City of West +minster REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935 ANDREW J. SHINNIE, M.D., D.P.H. (LOND.), Medical Officer of Health and Administrative Tuberculosis Officer Printed by Order of the Council LONDON: HARRISON AND SONS, LTD. PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C.2. III CONTENTS. PAGE Committees VI Introduction ix Statistics and Social Conditions of the Area 5 Births 7 Deaths 10 Causes of, compiled by Medical Officer of Health 14 „ „ „ „ Registrar General 10 Common Lodging-House 26 Distribution of, in Wards 19 Infantile Mortality 19 Stillbirths 12 Meteorological 6 Population 5 Social Conditions 5 Staff of the Public Health Department 1 Statistics, General and Vital 5 Unemployment 6 Prevalence of, and Control over, Infectious Diseases 26 Bacteriological Laboratory 36 Cerebro-spinal Fever 35 Chicken-pox 35 Diarrhoea and Enteritis 34 Diphtheria 32 Anti-toxin 33 Schick Test and Immunization Treatment 32 Enteric Fever 33 Influenza 34 Measles 33 Mumps 35 Notifications 26, 30 Ophthalmia Neonatorum 35,61 Poliomyelitis 35 Puerperal Fever 35 Puerperal Pyrexia 35 Scarlet Fever 32 Tuberculosis 36 Cases on Register 42 Deaths 37 Dispensary, Annual Report 43 Returns (Ministry of Health) 47 Notifications—primary 37 Tables 38 Vaccination 27 Whooping Cough 34 9069) a 2 IV PAGE General Provision of Health Services in the Area 49 Ambulance facilities 49 Ante-natal services 54 „ cases 56 „ clinics 56 „ visiting 56 Barlow's Gift Charity 64 Clinics and Treatment Centres 49 Convalescent Treatment 57 Day Nursery 50, 68 Dental Clinic, Annual Report 65 Dental Treatment 65 Health Visiting 63, 66 Home Helps 64 Hospitals 51, 57 Infant Clinics 59 Infant Life Protection 63 Institutional Provision for Mothers and Children 56 Insulin Treatment 65 Laboratory facilities 49 Lectures and Demonstrations 68 Maternal Mortality 57 Maternity and Child Welfare Services 52 Maternity Beds 56 Midwifery Services 53 Midwifery—Consultant services 54 Midwives Bill 69 Midwives, Medical Assistance to 54 Mothercraft Classes 62 Milk, supply of, to Necessitous Mothers and Infants 64 Nursing in the Home 49, 61 Sunlight Treatment 6 Unmarried Mothers, Homes for 64 Sanitary Circumstances of the Area 69 Atmospheric Pollution 106 Cleansing of Persons 86 Common Lodging Houses 83 Coroner's Court and Mortuary 89 Disinfection 86 Dogs, Fouling of Footways by 85 Drainage and Sewerage 72 Factories, Workshops and Workplaces 79 Fumigation of Furniture 87 Infirm and Diseased Persons—Removal of 86 Mosquitoes 71 New Sanitary Construction 73 Nuisances 77 Offensive Refuse—Removal of 78 Outworkers 82 Pigeons, Nuisance from 86 Premises and Occupations subject to control by Local Authority 83 Public Cleansing 73 Public Sanitary Conveniences 73 Public Swimming Pools, etc 69 Rag and Bone Dealers 84 Rag Flock Acts 84 Rat Repression 85 V page Sanitary Circumstances of the Area—(contd.) Refuse Collection and Disposal 73 Rent Restriction Acts 76 Sanitary Inspection of the Area 75 Schools 84 Shops Act 1934 78 Smoke Abatement 105 Tenement Buildings—Lighting of Staircases 78 Tenement Houses 84, 92 Water Supply 69,77 Housing Basements 95, 102 Block Dwellings 95 Cottage Dwellings 94 General Observations 90 Housing Act, 1935 91, 96 Houses Let in Tenements 84, 92 Housing Schemes, New Estates 102 Overcrowding Survey 96 Rehousing Operations 103 Statistics required by Ministry of Health 104 Underground Rooms, Unfit 102 Unfit Habitations, Clearance, Demolition and Closure 101 Inspection and Supervision of Food 109 Agricultural Produce (Grading and Marking) Act, 1928 110 Artificial Cream Act, 1929 111 Bakehouses 119 Condensed Milk Regulations, 1923-1927 114 Dairymen and Dairy premises—registration 112 Dried Milk Regulations, 1923-1927 114 Food products—certification for export 109 Food and Drugs (Adulteration) Act, 1928 112 Samples, results of analysis, action taken, etc. 115 Food, Unsound 120 Food Poisoning 120 Fried Fish Shops 120 Ice-cream premises 109 Ice-cream, Bicteriological Examination 109 L.C.C. (General Powers) Act, 1932 109 Meat Regulations, 1924 119 Merchandise Marks Act, 1926 111 Milk Act, 1934 114 Milk, Bacteriological Examination 111 Milk and Dairies Amendment Act, 1922 111 Milk and Dairies (Consolidation) Act, 1915—tubercle in milk 111 Milk and Dairies Order, 1926 112 Milk Samples—analysis of 112 Milk (Special Designations) Order, 1923 111 Preserved Meat, etc., premises 110 Public analysts—Observations by 117 Preservatives in Food Regulations, 1925-1927 114 Restaurants 119 Schools, Supply of Milk to 114 Street Trading—regulation of 119 VI Public Health and Maternity and Child Welfare Committee. Mayor: Alderman Captain J. C. Dalton, D.L., J.P., L.C.C. Deputy Mayor: Councillor The Rev. E. St. G. Schomberg, D.L.. 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. Memberx : Councillor T. C. Claxton. G. H. Heilbuth. ,, Mrs. Alderson Home. „ Lieut.-Colonel W. Merrick, T.D. „ Mrs. F. M. Odone. „ Albert J. Offer, J.P. „ The Rev. Jocelyn Perkins, M.A., D.C.L., F.S.A. ,, Dr. F. E. L. Phillips. „ A. Sargeant. „ H. H. Sparks. „ Mrs. C. J. Storrs. † ,, H. S. E. Vanderpant. The Hon. Mrs. Douglas Vickers, J.P. Maternity and Child Welfare Sub-Committee. Members of the Council: Councillor T. C. Claxton. „ Mrs. Alderson Horne „ G. F. Jerdein. Mrs. F. M. Odone (Chairman). ,, F. R. Ridley, J.P. Councillor A. Sargeant. „ H. H. Sparks. „ Mrs. C. J. Storrs. ,, H. S. E. Vanderpant. „ The Hon. Mrs. Douglas Vickers, J.P. Co-opted Members: Dalton, Mrs. J. C. Haldane, Miss E. S. (City of Westminster Health Society). Wyatt, Mrs. A. E. (Women's Co-operative Guild, Westminster Branch). † Chairman of Standing Sub-Committee. (The Public Health Standing Sub-Committee consists of all members of the Main Committee.) Vll Sub-Committee re New Maternity and Child Welfare Centre and Day Nursery. Members of the Council : Councillor Mrs. Alderson Home. „ G. F. Jerdein (Chairman). „ Mrs. F. M. Odone. Councillor F. R. Ridley, J.P, „ H. S. E. Vanderpant ,, The Hon. Mrs. Douglas Vickers, J.P. Co-opted Members representing the City of Westminster Day Nursery Committee: Mrs. J. F. C. Bennett. Lady Bradford. Lady Gluckstein. A. F. Stallwood, F.S.A.A. (Hon. Treasurer). Committee Cleric: F. J. Burbridge. IX Annual Report on the Health and Sanitary Condition of the City of Westminster. 1935. Mr. Mayor, My Lords, Ladies and Gentlemen, I have the honour to present my annual report for the year 1935. The Minister of Health in Circular No. 1492 requires the report to be an "ordinary report" and not a survey report, which is contrary to expectation seeing that five years have elapsed since the last survey report. Vital Statistics. The crude death rate exceeds the birth rate by a still greater margin than last year. The birth rate has fallen to 8.3; a figure so low has never yet been recorded in this City, while the death rate at 11.5 is about the average for recent years. The excess of deaths over births which shews a tendency to apply to the whole country must of course result in a decline in the population. As the expectation of life is steadily rising (some seven years in the last twenty years), it follows that if the fall in the birth rate continues the time will come when the majority of the inhabitants of this island are over 40 years of age. The point should not need emphasis that every practicable step should be taken to preserve the life of every child born and to ensure that it shall be brought up without physical defect and strong in body and in mind. Infectious Disease. There were relatively few cases of measles, decreases in diphtheria and scarlet fever, but considerably more cases of chicken pox, mumps and whooping cough. The only matter for comment seems to be the further decline in tuberculosis both in cases and deaths. Well-established experience teaches that tuberculosis flourishes where food is scarce or deficient in nutritive value. The fact that this disease is claiming fewer victims is a favourable commentary on the state of nutrition prevailing among the people of this City. Maternity and Child Welfare. Fewer infants died, but as fewer infants were born the Infant Mortality figure is slightly higher. This figure is artificially raised because of the number of cases where women about to have children take up temporary residence in the City. In such cases infant mortality is higher than among genuine Westminster residents. These mothers register a Westminster address, but when visited usually cannot be found. The percentage of infants' attendances at the Welfare Centres as compared with the number of births was 72. Maternal Mortality. The rate for 1935 would have been nil had it not been for an unmarried woman who died following a procured abortion. In the year previous four mothers lost their lives. Fortunately there is a tendency for a general reduction in maternal mortality throughout the country. The Maternity and Child Welfare Services are dealt with in considerable detail in this report. The Council's midwifery scheme is a completely co-ordinated service both for confinements at home and in hospital X and as such was referred to in the debates in both Houses of Parliament as exemplifying the main purposes which it is hoped to achieve for other districts in the Midwives Bill. Among other developments in this service since the end of 1935 are the separate appointments of medical officers for women and for children at the welfare clinics. The appointment of these part-time specialists should provide greater opportunities for detailed study in these two main branches of this service. Prematurity, the principal cause of death among infants, merits special inquiry. The subject of nutrition has been much under public notice. With a view to instructing the mothers of the district the Council has instituted special courses in cooking, food values and food buying under a qualified teacher. These classes are held at four of the Welfare Centres and should prove of definite educative value. To all cases receiving free or half-price milk grants, the Council has also granted free issues of cod liver oil preparations when advised by its medical officers. Fewer infants were afflicted with ophthalmia and none died from venereal disease. Plans of Sanitary Work. The number submitted has reached a new record, 1,080. The building of flats and business buildings shews no sign of diminishing. In Westminster many of the new buildings exceed 2,000,000 feet cube. The study of plans and supervision of the work when in progress is therefore making serious demands on the time of the inspectors. The Town Planning provisions of the Act of 1932 has thrown additional duties on the Council. A special Sub-Committee sits almost weekly to report its observations to the London County Council. As points relating to sanitary conveniences, ventilation and the use of underground rooms are frequent matters for comment, the Senior Sanitary Inspector, Mr. John Sanderson, attends fcr the purpose of advising on these points. Atmospheric Pollution. Four methods of investigation are in operation, namely (1) impurities deposited or washed out of the air by rain, (2) impurities in suspension, (3) amount of sulphur gas content in the air, (4) effect of sulphur gas on exposed fabrics. The last named method to measure the destructive properties of sulphur gas was installed in March of last year. While there is some evidence showing a reduction in suspended impurities during 1935 as compared with the previous two years no general statement regarding a higher degree of atmospheric purity can yet be made. A careful analysis of the results of the other lines of investigation must be made, paying regard to wind, rainfall and other factors. Food and Drugs. The section in this report has been extended as compared with that of last year. Adulteration, especially of imported tinned foods, is discussed in some detail, particularly as regards metallic contamination. As noted last year the proportion of milk samples of high cream content, i.e., 3.8 per cent, and over, is relatively low (25 per csnt. of samples) as compared with 50.4 per cent, ten years ago. The percentage of those below standard (3 per cent.) is, however, lower namely, .7 per oent. Housing. The reports of the two surveys, the detailed housing survey under the Act of 1930 and the overcrowding survey under the Act of 1935, are summarized. The former took over two years to complete; the latter because of the ground already XI covered only took two months. In most other metropolitan boroughs the work of measuring rooms in working class dwellings for the purpose of enforcing the provisions of the Act of 1935 has yet to be done. In Westminster that had been all but completed in the first detailed survey before the Overcrowding Bill became law. Any left over, such as rooms in block industrial dwellings, were measured in the early part of the present year. These surveys have revealed the remarkable improvement in housing which has taken place during the past ten years. Old and decaying houses to the number of 420 have vanished from the scene ; others are doomed to follow suit. In this decade 1,265 new flats for City workers have been completed and an equal number of families have been rehoused in vastly improved conditions. Perhaps the most gratifying feature is the improvement in basement dwellings. The policy of rehousing basement families, thus enabling alterations t j the structure to be carried out by the owners, is one of the most important ever adopted by the City Council. Thereby dampness is being eradicated, and better access to daylight and air is being provided. Permanent closing of basements is not desirable in most cases. Closed and derelict basement rooms may be a source of nuisance. They deprive the owner of part of his income and sterilize part of his property. Almost every owner of basement rooms declared by the Council to be unfit has the opportunity of improving the value of his property if prepared to undertake the expenditure. In some cases this may be considerable. The worse the basement, the more comprehensive and costly is the remedial work likely to be. No closing order is ever absolute. The law decrees that every owner may recondition his property, but the local authority must be satisfied as to fitness for human habitation before a closing order is determined. On the other hand if the owner does not feel justified in undertaking any expenditure to render fit again the closing order remains in force. Another alternative is use of the premises for other purposes than human habitation. The Council may approve such use by formal undertaking given by the owner. If a closing order has been made it remains in force as regards human habitation. Staff. During the past three years because of the surveys and other housing work the staff had to be increased by the addition of six temporary sanitary inspectors and eight temporary clerks. But the coming into force of the Shops Act, 1934, and the Pharmacy and Poisons Act have further greatly added to the duties of the department. Now that both surveys are completed the tasks which lie ahead are taking more definite shape. The special housing staff, mostly composed of temporary members, has undergone several changes during those three years. Individuals leave on obtaining permanent posts elsewhere. These changes are a handicap because housing work, particularly as regards basements, requires continuity. This and the enforcement of the new overcrowding provisions which become operable on 1st January, 1937, call for a more permanently constituted housing staff. Because of these and other increasing duties some further reorganization will be necessary. Both housing surveys were carried through remarkably smoothly and expeditiously and each in itself was as onerous as it was extensive. The detailed responsibility in each case fell primarily on Mr. H. E. White, whom the Council designated Housing Inspector, and on Mr. J. W. Anderson, in immediate charge of temporary housing clerks. While all the staff worked wholeheartedly, special tribute is due to those mentioned for the success achieved in these surveys. Mr. Lowe, Vaccination Officer, retired on 31st March on reaching the age of 60 years. He had prior to the transfer of vaccination duties to the City Council held XII the same post under the Westminster Guardians for many years. It is largely due to him that the transfer was effected so easily. He carried out his duties efficiently and without ever having recourse to legal proceedings to enforce vaccination. On Mr. Lowe's retirement the duties of Vaccination Officer were taken over by Mr. Sambrook, Chief Clerk, who was designated Vaccination Officer, Mr. W. F. Lake being appointed first assistant to the Vaccination Officer and Mr. F. E. Norwood, Second Division Clerk, second assistant. During the year the following were appointed to the permanent staff :— Mr. S. G. Bennett, Sanitary Inspector. Miss G. C. H. Thomson, Health Visitor. Mr. M. J. Flynn, Third Division Clerk. Miss Howell Evans, Health Visitor, attached to the Bessborough Street Centre, resigned on the grounds of ill-health in April. She had been in the service of the Council since 1921. She was a capable health visitor, very acceptable to the families she visited because of the quiet and tactful manner in which she carried out her duties. Miss Gillian Thomson, Health Visitor to the County Borough of Croydon, was appointed to succeed her. Mr. Mark Canton, an able and experienced sanitary inspector in the Council's service since 1926, died with tragic suddenness in September while on holiday. Mr. S. G. Bennett, who held temporary rank as a sanitary inspector, was appointed to the permanent post rendered vacant by Mr. Canton's death. During the year 89 reports were submitted by me to Committees of the Council. On housing matters 129 representations and 54 other reports were made. The correspondence of the department included 12,914 incoming and 15,929 outgoing communications. The year has been characterized by greatly increasing demands on the time and attention of both the Public Health and the Housing Committees. Not only have there been many additional meetings of the Committees but groups of members or individuals have paid many visits to premises in connection with housing or public health matters. The new Welfare Centre and Day Nursery scheme has specially engaged the attention of the Public Health Committee. The Chairman, Councillor F. R. Ridley, J.P., and Vice-Chairman, Councillor G. F. Jerdein (the latter as Chairman of the Joint Sub-Committee with members of the Day Nursery), have personally devoted a great deal of time and consideration to the proposals. In this they were greatly assisted by the Chairman of the Public Health Standing Sub-Committee, Councillor H. S. E. Vanderpant, whose special knowledge has been freely placed at their service, and has been greatly appreciated. The Chairman of the Maternity and Child Welfare Sub-Committee, Councillor Mrs. F. M. Odone, and Councillor the Hon. Mrs. Douglas Vickers, both past-Chairmen of the Public Health Committee, the latter being Chairman of the Day Nursery (Voluntary) Committee, have likewise been specially helpful in the practical aspects affecting the welfare of mothers and children. The staff of the department in a year of considerable pressure have frequently worked much beyond their office hours. I am grateful for their willing help and co-operation. I have the honour to be, Your obedient servant, ANDREW J. SHINNIE. July, 1936. 1 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. Shinnie 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. (Deceased 19ih January, 1936). (Maternity and Child Welfare.) *A. D. C. Bell M.A., M.B., Ch.B., M.R.C.P. (Maternity and Child Welfare.) Obstetric Consultants on the Hon. Staff of Westminster Hospital and as such acting on behalf of the City Council in accordance with the joint scheme of the Council and the Hospital for assistance to medical practitioners and to midwives: Aubrey Goodwin O.B.E., M.D., F.R.C.S. *Charles D. Read M.B., Ch.B. F.R.C.S. (to April, 1935). *C. H. Bell .B., B.S. (Lond.), F.R.C.S. *B. Blaikley .B.,B.S. (Lond.), F.R.C.S. *Gough Stewart M.R.S.S., L.R.C.P. (from April, 1935.) 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 Belgrave and Knightsbridge District Westminster (St. Margaret and St. I John) District. Westminster (St. Anne and St. James) District Strand District *Kenneth R. Hay, O.B.E., M.B., 47, Hill St., Berkeley Square, W.l. (Resigned, 31s( Oct., 1935.) *Albert E. Cope, M.D., 66, Belgrave Road, S.W.I. (Deceased, 5th June, 1936.) Vaccination Officers: James H. Lowe. (Retired 31s« March, 1935.) W. D. Sambrook. (Appointed 1st April, 1935.) Dental Clinic: *T. Stewart Tait (Dental Surgeon) L.D.S., R.C.S. Edin. *F. J. Gordon (Anaesthetist) ... M.R.C.S., L.R.C.P. 2 Public Analysts : *F. W. Edwards F.I.C. *T. McLachlan A.C.G.F.C., F.I.C. Senior Sanitary Inspector : John Sanderson R.S.I., San. Sc. Cert., Gold Medallist, Carpenters' Company. Chief Clerk : W. D. Sambrook. Sanitary Inspectors : S. G. Bennett S.I.E.B., Meat and Food Cert. M. Canton S.I.E B., Meat Cert., R.S.I. (Deceased 1st Sept., 1935.) W. J. Davies (Sampling Officer) S.I.E.B., Meat and Food Cert. C. J. Dee S.I.E.B., R.S.I., Meat and Food Cert. W. L. French S.I.E.B., R.S.I., Meat and Food Cert. F. J. Haigh S.I.E.B. , H. R. Hardy R.S.I., M.I. San. Eng. T. H. Jackson S.I.E.B. C. Ratcliff S.I.E.B., Meat and Food Cert. F. E. Siddle S.I.E.B., Meat Cert., R.S.I. W. G. J. Sutton (Sampling Officer)... S.I.E.B., Meat and Food Cert. Miss C. Hughesdon S.I.E.B., R.S.I., Health Visitor's Certificate, Certified Midwife, Dipl. Nat. Health Soc. Housing Inspector in charge of Inspection under the Housing Acts : H. E. White S.I.E.B., R.S.I., Meat and Food Cert., Dipt. Inst, of Hygiene. Temporary Sanitary Inspectors (Engaged on Housing Survey Duties) : H. J. Aldhous S.I.E.B., Meat and Food Cert. (Resigned mh May, 1935.) S. J. Cassidy S.I.E.B., Meat and Food Cert. W. G. F. Colebeck S.I.E.B., Meat and Food Cert. (Resigned 15th June, 1935.) C. W. J. Manley S.I.E.B. (Appointed 15th July, 1935.) W. L. Morris S.I.E.B., Meat and Food Cert. F. J. Nutter S.I.E.B. (Appointed l&th October, 1935.) J, Williams (Shops Act Inspector)... S.I.E.B. (Appointed 18th February, 1935. Resigned. 31st December, 1935.) 3 Health Visitors : Miss A. Sanders Health Visitor's Certificate. Miss J. G. Alexander Health Visitor's Certificate, Certified Midwife, State Registered Nurse. Miss D. H. M. Waldinq 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. (Retired lsi April, 1935.) Miss M. M. Scott Health Visitor's Certificate, Certified Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Miss H. Blick Health Visitor's Certificate, Certified Midwife, Board of Education Health Visitor's Diploma. Miss P. L. Luff Certified Midwife, Board of Education Health Visitor's Diploma, S.I.E.B. Miss E. M. CraiGie Certified Midwife, Health Visitor's Certificate, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. Miss G. C. H. Thomson Certified Midwife, Health Visitor's Certificate, State Registered Nurse. (Appointed 17th June, 1935.) *Mrs. R. Coleman (Instructor in Mothercraft at Centres) Royal Red Cross Certificate, 1st Cl., and Gold Medal. Clerical Staff : A. J. Manhood. M. J. Flynn. (Appointed 8th April, W. F. Lake (Assistant Vaccination 1935.) Officer). Miss E. M. Armstrong. F. E. Norwood. Miss M. McFarlane (Tuberculosis W. Jenkins. Dispensary). Temporary Clerks. J. W. Anderson. F. Hemming (Appointed 11 th November, H. J. Bright. 1935.) E. Jones. G. H. Browne. w p c kinq J. M. Burbridge. T. G. Telford. 4 Coroner's Court and Mortuary. Superintendent. A. R. Ford (late Chief Petty Officer, R.N.). R. Watling Mortuary Keeper. A. W. Nicholls Assistant Mortuary Keeper. *Miss S. Gardiner Nurse Attendant. State Registered Nurse. Disinfecting Stan. S. C. West, Foreman Disinfector. J. Atkins, Disinfector. P. W. Attwater, Disinfector. (Retired 23rd November, 1935.) N. Heathcote, Disinfector and Rat Officer. A. B. Holland, Disinfector. J. R. Doyle, Motor Driver. J. Shillingford, Disinfector (temporary). 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—Mrs. Mates, Miss Hamilton. The following are the staff of the City of Westminster Health Society, a voluntary organisation carrying out Maternity and Child Welfare services in a part of the City on behalf of the City Council. Medical Officers : *The Hon. Mrs. N. Olivier Richards M.D., M.R.C.P. *Miss E. E. Gourlay M.D., D.S. (Lond.). Secretary : Miss A. Fiennes, Health Visitors, &c. : Miss Callaghan (Supt., Centre) Health Visitor's Certificate, Final Cert. and Medal, Princess Christian Training College, &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 Health Visitor's certificates and with nursing experience.) Mrs. Steffens (Mothercraft Classes). 5 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, 1935 (Registrar General's Estimate)—124,400. Number of Inhabited Houses (Census 1931)—22,536. Rateable value—£10,480,000 (March, 1936). Sum represented by a penny rate £40,180 (Estimate). Extracts from Vitat. Statistics for the Year. Total. Males. Females. Live Births— Legitimate 913 491 422 Illegitimate 129 68 61 1,042 559 483 Birth-rate per 1,000 of the estimated resident population—8.3. Stillbirths—28. Rate per 1.000 total (live and still) births—26.1. Deaths—1,436. Death-rate per 1,000 of the estimated resident population—Crude rate 11-5. Adjusted rate 11.8. