WES 47 City of Westminster REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 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 TO HIS MAJESTY THE KING, ST. MARTIN'S LANE, W.O.2. Ill CONTENTS. page Committees vi Introduction ix Statistics and Social Conditions 6 Births 8 Deaths 11 Cause3 of, compiled by Medical Officer of Health 14 „ „ „ „ Registrar General 11 Common Lodging-Houses 25 Distribution of, in Wards 19 Infantile Mortality 19 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 26 Bacteriological Laboratory 37 Cerebro-spinal Fever 35 Chicken-pox 35 Diarrhoea and Enteritis 34 Diphtheria 32 Anti-toxin 33 Schick Test and Immunization Treatment 32 Enteric Fever 33 German Measles 34 Influenza 34 Measles 34 Mumps 35 Notifications 26, 30 Ophthalmia Neonatorum 36, 65 Puerperal Fever 35 Puerperal Pyrexia 36 Scarlet Fever 32 Tuberculosis 37 Cases on Register 43 Deaths 37, 42 Dispensary—Annual Report 44 Returns (Ministry of Health) 48 Notifications—primary 37 Tables 37 Vaccination 27 Whooping Cough 35 (7638) a 2 IV page General Provision of Health Services 50 Adoption of Children Act, 1926 68 Ambulance facilities 50 Ante-natal services 56 „ cases 57 „ clinics 57 „ visiting 57 Barlow's Gift Charity 69 Child Life Protection 68 Clinics and Treatment Centres 50 Convalescent Treatment 58 Cookery classes 69 Day Nursery 51, 74 Dental Clinic—Annual Report 71 Dental Treatment 71 Health Visiting 67 Health Visitors' Notes 72 Home Helps 71 Hospitals 51, 55 Infant Clinics 63 Institutional Provision for Mothers and Children 58 Insulin Treatment 71 Laboratory facilities 50 Lectures and Demonstrations 73 Maternal Mortality 59 Maternity and Child Welfare Centres 50 „ „ „ Services 52 „ „ „ Medical Officers' Notes 61 Maternity Beds 58 Midwifery Service 54 Midwifery—Consultant services 56 Midwives Act, 1936 54 Midwives—Medical Assistance 56 Minor Ailment Clinics 54 Mothercraft Classes 67 Milk—Supply to Necessitous Mothers and Infants 69 National Health Campaign 73 Nursing in the Home 50,65 Nutrition 69, 70 Physical Training and Recreation Act, 1937 74 Toddlers' Clinics 63 Unmarried Mothers—Homes for 69 Sanitary Circumstances 74 Aliens—Medical inspection 78 Atmospherio Pollution 95 Cleansing of Persons 91 Common Lodging Houses 87 Coroner's Court and Mortuary 94 Disinfection 91 Disinfestation 92 Drainage and Sewerage 76 Factories, Workshops and Workplaces 82 Factories Act, 1937 86 Fumigation of Furniture 93 Infirm and Diseased Persons—Removal to Institutions 91 New Sanitary Construction 76 Nuisances—General 81 „ —Noise 99 Outworkers 85 Pigeons 90 V page Sanitary Circumstances—(contd.) Public Cleansing 77 Public Sanitary Conveniences 77 Public Swimming Pools, etc 75 Rag and Bone Dealers 88 Rag Flock Acts 88 Rat Repression 89 Refuse Collection and Disposal 77 Rent Restriction Acts 81 Sanitary Inspection 79 Schools 89 Shops Act 1934 81 Smoke Abatement 95 Tenement Houses 88 Town and Country Planning Act, 1932 76 Water Supply 74,81 Housing 98 Basement dwellings 99, 103 Clearance Areas 99 Housing Schemes—New Estates 102 Overcrowding 98 Rehousing Operations 102 Statistics required by Ministry of Health 104 Unfit Habitations—Closing Orders 99 „ „ —Demolition Orders 100 „ „ —Reconditioning 100 Inspection and Supervision of Food, etc 106 Agricultural Produce (Grading and Marking) Act, 1928 108 Artificial Cream Act, 1929 108 Bakehouses 120 Condensed Milk Regulations, 1923-1927113 Dairymen and Dairy premises—registration 111 Dried Milk Regulations, 1923-1927 113 Food products—certification for export 106 Food and Drugs (Adulteration) Act, 1928 111 Samples, results of analysis, action taken, etc 114 Food, Unsound 120 Food Poisoning 120 Fried Fish Shops 120 Ice-cream premises 106 Ice-cream—Bacteriological Examination 107 Meat Regulations, 1924 119 Merchandise Marks Act, 1926 108 Milk Act, 1934 113 Milk Bars 111 Milk—Bacteriological Examination 109 Milk and Dairies Amendment Act, 1922 109 Milk and Dairies (Consolidation) Act, 1915—tubercle in milk 109 Milk and Dairies Order, 1926 111 Milk Samples 111 Milk (Special Designations) Order, 1936 109 Milk—Supply to Schools 113 Pharmacy and Poisons Act, 1933 121 Preserved Meat, etc., premises 108 Public analysts' observations on food samples 117 „ „ „ poisons samples 121 Preservatives in Food Regulations, 1925-1927113 Restaurants 119 Schools—Supply of Milk 113 Street Trading 119 VI Public Health and Maternity and Child Welfare Committee. Mayor: Councillor H. S. E. Vanderpant, J.P. Deputy Mayor: Councillor The Hon. Arthur Howard, C.V.O., D.L. 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 G. F. Jerdein. Vice-Chairman: † Councillor H. H. Sparks. Members: Alderman Capt. J. F. C. Bennett, D.L., C.C. „ Capt. J. C. Dalton, D.L., J.P. Councillor Lady Doris Blacker. „ Norman Bower. „ Capt. H. N. Edwards. „ G. H. Heilbuth, C.C. „ Mrs. Alderson Home. „ Mrs. F. M. Odone. „ S. Parks. „ The Rev. Jocelyn Perkins, M.V.O., M.A., D.C.L., F.S.A. „ F. R. Ridley, J.P. (deceased August, 1937). „ A. Sargeant. „ Mrs. Francis Storrs. „ The Hon. Mrs. K. A. Vickers, J.P. Maternity and Child Welfare Sub-Committee. Members of the Council: Councillor Lady Doris Blacker. Councillor Mrs. F. M. Odone. „ Norman Bower. „A. Sargeant. „ Capt. H. N. Edwards. „ H. H. Sparks. „ Mrs. Alderson Home „ Mrs. Francis Storrs. (Chairman). ,, The Hon. Mrs. K. A. „ G. F. Jerdein. Vickers, J.P. Co-opted Members: Mrs. J. C. Dalton. Miss E. S. Haldane, C.H., J.P. (City of Westminster Health Society) (deceased December, 1937). † Chairman of Standing Sub-Committee. (The Public Health Standing Sub-Committee consists of all members of the Main Committee.) VII Sub-Committee re Children under School Age. Members of the Council: Councillor Lady Doris Blacker. Councillor The Hon. Mrs. K. A. „ Mrs. Alderson Home. Vickers, J.P. „ G. F. Jerdein. „ Mrs. F. M. Odone (Chairman). Co-opted Members representing the City of Westminster Health Society-. Miss E. S. Haldane, C.H., J.P. Miss Margaret Horn. (deceased December, 1937). Mrs. M. Munro. Committee Clerk: F. J. Burbridge. IX Annual Report on the Health and Sanitary Condition of the City of Westminster. 19 3 7. Mr. Mayor, My Lords, Ladies and Gentlemen, I beg to submit my annual report on the health and sanitary conditions of the City during 1937, included in which is an account of the work of your Public Health Department. The report is drawn up in accordance with Circular 1657 of the Minister of Health and includes information on the particular matters required by the Minister. Vital Statistic. The birth rate, 8.2 per thousand, shows a decrease of .3 on that of last year. There were 1,021 births, compared with 1,063 for the previous year and 1,042 in 1935. The death rate at 11.5 is less than last year and may be partially accounted for by a greater survival of infants, there being 60 deaths as compared with 70 in 1936. Infectious Disease. In contrast to 1936 measles did not predominate, only 106 cases occurring ; last year they numbered 590. The mortality was nil. The Minister is shortly bringing into force an order for London making measles and whooping cough compulsorily notifiable. The main object is not to achieve isolation, as both diseases are probably most infectious before their characteristic symptoms are manifest; it is to secure at an earlier stage medical and nursing facilities for cases among the poorer families and thus to prevent such dangerous conditions as broncho-pneumonia which not infrequently complicate measles among the very young. There were 258 cases of scarlet fever and no deaths. As regards diphtheria, among 133 cases 2 died, whereas there were 82 cases in the previous year and 4 deaths. Enteric fever in its various forms increased from 12 to 16 cases but none died. It will be remembered that about the time of the Croydon outbreak there was an unusual number of enteric cases in the country generally and much public apprehension. Mumps and whooping cough showed a decrease but there were four deaths from the latter cause. Maternity and Child Welfare. The outstanding event of the year was the opening by Her Majesty, Queen Elizabeth, of the building which contains the new maternity and child welfare centre and day nursery in Bessborough Street, on November 25th. Her gracious Majesty, who was received by the Right Worshipful the Mayor, Councillor H. S. E. Vanderpant, J.P., the Deputy Mayor, the Hon. Arthur Howard, C.V.O., D.L., and the Chairman of the Public Health and Maternity and Child Welfare Committee, Councillor G. F. Jerdein, opened the building with these words :— " It gives me great pleasure to come here to-day to open this new centre and day nursery. I am particularly glad to pay this visit during the year of our Coronation, and in view of the many years during which our home has been within the boundaries of Westminster. I understand that this building has been designed by the Westminster City Council in collaboration with the Westminster Day Nursery, thus happily combining municipal and voluntary effort under one roof. From what the Mayor has told us, it is quite clear that great foresight has been shown in planning it for the various purposes it has to fulfil. There is one feature which specially appeals to me. That is the night nursery X accommodation for children in time of emergency. I can well imagine the boon that is to a household in which the mother is seized with a sudden illness. I feel sure the centre will prove a real asset to the mothers and children of Westminster—the City so closely associated with our own home—and I have great pleasure in declaring the building open. May it bring health and happiness to all who come within its doors." A description of the building and its purposes has been given in former reports. The building has been a centre of interest to various bodies concerned in Maternity and Child Welfare, both at home and abroad. A large number of visitors representing local authorities, and private individuals, many of them distinguished in voluntary public service, have inspected the building. The City Council has been complimented on all sides for this notable contribution to the cause of maternity and child welfare. Midwives Act, 1936. The London County Council scheme providing a whole time service of salaried midwives came into force on January 1st, 1938. The County Council did not deem it necessary to appoint any whole time municipal midwife in Westminster nor did it in any measure alter the City Council's own midwifery organisation. The only change was that the County Council, as required by statute, entered into formal agreements with the two voluntary associations already carrying out district midwifery throughout the City under the aegis of the City Council. These two associations, Westminster Hospital and the Westminster Health Society, are now directly responsible to the London County Council for district midwifery, but the latter has considered the City Council in every possible respect. Not only has it allowed the City Council's own scheme (complete with hospital beds, consultants for doctors and midwives, &c.) to operate as before, but the City Council's Public Health Committee has been permitted to continue the assessment of patient's contributions as it has been doing for over 20 years, and those contributions will be paid to the associations as heretofore. The introduction of new administration to an existing scheme has been achieved without any element of discord or hitch. This is a tribute to the gracious and understanding attitude of the London County Council and its officers and to the efficiency of the City Council's existing midwifery services. Children under School Age. The arrangements referred to in last year's report for the treatment of physical defects and minor ailments were completed and are in operation. Facilities at the School treatment centres in Castle Street, Drury Lane, Gerrard Street, Greencoat Place and Rochester Row are being used, while the Ear, Nose and Throat Hospital, Golden Square, and the Infants' Hospital are available for ear, nose and throat cases, the latter hospital also functioning as a consultation centre for cases requiring special investigation. At the centres 677 or 66 per cent. of infants of Westminster parents attended during 1937, while 83.6 per cent. of the mothers attended. Maternal Mortality. In 1936 only one woman died ; an abortion case. In 1937 nine women lost their lives from various causes connected with pregnancy. These cases are fully discussed in the report and it would appear from facts elicited that except in the abortion cases there was no lack of skilled attention throughout the pregnancies. XI Sanitary Work and New Buildings. The number of plans submitted, 960, is less than last year, perhaps due to a slight check in business enterprise. Plans of proposed building schemes or alteration in user of buildings numbering 269 have come to the notice of the department through the Plans Sub-Committee of the Improvements Committee. Food and Drugs. Attention is particularly drawn to the bacteriological examination of milk supplied to schools under the scheme of the Milk Marketing Board. The milk as authorised by the board is pasteurised and was found to be uniformly satisfactory. Milk and ice cream sold in milk bars were also examined. In those cases where a high bacterial count and the presence of B. Coli in .001 c.c. showed evidence of contamination, successful measures were taken to eliminate the sources of contamination. Housing. The City Council's programme of clearance, demolition and closure of unfit parts of buildings continues to progress satisfactorily. Since 1932, 309 dwellings have been demolished and cleared ; 823 parts of buildings, including basements, have been dealt with by closing order, undertaking or change of user. Some 283 basements have been reconditioned and re-occupied, while 364 remain closed and vacant. A most encouraging feature in dealing with basements is the increasing amount of voluntary reconditioning by owners. Work in 201 instances has been initiated by owners themselves before any formal action has been taken. The basement problem in Westminster is for the time being perhaps the most important issue in housing and has received most attention in recent years. Overcrowding was and is of less magnitude. In 1934, the year of the Overcrowding Survey, 1,083 cases were found ; the number has now fallen to 622. Details are set out in the form of annual return required by the Minister. The provision of additional amenities such as water supplies, washing accommodation. food cupboards, etc., in tenement houses, some of which are statutory requirements, is proceeding, particularly in the decontrolled houses to which appropriate by-laws now apply. Air Said Precautions. These very necessary measures have in certain respects fallen to the Public Health Department to carry out, and to some extent have disturbed the ordinary work. In consequence overtime has not been an uncommon feature during 1937. Two of the Council's sanitary inspectors were nominated for the Falfield course in Air Raid Precautions and received first-class instructors' certificates. The Deputy Medical Officer of Health also qualified in the Medical Officers' course at Falfield. The two inspectors who had been instructing the Council's staff after office hours were in December seconded for Air Raid Precautions duties. In the same month the Council resolved to appoint a whole-time Assistant Medical Officer of Health on a temporary basis to assist in those duties. The duties within the reference of the Medical Officer of Health include instruction of the staff in anti-gas measures, decontamination of persons, dwellings, and foodstuffs, first aid training of personnel, and organisation and equipment of first-aid posts. All volunteer A.R.P. Wardens are trained under Mr. Ratcliff, the Chief Instructor, and the deputy Chief Instructor, Mr. Bennett, the two sanitary inspectors seconded for this work. Dr. Ian Thomson, the Deputy XII Medical Officer of Health, has given much time, including evenings, to the organisation of first-aid services in co-operation with the St. John Ambulance Brigade and the British Red Cross Society. Among his duties and those of Dr. Hardy, the Assistant Medical Officer of Health, are the medical examination of the staff for decontamination duties and supervision of persons undergoing gas tests. Other Staff Matters. The death of Miss Hilda Blick, one of the Council's Health Visitors, in June, 1938, must be reported with regret. Miss Blick was a particularly competent and energetic officer, who gave valued service to the Council for nearly twelve years. The death also occurred, in April, 1938, of Mr. R. Watling, Mortuary Keeper at the Coroner's Court and Mortuary in Horseferry Road, who had been in the Council's service for some thirty years. Miss A. Sanders, Senior Health Visitor and Secretary of the Tuberculosis Care Committee, retired in March, 1938. After long experience of similar work with voluntary bodies, Miss Sanders came into the Council's service in 1916, and did valuable pioneer work at the beginning of the Council's tuberculosis scheme, and a little later at the opening of its first Maternity and Child Welfare Centre. Her organising ability and her great knowledge and experience of social work were of high value to the Council. In July, 1937, Mr. S. J. Cassidy, a temporary Sanitary Inspector, was placed on the permanent staff, and Mr. A. J. Allison was appointed to take his place as temporary Sanitary Inspector. In February, 1937, Miss P. Arnold was appointed a temporary Health Visitor, and Miss R. Turner, temporary clerk for maternity and child welfare work. These additional appointments were made to enable the Health Visitors to devote a larger proportion of their time to the visiting of children between 2 and 5 years of age. It is with deep regret that one must refer to the death of Councillor Frank R. Ridley, J.P., in August, 1937. Councillor Ridley had been for many years a member of the Public Health Committee, and was its Chairman from 1934 to 1936. In a full and busy life, with a fine record of public service in many spheres, he devoted much time and interest to the work of the Public Health Department. Reference must also be made to the loss due to the death, in December, 1937, of Miss Elizabeth Haldane, C.H., J.P. Miss Haldane was a recognised authority on education and nursing services, and a pioneer in voluntary health and social work in the City. She was for many years a co-opted member of the Maternity and Child Welfare Sub-Committee, representing the City of Westminster Health Society, which she had helped to found in 1903. 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, 1938 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.). Maternity Medical Officer : *Miss Margaret Salmond M.D., B.S., F.R.C.S., M.C.O.G. 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. *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., M.C.O.G. *B. Gilbert M.D., B.S., F.R.C.S., M.C.O.G. Assistant Medical Inspectors under Aliens Order, 1920 : *D. G. Ferriman B.M., B.Ch., M.R.C.P. *E. A. Hardy M.D., B.S., M.R.C.P. Westminster Hospital Laboratories : *R. J. V. Pulvertaft, M.D., B.Ch., F.R.C.P., M.R.C.S. Bacteriologist to the Hospital. (7638) A 2 Public Vaccinators : 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, Taehbrook John District. Street, S.W.I Westminster North District *J. Forbes, M.A., B.Sc., M.B., C.M., 106, Shaftesbury Ave., W.l Dental Clinic : *T. Stewart Tait (Dental Surgeon) L.D.S., R.C.S.(Ed.). *F. J. Gordon (Anaesthetist) 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. S. J. Cassidy S.I.E.B., Meat and Food Cert. W. J. Davies (Sampling Officer) S.I.E.B., Meat and Food Cert. C. J. Dee S.I.E.B., R.S.I., Meat and Food Cert. W. L. French S.I.E.B., R.S.I., Meat and Food Cert. F. J. Hatch 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. Stddle 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. Hcohesdon 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., Dipl. Inst. of Hygiene. Temporary Sanitary Inspectors (Engaged on Housing Duties): J. R. Baily S.I.E.B., Meat and Food Cert. H. D. Luke S.I.E.B., Meat and Food Cert. A. J. Allison S.I.E.B. (Appointed 19th July, 1937.) Health Visitors : Miss A. Sanders Health Visitor's Certificate. (Retired 14th March, 1938.) Miss J. G. Alexander Health Visitor's Certificate, Certified Midwife, State Registered Nurse. Miss D. H. M. Walding Board of Education Health Visitor's Diploma, S.I.E.B., National Health Society's Diploma, Nursing. Miss 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. (Deceased 3rd June, 1938.) Miss P. L. Luff Board of Education Health Visitor's Diploma, Certified Midwife, S.I.E.B. Miss E. M. Craigie Health Visitor's Certificate, Certified Midwife, State Registered Nurse, Mothercraft Training Certificate, Ophthalmic Nursing Certificate. Miss G. C. H. Thomson Health Visitor's Certificate, Certified Midwife, State Registered Nurse. Miss F. A. K. Arnold (temporary) Health Visitor's Certificate, Certified Midwife, State Registered Nurse, S.I.E.B., R.S.I. (Appointed 12th February, 1937.) Nutrition and Dietetics. *Mrs. B. M. Latey (nee Beresford) 1st Class Diploma in Domestic Science. Mothercraft: *MlSS F. WlLLATS. Clerical Staff : A. J. Manhood, 1st Division Clerk. M. J. Flynn, 3rd Division Clerk. W. F. Lake, 1st Division Clerk. (As- W. F. C. King, 3rd Division Clerk. sistant Vaccination Officer.) S. F. Hammond, Junior Clerk. A E. Hobbs, 1st Division Clerk. Miss E. M. Armstrong. F. E. Norwood, 2nd Division Clerk. Miss M. McFarlane (Tuberculosis W. Jenkins, 3rd Division Clerk. Dispensary). (7638) a 2 4 Temporary Clerks. J. W. Anderson. J. P. Robertson. H. J. Bright. Miss R. M. Turner (Maternity and Child J. M. Burbridge. Welfare. Appointed 10th February, E. Jones. 1937.) Coroner's Court and Mortuary. Superintendent. A. R. Ford (late Chief Petty Officer, R.N.). R. Wailing Mortuary Keeper. (Deceased 16th April, 1938.) A. W. Nicholls Assistant Mortuary Keeper. *Miss S. Gardiner (State Registered Nurse Attendant. (Resigned 9th October, Nurse) 1937.) *Miss E. S. Dunfokd (State Registered Nurse Attendant. (Appointed 9th NovemNurse) ber, 1937.) Disinfecting Staff. S. C. West, Foreman Disinfector. J. Atkins, Disinfector. N. Heathcote, Disinfector and Rat Officer. A. B. Holland, Disinfector. J. Shillingford, Disinfector. J. R. Doyle, Motor Driver. W. T. Brady, Disinfector (temporary). Assistants in the Department. A. T. Steward, Assistant to Sanitary Inspectors. W. H. Smith, Messenger. Caretakers, Attendants, etc. Disinfecting Station—Mrs. Nicholls. Maternity and Child Welfare Centres— Ebury Bridge—Mrs. Whittlesea, Bessborough Street—Mr. & Mrs. W. Happy, Resident Caretakers. D. Jackson, Assistant Caretaker. Mrs. Pinnock, Cleaner. 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 tary 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. Olivier Richards, M.D., M.R.C.P. Miss Elizabeth Gourlay, M.D. Director of Remedial Exercises Mrs. A. Kellgren Cyriax, L.R.C.P. and S. Edin. Superintendent and Health Visitor Miss H. Callaghan, Final Certificate and Medal at Princess Christian Training College, Manchester, H. V. Cert., Royal Sanitary Institute. Assistant Health Visitor Miss Pinchen, National Health Diploma. Assistant Health Visitor and Midwife Miss Reed, Certified Midwife, H. V. Cert., Royal Sanitary Institute. Midwife Miss Cross, Cert. Midwife. Organiser of Special Toddlers' Nursery Miss A. Fiennes, Norland Cert. Superintendent of Mothercraft Work Mrs. Steffens, Professionally trained teacher of Needlecraft. Cookery Teacher Mrs. W. Macmillan. Sister-in-Charge of Special Infants' Miss E. Heath, S.R.N., Cert. Midwife, Nursery and Babies' Club Mothercraft Training Society. Secretary Miss A. Fiennes. 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, 1937 (Registrar General's Estimate)—124,300. Number of Inhabited Houses (Census 1931)—22,536. Rateable value—£10,830,500 (March, 1938). Sum represented by a penny rate—£42,400 (Estimate). Extracts from Vital Statistics for the Year. Total. Males. Females. Live Births— Legitimate 883 449 434 Illegitimate 138 80 58 1,021 529 492 Birth-rate per 1,000 of the estimated resident population—8-2. Stillbirths—41. Rate per 1,000 total (live and still) births—38.6. Deaths—1,432. Death-rate per 1,000 of the estimated resident population—Crude rate 11.5. Adiusted rate 11.8. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 4 3.7 Other puerperal causes 5 4.7 Total 9 8.4 Death-rate of infants under one year of age:— All infants per 1,000 live births 58.7 Legitimate infants per 1,000 legitimate live births 48.6 Illegitimate infants per 1,000 illegitimate live births .. 123.1 Deaths from measles (all ages) — „ whooping cough (all ages) 4 „ diarrhoea (under 2 years of age) 14 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. Unemployment. 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 1937. Month. Men. Women. Boys. Girls. January 1,782 481 11 20 February 1,882 539 8 11 March 1,760 511 8 9 April 1,674 482 15 5 May 1,594 473 6 12 June 1,639 408 5 5 July 1,544 374 6 3 August 1,437 433 15 21 September 1,618 421 13 10 October 1,807 489 25 5 November 2,121 529 14 9 December 2,121 503 8 5 Meteorological. The following note is extracted from a letter appearing in The Times of 3rd January, 1938, by Mr. W. G. Cochran, of the Rothamsted Experimental Station, Harpenden, Herts.:— The outstanding features of the weather during 1937 were the remarkable incidence of rainfall and the consistent deficiency of sunshine. The first five months of the year were all wet, the rainfall total at Rothamsted from January to May being easily the highest for that period since records began there in 1853. Then followed a succession of relatively 8 dry months from June to November, the only partial exception being September, for which the rainfall over England and Wales as a whole was just about the average. The rainfall total for the year at Eothamsted was 35.39 inches, 6.77 inches above the average and the highest since 1927. Eleven months were deficient in sunshine, November being the only exception. The sunshine total is 14.7 hours below that of last year and 279.3 hours below the average. The average temperature for the year was slightly above normal. December was the coldest month, with a mean temperature of 35.9 deg., F., 2.7 deg. F. below normal. Of the other months, March was also cold, while the relatively warm months were January, February and August. There were, however, no exceptionally hot days, and despite the rigours of December, no unusually severe night frosts, the lowest screen temperature at Eothamsted being 18.1 deg. F. on 20th December. The year was a much better one for the holiday-maker than it appears to be on paper. The dry summer was very favourable to outdoor activities, and with the continuance of mild, dry weather in autumn, one did not feel that winter had come until the snows arrived early in December. Births. The births registered in Westminster during 1937 (52 weeks) numbered 1,460, but of these the homes of 952 were in other districts, and have therefore to be deducted from the total. There were, however, 513 children belonging to Westminster parents born in institutions outside the City, and these must be added. This gives a net total of 1,021, which is 42 less than the corresponding figure for 1936. The Birth Bate for the City was 8.2, for London 13.3 and for England and Wales 14.9. The comparative net totals of the registered births for the last three years are:— Table I.—Legitimate and, Illegitimate Births. 1935. 1936. 1937. Legitimate. Legitimate. Legitimate. Males 491 460 449 Females 422 470 434 Illegitimate. Illegitimate. Illegitimate. Males 68 76 80 Females 61 57 58 1,042 1,063 1,021 9 Table II.—Registered and Notified Births. Births Registered. Births Notified. In Westminster. Belong elsewhere. Born out of Westminster. Net. Total. Alive. Stillborn. 1917 1,325 159 378 1,544 1,020 985 36 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 1025 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 1,367 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 1937 1,460 952 513 1,021 1,488 1,448 40 The numbers in brackets are registrations under the Legitimacy Act, and cannot be classified as births. Table III.—Distribution of Legitimate and Illegitimate Births. The legitimate and illegitimate births are distributed as follows:— Legitimate. Males 669 - 417 + 197 = 449 Females 636 - 419 + 217 = 434 1,305 - 836 + 414 = 883 Illegitimate. Males 90 - 68 + 58 = 80 Females 65 - 48 + 41 = 58 155 - 116 + 99 = 138 As shown in Table II, 1,488 notifications of births were received by the department for 1937 as compared with 1,551 in 1936. Of the total notifications, 245 were sent by midwives. 10 The following table shows the number of male and female children born since 1921, 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. 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 1937 529 492 39 21 490 471 The number of boys born again exceeded that of girls, but 39 boys and 21 girls failed to survive the first year of life. 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, 1937. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. 750 38 3 2 3 23 29 44 97 172 188 151 F. 698 20 5 6 6 19 28 45 75 100 169 225 1. Typhoid and paratyphoid fevers M. — — — — — — — — — — — — F. 1 — — — — — — — — — 1 — 2. Measles M. — — — — — — — — — — — — F. — — — — — — — — — — — — 3. Scarlet fever M. — — — — — — — — — — — — F. — — — — — — — — — — — — 4. Whooping-cough M. 1 — 1 — — — — — — — — — F. 3 1 1 1 — — — — — — — — 5. Diphtheria M. — — — — — — — — — — — — F. 3 — 1 — 2 — — — — — — — 6. Influenza M. 15 — 1 — — — — 2 2 2 5 3 F. 21 — — — — — — 1 5 5 5 6 7. Encephalitis lethargica M. — — — — — — — — — — — — F. — — — — — — — — — — — — 8. Cerebro-spinal fever M. — — — — — — — — — — — — F. 1 — — — — 1 — — — — — — 9. Tuberculosis of respiratory system M. 57 — — — — 5 13 9 12 10 7 1 F. 29 — — — — 7 7 9 2 2 2 — 10. Other tuberculous diseases M. 8 — — 1 — 4 1 2 — — — — F. 3 — 1 — — — — 2 — — — — 11. Syphilis M. 3 1 — — — — — — — 2 — — F. — — — — — — — — — — — — 12. General paralysis of the insane, tabes dorsalis M. 4 — — — — — — 1 2 — 1 — F. 1 — — — — — — — — — 1 — 13. Cancer, malignant disease M. 117 — — — — 1 1 10 15 46 31 13 F. 122 — — — — 1 1 10 26 25 34 25 14. Diabetes M. 10 — — — — — — — 2 2 3 3 F. 15 — — — — 1 — — — 2 8 4 15. Cerebral hæmorrhage, etc. M. 29 — — — — — — — 2 8 10 9 F. 44 — — — — — — 1 4 11 12 16 16. Heart disease M 198 — — — 1 1 1 3 26 33 60 73 F. 183 — — — — 3 4 5 10 22 51 88 17. Aneurysm M. 7 — — — — — 1 — — — 4 2 F. 5 — — — — — — — 2 — 1 2 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. 22 — — — — — — 1 3 4 8 6 F. 31 — — 1 — — — — 2 1 10 17 19. Bronchitis M 41 — — — — — — — 4 8 21 8 F. 26 2 — — — — 1 — 1 4 4 14 20. Pneumonia (all forms) M 39 3 — — — 3 — 2 6 11 7 7 F. 36 1 1 1 1 1 1 2 3 3 11 11 21. Other respiratory diseases M. 6 — — — — — — 2 1 1 1 1 F. 7 — — — — — — 1 2 — 1 3 22. Peptic ulcer M 19 — — — — — — 1 4 8 5 1 F. 4 — — — — — — — — 1 — 3 23. Diarrhoea, etc M. 10 7 — — — — 1 — — 1 — 1 F. 8 4 — — — — 1 — 1 1 1 24. Appendicitis M. 4 — — — — 1 — 1 1 — 1 — F. 4 — — — — — 1 — 1 — 1 1 25. Cirrhosis of liver M. 6 — — — — — — 1 2 3 — — F. 2 — — — — — — — 1 1 — — 26. Other diseases of liver, etc. M. 1 — — — — — — — — 1 — — F. 2 — — — — — — 1 — — 1 — 27. Other digestive diseases M 15 1 1 — — — — 9 3 3 4 1 F. 21 — — — 1 — 1 3 2 5 4 5 28. Acute and chronic nephritis M 11 — — — — — — 1 2 2 3 3 F. 8 — — — — — 1 — — 2 3 2 29. Puerperal sepsis F. 3 — — — — 1 1 1 — — — — 30. Other puerperal causes F. 3 — — — — 1 1 1 — — — — 31. Congenital debility, premature birth, malformation, etc. M. 17 17 — — — — — — — — — — F. 10 10 — — — — — — — — — — 32. Senility M 4 — — — — — — — — — — 4 F. 10 — — — — — — — — — — 10 33. Suicide M 20 — — — — 2 2 2 7 6 — 1 F. 5 — — — — — 1 2 2 — — — 34. Other violence M. 27 2 — — 1 4 5 3 ?, 5 3 2 F. 29 — — 2 — 1 3 — 2 7 8 6 35. Other defined diseases M. 58 7 — 1 1 2 4 1 1 15 14 12 F. 57 2 1 1 2 2 4 6 9 8 10 12 36. Causes ill-defined, or unknown M 1 — — — — — — — — 1 — — F. 1 — — — — — — — — — — 1 13 Table VI.—Still-births. Notification and Registration. Forty still-born children were notified during the year. Still-births Registered. Inward Transfers. Outward Transfers. Allocated to Westminster. Total Legitimate and Illegitimate Males 27 14 18 23 Females 17 14 13 18 Illegitimate Males 7 2 3 6 Females 3 2 3 2 Table VII.—Infectious Diseases. The following shows the number of cases of certain infectious diseases in the area during the 52 weeks ended 1st January, 1938:— Westminster, City of, Met. B. Number of Cases of Infectious Diseases Notified. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Puerperal pyrexia. Puerperal fever. Erysipelas. Pneumonia. — 241 134 16 27 2 43 28 (The case rates of these diseases for England and Wales per 1,000 living are respectively as follows:—Scarlet fever, 2.33; diphtheria, 1.49; enteric fever, 0.05; and erysipelas, 0.37.) The preceding death table and the figures in respect of registered stillbirths and infectious diseases 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 52 week year, allowance is made by the Medical Officer of Health for cases cancelled because of revised diagnosis. For example, 33 cases of diphtheria, scarlet fever and dysentery were discharged from hospital owing to incorrect diagnosis during 1937. 14 MALES. Table VIII.—Causes of and Ages at, Death during the year 1937. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Aoes). 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. 1 Great Marlborough. Pall Mall. Regent. | Charing Cross. Covent Garden. | Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet, fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 15 — 1 — — — 2 4 8 — 2 — 1 6 2 1 — — — 1 — 2 — — Whooping-cough — — 1 — — — — — — — — — — — — 1 — — — — — — — — Diphtheria, Memb. croup — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal meningitis — — — — — — — — — — — — — — — — — — — — — — — — Poliomyelitis 1 — — 1 — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — — Diarrhoea, enteritis 10 9 1 — — — — — — — 1 — 1 4 1 3 — — — — — — — — Erysipelas 3 — — — — — 1 1 1 —— 1 — — 2 — — — — — — — — Other septic diseases 3 — — — — — — 2 1 — 1 — — 1 — — — — 1 — — — — — Syphilis, &c... 5 1 — — — — — 3 1 — — — — 2 1 — 2 — — — — — — — Diabetes 8 — — — — — — 4 4 — — 1 — 2 2 — 2 — — — — 1 — — Rheumatic fever 2 — — — — — — 2 — — 1 — — — — — — — — — — — 1 — Tuberculosis of lungs 55 — — — — 4 21 21 9 — 2 2 18 2 14 6 — — 1 — 3 7 — Other forms of tuberculosis 6 — — 1 — 3 2 — — — 2 — — 3 — 1 — — — — — — — — Malignant growths 110 — — — — — 11 58 41 2 11 8 15 30 3 13 8 — 4 3 2 7 4 — Congenital debility, malformation, and premature birth 16 16 — — — — — — — 1 1 — 2 5 — 5 — 1 — — — 1 — — Old age 4 — — — —- — — — 4 — — 1 1 1 1 — — — — — — — — — Meningitis and convulsions 2 1 — — — — — 1 — — — —- — 1 — 1 — — — — — — — — I—1 Ox Loc. ataxia and general paralysis 3 — — — — 1 — 1 1 — — — — 1 — 1 — — — 1 — — — — Other diseases of nervous system 7 — — — 1 — 3 3 — 1 — — — 2 — 1 1 — — 1 — — 1 — Valvular diseases of heart. 6 — — — —— — — 3 3 — — — — — — 3 1 — — 1 1 — — — Other circulatory diseases 221 3 — — 1 1 5 69 142 2 23 7 19 74 18 44 3 2 8 2 4 5 8 2 Bronchitis 70 — — — — — — 21 49 — 2 3 5 23 5 17 1 — 1 — — 2 9 2 Broncho-pneumonia 28 5 — — — 1 1 8 13 — 2 — — 12 1 5 — — 1 1 2 2 1 1 Pneumonia, other forms 16 1 — — — 2 2 7 4 — 4 — — 3 1 6 1 — — 1 — — — — Other respiratory diseases 7 — — — — 1 2 2 2 — 1 — 3 — — 2 — — — — 1 — — — Alcoholism 3 — — — — — 1 1 1 — 2 — — — — — — — — — — — — — Cirrhosis of liver 7 — — — — — — 6 1 — 1 1 — 3 — — — — — I — — 1 — Appendicitis and typhlitis 4 — — — — 1 1 1 1 — 1 1 — — — — — — — — — — — — Other digestive diseases 30 — — — — — 3 19 8 — 2 — 3 8 3 9 1 — 1 — — — 1 2 Bright's disease, &c. 23 — — — — 1 2 6 14 — 3 — 4 6 3 3 — — — — — 1 1 2 Cystitis, &c. 19 — — — — — — 1 18 — 2 1 3 10 — — — — — 1 2 — — — Deaths by accident or negligence 27 1 — — 1 4 8 9 4 — 1 2 3 9 2 5 1 — — — — 2 1 1 Deaths by suicide and murder 18 1 — — 1 1 3 11 1 — 1 1 1 10 — — 1 — — — 1 2 — 1 Other defined diseases 8 1 — — — — 2 3 2 — — — 3 — — 4 — — — — — — — 1 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — All causes 738 39 3 2 4 20 70 267 333 6 66 28 66 234 46 142 28 3 16 15 13 28 35 12 lb FEMALES. Table VIII (continued).—Causes of, and. Ages at, Death during the year 1937. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All agea. . Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Homeless. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — Influenza 17 — — — — — — 8 9 — 4 — 1 5 — 4 — — — 2 — — — 1 Whooping-cough 3 1 1 1 — — — — — — — — 1 — 2 — — — — — — — — Diphtheria, Memb. croup 2 — — — 2 2— — — — — — — — 1 — — — 1 — — — — — — Cerebro-spinal meningitis 1 — — — — 1 — — — — — — — — — 1 — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever — — — — — — — — — — — — — — — — — — — — — — — Diarrhoea, enteritis 6 4 — — — — — 1 1 — — — 1 1 — 2 — — 1 — — 1 — — Erysipelas 1 — — — — — — — 1 — — — — 1 — — — — — — — — — — Puerperal fever — — — — — — — — — — — — — — — — — — — — — — — — Other septic diseases 9 — — 1 1 — 2 4 1 1 1 — 1 2 — 3 — — — — — 1 — — Svphilis, &c — — — — — — — — — — — — — — — — — — — — — — — — Diabetes 15 — — — — 2 — 2 11 — 1 1 — 7 1 — 1 1 — — 1 2 — — Rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of lungs 29 — 1 — — 7 15 4 2 1 — 1 2 12 — 11 — — — — — 2 — — Other forms of tuberculosis 4 — 1 — — — 3 — — — — — — — 1 3 — — — — — — — — Malignant growths 118 — — — — — 11 51 56 1 16 5 9 35 10 14 9 2 2 4 3 6 — 2 Congenital debility, malformation, and premature birth 10 10 — — — — — — — — — — — 5 — — 3 — 1 — — — — — Old age 10 — — — — — — — 10 — — — 3 4 1 1 — — 1 — — — — — Meningitis and convulsions 2 1 — — 1 — — — — — — — — 2 — — — — — — — — — — 17 (8S9i) $$$]Loc. ataxia and general paralysis 1 — — — — — — — 1 — — — — 1 — — — — — — — — — — Other diseases of nervous system 13 1 — — — — 2 4 6 — 2 1 — 5 — 3 — — — — — 1 — 1 Valvular diseases of heart 6 — — — — 1 — 1 4 — — 1 — — — 1 1 — — 2 1 — ——. — Other circulatory diseases 226 — — — — 3 6 45 172 6 19 11 22 71 18 51 3 1 2 6 2 13 — 1 Bronchitis 43 2 — 1 — —. 1 9 30 — 2 1 3 17 2 11 2 1 — 1 — 3 — — Broncho-pneumonia 35 1 1 1 1 1 1 6 23 — 2 — 7 12 2 6 — — 1 3 — 2 — — Pneumonia, other forms 12 — — — — 1 2 1 8 1 4 — 1 4 — 2 — — — — — — — — Other respiratory diseases 13 — — — 1 — 3 4 5 — 2 — 1 6 — 3 — — — 1 — — — — Alcoholism 3 — — — — — — 2 1 — — — — 2 — — 1 — — — — — — — Cirrhosis of liver 2 — — — — — — 2 — — — — — 1 — 1 — — — — — — — — Appendicitis and typhlitis 3 — — — — — 1 1 1 — — — 1 — — 1 — — — — — — 1 — Other digestive diseases 29 — — — 1 — 4 7 17 — 3 1 3 9 2 8 — — — 2 — 1 — — Bright's disease, &c. 19 — — — — — 4 4 11 — 1 2 2 6 3 1 1 — — 2 — — — 1 Cystitis, &c. 3 — — — — — — 1 2 — — — — 1 1 1 — — — — — — — — Accidents and diseases of parturition 9 — — — — 4 4 1 — — 1 — — 4 1 2 1 — — — — — — — Deaths by accident or negligenoe 26 1 — 2 — 1 2 8 12 — 2 3 2 9 1 5 — — — 1 1 — — 2 Deaths by suicide and murder 5 — — — — — 3 2 — — — — — 3 — 1 — — — — — 1 — — Other defined diseases Diseases, ill defined or 17 — 1 — — 1 5 2 8 1 — — — 8 2 5 1 — — — — — — — unknown 2 — — — — — 1 1 — — — — — — — 1 — — — — — — — 1 All causes 694 21 5 6 7 22 70 171 392 11 61 27 59 235 45 144 23 6 8 24 8 33 1 9 18 Registered deaths numbered 1,512 in the City during 1937. After deducting 885 deaths of non-citizens in public institutions, etc., in the City, and adding those of 805 citizens who died in other districts, the corrected total is 1,432 as compared with 1,477 in 1936, and is equivalent to an annual crude rate of 11.5 per 1,000 persons compared with 11.9 last year. The London death-rate for 1937 was 12.3 and for England and Wales, 12.4. The number of deaths and the death-rates per 1,000 for the past fifteen years are shown below :— Table IX. Death Rates from 1923 to 1937. Year. Number of Deaths. Westminster Rate. London Rate. 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 1937 1,432 11.5 12.3 The deaths of males were 738, females 694. Table X. Deaths Distributed amongst Age Groups. This table shows the total deaths distributed among age periods :— 1937. 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 3 2 4 20 70 267 333 738 f. 21 5 6 7 22 70 171 392 694 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 1937 60 8 8 11 42 140 438 725 1,432 19 The causes of death are set out in Table VIII. There was an increase among males of deaths from the following causes :—influenza, erysipelas, and diseases of the circulatory system. Among females the causes showing an increase were influenza, whooping cough, diabetes and accidents and diseases of parturition. 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. 1933. 1934. 1935. 1936. 1937. m. f. Total. m. f. Total m. f. Total. m. f. Total. m. f. Total. Conduit 5 1 6 - 3 3 8 4 12 4 6 10 6 11 17 Grosvenor 86 55 141 64 61 125 61 57 118 60 53 113 66 61 127 Hamlet 19 22 41 12 24 36 14 30 44 23 28 51 28 27 55 K. St. George 67 65 132 60 61 121 45 70 115 42 55 97 66 59 125 Victoria 212 230 442 224 235 459 226 240 466 209 276 485 234 235 469 St. Margaret 39 39 78 43 40 83 39 34 73 49 42 91 46 45 91 St. John 235 167 402 183 144 327 190 147 337 184 137 321 142 144 286 St. Anne 28 31 59 27 34 61 24 31 55 19 31 50 28 23 51 Gt. Marlborough 15 10 25 12 19 31 11 7 18 8 9 17 3 6 9 Pall Mall 20 3 23 22 10 32 21 5 26 23 11 34 16 8 24 Regent 31 20 51 16 25 41 21 19 40 18 28 46 15 24 39 Charing Cross 20 11 31 17 5 22 19 6 25 20 12 32 13 8 21 Co vent Garden 41 33 74 24 31 55 24 23 47 24 31 55 28 33 61 Strand 32 3 35 32 3 35 28 5 33 42 4 46 35 1 36 Homeless 28 5 33 20 15 35 16 11 27 20 9 29 12 9 21 Infantile Mortality.—The corrected death-rate of infants for Westminster was 58.7 per 1,000 births. The mortality among legitimate infants was 48.6 per 1,000; that of illegitimate 123.1. The infant mortality rate for London was 60. The number of infants dying under 1 year was 60, a decrease of 10 on the figure of last year. The chief contributory causes of death were congenital defects, prematurity, broncho-pneumonia, and affections of the stomach and bowels. (7638) 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 1934. Total 1935. Total 1936. Total 1937. 1st Quarter 30 26 22 17 2nd „ 18 18 17 14 3rd „ 11 14 19 13 1th 18 17 12 16 77 75 70 60 Table XIII shows the births and deaths of infants, legitimate and illegitimate, since 1910 onwards, with the corresponding infantile mortality rates for Westminster and for London. Table XIII.—Infantile Mortality since 1910. 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. 1910 2,399 189 78 183 26 129 82 103 1911 2,195 210 95 166 25 198 103 129 1912 2,194 168 76 155 33 174 83 91 1913 2,057 184 89 176 27 164 95 105 1914 1,995 147 73 162 29 148 79 104 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 99 715 217 36 188 87.5 85 1920 2,047 123 60 219 41 200 73.6 76 1921 1,729 117 67.7 190 44 194 80.2 80 1022 1,703 84 49.3 199 37 100 54.6 74 1923 1,582 68 42.9 176 20 85.7 47.2 60 1924 1,489 82 55.0 138 15 101.4 59.0 69 1925 1,418 88 62.0 117 14 153.8 690 67 1926 1,449 76 52.4 157 18 127.3 59.7 64 1927 1,255 81 64.5 144 20 104.1 68.6 59 1928 1,220 65 53.2 150 15 100.0 58.39 67 1929 1,190 83 67.7 167 15 131.7 77.37 70 1930 1,202 52 43.2 166 22 174.6 59.21 59 1931 1,063 74 69.6 148 29 114.8 75.1 65 1932 1,020 50 49.0 132 17 196.9 65.9 66 1933 970 54 55.6 129 26 162.7 68 59 1934 1,015 56 551. 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 1937 883 43 48.6 138 17 123.1 58.7 60 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 1930 onwards, showing the proportion per 1,000 births applicable under each heading:— Table XIV.—Infantile Mortality—Causes. 1930. 1931. 1932 1933. 1934. 1935. 1936. 1937. Influenza — — — 2.7 — — 0.94 — Measles 3.6 — 0.86 — 085 — 0.94 — Whooping Cough 0.73 0.82 0.86 1.8 — 1.9 — 0.97 Bronchitis and pneumonia 14.6 223. 12.1 10.9 12.0 12.4 4.7 8.8 Stomach and bowel diseases 5.8 13.2 8.6 9.0 15.4 11.5 11.2 12.7 Syphilis 2.1 1.6 1.7 3.6 1.71 — — 0.97 Congenital malformations, debility, etc. 4.3 6.6 — 1.8 2.57 8.6 15.9 5.8 Prematurity 18.2 22. 3 19.9 16.3 20.5 20.1 15.0 19.5 Tuberculosis 1.4 — 0.86 — — — — — Murder 1.4 — 0.86 — — 1.9 1.8 0.97 Accidents and negligence — 1.6 0.86 0.9 1.71 8.6 6.5 1.9 Cerebro-spinal Meningitis — 0.82 0.86 0.9 — 1.9 — — Erysipelas — — 0. 86 0.9 0.85 — — — Other causes 1.4 1.6 3.4 1.8 6.85 4.7 5.6 6.8 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. CAU8H3 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 Month3. 9 Months and under 12 months. ; | Total Deaths j under 1 Year. Bronchitis and Pneumonia (all forms) — — — — — 3 2 4 — 9 Premature birth 12 4 — 1 17 3 — — — 20 Other causes 2 — — — 2 — 2 3 — 7 Stomach and bowel — — — — — 4 5 4 — 13 Accidents and negligence 1 — — — 1 — 1 — — 2 Congenital Defects 1 1 1 — 3 2 — 1 — 6 Murder 1 — — — 1 — — — — 1 Whooping Cough — — — — — — — 1 — 1 Syphilis — 1 — — 1 — — — — 1 17 6 1 1 25 12 10 13 — 60 22 Table XVI.—Births and Infantile Deaths. Nett Births in the year:— Males. Females. Total. Legitimate 449 434 883 Illegitimate 80 58 138 529 492 1,021 Nett Deaths in the year of :— Males. Females. Total. Legitimate infants 27 16 43 Illegitimate infants 12 5 17 39 21 60 The causes of death of the Illegitimate were :—murder 1, prematurity 7, stomach and bowel diseases 6, congenital defects 1, and accidents and negligence 2. Table XVII. Infant Mortality.—Nett Deaths from stated causes at various ages undei One Year of Age in Pimlico A rea (Victoria, Knightsbridge St. Georqe and Hamlet Wards). CAUSES of death. | Under 1 Week. j 1—2 Weeks. ! 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Mouths. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under On® Year. Meningitis — — — — — — 1 1 — 2 Bronchitis and Pneumonia (all forms) .. — — — — — 2 2 1 — 5 Stomach and bowel — — — — — — 3 2 — 5 Premature birth 6 — — — 6 1 — — — 7 Accident — — — — — — 1 — — 1 Congenital defects — 1 2 — 3 1 — 1 — 5 Other causes — — — — — — 1 — — 1 Totals .. 6 1 2 — 9 4 8 5 — 26 Nett Deaths in the above area during the year :— Males. Females. Total Legitimate .... .... .... 11 9 20 Illegitimate .... .... .... 5 1 6 23 Table XVIII. Infant Mortality.—Nett Deaths from stated causes at various ages under One Year of Age in St. John and St. Ma rgaret 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. Whooping Cough — — — — — — — 1 — 1 Congenital defects 1 — — — 1 — — — — 1 Stomach complaints — — — — — 3 2 1 — 6 Premature birth 3 — — — 3 1 — — — 4 Other causes 1 — — — 1 — — 1 — 2 Bronchitis and monia — — — — — 1 — 3 — 4 Totals 5 — — — 5 5 2 6 — 18 Nett deaths in the above area during the year :— Males. Females. Total Legitimate infants 11 3 14 Illegitimate infants 3 1 4 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 Charing Cross and Covent Garden Wards). causes OF death. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year Premature birth 3 2 1 6 3 — — — 9 Stomach complaints.. — — — — — 1 — 1 — 2 Circulatory diseases 1 — — — 1 — 1 — — 2 Syphilis — 1 — — 1 — — — 1 1 Totals 4 3 — 1 8 4 1 1 1 14 Nett deaths in the above area during the year :— Males. Females. Total. Legitimate infants 5 4 9 Illegitimate infants 2 5 Births in this area numbered 157, therefore the Infant MortalityRate for the North district was 89.1 per 1,000. 24 Table XX. Deaths of infants with no known address, or found in streets, parks, dec.:— CAUSES OF DEATH. Under 1 Week. ]—2 Weeks. 2—3 Weeks. 3—1 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. Accidents 1 — — — 1 — — — — 1 Murder 1 — — — 1 — — — — 1 2 — — — 2 — — — — 2 Deaths of children unknown :— Males. Females. Total. Legitimate — — — Illegitimate 1 1 2 Table XXI.—Infant Moetality 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. 1 Total Births, 1937. Legitimate. Illegitimate. Total Infant Deaths, 1937. Legitimate. Illegitimate. 1937—Infant death rate per 1,000 births. Legitimate. Illegitimate. Total Rate. Conduit 2,086 7 4 3 Grosvenor 13,318 47 37 10 5 3 2 81.0 200 106.3 Pall Mall 2,872 7 4 3 1 1 333.3 142.8 Regent 4,047 16 12 4 _ Gfc.Marlborough 3,331 12 10 2 1 1 100 83.3 St. Anne 5,405 25 18 7 5 3 2 166.6 285.7 200 Covent Garden 6,655 39 38 1 2 2 52.6 51.2 Charing Cross.... 3,210 3 2 1 Strand 2,052 1 1 Victoria 36,955 429 377 52 23 18 5 47.7 96.1 53.6 K. St. George.... 11,445 76 65 11 3 2 1 30.7 90.9 39.4 Hamlet 6,461 30 27 3 _ St. Margaret .... 8,671 46 41 5 1 1 200 21.7 St. John 23,071 266 247 19 17 14 3 56.5 157.8 63.9 Homeless, etc. — 17 — 17 2 2 — 117.6 117.6 Total 129,579 1,021 883 138 60 43 17 48.6 123.1 58.7 25 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 1937. Cities and Boroughs. 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. West Districts— Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 Fulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 City of Westminster 124,300 8.2 11.5 11.8 58.7 North Districts— St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.5 12. 