v \2>* 50C ^\Sb1 WES 44 City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 ANDREW J. SHINNIE, MD, D.P.H. (Lond.), Medical Officer of Health and Administrative Tuberculosis Officer Printed by Order of the Oouncil LONDON: HARRISON AND SONS, LTD. PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2, 65748 iii CONTENTS. page Committees vi Introduction ix Statistics and Social Conditions ol the Area 1 Births 6 Deaths 9 Causes of, compiled by Medical Officer of Health 12 „ „ „ „ Registrar General 9 Common Lodging-House 23 Distribution of, in Wards 17 Infantile Mortality 17 Stillbirths 11 Meteorological 6 Population 1 Social Conditions 2 Staff of the Public Health Department 2 Statistics, General and Vital 1 Unemployment 2 Prevalence oi, and Control over, fnlectious Diseases 24 Bacteriological Laboratory 34 Cerebro-spinal Fever 33 Chicken-pox 33 Diarrhoea and Enteritis 32 Diphtheria 30 Anti-toxin 31 Schick Test Immunization 30 Enteric Fever 32 Influenza 32 Measles 32 Mumps 33 Notifications 28 Ophthalmia Neonatorum 34, 59 Poliomyelitis 33 Puerperal Fever 33, 55 Puerperal Pyrexia 34, 55 Scarlet Fever 30 Small-pox 25 Tuberculosis 35 Deaths and non-notified deaths 39, 40 Dispensary Report 41 Returns (Ministry of Health) 45 Notifications—-primary 35 Tables 35 Vaccination 25 Whooping Cough 33 (9169) A 2 IV page General Provision of Health Services in the Area 47 Ambulance facilities 47 Ante-natal services 51 „ cases 53 „ clinics 53 „ visiting 53 Barlow's Gift Charity 62 Clinics and Treatment Centres 48 Convalescent Treatment 55 Day Nursery 48, 64 Dental Treatment 63 Health Visiting 61 Hospitals 49 Infant Clinics 57 Infant Life Protection 61 Institutional Provision for Mothers and Children 54 Insulin Treatment 63 Laboratory facilities 47 Maternal Mortality 55 Maternity and Child Welfare 49 Maternity Beds 54 Midwifery Services 49 Midwifery—consultant services 51 Midwives, Medical Assistance to 51 Mothercraft 60 Milk, supply of 62 Nursing in the Home 47, 59 Unmarried Mothers, Homes for 62 Sanitary Circumstances of the Area 65 Atmospheric Pollution 82, 84 Common Lodging Houses 75 Coroner's Court and Mortuary 80 Disinfection 79 Dogs, Fouling of Footways by 77 Drainage and Sewerage 65 Factories, Workshops and Workplaces 71 Infirm and Diseased Persons—Removal of 78 New Sinitjry Construction 66 Nuisances 70 Offensive Refuse—Removal of 71 Outworkers 74, 75 Pigeons, Nuisance from 78 Premises and Occupations subject to control by Local Authority 75 Public Cleansing 66 Public Sanitary Conveniences 66 Public Swimming Pools, etc. 65 Rag Flock Acts 76 Rat Repression77 Rent Acts 69 Sanitary Inspection of the Area 68 Schools 76 Shops Act 1934 76 Smoke Abatement 81 Tenement Buildings—Lighting of Staircases 71 Water Supply 65, 70 Housing 85 Clearance, Demolition and Closure of Unfit Habitations 88 General Observations 85 V page Housing—(contd.) 85 Housing Schemes of the City Council 91 Overcrowding 93 Re-conditioning of Dwellings 89 Rehousing Operations 92 Statistics required by Ministry of Health 94 Town and Country Planning Act 1932 91 Underground Rooms 94 Inspection and Supervision of Food 96 Artificial Cream Act, 1929 97 Condensed Milk Regulations, 1923-1927 102 Dairymen and Dairy premises—registration 99 Dried Milk Regulations, 1923 -1927 102 Food products—certification for export 96 Food and Drugs (Adulteration) Act, 1928 99 Samples, results of analysis, action taken, etc. 99-105 Food, Inspection and Destruction of 108 Food Poisoning 108 Ice-cream premises 96 L.C.C. (General Powers) Act, 1932 96 L.C.C. Schools, Supply of Milk to 101 Milk Act, 1934 101 Meat Regulations, 1924 107 Merchandise Marks Act, 1926, and the Agricultural Produce (Grading and Marking) Act, 1928 97 Milk and Dairies Amendment Act, 1922 98 Milk and Dairies (Consolidation) Act, 1915—tubercle in milk 97 Milk and Dairies Order, 1926 99 Milk Samples—analysis of 99 Preserved Meat, etc., premises 96 Public analysts—Observations by 105 Preservatives in Food Regulations, 1925-1927 102 Restaurants and other Food Premises 107 Street Trading—regulation of 107 VI Public Health and Maternity and Child Welfare Committee. Mayor: Councillor F. G. Rudler, J.P. Deputy Mayor: Councillor The Rev. E. St. G. Schomberg, M.A. Note.—The Mayor and Deputy Mayor are Members ex officio of all Committees and Sub-Committees, with the exception of the Assessment Committee and Barlow's Gift Special Committee. Chairman: *Councillor F. R. Ridley, J.P. Vice-Chairman: *Councillor G. F. Jerdein. Members: Councillor Capt. J. F. C. Bennett. * „ T. C. Claxton. „ G. H. Heilbuth. * „ Mrs. Alderson Home. * „ Lieut.-Colonel W. Merrick. * „ Mrs. F. M. Odone. * „ Albert J. Offer. * ,, The Rev. Jocelyn Perkins, M.A., D.C.L., F.S.A. ,, Dr. F. E. L. Phillips. * „ A. Sargeant. * „ Mrs. C. J. Storrs. f „ H. S. E. Yanderpant. „ The Hon. Mrs. Douglas Yickers, J.P. Maternity and Child Welfare Sub-Committee. Members of the Council: Councillor Mrs. Alderson Horne. Councillor A. Sargeant. „ G. F. Jerdein. ,, Mrs. C. J. Storrs. ,, Mrs. F. M. Odone „ H. S. E. Vanderpant. {Chairman). „ The Hon. Mrs. Douglas „ F. R. Ridley, J.P. Vickers, J.P. Co-opted Members: Dalton, Mrs. J. C. Haldane, Miss E. S. (City of Westminster Health Society). Spelman, Mrs. M. (Westminster Labour Party). Wyatt, Mrs. A. E. (Women's Co-operative Guild, Westminster Branch). †Chairman of Expenditure Sub-Committee. *Members of ,, ,, VII Sub-Committee re New Maternity and Child Welfare Centre and Day Nursery. Members of the Council. Councillor Mrs. Alderson Home. Councillor F. R. Ridley, J.P. ,, G. F. Jerdein (Chairman). ,, H. S. E. Vanderpant. „ Mrs. F. M. Odone. „ The Hon. Mrs. Douglas Vickers, J.P. Co-opted Members representing the City of Westminster Day Nursery Committee. Mrs. J. F. C. Bennett. Lady Gluckstein. Lady Bradford. A. F. Stallwood (lion. Treasurer). Committee Clerk: F. J. Burbridge. IX Annual Report on the Health and Sanitary Condition of the City of Westminster. 1934. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1934. This Report, as required by the Minister of Health in Circular 1417, is an ordinary report in contradistinction to the larger survey reports which the Minister requires from time to time. In an ordinary report the Minister does not request full particulars throughout the health services, but only a record of any alterations, improvements and developments which have taken place during the year. There is no need, therefore, to repeat information which has been given in detail in former years. Vital Statistics. Last year the birth rate made the lowest record ever known in Westminster, namely 8.7, but in 1934 the birth rate has risen again to 9.4. The crude death rate showed an improvement on 1933, namely 11.8 as compared with 12.4. The Minister has asked for comment on the incidence of unemployment, and, by the courtesy of the Minister of Labour, the incidence of unemployment is shown month by month throughout the year. There is a reduction over all as compared with 1933, and the total itself is, of course, considerably less than that found in most other areas of the country in relation to the population. There is no evidence that the health of the people has suffered on account of existing unemployment. Infectious Disease. No cases of smallpox occurred. This is the first year since 1927 without a notification of smallpox. The mild smallpox which seemed to be endemic in London during the past five or six years has apparently disappeared. There was a small increase in the number of cases both of diphtheria and scarlet fever, and a large increase in measles, 1934 being what is called a measles year. There were a few more new cases of tuberculosis. The death rate from this disease was slightly reduced. Notification of cases of tuberculosis is being better carried out, as there were fewer X deaths from tuberculosis in cases which had not been notified during life. More new cases were seen at the Tuberculosis Dispensary. Maternity and Child Welfare. Special note is made of a new service which the City Council has provided in connection with maternity services, namely, expert assistance to medical practitioners and likewise to practising midwives in difficult confinements. The Minister of Health issued a circular in the autumn exhorting local authorities to take further measures towards reduction of maternal mortality, but the City Council had anticipated his intention by improving its maternity services, and was in a position to report to the Minister on these lines in December. Extracts from the Committee's report are given in the maternity and child welfare section. Discussion on the question of maternal mortality has emphasised the importance of attendance of expectant mothers at ante-natal clinics. The number of expectant mothers in relation to the total births in the City who attended the ante-natal clinics has increased. The exact percentage of expectant mothers attending those clinics in the City is 76.6. As the benefits of ante-natal attendance are more and more realised, it is hoped that even this high percentage will further increase. There were four maternal deaths as compared with five last year. This gives a maternal mortality rate of 3.3 as compared with 4.4 for England and Wales. This is an improvement on last year. It is noteworthy that these four women lost their fives in first confinements. In Westminster, with its remarkably low birth rate (and restricted families), there is obviously a high proportion of first births among the total births. First births are generally accepted as being attended with greater difficulties than subsequent births. Somewhat full comment is made on the danger of accepting maternal mortality figures in dealing with small populations and low birth rates. There was a noticeable reduction in ophthalmia neonatorum and also in infant deaths from venereal disease generally. Plans of Sanitary Work in New and Old Buildings. The number of plans submitted, namely 935, is the highest yet recorded and again implies continued activity in the building trade. In 1924 only 602 plans were submitted. Atmospheric Pollution. Charts indicating the estimation of sulphur gas in the atmosphere throughout the year, and also the suspended impurities in the air, are shown on page 84. During the holiday month of August there is XI much less sulphur gas and the visibility is, of course, considerably improved. The Public Health Committee was impressed with the need for estimating the deleterious effects of sulphur on buildings and fabrics, etc., and is proposing to instal an instrument for the measurement of these effects. Coroner's Court and Mortuary. A note is made of the further improvements which have been made to the Court and Mortuary during the year. Food and Drugs. During the past two years a tendency to an increase of food adulteration has been observed. This applies particularly to milk, where the percentage of samples classified by the public analysts as of good quality has fallen to 25 per cent. A new feature is a note by the public analysts of their work, to be found on page 105. It was thought that in view of the importance of the work done by the analysts of the City it would be appropriate to invite them to comment on it. Notes on investigation of three cases of food poisoning are included. Housing. The detailed housing survey of the working class dwellings in the City, to which reference was made in last year's report, continued throughout the year. The subject of housing being of such importance receives considerable comment in the body of the report. The housing programme of the City Council is dealt with, and also the progress which has been made in the matter of occupation of basement rooms. By the time this report is published the overcrowding Bill will have become an Act of Parliament, and it will be a source of some satisfaction to the City Council to know that a great deal of the work required under this new statute has already been accomplished in the housing survey which, at the time of writing, has been completed. The objects of this survey are set out in this report, and they included the assessment of overcrowding together with measurement of rooms, etc., which are required under the new Act. For the purpose of overcrowding, therefore, it will be necessary only to survey the blocks of industrial tenements owned by the London County Council, the Peabody Donation Fund, and other Housing Corporations. None of these was included in the present housing survey. Reference is also made to the new housing scheme of the Council for the erection of 280 flats to be completed in 1936-7, and to the clearance areas which have been declared and dealt with by the City Council during the year. XII Staff. Only one staff change has been made during the year, and that of considerable importance. Mr. W. D. Sambrook, who had been assistant to the Public Health Committee Clerk in the Town Clerk's Department for many years and had thus gained extensive experience in public health administration, was appointed to the post of chief clerk of the Public Health Department on the retirement of Mr. A. Wise. Mr. Wise had been in the Public Health Department, not only of the City Council but of the Vestry of St. Margaret and St. John, since 1892, and was promoted to the post of chief clerk in 1930. He had thus completed 42 years' service. During the year 57 reports, both routine and special, were submitted by me to Committees of the Council. The correspondence of the department included 18,691 incoming communications and 16,666 outgoing. In conclusion, I would express my sincere thanks to the Public Health Committee and to its Chairman, Councillor F. R. Ridley, J.P., the Vice-Chairman, Councillor 6. F. Jerdein; the Chairman of the Public Health and Expenditure Sub-Committee, Councillor H. S. E. Vanderpant; and Councillor Mrs. F. M. Odone, Chairman of the Maternity and Child Welfare Sub-Committee, for much personal kindness, helpfulness, and invariable consideration. The staff deserve commendation and appreciation for their work in the various branches of the department. I have the honour to be, Your obedient servant, ANDREW J. SHINNIE. August, 1935. 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)—129,579. Population, June, 1934 (Registrar General's Estimate)—124,050. Number of Inhabited Houses (Census 1931)—22,536. Rateable value—£11,290,000 (March, 1935). Sum represented by a penny rate £43,040 (Estimate). Extracts from Vitat. Statistics for the Year. Total. Males. Females. Live Births— Legitimate 1,015 528 487 Illegitimate 151 77 74 1,166 605 561 Birth-rate per 1,000 of the estimated resident population—9.4. Stillbirths—42. Rate per 1,000 total (live and still) births—34.7. Deaths—1,466. Death-rate per 1,000 of the estimated resident population—Crude rate 11-8. Adjusted rate 12.1. Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 2 1.6 Other puerperal causes 2 1.6 Total 4 3.3 Death-rate of infants under one year of age:— All infants per 1,000 live births 66 Legitimate infants per 1.000 legitimate live births 55.1 Illegitimate infants per 1,000 illegitimate live births 139 Deaths from measles (all ages) 11 ,, whooping cough (all ages) 9 „ diarrhoea (under 2 years of age) 16 2 Social Conditions. Westminster ia a City of shops, offices, hotels and restaurants, and its workpeople find employment in those main industries as well as in tailoring and other allied trades. Unemployment. The unemployment figures show some improvement over those of 1933, and I am indebted to the Manager of the local Ministry of Labour Employment Exchange for the figures set out in the following table:— Number of Unemployed Persons signing the Register at the Westminster Employment Exchange during one selected week in each of the 12 months of 1934. Month. Men. Women. Boys. Girls. January 2,370 718 34 19 February 2,353 681 23 18 March 2,159 653 12 18 April 2,131 612 31 27 May 1,944 613 14 11 June 1,773 580 8 41 July 1,738 586 46 33 August 1,772 607 29 27 September 1,974 650 41 15 October 2,228 678 34 33 November 2,265 673 10 17 December 2,098 640 51 44 24,805 7,686 333 303 Total corresponding figures for 1933 are as follows:— 1933 28,285 8,642 373 301 The following are the Public Health Officers of the City Council. 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. Shinnib M.D., D.P.H., &c. Assistant Medical Officer of Health and Clinical Tuberculosis Officer. Ian S. Thomson M.A., M.D., D.P.H. Assistant Medical Officers: *Ethel M. Vernon M.D., B.S. (Maternity and Child Welfare.) *A. D. C. Bell M.A., M.B., Ch.B., M.R.C.P. (Maternity and Child Welfare.) 3 Obstetric Consultants: *Aubrey Goodwin O.B.E., M.D., F.R.C.S. Chakles D. Read M.B., Ch.B. F.R.C.S. A. C. H. Bell M.B., B.S. (Lond.), F.R.C.S. Westminster Hospital Laboratories. *R. J. V. Pulvertaft, M.B., Ch.B. Bacteriologist to the Hospital. (Cantab.), M.R.C.P., &c. Public Vaccinators : Mayfair District *Kenneth R. Hay, O.B.E., M.B., 47, Hill St., Berkeley Square, W.l. Belgrave and Knights bridge District Westminster (St. Margaret and St. John) District. Westminster (St. Anne and St. James) *Albert E. Cope, M.D., 66 Belgrave Road, S.W.1. District Strand District Vaccination Officer: James H. Lowe. Dental Clinic: *T. Stewart Tait L.D.S., R.C.S. Edin. *F. J, Gordon (Anaesthetist) M.R.C.S., L.R.C.P. Public Analysts : *T. McLaohlan A.C.G.F.C., F.I.C. *F. W. Edwards F.I.C. Senior Sanitary Inspector: John Sanderson R.S.I., San. Sc. Cert., Gold Medallist, Carpenters' Company. Chief Clerk. W. D. Sambrook Appointed ls< August, 1934. 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. Haiqh 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. Sdtton (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. 4 Sanitary Inspectors—continued: Miss C. Hughesdon S.I.E.B., R.S.I., Health Visitor's Certificate, Certified Midwife, Dipl. Nat. Health Soc. Temporary Sanitary Inspectors (Engaged on Housing Survey Duties): H. J. Aldhous S.I.E.B., Meat and Food Cert. (Appointed Ith June, 1934). S.G.Bennett S.I.E.b., Meat and Food Cert. (Appointed. 29th January, 1934). L.G.Brooks S. I. E.B., Meat and Food Cert. (Appointed 4th June—Resigned 1th July, 1934). S. J. Cassidy S.I.E.B. (Appointed 1th July, 1934). W. G. F. Colebeck S.I.E.B., Meat and Food Cert. (Appointed 28th June, 1934). W.L.Morris S.I.E.B., Meat and Food Cert. (Appointed 23rd July, 1934). Health Vialtors: 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. Mlss P. L. Luff Certified Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Miss E. M. Craigie Certified Midwife, Health Visitor's Certificate, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. *Mrs. R. Coleman (Instructor Royal Red Cross Certificate, 1st CI., and in Mothercraft at Centres) Gold Medal. Clerical Staff: Arthur Wise (Retired 31st July, 1934). A. J. Manhood. S. G. Bennett, S.I.E.B., Meat and Food Cert, (acting temporarily as Sanitary Inspector). F. W. Lake. F. E. Norwood. W. Jenkins. Miss M. McFarlane (Tuberculosis pensary). 5 Clerical Staff—continued Temporary Clerks J W Anderson (Appointed 29th January, 1934) Miss E M Armstrong (Appointed 31 st January, 1934) H J Bright (Appointed lsi March, 1934) G H Browne (Appointed 3rd June, 1934) J M Burbridge (Appointed 15th October, 1934) E Jones (Appointed 29th August, 1934) W F C King (Appointed 3rd June, 1934) P J Orchard (Appointed 29th May—Terminated 23rd Jun1934) T C Telford (Appointed 25th June, 1934) Coroner's Court and Mortuary Superintendent A R Ford (lite Chief Petty Officer, RN) R Watling Mortuary Keeper A W Nicholls Assistant Mortuary Keeper *Miss S Gardiner Nurse Attendant State Registered Nurse Disinfecting Staff S C West, Foreman Disinfector J Atkins, Disinfector P W Attwater, Disinfector N Heathcote, Disinfector and Rat Officer A B Holland, Disinfector J R Doyle, Motor Driver Assistants in the Department A T Steward, Assistant to Sanitary Inspectors W H Smith, Messenger Female Caretakers, Attendants, etc Disinfecting Station—Mrs Starling Maternity and Child Welfare Centres— Ebury Bridge—Mrs Whittlesea, 15, Bessborough Street—Mrs Nicholls Marshall Street—Mrs Ratcliffe, Miss Farrow Tuberculosis Dispensary—Mrs Crowley Coroner's Court—Miss Mates, Miss Hamilton The following are the staff of the City of Westminster Health Society, a voluntary Maternity and Child Welfare organisation working in close operation with the City Council Medical Officers: *The Hon Mrs N Olivier Richards MD, MRCP *Mrs Winifred Jennings MD Health Visitors: Miss Callaghan (Supt, Centre) Health Visitor's Certificate, Cert Domestic Economy, &c Miss Pinchen Health Visitor's Certificate, Dipl National Health Society Miss Reed Health Visitor's Certificate and Certificated Midwife Miss Cross Certificated Midwife (With assistants, paid and voluntary, holding Heilth Visitor's certificates and with nursing experience) Mrs Steffens (Mothercraft Classes) (9169) B 6 Meteorological. The following note is extracted from a letter appearing in "The Times" of January 1st, 1935, by Mr. W. G. Cochran, of the Rothamsted Experimental Station, Harpenden, Herts. Mr. Cochran states that the weather of 1934 will be remembered chiefly for the acute and prolonged lack of water in many parts of England. The drought, considered to have started in November, 1932, continued until December, 1934, when rain fell on no less than 28 days, giving a rainfall for the month of 5.39 inches, over double the average of 2.59 inches for that month. December, besides being a wet month, was also unusually mild. March and September also gave more than the average rainfall, whilst February was the driest month of the year. The total rainfall for the year was 25.13 inches, as compared with an average of 28.56 inches. With regard to sunshine, July with 275 hours stands the highest since July, 1928. The last quarter of the year Mr. Cochran describes as being somewhat gloomy, all three moiiths being distinctly less sunny than the average. There were no extremes of heat or cold, the highest temperature being on June 17th and July 8th with screen temperatures of 83.4 degrees F. and the coldest on January 24th with 22 degrees F. Births. The births registered in Westminster during 1934 numbered 1,609, but of these the homes of 966 were in other districts, 3 were either registered under the Legitimacy Act or were re-registrations, and have therefore to be deducted from the total. There were, however, 526 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,166, which is 67 more than the corresponding figure for 1933. The Birth Rate for the City was 9-4, for London 13.2 and for England and AVales 14.8. 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 966 in 1934, and includes not only women from the various metropolitan boroughs but also from the counties around London. Even within the short period of fifteen years such a far-reaching change in domestic life is noteworthy. It may be that in these days of small families the coming of a baby is a much more portentous event than formerly. This change must also be associated with a definite falling off in the midwifery practice of general practitioners. 7 The comparative net totals of the registered births for the last three years are:— Table I. 1932. 1933. 1934. Legitimate. Legitimate. Legitimate. Males 535 467 528 Females 485 503 487 Illegitimate. Illegitimate. Illegitimate. Males 70 58 77 Females 62 71 74 1,152 1,099 1,166 Table II. Births Registered Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 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 1,450 911 888 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 1933 1,610 977 (15) 466 1,099 1,615 1,559 56 1934 ],609 969 (3) 526 1,166 1,567 1,516 51 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. The legitimate and illegitimate births are distributed as follows:— Table III. Legitimate. Males 766 441 + 203 = 528 Females 703 420 + 204 = 487 1,469 861 + 407 = 1,015 (9169) B 2 8 Illegitimate. Males 74 - 58 + 61 = 77 Females 66 - 50 + 58 = 74 140 — 108 + 119 = 151 The legitimate births show an increase of 45 and the illegitimate an increase of 22 on the figures of 1933. As shown in Table II, 1,567 notifications of births were received by the department for 1934 as compared with 1,615 in 1933. Of the total notifications, 483 were sent by midwives, of whom 30 were practising in the City during 1934. The following table shows the number of male and female children born since 1918, 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 IV. Number Born. Number of Deaths under 1 year Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 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 1933 525 574 49 26 476 548 1934 605 561 45 32 560 529 For each 1,000 girls born, there were in— 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. 