections without preliminary testing. The number dealt with in this way has been greater during 1932. This procedure leads to a saving of time and material, which is justifiable because it has been found that the great majority of children under five years of age give positive results when tested and therefore require treatment. The method is also acceptable to the patients and their parents as one attendance less is required. 140 new cases were dealt with in 1932 as compared with 161 in the previous year. New cases attended the different Centres as follows:—. Ebury Bridge Centre 54 Bessborough Street Centre 40 Marshall Street Centre 24 Westminster Health Society 22 140 The work entailed 78 tests and retests, 402 injections and 68 attendances for reading of results, a total of 548 attendances. As in other years, it was found that a considerable proportion (12 per cent, in 1932) of those who presented themselves for treatment had never been vaccinated against smallpox. 34 The, following table indicates the treatment given and the results where tests were performed. All positive reactors received preventive treatment. Age. Positive. Negative. Not tested. Total. Under 5 years 3 1 116 120 „ 10 years 3 1 10 14 Over 10 years 1 5 0 6 7 7 126 140 Sixty.four retests were performed, 61 being negative. Three cases were positive or doubtful, and received additional treatment. Three cases which had required extra treatment in the previous year were found to be negative at a second retest in 1932. Retests are not performed until at least six months have elapsed after the inoculations as the immunity process started by these injections does not have its full effect for several months. Until a negative retest has been obtained, there is no definite indication that satisfactory protection has been received. The retest is therefore of the utmost importance. 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. Enteric Fever.—There were 7 cases of typhoid and paratyphoid which came to the knowledge of the department during 1932. Of these 2 were notified as paratyphoid and 5 as typhoid. There was a history of oysters having been consumed in 1 case, 3 cases came from abroad, and no history was obtainable in 3 cases. There were no deaths. The death rate of this disease for England and Wales was 0.01. The case rate for England and Wales was 0'06 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 :— 1928. 1929. 1930. 1931. 1932. 997 381 551 74 810 35 The death rate for England and Wales per 1,000 population was 0.08, for London 0.19, and for Westminster 0.02. 229 cases were removed to hospital, 146 being between the ages of 1 and 5.3 deaths occurred. Measles is usually a serious menace to child life and in a ' measles year ' such as 1932 the comparatively low death rate is to some extent the result of greater use of nursing and hospital facilities provided by the authorities. Table XXV. Influenza.—The deaths certified from this cause during the last five years are as follows :— 1928. 1929. 1930. 1931. 1932. Males 12 51 3 13 21 Females 6 48 3 24 37 18 99 6 37 58 The death rate in 1932 for Westminster was 0.46 per 1,000; for London 0.27, and for England and Wales 0.32. Last year the corresponding rates were 0.32 for Westminster, 0.03 for London, and 0.36 for England and Wales. Diarrhoea and Enteritis.—The total deaths were 11—5 males and 6 females—8 being under 1 year old. The infant death rate from this cause in Westminster was 8.6. Table XXVI. Deaths from Diarrhoea and Enteritis. Under 1 year. Other ages. Total. 1928 14 4 18 1929 7 1 8 1930 7 1 8 1931 16 6 22 1932 8 3 11 52 15 67 Whooping Cough.—138 cases were notified during the year, with 2 deaths. This is an increase on the figures of 1931, when 83 cases, were recorded. 54 cases were moved to hospital, 44 being between the ages of 1 and 5. The death rate for Westminster was 0.01, for London 0.08, and for England and Wales 0.07. 36 The deaths from whooping cough during the last five years are thus set out:— Table XXVII. Under 1 year. At other ages. Total. 1928 3 - 3 1929 11 8 19 1930 1 1 2 1931 1 3 4 1932 1 1 2 17 13 30 Cerebro-spinal Fever.—6 cases of this disease occurred with 5 deaths. Poliomyelitis.—1 case occurred with 1 death. Encephalitis Lethargica.—2 cases were notified. Chicken Pox.—201 cases occurred, 30 being moved to hospital. Mumps.—92 cases were recorded, 3 cases being moved to hospital. Anthrax.—There were no cases in 1932. Puerperal Fever.—7 cases were notified and 1 death occurred. All cases were removed to hospital. The following table shows the number of births for the last five years, together with the number of cases of puerperal fever and deaths :— Year. No. of births. No. of cases. Deaths. 1928 1,370 6 3 1929 1,357 10 3 1930 1,368 6 4 1931 1,211 4 4 1932 1,152 7 1 Puerperal Pyrexia.—8 cases occurred, 7 being removed to hospitals. 1 case arose from abortion. Ophthalmia Neonatorum.—13 cases occurred in 1932, 9 were admitted to hospital and 4 treated either at home or as out-patients of hospitals. In addition to these notified cases, 14 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 37 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 1932 :— Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 13 4 9 13 — — — Cancer.—The following table shows an analysis of deaths from this cause during 1932. 69 per cent, of the deaths occurred in persons usually resident in houses occupied by the working classes. Table XXVIII. Cancer Deaths, 1932. Age periods: 15 and 30. 30 and 40. 40 and 50. 50 and 60. 60 and over. Tongue 5 5 M. — — 1 1 3 0F. — — — Mouth (Maxilla, Antrum, Jaw, Cheek and Neck) 6 5M. — — — 1 4 1F _—_ — — 1 — Larynx 5 5 M. — — 1 2 2 0F. — — — — — Oesophagus 12 11 M. — — — 2 9 1 F. — — — — 1 Tonsils and Glands 7 4 m. — — 1 2 1 3 F. 1 — — — 2 Lungs 7 3M. — — — 1 2 4 F. — — 1 1 2 Liver 19 0M. — — — 3 7 9 F. — 1 3 1 4 Stomach (Pancreas, Gall Bladder and Intestines) 51 26 M. — — 1 7 18 25 F. — — — 3 22 Heart 3 1 M. — — — 1 — 2 F. 2 — — — — Rectum 19 io m. — — — 1 9 9 F. — — 2 2 5 Prostate 5 5M. — — — 1 4 0F. — — — — — 0 M — — — — — Uterus (Ovaries, Vulva and Cervix) 19 19 F. — — 9 2 8 0 M. — — — — — Breast 18 18 f. — — 4 1 13 2 M — — — — 2 Bladder 3 1 F. — — —___ — 1 2 M. — — — 1 — Chest 2 0 F. — — — — — 1 M. — — 1 — — General causes 1 0F. — — — — — 38 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 457 Sputa for investigation of T.B 405 Expenditure on first was £72 17s. 10d.t and for the second £56 18s. 0d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1932, 248 new cases of pulmonary tuberculosis came to the knowledge of the Department, including 9 cases who had moved into the City, and 22 non-notified deaths. Non-pulmonary forms of tuberculosis gave 62 cases—12 of these being non-notified deaths, and 3 transfers. Table I. Tuberculosis, 1932. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. m. f. m. f. m. f. m. F. Under 1 — — 1 — — — 1 — 1 — — 6 4 — — 2 — 5 3 — 5 6 1 — — 1 10 1 2 2 1 — 1 — 15 9 12 4 6 2 4 2 2 20 24 13 4 5 9 2 1 — 25 27 28 3 9 7 8 1 1 35 41 16 1 3 18 5 2 1 45 33 9 — 1 13 3 — — 55 20 2 — 1 9 — — 1 65 and upwards 6 2 — — 7 2 — — Totals 164 84 26 36 66 24 10 6 39 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 1932 show a total increase of 45 on those of 1931. There was an increase of 36 among the pulmonary cases. Nonpulmonary showed an increase of 6 males and 13 females. There was also a slight increase in the number of non-notified deaths. Out of the total cases primarily notified in 1932, 35 died, and the following table shows the period between notification and death of these cases:— Weeks. J Months. 1—2 2—3 3—4 1—2 2—3 3—4 4—5 5—6 6—7 7—8 8—9 9—10 10—11 10 8 1 5 4— 1 312— — — Table II. 1928 1929 1930 1931 1932 New cases notified 213 247 209 201 242 Number included in above who died during the year 32 41 23 36 35 (15.0%) (16.5%) (11.0%) (17.9%) (14.4%) Total Tuberculous Deaths .... 108 124 107 121 106 Death Rates per 100,000 83.2 98.8 85.0 104.6 83.8 Table III. Tuberculosis.—Notifications received during the period from 3rd January, 1932, to 31st December, 1932. Age periods. Number of notifications on Form A. Total notifications, on Form A, including cases previously notified. Primary notifications. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males — — 2 — 7 23 26 31 25 17 3 134 142 Females — — — 2 9 11 22 14 9 2 — 69 76 Non-pulmonary— Males — 5 2 1 3 3 1 — — — — 15 16 Females — 3 5 — 3 5 7 1 — — — 24 27 Total — 8 9 3 22 42 56 46 34 19 3 242 261 40 41 Table IV. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1932. 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— Male 1 1 2 1 1 10 8 3 3 30 Females 3 2 6 2 — — 2 15 Non-pulmonary— Males 1 1 3 1 1 1 2 1 — — — 11 Females — 1 1 1 3 — 2 2 1 1 — 12 Total 1 2 5 3 9 4 11 15 9 4 5 68 42 Table V. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such, persons who have been treated in Institutions. 1932. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covcnt Garden. Strand. St. Anne. Homeless. Received Institutional Treatment during! 1932. Pulmonary— Males 164 - 9 12 40 8 59 1 1 1 5 1 5 15 6 1 108 Females 84 - 6 8 27 2 23 4 — — — 2 6 — 5 1 47 Males 26 2 3 3 1 10 1 1 1 1 3 - 24 Females 36 - 1 3 11 1 11 2 2 1 — 1 2 — 1 — 28 310 — 18 26 81 12 103 7 4 3 5 4 14 16 15 2 207 43 Table VI. Tuberculosis Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all form. 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 1932 136 84 28 — 248 26 36 62 310 (Military cases which were excluded during the war were again made notifiable in 1920.) A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the City. Notification of cases of tuberculosis have somewhat increased as regards males, both pulmonary and non-pulmonary ; while non-pulmonary only have increased among females. Deaths from tuberculosis in all categories have decreased, and are in fact the fewest since 1929. The considerable reduction in cases on the register at the end of 1932 as compared with 1931 is mainly explained by a special review of the register carried out during 1932 at the request of the Ministry. Formerly the register of cases had been purged of cured, removed, and lost sight of cases every five years. Non-notified Deaths.—There were 34 deaths from Tuberculosis during 1932 of persons who had not been notified in Westminster. The 44 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 34 non-notified deaths gave a percentage of 32.0 of the total deaths from Tuberculosis for the year. The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths is slightly higher this year, having risen from 25 to 34 ; the corresponding percentage proportions are 20.6 per cent. (1931) and 32.0 per cent. (1932). 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 11 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 1932. The total number of cases of Tuberculosis on the Register at the end of 1932 was 1,302 as compared with 1,631 at the end of the year 1931, from which latter figure has been deducted the 611 removed cases and the notifications for the year added. Of the 611 cases removed from the Register during the year 1932, 146 were on account of death, 463 persons suffering from Tuberculosis moved from the City, and notification was withdrawn in 2 cases. Table VII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on Register at beginning of year 1932 765 465 176 225 Notified for the first time during year *151 78 20 33 916 543 196 258 Removed from the Register on account of death or removal from Westminster 270 210 59 72 646 333 137 186 * Including 6 return cases. 45 Deaths from Tuberculosis.—The total number of deaths from Tuberculosis for 1932 (all forms) was 106—Males 76, Females 30. This gives a death-rate for this disease of 0.83 per 1,000. The following table shows the number of deaths from Tuberculosis for the last 5 years, together with the death-rate. Year. Deaths. Rate per 1,000. 1928 108 .83 1929 124 .98 1930 107 .85 1931 121 1.04 1932 106 83 The following table shows Deaths per 100.000 of civilian population since 1919. Table VIII. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rate. Deaths. Rates. 1919 annual 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 1932 ,, 76 60.1 30 23.7 106 83.8 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. 