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.9 Other puerperal causes — — Total 1 0.9 Death-rate of infants under one year of age All infants per 1,000 live births 72 Legitimate infants per 1,000 legitimate live births 59.1 Illegitimate infants per 1,000 illegitimate live births 162.7 Deaths from measles (all ages).. — ,, whooping cough (all ages) 2 ,, diarrhœa (under 2 years of age) 10 Social Conditions. Westminster includes within its boundaries the residences of the Sovereign and members of his family. (9069) b 6 It is the seat of Government of both State and Church, the centre for the learned professions and the Arts and Sciences. It is the capital City of the Empire contained within the County of London. It follows that while there are few local industries in the accepted sense offices, large shops, hotels, restaurants, theatres, cinemas and clubs being so conspicuous a feature of this City provide in large measure employment for the occupied population. By far the greater proportion of the occupied population does not reside in Westminster but flocks in daily in hundreds of thousands from the suburbs to places of employment in the City. Unemployment. The upemployment figures show a slight increase amongst adults but reveal an encouraging reduction in juvenile unemployment as compared with the figures for 1934. 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 1935. Month. Men. Women. Boys. Girls. January 2,180 639 45 48 February 2,357 692 36 15 March 2,339 721 11 20 April 2,146 655 8 17 May 2,004 602 23 26 June 2,021 549 17 9 July 1,854 545 16 14 August 1,792 490 17 12 September 1,949 512 22 16 October 2,094 623 15 9 November 2,176 671 16 12 December 2,111 637 2 11 Meteorological. The following note is extracted from a letter appearing in "The Times" of January 3rd, 1936, by Mr. W. G. Cochran, of the Rothamsted Experimental Station, Harpenden, Herts. The average weather during 1935 was milder and sunnier than usual, but there were greater variations within short periods than in the two previous years. Eight months had mean temperatures above the average, but there were remarkably cold spells in May and December. 7 The number of hours of sunshine during the year was 2.5 per cent, more than the average. July, with 280.1 hours, was the only outstanding month as regards sunshine, but no month was exceptionally sunless, the two wettest months having almost as much as the average. The year was wetter than usual, the total rainfall being 32.12 in. (average for past 80 years—28.52 in.). April, September and November were unusually wet months, while March (0.63 in.) and July (0.96 in.) were the two driest. There was no exceptionally hot weather, but towards the end of October there were some remarkable variations in temperature (e.g.—28i degrees F. in minimum night temperature in 7 days). During December the combination at times of sun, frost and snow gave the weather an Alpine character, but fog was prevalent at Christmas time. The highest screen temperature recorded during the year at Rothamsted was 84 degrees F., and the lowest 13.4 degrees F. Gales were unusually frequent and severe during October, November and December. Births. The births registered in Westminster during 1935 numbered 1,527 but of these the homes of 937 were in other districts, 7 were either registered under the Legitimacy Act or were re-registrations, and have therefore to be deducted from the total. There were, however, 459 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,042, which is 124 less than the corresponding figure for 1934. The Birth Rate for the City was 8.3, for London 13.3 and for England and Wales 14.7. The comparative net totals of the registered births for the last three years are Table I.—-Legitimate and Illegitimate Births. 1933. 1934. 1935. Legitimate. Legitimate. Legitimate. Males 467 528 491 Females 503 487 422 Illegitimate. Illegitimate. Illegitimate. Males 58 77 68 Females 71 74 61 1,099 1,166 1,042 (9069) b 2 8 Table II.—Registered and Notified Births. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 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 1,609 969 (3) 526 1,166 1,567 1,516 51 1935 1,527 944 (7) 459 1,042 1,537 1.488 49 The numbers in brackets are registrations under the Legitimacy Act, and rannot be classified as births. This is the lowest birth rate yet recorded in the City of Westminster. The death rate has been higher than the birth rate since 1924, but this year the difference is more pronounced. This may not be of great local significance as Westminster is regarded as a central and administrative area, but the tendency has now spread to the country generally. Recent returns show a considerable excess of deaths over births, a state of affairs which cannot be viewed with complacency, especially if the gap between the two increases as the years pass by. Table III.—Distribution of Legitimate and Illegitimate Births. The legitimate and illegitimate births are distributed as follows:— Legitimate. Males 751 — 446 + 186 = 491 Females 642 - 401 + 181 = 422 1,393 — 847 + 367 = 913 Illegitimate. Males 70 — 55 + 53 = 68 Females 64— 42 + 39 = 61 134 — 97 + 92 = 129 9 The legitimate births show a decrease of 102 and the illegitimate a decrease of 22 on the figures of 1934. As shown in Table II, 1,537 notifications of births were received by the department for 1935 as compared with 1,567 in 1934. Of the total notifications, 1,146 were sent by midwives, of whom 30 were practising in the City during 1935. The following table shows the number of male and female children born since 1919, 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.—Male and Female Births. Number Born. Number of Deaths under 1 year Number remaining at end of year. Boys. Girls. Boys. Girls. Boys. Girls. 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 1935 559 483 48 27 511 456 The table indicates the universal truth that girl babies possess greater hardiness than boys. Although the year began with an excess of 76 in favour of males the advantage had fallen to 55 by the end of the year. 10 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, 1935. Causes of Death. Sex. All Ages. 0— 1— 2 5— 15— 25— 35- 45—55— 65— 75— All Causes M. 754 49 2 3 5 17 28 43 77 171 200 159 F. •697 28 3 6 5 17 26 33 65 126 159 229 I. Typhoid and paratyphoid fevers M. — — — — — — — — — — — — F. — — — — — — — — — — — — 2. Measles M. — — — — — — — — — — — — F. — — — — — — — — — — — — 3. Scarlet fever M. — — — — — — — — — — — — F. — — — — — — — — — — — — 4. Whooping-cough M. 1 1 — — — — — — — — — — F. 1 1 — — — — — — — — — — 5. Diphtheria M. 3 — 2 — — — 1 — — — F. 2 — 1 — 1 — — — — — — — 6. Influenza M 6 — — — — — — 1 3 — 1 1 F. 10 — — — — — 1 — — 4 1 4 7. Encephalitis lethargica M. — — — — — — — — — — — — F. — — — — — — — — — — — — 8. Cerebro-spinal fever M. — — — — — — — — — — — — F. 3 2 — — 1 — — — — — — — 9. Tuberculosis of respiratory system M 49 — — — — 5 11 9 8 11 — — F. 15 — — — 1 4 3 4 2 — — 1 10. Other tuberculous diseases M. 4 _ 1 1 1 1 F. 2 — — — — 1 — — — — 1 — 11. Syphilis M. 2 — — — — — — 1 — 1 — — F. — — — — — — — — — — — — 12. General paralysis of the insane, tabes dorsalis M. 6 — — — — — — 1 2 2 1 — F. 2 — — — — — — — 2 — — — 13. Cancer, malignant disease M. 107 — — — — 1 1 6 10 34 37 18 F. 109 — — — — — 1 5 22 30 31 20 14. Diabetes M. 7 — — — — — — — — 1 4 2 F. 12 — — — — 1 — — 1 1 6 3 15. Cerebral haemorrhage, etc. M. 27 — — — — — — 2 3 6 8 8 F. 42 — — — — 1 1 — 3 11 13 13 16. Heart disease M. 217 — — — — 1 1 7 17 50 72 67 F. 298 — — 1 — 3 1 7 11 26 49 100 17. Aneurysm. 6 — — — — — — — 2 — 2 2 F. 5 — — — — — — 1 1 1 1 1 11 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. 31 — — — — — — 2 1 4 13 11 F. 36 — — — — — — — — 3 15 18 19. Bronchitis M. 20 1 — — — — — 1 — 4 9 5 F. 25 — 1 — — — — — — 4 4 16 20. Pneumonia (all forms) M. 46 9 2 — — — — — 8 12 9 6 F. 41 4 — 3 — 1 2 3 3 9 3 13 21. Other respiratory diseases M. 6 — — — — 1 — — — 3 1 1 F. 6 — — — — — — — 1 2 1 22. Peptic ulcer M. 21 — — — — — — — 4 9 4 4 F. 6 — — — — — 1 — 2 1 1 1 23. Diarrhoea, etc M. 6 6 — — — — — — — — — — F. 6 5 — — — — 1 — — — — — 24. Appendicitis M. 8 — — 1 1 1 — 2 1 2 F. 6 — — — 1 1 — 1 — 2 1 — 25. Cirrhosis of liver M. 5 — — — — — — — — 2 2 1 F. 5 — — — — — — 1 1 2 1 — 26. Other diseases of liver, etc. M. 5 — — — — — 1 — 1 1 1 1 F. 6 — — — — — — — — 6 — — 27. Other digestive diseases M. 10 1 — — — 1 — 1 2 1 4 — F. 23 — — — — — 2 1 5 3 7 s 28. Acute and chronic nephritis M. 28 — — — — 1 1 2 4 9 5 6 i'. 12 — — — — — 2 1 — 5 2 2 29. Puerperal sepsis F. 1 — — — — 1 — — — — — — 30. Other puerperal causes F. — — — — — — — — — — — — 31. Congenital debility, premature birth, malformation, etc. M. 20 20 — — — — — — — — — — F. 10 10 — — — — — — — — — — 32. Senility M. 4 — — — — — — — — — 1 3 F. 13 — — — — — — — — 1 1 11 33. Suicide M. 19 — 1 7 1 4 2 1 3 F. 12 — — — — 1 a 3 2 1 —' — 34. Other violence M. 31 7 — — 4 2 2 5 1 4 2 4 F. 32 3 1 1 1 1 1 1 — 5 12 6 35. Other defined diseases M. 59 4 — 1 1 3 2 2 6 11 16 13 F. 55 3 — 1 — 2 5 5 9 8 8 14 36. Causes ill-defined, or unknown M. — — — — — — — — — — — — F. 1 — — — — — — — — 1 — — 12 These death tables provide material for most interesting speculation, but there is neither space nor time to do other than touch upon one or two points. Thirty years ago Typhoid and Scarlet fever and measles caused 64 deaths. In 1935 there were none. In 1905 179 persons died of Cancer, but in 1935 the number had risen to 216, and during those thirty years the population has fallen from 175,606 to the present figure of 124,400. Tuberculosis, on the other hand, has fallen from 334 to 70— from being the principal cause of death to fifth or sixth place. No wonder that public interest in the "great white plague" has somewhat waned. Heart disease is now by far the predominating cause of death, but for almost one-third of those who fall from this cause it is a gentle summons in the late evening of life. Table VI.—Still-births. Notification and Registration. Forty-nine still-born children were notified during the year. Still-births Registered. Inward Transfers. Outward Transfers. Allocated to Westminster. Total Legitimate and Illegitimate Males 25 10 21 14 Females 26 5 17 14 Illegitimate Males. 4 2 4 2 Females 2 1 2 1 Table VII.—Infectious Diseases. Statement showing the number of cases of certain infectious diseases in the area during the 52 weeks ended 28th December, 1935:— Westminster, City of. Met. B. Number of Cases of Infectious Diseases Notified. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. 1 Puerperal fever. Erysipelas. Pneumonia. — 186 112 12 17 9 43 35 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Scarlet fever, 2.96; diphtheria, 1.60; enteric fever, 0.04; puerpera pyrexia, 9.44; puerperal fever, 3.60; and erysipelas, 0.42.). 13 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. For example, 16 cases of diphtheria and scarlet fever were discharged from hospital owing to incorrect diagnosis during 1935. 14 MALES. Table VIII.—Causes of, and Ages at, Death during the year 1935. Causes op Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 5 — — — — — 1 2 2 — 2 — — 1 1 1 — — — — — — — — Whooping—cough 1 1 — — — — — — — — — — — — — 1 — — — — — — — — Diphtheria, Memb. croup 3 — — 2 — — — 1 — — — — 1 1 — — — — — — — — 1 — Cerebro—spinal meningitis — — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhœa, enteritis 7 7 — — — — — — — — — — — 4 — 1 — — — — — 2 — — Erysipelas 1 — — — — — — — 1 — — — — — — 1 — — — — — — — — Other septic diseases 8 — — 1 — 1 1 2 3 — 1 — 1 — 1 3 — 1 — — — 1 — — Syphilis, &c. 2 — — — — — 1 — 1 — 1 — — — — — 1 — — — — — — — Diabetes 7 — — — — — — 1 6 — 2 — 1 — — 2 1 — 1 — — — — — Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of lungs 47 — — — — 10 22 11 4 1 5 1 6 11 4 11 1 — — — 2 4 1 — Other forms of tuberculosis 3 — — — — 1 1 1 — — — — 1 — — 1 — — — — — — 1 — Malignant growths 98 — — — — 1 5 42 50 1 8 2 8 31 4 19 4 1 7 5 — 3 3 2 Congenital debility, malformation, and premature birth 21 21 — — — — — — — — 1 — — 10 2 5 1 — — — 2 — — — Old age 4 — — — — — — — 4 — — — — 2 — 1 — — — — — — 1 — Meningitis and convulsions 2 1 — — — — 1 — — — — — — 1 — — — — — — — 1 — — 15 Loc. ataxia and general paralysis 6 — — — — — 1 4 1 — — 1 — 2 — 3 — — — — — — — — Other diseases of nervous system 7 — — — — 1 — 3 3 — 1 — — 4 — 1 — — 1 — — — — — Valvular diseases of heart 9 — — — — — — 6 3 — 2 — — 3 — 2 — 1 — 1 — — — — Other circulatory diseases 228 — — — — 1 9 68 150 4 15 8 10 56 12 66 8 4 9 10 6 6 8 6 Bronchitis 53 1 — — — — 2 13 37 — 2 — 2 21 2 17 1 1 — 1 1 1 4 — Broncho—pneumonia 35 7 1 — — 1 — 10 16 1 3 — 2 13 1 8 — 1 — — 3 — 3 — Pneumonia, other forms 26 1 1 — — — 2 13 9 — 6 — 2 7 1 5 1 — 1 1 — 1 1 — Other respiratory diseases 6 — — — — — 1 3 2 — — — — 3 — 1 1 — — 1 — — — — Alcoholism 1 — — — — — — — 1 — — — 1 — — — — — — — — — — — Cirrhosis of liver 6 — — — — — 1 3 2 — — — — 3 — 1 1 — — — 1 — — — Appendicitis and typhlitis 8 — — — — 1 2 2 3 — 2 — 2 2 — 2 — — — — — — — — Other digestive diseases 28 1 — — — — 1 15 11 — 1 — 4 9 2 8 1 — 1 — 1 — 1 — Bright's disease, &c. 42 — — — — 1 4 19 18 1 3 — 2 12 5 10 2 — — 1 2 2 1 1 Cystitis, &c. 22 — — — — — — 5 17 — 2 1 — 9 1 6 — 1 — — — — 2 — Deaths by accident or negligence 32 6 — — 4 3 7 4 8 — 1 — — 10 3 9 1 1 — 1 1 1 1 3 Deaths by suicide and murder 21 1 — — — 1 8 6 5 — 3 — 2 8 — 3 — — — — — 2 — 3 Other defined diseases 8 1 — — 1 — 3 1 2 — — 1 — 3 — 2 — — 1 — — — — 1 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 747 48 2 3 5 22 73 235 359 8 61 14 45 226 39 190 24 11 21 21 19 24 28 16 16 FEMALES. Table VIII (continued).—Causes of, and Ages at, Death during the year 1935. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 10 — — — — — 1 4 5 — — 2 — 6 1 — — — — 1 — — — — Whooping—cough 1 1 — — — — — — — — — — — 1 — — — — — — — — — — Diphtheria, Memb. croup 2 — 1 — 1 — — — — — — 1 — — — 1 — — — — — — — — Cerebro—spinal meningitis 3 2 — — 1 — — — — — — 2 — — — 1 — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhœa, enteritis 5 3 — — — — — 1 1 — — — — 3 — 1 1 — — — — — — — Erysipelas 1 — — — — — — — 1 — — — — — — 1 — — — — — — — — Puerperal fever — — — — — — — — — — — — — — — — — — — — — — — — Other septic diseases 4 — — — — — 1 2 1 1 1 1 — — — 1 — — — — — — — — Syphilis, &c 2 — — — — — 1 1 — — — — — — — 1 — — — — — 1 — — Diabetes 9 — — — — — — 2 7 1 1 — — 1 1 4 — — — — 1 — — — Rheumatic fever 5 — — — — 2 — 1 2 — 1 — — — — 4 — — — — — — — — Tuberculosis of lungs 14 — — — 1 4 6 2 1 — — 2 — 2 — 5 3 — — 1 — 1 — — Other forms of tuberculosis 3 — — — — 1 1 — 1 — — — — 1 — — 1 — — 1 — — — — Malignant growths 114 — — — — 2 6 53 53 — 11 3 15 40 7 24 3 1 1 4 — 3 — 2 Congenital debility, malformation, and premature birth 9 9 — — — — — — — — — — — 3 — 2 — 1 — 1 1 1 — — Old age 8 — — — — — — — 8 — — — 1 3 — 4 — — — — — — — — Meningitis and convulsions 1 — — — — 1 — — — — — — — — — — — — — — — 1 — — 17 Loc. ataxia and general paralysis — — — — — — — — — — — — — — — — — — — — — — — — Other diseases of nervous system 7 1 — — — — 1 1 4 — — — 4 3 — — — — — — — — — — Valvular diseases of heart 7 — — — — — 1 2 4 — 2 — 1 3 — 1 — — — — — — — — Other circulatory diseases 240 — — 2 — 2 13 46 177 — 19 7 27 88 10 54 12 4 2 7 — 5 3 2 Bronchitis 53 — 1 — — — — 8 44 — 3 — 2 26 2 16 2 — — — — 2 — — Broncho-pneumonia 41 2 — 1 — — 6 14 18 — 4 3 2 8 8 9 4 — 2 — — — 1 — Pneumonia, other forms 18 2 — 2 — — 2 6 6 — 3 1 3 4 2 2 — — — — — 3 — — Other respiratory diseases 4 — — — — — — 2 2 1 — — — 2 — 1 — — — — — — — — Alcoholism 3 — — — — — 1 2 — — — — 1 — — 1 1 — — — — — — — Cirrhosis of liver 4 — — — — — — 3 1 — 1 1 — 2 — — — — — — — — — — Appendicitis and typhlitis 5 — — — 1 1 1 2 — — 1 — — 1 2 — — — — 1 — — — — Other digestive diseases 23 1 — — — — 3 10 9 — 1 3 1 9 1 6 1 — — — — — — 1 Bright's disease, &c. 19 — — — — — 3 6 10 1 1 1 2 4 — 1 — — — — 4 4 — 1 Cystitis, &c. 5 — — — — — — 2 3 — 2 — 3 — — — — — — — — — — — Accidents and diseases of parturition 1 — — — — 1 — — — — — — — — — — 1 — — — — — — — Deaths by accident or negligence 24 3 — — — — 2 5 14 — 2 1 5 7 — 2 — 1 — 1 — 2 1 2 Deaths by suicide and murder 18 1 1 1 1 1 9 3 1 — 3 1 1 9 — 1 — — — 2 — — — 1 Other defined diseases 26 2 — — — 1 2 10 11 — 1 1 2 14 — 4 2 — — — — — — 2 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 689 27 3 6 5 16 60 188 384 4 57 30 70 240 34 147 31 7 5 19 6 23 5 11 18 1,604 deaths were registered in the City during 1935. After deducting 938 deaths of non-citizens in public institutions, etc., in the City, and adding those of 770 citizens who died in other districts, the corrected total is 1,436 as compared with 1,466 in 1934, and is equivalent to an annual crude rate of 11.5 per 1,000 persons compared with 11.8 last year. The London death-rate for 1935 was 11-4 and for England and Wales, 11-7. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below:— Table IX. Death Rates from 1921 to 1935. Year. Number of Deaths. Westminster Rate. London Rate. 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 1935 1,439 11.5 11.4 The deaths of males were 747, females 689. Table X. Deaths Distributed amongst Age Groups. This table shows the total deaths distributed among age periods:— 1935. 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. 48 2 3 5 22 73 235 359 747 F. 27 3 6 5 16 60 188 384 689 1924 96 32 39 41 46 184 557 700 1,695 1925 106 28 22 25 65 198 496 788 1,728 1926 96 28 20 24 50 185 509 696 1,608 1927 96 13 20 24 42 179 533 775 1,682 1928 80 14 10 31 51 164 466 681 1,497 1929 105 28 18 20 43 167 620 874 1,875 1930 81 13 13 21 42 171 474 663 1,478 1931 91 18 11 17 59 166 481 766 1,609 1932 76 14 12 16 53 181 447 758 1,557 1933 75 10 16 12 38 157 523 742 1,573 1934 77 23 13 22 50 169 438 674 1,466 1935 75 5 9 10 38 133 423 743 1,438 19 While the fall in the deaths of children under 1 year has been well maintained since 1932, the remarkable reduction in deaths among the "toddler" groups (1 to 2 years and 2 to 5 years) gives ground for satisfaction and this improvement is continued until school leaving age. In fact the only increase in the number of deaths is in the 65 years and over groups which means that survival is somewhat longer in 1935 than in 1934. The causes of death are set out in Table VIII. There was a slight increase among males of deaths from the following causes:—cancer, general paralysis and diseases of the urinary, circulatory and respiratory systems. Among females the causes showing an increase were influenza, suicide and murder, and diseases of the circulatory and respiratory 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.—Deaths According to Wards. — 1931. 1932. 1933. 1934. 1935. m. f. Total. m. Total. m. f. Total m. f. Total. m. f. Total. Conduit 7 9 16 3 4 7 5 1 6 _ 3 3 8 4 12 Grosvenor 64 58 122 55 63 118 86 55 141 64 61 125 61 57 118 Hamlet 19 24 43 17 20 37 19 22 41 12 24 36 14 30 44 K. St. George 60 67 127 67 70 137 67 65 132 60 61 121 45 70 115 Victoria 234 259 493 214 244 458 212 230 442 224 235 459 226 240 466 St. Margaret 28 49 77 38 50 88 39 39 78 43 40 83 39 34 73 St. John 219 187 406 226 179 405 235 167 402 183 144 327 190 147 337 St. Anne 38 25 63 32 21 53 28 31 59 27 34 61 24 31 55 Gt. Marlborough 11 11 22 12 9 21 15 10 25 12 19 31 11 7 18 Pall Mall 23 6 29 23 10 33 20 3 23 22 10 32 21 5 26 Regent 23 28 51 30 19 49 31 20 51 16 25 41 21 19 40 Charing Cross 22 6 28 11 3 14 20 11 31 17 5 22 19 6 25 Covent Garden 42 24 66 36 26 62 41 33 74 24 31 55 24 23 47 Strand 28 2 30 36 – 36 32 3 35 32 3 35 28 5 33 Homeless 25 11 36 24 15 39 28 5 33 20 15 35 16 11 27 Infantile Mortality.—The corrected death-rate of infants for Westminster was 72 per 1,000 births. The mortality among legitimate infants was 59.1 per 1,000; that of illegitimate 162.7. The infant mortality rate for London was 58. The number of infants dying under 1 year was 75, a decrease of 2 on the figure of last year. The chief contributory causes of death were accidents and negligence, broncho-pneumonia, prematurity, and gastroenteritis. 20 Although the number of infant deaths is less the rate is higher because it is based on over one hundred fewer births—a decline in births of over 10 per cent. Table XII shows the deaths as they occurred during the four quarters of the last four years:— Table XII.—Infantile Mortality. Total 1932. Total 1933. Total 1934. Total 1935. 1st Quarter 21 26 30 26 2nd ,, 17 23 18 18 3rd „ 22 11 11 14 4th „ 16 15 18 17 76 75 77 75 Table XIII shows the births and deaths of infants, legitimate and illegitimate, since 1908 onwards, with the corresponding infantile mortality rates for Westminster and for London:— Table XIII.—Infantile Mortality since 1908. Year. Legitimate. Illegitimate. Total Rate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 1908 2,739 266 97 174 34 155 100 113 1909 2,548 232 91 203 27 128 93 108 1910 2,399 189 78 193 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 1915 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 44 194 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 1935 913 54 59.1 129 21 162-7 72 58 21 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 1928 onwards, showing the proportion per 1,000 births applicable under each heading:— Table XIV.—Infantile Mortality—Causes. — 1928. 1929. 1930. 1931. 1932 1933. 1934. 1935. Diphtheria 1.4 0.73 — — — — — — Influenza — 0.73 — — — 2.7 — — Measles — 0.73 3.6 — 0.86 — 0.85 — Whooping Cough 2.1 81 0.73 0.82 0.86 1.8 — 1.9 Bronchitis and pneumonia 13.8 14.7 14.6 22.3 12.1 10.9 12.0 12.4 Stomach and bowel complaints 10.9 7.3 5.8 13.2 8.6 9.0 15.4 11.5 Syphilis 0.72 0.73 2.1 1.6 1.7 3.6 1.71 — Congenital malformations debility, etc. 5.1 4.4 4.3 6.6 — 1.8 2.57 8.6 Prematurity 9.4 19.8 18.2 22.3 19.9 16.3 20.5 20.1 Tuberculosis 2.1 2.2 1.4 — 0.86 — — — Murder — — 1.4 — 0.86 — — 1.9 Accidents and negligence — — — 1.6 0.86 0.9 1.71 8.6 Cerebro-spinal Meningitis — — — 0.82 0.86 0.9 — 1.9 Erysipelas — — — — 0.86 0.9 0.85 — Other causes 2.1 13.2 1.4 1.6 3.4 1.8 6.85 4.7 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.—Causes at various ages. CAUSES OF death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 months. Total Deaths under 1 Year. Bronchitis and Pneumonia (all forms) — 1 1 — 2 2 1 5 3 13 Premature birth 18 2 — — 20 — 1 — — 21 Other causes 1 — 1 — 2 2 — 1 — 5 Stomach and bowel — — — — — 2 3 6 1 12 Accidents and negligence 6 — — — 6 1 1 1 — 9 Congenital Defects 4 1 1 — 6 2 1 — — 9 Whooping Cough — — — — — — — — 2 2 Murder 2 — — — 2 — — — — 2 Cerebro-spinal Meningitis — — — — — 1 1 — — 2 31 4 3 — 38 10 8 13 6 75 Prematurity has for the last four years held priority as a cause of infant mortality and accounts roughly for one fourth of the deaths. During the first four weeks, it claims more than one half while after that (9069) c 22 it is negligible. This is a problem which seems bound up with ante-natal care rather than with infant welfare. The question is not so much the prevention of deaths of premature infants for their hold on life is exceedingly precarious, but the prevention of premature birth. This will certainly receive serious investigation during the current year. Table XVI.—Births and Infantile Deaths. Nett Births in the year:— Males. Females. Total. Legitimate 491 422 913 Illegitimate 68 61 129 559 483 1,042 Nett Deaths in the year of :— Males. Females. Total. Legitimate infants 35 19 54 Illegitimate infants 13 8 21 48 27 75 The causes of death of the Illegitimate were:—Murder 1, prematurity 7, pneumonia 2, stomach and bowel diseases 1, congenital defects 3, accidents and negligence 6, and other causes 1. Table XVII. Infant mortality.—Nett Deaths from stated causes at various ages under One Year of Age in Pimlico Area (Victoria, Knightsbridge St. Georqe 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 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Cerebro-spinal Meningitis — — — — — 1 1 — — 2 Bronchitis and Pneumonia (all forms) — 1 1 — 2 1 1 2 3 9 Stomach and bowel — — — — — 1 3 4 1 9 Whooping Cough — — — — — — — — 1 1 Premature birth 8 — — — 8 — 1 — — 9 Accident — — — — — 1 — 1 — 2 Congenital defects — 1 — — 1 1 1 — — 3 Other causes — — 1 — 1 2 — 1 — 4 Murder 1 — — — 1 — — — — 1 Totals 9 2 2 — 13 7 7 8 5 40 Nett Deaths in the above area during the year:— Males. Females. Total. Legitimate 16 13 29 Illegitimate 7 4 11 23 Table XVIII. Infant Mortality.—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. Congenital defects 2 — — — 2 1 — — — 3 Bronchitis and Pneumonia (all forms) — — — — — 1 — — — 2 Stomach complaints — — — — — — — 1 — 1 Premature birth 6 1 — — 7 — — — — 7 Whooping Cough — — — — — — — — 1 1 Accidents — — — — — — 1 — — 1 Totals 8 1 — — 9 2 1 2 1 15 Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 11 1 12 Illegitimate infants 2 1 3 Table XIX. Infant Mortality. Nett Deaths from stated causes at various ages under One Year of Age in the North District (Grosvenor, Conduit, St. Anne, Pall Mall, liegent, Gt. Marlborough, Strand, Charing Cross and Covent Garden Wards). CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year Murder 1 — — — 1 — — — — 1 Pneumonia — — — — — — — 2 — 2 Premature birth 4 1 — — 5 — — — — 5 Stomach complaints — — — — — 1 — 1 — 2 Congenital defects 2 — 1 — 3 — — — — 3 Accidents 1 — — — 1 — — — — 1 Other causes 1 — — — 1 — — — — 1 Totals 9 1 1 — 11 1 — 3 — 15 Nett deaths in the above area during the year:— Males. Females. Total. Legitimate infants 8 5 13 Illegitimate infants 1 1 2 (9069) •C 2 24 Table XX. 