13.2 66 Stoke Newington 60,250 14.2 12.5 12.0 37.5 Hackney 206,700 13.8 11.1 11.7 43.38 Central Districts— Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36.3 East Districts— Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60.5 Poplar 136,800 15.5 12.6 14.0 31 South Districts— Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70.43 Wandsworth. 341,700 11.53 12..36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 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 or forty years although their original residence, and perhaps a temporary one at that, was in a common lodging house in the City. Deaths 26 among the latter class of people tend to increase the death-rates of the wards in which those lodging houses are situated ; 58 deaths of persons giving addresses in common lodging houses occurred in 1937. They were mostly in institutions. Table XXIII.—Deaths in Common Lodging Houses. Deaths . Ward. Bruce House (L.C.C.) 25 Strand 33, Great Peter Street 4 St. John. 7, St. Ann's Street (Salvation Army) 21 16, Strutton Ground 7 Church Army Home, Greencoat Place 1 58 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 1933-1937. Details respecting the notifications of infectious disease received are set out in the following pages. Table XXIV.—Notifications of Infectious Disease. 1933 1934 11*35 1936 1937 Smallpox 1 — — — — Diphtheria 142 153 111 82 133 Erysipelas 53 63 44 35 42 Scarlet fever 354 375 194 198 258 Enteric fever 7 6 11 12 16 Continued fever 1 — Puerperal fever 4 5 9 1 3 Puerperal pyrexia 11 13 17 13 26 Cerebro-spinal meningitis 11 4 3 4 12 Encephalitis lethargica 1 — — — — Poliomyelitis 2 5 2 — 2 Ophthalmia neonatorum 7 4 1 11 9 Measles 255 807 195 590 136 German measles 45 39 10 27 51 Pneumonia 66 48 35 22 28 Malaria 1 15 2 3 Dysentery 1 3 15 14 32 Chicksnpox 167 146 194 162 164 Mumps 130 105 272 102 90 Whooping-couch 135 95 134 141 127 27 Vaccination.—The Vaccination Officer reports that the following number of persons were vaccinated by the Public Vaccinators during the year:— Primary .. .. .. .. 415 Secondary .. .. .. .. 36 These figures do not include vaccinations and re-vaccinations done by private practitioners. No vaccination was done by the Medical Officer of Health under the Public Health (Smallpox Protection) Regulations, 1917. The report of the Vaccination Officer is given below in the form of tables prescribed by the Ministry of Health in the Vaccination Order. 28 Table XXV. Vaccination Return for the Year ended 31st December, 1936. Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st December, 1936. Number of these Births duly entered by 31st January, 1938, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1938, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st Jan., 1938, neither duly entered in the " Vaccination Register " (cols. 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (cols. 8, 9 and 10 of this Return). Total number of Certificates of Successful Primary Vaccination of children under 14 received during the calendar year 1937. 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 1937. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Dead, Unvaccinated. Postponement by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to Places unknown, or which cannot be reached; and Cases not having been found. Insusceptible of Vaccination. Had Smallpox. 1,543 816 4 — 301 55 i 224 138 4 970 267 Table XXVI. Summary of Monthly Returns for the Year ended 31st December, 1937. 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. 1,442 970 11 267 1 95 265 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, 1937. Name of Public Vaccinator and District. Numbers of successful primary vaccinations of persons r of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at soma previous time. Under 1 year of age. 1 year and upwards. Total. Dr. J. Forbes (Mayfair, Strand, St. James and St. Anne) 32 1 33 6 Dr. J. Gorsky (Westminster, St. Margaret and St. John) 164 7 171 21 Dr. T. Bromley (Belgrave and Knightsbridge) 235 14 249 15 Totals 431 22 453 42 30 Table XXVIII.—Cases of Infectious Disease Notified. Notifiable Diseases. At all Age?. Cases Notified. Cases removed to Hospital. Treated at Home. At all Ages. Deaths. At Ages—Years. At Ages—Years. Under 1. 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. Under 1. J 1-2. 2-3. 3-4. 4-5. 5-10. 10-15. 15-20. 20-35. 35-45. 45-65. 65 and over. 1 Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera (C). Plague (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria 119 2 2 6 8 13 47 12 13 15 1 — — 119 — 2 — — — — — 2 — — — — — — Erysipelas 41 1 — 1 1 1 1 7 6 19 4 40 1 4 — — — — — — — — 1 1 2 Scarlet fever 236 1 5 18 13 22 80 20 21 45 5 5 1 236 — — — — — — — — — — — — — — Typhus fever — — — — — — — — .— — — — — — Enteric fever 16 — — — — — 2 — 2 4 — 4 4 15 1 — — — — — — — — — — — — — Relapsing fever (R) — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal meningitis 12 — — — — — — — 5 6 — 1 — 12 — 1 — — — — — — — — 1 — — — Poliomyelitis 2 — — — — — 1 — 1 — — — — 1 1 1 — — — 1 — — — — — — — — Encephalitis lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum 9 9 — — — — — — — — — — — — — 9 — — — — — — — — — — — — Pneumonia 28 — 1 — 2 — 2 — 2 8 2 9 2 20 8 28 1 — — — — — — 2 2 3 8 12 Malaria 3 — — — — — — — — 2 — 1 — 3 — — — — — — — — — — — — — — Dysentery 32 4 1 10 — 1 5 2 2 3 4 32 — — — — — — — — — — — — — — Puerperal pyrexia 26 — — — — — — — — 21 5 — — 26 — — — — — — — — — — — — — — Totals 527 17 9 3f) 24 36 138 32 47 113 22 43 11 516 11 36 1 — — 1 — 2 — 2 4 3 9 14 Correction has been made for errors in notification or revision of diagnosis in 33 cases. Diphtheria 19, Scarlet Fever 9, Dysentery 6. Cases not notified :— Scarlet fever, 22. Diphtheria, 14. 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 6 4 44 8 45 1 3 7 2 2 4 4 3 Erysipelas — 4 2 12 2 12 — — 3 — — 1 3 1 2 Scarlet fever 5 16 6 88 16 92 3 2 8 1 1 8 2 6 14 Typhus fever — — — — — — — — — — — — — — — Enteric fever — 2 3 2 1 4 1 2 1 — — — — — — Relapsing fever (R) — — — — — Puerperal fever — 1 1 1 __. _ , Cerebro-spinal meningitis 2 4 4 1 _ 1 — Poliomyelitis 1 — __ — — 1 Encephalitis lethargica __ — — — — — Ophthalmia neonatorum 1 4 1 1 2 — Pneumonia — 5 2 8 1 10 — __ 1 1 Malaria.. — — — 2 1 __ Dysentery — — — 4 4 12 1 _ 4 ___ 7 Puerperal pyrexia — 1 1 9 2 7 — 1 3 2 Membranous Croup — — — — — — — — — — — — — — — Totals 5 25 19 176 39 188 8 8 21 4 3 20 5 16 27 32 Scarlet Fever.—Two hundred and fifty-eight cases of this disease occurred in 1937, an increase of 60 on the figures of 1936. No death occurred. The case rate of this disease per 1,000 of the population was 2.07 for the City, and for England and Wales 2.33. The death-rate for London was 0.01 per 1,000, and for England and Wales 0.01. Diphtheria.—-One hundred and thirty-three cases of this disease occurred, showing an increase of 51 on the figures of 1936. The case rate of this disease for Westminster was 1.06 per 1,000 living, and for England and Wales 1.49. There were 2 deaths. The death-rate for England and Wales was 0.07, for London 0.05, and for Westminster 0.01. Report on Schick Testing and Immunisation Treatment against Diphtheria in Westminster, 1937, by Dr. Ian S. Thomson, Deputy Medical Officer of Health. Weekly clinics for this purpose were held throughout the year at each of the Council's Maternity and Child Welfare Centres, and at the Westminster Health Society's Centre. During the year 254 children were dealt with, as compared with 245 and 235 in the two preceding years. New cases attended the Centres as follows Ebury Bridge 69 Bessborough Street 24 Marshall Street 86 Westminster Health Society.. 75 254 Treatment was continued on the lines indicated in previous reports. The preliminary Schick test was only done on older children, or for some special reason in particular cases. Treatment was carried out without difficulty and with satisfactory results, and very few children failed to complete the full course of treatment. 33 The following Table shows the numbers in different age groups, and the results of tests where these were made :—• Table XXX.—Diphtheria Immunisation. Positive. Negative. No Test. Total. Under 5 years 1 2 183 186 Under 10 years 2 3 51 56 Over 10 years 6 6 0 12 9 11 234 254 All positive reactors received immunising treatment. Several of the children had had previous treatment in County Council residential schools or elsewhere and in these cases treatment was completed or re-tests were made. One hundred and fifty patients who had previously received treatment were re-tested. Two of these did not report for reading of the test; 142 gave negative results. Five gave slight positive results on re-testing, and received additional treatment. One child, who had been positive at the first re-test, and had received a second course of treatment,, was still positive at the second re-test. Further treatment was given. Antitoxin, for use in cases of diphtheria, is provided free ot charge for medical practitioners attending patients residing in the City. The supply is available on application at the City Hall and at the Coroner's Court in Horseferry Road. Enteric Fever.—There were 16 cases of typhoid and paratyphoid which came to the knowledge of the department during 1937. Of these, 7 were notified as paratyphoid and 9 as typhoid. The case rate for England and Wales was 0 05 and for Westminster 0'12. No death occurred. Towards the close of 1937 an increased incidence of Enteric Fever and fevers of the " para " groups was experienced throughout the Country generally and Westminster shared in this increase. Whilst during the last four months of 1936 no case was notified, in the corresponding period of 1937 notifications numbered nine. It was during this period that the Croydon outbreak occurred. A considerable number of Croydon contacts work in Westminster and even a few of the persons subsequently taken ill, but fortunately in the City there was no evidence of any spread of typhoid (7638) o 35 Table XXXIII. Deaths from Diarrhcea and Enteritis. Under 1 year. Other ages. Total. 1933 10 1 11 1934 16 3 19 1935 10 2 12 1936 12 3 15 1937 13 3 16 Whooping Cough.—127 cases were notified during the year, with 4 deaths, 15 cases were moved to hospital, 57 being between the ages of 1 and 5. The death rate for Westminster was 0.03, for London 0.06, and for England and Wales 0.04. 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. 1933 2 4 6 1934 9 9 1935 2 2 1936 — 3 3 1937 1 3 4 Cerebro-spinal Fever-12 cases of this disease occurred. Eleven of these cases were between the ages of 18 and 24. Seven were in-patients of Military Hospitals, admitted from various military establishments in the City, one case was admitted to a nursing home from the country and four were in-patients of the Special and General hospitals. One death occurred. Chicken Pox.—164 cases occurred, 45 being moved to hospital. Mumps.—90 cases were recorded, 14 cases being moved to hospital. Puerperal Fever.—-3 cases were notified and removed to hospital. (7638) c 2 26 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 1933 1,099 4 1 0.91 1934 1,166 5 — 1935 1,042 9 1 0.9 1936 1,063 1 1937 1,021 3 Puerperal Pyrexia.—26 cases occurred, all being removed to hospital. Ophthalmia Neonatorum.—9 cases occurred in 1937. In addition to these notified cases, 6 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. Three mothers and 6 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. The following details in tabular form are required by the Ministry of Health of the cases notified in 1937 :— Table XXXVI.—Ophthalmia Neonatorum. Cases. Vision unimpaired. Vision impaired. Total blindness. Deaths. Left district. Total. Treated. At home. In hospital. 9 — 9 4 — — 1 4 37 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 and blood, etc., for investigation of enteric and dysentery .. .. .. .. .. .. 777 Sputa for investigation of tuberculosis .. .. 282 Expenditure on the first was £111 19s. lid., and on the second £51 15s. 5d., including cost of outfits, postage and telegrams. TUBERCULOSIS. In 1937, 206 new cases of pulmonary tuberculosis came to the knowledge of the department, including 5 cases who had moved into the City and 12 non-notified deaths. Non-pulmonary forms of tuberculosis gave 45 cases—5 of these being non-notified deaths and 1 transfer from another district. 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 2 — 1 1 1 5 .. 10 — — 2 4 — — — — 10 „ 15 „ — 3 2 — — — — — 15 „ 20 „ 7 9 5 3 — 3 3 — 20 „ 25 „ 19 16 2 2 4 4 — — 25 ,. 35 „ 35 18 4 3 10 7 2 — 35 ,, 45 „ 16 19 3 4 11 8 — 3 45 „ 55 „ 24 8 2 2 12 2 — — 55 „ 65 „ 19 3 2 1 9 2 — — 65 and upwards 5 3 — — 9 2 — — Totals 126 80 23 22 55 29 6 4 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. 38 The total cases for 1937 show an increase of 27 on those of 1936. Out of the total cases primarily notified in 1937, 31 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 u—12 10 1 3 1 4 2 3 1 2 3 — 1 — — Table XXXIX.—Tuberculosis Deaths. 1933 1934 1935 1936 1937 New cases notified 202 266 201 188 228 Number included in above who died during the year 34 (16.8%) 38 (14.28%) 20 (9.9%) 24 (12.7%) 31 (13.6%) Total Tuberculous Deaths 101 99 67 90 94 Death Rates per 100,000 79.9 79.8 53.8 72.5 75.6 39 Table XL. Tuberculosis.—Notifications received during the period from lst January, 1937, to 31 st December, 1937. Age periods. Number of notifications on Form A. Primary notifications. Total notifications, on Form A, including cases previously notified. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new cases. Pulmonary— Males — 1 — 7 16 33 14 21 17 3 112 124 Females — 1 — 3 9 16 17 19 6 3 3 77 88 Non-pulmonary— Males — 1 2 2 3 2 2 3 2 2 — 19 19 Females 1 2 4 — 2 2 3 3 2 1 — 20 20 Total 1 5 6 5 21 36 55 39 31 23 6 228 251 40 Table XLI. Tuberculosis.—New cases coming to the knowledge of the Medical Officer of Health otherwise than by Notification under the Regulations. 1937. 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. Males — — — — — 3 2 2 3 — 2 14 Females — — — — — — 1 — 2 — — 3 Non-pulmonary— Males — — — — 2 — 2 — — — — 4 Females — — — — 1 — — 1 — — — 2 Total — — — — 3 3 5 3 5 2 2 23 11 Table XLII. Tuberculosis.— Table showing distribution in Wards of notified and unnotified cases, and numbers of such persons who have been treated in Institutions. 1937. All Ages. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Received Institutional Treatment during 1936. Pulmonary— Males 120 1 6 4 39 6 31 2 — 2 — 3 4 15 13 — 95 Females Non-pulmonary— 80 — 4 6 29 7 21 2 1 1 — 2 6 — 1 — 52 Males 23 1 3 — 11 1 4 — — 1 — — — — 2 — 17 Females 22 — — 1 12 1 4 3 — — 1 — — — — — 13 251 2 13 11 91 15 60 7 1 4 1 5 10 15 16 — 177 42 Table XLIII. Tuberculosis Notifications. The figures for a series of years are shown below:— Pulmonary. Non-Pulmonary. Total of all form. General Population. c.l.h. and no Address. Total. Males. Females. Males. Females. Males. Females. Total. 1917 209 164 51 7 431 42 34 76 507 1918 293 225 40 4 562 50 55 105 667 1919 197 122 30 4 353 35 23 58 411 1920 143 133 29 4 309 29 29 58 367 1921 118 114 37 2 271 19 22 41 312 1922 119 110 42 2 273 24 30 54 327 1923 111 114 42 1 268 24 32 56 324 1924 140 122 33 1 296 27 24 51 347 1925 108 92 27 1 228 23 31 54 282 1920 117 90 29 4 240 18 30 48 288 1927 103 67 24 1 195 21 29 50 245 1928 97 61 27 2 187 22 27 49 236 1929 106 105 42 6 259 14 28 42 301 1930 104 69 16 1 190 24 33 57 247 1931 108 86 17 1 212 20 23 43 255 1932 136 84 28 — 248 26 36 62 310 1933 106 75 24 205 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 1937 110 80 16 — 206 23 22 45 251 A return required by the Ministry is appended, also a table showing the distribution of the cases in the various wards of the City. Non-notified Deaths.—The number of unnotified deaths during the year was 17; the corresponding percentage proportions are 24.4 per cent. (1936) and 18.0 per cent. (1937). Enquiries were made, but in no instance did there appear to be neglect to notify a case on the part of a medical practitioner. 13 deaths occurred in institutions and 4 at home. Public Health (Prevention of Tuberculosis) Regulations, 1925. The object of these regulations is to prevent anyone who is aware that he is suffering from an infectious form of tuberculosis from engaging in certain departments of the milk trade. There was no occasion for exercising the powers conferred by these regulations during 1937. 43 Table XLIV.—Tuberculosis—Cases on the Register. Pulmonary. Non-Pulmonary. Males. Females. Males. Females. Number of cases on register at beginning of year 1937 788 381 162 184 Notified for the first time during year 126 80 23 22 914 461 185 206 Removed from the register on account of death or removal etc., from Westminster 95 69 23 14 819 392 162 192 Of the 201 cases removed from the register during the year 1937, 90 were on account of death, 105 persons suffering from tuberculosis moved from the City and notification was withdrawn in 6 cases. The total number of cases of tuberculosis on the Register at the end of 1937 was 1,565 (as compared with 1,515 at the end of the year 1936), of which 1,211 were pulmonary cases, consisting of 819 males and 3S2 females. Deaths from Tuberculosis.—The total number of deaths from tuberculosis for 1937 (all forms) was 94—males 61, females 33. This gives a death-rate for this disease of 0.75 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. 1932 106 .83 1933 101 .79 1934 99 .79 1935 67 .53 1936 90 .72 1937 94 .75 44 The following table shows deaths per 100,000 of civilian population since 1923. Table XLY. Westminster—Deaths from Tuberculosis per 100,000 civilian population. Years. Pulmonary. Non-pulmonary. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1923 annual 103 73.3 16 11.3 119 84.7 1924 124 86.7 14 9.9 138 96.5 1925 115 82.3 14 10.0 129 92.4 1926 119 85.9 14 10.1 133 96.0 1927 100 73.2 14 10.2 114 83.5 1928 90 69.3 18 13.8 108 83.2 1929 113 81.8 11 8.7 124 98.8 1930 98 77.9 9 7.1 107 85.0 1931 105 90.8 16 13.8 121 104.6 1932 90 71.2 16 12.6 106 83.8 1933 92 72.8 9 7.1 101 79.9 1934 83 66.9 16 12.8 99 79.8 1935 61 49.0 6 4.8 67 53.8 1936 82 66.0 8 6.4 90 72.5 1937 84 67.5 10 8.0 94 75.6 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, 1937. The work of the Dispensary has been carried on throughout the year on the established lines. New patients numbering 405 were seen during the year, of whom 211 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. 1935. 1936. 1937. Medical Practitioners 140 136 121 Health Visitors 143 171 189 St. Stephen's Hospital 97 115 65 Ministry of Pensions 0 0 0 School Medical Officer 25 18 12 Voluntary Hospital 12 7 9 Friends, Charitable Organisations, &c. 8 9 9 425 456 405 45 The value of the arrangement whereby the Tuberculosis Officer visits the wards of St. Stephen's 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. A rearrangement of duties, whereby the consulting work is shared with the Tuberculosis Officer of another Borough has resulted in some decrease in the total number of patients seen, but endeavour is made to keep in touch with all Westminster cases. The following table gives certain details of the work of the Dispensary during 1937 and the four preceding years:— Table XLVII. 1933. 1934. 1935. 1936. 1937. New patients attending 412 462 425 456 405 Old patients attending 430 473 472 494 497 New contacts examined 126 109 108 127 114 Individual attendances 842 93.1 897 950 902 Total attendances 2,165 2,615 2,454 2,393 2.141 Written reports to Medical Practitioners and Public Authorities 1,090 1,066 1,064 1,108 1,171 Home Visits 82 67 73 109 95 Consultations with Medical Practitioners 117 153 145 131 113 Visits by Health Visitors to Dispensary Cases 3,404 3,526 3,335 2,885 2,915 Sputum Examinations 164 193 171 187 162 X-Ray Examinations 61 60 78 100 123 Patients have been recommended for institutional treatment from the Dispensary as follows:— Table XLVIII. Hospitals. Sanatoria. Insured Males 22 55 Insured Females 11 30 Uninsured Males 0 2 Uninsured Females 1 9 Boys 0 2 Girls 2 2 36 100 46 This Table does not include patients sent direct to St. Stephen's Hospital. Many of these are transferred to a Sanatorium later. In addition, 66 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, the 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, &c. School children requiring dental treatment were referred to the School dentist. Six adult patients were referred to the Council's Dental Clinic, twenty-three extractions were carried out and three of the patients were fitted with dentures. Seventeen patients received Artificial Pneumothorax treatment at Brompton Hospital and elsewhere and had in all 241 refills. One case of Lupus received special Light treatment at a cost to the Council of £4 4s. Od. The Tuberculosis Care 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 for dentures and recommends to the Council the granting of extra nourishment where this is considered helpful to the patient's treatment. Forty-two patients received this extra diet allowance at a total cost to the Council of £254. There are many patients who, while not requiring economic relief, have difficulty in supplying the extras of nutritional value for which the medical condition calls. In such cases the Council's daily grant of milk 47 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. 48 Table XLIX. TUBI ULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL. (A) Return showing the Work of the Dispensary during the Year 1937. 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 98 3 1 11 12 6 5 142 110 9 6 267 *(b) Diagnosis not completed — — — — — — — — — 1 — — 1 (c) Non-tuberculoua — — — — — — — — 20 36 16 17 89 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 3 1 1 — 2 1 2 3 3 2 10 *(b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 7 22 39 36 104 (a) Recovered — — — — — — — — — — — — — (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 29 61 59 57 206 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 281 184 24 22 36 42 49 47 317 226 73 69 685 (b) Diagnosis not completed — — — — — — — — — 1 — — 1 * i.e., remaining undiagnosed on 31st December. 49 (7638) Table XLIX—continued. TUBERCULOSIS SCHEME OF THE WESTMINSTER CITY COUNCIL—continued. (A) Return showing the Work of the Dispensary during the Year 1937—continued. 1. Number of cases on Dispensary Register on 1st January 646 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 95 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 26 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,915 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight 176 10. Number of— 162 (a) Specimens of sputum, etc., examined 4. Cases written off during the year as Dead (all causes) 75 (b) X-ray examinations made in connection with Dispensary work 123 5. Number of attendances at the Dispensary (including Contacts) 2,141 6. Number of Insured Persons under Domiciliary Treatment on 31st December 229 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 233 (a) Personal 113 (b) Other 299 (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 Nil 50 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, special examinations of water, 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 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 in the City by three District Nursing Associations. 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 1937 amounted to £199 15s. id., representing some 2,874 visits as compared with 2,639 for the previous year. 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.1. 2. Maternity and Child Welfare Centre, Marshall Street, Golden Square, W.l. 3. Maternity and Child Welfare Centre, Bessborough Street, S.W.1. 4. City of Westminster Health Society, 121, Marsham Street, S.W.1. BESSBOROUGH STREET CENTRE AND DAY NURSERY FROM THE SOUTH. 