WES 46 City of Westminster REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 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 6 Births 8 Deaths 11 Causes of, compiled by Medical Officer of Health 14 „ „ „ „ Registrar General 11 Common Lodging-House 25 Distribution of, in Wards 19 Infantile Mortality 20 Stillbirths 13 Meteorological 7 Population 6 Social Conditions 7 Staff of the Public Health Department 1 Statistics, General and Vital 6 Unemployment 7 Prevalence of, and Control over, Infectious Diseases 13, 26 Bacteriological Laboratory 36 Cerebro-spinal Fever 35 Chicken-pox 35 Diarrhœa 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 35,66 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 37 Vaccination 27 Whooping Cough 34 (8342) a 2 IV page General Provision of Health Services 49 Ambulance facilities 49 Ante-natal services 55 „ cases 55 „ clinics 56 „ visiting 56 Barlow's Gift Charity 68 Child Life Protection 67 Child Welfare 57 Clinics and Treatment Centres 49 Convalescent Treatment 57 Cookery classes 68 Day Nursery 50, 60, 73 Dental Clinic, Annual Report 70 Dental Treatment 70 Health Visiting 58, 67 Health Visitors—Notes by 71 Home Helps 69 Hospitals 51, 57 Infant Clinics 63 Institutional Provision for Mothers and Children 56 Insulin Treatment 70 Laboratory facilities 49 Lectures and Demonstrations 72 Maternal Mortality 57 Maternity and Child Welfare Centres 49 „ ,, ,, Services 51 „ ,, ,, Medical Officers—Notes by 60 Maternity Beds 56 Midwifery Services 53 Midwifery—Consultant services 55 Midwives Act, 1936 53 Midwives, Medical Assistance to 55 Minor Ailment Clinics 59 Mothercraft Classes 67 Milk, supply of, to Necessitous Mothers and Infants 69 Nursing in the Home 49,65 Toddlers' Clinics 59 Unmarried Mothers, Homes for 69 Sanitary Circumstances 73 Aliens, medical inspection of 77 Atmospheric Pollution 106 Cleansing of Persons 90 Common Lodging Houses 87 Coroner's Court and Mortuary 92 Disinfection and disinfestation 89 Drainage and Sewerage 74 Factories, Workshops and Workplaces 82 Fumigation of Furniture 91 Infirm and Diseased Persons—Removal of 89 New Sanitary Construction 75 Nuisances 80 Outworkers 85 Pigeons, Nuisance from 88 Public Cleansing 76 Public Health (London) Act, 1936 82 Public Sanitary Conveniences 75 V PAGE Sanitary Circumstances—(contd.) Public Swimming Pools, etc. 73 Rag and Bone Dealers 87 Rag Flock Acts 87 Rat Repression 88 Refuse Collection and Disposal 76 Rent Restriction Acts 82 Sanitary Inspection of the Area 79 Schools 87 Shops Act 1934 82 Smoke Abatement 105 Tenement Buildings—Lighting of Staircases 81 Tenement Houses 87 Water Supply 73, 81 Housing 95 Clearance Areas 97 General Observations 95 Housing Policy 96 Housing Schemes, New Estates 101 Overcrowding 96 Rehousing Operations 102 Statistics required by Ministry of Health 103 Underground Rooms 99 Unfit Habitations, Closure of 98 „ „ Reconditioning of 99 Inspection and Supervision of Food, etc. 109 Agricultural Produce (Grading and Marking) Act, 1928 112 Artificial Cream Act, 1929 113 Bakehouses 123 Condensed Milk Regulations, 1923-1927 116 Dairymen and Dairy premises—registration 114 Dried Milk Regulations, 1923-1927 116 Food Byelaws 123 Food products—certification for export 110 Food and Drugs (Adulteration) Act, 1928 115 Samples, results of analysis, action taken, etc. 117 Food, Unsound 123 Food Poisoning 124 Fried Fish Shops 123 Ice-cream premises 110 Ice-cream, Bacteriological Examination 110 Meat Regulations, 1924 122 Merchandise Marks Act, 1926 112 Milk Act, 1934 116 Milk, Bacteriological Examination 116 Milk and Dairies Amendment Act, 1922 113 Milk and Dairies (Consolidation) Act, 1915—tubercle in milk 113 Milk and Dairies Order, 1926 114 Milk Samples 115 Milk (Special Designations) Order, 1936 113 Pharmacy and Poisons Act, 1933 125 Preserved Meat, etc., premises 112 Public analysts—Observations by 120 Preservatives in Food Regulations, 1925-1927 117 Restaurants 123 Schools, Supply of Milk to 116 Street Trading 122 VI Public Health and Maternity and Child Welfare Committee. Mayor: Councillor The Hon. Arthur Howard, C.V.O., D.L., J.P. Deputy Mayor: Alderman Captain J. C. Dalton, D.L., J.P,. L.C.C. 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 6. F. Jerdein. Vice-Chairman: † Councillor H. S. E. Vanderpant. Members: Councillor Lady Doris Blacker. ,, T. C. Claxton. G. H. Heilbuth, C.C. „ Mrs. Alderson Home. ,, Lieut.-Colonel W. Merrick, T.D. ,, Mrs. F. M. Odone. ,, S. Parks. „ The Rev. Jocelyn Perkins, M.A., D.C.L., F.S.A. ,, Dr. F. E. L. Phillips. ,, F. R. Ridley, J.P. „ A. Sargeant. „ Mrs. Francis Storrs. The Hon. Mrs. Douglas Vickers, J.P. Maternity and Child Welfare Sub-Committee. Members of the Council: Councillor Lady Doris Blacker. Councillor F. R. Ridley, J.P. „ T. C. Claxton. ,, A. Sargeant. ,, Mrs. Alderson Home. ,, Mrs. Francis Storrs. ,, G. F. Jerdein. „ H. S. E. Vanderpant. ., Mrs. F. M. Odone „ The Hon. Mrs. Douglas (Chairman). 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.) VII Sub-Committee re New Maternity and Child Welfare Centre and Day Nursery. Members of the Council: Councillor Mrs. Alderson Horne. ,, G. F. Jerdein. ,, Mrs. F. M. Odone. Councillor F. R. Ridley, J.P. (Chairman) ,, H. S. B. Vanderpant, Councillor The Hon. Mrs. Douglas Vickers, J.P. Co-opted Members representing the City of Westminster Day Nursery Committee : Mrs. J. F. C. Bennett. Lady Gluckstein. Mrs. Arthur Rye. A. F. Stallwood, F.S.A.A. (Hon. Treasurer). Sub-Committee re Children under School Age. Members of the Council: Councillor Mrs. Alderson Horne. ,, G. F. Jerdein. ,, The Hon. Mrs. Douglas Vickers, J.P. Councillor Mrs. F. M. Odone (Chairman). ,, H. S. E. Vanderpant. Co-opted Members representing the City of Westminster Health Society : Miss E. S. Haldane. Miss Margaret Horn. Mrs. M. Munro. Committee Clerk: F. J. Burbridge. IX Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 3 6. Mr. Mayor, My Lords, Ladies and Gentlemen, I beg to submit my annual report on the Health and Sanitary Condition of the City during 1936. The report is drawn up in accordance with Circular 1561 of the Minister of Health and, as in previous years, follows the lines laid down by the Minister as regards the matters on which he desires to be informed. This report has been prepared during the time ever to be associated with the Coronation of their Gracious Majesties King George VI and Queen Elizabeth. It was thought, therefore, that it might be of interest to add to the usual features by introducing a few notes by certain officers of the department relating to the special branches for which they are responsible. In particular, Mr. John Sanderson, the Senior Sanitary Inspector, who joined the department in the days of the St. Martin's Vestry, has contributed a retrospective note on the changing conditions during his forty years' service, begun in the year of Queen Victoria's Diamond Jubilee. Vital Statistics. The birth rate has increased slightly from 8.3 in 1935 to 8.5 in 1936; on the whole a little encouraging. The former figure was the lowest ever recorded in the City and it may be that the downward trend has been arrested. During the past eighteen months the fall in the national birth rate has been causing concern and the Minister has set up a special committee under the chairmanship of Professor Carr Saunders to investigate the causes and to report on the effects. It does not seem long ago since the benefits of birth control were being widely canvassed as a means of social betterment, but the tide seems to be receding. The death rate, however, is greater than last year, 11.9 as compared with 11.5 (crude), due in some measure to increased winter deaths among the elderly from Influenza and Pneumonia. Fewer deaths among infants are recorded, giving a rate of 65.8 as compared with 72 in 1935. There was far less wastage among the illegitimate infants, which seems to indicate that the Council's Maternity and Child Welfare services were able to get in closer touch with this somewhat elusive element of society. Infectious Disease. As was expected 1936 was a "measles" year, 590 cases as compared with 195 in 1935, but the death rate was considerably lower than for England and Wales. No deaths occurred from scarlet fever, the case rate being about the same. As regards diphtheria, there was again a substantial reduction in the number of cases and four deaths as compared with five last year. Enteric fever, with 12 cases, remains about the same with no deaths. There were fewer cases of mumps, but more X of whooping cough. As regards tuberculosis the number of notifications is the lowest yet recorded, but the death rate has risen chiefly because of the catarrhal conditions, which also contributed to the generally higher death rate. Maternity and Child Welfare. In this section will be found notes by the medical officers of the clinics based on their observations at the Council's three centres. Throughout the year little or no evidence of malnutrition seems to have come to their notice. In addition to an increased consumption under the Council's assisted milk scheme, cod liver oil and other accessories to diet are also provided free of cost, or at reduced price, according to circumstances. Instruction in dietetics, cookery and marketing, has been a regular feature of the work at the welfare centres throughout the year. At the classes, which are held weekly, the mothers themselves are encouraged to take part in cooking the various dishes. From the notes supplied by the Superintendents of the centres, it would seem that these food and cooking classes are greatly appreciated by the mothers and are exercising a beneficial influence on the dietaries of the welfare centre families. The Minister of Health desires, and everyone will agree with him, that the fullest use should be made of these and other health services by those for whom they are intended. As regards the Council's centres, 726 (or 68 per cent.) of the infants born to Westminster parents attended the clinics during 1936, while 75.7 per cent. of the mothers attended the centres before and after the birth of their children. In a central area such as Westminster the population must to a considerable extent be a shifting one, yet there are many mothers who were themselves "welfare centre" children. Maternity and Child Welfare, through the Westminster Health Society, has been actively proceeding in the City since Edwardian days and the Council itself began conducting its own centres almost twenty years ago. A tradition of attendance at the welfare centres is being handed on from mother to daughter and has become firmly established as a family habit. For example, at Ebury Bridge, the earliest of the Council's centres, a large proportion of the mothers now attending were themselves tak n as infants regularly between 1910 and 1917 to the welfare centre in the old building now replaced by the modern welfare centre on the same site. Steps are being taken to follow up the Minister's wish for improved care and welfare of the child under school age. An additional health visitor has been appointed, for the present on a temporary basis, and arrangements are being made with certain of the voluntary hospitals and school treatment centres for better facilities for the treatment of physical defects and minor ailments occurring among these " toddlers." It is also intended to establish a consultation centre at one of the hospitals where special cases may be sent for investigation. Maternal Mortality. One woman died as a result of abortion. She did not live in Westminster and had not done so for a number of years, but at the hospital in an outlying district where she died she gave the address of her parents' home in Westminster. She had no other home. There were no cases of puerperal sepsis. With the provisions of the new Midwives Act, shortly coming into force, it should be remembered that the Council's midwifery scheme in conjunction with Westminster Hospital continues to meet all the midwifery needs of the City adequately. XI Sanitary Work and Buildings. The number of plans submitted has again increased, to 1,087. The work arising from town-planning applications qua construction of, and user of underground rooms and questions as to ventilation, sanitary conveniences, etc. continue to demand increasing attention. These town-planning aspects are a new development, intimately related to public health. Atmospheric Pollution. Investigations have continued on lines already established. These include estimation of deposited impurities, suspended impurities, sulphur gas content and the destructive effects of sulphur gas. The details are set out in this report. It does not appear that there is any marked improvement in the purity of the atmosphere as compared with last year. Food and Drugs. Comment is made on certain articles of food deserving of special notice from the point of view of adulteration and the Public Analysts have added their observations in these and other matters relating to food adulteration. At the time of writing the Council has been successful in both the Police Court and on appeal to Quarter Sessions in maintaining that vinegar not manufactured from acetous fermentation of grain and other natural substances should be clearly distinguishable by the ordinary purchaser from vinegar prepared synthetically from acetic acid. Housing. The usual information as to housing activities is set out in tabular form on pages 103 to 105 as required by the Minister. This is the first occasion on which details relating to overcrowding as required by the Housing Act of 1935 are included. The policy of clearance and closure of unfit houses continues pari passu with the provision of new housing accommodation. During the year 41 houses were demolished or were the subject of confirmed clearance orders. Since the coming into force of the clearance provisions of the Housing Act of 1930 the London County Council has not itself made any clearance resolutions as regards the City of Westminster. The City Council with the assent of the former has been responsible for all the procedure relating to clearance areas. Basement and other rooms numbering 567 have been closed or reconditioned and re-occupied. This great work of improvement and restoration in buildings otherwise structurally sound has proceeded smoothly and in the vast majority of cases with the complete co-operation of the owners. New Maternity and Child Welfare Building. This building, fully described in the last two annual reports, is approaching completion and will be formally opened in the autumn of the present year. The welfare centre on the ground floor will be the largest in the City and as regards planning and equipment will be one of the most up-to-date in the country. The Day Nursery occupying two upper floors and part of the top floor, will be in the charge of a voluntary committee to whom the Council will grant a tenancy of the nursery premises. The accommodation for 80-90 children has been specially planned with a view to separating the different age groups of children, thereby minimising the risk of infection. Labour-saving devices will be evident throughout the building. XII Staff. It is with deep regret that one records the deaths of Dr. Ethel Vernon and Dr. Albert Cope, the former in January, the latter in June. Both were general practitioners of many years standing in Westminster. In separate spheres each had earned the affection and deep respect of a large circle of patients and friends. Both were experienced and highly skilled and were held in much esteem throughout the City. Dr. Vernon had been medical officer to two of the Council's Welfare Centres since 1919. Dr. Cope, Public Vaccinator in Westminster for upwards of 40 years, had been employed by the City Council as such for seven. He was known throughout the country as an expert and authority on vaccination. Mr. Charles F. Brockett, Sanitary Inspector in the borough of Stepney, was appointed a permanent Sanitary Inspector for housing purposes in place of a temporary inspector, resigned. To strengthen the clerical side in the housing section, the post of additional first division clerk was established. Mr. Hobbs, Chief Clerk in the Public Health Department of the Bristol Corporation, was appointed in June. Mr. S. F. Hammond was also appointed junior clerk in the department. Among the temporary staff, Messrs. Manley, Morris, Nutter and Williams, Sanitary Inspectors, resigned on obtaining appointments elsewhere. Mr. G. H. Browne, Mr. F. Hemming and Mr. T. C. Telford, temporary clerks, also resigned for similar reasons. Mr. J. P. Robertson was engaged as a temporary clerk from May 1936. During the year 107 reports were submitted by me to committees of the Council. On housing matters 252 representations and 59 other reports were made. The Housing Committee and its Sub-Committee held 28 meetings and the Public Health and Maternity and Child Welfare Committee and its Sub-Committees 21. Correspondence included 15,251 incoming and 15,982 outgoing communications. The work of the department continues to increase. In the autumn the department was called upon at the request of the Ministry to carry out an entirely unexpected service, namely the administration of the medical side of the Aliens Act and Order. This is usually associated with sea and air-ports ; but the new enterprise of the Southern Railway Company bringing passengers over by train ferry and disembarking them at Victoria Station has made the City of Westminster a " port." The two Medical Registrars of Westminster Hospital, by consent of the Governors of the hospital, were appointed part-time officers of the Council for this purpose and each awaits the ferry train on alternate days throughout the year. Dr. Ian Thomson, the Deputy Medical Offieer of Health, also acts when these two medical officers are not available. I would express my gratitude to the Chairman and Vice-Chairman of the Public Health Committee and of the Housing Committee for their kindness and helpfulness to me in all that concerns the work performed for these committees by my department. The staff also deserve praise for the willing and competent manner in which they have served those two committees throughout the year. I have the honour to be, Your obedient servant, ANDREW J. SHINNIE. Medical Officer of Health. July, 1937. 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, Administrative Tuberculosis Officer and Medical Inspector (Aliens Order, 1920) : Andrew J. Shinnie M.D., D.P.H., &c. Deputy Medical Officer of Health, Clinical Tuberculosis Officer and Assistant Medical Inspector (Aliens Order, 1920) : Ian S. Thomson M.A., M.D., D.P.H. Infant Welfare Medical Officers : *A. D. C. Bell M.A., B.M., B.Ch., M.R.C.P. *G. Ormiston M.D., Ch.B., M.R.C.P.(Ed.) (from June, 1936). Miss Ethel Vernon M.D., B.S. (deceased 19th January, 1936). *Miss Rosa Turner M.R.C.S., L.R.C.P. (to June, 1936). Maternity Medical Officer : *Miss Margaret Salmond M.D., B.S., F.R.C.S.. M.C.O.G. (from June, 1936). 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., B.S., F.R.C.S. *A. C. H. Bell M.B., B.S., F.R.C.S. | ♦J. B. Blaikley M.B., B.S., F.R.C.S. I (to April, 1936.) *J. Gough Stewart M.B., B.S., M.R.C.S., L.R.C.P. *W. N. Searle M.B., Ch.B., F.R.C.S. *B. Gilbert M.D., B.S., F.R.C.S. (from April, 1936). Assistant Medical Inspectors under Aliens Order, 1920 : *D. G. Ferriman M.B., Ch.B., M.R.C.P. *E. A. Hardy M.B., B.S., M.R.C.P. (Appointed 16th October, 1936). Westminster Hospital Laboratories : *R. J. V. Pulvertaft, M.D., Ch.B., M.R.C.P., M.R.C.S. Bacteriologist to the Hospital. (8342) a 2 Public Vaccinators: * Albert E. Cope, M.D., 66, Belgrave Road, S.W.I (deceased June, 1936). Belgrave and Knightsbridge District *T. Bromley, M.R.C.S.,L.R.C.P., 66, Belgrave Road, S.W.I Westminster, St. Margaret and St. *J. A. Gorsky, L.M.S.S.A., 40, John District. Tachbrook Street, S.W.I Westminster North District *J. Forbes, M.A., B.Sc., M.B., C.M., 106, Shaftesbury Ave., W.l (from June, 1936). Dental Clinic: *'I. Stewart Tait (Dental Surgeon) L.D.S., R.C.S.(Ed.). *F. J, Gordon (Anæsthetist) B.A., M.R.C.S., L.R.C.P. 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 and Vaccination Officer: W. D. Sambrook. Sanitary Inspectors: S. G. Bennett S.I.E.B., Meat and Food Cert. C. F. Brockett S.I.E.B., Meat and Food Cert. (Appointed 23rd November, 1936.) 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. I. S. Hagard S.I.E.B., Meat and Food Cert. (Appointed 1st April, 1936. Resigned 30th September, 1936.) 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. 3 Housing Inspector : H. E. White S.I.E.B., R.S.I., Meat and Food Cert., Dipi. Inst, of Hygiene. Temporary Sanitary Inspectors (Engaged on Housing Duties): J. R. Baily S.I.E.B., Meat and Food Cert. (Appointed 21 st September, 1936.) S. J. Cassidy S.I.E.B., Meat and Food Cert. H. D. Luke S.I.E.B. (Appointed 5th October, 1936.) C. W. J. Manley S.I.E.B. (Resigned 29th August, 1936.) W.L.Morris S.I.E.B., Meat and Food Cert. (Resigned 19th September, 1936.) F. J. Nutter S.I.E.B. (Resigned 14th March, 1936.) 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. Waldino Board of Education Health Visitor's Diploma, S.I.E.B., National Health Society's Diploma, Nursing. 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, State Registered Nurse, 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. Nutrition and Dietetics. *Mrs. G. M. Birtwistle B.Sc. in Household and Social Science. (Appointed 20th April, 1936. Resigned 12th September, 1936.) *Miss B. M. Beresford 1st Class Diploma in Domestic Science. (Appointed 19th October, 1936.) Mothercraft: *Mrs. r. Coleman (Resigned 15th May, 1936.) *Miss F. Willats (Appointed 22nd July, 1936.) (8342) A2 4 Clerical Staff : A. J. Manhood, 1st Division Clerk. W. F. Lake, 1st Division Clerk. (Assistant Vaccination Officer.) A. E. Hobbs, 1st Division Clerk. (Appointed 15th June, 1936.) F. E. Norwood, 2nd Division Clerk. W. Jenkins, 3rd Division Clerk. M. J. Flynn, 3rd Division Clerk. S. F. Hammond, Junior Clerk. (Appointed 6th April, 1936.) Miss E. M. Armstrong. Miss M. McFarlane (Tuberculosis Dispensary). Temporary Clerks. J. W. Anderson. H. J. Bright. G. H. Browne. (Resigned 30th May, 1936.) J. M. Burbridge. F. Hemming. (Resigned 30th May, 1936.) E. Jones. W. F. C. King. J. P. Robertson. (Appointed 25th May, 1936.) T. C. Telford. (Resigned 4th April, 1936.) 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 Staff. S. C. West, Foreman Disinfector. J. Atkins, Disinfector. 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, *Mrs. Moreton. Tuberculosis Dispensary—Mrs. Crowley. Coroner's Court—Miss Hamilton, *Mrs. Cattermole. 5 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. 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 Certified Midwife. Miss Cross Certified Midwife. (With assistants, voluntary and paid, holding Health Visitor's certificates and with nursing experience.) Mrs. Steffens (Mothercraft Classes) Mrs. McMillan (Lecturer in Nutrition and Dietetics). 6 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. 1936 (Registrar General's Estimate)—124,100. Number of Inhabited Houses (Census 1931)—22,536. Rateable value—£10,666,900 (March, 1937). Sum represented by a penny rate—£41,330 (Estimate). Extracts from Vital, Statistics for the Year. Total. Males. Females. Live Births— Legitimate 930 460 470 Illegitimate 133 76 57 1,063 536 527 Birth-rate per 1,000 of the estimated resident population—8.5. Stillbirths—36. Rate per 1,000 total (live and still) births—32.7. Deaths—1,477. Death-rate per 1,000 of the estimated resident population—Crude rate 11.9. Adjusted rate 12.2. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — Other puerperal causes 1 0.9 Total 1 0.9 Death-rate of infants under one year of age :— All infants per 1,000 live births 65.8 Legitimate infants per 1,000 legitimate live births 60 Illegitimate infants per 1,000 illegitimate live births 105.2 Deaths from measles (all ages) 5 „ whooping cough (all ages) 3 „ diarrhoea (under 2 years of age) 13 7 Social Conditions. As stated in previous reports Westminster includes within its boundaries the residences of the Sovereign and members of His family. 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. U reemployment. I am indebted to the Manager of the local Ministry of Labour Employment Exchange for the figures of unemployed persons set out in the following table :— Number of Unemployed Persons on the Register at Westminster Employment Exchange during one selected week in each of the 12 months 1936. Month. Men. Women. Boys. Girls. January 1,938 634 21 41 February 2,288 716 16 14 March 2,347 660 7 13 April 2,071 691 14 15 May 1,953 560 2 9 June... 1,736 453 6 5 July 1,562 355 13 4 August 1,565 412 11 10 September 1,655 420 14 13 October 1,793 529 7 14 November 1,894 535 13 15 December 1,835 430 5 8 Meteorological. The following note is extracted from a letter appearing in "The Times" of 4th January, 1937, by Mr. W. G. Cochran, of the Rothamsted Experimental Station, Harpenden, Herts. The most striking feature of the weather during 1936 was the persistent deficiency in sunshine, the total for the year being 270.6 hours below the average, and the weather generally was notably unseasonable in Spring, Summer, and Autumn. 8 Rainfall was below normal from March to May. June and July were exceptionally wet, while August, although dry, was not unusually warm or sunny. September was cloudy and sunless with exceptionally mild nights. The weather of the last three months of the year was not particularly unusual, with rain, frost, and fog locally. The total rainfall for the year, 33.25 inches, is 4.68 inches above the average, and is about the same as in 1935. June, with 6.34, inches was easily the wettest month of the year, July being the second wettest with 4.94 inches. January and November were also unusually wet, and storms were frequent during October, November and December. 1936 produced no heat waves, and no prolonged frosts. The highest screen temperature recorded at Rothamsted was 82.3 degrees on 20th, June and the lowest, 18.3 degrees on January 19th. Births. The births registered in Westminster during 1936 (53 weeks) numbered 1,563, but of these the homes of 967 were in other districts, 3 were either registered under the Legitimacy Act or were re-registrations, and have therefore to be deducted from the total. There were, however, 470 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,063, which is 21 more than the corresponding figure for 1935. The Birth Rate for the City was 8.5, for London 13.6 and for England and Wales 14.8. The comparative net totals of the registered births for the last three years are Table I.— Legitimate and Illegitimate Births. 1934. 1935. 