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 5 — — — 5 I — — — — 5 Deaths of children unknown:— Males. Females. Total. Legitimate — — — Illegitimate 3 2 5 Table XXI.—Infant Mortality and Births in Wards. 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, 1935. Legitimate. Illegitimate. Total Infant Deaths, 1935. Legitimate. Illegitimate. 1935—Infant death rate per 1,000 births Legitimate. Illegitimate. Total Rate. Conduit 2,086 5 4 1 — — — — — — Grosvenor 13,318 56 50 6 1 1 — 20.0 — 17.8 Pall Mall 2,872 6 3 3 — — — — — — Regent 4,047 26 24 2 1 1 — 41.6 — 38.4 Gt.Marlborough 3,331 8 7 1 1 1 — 142.8 — 125.0 St. Anne 5,405 28 23 5 3 2 1 86.9 200.0 107.1 Covent Garden 6,655 52 48 4 6 5 1 104.1 250.0 115.3 Charing Cross 3,210 8 8 — 3 3 — 375.0 — 375.0 Strand 2,052 4 4 — — — — — — — Victoria 36,955 425 358 67 34 24 10 67.0 149.2 80.0 K. St. George 11,445 64 58 6 5 4 1 68.9 166.0 78.1 Hamlet 6,461 40 37 3 1 1 — 27.0 — 25.0 St. Margaret 8,671 24 24 — 2 1 1 41.6 — 83.3 St. John 23,071 281 264 17 13 11 2 41.6 117.6 46.2 Homeless — 15 1 14 5 — 5 — 357.1 333.3 Total 129,579 1,042 913 129 75 54 21 59.1 162.7 72 The infant death rate for Charing Cross Ward seems staggering until it is noted that only eight babies were born in a population of over 3,000. If this were a village or county township the lack of fertility would be abnormal but here the population consists of elderly caretakers, a high proportion of single persons e.g., hotel and club servants, &c. The eight children were all born to married parents and the three died of prematurity. 25 The difference in the death rate of infants as between Victoria and St. John is also remarkable. The type of population is not exactly similar. In the latter area there are more settled families whose parents and even grand parents in many cases have resided in the district. In the former there is a larger floating population, strangers from distant parts of the country seeking employment who perhaps during only a few weeks residence are quite unacquainted with the local health services and whose young children therefore do not come under medical supervision. The following table is inserted by courtesy of the Medical Officer of Health for Poplar, by whom the figures were compiled. Table XXII.—Birth and Death Rates in Metropolitan Boroughs for 1935. Cities and Borough. Est. Resident Population (mid-1935). Live Births rate per 1,000 Population. Death rate per 1,000 Population. Infantile Mortality rate per 1,000 Live Births. Crude. Adjusted. West Districts— Paddington 138,000 14.17 12.08 11.95 71 Kensington 178,300 12.4 12.1 11.3 79 Hammersmith 128,100 14.7 11.9 12.3 70 Fulham 143,600 13.8 11.6 11.7 51 Chelsea 57,320 10.2 12.6 10.7 59.6 City of Westminster 124,400 8.3 11.5 11.8 72 North Districts— St. Marylebone 92,200 9.72 11.8 11.7 55 Hampstead 90,600 11.02 11.2 10.5 49 St. Pancras 185,300 13.3 11.97 12.2 62.8 Islington 308,170 14.85 – 10.99 52 Stoke Newington 50,210 13.9 11.1 10.6 51 Haekney 210,600 14.0 10.6 11.1 47.6 Central Districts— Holborn 35,400 7.65 11.9 12.7 89 Finsbury 63,100 14.7 12.6 13.7 59 City of London 9,360 7.6 11.0 12.2 113 East Districts— Shoreditch 88,400 14.6 11.3 12.4 52 Bethnal Green 99,910 14.4 10.3 11.6 51 Stepney 211,500 14.3 11.3 12.8 63 Poplar 143,700 15.4 11.0 12.3 46 South Districts— Southwark 156,100 14.8 – 12.4 66 Bermondsey 102,700 14.5 11.7 13.3 69 Lambeth 279,900 13.65 12.15 12.02 59 Battersea 148,200 14.2 12.0 11.9 65.11 Wandsworth 343,300 11.03 11.00 10.23 55 Camberwell 234,400 13.4 11.8 11.8 60 Deptford 99,500 14.4 11.1 11.5 52 Greenwich 96,600 13.87 10.83 11.04 59 Lewisham 223,000 12.5 9.9 10.0 43 Woolwich 146,400 14.0 10.2 10.8 44 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 26 the City. Some of the residents are permanent in so far that they have been resident in the Public Assistance 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 1935. They were mostly in institutions:— Table XXIII.—Deaths in Common Lodging Houses. Deaths. Ward. Bruce House (L.C.C.) (licensed for 716 men) 23 Strand 33, Great Peter Street (licensed for 80 men) 1 St. John. 7, St. Ann's Street (Salvation Army) (licensed for 565 men) 16 16, Strutton Ground (licensed for 201 men) 35 Church Army Home, Greencoat Place (184 women) 2 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 1931-1935. Details respecting the notifications of infectious disease received are set out in the following pages. Table XXIV.—Notifications of Infectious Disease. 1931 1932 1933 1934 1935 Smallpox 2 3 1 — — Diphtheria 140 80 142 153 Ill Erysipelas 46 50 53 63 44 Scarlet fever 196 211 354 375 194 Enteric fever 7 7 7 6 11 Continued fever — — — 1 — Puerperal fever 4 7 4 5 9 Puerperal pyrexia 15 8 11 13 17 Cerebro-spinal meningitis 8 6 11 4 3 Encephalitis lethargica 1 2 1 — — Poliomyelitis — 1 2 5 2 Ophthalmia neonatorum 7 13 7 4 1 Measles 74 810 255 807 195 German measles 23 18 45 39 10 Pneumonia 49 51 66 48 35 Malaria 1 1 — 1 15 Dysentery 1 2 1 3 15 Chicken pox 204 201 167 146 194 Mumps 80 92 130 105 272 Whooping-cough 83 138 132 95 134 Membranous croup 1 — — — — 27 Diphtheria and Scarlet Fever waned. It was not a "measles year" but there was a sharp outbreak of Whooping Cough in the months of November and December, causing two deaths. The cases were mostly among children of school age attending schools in the Victoria and St. John Wards. The fifteen cases of Malaria were notified from the Military Hospital at Millbank and the Hospital for Tropical Diseases, Gordon Street, W.C.1, as were the majority of the fifteen cases of dysentery. No cases of anthrax, epidemic jaundice, undulant fever, glandular fever or psittacosis came to the notice of the department. Rheumatic Fever is not notifiable in Westminster. Vaccination.—The Vaccination Officer reports that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 534 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. 28 Table XXV. Vaccination Return for the Year ended 31st December, 1934. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1934. Number of these Births duly entered by 31st January, 1936, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1936, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1936, 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 1936. 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 1935. 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. 1,603 969 3 — 303 62 13 128 122 3 1,144 290 Table XXVI. Summary of Monthly Returns for the Year ended 31st December, 1935. 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. 1,547 1,144 26 290 3 91 49 243 29 The percentage of successful primary vaccinations to total births is 60.8. Last year the percentage was 61. The proportion of vaccinations still remains one of the highest in the whole country and that in spite of staff changes consequent on retirements which might necessarily cause some slight dislocation in the routine administration of vaccination. Table XXVII. 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, 1935. 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) 7 – 7 – Dr. A. E. Cope (Belgrave and Knightsbridge) 230 9 239 15 Dr. A. E. Cope (Westminster, St. Margaret and St. John) 205 22 227 18 Dr. A. E. Cope (St. Anne and St. James) 37 4 41 2 Dr. A. E. Cope, Strand 17 3 20 1 Totals 496 38 534 36 30 Table XXVIII.—Cases of Infectious Disease Notified. 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 over. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 107 1 6 8 10 8 32 11 9 6 13 3 — 105 2 5 — 1 — — 2 — — — — — 1 — Erysipelas 44 2 1 — — 1 — — 2 3 9 14 12 35 9 2 — — — — — — — — — — — 2 Scarlet fever 180 4 3 8 10 11 55 25 24 18 26 2 — 181 5 — — — — — — — — — — — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 11 — — — — — — 1 1 2 6 1 — 11 — — — — — — — — — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 9 — — — — — — — — 9 — — — 9 — — — — — — — — — — — — — — Cerebro-spinal meningitis 3 2 — 1 — — — — — — — — — 3 — 3 2 — — — — 1 — — — — — — Poliomyelitis 2 — — — — — 1 — — 1 — — — 2 — — — — — — — — — — — — — — Encephalitis lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum 1 1 — — — — — — — — — — — 1 — — — — — — — — — — — — — — Pneumonia 35 — 1 — 2 — 1 2 2 3 11 13 — 32 3 44 3 1 1 1 — — — — — 4 19 15 Malaria 15 — — — — — — — — — 10 5 — 14 1 — — — — — — — — — — — — — Dysentery 15 — — 1 — — 2 1 — — 8 3 — 15 — — — — — — — — — — — — — — Puerperal pyrexia 17 — — — — — — — 2 13 2 — — 15 2 — — — — — — — — — — — — — Totals 445 10 11 18 22 20 91 40 40 55 85 41 12 423 22 54 5 2 1 1 2 2 — — — 4 20 17 Correction has been made for errors in notification or revision of diagnosis in 16 cases. Diph. 9, Scarlet Fever 7. Cases not notified:— Scarlet fever, 8. Diphtheria, 4. 31 Table XXIX.—Infectious Diseases, Distributed according to Ward. Notifiable Diseases. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless and non-residents. Smallpox — — — — — — — — — — — — — — — Cholera (c). Plague (R) — — — — — — — — — — — — — — — Diphtheria — 9 11 25 1 37 6 1 8 1 1 3 1 4 3 Erysipelas — 1 2 11 4 10 1 — 2 1 1 1 — 1 3 Scarlet fever 8 13 25 50 8 56 5 1 5 1 1 7 1 6 7 Typhus fever — — — — — — — — — — — — — — — Enteric fever 1 3 — 4 — 2 — — — — 1 — — — — Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — — — 2 — 1 — — — — 1 1 — — 4 Cerebro-spinal meningitis — — 1 1 — — 1 — — — — — — — — Poliomyelitis — — — — — 1 — — — — — — — 1 — Encephalitis lethargica — — — — — — — — — — — — — — — Ophthalmia neonatorum — — — 1 — — — — — — — — — — — Pneumonia — 2 — 11 — 14 — — 1 — 1 3 1 1 1 Malaria — 3 — 3 — 5 — 1 3 — — — — — — Dysentery — 1 — 1 1 3 3 — 2 — 1 — 1 — 2 Puerperal pyrexia — 1 2 8 — 4 — — — — — 1 — 1 — Membranous Croup — — — — — — — — — — — — — — — Totals 9 33 41 117 14 139 16 3 21 3 7 16 4 14 20 32 Scarlet Fever.—One hundred and ninety-four cases of this disease occurred in 1935, a decrease of 181 on the figures of 1934. No death occurred. The case rate of this disease per 1,000 of the population was 1.56 for the City, and for England and Wales 2.96. The death-rate for London was 0.01 per 1,000, and for England and Wales 0.01. Of the total cases in Westminster 97.0 per cent, were removed to hospital. Diphtheria.—One hundred and eleven cases of this disease occurred, showing a decrease of 42 on the figures of 1934. The case rate of this disease for Westminster was 0.8 per 1,000 living, and for England and Wales 1.60. There were 5 deaths, males aged 4, 4 and 47 years; females aged 1 and 6 years. The death-rate for England and Wales was 0.08, for London 0.06, and for Westminster 0.04. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1935, 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. Two hundred and thirty-five cases were dealt with during the year as compared with 249 and 121 in 1934 and 1933 respectively. New cases attended the Centres as follows:— Ebury Bridge 81 Bessborough Street 22 Marshall Street 83 Westminster Health Society 49 235 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 XXX.—Diphtheria Immunisation. Positive. Negative. Treated without Test Total. Under 5 3 1 151 155 Under 10 5 3 56 64 Over 10 6 8 2 16 14 12 209 235 33 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 small-pox. One hundred and fifty-eight re-tests or tests after treatment were performed ; 150 gave a negative result six months or more after preventive treatment. Three were still positive and received further treatment. Three others did not attend to show the result of the test. Two second re-tests after an additional course of treatment showed that the patients were now negative. 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. Enteric Fever.—There were 11 cases of typhoid and paratyphoid which came to the knowledge of the department during 1935. Of these 3 were notified as paratyphoid and 8 as typhoid. The case rate for England and Wales was 0.04 and for Westminster 0.08. The number of cases infected abroad and included in the total was two. No deaths occurred. 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 XXXI.—Measles—Cases Notified. 1931. 1932. 1933. 1934. 1935. 74 810 255 807 195 The death-rate for England and Wales per 1,000 population was 0.08. Sixty-seven cases were removed to hospital, 42 being between the ages of 1 and 5. No death occurred. German Measles.—Ten cases were notified. 34 Influenza.—The deaths certified from this cause during the last five years are as follows:— Table XXXII.—Deaths from Influenza. 1931. 1932. 1933. 1934. 1935. Males 13 21 37 12 5 Females 24 37 29 6 10 37 58 66 18 15 The death-rate in 1935 for Westminster was 0.12 per 1,000; for London 0.11, and for England and Wales 0.18. Last year the corresponding rates were 0.14 for Westminster, 0.12 for London, and 0.14 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 12—7 males and 5 females—10 being under 1 year. The infant death-rate from this cause in Westminster was 11.5. Table XXXIII. Deaths from Diarrhœa and Enteritis. Under 1 year. Other ages. Total. 1931 16 6 22 1932 8 3 11 1933 10 1 11 1934 16 3 19 1935 10 2 12 Whooping Cough.—134 cases were notified during the year, with 2 deaths, 26 cases were moved to hospital, 22 being between the ages of 1 and 5. The death rate for Westminster was 0.01, for London 0.04, and for England and Wales 0.04. 35 The deaths from whooping cough during the last five years are thus set out:— Table XXXIV.—Deaths from Whooping Cough. Under 1 year. At other ages. Total. 1931 1 3 4 1932 1 1 2 1933 2 4 6 1934 — 9 9 1935 2 — 2 Cerebro-spinal Fever.—3 cases of this disease occurred with 3 deaths. Poliomyelitis.—2 cases occurred. Chicken Pox.—194 cases occurred, 62 being moved to hospital. Mumps.—272 cases were recorded, 39 cases being moved to hospital. Puerperal Fever.—9 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 XXXV.—Puerperal Fever. Year. No. of births. No. of cases. Deaths. Death rate per 1000 births 1931 1,211 4 4 3.3 1932 1,152 7 1 0.86 1933 1,099 4 1 0.91 1934 1,166 5 — — 1935 1,042 9 1 0.9 Puerperal Pyrexia.—17 cases occurred, 15 being removed to hospital. Ophthalmia Neonatorum.—1 case only occurred in 1935. In addition to this notified case, 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 are also admitted, and, if necessary, receive treatment. The Public Health (Ophthalmia Neonatorum) Regulations, 1926. These regulations have been in force since October, 1926, and under them midwives are no longer obliged to notify, but they are obliged to call qualified medical assistance to all cases of inflammation of the eyes. 36 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 1935:— Table XXXVI.—Ophthalmia Neonatorum. Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Total. Treated. At. home. In hospital. 1 — 1 1 — — — 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 474 Sputa for investigation of tuberculosis 302 Expenditure on the first was £81 8s. 1d., and for the second £36 5.s. 2d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1935, 184 new cases of pulmonary tuberculosis came to the knowledge of the department, including 10 cases who had moved into the City and 11 non-notified deaths. Non-pulmonary forms of tuberculosis gave 45 cases—3 of these being non-notified deaths, and 4 transfers from other districts. 37 Table XXXVII.—Tuberculosis, New Cases and Deaths. Age-Periods. New Cases. Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. Under 1 — — — — — — — — 1 — 2 2 1 — — — — 5 1 4 7 — — — — — 10 2 3 4 2 — 1 — — 15 4 5 1 1 1 — 1 20 14 11 4 4 4 4 — — 25 25 17 4 6 11 2 1 1 35 23 15 2 1 9 4 1 — 45 33 3 2 1 9 2 — — 55 16 1 — — 8 — 1 — 65 and upwards 4 1 — 2 5 1 — 1 Totals 122 62 27 18 47 14 3 3 In this table all primary notifications are included, and also other new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during the year. The total cases for 1935 show a decrease of 76 on those of 1934. Out of the total cases primarily notified in 1935, 20 died, and the following table shows the period between notification and death of these eases :— Table XXXVIII.—-Tuberculosis Period between Notification and Death. 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 8 1 1 5 3 — — 1 1 — — — — — Table XXXIX.—-Tuberculosis Deaths. 1931 1932 1933 1934 1935 New cases notified 201 242 202 266 201 Number included in above who died during the year 36 35 34 38 20 (17.9%) (14.4%) (16.8%) (14.28%) (9.9%) Total Tuberculous Deaths 121 106 101 99 67 Death Bates per 100,000 104.6 83.8 79.9 79.8 53.8 (9069) D 38 Table XL. Tuberculosis.—Notifications received during the period from lst January, 1935, to 31st December, 1935. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males — — 1 1 3 12 25 21 32 14 3 112 121 Females — 2 4 2 3 8 15 13 3 1 — 51 57 Non-pulmonary— Males — 2 7 4 1 3 4 2 2 — 1 26 26 Females — 1 — 2 — 4 3 — 1 — 1 12 12 Total — 5 12 9 7 27 47 36 38 15 5 201 216 39 (9069) Table XLI. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1935. Age Periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total. Pulmonary— Males — — — 1 1 2 — 2 1 2 1 10 Females 1 2 3 2 2 1 11 Non-pulmonary— Males — — — 1 — — — — ' — 1 Females — — — — 1 — 3 1 — — 1 6 Total — — — 2 4 6 5 5 1 2 3 28 v 2 40 Table XLII. Tuberculosis.—Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1935. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Co vent Garden. Strand. St. Anne. Homeless. Keceived Institutional Treatment during 1935. Pulmonary— Males 122 1 7 3 32 8 42 1 1 3 —- 1 7 11 3 2 88 Females 62 — 4 7 24 1 14 3 —- 3 1 —- 3 —- 2 —- 34 Non-pulmonary— Males 27 —- —- —- 12 1 6 1 —- 1 1 2 1 1 1 17 Females 18 —- —- 8 1 2 1 —- 1 1 —- 3 — 1 — 11 229 1 11 10 76 11 64 6 1 8 3 1 15 12 7 3 150 41 Table XLIII. Tubeiiculosis 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. 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 1920 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 1935 93 62 29 — 184 27 18 45 229 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 14 deaths from tuberculosis during 1935 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 14 non-notified deaths gave a percentage of 20.9 of the total deaths from tuberculosis for the year. The total number of cases of tuberculosis on the Register at the end of 1935 was 1,474 (as compared with 1,400 at the end of the year 1934), of which 1,117 were pulmonary cases, consisting of 746 males and 371 females. 42 The Public Health (Tuberculosis) Regulations, 1924. The number of unnotified deaths during the year was 14; the corresponding percentage proportions are 24.2 per cent. (1934) and 20.9 per cent. (1935). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner. 12 deaths occurred in institutions and 2 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 1935. Table XLIV.—Tuberculosis—Cases on the Register. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on register at beginning of year 1935 705 356 152 187 Notified for the first time during year .... 122 62 27 18 Removed from the register on account of death or removal etc., from Westminster 827 81 418 47 179 12 205 15 746 371 167 190 Of the 155 cases removed from the register during the year 1935, 67 were on account of death, 87 persons suffering from tuberculosis moved from the City and notification was withdrawn in 1 case. Deaths from Tuberculosis.—The total number of deaths from tuberculosis for 1935 (all forms) was 67—males 50, females 17. This gives a death-rate for this disease of 0.53 per 1,000. death-rate for this disease of 0.53 per 1,000. The following table shows the number of deaths from tuberculosis for the last 6 years, together with the death-rate. Rate per Year. Deaths. 1,000. 1930 107 .85 1931 121 1.04 1932 106 .83 1933 101 .79 1934 99 .9 1935 67 .53 43 The following table shows deaths per 100.000 of civilian population since 1921. Table XLV. 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 1935 ,, 61 49.0 6 4.8 67 53.8 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. Annual Report, 1935. The work of the Dispensary has been carried on throughout the year on the established lines. Four hundred and twenty-five new cases were seen during the year, of which two hundred and thirty were considered to be tubercular. These cases classed as tubercular for Dispensary purposes do not all show evidence of recent active disease. The number of new cases during 1935 is lower by 39 than the corresponding figure for 1934, though slightly higher than that for 1933. These figures have a definite relation to the number of cases of tuberculosis notified in the City in the particular year. The sources of reference of new cases to the Dispensary during the last three years are shown in the following table. The proportion from each source shows comparatively little variation from year to year. 44 Table XLVI. 1933. 1934. 1935. Practitioners 140 157 140 Health Visitors 162 161 143 St. Stephen's Hospital 72 99 97 Ministry of Pensions 0 1 0 School Medical Officer 18 23 25 Hospitals 10 9 12 Referred by friends, charitable organisations, &c. 10 12 8 412 462 425 The proportion of these cases first seen at St. Stephen's Hospital remains high. The value of the arrangement whereby the Tuberculosis Officer visits the tuberculosis wards of the hospital has been stressed in previous reports. This is of increasing importance as there has been a greater tendency in the last few years for medical practitioners to send definite cases of tuberculosis direct to the County Council General Hospitals. This method is particularly useful for persons in crowded homes or temporary lodgings, as they commence treatment and are removed from contact with others at the earliest possible time. The Tuberculosis Officer comes in touch with these cases in the hospital and after an initial period of rest they are passed on to a sanatorium, if suitable for such treatment. The following table gives certain details of the work of the Dispensary during 1935 and the four preceding years :— Table XLVII. 1931. 1932. 1933. 1934. 1935. New patients attending 400 484 412 462 425 Old patients attending 427 477 430 473 472 New contacts examined 85 105 126 109 108 Individual attendances 827 961 842 935 897 Total attendances 2,314 2,321 2,165 2,615 2,454 Written reports to public authorities and medical practitioners 1,187 1,228 1,090 1,066 1,064 Home visits 72 73 82 67 73 Consultations with practitioners 157 132 117 153 145 Visits by health visitors to dispensary cases 3,469 3,373 3,404. 3,526 3,335 Sputum examinations 192 225 164 193 171 X-ray examinations 42 61 60 78 78 45 The examination of family contacts is carried out whenever this is possible, but an analysis of cases notified during 1935 shows that only about 40 per cent. can be said to belong to families resident in Westminster. Our patients have always included a great many who are employed in indoor service in hotels, clubs or private houses, or who live alone in temporary lodgings, hostels, lodging houses, &c. There seems reason to believe that in recent years the new tuberculosis patients have been provided increasingly from these non-family groups. The number of contacts available for examination is therefore proportionately lower than in areas of a more residential nature. Patients have been recommended for institutional treatment from the Dispensary as follows :— Hospitals. Sanatorium. Insured males 8 40 Insured females 8 23 Uninsured males 1 1 Uninsured females 2 7 Boys 4 4 Girls 2 3 25 78 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 the British Red Cross Society, and for many children through the Invalid Children's Aid Association, the Public Assistance Committee, the School Care Committee, 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. Twelve adult patients were referred to the Council's dental clinic ; 20 extractions and 4 fillings were carried out, and 7 of the patients were fitted with dentures. Fourteen patients received Artificial Pneumothorax treatment at Brompton Hospital and elsewhere and had, in all, 170 refills. Three cases of Lupus received special light treatment at a cost to the Council of £21 8s. 46 The Tuberculosis Care Committee has now exercised its functions over a period of twenty years, and is preparing a report of its work giving special consideration to changes which have taken place during that period. The Committee gives careful consideration to the economic position of each patient and his dependants during and after his treatment and arranges appropriate help when this is needed. Owing to the representative nature of the Committee, advice and help can be obtained from many different sources. The Committee also considers the question of assistance towards the payment of dentures and recommends to the Council the granting of extra nourishment where this is considered helpful to the patient's treatment. Thirty-two patients received this extra diet allowance at a total cost to the Council of £169 18s. \0d. The work of the Handicraft Class, run for Dispensary patients by a voluntary committee, was continued with very good results. Miss McFarlane and Miss Willats continued their excellent work as secretary and teacher respectively. A high standard of work is maintained and the members derived interest and benefit from the work of the Class. There is, however, somedifficulty in maintaining the numbers as many members return to work, break down, or leave the district. At the end of the year the Mayor opened a very successful sale of the patients' work. This was held in conjunction with the corresponding class in Southwark and the Mayor of Southwark was also present. The Class remains in a satisfactory financial position, deriving its income from the sale of goods and from various generous donations from persons interested. In addition the Barlow's Gift Charity Committee has, since 1931, granted some £16 annually to the Handicraft Class. Without this help it would have been difficult to carry on this useful work. 47 Table XLV1II. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work or the Dispensary during the Year 1935. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — (a) Definitely tuberculous 125 78 5 5 12 18 14 8 137 96 19 13 265 *(b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 18 41 18 23 100 B.—Contacts examined during the year :— (a) Definitely tuberculous 2 1 4 3 1 — 2 — 3 1 6 3 13 *(4) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 4 37 36 18 95 C.—Cases written off the Dispensary Register as— (a) Recovered 2 3 — — — — — — 2 3 — — 5 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 28 88 66 49 231 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 245 182 24 29 34 43 54 41 279 225 78 73 655 (6) Diagnosis not completed — — — — — — — — — — — — * i.e., remaining undiagnosed on 31st December. 48 Table XLIX—continued. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL—continued. (A) Return showing the Work of the Dispensary during the Year 1935—continued. 1. Number of cases oiWDispensary Register on January 1st 691 8. Number of visits by Tuberculosis Officers to homes (including 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 13 personal consultations) 9. Number of visits by Nurses or Health Visitors to homes for 73 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight pensary purposes 10. Number of— 3,335 of" 234 (a) Specimens of sputum, etc., examined 171 4. Cases written off during the year as Dead (all causes) 52 (6) X-ray examinations made in connexion with Dispensary 5. Number of attendances at the Dispensary (including Contacts) 2,454 work 78 6. Number of Insured Persons under Domiciliary Treatment on 11. Number of " Recovered" cases restored to Dispensary Register, the 31st December 213 and included in A (a) and A (6) above .... Nil 7. Number of consultations with medical practitioners— 12. Number of " T.B. plus" cases on Dispensary Register on (a) Personal 145 December 31st 210 (6) Other 229 (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 — 49 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Laboratory Facilities.—The arrangement with Westminster Hospital for the bacteriological examination of material from suspected cases of tuberculosis, diphtheria, &c., continues as heretofore. 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, ice-cream &c., are also carried out at the hospital laboratories. The examination of certified milk under the Milk (Special Designations) Order, 1923, is carried out at the laboratories of the Clinical Research Association. While the routine bacteriological examination of the milk (pasteurized) supplied to schoolchildren is carried out at Westminster Hospital, the chemical analysis of food and drugs is performed by the Council's two public analysts at their respective laboratories. The analysis of matter in connection with investigation of atmospheric pollution is 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 cough. The 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 1935 amounted to £167 7s. 0d., representing some 2363 visits as compared with 3,360 for the previous year. Clinics and Treatment Centres.—These institutions, apart from the voluntary general hospitals, 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. 50 Proposed Maternity and Child Welfare Centre and Day Nursery in Bessborough Street. Mention was made in last year's report of the measures taken by the Council to replace the existing Maternity and Child Welfare Centre, at 15 Bessborough Street, by a modern building on the site of Nos. 1, 3, 5 and 7, Bessborough Street, adjoining the Westminster Housing Trust's Tachbrook Housing Estate. In considering the type of building to be erected, the City Council had regard to the inadequacy of the day nursery accommodation in the City, and decided to provide on the upper floors of the proposed new building accommodation for a day nursery to be administered by the same voluntary body, the Westminster Day Nursery Committee, who at present conduct the small day nursery at 147, Warwick Street. This in due course will be given up at the expiry of the lease. Mr. F. Milton Harvey, A.R.I.B.A., A.M.I.C.E., the architect for the adjoining Tachbrook Housing Estate, was retained to design the building. The Public Health and Maternity and Child Welfare Committee of the Council appointed a Sub-Committee to deal with the matter and, in order to attain the fullest co-operation with the Westminster Day Nursery Committee, co-opted four members of the latter at the outset. This Sub-Committee held several meetings during the year and the members were each given the sketch plans and an opportunity of submitting their individual observations. Valuable suggestions were thus obtained and incorporated in the plans. The plans were subsequently informally submitted to the experts of the Ministry of Health, who kindly made some valuable suggestions, with the result that further important improvements were made. Ultimately, the draft scheme was submitted and approved by the Council, and the accompanying reproduction of the elevation and drawings show that the proposed building, when completed, will be one of the best of its kind. The following is a brief description of the accommodation to be provided. Basement.—The existing vaults will be reconstructed and utilised for storing the perambulators of the children brought to the Day Nursery. In the basement will be a laundry and drying room, cleaners' room, fuel store and central heating chamber and other storage accommodation. Ground, Floor.—This floor is laid out as a maternity and child welfare centre. The main entrance is centrally situated, but a separate entrance is provided for expectant mothers so that they may directly enter the waiting room provided for them on the south side, and proceed from Drawings of New Maternity and Child Welfare Centke and Day Nursery. Bessborough Street, S.W.I. 50a Elevation. 50b 51 there into the dressing compartments of the ante natal clinic. Other accommodation on the south side consists of a doctors' room and a demonstration and weighing room where health lectures, etc., will be given. The accommodation on the north side consists of offices, committee, waiting, and health visitors' rooms. First Floor.—Separate entrances are provided on both the east and west ends to the Day Nursery, situated on the first floor. The principal rooms facing south have been allocated to three age groups of children—cot babies, older babies, and toddlers, with a spacious sun balcony outside. On the north side will be a large bathroom, with children's pedestal cots, kitchen, nurses' and children's dining rooms and a receiving and committee room. Second Floor.—On this floor are wards for resident children and staff quarters. The wards will be utilised for the temporary accommodation of children whose mothers have to attend hospital for inpatient treatment, or where the mother is compelled temporarily to leave the home for other urgent reasons. Top Floor.—On this floor will be the caretaker's flat, a flat for the superintendent health visitor of the Maternity and Child Welfare Centre and further day nursery staff quarters with balcony space on the south side. 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 in Sheffield Street controlled by the London County Council which has 82 beds, 30 for parturient venereal cases and 52 for ordinary cases suffering from venereal disease. Voluntary.—There are 14 voluntary hospitals in the City. 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. 52 (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. The statutory powers with which the Council is endowed for providing services under this heading have enabled a comprehensive welfare scheme to be established. Before the consideration of details it might be of advantage to summarize these services as follows. They are :— (1) Care of the expectant mother by—- (a) Visits of advice by health visitors. (b) Attendance at ante-natal clinics under the care of a woman gynaecologist. (c) Confinement at home by a midwife. (d) Services of an obstetric consultant in case of difficulty. (e) In the event of illness after confinement the services of an obstetric consultant, pathologists, nursing and treatment in hospital. (/) Confinement as in-patient in hospital. (g) Provision of home help during the mother's period of ability. (h) Convalescent treatment if necessary before and after finement. (i) Instruction in mothercraft, i.e. :— (1) Classes for making garments. (2) Classes for cookery, food values, and marketing. (3) A variety of health lectures. (j) Dental treatment, and supply of dentures. (k) Extra nourishment. (2) Care of the mother after confinement and the infant:— (a) Eegular home visits by health visitor. (b) Attendance at clinic with the infant for advice by a specialist in children and at a post-natal clinic for herself. (c) Provision of extra nourishment in the form of fresh or dried milk, according to medical advice, to cases within the scale approved by the Minister. 53 (d) Dental and convalescent treatment as on previous table for women, and children up to 5 years of age. (e) Nursing services. (/) Special treatment, e.g., artificial sunlight. (g) Special items such as spectacles provided in necessitous cases through the Barlow Charity. It might be added that even in cases not associated with the welfare centres expert obstetric assistance is available for all medical practitioners requiring it in abnormal confinements and likewise for all private practising midwives in similar circumstances. 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. 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 L.—Westminster Hospit al. M dwifer1 { Visits 1932. 1933. 1934. 1935. Number of— Pre-natal visits .... 209 93 71 34 Lying-in visits 1,141 1,016 1,022 961 Subsequent visits — 32 28 18 Total number of visits 1,350 1,141 1,121 1,013 Number of cases attended 88 77 78 74 (9069) 54 Table LI. Attendances by midwives at ante-natal and other clinics :— 1932. 1933. 1934. 1935. Ebury Bridge 52 50 50 50 15, Bessborough Street 52 49 48 49 Total 104 99 98 99 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 LII.—Westminster Health Society, Midwifery and Nursing Visits. Number of cases attended— St. Margaret and St. John Wards. As midwife 47 With hospital students 3 With private doctors 1 51 Midwifery visits 874 Nursing visits 82 956 Consultant Services for Complicated Cases of Midwifery.—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 (special telephone Whitehall 3901) can have such skilled assistance, and also skilled medical assistance to all midwives practising in Westminster who may require it. Advantage was taken of this service in two cases during the year. Ante-natal Services.—There are six ante-natal clinics in the City of Westminster and at least two others within half a mile of the boundaries. 55 * Two of those clinics are directly under the City Council's control at its own centres, one at a voluntary centre, three in general hospitals in the City and two at hospitals outside the City but in the vicinity. 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 efiort. 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. While the net number of births registered during the year was 1,042, the number of expectant mothers dealt with at the centres was 829; that is to say some 79-5 per cent, of the total cases, as compared with the percentage of 76-6 for the previous year. (9089) e 2 56 Table LIII.—Ante-natal Cases. Name of Hospital. City Council's Centres. Westminster Health Society. Totals. Ebury Bridge. No. lo, Besslorough Street. Marshall Street. Marsham Street. King's College - 2 - - 2 General Lying-in 17 12 3 16 48 St. George's 23 21 1 7 52 Westminster 40 44 2 33 119 St. Thomas' 1 3 1 5 10 Charing Cross 3 8 41 9 61 Middlesex 2 8 21 — 31 Elizabeth Garrett Anderson 1 — — - 1 St. Stephen's 39 35 5 23 102 St. Mary Abbots Hospital — 1 1 — 2 Found by Health Visitors 46 46 19 54 165 Reported to Centre voluntarily 69 93 9 62 233 Other Boroughs — 3 — — 3 Totals 241 276 103 209 829 Anle-nital Visiting.—To the 829 expectant mothers who became known to the centres, 788 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,286. The attendances by those mothers at the clinics are detailed below :— Table LIV.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Ebury Bridge 48 103 163 266 186 Bessborough Street 49 109 192 301 159 Westminster Health 51 96 324 420 101 Society. Ante-natal clinics are also held at Charing Crosa, St. George's, Westminster and Middlesex Hospitals for mothers who have made arrangemen ts for their confinements with these hospitals. 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 57 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. Hospital beds are available as follows :—Charing Cross, 15; St. George's, 11; Westminster, 12; Sheffield Street, 30; *St. Stephen's, 28. 925 women from other districts and 416 women belonging to the City were delivered in these hospitals. The following table shows the number of confinements in the hospitals mentioned :— Table LV.—Confinements in Hospitals. Charing Cross Hospital: 451, of which 81 were Westminster cases. St. George's Hospital: 288, of which 43 were Westminster cases. Westminster Hospital: 312, of which 134 were Westminster cases. Sheffield St. Hospital : 132, place of residence doubtful. St. Stephen's Hospital: 188, all were Westminster cases. Convalescent Treatment.—The Council has during the year contributed towards the cost of the convalescent treatment of 16 Westminster patients at convalescent homes, and 15 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 £78 6s. 0d. Maternal Mortality.—The number of maternal deaths in Westminster during the year ended December, 1935, was 1, which gives a maternal mortality rate of 0.9 per thousand (live and still) births, as compared with the rate for the whole country of 3'93 per thousand (live and still) births. Particulars of this case are given below:— * Situated in Chelsea. 58 Spinster (22).—Admitted to Hospital suffering from effects of a recent abortion with evidence of septic metritis. Condition gradually deteriorated with severe toxaemia. Died 48 days after admission to Hospital. She had not sought any ante-natal care and in fact the evidence rather pointed to procured abortion. It is very satisfactory to report only one case of maternal death in the City during the year. The problem of maternal illness and mortality is not one that concerns a community so much as individuals, as each case presents its own peculiar features. As an illustration of the difficulties which beset local authorities in dealing with the problem the following case of a woman who became dangerously ill with puerperal fever after the birth of a still-born child may be mentioned. She was removed to a special hospital in a very grave condition. After two or three days, however, both patient and her husband became insistent that she should return to her home. Conditions at the home were such that she would have been without proper treatment or nursing. This most probably would have caused her death. After some fruitless discussion with the husband it was reluctantly decided to put in motion the provisions of Section 67 of the Public Health (London) Act, 1891, for her compulsory detention in hospital. Fortunately, however, it did not prove necessary to enforce those powers as the husband and wife were finally persuaded to accept the advice of the doctors to remain in hospital. The patient, after some six weeks' treatment, returned home restored to health and resumed her domestic duties. The woman, on recovery spoke in terms of warmest appreciation and gratitude of her treatment in hospital and attributed her earlier and somewhat peculiar attitude to her condition of acute illness at that time; a state of mind not uncommon in cases of serious illness after confinement. Another case was that of a woman removed to one of the London County Council's special Hospitals suffering from puerperal pyrexia following miscarriage, who insisted against medical advice on being discharged from the Hospital. On the health visitor calling at the home the patient stated that she felt all right, and the husband intimated that further visits from the health visitor were not desired. Steps were therefore taken for the medical practitioner who had secured the patient's removal into hospital to attend the case and thus secure for her adequate medical attention and nursing. 59 Fortunately both patients recovered, but there was a grave risk in each case. They might easily have died, causing a maternal mortality rate of 2.7 and not 0.9 which is the actual rate for the year. The point of importance is that had this unfortunate woman who died sought ante-natal care and had not attempted to end her pregnancy she would most likely have been alive to-day, thus enabling the City to have had a clean sheet as regards maternal mortality. It is cases such as this and the two described above which can contribute to maternal mortality quite irrespective of the most efficient maternity service which it is possible to devise. They indicate the predominantly subjective or individual aspect of maternal illness or mortality. 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 1930 are also shown. 60 Table LVI. Attendances at Infant Consultations, 1935. Centre. Number of Sessions. First Attendances. Subsequent Attendances. Total. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Total. Ebury Bridge 100 217 91 2,484 1,499 2,701 1,590 4,291 15, Bessborough Street 100 225 63 2,898 1,973 3,123 2,036 5,189 Marshall Street 51 101 24 1,230 1,033 1,331 1,057 2,388 Marsham Street 100 211 61 2,404 1,055 2,615 1,916 4,531 1935 351 754 239 9,016 6,360 9,770 6,599 16,369 1934 303 778 240 9,291 6,513 10,069 6,753 16,822 1933 354 759 245 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 The average attendances per session were— 1935. 1934. 1933. 1932. 1931 1930. Ebury Bridge 42.9 46.9 50.2 47.1 37.7 43.5 Bessborough Street 51.5 55.7 54.5 54.4 56.3 49.5 Marshall Street 46.8 44.3 48.0 43.9 43.4 40.9 Marsham Street 45.3 38.1 37.6 41.1 40.1 43.1 The number of individual children medically inspected were— Ebury Bridge 581 Marshall Street 265 15, Bessborough Street 572 121, Marsham Street 596 61 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 LVII.—Home Nursing. Patients. Visits. Affections of the eyes 17 206 Complications of maternity 40 607 Pneumonia 15 255 Bronchitis 9 149 Measles 8 112 Othar complaints 96 1,034 Total 185 2,365 Ophthalmia neonatorum.—One case was notified during the year. 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 17 cases, 206 visits being paid. Ophthalmia neonatorum has been notifiable since 1911. The percentage of mild (non-purulent) and notified (purulent) cases in relation to births from the year 1926 is as follows:— 62 Table LVIII.—Ophthalmia Neonatorum. Cases. Rate per 100 births for both classes of cases. 1926 16 1.6 1927 14 1.9 1928 7 12 1929 11 1.9 1930 16 2.2 1931 20 1.6 1932 27 2.3 1933 12 1.1 1934 11 0.94 1935 8 0.76 With regard to the incidence of venereal disease the following table shows the annual death-rates of infants per 1,000 births, certified to have died from syphilis since 1926: previous to this the figures correspond to quinquennia. No infant died from syphilis in 1935. Table LIX.—Deaths from Syphilis. 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 3.8 1927 2.8 1934 1.71 1928 0.72 1935 — Mothercraft.—Classes in mothercraft are held at the various centres, and health talks are given each week throughout the year in connection with those classes. Table LX.—Mothercraft Classes. 1935. Ebury Bridge. Bessboro' Street. Marshall Street. Marsham Street. Total. Number of classes 48 49 47 90 234 Total attendances 1,805 841 540 2,931 6,117 Average attendances 37.6 17.1 11.4 32.5 26.1 Number of expectant mothers 81 95 50 61 287 Number of attendances by expectant mothers 345 307 252 803 1,707 Number of other mothers 213 128 76 90 507 Number of attendances by other mothers 1,460 534 288 2,128 4,410 Attendances of children in nurseries during classes 1,296 621 398 3,205 5,520 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 1,058; at 63 Bessborough Street, 688; at Marshall Street, 308; and at Marsham Street, 1,626. In addition to those, many renovations were carried out. Health Visiting.—The following table shows the number of visits paid in connection with the four centres:— Table LXI.—Health Visiting. 1935 Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 241 240 102 205 788 Other visits 417 393 65 411 1,286 Children under 1 year of age— First visits 335 251 137 220 943 Other visits 1,171 1,099 701 1,056 4,027 Children over 1 and under 5 years— Visits 2,003 2,650 2,279 2,254 9,186 Death enquiries, still-births, &c 36 31 27 9 103 Infectious diseases 182 94 104 119 499 Infant Life Protection.—At the end of the year the register contained the names of 17 foster mothers who were then in possession of foster children. Each had one child only. Seven new registrations were made and it is satisfactory to report that no deaths occurred amongst foster children during the year. Notices numbering 100 were received from other authorities in respect of the transfer of children from the care of foster mothers in those districts 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 LXII.—Foster Children. District. Southwest. Southern. Northern. Visits bv Infant Life Protection Visitors to:— Foster Children under 5— First visits 15 24 8 Subsequent visits 73 25 11 Foster Children 5 to 9— First visits 2 4 7 Subsequent visits 10 2 5 64 Barlow's Gift.—The special committee administering this trust has again made the annual allocation equally between maternity and child welfare, the tuberculosis handicrafts Committee and the Westminster Nursing Committee. The total income amounts to £37 and so far as maternity and child welfare is concerned the share is spent on necessary articles which cannot properly be provided by the rates. As regards the handicraft class it is used for providing materials. 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, the minimum period of residence being eight months. During 1935 eight Westminster women were admitted to the home. This home serves a most useful purpose. The women generally admitted on the recommendation of the rescue worker are maintained at least three months before confinement and are retained from 9 to 12 months after. During this period they are trained for domestic or other useful occupation. 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 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.* Preparations of dried milk amounting to 3,602 pounds were distributed during the year. The amount expended by the Council for fresh milk as extra nourishment for mothers and infants amounted to £633 9s. 4d. Home Helps.—Provision was made in three cases for the services of home helps at a cost of £15 2s., in one case over an extended period. There is no panel of home helps. It is found more satisfactory for the woman requiring this service to make her own free choice of the individual * The number of recipients has increased from 150 in 1930 to 350 in 1935. This does not imply, and indeed there is no evidence of, increasing poverty or ill-health in the district. It means that the type of family most in need of the maternity and child welfare service is taking greater advantage of it. 65 who is to take her place in the home. In these three cases the Council paid the whole cost of the services of the home helps. Insulin Treatment.—One patient is still under treatment and the cost to the Council for the year was £8 9s. 6d. 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. Patients contributed £10 8s. 6d. in small sums according to their means. The Council contributed sums totalling £32 12s. 6d. towards the cost of dentures (£4 per set), which were supplied in 29 cases. Mr. Stewart Tait, Dental Surgeon, submits the following report:— Dental Clinic (held in the premises of the Westminster General Dispensary). The annexed Report for 1935 shows that there has been a drop in the numbers as compared with the previous year. However, to offset this reduction in figures is the fact that there have been fewer sessions held, 87 in all. If this fact is borne in mind one can say that the work done at the Clinic compares very favourably with that of the past years. There is also to be noted an increase on the conservative side of the work which is most gratifying. New Cases. Reappoint ments. Extractions. Fillings. Other Operations. Anaesthetics. Local. General. Dentures Supplied. 