1924 1,086 boys. 1933 914 boys. 1925 1,041 boys. 1934 1,078 boys. 9 Deaths. The following tables are supplied by the Registrar General at the request of the Ministry of Health:— Table V.—Causes of Death at different Periods of Life in the Metropolitan Borough of Westminster, 1934. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. 761 45 12 10 10 29 46 49 85 171 176 128 F. 714 32 10 4 11 20 28 50 62 123 164 210 1. Typhoid and paratyphoid fevers M. - - - - - - - - - - - - F. - - - - - - - - - - - — 2. Measles M. 5 1 2 2 - - - - - - - - F. 8 - 4 1 1 1 1 - - - - - 3. Scarlet fever M 2 - 1 - - 1 - - - - - - F. 1 - - - 1 - - - - - - - 4. Whooping-cough M. 6 - 3 3 - - - - - - - - F. 4 — 4 - - - - - - - - - 5. Diphtheria M. 5 - 1 1 3 - - - - - - - F. 4 — - 2 2 — — — — — — — 6. Influenza M. 14 - - - - - - - 4 3 3 4 F. 6 - - - - - - - 2 2 1 1 7. Encephalitis lethargica M - - - - - - - - - - - - F. - - - - - - - - - - - - 8. Cerebro-spinal fever M. 1 - - - - - 1 - - - - - F. - - - - - - - - - - - - 9. Tuberculosis of respiratory system M. 59 - - 1 - 5 10 11 10 14 7 1 F. 27 — — — 1 6 7 5 3 5 — - 10. Other tuberculous diseases M 6 - - - 1 2 - - - 1 - - F. 6 — - — 1 3 1 1 — - — — 11. Syphilis M. 5 1 - - - - - 1 1 1 1 - F. 3 1 - - - - - - 2 - - - 12. General paralysis of the insane, tabes dorsalis M. 2 - - - - - - - - 1 1 — F. 2 - - - - - - 1 - - 1 - 13. Cancer, malignant disease M. 101 - - - - 2 5 2 12 31 32 17 F. 131 — — — — 1 3 12 20 35 35 25 14. Diabetes M. 8 - - - - 1 - - - 2 2 3 F. 8 - - - - - - - - 1 6 1 15. Cerebral haemorrhage, etc. M. 30 - - - - - 1 1 4 9 6 9 F. 39 - - - - - - 1 2 5 13 18 16. Heart disease M. 187 - - - 2 2 2 7 14 51 61 48 F. 165 1 — — 1 1 2 4 7 21 56 72 17. Aneurysm M 7 - - - - - - - 2 ] 3 1 F. 5 - - - - - - 1 1 3 - - 16 Table V- -continued. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35- 45— 55— 65— 75— 18. Other circulatory diseases M. 23 - - - - - - 1 1 5 10 6 F. 41 - - - - - - - 1 5 11 24 19. Bronchitis M. 24 - - - - - 1 - 3 8 8 4 F. 27 - - - - - 1 1 - 1 6 18 20. Pneumonia (all forms) M. 46 5 2 - - 2 5 4 8 6 8 6 F. 36 6 2 1 — — 3 2 5 5 7 5 21. Other respiratory diseases M. 5 - - - - 1 - - 1 3 1 - F. 4 — — — — - 1 — - 1 - 2 22. Pepticulcer M. 9 - - - - - - 2 2 1 2 2 F. 6 - - - - - - - 1 3 1 1 23. Diarrhoea, etc. m 13 10 - 1 1 - - - - - - - F. 9 6 — - - — — 1 — 1 1 — 24. Appendicitis m 7 - - - - - 1 2 1 3 - - F. 6 — — — — — 1 1 - 2 2 — 25. Cirrhosis of liver M. 8 - - - - - - 1 1 5 - 1 F. 3 — — — 1 — — — — 1 1 — 26. Other diseases of liver, etc. M. 1 - - - - - - - - - - 1 F. 9 - - - - - - 2 1 3 1 2 27. Other digestive diseases M. 15 1 - 1 - - 1 - 2 2 4 4 F. 19 - - - - - - 3 4 4 3 5 28. Acute and chronic nephritis M. 22 - - - 1 - 1 2 3 5 5 5 F. 14 - - - - - 1 — 2 4 5 2 29. Puerperal sepsis F. 2 — — — — 1 1 - - - - - 30. Other puerperal causes F. 2 — — — — — 1 1 — — — ... 31. Congenital debility, premature birth, malformations, etc. M. 24 24 - - - - - - - - - - F. 12 11 - - - - 1 - - - - - 32. Senility m. 2 - - - - - - - - - 2 - F. 16 - - - - - - - - - 1 15 33. Suicide M. 24 - - - - 4 4 6 5 3 2 - F. 13 — — — — 5 2 3 1 1 1 — 34. Other violence M. 35 - - - - 6 10 3 4 6 3 3 F. 24 4 — — 1 — 1 3 2 2 5 6 35. Other defined diseases M. 65 3 1 1 2 3 4 6 7 11 14 13 F. 59 1 — — 2 2 1 8 8 18 6 13 36. Causes ill-defined, or unknown M. - - - - - - - - - - - - F. 3 2 - - - - - - - - 1 - 11 Still-births.—Fifty-one still-born children were notified during the year. Table VI. Still-births Registered. Inward Transfers. Outward Transfers. Allocated to Westminster. Total Legitimate and Illegitimate Males 29 7 21 15 Females 30 11 14 27 Illegitimate Males 2 - 1 1 Females 1 3 1 3 Although births increased in 1934, 1,166 as compared with 1099 in 1933, there were fewer still-born infants. Infectious diseases. Statement showing the number of cases of certain infectious diseases in the area during the 52 weeks ended 29th December, 1934:- Table YII. Westminster, City of, Met. B. Number of Cases of Infectious Diseases Notified (Civilians). Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. Pneumonia. — 363 167 6 13 5 65 48 (The case rates of these diseases for England and Wales per 1,000 living are respectively asfollows:—Smallpox, 0 004; scarlet fever, 3.76; diphtheria, 1.70; enteric fever, 0.03 puerperal pyrexia, 0.15; puerperal fever, 0.06; and erysipelas, 0.51.) The preceding 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 by the Medical Officer of Health for cases cancelled because of revised diagnosis. 36 cases of diphtheria and scarlet fever were discharged from hospital owing to incorrect diagnosis during 1934. 12 MALES. Table VIII.—Causes of, and Ages at, Death during the year 1934. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Measles 4 1 2 1 - - - - - - - - - 1 — 1 — 1 - 1 — — — — Scarlet fever 1 - - - - - - - - - - - - - - - - - - - - - - - Influenza 12 - - - - - - 7 5 — 4 — — 5 — 2 1 — - — — — — — Whooping-cough 6 — 3 3 - - - - - - - - - - - - - - - - - - - - Diphtheria, Memb. croup 5 — 1 1 3 - - - - - - - - - - - - - - - - - - - Cerebro spinal meningitis 1 - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever - - - - - - - - - - - - - - - - - - - - - - - - Diarrhœa, enteritis 13 10 — 1 1 — - - 1 - 1 — 2 2 i 5 2 — - — — — — — Erysipelas 5 1 - - - - 1 1 2 - - - - - - - - - - - - - 1 — Other septic diseases 9 - - - - - 2 4 3 - — - 1 1 - 4 — — 1 — — — 2 — Syphilis, &c. 5 1 — — - — 1 2 1 — 1 1 — 1 1 1 - - - - - - - - Diabetes 8 - — — - 1 - 3 4 — — 2 — 2 i — — — - — 1 — 2 — Rheumatic fever - - - - - - - - - - - - - - - - - - - — — — — — Tuberculosis of lungs 57 - — 1 - 3 21 24 8 - — - 3 25 3 14 3 — 1 — — 2 5 1 Other forms of tuberculosis 9 - 3 — 1 4 — 1 — — 1 - 1 2 1 1 2 — - — — — — 1 Malignant growths 93 — — — - 2 6 38 47 — 9 2 10 16 8 19 6 3 5 1 5 3 4 2 Congenital debility, malformation, and premature birth 19 19 - - - - - - - - - 1 2 9 1 4 1 1 - - - - - - Old nge 1 — — — - — — — 1 — - - 1 — — — — — — — — — — Meningitis and convulsions 2 - 1 - - - 1 - - - - - - - - - - - - - - - - - 13 Loc. ataxia and general 1 - - - - - - - 1 - - - - - - - - - - - - - - - Other diseases of nervous system 6 - - - - 1 - 3 2 - 1 - - - - 2 - - 1 - - 1 - 1 Valvular diseases of heart 14 — — — — 1 1 9 3 — 2 — 2 5 1 2 — — 1 - 1 - - — Other circulatory diseases 208 2 — 1 3 1 9 73 119 — 21 2 14 73 9 46 2 2 3 4 4 12 9 7 Bronchitis 52 — 1 — — — 2 18 31 — 2 — 3 16 — 23 — 1 1 1 - 1 4 — Broncho-pneumonia 32 5 2 — — 1 6 6 12 — 1 — 2 10 1 10 4 1 1 1 — - 1 Pneumonia, other forms 23 1 — — — 1 5 10 6 — 3 — 1 6 3 4 2 — 1 1 1 - 1 — Other respiratory diseases 8 1 — — — 1 — 3 3 — 1 — 1 1 1 — 1 2 — — — — 1 — Alcoholism 4 - - - - - 1 3 - - 1 - - - - 1 - - - 1 1 - - - Cirrhosis of liver 8 - - - - 1 — 6 1 — 2 1 1 1 1 - - — - — 1 — - 1 Appendicitis and typhlitis 8 — — — — — 4 4 — — 1 1 — 2 1 1 — — — 1 — 1 — — Other digestive diseases 19 1 — — — — 2 6 10 — 5! — 4 4 — 2 1 — 2 — 1 1 1 - Bright's disease, &c. 35 — — — 1 — 2 12 20 — 3 2 2 12 3 9 — — 2 1 - — 1 — Cystitis, &c. 17 - - - - - - 3 14 — 1 — 1 2 — 5 2 — 1 2 1 1 1 — Deaths by accident or negligence 32 2 - - - 5 13 7 5 - 4 - 4 11 2 7 - 1 1 - 1 1 - - Deaths by suicide and murder 23 - - - - 5 7 9 2 - 3 - 4 8 2 4 - - - - - - - 2 Other defined diseases 14 1 — 1 1 2 4 2 3 — — — 1 3 1 6 — — 1 1 — — — 1 Diseases, ill defined or unknown 2 — — — — — 1 1 - - - - - - - - - - - - - - - 2 All causes 756 45 13 9 10 30 90 255 304 - 64 12 60 224 43 183 27 12 22 16 17 24 32 20 14 FEMALES. Table VIII (continued).—Causes of, and Ages at, Death during the year 1934. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). AH 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 - - - - - - - - - - - - - - - - - - - - - - - - Measlea 7 - 3 1 1 1 1 - — - 1 - — 3 - 3 - - - - - - - - Scarlet fever 1 - — - 1 - - - — - - - — — — 1 - - - - — - - - Influenza 6 - - - - - - 4 2 - - - 1 1 1 3 - - - - - - - - Whooping-cough 3 - 3 - - - - - - - - - - 1 - 2 - - - - - - - - Diphtheria, Memb. croup 5 - 1 2 2 - - - - - - - - 4 - 1 - - - - - - - - Cerebro-spinal meningitis - - - - - - - - - - - - - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever — - - - - - - - - - - - - - - - - - - - - - - - Diarrhœa, enteritis 6 6 - - - - - - - - - - - 3 1 2 - - - - - - - - Erysipelas 2 - — — - - - 2 - - 1 - - 1 - - - - - - - - - - Puerperal fever — - — — — - - — — - - - - - - - - - - - - - - - Other septic diseases 9 - — — — - 2 3 4 - 2 - 2 2 — 2 - - - - - - 1 — Syphilis, &c. 4 1 1 - - - - 2 - - - - - - - 3 1 - - - - - - - Diabetes 9 - - - - - - 2 7 - 1 - 1 2 1 1 - 1 - 1 - - - 1 Rheumatic fever — - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis of lungs 26 - - - - 6 11 9 - - - 1 1 6 3 10 2 1 - 2 - - - - Other forms of tuberculosis 7 - - - 2 3 2 - - - - - 1 3 - - 2 - - 1 - - - Malignant growths 123 - - - - 1 15 50 57 1 11 10 11 44 6 15 7 4 1 2 1 6 1 3 Congenital debility, malformation, and premature birth 8 8 - - - - - - - - 1 - - 2 - 1 1 - 1 - - 2 - - Old age 13 — — — — — — — 13 2 2 4 3 — 2 - — - — — — - - Meningitis and convulsions 1 - - - - 1 - - - - - - - - - - - - - - - - - - 15 Loc. ataxia and general paralysis 2 - - - - - 1 - 1 - - - - 1 - 1 - - - - - - - - Other diseases of nervous system 11 - - - - - 2 6 3 - 1 - 1 4 1 3 - - 1 - - - - - Valvular diseases of heart 14 - - - - - - 7 7 - 1 — 2 3 1 3 2 1 — — — 1 — — Other circulatory diseases 221 1 - - 2 2 10 11 165 - 20 9 19 71 14 41 12 7 2 10 1 13 — 2 Bronchitis 52 - - - - - 3 3 46 - 3 - 5 18 1 17 1 2 2 1 1 — 1 — Broncho-pneumonia 34 7 2 1 - - 2 7 15 - 1 — 2 13 2 9 2 2 — 1 — 2 — — Pneumonia, other forms 15 1 — - — 3 6 5 3 — 2 4 1 2 — — — 1 1 1 — — Other respiratory diseases 8 1 - - - - 1 4 2 - 2 — — 5 — 1 — — — — — — — — Alcoholism 3 - - - - - 1 2 — - 1 — — 1 — 1 — — — — — — — — Cirrhosis of liver 6 - - - 1 - - 2 3 - — — 1 4 — 1 — — — — — — — — Appendicitis and typhlitis 4 - - - - - 1 1 2 - 1 — — 2 — 1 — — — — — — — — Other digestive diseases 20 1 - - - - - 9 5 - 4 1 2 5 2 3 - — 1 — — — — Bright's diseases, &c. 24 - - - - - 2 13 9 - 3 — 1 9 1 7 - — 1 — — 1 — 1 Cystitis, &c. 4 - - - - - - 1 3 — — - 1 2 - - - - - - - 1 - - Accidents and diseases of parturition 4 — - — — 1 3 — — — — - — 2 — 1 1 — — — — — — — Deaths by accident or negligence 27 4 - - 1 - 6 4 12 1 1 1 4 6 1 3 1 — — 3 - 1 — 5 Deaths by suicide and murder 13 - - - - 5 5 2 1 1 - - - 5 2 — 1 1 1 1 — — — 1 Other defined diseases 17 1 — 1 1 3 3 8 - 1 — — 5 2 4 1 — — — 1 2 - 1 Diseases, ill defined or unknown 1 1 — - - — — — — — — - — — - — — — - — — — — 1 All causes 710 32 10 4 12 20 79 183 370 3 61 24 61 235 40 144 34 19 10 25 5 31 3 15 16 1,450 deaths were registered in the City during 1934. After deducting 971 deaths of non-citizens in public institutions, etc., in the City, and adding those of 987 citizens who died in other districts, the corrected total is 1,466 as compared with 1,573 in 1933, and is equivalent to an annual crude rate of 11.8 per 1,000 persons compared with 12.4 last year. The London death-rate for 1934 was 11.9 and for England and Wales, 11.8. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below:— Table IX. (From 1920 to 1934.) Year. Number of Deaths. Westminster Bate. London Rate. 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 1933 1,573 12.4 12.2 1934 1,466 11.8 11.9 *Corrected rate. The deaths of males were 756, females 710. Table X. This table shows the total deaths distributed among age periods:— 1934. 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 over Total. m. 45 13 9 10 30 90 255 304 756 f. 32 10 4 12 20 79 183 370 710 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 50 185 509 698 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 1g7 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 1933 75 10 16 12 38 157 523 742 1,573 1934 77 23 13 22 50 169 438 674 1,466 17 The causes of death are set out in Table VIII. There was a slight increase among males of deaths from the following causes:—whooping cough, diphtheria, enteritis, tuberculosis, pneumonia and valvular disease of the heart. Among females the causes showing an increase were measles, diphtheria, tuberculosis, cirrhosis of liver, suicide, cancer and diseases of the circulatory, respiratory and digestive systems. 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 XI. 1930. 1931. 1932. 1933. 1934. M. F. Total. M. F. Total. M. F. Total. M. F. Total M. F. Total. Conduit 8 3 11 7 9 16 3 4 7 5 1 6 3 3 Grosvenor 70 61 131 64 58 122 55 63 118 86 55 141 64 61 125 Hamlet 20 26 46 19 24 43 17 20 37 19 22 41 12 24 36 K., St. George 62 56 118 60 67 127 67 70 137 67 65 132 60 61 121 Victoria 222 212 434 234 259 493 214 244 458 212 230 442 224 235 459 St. Margaret 30 31 64 28 49 77 38 50 88 39 39 78 43 40 83 8t. John 186 179 365 219 187 406 226 179 405 235 167 402 183 144 327 St. Anne 38 18 56 38 25 63 32 21 53 28 31 59 27 34 61 Gt. Marlborough 8 8 16 11 11 22 12 9 21 15 10 25 12 19 31 Pall Mall 20 7 27 23 6 29 23 10 33 20 3 23 22 10 32 Regent 24 24 48 23 28 51 30 19 49 31 20 51 16 25 41 Charing Cross 12 11 23 22 6 28 11 3 14 20 11 31 17 5 22 Covent Garden 26 28 54 42 24 66 36 26 62 41 33 74 24 31 55 Strand 39 3 42 28 2 30 36 — 36 32 3 35 32 3 35 Homeless 28 15 43 25 11 36 24 15 39 28 5 33 20 15 35 Infantile Mortality.—The corrected death-rate of infants for Westminster was 66 per 1,000 births. The mortality among legitimate infants was 55.1 per 1,000; that of illegitimate 139. The infant mortality rate for London was 67. The number of infants dying under 1 year was 77, an increase of 2 on the figure of last year. The chief contributory causes of death were broncho-pneumonia, prematurity, and gastro-enteritis. 18 Table XII shows the deaths as they occurred during the four quarters of the last four years:— Table XII. Total 1931. Total 1932. Total 1933. Total 1934. 1st Quarter 29 21 26 30 2nd „ 22 17 23 18 3rd „ 16 22 11 11 4th „ 24 16 15 18 91 76 75 77 Table XIII shows the births and deaths of infants, legitimate and illegitimate, since 1907 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table XIII. Year. Legitimate. Illegitimate. Total Kate, Westminster. Total Rate, London. Births. Deaths. Death.rate per 1,000 Births. Births. Deaths. Death.rate per 1,000 Births. 1907 2,764 269 97 163 38 208 103 116 1908 2,739 266 97 174 34 155 100 113 1909 2,548 232 91 203 27 128 93 108 1910 2,399 189 78 183 26 129 82 103 1911 2,195 210 95 166 25 198 103 129 1912 2,194 168 76 155 33 174 83 91 1913 2,057 184 89 176 27 164 95 105 1914 1,995 147 73 162 29 148 79 104 1916 1,798 141 78 181 24 225 92 112 1916 1,632 110 68 178 41 230 83.4 89 1917 1,348 112 83 196 41 239 103.6 104 1918 1,234 112 86.6 225 48 155 100 108 1919 1,383 99 71.5 217 36 188 87.5 85 1920 2,047 123 60 219 41 200 73.6 76 1921 1,729 117 67.7 190 41 194 80.2 80 1922 1,703 84 49.3 199 37 100 54.6 74 1923 1,582 68 42.9 176 20 85.7 47.2 60 1924 1,489 82 55.0 138 15 101.4 59.0 69 1925 1,418 88 62.0 117 14 153.8 69.0 67 1926 1,449 76 52.4 157 18 127.3 59.7 64 1927 1,255 81 64.5 144 20 104.1 68.6 59 1928 1,220 65 53.2 150 15 100.0 58.39 67 1929 1,190 83 67.7 167 15 131.7 77.37 70 1930 1,202 52 43.2 166 22 174.6 59.21 59 1931 1,063 74 69.6 148 29 114.8 75.1 65 1932 1,020 50 49.0 132 17 196.9 65.9 66 1933 970 54 55.6 129 26 162.7 68 59 1934 1,015 56 55.1 151 21 139 66 67 Table XIV shows the causes of death of children who died under one year of age. Figures under the same grouped causes are given from 1927 19 onwards, showing the proportion per 1,000 births applicable under each heading:— Table XIV. 1927. ] 928. 1929. 1930. 1931. 1932 1933. 1934. Diphtheria 1.4 1.4 0.73 - - - - .- Influenza 0.71 — 0.73 — — — 2.7 — Measles — - 0.73 3.6 — 0.86 —, 0 85 Whooping Cough 1.4 2.1 81 0.73 0.82 0.86 1.8 — Septic diseases 0.71 — — — — 0.86 0.9 — Bronchitis and pneumonia 6.4 13.8 14.7 14.6 22.3 12.1 10.9 12.0 Stomach and bowel complaints 12.1 10.9 7.3 58 13.2 8.6 9.0 15.4 Syphilis 2.8 0.72 0.73 2.1 1.6 1.7 3.6 1.71 Congenital malformations 7.8 5.1 4.4 4.3 6.6 - 1.8 2.57 Prematurity 20.0 9.4 19.8 18.2 22.3 19.9 16.3 20.5 Neglect and injury at birth 4.2 4.3 1.4 1.4 2.4 7.8 5.4 3.42 Debility from birth and atrophy, rickets, atelectasis 4.2 3.6 22 27 3.3 5.2 8.1 - Tuberculosis 2.1 2.1 2.2 1 4 — 0.86 — — Murder - — — 1.4 - 0.86 — — Accidents — — — — 1.6 0.86 0.9 1.71 Cancer — — — — 0.82 — — — Cerebro.spinal Meningitis - - - - 0.82 0.86 0.9 - Erysipelas — — — — — 0 86 0.9 0.85 Other causes 4.2 2.1 13.2 1.4 1.6 3 .4 1.8 6.85 68.6 58.39 77.37 59.21 75.1 65.9 68.2 66.0 Table XV shows nett deaths from various causes at several age periods during the first year of life in the City of Westminster:— Table XV.—Infant Mortality, 1934. 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 0 Months. 6 Mont lis and under 9 Months. 9 Mont lis and under 12 months. Total Deaths under 1 Year. Circulatory 3 — — — 3 — — — — 3 Bronchitis and Pneumonia (all forms) - - - - - 6 4 2 2 14 Premature birth 24 — — — 24 — — — — 24 Other causes 3 — — — 3 1 — 1 — 5 Syphilis 1 — — — 1 — — — 1 2 Neglect at birth 4 — — — 4 — — — — 4 Stomach and bowel — — — 3 3 7 2 5 1 18 Accidents - - — - — 2 — — — 2 Erysipelas - — — — - 1 — — — 1 Measles - - - - - - - - 1 1 Congenital Defects 1 2 — — 3 — — — — 3 36 2 — 3 41 17 6 8 5 77 20 Table XVI. Nett Births in the year :— Males. Females. Total. Legitimate 528 487 1,015 Illegitimate 77 74 151 605 561 1,166 Nett Deaths in the year of:- Males. Females. Total. Legitimate infants 34 22 56 Illegitimate infants 11 10 21 45 32 77 The causes of death of the Illegitimate were:—Neglect at birth 3, prematurity 6, erysipelas 1, bronchitis 1, stomach and bowel complaints 7, congenital defects 1, and other causes 2. Table XVII. Infant Mortality, 1934.—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 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 .\I».nths and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Death* under One Year. Syphilis - - 1 - 1 - - - - 1 Bronchitis and Pneumonia (all forms) - - - - - 5 3 2 1 11 Stomach and bowel - - - - - 3 1 3 1 8 2 - - - 2 - - - - 2 Premature birth 11 - - — 11 - - - - 11 Accident - - - - - 1 - - - 1 Congenital defects 1 1 — — 2 1 - - - 3 Other causes 4 — — — 4 — — - — 4 Totals 18 1 1 — 20 10 4 5 2 41 Table XVIII. Nett Deaths in the above area during the year:— Males. Females. Total. Legitimate 20 14 34 Illegitimate 7 — 7 21 Table XIX. Infant Mortality, 1934.—Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Syphilis - - - - - - - - 1 i Bronchitis and Pneumonia (all forms) - - - - - i 1 - 1 3 Stomach complaints - - - 1 1 4 1 2 - 8 Premature birth 3 3 - — 6 - - - - 6 Erysipelas — — — — — 1 — - - 1 Other causes — — — — — - — 1 — 1 Accidents — — — — — 1 — - — 1 Totals 3 3 — 1 7 7 2 3 2 21 Table XX. Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 10 5 15 Illegitimate infants 3 3 6 Table XXI. Infant Mortality, 1934. Nett Deaths from stated causes at various ayes 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 J 1 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Mouths. Total Deaths under 1 Year Measles - - - - - - - - 1 1 Premature birth 6 - 1 - 7 - - - - 7 Stomach complaints — — - 2 2 — — - - 2 Other causes 1 — — - 1 — — — — 1 Totals 7 — i 2 10 — — — i 11 22 Table XXII. Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 4 3 7 Illegitimate Infants 1 3 4 Table XXIII. 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. Neglect at birth 2 . . . 2 . . . . 2 Other causes 1 — — — 1 1 — — — 2 Total 3 — . — 3 1 — — — 4 Table XXIV. Deaths of children unknown Males. Females. Total. Legitimate . — — Illegitimate . 4 4 Table XXIVa. 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, 1934. Legitimate. Illegitimate. Total Infant Deaths, 1934. Legitimate. Illegitimate. 1934—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total Rate. Conduit 2,086 7 7 - - - - - - - Grosvenor 13,318 60 49 11 1 1 - 20.4 - 16.6 . Pall Mall 2,872 10 8 2 2 1 1 125.0 500.0 200.0 Regent 4,047 25 18 7 1 1 - 55.5 — 40.0 Gt.Marlborough 3,331 15 12 3 1 1 - 83.3 — 66.6 St. Anne 5,405 36 26 10 4 2 2 76.9 200.0 111.1 Covent Garden 6,655 47 43 4 2 1 1 23.2 250.0 42.5 Charing Cross 3,210 14 7 7 - - — — — — Strand 2,052 1 1 - - - - - - - Victoria 36,953 454 397 57 35 32 3 80.6 52.6 77.0 K. St. George 11,445 . 87 75 12 5 2 3 26.6 250 .0 57.4 Hamlet 6,461 27 25 2 1 - 1 - 500.0 37.0 St. Margaret 8,671 39 38 1 2 1 1 26.3 1000.0 51.2 St. John 23,071 330 308 22 19 14 5 45.4 227.2 57.5 Homeless - 14 1 13 4 — 4 — 307.6 285.7 Total 129,579 1,166 1,015 151 77 56 21 55.1 139.0 66 23 The following table is inserted by courtesy of the Medical Officer of Health for Poplar, by whom the figures were compiled. Table XXV. Statistics for 1934. Cities and Boroughs. Est. Resident Population (mid.1934). Live Births (rate). Death rate. Infantile Mortality per 1,000 Births. Crude. Adjusted. West Districts— Paddington 139,790 13.7 12.4 12.3 95 Kensington 179,0S0 12.3 13.3 12.5 93 Hammersmith 129,170 13.8 12.9 13.3 77 Fulham 145,400 13.7 12.6 12.7 59 Chelsea 53,160 10.8 13.4 11.4 65 City of Westminster 124,050 9.4 11.8 12.1 66 North Districts— St. Marylebone 92,320 9.00 12.7 12.6 51 Hampstead 90,000 10.4 11.3 10.6 53 St. Pancras 187,540 13.1 12.84 13.19 65 Islington 314,200 14.7 11.8 11.9 62 Stoke Newington 50,620 13.7 11.5 110 60.6 Haekney 211,120 14.2 11.7 12.2 56 Central Districts— Holborn 36,000 8.58 12.2 ? 71 Finsbury 64,970 15.1 13.4 14.6 51 City of London 9,660 6.8 10.5 11.6 121 East Districts— Shoreditch 90,630 16.1 13.1 14.4 84 Bethnal Green 102,000 14.3 11.8 13.3 72.6 Stepney 214,990 15.3 12.3 14.3 87.2 Poplar 146,370 15.5 12.3 13.7 62 South Districts— Southwark 159,930 14.9 13.5 14.4 77 Bermondsey 105,060 14.8 12.4 14.1 64 Lambeth 283,900 14.21 12.78 12.65 63.38 Battersea 150,870 14.3 12.5 12.3 61.3 Wandsworth 345,250 10.98 11.18 10.39 57 Camberwell 238,360 13.22 12.31 12.31 67 Deptford 101,380 15.8 13.1 13.6 68 Greenwich 97,250 13.71 12.23 12.47 87 Lewisham 222,180 12.2 10.0 10.1 43 Woolwich 145,520 13.7 11.3 12.0 63 Common Lodging House Deaths. Reference has been made in former reports to the shifting population which inhabits the five common lodging houses which are licensed in the City. Some of the residents are permanent in so far that they have been resident in the Poor Law institutions for perhaps thirty or forty years although their original residence and perhaps even temporary at that was in a common lodging house in the City. Deaths among the latter class of people tend to increase the death.rates of the wards in which those lodging houses are situated; 80 deaths of persons giving addresses in common lodging houses occurred in 1934. They were mostly in institutions (9169) C 2 24 Table XXVI. Deaths. Ward. Bruce House (L.C.C.) (licensed for 716 men) 28 Strand 33, Great Peter Street (licensed for 80 men) 3 St. John. 7, St. Ann's Street (Salvation Army) (licensed for 565 men) 22 16, Strutton Ground (licensed for 201 men) 19 Church Army Home, Greencoat Place (184 women) 5 40, Great Peter Street (Church Army) (now pulled down) 3 80 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 1930-1934. Details respecting the notifications of infectious disease received are set out in the following pages. Table XXVII. 1930 1931 1932 1933 1034 Smallpox 3 2 3 1 — Diphtheria 256 140 80 142 153 Erysipelas 37 46 50 53 63 Scarlet fever 265 196 211 354 375 Enteric fever 18 7 7 7 6 Continued fever — — — — 1 Puerperal fever 6 4 7 4 5 Puerperal pyrexia 16 15 8 11 13 Cerebro-spinal meningitis — 8 6 11 4 Encephalitis lethargica 3 1 2 1 — Poliomyelitis 3 — 1 2 5 Ophthalmia neonatorum 16 7 13 7 4 Measles 551 74 810 255 807 German measles 15 23 18 45 39 Pneumonia 25 49 51 66 48 Malaria — 1 1 — 1 Dysentery — 1 2 1 3 Chicken pox 173 204 201 167 146 Mumps 166 80 92 130 105 Whooping-cough 14 83 138 132 95 Membranous croup — 1 — — — 25 Vaccination.