1936. Legitimate. Legitimate. Legitimate Males 528 491 460 Females 487 422 470 Illegitimate. Illegitimate. Illegitimate. Males 77 68 76 Females 74 61 57 1,166 1,042 1,063 9 Table II.— Registered and Notified Births. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. born. 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 1936 1,563 970 (3) 470 1,063 1,551 1,499 52 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. The numbers of registered and notified births show a slight increase over the figures for 1935, but on the other hand, the number of deaths is greater so that the gap between the deaths in the City as compared with the births is greater than in 1935. This gap has been gradually increasing from 1924 when the deaths exceeded the births by 71 to the present year, when the excess is 414. Whilst the birth rate is considerably below that for London and the Country, the death rate, although overlapping the births, is below the rate for London and that of the country. Table III.— Distribution of Legitimate and Illegitimate Births. The legitimate and illegitimate births are distributed as follows :— Legitimate. Males 716 - 442 + 186 = 460 Females.... 683 - 412 + 199 = 470 1,399 - 854 + 385 = 930 Illegitimate. Males 79 - 54 + 51 = 76 Females 85 - 62 + 34 = 57 164 - 116 + 85 = 133 10 As shown in Table II, 1,551 notifications of births were received by the department for 1936 as compared with 1,537 in 1935. Of the total notifications, 1,149 were sent by midwives, of whom 30 were practising in the City during 1936. The following table shows the number of male and female children born since 1920, 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. 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 1936 536 527 39 31 497 496 The results again demonstrate the universal truth that girl babies maintain greater hardiness than boys. Although the number of boys born exceeded that of girls by 9, at the end of the year the numbers were almost equal. 11 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, 1936. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M 730 37 9 4 13 17 19 41 101 164 180 145 F. 718 31 3 6 7 16 25 43 61 107 187 232 1. Typhoid and paratyphoid fevers M, — — — — — — — — — — — — F. — — — — — — — — — — — — 2. Measles M 3 1 — 1 — — — — — — 1 — F. 2 — 1 — 1 — — — — — — — 3. Scarlet fever M. 1 — — — 1 — — — — — — — F. — — — — — — — — — — — — 4. Whooping-cough M. 3 — 3 — — — — — — — — — F. 1 1 — — — — — — — — — — 5. Diphtheria M. 2 — — 1 1 — — — — — — — F. 2 — — 1 1 — — — — — — — 6. Influenza M. 7 1 — — — — — — — — 6 — F. 8 — — — — — 1 — — 1 5 1 7. Encephalitis lethargica M. 1 — — — — — — — — 1 — — F. — — — — — — — — — — — — 8. Cerebro-spinal fever M. 1 1 — — — — — — — — — — F. — — — — — — — — — — — — 9. Tuberculosis of respiratory system M. 46 — — — — 5 6 9 12 11 2 1 F. 31 — — — 1 7 7 4 6 3 2 1 10. Other tuberculous diseases M. 5 _ — 1 1 1 1 1 — — — — F. 3 — — 1 — 2 — — — — — — 11. Syphilis M. 7 — — — 1 — — — 2 3 1 — F. 1 — — — — — — — 1 — — — 12. General paralysis of the insane, tabes dorsalis M. 7 — — — — — — — 2 3 2 — F. 2 — — — — — — 1 1 — — — 13. Cancer, malignant disease M. 114 — — — — — — 5 22 40 35 12 F. 115 — — — — — 3 8 14 20 41 29 14. Diabetes M. 9 — — — — — — — 2 3 1 3 F. 9 — — — — — 1 — — — 2 6 15. Cerebral haemorrhage, etc. M. 24 — — — — — — 1 4 4 6 9 F. 34 — — — — — — 2 2 6 10 14 16. Heart disease M. 197 — — — — 1 1 3 16 36 66 74 F. 207 — — — — 1 3 1 9 29 61 103 17. Aneurysm M. 4 — — — — — — — 1 — 1 2 F. 4 — — — — — — 1 1 1 1 — 12 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. 13 — — — — — — — 1 2 3 7 F. 36 — — — — — 1 — 2 5 11 17 19. Bronchitis M. 39 1 — 1 — — — 1 3 11 11 11 F. 32 1 — — — — — 1 4 6 7 13 20. Pneumonia (all forms) M. 47 3 3 — 1 1 1 4 9 10 12 3 F. 39 1 — 1 — 1 — 4 6 5 13 8 21. Other respiratory diseases M. 6 — — — — — 1 1 — 1 — 2 F. 9 — — — — — — — 1 1 2 5 22. Peptic ulcer M. 16 — — — — — — 3 — 6 3 2 F. 6 — — — — — — 1 1 1 2 1 23. Diarrhœa, etc. M. 11 8 — — — 1 — 1 — — — 1 F. 7 3 — — — — — — 1 — — 3 24. Appendicitis M. 7 — — — 1 — — 3 1 2 — — F. 6 — — — — 1 1 1 — 2 1 — 25. Cirrhosis of liver M. 7 — — — — — — — — 1 3 — F. 4 — — — — — — 1 1 1 1 — 26. Other diseases of liver, etc. M. 5 — — — — — — 1 — 2 — 1 F. 7 — — — — — — — — 1 4 2 27. Other digestive diseases M. 10 — — — 1 — — — 1 3 4 1 F. 18 — 1 — 1 1 — 2 — 4 5 2 28. Acute and chronic nephritis M. 18 — — — — 1 2 1 1 6 2 5 F. 19 — — — 1 — — 3 1 4 5 5 29. Puerperal sepsis F. — — — — — — — — — — — — 30. Other puerperal causes F. 2 — — — — 2 — — — — — — 31. Congenital debility, premature birth, malformation, etc. M. 20 19 — — 1 — — — — — — — F. 16 16 — — — — — — — — — — 32. Senility M. 3 — — — — — — — — — 2 1 F. 6 — — — — — — — — — — 6 33. Suicide M. 18 — — — — 1 3 3 3 7 1 — F. 8 — — — — — 2 1 — 4 1 — 34. Other violence M. 22 1 1 — 2 3 2 1 2 4 4 2 F. 37 6 1 3 1 1 2 7 2 3 5 6 35. Other defined diseases M. 57 2 2 — 3 3 2 3 12 8 14 8 F. 46 3 — — 1 — 4 5 6 10 8 9 36. Causes ill-defined, or unknown M. — — — — — — — — — — — — F. 1 — — — — — — — — — — 1 13 Table VI.— Still-births. Notification and Registration. Fifty-two still-born children were notified during the year. Still-births Registered. Inward Transfers. Outward Transfers. Allocated to Westminster. Total Legitimate and Illegitimate Males 33 10 23 20 Females 26 6 16 16 Illegitimate .... Males 4 1 3 2 Females 6 2 3 5 Table VII.—Infectious Diseases. The following shows the number of cases of certain infectious diseases in the area during the 53 weeks ended 2nd January, 1937:— Westminster, City of, Met. b. Number of Cases of Infectious Diseases Notified. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. Pneumonia. — 200 89 12 13 1 36 22 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:— Scarlet fever,' 2.53; diphtheria, 1.39; enteric fever, 0.06; and erysipelas, 0.40.) 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 a different system of tabulation is employed, the figures being calculated for the calendar year, while in the latter, based on a 53 week year, allowance is made by the Medical Officer of Health for cases cancelled because of revised diagnosis. For example, 26 cases of diphtheria and scarlet fever were discharged from hospital owing to incorrect diagnosis during 1936. 14 MALES. Table VIII.—Causes of, and Ages at, Death during the year 1936. [###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 15. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox – – – – – – – – – – – – – – – – – – – – – – – – Measles 3 1 — 1 – – – – 1 – – – – 2 – – – – – – – 1 – – Scarlet fever – – – – – – – – – – – – – – – – – – – – – – – – Influenza 7 1 — — – — — — 6 — 2 – — 2 1 1 — — – — 1 — — — Whooping-couph 3 – 3 – – – – – – – – – – – – 2 – – – 1 – – – – Diphtheria, Memb. croup 2 – – 2 – – – – – – – – – – 2 – – – – – – – – – Cerebro-spinal meningitis – – – – – – – – – – – – – – – – – – – – – – – – Poliomyelitis – – – – – – – – – – – – – – – – – – – – – – – – Enteric fever – – – – – – – – – – – – – – – – – – – – – – – – Diarrhoea, enteritis 9 8 1 – – – – – – – – – – 4 1 3 – – – – – 1 – – Erysipelas. – – – – – – – – – – – – – – – – – – – – – – – – Other septic diseases 3 – – – – – 1 2 — — — — — 2 — – — — 1 — — — — — Syphilis,&c. 7 — — 1 — — 5 1 — 2 — — 2 — 1 1 1 — Diabetes 9 — — — — — — 5 4 — 5 – – 1 — 1 1 – – — — 1 – – Rheumatic fever – – – – – – – – – – – – – – – – – – – – – – – – Tuberculosis of lungs 51 — — – — 6 10 26 3 — 1 3 4 18 1 10 – 1 – 4 — 2 6 1 Other forms of tuberculosis 5 — — 1 1 1 2 — — — – — – 2 — 2 — – – — 1 — — – Malignant growths 113 — — – — — 4 57 52 — 10 6 9 32 4 29 2 2 6 1 3 1 6 2 Congenital debility, malformation, and premature birth 17 17 – – – – – – – – – – 3 8 1 4 – –– – – – – – 1 Old age 1 – – – – – – – 1 — — — — 1 – – – – – – – – – – Meningitis and convulsions 3 3 – – – – – – – – – – – 2 – 1 – – – – – – – – 15 Loc. ataxia and general paralysis 4 – – – – – – 3 1 – – – – 1 – 2 – – – – – – – 1 Other diseases of nervous system 11 – – – – – 3 3 5 1 – 1 – 5 – 3 – – – – – – – – Valvular diseases of heart 8 – – – – – 1 3 4 — 2 — — 4 — 1 — — — — – — 1 — Other circulatory diseases 202 1 — — 3 1 5 51 141 2 19 7 12 48 19 46 6 — 4 3 5 11 13 7 Bronchitis 68 — — 1 — — 1 24 42 — 1 2 1 15 7 27 2 3 — 4 — 2 3 1 Broncho-pneumonia 48 4 4 — – 2 1 17 20 — 2 – 1 16 4 13 2 1 2 1 2 2 – — Pneumonia, other forms 17 — — — 2 — 4 8 3 – 1 1 — 4 1 5 2 — — — – 1 — — Other respiratory diseases 10 — — — — — 3 4 3 — — — 1 2 — 2 1 — 1 — — — 2 1 Alcoholism 3 – – – – – – 2 1 – – – – 1 – – – – 1 – 1 – – – Cirrhosis of liver 6 – – – – – 1 3 2 — 1 — – 1 — 2 — — 1 — 1 — – — Appendicitis and typhlitis 8 — — 1 1 1 3 2 — – — — — 2 1 2 – 1 — — — 1 1 — Other digestive diseases 35 — — — — 1 5 15 14 .— 3 1 4 12 2 7 — — 2 1 — — 1 2 Bright's disease, &c. 21 — — — – 1 2 9 9 1 2 — — 4 — 8 – — 2 – — — 3 1 Cystitis, &e. 20 – – – – – 1 8 11 — 3 1 4 — 3 5 1 — — - 1 — 1 1 Deaths by accident or negligence 28 3 1 1 4 4 1 7 7 – 3 1 1 9 1 5 – – 2 1 2 1 2 – Deaths by suicide and murder 18 – – – – 1 6 10 1 – 2 – – 8 1 2 1 – 1 – – – 1 2 Other defined diseases 5 1 — — — — 1 2 1 — 1 — 2 1 — — — — — 1 — — — — Diseases, ill defined or unknown – – – – – – – – – – – – – – – – – – – – – – – – All causes 745 39 9 7 12 18 61 26f> 333 4 60 23 42 209 49 184 19 8 23 18 20 24 42 20 h-« o FEMALES. Table VIII (continued).—Causes of, and Ages at, Death during the year 1936. 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 2 — 1 – 1 – – – – – – – – – – – 1 – – — 1 – – – Scarlet fever — — – – – – – – — — – — — — — – – – – – – – – – Influenza 7 — – – – – 1 2 4 — 1 — 1 — 3 1 1 – – – – – – – Whooping-cough — — – – – – – — — – – — — — — — – — – — — – – — Diphtheria, Memb. croup 2 — – 1 1 – – – – – – – – 1 – 1 – – – – – – – – Cerebro-spinal meningitis – – – – – – – – – – – – – – – – – – – – – – – – Poliomyelitis — — – – – – – — — — – — — — — — – — – — — – – — Enteric fever – – – – – – – – – – – – – – – – – – – – – – – – Diarrhoea, enteritis 6 4 – – – – – – 2 1 1 — — 2 — — 1 — – — — 1 – — Erysipelas – – – – – – – – – – – – – – – – – – – – – – – – Puerperal fever – – – – – – – – – – – – – – – – – – – – – – – – Other septic diseases 9 2 – – 1 – 3 1 9 — – – 1 5 – – – – – – – – – – Syphilis, &c 1 – – – – – – 1 — — – — — – – 1 – – – — — – – — Diabetes 9 — – – – 1 — 1 7 — 2 2 1 — — 1 1 — 1 1 — – – –– Rheumatic fever – – –– – – – – – – – – – – – – – – – – – – – – – Tuberculosis of lungs 31 — – – 1 7 11 8 4 — — 1 2 14 — 7 3 — – 2 — 2 – – Other forms of tuberculosis 3 — – 1 – 2 — — — — — 1 — — — 1 – — – — — 1 – – Malignant growths 113 – – – – – 10 34 69 2 9 4 8 48 5 17 4 1 2 7 2 3 – 1 Congenital debility, malformation, and premature birth 16 16 – – – – – – – – – 1 2 5 – 4 1 1 – I – 1 – – Old age 7 – – – – – – – 7 — — 1 1 1 1 2 – — – – – 1 – – Meningitis and convulsions 2 1 – – – – – 1 – – 1 – – – – 1 – – – – – – – – 17 Loc. ataxia and general paralysis 2 – – – – – 1 1 – – – – 1 – – 1 – – – – – – – – Other diseases of nervous system 11 – – – 1 – 5 1 4 – 1 1 1 6 – 2 – – – – – – – – Valvular diseases of heart 10 — — — — – – 3 7 – – – – 4 – 3 – – 1 1 – 1 – – Other circulatory diseases 239 — — — — 1 7 49 182 1 14 11 17 95 16 44 7 3 4 8 3 12 2 2 Bronchitis 55 — — — — — 1 12 42 –– 5 – 4 22 6 9 – – – 1 1 1 – – Broncho-pneumonia 48 — – 1 — 1 4 15 27 – 5 2 3 20 4 7 1 2 1 1 – 2 – – Pneumonia, other forms 21 1 — – — – 3 7 10 1 3 – 1 5 1 8 – – – 1 – 1 – – Other respiratory diseases 14 — — – – 1 3 3 7 – 1 1 2 3 1 2 1 – – 1 – 1 1 – Alcoholism 4 — — – – – 2 2 – – – – – 2 – 1 – – – – 1 – – – Cirrhosis of liver 2 _ – – 2 – 1 – – – – 1 – – – – – – – – Appendicitis and typhlitis 5 — — – — 1 1 2 1 – 1 – 1 2 1 – – – – – – – – – Other digestive diseases 27 1 — — – – 1 10 15 1 2 – 1 12 1 4 1 – 2 – 2 1 – – Bright's disease, &c. 29 — — — 1 – 5 7 16 – 3 1 5 9 1 4 1 1 – 1 – 2 1 – Cystitis, &c. 4 — .– – – – – – 4 – – – – 2 – 1 – – – – 1 – – – Accidents and diseases of parturition 1 – – – – 1 – – – – – – – – – 1 – – – – – – – – Deaths by accident or negligence 27 4 1 3 1 – 6 4 8 – 2 – 3 8 – 5 1 – – 3 – 1 – 4 Deaths by suicide and murder 12 2 – – – 3 2 4 1 – – – – 3 2 3 1 1 – – – – – 2 Other defined diseases 13 – 1 – 1 – 1 5 5 – 1 2 – 7 – 2 – – – – 1 – – – Diseases, ill defined or unknown — — — — — — — — — — — — – — — — — — — – — – — All causes 732 31 3 6 8 18 67 173 426 6 53 28 55 276 42 137 31 9 11 28 12 31 4 9 18 1,606 deaths were registered in the City during 1936. After deducting 994 deaths of non-citizens in public institutions, etc., in the City, and adding those of 865 citizens who died in other districts, the corrected total is 1,477 as compared with 1,436 in 1935, and is equivalent to an annual crude rate of 11.9 per 1,000 persons compared with 11.5 last year. The London death-rate for 1936 was 12.5 and for England and Wales, 12.1. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below :— Table IX. Death Rates from 1922 to 1936. Year. Number of Deaths. Westminster Rate. London Rate. 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 1,436 11.5 11.4 1936 1,477 11.9 12.5 The deaths of males were 745, females 732. Table X. Deaths Distributed amongst Age Groups. This table shows the total deaths distributed among age periods:— 1936 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. 39 9 7 12 18 61 266 333 745 F. 31 3 6 8 18 67 173 426 732 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 1,436 1936 70 12 13 20 36 128 439 759 1,477 19 The causes of death are set out in Table VIII. There was an increase among males of deaths from the following causes:—cancer, syphilis, tuberculosis, and diseases of the nervous, digestive and respiratory systems. Among females the causes showing an increase were septic diseases, tuberculosis and diseases of the urinary 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. - 1932. 1933. 1934. 1935. 1936. M. F. Total. M. F. Total M. F. Total. M. F. Total. M. F. Total. Conduit 3 4 7 5 1 6 — 3 3 8 4 12 4 6 10 Glrosvenor 55 63 118 86 55 141 64 61 125 61 57 118 60 53 113 Hamlet 17 20 37 19 22 41 12 24 36 14 30 44 23 28 51 K. St. George 67 70 137 67 65 132 60 61 121 45 70 115 42 55 97 Victoria 214 244 458 212 230 442 224 235 459 226 240 466 209 276 485 St. Margaret 38 50 88 39 39 78 43 40 83 39 34 73 49 42 91 St. John 226 179 405 235 167 402 183 144 327 190 147 337 184 137 321 St. Anne 32 21 53 28 31 59 27 34 61 24 31 55 19 31 50 Gt. Marlborough 12 9 21 15 10 25 12 19 31 11 7 18 8 9 17 Pall Mall 23 10 33 20 3 23 22 10 32 21 5 26 23 11 34 Regent 30 19 49 31 20 51 16 25 41 21 19 40 18 28 46 Charing Cross 11 3 14 20 11 31 17 5 22 19 6 25 20 12 32 Movent Garden 36 26 62 41 33 74 24 31 55 24 23 47 24 31 55 Strand 36 — 36 32 3 35 32 3 35 28 5 33 42 4 46 Homeless 24 15 39 28 5 33 20 15 35 16 11 27 20 9 29 Infantile Mortality.—The corrected death-rate of infants for Westminster was 65.8 per 1.000 births. The mortality among legitimate infants was 60.0 per 1,000; that of illegitimate 105.2. The infant mortality rate for London was 66. The number of infants dying under 1 year was 70, a decrease of 5 on the figure of last year. The chief contributory causes of death were congenital defects, prematurity, and affections of the stomach and bowels. (8342) B 2 20 Table XII shows the deaths as they occurred during the four quarters of the last four years:— Table XII.—Infantile Mortality. Total 1933. Total 1934. Total 1935. Total 1936. 1st Quarter 26 30 26 22 2nd „ 23 18 18 17 3rd „ 11 11 14 19 4th „ 15 18 17 12 75 77 75 70 Table XIII shows the births and deaths of infants, legitimate and illegitimate, since 1909 onwards, with the corresponding infantile mortality rates for Westminster and for London. Although the variations are of little significance there is a slight increase in births both legitimate and illegitimate, and a definite saving among the lives of the illegitimate. This may suggest a higher sense of responsibility among these unfortunate mothers. Table XIII.—Infantile Mortality since 1909. Year. Legitimate. Illegitimate. Total Bate, Westminster. Total Rate, London. Births. Deaths. Death-rate per 1,000 Births. Births. Deaths. Death-rate per 1,000 Births. 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 86 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 68 1925 1,418 88 62.0 117 14 153.8 69.0 67 [926 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 1936 930 56 60 133 14 105.2 65.8 66 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 1929 onwards, showing the proportion per 1,000 births applicable under each heading:— Table XIV.—Infantile Mortality—Causes. — 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. Influenza . 0.73 – – – 2.7 –– – 0.94 Measles 0.73 3.6 0.86 – 0.85 – 0.94 Whooping Cough 8.1 0.73 0.82 0.86 1.8 — 1.9 — Bronchitis and pneumonia 14.7 14.6 22.3 1.21 10.9 12.0 12.4 4.7 Stomach and bowel diseases 7.3 5.8 13.2 8.6 9.0 15.4 11.5 11.2 Syphilis 0.73 2.1 1.6 1.7 3.6 1.71 — — Congenital malformations debility, etc. 4.4 4.3 6.6 – 1.8 2.57 8.6 15.9 Prematurity 19.8 18.2 22.3 19.9 16.3 20.5 20.1 15.0 Tuberculosis 2.2 1.4 – 0.86 – – – – Murder — 1.4 – 0.86 – – 1.9 1.8 Accidents and negligence – – 1.6 0.86 0.9 1.71 8.6 6.5 Cerebro-spinal Meningitis – – 0.82 0.86 0.9 – 1.9 – Erysipelas — — — 0.86 0.9 0.85 — — Other causes 13.2 1.4 1.6 3.4 1.8 6.85 4.7 5.6 Prematurity and other enfeebling factors in the new-born remain the heaviest handicaps on infant life. It must be difficult to diagnose influenza in an infant under one year, but as it is registered as a cause of death it must be accepted. Possibly it is an omnibus term covering a range of febrile affections due to some bacterial origin. 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) – – – – – 2 1 2 – 5 Premature birth 10 4 – l 15 – 1 – – 16 Other causes – – – – – 2 2 1 3 8 Stomach and bowel – – – – – 1 3 5 4 13 Accidents and negligence 7 1 – – 8 – – – 1 9 Congenital Defects 12 1 1 – 14 1 2 – – 17 Murder 2 – — — 2 — — — — 2 31 6 1 1 39 6 9 8 8 70 22 Table XVI.—Births and Infantile Deaths. Nett Births in the year :— Males. Females. Total. Legitimate 460 470 930 Illegitimate 76 57 133 536 527 1,063 Nett Deaths in the year of :— Males. Females. Total. Legitimate infants 34 22 56 Illegitimate infants 5 9 14 39 31 70 The causes of death of the Illegitimate were :—murder 2, prematurity 2, pneumonia 1, stomach and bowel diseases 1, congenital defects 4, and accidents and negligence 4. 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. Meningitis — — — — — — 1 — 1 2 Bronchitis and Pneumonia (all forms) — — — — — 2 1 2 — 5 Stomach and bowel — — — — — — 1 3 2 6 Premature birth 6 1 — 1 8 — — — — 8 Accident 2 — — — 2 — — — 1 3 Congenital defects 7 1 1 — 9 1 1 — — 11 Other causes — — — — — 1 1 — — 2 Totals 15 2 1 1 19 4 5 5 4 37 Nett Deaths in the above area during the year :— Males. Females. Total Legitimate 22 10 32 Illegitimate 4 1 5 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 Stomach complaints — — — — — — 1 1 2 4 Premature birth 4 2 — — 6 — — — — 6 Other Causes — — — — — 1 — 1 1 3 Accidents 1 1 — — 2 — — — — 2 Totals 7 3 — — 10 1 2 2 3 18 Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 9 7 16 Illegitimate infants 1 1 2 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, Regent, Gt. Marlborough, Strand, Gharing 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 Months. 6 Months and under 9 Months. 9 Months and under 12 Mouths Deaths under 1 Year Premature birth — 1 — — 1 — 1 — — 2 Stomach complaints — — — — — 1 1 1 — 3 Congenital defects 2 — — — 2 — — — — 2 Measles — — — — — — — — 1 1 Totals 2 1 — — 3 1 2 1 1 8 Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 2 5 7 Illegitimate infants — 1 1 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. Congenital defects 1 — — — 1 — — — — 1 Neglect at birth 4 — — — 4 — — — — 4 Murder 2 — — - 2 — — — — 2 7 — — — 7 — — — — 7 Deaths of children unknown :— Males. Females. Total Legitimate 1 — 1 Illegitimate — 6 6 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, 1936. Legitimate. Illegitimate. Total Infant Deaths, 1936. Legitimate. Illegitimate. 1936—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total Rate. Conduit 2,086 7 4 3 1 — 1 — 333.3 142.8 Grosvenor 13,318 47 43 4 — — — — — — Pall Mall 2,872 6 6 — — — — — — — Regent 4,047 19 15 4 1 1 — 66.6 — 52.6 Gt.Marlborough 3,331 13 12 1 1 1 — 83.3 — 76.9 St. Anne 5,405 39 29 10 2 2 — 68.9 — 51.2 Covent Garden 6,655 30 28 2 3 3 — 107.1 — 100.0 Charing Cross. 3,210 5 5 — — — — — — — Strand 2,052 — — — — — — — — — Victoria 36,955 431 376 55 29 25 4 66.5 72.7 67.2 K. St. George 11,445 75 66 9 7 6 1 90.9 111.1 93.3 Hamlet 6,461 36 37 5 1 1 — 32.2 — 27.7 St. Margaret 8,671 46 43 3 1 1 — 23.2 — 21.7 St. John 23,071 291 272 19 17 15 2 55.1 105.2 58.4 Homeless, etc. — 18 — 18 7 1 6 — 333.3 388.8 Total 129,579 1,063 930 133 70 56 14 60.0 105.2 65.8 These figures once again serve to illustrate the danger of making general deductions from scanty data. In Conduit Ward with a population as large as that of many country towns there were only 7 25 births, 3 of which were illegitimate. The four born in wedlock survived, but one of those born outside it died and the resulting infant mortality rate is 142.8 If that poor child had survived the infant mortality rate would have been nil! 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 1936. Cities and Borough. Est. Resident Population (mid-1936). Live Births rate per 1,000 Population. Death rate per 1,000 Population. Infantile Mortality rate per 1,000 Live Births. Crude. Adjusted. W eat Districts— Paddington 139,200 13.8 12.98 12.81 72 Kensington 176,100 12.7 12.5 11.7 73 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 City of Westminster 124,100 8.5 11.9 12.2 65.8 North Districts— St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65.8 St. Paneras 183,900 13 13.5 13.8 79 Islington 304,100 15.24 12.44 12.56 61 Stoke Newington 50,350 13.7 11.4 10.9 44.6 Haokney 209,100 14.4 12 12.6 62.9 Central Districts— Holborn 34,850 8.29 11.99 12.83 62 Finsbury 60,800 13.8 14 15.3 81 City of London 9,100 7.5 11.4 12.65 147 East Districts— Shoreditch 85,400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14.7 12.6 14.7 100.09 Poplar 140,300 15 12.5 13.8 72 South Districts— Southwark 152,200 14.8 13.1 59 Bermondsey 100,400 15.4 12.8 14.6 60 Lambeth 277,500 13.9 12.5 12.4 59 Battersea 145,500 14.63 13.06 12.93 59.21 Wandsworth 343,000 11.46 11.79 10.96 58 Camberwell 229,300 13.93 12.64 12.64 58.86 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.82 11.36 11.58 49 Lewisham 224,000 13 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 Common Lodging House Deaths. Reference has been made in former reports to the shifting population which inhabits the five common lodging houses which are licensed in the City. Some of the residents are permanent in so far that they have been resident in the Public Assistance institutions for perhaps thirty 26 or forty years although their original residence, and perhaps a temporary one 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; 84 deaths of persons giving addresses in common lodging houses occurred in 1936. They were mostly in institutions:— Table XXIII.—Deaths in Common Lodging Houses. Deaths. Ward. Bruce House (L.C.C.) 38 Strand 33, Great Peter Street 3 St. John. 7, St. Ann's Street (Salvation Army) 27 16, Strutton Ground 15 Church Army Home, Greencoat Place 1 84 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 1932-1936. Details respecting the notifications of infectious disease received are set out in the following pages. Table XXIV.—Notifications of Infectious Disease. 1932 1933 1634 1935 1936 Smallpox 3 1 — — — Diphtheria 80 142 153 111 82 Erysipelas 50 53 63 44 35 Scarlet fever 211 354 375 194 198 Enteric fever 7 7 6 11 12 Continued fever — — 1 — — Puerperal fever 7 4 5 9 1 Puerperal pyrexia 8 11 13 17 13 Cerebro-spinal meningitis 6 11 4 3 4 Encephalitis lethargica 2 1 — — — Poliomyelitis 1 2 5 2 — Ophthalmia neonatorum 13 7 4 1 11 Measles 810 255 807 195 590 German measles 18 45 39 10 27 Pneumonia 51 66 48 35 22 Malaria 1 — 1 15 2 Dysentery 2 1 3 15 14 Chickenpox 201 167 146 194 162 Mumps 92 130 105 272 102 Whooping-cough 138 132 95 134 141 27 Diphtheria continued on the wane, whereas Scarlet Fever showed a slight increase over the figures for last year. Measles showed an increase over last year but was very much lower than for 1932 or 1934. Vaccination.—The Vaccination Officer reports that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary 451 Secondary 64 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, 1935. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1935. Number of these Births duly entered by 31st January, 1937, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1937, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1937, neither dulv 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 1936. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Un vaccinated. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to Places unknown,or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had Smallpox. 1,524 880 2 — 282 59 6 175 116 4 1,056 304 Table XXVI. Summary of Monthly Returns for the Year ended 31st December, 1936. 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 removed out of District or otherwise not found. No. of Entries in List sent to Public Vaccinators 1,535 1,056 21 304 4 89 291 29 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, 1936. 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. A. E. Cope to 8.6.36 and Dr. J. Forbes to 30.9.36 (Mayfair, Strand, St. James and St. Anne) 46 1 47 3 Dr. A. E. Cope to 8.6.36 and Dr. J. Gorsky to 30.9.36 (Westminster, St. Margaret and St. John) 159 13 172 30 Dr. A. E. Cope to 8.6.36 and Dr. T. Bromley to 30.9.36 (Belgrave and Knightsbridge) 181 9 190 36 Totals 386 23 409 69 30 Table XXVIII.—Cases of Infectious Disease Notified. Notifiable Diseases. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At all Ages. 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 76 1 4 1 4 11 25 ii 7 10 — 2 — 76 — 4 — — 1 — 2 — — — — — — Erysipelas 35 2 1 — 1 — 2 2 1 4 6 12 4 30 5 — — — — — — — — — — — — — Scarlet fever 190 — 10 13 17 17 52 18 21 27 9 6 — 189 1 — — — — — — — — — — — — — Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 12 — 2 —. — — 2 1 2 2 — 3 — 12 — — — — — — — — — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 1 — — — — — — — — 1 — — — 1 — — — — — — — — — — — — — — Cerebro-spinal meningitis 4 2 — — — — — — — 2 — — — 4 — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum 11 11 — — — — — — — — — — — 7 4 — — — — — — — — — — — — — Pneumonia 22 — — — — — — — 2 7 8 2 3 16 6 38 1 — — — — 1 — — 1 6 16 13 Malaria 2 — — — — — — — — 1 1 — — 2 — — — — — — — — — — — — — — Dysentery 14 5 1 1 3 2 — — — 2 — — — 3 1 — — — — — — — — — — — — — Puerperal pyrexia 13 — — — — — — — 1 11 1 — — 13 — — — — — — — — — — — — — — Totals 380 21 18 15 25 30 81 32 34 67 25 25 7 363 17 42 1 — 1 — 2 2 — — 1 6 16 13 Correction has been made for errors iD notification or revision of diagnosis in 28 caaos. Diphtheria 13, Scarlet Fever 13, Dysentery 2. Cases not notified:— Scarlet fever, 8. Diphtheria, 6. 