51 New Maternity and Child Welfare Centre and Day Nursery, Bessborough Street. This building, a description of which has been given in previous reports, was completed during the year and officially opened by Her Majesty the Queen on the 25th November. The building serves a dual purpose of a Maternity and Child Welfare Centre and Day and Night Nursery. The Centre on the ground floor is under the direct administration of the City Council, whilst the nurseries on the first and second floors and part of the top floor are administered by a voluntary association, the City of Westminster Day Nursery Association as tenants of the City Council. The building is planned on modern lines, each floor being provided with a spacious balcony facing South, and is reached by a passenger lift in addition to wide staircases at each end. Three separate entrances give access to the building. One, leading direct to the ante-natal waiting room, is reserved for expectant mothers ; the central doorway forms the main entrance to the Centre, whilst the third is reserved for the Nursery. There is accommodation in the Day Nursery for some 80 to 90 children and some half-dozen children can be accommodated in the night nursery. Both these important activities were formerly housed in old and unsuitable buildings, the Centre at 15, Bessborough Street, and the Nursery at 147, Warwick Street. The accommodation at the latter was restricted to forty children. With the completion of this centre all the City Council's maternity and child welfare centres are now modern buildings designed for the purpose, whilst the Westminster Health Society's Centre in Marsham Street is also similarly designed and of modern construction. 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. (7638) D2 52 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. (c) With the Ear, Nose and Throat Hospital, Golden Square, for the treatment of ear, nose and throat affections in children under school age referred thereto from the Council's Infant Welfare Centre at Marshall Street. (d) With the Infants Hospital, Vincent Square— (i) For the treatment of ear, nose and throat affections in children under school age sent from the Council's Infant Welfare Centres at Bessborough Street and Ebury Bridge and the Westminster Health Society's Centre in Marsham Street. (ii) Whereby the hospital acts as a consulting centre for cases sent from the Council's and the Health Society's Centres. MATERNITY AND CHILD WELFARE. The statutory powers with which the Council is endowed for providing services under this heading have enabled a comprehensive welfare scheme to be established. Before the consideration of details it might be of advantage to summarize these services as follows. They are:— (1) Care of the expectant mother by— (a) Visits of advice by health visitors. (b) Attendance at ante-natal clinics under the care of a woman gynaecologist. (c) Confinement at home by a midwife. (d) Services of an obstetric consultant in case of difficulty. 53 (e) In the event of illness after confinement the services of an obstetric consultant, pathologists, nursing and treatment in hospital. (/) Confinement as in-patient in hospital. (g) Provision of home help during the mother's period of ability. (h) Convalescent treatment if necessary before and after finement. (i) Instruction in mothercraft, i.e.:— (1) Classes for making garments. (2) Classes for cookery, food values, and marketing. (3) A variety of health lectures. (j) Dental treatment, and supply of dentures. (k) Extra nourishment. (2) Care of the mother after confinement and the infant:— (a) 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 falling within the Council's Income scale, with the addition of such accessories to diet as cod liver oil, iron and calcium. (d) Dental and convalescent treatment as above for women, and children up to 5 years of age. (e) Nursing services. (/) Special treatment, e.g., artificial sunlight. (g) Treatment of minor ailments in children under school age. (h) 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. 54 Midwifery Service. Midwives Act, 1936.—The scheme made by the London County Council to give effect to the provisions of this Act received the approval of the Minister of Health during the year. Under the Scheme, which came into force on the 1st January, 1938, London is divided into five areas, Westminster being included in Area "C" which also includes the boroughs of Chelsea, Fulham, Hammersmith, Hampstead, Paddington and Kensington. The object of the Scheme is to secure an adequate domiciliary midwifery scheme throughout London, but so far as Westminster is concerned, there has for many years been a complete and unified midwifery scheme operating under the aegis of the City Council. The midwives of the Westminster Hospital attend necessitous women on behalf of the City Council throughout the greater part of the City and in the remainder the midwives of the Westminster Health Society practice for the same purpose. Under the County Council's Scheme voluntary Associations and Hospitals providing domiciliary midwifery service were given an opportunity of entering into an agreement with the County Council for the carrying out of midwifery services under which they were to be paid a fixed sum per case attended, less any payments received from the borough councils or any fees received from patients. Both the Health Society and the Westminster Hospital have signed this agreement so that their respective midwives have to conform to the requirements of the County Council's scheme. It is a source of satisfaction to know that the County Council's scheme has left undisturbed the smooth working of the City Council's own scheme save that where the method of assessment of the fees to be paid by patients was formerly made by the City Council, it now has to be made in accordance with the County Council's rules. The County Council found it unnecessary to employ any midwives in Westminster additional to those already employed by voluntary bodies. Treatment of Minor Ailments in Children of Pre-School Age.—During the year the City Council entered into an arrangement with the London County Council whereby children under school age attending the Council's and the Westminster Health Society's Centres found to be suffering from minor ailments, such as discharging ears, external eye diseases, such as blepharitis and conjunctivitis, and skin diseases, such as impetigo and sores, can be referred to certain school clinics in the City for treatment, the City Council paying the County Council for these services an agreed sum per case treated. The City Council has also made provision for the treatment 55 of ear, nose and throat affections in such children at the Ear, Nose and Throat Hospital, Golden Square, and the Infants Hospital, Vincent Square. Consulting Centre.—The need has for some time been felt for a consulting centre where children could be referred by the medical officers at the Council's and the Health Society's Infant Welfare Centres for special examinations, and negotiations were completed with the Infants Hospital, Vincent Square, for this purpose. Under this arrangement the Infant Welfare doctors send particulars of the patient with a clinical note of the case to the Hospital. An appointment is then made for one of the honorary consultants on the staff of the Hospital to examine the patient, a report is sent back to the Infant Welfare doctor on the case, and, where necessary, treatment is given. 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. 1934. 1935. 1936. 1937. Number of— Pre-natal visits 71 34 29 20 Lying-in visits 1,022 961 897 1,663 Subsequent visits 28 18 26 23 Total number of visits 1,121 1,013 952 1,706 Number of cases attended 78 74 71 100 The number of cases attended shows an increase of 41 per cent, over those of the previous year, whilst the progressive decline in pre-natal visits to the home of the patient is accounted for by the fact that all the cases are regularly seen by the midwives at the Council's and the hospital ante-natal clinics. Table LI. Attendances by midwives at ante-natal and other clinics :— 1934. 1935. 1936. 1937. Ebury Bridge 50 50 51 51 Besaborough Street 48 49 50 49 Marshall Street — — — 8 Total 98 99 101 108 56 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, 1937. Pre-natal visits 330 Lying-in visits 1,109 Subsequent visits 80 Total number of visits 1,519 Number of cases attended 53 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 Victoria 7475) can have such skilled assistance, which is also available to all mid wives practising in Westminster who may require it. These services were utilized on three separate occasions during the year. 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 1,021, the number of expectant mothers dealt with at the centres was 854; that is to say, some 83.6 per cent, of the total cases, as compared with the percentage of 75.7 for the previous year. Cases were brought to the notice of the centres from the following sources:— 57 Table LIII.—Ante-natal Cases. Source of Information. City Council's Centres. Westminster Health Society. Totals. Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Queen Charlotte's Hospital 1 — 1 — 2 Hammersmith Hospital — 2 — — 2 General Lying-in 10 13 1 33 57 St. George's 30 15 2 7 54 Westminster 17 31 1 18 67 St. Thomas — 2 — 2 4 Charing Cross 5 2 33 4 44 Middlesex 2 4 24 — 30 Royal Free Hospital 1 1 — — 2 St. Stephen's 35 25 2 20 82 University College — — 2 — 2 St. Mary Abbot's Hospital 10 9 3 — 22 Found by Health Visitors 65 51 23 27 166 Reported to Centre voluntarily 128 106 20 66 320 Totals 304 261 112 177 854 Ante-natal Visiting.—To the 854 expectant mothers who became known to the centres, 823 primary visits were paid by health visitors. Subsequent visits were also paid to these cases to the number of 1,756. 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 51 148 465 613 164 Bessborough Street 40 134 451 585 163 Marshall Street 24 25 45 70 28 Westminster Health Society. 12 78 273 351 91 These clinics are held at the following times:— Ebury Bridge Tuesday, 2 p.m. to 4 p.m. Bessborough Street Friday, 2 p.m. to 4 p.m. Marshall Street Tuesday, 10.30 a.m. to 12.30 p.m., fortnightly. Westminster Health Society Thursday, 2 p.m. to 4 p.m. fortnightly. 58 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 Conditions.—By agreement with Westminster Hospital the Council has the right of admission for cases recommended through its welfare centres to beds in Westminster Hospital up to 100 patients per annum. There is also an agreement with St. George's Hospital for admission of individual cases to beds, payment being made therefor by the City Council. Apart from the City Council's own maternity scheme, beds are available in the London County Council hospitals, e.g., St. Stephen's, and also in voluntary hospitals such as Charing Cross, Middlesex, General Lying-in, etc., but these beds have to provide for cases not only from London but from the Home Counties as well, and this applies to some extent to Westminster Hospital. Hospital beds are available as follows:—Charing Cross, 15; St. George's, 11; Westminster, 12; Sheffield Street, 30; *St. Stephen's, 28. 368 women belonging to the City were delivered in these hospitals. The following table shows the number of confinements in the hospitals mentioned:— Table LV.—Confinements in Hospitals. Charing Cross Hospital: 310, of which 31 were Westminster oases. St. George's Hospital: 316, of which 57 were Westminster cases. Westminster Hospital: 257, of which 107 were Westminster cases. Sheffield St. Hospital: 184, place of residence doubtful. St. Stephen's Hospital: 173 (Westminster cases only). Convalescent Treatment.—The Council has during the year contributed towards the cost of the convalescent treatment of 15 Westminster patients at convalescent homes, and 14 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 £102. * Situated in Chelsea. 59 Maternal Mortality.—The number of maternal deaths in Westminster during the year ended December, 1937, was 9, which gives a maternal mortality rate of 8.4 per thousand (live and still) births, as compared with the rate for the whole country of 3.11 per thousand (live and still) births. Notes on Cases of Maternal Mortality in 1937. 1. M.A.W. Died early in pregnancy from paralysis of bowel following an operation for haemorrhage due to rupture of extra-uterine pregnancy. This paralysis may follow any abdominal operation. 2. H.J. Suffered from disease of one kidney, and the extra strain placed on the other kidney caused pyelitis. This was followed by bronchopneumonia and empyema, from which the patient died. The patient had full ante-natal supervision, and hospital treatment for some weeks before labour. 3. N.A.V.L. Died of puerperal septicaemia after difficult labour. Under hospital supervision throughout pregnancy. 4. V.T. Patient had made no arrangements before onset of labour. A dead child, illegitimate, was delivered. Death was due to pulmonary embolism two days after confinement. 5. K. Died of septicaemia following septic abortion. No evidence of effort to secure ante-natal attention. 6. K.S. Died as a result of abortion. Patient concealed pregnancy and delayed in seeking treatment after abortion. 7. G.R.A. Died from toxaemia and paralysis of the bowel following an operation for rupture of extra-uterine pregnancy. 8. Patient was in poor health during pregnancy, and had a difficult labour, which was impeded by a contraction ring. Caesarian section was performed. Patient died from septicaemia following a pelvic abscess. 9. Patient suffered from toxaemia during pregnancy. She died under anaesthesia for craniotomy operation during difficult labour. Myocardial degeneration and toxaemia were contributory factors. Had full ante-natal care. Thus in two cases death was due to a fairly uncommon sequel to an operation for abnormal pregnancy. Two cases were due to abortion, while in a third, concealed pregnancy, pulmonary embolism followed. In two cases death from septicaemia followed difficult labour. In one of these cases, and in the remaining two, health during pregnancy was bad, and full ante-natal care did not succeed in saving the patient's life. 60 These notes give only a brief summary of the full enquiry that has been made into each of these unfortunate cases. The maternal mortality rate of 8.4 per thousand, as compared with 0.9 per thousand in the previous year, is a very high one, and one must consider carefully in each case whether there are any circumstances which indicate failure in the provision of suitable prenatal or midwifery care. In two cases of abortion, and in a third where concealed pregnancy was followed by death from pulmonary embolism, there was undoubtedly failure on the part of the patient to take advantage of the available services. Two of the cases present a curiously similar history. In each case the relatively uncommon condition of pregnancy outside the uterus occurred and operative treatment became essential. In each case the operation was followed by fatal paralysis of the bowel. This again is a relatively uncommon condition, although it may follow any operation involving the peritoneum. In two cases death was caused by septicaemia. In such cases one must always consider the possibility of some failure in technique. In these two cases, however, skilled medical and nursing care appears to have been available during labour and for some months preceding it. Both were cases of abnormal labour, where the danger of sepsis is always greater. In one of these cases, and in the two remaining, the patient was in bad health during pregnancy and was perhaps unsuited to stand the strain of motherhood, even with the help of full pre-natal care. Thus three cases must be excluded as having failed to take advantage of facilities which are available. The remainder appear to have had skilled treatment and every possible care, and must be considered as an unfortunate series of those deaths which appear to be unavoidable even when the best services are provided and used. This is all the more a cause for concern when it is remembered that in Westminster facilities for ante-natal care and skilled attention in confinement are readily available for every mother. Last year and the year before, only one woman died from conditions associated with pregnancy. This year with midwifery services even more developed it is most disquieting to record nine deaths, the highest for five years. Five of the nine had skilled antenatal care; four of them were in hospital before labour had begun ; one came into labour at home and was removed to hospital because of complications and subsequent illness. Maternal mortality is not a community problem to be considered in terms of preventive measures such as may be applied to epidemic disease. It is definitely, in London at any rate, of 61 a purely individual character; an error of nature converting a physiological function into a pathological catastrophe. In the five fatal cases under careful supervision from the first there was no malnutrition, poverty or bad housing as indirect factors. The truth still lies hidden among the many unknown influences which transform the healthy body to one of disease. Notes by the Medical Officers at the Council's Maternity and Child Welfare Centres. Infant Welfare Centre, Marshall Street. Dr. A. Doyne Bell. The area of the City of Westminster which is served by the Marshall Street Centre is so built up in character that it cannot be considered ideal for the upbringing of young children. It has been our aim in the centre for many years now to stimulate in the parents an interest in all aspects of mothercraft, including the importance of healthy housing conditions. This aim has been chiefly furthered by the unremitting efforts of the health visitors during their visits to the families in their homes. There is a welcome tendency among families who hitherto would have been content to dwell in this somewhat congested district to take advantage of housing developments further afield and thus enjoy more open air conditions and the extra space for play and exercise which suburban housing estates provide. All the same, there is no lack of important work still to be done among those families who for various reasons have to live in this area. The work of any welfare centre is essentially preventive. In the past, much attention was paid to diseases caused by gross errors in feeding, but a more widespread appreciation of the importance of dietetic hygiene has made these diseases less common. Foremost amon g our present-day problems is that of respiratory infections, both chronic and mildly acute, and the study of these disabling conditions from the preventive aspect is likely to yield one of the most fruitful contributions that the Welfare Centre can make to the betterment of the health of the rising generation. The predisposing factors of respiratory infections in young children are certainly multiple ; malnutrition, faulty posture, over-crowded living conditions, all are contributory, and the social worker no less than the medical officer, plays a part in their investigation and prevention. I therefore count myself lucky in working with health visitors who fully realise the nature of the problem which confronts us jointly. A. Doyne Bell. Ebury Bridge and Bessborough Street Infant Welfares Centres. Dr. George Ormiston. During 1937 mothers and others in charge of infants became well adapted to the modern methods of feeding now in use at the above welfare centres. These methods include the graduated introduction of solid foods in suitable form from the fourth month of life onwards, close attention being paid to the vitamin intake in accordance with the newer knowledge. 62 General results are (1) the complete absence of any difficulty in weaning from the breast or bottle such as was the common experience when infants were fed on one or both of these exclusively, for the first nine months, in the traditional manner; (2) few cases of anæemia, and these relatively mild; (3) improvement in general nutrition and muscle tone. Continual emphasis has been placed on the importance of sunlight and fresh air as aids to health and the prevention of tuberculosis and rickets. Air and sun baths have been advocated, even for young infants. This involves the exposure of the naked body to these elements once daily for increasing periods up to fifteen minutes. A considerable number of mothers have ventured to follow this advice, with excellent results. No cases of glandular or pulmonary tuberculosis have become manifest amongst those attending the centres. There is a tendency, however, for the persistence of a small number of cases of mild rickets, in spite of every care on the part of the medical staff towards the prevention of the condition. This is to be explained by ignorance or indifference to advice, or poverty, and has been met as far as possible by the extension of grants of free milk and cod liver oil, and multiple visits by the health visitors. One of the chief aims has been to increase to the uttermost the function of the welfare centres as agencies for the prevention or curtailment of disease and the promotion of health, both as an ideal work striving for for its own sake and in the interests of the nation. Every effort is being made to check disease and remedy deformities at an early stage. Where there is need, all who have the means are referred to the family doctor. Otherwise, increasing use is being made of the hospital, dental, sunlight and other clinics. A special word of acknowledgment is due to the orthopœdic department of Westminster Hospital for helpful co-operation and advice regarding cases of knock-knee, flat-foot and other deformities which have been frequently referred to it. A system of seeing infants and children on clinic days by appointment has been instituted. This has cut down the gross number of attendances and has led to an economy of time beneficial to both the staff and the mothers, and also an increased efficiency in handling. In conclusion, I wish to acknowledge with grateful thanks the loyal and efficient co-operation of all members of the staffs who have assisted me throughout the year. (Signed) George Ormiston. Maternity Centres, Bessborough Street, Ebury Bridge and Marshall Street. Dr. Margaret Salmond. The Ante-and Post-Natal Clinics have been held weekly at Ebury Bridge and Bessborough Street and fortnightly at Marshall Street. The attendances are well maintained and there has been a definite increase in the number of confinements conducted by the Westminster City Council Midwife. The health of the mothers is, on the whole, good, and they have co-operated well and more are now attending the dental clinic than in previous years. There have 63 been few serious abnormalities. Co-operation with the Westminster Hospital and St. Stephen's Hospital is maintained happily and any abnormalities occurring in domiciliary cases can, fortunately, be transferred immediately to hospital. I have to thank the Westminster City Council Midwife and her assistant and the staffs of the clinics concerned for all the hard work they do, and for their help in making the clinics run smoothly and happily for all concerned. The information they provide about patients is often of inestimable value in the determination of that most important factor in ante- and post-natal work, namely, the nutrition of the patient. (Signed) Margaret Salmond. 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. 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—1st Tuesday each month at 10 a.m. 2nd Tuesday each month at 2 p.m. Clinics are also held at the Infants' Hospital, Vincent Square and Charing Cross Hospital. It will be noted from the following table of attendances that the work at the centres continues satisfactorily, although there is a slight decrease in total attendances and in average attendances at each centre. This is due to the declining birth rate and to the migration of young families to outlying housing estates. The proportion of elderly people in the population of the City seems to be rising. The comparative totals since 1932 are also shown. 64 Table LVI. Attendances at Infant Consultations, 1937. 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 102 243 101 2,781 1,581 3,024 1,682 4,706 Bessborough Street 99 174 31 2,560 1,535 2,734 1,566 4,300 Marshall Street 51 72 33 877 1,126 949 1,159 2,108 Marsham Street 100 188 47 2,159 1,552 2,347 1,599 3,946 1937 352 677 212 8,377 5,794 9,054 6,006 15,060 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 The average attendances per session were— 1937. 1936. 1935. 1934. 1933. 1932. Ebury Bridge 46.1 44.6 42.9 46.9 50.2 47.1 Bessborough Street 43.4 53.4 51.5 55.7 54.5 54.4 Marshall Street 41.3 44.4 46.8 44.3 48.0 43.9 Marsham Street 39.4 44.3 45.3 38.1 37.6 41.1 The number of individual children medically inspected were— Ebury Bridge 593 Marshall Street 250 Bessborough Street 563 121, Marsham Street 528 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. 