1935 191 922 1,028 175 349 11 183 29 F. Stewart Tait, L.D.S. 66 Notes by the senior health visitors on the work at the Centres. Bessborough Street.—The work of this centre was disorganized to some extent during the later months of 1935 owing to a part of the building being out of use whilst certain repairs to the structure were being executed. Clinics and Classes were held by arrangement with St. Gabriel's Parochial Church Council at St. Gabriel's Hall, Glasgow Terrace, during a period of some three months ending in December, 1935. Ailments.—Infectious and other minor ailments, colds, slight bronchitis and lesser digestive troubles have been prevalent, but fortunately infectious diseases have proved less serious than in former years. One death occurred from pertussis; this was a very delicate child who had scarlet fever in the early months of his life. Sunlight Treatment.—The sunlight treatment at the St. John Clinic is proving of value. Children who have been flagging in health, not gaining weight, of poor muscle tone, etc., have shown marked improvement in general health, but no great gain in weight has so far been noticed. Seven cases were recommended by the medical officer of the centre for this treatment, the Council contributing part or whole of the cost. Foster-Mothers.—There is still a demand for good foster-mothers, but it is hoped that when the new and enlarged day nursery is opened with its greatly increased accommodation for children whose mothers are compelled to work the need for these will not be so great. Re-housing.—The re-housing of some of the poorer families from basements and unsuitable dwellings to new and up-to-date block buildings has given gratifying results. It is found that such families do respond to new and pleasant surroundings by showing signs of increased health and vitality. Lectures.—The eight lectures on health subjects which have taken place at the Centre during the year have been greatly appreciated by the mothers and are of considerable educative importance. Ebury Bridge. Mother-Craft Class.—The attendances during 1935 numbered 1,805, being 331 more than in 1934. The class has been a hive of industry, no fewer than 1,058 garments being cut out and made up. Infant Life Protection.—The chief work under this Act has been visiting to verify the return to the care of relatives of children who have been in the care of foster-mothers in other districts. 67 At the end of the year there were five foster-mothers on the active list in this area. One had retired because of ill-health during 1935, and one had given up, a third had moved away. One new foster-mother had been registered. All five are decent women, and are giving good care to their foster children, no trouble having arisen during the year. As in former years, applications to place children with foster mothers have been greatly in excess of the available foster mothers. General Observations—St. Stephen's Ante-Natal Clinic.—The regular supervision of mothers booked for admission to St. Stephen's Hospital has been one of the most satisfactory developments of 1935. Mothers now receive at St. Stephen's treatment that could formerly only be obtained at up-to-date General or Lying-in Hospitals. There are still a great number of young women who come up to London from the depressed areas in Wales, Scotland, the north-east coast and Ireland, to find domestic work, but they soon get married here and settle. Some of these make excellent mothers, others are woefully ignorant of all matters pertaining to child welfare. A good many of our young parents tire of matrimony when offspring arrive, and there is an increase in the number who wish to "get a separation" directly any trouble arises. The Police Court Missionary has been of great help in these cases. Marshall Street.—The work at this centre grows annually. The increasing amount of clerical work now to be done occupies a great part of the Health Visitor's time and detracts from the visiting which should be her chief work. The work of guiding and teaching the mother must be done in the home because it is the mothers who never enter a welfare Centre who require the most help and advice and this cannot be completed in one visit: the same thing must be said again and again and these visits take time. The population of Soho is ever changing and now there seems to be a greater influx of Cypriots and men of coloured races. They marry or contract irregular unions with the women of the neighbourhood and their children require the most care and attention. There has been an increase in the attendances at the various clinics, noticeably at the infant consultation clinic, the Schick clinic and the mothercraft class. It is pleasing to see so many young mothers attending the sewing class for instruction and turning out really useful and pretty garments. 68 A valuable branch of the work is the training of students who come to this centre for their practical training. Ten students have attended during the past year—four from Battersea Polytechnic Department of Hygiene and Public Health and six from Bedford College for Women, Of the last six, two were Canadians, one French and one Pole. The latter were in England to learn our public health methods, considered by them to be the best. All were women of wide experience and returning to good posts in their own countries hoping to introduce our methods into their work. The training of these students has been extremely interesting but, while it takes time, yet is stimulating and well worth the time spent. Lectures, etc., Held at the Council's Centres. Lectures, demonstrations, etc., were held at the Centres during the year in the following subjects:— Film Displays.— "Growing Up" "Food Values and Nutrition" "Dangers of Dirt" " The Irresponsibles " "Deferred Payment" Lectures and Demonstrations.— Home Remedies. Teeth and Dental Care. How to reduce Doctor's Bills by Cleanliness. Home Laundry. Modern Housecraft. New and Old Fashions. Food values and Cookery. Baby's Bath. 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 total attendances were 10,050 by 89 individual children in the following age groups:— (a) Under one year, 54. (b) Over one year and under three years, 25. (c) Over three years and under five years, 10. 69 The average daily attendance during the year was 34. 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. Midwives Bill.—The Minister of Health acting on the recommendations of the Joint Council of Midwifery contained in their report published in 1935 decided to introduce a Bill to establish a public service of midwives throughout the country. It was submitted in the report of the Joint Council that an adequate service of trained midwives would have an important influence in reducing maternal illness and mortality. Much stress was laid on the poor remuneration paid to private midwives as a result of which the profession was not attracting the most efficient type of recruits. It was a strenuous but ill-paid calling. The custom in certain areas for unqualified handy women to conduct confinements under cover of a doctor nominally engaged was fraught with danger for the mother and this would be stopped under the Bill. The administration of the new provisions would be undertaken by the existing supervisory authorities. In London this would seriously prejudice the local maternity and child welfare authorities who have been providing midwifery services for a great many years. Their work would be handed over to the London County Council unless some machinery for preserving and co-ordinating it within a London County Council scheme is authorized by the Bill. In Westminster, at any rate, the midwifery needs of the City are already amply met by the City Council's own scheme. 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. During the year three deep wells were sunk, one at Princes Court, Knightsbridge and two at the Royal Empire Society, Northumberland Avenue. The total number of premises supplied from deep wells is now 88, but it is noteworthy that in one very large building the supply from the well shows signs of failing: the owners have very wisely turned to the Water Board for supply. Public Swimming Pools, Laundries, &c.—There are three municipal establishments, situated at Buckingham Palace Road, Great Smith Street, and Marshall Street. (9069) F 70 The numbers using the swimming pools and private baths in 1935 were :— Buckingham Palace Road: 119,249 men; 69,033 women. Great Smith Street: 131,442 men; 53,879 women. Marshall Street: 162,707 men; 105,471 women. The numbers relating to users of the public laundries were:— Buckingham Palace Road, 27,023; Great Smith Street, 22,636; Marshall Street, 9,448. Sterilisation of Water in Public Swimming Pools.—The Baths and Washhouses Committee requested the Medical Officer of Health to inquire whether the present methods employed for the purification of the water in the City Council's Swimming Pools could in any way be improved in the light of modern developments. At that period trial tests were being carried out at one of the City Council's pools with the chloramine (chlorine-ammonia) method of sterilisation, and finally comparative tests of the chlorine and chloramine methods of treatment were arranged and carried out at the Marshall Street Baths. The following is a summary of the results obtained:— (1) The use of chloramine has a definite advantage over chlorine in that the stated level of bactericidal action is maintained, particularly in the deep end of the baths. (2) A satisfactory bactericidal action can be maintained with chloramine while materially lessening the smell and other unpleasant effects of chlorine in the baths. (3) The value of the residual chlorine, using the chloramine method, must be considerably higher than with chlorine alone, and the level should be maintained at not less than 0.9 parts per million, This point must be taken into consideration when evaluating the methods from an economic standpoint. (4) Owing to the binding action of ammonia, this higher level should be attainable without a gross increase in the use of chlorine. (5) It was observed from a comparison of the chlorine content under the two methods that the chlorine is more evenly distributed in the water when incorporated with ammonia while when chlorine alone is used the water at the deep end is somewhat deficient in chlorine. That is to say, whilst the water at the shallow end and perhaps the middle would be sterile that at the deep end would not have the same degree of purity when the pure chlorine is used. 71 (6) Again with chloramine the water retains its sterility for a much longer period than with chlorine alone, e.g., water containing 0.5 parts per million when the baths are closed at night time would be found to contain very little chlorine on the following morning, whereas with chloramine the depreciation of chlorine would be very small. Other methods of sterilisation were investigated, and the Medical Officer of Health is indebted to the London School of Hygiene and Tropical Medicine for the assistance rendered by them in furnishing data of the methods and experiments carried out in other countries, including particularly that of ozonisation. In the result the Medical Officer of Health was able to report that so far there was no conclusive evidence available of the advantages of ozonisation as a sterilising agent of water in public swimming pools. The high cost of the installation of the necessary plant may be one reason for retarding its adoption. The chloramine method was accordingly installed at the Marshall Street Baths. Regular reports submitted by the bacteriologist on the condition of the water in the Council's swimming pools go to show that the water in the pools is maintained at a high degree of purity throughout the year. Mosquitoes.—In the early part of the summer several complaints were received from residents and others in the neighbourhood of Chelsea Gardens of nuisance by mosquitoes. Investigation by the Sanitary Inspector having failed to reveal the breeding ground, the City Council arranged for an expert entomologist from the London School of Hygiene and Tropical Medicine to undertake an investigation and to report upon any methods of prevention necessary. The entomologist reported that his first visit to the area was on the 9th May and the inspection continued until the 29th June. Between those dates he heard many complaints of mosquito "bites" and the effects thereof upon the complainants. Tubes for the collection of specimens were distributed and among the insects obtained were non-biting midges (Chironomus) and some mosquitoes, all of which were female (Culex Pipiens). A number of the mosquitoes contained blood and some in fact were caught feeding on humans. Every likely source of breeding place was searched and examined including the London County Council Pumping Station, the City Council's Stone Yard, Refuse Disposal Depot at Grosvenor Canal, and Disinfecting Station, a barge repairers' enclosure and the premises of a large firm of builders. (9069) F 2 72 The Entomologist's conclusions were as follows:— "No larvae or pupae of Culex pipiens were found in any of the water collections examined ; neither was any evidence (such as larval or pupal skins) obtained to show that Culex pipiens had ever bred in the past in such water collections. It is therefore my opinion that the area investigated is entirely free of the breeding places of this insect, and that they must invade the area from breeding places outside the boundaries of the City of Westminster." The area affected abutted on the Borough of Chelsea, and was near certain Government buildings in that Borough, and Battersea Park. The Medical Officer of Health of Chelsea was therefore communicated with, as also were the Minister of Health and the Medical Officer of Health of the London County Council. Investigation by the Chelsea authorities, by officials of the Government and by the London County Council failed to discover any breeding grounds in the areas over which they had control, but certain precautionary measures were taken by those authorities. Drainage and Sewerage.—During the year 1,080 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 but in itself is no indication of the extent of the work which supervision of drainage under the two sets of by-laws entails. While one drainage plan may indicate the addition of a bath and w.c. in a small house another plan for single premises may represent the drainage scheme for 300 flats or offices. The new Dolphin Court advertised as the largest block of fiats in Europe is a case in point. It will contain 1,250 separate dwellings with some 7,000-8,000 sanitary fitments, special arrangements for water supplies, the discharge of waste water from swimming pools, heating and cooling plants etc. Close supervision of the progress of the work in this building would require the whole time of a sanitary inspector every working day during the two year period of construction. 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. Considerable experience has now been obtained of the operation of what is known as the "one-pipe" system of drainage, now permissible under the new by-laws of the London County Council. This method of draining large blocks of buildings such as are erected in Westminster is very popular and in many instances effects a reduction in cost. 73 New Sanitary Construction.—Of the 1,080 plans relating to drainage and other sanitary works, 94 represented sanitary provisions in entirely new buildings. The corresponding figures since 1931 are as follows:— Table LXIIT.—Drainage and other Sanitary Works. — 1931. 1932. 1933. 1934. 1935. Plans 748 757 926 935 1,080 Plans of work in new buildings included in above 71 68 96 102 94 Combined drainage orders were made in 24 cases. Infringements of the by-laws were reported by the sanitary inspectors in 25 instances in respect of failure to give notice of intention to construct or to deposit plans. In 9 cases the builders concerned were cautioned. In two others, where the work had been carried out in a manner contrary to the by-laws, prosecutions were ordered. One defendant was fined a total of £18 2s. 0d. (9 summonses), and the other £4 1s. 0d. (2 summonses) including costs. 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. Of these 4 for men and 2 for women are open both day and night. Free conveniences for both sexes are provided at all establishments. 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:— "Refuse Collection.—There is a daily collection of refuse throughout the City and the quantities collected and barged away during the year ended 31st March, 1936, were as follows:— tons. House refuse 94,212 Trade refuse 1,819 Total 96,031 74 Modernisation of Transport.—The scheme for the complete modernisation of the Council's transport approved by the Council in December, 1933, is being carried out over a period of four years, partly in order that each new type of vehicle purchased may be thoroughly tried out under working conditions before further quantities are purchased, and partly in order that the capital outlay may be evenly distributed over a lengthy period. The "Mechanical Horse" motive units purchased in the previous year proved very suitable for all types of work on which they were employed and a further 17 have therefore been put into commission. The Refuse Collecting Bodies and Street Washing Tanks designed for operating with these Units have also proved very efficient and 18 Refuse Collecting Bodies and 11 Street Washing Tanks were in operation at the end of the year under review. With regard to horse transport, exhaustive tests having proved that this was more costly and less efficient in operation than motor transport for the Council's purposes, it was entirely superseded by motor transport in April, 1935, and the Council's stud of horses and vehicles disposed of. The welfare of the horses sold was duly safeguarded as they were all taken over by the Ada Cole Memorial Stables with the exception of two which were purchased by Frances, Countess of Warwick. With regard to the new type of all-metal orderly truck, of which 80 were purchased in the previous year, a further 90 have now been put into commission and the old type of wooden truck has been practically abolished. Refuse Collection by Container System.—This system of refuse storage collection has proved increasingly popular and demands for its installation have exceeded the rate of delivery which could be obtained from the manufacturers of the Containers and Chassis. Although by the end of the year under review 4 chassis and 167 containers were in operation there is undoubtedly considerable scope for further extension in Westminster and, in view of the large number of hotels, clubs, public buildings, etc., within the City and the continued erection of large blocks of flats, it is impossible yet to estimate to what extent the Container system will eventually supersede the ordinary receptacle. Refuse Receptacles.—In connection with a general reorganisation of the system of refuse collection throughout the City a house-to-house inspection of the types of receptacles in use is now in progress. This investigation has proved that a large number of occupiers of premises are not complying with the By-laws of the City Council and the London County Council made under the Public Health (London) Act, 1891 by (a) not having any refuse receptacles at all and depositing their refuse either in other people's receptacles or in parcels on the public footway; (6) not having a sufficient number of receptacles; (c) using receptacles in a defective and dangerous condition; or (d) using receptacles considerably above the maximum size prescribed in the By-laws, which are too heavy for one man to empty. Difficulty is also experienced with regard to lock-up shops, etc., where receptacles are put out on the public footway in the early evening owing to the fact that the premises are not open until 9 a.m. or later. Apart from the fact that this gives the streets an untidy appearance, the contents of the receptacles are sorted by "totters" and the footways considerably littered thereby. Although these difficulties are being overcome as 75 far as possible by interviews and/or correspondence with the persons concerned, it would appear that further powers will have to be obtained before they can all be effectively eradicated. Refuse Disposal.—The Refuse Disposal Plant which commenced on the 25th September, 1934, is effectively handling the whole of the City's refuse and, as previously mentioned, the centralisation of disposal effected an immediate saving in barging costs, whilst a further saving in this direction may be confidently anticipated. Two more conveyors were added to the Plant during the year, making eight in all, and although nearly 110,000 tons of refuse were handled during the year, the Plant was working well within its capacity. The erection of a new Central Depot, Garage, Stores, etc., is now proceeding and this will completely surround and cover the Plant from public view. Provision has also been made in the plans for the installation of the latest type of Dust Extraction equipment and for the discharge of refuse into the barges to be carried out in an enclosed tunnel with doors for sealing the tunnel at each end when the barges are in position. Both the plant and the barges are frequently sprayed with a fly preventative solution during the summer months which has proved very effective. When the barges are fully loaded they are properly covered with tarpaulins; one contractor is already using barges with fixed coamings and wooden hatches and this requirement will be included in the specification of the new contract for barging the remaining portion of the refuse when the current contract expires. In addition to regular inspection by the Supervisor of Refuse Disposal, the Contractors' dumps to which the City's refuse is taken are periodically visited by Members of the Committee and by the Director of Public Cleansing. The Dumps are also inspected at intervals by representatives of the Essex County Council and satisfaction has been expressed generally with regard to the manner in which they are conducted." 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. Details of inspections and special surveys made under the Housing Acts during the year appear in the Housing Section of this Report. 76 Table LXIV.—Sanitary Inspection. Inspection of premises:— Dwelling-houses— Water-Closets— Directly approached from Primary Inspections— rooms 39 (a) On complaint 891 Accommodation insufficient 132 (b) Infectious disease 586 Water Supply— (c) Housing Regulations, 1925 3,380 Insufficient or unsatisfactory 42 Cisterns dirty and uncovered 118 (d) Housing applications 104 Absence of—in upper floors of tenement houses 4 (e) Other reasons 3,005 Total 7,966 Dustbins— Absence of 72 Re-inspections 24,282 Insufficient 41 Defective 65 Other Premises— Animals kept so as to be a nuisance 17 Primary inspections— (a) On complaint 372 Other nuisances 442 (b) Other reasons 5,430 Dangerous structures noted 13 Overcrowding †1.083 Total 5,802 Sanitary works supervised:— Re-inspections 7,786 Drains (including soil, waste, rainwater nines, etc.)— Sanitary Works— Constructed 4,810 Total Inspections— Altered, repaired, etc 2,115 (a) Under notice 1,759 Intercepting traps fixed 107 (b) Voluntary works 12,087 Petrol interceptors provided 12 Nuisances, etc.:— Tested by smoke 241 „ chemical 316 Defective or dirty conditions „ water 1,739 of internal structure 1,462 „ air 648 Verminous conditions 329 Water-closets— Damp conditions 337 Constructed 2,437 Inadequate under-floor ventilation 38 Repaired and reconditioned Urinals— 505 Defective drainage, water closets, etc. 646 Constructed 399 Repaired and reconditioned 88 „ roofs 273 Water Fittings fixed— „ paving of areas, etc. 102 Baths 1,762 Water-closets— Bidets 131 Insufficiently ventilated or lighted 98 Lavatory basins 3,740 Sinks, etc. 1,507 † This figure represents the result of the survey under the Overcrowding Act, 1935. 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 two hundred persons inspected the register. Twenty-two applications were received for the registration of decontrolled premises on certificates granted by the County Court under Section 2 (4) of the Act of 1933. The number of "dwelling-houses" included in those applications totalled 101. Certificates of registration or non-registration, which local authorities are required to grant on payment of a fee of 1s., have been issued in 77 106 cases, 105 being in respect of registered houses and one non-registered. There have been no cancellations of registration by the County Court. Nuisances.—Intimation notices were served in 1,776 instances, the number of premises concerned being 1,733. Statutory notices authorised by the sanitary authority numbered 89 and related to 88 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. (1) Insufficient ventilation in a workplace; water closet unsuitable and defective, &c. (2) Insufficient ventilation in a restaurant kitchen ; absence of W.C. accommodation. (3) Dirty and defective conditions in a ment house. Result of Proceedings. Abatement order on each of two summonses and £1 1s. costs, one summons withdrawn. Abatement order, £3 3s. costs, one summons withdrawn. Withdrawn on payment of 10s. 6d. costs. (Work completed.) The following are the comparative figures since 1931:— Table LXV.