46 CITY OF WESTMINSTER TUBERCULOSIS DISPENSARY. Annual Report, 1932. The work of the Dispensary has followed the usual routine throughout. Four hundred and eighty-four new patients were seen by the Tuberculosis Officer throughout the year, as compared with 400 in 1931 and 341 in 1930. Two hundred and eighty-seven of the new cases were considered to be tubercular subjects, though not all at an active stage of the disease. In addition, 48 cases were recommended for institutional treatment by general hospitals. Necessary action, with regard to these cases was taken by the Dispensary staff and the Care Committee, and many of them will attend the Dispensary after institutional treatment. The sources from which new cases were obtained during the past three years are shown in the following table :— 1930. 1931. 1932. Practitioners 139 152 164 Health Visitors 121 134 196 St. Stephen's Hospital ' 41 76 82 Ministry of Pensions 6 5 3 School Medical Officer 15 18 16 Hospitals 7 7 5 Referred by Friends, Charitable Organisations, etc. 12 8 18 341 400 484 The increase in the number of new patients during the past year may be attributed partly to the normal annual fluctuation in the number of available patients, and possibly also to the return of the Dispensary to its well-known situation at Ebury Bridge. It may be noted that there is a proportional increase in the number of cases referred by Health Visitors. This reflects an increase in the number of contact cases examined. This increase is particularly among female adult contacts. As has been pointed out, owing to the preponderant types of case occurring in Westminster, the number of available child contacts is smaller than in many other districts. The number of cases first seen at St. Stephen's Hospital also shows an increase. The importance of the collaboration between the medical officers of the hospital and the Tuberculosis Officer has been stressed in previous reports. 47 The following table gives certain details of the work of the Dispensary during 1932 and the four previous years :— 1928. 1929. 1930. 1931. 1932. New Patients 452 461 341 400 484 Old Patients 551 430 507 427 477 New Contacts Examined 98 111 55 85 105 Individual Attendances 1,003 891 848 827 961 Total Attendances 2,370 2,312 2,210 2,314 2,321 Written Reports to L.C.C. and Practitioners 1,300 1,333 1,250 1,187 1,228 Consultations with Practitioners 98 143 106 157 132 Other Visits 112 97 82 72 73 Visits by Health Visitors to Dispensary Cases 3,444 3,257 2,967 3,469 3,373 Sputum Examinations 159 154 225 192 225 X-ray Examinations 16 12 29 42 61 Patients have been recommended for institutional treatment in hospitals and sanatoria as follows : (The table does not include patients for whom direct admission to St. Stephen's Hospital was arranged.) Hospitals. Sanatoria. Insured Males 10 59 Insured Females 10 15 Uninsured Males 0 2 Uninsured Females 5 9 Boys 0 1 Girls 1 1 26 87 In addition, convalescent treatment has been arranged for Ex-Service men through the United Services Fund, and for many children through the Invalid Children's Aid Association, the Public Assistance Committee, the School Authorities, St. Henry Fund and other agencies. Convalescent treatment for adults, especially those who are not insured persons, is sometimes difficult to arrange, but the Friends of the Poor and the Charity Organisation Society can often assist the case. It has often been felt that a Convalescent Home for tuberculous adults who require a few weeks' holiday rather than any actual treatment might in the long run save a good deal of sanatorium treatment. The association with Westminster Hospital has continued, and many cases were referred there during the year for surgical opinions, for orthopædic treatment, or for such treatment as the removal of tonsils and adenoids. 48 Children requiring dental treatment are referred to the school authorities, and other eases are referred to the Council's Dental Clinic. When dentures are required, financial aid can, if necessary, be arranged for the patient by application for grants from charitable organisations or from the Council. Sixty-one cases have had X-ray examinations during the year, and 225 sputum examinations were made for Dispensary patients. Five patients receiving Artificial Pneumothorax treatment had sixty-six refills in all, at a cost to the Council of 10s. 6d. each refill. Two cases of Lupus received special Light treatment at a total cost of £19 2s. The work of the Tuberculosis Care Committee has continued on the lines indicated in previous reports, and in the reports issued by the Committee from time to time. The Committee assesses the amount to be paid by patients who can afford to contribute towards the cost of institutional treatment. New arrangements made by the London County Council will entail an increase in this assessment work in the future. The Committee give careful consideration to the economic position of each patient at the commencement and at the end of institutional treatment. Suitable aid can be arranged in almost every case where this is necessary. The Committee recommended during the year that the Council should grant extra diet allowances to twenty-one patients for varying periods at a total cost of £80 13s. 11d. The work of the Handicraft Class, which is run for Dispensary patients by a voluntary committee, has continued. The numbers have been maintained and an increase is shown in the number of male patients. The interest and occupation afforded by the work of the class is undoubtedly of benefit to its members. Miss Willatts has continued her valuable work as teacher, and Miss McFarlane has carried out effectively the duties of Secretary to the Committee. The Class took part in an exhibition and sale in the Carpenters' Hall, in conjunction with similar classes in other Metropolitan Boroughs. The sale was opened by the Lord Mayor, and attracted considerable interest. The Class also held a small private sale in the Dispensary, which helped further in disposing of the work done by the patients. The Council again allotted a portion of the income of Barlow's Gift to the work of the class. This made it possible for the class to remain on a satisfactory finanpial basis. 49 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work of the Dispensary during the Year 1S32. Diagnosis. Pulmonary. Non-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 147 80 1 6 9 14 13 6 156 94 14 12 276 *(b) Diagnosis not completed _ _ — 2 2 1 — 5 (c) Non-tuberculous — — — — — — — — 30 59 32 25 146 B.—Contacts examined during the year :— (a) Definitely tuberculous 1 2 2 2 4 1 2 4 4 11 *(6) Diagnosis not completed — — — — — — — — — — — — — (e) Non-tuberculous — — — — — — — — 7 33 39 15 94 C.—Cases written off the Dispensary Register as— (a) Recovered 3 4 — — 2 2 3 4 2 2 11 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 41 97 75 43 256 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 255 189 25 25 32 34 53 42 287 223 78 67 655 (6) Diagnosis not completed — — — — — — — — 2 2 1 — 5 * i.e., remaining undiagnosed on 31st December. 50 TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL—continued. (A) Return showing the Work of the Dispensary during the Year 1932—continued. 1. Number of cases on Dispensary Register on January 1st 651 8. Number of visits by Tuberculosis Officers to homes (including 2. Number of cases transferred from other areas and cases returned personal consultations) 73 after discharge under Head 3 in previous years 39 9. Number of visits by Nurses or Health Visitors to homes for 3. Number of cases transferred to other areas, cases not desiring pensary purposes 3,373 further assistance under the scheme, and cases "lost sight 10. Number of— of" 220 (a) Specimens of sputum, etc., examined 207 4. Cases written off during the year as Dead (all causes) 75 (b) X-ray examinations made in connection with Dispensary 5. Number of attendances at the Dispensary (including Contacts) 2,321 work 61 6. Number of Insured Persons under Domiciliary Treatment on 11. Number of " Recovered " cases restored to Dispensary Register, the 31st December 211 and included in A (a) and A (6) above Nil 7. Number of consultations with medical practitioners— 12. Number of " T.B. plus" cases on Dispensary Register on (а) Personal 132 December 31st 225 (b) Other 311 (B) Number of Dispensaries for the Treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council Joint Committee One Provided by Voluntary Bodies 51 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. It is suggested in Circular 1269 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 1932. Accordingly, as these services have been somewhat fully dealt with in recent years, the report for 1930 being a full or survey report, they are again 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, 1s. 6d. is paid to the association for each nursing visit; 3,069 visits were paid in 1932 at a cost of £230 3s. 6d. 2. Midwives.—Thirty were practising in the area in 1932. This number includes the qualified midwives of the outdoor departments of Westminster and Middlesex Hospitals and the staff of the Ormond Home, Chelsea. Confinements at home attended by the midwives from these Institutions were as follows :— Westminster 82 Middlesex. 6 Ormond Home 6 Private Midwives 243 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. 3. Laboratory Facilities.—Arrangements with Westminster Hospital for the bacteriological examination of material from suspected cases of 52 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 also undertakes the investigation of atmospheric pollution. On several occasions it was found that delay was caused in the examination of swabs during the week-end. By special arrangement with the Hospital all swabs submitted on Sunday are examined and the result reported immediately to the practitioner concerned. 4. Legislation in Force.—No additions have been made to existing local legislation during the year. 5. Hospitals.—This subject has been fully discussed in recent reports details of the various hospitals in the City and the purposes for which beds were allocated being 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. Stephen's Hospital (750 beds), formerly reserved for Westminster inhabitants, now receives patients from a much wider area. As regards tuberculosis and infectious diseases generally, AVestminster 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. 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. Ambuiance 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.—There have been no additions to the number of centres. These institutions 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. Maternity and Child Welfare Centre, 15, Bessborough Street, S.W. 4. AVestminster Health Society, 121, Marsham Street, S.W.I. 53 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 conditions do not remain at home for treatment, but are immediately admitted to hospital on notification. There were five maternal deaths. A summary of results of inquiry are given below :— E. L. S. (34).—Married, 3 months' pregnancy. Admitted to hospital with miscarriage. Also suffering from influenzal br. pneu. and Graves disease. Blood clot at placental site found at P.M. E. A. (18).—Single. Eclampsia. First pregnancy. Not delivered. Died in hospital. M. G. (44).—Single. Nine previous pregnancies (3 miscarriages, 2 stillbirths and 4 children died at 6 weeks). Albumin in urine, oedema in feet, face and hands. Child born before midwife was called. At first refused removal to hospital. Had two eclamptic fits before being finally removed. Died puerperal mania. A. F. S. (42).—Married. Eight previous pregnancies. Confined at home. Placenta prævia. Severe haemorrhage occurred. Anaesthetic administered after heavy meal. Food regurgitated into air passage. B. H. (30).—Died in hospital—septicaemia following abortion. Although maternal deaths, numbering five, were exactly half those recorded in 1931, it need not be supposed that this welcome reduction is otherwise than fortuitous. Maternity Beds.—The agreement with the Westminster Hospital for the provision of maternity beds continues to work very satisfactorily. As mentioned on a previous occasion the scheme has provided a long-felt want and is a notable contribution to the solution of the problem of maternal mortality. The cases admitted are those recommended from the Council's three Maternity and Child Welfare Centres and that of the Westminster Health Society. The grounds on which hospital accommodation is sought are those laid down in Circular M. & C.W. 4, detailed in a previous report. The total number of women admitted and confined in the hospital was 54. Of these, 23 were from the centre at Ebury Bridge, 15 from Bessborough Street, 6 from Marshall Street, and 10 from Marsham Street (Westminster Health Society). 