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 9 142 Complications of maternity 40 633 Pneumonia (including adults) 12 131 Bronchitis 12 176 Influenza 1 1 Other illness 149 1,791 Total 223 2,874 Ophthalmia neonatorum.—Nine cases were notified during the year. There were also 6 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 9 cases, 142 visits being paid. Ophthalmia neonatorum has been notifiable since (7638) e 66 1911. The percentage of cases, both mild and purulent (notifiable) in relation to births from the year 1928 is as follows:— Table LVIII.—Ophthalmia Neonatorum and Inflammation of the Eyes. Cases. Rate per 100 births for both classes of cases. 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 1937 15 1.4 The incidence of venereal disease among the population is an unknown quantity, but may rightly be gauged by attendances at V.D. Clinics (vide London County Council reports) and by the death returns of the registrars. The following table of death rates of infants per 1,000 births certified as due to syphilis shows an aspect of the incidence of this hereditary infection. One infant died from syphilis in 1937. Table LIX.—Deaths from Syphilis. 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 — 1930 2.1 1937 0.9 67 Health Visitiiig.—The following table shows the number of visits paid in connection with the four centres:— Table LX.—Health Visiting. 1937 Ebury Bridge. Bessborough Street. Marshall Street. Marsham Street. Total. Pre-natal— First visits 292 241 112 178 823 Other visits 529 494 247 486 1,756 Children under 1 year of age— First visits 351 261 175 230 1,017 Other visits 1,278 1,306 663 1,027 4,274 Children over 1 and under 5 years— Visits 3,430 2,649 2,501 2,328 10,908 Death enquiries, still-births, &c. 40 34 25 18 117 Infectious diseases 88 118 110 47 363 Mothercraft.—Classes in mothercraft are held weekly at the various centres, and health talks are given each week throughout the year in connection with those classes. Various voluntary societies engaged in health education have generously supplied lecturers. The subjects covered by these lectures are set out on page 73. Table LXI.—Mothercraft Classes. 1937. Ebury Bridge. Bessboro' Street. Marshall Street. Marsham Street. Total. Number of classes 48 50 45 89 232 Total attendances 2,341 1,232 451 2,804 6,828 Average attendances 48.7 24.6 10.2 31.5 29.4 Number of expectant mothers 80 89 30 50 249 Number of attendances by expectant mothers 491 410 142 683 1,726 Number of other mothers 92 104 30 88 314 Number of attendances by other mothers 1,850 822 309 2,121 5,102 Attendances of children in nurseries during classes 1,617 772 477 2,866 5,732 Materials are purchased in quantity, and sold to the mothers at cost price. The number of garments made at Ebury Bridge was 1,932; at Bessborough Street, 830; at Marshall Street, 290; and at Marsham Street, 1,576. Much work of a repair or remodelling nature is done to old garments in the interests of family economy. An important feature is the instruction of the mothers in knitting woollen garments. (7638) e 2 68 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. Seven new registrations were made. No death occurred amongst foster children during the year. Notices numbering 65 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 renewed for a further period of one year the certificate of exemption, granted in 1936, under the provisions of Section 271 (2) of the Act, in respect of the Nursery established at Dolphin Square, Grosvenor Road, a building comprising some 1,250 flats. The Nursery which is provided for the use of tenants only, has accommodation for some 40 children, and is well conducted. The certificate exempts from visitation by the Council's officers and the necessity for giving notice to the Council of the reception and 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 21 21 11 Subsequent visits 20 57 1 Foster Children 5 to 9— First visits 4 1 3 Subsequent visits 13 12 2 Adoption of Children Act, 1926.—The Medical Officer of Health was appointed guardian ad litem by the County Court in two cases where application had been made to the Court by residents in the City for adoption orders for infants, under the above Act. The orders were made in both instances. In carrying out this duty the Medical Officer has to satisfy the Courtas to the suitability of the proposed adoptors and that the interests of the infant will be safeguarded. 69 Instruction in Nutrition and Cookery Classes.—The lecture demonstrations on cookery held at the maternity and child welfare centres, inaugurated in 1936, have been continued throughout the year. A limited number of about twelve 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. Mrs. Latey, a fully qualified teacher, holding a diploma in domestic science, attends at Ebury Bridge and Bessborough Street to hold cookery classes. At the Westminster Health Society similar classes are held by Mrs Macmillan. The mothers having received instruction actually take part in cooking various dishes at the classes. Barlow's Gift.—The special committee administering this trust has again made the annual allocation between maternity and child welfare, the tuberculosis handicrafts Committee and the Westminster, Belgravia and Pimlico Association for Women's Welfare. The total annual income amounts to £37 5s. 4d., 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 1937 five Westminster women were admitted to the home. This home serves a most useful purpose. The women generally admitted on the recommendation of the Westminster rescue worker are maintained for 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, arrangements being made for the future employment of the woman and the welfare of her child. 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 the Council's scale of income. 70 Applications are dealt with at the meetings of the Maternity and Child Welfare Sub-Committee. 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. A few other special dietetic articles containing calcium and/or iron 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 4,504 pounds were distributed during the year. The amount expended by the Council for fresh milk as extra nourishment for mothers and infants was £660 10s. 0d. Nutrition.—The Minister of Health in Circular No. 1519 issued to Maternity and Child Welfare Authorities in April, 1937, drew attention to the report of the Advisory Committee on Nutrition and in particular to the emphasis laid in the report on the nutritional value of milk, and requested the local authorities concerned to take an early opportunity of reviewing their arrangements for Maternity and Child Welfare in the light of the report. The Minister referred to a circular issued in 1932 in which attention was drawn to the importance of securing that nursing mothers should be provided with a sufficiency of calcium, phosphates and vitamin D in their diet, and of increasing the consumption of milk, especially by growing children. He urged that the arrangements made by local authorities should enable sufficient milk or other food to be provided whenever necessary for the maintenance of the health of the mother or young child, and that existing rules limiting the supply of milk to expectant mothers to the last two or three months of pregnancy or in the case of children up to a certain age (normally three years) should be revised. The Medical Officer of Health in a report to the Public Health Committee, pointed out that the City Council in 1936 had reviewed its arrangements for the supply of extra nourishment to expectant and nursing mothers and infants and that the suggestions made by the Minister in this respect had been practically fulfilled. He suggested, however, 71 that the existing scheme be revised to the extent of providing milk to children up to five years of age, and to expectant mothers during the whole period of pregnancy, in those cases where the Council's Maternity and Child Welfare Medical Officers considered it necessary for the maintenance of health. The Council adopted this suggestion and agreed with a recommendation of the Minister that, wherever practicable, pasteurised milk only be supplied under the Council's scheme. Home Helps.—Provision was made in two cases for the services of home helps at a cost of £'2 0s. 0d. There is no panel of home helps. It is found more satisfactory for the woman requiring this service to make her own free choice of the individual who is to take her place in the home. Insulin Treatment.—Two patients were under treatment and the cost to the Council for the year was £17 7s. 3d. 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 £10 0s. 0d. in small sums according to their means. The Council contributed sums totalling £37 3s. 0d. towards the cost of dentures (£4 per set), which were supplied in 32 cases. Dental Clinic (held in the premises of the Western Dispensary). Mr. Stewart Tait, Dental Surgeon, submits the following report:— I have much pleasure in submitting my report for the above Clinic for the year ending December, 1937. From the appended figures for the years 1936 and 1937, one sees that there has been a considerable increase in the number of new cases seen during the past year. While this is most gratifying, it has also resulted in the work increasing in all branches over the previous years. The gas sessions have been fully attended and there is every indication of a continued increase in the attendances at the Clinic during the ensuing year. New Cases. Reappoint ments. Extractions. Fillings. Other Operations. Anaesthetics. Local. General. Dentures Supplied. 1937 237 950 843 260 370 6 193 32 1936 184 832 861 154 324 7 181 28 T. Stewart Tait, L.D.S. 72 Notes by the senior health visitors on the work at the Centres. Bessborough Street:— The work of the Centre was carried on during 1937 on the same lines as in former years, except that the usual programme of demonstrations and films could not be arranged owing to the uncertainty as to the date of opening of the new Centre. This long looked for event, the culmination of the hopes and expectations of many years, took place on Thursday, 25th November. By Monday, 29th November, we were fully installed in the new premises, and the ordinary activities of the Centre were in full operation. We still find many families are moving out and others moving into this area. A number of those who move to outlying districts return after a year or two to Westminster and resume attendance at the Centre. There is a continued demand for the new up-to-date flats which have sprung up in our midst and which have proved such a boon to families who have long endured the inconveniences of tenement houses. We look forward to a year of increased activity and progress in all matters relating to the well-being of our mothers and their infants and young children. Ebury Bridge:— The ordinary work of the Centre has been carried on as usual, despite changes in staff and new developments. Changing times and conditions have brought great alterations in the type of family resident in the Ebury Bridge area. The comparative scarcity of unemployment in the City has brought many families from the distressed areas to settle in the locality. In addition to these immigrants from afar, many families from overcrowded or unsatisfactory dwellings in other parts of the City have been moved into the City Council's new flats at Ebury Bridge. The effect of these changes became more pronounced in 1937, and gave additional interest to the social side of the work. The working-class families resident in the area can be divided into three distinct groups:— (1) The old residential families, born, educated, employed and married in the City. (2) The Army families stationed at Hyde Park and Chelsea Barracks for the regulation stay, and often returning after periods at other Military towns. (3) The immigrant families from the distressed and other areas. An outstanding feature of the year's work has been the increasing number of young mothers attending the Centre who themselves attended as infants. In one instance, an "old" mother brought successively three of her daughters, and two daughters-in-law to the Centre. At the end of 1937, two members of this family were attending the ante-natal clinic. 73 Infant Life Protection.—There are still only seven foster mothers in the Ebury Bridge area. Four of them live in Council or Industrial Dwellings. Three are in tenements. Mothercraft Class.—The Class has again shown a very healthy growth, both in the number of attendances, and in the work done. The number of children attending the Mothercraft Nursery increased from 1,326 to 1,617. Film Talks, Lectures, &c.—An interesting programme of talks, demonstrations, and films was provided for the Winter months. Co-operation.—Co-operation has been maintained with all the agencies of the district dealing with mothers and children, and much help has been obtained from hospitals, churches, and charitable associations. Lectures, &c., Held at the Council's Centres. Lectures, demonstrations, and film displays were held at the Centres during the year in the following subjects Dental Care. Food Values. "Guarding Motherhood." "Health for all." Hints on Marketing. Hygiene of the baby. Nursing. Prevention of Tuberculosis. "Safety First." Special milk dishes. "Sunshine and Health." Vermin in the home. National Health Campaign.—In the Autumn the Prime Minister inaugurated a national campaign to encourage the wider use of the various health services, under the auspices of the Minister of Health and the President of the Board of Education, and in co-operation with local authorities and voluntary bodies interested in the subject of health education. Local authorities were asked to assist by publishing information relating to the services available in their areas, and by arranging for lectures, demonstrations and film displays on various subjects to be given at local centres. The Minister arranged with the PostmasterGeneral for information supplied by local authorities to be made available to the public at post offices. The City Council authorized the publication of a booklet containing a description of the services provided by itself and by the London County Council, together with a detailed list of the 74 maternity and child welfare centres, clinics, treatment centres, &c., available to inhabitants of the City. Lectures, demonstrations and film displays were arranged at the Council's welfare centres, as mentioned elsewhere in this report. Physical Training and Recreation Act, 1937.—This Act came into operation in July, 1937, its object being to extend the existing powers of local authorities, mainly Education Authorities, to enable them to provide further facilities for physical training and recreation, and thereby to assist in improving the health and general physical standard of the nation. The Act deals with community centres on housing estates provided by local authorities under the Housing Acts, gymnasia and playing fields, holiday camps, swimming baths, &c., and provides for co-operation between authorities, who are empowered to contribute towards expenses incurred by a neighbouring authority in establishing various facilities. Day Nurseries.—The City of Westminster Day Nursery, which is administered by a voluntary association, and which has for many years been conducted at 147, Warwick Street, was transferred on 1st December to new premises provided by the Council in Bessborough Street, as described elsewhere in this report. The old Nursery provided accommodation for forty children, whereas some eighty to ninety can be catered for in the new premises as well as some half-a-dozen resident children. The total attendances at the Nursery were 8,549 by 91 individual children in the following age groups:— (a) Under one year—34. (b) Over one year and under three years—28. (c) Over three years and under five years—29. The average daily attendance during the year was 28. The Nursery is open on five and a half days in the week for children, the charge to parents being 5s. for each child per week with remissions in special cases. The charges for resident children range from 12s. 6d. to 15s. per week. 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 two deep wells were sunk, one at 25, Buckingham Gate and one at the Odeon Theatre, Leicester Square. 75 There is a total of 149 deep wells in the City. Fifty-one of them are now out of use owing to the supply of water failing. Some were sunk as far back as seventy to eighty years ago. As the years have passed, wells have had to be bored to greater depths with the result that the deeper wells have in some cases deprived the more shallow ones of supplies of water. Many of the large blocks of business premises and flats contain more than one well, such as Bush House (6), Dolphin Square (4), Liberty House (3), Devonshire House (3), and nineteen other properties have two wells each. The ninety-eight wells now in use serve some 64 premises. In view of the intense public interest in water supplies from wells which became apparent towards the end of the year, it seemed desirable to have an analysis of water from each deep well in the City. It was found on inquiry that a number of owners were already in possession of periodical reports of analysis and others were advised to obtain such reports and to acquaint the Medical Officer of Health with the results. 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 1937 were :— Buckingham Palace Road: 123,327 men; 63,565 women. Great Smith Street: 133,833 men; 52,335 women. Marshall Street: 155,237 men; 92,344 women. The numbers relating to users of the public laundries were:— Buckingham Palace Road, 22,761; Great Smith Street, 17,582; Marshall Street, 6,792. Sterilization of Water in Public Swimming Pools and Baths.—Efficient filtration and sterilization plants are installed at the City Council's three establishments, 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 fourteen 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. All are well maintained and under competent supervision. 76 Drainage and Sewerage.—During the year 990 plans of drainage and other sanitary works relating to existing and new buildings were examined and approved by the Public Health Committee. 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. Town and Country Planning Act, 1932.—The City Council, while not a town planning authority, acts in an advisory capacity on all schemes, except those of a minor character, submitted to the London County Council and affecting Westminster. The special Sub-Committee of the Improvements Committee dealing with these schemes, meets on three occasions each month. In 1937, 269 schemes, with plans, were examined. The Senior Sanitary Inspector representing the Medical Officer of Health, attends in an advisory capacity. Observations relating to such matters as use of underground rooms, planning and suitability of sanitary conveniences, &c., having in mind the provisions of the Public Health, Factories and Shops Acts, are embcdied in appropriate cases in the reports of the Sub-Committee. New Sanitary Construction.—Of 990 plans submitted relating to drainage and other sanitary works, 113 represented sanitary provisions in entirely new buildings. The corresponding figures since 1933 are as follows:— Table LXIII.—Drainage and other Sanitary Works. — 1933. 1934. 1935. 1936. 1937. Plans 926 935 1,080 1,087 990 Plans of work in new buildings included in above 96 102 94 102 113 Combined drainage orders were made in 18 cases. Infringements of the by-laws were reported by the sanitary inspectors in 10 instances in respect of failure to give notice of intention to construct, or to deposit plans. In 3 cases the builders concerned were cautioned; no action was taken in the remaining cases, the works being of a minor character. Closet Accommodation.—The water carriage system is in existence throughout the City. 77 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, 7 for men and 4 for women are open both day and night. Free conveniences for both sexes are provided at all establishments. In addition, there are 28 public urinals for men. Under the Council's scheme for the modernizing of the public conveniences in the City, the establishments at the Law Courts (Strand), Parliament Street and Leicester Square (men's) were dealt with during the year. The work of reconstructing the women's convenience at Leicester Square was in progress at the end of the year, and a new men's convenience to replace an existing urinal in South Bruton Mews was in course of construction. Public Cleansing.—This is carried out by a separate department of the City Council under the Director of Public Cleansing (Mr. H. Ardern, M.B.E., 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, 1938, were as follows:— tons. House refuse 91,975 Trade refuse 4,060 Total 96,035 This figure is a reduction of 2,853 tons on last year and this is probably mainly due to the changing character of the refuse, which tends to decrease in weight but increase in volume. Modernization of Transport.—The four-year programme for the complete modernization of transport, adopted by the Council in 1933, has been practically completed and at the end of the year under review thirty-nine Motive Units of the "Mechanical Horse" type were in commission, nineteen having petrol engines and twenty being electrically operated. The latter type has proved of great benefit as most of the refuse collection and clear sing service has to be carried out at night. As stated in last year's report, the principal asset of these Motive Units is that they can be employed on all the various services, being coupled to articulated trailers with suitable bodies for refuse collection, street flushing, gully cleansing, general transport work, &c. Refuse Collection by Container System.—The number of premises at which this system is installed continues to increase. It is undoubtedly the most suitable system for all premises where large quantities of refuse are produced, being most hygienic and economic in space and labour. It also has the advantage from the point of 78 view of the local authority that the Containers can be exchanged at any time during the twenty-four hours, thus materially relieving the "peak period" of refuse collection in the early morning. Refuse Receptacles.—The house-to-house inspection of refuse receptacles in use throughout the City is still proceeding and the installation of a very large number of receptacles in accordance with the London County Council By-laws has been obtained. Occupiers of premises are also being instructed with regard to bins being unnecessarily put out overnight or left out over the week-end and on public holidays. The British Standards Institution have set up a special Sub-Committee which is now considering the issue of standard specifications for refuse receptacles of various approved sizes, to which all manufacturers will be requested to conform. This will materially assist local authorities as at the present time receptacles are being offered for sale which are either too lightly constructed to last for a reasonable time or are too large for one man to lift when full of refuse. Refuse Disposal.—The New Central Depot being erected for the Council at Grosvenor Dock is proceeding very satisfactorily and it is anticipated that it will be ready for occupation in October, 1938. Details of this building have been given in previous reports and it will be recalled that this Depot, which will comprise a garage for all the Council's vehicles, workshops, general stores, &c., is built over and around the centralized refuse disposal plant. Incorporated in the building is a dust extraction plant of the latest type which will collect the dust caused by the discharge of refuse from vehicles and the loading of the barges; this is discharged through hoppers into large bags which are properly sealed and deposited in the refuse barges. As previously stated, the Council's contract with the barging contractors provides that only steel barges with fixed coamings and wooden hatches completely covered by tarpaulins are permitted to be used. All the refuse is now barged to one con. tractor's dump at Pitsea, where the tipping is carried out strictly in accordance with the recommendations of the Ministry of Health and the requirements of the Essex County Council and the local authority concerned. Frequent visits to the dump are made by an officer of the department and the Committee visit periodically. Medical Inspection of Aliens. The Medical Inspection of Aliens arriving at Victoria Station by the through sleeping car service from Paris, initiated in October, 1936, at the request of the Ministry of Health, was carried out daily throughout the year, with the exception of a few days on which the boat service was cancelled owing to unfavourable weather conditions. A total of 10,160 passengers from 358 boats were dealt with during the year by the assistant medical inspectors appointed by the Council for this purpose. 