—Nuisances. — 1931. 1932. 1933. 1934. 1935. Intimation Notices 1,244 1,378 1,223 2,060 1,776 Statutory Notices 62 57 50 66 89 Legal Proceedings 5 4 7 3 3 Water Supply.—The Metropolitan Water Board sent 15 notices of withdrawal of water supply to premises, consequent upon the failure of the occupiers to pay the water rate. Appropriate action was taken in each case. Water Supply in Tenement Houses.—Power to effect this provision is given under Section 48 of the Public Health (London) Act, 1891, and under Section 78 of the London County Council (General Powers) Act, 1907. The number of cases in which this action was taken since 1931 is as follows:— 1931. 19 1932. 9 1933. 12 1934. 6 1935. 4 78 London County Council (General Powers) Act, 1935 (Section 67).—The Section of this Act, which came into force in 1935, provides that in the case of all buildings which are either constructed after 1935 or are divided after 1935 into separate tenements and used for human habitation or as a place where persons are employed, the local authority shall require that there is a supply of drinking water direct from the mains, adequate and readily accessible having regard to the number of persons using the building. The Section does not apply to cases in which, owing to the height of the tenement or by agreement the Metropolitan Water Board are not required to supply water for domestic purposes or where the Sanitary Authority are satisfied with a supply obtained from a permanent source other than the mains of the Water Board. By-laws as to Removal of Offensive Refuse.—Two cases were reported and the persons concerned were prosecuted and fined 10s. each. Lighting of staircases in tenement buildings.—London County Council (General Powers) Act, 1927 (Sec. 61)—At four tenement houses lighting of staircases was installed or improved following the service of formal notices. Shops Act, 1934.—This Act came into force at the beginning of the year and as there are considerably over six thousand shops throughout the City the Council in February appointed a temporary Sanitary Inspector to assist in the work of inspection with a view to ascertaining whether the provisions of the Act were complied with. By the end of the year, 1431 shops had been inspected, and the results of these inspections recorded. A total of 318 notices were served requiring the provision of:— Notices. Suitable and sufficient means of ventilation 72 Means to maintain a reasonable temperature 14 Suitable and sufficient sanitary conveniences 140 Remedying other defects 92 Total 318 Housing has occupied so prominent a place as regards inspection that with the existing staff it has not been possible to overtake more than one quarter of the primary inspections required by this statute. It is further to be noted that the Act requires a satisfactory standard of ventilation and heating to be maintained. This obviously implies a need for routine re-inspections. 79 The Act provides that a certificate may be granted exempting a shop from the provision of the Act with regard to sanitary conveniences if the sanitary authority are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable that such a certificate shall be in force and that such conveniences are otherwise conveniently available. Thirteen certificates of exemption were granted. 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 1935, the number of inspections made, and the results of such inspections:— Table LXVI.—Factories, Workshops and Workplaces. Premises Registered. Work Premises. Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,432 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc. 1,410 Leather workers, boot and shoe makers, harness makers, etc. 76 Carpentry, upholstery, carvers, gilders, etc. 91 Surgical and dental instrument makers 6 Tobacco manufacturers 9 Wig makers and hair workers 52 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 64 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 76 Metal workers 79 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 75 Florists 21 Laundries 19 Bakehouses 61 Photographers 58 Jewel case makers 6 Cinema film workplaces 18 Total 3,553 The use of 115 workshops was discontinued, and 238 additions were made to the register during the year. 80 Table LXVII.—Factories, Workshops and Workplaces. Inspection. Premises. (i) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including factory laundries) 384 4 — Workshops (including workshop laundries) 3,315 331 — Workplaces (other than Outworkers' premises) 4,112 369 2 Total 7,811 704 2 Table LXVIII.—Factories, Workshops and Workplaces. 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 229 229 — — Want of ventilation 49 48 — — Overcrowding 17 17 — — Want of drainage of floors 1 1 — — Other nuisances 175 175 — — Sanitarv accommodation— Insufficient 103 103 — — Unsuitable or defective 129 128 — 1 Not separate for sexes 27 27 — — 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 730 728 — 2 81 Table LXIX.—Factories, Workshops and Workplaces. Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 126 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 133 Absence of means of warming — Matters referred by H.M. Inspectors 67 Workrooms measured 263 Visits of Enquiry re Employment of Women 99 ,, ,, Outworkers 110 Underground bakehouses in use at the end of the year 42 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. 82 Table LXX.—Factories, Workshops and Workplaces. Outworkers. 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 934 1,782 7,384 41 25 53 428 5,094 — — — — — — 19 — — Linens, etc. 6 34 55 — — — 16 51 — — — — — — — — — Furriers 7 25 7 — — — — 29 — — — — — — — — — Umbrellas, toys, artificial flowers, etc 3 — 15 — — — 6 21 — — — — — — — — — General Stores, etc. 2 50 26 — — — — 48 — — — — — — — — — Total 952 1,891 7,487 41 25 53 450 5,243 — — — — — — 19 — — 83 Outworkers.—A total of 993 lists was received during the year. Notices in respect of failure to send lists were sent to 126 firms. No legal proceedings were necessary, but six firms were cautioned. The lists contained 9,456 names and addresses, of which 5,243 were in other districts, 4,311 being within the Metropolitan area and 498 in the London Suburban districts. The number of individual outworkers in the City at the close of the year was 1,656, of whom 1,564 were registered as occupying workshops. The number of premises in which outwork was being carried on was 703. 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. Women. 16, Strutton Ground 201 — Bruce House, Kemble Street 716 — 33, Great 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, 1935, to 30th June, 1936. 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, 183 inspections were made, 73 being between the hours of 6 p.m. and 9 a.m. Conditions were generally found to be satisfactory. (2) Seamen's lodging houses. (3) Slaughter houses. There are none in the City. (4) Offensive trades. (5) Cowsheds.—There are no cowsheds in the City, but a temporary licence to keep two cows for a period of 14 days was granted to the Milk Marketing Board in respect of an exhibition held in the Booking Hall of Charing Cross Underground Railway Station. 84 (6) Houses Let in Tenements.—The sanitary inspectors paid 8,127 visits of inspection to houses of this class, which number some 3,350. Legal proceedings in respect of infringements of statutory provisions were taken in one case, as detailed on page 77. (7) Underground Rooms. (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 at these premises during the year. The Commissioner of Police reported an infringement, by an itinerant dealer, of the London County Council's by-law which prohibits the giving of toys, balloons, &c., in exchange for rags, bottles and similar articles, under a penalty of £5. This being the first case of its kind in the City it was decided not to prosecute but to caution the offender. (15) Fried-fish Shops and Fish Curers. (16) Street Traders. (17) Shops as defined in Shops Acts, 1912-1934. Particulars relating to premises and occupations included in the foregoing list, other than those already dealt with, 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. 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. 85 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 the following nine schools additions or improvements were made to the sanitary arrangements during the year :— Ecole de Notre Dame de France. St. Martin's, Adelaide Street. Greycoat Hospital. St. Martin's, Castle Street. Millbank. Warwick Senior. St. Margaret's. Westminster Technical Institute. Westminster School, Dean's Yard. Fouling of Footways by Dogs.—By-law—Eighteen cases of infringement of the by-law were reported to the Council by the Commissioner of Police. In each instance the offender was prosecuted and a conviction obtained. The penalties inflicted varied from 2s. to 10s. and totalled, with costs, £4 14s. 0d. Rat Repression.—During the year 142 complaints were received and investigated, 492 inspections being made by the sanitary inspectors. The Council's rat officer visited 35 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 185 visits to these premises. At the request of the department, the City Engineer's staff examined the sewer connections of some 94 premises, of which 35 were found to be defective and were subsequently repaired or renewed. Several complaints relating to invasion of premises by rats disturbed in the course of demolition operations in adjoining properties were dealt with during the year. The staff of the Works Department have, in addition to laying baits in the sewers throughout the year, treated several small sections of sewers with anti-rat gas. During "Rat Week" in November, circulars of advice on methods of rat destruction and prevention were distributed to householders and others, particularly to those dealing in foodstuffs, restaurants etc. A total of 13,650 baits were laid in the sewers and 993 at the council's depots, etc. The number of dead rats discovered was small, but the baits were reported to have been taken freely. (9069) g 86 Nuisance from Pigeons.—The member of the disinfecting staff whose duties are concerned largely with rat repression and investigation of complaints of nuisances caused by pigeons, visited some 12 sets of premises on complaint and advised owners or occupiers as to measures necessary to prevent pigeons roosting or nesting on or about their property. On being satisfied that congregations of pigeons without owners were causing nuisance in various parts of the City, the Council arranged for a reduction in their number totalling 600 throughout the year. London County Council (General Powers) Act. 1928, Sec. 28—Removal of Infirm and Diseased Persons to Suitable Institutions. Ten cases of elderly persons living alone and unable to devote to themselves proper care and attention came to the notice of the Department during the year, but in none was it found necessary to invoke the compulsory powers contained in this Act. 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 and other 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 for treatment by steam disinfection. Books are treated with formalin. The cleansing of persons and disinfection of their clothing, etc., are carried out by the disinfecting staff. Visits were paid to 171 houses, and 9,789 articles of clothing, bedding, etc., were removed for disinfection. Individuals, numbering 560 men, 55 women, and 14 children (under school age), were given medicated baths at the disinfecting station, making 723 attendances. Under an agreement with the London County Council, some schoo1 children from the boroughs of Battersea, Chelsea, Fulham, Holborn, Kensington, Lambeth, Paddington, St. Pancras, St. Marylebone, and Southwark attended for treatment at the disinfecting station. Among Westminster school children 399 cases of head lice, and 27 of scabies were treated. In all these cases, the clothing was disinfected, together with the bedding from their homes, amounting in all to 1,230 articles. Children from the above-mentioned boroughs treated for similar 87 conditions were as follows: 180 for head lice, and 16 for scabies. The total number of attendances of school children for baths at the disinfecting station was 1,204. Articles of clothing disinfected numbered 604. The following table shows the total number of individuals treated at the station for verminous conditions: Table LXXI.—Cleansing of Verminous Persons. 1935. Head lice. Body lice. Scabies. Total. Children (including those under school age). 579 2 55 636 Adults 8 548 59 615 587 550 114 1,251 Fumigation of Furniture.—In the Report for 1934, reference was made to the steps being taken by the Council to deal with the problem of the bed bug, particularly in relation to the re-housing of families in the Council's new dwellings. A van of special design for the fumigation of furniture was ordered and was delivered in the latter part of 1935. This van consists of a metal body of some 700 cubic ft. capacity, mounted on a trailer chassis for transportation by "mechanical horse" units in use by the Highways Department. Double doors are provided at the rear end and a porthole some 2 ft. by 1 ft. in front for the purpose of ventilation after fumigation. In order to gain experience of the various methods of fumigation by hydrocyanic acid gas, three firms specialising in this class of work were invited to undertake a number of fumigations in the Council's van. The furniture and effects of some 17 families were dealt with, bedding and similar furnishings being removed to the Disinfecting Station for treatment by steam disinfection. The Council, having considered reports of the results of these experimental fumigations, decided to invite tenders for the removal and fumigation of the effects of some 128 families proposed to be rehoused in the Council's new dwellings which were nearing completion at the end of the year. The firms concerned were asked to quote for the complete operation of removal of furniture from the old dwellings, fumigation and transfer to the new dwellings. A contract was entered into on this basis with a firm who carry out the fumigation by means of a special plant housed in a (9069) g 2 88 small building erected in the yard of the Council's Depot at Monck Street. This consists of an apparatus for first warming the air inside the van to a controlled temperature and the subsequent introduction of gas at the required concentration. The apparatus is so designed that the operation can be carried out with the minimum of risk to the operator. The van having been charged with gas is left for a period of some three hours after which heated air is again employed under controlled pressure to eject the residual gas, this operation being effected by means of a ventilating tube in the roof. This latter operation is maintained for a prescribed period during which it is calculated that all accumulations of gas have been eliminated. The van is then opened up and tests for the presence of gas are made with certain chemical re-agents. If these prove satisfactory, the van proceeds to the new dwelling to unload its contents. Further tests are then carried out to ensure that the furniture is free from concentrations of gas, particular attention being paid to articles in which gas is likely to be retained, such as upholstered articles, wardrobes, etc. Bedding and similar furnishings are subjected to disinfection by steam at the Council's Disinfecting Station. The furniture and effects so treated have been periodically reinspected but in no case has there been discovered any recurrence of vermin. The Council has provided furnished accommodation in its own dwellings for families who may require temporary accommodation whilst their effects are being disinfected, but it is found from experience that in the majority of cases they prefer to make their own arrangements. The work under this contract had not been started before the end of the year owing to the flats not being ready for occupation but a commencement was made in the middle of February, 1936. The disinfecting staff dealt with the bedding of some 50 families, who were rehoused in the dwellings of the London County Council and the Westminster Housing Trust, the furniture and effects being disinfected by those bodies. Table LXXII.—General Disinfection of Premises, Articles, etc. 1931. 1932. 1933. 1934. 1935. Rooms 613 781 747 1,058 674 Articles disinfected 22,004 22,314 21,598 22,174 22,759 Articles washed 3,576 3,690 3,500 3.450 3,800 Articles destroyed 424 1,020 2,218 300 281 Books disinfected* 62 276 723 132 421 Vehicles ,, 7 6 4 15 38 Offices and business premises 15 11 6 6 11 *Library books, 45; private books, 106; school books, 270. 89 Motor Disinfecting Van.—The motor van during 1935 completed 4,813 miles, carrying 3,098 cwts. of goods. Coroner's Court and Mortuary. There were 244 bodies removed to the mortuary during the year by order of the Coroner or to await burial. Inquests were held in 138 cases but not in 88 while 3 bodies were received to await burial. Post-mortem examinations were made in 146 instances. The following is a list of the causes of death of 244 cases brought to the mortuary:— Drowning 16 Street accidents 34 Other accidents 22 Murder 2 Suicide 43 Natural causes 80 Misadventure 33 Other miscellaneous causes 14 During the year repairs and decorations were carried out at the Court and Mortuary premises at a cost of £577. The works included the renewal of the floors in the Court, post mortem and viewing rooms, etc., the rewiring and replacement of certain electric light fittings, internal and external painting and a general overhaul of the roofs and of the fixtures and fittings inside and out. The premises are so well equipped and up to date that representatives from several other local authorities have paid visits of inspection. In June, the Chairman of the special committee, Mr. H. S. E. Vanderpant, who dealt with the improvements, invited a company of interested parties including representatives from the Ministry of Health, London County Council, the City of London, the London School of Hygiene and Tropical Medicine, the Coroners of the City of London and Westminster and certain eminent pathologists to meet the Chairman of the Public Health Committee and other representative members of the City Council. After being entertained at lunch the party was conveyed to the Court for a visit of inspection. 90 HOUSING. In the Report for 1934 it was pointed out that housing had grown to occupy such an important place in the work of the Public Health Department that, in consequence, it was likely to be found necessary to retain in some form or other the special staff organisation which was instituted for the purpose of the earlier survey under the 1930 Act. This has been done and a distinctive section of the staff has been formed within the department, and, it is satisfactory to report, functioning efficiently. Reference has been made in previous reports to a comprehensive Housing survey of working class dwelling houses carried out under the provisions of the Housing Act of 1930. This was initiated late in 1933 and completed in July, 1935. The object of this survey was to ascertain within a reasonably limited period any areas which might be considered suitable for clearance in addition to those already scheduled for such action, and generally to assess the housing needs of the working class population of the City. Particular attention was paid to basement occupation, overcrowding and otherwise unsatisfactory accommodation due to insanitary or other defective structural condition of houses and absence of reasonable amenities. During the course of the survey, 7,021 houses in 293 streets were inspected and classified as follows:— Houses let in tenements 4,720 Tenements combined with business premises 1,482 Flats over Garages, Mews, etc. 589 Cottage type 230 The large blocks of dwellings in the ownership of the City Council, the London County Council and Public Utility Societies and Trusts were excluded from this survey because apart from any incidental overcrowding housing conditions in them did not call for special attention. Valuable information has been obtained from the survey, some of the most useful points being:— (a) the number of families and the population living in working class houses, the distribution of such families and the localities in which the principal wage earners are employed; (b) details concerning the lay-out and condition of every basement, together with the manner of occupation; 91 (c) particulars of measurement of all rooms. (This work was carried out partly in anticipation of the provisions of the Housing Act, 1935, which became operative in August of that year) ; (d) the exact location of the water supplies, water closet tion, the extent of food storage accommodation, cooking and washing accommodation ; and (e) other general conditions. The Housing Act of 1935 which, as before stated, became operative in August, 1935, placed on local authorities the duty of assessing the extent of overcrowding in the working class dwellings in their respective areas; and, so far as the Metropolitan Boroughs were concerned, vested in the London County Council the duty of directing those activities as to the rate of progress in collaboration with the Metropolitan Boroughs. The London County Council ordained, perhaps wisely, that a survey of overcrowding for London as a whole should be simultaneous and fixed November, 1935 for its commencement. Accordingly the City Council instituted a further survey, during November and December, to ascertain the exact number of overcrowded families living in the City. This survey took the form of a somewhat rapid enumeration of every working class family, including those living in the block industrial dwellings, which latter were not included in the previous housing survey. The collaboration throughout between the officials of the City Council and those of the London County Council in this connection was completely harmonious. It was foreseen that as the necessity would later arise for the enforcement of the provisions of the Act of 1935, the City Council should be in possession of the measurements of all rooms in the working class dwellings of the City. This work was completed before the end of the year, and by that time complete records of the measurements of all rooms in working class dwellings in its area had been obtained. It is important to realize that until such information is at the disposal of the local authority it is not possible to supply owners of houses with details of the number of persons who can be permitted to occupy any particular accommodation ; until owners are so supplied the overcrowding provisions of the Act cannot be enforced. The Minister of Health has power to fix an appointed day, from which date the overcrowding provisions of the Act of 1935 shall come into operation. Following the two surveys it may be said that housing conditions in working class dwellings in the City generally are steadily improving. 