54 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 following table shows the number of visits paid in connection with the four centres:— Table I. Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 244 226 159 153 782 Other visits 632 442 297 314 1,685 Children under 1 year of age— First visits 357 323 404 229 1,313 Other visits 1,749 1,674 1,327 1,046 5,796 Children over 1 and under 5 years- Visits 2,661 3,411 2,698 2,355 11,125 Death enquiries, still-births, &c. 33 41 36 19 129 Infectious diseases 256 189 248 81 774 The staff of health visitors remains as in 1930 and 1931, and from the above table it will be seen that the visiting of children between the ages of 1 to 5 years is receiving adequate attention. Children Act, 1908.—Until 1st April, 1933, the duties imposed under Part I of this Act relating to foster mothers and boarded-out children were carried out by the London County Council, after this date the administration will be transferred to the City 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 purposes of audit. 55 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, and there is interchange of much useful information between those bodies which should result in greatly improved conditions for confinements. The number of births was 1,152 and the number of expectant mothers dealt with by the centres, 777. This proportion, amounting to over 67 per cent., is a satisfactory indication of the manner in which the Council's Maternity and Child Welfare service is meeting the needs of the community. Table II.—Ante-natal Cases. Name of Hospital. City Council's Centres. Westminster Health Society. Totals. Ebury Bridge. No. 15, Bessborough Street. Marshall Street. Marsham Street. General Lying-in 11 17 4 11 43 St. George's 15 12 4 3 34 Westminster 23 34 3 16 76 St. Thomas's 1 2 _ 1 4 Charing Cross 3 9 20 1 39 Middlesex — 1 21 1 23 Elizabeth Garrett Anderson — 1 2 — 3 St. Stephen's — 7 — 2 9 Queen Charlotte's _ — St. Mary's — — — — — Clapham Maternity — — — — — Royal Free — — — — — Woolwich — — — — — Found by Health Visitors 76 100 22 44 242 By Private Doctors and Midwives ¯ ¯ ¯ 1 1 Reported to Centre voluntarily 118 81 22 82 303 Totals 247 264 104 162 777 Ante-natal Visiting.—To the 777 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 1,685. E 56 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 52 138 294 432 244 Besaborough Street 48 128 216 354 197 Westminster Health Society. 51 71 286 357 71 Ante-natal clinics are also held at Charing Cross, St. George's, Westminster and Middlesex Hospitals for mothers who have made arrangements for their confinements with these hospitals. Mothercraft.—Classes in mothercraft are held at the various centres, and health talks have been given each week throughout the year in connection with those classes. Table IV.—Mothercraft Classes. 1932. Ebury Bridge. Bessboro Street. Marshall Street. Marsham Street. Total. Number of classes 47 51 51 131 280 Total attendances 1,181 1,115 346 3,751 6,393 Average attendances 25.1 21.8 6.7 28.7 22.4 Number of expectant mothers 68 115 37 51 271 Number of attendances by expectant mothers 277 339 98 466 1,180 Number of other mothers 166 162 63 82 473 Number of attendances by other mothers 904 776 258 3,285 5,223 Attendances of children in nurseries during classes 870 809 291 4,385 6,355 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 743 ; at Bessborough Street, 820; at Marshall Street, 191 ; and at Marsham Street, 2,029. 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 1927 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 by the City of Westminster Health Society. 57 Table V. 1927. 1928. 1929. 1930. | 1931. 1932. Number of cases attended— As midwife 65 77 72 62 62 88 As emergency — — — — — — With hospital students — — — — — — With private doctor — — — — — — Total 65 77 72 62 62 88 Number of— Pre-natal visits 678 599 579 576 240 209 Lying-in visits 812 1,149 1,003 909 794 1,141 Subsequent visits 415 442 437 420 62 — Visits to infants under 1 year, other than lying-in visits 376 433 361 292 — — Total number of visits 2,281 2,623 2,380 2,197 1,093 1,350 Table VI. Attendances by midwife at ante-natal and other clinics :— 1927 1928 1929 1930 1931 1932 Westbourne St. and Ebury Bge 39 40 43 36 51 52 15, Bessborough Street 82 86 97 93 49 52 Total 121 126 140 129 100 104 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 48 With hospital students 6 With private doctors 2 56 Midwifery visits 939 Nursing visits 31 970 E 2 58 There is an increasing tendency for women from other districts to come into Westminster institutions for their confinements. The hospital beds available are as follows :—Charing Cross, 15 ; St. George's, 11; Westminster, 15; St. Stephen's, 28. 942 women from other districts were confined in Westminster and 445 women belonging to the City were delivered in the hospitals mentioned—the number in St. Stephen's alone being 219. The number of children born to Westminster parents in institutions outside the City numbered 498. The following table shows the number of confinements in the hospitals mentioned:— Table VIII. Charing Cross Hospital: 460, of which 60 were Westminster cases. St. George's Hospital: 228, of which 29 were Westminster cases. Westminster Hospital: 382, of which 142 were Westminster cases. Sheffield St. Hospital: 106. St. Stephen's Hospital: 219. 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—2nd Wednesday each month at 2.30 p.m. Clinics are also held at the Infants Hospital, Vincent Square and Charing Cross Hospital. 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 59. 59 Table IX. Attendances at Infant Consultations, 1932. 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. Ebury Bridge 104 262 99 3,142 1,396 3,404 1,495 4,899 15, Bessborough Street 101 231 66 2,701 2,500 2,932 2,566 5,498 Marshall Street 52 105 34 1,265 883 1,370 917 2,287 Marsham Street 107 205 77 2,245 1,874 2,450 1,951 4,401 1932 364 803 276 9,353 6,653 10,156 6,929 17,085 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— 1932. 1931. 1930. 1929. 1928. 1927. Ebury Bridge 47.1 37.7 43.5 36.5 39.9 37.1 Bessborough Street 54.4 56.3 49.5 48.8 44.9 44.7 Marshall Street 43.9 43.4 40.9 33.1 27.1 29.2 Marsham Street 41.1 40.1 43.1 38.1 36.9 40.1 The number of individual children medically inspected were— Ebury Bridge 620 Marshall Street 283 15, Bessborough Street 656 121, Mar sham Street 679 60 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 included in the maternity and child Welfare services of the Council. 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 2 20 Puerperal pyrexia 27 491 Influenza — — Pneumonia 11 177 Bronchitis 9 132 Measles 30 250 Whooping cough — — Other complaints 143 1,508 Total 222 2,578 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. 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 1.6 1927 14 1.9 1928 7 1.2 1929 11 1.9 1930 16 2.2 1931 20 1.6 1932 27 2.3 01 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 1927 2.8 1906-10 3.2 1928 0.72 1911-15 2.4 1929 0.73 1916-20 4.95 1930 2.1 1921-25 1.7 1931 1.6 1926 0.62 1932 1.7 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. Thirteen cases were notified during the year, 9 of those being treated in hospital. There were also 14 instances of watery discharge from the eyes which were brought to the notice of the health visitors. All cases of ophthalmia neonatorum are visited as soon as possible after notification in order to see that adequate treatment is being provided. Treatment by the district nurses was carried out in 2 cases, 20 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 report shows that the increase in 1931 has not been maintained, there being a slight decrease in the totals of the various operations. This decrease can, I think, be attributed mainly to the general conditions that prevailed during the year, viz., trade depression and 62 subsequent unemployment amongst those eligible for treatment at the Centre. The reduction in the figures under some headings, although disappointing, is gratifying in the case of extractions done. This, although it is small in comparison with the reduction in 1931, helps to further emphasise the point that the mothers are still appreciating the advantages of the conservation of the teeth—a principle which I have been striving to impress on them during the past years. New Cases 241 Subsequent attendances 1,286 Teeth extracted 1,089 Teeth filled 207 Other dental operations 720 Anaesthetics administered:— Local 12 General 242 Dentures supplied 13 Number of sessions 99 Table XII. Comparative statement of work of Dental Clinic (M. & C.W. section) since 1926:— 1926. 1927. 1928. 1929. 1930. 1931. 1932. Number of Sessions 92 90 88 89 78 95 99 New patients 209 204 172 153 257 257 241 Subsequent attendances 629 802 807 793 1,129 1,414 1,286 Teeth extractions 1,668 1,198 930 1,172 1,305 1,107 1,089 Teeth filled 189 248 208 148 201 222 207 Other dental operations 699 777 638 663 1,225 1,174 720 Anæsthetics administered— Local 31 17 28 33 23 25 12 General 295 263 182 194 253 255 242 Dentures supplied 2 6 14 18 22 15 13 Patients contributed £17 4s. 0d. in small sums according to their means. Convalescence.—The Council has again provided in the estimates for assistance in obtaining convalescent treatment. 15 Westminster 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. The total amount expended in the year amounted to £33 12s. 0d.. 63 Day Nursery at 147, Warwick Street.—With the approval of the Ministry of Health the City of Westminster Day Nursery Interim Committee took over, on and from the 26th December, 1931, the administration and maintenance of this day nursery. The administration and finances of the nursery are now on a sound basis very largely owing to the enthusiasm and untiring efforts of Mrs. J. F. C. Bennett, the hon. secretary. The committee, which has had a most successful year, is now directing its energies towards raising funds for acquiring larger premises. The present building has long been inadequate for the needs of the district. Homes for Unmarried Mothers, etc.—The Council made a grant of £75 to the Home of St. John the Baptist at Tulse Hill. This home was formerly in the City, and cases from Westminster are eligible for admission. The two other homes in the City which exist for a similar purpose were mentioned 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, 5,088 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 £259 13s. 3d. 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, but it is hoped that a scheme of co-operation with the Public Assistance Committee may be worked out whereby mothers and infants in receipt of public assistance may be referred to the centres for special recommendations for extra nourishment on medical grounds. This extra nourishment will be additional to any relief in kind and would then be provided by the Public Assistance Committee. Insulin Treatment.— One patient is still under treatment and the cost to the Council for the year was £13. 61 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 150 houses, and 10,521 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 413 men and 38 women, and 14 children under school age, were given medicated baths at the Disinfecting Station, making 535 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 51. The Disinfecting Foreman and the Sanitary Inspectors paid 127 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, St. Pancras, St. Marylebone, Fulham, and Stoks Newington. Among Westminster school children 542 cases of head lice, 1 case of body lice, and 50 of scabies were treated. In all these cases, the clothing was disinfected, together with the bedding from their homes, amounting in all to 1,462 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 216 for head lice, and 19 for scabies. The number of attendances of these children for baths at the station was 1,069. The following table shows the total number of individuals treated at the station for verminous conditions:— Table XIII. 1932. Head lice. Body lice. Scabies. Total. Children (including those under school age). 759 1 82 842 Adults — 386 65 451 759 387 147 1,293 65 Table XIV. General disinfection of premises, articles, etc.:— 1928. 1929. 1930. 1931. 1932. Rooms 891 946 992 613 781 Articles disinfected 20,628 20,291 23,853 22,004 22,314 Articles washed 5,062 4,994 5,304 3,576 3,690 Articles destroyed 1,169 337 190 424 1,020 Books disinfected * 59 96 179 62 276 Vehicles ,, 6 18 8 7 5 Offices and business premises 10 8 39 15 11 * Library books, 39 ; private books, 89. School books, 148. Motor Disinfecting Van.