79 The following are particulars of the inspections and examinations made during the year:— Table LXIV.—Medical Inspection of Aliens. Classification of Aliens arriving at Victoria Station. Total. Medically Inspected. Medically Examined. Temporary Residents. Visitors 4,475 4,446 18 Business Visitors 3,599 3,595 1 Diplomatic 519 519 — Seamen — — — Contract Seamen 6 6 — Permanent Residents. Returning Residents 662 661 — Ministry of Labour Permits. Males 104 103 3 Females 69 69 6 Children 3 3 3 Immigrants. Males 161 160 2 Females 94 94 2 Children 34 34 — In Transit 434 434 1 Total 10,160 10,124 36 Rejected for all causes — — — Transmigrants — — — Grand Total 10,160 10,124 36 One certificate was issued by a medical inspector to the Immigration Officer where an alien was 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 are 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 requirements of the Public Health (London) Act, 1936, and the drainage, &c., by-laws of the London County Council, 80 duties connected with housing and infectious disease, factories, workshops and workplaces, 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. Table LXY.—District Sanitary Inspection. Inspection of premises:— Dwelling-houses— water-Closets— Directly approaohed from rooms 122 Primary Inspections— Accommodation insufficient 102 (a) On complaint 1,101 (b) Infectious disease 786 Water Supply— (c) Special Housing Inspections 2,663 Insufficient or unsatisfactory 35 Cisterns dirty and uncovered 62 (d) Housing Regulations, 1925 2,449 Absence of—in upper floors of tenement houses 3 (e) Housing applications 412 (f) Other reasons 2,980 Dustbins— Total 10,391 Absence of 56 Insufficient 42 Re-inspections 13,847 Defective 39 Animals kept so as to be a nuisance 4 Other Premises— Other nuisances 422 Primary inspections— (a) On complaint 478 Dangerous structures noted 23 (6) Other reasons 6,105 Overcrowding 98 Total 6,583 Sanitary works supervised:— Re-inspections 3,942 Drains (including soil, waste, rainwater pipes, etc.)— Total number of inspections for all purposes 34,763 Constructed 8,233 Altered, repaired, etc. 1,942 Sanitary Worlcs— Total Inspections— Intercepting traps fixed 95 Petrol interceptors provided 26 (a) Under notice 2,256 Tested by smoke 603 (b) Voluntary works 14,872 „ chemical 348 Nuisances, etc.:— „ water 1,427 „ air 646 Defective or dirty conditions of internal structure 1,629 Water-closets— Verminous conditions 351 Constructed 2,562 Damp conditions 709 Repaired and reconditioned 876 Inadequate under-floor ventilation 439 Urinals— Constructed 305 Defective drainage, waterclosets, etc. 562 Repaired and reconditioned 33 „ roofs 216 Waste Fittings fixed— ,, paving of areas, etc. 63 Baths 1,461 Water-closets— Bidets 106 Insufficiently ventilated or lighted 480 Lavatory basins 3,672 Sinks, etc. 2,445 81 Nuisances.—Intimation notices were served in 1,080 instances, the number of premises concerned being 1,039. Statutory notices authorised by the sanitary authority numbered 57 and related to 52 premises. Police court proceedings were taken in one instance in order to enforce compliance with the requirements of a statutory notice relating to unsatisfactory ventilation of a restaurant kitchen. The summons was withdrawn on payment of £1 1s. 0d. costs, the work having been satisfactorily completed before the hearing of the summons. The following are the comparative figures since 1933:— Table LXVI.—Nuisances. — 1933. 1934. 1935. 1936. 1937. Intimation Notices 1,223 2,060 1,776 1,471 1,080 Statutory Notices 50 66 89 73 57 Legal Proceedings 7 3 3 5 1 Water Supply.—The Metropolitan Water Board sent 15 notices of withdrawal of water supply to premises, consequent upon the failure of the occupiers to pay the water rate. Appropriate action was taken in each case. No legal proceedings were necessary. Water Supply in Tenement Houses.—Power to effect this provision is contained in The Public Health (London) Act, 1936, and in appropriate sections of the Housing Act, 1936. During the year 38 water supplies (additional) were provided in these working-class tenement houses. Shops Act, 1934.—During the year, 304 shops were inspected, and the results of the inspections recorded. A total of 45 notices was served requiring the provision of:— Notices. Suitable and sufficient means of ventilation 18 Means to maintain a reasonable temperature 4 Suitable and sufficient sanitary conveniences 8 Remedying other defects 15 Total 45 Rent Restriction Acts, 1920-33.—During the year 11 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. (7638) F 82 The number of "dwelling-houses" included in those applications totalled 54. The number of dwelling-houses on the register at the end of the year was 7,918. Certificates of registration or non-registration, which local authorities are required to issue on payment of a fee of 1s., were issued in 68 cases, 67 being in respect of registered houses and one non-registered. There were no cancellations of registration by the County Court. 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 1937, the number of inspections made, and the results of such inspections:— Table LXVII.—Factories, Workshops and Workplaces. Premises Registered. Work Premises. Total Number. Tailors, shirt makers, hat and cap makers 1,535 Dressmakers, milliners, embroiderers, costumiers, lingerie makers, children's outfit makers, feather workers, corset makers, furriers, etc. 1,455 Leather workers, boot and shoe makers, harness makers, etc. 79 Woodworkers, upholsterers, carvers, gilders, etc. 98 Surgical and dental instrument makers 8 Tobacco manufacturers 7 Wig makers and hair workers 45 Printers, bookbinders, lithographers, stationers, relief stampers, etc. 61 Jewellers, silversmiths, diamond cutters and polishers, engravers, etc. 62 Metal workers 68 Miscellaneous 89 Florists 22 Laundries 16 Bakehouses 50 Photographers 62 Cinema film workplaces 17 Total 3,674 The use of 139 workshops was discontinued, and 187 additions were made to the register during the year. 83 Table LXVIII.—Factories, Workshops and Workplaces. Inspection. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including factory laundries) 316 — — Workshops (including workshop laundries) 2,956 209 — Workplaces (other than Outworkers', premises) 4,703 262 1 Total 7,975 471 1 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 245 245 — — Want of ventilation 46 46 — — Overcrowding 18 18 — — Want of drainage of floors 1 1 — — Other nuisances 127 126 — 1 Sanitary accommodation— Insufficient 38 38 — — Unsuitable or defective 70 70 — — Not separate for sexes 25 25 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers Order, 1921.) — — — — Total 570 569 — 1 (7638) f 2 84 Table LXX.—Factories, Workshops and Workplaces. Other Matters. Class. Number. Visits to Outworkers' premises other than workshops 118 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act 139 Absence of means of warming 6 Matters referred by H.M. Inspectors 107 Workrooms measured 159 Visits of Enquiry re Employment of Women 137 „ „ Outworkers 101 Underground bakehouses in use at the end of the year 34 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. Trade. Outworkers' Lists, Section 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 & 110. Lists received from employers. Addresses of Outworkers. Notices served on occupiers as to keeping or sending of lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Section 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Received from other Councils. Sent to other Councils. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing apparel 907 1,978 7,162 27 56 35 325 4,977 183 — — — — — 20 — — Linens, etc. 5 21 36 — — — 4 96 — — — — — — — — — Furriers 9 38 11 — — — 15 52 — — — — — — — — — Miscellaneous 7 57 43 — — — 29 38 — — — — — — — — — Total 928 2,094 7,252 27 56 35 373 5,163 183 — — — — — 20 — — 86 Outworkers.—A total of 955 lists was received during the year. Notices in respect of failure to send lists were sent to 183 firms. No legal proceedings were necessary, but four firms were cautioned. The lists contained 9,437 names and addresses, of which 5,163 were in other districts, 4,462 being within the Metropolitan area and 688 in the London Suburban districts. The number of individual outworkers in the City at the close of the year was 1,655, of whom 1,585 were registered as occupying workshops. The number of premises in which outwork was being carried on was 674. Factories Act, 1937.—This Act received the Royal Assent in July, 1937, and will come into force on the 1st July, 1938. It repeals the Factory and Workshop Act of 1901 and subsequent Acts and amends certain sections of the Public Health (London) Act, 1936, and a number of other Acts containing provisions relating to factories and workshops. In the Act of 1901 a distinction was made between a factory and a workshop, but this is abolished in the new Act and the expression "workshop" omitted, only one term "factory" being employed. The provisions with which local authorities are primarily concerned are those relating to (a) cleanliness, overcrowding, temperature, ventilation and drainage of floors in factories in which mechanical power is not used; (6) sanitary conveniences in all factories; (c) basement bakehouses; and (d) outworkers. Cleanliness.—The general rule that every factory shall be kept in a clean state is supplemented by two new definite requirements:— (а) Accumulations of dirt and refuse must be removed daily from floors and benches of workrooms and from staircases and passages. (b) The floor of every workroom must be cleaned at least once a week by washing, or, if it is effective and suitable, by sweeping or other method. The provisions as to cleaning or whitewashing walls and ceilings of rooms, passages and staircases are made more precise. Overcrowding.—The standard for the prevention of overcrowding is raised from 250 cubic feet to 400 cubic feet per person. This will apply in the case of workrooms newly established after the date of the passing of the Act (30th July, 1937), and in certain circumstances to existing workrooms. The latter will be excepted from the application of the new standard for a period of five years from the above-mentioned date, and if suitable mechanical ventilation is provided before the expiration of that period will be excepted for a further period of five years. The new standard will, however, apply in the following circumstances:— (а) If the workroom passes out of the hands of the occupier or his successor in the same business. (b) If, during the first of the five-year periods, suitable mechanical ventilation has been required to be provided and default has been made in complying with this requirement. (c) If such mechanical ventilation has been provided in pursuance of requirements and ceases to be maintained. 87 Temperature.—A new provision requires a temperature of not less than 60 degrees to be maintained after the first hour in workrooms in which a substantial proportion of the work is done sitting and does not involve serious physical effort. Basement Bakehouses.—Section 54 re-enacts existing law prohibiting the use of basement bakehouses other than those previously existing which were certified as suitable by the local authority. It also strengthens the law in two ways:— (1) Provision is made for the Local Authority to review their certificates in the first year after the Act comes into force and every five years thereafter. The occupier may appeal to the Courts against the Council's decision to revoke a certificate. (2) A basement bakehouse which is not used as a bakehouse for a period of twelve months must not be so used again. The prohibition is to be enforced by the Local Authority. Underground Workrooms.—An important new provision prohibits work being carried on in any underground room which is certified by H.M. Inspector of Factories as unsuitable as regards construction, height, light or ventilation, or on any hygienic ground, or on the ground that adequate means of escape from fire are not provided. Abstracts.—The Medical Officer of Health is required to notify H.M. Inspector of Factories of any factory in which no abstract of the Act is affixed in accordance with the Act. This requirement was previously confined to factories employing women and young persons. Regulations and orders in force under previous Acts will continue in force until varied or revoked. These new and other extended provisions will entail additional duties for the officers of the Department. 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 from 1st July, 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, 166 inspections were made, 58 being between the hours of 6 p.m. and 9 a.m. Conditions generally were found to be satisfactory. 88 The only change of any importance during the year was the reconstruction into cubicles of a large dormitory at 28, Greencoat Place (Queen Mary Hostel). This met a definite need for in spite of the increased price, 1s. 6d. or 1s. 3d. per night according to the position, the cubicles are always occupied, the only vacancies being in the large dormitories and very seldom in the small dormitories. A foreign agency for the supply of domestic helps and servants uses Queen Mary Hostel as a pied a terre for girls on their arrival in England, pending their transfer to situations which have been found for them. The proximity of the hostel to Victoria Station is probably the reason for the hostel being so used as these girls are generally not of the type for which a common lodging house normally caters. Houses Let in Tenements.—The sanitary inspectors paid 4,841 visits of inspection to houses of this class, which number some 3,350. The matters of concern are state of repair, water supplies, sanitary conveniences, &c., the subject of notice in 367 cases. The existence of overcrowding, unfitness of parts of the building, e.g., underground rooms, are included in the Housing section of this report. Rag-and-Bone Dealers.—There are 5 premises in the City in which this business is carried on. They were regularly inspected during the year, but no defects calling for special attention were found. On a report received from the Commissioner of Police, a prosecution was instituted against an itinerant rag and bone dealer for exchanging toys for rags contrary to the byelaws of the London County Council. The defendant was ordered to pay 2s. costs, no fine being inflicted. A report was also received from the Police that two men had been found distributing handbills outside a school in the City, intimating that they would exchange toys, &c., for parcels of woollen goods. The Council's solicitors, however, advised that there was not sufficient evidence to justify a prosecution and warnings were therefore addressed to the persons concerned. Rag Flock—Public Health Act, 1936, Sec. 136.—There is one factory in the City which comes within the provisions of the Act. Rag flock is not actually manufactured there, but it is used in making up material for mattresses, &c. One sample taken during the year was found to be satisfactory, containing ten parts per 100,000 of free chlorine, the figure permitted under the Rag Flock Regulations being 30 parts per 100,000. 89 Schools.—In addition to the large number of academic institutions in Westminster there are 29 elementary and 4 secondary schools either wholly or partly under the control and management of the London County Council. The Burlington School for Girls, Boyle Street, moved to a new building at Hammersmith during 1937. The site is in course of development for business purposes. 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 educational establishments, additions or improvements were made to the sanitary arrangements during the year:— London School of Economics, Houghton Street. St. Margaret's School, Dean Farrar Street. St. Barnabas School, Pimlico Road. St. Martin's School of Art, Charing Cross Road (rebuilding). Warwick Junior School, Ranelagh Road. Rat Repression.—During the year 153 complaints were received and investigated, 479 inspections being made by the sanitary inspectors. The Council's rat officer visited premises for the purpose of investigation and to advise owners and occupiers in remedial and preventive measures. These complaints mainly arose in proximity to buildings demolished or in course of demolition, e.g., Adelphi Terrace. Rehousing had become an urgent necessity for the rat whose house was being pulled down about his ears. His new landlord found him an undesirable tenant, hence the complaint. The City Engineer's staff examined the sewer connections of some 135 premises ; 26 were found to be defective and notices requiring repair or renewal were served upon the persons responsible. A number of disused "eyes" to the sewers received attention as a result of those examinations, and ten sections of sewers or connections were treated with "Taboo'' gas, lethal to rats. 90 During "Rat Week," 14,660 baits were laid in the sewers and 1,783 at the Council's depots, etc. The number of dead rats discovered was 114. The laying of baits in the sewers is carried out at regular intervals throughout the year as a matter of routine. Nuisance from Pigeons.—During the year, eight complaints of nuisance from pigeons were received and investigated. The Council's contractors, on instructions from the department, caught and destroyed some 700 pigeons in the course of the year, principally in Trafalgar Square. The figure thus reported will give dissatisfaction to individuals of two opposing schools of opinion. Those who suffer from pigeon nuisance will say it is not enough ; those who admire pigeons and encourage them to congregate will regard it as a massacre. Nevertheless, the Council, in authorizing this measure of reducing the number of pigeons, is only carrying out its statutory duty as laid down in Section 121 of the Public Health (London) Act, 1936. The work is carried out by an experienced firm fully acquainted with the varieties and habits of pigeons, their nesting and breeding. Close co-operation is maintained with officials of the R.S.P.C.A. in regard to the methods employed in dealing with the birds. Noise Nuisances.—Nuisances from noise may now be dealt with by the local authority under the Nuisance Sections of the Public Health (London) Act, 1936, a provision to this effect having been included in the London County Council (General Powers) Act, of 1937. Under this provision, a noise nuisance is deemed to exist where any person makes or continues or causes to be made, etc., any excessive or unreasonable or unnecessary noise, which is injurious or dangerous to health. Exemption is, however, provided in the case of noise occasioned by the carrying out of works under any Act of the County Council or Sanitary Authorities or by any public undertaking. In the case of proceedings taken in respect of noise from any trade, business or occupation, it is a good defence for the person summoned to show that he has taken the best practicable means for preventing or mitigating the nuisance having regard to cost and other relevant circumstances. Seventeen complaints were received during the year and these were adequately dealt with by informal action. These related to noise of machinery in business premises adjoining dwellings, building operations carried out at night, the use of electric drills in streets or in demolition of buildings, wireless sets, dogs, &c. One complaint was of noise caused by persons frequenting a club in the early hours of the morning. Admirable as these provisions are, they bring but little comfort to those 91 who reside near busy streets where late motor traffic frequently interrupts the hours of sleep. Public Health (London) Act, 1936, Section 224.—Removal of Aged, Infirm or Physically Incapacitated Persons to Suitable Institutions. Eighteen cases of elderly persons living alone and unable to devote to themselves proper care and attention were dealt with during the year. In one case it was necessary to obtain the authority of the Public Health committee for application to be made to the court for an order for the removal to hospital of an infirm elderly woman living alone in a single room in a dirty and insanitary state. An order was obtained for her removal to St. Stephen's Hospital, but fortunately it was not necessary to put the order into operation. Persuasion by the council's officers, strengthened by the fact that an order for her removal had been obtained, resulted in her agreeing to enter a home for aged persons, provided by a benevolent society. These elderly people, mostly incurably ill and living in conditions of distress and filth, are quite unable to realize that removal to hospital for care and nursing is in their best interest. They are sometimes unreasonably obdurate and it speaks well for the persuasiveness of the Council's officers in dealing with them that in only one case out of 18 had application to be made to the Court. In fact, this is the first application of the kind in five years. Disinfection.—Disinfection of rooms in cases of notifiable infectious disease is carried out free of charge, the method employed being the formaldehyde spray. Bedding and wearing apparel are removed to the disinfecting station for treatment by steam disinfection. Books are treated with formalin. 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. Cleansing of Persons.—The cleansing of persons and disinfection of their clothing, etc., are carried out by the disinfecting staff. Individuals, numbering 348 men, 63 women, and 14 children (under school age), were given medicated baths at the disinfecting station, making 617 attendances, and 9,847 articles of clothing, bedding, etc., were disinfected. Visits to premises for vermin numbered 120. 92 Cleansing of School Children.—Under an agreement with the London County Council, school children from the boroughs of Battersea, Chelsea, Fulham, Holborn, Lambeth, St. Pancras and Southwark attended for treatment at the disinfecting station. Among Westminster school children 448 cases of head lice, 2 of body lice, and 41 of scabies were treated. In all cases the clothing was disinfected, together with the bedding from their homes, amounting in all to 2,080 articles. Children from the above-mentioned boroughs treated for similar conditions were as follows: 110 for head lice and 30 for scabies. Articles of clothing disinfected numbered 1,170. The total number of attendances of school children for baths at the disinfecting station was 1,355. Notices from the London County Council in respect of verminous children numbered 32 and 50 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. 1937. Head lice. Body lice. Scabies. Total. Children (including those under school age). 558 2 85 645 Adults 3 277 131 411 561 279 216 1,056 Eradication of bed bugs.—The Ministry of Health in Circular 1650 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, and as to measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing. Infested Houses.—The number of Council houses (flats) found to be infested was 50 and of other houses 351. All were disinfested, the work in the case of the Council houses being carried out by the Council's staff and in the others by the 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 93 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. Methods for disinfesting furniture, etc.