92 Overcrowding in itself is fairly symptomatic of bad housing. Where gross overcrowding exists housing conditions generally are invariably bad ; there is a very proximate correlation between them. It has always been held that overcrowding is not a major problem in Westminster and the very close and exact investigation now completed confirms this premise. The following figures given by the Registrar General at the censal periods clearly shows the decline in overcrowding over a period of 20 years. Population in Westminster of persons living at a density of more than 2 persons per room. 1911 16,596 1921 11,364 1931 7,223 Among London boroughs, Westminster with 4.2 per cent. now stands well. Those showing less overcrowding are the suburban districts of Hampstead, 2.4 per cent., Woolwich, 2.7 percent., Wandsworth, 3.2 per cent., and Lewisham, 3.3 per cent. In such a central area as Westminster where the demand for housing near places of work is so great the City Council may take credit for the administration of the public health during those decades during which the nuisance of overcrowding has so impressively diminished. The surveys have likewise revealed the upward trend in housing conditions in working class dwellings which has been revealing itself during the past ten years. This may partly be due to better ownership, but also in great measure to a growing sense of responsibility among the tenants; the results perhaps of improved education, greater social consciousness and sobriety. Houses Let In Tenements. In those of the better type in this category coming within the application of the London County Council by-laws it is found that no less than 56 per cent. have baths and in only 25 per cent. can it be said that water supply is not readily accessible to every tenant. It is important to note that there has been an increase in the provision of these and other amenities since 1926 when the by-laws came into force. Other factors responsible for the improvement of housing standards may be those established by the Council itself in its working class dwellings, and the special requirements laid down by Parliament in the post-war Housing Acts. 93 In the majority of instances in these working class houses in the City the structure is in a fair state of preservation, but considerable variation exists in regard to the internal fittings, accessibility of sanitary accommodation, water supply and other amenities. It is encouraging to note that there is a definite tendency on the part of owners of this class of house to increase and improve amenities for their tenants. Prospective tenants are more and more inclined to expect baths or other conveniences for washing, proper provision for cooking, food storage, etc. Nevertheless it is evident that, by comparison, there are few which approach the standard of convenience and comfort existing in the City Council's own flats. The general conditions of cleanliness are dependent to a large degree upon the tenant. Many take pride in the upkeep of their homes; others through carelessness or ignorance, allow their dwellings to become dirty and verminous. In some instances neglect on the part of owners reacts on the occupiers, who may become likewise inured to dirty and unsatisfactory surroundings. But this is becoming less frequent than was the case some years ago. Undoubtedly the moral effect of the Housing Survey, apart from the actual service of notices, has played some part in creating a desire for cleanliness and better conditions on the part of both owners and tenants. The most unsatisfactory type of tenant is nearly always found in badly maintained houses. The reason for this may well be that owners become discouraged in constantly re-decorating, carrying out repairs, etc., for tenants, who through neglect or carelessness, fail to take sufficient interest in their homes to keep them clean and tidy. This comment, however, does not apply generally to basements. These are sought by tenants who are often unable to pay the rents of rooms above ground level, or who have families of young children and find the lower rents and separate entrances more advantageous. In these dwellings the average rent including basement rooms may be put at 6s. 8d. per room. This compares unfavourably with that of the Council's dwellings at 4s. 3d. per room. Tenements Combined with Business Premises. This type of working class dwelling is to be found chiefly in the northern wards of the City and may be roughly divided into two classes ; selfcontained flats and ordinary rooms occupied as a tenement. The dwelling rooms are sometimes over shops; in others they form part of the business or are let off for that purpose. 94 The self-contained flats produce a higher rent and the conditions are usually unexceptionable. The other tenement dwellings in these buildings are, in many instances, not very satisfactory ; having all the defects found in the lower grade houses let wholly in tenements. Flats Over Garages, Mews, etc. On the whole, conditions can be described as more or less satisfactory in this type of dwelling. The principal defect found to exist in the least satisfactory is the restriction of light and free circulation of air. Dwellings in this category in Trinity Mews were the subject of closure largely on account of this defect. A marked change in the occupation of dwellings over mews, etc., has been observed during recent years. When working class families move out, particularly in certain districts, the premises are often re-conditioned and re-let at rentals well beyond the means of working-class families. Cottage Type. This type of dwelling is rapidly disappearing from the City. Within the past few years over 300 of such dwellings have disappeared owing to the action taken by the City Council in various ways—for example Millbank Improvement Scheme, Clearance Orders or by negotiation with owners. Cottages in the following areas have been closed or demolished for these reasons during the past few years:— Number. Number. Millbank 128 Horseshoe Alley 22 Cottage Place 13 Commercial Place 5 Tylers Court .. 4 Ross Street 27 Douglas Place 16 Wilton Road Area 75 Lancelot Place 11 Other isolated properties of this description 6 Sooner or later other similar vestiges of Westminster of the 'fifties of last century will disappear. There are still a few closes and alleys of small cottages fringing on the great houses of Belgravia. Almost all have a patch of garden and some even a few square yards of lawn. There is one such oasis not far from what was once the leafy garden of St. Michael's vicarage. In summer there are flowers and quietness but in winter the prospect is less inviting; perhaps dampness and mustiness indoors. They are just country cottages, although many years have 95 passed since privies gave place to modern W.C.s. The structures are aged and decaying and while frequent repairs try to keep pace with defects, maintenance must be relatively costly. In a changing world should they remain as a hostage to the days that are past ? Must seclusion and quiet be paid for by damp and ageing structures? Life in modern flat dwellings cannot give that repose but it can offer other conditions more conducive to health. Block Dwellings. There are nearly 8,000 of these dwellings in the City including 1,316 belonging to or under the direct control of the City Council. With very little exception this type of property is well managed and maintained, and, apart from some overcrowding, gives little concern to the Public Health Department. Basements. Basement occupation exists only in two types of dwellings : (a) Houses let in tenements, and, to a lesser degree, (b) Tenements combined with business premises. At the time of the housing survey the provisions of the City Council's Regulations as to underground rooms applied only to rooms habitually used for sleeping purposes; but the Housing Act of 1935, which became law in August, 1935, immediately following the completion of the survey, altered the position. Under this Act any underground room which does not comply with the Regulations is to be deemed to be unfit for human habitation, and thus the question as to whether such room is used habitually as a sleeping place no longer arises. Of the total number of premises inspected during the survey 5,301 were basement houses, and of this number 1,257 basements were found to be used for business purposes, stores, etc.: 755 complied with, and 3,289 contravened to a greater or lesser extent the provisions of the City Council's Regulations as extended by the provisions of the Housing Act 1935. In approximately one-half of the number the basement rooms were occupied as living rooms, kitchens, etc., in conjunction with other rooms in the house. Defects in Basements. During the course of the survey dampness was found to be the predominating cause of complaint in occupied basements. 96 Dampness in this particular type of dwelling varies considerably from time to time, being in some measure seasonal. At one inspection a basement may appear to be perfectly dry, but at the subsequent inspection, even within a week or two, serious dampness may be found. Various factors tend to create these circumstances, for instance, after long periods of continuous rain basements are found to become increasingly damp particularly if they have remained vacant for a time and therefore without domestic fires whilst those in which fires have been kept burning during inclement weather are often less seriously affected. No doubt condensation plays a considerable part in creating dampness but again this can be obviated by the ventilating action of a brisk fire. Advancing age with the resultant decay of the structure also plays a part in encouraging dampness to permeate walls and floor timbers. Another factor which must be mentioned with regard to basements, particularly those which are occupied as separate dwellings, is that of the back rooms at yard level. These do not appear to fall within the definition of underground rooms under the provisions of the Housing Acts and Regulations. Nevertheless in some instances they have been found to be darker and as damp as the front rooms, because of the back addition rooms on the floor above which project outwards over the back yards thus cutting off light and ventilation. Therefore, in considering as to whether a basement in its entirety is unfit for human habitation the whole circumstances must be taken into account. Overcrowding Survey. The information obtained during the Overcrowding Survey was assessed on the standards laid down in the Act of 1935, which are as follows:— First Schedule. "For the purpose of this Act the expression ' the permitted number of persons ' means, in relation to any dwelling house, either:— (a) the number specified in the second column of Table I in the annex hereto in relation to a house consisting of the number of rooms of which that house consists, or 97 (b) the aggregate for all the rooms in the house obtained by reckoning, for each room therein of the floor area specified in the first column of Table II in the annex hereto, the number specified in the second column of that Table in relation to that area, whichever is the less. Provided that in computing for the purpose of the said Table I the number of rooms in a house, no regard shall be had to any room having a floor area of less than 50 square feet." Annex. Table I. Table II. Where a house consists of:— Where the floor area of a room is:— (a) One room 2 (a) 110 sq. ft. or more 2 (6) Two rooms 3 (b) 90 sq. ft. or more but less than 110 sq. ft. 1½ (c) Three rooms 5 (c) 70 sq. ft. or more, but less than 90 sq. ft. 1 (d) Four rooms 7½ (d) 50 sq. ft. or more but less than 70 sq. ft. ½ (e) Five rooms or more 10* (e) under 50 sq. ft Nil *with an additional 2 in respect of each room in excess of five. In addition the Act provides that a dwelling house shall be deemed to be overcrowded when the number of persons sleeping therein is such that any two of those persons being over 10 years of age and of opposite sexes and not a man and wife must sleep in the same room. Only 4 cases of overcrowding of this description were found during the survey. 98 The families recorded on the left of the thick diagonal .line are all overcrowded and the worst cases of overcrowding are those farthest from the line. The families recorded to the right of the line are families not overcrowded. HOUSING ACT, 1935.-OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. CITY OF WESTMINSTER. Size of lent number of persons). Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Total* of Families. *0 *½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over. Overcrowded. Not Overcrowded. Total. 1 – – 156 3,932 1,526 1,791 318 – 583 2 80 – 209 – 2 8 37 – – 17 2 – 7 – – – 8 – 8,678 8,678 1½ – – 27 4 23 27 33 – 6 2 3 – 3 – – 1 – – – – – – – – – – – 27 102 129 2 – – 16 46 1,038 2,937 835 3 1,888 32 282 – 594 7 13 26 173 4 6 87 4 – 10 – – – 39 †68 7,974 8,042 2v – – 1 23 29 16 660 3 398 10 60 1 110 1 1 6 22 – – 10 – 1 – – – – 4 53 1,323 1,376 3 – – – 6 21 13 890 2 1,483 ——— 24 194 1 569 5 17 42 160 2 7 92 6 1 32 – 1 – 36 40 3,564 3,604 3½ – – – 1 8 92 57 1 267 6 40 – 95 2 5 8 18 1 1 6 2 – 3 – – – 1 153 456 614 4 – – – – 1 131 100 4 23 39 536 1 475 11 19 39 152 5 6 72 6 – 22 1 – – 24 236 1,431 1,667 4½ – – – – – 34 23 – 5 11 125 7 97 2 5 4 20 – – 6 – – 4 – – – 5 62 286 348 5 – – – 1 2 25 36 – 8 10 225 1 221 1 11 16 115 1 4 47 3 – 11 2 – – 25 82 683 765 5½ – – – – – 7 11 1 44 5 3 1 35 2 3 4 16 – 1 5 1 – 2 – – – 3 71 73 144 6 – – – – – 10 5 – 78 – 15 1 7 11 24 48 57 – 2 18 4 – 8 1 2 – 21 109 203 312 6½ – – – – – 2 3 – 26 1 7 1 1 3 9 15 20 – – 8 2 – 2 – – – – 41 59 100 7 – – – – – 4 1 – 21 1 6 3 4 2 7 34 25 1 4 7 3 – 4 – – – 5 42 90 132 7½ – – – – – – 1 – 4 – – – 3 – 6 14 12 1 – 2 – – – – – – 1 14 30 44 8 – – – – – – – – 5 – 3 1 18 – 2 3 3 2 4 12 7 1 5 – – – 14 32 48 60 8½ – – – – – – – – 2 – 1 – 13 – 1 1 – – 3 7 3 – – – – – 1 18 14 32 9 – – – – – – 1 – – – 2 – 4 1 – 1 – 1 3 9 1 – – – – – 6 10 19 29 9½ – – – – – 1 – – 1 – – – 1 1 – – 1 – – 3 1 – 1 – – – 3 5 8 13 10 – – – – – – – – 1 – – – 1 – – 3 1 – 1 – 2 –- 2 – – – 4 7 8 15 10½ – – – – – – – – – – – – 1 – – – 3 – – – – – – – – – – 4 – 4 11 – – – – – – – – – – – – 2 – – – 1 – – – – – – – – – 2 3 2 5 11½ – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 12 – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – 1 1 12½ – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 13 & over – – – – – – – – – – – – – – – – – – – 1 – – – – – – 1 1 1 2 TOTAL OF DWELLINGS CROWDER – – 44 79 t65 319 238 5 195 17 37 6 48 4 9 8 6 1 1 1 – – – – – – – 11,083 NOT CROWDER – – 156 3,936 2,563 1,771 2,756 9 4,648 126 1,545 12 2,416. 45 116 265 830 17 41 408 47 3 113 4 4 – 203 25,053 TOTAL – – 200 4,015 2,648 6,090 2,994 14 4,643 143 1,582 18 2,463 49 125 273 836 18 42 409 47 3 113 4 4 – 203 26,136 *0 = a dwelling of 1 room under 50 square feet: ½ = a dwelling of 1 room between 50 and 70 square feet (see preamble, p. 1). †Including 4 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 99 Summary showing the number of families found to be overcrowded and the distribution of such overcrowding in the wards of the City:— Ward. Total No. of Families. No. of Families Overcrowded. Percentage of Overcrowded Families. Per cent. Charing Cross 350 5 1.4 Conduit 87 2 2.3 Covent Garden 1,211 71 5.8 Great Marlborough 346 31 9.0 Grosvenor 766 8 1.0 Hamlet of Knightsbridge 283 5 1.7 Knightsbridge St. George 1,968 22 1.1 Pall Mall 15 — — Regent 804 70 8.7 St. Anne 1,368 81 5.9 St. Margaret 777 41 5.3 St. John 5,734 318 5.5 Strand 20 — — Victoria 12,407 429 3.4 26,136 1,083 4.2 100 In order to give a comparative indication of the incidence of overcrowding in the County of London, the following table, which gives the extent of overcrowding in each Metropolitan Borough in relation to overcrowding in London as a whole, has been prepared by the London County Council. The table gives the proportion which the "equivalent number" of persons living in overcrowded conditions bears to the estimated total "equivalent population" in each borough. Metropolitan Borough. Number of overcrowded families. Number of " equivalent persons " overcrowded. Proportion of estimated total " equivalent population " in the Borough overcrowded. Per Cent. Battersea 1,968 10,371 7.4 Bermondsey 3.163 17,042 17.8 Bethnal Green 3,894 20,219 21.7 Camberwell 2,950 15,706 7.1 Chelsea 749 3.661 6.6 Deptford 1,317 6,604 7.1 Finsbury 2,458 12,187 20.5 Fulham 1,795 9,323 6.9 Greenwich 1,091 6,356 7.1 Hackney 2,651 13,600 6.9 Hammersmith 1,728 8,182 6.8 Hampstead 449 2,063 2.4 Holborn 700 3,226 9.4 Islington 6,757 31,941 11.2 Kensington 2,529 11 786 7.0 Lambeth 3,881 19,798 7.5 Lewisham 10,57 6,728 3.3 Paddington 1,998 8,879 6.7 Poplar 4,080 22,386 16.8 St. Marylebone 1,619 7,364 8.4 St. Pancras 4,464 20,712 11.8 Shoreditch 3,898 19,353 23.6 Southwark 4,096 20,478 14.0 Stepney 7,632 38,864 19.7 Stoke Newington 462 2,193 4.6 Wand worth 1,801 10,333 3.2 Westminster 1,083 5,030 4.2 Woolwich 683 3,606 2.7 Total for County of London (i.e., exclusive of the City of London) 70,953 357,989 9.1 101 In addition there were four families occupying a one-roomed dwelling each, and who were socially overcrowded, i.e., although not overcrowded under the standards of measurement of rooms as prescribed by the Act have insufficient accommodation for the proper segregation of the sexes. Details concerning 17,641 families who were occupying the 7,021 houses were recorded, and represented a population of 39,075, including 3,508 children under 10 years of age. 4,167 families were living in furnished rooms, the majority of whom were single persons. 163 working class families were living in houses in which the basements only were inspected, the other portions of the houses being occupied by families who would not fall within the definition of working class. 1,350 houses are let either wholly or in part as furnished lodgings. Of the total number of working class families living in the houses inspected, it was found that approximately 60 per cent. of the principal wage earners were engaged in employment within the City. The occupations of these wage earners were found to vary very considerably, particularly in the Victoria Ward, whilst in Soho the occupations are confined within narrower limits e.g., hotel and club workers, market porters and persons engaged in the tailoring trades. The approximate rent paid in working class dwellings in the northern wards average 7s. 9d. per room, whereas in the Victoria, St. John and St. Margaret Wards the average is 5s. 10d. per room. Clearance, Demolition and Closure of Unfit Habitations. Orders as to clearance, demolition or closure have been made in respect of the following areas or houses:— The Minister of Health, after Inquiry, confirmed Clearance Orders made by the City Council in respect of houses in the under-mentioned areas. Wilton Road Area.—74 dwelling houses consisting of old cottage property in an advanced state of decay, and occupied by 61 families. Lancelot Place.—11 dwelling houses consisting of old cottage property occupied by 11 families. Laundry Yard.—Demolition Orders were made in respect of Nos. 3 and 4 Laundry Yard. The tenants will be rehoused by the City Council. Goodwin's Court.—Statutory Undertakings that the premises should not be used for habitation until they shall have been rendered fit for that purpose to the satisfaction of the City Council were accepted in lieu of (9069) h 102 Demolition Orders in respect to 9 houses in Goodwin's Court and one in Bedfordbury. The tenants will be offered accommodation in the City Council's dwellings. Unfit parts of buildings and underground Rooms.—Sixty-four Closing Orders were made prohibiting the use of parts of buildings for human habitation, and in two instances statutory undertakings were accepted that the rooms would not be used until rendered fit to the satisfaction of the Council. Sixty-five of these referred to basements. In 55 additional cases the necessary procedure for closure was in process at the end of the year so that formal action had been applied to 120 basements. Some 30 basements were closed or reconditioned as the result of informal action bringing the total basements dealt with up to 150. It was found necessary in two instances to take legal proceedings in respect of the non-compliance with closing orders. Three applications were made and granted by the Council for dispensation from the requirements of Section 96 of the Public Health (London) Act 1891 for a period of one year. During the year, 587 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. This useful procedure acquainted owners of the trend of the Council's policy and in some cases made a prelude to formal action. Provision of New Houses for the Working Classes. Grosvenor Housing Scheme.—The last block (Bennett House), consisting of 96 flats, was nearing completion in December and will be ready for occupation early in the new year; thus completing the 616 working class flats in the Scheme. Ebury Bridge Housing Estate Extension Scheme.—The first block in this scheme was well in hand and the second block commenced by the end of the year. The 106 flats contained in these blocks will be ready for occupation in March and June 1936, respectively. The whole scheme provides for the erection of 280 flats; and when completed will provide accommodation for over 1,300 persons. Tachbrook Estate.—This estate, owned by the Westminster Housing Trust Ltd., has been completed and consists of 180 flats. Peabody Estate, Orchard Street.—A block of 15 flats was completed during the year and, in accordance with the conditions of the grant of the lease, the City Council exercised its right in nominating the tenants. 103 Underground Rooms—Rehousing.—The number of families rehoused from basements during the year was as follows:— By the City Council 20 By the London County Council 11 By other housing authorities or found accommodation themselves 61 Rehousing Operations.—During the year 87 families were rehoused by the City Council and 88 by the London County Council, making a total of 175 families. The estates on which they were accommodated were as follows:— City Council's Estates. Families. Ebury Bridge 13 Grosvenor Housing Scheme 22 Regency Street 47 Schomberg House — Admiral House — Walden House 1 Marshall Street 2 St. James' Dwellings 2 Total 87 London County Council Estates. Families. St. Helier, Morden 34 Becontree, Essex 10 Wormholt, Hammersmith 4 Downham, Lewisham 1 Chadworth Estate, Lever Street 2 Watling, Edgware 4 Millbank, L.C.C. 18 Hon6r Oak 1 Herbrand Street Estate, 1 Clapham Park 3 Roehampton 3 Battersea Bridge Buildings 2 East Hill, Wandsworth 1 Drury Lane 1 Kennington Park 2 Norbury 1 Total 88 (9069) h 2 104 In addition to the above, 40 families were rehoused on the Tachbrook Estate by the Westminster Housing Trust, Ltd. Table LXXIII. 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) 7,966 (b) Number of inspections made for the purpose 32,248† (2)—{a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,380 (b) Number of inspections made for the purpose 12,135 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 249‡ (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 1,042* 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 257 3. Action wider Statutory Powers during the year. A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 0 (6) By Local Authority in default of owners 0 *Notices served in respect of these houses are included in the number shown in 3. B. (1) on page 105. †Including special visits under provisions of Housing Act, 1935. ‡Includes all unfit dwelling houses where formal action has been taken under the Housing Acts. 105 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,174 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,173* (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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (3) Number of dwelling-houses voluntarily demolished 104 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 64 (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 12 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:— *One dwelling-house was the subject of legal proceedings for non-compliance with the requirements of a Statutory Notice. 106 Table LXXIV.—Smoke Abatement—Results of Observations and Action Taken. — 1931. 1932. 1933. 1934. 1935. Complaints received 49 35 63 58 47 Observations taken 854 629 749 875 830 Notices issued— Preliminary 10 11 10 5 22 Statutory 2 2 1 — — Legal Proceedings — 2 — — — There were no prosecutions in respect of smoke nuisances during 1935. 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 Bristol and reported fully to the Committee on the proceedings. Investigation of Atmospheric Pollution.-—Department, of Scientific and Industrial Research, 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. Atmospheric Pollution. Investigations on the state of the atmosphere in 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 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. 107 Table LXXV.—Atmospheric Pollution—Analyses of Deposited Impurities. 1935. Figures in English Tons per Square Mile. Horseferry Road. Mount Street. Finsbury Park. Total Solids. Sulphur SO3 Daily Average. Total Solids. Sulphur. SO3 Daily Average. Total Solids. January 37.07 5.42 1.19 24.20 2.01 0.78 31.21 February 34.52 3.09 1.23 23.49 2.09 0.84 48.36 March 30.34 1.14 0.98 20.18 0.62 0.65 22.45 April 36.06 3.11 1.20 36.75 3.04 1.22 37.58 May 24.74 2.17 0.79 26.62 1.57 0.86 22.86 June 26.24 3.44 0.87 27.55 2.62 0.92 26.22 July 18.33 1.09 0.59 18 .67 1.24 0.60 15.69 August 15.67 1.57 0.51 20.02 1.66 0.65 22.15 September 28.36 2.42 0.95 22.88 2.32 0.76 26.66 October 28.29 2.54 0.91 21.12 1.59 0.68 24.97 November 29.84 3.09 0.99 25.61 2.93 0.85 45. 65 December 30.15 4.06 0.97 25.58 4.15 0.82 52.71 (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 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 1935, together with similar curves for days in 1933 and 1934. It will be seen that there is a peak about 10 a.m. corresponding to the initial lighting of fires and a secondary peak in the early evening, which corresponds with the making up of fires in restaurants, hotels, etc. (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 retained in the solution are subsequently measured by chemical analysis. Chart "B" indicates graphically the amount of sulphur gas correlated with visibility, wind direction and rainfall during 1935. The code used for the "visibility" curve is that issued by the Meteorological Office and is as follows:— 108 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 ,, „ 1¼ miles. 5. Poor, visibility „ „ 2½ „ 6. Moderate visibility „ „ 6¼ „ 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. (4) Measurement of Sulphur Activity.—The type of apparatus in use has been designed by the Department of Scientific and Industrial Research, and gives an indication of the activity of sulphur compounds in the atmosphere. The apparatus consists of a porcelain cylinder around which is bound a piece of fabric impregnated with lead peroxide. This cylinder is exposed to the atmosphere for a period of one calendar month, and sulphur gases which come in contact with it change the lead peroxide into lead sulphate. According to the amount of gaseous sulphurous impurities present, the amount of lead sulphate formed will vary, and from this data can be assessed the injurious effect of such impurities on building materials. Three of these cylinders were installed during the year, one at the City Hall, one at Mount Street Gardens, Mayfair, and one at the Coroner's Court, Horseferry Road. Records have been obtained since March 1st, and are shown in the following table. Table LXXVI.