—The motor van during 1932 completed 4,173 miles, carrying 3,349 cwts. of goods. The petrol consumed was 401 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 319. Inquests were held at the Coroner's Court, Horseferry Road, in 312 cases, and there were 10 adjourned inquests. Post-mortem examinations were made in 195 instances. Seven bodies were received in the mortuary chapel to await burial. Modernisation of Public Mortuaries :—This subject has recently drawn a great deal of public attention. In November the Medical Officer of Health reported as to the need for bringing the mortuary in Horseferry Road up to date, and a sub-committee was formed to deal with matters relating to staff and premises. The work of this subcommittee will be fully reported upon next year. The number of bodies taken to the mortuary for purposes of inquest, and to await burial, during the last 30 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 1932 319 312 7 66 It may be of interest to note that of the 319 bodies brought to the mortuary, 19 were cases of drowning, 31 of street accidents, 39 of other accidents, 5 of murder, 62 of suicide, 123 of sudden death, natural causes and misadventure, and 40 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 (previously reported) which are supplied with water from deep wells, the whole of Westminster takes its supply of water from the Metropolitan Water Board. Deep wells have also been sunk at the undermentioned large blocks of new buildings :— Thames House, Millbank. South Africa House, Trafalgar Square. Romney House, Marsham Street. Public Swimming Baths, Washhouses, &c.—There are three establishments, situated at Buckingham Palace Road, Great Smith Street, and Marshall Street. The numbers using the swimming baths in 1932 were :— Great Smith Street: 159,850 men ; 66,206 women. Buckingham Palace Road : 132,597 men ; 88,762 women. Marshall Street: 172,691 men ; 127,837 women. The numbers relating to users of the public washhouses were :— Great Smith Street, 32,799 ; Buckingham Palace Road, 34,000 ; Marshall Street, 13,630. Frequent bacteriological examinations of the water in the first- and second-class baths at the Council's three establishments have been made throughout the year. The results were reported to the Baths Committee at their monthly meetings and have shown that the water in each wimming pool has been maintained at a highly satisfactory standard of purity by means of the filtration and purification plants. Drainage and Sewerage.—During the year 757 plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. The supervision of these works occupies a considerable amount of the time of the Sanitary Inspectors and it is seldom that 67 alterations are carried out according to the original proposals. This entails further consideration and adds to the number of visits which have to be paid in connection therewith. A number of small alterations, such as the diversion of pipes, replacement of fittings, &c., of a character that the deposit of plans was not required have also received attention. New Sanitary Construction.—Of the 757 plans relating to drainage and other sanitary works, 68 represented sanitary provisions in entirely new buildings. The corresponding figures since 1928 are as follows :— 1928. 1929. 1930. 1931. 1932. Plans 752 877 891 748 757 Plans of work in new buildings included in above 81 91 96 71 68 Combined drainage orders were made in 15 cases. Infringements of the by-laws were reported by the Sanitary Inspectors in 32 instances in respect of failure to give notice of intention to construct or to deposit plans. Twelve builders were cautioned, and two were summoned in respect of these offences and were convicted, fines and costs amounting to £8 12s. 0d. In the two latter cases the work had been carried out in a manner contrary to the by-laws. 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. The convenience in Piccadilly by the Green Park was reconstructed in connection with the rebuilding and extension of Dover Street Underground Railway Station. Increased accommodation for both men and women was provided. Public Cleansing.—This is not under the control of the Public Health Department, but is carried out by a separate department of the City 68 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 1932 are as follows:— Tons. House refuse collected 92,392 Trade refuse collected 1,417 93,809 Refuse barged away 92,734 Refuse dealt with in Salvage Plant 1,075 The salvage plant at Gatlifi Road, which had been in operation since 1920, was closed down in January. The main reason for closure was the rapidly diminishing market for the product of the plant—separated and pulverized refuse. At the end of the year the whole of the City refuse was being dealt with by controlled tipping in Essex and in Middlesex. Some years ago it was mentioned in this report that the method of tipping then in vogue in Essex had given rise to well-deserved criticism. Since then conditions have improved enormously; controlled tipping is insisted upon in the Council's contracts, and although the methods in use do not come up to " Bradford " standards, yet progress towards that end is steadily being made and the possibilities of nuisance are gradually being overcome. Combined dust shoot and incinerator.—The only instance in the city was reported upon last year. It continues to operate satisfactorily ; no complaints have been received and no nuisance has been observed. There is no more hygienic or rapid method of dealing with house refuse in blocks of flats. The economic advantages are at once apparent when it is stated that instead of a daily collection of house refuse the dustman requires to call only once a month at the flats where this incinerator is installed. To maintain such an apparatus in an efficient condition requires experience and intelligence on the part of the person responsible. It ought to be practicable to instal shoot incinerators in industrial dwellings and thus to do away with the haulage of dust bins up and down stairs, and the noise, litter and general unsightliness which accompany such operations. 69 Draft Revised By-laws made by the London County Council under Section 16 (2) Public Health (London) Act, 1891, with respect to the closing and filling up of cesspools and privies, and the removal and disposal of refuse, etc. Draft Revised By-laws made by the London County Council under Section 39 (1) Public Health (London) Act, 1891, and Section 34 of the London County Council (General Powers) Act, 1928, with respect to ashpits and receptacles for dung, etc. These draft revised by-laws were reported on by the Town Clerk the Medical Officer of Health and the City Cleansing Surveyor each within his respective sphere to the Committees concerned, and the observations thereon were submitted to the Metropolitan Boroughs' Standing Joint Committee. Generally the proposals were agreed to in principle, but with regard to certain details recommendations were made. The most important matters contained in the draft by-laws were proposed additions dealing with the construction of shoots and incinerators for house refuse. These are commented upon by the Medical Officer of Health in the preceding paragraphs. It is inevitable that in the construction of blocks of flats and other large buildings, up to date architects will design convenient means for the disposal of refuse. This will take the form of shoots for house refuse and in some cases the shoots will discharge into furnaces designed to burn the refuse. It is desirable that building owners should be encouraged to provide means for the destruction of refuse thereby saving the cost of removal and obviating frequent nuisance. Drainage By-laws (with Draft Amendments) made by the London County Council under Section 202 Metropolis Management Act, 1855, and the Metropolis Management Acts Amendment (By-laws) Act, 1899. The proposed amendments of these by-laws are intended to allow what is known as the " one pipe " system of drainage. They were reported upon by the Medical Officer of Health to the appropriate Committee, the principle being approved. The system will permit all fittings, water closets, urinals, lavatory basins, baths, sinks, etc., to be discharged into the same pipe, thus reducing the amount of pipe work, with consequential reduction in cost. It will be particularly suitable in large buildings where fittings are numerous and where a high standard of work is adopted. 70 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 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— Water-Closets— Primary Inspections— Directly approached from rooms 27 (a) On complaint 975 (b) Infectious disease 542 Accommodation insufficient 36 (c) Housing Regulations, 1925 875 Water Supply— Cisterns dirty and uncovered 98 (d) Housing applications 179 Absence of—in upper floors of tenement houses 9 (e) Other reasons 2,308* Total 4,879 Dustbins— Absence of 83 Insufficient 67 Re-inspections 11,583 Defective 102 Other Premises—- Animals kept so as to be a nuisance 19 Primary inspections— (a) On complaint 365 Other nuisances 345 (b) Other reasons 1,930 Dangerous structures noted 27 Total 2,295 Overcrowding 25 Underground rooms illegally occupied 92 Re-inspections 6,214 Sanitary works supervised :— Sanitary Works— Total Inspections— (a) Under notice 1,384 Drains (including soil, waste, rainwater pipes, etc.)— (6) Voluntary works 10,943 Nuisances, etc.:— Constructed 2,892 Altered, repaired, etc 983 Defective or dirty conditions of internal structure 1,134 Intercepting traps fixed 143 Petrol interceptors provided 24 Tested by smoke 264 Verminous conditions 178 ,, chemical 402 Damp conditions 332 ,, water 2,736 Defective drainage, waterclosets, etc. 283 ,, air 654 W ater-closets—- „ roofs 225 Constructed 1,438 „ paving of areas, etc. 143 Repaired and reconditioned 476 Water-closets— Urinals— Insufficiently ventilated or lighted 38 Constructed 261 Repaired and reconditioned 82 * This figure includes 130 visits of enquiry in respect of smallpox contacts. Restriction of Rent Acts.—No applications were received for certificates under these Acts. 71 Nuisances.—Intimation notices were served in 1,378 instances, the number of premises concerned being 1,332. Statutory notices authorised by the sanitary authority numbered 57 and related to 56 premises. Police court proceedings as detailed below were taken in 4 instances in order to enforce compliance with the requirements of statutory notices: — Details of Nuisance. Result of Proceedings. (1) Defective drains and rat infestation Abatement Order and £2 2s. costs. (2) Lock-up shops without a water Summons dismissed. (The Magistrate supply held that a water supply was necessary.) (3) Defective roof and rain water pipe Abatement Order (14 days) and £2 2s. costs. (4) Filthy state of a room occupied as a Warrant granted to Council's officers to dwelling (refusal to admit the make forcible entry. (On entrance Sanitary Inspector) being obtained, it was found that occupants had left the premises, which were subsequently cleansed by the owner.) The following are the comparative figures since 1928 :— 1928. 1929. 1930. 1931. 1932. Intimation Notices 1,778 1,158 1,239 1,244 1,378 Statutory Notices 45 59 72 62 57 Legal Proceedings 4 7 5 5 4 Water Supply.—The Metropolitan Water Board sent thirteen 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 1928 is as follows :— 1928. 1929. 1930. 1931. 1932. 6 5 21 19 9 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. F 72 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 1932, 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 1,202 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc. 1,341 Leather workers, boot and shoe makers, harness makers, etc. 54 Carpentry, upholstery, carvers, gilders, etc. 73 Surgical and dental instrument makers 12 Tobacco manufacturers 9 Wig makers and hair workers 42 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 55 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 62 Metal workers 37 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 58 Florists 20 Laundries 15 Bakehouses 60 Photographers 44 Jewel case makers 8 Cinema film workplaces 27 Total 3,119 The use of 331 workshops was discontinued, and 375 additions were made to the register during the year. Table III.