—The removal and fumigation by hydrocyanic acid gas of the furniture, etc., of families to be rehoused in the Council's dwellings and elsewhere is carried out by a contractor. Details of the method employed have been given in previous reports. The cyanide fumigating plant is situated at the Council's Monck Street Depot, the furniture being brought there by the Council's or the contractor's cyanide van in which the articles are treated. The arrangement entered into with the Chelsea Borough Council in 1936 for the removal and fumigation of the furniture of Chelsea families through the agency of the City Council's removal and fumigation facilities was continued during 1937. During the year the furniture and effects of 366 families were dealt with by the contractor. Of this number, 260 were removed to the City Council's dwellings, 73 to dwellings of the Chelsea Borough Council, and 3 to the Tachbrook Estate of the Westminster Housing Trust. Thirty cases were dealt with at the request of the Grosvenor Estate, the families concerned being rehoused in re-conditioned dwellings belonging to the Estate. Articles of bedding, clothing, etc., totalling 14,584, including those from bug-infested houses and those under the Council's " bug prevention " scheme in rehousing operations, were subjected to disinfection by steam at the Disinfecting Station. The shelter provided (a flat allocated for the purpose in the Council's dwellings) for the use of families whilst their homes or belongings are being disinfested was occupied on 11 occasions during the year and has proved to be of great convenience. In the rehousing of tenants in its own dwellings, the Council has adopted the policy that the furniture of all families concerned, whether transferred from private dwellings or from one Council dwelling to another, shall undergo the process of fumigation. This uniform policy for all tenants is becoming greatly appreciated as the objects have become understood. During the year under review no instances of re-infestation came to notice in the flats occupied by tenants whose effects had been treated by the above-mentioned methods. 94 Measures taken to prevent infestation or re-infestation after cleansing.— The Council's Woman Property Manager keeps in close touch with the tenants of the Council's Housing Estates and pays particular attention to those who appear to be in need of advice and encouragement in the direction of keeping their homes clean and orderly. In those cases where advice and help appears to be necessary in dealing with vermin, a joint visit is paid with the sanitary inspector in charge of disinfestation work (Mr. W. L. French). Tenants are generally willing to accept the advice offered them and to do their part in keeping their furniture and effects free from vermin by regular cleansing and attention to details. Talks by Mr. French to the mothers attending the Maternity and Child Welfare Centres, on the subject of vermin in the home, have been given on several occasions during the year. Table LXXIII.—General Disinfection of Premises, Articles, etc. 1933. 1934. 1935. 1936. 1937. Rooms 747 1,058 074 837 663 Articles disinfected 21,598 22,174 22,759 25,643 26,951 Articles washed 3,500 3,450 3,800 3,400 3,450 Articles destroyed 2,218 300 281 565 312 Books disinfected* 723 132 421 114 206 Vehicles „ 4 15 38 41 53 Offices and business premises 6 6 11 17 5 *Library books, 28; private books, 177; school books, 1. Motor Disinfecting Van.—The motor van during 1937 completed 5,280 miles, carrying 4,001 cwts. of goods. Coroner's Court and Mortuary. There were 250 bodies removed to the mortuary during the year by order of the Coroner or to await burial. Inquests were held in 153 cases but not in 92, while 5 bodies were received to await burial. Post-mortem examinations were made in 149 instances. The following is a list of the causes of death of the cases brought to the mortuary:— Drowning 21 Street accidents 30 Other accidents 26 Murder 1 Suicide 36 Natural causes 83 Misadventure 21 Other miscellaneous causes 32 95 Smoke Abatement.—The following table shows the extent to which smoke has been a cause of complaint to the sanitary authority during the past five years, and also a summary of the measures taken in mitigation:— Table LXXIV.—Smoke Abatement—Results of Observations and Action Taken. — 1933. 1934 1935. 1936. 1937. Complaints received 63 58 47 78 36 Observations taken 749 875 830 728 522 Notices issued— Preliminary 10 5 22 19 24 Statutory 1 — — 2 2 Legal Proceedings — — — — — There were no prosecutions in respect of smoke nuisances during 1937. 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, Mayfair, and at the Coroner's Court, Horseferry Road, together with the results of analyses of deposits from a similar gauge in Finsbury Park for comparison. 96 Table LXXV.—Atmospheric Pollution—Analyses of Deposited Impurities. 1937. 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. so3. Daily Average. Total Solids. January 45.61 5.15 1.47 30.70 4.43 0.99 19.75 February 51.89 5.16 1.86 27.14 3.24 0.97 17.38 March 135.93 7.29 4.39 30.80 3.92 0.99 14.43 April 62.63 5.70 2.09 32.55 3.58 1.08 15.02 May 48.16 3.97 1.55 29.40 3.29 0.95 20.84 June 31.35 1.95 1.05 31.29 4.49 1.04 15.93 July 26.94 1.28 0.87 24.02 2.15 0.77 12.37 August 30.41 2.4'i 0.98 29.46 4.27 0.95 19.34 September 28.37 4.26 0.94 21.14 4.70 0.70 12.16 October 37.96 4.57 1.22 38.57 5.46 1.24 14.30 November 41.02 4.73 1.36 37.98 4.38 1.26 26.60 December 44.16 5.74 1.42 40.18 5.69 1.29 17.39 It will be noted that high figures were returned for the gauge installed at Horseferry Road, particularly during March, 1937. This was due to. extensive building operations in the immediate locality. (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 1937, together with a similar curve for the years 1931 to 1936. 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 1937. The code used for the "visibility" curve is that issued by the Meteorological Office and is as follows:— To face page 96. DEGREES OF POLLUTION. (1 degree = 0.54 lb. of dirt per million cubic yards of air.) CHART "A." ATMOSPHERIC POLLUTION, AUTOMATIC AIR FILTER. Readings taken at the City Hall. 1937 shown thus— Average for 5 years 1931-36— Average degrees of suspended matters (mostly dirt) estimated for the year 1937, compared with the average for the five years 1931-36, 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. 97 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. (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:— Table LXXVI.—Atmospheric Pollution—Measurement of Sulphur Activity. Month. City Hall, VV.C.2. Farm Street, W.l. Horseferry Road, S.W.1. January 4.94 4.60 4.44 February 4.69 5.08 4.88 March 3.83 4.17 3.72 April 3.66 4.27 3.13 May 2.78 3.10 2.24 June 1.55 1.46 1.87 July 1.66 2.03 1.56 August 1.94 2.10 1.66 September 2.20 3.41 1.90 October 3.53 4.01 3.61 November 3.76 3.97 4.33 December 2.91 No result. 2.82 (7638) G 98 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 Farm Street. HOUSING. Steady progress has been made during the year and the steps taken to advance the City Council's housing programme are outlined in the following pages. Overcrowding. The provisions of the Housing Act, 1936, in regard to the prevention and abatement of overcrowding came fully into force in the City on the 1st of January, 1937. From that date fresh overcrowding, apart from certain exceptions, constitutes an offence. The pamphlet prepared by the Council for the guidance of persons concerned has been widely distributed and copies are still available upon application to the Public Health Department. Many applications were received during the year for particulars of the numbers of persons permitted to occupy dwelling houses and schedules giving the required information were supplied. A number of these applications arose as a result of communications informing the persons responsible of their failure to insert the requisite information in rent books. In 98 instances new cases of overcrowding were discovered, the majority occurring in families where children had attained the ages of one or ten years during the year. An endeavour has been made during the year to keep in touch with families recorded as overcrowded during the survey carried out in 1935, but it has proved a somewhat difficult task as numbers of these families have moved away to destinations unknown, many outside the City. In cases where the new address has been ascertained to be within the City, it has been invariably found that the fresh accommodation has been sufficiently large to accommodate the family without overcrowding. The object of the overcrowding provisions of the Housing Act is clearly to help families that are overcrowded, often through no fault of their own ; in consequence discretion and sympathy are specially called for in the administration of this aspect of Public Health legislation. 99 Alleviation of overcrowding was effected in the following instances:— Rehoused by the Westminster City Council 55 Rehoused by the London County Council 32 Rehoused by Housing Trusts, Societies, Private Corporations, &c. 32 Families who have obtained other or additional accommodation in privately-owned dwelling houses or where some members of the family have left the household 284 Total 403 Clearance Areas. Clifford's Row, Ebury Gardens, Eaton Cottages, Ebury Bridge Road (part), Gregory Cottages, Grosvenor Cottages and Willow Place. These areas have been dealt with by the City Council by means of Clearance Orders made under the provisions of the Housing Act. A local inquiry was held by the Minister of Health in one instance, that of the Willow Place Area. The several areas originally embraced 64 houses, but in the case of Willow Place, two vacant houses were demolished before the date of the inquiry and the Orders were confirmed by the Minister of Health for 62 houses, mostly the cottage type, occupied by 68 families. Closure of Parts of Buildings. Closing Orders to the number of 247 were made prohibiting the use of parts of buildings for human habitation and in four instances statutory undertakings by the owners not to re-let until the rooms were rendered fit were accepted by the City Council. Of these Closing Orders and Undertakings, 249 related to basements and 2 to other parts of houses, comprising in all 660 rooms. In 110 other cases statutory procedure for closure of basements was in process at the end of the year, so that formal action has been applied to 359 basements. In addition to the basements which have been the subject of formal procedure, 134 have been closed voluntarily by owners pending reconditioning or consideration as to future user; thus the total number of basements dealt with during the year has been 593(1,320 rooms). (7638) G 2 100 A Closing Order made in respect of two basement rooms was the subject of an unsuccessful appeal in the County Court. Since the procedure relating to basements was begun, 973 have been dealt with up to the end of 1937. The total of Closing Orders made is 507 ; undertakings 29. Reconditioning for occupation has been completed or was in hand in 410 basements, including those done voluntarily, while 327 remain closed. Twenty-eight of this number have been approved for use as storerooms, etc. Demolition Orders. One house was made the subject of a Demolition Order and action has been commenced with regard to three other dwelling houses. The Housing Committee and its Standing Sub-Committee, besides meeting on 18 occasions, held 7 special meetings for the purpose of interviewing persons interested in the premises under consideration for closure or demolition ; 2,987 notices were served upon freeholders, leaseholders, mortgagees, &c., in accordance with the requirements of the Housing Acts. Reconditioning of Unfit Dwellings. Specifications to the number of 237 were received from owners desirous of carrying out reconditioning work to premises, as follows:— For reconditioning basements the subject of closing orders or statutory undertakings 113 For reconditioning basements prior to or apart from any formal action by the City Council 109 For reconditioning whole houses 15 Reconditioning works were carried out in 185 basements during the year, whilst in 127 other cases the work was proceeding or about to be put in hand. Following applications from owners, approval was given by the Council to the use of 19 basements for purposes other than that of human habitation. One application was received for a certificate under the provisions of Section 51 of the Housing Act, 1936, as to the condition of the house after reconditioning; this was granted for a period of five years. It is interesting to record that the number of basements which have been reconditioned by owners prior to formal action being taken is practically equal to the number which have been rendered fit following the making of closing orders. This fact illustrates the point mentioned in the 101 report of last year that many owners consider it a sound policy to recondition basements even at considerable cost rather than allow the rooms to remain empty. The number of basements which were reconditioned during the year was considerably in excess of that for 1936, with the obvious result that inspections and consultations between the inspectors of the Department and owners, builders, &c., have increased proportionately. Although some differences of opinion have arisen from time to time with owners or leaseholders as regards the extent of reconditioning necessary in no case have the difficulties proved insurmountable in the preparation of satisfactory specifications. A noticeable feature has been the tendency shown by owners to carry out improvements as the work proceeds in addition to those embraced in the specification. This would appear to indicate a genuine appreciation by owners of the need for better housing conditions rather than a narrow or parsimonious conception of the objects in view. The tendency to provide facilities for hot water supplies and even baths is to be welcomed as is also the supply of artificial lighting in yard W.Cs. The scheme of general reconditioning of houses on the West side of Aylesford Street has proceeded and is now approaching completion. Of 17 houses, 9 have been reconditioned and the work was in progress in most of those remaining. The results are satisfactory from more than one point of view. The high standard of work carried out in the first one or two houses, more or less experimentally, has been maintained ; the reconditioned flats are being re-occupied by the working-class families displaced from houses to be reconditioned in the same street; and the rents charged vary little from those paid for similar accommodation prior to reconditioning. In a few other instances, however, where whole houses have been reconditioned, owing to the higher rents charged, and the type of incoming tenant, the premises can no longer be recognized as being working-class dwellings. During the year a public utility society purchased three houses, two of which have been reconditioned, the City Council making a grant of £150 towards the cost. In considering specifications of work for reconditioning of any description in controlled or decontrolled houses, the bye-laws relating to houses divided into separate tenements are taken as one of the guiding principles. 102 Provision of New Houses for the Working Classes. Ebury Bridge Housing Estate Extension Scheme.—The third block (Cheylesmore House) of 74 flats was opened early in the year, thus completing 180 flats out of 280 in the whole scheme. Rehousing Operations.—During the year 145 families were rehoused by the City Council and 138 by the London County Council, making a total of 283 families removed from unsatisfactory dwellings. The estates on which these families were accommodated were as follows:— Westminster City Council Estates. Admiral House 1 Canal Buildings 1 Ebury Bridge 18 Ebury Bridge Extension 51 83, Ebury Bridge Road 1 Grosvenor Housing Scheme 25 10/11, Monck Street 1 Regency Street Dwellings 43 St. James' Dwellings 1 Walden House 3 — 145 London County Council Estates Battersea Bridge Buildings 1 Becontree 7 Bellingham 1 Bourne 5 Clapham Park 6 Downham 2 Duke's Court and York Street 4 East Dulwich 5 East Hill, Wandsworth 4 Glebe 3 Hanwell 13 Herbrand Street 3 Honor Oak 3 Kenmore Park 10 Millbank 32 Mottingham 1 Norbury 1 Oaklands 1 103 London County Council Estates—continued. Old Oak 2 Ossulston 2 Roehampton 1 St. Helier (including Morden) 15 Shelton Street 3 Stockwell 3 Totterdown 2 Vassal Road (including Cowley) 1 Wormholt 3 Watling 4 — 138 Total 283 Two hundred and ninety applications for rehousing (other than from basements) have been investigated and reported upon by the Medical Officer of Health to the Housing Committee. Of the 145 families rehoused by the City Council, 67 were from unfit basements, 19 from houses in clearance areas, and 59 from houses in which the conditions were unsatisfactory or for reasons of health. Forty-four of the rehoused families were overcrowded. By means of transfer to more suitable accommodation, 11 cases of overcrowding were also alleviated in the City Council's flats. Unfit Basements.—In addition to the 67 families rehoused by the City Council, the London County Council rehoused 11, whilst 78 families were rehoused by other housing associations or themselves obtained other accommodation. The City Council's programme of housing improvement as regards houses for clearance, demolition of individual unfit dwellings, the closure and subsequent reconditioning of basements as unfit parts of buildings and the relief of overcrowding has continued uninterruptedly though perhaps unobtrusively. Very few if any of the old decayed type of houses suitable only for clearance now remain, while there are very few streets either in Victoria or St. John Wards where basements have not been improved. Nowadays, the general plea in applications for rehousing concerns the health of one or more members of the family, e.g., too many stairs to be climbed; or often it is the easily understood wish to obtain the advantages of the lower rents in the Council dwellings. Applications 104 made on grounds of bad housing or overcrowding are becoming less frequent. As regards the latter, the number of known statutory overcrowded families has fallen from 1,083 in 1935 to 622 at the present time. The larger housing problem lay in the southern districts of the City. Now that it is being solved attention is being directed to the northern parts, particularly of Soho, where some of the most unsuitable dwellings exist. They are scattered, mainly old, many showing a degree of decay and dilapidation found nowhere else in the City. Table LXXVII. 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) 10,391 (b) Number of inspections made for the purpose 24,238 (2)—(a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,449 (b) Number of inspections made for the purpose 9,622 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 361† (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 684* 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 324 *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. 105 3. Action under Statutory Powers during the year. A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (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 590 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 590 (b) By Local Authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 D.—Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 251 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 82 106 4. Housing Act, 1936. Part IV.—Overcrowding. (a)—(i) Number of dwellings overcrowded at end of year 622 (ii) Number of families dwelling therein 622 (iii) Number of persons dwelling therein 3,249 (b) Number of new cases of overcrowding reported during the year 98 (c)—(i) Number of cases of overcrowding relieved during the year 403 (ii) Number of persons concerned in such cases 1,848 (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 — 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 fifteen samples of various foods and drugs were purchased for analysis, while 3,052 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 108 were served in respect of various defects, mainly lack of proper cleanliness. Certification of food for export.—Twelve certificates were issued in respect of the export of food products to Canada and Italy. Ice Cream, Preserved Meat, etc., Premises. Under Section 187 of the Public Health (London) Act, 1936, 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 and other foods to be registered with the local authority. Ice Cream premises. At the 31st December, 1937, there were 132 premises on the register for the sale or storage of ice cream, of which 29 were also registered for the manufacture of this commodity. Twenty-six premises were added to the register, and one hundred and eighty-one inspections were made during the year. 107 During the year 23 samples of ice-cream were obtained for bacteriological examination and the results as tabulated below indicate an improvement over those of last year. This improvement may be attributed to the policy of the Public Health Committee in requiring efficient sterilizing apparatus and a high standard of cleanliness in the premises and on the part of the workers. In every case where a high bacterial count was found, together with evidence of contamination (B. coli in .001 c.c. or less) satisfactory improvement has been attained where these requirements have been put into force. In the case of Sample No. S.8, which returned the highest count during 1937, the ice-cream was manufactured in premises outside the City and necessary particulars were accordingly communicated to the Medical Officer of Health for the district in which the premises were situated. Table LXXVIII.—Ice-Cream Bacteriological Examinations. No. of Sample. Colonies per c.c. B. Coli per c.c. Positive. Negative. s.1 96,000 +0.01 —0.001 S.2 22,000 — —0.1 S.3 10,200 — —0.1 S.4 31,000 — —0.1 S.5 56,000 +0.1 —0.01 S.6 121,000 +0.01 —0.001 S.7 600,000 +0.001 — S.8 900,000 +0.001 — S.9 290,000 +0.001 — S.10 180,000 +0.01 —0.001 S.ll 81,000 +0.001 — S.12 40,400 +0.01 — S.13 640,000 +0.001 — N.2 336,000 +0.1 —0.01 N.3 490,000 +0.001 — N.4 252,000 +0.1 —0.01 N.5 108,000 +0.01 —0.001 N.6 46,000 — —0.1 N.7 76,000 +0.001 — N.8 160,000 +0.001 — N.9 162,000 +0.001 — N.10 168,000 +0.1 —0.01 N.11 180,000 — —0.1 Where counts of over 200,000 colonies per c.c. were obtained or B. coli was found to be present in .001 c.c. or less, the matter was taken up with the purveyors. In each case improvements in methods of cleansing utensils were suggested by the Inspectors and subsequent samples showed distinctly better bacterial counts. 108 Preserved meat, etc., premises. One hundred and fourteen premises were on the register for the manufacture of pressed, pickled, potted or preserved meat, fish or other foods. Two new registrations were made during the year. Seventyeight inspections were made. Three notices were served for lack of proper cleanliness and conditions were at once remedied. The premises generally were satisfactory and well conducted. 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 286 observations. No infringements were observed. 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. During the year new regulations were issued by the Board of Agriculture and Fisheries relating to types of fruit and vegetables (fresh and canned), cheese, eggs, wheat-flour and wheat flakes, etc. The duties under these Acts are carried out by the food inspectors in the course of their inspection of food premises and stalls. Artificial Cream Act, 1929. There are two premises in the City registered under the provisions of this Act and three visits of inspection were paid to them. 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 cases. 109 Milk and Dairies (Consolidation) Act, 1915. Tubercle in milk—Eight samples of milk were taken during the year for examination as to the presence of tubercle bacilli. The milk was taken from shops in the ordinary course of delivery from purveyor to customer. No evidence of tubercle was found in any of the samples. Milk and Dairies Amendment Act, 1922. Milk (Special Designations) Order, 1936. The following dealers' licences were issued by the Council during the year:— Tuberculin tested 25 Accredited 7 Pasteurized milk 37 Pasteurization of milk is not undertaken at any premises in the City. Bacteriological Examination of Milk. Continued attention was given during the year to the milk sold in the City and particularly to that sold in milk bars. Thirty-eight samples were taken for bacteriological examination and the following results were reported. All except three were taken at or in course of delivery to milk bars Table LXXIX.