—Atmospheric Pollution—Measurement of Sulphur Activity. Month. City Hall. Mount Street. Horseferry Road. March 3.49 3.52 3.27 April 2.86 2.94 2.57 May 2.09 2.55 1.33 June 1.18 1.37 1.21 July 1.47 1.52 1.40 Aug 1.47 1.48 1.03 September 1.94 1.73 1.57 October 2.84 2.66 2.67 November 3.28 3.05 2.85 December 3.84 4.10 3.93 To face page 108. 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 1935 shown thus Average degrees of suspended matters (mostly dirt) estimated for the years 1933, 1934 and 1935, 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. To face page 108. CHART "B." ATMOSPHERIC POLLUTION. SULPHUR GAS IN THE ATMOSPHERE. Variations throughout the year of SO2 measured by weight, with corresponding readings of rainfall, wind and visibility. Weight of S02 — Visibility Rainfall—TR. = under 0.1 mm. (average is 1.2 mm.). VAR—Wind direction variable. DATE 6.4 11.12 17.18 24.25.31.1 8.9 14.15 21.22 28.1 7.8 14.15 21.22 28.29 4.5 11.12 18.19 25.26 2.3 9.10 16.17 23.24 30 31 6.7 13.14 20.21 27.28 4.5 11.12 18.19 25.26 1.2 8.9 15.16 22.23 29.30 5.6 12.13 1920 26.27 3.4 10.11 17.18 24.25 31.1 7.8 14.15 21.22 28.29 5.6 12.13 19.20 26.27 1 JANUARY,FEBRUARY, MARCH , APRIL , MAY , JUNE , JULY , AUGUST , SEPTEMBER, OCTOBER,NOVEMBER, DECEMBER 1955 WIND DIRECTION NW SW NE SW W NEW SW S E VAR SW NW NV VAR. SW N VAR NE NE NE E SW SW SW SW SW NE W NE S VAR SW SW.SW SW SW SW SW SE SW E SW N SW N SWSW NE N SW RAINFALL - 5 0.1 1.2 -TR - 5- - - - 3 2 2 7.2 - TR. TR - 02 12 1.0 1.0 - - 3.5 5 - - - - - - - - -4 -8 TR0.2 0.5 11.4 2 - 0.3 8 26 1.0 0.1 TR.TR - 0-7 6 MILLIMETRES 109 These figures show the amount of sulphur tri-oxide, in milligrammes, formed on a piece of fabric 100 square centimetres in area, per day, due to the active sulphurous impurities in the atmosphere. INSPECTION AND SUPERVISION OF FOOD. The inspection of food and of premises where foodstuffs are stored or sold receives continual attention. One thousand eight hundred and fourteen samples of various foods and drugs were purchased for analysis, and 2,955 visits were paid to premises where food is sold, stored, or otherwise handled, for the purpose of observations as to condition of food and premises, cleanliness, and methods of handling. Notices numbering 98 were served in respect of various defects, mainly lack of proper cleanliness. There was one prosecution, details of which appear in page 77. In addition, foods sold at Charity "Markets" and Bazaars have been the subject of inspection. Certification of food for export.—Three certificates were issued in respect of the export of food products to Canada. London County Council (General Powers) Act, 1932. 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. Ice cream premises. At the 31st December, 1935, there were 89 premises on the register for the sale or storage of ice cream, of which 25 were also registered for the manufacture of this commodity. Eighteen premises were added to the register. Ninety-eight inspections were made during the year. Twelve samples of ice cream were obtained for bacteriological examination and counts varying from 55 to 4,990,000 colonies per c.c. were reported. The reports are set out more fully in the following table :— Table LXXVII.—Ice Cream—Bacteriological Examinations. Sample No. Colonies per c.c. Bacillus Coli e.c. S.1. 120,000 +0.01-0.001 S.2. 64,000 +0.1 -0.01 S.3. 248,000 +0.01-0.001 S.4. 4,950,000 +0.01-0.001 S.5. 4,990,000 +0.001 S.6. 380,000 +0.0001 N.1. 4,230,000 +0.001 N.2. 240,000 +0.001 N.3. 25,800 +0.01-0.001 n.4. 11,000 -0.1 N.5. 55 +0.01-0.001 N.6. 49,000 +0.01-0.001 110 Samples Nos. N. 3 and N. 4 were obtained from firms who retail ice cream in the City, but manufacture it in other districts. The remaining samples were obtained from persons who manufacture this commodity at premises within the City. Many of these samples were obtained rather late in the summer season, and by the time the results were received from the bacteriologist the majority of the makers had ceased to manufacture ice cream for the year. In those cases where the bacteriologist reported that the sample contained more than 100,000 colonies per c.c. the manufacturers' attention was drawn to the results of the examinations, and it was intimated that if the sale of ice cream was to be continued, considerable improvements would need to be effected in the methods of manufacture, otherwise the Council would have to consider the question of removing the premises from the register. In all except one case, the premises concerned were small shops at which ice cream is sold only during the summer months. Samples No. N.l and N.6 were obtained from the same manufacturer, the latter being taken after improvements had been effected. Preserved meat etc., premises. One hundred and nineteen premises were on the register for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods, five of which were registered during the year. One hundred and sixty-eight inspections were made. One firm of butchers were fined 10s. and ordered to pay £1 1s. costs., for failing to register their premises for the manufacture and sale of sausages. 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. The administration of the 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. 111 Merchandise Marks Act, 1926. The main provision of this Act is that goods imported into this country, in respect of which orders have been made by the Privy Council, 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 506 observations. An infringement of the appropriate order was detected during the Christmas season when at one establishment imported turkeys were found exposed for sale without an indication of the country of origin. Legal proceedings were instituted, but the summons was dismissed under the Probation of Offenders Act on payment of £5 5s costs. Artificial Cream Act, 1929. There are two premises in the City registered under the provisions of this Act. A considerable amount of artificial cream is also made in bakehouses for use in confectionery, and in restaurants for consumption on the premises, but registration is not necessary in these latter cases. Milk and Dairies (Consolidation) Act, 1915. Tubercle in milk—Two samples of milk were taken during the year for examination as to the presence of tubercle bacilli. The milk was taken from shops in the ordinary course of delivery from purveyor to customer. No tubercle bacilli were found in either of the samples. 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 14 Grade A (Tuberculin tested) milk 23 Grade A milk 12 Pasteurized milk 38 Grade A pasteurized milk 2 Ten samples of Certified milk were examined bacteriologically at the request of the Ministry of Health, all of which passed the prescribed tests. Pasteurization is not undertaken at any premises in the City. 112 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 LXXVIII.—Registration of Dairymen and Dairies. Premises. Persons. Registered to 31st December, 1934 176 233 Registered during year 1935 7 8 Removed from register (ceased or transferred business) 8 12 Registered to 31st December, 1935 175 229 The inspectors paid 347 visits to milk shops and dairies during the year. One notice was served in respect of minor defects which were duly rectified. Proceedings were instituted in one instance in which a sale of milk was effected to the Council's Inspector at premises not registered as a dairy. The summons was however dismissed, the magistrate being of opinion that the defendant was not carrying on the trade of dairyman as a regular business. Food and Drugs (Adulteration) Act, 1928. Analysis of Milk Samples.—The percentage of adulterated samples since 1925 is given in Table Ixxix below, together with the results of the samples taken in each of the two districts of the City during 1935:— 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. 113 Table LXXIX.—Analysis of Milk Samples. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. Sn. Percent. No. Per cent. No. Per cent. North 453 95 21.2 305 67.3 47 10.4 5 1.1 South 456 132 28.9 300 65.8 23 5.0 1 0.2 1935 909 228 25.1 605 66.5 70 7.7 6 0.7 1934 887 223 25.5 581 65.5 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 944 oil 54.1 345 36.5 71 7.5 17 1.8 1926 910 502 55.1 298 32.7 100 10.9 10 1.0 1925 970 489 50.4 368 37.9 98 10.1 15 1.5 Of the total of 909 samples of milk taken during the year, 105 were taken on Sundays. None of these proved to be adulterated. The action taken in regard to adulterated samples of milk is shown below:— Adulterated Samples of Milk Sample No. Action taken. 50 N. Contained 1 per cent. of added water. Vendors attention called to result of analysis. 112 S. 15.6 per cent. of original fat abstracted. Summons dismissed on payment of £2 2s. 0d. costs. 109 N. Contained 2 per cent. of added water. Vendor cautioned. 259 N. 5 par cent. of original fat abstracted. Summons dismissed on payment of £2 2s. ()d. costs. 519 N. Contained 1 per cent. of extraneous water and was deficient in fat to extent of 6.7 per cent. Summons dismissed. Defendant proved a warranty to the satisfaction of the magistrate. 889 N. Deficient in fat to the extent of 12 per cent. Summons dismissed under Probation of Offenders Act on payment of 108. costs. 114 The Milk Act, 1934. Milk Marketing Board's Scheme for the Supply of Milk to Schools. By arrangement with the London County Council samples of milk delivered to schools in the City under this scheme were taken in course of delivery to such schools for the purpose of chemical analysis and bacteriological examination. The results of analysis or examination as the case may be are communicated in each case to the Head Teachers of the Schools concerned. Forty-one samples for bacteriological examination were obtained, all of which, with one exception, showed bacterial counts well below the maximum allowed. In one case the bacterial count was 220,000 per c.c., whereas the standard for pasteurised milk is 100,000 per c.c. The attention of the authorities concerned was drawn to the result of the examination, and subsequent samples obtained from the same vendor proved satisfactory. Forty-one samples taken for chemical analysis were found to be genuine. Public Health (Condensed Milk) Regulations, 1923 and 1927. Thirty-five samples were taken and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 and 1927. Two 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. Seven infringements of these regulations were found as a result of analysis of samples, details of which are set out in the following pages. 115 Table LXXX. Samples purchased under the Food and Drugs (Adulteration) Act, 1928, showing results of Analysis and subsequent Proceedings for year 1935. Number. Article of Food. Number of samples purchased. Genuine. adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ S. d. 1 Butter 143 143 — — — — — — 2 Cereals 27 27 — — — — — — 3 Cheese 25 25 — — — — — — 4 Coffee and Chicory 13 13 — — — — — — 5 Condiments & Spices 25 24 1 — — — — — 6 Confectionery 32 26 6 1 — 1 — — 7 Cooking Fats 3 2 1 — — — — — 8 Cream 70 70 — — — — — — 9 Cream (tinned) 4 4 — — — — — — 10 Custard Powder 1 1 — — — — — — 11 Drugs 46 41 5 1 — 1 — 2 2 0 12 Eggs 10 10 — — — — — — 13 Fish preparations 51 46 5 — — — — — 14 Flour 3 3 — — — — — — 15 Fruit Cordials 30 29 1 — — — — — 16 Fruits (preserved) 43 39 4 — — — — — 17 Ice Cream 12 12 — — — — — — 18 Jams & Preserves 23 23 — — — — — — 19 Lard 10 10 — — — — — — 20 Margarine 37 37 — — — —> — — 21 Milk 909 903 6 4 — 4 — 4 14 0 22 Milk (Condensed) 35 35 — — — — — — 23 Milk (Dried) 2 2 — — — — — — 24 Oils 23 23 — — — — — — 25 Pickles & Sauces 15 15 — — — — — — 26 Potted Meats and Meat Pies 43 42 1 — — — — — 27 Sausages 43 43 — — — — — — 28 Spirits 45 45 — — — — — — 29 Sugar 3 3 — — — — — — 30 Tea 22 22 —— — — — — — 31 Vegetables (Pres.) 25 25 — — — — — — 32 Vinegar 23 21 2 — — — — — 33 Wines 18 18 — — — — — — 1,814 1,782 32 6 — 6 — 0 16 0 Adulterated Samples other than Milk. Minced Meat.—Two samples of minced meat were purchased. One of these was found to contain 137 parts of sulphur dioxide per million. The vendor was cautioned. Tomato Puree.—An informal sample of Tomato Puree was found on analysis to contain 31/3 grains of tin per pound. The sample was part of a quantity of this product exposed for sale and the remainder of the stock 116 was seized and condemned as unfit for food because of the condition of the tins. Proceedings were taken against the vendor and a penalty of £10 0s. 0d. was imposed. Paregoric.—A sample of Paregoric was found to be 50 per cent. deficient in morphine, i.e. it only contained 0.025 per cent. of morphine instead of the 0.05 per cent. required by the British Pharmacopoeia. This was an informal sample; a formal sample taken from the same source was found to be genuine. Anchovy Paste.—This sample was of foreign origin and was sold in a collapsible metal tube. It was found to contain 3 grains of tin per pound. The vendors were informed of the result of the analysis and the goods were withdrawn from sale and returned to the country of origin. Confectionery.—Thirty-two samples of confectionery, consisting of varieties of Cream Cakes were purchased. Six of these were found to be made up with "Cream" which contained fats other than butter fat. Summonses were issued in two of these cases, but were withdrawn on counsel's advice. Carbolic Ointment.—Two samples were found to be adulterated. One of these was an informal sample and was deficient in carbolic acid to the extent of 79 per cent. A formal sample subsequently purchased from the same vendor was found to be 48 per cent. deficient in carbolic acid. Proceedings were instituted but the summons was dismissed under the Probation of Offenders Act on payment of £2 2s. 0d. costs. Vinegar.—Twenty-three samples of vinegar were purchased during the year. Two of these samples were found to be adulterated in as much as they were deficient in acetic acid to the extent of 6 per cent. and 4 per cent. respectively. The vendors were cautioned in each case. Compound Syrup of Figs.—Two samples of this product were found to contain salicylic acid. A sample purchased informally was found to contain 375 parts of salicylic acid per million parts of compound. A formal sample taken subsequently contained 82 parts per million. The vendors were cautioned. Grape Fruit Powder.—This sample consisted merely of sugar, slightly coloured green and flavoured with tartaric acid. This was an informal sample, and it was not found possible to obtain a formal sample as the pseudo grape fruit powder had been withdrawn from sale. 117 Preserved Fruits.—43 samples of tinned, dried, and crystallised fruits were purchased during the year. Four samples of tinned fruits proved to contain either tin or iron. In each case the existing stocks of the purveyors were overhauled and a number of tins voluntarily surrendered for destruction. The vendors were warned against a repetition of the offence. Condiments and Spices.—25 samples of various condiments and spices were taken during the course of the year. One sample of ground cloves contained a large proportion of cinnamon. On taking the matter up with the purveyors it was found that a fresh consignment of ground cloves had been placed in a receptacle that had previously been used for the storage of cinnamon and had not been properly cleansed. Fish Products.—During the year informal samples of tinned smoked salmon were purchased by the Council's Inspectors which, on analysis were found to contain hydroxybenzoic acid, a preservative the use of which is prohibited by the Public Health (Preservatives &c. in Food) Regulations. On the vendors being informed of the fact, they voluntarily surrendered the whole of their stocks for destruction. It appeared that the consignments were imported from a foreign country where the presence of hydroxybenzoic acid as a preservative in foods is permitted. The vendors were warned against a repetition of the offence. One sample of spiced anchovies packed in glass jars was found to be decomposed. The remaining stocks of the same consignment were voluntarily surrendered and destroyed. The vendors were warned against a repetition of the offence. Observations by the Public Analysts. During the year under review several authorities, including the City of Westminster, attempted to restrict the growing practice of selling confectionery containing pastes made with fats other than milk fat as "Cream Pastries The generic term "cream" is now applied to such a variety of articles not necessarily foodstuffs that some clear restrictive definition seems called for when used as a food designation. Several samples of tinned fish were examined during the last quarter of the year following information from the Port of London Authority that consignments of tinned smoked salmon had been found to contain salicylic acid. Some were found to contain this preservative, or possibly its isomer, parahydroxybenzoic acid, in quantities up to 800 parts per million. (9069) i 118 Differentiation between the ortho-acid (salicylic acid) and parahydroxybenzoic acid in the quantity usually added to foodstuffs is difficult. The results reported were expressed in terms of hydroxybenzoic acid, the generic name covering both alternatives. It is hoped that as a result of research on the part of both Analysts for the City methods will soon be available which will facilitate differentiation. This work is important inasmuch as some continental countries permit the use of parahydroxybenzoic acid, whereas our own laws do not, and it is practically certain that produce containing it will reach this country. The condition in which some tinned or bottled foods are sold nowadays calls for comment. We have this year encountered instances of metallic contamination and of unsound condition of which the few examples quoted below may prove of interest:— A tomato puree was found to contain three and one-third grains of tin per pound. The can in which it was sold showed distinct signs of "blowing" and marked corrosion of the metal beneath a partly destroyed lacquer coating. A sample of spiced anchovy was certified to be so decomposed as to be totally unfit for food. A sample of anchovy paste sold in a collapsible tin tube was found to contain three grains of tin per pound. Two curious cases of contamination of tinned plums with iron were encountered. Although iron is not regarded as a poisonous metal, the amount found in both these samples was sufficient to convey to the fruit a very disagreeable astringent taste and possibly to render them indigestible. It is difficult to understand how so much iron could have got into the fruit, since the only obvious cause might have been careless preparation in iron vessels. Thus it is possible that if the acid juice from one boiling were left for a time in the pans and not removed before the next boiling, an undue amount of iron might be dissolved and find its way into .the next lot of fruit. One of the cans proved to be slightly "blown" and the other had a small puncture. A sample sold as "A tonic in a preserve—selected grape fruit, oranges, lemons and finest cane sugar" was reported inferior on account of its being mouldy on receipt. After so many instances of samples which had to be reported against it is pleasing to mention one which proved to be better than might have been expected. This was a sample of wine which was submitted for analysis upon the complaint of a resident in the City that it caused intoxication in servants of his household. Since it was wine of good alcohol content the complaint was not without foundation ! 119 Some of the Orders made under the Agricultural Produce (Grading and Marking) Act may prove useful as first steps towards standards for food. Stilton, Cheddar, Caerphilly and cream cheeses, creamery butter, wheat flakes, bottled fruits and bottled vegetables are among the chief articles for which standards of a chemical nature are laid down. Although these standards are at present only intended to cover National Mark produce, they are capable of being quoted in support of cases of adulteratipn in regard to any food found to be defective although it may not bear the National Mark. To state a concrete case, if a Cheddar cheese is found to be deficient in fat the analyst now has a regulation which he may use in support of his view that the article is adulterated by reason of the deficiency in fat. 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 300, and some 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 1935 was 153. The inspectors paid 229 visits to these premises, including stalls, 4 notices were served and the defects were remedied in each case. Restaurants.—The register of restaurants includes 1,411 premises. During the year 1,465 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 47 instances, and in each case the work was satisfactorily carried out. Bakehouses.—At the end of 1935 there were 61 bakehouses in use in the City, of which 42 were underground. 192 visits of inspection were (9069) 12 120 made, and in all instances the cleansing which is required to be done twice a year was carried out. In the early part of the year a special inspection of bakehouses was carried out with a view to ascertaining the extent of infestation, if any, by cockroaches or other vermin. Visits were paid both during the day and at night, but there was little evidence of infestation. The occupiers appeared to be fully alive to the need for keeping their premises free from vermin. Fried Fish Shops.—There are 25 fried fish shops in the City to which the food inspectors paid 40 visits. It was necessary to send two notices for cleansing. Unsound Food. The following table shows the nature and quantity of the various articles of food voluntarily surrendered or submitted for destruction during the year:— Table LXXXI.—Unsound Food. Article Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Apples 2 18 1 10 Lichees 5 2 24 Apricots 8 2 0 Melons 11 4 1 0 Artichokes 1 1 0 Mushrooms 2 0 0 Asparagus 10 0 0 Oranges 30 1 2 0 Beans 18 1 0 Passion Fruit 1 0 0 Carrots 2 10 0 0 Peas 4 0 0 Cauliflowers 13 3 0 Peaches 3 0 14 Chestnuts 6 16 3 0 Pears 5 3 1 1 Cranberries 1 8 0 0 Pineapples 10 1 16 Grapes 20 10 0 0 Potatoes 1 15 0 0 Grape Fruit 19 11 2 0 Radishes 1 0 3 14 Green Almonds 5 1 0 Skate 3 0 Horse-radish 1 6 0 0 Sprouts 1 11 0 0 Lettuce 3 18 3 14 Pheasants (4) Limes 6 0 0 Fruit and vegetables 1,925 tins. Food Poisoning. Cases of illness attributed to articles of food purchased or consumed at premises in the City were investigated during the year:— (1) Six members of the staff of a hospital in another district were taken ill after a meal of sausages supplied by a firm in Westminster. Conditions at the premises where the sausages had been manufactured were not altogether satisfactory, but no definite cause of infection could be traced. Other members of the hospital staff had partaken of the same meal without ill effects. 121 (2) A resident in the City was notified as suffering from food poisoning, following a dinner party held at a restaurant in Westminster. Food consumed included oysters, fish and kidneys, but inquiries disclosed that none of the other participants had been affected. The restaurant premises were clean and the stock was in a satisfactory condition. (3) Sixty residents of an educational establishment outside of the City were affected after a meal comprising several different articles of food amongst which were minced meat and figs supplied by a firm in "Westminster. An unconsumed portion of the minced meat was bacteriologically examined with negative results. Samples of minced meat and figs taken at the firm's premises also gave negative results upon examination. (4) A meat pie purchased at a coffee stall in the City was suspected to be the cause of a case in another district. A pie of the same make was purchased at the stall and submitted for bacteriological examination, but the result was negative. (5) One case attributed to the consumption of tinned salmon occurred in the City. A tin of the same brand of salmon upon examination was found to be in a satisfactory condition. (6) Notification was received of a suspected case of food poisoning in the person of an operator at a telephone exchange. On inquiry it was found that some 53 other employees had been affected after a meal of boiled beef consumed in the staff canteen. The remaining portion of the beef was examined by the Council's bacteriologist who expressed the opinion that the most probable cause of the epidemic was " staphylococcal toxin " consumed in the meat. The premises of the butcher from whom the meat had been obtained, situated in St. Pancras, were inspected by the Medical Officer of Health of that Borough and samples of meat and pickling brine were taken for examination, but no obvious source of contamination was discovered. In all except the one notified case, the persons concerned were only mildly affected and returned to duty on the following day.