—Inspection. Premises. (i) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including factory laundries) 295 14 — Workshops (including workshop laundries) 2,635 182 — Workplaces (other than Outworkers' premises) 2,745 143 — Total 5,675 339 — 73 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 226 226 — — Want of ventilation 29 29 — — Overcrowding 30 30 — — Want of drainage of floors — — — — Other nuisances 69 69 — — Sanitary accommodation— Insufficient 5 5 — — Unsuitable or defective 114 114 — — Not separate for sexes 23 23 — — 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 496 496 — — 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 218 Absence of means of warming — Matters referred by H.M. Inspectors 84 Workrooms measured 231 Visits of Enquiry re Employment of Women 102 „ ,, Outworkers 118 Underground bakehouses in use at the end of the year 43 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. F 2 74 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 1,031 1,716 7,544 21 9 89 492 4,545 95 — — — — — 10 — — Linens, etc. 4 33 61 — — 5 58 — — — — — — — — — Furriers 7 39 25 16 32 Umbrellas, toys, artificial flowers, etc 4 83 97 — — — — 88 — — — — — — — — — Total 1,046 1,871 7,727 21 9 89 513 4,723 95 — — — — 10 — — 75 Outworkers.—The total number of lists received during the year amounted to 1,067. Notices in respect of failure to send lists were sent to 95 firms. No legal proceedings were necessary in respect of this offence. The lists contained 9,696 names and addresses, of which 5,723 were in other districts, 4,906 being within the Metropolitan area and 559 in the Loudon Suburban Districts. The number of individual outworkers in the City at the close of the year was 1,619, of whom 1,511 were registered as occupying workshops. The number of premises in which outwork was being carried on was 742. 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. - 1928. 1929. 1930. 1931. 1932. Complaints received 36 52 31 49 35 Observations taken 610 854 755 854 629 Notices issued— Preliminary 21 12 16 10 11 Statutory 1 — 2 2 2 Legal Proceedings 2 2 Two firms were summoned under the Public Health Acts, 1891 to 1926, for allowing chimneys to send forth smoke in such quantities as to be a nuisance. In one case the Magistrate stated he was satisfied there had been a nuisance, but felt that the case could be met by adjourning the summons sine die. In the other case the Magistrate made an order to abate the nuisance within 14 days and ordered the defendants to pay £3 3s. costs. Greater London Joint Smoke Abatement Committee.—This Committee held at least one meeting during the year. Your Medical Officer of Health is a representative of the Metropolitan Boroughs' Standing Joint Committee on this Committee, The question of issuing an instruction 76 card for stokers was discussed. The Committee has now issued two sets of such cards, one applying to coal and coke furnaces and the other for oil burning plants. The Council has purchased a stock of these cards, which have been distributed by the smoke inspectors and it is believed that they have proved useful as a contribution to smoke abatement. 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, &c., 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. On the death of Mr. Cribb (which took place on 13th June, 1932), Mr. J. McLachlan, his successor as public analyst, was appointed in his place. The Council's representatives attended the meetings held in May and October when matters relating to administration of smoke legislation and research were discussed. Sulphur Gas—Measurement of.—Readings have been taken of the amount of sulphur impurities in the atmosphere during the year by means of apparatus devised by the Department of Scientific and Industrial Research, which has been installed at the City Hall. By means of this apparatus a measured volume of air is passed through a solution of hyperol. 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. The results obtained during the year are shown on the opposite page :— 77 Sulphur dioxide in parts per million. Date. Volume of Time of air examined. Experiment. Volumetric. Gravimetric. 1932. cub. ft. hrs. mins. 3-4 February 63 24 0 0.41 0.44 4 April 156 24 0 0.119 0.13 27-28 April 202 24 0 0.093 0.092 5-6 May 85 23 0 0.099 0.120 12-13 May 103 24 25 0.085 0.085 19-20 May 77 24 0 0.067 0.044 2-3 June 107 24 0 0.071 0.094 9-10 June 62 24 0 0.063 0.054 16-17 June 92 24 0 Nil 0.036 23-24 June 55 24 0 Nil Insufficient barium sulphate to weigh 30 June to 1 July 112 23 30 0.024 0.030 7-8 July 53 27 0 0.054 0.064 14-15 July 99 23 30 0.038 0.034 21-22 July 153 24 0 0.051 0.053 28-29 July 110 24 0 0.055 0.061 4-5 August 55 24 0 0.078 0.123 11-12 August 116 24 20 0.167 0.146 18-19 August 116 24 0 0.128 0.110 26-27 August 55 24 5 0.100 0.090 1-2 September 160 23 30 0.050 0.042 8-9 September 117 24 30 0.048 0.041 15—16 September 143 24 10 0.156 0.154 22-23 September 100 24 3 0.119 0.135 29-30 September 128 24 25 0.113 0.119 6—7 October 93 25 15 0.109 0.114 13-14 October 88 24 0 0.108 0.134 20-21 October 68 27 45 0.133 0.174 28-29 October 149 23 45 0.172 0.182 3-4 November 183 23 0 0.091 0.111 10-11 November 82 24 10 0.245 0.227 17-18 November 162 24 0 0.188 0.177 24—25 November 155 24 0 0.187 0.207 1—2 December 104 25 30 0.213 0.206 8-9 December 118 24 15 0.205 0.229 15—16 December 114 24 15 0.183 0.193 22—23 December 152 22 45 0.113 0.088 29-30 December 150 23 45 0.156 0.158 78 The following table shows the results of the monthly analyses of the amount of dirt collected in the deposit gauges, at Mount Street Gardens, Mayfair, and at the Mortuary premises, Horseferry Road, Table VIII. 1932. Figures in English Tons per Square Mile. Horseferry Road. Mount Street. Wandsworth Common. (For comparison.) Total Solids. Sulphur. Total Solids. Sulphur. Total Solids. Sulphur. January 33.74 3.42 30.25 2.76 12.39 1.61 February 25.30 2.39 23.58 1.75 11.02 1.38 March 41.01 3.86 30.09 2.73 22.21 2.40 April 26.97 2.59 30.13 3.05 14.59 2.07 May 33.72 2.99 31.37 3.33 16.55 2.93 June 13.80 0.86 17.23 1.22 13.01 1.33 July 19.94 1.43 15.47 1.59 16.25 2.14 August 18.00 1.33 18.35 1.50 10.89 1.66 September 23.76 2.07 21.23 2.03 13.87 2.68 October 31.37 3.41 21.79 3.96 16.64 3.47 November 24.01 2.93 24.44 2.41 11.68 2.35 December 38.33 3.13 22.79 1.98 12.42 1.86 Special Classes of Premises and Occupations subject to control by the Local Authority. (1) Common Lodging Houses.—Six in number (detailed on page 27). They are at present controlled and supervised by the L.C.C., but as mentioned elsewhere in this report, it is intended to transfer these powers to the City Council by Order under the Local Government Act, 1929. (2) Slaughter Houses.—There are none in the City. (3) Offensive Trades.—There are none such registered in the City. (4) Cowsheds.—There are none in the City. (5) Houses Let in Tenements.—The number of houses on the register at the end of the year was 412. The Sanitary Inspectors paid 1,728 visits of inspection to these houses and infringements of the by-laws were reported in a number of instances, 79 Appropriate action was taken with regard to the infringements. In no case was it necessary to take legal action under the by-laws. (6) Underground Sleeping Places. (7) Butchers Shops and Stalls. (8) Dairies and Milkshops. (9) Ice-cream Premises. (10) Preserved Meat, etc., Premises. (11) Bakehouses. (12) Workshops and Workplaces. (13) 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. (14) Fried-fish Shops and Fish Curers. (15) Street Traders. Particulars relating to premises and occupations included in the foregoing list, other than Nos. 5 and 13, may be found under the appropriate headings elsewhere in this report. Rag Flock Acts, 1911 and 1921.—There are no premises in the City which come within the provisions of these Acts. 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. Other Sanitary Conditions requiring Notice. Fouling of Footways by Dogs—By-law.—Six cases of infringement of the by-law were reported to the Council by the Commissioner of Police, and one by a private person. Summonses were issued against the offenders, and a conviction was obtained in each case. The penalties inflicted varied from 5s. to 30s. Rat Repression.—During the year, 89 complaints were received and investigated and 218 premises inspected with regard to rat infestation. Most of those complaints resulted in many visits being paid to the houses affected; 45 inspections were made of sewers and of the house drains discharging to the sewers. As a result of these examinations, 10 80 drainage connections to the sewers were relaid and other drainage defects were dealt with in 12 instances. One of the disinfectors by arrangement with the Port of London Authority received instruction at the docks in methods of rat destruction. He has given useful help to the Sanitary Inspectors and occupiers of premises and has visited 29 premises for the purpose of tracing the source of infestation, baiting and setting of traps. Officers of the Works Department have, in addition to laying baits in the sewers throughout the year, treated four sections of sewers with gas and also the drainage systems of 9 houses and other premises. During " Rat Week " in November the efforts in connection with rat destruction were intensified, circulars were distributed and the number of baits laid throughout the year in the sewers and at the Council's house refuse depots and other places were largely increased. 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 he Report of 1928. Seven 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. A member of the disinfecting staff whose duties are mostly concerned with rat disinfestation also devotes some time to reducing the number of pigeons on complaint. During the autumn he visited same 15 premises and caught 389 pigeons; Messrs. Daltons also operated in Trafalgar Square and Parliament Square and reduced the number of pigeons by 200. Local Government Act, 1929—Section 64.—This section gives power to the Minister to make an order on the application of the London County Council or any representative association of the Metropolitan Borough Councils for the transfer of certain functions exercisable by the County Council to the Borough Councils and for the delegation of other functions of the County Council to the Borough Councils acting as agents of the former. After the passing of the Act, discussion as to possible transfer and delegation had proceeded between the County Council and the Metropolitan Boroughs' Standing Joint Committee for upwards of two years without final agreement being reached. Both bodies therefore thought it best for the Minister to decide and for that purpose made a joint application to him. 81 The Minister agreed to decide as to the transfer, &c , of functions and in September, 1932, made a draft order embodying his proposals. Those proposals, so far as they relate to public health, included the transfer from the London County Council of the administration of seamen's lodging houses, common lodging houses, cow houses, offensive trades, slaughter houses and under maternity and child welfare services, the administration of infant life protection under Part 1 of the Children Act, 1908. The Medical Officer of Health reported that there were no seamen's lodging houses, cow houses, offensive trades or slaughter houses in the City and that the supervision of the six common lodging houses in the City could be carried out by the Council's Sanitary Inspectors. The number of children under the care of foster mothers being relatively small, the work of supervision, &c., under the Children Act, 1908, might be undertaken by the Council's Health Visitors. In neither case was additional staff required; the general cost of administration should not exceed £50 per annum. The City Council agreed to the transfer to itself of the above-mentioned public health duties as proposed in the draft orders. Ministry of Health Survey.—The survey carried out by Dr. F. R. Seymour at the request of the Ministry of Health, and referred to in last year's Report, was completed early in 1932. In October the Minister communicated to the City Council his views after consideration of Dr. Seymour's report, of which the chief points are briefly as follows :— 1. A reasonable standard of efficiency and progress in public health services is being maintained by the Council. Note.—This is the term of reference quoted from the Local Government Act, 1929. 2. Co-operation with voluntary hospitals is good, but might be improved in the sphere of ante-natal work. Note.