—The Vaccination Officer reports that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 501 Secondary .. .. .. .. 36 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. 26 Table XXVIII. Vaccination Return for the Year ended 31st December, 1933. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1933. Number of these Births duly entered by 31st January, 1931, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1935, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1935, 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 1934. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the children to which they relate, during the calendar year 1934. Col. I. Successfully Vaccinated. Col. ii. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to Places unknown,or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had Smallpox. 2 3 4 5 6 7 8 9 10 11 12 13 1,603 971 11 — 300 72 5 116 128 — 1,221 306 Table XXIX. Summary of Monthly Returns for the Year ended 31st December, 1934. No. of Cases in Birth Lists received. No. of Certificates of Vaccination received. No. of Certificates of Postponement owing to health of Child. No. of Statutory Declarations under Section 1 of the Vaccination Act, 1907. No. of Certificates of Insusceptibility. No. of Cases. No. of Entries in List sent to Public Vaccinators. Parents Removed out of District. Otherwise not found. 1,568 1.221 45 308 3 118 101 241 27 Table XXX. Return showing the number of Persons successfully vaccinated and re-vaccinated at the cost of the rates by public Vaccinators during the Year ended 30th September, 1931. Name of Public Vaccinator and District. Numbers of successful primary vaccinations of persons Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Dr. K. R. Hay (Mayfair) 10 1 11 - Dr. H. W. Doll (Belgrave and Knightsbridge) to 31.12.33 42 8 50 1 Dr. A. E. Cope (Belgrave and Knightsbridge) from 1.1.34 162 18 180 14 Dr. A. E. Cope (Westminster, St. Margaret and St. John) 168 23 191 12 Dr. H. M. Whitby (St. Anne and St. James) to 31.8.34 33 1 34 - Dr. A. E. Cope (St. Anne and St. James) from 1.9.34 3 - 3 - Dr. H. 11. Whitby (Strand) to 31.8.34 27 3 30 1 Dr. A. E. Cope, Strand, from 1.9.34 — 1 1 — Totals 445 55 500 28 The percentage of infants vaccinated in relation to births is 61—a most satisfactory result when it is realised that the percentage figure for the whole country is 38. 28 Table XXXI. City of Westminster.—Cases of Infectious Disease Notified during the Year 1934. Notifiable Diseases. At all Age. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. | 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. ! 15-20. 20-35. 35-45. 45-65. 65 and 1 over. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera (c). Plague (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria 146 2 8 12 15 17 42 13 12 24 1 — — 146 — 10 — 2 — 3 — 4 1 — — — — — Erysipelas 63 2 1 1 - - 2 2 1 14 14 23 3 50 13 7 1 - - - - - - - - 1 3 2 Scarlet fever 351 - 9 15 25 19 122 63 20 60 12 6 — 325 26 2 - - - - - 1 - - 1 - - - Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 6 - - - - - - - 1 4 1 — — 4 2 — — — — — — — — — — — — — Relapsing fever (r) - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued fever (c) 1 - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 5 - - - - - — — 1 2 2 — — 5 — — — —• — — — — — — — — — — Cerebro-spinal meningitis 4 - — — — — 1 — 1 2 — — — 4 — 1 — — — — — — — — 1 — — — Poliomyelitis 5 - 1 1 — — 1 1 1 — — — — 4 1 — — — — — — — — — — — — — Encephalitis lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia neonatorum 4 4 - - - - - - - - - - - 2 2 - - - - - - - - - - - - - Pneumonia 48 1 — — — — 1 2 3 13 10 13 5 44 4 38 2 - - - - - - - 5 4 16 11 Malaria 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - Dysentery 3 - - - - - - - 1 2 - - - 3 - - - - - - - - - - - - - - Puerperal pyrexia 13 - - - - - - - - 11 2 - - 13 - - - - - - - - - - - - - - Totals 650 9 19 29 40 36 169 81 41 132 43 43 8 602 48 58 3 2 — 3 — 5 1 — 7 5 19 13 Correction has been made for errors in notification or revision of diagnosis in 36 cases. Diph. 24, Scarlet Fever 12. Cases not notified:— Scarlet fever, 24. Diphtheria, 7. 29 Table XXXII. City of Westminster.—Infectious Diseases, Distributed in each Ward. Notifiable Diseases. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. 1 Strand. St. Anne. Homeless and non-residents. Smallpox - - - - - - - - - - - - - - - Cholera (c). Plague (R) — — — — — — — — — — — — — — — Diphtheria 1 5 12 49 3 58 — — 4 — 3 8 — 6 4 Erysipelas - 5 7 16 5 22 3 1 - — — — — 1 3 Scarlet fever 2 17 27 118 9 138 3 4 16 5 5 11 1 11 8 Typhus fever — — — — — — — — — — — — — — — Enteric fever — — 1 — — 2 1 — — — — — — 1 1 Relapsing fever (R) - - - - - - - - - - - - - - - Continued fever (C) - - - - - - - - - - - - - - - Puerperal fever — — — 1 1 2 1 - - - - - - - — Cerebro-spinal meningitis - 1 1 - - - - - - - - - - - 2 Poliomyelitis — - - 1 1 — — — — — 1 — — — 2 Encephalitis lethargica - - - - - - - - - - - - - - - Ophthalmia neonatorum - - - - - - - - - - - - - Pneumonia — 6 2 13 2 17 — - 1 1 1 1 - - — Malaria - - - - - - - - - - - - - - - Dysentery — 1 1 — 1 — — — — — — — — — — Puerperal pyrexia — — 2 5 1 3 - - - - - 1 — 1 — Membranous Croup - - - - - - - - - - - - - - - Totals 3 35 53 207 23 244 8 5 21 6 10 21 3 22 20 30 Scarlet Fever.—375 cases of this disease occurred in 1934, an increase of 21 on the figures of 1933. There were 2 deaths, male aged 20, female aged 5. The case rate of this disease per 1,000 of the population was 3.02 for the City, and for England and Wales 3.76. The death.rate for London was 0.02 per 1,000, for England and Wales 0.02, and for Westminster 0.02. Of the total cases in Westminster 93.0 per cent. were removed to hospital. The wards showing an increase were Victoria, Regent, Gt. Marlborough and Covent Garden. Eight patients admitted with scarlet fever contracted diphtheria whilst in hospital. Diphtheria.—153 cases of this disease occurred, showing a slight increase on the figures of 1933. The largest number of cases occurred between the ages of 5.15 and 20.35. The case rate of this disease for Westminster was 1.23 per 1,000 living, and for England and Wales 1.70. There were 10 deaths, males aged 1, 3, 5, 5, 6 years; females aged 1, 3, 3, 7, 11 years. The death.rate for England and Wales was 0.10, for London 0.11, and for Westminster 0.08. Four diphtheria patients contracted scarlet fever whilst in hospital. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1934, by Dr. Ian S. Thomson, Assistant Medical Officer of Health. This treatment was continued throughout the year at the Council's maternity and child welfare centres, and at the Westminster Health Society's centre. One clinic is held at each centre each week. 249 cases were dealt with during the year, as compared with 121 and 140 in 1933 and 1932 respectively. The increased number of applicants became apparent towards the end of 1933 and continued through 1934 and may be ascribed to the greater incidence of diphtheria during the period. New cases attended the centres as follows:— Ebury Bridge 122 Bessborough Street 22 Marshall Street 76 Westminster Health Society 29 249 i . . 31 Treatment was continued on the lines indicated in previous reports. The preliminary Schick test was only done on older children or for some special reason in particular cases. Treatment given and the results of the tests are shown in the following table. Positive reactors were given preventive treatment. Table XXXIII. Positive. Negative. Treated without test. Total. Under 5 years 0 2 183 185 5 to 10 years 0 2 49 51 10 to 15 years 5 6 2 13 5 10 234 249 Treatment was carried out without difficulty and with satisfactory results. Only a very small number failed to complete the treatment. Over 12 per cent. who presented themselves for treatment had not been vaccinated against smallpox, 108 re-tests or tests after treatment were performed. 97 gave a negative result six months or more after preventive treatment. Two were still positive and received further treatment. Two did not attend for reading the result of the re-test. One second re-test after an additional course of treatment showed that the patient was now negative. Two cases, negative four and five years previously, were re-tested at the parent's request and were still negative. Two negative cases, where the result was ascribed to temporary immunity following the administration of adult human serum, gave positive results when re-tested later, the temporary immunity having passed off. All these results are in conformity with the theory of the treatment. 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 Coroner's Court 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. 32 Enteric Fever.—There were 6 cases of typhoid and paratyphoid which came to the knowledge of the department during 1934. Of these 3 were notified as paratyphoid and 3 as typhoid. The case rate for England and Wales was 0'03 and for Westminster 0.04.' Measles.—The following table shows the number of cases notified by head teachers of schools, hospitals and private practitioners during the last five years:— Table XXXIV. 1930. 1931. 1932. 1933. 1934. 551 74 810 255 807 The death-rate for England and Wales per 1,000 population was 0.09, for London 0.20, and for Westminster 0.08. 321 cases were removed to hospital, 180 being between the ages of 1 and 5. 11 deaths occurred. Six children suffering from measles contracted diphtheria in hospital, and 6 contracted scarlet fever. German Measles.—59 cases were notified. Table XXXV. Influenza.—The deaths certified from this cause during the last five years are as follows:— 1930. 1931. 1932. 1933. 1934. Males 3 13 21 37 12 Females 3 24 37 29 6 6 37 58 66 18 The death.rate in 1934 for Westminster was 0.14 per 1,000; for London 0.12, and for England and Wales 0.14. Last year the corresponding rates were 0.52 for Westminster, 0.51 for London, and 0.57 for England and Wales. Influenza by itself is not notifiable under existing regulations but only when complicated by pneumonia, therefore no reasonable deductions can be made by comparing the notification rate of influenzal pneumonia with the death.rate from influenza. Diarrhoea and Enteritis.—The total deaths were 19—13 males and 6 females—16 being under 1 year old. The infant death.rate from this cause in Westminster was 15.4. 33 Table XXXVI. Deaths from Diarrahœa and Enteritis. Under 1 year. Other ages. Total. 1930 7 1 8 1931 16 6 22 1932 8 3 11 1933 10 1 11 1934 16 3 19 57 14 71 Whooping Cough.—95 cases were notified during the year, with 9 deaths (9.4% of the cases notified), 32 cases were moved to hospital, 28 being between the ages of 1 and 5. The death rate for Westminster was 0.07, for London 0.07, and for England and Wales 0.05. The deaths from whooping cough during the last five years are thus set out:— Table XXXVII. Under 1 year. At other ages. Total. 1930 1 1 2 1931 1 3 4 1932 1 1 2 1933 2 4 6 1934 — 9 9 5 18 23 Cerebro.spinal Fever.—4 cases of this disease occurred with 1 death. Poliomyelitis.—5 cases occurred. Chicken Pox.—146 cases occurred, 41 being moved to hospital. Mumps.—105 cases were recorded, 15 cases being moved to hospital. Puerperal Fever.—5 cases were notified. 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 Table XXXVIII. Year. No. of births. No. of cases. Deaths. Death rate per 1000 births 1930 1931 1,368 1,211 6 4 4 4 2.9 3.3 1932 1,152 7 1 0.86 1933 1,099 4 1 0.91 1934 1,166 5 — — This is the first occasion during the quinquennium in which there have been no deaths from puerperal fever. 34 Puerperal Pyrexia.—13 cases occurred, all being removed to hospitals. Ophthalmia Neonatorum.—4 cases occurred in 1934, 2 were admitted to hospital and 2 treated either at home or as out-patients of hospitals. In addition to these notified cases, 7 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 arc also admitted, and, if necessary, receive treatment. The Public Health (Ophthalmia Neonatorum) Regulations, 1926. These regulations have been in force since October, 1926, and under them midwives are no longer obliged to notify, but they are obliged to call qualified medical assistance to all cases of inflammation of the eyes. If the medical practitioner considers the case one of ophthalmia neonatorum, he must notify the Medical Officer of Health. The following details in tabular form are required by the Ministry of Health of the cases notified in 1934:— Table XXXIX. Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At home. In hospital. 4 2 2 4 — — — 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 is made for work done on behalf of individuals whose place of occupation is in Westminster, and 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 578 Sputa for investigation of tuberculosis 356 Expenditure on the first was £92 9s. 4d., and for the second £44 19s. 9d., including cost of outfits, postage and telegrams. 35 TUBERCULOSIS. In 1934, 251 new cases of pulmonary tuberculosis came to the knowledge of the department, including 12 cases who had moved into the City, 1 by posthumous notification, and 17 non-notified deaths. Non-pulmonary forms of tuberculosis gave 54 cases—7 of these being non-notified deaths, and 2 transfers. Table XL. Tuberculosis, 1934. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. m. f. m. f. m. f. m. f. Under 1 - - - - - - - - 1 2 2 5 2 1 — 3 — 5 3 3 6 4 — — 1 2 15 4 8 1 3 1 1 1 2 20 23 23 10 3 0 5 3 1 25 34 30 6 3 10 7 — 1 35 28 12 — 6 11 4 — 1 45 32 7 1 1 10 3 — — 55 21 9 1 1 14 6 1 — 05 and upwards 10 — — — 8 — — — Totals 157 94 31 23 57 26 9 7 In this table all primary notifications are included, and also other new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the year. The total cases for 1934 show an increase of 59 on those of 1933. Out of the total cases primarily notified in 1934, 38 died, and the following table shows the period between notification and death of these cases:— Table XLI. Weeks. Months. 1-2 2-3 3-4 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 14 — 7 6 2 4 — 3 — — 1 — 1 — Table XLII. 1930 1931 1932 1933 1934 New cases notified 209 201 242 202 266 Number included in above who died during the year 23 36 35 34 38 (11 .0%) (17.9%) (14.4%) (16.8%) (14.28%) Total Tuberculous Deaths 107 121 106 101 99 Death Rates per 100,000 85.0 104.6 83.8 79.9 79.8 36 Table XLIII. Tuberculosis.—Notifications received during the period from 1st January, 1934, to 31st December, 1934. 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 3 - 4 23 32 25 27 20 7 143 149 Femnles — 1 3 — 8 19 27 10 6 4 — 78 81 Non-pulmonary— Males — 3 5 1 1 10 5 — 1 — — 26 26 Females — 2 3 - 3 2 2 5 1 1 — 19 19 Total — 8 14 1 16 54 66 40 35 25 7 266 275 37 Table XLiv. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 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 65. 55 to 65. 65 and up. Total. Pulmonary— Males — - — — — — 2 3 5 1 3 14 Females — 1 — — — 4 3 2 1 5 — 10 Non-pulmonary— Males — 2 1 — — — 1 — — 1 — 5 Females — — 1 — — 1 1 1 — — — 4 Total — 3 2 — — 5 7 6 6 7 3 39 (9169) 38 Table XLV. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1934. All Ages. Conduit. Grosvenor. Knights- bridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Received TnstlntIr>nnlTreat ment during 1934. Males 157 - 6 9 57 12 38 1 1 3 2 1 5 11 9 2 107 Females 94 - 8 6 29 1 22 4 3 3 4 2 1 - 11 — 65 Non-pulmonarv— - Males 31 1 5 6 5 8 1 — — — — 2 - 3 — 14 Females 23 - 1 3 9 — 4 1 1 2 — — 1 - 1 — 9 305 — 16 23 101 18 72 7 5 8 R 3 9 11 24 2 195 39 Table XLVI. TUBERCULOSIS Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all forms. General Population. C.L.H. and no Address. Total. Males. Females. Males. Females. Males. Females. Total. 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 1933 106 75 24 - 205 19 22 41 246 1934 130 94 27 — 251 31 23 54 305 A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the City. Non-notified Deaths.—There were 24 deaths from tuberculosis during 1934 of persons who had not been notified in Westminster. The majority of these had been notified elsewhere, some were sudden deaths of visitors to this country, of inmates of asylums, etc., and the cause of death in some cases was only discovered on post-mortem examination. These 24 non-notified deaths gave a percentage of 24.2 of the total deaths from tuberculosis for the year. The total number of cases of tuberculosis on the Register at the end of 1934 was 1,400 (as compared with 1,313 at the end of the year 1933), of which 1,061 were pulmonary cases, consisting of 705 males and 356 females. Children under 15 years of age number about 80 pulmonary and 130 non-pulmonary; of these some 25 are in institutions at any one time, the remainder are attending special or ordinary schools. (9169) p 2 40 Some 10 per cent, of the adult males are in institutions; 49 per cent, are at work; 40 per cent, at home and ambulant, whilst some 1 per cent, are confined to bed at home. On the other hand, 6 per cent, of the adult females are in institutions; 35 per cent, at work; 43 per cent, are able to attend to their household duties, whilst 15 per cent, are at home and walking about, and the remaining 1 per cent, at home in bed. The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths during the year was 24; the corresponding percentage proportions are 28-7 per cent. (1933) and 24-2 per cent. (1934). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner. 16 deaths occurred in institutions and 8 at home. 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 1934. Table XLVII. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on register at beginning of year 1934 652 339 137 185 Notified for the first time during year 157 94 31 23 809 433 168 208 Removed from the register on account of death or removal etc., from Westminster 104 77 16 21 705 356 152 187 Of the 218 cases removed from the register during the year 1934, 99 were on account of death, 114 persons suffering from tuberculosis moved from the City, notification was withdrawn in 1 case, and 4 cases recovered. Deaths from Tuberculosis.—The total number of deaths from tuberculosis for 1934 (all forms) was 99—Males 66, Females 33. This gives a death-rate for this disease of 0-79 per 1,000. The following table shows the number of deaths from tuberculosis for the last 5 years, together with the death-rate. 41 Table XLVIII. Rate per Year. Deaths. 1,000 1930 107 .85 1931 121 1.04 1932 106 .83 1933 101 .79 1934 99 .79 The following table shows deaths per 100,000 of civilian population since 1921. Table XLIX. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non.pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1921 annual 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 90 71.2 16 12.6 106 83.8 1933 92 72.8 9 7.1 101 79.9 1934 83 66.9 16 12.8 99 79.8 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. City of Westminster Tuberculosis Dispensary. The work of the dispensary has been carried on throughout the year without any marked change in the routine. Four hundred and sixty.two new cases were seen by the Tuberculosis Officer, as compared with 412 in 1933, and 484 in 1932. Two hundred and seventy.two of the cases were considered to be tubercular, although not all at an active stage of the disease. In addition action was taken with regard to 32 cases recommended for sanatorium treatment by voluntary hospitals. These cases did not attend the dispensary in 1934, but many of them will do so when their institutional treatment is completed. 42 The sources from which new cases were referred to the dispensary during the last four years are shown in the following table:— Table L. 1931. 1932. 1933. 1934. Practitioners 152 164 140 157 Health Visitors 134 196 162 161 St. Stephen's Hospital 76 82 72 99 Ministry of Pensions 5 3 0 1 School Medical Officer 18 16 18 23 Hospitals 7 5 10 9 Referred by Friends, Charitable Organisations, etc. 8 18 10 12 400 484 412 462 These figures remain in fairly constant proportion. The number seen at St. Stephen's Hospital is the highest for some years. This is evidence of the useful co-operation between the hospital staff and the dispensary. As mentioned previously the Tuberculosis Officer has been appointed honorary consultant in tuberculosis to the hospital. A weekly visit is paid to the two tuberculosis wards, and many special cases are seen in other wards at the request of the medical superintendent. Increasing use has been made of the services of the Tuberculosis Officer since the arrangement, first started under the Westminster Guardians in 1923, received official confirmation by the London County Council in 1933. The following table gives certain details of the work of the dispensary during 1934, and the four preceding years:— Table LI. 1930. 1931. 1932. 1933.  New Patients attending 341 400 484 412 462 Old PatientB attending 507 427 477 430 473 New Contacts examined 55 85 105 126 109 Individual attendances 848 827 961 842 935 Total attendances 2,210 2,314 2,321 2,165 2,615 Written Reports to Public Authorities and to Practitioners 1,250 1,187 1,228 1,090 1,066 Home Visits 82 72 73 82 67 Consultations with Practitioners 106 157 132 117 153 Visits by Health Visitors to Dispensary Cases 2,967 3,469 3,373 3,404 3,526 Sputum Examinations 225 192 225 164 193 X-rav Examinations 29 42 61 60 78 43 As noted last year, there is a steady increase in the number of X-ray examinations, which is likely to be continued, as much more stress has been laid on this side of tuberculosis work in recent years. Each year a larger number of cases are referred to the Dispensary by medical practitioners with special requests for X-ray examination. The examination is carried out at Westminster Hospital at the expense of the City Council. The films supplied by the hospital reach a high technical standard. The figure given refers to films taken at the expense of the City Council. In addition the Tuberculosis Officer sees films of almost all his patients in St. Stephen's Hospital and receives radiological reports of sanatorium and hospital cases. Patients have been recommended for institutional treatment from the dispensary as follow:— Hospitals. Sanatorium. Insured Males 17 55 Insured Females 4 37 Uninsured Males 1 5 Uninsured Females 2 12 Boys 3 5 Girls 2 7 29 121 This table does not include patients sent direct to St. Stephen's Hospital. Many of these are transferred to a sanatorium later. Convalescent treatment was arranged for a number of 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 Care Committees, St. Henry Fund and other agencies. The association with Westminster Hospital has continued and cases were referred there during the year for surgical and orthopaedic treatment, &c. School children requiring dental treatment were referred to the school dentist. Ten adult patients were referred to the Council's dental clinic. Fifty extractions and one filling were carried out, and four of the patients were fitted with dentures. Sixteen patients received artificial pneumothorax treatment at Brompton Hospital and elsewhere, and had, in all, 174 refills. Three cases of lupus received special light treatment at a cost to the Council of £26. 