—Milk. Bacteriological Examinations. No. of Sample. Colonies per c.c. B. Coli per c.c. Positive. Negative. N.l 1,250,000 +0.001 — N.2 3,000,000 +0.001 — N.3 80,000 — —0.1 N.4 750,000 +0.001 — N.5 3,000,000 +0.001 — N.6 760,000 +1.001 — N.7 2,000,000 +0.001 — N.8 104,000 +0.01 —0.001 N.9 200,000 +0.1 —0.01 N.10 80,000 +0.001 — N.ll 100,000 +0.01 — 0.001 N.12 54,000 — — 0.1 N.13 220,000 +0.01 —0.001 N.14 44,000 +0.01 —0.001 n.15 120,000 +0.01 —0.001 110 Table LXXIX—continued. No. of Sample. Colonies per c.c. B. Coli per. c.c. Positive. Negative. N.16 158,000 + 01 - 0.001 N.17 34,000 — - 0.1 N.18 40,000 — - 0.1 N.19 33,600 — - 0.1 N.20 68,000 — - 0.1 N.21 12,000 — - 0.1 N.22 20,400 — - 0.1 N.23 960,000 + 0.001 — N.24 90,000 + 0.1 - 0.01 N.25 85,000 + 0.01 - 0.001 N.26 8,000 — - 0.1 N.27 14,000 — - 0.1 N.28 40,000 + 0.1 - 0.01 N.29 86,400 + 0.1 - 0.01 N.30 48,000 + 0.01 - 0.001 N.31 344,000 + 0.001 — S.1 300,000 + 0.001 — S.2 206,000 + 0.001 — S.3* 9,200 — - 0.1 S.4 21,000 + 0.001 — S.5 † 4,400 — - 0.1 S.6 10,000 — - 0.1 S.7 8,000 — - 0.1 * Pasteurised. † T.T. (Cert.). Eleven samples showed a high count of bactaria, B. coli being present in .001 c.c. of twelve samples. The attention of the vendors was directed to the reports and they were informed that steps must be taken to improve the condition of the milk sold by them and to ensure that the apparatus and utensils used were kept clean and sterile. In eleven cases, in order to establish whether the milk was in good condition when delivered at the premises, and to see that the measures taken by the vendors were attended with good results, samples of milk were taken in course of delivery in the early morning and samples of the same milk were obtained later on the same day. These investigations indicated that in the case of one milk bar the bacteria had multiplied considerably since the milk had been deposited at the premises. The proprietors, who own two milk bars in the district, were interviewed and possible sources of contamination discussed with them, and arrangements were made for samples of milk to be examined by their own bacteriologists at different periods of the day. As a result, improved means of storage and handling were installed with satisfactory results. Samples taken subsequently indicated a general improvement. 11l Milk Bars.—The number of milk bars established in the City continues to grow, having increased from 12 to 21 by the end of the year. It is in accordance with the milk policy of the country that more milk should be drunk and milk bars form a very convenient and inviting means for that purpose. The planning and fitting of the milk bar does not always take into account that storage and cleansing facilities in a milk business are fully as important as counter space and the consumers' side of the bar. Special attention has, therefore, been paid by the food inspectors to this type of premises to ensure that the milk, ice cream and other beverages are clean and wholesome. It is satisfactory to report that at the end of the year there was no cause for reproach at any milk bar in the City. Samples of milk and ice-cream have been obtained from these premises both for chemical and bacteriological examination. The results of these examinations and action taken are reported elsewhere. Milk and Dairies Order, 1926. Registration of Dairymen and Dairy Premises.—Premises where milk is sold only in sealed receptacles as received, need not be registered with the local authority, although the purveyor must be registered. The following table shows the number of premises and persons registered with the Council during the year:— Table LXXX.-—Registration of Dairymen and Dairies. Premises. Persons. Registered to 31st December, 1936 169 227 Registered during year 1937 15 11 Removed from register (ceased or transferred business) 15 9 Registered to 31st December, 1937 169 229 The inspectors paid 439 visits to milk shops and dairies during the year, Five notices were served in respect of minor defects which were duly rectified. Food and Drugs (Adulteration) Act, 1928. Analysis of Milk Samples.—The percentage of adulterated samples since 1927 is given in Table LXXX below, together with the results of the samples taken in each of the two districts of the City during 1937:— 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. 112 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 LXXXI.—Analysis of Milk Samples. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Per cent. No. Per cent. North 459 92 20.0 275 59.9 90 19.6 2 0.4 South 461 91 19.7 295 64.0 67 14.5 8 1.7 1937 920 183 19.9 570 61.9 157 17.1 10 1.1 1935 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 Of the total of 920 samples of milk taken during the year, 96 were taken on Sundays. The action taken in regard to adulterated samples of milk is shown below:— Adulterated Samples of Milk. Sample No. Extent of Adulteration. n taken and result thereof. N.858 Contained 1.3 per cent. of added water Vendor's attention called to result of analysis. N.865 Contained 0.9 per cent. of added water. Vendor's attention called to result of analysis. S.255 Was 12 per cent. deficient in fat Summary proceedings. Summons dismissed on payment of £3 3 s. 0d. costs. S.456 W as 12 per cent. deficient in fat Summary proceedings. Summons dismissed under Probation of Offenders' Act on payment of 10s. costs. S.464 Was 14 per cent. deficient in fat Summary Proceedings. Summons dismissed under Probation of Offenders' Act on payment of 10s. costs. S.538 Was 20 per cent. deficient in fat Summary proceedings. Summons dismissed on payment of £3 3s. 0d. costs. S.643 Contained 1 per cent. of extraneous water Vendor's attention called to result of analysis. S.649 Contained 1 per cent. of extraneous water Vendor's attention called to result of analysis. S.794 Contained 1.5 per cent. of extraneous water Vendor cautioned. S.855 Was 9 per cent. deficient in fat. (This sample was purchased at a Milk Bar.) Summary Proceedings. Summons dismissed under Probation of Offenders' Act on payment of £3 3s. 0d. costs. To face page 96. # 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. 113 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. Thirty-four samples for bacteriological examination were obtained, all of which showed bacterial counts well below the maximum allowed. Samples taken at the same time for chemical analysis were found to be genuine. Public Health (Condensed Milk) Regulations, 1923 and 1927. Thirty-seven samples were taken and found to be genuine and properly labelled. Public Health (Dried Milk) Regulations, 1923 and 1927. Five samples were taken and found to be genuine and properly labelled. Public Health (Preservatives, &c., in Food) Regulations, 1925-27. Only certain articles of food may contain preservative, which must be either sulphur dioxide or benzoic acid as specified in the regulations. Four infringements of these regulations were found as a result of analysis of samples, details of which are set out in the following pages. (7638) H 114 Table LXXXII. Samples purchased under the Food and Drugs (Adulteration) Act, 1928, showing results of Analysis and subsequent Proceedings for year 1937. Number. Article of Food or Drug. Number of samples purchased. Genuine. Adulterated. Prosecutions. Convictions. Withdrawn or dismissed. Fines. Costs. £ s. d. £ s. d. i Butter 140 139 1 1 1 — 1 0 0 — — — 2 Cereals 36 36 — — :— — — — — — — — 3 Cheese 24 22 2 1 — 1 — — — 3 3 0 4 Cocoa 4 4 — — — — — — — — — — 5 Coffee and Chicory 4 4 — — — — — — — — — — 6 Condiments & Spices 15 15 — — — — — — — — — — 7 Confectionery 37 36 1 — — — — — — — — — 8 Cooking Fats 1 1 — —— — — — — — — — — 9 Cream 72 72 — — — — — — — — — — 10 Cream (tinned) 1 1 — — — — — — — — — — 11 Culinary Flavours 5 5 — — — — — — — — — — 12 Drugs 35 34 1 — — — — — — — — — 13 Fish Preparations 31 31 — — — — — — — — — — 14 Fruit Cordials 19 19 — — — — — — — — — — 15 Fruits (preserved) 54 53 1 — — — — — — — — — 16 IceCream 28 28 — — — — — — — — — — 17 Jams & Preserves 59 57 2 — — — — — — — — — 18 Lard 7 7 — — — — — — — — — — 19 Margarine 21 21 — — — — — — — — — — 20 Milk 920 910 10 5 — 5 — — — 10 9 0 21 Milk (condensed) 37 37 — — — — — — — — — — 22 Milk (dried) 5 5 — — — — — — — — — — 23 Oils 11 11 — — — — — — — — — — 24 Pickles & Sauces 23 23 — — — — — — — — — — 25 Potted Meats and Meat Pies 36 36 — — — — — — — — — 26 Rennet, Essence of 1 1 — — — — — — — — — — 27 Sausages 52 50 2 2 — 2 — — — 1 10 0 28 Spirits 53 53 — — — — — — — — — — 29 Tea 20 20 — — — — — — — — — — 30 Vegetables (preserved) 8 8 — — — — — — — — — — 31 Vinegar 34 32 2 1 1 — 0 10 0 — — — 32 Wines 22 22 — — — — — — — — — — 1,815 1,793 22 10 2 8 1 10 0 15 2 0 Butter.—One sample of butter purchased in the form of pats at a restaurant was found to contain about 34 per cent. of margarine. The vendor was fined £1 0s. 0d. Cheese.—Twenty-four samples of cheese were obtained during the year, the majority of these being of the " wrapped " type, i.e., covered with some form of metallic wrapping. All the samples of this type of cheese proved to be satisfactory. Two samples of unwrapped cheese were found 115 to contain boric acid. The defendants stated that the boron compound was used on the paper labels attached to the cheese to prevent the growth of moulds. The Magistrate dismissed the summons under the Probation of Offenders Act on payment of £3 3s. 0d. costs. Confectionery.—Thirty-seven samples of various sweets and fancy cakes were purchased. In one case, a cream gateau, the analyst reported the cream to consist of fats other than butter fats. No action was taken in this case. Drugs.—Of the 35 drugs of various kinds obtained during 1937, 34 were found to be satisfactory. The remaining sample, sulphur lozenges, was found to be 50 per cent, deficient in sulphur. The manufacturers and purveyors were both communicated with. Fruits (Preserved).—Pifty-four samples of tinned, crystallized, dried, etc., fruits were purchased for analysis. A box of dates submitted to the analyst was found to be infested with maggots. The remainder of the stock in the purveyor's possession was surrendered and destroyed. Sausages.—Two samples of sausages were found to contain preservative although when sold the sausages bore no label to that effect. The summons against one vendor was dismissed under the Probation of Offenders Act on payment of £1 10s. 0d. costs. The action against the second vendor was adjourned sine die. Vinegar.—Of the 34 samples of vinegar examined two samples of wine vinegar were found to be deficient in acetic acid. In one case the deficiency was due to selling the soured wine before the acetification of the alcohol was completed. The purveyor of the second sample, an Orleans Vinegar, 17.5 per cent. deficient in acetic acid, was fined 10s. During 1936, a half-pint of "Table Vinegar" was purchased at a fried fish shop in the City. The liquid was served from a barrel which bore the words "Table Vinegar (non-brewed)." The public analyst certified that the sample contained 100 per cent. of artificial vinegar. Legal proceedings were authorized by the Council and the case was heard before the Chief Metropolitan Magistrate, Sir Rollo Graham-Campbell at Bow Street. The case developed into what might be regarded as a test case, Counsel appearing for both sides. (7638) H 2 116 The Chief Magistrate in the course of a considered judgment, said :— " The original form of vinegar was, no doubt, the vin aigre—-a sour wine, but this kind of vinegar appears to have been comparatively little used in this country owing to the fact that England is not a wine producing country and it had to be imported and was expensive. There can, I think, be no doubt that since the early part of the 17th century the commodity ordinarily sold in this country as vinegar was the product of fermentation, and that it was not until about the year 1890 that the fluid which we are now considering made its appearance on the market, although possibly there may have been isolated cases in which it was sold as vinegar as far back as 1860. Mr. Murphy (counsel for the defence) says it is agreed on all sides that the substance sold by his client is innocuous and unadulterated and is a perfectly harmless condiment which can properly be mixed with pickles supplied for human use or given to people who want to pour a little over their fried fish or their salad, but the real question is not whether this condiment is innocuous or adulterated, but whether it can properly be sold as vinegar. Both vinegar, which is the product of fermentation and the substance sold by Mr. Murphy's client are composed of acetic acid diluted with water in very much the same proportions, but the acetic acid in the one is produced in a way different from that in the other and the vinegar produced by fermentation is not only produced in a way which does give the finished article a better aroma and flavour, it also contains other products of fermentation not present in the synthetic compound. Bearing in mind the fact that for some three hundred years the substance sold as vinegar was the product of fermentation and that it is admitted by the witnesses for the Defence that it is produced in a way which undoubtedly gives it a better aroma and flavour, I have come to the conclusion that it is not permissible to sell as vinegar or table vinegar a substance which is not the product of fermentation." The defendant was fined £5 and ordered to pay 25 guineas costs. The defendant appealed to Quarter Sessions against the decision. In dismissing the appeal, on payment of 75 guineas costs, the Chairman said : " The Committee cannot agree with Mr. Swan's contention that the evidence shows that the words ' Table Vinegar ' have become a term of art and are now by the custom in this trade used to denote what may conveniently be termed ' synthetic vinegar.' The fact that a very large majority of the manufacturers add such words as ' wood,' ' non-brewed,' 117 or similar words of that description, to the product shows, in the opinion of the Committee, that the words ' Table Vinegar ' are not considered by the custom of the trade sufficient to describe it. The Committee is satisfied on the evidence that the substance sold as ' Vinegar ' or ' Table Vinegar ' without any qualification or explanation as to its origin being given by the seller to the purchaser, implies that the substance sold is produced by a process of fermentation." Jam.—Two samples of apricot jam when purchased bore labels which guaranteed that the jam conformed to the Full Fruit Standard of the Food Manufacturers' Federation. On analysis the samples were found to contain not more than 30 to 32 per cent, of apricots, whereas " Full Fruit Standard " Apricot Jam should contain not less than 40 per cent, of apricots. Both samples were obtained from the same firm whose attention was drawn to the result of the analyses. They stated in reply that they viewed the matter very seriously and were taking it up with the manufacturers. Their remaining stocks of this consignment were temporarily withdrawn from sale and the wording of the labels amended. Observations by the Public Analysts. During the year under review certain samples have presented points of interest which are worth noting. Vinegar.—Two samples of vinegar were returned as adulterated. One was Orleans Vinegar, a distilled wine vinegar, which was 17.5 per cent. deficient in acetic acid and had no doubt been diluted with water to that extent. The second sample was sold as Red Wine Vinegar and was found to be 22.5 per cent. deficient in acetic acid. When certain barrels of wine become acid, it is the custom to leave the acetifying wine until it has more or less stabilised itself, and then to sell it as wine vinegar. Such vinegar is very aromatic owing to the large amount of ester present, but, owing to a shortage of air, the tendency is for the vinegar not to acetify completely. In the present case, it was found that there was more than sufficient alcohol present to account for the deficiency in acetic acid. Butter.—An old form of adulteration which had not been met with for some time, the admixture of margarine with butter, again appeared this year. A sample sold as butter was found to contain not less than 34 per cent. of fat other than butter fat. 118 Cream Confectionery.—Samples of cream confectionery were, as a general rule, found to contain real cream, but one of cream gateau contained a substance resembling cream but which was not cream in fact. Cream.—The use of false or misleading labels on tins of cream is well illustrated by one of the series of samples among which the following labels were found :— 1. " Finest Rich Thick Cream." 2. " Pure Thick Devonshire Cream—Rich English Cream." 3. " Guaranteed absolutely pure. Absolutely free from preservatives or other foreign substances. A small percentage of cane sugar is added to bring out the full rich flavour of the cream." Since all of these samples were very poor in fat, the use of the word "Rich" constitutes false description. In regard to the last example the second sentence on the label is flatly contradicted by the third sentence, for cane sugar is a foreign ingredient in cream. Jam.—Two samples of apricot jam, were also found to bear false labels. One was 20 per cent, deficient in apricots and the other 25 per cent, deficient. Both were sold as " Full fruit standard " jam and should therefore have complied with the agreed standard of 40 per cent, of the named fruit. Drugs.—A sample of sulphur lozenges was 50 per cent, deficient in sulphur. Although sulphur lozenges were omitted from the British Pharmacopoeia, 1932, they were transferred to the British Pharmaceutical Codex, 1934. Moreover, the fact that a preparation has been dropped from the Pharmacopoeia does not entitle manufacturers to make a similar product of lesser strength and to utilise the former official name for such a medicine. Presert in Food.—A sample of sausages, sold without the required declaration of the presence of preservative, contained sulphur dioxide to the extent of parts per million. Two samples of cheese, both from the same vendor, one informal and the other formal, were found to contain boric acid, one of the substances prohibited by the Public Health (Preservatives, &c., in Food) Regulations. 119 Samples alleged to be unfit for food.—A box of dates was found to be so infested with maggots as to be unfit for food, but a sample of chocolates which was submitted with a similar complaint was found to be free from maggots. A tin of prawns, received following a complaint that another tin from the same consignment had caused sickness, was found to contain nothing injurious and to be perfectly sound. A whisky which was suspected to be tainted in some way because it had a peculiar taste was found to contain nothing deleterious to health, and a meat pie which was said by the purchaser to have an objectionable taste was found to be normal in all respects and to show no justification for the complaint. A sample of butter submitted to the Public Health Department by a private person who suspected that it was poisoned was found on analysis to be quite satisfactory. 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 1937 was 156. The inspectors paid 161 visits to these pr???, including stalls. Two notices were served in respect of minor defects which were duly rectified. Restaurants.—The register of restaurants includes 1,447 premises. During the year 1,601 visits were paid. Kitchens, pantries, messroom arrangements for staff, systems for washing up, and general sanitary 120 arrangements were specially observed. Defects requiring notices were found in 95 instances, and in each case the work was satisfactorily carried out. Bakehouses.—At the end of 1937 there were 50 bakehouses in use in the City, of which 34 were underground. One hundred and fifty-four visits of inspection were made, and in all instances the cleansing which is required to be done twice a year was carried out. Notices were served in four instances. Fried Fish Shops.—There are 19 fried fish shops in the City to which the food inspectors paid 17 visits. It was necessary to send one notice for cleansing. Table LXXX 111.—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:— Article. Tons. cwts. qrs. lbs. Article. Tons. cwts. qrs. lbs. Almonds (green) 20 Marrows 1 4 0 4 Apples 16 1 20 Melons 19 16 0 0 Apricots 1 16 2 0 Mushrooms Artichokes 4 2 0 Onions 7 0 0 0 Asparagus 2 5 3 13½ Oranges 320 18 0 0 Aubergines 2 1 12 Parsley 1 0 Beans ... 4 7 2 14 Peaches 11 3 0 Blackcurrants 4 3 8 Pears 10 0 2 6 Cabbage 1 8 0 0 Peas 3 3 0 Carrots 2 15 3 26 Pineapples 1 9 1 3 Cauliflowers 3 2 0 Plums 6 2 0 Cherries 1 3 20 Potatoes 1 0 0 Chicory 9 1 20 Radishes 1 6 0 24 Cucumber 1 2 14 Raspberries 3 2 8 Dates 3 1 27½ Sabre Mangoes 15 1 14 Endives 3 14 Spinach 1 18 2 0 Grapes 3 3 20 Sprouts 4 2 0 Grapefruit 27 12 0 0 Tomatoes 6 11 0 24 Greengages 13 2 0 Turnips 4 3 0 Horseradishes 6 0 0 Walnuts 1 0 24 Lemons 16 0 0 Fish 1 0 23 Lettuce 6 11 2 0 Meat 1 0 0 Mandarines 4 6 2 0 Rabbits 2 0 19 Unsound Food.—A firm of caterers was prosecuted for depositing for sale at a branch shop in the City, a number of unsound sausage rolls. The Magistrate at Bow Street Police Court, before whom the case was heard, inflicted a fine of 40s. and ordered the payment of £5 5s. 0d. costs. Food Poisoning.—No case was notified by medical practitioners in the City, but seven cases brought to notice by Medical Officers of other districts or directly by the persons affected were investigated. The 121 articles of food suspected were respectively butter, dates, pork, potato crisps, prawns (curried), sandwiches and veal and ham pie. The premises at which the various foods had been purchased or consumed were inspected and samples taken for examination where possible, but no definite results indicating that the particular foodstuff suspected was the cause of the patients' indisposition were obtained. 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 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 230 firms and individuals were on the Council's list at the end of the year, the trades concerned being mainly grocers and provision dealers, oil and colour merchants, ironmongers, hairdressers, and horticultural sundriesmen. Eleven names were removed from the register and 24 were added during the year. Ten samples of various preparations were examined. Six were found to be satisfactory, but three samples containing listed poisons were sold without that fact being declared to the purchaser as required by the Act and the rules made thereunder. The vendors were communicated with and requested to conform to legal requirements in the case of future sales of similar preparations. Another sample was found to contain a substance included in Part I of the Poisons List, which may be sold only by a registered pharmacist. On the vendor's attention being called to the matter, the article was withdrawn from sale. The following are notes by the public analysts on the samples examined by them :— Of the samples analysed two insecticides were found to contain none of the listed poisons ; one was merely a solution of soap and the other, sold as a white fly fumigant, was tetrachlorethane coloured with a red dye. A medicine sold as " Compound Syrup of Hypophosphites" was reported to consist of a syrup containing hypophosphites of quinine, iron, manganese, calcium and potassium. It contained no strychnine or other poisonous substance. 122 ( A sample sold as a hair dye consisted of two phials; one contained hydrogen peroxide solution and the other contained one or more of the phenylenediamines or toluylenediamines included in Part II of the Poisons List. No declaration to the effect that the sample contained listed poisons was affixed to the container. Another hair dye was being sold without any declaration and was found to contain paratoluylenediamine, a listed poison. The manufacturers (a foreign concern) claimed that certain chemicals are added in the course of preparation, which combine with the diamine and convert it into a compound, which does not come within the purview of the Pharmacy and Poisons Act, but the Public Analysts were unable to subscribe to that view. A third hair dye consisted of two separate powders and some tablets, all of which were compound preparations. A sample of Depilatory Powder which was being retailed in the ordinary way, was found to contain 18 per cent, of barium sulphide and should only have been sold by a registered pharmacist. Three similar preparations contained only calcium sulphide as the hair remover and were therefore satisfactory.