—The new conditions of the Council's grant to Charing Cross Hospital embodies this suggestion. 3. New premises for the centre at Bessborough Street should be considered when an opportunity arises. Note.—When conditions improve this suggestion will receive early consideration. 4. The Tuberculosis Notification Register should be revised more frequently. Note. -Revision is now made annually and not quinquennially as formerly. 82 5. More contacts should be examined in connection with the losis Dispensary. Note.—Since the new dispensary was opened the number examined has increased, but from the constitution of the population, e.g., large proportion of single persons without dependants the number of contacts available must always be relatively smaller than in most other towns. 6. Further use of X-rays at the Tuberculosis Dispensary should be made. Note.—At the new dispensary the number is increasing' but it is felt that X-rays should be reserved for cases not demonstrable by clinical or bacteriological means. 7. Milk should be examined for tubercle bacilli. Note.—The London County Council already does this on a large scale, some 3,000 samples per annum, nevertheless, the Council considers that a limited number of examinations should be made and has arranged accordingly. 8. Restaurants should be visited more frequently. Note.-—They are visited at least once a year as a routine ; more often on complaint. It is pointed out the types of restaurant vary so greatly that while some large well conducted establishments require a routine visit, say, twice in 18 months, others are visited every six months or so. The notes attached to each comment indicate the gist of the observations submitted by the City Council to the Minister, as requested by him in his communication. Housing. General Observations as to Housing Conditions. The housing conditions of the working classes in the City show progressive improvement year by year. The question was discussed in detail and at some considerable length in the report for 1930, and it is proposed now only to mention a few points, as during the course of the next year or two housing conditions will again come under complete review. The question of housing continues to occupy a dominating position in both national and local government policy, and it might be well again to bring to public notice the extent of working-class accommodation existing in the City. It is sometimes stated that working-class dwellings are being demolished and are giving place to office and other buildings. This statement, where applicable, refers usually to old working-class 83 dwellings, the main structure of which has become unstable, thus meriting demolition under the authority of the district surveyor. These are relatively so few in number that with the additions which have been and are being made, the total of working-class accommodation remains as a high proportion of other occupied dwellings in the City. At the census of 1931 there were 22,536 inhabited houses in Westminster, that is to say, structurally separate dwellings, containing a total of 33,056 private families in a total population of 129,579. From the housing summary which was outlined in the report of 1930, the number of working-class families was estimated at 22,740. Of these 6,933 were accommodated in industrial dwellings. It was computed that some 11,993 families lived in houses let in separate tenements. These, by reason of the absence of the self-contained principle, are not so acceptable as dwellings, while some of them fall far short of modern housing standards. A number of working-class dwellings in the City are in cottage properties; some of these, as for example the Ecclesiastical Commissioners properties in Garden Street, are structurally sound, while others, such as those in Ross Street, Douglas Place, etc., are mostly worn out, and by reason of general structural deterioration cannot be regarded as fit dwellings. Some 1,510 families were estimated to be living in cottage properties and in dwellings in mews over what were formerly stables. The remaining working-class accommodation is found in rooms over shops where they are sometimes combined as work places. Industrial dwellings have now increased to 7,405, and it is extremely doubtful whether any municipality in the country contains within its boundaries such a high proportion of what are accepted to be satisfactory working-class dwellings. When one considers that the City of Westminster is not an industrial area but a centre of administrative, scientific, business, banking and social life it should be conceded that the quota of dwellings for the working-classes is far from meagre. This does not imply that improvement in housing conditions is not necessary. As already indicated there are a number of dwellings which cannot reasonably be regarded as fit. Defects of structure, dampness (particularly in underground rooms), overcrowding, lack of, or not readily accessible modern conveniences are problems requiring constant attention and from the succeeding paragraphs it will be noted that still further progress has been made in effecting satisfactory improvements in those conditions during the year. In Westminster the housing situation implies a need for replacement and improvement of old, unfit and unsatisfactory dwellings, So far as 84 additional housing accommodation is concerned it has previously been pointed out that the City is almost a completely built up area, and any suitable sites which may become available are those already partly or wholly built over. The cost of such sites for working class dwellings is usually prohibitive, and they could be acquired only by such mutual arrangements between the parties concerned as would bridge the gulf between economic rents based on ordinary site value and the rents usually applicable to working class dwellings. Census, 1931. Certain figures supplied by the Registrar-General as a result of the 1931 Census throw some light on the situation with regard to housing in Westminster. These figures show an improvement in every case. This is, of course, partly due to the fall in the total population of the City, but a share of the improvement may reasonably be ascribed to the increase in the available accommodation resulting from the Council's housing schemes, and from the continual efforts made to deal with families whose housing conditions are unsuitable. The total acreage of the City of Westminster is given as 2,503 acres, and the density of population as 51.8 to the acre. This compares favourably with the previous figures of 56.5 per acre at the previous census, and 73.1 per acre in 1911. The City of London has a population density of only 16.2 per acre, but only five other boroughs show a lower density than Westminster, and these are not Central London Boroughs. The highest density, 151.7, is found in Southwark, and several East End boroughs have figures nearly as high. The density for the whole county is 58.7. The greatest Ward density is in St. John's and St. Anne's, 108.8 and 100.1 respectively. The lowest figure is 15.1 in Charing Cross, followed by the Hamlet of Knightsbridge, 18.8, and Strand, 23.6. There are in Westminster 33,056 private families, comprising a total of 101,442 persons; 22,536 structurally separate dwellings are occupied with 132,882 rooms in all. The number of persons per room is 0.76, as compared with 0.81 in 1921. The figure for the whole county is 0.98. Hampstead, with 0.70, is the only borough in which this figure is lower than in Westminster. The highest figure is in Shoreditch, 1.45, which is double the figure for Westminster. This figure is to some extent affected by the average size of family in the particular borough. The average size in Westminster is 3.07 persons, only Holborn and the City of London showing a smaller average. Families are largest in the Eastern boroughs, Stepney having an average of 3.92. 85 The Registrar-General adopts as a density standard by which to judge overcrowding the proportion of private-family population living with more than two persons per room. Westminster stands seventh lowest on this list, with 7,223 persons, or 7.1 per cent. This compares well with the Westminster figures for 1921 of 11,364 or 10.1 per cent. This figure is highest in Finsbury, 29.4 per cent., and lowest in Hampstead and Lewisham, each with 4.1 per cent. It will thus be seen from these figures of population with regard to housing accommodation, that Westminster stands in a comparatively favourable position. It must be realized, of course, that statistical comparison between boroughs which show great variation in their local conditions must not be stressed unduly. The point of outstanding importance is that the figures for Westminster in 1931 show in every instance a marked improvement on the corresponding figures for the preceding census of 1921. Grosvenor Housing Scheme. Two more blocks of dwellings, comprising 225 flats, were completed and occupied during the year. There are now 5 blocks containing 379 flats, fully occupied. Another large block of 141 flats is expected to be finished and ready for occupation by October next. The remaining block of 84 flats will not be commenced until after the leases end in 1934. The site of this proposed last block is occupied by business firms, and it is hardly worth while to take steps to displace these firms, pay compensation, and incur legal and other incidental expenses in connection therewith for the sake of a few months. Re-housing Operations.—During the year 300 families were rehoused by the City Council and 97 by the London County Council, making a total of 397 families. The estates on which they were accommodated were as follows :— City Council's Estates. Families. Ebury Bridge 8 Grosvenor Housing Scheme 225 Regency Street 53 Schomberg House 4 Admiral House 2 Walden House 2 Marshall Street 2 St. James' Dwellings 4 Total 300 86 London County Council Estates. Families. St. Helier, Morden 17 Becontree, Essex 25 Wormholt, Hammersmith 4 Downham, Bromley 3 Bellingham, Catford 2 Roehampton, S.W. 1 Watling, Edgware 4 Millbank, L.C.C 17 Streatham Hill, S.W. 5 Loughborough Road, Stockwell 3 Bourne Estate, Clerkenwell 1 Clapham Park, S.W. 5 East Hill, Wandsworth 4 Fulham, S.W. 1 Glebe Estate, Camberwell 2 White Hart Lane, Tottenham 1 Stamford Hill, N. 2 Total 97 Clearance Areas. Reference was made in the report of last year to some small areas which had been described in the report of the year 1930 as coming under the description of " Clearance Areas." Two of these areas, Cottage Place and Horse Shoe Alley, have been cleared of working-class dwellings. The City Council, by arrangement with the owners, rehoused 10 families from Horse Shoe Alley. The other families either found alternative accommodation, assisted by the owners in some cases, or were provided with such accommodation by the owners. Pulford Street Site.—This site is now in course of development by a Public Utility Society formed in 1930 and known as the " Westminster Housing Trust, Ltd." The land extends to some 2½ acres of which about 2 acres is vacant land acquired from the London County Council at the cost of £32,000: the remainder comprises the street frontage of the property, on which stand some 36 houses, and it is being conveyed to the Trust as a free gift for housing purposes by the Duke of Westminster. The capital cost of the buildings to be erected is estimated at some £75,000. The Council has undertaken to contribute an amount equal to 15 per cent, of the total cost of the buildings (exclusive of the land), 87 and not exceeding £20,000. On the present estimates of cost the Council's contribution will be about £11,500. The Ministry has agreed to contribute the sum of £7 10s. 0d. per annum in respect of each flat for a period of 40 years, under the provisions of the Housing (Financial Provisions) Act, 1924. The Council's grant was made subject to certain conditions, one of which was that the Council should have the right to nominate the tenants for a number of the flats in proportion to the amount of the Council's grant. It was also laid down that the rents to be charged should approximate to those charged by the Council for its own dwellings and that in the letting of the flats priority should be given to persons living and/or working in the City of Westminster. The scheme provides for the erection of 7 blocks of buildings, each of 5 storeys, containing altogether 180 flats, of which 155 will have 3 rooms, and the remainder 4 rooms. No one or two-roomed flats will be provided. The rents to be charged will average about 3s. 6d. per room per week, exclusive of rates. It is intended in the first place to rehouse those families, numbering about 92, at present living in the 36 houses belonging to the Duke of Westminster. The number of families to be nominated by the Council will be 27. Flats in Causton Street.