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 — 5 6 22 4 28 — 3 4 4 1 1 — 3 1 Erysipelas 1 7 3 8 2 6 2 — — — — 2 1 1 2 Scarlet fever 2 13 9 74 16 48 3 4 8 4 2 2 1 4 8 Typhus fever — — — — — — — Enteric fever — 2 1 4 — 2 — — — — 1 — — — 2 Relapsing fever (R) — — — — — — — — — — — — — — — Continued fever (C) — — — — — — — — — — — — — — — Puerperal fever — — — 1 — — — — — — — — — —- — Cerebro-spinal meningitis — — — 1 1 — — — — — — — — 2 Poliomyelitis — — — — — — — — — — — — — — — Encephalitis lethargica — — — — — — — — — — — — — — Ophthalmia neonatorum — — 1 6 — 3 — — — 1 — — — — — Pneumonia — 4 2 2 — 9 — — 1 — — — 1 2 1 Malaria — — — — — — — — — — 1 — — 1 — Dysentery — — — 2 3 6 — — — — _ 2 — — 1 Puerperal pyrexia — 2 2 4 2 1 — — — — — — — 2 — Membranous Croup — — — — — — — — — — — — — — — Totals 3 33 24 124 28 103 5 7 13 9 5 7 3 13 17 32 Scarlet Fever.—One hundred and ninety-eight cases of this disease occurred in 1936, an increase of 4 on the figures of 1935. No death occurred. The case rate of this disease per 1,000 of the population was 1.59 for the City, and for England and Wales 2.53. The death-rate for London was 0.01 per 1,000, and for England and Wales 0.01. Of the total cases in Westminster 99.4 per cent. were removed to hospital. Diphtheria.—Eighty-two cases of this disease occurred, showing a decrease of 29 on the figures of 1935. The case rate of this disease for Westminster was 0.66 per 1,000 living, and for England and Wales 1.39. There were 4 deaths: 2 males aged 4 years; females aged 2 and 5 years. The death-rate for England and Wales was 0.07, for London 0.05, and for Westminster 0.03. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1936, by Dr. Ian S. Thomson, Deputy Medical Officer of Health. This treatment was continued throughout the year, one clinic being held weekly at each of the Council's Maternity and Child Welfare Centres and at the Westminster Health Society's Centre. During the year 245 cases were dealt with, as compared with 235 and 249 in 1935 and 1934 respectively. New cases attended the Centres as follows :— Ebury Bridge 80 Bessborough Street 85 Marshall Street 36 Westminster Health Society 44 245 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. The treatment was carried out without difficulty and with satisfactory results. The following Table shows the age groups of those treated and the result of such preliminary tests as were performed :— 33 Table XXX.—Diphtheria Immunisation. Positive. Negative. No Test. Total. Under 5 1 - 170 171 Under 10 2 2 63 67 Over 10 1 4 2 7 4 6 235 245 Five of the negative cases were known or believed to have had protective treatment elsewhere. One hundred and twenty-eight cases who had previously been treated were re-tested during the year. Two of these were still positive and received further doses of the protective material. A third was doubtful but further treatment was not desired. The remaining 125 cases gave negative results. Antitoxin, for use in cases of diphtheria, is provided free of chargc 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 12 cases of typhoid and paratyphoid which came to the knowledge of the department during 1936. Of these, 3 were notified as paratyphoid and 9 as typhoid. The case rate for England and Wales was 0.06 and for Westminster 0.09. No death 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. 1932. 1933. 1934. 1935. 1936. 810 255 807 195 590 The death-rate for England and Wales per 1,000 population was 0.07, and for Westminster 0.04. Two hundred and forty-six cases were removed to hospital, 104 being between the ages of 1 and 5. 5 deaths occurred. German Measles.—Twenty-seven cases were notified. (8342) c 34: Influenza.—The deaths certified from this cause during the last five years are as follows :— Table XXXII.—Deaths from Influenza 1932. 1933. 1934. 1935.  Males 21 37 12 5 7 Females 37 29 6 10 7 58 66 18 15 14 The death-rate in 1936 for Westminster was 0.11 per 1,000; for London 0.14, and for England and Wales 0.14. Last year the corresponding rates were 0.12 for Westminster, 0.11 for London, and 0.18 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 15—9 males and 6 females—12 being under 1 year. The infant death-rate from this cause in Westminster was 11.2. Of the deaths under one year, 11 occurred in hospital. Ten of the children had been admitted suffering from enteritis, while one was infected in hospital. Table XXXIII. Deaths from Diarrhcea and Enteritis. Under 1 year. Other ages. Total. 1932 8 3 11 1933 10 1 11 1934 16 3 19 1935 10 2 12 1936 12 3 15 Whooping Cough.—141 cases were notified during the year, with 3 deaths, 68 cases were moved to hospital, 54 being between the ages of 1 and 5. The death rate for Westminster was 0.02, for London 0.06, and for England and Wales 0.05. 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. 1932 1 1 2 1933 2 4 6 1934 — 9 9 1935 2 — 2 1936 — 3 3 Cerebro-spinal Fever.—4 cases of this disease occurred. Chicken Pox.—162 cases occurred, 54 being moved to hospital. Mumps.—102 cases were recorded, 19 cases being moved to hospital. Puerperal Fever.—One case was notified and 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 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 1936 1.063 1 — — Puerperal Pyrexia.—13 cases occurred, all being removed to hospital. Ophthalmia Neonatorum.—11 cases occurred in 1936. In addition to these notified cases, 5 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. One mother and 7 children were admitted for 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 required to call qualified medical assistance to all cases of inflammation of the eyes. If the medical practitioner considers the case one of ophthalmia neonatorum, he must notify the Medical Officer of Health. (8342) c 2 36 The following details in tabular form are required by the Ministry of Health of the cases notified in 1936 :— Table XXXVI.—Ophthalmia Neonatorum. Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Left district. Total. Treated. At home. In hospital. 11 4 7 8 — — — 3 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 462 Blood for investigation of enteric 32 Sputa „ „ tuberculosis 320 Expenditure on the first two was £79 9s. 1d., and on the third £44 10s. 9d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1936, 199 new cases of pulmonary tuberculosis came to the knowledge of the department, including 8 cases who had moved into the City and 20 non-notified deaths. Non-pulmonary forms of tuberculosis gave 25 cases—2 of these being non-notified deaths, 5 transfers from other districts, and 1 posthumous notification. 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 year — 1 — — — — — — 1 to 5 years — — 1 — — — 1 1 5 „ 10 .. — — 3 — — — — — 10 „ 15 „ — 2 2 1 — 1 1 — 15 „ 20 „ 5 4 2 2 1 — — i 20 „ 25 „ 22 22 3 1 5 7 1 1 25 „ 35 „ 27 20 3 3 6 7 1 — 35 „ 45 „ 27 11 1 3 10 4 1 — 45 ,, 55 „ 21 8 — — 13 6 — — 55 ,, 65 ,, 18 3 — — 13 3 — — 65 and upwards 6 2 — — 3 3 — — Totals 126 73 15 10 51 31 5 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 1936 show a decrease of 5 on those of 1935. Out of the total cases primarily notified in 1936, 24 died, and the following table shows the period between notification and death of these cases :— 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 10 2 1 5 2 1 — 1 2 — — — — — Table XXXIX.—Tuberculosis Deaths. 1932 1933 1934 1935 1936 New cases notified 242 202 266 201 188 Number included in above who died during the year 35 (14.4%) 34 (16.8%) 38 (14.28%) 20 (9.9%) 24 (12.7%) Total Tuberculous Deaths 106 101 99 67 90 Death Rates per 100,000 83.8 79.9 79.8 53.8 72.5 38 Table XL. Tuberculosis.—Notifications received during the period from 1st January, 1936, to 31st December, 1936. 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. Pulmonsry Males — — — — 5 20 21 24 17 15 5 107 111 Females 1 — — 2 4 20 18 10 6 2 1 64 73 Non-pulmonary— Males — 1 3 1 2 3 2 — — — — 12 13 Females — — — — 1 1 2 1 — — — 5 5 Total 1 I 3 3 12 44 43 35 23 17 6 188 202 39 Table XLI. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1936. 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 — — — — — 2 6 3 4 3 1 19 Females — — — — — 2 2 1 2 1 1 9 Non-pulmonary— Males — — — 1 — — 1 1 — — — 3 Females — — — 1 1 — 1 2 — — — 5 Total — — — 2 1 4 10 7 6 4 2 36 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. 1936. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. j St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing I Cross. 1 Covent Garden. Strand. St. Anne. Homeless. j Received Institutional Treatment during 1 1936. Pulmonary— Stales 126 2 4 4 39 7 35 4 1 1 4 4 12 8 1 112 Females 73 1 3 6 27 2 15 3 2 G — 2 1 — 5 — 57 Non-pulmonary— Males 15 1 — — 5 1 4 1 — — — I — 1 — 1 13 Females 10 — 1 — 3 1— 3 2 — — 1 — — — — — 4 224 4 8 10 74 10 57 10 2 7 2 7 5 13 13 2 186 41 Table XLIII. Tuberculosis Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all forms. General Population. c.L.H. and no Address. Total. Males. Females. Males. Females. Males. Females. Total. 1917 209 164 51 7 431 42 34 76 507 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 1922 119 110 42 2 273 24 30 54 327 1923 111 114 42 1 268 24 32 56 324 1924 140 122 33 1 296 27 24 51 347 1925 108 92 27 1 228 23 31 54 282 1926 117 90 29 4 240 18 30 48 288 1927 103 67 24 1 195 21 29 50 245 1928 97 61 27 2 187 22 27 49 236 1929 106 105 42 6 259 14 28 42 301 1930 104 69 16 1 190 24 33 57 247 1931 108 86 17 1 212 20 23 43 255 1932 136 84 28 — 248 26 36 62 310 1933 106 75 24 — 205 18 22 41 246 1934 130 94 27 — 251 31 23 54 305 1935 93 62 29 — 184 27 18 45 229 1936 98 72 28 1 199 15 10 25 224 42 Table XLIV.—Tuberculosis—Cases on the Register. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on register at beginning of year 1936 746 371 167 190 Notified for the first time during year 126 73 15 10 872 444 182 200 Removed from the register on account of death or removal etc., from Westminster 84 63 20 16 788 381 162 184 Of the 183 cases removed from the register during the year 1936, 91 were on account of death, 87 persons suffering from tuberculosis moved from the City and notification was withdrawn in 5 cases. The total number of cases of tuberculosis on the Register at the end of 1936 was 1,515 (as compared with 1,474 at the end of the year 1935), of which 1,169 were pulmonary cases, consisting of 788 males and 381 females. Deaths from Tuberculosis.—The total number of deaths from tuberculosis for 1936 (all forms) was 90—males 56, females 34. This gives a death-rate for this disease of 0-72 per 1,000. The following table shows the number of deaths from tuberculosis for the last 6 years, together with the death-rate. Year. Deaths. Rate per 1,000. 1931 121 1.04 1932 106 .83 1933 101 .79 1934 99 .79 1935 67 .53 1936 90 .72 43 The following table shows deaths per 100,000 of civilian population since 1922. Table XLV. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates Deaths. Rates. 1922 annual 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.l 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 1936 „ 82 66.0 8 6.4 90 72.5 The following report and tables of statistics required by the Ministry of Health are submitted by Dr. Ian S. Thomson, Tuberculosis Officer and Deputy Medical Officer of Health. City of Westminster Tuberculosis Dispensary. Annual Report, 1936. The work of the Dispensary has been carried on throughout the year on the established lines. New patients numbering 456 were seen during the year, of whom 219 were considered to be tubercular. These cases classed as tubercular for Dispensary purposes do not all show evidence of recent active disease. The following Table shows the source of reference of cases to the Dispensary during the last three years:— Table XLVI. 1934. 1935. 1936. Medical Practitioners 157 140 136 Health Visitors 161 143 171 St. Stephen's Hospital 99 97 115 Ministry of Pensions 1 — — School Medical Officer 23 25 18 Voluntary Hospitals 9 12 7 Friends, Charitable Organisations, etc. 12 8 9 462 425 456 44 The variation from year to year in the proportions from each source is not great. The increase in the number referred by the Health Visitors is in part due to the fact that rather more contact cases were available for examination. An increase in the number of cases first seen in St. Stephen's Hospital may be noted. The value of the arrangement whereby the Tuberculosis Officer visits the 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 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 pass on to a Sanatorium if suitable for such treatment. The following table gives certain details of the work of the Dispensary during 1936 and the four preceding years Table XLVII. 1932. 1933 1934. 1935. 1936. New patients attending 484 412 462 425 456 Old patients attending 477 430 473 472 494 New contacts examined 105 126 109 108 127 Individual attendances 961 842 935 897 950 Total attendances 2,321 2,165 2,615 2,454 2,393 Written reports to public authorities and medical practitioners 1,228 1,090 1,066 1,064 1,108 Home visits 73 82 67 73 109 Consultations with medical practitioners 132 117 153 145 131 Visits by health visitors to dispensary eases 3,373 3,404 3,526 3,335 2,885 Sputum examinations 225 164 193 171 187 X-ray examinations 42 61 60 78 100 The number of contacts examined shows a slight increase in proportion to the total number of new cases. It has previously been pointed out that the number of available contacts is relatively low in Westminster, owing to the large number of single persons living in lodgings or hostels, and of persons living-in at their places of employment. There seems reason to feel that the proportion of cases from this group is increasing. 45 Patients have been recommended for institutional treatment from the Dispensary as follows:— Table XLVIII. Hospitals. Sanatorium. Insured males 14 37 Insured females 4 27 Uninsured males — 2 Uninsured females 1 7 Boys 2 1 Girls 4 2 25 76 This Table does not include patients sent direct to St. Stephen's Hospital. Many of these are transferred to a Sanatorium later. In addition, 40 cases were recommended for institutional treatment by voluntary hospitals and transferred direct. Many of these cases are seen at the Dispensary when institutional treatment has been completed. Convalescent treatment was arranged for many children through the Invalid Children's Aid Association, the Public Assistance Committee, the School Care Committees, St. Henry Fund and other agencies. Convalescent treatment for Ex-service men is now less frequently required, but use is still made of the help in this and other matters provided by the organisations which deal with the welfare of Ex-Service men and their families. The association with Westminster Hospital has continued and cases were referred there during the year for surgical and orthopaedic treatment, etc. School children requiring dental treatment were referred to the school dentist. Six adult patients were referred to the Council's Dental Clinic, 55 extractions were carried out and five of the patients were fitted with dentures. Thirteen patients received Artificial Pneumothorax treatment at Brompton Hospital and elsewhere and had, in all, 149 refills. Two cases of Lupus received special Light treatment at a cost to the Council of £9 10s. During the year a special report was issued on the work of the Tuberculosis Care Committee. This report gave an outline of the duties 46 performed by the Committee, and considered in retrospect certain aspects of the work during the twenty years through which the Committee has functioned. 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 ot extra nourishment where this is considered helpful to the patient s treatment. Thirty-five patients received this extra diet allowance at a total cost to the Council of £186 4s. 5d. There are many patients who, while not actually requiring economic relief, have difficulty in supplying the extras of nutritional value for which their medical condition calls. In such cases the Council's daily grant of milk and eggs has proved of the highest value to health. It has particular application to patients in the difficult period following return from a Sanatorium, and to others with disease of longer standing who are with difficulty maintaining at least moderately good health. 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 derive interest and benefit from the work of the Class. There is, however, some difficulty in maintaining the numbers as many members return to work, break down or leave the district. In previous years it has been found necessary to organise Sales of Work to dispose of the goods made by the members of the Class. It is not desired that such Sales should be too frequent, and during the year successful efforts were made to dispose of all the work by private sale. 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 £16 annually to the Handicraft Class. Without this help it would be difficult to carry on this useful work. 47 Table XLIX. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work of the Dispensary during the Year 1936. 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 131 90 1 2 7 9 3 8 138 99 4 10 251 *(6) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 21 61 17 19 118 B.—Contacts examined during the year (a) Definitely tuberculous — 2 — 1 — — 1 4 — 2 1 5 8 *(b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 15 29 38 37 119 C.—Cases written off the Dispensary Register as— (a) Recovered 1 — — 1 — — 1 — 1 — 1 1 3 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 38 94 58 58 248 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 262 170 25 26 34 36 46 47 296 206 71 73 646 (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 1936—continued. 1. Number of cases on Dispensary Register on 1st January 655 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 109 2. N umber of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 15 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,885 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 201 10. Number of— (a) Specimens of sputum, etc., examined 187 4. Cases written off during the year as Dead (all causes) 68 (6) X-ray examinations made in connection with Dispensary work 100 5. Number of attendances at the Dispensary (including Contacts) 2,393 6. Number of Insured Persons under Domiciliary Treatment on 31st December 203 11. Number of "Recovered" cases restored to Dispensary Register, 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 31st December 203 (a) Personal 131 (b) Other 245 (B) Number of Dispensaries for the Treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council 1 Provided by Voluntary Bodies 3 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, ice-cream and other foods, particularly in the investigation of foods suspected of being the cause of food poisoning, are also carried out at the hospital laboratories. The examination of certified milk under the Milk (Special Designations) Order, 1936, 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 1s. 6d. per nursing visit and the total amount paid during 1936 amounted to £178 6s. 8d., representing some 2,639 visits as compared with 2,363 for the previous year. Subsequent reference is made in this report to the extension of nursing services to all cases of tuberculosis and all cases of illness in children under 5 years, to take effect in 1937. Clinics and Treatment Centres.—These institutions, apart from the voluntary general and special 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.I. 3. Maternity and Child Welfare Centre, 15, Bessborough Street, S.W.l. 4. City of Westminster Health Society, 121, Marsham Street, S.W.I. (0342) d 50 New Maternity and Child Welfare Centre and Day Nursery in Bessborough Street. A description of the new building proposed to be erected by the Council in Bessborough Street for use as a Maternity and Child Welfare Centre and Day Nursery was included in the Annual Report for last year, together with a reproduction of the elevation and internal lay-out. During the year prolonged negotiations for the acquisition of the site were concluded. Working drawings having in the meantime been prepared were submitted to tender ; that of Messrs. Prestige & Co., Ltd., was accepted. The demolition of the dwelling-houses on the site, namely, Nos. 1, 3, 5 and 7, Bessborough Street, was carried out and the site cleared in July, 1936. Building operations began on the 13th July. Towards the close of the year substantial progress had been made with the construction, and it is estimated that the work will be completed and the building ready for occupation during the Summer of 1937. The building will serve the dual purpose of a Maternity and Child Welfare Centre and Day Nursery. The former, on the ground floor, will be under the direct administration of the Public Health Department, whilst the Day Nursery, administered by a voluntary committee, will be accommodated on the first and second floors and part of the top floor, as tenants of the City Council, paying an inclusive rental for the usual services. Each floor is provided with a spacious sun balcony facing South and is reached by passenger lift in addition to wide staircases at each end of the building. Day Nursery accommodation for some 80—90 children and for some half-dozen resident children has been provided. The present small day nursery premises for 40 children at 147, Warwick Street under the control of the same voluntary committee will be vacated at the end of September, 1937, when the lease expires. The Maternity and Child Welfare Centre will also be removed from old premises situated at 15, Bessborough Street. The transfer of these important maternity and child welfare activities from old and unsuitable buildings to a modern building will enable those activities to be more adequately carried out and will mark an epoch in the development of those services in the City. Maternity and Child Welfare is more than merely a branch of public health work; it is an expression of National opinion, a movement which transcends all others in its influence on the future position and prosperity of this country. 51 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 12 voluntary hospitals and two military hospitals in the City. The City Council has by agreement entered into an arrangement with two hospitals for the admission of certain patients, viz.:— (a) With St. George's Hospital for the admission and treatment of maternity patients. (b) With Westminster Hospital for— (i) The provision of maternity beds for patients sent through the Council's maternity and child welfare centres. (ii) The services of midwives to attend necessitous women in their own homes. (iii) The provision of skilled obstetric assistance to medical practitioners in difficult cases of midwifery occurring in the patients' own homes. (iv) The provision of skilled medical assistance to midwives in difficult cases. MATERNITY AND CHILD WELFARE. 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— (а) 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. (8342) D 2 52 (f) 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:— (а) Regular 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, with the addition of such accessories to diet as cod liver oil, iron and calcium. (d) Dental and convalescent treatment as on previous table for women, and children up to 5 years of age. (e) Nursing services. (f) Special treatment, e.g., artificial sunlight. (g) Special items such as umbilical belts 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. Comprehensive as those services outlined above and provided by the Council are, improvements and developments are going on from year to year. The Minister has wisely suggested that throughout the country services such as these should be better known and more generally used by the people for whom they are intended. 53 Midwifery Service. Midwives Act, 1936.—Reference was made last year to the Bill, now an Act of Parliament. It is now an obligation for the local authorities designated under the Act to prepare schemes for submission to the Minister providing a salaried midwives service either by direct employment of midwives, by arrangements with welfare councils, or through voluntary associations. In London the Welfare Councils are the Metropolitan borough councils, each of which, since the passing of the Maternity and Child Welfare Act of 1918, has in the way most suitable for its particular locality developed an adequate maternity and child welfare service, including district midwifery. In some, municipal midwives are directly employed; in others, special arrangements are made with voluntary hospitals or nursing associations for the discharge of these services, while in others still the districts have been so well served, almost from time immemorial and long before maternity and child welfare became a duty of a local authority, by a well-established voluntary hospital or nursing association that the local authority, beyond extending goodwill and possibly donations, has found it quite unnecessary to develop a scheme of its own. Thus the advent of this new Act has found London, unlike some less fortunately placed areas both urban and rural, well supplied with district midwifery services catering for all classes, particularly the very poor. Such objects as are to be achieved in London under this Act could be met by some measure of co-ordination rather than by a heavy expenditure on establishing a new service. In the City of Westminster, at any rate, a complete and unified midwifery scheme has been operating under the ægis of the Council for some seven years. It is fervently to be hoped that any measures to be applied in Westminster will not disturb or disintegrate a scheme which has developed by experience and cannot be dissociated from the other aspects of maternity and child welfare without injury and dislocation to the service as a whole. 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. In both cases the service is restricted within the City boundaries and to patients introduced through the welfare centre. 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, 54 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 Hospital. Midwifery Visits. 1933. 1934. 1935. 1936. Number of— Pre-natal visits 93 71 34 29 Lying-in visits 1,016 1,022 961 897 Subsequent visits 32 28 18 26 Total number of visits 1,141 1,121 1,013 952 Number of eases attended 77 78 74 71 Table LI. Attendances by midwives at ante-natal and other clinics:— 1933. 1934. 1935. 1936. Ebury Bridge 50 50 50 51 15, Bessborough Street 49 48 49 50 Total 99 98 99 101 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— St. Margaret and St. John Wards, 1936. Pre-natal visits 315 Lying-in visits 1,002 Subsequent visits 89 Total number of visits 1,406 Number of cases attended 53 55 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, which is also available to all midwives practising in Westminster who may require it. Ante-natal Services.