44 During the year the London County Council decided to provide institutional treatment for tuberculosis free of charge to patients, although voluntary contributions are still accepted. The Tuberculosis Care Committee was thus relieved of a considerable volume of work with regard to the assessment of contributions. More time is therefore available for the consideration of the care necessary for patients after institutional treatment, and for their dependents while they are away. The Committee also considers the question of assistance towards payment for dentures and recommends to the Council the granting of extra nourishment, where this is considered helpful to the patient's treatment. Twenty-nine patients received this extra diet allowance at a total cost to the Council of £166 6s. 2d. The work of the handicraft class, run for dispensary patients by a voluntary committee, was continued with excellent results. Miss Willatts and Miss McFarlane continued their excellent work as teacher and secretary respectively. Seventeen patients took part in the work, making 235 total attendances. The class took part in a sale of work at the Carpenters Hall, and in a competition at the County Hall, along with other metropolitan handicraft classes. In the competition three Westminster patients were awarded prizes for their work. If it were not for the assistance granted by the Barlow's Gift Charity Committee, some £16 each year since 1931, this useful and beneficial work could not continue. 45 Table LII. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work of the Dispensary during the Year 1934 Diagnosis. Pulmonary. N on-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 141 103 - 3 10 9 13 10 151 112 13 13 289 *(b) Diagnosis not completed — — — — — — — — 1 — — — 1 (c) Non-tuberculous - - - - - - - - 26 35 25 9 95 B.—Contacts examined during the year:— (a) Definitely tuberculous - 2 2 3 - - 3 5 - 2 5 8 15 *(b) Diagnosis not completed - - - - - - - - 2 - - - 2 (c) Non-tuberculous — — — — — — — — 18 23 28 23 92 C.—Cases written off the Dispensary Register as— (a) Recovered 4 8 - - 1 - 2 - 5 8 2 - 15 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 55 79 65 43 242 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 253 214 24 27 26 37 55 52 279 251 79 79 688 (6) Diagnosis not completed — — — — — — — — 3 — — — 3 * i.e., remaining undiagnosed on 31st December. 46 (B) Number of Dispensaries for the Treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council One Provided by Voluntary Bodies. Table LII—continued. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL—continued. (A) Return showing the Work of the Dispensary during the Year 1934—continued. 1. Number of cases on Dispensaiy Register on January 1st 659 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 67 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 28 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,526 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 170 10. Number of— 193 (a) Specimens of sputum, etc., examined 4. Cases written off during the year as Dead (all causes) 63 (b) X-ray examinations made in connexion with Dispensary work 78 5. Number of attendances at the Dispensary (including Contacts) 2,615 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 230 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 7. Number of consultations with medical practitioners— 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 242 (a) Personal 153 (6) Other 263 47, GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA The Minister of Health, in Circular 1417, intimated that it will be sufficient for the purposes of this report to indicate any alteration) improvement or developments of the health services which have taken place during the year. Accordingly the services which were dealt with fully in the survey report of 1930 are on this occasion, only briefly referred to. Laboratory Facilities.—The arrangement with Westminster Hospital for the bacteriological examination of material from suspected cases of tuberculosis, diphtheria, &c., continues satisfactorily. Examinations of milk for tubercle bacilli, special examinations of water, milk and other foods, particularly in the investigation of foods suspected of being the cause of food poisoning, are also carried out at the hospital. The Milk Marketing Board's scheme for the supply of milk to school children which came into operation on 1st October, 1934, required that the medical officer of health should be satisfied as to the quality of such milk. Arrangements were accordingly made for the bacteriological examination of milk supplied to Westminster schools at the hospital laboratories. From the date of commencement of the scheme to the end of the year four samples were examined and gave satisfactory results. During the year four samples of Certified milk were examined for brucella abortus. The examination of graded milk under the Milk (Special Designations) Order, 1923, is carried out at the laboratories of the Chemical Research Association. The chemical analysis of food and drugs is performed by the Council's two public analysts. The analysis of matter in connection with investigation of atmospheric pollution is also carried out by one of the public analysts. Ambulance Facilities.—The various services have been fully set out in previous reports and are efficient and adequate. Nursing in the Home.—The nursing of general illness in the home is undertaken by three District Nursing Associations in the City. By agreement, the City Council, as the maternity and child welfare authority, pays these associations for nursing cases of puerperal fever and puerperal pyrexia and other illnesses connected with childbirth, likewise for ailments in children up to five years of age, including measles and whooping coughThe nursing of primary pneumonia and influenzal pneumonia is also undertaken by the associations on behalf of the Council. The rate of payment is Is. 6d. per nursing visit and the total amount paid during 48 1934 amounted to £235 6s. 8d., representing some 3,360 visits as compared with 2,434 for the previous year. The larger number of visits indicates that the nursing service which the Council provides is being taken advantage of to an increasing extent. 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.I. 4. City of Westminster Health Society, 121, Marsham Street, S.W.I. Proposed New Maternity and Child Welfare Centre and Day Nursery. For some years the Council has had under consideration the question of the provision of a new maternity and child welfare centre to replace the one at present housed in an old building at 15, Bessborough Street, and enquiries have been proceeding as to possible sites, with the result that a suitable site has now been selected in Bessborough Street. In considering the type of building to be erected, the Council was impressed with the fact that the day nursery accommodation in Westminster was limited, and that the voluntary body (the City of Westminster Day Nursery Committee) carrying on day nursery services at 147, Warwick Street, were severely handicapped by the lack of accommodation and the inconvenient lay-out of their present building. It was therefore decided to instruct an architect to prepare sketch plans of a building providing accommodation on the ground floor for a maternity and child welfare centre, and day nursery accommodation on the upper floors, together with an estimate of the cost. Such plans are at present under consideration by the appropriate committee. The preliminary lay-out comprises a maternity and child welfare centre on the ground floor, day nursery accommodation on the first floor divided into three large wards for different age groups of children; with sun balconies. The second floor is also devoted to day nursery purposes and includes small wards and nursing accommodation. The third floor comprises three self-contained flats for the staff, and prams and stores are housed in the basement. All the principal rooms have a southerly aspect and access is provided direct from the balconies and ground floor to a spacious garden in the rear. 49 Hospitals. Municipal.—Particulars of the various hospitals in the City have been fully outlined in previous reports. One municipal hospital is situated in the City, viz.that at Sheffield Street controlled by the London County Council which has accommodation for 52 beds for pregnant women suffering from venereal disease. Voluntary.—Westminster is a city of hospitals, no fewer than 14 being within its borders. The City Council has by agreement entered into an arrangement with two hospitals for the admission of certain patients, viz.:— (а) With St. George's Hospital for the admission and treatment of maternity patients. (б) With Westminster Hospital for— (i) The provision of maternity beds for patients sent through the Council's maternity and child welfare centres. (ii) The services of midwives to attend necessitous women in their own homes. (iii) The provision of skilled obstetric assistance to medical practitioners in difficult cases of midwifery occurring in the patients' own homes. (iv) The provision of skilled medical assistance to midwives in difficult cases. Maternity and Child Welfare. Midwifery Service. Trained Midwives for all Confinements.—For women living in the City who apply through the Council's welfare centres there is a complete midwifery service. Throughout the greater part of the City the midwives of Westminster Hospital attend necessitous women on behalf of the Council, and in the remainder the midwives of the City of Westminster Health Society practise for the same purpose. The local welfare centres are the pivots of the scheme in both areas. For those who do not attend the welfare centres the supply of private midwives is adequate. Certain other voluntary hospitals, e.g., Middlesex, Charing Cross, General Lying-in, etc., and the Ormond Home, Chelsea, provide free or at small cost district midwifery services in the City. The demand for such services is considerably less than the supply; patients may pick and choose. Such is the effect of a very low birth rate. 50 In the case of the City Council's own scheme the midwives working in the district have the entire resources of Westminster Hospital to support them—maternity beds, consultant and other medical services. The work performed by the midwives provided by the Westminster Hospital under the City Council's scheme is summarised below. Table LIII. 1931. 1932. 1933. 1934. Xumlier of— Pre-natal visits 240 209 93 71 Lying-in visits 794 1,141 1,016 1,022 Subsequent visits 62 — 32 28 Total number of visits 1,093 1,350 1,141 1,121 Number of cases attended 62 88 77 78 Table LIV. Attendances by midwife at ante-natal and other clinics:- 1931 1932 1933 1934 Ebury Bridge 51 52 50 50 15, Bessborough Street 49 52 49 48 Total 100 104 99 98 The Westminster Health Society provides midwifery services in St. Margaret and St. John Wards, the western boundary of its area being Vauxhall Bridge Road. The following table gives figures relating to the work performed in this area during the year:— Table LV. Number of cases attended— St. Margaret and St. John Wards. As midwife 52 With hospital students 3 With private doctors 1 56 Midwifery visits 684 Nursing visits 100 784 51 Consultant Services for Complicated Cases of Midwifery.—It might appear that skilled obstetric assistance being available in the hospitals in and near the City, the local authority need not be called upon to supply this service. But the City Council was impressed with the possibility that in a difficult case conducted at home, delay in removal to hospital might occur owing perhaps to doubt in the practitioner's mind as to any imminent gravity. Further, there is often present a certain unwillingness on the part of the patient to enter a hospital, together with natural fears, especially in first confinements. To meet such circumstances, the Council has provided through the consulting staff of Westminster Hospital the services by day and by night at the patient's home of an obstetrician of consulting status. Those services are for necessitous cases, that is to say, those who cannot ordinarily afford the services of a specialist. Any medical practitioner in doubt or difficulty by telephoning to the hospital can have such skilled assistance. There is a further aspect, namely, the need for skilled assistance to midwives in difficult cases. In Westminster, as perhaps in other central districts, practising midwives have for some years past been experiencing increasing difficulty in obtaining medical assistance in response to summonses issued under the rules of the Central Midwives Board. One need not go into the reasons for those difficulties, the attendant circumstances or possible consequences. The complaints of the midwives have been investigated and confirmed. They were in the first instance submitted to the City Council by the Medical Officer of the Local Supervising Authority administering the Midwives Acts, namely, the London County Council. The City Council took immediate steps to solve those difficulties, and with the concurrence of the London County Council has provided not only medical assistance, but specially skilled medical assistance to all midwives practising in Westminster who may require it. These services came into operation on 1st October, 1934. They are the subject of formal agreements between the City Council and the Governors of Westminster Hospital. During the short period of operation of this scheme advantage has been taken of the new services by a midwife and by a medical practitioner. In the latter case it may be reasonably claimed that by the assistance of the obstetric consultant the difficult case of pregnancy was treated with success in regard to both mother and child. Ante-natal Services.—In Circular Memo 156/MCW of December, 1930, the Minister of Health, referring to the function of an ante-natal clinic, recommends that it should be the ante-natal centre for the maternity work of the area. When this Circular was issued there were 52 • already six ante-natal clinics in the City of Westminster and at least two others within half a mile of the boundaries. Two of those clinics were directly under the City Council's control at its own centres, one was at a voluntary centre, three in general hospitals in the City and two at hospitals outside the City but in the vicinity. While a number of medical practitioners and likewise private midwives in Westminster may avail themselves of the ante-natal clinics at the hospitals, they make little use of the ante-natal clinics at the welfare centres. During the past few years the attention of both doctors and midwives has been drawn to the facilities at those welfare centres, but they are not made use of by either to any appreciable extent. With a view to combining the spheres of work of hospital ante-natal clinics with those of the centres the Council by its agreement with Westminster Hospital has arranged that both indoor and outdoor cases, in addition to attending the welfare ante-natal clinics, shall also attend the hospital ante-natal clinics at least once, or more frequently as the obstetrician may direct. In this way the educational, preventive and social side is linked up with the clinical and therapeutic side of ante-natal care. The midwives of the hospital who are in fact agents of the City Council attend both sets of ante-natal clinics and form the essential link in a circle of co-operative effort. They see the patient in her home, at the welfare centre, at the hospital, and eventually attend her confinement, whether that be in her own home or in the hospital. This arrangement applies also to the maternity service of the City of Westminster Health Society. And although there may be no formal agreement with the other general hospitals yet it is a fact that women who have arranged for their confinements through those other hospitals attend locally at the welfare centre ante-natal clinics. The hospital almoners and the health visitors are in constant communication and collaboration over those cases. It should be added that these ante-natal services, linked up as they are with general hospitals have at their disposal all the specialist medical skill which the hospitals have at their command. Thus no pregnant woman in the City of Westminster need lack ante-natal care. Those who prefer not to avail themselves of the services supplied directly or indirectly by the Council may attend the voluntary general hospitals as ordinary patients or, alternatively, become patients of the London County Council hospitals where ante-natal clinics are also provided. As regards the proportion of expectant mothers attending the ante-natal clinics of the City Council (and those of the City of Westminster Health Society), while the net number of births registered during the year was 1,166, the number of expectant mothers dealt with at the centres was 894; 53 that is to say some 76-6 per cent, of the total cases, as compared with the percentage of 73 for the previous year. Table LVI.—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 8 20 2 25 64 St. George's 26 27 3 5 61 Westminster 21 38 4 46 109 St. Thomas's 0 5 4 2 13 Charing Cross 1 13 26 5 45 Middlesex — — 18 — 18 Elizabeth Garrett Anderson — 1 1 - 2 St. Stephen's 34 62 8 23 127 St. Mary's 2 1 — — 3 University College — — 1 — 1 Royal Free 1 3 — — 4 St. Mary Abbots Hospital 1 1 — — 2 Found by Health Visitors 51 69 19 50 189 Reported to Centre voluntarily 96 72 23 65 256 Totals 243 321 109 221 894 Ante-natal Visiting.—To the 894 expectant mothers who became known to the centres, 826 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,322. The attendances by those mothers at the clinics are detailed below:— Table LVII.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Ebury Bridge 50 118 183 301 131 Bessborough Street 49 103 167 276 162 WestminsterHealth 51 83 374 457 92 Society. 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, (9169) B 54 Institutional Provision for Mothers and Children. Maternity Beds for Complicated Cases and for those with Unsuitable Home Conditions.—By agreement with Westminster Hospital the Council has the right of admission for cases recommended through its welfare centres to beds in Westminster Hospital up to 100 patients per annum. There is also an agreement with St. George's Hospital for admission of individual cases to beds, payment being made therefor by the City Council. Apart from the City Council's own maternity scheme, beds are available in the London County Council hospitals, e.g., St. Stephen's, and also in voluntary hospitals such as Charing Cross, Middlesex, General Lying-in, etc., but these beds have to provide for cases not only from London but from the Home Counties as well, and this applies to some extent to Westminster Hospital. As has been pointed out in the annual reports of the Medical Officer of Health for the past 10 years a rapidly increasing number of women prefer to be confined in hospital. In 1919, 98 women whose home addresses were not in the City were delivered in residential institutions in Westminster; in 1934 the number had grown to 966. Only 238 Westminster women were confined in such institutions. The City Council, being conscious of the increasing demand for beds for urgent cases, and further to safeguard the interests of Westminster mothers by ensuring accommodation for them, made additional provisions in Westminster Hospital in 1929. About that time the Guardians' hospital was not universally favoured, although accommodation was always available. During the past two years or so as a London County Hospital it has become much more acceptable, no doubt because of its own ante-natal arrangements. It has, however, the disadvantage of distance, being some four miles from the eastern districts of the City. There is at present a definite need for more maternity beds in connection with general hospitals in the City. The hospital beds available are as follows:—Charing Cross, 15; St. George's, 11; Westminster, 12; *St. Stephen's, 28. 966 women from other districts were confined in Westminster and 458 women belonging to the City were delivered in the hospitals mentioned. The number of children born to Westminster parents in institutions outside the City numbered 526. * Situated in Chelsea. 55 The following table shows the number of confinements in the hospitals mentioned:— Table LVIII. Charing Cross Hospital: 428, of which 61 were Westminster cases. St. George's Hospital: 300, of which £51 were Westminster case.4. Westminster Hospital: 314, of which 126 were Westminster cases. Sheffield St. Hospital: 138, place of residence unknown. St. Stephen's Hospital: 220, all were Westminster cases. Convalescent Treatment.—The Council has during the year contributed towards the cost of the convalescent treatment of 9 Westminster patients at the Infants Hospital convalescent home at Burnham. and 7 necessitous mothers, suffering from poor health following confinement, have been sent to various convalescent homes with their babies at the cost of the Council, to recuperate for appropriate periods. The total cost of this service was £47 15s. 9d. • Maternal Mortality.—The number of maternal deaths in Westminster during the year ended December, 1934, was 4, which gives a maternal mortality rate of 3.3 per thousand (live and still) births, as compared with the rate for the whole country of 4.4 per thousand (live and still) births. A summary of results of enquiry are given below:— (1) M. (29).—Attended ante-natal clinic at hospital. Admitted to hospital two days prior to confinement with diaphragmatic pleurisy. Became comatose 31/2, hours before delivery of stillborn child by forceps, and died in eclamptic coma 3| hours after delivery. (First birth.) (2) M. (35).—Forceps delivery after 51 hours of labour owing to presence of Bandl's ring round neck of child preventing delivery of shoulders. Died in nursing home of uraemia and splanchnic shock 2 days later. (First birth.) (3) Spinster. (21).—Admitted to hospital as an inevitable abortion. Patient developed paramatritis and B. Coli pyelitis and subsequent lung trouble developed into pleural effusion. She died 11 days after the abortion. Three blood transfusions were given. (First birth.) (4) M. (29).—Attended ante-natal clinic at hospital. Forceps delivery after 41 hours of labour. Died in hospital of puerperal peritonitis after 14 days' illness. (First birth.) Puerperal Sepsis.—The special hospital provisions in the first place of the Metropolitan Asylums Board and latterly of the London County Council (9169) F 2 56 meet all requirements. In Westminster the consultant and pathological services provided by the City Council are very rarely called for; as soon as a patient shows evidence of morbidity she is notified by the doctor attending and removed to the special London County Council hospital. In 1934, 13 cases of puerperal pyrexia were notified and removed to hospital; puerperal fever cases numbering five were notified and all were likewise removed to the London County Council hospitals. By agreement with the three district nursing associations operating in Westminster the City Council provides, at the request of doctors, nursing in their own homes of cases of illness occurring before and after confinement. Generally speaking, the requests are made for the less serious illnesses, e.g., breast inflammation, and mainly come through the welfare centres. As indicated above, morbid cases after confinement are removed expeditiously to the London County Council special hospitals, while those occurring during pregnancy are admitted to the voluntary hospitals and to the London County Council general hospitals. There are two contributory factors, the exact significance of which must first be appreciated before conclusions can be drawn as to the ri^k of childbed in districts such as Westminster. (1) The abnormally low birth-rate. To make this point clear, an analogy in infantile mortality in certain wards of Westminster must be quoted. In 1929, in the Strand ward, with a population of 2,116, there were only three babies born; one of those died of prematurity. This gives an infantile mortality rate of 333 per 1,000, a figure which at first glance and by itself might be held to indicate conditions of ignorance, squalor and poverty. As a matter of fact, as regards standards of housing, social conditions and maternity and child welfare services, there are few better in the country. Again, if one of those three mothers had died in childbed the maternal mortality figure would again have been 333 per thousand, a figure easy to misinterpret until studied on the basis of the abnormally low birth-rate. (2) The factor of illegitimacy has been commented upon by Sir F. Menzies, the County Medical Officer of Health, in his annual report, and likewise the fallacy of including maternal deaths from abortion in making a calculation based on the number of births. In Westminster there is a high illegitimacy rate. With illegitimacy are associated attempts at concealment of birth and abortion with all its dangers. This is a not inconsiderable factor in maintaining a high maternal mortality rate. Mo3t women in such circumstances eschew ante-natal clinics, make no arrangements for their confinements, practise furtive methods too often ending in conditions which no amount of skilled treatment can overcome. 