—A small block containing 16 self-contained flats of two and three rooms was erected during the year by the Ecclesiastical Commissioners on a site at the corner of Regency Street. The flats are " all-electric," no gas being provided. Rents vary from 18s. to 21s. per week, according to position and size of rooms, and include the use of electrical appliances for cooking, etc. A second block of similar flats will be erected on an adjoining site during 1933. Underground, Rooms.—Housing conditions during and since the war have been such that it has been difficult to enforce the law and to deal satisfactorily with underground rooms, but the special attention given to underground dwellings separately occupied, and to basement sleeping rooms during last year, has been continued throughout 1932. The Public Health Committee expressed the view that as the situation with regard to housing of the working classes in Westminster is now somewhat easier and it is not so difficult to find alternative accommodation, the powers with regard to underground dwellings and sleeping rooms should be more rigidly enforced. The Committee approved the proposals of the Medical Officer of Health that owners and other persons having G 88 control of underground rooms be communicated with when such rooms were illegal for separate occupation as dwellings under the Public Health (London) Act, 1891, or where rooms do not comply with the City Council's regulations as to underground rooms used for sleeping purposes. The Medical Officer of Health has accordingly caused owners and others subletting to be written to when illegal rooms became vacant, warning them that action will be taken if letting or occupation takes place contrary to the Act and regulations. Where rooms are at present illegally occupied owners and others are warned not to relet or occupy illegally after the present illegal conditions cease. Many of these cases are not so serious as to call for immediate action, being occupied by single people who are away during the day time, but steps are being taken to prevent illegal occupation in the future, and the worst cases are being rehoused by the City Council or recommended to the London County Council for rehousing as opportunities occur. Another class of underground rooms being dealt with are those which are illegal for separate occupation as dwellings, or contrary to the regulations for sleeping purposes, but are not so occupied. These rooms are suitable for occupation as living rooms when used in connection with rooms on the floors above, and the owners are communicated with and informed that they are contrary to the provisions of the Public Health or Housing Acts. During the year written undertakings were given under the Housing Act, 1930, sec. 19, by owners and also in many cases by tenants subletting, that rooms in the basements which were contrary to the Act would not be relet or used as sleeping places in respect of 91 houses. The number of inspections, of communications to owners and tenants who sub-let, and the recording and reinspections, entail a considerable amount of work, which necessarily progresses somewhat slowly, and it will take a considerable time before the occupation of underground rooms is completely brought under regular control. Several owners have expressed approval of the action taken by the Council prohibiting sleeping in basements. At three houses underground rooms have been improved and made to comply with legal requirements. In a few cases extra rooms have been taken in basements, as a temporary measure, to abate overcrowding. Five notices were served re illegal occupation. The number of underground dwellings recorded as illegally occupied under the Public Health (London) Act, 1891, sec. 96, at the end of 1932, was 70, while underground sleeping rooms occupied contrary to the City Council's regulations numbered 81. 89 In addition to those above referred to some 54 others, discovered during the year to be occupied contrary to the Public Health (London) Act, 1891, sec. 96, or to the Council's regulations, and 11 of the previously recorded cases, have ceased to be occupied illegally. Overcrowding.—During the year 9 new cases of illegal overcrowding were discovered, and 16 cases which were overcrowded in the social sense. By means of the housing schemes of the City Council and of the London County Council some 80 cases of overcrowding were relieved. A complete re-inspection of all recorded cases of overcrowding was carried out during the year, and as a result it was found that some 114 families had moved elsewhere, having presumably obtained other accommodation by their own efforts. With the exception of a few cases, which were known to have moved to other addresses in Westminster, no informa-. tion was available as to where these families had gone, HOUSING STATISTICS. 1. Inspection of Dwelling Houses during the Year. (1)—(a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,879 (b) Number of inspections made for the purpose 16,462 (2)—(a) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations 875 (b) Number of inspections made for the purpose 3,842 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 33 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 612 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 187 o 2 90 3. Action under 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:— (а) By owners 0 (b) By Local Authority in default of owners 0 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 851 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 849* (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 suance 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 0 (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 *Two dwelling-houses were the subject of legal proceedings for non-compliance with the requirements of Statutory Notices. 91 E.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 0 (б) Bv 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 33 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 1 (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 1 (4) Number of dwelling-houses demolished in ance of Demolition Orders 1 (5) Number of dwelling-houses voluntarily molished 37 INSPECTION AND SUPERVISION OF FOOD. The legislation relating to food and food premises proposed in the London County Council (General Powers) Bill, 1932, became law in July, 1932. They may again be briefly summarized from Part II of the Act. 1. Registration required of premises used or proposed to be used for the sale, manufacture for sale or storage of ice cream or similar commodity. 2. Registration required likewise of premises in which manufacture of sausages, potted, pressed, pickled or preserved meat, fish or other food intended for sale takes place or is intended to take place. 3. Penalty for failing to register not exceeding 40s. and for each day of offence after conviction 20s. 92 4. Power of sanitary authority to refuse registration to premises not suitable and to revoke registration in similar circumstances. 5. Procedure for allowing appeal by anyone aggrieved. 6. The word "preserved," as far as meat or fish is concerned, includes cooking. 7. Clubs, hotels and restaurants are exempt from the above provisions. 8. Theatres, music halls and cinemas are registrable only if ice cream is manufactured on the premises. This proviso also applies to the Royal Albert Hall. 9. The County Council may make bye-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. This is probably the most important and far reaching of these food provisions. The bye-laws when made may be subject to certain modifications, limitations or exceptions. If, however, they set up certain definite standards in general cleanliness in the food industry as regards premises, persons, apparatus, and materials they will have achieved an advance for which those who have the interests of the public health at heart have been striving for many years. 10. Cases of food poisoning or suspected cases are notifiable just like those of certain infectious diseases. The object of this provision is to ensure early information of such cases reaching the medical officers of health so that investigations may be begun and communication established with other districts should evidence warrant it. 11. Food intended for human consumption and given as a prize at any public entertainment or similar gathering or given away for adver. tising purposes shall be subject to the existing law relating to unsound food. Formerly only food exposed for sale or in preparation or deposited for sale, etc., could be dealt with. There are other provisions relating to definitions, powers of entry, applications of existing statutes, etc. Since the Act came into force the City Council has taken every possible means to bring its provisions to the notice of those in the trades concerned by posters, advertisement and handbills distributed by the food inspectors. By the end of the year only some 40 applications for registration had been received. In 14 cases alterations to premises and in methods were required 93 before registration was granted. At the end of the year 20 premises had been registered. Medical practitioners were likewise made aware of the requirements as to cases of food poisoning. From July to 31st December five notifications were received and investigated. None of these was of serious nature. Merchandise Marks Act, 1926. The Agricultural Produce (Grading and Marking) Act, 1928. The orders made under these statutes now number 9 and relate to (1) Fresh apples. (2) Raw tomatoes. (3) Eggs in shell (i.e., hen and duck eggs). (4) Dried eggs. (5) Currants, sultanas and raisins. (6) Oat products (i.e., oatmeal, rolled oats, oat floiir and groats). (7) Honey. (8) Salmon and trout. (9) Butter. Administration mainly consists in seeing that food vendors observe the requirements by displaying distinctive marks, labels, etc., distinguishing the origin, Home, Empire, Foreign, as the case may be, of the produce for sale. For really adequate supervision it would be necessary to employ special staff. The food inspectors carry out the purposes of these Acts usually in the course of routine food inspections and made 666 observations as to marking, etc., in shops and at food stalls. Purchasers made three complaints, but in no case did there appear deliberate intent to deceive. Some nine verbal and written warnings were issued. Artificial Cream Act, 1929. There are no premises in the City subject to the provisions of this Act. Sampling of milk delivered to London County Council Hospitals and Schools.—In response to a special request from the County and School Medical Officer samples of milk about to be delivered to the one County Council hospital in the City (Sheffield Street), and the 18 schools have been submitted to chemical analysis. In one case the milk proved to be of poor quality. The work is carried out in the ordinary course of milk 94 sampling, informal samples being taken. Should an informal sample prove deficient, formal sampling would then follow with a view to legal proceedings. One formal sample was taken in consequence of the defective informal one mentioned. The former proved genuine, thus confirming the opinion that a deficiency in fat was due to lack of stirring. 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 11 Grade A (Tuberculin tested) milk 12 Grade A milk 5 Pasteurized milk 22 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. Eight samples of Certified milk were requested to be examined bacteriologically by the Ministry of Health, one of which proved to contain 37,200 organisms per cc. instead of the permitted maximum of 30,000. Suitable action in regard to the producer was taken by the Ministry. The local authority has no power to deal with any infringements by a producer of Certified milk. The remaining samples were found to comply with the bacteriological standards of the order. Pasteurization of milk is not undertaken at any premises in the City. Milk and Dairies 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, 1931 177 167 Registered during the year 8 38 Removed from the register 8 12 (ceased or transferred business) Registered to 31st December, 1932 177 193 The inspectors paid 388 visits to milk shops and dairies during the year. Nine notices were served in respect of minor defects which were duly rectified. 