—There are seven ante-natal clinics in the City of Westminster and at least two others within half a mile of the boundaries. Three 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. While the nett number of births registered during the year was 1,063, the number of expectant mothers dealt with at the centres was 805; that is to say, some 75.7 per cent. of the total cases, as compared with the percentage of 79.5 for the previous year. Cases were brought to the notice of the centres from the following sources:— Table LIII.—Ante-natal Cases. Source of Information. City Council's Centres. Westminster Health Society. Totals. Ebury Bridge. No. 15, Bessborough Street. Marshall Street. Marsham Street. St. Mary's Hospital — 1 — 1 Hammersmith Hospital 1 — 1 — 2 General Lying-in 7 7 — 20 34 St. George's 37 23 3 5 68 Westminster 18 29 — 35 82 St. Thomas' 4 7 — 7 18 Charing Cross 3 7 32 2 44 Middlesex 4 1 19 1 25 Royal Free Hospital — — 1 — 1 St. Stephen's 48 56 6 26 136 University College — — 1 — 1 St. Mary Abbots Hospital 2 — 2 — 4 Found by Health Visitors 58 36 18 27 139 Reported to Centre voluntarily 84 90 11 61 246 Other Boroughs — 2 — — 2 St. Pancras Hospital — — 2 — 2 Totals 266 259 96 184 805 56 Ante-natal Visiting.—To the 805 expectant mothers who became known to the centres, 789 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,269. The attendances by mothers at the clinics are detailed below:— Table LIV.—Ante-natal Clinics. Centre. Sessions. First Attendance. Subsequent Attendances. Total. No. of Individuals. Ebury Bridge 50 112 257 369 119 Bessborough Street 49 112 324 436 122 Marshall Street 5* 3 8 11 3 Westminster Health Society. 12 72 319 391 93 * Begun October, 1936. Certain changes were made with regard to these clinics during the year. In earlier years the women's and the children's clinics at the Ebury Bridge and Bessborough Street Centres were conducted by the same medical officer. In 1936 the clinics were completely separated, each being placed in the charge of a part-time medical officer, who is a specialist in the particular subject. A new women's clinic was also started at the Marshall Street Centre, and thus the Council's ante-natal services now cover the whole area of the City. These clinics deal with post-natal as well as with ante-natal cases, so the term women's clinics is to be preferred. These clinics are held at the following times:— Ebury Bridge Friday, 4 p.m. Bessborough Street Tuesday, 2 p.m. Marshall Street Tuesday, 10.30 a.m., fortnightly. Westminster Health Society Thursday, 2 p.m., monthly. Ante-natal clinics are also held at Charing Cross, St. George's, Westminster and Middlesex Hospitals for mothers who have made arrangements for their confinements with these hospitals. Institutional Provision for Mothers and Children. Maternity Beds for Complicated Cases and for those with Unsuitable Home Conditiom.—By agreement with Westminster Hospital the Council has the right of admission for cases recommended through its welfare centres to beds in Westminster Hospital up to 100 patients per annum. 57 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. 438 women belonging to the City were delivered in these hospitals. The following table shows the number of confinements in the hospitals mentioned:— Table LY.—Confinements in Hospitals. Charing Cross Hospital: 481, of which 60 were Westminster cases. St. George's Hospital: 303, of which 74 were Westminster cases. Westminster Hospital: 276, of which 108 were Westminster cases. Sheffield St. Hospital : 158, place of residence doubtful. St. Stephen's Hospital: 196 (Westminster cases only). Convalescent Treatment.—The Council has during the year contributed towards the cost of the convalescent treatment of 11 Westminster patients at convalescent homes, and 19 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 to the Council was £46 4s. 9d. Maternal Mortality.—The number of maternal deaths in Westminster during the year ended December, 1936, 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 3.81 per thousand (live and still) births. Child Welfare. Consequent on the death of Dr. Ethel Vernon in the early part of the year, it was decided to appoint a part-time woman doctor with special experience in conditions associated with pregnancy and the puerperium to conduct ante-natal and post-natal clinics at the Council's three centres, and a male practitioner with special experience in pediatrics to conduct * Situated in Chelsea. 58 the infant welfare clinics at the Bessborough Street and Ebury Bridge Centres. The appointments were advertised, and Dr. Margaret Salmond, M.D., B.S. (London), F.R.C.S., M.C.O.G., was appointed to the former post, and Dr. George Ormiston, M.D., Ch.B. (Edin.), M.R.C.P. (Edin.), to conduct the infant welfare clinics. The City Council during the year reviewed its arrangements for the supervision of children under school age following the receipt of Circular 1550 of the 29th May addressed by the Minister of Health to maternity and child welfare authorities. The Minister in his Circular stated that he had under consideration the arrangements made by local authorities for the supervision of the health of young children and that he was convinced that the arrangements were satisfactory so far as they related to those under 2 years of age. He was, however, concerned to find that in many areas insufficient attention was being given to the health of children over 2 and under 5 years, and he was informed that more than 16 per cent. of children entering school were found to require treatment for disease or defects, which in many cases could have been prevented or cured if adequate supervision had been exercised throughout the pre-school years. The Minister therefore made certain suggestions for remedying the existing state of affairs and requested that authorities would review their arrangements for supervising the health of young children and inform him of the result of the consideration of his Circular. The City Council expressed itself in full accord with the views of the Minister as to the measures to be taken for safeguarding the health of the pre-school child, and, in view of the abnormally low birth rate in the City, considered it wise that practical steps should be taken to ensure the welfare of the children born and to be brought up in the City. They surveyed the whole field of the services already provided by the Council in this connection, and, with a view to exploring what further developments could be achieved, appointed a special Sub-Committee to consider the matter with co-opted members from the City of Westminster Health Society. Health Visiting.—Apart from the welfare centres at two hospitals in the City, there are 11 fully-trained health visitors attached to the four welfare centres. The Council, however, in order to secure more adequate visiting of the toddler child and thus to learn more exactly the extent to which physical defects existed and required treatment, decided to appoint an additional Health Visitor. It was further resolved to engage 59 clerical assistance at the Council's Centres so that the health visitors should have more time for the more important work of home visiting. The Westminster Health Society were also asked to consider as to increasing their health visiting staff and obtaining clerical assistance. Minor Ailment Clinics.— Linking up of Infant Welfare Centres with School Clinics.—Among the measures recommended by the Minister as worthy of consideration was the extended use of clinics for the treatment of minor ailments on the lines adopted by the education authorities for school children. The Council in its survey recalled the voluntary efforts established in the City in 1903, when the City of Westminster Health Society was founded. Its objects included those to which the Minister has now drawn particular attention. The Society from its earliest days had organised co-operation with the school care committees and had achieved continuity in the medical history of the children from infancy to school age and beyond. During the War and since the Society had not been able to maintain this scheme of co-operation so completely as in the pre-war years because of the lack of sufficient voluntary workers. The City is well supplied with treatment centres—there are 13 general and special hospitals, four provident dispensaries, and five clinics of special character. At present, cases attending the welfare centres and requiring treatment for physical defects or for minor ailments, and who cannot afford private medical attendance, are referred by the centre medical officers to the most appropriate of those institutions. With the proposed increased visiting of toddlers and the detection of defects, the Council considered that some definite arrangements should be made to secure more readily accessible facilities for treatment, and directed the Medical Officer of Health to enquire into the possibility of linking up with the treatment centres of the education authority in the City, whereby cases from the welfare centres could be treated along with school children. The Council was also of opinion that there was a definite need for a consulting centre in the City to which cases difficult to diagnose or presenting serious features might be referred for special investigation or observation, e.g., where blood, bacteriological, or X-ray examinations were required, or for in-patient treatment where necessary. Negotiations with the authorities of the Infants' Hospital, Vincent Square, are accordingly being initiated as to establishing a consulting centre, etc. Toddlers' Clinics.—The Minister in his Circular mentioned that in some areas there were special clinics for toddlers. While the Westminster Health Society has conducted a special toddlers' clinic once a month for 60 some years, it has been found at the Council's centres more economical in time, both for the medical officers and the mothers, for the elder children to be seen at the same sessions as the babies. As previously mentioned, the Council in the early part of the year appointed medical officers separately for ante-natal clinics and for children's clinics, thus enabling more time to be devoted to the children's clinics. Day Nurseries.—The Minister emphasised the need for Day Nurseries in certain areas. The Council has long been fully aware of the urgent need for increased day nursery accommodation in a district where the demand for women's employment is so great, and has encouraged and actively assisted the voluntary association who conduct the present day nursery for 40 children by making a substantial annual contribution. The Council, as a further mark of appreciation, is engaged in building a new day nursery for the association with accommodation for between 80 and 90 children as part of the new scheme for a maternity and child welfare centre. A few resident children are also being provided for in cases, for instance, where the mother has to go into hospital for treatment. It is contemplated that it will be possible to organise nursery classes at the new building for children of the toddler age. Notes by the Medical Officers at the Council's Maternity and Child Welfare Centres. Infant Welfare Centre, Marshall Street. Dr. A. Doyne Bell. The list of the names of families attending the clinics at the Marshall Street Welfare Centre is striking for its variety of nationality. Here are Italian, Cypriot, French, Indian, German, Chinese, Greek names which would lead one to expect the waiting rooms to resemble with some exactitude the water-front at Marseilles. But in fact the clinics, though they have a strong foreign seasoning, are in the main visited by mothers whose parents are purely British. These girls have married into that polyglot colony in the heart of the City of Westminster which is known as Soho. Soho is commonly regarded as the Italian quarter of London, and it is true that a great number of Italians attend the Marshall Street clinics and some of them, in spite of many years in this country, speak little or no English. The fluent Italian of one of our health visitors is, in these cases, invaluable. The Anglo-Italian families which form a large proportion of the clinics appear to be stable units, and the children, usually bilingual, are well cared for and brought to the clinics with great regularity. Their progress is occasionally interrupted by the family visit to Italy, when the heat of the climate or the excessive indulgence of grand-parents can usually be counted on to produce a loss of weight and a dyspepsia which has to be treated on their return. 61 The working mother provides a problem which arises very constantly in these clinics. Either the father keeps a restaurant in which the mother does a large part of the management and her children have to share her ministrations with the customers, or the father follows one of those irregular and seasonal occupations such as scene-shifter, waiter, actor (film-crowd work) when the mother's earnings, though often appallingly small, give a slight stability to the family. In these circumstances one feels that the Welfare Centre, and especially the home visits by the health-visitor, is extremely valuable in keeping the home together and maintaining the health of the children. There are in the district served by the Centre a certain number of mothers who are virtually birds of passage. For this shifting population the Centre has little opportunity of doing very much : they come, in many cases, from the depressed areas of Wales and the North of England. In spite of the difficulties with which many of the families attending the Centre have to contend, the health of the children and their mothers is, on the whole, remarkably good. Their skill in mothercraft (shopping, cooking, sewing and mending) is greater than that of many more purely English populations living on a similar level, and the Soho section of the children brought to Marshall Street compares well with those of servants and caretakers who come to the Centre from their homes in Mayfair. (Signed) A. Doyne Bell. Ebury Bridge and Bessborough Street Infant Welfares Centres. Dr. George Ormiston. The death of Dr. Ethel M. Vernon was keenly felt by the community which she served. Dr. Vernon had a thorough knowledge of local conditions, and, by long years of unselfish devotion to their interests, she had won the complete confidence and respect of the mothers who attended her clinics. Dr. Turner carried on Dr. Vernon's work with much acceptance during the period of transition before I was appointed to the post of welfare officer to the above Centres in June, 1936. Changes are, in the nature of things, disturbing to medical work of this type, which, in order to be of full value, must be sympathetically identified with individual and family problems. A good knowledge of such problems can only be obtained by extended experience. I am glad to report at the end of my first year that I am conscious of progress in this direction. And I take this opportunity of thanking the centre staffs for their valuable assistance and co-operation. During the past 20 years, nutrition has emerged as a science upon which the wellbeing of the race depends. The adequate feeding of infants and children is, therefore, of vital importance, and demands two basic conditions: first, that food shall be of the right kind, and second, that the quantity of the food shall be sufficient. The first condition is met where the food is of good quality and is so constituted that there is no deficiency such as may lead to rickets, scurvy, or affections of the mucus membranes or the formation of unhealthy body tissues. The second is met where 62 the amount of food is sufficient to give contentment and promote normal growth. Recognition of these facts has governed our instructions to the mothers, and recently we have supplemented these instructions by diet sheets specially drawn up for our Centres. In addition, free milk and other assistance has been readily granted whereever necessary. Inevitably, a large number of minor ailments come under review, despite the fact that the primary interest of these Centres is the nutrition of the children. We have dealt with such ailments by reassurance where no treatment is necessary, and otherwise by referring the case to the family doctor, or to a hospital, according to the circumstances of the case. The opening of the new Bessborough Street Centre is eagerly anticipated, and cannot but lead to better work all round, in view of the inadequacy of the present quarters. (Signed) George Ormiston. Maternity Centres, Bessborough Street, Ebury Bridge and Marshall Street. Dr. Margaret Salmond. The Ante-Natal Clinics in the City of Westminster have had a most successful year's work. The numbers have increased considerably at the Bessborough Street and the Ebury Bridge Clinics and a new clinic has been started at Marshall Street which, it is hoped, will serve a useful purpose. The attendance of the mothers has been, on the whole, very regular and many have benefitted in health by advice given. Particular attention has been paid to the question of nutrition, and many mothers have received milk, iron, calcium, and vitamin D, which have improved their condition considerably. The health of the mothers has been, on the whole, fairly good, but many suffer from dental sepsis, and a great effort is being made to persuade them to avail themselves of the existing facilities for treatment. This effort is marked by slowly increasing success. Much, however, remains to be done in this respect and by endeavouring to educate the younger generation in the care of the teeth. Expectant mothers who have symptoms suggesting the possible presence of pulmonary tuberculosis are referred to the Tuberculosis Officer for investigation and radiological examination. There have been no maternal deaths this year amongst the mothers attending the clinics and a very small number of stillbirths and deaths of premature infants. There have also been few abortions, the cause of which is always difficult to trace with precision. Happy co-operation has been maintained with the Westminster Hospital and the neighbouring London County Council Hospitals for intern cases, and the service for extern cases is admirable. Excellent work has been done by the Sister Midwife and the various Superintendents and Health Visitors. Medical reports are sent with all patients seen if they are referred to their own doctors, to midwives or to hospitals and a real effort is made by all concerned at the Centres to link up the work of the Ante-Natal clinics with the surrounding Maternity Services. (Signed) Margaret Salmond. 63 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. Tuesday and 2 p.m. Thursday. 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 1931 are also shown. 64 Table LVI. Attendances at Infant Consultations, 1936, Centre. Number of Sessions. First Attendances. Subsequent Attendances. Total. Total. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Ebury Bridge 102 228 76 3,021 1,229 3,249 1,305 4,554 15, Bessborough Street 101 211 66 3,006 2,119 3,217 2,185 5,402 Marshall Street 53 76 23 1,090 1,165 1,166 1,188 2,354 Marsham Street 98 211 61 2,146 1,925 2,357 1,986 4,343 1936 354 726 226 9,263 6,438 9,989 6,664 16,653 1935 351 754 239 9,016 6,360 9,770 6,599 16,369 1934 363 778 240 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 The average attendances per session were— 1936. 1935. 1934. 1933. 1932. 1931. Ebury Bridge 44.6 42.9 46.9 50.2 47.1 37.7 Bess borough Street 53 4 51.5 55.7 54.5 54.4 56.3 Marshall Street 44 .4 46.8 44.3 48.0 43.9 43.4 Marsham Street 44 .3 45.3 38.1 37.6 41.1 40.1 Che number of individual children medically inspected were— Ebury Bridge 552 Marshall Street 253 15, Bessborough Street 628 121, Marsham Street 581 65 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. Towards the end of the year the three nursing associations requested the Council to review the rate of payment for their services on the grounds that maintenance of nursing services, owing to increases in nurses' salaries, pensions, and, in one instance, acquiring additional premises, had greatly increased expenditure. As a result of mutual discussion it was decided that the most practical and immediate way of meeting the increased expenditure was for the Council to undertake payment for cases on a somewhat wider basis. Accordingly, adult cases of tuberculosis and all cases of illness in children under 5 years of age, including the nursing of operative cases, were added to the list of approved cases. 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 32 425 Complications of maternity 46 476 Pneumonia 14 365 Bronchitis 9 118 Measles 9 156 Influenza 2 13 Other complaints 73 1,086 Total 185 2,639 (8342) E 66 Ophthalmia, neonatorum.—Eleven cases were notified during the year. There were also 5 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 affections of the eyes was carried out by the district nurses in 32 cases, 425 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 1927 is as follows:— Table LVIII.—Ophthalmia Neonatorum and Inflammation of the Eyes. Cases. Rate per 100 births for both classes of eases. 1927 14 1.9 1928 7 1.2 1929 11 1.9 1930 16 2.2 1931 20 1.6 1932 27 2.3 1933 12 1.1 1934 11 0.94 1935 8 0.76 1936 16 1.5 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 1936. Table LIX.—Deaths from Syphilis. 1911-15 2.4 1930 2.1 1916-20 4.95 1931 1.6 1921-25 1.7 1932 1.7 1926 0.62 1933 3.6 1927 2.8 1934 1.71 1928 0.72 1935 — 1929 0.73 1936 — 67 Health Visiting.—The following table shows the number of visits paid in connection with the four centres:— Table LX.—Health Visiting. 1936 Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 266 246 96 181 789 Other visits 357 378 186 348 1,269 Children under 1 year of age— First visits 314 256 140 221 921 Other visits 1,294 1,488 735 1,198 4,715 Children over 1 and under 5 years— Visits 2,166 2,865 2,301 2,487 9,819 Death enquiries, still-births, &c 19 8 11 22 60 Infectious diseases 346 299 248 268 1,161 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 LXI.—Mothercraft Classes. 1936. Ebury Bridge. Bessboro' Street. Marshall Street. Marsham Street. Total. Number of classes 48 52 44 89 233 Total attendances 1,859 1,027 407 2,738 6,031 Average attendances 38.7 19.7 9.2 30.7 25.8 Number of expectant mothers 54 84 20 67 225 Number of attendances by expectant mothers 363 347 120 688 1,518 Number of other mothers 100 83 21 117 321 Number of attendances by other mothers 1,496 680 287 2,050 4,513 Attendances of children in nurseries during classes 1,326 719 339 2,997 5,381 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 1,390; at Bessborough Street, 572; at Marshall Street, 248; and at Marsham Street, 1,638. In addition to those, many renovations were carried out. Child Life Protection.—Public Health (London) Act, 1936, Part XIII. At the end of the year the register contained the names of 14 foster mothers who were then in possession of foster children. Each had one child only. Six new registrations were made and it is satisfactory to report that no death occurred amongst foster children during the year. (8342) E 2 68 Notices numbering 114 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. The Council granted a certificate of exemption for a period of one year, under the provisions of Section 271 (2) of the Act, in respect of a Nursery established at Dolphin Square, Grosvenor Road, a large block of high-class flats. The Nursery, which was provided for the use of tenants only, has accommodation for some 40 children, and is under the supervision of a trained nursing staff. The certificate exempts from visitation by the Council's officers and the necessity for giving notice to the Council of the reception or removal of children. During the year visits to foster children were carried out as follows :— Table LXII.—Foster Children. District. SouthWest. Southern. Northern. Visits by Child Life Protection Visitors to:— Foster Children under 5— First visits 20 16 12 Subsequent visits 75 12 8 Foster Children 5 to 9— First visits 3 6 5 Subsequent visits 11 2 8 Cookery Classes.—During the year the Council appointed a qualified teacher of cookery, to give courses of demonstration lectures at the Maternity and Child Welfare Centres. A limited number of mothers are enrolled for each short course of demonstrations. These demonstrations aim at giving the young mothers not only some insight into the art of cookery, but also some knowledge of economical purchasing, so that the fullest use can be made of a small sum of money, in providing a meal which is attractive and is also suitable from the point of view of modern dietetic theory. The classes have been very successful and have proved both interesting and profitable to the mothers. 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. 69 The total income amounts to £37 5s. id., 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 1936 three 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. Although the addition of milk to the diet of mothers and children does much to ensure that they will be protected from any danger of vitamin deficiency, further protective additions to the diet are desirable in many cases. To meet this need the Council has arranged for the supply at the centres of cod liver oil preparations for mothers and children. Ostocalcium, Bemax and an iron preparation are also issued, when required, to ante-natal and post-natal cases in which there seems a possibility of a shortage of vitamins or of necessary minerals in the diet. These preparations are supplied on the recommendation of the medical officer conducting the clinic. They may be issued free in cases where the income falls within the limits which permit the issue of free milk. Preparations of dried milk amounting to 2,806 pounds were distributed during the year. The amount expended by the Council for fresh milk as extra nourishment for mothers and infants amounted to £651 15s. 9d. Home Helps.—Provision was made in one case for the services of a home help at a cost of £1 8s. 6d, There is no panel of home helps. It is found more satisfactory for the woman requiring this service to make 70 her own free choice of the individual who is to take her place in the home. In this case the Council paid the whole cost of the services of the home help. Insulin Treatment.—Two patients were under treatment and the cost to the Council for the year was £12 8s. 1d. Dental Treatment.