57 Sufficient has been said to indicate that, as regards births, infant deaths, and maternal deaths, the City of Westminster cannot be considered an average urban community on which to make deductions from vital statistics concerning these particular matters. 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—3rd Tuesday each month at 10 a.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 1929 are also shown. 58 Table LIX. Attendances at Infant Consultations, 1934. 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 102 236 78 3,042 1,436 3,278 1,514 4,792 15, Bessborough Street 100 234 62 2,908 2,372 3,142 2,434 5,576 Marshall Street 51 88 25 1,205 942 1,293 967 2,260 Marsham Street 110 220 75 2,136 1,763 2,356 1,838 4,194 1934 363 778 240 9,291 6,513 10,069 6,753 16,822 1933 351 759 245 9,566 6,282 10,325 6,527 16,852 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 The average attendances per session were— 1934. 1933. 1932. 1931. 1930. 1929. Ebury Bridge 46.9 50.2 47.1 37.7 43.5 36.5 Bessborough Street 55.7 54.5 54.4 56.3 49.5 48.8 Marshall Street 44.3 48.0 43.9 43.4 40.9 33.1 Marsham Street 38.1 37.6 41.1 40.1 43.1 38.1 The number of individual children medically inspected were— Ebury Bridge 58 Marshall Street 251 15, Bessborough Street 602 121, Marsham Street 671 59 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. The following table shows the nature of certain conditions for which nursing visits were paid:— Table LX. Patients. Visits. Affections of the eyes 25 386 Complications of maternity 36 491 Influenza 5 92 Pneumonia 25 404 Bronchitis 15 135 Measles 16 316 Whooping cough 2 80 Othar complaints 129 1,456 Total 253 3,360 Ophthalmia neonatorum.—Four cases were notified during the year, 2 of those being treated in hospital. There were also 7 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 for attention of the eyes was carried out by the district nurses in 25 cases, 386 visits being paid. It is satisfactory to note that although the total number of births show an increase of 67, 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. 60 Ophthalmia neonatorum has been notifiable since 1911. The percentage of mild (non-purulent) and notified (purulent) cases in relation to births from the year 1925 is as follows:— Table LXI. Cases. Rate per 100 births for both classes of cases. 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 1933 12 1.1 1934 11 0.94 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:— Table LXII. 1901-5 2.8 1928 0.72 1906-10 3.2 1929 0.73 1911-15 2.4 1930 2.1 1916-20 4.95 1931 1.6 1921-25 1.7 1932 1.7 1926 0.62 1933 3.6 1927 2-8 1934 1.71 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 LXIII. Mothercraft Classes. 1934. Ebury Bridge. Bessboro' Street. Marshall Street. Marsham Street. Total. Number of classes 47 50 46 91 234 Total attendances 1,454 976 440 2,515 5,385 Average attendances 30.9 19.5 9.5 27.6 23.0 Number of expectant mothers 67 104 37 57 265 Number of attendances by expectant mothers 281 327 197 701 1,506 Number of other mothers 188 147 66 85 486 Number of attendances by other mothers 1,173 649 243 1,814 3,879 Attendances of children in nurseries during classes 999 860 413 2,653 4,925 61 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 893; at Bessborough Street, 652; at Marshall Street, 359; and at Marsham Street, 1,561. In addition to those, many renovations were carried out. Health Visiting.—The figures given below in Table LXIV show the increasing attention which is being paid to expectant mothers, and to children between the ages of one and five years. The records of these children relating both to home conditions and their health history are now passed on to the education authority when the children enter school. The following table shows the number of visits paid in connection with the four centres:— Table LXIV. 1934 Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 240 262 105 219 826 Other visits 342 333 211 436 1,322 Children under 1 year of age— First visits 332 289 165 247 1,033 Other visits 972 911 1,041 1,128 4,052 Children over 1 and under 5 years— Visits 1,697 2,777 1,747 2,521 8,742 Death enquiries, still-births, &c. 47 39 21 21 128 Infectious diseases 317 272 129 231 949 Infant Life Protection.— At the end of the year the register contained the names of 20 foster mothers who were then in possession of foster children. Each had one child only. Fifteen new registrations were made during the year. One case of unsatisfactory conduct on the part of a foster mother was reported to the Public Health Committee who authorised the Medical Officer of Health to take such action as might be necessary under the provisions of Section 67 of the Children and Young Persons Act, 1932. The child had not been provided with proper sleeping accommodation and had been left unattended for long periods during the day. As a result of warnings and frequent visits by the Council's Infant Life Protection Visitor conditions were improved. The foster mother subsequently gave up the care of the child. Notices numbering 103 were received from other authorities in respect of the transfer of children from the care of foster mothers in those districts 62 to the care of their parents or other persons residing or said to be residing in Westminster. During the year visits to foster children were carried out as follows:— Table LXV. - District. SouthWest. Southern. Northern. Visits by Infant Life Protection Visitors to:— Foster Children under 5— First visits 36 31 31 Subsequent visits 38 43 25 Foster Children 5 to 9— First visits 4 8 3 Subsequent visits 4 10 3 Barlow's Gift.— The income from this trust, amounting to £33, was by resolution of the Barlow's Gift Committee divided between maternity and child welfare, the Tuberculosis Handicrafts Committee and the Westminster Nursing 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, flannel, wool and materials for handicrafts. Homes for Unmarried Mothers, etc.— The Council made a grant of £100 to the Home of St. John the Baptist at Tulse Hill. This home was formerly in the City, and cases from Westminster are eligible for admission. During 1934 five Westminster women received care and shelter over an average period of eight months. Supply of Milk.— Fresh or dried milk is supplied free or at half-price, in certain cases recommended by the medical officers of the maternity and child-welfare centres. Grants are made only in cases where the income of the family, after deductions have been made in respect of rent and other outgoings, is within the limits laid down in a scale of income prepared by the Minister of Health. Applications are dealt with at the meetings of the ladies of the Maternity and Child Welfare Sub-Committee, which take place once a month at one or other of the Council's centres. Grants are made for a period of one calendar month and are reconsidered at each subsequent meeting of the Committee. Cases in receipt of public assistance are not eligible for the council's extra nourishment scheme, but a scheme is in operation whereby mothers and infants in receipt of 63 public assistance may be referred to the centres for special recommendations for extra nourishment on medical grounds. This extra nourishment is additional to any relief in kind and is provided by the Public Assistance Committee. Necessitous nursing mothers attending the ante-natal clinics at the London County Council hospitals, resident in the City but outside the scope of public assistance are, on the recommendation of the medical officers of such hospitals, accepted for grant by the City Council of extra nourishment. Preparations of dried milk are sold at cost price at the centres, 3,984 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 £606 11s. 11d. Insulin Treatment.—One patient is still under treatment and the cost to the Council for the year was £12. 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. Measures have been adopted for bringing into closer relationship the work of the dental clinic and that of the health visitors. As far as is practicable the health visitors attend alternately at the sessions of the clinic when mothers and or infants from their respective centres are receiving dental treatment. Patients contributed £11 18s. in small sums according to their means. Mr. Stewart Tait, Dental Surgeon, submits the following report:— Dental Clinic. (held in the premises of the Westminster General Dispensary) The annexed table showing the figures for the year ending 1934, shows that there has been an increase in the totals as compared with the previous year. The numbers of new cases have increased but it is too early to say whether this is due to the closer co-operation of the centres in sending a representative to the sessions—as this system has only been in operation since the summer. I have, however, noticed that this co-operation has enabled them to get the mothers to attend and there have been fewer failures. I would therefore, suggest that this co-operation be continued as I feel that it will be to the benefit not only of the clinic, but of those entitled to attend for treatment. 64 In conclusion, I wish to thank all those who have co-operated with me in the work at the centre including those ladies sent from the various centres. Table LXVIII. New Cases. Reappoint ments. Extractions. Fillings. Other Operations. Anæsthetics. Dentures Supplied. Local. General. 1934 205 1,046 1,157 145 328 9 240 24 F. Stewart Tait, L.D.S. Day Nursery at 147, Warwick Street. This is the only institution of its kind in the City which caters for children of all ages up to 5 years, and is situated near Ebury Bridge. The administration of the nursery is well conducted and its finances are well managed. The accommodation is limited to 40 children and is totally inadequate to meet the needs of its immediate neighbourhood. The City Council as mentioned earlier in this report hope to provide accommodation for upwards of 80 children in the upper floors of a new maternity and child welfare centre building which they propose to erect on a site in Bessborough Street. Owing to the occurrence of infectious illness at various periods of the year the admission of new cases had to be reduced to prevent the spread of infection with a consequential reduction on the average daily attendance at the nursery. The total attendances were 8,582 by 96 individual children in the following age groups:— (a) Under one year, 68. (b) Over one year and under three years, 22. (c) Over three years and under five years, 6. The nursery is open on five and a half days in the week, the charge to parents being 5s. for each child per week, with remissions in special circumstances. 65 SANITARY CIRCUMSTANCES OF THE AREA. Water.— With the exception of certain premises which are supplied with water from deep wells, the whole of Westminster takes its supply from the Metropolitan Water Board. Public Swimming Pools, Laundries, &c.—There are three establishments, situated at Buckingham Palace Road, Great Smith Street, and Marshall Street. The numbers using the swimming pools and private baths in 1934 were:— Buckingham Palace Road: 130,176 men; 75,669 women. Great Smith Street: 145,726 men ; 61,981 women. Marshall Street: 166,793 men ; 110,983 women. The numbers relating to users of the public laundries were:— Buckingham Palace Road, 26,999; Great Smith Street, 25.712; Marshall Street, 11,689. Bacteriological examinations of the water in the swimming pools have been made at frequent intervals during the year. The results have shown that the water in each swimming pool has been maintained at a highly satisfactory standard of purity by means of the filtration and purification plants. Sterilisation of the water is carried out by means of chlorine gas. Experiments were carried out at one of the establishments in the use of ammonia in combination with chlorine as a sterilising agent, and although these tests are proceeding, the results so far obtained indicate that the ammonia-chlorine, or the chloramine method as it is known, has certain advantages over chlorine alone. Drainage and Sewerage.—During the year 935 plans of drainage and other sanitary works relating to existing and new buildings were examined and approved by the Committee. This is the highest number so far recorded and is an indication, not only of the continued and increasing activity in the building trade but also of the changes which are taking place in the developments of building land, etc. Apart from the depression year, 1931, there has been a steady increase in the number of plans submitted. In 1924 there were only 602. In addition to the works in respect of which plans were submitted, many small alterations such as the diversion of pipes, replacement of fittings, &c., were notified to the department and received supervision, though in such cases plans were not necessary. 66 The work of the department in this connection has become more exacting, as plans entail not only one but often many interviews. This is largely due to the difficulty experienced by owners in deciding as to the most suitable way of dividing buildings for letting purposes in relation to the sanitary arrangements originally proposed. Owners also naturally desire to reduce cost as much as possible and this frequently means interviewing more than one contractor. New Sanitary Construction.—Of the 935 plans relating to drainage and other sanitary works, 102 represented sanitary provisions in entirely new buildings. The corresponding figures since 1930 are as follows:— Table LXIX. — 1930. 1931. 1932. 1933. 1934. Plans 831 748 757 926 935 Plans of work in now buildings included in above 96 71 68 96 102 Combined drainage orders were made in 23 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. The offences were not sufficiently serious to warrant prosecution, but in 15 cases builders were cautioned. In the remaining cases no action was deemed 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 41 public conveniences in the City, 22 for men and 19 for women. In addition, there are 32 public urinals for men. Public Cleansing.—This is carried out by a separate department of the City Council under the Director of Public Cleansing (Mr. H. Ardern, A.M.I.Mech.E., F.Inst.P.C.), who has supplied the following notes:— Ref use Collection.—There is a daily collection of refuse throughout the City and the figures for the Council year ended 31st March, 1935, are as follows:— Tons. House refuse collected 87,306 Trade refuse collected 1,550 Total barged away 88,856 61 Modernisation of Transport.— The scheme for the complete modernisation of the Council's transport, approved by the Council in December, 1933, was started upon by the purchase of three "Mechanical Horse " motive units and three refuse bodies. With this type of transport the motive units can be used on practically all the services of the Highways Department such as refuse collection, street flushing and watering, and general transport work, by the attachment of appropriate bodies. These bodies are "articulated trailers," the front portion being superimposed on the rear of the motive unit and connected by a coupling device which can be operated from the driver's cab, a complete change of body being effected in a few minutes. The purchase of these three units and bodies enabled the Council to dispose of two of its oldest motors, which had been in operation since 1919. The refuse bodies are totally enclosed and the emptying of bins actually takes place inside the vehicle, so that the operation is as nearly dustless as practicable. The vehicles are fitted with "moving floors" (i.e. a composition of rubber and canvas running over rollers) and a moveable "dam," so that the refuse may be compressed towards the front of the vehicle whilst loading and the full load discharged by reversing the travel of the floor, thereby overcoming the necessity to tip the vehicle. These new vehicles proved very satisfactory on exhaustive tests under practical working conditions and the Council therefore approved the purchase of a further fifteen at its October meeting, but these were not actually delivered in the year now under review. In April, the Council approved the purchase of a 1,200 gallons water tank, fitted with street washing equipment and mounted on a "Carrier" unit for operation with a "Mechanical Horse." The machine was delivered and put into operation in July and has proved very efficient and a great improvement on the old water tanks. On a report by the Director of Public Cleansing that the orderly trucks were of very antiquated and unhygienic design, the Council also approved the purchase of twenty trucks of an entirely new type. These trucks are of all-metal construction, mounted on rubber tyred wheels and fitted with two square covered bins which are lifted out for emptying ; there is also a centre section for storage purposes and proper racks for tools. The trucks were put into operation in April and in view of their greater efficiency, easier manipulation and more pleasing appearance the Council approved the order of a further sixty in June. It is proposed to adopt this truck as the standard type for the future and eventually it will entirely displace the old wooden truck. Refuse Collection by "Container" System.—A brief description of this system, which had already been approved by the Council in principle, was given in the last report. It was first tried out on the Council's own housing estates and proved all that was expected of it, i.e., more hygienic for the storage of refuse on premises and considerably more expeditious and noiseless in collection. Before the end of the year the system had been installed in several large hotels and at a hospital and enquiries and requests were being received from so many other hotels, clubs, government buildings, etc., that it was obvious that the system would be considerably extended in 1935. Refuse Disposal.—For some time past the Council had been considering schemes for the erection of the necessary plant in order to centralise the disposal of the whole of the City's refuse at Grosvenor Dock, which was reconstructed in 1929 at a cost of nearly £100,000 with this intention in view. At its February meeting the 68 Council approved a scheme for the erection of suitable plant at the dock, together with other necessary ancillary works, such as foundations, pits, paving, etc. This plant consisted of six electrically operated elevators, enclosed in two housings of three elevators each, so that the loads of refuse discharged by the collecting vehicles into receiving hoppers could be taken up to the required height and dropped direct into the hold of the barge alongside the dock. The elevators are constructed of steel plate3 and the complete plant was designed to deal with approximately 120 tons of refuse per hour. The total cost of the plant and necessary ancillary works as mentioned above was £9,607. Erection was completed and the plant officially opened by His Worship the Mayor on the 19th September and the centralisation of refuse disposal through the plant commenced on the 24th September. The plant has proved quite capable of dealing with the City's output of approximately 100,000 tons of refuse per annum, and one immediate effect of the centralisation was a saving in barging costs of 1s. 3d. per ton on some 60,000 tons. Inspection at Refuse Dumps.—During the year the Council appointed a Supervisor of Refuse Disposal, whose duties include not only the supervision of the plant at Grosvenor Dock, but periodic inspections of the two contractors' dumps to which the City's refuse is taken, in order to ensure that the contractors are conforming with the Ministry of Health's precautions regarding "Controlled Tipping" and all other Acts and local by-laws relating thereto. 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 conditions of the City. The special housing survey authorized under the Housing Act, 1930, in which three of the Council's permanent inspectors as well as five temporary inspectors were engaged is referred to elsewhere. 69 Table LXX. Inspection of premises:— Dwelling-houses— Water-Closets— Primary Inspections— Directly approached from rooms 26 (a) On complaint 913 (b) Infectious disease 808 Accommodation insufficient 45 (c) Housing Regulations, 1925 3,909 Water Supply— Insufficient or unsatisfactory 61 (d) Housing applications 144 Cisterns dirty and uncovered 143 (e) Other reasons 3,490* Absence of—in upper floors of tenement houses 6 Total 9,204 Dustbins— Absence of 132 Re-inspections 11,827 Insufficient 95 Defective 144 Other Premises— Animals kept so as to be a nuisance 26 Primary inspections— (a) On complaint 448 Other nuisances 829 (b) Other reasons 3,429 Dangerous structures noted 22 Overcrowding 51 Total 3,877 Underground rooms illegally occupied 29 Re-inspections 8,024 Sanitary works supervised:— Sanitary Works— Drains (including soil, waste, rainwater pipes, etc.)— Total Inspections— (a) Under notice 1,523 Constructed 4,636 (b) Voluntary works 12,546 Altered, repaired, etc. 1,574 Intercepting traps fixed 182 Nuisances, etc.:— Petrol interceptors provided 19 Tested by smoke 463 Defective or dirty conditions of internal structure 1,523 „ chemical 782 „ water 2,122 Verminous conditions 552 „ air 656 Water-closets— Damp conditions 421 Constructed 1,895 Inadequate under-floor ventilation 323 Repaired and reconditioned 452 Defective drainage, waterclosets, etc. 292 Urinals— Constructed 192 Repaired and reconditioned 71 „ roofs 209 Water Fittings fixed— „ paving of areas, etc. 193 Baths 1,723 Water-closets— Bidets 229 Insufficiently ventilated or lighted 63 Lavatory basins 2,132 Sinks, etc. 1,917 * This figure includes 20 visits of enquiry in respect of smallpox contacts. Restriction of Rent Acts, 1920-33.—The registration of decontrolled houses was carried out by this department in 1933 and the register remains in the department where it may be inspected by any member of the public as permitted by Section 2 of the Act of 1933. During the year some three hundred persons inspected the register. Twelve applications were received for the registration of decontrolled dwelling-houses on certificates granted by the County Court under Section 2 (4) of the Act of 1933. The number of dwelling houses included in these applications totalled 59. Certificates of registration or non-registration, which local authorities are required to grant on payment of a fee of 1s., have been issued in (9169) F 70 52 cases, 50 being in respect of registered houses and 2 non-registered. There have been no cancellations of registration by the County Court. One certificate was issued under the provisions of the Acts as to the state of repair of a house. Nuisances.—Intimation notices were served in 2,060 instances, the number of premises concerned being 2,012. Statutory notices authorised by the sanitary authority numbered 66 and related to 64 premises. Police court proceedings as detailed below were taken in 3 instances in order to enforce compliance with the requirements of statutory notices:— Details of Nuisance, etc. Result of Proceedings. (1) Business premises without water supply Abatement order, 3s. costs. (2) Defective and dirty conditions in a tene- Withdrawn on payment of 10s. 6d. ment house costs. (3) Insufficient and unsuitable water-closet Fine £2. accommodation in business premises. The following are the comparative figures since 1930:— Table LXXI. — 1930. 