95 Milk and Dairies (Consolidation) Act, 1915. Tubercle in Milk.—Under this statute samples may be taken for examination as to the presence of tubercle bacilli. Hitherto the Council has not exercised this provision, but having considered the Minister's report of his officer's survey (vide supra) has authorised the taking of 10 samples for this purpose during 1933. Food and Drugs (Adulteration) Act, 1928. Analysis of Milk Samples.—The percentage of adulterated samples since 1920 is given in Table below. 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 1932 are given in the following table:— Table I. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Per cent. No. Per cent. North 447 115 25.8 298 66.6 29 6.4 5 1.2 South 474 337 71-0 128 27.0 6 1.3 3 0.7 1932 921 452 49.1 426 46.2 35 3.8 8 0.8 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 1.5 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 1.38 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 96 It is not the first time in these reports that the superiority in the quality of the milk in the Southern district has been noted. Of the total 921 samples of milk taken during the year, 30 were obtained on Sundays. These latter all proved genuine on analysis. Legal Proceedings for Adulteration.—Of the 9 adulterated samples, 4 were considered sufficiently serious to warrant prosecution. Details of the offences and results of proceedings are set out below. Milk— Fine. Costs. 5.2 per cent. of added water Summons dismissed £3 3s. 0d. under Probation of Offenders Act. 10.0 per cent. of fat abstracted £2 0s. — 13.0 per cent. of fat abstracted Summons dismissed £3 3s. 0d. under Probation of Offenders Act. 41.7 per cent. of fat abstracted Ditto £3 3s. 0d. Condensed Milk Regulations, 1923-1927. Forty-one samples were taken and were found to be properly labelled and genuine. Dried Milk Regulations, 1923-1927. Three samples were taken, and found to be genuine and properly labelled. Public Health (Preservatives in Food) Regulations, 1925, and Public Health (Preservatives in Food) Amendment Regulations, 1926 and 1927. Only the following articles may contain preservative which must be either sulphur dioxide or benzoic acid as specified in the regulations:— sausage and sausage meat, fruit and fruit pulp not dried, dried fruit, unfermented grape juice and non-alcoholic wines, cordials and fruit juices, jam, candied peel, sugar, corn, syrup, gelatine, beer, cider, alcoholic wines, sweetened mineral waters, brewed ginger beer, coffee extract, pickles and sauces made from fruit or vegetables. One infringement of these regulations was found as the result of analysis and related to sausages containing preservative not bearing a notice to that effect. 97 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 1932. Number. Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ 8. d. £ 8. d. 1 Butter 142 142 — — — — — — 2 Caviare 10 5 5 4 2 2 9 0 0 3 3 0 3 Cocoa 23 23 — — — — — — 4 Coffee, Chicory, etc. 15 15 — — — — — — 5 Condensed Milk 41 41 - — — — — — 6 Confectionery 1 1 - — — — — — 7 Cream 74 72 2 — — — — — 8 Culinary Flavours - - - - - - - - Colours 2 2 - - - — - - 9 Dried Milk 3 3 — — — — — — 10 Drugs 25 25 — — — — — — 11 Fish Pastes 27 27 — — — — — — 12 Fish (Tinned) 13 13 — — - — — — 13 Fruit Cordials 26 26 - — - — — — 14 Fruits (Preserved) 68 67 1 — — — — — 15 Ice Cream 24 24 — — — — — — 16 Jams and Preserves 26 26 — — — — — — 17 Junket Crystals 1 1 - — — — — — 18 Margarine 40 40 — — — — — — 19 Meat Pastes 25 25 — — — — — — 20 Meat Pies 34 34 - — — — — — 21 Milk 921 912 9 4 1 3 2 0 0 9 9 0 22 Olive Oil 18 18 — — — — — — 23 Pickles and Sauces 12 12 — — — — — — 24 Sausages 72 71 1 — — — — — 25 Soups(Tinned) 1 1 — — — — — — 26 Spices 7 7 — — — — — - 27 Spirits 87 87 — — — — — — 28 Sugar 2 2 — — — — — — 29 Tea 18 18 — — — — — — 30 Vegetables (Tinned) 29 29 — — — — — — 31 Walnuts 2 1 1 — — — — — 32 Wine 24 24 — — — — - — 1,813 1,794 19 8 3 5 11 0 0 12 12 0 The Council had given authority for 1,800 samples of food to be purchased during the year; authority was also given for an additional 25 samples of foods other than milk to be taken if necessary. 98 Caviare.— Of 10 samples 5 were found to contain boric acid. The following are the results of proceedings:— Fine. Costs. (1) 6 grains boric acid per pound £3 - (2)23.8 „ „ £6 - (3)24.08 ,, „ Dismissed £3 3s. 0d. (4)22.4 „ ,, Warranty proved. Summons dismissed. (5)6.0 „ „ No action (informal sample). Cream.—94 samples were taken of which 2 were adulterated. One contained 0.42 grains of boric acid per pound, while the other contained only 23.35 per cent. of butter fat. Both were unofficial samples. Preserved Fruit.—68 samples were taken and 1 was found to contain 2 grains of tin per pound. No action was taken. Sausages.—72 samples were taken, with one exception all were found to be genuine. This case has already been referred to as contravening the Preservatives Regulations in regard to labelling. The vendor was cautioned. Walnuts.—On information from the Port of Bristol a consignment of walnuts forwarded to London was examined for preservative. Sulphur dioxide to the extent of 34 parts per million was found in samples. The matter was thoroughly investigated by the British Fruit Growers Association in conjunction with the growers and exporters in France. It is the practice of some growers to store the walnuts in tanks of water. Small quantities of sulphur dioxide is sometimes introduced into these tanks as a preservative. In any case the amount of sulphur is small when compared with the permissible amounts in other fruits, and it is doubtful whether any specified amount of preservative applies to walnuts according to the terms of the regulations. Spirits.—Eighty-seven samples were analysed during the year. They consisted of Rum 2, Gin 18, Brandy 10 and Whiskey 57. All of these proveed to be genuine. During the year 49 milk sellers took advantage of the provisions contained in Section 21 and the Second Schedule of the Food and Drugs (Adulteration) Act, 1928, to request the Local Authority to take samples from the consignors at the place of delivery. The form of written 99 request is prescribed in the Schedule, and although 38 of the requests were in proper legal form, 11 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 49 samples were found on analysis to be "genuine." Regulation of Street Trading. The London County Council (General Powers) Act, 1927, provides for the regulation of street trading by the issue of licences which must be renewed annually. Special observation is kept by the Food Inspectors on all stalls where food is exposed for sale and also the premises where it is stored. Where stall-holders have their food stores in other districts the addresses are forwarded for the attention of the sanitary authorities concerned. The number of stalls registered in the City on which food is exposed for sale is about 200, but this number is continually changing. As a result of constant supervision only a few minor infringements of the by-laws have occurred. These were promptly rectified when pointed out by the inspectors. Otherwise conditions have been satisfactory. Meat Regulations, 1924. There are no slaughterhouses in the City and the duties imposed are confined to the supervision of meat shops, stalls and stores. In addition to routine and special inspection, visits are paid to all meat premises in the City at certain periods in the year for the purpose of the requirements of the regulations. A register is kept of all meat vendors and the number at the end of 1932 was 142. The inspectors paid 211 visits to these premises. Nine notices were served and the defects were rectified in each case. 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 3,326. These include visits to milk shops and butchers' shops which have already 100 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 217 notices requiring sanitary defects to be remedied were issued. Restaurants.—A register of all restaurants is kept and 1,247 have already been indexed. Daring the year 1,835 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 176 instances, and in each case the work was satisfactorily carried out. Suspected Food Poisoning. —No outbreaks of food poisoning occurred during the year. As mentioned elsewhere five suspected cases were notified under the new provisions for notification. They proved to be cases of slight and transient illness. Fish Shops and Fried Fish Shops were periodically inspected. There are 29 of these shops in the City to which the Food Inspectors paid 28 visits. Six of these are classified as restaurants, and inspections to them are returned as restaurant inspections. lee Cream Premises.—70 premises were on the registeron 31stDecember, 1931, as required by the London County Council (General Powers) Act. 1928. This number included all premises where ice cream was being made, stored or sold, except ice cream factories, hotels, restaurants and clubs. On the passing of the London County Council (General Powers) Act, 1932, theatres, except where ice cream is made on the premises, were exempt from registration. Under this provision 47 addresses were removed from the register. During 1932 14 new premises were registered for either the manufacture, storage or sale of ice cream, making 43 premises on the register at the end of 1932. The inspectors made 45 visits to these premises during 1932; conditions were satisfactory. Bakehouses.—At the end of 1932 there were 60 bakehouses in the City, of which 43 were underground. During the year, two above-ground bakehouses were discontinued as such. 229 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 101 including Sundays. The following table shows the nature and amount of food voluntarily surrendered or submitted for destruction:— Article. Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Apples 2 7 1 12 Horseradish - 10 — — Apricots 4 15 0 14 Melons 16 6 1 - Aubergines - 1 3 20 Monsterias — 1 2 14 Avocado Pears - 4 — 4 Nectarines 2 — 2 14 Asparagus - 19 2 16 Onions 1 6 — — Bananas 7 15 — — Paw Paws 1 2 2 11 Black Currants - 5 2 2 Pineapples - 10 - 4 Brussel Sprouts - 1 — — Persimmons - - 3 - Carrots - 8 2 — Plums 1 7 1 12 Cherries - - 3 — Peaches - — 2 14 Chestnuts 2 15 — — Potatoes 23 — 1 12 Cranberries — 8 3 8 Pears 5 8 — 16 Cauliflowers 7 — — — Quinces - — 2 16 Custard Apples - — 2 24 Radish — 3 — 24 Capsicums — — 1 20 Spinach - 1 — - Dabs - - 1 14 Sweet Potatoes 4 8 2 — Grapes — 8 1 8 Tomatoes 6 14 — — Gherkins - 1 1 — Turnips — 5 2 — Hams 1 11 2 — Walnuts - 8 2 23 While inspecting butchers' shops, one of the Inspectors found a number of joints of meat, mainly ribs of beef, in the refrigerator. The meat was unsound and unfit for food, was seized and submitted to a Magistrate, who ordered it to be destroyed. At the hearing of the summons against the defendants the Magistrate dismissed the summons under the Probation of Offenders Act on payment by the defendants of £10 10s. costs, in view of the reputation and satisfactory record of the defendants. Certification of Food for Export.—Certificates enabling the export of certain articles of food were granted in one instance—to Italy. Nutrition—Dissemination of Knowledge.—The Ministry of Health issued an important circular (1290) based on the work of Dr. Helen Mackay, carried out on behalf of the Medical Research Council on the question of nutritional anaemias of infancy. The circular also dealt with the prevention of rickets and dental disease by the supply of foods rich in vitamin D and calcium, e.g., milk, eggs and cod liver oil. The value of milk to growing children was also emphasised. The circular and original works of reference were obtained and circulated to the medical officers of the maternity and child welfare centres. The sub-committee of the Council concerned with maternity and child welfare attaches considerable importance to the influence of diet in this work, and has arranged for lectures and demonstrations to be given at the centres. The matter of a well balanced and correct diet is a fundamental principle in the health of any individual, and particularly the very young, the expectant mother, or those whose general health from whatever cause is below standard.