—The Council provides for the treatment of cases both under the maternity and child welfare and tuberculosis schemes. Expectant and nursing mothers, and children under five years of age are eligible for treatment. Patients contributed £9 12s. 6d. in small sums according to their means. The Council contributed sums totalling £30 15s. 6d. towards the cost of dentures (£4 per set), which were supplied in 28 cases. Mr. Stewart Tait, Dental Surgeon, submits the following report:— Dental Clinic (held in the premises of the Western Dispensary). During the past year there has been a steady attendance at the dental clinic. The general rule has been that mothers attending have taken more interest in their teeth and also in those of their children. The result has been that there is a considerable diminution in the amount of dental sepsis found; also in the number of carious teeth. However, in spite of this, there is much room for further improvement. The chief trouble 1 find with many who attend is the fear of dental treatment. Cases have arisen where, after attending for examination, the patient has failed to appear for treatment and has thus taken up the time of those mothers who are desirous of having their teeth put in a healthy state. There have been many young children brought to the Clinic where the amount of dental sepsis has been high, and in some cases the only possible treatment has been extraction. The result of this is that the child is deprived, at a very early and important stage of its life, of the full means of mastication. New Cases. Reappoint ments. Extractions. Fillings. Other Operations. Anaesthetics. Local. General. Dentures Supplied. 1936 184 832 861 154 324 7 181 28 T. Stewart Tait, L.D.S. 71 Notes by the senior health visitors on the work at the Centres. Bessborough Street The re-housing of families is changing to some extent the character of this neighbourhood. Many of our oldest families have been transferred to up-to-date flats in the City Council's Grosvenor or Ebury Bridge Estates ; others have been re-housed in the Westminster Housing Trust's Tachbrook Estate and in reconditioned houses in Aylesford Street, and have therefore remained in the area covered by this Centre. All these families show definite improvement in their standard of living. The houses vacated, however, are often re-occupied by families from outlying districts, the men out of work, the women young and inexperienced. These tenants drift from one address to another, and this causes many useless or unsatisfactory visits. Ante-natal cases, reported from hospitals, often remove, either before confinement takes place or immediately afterwards, so that systematic advice in the care of the expectant mother and young infant is interrupted. The cookery classes, which were initiated during the year, have proved interesting and instructive, especially to the young married woman who has had little or no training in domestic science in her parents' home. Ebury Bridge:— Mothercraft Class.—The attendances again were in excess of those of the previous year. The number of garments cut out and made was 1,390 compared with 1,058 of the previous year. Infants and Toddlers were accommodated in the Nursery while their mothers were in the Class. The attendances in the Nursery numbered 1,326. Dental Clinic.—During 1936, 84 cases were referred to the Council's Dentist for treatment as follows:— 16 Children. 35 Expectant Mothers. 33 Other Mothers. Dentures have been supplied in every case where necessary. The cost has been met by mothers when they have been able to pay, but the majority have needed assistance and this has been partly obtained through the following organisations Hospital Sunday Fund, Hospital Saturday Fund, Hyde Park Place Estate Trust, the balance of the cost being met by the City Council. Hospital Sunday Fund Letters have been kindly given by the following Churches:— St. Barnabas. St. Gabriels. St. Mary's, Cadogan Street. St. Michaels. St. Peter's. Church of the Holy Apostles. Westminster Cathedral. Child Life Protection.—As in former years, much of this work lay in visiting to verify the return to the care of their parents or other relative of children 72 temporarily boarded-out with foster mothers in other districts. Applications to place children with foster mothers have been very numerous. Co-operation.—Co-operation has been maintained with all agencies engaged in Social work in the district, especially with:— The Charity Organisation Society. Mutual Registration of Assistance. Invalid Children's Aid Association. The St. Henry Fund. The Friends of the Poor. London County Council School Officials. Hospital Almoners. Clergy and Church Workers. National Society for the Prevention of Cruelty to Children. Westminster Day Nursery. Marshall Street:— An ante-natal and post-natal clinic was started in October, two clinics being held each month. As had been expected, the attendances have been small, but when these facilities are more widely known, it is hoped that many mothers will take advantage of consulting Dr. Salmond, the Medical Officer of this clinic. Cookery Lectures and Demonstrations have been held at the centre. The food was purchased in the district and the lecturer showed how to prepare, cook and serve a good mid-day meal with best food values for a family. The training of students has continued. Five English, one Canadian, one Pole, and one French woman have attended during the year, in order to gain experience in practical work. Many families have been re-housed, some to London County Council flats out of the City, others to the new Westminster City Council flats in the Pimlico area. One hundred and twenty-seven families have been transferred out of this district during the year. Lectures, &c., Held at the Council's Centkes. Lectures, demonstrations, and film displays were held at the Centres during the year in the following subjects:— The Gift of Life The Food Value of Milk The Care of the Skin and Hair Spring Cleaning The Care of the Teeth "Keep Well and keep Fit" Bathing the Baby Simple Home Remedies Some Problems of Child Life Home Laundry Hints How to Prevent Baby catching Cold Meals for Children aged 1 and 1½ years 73 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 8,801 by 97 individual children in the following age groups:— (a) Under one year, 60. (b) Over one year and under three years, 30. (c) Over three years and under five years, 7. The average daily attendance during the year was 32. 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. 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 four deep wells were sunk, two at Dolphin Court, Grosvenor Road, and one each at Westminster Gardens, Marsham Street and Gt. Westminster House, Horseferry Road. The total number of premises supplied from deep wells is now 92. Public Swimming Pools, Laundries, &c.—There are three municipal establishments, situated at Buckingham Palace Road, Great Smith Street, and Marshall Street. The numbers using the swimming pools and private baths in 1936 were:— Buckingham Palace Road: 113,268 men; 63,256 women. Great Smith Street: 122,887 men; 47,332 women. Marshall Street: 154,687 men; 92,617 women. The numbers relating to users of the public laundries were:— Buckingham Palace Road, 25,255; Great Smith Street, 19,523; Marshall Street, 8,381. Sterilisation of water in Public Swimming Pools and Baths.—A communication was received in November, 1935, from the Minister of Health emphasizing the necessity of taking steps to ensure a proper 74 standard of cleanliness and purity of water in all swimming baths and pools open to the public, whether owned by the local authority or by private persons. Efficient filtration and sterilization plants are installed at the City Council's three baths, sterilization being carried out by the chlorine and chloramine (chlorine-ammonia) methods. Periodical tests made of the water in the pools during the year indicated that a high degree of purity was being maintained. There are twelve other pools in the City which are privately owned, but with the exception of two in Turkish Bath establishments they are not open to the general public. Seven are in clubs such as the Bath, Royal Automobile Club, &c., two in large hotels, and one is attached to a large private house. All are well maintained and under competent supervision. Two others are in course of construction, one in a club and the other in connection with a large estate of high class flats. Drainage and Sewerage.—During the year 1,087 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. 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. The " one-pipe " system of drainage, now becoming almost universal in large new buildings, has justified its period of trial. In no case has it been reported to be unsatisfactory. The supervision of drainage and consideration of plans submitted by architects and builders continues to increase and to occupy a more and more important place in the work of the department. The buildings in Westminster are of so diverse a character in size and design as to make it quite unique in the County of London. It is not merely a question of the simple sanitary arrangements in a row of villas, but of large hotels with fittings in each bedroom as well as in the bathrooms attached. Swimming pools may also be provided. Methods of artificial ventilation and air-conditioning have also to be considered. The special features of cinemas and those of large office buildings, so far as they concern environmental hygiene, raise special issues, while there are the new principles of town planning in relation to site and user which cannot be dissociated from public health. 75 New Sanitary Construction.—Of the 1,087 plans relating to drainage and other sanitary works, 102 represented sanitary provisions in entirely new buildings. The corresponding figures since 1932 are as follows:— Table LXIII.—Drainage and other Sanitary Works. 1932. 1933. 1934. 1935. 1936. Plans 757 926 935 1,080 1,087 Plans of work in new buildings included in above 68 96 102 94 102 Combined drainage orders were made in 7 cases. Infringements of the by-laws were reported by the sanitary inspectors in 22 instances in respect of failure to give notice of intention to construct, or to deposit plans. In 10 cases the builders concerned were cautioned. In the remaining cases no action was deemed necessary, the works being of a minor character. 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, 5 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 30 public urinals for men. The Council has adopted a scheme for the modernizing of the public conveniences throughout the City over a period of some five years. Increased accommodation will be provided where possible. The establishments first to be dealt with are those at Leicester Square, Parliament Street, and in the Strand by the Law Courts. During the year a women's association drew attention to the lack of public conveniences for women in certain underground railway stations in London. In Westminster the underground stations instanced were those at Hyde Park and Green Park. The complainants were reminded that public conveniences for both sexes provided by the City Council were readily available and adjoining each of the stations referred to. In some districts in the country there is still a scarcity of women's conveniences as compared with those provided for men. This is surely a relic of the days when women mostly stayed at home, except when on shopping or amusement expeditions. 76 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, 1937, were as follows:— tons. House refuse 95,397 Trade refuse 3,491 Total 98,888 It is interesting to note that the total has again approached that of the "peak" year, 1931, when 99,653 tons were collected. In 1932 there was a drop of 5,800 tons and a further drop of over 5,000 tons in 1933. The figures remained steady in 1934 but suddenly rose by 7,200 tons in 1935, and again rose by 2,800 tons in the year just completed. It can be reasonably predicted that last year's figure will be at least maintained in 1937 and probably will show a further substantial increase in view of the considerable influx of visitors to Central London during the Coronation period. The decreased tonnage in 1932—3—4 coincided with a period during which there was a considerable amount of empty property in Westminster and this no doubt mainly accounts for the smaller quantity of refuse produced. Modernization of Transport.—The Four-Year Programme for the complete modernization of transport adopted by the Council in December, 1933, has unfortunately not proceeded at the rate originally estimated; this has been partly due to delay in delivery of the new vehicles and partly to further tests carried out with vehicles of more recent design. As the greater part of the City's refuse has to be collected and the street gullies have to be emptied and flushed during the night and early hours of the morning, it would be difficult to over-emphasize the necessity of employing the most silent means of operation, and experiments were therefore carried out with an electrically operated motive unit for both these services and a specially designed trailer unit for gully cleansing, also motivated by an electric battery. The experiments were very successful and two electric motive units and one gully cleansing unit were purchased. From protracted comparative tests then carried out on refuse collection it was proved that the operating costs of the electric unit were practically the same as the petrol units, and the Council in December, 1936, therefore decided to revise its modernization programme and ordered 18 electric motive units. Arrangements were made for battery charging to be carried out at the Council's garage and a special rate for supply during "offpeak" hours was obtained from the Electric Supply Corporation. Tests have also been made with several of the latest types of refuse collecting bodies, resulting in orders having been placed for 11 of the "Direct Mechanical Compression" type and 7 of the "Moving Floor" type. Refuse Collection by Container System.—The popularity of this system at large premises has continued to increase as its advantages have become more widely known and appreciated. At the end of the year four chassis and 228 containers were in operation, another chassis was on order, and it was obviously necessary that 77 further containers would have to be purchased in the near future. A chassis is capable of transporting six containers of the size at present in use, but some of the property in Westminster is so large that six containers are insufficient to accommodate all refuse made between collections. To meet such cases a specially designed Refuse Trailer has been introduced and installed at premises on a hire rental basis; these trailers are left at premises arid exchanged when necessary, exactly the same as the Container System. Refuse Receptacles.—The house-to-house inspection of refuse receptacles in use throughout the City has continued and although the installation of over 5,000 receptacles in accordance with the London County Council By-laws has been obtained; there is still a considerable amount of improvement necessary in this direction. Another difficulty to be overcome is that, apart from lock-up shops where receptacles are not available until 9 a.m. or after, there are many premises where they are unnecessarily put out overnight and left out over the week-end and on public holidays. This practice not only gives important thoroughfares an untidy appearance, but encourages "totters," who sort over the contents and scatter the refuse on the footways. It is not always possible to deal with this as "obstruction of the public way" as in many cases the receptacles stand on a private forecourt although they are accessible to and in full view of the public. A special Sub-Committee has been set up by the Metropolitan Boroughs' Standing Joint Committee in conjunction with the British Standards Institute, to consider the issue of standard specifications for refuse receptacles of various approved sizes, to which all manufacturers may be asked to conform. This should materially assist Local Authorities, as at the present time receptacles are being offered for sale considerably above the maximum size permitted, which are more than one man can lift when full of refuse. Some are constructed of metal of too light a gauge and consequently soon become distorted, for which the dustmen are usually blamed. The eventual conclusions and recommendations of this Sub-Committee should prove of valuable assistance to all Authorities concerned with refuse storage and collection. Refuse Disposal.—A brief description of the Council's centralized Refuse Disposal Plant at Grosvenor Dock, and the new Central Depot which will totally enclose it eventually, has already been given in previous reports. The erection of the new Depot is proceeding satisfactorily, but its completion has been unavoidably delayed owing to the Government priority of steel. Westminster is setting an example to all Local Authorities who transport their refuse by barge, by insisting upon steel barges with fixed coamings and wooden hatches which are completely covered by tarpaulin. The two contractors' dumps to which the City's refuse is taken have been frequently and regularly inspected throughout the year, and tipping is being carried out strictly in accordance with the requirements of the Essex County Council and the Local Authority concerned. Medical Inspection of Aliens. At the request of the Ministry of Health the City Council agreed to the appointment by the Minister of the Medical Officer of Health as Medical Inspector of Aliens for the City under the Aliens Order, 1920, arising out of the introduction of a through sleeping car service by train ferry from 78 Paris to Victoria Station. The service was inaugurated on the 14th October, 1936, the ferry trains arriving at Victoria Station each morning at about 9 a.m. All aliens arriving by this service are subjected to visual medical inspection, and where considered necessary by the Medical Inspector or Immigration Officers have to be medically examined. It was found necessary to appoint assistant medical inspectors for this work, and with the consent of the Westminster Hospital authorities the Medical Registrar and Assistant Medical Registrar (Dr. D. Ferriman and Dr. E. A. Hardy) were appointed to carry out the actual inspection, on the assumption that the services of each would be required for approximately one hour every day throughout the year. In order to provide for emergencies such as might be encountered by delay in the arrival of the train, the Deputy Medical Officer of Health was also appointed Assistant Medical Inspector. The time of arrival of the ferry train at Victoria Station at first was not to schedule, but towards the close of the year became more regular, arriving about 9 a.m. The medical arrangements have worked smoothly and without difficulty and the following are particulars of the work carried out up to the end of the year:— Table LXIV.—Medical Inspection of Aliens. Classification of Aliens arriving at Victoria Station. Total. Medically Inspected. Medically Examined. Temporary Residents. Visitors 812 812 13 Business Visitors 833 833 3 Diplomatic 83 83 — Seamen — — — Contract Seamen 1 1 — Permanent Residents. Returning Residents 131 131 — Ministry of Labour Permits. Males 23 23 2 Females 14 14 — Children — — — Immigrants. Males 41 41 6 Females 14 14 — Children 11 11 — In Transit 94 94 — Total 2,057 2,057 24 Rejected for all causes 2 2 — Transmigrants 1 1 — Grand Total 2,060 2,060 24 79 Two certificates were issued by the medical inspectors to the Immigration Officer where aliens were found not to be medically sound. The entire cost of this service is recoverable from the Ministry of Health, and classified returns of the aliens medically inspected and examined have to be made to the Ministry every half year. Sanitary Inspection of the Area. The following table shows in detail matters relating to the general sanitary conditions 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 lequirements of the Public Health (London) Act, 1936, and the drainage, &c., by-laws of the London County Council, duties connected with housing and infectious disease, and others relating to the sanitary conditions of the City. Details of inspections, &c., made under the Housing Acts during the year appear in the Housing Section of this Report. A somewhat new development is the inspection of existing buildings where internal replanning is contemplated or where change in user is proposed. Such proposals are transmitted by the Town Planning Authority, the London County Council, for the observation of the City Council. A specially constituted sub-committee of the Improvements Committee meets at least three times per month to consider the schemes submitted. An average of ten plans are dealt with at each meeting and the Senior Sanitary Inspector attends all the meetings for the purpose of reporting on such aspects as change in user of underground rooms and other matters where public health considerations are concerned. During the year a number of special inspections were made on town planning questions for the purpose of reports to the SubCommittee. 80 Table LXV.—Sanitary Inspection. Inspection of premises:— Water-Closets— Dwelling-houses— Directly approached from rooms 37 Primary Inspections— Accommodation insufficient 96 (a) On complaint 833 (6) Infectious disease 563 Water Supply— (c) Special Housing Inspections 2,921 Insufficient or unsatisfactory 29 Cisterns dirty and uncovered 71 (d) Housing Regulations, 1925 2,838 Absence of—in upper floors of tenement houses 1 (e) Housing applications 890 Dustbins— (/) Other reasons 2,875 Total 10,920 Absence of 48 Insufficient 39 Defective 43 Re-inspections 15,367 Animals kept so as to be a nuisance 12 Other Premises— Other nuisances 386 Dangerous structures noted 40 Primary inspections— Overcrowding †91 (a) On complaint 39^ (b) Other reasons 6,782 Total 7,174 Sanitary works supervised:— Drains (including soil, waste, rainwater pipes, etc.)— Re-inspections 5,571 Constructed 7,454 Sanitary Works— Altered, repaired, etc. 2,187 Total Inspections— Intercepting traps fixed 85 (a) Under notice 1,459 Petrol interceptors provided 14 (b) Voluntary works 13,508 Tested by smoke 245 ,, chemical 382 Nuisances, etc. „ water 1,578 Defective or dirty conditions ,, air 607 of internal structure 1,815 Water-closets— Verminous conditions 388 Constructed 2,278 Damp conditions 297 Repaired and reconditioned 495 Inadequate under-floor ventilation 19 Urinals— Defeotive drainage, waterclosets, etc. 609 Constructed 272 Repaired and reconditioned 48 ,, roofs 242 Waste Fittings fixed— ,, paving of areas, etc. 70 Baths 1,291 Water-closets— Bidets 128 Insufficiently ventilated or Lavatory basins 3,809 lighted 72 Sinks, etc. 2,268 †Cases of overcrowding which have arisen since the completion of the survey in 1935. Nuisances.—Intimation notices were served in 1,471 instances, the number of premises concerned being 1,433. Statutory notices authorised by the sanitary authority numbered 73 and related to 70 premises. Police court proceedings were taken in 5 instances in order to enforce compliance with the requirements of statutory notices :— 81 Details of Nuisance, etc. (1) Defective drainage in business premises. (2) Dwelling-house without proper and sufficient water supply. (3) Defective and dirty conditions in a tenement house. (4) Do. do. (5) Overcrowding in workshop premises. Result of Proceedings. Abatement order (21 days) and £1 1s. costs. Fine 1s. and 20s. costs. (The supply had been reinstated before the hearing of the summons.) Abatement order (21 days) and 10s. 6d. costs. Do. do. Case dismissed with £2 2s. costs against the Council, the Magistrate not being satisfied that the offence had been proved. The following are the comparative figures since 1932:— Table LXVI.—Nuisances. 1932. 1933. 1934. 1935. 1936. Intimation Notices 1,378 1,223 2,080 1,776 1,471 Statutory Notices 57 50 GO 89 73 Legal Proceedings 4 7 3 3 5 Water Supply.—The Metropolitan Water Board sent 12 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. In one instance the occupier of a dwelling-house was prosecuted and fined 1s. and 20s. costs. Water Supply in Tenement Houses.—Power to effect this provision is given under Section 95 of the Public Health (London) Act, 1936. The number of cases in which this action was taken since 1932 is as follows:— 1932. 1933. 1934. 1935. 1936. 9 12 6 1 1 Lighting of staircases in tenement buildings.—London County Council. {General Powers) Act, 1927 (Sec. 61)—At seven tenement houses lighting of staircases was installed or improved following the service of formal notices. (8342) F 82 Shops Act, 1934.—During the year, 474 shops were inspected, and the results of the inspections recorded. A total of 49 notices was served requiring the provision of:— Notices. Suitable and sufficient means of ventilation 24 Means to maintain a reasonable temperature 6 Suitable and sufficient sanitary conveniences 10 Remedying other defects 9 Total 49 There are altogether some 6,200 shops in the City, of which 1,905 have already been inspected since the Act came into force. Routine primary inspections necessarily take their place in the day to day work of the department. Certain types of shop require more attention by way of re-inspections than others to see that suitable heating and ventilation are maintained. Rent Restriction Acts, 1920-33.—During the year 18 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 69. Certificates of registration or non-registration, which local authorities are required to grant on payment of a fee of 1s., were issued in 70 cases, 68 being in respect of registered houses and two non-registered. There were no cancellations of registration by the County Court. Public Health (London) Act, 1936.—This Act, which came into force on the 1st October, 1936, was introduced for the purpose of consolidating various enactments relating to public health in London. It re-enacts the principal provisions of the Public Health (London) Act, 1891, and amending Acts, which are wholly repealed, and includes provisions of a public health character, previously included in many other Acts, e.g., the Metropolitan Management Acts, various London County Council (General Powers) Acts, Children and Young Persons Acts, and others relating to Baths and Wash-houses, Common Lodging Houses, Cleansing of Persons, etc. 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 1936, the number of inspections made, and the results of such inspections 83 Table LXVII.