1931. 1932. 1933. 1934. Intimation Notices 1,239 1,244 1,378 1,223 2,060* Statutory Notices 72 62 57 50 66 Legal Proceedings 5 5 4 7 3 * The increase is explained by notices arising out of the housing survey. Water Supply.— The Metropolitan Water Board sent 27 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. Some of these cases arise because of the high rateable values in the City. Take the case say, of a small antique shop in a select district. If the rateable value be £400 the water rate is about £18 annually. Probably an average consumption of water in these premises does not exceed 2 gallons per day, then the water must cost about 6d. per gallon. It is not to be wondered at that the shopkeeper regards this as an expensive luxury. There was one prosecution in respect of failure to restore water supply following the service of a statutory notice. The defendant was ordered to abate the nuisance and to pay costs. Water Supply in Tenement Houses.—Power to effect this provision is given under Section 48 of the Public Health (London) Act, 1891, and 71 under Section 78 of the London County Council (General Powers) Act, 1907. The number of cases in which this action was taken since 1930 is as follows:— 1930. 1931. 1932. 1933. 1934. 21 19 9 12 6 By-laws as to Removal of Offensive Refuse.—Two cases were reported and the persons concerned were prosecuted and fined 7s. Gd each. Lighting of staircases in tenement buildings.—London County Council (General Powers) Act, 1927 (Sec. 61)—At three tenement houses lighting of staircases was installed or improved following the service of formal notices. 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 1934, the number of inspections made, and the results of such inspection:- Table LXXII. Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,410 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc. 1,380 Leather workers, boot and shoe makers, harness makers, etc. 77 Carpentry, upholstery, carvers, gilders, etc. 78 Surgical and dental instrument makers 8 Tobacco manufacturers 7 Wig makers and hair workers 42 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 64 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 70 Metal workers 60 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 61 Florists 19 Laundries 17 Bakehouses 62 Photographers 49 Jewel case makers 6 Cinema film workplaces 20 Total 3,430 The use of 227 workshops was discontinued, and 283 additions were made to the register during the year, (9169) F 2 72 Table LXXIII.— Inspection. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including factory laundries) 324 5 — Workshops (including workshop laundries) 3,192 312 — Workplaces (other than Outworkers' premises) 2,255 72 2 Total 5,771 389 2 Table LXXIV.— 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 321 321 — — Want of ventilation 26 26 — — Overcrowding 18 18 — — Want of drainage of floors 2 2 — — Other nuisances 125 124 — 1 Sanitary accommodation— Insufficient 15 14 — 1 Unsuitable or defective 107 107 — — Not separate for sexes 25 25 — — 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 639 637 — 2 73 Table LXXV.— Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 157 Matters notified to H. M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 198 Absence of means of warming — Matters referred by H. M. Inspectors 61 Workrooms measured 188 Visits of Enquiry re Employment of Women 151 „ „ Outworkers 129 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. 74 Table LXXVI. 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 994 1,628 7,413 19 37 91 514 5,040 99 — — — — — 14 — — Linens, etc. 4 23 56 — — — 6 52 — — — — — — — — — Furriers 6 20 4 — — — 19 16 — — — — — — — — — Umbrellas, toys, artificial flowers, etc. 8 63 77 — — — 7 175 — — — — — — — — — Total 1,012 1,734 7,550 19 37 91 546 5,283 99 — — — — — 14 — — 75 Outworkers.— The total number of lists received during the year amounted to 1,031. Notices in respect of failure to send lists were sent to 99 firms. No legal proceedings were necessary. The lists contained 9,412 names and addresses, of which 5,283 were in other districts, 4,662 being within the area of the County of London and 512 in the surrounding districts. The number of individual outworkers in the City at the close of the year was 1,668, of whom 1,585 were registered as occupying workshops. The number of premises in which outwork was being carried on was 697. Special Classes of Premises and Occupations subject to control by the Local Authority. (1) Common Lodging Houses. There are 5 common lodging houses in the City of Westminster, 4 for men and 1 for women, viz.:— Licensed to receive:— Men. W omen. 16, Strutton Ground 201 — Bruce House, Kemble Street 716 — 33, Creat Peter Street 80 — 7, St. Ann's Street 565 — 28-30, Greencoat Place — 184 The City Council renewed all licences for a period of one year, operating from 1st July, 1934, to 30th June, 1935. The common lodging house at 40, Gt. Peter Street, licensed for 57 women and 2 children, was closed on the 18th June, 1934. The duties of inspection involve visits both by day and by night and are carried out by a male sanitary inspector for men's lodging houses and the female sanitary inspector for the women's lodging house. During the year, 187 inspections were made, and generally conditions were found to be satisfactory. Complaints were received from time to time during the year as to the quality or soundness of the food supplied to the inmates, the condition of the washing arrangements and other matters of a minor character. On investigation, they were found to have little foundation in fact. (2) Seamen's Lodging Houses (3) Slaughter Houses There are none in the City. (4) Offensive Trades (5) Cowsheds 76 (6) Houses Let in Tenements.—The sanitary inspectors paid 8,943 visits of inspection to houses of this class. There were no infringements of the by-laws involving legal proceedings, except in one case, the details of which are in page 70. (7) Underground Sleeping Places. (8) Butchers' Shops and Stalls. (9) Dairies and Milkshops. (10) Ice-cream, Premises. (11) Preserved Meat, etc., Premises. (12) Bakehouses. (13) Workshops and Workplaces. (14) Rag-and-Bone Dealers.—There are 12 premises in the City in which this business is carried on. No matters requiring attention by the department have arisen during the year. (15) Fried-fish Shops and Fish Curers. (16) Street Traders. Particulars relating to premises and occupations included in the foregoing list, other than Nos. (1) (6) and (14), may be found under the appropriate headings elsewhere in this report. Rag Flock Acts, 1911 and 1928.—There is one factory in the City which comes within the provisions of these Acts. Although rag flock is not manufactured there, it is used in making up material for mattresses. No samples were taken during the year. New Legislation.—The Shops Act, 1934, which came into operation on the 30th December, 1934, placed upon the City Council the duty of enforcing provisions of that Act relating to ventilation and temperature of shops and to sanitary conveniences therein. There are over six thousand shops in the City to which the provisions of the Act apply, and towards the close of the year steps were being taken to implement those provisions. 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. As regards infectious disease in schools, there is close contact between the officers of the Sanitary Authority and those of the Education Authority. The former bring at once to the notice of the latter anything in the nature of even a minor outbreak at a school which the school medical officers can investigate at the earliest opportunity. 77 The Council's sanitary inspectors are required to visit schools to inform head teachers personally after inspecting homes from which school children, suffering from notifiable infectious disease, have been removed to hospital, and also to acquaint the teachers as to home contacts attending the same school. This is in addition to the written intimation from the Medical Officer of Health to the head teacher as required by law. At three schools additions or improvements were made to the sanitary arrangements during the year. Fouling of Footways by Dogs—By-Jaw.—Thirteen cases of infringement of the by-law were reported to the Council by the Commissioner of Police. A prosecution was ordered in each instance except one where the offender was a child. Convictions were obtained in nine cases, two were dismissed on payment of 5s. costs, and one was dismissed with a caution. The penalties inflicted varied from 5s. to 10s. and totalled, with costs, £3 10s. 0d. A number of complaints received of nuisance caused by dogs in different parts of the city were investigated by the sanitary inspectors but it was not found possible to obtain evidence of infringements of the by-law. In such cases, arrangements are made with the cleansing department to affix copies of the by-law in prominent positions in the streets where complaints have arisen. Rat Repression.—During the year 203 complaints were received and investigated, and 392 inspections were made by the sanitary inspectors. The Council's rat officer visited 120 premises for the purpose of investigation and to advise owners and occupiers as to the steps to be taken to rid premises of rats and to instruct them in measures of rat proofing. He paid altogether 270 visits to these premises. Many of those complaints involved detailed inspection of the premises affected, for the purpose of tracing rat runs and drainage and other defects likely to permit entry of rats. Rat infestation, particularly as regards dwelling houses, generally arises through faulty drains or sewer connections. At the request of the department, the City Engineer's staff examined the sewer connections of some 458 premises, of which 58 were found to be defective and were subsequently repaired or renewed. A number of complaints related to invasion of premises by rats disturbed in the course of demolition operations in adjoining properties. Appropriate action was taken to ensure that disused drain openings on the sites were sealed off and that accumulations of debris, &c., likely to provide harbourage for rats were removed. 78 The staff of the Works Department have, in addition to laying baits in the sewers throughout the year, treated one section of sewer with antirat gas. During "Rat Week" in November, efforts in connection with rat destruction were intensified; circulars of advice on methods of rat destruction were distributed to householders and others while posters issued by the Ministry of Agriculture were displayed on buildings in various parts of the City. A total of 14,450 baits were laid in the sewers and 565 at the council's depots and other places where rats were likely to be found. The number of dead rats discovered was small, but most of the baits were reported to have been taken. At the request of the Ministry of Agriculture and Fisheries, a special investigation was made as to the prevalence of the black rat in the City. This rat is the plague-carrying member of the rat family. The Sanitary Inspectors made enquiries at some 1,469 premises, at 42 of which rats were reported to have been found, but evidence as regards the black rat proved entirely negative. Nuisance from Pigeons.—The member of the disinfecting staff whose duties are concerned largely with rat disinfestation and investigation of complaints of nuisances caused by pigeons, visited some 20 premises on complaint and advised owners or occupiers as to what measures were necessary to prevent pigeons roosting or nesting on or about their property. On two other occasions a firm of contractors were authorized by the Council to undertake capture on a large scale and were successful in taking some 400 pigeons. London County Council (General Powers) Act, 1928, Sec. 28— Removal of Infirm and Diseased Person to Suitable Institution. One case was reported to the Public Health Committee with a view to proceedings being taken under the Act. The person concerned was a woman of 84 years living in a flat in a block of industrial dwellings. She was in an enfeebled state and incapable of devoting to herself proper care and attention. Her room was in a very dirty and verminous state. Efforts to persuade her to enter an institution were unsuccessful. Notice was served upon her in respect of the condition of her room, but before further action could be taken she vacated the premises for an address unknown. 79 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 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 133 houses, and 8,738 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 443 men, 37 women, and 3 children (under school age), were given medicated baths at the disinfecting station, making 512 attendances. Notices from the London County Council in regard to school children affected with vermin numbered 12. The disinfecting foreman and the sanitary inspectors paid 35 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 Stoke Newington. Among Westminster school children 346 cases of head lice, and 19 of scabies were treated. In all these cases, the clothing was disinfected, together with the bedding from their homes, amounting in all to 930 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 144 for head lice, and 5 for scabies. The total number of attendances of school children for baths at the disinfecting station was 962. The following table shows the total number of individuals treated at the station for verminous conditions: Table LXVI. 1934. Head lice. Body lice. Scabies. Total. Children (including those under school age). 490 — 27 517 Adults 5 429 46 480 495 429 73 997 80 Table LXVII. General disinfection of premises, articles, etc.:— 1930. 1931. 1932. 1933. 1934. Rooms 992 613 781 747 1,058 Articles disinfected 23,853 22,004 22,314 21,698 22,174 Articles washed 5,304 3,576 3,690 3,500 3,450 Articles destroyed 190 424 1,020 2,218 300 Books disinfected 179 62 276 723 132 Vehicles „ 8 7 5 4 15 Offices and business premises 39 15 11 6 6 * Library books, 81; private books, 51. Motor Disinfecting Van.— The motor van during 1934 completed 4,490 miles, carrying 3,399 cwts. of goods. Infestation by Bugs.— This matter has given considerable anxiety to local authorities throughout the Country. Local authorities in London became so concerned with the problem that they petitioned the Minister of Health to set up an Inquiry and to obtain information as to the habits of the pest and the means for its prevention and eradication. The Minister caused such an Inquiry to be made and published his findings in an excellent and exhaustive report. The report suggests that where tenants are moving to new premises, and shortly before the move takes place, the house and furniture should be thoroughly inspected. If bed bugs are found to be present, tenants should be encouraged to undertake systematic cleaning of all furniture and effects, to prevent infested furniture being removed from house to house. In addition to this, some scheme of efficient disinfestation will probably be necessary to ensure the tenants being started in the new house free from bed bug infestation. The provision of a moveable van, or container, which can be rendered gas-tight, is already in use by many local authorities with this purpose in view. The City Council has given instructions for a van of special design to be constructed in which a process of disinfestation of furniture may be carried out. The effects of tenants rehoused in certain estates in Westminster have been treated with cyanide gas in vans provided by firms specializing in this class of work. The fumigation was carried out under the supervision of the district sanitary inspector with satisfactory results. Coroner's Court and Mortuary. The reorganisation of the Council's Coroner's Court and Mortuary situate in Horseferry Road was begun in 1932, and continued in 1933, as part of a progressive scheme of modernisation and re-equipment. Attention was this year devoted principally to the mortuary. 81 Experience has shown that the working of the electrically-operated cold chamber installed in 1933 was entirely satisfactory, and had in every way justified its adoption. It was found, however, that the accommodation provided in the single installation for nine bodies was not sufficient at all times to accommodate the number of bodies received. A second unit to contain six bodies was therefore installed at a cost of £210, £60 being expended on the internal fittings. The temperature in the cold chamber is maintained at 40°F. for ordinary purposes but where decomposition has reached an advanced stage as is often the case where bodies have been recovered from the Thames, it has been found necessary to lower the temperature to 32°F., and this can be effected in a separate cell of the chamber. Works of decoration, alteration and renewal were carried out to the premises generally at a cost of £386. There were 275 bodies removed to the mortuary during the year by order of the Coroner or to await burial. Inquests were held in 185 cases but not in 81 while 9 bodies were received to await burial. Post-mortem examinations were made in 147 instances. The following is a list of the causes of death of 275 cases brought to the mortuary:— Drowning 10 Street accidents 44 Other accidents 20 Suicide 60 Natural causes 92 Misadventure 32 Other miscellaneous causes 17 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 LXXVII. — 1930. 1931. 1932. 1933. 1934 Complaints received 31 49 35 63 58 Observations taken 755 854 629 749 875 Notices issued— Preliminarv 16 10 11 10 5 Statutory 2 2 2 1 — Legal Proceedings 2 — 2 — — There were no prosecutions in respect of smoke nuisances during 1934. 82 National Smoke Abatement Society.— The City Council takes an active interest in the work of this Society. Councillor Mrs. Alderson Home, as a member of the Public Health Committee, attended its meetings and annual Conference at Glasgow and reported fully to the Committee on the proceedings. 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. T. McLachlan, one of the City's public analysts, as its representatives. They attended the meetings held in May and November when matters relating to administration of smoke legislation and research into causes of atmospheric pollution were discussed. Battersea Power Station. The Committee presided over by the Government Chemist, who have been investigating the efficacy of the methods employed at the Battersea Power Station for preventing the emission of dangerous fumes into the air, issued their second report on the 15th October, 1934. The Committee were impressed by the endeavour and energy displayed by the London Power Company to reduce the quantity of sulphur gases escaping into the air to a low value, the value then being about 0.03 grains of sulphur as sulphurous anhydride per cubic foot of air. The Committee point out that the results achieved from the present working of the plant for eliminating sulphur fumes, smoke, grit, etc., have fulfilled the expectations which were formed of the process during the experimental stage, and it is only because the problem is a new one and further improvement in the processes may reasonably be anticipated, that the Committee have recommended that sanction for the completion of the station should not be given without regard to the most recent developments in technical knowledge on the subject of the removal of sulphur compounds from flue gases. With the object, if possible, to ascertain whether the Battersea Station would increase the sulphur gas contained in the atmosphere of Westminster, the City Council in 1932, installed instruments for measuring the sulphur gas contained in the air. The results of those examinations for 83 the last four months of 1932, before the station, was in operation, compared with corresponding periods of 1933 and 1934, do not, however, indicate any increase of sulphur gas. Assuming, however, that the coal consumed at the Battersea Power Station had a sulphur content of 0.9 per cent., and that one ton of coal liberated 375,000 cubic feet of flue gas the amount of sulphur in the flue gases, estimated as sulphur dioxide, would be approximately 600 parts per million parts of flue gas, which is equivalent to 0.753 grains per cubic foot. According to the report of the Government Chemist's Committee the amount of sulphur in the flue gas after treatment is about 0.03 grains of sulphur as sulphur dioxide per cubic foot of flue gas, equivalent to 24 parts of sulphur dioxide per million parts of flue gas. It thus appears that the scrubbers at the Battersea Station are removing about 96 per cent, of the sulphur impurities. The average amount of sulphurous impurities in the atmosphere over the City of Westminster, estimated as sulphur dioxide for the years 1932, 1933 and 1934, are given below in parts per million and grains per cubic foot. 1932 0.137 parts per million. 0.00172 grains per cubic foot. 1933 0.130 parts per million. 0.000163 grains per cubic foot. 1934.0.136 parts per million. 0.000170 grains per cubic foot. These figures are the mean of the results obtained during the years mentioned by the instrument installed at the City Hall. Meteorological factors, which have predominating influence on those figures, must be taken into account, e.g., fog, temperature, humidity, rainfall, and direction of the wind. And although up to the present the Battersea Station is not shown to have caused any increase in the sulphur gas content as measured at the City Hall, yet on the evidence of the most recent report more than 2½ tons of sulphur in gaseous form is being added daily to the air over Central London. The station is but one-third completed and the Fulham Station has not yet come into the picture. It may be fairly prophesied, unless sulphur elimination becomes one hundred per cent, efficient that a much greater amount than 2½ tons of sulphur in gaseous form will be distributed daily through the air of these central districts, when the two stations referred to are in full working order. 84 Atmospheric Pollution. Investigations on the state of the atmosphere over the City were carried out during the year and the results obtained are given below. (1) The soluble and insoluble impurities deposited from the air, or washed out of the air by rain are collected in "deposit gauges." These gauges consist of large glass vessels to which are attached collecting funnels of known area. The deposited impurities together with the varying quantity of rain water collected in the vessels are examined by Mr. McLachlan, one of the public analysts, at the end of each month. The following table shows the results of the monthly analyses of the amount of impurities collected in the deposit gauges at Mount Street Gardens, Mayfair, and at the Coroner's Court, Horseferry Road, together with the result of analyses of deposits from a similar gauge in Finsbury Park for comparison. Table LXXVIII. 1934. Figures in English Tons per Square Mile. Horseferry Road. Mount Street. Finsbury Park. Total Solids. Sulphur S03. Daily Average. Total Solids. Sulphur. S03 Daily Average. Total Solids. January 120.99 18.42 3.90 19-29 2.22 0.62 81.36 February 2800 2.35 1.60 39-47 1.51 1.41 33.16 March 42.72 3.40 1.38 30-28 2.64 0.97 67.33 April 30.13 2.14 1.01 26-80 2.60 0.89 45.04 May 20.36 1.14 0.65 19-37 1.22 0.62 13.75 June 24.09 0.26 0.80 23.84 1.35 0.89 27.97 July 21.59 1.60 0.69 11.18 1.59 0.38 20.11 August 24.02 1.62 0.77 16.24 2.35 0.52 21.76 September 19.97 1.67 0.67 17.05 1.75 0.57 20.86 October 20.62 2.22 0.67 17.11 1.58 0.55 24.46 November 30.94 3.16 1.03 28.80 2.62 0.96 47.71 December 28.56 4.33 0.92 27.94 3.10 0.90 66.91 (2) The quantitative estimation of suspended impurities in the air is carried out by means of a colour standard. A measured volume of air is drawn through a disc of filter paper, rotated at regular intervals during every 24 hours and the colour of the resultant deposit from the air is compared with those on a chart of standard tints which represent the weight of dirt per million cubic yards of air. Chart "A" shows the amounts of suspended impurities for an average day of 1934, together with a similar curve for a day in 1933. It will be seen that there is a peak about 10 a.m. corresponding to the initial lighting To face page 84 DEGREES OF POLLUTION. (1 degree = 0.54 lbs of dirt per million cubic yards of air.) CHART "A." ATMOSPHERIC POLLUTION, AUTOMATIC AIR FILTER Readings taken at the City Hall. 1933 shown thus - - - - - - - - 1934 shown thus Average degrees of suspended matters (mostly dirt) estimated for the years 1933 and 1934, showing the variations at each hour in the 24 hours. The means are calculated on this graph to show in convenient form the sum of pollution throughout the whole year interpreted in terms of a single period of 24 hours. CHART "B." SULPHUR GAS IN THE ATMOSPHERE. Variations throughout the year of SO2 measured by weight, with corresponding readings of rainfall, wind and visibility. Weight of SO2 Visibility - - - - - - - Rainfall— TR. = under 0.1 mm. (average is 1.2 mm.). To face page 84. 85 of fires and a secondary peak in the early evening, which corresponds with the making up of fires in restaurants, hotels, and also private houses. (3) Estimation of sulphur gas (as sulphur dioxide). The method employed is that of bubbling a measured volume of air through a solution which has an affinity for sulphur. The sulphurous impurities are there washed out of the air and can be measured by chemical analysis. Chart "B" indicates graphically the amount of sulphur gas correlated with visibility, wind direction and rainfall during 1934. The code used for the "visibility" curve is that issued by the Meteorological Office and is as follows:— 0. Dense fog Objects not visible at 55 yards. 1. Thick fog ,, ,, 220 „ 2. Fog „ „ 550 „ 3. Moderate fog ,, „ 1,100 „ 4. Mist or haze „ „ 1 1/4 miles. 5. Poor visibility „ ,, 2½ „ 6. Moderate visibility „ „ 6 1/4 „ 7. Good visibility „ ,, 12½ ,, 8. Very good visibility ,, „ 31 ,, 9. Excellent visibility Beyond 31 miles. It is interesting to note that the amount of pollution follows the general "line" of the visibility. The periods of observations are those of 24 hours in each week, and are generally made between 10 a.m. Thursday and 10 a.m. Friday. HOUSING. The special housing survey initiated in the late autumn of 1933 and referred to in the report for that year, proceeded more intensively during 1934, and will be completed by the end of June or July 1935. The objects were to report within a reasonably limited period any areas which might be included for clearance; to discover the nature and extent of basement dwelling; to assess the prevalence of overcrowding and to note and to provide remedy for sanitary defects found in dwelling houses during the course of the house to house inspection of the survey. To enable the survey to be adequately undertaken and completed within the period indicated the Council appointed in all 5 temporary sanitary inspectors and 7 temporary clerks. The full complement of staff engaged on the survey was at work from July, 1934. (9169) G 86 A very great deal of exact information as to housing conditions throughout the City has been obtained and will be summarized in the Report for 1935. Up to the end of the year, 3,841 houses had been surveyed, the Victoria ward being completed by that date. It will be appreciated that as a detailed survey of this nature progressed a very great deal of work, apart from recording conditions found, was created and might be mentioned under the following heads:— (1) Issue of notices for urgent repairs and defects. (2) Following up of such notices to see whether the work was being undertaken. (3) Interviewing owners, their surveyors and builders relating to the requirements of notices. (4) Informal undertakings as to use of basement rooms structurally illegal for separate occupation or for sleeping purposes. (5) The issue of forms of such undertakings and making a special record of undertakings received. Correspondence and discussions with owners as to the responsibilities involved in such undertakings. (6) Preparation of official representations under Sections 1, 19 and 20 of the Housing Act of 1930. Housing has come to occupy such a predominant place in the work of the Public Health department and has grown to such an extent, that it has formed for itself a specialized section within the department. The overcrowding Bill, which is expected to become law in 1935, brings in a fresh aspect of housing policy and will impose new duties on the City Council. It is likely, therefore, that it will be necessary to retain in some form or other the special staff organisation which was put in being for the purpose of the survey. For many years, owing to the prevailing housing shortage which became acutely felt at the end of the war, unsatisfactory conditions such as overcrowding and illegal underground occupation have continued. Legal remedies existed, but were only resorted to in the most aggravated cases. But it must be clearly emphasised that in spite of the known prevalence of unsatisfactory and illegal occupation in the post-war era conditions were very much worse in the decades before the war. For instance, take oneaspect of the census figures of density of population. In Westminster the 87 population living at a density of more than 2 persons per room has fallen as follows:— 1911 16,596 1921 11,364 1931 7,223 In pre-war days the public generally took but little interest in housing; it had not then become a popular "cause." Housing conditions in the City have been undergoing uninterrupted improvement since 1919. Sometimes the rate of progress has slowed down but it has never ceased. Now that so much new housing has been provided, both in and outside the City, the rate of improvement will markedly increase. During the course of the survey owners have become conscious of the unsatisfactory conditions under which a number of their tenants were living. Previously, apart from fulfilling the requirement of repair or nuisance notices they had not realised that there were conditions capable of improvement. The advantages of discussing with the owners, say, occupation of basements at the premises, have created in many cases an entirely new conception and the great majority of owners are willing to co-operate with the local authority in whatever measures seem most expedient for remedying conditions. Can the separate occupation of a basement in all cases be regarded as a satisfactory dwelling for a family? In the best cases (i.e. those which satisfy all legal standards of occupation and are otherwise in a sanitary condition) there can never be the amount of sunlight and fresh air which is available for the ground and upper floors. In others, restricted ventilation and light, together with dampness, may be so serious as to call for closure for human habitation. Can such rooms be reconditioned after closure and used in conjunction with rooms on upper floors? The owner has the legal right to carry out such works as may enable the local authority to revoke its closing orders if it considers that the rooms have been made fit for habitation. In the great majority, the best that can be attained is to recondition so that they may be occupied together with rooms on the floor or floors above. The proper use would then be kitchens or washhouses with baths and additional w.c.'s. The owner's difficulty is to find tenants willing to take such additional accommodation, for which a higher rent must obviously be paid. It must always be remembered that these separate basement lettings are the cheapest in the district and are in much demand by the poorest inhabitants. As regards the detailed working of the survey it may be mentioned that all rooms in working-class houses, apart from block dwellings, in the (9169) G 2 88 City are being measured and recorded, and it is anticipated that for the purposes of the overcrowding Bill the Council will be in possession of sufficient data to be able to assess in a reasonable time the amount of overcrowding in the City judged on the standards laid down in the Bill. The number of houses inspected, together with other information concerning the work of the survey, is included in the general figures showing the year's work of the department, but the analysis of the mass of information obtained cannot properly be completed until the survey is brought to a close. Clearance, Demolition, and Closure of Unfit Habitations. Clearance, Demolition or Closing Orders have been made in respect of the following areas:— Ebury Bridge Road.—A Compulsory Purchase Order was made by the City Council in respect of six houses and business premises on the South side of Ebury Bridge Road for the purpose of the Ebury Bridge Housing Estate Extension Scheme. The Order was confirmed by the Minister of Health and the occupants rehoused by the Council. Tyler's Court.—A Compulsory Purchase Order was made by the Council in respect of four dwellings in this Court which were declared to be a Clearance Area under Section 1 of the Housing Act, 1930. The Order was confirmed by the Minister of Health following an Inquiry, the occupants rehoused by the Council, and the premises demolished. Douglas Place.—The Minister of Health, after Inquiry, confirmed a Clearance Order made by the Council affecting sixteen old, worn-out cottages occupied by 19 families, these latter also being rehoused by the Council. Wilton Road.—Following a report by the Medical Officer of Health, the City Council proposed dealing with this area as a clearance area. There are 73 dwellings concerned, consisting of old cottage property in an advanced state of decay ; 61 families are accommodated on the site. Commercial Place.—Five old cottages were included in this area which had been scheduled as a probable clearance area. The houses were demolished and the tenants rehoused by the owners during October. No formal action was taken by the City Council. Monck Street.—A Demolition Order was made in respect of No. 14 Monck Street, a dwelling house which was unfit for human habitation. The house was demolished and the tenants rehoused in the City Council's dwellings 89 Richards Cottages.— One house, No. 1, Richard's Cottages, was demolished following a demolition order made in the latter part of 1933, and the tenants rehoused by the London County Council. Trinity Mews.—In this area there were 17 dwellings over stables, garages, etc., containing 17 families. A somewhat different procedure was adopted in this instance. Statutory undertakings were accepted from the owners in lieu of closing orders to the effect that after the tenants have been rehoused the premises will not again be used for the purpose of human habitation. This method achieves the purpose of preventing the further use of the premises as dwellings without interfering with the businesses in the stables or garages below. The owners will also have the opportunity of utilizing the upper parts of the buildings for business purposes when the tenants have been rehoused. Other Areas.—Three closing orders were made prohibiting the use of parts of buildings (basements) for human habitation, and, in four other instances, statutory undertakings were accepted from owners in lieu of closing orders in regard to the use of certain basement rooms unfit for sleeping purposes. It was found necessary to take legal proceedings in one case in respect of the non-compliance of a closing order. Re-Conditioning of Dwellings. During the year a Public Utility Society purchased two 9-roomed houses in the St. John Ward and adapted them to provide accommodation for 9 families. The houses were redecorated: water supply, sinks and cooking accommodation being provided for each tenant, and a bathroom constructed in the back basement room. The City Council considered the scheme as one worthy of support and rendered financial assistance to the Society. Rehousing Policy. In December, 1933, a petition was presented to the City Council on the subject of housing in the City. The petitioners acknowledged that as a result of the Council's activities, the housing conditions of many people had been transformed, but alleged that bad housing conditions still obtained in certain parts of the City. The City Council subsequently issued a statement of policy, some of the main points of which are mentioned below. 90 The housing needs of Westminster, must be considered not as those of a self-contained town providing accommodation for the greater part of the people working in it, but in relation to the general economic development of the City, which is becoming more and more devoted to commercial and business purposes with values rising to a great height. Less and less land will be available for housing and the soundest policy is to secure that only those persons shall live within the City as must do so by the nature of their occupations, and to see that the accommodation for them is adequate and is kept in good order for the working classes. The present housing accommodation consists of, (i) large blocks of flats providing good homes for over 25,000 persons, (ii) cottages mostly old, but which either give rise to no serious problem, or, where no longer satisfactory as dwellings, are being cleared and the tenants rehoused under the Council's five-year programme, and (iii) large houses occupied by several families. These sublet houses require complete adaptation to become fit dwellings, but, pending action by the London County Council, who alone have power under the 1930 Act to declare Improvement Areas, consisting of more than 10 houses, much improvement has been and is still being accomplished by the City Council by enforcing the by-laws and statutes relating to them. Houses of all types and occupied by all classes of the community contain basements, but it is usually only where they are occupied as separate dwellings and are used for sleeping purposes that legitimate complaint can be made. In pursuance of the policy of the Council to close basements for sleeping purposes, many families have been removed and the five-year programme contemplates further substantial progress in this direction. Whilst overcrowding exists, the Council is carrying on a constant war of attrition against it, resulting in the extent of overcrowding being steadily and substantially reduced. The City Council has erected, or directly assisted in the erection, of 1,625 flats or houses (1,262 since the war). Other bodies have built 5,311 flats in Westminster (319 since the war), whilst the London County Council have afforded accommodation for some 1,250 families. The Council has adopted a five-year programme for the replacement of unsatisfactory dwellings by up-to-date flats. It includes, (i) the clearance of four areas comprising 68 houses and the rehousing of 91 families; and (ii) other schemes providing for 280 new flats were in contemplation. The City Council's policy of reserving the housing accommodation in the City for those who must live in the City, and of securing that it is Old Homes. Douglas Place. Clearance Area Old Homes. Douglas Place. Clearance Area. New Homes. Ebury Bridge Extension Housing Scheme. Old Homes. Trinity Mews, in respect of which Closing Orders have been made by the City Council, showing ill-arranged and restricted dwelling. New Homes. City of Westminster Grosvenor Housing Scheme. (Kitchenette.) 91 ample and in good order, is the only sound economic policy for Westminster. The Council has already undertaken many large housing schemes, and its five years' programme is a further genuine effort to meet the needs of the working classes of the City. Provision of New Houses for the Working Classes. Ebury Bridge Housing Estate Extension Scheme.— In order that the City Council should have accommodation ready for the tenants who will be displaced by the various schemes of clearance it was decided to provide new flats on a site adjoining Ebury Bridge Housing Estate. The scheme provides for the erection of 280 flats, of 840 rooms (exclusive of kitchenettes). When completed this estate will provide accommodation for approximately 1,380 persons. Grosvenor Housing Scheme.— Work was commenced in September, on the last portion of the Council's Grosvenor Housing Scheme. The final block (Bennett House), of some 96 flats will complete the 616 working class flats in the scheme. Tachbrook Estate, Pulford Street.—This estate, owned by the Westminster Housing Trust, Ltd., of which details have been given in earlier reports, was nearing completion at the end of the year. Two blocks containing 15 flats each were completed in 1933, and four blocks containing a total of 110 flats were erected during 1934. The remaining 40 flats were well in hand at the end of the year. Of the 140 families so far rehoused, 67 were tenants of the Trust's houses in Pulford Street, which stood on a part of the site acquired for the new dwellings. Twenty-two of the remaining 73 families were nominees of the City Council under the agreement between the Trust and the Council, by which the latter are entitled to nominate a proportion (27) of the first tenants of the 180 flats. Peabody Estate, Orchard Street.—In March, the City Council agreed to lease to the Peabody Donation Fund, for a term of 999 years at a pepper corn rent, a strip of surplus land at the corner of Great Peter Street and Perkins Rents which had been acquired in 1920 for street widening purposes and which was not suitable for development by itself. The Fund proposed to purchase the adjoining site occupied by the Church Army Common Lodging house, No. 40, Great Peter Street, and to erect on the two sites a block of 15 self-contained flats as an extension of their 92 Orchard Street Estate. It was a condition of the grant of the lease that the Council should have the right to nominate the first tenants of the flats. The building, comprising five two-room, five three-room, and five four-room flats, was well advanced by the end of the year, and was expected to be ready for occupation early in 1935. London County Council Estates. The City Council has entered into an agreement with the London County Council whereby the County Council will rehouse tenants displaced as a result of action taken by the City Council under Section 20 of the Housing Act, 1930, on payment of the sum of £1 17s. 6d. per annum for 40 years in respect of each house or flat provided for the purpose, the City Council to have the right to nominate succeeding tenants on such accommodation becoming vacant. Four cases were dealt with under this scheme during 1934. Underground Rooms—Rehousing.—The number of families rehoused from basements during the year was as follows:— By the City Council 14 By the London County Council 4 By other housing authorities or found accommodation themselves 40 Rehousing Operations.—During the year 79 families were rehoused by the City Council and 82 by the London County Council, making a total of 161 families. The estates on which they were accommodated were as follows:— City Council's Estates. Families. Ebury Bridge 6 Grosvenor Housing Scheme 8 Eegency Street 60 Schomberg House — Admiral House 1 Walden House — Marshall Street — St. James' Dwellings 4 Total 79 93 London County Council Estates. Families. St. Helier, Morden 29 Becontree, Essex 5 Wormholt, Hammersmith 9 Downham, Lewisham 2 Bellingham, Catford 2 Watling, Edgware 2 Millbank, L.C.C. 20 Streatham Hill 1 Bourne Estate, Clerkenwell 2 Clapham Park 2 Comber Road, Camberwell 1 White Hart Lane, Tottenham 1 China Walk, Lambeth 2 Drury Lane 3 Loughborough, S.E. 1 Total 82 In addition to the above, 110 families were rehoused on the Tachbrook Estate by the Westminster Housing Trust, Ltd. Overcrowding.— During the year 51 new cases of overcrowding were discovered. By means of the housing schemes of the City Council and of the London County Council and other bodies some 94 cases of overcrowding were relieved. Maintenance of Dwelling Houses in a fit Condition.— A circular was received from the Ministry of Health, explaining the importance of prompt and continuous action by the local authorities to maintain houses in a proper state of repair. The Minister pointed out that any relaxation of effort by the local authority would result in large numbers of persons living in unsatisfactory housing conditions, and would possibly result in the creation of conditions which would only be remedied by more stringent measures. The City Council has always been alive to the necessity for the maintenance in good repair of dwellings within its area and has usually found owners ready and willing to co-operate in maintaining where possible properties in a condition conforming to its requirements. 94 Underground Rooms.— During the year, 1,456 written undertakings (informal in character) were given by owners or by tenants that certain rooms in basements would not be occupied in a manner contrary to the provisions of the Housing Acts or Regulations made thereunder. The Town and Country Planning Act, 1932—Interim, Development Order.—In May, the London County Council intimated that it proposed to consider a resolution to prepare a town planning scheme for that part of the County of London not then subject to such a resolution and asked for the observations of the City Council upon the proposal. The City Council considered that very special care should be taken in preparing the details of any scheme affecting Westminster, and that each street, and, in the most central parts, each set of premises, should be separately considered, so that the provisions of the scheme should be appropriate and that any uncertainty as to the form of development should be reduced to a minimum. In view of the importance of the matter the City Council retained three well-known town planning consultants to prepare a joint report upon the whole City. Table LXXIX. 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) 9,264 (b) Number of inspections made for the purpose 21,091 (2)—(a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,909 (b) Number of inspections made for the purpose 11,427 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 42 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,315* * Notices served in respect of these houses are included in the number shown in 3. B. (1) on page 95. 95 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 258 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:— (a) 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 1,603 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,602* (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 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (3) Number of dwelling-houses voluntarily demolished 29 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 23 * One dwelling-house was the subject of legal proceedings for non-compliance with the requirements of a Statutory Notice. 96 (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 (3) Number of separate tenements or underground rooms in respect of which undertakings were accepted 1,456 INSPECTION AND SUPERVISION OF FOOD. The City of Westminster is unique in its position in that, probably, more meals are served within its boundaries on any one day of the year than are served in any other district twice or three times its area. In addition, what is probably the most widely known fruit and vegetable market is located within its boundaries. Covent Garden is known practically the whole world over, not only for its Opera House but also as the home of one of the most important fruit and vegetable markets of the world. Some 1,810 samples of food were purchased by the City Council during the year for the purpose of analysis, and 2,926 visits were paid by the Inspectors to premises where food is sold, stored, or otherwise handled, for the purpose of observations as to condition, cleanliness, state of premises and methods of working. Foods sold at "markets" held by various charity organisations have also been the subject of inspection. Certification of food for export.