—Factories, Workshops and Workplaces. Premises Registered. Work Premises. Total Number. Tailors, outfitters, shirt makers, hat, cap and helmet makers 1,499 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, etc. 1,438 Leather workers, boot and shoe makers, harness makers, etc. 04 Carpentry, upholstery, carvers, gilders, etc. 86 Surgical and dental instrument makers 4 Tobacco manufacturers 8 Wig makers and hair workers 50 Printing, bookbinding, lithographers, envelope making, stationers, relief stamping, etc. 68 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, etc. 65 Metal workers 72 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, etc. 91 Florists 25 Laundries 19 Bakehouses 56 Photographers 60 Jewel case makers 4 Cinema film workplaces 17 Total 3,626 The use of 159 workshops was discontinued, and 237 additions were made to the register during the year. Table LXVIII.—Factories, Workshops and Workplaces. Inspection. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including factory laundries) 380 1 — Workshops (including workshop laundries) 3,544 256 1 Workplaces (other than Outworkers' premises) 5,024 311 1 Total 8,948 568 2 (8342) F2 84 Table LXIX.—Factories, Workshops and Workplaces. Defects found. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to ELM. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 271 271 — — Want of ventilation 66 66 — — Overcrowding 21 20 — 1 Want of drainage of floors — — — — Other nuisances 143 142 — 1 Sanitary accommodationInsufficient 62 62 — — Unsuitable or defective 93 93 — — Not separate for sexes 45 45 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (a. 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 701 699 — 2 Table LXX.—Factories, Workshops and Workplaces. Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 138 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 141 Absence of means of warming 2 Matters referred by H.M. Inspectors 118 Workrooms measured 194 Visits of Enquiry re Employment of Women 164 ,, „ Outworkers 95 Underground bakehouses in use at the end of the year 37 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. 85 Table LXXI.—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. 1 Workmen. Wealing apparel 913 1,606 7,112 17 114 49 328 4,907 95 — — — — — 12 — — Linens, etc. 5 33 50 — — — 2 73 — — — — — — — — — Furriers 8 25 8 — — — 18 28 — — — — — — — — — Umbrellas, toys, artificial flowers, etc. 8 71 52 — — — 7 73 Total 934 1,735 7,222 17 114 49 355 5,081 95 — — — — — 12 — — 86 Outworkers.—A total of 951 lists was received during the year. Notices in respect of failure to send lists were sent to 95 firms. No legal proceedings were necessary, but six firms were cautioned. The lists contained 9,120 names and addresses, of which 5,081 were in other districts, 4,240 being within the Metropolitan area and 638 in the London Suburban districts. The number of individual outworkers in the City at the close of the year was 1,620, of whom 1,542 were registered as occupying workshops. The number of premises in which outwork was being carried on was 666. Note by the Lady Sanitary Inspector. The drift of high-class business generally from the Ebury Street area is moving further north. Court dressmakers and other trades of a like nature subject to seasonal influences have found it more suitable to settle in the neighbourhood of Grosvenor Street. Owing to changes in fashion the once flourishing industry of lace-repairing has almost vanished. A feature of tailoring in what is termed "the West End" is the apparent growth of the sale of ready-to-wear suits and other garments. This has naturally given rise to changes in the local industry as regards the demand for workshops and conditions of employment generally. There has been a tendency to unconventionality in dress almost entirely confined to the male sex which is reflected in the type of clothes in greatest demand. The change in habit and outlook, a greater appreciation of the benefits of outdoor pleasures and recreations, assisted by the motor car, has led in some measure to the abandonment of the more formal Sunday garments of a former generation. Nevertheless the high grade workmanship produced in the Savile Row district stands pre-eminent and there is no evidence of any decline in the quality of the goods produced there. In Westminster the following industries have almost disappeared, perhaps by moving to other districts; lace repairing, hand-made cigarettes, hand laundries, and small film repair workplaces. The introduction of "talkies" may have played a part as regards the last-mentioned. In the Mayfair district somewhat rapid changes in the conversion of residential streets to shopping purposes are occurring, particularly west of New Bond Street. With regard to the cheaper women's wear, many of the formerly busy shops in Berwick Street, Soho, are now empty. There seems to have been an exodus of the cheaper gown shops to Oxford Street and upper sections of New Bond Street. C. Hughesdon. 87 Common Lodging Houses. There are 5 common lodging houses in the City, 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, 1936, to 30th June, 1937. 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, 186 inspections were made, 69 being between the hours of 6 p.m. and 9 a.m. With the exception of one they were generally satisfactory. Conditions in one lodging house were found to be gradually deteriorating, but following representations to the owner some improvement was effected. Houses Let in Tenements.—The sanitary inspectors paid 7,402 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 two cases, as detailed on page 81. Rag-and-Bone Dealers.—There are 5 premises in the City in which this business is carried on. No matters requiring attention by the department have arisen during the year. Rag Flock—Public Health Act, 1936, Sec. 136.—There is one factory in the City which comes within the provisions of the Act. Although rag flock is not manufactured there, it is used in making up material for mattresses, etc. One sample was taken during the year and was found to be satisfactory. 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. 88 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. 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 six schools additions or improvements were made to the sanitary arrangements during the year:— Buckingham Gate School, St. Martin's High School, Leicester Wilfred Street. Square, (late Millbank School. Archbishop Tenison's School.) St. Anne's, Dean Street. Westminster School, Dean's Yard. Westminster City School, Palace Street. Rat Repression.—During the year 168 complaints were received and investigated, 525 inspections being made by the sanitary inspectors. The Council's rat officer visits 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. At the request of the Department, the City Engineer's staff examined the sewer connections of some 155 premises, of which 29 were found to be defective and were subsequently repaired or renewed. In the course of these examinations many disused "eyes" to the sewers were discovered and were sealed off. 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 six sections of sewers with anti-rat gas. During "Rat Week" a total of 13,876 baits were laid in the sewers and 1,331 at the Council's depots, etc. The number of dead rats discovered was small, but the baits were reported to have been taken freely. Nuisance from Pigeons.—The member of the disinfecting staff whose duties are concerned largely with rat repression and investigation of 89 complaints of nuisances caused by pigeons, visited some 5 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 750 throughout the year. Public Health (London) Act, 1936, Sec. 224.—Removal of Infirm and Diseased Persons to Suitable Institutions. Seventeen 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 the Act. In one case the Public Health Committee authorised application being made to the Court for an Order for the removal of an elderly woman in a poor state of health and living in a single room in dirty and verminous conditions, but persuasion on the part of the Council's officers and the Relieving Officer was eventually effective in securing her removal to hospital. 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. Individuals, numbering 261 men, 47 women, and 22 children (under school age) were given medicated baths at the disinfecting station, making 491 attendances, and 8,355 articles of clothing, bedding, etc., were disinfected. Visits to premises for vermin numbered 59. Under an agreement with the London County Council, school children from the boroughs of Battersea, Camberwell, Chelsea, Fulham, Holborn, Lambeth, St. Pancras, St. Marylebone, Stoke Newington and Wandsworth attended for treatment at the disinfecting station. Among Westminster school children 439 cases of head lice, 4 of body lice, and 38 of scabies were treated. In all cases the clothing was disinfected, together with the bedding from their homes, amounting in 90 all to 2,098 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows : 191 for head lice and 18 for scabies.. The total number of attendances of school children for baths at the disinfecting station was 1,121. Articles of clothing disinfected numbered 1,170. Notices from the London County Council in respect of verminous children numbered 29 and 55 visits of inspection were paid to the families concerned. The following table shows the total number of individuals treated at the station for verminous conditions:— Table LXXII.—Cleansing of Verminous Persons. 1936. Head lice. Body lice. Scabies. Total. Children (including those under school age). 630 4 78 712 Adults 2 225 81 308 632 229 159 1,020 Eradication of bed bugs.—The Ministry of Health in Circular 1561 ask for information as to the action taken during the year for the eradication of bed bugs, including particulars of the number of Council and other houses found to be infested, the methods employed for disinfesting houses, and for ensuring that the belongings of tenants are free from vermin before removal to Council houses. Infested Houses.—The number of Council houses (flats) found to be infested was 115 and of other houses 388. All were disinfested, the work in the case of the Council houses being carried out by the Council's own staff and in the others by the private owners or occupiers. Methods for disinfesting houses.—The methods in use for disinfesting flats in the Council's dwellings include fumigation by sulphur, the removal of woodwork and other projections on the walls, and the application of a blow lamp to all angles and crevices in the walls, etc. ; walls and floors are washed with a liquid soap containing a strong solution of ammonia. This treatment is followed by the complete painting or repainting of all walls and woodwork in the flat. These methods have been found to be effective in freeing infested flats and in preventing re-infestation. 91 Methods for disinfesting furniture, etc.—The Council in 1935 entered into a Contract for the removal and fumigation by hydrocyanic acid gas of the furniture of families to be rehoused in the new dwellings then in course of construction. The contract was made with a firm employing a special fumigating plant housed in a temporary building at Monck Street Depot. A detailed description of the plant was given in the report for 1935. The Council also entered into an arrangement with the Chelsea Borough Council for the removal and fumigation of the furniture of Chelsea families to be rehoused in that Council's dwellings. During the year the furniture and effects of 368 families were dealt with by the Contractor, the bedding, clothing, etc., being subjected to disinfection by steam at the Disinfecting Station. Of this number, 345 were removed to the City Council's dwellings, 17 to dwellings of the Chelsea Borough Council, and 2 to the Tachbrook Estate of the Westminster Housing Trust. Three cases were dealt with at the request of the Grosvenor Estate, and the remaining one concerned a family in a private house whose furniture after fumigation was returned to the same house, which in the meantime had been disinfested by the owner. The shelter provided for the use of families whilst their homes or belongings are being disinfested was occupied on twelve occasions during the year. In the rehousing of tenants in its own dwellings, the Council adopted the policy that the furniture of all the families concerned, whether from private dwellings or transferred from one Council dwelling to another, should undergo the process of fumigation. The Council's Woman Property Manager states that no instances of re-infestation have occurrred in the flats occupied by tenants whose effects have been treated by the above-mentioned methods. Table LXXIII.—General Disinfection of Premises, Articles, etc. 1932. 1933. 1934. 1935. 1936. Rooms 781 747 1,058 674 837 Articles disinfected 22,314 21,598 22,174 22,759 25,643 Articles washed 3,690 3.500 3,450 3,800 3,400 Articles destroyed 1,020 2,218 300 231 565 Books disinfected * 276 723 132 421 114 Vehicles ,, 5 4 15 38 41 Offices and business premises 11 6 6 11 17 * Library books, 39; private books, 28; school books, 47. 92 Motor Disinfecting Van.—The motor van during 1936 completed 5,332 miles, carrying 4,823 cwts. of goods. The weight of goods carried in the Disinfecting Van showed an increase of some 60 per cent, compared with the previous year. This was due principally to the disinfection of the bedding, etc., of some 368 families who were rehoused in the City Council's dwellings and elsewhere, the number of articles dealt with totalling 15,270. Coroner's Court and Mortuary. There were 254 bodies removed to the mortuary during the year by order of the Coroner or to await burial. Inquests were held in 164 cases but not in 80, while 10 bodies were received to await burial. Post-mortem examinations were made in 158 instances. The following is a list of the causes of death of 254 cases brought to the mortuary:— Drowning 17 Street accidents 32 Other accidents 21 Murder 3 Suicide 40 Natural causes 83 Misadventure 30 Other miscellaneous causes 28 During the year repairs and decorations were carried out at the Court and Mortuary premises at a cost of £250. The works included the provision of two new post-mortem tables in place of those existing and renewal of the electric lighting system in a part of mortuary premises. Note by the Senior Sanitary Inspector. It has been suggested that after nearly 40 years' service as sanitary inspector in Westminster, I should give a brief survey of the changes I have observed since I took office with the Vestry of St. Martin-in-the-Pields in 1897, the year of Queen Victoria's Diamond Jubilee. During these forty years I have had official dealings with all sorts and conditions of men. In a district so rich in the variety of its interests I have received as sanitary inspector abundant courtesy and goodwill, although in the early days conflicts of opinion were not unknown particularly with those who had cause to fear the visit of a sanitary inspector. Nowadays there is a general and widespread desire for improvement and the sanitary inspector is more the friend and adviser of the parties concerned. 93 The decline of the residential population from 257,282 in 1861 to 120,535 in 1931 is some indication of the changes which have taken place in the character of this great City, the age-long centre of fashion, social life, art and amusement, and now also rapidly becoming a commercial district. The old family mansions, such as Devonshire and Chesterfield Houses have given way to stately hotels and blocks of flats, and to commercial and office buildings. The Albany however remains to mark the flight of time. As some of the flats are freeholds even one occupant can delay rebuilding and improvement. The widening at the east end of the Strand, the construction of Kingsway and Aldwych and the rebuilding of Regent Street have taken place. I have also witnessed the complete transformation of the Millbank estate, mostly a township of old cottages, to palatial office buildings, residential flats, the new Westminster Medical School and Nurses Home, and the largest of the Council's new housing estates with its 616 flits also occupies the site. The disastrous Thames flooding in 1928 was the chief factor in creating this great new development. It is interesting to recall that while none of the five local authorities absorbed by the City Council in 1901 had erected any working-class dwellings, the City Council has built eight estates comprising a total of 1,516 dwellings. Behind Clement's Inn stood King's College Hospital, demolished for the new premises of Messrs. W. H. Smith & Son. During excavation of the site the large quantities of human remains found led some to believe that they had discovered an old plague pit. It proved in fact to have been a recognised burial place, but the burials must have taken plaos without any order or decency. The Adelphi, with its noble terrace, except for changes in occupation, remained until quite recently as when constructed by the Adam Bros, about the years 1768-72, unfortunately it is no more. Weird tales have been told of its arches. A flight of wooden steps from one of the darkest corners led to a large gloomy vaulted chamber known as " Fagin's Kitchen" ; whether the real den of Dickens' " Fagin " or not I am unable to say. The first area dealt with by the City Council under the Housing Acts was Turners Court, off St. Martin's Lane, a narrow court of eleven houses where the Coliseum now stands. The houses contained 55 families and proceedings were taken under the Housing Act, 1890 in the Police Court at Bow Street, when an order was made by the Magistrate, Mr. Fenwick, for the closure of the houses within 28 days. The order also provided for the payment by the owner of 20s. to each tenant towards the cost of removal. All the houses were vacated within the 28 days, the tenants themselves finding other accommodation. The upper parts of the majority of the houses in Soho used to be let in tenements and were occupied principally by the outworkers of tailoring and other firms, often to the legal limits and even in excess. A family might occupy a floor of 3 rooms, a workroom, a bedroom and a living room or kitchen. During working hours the workroom would be filled by the workers of the family and often by one or two extra sittings let to outsiders. At night, beds would be unrolled and laid on the floor of the workroom for the children and perhaps one or two others also. Night visits were frequently paid to prevent this overcrowding. Other trades during recent years have displaced many of the resident tailors who now live and work in more pleasant surroundings in the suburbs. 94 The smallpox epidemic of 1901-2 was a busy time for the Public Health Department. There were about 400 cases in Westminster spread more or less throughout the City, the greatest number being in the Clare Market area in the east of the City, which was soon afterwards demolished for the Strand to Holborn improvement. In this area were several common lodging houses in some of which isolation wards were arranged so that suspected cases could be segregated and kept under observation. When successful vaccination was secured of all close contacts in the early stages a second case seldom occurred. Great changes have taken place in the sanitary fitments of buildings. In the large hotels years ago, baths and sanitary conveniences were used in common by the residents, usually there being only 2 or 3 of each on a floor. In the recently constructed hotels, a bathroom, with all conveniences, is a necessary annexe to each bedroom. Such amenities, now provided as a matter of course in modern residences were unknown to the old family mansions of the Victorian era. I remember visiting a nobleman's mansion in St. James's in the early part of the century and was astonished to find there was not a single fixed bath in the house and such conditions also obtained very generally in Belgravia in the first decade. Central heating throughout, a more liberal supply of hot water and a system of mechanical ventilation in connection with all rooms, in hotels and largs blocks of flats have added enormously to personal comfort as it has to the cost of construction, and incidentally has greatly increased the work of a sanitary inspector. The Inspector's work has thus become more exacting because plans are becoming much more complicated as sanitary fittings are more varied and widely distributed in buildings. New forms and materials in construction likewise bring fresh problems in lay-out and arrangement. In the early days it was not uncommon to find the drainage of houses either inefficient or faulty and the highly satisfactory drainage of buildings both new and old in the City to-day may, in large measure, be attributed to the early principles and standards of sanitation applied by the inspectors some thirty or forty years ago and maintained with equal insistence by their successors. Nuisances arising from stables, private and commercial, formed a problem of its own, for there were thousands of horses kept in the City in those days. One bus company alone, with stables in Page Street, had over a thousand horses. It is doubtful if there are, excluding the Royal Mews and military establishments, now more than two or three hundred horses left. While changes such as these have relieved the sanitary inspector, other duties have been added. The abatement of nuisances has largely given place to a more constructive aspect, the creation of more healthy living and working conditions. The very considerable output of social legislation since the war has imposed fresh duties on local authorities and many of these come within the province of a sanitary inspector. Regulations, orders and bye-laws governing food and the intricacies of Housing Law and administration, are largely post-war developments. Most recently of all the aspects of Town Planning are more and more involving health considerations in the lay-out and user of buildings and the sanitary inspector must necessarily play his part in these matters. In my early days, the City being still largely residential, the demand for inexpensive restaurants was met by modest eating houses and taverns. Tea shops 95 or cafes where light meals could be had were scarce. Very few women were employed in offices, and the lack of speedy and convenient transport from the suburbs discouraged those with leisure and money to spend from journeying to town in the midday period. The rise of the tea shop type of restaurant has proceeded with, or may have stimulated, the conditions with which we are familiar to-day. Enterprising firms such as the Aerated Bread Company and J. Lyons & Co. were early in the field, and these and many others supply an ever-present need among the daily incomers to the City whether occupied in business or on pleasure bent. I should like to conclude this note by commenting upon the improvement in housing conditions, in places of work and in the food of the people. In these forty years there has been a great advance in the quality of food, its preparation and storage. Adulteration was six times as common in the early part of the century. Unsound food is very rarely exposed now for sale thanks in large measure to methods of cold storage. The conditions of restaurant kitchens, even in the well established, were sometimes deserving of reproach thirty-five to forty years ago. Now it is found profitable from every point of view to have large light and airy kitchens and proper facilities for the comfort and cleanliness of their employees. John Sanderson. HOUSING. The housing survey carried out in such great detail in the period 1933-35 forms the basis of all work in connection with the housing of the working-classes in the City. It is on the data then obtained that housing needs are assessed. Tenancies may change but the character of the buildings, except those reconditioned in whole or in part on specifications approved by the Housing Committee, do not alter greatly. The City Council in instituting this survey to a very great extent anticipated the survey required under the Overcrowding Act, and in consequence both the expenditure and the work entailed in meeting the requirements of the Minister and the London County Council under this Act were very much less than would ordinarily have been the case. There is, therefore, in the possession of the City Council full and exact information of the housing conditions of the working-classes in the City. In 1935 the City Council, having fully considered the survey reports, adumbrated its housing policy for the next ten years and some of the implications of this policy are referred to in this report. The aspects of clearance, demolition and closure and the alleviation of overcrowding are commented upon. In order adequately to undertake the execution of the City Council's policy certain of the temporary staff engaged on housing were retained and other permanent appointments were made. Even 96 with this specially designated and augmented staff it is difficult to maintain that degree of routine re-inspection which is so desirable in order to keep housing information up to date. The special requirements relating to overcrowding and the discussion of reconditioning proposals and specifications at the premises are developments which in themselves take up an increasing amount of time, apart from the preliminary work of detailed re-inspection and examination before representation relating to dwelling houses or parts of such houses can be considered by the Housing Committee. Housing Policy of the City Council. In April the City Council reviewed its housing policy in the light of the information obtained from the two housing surveys and, as a result, resolved that steps should be taken for the closure of all basements contravening the Housing Acts and the Council's Regulations made thereunder. The Council further agreed in principle (without committing itself until detailed proposals had been submitted) to provide 250 new flats for families to be displaced from basements, 242 new flats for rehousing overcrowded families and to inquire into the possibility of acquiring some houses for reconditioning. Additionally, it was decided that the London County Council be asked to rehouse 350 families from unfit basements whose needs do not require them to live in the City. Overcrowding. In the report for 1934 reference was made to the specific provisions of the Housing Act, 1935, for the abatement and prevention of overcrowding. The Minister of Health, in exercise of his powers under the Act, made an order in relation to the City of Westminster, fixing 1st July, 1936, as the appointed day for the purpose of Section 6 (which provides for entry in rent books of certain provisions relating to overcrowding) and 1st January, 1937, as the appointed day for the purpose of other sections containing provisions as to offences regarding overcrowding. A pamphlet setting out the principal provisions of the Act concerning the prevention and abatement of overcrowding was prepared for the guidance of all persons concerned and distributed by post or otherwise supplied to all inquirers. During the later months of the year many applications were received for particulars of the numbers of persons permitted to occupy dwelling-houses in accordance with the standards laid down in the Act. 97 During the year a number of cases of fresh overcrowding were discovered, the majority of these occurring in families where children had attained the ages of one or ten years and had, therefore, reached the stage when they must be regarded as children or adults respectively within the meaning of the statute. These could not be held to be offences as that part of the Act dealing with such cases had not come into force. This type of fresh overcrowding will naturally arise from time to time during the next few years, but it is important to remember that until an offer of suitable accommodation has been made no offence has been committed, providing application has been made to the Council for alternative accommodation. Alleviation of overcrowding was effected in the following instances:— Rehoused by the Westminster City Council 85 Rehoused by the London County Council 31 Rehoused by Housing Trusts, Societies, Private Corporations, etc. 39 Families removed to other accommodation in privately owned dwelling-houses 26 Families who have obtained additional accommodation in privately owned dwelling-houses or where some members of the family have left the household 66 Total 247 Clearance Areas. I.