—Two certificates were issued in respect of the export of food products—one to Canada and one to Italy. London County Council (General Powers) Act, 1932. Ice-cream and preserved meat, etc., premises. Under this Act it is necessary for premises used for the manufacture, storage or sale of ice cream, and premises used for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods to be registered with the local authority. At the 31st December, 1934, there were 75 premises on the register for the sale or storage of ice cream, of which 25 were also registered for the manufacture of this commodity. Nine premises were added to the register during the year. One hundred and fourteen premises were on 97 the register for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods, five of which were registered during the year. Eighty-seven inspections were made of ice-cream premises and 137 of preserved meat, etc., premises. Agricultural Produce (Grading and Marking) Act, 1928. This Act inaugurated the National Mark Scheme. Regulations are from time to time made by the Minister of Agriculture and Fisheries prescribing grades for "Home" produce. If the quality of the produce is consistent with these grades the National Mark may be affixed to the package. Regulations have been made covering a wide range of articles including vegetables, fruits, salads, meat, eggs, cider, malt and honey. The administration of these Regulations by the City Council consists in seeing that food vendors observe the requirements of labelling and that the National Mark is not applied to foods that are not of the prescribed standard. Merchandise Marks Act, 1926. The main provision of this Act is that goods, in respect of which orders have been made by the Privy Council, imported into this country, must on exposure for sale bear an indication of the country of origin. The food inspectors carry out the purposes of these Acts in the course of their routine food inspections, and during the year made 446 observations. Artificial Cream Act, 1929. There are no premises in the City requiring registration under the provisions of this Act. A considerable amount of artificial cream is made in restaurants for consumption on the premises, but registration is not necessary in these cases. Milk and Dairies (Consolidation) Act, 1915. Tubercle in milk—14 samples of milk were taken during the year for examination as to the presence of tubercle bacilli. The milk was taken from roundsmen and shops in the ordinary course of delivery from purveyor to customer. No tubercle bacilli were found in any of the samples. 98 Milk and Dairies Amendment Act, 1922. Under the Milk (Special Designations) Order, 1923, made under this Act the Council issued licences for sale of:— Certified milk 16 Grade A (Tuberculin tested) milk 20 Grade A milk 6 Pasteurized milk 31 Grade A pasteurized milk 2 Samples of Certified milk were examined bacteriologically at the request of the Ministry of Health. One producer was not able to supply a distributor in this area with certified milk, as, owing to a heath fire, which destroyed a large area of his pasturage, he had to curtail his production. One distributor ceased to sell certified milk. Twelve samples of certified milk were taken for bacteriological examination. Of these, three were unsatisfactory on account of high bacterial counts, which were 98,000, 167,500 and 900,000 bacteria per c.c., and in addition, in the last sample B. Coli was present. Suitable action was taken with the producers by the Ministry of Health, as the City Council has no power to deal with these infringements. Pasteurization is not undertaken at any premises in the City. Undulant Fever.—The notification of a case of this febrile illness suggested the investigation of samples of certified milk for the presence of this infection. The infection which is far from being uncommon among cattle is responsible for the condition known to veterinary surgeons as "contagious abortion." The causal organism is named brucella abortus after Sir David Bruce the military bacteriologist who carried out such successful researches in the kindred disease, Malta Fever. The organism cannot survive in milk if pasteurization is applied. Attention was therefore directed to Certified milk which by regulation must not be submitted to any treatment by heat and is bottled at the farm. Of the four samples of milk examined, two gave positive evidence of infection by brucella abortus. Milk infected by this organism if consumed by human beings may give rise to Undulant Fever. This disease although never of a fatal character may give rise to prolonged feverish illness with periods of remission. It may cause considerable invalidism. It is quite possible that a number of cases of ill-defined 99 intermittent feverish illness with malaise may be due to this cause, and the infection among human beings may be more prevalent than is supposed and certainly merits further investigation. Milk & Dairies Order, 1926. Registration of Dairymen and Dairy Premises.—Premises where milk is not sold otherwise than in sealed receptacles as received, need not be registered with the local authority, although the purveyor must be registered. The following table shows the number of premises and persons registered with the Council during the year. Table LXXX. Premises. Persons. Registered to 31st December, 1933 176 209 Registered during year 1934 5 39 Removed from register (ceased or transferred business) 5 15 Registered to 31st December, 1934 176 233 The inspectors paid 404 visits to milk shops and dairies during the year. One notice was served in respect of minor defects which were duly rectified. Food and Drugs (Adulteration) Act, 1928. Analysis of Milk Samples.—The percentage of adulterated samples sinco 1924 is given in Table LXXXI 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, 100 The results of the samples taken in each of the two districts of the City during 1934 are given in the following table:— Table LXXXI. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Percent. No. Per cent. North 434 110 253 239 66.6 32 7.4 3 0.7 South 453 116 25.6 291 64.3 37 8.2 9 1.9 1931 887 226 26.5 580 65.0 69 7.7 12 1.3 1933 907 221 24.4 596 65.6 79 8.8 11 1.2 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 1925 910 502 55.1 293 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 l.9 Of the total of 887 samples of milk taken during the year, 76 were taken on Sundays. Of these three proved to be adulterated. Action taken in regard to these samples is included in the following table:— Table LXXXII. Adulterated Samples of Milk:— Action taken. 7 N. 23 per cent. fat abstracted. Summons dismissed under the Probation of Offenders Act, on payment of £3 3,9. (id. costs. 8 N. 2 per cent. fat abstracted. Vendor cautioned. 50 S. 2.5 per cent. added water. Vendor cautioned 214 S. 12.5 per cent. fat abstracted. This was an informal sample obtained from a school. Subsequent samples proved to be genuine, and the deficiency was no doubt due to lack of mixing. 231 S. 1.5 per cent. added water. Vendor cautioned. 232 S. 1.5 per cent. added water. Vendor cautioned. 101 229 S. 10 per cent. added water. Summons dismissed under Probation of Offenders Act on payment of £2 2s. 0d. costs. 245 S. 1.5 per cent. added water. Vendor cautioned. 495 S. 3.5 per cent. added water. Vendor cautioned. 496 S. 3.0 per cent. added water. Vendor cautioned. 587 S. 2.0 per cent. added water. Vendor cautioned. 806 S. 10 per cent. deficiency in fat. Vendor fined £2 2s. 0d. and ordered to pay £2 2,9. 0d. costs. The Milk Act, 1934. Milk Marketing Board's Scheme for the Supply of Milk to Schools. At the request of the London County Council, samples of milk were taken for chemical analysis from schools and one hospital in the City. The 1st October, however, saw the coming into operation of the Milk Marketing Board's Scheme for the supply of milk to schools. Under this scheme, milk is supplied to schools in one-third pint bottles at a cost of ½d., and it is a condition of the scheme that the Medical Officer of Health for the district has to be satisfied as to the quality of the milk supplied. Prior to the coming into force of the scheme the London County Council, as the Education Authority of London, in consultation with the Metropolitan Medical Officers of Health, decided that pasteurised milk only should be supplied to the County Council Schools under the scheme and it was decided that samples of such milk should be bacteriologically examined as well as chemically analysed. The London County Council were accordingly furnished with particulars of the dealers licensed by the City Council under the Milk (Special Designations) Order, 1923, for the sale of pasteurised milk in the City, and on receipt from the London County Council of the names of the dealers appointed to supply milk to the Westminster schools, steps were at once taken to test the quality of such milk by taking samples in course of delivery to the schools. The result of the subsequent analysis or bacteriological examination is communicated to the head teacher of the school concerned. (9169) h 102 Four samples for bacteriological examination were obtained, all of which showed bacterial counts well below the maximum allowed, and 81 were taken during the year from both schools and hospitals for chemical analysis, which the public analysts graded as follows:— Good. Fair. Poor. Adulterated. 17 51 12 1 (subsequent sample genuine). The nature and extent of adulteration and action taken are given in the preceding table relating to adulterated milk samples in general. Public Health (Condensed Milk) Regulations, 1923 and 1927. Fifty-one samples were taken and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 and 1927. Five samples were taken and found to be genuine and properly labelled. Public Health (Preservatives, &c., in Food) Regulations, 1925-27. Only certain articles of food may contain preservative which must be either sulphur dioxide or benzoic acid as specified in the regulations. Seventeen infringements of these regulations were found as a result of analysis of samples, details of which are set out in the following pages. 103 Table LXXXIII. Samples purchased under the Food and Drugs (Adulteration) Act, 1928, showing results of Analysis and subsequent Proceedings for year 1934. Number Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s. d. 1 Brandy 5 5 — — — — — 2 Butter 149 147 2 — — — — — 3 Caviare 3 2 1 1 — 1 — 5 5 0 4 Cereals 27 27 — — — — — — 5 Cheese 23 23 — — — — — — 6 Coffee 6 6 — — — — — — 7 Confectionery 14 11 3 — — — — — 8 Cream 77 76 1 1 1 — 2 0 0 2 2 0 9 Culinary Flavours 1 1 — — — — — — 10 Desiccated Coco-nut 1 1 — — — — — — 11 Drugs 50 47 3 1 — — — - 12 Fish Preparations 37 34 3 — — — — — 13 Flour 2 2 — — — — — — 14 Fruit Cordials 22 22 — — — — — — 15 Fruits (Preserved) 48 48 - — — — — 16 Gin 8 8 - — — — — — 17 Ice Cream 24 24 — — — — — 18 Jams and Preserves 35 35 — — — — — — 19 Lard 15 15 — — — — 20 Macaroni 2 2 — — — — 21 Margarine 33 33 — — — — — — 22 Milk 886 874 12 3 1 2 2 0 0 7 7 0 23 ,, (Condensed) 51 51 — — — — — 24 ,, (Dried) 4 4 — — — — — — 25 ,, (Skimmed) 1 1 — — — — — — 26 Oils 27 27 — — — — — — 27 Pickles and Sauces 13 13 — — — — — — 28 Potted Meats 27 26 1 — —- — — — 29 Rum 1 1 — — — — — — 30 Rum and Coffee 1 1 — — — — — — 31 Sausages 38 38 — — — — — — 32 Spices 30 30 — — — — — — 33 Tea 19 19 — — — — — — 34 Vegetables (Pres.) 39 27 12 — — — — — 35 Vinegar 20 20 — — — — — — 36 Whisky 52 51 1 — — — — — 37 Wine 19 19 — — — — — — 1,810 1,771 39 6 o 3 4 0 0 14 14 0 Butter.—149 samples were taken, two of which were adulterated, to the extent of 2 per cent. and 3 per cent. of excess water respectively. The vendor was cautioned in each case. Caviare.—Three samples were taken one of which was found to contain 1,200 parts of boric acid per million parts of caviare. Proceedings were 104 instituted, but the summons was dismissed under the Probation of Offenders Act, on payment of £5 5s. 0d. costs. Cream.—77 samples of cream were submitted to the public analysts. One sample contained 850 parts of boric acid per million parts of cream. The vendors were prosecuted and fined £2 0s. 0d. and ordered to pay £2 2s. 0d. costs. Four samples were subsequently taken in course of delivery from wholesaler to the vendors and proved to be genuine. Drugs.—50 samples of various drugs were analysed, including such articles as aspirin, zinc, boric, sulphur and iodine ointments, Easton's Syrup, Parrish's Food, ammoniated tincture of quinine, compound syrup of hypophosphites, tincture of iodine, etc. Two samples of tincture of iodine were found to be 7 per cent. deficient in iodine, and 40 per cent. deficient in potassium iodide. The attention of the vendor was drawn to the results of the analyses. The public analyst reported that a sample of iodine ointment submitted to him as an informal sample was 90.75 per cent. deficient in iodine. A subsequent formal sample from the same vendor was found to be 91.25 per cent. deficient in iodine. Proceedings were instituted, but adjourned pending decision on a similar issue in another court. Fish Pastes, Etc.—37 samples were taken during the year. Two samples of imported fish pastes, marketed in collapsible metal tubes, were found to contain two parts of lead per million parts of paste; and eight parts of lead per million and 1,700 parts of iron per million, respectively. The vendor's attention was drawn to the results of the analysis and the remainder of the consignments were withdrawn from sale. An informal sample of sardines was found to contain 20 parts of lead per million parts of fish. A subsequent sample taken formally was, however, found to be genuine. Potted Meats.—27 samples were obtained. One of these contained 40 parts of sulphur dioxide per million. The vendor's attention was drawn to the result of the analysis. Preserved Vegetables.—39 samples of various tinned and dried vegetables and salads were taken. The result of analysis and action taken in each case, are enumerated below. Sample No. 576 S. Tinned Cauliflower. Contained 55 parts of sulphur dioxide per million parts of cauliflower. This was an imported article. Vendor cautioned. 105 701 N. Tinned Green Peas. Informal sample. 703 N. Tinned Green Peas. Formal sample. Both of these samples contained 50 parts of copper per million parts of peas. These were imported goods. Vendor cautioned, remainder of stock withdrawn from sale. 702 N. Tinned Macedoine of Vegetables. Contained 2 parts of copper per million parts of vegetables, and ten parts of copper per million in the leguminous portion. This sample was obtained informally from the warehouse of an importer. The importer was notified of the result of the analysis and he gave an undertaking that they would only be sold for export or used as ships stores. 744 N. Tinned Tomato Paste. Contained 28 parts of copper per million parts of paste. 746 N. Tinned Tomato Paste. Contained 16 parts of copper per million parts of paste. 748 N. Tinned Tomato Extract. Contained 28 parts of copper per million parts of Extract. 750 N. Tinned Tomato Puree. Contained 16 parts of copper per million parts of puree. 744 S. Tinned Tomato Puree. Contained 18 parts of copper per million parts of puree. 748 S. Tinned Tomato Puree. Contained 18 parts of copper per million parts of puree. 749 S. Tinned Tomato Puree. Contained 20 parts of copper per million parts of puree. All these samples of tomato preparations were of foreign origin. In each case the vendor was cautioned and the remainder of the consignments withdrawn from sale. 904 N. Russian Salad. Contained 8 parts of copper per million parts of salad. The vendor was cautioned. Apparently imported tinned vegetables had been used in the preparation of this comestible. Confectionery.—Eleven samples of confectionery including sweets, chocolates and cakes, etc., were submitted for analysis. The analysts reported that 3 samples of cream buns and doughnuts contained fillings which resembled cream but which were made of fats other than butter fats. The vendor in each case was communicated with. Whisky.—52 samples were obtained. One sample proved on analysis to be 36.5 degrees under proof instead of the legal standard of 35 degrees under proof. The vendor was cautioned. Observations by the Public Analysts. The two public analysts for the City have submitted the following general observations on their work during the year:— During the year under review the Departmental Committee issued its report on the composition and description of food. The report states that the Committee is of opinion "that the law should be so altered as to enable definitions or standards to be prescribed, or declarations of composition to be required, for articles of food other than liquid milk." It further states that" in our opinion the case for the extension of stan(9169) h 2 105 dards to all articles of food is not made out We are satisfied, however, that in some cases standards or declarations of composition, or definitions of some kind are necessary." Thus the Committee feels that foods specially packed for infants and invalids should bear labels disclosing their contents, but it does not think that any standards are required for sweetmeats, unless it is desirable to prohibit the use of certain ingredients. The question of the amount of extraneous matter, such as arsenic, lead, tin, or other impurity with which food may become contaminated is, we feel, to be one that should be treated generally. On the other hand, the amount of starch to be allowed in shredded suet is a question which should be reviewed. It so happens that this year has brought to light to some rather glaring examples of what, in our opinion, is gross mis-description or adulteration and it is very much to be regretted that the practice of mis-description is on the increase. For instance, the selling of confectionery with socalled "cream" filling made from fats other than milk fat. For many years past this confectionery was sold under some such description as "French" or "Vienna" pastry and there could, of course, be no objection to such nomenclature. Iodine ointment was omitted from the present issue of the British Pharmacopoeia and certain manufacturers felt that this afforded them an excellent opportunity to market a variety of preparations of iodine, some of which were not only worthless, but potentially dangerous to use. Some cases arising out of this are still sub judice. Numerous cases of the selling of artificial vinegar under such misleading titles as "Pure Wood Table Vinegar " have recently been reported, but in this City we seem to have been fortunate until now in not encountering such cases. The foregoing observations have been made with the desire to indicate that the type of adulteration moves with the times. It is only by constant vigilance that local authorities can hope to keep it in check and so protect the interests of the public and the honest tradesman from unfair competition. In the report of the Departmental Committee previously referred to, there is an expression of opinion that it should be legally enacted that, for the purpose of evidence as to nature, substance and quality, advertisements should be deemed part of the package label and that, regarding pre-packed articles, the invoice and label should be equivalent to a warranty. 10? 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. The number of stallholders licensed by the Council is about 350, and about 200 of these handle foodstuffs. The number is continually changing. As a result of constant supervision only minor infringements were observed. These were promptly rectified when pointed out by the inspectors. 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. A register is kept of all meat vendors and the number registered at the end of 1934 was 142. The inspectors paid 156 visits to these premises, including stalls, 4 notices were served and the defects were remedied in each case. Other Food Premises. The total number of inspections of food premises was 2,926. These include visits to milk shops, butchers' shops, ice-cream, &c., premises, which have already been detailed. Other premises where food is prepared for sale, deposited for sale or sold, include bakers' shops, greengrocery and fruit shops, fish shops, fried fish shops, eating places, tea shops and restaurants. As a result of these inspections 173 notices requiring sanitary defects to be remedied were issued. In one case, rats were found to have infested the premises and in order effectively to get rid of them the owner found it necessary to carry out substantial reconstruction works. Restaurants.—A register of all restaurants is kept and 1,319 have already been indexed. During the year 1,217 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 112 instances, and in each case the work was satisfactorily carried out. Bakehouses.—At the end of 1934 there were 62 bakehouses in use in the City, of which 43 were underground. 185 visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out. 108 Fried Fish Shops.—There are 23 fried fish shops in the City to which the food inspectors paid 25 visits. It was necessary to send one notice for cleansing. Inspection of Food.—Food exposed for sale has received regular inspection by the food inspectors, who have carried out this work daily. The following table shows the nature and amount of food voluntarily surrendered or submitted for destruction:— Table LXXXIV. Food Destroyed, 1934. Article. Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Apples 3 12 1 8 Oranges 3 7 0 0 Apricots 6 1 4 Pineapples 1 18 2 9 Artichokes 2 3 0 0 Plums 6 3 12 Asparagus 5 6 1 0 Prawns 1 14 Avocado Pears 2 1 12 Peas 1 7 3 12 Bananas 2 18 0 0 Peaches 7 5 1 0 Brussel Sprouts 2 10 0 0 Pears 3 13 2 8 Carrots 19 0 0 Plaice 2 0 Cauliflowers 3 15 1 22 Potatoes 8 0 0 Chestnuts 3 12 2 0 Radishes 1 0 20 Dates 1 1 0 Skate 1 0 0 Escallops 1 6 0 0 Spinach 4 3 8 French Beans 3 11 3 4 Squashes 1 3 1 4 Grapes 9 12 0 0 Swede Tops 4 0 0 Grape Fruit 4 11 2 0 Tomatoes 1 2 3 0 Haddocks 1 0 Walnuts 2 0 0 Lettuce 19 1 0 Chocolates 2 Melons 22 11 1 0 Hominy 2 0 0 Mushrooms 1 8 Turkeys 1 0 14 Nectarines 1 10 2 0 Condensed Milk 17 tins. Onions 5 19 0 0 Food Poisoning. (1) Notification was received on the 10th January, 1934:, from a medical practitioner in the City, that one of his patients was suffering from acute gastro-enteritis, due to poisoning by food. The patient was stated to have eaten some kidneys three days previously. Enquiries went to show that the kidneys were purchased in another borough, at a shop only the approximate position of which could be given. The Medical Officer for the district to whom the particulars were transmitted, reported that the shop in the position indicated was one of the cleanest and best-managed in the district. (2) Information was received from a seaside town on the 3rd May, that two residents had visited London on the 24th April and subsequently been reported as cases of food poisoning. The visitors had, during their stay, partaken of food at three establishments in Westminster, and had consumed tea, toast and butter at one place, smoked salmon, roll and 109 butter, coffee, and cheese at another, and tongue sandwich and coffee at the third. Blood agglutination gave negative results. On investigation at the premises concerned it was found that no other cases of food poisoning had been reported, and that there was no illness amongst the staff. (3) Intimation was received on the 16th October, of three cases of suspected food poisoning in another district following the consumption of a veal and ham pie purchased at a restaurant in Westminster, no other food having been consumed in common by the patients. Investigations at the premises concerned showed that the pies were not made on the premises and no stocks of the particular consignment were available. None of the restaurant staff was on the sick list, and no similar complaints had been received from any other source.