—Bateman's Buildings. This area has been dealt with by the City Council by means of a Clearance Order made under the provisions of the Housing Acts. It was considered that the only satisfactory method of dealing with the area was by way of clearance, not only because of the disrepair and sanitary defects existing in the individual houses but owing to the bad arrangement of the houses causing restriction of light and free circulation of air. The Minister of Health, after a local enquiry, confirmed a Clearance Order made by the City Council affecting the 11 tenement houses occupied by 51 families. The tenants are being rehoused by the City Council. These buildings in the heart of the Soho district comprise three-storeyed tenement dwellings built on both sides of a court running between Soho (8342) 6 98 Square and Bateman Street. They were occupied not only by English families but by others of various nationalities including Chinese, Burmese, and Indians. II.—Clifford's Row, Ebury Gardens, Eaton Cottages, Ebury Bridge Road (part), Gregory Cottages, Grosvenor Cottages, and Willow Place. The Council considered the question of declaring the above, mostly scattered rows of old cottages, to be Clearance Areas and, following the requirements of the statutes, have asked the London County Council whether they propose to deal with them as such. If the London County Council do not intimate their intention themselves to make Clearance Orders the City Council will proceed to deal with them in this way. The several areas embrace 64 houses, mostly of the cottage type, occupied by 68 families. Closure of Parts of Buildings Unfit for Human Habitation. Consequent upon the amendments made by the Housing Act, 1935, the Regulations made under the Housing, Town Planning, etc., Act, 1909, by the City Council in 1915 with regard to underground rooms were rescinded and new Regulations, based upon the Ministry of Health's model code, were made and adopted. The new regulations make restrictions as to the use for human habitation of any underground room not complying with their provisions. The former regulations were applicable only to underground rooms used for sleeping purposes. This is an important difference so far not generally fully appreciated by owners, who not infrequently feel that legal conditions will be satisfied by simply arranging that underground rooms not complying with the regulations shall no longer be used as bedrooms. Although the standards laid down in the regulations provide a useful and exact method of determining the fitness or unfitness of an underground room on matters of fact as distinct from those of opinion, the procedure adopted by the Council in dealing with basements is founded on the statutes themselves. The Act of 1935 enlarged the scope of these operations by extending the reference from rooms separately occupied to rooms not necessarily so occupied. Whereas it was formerly not possible to make a closing order on an empty room, an order can now be made if the room is suitable for occupation by the working classes. The removal of the former restrictions has considerably improved the machinery for dealing with underground rooms. 99 Reconditioning of Unfit Dwellings. The Housing Act, 1935 provides that before a demolition or closing order may be made, an owner shall be given an opportunity of submitting an offer with respect to the carrying out of works to render the premises fit for habitation, or as to the future user of the house or part thereof The Act further provides that a closing order shall be determined if the part of the building to which it relates has been rendered fit for human habitation. Many owners consider it sound policy to recondition basements even at considerable cost rather than allow the rooms to remain empty with the consequent risk of deterioration to the remainder of the house. In these circumstances, specifications of proposed works are forwarded by the owners and submitted to the Housing Committee for consideration. Before these are submitted in final form it is invariably necessary for meetings at the premises to be arranged between architects and builders and the Housing Inspector to discuss various points arising. In other ways the officers of the Council offer every assistance possible by way of advice in the preparation of satisfactory specifications. No serious differences of opinion have arisen between owners and inspectors of the department, and the advice offered appears to have been generally appreciated. Similar assistance is given in cases where owners indicate their desire to recondition houses or parts of houses voluntarily. Thus it is that the role of the sanitary inspector has nowadays become more that of a friendly adviser than one whose duty it is mainly to point out defects. Constant supervision is exercised by the sanitary inspectors from the beginning of the work until its completion ; unexpected difficulties which may arise during the progress of the work are thus dealt with without delay. The average time required to recondition a basement of two or three rooms completely is from six to eight weeks. The broad principles to be considered in reconditioning basements are briefly : the eradication of all dampness; the provision of oversite concrete and adequate ventilation under the floors; the enlargement of windows to obtain the maximum access to light to all the rooms, passages, etc.; the provision of extra glazed doors and windows internally to ensure not only access to light but good circulation of air throughout the basement; the modernization of sanitary accommodation; the provision of such amenities as food stores, good sinks, baths, facilities for the supply of hot water and the general repair and replacement of defective woodwork, (8342) G 2 100 plaster, yard paving and fittings generally. These principles apply in a somewhat modified manner to the reconditioning of whole houses ; the enlargement of windows is often not necessary in upper rooms. In Aylesford Street the owners adopted a scheme of general reconditioning and in some respects replanning of the houses. The work was well in hand at the end of the year. The results obtained in two houses, completed by December, have proved eminently satisfactory. The tenants were rehoused temporarily; the houses thoroughly disinfected ; plasterwork stripped; floors repaired or relaid; additional windows provided in the rear walls; additional rooms formed ; electric light provided in the rooms, staircases and w.cs., and the premises converted for use as separate flats with the provision of larders, coppers, baths, w.cs. and sinks for the use of each family. The basements were reconditioned on the lines already explained and will be occupied in conjunction with rooms on the ground floors. In this instance the scheme of reconditioning was, apart from the basements, entirely voluntary. The houses were of rather low grade tenement type, the internal planning narrow and inconvenient and the fittings somewhat unsubstantial. Only owners unhampered by lack of capital could embark on a scheme so radical in character and in houses so unpromising. The provisions of the bye-laws relating to houses divided into separate tenements are taken as guiding principles as to the provision of amenities when considering specifications both with regard to basements and complete houses. Closing orders to the number of 200 were made prohibiting the use of parts of buildings for human habitation and, in 24 instances, statutory undertakings by the owners were accepted, to the effect that the rooms would not be used for habitable purposes unless and until rendered fit to the satisfaction of the Council. Of these closing orders and undertakings, 221 related to basements and 3 to other parts of houses, comprising 567 rooms. In 70 other cases the necessary statutory procedure for closure of basements was in process at the end of the year, so that formal action has been applied to 291 basements. In addition to those parts of buildings dealt with statutorily, 137 basements were voluntarily closed for habitation or reconditioned as a result of informal action, bringing the total of the basements dealt with up to 428 during the year. Only in one instance was it found necessary to take legal proceedings in respect of the contravention of a closing order. 101 Owners submitted 112 specifications for the reconditioning of basements which were the subject of closing orders or undertakings, and in 106 of these, the Council considered that, if carried out, the works would render them fit for re-habitation, many being subject to certain additional works specified by the Council. Eighty-one specifications were received from owners desirous of carrying out reconditioning work in basements prior to or apart from any formal action by the Council, thus making a total of 193 specifications submitted during the year. At the end of the year 51 basements had been reconditioned to the satisfaction of the Council; the closing orders were accordingly revoked and the premises re-occupied. Some 52 others had been brought up to the requisite standard voluntarily. In 97 other cases the work was in hand or about to be undertaken. Following applications from owners, approval has been given by the Council in 13 cases allowing the use of closed basements for purposes other than that of human habitation. These purposes included the use of the rooms as storerooms, and in one or two instances the rooms were rendered fit for use as wash-houses, workrooms, etc. Specifications were considered and approved in 5 instances for the reconditioning of entire houses. In four cases applications were received from owners for certificates, under the provisions of Section 55 of the Housing Act, 1935, as to the condition of houses after reconditioning, and the certificates were granted for a period of five years in each case. The Housing Committee and its Standing Sub-Committee, besides meeting on 20 occasions, held 8 special meetings for the purpose of interviewing persons interested in the premises under consideration for closure. Some 120 persons attended and were heard by the Committee, in some cases being represented by solicitors or surveyors. In accordance with the procedure laid down in the Housing Acts it was found necessary to ascertain particulars of freeholders, leaseholders, mortgagees, etc., of the premises to be considered and in 2,500 instances formal notices have been prepared and served. Provision of New Houses for the Working Classes. Grosvenor Housing Scheme.—The last block (Bennett House) consisting of 96 flats was finished in March, thus completing the 616 workingclass flats incorporated in the Scheme. The official opening of Bennett 102 House and celebration of the completion of the estate was graciously performed in June by Mrs. Stanley Baldwin, who spoke of the possibilities of using roof space as playgrounds for the young and where the elders could enjoy fresh air. She also mentioned the need for resting places for the dead in large housing estates. Ebury Bridge Housing Estate Extension Scheme.—The first two blocks (Hillersdon and Doneraile Houses) consisting of 106 flats were completed and the third block of 74 flats was well in hand by the end of the year. The whole scheme provides for the erection of 280 flats. Rehousing Operations.—During the year 240 families were rehoused by the City Council and 110 by the London County Council, making a total of 350 families removed from unsatisfactory dwellings. The Estates on which these families were accommodated were as follows :— Westminster City Council's Estates. Ebury Bridge 24 Ebury Bridge Extension 70 Grosvenor Housing Scheme 94 Regency Street 50 St. James' Dwellings 1 Walden House 1 — 240 London County Council Estates. Becontree 7 Battersea Bridge Buildings 4 Bellingham 3 Clapham Park 10 Camberwell 1 Churchway 1 Downham 1 East Hill, Wandsworth 4 East Dulwich 1 Honor Oak 7 Herbrand Street 2 Kennington Park 2 Kenmore Park 1 Loughborough 1 Millbank 27 103 London County Council Estates—continued. Mottingham 2 Norbury 2 Oaklands 2 St. Helier, Morden 11 Streatham 3 Stamford Hill 1 Shelton Street 1 Tabard Gardens 1 Totterdown 1 Vassall Road 3 Vauxhall 1 Wormholt, Hammersmith 8 Watling, Edgware 1 York Road 1 — 110 Total 350 Three hundred and twenty-five applications for rehousing (other than from basements) have been investigated and reported by the Medical Officer of Health to the Housing Committee. Of the 240 families rehoused by the City Council, 110 were from unfit basements, 70 from houses in clearance areas or from houses the subject of demolition orders, and 60 from houses in which the conditions were unsatisfactory or for reasons of health. Fifty-eight of the rehoused families were overcrowded. Unfit Basements.—In addition to the 110 families rehoused by the City Council, the London County Council rehoused 27, whilst 33 families were rehoused by other housing associations or themselves obtained other accommodation. Table LXXIV. 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) 10,920 (b) Number of inspections made for the purpose 26,287 104 (2)—(a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,838 (6) Number of inspections made for the purpose 10,240 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 387† (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 647* 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 182 3, Action urider 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 — (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners — (b) By Local Authority in default of owners — B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 812 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 809‡ (b) By Local Authority in default of owners — * Notices served in respect of these houses are included in the number shown in 3. B. (1). † Includes all unfit dwelling-houses where formal action has been taken under the Housing Acts. ‡ Three dwelling-houses were the subject of legal proceedings for non-compliarce with statutory notices. 105 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 - (2) Number of dwelling-houses demolished in pursuance of Demolition Orders - (3) Number of dwelling-houses voluntarily demolished 30 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 224 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 53 4. Housing Act, 1935.—Overcrowding. (a)—(i) Number of dwellings overcrowded at end of year 927 (ii) Number of families dwelling therein 927 (iii) Number of persons dwelling therein 4,183 (b) Number of new cases of overcrowding reported during the year 91 (c)—(i) Number of cases of overcrowding relieved during the year 247 (ii) Number of persons concerned in such cases 1,331 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 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:— 106 Table LXXV.—Smoke Abatement—Results of Observations and Action Taken. - 1932. 1933. 1934. 1935. 1936. Complaints received 35 63 58 47 78 Observations taken 629 749 876 830 728 Notices issued— Preliminary 11 10 5 22 19 Statutory 2 1 _ 2 Legal Proceedings 2 — — — — There were no prosecutions in respect of smoke nuisances during 1936. National Smoke Abatement Society.—The City Council takes an active interest in the work of this Society. Councillor Mrs. Alderson Horne, as a member of the Public Health Committee, Councillor E. H. Keeling, and the Medical Officer of Health attended the annual Conference, held in London, as delegates of the City Council. 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, etc., actively interested in such investigations. The Council appointed the 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 of 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 Farm Street Depot, To face page 106. DEGREES OF POLLUTION. CHART "A." ATMOSPHERIC POLLUTION, AUTOMATIC AIR FILTER. Readings taken at the City Hall. Average degrees of suspended matters (mostly dirt) estimated for the years 1934, 1935 and 1936, 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 106. CHART "B." ATMOSPHERIC POLLUTION. SULPHUR GAS IN THE ATMOSPHERE. Variations throughout the year of S02 measured by weight, with corresponding readings of rainfall, wind and visibility. 107 Mayfair, and at the Coroner's Court, Horseferry Road, together with the result of analyses of deposits from a similar gauge in Finsbury Park for comparison. Table LXXVI.—Atmospheric Pollution—Analyses of Deposited Impurities. 1936. Figures in English Tons per Square Mile. Horseferry Road. s.W.I. Farm Street, W.l. Finsbury Park. Total Solids. Sulphur so3. Daily Average. Total Solids. Sulphur. s03. Daily Average. Total Solids. January 37.31 4.20 1.20 34.17 4.26 1.10 43.61 February 32.89 2.71 1.41 27.42 2.09 0.98 57.09 March 35 .67 2.89 1.15 29.57 2.29 0.95 30.04 April 24.96 1.58 0.83 26.07 1.88 0.86 21.65 May 20.53 1.34 0.65 21.32 1.51 0.63 18.18 June 26.76 2.72 0.89 26.69 3.01 0.86 29.35 July 23.70 2.43 0.86 21.99 1.97 0.71 22.62 August 17.22 1.45 0.56 10.55 0.91 0.34 12.34 September 28.04 3.20 0.93 33.72 4.89 1.14 27.87 October 33.01 3.58 1.03 24.96 2.57 0.79 30.52 November 46.49 7.67 1.55 38.56 5.87 1.28 42.97 December 32.37 3.27 1.04 28.23 2.57 0.91 21.24 (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 1936, together with similar curve3 for days in 1934 and 1935. 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 measured by chemical analysis. Chart " B " indicates graphically the amount of sulphur gas correlated with visibility, wind direction and rainfall during 1936. The code used 108 for the "visibility" curve is that issued by the Meteorological Office and is as follows:— 0. Dense fog Objects not visible at 55 yards. 1. Thick fog „ „ 220 ,, 2. Fog „ „ 550 „ 3. Moderate fog ,, „ 1,100 ,, 4. Mist or haze „ 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 will be noted 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. Special observation for the presence of sulphur gas in the atmosphere was carried out at the City Hall from 10 a.m. 23rd December to 10.30 a.m. 24th December, and during the same period on the two following days. During the first period of observation when business houses, theatres, restaurants, etc., were working normally, 0.266 part of sulphur dioxide was found to be present in one million parts of air, whereas during the second period, when most of these premises were closed, only 0.162 part was found. Weather conditions during these two periods were similar, i.e., wind slight (direction S.W.), visibility between 1,000 and 2,000 yards, and little rain. (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 are installed in the City, one at the City Hall, one at Farm Street Depot, Mayfair, and one at the Coroner's Court, Horseferry Road. The results obtained during the year are shown in the following table:— 109 Table LXXVII.—Atmospheric Pollution—Measurement of Sulphur Activity. Month. City Hall, W.C.2. Farm Street, W.l. Horseferry Road, S.W.I. January 3.80 3.73 3.66 February 4.09 4.39 4.27 March 3.70 4.17 3.70 April 2.33 2.84 2.69 May 2.24 2.34 2.21 June 1.85 1.78 1.88 July 6.52 2.82 1.20 August 1.54 1.63 1.40 September 2.15 2.29 1.92 October 2.40 2.95 2.35 November 4.59 3.90 4.29 December 3.78 4.45 4.04 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. The average for the year seems greatest at the City Hall. Batter sea Power Station.—In December, the Council received a communication from the Electricity Commissioners intimating that application had been made to them by the London Power Company, Limited, for consent to the extension of the generating plant at this Power Station. It was stated that the application was supported by the Central Electricity Board, whose programme for plant development would require the proposed extension at Batteresa to be available by 1940. The London County Council, as one of the authorities interested in the proposal, at the instigation of the City Council, suggested that a conference of officers of the County Council and the other authorities concerned should be held to consider the application and report to their respective councils. The City Council agreed and authorised certain officers to attend the proposed conference to be held early in 1937. INSPECTION AND SUPERVISION OF FOOD. The inspection of food and of premises where foodstuffs are stored or sold receives constant attention. One thousand eight hundred and seventeen samples of various foods and drugs were purchased for analysis, while 3,806 visits were paid to premises where food is sold, stored, or otherwise handled, for the purpose of observing the condition of food and premises, cleanliness, and methods of handling. Notices numbering 324 were served in respect of various defects, mainly lack of proper cleanliness. In addition, foods sold at Charity " Markets " and Bazaars have been the subject of inspection. 110 Certification of food for export.—Six certificates were issued in respect of the export of food products to Canada. Public Health (London) Act, 1936. Under Section 187 of this Act it is necessary for premises used for the manufacture, storage or sale of ice cream, and those 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, 1936, there were 106 premises on the register for the sale or storage of ice cream, of which 25 were also registered for the manufacture of this commodity. Twenty-seven premises were added to the register. Two hundred and thirty-four inspections were made during the year. Strict attention was paid to premises where the manufacture and sale of ice cream was carried on, particularly where during the previous ice-cream season bacteriological examinations of samples gave unsatisfactory results. In some of these cases the installation of proper means for the sterilization of utensils did not exist; in others the defect lay in the lack of suitable washing facilities for all persons engaged in the handling of this commodity.. These requirements were insisted upon as a condition of registration. The following are the results of the bacteriological examination of samples during the year:— Table LXXVIII.—Ice-Cream Bacteriological Examinations. No. of Sample. Colonies per c.c. b. Coli per c.c. S.l 3,600 -0.1 S.2 122,000 -0.1 S.3 765,000 +0.1-0.01 S.4 280,000 +0.001 S.5 672,000 +0.001 S.6 54,400 +0.1-0.01 S.7 24,400 +0.001 S.8 .16,000 -0.1 S.9 85,000 +0.1-0.01 S.10 125.000 +0.01-0.001 N.l 27,200 +0.1-0.01 N.2 3,840,000 +0.001 N.3 36.000 +0.01-0.001 N.4 196,000 +0.001 N.5 32,000 -0.1 N.6 23,000 -0.1 N.7 52,000 +0.01-0.001 N.8 13,200 +0.01-0.001 N.9 40,000,000 +0.001 N.10 130,000 -0.1 111 Samples S.3 and 5.—The attention of the respective manufacturers was drawn to the result of the bacteriologist's examination, and they were informed that unless a higher degree of purity in the manufactured article was attained the question of the removal of the premises from the register would have to be considered. The latter course was found to be unnecessary, subsequent samples having shown improvement. Sample S.4.—This sample was taken from a barrow in the street and revealed that manufacture was being carried out in temporary premises not entered on the Council's register. On the manufacturer being informed of the result of the examination, and the fact that the premises were considered unsuitable, he immediately decided to give up the manufacture and sale at those premises. In view of this action, the Committee decided not to institute proceedings for non-registration of the premises. Sample N.4.—On the vendor's attention being drawn to the result of the examination, improvements were effected and subsequent samples were satisfactory. Samples N.2, N.9 and N.10.—Application having been received for registration of premises for the manufacture and sale of ice cream, inspection of the premises disclosed that the arrangements were not satisfactory and the results of bacteriological examinations confirmed this view. The manufacturer was thereupon summoned to appear before the Public Health Committee to show cause why the Committee should not refuse to enter his premises in the register. Registration was adjourned on an undertaking being given by him to carry out specified works. The required improvements having been carried out and further bacteriological examinations having shown satisfactory improvement, the premises were duly registered. Experience has shown that close and continuous attention is required to be paid to the manufacture and sale of this commodity._There is no reason why the conditions applying to premises used for the sale of milk as laid down in the Milk and Dairies Order, 1926, should not be extended to apply to premises where ice cream or similar commodity is dealt with. Milk Bars. During the year a number of milk bars have been established in the City and the enterprise appears to be attended with some measure of success. Twelve have already been registered with the Council, and as the construction of others is in progress it is apparent that these establishments should be kept under close supervision. 112 Milk and ice cream are the principal foods sold, though in most of them other light refreshments are also supplied. Eleven samples of milk were taken for bacteriological examination and counts ranging from 11,000 to 324,000 per c.c. obtained. In cases where the bacteriological examination did not shew satisfactory results the matter was taken up with the proprietors with a view to improvements being obtained in the methods of sterilization and cleansing of utensils. Fifteen samples of milk were purchased for chemical analysis and all except one were reported as genuine. Three samples of ice cream were examined for bacteria; two were found to be of low bacterial count and the third shewed 196,000 bacteria per c.c. and B. Coli was present in 0.001 c.c. The proprietors in the latter case were immediately informed and made arrangements for supplies of ice cream from another source, as reported in the section dealing with ice cream. Preserved meat, etc., premises. One hundred and twelve premises were on the register for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods. No new registrations were made during the year. Two hundred and thirty-two inspections were made. Four notices were served. 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 appropriate provisions of these Acts in the course of their routine food inspections, and during the year made 397 observations. 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. 113 During the year eight new regulations were issued by the Board of Agriculture and Fisheries relating to types of fruits and vegetables (fresh and canned), cheese, eggs, poultry, etc. The duties under these Acts are not concerned with the Public Health, but they can be conveniently carried out by food inspectors when visiting food shops and stalls and in fact provide a ready pretext for general food inspection. Artificial Cream Act, 1929. There were 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—Ten 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. All samples were found to be free from the presence of tubercle bacilli. Milk and Dairies Amendment Act, 1922. Milk (Special Designations) Order, 1936. This Order, made by the Minister of Health, came into operation on the 1st June, 1936. It revoked the Orders of 1923 and 1934, and abolished the following designations for milk laid down in those Orders, viz.:—"Certified," "Grade A (Tuberculin Tested)," and "Grade A," although licences issued for those grades before the 1st June were permitted to remain operative until the 31st December, 1936. The new Order prescribed the following designations for milk:— "Tuberculin Tested."—This is milk from cows which have passed a veterinary examination and a tuberculin test. If pasteurized it must be described as "Tuberculin Tested Milk (Pasteurized)." If bottled on the farm the word "(Certified)" may be added to its description. "Accredited" is raw milk from cows which have passed a veterinary examination. (8342) H 114 "Pasteurized" is applicable both where "Accredited" milk and where ungraded milk is pasteurized in accordance with requirements of the Order. The Order prescribed maximum fees for various classes of licences and permitted licensing authorities to charge a lower scale of fees or dispense altogether with the payment of fees. The City Council decided to charge the maximum fees for the licences issued. The following dealers' licences were issued by the Council during the year:— Certified milk 13 Grade A (Tuberculin tested) milk 20 Grade A milk 6 Pasteurized milk 36 Grade A pasteurized milk 3 Eleven samples of Certified milk were examined bacteriologically at the request of the Ministry of Health, two of which contained a bacterial count in excess of the number permitted by the above Order. Pasteurization of milk is not undertaken at any premises in the City. Milk and 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 LXXIX.—Registration of Dairymen and Dairies. Premises. Persons. Registered to 31st December, 1935 175 229 Registered during year 1936 13 5 Removed from register (ceased or transferred business) 19 7 Registered to 31st December, 1936 169 227 The inspectors paid 354 visits to milk shops and dairies during the year. Six notices were served in respect of minor defects which were duly rectified. 115 Food and Drugs (Adulteration) Act, 1928. Analysis of Milk Samples.—The percentage of adulterated samples since 1926 is given in Table LXXX below, together with the results of the samples taken in each of the two districts of the City during 1936:— 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. Table LXXX.—Analysis of Milk Samples. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Percent. No. Percent. North 477 82 17.2 340 71.3 51 10.7 4 0.8 South 461 129 28.0 291 63.1 38 8.2 3 0.7 1936 938 211 22.5 631 67.3 89 9.5 7 0.8 1935 909 228 25.1 605 66.5 70 7.7 6 0.7 1934 887 226 25.5 580 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 944 511 54.1 345 36.5 71 7.5 17 1.8 1926 910 502 55.1 298 32.7 100 10.9 10 1.0 Of the total of 938 samples of milk taken during the year, 76 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. N 214. Was 57.3 per cent. deficient in fat. Summons dismissed under Probation of Offenders Act on payment of £5 5s. costs. N 325. Was 20 per cent. deficient in fat. Summons dismissed under Probation of Offenders Act on payment of £5 5s. costs. (8342) B 2 116 Sample No. Action taken. N 461. Was 2 per cent. deficient in fat. Vendor cautioned. N 893. Contained 2.7 per cent. of added water and was deficient in fat to the extent of 5.5 per cent. The vendors were convicted and fined £10. (This sample was purchased at a milk bar). S 168. Contained 2 per cent. of added water. Vendor cautioned. S427. Was 31.6 per cent. deficient in fat. Summons dismissed on payment of £5 5s. costs. S 497. Was 6 per cent. deficient in fat. Summons dismissed on payment of £2 2s. costs. 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-three 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 204,000 per c.c., whereas the standard for pasteurized 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-three samples taken for chemical analysis were found to be genuine. Public Health (Condensed Milk) Regulations, 1923 and 1927. Thirty samples were taken and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 and 1927. One sample was taken and found to be genuine and properly labelled. 117 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. One infringement of these regulations was found as a result of analysis of samples, details of which are set out in the following pages. Table LXXXI. Samples purchased under the Food and Drugs (Adulteration) Act, 1928, showing results of Analysis and subsequent Proceedings for year 1936. Number. Article of Food. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s.. d. 1 Ale 2 2 — — — — - 2 Butter 152 152 — — 3 Cereals 36 36 — — — - 4 Cheese 22 22 — — — - 5 Cocoa 1 1 — — 6 Coffee and Chicory 6 6 — — — - 7 Condiments & Spices 16 16 — — — 8 Confectionery 13 13 — — — — — - 9 Cooking Fats 3 3 — — — — — - 10 Cream Confectionery 17 8 9 Nil. — — — - 11 Cream 73 73 — — — — 12 Cream (tinned) 2 1 1 1 — 1 — - 13 Culinary Flavours 4 4 — — — — — - 14 Drugs 40 35 5 Nil. — — — - 15 Eggs 9 9 — — — — - 16 Fish preparations 29 29 — — — — — - 17 Fruit Cordials and Powders 32 29 3 Nil. - - - - 18 Fruits (preserved) 42 42 — — — — — - 19 Gelatine 2 2 Nil. — — - 20 Ice Cream 37 37 — — — - 21 Jams & Preserves 25 25 — — — - 22 Lard 8 8 23 Margarine 21 21 — — — — — - 24 Milk 938 931 7 5 1 4 10 0 0 17 17 0 25 Milk (Condensed) 30 30 - — — — — — 26 Milk (Dried) 1 1 — — — — — — 27 Oils (Salad) 22 22 — — — — 28 Pickles & Sauces 21 21 — — — — — 29 Potted Meats and Meat Pies 39 38 1 Nil. - - - - 30 Sausages 42 42 — — — — — — 31 Spirits 49 45 4 1 1 — 3 0 0 3 3 0 32 Suet 2 2 — — — 33 Tea . 20 20 34 Vegetahles(preserved) 26 26 — — — — — — 35 Vinegar 26 24 2 1 (Hearing adjourned) — 36 Wines 9 9 — — — — — — 1,817 1,783 34 8 2 5 13 0 0 21 0 0 118 Adulterated Samples other than Milk. Cream Confectionery.—Seventeen samples of cream confectionery were purchased, nine of which were found to contain a filling which had the composition of margarine fat. In the remaining eight the filling proved to be genuine milk fat. These samples were purchased in order to collect evidence of the extent to which cream, other than genuine fresh cream, is used in the manufacture of cream confectionery with a view to such evidence being submitted to the Ministry of Health for their consideration. There is no doubt that the use of genuine fresh cream as a filling in cream confectionery is not attended with any practical difficulties, and it is satisfactory to note that eight of the seventeen samples taken contained the genuine article. It is manifestly unfair to those manufacturers of the genuine article to know that cream confectionery sold perhaps by their immediate competitors consists of a filling made from something different. The purchaser, it is maintained, when demanding any of the several varieties of cream confectionery expects to receive a confectionery containing genuine milk fat, and the position should be made clear by regulation that the term "cream" when applied to any article of food means cream derived from the product of the cow. Cream (tinned).—Two samples of tinned cream were purchased, one of which was labelled "Pure Thick Devon Cream." The Public Analyst was of opinion that a cream so labelled should contain at least 50 per cent. of fat, whereas the sample in question contained only 24.4 per cent. Proceedings were instituted, but the defendant submitted evidence that it was impossible to produce palatable tinned cream with a fat content of more than 27 per cent. owing to the sterilization and other processes through which it must pass in order to be tinned, and that the word ''thick was recognised as referring to the consistency (as opposed to liquid cream), and had no implication of richness. The Magistrate accepted this evidence and held that as members of the public were familiar with the two sorts of cream they would not be misled by the label into imagining that the cream was of similar richness to fresh clotted cream. The summons was accordingly dismissed but no costs were ordered against the City Council as the Magistrate considered that the case was a proper one for the Council to have brought. Drugs.—Forty samples of various drugs were analysed during the year, of which five were found to be adulterated. 119 Phenol Ointment.—An informal sample of phenol ointment was 33.6 per cent. deficient in phenol, and a subsequent sample purchased from the same vendor was 16.6 per cent. deficient. The vendor was cautioned. Tincture of Quinine.—An informal sample of tincture of quinine was found on analysis to be 16 per cent. deficient in ammonia, but a subsequent formal sample purchased of the same vendor was found to be genuine. Ammoniated Quinine Tablets.—A sample of ammoniated quinine tablets was 37 per cent. deficient in ammonia, and on the attention of the vendor being drawn to the result of the analysis the remainder of the consignment was withdrawn from sale. Blaud's Pills.—One sample of Blaud's pills, although containing the full amount of iron, was found to be 18.5 per cent. deficient in ferrous carbonate. The vendor's attention was drawn to the result of the analysis and his existing stocks of the commodity were withdrawn from sale. Fruit Cordials and Fruit Powders.—Thirty-two samples of fruit cordials and powders were purchased, three of which were reported by the public analysts to be adulterated. One sample of lemon squash tablets consisted of an artificial preparation in the form of lemon-flavoured tablets, made from sugar, tartaric acid and sodium bicarbonate, intended apparently for making an effervescent drink, and was wholly deficient in lemon juice. The vendor was communicated with and an explanation from the manufacturers was subsequently received. Following a discussion with the Medical Officer of Health they intimated their intention to use only citric acid in the preparation of their products in the future. Two samples of lemonade powder were found on analysis to be prepared from tartaric acid instead of citric acid. The vendors' attention was called to the result of the analysis. The manufacturers subsequently undertook to employ citric acid in the preparation of these articles. Gelatine.—Two samples of gelatine were analysed and both were adulterated. A sample of leaf gelatine contained l/30th grain of arsenic per pound and the sample of powdered gelatine 1/50th grain of arsenic per pound. In each case the vendor was cautioned and asked to explain the presence of arsenic. The same firm of manufacturers were concerned with both these samples, and on their attention being drawn to the matter they at 120 once took steps to withdraw from sale all stocks of proprietary gelatine manufactured by them before the 1st September, 1936. The firm explained that through an oversight certain consignments had left their works without having been submitted to the usual chemical analysis. Potted Meats and Meat Pies.—Thirty-nine samples of potted meats and meat pies were purchased during the year for analysis and it is satisfactory to note that only one was found to be adulterated. This was a sample of ham and tongue paste which contained 45 parts of sulphur dioxide per million, whereas under the Public Health (Preservatives, etc., in Food) Regulations, 1925-27, meat paste should not contain any preservative. The vendor's attention was called to the result of the analysis. Spirits.—One sample of whisky proved on analysis to be 36.15 degrees under proof, instead of the legal standard of 35 degrees under proof. The vendor's attention was called to the result of the analysis. Another sample of whisky was found to be 46.5 degrees under proof. Proceedings were instituted and the vendor fined £3 and £3 3s. costs. Vinegar.—A sample of vinegar labelled "Table Vinegar (non-brewed)" was found on analysis to consist entirely of artificial vinegar. The result of the analysis was communicated to the manufacturers, who were requested to label their vinegar in such a manner as would indicate to the purchaser that it consisted entirely of artificial vinegar. The matter was taken up on behalf of the manufacturer by the Association of Pure Vinegar Manufacturers, who stated they were unable to advise their members to discontinue the use of the label to which exception had been taken. A further sample of vinegar similarly labelled "Table Vinegar (nonbrewed)" was subsequently purchased, and on being found on analysis to consist entirely of artificial vinegar, legal proceedings were instituted. The hearing of the summons, however, did not come before the Magistrate during the year under review. Observations by the Public Analysts. During the-year under review certain samples have presented points of interest which are worth noting. Gelatine.—Two samples of gelatine were found to contain excessive quantities of arsenic. Gelatine is largely made from scraps from the tanning industry and the raw hides employed for this purpose may be 121 preserved with arsenic or arsenic may be employed for removing the hairs from the hides. In either case it is difficult to remove the last traces of arsenic from the skins and manufacturers should take steps to see that only satisfactory pieces of hide are employed for the manufacture of food products. Lemonade Powder.—Two samples of lemonade powder were returned as adulterated because they had been prepared with tartaric acid instead of citric acid. Tartaric acid is preferred by manufacturers because it is less likely to absorb moisture in a damp atmosphere than is citric acid, but it should be remembered that tartaric acid is not natural to citrus fruits and that the physiological action of the two acids is quite different. Drugs.—A sample of Blaud's pills which was examined was found to be 18.5 per cent. deficient in ferrous iron, due to its having been oxidised during manufacture. Doctors prefer these pills to contain the ferrous iron in what is known as the "nascent" condition, but it may be safely considered that if the conditions of manufacture have been such that a good proportion of the iron has been oxidised, the greater portion of that which is in the ferrous condition would be definitely converted to ferrous carbonate during preparation. Metals in Food.—All samples of food and drugs likely to be contaminated with metals were submitted to a searching examination for traces of lead, tin and copper. Attention was especially directed to the presence of lead, for this metal is a cumulative poison and it is desired strictly to limit any avoidable excess. Two tins of sild were submitted for analysis following a complaint that they contained tin and lead. Both these metals were found, but amounts below the permitted limits. A sample of pimentos also contained tin below the permitted limit; all these were therefore reported genuine. Cream.—The sale of tinned cream and also of cheap cream as "coffee" or "half-price" cream has received attention during the year. Cherry Brandy.—The great discrepancy in the alcohol content of samples of cherry brandy examined during the year would seem to indicate the necessity of standards for this beverage. The samples submitted had alcoholic strengths ranging from 9.4 to 46.8 per cent. of proof spirit. The City Analysts hold the opinion that cherry brandy should contain not less than 35 per cent. of proof spirit. 122 Rag Flock.—A sample of rag flock taken under the Public Health Act, which now embodies the Rag Flock Act and the Regulations made thereunder, was reported genuine. The proportion of chlorine found in this flock was only 10 parts per 100,000, whereas the standard of cleanliness laid down allows up to 30 parts of 100,000. Pharmacy and Poisons Act Samples.—A sample sold as creosote oil was found to be a coal-tar creosote oil, and a tar-oil horticultural winter wash had the characteristics of a carbolic disinfecting fluid containing 7.8 per cent. of phenols; a similar preparation sold as a non-arsenical weed killer contained 15 per cent. of phenols. A fluid detergent contained one part of ammonia and 12.6 parts of soap, with water and perfume to make 100 parts. Two samples of hair dye were examined. One consisted of a waxy and gummy base with 30.5 per cent. of red iron oxide. In this, tests for toxic and irritant dyestuffs were negative. The other was sold in two separate parts, a white compressed tablet and a dark brown viscous liquid; the tablet consisted of a compound of urea with hydrogen peroxide and the brown liquid contained paraphenylenediamine, which is one of the listed poisons. A sample of yeast tablets was specially examined for the drug amidopyrine which is reported to have been found in similar preparations, but none was discovered. 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 1936 was 153. The inspectors paid 184 visits to these premises, including stalls. 123 Restaurants.—The register of restaurants includes 1,426 premises. During the year 2,149 visits were paid. Kitchens, pantries, messroom arrangements for stall, systems for washing up, and general sanitary arrangements were specially observed. Defects requiring notices were found in 303 instances, and in each case the work was satisfactorily carried out. Bakehouses.—At the end of 1936 there were 56 bakehouses in use in the City, of which 37 were underground. 174 visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out. It was only found necessary to serve notice in one instance. Fried Fish Shops.—There are 18 fried fish shops in the City to which the food inspectors paid 29 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 LXXXII.—Unsound Food. Article. Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Apples 9 15 2 24 Melons 23 19 0 0 Apricots 2 1 0 Mushrooms 3 17 Artichokes 5 0 0 Onions 12 1 0 14 Asparagas 9 9 1 16 Oranges 19 2 0 0 Bananas 3 0 0 Parsley 1 2 22 Beans 2 0 0 Parsnips 14 0 0 Cabbage 15 0 0 Pears 9 8 2 8 Cauliflowers 1 2 0 Pines 15 2 22 Celeriacs 10 0 0 Plums 12 1 0 Cherries 6 3 4 Potatoes 8 15 0 0 Chervil 2 1 14 Radishes 2 2 0 Chestnuts 19 2 19 Shallots 1 18 0 0 Chicory 2 14 Spinach 14 1 0 Chillies 1 23 Savoys 5 0 0 0 Endive 5 3 2 Smoked Salmon 1 Grapes 13 5 0 0 Strawberries 6 0 0 Grapefruit 3 19 1 0 Sweet Potatoes 1 2 0 Green Almonds 1 1 16 Tomatoes 1 4 2 0 Horseradishes 12 0 0 Walnuts 5 8 1 0 Leeks 1 8 2 0 Fruit Cordials 97 bottles. Lettuce 1 15 2 14 Fruit and Pickles 104 jars. Marrows 3 0 0 Mealies 1 2 2 14 By-laws for the Protection of Food. These by-laws made by the London County Council, and confirmed by the Minister of Health in December, 1936, became operative on the 1st January, 1937. 124 The by-laws are for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport and exposure for sale of any article intended to be sold for food. They require the occupier of any food premises to keep all internal surfaces in good repair and condition; to cause walls, ceilings, etc., to be limewashed or otherwise cleansed as may be reasonably necessary. Sufficient means of ventilation and lighting must be provided, and the wrapping of food intended for sale, in paper or other material that is not clean and reasonably suitable for the purpose, is prohibited. The occupier is also required to take steps as may be reasonably necessary, to prevent risk of contamination of food on the premises. Food during transit must be adequately protected from dust, dirt, flies, and other sources of contamination. Food Poisoning. Cases of illness attributed to articles of food purchased or consumed at premises in the City were investigated during the year:— (1) Information was received that 43 employees at a telephone exchange in the City were suffering from gastro-intestinal disorder which was suspected to be due to food poisoning. Portions of steak and kidney pie, plums, pineapple juice and gravy consumed by the affected persons were examined by the Council's bacteriologist, who reported that, in his opinion, the symptoms were definitely not attributable to any organism recognised to cause food poisoning. (2) Notification was received of thirty members of the staff in a large block of flats who were suspected to be suffering from food poisoning. Boiled salt beef which had been consumed by each of the affected persons was thought to be the source of infection. The unconsumed portion of the beef was examined by the Council's bacteriologist who reported that no organism of food poisoning or pathogenic group was isolated, and that the history of the outbreak suggested it was due to toxic products rather than an infection of living bacteria. (3) Notification was received of ten persons at a training college who had been mildly affected by food poisoning. Enquiries were made but it was not possible to trace the cause of the outbreak to any particular foodstuff, as each of the patients appeared to have consumed different articles of food. No further case was reported. 125 (4) Information was received from another district that a person had been admitted to hospital suspected to be suffering from food poisoning following a meal partaken at a restaurant situated in Westminster. Investigations were carried out but the patient's complaint was later diagnosed as appendicitis. (5) Two cases of food poisoning came to notice in which both patients had eaten corned beef purchased from a shop in the City. The Sanitary Inspector called at the shop to investigate the matter, but was informed that the remainder of the beef had been returned to the head office, situated in another district, following the receipt of a complaint by one of the persons affected. The matter was referred to the Medical Officer of Health for the district concerned. A report was subsequently received to the effect that a sample of the meat had been subjected to chemical and bacteriological tests with negative results. Pharmacy & Poisons Act, 1933. This Act placed upon Local Authorities the duty of enforcing Part II of the Act and the Rules made thereunder so far as they relate to poisons in Part II of the Poisons List. The Poisons List and the Poisons Rules referred to were made by the Secretary of State on the 31st December, 1935, and came into force on the 1st May, 1936. Part II of the Act provides, inter alia, that it shall not be lawful for a person not being registered pharmacist, to sell any poison included in Part II of the Poisons List unless his name is entered in a list to be kept by the Local Authority and the sale is effected on premises specified in that list as being premises on which he is entitled, subject to the provisions of the Act, to sell such poisons. (This provision applies only to sales by retail.) Power is given to the Local Authority to refuse to enter the name of any person or to remove his name from the list if in their opinion he is not fit to be entered on the list. Any person aggrieved by the action of the Local Authority has a right of appeal to Quarter Sessions. The Local Authority's list must be open at all reasonable times to the inspection of any person. It is the duty of the Local Authority, by means of inspection and otherwise, including the purchase of samples for analysis, to take all reasonable steps to secure compliance by persons, not being registered pharmacists, with the provisions of Part II of the Act. 126 The Poisons Rules, 1935. The Rules modify and relax certain of the provisions of the Act and prescribe additional precautions in the case of certain poisons and deal with the storage and transport, form of containers, and special provisions with regard to hospitals, the storage of poisons in institutions and the manufacture of pharmaceutical preparations. The poisons with which the Local Authority is concerned are principally those in common use for purposes other than the treatment of human ailments, e.g., ammonia, hydrochloric acid (spirits of salts), phenols (carbolic acid), hair dyes, sodium hydroxide (caustic soda), nicotine, certain arsenical and mercuric compounds, etc. The names of 217 firms and individuals were placed on the Council's list during the year, the trades concerned being mainly grocers and provision dealers, oil and colour merchants, ironmongers and hairdressers. Thirteen samples of various preparations were taken during the year, all of which were found to be satisfactory with one exception, a sample of hair dye which was found to contain a substance having the characteristics of paraphenylenediamine. This substance is a Part II poison, the sale of which in hair dyes is permissible, but in this case a printed leaflet accompanying the sample bore the words "free from paraphenylenediamine and every health-harming matter." The vendor was communicated with and undertook to amend the wording of the printed matter in respect of future sales of this preparation.